Clueing in on Calcium

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Clueing in on Calcium

• Karen Plawecki, MS, RD, LDN

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Outline of Presentation

• Happy Bones program overview
• Need for Calcium Focused Food Frequency
  Questionnaire (CF-FFQ)
• Pilot study for CF-FFQ validation
• Large scale validation study
• Whats next

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Development, Implementation, and Evaluation of an
Osteoporosis Prevention Program
Happy Bones Program 8 week class Class size 25
maximum Primary prevention community class
Brown Bag series
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Program Development Process

• Short Lecture/Discussion
• Power-point Presentation
• Activities and Handouts
• Active learning

Doing the Math for Calcium! See It, Do It, Teach
It! GEM No. 371, JNEB 2004
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Activity Examples

• Bone Jenga
• Anthropometric measures
• Crossword puzzles
• Math and label reading
• Balance and posture exercises
• Portion activity
• Taste testing

For copy of Happy Bones CD, email kmc_at_uiuc.edu
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Program Content

• Severity
• Susceptibility
• Barriers
• Exercise and vitamin D
• Medications
• Supplements and lactose intolerance
• Summary and graduation

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Outcome Measures

• Calcium intake
• Weight-bearing activity- step counting
• Change in theory construct from the HBM and TRA

Tussing, L and Chapman-Novakofski, K. J Amer
Dietetic Assoc 105(1)92-97, 2005
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Outcome Measure Calcium Intake

• Calcium Intake- (n42)
• Baseline 644 384 mg/day
• Post-intervention 821 372 mg/day (p.004)
• 36 now meeting AI of 1000 mg/day compared to 16
  at baseline
• Paired students t-test

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Study Need for Calcium Focused Survey

• Calcium was assessed via seven question survey
• Specifically addressed dairy foods fortified
  juice
• Open questions regarding additional fortified
  foods and other calcium sources
• No tool available that included calcium-rich and
  calcium-fortified foods

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Literature Review FFQ for Calcium

• Development of a food frequency questionnaire to
  estimate calcium intake of Asian, Hispanic, and
  white youth. Jensen, J.K, et al, JADA May 2004
• Reliability and validity of a brief questionnaire
  to assess calcium intake in female collegiate
  athletesWard, KD, et all, In J Sport Nutr Exerc
  Metab, 2004
• Development and assessment of a short instrument
  for assessing dietary intakes of calcium and
  vitamin D. Blalock, et al. J Am Pharm Assoc, 2003

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Fluid Nature of Fortification
Bread
Graham crackers
Orange juice
Other juice
Yogurt
Soy milk
Breakfast bars
Margarine
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CF-FFQ

• 7 food groups
• Dairy
• Foods with dairy
• Fruits
• Vegetables
• Grains
• Meat/meat alternatives
• Others

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Rationale for Group/Food Selection

• Common breakdown of groupsFoods with dairy
  used to highlight combination foods
• Minimum calcium content 50 mg/serving
• Data sources Food Finder, Bowes and Church,
  company material
• Items from Happy Bones FFQ

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CF-FFQ
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Pilot Study

• Reliability
• Test and re-test with university students in
  summer course
• N18

• Validity
• N 15 females
• Face validity clarity of use
• Validity Compared CF-FFQ vs 24 hour recall

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Reliability of CF-FFQ
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Reliability in the Dairy Group
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Results of CF-FFQ
Paired students t-test
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CF-FFQ Results Correlation
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Final Validation Methods

• Recruited college students in non-majors
  nutrition course
• Extra credit provided if adequately completed
• Each student completed CF-FFQ and 24 hour recall
• Analyzed 24 hr recall data with Nutritionist V
• Calculated CF-FFQ content with Access database

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Final Validation Results
N 300 females
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Limitations of Study

• College students may not be representative of
  adult population
• Compared against 24 hour recall vs. food diary
• Self-reported
• Not all fortified foods were found in nutrient
  analysis program

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Whats next?

• Incorporate CF-FFQ into web-based curriculum
• Use Happy Bones as base
• Target college-aged population

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Rationale and Plan

• College students independent food choices, final
  push to maximizing bone density
• Start with focus group
• Topics
• Evaluate program
• Use within campus recreational gyms

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Thank You!
For more information visit the website
http//lancaster.unl.edu/food/sne.htm or
contact Karen Plawecki at plawecki_at_uiuc.edu