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Kulczyński B, Sidor A, Brzozowska A, Gramza-Michałowska A. The role of carotenoids in bone health-A narrative review. Nutrition 2024; 119:112306. [PMID: 38211461 DOI: 10.1016/j.nut.2023.112306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024]
Abstract
Osteoporosis constitutes a serious challenge for public health. Dietary patterns belong to important, modifiable risk factors of this disease. Therefore, what and in what quantities we consume on a daily basis are extremely relevant. It is commonly known that bone health is positively affected by vitamins (e.g., vitamin D and vitamin K) as well as mineral components (e.g., calcium and magnesium). However, the human diet consists of many other groups of compounds that exhibit a potential antiosteoporotic and supporting bone-building effect. These dietary components include carotenoids. This paper presents a broad review of studies on the influence of particular carotenoids (β-carotene, lutein, zeaxanthin, β-cryptoxanthin, and lycopene) on bones. The paper discusses up-to-date in vitro experiments and research on animal models and presents how the results translate into clinical effect in humans.
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Affiliation(s)
- Bartosz Kulczyński
- Department of Gastronomy Science and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland
| | - Andrzej Sidor
- Department of Gastronomy Science and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland
| | - Anna Brzozowska
- Department of Gastronomy Science and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland
| | - Anna Gramza-Michałowska
- Department of Gastronomy Science and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland.
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Zhang R, Huang Q, Su G, Wei M, Cui Y, Zhou H, Song W, Di D, Liu J, Wang Q. Association between multiple vitamins and bone mineral density: a cross-sectional and population-based study in the NHANES from 2005 to 2006. BMC Musculoskelet Disord 2023; 24:113. [PMID: 36765290 PMCID: PMC9912521 DOI: 10.1186/s12891-023-06202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Bone mineral density (BMD) alterations in response to multivitamin exposure were rarely studied. Our study assessed the association of coexposure to six types of vitamins (i.e., vitamins B12, B9, C, D, A and E) with BMD measurements in adults in the US. METHODS Data were collected from participants aged ≥ 20 years (n = 2757) in the U.S. National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2006. Multiple linear regression, restricted cubic splines, principal component analysis (PCA) and weighted quantile sum (WQS) regression were performed for statistical analysis. RESULTS The circulating levels of vitamins B12 and C were positively associated with BMDs, and an inverted L-shaped exposure relationship was observed between serum vitamin C and BMDs. PCA identified two principal components: one for 'water-soluble vitamins', including vitamins B12, B9 and C, and one for 'fat-soluble vitamins', including vitamins A, D and E. The former was positively associated with total femur (β = 0.009, 95%CI: 0.004, 0.015) and femoral neck (β = 0.007, 95%CI: 0.002, 0.013) BMDs, and the latter was negatively associated with BMDs with non-statistical significance. The WQS index constructed for the six vitamins was significantly related to total femur (β = 0.010, 95%CI: 0.001, 0.018) and femoral neck (β = 0.008, 95%CI: 0.001, 0.015) BMDs, and vitamins B12 and C weighted the most. The WQS index was inversely related to BMDs with non-statistical significance, and vitamins E and A weighted the most. CONCLUSION Our findings suggested a positive association between water-soluble vitamin coexposure and BMD, and the association was mainly driven by vitamins B12 and C. Negative association between fat-soluble vitamin coexposure and BMD was indicated, mainly driven by vitamins E and A. An inverted L-shaped exposure relationship was found between vitamin C and BMD.
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Affiliation(s)
- Ruyi Zhang
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Qin Huang
- grid.33199.310000 0004 0368 7223Department of Rehabilitation Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Guanhua Su
- grid.33199.310000 0004 0368 7223Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Muhong Wei
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Yuan Cui
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Haolong Zhou
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Wenjing Song
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Dongsheng Di
- grid.33199.310000 0004 0368 7223MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Junan Liu
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Qi Wang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Gao SS, Zhao Y. The effects of β-carotene on osteoporosis: a systematic review and meta-analysis of observational studies. Osteoporos Int 2022; 34:627-639. [PMID: 36380163 DOI: 10.1007/s00198-022-06593-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim is to evaluate the effect of β-carotene for osteoporosis and provide quantitative evidence. METHOD PubMed, Embase, Web of Science, and Cochrane Library were searched for eligible studies. Fifteen studies were included. Random-effect model was applied to pool the odds ratio (OR). The risk of osteoporosis and fracture were compared between low β-carotene intake group and high β-carotene intake group. RESULT The intake of β-carotene was unassociated with the overall risk of osteoporosis [OR = 0.733, 95% Cl (0.528, 1.018), p = 0.064]. Subgroup analysis showed that the intake of β-carotene was negatively associated with the risk of osteoporosis in both male subgroup [OR = 0.7, 95% Cl (0.549, 0.893), I2 = 40.40%, p = 0.004] and female subgroup [OR = 0.684, 95% Cl (0.487, 0.960), I2 = 86.40%, p = 0.028]. There was also a negative association between β-carotene intake and osteoporosis in Asia subgroup [OR = 0.512, 95% Cl (0.403, 0.650), I2 = 0.00%, p = 0], whereas no association was observed in Western subgroup [OR = 1.107, 95% Cl (0.908, 1.350), I2 = 2.30%, p = 0.314]. In addition, random-effect model was adopted to pool the standard mean difference (SMD), and the results showed that β-carotene intake was positively associated with overall bone mineral density (BMD) [SMD = - 0.213, 95% Cl (- 0.391, - 0.034), I2 = 87.30%, p = 0.019]. Subgroup analysis showed that β-carotene intake was positively associated with BMD in Asian participants [SMD = - 0.394, 95% Cl (- 0.461, - 0.328), I2 = 0, p = 0], while unassociated in Western participants [SMD = - 0.047, 95% Cl (- 0.314, 0.219), I2 = 78.9%, p = 0.727]. CONCLUSION β-carotene may improve BMD and reduce the risk of osteoporosis and fracture. However, these effects could vary by gender and race and need to be further validated by longitudinal studies.
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Affiliation(s)
- Sa Sa Gao
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yongfang Zhao
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
- Science and Technology Department, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New Area, Shanghai, China.
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Monjotin N, Amiot MJ, Fleurentin J, Morel JM, Raynal S. Clinical Evidence of the Benefits of Phytonutrients in Human Healthcare. Nutrients 2022; 14:nu14091712. [PMID: 35565680 PMCID: PMC9102588 DOI: 10.3390/nu14091712] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Phytonutrients comprise many different chemicals, including carotenoids, indoles, glucosinolates, organosulfur compounds, phytosterols, polyphenols, and saponins. This review focuses on the human healthcare benefits of seven phytochemical families and highlights the significant potential contribution of phytonutrients in the prevention and management of pathologies and symptoms in the field of family health. The structure and function of these phytochemical families and their dietary sources are presented, along with an overview of their potential activities across different health and therapeutic targets. This evaluation has enabled complementary effects of the different families of phytonutrients in the same area of health to be recognized.
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Affiliation(s)
- Nicolas Monjotin
- Institut de Recherche Pierre Fabre, Pierre Fabre Medical Care, 81100 Castres, France;
| | - Marie Josèphe Amiot
- Montpellier Interdisciplinary Center on Sustainable Agri-Food Systems, INRAE, Agro Institute, Université de Montpellier, CIHEAM-IAMM, CIRAD, IRD, 34000 Montpellier, France;
| | | | | | - Sylvie Raynal
- Direction Médicale Patients et Consommateurs, Pierre Fabre Medical Care, 81100 Castres, France
- Correspondence:
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Charkos TG, Liu Y, Oumer KS, Vuong AM, Yang S. Effects of β-carotene intake on the risk of fracture: a Bayesian meta-analysis. BMC Musculoskelet Disord 2020; 21:711. [PMID: 33129293 PMCID: PMC7603770 DOI: 10.1186/s12891-020-03733-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Epidemiological studies examining the association between β-carotene intake and risk of fracture have reported inconsistent findings. We conducted a meta-analysis to investigate the association between β-carotene intake and risk of fracture. Methods We systematically searched PubMed, EMBASE and Cochrane library databases for relevant articles that were published until December 2019. We also identified studies from reference lists of articles identified from the clinical databases. The frequentist and Bayesian random-effects model was used to synthesize data. Results Nine studies with a total of 190,545 men and women, with an average age of 59.8 years, were included in this meta-analysis. For β-carotene intake (1.76–14.30 mg/day), the pooled risk ratio (RR) of any fracture was 0.67 (95% Credible Interval (CrI): 0.51–0.82; heterogeneity: P = 0.66, I2 = 0.00%) and 0.63 (95%CrI: 0.44–0. 82) for hip fracture. By study design, the pooled RRs were 0.55 (95% CrI: 0.14–0.96) for case-control studies and 0.82 (95% CrI: 0.58–0.99) for cohort studies. By geographic region, the pooled RRs were 0.58 (95% CrI: 0.28–0.89), 0.86 (95% CrI: 0.35–0.1.37), and 0.91(95% CrI: 0.75–1.00) for studies conducted in China, the United States, and Europe, respectively. By sex, the pooled RRs were 0.88 (95% CrI: 0.73–0.99) for males and 0.76 (95% CrI, 0.44–1.07) for females. There was a 95% probability that β-carotene intake reduces risk of hip fracture and any type of fracture by more than 20%. Conclusions The present meta-analysis suggests that β-carotene intake was inversely associated with fracture risk, which was consistently observed for case-control and cohort studies. Randomized controlled trials are warranted to confirm this relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03733-0.
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Affiliation(s)
- Tesfaye Getachew Charkos
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Kemal Sherefa Oumer
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, USA
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China.
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Ratajczak AE, Rychter AM, Zawada A, Dobrowolska A, Krela-Kaźmierczak I. Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases. Nutrients 2020; 12:E1702. [PMID: 32517239 PMCID: PMC7352179 DOI: 10.3390/nu12061702] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
The chronic character of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.
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Affiliation(s)
- Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (A.M.R.); (A.Z.); (A.D.)
| | | | | | | | - Iwona Krela-Kaźmierczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (A.M.R.); (A.Z.); (A.D.)
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Green AC, Martin TJ, Purton LE. The role of vitamin A and retinoic acid receptor signaling in post-natal maintenance of bone. J Steroid Biochem Mol Biol 2016; 155:135-46. [PMID: 26435449 DOI: 10.1016/j.jsbmb.2015.09.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 12/11/2022]
Abstract
Vitamin A and retinoid derivatives are recognized as morphogens that govern body patterning and skeletogenesis, producing profound defects when in excess. In post-natal bone, both high and low levels of vitamin A are associated with poor bone heath and elevated risk of fractures. Despite this, the precise mechanism of how retinoids induce post-natal bone changes remains elusive. Numerous studies have been performed to discover how retinoids induce these changes, revealing a complex morphogenic regulation of bone through interplay of different cell types. This review will discuss the direct and indirect effects of retinoids on mediators of bone turnover focusing on differentiation and activity of osteoblasts and osteoclasts and explains why some discrepancies in this field have arisen. Importantly, the overall effect of retinoids on the skeleton is highly site-specific, likely due to differential regulation of osteoblasts and osteoclasts at trabecular vs. cortical periosteal and endosteal bone surfaces. Further investigation is required to discover the direct gene targets of retinoic acid receptors (RARs) and molecular mechanisms through which these changes occur. A clear role for RARs in regulating bone is now accepted and the therapeutic potential of retinoids in treating bone diseases has been established.
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Affiliation(s)
- Alanna C Green
- St Vincent's Institute, Fitzroy, Victoria 3065, Australia; Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Victoria 3065, Australia.
| | - T John Martin
- St Vincent's Institute, Fitzroy, Victoria 3065, Australia; Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Victoria 3065, Australia
| | - Louise E Purton
- St Vincent's Institute, Fitzroy, Victoria 3065, Australia; Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Victoria 3065, Australia
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Vitamin A intake, serum vitamin D and bone mineral density: analysis of the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2011). Nutrients 2015; 7:1716-27. [PMID: 25763530 PMCID: PMC4377877 DOI: 10.3390/nu7031716] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 01/01/2023] Open
Abstract
The association of high vitamin A intake and low bone mineral density (BMD) is still controversial. To determine the association of dietary vitamin A intake and serum 25-hydroxyvitamin D (25(OH)D) concentration with BMD, a total of 6481 subjects (2907 men and 3574 women) aged ≥50 years from the Korean National Health and Nutrition Examination Survey (2008–2011) were divided into groups according to dietary vitamin A intake (tertiles) and serum 25(OH)D (<50, 50–75, >75 nmol/L), and evaluated for BMD after adjusting for relevant variables. Mean dietary vitamin A intakes were 737 and 600 μg RE (Retinol Equivalents) in men and women, respectively. Total hip and femoral neck BMD in men and lumbar spine BMD in women were both positively correlated with dietary vitamin A intake in subjects with serum 25(OH)D >75 nmol/L. Among men with serum 25(OH)D <50 nmol/L, both the top (mean 1353 μg RE) and bottom (mean 218 μg RE) tertiles of dietary vitamin A intake had lower BMD than the middle group (mean 577 μg RE). In this population, BMD was the highest among men and women with serum 25(OH)D = 50–75 nmol/L and that there were no differences in BMD by vitamin A intake in these vitamin D adequate groups. This cross-sectional study indicates that vitamin A intake does not affect bone mineral density as long as the serum 25(OH)D concentration is maintained in the moderate level of 50–75 nmol/L.
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Wu AM, Huang CQ, Lin ZK, Tian NF, Ni WF, Wang XY, Xu HZ, Chi YL. The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies. J Bone Miner Res 2014; 29:2032-9. [PMID: 24700407 DOI: 10.1002/jbmr.2237] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/16/2014] [Accepted: 03/26/2014] [Indexed: 11/06/2022]
Abstract
Osteoporotic fracture is a significant cause of morbidity and mortality and is a challenging global health problem. Previous reports of the relation between vitamin A intake or blood retinol and risk of fracture were inconsistent. We searched Medline and Embase to assess the effects of vitamin A (or retinol or beta-carotene but not vitamin A metabolites) on risk of hip and total fracture. Only prospective studies were included. We pooled data with a random effects meta-analysis with adjusted relative risk (adj.RR) and 95% confidence interval (CI). We used Q statistic and I(2) statistic to assess heterogeneity and Egger's test to assess publication bias. Eight vitamin A (or retinol or beta-carotene) intake studies (283,930 participants) and four blood retinol level prospective studies (8725 participants) were included. High intake of vitamin A and retinol were shown to increase risk of hip fracture (adj.RR [95% CI] = 1.29 [1.07, 1.57] and 1.40 [1.03, 1.91], respectively), whereas beta-carotene intake was not found to increase the risk of hip fracture (adj.RR [95% CI] = 0.82 [0.59, 1.14]). Both high or low level of blood retinol was shown to increase the risk of hip fracture (adj.RR [95% CI] = 1.87 [1.31, 2.65] and 1.56 [1.09, 2.22], respectively). The risk of total fracture does not differ significantly by level of vitamin A (or retinol) intake or by blood retinol level. Dose-response meta-analysis shows a U-shaped relationship between serum retinol level and hip fracture risk. Our meta-analysis suggests that blood retinol level is a double-edged sword for risk of hip fracture. To avoid the risk of hip fracture caused by too low or too high a level of retinol concentration, we suggest that intake of beta-carotene (a provitamin A), which should be converted to retinol in blood, may be better than intake of retinol from meat, which is directly absorbed into blood after intake.
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Affiliation(s)
- Ai-Min Wu
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ambrosini GL, Alfonso H, Reid A, Mackerras D, Bremner AP, Beilby J, Olsen NJ, Musk AW, de Klerk NH. Plasma retinol and total carotenes and fracture risk after long-term supplementation with high doses of retinol. Nutrition 2013; 30:551-6. [PMID: 24698346 DOI: 10.1016/j.nut.2013.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Observational studies suggest that moderate intakes of retinol and increased circulating retinol levels may increase fracture risk. Easy access to supplements, combined with an aging population, makes this a potentially important association. The aim of this study was to investigate plasma retinol and total carotene concentrations in relation to fracture risk after long-term supplementation with retinol and/or beta-carotene in 998 adults between 1990 and 2007. METHODS Participants were 663 men and 335 women in a cancer prevention program who were initially randomized to a retinol (7.5 mg RE/d) or beta-carotene (30 mg/d) supplement between 1990 and 1996. After 1996, all participants received the retinol supplement only. Plasma retinol and total carotene, medication use and various lifestyle factors were measured at annual clinic visits. Fractures were identified by self-report in 2007. The risk for any fracture or osteoporotic fracture was modeled using Cox proportional hazard models. RESULTS Over a median follow-up of 7.8 y, 123 participants with plasma samples reported an incident fracture. Although plasma retinol concentrations were markedly higher than those reported in observational studies, no association was observed between plasma retinol and risk for any fracture (hazard ratio [HR], 0.86 μmol/L; 95% confidence interval [CI], 0.65-1.14) or osteoporotic fracture (HR, 0.97 μmol/L; 95% CI, 0.66-1.43). A lower risk for any fracture was suggested with increasing plasma total carotenes (HR, 0.85 μmol/L; 95% CI, 0.71-1.01). CONCLUSIONS This study does not support earlier reports of an increased fracture risk associated with increased plasma retinol concentration. The potential for carotenes to prevent fractures deserves further investigation.
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Affiliation(s)
- Gina L Ambrosini
- School of Population Health, The University of Western Australia, Perth, Western Australia
| | - Helman Alfonso
- Western Australian Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia
| | - Alison Reid
- Centre for Medical Research, The University of Western Australia, Perth, Western Australia
| | - Dorothy Mackerras
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia; Food Standards Australia New Zealand, Canberra, Australian Capital Territory, Australia
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, Perth, Western Australia
| | - John Beilby
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia; Department of Molecular Genetics, PathWest Laboratories, Perth, Western Australia
| | - Nola J Olsen
- School of Population Health, The University of Western Australia, Perth, Western Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Arthur W Musk
- School of Population Health, The University of Western Australia, Perth, Western Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Nicholas H de Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia.
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