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D.iet & H.ealth : N.utrition Last Updated: Nov 12th, 2006 - 20:38:00

Usefulness of Calcium Supplementation in Kids Debatable
By Kathy Jones
Sep 15, 2006, 12:30

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15 Sep, ( - Calcium supplementation in healthy children is of questionable value since it produces a minimal increase in bone density and does not reduce the risk of fractures in children, Australian researchers claimed in a review of 19 studies.

Calcium supplements have been touted as having great value in adults especially women, since they are thought to be beneficial in reducing the risk of developing osteoporosis. But researchers say giving supplements to healthy children may not make their bones much stronger than normal.

Calcium supplements are given to children in the hope of fortifying their bones. It is thought that the uptake of calcium in young, growing children is very rapid and helps in the formation of strong bones. The idea of giving calcium supplementation is to prevent fractures at an early age.

But the current study, which reviewed 19 studies as a meta-analysis questions the reasoning behind calcium supplementation to healthy children. The research was conducted as a part of measures designed for osteoporosis prevention.

"At two of the areas where we worry about fractures in later life -- the spine and the hip -- the giving of calcium supplements had no effect on bone health in children," said study lead author Dr. Tania Winzenberg, a musculoskeletal epidemiologist at the Menzies Research Institute, in Tasmania.

The researchers conducted a meta analysis on the studies involving a total of 2859 children aged three to 18. The calcium supplementation in the studies ranged between 300 and 1200mg per day. The sources of calcium were from calcium citrate malate, calcium carbonate, calcium phosphate, calcium lactate gluconate, calcium phosphate milk extract or milk minerals.

They calculated that giving calcium supplements to children produced a "0.1 percent decrease in absolute risk of all fractures in childhood for girls, and a 0.2 percent decrease for boys."

Moreover calcium supplementation had little effect on bone mineral density. The study focused on the benefits of calcium supplementation for at least three months. Children who took these supplements had a 1.7 percent better bone density in their upper arms as compared to children who did not take any supplements.

The researchers also found no benefit of early calcium supplements on reducing the risk of common fracture sites, such as the hip and lumbar spine in later life.

"It had been thought that calcium supplements would be more helpful than that in children," Winzenberg said. "So, giving calcium supplements to children has little effect on fractures, and fractures is what we worry about." The findings of the study are published in the Sept. 16 edition of the British Medical Journal.

The researchers do admit that the review had some limitations. For example of the 19 studies only a few were conducted on children with low baseline intake of calcium, who may have a deficient intake and hence benefit from supplementation.

Another barrier was that there were limited number of studies in purely postpubertal and peripubertal children when the body needs increased amount of calcium to co-ordinate growth. ”Given that calcium accumulation in the skeleton accelerates during puberty, the paucity of data in the peripubertal period is an important gap,” the authors admit.

The findings don't apply to children who may have significant problems with their bones or who can't eat dairy products, Winzenberg said.

Calcium is important because the human body cannot make it. Adequate calcium intake is important because the body loses calcium every day through the skin, nails, hair, and sweat, as well as through urine and feces, according to the National Institutes of Health.

Calcium is regarded as a particularly important nutrient in growing children. Dietary calcium can be consumed through milk and calcium-fortified foods like orange juice, bread and cereals.

That is why the authors of the current review recommend that calcium intake be maximized through diet, especially increasing vitamin D intake and eating more fruit and vegetables. Vitamin D is mainly produced from exposure to sunlight, and is essential to the intestinal absorption of calcium.

"The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance. It may be appropriate to explore alternative nutritional interventions, such as increasing vitamin D concentrations and intake of fruit and vegetables," the authors said.

Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine agreed that dietary intake of calcium was essential.

"Healthy children, with an adequate diet, may have all the calcium they need to build bone,," he said. "Growing bone might need a combination of materials, such as calcium combined with vitamin D, to grow stronger," he said.

He stressed that the study did not exclude the usefulness of calcium supplementation in children with low intake of dietary calcium, or children with certain health problems.

"But it does indicate that calcium supplementation in healthy children is a questionable practice," Katz said. "For now, the tried-and-true approach to the early prevention of osteoporosis remains a healthful, balanced diet, and plenty of exercise."

It may be noted that osteoporosis is a preventable disease. Having an adequate bone density is the answer, through a diet rich in calcium and vitamin D. This is because almost 98 percent of skeletal mass is attained by the time people enter their 20s.

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