Effects of Calcium and Vitamin D Co-supplementation on the Lipid Profile: A Systematic Review and Meta-analysis

PURPOSE

Calcium and vitamin D co-supplementation is common and widely used, but randomized, controlled trials (RCTs) have yielded inconclusive results concerning its impact on the serum lipid profile.

METHODS

A comprehensive literature search of Medline, Web of Science, Scopus, Embase, Cochrane Central Register of Controlled Trials, and clinical trial registry databases was conducted to identify placebo-controlled RCTs that were published through September 2020 and that evaluated the impact of calcium and vitamin D co-supplementation on total cholesterol (TC), triglycerides (TGs), low- and very-low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C). Standardized mean differences (SMDs) were pooled using random-effects meta-analysis models.

FINDINGS

Thirteen studies in a total of 2304 participants met the inclusion criteria. Calcium and vitamin D co-supplementation was associated with significant reductions in both TC (SMD, -0.81; 95% CI, -1.35 to -0.27; I² = 94.6%) and TGs (SMD, -0.50; 95% CI, -0.91 to -0.08; I² = 91.5%), and with a significant increase in HDL-C (SMD, 1.22; 95% CI, 0.60 to 1.83; I² = 95.4%). However, calcium and vitamin D co-supplementation were not found to be associated with significantly decreased low-density lipoprotein cholesterol (SMD, -0.39; 95% CI, -0.78 to 0.01; I² = 90.1%) or very-low-density lipoprotein cholesterol (SMD, -0.01; 95% CI, -0.70 to 0.69; I² = 82.3%).

IMPLICATIONS

The findings from the present systematic review and meta-analysis suggest that calcium and vitamin D co-supplementation has a beneficial effect on TC, TG, and HDL-C. Larger-scale, well-designed RCTs are needed to clarify the effect of calcium and vitamin D co-supplementation on all lipid-profile components.

Prenatal nutrition supplementation and growth biomarkers in preadolescent Bangladeshi children: A birth cohort study

Little is known about the usefulness of biomarkers to study the influence of prenatal nutrition supplementation in improving child growth. Anthropometry is not always straightforward to understand how nutrition might impact growth, especially in settings with high rates of malnutrition and infections. We examined the effects of prenatal supplementation on growth and growth biomarkers and the relationship between anthropometric measures and growth biomarkers of children at 4.5 and 9 years of age. Children were enrolled from a longitudinal cohort, where mothers were randomized into daily supplementation with either early‐food (≤9 gestation week [GW]) or usual‐food (~20 GW) (608 kcal 6 days/week); they were further randomized to receive 30‐mg or 60‐mg iron with 400‐μg folic acid, or multiple micronutrients (MM) in rural Bangladesh. Anthropometric data were collected from mothers at GW8 and children at 4.5 (n = 640) and 9 years (n = 536). Fasting blood was collected from children at each age. Early‐food supplementation showed reduced stunting and underweight at 4.5 and 9 years age respectively compared to usual‐food. Prenatal supplementations did not have any effect on growth biomarkers except for STAT5b expression which was lower in the early‐food compared to the usual‐food group (β = −0.21; 95 CI% = −0.36, −0.07). Plasma concentrations of 25‐hydroxy vitamin D and calcium were both inversely associated with weight‐for‐age and body mass index‐for‐age Z‐scores at 9 years, particularly in early‐food and MM groups. Although there was minimal effect on child growth by prenatal supplementations, the associations of biomarkers with anthropometric indices were predominantly driven by timing of food or MM supplementations.

Activation of Cx43 Hemichannels Induces the Generation of Ca2+ Oscillations in White Adipocytes and Stimulates Lipolysis

The aim of the study was to investigate the mechanisms of Ca²⁺ oscillation generation upon activation of connexin-43 and regulation of the lipolysis/lipogenesis balance in white adipocytes through vesicular ATP release. With fluorescence microscopy it was revealed that a decrease in the concentration of extracellular calcium ([Ca²⁺]_ex) results in two types of Ca²⁺ responses in white adipocytes: Ca²⁺ oscillations and transient Ca²⁺ signals. It was found that activation of the connexin half-channels is involved in the generation of Ca²⁺ oscillations, since the blockers of the connexin hemichannels-carbenoxolone, octanol, proadifen and Gap26-as well as Cx43 gene knockdown led to complete suppression of these signals. The activation of Cx43 in response to the reduction of [Ca²⁺]_ex was confirmed by TIRF microscopy. It was shown that in response to the activation of Cx43, ATP-containing vesicles were released from the adipocytes. This process was suppressed by knockdown of the Cx43 gene and by bafilomycin A1, an inhibitor of vacuolar ATPase. At the level of intracellular signaling, the generation of Ca²⁺ oscillations in white adipocytes in response to a decrease in [Ca²⁺]_ex occurred due to the mobilization of the Ca²⁺ ions from the thapsigargin-sensitive Ca²⁺ pool of IP₃R as a result of activation of the purinergic P2Y1 receptors and phosphoinositide signaling pathway. After activation of Cx43 and generation of the Ca²⁺ oscillations, changes in the expression levels of key genes and their encoding proteins involved in the regulation of lipolysis were observed in white adipocytes. This effect was accompanied by a decrease in the number of adipocytes containing lipid droplets, while inhibition or knockdown of Cx43 led to inhibition of lipolysis and accumulation of lipid droplets. In this study, we investigated the mechanism of Ca²⁺ oscillation generation in white adipocytes in response to a decrease in the concentration of Ca²⁺ ions in the external environment and established an interplay between periodic Ca²⁺ modes and the regulation of the lipolysis/lipogenesis balance.

Protein- and Calcium-Mediated GLP-1 Secretion: A Narrative Review

Glucagon-like peptide 1 (GLP-1) is an incretin hormone produced in the intestine that is secreted in response to nutrient exposure. GLP-1 potentiates glucose-dependent insulin secretion from the pancreatic β cells and promotes satiety. These important actions on glucose metabolism and appetite have led to widespread interest in GLP-1 receptor agonism. Typically, this involves pharmacological GLP-1 mimetics or targeted inhibition of dipeptidyl peptidase-IV, the enzyme responsible for GLP-1 degradation. However, nutritional strategies provide a widely available, cost-effective alternative to pharmacological strategies for enhancing hormone release. Recent advances in nutritional research have implicated the combined ingestion of protein and calcium with enhanced endogenous GLP-1 release, which is likely due to activation of receptors with high affinity and/or sensitivity for amino acids and calcium. Specifically targeting these receptors could enhance gut hormone secretion, thus providing a new therapeutic option. This narrative review provides an overview of the latest research on protein- and calcium-mediated GLP-1 release with an emphasis on human data, and a perspective on potential mechanisms that link potent GLP-1 release to the co-ingestion of protein and calcium. In light of these recent findings, potential future research directions are also presented.

Dietary calcium, phosphorus, and osteosarcopenic adiposity in Korean adults aged 50 years and older

Calcium and phosphorus intake showed a significant negative relationship with osteosarcopenia and osteosarcopenic adiposity in Korean adults aged 50 years or older.

PURPOSE

Osteosarcopenic adiposity (OSA) is a syndrome accompanied by low bone mass, low muscle mass, and adiposity, and the association of the individual OSA components with dietary factors is considerable. The aim of this study was to investigate the association between the intake of dietary calcium and phosphorus and individual and/or combined bone-, muscle-, and fat mass-related abnormalities in body composition (components of OSA).

METHODS

This study investigated the relationship between OSA-related components and the intake of calcium and phosphorus in subjects aged 50 years and older (n = 7007) using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011.

RESULTS

After adjusting for various confounding factors that affect OSA, the groups with a low calcium intake (below the median value) had a significantly higher risk of osteosarcopenia (OR = 1.768, 95% CI: 1.018-3.073; p = 0.0432) and OSA (OR = 1.505, 95% CI: 1.040-2.180; p = 0.0304) compared to the groups with a high calcium intake (equal to or above the median value). In addition, phosphorus intake showed a significant negative relationship with sarcopenic adiposity.

CONCLUSION

In conclusion, the intake of calcium is associated with a lower risk of osteosarcopenia and OSA in Korean adults aged 50 years and older. These results will serve as baseline data on mineral intake for the management of multiple OSA-related components.

Tenth year reenrollment randomized trial investigating the effects of childhood probiotics and calcium supplementation on height and weight at adolescence

Microbiota and its modification with specific probiotics in early life could provide long term health benefits. Probiotics and calcium strengthen intestinal integrity and may support linear growth. This study investigated the long-term effects of childhood probiotics and calcium supplementation on growth in adolescence. We re-enrolled 238 adolescents aged 11-18 years from 494 children 10-years after 6-months of supplementation with either low-lactose milk fortified with low levels of calcium (LC, ∼50 mg/day, n = 53/124), with regular levels of calcium (RC, ∼440 mg/day, n = 70/126), or with regular calcium + 5 x 108 CFU/day Lactobacillus reuteri DSM 17938 (Reuteri, n = 55/124), or regular calcium + 5 x 108 CFU/day L. casei CRL 431 (Casei, n = 60/120). Changes in height-for-age z-score (HAZ) and body mass index-for-age z-score (BMIZ) were determined from the end of intervention to re-enrollment. General linear models were used to assess the effects on HAZ and BMIZ of group, gender, living area, maternal education, family income, physical activity, diet quality, nutritional status, and gut integrity as determined by urinary lactulose/mannitol ratio (L:M). Adolescent mean age was 15.3 years, mean HAZ was - 1.11, mean BMIZ was - 0.2 and median L:M (n = 155) was 0.23. Changes in HAZ and BMIZ were not significantly different between Casei, Reuteri, LC compared to RC. However, a significant decrease in BMIZ was observed among female adolescents in the Casei compared to RC group (- 0.5 SD, 95% CI - 0.8 to - 0.003, p = 0.048). Childhood probiotic and calcium supplementation may therefore selectively affect female adolescents.Clinical trial registration: This follow-up study has been registered at www.clinicaltrials.gov , Registry name: Rina Agustina, Registration number: NCT04046289, First Registration Date 06/08/19. web link: https://www.clinicaltrials.gov/ct2/show/NCT04046289 .

Vitamin D and Obesity: Current Evidence and Controversies

PURPOSE OF REVIEW

Evidence from observational studies suggests that obesity is associated with low vitamin D. As both obesity and hypovitaminosis D present an alarmingly increased prevalence worldwide, there is an intense research interest to clarify all aspects of this association. This review summarizes current evidence from meta-analyses investigating vitamin D status in obesity, including the effects of weight loss and bariatric surgery on vitamin D status and the outcomes of vitamin D supplementation on body weight. We also discuss potential pathophysiologic mechanisms and important controversies.

RECENT FINDINGS

Data from meta-analyses consistently support an inverse association of vitamin D levels with body weight. However, the impact of weight loss on improving vitamin D status is small, while studies on the supplementation with vitamin D after bariatric surgery have shown conflicting results regarding vitamin D status. Moreover, interventional studies do not support a beneficial effect of vitamin D supplementation on body weight. These findings warrant a cautious interpretation due to important methodological limitations and confounding factors, such as high heterogeneity of studies, variable methods of determination of vitamin D and definition of deficiency/insufficiency, use of various adiposity measures and definitions of obesity, and inadequate adjustment for confounding variables influencing vitamin D levels. The underlying pathogenetic mechanisms associating low vitamin D in obesity include volumetric dilution, sequestration into adipose tissue, limited sunlight exposure, and decreased vitamin D synthesis in the adipose tissue and liver. Experimental studies have demonstrated that low vitamin D may be implicated in adipose tissue differentiation and growth leading to obesity either by regulation of gene expression or through modulation of parathyroid hormone, calcium, and leptin. Obesity is associated with low vitamin D status but weight loss has little effect on improving this; vitamin D supplementation is also not associated with weight loss. Evidence regarding vitamin D status after bariatric surgery is contradicting. The link between vitamin D and obesity remains controversial due to important limitations and confounding of studies. More research is needed to clarify the complex interplay between vitamin D and adiposity.

Analyzing Blood Pressure Ascent during Aging in Non-Diabetics: Focusing on Links to Insulin Resistance and Body Fat Mass

BACKGROUND

A gradual upward progression of blood pressure (BP) occurs regularly in most humans during aging. This is unfortunate, because it is generally recognized that elevation of BP, even when relatively mild, is eventually detrimental to human health. Accordingly, considerably more understanding of the pathophysiology behind such a phenomenon is important in order to institute the correct remedies. Two components of the ubiquitous metabolic syndrome (MS) with nutritional implications, elevated insulin resistance (IR) and excess body fat mass (FM), are often postulated to be critical driving forces behind the elevated BP that is common with aging. The current study, therefore, focuses on the presence and importance of IR and/or body FM in BP regulation of non-diabetics over the lifespan.

METHODOLOGY

In cross sectional analyses, baseline data obtained from healthy, non-diabetic volunteers involved in prior clinical studies were analyzed by examining links between FBG measurements used as a surrogate for IR and body FM through their individual and combined effects on BP.

RESULTS

A significant positive correlation was found between FBG and FM and also between each employed individually as independent variables to the dependent BP and heart rate (HR) variables. In volunteers with higher body FM compared to lower, average systolic BP (SBP) values are increased to some extent at the same FBG measurement suggesting that other factors related to FM in addition to IR are the basis for slight pressure differences. Considering quartiles based upon levels of FM and FBG, low FM-low FBG display significantly reduced average SBP, diastolic blood pressure (DBP), and HR compared to the upper FM-FBG quartiles. While readings of FBG and FM display a decline in elderly subjects after age 70 years (aging paradox), such does not occur with SBP.

CONCLUSIONS

IR is a major driving force behind BP regulation even in non-diabetics. FM influences BP substantially through its relationship with IR and also via other mechanisms directly linked to FM.

Calcium Intake Is Inversely Related to Risk of Obesity among American Young Adults over a 30-Year Follow-Up

BACKGROUND

Calcium (Ca) is an essential nutrient that may play an important role in weight maintenance through its involvement in energy or lipid metabolism. However, little is known about the long-term associations of Ca intake with obesity risk.

OBJECTIVES

We aimed to prospectively examine the association between cumulative Ca intake and the incidence of obesity among American young adults over 30 y of follow-up.

METHODS

Participants were from the CARDIA (Coronary Artery Risk Development in Young Adults) study. A total of 4097 of 5115 black and white individuals aged 18-30 y at baseline in 1985-1986 were included in the current analysis. Dietary and supplemental Ca intake was assessed by the validated interview-based CARDIA diet history at baseline and exam years 7 and 20. Incident cases of obesity were identified when BMI was ≥30 kg/m2 for the first time since baseline. A survival analysis was performed using Cox proportional hazards regression models to estimate the HRs and corresponding 95% CIs for obesity incidence during follow-up.

RESULTS

During a 30-y follow-up (mean ± SD: 20 ± 10 y), 1675 participants developed obesity. Cumulative total Ca intake (dietary plus supplemental Ca) was inversely associated with incidence of obesity in multivariable-adjusted analysis [quintile (Q)5 (highest intake) compared with Q1 (lowest intake): HR: 0.68; 95% CI: 0.56, 0.82; P-trend < 0.01]. This inverse association persisted among Ca supplement users (Q5 compared with Q1: HR: 0.53; 95% CI: 0.40, 0.70; P-trend < 0.01), but was not seen among nonusers.

CONCLUSIONS

Following a cohort of Americans from young adulthood to midlife, an inverse association between calcium intake and obesity incidence was observed. Further studies are needed to confirm our findings.

Fatty Acids from Different Fat Sources and Dietary Calcium Concentration Differentially Affect Fecal Soap Formation in Growing Pigs

BACKGROUND

Calcium (Ca) can complex with free fatty acids in the gastrointestinal tract (GIT), leading to the formation of insoluble unabsorbable Ca-fatty acid soaps, contributing to the proposed effect of Ca on weight loss in humans.

OBJECTIVES

We determined the effect of dietary Ca concentration and the individual long-chain fatty acids on Ca-fatty acid soap formation and fatty acid digestibility.

METHODS

Nine-week-old crossbreed male pigs (n = 144; mean ± SD body weight: 21.7 ± 0.15 kg) were used as an animal model for digestion in the adult human. The animals received purified diets containing 4 Ca concentrations (0, 2, 4, and 6 g/kg diet) and 4 fat sources (tallow, palmolein oil, soybean oil, and olive oil) in a completely randomized design. Fatty acids, Ca, and Ca-fatty acid soaps were determined in feces (n = 9 per diet).

RESULTS

Increasing dietary Ca led to a 4-fold increase (P ≤ 0.05) in excreted palmitic and stearic acid when diets contained tallow or palmolein oil as the major fat source. More than 80% of these excreted fatty acids were present as soaps. For the tallow-based diets, increasing dietary Ca led to a decrease in stearic acid digestibility from 91% to 66% (P ≤ 0.01) and in palmitic acid digestibility from 96% to 83% (P ≤ 0.01). For the olive oil- and soybean oil-based diets dietary Ca did not (P > 0.05) influence fatty acid excretion.

CONCLUSIONS

Ca-fatty acid soap formation led to decreased fat absorption in the GIT of growing pigs, which supports the hypothesis that higher dietary Ca concentrations reduce fat absorption.

Whole and Isolated Protein Fractions Differentially Affect Gastrointestinal Integrity Markers in C57Bl/6 Mice Fed Diets with a Moderate-Fat Content

Various proteins or protein fractions reportedly positively affect gastrointestinal integrity and inflammation in diets providing >45% energy as fat. This study tested whether benefits were seen in diets providing 30% of energy as fat. Purified diets (PD) with isolated soy protein (ISP), dried whole milk powder (DWMP), milk fat globule membrane (MFGM), or milk protein concentrate (MPC) as protein sources were fed to C57BL/6J mice (n = 15/diet group) for 13 weeks. MFGM-fed mice were heaviest (p < 0.005) but remained within breeder norms. Growth rates and gut motility were similar for all PD-fed mice. FITC-dextran assessed gut permeability was lowest in DWMP and MFGM (p = 0.054); overall, plasma endotoxin and unprovoked circulating cytokines indicated a non-inflammatory state for all PD-fed mice. Despite differences in cecal butyrate and intestinal gene expression, all PDs supported gastrointestinal health. Whole milk provided more positive effects compared to its fractions. However, ISP-fed mice showed a >370%, (p < 0.006) increase in colonic myeloperoxidase activity indicative of tissue neutrophil infiltration. Surprisingly, FITC-dextran and endotoxin outcomes were many folds better in PD-fed mice than mice (strain, vendor, age and sex matched) fed a “chow-type” nutritionally adequate non-PD. Additional variables within a diet’s matrix appear to affect routine indicators or gastrointestinal health.

Association of Vitamin D Receptor Gene Polymorphisms With the Evolution of MODY Diabetes: Study in Tunisian Patients

Vitamin D (VD) cannot be considered as a true vitamin, but rather as a hormone, which exerts its action via a vitamin D receptor (VDR). Many genes have been shown to be involved in the evolution of diabetes in various populations, such as the vitamin D receptor gene. The aim of our study was to investigate if BsmI, TaqI, ApaI, FokI, and Tru9I, polymorphisms of VDR gene have an impact on MODY diabetes and its clinical aspects in a Tunisian population. A total of 95 patients and 153 controls were genotyped using PCR-RFLP. The comparison of the allelic and genotypic frequencies of the five polymorphisms between MODY subjects and control groups revealed the association of MODY diabetes with TaqI, Tru9I and BsmI polymorphisms and no significant differences were observed in the distributions for the ApaI and FokI polymorphisms. After stratification with biochemical and clinical parameters and TaqI, Tru9I and BsmI polymorphisms, we found an association between the three SNPs and different parameters such as age of diagnosis, therapy, hsCRP and HDL-C levels. Our results revealed that TaqI, Tru9I and BsmI polymorphisms may be more related to the progression of MODY diabetes. The possible role of vitamin D in the pathogenesis of MODY is far from being completely understood. Further knowledge on this issue may identify new candidate targets in the treatment and prevention of the disease. Our findings suggest that the TaqI, Tru9I and BsmI polymorphisms may be more related to the progression of MODY diabetes.

Sex-Specific Association between Serum Vitamin D Status and Lipid Profiles: A Cross-Sectional Study of a Middle-Aged and Elderly Chinese Population

Studies have shown that vitamin D status might be associated with dyslipidaemia, but results are conflicting and there might exist sex differences. The aim of our study was to explore the sex-specific association between vitamin D status and serum lipids and atherogenic index of plasma (AIP, a predictor for atherosclerosis) among Chinese middle-aged and elderly adults. A total of 4,021 middle-aged and elderly participants from a health management centre were included in this cross-sectional study. The individuals were classified into tertiles according to serum 25(OH)D. Linear and logistic regression models were used to estimate the association between vitamin D levels and serum lipids among the tertiles. The mean serum 25(OH)D level was 21.60 (16.60-27.20) ng/mL in all participants. After adjusting for potential confounders, a 10 ng/mL increase in 25(OH)D was associated with decreases of 1.156 mmol/L in triglycerides (TGs) and 0.068 in the AIP and an increase of 0.051 mmol/L in high-density lipoprotein cholesterol (HDL-C) in all subjects. In addition, 25(OH)D deficiency was associated with an increased prevalence of hypertriglyceridaemia (odds ratio (OR), 1.880; 95% confidence interval (CI), 1.351-2.615), hypoalphalipoproteinaemia/HDL (OR, 1.505; 95% CI, 1.146-1.977) and abnormal AIP (OR, 1.933; 95% CI, 1.474-2.534) in males, and 25(OH)D-deficient women had a 2.02-fold higher risk for hypoalphalipoproteinaemia/HDL than women with sufficient 25(OH)D levels (95% CI, 1.044-3.904; all p values <0.05). Vitamin D deficiency was positively associated with the prevalence of dyslipidaemia and abnormal AIP in the middle-aged and elderly Chinese population. And this association was stronger in men than in women.

Update on the Crosstalk Between Adipose Tissue and Mineral Balance in General Population and Chronic Kidney Disease

Adipose tissue is nowadays considered as a major endocrine organ, which apart from controlling lipid metabolism, displays a significant role in energy expenditure, food intake and in the regulation of various systemic physiological processes. Adipose derived pro-inflammatory cytokines and adipokines, particularly leptin and adiponectin, provide inter-communication of adipose tissue with various metabolic pathways, ultimately resulting in a complex network of interconnected organ systems. Recent clinical and experimental research has been focused on exploring the direct interaction between adipokine profile and elements of mineral metabolism, including parathormone (PTH), fibroblast growth factor-23 (FGF23) and calcitriol. The emerging crosstalk between adipose tissue and calcium and phosphorus homeostasis suggests that metabolic disorders from one system may directly affect the other and vice versa. It is current knowledge that fat metabolism disturbance, commonly encountered in obese individuals, influences the expression of calciotriopic hormones in general population, while various clinical trials attempting to successfully achieve body fat loss by modulating mineral profile have been published. In chronic kidney disease (CKD) state, there is an increasing evidence suggesting that mineral disorders, influence adipose tissue and linked endocrine function. On the contrary, the impact of disturbed fat metabolism on CKD related mineral disorders has been also evocated in clinical studies. Recognizing the pathogenetic mechanisms of communication between adipose tissue and mineral balance is critical for understanding the effects of metabolic perturbations from the one system to the other and for identifying possible therapeutic targets in case of disrupted homeostasis in one of the two connected systems. To that end, this review aims to enlighten the recent advances regarding the interplay between mineral metabolism, fat mass and adipokine profile, based on in vitro, in vivo and clinical studies, in general population and in the course of CKD.

The Effect of Vitamin D Supplementation on Blood Lipids in Patients with Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

Studies have found that vitamin D supplementation may improve blood lipids in patients with polycystic ovary syndrome, but the results are controversial, so this study will further analyze the effect of vitamin D supplementation on blood lipids in patients with polycystic ovary syndrome.

METHODS

PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases were searched up to May 2020, to identify randomized controlled trials of the effect of vitamin D supplementation on blood lipids in patients with polycystic ovary syndrome. The Cochrane risk of bias tool was applied to assess the risk of bias, and RevMan5.3 software was used for statistical analysis.

RESULTS

Ten studies were included in this study, including 543 subjects. The results of the meta-analysis showed that, compared with placebo, vitamin D supplementation can significantly reduce total cholesterol level (WMD = -11.32, 95% CI = [-14.51, -8.41], P < 0.00001), low-density lipoprotein cholesterol level (WMD = -4.83, 95% CI = [-7.52, -2.14], P=0.0004), and triglyceride level (WMD = -8.23, 95% CI = [-13.08, -3.38], P=0.0009, but the effect on high-density lipoprotein cholesterol level is not statistically significant (WMD = -0.32, 95%CI = [-1.24, 0.60], P=0.50).

CONCLUSION

Vitamin D supplementation can significantly reduce total cholesterol, low-density lipoprotein cholesterol, and triglycerides in patients with polycystic ovary syndrome. However, it has no significant effect on high-density lipoprotein cholesterol.

Meta-analysis of randomized controlled trials on calcium supplements and dairy products for changes in body weight and obesity indices

This meta-analysis was performed to investigate whether calcium supplements and dairy products change obesity indices including fat mass. Original articles published in English between July 2009 and August 2019 were identified. Ten and 14 randomised controlled trials (RCTs) with ≥ 12 weeks interventions of calcium supplements and dairy products among overweight or obese adults aged ≥18 were critically reviewed. Mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) were obtained using a random effect meta-analysis. Dairy products significantly changed fat mass (SMD, 95% CI; -0.40 [-0.77, -0.02]) and BMI (MD, 95% CI: -0.46 kg/m2 [-0.67, -0.26]), and calcium supplements also showed changes in fat mass (SMD, 95% CI; -0.15[-0.28, -0.02]). However, in the analysis of RCTs with low risk of bias scores, the significant changes remained only in the dairy-products intervention. Our findings suggest that dairy products without distinction of fat percentage may help reduce fat mass and BMI, but calcium supplements may not.

The effect of calcium supplement intake on lipid profile: a systematic review and meta-analysis of randomized controlled clinical trials

Despite the potential role of dietary calcium in fat excretion, the favorable effects of calcium supplements on lipid profile remains inconclusive. The current study aimed to review the effect of calcium supplement intake on lipid profile in randomized controlled clinical trials (RCTs). This systematic review and meta-analysis was conducted in PubMed, Scopus, Embase, and Central. RCTs which assessed the effects of calcium supplementation on lipid profile were included. All outcomes were recorded as continuous variables, and the effect size was measured. We classified studies according to dose of supplement, study duration, and dyslipidemia. Calcium supplement intake was associated with a significant reduction in low density lipoprotein cholesterol (LDL-C) level (WMD:-0.08; 95%CI:-0.16,-0.01)(mmol/l), especially with intakes of at least 1000 mg/day (WMD:-0.13; 95%CI:-0.23,-0.03)(mmol/l), with intakes of at least 12 weeks (WMD:-0.08; 95%CI: -0.16,-0.00)(mmol/l), and in individuals without dyslipidemia (WMD:-0.15; 95%CI:-0.26,-0.04)(mmol/l). Also, in another subgroup analysis, consumption of less than 1000 mg/day calcium supplement caused a significant increase in Total Cholesterol (TC) level (WMD: 0.24; 95%CI: 0.05,0.42) (mmol/l). In other blood lipids or study subgroups we observed no significant effect. We concluded that calcium supplements had a favorable effect on LDL-C level, especially in individuals without dyslipidemia, higher calcium intakes, and longer period of consumption.

Parathyroid Hormone and 25-Hydroxyvitamin D Do Not Mediate the Association between Dietary Calcium, Protein and Vitamin D Intake and Adiposity and Lipid Profile in Patients with Type 2 Diabetes: a Structural Equation Modeling Approach

This study aimed to utilize structural equation modeling (SEM) techniques to determine the effects of dietary calcium, protein and vitamin D on adiposity and lipidemia and to assess mediatory effects of parathyroid hormone (PTH) and 25-hydroxyvitamin D (25(OH)D) in patients with type 2 diabetes. In this cross-sectional study, a total of 150 diabetic patients (93 females and 57 males) were randomly selected. Anthropometric measures, biochemical analyses, and fat mass percent were recorded. Nutritional data were collected. SEM was performed. Based on the primary hypothesis, adiposity and lipidemia were fitted in a model. The direct effects of dietary calcium (λ = -0.165, p value = 0.002) and PTH (λ = -0.143, p value = 0.011) were significantly associated with lipidemia. There were no significant effects for dietary protein on PTH (λ = -0.270, p value = 0.057), 25(OH)D (λ = -0.071, p value = 0.613), lipidemia (λ = -0.044; p value = 0.638) or adiposity (λ = -0.009, p value = 0.949) as well as for dietary vitamin D on PTH (λ = -0.119, p value = 0.194), 25(OH)D (λ = 0.023, p value = 0.806), lipidemia (λ = 0.034, p value = 0.587) or adiposity (λ = -0.221, p value = 0.118). The correlation between calcium intake and lipidemia, and adiposity are not mediated by 25(OH)D and PTH. There were the direct effects of dietary calcium on adiposity in patients with type 2 diabetes. The model can be tested in future longitudinal and intervention studies to identify the predictors of obesity.

Lack of adipocyte purinergic P2Y6 receptor greatly improves whole body glucose homeostasis

Uridine diphosphate (UDP)-activated purinergic receptor P2Y₆ (P2Y₆R) plays a crucial role in controlling energy balance through central mechanisms. However, P2Y₆R's roles in peripheral tissues regulating energy and glucose homeostasis remain unexplored. Here, we report the surprising finding that adipocyte-specific deletion of P2Y₆R protects mice from diet-induced obesity, improving glucose tolerance and insulin sensitivity with reduced systemic inflammation. These changes were associated with reduced JNK signaling and enhanced expression and activity of PPARα affecting downstream PGC1α levels leading to beiging of white fat. In contrast, P2Y₆R deletion in skeletal muscle reduced glucose uptake, resulting in impaired glucose homeostasis. Interestingly, whole body P2Y₆R knockout mice showed metabolic improvements similar to those observed with mice lacking P2Y₆R only in adipocytes. Our findings provide compelling evidence that P2Y₆R antagonists may prove useful for the treatment of obesity and type 2 diabetes.

Vitamin D3 supplementation improves glycemic control in type 2 diabetic patients: Results from an Italian clinical trial

Background: to evaluate the effects of Vitamin D3 on glyco-metabolic control in type 2 diabetic patients with Vitamin D deficiency. Methods: one hundred and seventeen patients were randomized to placebo and 122 patients to Vitamin D3. We evaluated anthropometric parameters, glyco-metabolic control, and parathormone (PTH) value at baseline, after 3, and 6 months. Results: a significant reduction of fasting, and post-prandial glucose was recorded in Vitamin D3 group after 6 months. A significant HbA_1c decrease was observed in Vitamin D3 (from 7.6% or 60 mmol/mol to 7.1% or 54 mmol) at 6 months compared to baseline, and to placebo (p < 0.05 for both). At the end of the study period, we noticed a change in the amount in doses of oral or subcutaneous hypoglycemic agents and insulin, respectively. The use of metformin, acarbose, and pioglitazone was significantly lower (p = 0.037, p = 0.048, and p = 0.042, respectively) than at the beginning of the study in the Vitamin D3 therapy group. The units of Lispro, Aspart, and Glargine insulin were lower in the Vitamin D3 group at the end of the study (p = 0.031, p = 0.037, and p = 0.035, respectively) than in the placebo group. Conclusions: in type 2 diabetic patients with Vitamin D deficiency, the restoration of value in the Vitamin D standard has led not only to an improvement in the glyco-metabolic compensation, but also to a reduced posology of some oral hypoglycemic agents and some types of insulin used.

Conditional and unconditional genome-wide association study reveal complicate genetic architecture of human body weight and impacts of smoking

To reveal the impacts of smoking on genetic architecture of human body weight, we conducted a genome-wide association study on 5,336 subjects in four ethnic populations from MESA (The Multi-Ethnic Study of Atherosclerosis) data. A full genetic model was applied to association mapping for analyzing genetic effects of additive, dominance, epistasis, and their ethnicity-specific effects. Both the unconditional model (base) and conditional model including smoking as a cofactor were investigated. There were 10 SNPs involved in 96 significant genetic effects detected by the base model, which accounted for a high heritability (61.78%). Gene ontology analysis revealed that a number of genetic factors are related to the metabolic pathway of benzopyrene, a main compound in cigarettes. Smoking may play important roles in genetic effects of dominance, dominance-related epistasis, and gene-ethnicity interactions on human body weight. Gene effect prediction shows that the genetic effects of smoking cessation on body weight vary from different populations.

Evaluation of risk factors for insulin resistance: a cross sectional study among employees at a private university in Lebanon

BACKGROUND

Worldwide, the prevalence of insulin resistance ranges from 15.5 to 46.5%, among adults. Lebanon reported one of the highest rates reaching 44.6%. The literature suggests an association between dairy product consumption and insulin resistance, however results are inconclusive. To our knowledge, no study examined this association in the Middle Eastern Region. The aim of the study was to investigate the prevalence of insulin resistance among a sample of Lebanese adults, to identify its risk factors depending on gender, and to evaluate the association between insulin resistance and dairy products consumption.

METHODS

A cross-sectional study was conducted among employees at Notre Dame University - Louaize. Four questionnaires were administered including a background and International Physical Activity Questionnaire short form questionnaires, food frequency questionnaire and a 24 h recall. Bioelectric Impedance Analysis (BIA) was used to measure percent body fat (PBF). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used to quantify insulin resistance. A person with HOMA-IR ≥ 2.5 was considered as insulin resistant. Statistical analyses were performed using the Statistical Package for Social Sciences version 23 for Windows. P < 0.05 was considered statistically significant.

RESULTS

Out of 286 study participants, 38.0% were insulin resistant. Average dairy product intake in the total sample was 2.2 ± 1.0 servings per day. Among males, the odds of having insulin resistance were 3.9 times higher (95%CI 1.4-11.0; p = 0.009) for those having a risky waist circumference compared to those having a healthy waist circumference. Among females, being married (OR: 0.2, 95%CI 0.1-0.5; p = 0.002), PBF (OR: 1.2, 95%CI 1.0-1.3; p = 0.008) and hypertriglyceridemia (OR: 8.7, 95%CI: 2.1-35.9; p = 0.003) were associated with HOMA-IR, after controlling for confounders. Dairy intake was not associated with HOMA-IR neither among males (p = 0.777), nor among females (p = 0.968), after controlling for confounders.

CONCLUSION

Dairy consumption was not associated with increased insulin resistance. More research focusing on the relationship between dairy intake and insulin resistance is needed, especially in the Arab and Middle-Eastern region. Future studies should examine the effect of different types of dairy products and the effect of different nutrients in dairy products on insulin resistance.

Exertional rhabdomyolysis and causes of elevation of creatine kinase

Background: Rhabdomyolysis is a potentially fatal condition that can be triggered by a variety of inciting events, including excessive muscular exertion.The purpose of this study was to investigate the causes of creatine kinase elevation (CK≥1000U/L) to determine what percentage result from exRML, the etiology, and kinetics of CK levels, as well as the complications of exRML and comorbidities that may predispose an individual to this condition.Methods: We performed a cross-sectional analysis of the emergency department database for patients with CK≥1000U/L between 2012 and 2017. In total, there were 1957 cases of rhabdomyolysis diagnosed based on laboratory data and documentation. Trauma was the most common cause for rhabdomyolysis (n = 726/1957; 37.1%, respectively).Results: ExRML was identified in 2.1% (n = 42/1957) of the total cases. Patients with ExRML were significantly younger (30.1 ± 10.6 years) with a significantly higher maximal level of CK compared to the non-exertional causes of rhabdomyolysis, (CK = 16,884.4 ± 41,645.6U/L; both p < 0.005). The far majority of cases were sport or exercise related (n = 35/42; 83.3%), with strength training at the gym making up the largest group of athletes (n = 16/42; 38.1%). The main complication amongst the ExRML group was acute kidney insufficiency, which was observed in 42.9% of patients. The CK levels of the patients in the ExRML cohort steadily decreased after initiation of aggressive hydration.Conclusion: ExRML may be more prevalent than the current literature predicts, which is important to recognize as it has the potential to cause kidney failure, irregular heart rhythm, and death. Therefore, physicians and active individuals should be sensitized to the signs and symptoms that may lead to earlier recognition and proper treatment in exercising individuals.

High serum concentration of selenium, but not calcium, cobalt, copper, iron, and magnesium, increased the risk of both hyperglycemia and dyslipidemia in adults: A health examination center based cross-sectional study

BACKGROUND

Metabolic disorders of glucose and lipid were associated with some mineral elements, and data were warranted from various contexts to make the association more explicit.

OBJECTIVE

To investigate the relationships between the serum concentrations of six mineral elements (calcium, cobalt, copper, iron, magnesium, and selenium) and the risk of hyperglycemia and dyslipidemia in adults.

METHODS

The basic information and the over-night fasting serum samples of adults were randomly collected at a health examination center. The serum concentrations of glucose and lipids were measured with an automatic biochemical analyzer, and the mineral elements were measured with an inductively coupled plasma mass spectrometer. Data were analyzed between the hyperglycemia group (HGg) and the normal glucose group (NGg) as well as between the dyslipidemia group (DLg) and the normal lipid group (NLg).

RESULTS

A total of 1466 adults aged 22-81 years (male/female = 1.8) were included, 110 in the HGg and 1356 in the NGg, or 873 in the DLg and 593 in the NLg. The serum element concentration medians [P50 (P25-P75)] significantly different between the HGg and the NGg were 0.83 (0.75-0.94) vs. 0.76 (0.68-0.87) mg/L for copper and 100 (90-110) vs. 94 (87-103) μg/L for selenium (P < 0.001), while those between the DLg and the NLg were 99 (92-110) vs. 97 (90-106) mg/L for calcium, 0.78 (0.69-0.88) vs. 0.75 (0.66-0.85) mg/L for copper, 1.7 (1.4-2.0) vs. 1.6 (1.3-2.0) mg/L for iron, 24 (22-28) vs. 23 (22-27) mg/L for magnesium, and 97 (89-106) vs. 92 (84-100) μg/L for selenium (P < 0.05). When the copper and selenium between the HGg and the NGg were analyzed by logistic regression with age, gender, body mass index, and mineral elements adjusted, only the highest quartile of selenium concentration had association with the increased risk of hyperglycemia [quartile (Q) 4 against Q1: OR = 2.9, 95 % CI = 1.5-5.5, P < 0.001). When the five differed mineral elements between the DLg and the NLg were similarly analyzed, only iron and selenium had associations with the increased risk of dyslipidemia (e.g., Q4 against Q1: OR = 1.4, 95 % CI = 1.1-2.0 for iron and OR = 2.9, 95 % CI = 2.1-4.0 for selenium, P < 0.05).

CONCLUSION

In contrast to those of calcium, cobalt, copper, iron, and magnesium, the higher serum concentration of selenium increased the risk of both hyperglycemia and dyslipidemia in the study population of adult Chinese.

Increased consumption of calcium from fat-free milk, energy-restricted diet and educational activities improves metabolic control in overweight type 2 diabetic patients

We assessed the effects of increased Ca consumption from fat-free milk in an energy-restricted diet and educational activities in the metabolic control of overweight type 2 diabetes mellitus (T2DM) patients. Fourteen subjects with T2DM (BMI 29·4 (sd 4·5) kg/m2, low habitual Ca consumption (<600 mg/d)) were included in this randomised, crossover clinical trial. Subjects were randomly allocated to one of the two interventions: drink containing 700 mg of Ca (DAIR) or drink containing 0 mg of Ca (CONT) for ninety consecutive days each. Energy-restricted diets (-500 kcal/d; -2092 kJ/d), containing 800 mg of Ca from dietary sources/d, were prescribed for both groups. Questionnaires were applied at baseline and at the end of the study to assess the subjects' knowledge on the disease and on self-care, biochemical variables and physical activity. Blood pressure, food intake, body composition and anthropometry were assessed at baseline, days 45 and 90. There was a higher reduction of body fat %, waist circumference, hip circumference, neck circumference, waist:hip ratio, sagittal abdominal diameter, diastolic/systolic blood pressure and an increase in fat-free mass % in DAIR than in CONT. Uric acid, fasting glucose, Hb1Ac, parathyroid hormone and alanine aminotransferase concentrations reduced and vitamin D concentration increased after 90 d in DAIR compared with CONT. The consumption of energy-restricted diet containing 1200 mg Ca/d seems to favour metabolic control in subjects with T2DM. The educational activities increased the knowledge on the disease care.

Differential Impact of Calcium and Vitamin D on Body Composition Changes in Post-Menopausal Women Following a Restricted Energy Diet and Exercise Program

Vitamin D and calcium supplementation have been posited to improve body composition and different formulations of calcium may impact bioavailability. However, data are lacking regarding the combinatorial effects of exercise, diet, and calcium and/or vitamin D supplementation on body composition changes in post-menopausal women. Herein, 128 post-menopausal women (51.3 ± 4.5 years, 36.4 ± 5.7 kg/m², 46.2 ± 4.5% fat) were assigned to diet and supplement groups while participating in a supervised circuit-style resistance-training program (3 d/week) over a 14-week period. Diet groups included: (1) normal diet (CTL), (2) a low-calorie, higher protein diet (LCHP; 1600 kcal/day, 15% carbohydrates, 55% protein, 30% fat), and (3) a low-calorie, higher carbohydrate diet (LCHC; 1600 kcal/day, 55% carbohydrates, 15% protein, 30% fat). Supplement groups consisted of: (1) maltodextrin (PLA), (2) 800 mg/day of calcium carbonate (Ca), and (3) 800 mg/day of calcium citrate and malate and 400 IU/day of vitamin D (Ca+D). Fasting blood samples, body composition, resting energy expenditure, aerobic capacity, muscular strength and endurance measures were assessed. Data were analyzed by mixed factorial ANOVA with repeated measures and presented as mean change from baseline [95% CI]. Exercise training promoted significant improvements in strength, peak aerobic capacity, and blood lipids. Dieting resulted in greater losses of body mass (CTL -0.4 ± 2.4; LCHC -5.1 ± 4.2; LCHP -3.8 ± 4.2 kg) and fat mass (CTL -1.4 ± 1.8; LCHC -3.7 ± 3.7; LCHP -3.4 ± 3.4 kg). When compared to LCHC-PLA, the LCHC + Ca combination led to greater losses in body mass (PLA -4.1 [-6.1, -2.1], Ca -6.4 [-8.1, -4.7], Ca+D -4.4 [-6.4, -2.5] kg). In comparison to LCHC-Ca, the LCHC-Ca+D led to an improved maintenance of fat-free mass (PLA -0.3 [-1.4, 0.7], Ca -1.4 [-2.3, -0.5], Ca+D 0.4 [-0.6, 1.5] kg) and a greater loss of body fat (PLA -2.3 [-3.4, -1.1], Ca -1.3 [-2.3, -0.3], Ca+D -3.6 [-4.8, -2.5]%). Alternatively, no significant differences in weight loss or body composition resulted when adding Ca or Ca+D to the LCHP regimen in comparison to when PLA was added to the LCHP diet. When combined with an energy-restricted, higher carbohydrate diet, adding 800 mg of Ca carbonate stimulated greater body mass loss compared to when a PLA was added. Alternatively, adding Ca+D to the LCHC diet promoted greater% fat changes and attenuation of fat-free mass loss. Our results expand upon current literature regarding the impact of calcium supplementation with dieting and regular exercise. This data highlights that different forms of calcium in combination with an energy restricted, higher carbohydrate diet may trigger changes in body mass or body composition while no impact of calcium supplementation was observed when participants followed an energy restricted, higher protein diet.

Vitamin D-related genes and cardiometabolic markers in healthy children: a Mendelian randomisation study

Observational studies show associations between low serum 25-hydroxyvitamin D (25(OH)D) and cardiometabolic risk markers. This Mendelian randomisation study examined associations between cardiometabolic markers in children and SNP in genes related to vitamin D metabolism (DHCR7; group-specific complement (GC); cytochrome P450 subfamily IIR1 (CYP2R1); and CYP24A1) and action (CYP27B1 and VDR). In 699 healthy 8–11-year-old children, we genotyped eleven SNP. We generated a genetic risk score based on SNP associated with low 25(OH)D and investigated associations between this and blood pressure, plasma lipids and insulin. Furthermore, we examined whether SNP related to vitamin D actions modified associations between 25(OH)D and the cardiometabolic markers. All GC and CYP2R1 SNP influenced serum 25(OH)D. A risk score based on four of the six SNP was associated with 3·4 (95 % CI 2·6, 4·2) mmol/l lower 25(OH)D per risk allele (P < 0·001), but was not associated with the cardiometabolic markers. However, interactions were indicated for the three VDR SNP (Pinteraction < 0·081) on associations between 25(OH)D and TAG, systolic blood pressure and insulin, which all decreased with increasing 25(OH)D only in major allele homozygotes (β –0·02 (95 % CI –0·04, –0·01) mmol/l; β –0·5 (95 % CI –0·9, –0·1) mmHg; and β –0·5 (95 % CI –1·4, 0·3) pmol/l, respectively). In conclusion, genetic variation affected 25(OH)D substantially, but the genetic score was not associated with cardiometabolic markers in children. However, VDR polymorphisms modified associations with vitamin D, which warrants further investigation of VDR's role in the relationship between vitamin D and cardiometabolic risk.

Dietary Calcium Intake and the Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

Growing evidence has suggested a possible relationship between dietary calcium intake and metabolic syndrome (MetS) risk. However, the findings of these observational studies are inconclusive, and the dose-response association between calcium intake and risk of MetS remains to be determined. Here, we identified relevant studies by searching PubMed and Web of Science databases up to December 2018, and selected observational studies reporting relative risk (RR) with 95% confidence interval (CI) for MetS based on calcium intake and estimated the summary RRs using random-effects models. Eight cross-sectional and two prospective cohort studies totaling 63,017 participants with 14,906 MetS cases were identified. A significantly reduced risk of MetS was associated with the highest levels of dietary calcium intake (RR: 0.89; 95% CI: 0.80–0.99; I² = 75.3%), with stronger association and less heterogeneity among women (RR: 0.74, 95% CI: 0.66–0.83; I² = 0.0%) than among men (RR: 1.06, 95% CI: 0.82–1.37; I² = 72.6%). Our dose-response analysis revealed that for each 300 mg/day increase in calcium intake, the risk of MetS decreased by 7% (RR: 0.93; 95% CI: 0.87–0.99; I² = 77.7%). In conclusion, our findings suggest that dietary calcium intake may be inversely associated with the risk of MetS. These findings may have important public health implications with respect to preventing the disease. Further studies, in particular longitudinal cohort studies and randomized clinical trials, will be necessary to determine whether calcium supplementation is effective to prevent MetS.

Effects of Vitamin D Status and Supplements on Anthropometric and Biochemical Indices in a Clinical Setting: A Retrospective Study

CONTEXT

Obesity and low vitamin D status are linked. It is not clear that weight loss through lifestyle intervention is influenced by vitamin D status.

OBJECTIVE

The aim of this study was to investigate the effect of baseline vitamin D status and vitamin D supplementation on weight loss and associated parameters for participants on a weight loss program in a primary care setting.

DESIGN

A retrospective analysis of clinical records of patients who underwent an individually tailored weight loss program at a single dietetic clinic in Sydney, Australia.

SETTING

Primary care centers.

PATIENTS

205 overweight and obese men and women aged from 18 to 50 years.

INTERVENTIONS

Patients were referred to a dietetic clinic for a weight loss program. Patients with low serum 25-hydroxyvitamin D (25(OH)D) concentrations at baseline were advised to increase sun exposure and take multivitamins supplemented with 2000 IU or 4000 IU per day of vitamin D3, according to the preference of their primary care physician.

MAIN OUTCOME MEASURES

Clinical parameters of weight, height, waist circumference, and serum 25(OH)D, as well as blood pressure and fasting lipid profile were collected from both baseline and three-month follow-up consultations.

RESULTS

Subjects with sufficient baseline 25(OH)D levels (≥50 nmol/L) experienced significantly greater weight loss (-7.7 ± 5.9 kg vs. -4.2 ± 3.3 kg) and reductions in BMI (-2.6 ± 1.8 kg/m² vs. -1.5 ± 1.1 kg/m²) and waist circumference (-5.2 ± 3.5 cm vs. -3.1 ± 3.1 cm) as compared with those who were vitamin D insufficient at baseline (p < 0.001 for all). Vitamin D insufficient patients who were supplemented with daily 2000 IU or 4000 IU vitamin D experienced significantly greater decreases in weight (-5.3 ± 3.6 kg vs. -2.3 ± 1.6 kg), BMI (-1.9 ± 1.2 kg/m² vs. -0.8 ± 0.6 kg/m²) and waist circumference (-4.2 ± 3.4 cm vs. -1.2 ± 1.3 cm) as compared with those not supplemented (p < 0.001 for all). We also observed a greater decrease in low-density lipoprotein (LDL) cholesterol (-0.4 ± 0.5 mmol/L vs. -0.2 ± 0.5 mmol/L) in subjects insufficient at baseline and supplemented as compared with those insufficient at baseline and not supplemented (p < 0.01).

CONCLUSION

In a weight loss setting in a dietetic clinic, adequate vitamin D status at baseline, or achieved at three months through supplementation, was associated with significantly greater improvement of anthropometric measures. The study has implications for the management of vitamin D status in obese or overweight patients undergoing weight loss programs.

Determination of Elements in Gymnema inodorum Lour by Particle Induced X-Ray Emission (PIXE)

At present, Thailand uses medicinal plants to treat various diseases. Alternative medicine utilizes Gymnema inodorum Lour for antipyretic and anti-allergic purposes. There are also other research studies to treat diabetes mellitus, coronary artery disease, cataract, rheumatoid arthritis, gout, liver cancer, and stomach cancer. This study used particle-induced X-ray emission (PIXE) technique to analyze the elements in this plant. The advantage of this technique over other methods is the multi-elemental analysis and high sensitivity. The objective of this study was to determine the elemental compositions and to develop new standard methods for analyzing plant elemental compositions in Thailand. A 2-MeV proton beam was used to identify and characterize major and minor elements namely Mg, Al, Si, P, S, Cl, K, Ca, Ti, Mn, Fe, and Zn in Gymnema Inodorum Lour. Results have shown that these elements are present in varying concentrations in the selected parts: roots, stems, and leaves. The data of elemental analysis, applied in recommended quantities that are harmful to the body, describe the relationship between elements and efficacy of this plant in alternative medicine.

Advantage of Dairy for Improving Aging Muscle

The risk of sarcopenia increases with aging. Malnutrition in the elderly population is an important risk factor for sarcopenia. Calcium (Ca), phosphate (P), vitamin D and protein are key nutrients for the human body and affect muscle mass and quality. Dairy products are rich in these nutrients, which implicates that dairy products might be ideal for elderly population. This systematic review highlights the effects of dairy products on muscle mass, muscle strength and body performance in the elderly population in the perspective of Ca, P, vitamin D and protein.

The Effects of Dairy Intake on Insulin Resistance: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

The incidence of type 2 diabetes mellitus (DM) has increased in the US over the last several years. The consumption of low-fat dairy foods has been linked with decreasing the risk of DM but studies have yet to show a clear correlation. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the effects of dairy intake on homeostatic model assessment of insulin resistance (HOMA-IR), waist circumference, and body weight. In MEDLINE and Embase, we identified and reviewed 49 relevant RCTs: 30 had appropriate data format for inclusion in the meta-analysis. Using the Review Manager 5 software, we calculated the pooled standardized mean differences comparing dairy dietary interventions to control for our outcomes of interest. For HOMA-IR (794 individuals), we found a mean difference of −1.21 (95% CI −1.74 to −0.67; p-value < 0.00001; I² = 92%). For waist circumference (1348 individuals), the mean difference was −1.09 cm (95% CI 1.68 to −0.58; p-value < 0.00001; I² = 94%). For body weight (2362 individuals), the dairy intake intervention group weighed 0.42 kg less than control (p-value < 0.00001; I² = 92%). Our findings suggest that dairy intake, especially low-fat dairy products, has a beneficial effect on HOMA-IR, waist circumference, and body weight. This could impact dietary recommendations to reduce DM risk.

[Myths and fallacies in relation to the consumption of dairy products]

INTRODUCTION

In recent years the consumption of milk has declined, which could be due to the many myths and fallacies that exist about this food and other dairy products. Affirmations such as: "cow's milk is ideal for calves not humans", "humans are the only animals that drink milk beyond infancy", "milk lead to mucus production or occurrence of asthma" or "milk increases cholesterol levels", among others, are present in many conversations of the general population. However, due to the high nutritional value of dairy products, the elimination/restriction of these foods of our diet, without the existence of circumstances that support it, can have negative repercussions for health. Therefore, it is necessary to dismantle all these myths with scientific arguments.

High calcium intake from fat-free milk, body composition and glycaemic control in adults with type 2 diabetes: a randomised crossover clinical trial

We evaluated the effects of high-Ca fat-free milk v. low-Ca control diet on adiposity and on glycaemic control. Fourteen subjects with type 2 diabetes (aged 49·5 (sd 8·6) years, BMI 29·4 (sd 4·5) kg/m2, low habitual Ca consumption (<600 mg/d)) were included in this randomised, crossover clinical trial. Subjects participated in two 12-week experimental sessions (high-Ca fat-free milk (HC) or low-Ca control (LC)) separated by 8-week washout. Subjects daily consumed in the laboratory a breakfast shake containing 700 mg (HC) or 6·4 mg (LC) of Ca. Energy-restricted diets containing 800 mg of dietary Ca/d were prescribed. Dietary records data indicated the consumption of 1200 mg of Ca/d during HC and of 525 mg of Ca/d during LC. There was a greater reduction in body weight, body fat mass, waist circumference and waist:hip ratio after HC. Serum 25-hydoxyvitamin D and homeostatic model assessment-2 β-cell function (HOMA2-%B) increased, and serum uric acid, parathormone (PTH) and glycated Hb (HbA1c) concentrations reduced after HC. In addition, changes from baseline in terms of serum uric acid, glucose, HbA1c and PTH concentrations were lower, and those of HOMA2-%B, serum Ca and 25-hydoxyvitamin D were higher after the HC than after LC. The consumption of approximately three servings of fat-free milk and 1200 mg of dietary Ca/d enhanced weight loss, improved body composition and promoted glycaemic control in subjects with type 2 diabetes and low habitual Ca consumption (<600 mg/d).

Deep ocean minerals inhibit IL-6 and IGFIIR hypertrophic signaling pathways to attenuate diabetes-induced hypertrophy in rat hearts

We previously reported that deep sea water (DSW) prolongs the life span of streptozotocin (STZ)-induced diabetic rats by the compensatory augmentation of the insulin like growth factor (IGF)-I survival signaling and inhibition of apoptosis. Here, we investigated the effects of DSW on cardiac hypertrophy in diabetic rats. Cardiac hypertrophy was induced in rats by using STZ (65 mg/kg) administered via IP injection. DSW was prepared by mixing DSW mineral extracts and desalinated water. Different dosages of DSW-1X (equivalent to 37 mg Mg²⁺·kg^-1·day^-1), 2X (equivalent to 74 mg Mg²⁺·kg^-1·day^-1) and 3X (equivalent to 111 mg Mg²⁺·kg^-1·day^-1) were administered to the rats through gavage for 4 wk. Cardiac hypertrophy was evaluated by the heart weight-to-body weight ratio and the cardiac tissue cross-sectional area after hematoxylin and eosin staining. The protein levels of the cardiac hypertrophy signaling molecules were determined by Western blot. Our results showed that the suppressive effects of the DSW treatment on STZ-induced cardiac hypertrophy were comparable to those of MgSO₄ administration and that the hypertrophic marker brain natriuretic peptide (BNP) was decreased by DSW. In addition, DSW attenuated both the eccentric hypertrophy signaling pathway, IL-6-MEK-STAT3, and the concentric signaling pathway, IGF-II-PKCα-CaMKII, in DM rat hearts. The cardiac hypertrophy-associated activation of extracellular signal-regulated kinase (ERK) and the upregulation of the transcription factor GATA binding protein 4 (GATA4) were also negated by treatment with DSW. The results from this study suggest that DSW could be a potential therapeutic agent for the prevention and treatment of diabetic cardiac hypertrophy.NEW & NOTEWORTHY Deep sea water, containing high levels of minerals, improve cardiac hypertrophy in diabetic rats through attenuating the eccentric signaling pathway, IL-6-MEK5-STAT3, and concentric signaling pathway, IGF2-PKCα-CaMKII. The results from this study suggest that deep sea water could be a potential therapeutic agent for the prevention and treatment of diabetic cardiac hypertrophy.

Assessment of vitamin D status and parathyroid hormone during a combined intervention for the treatment of childhood obesity

BACKGROUND

Obesity is associated with vitamin D deficiency. The aim of this work is to analyze the changes in vitamin D status and PTH levels in a group of children with obesity receiving combined intervention program in order to get BMI status reduction.

METHODS

Longitudinal study in 119 children with obesity, aged 9.1-13.9 years, included in a 1-year combined dietary-behavioral-physical activity intervention. Anthropometric measurements (weight, height, BMI and fat mass index) were registered every 3 months and blood testing (calcium, phosphorous, 25(OH)D and PTH) were collected at the beginning and after 12 months of follow-up. A control group was recruited (300 healthy children, aged 8.1-13.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D.

RESULTS

Vitamin D deficiency was significantly higher in obesity group (31.1 vs. 14%). There was negative correlation between 25(OH)D and fat mass index (r = -0.361, p = 0.001). Patients with BMI reduction throughout combined intervention were 52 (43.7%). There was a significant increase in the prevalence of hypovitaminosis D in patients without BMI reduction at the end of follow-up, but in those patients with BMI reduction there was no changes of vitamin D status.

CONCLUSIONS

Obesity increases the prevalence of suboptimal vitamin D status, and a BMI status reduction in children with obesity may be required to at least stabilize vitamin D status.

Unravelled facets of milk derived opioid peptides: a focus on gut physiology, fractures and obesity

Beyond being a source of key nutrients, bovine milk influences physiological functions by synthesising bioactive peptides during the process of digestion. Some of the claimed negative health outcomes associated with milk consumption, such as cardiovascular diseases and type 1 diabetes may be attributed to an opioid peptide, beta-casomorphin-7 (BCM-7), derived from A1 beta-casein. BCM-7 exerts its function by binding to the μ-opioid receptors in the body. It is hypothesised that activation of the μ-opioid receptors in the gut can alter gut microbial composition, impair gut barrier integrity and bile acid metabolism, in addition to increasing gastrointestinal transit time and gut inflammation. Further, it is hypothesised that BCM-7 may influence fractures and obesity via μ-opioid receptor pathways. In conclusion, it appears that BCM-7 might have multiple functions pertinent to human health; however, the evidence is limited and warrants further pre-clinical and clinical studies for hypothesis confirmation.

Role of Calcium and Low-Fat Dairy Foods in Weight-Loss Outcomes Revisited: Results from the Randomized Trial of Effects on Bone and Body Composition in Overweight/Obese Postmenopausal Women

Several studies have investigated the possibility of dairy foods and calcium (Ca) mediating weight and body composition, but a consensus has not been reached. We aimed to investigate weight-loss-related outcomes during intervention with low-fat dairy foods or Ca + vitamin D supplements, both as complements to hypocaloric diets. Overweight/obese Caucasian, early-postmenopausal women (n = 135) were recruited for a 6 month energy-restricted weight loss study complemented with either low-fat dairy foods (D; 4–5 servings/day), or Ca + vitamin D supplements (S); both to amount a total of ~1500 mg/day and 600 IU/day of Ca and vitamin D, respectively, or placebo pills (C). Bone mineral density (BMD) and lean and fat tissue were measured by Lunar iDXA. Serum and urinary markers of bone turnover were analyzed. Diet and physical activity were assessed with 3-day records. Participants on average lost ~4%, ~3%, and ~2% of body weight, fat, and lean tissue, respectively. The significantly better outcomes were noticed in participants in the D group regarding body composition (fat loss/lean tissue preservation) and in participants in the S group regarding the BMD outcomes, compared to those in the C group. Therefore, increasing low-fat dairy foods to 4–5 servings/day and/or increasing Ca & vitamin D intake by supplements (in those who are at the borderline dietary intake) may be beneficial for weight loss/maintenance and may lead to more favorable bone and body composition outcomes in postmenopausal women during moderate weight loss.

Bioavailable Menthol (Transient Receptor Potential Melastatin-8 Agonist) Induces Energy Expending Phenotype in Differentiating Adipocytes

Recent evidence supports the role of menthol, a TRPM8 agonist, in enhanced energy expenditure, thermogenesis and BAT-like activity in classical WAT depots in a TRPM8 dependent and independent manner. The present study was designed to analyse whether oral and topical administration of menthol is bioavailable at subcutaneous adipose tissue and is sufficient to directlyinduce desired energy expenditure effects. GC-FID was performed to study menthol bioavailability in serum and subcutaneous white adipose tissue following oral and topical administration. Further, 3T3L1 adipocytes were treated with bioavailable menthol doses and different parameters (lipid accumulation, "browning/brite" and energy expenditure gene expression, metal analysis, mitochondrial complex's gene expression) were studied. No difference was observed in serum levels but significant difference was seen in the menthol concentration on subcutaneous adipose tissues after oral and topical application. Menthol administration at bioavailable doses significantly increased "browning/brite" and energy expenditure phenotype, enhanced mitochondrial activity related gene expression, increased metal concentration during adipogenesis but did not alter the lipid accumulation as well as acute experiments were performed with lower dose of menthol on mature adipocytes In conclusion, the present study provides evidence that bioavailable menthol after single oral and topical administration is sufficient to induce "brite" phenotype in subcutaneous adipose tissue However, critical dose characterization for its clinical utility is required.

Vitamin D and the Skin: A Review for Dermatologists

In recent years, the growing interest in the role played by vitamin D in skin disease has given rise to the publication of many studies of the relationship between this vitamin and certain skin conditions. As dermatologists, we need to understand, among other aspects, how vitamin D is synthesized and the main sources in humans, as well as plasma levels and the factors that can modify them. Of particular interest are the latest discoveries about the role of vitamin D in skin diseases such as lupus erythematosus, ichthyosis, atopic dermatitis, hidradenitis suppurativa, acne, alopecia areata, androgenetic alopecia, melanoma, and nonmelanoma skin cancer. Also of interest is the importance of vitamin D as adjuvant therapy in patients on long-term treatment with corticosteroids. In this review, we provide an overview of the most important and most recent information regarding the relationship between vitamin D and skin disease and discuss the importance of assessing individual vitamin D status and correcting deficiencies.

Dietary calcium affects body composition and lipid metabolism in rats

Calcium (Ca) intakes may affect cardiovascular disease risk by altering body composition (body weight and fat) and serum lipid profile, but results have been inconsistent and the underlying mechanisms are not well understood. The effects of dietary Ca on body composition and lipid metabolism were examined in rats. Male Sprague-Dawley rats were fed high-fat, high-energy diets containing (g/kg) low (0.75Ca, 0.86 ± 0.05; 2Ca, 2.26 ± 0.02), normal (5Ca, 5.55 ± 0.08) or high (10Ca, 11.03 ± 0.17; 20Ca, 21.79 ± 0.15) Ca for 10 weeks. Rats fed the lowest Ca diet (0.75Ca) had lower (p < 0.05) body weight and fat mass compared to other groups. Rats fed the high Ca diets had lower serum total and LDL cholesterol compared to rats fed normal or low Ca. Liver total cholesterol was lower in rats fed high compared to low Ca. In general, liver mRNA expression of genes involved in cholesterol uptake from the circulation (Ldlr), cholesterol synthesis (Hmgcr and Hmgcs1), fatty acid oxidation (Cpt2) and cholesterol esterification (Acat2) were higher in rats fed higher Ca. Apparent digestibility of total trans, saturated, monounsaturated and polyunsaturated fatty acids was lower in rats fed the high compared to the low Ca diets, with the largest effects seen on trans and saturated fatty acids. Fecal excretion of cholesterol and total bile acids was highest in rats fed the highest Ca diet (20Ca). The results suggest little effect of dietary Ca on body composition unless Ca intakes are very low. Decreased bile acid reabsorption and reduced absorption of neutral sterols and saturated and trans fatty acids may contribute to the better serum lipid profile in rats fed higher Ca.