Calcium intakes of Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks in the United States

Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999-2008

OBJECTIVE

Analyze the association between household food security status and diet quality during pregnancy.

METHODS

Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income.

RESULTS

Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample.

CONCLUSIONS FOR PRACTICE

In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.

Building better bones in childhood: a randomized controlled study to test the efficacy of a dietary intervention program to increase calcium intake

Background/Objectives

Many children do not consume the recommended daily allowance of calcium. Inadequate calcium intake in childhood may limit bone accrual. The objective of this study was to determine if a behavioral modification and nutritional education (BM-NE) intervention improved dietary calcium intake and bone accrual in children.

Subjects/Methods

139 (86 female) healthy children, 7–10 years of age, were enrolled in this randomized controlled trial conducted over 36 months. Participants randomized to the BM-NE intervention attended five sessions over a six-week period designed to increase calcium intake to 1500 mg/day. Participants randomized to the usual care (UC) group received a single nutritional counseling session. The Calcium Counts^© Food Frequency Questionnaire was used to assess calcium intake; DXA was used to assess areal bone mineral density (aBMD) and bone mineral content (BMC). Longitudinal mixed effects models were used to assess for an effect of the intervention on calcium intake, BMC and aBMD.

Results

BM-NE participants had greater increases in calcium intake that persisted for 12 months following the intervention compared to UC. The intervention had no effect on BMC or aBMD accrual. Secondary analyses found a negative association between calcium intake and adiposity such that greater calcium intake was associated with lesser gains in BMI and fat mass index.

Conclusions

A family-centered BM-NE intervention program in healthy children was successful in increasing calcium intake for up to 12 months but had no effect on bone accrual. A beneficial relationship between calcium intake and adiposity was observed and warrants future study.

Nutritional Considerations for Performance in Young Athletes

Nutrition is an integral component to any athletes training and performance program. In adults the balance between energy intake and energy demands is crucial in training, recovery, and performance. In young athletes the demands for training and performance remain but should be a secondary focus behind the demands associated with maintaining the proper growth and maturation. Research interventions imposing significant physiological loads and diet manipulation are limited in youth due to the ethical considerations related to potential negative impacts on the growth and maturation processes associated with younger individuals. This necessary limitation results in practitioners providing nutritional guidance to young athletes to rely on exercise nutrition recommendations intended for adults. While many of the recommendations can appropriately be repurposed for the younger athlete attention needs to be taken towards the differences in metabolic needs and physiological differences.

Household food insecurity and dietary intake among Mexican-American women participating in federal food assistance programs

PURPOSE

To explore the association between food insecurity and dietary intake among Mexican-American women after controlling for sociocultural and economic factors including participation in federal food assistance programs.

DESIGN

Cross-sectional.

SETTING

Three cities in Texas.

SUBJECTS

Seven hundred seven Mexican-American women (26-44 years).

MEASURES

Demographics, anthropometrics, acculturation, and food security status were obtained using validated measures. Dietary intake was assessed by a 24-hour dietary food record.

ANALYSIS

Logistic regression was used to examine the association between individual and household characteristics on food security status. One-way analysis of covariance tested the association between food security status and dietary intake after adjusting for socio-demographic variables, acculturation, body mass index, participation in federal food assistance programs, and energy intake.

RESULTS

About 77% of food-insecure women participated in at least one federal food assistance program. Each additional child in the household increased the odds of being food insecure by 25%. A higher proportion of obese women was found in the food-insecure group. No significant differences in dietary intake were found by food security status.

CONCLUSION

Food insecurity did not negatively influence dietary intake independently of women's participation in federal food assistance programs. Food security did not ensure consumption of nutritionally adequate foods. Educational and food assistance programs need to be optimized to facilitate enrollment and improve the nutritional status of this ethnic group, food secure or not.

Role of calcium during pregnancy: maternal and fetal needs

Although the demand for additional calcium during pregnancy is recognized, the dietary reference intake for calcium was lowered for pregnant women in 1997 to amounts recommended for nonpregnant women (1,000 mg/day), and recently (November 2010) the Institute of Medicine report upheld the 1997 recommendation. It has been frequently reported that women of childbearing age do not consume the dietary reference intake for calcium and that calcium intake in the United States varies among ethnic groups. Women who chronically consume suboptimal amounts of calcium (<500 mg/day) may be at risk for increased bone loss during pregnancy. Women who begin pregnancy with adequate intake may not need additional calcium, but women with suboptimal intakes (<500 mg) may need additional amounts to meet both maternal and fetal bone requirements. The objective of this review is to elucidate the changes in calcium metabolism that occur during pregnancy as well as the effect of maternal calcium intake on both maternal and fetal outcomes.

Food group intake patterns and nutrient intake vary across low-income Hispanic and African American preschool children in Atlanta: a cross sectional study

Background

The food group intake patterns of low income Hispanic and African American preschool children are not well documented. The aim of this study was to perform a food group intake analysis of low income minority preschool children and evaluate how macronutrient and micronutrient intake compares to Dietary Reference Intakes (DRI).

Methods

A cross sectional study design using three-day food diaries analyzed by dietary analysis software (Nutrient Database System for Research) was used. Children were recruited from well-child clinics at Children’s Healthcare of Atlanta at Hughes Spalding and North Dekalb Grady Satellite Clinic, Atlanta, GA. Low-income, African American and Hispanic preschool age children (n = 291) were enrolled. A total of 105 completed and returned the 3-day food diaries. Chi-squared tests were used to assess demographic variables. The mean percentage of intake per day of specific food groups and sub-groups were obtained (servings of given food group/total daily servings). Food intake data and proportion of children meeting DRIs for macro- and micronutrients were stratified by race/ethnicity, nutritional status, and caloric intake, and were compared using t-tests. Regression models controlling for age, BMI and sex were obtained to assess the effect of total caloric intake upon the proportional intake of each studied food group.

Results

The mean age of African American children was 2.24 ± 1.07 years and Hispanic children 2.84 ± 1.12 years. African Americans consumed more kcal/kg/day than Hispanics (124.7 ± 51 vs. 96.9 ± 33, p < 0.05). Hispanics consumed more fruits (22.0 ± 10.7% vs. 14.7 ± 13.7%, p < 0.05), while African Americans consumed more grains (25.7 ± 7.8% vs. 18.1 ± 6.4%, p < 0.05), meats (20.7 ± 9.0% vs. 15.4 ± 6.1%, p < 0.05), fats (9.8 ± 5.4% vs. 7.0 ± 5.8%, p < 0.05), sweet drinks (58.7 ± 17.1% vs. 41.3 ± 14.8%, p < 0.05) and low-fat dairy products (39.5 ± 19.3% vs. 28.9 ± 12.6%, p < 0.05). Among Hispanics, the proportional intake of fruits, fats and grains varied by total caloric intake, while no difference by total caloric intake was found for the dietary patterns of African Americans. Micronutrient intake also differed significantly between African American and Hispanic children.

Conclusions

Food group intake patterns among low-income children differ by ethnic group. There is a need for more research to guide program design and target nutritional interventions for this population.

Factors associated with use of calcium and calcium/vitamin D supplements in older Mexican Americans: Results of the Hispanic EPESE study

BACKGROUND

Current studies indicate that older Mexican Americans take fewer calcium or calcium/vitamin D supplements than do older non-Hispanic whites. Factors associated with calcium supplement use are not completely understood in this ethnic group.

OBJECTIVE

The purpose of this article was to determine the prevalence of calcium or calcium/vitamin D supplementation and factors associated with their use in older Mexican Americans.

METHODS

A cross-sectional survey was conducted in a random sample of older Mexican Americans residing in the southwestern United States who had participated in the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Self-identified Mexican Americans >or=75 years of age were enrolled through household interviews in 2004-2005. Each subject was asked to bring all prescription and nonprescription medications that they had used regularly during the previous 2 weeks to allow the interviewer to record the product names. Dosages were not recorded. Subjects were assigned to 1 of 3 categories based on their use of calcium or calcium/vitamin D supplements during the previous 2 weeks: (1) calcium supplement only, (2) calcium/vitamin D supplement, or (3) vitamin D supplement only. The subjects' sociodemographic and cultural factors, self-reported health and functional status, cognitive status, number of comorbidities, and use of antiosteoporosis medications were recorded.

RESULTS

A total of 2069 older Mexican Americans (1272 women, 797 men; mean age, 81.9 years) were enrolled. The overall prevalence of calcium supplement use was 10.6% (weighted). Calcium supplements were used more often by women (odds ratio [OR] = 1.76; 95% CI, 1.17-2.63), subjects with multiple comorbidities (OR = 1.29; 95% CI, 1.10-1.50), those who interviewed in English (OR = 1.59; 95% CI, 1.06-2.40), and those who used antiosteoporosis medications (OR = 3.57; 95% CI, 1.85-6.89).

CONCLUSIONS

Use of calcium or calcium/vitamin D supplements was low (<60%) among this group of older Mexican Americans. Men are particularly at risk. More should be done to raise awareness regarding the benefits of calcium supplementation in this ethnic group.

Anthropometric and lifestyle associations of bone mass in healthy pre-menopausal Mexican and Asian American women

Few studies have established the lifestyle predictors of peak bone mineral density (BMD) in Mexican-American (MA) and Asian-American (AA) women. Pre-menopausal MA (n = 48) and AA (n = 58) women aged 30-45 years old were tested for BMD, body composition, aerobic fitness, and muscle function. Socio-demographic characteristics, health status, prevalence of osteoporosis risk factors, physical activity, and diet were determined via questionnaire. Pearson's correlations and multiple linear regressions were used to test the associations between various osteoporosis risk factors and BMD. Body composition, anthropometric, and BMD differences were noted between groups. Hip, but not spine BMD, remained significantly higher for the MA compared to the AA group after adjustment for age, BMI, income, and physical activity index. Lean body mass was a significant predictor of hip BMD for both groups and this relationship was stronger for the AA group. Lean body mass may explain ethnic differences in BMD.

Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension

We evaluated whether hypertension control differs by ethnicity after accounting for patient characteristics, treatment, and adherence to treatment using the third National Health and Nutrition Examination Survey (US population estimate, 42,511,379). Outcome measures were prescribed treatment, treatment adherence, hypertension control (blood pressure [BP]<140/90 mm Hg). Multivariate logistic regression was performed with non-Hispanic whites (NHW) as the comparison group. Non-Hispanic blacks (NHB) were more likely to report medication prescription (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.5) and being advised to restrict salt (OR 1.5, CI: 1.2-2.0). Among those advised, NHB were more likely to report salt restriction (OR 1.5, CI: 1.1-2.1) and weight-loss attempts (OR 1.7, CI: 1.3-2.3). Among persons advised to follow exercise, alcohol restriction, smoking cessation, tension reduction, or diet modification, NHB (OR 2.2, CI: 1.6-3.0) and Mexican Americans (OR 2.0, CI: 1.1-3.9) were more likely to report adherence. The likelihood of uncontrolled hypertension was higher in NHB (OR 1.4, CI: 1.1-1.7) and Mexican Americans (OR 1.5, CI 1.1-2.0) despite medication adherence. Even after adjustment for treatment and adherence, substantial ethnic differences in hypertension control were found. Initiating treatment, while crucial, is not sufficient and future guidelines should emphasize aggressive treatment escalation to achieve hypertension control.

Lactose Maldigestion Revisited: Diagnosis, Prevalence in Ethnic Minorities, and Dietary Recommendations to Overcome It

Currently, an estimated 25% of Americans and 75% of individuals worldwide seem to suffer from lactose maldigestion. The authors' objective was to evaluate current prevalence of lactose maldigestion/intolerance in populations of various ethnic groups, examine the severity of symptoms, and recommend ways in alleviating them. In the United States, 25% of people who are lactose maldigesters are ethnic minorities. Earlier estimates report that ∽50% of Hispanic, almost 100% of Asian, and ∽80% of African Americans suffer from lactose maldigestion. There is evidence linking lactose maldigestion as a factor contributing to low calcium intake, leading to subsequent osteoporotic fractures. Although bone mineral density is higher in African and Hispanic American men and women compared to white and Asian Americans, osteoporosis is still a concern in those populations. Recent studies suggest that current estimates of lactose maldigestion may be grossly overestimated. Clinical trials show that even those individuals who do maldigest lactose could overcome adverse symptoms by a few simple dietary strategies. In addition, new research points to possible manipulation of colonic microflora toward alleviating symptoms.

Recent developments in calcium-related obesity research

The influence of calcium and dairy food intake on energy balance is the object of a growing scientific literature. This manuscript presents the information discussed by subject experts during a symposium on calcium and obesity, initially planned to document in a comprehensive manner the role of calcium and dairy food on energy balance and body composition. This manuscript is organized into 13 propositions statements which either resume the presentation of an invited speaker or integrate recent developments in calcium-related obesity research. More specifically, the effects of calcium and dairy consumption on body weight and adiposity level, appetite, weight loss intervention outcome, lipid-lipoprotein profile and the risk to develop metabolic syndrome are discussed together with the metabolic mechanisms proposed to explain these effects. Taken together, the observations presented in this manuscript suggest that calcium and dairy food intake can influence many components of energy and fat balance, indicating that inadequate calcium/dairy intake may increase the risk of positive energy balance and of other health problems.

Effect of dolomite oral exposure in Wistar rats during organogenesis period of pregnancy

The potential of oral exposure to dolomite, a natural product that contains calcium and magnesium, to initiate teratogenesis was analyzed in Wistar rats. Animals received dolomite oral dosages of 500 and 1500mg/kg during the period of gestation from day 6-15 post conceptionem (p.c.). Maternal, embryo and fetal toxicity were evaluated. Dolomite exposure did not produce maternal toxicity assessed by clinical observations, body weight gain, hematology parameters and relative organs weight. Signs of embryo-fetal toxicity were not observed. Skeletal malformations and visceral variations were similar in control and dolomite-treated groups. On the other hand, slight increase was observed in fetal body weight in the dolomite-treated group. Treatment with dolomite resulted in significantly decreased incidences of unossified xiphisternum, incomplete ossification of xiphisternum and sternebrae. These effects could be caused by a beneficial influence of calcium and magnesium salts present in dolomite on ossification process. In conclusion, in this study we found that the oral exposure to rats of up to 1500mg/kg of dolomite during organogenesis did not induce significant maternal and embryo-fetal toxicity.

Ethnic differences in dairy and related nutrient consumption among US adults and their association with obesity, central obesity, and the metabolic syndrome

BACKGROUND

Recent studies suggest dairy consumption and associated nutrients may be protective against some of the components of the metabolic syndrome (MetS).

OBJECTIVES

We examined the association between consumption of a variety of dairy products and their related nutrients with obesity, central obesity, and MetS, and attempted to explain some of the ethnic differences in metabolic outcomes through dairy consumption using national data.

DESIGN

Nationally representative indicators of obesity, central obesity, and MetS among US adults were constructed from National Health and Nutrition Examination Survey 1999-2004 data, including direct anthropometric assessments, blood pressure, and laboratory tests. Sample sizes ranged from 4519 for MetS to 14 618 for obesity. Associations between diet (assessed using 24-h recalls) and metabolic and other outcomes were tested using multivariate linear and logistic models and structural equation models.

RESULTS

We found a significant inverse association between intake of whole milk, yogurt, calcium, and magnesium and metabolic disorders. Odds ratios for one more daily serving of yogurt and 100 mg Mg for MetS were 0.40 (95% CI: 0.18, 0.89) and 0.83 (95% CI: 0.72, 0.96), respectively. The opposite was found for intakes of cheese, low-fat milk, and phosphorus. Using structural equation models, ethnic differences in some MetS outcomes, such as body mass index and systolic blood pressure, were partly explained by variations in dairy-related nutrients.

CONCLUSIONS

Various dairy products may have differential associations with metabolic disorders, including obesity. Ethnic differences in dairy consumption may explain in part the ethnic disparities in metabolic disorders in the US population.

Redefining osteoporosis treatment: Who to treat and how long to treat

Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.

Ethnicity and Nutrient Intake among Arizona WISEWOMAN Participants

BACKGROUND

Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described.

METHODS

Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified. Estimated mean nutrient intakes of Mexican Americans (n = 260) and non-Hispanic white (n = 88) women were compared based on ethnicity and acculturation levels. Using linear regression models, associations of individual characteristics were made on nutrients for which reported intakes were less than the estimated average requirement (EAR).

RESULTS

Mexican Americans had energy, vitamin E, and niacin intakes that were significantly lower than those of non-Hispanic whites, whereas vitamin A intake was significantly higher among Mexican Americans. Less acculturated Mexican American women had significantly higher intakes of vitamin E and folate than their more acculturated counterparts. For both ethnic and acculturation groups, intakes of vitamin E, calcium, and potassium were lower than the established standards in more than 70% of this population. Having a high body mass index (BMI) was associated with lower reported energy intake and higher protein and potassium intakes, and smoking was associated with lower intakes of vitamin E and folate.

CONCLUSIONS

Mexican American women had overall lower micronutrient intakes compared with uninsured non-Hispanic white older women; this difference may be attributed to their underreporting intake.

Ethnic Variation in Risk for Osteoporosis among Women: A Review of Biological and Behavioral Factors

Most studies of risk factors for osteoporosis and nontraumatic fracture involve white women, although more research is being geared toward bone health among various ethnic groups. The purpose of this review is to provide an overview of health disparity in osteoporosis, including assessment of bone mineral density (BMD), bone health screening, lifestyle risk factors, and treatment involving white, black, Hispanic, Asian, and Native American women. This review summarizes evidence that white, Asian, Hispanic, and Native American women are more at risk for osteoporosis than black women. These conclusions are supported by the disparity in BMD between white and black women, although the reason for this biological difference is not well characterized. Additional research is needed to determine if there is a significant difference in BMD among Hispanic, Asian, and Native American women independent of body weight and size. Similarly, there is also disparity in fracture rates, with the causes presumed to be multifactorial. Calcium intake is lower than recommended in all females at all ages; however, it is much lower in black and Native American women and highest in white and Hispanic women. Black women also have a lower vitamin D status than white women, with mean vitamin D status of Hispanic American women lying between that of black and white women. Similarly, although white women are more active than black and Hispanic women at all ages, data are lacking about physical activity habits of women of other ethnic backgrounds and how this impacts bone health. Finally, screening protocols for women of various ethnicities and effectiveness of treatments are not well established and remain a priority in women's health.

The myth of increased lactose intolerance in African-Americans

In the United States, approximately three fourths of African-Americans have the potential for symptoms of lactose intolerance because lactose digestion depends on the presence of the enzyme lactase-phlorizin hydrolase which is reduced by up to 90-95% in individuals with lactase nonpersistence. The 'African-American diet' is more likely to be low in a variety of vitamins and minerals, including calcium. African-Americans consume low amounts of dairy foods and do not meet recommended intakes of a variety of vitamins and minerals, including calcium. Low intake of calcium and other nutrients put African-Americans at an increased risk for chronic diseases. The 2005 Dietary Guidelines recommend consuming three servings of dairy foods per day to ensure adequate calcium intake, among other nutrients, and the National Medical Association has recently published a similar recommendation of three to four servings of dairy per day for the African-American population. Research has shown that lactose maldigesters, including African-American maldigesters, can consume at least one cup (8 oz) of milk without experiencing symptoms, and that tolerance can be improved by consuming the milk with a meal, choosing yogurt or hard cheeses, or using products that aid in the digestion of lactose such as lactase supplements or lactose-reduced milks.

Does milk make children grow? Relationships between milk consumption and height in NHANES 1999-2002

In the United States, milk (usually cow's milk) is widely considered an "essential food" to support bone growth among post-weaning age children, as evident in government-sponsored nutrition policies that mandate milk for children. Milk contains calories, protein, and calcium, among other nutrients, and bioactive components such as insulin-like growth factor-I (IGF-I), all of which may facilitate bone growth. There is a large literature on milk and/or calcium intake and its effects on bone density, but one aspect of bone mass--height--is not well studied in relation to milk consumption. Limited experimental studies show no consistent relationship across populations. To investigate this linkage among American children, analysis of the NHANES 1999-2002 was undertaken. NHANES data allow two hypotheses to be tested: (1) reported frequency of childhood milk consumption will be positively related to adult height and (2) height of children 5-18 years will be predicted by the reported frequency of milk consumption and/or milk intake from a 24-h dietary recall. Results indicate that adult height was positively associated with milk consumption at ages 5-12 and 13-17, after controlling for sex, education, and ethnicity. Among contemporary children, milk consumption had no effect on the height of 5-11 year olds after controlling for age, birthweight, energy intake, and ethnicity. In contrast, milk consumption frequency and milk intake (measured as grams of milk, or protein or calcium from milk) were significant predictors of the height of 12-18 year olds, along with age, sex, household income, and ethnicity. The greatest ethnic contrasts were between Mexican Americans and non-Hispanic whites and blacks, and milk variables remained significant predictors of height in these comparisons. Thus NHANES data show substantial variability in the effects of milk consumption on height.

Calcium Requirements for the Athlete

There is oftentimes a notion of "the more, the better" with regard to vitamin and mineral intake among individuals, and especially among athletes. Although adequate calcium intake is necessary to promote bone health and prevent osteoporosis, increased physical activity alone does not necessarily demand an increased intake of dietary calcium or other micronutrients. Athletes may lose calcium via sweat, in which case replenishment is advocated either via dietary intake of calcium-rich foods or a commercial calcium supplement. The important message to athletes is to consume a diet adequate in energy, protein, fat, vitamins, minerals, and fluids to support the physical demands and replenish the physiologic losses incurred with physical training.

Longitudinal Changes in Intake and Food Sources of Calcium from Childhood to Young Adulthood: The Bogalusa Heart Study

OBJECTIVE

To examine changes in calcium intake and food sources of calcium from childhood to young adulthood in a longitudinal sample.

METHODS

Information on food and nutrient intake was derived from a single 24-hour dietary recall collected on children who participated in a cross-sectional survey at age 10 and again in young adulthood. A cohort of 237 young adults who participated in the 1989-1991 young adult survey (ages 19 to 28 years) also participated in one of three cross-sectional surveys from 1973 to 1978 at 10 years of age. Repeated measures analysis of variance was applied to examine the longitudinal changes in intake of calcium and food sources from childhood to young adulthood.

RESULTS

Total calcium intake at age 10 was not significantly different than total calcium intake of those same individuals when they were young adults. Gender and ethnic differences were observed within the two age groups. In both childhood (age 10 years) and young adulthood, African-American females had significantly lower total calcium intake than Euro-American males. However, this ethnic difference in total calcium intake did not exist after adjusting for energy intake. Calcium intake per 1000 kcal was significantly lower in females than males at age 10, but not in young adulthood. A large percentage of 10-year-olds did not meet the RDA or AI for calcium intake (54% and 88%, respectively), and this was also shown when they were young adults (77% and 75%, respectively).

CONCLUSIONS

More effective nutrition educational efforts are needed to emphasize the importance of adequate calcium intake and the major food sources of calcium, beginning early in childhood and continuing into young adulthood.

Calcium intake during pregnancy among white and African-American pregnant women in the United States

OBJECTIVE

To characterize the calcium intake in a racially mixed cohort of pregnant women, including the contribution of supplementation and antacids.

METHODS

A cohort of women was interviewed twice during their pregnancies. The interviews included a food frequency questionnaire and questions on calcium supplementation and antacid intake. Pregnant women seeking prenatal care at a Pittsburgh hospital in the first trimester were enrolled. 454 women were enrolled and did not miscarry; 385 completed two interviews and were of white or African-American race.

RESULTS

Mean and median intakes of calcium were 1671 mg/day and 1482 mg/day. 36% of the women were under the former RDA level (1200 mg/day) for calcium, while 26% were under the current AI (1000 mg/day). Six percent were taking in less than 600 mg/day, and 15% over 2500 mg/day, the tolerable upper limit. Young women were particularly likely to have low intakes (12% of those less than 21 years of age had less than 600 mg/day). Black women were slightly overrepresented among those with low intake (8% vs. 5% of whites), but, overall, their intake was quite similar to whites. Milk and cheese provided more calcium than other food items. Many women took antacids, especially during the second half of pregnancy, and these were a major source of calcium for some members of the cohort.

CONCLUSIONS

Although mean and median calcium intake in the cohort were above the AI, many women had calcium intakes that were too high or low. Dairy products provided the most calcium for most pregnant women, and antacids were an important source for many.

Calcium intake trends and health consequences from childhood through adulthood

Issues involving low calcium intake and dairy product consumption are currently the focus of much debate and discussion at both the scientific and lay community levels. In this review, we examine the following major areas of interest: (1). the role of calcium intake and dairy product consumption in chronic diseases, (2). nutritional qualities of milk and other dairy products, (3). trends in calcium intake and dairy product consumption, (4). current status of calcium intakes and dairy product consumption in children, (5). tracking of calcium intake and diary product consumption, (6). the impact of school meal participation on calcium intake and dairy product consumption, (7). concerns related to calcium-fortified foods and beverages and (8). factors influencing children's milk consumption. To date, the findings indicate that calcium intake and dairy product consumption have beneficial roles in a variety of chronic diseases; dairy products provide an abundant source of vitamins and minerals; calcium intakes of children have increased over time, yet intakes are not meeting the current adequate intake (AI) calcium recommendations; dairy consumption has decreased, and soft drink consumption and, possibly, consumption of calcium-fortified products have increased; consumption of dairy products have a positive nutritional impact on diets of children, particularly from school meals, and there are many factors which influence children's milk consumption, all of which need to be considered in our efforts to promote adequate calcium intakes by children. Based on this review, areas that need immediate attention and future research imperatives are summarized in an effort to further our understanding on what we already know and what we need to know to promote healthier eating habits early in life.

Correlation of dietary intake and colorectal cancer incidence among Mexican-American migrants: the multiethnic cohort study

Studies of migrants, along with geographic and temporal variations in incidence, indicate that colorectal cancer is especially sensitive to changes in environmental factors, including, most importantly, diet. The goal of this research was to examine the changes in dietary practices that may be consistent with the changing incidence of colorectal cancer in the Los Angeles Mexican-American population. Cancer incidence and dietary intake data were available for over 35,000 Latinos of Mexican national origin currently participating in the prospective Multiethnic Cohort Study, representing the largest sample of Mexican-origin Latinos of any such study in the United States. The dataset is unique in that changes in cancer rates and in dietary behaviors across three generations could be examined. Most of the change in colorectal cancer rates occurred between the first and second generations, and, correspondingly, nearly all the dietary change also occurred between the first and second generations. Although some food traditions were retained by Mexican Americans, the dietary changes due to acculturation were significant and support an association between colorectal cancer risk and certain dietary components, notably, alcohol as a risk factor and nonstarch polysaccharides and vegetables as protective factors.

Antecedents to effective treatment of hypertension in Hispanic populations

Hypertension is a common medical disorder affecting >50 million people. It is a primary modifiable risk factor to cardiovascular disease and a leading cause of death in black and Hispanic groups. This article focuses on patient-specific and physician-specific barriers that contribute to underdiagnosis, undertreatment, access issues, and poor adherence to therapy. Two cross-cultural interviewing frameworks, ETHNIC and ADHERE, are discussed as approaches that complement the traditional clinical assessment and treatment of hypertension in Hispanics.

Calcium intake of Asian, Hispanic and white youth

OBJECTIVE

To examine calcium intake and food sources among Asian, white and Hispanic youth, in order to develop and target interventions to improve calcium intake.

METHODS

Cross-sectional survey with two 24-hour dietary recalls one week apart. Calcium intake was evaluated in 167 male and female adolescents of Asian, Hispanic and white ethnicity, ages 10-18 years, from six states. Main outcome measures were mean daily calcium intake (mg/day).

STATISTICAL ANALYSES PERFORMED

t tests, Chi-square and analysis of variance for differences by age, ethnicity and gender, multiple regression of factors influencing calcium intake.

RESULTS

Overall median calcium intake was 938 mg/day with 868 mg/day for Asians, 1180 mg/day for whites and 896 mg/day for Hispanics. Daily milk intake was the primary predictor of calcium intake with Asian ethnicity and female gender each showing a negative association to calcium intake in multiple regression models.

CONCLUSIONS

Milk intake was the primary factor positively influencing calcium intake, while Asian ethnicity and female gender negatively influenced calcium intake. Thus, interventions to improve calcium intake should focus on improving milk intake of Asians and females.

Relative bioavailability of calcium-rich dietary sources in the elderly

BACKGROUND

The recent increase in the dietary calcium recommendation from 800 to 1200 mg/d for persons aged > 51 y has made it important to identify alternative high-calcium dietary sources that the elderly can use in meeting their calcium requirement.

OBJECTIVE

We determined the bioavailability of calcium from 3 different sources: orange juice fortified with calcium-citrate malate, skim milk, and a calcium carbonate supplement.

DESIGN

Twelve subjects [9 women and 3 men with a mean (+/- SEM) age of 70 +/- 3 and 76 +/- 6 y, respectively] consumed low-calcium (300 mg/d) and high-calcium (1300 mg/d) diets for three 1-wk periods each during a 6-wk crossover study. The acute biochemical response to calcium from each of the 3 sources was assessed during a 4-h period after the initial breakfast meal of the high-calcium diet.

RESULTS

Postprandial suppression of serum parathyroid hormone did not differ significantly between the test meals containing calcium-fortified orange juice, the calcium carbonate supplement, and milk. This finding suggests that the calcium bioavailability from the 3 sources was equivalent. During the 1-wk high-calcium diet periods, fasting serum calcium increased by 3% (P < 0.0001), serum 1,25-dihydroxyvitamin D decreased by 20% (P < 0.0001), and a biomarker of bone resorption (serum N-telopeptide collagen cross-links) decreased by 14% (P < 0.02) compared with the low-calcium diet period. However, no differences among the supplemental calcium sources were found in these calcium-responsive measures or fasting serum parathyroid hormone concentration.

CONCLUSIONS

In elderly subjects, the calcium bioavailability of the 3 high-calcium dietary sources tested was equivalent, during both the acute postprandial and longer-term periods.

Dietary calcium intake and serum vitamin D are major determinants of bone mass variations in women. A longitudinal study

BACKGROUND AND AIMS

Bone mineral density (BMD) is one of the main determinants in the pathogenesis of fractures. However, data on factors predicting longitudinal variations in BMD are still limited and incomplete. Such data would be of great importance in order to better focus prevention strategies in both the clinical setting and at the population level. The aim of the study was to investigate the predictive value of both serological and questionnaire variables for bone mass variations in healthy women participating in a population-based longitudinal study carried out in Napoli, Italy.

METHODS

High completion rate (85.2%) and adequate sample size were obtained: 139 women (45 to 79 years of age) were examined at study entry and then again after two years (24 +/- 2 months) following the same protocol. They underwent medical examination, questionnaire, anthropometric measurements, blood sampling and urine collection. BMD was measured by dual energy X-ray absorptiometry (DEXA) at the lumbar spine (L1-L4) and femoral neck. Data analysis included calculation of the percent variation in BMD in the 2-year period. Longitudinal data underwent stepwise analysis for a global evaluation of mutual interactions between independent variables.

RESULTS AND CONCLUSIONS

Our findings indicate that dietary and serum calcium, and serum 25(OH)vitamin D are the only independent determinants of BMD variations at the lumbar and femoral level, respectively. While the pharmacological significance of calcium and vitamin D in the therapy of established osteoporosis is still controversial, the present longitudinal data evidence their role as essential nutrients in determining the natural history of BMD variations.

Perspectives on intake of calcium-rich foods among Asian, Hispanic, and white preadolescent and adolescent females

OBJECTIVE

Declining calcium intake among adolescents warrants attention. Our objective was to identify influences on adolescents' consumption of calcium-rich foods.

DESIGN

Focus groups were conducted with girls representing 2 age groups (11 to 12 or 16 to 17 years) and 3 macroethnic groups (Asian, Hispanic, or white).

SETTING

Public schools in 10 states.

PARTICIPANTS

A convenience sample (n = 200) was recruited through schools.

VARIABLES MEASURED

Focus groups (n = 35) were audiotaped and transcribed. Influences relative to consumption of milk or other calcium-rich foods were identified.

ANALYSIS

Comments were coded as motivators or barriers within each focus group. Content analysis procedures were used to compare ethnic and age groups.

RESULTS

A barrier to milk consumption that was more common among older girls and Asian groups was the limited expectation within families for drinking milk. Many controlled their own beverage choices, and milk, even if liked, was only one option. Milk was positively associated with strength and bone health, but these attributes were viewed as being more important for boys than girls. Milk was associated with breakfast, school lunches, cereal, and desserts. White girls had the most positive reactions to milk and Hispanic girls the most negative. All groups were positive toward pizza, ice cream, and cheese.

CONCLUSIONS AND IMPLICATIONS

To improve calcium intake among teens, interventions should include a family component, stress the benefits of milk for girls, and focus on breakfast.

Ethnic differences in titratable acid excretion and bone mineralization

PURPOSE

To test our hypothesis that differences in urinary calcium excretion among blacks and whites may be secondary to ethnic variations in acid (H(+)) metabolism and to prove that increases in titratable acid excretion would be found among individuals predisposed to the development of stress fractures.

METHODS

We administered 8 g NH(4)Cl acutely to 11 black and 18 white healthy volunteers and measured urinary sodium, calcium, and acid excretions. We measured the Na(+)/H(+) antiporter activity using acid-loaded platelets as surrogate markers for this exchanger expressed in renal epithelial cells. We also compared differences in titratable acid excretion among a cohort of subjects with, and without, a history of stress fracture.

RESULTS

NH(4)Cl-induced increases in titratable urinary acid correlated with changes in the renal excretion of calcium and sodium, and stimulated acid excretion correlated with basal acid loss. Despite comparable changes in plasma pH, whites, when compared to blacks, had much greater basal acid excretion and NH(4)Cl-induced acid excretion. Whites also had much greater baseline calcium excretion rates when compared to blacks. Following acid loading, whites continued to exhibit greater calcium excretion rates than blacks. Acid loading significantly decreased sodium excretion in whites but not in blacks. Blacks also had significantly attenuated Na(+)/H(+) exchange activity. In a cohort of resting, athletic students, we found enhanced basal H(+) and phosphate excretion among subjects who experienced stress fractures during their rigorous physical training when compared to those individuals who did not.

CONCLUSION

Blacks may have a greater endogenous buffering capacity than whites, or the reported ethnic differences in sodium and calcium excretion rates between blacks and whites may be secondary to racial variations in renal H(+) excretion. We conclude that both ethnic differences in bone mineralization and bone integrity in athletes are mediated by heritable differences in titratable acid excretion.

Ethnicity, nutrition, and birth outcomes in nulliparous women

OBJECTIVE

Ethnic differences in birth outcomes are well established, but it is not clear whether differences in nutrition may partly explain unaccounted differences in birth outcomes. Our purpose was to evaluate the relationship of nutrition to ethnic differences in birth outcomes.

STUDY DESIGN

This was a multicenter, prospective study of 4589 healthy nulliparous women who were enrolled in the Calcium for Preeclampsia Prevention trial conducted from 1992 to 1995. Main outcome measures were birth weight, gestational age at delivery, preterm birth, and small for gestational age birth after the data were controlled for maternal characteristics and intake of total calories, protein, carbohydrate, fat, and 13 vitamin and mineral constituents that were obtained from a 24-hour recall at 13 to 21 weeks' gestation.

RESULTS

Black and non-Hispanic white women differed significantly in birth outcomes, with odds ratios of 2.06 (95% confidence interval, 1.48-2.86) for small for gestational age and 1.38 (95% confidence interval, 0.98-1.95) for preterm birth, after adjustment for maternal characteristics. These odds ratios were hardly changed by the further adjustment for all nutritional variables, even though there were substantial nutritional differences between black and white women. Differences in birth outcomes between Hispanic and non-Hispanic white women were small. Hispanic women who spoke only Spanish were better nourished than those Hispanic women who spoke English, but this had only a modest effect on birth outcomes.

CONCLUSION

Nutritional variation among women in the United States does not appear to have a significant role in the explanation of ethnic differences in birth outcomes.

Lactose Maldigestion, Calcium Intake and Osteoporosis in African-, Asian-, and Hispanic-Americans

Dietary calcium is critical for the development of the human skeleton and likely plays an important role in the prevention of osteoporosis. Dairy products provide approximately three-fourths of calcium consumed in the diet and are the most concentrated sources of this essential nutrient. One obstacle that likely interferes with calcium consumption among many ethnic groups is lactose maldigestion. The real or perceived occurrence of intolerance symptoms after dairy food consumption may cause maldigesters to avoid dairy products. Several investigators have observed a relationship between lactose maldigestion, dietary calcium and osteoporosis in Caucasian populations. Research on ethnically diverse populations is necessary to better understand how lactose maldigestion influences the risk for osteoporosis. Low calcium intakes, a greater than previously thought potential for low bone density and extensive lactose maldigestion among Hispanic-American and Asian-American populations may create an elevated risk for osteoporosis. Dietary management strategies for lactose maldigesters to increase calcium consumption include consuming (1) dairy foods with meals, (2) yogurts, (3) calcium-fortified foods, (4) using lactose digestive aids and (5) including dairy foods daily in the diet to enhance colonic metabolism of lactose.

Comparison of energy and nutrient sources of elderly Hispanics and non-Hispanic whites in New Mexico

OBJECTIVE

Identification and comparison of frequently consumed foods and important food sources of energy, protein, total fat, vitamin A, vitamin C, vitamin E, vitamin B-6, folate, and calcium of elderly Hispanics and non-Hispanic whites.

DESIGN

Dietary intake data were collected using a modified Health Habits and History Questionnaire (a food frequency questionnaire) for 735 subjects who participated in the New Mexico Elder Health Survey.

SUBJECTS

The sample consisted of 330 Hispanics (176 men and 154 women) and 405 non-Hispanic whites (214 men and 191 women) between the ages of 65 and 96 years. Subjects were those with food frequency data among 883 participants who completed the clinical visit of the New Mexico Elder Health Survey.

RESULTS

Results show the top-ranked frequently consumed foods by gender and ethnicity and top-ranked food sources of energy and 8 nutrients. Regional foods were important sources of nutrients in the diets of both Hispanics and non-Hispanic whites, however, more so for the Hispanics. Chile sauces were notable sources of vitamin A, vitamin C, and folate among both groups. Both ethnic groups demonstrated selection of low-fat and skim milk and moderation in consumption of red meat.

APPLICATIONS

These data will be useful for designing nutrition education programs, for studying the relationship between diet and disease among elderly Hispanics and non-Hispanic whites, and for designing assessment instruments for the elderly and other ethnic populations.

Estimated dietary calcium intake and food sources for adolescent females: 1980-92

PURPOSE

To estimate dietary calcium intake of three groups of adolescent females ages 11-12 years, 13-14 years, and 15-18 years during four separate 2-year time periods from the years 1980-92; and to identify their food sources of calcium.

METHODS

Nutrient intake survey based on 14-day food consumption records collected from four national representative samples of 4,000 United States households.

RESULTS

Dietary calcium consumption declined significantly (p < .01) over the 10-year period for the 15-18 year olds. Calcium intake was significantly lower for 13-14 year olds compared to the youngest age group, and for 15-18 year olds when compared to the two younger age groups for all four study periods (p < .01). Over 90% of all adolescent females consumed < 100% of the RDA for calcium during all data collection periods. The percentage of adolescent females who consumed less than two-thirds of the RDA increased with age. Seventy-seven percent of 15-18 year olds consumed below this level from 1990-92. Milk and milk products were the best food sources of calcium contributing over one-half of the calcium to the diet. This percentage declined over time and with age to 44% for the 15-18 year old females in 1990. This drop can be attributed to a 7-12% decline in fluid milk consumption for the 11-12 year olds and 15-18 year olds, respectively.

CONCLUSIONS

Estimates indicate that dietary calcium intakes fall far short of both the Recommended Dietary Allowance (RDA) and National Institutes of Health (NIH) recommendations. Intakes have declined over time, with age, and appear to be related to a decline in fluid milk consumption. Efforts to increase calcium consumption among adolescent females appear critical. Clear recommendations to consume a minimum of three servings everyday of lowfat or nonfat dairy products such as milk and yogurt are needed to help this population meet daily calcium requirements.

Insufficient calcium and iron intakes among general female population in Japan, with special reference to inter-regional differences

Dietary intakes of calcium (Ca) and iron (Fe) were investigated in 227 women (mostly housewives) in 12 regions in Japan in 1991-1993 by the 24-hour food duplicate method. Nine regions out of 12 had been previously studied in 1977-1982. Utilizing Standard Food Composition database, mean Ca and Fe-intakes in 1991-1993 were estimated to be 602 and 10.4 mg/day, respectively; the former was barely sufficient and the latter was below sufficiency when compared with the Recommended Daily Allowance in Japan for pre-menopausal women. Ca- and Fe-intake did not increase in the 10-year period. Further analysis after classification of the women into three groups of farmers in Okinawa, farmers in Mainland Japan and urban residents showed that Ca and Fe insufficiency was most evident among Okinawa farmers. The leading Ca sources were milk, pulse, vegetables and fish-shellfish, but consumption of milk was generally low, especially among Okinawa farmers. Pulse, vegetables and fish-shellfish were 3 major Fe sources; Okinawa farmers depended more on vegetables and less on fish-shellfish.