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Original Paper
The Importance of Breakfast in Meeting Daily
Recommended Calcium Intake in a Group of
Schoolchildren
Rosa M. Ortega, PhD, FACN, Ana Marı´a Requejo, PhD, Ana M. Lo´pez-Sobaler, PhD, Pedro Andre´s, PhD,
M. Elena Quintas, Beatriz Navia, Mercedes Izquierdo, and Trinidad Rivas
Departamento de Nutricio´n (R.M.O., A.M.R., A.M.L-S., E.Q., B.N., M.I.) and Laboratorio de Te´cnicas Instrumentales (P.A.),
Facultad de Farmacia, Universidad Complutense, Madrid; and Departamento de Higiene Alimentaria (T.R.), Exmo.
Ayuntamiento de Madrid Madrid SPAIN
Key words: breakfast, calcium intake, schoolchildren, milk products
Objective: To evaluate the breakfast intake of calcium and milk products and to determine whether these
correlate with total intake of both calcium and milk products.
Methods: Food taken at breakfast and throughout the day was recorded using a 7 consecutive day food
record in 200 schoolchildren aged between 9 and 13 years.
Results: 65.3% of boys and 80.5% of girls showed intakes of calcium which were lower than recommended.
Milk products were the foods most frequently included in breakfast (95.5% of subjects included them in this
meal). A relationship was seen between energy provided by breakfast and the quantities of milk products
(r50.5735) and calcium (r50.6908) taken at this meal. A relationship was also seen between energy provided
by breakfast and daily intake of milk products (r50.4633) and calcium (r50.4954). The percentage of intakes
of calcium lower than those recommended decreased when breakfast provided $20% of total energy intake, and
when the consumption of milk products at breakfast was greater than the 50th percentile (200 ml). Subjects with
breakfast milk product intakes $200 ml showed higher intakes of the same over the rest of the day (233.36140.4
g) than did those who took lesser quantities of these foods at breakfast (161.56100.6 g). Further, those who took
$25% of the recommended intake of calcium at breakfast showed greater intakes of the same over the rest of
the day (600.46213.8 mg compared to 510.86200.7 mg in subjects with lower calcium intakes).
Conclusions: The intake of milk products (r50.7587) and calcium (r50.7223) at breakfast correlates with
the consumption of these foods in the whole diet. However, the total daily intake of milk products and calcium
does not depend solely on breakfast intake. Subjects with the greatest intakes at breakfast also showed greater
intakes over the rest of the day (r50.3953 for milk products and r50.4122 for calcium).
INTRODUCTION
It is of prime importance to monitor the intake of milk
products and calcium in young and adolescent children to meet
the high nutritional needs associated with growth and to safe-
guard health in later life [1].
Several studies have shown that an adequate calcium intake
allows the production of a greater bone mass—a factor that
retards the appearance of osteoporosis [2–5]. It is also of use in
the prevention of cancer of the colon [6–9], hypertension
[10,11], and hypercholesterolaemia [12].
Changes in eating habits are seen during adolescence since
young people begin to make their own decisions about what
they wish to eat. They frequently choose sweet drinks instead
of milk [3], and since they begin to worry about their appear-
ance it is common for adolescents to restrict their intake of
foods [13]. Their intakes of milk products and calcium are
frequently lower than those recommended [14–18].
Breakfast frequently includes milk products and this meal
therefore supplies an important quantity of the total calcium
provided by the diet. The aim of the present investigation was
to evaluate the breakfast intake of calcium and milk products
Address reprint requests to: Rosa M. Ortega, PhD, Departamento de Nutricion, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid SPAIN.
Journal of the American College of Nutrition, Vol. 17, No. 1, 19–24 (1998)
Published by the American College of Nutrition
19
and to determine whether these intakes impact total consump-
tion over the rest of the day.
MATERIALS AND METHODS
The study subjects were 200 schoolchildren aged between 9
and 13 years studying at two schools in Madrid. Subjects
belonged to either a middle or low socioeconomic level.
The selection of the two schools was performed by the
Madrid City Hall (Dept. of Health and Consumer Affairs)
[Exmo. Ayuntamiento de Madrid (A
´
rea de Salud y Consumo)],
through whom contact with the centers was made. A prelimi-
nary selection of schools was made bearing in mind the number
of students and the socioeconomic level of each center, whether
a school canteen was available and if present, whether a suffi-
ciently high number of children ate there. From the centers that
met preliminary selection requirements, which also included
that the school populations be of middle or low socioeconomic
status, those that finally took part were chosen at random.
Permission to perform the study was sought from the Directors
of the two schools selected, from the School Council and from
the Parents’ Association of each center.
Eight class groups were chosen at random from each center.
Participation was requested of those children who ate at the
school canteen (a total of 334 students). The parents of the selected
children were invited to attend a meeting where the nature of the
study was explained and their signed consent was sought. Of those
selected, 210 students (62.9%) finally agreed to participate.
Exclusion criteria included those suffering of any disease or
disorder that might modify the results of the parameters under
study e.g., hypercholesterolaemia, hypertriglyceridaemia, dia-
betes or other endocrine disorders and inadequate renal func-
tion. Other exclusion criteria included the consumption of
drugs such as glucocorticoids, diuretics and steroids, absence at
the time of the study and lack of consistency in answers given
in the different tests performed. Once exclusions were made the
final experimental population stood at 200 subjects (59.9% of
those originally selected).
This study was approved by the Research Committee of the
Facultad de Farmacia, Universidad Complutense de Madrid.
Diet Study
Food intake at breakfast and over the rest of the day was
monitored using a food record for 7 consecutive days. Subjects
and their parents received instructions about how the question-
naire should be completed. They were informed that all foods
taken over the course of each study day should be recorded,
including all drinks and sweets etc., and if possible that these be
weighed or recorded using traditional household quantities
(cups, spoonfuls, etc.). Kitchen scales were provided to parents
who needed them.
Given that the subjects took their midday meal in the school
canteen for 5 of the 7 days of the study (Monday through
Friday), the monitoring of foods taken at these times was
performed by “precise individual weighing.” Trained personnel
weighed the food served to each subject and they also weighed
the food left over by each.
Data of foods taken were transformed into values of energy
and nutrients using Tables of Food Composition published by
the Instituto de Nutricio´n [19]. Observed intakes were com-
pared to recommended intakes (RI) in order to evaluate the
adequacy of the diet [20].
Anthropometric Study
Weight and height were determined using a digital elec-
tronic weighing scale (Seca alpha; Rue Lavoisier 91430, Igmy,
France; range: 0.1 to 150 kg) and a digital stadiometer (Harp-
ender Pfifter 450; Badem, Padum Aveny, Carlstadt, NJ, USA)
(range: 70 to 205 cm), respectively. From the anthropometric
data the body mass index (BMI) was calculated. Measurements
were made first thing in the morning at the participating
schools. Following the norms of the World Health Organisation
(WHO) [21], measurements were taken with subjects dressed
only in underwear and without shoes.
Socioeconomic Study
In order to select schools that could be considered to have
student populations of middle and low socioeconomic level, the
monthly fee paid by parents and the characteristics of the
school’s home neighborhood were taken into consideration.
The socioeconomic status of individual subjects was estab-
lished considering the professions of the parents and the char-
acteristics of their homes [22]. The data collected confirmed the
socioeconomic status of subjects as middle and low.
Statistics
Where distribution of results was homogeneous, differences
between means were investigated by the Student “t” test.
Where distribution of results was not homogeneous, differences
between means were investigated by the Mann-Whitney test.
Linear correlation coefficients were also calculated between
different diet data.
Differences between the sexes with respect to the intake of
milk products or the energy provided by breakfast were estab-
lished using two way ANOVA.
RESULTS
The subjects (which included 118 boys and 82 girls) showed
no significant differences in age, weight, height or body mass
index (BMI) (Table 1).
Though the mean intake of calcium at breakfast was greater
than the 25% recommended, 33.9% of boys and 32.9% of girls
Breakfast and Daily Calcium Intakes
20 VOL. 17, NO. 1
showed values below this level. More importantly, 65.3% of
boys and 80.5% of girls did not consume the recommended
daily intake of calcium (Table 2). A correlation was seen
between the intake of milk products (r50.7587) and calcium
(r50.7223) at breakfast and in the whole diet.
Milk products were the foods most frequently included in
breakfast (95.5% of subjects included them in this meal). A
relationship was seen between the energy supplied by breakfast
and the quantity of milk products (r50.5735) and calcium
(r50.6908) contained in this meal. However, a relationship was
also seen between energy supplied by breakfast and daily
consumption of milk products (r50.4633) and calcium
(r50.4954).
Breakfasts that supplied ,20% of total energy intake also
included lower quantities of milk products and calcium than did
larger breakfasts. However, subjects whose breakfasts provided
,20% of their total energy intake also consumed fewer milk
products and less calcium over the rest of the day. Their dietary
calcium density (mg/1000 kcal) and index of nutritional quality
(INQ) (observed density/recommended density) with respect to
calcium were also lower (Table 3).
When breakfast included a quantity of milk products .50th
percentile (200 ml), significant greater intakes were seen in the
supply of milk products and calcium at breakfast and in the
whole diet, dietary calcium density and INQ with respect to
calcium, when compared to breakfasts containing lower intakes
of milk products (Table 4).
The percentage of subjects with calcium intakes lower than
those recommended was less when breakfast supplied $20% of
total energy and when the intake of milk products at breakfast
was above the 50th percentile (200 ml) (Tables 3 and 4).
Subjects who took $200 ml of milk products at breakfast
showed greater intakes over the rest of the day (233.36140.4 g)
than those who took lesser quantities at this meal (161.56100.6
g). Further, those who took $25% of calcium RI at breakfast
showed higher calcium consumption over the rest of the day
(600.46213.8 mg compared to 510.86200.7 mg in those with
lower breakfast calcium intake). Therefore, a greater total in-
take of milk products and calcium does not only depend upon
higher quantities taken at breakfast. Subjects with greater in-
takes at this meal also showed greater intakes over the rest of
the day, r50.3953 for milk products and r50.4122 for calcium.
DISCUSSION
The intake of milk products and calcium (Table 2) is similar
to that observed in other populations [15–18, 23] but lower than
that reported by Lo¨wik et al [24].
65.3% of boys and 80.5% of girls showed calcium intakes
lower than those recommended (800 mg/day in children aged 9
and 1000 mg/day in those aged 10 to 13) [20]. These figures
(especially that for girl subjects) are quite high (Table 2).
Some authors [25] consider that an intake of 1500 mg/day
of calcium during adolescence is necessary to achieve satisfac-
tory bone mass. Using this figure as a guide, the number of
insufficient calcium intakes observed is considerably greater
(Table 2).
Different studies have associated suboptimal calcium in-
takes with an increased risk of osteoporosis [2–5], cancer of the
colon [6–9], hypercholesterolaemia [12] and high blood pres-
sure [26]. It would therefore seem advisable that this population
increase its intake of milk products, and in turn increase its
calcium intake (Tables 2–4).
The School Breakfast Program (SBP) reports that it is
advisable to take 25% of the daily recommended intake of
energy and nutrients during this meal [27]. Using this figure as
a guide, 33.9% of boys and 32.9% of girls in the present study
show calcium intakes below 25% RI [20] (Table 2). Those
subjects with breakfast calcium intakes lower than recom-
mended also showed lower total calcium intakes (692.36232.9
Table 1. Characteristics of the Sample of Schoolchildren
(Mean6SD)
Males Females
n 118 82
Age (years) H 11.661.1 11.461.1
Weight (kg) H 44.9610.8 44.669.1
Height (cm) H 151.0610.2 150.269.2
Body mass index (kg/m
2
) H 19.563.0 19.662.7
No significant differences with respect to sex (using the Student “t” test for
homogeneous distributions (H) and the Mann-Whitney test for non homogeneous
distributions) (NH).
Table 2. Breakfast and Whole Diet-Daily Intakes of Milk Products and Calcium (Mean6SD)
Breakfast Whole diet
Males Females Males Females
Milk products (g/day) 204.4694.4 196.1667.1 NH 412.86185.3* 368.26159.2* H
Calcium (mg/day) 296.26126.3 274.1695.8 NH 902.46291.3* 792.96253.4* H
(% of RI) 29.6612.6 27.469.6 NH 90.2629.1* 79.3625.3* H
% ,RI 33.9 32.9 65.3 80.5
RI: Recommended intakes (800 mg/day in children aged 9 and 1000 mg/day in those aged 10 to 13), (Recommended intakes for breakfast: 25% of RI).
*(p,0.05) significant differences between sexes (using the Student “t” test for homogeneous distributions (H) and the Mann-Whitney test for non homogeneous
distributions) (NH).
Breakfast and Daily Calcium Intakes
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 21
mg/day) than did other subjects (940.76266.6 mg/day,
r50.7223).
The influence of breakfast energy intake on calcium intake
was studied since breakfast is the meal in which milk products
are most commonly taken [28,29]. In a previous study, it was
found that 92.9% of 742 subjects included milk products in
their breakfasts. It might therefore be considered that breakfast
composition play an important role in maintaining a satisfac-
tory calcium intake [29].
In the present study, milk products were included in 95.5%
of subjects’ breakfasts. A relationship was found between the
energy supplied by this meal and the amount of milk products
taken (r50.5735), and also with the amount of milk products in
the whole diet (r50.4633).
Andersen et al [30], Morgan et al [31] and Nicklas et al [32]
showed that the supply of nutrients from breakfast is very
important. Children who omitted breakfast did not compensate
for this loss of nutrients at other meals. Data such as these
confirm the importance of breakfast in the maintenance of an
adequate diet in schoolchildren. Hanes et al [28] also found that
children who habitually took breakfast showed greater intakes
of nutrients than did children who omitted this meal. This was
Table 3. Breakfast and Whole Diet-Daily Intakes of Milk Products and Calcium with Respect to Breakfast Energy Provision
(Mean6SD)
Breakfast provision ,20% of Total
Energy Provision
Breakfast provision $20% of Total
Energy Provision
Males
(n565)
Females
(n551)
Males
(n553)
Females
(n531)
Breakfast
Milk products (g/day) e 173.9684.9 181.2667.9 241.9692.7 220.7659.0
Calcium (mg/day) e 241.46105.3 249.2688.6 363.56117.7 315.0694.4
(% of RIB) e 24.1610.5 24.968.9 36.4611.8 31.569.4
% RIB 50.8 45.1 13.2 12.9
Whole diet
Milk products (g/day) e 366.66174.2 355.86158.6 469.36184.4 388.76160.9
Calcium (mg/day) es 828.56259.1 780.56241.0 993.06305.2 813.46275.4
(% of RI) es 82.9625.9 78.0624.1 99.3630.5 81.3627.5
(mg/1000 Kcal) e 367.0694.8 410.0698.1 425.86119.2 423.86119.2
INQ es 0.8860.26 0.8360.22 1.0260.36 0.8960.27
% ,RI 70.8 82.4 58.5 77.4
RI: Recommended intakes (800 mg/day in children aged 9 and 1000 mg/day in those aged 10 to 13), RIB: Recommended intakes for breakfast (25% of RI). INQ: Index
of nutritional quality (observed density/recommended density, recommended value51).
s,e(P,0.05) significant differences between sexes (s) and energy provided by breakfast (e) (using 2 way ANOVA and considering the influence of both variables).
Table 4. Differences in Daily Intake of Milk Products and Calcium with Respect to Breakfast Milk Product Intake (Mean6SD)
Consumption of milk Products At
Breakfast ,50th Percentile
Consumption of milk Products At
Breakfast $50th Percentile
Males
(n567)
Females
(n541)
Males
(n551)
Females
(n541)
Breakfast
Milk products (g/day) l 147.0659.1 151.5656.2 279.8677.7 240.7643.4
Calcium (mg/day) sl 219.9680.1 218.0680.9 396.66103.8 330.1674.8
(% of RIB) sl 22.068.0 21.868.1 39.7610.4 33.067.5
% ,RIB 59.7 61.0 0 4.9
Whole day
Milk products (g/day) sl 325.46129.5 291.16110.9 527.56186.0 445.46163.8
Calcium (mg/day) sl 782.56227.1 692.96227.3 1059.96293.1 892.96240.6
(% of RI) sl 78.2622.7 69.3622.7 106.0629.3 89.3624.1
(mg/1000 Kcal) l 359.5693.0 381.4697.5 437.96115.5 449.06104.5
INQ sl 0.8560.24 0.7760.21 1.0660.35 0.9360.24
% ,RI 82.1 90.2 43.1 70.7
RI: Recommended intakes (800 mg/day in children aged 9 and 1000 mg/day in those aged 10 to 13), RIB: Recommended intakes for breakfast (25% of RI). INQ: Index
of nutritional quality (observed density/recommended density, recommended value51).
s,1(P,0.05) significant differences with respect to sex (s) and intake of milk products at breakfast (l) (using 2 way ANOVA and considering the influence of both
variables).
Breakfast and Daily Calcium Intakes
22 VOL. 17, NO. 1
especially evident for calcium, perhaps because of the large
supply of milk products commonly taken at this meal.
As indicated by Sampson et al [33] in their study of 1151
children of low socioeconomic status, the omission of break-
fast, or the consumption of an inadequate breakfast, is associ-
ated with the appearance of substantial deficits of many nutri-
ents. Therefore, campaigns to ameliorate the nutritional status
of children should include education programs aimed at im-
proving their breakfasts.
In agreement with these authors, the present study showed
that breakfast energy intake plays an important role in milk
product and calcium supply both at breakfast and in the diet as
a whole (Table 3).
Additionally the intake of milk products and calcium during
breakfast influences the total daily intake of milk products &
calcium. It was found that subjects whose consumption of milk
products at breakfast was above the 50th percentile (200 ml)
showed greater intakes of milk products and calcium in the diet
as a whole (Table 4). However, differences in total diet were
not due solely to breakfast intake of milk products. Those
subjects who showed greater breakfast milk product intakes
also showed greater intakes over the rest of the day. Our results
agree with those of other authors [29,33,34] who have found
that the type of breakfast affects food habits and food intake
throughout the day.
Resnicow [35] relates the omission of breakfast with in-
creased cholesterolemia. The results of this author, from studies
with 500 schoolchildren aged between 9 and 19 years, suggest
that encouraging breakfast-skipping schoolchildren to change
this habit can improve their nutritive status and, possibly,
reduce the risk of future cardiovascular disease [35].
Some studies have shown that dietary calcium, which in-
creases the fecal excretion of cholesterol [36], might have an
effect in protecting against hypercholesterolaemia [12]. Sharlin
et al [37] have demonstrated the existence of a negative corre-
lation between calcium intake and serum cholesterol levels in
males.
In view of this it might be asked whether the nutrients
supplied by breakfast, in particular calcium, may be a contrib-
uting factor in the increased hypercholesterolemia described by
Resnicow [35] in children who omitted breakfast.
Increasing the consumption of milk products at breakfast
could increase their intake at other times during the day. How-
ever, the observed relationship between breakfast intake and
total consumption of milk products could simply be a reflection
of a greater total consumption by these subjects. In either case,
and given the number of subjects who showed intakes below
those recommended, it would seem advisable to increase the
quantities of milk products taken at breakfast and over the rest
of the day. To achieve this goal, it is necessary to further
analyze how children acquire healthy food habits [38] in order
to best prepare appropriate education campaigns.
ACKNOWLEDGMENTS
This study was possible through the collaboration of the
Exmo. Ayuntamiento de Madrid (A
´
rea de Salud y Consumo)
and Danone, S.A. which provided the financial support. Our
most sincere gratitude to Dr. D. Simo´n Vin˜als Pe´rez (Concejal
Delegado del A
´
rea de Salud y Consumo), Dr. D. Angel Go´mez
Mascaraque (Director de Servicios de Higiene y Salud Pu´blica)
and D. Juan Ignacio Rojas Ponce (Director de Servicios de
Consumo, Ordenacio´n Alimentaria y Salubridad Pu´blica) of the
Exmo. Ayuntamiento de Madrid, and to D. Jose Antonio Ma-
teos Guardia (Jefe del Servicio de Alimentacio´n y Nutricio´n y
de Estrategia Reglamentaria de Danone, S.A.).
REFERENCES
1. Agostoni C, Rottoli A, Trojan S, Riva E: Dairy products and
adolescent nutrition. J Int Med Res 22:67–76, 1994.
2. Anderson JJB, Henderson RC: Dietary factors in the development
of peak bone mass. In Burckhardt P, Heaney RP (eds): “Nutritional
Aspects of Osteoporosis,” Serono Symposia, vol. 85. New York:
Raven Press, pp 3–19, 1991.
3. Chan GM: Dietary calcium and bone mineral status of children and
adolescents. Am J Dis Child 145:631–634, 1991.
4. Hubbard RW, Mejia A, Horning M: The potential of diet to alter
disease processes. Nutr Res 14:1853–1895, 1994.
5. Johnston CC, Miller JZ, Slemenda CW, Reister TK, Hui S, Chris-
tian JC, Peacock M: Calcium supplementation and increases in
bone mineral density in children. N Engl J Med 327:82–87, 1992.
6. Slattery ML, Sorenson AW, Ford MH: Dietary calcium intake as a
mitigating factor in colon cancer. Am J Epidemiol 128:504–514,
1988.
7. Giovanucci E, Stampfer MJ, Colditz G, Rimm EB, Willett WC:
Relationship of diet to risk of colorectal adenoma in men. J Natl
Cancer Inst 84:91–98, 1992.
8. van der Meer R, Lapre JA: Calcium and colon cancer. International
Dairy Federation Bulletin. International Dairy Federation, Brus-
sels. 255:55–59, 1991.
9. Wargovich MJ, Lynch PM, Levin B: Modulating effects of cal-
cium in animal models of colon carcinogenesis and short term
studies in subjects at increased risk for colon cancer. Am J Clin
Nutr 54:202S–205S, 1991.
10. McCarron DA, Morris CD, Young E, Roullet C, Drueke T: Dietary
calcium and blood pressure: modifying factors in specific popula-
tions. Am J Clin Nutr 54:215–219, 1991.
11. Van Beresteijn ECH, Van Schaik M, Schaafsma G: Milk: does it
affect blood pressure?. A controlled intervention Study. J Int Med
228:477–482, 1990.
12. Levenson DI, Richard MD, Bockman S: A review of calcium
preparations. Nutr Rev 52:221–232, 1994.
13. Jeanneret O: Comportements alimentaires des adolescents
d’aujourd’hui: aspects e´pide´miologiques et psychosociaux. Soz
Praeventiv Med 34:85–93, 1989.
14. Boneu M, Gomez-Quirante A, Feijoo N, Martos C, Foz G: Eating
Breakfast and Daily Calcium Intakes
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 23
habits and the frequency of food consumption in 8th-grade school-
children from a Basic Health Area of Mataro. Aten Primaria
30:591–595, 1994.
15. Ortega RM, Lo´pez-Sobaler AM, Requejo AM, Andre´s P, Gonza´-
lez-Ferna´ndez M: Valoracio´n diete´tica del estado nutritivo de un
colectivo de adolescentes de Madrid. Nutr Clin 15:53–60, 1995.
16. Ortega RM, Andre´s P, Requejo AM, Lo´pez-Sobaler A, Redondo
MR, Gonza´lez-Ferna´ndez M: Ha´bitos alimentarios e ingesta de
energı´a y nutrientes en escolares con sobrepeso en comparacio´n
con los de peso normal. An Esp Pediatr 44:203–208, 1996.
17. Ortega RM, Requejo AM, Redondo R, Lo´pez-Sobaler AM, Andre´s
P, Ortega A, Gaspar MJ, Quintas E, Navia B: Influence of the
intake of fortified breakfast cereals on dietary habits and nutritional
status of Spanish schoolchildren. Ann Nutr Metab 40:146–156,
1996.
18. Requejo AM, Ortega RM, Rivas T: Estado nutritivo en colectivos
escolares madrilen˜os. Madrid: Ayuntamiento de Madrid. Area de
Salud Pu´blica, 1994.
19. Instituto de Nutricio´n (CSIC): “Tablas de Composicio´n de Alimen-
tos Espan˜oles.” Madrid: Instituto de Nutricio´n, 1994.
20. Departamento de Nutricio´n: “Ingestas recomendadas de energı´a y
nutrientes para la poblacio´n espan˜ola.” Madrid: Departamento de
Nutricio´n, 1994.
21. World Health Organization (WHO): Methodology of Nutritional
Surveillance. Technical report series 53, Geneve: WHO, pp 20–60,
1976.
22. Lucas Marı´n A: “Introduccio´n a la Sociologı´a.” Pamplona: Eunsa.
pp 141–146, 1992.
23. Gans DA, Norwell NJ, Harper AE: Three-day dietary intake of
incarcerated and nonincarcerated adolescent males. J Am Coll Nutr
11:93–101, 1992.
24. Lo¨wik MRH, Brussaard JH, Hulshof KFAM, Kistemaker C,
Schaafsma G, Ockhuizen T, Hermus RJJ: Adequacy of the diet in
the Netherlands in 1987–1988 (Dutch nutrition surveillance sys-
tem). Int J Food Sci Nutr 45 (Suppl 1): 1–62, 1994.
25. Matkovic V: Calcium metabolism and calcium requirements dur-
ing skeletal modelling and consolidation. Am J Clin Nutr 54:245–
260, 1991.
26. Gillman MW, Oliveria SA, Moore LL, Ellison RC: Inverse asso-
ciation of dietary calcium with systolic blood pressure in young
children. JAMA 267:2340–2343, 1992.
27. Devaney BL, Gordon AR, Burghardt JA: Dietary intakes of stu-
dents. Am J Clin Nutr 61:205S–212S, 1995.
28. Hanes S, Vermeersch J, Gale S: The national evaluation of school
nutrition programs: program impact on dietary intake. Am J Clin
Nutr 40:390–413, 1984.
29. Ortega RM, Requejo AM, Andre´s P, Ortega A, Redondo MR,
Lo´pez-Sobaler A, Navia B, Quintas E, Lo´pez-Bonilla D. Tenden-
cias de consumo de alimentos en nin˜os en funcio´n de sus ha´bitos
de desayuno. Nutr Clin 15:31–38, 1995.
30. Andersen LF, Nes M, Sandstad B, Bjorneboe GE, Drevon CA:
Dietary intake among Norwegian adolescents. Eur J Clin Nutr
49:555–64, 1995.
31. Morgan KJ, Zabik ME, Stampley GL: The role of breakfast in diet
adequacy of the U.S. adult population. J Am Coll Nutr 5(6):551–
563, 1986.
32. Nicklas TA, Webber LS, Srinivasan SR, Berenson GS: Secular
trends in dietary intakes and cardiovascular risk factors of 10-year-
old children. 1973–1988. Am J Clin Nutr 57:930–937, 1993.
33. Sampson AE, Dixit S, Meyers AF, Houser R Jr: The nutritional
impact of breakfast consumption on the diets of inner-city African-
American elementary school children. J Natl Med Assoc 87(3):
195–202, 1995.
34. Ikeda J, Nagata H, Higashi A, Aoike A, Kawai K, Baba K,
Miyanaga M: Effects of food intake, dietary habits and life style on
health status as determined by clinical blood tests of adult men.
Nippon Koshu Eisei Zasshi. 39:428–436, 1992.
35. Resnicow K: The relationship between breakfast habits and plasma
cholesterol levels in schoolchildren. J Sch Health 61:81–85, 1991.
36. Bhattacharyya AK, Phil D, Thera C, Anderson JT, Grande F, Keys
A: Dietary calcium and fat: effect on serum lipids and fecal
excretion of cholesterol and its degradation products in man. Am J
Clin Nutr 22(9):1161–1174, 1969.
37. Sharlin J, Posner BM, Gershoff SN, Zeitlin MF, Berger PD:
Nutrition and behavioral characteristics and determinants of
plasma cholesterol levels in men and women. J Am Diet Assoc
92(4):434–440, 1992.
38. Graham MV, Uphold CR: Health perceptions and behaviours of
school-age boys and girls. J Community Health Nurs 9(2):77–86,
1992.
Received December 1996; revision accepted July 1997.
Breakfast and Daily Calcium Intakes
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