Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status

BACKGROUND: Longitudinal data regarding the influence of beverage intakes on calcium adequacy are lacking. OBJECTIVE: This study evaluated calcium intake from ages 5 to 9 y as a function of mother-daughter beverage choices and as a predictor of bone mineral status. DESIGN: Intakes of energy, calcium, milk, sweetened beverages, fruit juices, and non-energy-containing beverages were measured with the use of three 24-h dietary recalls in 192 non-Hispanic white girls aged 5, 7, and 9 y and their mothers. Calcium intakes from ages 5 to 9 y were categorized as either meeting or falling below recommended adequate intakes (AIs). The girls' bone mineral status was assessed with dual-energy X-ray absorptiometry at age 9 y. RESULTS: The mean 5-y calcium intake was related to bone mineral density at age 9 y (beta = 0.27, P < 0.001). The girls who met the AI for calcium were not heavier (P = 0.83) but had higher energy intakes (P < 0.0001) than did the girls who consumed less than the AI. Compared with the girls who consumed less than the AI, the girls who met the AI consumed, on average, almost twice as much milk (P < 0.0001), had smaller decreases in milk intake (P < 0.01), and consumed 18% less sweetened beverages (P < 0.01) from ages 5 to 9 y; the 2 groups did not differ significantly in juice and non-energy-containing beverage intakes. The girls who met the AI were also served milk more frequently than were the girls who consumed less than the AI (P < 0.0001) and had mothers who drank milk more frequently (P < 0.01) than did the mothers of the girls who consumed less than the AI. CONCLUSIONS: These findings provide new longitudinal evidence that calcium intake predicts bone mineral status during middle childhood and reflects mother-daughter beverage choice patterns that are established well before the rapid growth and bone mineralization observed in adolescence.     

Girls' calcium intake is associated with bone mineral content during middle childhood

We examined longitudinally the association between calcium intake and total body bone mineral content (TBBMC) in 151 non-Hispanic white girls. Intakes of dairy, energy, and calcium were assessed using three 24-h dietary recalls in girls at ages 5, 7, 9, and 11 y. We assessed their total-body bone mineral content with dual-energy X-ray absorptiometry at ages 9 and 11 y. Dairy foods comprised the major contributor (70%) to calcium intake over the 6-y period; 28% of calcium came from other foods, and 2% from supplements. By age 9 and 11 y, the majority of girls did not meet calcium recommendations. Higher calcium intake at ages 7 and 9 y was associated with higher TBBMC at age 11 y. Calcium intake at age 9 y was also positively associated with TBBMC gained from age 9 to 11 y. Calcium intake at age 11 y was not correlated with TBBMC at the same age. Relations between calcium intake and TBBMC did not differ for total calcium and for calcium from dairy sources, likely reflecting the fact that dairy products were the major source of calcium in this sample. Results from the present study provide new longitudinal evidence that calcium intake, especially calcium from dairy foods, can have a favorable effect on girls' TBBMC during middle childhood.     

Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls' diets

Milk intake constitutes an important source of dietary calcium for young girls but declines throughout childhood. Recent work shows that the intake of soft drinks may contribute to this decline. Influences on the apparent tradeoff between soft drinks and milk in young girls' diets are not well described. The objective of this research was to test a model depicting maternal beverage choices as predictors of their daughters' milk and soft drink intake. A structural equation model describing maternal influences on daughters' milk, soft drink and calcium intakes was tested using data from 180 non-Hispanic, white families with 5-y-old daughters. Mothers' calcium, milk and soft drink intakes were evaluated as predictors of their daughters' intakes. Mothers' and daughters' soft drink intakes were also examined as predictors of their own milk and calcium intakes. The model provided a good fit to the data, revealing mother-daughter similarities in beverage intake. Mothers who drank milk more frequently had daughters who drank milk more frequently and drank fewer soft drinks. For both mothers and daughters, soft drink consumption was negatively related to both milk and calcium intake. This research provides evidence that mothers' beverage choices influence the tradeoff between milk and soft drinks in their daughters' diets. In particular, mothers' milk and soft drink intakes may affect their daughters' calcium adequacy in early childhood by influencing the frequency with which their daughters consume those beverages.     

Ethnicity and nutrition of adolescent girls in Hawaii

OBJECTIVE: To describe the ethnicity and nutrition of adolescent girls in Hawaii. DESIGN: This was a cross-sectional survey. SUBJECTS: Girls, aged 9 to 14 years, were identified from the membership files of Kaiser Permanente Hawaii, a large Hawaii health maintenance organization. MAIN OUTCOME MEASURES: Nutrient and food group intakes were compared against recommended intakes, physical activity levels, and anthropometric measurements of height, weight, body mass index (BMI), and subscapular and iliac skinfold thicknesses. STATISTICAL ANALYSIS PERFORMED: Asian girls, girls of mixed ethnicity, and white girls were compared using analysis of variance. RESULTS: Although Asian girls weighed the least and were the most sedentary, white girls had the lowest BMIs. Mixed ethnicity girls had the highest weights, BMIs, and subscapular and iliac skinfold thicknesses. No significant differences were found in major macronutrient intake. However, mixed ethnicity and Asian girls had lower fiber, iron, folate, and calcium intake than white girls. All groups met recommendations for iron intake, whereas none met fiber and calcium recommendations. All girls met folate recommendations. No differences were found in intakes for tofu, soy, grains, vegetables, or fruit and nuts food groups. Mixed ethnicity girls had the highest sweetened carbonated beverage intake although overall sugar intake was highest in white girls. Asian and mixed ethnicity girls' meat intakes were higher than white girls'. Intakes of mixed ethnicity girls more closely resembled those of Asians, although they exhibited the highest BMIs. CONCLUSIONS: These data suggest grain, vegetable, fruit, and dairy intake should be encouraged as part of a balanced diet for adolescent girls in Hawaii.     

Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years (National Health and Nutrition Examination Survey 2001-2002)

BACKGROUND: In the United States, >50% of dietary calcium is provided by milk and milk products. Calcium intakes in the United States are inadequate for many children, and a large proportion do not drink milk or consume dairy products. However, no studies have addressed whether dairy-free diets can provide adequate calcium while meeting other nutrient recommendations. OBJECTIVE: To determine the highest calcium intake for adolescents obtained from dairy-free diets, and to examine the relationship between intakes of calcium-fortified foods, using citrus juice as an example, and maximal calcium intakes. DESIGN: In the National Health and Nutrition Examination Survey 2001 to 2002, 65 females and 62 males, aged 9 to 18 years, reported no intake of dairy. We used linear programming to generate diets with maximal calcium intake, while meeting Dietary Reference Intakes for a set of nutrients, limiting energy and fat intakes, and not selecting food quantities exceeding amounts usually eaten in the population. RESULTS: With food use and energy and fat constraints, diets formulated by linear programming provided 1,150 and 1,411 mg/day of calcium for girls and boys, respectively. With the Dietary Reference Intakes constraints, these decreased to 869 and 1,160 mg/day. When we introduced 1.5 servings of fortified juice to the diets, the highest calcium intake increased to 1,302 mg/day for girls and to 1,640 mg/day for boys. CONCLUSIONS: Adequate intake for calcium cannot be met with dairy-free diets while meeting other nutrient recommendations. To meet the adequate intake for calcium without large changes in dietary patterns, calcium-fortified foods are needed. In addition, greater physical activity and responsible sunlight exposure should be encouraged to promote vitamin D adequacy.     

Sugar-added beverages and adolescent weight change

OBJECTIVE: The increase in consumption of sugar-added beverages over recent decades may be partly responsible for the obesity epidemic among U.S. adolescents. Our aim was to evaluate the relationship between BMI changes and intakes of sugar-added beverages, milk, fruit juices, and diet soda. RESEARCH METHODS AND PROCEDURES: Our prospective cohort study included >10,000 boys and girls participating in the U.S. Growing Up Today Study. The participants were 9 to 14 years old in 1996 and completed questionnaires in 1996, 1997, and 1998. We analyzed change in BMI (kilograms per meter squared) over two 1-year periods among children who completed annual food frequency questionnaires assessing typical past year intakes. We studied beverage intakes during the year corresponding to each BMI change, and in separate models, we studied 1-year changes in beverage intakes, adjusting for prior year intakes. Models included all beverages simultaneously; further models adjusted for total energy intake. RESULTS: Consumption of sugar-added beverages was associated with small BMI gains during the corresponding year (boys: +0.03 kg/m2 per daily serving, p = 0.04; girls: +0.02 kg/m2, p = 0.096). In models not assuming a linear dose-response trend, girls who drank 1 serving/d of sugar-added beverages gained more weight (+0.068, p = 0.02) than girls drinking none, as did girls drinking 2 servings/d (+0.09, p = 0.06) or 3+ servings/d (+0.08, p = 0.06). Analyses of year-to-year change in beverage intakes provided generally similar findings; boys who increased consumption of sugar-added beverages from the prior year experienced weight gain (+0.04 kg/m2 per additional daily serving, p = 0.01). Children who increased intakes by 2 or more servings/d from the prior year gained weight (boys: +0.14, p = 0.01; girls +0.10, p = 0.046). Further adjusting our models for total energy intake substantially reduced the estimated effects, which were no longer significant. DISCUSSION: Consumption of sugar-added beverages may contribute to weight gain among adolescents, probably due to their contribution to total energy intake, because adjustment for calories greatly attenuated the estimated associations.     

Girls' dairy intake, energy intake, and weight status

We explored the relationships among girls' weight status, dairy servings, and total energy intake. The hypothesis that consuming dairy could reduce risk for overweight was evaluated by comparing energy intake and weight status of girls who met or consumed less than the recommended three servings of dairy per day. Participants included 172 11-year-old non-Hispanic white girls, assessed cross-sectionally. Intakes of dairy, calcium, and energy were measured using three 24-hour recalls. Body mass index and body fat measures from dual-energy x-ray absorptiometry were obtained. Because preliminary analyses suggested systematic underreporting of energy intake, the relationships among dairy servings and measures of weight status were examined for the total sample and for subsamples of under-, plausible, and overreporters. Data for the total sample provided support for the hypothesized relationship among weight status, dairy servings, and energy intake. Thirty-nine percent of girls reported consuming the recommended >/=3 servings of dairy per day; these girls also reported higher energy intake but had lower body mass index z scores and body fat than the girls who consumed fewer than three dairy servings each day. Among plausible reporters, no relationship between dairy intake and weight status was noted. This discrepancy may be attributable to a high percentage (45%) of overweight underreporters in the total sample. Our findings reveal that reporting bias, resulting from the presence of a substantial proportion of underreporters of higher weight status, can contribute to obtaining spurious associations between dairy intake and weight status. These findings underscore the need for randomly controlled trials to assess the role of dairy in weight management.     

Beverage choices of young females: changes and impact on nutrient intakes

OBJECTIVE: To examine trends in beverage consumption and evaluate the impact of beverage choices on the nutrient intakes of females ages 12 to 19 years. DESIGN: Dietary intake data from the USDA's Nationwide Food Consumption Surveys, including the Continuing Survey of Food Intakes by Individuals (CSFII), were assessed for trends in beverage consumption. The CSFII 1994-1996 data was used to examine the diets of young females grouped based on their milk and soda consumption status. Mean energy, nutrient, and beverage intakes were compared. SUBJECTS: Females with complete dietary intake information on Day 1 of the survey were included in the study. There were 732 females ages 12 to 19 years in the CSFII 1994-1996.Statistical Analysis Percentages of females consuming specific beverages were estimated. Pairwise mean comparisons were made between groups based on milk and soda consumption status. RESULTS: Milk intakes decreased by 36% whereas that of sodas and fruit drinks almost doubled from the late 1970s to the mid 1990s. The CSFII 1994-1996 data showed that between ages 12 and 19 years, intakes of fruit juices, soda, tea, fruit drinks, and alcoholic beverages either increased or remained relatively steady, while milk intakes decreased with an increase in age. At age 12 years, 78% drank milk and had the lowest soda intake (276g), while at age 19-years, only 36% drank milk and drank a high amount of soda (423g). Those who did not drink milk had inadequate intakes of vitamin A, folate, calcium, phosphorus, and magnesium. APPLICATION: A rapid decrease in milk intake during the early adolescent years indicates a need for interventions at this age. Dietitians should identify barriers to drinking milk and recommend strategies for including appropriate food sources to increase calcium intakes during growing years. Nutrition educators should provide parents of adolescent children with ideas for ensuring the adequacy of their children's calcium intakes. J Am Diet Assoc. 2002; 102: 1234-1239.     

First Quantification of Calcium Intake from Calcium-Dense Dairy Products in Dutch Fracture Patients (The Delft Cohort Study)

Recommendations for daily calcium intake from dairy products are variable and based on local consensus. To investigate whether patients with a recent fracture complied with these recommendations, we quantified the daily dairy calcium intake including milk, milk drinks, pudding, yoghurt, and cheese in a Dutch cohort of fracture patients and compared outcomes with recent data of a healthy U.S. cohort (80% Caucasians). An observational study analyzed dairy calcium intakes of 1526 female and 372 male Dutch fracture patients older than 50. On average, participants reported three dairy servings per day, independently of age, gender or population density. Median calcium intake from dairy was 790 mg/day in females and males. Based on dairy products alone, 11.3% of women and 14.2% of men complied with Dutch recommendations for calcium intake (adults ≤ 70 years: 1100 mg/day and >70 years: 1200 mg/day). After including 450 mg calcium from basic nutrition, compliance raised to 60.5% and 59.1%, respectively, compared to 53.2% in the U.S. cohort. Daily dairy calcium intake is not associated with femoral neck bone mineral density (BMD) T-scores or WHO Fracture Assessment Tool (FRAX) risk scores for major fracture or hip fracture. However, when sub analyzing the male cohort, these associations were weakly negative. The prevalence of maternal hip fracture was a factor for current fracture risks, both in women and men. While daily dairy calcium intake of Dutch fracture patients was well below the recommended dietary intake, it was comparable to intakes in a healthy U.S. cohort. This questions recommendations for adding more additional dairy products to preserve adult skeletal health, particularly when sufficient additional calcium is derived from adequate non-dairy nutrition.     

Diet quality in young children is influenced by beverage consumption

BACKGROUND: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality. OBJECTIVE: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children. METHODS: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1-5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods. RESULTS: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1-5 years), soda pop (2, 3, 4, 5 and 1-5 years) and added sugar beverages (2, 3, 4, 5 and 1-5 years). Dairy dependent fractions of 1-5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1-5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes. CONCLUSIONS: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.     

Determination of the optimal number of dairy servings to ensure a low prevalence of inadequate calcium intake in Americans

BACKGROUND: Many Americans are not getting the recommended amounts of calcium in their diet. Since dairy foods provide most of the calcium in the diet, the number of recommended servings of dairy products may need to be revised. OBJECTIVE: 1. To determine the calcium intake of various age groups that met or exceeded the intake of dairy products recommended by the Food Guide Pyramid (FGP). 2. To determine the optimal level of dairy consumption that ensures a low prevalence of inadequate calcium (Ca) intake by Americans. METHODS: Using data from the Continuing Survey of Food Intake by Individuals, 1994-96, 1998, (CSFII) and the National Health and Nutrition Examination Survey, 1999-2000 (NHANES) we determined the calcium intake in individuals who met the recommended daily dairy servings as well as the minimum number of dairy servings required for the mean Ca intake of various age groups to exceed their respective Adequate Intakes (AI). RESULTS: Objective 1: Meeting or exceeding the FGP dairy recommendation led to calcium intakes that met recommended levels. However, very few individuals in all age groups met or exceeded the number of dairy servings recommended by FGP. Objective 2: Results indicated that in children 2-8 yrs, 2 dairy servings/d were required for the mean Ca intake (835 +/- 72 and 822 +/- 68 mg/d, in CSFII and NHANES IV, respectively) to exceed the AI. In children 9-18 yrs, 4 dairy servings/d) were required for the mean Ca intake of the group (1540 +/- 93 and 1518 +/- 86 mg/d) to exceed the AI. Similar data were observed in adults 19+ yrs, e.g., in adults 51+ yrs, 3 dairy servings/d were required for the mean Ca intake of the group (1241 +/- 53 and 1217 +/- 53 mg/d) to exceed the AI. CONCLUSION: Groups that met or exceeded the FGP dairy recommendations were more likely to have a mean calcium intake above the AI but had an average intake of about one serving higher than current recommendations. In individuals 9 yrs and older, 3-4 servings of dairy products are needed to meet or exceed the Ca AI and to ensure a low prevalence of inadequate Ca intake.     

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.     

Children and adolescents' choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups.

PURPOSE: To determine associations between intakes of the primary food and beverage sources of added sugars and intakes of key nutrients and food pyramid groups among U.S. children aged 6-17 years. METHODS: The 1994-96 and 1998 U.S. Department of Agriculture (USDA) Continuing Survey of Food Intakes by Individuals (CSFII) were used to examine the diets of U.S. children aged 6-17 years, who provided 2 full days of dietary data. The nationally representative sample (n = 3038) included children age 6-11 (n = 1913) and adolescents age 12-17 (n = 1125). Food codes for sweetened foods and beverages were selected from the USDA Food Coding Scheme and categorized into five food and beverage categories. The Statistical Analysis System software program was used to recode and format the data for statistical analysis and the Survey Data Analysis System was used to apply sample weights and generate statistical procedures. RESULTS: The consumption of sweetened dairy products was positively associated with calcium intakes for children and adolescents. Consumption of presweetened cereals increased the likelihood of the children and adolescents meeting recommendations for the essential shortfall micronutrients calcium, folate, and iron, whereas the consumption of sugar-sweetened beverages, sugars and sweets, and sweetened grains decreased the likelihood of meeting the Dietary Reference Intakes (DRI) for these nutrients. Only children who were nonconsumers of sugar-sweetened beverages had a mean calcium intake that met the adequate intakes (AI). Consumption of sweetened dairy products and presweetened cereals was positively associated with the number of dairy servings consumed per day for both age groups. CONCLUSIONS: On average, consumption of sweetened dairy foods and beverages and presweetened cereals had a positive impact on children and adolescents' diet quality, whereas sugar-sweetened beverages, sugars and sweets, and sweetened grains had a negative impact on their diet quality.     

The nutritional impact of dairy product consumption on dietary intakes of adults (1995-1996): the Bogalusa Heart Study

OBJECTIVE: To examine the nutritional impact of dairy product consumption on the dietary intakes of adults. DESIGN: Dietary intakes of adults who participated in a cross-sectional survey (1995-1996) in Bogalusa, LA. SUBJECTS: Dietary intake data were collected on 1,266 adults (61% women, 39% men; 74% white, 26% African American) in Bogalusa, LA. STATISTICAL ANALYSIS: Analysis of covariance was used to examine the mean nutrient intake differences among four dairy consumption groups. Significance tests in multiple comparisons between any two groups were conducted using Tukey's procedure. RESULTS: Forty-eight percent of adults consumed one serving or less of dairy products, 32% consumed two servings, 12% consumed three servings, and 8% consumed four or more servings. Overall mean intake of dairy was higher in whites (mean=1.63) compared with African Americans (mean=1.22) (P<.0001), especially the consumption of milk and cheese. No differences were found in overall mean intake of dairy servings by sex after adjusting for energy intake. However, women consumed significantly more servings of cheese (P<.0001) and yogurt (P<.01) than men. There were higher intakes of total energy, saturated fat, total protein, animal protein, and lactose (P<.0001), with greater number of servings of dairy products consumed. There were lower intakes of monounsaturated and polyunsaturated fatty acids (P<.0001), vegetable protein (P<.0001), total carbohydrates (P<.01), sucrose (P<.001), fructose (P<.0001), and fiber (P<.001). The percentage of energy from saturated fat (P<.0001) and protein (P<.001) increased with increasing number of dairy servings consumed. Intakes of calcium; magnesium; potassium; zinc; sodium; folate; thiamin; riboflavin; and vitamins B-6, B-12, A, D, and E were higher with greater number of dairy servings consumed. There was lower consumption of sweetened beverages (P<.001), specifically regular soft drinks (P<.0001), with greater consumption of milk products. CONCLUSIONS: Dairy product consumption by adults has a major influence on their vitamin and mineral intakes. The higher intakes of saturated fat, total energy, and animal protein and lower intake of fiber suggest that it may be useful to consume lower-fat dairy products and/or modify eating patterns to optimize the nutritional contributions of dairy products. Public health organizations and dietetics professionals need to educate adults on practical strategies for increasing dairy product consumption for improving the nutritional quality of adults' diets.     

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.     

Contents of calcium and phosphorus in the diet of youth from Warsaw elementary schools

The purpose of this study was an assessment average daily intake of calcium and phosphorus by prepubertal adolescents (aged 11 and 12) during monitoring their diets in last 10 years. In 1989-1999 years, it was investigated 767 randomly selected girls and 817 boys, aged 11 and 12 in Warsaw. Information on dietary intake was obtained by 24-hour recall method, always spring, having representation of weekdays and weekends. Among environmental factors, nutrition, and particularly calcium intake is assumed to influence whether the genetically determined maximal peak bone mass is reached. However, near half of examined prepubertal adolescents have intake less than 600 mg calcium per day. It was also observed low calcium to phosphorus ratio in diets and stated Ca:P < 0.25 among 10% diet in different groups of girls and boys. Consequently, due to consider the activity educational efforts directed to prepubertal adolescent with reference to means realization of calcium RDA in daily diet through increase milk and dairy products consumption.     

Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns

OBJECTIVE: To identify correlates of calcium, dairy, and milk intakes among male and female adolescents. DESIGN: Cross-sectional study design. Adolescents self-reported measures pertaining to correlates on the Project EAT (Eating Among Teens) survey and completed a food frequency questionnaire at school. SUBJECTS/SETTING: Subjects were a total of 4,079 middle and high school students from Minneapolis/St Paul, MN, public schools. STATISTICAL ANALYSES PERFORMED: Multiple linear regression models based on social cognitive theory were examined by sex. RESULTS: Male adolescents reported higher daily intakes of calcium (male: 1,217+/-663 mg; female: 1,035+/-588 mg; P<0.001), dairy servings (male: 2.9+/-1.9; female: 2.4+/-1.7; P<0.001), and milk servings (male: 2.0+/-1.5; female: 1.5+/-1.4; P<0.001) than female adolescents. Calcium intakes of male adolescents were significantly and positively related to availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, and social support for healthful eating; intakes were significantly and inversely related to consumption of soft drinks and fast food. Among female adolescents, availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, personal health/nutrition attitudes, and self-efficacy to make healthful food choices were significantly and positively related to intakes; intakes were significantly and inversely related to fast-food consumption. Models of calcium intake explained 71% of the variance in male adolescents and 72% of the variance in female adolescents. CONCLUSIONS: Multicomponent interventions with a focus on the family environment are likely to be most effective in increasing calcium intakes among adolescents.     

膳食因素对青少年骨密度水平影响

目的 明确膳食因素对青少年骨密度的影响及其作用水平。方法 选取河北省唐山市1 583名初、高中13~19岁学生,进行骨健康相关因素调查、膳食调查和骨密度测定。结果 青少年超声骨密度的声波传导速度（SOS）均值男生为（1 542.7±19.6）m/s、女生为（1 539.8±20.2）m/s,均随年龄增长而升高,16岁开始男生SOS值高于女生;当每天饮用碳酸饮料<300 mL、奶类摄入200~299或300~900 g、水产品摄入50~99或100~350 g、豆制品摄入25~49、99~200或50~99 g、蔬菜摄入150~299或100~149 g、钙摄入50%~99%适宜摄入量（AI）或100%~200%AI、磷摄入125%~149%AI或100%~124%AI时,SOS值达到或高于95%医学参考值范围。结论 促进青少年骨密度增值的膳食因素为不经常饮用碳酸饮料,充足摄入奶类、水产品、豆制品和钙,适宜摄入蔬菜和磷。     

Dairy products, calcium, and prostate cancer risk in the Physicians' Health Study

BACKGROUND: A high calcium intake, mainly from dairy products, may increase prostate cancer risk by lowering concentrations of 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], a hormone thought to protect against prostate cancer. The results of epidemiologic studies of this hypothesis are inconclusive. OBJECTIVE: We investigated the association between dairy product and calcium intakes and prostate cancer risk in the Physicians' Health Study, a cohort of male US physicians. DESIGN: At baseline, the men answered abbreviated dietary questionnaires. During 11 y of follow-up, we documented 1012 incident cases of prostate cancer among 20885 men. We estimated dairy calcium intake on the basis of consumption of 5 major dairy products and used logistic regression to estimate relative risk. RESULTS: At baseline, men who consumed >600 mg Ca/d from skim milk had lower plasma 1,25(OH)(2)D(3) concentrations than did those consuming < or =150 mg Ca/d [71 compared with 85 pmol/L (30.06 compared with 35.64 pg/mL); P = 0.005]. Compared with men consuming < or =0.5 daily servings of dairy products, those consuming >2.5 servings had a multivariate relative risk of prostate cancer of 1.34 (95% CI: 1.04, 1.71) after adjustment for baseline age, body mass index, smoking, exercise, and randomized treatment assignment in the original placebo-controlled trial. Compared with men consuming < or =150 mg Ca/d from dairy products, men consuming >600 mg/d had a 32% higher risk of prostate cancer (95% CI: 1.08, 1.63). CONCLUSIONS: These results support the hypothesis that dairy products and calcium are associated with a greater risk of prostate cancer.     

The contribution of yogurt to nutrient intakes across the life course

Yogurt is a nutrient‐dense food within the milk and dairy products food group. The nutritional content of yogurt varies depending on the processing method and ingredients used. Like milk, it is a good source of protein and calcium, and can be a source of iodine, potassium, phosphorus and the B vitamins – riboflavin (B₂) and vitamin B₁₂ (depending on type). Some yogurt products are also fortified with vitamin D. The nutritional value of dairy products (milk, cheese and yogurt) and the importance of the nutrients they provide for bone health are well recognised. These foods are collected together as one of the four main food groups within the UK's eatwell plate model that illustrates a healthy, balanced diet. Studies exploring the nutritional and health attributes of yogurt are limited but some research has suggested benefits in relation to bone mineral content, weight management, type 2 diabetes and metabolic profile. Yogurt consumption has also been associated with diet quality. The aim of this paper is to use national survey data to examine yogurt consumption in the UK and consider its contribution to nutrient intakes at different life stages within the context of nutritional challenges in each age group. The contribution of yogurt to energy and nutrient intakes across the life course was calculated via secondary analysis of data from the Diet and Nutrition Survey of Infants and Young Children (2011) and the National Diet and Nutrition Survey (2008/2009–2010/2011). The products categorised within the ‘yogurt group’ included all yogurt, fromage frais and dairy desserts, and fortified products. Comparisons were also made between specific sub‐categories of yogurt, namely ‘yogurt’, ‘fromage frais’ and ‘dairy desserts’. Nutrients included in the analyses were energy; the macronutrients; micronutrients that yogurt can be defined as a ‘source of’; micronutrients that may be of concern in the UK population; and vitamin D for fortified products. A simple dietary modelling exercise was also undertaken to investigate the potential impact of including an additional pot of yogurt per day on the nutrient intakes of adolescents. Children aged 3 years and under had the highest intakes of yogurt [mean intake 43.8 g/day (SD 39.7 g) in 4–18 month‐olds; 46.7 g/day (SD 39.1 g) in 1.5–3 year‐olds], and adolescents (11–18 years) consumed the least [21 g/day (SD 38.0 g)]. In adults, highest mean consumption [35.7 g/day (SD 55.0 g)] was during middle age (50–64 years), equivalent to less than a third of a standard 125 g pot. Around 80% of young children (aged 3 years and under) but only a third of teenagers and young adults had consumed any yogurt product during the survey period of 4 days. Average yogurt consumption was twice as high in women as men among older adults (65 years and over), while gender differences in consumption were less apparent in children. Fromage frais and fortified yogurt products were most commonly consumed by younger children, as were dairy desserts in those aged 4–18 years. Among adults, yogurt per se was most commonly consumed. Children aged 4–10 years exhibited the most variety in the types of yogurt consumed. Low‐fat yogurt (including those with added fruit, nuts and cereals) was the most commonly consumed yogurt type when all ages were combined. More than a third of all yogurt products consumed by children aged 3 years and under were fortified, compared with 18% in those aged 4–10 years. During adulthood, the consumption of fortified products was negligible. The yogurt group made a useful contribution to micronutrient intakes in children aged 4 months to 10 years, particularly vitamin B₁₂ (4–18 months: 7.6%; 1.5–3 years: 5.3%; 4–10 years: 3.8%), riboflavin (7.8%, 6.9%, and 5.7%, respectively), calcium (9.5%, 8.2%, and 5.9%, respectively), iodine (7.2%, 7.6%, and 7%, respectively) and phosphorus (8.1%, 6.3%, and 4.3%, respectively). It also provided 3.9% of the total intake of vitamin D in those aged 4–18 months and 10.5% in those aged 1.5–3 years. Although the contribution to total dietary energy intake was low (4.9% at 4–18 months and 4.2% at 1.5–3 years), yogurt contributed a high proportion of non‐milk extrinsic sugars (NMES) to the diets of young children (22.7% and 11.1% in 4–18 months and 1.5–3 years, respectively). However, the total NMES intake was comparatively low in children aged 4–18 months (6.7% total energy), and 11.6% in 1.5–3 year‐olds (compared to 15.3% total energy in children aged 11–18 years in this survey). As children aged, the contribution of yogurt (all categories combined) to micronutrient intake, as well as to NMES, decreased, reflecting the increasing amounts and variety of foods in the diet. Yogurt made a small contribution to energy and macronutrient intakes during adulthood, with the greatest proportions mostly in the older age group (65 years and over) (energy: 1.7%; fat: 1.3%; saturated fatty acids: 2.1%; NMES: 4%). As intake was higher among women, yogurt made a greater contribution to their micronutrient intakes compared with men, providing >5% of the reference nutrient intakes (RNIs) for phosphorus, iodine, calcium, vitamin B₁₂ and riboflavin. Simple dietary modelling was carried out to investigate the hypothetical change in mean nutrient intakes among adolescents aged 11–14 and 15–18 years, if they were all to add an extra 125 g pot of low‐fat fruit yogurt to their current diet. This showed an increase in average intake, as a percentage of the RNI, for several micronutrients for which there is some evidence of low intakes in this age group, notably calcium in boys and girls (11–18 years) and iodine in girls (11–18 years). Although some benefits for micronutrient intakes were noted, such advice would impact on energy and macronutrient intakes (including NMES), and would need to be given in the context of the wider diet (e.g. as ‘swaps’ for less nutrient‐dense foods). In conclusion, yogurt makes a small but valuable contribution to nutrient intakes in the UK, particularly in young children. Among adolescents, the addition of a low‐fat yogurt would help meet recommended intakes for several micronutrients, particularly calcium and iodine, which are of concern in some teenage diets. Advice to replace some types of snacks and desserts, particularly those high in fat and sugars and low in micronutrients, with a pot of yogurt or similar dairy product may improve the nutrient density of their diet.