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

Parental influence on eating behavior: conception to adolescence

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices.

Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months from western Sydney, Australia

Objective

This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

Design

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to theAustralian Guide to Healthy Eating.

Setting

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Participants

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results

The mean consumption of ‘extra’ foods was ∼150 g day− 1and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

Conclusions

The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.

Beverage Consumption in the US Population

OBJECTIVE

The purpose of this study was to examine beverage consumption across age, sex, and race/ethnicity categories using the most current data available, the National Health and Nutrition Examination Survey 1999-2002.

DESIGN

Beverage consumption that included fluid milk, fruit juices, regular and diet carbonated soft drinks, regular and diet fruit drinks/ades, coffee, and tea was examined among white, African-American, and Mexican-American persons in age groups 6 to 11 years, 12 to 19 years, 20 to 39 years, 40 to 59 years, and >60 years. Data from the National Health and Nutrition Examination Survey 1999-2002 were used in this study.

STATISTICAL ANALYSIS

Group means were estimated for the age group, sex, and race/ethnicity subgroups. The probability that any of these group means were equal to one another was tested using statistical software.

RESULTS

The data showed marked differences in beverage consumption depending on age, sex, and race/ethnicity. In general, males consumed more beverages than did females. Specifically, white and Mexican-American persons of all ages consumed more milk than did African-American persons. On average, African-American males and females of all ages consumed significantly more fruit drinks/ades than did other race/ethnicity groups. In contrast, white persons consumed more carbonated soft drinks than did other race/ethnicity groups.

CONCLUSION

Average beverage consumption varied depending on age, sex, and race/ethnicity. Knowledge of differences in beverage consumption patterns is important for food and nutrition professionals and nutrition policymakers. Better understanding of the many factors that influence beverage consumption levels is needed.

Low dairy intake in early childhood predicts excess body fat gain

OBJECTIVE

To estimate the effect of dairy intake in early childhood on the acquisition of body fat throughout childhood.

RESEARCH METHODS AND PROCEDURES

Ninety-nine of the original 106 families enrolled in the Framingham Children's Study with a child age to 6 years at baseline were followed into adolescence through yearly clinic visits and periodic data collection throughout each year. Dairy intake for these analyses was derived from a mean of 15 days of diet records per subject collected before age 6. A trained examiner took two measurements each year of height, weight, and triceps, subscapular, suprailiac, and abdominal skinfolds using a standardized protocol. Yearly change in body fat was estimated as the slope of these anthropometry measures from ages 5 to 13 years. Early adolescent body fat was estimated as the mean of all available measurements from 10 to 13 years of age.

RESULTS

Children in the lowest sex-specific tertile of dairy intake during preschool (i.e., <1.25 servings per day for girls and <1.70 servings per day for boys) had significantly greater gains in body fat during childhood. These children with low dairy intakes gained more than 3 additional mm of subcutaneous fat per year in the sum of four skinfold measures. By the time of early adolescence, those in the lowest tertile of dairy intake had a BMI that was approximately two units higher and an extra 25 mm of subcutaneous fat.

DISCUSSION

Suboptimal dairy intakes during preschool in this cohort were associated with greater gains in body fat throughout childhood.

Modifiable environmental and behavioral determinants of overweight among children and adolescents: report of a workshop

The number of children at risk for overweight and the number of overweight children are increasing and have become a serious public health concern. Interventions that could be applied at the population level have not been proven effective. The development of effective strategies is thought to be hampered by the lack of understanding of which behavioral and environmental factors need to be modified. On June 14 and 15, 2004, the NIH held a meeting of experts to discuss the issue of modifiable determinants of obesity in children and adolescents. Included were presentations on interventions among children that have been proven effective, dietary and physical activity behavioral determinants, physical, social, and family environmental determinants, and the quality of measures of determinants and correlates of overweight.

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.

Calcium supplementation for improving bone mineral density in children

BACKGROUND

Clinical trials have shown that calcium supplementation in children can increase bone mineral density (BMD) although this effect may not be maintained. There has been no quantitative systematic review of this intervention.

OBJECTIVES

. To determine the effectiveness of calcium supplementation for improving BMD in children. . To determine if any effect varies by sex, pubertal stage, ethnicity or level of physical activity, and if any effect persists after supplementation is ceased.

SEARCH STRATEGY

We searched CENTRAL, (Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to 1 April 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (1945 to 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005) and Human Nutrition (1982 to 1 April 2005). Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research) were hand-searched.

SELECTION CRITERIA

Randomised controlled trials of calcium supplementation (including by food sources) compared with placebo, with a treatment period of at least 3 months in children without co-existent medical conditions affecting bone metabolism. Outcomes had to include areal or volumetric BMD, bone mineral content (BMC), or in the case of studies using quantitative ultrasound, broadband ultrasound attenuation and ultrasonic speed of sound, measured after at least 6 months of follow-up.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data including adverse events. We contacted study authors for additional information.

MAIN RESULTS

The 19 trials included 2859 participants, of which 1367 were randomised to supplementation and 1426 to placebo. There was no heterogeneity in the results of the main effects analyses to suggest that the studies were not comparable. There was no effect of calcium supplementation on femoral neck or lumbar spine BMD. There was a small effect on total body BMC (standardised mean difference (SMD) +0.14, 95% CI+0.01, +0.27) and upper limb BMD (SMD +0.14, 95%CI +0.04, +0.24). Only the effect in the upper limb persisted after supplementation ceased (SMD+0.14, 95%CI+0.01, +0.28). This effect is approximately equivalent to a 1.7% greater increase in supplemented groups, which at best would reduce absolute fracture risk in children by 0.1-0.2%per annum. There was no evidence of effect modification by baseline calcium intake, sex, ethnicity, physical activity or pubertal stage. Adverse events were reported infrequently and were minor.

AUTHORS' CONCLUSIONS

While there is a small effect of calcium supplementation in the upper limb, the increase in BMD which results is unlikely to result in a clinically significant decrease in fracture risk. The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.

Dairy and dairy-related nutrient intake during middle childhood

OBJECTIVE

To characterize patterns of dairy intake among girls in middle childhood.

DESIGN

Longitudinal data were used to characterize girls' patterns of dairy intake at age 5, 7, 9, and 11 years.

SUBJECTS

Participants were 151 girls from predominately middle-class and exclusively non-Hispanic white families living in central Pennsylvania.

STATISTICAL ANALYSES

Intakes of dairy, energy, macronutrients, vitamin D, calcium, and phosphorus were assessed using three 24-hour dietary recalls in 151 non-Hispanic white girls at age 5, 7, 9, and 11 years. Analyses of changes over time were conducted using repeated measures analysis of variance. McNemar's chi(2) test was used to analyze change in percentage of dairy consumers over time.

RESULTS

From age 5 to 11 years, girls' total dairy intake remained stable. Total milk consumption declined, due to a decline in intake of milk as a beverage, while intakes of cheese and dairy desserts increased. Much of the decline in milk intake from age 5 to 11 years, especially for milk as a beverage, was due to a reduction in the percentage of girls consuming milk as a beverage, not simply due to a decline in the servings of milk as a beverage consumed by consumers. On average, girls met vitamin D recommendations over time; however, by age 9 and 11 years girls failed to meet calcium and phosphorus recommendations.

CONCLUSIONS

Although girls' dairy intake was stable over time, at age 7, 9, and 11 years girls did not meet the recommended three servings per day, leading to suboptimal intakes of calcium and phosphorus at age 9 and 11 years. Increasing milk intake among all children should continue to be a major focus of interventions.

A mother-based intervention trial for osteoporosis prevention in children

OBJECTIVE

To assess whether a lifestyle intervention delivered to mothers might impact on osteoporosis preventive behaviors in their children.

METHODS

We performed a 2-year randomized controlled trial of individualized bone mineral density feedback with either an osteoporosis information leaflet, or small group education, in a population-based sample of 354 mothers from Southern Tasmania, Australia in 2000-02. Main outcomes were maternal report of calcium intake and physical activity change in their children.

RESULTS

Receiving small group education was associated with mothers' report of increasing children's calcium intake (odds ratio 2.3, 95% confidence interval 1.4, 3.8), as was low t-score feedback (odds ratio 2.0, 95% confidence interval 1.2, 3.3). Mothers who increased their own physical activity were more often reported increasing both physical activity (odds ratio 2.7, 95% confidence interval 1.5, 5.0) and calcium intake in their children (odds ratio 2.2, 95% confidence interval 1.3, 3.7). Mothers who commenced calcium supplements more often reported increasing children's calcium intake (odds ratio 2.6, 95% confidence interval 1.0, 6.7) but not physical activity.

CONCLUSIONS

Both bone mineral density feedback and small group education delivered to mothers are effective at inducing maternally reported osteoporosis preventive behavior change in their children. These results require confirmation by studies with objective outcome measures.

Reexamining obesigenic families: parents' obesity-related behaviors predict girls' change in BMI

OBJECTIVE

It has been shown that girls from families in which mothers and fathers had high dietary intake and low physical activity (i.e., obesigenic families) were at increased risk of obesity from ages 5 to 7 years. This follow-up study uses additional data collected when girls were 9 and 11 years old to examine whether girls from obesigenic families continued to show greater increases in BMI over time and reported unhealthy dietary and activity patterns.

RESEARCH METHODS AND PROCEDURES

Families from the original cohort were reexamined when girls were 9 and 11 years of age. Parents' and girls' BMI, dietary intake, and physical activity and girls' percentage body fat and television viewing were assessed.

RESULTS

In comparison with girls from non-obesigenic families, girls from obesigenic families showed greater increases in BMI and BMI z score from ages 5 to 7 years that were maintained across ages 7 to 11 years. Furthermore, girls from obesigenic families had higher percentage body fat at ages 9 and 11 years. These results were independent of parents' BMI. Additional findings showed that girls from obesigenic families had diets higher in percentage fat and had higher levels of television viewing than girls from non-obesigenic families.

DISCUSSION

The environment that parents create, by way of their own dietary and physical activity behaviors, may have a lasting negative effect on children's weight trajectories and their emerging obesity risk behaviors, such as their dietary patterns. These findings further highlight the importance of the family in establishing children's obesity risk and the necessity of targeting parents of young children in obesity prevention efforts.

Links between parents' and girls' television viewing behaviors: a longitudinal examination

OBJECTIVE

This longitudinal study examines links between parents' television (TV)-related parenting practices and their daughter's daily TV viewing hours.

STUDY DESIGN

Participants included 173 non-Hispanic white girls and their parents who were examined when girls were age 9 and 11 years. Girls' daily TV viewing hours, mothers' and fathers' daily TV viewing hours, parents' use of TV as a recreational activity, family TV co-viewing, and parents' restriction of girls' access to TV were assessed.

RESULTS

Approximately 40% of girls exceeded the TV-viewing recommendations (ie, < or =2 hours/day). Girls watched significantly more TV when their parents were high-volume TV viewers, relied heavily on TV as a recreational activity, watched TV with them, and failed to limit their access to TV. A parenting risk score was calculated by collapsing information across all parenting variables. In comparison with girls exposed to 1 or fewer parenting risk factors at age 9, girls exposed to 2 or more parenting risk factors were 5 to 10 times more likely to exceed TV viewing recommendations at age 9 and 11.

CONCLUSIONS

Efforts to reduce TV viewing among children should encourage parents to limit their own TV viewing, reduce family TV viewing time, and limit their children's access to TV.

Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance

No previous longitudinal studies of calcium intake, anthropometry and bone health in young children with a history of avoiding cow's milk have been undertaken. We report the 2-year changes of a group of 46 Caucasian children (28 girls, l8 boys) aged 8.1+/-2.0 years (mean +/- SD) who had low calcium intakes at baseline and were short in stature, with elevated body mass index, poor skeletons and lower Z scores for both areal bone mineral density (BMD, in grams per square centimeter) and volumetric density (bone mineral apparent density, BMAD, in grams per cubic centimeter), compared with a reference population of milk drinkers. At follow-up, adverse symptoms to milk had diminished and modest increases in milk consumption and calcium intake had occurred. Total body bone mineral content (BMC) and bone area assessed by dual energy X-ray absorptiometry had increased (P<0.05), and calcium intake from all sources was associated with both these measures (P<0.05). However, although some catch-up in height had taken place, the group remained significantly shorter than the reference population (Z scores -0.39+/-1.14), with elevated body mass index (Z scores 0.46+/-1.0). The ultradistal radius BMC Z scores remained low (-0.31+/-0.98). The Z scores for BMD had improved to lie within the normal range at predominantly cortical sites (33% radius, neck of femur and hip trochanter) but had worsened at predominantly trabecular sites (ultradistal radius and lumbar spine), where values lay below those of the reference group (P<0.05). Similarly, although volumetric BMAD Z scores at the 33% radius had normalized, BMAD Z scores at the lumbar spine remained below the reference population at follow-up (-0.67+/-1.12, P<0.001). Our results demonstrate persisting height reduction, overweight and osteopenia at the ultradistal radius and lumbar spine in young milk avoiders over 2 years of follow-up.

Pediatrician's office: a solution in the prevention of childhood obesity

A mother's ability to correctly perceive her child's weight status and her concern toward the overweight status of her child are important in the prevention of childhood obesity. Mothers should have adequate nutrition knowledge that enables them to plan and provide nutritious meals to their children.

CONCLUSION

Pediatricians may play a role in childhood obesity prevention interventions by helping mothers understand growth charts and by providing mothers with appropriate nutrition guidance for planning a balanced diet.

Current advances in bone health of disabled children

PURPOSE OF REVIEW

Bone health is now recognized to contribute to overall lifetime management of children, adolescents, and adults with disabling conditions including physical and intellectual disability and with many chronic disease processes. Such disorders have multiple components, with aspects of care covering a wide number of specialist practices. This review will highlight advances in understanding the nature of bone mass accumulation through childhood and adolescence, the impingement of a spectrum of chronic and disabling diseases and their treatments on bone, and will address current approaches to interpretation of bone mass in the growing skeleton and interventional strategies for improving outcomes for this group.

RECENT FINDINGS

Increased skeletal fragility in the disabled child is well recognized. Insights into the contributions of skeletal size and bone strength in males and females have altered interpretation of data, allowing a new focus on determinants of future bone health, particularly with regard to the contributions of growth and puberty. Strategies to address bone health including public and medical education concerning consumption of calcium, appropriate selection of vitamin D preparations, pubertal contribution to phases of growth and possible specialist use of newer drugs, such as bisphosphonates where indicated, are changing the outlook for this large group.

SUMMARY

Implications of these changed understandings provide a new focus on maximizing bone mass accumulation by the end of adolescence within the constraints of what is possible to achieve for an individual and for provision of an holistic approach to bone health.