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Determination of the Optimal Number of Dairy Servings to Ensure a Low Prevalence of Inadequate Calcium Intake in Americans

Nutrition Impact, Battle Creek, Michigan (V.L.F.)
National Dairy Council, Rosemont, Illinois (P.J.H., D.B.D., G.D.M.)

Address reprint requests to: Peter J. Huth, PhD, National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616. E-mail peterh{at}rosedmi.com

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
Background: Many Americans are not getting the recommended amounts of calcium in their diet. Since dairy foods provide most of the calcium in the diet, the number of recommended servings of dairy products may need to be revised.

Objective: 1. To determine the calcium intake of various age groups that met or exceeded the intake of dairy products recommended by the Food Guide Pyramid (FGP). 2. To determine the optimal level of dairy consumption that ensures a low prevalence of inadequate calcium (Ca) intake by Americans.

Methods: Using data from the Continuing Survey of Food Intake by Individuals, 1994–96, 1998, (CSFII) and the National Health and Nutrition Examination Survey, 1999–2000 (NHANES) we determined the calcium intake in individuals who met the recommended daily dairy servings as well as the minimum number of dairy servings required for the mean Ca intake of various age groups to exceed their respective Adequate Intakes (AI).

Results: Objective 1: Meeting or exceeding the FGP dairy recommendation led to calcium intakes that met recommended levels. However, very few individuals in all age groups met or exceeded the number of dairy servings recommended by FGP. Objective 2: Results indicated that in children 2–8 yrs, 2 dairy servings/d were required for the mean Ca intake (835 ± 72 and 822 ± 68 mg/d, in CSFII and NHANES IV, respectively) to exceed the AI. In children 9–18 yrs, 4 dairy servings/d) were required for the mean Ca intake of the group (1540 ± 93 and 1518 ± 86 mg/d) to exceed the AI. Similar data were observed in adults 19+ yrs, e.g., in adults 51+ yrs, 3 dairy servings/d were required for the mean Ca intake of the group (1241 ± 53 and 1217 ± 53 mg/d) to exceed the AI.

Conclusion: Groups that met or exceeded the FGP dairy recommendations were more likely to have a mean calcium intake above the AI but had an average intake of about one serving higher than current recommendations. In individuals 9 yrs and older, 3–4 servings of dairy products are needed to meet or exceed the Ca AI and to ensure a low prevalence of inadequate Ca intake.

Key words: calcium, dairy, nutrient intake, meeting recommended intakes, dietary surveys, CSFII, NHANES

	INTRODUCTION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
Adequate calcium consumption leads to considerable health benefits. In addition to bone health early in life, the importance of calcium in maintaining skeletal integrity across the life span is well accepted. Inadequate dairy food consumption and thus calcium intake in youth sets the stage for skeletal fragility later in life, resulting in osteoporosis and increased risk of osteoporotic fracture. Osteoporosis is now recognized as a "pediatric disease with geriatric consequences" since more than 90% of peak bone mass is achieved by about age 20 [1,2]. Recognition of calcium’s critical role in bone health contributed to the Food and Nutrition Board’s (FNB) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and specifically the Panel on Calcium and Related Nutrients decision in 1997 to increase calcium intake recommendations in adolescents, adults, and adults 51+ years [3]. Unfortunately, nationwide surveys indicate that few Americans are meeting dietary recommendations for calcium intake [4–8].

Dairy foods have long been recognized as an excellent source of calcium due to their high calcium content and bioavailability, high density of other synergistic nutrients for bone health and relative low cost [9–14]. Adequate intake of calcium and other nutrients from dairy has also been demonstrated to help reduce the risk of high blood pressure [15–17], body weight/fat gain [18,19], and colon cancer [20–22]. Potential beneficial roles for calcium in other disorders such as kidney stones [23–26] and premenstrual syndrome [27,28] have been reported. The effect of the nutrient package dairy foods deliver (e.g., potassium, magnesium, etc.) has been observed to be more effective than calcium alone for blood pressure reduction and body weight/fat loss [15,18].

In the U.S., about 70% of dietary calcium intake is supplied by milk, cheese, yogurt, and by mixed dishes that use milk and cheese as ingredients [7,8]. The original U.S. Department of Agriculture’s (USDA) Food Guide Pyramid (FGP) recommend that Americans 2 years and over consume 2–3 dairy servings per day depending on age—3 servings for individuals 11–24 and 2 servings for all others [29]. In a reassessment of the FGP recommendations for dairy servings based on the new Dietary Reference Intakes (DRI) for calcium, Shaw et al. [32] reaffirmed that 2–3 servings of dairy approach or meet the calcium DRI’s albeit the majority of the population groups require 3 servings. These conclusions were based on idealized diets that used FGP recommended dietary patterns which included non-dairy calcium derived from recommended intakes of grains, vegetables, fruit, and meat (about 250–475 mg of calcium/d).

However, most Americans consume substantially less than the recommended servings of whole grains, vegetables and fruit [33]. Substantial quantities of these foods would be required to meet the increase in the DRIs for calcium and some have indicated that increasing servings of food groups other than dairy to meet calcium is probably not practical, at least in the near term [32]. Although consumption of whole grains, vegetables and fruit is to be encouraged, it is not realistic to recommend significant increases in the numbers of servings from these foods to meet calcium needs [32]. Given the low consumption of whole grains, vegetables and fruit, it is currently unclear whether the actual calcium intake in those groups who consume the recommended number of dairy servings are meeting the Adequate Intake (AI) of calcium for various age groups established by the FNB (Table 1) [3].

	MATERIALS AND METHODS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
The data used in these analyses were from CSFII (1994–96, 1998) and NHANES (1999–2000). The CSFII dietary survey was based on 3 independent, nationally representative 1-year samples (1994–96) of noninstitutionalized population groups in the United States; in 1998 additional data became available on children ages 10 years and younger [35]. Food intake was obtained on two separate days using a 24-hour dietary recall. NHANES is a stratified multistage probability sample of the US population based on two annual surveys [36]. Dietary information was obtained via a 24-hour recall questionnaire.

Subjects from the CSFII and NHANES datasets were selected on stratified, clustered, multistage techniques with oversampling of select groups (e.g., low income persons, certain ethnic groups, certain age groups, etc.), thus appropriate sample weights must be utilized to ensure results are representative of the US population. For CSFII data we used the average of the two-day intakes. In each study we used the number of dairy servings provided by the USDA Healthy Eating Index (HEI) files for CSFII [37] and NHANES [38]. The HEI files calculated the number of dairy servings from all foods consumed per subject and was used to determine the HEI scoring for meeting the recommended number of dairy servings. We only used data for individuals aged 2 years and higher which had complete and reliable dietary records leaving us 17,960 subjects in CSFII and 8,073 subjects in NHANES. The NHANES data were used to ascertain the level of agreement with the larger, but older data in CSFII.

For both objectives, we grouped subjects into four age groups: 2–8 years, 9–18 years, 19–50 years, and greater than 50 years. These age groups were chosen based on the age classifications created by FNB and the fact that the FGP is used for Americans two years and older. For objective 1, we then separated subjects into two groups: 1) those that met or exceeded the number of dairy servings according to the FGP (2 or 3 servings depending on age) and 2) those that consumed less than the recommended number of dairy servings. Average calcium intake, average dairy serving intake and the percentage of the population meeting or not meeting the AI for calcium were calculated for all groups. For objective 2, we determined the optimal level of dairy consumption that ensures a low prevalence of inadequate calcium intake in Americans; we separated subjects into six groups based on dairy serving consumption (<1, 1–1.5, 1.5–2.5, 2.5–3.5, 3.5–4.5, and >4.5 dairy servings per day). Average calcium intake, average dairy serving intake and the percentage of the population meeting or not meeting the AI for calcium were calculated for all these groups. When the mean calcium intake exceeded the AI for a particular age group, we concluded that the prevalence of inadequate calcium intake was low [34].

Statistical Analysis
For both objectives, analyses were conducted using SAS (Statistical Analysis System, Release 8.1 for Windows; SAS Institute, Cary NC) and SUDAAN (Research Triangle Institute, Research Triangle Park, NC). Appropriate study specific sampling weights were employed to adjust for over-sampling of selected groups and survey non-response of some individuals in each study. Means and standard errors were calculated for variables of interest.

	RESULTS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
Are 2–3 Servings of Dairy Enough to Meet Recommended Calcium Intakes?
Objective 1. Meeting/Exceeding FGP Recommendations
A. CSFII.
Table 2 presents data on mean calcium intake and the percentage of the groups that met the AI for calcium for various age categories based on whether individuals within a particular age category met/exceeded or did not meet the current FGP recommendation for dairy servings consumption from CSFII. Results showed that 44.5% of children 2–8 years met/exceeded the FGP recommendations to consume 2 or more dairy servings per day and the average calcium intake was 850 ± 6.4 mg/day (Table 2). The average number of dairy servings for the group meeting the FGP dairy recommendation was 2.95 dairy servings per day. With this level of dairy consumption, the mean intake of calcium in the 2–8 year olds that met/exceeded the FGP dairy recommendations was 1145 ± 7.8 mg/day. Since the mean calcium intake of this group exceeds the AI for calcium for this age group we conclude that when children of this age consume approximately three servings of dairy products per day there is a low likelihood that this group has inadequate calcium intake. In contrast, the 2–8 year olds not meeting the FGP dairy recommendations (55.4%) only consumed an average of 1.22 dairy servings per day and mean calcium intake of this group was only 607 mg/day.

B. NHANES.
The data from NHANES 1999–2000 (Table 3) leads to similar conclusions as that from data in CSFII. For example, the mean calcium intake in all groups greater than 9 years of age was lower than the AI for calcium for the respective groups. In all groups greater than 9 years of age, only in those groups that met/exceeded the FGP dairy recommendation can we conclude that the likelihood of inadequate calcium intake is low (mean calcium intake exceeded the respective AI for calcium). For example, children 9–18 years of age that met/exceeded the FGP dairy recommendation consumed an average of 4.60 dairy servings per day and had a mean calcium intake of 1748 ± 42.8 mg/day. Additionally, in adults greater than 50 years of age those that met/exceeded the FGP dairy recommendations consumed on average 4.43 servings of dairy per day and 1625 ± 51.0 mg calcium per day. We can say, with some confidence, that in individuals greater than 9 years of age that meet/exceed the FGP dairy recommendations consume, on average, more than 3 servings of dairy products per day and that mean calcium intake exceeds the respective AI and as such the likelihood of the prevalence of inadequate calcium intake in these groups is low.

A. CSFII.
Results showed that 1.5 to 2.5 servings (average about two servings per day) appeared to be the first intake level to exceed the AI for children 2–8 years of age in CSFII (Table 4). In children 9–18 years of age, with an AI of 1300 mg calcium/day, the first group mean intake above the AI was at 3.5 to 4.5 dairy servings per day (average 3.92 servings per day). For adults 19–50 years of age the first group mean intake greater than the AI for this group (1000 mg calcium/day) occurred at 2.5 to 3.5 dairy servings per day (average 2.94 servings per day). In adults older than 50 years of age, the first group mean intake to exceed the AI of 1200 mg calcium per day occurred at 2.5 to 3.5 dairy servings per day (average 2.89 servings per day).

	DISCUSSION

Based on these analyses an estimate of the ideal number of dairy servings required to meet the AI for calcium

1. Children 2–8 years of age need at least 2 servings of dairy per day—the same as the current recommendation;
   
2. Children 9–18 years of age need on average 4 servings of dairy per day—one serving more then the current recommendation;
   
3. Adults aged 19–50 years of age need at least 3 servings of dairy per day—one serving more then the current recommendation;
   
4. Adults older than 51 years of age need 3 servings of dairy per day—the same as the current recommendation.
   

This indicates that the number of dairy servings recommended by the FGP should be increased by one serving for all age groups over 9 years of age to ensure the likelihood of inadequate intake of calcium is low.

One strength of our analyses is the use of very large nationally representative dietary surveys, which use well-established and accepted methodologies. Additionally, we saw very similar results across both surveys even though CSFII analyses contained two-day intakes and NHANES only contained a single day of intake.

Our results raise some important considerations for dietary recommendations. It is clear the FGP recommends an idealized dietary pattern and thus if certain components of the dietary pattern are not consumed as suggested, then the intake of certain nutrients may be compromised. For example, depending on the caloric pattern, FGP expects 250–475 mg of calcium to come from grains, fruits, and vegetables, particularly dark green leafy vegetables and legumes [32]. However, consumption of dark green leafy vegetables and legumes are each only 0.2 of a serving per day [33], considerably less than amounts suggested. The Dietary Guidelines suggest that certain non-dairy sources (e.g., canned fish with bones, fortified orange juice, fortified soy beverage, tofu, and some dark green leafy vegetables [greens]) could be consumed to increase calcium in the diet. In CSFII, however, less than 0.2% of food occasions were for canned fish, fortified orange juice, fortified soy beverage, tofu, and greens combined as compared to 10% of food occasions for milk, cheese and yogurt (data not shown). Our data looks at actual food consumption and suggests that, at least to meet calcium requirements, an additional serving of dairy products might be more impactful to calcium nutriture than to try and increase dark green vegetable, legumes or other sources of calcium suggested by others.

Table 6 shows that considerable amounts of these foods (6–15 servings) would be required to meet the calcium content of one dairy serving. Hence, increasing servings of food groups other than dairy foods to meet calcium DRI’s is unlikely to be realistic or practical [33]. Additionally others have pointed out the lower calcium bioavailability from plant foods containing oxalic or phytic acid and specifically mentions that calcium absorption from dried beans is about half and from spinach is about one tenth that of calcium absorption from milk [3]. Calcium from fortified soy beverages was reported to be absorbed at only 75% of the efficiency of calcium from cow milk [42]. Furthermore, Healthy People 2010 have stated the critical need of dairy products to meet calcium needs: "With current food selection practices, use of dairy products may constitute the difference between getting enough calcium in one’s diet or not" [40].

	ACKNOWLEDGMENTS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
To Sue Kelleher for help in manuscript preparation.

Received February 10, 2004. Accepted June 4, 2004.

	REFERENCES

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 

1. Power ML, Heaney RP, Kalkwarf HJ, Pitkin RM, Repke JT, Tsang RC, Schulkin: The role of calcium in health and disease. Am J Obstet Gynecol181 :1560 –1569,1999 .[Medline]
2. Wosje KS, Specker BL: Role of calcium in bone health during childhood. Nutr Rev58 :253 –268,2000 .[Medline]
3. Institute of Medicine, National Academy of Sciences, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board: "Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride." Washington DC: National Academy Press,1997 .
4. Alaimo K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM, Johnson CL: "Dietary Intakes of Vitamins, Minerals, and Fiber of Persons Ages 2 Months and Over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988–1991." Advance Data from Vital and Health Statistics: No 258. Hyattsville MD: National Center for Human Statistics,1994 .
5. US Department of Agriculture, Agricultural Research Service. Data Tables: "Results from USDA’s 1994–96 Continuing Survey of Food Intakes by Individuals and 1994–96 Diet and Knowledge Survey." Riverdale MD: ARS, USDA, February1999 . Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/hom.htm
6. US Department of Agriculture, Agricultural Research Service: "Food and Nutrient Intakes by Children 1994–96, 1998." Beltsville MD: ARS, USDA, December1999 . Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/hom.htm
7. Fleming KH, Heimbach JT: Consumption of calcium in the U.S.: food sources and intake levels. J Nutr124 :8 (Suppl):1426S –1430S,1994 .
8. Albertson AM, Tobelmann RC, Marquart L: Estimated dietary calcium intake and food sources for adolescent females: 1980–92. J Adolesc Health20 :20 –26,1997 .[Medline]
9. Heaney RP: Calcium, dairy products and osteoporosis. J Am Coll Nutr19 :2 (Suppl):83S –99S,2000 .[Abstract/Free Full Text]
10. NIH Consensus Statement 12:4. Bethesda, MD: National Institutes of Health; Continuing Medical Education,1994 .
11. Murphy S, Khaw KT, May H, Compston JE: Milk consumption and bone mineral density in middle aged and elderly women. Br Med J308 :939 –941,1994 .[Abstract/Free Full Text]
12. Guthrie JF: Dietary patterns and personal characteristics of women consuming recommended amounts of calcium. Fam Econ Nutr Rev9 :33 –49,1996 .
13. Shanklin CW, Wie S: Nutrient contribution per 100 kcal and per penny for the 5 meal components in school lunch: entrée, milk, vegetable/fruit, bread/grain, and miscellaneous. J Am Diet Assoc101 :1358 –1361,2001 .[Medline]
14. Nicklas TA, McQuarrie A, Fastnaught C, O’Neil CE: Efficiency of breakfast consumption patterns of ninth graders: nutrient-to-cost comparisons. J Am Diet Assoc102 :226 –233,2002 .[Medline]
15. Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ: The influence of dietary and nondietary calcium Supplementation on blood pressure: and updated metaanalysis of randomized controlled trials. Am J Hypertens12 :84 –92,1999 .[Medline]
16. Miller GD, DiRienzo DD, Reusser ME, McCarron DA: Benefits of dairy product consumption on blood pressure in humans: a summary of the biomedical literature. J Am Coll Nutr19 (Suppl) :147S –164S,2000 .
17. Appel LJ, Moore TH, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N: A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med336 :1117 –1124,1997 .[Abstract/Free Full Text]
18. Zemel MB, Thompson W, Zemel P, et al.: Dietary calcium and dairy products accelerate weight and fat loss during energy restriction in obese adults. Am J Clin Nutr75 (Suppl) :342S ,2002 .
19. Zemel MB: Role of dietary calcium and dairy products in modulating adiposity. Lipids38(2) :139 –46,2003 .
20. Holt PR: Dairy foods and prevention of colon cancer: human studies. J Am Coll Nutr18(Suppl.) :379S –391S,1999 .
21. Lupton JR: Dairy products and colon cancer: mechanisms of the protective effect. J Am Coll Nutr66 :1065 –1066,1997 .
22. Holt PR, Atillasoy EO, Gilman J, Guss J, Moss SF, Newmark H, Fan K, Yang K, Lipkin M: Modulation of abnormal colon epithelial cell proliferation and differentiation by low-fat dairy foods: a randomized controlled trial. JAMA280 :1074 –1079,1998 .[Abstract/Free Full Text]
23. Heller HJ: The role of calcium in the prevention of kidney stones. J Am Coll Nutr18(Suppl) :373S –378S,1999 .
24. Curhan GC, Willett WC, Rimm EB, Stampfer MJ: A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl Med328 :833 –838,1993 .[Abstract/Free Full Text]
25. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ: Comparison of dietary calcium with Supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med126 :497 –504,1997 .[Abstract/Free Full Text]
26. Massey LK, Kynast-Gales SA: Substituting milk for apple juice does not increase kidney stone risk in normocalciuric adults who form calcium oxalate stones. J Am Diet Assoc98 :303 –308,1998 .[Medline]
27. Thys-Jacobs S, Starkey P, Bernstein D, Tian J, and the Premenstrual Syndrome Study Group: Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol179 :444 –452,1998 .[Medline]
28. Thys-Jacobs S: Micronutrients and the premenstrual syndrome: the case for calcium. J Am Coll Nutr19 :220 –227,2000 .[Abstract/Free Full Text]
29. "Nutrition and Your Health: Dietary Guidelines for Americans," Home and Garden Bulletin No. 232. Washington, DC: United States Department of Agriculture; United States Department of Health and Human Services, 5th ed,2000 .
30. Cronin F, Shaw A, Krebs-Smith S, Marsland P, Light L: Developing a food guidance system to implement the Dietary Guidelines. J Nutr Educ12 :281 –301,1987 .
31. Welsh S, Davis C, Shaw A: Development of the Food Guide Pyramid. Nutr Today27 :12 –23,1992 .
32. Shaw AM, Escobar AJ, Davis P: Reassessing the Food Guide Pyramid: Decision making framework. J Nutr Educ32 :111 –118,2000 .
33. US Department of Agriculture, Agricultural Research Service, Food Surveys Research Group: "Pyramid Servings Data. Results from USDA’s 1994–96 continuing Survey of Food Intakes by Individuals." Riverdale MD: ARS, USDA,1999 . Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm
34. Institute of Medicine, Food and Nutrition Board. "Dietary Reference Intake: Applications in Dietary Assessment." Washington, DC: National Academy Press,2000 .
35. U.S. Department of Agriculture. 2000. 1994–96, 1998 Continuing Survey of Food Intakes by Individuals and 1994–96 Diet and Health Knowledge Survey. CD-ROM. Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/cd98.html
36. National Health and Nutrition Examination Survey (NHANES), 1999–2000. Available at: http://www.cdc.gov/nchs/nhanes.htm
37. Healthy Eating Index file for CSFII. Available at: http://www.usda.gov/heisas.exe and http://www.usda.gov/hei98sas.exe
38. Healthy Eating Index file for NHANES, 1999–2000. Available at: http://www.usda.gov/cnpp/Pubs/HEI/pyraserv9900SAS.exe
39. Nicklas, TA: Calcium Intake Trends and Health Consequences from Childhood through Adulthood. JACN22 :340 –356,2003 .
40. US Department of Health and Human Services: "Healthy People 2010 (Conference Edition, in Two Volumes)." Washington DC: pp19 –32, January2000 . Available at: http://www.health.gov/healthypeople
41. 5 A Day for Better Health Program Evaluation Report: Evaluation. Available at: http://www.cancercontrol.cancer.gov/5ad_6_eval.html
42. Heaney RP, Dowell SM, Rafferty K, Bierman J: Bioavailability of the calcium in fortified soy imitation milk, with some observations on method. Am J Clin Nutr71 :1166 –1169,2000 .[Abstract/Free Full Text]
43. Shaw A, Fulton L, Davis C, Hogbin M: Using the Food Guide Pyramid: A Resource for Nutrition Educators, U.S. Department of Agriculture. Food, Nutrition and Consumer Services, Center for Nutrition Policy and Promotion.
44. Miller GD, Jarvis JK, McBean LD: The importance of meeting calcium needs with foods. J Am Coll Nutr20 :168S –185S,2001 .[Abstract/Free Full Text]
45. McCarron DA and Heaney RP: Estimated healthcare savings associated with adequate dairy food intake. Am J Hypertens17 :88 –97,2004[Medline]

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