Calcium-binding capacities of different brans under simulated gastrointestinal pH conditions. In vitro study with (45)Ca

Unraveling the potential of bacterial phytases for sustainable management of phosphorous

Phosphorous actively participates in numerous metabolic and regulatory activities of almost all living organisms including animals and humans. Therefore, it is considered as an essential macronutrient required supporting their proper growth. On contrary, phytic acid (PA), an antinutritional substance, is widely known for its strong affinity to chelate essential mineral ions including PO4 3- , Ca2+ , Fe2+ , Mg2+ , and Zn2+ . Being one the major reservoir of PO4 3- ions, PA has great potential to bind PO4 3- ions in diverse range of foods. Once combined with P, PA transforms into an undigested and insoluble complex namely phytate. Produced phytate leads to a notable reduction in the bioavailability of P due to negligible activity of phytases in monogastric animals and humans. This highlights the importance and consequent need of enhancement of phytase level in these life forms. Interestingly, phytases, catalyzing the breakdown of phytate complex and recycling the phosphate into ecosystem to its available form, have naturally been reported in a variety of plants and microorganisms over past few decades. In pursuit of a reliable solution, the focus of this review is to explore the keynote potential of bacterial phytases for sustainable management of phosphorous via efficient utilization of soil phytate. The core of the review covers detailed discussion on bacterial phytases along with their widely reported applications viz. biofertilizers, phosphorus acquisition, and plant growth promotion. Moreover, meticulous description on fermentation-based strategies and future trends on bacterial phytases have also been included.

Effect of Fiber Fermentation and Protein Digestion Kinetics on Mineral Digestion in Pigs

Nutrient kinetic data and the timing of nutrient release along the gastrointestinal tract (GIT), are not yet widely used in current feed formulations for pigs and poultry. The present review focuses on interactions between fermentable substrates (e.g., starch, fiber, and protein) and selected minerals on nutrient digestion and absorption to determine nutritional solutions to maximize animal performance, principally in the grower-finisher phase, with the aim of minimizing environmental pollution. For phosphorus (P), myo-inositol 1,2,3,4,5,6-hexakis (dihydrogen phosphate) (InsP6), copper (Cu), and zinc (Zn), no standardized methodologies to assess in vitro mineral digestion exist. The stepwise degradation of InsP6 to lower inositol phosphate (InsP) forms in the GIT is rare, and inositol phosphate4 (InsP4) might be the limiting isomer of InsP degradation in diets with exogenous phytase. Furthermore, dietary coefficients of standardized total tract digestibility (CSTTD) of P might be underestimated in diets with fermentable ingredients because of increased diet-specific endogenous P losses (EPL), and further clarification is required to better calculate the coefficients of true total tract digestibility (CTTTD) of P. The quantification of fiber type, composition of fiber fractions, their influence on digestion kinetics, effects on digesta pH, and nutrient solubility related to fermentation should be considered for formulating diets. In conclusion, applications of nutrient kinetic data should be considered to help enhance nutrient digestion and absorption in the GIT, thereby reducing nutrient excretion.

Cereal grain fiber composition modifies phosphorus digestibility in grower pigs

Increased fermentable carbohydrates (e.g., β-glucan, amylose) may increase endogenous losses including for P, and thereby reduce apparent total tract digestibility (ATTD) of P. The present study assessed effects of barley cultivars varying in fermentable starch and fiber on apparent ileal digestibility (AID) and ATTD of P, myo-inositol 1,2,3,4,5,6-hexakis (dihydrogen phosphate; InsP6) and Ca, and standardized total tract digestibility (STTD) of P and the presence of lower inositol phosphates (InsP) compared to wheat. In a 6 (period) × 5 (diet) Youden square, 7 ileal-cannulated barrows (initial BW, 27.7 kg) were fed diets containing 80% of 1 of 5 cereal grains differing in amylose, β-glucan, and fiber content: 1) high-fermentable, high-β-glucan, hull-less barley (HFB); 2) high-fermentable, high-amylose, hull-less barley (HFA); 3) moderate-fermentable, hull-less barley (MFB); 4) low-fermentable, hulled barley (LFB); and 5) low-fermentable, hard red spring wheat (LFW). On dry matter (DM) basis, cereal grains contained between 0.32 to 0.53% total P and 0.24 to 0.50% InsP6-P. The InsP6-2-P was calculated as the sum of all detected InsP-P (InsP6-P to InsP2-P) in the sample. The P release of degraded InsP-P was calculated by using the following equation: sum InsP6-2-Pdiet (g/kg DM) × (AID or ATTD sum InsP6-2-P (%) / 100). Data were analyzed using a mixed model with diet as fixed effect, and pig and period as random effects. On DM basis, diets contained 41.4 to 50.6% starch, 0.88 to 8.54% β-glucan, 0.81 to 0.89% total P, and 0.19 to 0.35% InsP6-P. The MFB, LFB, and LFW had greater (P < 0.05) diet AID of P than HFB and HFA, and MFB had greater (P < 0.05) diet ATTD and STTD of P than HFB. The ATTD of InsP6-P was greater (P < 0.05) for HFB than LFB and the ATTD of the sum InsP6-2-P was greater (P < 0.05) for HFB and HFA than LFB. Total tract P release was greater (P < 0.001) for HFB, HFA, and LFW than MFB and LFB. The LFW had greater (P < 0.05) ATTD of Ca than LFB. Diet β-glucan content was not correlated with STTD of P (R 2 = 0.03) or ATTD of InsP6 (R 2 = 0.05). In conclusion, cereal grains high in fermentable fiber, e.g., amylose and β-glucans included in specific hull-less barley cultivars, had lower diet AID, ATTD, and STTD of P, but greater ATTD of InsP6-P and sum InsP6-2-P. Carbohydrate fermentation thus results in greater total tract P release from InsP-P hydrolysis.

The impact of dietary calcium content on phosphorus absorption and retention in growing pigs is enhanced by dietary microbial phytase supplementation

Sixty growing male pigs were used to test the hypothesis that high dietary Ca content reduces P absorption to a greater extent in microbial phytase-supplemented diets via reducing inositol phosphate (IP) degradation and enhancing P precipitation. Pigs were equally allotted over diets with three Ca contents 2·0, 5·8 and 9·6 g/kg with or without microbial phytase (0 v. 500 FTU/kg) in a 2 × 3 factorial arrangement. Faeces and urine were collected at the end of the 21-d experimental period. Subsequently, pigs were euthanised and digesta quantitatively collected from different gastrointestinal tract (GIT) segments. Increasing dietary Ca content reduced apparent P digestibility in all GIT segments posterior to the stomach (P < 0·001), with greater effect in phytase-supplemented diets in the distal small intestine (Pinteraction = 0·007) and total tract (Pinteraction = 0·023). Nonetheless, increasing dietary Ca to 5·8 g/kg enhanced P retention, but only in phytase-supplemented diets. Ileal IP6 degradation increased with phytase (P < 0·001) but decreased with increasing dietary Ca content (P = 0·014). Proportion of IP esters in total IP (∑IP) indicated that IP6/∑IP was increased while IP4/∑IP and IP3/∑IP were reduced with increasing dietary Ca content and also with a greater impact in phytase-supplemented diets (Pinteraction = 0·025, 0·018 and 0·009, respectively). In all GIT segments, P solubility was increased with phytase (P < 0·001) and tended to be reduced with dietary Ca content (P < 0·096). Measurements in GIT segments showed that increasing dietary Ca content reduced apparent P digestibility via reducing IP degradation and enhancing P precipitation, with a greater impact in phytase-supplemented diets due to reduced IP degradation.

Effect of feeding acidified or fermented barley using Limosilactobacillus reuteri with or without supplemental phytase on diet nutrient digestibility in growing pigs

Fermentation of cereal grains may degrade myo-inositol 1,2,3,4,5,6-hexakis (dihydrogen phosphate) (InsP6) thereby increasing nutrient digestibility. Effects of chemical acidification or fermentation with Limosilactobacillus (L.) reuteri with or without phytase of high β-glucan hull-less barley grain on apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of nutrients and gross energy (GE), standardized ileal digestibility (SID) of crude protein (CP) and amino acids (AAs), and standardized total tract digestibility (STTD) of P were assessed in growing pigs. Pigs were fed four mash barley-based diets balanced for water content: 1) unfermented barley (Control); 2) chemically acidified barley (ACD) with lactic acid and acidic acid (0.019 L/kg barley grain at a ratio of 4:1 [vol/vol]); 3) barley fermented with L. reuteri TMW 1.656 (Fermented without phytase); and 4) barley fermented with L. reuteri TMW 1.656 and phytase (Fermented with phytase; 500 FYT/kg barley grain). The acidification and fermentation treatments occurred for 24 h at 37 °C in a water bath. The four diets were fed to eight ileal-cannulated barrows (initial body weight [BW], 17.4 kg) for four 11-d periods in a double 4 × 4 Latin square. Barley grain InsP6 content of Control, ACD, Fermented without phytase, or Fermented with phytase was 1.12%, 0.59%, 0.52% dry matter (DM), or not detectable, respectively. Diet ATTD of DM, CP, Ca, and GE, digestible energy (DE), predicted net energy (NE) value, and urinary excretion of P were greater (P < 0.05) for ACD than Control. Diet ATTD of DM, CP, Ca, GE, DE and predicted NE value, urinary excretion of P was greater (P < 0.05), and diet AID of Ca and ATTD and STTD of P tended to be greater (P < 0.10) for Fermented without phytase than Control. Diet ATTD of GE was lower (P < 0.05) and diet ATTD and STTD of P, AID and ATTD of Ca was greater (P < 0.05) for Fermented with phytase than Fermented without phytase. Acidification or fermentation with/without phytase did not affect diet SID of CP and AA. In conclusion, ACD or Fermented without phytase partially degraded InsP6 in barley grain and increased diet ATTD of DM, CP, and GE, but not SID of CP and most AA in growing pigs. Fermentation with phytase entirely degraded InsP6 in barley grain and maximized P and Ca digestibility, thereby reducing the need to provide inorganic dietary P to meet P requirements of growing pigs.

Revisiting phytate-element interactions: implications for iron, zinc and calcium bioavailability, with emphasis on legumes

Myo-Inositol hexakisphosphate or phytic acid concentration is a prominent factor known to impede divalent element bioavailability in vegetal foods including legumes. Both in vivo and in vitro studies have suggested that phytic acid and other plant-based constituents may synergistically form insoluble complexes affecting bioavailability of essential elements. This review provides an overview of existing investigations on the role of phytic acid in the binding, solubility and bioavailability of iron, zinc and calcium with a focus on legumes. Given the presence of various interference factors within legume matrices, current findings suggest that the commonly adapted approach of using phytic acid-element molar ratios as a bioavailability predictor may only be valid in limited circumstances. In particular, differences between protein properties and molar concentrations of other interacting ions are likely responsible for the observed poor correlations. The role of phytate degradation in element bioavailability has been previously examined, and in this review we re-emphasize its importance as a tool to enhance mineral bioavailability of mineral fortified legume crops. Food processing strategies to achieve phytate reduction were identified as promising tools to increase mineral bioavailability and included germination and fermentation, particularly when other bioavailability promoters (e.g. NaCl) are simultaneously added.

[Disorders of calcium metabolism]

The majority of clinical complaints derive from disorders of calcium metabolism and are associated with a wide variety of clinical symptoms caused by numerous diseases with entirely different types of pathophysiology. The prognosis varies from favorable to fatal depending on the pathophysiology of the underlying disorder of calcium metabolism; therefore, the diagnostic work-up aims to quickly identify the underlying disease causing the disturbance in calcium homeostasis. Every clinical situation with a diminished state of calcium absorption is treated with calcium and vitamin D in varying doses whereas every disorder with an increased calcium absorptive or resorptive state is treated with improved diuresis in addition to antiresorptive drugs, such as bisphosphonates. In many situations the management of a disturbed calcium balance requires an interdisciplinary approach in order to treat the underlying disease in parallel with correction of the calcium homeostasis.

Heat-treatment, phytase and fermented liquid feeding affect the presence of inositol phosphates in ileal digesta and phosphorus digestibility in pigs fed a wheat and barley diet

The aim was to evaluate the effect of heat-treatment, microbial phytase addition and feeding strategy (dry feeding v. fermented liquid feeding) on degradation of phytate (myo-inositol hexakisphosphate, InsP6) and formation and further degradation of lower inositol phosphates (myo-inositol pentakisphosphate-myo-inositol bisphosphate, InsP5-InsP2) at the distal ileum of pigs. Furthermore, the apparent ileal digestibility/degradability (AID) of phosphorus (P), InsP6-P and calcium (Ca) and the apparent total tract digestibility (ATTD) of P and Ca were studied. Pigs were fitted with a T-shaped ileal cannula for total collection of digesta at 2 h intervals during an 8 h sampling period after feeding the morning meal. Each period lasted for 2 weeks: 8 days of adaptation followed by 3 days of total collection of faeces and 3 days of total collection of ileal digesta. The experiment was designed as a 4 × 4 Latin square with four pigs fed four diets. A basal wheat/barley-based diet was fed either as non-heat-treated or heat-treated (steam-pelleted at 90°C). The heat-treatment resulted in an inactivation of plant phytase below detectable level. Diet 1 (non-heat-treated basal diet fed dry); diet 2 (heat-treated basal diet fed dry); diet 3 (as diet 2 but with microbial phytase (750 FTU/kg as fed) fed dry); diet 4 (as diet 3 fed liquid (fermented for 17.5 h nighttime and 6.5 h daytime at 20°C with 50% residue in the tank)). Chromic oxide (Cr2O3) was included as marker and ATTD was determined both by total collection of faeces (ATTDTotal) and Cr2O3 (ATTDCr). InsP6 was completely degraded in diet 4 before feeding resulting in no InsP6-P being present in ileal digesta. InsP6-P concentration in ileal digesta decreased with increasing dietary levels of plant or microbial phytase in pigs fed the dry diets. Consequently, AID and ATTD of P and Ca were greatest for pigs fed diet 4 followed by diets 3, 1 and 2. The ATTD of P depended on the used method as ATTDTotal of P was 72%, 61%, 44% and 34%, whereas ATTDCr of P was 65%, 52%, 38% and 23% for diets 4, 3, 1 and 2, respectively. In all pigs the ileal concentration of InsP5-InsP2-P was extremely small, and thus unimportant for maximisation of ATTD of plant P. In conclusion, fermented liquid feeding with microbial phytase seems to be an efficient approach to improve ATTD of plant P compared with dry feeding. This opens up for further reductions in P excretion.

A novel model to explain dietary factors affecting hypocalcaemia in dairy cattle

Most dairy cows exhibit different degrees of hypocalcaemia around calving because the gestational Ca requirements shift to the disproportionately high Ca requirements of lactation. Ca homeostasis is a robust system that effectively adapts to changes in Ca demand or supply. However, these adaptations often are not rapid enough to avoid hypocalcaemia. A delay in the reconfiguration of intestinal Ca absorption and bone resorption is probably the underlying cause of this transient hypocalcaemia. Several dietary factors that affect different aspects of Ca metabolism are known to reduce the incidence of milk fever. The present review describes the interactions between nutrition and Ca homeostasis using observations from cattle and extrapolations from other species and aims to quantitatively model the effects of the nutritional approaches that are used to induce dry cows into an early adaptation of Ca metabolism. The present model suggests that reducing dietary cation–anion difference (DCAD) increases Ca clearance from the blood by dietary induction of systemic acidosis, which results in hypercalciuria due to the loss of function of the renal Ca transient receptor potential vanilloid channel TRPV5. Alternatively, reducing the gastrointestinal availability of Ca by reducing dietary Ca or its nutritional availability will also induce the activation of Ca metabolism to compensate for basal blood Ca clearance. Our model of gastrointestinal Ca availability as well as blood Ca clearance in the transition dairy cow allowed us to conclude that the most common dietary strategies for milk fever prevention may have analogous modes of action that are based on the principle of metabolic adaptation before calving.

Effect of compositional alteration of food matrices and processing on availability of selected nutrients and bioactive components in rice products

The aim was to determine the influence of compositional alteration and processing on the digestibility/availability of nutrients and bioactive components [protein (IVPD), starch (IVSD), iron, calcium, polyphenols, flavonoids] in rice products. The compositional changes representing fortified foods in 'wafers' and 'noodles' were addition of iron, rice bran, onion and cabbage. The moisture content of wafer and noodles ranged from 4.1 to 4.8% and from 73.3 to 82.1%, respectively. Wafer control (73.9-75.9%) and noodle with iron and control (85.4-87.0%) showed the highest IVPD and IVSD. Addition of rice bran decreased nutrient digestibility. The control and iron-added products exhibited least and highest available iron (2.50-2.69% and 5.99-7.07%). Total and available bioactive components increased in proportion to added external source. Overall availability of all components was better in noodles than in wafers, indicating high moisture supported higher availability. In conclusion, it can be said that both composition of the food matrix and processing influenced the availability of analyzed components.

Whole grain intake, incident hip fracture and presumed frailty in the Iowa Women's Health Study

Whole cereal grain foods are rich in phytate, a Ca chelator, and could increase the risk of hip fracture. The objective of the present study was to investigate the association between baseline whole grain intake and incident hip fracture. In the present study, 29 192 women who at baseline in 1986 were aged 55-69 years, free of diabetes, and reported a plausible energy intake of 2508-20 900 kJ/d and reported no fracture since the age of 35 years were followed. Hip fracture (n 746) was self-reported in five questionnaires through 2004. Of 1451 hip fractures identified passively by Medicare linkage through 31 December 2004 (Medicare hip fracture), 507 had also been self-reported. Whole grain intake was inversely related to Medicare hip fracture (P trend = 0.02), but it was unrelated to self-reported hip fracture (P trend = 0.27). The hazard ratio in the highest to lowest quintile of whole grain intake for incident Medicare-only hip fracture (n 944) was 0.66 (95% CI 0.53, 0.82) after adjustment for age, energy intake, education, BMI, waist-to-hip ratio, farm residence, physical activity, oestrogen use, smoking, alcohol use, history of cancer and other dietary variables. Medicare-only cases may have failed to self-report due to severe illness; hazard ratio for total mortality after hip fracture was 2.92 (2.37, 3.59) for Medicare-only cases v. Medicare-confirmed self-reported cases. In conclusion, in this cohort, the inverse association between whole grain intake and hip fracture was explained by ascertainment bias. Whole grain intake may increase the ability to respond to a questionnaire and self-report hip fracture, and could reflect less undocumented frailty.

Phytate: impact on environment and human nutrition. A challenge for molecular breeding

Phytic acid (PA) is the primary storage compound of phosphorus in seeds accounting for up to 80% of the total seed phosphorus and contributing as much as 1.5% to the seed dry weight. The negatively charged phosphate in PA strongly binds to metallic cations of Ca, Fe, K, Mg, Mn and Zn making them insoluble and thus unavailable as nutritional factors. Phytate mainly accumulates in protein storage vacuoles as globoids, predominantly located in the aleurone layer (wheat, barley and rice) or in the embryo (maize). During germination, phytate is hydrolysed by endogenous phytase(s) and other phosphatases to release phosphate, inositol and micronutrients to support the emerging seedling. PA and its derivatives are also implicated in RNA export, DNA repair, signalling, endocytosis and cell vesicular trafficking. Our recent studies on purification of phytate globoids, their mineral composition and dephytinization by wheat phytase will be discussed. Biochemical data for purified and characterized phytases isolated from more than 23 plant species are presented, the dephosphorylation pathways of phytic acid by different classes of phytases are compared, and the application of phytase in food and feed is discussed.

Influence of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion

OBJECTIVE

To compare quantitatively the effect of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion.

SUBJECTS AND METHODS

Eight healthy volunteers (three men and five women, mean age 28.6+/-6.3) were studied. Each volunteer performed the [(13)C(2)]oxalate absorption test thrice on a low-oxalate mixed diet, thrice on a low-oxalate vegetarian diet and thrice on a high-oxalate vegetarian diet. For each test, the volunteers had to adhere to an identical diet and collect their 24-h urines. In the morning of the second day, a capsule containing [(13)C(2)]oxalate was ingested.

RESULTS

On the low-oxalate vegetarian diet, mean intestinal oxalate absorption and urinary oxalate excretion increased significantly to 15.8+/-2.9% (P=0.012) and 0.414+/-0.126 mmol/day (P=0.012), compared to the mixed diet. On the high-oxalate vegetarian diet, oxalate absorption (12.5+/-4.6%, P=0.161) and urinary excretion (0.340+/-0.077 mmol/day, P=0.093) did not change significantly, compared to the mixed diet.

CONCLUSIONS

A vegetarian diet can only be recommended for calcium oxalate stone patients, if the diet (1) contains the recommended amounts of divalent cations such as calcium and its timing of ingestion to a meal rich in oxalate is considered and (2) excludes foodstuffs with a high content of nutritional factors, such as phytic acid, which are able to chelate calcium.

Speciation of phytate ion in aqueous solution. Sequestering ability toward mercury(II) cation in NaClaq at different ionic strengths

As a contribution to understanding the speciation of mercury in the environment and to the study of the sequestering ability of phytate (Phy) toward heavy metal and organometal cations, this paper describes the results of an investigation (at t = 25 degrees C by potentiometry, ISE-H+ glass electrode) of its interactions with mercury(II) cation in NaCl aqueous solutions at different ionic strengths (I = 0.15 and 1.0 mol L(-1)), in the pH range 2.5 < or = pH < or = 9.5 and considering metal-to-ligand ratios of 1:1 < or = Hg/Phy < or = 4:1. The formation of 11 HgiHjPhy(12-2i-j)(- species with i = 1 and 0 < or = j < or = 7 and i = 2 and 0 < or = j < or = 2 was observed. Their complex formation constant values proved to be fairly dependent on ionic strength. The speciation of phytic acid and mercury(II) is also dependent on the metal-to-ligand ratio; the dependence of the stability of phytate-mercury(II) species on the phytate protonation step was modeled, and an empirical predictive relationship was proposed. From the results obtained, phytate has very good sequestering ability toward Hg2+, even in the presence of considerable excesses of chloride ion, that is, another ligand strongly interacting with mercury; this supports future studies both on the use of plants that naturally synthesize it for phytoremediation purposes and on its direct application in remediation techniques.

Idiopathic calcium oxalate urolithiasis: risk factors and conservative treatment

Idiopathic calcium oxalate urolithiasis is a frequent and recurrent multifactorial disease. This review focuses on urinary and dietary risk factors for this disease and conservative strategies for rectifying them. Dietary oxalate and calcium and their respective urinary excretions have been extensively investigated during the last 10 years. Urinary oxalate has emerged as the most important determinant of calcium oxalate crystallization while the role of urinary calcium has shifted to bone balance and osteoporosis. Dietary calcium restriction increases urinary oxalate and contributes to a negative bone balance. It has therefore been abandoned as a means to reduce the risk of calcium oxalate kidney stone formation. Calcium oxalate kidney stone patients are advised to increase their fluid intake to achieve a urine volume of 2 l or more; the recommended calcium intake is 800-1200 mg/day; high oxalate foods should be restricted; daily protein intake should be between 0.8 and 1 g/kg body weight/day; essential fats should be included; vegetable and fruit (except oxalate-rich vegetables) intake should be increased. The use of calcium supplements has potential benefits but needs to be examined further.

Dietary risk factors for hyperoxaluria in calcium oxalate stone formers

BACKGROUND

Hyperoxaluria is a major predisposing factor in calcium oxalate urolithiasis. The aim of the present study was to clarify the role of dietary oxalate in urinary oxalate excretion and to assess dietary risk factors for hyperoxaluria in calcium oxalate stone patients.

METHODS

Dietary intakes of 186 calcium oxalate stone formers, 93 with hyperoxaluria (>or=0.5 mmol/day) and 93 with normal oxalate excretion (<0.4 mmol/day), were assessed by a 24-hour weighed dietary record. Each subject collected 24-hour urine during the completion of the food record. Oxalate content of foods was measured by a recently developed analytical method.

RESULTS

The mean daily intakes of energy, total protein, fat and carbohydrates were similar in both groups. The diets of the patients with hyperoxaluria were estimated to contain 130 mg/day oxalate and 812 mg/day calcium as compared to 101 mg/day oxalate and 845 mg/day calcium among patients without hyperoxaluria. These differences were not significant. The mean daily intakes of water (in food and beverages), magnesium, potassium, dietary fiber and ascorbic acid were greater in patients with hyperoxaluria than in stone formers with normal oxalate excretion. Multiple logistic regression analysis revealed that urinary oxalate excretion was significantly associated with dietary ascorbate and fluid intake, and inversely related to calcium intake. Differences of estimated diet composition of both groups corresponded to differences in urinary parameters.

CONCLUSIONS

These findings suggest that hyperoxaluria predominantly results from increased endogenous production and from intestinal hyperabsorption of oxalate, partly caused by an insufficient supply or low availability of calcium for complexation with oxalate in the intestinal lumen.