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Cherni I, Nouir R, Daoud F, Hamzaoui S, Ghalila H. Fast diagnostic of osteoporosis based on hair analysis using LIBS technique. Med Eng Phys 2022; 103:103798. [PMID: 35500991 DOI: 10.1016/j.medengphy.2022.103798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/29/2022]
Abstract
Currently, the reference method for the diagnose of the osteoporosis pathology is the Dual energy X-ray Absorptiometry (DXA) technique which assesses Bone Mineral Density (BMD). As a major public health problem, classified as such by the World Health Organization, it is necessary to develop new techniques that are more accessible, especially for developing countries. The objective of this work is to propose a new technique based on laser-induced breakdown spectroscopy (LIBS) using calcium and sodium in hair as a biomarker for the detection of osteoporosis pathology. The study involved 90 women aged 50 to 70 years divided in three groups, thirty women with osteoporosis, thirty women with osteopenia and thirty healthy women. The application of LIBS technique on their hair to correlate calcium and sodium lines with T-scores allows a quick and cheap screening of the disease. The results showed strong correlations between calcium lines and disease. We noted a negative correlation between the intensity of calcium and sodium lines. In addition to these results, we show that we were able to cluster the three groups using the emission lines of these two elements. All these results support the idea that the use of LIBS applied to hair to evaluate calcium and sodium elements as effective biomarkers for the detection of osteoporosis is a promising approach.
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Affiliation(s)
- Imen Cherni
- Laboratoire de Spectroscopie Atomique, Moléculaire et Applications (LSAMA), Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, P.O. Box 2092 Tunisia.
| | - Rihem Nouir
- Laboratoire de Spectroscopie Atomique, Moléculaire et Applications (LSAMA), Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, P.O. Box 2092 Tunisia
| | - Fatma Daoud
- Habib Thameur University Hospital Center, 8, Ali Ben Ayed Street Montfleury Tunis, 1008 Tunisia
| | - Sami Hamzaoui
- Laboratoire de Spectroscopie Atomique, Moléculaire et Applications (LSAMA), Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, P.O. Box 2092 Tunisia
| | - Hassen Ghalila
- Laboratoire de Spectroscopie Atomique, Moléculaire et Applications (LSAMA), Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, P.O. Box 2092 Tunisia
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Grez-Capdeville M, Crenshaw TD. Evaluation of calcium to phosphorus ratio in spot urine samples as a practical method to monitor phosphorus intake adequacy in sows. J Anim Sci 2021; 99:6427505. [PMID: 34791271 DOI: 10.1093/jas/skab335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to evaluate the reliability of using Ca to P ratio measured in spot urine samples to assess P intake adequacy in gestating and lactating sows. A total of 36 sows were fed one of six concentrations of dietary total P (0.40%, 0.48%, 0.56%, 0.64%, 0.72%, and 0.80%) from day 7.5 ± 1 after breeding until the end of lactation (day 26.6 ± 1). Dietary Ca to P ratio was maintained constant across treatments at 1.25:1. Total 24-h urine samples were collected in mid- and late gestation (days 77.1 ± 2 and 112.4 ± 1), and early and late lactation (days 4.5 ± 1 and 18.2 ± 1). In parallel to 24-h collections, spot urine samples were collected at three different times (early morning, late morning, and late afternoon) in late gestation and late lactation. Urine Ca and P concentrations were measured and Ca to P ratio was calculated. Sows were classified as P-adequate or P-deficient according to dietary P intake. Urine Ca to P ratio was greater in sows fed P-deficient diets than sows fed P-adequate diets (P < 0.001). Receiver operating characteristic (ROC) curves were used to determine the cutoff values for urine Ca to P ratio to predict P intake adequacy. Three different categories of P intake were defined according to urine Ca to P ratio: deficient, adequate, and excessive. The area under the ROC for Ca to P ratio was 0.88 (95% CI 0.81 to 0.95). Best cutoff value of urine Ca to P ratio was 1.5 (sensitivity 94% and specificity 68%) to identify sows fed P-deficient diets and 0.5 for P-excessive diets (sensitivity 82% and specificity 82%). A strong relationship between Ca to P ratio in 24-h and spot urine samples was determined (r = 0.93, P < 0.01), independent of physiological state and collection time of spot samples (adjusted-R2 = 0.86, P < 0.01). The degree of agreement between spot and 24-h urine for P intake adequacy, assessed by Cohen's weighted kappa analysis, was substantial (0.78, 95% CI 0.69 to 0.88). We conclude that urinary Ca to P ratio provides a reliable prediction of the adequacy of P intake in reproducing sows. Urinary Ca to P ratio measurements in random spot urinary offers a practical method to determine dietary P adequacy.
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Affiliation(s)
- Mariola Grez-Capdeville
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Thomas D Crenshaw
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
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Cowieson AJ, Perez-Maldonado R, Kumar A, Toghyani M. Possible role of available phosphorus in potentiating the use of low-protein diets for broiler chicken production. Poult Sci 2020; 99:6954-6963. [PMID: 33248611 PMCID: PMC7705028 DOI: 10.1016/j.psj.2020.09.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
A total of 945 male Ross 308 broiler chicks were used in a growth study to explore the interaction between dietary crude protein concentration and available phosphorus. Nine experimental treatments were constructed factorially by offering low, medium, or standard protein concentrations without or with low, standard, or high available phosphorus. Diets were based on corn, wheat, and soybean meal and all nutrients other than protein/amino acids and available phosphorus were maintained at or above breeder guidelines. Additional synthetic amino acids were used in the diets with low protein concentration in attempt to maintain digestible amino acid supply. Diets were offered to 7 replicate pens of 15 chicks per pen from day 8 to 35. Growth performance was measured during the grower (day 8-24) and finisher (day 25-35) periods. On day 35 carcass composition was determined, blood was drawn for various biochemical measurements and the tibia was excised for mechanical and compositional analyses. Birds that received the low-protein diet had lower terminal body weight and higher feed conversion ratio compared with those that received diets with adequate crude protein content. However, addition of available phosphorus to the low-protein diet resulted in significant reductions in weight-corrected feed conversion that were not evident in the diet with adequate protein content. Bone architecture was only moderately influenced by dietary treatment but birds that ingested the diets containing low and medium protein concentrations had relatively heavier abdominal fat pad weight. Blood biochemistry, especially ammonia, uric acid, and phosphorus, was influenced by both dietary protein and available phosphorus and trends suggested that both axes are involved in protein accretion and catabolism. It can be concluded that performance losses associated with feeding low protein diets to broiler chickens may be partially restored by additional available phosphorus. The implications for use of exogenous enzymes such as protease and phytase and protein nutrition per se warrants further examination.
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Affiliation(s)
- A J Cowieson
- Animal Nutrition and Health, DSM Nutritional Products, 4303 Kaiseraugst, Switzerland.
| | - R Perez-Maldonado
- Animal Nutrition and Health, DSM Nutritional Products, Minatu Ku, Tokyo, Japan
| | - A Kumar
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - M Toghyani
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
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Melse-Boonstra A. Bioavailability of Micronutrients From Nutrient-Dense Whole Foods: Zooming in on Dairy, Vegetables, and Fruits. Front Nutr 2020; 7:101. [PMID: 32793622 PMCID: PMC7393990 DOI: 10.3389/fnut.2020.00101] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
In order to fully exploit the nutrient density concept, thorough understanding of the biological activity of single nutrients in their interaction with other nutrients and food components from whole foods is important. This review provides a narrative overview of recent insights into nutrient bioavailability from complex foods in humans, highlighting synergistic and antagonistic processes among food components for two different food groups, i.e., dairy, and vegetables and fruits. For dairy, bioavailability of vitamins A, B2, B12 and K, calcium, phosphorous, magnesium, zinc and iodine are discussed, whereas bioavailability of pro-vitamin A, folate, vitamin C and K, potassium, calcium, magnesium and iron are discussed for vegetables and fruits. Although the bioavailability of some nutrients is fairly well-understood, for other nutrients the scientific understanding of uptake, absorption, and bioavailability in humans is still at a nascent stage. Understanding the absorption and bioavailability of nutrients from whole foods in interaction with food components that influence these processes will help to come to individual diet scores that better reflect absorbable nutrient intake in epidemiologic studies that relate dietary intake to health outcomes. Moreover, such knowledge may help in the design of foods, meals, and diets that aid in the supply of bioavailable nutrients to specific target groups.
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Affiliation(s)
- Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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6
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Abstract
Calcium kidney stones are common worldwide. Most are idiopathic and composed of calcium oxalate. Calcium phosphate is present in around 80% and may initiate stone formation. Stone production is multifactorial with a polygenic genetic contribution. Phosphaturia is found frequently among stone formers but until recently received scant attention. This review examines possible mechanisms for the phosphaturia and its relevance to stone formation from a wide angle. There is a striking lack of clinical data. Phosphaturia is associated, but not correlated, with hypercalciuria, increased 1,25 dihydroxy-vitamin D [1,25 (OH)2D], and sometimes evidence of disturbances in proximal renal tubular function. Phosphate reabsorption in the proximal renal tubules requires tightly regulated interaction of many proteins. Paracellular flow through intercellular tight junctions is the major route of phosphate absorption from the intestine and can be reduced therapeutically in hyperphosphatemic patients. In monogenic defects stones develop when phosphaturia is associated with hypercalciuria, generally explained by increased 1,25 (OH)2D production in response to hypophosphatemia. Calcification does not occur in disorders with increased FGF23 when phosphaturia occurs in isolation and 1,25 (OH)2D is suppressed. Candidate gene studies have identified mutations in the phosphate transporters, but in few individuals. One genome-wide study identified a polymorphism of the phosphate transporter gene SLC34A4 associated with stones. Others did not find mutations obviously linked to phosphate reabsorption. Future genetic studies should have a wide trawl and should focus initially on groups of patients with clearly defined phenotypes. The global data should be pooled.
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Affiliation(s)
- Valerie Walker
- Department of Clinical Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Trautvetter U, Ditscheid B, Jahreis G, Glei M. Calcium and Phosphate Metabolism, Blood Lipids and Intestinal Sterols in Human Intervention Studies Using Different Sources of Phosphate as Supplements-Pooled Results and Literature Search. Nutrients 2018; 10:nu10070936. [PMID: 30037054 PMCID: PMC6073240 DOI: 10.3390/nu10070936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
Phosphates are associated with negative physiological effects. The objectives of this publication were to compare differential effects of supplementation with calcium phosphate or phosphate alone in healthy humans. Four adult human studies were conducted with pentacalcium hydroxy-trisphosphate supplementation (CaP; 90 subjects) and their data were pooled for assessment. For literature search; PubMed and ISI Web of Knowledge were used and 21 items were assigned to three main topics. The pooled study results show that following CaP supplementation, faecal calcium and phosphorus and urinary calcium were increased, blood lipids were positively modulated, and faecal bile acids were increased, as compared with placebo. The literature search reveals that following calcium phosphate supplementation, urinary calcium was increased. Following solely phosphate supplementation, urinary phosphorus was increased and urinary calcium was decreased. Postprandial calcium concentrations were increased following calcium phosphate supplementation. Postprandial phosphate concentrations were increased following solely phosphate supplementation. Calcium phosphate supplementation resulted in rather positively modulated blood lipids and gut-related parameters. The presented results show the relevance to distinguish between calcium phosphate and solely phosphate supplementations, and the importance of a balanced calcium and phosphorus intake.
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Affiliation(s)
- Ulrike Trautvetter
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Straße 24, 07743 Jena, Germany.
| | - Bianka Ditscheid
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Straße 24, 07743 Jena, Germany.
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany.
| | - Gerhard Jahreis
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Straße 24, 07743 Jena, Germany.
| | - Michael Glei
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Straße 24, 07743 Jena, Germany.
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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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Shams-White MM, Chung M, Du M, Fu Z, Insogna KL, Karlsen MC, LeBoff MS, Shapses SA, Sackey J, Wallace TC, Weaver CM. Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation. Am J Clin Nutr 2017; 105:1528-1543. [PMID: 28404575 DOI: 10.3945/ajcn.116.145110] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Considerable attention has recently focused on dietary protein's role in the mature skeleton, prompted partly by an interest in nonpharmacologic approaches to maintain skeletal health in adult life.Objective: The aim was to conduct a systematic review and meta-analysis evaluating the effects of dietary protein intake alone and with calcium with or without vitamin D (Ca±D) on bone health measures in adults.Design: Searches across 5 databases were conducted through October 2016 including randomized controlled trials (RCTs) and prospective cohort studies examining 1) the effects of "high versus low" protein intake or 2) dietary protein's synergistic effect with Ca±D intake on bone health outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments. Strength of evidence was rated by group consensus. Random-effects meta-analyses for outcomes with ≥4 RCTs were performed.Results: Sixteen RCTs and 20 prospective cohort studies were included in the systematic review. Overall ROB was medium. Moderate evidence suggested that higher protein intake may have a protective effect on lumbar spine (LS) bone mineral density (BMD) compared with lower protein intake (net percentage change: 0.52%; 95% CI: 0.06%, 0.97%, I2: 0%; n = 5) but no effect on total hip (TH), femoral neck (FN), or total body BMD or bone biomarkers. Limited evidence did not support an effect of protein with Ca±D on LS BMD, TH BMD, or forearm fractures; there was insufficient evidence for FN BMD and overall fractures.Conclusions: Current evidence shows no adverse effects of higher protein intakes. Although there were positive trends on BMD at most bone sites, only the LS showed moderate evidence to support benefits of higher protein intake. Studies were heterogeneous, and confounding could not be excluded. High-quality, long-term studies are needed to clarify dietary protein's role in bone health. This trial was registered at www.crd.york.ac.uk as CRD42015017751.
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Affiliation(s)
- Marissa M Shams-White
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, and
| | - Mengxi Du
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhuxuan Fu
- Department of Public Health and Community Medicine, School of Medicine, and
| | - Karl L Insogna
- Yale Bone Center at the Yale School of Medicine, Yale University, New Haven, CT
| | - Micaela C Karlsen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Meryl S LeBoff
- Skeletal Health and Osteoporosis Center and Bone Density Unit, Harvard Medical School, Boston, MA.,Endocrine, Diabetes and Hypertension Division, Brigham and Women's Hospital, Boston, MA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
| | - Joachim Sackey
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Taylor C Wallace
- National Osteoporosis Foundation, Arlington, VA; .,Department of Nutrition and Food Studies, George Mason University, Fairfax, VA; and
| | - Connie M Weaver
- Department of Nutrition Science, Women's Global Health Institute, Purdue University, West Lafayette, IN
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Rubio-López N, Llopis-González A, Morales-Suárez-Varela M. Calcium Intake and Nutritional Adequacy in Spanish Children: The ANIVA Study. Nutrients 2017; 9:nu9020170. [PMID: 28230804 PMCID: PMC5331601 DOI: 10.3390/nu9020170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 12/24/2022] Open
Abstract
Calcium is an important nutrient for child development. The main objective of this study was to assess calcium intake and its adequacy with dietary reference intake (DRI) in Spanish children. The ANIVA (Antropometría y Nutrición Infantil de Valencia) study is a descriptive cross-sectional study. During two academic years 2013–2014 and 2014–2015, 1176 schoolchildren aged 6–9 years were selected from 14 primary schools in Valencia (Spain). Three-day food records were used to assess dietary intake, completed by parents/guardian. Anthropometric data (weight and height) were evaluated in all subjects. Nutritional intake was compared to estimated average requirements (EARs) and adequate intake (AI) values to determine nutritional adequacy. A percentage of 25.77% had inadequate calcium intake, and a significantly higher prevalence was observed in girls (p = 0.006). Adequate calcium intake showed a positive association with the height z-score (p = 0.032). When assessing dietary patterns, schoolchildren with adequate calcium intakes had better nutritional adequacy in all nutrients, except cholesterol (p = 0.086) and fluorine (p = 0.503). These results suggest a public health problem that must be addressed through nutrition education programs to increase intake of calcium-rich food and to correct the associated dietary pattern.
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Affiliation(s)
- Nuria Rubio-López
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain.
- Biomedical Research Center Network on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Agustín Llopis-González
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain.
- Biomedical Research Center Network on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - María Morales-Suárez-Varela
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain.
- Biomedical Research Center Network on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
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11
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Abstract
Osteoporosis is normally the result of a wrong life-style (diet, physical inactivity, smoke, dental hygiene, intestinal dysbiosis,…) and environmental toxicity which stimulate the chronic expression of inflammatory genes and alter the immuno-endocrine balance. A natural approch should face all the factors involved, leading the patients to become aware of their own responsability, and helping them with natural therapies, healthy food and life-style which support their body in the process of self-healing.
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Affiliation(s)
- Emanuela Bartolozzi
- Nutritionist and Homeopath, Expert in Environmental Medicine, Adjunct Professor University of Florence, Florence, Italy
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Relevance of dietary protein concentration and quality as risk factors for the formation of calcium oxalate stones in cats. J Nutr Sci 2014; 3:e51. [PMID: 26101619 PMCID: PMC4473174 DOI: 10.1017/jns.2014.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 11/17/2022] Open
Abstract
The role of dietary protein for the development of feline calcium oxalate (CaOx) uroliths has not been conclusively clarified. The present study evaluated the effects of a varying dietary protein concentration and quality on critical indices for the formation of CaOx uroliths. Three diets with a high protein quality (10–11 % greaves meal/diet) and a varying crude protein (CP) concentration (35, 44 and 57 % in DM) were compared. Additionally, the 57 % CP diet was compared with a fourth diet that had a similar CP concentration (55 % in DM), but a lower protein quality (34 % greaves meal/diet). The Ca and oxalate (Ox) concentrations were similar in all diets. A group of eight cats received the same diet at the same time. Each feeding period was divided into a 21 d adaptation period and a 7 d sampling period to collect urine. There were increases in urinary volume, urinary Ca concentrations, renal Ca and Ox excretion and urinary relative supersaturation (RSS) with CaOx with increasing dietary protein concentrations. Urinary pH ranged between 6·34 and 6·66 among all groups, with no unidirectional effect of dietary protein. Lower renal Ca excretion was observed when feeding the diet with the lower protein quality, however, the underlying mechanism needs further evaluation. In conclusion, although the observed higher urinary volume is beneficial, the increase in urinary Ca concentrations, renal Ca and Ox excretion and urinary RSS CaOx associated with a high-protein diet may be critical for the development of CaOx uroliths in cats.
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Effects of dietary protein and glycaemic index on biomarkers of bone turnover in children. Br J Nutr 2014; 111:1253-62. [PMID: 24503413 DOI: 10.1017/s0007114513003760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For decades, it has been debated whether high protein intake compromises bone mineralisation, but no long-term randomised trial has investigated this in children. In the family-based, randomised controlled trial DiOGenes (Diet, Obesity and Genes), we examined the effects of dietary protein and glycaemic index (GI) on biomarkers of bone turnover and height in children aged 5-18 years. In two study centres, families with overweight parents were randomly assigned to one of five ad libitum-energy, low-fat (25-30% energy (E%)) diets for 6 months: low protein/low GI; low protein/high GI; high protein/low GI; high protein/high GI; control. They received dietary instructions and were provided all foods for free. Children, who were eligible and willing to participate, were included in the study. In the present analyses, we included children with data on plasma osteocalcin or urinary N-terminal telopeptide of collagen type I (U-NTx) from baseline and at least one later visit (month 1 or month 6) (n 191 in total, n 67 with data on osteocalcin and n 180 with data on U-NTx). The level of osteocalcin was lower (29.1 ng/ml) in the high-protein/high-GI dietary group than in the low-protein/high-GI dietary group after 6 months of intervention (95% CI 2.2, 56.1 ng/ml, P=0.034). The dietary intervention did not affect U-NTx (P=0.96) or height (P=0.80). Baseline levels of U-NTx and osteocalcin correlated with changes in height at month 6 across the dietary groups (P<0.001 and P=0.001, respectively). The present study does not show any effect of increased protein intake on height or bone resorption in children. However, the difference in the change in the level of osteocalcin between the high-protein/high-GI group and the low-protein/high-GI group warrants further investigation and should be confirmed in other studies.
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14
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Perry GML, Scheinman SJ, Asplin JR. Effects of Sex on Intra-Individual Variance in Urinary Solutes in Stone-Formers Collected from a Single Clinical Laboratory. PLoS One 2013; 8:e53637. [PMID: 23840293 PMCID: PMC3686766 DOI: 10.1371/journal.pone.0053637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
Abstract
Background/Aims Our work in a rodent model of urinary calcium suggests genetic and gender effects on increased residual variability in urine chemistries. Based on these findings, we hypothesized that sex would similarly be associated with residual variation in human urine solutes. Sex-related effects on residuals might affect the establishment of physiological baselines and error in medical assays. Methods We tested the effects of sex on residual variation in urine chemistry by estimating coefficients of variation (CV) for urinary solutes in paired sequential 24-h urines (≤72 hour interval) in 6,758 females and 9,024 males aged 16–80 submitted to a clinical laboratory. Results Females had higher CVs than males for urinary phosphorus overall at the False Discovery Rate (P<0.01). There was no effect of sex on CV for calcium (P>0.3). Males had higher CVs for citrate (P<0.01) from ages 16–45 and females higher CVs for citrate (P<0.01) from ages 56–80, suggesting effects of an extant oestral cycle on residual variance. Conclusions Our findings indicate the effects of sex on residual variance of the excretion of urinary solutes including phosphorus and citrate; differences in CV by sex might reflect dietary lability, differences in the fidelity of reporting or genetic differentiation in renal solute consistency. Such an effect could complicate medical analysis by the addition of random error to phenotypic assays. Renal analysis might require explicit incorporation of heterogeneity among factorial effects, and for sex in particular.
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Affiliation(s)
- Guy M. L. Perry
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
- * E-mail:
| | - Steven J. Scheinman
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - John R. Asplin
- Litholink Corporation, Chicago, Illinois United States of America
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Bihuniak JD, Simpson CA, Sullivan RR, Caseria DM, Kerstetter JE, Insogna KL. Dietary protein-induced increases in urinary calcium are accompanied by similar increases in urinary nitrogen and urinary urea: a controlled clinical trial. J Acad Nutr Diet 2013; 113:447-451. [PMID: 23438496 DOI: 10.1016/j.jand.2012.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
Abstract
To determine the usefulness of urinary urea as an index of dietary protein intake, 10 postmenopausal women were enrolled in and completed a randomized, double-blind, cross-over feeding trial from September 2008 to May 2010 that compared 10 days of a 45-g whey supplement with 10 days of a 45-g maltodextrin control. Urinary nitrogen, urinary calcium, urinary urea, and bone turnover markers were measured at days 0, 7, and 10. Paired sample t tests, Pearson's correlation statistic, and simple linear regression were used to assess differences between treatments and associations among urinary metabolites. Urinary nitrogen/urinary creatinine rose from 12.3±1.7 g/g (99.6±13.8 mmol/mmol) to 16.8±2.2 g/g (135.5±17.8 mmol/mmol) with whey supplementation, but did not change with maltodextrin. Whey supplementation caused urinary calcium to rise by 4.76±1.84 mg (1.19±0.46 mmol) without a change in bone turnover markers. Because our goal was to estimate protein intake from urinary nitrogen/urinary creatinine, we used our data to develop the following equation: protein intake (g/day)=71.221+1.719×(urinary nitrogen, g)/creatinine, g) (R=0.46, R(2)=0.21). As a more rapid and less costly alternative to urinary nitrogen/urinary creatinine, we next determined whether urinary urea could predict protein intake and found that protein intake (g/day)=63.844+1.11×(urinary urea, g/creatinine, g) (R=0.58, R(2)=0.34). These data indicate that urinary urea/urinary creatinine is at least as good a marker of dietary protein intake as urinary nitrogen and is easier to quantitate in nutrition intervention trials.
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16
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Update on nutrients involved in maintaining healthy bone. ACTA ACUST UNITED AC 2012; 60:197-210. [PMID: 23273614 DOI: 10.1016/j.endonu.2012.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/30/2012] [Accepted: 09/12/2012] [Indexed: 11/22/2022]
Abstract
Osteoporosis is a leading cause of morbidity and mortality in the elderly and influences quality of life, as well as life expectancy. Currently, there is a growing interest among the medical scientists in search of specific nutrients and/or bioactive compounds of natural origin for the prevention of disease and maintenance of bone health. Although calcium and vitamin D have been the primary focus of nutritional prevention of osteoporosis, a recent research has clarified the importance of several additional nutrients and food constituents. Based on this review of the literature, supplementation with vitamins B, C, K, and silicon could be recommended for proper maintenance of bone health, although further clinical studies are needed. The results of studies on long-chain polyunsaturated fatty acids, potassium, magnesium, copper, selenium, and strontium are not conclusive, although studies in vitro and in animal models are interesting and promising.
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Abstract
Nutrition, in sufficient amount and substance, is crucial for healthy growth and development of the skeleton and surrounding tissues, especially in physically active populations. Inadequate nutrition has been linked to maladies such as the female athlete triad, as well as poor training or competitive performance and increased risk of injury. Dietary choices favoring items high in quality protein of animal or plant origin, polyunsaturated fatty acids, fruits and vegetables high in potassium and fiber, and dairy products or other beverages fortified with calcium and vitamin D are essential to athletes to ensure adequate vitamin and mineral availability to the skeleton, which in turn can affect peak physical performance.
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Affiliation(s)
- Caeley Lorincz
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Maalouf NM, Moe OW, Adams-Huet B, Sakhaee K. Hypercalciuria associated with high dietary protein intake is not due to acid load. J Clin Endocrinol Metab 2011; 96:3733-40. [PMID: 21976719 PMCID: PMC3232614 DOI: 10.1210/jc.2011-1531] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVE Dietary intake of animal proteins is associated with an increase in urinary calcium and nephrolithiasis risk. We tested the hypothesis that the acid load imposed by dietary proteins causes this hypercalciuria. DESIGN AND SETTING In a short-term crossover metabolic study, an alkali salt was provided with a high-protein diet (HPD) to neutralize the acid load imparted by dietary proteins. PARTICIPANTS AND INTERVENTIONS Eleven healthy volunteers were evaluated at the end of each of four phases while consuming metabolic diets with fixed calcium and sodium content. Phases 1 and 3 consisted of a control diet (CD). Phases 2 and 4 consisted of a eucaloric HPD (60 g/d animal proteins added to CD). Along with HPD in phases 2 and 4, subjects ingested 30 mEq twice daily of either potassium citrate (KCitrate, alkaline salt) or potassium chloride (KCl, control neutral salt). RESULTS KCitrate completely neutralized the acid load imparted by HPD (based on changes in urine pH and net acid excretion) and increased urinary citrate. Urinary calcium increased during both HPD phases compared with CD but was not significantly different between the HPD + KCl and HPD + KCitrate phases (182 ± 85 vs. 170 ± 85 mg/d; P = 0.28). Increased urinary saturation with respect to calcium oxalate and uric acid with HPD was abrogated by KCitrate. CONCLUSIONS This study suggests that, at least in the short-term, mechanism(s) other than acid load account for hypercalciuria induced by HPD. The beneficial effect of KCitrate on nephrolithiasis risk with HPD is through correction of declines in urine pH and citrate.
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Affiliation(s)
- Naim M Maalouf
- Department of Internal Medicine and Charles, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8885, USA.
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Abstract
High-protein (HP) diets exert a hypercalciuric effect at constant levels of calcium intake, even though the effect may depend on the nature of the dietary protein. Lower urinary pH is also consistently observed for subjects consuming HP diets. The combination of these two effects was suspected to be associated with a dietary environment favorable for demineralization of the skeleton. However, increased calcium excretion due to HP diet does not seem to be linked to impaired calcium balance. In contrast, some data indicate that HP intakes induce an increase of intestinal calcium absorption. Moreover, no clinical data support the hypothesis of a detrimental effect of HP diet on bone health, except in a context of inadequate calcium supply. In addition, HP intake promotes bone growth and retards bone loss and low-protein diet is associated with higher risk of hip fractures. The increase of acid and calcium excretion due to HP diet is also accused of constituting a favorable environment for kidney stones and renal diseases. However, in healthy subjects, no damaging effect of HP diets on kidney has been found in either observational or interventional studies and it seems that HP diets might be deleterious only in patients with preexisting metabolic renal dysfunction. Thus, HP diet does not seem to lead to calcium bone loss, and the role of protein seems to be complex and probably dependent on other dietary factors and the presence of other nutrients in the diet.
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20
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Bradley-Popovich GE, Mohr CR. Augmented protein intake for athletes: Are safety concerns well founded? J Chiropr Med 2011; 2:13-5. [PMID: 19674590 DOI: 10.1016/s0899-3467(07)60068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2002] [Revised: 10/07/2002] [Indexed: 11/17/2022] Open
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21
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Lee Alekel D, Messina M, Gugger E. Soy Protein, Soybean Isoflavones, and Bone Health. ACTA ACUST UNITED AC 2010. [DOI: 10.1201/9781420036695.ch5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Fenton TR, Lyon AW, Eliasziw M, Tough SC, Hanley DA. Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr J 2009; 8:41. [PMID: 19754972 PMCID: PMC2761938 DOI: 10.1186/1475-2891-8-41] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 09/15/2009] [Indexed: 11/30/2022] Open
Abstract
Background The acid-ash hypothesis posits that increased excretion of "acidic" ions derived from the diet, such as phosphate, contributes to net acidic ion excretion, urine calcium excretion, demineralization of bone, and osteoporosis. The public is advised by various media to follow an alkaline diet to lower their acidic ion intakes. The objectives of this meta-analysis were to quantify the contribution of phosphate to bone loss in healthy adult subjects; specifically, a) to assess the effect of supplemental dietary phosphate on urine calcium, calcium balance, and markers of bone metabolism; and to assess whether these affects are altered by the b) level of calcium intake, c) the degree of protonation of the phosphate. Methods Literature was identified through computerized searches regarding phosphate with surrogate and/or direct markers of bone health, and was assessed for methodological quality. Multiple linear regression analyses, weighted for sample size, were used to combine the study results. Tests of interaction included stratification by calcium intake and degree of protonation of the phosphate supplement. Results Twelve studies including 30 intervention arms manipulated 269 subjects' phosphate intakes. Three studies reported net acid excretion. All of the meta-analyses demonstrated significant decreases in urine calcium excretion in response to phosphate supplements whether the calcium intake was high or low, regardless of the degree of protonation of the phosphate supplement. None of the meta-analyses revealed lower calcium balance in response to increased phosphate intakes, whether the calcium intake was high or low, or the composition of the phosphate supplement. Conclusion All of the findings from this meta-analysis were contrary to the acid ash hypothesis. Higher phosphate intakes were associated with decreased urine calcium and increased calcium retention. This meta-analysis did not find evidence that phosphate intake contributes to demineralization of bone or to bone calcium excretion in the urine. Dietary advice that dairy products, meats, and grains are detrimental to bone health due to "acidic" phosphate content needs reassessment. There is no evidence that higher phosphate intakes are detrimental to bone health.
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Affiliation(s)
- Tanis R Fenton
- Clinical Nutrition, Alberta Health Services, Calgary, AB, Canada.
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23
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García-Arias MT, Castrillón AM, Navarro MP. Protein, calcium and phosphorus utilisation in diets containing raw, cooked or canned tuna. Influence of 1 and 3 years' storage time. Int J Food Sci Nutr 2009. [DOI: 10.3109/09637489409166164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bone Disease in Patients With Primary Hypercalciuria and Calcium Nephrolithiasis. Urology 2009; 74:22-7. [DOI: 10.1016/j.urology.2008.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 10/22/2008] [Accepted: 11/04/2008] [Indexed: 11/21/2022]
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Hunt JR, Johnson LK, Fariba Roughead ZK. Dietary protein and calcium interact to influence calcium retention: a controlled feeding study. Am J Clin Nutr 2009; 89:1357-65. [PMID: 19279077 DOI: 10.3945/ajcn.2008.27238] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of meat protein on calcium retention at different calcium intakes is unresolved. OBJECTIVE The objective was to test the effect of dietary protein on calcium retention at low and high intakes of calcium. DESIGN In a randomized controlled feeding study with a 2 x 2 factorial crossover design, healthy postmenopausal women (n = 27) consumed either approximately 675 or approximately 1510 mg Ca/d, with both low and high protein (providing 10% and 20% energy) for 7 wk each, separated by a 3-wk washout period. After 3 wk, the entire diet was extrinsically labeled with (47)Ca, and isotope retention was monitored by whole-body scintillation counting. Clinical markers of calcium and bone metabolism were measured. RESULTS High compared with low dietary protein significantly increased calcium retention from the low-calcium (29.5% compared with 26.0% absorbed) but not the high-calcium diet (18% absorbed). For the low-calcium diet, this effect nearly balanced a protein-related 0.5-mmol/d greater urinary calcium excretion. Protein-related calciuretic effects were independent of dietary calcium. Testing at 1, 2, 3, 5, and 7 wk showed no long-term adaptation in urinary acidity or urinary calcium excretion. High compared with low dietary protein decreased urinary deoxypyridinoline and increased serum insulin-like growth factor I without affecting parathyroid hormone, osteocalcin, bone-specific alkaline phosphatase, or tartrate-resistant acid phosphatase. CONCLUSIONS In healthy postmenopausal women, a moderate increase in dietary protein, from 10% to 20% of energy, slightly improved calcium absorption from a low-calcium diet, nearly compensating for a slight increase in urinary calcium excretion. Under practical dietary conditions, increased dietary protein from animal sources was not detrimental to calcium balance or short-term indicators of bone health.
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Affiliation(s)
- Janet R Hunt
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND, USA.
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26
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Lee K, Lee J, Bae WK, Choi JK, Kim HJ, Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: a double-blind, randomised controlled trial of two diet plans - one high in protein and one nutritionally balanced. Int J Clin Pract 2009; 63:195-201. [PMID: 19196357 DOI: 10.1111/j.1742-1241.2008.01965.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Little is known about the relative efficacy of high-protein vs. conventional diet plans that include partial meal replacements on body fat loss in obese subjects with metabolic syndrome. OBJECTIVE We aimed to evaluate the efficacy of two low-calorie diets with partial meal replacement plans-a high-protein plan (HP) and a nutritionally balanced conventional (C) plan-on reducing obesity in obese subjects with metabolic syndrome. DESIGN In a 12-week, double-blind study, we randomised 75 participants to either the HP- or the C-plan group. We recorded key metrics at 0 and 12 weeks. RESULTS The overall mean weight loss was 5 kg in the HP-plan group and 4.9 kg in the C-plan group (p = 0.72). Truncal fat mass decreased 1.6 kg in the HP-plan group (p < 0.05) and 1.5 kg in the C-plan group (p < 0.05), while whole body fat mass decreased 2.5 kg in the HP-plan group (p < 0.05) and 2.3 kg in the C-plan group (p < 0.05). Between-group losses did not differ significantly for truncal (p = 0.52) or whole body (p = 0.77) fat mass. Among subjects with > or = 70% dietary compliance, however, truncal and whole body fat mass decreased more in the HP-plan group (Delta 2.2 kg and Delta 3.5 kg respectively) than in the C-plan group (Delta 1.3 kg and Delta 2.3 [corrected] kg respectively) (p < 0.05). CONCLUSION The HP- and C-plans had a similar effect on weight and abdominal fat reduction, but the HP-plan was more effective in reducing body fat among compliant subjects.
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Affiliation(s)
- K Lee
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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Fenton TR, Eliasziw M, Lyon AW, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis. Am J Clin Nutr 2008; 88:1159-66. [PMID: 18842807 DOI: 10.1093/ajcn/88.4.1159] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The acid-ash diet hypothesis of osteoporosis suggests that acid from the modern diet causes a demineralization of the skeleton, and mobilized bone calcium is excreted. A systematic approach has not been used to summarize the findings of the numerous studies about the hypothesis. OBJECTIVES The purpose of this meta-analysis was to estimate the quantity of net acid excretion and calciuria associated with the modern diet, to assess the association between acid excretion and calcium excretion, and to assess the influence of urine preservatives on calcium measurement. DESIGN We systematically searched for trials of the acid-ash hypothesis and conducted a meta-analysis. RESULTS Twenty-five of 105 studies met the inclusion criteria. The estimated quantity of net acid excretion from the weighted average of the control diets from 11 studies was 47 mEq/d. The increase in urinary calcium with a change in renal net acid excretion depended on whether the urine was acidic or alkaline (P < 0.001). A significant linear relation was observed between net acid excretion and calcium excretion for both acidic and alkaline urine (P < 0.001). The estimated change in urine calcium associated with a change of 47 mEq of net acid excretion in acidic urine was 1.6 mmol/d (66 mg/d) of calcium. CONCLUSION Evidence suggests a linear association between changes in calcium excretion in response to experimental changes in net acid excretion. However, this finding is not evidence that the source of the excreted calcium is bone or that this calciuria contributes to the development of osteoporosis.
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Affiliation(s)
- Tanis R Fenton
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Dawson-Hughes B, Harris SS, Rasmussen HM, Dallal GE. Comparative effects of oral aromatic and branched-chain amino acids on urine calcium excretion in humans. Osteoporos Int 2007; 18:955-61. [PMID: 17252311 DOI: 10.1007/s00198-006-0320-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED In 30 adults, increasing intake of aromatic amino acids increased calcium excretion and serum IGF-1, but not indices of bone turnover, when compared with similar increases in intake of branched-chain amino acids. The mechanisms involved are not certain but these findings suggest a role for the calcium sensor receptor. INTRODUCTION In contrast to branched-chain amino acids (BCAAs), aromatic amino acids (AAAs) bind to the calcium sensing receptor (CaR) and thus have an increased potential to affect calcium homeostasis. In this study we compare the effects of increased intake of AAAs versus BCAAs on calcium excretion, serum IGF-1, markers of bone turnover, and 4-hr calcium excretion after an oral calcium load. METHODS After two weeks on low-protein metabolic diets, 30 healthy subjects were randomized to a fivefold increase in intake of AAAs or BCAAs for two weeks. Changes in calcium excretion and other measures were compared in the two groups. RESULTS With the increase in amino acid intake, 24-hr calcium excretion (P = 0.027), IGF-1 (P = 0.022), and 4-hr calcium excretion after an oral load (P = 0.023) increased significantly in the AAA relative to the BCAA group. Group changes in turnover markers did not differ significantly. CONCLUSION In comparison with BCAAs, AAAs promoted calcium excretion. The calciuria does not appear to result from increases in bone resorption and may occur by increasing calcium absorption. The AAAs also increased circulating levels of IGF-1. Collectively these findings raise the possibility that AAAs may selectively influence calcium homeostasis through their interactions with the CaR.
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Affiliation(s)
- B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA.
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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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Buzinaro EF, Almeida RNAD, Mazeto GMFS. Biodisponibilidade do cálcio dietético. ACTA ACUST UNITED AC 2006; 50:852-61. [PMID: 17160208 DOI: 10.1590/s0004-27302006000500005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Accepted: 05/17/2006] [Indexed: 11/22/2022]
Abstract
O cálcio (Ca) dietético é fundamental para a saúde óssea. Tanto o teor como a biodisponibilidade do elemento nos alimentos devem ser considerados. Este artigo objetiva sumarizar os fatores envolvidos na absorção e destacar os alimentos com melhor disponibilidade do Ca. Este é absorvido principalmente no jejuno e o pH baixo parece favorecer sua absorção, que é maior no crescimento, na gestação/lactação e na carência de Ca ou fósforo (P), e menor no envelhecimento. As maiores fontes, e com melhor absorção, são os laticínios bovinos. Outros alimentos apresentam concentrações elevadas de Ca, mas com biodisponibilidade variável: os ricos em ácidos oxálico e fítico apresentariam uma menor absorção, enquanto que os ricos em carboidratos teriam uma absorção maior. Por apresentarem uma biodisponibilidade do Ca mais próxima da do leite bovino, o leite de outros animais, o de soja enriquecido e alguns vegetais, em quantidades adequadas, poderiam ser usados como alternativas a este.
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Affiliation(s)
- Elizabeth F Buzinaro
- Hospital das Clínicas, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP
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Giannini S, Nobile M, Sella S, Dalle Carbonare L. Bone disease in primary hypercalciuria. Crit Rev Clin Lab Sci 2005; 42:229-48. [PMID: 16047539 DOI: 10.1080/10408360590913533] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Primary hypercalciuria (PH) is very often accompanied by some degree of bone demineralization. The most frequent clinical condition in which this association has been observed is calcium nephrolithiasis. In patients affected by this disorder, bone density is very frequently low, and increased susceptibility to fragility fractures is reported. The very poor definition of this bone disease from a histomorphometric point of view is a crucial aspect. At present, the most common finding seems to be a low bone turnover condition. Many factors are involved in the complex relationships between bone loss and PH. Since bone loss was mainly reported in patients with fasting hypercalciuria, a primary alteration in bone metabolism was proposed as a cause of both hypercalciuria and bone demineralization. This hypothesis was strengthened by the observation that some bone resorbing-cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor nechrosis factor-alpha (TNF-alpha), are high in hypercalciuric patients. An excessive response to the acid load induced by dietary protein intake seems to be an additional factor explaining a primitive alteration of bone. The intestine plays a major role in the clinical course of bone disease in PH. Patients with absorptive hypercalciuria less frequently show bone disease, and a reduction in dietary calcium greatly increases the probability of bone loss in PH subjects. It has recently been reported that greater bone loss is associated with a larger increase in intestinal calcium absorption in PH patients. Considering the absence of parathyroid hormone (PTH) alterations, it was proposed that this is not a compensatory phenomenon, but probably the marker of disturbed cell calcium transport, involving both intestinal and bone tissues. While renal hypercalciuria is rather uncommon, the kidney still seems to play a role in the pathogenesis of bone loss in PH patients, possibly via the effect of mild-to-moderate urinary phosphate loss with secondary hypophosphatemia. In conclusion, bone loss is very common in PH patients. Even if most of the factors involved in this process have been identified, many aspects of this intriguing clinical condition remain to be elucidated.
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Affiliation(s)
- Sandro Giannini
- Department of Medical and Surgical Sciences, University of Padova, Italy.
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Mullins NM, Sinning WE. Effects of resistance training and protein supplementation on bone turnover in young adult women. Nutr Metab (Lond) 2005; 2:19. [PMID: 16098231 PMCID: PMC1208950 DOI: 10.1186/1743-7075-2-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 08/17/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The strength of aging bone depends on the balance between the resorption and formation phases of the remodeling process. The purpose of this study was to examine the interaction of two factors with the potential to exert opposing influences on bone turnover, resistance exercise training and high dietary protein intake. It was hypothesized that resistance training by young, healthy, untrained women with protein intakes near recommended levels (0.8 g.kg(-1).d(-1)) would promote bone formation and/or inhibit bone resorption, and that subsequent supplementation to provide 2.4 g protein.kg(-1).d(-1) would reverse these effects. METHODS Bone formation was assessed with serum bone-specific alkaline phosphatase (BAP) and osteocalcin (OC), and bone resorption with urinary calcium and deoxypyridinoline (DPD). Biochemical, strength, anthropometric, dietary, and physical activity data were obtained from 24 healthy, untrained, eumenorrheic women (18-29 y) at baseline, after eight weeks of resistance training (3 d.wk(-1), approximately 1 hr.d(-1); 3 sets, 6-10 repetitions, 13 exercises, 75-85% maximum voluntary contraction), and after 12 weeks of resistance training and 10 days of protein/placebo supplementation. Subjects were randomized (double-blind) to either a high protein (HP) or training control (TC) group and, during the final 10 days, consumed either enough purified whey protein to bring daily protein intake to 2.4 g.kg(-1).d(-1), or an equivalent dose of isoenergetic, carbohydrate placebo. RESULTS Strength, lean tissue mass, and DPD increased significantly in both groups over time, while percent body fat and BAP decreased (repeated measures ANOVA, p < or = 0.05, Bonferroni correction). No significant changes were observed for serum OC or urinary calcium, and no significant group (TC, HP) x time (baseline, week 8, week 12) interactions emerged for any of the biochemical measures. CONCLUSION (1) Twelve weeks of high-intensity resistance training did not appear to enhance bone formation or inhibit bone resorption in young adult women, as assessed by biochemical markers of bone metabolism. (2) Subsequent maintenance of a high protein intake for 10 days in these regularly-training, calcium-replete women also showed no effects on bone metabolism.
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Affiliation(s)
- Nicole M Mullins
- Department of Human Performance and Exercise Science, Youngstown State University, Youngstown, OH 44555, USA
| | - Wayne E Sinning
- Exercise Science Laboratory, School of Exercise Leisure and Sport, Kent State University, Kent, OH 44242, USA
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Moreira P, Padez C, Mourão I, Rosado V. Dietary calcium and body mass index in Portuguese children. Eur J Clin Nutr 2005; 59:861-7. [PMID: 15915159 DOI: 10.1038/sj.ejcn.1602147] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of our study was to assess nutritional intake in school children (7-9-y-old) and relate calcium intake to body mass index (BMI). DESIGN This study was a cross-sectional analysis. SETTING The data were derived from a community-based survey of children from primary schools of Portugal. SUBJECTS In all, 3044 Portuguese children (1503 girls and 1541 boys) from a community-based sample of 7-9-y-olds. METHODS Height and weight were measured according to international standards, and BMI was calculated. Children's parents completed a self-administered questionnaire that provided information on general family background characteristics and children's physical activity. Children's dietary intake was measured using a 24-h dietary recall. Calcium intake was expressed as the calcium-to-protein ratio, and regression analysis was used to estimate the association between calcium intake and BMI, adjusting for energy intake and confounders. RESULTS The prevalence of children with calcium intake below the Dietary Reference Intake was higher in girls (36.4 vs 33.0%, P = 0.053). Calcium-to-protein ratio predicts BMI only in girls (beta = -0.052, P = 0.002), even after adjusting for age, energy intake, parental education, and physical activity. CONCLUSION We found an inverse relationship between calcium intake and BMI only in girls. These data reinforce the need for controlled trials to assess the effects of dietary calcium on body mass in each gender.
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Affiliation(s)
- P Moreira
- Faculty of Nutrition, University of Porto, Porto, Portugal.
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Abstract
High-protein (HP) weight-loss diets have existed in the United States for decades, although their popularity has recently surged as obesity has become more common. Despite their widespread use, valid concerns exist that HP diets may induce clinically important alterations in renal function and health. HP consumption has been found, under various conditions, to lead to glomerular hyperfiltration and hyperemia; acceleration of chronic kidney disease (CKD); increased proteinuria; diuresis, natriuresis, and kaliuresis with associated blood pressure changes; increased risk for nephrolithiasis; and various metabolic alterations. Unfortunately, a comprehensive understanding of the implications of HP diets is limited by the lack of a universally accepted definition for HP intake, a paucity of rigorous long-term human interventional studies that necessitate relying on short-term or fairly circumstantial evidence, and sparse data on the effects of HP consumption in obese individuals. In addition, matters are further complicated because the renal impact HP diets for limited periods is most likely different than that for more chronic consumption. Nevertheless, although there are no clear renal-related contraindications to HP diets in individuals with healthy kidney function, the theoretical risks should be reviewed carefully with the patient. In contrast, HP diets have the potential for significant harm in individuals with CKD and should be avoided if possible. Because CKD is often a silent disease, all individuals should undergo a screening serum creatinine measurement and urinary dipstick test for proteinuria before the initiation of such a diet.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Spence LA, Lipscomb ER, Cadogan J, Martin B, Wastney ME, Peacock M, Weaver CM. The effect of soy protein and soy isoflavones on calcium metabolism in postmenopausal women: a randomized crossover study. Am J Clin Nutr 2005; 81:916-22. [PMID: 15817872 DOI: 10.1093/ajcn/81.4.916] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence suggests that soy isoflavones act as estrogen agonists and have beneficial skeletal effects, but the effects on calcium metabolism in humans are not known. OBJECTIVE This study tested whether soybean isoflavones, soy protein, or both alter calcium metabolism in postmenopausal women. DESIGN Calcium metabolism in 15 postmenopausal women was studied by using metabolic balance and kinetic modeling in a randomized, crossover design of three 1-mo controlled dietary interventions: soy protein isolate enriched with isoflavones (soy-plus diet), soy protein isolate devoid of isoflavones (soy-minus diet), and a casein-whey protein isolate (control diet). RESULTS There was no significant difference between the diets in net acid excretion (P = 0.12). Urinary calcium excretion was significantly (P < 0.01) less with consumption of either of the soy diets (soy-plus diet: 85 +/- 34 mg/d; soy-minus diet: 80 +/- 34 mg/d) than with consumption of the control diet (121 +/- 63 mg/d), but fractional calcium absorption was unaffected by treatment. Endogenous fecal calcium was significantly (P < 0.01) greater with consumption of the soy-minus diet than with consumption of the other diets. Total fecal calcium excretion, bone deposition and resorption, and calcium retention were not significantly affected by the dietary regimens. CONCLUSIONS The lower urinary calcium seen with the consumption of an isolated soy protein than with that of an isolated milk protein was not associated with improved calcium retention. This finding reinforces the importance of evaluating all aspects of calcium metabolism. Soy isoflavones did not significantly affect calcium metabolism.
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Affiliation(s)
- Lisa A Spence
- Department of Foods and Nutrition, Purdue University, West Lafayette, IN, USA
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Abstract
The effects of dietary protein on bone health are paradoxical and need to be considered in context of the age, health status and usual diet of the population. Over the last 80 years numerous studies have demonstrated that a high protein intake increases urinary Ca excretion and that on average 1 mg Ca is lost in urine for every 1 g rise in dietary protein. This relationship is primarily attributable to metabolism of S amino acids present in animal and some vegetable proteins, resulting in a greater acid load and buffering response by the skeleton. However, many of these early studies that demonstrated the calciuric effects of protein were limited by low subject numbers, methodological errors and the use of high doses of purified forms of protein. Furthermore, the cross-cultural and population studies that showed a positive association between animal-protein intake and hip fracture risk did not consider other lifestyle or dietary factors that may protect or increase the risk of fracture. The effects of protein on bone appear to be biphasic and may also depend on intake of Ca- and alkali-rich foods, such as fruit and vegetables. At low protein intakes insulin-like growth factor production is reduced, which in turn has a negative effect on Ca and phosphate metabolism, bone formation and muscle cell synthesis. Although growth and skeletal development is impaired at very low protein intakes, it is not known whether variations in protein quality affect the achievement of optimal peak bone mass in adolescents and young adults. Prospective studies in the elderly in the USA have shown that the greatest bone losses occur in elderly men and women with an average protein intake of 16-50 g/d. Although a low protein intake may be indicative of a generally poorer diet and state of health, there is a need to evaluate whether there is a lower threshold for protein intake in the elderly in Europe that may result in increased bone loss and risk of osteoporotic fracture.
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Affiliation(s)
- Fiona Ginty
- MRC Human Nutrition Research, The Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulié D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes (Lond) 2004; 28:514-9. [PMID: 14968129 DOI: 10.1038/sj.ijo.0802605] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the influence of weight-reducing diets containing different amounts of protein and CHO on body composition in obese adolescents and to examine dietary and physical activity behaviours during follow-up. METHODOLOGY DESIGN Prospective randomised study comparing two weight-reducing diets with the same energy (1750 kcal) and fat (31%) content, but different protein and carbohydrate contents: PROT- (15% protein, 54% CHO) vs PROT+ (19% protein, 50% CHO). PATIENTS Massively obese 11- to 16-year-old children (32 boys and 89 girls). SETTING A 9-month treatment in a medical centre (boarding school) plus a 2-y follow-up in free-living patients examined at home 1 and 2 y after treatment. MEASUREMENTS Anthropometry, bioelectrical impedance, nutritional intakes and physical activity. RESULTS Of the 121 eligible children (61 in PROT- and 60 in PROT+), 82% completed the trial until the end of weight loss treatment and 60% were followed 2 y after treatment. Body mass index (BMI) value at inclusion was 36.3 kg/m(2) or 4.3 z-scores (2.9-5.9). BMI z-score decreased to 1.7 at the end of treatment and went back to 2.8 (0.8-6.1) 2 y after treatment. This corresponded to a weight loss of 30.3 kg and weight regain of 21.3 kg. After treatment, energy intake increased and physical activity decreased. The contribution of energy ingested at breakfast decreased while snacking increased. For all measurements, no dietary group differences existed at baseline or at any time during the intervention and follow-up. CONCLUSION A higher protein content of the diet did not confer any benefit in the treatment of childhood obesity. Substantial weight loss was obtained with a moderately energy-restricted diet and normal fat content. After weight loss, mean weight increased in spite of moderate energy intake, together with a drift towards obesity-associated behavioural patterns. The causes of the inability to adopt normal weight subjects' behaviour permanently deserve to be investigated further.
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Ankra-Badu GA, Aggrey SE, Pesti GM, Bakalli RI, Edwards HM. Modeling of Parameters Affecting Phytate Phosphorus Bioavailability in Growing Birds. Poult Sci 2004; 83:1083-8. [PMID: 15285496 DOI: 10.1093/ps/83.7.1083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The current study was undertaken to establish a population from an unselected random-mating chicken population for the development of a model to predict factors that affect phytate P utilization in growing birds. A population was established from a mating of 40 male and 200 female chickens from the Athens Canadian randombred population. At 4 wk of age, birds were housed in individual metabolic cages and fed a diet containing 1.06% Ca, 0.35% total P, and 0.03% available P. After 3 d of acclimatization, feed consumption (FC) was measured and excreta produced in 3 consecutive d were collected. Individual 4-wk BW, BW gain (BWG), phytate P intake (PPI), inorganic P intake (IPI), Ca intake (CaI), N intake (NI), and energy intake (EI) during the 3 d excreta collection period were also measured. Feed conversion ratios (FCR) and relative growth rate were calculated. Phytate P bioavailability (PPB), Ca bioavailability (CaB), and N bioavailability (NB) were estimated from the disappearance of the nutrients during the passage of feed through the gastrointestinal tract. Energy bioavailability (EB) was measured by bomb calorimetry as the difference in the gross energy of the feed and the energy of the excreta. The major factors affecting PPB were CaB and EB for both sexes. In the males, BW contributed significantly to PPB. However, in the females, NB also contributed significantly to PPB. Faster growing birds tended to have a reduced retention time of feed compared with slow growing birds, and as a result utilized phytate P less. Birds that are able to utilize phytate P better are putatively able to release P for energy utilization. Therefore, the birds that were able to utilize phytate P better were also better energy utilizers.
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Affiliation(s)
- G A Ankra-Badu
- University of Georgia, Department of Poultry Science, Athens, Georgia 30602, USA
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Bowen J, Noakes M, Clifton PM. A high dairy protein, high-calcium diet minimizes bone turnover in overweight adults during weight loss. J Nutr 2004; 134:568-73. [PMID: 14988448 DOI: 10.1093/jn/134.3.568] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Weight loss induces bone resorption and this can be attenuated by calcium supplementation. Protein-rich diets were recently associated with favorable effects on bone density, although this remains controversial. We hypothesized that a diet high in calcium and protein would minimize bone resorption during weight loss compared with a lower calcium, protein-rich diet. The effects of dietary calcium in high protein diets on calcium excretion and bone metabolism were examined in overweight adults (n = 50, BMI 33.4 +/- 2.1 kg/m(2)) during 12 wk of energy restriction followed by 4 wk of energy balance. Subjects were randomly assigned to isoenergetic diets (5.5 MJ/d, 34% energy from protein, 41% carbohydrate, 24% fat) high in either dairy protein (DP, 2400 mg Ca/d) or mixed protein sources (MP, 500 mg Ca/d). During energy restriction, weight loss was 10% (-9.7 +/- 3.8 kg, P < 0.01), and 24-h urinary calcium excretion decreased independently of diet (-1.09 +/- 0.23 mmol/d, P < 0.01). By wk 16, the MP diet group had a 40% greater increase in deoxypyridinoline (bone resorption marker) than the DP diet group (P = 0.008). Osteocalcin (bone formation marker) increased from wk 0 to 16 in only the MP diet group [+2.16 +/- 0.63 micro g/L (+0.63 +/- 0.11nmol/L), P = 0.001]. In conclusion, weight loss was associated with increased bone resorption, yet the DP diet had a modest advantage over the MP diet by minimizing overall turnover. Combined with reduced urinary calcium excretion, this suggests that a high-protein, calcium-replete diet may protect against bone loss during weight reduction.
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Affiliation(s)
- Jane Bowen
- CSIRO Health Sciences and Nutrition, Adelaide, South Australia, Australia, 5000
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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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41
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42
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Remer T, Manz F. High Meat Diet, Acid-Base Status and Calcium Retention. J Nutr 2003; 133:3239; author reply 3240. [PMID: 14519818 DOI: 10.1093/jn/133.10.3239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kerstetter JE, O'Brien KO, Insogna KL. Dietary protein, calcium metabolism, and skeletal homeostasis revisited. Am J Clin Nutr 2003; 78:584S-592S. [PMID: 12936953 DOI: 10.1093/ajcn/78.3.584s] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
High dietary protein intakes are known to increase urinary calcium excretion and, if maintained, will result in sustained hypercalciuria. To date, the majority of calcium balance studies in humans have not detected an effect of dietary protein on intestinal calcium absorption or serum parathyroid hormone. Therefore, it is commonly concluded that the source of the excess urinary calcium is increased bone resorption. Recent studies from our laboratory indicate that alterations in dietary protein can, in fact, profoundly affect intestinal calcium absorption. In short-term dietary trials in healthy adults, we fixed calcium intake at 20 mmol/d while dietary protein was increased from 0.7 to 2.1 g/kg. Increasing dietary protein induced hypercalciuria in 20 women [from 3.4 +/- 0.3 ( +/- SE) during the low-protein to 5.4 +/- 0.4 mmol/d during the high-protein diet]. The increased dietary protein was accompanied by a significant increase in intestinal calcium absorption from 18.4 +/- 1.3% to 26.3 +/- 1.5% (as determined by dual stable isotopic methodology). Dietary protein intakes at and below 0.8 g/kg were associated with a probable reduction in intestinal calcium absorption sufficient to cause secondary hyperparathyroidism. The long-term consequences of these low-protein diet-induced changes in mineral metabolism are not known, but the diet could be detrimental to skeletal health. Of concern are several recent epidemiologic studies that demonstrate reduced bone density and increased rates of bone loss in individuals habitually consuming low-protein diets. 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, USA.
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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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45
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Cloutier GR, Barr SI. Protein and bone health: literature review and counselling implications. CAN J DIET PRACT RES 2003; 64:5-11. [PMID: 12631403 DOI: 10.3148/64.1.2003.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
For decades, public health promotion campaigns on bone health have emphasized the importance of adequate calcium and vitamin D intakes, as well as weight-bearing physical activity. However, no obvious consensus has emerged on the role of dietary protein. To identify what agreement does exist in the literature, in this article we review the theoretical basis for protein's role in bone health, assess some recent cross-sectional and prospective studies, and generate recommendations for practice. There is general agreement in the literature that higher protein intake increases urinary calcium loss; the body compensates for this loss by increasing calcium absorption in the gut, providing that calcium intake is sufficient. A possible explanation for calcium loss, the "acid-ash" hypothesis, is discussed, and suggestions are made about food choices that may counter the calciuric effect of protein. A survey of cross-sectional and prospective studies shows equivocal results, with confounding variables complicating the analysis. Both deficient and excessive protein intakes have been shown to affect bone health negatively, although lower and upper thresholds have not been determined. Practical advice on achieving bone health is given, with an emphasis on the use of Canada's Food Guide to Healthy Eating in setting dietary goals.
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Affiliation(s)
- Gilles R Cloutier
- Food, Nutrition and Health, University of British Columbia, Vancouver
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Roughead ZK, Johnson LK, Lykken GI, Hunt JR. Controlled high meat diets do not affect calcium retention or indices of bone status in healthy postmenopausal women. J Nutr 2003; 133:1020-6. [PMID: 12672913 DOI: 10.1093/jn/133.4.1020] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Calcium balance is decreased by an increased intake of purified proteins, although the effects of common dietary sources of protein (like meat) on calcium economy remain controversial. We compared the effects of several weeks of controlled high and low meat diets on body calcium retention, using sensitive radiotracer and whole body scintillation counting methodology. Healthy postmenopausal women (n = 15) consumed diets with similar calcium content (approximately 600 mg), but either low or high in meat (12 vs. 20% of energy as protein) for 8 wk each, in a randomized crossover design. After 4 wk of equilibration of each diet, calcium retention was measured by extrinsically labeling the 2-d menu with (47)Ca, followed by whole body scintillation counting for 28 d. Urinary and blood indicators of bone metabolism were also determined for each diet. Calcium retention was not different during the high and low meat dietary periods (d 28, mean +/- pooled SD: 17.1 and 15.6%, +/-0.6%, respectively; P = 0.09). An initially higher renal acid excretion in subjects consuming the high meat compared with the low meat diet decreased significantly with time. The diets did not affect urinary calcium loss or indicators of bone metabolism. In conclusion, under controlled conditions, a high meat compared with a low meat diet for 8 wk did not affect calcium retention or biomarkers of bone metabolism in healthy postmenopausal women. Calcium retention is not reduced when subjects consume a high protein diet from common dietary sources such as meat.
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Affiliation(s)
- Zamzam K Roughead
- Grand Forks Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Grand Forks, ND 58202-9034, USA.
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Roughead ZK. Is the interaction between dietary protein and calcium destructive or constructive for bone? J Nutr 2003; 133:866S-869S. [PMID: 12612171 DOI: 10.1093/jn/133.3.866s] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zamzam K Roughead
- Agricultural Research Service, Grand Forks Human Nutrition Research Center, U.S. Department of Agriculture, Grand Forks, ND 58202-9034, USA.
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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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49
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Smith TL, Knight S. Evaluation of a Calcium- and Protein-Fortified Pasta Designed for the Older Population. J Appl Gerontol 2002. [DOI: 10.1177/073346402237629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A high-protein, high-calcium pasta developed to help meet the nutritional needs of the elderly was fed to experimental animals to determine whether added nutrients were absorbed and used. To test whether the 17% protein in the pasta inhibited calcium absorption, two pasta diets were fed. To test for protein use, two marginal protein diets were used. For the pasta diets, the higher protein diet produced greater weight gain, fecal measures, carcass protein, and tibia but a lower protein efficiency ratio. For the 10% marginal protein diets, fecal protein and carcass energy were significantly greater for the 10% protein pasta diet when compared with the casein-based diet but the carcass protein was significantly lower. Protein was well absorbed and used from the pasta diets. Furthermore, the 17% protein pasta diet supported adequate rat growth without diminishing bone parameters.
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Sanderson P, Finnegan YE, Williams CM, Calder PC, Burdge GC, Wootton SA, Griffin BA, Joe Millward D, Pegge NC, Bemelmans WJE. UK Food Standards Agency alpha-linolenic acid workshop report. Br J Nutr 2002; 88:573-9. [PMID: 12425738 DOI: 10.1079/bjn2002691] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The UK Food Standards Agency convened a group of expert scientists to review current research investigating whether n-3 polyunsaturated fatty acids (PUFA) from plant oils (alpha-linolenic acid; ALA) were as beneficial to cardiovascular health as the n-3 PUFA from the marine oils, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The workshop also aimed to establish priorities for future research. Dietary intake of ALA has been associated with a beneficial effect on CHD; however, the results from studies investigating the effects of ALA supplementation on CHD risk factors have proved equivocal. The studies presented as part of the present workshop suggested little, if any, benefit of ALA, relative to linoleic acid, on risk factors for cardiovascular disease; the effects observed with fish-oil supplementation were not replicated by ALA supplementation. There is a need, therefore, to first prove the efficacy of ALA supplementation on cardiovascular disease, before further investigating effects on cardiovascular risk factors. The workshop considered that a beneficial effect of ALA on the secondary prevention of CHD still needed to be established, and there was no reason to look further at existing CHD risk factors in relation to ALA supplementation. The workshop also highlighted the possibility of feeding livestock ALA-rich oils to provide a means of increasing the dietary intake in human consumers of EPA and DHA.
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Affiliation(s)
- Peter Sanderson
- Nutrition Division, Food Standards Agency, Aviation House, 125 Kingsway, London WC2 6NH, UK.
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