Calcium absorption and kinetics are similar in 7- and 8-year-old Mexican-American and Caucasian girls despite hormonal differences

Calcium kinetic rates in Caucasian males and females from birth to adulthood

Calcium plays an important role in bone physiology and its kinetics change over lifetime. The analysis of calcium deposition and release through stable isotope techniques has guided recommendations on nutritional uptake for overall health. In addition, calcium kinetics have great relevance for toxicokinetic studies of bone-seeking elements (e.g, aluminium and lead) since these elements use common uptake and release pathways. While the impact of many factors on calcium kinetics have been investigated individually, a consolidated age- and sex-dependent kinetic description amenable for toxicokinetic modeling, however, is still lacking. Motivated by this need, we systematically reviewed the existing literature on calcium kinetics and assembled a large and consistent dataset. Then, building on the work of O'Flaherty in the 1990s, we formulated age- and sex-dependent functions describing calcium deposition, release, net retention, and mass. This description represents the current knowledge on calcium kinetics in a reference individual of Caucasians as most data was from this population.

Stable Isotopes of Minerals as Metabolic Tracers in Human Nutrition Research

Enriched stable isotopes used as tracers have proven to be valuable in studies of the absorption and metabolism of minerals. Unlike radioisotopes, they can be used in high-risk population groups such as infants, children, and pregnant or lactating women. Estimates of mineral absorption can be made from the oral administration of a single tracer or from two tracers, one given orally and the other intravenously (IV). It is possible to determine the metabolism of the mineral with modeling based on the amount of the tracer or tracers in different biological samples. One of the key decisions in studies of this type is determining which enriched isotope and what amount to use. An example is given of calculations to estimate and compare the amounts of tracers needed for an absorption study. Methods for calculating the amounts of tracer in oral and IV doses are presented, and limits of detection and quantitation are discussed in terms of percent of enrichment and related to isotope ratio measurement precision. A general review of the use of mass spectrometric instruments for quantifying various stable isotopes is given.

Free 25(OH)D and Calcium Absorption, PTH, and Markers of Bone Turnover

CONTEXT

It has been proposed that serum free 25-hydroxyvitamin D [25(OH)D] may better reflect vitamin D action than total 25(OH)D. An ELISA for serum free 25(OH)D has recently become available, permitting direct assay.

OBJECTIVE

To determine whether serum free 25(OH)D provides additional information in relation to calcium absorption and other biomarkers of vitamin D action compared to total serum 25(OH)D.

SETTING

Ambulatory research setting in a teaching hospital.

OUTCOME

Serum free 25(OH)D measured in a previously performed study of varied doses of vitamin D3 (placebo and 800, 2000, and 4000 IU) on calcium absorption, PTH, procollagen type 1 N-terminal propeptide, and C-terminal telopeptides of type I collagen. Free 25(OH)D was measured by ELISA. Calcium absorption was measured at baseline and at 10 weeks using stable dual calcium isotopes.

RESULTS

Seventy-one subjects completed this randomized, placebo-controlled trial. Baseline group mean free and total 25(OH)D varied from 4.7 ± 1.8 to 5.4 ± 1.5 pg/mL, and from 23.7 ± 5.9 to 25.9 ± 6.1 ng/mL, respectively. Participants assigned to the 4000-IU dose arm achieved free 25(OH)D levels of 10.4 pg/mL and total 25(OH)D levels of 40.4 ng/mL. Total and free 25(OH)D were highly correlated at baseline and after increasing vitamin D dosing (r = 0.80 and 0.85, respectively). Free 25(OH)D closely reflected changes in total 25(OH)D. PTH was similarly correlated at baseline and follow-up with total and free 25(OH)D. Serum C-terminal telopeptides of type I collagen had a moderate positive correlation with total and free 25(OH)D at follow-up. The serum 1,25-dihydroxyvitamin D change increased significantly with the change in 25(OH)D but not with the change in free 25(OH)D.

CONCLUSION

There was no advantage from measuring free over total 25(OH)D in assessing the response of calcium absorption, PTH, and markers of bone turnover to vitamin D. Free 25(OH)D responded to increasing doses of vitamin D in a similar fashion to total 25(OH)D.

Vitamin D supplementation increases calcium absorption without a threshold effect

BACKGROUND

The maximal calcium absorption in response to vitamin D has been proposed as a biomarker for vitamin D sufficiency.

OBJECTIVE

The objective was to determine whether there is a threshold beyond which increasing doses of vitamin D, or concentrations of serum 25-hydroxyvitamin D [25(OH)D], no longer increase calcium absorption.

DESIGN

This was a placebo-controlled, dose-response, randomized, double-blind study of the effect of vitamin D on calcium absorption in healthy postmenopausal women. Seventy-six healthy postmenopausal women were randomly assigned to placebo or 800 IU (20 μg), 2000 IU (50 μg), or 4000 IU (100 μg) vitamin D₃ for 8 wk. The technique of dual isotopes of stable calcium was used with a calcium carrier to measure calcium absorption at baseline and after 8 wk.

RESULTS

Seventy-one women with a mean ± SD age of 58.8 ± 4.9 y completed the study. The mean calcium intake was 1142 ± 509 mg/d and serum 25(OH)D was 63 ± 14 nmol/L at baseline. A statistically significant linear trend of an increase in calcium absorption adjusted for age and body mass index with increasing vitamin D₃ dose or serum 25(OH)D concentration was observed. A 6.7% absolute increase in calcium absorption was found in the highest vitamin D₃ group (100 μg). No evidence of nonlinearity was observed in the dose-response curve.

CONCLUSIONS

No evidence of a threshold of calcium absorption was found with a serum 25(OH)D range from 40 to 130 nmol/L. Calcium absorption in this range is not a useful biomarker to determine nutritional recommendations for vitamin D.

New reference values for calcium

The nutrition societies of Germany, Austria and Switzerland are the joint editors of the 'reference values for nutrient intake'. They have revised the reference values for the intake of calcium and published them in June 2013. The reference values for the calcium intake for infants are derived from the calcium content of breast milk. For infants from 4 to <12 months of age, the calcium intake from solid foods is included in addition to the calcium intake from breast milk. Thus, the reference values for infants are estimated values; they are 220 mg/day for infants to <4 months and 330 mg/day for infants from 4 to <12 months of age. As a parameter for determining the calcium requirement in children and adolescents, calcium retention is taken into account. The average requirement is calculated by the factorial method. A balanced calcium metabolism is calculated based upon calcium balance studies and used as a parameter for the determination of the calcium requirement in adults. On the basis of the average requirement, recommended calcium intake levels for children, adolescents and adults are derived. Depending on age, the recommended calcium intake ranges between 600 mg/day for children aged 1 to <4 years and 1,200 mg/day for adolescents aged 13 to <19 years; for adults, it is 1,000 mg/day.

Supplementation with 1000 IU vitamin D/d leads to parathyroid hormone suppression, but not increased fractional calcium absorption, in 4-8-y-old children: a double-blind randomized controlled trial

BACKGROUND

The effects of vitamin D supplementation in healthy prepubertal children on physiologic outcomes have not been investigated.

OBJECTIVE

The objective was to evaluate the effects of supplementation with 1000 IU vitamin D(3)/d on calcium absorption.

DESIGN

In a double-blind, placebo-controlled trial, we randomly assigned 64 children to 1000 IU vitamin D(3)/d (n = 32) or placebo (n = 32) for 8 wk. Stable isotopes were used to assess calcium absorption. The main outcome measure was calcium absorption before and after supplementation.

RESULTS

All of the data are shown as means ± SDs. At baseline, vitamin D intake was 221 ± 79 IU/d and calcium intake was 830 ± 197 mg/d. Baseline serum 25-hydroxyvitamin D [25(OH)D] was not significantly correlated with fractional or total calcium absorption. After 8 wk, with baseline values used as a covariate, no differences were seen in fractional or total calcium absorption based on supplementation group (P = 0.75 and 0.36, respectively). Supplemented children had a significant increase in 25(OH)D concentrations (from 27.7 ± 7.4 to 36.0 ± 10.3 ng/mL; P < 0.0001) and a decrease in parathyroid hormone (from 21.4 ± 10.4 to 12.9 ± 7.1 pg/mL; P < 0.001); no significant changes in the placebo group were observed. No adverse side effects were noted in either group.

CONCLUSIONS

Vitamin D(3) supplementation at 1000 IU/d increases 25(OH)D and decreases parathyroid hormone in children with average vitamin D intakes below the dietary recommendations of the Institute of Medicine. However, no significant effects of this change on calcium absorption occurred. This trial was registered at clinicaltrials.gov as NCT 00868738.

Effects of ethnicity and vitamin D supplementation on vitamin D status and changes in bone mineral content in infants

Abstract

Trial Registration

ClincalTrials.gov NCT00697294

Cross-calibration of 45calcium kinetics against dynamic histomorphometry in a rat model to determine bone turnover

Techniques for assessing bone dynamic are in high demand. Calcium (Ca) kinetic studies are currently being used in our clinical studies of bone turnover in adolescents and elderly. The technique has rarely been compared to the standard method of bone dynamic histomorphometry. We perturbed bone turnover through ovariectomy and sub-optimal dietary Ca in a female rat model to cross-calibrate Ca kinetics against dynamic histomorphometry. Kinetic studies involved oral and intravenous administration of (45)Ca and monitoring the tracer in blood, urine, feces, and bone over a 3-day period as part of a metabolic Ca balance study. Histomorphometric indices of mineral apposition rate, mineralizing surface, and bone formation rate were obtained from proximal metaphysis and mid-diaphysis region of tibial bone. Bone mineralization and resorption rates at the whole skeletal level as evaluated by kinetic studies were significantly correlated with the volume-based bone formation rate (BFR/BV) evaluated by dynamic histomorphometry in metaphyseal trabecular bone (r=0.72 and r=0.61, respectively, p<0.001) and surface-based bone formation rate (BFR/BS) in tibial cortex (r=0.63, p<0.001 and r=0.59, p<0.01, respectively). Significant correlations were also demonstrated between bone resorption and mineralization rates at the whole skeletal level (r=0.91, p<0.001) using (45)Ca kinetic data. Ca kinetic modeling showed an increase (p<0.001) in skeletal resorption and formation rates in response to ovariectomy (27.6 vs. 13.8 mg/d for bone resorption and 42.7 vs. 28 mg/d for bone formation in ovariectomized vs. their Sham-operated control animals, respectively). Ca kinetic data also showed that bone formation decreased by 30% and whole bone balance by 50%, when dietary Ca level was reduced from 0.4% to 0.2% (34.2 vs. 23.8 mg/d and 10.4 vs. 5.1 mg/d, respectively, p<0.001). Our data suggest that Ca kinetic studies can be used reliably to rapidly detect changes in bone turnover at the whole skeletal level in response to interventions.

Calcium absorption in infants and small children: methods of determination and recent findings

Determining calcium bioavailability is important in establishing dietary calcium requirements. In infants and small children, previously conducted mass balance studies have largely been replaced by stable isotope-based studies. The ability to assess calcium absorption using a relatively short 24-hour urine collection without the need for multiple blood samples or fecal collections is a major advantage to this technique. The results of these studies have demonstrated relatively small differences in calcium absorption efficiency between human milk and currently available cow milk-based infant formulas. In older children with a calcium intake typical of Western diets, calcium absorption is adequate to meet bone mineral accretion requirements.

Higher serum 25-hydroxyvitamin D levels in school-age children are inconsistently associated with increased calcium absorption

CONTEXT

Increasing serum 25-hydroxyvitamin D (25-OHD) in adults may enhance calcium absorption (Ca-abs). There are few similar pediatric data leading to uncertainty about the optimal target for 25-OHD to maximize Ca-abs.

OBJECTIVE

Our objective was to evaluate the relationship between 25-OHD and Ca-abs in a large cohort of school-age children and adolescents.

DESIGN

We evaluated data from 439 Ca-abs measurements performed using dual-tracer stable isotope techniques conducted at our center over a 15-yr period in 251 healthy children, 4.9-16.7 yr of age.

RESULTS

Serum 25-OHD ranged from 28 to 197 nmol/liter (mean 85 +/- 2 nmol/liter) (sem). Total Ca-abs (intake times fractional absorption) were significantly correlated to 25-OHD in the whole population (r = 0.16, P = 0.001). This relationship was closer in the 197 studies in early puberty (Tanner 2 or 3, r = 0.35, P < 0.001) and not significant in pre- or late pubertal subjects. For the whole population, fractional Ca-abs adjusted for calcium intake were slightly but significantly higher at 25-OHD of 28-50 nmol/liter (0.344 +/- 0.019) compared with 25-OHD of 50-80 nmol/liter (0.280 +/- 0.014) or 25-OHD greater than 80 nmol/liter (0.297 +/- 0.015, P < 0.01 for each), suggesting adaptation to moderately low 25-OHD values.

CONCLUSION

There is no consistent pattern of relationship between 25-OHD and either fractional or total calcium absorption in school-age children. However, there appears to be a modest calcium absorptive response to higher 25-OHD during early puberty.

Vitamin D status and its relationship with parathyroid hormone and bone mineral status in older adolescents

Osteoporosis is an important contributor to the global burden of disease, and in the UK alone results in one in three women and one in twelve men aged >50 years experiencing a fragility fracture. Optimising peak bone mass in early adulthood is thought to reduce osteoporosis risk by offsetting bone losses in later life. Ensuring sufficient vitamin D status (measured as 25-hydroxyvitamin D (25OHD) in plasma), among other factors, is believed to facilitate the achievement of optimum peak bone mass. Lower 25OHD is associated with a higher plasma concentration of parathyroid hormone (PTH). As PTH is associated with increased bone turnover and bone loss, maintenance of sufficient 25OHD is thought to have a protective effect on bone health. However, there is a lack of consensus internationally on what constitutes an optimum 25OHD concentration, and values between 30 and 80 nmol/l have been suggested. These values have been based on findings from various studies in adults in which PTH has been observed to plateau at a 25OHD concentration of >30 nmol/l; however, not all studies have found such a plateau. Although studies in younger adolescents (14–16 years) have shown an inverse relationship between PTH and 25OHD, the concentration of 25OHD required for achievement of optimum peak bone mass is unknown. The present review examines the evidence defining vitamin D insufficiency thresholds, and the relevance of such thresholds to adolescent bone health.

Vitamin D, parathyroid hormone, and bone mass in adolescents

This article provides a review of the evidence identifying the factors related to vitamin D status in adolescents. The prevalence of vitamin D deficiency based on 25-hydroxyvitamin D [25(OH)D] of <25 nmol/L ranges from 0 to 32% depending on the season measured and the latitude of the population assessed. The factors that have been reported to affect serum 25(OH)D in adolescents include ethnicity, gender, puberty stage, parathyroid hormone (PTH), dietary vitamin D intake, and sun exposure. Vitamin D supplementation studies are limited to small populations and with supplementation focused on winter months when sunlight may be inadequate. The effects of vitamin D status and supplementation on bone assessment provide varied results. Differences in study design, modalities of bone assessment, and stage of puberty could contribute to disparate findings. Overall, the results from the available literature provide more questions than answers concerning the role of vitamin D in bone accrual in adolescents.

Relationships among vitamin D levels, parathyroid hormone, and calcium absorption in young adolescents

BACKGROUND

Evidence suggests that vitamin D status in adults, as assessed by serum 25-hydroxyvitamin D (25-OHD), is positively associated with calcium absorption fraction and inversely associated with serum PTH. Few comparable pediatric data exist.

OBJECTIVES

The objective of this study was to evaluate the relationships among vitamin D status, PTH, and calcium absorption in midpubertal boys and girls.

METHODS

Calcium absorption was measured as part of an evaluation of the effects of prebiotics (inulin-type fructans) using a stable isotope method in 93 young adolescents, 12.7 +/- 1.0 yr of age, receiving diets averaging approximately 900 mg/d calcium.

RESULTS

A significant positive relation to calcium absorption was found for serum 1,25-dihydroxyvitamin D (P = 0.048) and PTH (P = 0.007), but not for 25-OHD (P = 0.77). PTH was significantly inversely related to 25-OHD and was positively related to serum 1,25-dihydroxyvitamin D and osteocalcin. PTH was marginally significantly inversely related to lumbar spinal, but not whole body, bone mineral density.

CONCLUSIONS

These data suggest that in adolescents, especially in the presence of vitamin D insufficiency, PTH secretion increases to adapt to higher rates of bone formation associated with growth. This results in higher serum 1,25(OH)2D concentrations and increased calcium absorption results. Vitamin D status, as reflected by the serum 25-OHD level, is not closely related to calcium absorption. Whether adaptation to low serum 25-OHD is adequate under physiologically stressful situations, including those leading to very low serum 25-OHD levels, is unknown.

Vitamin D receptor Fok1 polymorphisms affect calcium absorption, kinetics, and bone mineralization rates during puberty

Few studies of the VDR polymorphisms have looked at calcium metabolism or long-term effects. We measured bone mineralization and calcium metabolic parameters longitudinally in a group of 99 adolescents. We found a significant relationship between calcium absorption and skeletal calcium accretion and the Fok1, but not other VDR or related, genetic polymorphisms. It seems that the Fok1 polymorphism directly affects bone mineralization during pubertal growth through an effect on calcium absorption.

INTRODUCTION

There are few data regarding the relationship between genetic markers for low bone mass and changes in calcium metabolism in childhood or adolescence. We sought to identify the effects of polymorphisms of the vitamin D receptor (VDR) on calcium and bone mineral metabolism in a longitudinal study of pubertal adolescents.

MATERIALS AND METHODS

Adolescents (n = 99) received comprehensive stable isotope studies of calcium absorption, bone calcium kinetics, and bone mineralization. Studies were repeated 12 months later. Polymorphisms of putative genetic markers were determined and related to bone mineralization and calcium metabolic finding. Results were analyzed by ANOVA in which changes over time were determined using the initial value as a covariate.

RESULTS

Polymorphisms of the Fok1 gene of the VDR were significantly related to calcium absorption (p = 0.008) and whole body BMC (p = 0.03) and BMD (p = 0.006). The Fok1 effect on whole body BMD was significant for those with Ca intake >800 mg/day (p < 0.001), whereas for those with Ca intake < or = 800 mg/day, the Fok1 genotype did not have a significant effect on whole body BMD (p = 0.40). The Fok1 genotype was significantly related to the changes during the year in whole body calcium accretion, with the ff genotype having a 63 +/- 20 mg/day deficit compared with the FF genotype (p = 0.008).

CONCLUSIONS

The Fok1 polymorphism of the VDR receptor seems to directly affect bone mineral accretion during pubertal growth through an effect on calcium absorption. The relationship between different genetic polymorphisms and bone mineral metabolism may vary by life stage as well as diet.

Inductively Coupled Plasma Mass Spectrometric Analysis of Calcium Isotopes in Human Serum: A Low-Sample-Volume Acid-Equilibration Method

Background: Analytical methods for measuring the calcium isotope distribution in enriched human serum samples that use low blood volumes, simple preparation methods, and rapid analysis are important in clinical studies of calcium kinetics. Previously, sample preparation by oxalate precipitation typically required 500 μL of serum. This method was time-consuming, and the blood volume required was limiting in circumstances when only a small amount of serum could be obtained.

Methods: Serum was collected from humans who were administered 42Ca, and 20 μL of serum was mixed with 2 mL of 0.22–0.67 mol/L HNO3 at room temperature for between 1 min and 16 h. The 42Ca/43Ca ratio in the supernatant was measured by a magnetic sector inductively coupled plasma mass spectrometer (ICP-MS). Calcium isotope ratios from these equilibration solutions were compared with data from oxalate-precipitated serum samples to determine the optimum equilibrium time and the effect of acid concentration on equilibrium.

Results: Various amounts of aggregated particles developed in different acid-serum mixtures. These affected the time required for isotope equilibration in the mixture. The shortest equilibrium time needed for the calcium isotopes varied from 1 to 6 h for samples acidified with 0.22–0.45 mol/L HNO3. Data obtained from these solutions were consistent with data from oxalate-precipitated calcium. The precision of 42Ca/43Ca ratio measurements was better than 0.5%.

Conclusions: We have developed a simple, rapid sample preparation technique for ICP-MS analysis in which 20 μL of serum can be used for accurate measurement of the calcium isotope distribution in a sample with good precision and a rapid analysis time.

Calcium, magnesium, phosphorus and vitamin D fortification of complementary foods

Provision of the bone minerals and vitamin D as fortificants in food or as dietary supplements designed for older infants and toddlers in Latin America is likely to be beneficial and safe. Currently available data are inadequate to establish the precise amounts of these nutrients that would be required for such a supplement. These amounts would vary according to the local base diet. However, reasonable estimates can be made on the basis of current dietary recommendations as well as existing data on bioavailability and customary intake. The strongest case can be made for calcium and vitamin D supplementation. Because excessive dietary calcium can reduce zinc absorption as a result of interactive effects within the intestine, an appropriate ratio of calcium to zinc should be used, even if this means adding zinc as a fortificant or supplement. Magnesium supplementation may be appropriate in some circumstances but it cannot be routinely advocated at present. It is unlikely that phosphorus supplementation is needed for most population groups because of the relatively high usual dietary phosphorus intakes, primarily from phosphate salts added to carbonated beverages and as food preservatives.

A novel dual radio- and stable-isotope method for measuring calcium absorption in humans: comparison with the whole-body radioisotope retention method

BACKGROUND

Dietary calcium absorption can be determined only with the use of isotope techniques. Currently used isotope techniques require exclusive equipment or are not true tracer approaches.

OBJECTIVE

The objective was to compare a dual-isotope method combining radioisotopes and stable isotopes with a whole-body radioisotope retention method for measuring calcium absorption.

DESIGN

Seven healthy adults aged 21-27 y consumed a test meal containing 63 +/- 14 (macro x +/- SD) mg Ca together with a water solution of (47)Ca (0.11 MBq). One hour after ingestion, 18 mg (44)Ca was administered intravenously. All feces and urine were collected for 5 and 6 d, respectively. Calcium absorption was estimated from whole-body retention of the radioisotope 12 times over 3 wk after ingestion and from the excretion of (47)Ca and (44)Ca in a 24-h urine sample collected on day 2. (44)Ca in urine was determined by inductively coupled plasma mass spectrometry.

RESULTS

Mean (+/- SD) calcium absorption was 75 +/- 9% with the dual-isotope method and was 74 +/- 8% with the whole-body radioisotope retention method. There was a high degree of agreement between the methods.

CONCLUSION

The dual-isotope method is a valid approach for measuring calcium absorption from a single meal.

Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III

Subclinical vitamin D deficiency may be common in certain subgroups in the U.S., but to date vitamin D data from other groups in the population have not been available. We used serum 25-hydroxyvitamin D (25-OHD) data from 18,875 individuals examined in the Third National Health and Nutrition Examination Survey (NHANES III 1988-1994) to assess the vitamin D status of selected groups of the noninstitutionalized U.S. adolescent and adult population. Serum 25-OHD levels were measured by a radioimmunoassay kit (DiaSorin, Inc., Stillwater, MN; normal range 22.5-94 nmol/L). Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter; instead data were collected in northern latitudes during summer and in southern latitudes in winter. To address this season-latitude aspect of the NHANES design, we stratified the sample into two seasonal subpopulations (winter/lower latitude and summer/higher latitude) before examining vitamin D status. Less than 1% of the winter/lower latitude subpopulation had vitamin D deficiency (25-OHD <17.5 nmol/L). However, the prevalence of vitamin D insufficiency in this group ranged from 1%-5% with 25-OHD <25 nmol/L to 25%-57% with 25-OHD <62.5 nmol/L, even though the median latitude for this subsample (32 degrees N) was considerably lower than the latitude at which vitamin D is not synthesized during winter months (approximately 42 degrees N). With the exception of elderly women, prevalence rates of vitamin D insufficiency were lower in the summer/higher latitude subpopulation (<1%-3% with 25-OHD <25 nmol/L to 21%-49% with 25-OHD <62.5 nmol/L). Mean 25-OHD levels were highest in non-Hispanic whites, intermediate in Mexican Americans, and lowest in non-Hispanic blacks. Our findings suggest that vitamin D deficiency is unlikely in the two seasonal subpopulations of noninstitutionalized adolescents and adults that can be validly assessed in NHANES III. However, vitamin D insufficiency is more common in these two seasonal subpopulations. Of particular interest is that insufficiency occurred fairly frequently in younger individuals, especially in the winter/lower latitude subsample. Our findings support continued monitoring of this vitamin in the U.S. population.

Calcium fractional absorption and metabolism assessed using stable isotopes differ between postpartum and never pregnant women

Determining the fractional absorption (FA) of calcium using the incorporation into urine of stable isotopes given intravenously (IV) and orally has become a routine procedure. We investigated the FA of calcium in two groups of (2-3 mo) postpartum women lactating (LACT) (n = 6) and nonlactating (PPNL) (n = 6), and in never pregnant (NP) women (n = 7). The women consumed a controlled diet containing 30-33 mmol/d calcium (Ca) for 21 d. On d 7 of the controlled diet, the women received 0.05 mmol of 42Ca IV and 0.25 mmol 44Ca orally in milk. Urine samples (24-h) were collected for the next 14 d and morning blood samples were collected from fasting subjects before dosing and at 24 and 48 h after receiving the isotopes. Milk samples from the LACT women were collected from each feeding beginning 24 h before to 72 h after dosing. There were no significant differences in the FA of calcium as measured by stable isotope incorporation into urine (23.8 +/- 2.9%), serum (24.0 +/- 3.4%) or milk (23.6 +/- 3.6%) of LACT women. The fractional calcium absorption measured in urine of the postpartum women (LACT and PPNL, 23.8 +/- 2.9% and 25.0 +/- 3.3%, respectively) did not differ but was greater (P < 0.028) than that of the NP women (17.3 +/- 1.3%). The postpartum LACT and PPNL women had a reduced urinary excretion of calcium (P < 0.01) compared with the NP women. There was a significantly greater incorporation (P < 0.001) by LACT women of the oral isotope dose into milk than into urine. Calcium FA can be determined from incorporation of stable isotopes into breast milk and serum as well as urine.

Prompting methods affect the accuracy of children's school lunch recalls

OBJECTIVES

To evaluate the feasibility of implementing 3 specific prompting methods among students in the first and fourth grades (mean age = 7.2 and 10.1 years, respectively), to validate recall accuracy of first- and fourth-grade students against observation, to develop a single measure of inaccuracy that cumulated errors in reporting food items and amounts without allowing underreporting and overreporting to cancel each other, and to establish information regarding the measure of inaccuracy for use in future studies.

DESIGN

Children were interviewed the morning after they were observed eating lunch provided by the school. Interviews included free recall, nonsuggestive prompted recall, and specific prompted recall (either preference, food category, or visual).

SUBJECTS/SETTING

Ninety-six children (48 students per grade) were studied--32 per the specific prompting method--stratified by grade, sex, and ethnicity (African-American or white). Specific prompting method was randomly assigned to children within strata.

STATISTICAL ANALYSIS

Food items were categorized and weighted as: combination entree = 2, condiments = 1/3, and other = 1. To calculate inaccuracy of recall, absolute differences between amounts reported and observed eaten were calculated for each item and then multiplied by each item's weight; these values were then summed across all items for each child. Inaccuracy of recall was determined before specific prompting and after specific prompting and for the difference (inaccuracy after specific prompting minus inaccuracy before specific prompting).

RESULTS

Before specific prompting, median inaccuracy was 2.7 servings for the 48 first-grade students and 1.7 servings for the 48 fourth-grade students. The median difference in inaccuracy from before to after specific prompting was 0 for both grades. Specific prompting increased recall accuracy for 9 first-graders and 12 fourth-graders, but decreased recall accuracy for 21 first-graders and 7 fourth-graders, and did not change recall accuracy for 18 first-graders and 29 fourth-graders. Among children whose recall accuracy increased after specific prompting, 5 first-graders and 8 fourth-graders received prompting for food category.

APPLICATIONS/CONCLUSIONS

Among first-grade students, specific prompting (either preference, food category, or visual) may hurt more than help recall accuracy. Among fourth-grade students, prompting for food category yields small gains in recall accuracy with minimal losses. Validation studies are needed with larger sample sizes to determine prompting methods that produce more accurate dietary recalls from children of various socioeconomic status groups, other racial/ethnic groups, and at other meals.

Human body composition: in vivo methods

In vivo methods used to study human body composition continue to be developed, along with more advanced reference models that utilize the information obtained with these technologies. Some methods are well established, with a strong physiological basis for their measurement, whereas others are much more indirect. This review has been structured from the methodological point of view to help the reader understand what can be examined with each technique. The associations between the various in vivo methods (densitometry, dilution, bioelectrical impedance and conductance, whole body counting, neutron activation, X-ray absorptiometry, computer tomography, and magnetic resonance imaging) and the five-level multicompartment model of body composition are described, along with the limitations and advantages of each method. This review also provides an overview of the present status of this field of research in human biology, including examples of reference body composition data for infants, children, adolescents, and adults.

Using stable isotopes to assess mineral absorption and utilization by children

Adequate mineral intake is a crucial part of a healthy diet for children-it supports appropriate growth and development and provides protection against childhood conditions like anemia and helps to prevent future adult diseases such as osteoporosis. Challenges in performing and interpreting studies in infants and children have hampered the accurate assessment of their mineral utilization. Many of the most powerful techniques used in adults, such as radioisotope testing, are not appropriate for use in children. In recent years, advanced mineral stable-isotope techniques have been developed to fill this gap. Pediatric applications include studies of calcium absorption and kinetics during puberty and evaluation of the calcium-iron interaction in infants and toddlers. The effects of genetics in determining calcium absorption and bone turnover may become an important research area. The goals and methods of ongoing mineral stable-isotope research in infants and children are examined in this report. In the past, the cost and difficulties in obtaining isotopes have limited such research. This situation has improved considerably, although relatively few nutrition research laboratories are prepared to perform sample analyses.