Calcium Bone is a dynamic tissue that is constantly being formed and resorbed; in children, bone formation is greater than resorption. Adequate calcium intake during childhood is essential for bone mass development. Data for calcium intake, presented in Table 2, indicate that for children in the United States, only those younger than 8 years of age are meeting their recommended intake. Factors that may contribute to low calcium intake are restriction of dairy products, low vegetable consumption, and high intake of low-calcium beverages such as juices and sodas. The highest calcium intake levels are required during the preteen and adolescent years to support the rapid growth and bone mineralization associated with pubertal development. In girls, peak calcium absorption and deposition takes place at or near menarche; at this life cycle stage, the bone calcium deposition rate is five times greater than that in adults. During peak bone mass development, calcium intakes of less than 1000mg/day are associated with lower bone mineral density. Epidemio-logic studies have found a direct correlation between calcium intake and bone density in children. Evidence suggests that low intake of dairy products during childhood and adolescence may result in less bone mass and greater risk of fracture as an adult. In addition, evidence from randomized trials suggests that increasing the calcium intake of girls is

Table 2 Average calcium intake and recommended adequate intake levels for US children


1-3 years/ 4-8 years/ 9-13 years/ 9-13 years/ 14-18 years/ 14-18 years/ M and F M and F F M F M

Average intake (mg) 793 838 918 1025 753 1169

Adequate intake (mg) 500 800 1300 1300 1300 1300

From Institute of Medicine (1997) Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press.

associated with increased bone mineral deposition, especially during prepuberty. Although it is best to obtain as much calcium as possible from foods, because calcium-rich foods also provide nutrients involved in calcium utilization, calcium supplements may be necessary for children who do not eat calcium-rich foods.

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