Nutrition that nurtures

Toddlerhood. Teenagedom. It's that ironic time when kids need extra nourishment to fuel their rapid growth — yet refuse to eat anything remotely healthy. But for food and supplements companies willing to invest in this growing — ahem — demographic, this is shaping up to be a golden era. Todd Runestad surveys the market-driven concepts and top five science-based ingredients for this segment of the market

A message for food, beverage and supplements makers: that knocking sound you hear is quite likely opportunity at the door … to get in on the erupting offerings for the youthful set.

We've gotten past Flintstone's chewables as the end-all and be-all for children's nutrition. Natural and organic foods are gaining sway as mothers food shopping for the family intuitively recognise chemicals are not good for growing bodies — with milk fairly being the gateway organic product. The new standards are 'all natural' and 'free from' pesticides, gluten, additives, allergens, trans fats and more. Changes in school and vending-machine policies have opened the door to better-for-you foods and drinks.

Obesity and diabetes are the twin pillars of poor health, with insidious lifelong effects that are striking Americans at earlier and earlier ages. But other conditions, especially immunity and brain health, are big drivers for shoppers for the younger set. And as research validates the concept that osteoporosis and bone breaks in years distant have their genesis in bone-mineral density accumulated in childhood, bone health for youngsters is gaining in importance. And everyone wants their kids to be smartest in the class.

"Consumers are looking to provide condition-specific health products for themselves and extend the concept to their children," says Holly Petty, senior product-innovation scientist at Seltzer Nutritional Technologies. "Categories might include immunity, energy, mood/cognitive health and for young athletes."

"Our research shows parents want more nutritious options for their kids, and children are open to fruits, veggies and healthier versions of standard fare," says Maria Caranfa, RD, director of Mintel Menu Insights.

"I work for a K-12 private school, and whole grains are big," says Erick Gilbert, food-service manager at a Washington, DC-area school. "I also look for natural ingredients that I understand."

Market-data firm IRI recently created a set of better-for-you standards for food manufacturers. For example, cereals should contain no more than 2g fat, 12g sugar, 230mg sodium, and 200 calories per serving.

Beyond more nutritious foods, nutrients are needed for general growth and development — from bones to brains — as well as specific health concerns.

"I also think you will see more fortification — for example, cereals and whey protein bars with added calcium and vitamin D. More fortified beverages and water," says Angela Walter, business-development director, speciality nutrition, at Milk Specialties Global.

And here is the sage advice from calcium and vitamin-D guru Robert P Heaney, MD, a Creighton University, Nebraska, professor and widely published researcher: "The principal recommendation for children's nutrition is less input of sweetened beverages, and more outdoor exercise. I don't know of anything that will improve children's nutrition as much as those two steps, and in fact, I cannot think of anything that would work without those two steps."

The low- and no-cal sweetener market is maturing to the point where these sugar alternatives need not be added to only diet drinks. Stevia has arrived at a perfect time in the changing of the zeitgeist. Granted, Reb-A costs significantly more than high-fructose corn syrup, and, for teens anyway, the allure of Red Bull-type energy drinks is a frightening proposition because teenagers are about the last demographic group in need of energy. But the cache of Reb-A-derived 'naturally sweetened' on the label — with nary a suspicious peep from Center for Science in the Public Interest — should not be underestimated in importance to mothers doing the food shopping.

Five to thrive
Calcium: Heaney's beverage and bone advice can be summed up in one word: dairy. He asserts the principal bone-health nutrients are calcium, protein and vitamin D, and to lesser extents potassium, magnesium, zinc and several other vitamins. "Given modern food sources, it is difficult to devise a diet that is 'bone healthy' without including three servings of dairy per day," he writes in a 2009 paper, "not just because of dairy calcium, but dairy protein and potassium as well."1

Everybody knows by now that calcium equates to bone health. Only recently has evidence cemented the proposition that calcium intake in childhood and adolescence can help prevent osteoporosis later in life. What's more, increased calcium intake in later years may not reduce the accelerated risk of osteoporosis resulting from inadequate calcium intake during childhood and adolescence.2 Peak bone mass, which is obtained during childhood and adolescent growth, is a key determinant of the lifetime risk of osteoporosis and bone fracture. About 35 per cent of a mature adult's peak bone mass is built up during puberty.3 Retrospective studies in adults suggest that childhood calcium intake is associated with risk of later osteoporosis and attendant bone breakage.4 Indeed, one study found low milk intake during childhood was associated with a two-fold greater risk of fracture among women aged 50 and older.5

The problem is, despite the clear and present benefit of calcium for children's lifelong health, children's multivitamins routinely skimp on calcium. That's because vitamins generally have very low masses, and so a lot can be combined into a single small dosage form, but calcium is bulky, and to put a useful amount into a children's multivitamin pill would make it big enough that many kids wouldn't take it.

This brings us back to dairy. A 12-year study, concluded in 2008, followed 106 adolescents initially aged between three and five years old. Those who consumed two or more servings of dairy per day had higher bone-mineral content and density,6 which makes dairy good not just in and of itself, but also as a delivery system for complementary bone-health ingredients.

Vitamin K2 is one such ingredient. A tiny dose of only 45mcg/day can do the trick — that's micrograms, not milligrams. One branded K2 ingredient, MenaQ7, is GRAS for dairy. In studies, a better vitamin K status is associated with better bone mass in healthy kids.7 And, 55 healthy prepubertal who supplemented with 45mcg/day menaquinone-7 (MenaQ-7 brand natural vitamin K2) for eight weeks got both higher blood levels of MK-7 and increased osteocalcin carboxylation.7 Osteocalcin is a vitamin K-dependent protein that is essential for the body to utilise calcium in bone tissue. Without adequate vitamin K, the osteocalcin remains inactive.

"The present study is the first one to demonstrate that increased vitamin K intake by supplement improves the osteocalcin activity in children," says lead researcher Cees Vermeer. "The next step must be that an effect of MenaQ7 on bone strength or fracture risk is demonstrated in this age group."

These results confirm previous laboratory, epidemiological and human clinical studies linking better vitamin-K status in children with higher bone-mineral density.8

As Eric Anderson, brand manager for PL Thomas' MenaQ7 ingredient, summed in a Twitter-like email haiku, "Better K status = higher peak bone mass = more bone to lose = push back risk of osteo."

Children are far more vitamin K-deficient than adults because of the rapid growth of their bones and the consequent high vitamin K demand by bones for production of osteocalcin, explained Vermeer.

In August 2009, the European Union formally approved K2 as a safe ingredient for foods and supplements. Fermented cheese is the best naturally occurring source of vitamin K2 in the Western diet (commercial K2 is derived from natto, a Japanese food made by fermenting soy), making it an elegant complementary food ripe for fortification, though the Natto Pharma/PL Thomas/Danisco MenaQ7 ingredient is GRAS for all dairy apps.

Synthetic menaquinone-4 is also commercially available, derived from animal tissue, though it gets excreted from the body more rapidly, making significantly higher doses necessary (mg vs mcg). However, researchers say vitamin K from food sources are converted in the body to menaquinone-4, not -7. On the other hand, a head-to-head rat study comparing MK-4 with MK-7 found MK-7 was superior in preventing bone loss and calcium loss.9

However, it's important to note that vitamin K research is in its relative infancy, and all research on menaquinone-7 is both still emerging and only coming out of a group entirely funded by Natto Pharma (PL Thomas has rights to supplements in North America, while Danisco has rights to food applications worldwide), which has a commercial stake in the results. "As a scientist, I always like seeing research replicated by people with different research agendas," said Sarah Booth, a vitamin K researcher at Tufts University and associate director of the Jean Mayer USDA Human Nutrition Research Center on Aging.10 "I admire \[Natto Pharma\] for forging forward and they're doing it very well. The science is emerging and that's what it is."

Vitamin D: Speaking of higher doses, it's only a matter of time before the US Food and Nutrition Board at the Institute of Medicine dramatically increases the recommended daily intake of vitamin D. The question is, will it raise the amount from its current 200IU/day to 2,000IU, as many scientists and organisations are recommending, or hedge its bets because of vagaries of race, latitude and outdoor exposure to a more modest 1,000IU?11

"Vitamin D, of course, is vital at all ages, and is likely to be deficient throughout childhood," says Heaney. "You may have seen the recent publication in Pediatrics from NHANES 2001-2004 showing, for the three major ethnic groups in this country, the prevalence of serum 25(OH)D values below critical cut-off points at various ages. The group with the best status \[Caucasians\] still had more than 60 per cent of its members below a desirable figure of 30ng/mL, and for black teenage girls, to go to the other extreme, something like 98 per cent had suboptimal values."12

This recent analysis echoes a rigorous 2004 assessment of 307 adolescents in a Boston hospital, which found that 24 per cent were vitamin-D deficient — and that was looking at deficiency at a level of 15ng/mL, which is half the level that Heaney advises as being optimal. Using a slightly broader definition of 20ng/mL, researchers found 42 per cent of Boston kids to be D-deficient.13

Because all cells in the body have vitamin-D receptors, it's becoming clear that vitamin D helps enhance cellular communication, which is why health benefits of vitamin D extend far beyond bone health, including boosting immunity, hormone regulation, brain health, metabolism, diabetes prevention, cancer prevention and cardiovascular health. As vitamin-D levels were found to be 24 per cent lower during winter compared with summer, could vitamin-D deficiencies be the reason people get sicker in wintertime?

"As vitamin D, at the daily dose level, is relatively inexpensive, it seems any product addressing functional nutrition for children should include vitamin D in its formulation," says Mac Weber, president of Provitas, which supplies feed and food ingredients.

The great commercial benefit of vitamin D is that consumers are clamouring for it, regulatory agencies are poised to significantly up the recommended intake, and it's a very inexpensive ingredient. Let the sun shine in!

Probiotics: Perhaps the top health concern of parents vis a vis their children is immune function. Nobody wants to have to stay home from work to tend to a sick child. A 2005 study of 479 healthy people found those who took daily probiotics supplements for at least three months experienced shorter and less-severe colds. The combination consisted of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, and B bifidum MF 20/5 (Tribion harmonis, Merck Consumer Health Care, Germany).14

Granted, these were not children, but the proof of concept applies. And, a July 2009 study with 326 bona-fide children ages three to five at a child-care centre in China found probiotics reduced the incidence of cold and flulike symptoms in children by 50 per cent. Children supplemented with L acidophilus NCFM and B lactis Bi-07 (supplied by Danisco). Interestingly, the combination worked better than either individually. Whereas acidophilus alone reduced fever incidence by 53 per cent, runny noses by 28 per cent and coughing by 41 per cent, acidophilus plus lactis led to fever reductions by 73 per cent, runny noses by 59 per cent and coughing by 62 per cent.15

Probiotics have also been found to reduce eczema by 50 per cent in young children by two years of age when using L rhamnosus (supplied by Fonterra).16

Chewable probiotics for kids are now available, as are single-serving sachets.

Lipids: Omega-3 DHA is a well entrenched ingredient in the children's nutrition world in no small part because it's routinely used in infant formula. For children ages two to five, a daily dose of 200mg DHA is seen as appropriate.

Research into omega-3s is prodigious. It includes general children's health and development; autism; attention, learning and behaviour; asthma; intelligence; and visual development. An impressive online collection of research can be found at

As a representative sample of research, we'll start at the beginning: infants. Pregnant mothers who consumed 300mg DHA in a bar form five days a week had children at nine months who demonstrated statistically significantly superior problem-solving skills, but not overall intelligence.17

In four-year-olds, taking 400mg DHA/day for four months led to statistically significant superior listening-comprehension and vocabulary-acquisition skills.18

Provocative recent research shows that form might matter. In a double-blind, randomised clinical trial, omega-3 DHA in the phospholipid form (supplied by Enzymotec) was superior to the triglyceride form — the omega-3/phospholipids group had 94 per cent increases in attention measures, compared to 37 per cent increases in the regular fish-oil group.19

This study should kick off debate over form. It could also give a boost to the krill sector, as krill is rich in phospholipids. Two sticking points: Enzymotec says its ingredient studied is richer in DHA than krill. Also, the Enzymotec ingredient contained phosphatidylserine (PS), whereas the phospholipid in krill is phosphatidylcholine (PC). Both phospholipids, but different types. "Fish oil does not contain choline nor phosphatidylserine, so this is a clear difference that is not in dispute," said Michael Schmidt, PhD, science director for krill supplier Azantis. "Choline is a limiting nutrient — in recent studies up to 90 per cent of adults and college students do not meet the RDI. Thus, krill oil provides part of the RDI for choline, which fish oil does not. But, added phosphatidylserine has its own specific benefits."

When food graduates
What does food want to be when it's all grown up? The food industry has been much maligned for contributing to the childhood-obesity and diabetes epidemics. Advances in nutrition science and food technology seem to be aligning to help solve the problems.

Even though children's vitamin use can be chalked up to all the usual parameters — wealth, education, Caucasian, good diet, greater physical activity, better health-care access — only about one third of American children regularly consume vitamin supplements.20 Plus, recent USDA statistics revealed that four out of five younger kids are not getting their daily requirement of vitamin E, 85 per cent are not receiving enough zinc, and 60 per cent are not getting enough iron. So the need is there, and the market is there.

Add to that an increasing diversity of delivery systems — drinks are the most obvious, but so are single-serving tear pouches and gummy bear-type nutrients that are extending far beyond multivitamins.

Against the grain: Fibre flakes vs chocolate-frosted sugar bombs
Australia is ground zero for the Glycaemic Index movement. At the University of Western Australia, assistant professor Jonathan Foster and PhD grad student Michael Smith have published three studies in the past year comparing how children's memories fare under the influence of high-glycaemic vs low-glycaemic meals. Under their test conditions, sugar wins. We talked with Michael Smith.

Fi: What did you feed the children?

MS: The low-GI meal was 30 on the Glycaemic Index. It was composed of 30g All-Bran with 125ml semi-skimmed, 1.8 per cent fat milk — 158 kcal, 8.8g protein, 2.8g fat, 20.5g carbohydrate. The high-GI meal, 77 on the index, was composed of 30g cornflakes with 125ml semi-skimmed, 1.8 per cent fat milk — 172kcal, 6.5g protein, 2.0g fat, 31.2g carbohydrate.1

Fi: Because high-GI meals are generally thought to be unhealthy, did the results surprise you?

MS: In this study, better remembering was associated with ingestion of the high-GI meal, relative to the low-GI meal. It is important to note that the cognitive demand of memory task employed in this study was high, in that participants were required to encode lists of words at the same time as performing a secondary task, which involved performing sequences of hand movements.

Previous studies in healthy adults have demonstrated that when the cognitive demand of a task is high, oral glucose ingestion can be beneficial in improving task performance, relative to an aspartame placebo. \[See Sünram-Lea et al, Psychopharmacology 2002;160:387-97 for a detailed discussion.\] So from this standpoint, the results were unsurprising. However, it is also important to consider previous studies that have demonstrated that low-GI meals may be of relatively greater benefit than high-GI meals in terms of enhancing attention across a longer duration than studied here, and also on more basic memory tasks.

Fi: Another recent study of yours was similar, but instead of a high-GI meal, subjects were fed straight glucose.2 Were the effects better than with the meal, suggesting not merely high GI but high sugar is better for student recollection and hence test results?

MS: Numerous studies have now reported the benefit of glucose ingestion in terms of cognitive performance. In younger individuals, this 'glucose memory facilitation effect' appears to be most reliably observed under conditions of high cognitive demand.

Fi: What are health-conscious parents who endeavour to feed their children nutritious meals to think of these results?

MS: We have not sought the opinion of parents on the findings of our study.

1. Smith MA, Foster JK. The impact of a high versus a low glycaemic index breakfast cereal meal on verbal episodic memory in healthy adolescents. Nutr Neurosci 2008 Oct;11(5):219-27.
2. Smith MA, Foster JK. Glucose modulates event-related potential components of recollection and familiarity in healthy adolescents. Psychopharmacology (Berl) 2009 Jul;205(1):11-20.

Nutrition Business Journal 2009 Healthy Kids' Market Report: breaking the entry barrier
Looking for actionable intelligence to get into or grow in the healthy, better-for-you kids' category? The new NBJ report details the market size, growth and sales estimates. Whether you're looking at trends for supplements, foods or beverages, this 194-page report dives deep into product and marketing trends for babies, children and teens. To view the table of contents, list of figures and executive summary, go to Cost is $2,495.

Honey - Sweet option for sweet goods
Escalating childhood obesity rates are easily generating enough of an impact to force concerned parents to look beyond the brand of food they purchase, and focus instead on the ingredients listing. And what is the first thing most parents look for? The sweetener.

The sweeteners children consume are coming under fire both at home and in school. This issue is of great concern to food manufacturers as they seek to develop products that not only taste good, but that also have ingredients listings that are natural. Honey provides food manufacturers with the flavour profile and composition necessary to produce clean-label sweet goods without sacrificing taste.

Honey is a nutritive sweetener composed of numerous sugars, including fructose (38.5 per cent), glucose (31 per cent), maltose (7.2 per cent), and sucrose (1.5 per cent). Honey also contains a variety of flavonoids and phenolic acids, which act as antioxidants that scavenge free radicals. Generally, darker honeys have a higher antioxidant content than lighter honeys.

In food products, honey is simply labelled as 'honey,' and offers producers a sweetener with a familiar name that, according to a National Honey Board consumer survey, 94 per cent of consumers regard as 'natural.' From marketing and nutrition standpoints, the use of honey as the sweetener in sweet goods is a natural choice. But what about formulating child-targeted sweet goods, such as cookies and snack cakes with honey?

In almost all sweet-goods formulations, honey can replace the existing sweetener, including sugar and high-fructose corn syrup (HFCS), with only minor modifications, such as the addition of a small amount of baking soda and an overall reduction in liquids. Oven temperatures also should be reduced by about 25°F to prevent overbrowning.

On a sweetening basis, honey is about 25 per cent sweeter than sugar or sucrose due to its fructose content (about 38.5g fructose per 1,000g of honey).

See the chart below for specific honey substitution information. Also, visit the National Honey Board's website,

— Keith Seiz

Honey substitution chart

Sugar — (gram basis)




Sucrose (dry)






Conversion factor:
1,000g solids in 1,000g sucrose/824g solids in 1,000g honey = 1.2135922.
To replace 1,000g sucrose with honey, use 1,214g honey and subtract 214g water from the total formula.

High fructose corn syrup (42%) — (gram basis)

HFCS (42%)






Conversion factor:
710g solids in 1,000g HFCS (42%)/824g solids in 1,000g honey = 0.86165048.
To replace 1,000g HFCS (42%) with honey, use 862g honey and add 138g water to the total formula.

HFCS (55%) — (gram basis)

HFCS (55%)






Conversion factor:
770g solids in 1,000g HFCS (55%)/824g solids in 1,000g honey = 0.934466.
To replace 1,000g HFCS (55%) with honey, use 934g honey and add 66g water to the total formula.

HFCS (90%) — (gram basis)

HFCS (90%)






Conversion factor:
750g solids in 1,000g HFCS (90%)/824g solids in 1,000g honey = 0.9101942.
To replace 1,000g HFCS (90%) with honey, use 910g honey and add 90g water to the total formula.

Liquid Sucrose — (gram basis)

Liquid Sucrose*






*average 67.5 °Brix
Conversion factor:
675g solids in 1,000g liquid sucrose/824g solids in 1,000g honey = 0.8191748.
To replace 1,000g liquid sucrose with honey use 819g honey and add 181g water to the total formula.

Liquid Invert Sugar — (gram basis)

Liquid invert sugar






*average 76.55 °Brix
Conversion factor:
765.5g solids in 1,000g liquid invert sugar/824g solids in 1,000g honey = 0.9290049.
To replace 1,000g liquid invert sugar with honey, use 929g honey and add 71g water to the total formula.

Corn Syrup (42 DE) — (gram basis)

Corn Syrup (42 DE)






Conversion factor:
803g solids in 1,000g corn syrup (42 DE)/824g solids in 1,00 g honey = 0.9745245.
To replace 1,000g corn syrup (42 DE) with honey, use 974g honey and add 26g water to the total formula.

Molasses — (gram basis)







*including 2% ash
Conversion factor:
700g solids in 1,000g molasses/824g solids in 1,000g honey = 0.8737864.
To replace 1,000g molasses with honey, use 874g honey and add 126g water to the total formula.

Select suppliers: The ABCs of children's-nutrition suppliers

AGD Nutrition
Vitamin D3 supplier for more than 40 years. Company has been involved in analytical research and organic chemical processes that drive production of Vitamin D. Partners with Zhejiang Garden Biochemical in China.

Aker BioMarine
Superba krill oil is rich in omega-3 phospholipids and astaxanthin. This product has 100 per cent product traceability.

Pharmaceutical-grade Antarctic krill oil contains at least 42 per cent krill phospholipids, 15 per cent omega-3 EPA and nine per cent omega-3 DHA. The company markets bulk oil, bulk capsules, unlabelled bottles and blister cards.

Inulin and oligofructose prebiotic fibres should be integrated into any probiotic formulation for increased performance. The prebiotics can also be used in a low-cal sweetener blend.

Litesse polydextrose is a 1kcal/g carbohydrate that replaces sugar and fat in cookies, cakes, beverages and more. Lactitol is a reduced-calorie sweetener for formulating sugar-free products.

Premium omega-3 fish oils for supplements, beverages, dairy, bakery, cereals, margarines, pet nutrition and more.

Integrated vitamin producer of a range of vitamins, Quali micronutrient blends for infant nutrition.

InPUFA mimics mother's milk phospholipids structure to increase DHA intake. Crill is its branded krill oil. SharpPS Silver is a combination of phosphatidylserine and DHA. Enzymotec makes lipid-based ingredients for supplements, foods, clinical nutrition and infant nutrition.

High-concentrate marine-based omega-3 oils are formulated with varying ratios of EPA and DHA to target specific health conditions.

TruCal milk minerals are soluble in an acidic pH range, with bland flavour and high calcium content to make it suitable for beverages, supplements, meal replacements, baked goods, nutrition bars, fresh dairy products and confectionery.

GTC Nutrition
Aquamin natural calcified mineral source is high in calcium and magnesium to support bone health. Derived from sea algae with unique organoleptic properties, it is ideal for foods, beverages and supplements.

Institut Rosell
Diverse range of probiotics including ProbioKid, which targets children's immune health.

Martek Biosciences
life'sDHA fermented algae-sourced DHA is a vegetarian source used in infant formulas as well as the range of foods and supplements.

National Starch

Hi-maize resistant starch allows formulators to add fibre without sacrificing taste, texture or appearance. Eating just one meal containing the high amylose corn resistant starch can increase fat burning in healthy people by 20-25 per cent.

Natto Pharma
MenaQ7 is licensed to PL Thomas for marketing and distribution for supplements in North America, and to Danisco for foods (it's GRAS for dairy, the only GRAS K2 ingredient on the market). Natto Pharma sells directly in Europe.

Nebraska Cultures
Dr Shahani's custom-made and stabilized probiotics specialises in the DDS-1 strain of L. acidophilus.

Neptune Technologies & Bioressources
NKO Neptune Krill Oil has more research conducted on it than any other krill source.

Ocean Nutrition Canada
Meg-3 omega-3 fish oils using the exclusive Powder-loc technology with double-shell protection makes for a free-flowing, dry powder with no taste or odour. GRAS.

PL Thomas
MenaQ-7, the natural menaquinone-7 ingredient, is distributed in North America for supplements.

Saatwic Foods
CarboStar allows starch to function like a dietary fibre by strengthening the protective wall of a starch cell, which slows its caloric release. Can be used to produce any product that is made from processed corn, wheat, potato and rice, and pasta to cereals. CarboStar foods contain 56 per cent more fibre, 50 per cent fewer calories from carbohydrates, and a glycaemic impact 35 per cent lower.

1. Heaney RP. Dairy and bone health. J Am Coll Nutr. 2009 Feb;28 Suppl 1:82S-90S.
2. Stracke H, et al. Osteoporosis and bone metabolic parameters in dependence upon calcium intake through milk and milk products. Eur J Clin Nutr 1993 Sep;47(9):617-22.
3. Bachrach LK. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab 2001 Jan-Feb;12(1):22-8.
4. Stallings VA. Calcium and bone health in children: a review. Am J ther 1997 Jul-Aug;4(7-8):259-73.
5. Kalkwarf HJ, et al. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutr 2003 Jan;77(1):257-65.
6. A 2008 study for 12 years followed 106 adolescents initially aged between three and five years old. Those who consumed two or more servings of dairy per day had higher bone mineral content and density
7. van Summeren MJ, et al. The effect of menaquinone-7 (vitamin K2) supplementation on osteocalcin carboxylation in healthy prepubertal children. Br J Nutr 2009 May 19:1-8. \[Epub ahead of print\]
8. O'Connor E, et al. Serum percentage undercarboxylated osteocalcin, a sensitive measure of vitamin K status, and its relationship to bone health indices in Danish girls. Br J Nutr 2007;97:661-6.
9. Maalouf J, et al. Short-term and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab 2008 Jul;93(7):2693-701.
10. Saintonge S, et al. Implications of a new definition of vitamin D deficiency in a multiracial us adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics. 2009 Mar;123(3):797-803.\]
11. Gordon CM, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004 Jun;158(6):531-7.
12. De Vrese M, et al. Effects of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: A double blind, randomized, controlled trial. Clin Nutr 2005;24:481-91.
13. Leyer GJ, et al. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics 2009;124:e172-e179.
14. Wickens K, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: A double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol Oct;122(4):788-94.
15. Judge MP, et al. DHA supplementation during pregnancy shows infant cognitive function. Am J Clin Nutr 2007 Jun;85(6):1572-7.
16. Ryan A, Nelson E. Assessing the effect of docosahexaenoic acid on cognitive functions in healthy, preschool children: a randomized, placebo-controlled, double-blind study. Clin Pediatr (Phila). 2008;47(4):355-62.
17. Vaisman N, et al. Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids. Am J Clin Nutr 2008 May;87:1170-80.
18. Shaikh U, et al. Vitamin and mineral supplement use by children and adolescents in the 1999-2004 National Health and Nutrition Examiniation Survey: relationship with nutrition, food security, physical activity, and health care access. Arch Pediatr Adolesc Med 2009 Feb;163(2):150-7.

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