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Willi S, Stamm L, Aldakak L, Staub K, Rühli F, Bender N. National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines. Nutr Rev 2021; 79:462-478. [PMID: 33015718 DOI: 10.1093/nutrit/nuaa062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%-100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.
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Affiliation(s)
- Sandra Willi
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Lea Stamm
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Lafi Aldakak
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
| | - Nicole Bender
- Institute of Evolutionary Medicine, University of Zurich, Switzerland
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D. J Ren Nutr 2020; 31:132-143. [PMID: 32586712 DOI: 10.1053/j.jrn.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022] Open
Abstract
We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick, Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan, Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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Abstract
A large number of dietary interactions have been described. Of these, only a relatively small number have been proved of relevance for human nutrition under the conditions of real diets. These interactions most often occur at the intestinal lumen, but they may also take place during utilization or storage of nutrients. Traditional diets of developing countries, which usually include non-refined cereals and other sources of fibre, may inhibit the bioavailability of mineral nutrients, contributing to specific deficiencies. Drug-nutrient interactions may also impact on nutritional status, particularly in population groups such as the elderly, who frequently receive prolonged medication and may have an inadequate food intake.
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Wallace TC, Frankenfeld CL. Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2017; 36:481-496. [PMID: 28686536 DOI: 10.1080/07315724.2017.1322924] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dietary intake of protein is fundamental for optimal acquisition and maintenance of bone across all life stages; however, it has been hypothesized that intakes above the current recommended dietary allowance (RDA) might be beneficial for bone health. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when preparing and reporting this systematic review and meta-analysis. A literature search strategy through April 11, 2017, was developed for the following 3 databases: PubMed, Ovid Medline, and Agricola. Included studies were those randomized controlled trials and prospective cohort studies among healthy adults ages 18 and older that examined the relationships between varying doses of protein intake at or above the current U.S. RDA (0.8 g/kg/d or 10%-15% of total caloric intake) from any source on fracture, bone mineral density (BMD)/bone mineral content (BMC), and/or markers of bone turnover. Twenty-nine articles were included for data extraction (16 randomized controlled trials [RCTs] and 13 prospective cohort studies). Meta-analysis of the prospective cohort studies showed high vs low protein intakes resulted in a statistically significant 16% decrease in hip fractures (standardized mean difference [SMD] = 0.84, 95% confidence interval [CI], 0.73, 0.95; I2 = 36.8%). Data from studies included in these analyses collectively lean toward the hypothesis that protein intake above the current RDA is beneficial to BMD at several sites. This systematic review supports that protein intakes above the current RDA may have some beneficial role in preventing hip fractures and BMD loss. There were no differences between animal or plant proteins, although data in this area were scarce. Larger, long-term, and more well-controlled clinical trials measuring fracture outcomes and BMD are needed to adequately assess whether protein intake above the current RDA is beneficial as a preventative measure and/or intervention strategy for osteoporosis. Key teaching points: • • Bone health is a multifactorial musculoskeletal issue, and optimal protein intakes are key in developing and maintaining bone throughout the life span. • • Dietary protein at levels above the current RDA may be beneficial in preventing hip fractures and BMD loss. • • Plant vs animal proteins do not seem to differ in their ability to prevent bone loss; however, data in this area are scarce. • • Larger, long-term RCTs using women not using hormone replacement therapy (HRT) are needed to adequately assess the magnitude of impact that protein intakes above the RDA have on preventing bone loss.
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Affiliation(s)
- Taylor C Wallace
- a Department of Nutrition and Food Studies , George Mason University , Fairfax , Virginia , USA.,b Think Healthy Group, Inc. , Washington , DC
| | - Cara L Frankenfeld
- c Department of Global and Community Health , George Mason University , Fairfax , Virginia , USA
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Bel-Serrat S, Stammers AL, Warthon-Medina M, Moran VH, Iglesia-Altaba I, Hermoso M, Moreno LA, Lowe NM. Factors that affect zinc bioavailability and losses in adult and elderly populations. Nutr Rev 2014; 72:334-52. [DOI: 10.1111/nure.12105] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Silvia Bel-Serrat
- GENUD (Growth, Exercise, Nutrition and Development) Research Group; Faculty of Health Sciences; University of Zaragoza; Zaragoza Spain
| | - Anna-Louise Stammers
- International Institute of Nutritional Sciences and Food Safety Studies; University of Central Lancashire; Preston UK
| | - Marisol Warthon-Medina
- International Institute of Nutritional Sciences and Food Safety Studies; University of Central Lancashire; Preston UK
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit; University of Central Lancashire; Preston UK
| | - Iris Iglesia-Altaba
- GENUD (Growth, Exercise, Nutrition and Development) Research Group; Faculty of Health Sciences; University of Zaragoza; Zaragoza Spain
| | - Maria Hermoso
- Ludwig-Maximilians-University of Munich; Dr. von Hauner Childrens Hospital; Div. Metabolic Diseases and Nutritional Medicine; Munich Germany
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group; Faculty of Health Sciences; University of Zaragoza; Zaragoza Spain
| | - Nicola M Lowe
- International Institute of Nutritional Sciences and Food Safety Studies; University of Central Lancashire; Preston UK
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Molina RM, Schaider LA, Donaghey TC, Shine JP, Brain JD. Mineralogy affects geoavailability, bioaccessibility and bioavailability of zinc. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2013; 182:217-24. [PMID: 23933126 PMCID: PMC3885901 DOI: 10.1016/j.envpol.2013.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 05/04/2023]
Abstract
We correlated mineralogical and particle characteristics of Zn-containing particles with Zn geoavailability, bioaccessibility, and bioavailability following gavage and intranasal (IN) administration in rats. We compared samples of Zn/Pb mine waste and five pulverized pure-phase Zn minerals (<38 μm). Particles were neutron-activated to produce radioactive (65)Zn. We assessed geoavailability using sequential extractions and bioaccessibility using in vitro extraction tests simulating various pH and biological conditions. Zn in vivo bioavailability and in vitro bioaccessibility decreased as follows: mine waste > hydrozincite > hemimorphite > zincite ≈ smithsonite >> sphalerite. We found significant correlations among geoavailability, bioaccessibility and bioavailability. In particular, Zn bioavailability post-gavage and post-IN was significantly correlated with bioaccessibility in simulated phagolysosomal fluid and gastric fluid. These data indicate that solid phase speciation influences biological uptake of Zn and that in vitro tests can be used to predict Zn bioavailability in exposure assessment and effective remediation design.
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Affiliation(s)
- Ramon M Molina
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Cao JJ, Johnson LK, Hunt JR. A diet high in meat protein and potential renal acid load increases fractional calcium absorption and urinary calcium excretion without affecting markers of bone resorption or formation in postmenopausal women. J Nutr 2011; 141:391-7. [PMID: 21248199 DOI: 10.3945/jn.110.129361] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our objective in this study was to determine the effects of a high-protein and high-potential renal acid load (PRAL) diet on calcium (Ca) absorption and retention and markers of bone metabolism. In a randomized crossover design, 16 postmenopausal women consumed 2 diets: 1 with low protein and low PRAL (LPLP; total protein: 61 g/d; PRAL: -48 mEq/d) and 1 with high protein and high PRAL (HPHP; total protein: 118 g/d; PRAL: 33 mEq/d) for 7 wk each separated by a 1-wk break. Ca absorption was measured by whole body scintillation counting of radio-labeled (47)Ca. Compared with the LPLP diet, the HPHP diet increased participants' serum IGF-I concentrations (P < 0.0001), decreased serum intact PTH concentrations (P < 0.001), and increased fractional (47)Ca absorption (mean ± pooled SD: 22.3 vs. 26.5 ± 5.4%; P < 0.05) and urinary Ca excretion (156 vs. 203 ± 63 mg/d; P = 0.005). The net difference between the amount of Ca absorbed and excreted in urine did not differ between 2 diet periods (55 vs. 28 ± 51 mg/d). The dietary treatments did not affect other markers of bone metabolism. In summary, a diet high in protein and PRAL increases the fractional absorption of dietary Ca, which partially compensates for increased urinary Ca, in postmenopausal women. The increased IGF-I and decreased PTH concentrations in serum, with no change in biomarkers of bone resorption or formation, indicate a high-protein diet has no adverse effects on bone health.
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Affiliation(s)
- Jay J Cao
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58202, USA.
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11
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The effect of high salt and high protein intake on calcium metabolism,
bone composition and bone resorption in the rat. Br J Nutr 2007. [DOI: 10.1017/s0007114500001227] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effects of salt (NaCl) supplementation of rat diets (50 g/kg diet),
with normal (200 g/kg) or high (500 g/kg) dietary casein content, were
studied in 3-week-old male rats over a 3-week period. Weight gain was
reduced by dietary salt but was unaffected by dietary casein.
Salt-supplemented rats exhibited a two-and three-fold increase in urinary Mg
and Ca excretion respectively, irrespective of dietary casein content.
Dietary casein had no effect on urinary Ca or Mg. Salt reduced femoral mass
but not femoral mass expressed relative to body weight, but neither variable
was affected by dietary casein. Femoral Mg and P contents and concentrations
were unaffected by dietary salt or casein. While femoral Ca concentration
was unaffected by dietary salt, the Ca content was reduced by salt
supplementation, irrespective of dietary casein content. Neither the content
nor concentration of Ca in femora was affected by dietary casein. Urinary
pyridinoline and deoxypyridinoline levels were increased by salt
supplementation, irrespective of dietary casein content, but were unaffected
by casein. Net Ca absorption was unaffected by dietary salt or casein. In
conclusion, these results show that salt supplementation over the short-term
increased the rate of bone resorption in rats. This was as a consequence of
Na-induced calciuria. On the other hand, a high dietary protein intake had
no effect on Ca metabolism, bone composition or bone resorption, nor did it
augment the Na-induced calciuria or increased rate of bone
resorption.
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Hunt CD, Johnson LK. Magnesium requirements: new estimations for men and women by cross-sectional statistical analyses of metabolic magnesium balance data. Am J Clin Nutr 2006; 84:843-52. [PMID: 17023712 DOI: 10.1093/ajcn/84.4.843] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current recommendations for magnesium requirements are based on sparse balance data. OBJECTIVE To provide new estimates of the average magnesium requirement for men and women, we pooled magnesium data from 27 different tightly controlled balance studies conducted at the US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND. DESIGN Magnesium balance data (magnesium intake - [fecal magnesium + urinary magnesium]) (664 data points) were collected from 243 subjects (women: n = 150; weight: 71.6 +/- 16.5 kg; age: 51.3 +/- 17.4 y; men: n = 93, weight: 76.3 +/- 12.5 kg; age: 28.1 +/- 8.1 y). Data from the last 6-14 d of each dietary period (> or =28 d) of each study were analyzed and were excluded if individual intakes of calcium, copper, iron, phosphorus, or zinc fell below respective estimated average requirements (EARs) or exceeded 99th percentiles of usual intakes of those elements (iron: above the upper limit) from the 1994 Continuing Survey of Food Intakes by Individuals. Daily intakes of magnesium ranged between 84 and 598 mg. The relation between magnesium intake and magnesium output was investigated by fitting random coefficient models. RESULTS The models predicted neutral magnesium balance [defined as magnesium output (Y) equal to magnesium intake (M)] at magnesium intakes of 165 mg/d [95% prediction interval (PI): 113, 237 mg/d; Y = 19.8 + 0.880 M], 2.36 mg . kg(-1) . d(-1) (95% PI: 1.58, 3.38 mg . kg(-1) . d(-1); Y = 0.306 + 0.870 M), or 0.075 mg . kcal(-1) . d(-1) (95% PI: 0.05, 0.11 mg . kcal(-1) . d(-1); Y = 0.011 + 0.857 M). Neither age nor sex affected the relation between magnesium intake and output. CONCLUSION The findings suggest a lower magnesium requirement for healthy men and women than estimated previously.
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Affiliation(s)
- Curtiss D Hunt
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58202-9034, USA.
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Harrington M, Bennett T, Jakobsen J, Ovesen L, Brot C, Flynn A, Cashman KD. The effect of a high-protein, high-sodium diet on calcium and bone metabolism in postmenopausal women and its interaction with vitamin D receptor genotype. Br J Nutr 2004; 91:41-51. [PMID: 14748937 DOI: 10.1079/bjn20031016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The influence of a high-Na, high-protein (calciuric) diet on Ca and bone metabolism was investigated in postmenopausal women (aged 50-67 years) who were stratified by vitamin D receptor (VDR) genotype. In a crossover trial, twenty-four women were randomly assigned to a diet high in protein (90 g/d) and Na (180 mmol/d) or a diet adequate in protein (70 g/d) and low in Na (65 mmol/d) for 4 weeks, followed by crossover to the alternative dietary regimen for a further 4 weeks. Dietary Ca intake was maintained at usual intakes (about 20 mmol (800 mg)/d). Urinary Na, K, Ca, N and type I collagen cross-linked N-telopeptide (NTx; a marker of bone resorption), plasma parathyroid hormone (PTH), serum 25-hydroxycholecalciferol (25(OH)D3), 1,25-dihydroxycholecalciferol (1,25(OH)2D3), osteocalcin and bone-specific alkaline phosphatase (B-Alkphase) were measured in 24 h urine samples and fasting blood samples collected at the end of each dietary period. The calciuric diet significantly (P<0.05) increased mean urinary Na, N, K, Ca and NTx (by 19 %) compared with the basal diet, but had no effect on circulating 25(OH)D3, 1,25(OH)2D3, PTH, osteocalcin or B-Alkphase in the total group (n 24). There were no differences in serum markers or urinary minerals between the basal and calciuric diet in either VDR genotype groups. While the calciuric diet significantly increased urinary NTx (by 25.6 %, P<0.01) in the f+ VDR group (n 10; carrying one or more (f) Fok I alleles), it had no effect in the f- VDR group (n 14; not carrying any Fok I alleles). It is concluded that the Na- and protein-induced urinary Ca loss is compensated for by increased bone resorption and that this response may be influenced by VDR genotype.
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Affiliation(s)
- Mary Harrington
- Department of Food and Nutritional Sciences, Cork, Republic of Ireland
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Barclay D, Mauron J, Blondel A, Cavadini C, Verwilghen A, Van Geert C, Dirren H. Micronutrient intake and status in rural Democratic Republic of Congo. Nutr Res 2003. [DOI: 10.1016/s0271-5317(03)00027-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kerstetter JE, O'Brien KO, Insogna KL. Low protein intake: the impact on calcium and bone homeostasis in humans. J Nutr 2003; 133:855S-861S. [PMID: 12612169 DOI: 10.1093/jn/133.3.855s] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Increasing dietary protein results in an increase in urinary calcium. Despite over 80 y of research, the source of the additional urinary calcium remains unclear. Because most calcium balance studies found little effect of dietary protein on intestinal calcium absorption, it was assumed that the skeleton was the source of the calcium. The hypothesis was that the high endogenous acid load generated by a protein-rich diet would increase bone resorption and skeletal fracture. However, there are no definitive nutrition intervention studies that show a detrimental effect of a high protein diet on the skeleton and the hypothesis remains unproven. Recent studies from our laboratory demonstrate that dietary protein affects intestinal calcium absorption. We conducted a series of short-term nutrition intervention trials in healthy adults where dietary protein was adjusted to either low, medium or high. The highest protein diet resulted in hypercalciuria with no change in serum parathyroid hormone. Surprisingly, within 4 d, the low protein diet induced secondary hyperparathyroidism that persisted for 2 wk. The secondary hyperparathyroidism induced by the low protein diet was attributed to a reduction in intestinal calcium absorption (as assessed by dual stable calcium isotopes). The long-term consequences of these low protein-induced changes in calcium metabolism are not known, but they could be detrimental to skeletal health. Several recent epidemiological studies demonstrate reduced bone density and increased rates of bone loss in individuals habitually consuming low protein diets. Therefore, studies are needed to determine whether low protein intakes directly affect rates of bone resorption, bone formation or both.
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Affiliation(s)
- Jane E Kerstetter
- School of Allied Health, University of Connecticut, Storrs 06269-2101, USA.
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Jenkins DJA, Kendall CWC, Vidgen E, Augustin LSA, Parker T, Faulkner D, Vieth R, Vandenbroucke AC, Josse RG. Effect of high vegetable protein diets on urinary calcium loss in middle-aged men and women. Eur J Clin Nutr 2003; 57:376-82. [PMID: 12571674 DOI: 10.1038/sj.ejcn.1601530] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2001] [Revised: 05/08/2002] [Accepted: 05/14/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of high-protein diets, which have recently been promoted for their health benefits, on urinary calcium losses and bone turnover in older subjects. DESIGN Randomized controlled cross-over study. SETTING Teaching hospital and university. SUBJECTS Twenty hyperlipidemic men and postmenopausal women (age 56+/-2 y) completed the study. INTERVENTION One-month test and control phases during which subjects consumed equi-energy metabolic diets high in calcium (1578 and 1593 mg/day, respectively). On the test diet 11% of total dietary energy from starch in the control bread was replaced by protein (wheat gluten), resulting in 27% of energy from protein on the test diet vs 16% on the control diet. MAIN OUTCOME MEASURE Urinary calcium excretion. RESULTS Compared with the control diet, at week 4, the test diet increased mean (+/-s.e.m.) 24 h urinary output of calcium (139+/-15 vs 227+/-21 mg, P=0.004). The treatment difference in urinary calcium loss correlated with the serum anion gap as a marker of metabolic acid production (r=0.57, P=0.011). Serum calcium levels were marginally lower 2.41+/-0.02 vs 2.38+/-0.02 mmol/l (P=0.075), but there was no significant treatment difference in calcium balance, possibly related to the high background calcium intake on both diets. CONCLUSION In the presence of high dietary calcium intakes the vegetable protein gluten does not appear to have a negative effect on calcium balance despite increased urinary calcium loss.
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Affiliation(s)
- D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada.
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Hambidge M, Krebs NF. Interrelationships of key variables of human zinc homeostasis: relevance to dietary zinc requirements. Annu Rev Nutr 2001; 21:429-52. [PMID: 11375444 DOI: 10.1146/annurev.nutr.21.1.429] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Currently, estimates of human zinc requirements depend primarily on a factorial approach. The availability of tracer techniques employing zinc stable isotopes has facilitated the acquisition of data on major variables of zinc homeostasis in addition to those that can be measured with careful metabolic balance techniques. These data have promising potential to facilitate and improve the factorial approach. The thesis proposed in this paper is that realistic estimations of dietary zinc requirements by a factorial approach require attention to the dynamic interrelationships between major variables of zinc homeostasis. This applies especially to the positive relationship between endogenous fecal zinc and total absorbed zinc, which is the essential starting point in estimating physiologic and, from there, dietary requirements.
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Affiliation(s)
- M Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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Bennett T, Desmond A, Harrington M, McDonagh D, FitzGerald R, Flynn A, Cashman KD. The effect of high intakes of casein and casein phosphopeptide on calcium absorption in the rat. Br J Nutr 2000; 83:673-80. [PMID: 10911776 DOI: 10.1017/s0007114500000854] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The effect of the level or source of dietary protein or protein-derived peptides on Ca absorption is not well understood. We determined, therefore, the influence of habitual dietary casein level, meal casein and meal casein phosphopeptide (CPP) on Ca absorption in the rat. True fractional Ca absorption was investigated in male 7-week-old rats, Wistar strain, in three separate studies using a faecal 47Sc: 47Ca ratio method. In studies A and C, rats (n 8 per group) were fed on a purified diet containing 200 g casein/kg for 2 weeks. Rats were then given a 47Ca-labelled meal (10 g) containing (per kg) either 0, 100, 200, or 300 g casein (study A) or 0, 100, 200, 350 or 500 g CPP (study C). In study B, rats (n 24 per group) were fed on a purified diet containing (per kg) either 200, 350 or 500 g casein for 2 weeks. Each group was then further randomized into three groups (n 8 per group) and given a 47Ca-labelled meal (10 g of the same diet) containing (per kg) either 200, 350 or 500 g casein. Ca absorption from a meal was unaffected by increasing meal casein concentration from 0 to 300 g/kg (study A), but was increased with a meal casein content of 500 g/kg (study B). Fractional Ca absorption decreased with increasing usual dietary casein intake in the range 200-500 g/kg (study B), suggesting intestinal adaptation. Ca absorption was unaffected by inclusion of 100 g CPP/kg in a single meal but was significantly (P < 0.001) reduced by 200, 350 and 500 g CPP/kg meal, with no evident dose-relationship. Thus, while Ca absorption was enhanced by high-casein meals, the mechanism remains unclear.
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Affiliation(s)
- T Bennett
- Department of Nutrition, University College, Cork, Ireland
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Abstract
In the past, a major challenge for nutrition research was in defining indicators of nutritional adequacy. More recently, the research base related to the role of nutrition in chronic disease has expanded sufficiently to permit moving beyond deficiency indicators to other indicators with broader functional significance. Thus, nutrition research is faced with the new challenge of defining 'optimal nutrition'. One definition of optimal nutrition with respect to any particular nutrient could be when a functional marker reaches an 'optimal value' or plateau beyond which it is not longer affected by intake or stores of the nutrient. A functional marker of nutrient status could be defined as a physiological or biochemical factor which (1) is related to function or effect of the nutrient in target tissue(s) and (2) is affected by dietary intake or stores of the nutrient (which may include markers of disease risk). Examples of such indicators or markers are those related to risk of chronic diseases such as osteoporosis, CHD, or hypertension. The present review focuses on the concept of optimal nutrition with respect to three nutrients, Ca, Mg and P. However, for P and Mg there are as yet no functional indicators which respond to dietary intake, and in such cases nutrient requirements are established using more traditional approaches, e.g. balance data. For Ca, there has been interest in using maximal Ca retention, which is based on balance data, bone mass measurements and biomarkers of bone turnover as useful functional indicators of the adequacy of Ca intake.
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Affiliation(s)
- K D Cashman
- Department of Nutrition, University College, Cork, Republic of Ireland.
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Affiliation(s)
- R K Rude
- University of Southern California, Los Angeles 90033, USA
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Randhawa RK, Kawatra BL. Effect of dietary protein on the absorption and retention of Zn, Fe, Cu and Mn in pre-adolescent girls. DIE NAHRUNG 1993; 37:399-407. [PMID: 8377806 DOI: 10.1002/food.19930370414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Three experimental diets, viz. habitually consumed diet (D1), D1 + 34 g pulses (D2), D1 + 190 ml milk (D3) were fed to 18 healthy pre-adolescent girls of low socio-economic group. The additional amount of pulses/milk provided 8 g of additional protein/day. The overall results indicate that the supplementation of habitually consumed diet with a small amount of milk greatly improved the absorption and retention of trace minerals. Minimum daily intake of Zn, Cu and Mn required to maintain equilibrium of these minerals in pre-adolescent children was calculated using the prediction equations and was found to be 8.77, 2.01 and 1.91 mg, respectively. The requirement of Fe could not be calculated due to wide variations among the subjects.
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Affiliation(s)
- R K Randhawa
- Department of Foods and Nutrition, Punjab Agricultural University, Ludhiana, India
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Affiliation(s)
- E S Orwoll
- Department of Veterans Affairs, Portland, OR
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24
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Moderate and high amounts of protein from casein enhance human absorption of zinc from whole-wheat or white rolls. Nutr Res 1991. [DOI: 10.1016/s0271-5317(05)80003-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Thomas AJ, Bunker VW, Sodha N, Clayton BE. Calcium, magnesium and phosphorus status of elderly inpatients: dietary intake, metabolic balance studies and biochemical status. Br J Nutr 1989; 62:211-9. [PMID: 2789984 DOI: 10.1079/bjn19890021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The calcium, magnesium and phosphorus status of a group of elderly inpatients was studied by use of duplicate meal analysis over a 5 d period and biochemical indices in twenty-one patients, and metabolic balance (5 d) in six of these. Mean daily Ca intake was lower than that of apparently healthy elderly subjects in metabolic equilibrium, although commensurate with present UK recommendations. Metabolic balance was negative for Ca. Mean daily Mg intake was approximately half the US recommendation, and half the intake at which metabolic balance has been observed in healthy elderly people. The five patients studied were in metabolic balance for Mg. Mean daily P intake was close to the UK recommendation, but negative metabolic balance was observed. The disparity between official recommendations for Ca-intake, factors contributing to suboptimal Ca status, and measures that may improve Ca status in this group are discussed.
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Affiliation(s)
- A J Thomas
- Faculty of Medicine, University of Southampton
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26
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Abstract
The utilization of most minerals can be altered not only by varying the dietary levels of protein, carbohydrate, fiber, fat, and vitamins but also by varying the forms of macronutrients fed. Interactions among minerals are frequent and sometimes complex. Thus, all assessments of mineral requirements should include discussions of the effects of interactions on mineral bioavailability. Some of these interactions occur in the gut and affect the absorption of minerals. Other interactions affect the metabolism, transport and storage of minerals, and ultimately their excretion in urine or in endogenous gut secretions.
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Affiliation(s)
- J L Greger
- Department of Nutritional Sciences, University of Wisconsin, Madison
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27
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Abstract
Current dietary recommendations urge, inter alia, an increased consumption of fibre-containing foods. Some experimental studies made on various animals and man indicate that the associated increases in intakes of fibre and phytic acid may prejudice mineral status respecting calcium, magnesium, iron and zinc. An examination has been made of the experimental evidence, also of the epidemiological evidence on numerous types of populations, past and present, developing and developed. It has been concluded that diets high in fibre, characteristically do not have meaningful ill effects on well-being or unequivocally enhance morbidity. In particular populations in certain regions where deleterious effects have been reported it is judged that local factors, not wholly understood, are in operation. In assessing the extent of the benefit to be derived from the dietary changes urged, results must be viewed holistically and not in isolation. It is believed that the beneficial effects respecting reduced pronenesses to various degenerative diseases are likely to far outweigh the possible adverse effects of reduced bioavailability of mineral nutrients.
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28
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Black AE, Wiles SJ, Paul AA. The nutrient intakes of pregnant and lactating mothers of good socio-economic status in Cambridge, UK: some implications for recommended daily allowances of minor nutrients. Br J Nutr 1986; 56:59-72. [PMID: 3676209 DOI: 10.1079/bjn19860085] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
1. Forty-two mothers from social classes I, II and III non-manual and twenty-one from social classes III manual M), IV and V were studied longitudinally. The mean daily nutrient intakes in months 4-9 of pregnancy, months 2-4 of lactation and 3 and 6 months post-lactation are presented and are compared with the UK and the US recommended daily allowances (RDA). 2. The quality of the diets (nutrients per 4184 kJ (1000 kcal] was found to be better than that of other adult female populations studied in the UK, except for a group of dietitians. 3. The mean daily intakes of nutrients for which there are UK RDA were almost all greater than 100% of the RDA. The exceptions were iron, which in the manual group (social classes IIIM, IV and V) was 85% of the RDA in pregnancy and 75% post-lactation, and vitamin D. 4. Among the nutrients for which there are US, but not UK RDA, only phosphorus and vitamin B12 intakes were greater than 100% of the RDA in both groups at all stages of the study. Intakes of other nutrients were below the RDA: pantothenate 70-91, vitamin B6, zinc, vitamin E and copper 40-72, folate 21-44, and biotin less than 20% of the RDA. 5. The bases of the RDA for adult women were examined; for most nutrients the information is limited. It was concluded that the RDA for magnesium, vitamin E and pantothenate are probably higher than necessary and that deficiency is unlikely; that zinc, copper, vitamin B6 and folate are probably 'marginal' nutrients for 'at risk' groups; and that information on biotin is insufficient even roughly to assess the dietary requirement.
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29
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Atinmo T, Friday M. Calcium, magnesium, and zinc status of young adult females on an adequate protein and calorie intake. Biol Trace Elem Res 1985; 8:157-66. [PMID: 24257940 DOI: 10.1007/bf02917454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/1984] [Accepted: 02/15/1985] [Indexed: 11/30/2022]
Abstract
Calcium, magnesium, and zinc balances were determined in eleven young adult college females (mean age, 24.9±2.35) during a 39-d metabolic study when the subjects were fed an adequate calorie and protein diet based on habitually consumed foods. Analysis showed that the dietary contribution of calcium, magnesium, and zinc to the RDA were 53.6, 26.4, and 57.9%, respectively. Mean fecal losses of calcium and magnesium were low, while fecal zinc losses were higher than the daily intake. Mean urinary excretion of calcium was within the normal range, but was low for magnesium whereas urinary zinc was higher than normal. Mean daily apparent retentions of calcium and magnesium were positive, whereas positive apparent retention for zinc were observed in four of the subjects. Plasma calcium and magnesium remained normal, but mean plasma zinc declined at the end of the study. Significant correlations were observed between the fecal losses of calcium and magnesium and calcium and zinc. Urinary calcium also correlated significantly (P<0.05) with urinary magnesium, but not with zinc. It appears that adequate protein and calorie intake in the presence of low dietary intake of calcium, magnesium, and zinc has no significant effect on calcium and magnesium status whereas a lowering effect on plasma zinc and apparent zinc retention was observed in the subjects studied.
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Affiliation(s)
- T Atinmo
- Department of Human Nutrition, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Atinmo T, Adeyefa IO, Fadero EA, Olorunleke JF. Effect of a moderate variation in dietary energy intake on the retention and excretion of zinc, calcium, and magnesium. Biol Trace Elem Res 1985; 8:93-104. [PMID: 24257869 DOI: 10.1007/bf02917463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/1985] [Accepted: 02/26/1985] [Indexed: 11/24/2022]
Abstract
Mineral balance was studied by metabolic balance techniques in 13 healthy college females aged 21-23 yr. They were fed diet containing 1780 kcal, 2580 kcal, and 25 g protein in a 20-d experiment period. Both diets contained approximately 5.28 mg zinc, 216.85 mg calcium, and 364.3 mg magnesium. The diet consisted of habitually consumed foods. Blood, urine and fecal samples were collected for mineral analysis using atomic absorption spectrophotometry. Plasma mineral levels were not affected by the change in dietary energy intake. Fecal calcium and magnesium were significantly higher when subjects were fed the low calorie (1780 kcal) diet, whereas there was no significant difference in fecal zinc for the two levels of dietary energy. Urinary calcium and magnesium were also significantly higher when the diet provided 1780 kcal though, on the other hand, urinary zinc was significantly higher when the diet provided 2680 kcal (P<0.05). Urinary calcium and magnesium correlated negatively, whereas urinary zinc correlated positively, with the dietary energy intake (P (o)<0.05). Dietary energy intake has a significant effect on the mineral balance of the subjects.
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Affiliation(s)
- T Atinmo
- Department of Human Nutrition, College of Medicine, University of Ibadan, Ibadan, Nigeria
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31
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Walker AR, Walker BF. Enigma of bone loss and osteoporosis. Med J Aust 1985; 143:50-1. [PMID: 4010606 DOI: 10.5694/j.1326-5377.1985.tb122783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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