Consumption Of Calcium And Knowledge About Calcium Sources

Introduction

Sufficient calcium consumption is required for bone strengthening and osteoporosis prevention.^1–4 The physique wants ample calcium in any respect ages, however notably in early adolescence^5,6 as calcium consumption performs a major position in bone mineral accretion throughout speedy bone improvement at this age. Attaining optimum peak bone mass, ie most calcium deposition, in early maturity then helps delay bone loss later in life.^5,6 However, analysis findings present that calcium deficiency in early adolescents is among the mostly reported micronutrient deficiencies worldwide,^7–11 together with Thailand.¹² The ages 10 by 14 years are sometimes called early adolescence.¹³ Within the Thai education system, college students in decrease secondary college (grades 7–9) fall into this age vary.¹⁴ One of many main modifications when college students transfer up from major college (grades 1–6) to decrease secondary college is that they’re not supplied with free college lunch and free milk. They and their household must plan their very own meals to acquire ample quantities of vitamins together with calcium.

The Thai really useful day by day consumption (TRDI) of calcium is 800 mg.¹⁵ Earlier research carried out over a 17-year time interval discovered that decrease secondary college college students devour roughly one third of the TRDI of calcium^16–18 indicating that inadequate consumption of calcium has lengthy been an issue on this inhabitants group. As well as, it was discovered from these earlier research that promotion of dietary calcium was centered on dairy merchandise, notably milk, because the calcium supply although calcium is present in a number of different meals sources corresponding to boned animals and darkish inexperienced greens. 4 research that explored different dietary sources of calcium recommended that decrease secondary college college students could be unlikely to realize the TRDI of calcium if they don’t embrace excessive calcium merchandise of their meal plan.^16–19

Excessive calcium merchandise are outlined as having ≥15% of the TRDI per 100 ml for liquid or ≥ 30% of the TRDI per 100 g for stable merchandise.¹⁵ Though there are a number of excessive calcium meals out there in Thai markets, it isn’t identified whether or not decrease secondary college college students learn about or devour these merchandise. Estimation of the amount of micronutrients, together with calcium, contained in meals requires information and ability. For meals which don’t present micronutrient info, customers should memorize the quantity of calcium per serve and the amount per serve of every meals. For meals having micronutrient info on the packages, customers can plan their calcium consumption based mostly on this info supplied they will interpret the data appropriately.

Thailand launched the Vitamin Data Panel (NIP) for meals in 1998. The presentation of the data field is much like the US diet label. In keeping with the meals diet labelling rules in Thailand, the total format diet label should present the energy per serve, amount and % TRDI for seven macronutrients and sodium, and % TRDI for 5 micronutrients. Nonetheless, gadgets which might be current in small quantities are allowed to be omitted on the label.¹⁵ The TRDI designates 2,000 kcal of complete power day by day. The 5 micronutrients listed on the diet label of the meals package deal are vitamin A, vitamin B1, vitamin B2, iron and calcium. The TRDIs of the micronutrients have been adopted from the Codex Nutrient Reference Values (NRV) and adjusted to be appropriate for wholesome Thai folks above 6 years previous (Thai FDA). It must be famous that the precise quantities of the micronutrients are usually not required to be proven on the diet label. It’s broadly identified {that a} lack of understanding about dietary info limits wholesome dietary behaviour. An intensive literature evaluation didn’t uncover any stories about whether or not decrease secondary college college students know which meals are sources of excessive calcium, or whether or not they’re able to interpret calcium info on diet labels.

Aims

There have been three research within the analysis program. The target of examine I used to be to establish excessive calcium merchandise out there available in the market. The target of examine II was to establish excessive calcium merchandise that have been identified or consumed by decrease secondary college college students within the final three months. The goals of examine III have been to establish the overall quantity and the sources of calcium that the decrease secondary college college students had consumed within the prior 24 hours and verify their information about sources of excessive calcium and learn how to interpret calcium info on diet labels of meals packages.

Strategies

Khon Kaen province was chosen as a examine space as a result of it is among the largest provinces within the northeastern area of Thailand. It’s a middle of enterprise and training on this area. It’s also thought of a multicultural metropolis because the inhabitants of this province combines native northeasterners and people who moved from different areas to work and examine. The decrease secondary college chosen for this analysis mission was positioned in a semi-urban space in Khon Kaen province.

The analysis protocol was permitted by the Ethics Committee in Human Analysis of Khon Kaen College based mostly on the Declaration of Helsinki and the ICH Good Medical Apply Pointers (HE 612266). Signed consent was obtained from the contributors guardians. In research II and III, permission to conduct the analysis was granted by the college principal.

Previous to conducting research II and III, a pilot take a look at was carried out to establish the parameters wanted for pattern measurement estimation and to validate the info assortment devices (questionnaires). Topics have been 30 college students enrolled in one other decrease secondary college in a semi-urban space in Khon Kaen province. Permission to conduct the pilot examine was obtained from the college principal.

All through this examine, “excessive calcium meals” is outlined as meals containing at the least 160 mg calcium per serve. This was based mostly on the quantity of calcium per serve in UHT milk, which was the most typical supply of calcium in earlier research.¹⁸ A serve was outlined as the amount of the product for one serve listed on the diet label for meals in sealed packages with diet labels. For recent meals, one serve was 100 grams.

Research I

Design

A cross-sectional market survey was employed to establish excessive calcium merchandise out there in Khon Kaen province. The survey was carried out in September 2018.

Setting and Survey Web site Recruitment Process

The survey was carried out in markets in Khon Kaen province. On-line markets weren’t included on this survey as a result of decrease secondary college college students are usually not eligible to purchase merchandise on-line. Meals shops have been categorised into 4 teams in keeping with the kind of merchandise they carried: grocery store, franchise comfort retailer, native grocery retailer, and recent market. This was to make sure that the survey captured as many calcium merchandise out there in Khon Kaen province as doable. Though supermarkets carried a variety of merchandise, they didn’t inventory indigenous greens and native meat merchandise. These merchandise have been present in recent markets. Some merchandise present in franchise comfort shops have been additionally present in supermarkets nonetheless franchise comfort shops additionally carried their very own model merchandise. Merchandise fabricated from native elements or farmers’ merchandise have been present in native grocery shops.

In Khon Kaen, there have been 5 manufacturers of supermarkets, 4 manufacturers of franchise comfort shops, and several other native grocery shops and recent markets. The checklist of native grocery shops and recent markets was obtained from the Khon Kaen Municipality. An skilled panel was employed to pick out the meals shops. All three specialists have been nutritionists who lived in Khon Kaen and shopped in all 4 kinds of meals shops. The factors to pick out the shops have been the situation of the meals shops (close to to or throughout the surveyed college in research II and III) and the vary of merchandise out there in every sort of meals outlet. Based mostly on the panel dialogue, the next ten shops have been chosen: three manufacturers of supermarkets, two manufacturers of franchise comfort shops, three recent meals markets (one massive measurement, one medium measurement and one small measurement), and two native grocery shops.

Instrument and Information Assortment Process

A file type and a guidelines of excessive calcium recent merchandise have been used to establish excessive calcium merchandise out there within the surveyed meals shops. The file type and the guidelines have been assessed by the identical three specialists who chosen the surveyed meals shops.

The file type was used to establish excessive calcium merchandise that have been in seal packages with diet labels. The file type consisted of (1) the identify of the packaged meals product, (2) a photograph of the package deal back and front sides, (3) the elements listed on the package deal that have been the supply of calcium and (4) the % TRDI of calcium per serve, which was proven on the diet label on the meals package deal.

A listing of excessive calcium merchandise was extracted from three references^20–22 and used to establish excessive calcium recent meals in Khon Kaen markets. Data extracted from these three references have been the identify of the product and the quantity of calcium in milligrams per serve (100 grams). For merchandise during which the quantity of calcium differed among the many references, the typical was used.

The researchers visited the chosen meals shops and checked each product merchandise. For the sealed merchandise with dietary labels, the data was written onto the file type in the event that they met the definition of “excessive calcium meals”. For recent meals, the identify of the product was checked whether or not or not it appeared within the excessive calcium recent product guidelines. Samples of all merchandise that met the definition of excessive calcium for this examine have been bought from the surveyed meals shops. All chosen shops have been surveyed two occasions, one week aside.

Information Administration and Evaluation

The quantity of calcium per serve within the meals gadgets that have been bought have been independently calculated by two researchers. For packaged meals, the quantity of calcium was decided from the diet labels. For recent meals, or meals with out diet labels, the quantity of calcium was estimated from the reference quantities.^20–22

The excessive calcium product gadgets have been categorized into 5 teams: meat and meat merchandise; greens; dairy and dairy merchandise; legumes, nuts, and seed merchandise; and calcium complement tablets.

Research II

Research Design and Setting

A college-based cross-sectional survey was carried out. The chosen college was a medium-sized secondary college positioned in a semi-urban space in Khon Kaen province within the northeastern a part of Thailand. This college was purposively chosen as a result of its traits represented decrease secondary faculties in semi-urban areas in Khon Kaen Province. The examine was carried out in December 2018.

Inhabitants, Pattern Dimension and Sampling Method

The survey inhabitants was decrease secondary college students enrolled in grades 7, 8, and 9. The age vary of this inhabitants group was 11 to 14 years previous. The whole variety of college students was 309. The system to estimate the proportion in a single finite inhabitants²² was used to find out the pattern measurement with the next assumptions: p (proportion of scholars who knew the excessive calcium merchandise out there in Khon Kaen market was assumed to be 70%, based mostly on the pilot examine), d (margin of error = 5%), Z_α/2 (customary regular distribution worth for 95% confidence degree = 1.96) based mostly on this system, the minimal pattern measurement was 159.

Because the estimated response price was not identified, all 309 college students have been invited to take part. The primary writer met with college students to elucidate the analysis goals and requested them to cross the permission to take part type (knowledgeable consent) to their guardians. College students have been requested to return the permission type on the appointment dates for information assortment. In complete, signed consent was obtained from the guardians of 168 college students.

Instrument and Information Assortment Process

A self-developed questionnaire was used to gather information. The primary half was demographic info; intercourse, present grade enrolled, weight in kilograms, top in centimeters, age in years, and allowance per day in Thai baht (32 Thai baht [THB] is roughly 1 US$). The second half was a guidelines of excessive calcium merchandise identified or consumed by the scholars. Photos of the 93 excessive calcium merchandise contained within the guidelines have been these recognized within the excessive calcium product survey (examine I). For every image, college students have been requested to establish whether or not they “don’t know this product”, “know this product”, or “had eaten this product within the final three months”. The amount consumed was not requested. Previous to administering the questionnaire, the readability of the language and the photographs of the meals have been assessed by 5 specialists who have been teachers with an academic background in pharmacy or public well being. The questionnaire was then pretested in 30 decrease secondary college college students in one other college, which was much like the surveyed college.

On the appointment dates for information assortment, the scholars whose mother and father gave permission to take part within the analysis examine have been known as into the college auditorium. A researcher distributed the self-administered questionnaires to the scholars, defined learn how to fill out the questionnaire and requested them to return the questionnaire to the field in the back of the auditorium after completion. All solutions within the questionnaire have been self-reported.

Information Evaluation

Descriptive statistics are used to explain the demographic info of the studied college students. Physique mass index (BMI) was calculated by dividing the coed’s weight in kilograms by the peak in meters squared. The BMI values have been categorized into 4 classes: lower than 18.5 (underweight), 18.5–22.9 (regular weight), 23.0–24.9 (in danger), and 25.0 or increased (overweight).²⁴ For every excessive calcium merchandise, the responses of “know this product”, or “had eaten this product within the final three months” have been summed. The excessive calcium merchandise that have been identified or had been consumed by at the least 50% of the respondents (84 college students) have been used within the questionnaire of examine III.

Research III

Research Design and Setting

A college-based cross-sectional survey was employed. Research III was carried out in the identical college and the identical cohort as that of examine II. Research III was carried out one month after the completion of examine II (January 2019).

Inhabitants, Pattern Dimension and Sampling Method

The survey inhabitants was 309 decrease secondary college students enrolled in grades 7, 8, and 9. The system to calculate the pattern measurement for a inhabitants imply estimation²³ was used to find out the variety of topics with the next assumptions: (the mean amount of calcium consumption in milligrams in 24 hours, which was assumed to be 575 mg, based on the pilot study), SD (standard deviation of the amount of calcium consumption in milligrams in 24 hours, which was 370), d (margin of error = 5% of the mean amount of calcium consumption in milligrams in 24 hours), Z_α/2 (standard normal distribution value for 95% confidence level = 1.96). Based on this formula, the minimum sample size was 209.

Descriptive statistics are used to describe the demographic information of the studied students. The amount of calcium consumption per day was calculated by multiplying the number of serves of calcium-rich food that the students had consumed in the previous 24 hours with the quantity of calcium in the food.20–22 The whole quantity of calcium consumed is introduced because the median, minimal and most, and interquartile vary. Distribution of the sources of calcium is introduced with frequency and %. Imply and customary deviation (SD) are used to current the calcium information scores. To calculate calcium information scores, every right reply was given one level with the overall most rating 17.

Outcomes

Traits of the Studied Inhabitants

Within the school-based cross-sectional research (research II and III), 168 and 209 decrease secondary college college students responded to the surveys, respectively. The traits of the respondents have been constant amongst examine II and examine III and to the entire 309 college students of the decrease secondary college. The typical allowance per day present in examine II was barely decrease than that present in examine III (49.4 vs 67.7 Thai baht). Nonetheless, this distinction is small and isn’t thought of virtually important. Roughly half of the respondents have been underweight (BMI lower than 18.5). It must be famous that a few of the respondents in examine II additionally participated in examine III. The demographic traits of the contributors in each research are proven in Table 1.

Desk 1 Traits of the Respondents and College students of Studied Decrease Secondary College

Excessive Calcium Merchandise in Khon Kaen Province

In examine I, 93 out there excessive calcium meals have been recognized (Table 2). The vast majority of the out there excessive calcium merchandise have been meat and meat merchandise (together with processed meals, meals comprised of recent elements, and able to eat meals). Within the dairy product group, UHT milk of assorted manufacturers was present in all surveyed shops. Lactose free milk, excessive protein milk, yogurt and cheese have been discovered solely in supermarkets and franchise comfort shops.

Desk 2 Sources of Calcium Accessible to and Identified by Respondents

Excessive Calcium Merchandise Identified or Consumed by Decrease Secondary College College students

Of the 93 merchandise discovered available in the market survey (examine I), 49 have been identified or consumed by the scholars who responded to the survey in examine II (Table 2). Examples of dairy merchandise having excessive calcium per serve that have been identified however had not been consumed by the respondents throughout the previous three months have been excessive calcium milk for pregnant girls (quadruple high-calcium milk: 800 mg of calcium in 125 ml), UHT high-calcium milk (480 mg of calcium in 180 ml), lactose free milk, cheeses, and imported yogurt. Examples of dairy merchandise that had been consumed by most respondents throughout the previous three months have been UHT milk, pasteurized milk, yogurt, and malt drink. These merchandise contained between 160 and 240 mg of calcium per serve. Examples of meat or meat merchandise having excessive calcium per 100 g serve that have been identified however had not been consumed by the respondents over the last three months have been floor lizard (3,808 mg),²² frog (3,565 mg)²² and pond snail (1,053),²² Examples of meat or meat merchandise that had been consumed by some respondents over the last three month have been edible minnow (3,496 mg),²² small-size freshwater shrimp (806 mg),²² canned fish with delicate bone (160–1,040 mg).²² It must be famous that prime calcium merchandise contained in a pack corresponding to fried shrimp legs or small crabs weren’t identified and had not been consumed by any respondents. Instance of legumes, nuts, seeds and their merchandise having excessive calcium per serve that have been identified by the respondents have been large pink beans (965 mg per 100 g),²² exhausting tofu (830 mg per 100 g),²² and calcium fortified UHT soymilk (400 mg of calcium per 300 ml carton). Solely the latter two gadgets have been reported to be consumed by respondents over the last three months. Among the many group of greens having excessive calcium (at the least 160 mg of calcium per 100 g of serve) that have been identified and had been consumed by the respondents have been turkey berry (182 mg),²² cork wooden flowers (395 mg),²² pak waan (Scientific identify: Melientha suavis) (252 mg),²² and Chinese language kale (164 mg).²² These greens are generally cooked by blanching or stir-frying and are present in curry or soup. Chinese language kale was reported to be consumed by all respondents. The remaining three greens that weren’t identified and had not been consumed by the respondents have been both not in season (Tangerine leaves: 182 mg),²² had an disagreeable style (Noni leaves: 469 mg)²² or had pungent odor (Dill: 203 mg).²²

Quantity of Calcium Consumed and Sources of Calcium

Of the 209 decrease secondary college college students that responded to the third survey (examine III), 62 (29.7%) had consumed an enough quantity of calcium in keeping with the TRDI (≥ 800 mg) within the earlier 24 hours. The median calcium consumption over the earlier 24 hours was 410 mg for the entire group, 1,229 mg for college students that consumed an enough quantity of calcium, and 254 mg for college students that consumed an insufficient quantity of calcium (< 800 mg). The principle sources of calcium consumed by college students within the earlier 24 hours have been dairy merchandise and meat merchandise (Table 3). The imply quantity of calcium consumed from dairy was a lot increased for the group that consumed an enough quantity of calcium than for the group that consumed an insufficient quantity of calcium (840 mg vs 160 mg). The distinction was because of the amount of milk they consumed. The distinction in imply quantity of calcium consumed from meat between the 2 teams was additionally because of the amount consumed.

Desk 3 Quantity of Calcium Consumed by the Respondents in Earlier 24 Hours (n=209)

The sources of calcium and the sample of meals consumption in each teams (enough vs insufficient calcium consumption) have been comparable (Table 4). 100 and sixty-six respondents reported consumption of dairy merchandise. The highest two dairy merchandise reported to be consumed by respondents have been UHT milk and malt drink. Lower than 20% of the scholars that consumed dairy merchandise consumed yogurt throughout the earlier 24 hours (29 out of 166). Not one of the respondents had consumed cheese prior to now 24 hours. Ninety-eight respondents reported consumption of excessive calcium meat and meat merchandise. Canned fish (sardines in tomato sauce) and minnow have been reported to be consumed by a majority of respondents (n= 62). Forty-three respondents reported consumption of excessive calcium greens listed within the questionnaire. Nearly all of them (n = 39) reported consuming Chinese language kale. Just a few reported consuming turkey berry and pak waan leaves. Thirty-seven respondents reported consumption of merchandise within the legume group. Solely calcium fortified UHT soymilk was reported to be consumed within the earlier 24 hours.

Desk 4 Sources of Calcium Consumed by the Respondents in Earlier 24 Hours (n=209)

Data About Sources of Excessive Calcium and Easy methods to Interpret Calcium Data on Vitamin Labels

The general common information rating amongst 209 respondents (examine III) was 6.5±2.4 out of a most of 17. The typical information scores for meals sources which might be excessive in calcium and for deciphering the calcium info on a pattern diet label have been 4.6+1.8 (out of 12), and 1.9±1.2 (out of 5), respectively. Of the 5 questions in regards to the calcium info on a diet label, solely the query in regards to the share of calcium contained within the pattern meals may very well be answered by a majority of the scholars (Table 5).

Desk 5 The Respondents’ Data About Sources of Calcium and Calcium Data on Vitamin Labels (n=209)

Dialogue

Our survey confirmed that there have been many excessive calcium merchandise out there within the markets in Khon Kaen province. Nonetheless, solely half of these have been identified by the decrease secondary college college students surveyed in our examine. The survey of meals consumption over 24 hours indicated that few excessive calcium merchandise have been consumed by surveyed college students. The typical calcium consumption of our decrease secondary college college students (median 410 mg) was much like findings of a earlier examine carried out in Thailand.18 The quantity of calcium consumed per day by decrease secondary college college students within the current examine was barely lower than that of Korean, Greek, Brazilian and Mexican early adolescents.^7–11 This may very well be as a consequence of variations within the kinds of frequent elements in native meals.

The principle supply of calcium of the surveyed decrease secondary college college students was UHT milk in keeping with examine III. This may very well be influenced by the aggressive commercial of milk in Thailand. The important thing message of most milk commercials is that milk promotes bone well being. Nonetheless, the amount of milk required to be consumed every day to succeed in the really useful quantity of calcium per day will not be talked about. The worth for one carton of milk was roughly 15 THB (US$ 0.45) and to realize the calcium TRDI every household would want to spend 30–60 THB (US$ 1–2) per baby per day. This quantity could be tough for many households in rural or semi-urban areas in northeast of Thailand as the typical earnings is just 18,294 THB per thirty days (US$572).²⁵ It must be famous that the worth of a few of the excessive calcium dairy merchandise that weren’t identified or eaten by college students, for instance lactose free milk and cheese, have been triple the worth of the UHT milk that almost all of the scholars within the current examine consumed. Malt drink additionally comprises excessive calcium (160 mg per serve) as the primary ingredient is milk. Our findings from examine III confirmed that solely 40.2% of the scholars knew that malt drink was a excessive calcium product. That is more likely to be because of the key message delivered by commercials of malt drink in Thailand as a great supply of power, not as a supply of calcium. Though roughly half of the surveyed decrease secondary college college students (53.1%) knew that yogurt was a great supply of calcium, they didn’t devour these merchandise. This isn’t stunning as yogurt will not be marketed as excessive calcium product, however as a supply of probiotics.²⁶ Solely 16% of the surveyed decrease secondary college college students knew that cheese was a great supply of calcium. Not one of the surveyed decrease secondary college college students reported consuming cheese in both examine II or examine III. Once more, this isn’t stunning as cheese is comparatively costly. It must be famous that cheese and different dairy merchandise are usually not frequent elements within the Thai food plan. Therefore it could be impractical to recommend that college students or mother and father incorporate dairy merchandise into college students’ meals.

Even supposing many meat merchandise recognized in our cross-sectional market survey (examine I) contained very excessive quantities of calcium per serve, only some gadgets, corresponding to canned fish (sardines in tomato sauce) and minnow (small fish with bones), have been consumed by decrease secondary college college students in small portions. As these merchandise are comparatively cheap and simple to search out in native recent markets, elevated consumption of meat merchandise must be promoted to extend calcium consumption. Within the information take a look at about sources of excessive calcium (examine III), solely 13.9% of the surveyed college students knew that pink tilapia didn’t comprise excessive calcium. College students must be knowledgeable that canned fish comprises comparatively increased calcium than giant fish as a result of canned fished contains softened bones. College students and oldsters have to be made conscious of the excessive calcium merchandise out there of their communities.

Most excessive calcium greens, besides turkey berry and Chinese language kale, could be discovered solely in season. Conventional and novel menus that incorporate turkey berry and/or Chinese language kale must be promoted amongst college students. Some greens comprise oxalate, which prevents calcium from being absorbed into the physique,^27–29 and excessive oxalate meals might enhance threat of getting bladder stones.^30,31 College students, mother and father and meals suppliers in school canteens must be knowledgeable that boiling or steaming greens can scale back soluble oxalate by 30–87% and 5–53%, respectively.³² Nonetheless, college students and oldsters must be knowledgeable to not rely solely on greens to offer all of their day by day calcium wants.

Many of the excessive calcium merchandise within the legume, nut and seed group are comparatively cheap and may simply be present in Thailand, together with in Khon Kaen province. Nonetheless solely half of the merchandise on this group have been identified or consumed by the respondents prior to now three months in examine II, and solely calcium fortified UHT soymilk was reported to be consumed within the earlier 24 hours in examine III. Our findings confirmed that the majority the respondents mistakenly believed that tofu drink was a supply of excessive calcium. Tofu drink is a typical beverage for breakfast and is comparatively cheap, however one serve of tofu drink comprises solely 24 mg of calcium.³³ That is in contrast to UHT soymilk and exhausting tofu. Many of the soymilk offered in cartons is fortified with calcium³⁴ and exhausting tofu is made by including calcium sulphate to soybean liquid.^35,36 Therefore, they’re good sources of calcium. Decrease secondary college college students must be knowledgeable in regards to the completely different quantities of calcium in tofu drink, UHT soymilk and exhausting tofu. Since not all UHT soymilks are fortified with calcium, college students also needs to learn to learn the diet label.

Respondents confirmed poor information about sources of calcium and deciphering diet labels (Table 5). The low scores within the information take a look at of the calcium info supplied in a pattern diet label indicated that decrease secondary college college students didn’t know the TRDI for calcium. That is much like the discovering of a earlier examine carried out in adults in Khon Kaen.³⁷ Our findings additionally recommended that decrease secondary college college students couldn’t interpret messages about micronutrients on the diet label. Most of them didn’t know what “calcium 30%” written on the diet label meant. They confused the idea of day by day calorie consumption with TRDI for calcium, and most of them appeared unaware that the quantity of calcium they should devour every day should attain 100% of the TRDI. The findings recommended an pressing want to offer decrease secondary college college students with information about sources of calcium and practice them to learn and interpret diet labels. The present diet label didn’t appear to be assist them to plan their day by day calcium consumption. Lately within the US, the diet label was modified. The quantity of every micronutrient within the product is asserted along with the % day by day worth.³⁸ This sort of change may assist customers in planning and sustaining wholesome dietary practices³⁹ in Thailand.

The principle power of this analysis program was to establish the excessive calcium merchandise that have been identified or consumed by decrease secondary college college students previous to conducting the survey of meals consumption. This course of helped scale back the variety of gadgets within the checklist of excessive calcium merchandise which helped decrease info bias and the quantity of lacking information that might end result from an extended questionnaire.⁴⁰ Nonetheless, since solely meals that have been identified or had been consumed within the final three months have been included within the meals frequency questionnaire, it’s doable that calcium consumption may have been barely underestimated as the scholars might have consumed different frequent meals that contained low or average quantities of calcium corresponding to egg, pork, banana, and rice. As well as, it’s endorsed that the 24-hour recalled meals consumption survey must be administered a number of occasions to account for day-to-day variation in meals consumption.⁴¹ Lastly, whereas the researchers are assured that the traits of the college chosen for this examine precisely signify decrease secondary faculties in semi-urban areas in Khon Kaen province, the findings might not be generalised to incorporate different populations.

Conclusions

Thailand is among the world’s growing old societies. If complete bone well being promotion will not be severely applied, notably amongst decrease secondary college college students on the stage of speedy bone improvement, the price of osteoporosis might turn out to be one of many principal burdens to the Thai well being system. This analysis mission indicated that, though there have been many excessive calcium merchandise out there, calcium deficiency was nonetheless a well being drawback in decrease secondary college college students and that only some excessive calcium gadgets have been identified and consumed by them. College students exhibited poor information about excessive calcium meals sources and lacked understanding in regards to the quantity of calcium indicated on diet labels.

Along with milk, the excessive calcium gadgets mostly consumed by decrease secondary college college students have been milk, malt drink, minnow, canned fish, calcium fortified soy milk and Chinese language kale. College students must be launched to different excessive calcium merchandise which might be out there of their neighborhood corresponding to exhausting tofu, small freshwater shrimp, and golden apple snail. Academic applications on diet label interpretation are wanted. Appropriate strategies and channels to disseminate this data must be explored.

Acknowledgments

This examine was partially funded by the College of Pharmaceutical Sciences of Khon Kaen College. The authors would additionally wish to thank Dr Glenn Borlace, College of Pharmaceutical Sciences, Khon Kaen College, for enhancing English grammar.

Disclosure

The authors report no conflicts of curiosity on this work.

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