Geila S. Rozen

Calcium Intake and Bone Mass Development Among Israeli Adolescent Girls

Objective: To determine the possible relationship between food and life style habits and bone health in adolescent Israeli females. Methods: 2,000 adolescent Israeli Jewish and Arab high-school girls (mean age 14.5) completed a semi-quantitative food frequency questionnaire and a personal history questionnaire. 27 food components were calculated for each subject. Bone mineral content and density were determined for 112 subjects with calcium intake below 800 mg/day. Results: Average calcium intake was found to be 1,260 mg/day, but 20% of all girls had a calcium intake below 800 mg/day. All low-energy diets were very low in calcium, as mean calcium intake per 1,000 calories was 411±128 grams. A large percentage of diets with less than 800 mg calcium were also deficient in phosphorus (95.2%), magnesium (84.8%), iron (90.5%) and zinc (100%). Due to differences in food sources, Jewish girls had more phosphorus in their diet, but less magnesium and iron compared to Arab girls. Calcium and zinc deficiencies in Jewish and Arab diets were similar. A negative correlation was found between body mass index (BMI) and age at menarche for all girls in the study. Bone mineral density (BMD) measured for girls with calcium intake below 800 mg/day distributed normally around the average when compared to age matched controls despite their low calcium intake. There was a strong positive correlation between BMD and bone mineral content (BMC) at all sites and body weights. Conclusions: Low calcium intake, other nutritional deficiencies and delayed menarche due to low-energy diet in the growing period and in adolescence may prevent the formation of healthy bones. There is no evidence of lower bone mass among the low calcium intake group in the study population at this stage. It remains to be documented if the window of opportunity for optimal bone accretion for this group will be missed in the future, possibly leading to increased risk of osteoporosis.

Standardized versus individualized parenteral nutrition in very low birth weight infants: a comparative study.

Background: Parenteral nutrition (PN) improves the growth and outcome of very low birth weight (VLBW) infants. Optimal PN composition, standard (STD-PN) or individualized (IND-PN), is still controversial. Aim: To compare IND-PN and STD-PN as to nutritional and growth parameters, complications and cost. Patients and Methods: 140 VLBW infants were studied. Each of the 70 neonates from the IND-PN group was matched with a neonate of similar gestational age (GA; ±4 days) on STD-PN. Data collection included demographic, maternal, intrapartum, neonatal, interventional, growth and nutritional data. Results: Compared to STD-PN infants, IND-PN infants had a significantly lower mean birth weight, greater need for resuscitation at birth and interventions thereafter. Nevertheless, IND-PN infants showed significantly greater weight gain SDS during the 1st week (p = 0.036) and the 1st month of life (p = 0.0004), and higher discharge weight SDS (p = 0.012) and head circumference SDS (p = 0.006). IND-PN infants received higher mean daily caloric intakes. They also had significantly shorter durations of exclusive PN and needed less electrolyte corrections. Conclusions: Compared to STD-PN infants, IND-PN infants achieved significantly better growth without added clinical or laboratory complications, had a shorter period of exclusive PN and less electrolyte corrections. IND-PN, in accordance with the current more aggressive nutritional approach, appears optimal for PN of VLBW infants. Yet, STD-PN with adequate composition is an appropriate alternative.

Physical activity and bone mineral density in adolescents with vitamin D deficiency.

INTRODUCTION Studies have shown that physical activity (PA) is superior to many other environmental factors in determining bone mineral density (BMD), but none has examined the independent relationship between PA and vitamin D status. PURPOSE The aim of this study was to assess the relationship among amount of PA, vitamin D (25(OH)D), and BMD. METHODS A total of 166 female ballet dancers and sedentary adolescents were divided by tertiles of serum levels of 25(OH)D (< 11.3, 11.3-14.9, and > or = 15 ng·mL(-1)). Diet, PA, and menstruation were assessed by questionnaires; BMD was measured in three sites by dual-energy x-ray absorptiometry. RESULTS Across 25(OH)D tertiles, there were no differences in mean participant age, weight, height, PA, calcium and energy intake, BMD, or parathyroid hormone. PA was positively associated with BMD in participants with vitamin D deficiency. Multivariable regression analysis, controlling for age, body mass index, parathyroid hormone, and bone turnover markers, showed that total body, femoral neck, and lumbar spine BMD were all positively related to PA, with regression coefficients increasing as vitamin D levels dropped across tertiles. CONCLUSIONS PA is positively related to BMD in vitamin D-deficient female adolescents and with increasing magnitude as serum vitamin D levels drop. These findings suggest that PA may counteract the detrimental effect of marked vitamin D deficiency on bone mass.

Bone Density in Axial and Appendicular Skeleton in Patients with Lactose Intolerance: Influence of Calcium Intake and Vitamin D Status

Background: Lactose intolerance (LI) is a common enzymatic insufficiency, manifesting by poor tolerance of dairy products, leading to low calcium intake and poor calcium absorption from dairy products. These changes might lead to an impairment of bone metabolism [1]. Objectives: To evaluate the impact of LI on quantitative bone parameters in axial and appendicular skeletal sites. To assess the impact of calcium intake from dairy and non-dairy nutritional sources, calcium regulating hormones and bone turnover on quantitative bone parameters in LI patients. Methods: We evaluated calcium intake and bone status in sixty-six patients with LI, 49 women and 17 men, aged 20 to 78. Bone mass was assessed at the lumbar spine (LS), total hip (TH) and femoral neck (FN) by dual-energy x-ray absorptiometry (DEXA) and at the radius, tibia, phalanx by quantitative ultrasound. Serum calcium, albumin, inorganic phosphate, calcium regulating hormones and markers of bone turnover were evaluated. Results: Total daily calcium intake was below the recommended by the American Dietetic Association [2] in all study participants (mean 692 mg/day ± 162). Elevated level of urinary deoxypyridinoline crosslinks (DPD) was observed in 63 (96%) patients and was negatively correlated with total daily calcium intake (r = −0.998, p = 0.025) and with nondairy calcium intake (r = −0.34, p = 0.015). Parathyroid hormone (PTH) level in the upper third of normal range (45–65 ng/L) was observed in 11 (17%) patients. Parathyroid hormone (PTH) was inversely correlated with total calcium intake (r = −0.4, p = 0.001), dairy calcium intake (r = −0.83, p = 0.05), non-dairy calcium intake (r = −0.29, p = 0.043), 25OHD3 serum level (r = −0.3, p = 0.007) and positively correlated with bone turnover markers (deoxypyridinoline crosslinks [DPD], r = 0.36, p = 0.01 and bone specific alkaline phosphatase [BSAP] r = 0.36, p = 0.01). Decrease in quantitative bone parameters compared to age-matched controls was observed in the axial and in the appendicular skeleton in men and in postmenopausal women: mean z-score for LS −0.87 ± 0.22 and −1.32 ± 0.65, p = 0.004 and 0.015, tibia −1.15 ± 0.53 and −0.44 ± 0.044, p < 0.001 and 0.27, phalanx −0.98 ± 0.22 and −0.52 ± 0.98, p < 0.001. We observed decrease in bone mass in patients with serum PTH in the upper tertile of normal range in the FN (z-score −0.57 ± 0.6 versus −0.03 ± 0.9, p = 0.025), TH (−0.51 ± 0.96 versus 0.04 ± 0.9, p = 0.05) and radius (−1.84 ± 0.27 versus −0.07 ± 1.61, p = 0.025, respectively). z-scores in FN and TH positively correlated with serum 25OHD3 level (r = 0.31, 0.29; p = 0.014, 0.019). In postmenopausal women serum 25OHD3 level correlated also with LS z-scores (r = 0.52, p = 0.004); FN and TH z-scores negatively correlated with DPD level (r = −0.51, p = 0.02 and r = −0.55, p = 0.04). Conclusion: LI state may lead to increased bone turnover and decreased bone mass especially in men and postmenopausal women. Impaired vitamin D status and low calcium intake may be deleterious to bone in this condition.

Validity and Reproducibility of a Semi-Quantitative Food Frequency Questionnaire Adapted to an Israeli Population

Assessment of individual representative dietary practices in epidemiologic research has long been a challenge. Given the differences in eating habits and availability of foods between populations, a study was set to test the reproduci- bility and validity of an Israeli-adapted semi-quantitative food frequency questionnaire (SFFQ) used in case-control stud- ies of cancer etiology. Two hundred volunteers between the ages 22-60 were randomly assigned to either complete an SFFQ independently or by nutritionist interview. Participants were then asked to fill out a 3-day food record (FR). SSFQ was repeated 3 months later. Reliability of the repeated SSFQ was examined using Pearson correlations; paired t-tests and Mann-Whitney Rank Test were used to measure reliability and validity of the SFFQ. Overall, there was >85% agreement ± 1 category between the two encounters in over 75% of the food items. Percent of calories from proteins, fats and carbohydrates were similar for both self-administered and interviewed groups. The major- ity of correlations between the 1 st and 2 nd SSFQs for the micronutrients were above 0.75. No differences were noted in percent energy from proteins, fats or carbohydrates between self-administered and interviewer-assisted SSFQ and FR. The Israeli FFQ was found in our study to be highly reproducible and valid compared to a dietary record.

Dietary Intake of Carotenoid Isomers in Israel

Controversy exists regarding the possible protective role of carotenoids against cancer. Evidence is mainly against all-E-beta-carotene, while there is no evidence against other carotenoids or against mixtures of beta-carotene stereoisomers. Carotenoid isomers could account for the variability in study results but are rarely estimated, and reference to the degree of their consumption is lacking. The aim of our study was to create a comprehensive database of carotenoid isomers content in food items commonly consumed in Israel. Food items were analyzed using a liquid chromatography system to determine the content of carotenoid isomers in Israeli food. The main sources of carotenoids detected in Israeli foods were tomato juice, tomato, watermelon, parsley, coriander, spinach, carrot, sweet potato, banana, zucchini, mango, loquat, pepper, eggplant, and chickpeas. Data were used to measure consumption in healthy participants of a case-control study, using a semi-quantitative food-frequency 187-item questionnaire. Compared to reference studies, the median carotenoid isomers intake in 712 Israeli healthy controls (age range 23-95 years, mean 71 +/- 10.9 years, median 73 years) was higher for beta-carotene, alpha-carotene, beta-cryptoxanthin, and zeaxanthin, while the intake of lycopene was lower. Major differences in consumption were noticed between ethnic groups consuming Mediterranean diets and those consuming Western-type diets. Population consumption patterns of carotenoid isomers using a comprehensive database are used to improve our understanding in disease prevention. Consumption in Israel seems to be generally higher than that reported in studies conducted elsewhere, and varies by ethnic group.

Osteocalcin is independently associated with body mass index in adolescent girls.

Osteocalcin is a bone‐related protein, recently found to correlate with body mass index (BMI), waist circumference, fat percentage and metabolic syndrome in adults. The aim of this study was to determine the relationship between osteocalcin and BMI in adolescence, a time of significant bone accrual, while considering possible confounders related to bone and body composition.