1
|
Li BY, Mahe JL, Hao JY, Ye WH, Bai XF, Feng HT, Szeto IMY, Jing LP, Zhao ZF, Chen YM. Formula Milk Supplementation and Bone Acquisition in 4-6 Years Chinese Children: A 12-Month Cluster-Randomized Controlled Trial. Nutrients 2023; 15:nu15082012. [PMID: 37111231 PMCID: PMC10143222 DOI: 10.3390/nu15082012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Dairy foods are crucial for adequate calcium intake in young children, but scarce data are available on the effects of formula milk on bone acquisition. This cluster-randomized controlled trial investigated the effects of the supplementation of formula milk on bone health in rural children accustomed to a low-calcium diet between September 2021 and September 2022. We recruited 196 healthy children aged 4-6 years from two kindergartens in Huining County, Northwest China. A class-based randomization was used to assign them to receive 60 g of formula milk powder containing 720 mg calcium and 4.5 µg vitamin D or 20-30 g of bread per day for 12 months, respectively. Bone mineral density (BMD) and bone mineral content (BMC) at the left forearm and calcaneus, bone biomarkers, bone-related hormones/growth factors, and body measures were determined at baseline, 6, and 12 months. A total of 174 children completed the trial and were included in the analysis. Compared with the control group, formula milk intervention showed significant extra increments in BMD (3.77% and 6.66%) and BMC (4.55% and 5.76%) at the left forearm at 6th and 12th months post-intervention (all p < 0.001), respectively. Similar trends were observed in BMD (2.83%) and BMC (2.38%) in the left calcaneus at 6 months (p < 0.05). The milk intervention (vs. control) also showed significant changes in the serum concentrations of osteocalcin level (-7.59%, p = 0.012), 25-hydroxy-vitamin-D (+5.54%, p = 0.001), parathyroid hormone concentration (-15.22%, p = 0.003), and insulin-like growth factor 1 (+8.36%, p = 0.014). The percentage increases in height were 0.34%, 0.45%, and 0.42% higher in the milk group than in the control group after 3-, 6-, and 9-month intervention, respectively (p < 0.05). In summary, formula milk supplementation enhances bone acquisition at the left forearm in young Chinese children.
Collapse
Affiliation(s)
- Bang-Yan Li
- Department of Epidemiology, School of Public Health, Sun Yet-sen University, Guangzhou 510080, China
| | - Jin-Li Mahe
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Jing-Yu Hao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Wen-Hui Ye
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Xue-Fei Bai
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Hao-Tian Feng
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Li-Peng Jing
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Zi-Fu Zhao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Yu-Ming Chen
- Department of Epidemiology, School of Public Health, Sun Yet-sen University, Guangzhou 510080, China
| |
Collapse
|
2
|
Abstract
Peak bone mass (PBM) is a key determinant of bone mass and fragility fractures later in life. The increase in bone mass during childhood and adolescence is mainly related to an increase in bone size rather to changes in volumetric bone density. Race, gender, and genetic factors are the main determinants of PBM achievement. Nevertheless, environmental factors such as physical activity, calcium and protein intakes, weight and age at menarche, are also playing an important role in bone mass accrual during growth. Therefore, optimization of calcium and protein intakes and weight-bearing physical activity during growth is an important strategy for optimal acquisition of PBM and bone strength and for contributing to prevent fractures later in life.
Collapse
Affiliation(s)
- Thierry Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
3
|
Association between calcium supplementation and bone mineral density in children: a systematic review and meta-analysis. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective
To evaluate the effects of calcium supplementation on bone mineral density in children.
Methods
The PubMed, Embase, and Cochrane library were systematically searched. The retrieve inception date was between October 2001 and October 2019. Two reviewers independently performed the data extraction and assessed methodology quality. Studies were limited to randomized clinical trials comparing calcium supplement with a placebo for bone mineral density in children. A meta-analysis was performed to calculate standard mean difference (SMD) and 95% confidence interval (CI).
Results
A total of 6 randomized controlled trials involving 408 participants (calcium supplementation group: 198; placebo group: 210) were finally included in this study. The meta-analysis revealed that, compared with placebos, calcium supplementation had no effect on the bone mineral densities [the whole-body: SMD with CI = 0.43 (−0.05–0.91), P=0.08, I
2 = 75%; the 2nd–4th lumbar vertebrae: SMD with 95% CI = 0.27 (−0.17 to 0.70), P = 0.07, I
2 = 0%)]. Sensitivity analysis revealed that the results of the whole-body bone mineral density were unstable and that the bone density of the 2nd–4th lumbar spine was robust.
Conclusions
The results of this meta-analysis suggested that calcium supplementation did not improve bone mineral density in children. However, there continues to be a need for more high-quality studies to verify this fact in the future.
Collapse
|
4
|
Obidiegwu JE, Lyons JB, Chilaka CA. The Dioscorea Genus (Yam)-An Appraisal of Nutritional and Therapeutic Potentials. Foods 2020; 9:E1304. [PMID: 32947880 PMCID: PMC7555206 DOI: 10.3390/foods9091304] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/19/2022] Open
Abstract
The quest for a food secure and safe world has led to continuous effort toward improvements of global food and health systems. While the developed countries seem to have these systems stabilized, some parts of the world still face enormous challenges. Yam (Dioscorea species) is an orphan crop, widely distributed globally; and has contributed enormously to food security especially in sub-Saharan Africa because of its role in providing nutritional benefits and income. Additionally, yam has non-nutritional components called bioactive compounds, which offer numerous health benefits ranging from prevention to treatment of degenerative diseases. Pharmaceutical application of diosgenin and dioscorin, among other compounds isolated from yam, has shown more prospects recently. Despite the benefits embedded in yam, reports on the nutritional and therapeutic potentials of yam have been fragmented and the diversity within the genus has led to much confusion. An overview of the nutritional and health importance of yam will harness the crop to meet its potential towards combating hunger and malnutrition, while improving global health. This review makes a conscious attempt to provide an overview regarding the nutritional, bioactive compositions and therapeutic potentials of yam diversity. Insights on how to increase its utilization for a greater impact are elucidated.
Collapse
Affiliation(s)
- Jude E. Obidiegwu
- National Root Crops Research Institute, Umudike, Km 8 Umuahia-Ikot Ekpene Road, P.M.B 7006 Umuahia, Abia State, Nigeria
| | - Jessica B. Lyons
- Department of Molecular and Cell Biology and Innovative Genomics Institute, University of California, Berkeley, 142 Weill Hall #3200, Berkeley, CA 94720-3200, USA;
| | - Cynthia A. Chilaka
- Institute of Pharmacology and Toxicology, Julius Maximilian University of Würzburg, Versbacher Straβe 9, 97078 Würzburg, Germany; or
| |
Collapse
|
5
|
de Sousa LFA, Paupitz JA, Aikawa NE, Takayama L, Caparbo VF, Pereira RMR. Risk factors for bone loss in juvenile-onset systemic lupus erythematosus: a prospective study. Lupus 2019; 28:1224-1232. [PMID: 31409184 DOI: 10.1177/0961203319869467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Juvenile-onset systemic lupus erythematosus (JoSLE) is associated with low bone mass for age and fractures; nevertheless, risk factors for bone impairment are poorly understood. The aim of this study was to evaluate risk factors for bone mass loss in JoSLE patients. METHODS Forty-nine female JoSLE patients were evaluated at baseline and after a 3.5-year follow-up regarding clinical, laboratory (including bone turnover markers), areal bone mineral density (aBMD) and bone microarchitecture parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT). Based on the difference between final and baseline aBMD value, the patients were divided into three groups: aBMD gain (BG), aBMD loss (BL) and aBMD no change (NC). RESULTS The mean patient age was 18.7 ± 3.3 years. Sixty-one percent of patients presented with aBMD gain, 18.4% aBMD loss, and 20.4% remained stable during this follow-up period. Comparing the BL with the BG group, there was a higher frequency of alcohol consumption (p = 0.009), a higher frequency of inadequate calcium intake (p = 0.047) and lower levels of baseline procollagen type 1 amino-terminal propeptide (P1NP) (p = 0.036) in the BL group. Moreover, worsening of HR-pQCT parameters trabecular volumetric density (p = 0.003) and cortical thickness (p = 0.009) was observed in the BL group. In addition, a higher frequency of renal activity was observed comparing the BL + NC with the BG group (p = 0.036). CONCLUSIONS This is the first longitudinal study that has analyzed the risk factors of bone loss in JoSLE patients. The authors emphasize the importance of evaluating lifestyle habits and renal disease activity in these young women. Furthermore, this study suggests that trabecular and cortical compartments deteriorated, and low levels of P1NP may be a predictor of bone impairment in JoSLE.
Collapse
Affiliation(s)
- L F A de Sousa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - J A Paupitz
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - N E Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L Takayama
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - V F Caparbo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R M R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Pecoraro L, Trotolo A, Piacentini G, Pietrobelli A. Sweet at birth, bitter in growth. Int J Food Sci Nutr 2019; 71:133-137. [PMID: 31335227 DOI: 10.1080/09637486.2019.1642859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Complementary feeding plays a primary role in the life of an infant, as long as the correct assumption of nutrients in terms of timing and quality is the key to a healthy growth. Since infants are totally dependent on their parents during complementary feeding, educational programmes and intervention plans are needed to educate parents and caregivers. As to this, children's sugar consumption throughout their life has been specifically investigated and several critical points have been detected, demonstrating how sugar intake should not be higher than necessary in children and should not include sweetened beverages in daily nutrition. The association between children's diet and the subsequent consequences in their later life has been extensively studied, pointing out how countries should invest in policies that aim at decreasing sugar intake and encouraging parents, as well as children, to a healthier behaviour. The aim of this article is to look at the problem from three different perspectives, the parents' one, the scientific one, and the paediatrician one, in order to offer a new insight on the future of complementary feeding.
Collapse
Affiliation(s)
- Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Alessandro Trotolo
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy.,Pennington Biomedical Research Center, Baton Rouge, LA, USA
| |
Collapse
|
7
|
Neela S, Fanta SW. Review on nutritional composition of orange-fleshed sweet potato and its role in management of vitamin A deficiency. Food Sci Nutr 2019; 7:1920-1945. [PMID: 31289641 PMCID: PMC6593376 DOI: 10.1002/fsn3.1063] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/13/2019] [Accepted: 04/13/2019] [Indexed: 01/09/2023] Open
Abstract
A wide variety of the roots and tubers plays a major role in human diet, animal feed, and industrial raw materials. Sweet potatoes (SPs) play an immense role in human diet and considered as second staple food in developed and underdeveloped countries. Moreover, SP production and management need low inputs compared to the other staple crops. The color of SP flesh varied from white, yellow, purple, and orange. Scientific studies reported the diversity in SP flesh color and connection with nutritional and sensory acceptability. Among all, orange-fleshed sweet potato (OFSP) has been attracting food technologists and nutritionists due to its high content of carotenoids and pleasant sensory characteristics with color. Researchers reported the encouraging health effects of OFSP intervention into the staple food currently practicing in countries such as Uganda, Mozambique, Kenya, and Nigeria. Scientific reviews on the OFSP nutritional composition and role in vitamin A management (VAM) are hardly available in the published literature. So, this review is conducted to address the detailed nutritional composition (proximate, mineral, carotenoids, vitamins, phenolic acids, and antioxidant properties), role in vitamin A deficiency (VAD) management, and different food products that can be made from OFSP.
Collapse
Affiliation(s)
- Satheesh Neela
- Faculty of Chemical and Food Engineering, Bahir Dar Institute of Technology Bahir Dar University Bahir Dar Ethiopia
| | - Solomon W Fanta
- Faculty of Chemical and Food Engineering, Bahir Dar Institute of Technology Bahir Dar University Bahir Dar Ethiopia
| |
Collapse
|
8
|
Marsh S, Jiang Y, Carter K, Wall C. Evaluation of a Free Milk in Schools Program in New Zealand: Effects on Children's Milk Consumption and Anthropometrics. THE JOURNAL OF SCHOOL HEALTH 2018; 88:596-604. [PMID: 29992602 PMCID: PMC6175117 DOI: 10.1111/josh.12649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 10/09/2017] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND While dietary sources of calcium are important for bone health, the intake of milk and milk products decreases as children get older. A free milk in schools program may mitigate this decrease in milk consumption. We evaluated the Fonterra Milk for schools program (a free milk initiative) by determining changes in children's milk consumption and anthropometric measures over a 2-year period. METHODS The evaluation was conducted in children aged 7-9 years in a representative sample of primary schools participating in the free milk program, in Auckland, New Zealand. The primary outcome was the proportion of children meeting the New Zealand guidelines for dairy and milk product consumption over 7 days (≥2 servings per day). Changes in anthropometric measures were also assessed as secondary outcomes. RESULTS Nine schools (N = 511 children) participated in the evaluation. The proportion of children meeting the New Zealand guidelines for milk and milk product consumption over 7 days increased significantly from baseline to 2 years' follow-up (72% vs 94%; p < .001). Body mass index z scores did not change significantly between baseline and 2 years' follow-up. CONCLUSIONS The Fonterra Milk for Schools initiative appears to be an effective way of increasing milk/milk product consumption behaviors in school-aged children.
Collapse
Affiliation(s)
- Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Karen Carter
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Clare Wall
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand.
| |
Collapse
|
9
|
Maíra DCDA, Letícia RP, Rodrigues da Costa L, Ferolla da Camara Boueri B, Carolina RP, D'Avila Pereira A, Cavalcante Ribeiro D, Moreira da Silva E, Soares da Costa CA, Gilson TB. Flaxseed (linum usitatissimum) flour contributes to bone health in adult male rats. Nutrition 2018; 49:48-50. [DOI: 10.1016/j.nut.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 11/17/2022]
|
10
|
Bone mineral density in anorexia nervosa: Only weight and menses recovery? ACTA ACUST UNITED AC 2016; 63:458-465. [DOI: 10.1016/j.endonu.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/18/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022]
|
11
|
Fina BL, Brun LR, Rigalli A. Increase of calcium and reduction of lactose concentration in milk by treatment with kefir grains and eggshell. Int J Food Sci Nutr 2016; 67:133-40. [DOI: 10.3109/09637486.2015.1137888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Brenda L. Fina
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Argentina
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Lucas R. Brun
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Argentina
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Alfredo Rigalli
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Argentina
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
- Rosario National University Research Council, Rosario, Argentina
| |
Collapse
|
12
|
Pampaloni B, Cianferotti L, Gronchi G, Bartolini E, Fabbri S, Tanini A, Brandi ML. Growing Strong and Healthy with Mister Bone: An Educational Program to Have Strong Bones Later in Life. Nutrients 2015; 7:9985-98. [PMID: 26633485 PMCID: PMC4690062 DOI: 10.3390/nu7125510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/03/2023] Open
Abstract
Optimal peak bone mass and bone health later in life are favored by a sufficient calcium intake in infancy, childhood and adolescence. The purpose of this study was to test a new educational program created to monitor and to improve calcium and vitamin D intake in children. Nutritional habits in children were evaluated through a food frequency questionnaire (FFQ) to assess the intake of calcium, vitamin D, dairy products, and total caloric energy at baseline and after seven months of exposure to a unique educational program applied between November 2013 and May 2014 in 176 schoolchildren (48% male, 52% female) attending the fourth and fifth grades of two selected primary schools in Florence, Italy. A significant increase of calcium (from 870 ± 190 to 1100 ± 200 mg/day, p < 0.05), and vitamin D (from 3.6 ± 1.53 to 4.1 ± 2 µg/day) intake in children was documented after the educational program. The amount of specific foods important for bone health consumed, such as milk and vegetables, increased significantly, both in male and female children (p < 0.05). The proposed educational program appears to be effective in modifying calcium intake in children, with a significant increase in the consumption of dairy products and vegetables, but without a significant change in the total caloric intake.
Collapse
Affiliation(s)
- Barbara Pampaloni
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Giorgio Gronchi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Elisa Bartolini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Sergio Fabbri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Annalisa Tanini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| |
Collapse
|
13
|
Lappe JM, Watson P, Gilsanz V, Hangartner T, Kalkwarf HJ, Oberfield S, Shepherd J, Winer KK, Zemel B. The longitudinal effects of physical activity and dietary calcium on bone mass accrual across stages of pubertal development. J Bone Miner Res 2015; 30:156-64. [PMID: 25130421 PMCID: PMC4280289 DOI: 10.1002/jbmr.2319] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022]
Abstract
Childhood and adolescence are critical periods of bone mineral content (BMC) accrual that may have long-term consequences for osteoporosis in adulthood. Adequate dietary calcium intake and weight-bearing physical activity are important for maximizing BMC accrual. However, the relative effects of physical activity and dietary calcium on BMC accrual throughout the continuum of pubertal development in childhood remains unclear. The purpose of this study was to determine the effects of self-reported dietary calcium intake and weight-bearing physical activity on bone mass accrual across the five stages of pubertal development in a large, diverse cohort of US children and adolescents. The Bone Mineral Density in Childhood study was a mixed longitudinal study with 7393 observations on 1743 subjects. Annually, we measured BMC by dual-energy X-ray absorptiometry (DXA), physical activity and calcium intake by questionnaire, and pubertal development (Tanner stage) by examination for up to 7 years. Mixed-effects regression models were used to assess physical activity and calcium intake effects on BMC accrual at each Tanner stage. We found that self-reported weight-bearing physical activity contributed to significantly greater BMC accrual in both sexes and racial subgroups (black and nonblack). In nonblack males, the magnitude of the activity effect on total body BMC accrual varied among Tanner stages after adjustment for calcium intake; the greatest difference between high- and low-activity boys was in Tanner stage 3. Calcium intake had a significant effect on bone accrual only in nonblack girls. This effect was not significantly different among Tanner stages. Our findings do not support differential effects of physical activity or calcium intake on bone mass accrual according to maturational stage. The study demonstrated significant longitudinal effects of weight-bearing physical activity on bone mass accrual through all stages of pubertal development.
Collapse
|
14
|
Bone Mineral Density in Children From Anthropological and Clinical Sciences: A Review. ANTHROPOLOGICAL REVIEW 2014. [DOI: 10.2478/anre-2014-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Bone mineral density (BMD) is a frequent topic of discussion in the clinical literature in relation to the bone health of both adults and children. However, in archaeological and/ or anthropological studies the role of BMD is often cited as a possible factor in the poor skeletal preservation which can lead to an under-representation of juvenile skeletal remains. During skeletal development and growth throughout childhood and adolescence changes take place in both the size and shape of bones and these changes also result in the increasing of mineral content. BMD can be affected by many factors, which include, age, genetics, sexual maturation, amount of physical activity and dietary calcium. This paper aims to review the clinical and anthropological literature on BMD and discuss the numerous methods of measurement and how the availability of certain methods such as Dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) can influence the study of bone density in archaeological skeletal collections and also the future potential for forensic anthropological studies.
Collapse
|
15
|
Reza SM, Rasool H, Mansour S, Abdollah H. Effects of calcium and training on the development of bone density in children with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4304-4309. [PMID: 24157403 DOI: 10.1016/j.ridd.2013.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/24/2013] [Accepted: 08/26/2013] [Indexed: 06/02/2023]
Abstract
In this study we examined the effects of physical training and calcium intake on the development of bone mineral density (BMD) in children with Down syndrome (DS). A total of 48 children with DS (age 7-12 years old) matched for age and BMD were assigned to four groups exercise and calcium intake (Ex(+)Ca(+)), calcium intake-no-exercise (Ex(-)Ca(+)), exercise no-calcium intake (Ex(+)Ca(-)) and non-exercise-no-calcium intake (Ex(-)Ca(-)). The training protocol included 45 min of weight bearing exercise performed 3 sessions per week in addition to dietary calcium rich food intake of enriched cow milk with vitamin D containing 200 mg calcium per serving or no enriched dietary supplement for a duration of 4 months. Data analysis was performed on data by using t-test, one-way ANOVA analysis and Tukey post hoc tests to determine the main and combined effects of training and calcium regiment on BMD. All groups showed greater femoral neck BMD after 4 months. The increase in femoral neck BMD in the Ex(+)Ca(+) group was 5.96% greater than the Ex(+)Ca(-) group (p<0.01). The effect of training was greater than calcium intake alone. The Ex(+)Ca(-) group achieved 3.52% greater BMD than Ex(-)Ca(+) group (p<0.01). In this study, all the experimental groups had greater BMD than the no-calcium-no-exercise group that served as the control group (p<0.01). It was concluded that additional weight bearing exercise and calcium supplementation resulted in a greater increase in BMD in children with DS.
Collapse
|
16
|
Pampaloni B, Bartolini E, Barbieri M, Piscitelli P, Di Tanna GL, Giolli L, Brandi ML. Validation of a food-frequency questionnaire for the assessment of calcium intake in schoolchildren aged 9-10 years. Calcif Tissue Int 2013; 93:23-38. [PMID: 23543130 DOI: 10.1007/s00223-013-9721-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
Bone mass increases steadily until age 20-30 years, when peak bone mass (PBM) is acquired. Nutrition plays a critical role in achievement of the optimal genetically programmed PBM, with reduction in the risk of osteoporosis later in life. Intake of nutrients can be estimated through the use of various tools; typically, food-frequency questionnaires (FFQs) are used in epidemiologic studies. The aim of this study was to validate a 21-item, semiquantitative FFQ to assess important nutrient intakes for bone health in Italian schoolchildren 9-10 years of age. Relative validation was accomplished through comparison of the 7-days weighed food record (7D records) with an FFQ developed ad hoc, completed by a group of 75 Italian schoolchildren (36 females, 39 males). Agreement between the two methods was evaluated by Spearman's correlation test and Bland-Altman analysis applied on the data on intake of energy, macronutrients, and micronutrients. Particular attention was devoted to nutrients relevant for bone health. Good correlations between the two methods (FFQ and 7D records) were observed for all nutrients. In particular, mean dietary calcium intakes were 725.6 mg/day (95 % CI 683.2-768.1) from 7D records and 892.4 mg/day (95 % CI 844.6-940.2) from the FFQ. These results indicate that our FFQ for schoolchildren aged 9-10 years is highly acceptable as it is an accurate method that can be used in large-scale or epidemiological studies for the evaluation of nutrient intakes important for the prevention of osteoporosis in a similar population.
Collapse
Affiliation(s)
- B Pampaloni
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
17
|
Uusi-Rasi K, Kärkkäinen MUM, Lamberg-Allardt CJE. Calcium intake in health maintenance - a systematic review. Food Nutr Res 2013; 57:21082. [PMID: 23687486 PMCID: PMC3657072 DOI: 10.3402/fnr.v57i0.21082] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/21/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022] Open
Abstract
Background Calcium (Ca) is an essential nutrient for the human body. Despite lively research, there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases. Objectives The aim was to conduct a review to update requirements and desirable or harmful health effects of Ca on the current scientific evidence. Methods We searched Medline and Swemed from January 2000 to December 2011 and included all systematic reviews that reported Ca supplementation or usual Ca intake on health outcomes. Meta-analyses, randomized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011. This review concentrated on studies reporting independent effects of Ca, although a few recent trials report sole effects of Ca on health outcomes, most trials use Ca in combination with vitamin D vs. placebo. Results In total, we reviewed 38 studies addressing the effects of Ca on bone, pregnancy-related outcomes, cancers, cardiovascular outcomes, obesity, and mortality. There was a lot of heterogeneity in the study protocols, which made it difficult to draw any strong conclusions. According to the literature, high Ca intake seems to have a small positive effect on bone mineral content (BMC) or bone mineral density (BMD) in children and postmenopausal women. We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men. Also, the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent. Maternal diet may influence the peak bone mass of offspring but more studies are required. There was no overall effect of Ca intake on cancers. Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies. No associations were found with other cancers. We found no consistent association between cardiovascular outcomes and Ca intake except for blood pressure. A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation. Reviewed studies did not show consistent evidence relating Ca intake to either mortality or obesity. Conclusion Based on this evidence, there is no need to change the Nordic recommendations for Ca intake. However, due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement.
Collapse
|
18
|
Arab Ameri E, Dehkhoda MR, Hemayattalab R. Bone mineral density changes after physical training and calcium intake in students with attention deficit and hyper activity disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:594-599. [PMID: 22155532 DOI: 10.1016/j.ridd.2011.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 10/21/2011] [Indexed: 05/31/2023]
Abstract
In this study we investigate the effects of weight bearing exercise and calcium intake on bone mineral density (BMD) of students with attention deficit and hyper activity (ADHD) disorder. For this reason 54 male students with ADHD (age 8-12 years old) were assigned to four groups with no differences in age, BMD, calcium intake, and physical activity: exercise groups with or without calcium supplementation (Ex+Ca+ and Ex+Ca-) and non-exercise groups with or without calcium supplementation (Ex-Ca+ and Ex-Ca-). The intervention involved 50 min of weight bearing exercise performed 3 sessions a week and/or the addition of dietary calcium rich food using enriched cow milk with vitamin D containing 250 mg calcium per serving, over 9 months. Paired-samples t-test, one way ANOVA analysis, and Tukey tests were used to determine the main and combined effects of training and calcium on BMD. All groups showed greater femoral neck BMD after 9 months. The increase in femoral neck BMD was significantly different between all groups (p < 0.05). Ex+Ca+ group has greater increase in BMD than other groups. Apparently, the effect of training was greater than calcium intake (p < 0.05). These results help to provide more evidence for public health organizations to deal with both exercise and nutrition issues in children with ADHD disorder for the achievement of peak BMD.
Collapse
Affiliation(s)
- Elahe Arab Ameri
- Department of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | | | | |
Collapse
|
19
|
Abstract
UNLABELLED The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. OBJECTIVE To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. METHODS Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. RESULTS Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB.
Collapse
Affiliation(s)
- Humberto Filipe Marreiros
- Correspondence to: Humberto Filipe Marreiros, Hospital Dona Estafania, Rua Jacinta Marto, 1169-045 Lisboa, Estremadura 1500-540, Portugal.
| | | | | | | |
Collapse
|
20
|
Female reproductive system and bone. Arch Biochem Biophys 2010; 503:118-28. [PMID: 20637179 DOI: 10.1016/j.abb.2010.07.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 07/03/2010] [Accepted: 07/09/2010] [Indexed: 12/20/2022]
Abstract
The female reproductive system plays a major role in regulating the acquisition and loss of bone by the skeleton from menarche through senescence. Onset of gonadal sex steroid secretion at puberty is the major factor responsible for skeletal longitudinal and radial growth, as well as significant gain in bone density, until peak bone density is achieved in third decade of life. Gonadal sex steroids then help maintain peak bone density until menopause, including during the transient changes in skeletal mineral content associated with pregnancy and lactation. At menopause, decreased gonadal sex steroid production normally leads to rapid bone loss. The most rapid bone loss associated with decreased estrogen levels occurs in the first 8-10 years after menopause, with slower age-related bone loss occurring during later life. Age-related bone loss in women after the early menopausal phase of bone loss is caused by ongoing gonadal sex steroid deficiency, vitamin D deficiency, and secondary hyperparathyroidism. Other factors also contribute to age-related bone loss, including intrinsic defects in osteoblast function, impairment of the GH/IGF axis, reduced peak bone mass, age-associated sarcopenia, and various sporadic secondary causes. Further understanding of the relative contributions of the female reproductive system and each of the other factors to development and maintenance of the female skeleton, bone loss, and fracture risk will lead to improved approaches for prevention and treatment of osteoporosis.
Collapse
|
21
|
Association between lifestyle habits and bone mineral density in Japanese juveniles. Environ Health Prev Med 2010; 15:222-8. [PMID: 21432549 DOI: 10.1007/s12199-009-0131-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/25/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES We explored the relationship between bone mineral density (BMD) and lifestyle in juveniles to identify factors leading to higher peak bone mass and prevention of osteoporosis in later life. METHODS Juveniles (1,364 students: 770 boys and 594 girls, aged 6-18 years) attending school in Hokkaido prefecture, Japan, were asked to complete a brief self-administered diet history questionnaire for 10-year-olds (BDHQ10y) providing information about personal history, lifestyle, and intake of nutritional elements. In addition, BMD and grip strength were measured. We analyzed the relationship between BMD and lifestyle factors. RESULTS The difference in BMD for boys was larger among the junior and senior high school groups. The difference in BMD for girls was larger among older elementary and later school children. Anthropometric variables and grip strength were strongly correlated with BMD. Having a nap-time routine was significantly correlated with BMD, but sleep time and sports club activities were not. BMD among juveniles who attained secondary sexual characteristics was significantly higher than that of juveniles of the same age who had not attained these characteristics. Calcium intake was significantly lower in senior high school students compared with other grades. Consumption of milk by senior high school boys and junior high school girls was weakly correlated with BMD. CONCLUSIONS Our findings encourage educational interventions to counsel students to avoid weight loss and calcium deficiency. This effective intervention should begin before the higher elementary school, when juveniles have the greatest likelihood for preventing lower peak bone mass and osteoporosis.
Collapse
|
22
|
Budek AZ, Mark T, Michaelsen KF, Mølgaard C. Tracking of size-adjusted bone mineral content and bone area in boys and girls from 10 to 17 years of age. Osteoporos Int 2010; 21:179-82. [PMID: 19387763 DOI: 10.1007/s00198-009-0932-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Positive correlations for bone mineral content (BMC) between 10 and 17 years of age were found for boys and girls after adjusting for body size, puberty, and diet. This tracking of BMC indicated that osteoporosis prevention should begin already in prepuberty. INTRODUCTION Previous studies indicate that BMC is tracking during growth, but it remains unclear whether this would remain significant after adjusting for important confounders. We tested the hypothesis that BMC and bone area (BA) track from 10 to 17 years of age, independently of body size, pubertal stage, and dietary intake of energy, calcium and protein. METHODS A longitudinal study where whole body (T) and lumbar spine (LS) BMC and BA (dual-energy X-ray absorptiometry) and dietary intake (7-day food records) were assessed at 10 and 17 years of age in boys and girls (n = 91). Tracking of bone variables from 10 to 17 years was estimated by Pearson's correlations adjusted for the selected confounders. RESULTS The unadjusted correlations for T-BMC between 10 and 17 years, likewise for LS-BMC and T-BA, were positive for both sexes (0.51-0.81; P < 0.0001) and remained significant after correcting for the selected confounders. The unadjusted correlations for LS-BA between 10 and 17 years were significant only for girls (0.29; P < 0.05), but not after further corrections. CONCLUSIONS Bone mass tracks from 10 to 17 years of age in boys and girls, especially after accounting for important confounders, indicating that osteoporosis prevention should begin in early stages of bone development.
Collapse
Affiliation(s)
- A Z Budek
- Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | | | | | | |
Collapse
|
23
|
Abstract
Life expectancy for the 400 000 adults with cerebral palsy (CP) in the USA is increasing. Although there is a perception of increased fractured rate in the adult with CP, it has not been well studied. Low bone mineral density is found in more than 50% of adults with a variety of disabilities, including CP. Dual-energy X-ray absorptiometry scanning is commonly used to assess bone mineral density, but is limited by positioning and other artifacts in adults with CP. Novel scanning regions of interest, such as the distal femur, are not yet standardized in adults. Nutritional assessment and physical activity, the basis of most fracture prevention programs, are difficult to do in the adult with CP. A better understanding of the 'muscle-bone unit' physiology and its exploitation may lead to better treatment modifications. Clinical research trials with bisphosphonates (e.g. pamidronate), estrogen, selective estrogen receptor modulators, parathyroid hormone analogs, and growth hormone need to be targeted to the adult with CP. Longitudinal studies of fracture risk factors, genetic research in bone and neuromuscular biology, and the development of treatment surrogates for physical activity are additional areas of needed expertise. This could be facilitated by an adult CP registry and the centralization of clinical research efforts.
Collapse
Affiliation(s)
- Kevin J Sheridan
- Department of Pediatrics, Gillette Children's Specialty Care, Saint Paul, MN 55101, USA.
| |
Collapse
|
24
|
Keller KL, Kirzner J, Pietrobelli A, St-Onge MP, Faith MS. Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3- to 7-year-old children at multi-item laboratory lunches. ACTA ACUST UNITED AC 2009; 109:497-501. [PMID: 19248869 DOI: 10.1016/j.jada.2008.11.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 07/25/2008] [Indexed: 11/16/2022]
Abstract
Dietary survey data show that intake of sugar-sweetened beverages is negatively associated with intake of milk, but these findings have yet to be confirmed by laboratory feeding studies. The objectives of the present study were to analyze children's intake across two laboratory-based ad libitum lunches to (a) investigate the relationships between intake of sweetened beverages, milk, and calcium, and (b) explore relationships between beverage consumption and child age and weight status. Data were extracted from a cohort of 126 3- to 7-year-old twins from diverse ethnic backgrounds who participated in a cross-sectional study (conducted from November 1999 to September 2002) designed to determine the genetic and environmental contributions to eating and body weight. At two visits, children ate ad libitum from lunches that offered a variety of sugar-sweetened and calcium-rich beverages. Total beverage and nutrient intakes were computed from the test meals. Weight, height, and waist circumference were assessed on the final visit. Regression analyses tested the associations among intake of sweetened beverages, calcium, and milk (primary aim), and whether these variables were associated with child age and weight status (secondary aim). Sweetened beverage intake was negatively correlated with both milk (P<0.01) and calcium (P<0.01) intakes, and these relationships remained after controlling for age, sex, and ethnicity (P<0.01). Child age was negatively associated with milk intake (r=-0.22, P<0.01) but positively associated with intake of sweetened beverages (r=0.27, P<0.01). Results support the notion that sugar-sweetened beverages displace milk in a single meal, and this phenomenon may vary with child age. Due to the cross-sectional nature of this study, future investigations are needed to determine the long-term implications of this consumption pattern. The possibility that limiting sweetened beverages may help optimize dietary calcium during childhood is a topic that merits further research.
Collapse
Affiliation(s)
- Kathleen L Keller
- New York Obesity Research Center, St Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, 1090 Amsterdam Ave, 14A, New York, NY 10025, USA.
| | | | | | | | | |
Collapse
|
25
|
Evaluation of the Mediterranean Diet Quality Index (KIDMED) in children and adolescents in Southern Spain. Public Health Nutr 2008; 12:1408-12. [PMID: 19087384 DOI: 10.1017/s1368980008004126] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The Mediterranean diet is considered one of the healthiest dietary models. Recent changes in the actual Mediterranean diet include a reduction in energy intake and a higher consumption of foods with low nutrient density (e.g. soft drinks, candy, sweets, etc.). In Spain, in association with cultural and lifestyle changes, there has been a reduction in the intake of antioxidants and vitamins, an increase in the proportion of SFA and a decrease in the consumption of fibre, among other changes. Children and adolescents may be the age groups with the most deteriorated Mediterranean diet. The current paper presents the results of applying the Mediterranean Diet Quality Index for children and adolescents (KIDMED) to a large sample of Spanish schoolchildren. DESIGN Data from questionnaires were used to calculate the KIDMED index. SETTING Granada, Southern Spain. SUBJECTS Schoolchildren (n 3190) aged 8-16 years. RESULTS Among the 8-10-year-olds, the KIDMED index classification was 'good' in 48.6% of the population, 'average' in 49.5% and 'poor' in 1.6%. Among the 10-16-year-olds, the KIDMED index classification was good in 46.9% of the population, average in 51.1% and poor in 2.0%. CONCLUSIONS The nutritional behaviour of the present population of schoolchildren is similar to that found in the earlier KIDMED study.
Collapse
|
26
|
Moore LL, Bradlee ML, Gao D, Singer MR. Effects of average childhood dairy intake on adolescent bone health. J Pediatr 2008; 153:667-73. [PMID: 18701115 PMCID: PMC4135716 DOI: 10.1016/j.jpeds.2008.05.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 03/28/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effects of usual childhood dairy intake on adolescent bone health. STUDY DESIGN Dietary data collected in the Framingham Children's Study over 12 years were used to evaluate usual dairy consumption and adolescent bone health. Each child's average Food Pyramid servings were estimated from yearly sets of 3-day diet records. Bone mineral content (BMC) and area (BA) for total body and 6 regions (arms, legs, trunk, ribs, pelvis, and spine) at ages 15 to 17 years were the primary outcomes. Analysis of covariance was used to adjust for potential confounding by sex and physical activity, as well as age, height, body mass index and percent body fat at the time of the bone scan. RESULTS Consuming >or= 2 servings/day of dairy (versus less) was associated with significantly higher mean BMC and BA. Higher intakes of meats/other proteins (>or= 4 servings per/day) were also associated with higher mean BMC and BA values. Children with higher intakes of both dairy and meats/other proteins had the highest adjusted BMC (3090.1 g), and children consuming less of each had the lowest BMC (2740.2 g). CONCLUSIONS These prospective data provide evidence for a beneficial effect of childhood dairy consumption on adolescent bone health.
Collapse
Affiliation(s)
- Lynn L. Moore
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, Boston, MA 02118
| | - M. Loring Bradlee
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, Boston, MA 02118
| | - Di Gao
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, Boston, MA 02118
| | - Martha R. Singer
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, Boston, MA 02118
| |
Collapse
|
27
|
Calcium and bone growth ‐ Scientific substantiation of a health claim related to calcium and bone growth pursuant to Article 14 of Regulation (EC) No 1924/2006 ‐ Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies. EFSA J 2008. [DOI: 10.2903/j.efsa.2008.826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
28
|
Jayasinghe Y, Grover SR, Zacharin M. Current concepts in bone and reproductive health in adolescents with anorexia nervosa. BJOG 2008; 115:304-15. [PMID: 18190366 DOI: 10.1111/j.1471-0528.2007.01601.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.
Collapse
Affiliation(s)
- Y Jayasinghe
- Department of Gynaecology Royal Children's Hospital, Melbourne, Victoria, Australia.
| | | | | |
Collapse
|
29
|
Vicente-Rodríguez G, Ezquerra J, Mesana MI, Fernández-Alvira JM, Rey-López JP, Casajus JA, Moreno LA. Independent and combined effect of nutrition and exercise on bone mass development. J Bone Miner Metab 2008; 26:416-24. [PMID: 18758899 DOI: 10.1007/s00774-007-0846-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 12/14/2007] [Indexed: 01/19/2023]
Abstract
Food intake provides the necessary components for adequate metabolic functions in bone. Calcium, phosphorus, vitamin D, magnesium, proteins, and fluoride are some of the most important nutrients in this regard. These have different effects on bone mass. Additionally, exercise has been shown to elicit osteogenic responses in bone development; indeed, it seems to potentiate, for example, the effect of calcium supplementation on bone mass. However, the nutrition-exercise-bone mass relationship is complex and needs further in-depth investigation. As a first step, therefore, we reviewed current knowledge about the role of nutrition on the development of bone tissue and how physical activity affects the nutrient-bone relationship.
Collapse
Affiliation(s)
- Germán Vicente-Rodríguez
- University School of Health Science and Pediatrics Department, HELENA Study Group, University of Zaragoza, C/Corona de Aragón 42, Zaragoza, Spain.
| | | | | | | | | | | | | |
Collapse
|
30
|
Prais D, Diamond G, Kattan A, Salzberg J, Inbar D. The effect of calcium intake and physical activity on bone quantitative ultrasound measurements in children: a pilot study. J Bone Miner Metab 2008; 26:248-53. [PMID: 18470665 DOI: 10.1007/s00774-007-0814-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 08/27/2007] [Indexed: 01/13/2023]
Abstract
Environmental factors, such as nutritional status, physical activity, and drug therapy, can affect bone mineralization. Our objective was to evaluate the relationship between nutritional status, physical activity, and bone mineralization as assessed by multisite quantitative ultrasound technology in children. The study group comprised 67 children, aged 6-17 years (mean, 9.4), attending a primary care clinic. Data on calcium intake and physical activity were collected using a detailed questionnaire. Speed of sound measurements were performed at the distal 1/3 radius and the midshaft tibia using Sunlight Omnisense apparatus. The reported mean calcium intake was 1105 mg/day. There was a significant difference in Z-scores at the radius and tibia between the low-and high-calcium-intake groups (P = 0.004, P = 0.035, respectively). A similar difference was found between the low-and normal-physical-activity groups (P = 0.015, P = 0.036, respectively). In this pilot study, a positive association was found between calcium intake, physical activity, and bone status, as assessed by the quantitative ultrasound technique.
Collapse
Affiliation(s)
- Dario Prais
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Israel.
| | | | | | | | | |
Collapse
|
31
|
Chevalley T, Bonjour JP, Ferrari S, Rizzoli R. High-protein intake enhances the positive impact of physical activity on BMC in prepubertal boys. J Bone Miner Res 2008; 23:131-42. [PMID: 17892378 DOI: 10.1359/jbmr.070907] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED In 232 healthy prepubertal boys, increased physical activity was associated with greater BMC at both axial and appendicular sites under high-protein intake. INTRODUCTION Physical activity is an important lifestyle determinant of bone mineral mass acquisition. Its impact during childhood can be modulated by nutrition, particularly by protein and calcium intakes. We analyzed the relationship between physical activity levels and protein compared with calcium intake on BMC. MATERIALS AND METHODS In 232 healthy prepubertal boys (age: 7.4 +/- 0.4 [SD] yr; standing height: 125.7 +/- 5.9 cm; body weight: 25.3 +/- 4.6 kg), physical activity and protein and calcium intakes were recorded. BMC was measured by DXA at the radial metaphysis, radial diaphysis, total radius, femoral neck, total hip, femoral diaphysis, and L(2)-L(4) vertebrae. RESULTS In univariate analysis, the correlation coefficients r with BMC of the various skeletal sites were as follows: physical activity, from 0.26 (p = 0.0001) to 0.40 (p = 0.0001); protein intake, from 0.18 (p = 0.005) to 0.27 (p = 0.0001); calcium intake, from 0.09 (p = 0.181) to 0.17 (p = 0.007). By multiple regression analysis, the beta-adjusted values remained correlated with BMC, ranging as follows: physical activity, from 0.219 (p = 0.0007) to 0.340 (p < 0.0001); protein intake, from 0.120 (p = 0.146) to 0.217 (p = 0.009). In contrast, it was not correlated for calcium intake: from -0.069 (p = 0.410) to 0.001 (p = 0.986). With protein intake (mean = 2.0 g/kg body weight/d) above the median, increased physical activity from 168 to 321 kcal/d was associated with greater mean BMC Z-score (+0.6, p = 0.0005). In contrast with protein intake (mean = 1.5 g/kg body weight/d) below the median, increased physical activity from 167 to 312 kcal/d was not associated with a significantly greater mean BMC Z-score (+0.2, p = 0.371). The interaction between physical activity and protein intake was close to statistical significance for mean BMC Z-score (p = 0.055) and significant for femoral neck BMC (p = 0.012). In keeping with the results derived from multiple regression analysis, the increased physical activity on mean BMC Z-score was not influenced by difference in calcium intake above (mean = 945 mg/d) and below (mean = 555 mg/d) the median. CONCLUSION In healthy prepubertal boys, the impact in increased physical activity on BMC seems to be enhanced by protein intake within limits above the usual recommended allowance.
Collapse
Affiliation(s)
- Thierry Chevalley
- Division of Bone Diseases [WHO Collaborating Centre for Osteoporosis Prevention], Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
| | | | | | | |
Collapse
|
32
|
Effect of calcium and vitamin D supplementation on bone mineral density in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2007; 45:538-45. [PMID: 18030230 DOI: 10.1097/mpg.0b013e3180dca0cc] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of calcium and vitamin D2 supplementation on bone mineral density (BMD) in children with inflammatory bowel disease (IBD). PATIENTS AND METHODS This was an open-label, prospective study conducted over a 12-month period. Seventy-two patients were divided into 2 groups based on lumbar spine areal BMD (L2-4 aBMD). Patients with an L2-4 aBMD z score of -1 or higher were assigned to the control group (n = 33; mean age, 11.0 +/- 3.5 years; 20 boys). Patients with an L2-4 aBMD of less than -1 (n = 39; mean age 11.8 +/- 2.5 years; 25 boys) were allocated to the intervention group and received 1000 mg of supplemental elemental calcium daily for 12 months (n = 19) or supplemental calcium for 12 months and 50,000 IU of vitamin D2 monthly for 6 months (n = 20). RESULTS The 2 groups differed in L2-4 aBMD z scores (intervention, -1.9 +/- 0.6; control, -0.2 +/- 0.6; P < 0.001) and volumetric L2-4 BMD (vBMD; intervention, 0.29 +/- 0.04; control, 0.33 +/- 0.06; P < 0.001). After 1 year of therapy, the control and intervention groups had similar changes in height z scores, L2-4 aBMD, L2-4 vBMD (z score change, L2-4 aBMD: control 0.2 +/- 0.6 [n = 21], intervention 0.4 +/- 0.6; P = 0.4 [n = 26]; z score change, L2-4 vBMD: control 0.1 +/- 0.4, intervention 0.2 +/- 0.6; P = 0.74). The changes in these parameters were similar between patients who had received calcium only or calcium plus vitamin D. CONCLUSIONS These results suggest that, in children with IBD, supplementation of calcium and vitamin D does not accelerate accrual in L2-4 BMD.
Collapse
|
33
|
Abstract
OBJECTIVE To review current consensus and controversy surrounding the diagnosis and treatment of osteoporosis in childhood and adolescence. METHODS The medical literature was reviewed with emphasis on the importance of early skeletal health, risk factors for bone fragility, and the diagnosis and management of children at risk for osteoporosis. RESULTS Childhood and adolescence are critical periods for optimizing bone growth and mineral accrual. Bone strength is determined by bone size, geometry, quality, and mass-variables that are influenced by genetic factors, activity, nutrition, and hormones. For children with genetic skeletal disorders or chronic disease, bone growth and mineral accrual may be compromised, increasing the lifetime risk of osteoporosis. The goal for the clinician is to identify children at greatest risk for future fragility fracture. Bone densitometry and turnover markers are challenging to interpret in children. Prevention and treatment of bone fragility in children are less well established than in adults. Optimizing nutrition and activity may not restore bone health, but the drug armamentarium is limited. Sex steroid replacement has not proven effective in restoring bone mass in patients with anorexia nervosa or exercise-associated amenorrhea. Bisphosphonates can increase bone mass and may reduce bone pain and fractures, most convincingly in patients with osteogenesis imperfecta. Further studies are needed to establish the safety, efficacy, and optimal drug, duration, and dosage in pediatric patients. CONCLUSION Bone health during the first 2 decades contributes to the lifetime risk of osteoporosis. Further research is needed to develop evidence-based recommendations for the diagnosis and treatment of osteoporosis in childhood.
Collapse
Affiliation(s)
- Laura Keyes Bachrach
- The Department of Pediatrics, Stanford University School of Medicine, Stanford, California 94035-5208, USA
| |
Collapse
|
34
|
|
35
|
Winzenberg T, Shaw K, Fryer J, Jones G. Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 2006; 333:775. [PMID: 16980314 PMCID: PMC1602024 DOI: 10.1136/bmj.38950.561400.55] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effectiveness of calcium supplementation for improving bone mineral density in healthy children and to determine if any effect is modified by other factors and persists after supplementation stops. DESIGN Meta-analysis. DATA SOURCES Electronic bibliographic databases, hand searching of conference proceedings, and contacting authors for unpublished data. REVIEW METHODS We included randomised placebo controlled trials of calcium supplementation in healthy children that lasted at least three months and had bone outcomes measured after at least six months of follow-up. Two reviewers independently extracted data and assessed quality. Meta-analyses predominantly used fixed effects models with outcomes given as standardised mean differences. RESULTS We included 19 studies involving 2859 children. Calcium supplementation had no effect on bone mineral density at the femoral neck or lumbar spine. There was a small effect on total body bone mineral content (standardised mean difference 0.14, 95% confidence interval 0.01 to 0.27) and upper limb bone mineral density (0.14, 0.04 to 0.24). This effect persisted after the end of supplementation only at the upper limb (0.14, 0.01 to 0.28). There was no evidence that sex, baseline calcium intake, pubertal stage, ethnicity, or level of physical activity modified the effect. CONCLUSIONS The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance.
Collapse
Affiliation(s)
- Tania Winzenberg
- Menzies Research Institute, Private Bag 23, Hobart, Tas 7001, Australia.
| | | | | | | |
Collapse
|
36
|
Borges JLC, Brandão CMA. Low bone mass in children and adolescents. ACTA ACUST UNITED AC 2006; 50:775-82. [PMID: 17117302 DOI: 10.1590/s0004-27302006000400022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 05/20/2006] [Indexed: 11/22/2022]
Abstract
Osteoporosis is a disease characterized by low bone mass and micro architectural alterations of bone tissue leading to enhanced bone fragility and increased fracture risk. Although research in osteoporosis has focused mainly on the role of bone loss in the elderly population, it is becoming increasingly clear that the amount of bone that is gained during growth is also an important determinant of future resistance to fractures. Thus, considerable interest is being placed on defining preventive strategies that optimize the gain of bone mass during childhood and adolescence. Knowledge of the determinants accounting for the physiologic and genetic variations in bone accumulation in children will provide the best means toward the early diagnosis and treatment of osteoporosis. This article reviews the techniques available for bone mass measurements in children and the major determinants and diseases influencing bone accretion during childhood and adolescence.
Collapse
|
37
|
Winzenberg TM, Shaw K, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2006; 2006:CD005119. [PMID: 16625624 PMCID: PMC8865374 DOI: 10.1002/14651858.cd005119.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinical trials have shown that calcium supplementation in children can increase bone mineral density (BMD) although this effect may not be maintained. There has been no quantitative systematic review of this intervention. OBJECTIVES . To determine the effectiveness of calcium supplementation for improving BMD in children. . To determine if any effect varies by sex, pubertal stage, ethnicity or level of physical activity, and if any effect persists after supplementation is ceased. SEARCH STRATEGY We searched CENTRAL, (Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to 1 April 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (1945 to 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005) and Human Nutrition (1982 to 1 April 2005). Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research) were hand-searched. SELECTION CRITERIA Randomised controlled trials of calcium supplementation (including by food sources) compared with placebo, with a treatment period of at least 3 months in children without co-existent medical conditions affecting bone metabolism. Outcomes had to include areal or volumetric BMD, bone mineral content (BMC), or in the case of studies using quantitative ultrasound, broadband ultrasound attenuation and ultrasonic speed of sound, measured after at least 6 months of follow-up. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data including adverse events. We contacted study authors for additional information. MAIN RESULTS The 19 trials included 2859 participants, of which 1367 were randomised to supplementation and 1426 to placebo. There was no heterogeneity in the results of the main effects analyses to suggest that the studies were not comparable. There was no effect of calcium supplementation on femoral neck or lumbar spine BMD. There was a small effect on total body BMC (standardised mean difference (SMD) +0.14, 95% CI+0.01, +0.27) and upper limb BMD (SMD +0.14, 95%CI +0.04, +0.24). Only the effect in the upper limb persisted after supplementation ceased (SMD+0.14, 95%CI+0.01, +0.28). This effect is approximately equivalent to a 1.7% greater increase in supplemented groups, which at best would reduce absolute fracture risk in children by 0.1-0.2%per annum. There was no evidence of effect modification by baseline calcium intake, sex, ethnicity, physical activity or pubertal stage. Adverse events were reported infrequently and were minor. AUTHORS' CONCLUSIONS While there is a small effect of calcium supplementation in the upper limb, the increase in BMD which results is unlikely to result in a clinically significant decrease in fracture risk. The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.
Collapse
Affiliation(s)
- T M Winzenberg
- University of Tasmania, Menzies Resarch Institute, Private Bag 23, Hobart, TAS, Australia, 7001.
| | | | | | | |
Collapse
|
38
|
Stark LJ, Davis AM, Janicke DM, Mackner LM, Hommel KA, Bean JA, Lovell D, Heubi JE, Kalkwarf HJ. A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis. J Pediatr 2006; 148:501-7. [PMID: 16647414 DOI: 10.1016/j.jpeds.2005.11.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2005] [Revised: 10/26/2005] [Accepted: 11/30/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine a behavioral intervention (BI) to increase calcium intake in children with juvenile rheumatoid arthritis (JRA) on calcium intake and bone mass 6 and 12 months after treatment. STUDY DESIGN A randomized trial compared a 6-session BI to a 3-session enhanced standard of care (ESC) with 49 children ages 4 to 10 years with JRA. Calcium intake was assessed via 3-day diet diaries. Total body bone mineral content (BMC), arms and legs BMC, and lumbar spine bone mineral density were assessed by dual energy x-ray absorptiometry. RESULTS BI maintained an average calcium intake of 1500 mg/d at 6- and 12-month follow-up. This was greater than their baseline level of 972 mg/d, but not greater than the intake of 1300 mg/day maintained by ESC (P=.09). The BI had a 4% and 2.9% greater gain in total body bone mineral content than ESC at 6 and 12 months, respectively (P=.005), and a 7.1% and 5.3% greater gain in arms and legs BMC at 6 and 12 months than ESC (P=.0007). CONCLUSIONS BI is effective in increasing calcium intake and BMC in children with JRA over a 12-month period.
Collapse
Affiliation(s)
- Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, OH 45229, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Most older children and adolescents in the United States currently do not achieve the recommended intake of calcium. Maintaining adequate calcium intake during childhood and adolescence is necessary for the development of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. Optimal calcium intake is especially relevant during adolescence, when most bone mineral accretion occurs. Because of the influence of the family's diet on the diet of children and adolescents, adequate calcium intake by all members of the family is important. Assessment of calcium intake can be performed in the physician's office. A well-rounded diet including low-fat dairy products, fruits, and vegetables and appropriate physical activity are important for achieving good bone health. Establishing these practices in childhood is important so that they will be followed throughout the life span.
Collapse
|
40
|
|
41
|
Bounds W, Skinner J, Carruth BR, Ziegler P. The relationship of dietary and lifestyle factors to bone mineral indexes in children. ACTA ACUST UNITED AC 2005; 105:735-41. [PMID: 15883550 DOI: 10.1016/j.jada.2005.02.046] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify factors related to children's bone mineral indexes at age 8 years, and to assess bone mineral indexes in the same children at ages 6 and 8 years. DESIGN Bone mineral content (BMC [g]) and bone mineral density (BMD; calculated as g/cm 2 ) were measured by dual-energy x-ray absorptiometry (DEXA) in children and their mothers when the children were 8 years of age. A subset of children had an earlier DEXA assessment at age 6 years. Children's dietary intake, height, weight, and level of sedentary activity were assessed as part of a longitudinal study from ages 2 months to 8 years. SUBJECTS/SETTING Fifty-two healthy white children (25 male, 27 female) and their mothers. Main outcome measures Children's total BMC and BMD at age 8 years. STATISTICAL ANALYSES PERFORMED Correlations and stepwise multiple regression analyses. RESULTS Factors positively related to children's BMC at age 8 years included longitudinal intakes (ages 2 to 8 years) of protein, phosphorus, vitamin K, magnesium, zinc, energy, and iron; height; weight; and age ( P < or = .05). Factors positively related to children's BMD at age 8 years included longitudinal intakes of protein and magnesium ( P < or = .05). Female sex was negatively associated with BMC and BMD at age 8 years ( P < or = .05). Children's bone mineral indexes at ages 6 and 8 years were strongly correlated ( r =0.86, P < .0001 for BMC; r =0.92, P <.0001 for BMD). CONCLUSIONS Because many nutrients are related to bone health, children should consume a varied and nutrient-dense diet.
Collapse
Affiliation(s)
- Wendy Bounds
- Department of Nutrition and Food Systems, University of Southern Mississippi, 118 College Drive, Hattiesburg, MS 39406, USA.
| | | | | | | |
Collapse
|
42
|
|
43
|
Lanou AJ, Berkow SE, Barnard ND. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics 2005; 115:736-43. [PMID: 15741380 DOI: 10.1542/peds.2004-0548] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Numerous nutrition policy statements recommend the consumption of 800 to 1500 mg of calcium largely from dairy products for osteoporosis prevention; however, the findings of epidemiologic and prospective studies have raised questions about the efficacy of the use of dairy products for the promotion of bone health. The objective of this study was to review existing literature on the effects of dairy products and total dietary calcium on bone integrity in children and young adults to assess whether evidence supports (1) current recommended calcium intake levels and (2) the suggestion that dairy products are better for promoting bone integrity than other calcium-containing food sources or supplements. METHODS A Medline (National Library of Medicine, Bethesda, MD) search was conducted for studies published on the relationship between milk, dairy products, or calcium intake and bone mineralization or fracture risk in children and young adults (1-25 years). This search yielded 58 studies: 22 cross-sectional studies; 13 retrospective studies; 10 longitudinal prospective studies; and 13 randomized, controlled trials. RESULTS Eleven of the studies did not control for weight, pubertal status, and exercise and were excluded. Ten studies were randomized, controlled trials of supplemental calcium, 9 of which showed modest positive benefits on bone mineralization in children and adolescents. Of the remaining 37 studies of dairy or unsupplemented dietary calcium intake, 27 studies found no relationship between dairy or dietary calcium intake and measures of bone health. In the remaining 9 reports, the effects on bone health are small and 3 were confounded by vitamin D intake from milk fortified with vitamin D. Therefore, in clinical, longitudinal, retrospective, and cross-sectional studies, neither increased consumption of dairy products, specifically, nor total dietary calcium consumption has shown even a modestly consistent benefit for child or young adult bone health. CONCLUSION Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralization.
Collapse
Affiliation(s)
- Amy Joy Lanou
- Physicians Committee for Responsible Medicine, 5100 Wisconsin Ave NW, Suite 400, Washington, DC 20016, USA.
| | | | | |
Collapse
|
44
|
Bonjour JP. Is peripuberty the most opportune time to increase calcium intake in healthy girls? ACTA ACUST UNITED AC 2005. [DOI: 10.1138/20050153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Abstract
Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.
Collapse
Affiliation(s)
- Pekka Kannus
- Accident & Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
| | | | | | | |
Collapse
|
46
|
Agarwal MM, Khandelwal N, Mandal AK, Rana SV, Gupta V, Chandra Mohan V, Kishore GVMK. Factors affecting bone mineral density in patients with prostate carcinoma before and after orchidectomy. Cancer 2005; 103:2042-52. [PMID: 15830347 DOI: 10.1002/cncr.21047] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Orchidectomy is an accepted form of androgen-deprivation therapy (ADT) for prostate carcinoma. Osteoporosis is common in elderly individuals and is accelerated by ADT. The authors studied changes in bone mineral density (BMD) after ADT and factors that affected those changes. METHODS Fifty patients with prostatic adenocarcinoma who opted to undergo orchidectomy were studied prospectively. All patients completed 6 months of follow-up, and 20 of those patients completed 12 months of follow-up. Patients' age, weight, height, body mass index (BMI), physical activity, addiction (smoking, alcohol), dietary calcium intake, and lactose tolerance status were noted. Lumbar spinal (L1-L3) trabecular BMD was measured with quantitative computed tomography (QCT) at baseline and every 6 months for 1 year and was compared with preoperative values. The effects of various patient characteristics on preoperative BMD and changes in BMD also were analyzed. RESULTS The mean +/- standard deviation (SD) age of the patients was 69.5 +/- 8.1 years, BMI was 23.5 +/- 3.9 kg/m2, dietary calcium intake was 1066.1 +/- 443.3 mg per day. Thirty-eight percent of patients were lactose intolerant. Sixty-two percent of patients were in the light weight-bearing activity group. The mean +/- SD preoperative BMD was 119.2 +/- 34.9 mg/cc, with T-scores of - 1.77 +/- 1.22 and Z-scores of 0.43 +/- 1.27. A decrease in BMD during the first 6 months ( approximately 13%) was statistically significant (P = 0.0001) and continued further during next 6 months (BMD loss of approximately 18% at 12 months). Patients with osteoporosis, as defined by T-scores < or = - 2.5, increased from 24% at baseline to 48% at 6 months. Nonsmokers, nonalcoholics, patients with higher physical activity, and patients with a BMI > 25 kg/m2 had statistically significant higher BMD compared with their counterparts (P < 0.05). Body weight < 60 kg and BMI < 25 kg/m2 were significant risk factors for loss of BMD (P < 0.05). Dietary calcium had a discernible but statistically insignificant effect on BMD (P = 0.16). Lactose intolerance had no significant effect on BMD or bone loss. CONCLUSIONS Osteoporosis was common in the population affected by prostate carcinoma. Orchidectomy led to accelerated bone loss. Periodic measurement of BMD after ADT would help in the early detection of osteoporosis. Maintenance of high BMI, weight-bearing physical activity, avoidance of alcohol and smoking, and possibly high dietary calcium intake help in maintaining bone mass.
Collapse
Affiliation(s)
- Mayank M Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW We present an update on amenorrhea in adolescent girls and young women. Amenorrhea may herald the onset of estrogen deficiency, which can adversely affect peak bone mass and ultimate risk of osteoporosis. RECENT FINDINGS Adolescence is a critical period for bone accretion. Important modifiable factors that optimize bone accretion during this time are calcium intake, vitamin D, nutrition, and exercise. Another modifiable factor in the hands of the clinician is the prompt recognition and therapy of amenorrhea associated with estrogen deficient states, caused by conditions such as hyperprolactinemia and ovarian failure. An important recent observation is that adolescents with amenorrhea who diet, but who do not meet diagnostic criteria for anorexia nervosa, are nonetheless at significant risk for low bone density. Also, multiple factors contribute to the bone loss experienced by patients with anorexia nervosa, and the associated estrogen deficiency may not be the major contributor. Recent evidence also suggests that the contraceptive depot medroxyprogesterone acetate may contribute to impaired bone accretion. While estrogen/progestin replacement therapy has a clear role in the management of girls and young women with primary ovarian insufficiency, the exact role of this therapy in the amenorrhea associated with anorexia nervosa or exercise remains controversial. SUMMARY Increasingly, osteoporosis prevention is recognized as an important role for health care providers of adolescent girls and young women. Viewed from this perspective, there is a need for more aggressive evaluation and management of amenorrhea, and research is needed to define sound and cost effective strategies.
Collapse
Affiliation(s)
- Catherine M Gordon
- Children's Hospital Bone Health Center and Department of Pediatrics, Harvard Medical School, Divisions of Adolescent/Young Adult Medicine and Endocrinology, Children's Hospital, Boston, Massachusetts 02115, USA.
| | | |
Collapse
|
48
|
Iwamoto J, Takeda T, Sato Y, Yeh JK. Response of Cortical and Cancellous Bones to Mild Calcium Deficiency in Young Growing Female Rats: A Bone Histomorphometry Study. Exp Anim 2004; 53:347-54. [PMID: 15297708 DOI: 10.1538/expanim.53.347] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The purpose of the present study was to clarify the differences in the alterations of cellular activities of osteoblasts and osteoclasts, mineralization, and bone mass in cortical and cancellous bones of young growing rats with mild calcium deficiency. Twenty female Sprague-Dawley rats, 6 weeks of age, were randomized by the stratified method into two groups with 10 rats in each group: 0.5% (normal) calcium diet group and 0.1% (low) calcium diet group. After 10 weeks of feeding, bone histomorphometric analysis was performed on cancellous bone of the proximal tibia as well as cortical bone of the tibial shaft. Calcium deficiency increased eroded surface (ES/bone surface [BS]) and the number of osteoclast (N.Oc/BS) with an increase in osteoblast surface (ObS/BS), but decreased bone formation rate (BFR/BS) in cancellous bone. However, cancellous bone volume was preserved, while cortical bone area was decreased as a result of decreased periosteal bone gain and enlargement of the marrow cavity. These results suggest that short-term mild calcium deficiency in young growing female rats increased bone resorption by increasing osteoclastic recruitment, and suppressed mineralization followed by increased osteoblastic recruitment in cancellous bone, but cancellous bone loss was counteracted through redistribution of calcium from cortical bone to cancellous bone.
Collapse
Affiliation(s)
- Jun Iwamoto
- Department of Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | | | | |
Collapse
|
49
|
Affiliation(s)
- Ronald E Kleinman
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | | | | |
Collapse
|
50
|
Looker AC. Interaction of science, consumer practices and policy: calcium and bone health as a case study. J Nutr 2003; 133:1987S-1991S. [PMID: 12771351 DOI: 10.1093/jn/133.6.1987s] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Data to support a relationship between calcium and bone health are a major part of the body of evidence that underlie calcium-related policy in the United States. Examples of these policies include dietary intake recommendations, health claims for calcium and osteoporosis on food labels and an objective to improve calcium intake of the U.S. population in Healthy People 2010. Median calcium intakes among females fall below recommended levels after childhood even when supplemental calcium intakes are included. This is a concern in light of data that support a positive relationship between calcium and bone health. Most of the studies on the calcium-bone relationship have focused on older women, and several have used fracture as the endpoint; a meta-analysis of their results suggests that increased calcium intake is associated with approximately 30% decrease in fracture risk. Studies in children, adolescents and premenopausal women have focused on the relationship between calcium and bone mineral density rather than fracture; most of these also support a positive relationship between calcium intake and skeletal health although some data gaps remain. Calcium appears to be a threshold nutrient (e.g., intakes above a certain level do not result in further benefit to bone). The effect of increased calcium intake on bone density does not appear to persist unless the higher intakes are sustained. There are certain conditions, such as lactation, during which calcium intake does not appear to influence bone. Other factors that may influence the effect of calcium on bone include bone-specific genotypes and physical activity.
Collapse
Affiliation(s)
- Anne C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
| |
Collapse
|