Validation of a short questionnaire for estimating dietary calcium intakes
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Concern about calcium supplements, and mainly minor side effects (e.g. constipation) impacting on compliance, means that assessing dietary calcium intake is important. There is no suitable biomarker. Compared to food diaries, a short questionnaire was an efficient way of confirming that patients had adequate calcium intakes (>700 or >1,000 mg)
Calcium is usually given alongside treatments for osteoporosis, but recent concerns about potential side effects have led to questioning whether supplements are always necessary. It is difficult to assess calcium intake in a clinical setting and be certain that the patient is getting enough calcium. The aim of this study was to determine whether a short questionnaire for estimating dietary calcium intakes in a clinical setting was fit for purpose.
We assessed dietary calcium intakes using a short questionnaire (CaQ) in patients attending an osteoporosis clinic (n = 117) and compared them with calcium intakes obtained from a 7-day food diary (n = 72) and a food frequency questionnaire (FFQ) (n = 33).
Mean (SD) daily calcium intakes from the CaQ were 836 (348) mg; from the diaries, 949 (384) mg; and from the FFQ, 1,141 (387) mg. The positive predictive value (PPV) was >80 % for calcium cut-offs > 700 mg and 70 % for cut-offs > 1,000 mg. The calcium intakes for the false positives results were not far below the cut-off. For 1,200 mg, the PPV was 67 % or less.
The CaQ is an adequate tool for assessing whether a patient has daily calcium intakes above 700 or 1,000 mg; if below these cut-offs, it is possible that the patient still has enough calcium in the diet, which could be clarified by questioning the patient further. As there were few patients with calcium intakes above 1,200 mg a day, the CaQ cannot be recommended as a tool for confirming higher dietary calcium intakes.
KeywordsDietary calcium Osteoporosis patients Questionnaire Validation
- 1.Department of Health (1991) Dietary reference values for food energy and nutrients for the United Kingdom. HMSO, LondonGoogle Scholar
- 5.Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92(4):1415–1423PubMedCrossRefGoogle Scholar
- 7.National Institute for Health and Clincal Excellence (2011) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended) TA161. http://guidance.nice.org.uk/TA161. NICE, London
- 10.Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352PubMedCrossRefGoogle Scholar
- 14.Henderson L, Irving K, Gregory J et al (2003) National Diet and Nutrition Survey: adults aged 19 to 64 years, vol 3, Vitamin and mineral intake and urinary analytes. TSO, LondonGoogle Scholar
- 15.Department_of_Health (1998) Nutrition and bone health: with particular reference to calcium and vitamin D. HMSO, LondonGoogle Scholar
- 21.Crawley H (ed) (1988) Food portion sizes. HMSO, LondonGoogle Scholar
- 22.Fisher P (1992) Dietary calcium intake in postmenopausal women: validation and application of a food frequency questionnaire. MSc thesis, University of Aberdeen, ScotlandGoogle Scholar
- 23.New SA (1995) An epidemiological investigation into the influence of nutritional factors on bone mineral density and bone metabolism. Ph.D. thesis, University of Aberdeen, ScotlandGoogle Scholar
- 25.Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT (1992) McCance and Widdowson’s The Composition of Foods, 5th edn. Royal Society of Chemistry, Cambridge, UKGoogle Scholar
- 28.Food_Standards_Agency (2002) In: Sixth summary edition (ed) McCance and Widdowson's The Composition of Foods, Sixthth edn. Royal Society of Chemistry, Cambridge, UKGoogle Scholar
- 29.Woodward M (1999) Epidemiology: study design and data analysis. Chapman & Hall/CRC, New York, pp 94–97Google Scholar
- 30.Nieves JW ZM, Ruffing J, Tendy S, Garrett P, Lindsay R, Cosman F (2013) Serum 25(OH)D and calcium intake predict changes in hip BMD and structure in young active men. In: Burckhardt P, Dawson-Hughes B, Weaver CM (eds) Nutritional aspects of osteoporosis. 8th International Symposium on Nutritional Aspects of Osteoporosis, Switzerland, 2012, Springer, London, pp 213–219 Google Scholar
- 32.Bates B, Lennox A, Swan G. National Diet and Nutrition Survey: headline results from year 1 of the rolling programme (2008/2009). 2010. http://www.food.gov.uk/science/dietarysurveys/ndnsdocuments/ndns0809year1.
- 36.Suzana S, Noor Aini MY, Nik Shanita S, Rafidah G, Roslina A (2009) Atlas of food exchanges & portion sizes, 2nd edn. MDC Publishers, Kuala LumpurGoogle Scholar
- 37.Holland B, Unwin ID, Buss DH (eds) (1988) Cereals and cereal products: third supplement to McCance and Widdowson's The Composition of Foods. Royal Society of Chemistry, Cambridge, UKGoogle Scholar
- 38.Unwin ID, Brown J, Buss DH (eds) (1993) Fish and fish products: third supplement to 5th edition of McCance and Widdowson’s The Composition of Foods. Royal Society of Chemistry, Cambridge, UKGoogle Scholar
- 39.(SIGN) SIGN (2003) Management of osteoporosis. SIGN publication 71. SIGN, EdinburghGoogle Scholar