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Original article
Relationship between dietary calcium intake and adiposity in female adolescents
Relación entre ingesta dietética de calcio y adiposidad corporal en adolescentes mujeres
José Castro Burbano
Corresponding author
jcastro@internacional.edu.ec

Corresponding author.
, Pamela Fajardo Vanegas, Julieta Robles Rodríguez, Karina Pazmiño Estévez
Escuela de Nutriología, Universidad Internacional del Ecuador, Quito, Ecuador
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-communicable chronic diseases represent a worldwide health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> They have a substantial impact on health and have serious adverse effects on the quality of life&#44; favor early mortality&#44; and cause high costs to society&#46; Cardiovascular disease&#44; cancer&#44; chronic respiratory tract disease&#44; and diabetes account for 60&#37; of deaths worldwide&#46; It is estimated that 41 million people will die from non-communicable chronic diseases in 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Obesity is considered by the World Health Organization to be the &#8220;epidemic of the 21st century&#8221;&#44; and its prevalence has increased and continues to increase in developed countries&#44; as well as in countries with economies in transition&#44; and has acquired epidemic proportions&#46; Overweight and obesity account for approximately 2&#46;6 million deaths annually&#46; Considering its multifactorial etiology&#44; genetic factors appear to have played only a secondary role in the increased prevalence of obesity&#44; while environmental factors such as diet and physical inactivity emerge as the most significant determinants of increased adiposity in the past 30 years&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The prevalence and magnitude of obesity are also rapidly increasing in children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Childhood obesity is the most common cause of insulin resistance in children and adolescents and is associated with dyslipidemia&#44; type 2 diabetes mellitus&#44; long-term vascular complications&#44; and usually with increased morbidity and mortality in adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Research has often focused on the identification of combinations of macronutrients able to regulate body weight&#44; but the effects of micronutrients need to be further explored&#46; Some minerals are involved in energy metabolism and in insulin secretion and action&#44; and may interfere with obesity control&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Studies searching for epidemiological explanations of increased adiposity have identified dietary calcium intake as one of the factors inversely correlated to the body mass index &#40;BMI&#41;&#46; Thus&#44; consistent evidence concerning the role of calcium and dairy product consumption in obesity prevention has started to appear in recent years&#46; The first report by McCarron&#44; two decades ago&#44; of the finding of lower body weights in US people who reported higher calcium intake in the National Health Survey opened a line of basic&#44; clinical&#44; and molecular research aimed at first confirming&#44; and then explaining the mechanisms by which a mineral apparently unrelated to the energy equation could contribute to weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Short-term studies have reported negative associations between calcium consumption and the BMI&#44; percent fat&#44; and waist circumference&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Experimental studies in rats to determine the effect of subchronic dietary calcium intake on body weight and lipid metabolism showed that the administration of calcium added to a high-fat diet decreased body weight and abdominal fat contents during treatment&#44; from which a potential decrease in fat absorption and a potential increase in fatty tissue apoptosis was inferred&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A reanalysis of several prospective studies designed to assess the effect of dairy products on the prevention of osteoporosis showed that groups treated with calcium or with a greater intake of dairy products consistently had less risk of overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> A greater relative risk of high body adiposity was found in people with the lowest calcium intake&#44; and the risk gradually decreased as calcium intake increased&#59; relative risk was 0&#46;75 for the second quartile&#44; 0&#46;40 for the third quartile&#44; and 0&#46;16 for the fourth quartile of calcium intake in women&#46; The intake of dairy products&#44; dietary protein&#44; and calcium was associated with more favorable body composition in obese males and females&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The results of clinical studies of calcium intake found significant negative associations between calcium intake and body weight in all age groups&#44; and the range of probability to be overweight &#40;BMI &#62;25&#41; was 2&#46;25 for females in the lower half of calcium intake&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand&#44; some studies have reported that increased consumption of dairy products with no energy restriction does not lead to a significant change in body weight or composition&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the foregoing and because of the inconsistency of the effects of dairy products on body weight and composition reported by various observational and experimental studies&#44; a study was undertaken to assess whether the intake of calcium and dairy products in diet correlated to the degree of adiposity and development of overweight in a group of female adolescents&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0050" class="elsevierStylePara elsevierViewall">To determine whether dietary calcium intake correlates to the BMI and body fat distribution in female adolescents&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">To determine whether dairy product intake correlates to the BMI and body fat distribution in female adolescents&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><p id="par0060" class="elsevierStylePara elsevierViewall">This was a cross-sectional&#44; observational&#44; epidemiological study that enrolled 244 female adolescents aged 12&#8211;19 years&#44; randomly selected from public and private schools from the list of schools of the Ministry of Education of Ecuador&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">All participants voluntarily agreed to take part in the study&#44; and written informed consent signed by their parents or tutors was obtained&#46; Adolescents with any physical disability that made the taking of anthropometric measurements difficult and those who had a clinical history of endocrine or metabolic problems&#44; or cardiovascular&#44; respiratory or musculoskeletal disease were excluded from the study&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study was approved by the bioethics committee of Universidad San Francisco in Quito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The sample was estimated with Epi Info &#40;version 6&#41; software using the following parameters&#58; 95&#37; confidence interval&#44; expected prevalence of overweight of 12&#37;&#44; and 7&#37; precision&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definition of variables</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Anthropometrics</span>&#46; The following anthropometric measurements were taken&#58; body weight&#58; using a SECA scale &#40;Germany&#41;&#59; height&#58; using a stadiometer&#59; waist circumference&#58; measured halfway between the costal margin and the iliac crest&#59; and hip circumference&#58; measured at the widest part of the hip&#44; at the level of the greater trochanters&#44; using a non-stretchable measuring tape&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The BMI was calculated as&#58; weight &#40;kg&#41;&#47;height &#40;m<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Overweight and obesity</span>&#46; Overweight and obesity were defined based on the BMI&#46; Overweight was defined as a BMI above the 85th percentile&#44; and obesity as a BMI above the 95th percentile&#46; The resulting values were compared to those provided in the tables of the National Center for Health Statistics &#40;NCHS&#41; according to age and sex&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fat distribution</span>&#46; The waist&#47;hip ratio was used to determine body fat distribution&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Intake of calories&#44; macronutrients&#44; calcium&#44; and dairy products</span>&#46; This was calculated using a 24<span class="elsevierStyleHsp" style=""></span>h recall instrument&#46; To facilitate recall of the size of portions and to decrease recall bias&#44; participants were shown the book with pictures of food portions of the American Dietetic Association&#46; To determine differences between week days and weekends&#44; three recalls per person were used in adolescents from state schools&#44; and two recalls in those from private schools&#46; The information thus collected was analyzed with Food Processor software &#40;Nutrition Analysis ESHA&#41;&#44; with which total calorie and macronutrient intake&#44; percent macronutrients in total calories&#44; and daily calcium intake were determined&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Based on the frequency distributions obtained for this group of adolescents&#44; calcium consumption was divided into three groups&#58; adequate intake&#58; adolescents who consumed 1200<span class="elsevierStyleHsp" style=""></span>mg&#47;day or more&#59; low intake&#58; those consuming less than 1200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#59; very low intake&#58; those consuming 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day of calcium or less&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A consumption frequency questionnaire was used to assess the consumption of dairy products &#40;milk&#44; cheese&#44; and yogurt&#41;&#46; Adequate intake was defined as the consumption of one or more portions of dairy products daily&#44; and low intake as the consumption of less than one portion daily&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Data analysis</span>&#46; Variables were analyzed using descriptive statistics and are given as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>one standard deviation for continuous variables&#44; and as percentages for nominal variables&#46; The differences between groups were analyzed using a Student&#39;s <span class="elsevierStyleItalic">t</span> test for continuous variables and a <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">Chi</span></span>-square for categorical variables&#46; To establish the association of the BMI&#44; waist circumference&#44; hip circumference&#44; and waist&#47;hip ratio with predictive variables&#44; multiple regression analyses were performed&#46; Values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered statistically significant&#46; Excel 2013 software was used to record data&#44; and SPSS version 22 for Windows was used for processing and statistical analysis&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0120" class="elsevierStylePara elsevierViewall">Multiple regression analysis showed that calcium intake adjusted for calorie intake negatively correlated to the BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; waist circumference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; hip circumference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and waist&#47;hip ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">As regards the relationship between nutritional state and calcium intake&#44; adolescents with overweight were found to have a lower mean calcium intake than adolescents of normal weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;06&#41;&#59; adolescents with overweight were also found to have a lower calorie intake as compared to adolescents of normal weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">With regard to the association of calcium intake and body weight&#44; overweight and obese adolescents were found to have a very low and low calcium intake&#44; and no adolescent in these groups had an adequate calcium intake &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Finally&#44; adolescents with a low intake of dairy products &#40;milk&#44; cheese&#44; and yogurt&#41; had on average greater values of BMI &#40;20&#46;09 vs 19&#46;58&#41; and waist circumference &#40;71&#46;3 vs 69&#46;18&#41; as compared to adolescents with adequate intake &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The results of this study show that the dietary intake of calcium and dairy products was inversely correlated to body adiposity and overweight and obesity in these female adolescents&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Other similar cross-sectional studies conducted on adolescents have also shown a negative correlation between calcium intake and anthropometric indicators &#40;weight&#44; the BMI&#44; fat mass&#44; and percent fat&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> The pathophysiological mechanism of this association appears to be related to the oxidative capacity of adipose tissue&#44; with high calcium intake inducing a decrease in intracellular calcium levels in adipose tissue&#44; so promoting fat oxidation&#44; rather than fat deposition&#44; and&#44; by contrast&#44; low dietary calcium intake having the reverse effect&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Various studies in humans have similarly shown an inverse relationship between high calcium intake and the presence of metabolic disorders related to obesity such as high blood pressure&#44; diabetes&#44; and insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In addition&#44; some studies have reported that the consumption of calcium from dairy products promotes the loss of fat mass in premenopausal obese women&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Finally&#44; animal models have provided a potential mechanism through which low calcium intake could influence body fat deposits&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Among these mechanisms&#44; it has been suggested that a low calcium diet increases intracellular calcium concentrations by stimulating calciotropic hormones such as 1&#44;25 dihydroxyvitamin D and parathormone&#44; which may increase intra-adipocyte calcium&#46; These elevated intra-adipocyte calcium concentrations may then increase the rate of lipogenesis and inhibit lipolysis&#44; resulting in increased adiposity&#46; Thus&#44; an increased dietary calcium intake could be proposed to prevent the triggering of this cascade by maintaining low calciotropic hormone levels&#44; therefore decreasing intracellular calcium and lipid contents in adipocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">On the other hand&#44; calcium has been seen to dose-dependently increase the fecal excretion of fatty acids&#46; A person consuming 2500<span class="elsevierStyleHsp" style=""></span>kcal with one third of the energy coming from fat and also taking 2<span class="elsevierStyleHsp" style=""></span>g of elemental calcium daily&#44; could be expected to excrete an additional 1&#37; of energy from fat daily&#44; and an energy loss of 3010<span class="elsevierStyleHsp" style=""></span>kcal&#47;year in feces could be anticipated&#46; This energy deficiency could cause a change in body weight of &#8722;0&#46;4<span class="elsevierStyleHsp" style=""></span>kg&#47;year&#46; The effects of calcium on fat excretion are however insufficient to explain the greater difference in body weight shown by some studies in animals and humans&#44; particularly of calcium from dairy products&#46; Studies conducted in transgenic mice have also shown that high calcium diets stimulate the expression of the uncoupling proteins in adipose tissue &#40;UCP&#41;2 and skeletal muscle &#40;UCP&#41;3&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">An additional mechanism by which dietary calcium intake may affect body adiposity is an effect on triacylglycerol absorption from the gastrointestinal tract&#46; Calcium fortification has been shown to increase the percentage of saturated fat excreted in feces by 6&#8211;13&#37; daily&#46; A high calcium diet also significantly decreased total cholesterol by 6&#37;&#44; LDL cholesterol by 13&#37;&#44; and the apolipoprotein B level by 7&#37; as compared to a low calcium diet&#46; Dietary calcium intake may therefore be inversely related to the development of metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> It would be interesting to assess whether greater calcium intake&#44; mainly from diet&#44; not only decreases the risk of developing overweight or obesity&#44; but also whether the apparent lowering effect on lipid and glucose levels is able to reduce long-term cardiovascular risk&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our study mainly found that dietary calcium intake is the factor with the greatest correlation to total and abdominal adiposity&#44; and also to the presence of overweight and obesity&#44; while the intake of dairy products also showed a negative correlation&#44; although not a significant one&#46; This agrees with most studies&#44; which found a negative correlation between the dietary intake of calcium&#44; especially from dairy products&#44; and the development of overweight and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The explanation for the lack of a significant correlation in our study between dairy product intake and adiposity level&#44; in contrast to the significant association found for dietary calcium&#44; may be that no differentiation was made of the type of dairy products preferentially consumed&#44; i&#46;e&#46; if they were whole milk or skimmed milk products&#46; Most probably&#44; in agreement with our dietary habits&#44; a majority consumed whole milk dairy products with high fat contents&#44; which would explain the poor correlation between the consumption of dairy products and body adiposity&#44; while total calcium intake was negatively and significantly associated with total adiposity&#44; and especially with clinically important abdominal adiposity&#44; which is closely related to glucose metabolism&#44; hypertriglyceridemia&#44; low HDL cholesterol&#44; increased blood pressure&#44; metabolic syndrome&#44; type 2 diabetes&#44; and cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> An alternative explanation for the non-significant association between dairy product intake and the development of overweight may be the small sample size of the study&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In any case&#44; regardless of the mechanism involved&#44; most studies support the conclusion that dietary calcium may play a role in body fat regulation and the hypothesis that increased dietary calcium intake may decrease future weight gain and reduce the risk of developing cardiometabolic disorders&#46; However&#44; only small clinical studies specifically designed for exploring the effects of dietary calcium on body weight&#44; total adiposity&#44; and lipid and glucose levels have been conducted&#46; Prospective clinical studies should be conducted to determine whether body weight may be modified by calcium supplementation or by increasing low-fat dairy products in diet&#44; and whether these measures may also decrease the risk of developing those metabolic changes related to visceral fat accumulation&#44; such as diabetes or cardiovascular disease&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors state that they have received no funding for the conduct of this research&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors state that they have no conflicts of interest related to the conduct of this research study&#46;</p></span></span>"
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            0 => "Adolescents"
            1 => "Calcium"
            2 => "Intake"
            3 => "Adiposity"
            4 => "Overweight"
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            0 => "Adolescentes"
            1 => "Calcio"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The prevalence and magnitude of obesity in children and adolescents increase rapidly&#46; Besides genetic and environmental factors&#44; calcium intake has recently been identified as a dietary factor that is inversely related with body mass index and development of overweight and obesity&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study was to assess the correlation between dietary calcium intake and body mass index and fat distribution in female adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study where anthropometric variables &#40;weight&#44; height&#44; body mass index&#44; waist and hip circumference&#41; were collected in 244 female adolescents to establish total body adiposity and fat distribution&#46; A 24-h recall and a food frequency questionnaire were used to assess total calorie&#44; calcium&#44; and dairy products intake&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Calcium intake was inversely related to body mass index &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; waist circumference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; hip circumference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; and waist to hip ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;Overweight &#40;8&#46;3&#37;&#41; and obese &#40;0&#46;7&#37;&#41; adolescents had a lower mean calcium intake than adolescents of normal weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;06&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Dietary calcium intake and&#44; to a lesser extent&#44; consumption of dairy products are inversely related to total and abdominal adiposity&#44; and also to the prevalence of overweight in this group of adolescents&#46;</p></span>"
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            "titulo" => "Background and objective"
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            "titulo" => "Materials and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La prevalencia y magnitud de la obesidad en ni&#241;os y adolescentes se incrementa aceleradamente&#46; Aparte de los factores gen&#233;ticos y ambientales&#44; se ha identificado recientemente la ingesta de calcio diet&#233;tico como uno de los factores que se correlaciona inversamente con el &#237;ndice de masa corporal y con el desarrollo de sobrepeso y obesidad&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente estudio es determinar la correlaci&#243;n entre la ingesta diet&#233;tica de calcio con el &#237;ndice de masa corporal y la distribuci&#243;n de la grasa en adolescentes mujeres&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Es un estudio de corte transversal en el cual se realiz&#243; la evaluaci&#243;n antropom&#233;trica &#40;peso&#44; talla&#44; &#237;ndice de masa corporal&#44; circunferencia de cintura&#44; circunferencia de cadera&#41; en 244 adolescentes mujeres&#44; para establecer la adiposidad corporal total y la distribuci&#243;n de la grasa&#46; Se utiliz&#243; el recordatorio de 24<span class="elsevierStyleHsp" style=""></span>h y un cuestionario de frecuencia de consumo para determinar la ingesta cal&#243;rica total&#44; ingesta de calcio y consumo de l&#225;cteos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La ingesta de calcio se correlacion&#243; inversamente con el &#237;ndice de masa corporal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; circunferencia de cintura &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; circunferencia de cadera &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e &#237;ndice cintura cadera &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Las adolescentes con sobrepeso &#40;8&#44;3&#37;&#41; y obesidad &#40;0&#44;7&#37;&#41; tuvieron una ingesta promedio de calcio inferior al de las adolescentes de peso normal &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La ingesta diet&#233;tica de calcio y en menor grado el consumo de productos l&#225;cteos se relaciona inversamente con la adiposidad total y abdominal as&#237; como con la prevalencia de sobrepeso en las adolescentes estudiadas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Castro Burbano J&#44; Fajardo Vanegas P&#44; Robles Rodr&#237;guez J&#44; Pazmi&#241;o Est&#233;vez K&#46; Relaci&#243;n entre ingesta diet&#233;tica de calcio y adiposidad corporal en adolescentes mujeres&#46; Endocrinol Nutr&#46; 2016&#59;63&#58;58&#8211;63&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anthropometric measurements&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Calcium intake &#40;mg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Body mass index &#40;BMI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BMI percentile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Waist circumference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip circumference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Waist&#47;hip ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Calories&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">338&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;992&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">789&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal weight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">367&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;736&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">386&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1336&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">483&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">485&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">364&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;738&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">738&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;47&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;47&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doen&#231;as cr&#244;nicas n&#227;o transmiss&#237;veis no Brasil&#58; carga e desafios atuais&#46; The Lancet Sa&#250;de no Brasil"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "B&#46;B&#46; Duncan"
                            2 => "G&#46; Azevedo e Silva"
                            3 => "A&#46;M&#46; Menezes"
                            4 => "C&#46;A&#46; Monteiro"
                            5 => "S&#46;M&#46; Barreto"
                          ]
                        ]
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                    ]
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                        "fecha" => "2011"
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                        "editorial" => "Sa&#250;de no Brasil 4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "World Health Organization"
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              "identificador" => "bib0165"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anthropometric characteristic and physical fitness level in relation to body weight status in Chilean preschool children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Cadenas-S&#225;nchez"
                            1 => "E&#46;G&#46; Artero"
                            2 => "F&#46; Concha"
                            3 => "B&#46; Leyton"
                            4 => "J&#46; Kain"
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                    0 => array:2 [
                      "doi" => "10.3305/nh.2015.32.1.9092"
                      "Revista" => array:6 [
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                        "fecha" => "2015"
                        "volumen" => "32"
                        "paginaInicial" => "346"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26262737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
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              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relation of adiposity to cognitive control and scholastic achievement in preadolescent children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Kamijo"
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                            2 => "M&#46;B&#46; Pontifex"
                            3 => "M&#46;R&#46; Scudder"
                            4 => "E&#46;S&#46; Drollette"
                            5 => "L&#46;B&#46; Raine"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/oby.2012.112"
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                        "paginaInicial" => "2406"
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                0 => array:2 [
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                      "titulo" => "Minerais e obesidade in Cozzolino SMF&#46; Biodisponibilidade de nutrientes"
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                        0 => array:2 [
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ISSN: 21735093
Original language: English
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