Vitamin D and Calcium Intakes, Physical Activity, and Calcaneus BMC among School-Going 13-Year Old Malaysian Adolescents

Abstract

Background: Dietary calcium and vitamin D are essential for bone development. Apart from diet, physical activity may potentially improve and sustain bone health. Objective: To investigate the relationship between the dietary intake of calcium and vitamin D, physical activity, and bone mineral content (BMC) in 13-year-old Malaysian adolescents. Design: Cross-sectional. Setting: Selected public secondary schools from the central and northern regions of Peninsular Malaysia. Participants: The subjects were from the Malaysian Health and Adolescents Longitudinal Research Team Cohort study (MyHeARTs). Methods: The data included seven-day diet histories, anthropometric measurements, and the BMC of calcaneal bone using a portable broadband ultrasound bone densitometer. Nutritionist Pro software was used to calculate the dietary calcium and vitamin D intakes from the diet histories, based on the Nutrient Composition of Malaysian Food Database guidance for the dietary calcium intake and the Singapore Energy and Nutrient Composition of Food Database for vitamin D intake. Results: A total of 289 adolescents (65.7% females) were recruited. The average dietary intakes of calcium and vitamin D were 377 ± 12 mg/day and 2.51 ± 0.12 µg/day, respectively, with the majority of subjects failing to meet the Recommended Nutrient Intake (RNI) of Malaysia for dietary calcium and vitamin D. All the subjects had a normal Z-score for the BMC (−2.00 or higher) with a mean of 0.55 ± 0.01. From the statistical analysis of the factors contributing to BMC, it was found that for those subjects with a higher intake of vitamin D, a higher combination of the intake of vitamin D and calcium resulted in significantly higher BMC quartiles. The regression analysis showed that the BMC might have been influenced by the vitamin D intake. Conclusions: A combination of the intake of vitamin D and calcium is positively associated with the BMC.

Ethnic variation in osteoporosis risk factors: dietary calcium, vitamin D intake and body mass index (BMI)

“…For vitamin D, 1.37 μg/day intake was not within the normal range for the recommended intake of Malaysian population and is far from RNI 2017. The results of the previous study among postmenopausal women, pregnant women as well as adolescent were in accordance with the present study with the majority of respondents fail to meet the RNI of Malaysia for dietary vitamin D (Rahman et al, 2004;Zaleha et al, 2015;Suriawati et al, 2016). Therefore, interventions and stricter reinforcements of existing guidelines for vitamin D supplementation are needed in Malaysia, especially for groups at risk of vitamin D insufficiency or deficiency.…”

“…Previous studies found that the calcium intake of Malaysians averaged between 357 mg/day to 397.2 mg/ day (Mirnalini et al, 2008;Zainuddin, 2015;Suriawati et al, 2016). Hence, 348.3 mg/day (34.8% RNI 2017) calcium intake by respondents in the present study was close to the average Malaysian adults' intake, which is consistently below the RNI.…”

Association between dietary calcium intake and BMD in children and adolescents

“…The results of another two cross-sectional studies in Spanish revealed that high Ca intake associated with a higher BMD in children between 5 and 12 years old (12), and total BMD was positively related to Ca intakes in adolescents aged 12.5 to 17.5 years (13), respectively. However, some other studies supported that Ca intake had no effect on BMD (14,15,16,17,18). A previous review by Lanou et al (6) reported that nine cross-sectional studies of 13 did not find an association of dietary Ca intake with BMD or bone mineral content in adolescent girls.…”

“…In the present cross-sectional study, we found dietary Ca intake positively correlated with total BMD. In addition, the strongest association was observed in 12-15 year old whites, 8-11 year old and 16-19 year old Mexican Americans, and [16][17][18][19] year old individuals from other races, in whom each quintile of Ca intake was increased. The trend tests remained significant in all groups except the 8-11 year old other race group.…”

“…In the subgroup analysis stratified by age and race/ethnicity, we observed a positive association of dietary Ca intake with total BMD (Table 3) in whites, blacks, Mexican Americans, and the 12 to 15 years group and 16 to 19 years group of other race/ethnicity. The strongest association was observed in 12-15 year old whites, [8][9][10][11] year old and [16][17][18][19] year old Mexican Americans, and [16][17][18][19] year old individuals from other race/ethnicity, in whom each quintile of Ca intake was increased. Compared with the lowest quintile of dietary Ca intake, the mean BMD was greater in the highest quintile in all groups.…”