Dietary Allowance For Calcium Research Articles

Elemental Fingerprinting of Pecorino Romano and Pecorino Sardo PDO: Characterization, Authentication and Nutritional Value.

Sardinia, located in Italy, is a significant producer of Protected Designation of Origin (PDO) sheep cheeses. In response to the growing demand for high-quality, safe, and traceable food products, the elemental fingerprints of Pecorino Romano PDO and Pecorino Sardo PDO were determined on 200 samples of cheese using validated, inductively coupled plasma methods. The aim of this study was to collect data for food authentication studies, evaluate nutritional and safety aspects, and verify the influence of cheesemaking technology and seasonality on elemental fingerprints. According to European regulations, one 100 g serving of both cheeses provides over 30% of the recommended dietary allowance for calcium, sodium, zinc, selenium, and phosphorus, and over 15% of the recommended dietary intake for copper and magnesium. Toxic elements, such as Cd, As, Hg, and Pb, were frequently not quantified or measured at concentrations of toxicological interest. Linear discriminant analysis was used to discriminate between the two types of pecorino cheese with an accuracy of over 95%. The cheese-making process affects the elemental fingerprint, which can be used for authentication purposes. Seasonal variations in several elements have been observed and discussed.

An investigation into the potential anticaries benefits and contributions to mineral intake of bottled water

BackgroundBottled water has become the most consumed beverage in the United States. The authors aimed to inform the dental profession about the potential anticaries benefits of some bottled waters and to provide information about their possible contributions to fluoride, calcium, magnesium, sodium, and potassium intakes. MethodsThe authors chose a convenience sample by purchasing all different bottled waters from the main supermarkets operating in Indianapolis, Indiana. The authors analyzed the fluoride content using a fluoride ion–specific electrode and metal concentrations using atomic absorption spectroscopy. They used dietary reference intakes to calculate hypothetical intakes of all minerals. ResultsThe authors identified 92 different bottled waters. Fluoride concentrations were generally low (mean, 0.11 parts per million [ppm]; median, 0.04 ppm). Only 2 waters contained more than 0.7 ppm fluoride (0.95 ppm and 1.22 ppm). Metal concentrations varied considerably among waters. Calcium concentrations ranged from less than 0.1 through 360 ppm (mean, 26.9 ppm; median, 5.2 ppm), which were greater than those of magnesium (range, < 0.01-106 ppm; mean, 7.5 ppm; median, 1.9 ppm), sodium (range, < 0.01-109 ppm; mean, 11.1 ppm; median, 2.9 ppm), and potassium (range, < 0.01-43 ppm; mean, 3.6 ppm; median, 1.2 ppm). Overall, most bottled waters do not contribute to adequate intakes of fluoride, potassium, or sodium or to recommended dietary allowances for calcium and magnesium. Nonetheless, some waters can provide meaningful contributions to fluoride, calcium, and magnesium intake. ConclusionsThe fluoride concentration in 90 of the 92 studied bottled waters is insufficient to contribute to caries prevention. Only a few bottled waters can be considered health-promoting. Practical ImplicationsDental professionals should consider the mineral content of water consumed by their patients during caries risk assessment.

Dietary Intakes of Women’s Health Initiative Long Life Study Participants Falls Short of the Dietary Reference Intakes

BackgroundUnderstanding how nutrient intake in older women compares with recommendations is important. The Academy of Nutrition and Dietetics position statement summarizes the nutrient needs of older adults (aged ≥60 years) based on a systematic review. ObjectiveThe objective of this study was to compare nutrient intake of Women's Health Initiative Long Life Study participants to the Dietary Reference Intakes for nutrients reviewed in the Academy of Nutrition and Dietetics position statement. DesignThe study is a cross-sectional analysis. Participants/settingParticipants (n=7,875) were mailed the General Nutrition Assessment Food Frequency Questionnaire during 2012-2013, of whom 77% (n=6,095) completed it, and 5,732 were included in the analytic sample after exclusion for implausible energy intakes. Main outcome measuresMean intake of energy and protein, calcium, fiber, folate, potassium, sodium, vitamins B-12, D, E, and K were described overall and compared with recommendations. Statistical analyses performedDemographic and lifestyle characteristics were summarized using descriptive statistics. The proportion of participants meeting recommendations was computed. ResultsMean age of completers was 79±7 years and 53.5% were non-Hispanic white, 30% were non-Hispanic black, and 16.5% were Hispanic/Latina. Only one-third of women consumed ≥21 g/day fiber, whereas fewer met the Recommended Dietary Allowance for calcium (18.6%), vitamin E (16.9%), and vitamin D (1.7%). Just more than half (56%) of participants met the Recommended Dietary Allowance for protein of 0.8 g/kg body weight/day, and just less than half (47.0%) met potassium guidelines. ConclusionsThese findings suggest older women within the Women’s Health Initiative were generally not achieving recommended intake for several key nutrients highlighted by the Academy of Nutrition and Dietetics position statement. These findings underscore the need to identify effective approaches for improving the nutrient density of dietary intake in older women.

Bone health assessments by student pharmacists during interprofessional education

IntroductionBone-healthy lifestyle is a cornerstone of osteoporosis prevention and treatment. Student pharmacists are ideally suited to perform bone health assessments during interprofessional education (IPE) programs. In this article, we describe the outcomes of bone health assessments performed by second-year student pharmacists (P2s) as part of a novel IPE activity. MethodsBone health assessments provided by P2s to older adults during an interprofessional team home visit were evaluated. Three health profession students (pharmacy, medicine, physician assistant, nursing, physical therapy, occupational therapy, and/or social work) worked as collaborative teams, with each student completing discipline-specific patient assessments. Data collected included bone density scan status, Fracture Risk Assessment Tool (FRAX) score, and calcium and vitamin D intakes. P2s' recommendations for bone density testing and adjustments to dietary intakes based on patient-specific factors were also evaluated. ResultsAll P2s (n = 98) completed a bone health assessment with their older adult. Almost all older adults (85.6%) met risk criteria for bone density scanning. In addition, 51.5% and 27.8% reported taking less than their age and sex-specific recommended dietary allowance of calcium and vitamin D, respectively. P2s recommended changes in calcium and vitamin D dietary intake, supplement use, or both for 64.3% of the older adults. ConclusionsIn a novel IPE home-visit program, P2s were successfully utilized to assess bone health and provide recommendations for bone density scanning and calcium and vitamin D intakes to volunteer older adult patients.

Supplemental calcium intake in the aging individual: implications on skeletal and cardiovascular health.

Adequate calcium intake during childhood is necessary to achieve optimal peak bone mass and this has the potential by increasing bone reserves, to modulate the rate of age-associated bone loss. However, data regarding the efficacy of calcium obtained either through the diet or in the form of medicinal supplementation, for prevention of bone loss and osteoporotic fractures in the elderly is conflicting. Calcium alone is unlikely to be of benefit for this purpose though the co-administration of calcium and vitamin D may have modest fracture risk benefits. Supplemental calcium with or without vitamin D has recently come into the spotlight after the publication of the findings from a controversial randomized controlled trial that associated calcium supplementation with an increased risk of myocardial infarction. Since then, multiple studies have explored this potential link. The data remains conflicting and the potential mechanistic link if any exists, remains elusive. This review examines the relationship between supplemental calcium intake and skeletal and cardiovascular health in the aging individual through an appraisal of studies done on the subject in the last three decades. It also briefly details some of the studies evaluating fractional absorption of calcium in the elderly and the rationale behind the current recommended dietary allowances of calcium.

Effect of incorporation of calcium lactate on physico-chemical, textural, and sensory properties of restructured buffalo meat loaves.

Aim:The present study was conducted to develop a functional meat product by fortifying calcium (in the form of calcium lactate) with restructured buffalo meat loaf (RBML).Materials and Methods:Deboned buffalo meat obtained from the carcass of adult female buffalo within 5-6 h of slaughter and stored under frozen condition. Calcium fortified RBML were prepared by replacing the lean buffalo meat with calcium lactate powder at 0%, 1%, 1.25%, and 1.5% level through the pre-standardized procedure. The developed products were evaluated for physico-chemical properties, proximate composition, calcium concentration (mg/100 g), water activity (aw), Lovibond® tintometer color units, texture profile analysis (TPA), and sensory qualities as per-standard procedures.Results:Of the various product quality parameters evaluated, cooking yield (%), product pH, moisture (%), protein (%), fat (%), and water activity (aw) decreases significantly with increasing level of calcium lactate. Calcium content of fortified functional RBMLs was 135.02, 165.73, and 203.85 mg/100 g as compared to 6.48 mg/100 g in control. Most of the sensory scores at 1% and 1.25% levels of calcium lactate in treatment products remained comparable among themselves and control product, with a gradual decline.Conclusions:The present study concluded that 1.25% calcium lactate was the optimum level for the fortification of calcium in RBML without affecting the textural and sensory properties which could meet out 15% of recommended dietary allowance for calcium.

Effects of the National School Lunch Program on Bone Growth in Japanese Elementary School Children.

The Japanese school lunch program with milk was designed to supply 33-50% of the necessary nutrients per day and 50% of the recommended dietary allowance for calcium, which is difficult to obtain from Japanese meals. Although this program contributes to the mental and physical development of children, the effect of these meals on the bone growth in children remains unknown. Therefore, we compared the effect of school lunch with milk on bone growth between elementary school children attending schools that did not enforce the school lunch with milk program (box-lunch group) and those attending schools that did enforce the program (school-lunch group). The study subjects included fourth-grade children during the 2009-2013 school years, of whom 329 children were in the school-lunch group and 484 children in the box-lunch group. The bone area ratio of the right calcaneus was evaluated using quantitative ultrasound (Benus III). Dietary intakes were assessed using brief self-administered diet history questionnaires. The subjects were asked to record their activities for 3 d so that the mean physical activity intensity and the time spent sleeping could be estimated. The bone area ratios (%) were significantly higher in the school-lunch group than in the box-lunch group (males 31.0±0.3 vs. 30.3±0.2; females 30.6±0.2 vs. 29.7±0.2). This tendency did not change even after adjustment for confounding factors associated with bone growth. The results suggest that nutrients supplied by the Japanese school lunch program contributed to increased bone growth in elementary school children.

Relationship of Consumption of Meals Including Grain, Fish and Meat, and Vegetable Dishes to the Prevention of Nutrient Deficiency: The INTERMAP Toyama Study.

A Japanese-style diet consists of meals that include grain (shushoku), fish and meat (shusai), and vegetable dishes (fukusai). Little is known about the association of such meals (designated well-balanced meals hereafter) with nutrient intake. We therefore examined the frequency of well-balanced meals required to prevent nutrient deficiency. Participants were Japanese people, ages 40 to 59 y, from Toyama, recruited for INTERMAP, in an international population-based study. Each person provided 4 in-depth 24-h dietary recalls (149 men, 150 women). The prevalence of risk ratios of not meeting the Dietary Reference Intakes for Japanese (2015) was calculated. Well-balanced diets were assessed by the Japanese Food Guide Spinning Top. We counted the frequencies of meals in which participants consumed 1.0 or more servings of all 3 dishes categories. We divided the frequency of consumption of well-balanced meals into the following 4 groups: <1.00 time/d, 1.00-1.49 times/d, 1.50-1.74 times/d, and ≥1.75 times/d. Compared with participants in the highest frequency group for well-balanced meals, those who consumed well-balanced meals less than once a day had a higher risk of not meeting the adequate intake for potassium and the recommended dietary allowance for vitamin A. Those who consumed well-balanced meals on average less than 1.50 times per day had a higher risk of not meeting the recommended dietary allowance for calcium and vitamin C. Our results suggest that individuals should on average consume well-balanced meals more than 1.5 times per day to prevent calcium and vitamin C deficiencies.

Harden My Heart

For more than 20 years, older women were encouraged by their healthcare providers to supplement their diets with calcium and vitamin D3 to reduce their risk of hip and other fractures. In recent years, evidence has been mounting that calcium supplementation, but not dietary calcium intake, is associated with increased risk of myocardial infarction and heart disease. At the same time, the validity of the recommendation to supplement the diet with calcium for bone health has been questioned. As of yet, there is no change in nonpharmacological clinical guidelines for bone and heart health. Patients, however, are asking if they should supplement diets that do not meet the recommended dietary allowance for calcium. We suggest they discuss their concern with their primary care provider. We present 2 cases from our family medicine practice to demonstrate an approach to answering the patient’s queries based on the patient-oriented evidence available. We also present a brief review of the evidence supporting our recommendations, recognizing this is a hot topic of discussion. Nutr Today. 2016;51(1):18Y24

Calcium Supplementation: Is Protecting Against Osteoporosis Counter to Protecting against Cardiovascular Disease?

Calcium is the dominant mineral in bone and is a shortfall nutrient in the diet. For those consuming inadequate dietary calcium, calcium supplements have been a standard strategy for prevention of osteoporosis. Recently, calcium supplementation has been linked to both increased and decreased cardiovascular disease risk creating considerable uncertainty. Moreover, recent reports have shed uncertainty over the effectiveness of calcium supplements to reduce risk of fracture. The evidence for calcium supplementation effects to both reduce risk of fracture and increase coronary heart disease and mortality are reviewed. Although the importance of good calcium nutrition is well known, determining the advantage of calcium supplementation to either bone or heart health has been hampered by poor subject compliance and study design flaws. At present, the current Recommended Dietary Allowances for calcium still appear to be a good target with potential risks for chronic disease if intakes fall too short or greatly exceed these recommendations.

Letter to the editor

Letter to the editor

The patients knowledge about the role of calcium in the primary prevention of colorectal cancer

Aim of the studyThe objective of this research was to become aquainted with patients’ knowledge of the calcium role in the primary prevention of colorectal cancer.Material and methodsA group of 400 patients treated in Nikolay Pirogov Provincial Specialist Hospital in Łódź was interviewed by means of the author's own survey in which specific tools were used to become aquainted with patients’ knowledge of the calcium role in the primary prevention of colorectal cancer. The necessary statistics were conducted by means of STATISTICA 7.1 and EXCEL 2008 programmes.ResultsThe analysis of the results shows that 363 (90.7%) of respondents did not know about the protective role of calcium in the digestive tract and reduce the risk of colorectal cancer. The study shows that 396 (99.0%) of respondents were not informed by doctors about the protective effect of calcium in the digestive tract. In this survey 357 (89.25%) of respondents did not know what is the recommended daily intake of calcium in the diet.ConclusionsThe results of the study shows that patients do not know about the role of calcium in primary prevention of colorectal cancer and were not informed by their doctors about such action of calcium. Patients were not aware of the need to consume the Recommended Dietary Allowance of calcium in the diet, which shows little knowledge of the subjects on the diet. It seems necessary to change the eating habits of patients, while the introduction of nutrition education from an early age in the society. Such actions may prevent in the future many civilization diseases.

INTAKE OF CALCIUM AND PHOSPHORUS AND LEVELS OF BONE MINERALIZATION (BMC) AND MINERAL BONE DENSITY (BMD) OF FEMALE SWIMMERS IN THE PUBESCENCE PERIOD

The objective of this study was to evaluate bone mineralization (BMC) and bone mineral density (BMD) of the osseous tissue in girls training swimming an being in the period of reaching the peak bone mass, as compared to girls being at a similar age and non-practicing sport, taking into ac- count dietary allowances for calcium and phosphorus and dietary ratios of these elements. Both the swimmers and their non-training colleagues were found to meet nutritional demands to the same extent and their diets did not differ in the intakes of energy nor nutrients (protein, calcium, phosphorus), which is incorrect in the case of the non-training girls. An alarmingly low intake of calcium at a, simultaneously, excessive intake of protein and phosphorus, as well as incorrect ratios between calcium and phosphorus and between calcium and protein observed especially in the case of the swimmers, might have an adverse effect on the mineralization of osseous tissue in the period of reaching peak bone mass.

Nutrition and bone health. Calcium intake and bone health

How much calcium is required for bone health, in terms of gaining and maintaining bone minerals? In the Guidelines on the management and treatment of osteoporosis (2006), 800 mg of calcium intake per day is recommended, and Dietary Reference Intakes for Japanese (2010), which is aimed at healthy people, shows that the recommended dietary allowance of calcium for adult women is 600 - 650 mg/day. These amounts are based on assumption when sufficient bone minerals were secured at their growth periods. Because there is a significant relationship between calcium intake and bone mass, more calcium intake should be recommended.

Daily menus can result in suboptimal nutrient intakes, especially calcium, of adolescents living in dormitories

The aims of this study were to evaluate daily menus in Croatian dormitories and to assess the overall intake of dairy products among resident adolescents. For this purpose, 168 daily menus were chosen for nutritional evaluation by random sampling. In addition, 227 adolescents (133 girls and 94 boys) participated in a questionnaire focused on food intake in addition to the meals supplied in dormitories with the aim to assess the amount and the type of dairy products consumed. The results showed that only 35% of the daily menus were nutritionally balanced. Most of the menus provided an excess of energy, protein, carbohydrate, saturated fat, phosphorus, riboflavin, and vitamin A. The levels of calcium and magnesium in the menus were suboptimal. The menus offered to adolescents provided approximately 2 servings of dairy products per day. Milk was the most often supplied dairy product (1.1 servings per day), whereas yogurt had the lowest frequency of serving (0.2 servings per day). The most preferred dairy-based snack for both sexes was milk. Dairy-based snacks provided about 1 serving per day for both sexes and contributed to about 30% of the recommended dietary allowances for calcium. Adolescents who regularly consumed dairy-based snacks meet the recommendations (3.2 servings of dairy products per day and about 98% recommended dietary allowances for calcium). We conclude that the institutional menu planning should be improved because the intake of dairy snacks will continue to be a problem for achieving a healthy diet in adolescences.

Calcium in Chronic Kidney Disease: Recommended Intake and Serum Targets

Abnormal mineral metabolism has the potential to significantly increase mortality in patients with chronic kidney disease, especially by the time renal replacement therapy is required. While excess phosphorus and hyperphosphatemia have long been identified as risks for increased morbidity and mortality, the roles of calcium load and serum calcium levels have been less clear. Calcium-based recommendations in the K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease were labeled as expert opinion. The rationale behind the opinion-based recommendations is reviewed along with additional supportive information that has become available since the bone and mineral guidelines were published.

Dietary calcium and bone density in adolescent girls and young women in Europe.

The objective of this study was to investigate the association between dietary calcium intake and radial bone density among young women, over the whole range of intake and at different levels of calcium intake. The study design was a cross-sectional, observational multicenter investigation in six European countries. One thousand one hundred and sixteen healthy Caucasian girls aged 11-15 years and 526 women aged 20-23 years participated, after having been selected from larger population samples to represent a large range in calcium intake. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at the ultradistal and middistal radius. Calcium intake was assessed with 3-day food records. Other potential determinants of BMD were measured by anthropometry or questionnaires. Mean calcium intake among the girls varied between 609 mg/day in Italy and 1267 mg/day in Finland; intakes for women were in a similar range. After adjustment for height, weight, and age at menarche for the women, and adjustment for age, height, weight, Tanner stage, and bone area for the girls, radial BMD at both sites did not significantly vary among quartiles of calcium intakes for both age groups. In multivariate linear regression, calcium was weakly positively associated with BMD at both sites in the girls (per 100 mg of calcium: beta = 0.57 mg/cm2, p = 0.03 for middistal BMD and beta = 0.56 mg/cm2, p = 0.01 for ultradistal BMD). For middistal BMD, the association was observed predominantly in pre-menarcheal girls. The associations were no longer statistically significant after full adjustment for all determinants of BMD, except again in pre-menarcheal girls. Radial BMD in the women was not associated with calcium intake, except after full adjustment for determinants of BMD, when ultradistal BMD became inversely associated with calcium intake (per 100 mg beta = -1.02, p = 0.03); this finding was due to results in one of the countries and not found in other countries. There was no evidence for a different relation between calcium and BMD at different levels of intake; although there was a positive association at calcium intake levels < 600 mg/day, the interaction was not significant and there was no consistent trend over intake categories. These results do not support the hypothesis that dietary calcium is a determinant of peak BMD in European women, for a wide range of intake. This study does not provide evidence that Recommended Dietary Allowances for calcium should be increased.

Effects of variations in dietary calcium and phosphorus supply on plasma and bone osteocalcin concentrations and bone mineralization in growing pigs.

Growing pigs were fed diets supplying 45% (low), 70% (intermediate) and 100% (high) recommended dietary allowances of calcium (the Ca:P ratio was kept constant), but otherwise adequate in nutrients. The effects of varying calcium and phosphorus intakes on bone and plasma osteocalcin were monitored. Mineral content of the diet did not affect feed conversion and live weight gain. Plasma phosphorus concentrations decreased significantly in pigs fed a low mineral diet compared with those fed the high mineral diet, but there were no changes in plasma calcium and osteocalcin concentrations. Bones from the low mineral group had marked reductions in dry matter, calcium and phosphorus contents, as well as increased collagen, pyridinoline and deoxypyridinoline concentrations: osteocalcin concentrations in bone were unaffected by treatment. The results showed no direct link between osteocalcin and the degree of bone mineralization.

Calcium retention in relation to calcium intake and postmenarcheal age in adolescent females

Achievement of maximal calcium retention during adolescence may influence the magnitude of peak bone mass and subsequently lower the risk of osteoporosis. Calcium retention is generally considered to reach a plateau at a certain calcium intake. To test this hypothesis, calcium balance was measured in 35 females with a mean (+/-SD) age of 12.7 +/- 1.2 y (range: 12-15 y) who consumed from 841 +/- 153 to 2173 +/- 149 mg Ca/d. Subjects ate a basal diet that included a fortified beverage containing different amounts of calcium citrate malate. Twenty-one subjects were studied at two dietary calcium intakes with use of a crossover design. Results from a previous study in 14 subjects who were studied at only one calcium intake were included in the data analysis. Calcium retention was modeled as a nonlinear function of calcium intake that included a parameter representing mean maximal retention. Mean maximal calcium retention was 473 mg/d (95% CI: 245, 701 mg Ca/d). At higher postmenarcheal ages, maximal calcium retention was lower but the intake required to achieve this was not affected. Calcium intake explained 79% and 6%, respectively, of the variation in fecal and urinary calcium excretion. Intake of 1200 mg Ca/d, the recommended dietary allowance for calcium published in 1989, resulted in a mean calcium retention that was 57% of the maximal value (95% CI: 25%, 89%). Intake of 1300 mg Ca/d was the smallest intake that allowed some adolescent females to achieve 100% of maximal calcium retention (95% CI: 26%, 100%). These data support the idea that calcium retention plateaus at a certain calcium intake although it continues to increase at intakes > 2 g/d.

Zinc balance in adolescent females consuming a low- or high-calcium diet

There is increasing evidence that calcium intake up to the threshold amount (1480 mg/d) increases bone mass during growth. However, there is concern that such a high calcium intake may interfere with the utilization of other nutrients such as zinc, which is also important for skeletal development. The purpose of our study was to investigate the effect of long-term calcium supplementation on zinc utilization in 26 adolescent females (mean +/- SD age 11.3 +/- 0.5 y) during a 14-d period. Each day subjects consumed a metabolic diet containing 722 mg Ca and 6.3 mg Zn. Participants were randomly assigned to receive either a placebo or a calcium supplement containing 1000 mg supplemental Ca/d as calcium citrate malate. Supplementation began 15 wk before the balance period to allow for adaptation to the greater calcium intake. Mean (+/-SD) zinc balance (0.8 +/- 0.8 compared with 0.3 +/- 1.1 mg/d, P = 0.23), fecal zinc (4.3 +/- 0.6 compared with 4.7 +/- 1.4 mg/d, P = 0.27), urinary zinc (0.4 +/- 0.2 compared with 0.5 +/- 0.1 mg/d, P = 0.55), and net zinc absorption (21% compared with 15%, P = 0.33) were not significantly different between the high- and low-calcium groups. Our results suggest that increasing the recommended dietary allowance of calcium to 1500 mg/d as recommended by the National Institutes of Health consensus panel will not have adverse effects on zinc utilization in adolescent females.