Building better bones in childhood: a randomized controlled study to test the efficacy of a dietary intervention program to increase calcium intake

D R Weber, L J Stark, R F Ittenbach, V A Stallings, B S Zemel, D R Weber, L J Stark, R F Ittenbach, V A Stallings, B S Zemel

Abstract

Background/objectives: Many children do not consume the recommended daily allowance of calcium. Inadequate calcium intake in childhood may limit bone accrual. The objective of this study was to determine if a behavioral modification and nutritional education (BM-NE) intervention improved dietary calcium intake and bone accrual in children.

Subjects/methods: 139 (86 female) healthy children, 7-10 years of age, were enrolled in this randomized controlled trial conducted over 36 months. Participants randomized to the BM-NE intervention attended five sessions over a 6-week period designed to increase calcium intake to 1500 mg/day. Participants randomized to the usual care (UC) group received a single nutritional counseling session. The Calcium Counts Food Frequency Questionnaire was used to assess calcium intake; dual energy X-ray absorptiometry was used to assess areal bone mineral density (aBMD) and bone mineral content (BMC). Longitudinal mixed effects models were used to assess for an effect of the intervention on calcium intake, BMC and aBMD.

Results: BM-NE participants had greater increases in calcium intake that persisted for 12 months following the intervention compared with UC. The intervention had no effect on BMC or aBMD accrual. Secondary analyses found a negative association between calcium intake and adiposity such that greater calcium intake was associated with lesser gains in body mass index and fat mass index.

Conclusions: A family-centered BM-NE intervention program in healthy children was successful in increasing calcium intake for up to 12 months but had no effect on bone accrual. A beneficial relationship between calcium intake and adiposity was observed and warrants future study.

Trial registration: ClinicalTrials.gov NCT00063037.

Conflict of interest statement

Conflict of interest statement: None of the other authors have a relevant conflict of interest to disclose.

Figures

Figure 1. Randomization and follow up of…
Figure 1. Randomization and follow up of study participants
Figure 2. Median adjusted calcium intake in…
Figure 2. Median adjusted calcium intake in the usual care compared to behavioral modification-nutritional education (BM-NE) intervention group
Predicted calcium intake adjusted for age, sex, history of milk refusal, black racial group, BM-NE intervention*visit interaction. Calcium intake from food frequency questionnaire was adjusted by nutritionists to account for overestimation of calcium intake by participants. * indicates significantly different from usual care, p

Figure 3. Median whole body (A) and…

Figure 3. Median whole body (A) and lumbar spine (B) bone mineral content and whole…

Figure 3. Median whole body (A) and lumbar spine (B) bone mineral content and whole body (C) and lumbar spine (D) bone mineral density in the usual care compared to behavioral modification-nutritional education (BM-NE) intervention group
Predicted whole body and lumbar spine bone mineral content and bone mineral density adjusted for age, sex, height, LBMI, and black racial group. No significant effect of the BM-NE was observed at any of the study time points for any bone outcome.
Figure 3. Median whole body (A) and…
Figure 3. Median whole body (A) and lumbar spine (B) bone mineral content and whole body (C) and lumbar spine (D) bone mineral density in the usual care compared to behavioral modification-nutritional education (BM-NE) intervention group
Predicted whole body and lumbar spine bone mineral content and bone mineral density adjusted for age, sex, height, LBMI, and black racial group. No significant effect of the BM-NE was observed at any of the study time points for any bone outcome.

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