Advertisement

Optimizing Nutrition to Promote Adolescent Bone Health

Chapter

Abstract

There are many nutrients that contribute to adolescent bone health. The Dietary Reference Intakes, or DRIs, provide reference values for each of these nutrients to ensure that adolescents meet their needs. To support bone health, adolescents need to consume adequate amounts of protein, without exceeding their needs to avoid upsetting the acid-base balance in the body. Most adolescents need to increase their intakes of calcium, vitamin D, magnesium, and, for adolescent females, iron. Fewer adolescents need to increase their intakes of vitamins A and K. Generally speaking, intakes of boron, copper, fluoride, manganese, phosphorus, and zinc are adequate. Other nutritional factors that can negatively impact bone health include binge drinking, caffeinated beverages, carbonated beverages, sodium, and, due to the interference of mineral absorption, dietary fiber. Adolescents with lactose intolerance, a milk allergy, or those who follow a vegan diet may have increased risk of nutritional deficiency if their diet is not well balanced. Assessing the dietary habits and nutrient intake of your patients is important to determine their risk of a possible nutritional deficiency. If their diet is lacking a particular food group, they should receive nutrition education about the nutrients they may be missing and advice on how to increase their intake. If they are unable to increase their intakes from food, a supplement should be recommended. Dietary supplements should be cautiously recommended as there is the potential for an adolescent to exceed the tolerable upper limit of a nutrient.

Keywords

Nutrition Supplements Calcium Vitamin D Milk 

References

  1. 1.
    Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. Washington: The National Academies Press; 2006.Google Scholar
  2. 2.
    Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington: The National Academies Press; 2005.Google Scholar
  3. 3.
    Ervin RB, Ogden CL. Trends in intake of energy and macronutrients in children and adolescents from 1999–2000 through 2009–2010. NCHS data brief, no 113. Hyattsville: National Center for Health Statistics; 2013.Google Scholar
  4. 4.
    Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington: The National Academies Press; 2011.Google Scholar
  5. 5.
    Greer FR, Krebs NF, American Academy of Pediatrics Committee on N. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics. 2006;117:578–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Heaney RP. Protein intake and the calcium economy. J Am Diet Assoc. 1993;93:1259–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Cashman KD. Calcium intake, calcium bioavailability and bone health. Br J Nutr. 2002;87(Suppl 2):S169–77.CrossRefPubMedGoogle Scholar
  8. 8.
    Nordin B. Calcium in health and disease. Food Nutr Agric. 1997;20:13–26.Google Scholar
  9. 9.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th ed. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/
  10. 10.
    Braun M, Palacios C, Wigertz K, Jackman LA, Bryant RJ, McCabe LD, Martin BR, McCabe GP, Peacock M, Weaver CM. Racial differences in skeletal calcium retention in adolescent girls with varied controlled calcium intakes. Am J Clin Nutr. 2007;85:1657–63.PubMedGoogle Scholar
  11. 11.
    Bryant RJ, et al. Racial differences in Bone Turnover and Calcium Metabolism in Adolescent Females. J Clin Endocrinol Metab. 2003;88:1043–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Abrams SA, Griffin IJ, Hawthorne KM, Liang L, Gunn SK, Darlington G, Ellis KJ. A combination of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. Am J Clin Nutr. 2005;82:471–6.PubMedGoogle Scholar
  13. 13.
    Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999;70:543s–8s.PubMedGoogle Scholar
  14. 14.
    Abrams SA, Griffin IJ, Davila P, Liang L. Calcium fortification of breakfast cereal enhances calcium absorption in children without affecting iron absorption. J Pediatr. 2001;139:522–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Lytle LA, Seifert S, Greenstein J, McGovern P. How do Children’s eating patterns and food choices change over time? Results from a cohort study. Am J Health Promot. 2000;14:222–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Cavadini C, Siega-Riz AM, Popkin BM. US adolescent food intake trends from 1965 to 1996. West J Med. 2000;173:378–83.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Albertson AM, Tobelmann RC, Marquart L. Estimated dietary calcium intake and food sources for adolescent females: 1980–92. J Adolesc Health. 1997;20:20–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Frary CD, Johnson RK, Wang MQ. Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. J Adolesc Health. 2004;34:56–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc. 1999;99:436–41.CrossRefPubMedGoogle Scholar
  20. 20.
    Committee on Nutrition. American Academy of Pediatrics: the use and misuse of fruit juice in pediatrics. Pediatrics. 2001;107:1210–3.CrossRefGoogle Scholar
  21. 21.
    Perez AV, Picotto G, Carpentieri AR, Rivoira MA, Peralta Lopez ME, Tolosa de Talamoni NG. Minireview on regulation of intestinal calcium absorption. Emphasis on molecular mechanisms of transcellular pathway. Digestion. 2008;77:22–34.CrossRefPubMedGoogle Scholar
  22. 22.
    Administration USFD. The new and improved nutrition facts label- key changes. 2017. Available at https://www.fda.gov/downloads/food/ingredientspackaginglabeling/labelingnutrition/ucm511646.pdf
  23. 23.
    Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr. 2010;140:817–22.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bailey RL, Fulgoni VL 3rd, Keast DR, Lentino CV, Dwyer JT. Do dietary supplements improve micronutrient sufficiency in children and adolescents? J Pediatr. 2012;161:837–42.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract. 2007;22:286–96.CrossRefPubMedGoogle Scholar
  26. 26.
    Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington: The National Academies Press; 1997.Google Scholar
  27. 27.
    Calvo MS, Kumar R, Heath H 3rd. Elevated secretion and action of serum parathyroid hormone in young adults consuming high phosphorus, low calcium diets assembled from common foods. J Clin Endocrinol Metab. 1988;66:823–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Fulgoni VL 3rd, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: where do Americans get their nutrients? J Nutr. 2011;141:1847–54.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69:727–36.PubMedGoogle Scholar
  30. 30.
    New SA, Robins SP, Campbell MK, Martin JC, Garton MJ, Bolton-Smith C, Grubb DA, Lee SJ, Reid DM. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr. 2000;71:142–51.PubMedGoogle Scholar
  31. 31.
    Chapin RE, Ku WW, Kenney MA, McCoy H, Gladen B, Wine RN, Wilson R, Elwell MR. The effects of dietary boron on bone strength in rats. Fundam Appl Toxicol. 1997;35:205–15.CrossRefPubMedGoogle Scholar
  32. 32.
    Nielsen FH, Hunt CD, Mullen LM, Hunt JR. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J. 1987;1:394–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Beattie JH, Peace HS. The influence of a low-boron diet and boron supplementation on bone, major mineral and sex steroid metabolism in postmenopausal women. Br J Nutr. 1993;69:871–84.CrossRefPubMedGoogle Scholar
  34. 34.
    Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington: The National Academies Press; 2001.Google Scholar
  35. 35.
    Meacham SL, Hunt CD. Dietary boron intakes of selected populations in the United States. Biol Trace Elem Res. 1998;66:65–78.CrossRefPubMedGoogle Scholar
  36. 36.
    Medeiros DM, Ilich J, Ireton J, Matkovic V, Shiry L, Wildman R. Femurs from rats fed diets deficient in copper or iron have decreased mechanical strength and altered mineral composition. J Trace Elem Exp Med. 1997;10:197–203.CrossRefGoogle Scholar
  37. 37.
    Jonas J, Burns J, Abel EW, Cresswell MJ, Strain JJ, Paterson CR. Impaired mechanical strength of bone in experimental copper deficiency. Ann Nutr Metab. 1993;37:245–52.CrossRefPubMedGoogle Scholar
  38. 38.
    Medeiros DM, Plattner A, Jennings D, Stoecker B. Bone morphology, strength and density are compromised in iron-deficient rats and exacerbated by calcium restriction. J Nutr. 2002;132:3135–41.CrossRefPubMedGoogle Scholar
  39. 39.
    Am Acad Pediatrics Committee on Nutrition. In: Kleinman RE, Greer FR, editors. Pediatric nutrition. 7th ed. Elk Grove Village: American Academy of Pediatrics; 2013.Google Scholar
  40. 40.
    Stoltzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Washington, DC: ILSI Press; 1998.Google Scholar
  41. 41.
    Finley JW, Johnson PE, Johnson LK. Sex affects manganese absorption and retention by humans from a diet adequate in manganese. Am J Clin Nutr. 1994;60:949–55.Google Scholar
  42. 42.
    Pennington JA, Young BE. Total diet study nutritional elements, 1982–1989. J Am Diet Assoc. 1991;91:179–83.PubMedGoogle Scholar
  43. 43.
    Yamaguchi M. Role of nutritional zinc in the prevention of osteoporosis. Mol Cell Biochem. 2010;338:241–54.CrossRefPubMedGoogle Scholar
  44. 44.
    US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. USDA Branded Food Products Database. Version Current: January 2017. Internet: http://ndb.nal.usda.gov.
  45. 45.
    Center NIoHOaRBDNR. Vitamin A and bone health. Bethesda; 2015. https://www.bones.nih.gov/health-info/bone/bonehealth/nutrition/vitamin-and-bone-health
  46. 46.
    Melhus H, Michaelsson K, Kindmark A, Bergstrom R, Holmberg L, Mallmin H, Wolk A, Ljunghall S. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Ann Intern Med. 1998;129:770–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Feskanich D, Singh V, Willett WC, Colditz GA. Vitamin A intake and hip fractures among postmenopausal women. JAMA. 2002;287:47–54.CrossRefPubMedGoogle Scholar
  48. 48.
    Team DSID. Children’s multivitamin/mineral (MVM) dietary supplement study. US Department of Agriculture, Agricultural Research Service; 2015.Google Scholar
  49. 49.
    Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Makitie O, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101:394–415.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.PubMedGoogle Scholar
  51. 51.
    Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Lewis RD, Laing EM, Hill Gallant KM, Hall DB, McCabe GP, Hausman DB, Martin BR, Warden SJ, Peacock M, Weaver CM. A randomized trial of vitamin D(3) supplementation in children: dose-response effects on vitamin D metabolites and calcium absorption. J Clin Endocrinol Metab. 2013;98:4816–25.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine S. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.CrossRefPubMedGoogle Scholar
  54. 54.
    Booth SL, Tucker KL, Chen H, Hannan MT, Gagnon DR, Cupples LA, Wilson PW, Ordovas J, Schaefer EJ, Dawson-Hughes B. Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr. 2000;71:1201–8.PubMedGoogle Scholar
  55. 55.
    Kalkwarf HJ, Khoury JC, Bean J, Elliot JG. Vitamin K, bone turnover, and bone mass in girls. Am J Clin Nutr. 2004;80:1075–80.CrossRefPubMedGoogle Scholar
  56. 56.
    Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr. 1999;69:74–9.PubMedGoogle Scholar
  57. 57.
    US Department of Justice, Office of Justice Programs and Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and Prevention Policy. Calverton, MD. Pacific Institute for Research and Evaluation; 2005.Google Scholar
  58. 58.
    Callaci JJ, Juknelis D, Patwardhan A, Sartori M, Frost N, Wezeman FH. The effects of binge alcohol exposure on bone resorption and biomechanical and structural properties are offset by concurrent bisphosphonate treatment. Alcohol Clin Exp Res. 2004;28:182–91.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Wosje KS, Kalkwarf HJ. Bone density in relation to alcohol intake among men and women in the United States. Osteoporos Int. 2007;18:391–400.CrossRefPubMedGoogle Scholar
  60. 60.
    Petridou E, Karpathios T, Dessypris N, Simou E, Trichopoulos D. The role of dairy products and non alcoholic beverages in bone fractures among schoolage children. Scand J Soc Med. 1997;25:119–25.CrossRefPubMedGoogle Scholar
  61. 61.
    Wyshak G, Frisch RE. Carbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys. J Adolesc Health. 1994;15:210–5.CrossRefPubMedGoogle Scholar
  62. 62.
    Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154:610–3.CrossRefPubMedGoogle Scholar
  63. 63.
    Heaney RP, Rafferty K. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr. 2001;74:343–7.PubMedGoogle Scholar
  64. 64.
    Barness LA, Daliman PR, Anderson H, Collipp PJ, Nichols BL, Walker WA, Woodruff CW, Anderson BE, White PL, Egan MC. Plant fiber intake in the pediatric diet. Pediatrics. 1981;67:572–5.Google Scholar
  65. 65.
    Abrams SA, Griffin IJ, Hawthorne KM. Young adolescents who respond to an inulin-type fructan substantially increase total absorbed calcium and daily calcium accretion to the skeleton. J Nutr. 2007;137:2524s–6s.CrossRefPubMedGoogle Scholar
  66. 66.
    Matkovic V, Ilich JZ, Andon MB, Hsieh LC, Tzagournis MA, Lagger BJ, Goel PK. Urinary calcium, sodium, and bone mass of young females. Am J Clin Nutr. 1995;62:417–25.CrossRefPubMedGoogle Scholar
  67. 67.
    Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr. 1995;62:740–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Medicine Io. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington: The National Academies Press; 2005.Google Scholar
  69. 69.
    Wachman A, Bernstein D. Diet and osteoporosis. Lancet. 1968;291:958–9.CrossRefGoogle Scholar
  70. 70.
    Wynn E, Krieg MA, Lanham-New SA, Burckhardt P. Postgraduate symposium: positive influence of nutritional alkalinity on bone health. Proc Nutr Soc. 2010;69:166–73.CrossRefPubMedGoogle Scholar
  71. 71.
    Deriemaeker P, Aerenhouts D, Hebbelinck M, Clarys P. Nutrient based estimation of acid-base balance in vegetarians and non-vegetarians. Plant Foods Hum Nutr. 2010;65:77–82.CrossRefPubMedGoogle Scholar
  72. 72.
    Sebastian A, Harris ST, Ottaway JH, Todd KM, Morris Jr RC. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med. 1994;330:1776–81.CrossRefPubMedGoogle Scholar
  73. 73.
    Dawson-Hughes B, Harris SS, Palermo NJ, Castaneda-Sceppa C, Rasmussen HM, Dallal GE. Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metabol. 2009;94:96–102.CrossRefGoogle Scholar
  74. 74.
    Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118:1279–86.CrossRefPubMedGoogle Scholar
  75. 75.
    Suchy FJ, Brannon PM, Carpenter TO, Fernandez JR, Gilsanz V, Gould JB, Hall K, Hui SL, Lupton J, Mennella J. NIH consensus development conference statement: lactose intolerance and health. NIH Consens State Sci Statements. 2010;27:1–27.PubMedGoogle Scholar
  76. 76.
    Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol. 2007;120:1172–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Høst A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Allergy. 1990;45:587–96.CrossRefPubMedGoogle Scholar
  78. 78.
    Saarinen KM, Pelkonen AS, Mäkelä MJ, Savilahti E. Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol. 2005;116:869–75.CrossRefPubMedGoogle Scholar
  79. 79.
    Nachshon L, Goldberg MR, Schwartz N, Sinai T, Amitzur-Levy R, Elizur A, Eisenberg E, Katz Y. Decreased bone mineral density in young adult IgE-mediated cow's milk-allergic patients. J Allergy Clin Immunol. 2014;134:1108–1113 e1103.CrossRefPubMedGoogle Scholar
  80. 80.
    Mangels AR. Bone nutrients for vegetarians. Am J Clin Nutr. 2014;100:469S–75S.CrossRefPubMedGoogle Scholar
  81. 81.
    Knurick JR, Johnston CS, Wherry SJ, Aguayo I. Comparison of correlates of bone mineral density in individuals adhering to lacto-ovo, vegan, or omnivore diets: a cross-sectional investigation. Forum Nutr. 2015;7:3416–26.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Adolescent/Young Adult MedicineBoston Children’s HospitalBostonUSA
  2. 2.Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborUSA

Personalised recommendations