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4 pp. / Healthy bone growth and maintenance requires adequate calcium intake. You can meet your calcium needs from foods, beverages, and if necessary, supplements. This publication contains the calorie and calcium content of some foods from each group of the Food Guide Pyramid which includes bread, cereal, rice, & pasta group; vegetable group; fruit group; milk, yogurt, & cheese group; meat, poultry, fish, dry beans, eggs, & nuts group; and fats, oils & sweets.

Background: African Americans have disproportionately higher burden of prostate cancer compared to European Americans. However, the cause of prostate cancer disparities is still unclear. Several roles have been proposed for calcium and vitamin D in prostate cancer pathogenesis and progression, but epidemiologic studies have been conducted mainly in European descent populations. Here we investigated the association of calcium and vitamin D intake with prostate cancer in multiethnic samples. Methods: A total of 1,657 prostate cancer patients who underwent screening and healthy controls (888 African Americans, 620 European Americans, 111 Hispanic Americans, and 38 others) from Chicago, IL and Washington, D.C. were included in this study. Calcium and vitamin D intake were evaluated using food frequency questionnaire. We performed unconditional logistic regression analyses adjusting for relevant variables. Results: In the pooled data set, high calcium intake was significantly associated with higher odds for aggressive prostate cancer (ORQuartile (1 vs. Quartile) (4) = 1.98, 95% C.I.: 1.01-3.91), while high vitamin D intake was associated with lower odds of aggressive prostate cancer (ORQuartile 1 vs. Quartile (4) = 0.38, 95% C.I.: 0.18-0.79). In African Americans, the association between high calcium intake and aggressive prostate cancer was statistically significant (ORQuartile 1 vs. Quartile 4 = 4.28, 95% C.I.: 1.70-10.80). We also observed a strong inverse association between total vitamin D intake and prostate cancer in African Americans (ORQuartile 1 vs. Quartile 4 = 0.06, 95% C.I.: 0.02-0.54). In European Americas, we did not observe any significant associations between either calcium or vitamin D intake and prostate cancer. In analyses stratifying participants based on Body Mass Index (BMI), we observed a strong positive association between calcium and aggressive prostate cancer and a strong inverse association between vitamin D intake and aggressive prostate cancer among men with low BMI (<27.8 kg/m(2)), but not among men with high BMI (>= 27.8 kg/m(2)). Interactions of race and BMI with vitamin D intake were significant (P-Interaction < 0.05). Conclusion: Calcium intake was positively associated with aggressive prostate cancer, while vitamin D intake exhibited an inverse relationship. However, these associations varied by race/ethnicity and BMI. The findings from this study may help develop better prostate cancer prevention and management strategies.

The relationship between calcium intake and hypertension is receiving increased research attention. The prevalence of hypertension is high among the obese populations. Calcium is a mineral that influences blood pressure. The aim of the study was to examine the association between calcium intake and hypertension in a large nationally representative sample of obese American adults. A total of 14 408 obese adults aged 20 years or older were obtained from the 1999–2010 National Health and Nutrition Examination Survey. Analysis of variance and linear regression models were used to examine relationships between calcium intake and systolic blood pressure (SBP) as well as diastolic blood pressure (DBP). Multiple logistic regression models were used to examine the association between calcium intake and hypertension after adjusting for potential confounders and interactions, including: age, race, education level, alcohol use, smoking, diabetes status, sodium intake and potassium intake. Calcium intake was significantly lower for the hypertensive group compared with the normotensive group (P < 0.0001), especially among those obese female young adults aged 20–44 years and among non-diabetic obese adults. Based on ordinary linear regression analysis, a significant inverse relationship was detected, SBP and DBP decreased if calcium intake increased (SBP: regression coefficient estimate=−0.015, P < 0.0001; DBP: regression coefficient estimate=−0.028, P < 0.0001). Multiple logistic regression showed that calcium intake was negatively associated with the probability of hypertension (odds ratio (OR)=0.81, 95% confidence interval (CI): 0.74–0.87, P < 0.0001). In stratified analysis, calcium intake in youngest adults (age 20–44 years) had the lowest likelihood of hypertension (OR=0.77, 95% CI: 0.64–0.93, P < 0.0001), the inverse relationship between calcium intake and probability of hypertension was stronger among females (OR: 0.68, 95% CI: 0.55–0.84, P < 0.0001), when compared with the whole sample including all of 14 408 obese adults. The protective effect of calcium intake and hypertension was found significantly in obese non-diabetic adults (OR: OR=0.77, 95% CI: 0.67–0.89, P < 0.0001) not in obese diabetic adults. SBP, DBP and calcium intake were log transformed for both ordinary linear regression analysis and logistic regression analysis. Our study findings underscore the need to explore the physiological mechanism between calcium intake and hypertension. In this study, increased calcium intake was associated with the lowest risk of hypertension. Future studies utilizing longitudinal research designs are needed to quantify therapeutic levels of calcium for control of hypertension among obese adults. Increasing calcium intake among American adults may offer promise as a cost-effective strategy to improve hypertension among obese adults; however, further scientific exploration is warranted.

Evidence has accumulated for a link between the adequacy of lifetime calcium intake, and osteoporosis. Osteoporosis increases in prevalence with age and is of concern as it results in irreversible and debilitating effects. The result has been an increased recognition of the need to survey the consumption patterns of foods that contribute to calcium intake levels in Australia, the focus being milk and milk products.. A better understanding of calcium intake in women and the factors influencing it across the lifespan is of increasing importance as the longevity of Australian women continues to increase. Without preventive measures the costs incurred in managing osteoporosis will continue to escalate. An understanding of women's food behaviour is important if calcium intake levels in women are to effectively increase. A self administered questionnaire assessed the calcium intake levels and food sources in 158 premenopausal and 142 postmenopausal women. It also assessed significant differences in calcium intake levels and the relative contributions of food sources to this intake. The questionnaire comprised a semiquantitative food frequency questionnaire and closed end questions. The closed ended questions measured psychosocial factors, stage of dietary change, levels of physical activity and demographic factors. These factors formed the basis of an investigation into factors best associated with the levels of adequacy of intake. The results suggest no significant difference in calcium intake (milligrams per day) in the two groups of women. There was a significant difference in the relative levels of adequacy of the estimated calcium intake levels. Milk and milk products contributed up to 84% of the daily calcium intake with 72.2 and 84.7% as the respective contributions in premenopausal and postmenopausal women. Fortified milk types have a relatively higher calcium content than unfortified types. A higher consumption of fortified milk noted in the postmenopausal women could explain the higher though not significant mean intake values post-menopausally. Several of the enabling factors but none of the predisposing factors were noted to influence intake of fortified milk. Taste generally influenced intake of fortified milk in the whole sample of 300 women whereas perceived costs and health concerns were an issue with the premenopausal women only. Other enabling factors such as the perceptions of the adequacy of the present diet, and the feeling that there was too much nutrition information that was in itself confusing influenced the intake of fortified milk in postmenopausal but not premenopausal women.The influence of change related factors was also noted. The importance ratings for nutrient issues influenced the intake of fortified milk intake in the whole sample. Food preference was the only enabling factor found to influence the adequacy of calcium intake in the both the premenopausal and postmenopausal women. Change related factors, were also noted to influence the adequacy of calcium intake in the premenopausal and postmenopausal women and these included; the stage of change for adopting a high calcium diet, the importance ratings for; increasing intake of milk and milk products and the perceived adequacy of this intake. The other suggested determinants of the adequacy of intake varied between the two groups of women. These inc1uded;enabling factors; perceived cost of milk and milk products, milk allergies, social support, availability of milk at home on a daily basis and the frequency of meal preparation in the premenopausal group. Change related factors on the other hand determined the postmenopausal intake and these included importance ratings for eating low fat foods, perceived adequacy of fruit and vegetable intake, and importance rating for an increased dietary calcium intake. The enabling factors; preferences, social support and perceived adequacy of milk and milk products' intake were the best predictors of the adequacy of premenopausal calcium intake whereas the change related factors; the importance rating for a high calcium diet and the reluctance to change a diet considered to be enjoyable best predicted the adequacy post-menopause. Knowledge is a predisposing factor for behaviour change. The results show that knowledge on the importance of a high calcium intake exists in the sample population. This knowledge is however not being effectively translated into food behaviour. This highlights the need for Nutrition education programs that stress the importance of food behaviours. These programs should aim at increasing women's calcium intake levels and destroying the few existing misconceptions regarding milk and milk product consumption. The factors identified as determinants of intake in the premenopausal and postmenopausal women are the basis of these education programs.

5 p. / Originally published: 2011 / Healthy bone growth and maintenance requires adequate calcium intake. You can meet your calcium needs from foods, beverages, and, if necessary, supplements.

Osteoporosis affects half of all women over the age of fifty, but can be prevented through proper nutrition and exercise early in life. Few studies have been conducted that document positive gains in knowledge about osteoporosis prevention in young girls and no research has been completed in which osteoporosis education is delivered by peers in children. A 3-A-Day™ of dairy peer education program was developed by local Girl Scouts with the purpose of teaching other Girl Scouts about the importance of calcium intake and weight-bearing activities in the prevention of osteoporosis, overweight, and hypertension. Peer educators had significant increases in their overall knowledge of dairy (p<0.001) and self-efficacy related to 3-A-Day™ (p<0.05) after teaching peer education programs. Program participants had significant improvements in knowledge of calcium-rich foods (p<0.001) and weight-bearing activities (p<0.001). Participants were able to identify the recommended number of dairy servings per day (p<0.01). Although parents indicated that their daughters' knowledge increased after participation in the peer education program, parents' ratings of knowledge were not significantly related with daughters' ratings. Qualitative evaluation indicated that these Girl Scouts enjoyed serving as peer educators. This research supports the importance of osteoporosis education in young girls and demonstrates positive outcomes of peer education for both educators and program participants. / Master of Science

Introdução: Dentre as inúmeras contribuições nutricionais para a obesidade, alguns estudos evidenciam o cálcio dietético como um fator negativamente relacionado com o Índice de Massa Corporal. Ensaios clínicos e experimentais demonstraram que o mecanismo provável é a maior disponibilidade do cálcio intracelular capaz de promover aumento da lipogênese, inibição da lipólise e hiperinsulinemia. Devido a escassez de dados semelhantes em adolescentes, o presente trabalho avaliou a relação do cálcio com a obesidade nesta população. Métodos: Estudo caso-controle e transversal, envolvendo adolescentes eutróficos (GE) e obesos (GO). Os participantes foram submetidos à avaliação antropométrica (peso e estatura), avaliação da composição corporal (DXA), avaliação bioquímica, incluindo perfil lipídico, glicemia de jejum, insulina e dosagem dos hormônios grelina e leptina (apenas nos obesos) e avaliação alimentar (registro de três dias). A resistência à insulina foi estimada por meio do HOMA-IR. A análise estatística constou de teste t Student, correlação de Pearson, Qui-Quadrado, teste exato de Fisher, ANOVA e Odds Ratio. A ingestão de cálcio foi ajustada pelo consumo energético da dieta por meio do método de nutriente residual. Resultados: Foram avaliados 96 adolescentes, pareados por sexo e idade (16,6±1,3 anos), sendo 47 do GE e 49 do GO. A média de ingestão de energia e macronutrientes foi semelhante entre os grupos. A ingestão de cálcio ajustado foi estatisticamente superior no GE (692,1±199,5mg vs 585,2±249,9 no GO; p=0,02). Verificou-se redução significativa da gordura corporal, da gordura do tronco e da gordura periférica com o aumento dos quartis de ingestão de cálcio. Além disso houve diferença estatisticamente significante entre o primeiro e o último quartil de cálcio com relação a glicemia e insulina. Em relação aos grupos de estudo verificou-se dentre os obesos, associação inversa da ingestão de cálcio ajustado com a gordura do tronco (r=-0,287; p=0,046), com a concentração de insulina (r=-0,360; p=0,01), com os níveis do HOMA-IR (r=-0,365; p=0,01) e com a concentração de leptina (r=-0,345; p=0,02). Não houve relação da ingestão de cálcio com a antropometria e composição corporal ou parâmetros bioquímicos no GE. Destaca-se que as adolescentes no maior quartil de ingestão de cálcio apresentavam uma significativa redução da chance de obesidade quando comparadas aquelas no primeiro quartil (OR=0,13; IC95%=0,02-0,78; p=0,01). Não houve proteção à adiposidade pela ingestão de cálcio entre os meninos. Conclusão: O estudo demonstrou que a ingestão de cálcio foi um fator envolvido na obesidade e na resistência à insulina dos adolescentes pós-púberes, e que houve proteção à adiposidade pela maior ingestão de cálcio entre as meninas. Estes resultados demonstram que o consumo de alimentos fontes desse mineral durante este estágio de vida deve ser incentivado. / Introduction: Several nutritional risk factors are related to obesity. Recently, some studies had demonstrated that dietary calcium intake as a negative contributor to adiposity. Clinical and experimental studies demonstrated that a possible mechanism is an increasing intracellular calcium concentration, which in turn act to promote lipogenesis, reduce lipolysis and hyperinsulinemia. Considering the shortage of similar data in adolescents, the present study evaluated the relation between dietary calcium intake with obesity in this population. Methods: Case-control and cross-sectional study, with normal weight (NW) and obese adolescents (OB). Anthropometric (weight and height) and body composition assessment (DXA) was analyzed. Biochemical analysis, included lipid profile, fasting glucose and insulin, as well as leptin and ghrelin. Dietary intake was assessed by a 3-day dietary record. Insulin resistance was calculated by HOMA-IR. Student’s t-tests, Pearson’s correlations, Chi-square or Fisher exact test, ANOVA and Odds-ratio were used to statistical analysis. The dietary calcium intake was adjusted by energy intake with residual nutrient method. Results: 96 post-pubertal adolescents, mean age 16.6(1.3)y were evaluated. Adolescents were divided in two groups paired by age and gender, 47 NW and 49 OB. Mean energy and macronutrients intake were similar between groups. Adjusted calcium intake was statistically higher in NW (692.1±199.5mg vs 585.2±249.9 in GO; p=0.02). A significant lower body fat mass, trunk and periferic fat mass were observed in the highest calcium intake quartile. Furthermore, glucose and insulin concentrations presented a statiscally significant difference between the lowest and highest calcium quartile. Analysis within study groups, showed an inverse association between adjusted calcium with trunk fat (r=-0.287, p=0.04), insulin concentration (r=-0.360, p=0.01), HOMA-IR levels (r=-0.365, p=0.01) and leptin (r=-0.345, p=0.02) in obese group. There was no relation between calcium intake with anthropometry and body composition or biochemical parameters in normal weight. Adolescents girls on highest quartile of calcium intake had significant reduction of obesity chance compared to lowest quartile (OR=0.13; IC95%=0.02-0.78; p=0.01). However, no adiposity protection by calcium intake was observed in boys. Conclusions: The results demonstrated that calcium intake was one factor related to obesity and insulin resistance in post-pubertal adolescents, and calcium intake seems to be a protective factor for obesity in girls, and encourage the recommendation for increase calcium intake in this life stage.

Introdução: Dentre as inúmeras contribuições nutricionais para a obesidade, alguns estudos evidenciam o cálcio dietético como um fator negativamente relacionado com o Índice de Massa Corporal. Ensaios clínicos e experimentais demonstraram que o mecanismo provável é a maior disponibilidade do cálcio intracelular capaz de promover aumento da lipogênese, inibição da lipólise e hiperinsulinemia. Devido a escassez de dados semelhantes em adolescentes, o presente trabalho avaliou a relação do cálcio com a obesidade nesta população. Métodos: Estudo caso-controle e transversal, envolvendo adolescentes eutróficos (GE) e obesos (GO). Os participantes foram submetidos à avaliação antropométrica (peso e estatura), avaliação da composição corporal (DXA), avaliação bioquímica, incluindo perfil lipídico, glicemia de jejum, insulina e dosagem dos hormônios grelina e leptina (apenas nos obesos) e avaliação alimentar (registro de três dias). A resistência à insulina foi estimada por meio do HOMA-IR. A análise estatística constou de teste t Student, correlação de Pearson, Qui-Quadrado, teste exato de Fisher, ANOVA e Odds Ratio. A ingestão de cálcio foi ajustada pelo consumo energético da dieta por meio do método de nutriente residual. Resultados: Foram avaliados 96 adolescentes, pareados por sexo e idade (16,6±1,3 anos), sendo 47 do GE e 49 do GO. A média de ingestão de energia e macronutrientes foi semelhante entre os grupos. A ingestão de cálcio ajustado foi estatisticamente superior no GE (692,1±199,5mg vs 585,2±249,9 no GO; p=0,02). Verificou-se redução significativa da gordura corporal, da gordura do tronco e da gordura periférica com o aumento dos quartis de ingestão de cálcio. Além disso houve diferença estatisticamente significante entre o primeiro e o último quartil de cálcio com relação a glicemia e insulina. Em relação aos grupos de estudo verificou-se dentre os obesos, associação inversa da ingestão de cálcio ajustado com a gordura do tronco (r=-0,287; p=0,046), com a concentração de insulina (r=-0,360; p=0,01), com os níveis do HOMA-IR (r=-0,365; p=0,01) e com a concentração de leptina (r=-0,345; p=0,02). Não houve relação da ingestão de cálcio com a antropometria e composição corporal ou parâmetros bioquímicos no GE. Destaca-se que as adolescentes no maior quartil de ingestão de cálcio apresentavam uma significativa redução da chance de obesidade quando comparadas aquelas no primeiro quartil (OR=0,13; IC95%=0,02-0,78; p=0,01). Não houve proteção à adiposidade pela ingestão de cálcio entre os meninos. Conclusão: O estudo demonstrou que a ingestão de cálcio foi um fator envolvido na obesidade e na resistência à insulina dos adolescentes pós-púberes, e que houve proteção à adiposidade pela maior ingestão de cálcio entre as meninas. Estes resultados demonstram que o consumo de alimentos fontes desse mineral durante este estágio de vida deve ser incentivado. / Introduction: Several nutritional risk factors are related to obesity. Recently, some studies had demonstrated that dietary calcium intake as a negative contributor to adiposity. Clinical and experimental studies demonstrated that a possible mechanism is an increasing intracellular calcium concentration, which in turn act to promote lipogenesis, reduce lipolysis and hyperinsulinemia. Considering the shortage of similar data in adolescents, the present study evaluated the relation between dietary calcium intake with obesity in this population. Methods: Case-control and cross-sectional study, with normal weight (NW) and obese adolescents (OB). Anthropometric (weight and height) and body composition assessment (DXA) was analyzed. Biochemical analysis, included lipid profile, fasting glucose and insulin, as well as leptin and ghrelin. Dietary intake was assessed by a 3-day dietary record. Insulin resistance was calculated by HOMA-IR. Student’s t-tests, Pearson’s correlations, Chi-square or Fisher exact test, ANOVA and Odds-ratio were used to statistical analysis. The dietary calcium intake was adjusted by energy intake with residual nutrient method. Results: 96 post-pubertal adolescents, mean age 16.6(1.3)y were evaluated. Adolescents were divided in two groups paired by age and gender, 47 NW and 49 OB. Mean energy and macronutrients intake were similar between groups. Adjusted calcium intake was statistically higher in NW (692.1±199.5mg vs 585.2±249.9 in GO; p=0.02). A significant lower body fat mass, trunk and periferic fat mass were observed in the highest calcium intake quartile. Furthermore, glucose and insulin concentrations presented a statiscally significant difference between the lowest and highest calcium quartile. Analysis within study groups, showed an inverse association between adjusted calcium with trunk fat (r=-0.287, p=0.04), insulin concentration (r=-0.360, p=0.01), HOMA-IR levels (r=-0.365, p=0.01) and leptin (r=-0.345, p=0.02) in obese group. There was no relation between calcium intake with anthropometry and body composition or biochemical parameters in normal weight. Adolescents girls on highest quartile of calcium intake had significant reduction of obesity chance compared to lowest quartile (OR=0.13; IC95%=0.02-0.78; p=0.01). However, no adiposity protection by calcium intake was observed in boys. Conclusions: The results demonstrated that calcium intake was one factor related to obesity and insulin resistance in post-pubertal adolescents, and calcium intake seems to be a protective factor for obesity in girls, and encourage the recommendation for increase calcium intake in this life stage.

Background: Hypertension is defined as an elevated systolic blood pressure (SBP ≥ 140 mmHg), or an elevated diastolic blood pressure (DBP ≥ 90 mmHg). The prevalence of hypertension is high in obese population. The potential effects of inadequate calcium intake on hypertension are receiving growing attention. The aim of the study was to examine the association between calcium intake and hypertension among obese adults. Methods: A total of 14,856 obese adults aged 20 years or older were obtained from the 1999-2010 National Health and Nutrition Examination Survey. Analysis of variance was used to examine if there was a relationship between calcium intake and blood pressure, SBP or DBP. Multiple logistic regressions were used to examine the association between calcium intake and hypertension after adjusting for potential confounders (energy intake, age, race, education level, alcohol use, smoking, and diabetes). Results: Prevalence of hypertension decreased with an increasing quartile of calcium intake (p < 0.0001). Multiple logistic regression showed that lowest quartile of calcium intake was associated with an increased risk of elevated SBP and elevated DBP (Odds Ratio (OR) =1.332, 95% Confidence Interval (CI): 1.084-1.636; OR=1.700, 95% CI: 1.234-2.342, respectively). Compared with adults in the highest quartile of calcium intake, those in lowest quartile had 1.4 times increased risk of hypertension (OR=1.400, 95% CI: 1.157-1.694). Conclusion: Our study provides support of research perspective that inadequate calcium intake may increase the risk of hypertension, high SBP, or high BDP among obese adults. Further studies are needed to understand physiological mechanism. Increasing the calcium intake in obese adults can be considered as a strategy to prevent hypertension.