Table 8.
Food patterns and bone health in children and adolescents
| Food | Source | Study description | Population description | Number of subjects | End points | Results | |||
|---|---|---|---|---|---|---|---|---|---|
| RCTs | |||||||||
| Dairy | Du et al. 2004 [170] | 2-year school-based randomized trial of 330 mL milk, 330 mL milk + 5 or 8 μg vitamin D3, or control | Sex: female Age: 10–12 years Race: Chinese Location: Beijing, China |
757 | Group mean increase | P | |||
| Treatment | Placebo/control | ||||||||
| Height | 0.95 % | 0.087 % | <0.0005 | ||||||
| Total body BMC | 38.4 % | 35.9 % | 0.03 | ||||||
| Bone area | 29.5 % | 31.3 % | 0.2 | ||||||
| Dairy | Courteix et al. 2005 [158] | 12-month randomized, double-blind, placebo-controlled study Baseline calcium: supplement = 1008 (398); placebo = 988 (345) Was combined with an exercise intervention that found a combined effect not reported here. After randomization, fewer subjects were in the dairy group than in the placebo group (34 vs 79, respectively, at the baseline). It was expected that 240 subjects would be recruited, but because of the publicity surrounding Mad Cow disease, many parents were afraid of dairy products. |
Sex: premenarchal female Age: 8–13 years Race: Caucasian Location: France |
113 | Calcium supplement | Placebo | |||
| Total body | BMC | 155 ± 79 | 166 ± 66 | ||||||
| Lumbar spine | BMC | 3.429 ± 2.388 | 3.228 ± 2.642 | ||||||
| Femoral neck | BMC | 0.248 ± 0.187 | 0.185 ± 0.103 | ||||||
| Trochanter | BMC | 0.941 ± 0.525 | 0.796 ± 0.582 | ||||||
| Wards | BMC | 0.001 ± 0.054 | 0.047 ± 0.086 | ||||||
| Ultradistal radius | BMC | 0.104 ± 0.091 | 0.111 ± 0.107 | ||||||
| Mid radius | BMC | 0.305 ± 0.230 | 0.355 ± 0.322 | ||||||
| 1/3 distal | BMC | 0.072 ± 0.078 | 0.093 ± 0.077 | ||||||
| Adjusted for lean tissue mass. All NS | |||||||||
| Dairy | Cheng et al. 2005 [159] | 2 year double-blind, placebo-controlled RCT of calcium (1000 mg) + vitamin D3 (200 IU), calcium (1000 mg), cheese (1000 mg calcium), and placebo | Sex: female Age: 10–12 years Race: presumed white Location: Finland |
195 | Cheese | P | |||
| Total body | BMD (%) | 10.4 | 8.9 (compliance >50) | 0.044 | |||||
| Femoral neck | BMC (%) | 26.5 | 22.4 | NS | |||||
| Total femur | BMC (%) | 36.9 | 33.6 | NS | |||||
| Spine | BMC (%) | 52.4 | 47.0 | NS | |||||
| Tibia cortical thickness | pQCT (%) | 37.1 | 31.1 (compliance 50) | 0.01 | |||||
| Dairy | Merrilees et al. 2000 [169] | 2-year RCT of dairy food supplementation and 1-year follow-up after cessation of intervention | Sex: female Age: 15–17 years Race: presumed white Location: New Zealand Stratified by forearm BMD at baseline |
91 | Total body | BMC (g) | 168.9 | 167.4 | NS |
| Lumbar spine | BMC (g) | 3.83 | 2.58 | NS | |||||
| Femoral neck | BMC (g) | 0.12 | 0.06 | NS | |||||
| Trochanter | BMC (g) | 0.75 | 0.25 | <0.05 | |||||
| Difference disappeared 1 year after cessation | |||||||||
| Fiber | Abrams et al. 2005 [193] | 1-year placebo-controlled RCT of 8 g/day mixed short and long inulin-type fructans | Sex: half were male and half were female Age: 9–13 years Tanner stage 2 or 3 Race: 53 % white, 14 % black, 22 % Hispanic, 10 % Asian Location: Houston, TX Between 5th and 95th percentile BMI |
100 | Total body | BMC, % | 18.3 | 16.7 | 0.03 |
| Observational studies | |||||||||
| Total diet | Wosje et al. 2010 [335] | Prospective study with cross-sectional analysis by age to relate 3-day diet records to fat and bone mass in children during the age period of 3.8–7.8 years, using reduced-rank regression | Sex: male and female (167/158) Age: 3.8–7.8 years Race: 75 % white, 25 % black Location: Cincinnati, OH Year(s): 2000–2004 |
325 | Fat mass (kg) Bone mass (g) |
Diets high in dark-green and deep-yellow vegetables and processed meats and low in fried foods were associated with lower fat mass (P < 0.001) and higher bone mass (P = 0.03 for year 1, P = 0.2 for year 2, and P < 0.01 for years 3 and 4) | |||
| Fruits and Vegetables | Prynne et al. 2006 [189] | Cross-sectional Cambridge Bone Studies to relate fruit and vegetable and nutrient intake from 7-day food diaries in 5 age and sex cohorts | Sex: female and male, nearly half of each Age: 16–19 years Race: presumed white Location: UK |
257 | Percent change with doubling in fruit and vegetable intake from univariate analysis | ||||
| Boys | P | Girls | P | ||||||
| Total body BMC | 9.2 | <0.001 | 5.2 | 0.02 | |||||
| Spine BMC | 7.8 | 0.002 | 8.8 | 0.001 | |||||
| Total hip BMC | 6.6 | 0.008 | 5.0 | 0.04 | |||||
| Femoral neck BMC | 10.3 | <0.001 | 6.5 | 0.07 | |||||
| Trochanter BMC | 7.9 | 0.01 | 5.2 | NS | |||||
| Fruits and vegetables | McGartland et al. 2004 [195] | Cross-sectional study on effect of fruit and vegetable intake on BMD | Sex: male and female Age: 12 and 15 years Race: presumed white Location: Northern Ireland |
1345 | Forearm BMD Heel BMD |
12-year-old girls consuming high amounts of fruit had significantly higher heel BMD (β = 0.037; 95 % CI, 0.017, 0.056). No other associations were observed. | |||
| Fruits and vegetables | Tylavsky et al. 2004 [196] | Cross-sectional study on the effect of low (<3 servings) versus high (≥3 servings) fruit and vegetable intake on urinary calcium excretion and bone mass | Sex: female Age: 8–13 years Race: white Location: Tennessee, USA |
56 | Total body bone area Wrist bone area |
Compared with the low-consumption group, the high fruit and vegetable consumption group had 6 and 8.3 % larger total body (P < 0.03) and wrist bone area (P < 0.03). | |||
| Total body BMC Wrist BMC |
Whole body and wrist BMC was 7.4 (P = 0.07) and 7.0 % (P = 0.09) larger in the high-consumption group (P > 0.05). | ||||||||
| Total body BMD Wrist BMD |
Whole body and wrist BMD did not differ significantly between the low- and high-consumption groups (P > 0.05). | ||||||||
| Urinary calcium | Those reporting high fruit and vegetable intake had lower concentrations of urinary calcium/kg body weight (P < 0.02). | ||||||||
| Fruits and vegetables | Whiting et al. 2004 [197] | Cross-sectional study of bone growth in children | Sex: male and female Age: 8–14 years Race: presumed white Location: Saskatoon, Canada Year(s): 1991–1997 |
131 | BMC | Fruit and vegetable intake appears to influence BMC in adolescent girls but not boys. | |||
| Fruits and vegetables | Vatanparast et al. 2005 [198] | Cross-sectional study on the effect of milk products, vegetables, and fruit on total body BMC | Sex: male and female Age: 8–20 years Race: presumed white Location: Saskatoon, Canada Year(s): 1991–1997 |
150 | Total body BMC | Fruit and vegetable intake was a significant independent predictor of total body BMC in boys but not girls. | |||
| Caffeine | Conlisk and Galuska 2000 [204] | Cross-sectional study on effect of caffeine on BMD in healthy women | Sex: 177 women Age: 19–26 years Race: presumed white Location: Midwestern USA Year(s): 1991 |
177 | Caffeine consumption for past 12 weeks by self-report BMD at the lumbar spine and femoral neck by DXA |
Caffeine was not significantly associated with BMD. | |||
| Carbonated beverages | Wyshak 2000 [200] | Cross-sectional study of carbonated beverage consumption and bone fractures | Sex: girls Age: 9th and 10th graders (mean age 15.8 years) Race: unspecified, American high school students Location: “urban high school,” USA |
460 | Self-reported physical activity, carbonated beverage consumption, and bone fractures | Carbonated beverage consumption and bone fractures were associated (OR, 3.14; 95 % confidence limit, 1.45, 6.78; P = 0.004). | |||
| Carbonated beverages | McGartland et al. 2003 [194] | Cross-sectional observational study of the association between CSDs and BMD in postprimary schools in Northern Ireland | Sex: 744 girls, 591 boys Age: 12 years (323 boys, 376 girls); 15 years (268 boys, 368 girls) Race: presumed white Location: Belfast, Northern Ireland Year(s): 2000 |
1335 | CSD consumption via RD-administered dietary history method BMD of the nondominant forearm (distal radius) and dominant heel (os calcis) by DXA |
A significant inverse relationship between total CSD intake and BMD was observed in girls at the dominant heel (β, −0.099; 95 % CI, −0.173 to −0.025). Non-cola consumption was inversely associated with dominant heel BMD in girls (β, −0.121; 95 % CI, −0.194 to −0.048), and diet drinks were also inversely associated with heel BMD in girls (β, −0.087; 95 % CI, −0.158 to −0.016). No consistent relationships were observed between CSD intake and BMD in boys. | |||
| Carbonated beverages | Ma and Jones 2004 [199] | Population-based case–control study to investigate the association between soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children aged 9–16 years | Sex: half male and half female Age: 9–16 years Race: presumed white Location: Tasmania, Australia Year(s): 1998–2002 |
206 fractures 206 controls |
Bone mass using DXA at the total body, lumbar spine, right femoral neck: BMC aBMD BMAD Soft drink and dairy drink consumption (in-person interview) |
None of the drink types (milk, cola, and carbonated drinks) was significantly different between cases and controls for total fracture. For wrist and forearm fractures, there was a positive association between cola drink consumption and fracture risk (OR, 1.39/unit; 95 % CI, 1.01, 1.91). | |||
| Carbonated beverages | Manias et al. 2006 [201] | Cross-sectional study of recurrent fracture, diet, and physical activity | Sex: 78 girls, 72 boys Age: 4–16 years Race: presumed white Location: Sheffield, UK |
150 | Bone area, BMC, BMD of spine, lower body, and upper body by DXA Fracture history and trauma severity Diet (including beverage consumption), physical activity, and other lifestyle factors via questionnaires |
Children with recurrent fractures had a significantly lower milk intake, lower levels of physical activity, a higher BMI, and a higher consumption of carbonated beverages than controls. | |||
| Carbonated beverages | Libuda et al. 2008 [202] | Prospective (DONALD) study of diet from 3-day diet records for 4 years prior to a single forearm pQCT measure | Sex: 113 girls, 115 boys Age: 6–18 years Race: presumed white Location: Germany |
228 | Forearm pQCT | Carbonated beverage consumption was inversely associated with BMC (P < 0.05), cortical area (P < 0.05), and polar strength strain index (P < 0.05), polar strength strain index (P < 0.01), and periosteal circumference (P < 0.05) of the radius assessed by pQCT, after adjustment for age, sex, total energy intake, muscle area, BMI SD scores, and growth velocity. | |||
95 % CI 95 % confidence interval, aBMD areal bone mineral density, BMAD bone mineral apparent density, BMC bone mineral content, BMD bone mineral density, CSD carbonated soft drink, DONALD Dortmund Nutritional and Anthropometric Longitudinally Designed, DXA dual-energy x-ray absorptiometry, NS not significant, OR odds ratio, pQCT peripheral quantitative computed tomography, RCT randomized controlled trial, RD registered dietician, SSI stress–strain index