title: Building better bones in childhood: a randomized controlled study to test the efficacy of a dietary intervention program to increase calcium intake.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester NY, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Weber
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Stark
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Ittenbach
authors.affiliation: The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: V A
authors.initials: VA
authors.lastname: Stallings
authors.affiliation: The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Zemel
mesh_terms: D015502:Absorptiometry, Photon; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects; D001846:Bone Development / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D002136:Calcium, Dietary / Q000008:administration & dosage*; D002648:Child; D002657:Child Development; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male
chemical_list: D002136:Calcium, Dietary