Effect of dietary aluminum on mineral metabolism of adult males

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

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.

Magnesium Status and Stress: The Vicious Circle Concept Revisited

Magnesium deficiency and stress are both common conditions among the general population, which, over time, can increase the risk of health consequences. Numerous studies, both in pre-clinical and clinical settings, have investigated the interaction of magnesium with key mediators of the physiological stress response, and demonstrated that magnesium plays an inhibitory key role in the regulation and neurotransmission of the normal stress response. Furthermore, low magnesium status has been reported in several studies assessing nutritional aspects in subjects suffering from psychological stress or associated symptoms. This overlap in the results suggests that stress could increase magnesium loss, causing a deficiency; and in turn, magnesium deficiency could enhance the body’s susceptibility to stress, resulting in a magnesium and stress vicious circle. This review revisits the magnesium and stress vicious circle concept, first introduced in the early 1990s, in light of recent available data.

Magnesium requirements: new estimations for men and women by cross-sectional statistical analyses of metabolic magnesium balance data

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.

Optimal nutrition: calcium, magnesium and phosphorus

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.

Dietary standards for manganese: overlap between nutritional and toxicological studies

The Estimated Safe and Adequate Daily Dietary Intake (ESADDI) for adults for manganese is 2-5 mg Mn/d. The LOAEL (lowest-observable-adverse-effect level) for manganese in water is 0.06 mg Mn/(kg.d) or 4.2 mg Mn/d for a 70-kg individual. The inconsistency in these standards reflects limitations in the available data as well as differences in the way in which the standards are calculated. Manganese balance and excretion data are not useful biomarkers of manganese exposure but do demonstrate that the body is protected against manganese toxicity primarily by low absorption and/or rapid presystemic elimination of manganese by the liver. Serum manganese concentrations in combination with lymphocyte manganese-dependent superoxide dismutase (MnSOD) activity, and perhaps blood arginase activity, seem to be the best way to monitor ingestion of insufficient manganese. Serum manganese concentrations in combination with brain magnetic resonance imaging (MRI) scans, and perhaps a battery of neurofunctional tests, seem to be the best way to monitor excessive exposure to manganese.

The effects of aluminum, iron, chromium, and yttrium on rat intestinal smooth muscle in vitro

The modification of peristaltic activity in the presence of several metal ions has been investigated in the rat intestine by the isolated organ technique. The metals tested modify the intestinal movements: aluminum, chromium, and yttrium cause a decrease of amplitude, while iron showed no effect. By use of microscopic techniques, the presence of yttrium hydroxide was observed in the intestinal tissues. Iron also appears as a precipitate outside of the intestinal serosal, which may explain why iron did not modify the peristaltism. Chromium and aluminum were not apparent to microscope, despite being detected and quantified in the tissues by means of atomic emission spectrometer. We conclude that the trivalent ions of these elements may operate differently on the mechanisms of intestinal contractions: yttrium precipitates in intercellular spaces, iron precipitates outside the intestines, and chromium and aluminum remain in solution and are distributed homogeneously in the smooth intestinal muscle.

Aluminum exposure and metabolism

Aluminum (Al) is a nonessential, toxic metal to which humans are frequently exposed. Oral exposure to aluminum occurs through ingestion of aluminum-containing pharmaceuticals and to a lesser extent foods and water. Parenteral exposure to aluminum can occur via contaminated total parenteral nutrition (TPN), intravenous (i.v.) solutions, or contaminated dialysates. Inhalation exposure may be important in some occupational settings. The gut is the most effective organ in preventing tissue aluminum accumulation after oral exposure. Typically gastrointestinal absorption of aluminum from diets is < 1%. Although the mechanisms of aluminum absorption have not been elucidated, both passive and active transcellular processes and paracellular transport are believed to occur. Aluminum and calcium may share some absorptive pathways. Aluminum absorption is also affected by the speciation of aluminum and a variety of other substances, including citrate, in the gut milieu. Not all absorbed or parenterally delivered aluminum is excreted in urine. Low glomerular filtration of aluminum reflects that most aluminum in plasma is nonfiltrable because of complexation to proteins, predominantly transferrin. The importance of biliary secretion of aluminum is debatable and the mechanism(s) is poorly understood and appears to be saturable by fairly low oral doses of aluminum.

Effects of aluminium on the mineral metabolism of rats in relation to age

The present study was conducted to assess in rats the effects of chronic aluminium (Al) exposure on calcium (Ca), magnesium (Mg), manganese (Mn), copper (Cu), zinc (Zn) and iron (Fe) accumulation and urinary excretion in relation to the age of the animals. Male young (21 day old), adult (8 months), and old (16 months) rats were orally exposed to 0, 50, or 100 mg Al/kg/day for a period of 6.5 months. Urinary levels of essential elements were determined after 3 and 6.5 months of exposure, whereas tissue Ca, Mg, Mn, Cu, Zn and Fe concentrations were examined after 6.5 months of Al administration. A number of age-related changes in tissue accumulation and urinary excretion of essential elements following chronic exposure to Al were found. Concentrations of essential elements in most tissues of young Al-exposed rats were generally lower than those of adult and old rats. The highest levels of essential elements were found in old animals. Liver, testes and spleen were the tissues that showed the most remarkable increases in relation to the levels found in those tissues of young rats. Adult rats showed a pattern comparable to that of old animals for mineral metabolism in brain, whereas in bone and testes the pattern of accumulation was closer to that of young rats. While the urinary levels of Ca were generally reduced in the Al-exposed groups, no Al-associated changes were noted for Mg, Mn, Cu and Zn. In turn, after 6.5 months of Al administration Fe excretion was increased in Al-treated adult and old rats. The results of this study suggest that early stages of life cycle should be of special concern for Al-induced changes in the metabolism of essential elements.

Element variations in pregnant and nonpregnant female rats orally intoxicated by aluminum lactate

Pregnant or nonpregnant female rats were orally intoxicated by aluminum lactate (400 mg Al/kg/d) from d 0-19 of gestation to determine the treatment's influence on element variations in the females and their fetuses. The aluminum levels of plasma, liver, spleen, and kidneys were significantly higher in treated pregnant rats than non-pregnant female rats. Differences of P, Ca, Cu, Zn, or Mg levels were observed among the four groups of female rats in the tissues and plasma. The aluminum content of the 20-d-old fetuses did not significantly differ between the treated and control groups. On the contrary, calcium and magnesium levels in the whole fetuses from treated or nontreated dams are significantly different.

Aluminum induces neurite elongation and sprouting in cultured hippocampal neurons

It has been reported that the aluminum content in the human brain increases with age, and it is particularly high in those with Alzheimer's disease. In this study, we found that a low aluminum concentration (100 mumol/L) in the culture media of opossum hippocampal neurons can induce extensive neurite outgrowth (ie, elongation and branching of neurites) and sprouting (ie, outgrowth of filiform processes from neurite varicosities) within 48 hours. Such changes in neurite morphology were remarkably similar to those described in the aged or Alzheimer's disease brain. Neurites that responded to aluminum varied greatly in length, thickness, and branching pattern. Many neurites appeared to have no clear directional growth pattern because they frequently changed their course and formed a meshwork of neurites with others originating from the same cell body. Sprouting neurites varied in length, thickness, and branching pattern, but they always originated from a globular enlargement of neurites along the neurite shaft or at the terminal end. Such growth pattern and extensive sprouting of neurites did not fit the growth pattern displayed by the control neurons. Our findings suggest that aluminum may be involved in the neuronal remodeling characteristic of aging and Alzheimer's disease.

The effect of exposure to aluminium on concentrations of essential metals in serum of foundry workers

The concentrations of aluminium (Al) in serum and urine of 33 volunteers exposed to inhalation of Al2O3 dust at a concentration in the air of less than 1 mg Al/m3 were measured. These were compared with results from 20 normal subjects not exposed. The concentrations of copper (Cu), zinc (Zn), and total iron (Fe) in serum were also measured. The Al concentration in serum was significantly raised in the subjects exposed to dust, but Al concentrations in urine showed no significant difference from controls. This suggests a possible change in distribution of metals in the body tissues due to the presence of Al, with incomplete excretion of Al in the urine. This redistribution was selective, as the serum concentrations of Cu were conclusively decreased whereas the serum concentrations of Zn were conclusively increased. The serum concentration of Fe did not change significantly.

Effects of parathyroidectomy on tissue calcium, phosphorus, magnesium, and copper concentrations in aluminum-loaded uremic rats

Rats were subjected to a two-stage 5/6 nephrectomy and treated with Al for 2 and 4 wk with a cumulative dose of 4.2 and 8.4 mg of Al, respectively. Other animals were parathyrectomized (PTx) and loaded with 8.4 mg of Al for 4 wk. Total Al, Ca, P, Mg, and Cu contents were analyzed in the liver, kidney, and bone by inductively coupled plasma atomic emission spectrometry (ICP-AES). The results showed that Al given to growing uremic rats significantly increased the content of Al in the liver, kidney, and bone. Moreover, Al treatment increased the liver and kidney Ca levels and decreased the Ca and P values in bone. Previous parathyroidectomy significantly reduced Al accumulation within organs and changes in the Ca and P levels in the bone, liver, and kidney. The result was not influenced by different degrees of renal failure.

Aluminum-induced neurotoxicity: alterations in membrane function at the blood-brain barrier

Aluminum is established as a neurotoxin, although the basis for its toxicity is unknown. It recently has been shown to alter the function of the blood-brain barrier (BBB), which regulates exchanges between the central nervous system (CNS) and peripheral circulation. The BBB owes its unique properties to the integrity of the cell membranes that comprise it. Aluminum affects some of the membrane-like functions of the BBB. It increases the rate of transmembrane diffusion and selectively changes saturable transport systems without disrupting the integrity of the membranes or altering CNS hemodynamics. Such alterations in the access to the brain of nutrients, hormones, toxins, and drugs could be the basis of CNS dysfunction. Aluminum is capable of altering membrane function at the BBB; many of its effects on the CNS as well as peripheral tissues can be explained by its actions as a membrane toxin.

Aluminium content of foods and diets

Literature data on the aluminium content of individual foods have been compiled, summarized and presented by food groups. The contribution of aluminium from food preparation and cooking utensils and from food additives is discussed. Literature data on the daily intake of aluminium are summarized, and the contribution of food groups to daily aluminium intake is estimated. The major sources of dietary aluminium include several with aluminium additives (grain products, processed cheese and salt) and several that are naturally high in aluminium (tea, herbs and spices). The aluminium that may migrate from aluminium utensils is probably not a major or consistent source of this element. Daily intakes of aluminium, as reported prior to 1980, were 18-36 mg per day. More recent data, which are probably more accurate, indicate intakes of 9 mg per day for teenage and adult females and 12-14 mg per day for teenage and adult males.

Effects of ingested 4000ppm aluminum on the essential metals, especially zinc, in intact and ethanol treated mice

The effects of ingested Al on the essential metals were investigated using mice. Animals were divided into 4 groups: 1) Control, 2) Al, 3) EtOH and 4) Al+EtOH groups. Powdered commercial food, containing 1.26% P, 1.36% Ca, 70ppm Zn, 15ppm Cu, 200ppm Fe and 3.1ppm Al, was used to prepare the diets. For Al-treated groups, Al(AlCl3) was added to powdered food at a concentration of 4000ppm. The co-existing effect of EtOH which is known to affect the essential metals, was also investigated as a possible modulater of Al toxicity at a concentration of 5% for 22 days, followed by 10% for 36 days in the drinking water. After 58 days feeding with food containing Al and / or EtOH containing water, the Al effects on serum and femur P and Ca were found to be slight except for a significant decrease of serum P concentration in the Al+EtOH group. In this group, femur weight was less and femur Al concentration was more compared with the Al group. The effects on Fe and Cu were little. We observed a significant decrease of serum Zn concentration with 4000ppm Al diet in both the Al-treated groups. The fact that serum ALPase activity, a Zn enzyme, increased in disregard of a significant decrease of serum Zn concentration suggested the enzyme release from injures tissues. It is noticeable that a significant decrease of serum Zn concentration was observed when dietary Zn was sufficient. It is reported that the dietary intake of Zn is under the recommended allowance for many people. Since Al compounds are widely used as drugs, food additives and a conditioned latent Zn deficiency is rather common in human diseases, the effects of Al on the Zn metabolism are to be investigated further.

Aluminium toxicity in chronic renal insufficiency

Aluminium is a ubiquitous element in the environment and has been demonstrated to be toxic, especially in individuals with impaired renal function. Not much is known about the biochemistry of aluminium and the mechanisms of its toxic effects. Most of the interest in aluminium has been in the clinical setting of the haemodialysis unit. Here aluminium toxicity occurs due to contamination of dialysis solutions, and treatment of the patients with aluminium-containing phosphate binding gels. Aluminium has been shown to be the major contributor to the dialysis encephalopathy syndrome and an osteomalacic component of dialysis osteodystrophy. Other clinical disturbances associated with aluminium toxicity are a microcytic anaemia and metastatic extraskeletal calcification. Aluminium overload can be treated effectively by chelation therapy with desferrioxamine and haemodialysis. Aluminium is readily transferred from the dialysate to the patient's bloodstream during haemodialysis. Once transferred, the aluminium is tightly bound to non-dialysable plasma constituents. Very low concentrations of dialysate aluminium in the range of 10-15 micrograms/l are recommended to guard against toxic effects. Very few studies have been directed towards the separation of the various plasma species which bind aluminium. Gel filtration chromatography has been used to identify five major fractions, one of which is of low molecular weight and the others appear to be protein-aluminium complexes. Recommendations on aluminium monitoring have been published and provide 'safe' and toxic concentrations. Also, the frequency of monitoring has been addressed. Major problems exist with the analytical methods for measuring aluminium which result from inaccurate techniques and contamination difficulties. The most widely used analytical technique is electrothermal atomic absorption spectrometry which can provide reliable measurements in the hands of a careful analyst.