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Editorial |
National Dairy Council,
Dairy Management Inc.,
Rosemont, IL
The article by Ortega et al [1] in this issue identifies low calcium intakes among teenagers in Madrid, Spain and the importance of consuming an adequate breakfast in improving calcium, as well as overall nutrient, status. Teens who consumed greater amounts of calcium and dairy foods at breakfast had higher intakes of calcium and dairy foods throughout the rest of the day [1]. These findings in Spain support those in the US.
In the Madrid study, 65% of the boys and 80% of the girls aged 9 to 13 years had calcium intakes below recommended levels [1]. Likewise in the US, the majority of teens have suboptimal calcium intakes. According to the latest US Department of Agriculture Continuing Survey of Food Intakes by Individuals [2], more than 64% of teenage boys and 87% of teenage girls are not meeting the 1989 Recommended Dietary Allowances (RDAs) [3] for calcium. Considering that the calcium recommendation in the US has recently been raised to 1,300 mg/day for children 9 through 18 (i.e., from the 1989 RDA of 800 mg/day for 7 through 10 year olds and 1,200 mg/day for 11 through 18 year olds) [4], the percentage of US teens failing to meet calcium recommendations is likely to be even higher.
The teen years are critical for building bone density since up to 40% of adult bone mass is formed during the adolescent growth spurt [5,6]. Teens with low calcium intakes are at increased risk of stress fractures and weak bones and, in later years, bone-crippling osteoporosis. Dairy foods provide 73% of the calcium, as well as significant amounts of other essential nutrients, available in the US food supply [7]. Teenagers’ low intake of calcium may be explained by their low intake of dairy foods, especially fluid milk [8]. Dieting or fear of fat among teenage girls has been associated with their low intake of dairy foods [9]. Yet, research demonstrates that teenage girls can increase their calcium intake through dairy foods without increasing their calorie or fat intake, body weight, or percent body fat [10,11].
Skipping breakfast or eating a nutritionally poor breakfast may also explain why many American teenagers fail to consume recommended intakes of calcium. Studies conducted in the US since the early 1980s have documented the benefits of breakfast consumption in improving children’s overall daily nutrient intake, especially of milk-related nutrients such as calcium [12–17].
Recognition of the benefits of a nutritious breakfast for children led the US government to permanently establish the School Breakfast Program (SBP) in 1975. This federally funded program is available to all schools and children. However, students may participate in the program only if their school chooses to offer it. The SBP must provide one-quarter of the RDAs for calories, protein, vitamins A and C, iron, and calcium. It also must provide no more than 30% of calories from fat, consistent with the Dietary Guidelines for Americans [18]. A nationwide evaluation of the SBP in the mid-1980s revealed that breakfast participants had superior intakes of milk-related nutrients—calcium, phosphorus, riboflavin, protein—and were better nourished over a 24-hour period compared with breakfast skippers [13,14].
More recently, a survey of over 1,000, mostly low-income, African American Elementary school children in New Jersey revealed that 25% of the children who skipped breakfast consumed less than 50% of the RDAs for calories, vitamin C, calcium, and iron [17]. According to the Bogalusa Study [16], a 20-year investigation of cardiovascular disease risk factors in a biracial community of children and young adults in Bogalusa, LA, breakfast skippers consumed less daily energy, vitamins (e.g., A, E, D, B6), and minerals (e.g., calcium, phosphorus, magnesium) than children who ate this meal. Children may not be able to make up for the nutrients provided by breakfast at other meals during the day.
Participating in the SBP not only improves total daily nutrient intake and nutritional status, but it also enhances students’ ability to learn [15,19–22]. Hungry children, regardless of income or socioeconomic status, face difficulties learning [23]. Hunger reduces a child’s ability to respond to the environment, to pay attention, and to obtain information [23]. The availability of the SBP can help relieve children’s hunger and may improve their ability to succeed at school. A recent critical review of studies published since 1978 on the educational benefits of breakfast led the author to conclude that "In populations where children are nutritionally at risk, the availability of breakfast may make it possible for a child to be well nourished over the long term and may prevent or reverse nutrient deficiencies that affect cognition" [21]. Findings from the studies reviewed indicate that, compared to children who skip breakfast, children who eat breakfast make fewer errors on standardized achievement tests and exhibit improved vigilance, attention, school attendance, and reduced tardiness [21]. Missing breakfast reduces children’s speed and accuracy of information retrieval and memory.
The educational advantage of breakfast was recently demonstrated in Minnesota where, in a pilot study, breakfast was served free to all students in four elementary schools [22]. Increased student attention, fewer behavioral problems and visits to the nurse, and a general increase in math and reading scores were attributed to participation in this program [22].
Nationally, participation in the SBP has continued to rise for more than a decade. Today, this program provides a nutritious morning meal to 6.8 million children a day at 67,063 schools and institutions, or 94% more schools than in 1987–88 [24]. Currently, 22 states mandate that certain schools participate in the SBP [24]. Approximately 86% of breakfasts are served free or at a reduced price to eligible children. However, low income is not the only reason children come to school hungry. Some parents’ work schedules may limit their ability to prepare and serve breakfasts to their families. Other children may have long bus rides to school leaving them hungry when they arrive at school. A recent national survey found that while 79% of 8 and 9 year olds ate breakfast every day, only 58% of 12 and 13 year olds did so [25]. The older children’s top reasons for skipping this meal were "not enough time" and "not hungry" in the morning.
Recognition of the benefits of the SBP has led to concerted efforts to expand this program. Legislation has recently been introduced into Congress that, if approved, would provide free breakfasts to all elementary children in the US regardless of income [26]. The availability of breakfast, whether at home or at school, for all students in the US would go a long way towards improving their nutrient status, including calcium status, and their academic performance.
Received December 1, 1997. REFERENCES
This article has been cited by other articles:
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  G. C. Rampersaud Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners American Journal of Lifestyle Medicine, March 1, 2009; 3(2): 86 - 103. [Abstract] [PDF]
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 T. A. Nicklas Calcium Intake Trends and Health Consequences from Childhood through Adulthood J. Am. Coll. Nutr., October 1, 2003; 22(5): 340 - 356. [Abstract] [Full Text] [PDF]
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G. D. Miller, J. K. Jarvis, and L. D. McBean The Importance of Meeting Calcium Needs with Foods J. Am. Coll. Nutr., April 1, 2001; 20(2): 168S - 185. [Abstract] [Full Text] [PDF]
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L. D. McBean and G. D. Miller Enhancing the Nutrition of America's Youth J. Am. Coll. Nutr., December 1, 1999; 18(6): 563 - 571. [Abstract] [Full Text] [PDF]
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