Clinical Briefs

Am Fam Physician. 2000 Jul 15;62(2):446-448.

Calcium Needs of Infants, Children and Adolescents

The Committee on Nutrition of the American Academy of Pediatrics (AAP) has released a statement on the calcium requirements of infants, children and adolescents. The statement reviews the physiology of calcium metabolism and the data on the relationship between calcium intake and bone growth, and metabolism. The statement appears in the November 1999 issue of Pediatrics.

According to the AAP committee, a large number of recent studies have identified a relationship between childhood calcium intake and bone mineralization and the potential relationship of these data to fractures in adolescents and the development of osteoporosis in adulthood. Calcium requirements are affected substantially by genetic variability and other dietary constituents. Because of the ways these factors interact, identifying a single number for the calcium “requirement” for all children is impossible. However, several recent dietary guidelines have considered the data on calcium requirements and recommended calcium intake levels that are calculated to benefit most children (see accompanying table).

Recommendations for Dietary Calcium Intake*

Age 1997 NAS (mg per day) 1994 NIH (mg per day)

0 to 6 months†

210

400

6 months to 1 year†

270

600

1 to 3 years

500

800

4 to 8 years

800

800 (4 to 5 years)

800 to 1,200 (6 to 8 years)

9 to 18 years

1,300

800 to 1,200 (9 to 10 years)

1,200 to 1,500 (11 to 18 years)


NAS = National Academy of Sciences; NIH = National Institutes of Health.

*—Recommended intakes were provided in different forms by each source cited. The Food and Nutrition Board of the NAS released Recommended Dietary Allowances until 1997. In 1997, it chose to use the term adequate intake for the recommendations for calcium intake but indicated that these values were to be used as Recommended Dietary Allowances. The NIH Consensus Conference did not specify a specific term, but indicated that these values were the “optimal” intake levels. Dietary recommendations by the NAS are set to meet the needs of 95 percent of the identified population of healthy subjects. The NAS guideline should be the primary guideline used.

—For infant values, the 1994 NIH Consensus Conference indicated values for formula-fed infants, whereas the 1997 NAS report used the infant-fed human milk as the standard.

Adapted with permission from American Academy of Pediatrics. Calcium requirements of infants, children, and adolescents. Pediatrics 1999;104:1152–7.

Recommendations for Dietary Calcium Intake*

View Table

Recommendations for Dietary Calcium Intake*

Age 1997 NAS (mg per day) 1994 NIH (mg per day)

0 to 6 months†

210

400

6 months to 1 year†

270

600

1 to 3 years

500

800

4 to 8 years

800

800 (4 to 5 years)

800 to 1,200 (6 to 8 years)

9 to 18 years

1,300

800 to 1,200 (9 to 10 years)

1,200 to 1,500 (11 to 18 years)


NAS = National Academy of Sciences; NIH = National Institutes of Health.

*—Recommended intakes were provided in different forms by each source cited. The Food and Nutrition Board of the NAS released Recommended Dietary Allowances until 1997. In 1997, it chose to use the term adequate intake for the recommendations for calcium intake but indicated that these values were to be used as Recommended Dietary Allowances. The NIH Consensus Conference did not specify a specific term, but indicated that these values were the “optimal” intake levels. Dietary recommendations by the NAS are set to meet the needs of 95 percent of the identified population of healthy subjects. The NAS guideline should be the primary guideline used.

—For infant values, the 1994 NIH Consensus Conference indicated values for formula-fed infants, whereas the 1997 NAS report used the infant-fed human milk as the standard.

Adapted with permission from American Academy of Pediatrics. Calcium requirements of infants, children, and adolescents. Pediatrics 1999;104:1152–7.

The AAP committee makes the following recommendations for calcium intake in children:

  • Physicians should actively support the goal of achieving calcium intakes in children and adolescents comparable to those in recently recommended guidelines. Potential benefits of achieving these goals include preventing future osteoporosis and decreasing the risk of childhood and adolescent fractures. These benefits should be discussed with patients because relatively few children and adolescents currently achieve dietary calcium intake goals.

  • Physicians should consider including the following questions about dietary calcium intake to emphasize the importance of calcium: What do you drink, white or chocolate milk, with your meals? Do you drink milk with meals, snacks or cereal, or any other time during the day? Do you eat cheese, yogurt or other dairy products such as cottage cheese? Do you drink calcium-fortified juices or eat any calcium-fortified foods? Do you eat any of the following foods: broccoli, tofu, oranges or legumes (such as dried beans and peas)? Do you take any mineral or vitamin supplements?

  • For children and adolescents whose calcium intake seems deficient, specific information about the sources of dietary calcium should be provided. Adolescents may need to be reminded that low-fat dairy products, including skim milk and low-fat yogurts, are good sources of calcium that are not high in fat.

Rubella Outbreak Among Hispanic Adults

The incidence of rubella has been low since 1994. Most cases of rubella have been associated with outbreaks, which have recently occurred among Hispanic adults, many of whom are from countries where rubella vaccination is not routine or has been implemented only recently. A report published in the March 24, 2000 issue of Morbidity and Mortality Weekly Report summarizes the characteristics of the recent outbreaks in the United States.

According to the report from 1969 through 1989, the annual number of reported cases of rubella in the United States decreased by 99.6 percent as a result of a successful childhood vaccination program. However, two thirds of other countries did not routinely vaccinate against rubella before 1997. The disease is still endemic in many Latin American countries and large epidemics of rubella occur periodically.

From 1996 through 1998, 14 rubella outbreaks were reported in the United States. Of the outbreaks, seven were associated with the work-place and most occurred among employees of food-processing plants or other industries that employ mainly persons born in other countries. Most of the reported cases were among persons of Hispanic origin.

Even though rubella is near record low levels in the United States, epidemics still occur among susceptible adults born in other countries. Persons born outside of the United States are a potentially susceptible population in which outbreaks may occur after the virus is imported from areas outside of the United States where rubella is endemic. Vaccinating persons in the workplace may be a way to reach this susceptible population and may help to eliminate indigenous rubella. The report recommends that public health professionals, other health care professionals, and industrial health care services implement appropriate programs to ensure high coverage of foreign-born employees with rubella vaccine.

New Drug for Irritable Bowel Syndrome in Women

The U.S. Food and Drug Administration (FDA) has approved a new treatment for women with the diarrhea predominant type of irritable bowel syndrome (IBS). Alosetron hydrochloride (Lotronex) is a potent and selective 5-HT3 antagonist that has been proved in large clinical trials to address multiple symptoms of the condition.

According to a study in Lancet, IBS is one of the most commonly diagnosed yet least understood medical conditions in the United States. Up to one in five American adults may have IBS, and the disorder affects three times as many women as men. More Americans have IBS than asthma or diabetes. Until now, treatment options have been limited and the available medications have been directed at treating a single symptom. The FDA approval of alosetron is significant because the drug may relieve multiple symptoms among women with the diarrhea predominant type of IBS.

In clinical studies, the drug was generally well tolerated. The most common side effect was constipation, reported by approximately 30 percent of study participants who were taking alosetron. Other adverse effects included nausea, gastrointestinal pain and discomfort, and neurologic and respiratory problems. Ischemic colitis was reported by 0.1 to 1.0 percent of study participants; however, a causal relationship between acute colitis and treatment with alosetron hydrochloride has not been determined. The drug should not be used by patients who are currently constipated or whose main bowel symptom is constipation. The safety and efficacy of alosetron therapy in men have not been established.

Alosetron will be available in 1-mg tablet form with a recommended dosage of one tablet twice a day. Prescribing information via fax is available by calling 800-753-0352, ext. 733.


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