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Low calcium and vitamin D intake in healthy children and adolescents and their correlates

Abstract

Background: Optimal dietary calcium and possibly vitamin D intake throughout childhood and adolescence may enhance bone mineral accrual. Little data on the intake of these nutrients in Mediterranean countries exist, and predictors of their suboptimal intake are not well defined.

Objective: To evaluate systematically the effect of gender, lifestyle factors, and socioeconomic status on mean calcium and vitamin D intake in healthy school children and adolescents from Lebanon.

Design: A total of 385 students aged 10–16 y were selected from four public and four private schools between Fall 1999 and Spring 2000. Information on calcium and vitamin D intake, through a semiquantitative food frequency questionnaire that was validated against a 7-day daily record, and on socioeconomic and lifestyle factors were obtained.

Results: Only 12% of the students met the adequate intake (AI) recommendation of 1300 mg of calcium/day, and only 16% met the AI recommendation of 200 IU of vitamin D/day. Boys had a significantly higher mean daily calcium intake than girls. Socioeconomic status as assessed by children's pocket money was a predictor of higher calcium and vitamin D intake. Eating breakfast and physical activity were other correlates of daily calcium and vitamin D intake.

Conclusions: Only a minority of students in our study met the AI for calcium and vitamin D. Gender, lifestyle factors, and socioeconomic status were significant predictors of calcium and vitamin D intake. Our findings have important implications regarding the institution of dietary public health strategies to promote skeletal health in Mediterranean countries during a critical time for bone mass accrual.

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References

  • American Academy of Pediatrics. Committee on nutrition (1999): Calcium requirements of infants, children, and adolescents. Pediatrics 104, 1152–1156.

  • Angus RM, Sambrook PN, Pocock NA & Eisman JA (1989): A simple method for assessing calcium intake in Caucasian women. J. Am. Diet. Assoc. 89, 209–214.

    CAS  PubMed  Google Scholar 

  • Appel L, Moore T, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH & Karanja N (1997): A clinical trial of the effects of dietary patterns on blood pressure. N. Engl. J. Med. 336, 1117–1124.

    Article  CAS  Google Scholar 

  • Baba NH, Hamadeh S & Adra N (1991): Nutritional status of Lebanese school children from different socioeconomic background. Ecol. Food Nutr. 25, 183–192.

    Article  Google Scholar 

  • Baba NH, Shaar K, El-Sheikh Ismail L & Adra N (1996): Comparison of nutritional status of preschool children at day care centers and at home from different socioeconomic backgrounds in Beirut. J. Hum. Nutr. Diet. 9, 89–103.

    Article  Google Scholar 

  • Barr SI (1994): Associations of social and demographic variables with calcium intakes of high school students. J. Am. Diet. Assoc. 94, 260–266.

    Article  CAS  Google Scholar 

  • Bonjour JP, Carrie AL, Ferrari S, Clavien I, Solsman D, Theintz G & Rizzoli R (1997): Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized double-blind, placebo controlled trial. J. Clin. Invest. 99, 1287–1294.

    Article  CAS  Google Scholar 

  • Bonjour JP, Slosman D, Barclay D & Rizzoli R (1999): A significant effect of calcium-enriched foods on bone mineral mass gain is maintained more than 3 years after discontinuation of the intervention. J. Bone. Miner. Res. 14 (Suppl 1), S311 (Abstract).

    Google Scholar 

  • Bonjour JP, Theintz G, Buchs B, Slosman D & Rizzoli R (1991): Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J. Clin. Endorinol. Metab. 73, 555–563.

    Article  CAS  Google Scholar 

  • Boot AM, deRidder MAJ, Pols HA, Krenning EP & deMuinck Keizer-Schrama SMPF (1997): Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J. Clin. Endocrinol. Metab. 82, 57–62.

    CAS  PubMed  Google Scholar 

  • Bouillon R, Carmeliet G, Daci E, Segaert S & Verstuyf A (1998): Vitamin D metabolism and action. Osteoporos. Int. 8 (Suppl), S13–S19.

    Article  CAS  Google Scholar 

  • Bowering J & Clancy KL (1986): Nutritional status of children and teenagers in relation to vitamin and mineral use. J. Am. Diet. Assoc. 86, 1033–1038.

    CAS  PubMed  Google Scholar 

  • Cadogan J, Eastell R, Jones N & Barker ME (1997): Milk intake and bone mineral acquisition in adolescent girls. BMJ 315, 1255–1260.

    Article  CAS  Google Scholar 

  • Carruth BR & Skinner JD (2001): The role of dietary calcium and other nutrients in moderating body fat in preschool children. Int. J. Obes. Relat. Metab. Disord. 25, 559–566.

    Article  CAS  Google Scholar 

  • Chan GM, Hoffman K & McMurray M (1995): Effect of dairy products on bone and body composition in pubertal girls. J. Pediatr. 126, 551–556.

    Article  CAS  Google Scholar 

  • Cruz JA (2000): Dietary habits and nutritional status in adolescents over Europe-Southern Europe. Eur. J. Clin. Nutr. 54 (Suppl 1), S29–S35.

    Article  CAS  Google Scholar 

  • Dietary Reference Intakes reports, seewww.nap.edu.

  • Docio S, Riancho JA, Perez A, Olmos JM, Amado JA & Gonzallez-Macias J (1998): Seasonal deficiency of vitamin D in children: a potential target for osteoporosis preventing strategies. J. Bone Miner. Res. 13, 544–548.

    Article  CAS  Google Scholar 

  • Eastell R & Lambert H (2002): Diet and healthy bones. Calcif. Tissue Int. 70, 400–404.

    Article  CAS  Google Scholar 

  • El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Chahine C, Kizirian A & Tannous R (2001): Hypovitaminosis D in healthy school children. Pediatrics 107, E53.

    Article  CAS  Google Scholar 

  • Fleming KH & Heimbach JT (1994): Consumption of calcium in the US: Food sources and intake levels. J. Nutr. 124, 1426S–1430S.

    Article  CAS  Google Scholar 

  • Ghatge KD, Lambert HL, Barker ME & Eastell R (2001): Bone mineral gain following calcium supplementation in teenage girls is reversed two years after withdrawal of the supplement. J. Bone. Miner. Res. 16 (Suppl 1), S173 (Abstract).

    Google Scholar 

  • Guillemant J, Cabrol S, Allemandou A, Peres G & Guillemant S (1995): Vitamin D dependent seasonal variation of PTH in growing male adolescents. Bone 17, 513–516.

    Article  CAS  Google Scholar 

  • Guillemant J, Taupin HTLe, Taright N, Alemandou A, Peres G & Guillemant S (1999): Vitamin D status during puberty in French healthy male adolescents. Osteoporos. Int. 10, 222–225.

    Article  CAS  Google Scholar 

  • Hansen MA, Overgaard K, Riis BJ & Christiansen C (1991): Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. Br. Med. J. 303, 961–964.

    Article  CAS  Google Scholar 

  • Harries S, Soteriades E, Coolidge JAS, Mudgal S & Dawson-Hughes B (2000): Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J. Clin. Endocrin. Metab. 85, 4125–4130.

    Google Scholar 

  • Ilich JZ, Hsieh LC, Tzagournis MA & Matkovic V (1994): Validation of food frequency method for assessing calcium intake in children: comparison with 3-day dietary records. Faseb. J. 8, A179 (Abstract).

    Google Scholar 

  • Institute of Medicine, Food and Nutrition Board (1997): Dietary Reference. Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington DC: National Academy Press.

  • Iuliano-Burns S, Whiting SJ, Faulkner RA & Bailey DA (1999): Levels, sources, and seasonality of dietary calcium intake in children and adolescents enrolled in the university of Saskatchewan pediatric bone mineral accrual study. Nutr. Res. 19, 1471–1483.

    Article  CAS  Google Scholar 

  • James WP, Nelson M, Ralph A & Leather S (1997): The contribution of nutrition to inequalities in health. BMJ 314, 1545–1549.

    Article  CAS  Google Scholar 

  • Johnston CC, Miller IZ, Slemenda CW, Reister TK, Hui S, Christian JC & Peacock M (1992): Calcium supplementation and increases in bone mineral density in children. N. Engl. J. Med. 327, 82–87.

    Article  Google Scholar 

  • Krall EA & Dawson-Hughes B (1993): Heritable and lifestyle determinants of bone mineral density. J. Bone Miner. Res. 8, 1–9.

    Article  CAS  Google Scholar 

  • Lee WT, Leung SS, Leung DM, Tsang HS, Lau J & Cheng JC (1995): A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children. Br. J. Nutr. 74, 125–139.

    Article  CAS  Google Scholar 

  • Lee WTK, Leung SS, Wang SH, Xu YC, Zeng WP, Lau J, Oppenheimer SJ & Cheng JC (1994): Double-blind controlled calcium supplementation and bone mineral accretion in children accustomed to low calcium diet. Am. J. Clin. Nutr. 60, 744–750.

    Article  CAS  Google Scholar 

  • Lehtonen-Veromaa M, Mottonen T, Irjala K, Karkainen D, Lamberg-Allardt C, Hakols P & Viikari J (1999): Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur. J. Clin. Nutr. 53, 746–751.

    Article  CAS  Google Scholar 

  • Lehtonen-Veromaa M, Mottonen T, Nuotio I, Irjala K, Leinao A & Viikari J (2002): Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Am. J. Clin. Nutr. 76, 1446–1453.

    Article  CAS  Google Scholar 

  • Llyod T, Andon MB, Rollings N, Martel JK, Laudis JR, Demers LM, Eggli DF, Kieselhorst K & Kulin HE (1993): Calcium supplementation and bone mineral density in adolescent girls. JAMA 270, 841–844.

    Article  Google Scholar 

  • Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW & Sahyoun NR (2002): Serum 25-hydroxy vitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30, 771–777.

    Article  CAS  Google Scholar 

  • Looker AC, Sempos CT, Johnson CL & Yetley EA (1987): Comparison of dietary intakes and iron status of vitamin–mineral supplement users and non-users, aged 1–19 years. Am. J. Clin. Nutr. 46, 665–672.

    Article  CAS  Google Scholar 

  • Mahan LK & Escott-Stump S (1996): Krause's Food, Nutrition, and Diet Therapy, 9th Edition. W.B. Saunders Company: Philadelphia, USA.

    Google Scholar 

  • Matkovic VJT, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, Andon MB, Smith KT & Heaney RP (1994): Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. J. Clin. Invest. 93, 799–808.

    Article  CAS  Google Scholar 

  • Merrilees MJ, Smart EJ, Gilchrist NL, Frampton C, Turner JG, Hooke E, March RL & Maguire R (2000): Effect of dairy food supplements on bone mineral density in teenage girls. Eur. J. Nutr. 39, 256–262.

    Article  CAS  Google Scholar 

  • National Institutes of Health Consensus Conference (1994): NIH consensus development panel on optimal calcium intake. JAMA 272, 1942–1948.

  • Nguyen TV, Howard GM, Kelly PJ & Eisman JA (1998): Bone mass, lean mass and fat mass: same genes or same environment? Am. J. Epidemiol. 147, 3–16.

    Article  CAS  Google Scholar 

  • NHANES III: http://www.cdc.gov/nchs/data/series/sr_11/sr11_245.pdf.

  • Oliveri MB, Ladizesky M, Mautalen CA, Alonso A & Martinez L (1993): Seasonal variations of 25 hydroxyvitamin D and parathyroid hormone in Ushuaia (Argentina), the southernmost city in the world. J. Bone Miner. Res. 20, 99–108.

    Article  CAS  Google Scholar 

  • Outila TA, Karkkainen MUM & Lamberg-Allardt CJE (2001): Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral densirty. Am. J. Clin. Nutr. 74, 206–210.

    Article  CAS  Google Scholar 

  • Pellet PL & Shadaverian S (1970): Food Composition: Tables for Use in the Middle East, 2nd Edition, Beirut, Lebanon: Heidelberg Press.

    Google Scholar 

  • Rockett HR, Wolf AM & Colditz GA (1995): Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J. Am. Diet. Assoc. 95, 336–340.

    Article  CAS  Google Scholar 

  • Sempos CT, Liu K & Ernst N (1999): Food and nutrient exposures: what to consider when evaluating epidemiologic evidence. Am. J. Clin. Nutr. 69 (Suppl), 1330S–1338S.

    Article  CAS  Google Scholar 

  • Stang J, Story MT, Harnack L & Neumark-Sztainer D (2000): Relationships between vitamin and mineral supplement use, dietary intake, and dietary adequacy among adolescents. J. Am. Diet. Assoc. 100, 905–910.

    Article  CAS  Google Scholar 

  • Thacher TD, Fisher PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC & Chang GM (1999): A comparison of calcium, vitamin D or both for nutritional rickets in Nigerian children. N. Engl. J. Med. 341, 563–568.

    Article  CAS  Google Scholar 

  • Weaver CM, Peacock M & Johnston CC (1999): Adolescent nutrition in the prevention of postmenopausal osteoporosis. J. Clin. Endocrinol. Metab. 84, 1839–1843.

    Article  CAS  Google Scholar 

  • Wyatt CJ & Triana Tejas MA (2000): Nutrient intake and growth of preschool children from different socioeconomic regions in the city of Oaxaca, Mexico. Ann. Nutr. Metab. 44, 14–20.

    Article  CAS  Google Scholar 

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Acknowledgements

We acknowledge the support from the administrators, parents, and students from all schools who participated in the survey and made the study possible.

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Correspondence to G A El-Hajj Fuleihan.

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Salamoun, M., Kizirian, A., Tannous, R. et al. Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr 59, 177–184 (2005). https://doi.org/10.1038/sj.ejcn.1602056

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