Calcium Intake In Children Research Articles

Calcium Intake in Children with Eczema and/or Food Allergy: A Prospective Cohort Study.

Eczema and food allergy may impact diet. Using data from a cohort of Manitoba children born in 1995, we examined calcium intake, defined as the frequency and quality of calcium products consumed (with the exception of cheese), amongst Manitoba adolescents (12–14 years) with eczema or food allergy in childhood (7–8 years) or adolescence. At both ages, children were assessed by a physician for eczema and food allergy. Adolescents completed food frequency questionnaires. Calcium intake was defined as 1+ vs. <1 weekly. Linear and logistic regression was used as appropriate, with adjustments for confounders. Overall, 468 adolescents were included, of whom 62 (13.3%) had eczema only in childhood, 25 (5.3%) had food allergy only, and 26 (5.6%) had eczema and food allergy. Compared to children without eczema, those with eczema only had poorer calcium intake in adolescence (β −0.44; 95%CI −0.96; 0.00). Girls, but not boys, with eczema in childhood had poorer calcium intake in adolescence than girls without eczema (β −0.84; 95%CI −1.60; −0.08). These patterns persisted even if children experienced transient vs. persistent eczema to adolescence. Similar but non-significant trends were found for food allergy. Childhood eczema is associated with significantly lower calcium intake and consumption in adolescence. These differences persist to adolescence, even if a child “outgrows” their allergic condition.

Dietary calcium intake and sunlight exposure among children aged 6-23 months in Dale Woreda, Southern Ethiopia

Nutritional rickets can be caused by either or both calcium and vitamin D deficiencies, and can frequently occur in Africa. In Ethiopia, limited evidence exists regarding the calcium intake of children and their sunlight exposure practices. The purpose of this study was to assess information regarding dietary calcium intake and sunlight exposure practice, which are factors related to nutritional rickets. The study was conducted in Dale Woreda, Southern Ethiopia using a community based cross-sectional survey design with both descriptive and analytic components. A total of 170 children were selected using multi-stage sampling technique. A structured questionnaire and an interactive 24-hour dietary assessment method were used to collect data on sociodemographic and economic information and to assess dietary calcium intake of participant children. The Ethiopian food composition table supplemented by world food data were used to convert dietary intake into nutrient content. The mean (SD) age of the study children was 14.4 (+4.7) months. The male to female ratio was 1.24. The mean (± SD) calcium intake of participant children was 407 ± 235 mg/day; 26.5% had low dietary calcium intake compared with their age specific recommended nutrient intake (RNI) value. Regarding sunlight exposure, 41.1% participant mothers exposed their child to sunlight within 1 (one) month of birth and 56.5% of study children were exposed to sunlight for 20 to 30 minutes per day. In conclusion, the risk of dietary calcium inadequacy was prevalent because of low intakes by some children. Even if only 26.5% of participating children had low dietary calcium intake, the children in the study area have some risk of dietary calcium inadequacy due to the high content of phytate in the prevailing complementary foods such as fruits and maize based complementary food, which can inhibit bioavailability of calcium. The participant children were not at risk of inadequate exposure to sunlight because they had good exposure practices and there was no sunlight avoidance practices among the majority of participant children. Key words : Calcium, Children, Ethiopia, Rickets, Sunlight exposure, Vitamin D, Phytate, Complementary foods

Growing Strong and Healthy with Mister Bone: An Educational Program to Have Strong Bones Later in Life.

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.

Reproducibility and Intermethod Reliability of a Calcium Food Frequency Questionnaire for Use in Hispanic, Non-Hispanic Black, and Non-Hispanic White Youth

BackgroundA dietary assessment instrument designed for use in a nationally representative pediatric population was required to examine associations between calcium intake and bone mineral accrual in a large, multicenter study. ObjectiveTo determine the reproducibility and intermethod reliability of a youth calcium food frequency questionnaire (FFQ) in a multiracial/ethnic sample of children and adolescents. DesignReproducibility (n=69) and intermethod reliability (n=393) studies were conducted by administering repeat FFQs and three unannounced 24-hour dietary recalls to stratified random samples of individuals participating in the Bone Mineral Density in Childhood Study. Participants/settingChildren and adolescents ages 5 to 21 years. Main outcome measuresCalcium intake estimated from the FFQ and 24-hour dietary recalls. Statistical analysisReproducibility was assessed by the intraclass correlation coefficient (ICC). Intermethod reliability was assessed by deattenuated Pearson correlations between the FFQ and 24-hour recalls. Attenuation factors and calibration corrected effect estimates for bone density were calculated to determine the potential influence of measurement error on associations with health outcomes. ResultsThe ICC (0.61) for repeat administrations and deattenuated Pearson correlation between the FFQ and 24-hour recalls (r=0.60) for all subjects indicated reproducibility and intermethod reliability (Pearson r=0.50 to 0.74 across sex and age groups). Attenuation factors were ≤0.50 for all sex and age groups and lower for non-Hispanic blacks (λ=0.20) and Hispanics (λ=0.26) than for non-Hispanic whites (λ=0.42). ConclusionsThe Bone Mineral Density in Childhood Study calcium FFQ appears to provide a useful tool for assessing calcium intake in children and adolescents drawn from multiracial/ethnic populations and/or spanning a wide age range. However, similar to other FFQs, attenuation factors were substantially <1, indicating the potential for appreciable measurement error bias. Calibration correction should be performed and racial/ethnic differences in performance considered when analyzing and interpreting findings based on this instrument.

Validation of a Food Frequency Questionnaire for rapid assessment of daily dietary calcium intake in children

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Bone mineral density, growth, pubertal development and other parameters in Brazilian children and young adults with sickle cell anaemia

To evaluate the occurrence of low bone mineral density (BMD) and its relationship with clinical and laboratorial characteristics in children and young adults with sickle cell anaemia living in Northeast-Brazil, and to assess the role of radiography in diagnosing low BMD. Bone mineral density of lumbar spine was measured by dual energy X-ray absorptiometry (DXA) in 27 patients with Sickle cell anaemia (SCA) aged 7-28years. Clinical history, calcium and calorie intake, laboratory measurements, anthropometrics and pubertal development were assessed, and X-rays were obtained. Z-scores and T-scores for weight, height, Body Mass Index (BMI) and BMD were calculated using age and gender matched reference data. Mean lumbar spine BMD Z-scores and T-scores were -1.81 SD in boys and -0.80 SD in girls. BMD Z-scores were below -2 SD in 33.3% of girls and in 46.7% of boys. Low BMD (<-2 SD) occurred significantly more in patients with low height-for-age (P=0.02), low weight-for-age (P=0.001) and low BMI-for-age (P=0.006). No significant relationships were found between BMD and other clinical and laboratory parameters. Radiography had a sensitivity of 75% and a specificity of 36% to detect low BMD, and was considered not useful in this context. Patients with low height and/or low weight-for-age seem to be at high risk for developing low BMD.

Assessment of vitamin D nutrition status and dietary calcium intake in children 2-5 years of age

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Lactase non-persistence as a determinant of milk avoidance and calcium intake in children and adolescents.

This study examines if lactase non-persistent (LNP) children and adolescents differ from those who are lactase persistent (LP) as regards milk avoidance and Ca intake. We also studied potential differences in anthropometric features related to obesity, and examined if milk avoidance is associated with lactase-persistence status. Additionally, we aimed to determine if heterozygous subjects showed an intermediary phenotype as regards Ca intake. Furthermore, we tested if LP and LNP influence vitamin D intake. The European Youth Heart Study is an ongoing international, multi-centre cohort study primarily designed to address CVD risk factors. Children (n 298, mean age 9·6 years) and adolescents (n 386, mean age 15·6 years) belonging to the Swedish part of the European Youth Heart Study were genotyped for the LCT-13910 C>T polymorphism. Mendelian randomisation was used. Milk avoidance was significantly more common in LNP adolescents (OR 3·2; 95% CI 1·5, 7·3). LP subjects had higher milk consumption (P<0·001). Accordingly, energy consumption derived from milk and Ca intake was lower in LNP (P<0·05 and P<0·001, respectively). Heterozygous subjects did not show an intermediary phenotype concerning milk consumption. LP or LNP status did not affect vitamin D intake or anthropometric variables. LNP in children and adolescents is associated with reduced intake of milk and some milk-product-related nutritional components, in particular Ca. This reduced intake did not affect the studied anthropometric variables, indicators of body fat or estimated vitamin D intake. However, independently of genotype, age and sex, daily vitamin D intake was below the recommended intakes. Milk avoidance among adolescents but not children was associated with LNP.

초등학생의 Vegetarian(lacto-ovo vegetarian)과 Non-Vegetarian의 식습관, 영양소 섭취 및 건강습관 차이에 관한 연구

본 연구는 초등학교 12∼13세(5∼6학년) 어린이를 대상으로 채식주의군(lacto-ovo vegetarian 포함)과 비채식주의군으로 나누어 식습관, 영양소 섭취 상태 및 건강상태에 미치는 영향과 그 차이를 알아보기 위해 실시하였다. 본 연구에서 채식주의군과 비채식주의군의 식습관은 통계적으로 유의한 차이는 보이지 않았다. 전체 아동들의 간식 횟수로는 하루에 한번이 가장 높은 비율(66.5%)을 차지하였으나, 하루에 간식을 두 번 섭취하는 비율은 비채식주의군이 34.0%로 채식주의군에 비해 횟수가 높은 것으로 조사되었다. 채식주의군이 섭취하는 간식으로는 과일류가 55.9%로 가장 높았으며, 비채식주의군은 탄산음료와 아이스크림의 섭취비율이 채식주의군에 비해 매우 높게 조사되었다(p＜0.05). 식생활 평가에서 보면, 채식주의군은 과일(1개)이나 과일주스(1잔)를 매일 먹는 비율이 55.9%로 비채식주의군에 비해 높게 조사(p＜0.05)된 반면에, 비채식주의군은 우유나 유제품(요구르트, 요플레 등)의 섭취, 육류?생선?달걀?콩?두부 등으로 된 단백질 음식을 끼니마다 섭취, 튀김이나 기름에 볶는 요리를 주 2회 이상 섭취 및 아이스크림?과자?케이크, 탄산음료 등을 섭취하는 비율이 높게 조사되었다. 완전 채식주의 아동도 외식이나 학교 근처에서 간식을 통해 우유 및 유제품, 튀김식품 등을 섭취하는 것으로 조사되어 실제로 초등학교 아동이 완전 채식을 하는 것은 현실적으로 어려움이 있다고 사료된다. 영양소 섭취상태에서는 전체 조사 아동의 열량(채식주의군 남아 73.6%/여아 88.6%, 비채식주의군 남아 81.4%/여아 94.4%)은 기준치(20)에 비해 절대적으로 부족하게 조사되었다. 채식주의군 중 남아의 경우 열량, 비타민 B2, 비타민 E, 엽산, 칼슘 및 식이섬유가 기준치(20)에 비해 낮았으며, 여아는 열량, 엽산, 칼슘 및 식이섬유가 기준치(20)에 비해 낮았다. 비채식주의군에서는 남아와 여아 모두 열량, 엽산, 식이섬유의 섭취가 부족한 반면에 지방, 비타민 B2, 칼슘 및 콜레스테롤의 섭취를 과잉으로 하는 것으로 조사되었다(p＜0.05). 식이섬유의 경우 두 군 모두 기준치(20)보다 낮게 조사되었지만, 채식주의군(22.5±11.0 g)은 비채식주의군(19.5±10.2 g)에 비해 식이섬유소의 섭취가 유의하게 높게 조사되었다(p＜0.05). 식사평가의 만족도는 두 그룹(채식주의군 79.4%, 비채식주의군 84.0%) 모두 세끼 식사 중 저녁식사에서 식사의 질과 양에 만족하는 비율이 높았다. 영양제 복용율은 비채식주의군(45.7%)에서 높았고, 복용하는 영양 보충제의 종류로는 채식주의군은 한약(34.5%), 비채식주의군은 종합영양제(53.5%)를 가장 많이 섭취하고 있는 것으로 조사되었다. 아동의 건강상태가 양호하다고 답한 응답자는 비채식주의군이 높았으며, 아토피피부염 발생 아동은 채식주의군이 18.6%로 조사되어 아토피피부염으로 인해 채식을 하고 있다고 답하였다(p＜0.05). 본 연구 결과에 의하면, 조사대상 아동은 종교적인 이유와 아토피성 피부염 등의 질병완화를 위해 채식을 선택한 경우가 많았으며, 그로 인해 열량, 엽산, 칼슘 및 식이섬유 등의 부족으로 영양의 불균형을 초래할 수 있는 것으로 사료됨에 따라 아동의 균형적인 신체발달과 성장을 위해서는 여러 종류의 식품을 골고루 섭취하고 부족한 영양소를 보충할 수 있도록 올바른 식품선택이 필요하다. 또한 지루하기 쉬운 식단을 먹고 싶은 식단으로 만들기 위해 식품에 대한 다양한 조리법이 개발되어야 하며, 올바른 식품선택을 위한 영양교육의 필요성이 요구된다. 비채식주의 아동들의 경우 영양과잉이 되지 않고, 섬유소 섭취를 증가시키는 식사관리를 해야 할 것으로 사료된다.

Relationship of calcium absorption with 25(OH)D and calcium intake in children with rickets

Nutritional rickets has long been considered a disease caused by vitamin D deficiency, but recent data indicate that inadequate dietary calcium intake is an important cause of rickets, particularly in tropical countries. Children with rickets due to calcium deficiency do not have very low 25(OH)D concentrations, and serum 1,25(OH)(2) D values are markedly elevated. Studies of Nigerian children with rickets demonstrated they have high fractional calcium absorption. A high-phytate diet was demonstrated to increase calcium absorption compared with the fasting state, and enzymatic dephytinization did not significantly improve calcium absorption. When given vitamin D, children with rickets have a marked increase in 1,25(OH)(2) D concentrations without any change in fractional calcium absorption. No positive relationship was found between fractional calcium absorption and serum 25(OH)D concentrations in children on low-calcium diets. More research is needed to understand the interaction between calcium and vitamin D and the role of vitamin D in calcium absorption.

Calcium bioavailability from a fortified cereal-legume snack ( laddoo)

Objective Calcium intakes in underprivileged Indian children are often low. Improving calcium intake fortification of indigenous foods may be a viable strategy. The aim of this study was to evaluate calcium absorption, as judged by an acute increase in serum ionized calcium concentration, after ingestion of a calcium-fortified cereal-legume snack ( laddoo). Methods Three groups of eight children (8–12 y old) with low habitual dietary calcium intake were recruited for the study. After an overnight fast, a calcium-fortified (500 mg of calcium carbonate) cereal-legume snack ( laddoo) was given to group A, a similar but non-fortified snack was given to group B, and group C received calcium carbonate (500 mg) alone. Serum concentrations of ionized calcium and intact parathyroid hormone were measured at 0, 1, 2, 3, 4, and 5 h. Results In group A, a peak of 6% above baseline was observed at 1 h in serum ionized calcium, whereas group C showed a peak of 5.5% at 4 h and group B showed a small increase of 1.8% at 1 h. The change in area under curve of groups A and C were of similar order (4.6 and 5.5, respectively), whereas that of group B was significantly lower (0.82). Serum parathyroid hormone was lowest at 2 h in groups A and B and at 3 h in group C. Conclusion The fortified cereal-legume laddoo may act as a novel vehicle for increasing calcium intake in children.

Quantifying calcium intake in school age children: development and validation of the Calcium Counts! food frequency questionnaire.

Quantifying dietary behavior is difficult and can be intrusive. Calcium, an essential mineral for skeletal development during childhood, is difficult to assess. Few studies have examined the use of food frequency questionnaires (FFQs) for assessing calcium intake in school-age children. This study evaluated the validity and reliability of the Calcium Counts! FFQ (CCFFQ) for estimating calcium intake in school children in the US. Healthy children, aged 7-10 years (n = 139) completed the CCFFQ and 7-day weighed food records. A subset of subjects completed a second CCFFQ within 3.6 months. Concurrent validity was determined using Pearson correlations between the CCFFQ and food record estimates of calcium intake, and the relationship between quintiles for the two measures. Predictive validity was determined using generalized linear regression models to explore the effects of age, race, and gender. Inter- and intra-individual variability in calcium intake was high (>300 mg/day). Calcium intake was approximately 300 mg/day higher by CCFFQ compared to food records. Concurrent validity was moderate (r = 0.61) for the entire cohort and higher for selected subgroups. Predictive validity estimates yielded significant relationships between CCFFQ and food record estimates of calcium intake alone and in the presence of such potential effect modifiers as age group, race, and gender. Test-retest reliability was high (r = 0.74). Although calcium intake estimated by the CCFFQ was greater than that measured by food records, the CCFFQ provides valid and reliable estimates of calcium intake in children. The CCFFQ is especially well-suited as a tool to identify children with low calcium intakes.

Recommended calcium intakes in children: Have we set the bar too high?

Increasing peak bone mass in childhood has the potential to reduce the impact of age-related bone loss, so identifying ways to improve childhood bone acquisition is important. Research into nutritional factors influencing childhood bone acquisition to date has focused on the role of calcium. Evidence from calcium balance studies supports the setting of recommended calcium intakes up to 800 mg/day for children and up to 1300 mg/day for adolescents. However, recent evidence from a meta-analysis of randomized controlled trials of calcium supplements in children suggests that increasing calcium intake to levels approaching recommended levels has only limited benefits for improving bone acquisition. Focusing on achieving high levels of calcium intake risks neglecting other potential lifestyle factors that could have greater benefits and possibly less potential for long-term adverse effects. While calcium remains important for skeletal health, it may be that high levels of recommended calcium intake are both unnecessary and unrealistic targets. The resources used to encourage and enable otherwise healthy individuals to meet these high levels may be better used in promoting other aspects of a healthy lifestyle for bone development and in researching alternative nutritional interventions to improve bone health. IBMS BoneKEy. 2008 February;5(2):59-68. ©2008 International Bone & Mineral Society

Daily calcium intake in male children and adolescents obtained from the rapid assessment method and the 24-hour recall method.

BackgroundIn order to rapidly assess nutrient intake, Food Frequency Questionnaires (FFQ) have been developed and proven to be reliable for quick, user friendly analysis in adults. However, the accuracy of these questionnaires in children has been studied to a limited extent. The aim of this study was to compare the daily calcium intake values obtained from the Rapid Assessment Method (RAM), an FFQ, for assessing daily calcium intake in child and adolescent males with the values obtained from the 24-hour recall method.MethodsSubjects included 162 child and adolescent males, aged 9–16 years, subdivided into elementary school (ES, 9–12 years) and high school (HS, 14–16 years) age groups.ResultsDaily calcium intake was significantly lower in ES compared with HS, using both methods. The intra-class correlation coefficients (ICC) between RAM values and those obtained using the 24-hour recall questionnaire were significant yet moderate (ICC = 0.46 and 0.43 for ES and HS, respectively). However, daily calcium intake obtained using RAM was significantly higher when compared with the 24-hour recall values in both ES (1576 +/- 1101 vs. 1003 +/- 543 mg, in RAM and 24-hour, respectively) and in HS males (1873 +/- 739 vs. 1159 +/- 515 mg, in RAM and 24-hour, respectively).ConclusionRAM overestimates daily calcium intake as compared with the 24-hour recall method in both child and adolescent males.

Rickets: new insights into a re-emerging problem

Rickets is a disease that has plagued communities for centuries. Once thought of as a disease that was left behind in the industrial revolution of the nineteenth century, nutritional rickets is re-emerging as a problem in Western Europe and the US. Reduction in vitamin D and calcium intake in children's diets along with migration of culturally vulnerable groups to more temperate climates have increased, predisposing large populations to vitamin D deficiency and rickets. Recent evidence suggests that vitamin D deficiency during pregnancy may have both an immediate and longer-term deleterious effect on children. Focus on hypophosphataemic rickets has identified FGF23 as the phosphaturic factor central to renal phosphate loss. Mutations in the dentin matrix protein-1 gene have been implicated in autosomal recessive hypophosphataemic rickets. Rickets is the most common form of metabolic bone disease worldwide. Measures such as adequate sunlight exposure and dietary supplementation are simple but effective in reducing rickets. It is important to target culturally vulnerable groups and pregnant women. Preterm babies form a specific population that is particularly vulnerable to the metabolic consequences of calcium and phosphate deficiency, requiring early intervention.

How do women change osteoporosis-preventive behaviours in their children?

We have reported that a lifestyle intervention with mothers improved calcium intake and physical activity in both mothers and their children. In this study, we aimed to describe the strategies and approaches used by these mothers to improve their children's calcium intake and physical activity. A qualitative study using semistructured interviews. Population-based convenience sample. A subsample of 39 mothers were taken from a population-based random sample of 354 mothers who had participated in the original osteoporosis-prevention trial. Mothers described specific dietary changes they made to increase their children's calcium intake. They also described strategies for improving calcium intake and physical activity such as raising awareness of the importance of calcium; ensuring calcium-rich foods were accessible; assessing their children's likes and dislikes and working within these; role modelling; information provision; taking a balanced approach to attempting behaviour change; and encouraging activities that they could do with their children. Mothers emphasized the general importance of a balanced diet and lifestyle, rather than just focussing on lifestyle factors specific to osteoporosis prevention. Even without specific guidance, mothers are adept at developing strategies to apply to changing lifestyle behaviours in their children and identifying barriers to change. These results provide information, which could be incorporated into future interventions for lifestyle change in children and also provide further support for considering parent-focused approaches to this problem.

Food sources of dairy and calcium in U.S. children age 2–18 years

In an effort to effectively encourage children to increase dairy and calcium intake, it is important to examine their actual food sources of dairy and calcium. This study investigated the food sources of dairy and calcium consumed by a nationally representative sample of children aged 2–18 years using individual foods files in the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002.7,716 children were separated into four age groups (2–3, 4–8, 9–13 and 14–18 year-olds) with a combined total consumption of 19,165 dairy and 104,770 calcium food records. In younger children, fluid cow’s milk (whole, reduced fat, or non-fat variety) contributed more than 50% of total dairy and more than 30% of total calcium intake, however, in older children less than 50% of total dairy and less than 30% of total calcium intake were from that source. Cheese alone or as an ingredient in pizza or pasta was the second highest contributor of total dairy and calcium, especially in 14–18 year-olds where it contributed more than 30% to the total dairy and calcium consumption. Yogurt was in the top 10 food sources of dairy and calcium only in 2–3 year-old children. In conclusion, older children obtained a relative high amount of dairy and calcium (16–24%) from cheese-containing mixed foods, whereas younger children consumed milk, cheese and yogurt. Thus, promoting dairy and calcium intake in children should target age-specific choices, especially for children older than 9 years. Supported by Pennsylvania State University, Population Research Institute Seed grant

Fat mass gain is lower in calcium-supplemented than in unsupplemented preschool children with low dietary calcium intakes

Dietary calcium may play a role in the stimulation of lipolysis and the inhibition of lipogenesis, thereby reducing body fat. The aim was to determine whether an association existed between change in percentage body fat (%BF) or fat mass and calcium intake in children aged 3-5 y. A secondary analysis of a 1-y randomized calcium and activity trial in 178 children was conducted. Three-day diet records and 48-h accelerometer readings were obtained at 0, 6, and 12 mo. Body composition was measured by dual-energy X-ray absorptiometry at 0 and 12 mo. The decrease in %BF was less in girls (-0.6 +/- 2.8%) than in boys (-1.5 +/- 2.6%; P = 0.03) and correlated with age (r = 0.19, P = 0.01) and maternal body mass index (r = 0.19, P = 0.02). Changes in fat mass were not significantly different by activity group or between children randomly assigned to receive calcium or placebo (0.5 +/- 0.9 and 0.6 +/- 0.8 kg, respectively; P = 0.32). Similar findings were observed for the change in %BF. No correlations between %BF and fat mass changes and dietary calcium (r = -0.01, P = 0.9 and r = -0.05, P = 0.5) or total (dietary + supplement) calcium intake (r = -0.02, P = 0.8 and r = -0.06, P = 0.4) were observed. Among children in the lowest tertile of dietary calcium (<821 mg/d), fat mass gain was lower in the calcium group (0.3 +/- 0.5 kg) than in the placebo group (0.8 +/- 1.1 kg) (P = 0.04) but was not correlated with mean total calcium intake (r = -0.20). These findings support a weak relation between changes in fat mass gain and calcium intake in preschool children, who typically consume below recommended amounts of dietary calcium.

A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis

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. 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. 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). BI is effective in increasing calcium intake and BMC in children with JRA over a 12-month period.

A mother-based intervention trial for osteoporosis prevention in children

Objective. To assess whether a lifestyle intervention delivered to mothers might impact on osteoporosis preventive behaviors in their children. Methods. We performed a 2-year randomized controlled trial of individualized bone mineral density feedback with either an osteoporosis information leaflet, or small group education, in a population-based sample of 354 mothers from Southern Tasmania, Australia in 2000–02. Main outcomes were maternal report of calcium intake and physical activity change in their children. Results. Receiving small group education was associated with mothers' report of increasing children's calcium intake (odds ratio 2.3, 95% confidence interval 1.4, 3.8), as was low t-score feedback (odds ratio 2.0, 95% confidence interval 1.2, 3.3). Mothers who increased their own physical activity were more often reported increasing both physical activity (odds ratio 2.7, 95% confidence interval 1.5, 5.0) and calcium intake in their children (odds ratio 2.2, 95% confidence interval 1.3, 3.7). Mothers who commenced calcium supplements more often reported increasing children's calcium intake (odds ratio 2.6, 95% confidence interval 1.0, 6.7) but not physical activity. Conclusions. Both bone mineral density feedback and small group education delivered to mothers are effective at inducing maternally reported osteoporosis preventive behavior change in their children. These results require confirmation by studies with objective outcome measures.