Oct. 19, 1999 PHILADELPHIA — Most of us don’t look at groups of 10-year-olds and envision them as bone-weary senior citizens, but that’s the kind of long-range thinking behind a nutrition intervention program at The Children’s Hospital of Philadelphia. By having children increase their consumption of calcium now, the program aims to keep their bones strong and healthy past the middle of the 21st century. Through a combination of health education, sophisticated measuring devices and structured rewards for the participating children, the goal is to improve eating habits, one meal at a time.
Children who regularly drink milk and eat other foods high in calcium may lower their risks in later life of suffering osteoporosis, the reduction in bone mass and bone density that leaves many older people vulnerable to disabling falls and broken bones. "A small shift in a population’s dietary habits can drastically reduce the number of 80-year-olds with fractures," says nutritional anthropologist Babette S. Zemel, Ph.D., scientific director of the Nutrition and Growth Laboratory at Children’s Hospital and the principal investigator of the project.
Osteoporosis currently exacts high human costs, in loss of independence and higher mortality rates after elderly people suffer fractures. Osteoporosis affects an estimated 25 million Americans, with a price tag of approximately $13.8 million per year in increased hospitalization, medical and nursing home costs. But future costs could be reduced dramatically with dietary changes during the pre-adolescent years. "Before puberty is the important time to get calcium, before the body begins growing rapidly in adolescence," says Dr. Zemel. "Adults can receive some benefits from taking calcium supplements, but the improvements are limited." Thanks to a recent five-year grant award from the National Institutes of Health, Dr. Zemel expects to initiate the program with her first group of children later this year.
A total of 150 healthy children will be recruited. Half of them might be at risk for low bone density due to a previous fracture, a family history of osteoporosis or refusal to consume dairy products. Evenly divided between boys and girls, the children will be 7 to 10 years old. Half of the children will attend five educational sessions. With parents in one group, children in the other, program staff will explain the importance of increasing calcium consumption, provide cooking demonstrations and devise individualized plans to incorporate calcium-rich foods. "It’s important to break the plans into manageable steps, and come up with foods that the children will accept and incorporate into their diets," says Dr. Zemel.
Rewards are built into the program: families monitor their progress by putting colored stars on charts, and children are awarded trophies that increase in size with succeeding steps. Within the study, a companion group will receive individual counseling about calcium intake and bone health but will not participate in the educational sessions.
The new program builds on earlier successes at Children’s Hospital in improving nutrition in children whose growth and bone development are impaired by particular diseases or medications. The Hospital’s Nutrition Center has had a national influence in defining nutritional needs for children with cystic fibrosis and cerebral palsy, and has more recently been studying similar issues for children with sickle cell disease.
The behavioral modification-nutrition education program at Children’s Hospital is based on a similar program by Lori Stark, Ph.D., a psychologist from Cincinnati Children’s Hospital, who is a consultant to the project. Dr. Stark found an intervention program succeeded in getting children with cystic fibrosis to increase their needed intake of calories. Dr. Zemel’s program will test whether similar techniques are effective in improving nutrition in healthy children. "The goal will be to implement changes in behavior over a short period of time that will have long-lasting effects," she adds.
In addition to monitoring dietary changes through interviews and through record-keeping by children and families, the program has access to sophisticated measuring equipment in the Growth and Nutrition Laboratory at Children’s Hospital. A specialized, low-radiation X-ray machine that measures bone density and body composition produces real-time images that lets fascinated children see their own bones on a screen. Another instrument, a QCT (quantitative computerized tomography) scanner, measures two distinct layers of growing bone. Both are considered safe for children.
In contrast to the high-tech measuring tools, the "treatments" are simple enough: yogurt, cheese, pudding and calcium-fortified orange juice and cereals. "Calcium from food sources may have a greater impact on bone density than calcium supplements," says Dr. Zemel. "This study will give us measurable results for that impact, in addition to helping us test methods to change children’s eating habits."
The Children's Hospital of Philadelphia, the nation's first children's hospital, is a leader in patient care, education and research. This 373-bed multispecialty hospital provides comprehensive pediatric services, including home care, to children from before birth through age 19. The Children's Hospital of Philadelphia admits more than 16,000 patients, and cares for more than 50,000 emergency patients and 500,000 outpatients annually. The Hospital operates a pediatric healthcare network that also includes The Joseph Stokes, Jr. Research Institute, eight outpatient specialty care centers, four primary care centers, inpatient units at three community hospitals, a poison control center and 28 KidsFirst physician practices in Pennsylvania, New Jersey and Delaware.
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