Abstract
Objective
To validate a short food frequency questionnaire (screener) estimating daily average calcium intake from dietary sources to guide calcium supplementation of patients with osteoporosis in clinical practice.
Methods
An eight-item calcium screener was developed based on existing literature, food consumption data and expert opinion. Convergent validity was determined by comparison with 3-day food records using mean difference, Spearman’s correlation coefficients (SCC) and Bland-Altman analysis. Test-retest reliability was assessed by SCC and intraclass correlation coefficients (ICC). We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to identify patients requiring calcium supplementation (<1200 mg dietary calcium intake/day).
Results
Fifty-two patients filled out the eight-item calcium screener and the 3-day Food record (mean age of 66.8 ± 12.9 (SD)) and 38 patients filled out the screener twice for reliability analysis (mean age of 65.8 ± 12.8 (SD)). Dietary calcium intake between the calcium screener and food records showed a strong correlation (N = 52 patients, SCC = 0.53, p ≤ 0.001) and mean difference of 21 mg (p = 0.70). Bland-Altman analysis showed agreement within 95% confidence intervals for 49/52 comparisons (94%). Test-retest reliability of the calcium screener was excellent (SCC = 0.96, p ≤ 0.001; ICC = 0.99, p ≤ 0.001).
Conclusion
The calcium screener shows good convergent validity, reliability and feasibility to estimate daily calcium intake of patients with osteoporosis in routine clinical practice.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors would like to thank all study participants for contributing to this research. Natacha Dielen and Dorien Wouters (University College Leuven Limburg—BSc Dietetics) are acknowledged for their dedicated contribution to data collection and preliminary analysis. We thank the members of the Centre for Metabolic Bone Diseases for their assistance: Herman Borghs, Evelien Gielen, Frank P. Luyten, Marian Dejaeger and Kurt De Vlam.
Funding
This research was funded by a PhD Fellowship Strategic Basic Research Grant (1S96721N) of the Research Foundation Flanders (FWO).
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MRL and CM conceptualized, designed and set up the study. MRL supervised the data acquisition. JV and MRL analyzed the data and wrote the manuscript. CM reviewed the manuscript. All authors approve the submitted version and are accountable for all aspects of the work.
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MRL has received consultancy and/or lecture fees from Alexion, Amgen, Galapagos, Kyowa Kirin, Menarini, Orifarm, Pharmanovia, Takeda, UCB and Will-Pharma, unrelated to this work. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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This study was approved by the Medical Ethics Committee of University Hospital Leuven (UZ Leuven) and received registration number S56083.
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Verbeke, J., Laurent, M.R. & Matthys, C. Development and validation of an eight-item calcium screener to assess daily calcium intake of patients with osteoporosis in clinical practice. Eur J Clin Nutr 78, 301–306 (2024). https://doi.org/10.1038/s41430-023-01390-9
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DOI: https://doi.org/10.1038/s41430-023-01390-9