Validation of a calcium assessment tool in postmenopausal Canadian women

Osteoporosis and Women's Health Programs, University Health Network, Toronto General Hospital, Toronto, Canada.
Maturitas (Impact Factor: 2.94). 03/2011; 69(2):168-72. DOI: 10.1016/j.maturitas.2011.02.016
Source: PubMed


Adequate calcium intake is important for optimal bone health. Assessing dietary calcium intake, however, is neither widely done nor standardized in North American clinical practices.
Our goal was to validate a calcium assessment tool (CAT), a modified version of the Calcium Calculator™, against the 3-day food record.
Data were obtained from 348 participants in the ECKO (Evaluation of the Clinical use of vitamin K supplementation in postmenopausal women with Osteopenia) trial. In this study, CAT data was collected at baseline and 3-day food records (FRs) were collected at baseline and 3 months by trained study coordinators. CAT and 3-day FR data were compared using correlations and Bland-Altman plots. Additionally, receiver operator characteristic (ROC) curves of CAT were constructed to identify subjects with low calcium intake at thresholds of 500 mg/day and 1000 mg/day on the 3-day FR curves.
Mean calcium intake values per day were 902 mg for the 3-day FRs and 781 mg for the CAT. The Pearson correlation was 0.57 (95% CI: 0.50-0.64). Areas under the ROC curves at thresholds of 500 and 1000 mg calcium were 0.81 (95% CI: 0.73-0.89) and 0.82 (95% CI: 0.78-0.86), respectively.
The CAT is a valid tool for the measurement of dietary calcium intake using cut-off values of 500 mg and 1000 mg in postmenopausal women, even though there is only moderate correlation between the CAT and 3-day FR. This tool may facilitate the determination of whether calcium supplements are needed in the clinical setting.

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    • "The questionnaire served as pretest and posttest assessment along with a follow-up assessment of the calcium intake, osteoporosis health beliefs, osteoporosis self-efficacy, and knowledge before and after the program, respectively. The calcium food frequency questionnaire (FFQ), adapted from Barr [28] and Hung et al. [29], was included to assess the diet quality of participants concerning calcium-rich foods with the following modifications: (i) soft drinks, pizza, and muffin were excluded from the FFQ since the FFQ aimed to assess frequency consumption of calcium-rich foods only and (ii) “paneer” (Indian cottage cheese), tofu, soy milk and fruits such as grapes and papaya were included as they also contain a significant amount of calcium according to the USDA [30] and are easily available in Mauritius. This section consisted of one more question on the number of glasses of milk drunk daily, as previously assessed by Heaney [31], who stressed upon the importance of evaluating improvements in milk consumption after an education program. "
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    ABSTRACT: Background. Low calcium intake, a risk factor of osteoporosis and subsequent fractures, has been previously reported among post-menopausal women in Mauritius. Objective. To assess the effectiveness of a theory-based educational intervention in improving the calcium intake, self-efficacy, and knowledge of older Mauritians. Methodology. The study was conducted as a pre- and post-test design which was evaluated through a baseline, immediate postintervention, and 2-month follow-up assessments. Participants were adults (n = 189) aged ≥40 years old from 2 urban community-based centres. The intervention group (IG) (n = 98) participated in 6 weekly interactive lessons based on the health belief model (HBM). The main outcome measures were calcium intake, HB scale scores, knowledge scores, and physical activity level (PAL). Anthropometric measurements were also assessed. Results. The IG significantly increased its baseline calcium intake, knowledge and self-efficacy (P < 0.001) at post-assessments. A significant decrease in waist circumference in the IG was noted (P < 0.05) after intervention. PAL significantly increased by 12.3% at post-test and by 29.6% at follow-up among intervention adults when compared to the CG (P < 0.001). Conclusion. A theory-driven educational intervention is effective in improving the dietary calcium intake, knowledge, self-efficacy, and PAL of older community-based Mauritian adults.
    The Scientific World Journal 12/2013; 2013(2):750128. DOI:10.1155/2013/750128 · 1.73 Impact Factor
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    • "Of the methods that can be used for dietary assessment, FFQ appears to be simple, reliable, and quite convenient. The validated simple FFQ called the Calcium Calculator™[8] and an online version[9] are available to assess the calcium intake of western populations, whose major source of calcium is dairy products. However, we previously showed that Korean women consumed only 1/3 of their calcium intake from dairy products, and that vegetables were a very important source of calcium.[10] "
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