Usual Calcium Intake Research Articles

Comparative Analysis of Dietary and Supplemental Intake of Calcium and Vitamin D among Canadian Older Adults with Heart Disease and/or Osteoporosis in 2004 and 2015.

Despite the role of calcium and vitamin D in osteoporosis and heart disease, little research has examined changes in the intake of calcium and vitamin D among individuals with these conditions over time. Using data from the 2004 and 2015 Canadian Community Health Surveys, we investigated changes in dietary and supplemental intake of calcium and vitamin D among Canadian older adults aged ≥ 50 years, both with and without heart disease and/or osteoporosis, between 2004 and 2015. Notable declines in dietary calcium intake occurred, particularly among non-supplement users. Surprisingly, individuals with osteoporosis and heart disease, who are at higher nutritional risk, were less likely to use calcium supplements in 2015 compared to 2004. Among calcium supplement users, those with osteoporosis or both conditions experienced significant reductions in their usual calcium intake in 2015, with an increased proportion failing to meet recommended intake levels. Conversely, vitamin D supplement users experienced a substantial rise in vitamin D intake in 2015. In 2015, only a small proportion of supplement users did not meet the recommended vitamin D intake levels. These findings underscore the importance of public health initiatives to facilitate safe increases in calcium and vitamin D intake for older adults, particularly those with heart disease and osteoporosis.

Food Sources of Fiber and Micronutrients of Concern in Infants and Children in the United Arab Emirates: Findings from the Feeding Infants and Toddlers Study (FITS) and the Kids Nutrition and Health Survey (KNHS) 2020.

We estimated the usual intakes of fiber, iron, zinc, calcium, folate, vitamin D, and vitamin A and the top foods that contribute to them among children in the UAE. Dietary intake was assessed using 24 h recalls among 5 age groups of infants and children. Foods were clustered into 54 food groups and ranked by their percentage contribution to the nutrients of interest in this study. The percentage achieving the adequate intake (AI) of fiber was negligible among all children. The top source of fiber was vegetables among children under 4 years, and white breads among those over 4 years. Only 45% of infants achieved iron adequacy, but iron standards were met by most children beyond the age of 1. The main contributors to iron intake were infant/young child formula and baby cereal in children under 4 years, while children over 4 years obtained it primarily from grains (fortified) and meat/fish. Vitamin D was inadequate across all age groups, with the percentage achieving adequacy ranging from 0 to 19% among pre-adolescents and toddlers, respectively. The top sources of vitamin D were fortified milks. Overall, nutrient inadequacies in fiber, calcium, and vitamin D highlight the need for greater intakes of whole grains and fortified dairy products in the UAE.

Calcium Intake from Food and Supplemental Sources Decreased in the Canadian Population from 2004 to 2015

In light of the publications (2008-2014) linking calcium intake, mainly from supplements, to the elevated risk of cardiovascular events, there is a need to determine if there have been any changes in usual intakes of calcium among Canadians. We aimed to examine changes in dietary and total usual intake of calcium among Canadians aged ≥1 y over the period 2004-2015. We used nutrition data from 2 nationally representative surveys conducted in 2004 and 2015 (CCHS 2004 Cycle 2.2 and CCHS-Nutrition 2015). This study included all the Canadians across 10 provinces, and the analyses were performed across different age/sex groups. We used the National Cancer Institute (NCI) method to estimate the usual intake of calcium and the prevalence of calcium inadequacy. Multiple logistic regression was performed to assess the relation between supplement uses and sociodemographic variables. From 2004 to 2015, the usual intake of calcium from food sources significantly decreased in calcium supplement nonusers (from 872±18.2mg/d to 754±18.0mg/d), but not in calcium supplement users. The contribution of calcium from the Milk and alternatives food group significantly decreased by 7.5% and 6.1% in calcium supplement users and nonusers, respectively. The prevalence of calcium supplement use significantly decreased from 2004 to 2015 in the Canadian population, from 27.5% to 22.0%. During this time, the percentage contribution of calcium from supplemental sources significantly decreased among Canadians, especially women. The prevalence of calcium inadequacy increased from 58.0% to 68.0% in supplement nonusers; however, among users of calcium supplements, the prevalence of calcium inadequacy remained at ∼31%. Calcium intake from both food and supplemental sources decreased in the Canadian population over an 11-y period, which must be addressed by policy-makers in their efforts to decrease the high prevalence of calcium inadequacy.

The association of calcium intake with osteoporotic vertebral fractures in a large Chinese cohort.

The effect of calcium on prevention of osteoporosis and related fracture which are aging issues is unclear. The aim of this study is to explore the association of calcium intake with vertebral fracture. This study enrolled 3,457 participants from China Action on Spine and Hip Status (CASH) study from 2013 and 2017. Dietary calcium intake was collected using validated food frequency questionnaires (FFQ). Vertebral fracture of CT images was defined as the primary outcome. The mean calcium intake of men and women were 522.75mg/day and 507.21mg/day, respectively. 6% reduction in the odds of fracture risk was observed per 100 unit increase of calcium intake from food among females (OR, 0.94; 95% CI, 0.89-0.99), but results among males were not significant. We divided calcium intake into quintiles when modelling its associations with fracture risk, negative associations of fracture risk with calcium intake were found among females. In a population with low usual calcium intake, higher dietary calcium intake was associated with fewer vertebral fracture in women and that no such association was seen in men.

Simulated effects of home fortification of complementary foods with micronutrient powders on risk of inadequate and excessive intakes in West Gojjam, Ethiopia

Home fortification of complementary foods (CFs) with multiple micronutrient powders (MNPs) is being scaled up in various countries, but little is known about the prevailing complementary feeding practices and the type and nutrient gaps to be filled with MNPs. The present study evaluated the complementary feeding practices of young children and simulated the risk of inadequate and excessive intakes associated with home fortification with MNPs. We have assessed the sociodemographic status, anthropometry, and complementary feeding practices of young children (N=122) in Mecha district, rural Ethiopia. Using a 2-day, quantitative 24-hr recall, usual intakes of energy, protein, iron, zinc, and calcium were estimated. The risks of inadequate and excessive iron and zinc intakes with or without home fortification scenarios were assessed. The simulations considered intakes from CFs assuming average breast milk contributions and additional nutrients provided by the MNPs. Stunting was highly prevalent (50%) and was associated with a lower dietary diversity (P=.009) and nutrient intakes from the CFs. Median energy, zinc, and calcium intakes were below the estimated needs from CFs; protein needs were met. Median dietary iron intake appeared adequate, but 76%, 95% CI [68%, 84%], of children had inadequate intake (assuming low bioavailability), whereas another 8%, 95% CI: [3%, 13%], had excessive intakes. Simulation of daily and alternative day's fortification with MNP decreased the prevalence of inadequate iron and zinc intake but significantly increased the risk of excessive intakes that remained unacceptably high for iron (>2.5%). Untargeted MNP interventions may lead to excessive intakes, even in settings where poor complementary feeding practices are prevalent.

Usual Intake of Key Minerals among Children in the Second Year of Life, NHANES 2003-2012.

Iron, calcium, and zinc are important nutrients for the young, developing child. This study describes the usual intake of iron, calcium, and zinc among US children in the second year of life using two days of dietary intake data from the National Health and Nutrition Examination Survey 2003–2012. Estimates were calculated using PC-SIDE to account for within and between person variation. Mean usual iron, calcium, and zinc intakes were 9.5 mg/day, 1046 mg/day, and 7.1 mg/day, respectively. Over a quarter of children had usual iron intakes less than the Recommended Dietary Allowance (RDA) (26.1%). Eleven percent of children had usual calcium intakes below the RDA and over half of children had usual intakes of zinc that exceeded the tolerable upper intake level (UL). Two percent or less had usual intakes below the Estimated Average Requirement (EAR) for iron, calcium, and zinc. Our findings suggest that during 2003–2012, one in four children and one in ten children had usual intakes below the RDA for iron and calcium, respectively. Children who are not meeting their nutrient requirements could be at increased risk for developing deficiencies such as iron deficiency or could lead to a shortage in adequate nutrients required for growth and development. One in every two children is exceeding the UL for zinc, but the interpretation of these estimates should be done with caution given the limited data on adverse health outcomes. Continued monitoring of zinc intake and further assessment for the potential of adverse health outcomes associated with high zinc intakes may be needed.

Consumo de Calcio Dietario en un Grupo de Estudiantes de la Universidad Nacional Mayor de San Marcos 1998

<span>OBJETIVOS: Evaluar la ingesta de calcio en un grupo de estudiantes de la UNMSM y estimar el probable riesgo de salud al que están expuestos. MATERIALES Y MÉTODOS: Se midió el consumo actual de calcio mediante un recordatorio de 24 horas y el consumo de calcio habitual mediante una encuesta de frecuencia de consumo semicuantitativa adaptada del International Vitamin A Consultative Group, estableciéndose a través de ella niveles de riesgo a largo plazo. RESULTADOS: En las 168 encuestas válidas, el consumo presente de calcio fue 557 ± 384 mg Ca+2/d, mediana 473 mg Ca+2/d. El 86% de los estudiantes tuvo un consumo inadecuado de calcio. El consumo de calcio fue similar en ambos géneros (p >0,05). La distribución de la población según niveles de riesgo fue: riesgo bajo 0,6%, riesgo mediano 11% y riesgo alto 88%. CONCLUSIÓN: El consumo de calcio estuvo por debajo de lo recomendado y la mayoría se encuentra dentro del grupo de riesgo alto a largo plazo.</span>

Calcium and Vitamin D Disparities Are Related to Gender, Age, Race, Household Income Level, and Weight Classification but Not Vegetarian Status in the United States: Analysis of the NHANES 2001–2008 Data Set

Objective: Adequate calcium and vitamin D intakes are critical during all life cycle stages. This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be targeted toward populations who are truly in need. Methods: The National Cancer Institute method was used to estimate usual intakes of calcium and vitamin D by source and compared usual intakes to the established Dietary Reference Intakes for U.S. residents aged ≥4 years using National Health and Nutrition Examination Survey 2001–2002, 2003–2004, 2005–2006, and 2007–2008 data sets. Results: These results showed for the first time that low-income, overweight, and/or obese minority populations may be at greater risk of calcium and vitamin D insufficiency. Children aged 4–8 years were more likely to obtain recommended dairy intakes compared with older children and adults of all ages. Food intakes of calcium decreased with age in adults. Adults who used supplemental calcium showed a lower prevalence of insufficiency. Calcium and vitamin D intakes from food and dietary supplements were not related to vegetarian status. Excessive intakes of calcium and vitamin D above the tolerable upper intake level were low among all studied populations and “overnutrification” was not widely present across these analyses. Conclusions: Age- and gender-specific supplementation and modest use of fortification with calcium and vitamin D may be warranted for targeting certain subpopulations, particularly older adults, teenagers, minorities, and those who are low income and overweight and/or obese. Practical Application: This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be better targeted. Low-income, overweight, and/or obese minority populations may be at a greater risk of calcium and vitamin D insufficiency.

A Measurement Error Approach to Assess the Association between Dietary Diversity, Nutrient Intake, and Mean Probability of Adequacy1–4

Collection of dietary intake information requires time-consuming and expensive methods, making it inaccessible to many resource-poor countries. Quantifying the association between simple measures of usual dietary diversity and usual nutrient intake/adequacy would allow inferences to be made about the adequacy of micronutrient intake at the population level for a fraction of the cost. In this study, we used secondary data from a dietary intake study carried out in Bangladesh to assess the association between 3 food group diversity indicators (FGI) and calcium intake; and the association between these same 3 FGI and a composite measure of nutrient adequacy, mean probability of adequacy (MPA). By implementing Fuller’s error-in-the-equation measurement error model (EEM) and simple linear regression (SLR) models, we assessed these associations while accounting for the error in the observed quantities. Significant associations were detected between usual FGI and usual calcium intakes, when the more complex EEM was used. The SLR model detected significant associations between FGI and MPA as well as for variations of these measures, including the best linear unbiased predictor. Through simulation, we support the use of the EEM. In contrast to the EEM, the SLR model does not account for the possible correlation between the measurement errors in the response and predictor. The EEM performs best when the model variables are not complex functions of other variables observed with error (e.g. MPA). When observation days are limited and poor estimates of the within-person variances are obtained, the SLR model tends to be more appropriate.

No effects of low and high consumption of dairy products and calcium supplements on body composition and serum lipids in Puerto Rican obese adults

Objective Epidemiologic studies have shown that a high calcium intake is related to lower body weight, fat, and serum lipids in obese individuals. However, clinical studies have shown inconclusive results. The present study was conducted to determine if dairy or calcium supplementation alters body composition or serum lipids in Puerto Rican obese adults without dietary energy restriction or exercise. Methods A 21-wk randomized clinical trial was conducted in 30 obese adults, aged 21–50 y, with usual calcium intakes <700 mg/d. Subjects were randomly assigned to the following: high dairy (∼1300 mg/d of calcium from dairy products by substituting foods); high calcium (∼1300 mg/d of calcium; ∼700 mg/d from diet and 600 mg/d from a supplement); or placebo. Subjects were asked to continue their established dietary intake (except for the high dairy group) and their physical activity during the study. Body weight was measured monthly; body fat, bone, and serum lipids (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triacylglycerol) were measured at baseline and at 21 wk. Pairwise differences in study endpoints among the groups were assessed using ANOVA and post-hoc analysis. Results Grand mean calcium intake was 1200 ± 370 (median 1187) mg/d in the high dairy group, 1171 ± 265 (median 1165) mg/d in the high calcium group, and 668 ± 273 (median 691) mg/d in the control group, which was significantly lower compared to the two treatment groups ( P < 0.001). There were no significant group effects in any of the outcome variables. Conclusion A high dairy or calcium diet alone did not alter body composition or serum lipids profile in a sample of Puerto Rican obese adults.

Evidence of dietary inadequacy in adults with chronic spinal cord injury

Cross-sectional, observational study. Estimate prevalence of inadequate dietary intakes in community-dwelling men and women with chronic spinal cord injury (SCI). Ontario, Canada. In-home interviewer administered multiple-pass 24-h recalls were collected at baseline (n=77) and at 6 months (n=68). Dietary intake (adjusted to remove intra-individual variation) was compared with the dietary reference intakes (DRIs), specifically the estimated average requirement, adequate intake (AI) and acceptable macronutrient distribution ranges (AMDR). Macronutrient intakes, as percentages of daily energy, for men (16% protein, 52% carbohydrate, 30% fat) and women (17% protein, 53% carbohydrate, 28% fat) were within the AMDR. Despite this, inadequate intakes for men (n=63) and women (n=14) were determined for vitamin A (92 and 57%), magnesium (89 and 71%), folate (75 and 79%), zinc (71 and 29%), vitamin C (52 and 14%), thiamine (22 and 14%), vitamin B12 (6 and 29%), riboflavin (5% men) and vitamin B6 (24% men). Mean usual intakes of fiber, vitamin D, calcium and potassium fell below the AI for men and women. In all, 53% of participants consumed a micronutrient supplement in the previous 24 h at baseline and at 6 months-specifically, calcium (29, 19%), multivitamin (26, 25%), vitamin D (22, 12%) and vitamin C (9, 6%). Our results show numerous nutrient inadequacies, relative to the DRIs, for men and women with SCI. This study has important implications for clinical dietetic practice in the SCI population.

Urinary CTX in children from 6 to 10 years as a function of age and usual calcium intake

Urinary CTX in children from 6 to 10 years as a function of age and usual calcium intake

Effect of Prebiotic Supplementation and Calcium Intake on Body Mass Index

To assess the effects of a prebiotic supplement and usual calcium intake on body composition changes during pubertal growth. We measured anthropometry and body fat with dual-energy X-ray absorptiometry in 97 young adolescents who were randomized to receive either a daily prebiotic supplement or maltodextrin (control) for 1 year. Subjects who received the prebiotic supplement had a smaller increase in body mass index (BMI) compared with the control group (BMI difference 0.52 +/- 0.16 kg/m2, P = .016), BMI Z-score (difference 0.13 +/- 0.06, P = .048) and total fat mass (difference 0.84 +/- 0.36 kg, P = .022). The prebiotic group maintained their baseline BMI Z-score (0.03 +/- 0.01, paired t test, P = .30), although BMI Z-score increased significantly in the control group (0.13 +/- 0.03, P < .001). In considering subjects whose usual calcium intake was > or = 700 mg/d, those who received the prebiotic supplement had a relative change in BMI that was 0.82 kg/m2 less than control subjects (P < .01), and BMI Z-score that was 0.20 less than control subjects (P = .003). Differences tended to be maintained 1 year after supplementation was stopped. Prebiotic supplementation and avoidance of a low calcium intake can have significant effects in modulating BMI and other body composition changes during puberty.

Dairy Consumption and Related Nutrient Intake in African-American Adults and Children in the United States: Continuing Survey of Food Intakes by Individuals 1994-1996, 1998, and the National Health and Nutrition Examination Survey 1999-2000

Objective To establish the first baseline of dairy and related nutrient intake in African Americans, an at-risk population of public health concern in the United States. To document dairy consumption in African Americans by age and sex during 1994-1998 and 1999-2000 and compare it with concomitant dairy, calcium, and related nutrient intakes in non–African-American adults and children. Design Duplicate and single 24-hour recalls were analyzed to determine dietary intake during the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 (CSFII), and the National Health and Nutrition Examination Survey 1999-2000 (NHANES), respectively. Subjects African Americans and non–African Americans of all ages who participated in CSFII 1994-1996, 1998, and in NHANES 1999-2000; both surveys are a stratified random sample of the total civilian, noninstitutionalized US population. Statistical Analysis Dairy food and nutrient intake per day were quantified according to age, sex, and ethnicity/race from CSFII 1994-1996, 1998, and NHANES 1999-2000. For NHANES, mean intakes from 1-day food records were sample-weighted, and standard errors estimated by the Taylor linearization method of SUDAAN (version 9.0, 2004, RTI International, Research Triangle Park, NC). Usual daily intakes of calcium, magnesium, and phosphorus were based on 2-day intake data from CSFII 1994-1996, 1998, and calculated using Software for Intake Distribution from Iowa State University. The percentage of individuals categorized as not meeting the Estimated Average Requirement for magnesium and phosphorus were calculated in the same way. Results CSFII 1994-1996, 1998, and NHANES 1999-2000 data both show that African Americans in all age groups consume fewer mean servings per day of total dairy, milk, cheese, and yogurt than non–African Americans, and have lower mean intakes of calcium, magnesium, and phosphorus. Significant differences were seen for men and women. Conclusions In this analysis, young African-American women did not meet Dietary Reference Intakes for phosphorus, and all African Americans did not meet Dietary Reference Intakes for calcium and magnesium. African Americans in all age groups did not meet dairy recommendations from the 2005 US Dietary Guidelines and the 2004 National Medical Association Consensus Report on the role of dairy and dairy nutrients in the diet of African Americans.

Calcaneal ultrasound analysis of Nigerian adults with type 2 diabetes

Objective : Type 2 diabetes is a major chronic disease in northern Nigeria. Although type 2diabetes is usually associated with increased bone mineral density, we were interested in estimating the bone mineral density of patients with type 2 diabetes in a region of the world where the usual calcium intake is well below the recommended dietary recommendations. Research Design and Methods : A total of 50 patients (25M/25F) with type 2 diabetes and 50 healthy controls (20M/30F) were recruited at the Jos University Teaching hospital in Jos, Nigeria. Information regarding age, weight, height, medication use and duration of disease were obtained. Body composition analysis to determine lean body mass and body fat was performed using bioelectrical impedance analysis. Bone quality was assessed using quantitative ultrasound of the calcaneus. Glucose control was monitored using fasting glucose concentrations. Results : Both male and females subjects with type 2 diabetes had superior ultrasound parameters including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) relative to controls. However, there were no significant differences in these parameters between the subjects with diabetes and the controls. No associations between ultrasound parameters and body mass index or body composition were found for either the diabetic subjects or controls. A non-significant trend was observed between glucose control and SI for the female diabetic subjects. A statistically 2 significant correlation was obtained between SI and duration of disease but only for the female diabetic subjects. Conclusions : Calcaneal ultrasound is a relatively inexpensive means for monitoring bone quality in patients with type 2 diabetes. The more favorable bone ultrasound parameters observed for patients with type 2 diabetes may be the result of the bonepromoting effects of hyperinsulinemia. Keywords : type 2 diabetes, bone density, calcaneal ultrasound, stiffness index, hyperglycemia, Nigeria Highland Medical Research Journal Vol. 3(2) 2005: 1-14

WITHDRAWN: Calcium supplementation on bone loss in postmenopausal women.

Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. To assess the effects of calcium on bone density and fractures in postmenopausal women. We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.

Review: calcium supplementation has a small positive effect on bone mineral density but not fractures in postmenopausal women

Shea B, Wells G, Cranney A, et al . Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2004;(1):CD004526. Q In postmenopausal women, what is the effect...

Girls on a high-calcium diet gain weight at the same rate as girls on a normal diet: A pilot study

Objective To determine whether pubertal girls assigned to calcium-rich diets or their usual calcium intakes differ significantly in weight gain. Design This is a pilot study conducted on data from an experimental research project. Subjects/Setting The sample included 59 girls, 9 years of age, from Omaha metropolitan communities. Intervention Participants were randomly assigned to a calcium-rich diet supplying at least 1,500 mg of calcium per day or their usual diet. Main outcome measure The outcome measure was change in weight during 2 years of study. Statistical analyses Data were analyzed using descriptive statistics, Mann-Whitney U, t tests of paired and independent samples, and analysis of covariance. Results The girls in the calcium-rich diet group had a mean (±standard deviation) calcium intake of 1,656±191 mg/day, whereas the girls on their usual diets averaged 961±268 mg/day. Although the participants in the treatment group consumed nearly twice as much dietary calcium—primarily from dairy foods—they did not have greater increases in body weight, body mass index, or fat or lean mass than the control group. These findings held when the data were grouped by tertile of calcium intake. Compared with girls on their usual diets, the girls who consumed the calcium-rich diet also significantly increased their intake of essential nutrients. Conclusion We conclude that calcium-rich diets do not cause excessive weight gain in pubertal girls but do contribute positively to overall nutrition. These findings provide support for programs to promote calcium-rich diets, which are critical for attaining peak bone mass.

VII. Meta-Analysis of Calcium Supplementation for the Prevention of Postmenopausal Osteoporosis

To summarize controlled trials examining the effect of calcium on bone density and fractures in postmenopausal women. We searched MEDLINE and EMBASE up to 1998 and the Cochrane Controlled Register up to 2000, and we examined citations of relevant articles and proceedings of international meetings. We contacted osteoporosis investigators to identify additional studies, and primary authors for unpublished data. We included 15 trials (1806 patients) that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm, or recorded the number of fractures, and followed patients for at least 1 yr. For each trial, three independent reviewers assessed the methodological quality and extracted data. We found calcium to be more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% [95% confidence interval (CI) 0.24-3.86] for total body bone density, 1.66% (95% CI 0.92-2.39) for the lumbar spine, 1.64% (95% CI 0.70-2.57) for the hip, and 1.91% (95% CI 0.33-3.50) for the distal radius. The relative risk (RR) of fractures of the vertebrae was 0.77, with a wide CI (95% CI 0.54-1.09); the RR for nonvertebral fractures was 0.86 (95% CI 0.43-1.72). Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but do not meaningfully address the possible effect of calcium on reducing the incidence of nonvertebral fractures.

Nutrient Intakes and Adequacy Among an Older Population on the Eastern Shore of Maryland: The Salisbury Eye Evaluation

Objective To describe the reported usual dietary intakes of the participants in the Salisbury Eye Evaluation (SEE) project and to estimate the prevalence of inadequate nutrient intakes using the probability approach. Subjects/setting A representative sample of elderly residents (aged 65 to 85 years) of Salisbury, Md. Design Cross-sectional survey, using a food frequency questionnaire to obtain nutrient intakes. We estimated energy and protein; percent of energy intake from carbohydrates, fat, and protein; as well as usual intakes of cholesterol, vitamin A, carotenoids, vitamin C, thiamin, riboflavin, vitamin B-6, vitamin E, niacin, iron, calcium, zinc, and folate. Estimates of prevalence of inadequate nutrient intakes were calculated using the probability approach among the 2,655 participants with complete nutrient intake information. Statistical analyses performed The χ 2 test for independence and analysis of variance. A P<.05 was considered significant in a 2-sided test. Result On average, white participants of both genders reported higher mean energy and nutrient intakes than did black participants. Zinc had the highest estimated prevalences of inadequacy across all gender and race categories, followed by calcium, vitamin E, and vitamin B-6. Vitamin C, with estimated prevalences of inadequacy lower than 13%, and folate, with prevalences lower than 17%, had the lowest estimated prevalences of inadequacy across all gender, race, and age categories. Conclusions In this population, there are race differences in estimated prevalences of inadequate nutrient intake. According to the current nutrient requirements for adults aged 51 years and older, many elderly persons have inadequate dietary intakes of key nutrients. J Am Diet Assoc. 1999;99:564–571.