Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial

Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y gastric bypass, sleeve gastrectomy, and one-anastomosis gastric bypass: a double-blind, randomized cross-over trial

OBJECTIVE

This study compared the efficacy of calcium (Ca) citrate and Ca carbonate supplementation on Ca absorption following Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and one-anastomosis gastric bypass (OAGB) surgeries.

SETTING

A single specialized bariatric center.

METHODS

A randomized, double-blinded, crossover study between October 2023 and February 2024. One hundred fifty participants 6 months postmetabolic bariatric surgery (MBS) were randomly selected from the electronic patient record system to create a pool of patients to randomize for the study. The intestinal absorption of Ca carbonate and Ca citrate among groups divided by surgical procedure was compared over 8 hours of testing. Measurements included serum and urine Ca concentrations for peak values (Cmax) and area under the curve (AUC0-8h), along with parathyroid hormone (PTH) levels to calculate minimum PTH (PTHmin) and cumulative PTH decline (AUC0-8h).

RESULTS

In total, 50 per each surgery group were included with an average age of 40.5 ± 7.6 years, of whom 128 (85.3%) were female. The participants' average BMI was 30.3 ± 2.0 kg/m2. The average time elapsed after MBS was 9.8 ± 1.0 months. Ca citrate intake significantly lowered PTH levels and showed enhanced relative Ca bioavailability compared to Ca carbonate. Specifically, PTH levels were notably reduced from 3 to 6 hours postadministration with Ca citrate, with significant differences (P < .001). Ca citrate also demonstrated superior relative bioavailability, as evidenced by a higher AUC0-8h of 76.1 mg/dL·h versus 74.7 mg/dL·h for carbonate (P = .001) and a Cmax of 9.8 mg/dL compared to 9.5 mg/dL for carbonate (P < .001). Additionally, urinary Ca excretion over 9 hours was significantly greater in the citrate group at 83.7 mg/dL compared to 68.6 mg/dL for carbonate (P < .001).

CONCLUSION

The study demonstrates that Ca citrate was significantly better than carbonate in reducing PTH levels, enhancing relative Ca bioavailability, and increasing urinary Ca excretion. Additionally, Ca citrate resulted in higher cumulative urinary Ca excretion, indicating better Ca absorption.

Anti-inflammatory, anti-diabetic, and biocompatibility properties of aqueous extract of Tamarindus indica L. fruit coat analyses by in-vitro and in-vivo approaches

The anti-inflammatory, anti-diabetic, and biocompatibility nature of Tamarindus indica L. fruit coat aqueous extract were investigated in this research through in-vitro and in-vivo studies. The anti-inflammatory property was determined through albumin denaturation inhibition and antiprotease activities as up to 39.5% and 41.2% respectively at 30 mg mL-1 concentration. Furthermore, the antidiabetic activity was determined through α-amylase and α-glucosidase inhibition as up to 62.15% and 67.35% respectively at 30 mg mL-1 dosage. The albino mice based acute toxicity study was performed by different treatment groups (group I-V) with different dosages of aqueous extract to detect the biocompatibility of sample. Surprisingly, findings revealed that the T. indica L. fruit coat aqueous extract had no harmful impacts on any of the groups. Urine, as well as serum parameter analysis, confirmed this. Moreover, the findings of SOD (Superoxide Dismutase), GST (Glutathione-S-transferase), & CAT (Catalase) as well as glutathione peroxidase as well as reduced glutathione antioxidant enzymes studies stated that the aqueous extract possess high antioxidant ability via a dose-dependent way. These findings indicate that T. indica fruit coat aqueous extract contains medicinally important phytochemicals with anti-inflammatory and anti-diabetic properties, as well as being biocompatible in nature.

Citrate-based dietary alkali supplements available in Germany: an overview

BACKGROUND

Fruits and vegetables are abundant in alkali precursors and effectively reduce the Potential Renal Acid Load (PRAL) from diet. Oral alkali supplements are supposed to exert comparable alkalizing effects on the human body, and have been shown to beneficially affect bone and kidney health. A comparative analysis of the available dietary alkali supplements in Germany was performed, contrasting their potential PRAL-lowering potential.

METHODS

We reviewed the currently available dietary citrate-based alkali supplements sold in Germany with a special focus on their mineral content, their PRAL-lowering potential and other characteristics inherent to each product. Supplements containing either potassium-, calcium- or magnesium citrate or any combination of these organic salts were reviewed. The total alkali load (TAL) was calculated based on the recommended daily dosage (RDD).

RESULTS

Sixteen supplements with a mean alkali powder content of 220.69 ± 111.02 g were identified. The mean magnesium content per RDD was 239.93 ± 109.16 mg. The mean potassium and median calcium content were 550 ± 325.58 mg and 280 (240) mg, respectively. Median TAL was 1220 (328.75) mg. The PRAL-lowering potential from a single RDD ranged from - 51.65 mEq to -8.32 mEq. Substantial price differences were found, and the mean price of the examined supplements was 16.67 ± 5.77 Euros. The median price for a 1 mEq PRAL-reduction was 3.01 (3.14) cents, and ranged from 0.77 cents to 10.82 cents.

CONCLUSIONS

Noticeable differences between the identified alkali supplements were encountered, warranting an individual and context-specific approach in daily clinical practice.

Understanding formation processes of calcareous nephrolithiasis in renal interstitium and tubule lumen

Kidney stone, one of the oldest known diseases, has plagued humans for centuries, consistently imposing a heavy burden on patients and healthcare systems worldwide due to their high incidence and recurrence rates. Advancements in endoscopy, imaging, genetics, molecular biology and bioinformatics have led to a deeper and more comprehensive understanding of the mechanism behind nephrolithiasis. Kidney stone formation is a complex, multi-step and long-term process involving the transformation of stone-forming salts from free ions into asymptomatic or symptomatic stones influenced by physical, chemical and biological factors. Among the various types of kidney stones observed in clinical practice, calcareous nephrolithiasis is currently the most common and exhibits the most intricate formation mechanism. Extensive research suggests that calcareous nephrolithiasis primarily originates from interstitial subepithelial calcified plaques and/or calcified blockages in the openings of collecting ducts. These calcified plaques and blockages eventually come into contact with urine in the renal pelvis, serving as a nidus for crystal formation and subsequent stone growth. Both pathways of stone formation share similar mechanisms, such as the drive of abnormal urine composition, involvement of oxidative stress and inflammation, and an imbalance of stone inhibitors and promoters. However, they also possess unique characteristics. Hence, this review aims to provide detailed description and present recent discoveries regarding the formation processes of calcareous nephrolithiasis from two distinct birthplaces: renal interstitium and tubule lumen.

Structural characterization and calcium absorption-promoting effect of sucrose-calcium chelate in Caco-2 monolayer cells and mice

Sucrose emerges as a chelating agent to form a stable sucrose-metal-ion chelate that can potentially improve metal-ion absorption. This study aimed to analyze the structure of sucrose-calcium chelate and its potential to promote calcium absorption in both Caco-2 monolayer cells and mice. The characterization results showed that calcium ions mainly chelated with hydroxyl groups in sucrose to produce sucrose-calcium chelate, altering the crystal structure of sucrose (forming polymer particles) and improving its thermal stability. Sucrose-calcium chelate dose dependently increased the amount of calcium uptake, retention, and transport in the Caco-2 monolayer cell model. Compared to CaCl2 , there was a significant improvement in the proportion of absorbed calcium utilized for transport but not retention (93.13 ± 1.75% vs. 67.67 ± 7.55%). Further treatment of calcium channel inhibitors demonstrated the active transport of sucrose-calcium chelate through Cav1.3. Cellular thermal shift assay and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assays indicated that the ability of sucrose-calcium chelate to promote calcium transport was attributed to its superior ability to bind with PMCA1b, a calcium transporter located on the basement membrane, and stimulate its gene expression compared to CaCl2 . Pharmacokinetic analysis of mice confirmed the calcium absorption-promoting effect of sucrose-calcium chelate, as evident by the higher serum calcium level (44.12 ± 1.90 mg/L vs. 37.42 ± 1.88 mmol/L) and intestinal PMCA1b gene expression than CaCl2 . These findings offer a new understanding of how sucrose-calcium chelate enhances intestinal calcium absorption and could be used as an ingredient in functional foods to treat calcium deficiency. PRACTICAL APPLICATION: The development of high-quality calcium supplements is crucial for addressing the various adverse symptoms associated with calcium deficiency. This study aimed to prepare a sucrose-calcium chelate and analyze its structure, as well as its potential to enhance calcium absorption in Caco-2 monolayer cells and mice. The results demonstrated that the sucrose-calcium chelate effectively promoted calcium absorption. Notably, its ability to enhance calcium transport was linked to its strong binding with PMCA1b, a calcium transporter located on the basement membrane, and its capacity to stimulate PMCA1b gene expression. These findings contribute to a deeper understanding of how the sucrose-calcium chelate enhances intestinal calcium absorption and suggest its potential use as an ingredient in functional foods for treating calcium deficiency.

Vitamin D in hypoparathyroidism: insight into pathophysiology and perspectives in clinical practice

Hypoparathyroidism (HypoPT) is a rare endocrine disorder characterized by the absence or insufficient parathyroid hormone production resulting in chronic hypocalcemia. Complications of HypoPT include perturbation of several target organs. The conventional treatment consists of the administration of active vitamin D, namely calcitriol. Regarding vitamin D status, few data are available, mostly in HypoPT subjects supplemented with parent vitamin D. In addition, perturbation of vitamin D metabolism has been poorly investigated, as well as the contribution of altered vitamin D status on the clinical expression of the disease. The most recent consensus on the management of chronic HypoPT suggests the baseline evaluation of serum 25-hydroxy-vitamin D [25(OH)D] and supplementation with parent vitamin D with the aim to achieve and maintain serum 25(OH)D levels in the range of 30-50 ng/mL. The rationale for using supplementation with parent vitamin D (either ergocalciferol or cholecalciferol) in HypoPT would be to provide sufficient 25(OH)D substrate to the residual 1-α-hydroxylase activity, thus ensuring its conversion to active vitamin D in renal and extra-renal tissues. More data from experimental and clinical studies are needed for better assessing how these mechanisms may significantly influence metabolic control in HypoPT and eventually skeletal and extra-skeletal manifestation of the disease. Finally, future data will clarify how the currently available parent vitamin D compounds (ergocalciferol, cholecalciferol, calcifediol) would perform in addressing these specific issues.

Process Optimization, Structural Characterization, and Calcium Release Rate Evaluation of Mung Bean Peptides-Calcium Chelate

To reduce grievous ecological environment pollution and protein resource waste during mung bean starch production, mung bean peptides-calcium chelate (MBP-Ca) was synthesized as a novel and efficient calcium supplement. Under the optimal conditions (pH = 6, temperature = 45 °C, mass ratio of mung bean peptides (MBP)/CaCl₂ = 4:1, MBP concentration = 20 mg/mL, time = 60 min), the obtained MBP-Ca achieved a calcium chelating rate of 86.26%. MBP-Ca, different from MBP, was a new compound rich in glutamic acid (32.74%) and aspartic acid (15.10%). Calcium ions could bind to MBP mainly through carboxyl oxygen, carbonyl oxygen, and amino nitrogen atoms to form MBP-Ca. Calcium ions-induced intra- and intermolecular interactions caused the folding and aggregation of MBP. After the chelation reaction between calcium ions and MBP, the percentage of β-sheet in the secondary structure of MBP increased by 1.90%, the size of the peptides increased by 124.42 nm, and the dense and smooth surface structure of MBP was transformed into fragmented and coarse blocks. Under different temperatures, pH, and gastrointestinal simulated digestion conditions, MBP-Ca exhibited an increased calcium release rate compared with the conventional calcium supplement CaCl₂. Overall, MBP-Ca showed promise as an alternative dietary calcium supplement with good calcium absorption and bioavailability.