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Abstract

It is unclear whether dairy foods promote bone health in all populations and whether all dairy foods are equally beneficial. The objective of this review was to determine whether scientific evidence supports the recommendation that dairy foods be consumed daily for improved bone health in the general US population. Studies were reviewed that examined the relation of dairy foods to bone health in all age, sex, and race groups. Outcomes were classified according to the strength of the evidence by using a priori guidelines and were categorized as favorable, unfavorable, or not statistically significant. Of 57 outcomes of the effects of dairy foods on bone health, 53% were not significant, 42% were favorable, and 5% were unfavorable. Of 21 stronger-evidence studies, 57% were not significant, 29% were favorable, and 14% were unfavorable. The overall ratio of favorable to unfavorable effects in the stronger studies was 2.0 (4.0 in <30-y-olds, 1.0 in 30-50-y-olds, and 1.0 in >50-y-olds). Males and ethnic minorities were severely underrepresented. Dairy foods varied widely in their content of nutrients known to affect calcium excretion and skeletal mass. Foods such as milk and yogurt are likely to be beneficial; others, such as cottage cheese, may adversely affect bone health. Of the few stronger-evidence studies of dairy foods and bone health, most had outcomes that were not significant. However, white women <30 y old are most likely to benefit. There are too few studies in males and minority ethnic groups to determine whether dairy foods promote bone health in most of the US population.

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Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods.

K Klipstein-Grobusch, F. Thielecke, Heiner Boeing … (1999)

The validation of dietary assessment instruments is critical in the evaluation of diet as a chronic disease risk factor. The objective was to assess the validity of a self-administered food-frequency questionnaire by comparison with dietary recall, urinary nitrogen excretion, and total energy expenditure data. Over a 1-y period, data from twelve 24-h dietary recalls, a food-frequency questionnaire, and four 24-h urine samples were obtained from 134 study participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) Study in Potsdam, Germany. In a substudy of 28 participants, total energy expenditure from doubly labeled water measurements was assessed. Energy-adjusted, deattenuated correlation coefficients between the questionnaire and the recalls ranged from 0.54 for dietary fiber to 0.86 for alcohol. Cross-classification of quintiles of nutrient intakes from the questionnaire and recalls indicated severe misclassification to be <4%. Reported protein intake correlated with estimated protein excretion (r = 0.46). Energy intake and total energy expenditure were also significantly correlated (r = 0.48); however, all but one subject underreported their energy intake. The magnitude of underreporting varied considerably, by 22% on average, and increased slightly with increasing energy intake. A similar pattern of underreporting was observed when energy intakes from the 24-h dietary recalls were compared with total energy expenditure. These data indicate an acceptable relative validity of the food-frequency questionnaire in this study population. Compared with measurements of total energy expenditure and protein excretion, however, only moderate agreement with both the food-frequency questionnaire and the 24-h dietary recalls was observed.

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Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein.

F Manz, T Remer (1994)

The object of this study was to determine whether it is possible to reliably estimate the renal net acid excretion (NAE) produced by adults consuming different amounts of dietary protein. A physiologically based calculation model that corrects for intestinal absorption of minerals and sulfur-containing protein and assumes a rate of urinary excretion of organic acids proportional to body surface area was used to estimate NAE. Urinary excretion of different minerals and NAE was measured during the last 48 h of each of four separate 5-d diet periods in six healthy adults. On the basis of food tables, the four nearly isoenergetic diets (one lacto-vegetarian and one high- and two moderate-protein diets) were estimated to yield the following NAE values: 3.7, 117.5, 62.2, and 102.2 mEq/d, respectively. The analytically determined urinary NAE (24.1 +/- 10.7, 135.5 +/- 16.4, 69.7 +/- 21.4, and 112.6 +/- 10.9 mEq/d) corresponded reasonably well to these estimates, suggesting that the calculation model is appropriate to predict the renal NAE from nutrient intake and anthropometric data.

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Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study.

J Dequeker, J Kanis, G Dilsen … (1995)

The aims of this study were to determine common international risk factors for hip fracture in women aged 50 years or more. We studied women aged 50 years or more who sustained a hip fracture in 14 centers from Portugal, Spain, France, Italy, Greece, and Turkey over a 1-year period. Women aged 50 years or more selected from the neighborhood or population registers served as controls. Cases and controls were interviewed using a structured questionnaire on work, physical activity, exposure to sunlight, reproductive, history and gynecologic status, height, weight, mental score, and consumption of tobacco, alcohol, calcium, coffee, and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), short fertile period, low physical activity. lack of sunlight exposure, low milk consumption, no consumption of tea, and a poor mental score. No significant adverse effects of coffee or smoking were observed. Moderate intake of spirits was a protective factor in young adulthood, but otherwise no significant effect of alcohol intake was observed. For some risks, a threshold effect was observed. A low BMI and milk consumption were significant risks only in the lowest 50% and 10% of the population, respectively. A late menarche, poor mental score, low BMI and physical activity, low exposure to sunlight, and a low consumption of calcium and tea remained independent risk factors after multivariate analysis, accounting for 70% of hip fractures. Excluding mental score and age at menarche (not potentially reversible), the attributable risk was 56%. Thus, about half of the hip fractures could be explained on the basis of the potentially reversible risk factors sought. In contrast, the use of risk factors to "predict" hip fractures had moderate sensitivity and specificity. We conclude that variations in lifestyle factors are associated with significant differences in the risk of hip fracture, account for a large component of the total risk, and may be of some value in selecting individuals at high risk.