The Role of Dairy in Meeting the Recommendations for Shortfall Nutrients in the American Diet

How sound is the science behind the dietary recommendations for dairy?

This review examined the evidence behind dietary guidelines for dairy. Most countries recommend consumption of dairy products; and when amounts are specified, recommendations are typically for 2 or 3 servings per day. Specific recommendations for dairy products are based partly on culture and availability but primarily on meeting nutrient requirements. Dairy products are a rich source of many minerals and vitamins as well as high-quality protein. Thus, dairy consumption is a marker for diet quality. A recent report found that yogurt specifically is a good marker of diet quality. The food patterns recommended by the 2010 Dietary Guidelines for Americans Advisory Committee (DGAC) include 3 cups of low-fat milk and milk products. Few people achieve their recommended intakes of several shortfall nutrients without meeting their recommendations for dairy. The evidence for a benefit of dairy consumption is moderate for bone health in children but limited in adults and moderate for cardiovascular disease, blood pressure, and diabetes and limited for metabolic syndrome. Newer data since the recommendations of the 2010 DGAC are presented. However, the strength of the evidence for dairy consumption and health is limited by the lack of appropriately powered randomized controlled trials.

Dried plums and their products: composition and health effects--an updated review

This paper describes composition of dried plums and their products (prune juice and dried plum powder) with special attention to possibly bioactive compounds. Dried plums contain significant amounts of sorbitol, quinic acid, chlorogenic acids, vitamin K1, boron, copper, and potassium. Synergistic action of these and other compounds, which are also present in dried plums in less conspicuous amounts, may have beneficial health effects when dried plums are regularly consumed. Snacking on dried plums may increase satiety and reduce the subsequent intake of food, helping to control obesity, diabetes, and related cardiovascular diseases. Despite their sweet taste, dried plums do not cause large postprandial rise in blood glucose and insulin. Direct effects in the gastrointestinal tract include prevention of constipation and possibly colon cancer. The characteristic phenolic compounds and their metabolites may also act as antibacterial agents in both gastrointestinal and urinary tracts. The indirect salutary effects on bone turnover are supported by numerous laboratory studies with animals and cell cultures. Further investigation of phenolic compounds in dried plums, particularly of high molecular weight polymers, their metabolism and biological actions, alone and in synergy with other dried plum constituents, is necessary to elucidate the observed health effects and to indicate other benefits.

Estimation of choline intake from 24 h dietary intake recalls and contribution of egg and milk consumption to intake among pregnant and lactating women in Alberta

Despite recommendations for higher choline intakes during pregnancy and lactation, there is limited research regarding maternal intake during these important periods. In the present study, we estimated dietary choline intake during pregnancy and lactation in a population of Albertan women and the contribution of egg and milk consumption to intake. Dietary intake data were collected from the first 600 women enrolled in a prospective cohort study carried out in Alberta, Canada. During the first and/or second trimester, the third trimester and 3 months postpartum, 24 h dietary intake recall data were collected. A database was constructed including foods consumed by the cohort and used to estimate dietary choline intake. The mean total choline intake value during pregnancy was 347 (SD 149) mg/d, with 23% of the participants meeting the adequate intake (AI) recommendation. During lactation, the mean total choline intake value was 346 (SD 151) mg/d, with 10% of the participants meeting the AI recommendation. Phosphatidylcholine was the form of choline consumed in the highest proportion and the main dietary sources of choline were dairy products, eggs and meat. Women who consumed at least one egg in a 24 h period had higher (P< 0·001) total choline intake and were eight times more likely (95% CI 5·2, 12·6) to meet choline intake recommendations compared with those who did not consume eggs during pregnancy. Women who reported consuming ≥ 500 ml of milk in a 24 h period were 2·8 times more likely (95 % CI 1·7, 4·8) to meet daily choline intake recommendations compared with those consuming < 250 ml of milk/d during pregnancy. Choline intake is below the recommendation levels in this population and the promotion of both egg and milk consumption may assist in meeting the daily choline intake recommendations.

Elementary and middle school children's acceptance of lower calorie flavored milk as measured by milk shipment and participation in the National School Lunch Program

BACKGROUND

The United States Department of Agriculture's (USDA) new nutrition standards for school meals include sweeping changes setting upper limits on calories served and limit milk offerings to low fat or fat-free and, if flavored, only fat-free. Milk processors are lowering the calories in flavored milks. As changes to milk impact school lunch participation and milk consumption, it is important to know the impact of these modifications.

METHODS

Elementary and middle schools from 17 public school districts that changed from standard flavored milk (160-180 kcal/8 oz) to lower calorie flavored milk (140-150 kcal/8 oz) between 2008 and 2009 were enrolled. Milk shipment and National School Lunch Program (NSLP) participation rates were collected for 3 time periods over 12 months (pre-reformulation, at the time of reformulation, and after reformulation). Linear mixed models were used with adjustments for free/reduced meal eligibility.

RESULTS

No changes were seen in shipment of flavored milk or all milk, including unflavored. The NSLP participation rates dropped when lower calorie flavored milk was first offered, but recovered over time.

CONCLUSIONS

While school children appear to accept lower calorie flavored milk, further monitoring is warranted as most of the flavored milks offered were not fat-free as was required by USDA as of fall 2012.

Acute interactions between intestinal sugar and calcium transport in vitro

Fructose consumption by Americans has increased markedly, whereas Ca(2+) intake has decreased below recommended levels. Because fructose metabolism decreases enterocyte ATP concentrations, we tested the hypothesis that luminal fructose acutely reduces active, diet-inducible Ca(2+) transport in the small intestine. We confirmed that the decrease in ATP concentrations was indeed greater in fructose- compared with glucose-incubated mucosal homogenates from wild-type and was prevented in fructose-incubated homogenates from ketohexokinase (KHK)(-/-) mice. We then induced active Ca(2+) transport by chronically feeding wild-type, fructose transporter glucose transporter 5 (GLUT5)(-/-), as well as KHK(-/-) mice a low Ca(2+) diet and measured transepithelial Ca(2+) transport in everted duodenal sacs incubated in solutions containing glucose, fructose, or their nonmetabolizable analogs. The diet-induced increase in active Ca(2+) transport was proportional to dramatic increases in expression of the Ca(2+)-selective channel transient receptor potential vanilloid family calcium channel 6 as well as of the Ca(2+)-binding protein 9k (CaBP9k) but not that of the voltage-dependent L-type channel Ca(v)1.3. Crypt-villus distribution of CaBP9k seems heterogeneous, but low Ca(2+) diets induce expression in more cells. In contrast, KHK distribution is homogeneous, suggesting that fructose metabolism can occur in all enterocytes. Diet-induced Ca(2+) transport was not enhanced by addition of the enterocyte fuel glutamine and was always greater in sacs of wild-type, GLUT5(-/-), and KHK(-/-) mice incubated with fructose or nonmetabolizable sugars than those incubated with glucose. Thus duodenal Ca(2+) transport is not affected by fructose and enterocyte ATP concentrations but instead may decrease with glucose metabolism, as Ca(2+) transport remains high with 3-O-methylglucose that is also transported by sodium-glucose cotransporter 1 but cannot be metabolized.

Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement

Dairy foods contribute nine essential nutrients to the diet including calcium, potassium and vitamin D; nutrients identified by the 2010 Dietary Guidelines for Americans as being "of public health concern" within the U.S. population. Milk and milk product intake is associated with better diet quality and has been associated with a reduced risk of chronic diseases or conditions including hypertension, cardiovascular disease, metabolic syndrome, Type 2 Diabetes and osteoporosis. Some research also indicates dairy food intake may be linked to reduced body fat, when accompanied by energy-restriction. On average, both African Americans and Hispanic Americans consume less than the recommended levels of dairy foods, and perceived or actual lactose intolerance can be a primary reason for limiting or avoiding dairy intake. True lactose intolerance prevalence is not known because healthcare providers do not routinely measure for it, and no standardized assessment method exists. Avoiding dairy may lead to shortfalls of essential nutrients and increased susceptibility to chronic disease. This updated Consensus Statement aims to provide the most current information about lactose intolerance and health, with specific relevance to the African American and Hispanic American communities. Topics covered include diagnostic considerations, actual and recommended dairy food intake and levels of consumption of key dairy nutrients among African Americans and Hispanic Americans; prevalence of self-reported lactose intolerance among various racial/ethnic groups; the association between dairy food intake, lactose intolerance and chronic disease; and research-based management recommendations for those with lactose intolerance.

The nutritional role of flavored and white milk in the diets of children

BACKGROUND

Some schools are removing flavored milk from lunchrooms based on the perception that consumption has a negative impact on the overall dietary quality. The goal of this study was to assess the contribution of flavored and white milk in the diets of children.

METHODS

Intake data from children 2 to 18 years (N = 7332) participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2006 were obtained from in-person 24-hour dietary recalls. Mean ± standard error of energy and nutrients were determined.

RESULTS

Flavored and white milk contributed, respectively, 2-6% of total energy consumed, 3-12% of saturated fats, 1-3% of sodium, and 4-0% of added sugars. The percent contribution of white milk to intakes of vitamin A (21%), vitamin D (54%), calcium (29%), potassium (17%), magnesium (12%), and phosphorus (19%) exceeded 10% of total intake. Consumption of flavored milk contributed a smaller percentage to total intake. For total dairy consumed the percent contribution to intake of vitamins A and D, calcium, potassium, magnesium, and phosphorus ranged from 19% to 68%.

CONCLUSIONS

Milk has an important nutritional role in the diets of children. More research is needed to understand the barriers to consuming milk and potential unintended nutrition consequences of removing flavored milk from the lunchrooms.

Association between obesity and calcium:phosphorus ratio in the habitual diets of adults in a city of Northeastern Brazil: an epidemiological study

BACKGROUND

Low calcium:phosphorus ratios (Ca:P ratio) in habitual diet have been observed worldwide, and it has been shown to be harmful to the bone health of the population. However, no study associating this ratio with obesity was found. Thus, considering that the intake of calcium and phosphorus will generate a ratio between them, which may be associated with obesity, this research seeks at evaluating the relation between obesity and the Ca:P ratio in the habitual diet of adults.

METHODS

Cross-sectional population-based epidemiological study with stratified and systematic sampling. The sample was composed of 506 adults, aged between 18 and 60 years, of both genders. Information on socioeconomic and demographic conditions was obtained through questionnaires completed during home visits, where anthropometric and dietary evaluations were also conducted.

RESULTS

In the habitual diet consumed by the study subjects, a Ca:P ratio above the median of 0.57 reduced the risk of central obesity based on waist-to-height ratio (WHtR) (OR: 0.61; 95% CI: 0.41 - 0.92). Habitual dietary intake of calcium (OR: 0.65; 95% CI: 0.43 - 0.97) and dairy products (OR: 0.56; 95% CI: 0.37 - 0.84) above the median value (485.4 mg and 0.9 servings, respectively) was found to be a protective factor related to central obesity based on WHtR.

CONCLUSIONS

Values above the median for the Ca:P ratio found in the habitual diet were negatively associated with central obesity based on WHtR. In addition, calcium and dairy consumption were negatively associated with central obesity based on WHtR. Therefore, higher Ca:P ratios contributed to a lower prevalence of central obesity.

Socio-economic differences in food group and nutrient intakes among young women in Ireland

The present study aimed to investigate socio-economic disparities in food and nutrient intakes among young Irish women. A total of 221 disadvantaged and seventy-four non-disadvantaged women aged 18-35 years were recruited. Diet was assessed using a diet history protocol. Of the total population, 153 disadvantaged and sixty-three non-disadvantaged women were classified as plausible dietary reporters. Food group intakes, nutrient intakes and dietary vitamin and mineral concentrations per MJ of energy consumed were compared between the disadvantaged and non-disadvantaged populations, as was compliance with dietary fibre, macronutrient and micronutrient intake guidelines. The disadvantaged women had lower intakes than the non-disadvantaged women of fruit, vegetables, fish, breakfast cereals, low-fat milk and wholemeal bread (all P< 0·001), yogurt (P= 0·001), low-fat spread (P= 0·002) and fresh meat (P= 0·003). They also had higher intakes of butter, processed red meats, white bread, sugar-sweetened beverages, fried potatoes and potato-based snacks (all P< 0·001) and full-fat milk (P= 0·014). Nutritionally, the disadvantaged women had higher fat, saturated fat and refined sugar intakes; lower dietary fibre, vitamin and mineral intakes; and lower dietary vitamin and mineral densities per MJ than their more advantaged peers. Non-achievement of carbohydrate (P= 0·017), fat (P< 0·001), saturated fat (P< 0·001), refined sugar (P< 0·001), folate (P= 0·050), vitamin C (P< 0·001), vitamin D (P= 0·047) and Ca (P= 0·019) recommendations was more prevalent among the disadvantaged women. Both groups showed poor compliance with Fe and Na guidelines. We conclude that the nutritional deficits present among these socially disadvantaged women are significant, but may be potentially ameliorated by targeted food-based interventions.

Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D

There is a need to understand the role of nutrition, beyond calcium and vitamin D, in the treatment and prevention of osteoporosis in adults. Results regarding soy compounds on bone density and bone turnover are inconclusive perhaps due to differences in dose and composition or in study population characteristics. The skeletal benefit of black cohosh and red clover are unknown. Dehydroepiandrosterone (DHEA) use may benefit elderly individuals with low serum dehydroepiandrosterone-sulfate levels, but even in this group, there are inconsistent benefits to bone density (BMD). Higher fruit and vegetable intakes may relate to higher BMD. The skeletal benefit of flavonoids, carotenoids, omega-3-fatty acids, and vitamins A, C, E and K are limited to observational data or a few clinical trials, in some cases investigating pharmacologic doses. Given limited data, it would be better to get these nutrients from fruits and vegetables. Potassium bicarbonate may improve calcium homeostasis but with little impact on bone loss. High homocysteine may relate to fracture risk, but the skeletal benefit of each B vitamin is unclear. Magnesium supplementation is likely only required in persons with low magnesium levels. Data are very limited for the role of nutritional levels of boron, strontium, silicon and phosphorus in bone health. A nutrient rich diet with adequate fruits and vegetables will generally meet skeletal needs in healthy individuals. For most healthy adults, supplementation with nutrients other than calcium and vitamin D may not be required, except in those with chronic disease and the frail elderly.

Yogurt consumption is associated with better diet quality and metabolic profile in American men and women

The evidence-based Dietary Guidelines for Americans recommends increasing the intake of fat-free or low-fat milk and milk products. However, yogurt, a nutrient-dense milk product, has been understudied. This cross-sectional study examined whether yogurt consumption was associated with better diet quality and metabolic profile among adults (n = 6526) participating in the Framingham Heart Study Offspring (1998-2001) and Third Generation (2002-2005) cohorts. A validated food frequency questionnaire was used to assess dietary intake, and the Dietary Guidelines Adherence Index (DGAI) was used to measure overall diet quality. Standardized clinical examinations and laboratory tests were conducted. Generalized estimating equations examined the associations of yogurt consumption with diet quality and levels of metabolic factors. Approximately 64% of women (vs 41% of men) were yogurt consumers (ie, consumed >0 servings/week). Yogurt consumers had a higher DGAI score (ie, better diet quality) than nonconsumers. Adjusted for demographic and lifestyle factors and DGAI, yogurt consumers, compared with nonconsumers, had higher potassium intakes (difference, 0.12 g/d) and were 47%, 55%, 48%, 38%, and 34% less likely to have inadequate intakes (based on Dietary Reference Intake) of vitamins B2 and B12, calcium, magnesium, and zinc, respectively (all P ≤ .001). In addition, yogurt consumption was associated with lower levels of circulating triglycerides, glucose, and lower systolic blood pressure and insulin resistance (all P < .05). Yogurt is a good source of several micronutrients and may help to improve diet quality and maintain metabolic well-being as part of a healthy, energy-balanced dietary pattern.

Food sources of energy and nutrients among adults in the US: NHANES 2003–2006

Identification of current food sources of energy and nutrients among US adults is needed to help with public health efforts to implement feasible and appropriate dietary recommendations. To determine the food sources of energy and 26 nutrients consumed by US adults the 2003-2006 National Health and Nutrition Examination Survey (NHANES) 24-h recall (Day 1) dietary intake data from a nationally representative sample of adults 19+ years of age (y) (n = 9490) were analyzed. An updated USDA Dietary Source Nutrient Database was developed for NHANES 2003-2006 using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked. The highest ranked sources of energy and nutrients among adults more than 19 years old were: energy - yeast bread/rolls (7.2%) and cake/cookies/quick bread/pastry/pie (7.2%); protein-poultry (14.4%) and beef (14.0%); total fat - other fats and oils (9.8%); saturated fatty acids - cheese (16.5%) and beef (9.1%); carbohydrate - soft drinks/soda (11.4%) and yeast breads/rolls (10.9%); dietary fiber - yeast breads/rolls (10.9%) and fruit (10.2%); calcium - milk (22.5%) and cheese (21.6%); vitamin D - milk (45.1%) and fish/shellfish (14.4%); and potassium - milk (9.6%) and coffee/tea/other non-alcoholic beverages (8.4%). Knowledge of primary food sources of energy and nutrients can help health professionals design effective strategies to reduce excess energy consumed by US adults and increase the nutrient adequacy of their diets.

Development of milk consumption and marketing analysis of its demand

The strategy of most households is to eliminate the negative effects of economic changes related mainly to the economic crisis by mobilizing available resources and reducing costs, but which cloud lead to a decrease in food consumption and changes in consumption patterns. Pensions and prices are factors that shape the demand for food and other estates. Both of these factors guarantee the economic viability of nutrition. Paper analyzes the development of the of milk consumption and level of its substitution by milk products. There was quantified the elasticity of demand and  estimated own price elasticity and income elasticity. For the past 17 years, consumption of milk, except cheese, cottage cheese, sour milk products and butter, decreased. Expressed by linear regression model in recent years (since 1995) in Slovakia occurred overall reduction in the consumption of milk and dairy products by an average of 0.988 kg per capita per year. This development was mainly conditioned by the annual descent of demand for milk, as its consumption with little variation in average decreased annually by up to 1.88 kg per capita. This development is largely due to the increase of milk prices and especially the increasing supply of a wide range of quality and flavored sour milk and cheese products. Acidified milk product consumption in recent observed years increased and is expressed by the average growth factor of 0.6748 kg per capita per year. Prognosis with a five percent risk of error of estimate could increase their consumption up to 13.936 kg per capita in 2014. Consumption of cheese and curd should the increase the current trend by an average of 0.0476 kg per person and would be able to achieve the level of consumption of 11.03 kg per capita in 2014.

Dairy food intake of Australian children and adolescents 2-16 years of age: 2007 Australian National Children's Nutrition and Physical Activity Survey

OBJECTIVE

Dairy food consumption is important for Australian children as it contributes key nutrients such as protein and Ca. The aim of the present paper is to describe dietary intake from dairy foods for Australian children aged 2-16 years in 2007.

DESIGN

Secondary analysis of a quota-sampled survey using population-weighted, 1 d (24 h) dietary recall data.

SETTING

Australian national survey conducted from February to August 2007.

SUBJECTS

Children (n 4487) aged 2-16 years.

RESULTS

Most Australian children consumed dairy foods (84-98 %), with the proportion consuming tending to decrease with age and males consuming significantly more than females from the age of 4 years. Milk was the most commonly consumed dairy food (58-88 %) and consumed in the greatest amount (243-384 g/d). Most children consumed regular-fat dairy products. The contribution of dairy foods to total energy intake decreased with age; from 22 % of total energy at age 2-3 years to 11 % at age 14-16 years. This trend was similar for all nutrients analysed. Dairy food intake peaked between 06.00 and 10.00 hours (typical breakfast hours) corresponding with the peak in dairy Ca intake. Australian children (older than 4 years) did not reach recommendations for dairy food intake, consuming ≤2 servings/d.

CONCLUSIONS

The under-consumption of dairy foods by Australian children has important implications for intake of key nutrients and should be addressed by multiple strategies.

Relationship between funding sources and outcomes of obesity-related research

This study examined the relationship between funding sources and the outcomes of published obesity-related research. A list of funded projects for human nutrition research linking food intake to obesity in 2001-2005 was drawn from two distinct sources: (a) the federal government's semi-public generic commodity promotion or "checkoff" programs for Fluid Milk and Dairy and (b) the National Institutes of Health (NIH). The Principal Investigator for each funded project was determined. Published literature by that individual was located using an Ovid MEDLINE and PubMed author search. All articles related to both dairy and obesity were included. Financial sponsorship for each article and article conclusions were classified by independent groups of co-investigators. Seventy-nine relevant articles were included in the study. Of these, 62 were sponsored by the checkoff programs and 17 by the NIH. The study did not find consistent evidence that checkoff-funded projects were more likely to support an obesity prevention benefit from dairy consumption. The study did identify a new research methodology for the investigation of bias by source of sponsorship.

Improving children's dairy food and calcium intake: can intervention work? A systematic review of the literature

OBJECTIVE

Strategies are needed to address the shortfall in children's dairy food and Ca intakes. The present review identified interventions targeting an increase in children's dairy food or Ca intakes, and determined characteristics associated with successful intervention.

DESIGN

A systematic literature search identified fourteen intervention studies, published in English, between 1990 and 2010. Studies were evaluated for study population, setting and mode of delivery, dietary targets and outcome measures, measures of intervention intensity, intervention description, the use of behaviour change techniques and intervention effectiveness.

SETTING

Interventions targeting an increase in dairy food or Ca intake.

SUBJECTS

Children aged 5-12 years.

RESULTS

Ten of the fourteen studies were considered to be effective. Studies focusing on encouraging intake of dairy foods or Ca alone were all effective, compared with 55 % of studies promoting dairy within the context of a healthy diet. Effective interventions tended to be higher in intensity, provide dairy foods and were delivered across a variety of settings to a range of primary targets. The number of behaviour change techniques used did not differentiate effective and ineffective interventions, but the use of taste exposure and prompting practice appeared to be important for effective intervention.

CONCLUSIONS

Interventions that target an increase in children's dairy food or Ca intake could potentially increase children's dairy food intake by about one serving daily. Research conducted outside the USA is needed. The review has identified some promising strategies likely to be part of effective interventions for improving dairy and Ca intakes in countries where children's intake is insufficient.

Fruit juice consumption is associated with improved nutrient adequacy in children and adolescents: the National Health and Nutrition Examination Survey (NHANES) 2003-2006

OBJECTIVE

To examine the contribution of 100 % fruit juice (FJ) consumption to dietary adequacy of shortfall nutrients by children and adolescents.

DESIGN

Cross-sectional.

SETTING

Secondary analysis of data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES).

SUBJECTS

Children and adolescents aged 2-18 years (n 7250). Usual intake, determined from two 24 h dietary recalls, was calculated using the National Cancer Institute method. The population was dichotomized into consumers or non-consumers of 100 % FJ. The age/gender-specific percentage of the two consumption groups with intakes less than the Estimated Average Requirement or that exceeded the Adequate Intake for selected nutrients was determined. A Z-statistic for differences in population proportions was used to determine significance (P < 0.05).

RESULTS

Children aged 2-5 years had the highest percentage of 100 % FJ consumers (71.1 %), followed by children aged 6-12 years (57.0 %) and adolescents aged 13-18 years (44.5 %). Compared with 100 % FJ consumers, a significantly higher percentage of non-consumers had intakes below the Estimated Average Requirement for vitamin A (24.4 (SE 2.5) % v. 42.2 (SE 2.5) %), vitamin C (0.1 (SE 0.2) % v. 38.9 (SE 4.1) %), folate (8.8 (SE 1.5) % v. 22.1 (SE 2.4) %), P (11.6 (SE 2.1) % v. 21.3 (SE 2.6) %) and Mg (25.8 (SE 1.7) % v. 46.1 (SE 2.0) %). A greater percentage of 100 % FJ consumers exceeded the Adequate Intake for K (2.4 (SE 0.5) v. 0.5 (SE 0.2) %) compared with non-consumers.

CONCLUSIONS

Consumption of 100 % FJ is associated with improved nutrient adequacy and can contribute to a healthy diet.

Suboptimal magnesium status in the United States: are the health consequences underestimated?

In comparison with calcium, magnesium is an "orphan nutrient" that has been studied considerably less heavily. Low magnesium intakes and blood levels have been associated with type 2 diabetes, metabolic syndrome, elevated C-reactive protein, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headache, asthma, and colon cancer. Almost half (48%) of the US population consumed less than the required amount of magnesium from food in 2005-2006, and the figure was down from 56% in 2001-2002. Surveys conducted over 30 years indicate rising calcium-to-magnesium food-intake ratios among adults and the elderly in the United States, excluding intake from supplements, which favor calcium over magnesium. The prevalence and incidence of type 2 diabetes in the United States increased sharply between 1994 and 2001 as the ratio of calcium-to-magnesium intake from food rose from <3.0 to >3.0. Dietary Reference Intakes determined by balance studies may be misleading if subjects have chronic latent magnesium deficiency but are assumed to be healthy. Cellular magnesium deficit, perhaps involving TRPM6/7 channels, elicits calcium-activated inflammatory cascades independent of injury or pathogens. Refining the magnesium requirements and understanding how low magnesium status and rising calcium-to-magnesium ratios influence the incidence of type 2 diabetes, metabolic syndrome, osteoporosis, and other inflammation-related disorders are research priorities.

Interactions of single nucleotide polymorphisms with dietary calcium intake on the risk of metabolic syndrome

BACKGROUND

Gene-nutrient interactions may be important in modulating susceptibility to metabolic disorders.

OBJECTIVES

The objectives of this study were to assess the association of dietary calcium intake with the risk of metabolic syndrome and to investigate the interaction effects between dietary calcium intake and candidate gene polymorphisms.

DESIGN

Subjects were participants in the Korea Association Resource project, which was initiated in 2007 as a large-scale, genomewide association analysis. A total of 8031 subjects were included in the study. Associations were assessed by using multivariable-adjusted logistic regression analyses.

RESULTS

High calcium intake appeared to be associated with a low risk of metabolic syndrome after covariates in both men (P-trend = 0.03) and women (P-trend = 0.0002) were controlled for. Among 27 single nucleotide polymorphisms (SNPs) selected as possible candidate gene polymorphisms affecting the risk of metabolic syndrome, 3 SNPs [rs6445834 in Rho guanine nucleotide exchange factor 3 (ARHGEF3), rs10850335 in T-box 5 (TBX5), rs180349 in BUD13 homolog (Saccaromyces cerevisiae) (BUD13)] showed significant interaction effects with calcium intake tertiles or sufficiency in both men and women. Subjects with major allele homozygotes of these gene polymorphisms and high calcium intakes generally had a lower risk of metabolic syndrome than did those with minor allele homozygotes and low calcium intakes.

CONCLUSION

Dietary calcium intake appears to be inversely associated with the risk of metabolic syndrome and may modulate susceptibility to the syndrome in subjects who are minor allele carriers of rs6445834 in ARHGEF3, rs10850335 in TBX5, or rs180349 in BUD13.

School children's consumption of lower-calorie flavored milk: a plate waste study

During January 2011, the US Department of Agriculture issued proposed regulations with substantial changes to nutrition standards for school foods and beverages to improve the healthfulness of school meals. Milk availability is limited to fat-free or 1% white milk and fat-free flavored milk. Most elementary school students choose flavored milk. Milk processors are lowering the calories provided by flavored milks by reducing the fat and/or added sugars content. Milk is an important source of shortfall nutrients; thus, it is important to know how children accept these new milks. Four schools in the northeast and south serving lower-calorie flavored milk (≤150 kcal/8 oz) were selected for a quasi-experimental plate waste study. Five control schools serving standard flavored milk (>150 kcal/8 oz) were enrolled from the same regions. During May and June 2010, flavored milk cartons were collected from 793 third- to fifth-grade students after lunch and individually weighed to determine consumption. Overall, students consumed an average of 5.52±0.10 oz flavored milk. Students consumed an average of 5.88±0.12 oz standard flavored milk (n=497) compared with an average of 4.92±0.17 oz lower-calorie flavored milk (n=296). Using linear mixed models, we found that children drinking standard milk were more likely to consume >7 oz, although the difference was not significant (P=0.09). After adjusting for group differences in socioeconomic status, region, and sex, no differences in consumption were detected (P=0.29). Because none of these milks were in full compliance with proposed regulations, milk consumption should be further monitored.

Evaluation of magnesium intake and its relation with bone quality in healthy young Korean women

Many studies have reported magnesium's role in nutrition as a vital factor involved in bone health. However, not enough studies have evaluated magnesium (Mg) intakes in young women. In this study, we evaluated Mg intake in healthy adults and its relation with bone quality. A total of 484 healthy young women in their early 20s were enrolled into the study. Anthropometric measurements, dietary intake survey using 3-day dietary records, and the bone quality of the calcaneus using quantitative ultrasounds were obtained and analyzed. Average age, height, and weight of the subjects were respectively 20.20 years, 161.37 cm, and 54.09 kg, respectively. Also, the average broadband ultrasound attenuation, speed of sound (SOS), stiffness index (SI), and calcaneus T scores were 114.32 dB/MHz, 1,568.45 m/s, 95.23, and 0.36 g/cm(2), respectively. The subject's average intake of energy was 1,543.19 kcal, and the average Mg intake was 185.87 mg/day. Mg intake per 1,000 kcal of consumed energy in our subjects was 119.85 mg. Subjects consumed 63.11% of the recommended intake for Mg. Food groups consumed with high Mg content in our subjects included cereals (38.62 mg), vegetables (36.97 mg), milk (16.82 mg), legumes (16.72 mg), and fish (16.50 mg). The level of Mg intake per 1,000 kcal showed significant correlation to the SOS in the calcaneus (r = 0.110, p < 0.05) after adjustment for age, BMI, and percent body fat. In addition, the intakes of Mg from potatoes (p < 0.001), legumes (p < 0.05), and fungi and mushrooms (p < 0.05) positively correlated with the SOS of the calcaneus. In conclusion, the magnesium intake status of young Korean women aged 19-25 years is unsatisfactory. Improving dietary intake of Mg may positively impact bone quality in this population.

Dried fruit consumption is associated with improved diet quality and reduced obesity in US adults: National Health and Nutrition Examination Survey, 1999-2004

Epidemiological studies examining potential associations between dried fruit consumption, diet quality, and weight status are lacking. The goal of this study was to examine the association of dried fruit consumption with nutrient intake, diet quality, and anthropometric indicators of overweight/obesity. A secondary analysis of dietary and anthropometric data collected from adult (19+ years) participants (n = 13 292) of the 1999-2004 National Health and Nutrition Examination Survey was conducted. Dried fruit consumers were defined as those consuming amounts ⅛ cup-equivalent fruit per day or more and identified using 24-hour recalls. Diet quality was measured using the Healthy Eating Index 2005. Covariate-adjusted means, SEs, prevalence rates, and odds ratios were determined to conduct statistical tests for differences between dried fruit consumers and nonconsumers. Seven percent of the population consumed dried fruit. Mean differences (P < .01) between consumers and nonconsumers in adult shortfall nutrients were dietary fiber (+6.6 g/d); vitamins A (+173 μg retinol activity equivalent per day), E (+1.5 mg α-tocopherol per day), C (+20 mg/d), and K (+20 mg/d); calcium (+103 mg/d); phosphorus (+126 mg/d); magnesium (+72 mg/d); and potassium (+432 mg/d). Dried fruit consumers had improved MyPyramid food intake, including lower solid fats/alcohol/added sugars intake, and a higher solid fats/alcohol/added sugars score (11.1 ± 0.2 vs 8.2 ± 0.1) than nonconsumers. The total Healthy Eating Index 2005 score was significantly higher (P < .01) in consumers (59.3 ± 0.5) than nonconsumers (49.4 ± 0.3). Covariate-adjusted weight (78.2 ± 0.6 vs 80.7 ± 0.3 kg), body mass index (27.1 ± 0.2 vs 28.1 ± 0.2), and waist circumference (94.0 ± 0.5 vs 96.5 ± 0.2 cm) were lower (P < .01) in consumers than nonconsumers, respectively. Dried fruit consumption was associated with improved nutrient intakes, a higher overall diet quality score, and lower body weight/adiposity measures.

Self-perceived lactose intolerance results in lower intakes of calcium and dairy foods and is associated with hypertension and diabetes in adults

BACKGROUND

Self-perceived lactose intolerance may result in adverse dietary modifications; thus, more studies are needed to understand the prevalence of self-perceived lactose intolerance and how it relates to calcium intake and selected health conditions.

OBJECTIVE

The objective was to examine the effects of self-perceived lactose intolerance as it relates to calcium intake and specific health problems that have been attributed to reduced intakes of calcium and dairy foods in a nationally representative multiethnic sample of adults.

DESIGN

This was a cross-sectional study in a national sample of 3452 adults. The relation between self-perceived lactose intolerance, calcium intakes, and physician-diagnosed health conditions was analyzed by using linear regression analyses.

RESULTS

Of the total sample, 12.3% of respondents perceived themselves to be lactose intolerant. The age-adjusted prevalence of self-perceived lactose intolerance was 7.8% for non-Hispanic whites, 20.1% for non-Hispanic blacks, and 8.8% for Hispanics. Respondents with self-perceived lactose intolerance had significantly lower (P < 0.05) average daily calcium intakes from dairy foods than did those without self-perceived lactose intolerance. A significantly higher (P < 0.05) percentage of respondents with self-perceived lactose intolerance than of respondents without self-perceived lactose intolerance reported having physician-diagnosed diabetes and hypertension. The odds of self-reported physician-diagnosed diabetes or hypertension decreased by factors of 0.70 and 0.60, respectively, for a 1000-mg increase in calcium intake from dairy foods per day.

CONCLUSIONS

Self-perceived lactose-intolerant respondents had a significantly lower calcium intake from dairy foods and reported having a significantly higher rate of physician-diagnosed diabetes and hypertension.

Obesity augments calcium-induced increases in skeletal calcium retention in adolescents

CONTEXT

Overweight adolescents have low bone mineral content for weight and are at increased risk for fractures.

OBJECTIVE

The aim was to determine whether overweight and obesity influence the positive relationship between dietary calcium intake and skeletal calcium retention in adolescents.

DESIGN

Analysis of pooled data from calcium balance studies in adolescents.

SETTING

Participants each underwent a 3-wk calcium balance study in a controlled environment.

PARTICIPANTS

Participants included 280 White, Black, and Asian boys (n = 73) and girls (n = 207) ages 10-16 yr.

MAIN OUTCOME MEASURE

The relationship among body mass index (BMI), calcium intake, and calcium retention was modeled using linear regression.

RESULTS

Calcium intake, BMI, sex, race, and age explained 27.9% of the variation in calcium retention. At low calcium intakes, there was no effect of BMI on skeletal calcium retention, but at higher calcium intakes, BMI increased skeletal calcium retention.

CONCLUSIONS

Greater gains in calcium retention occur with increases in calcium intake in adolescents with higher BMI compared with those with lower BMI. Additional studies are needed to investigate whether increasing calcium intake reduces the increased risk of fracture associated with overweight and obesity in adolescents.

Association between the Healthy Eating Index and bone turnover markers in US postmenopausal women aged ≥45 y

BACKGROUND

Some studies have reported that overall diet quality affects bone status in postmenopausal women; however, the findings are inconsistent.

OBJECTIVES

Our primary objective was to examine the association between overall diet quality and bone turnover markers (BTMs) in postmenopausal women aged ≥45 y by using the Healthy Eating Index 2005 (HEI-2005)-a diet quality-assessment tool-developed by the US Department of Agriculture. Our secondary objective was to explore the associations between the components of the HEI-2005 and the MyPyramid food groups and BTMs.

DESIGN

We used cross-sectional data from NHANES 1999-2002. Multiple regression models with adjustments for relevant confounders were used to examine the relation between the total HEI-2005 score and its components and food groups and serum bone-specific alkaline phosphatase (BAP), a biomarker of bone formation, and urinary N-telopeptides/creatinine (uNTx/Cr), a biomarker of bone resorption.

RESULTS

No association was found between the total HEI-2005 score and BTMs. The milk group component of HEI-2005 had a significant negative linear relation with uNTx/Cr. Women in the lowest tertile of the MyPyramid milk group had the highest uNTx/Cr. Those in the highest tertile of energy-adjusted added sugar intake had the highest BAP.

CONCLUSIONS

Our results support the ability of a healthy diet with adequate dairy intake to promote bone health in aging women. However, we found that the HEI-2005 is not a good measure of healthy eating for optimal bone health. Further research is needed to develop an overall dietary assessment tool in relation to bone health for postmenopausal women.

Relations of diet and physical activity to bone mass and height in black and white adolescents

Because the development of healthy bodies during the years of growth has life-long health consequences, it is important to understand the early influences of diet and physical activity (PA). One way to generate hypotheses concerning such influences is to conduct cross-sectional studies of how diet and PA are related to different components of body composition. The subjects were 660 black and white adolescents. Total body bone mineral content (BMC) was measured with dual-energy X-ray absorptiometry; free-living diet and PA were assessed with 4-7 separate 24-h recalls. The main dietary variables investigated were: total energy intake, macronutrient distribution (%), dairy servings, vitamin D, and calcium. The main PA variables were hours of moderate PA (3-6 METs) and vigorous PA (>6 METs). BMC was higher in blacks than in whites (P<0.01) and it increased more in boys than in girls (age by sex interaction) as age increased (P<0.01). After adjustment for age, race and sex, higher levels of BMC were associated with higher levels of energy intake, dairy servings, calcium, vitamin D, and vigorous PA (all P 's<0.05). In the multivariable model, significant and independent proportions of the variance in BMC were explained by race, the age by sex interaction, calcium, and vigorous PA (all P 's<0.01). When height was used as the outcome variable, similar diet results were obtained; however, there was a sex by vigorous PA interaction, such that vigorous PA was associated with height only in the girls. These data are consistent with the hypothesis that the bone mass and height of growing youths are positively influenced by higher dietary intake of energy and dairy foods, along with sufficient amounts of vigorous PA. This hypothesis needs to be tested in randomized controlled trials.

Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review

High fruit and vegetable intake may be associated with improved bone status among women aged ≥ 45 years. This is the first systematic review that specifically assessed this association and identified research gaps. The benefits of fruit and vegetables (F&V) on bone health remain unclear. Further studies are needed.

INTRODUCTION

F&V have several components that are beneficial to bones. Some studies report that high F&V intake is associated with improved bone status in middle aged and aged women; however, findings are inconsistent. The objective was to systematically review observational and interventional studies that investigated the effects of F&V intake on incidence of osteoporotic fractures, bone mineral density (BMD), and bone turnover markers (BTM) in women aged ≥ 45 years and to identify potential research gaps.

METHODS

Electronic databases were searched, and peer-reviewed manuscripts published in English, with F&V intake as a main dietary exposure, were included. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers.

RESULTS

Eight studies were included. One cohort study reported cross-sectional as well as longitudinal data. There was significant between-study heterogeneity in design, definition, and amount of F&V intake, outcomes, analyses, and reporting of results. Two studies had low, two had moderate, and four had high risk of bias. Among reports with low or moderate risk of bias, two cross-sectional analyses reported positive associations between F&V intake and BMD of the forearm, lumbar spine, or total hip, whereas one randomized controlled trial and two prospective cohort analyses reported no effects. One trial reported no associations between F&V and BTM.

CONCLUSIONS

Based on limited evidence, the benefits of F&V on bone health remain unclear for women aged ≥ 45 years. Further studies with low risk of bias are needed.

The Standard American Diet and its relationship to the health status of Americans

The Standard American Diet (SAD) has long been implicated in contributing to the health challenges experienced in the United States. Significant changes to the SAD have occurred since the 1950s, including a greater abundance and accessibility to calorie-dense and nutrient-poor food and beverage choices. The disparity of present consumption patterns to diet and nutrition recommendations from the Dietary Guidelines for Americans are addressed.

The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected

OBJECTIVE

To determine the self-reported incidence of lactose intolerance and its influence on dairy choices among African American adults.

DESIGN, SETTING, AND PARTICIPANTS

An online survey closely matched to the 2000 US Census was administered to a nationally representative sample of African Americans (2016 adults) and a comparison sample of the general population (1084 adults). Statistical analyses performed included pairwise t tests for proportion conducted on percent responses at the 95% confidence level.

RESULTS

African Americans were more likely to eat fewer dairy foods, experience physical discomfort after consumption, and believe they were lactose intolerant. While 49% of African Americans had ever experienced "some type of physical discomfort" after eating dairy foods, 24% believed they were lactose intolerant. Within this group, 85% of African Americans would be willing to consume more dairy products if they could avoid lactose intolerance symptoms.

CONCLUSIONS AND IMPLICATIONS

Dairy food, calcium, and vitamin D intake in African Americans and the general population are below US recommendations. Deficiencies of these nutrients are associated with chronic diseases that disproportionately affect African Americans. In the United States, dairy foods are the primary source of calcium and vitamin D, and lactose intolerance can be a significant barrier to dairy food intake. However, self-described lactose intolerance is less than commonly reported in African American populations. Low dairy intake may reflect concerns about lactose intolerance, other factors such as learned food habits and cultural preferences. Nutrition recommendations for African Americans and the general population should focus on the health benefits of dairy foods, provide culturally sensitive dietary options, and strategies to increase tolerance.

The selection and prevalence of natural and fortified calcium food sources in the diets of adolescent girls

OBJECTIVE

To assess the impact of calcium-fortified food and dairy food on selected nutrient intakes in the diets of adolescent girls.

DESIGN

Randomized controlled trial, secondary analysis.

SETTING AND PARTICIPANTS

Adolescent girls (n = 149) from a midwestern metropolitan area participated in randomized controlled trials of bone physiology from 1997 to 2008.

INTERVENTION

Subjects randomly assigned to a high-calcium (HC) diet supplying 1,500 mg calcium/d, or their usual diet (UC).

MAIN OUTCOME MEASURES

Dietary intake was assessed from 3-day food records and calcium intakes categorized by food source. Food group composites, representing calcium-fortified and dairy food categories, were examined for their relative nutrient contributions. Student t tests were used to evaluate differences in selected nutrient intakes between the 2 study groups.

RESULTS

Dairy food contributed 68% of the total mean 1,494 mg calcium/d in the HC group, and calcium-fortified food contributed 304 mg calcium. In the UC group, dairy food contributed 69% of the total mean 765 mg calcium/d and calcium-fortified food contributed 50 mg calcium. Nutrient profiles of the dairy composites differed significantly from the calcium-fortified composites (P < .05).

CONCLUSIONS AND IMPLICATIONS

Dairy food was the primary source of calcium selected by these adolescent girls; calcium-fortified food augmented calcium intakes.

Whole-grain consumption is associated with diet quality and nutrient intake in adults: the National Health and Nutrition Examination Survey, 1999-2004

BACKGROUND

The consumption of whole grains and its association with nutrient intake has not been assessed in a recent nationally representative population.

OBJECTIVE

To examine the association of consumption of whole grains, using the new whole-grain definition, with diet quality and nutrient intake in a recent, nationally representative sample of adults.

DESIGN

Secondary analysis of cross-sectional data from 1999-2004 National Health and Nutrition Examination Survey.

PARTICIPANTS AND METHODS

Adults aged 19 to 50 years (n=7,039) and aged 51 years and older (n=6,237).

MAIN OUTCOME MEASURES

Participants were divided into four whole-grain consumption groups: ≤0 to <0.6, ≥0.6 to <1.5, ≥1.5 to <3.0, and ≥3.0 servings (ounce equivalents)/day. Macro- and micronutrient intakes and diet quality, using the Healthy Eating Index, were determined for each group.

STATISTICAL ANALYSES

Sample weights were applied. The percentages of adults in whole-grain consumption groups were calculated. The covariates used were energy, ethnicity, sex, and age. Least-square means were calculated. P for linear trend analysis was determined using whole-grain intake as a linear covariate. A P value of ≤0.05 was considered significant.

RESULTS

Adults aged 19 to 50 and 51+ years consumed a mean of 0.63 and 0.77 servings of whole grains per day, respectively. For both age groups, diet quality and intake of energy, fiber, and polyunsaturated fatty acids were significantly higher in those consuming the most servings of whole grains. Intake of total sugars (19 to 50 year age group only), added sugars, saturated fatty acids, monounsaturated fatty acids, and cholesterol was significantly lower in those consuming the most servings of whole grains. Intake of all micronutrients, except vitamin B-12 and sodium, was higher among individuals who consumed the most servings of whole grains.

CONCLUSIONS

Overall consumption of whole grains in the US population was low using the recently updated whole-grain definition. Adults who consumed the most servings of whole grains had better diet quality and nutrient intakes.

Estimation of total usual calcium and vitamin D intakes in the United States

Our objective in this study was to estimate calcium intakes from food, water, dietary supplements, and antacids for U.S. citizens aged >or=1 y using NHANES 2003-2006 data and the Dietary Reference Intake panel age groupings. Similar estimates were calculated for vitamin D intake from food and dietary supplements using NHANES 2005-2006. Diet was assessed with 2 24-h recalls; dietary supplement and antacid use were determined by questionnaire. The National Cancer Institute method was used to estimate usual nutrient intake from dietary sources. The mean daily nutrient intake from supplemental sources was added to the adjusted dietary intake estimates to produce total usual nutrient intakes for calcium and vitamin D. A total of 53% of the U.S. population reported using any dietary supplement (2003-2006), 43% used calcium (2003-2006), and 37% used vitamin D (2005-2006). For users, dietary supplements provided the adequate intake (AI) recommendation for calcium intake for approximately 12% of those >or=71 y. Males and females aged 1-3 y had the highest prevalence of meeting the AI from dietary and total calcium intakes. For total vitamin D intake, males and females >or=71, and females 14-18 y had the lowest prevalence of meeting the AI. Dietary supplement use is associated with higher prevalence of groups meeting the AI for calcium and vitamin D. Monitoring usual total nutrient intake is necessary to adequately characterize and evaluate the population's nutritional status and adherence to recommendations for nutrient intake.

Role of dairy beverages in the diet

The U.S. Dietary Guidelines for Americans recommends 3 cups of low fat milk or equivalent daily for most calorie levels [1]. Milk provides over 10% of the requirement for calcium, vitamin D, magnesium, phosphorus, potassium, riboflavin, protein, and carbohydrates for most people. Obtaining adequate intakes of calcium, potassium, and magnesium without milk in the diet requires effort. Milk has bioactive ingredients that may play unique roles in health. Benefits of dairy consumption are associated with reduced risk of low bone mass, stroke, metabolic syndrome, and some cancers. Concerns over milk consumption have focused on saturated fats historically. More research is needed to resolve potential concerns of milk consumption and risk of several disorders including ovarian cancer and soft tissue calcification.

Nutrition and Bone: It is More than Calcium and Vitamin D

Unlike pharmacological agents that are taken for proscribed periods of time, food and nutrient intakes have the possibility of affecting bone health over the entire lifespan. While deficiencies or excesses of individual nutrients have been shown to affect bone, it is likely that individual foods or dietary patterns have important effects related to skeletal health. While biochemical mechanisms exist to relate a deficiency of vitamin K to altered bone metabolism, clinical trials related to supplementation of this nutrient have been confusing. It is likely that these disparate results are related to the fact that interactions of nutrients have not been considered or the possibility that suboptimal nutrient status is a marker of poor nutritional status. Vitamin A excess has been postulated to be related to high fracture risk; however, it is likely that retinol is not the best marker for the proposed interaction. Altering whole food patterns, such as the Dietary Approaches to Stop Hypertension diet, have demonstrated beneficial effects on bone metabolism. Individuals who select some vegetarian patterns may need to consider supplementation with nutrients such as calcium and protein. Future studies should center on whole food and dietary patterns and their relationship to bone metabolism and fracture risk.