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Nanri A, Mizoue T, Goto A, Noda M, Sawada N, Tsugane S. Vitamin D intake and all-cause and cause-specific mortality in Japanese men and women: the Japan Public Health Center-based prospective study. Eur J Epidemiol 2023; 38:291-300. [PMID: 36719520 PMCID: PMC9887248 DOI: 10.1007/s10654-023-00968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023]
Abstract
While higher circulating 25-hydroxyvitamin D concentrations have been reported to be associated with decreased risk of all-cause mortality, evidence on dietary vitamin D intake is limited and inconsistent. We investigated whether vitamin D intake is associated with all-cause and cause-specific mortality among Japanese adults. Participants were 42,992 men and 50,693 women who responded to the second survey of the Japan Public Health Center-based Prospective Study (1995-1998) and who were followed up for mortality through 2018. Dietary intake was ascertained using a validated food frequency questionnaire. Hazard ratios of deaths from the second survey to December 2018 were estimated using Cox proportional hazard regression analysis. During follow-up, we identified 22,630 deaths. Overall, the third and fourth quintiles, but not the highest quintile, of vitamin D intake were each associated with a significantly lower risk of all-cause mortality. In subgroups characterized by low sunlight exposure, risk of all-cause mortality decreased linearly with increasing vitamin D intake. The multivariable-adjusted hazard ratios (95% confidence intervals) of all-cause mortality for the highest versus lowest quintile of vitamin D intake were 0.87 (0.79-0.95) in women and 0.88 (0.79-0.97) in residents of higher latitude areas. Lower risk was also observed for all-cause mortality in participants with hypertension and for heart disease mortality in those with higher calcium intake. Higher vitamin D intake was associated with decreased risk of ischemic stroke and pneumonia mortality. Higher dietary vitamin D was associated with a lower risk of mortality among individuals with low sunlight exposure or hypertension. Individuals with potentially low vitamin D may benefit from increasing dietary vitamin D intake for the prevention of premature death.
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Affiliation(s)
- Akiko Nanri
- Department of Food and Health Sciences, International College of Arts and Sciences, Fukuoka Women's University, Fukuoka, Japan.
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
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2
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Abstract
Osteoporosis is a metabolic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to an increased risk of fragility fractures. Central dual-energy X-ray absorptiometry measurements are the gold standard for determining bone mineral density. A well-balanced diet containing adequate amounts of calcium and vitamin D, exercise, smoking cessation, and limited alcohol intake are important to maintain bone health. Pharmacologic agents should be recommended in postmenopausal women who are at high risk for fractures. Newer anabolic therapies including teriparatide, abaloparatide, and romosozumab have emerged for use in severe osteoporosis.
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Affiliation(s)
- Anika K Anam
- Department of Internal Medicine, Section of Endocrinology, Yale Bone Center, Yale University School of Medicine, 333 Cedar Street, FMP 107, PO Box 208020, New Haven, CT 06519, USA.
| | - Karl Insogna
- Department of Internal Medicine, Section of Endocrinology, Yale Bone Center, Yale University School of Medicine, 333 Cedar Street, FMP 107, PO Box 208020, New Haven, CT 06519, USA
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3
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Pana TA, Dehghani M, Baradaran HR, Neal SR, Wood AD, Kwok CS, Loke YK, Luben RN, Mamas MA, Khaw KT, Myint PK. Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis. Eur J Epidemiol 2021; 36:669-683. [PMID: 33382441 PMCID: PMC8403619 DOI: 10.1007/s10654-020-00710-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022]
Abstract
The role of dietary calcium in cardiovascular disease prevention is unclear. We aimed to determine the association between calcium intake and incident cardiovascular disease and mortality. Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold. A total of 17,968 participants aged 40-79 years were followed up for a median of 20.36 years (20.32-20.38). Compared to the first quintile of calcium intake (< 770 mg/day), intakes between 771 and 926 mg/day (second quintile) and 1074-1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83-0.99) and 0.85 (0.77-0.93), respectively) and cardiovascular mortality [HR 0.95 (0.87-1.04) and 0.93 (0.83-1.04)]. Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72-0.97), 0.83 (0.71-0.97), 0.78 (0.66-0.92) and 0.95 (0.78-1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality, regardless of average calcium intake. Calcium supplementation was associated with cardiovascular and all-cause mortality amongst women, but not men. Moderate dietary calcium intake may protect against cardiovascular and all-cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.
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Affiliation(s)
- Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, University of Aberdeen, Aberdeen, UK
- Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 4:013, Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Mohsen Dehghani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Ageing Clinical and Experimental Research (ACER) Team, University of Aberdeen, Aberdeen, UK
- Endocrinology Research Centre, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Samuel R Neal
- Ageing Clinical and Experimental Research (ACER) Team, University of Aberdeen, Aberdeen, UK
| | - Adrian D Wood
- Ageing Clinical and Experimental Research (ACER) Team, University of Aberdeen, Aberdeen, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research (ACER) Team, University of Aberdeen, Aberdeen, UK.
- Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 4:013, Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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Naghshi S, Naemi M, Sadeghi O, Darooghegi Mofrad M, Moezrad M, Azadbakht L. Total, dietary, and supplemental calcium intake and risk of all-cause cardiovascular, and cancer mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr 2021; 62:5733-5743. [PMID: 33749376 DOI: 10.1080/10408398.2021.1890690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Considerable controversy exists regarding the association between calcium intake and mortality risk. Therefore, this study aimed to summarize available findings on the associations of total, dietary and supplemental calcium intake with all-cause, CVD, and cancer mortality. We searched PubMed, Scopus, Embase, and ISI Web of Knowledge until February 2020 to identify eligible publications. Random-effects models were used to calculate pooled effect sizes (ESs) and 95% confidence intervals (CIs) for highest versus lowest categories of calcium intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between calcium intake and mortality. 36 publications were included in this systematic review and 35 in the meta-analysis. During the follow-up periods ranging from 4.2 to 28 years, the total number of deaths from all causes was 163,657 (83703 from CVD and 83929 from cancer). Total calcium intake was associated with a lower risk of CVD mortality (Pooled ES for highest v lowest category: 0.91; 95% CI: 0.83-0.99, I2=68.1%, P < 0.001). Dietary calcium intake was associated with a lower risk of all-cause mortality (Pooled ES for highest v lowest category: 0.95; 95% CI: 0.92-0.99, I2=62.1%, P < 0.001). Supplemental calcium intake was not significantly associated with risk of all-cause, CVD and cancer mortality. In the dose-response analysis, there was evidence of nonlinear association between calcium intake and risk of all-cause, CVD, and cancer mortality. In conclusion, a non-linear association between calcium intake with all-cause, CVD, and cancer mortality risk was observed in this meta-analysis. Moderate intake of total (1000-1800), dietary (600-1200), and supplemental calcium (600-1200) was inversely significantly associated with mortality risk but higher calcium intake was not associated with a lower risk of mortality.
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Affiliation(s)
- Sina Naghshi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Naemi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omid Sadeghi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Manije Darooghegi Mofrad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrasa Moezrad
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR
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Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS-2020 UPDATE. Endocr Pract 2020; 26:1-46. [PMID: 32427503 DOI: 10.4158/gl-2020-0524suppl] [Citation(s) in RCA: 425] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; AFF = atypical femoral fracture; ASBMR = American Society for Bone and Mineral Research; BEL = best evidence level; BMD = bone mineral density; BTM = bone turnover marker; CI = confidence interval; CPG = clinical practice guideline; CTX = C-terminal telopeptide type-I collagen; DXA = dual-energy X-ray absorptiometry; EL = evidence level; FDA = U.S. Food and Drug Administration; FRAX® = Fracture Risk Assessment Tool; GI = gastrointestinal; HORIZON = Health Outcomes and Reduced Incidence with Zoledronic acid ONce yearly Pivotal Fracture Trial (zoledronic acid and zoledronate are equivalent terms); ISCD = International Society for Clinical Densitometry; IU = international units; IV = intravenous; LSC = least significant change; NOF = National Osteoporosis Foundation; ONJ = osteonecrosis of the jaw; PINP = serum amino-terminal propeptide of type-I collagen; PTH = parathyroid hormone; R = recommendation; ROI = region of interest; RR = relative risk; SD = standard deviation; TBS = trabecular bone score; VFA = vertebral fracture assessment; WHO = World Health Organization.
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Adachi JD, Berger C, Barron R, Weycker D, Anastassiades TP, Davison KS, Hanley DA, Ioannidis G, Jackson SA, Josse RG, Kaiser SM, Kovacs CS, Leslie WD, Morin SN, Papaioannou A, Prior JC, Shyta E, Silvia A, Towheed T, Goltzman D. Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 2019; 14:53. [PMID: 31098708 DOI: 10.1007/s11657-019-0598-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/07/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy. PURPOSE Fracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures ("high-risk women"), risk prediction over a shorter horizon may have greater clinical relevance. METHODS A repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged ≥ 65 years with T score (total hip, femoral neck, spine) ≤ - 1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model. RESULTS The study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12 months (≥ 2 falls: HR = 1.9; 1 fall: HR = 1.5), low-trauma fracture in past 12 months (≥ 1 fracture: HR = 1.7), SF-36 physical component summary score (≤ 42.0: HR = 1.6), and total hip T score (≤ - 3.5: HR = 3.7; > - 3.5 to ≤ - 2.5: HR = 2.5; > - 2.5 to ≤ - 1: HR = 1.3). CONCLUSIONS Imminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.
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Affiliation(s)
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Derek Weycker
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA.
| | | | | | - David A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | | | | | | | | | - Erinda Shyta
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA
| | - Amanda Silvia
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA
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Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, Kleerekoper M, Lewiecki EM, Miller PD, Narula HS, Pessah-Pollack R, Tangpricha V, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS - 2016. Endocr Pract 2019; 22:1-42. [PMID: 27662240 DOI: 10.4158/ep161435.gl] [Citation(s) in RCA: 305] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABBREVIATIONS AACE = American Association of Clinical Endocrinologists AFF = atypical femur fracture ASBMR = American Society for Bone and Mineral Research BEL = best evidence level BMD = bone mineral density BTM = bone turnover marker CBC = complete blood count CI = confidence interval DXA = dual-energy X-ray absorptiometry EL = evidence level FDA = U.S. Food and Drug Administration FLEX = Fracture Intervention Trial (FIT) Long-term Extension FRAX® = Fracture Risk Assessment Tool GFR = glomerular filtration rate GI = gastrointestinal HORIZON = Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly IOF = International Osteoporosis Foundation ISCD = International Society for Clinical Densitometry IU = international units IV = intravenous LSC = least significant change NBHA = National Bone Health Alliance NOF = National Osteoporosis Foundation 25(OH)D = 25-hydroxy vitamin D ONJ = osteonecrosis of the jaw PINP = serum carboxy-terminal propeptide of type I collagen PTH = parathyroid hormone R = recommendation RANK = receptor activator of nuclear factor kappa-B RANKL = receptor activator of nuclear factor kappa-B ligand RCT = randomized controlled trial RR = relative risk S-CTX = serum C-terminal telopeptide SQ = subcutaneous VFA = vertebral fracture assessment WHO = World Health Organization.
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Hurley DL, Binkley N, Camacho PM, Diab DL, Kennel KA, Malabanan A, Tangpricha V. THE USE OF VITAMINS AND MINERALS IN SKELETAL HEALTH: AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND THE AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT. Endocr Pract 2018; 24:915-924. [PMID: 30035621 DOI: 10.4158/ps-2018-0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABBREVIATIONS 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; CV = cardiovascular; GI = gastrointestinal; IOM = Institute of Medicine; PTH = parathyroid hormone; RCT = randomized controlled trial; αTF = α-tocopherol; ucOC = undercarboxylated osteocalcin; VKA = vitamin K antagonist; WHI = Women's Health Initiative.
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Dietary Calcium Intake in Sample of School Age Children in City of Rabat, Morocco. J Nutr Metab 2018; 2018:8084623. [PMID: 29850234 PMCID: PMC5911322 DOI: 10.1155/2018/8084623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 01/16/2023] Open
Abstract
Calcium is an important mineral playing a vital role to maintain bone health. Calcium intake is considered as one of the most important determinants to assess the calcium status and to evaluate the calcium deficiency in the human body. Our study aims at estimating calcium intake in a sample of children and adolescent to be used in the global strategy to reduce calcium deficiency disorders in Morocco. Thus, 131 children and adolescents were recruited from public schools at Rabat and its regions in the framework of a descriptive cross-sectional study. For each participant, anthropometric parameters were measured. Calcium status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children's nutritional habits and to assess the consumption of calcium-rich food. Overall, the mean calcium intake was 522.0 ± 297.0 mg/day, and 85.5% of subjects highlighted calcium deficiency, with no significant difference between boys and girls. Calcium intake was significantly different according to age groups, and high consumption of calcium was found in subjects aged from 14 to 18 years (776.86 ±290.07 mg/day), giving evidence of the low calcium status of the studied population. Daily food intake and food frequency analysis showed that bread, vegetables, and fruits are the most consumed food and the main source of daily calcium intake. Consumption of dairy products, considered as the best source of calcium, is lower and represents only 14% of total calcium intake. Our study clearly showed that calcium status is very lower in Moroccan children and adolescents and a large proportion of this population have inadequate calcium intake. Hence, there's an urgent need of specific strategies, including children sensitisation and nutritional education, to increase calcium intake and therefore reduce calcium deficiency disorders impacting the whole body during childhood and in adult age.
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10
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Takahashi H, Cornish AJ, Sud A, Law PJ, Kinnersley B, Ostrom QT, Labreche K, Eckel-Passow JE, Armstrong GN, Claus EB, Il'yasova D, Schildkraut J, Barnholtz-Sloan JS, Olson SH, Bernstein JL, Lai RK, Schoemaker MJ, Simon M, Hoffmann P, Nöthen MM, Jöckel KH, Chanock S, Rajaraman P, Johansen C, Jenkins RB, Melin BS, Wrensch MR, Sanson M, Bondy ML, Turnbull C, Houlston RS. Mendelian randomisation study of the relationship between vitamin D and risk of glioma. Sci Rep 2018; 8:2339. [PMID: 29402980 PMCID: PMC5799201 DOI: 10.1038/s41598-018-20844-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/24/2018] [Indexed: 12/29/2022] Open
Abstract
To examine for a causal relationship between vitamin D and glioma risk we performed an analysis of genetic variants associated with serum 25-hydroxyvitamin D (25(OH)D) levels using Mendelian randomisation (MR), an approach unaffected by biases from confounding. Two-sample MR was undertaken using genome-wide association study data. Single nucleotide polymorphisms (SNPs) associated with 25(OH)D levels were used as instrumental variables (IVs). We calculated MR estimates for the odds ratio (OR) for 25(OH)D levels with glioma using SNP-glioma estimates from 12,488 cases and 18,169 controls, using inverse-variance weighted (IVW) and maximum likelihood estimation (MLE) methods. A non-significant association between 25(OH)D levels and glioma risk was shown using both the IVW (OR = 1.21, 95% confidence interval [CI] = 0.90–1.62, P = 0.201) and MLE (OR = 1.20, 95% CI = 0.98–1.48, P = 0.083) methods. In an exploratory analysis of tumour subtype, an inverse relationship between 25(OH)D levels and glioblastoma (GBM) risk was identified using the MLE method (OR = 0.62, 95% CI = 0.43–0.89, P = 0.010), but not the IVW method (OR = 0.62, 95% CI = 0.37–1.04, P = 0.070). No statistically significant association was shown between 25(OH)D levels and non-GBM glioma. Our results do not provide evidence for a causal relationship between 25(OH)D levels and all forms of glioma risk. More evidence is required to explore the relationship between 25(OH)D levels and risk of GBM.
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Affiliation(s)
- Hannah Takahashi
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Alex J Cornish
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Philip J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Karim Labreche
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Jeanette E Eckel-Passow
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Georgina N Armstrong
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth B Claus
- School of Public Health, Yale University, New Haven, Connecticut, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dora Il'yasova
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.,Cancer Control and Prevention Program, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Joellen Schildkraut
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.,Cancer Control and Prevention Program, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rose K Lai
- Departments of Neurology and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Matthias Simon
- Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Per Hoffmann
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Preetha Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Christoffer Johansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Margaret R Wrensch
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco, California, USA.,Institute of Human Genetics, University of California, San Francisco, California, USA
| | - Marc Sanson
- Sorbonne Universités UPMC Univ Paris 06, INSERM CNRS, U1127, UMR 7225, ICM, F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de neurologie 2-Mazarin, Paris, France
| | - Melissa L Bondy
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,William Harvey Research Institute, Queen Mary University, London, UK.,Guys and St Thomas Foundation NHS Trust, Great Maze Pond, London, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK. .,Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
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11
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12
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Ong AM, Weiler HA, Wall M, Goltzman D, Whiting SJ, Daskalopoulou SS, Morin SN. A 51-item calcium-focused food frequency questionnaire is a reliable tool to assess dietary calcium intake in postmenopausal women. Nutr Res 2017; 43:33-42. [DOI: 10.1016/j.nutres.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
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13
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Kirkpatrick SI, Vanderlee L, Raffoul A, Stapleton J, Csizmadi I, Boucher BA, Massarelli I, Rondeau I, Robson PJ. Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review. Adv Nutr 2017; 8:276-289. [PMID: 28298272 PMCID: PMC5347105 DOI: 10.3945/an.116.014027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.
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Affiliation(s)
- Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada;
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;
| | - Amanda Raffoul
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ilona Csizmadi
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;,Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Paula J Robson
- Cancer Measurement, Outcomes, Research, and Evaluation (C-MORE), Alberta Health Services Cancer Control, Edmonton, Alberta, Canada
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14
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Datta M, Vitolins MZ. Food Fortification and Supplement Use-Are There Health Implications? Crit Rev Food Sci Nutr 2017; 56:2149-59. [PMID: 25036360 DOI: 10.1080/10408398.2013.818527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Dietary supplements are a multi-billion dollar industry in the U.S., and their use is increasing exponentially. Additionally, many foods and beverages are increasingly being fortified with single or multiple vitamins and minerals. Consequently, nutrient intakes are exceeding the safe limits established by the Institute of Medicine. In this paper, we examine the benefits and drawbacks of vitamin and mineral supplements and increasing consumption of fortified foods (in addition to dietary intake) in the U.S. POPULATION The pros and cons are illustrated using population estimates of folic acid, calcium, and vitamin D intake, highlighting concerns related to overconsumption of nutrients that should be addressed by regulatory agencies.
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Affiliation(s)
- Mridul Datta
- a Department of Nutrition Science , Purdue University , West Lafayette , Indiana , USA
| | - Mara Z Vitolins
- b Wake Forest School of Medicine , Department of Epidemiology and Prevention , Winston-Salem , North Carolina , USA
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15
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Lima GAC, Lima PDA, de Barros MDGCRM, Vardiero LP, de Melo EF, Paranhos FDP, Madeira M, de Farias MLF. Calcium intake: good for the bones but bad for the heart? An analysis of clinical studies. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:252-63. [PMID: 27355855 PMCID: PMC10522307 DOI: 10.1590/2359-3997000000173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/10/2016] [Indexed: 11/22/2022]
Abstract
The proper dietary calcium intake and calcium supplementation, when indicated, are important factors in the acquisition of peak bone mass during youth and in the prevention of fractures in old age. In addition to its deposition in bone, calcium confers an increase in its resistance and exhibits important activities in different enzymatic pathways in the body (e.g., neural, hormonal, muscle-related and blood clotting pathways). Thus, calcium supplementation can directly or indirectly affect important functions in the body, such as the control of blood pressure, plasma glucose, body weight, lipid profile and endothelial function. Since one publication reported increased cardiovascular risk due to calcium supplementation, many researchers have studied whether this risk actually exists; the results are conflicting, and the involved mechanisms are uncertain. However, studies that have evaluated the influence of the consumption of foods rich in calcium have reported no increase in the cardiovascular risk, which suggests that nutritional intake should be prioritized as a method for supplementation and that the use of calcium supplements should be reserved for patients who truly need supplementation and are unable to achieve the recommended daily nutritional intake of calcium.
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Affiliation(s)
- Guilherme Alcantara Cunha Lima
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Endocrinologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Faculdade de Medicina de CamposCampos dos GoytacazesRJBrasil Serviço de Clínica Médica da Faculdade de Medicina de Campos (FMC), Campos dos Goytacazes, RJ, Brasil
| | - Priscilla Damião Araújo Lima
- Faculdade de Medicina de CamposCampos dos GoytacazesRJBrasil Serviço de Clínica Médica da Faculdade de Medicina de Campos (FMC), Campos dos Goytacazes, RJ, Brasil
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Reumatologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Maria da Glória Costa Reis Monteiro de Barros
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Reumatologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Centro Universitário Serra dos ÓrgãosTeresópolisRJBrasil Serviço de Clínica Médica do Centro Universitário Serra dos Órgãos (Unifeso), Teresópolis, RJ, Brasil
| | - Lívia Paiva Vardiero
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Reumatologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Elisa Fernandes de Melo
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Reumatologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Francisco de Paula Paranhos
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Endocrinologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Miguel Madeira
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Endocrinologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Universidade do Grande RioRio de JaneiroRJBrasil Serviço de Clínica Médica da Universidade do Grande Rio (Unigranrio), Rio de Janeiro, RJ, Brasil
| | - Maria Lucia Fleiuss de Farias
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Serviço de Endocrinologia da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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16
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Shin BR, Choi YK, Kim HN, Song SW. High dietary calcium intake and a lack of dairy consumption are associated with metabolic syndrome in obese males: the Korean National Health and Nutrition Examination Survey 2010 to 2012. Nutr Res 2016; 36:518-25. [DOI: 10.1016/j.nutres.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/04/2016] [Accepted: 01/08/2016] [Indexed: 12/16/2022]
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17
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Javed Z, Imam SF, Imam N, Saba K, Bukhari MH. Bone mineral density and diet of teachers of College of Home Economics at Lahore. Pak J Med Sci 2015; 31:970-4. [PMID: 26430440 PMCID: PMC4590379 DOI: 10.12669/pjms.314.8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the Bone Mineral Density (BMD) and diet of teachers of a Govt. College of Home Economics in Lahore. METHODS It was survey research. Purposive sampling technique was adopted for the selection of 50 teachers from Govt. College of Home Economics of age group 30 - 60 years. RESULTS About 46% of the subjects had BMD ratio in between -2.58 to -4.0 (Osteoporotic category). The root cause of low BMD ratio was not really age related but in majority of the sample it was due to sedentary life style and lack of awareness about the importance of exercise in relation to bone health. CONCLUSION The total mineral and vitamin intake required for bone health (calcium, magnesium, phosphorus & vitamin D) was below the recommended, among majority of the sample.
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Affiliation(s)
- Zahra Javed
- Zahra Javed, Department of Food and Nutrition, College of Home Economics, Lahore - Pakistan
| | - Sardar Fakhar Imam
- Sardar Fakhar Imam, Department of Medicine, Fatima Jinnah Medical University, Lahore - Pakistan
| | - Neelam Imam
- Neelam Imam, Department of Food and Nutrition, College of Home Economics, Lahore - Pakistan
| | - Kanwal Saba
- Kanwal Saba Department of Pathology Fatima Jinnah Medical University, Lahore - Pakistan
| | - Mulazim Hussain Bukhari
- Mulazim Hussain Bukhari Department of Pathology, Fatima Jinnah Medical University, Lahore - Pakistan
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18
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Di Carlo P, Siracusa L, Mazzola G, Colletti P, Soresi M, Giannitrapani L, Li Vecchi V, Montalto G. Vitamin D and Osteoporosis in HIV/HCV Coinfected Patients: A Literature Review. Int J Endocrinol 2015; 2015:969040. [PMID: 26273302 PMCID: PMC4530270 DOI: 10.1155/2015/969040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/23/2015] [Accepted: 02/10/2015] [Indexed: 02/06/2023] Open
Abstract
Vitamin D deficiency further increases the risk of osteoporosis in HIV-positive patients coinfected with hepatitis C virus (HCV); however, it is still unclear whether HCV-related increased fracture risk is a function of the severity of liver disease. The aim of this review was to identify studies on associative vitamin D deficiency patterns in high-risk populations such as HIV/HCV coinfected patients. We did this by searching MEDLINE and EMBASE databases, from inception to August 2014, and included bibliographies. The final 12 articles selected are homogeneous in terms of age but heterogeneous in terms of sample size, participant recruitment, and data source. Most of the HIV/HCV coinfected patients have less than adequate levels of vitamin D. After reviewing the selected articles, we concluded that vitamin D deficiency should be regarded as a continuum and that the lower limit of the ideal range is debatable. We found that vitamin D deficiency might influence liver disease progression in HIV/HCV coinfected patients. Methodological issues in evaluating vitamin D supplementation as a relatively inexpensive therapeutic option are discussed, as well as the need for future research, above all on its role in reducing the risk of HCV-related fracture by modifying liver fibrosis progression.
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Affiliation(s)
- Paola Di Carlo
- Department of Sciences for Health Promotion and Mother-Child Care “G. D'Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Lucia Siracusa
- Department of Sciences for Health Promotion and Mother-Child Care “G. D'Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Giovanni Mazzola
- Biomedical Department of Internal Medicine and Specialities, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Piero Colletti
- Biomedical Department of Internal Medicine and Specialities, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Maurizio Soresi
- Biomedical Department of Internal Medicine and Specialities, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Lydia Giannitrapani
- Department of Sciences for Health Promotion and Mother-Child Care “G. D'Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Valentina Li Vecchi
- Biomedical Department of Internal Medicine and Specialities, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Specialities, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
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19
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Asemi Z, Saneei P, Sabihi SS, Feizi A, Esmaillzadeh A. Total, dietary, and supplemental calcium intake and mortality from all-causes, cardiovascular disease, and cancer: A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2015; 25:623-634. [PMID: 25912278 DOI: 10.1016/j.numecd.2015.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
AIMS This systematic review and meta-analysis of observational studies was conducted to summarize the evidence on the association between calcium intake and mortality. METHODS AND RESULTS PubMed, Institute for Scientific Information (ISI) (Web of Science), SCOPUS, SciRUS, Google Scholar, and Excerpta Medica dataBASE (EMBASE) were searched to identify related articles published through May 2014. We found 22 articles that assessed the association between total, dietary, and supplementary intake with mortality from all-causes, cardiovascular disease (CVD), and cancer. Findings from this meta-analysis revealed no significant association between total and dietary calcium intake and mortality from all-causes, CVD, and cancer. Subgroup analysis by the duration of follow-up revealed a significant positive association between total calcium intake and CVD mortality for cohort studies with a mean follow-up duration of >10 years (relative risk (RR): 1.35; 95% confidence interval (CI): 1.09-1.68). A significant inverse association was seen between dietary calcium intake and all-cause (RR: 0.84; 95% CI: 0.70-1.00) and CVD mortality (RR: 0.88; 95% CI: 0.78-0.99) for studies with a mean follow-up duration of ≤10 years. Although supplemental calcium intake was not associated with CVD (RR: 0.95; 95% CI: 0.82-1.10) and cancer mortality (RR: 1.22; 95% CI: 0.81-1.84), it was inversely associated with the risk of all-cause mortality (RR: 0.91; 95% CI: 0.88-0.94). CONCLUSIONS We found a significant relationship between the total calcium intake and an increased risk of CVD mortality for studies with a long follow-up time and a significant protective association between dietary calcium intake and all-cause and CVD mortality for studies with a mean follow-up of ≤10 years. Supplemental calcium intake was associated with a decreased risk of all-cause mortality.
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Affiliation(s)
- Z Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Isfahan, Iran
| | - P Saneei
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S-S Sabihi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Feizi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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20
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Lopez-Garcia E, Leon-Muñoz L, Guallar-Castillon P, Rodríguez-Artalejo F. Habitual Yogurt Consumption and Health-Related Quality of Life: A Prospective Cohort Study. J Acad Nutr Diet 2015; 115:31-9. [DOI: 10.1016/j.jand.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
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21
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Lewis JR, Radavelli-Bagatini S, Rejnmark L, Chen JS, Simpson JM, Lappe JM, Mosekilde L, Prentice RL, Prince RL. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res 2015; 30:165-75. [PMID: 25042841 DOI: 10.1002/jbmr.2311] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 02/05/2023]
Abstract
Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta-analyses. We, therefore, undertook a meta-analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96-1.09; p = 0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95% CI, 0.91-1.02; p = 0.18). Heterogeneity among the trials was low for both primary outcomes (I(2) = 0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92-1.26; p = 0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95-1.24; p = 0.22) and chronic CHD 0.92 (95% CI, 0.73-1.15; p = 0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.
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Affiliation(s)
- Joshua R Lewis
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
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22
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Abstract
A hallmark of menopause, which follows the decline in the ovarian production of estrogen, is the aggressive and persistent loss of bone mineral and structural elements leading to loss of bone strength and increased fracture risk. This review focuses on newer methods of diagnosing osteoporosis and assessing fracture risk, as well as on novel management strategies for prevention and treatment. Fracture-risk prediction has been significantly enhanced by the development of methods such as the trabecular bone score, which helps assess bone microarchitecture and adds value to standard bone densitometry, and the Fracture Risk Assessment Tool (FRAX) algorithm techniques. The treatment of osteoporosis, which has the goals of fracture prevention and risk reduction, is moving beyond traditional monotherapies with antiresorptives and anabolic agents into new combination regimens.
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Affiliation(s)
- Panagiota Andreopoulou
- Department of Medicine, Endocrine Service, Hospital for Special Surgery, New York, NY, 10021;
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23
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Kuru P, Akyüz G, Cerşit HP, Çelenlioğlu AE, Cumhur A, Biricik Ş, Kozan S, Gökşen A, Özdemir M, Lüleci E. Fracture history in osteoporosis: risk factors and its effect on quality of life. Balkan Med J 2014; 31:295-301. [PMID: 25667782 DOI: 10.5152/balkanmedj.2014.13265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/11/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Fractures are one of the main outcomes in osteoporosis and have an important effect on the general health status. AIMS The purpose of this study was to determine the effect of major fracture history on quality of life. We also investigated the important risk factors and their effect on bone mineral density and fracture history. STUDY DESIGN Cross-sectional study. METHODS We recruited 105 patients who were admitted to an osteoporosis outpatient clinic. Medical history, family history, calcium intake, physical activity level and biochemical tests were evaluated. Lumbar spine and femur neck bone mineral density were measured. The Qualeffo-41 questionnaire was also used for evaluating quality of life. RESULTS The average age of the 105 patients included in the study was 56.04±13.73 and 89% of them were post-menopausal women. The average body mass index was 26.84±5.99, which means that the women were overweight. Also, 48.5% of the patients were diagnosed with osteoporosis and 51.5% of them were diagnosed as low bone density. A total of 34 patients had a fracture history with minor trauma and some of the patients had more than one fracture (12 ankle and foot, 10 forearm, 9 vertebral, 4 hand, 3 hip, 2 rib, 1 tibial). When the patients with and without fracture history were compared, the mean Qualeffo-41 score in patients with fracture was 43.85±2.57 and in the non-fracture group was 36.27±2.01. CONCLUSION Forearm, ankle and foot fractures can be commonly seen in osteoporosis patients with fracture history. We suggest that it is important to recognise osteoporosis prior to first fracture and disease-specific quality of life assessment should be done.
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Affiliation(s)
- Pınar Kuru
- Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Gülseren Akyüz
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Hülya Peynirci Cerşit
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Alp Eren Çelenlioğlu
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Cumhur
- Marmara University Faculty of Medicine, İstanbul, Turkey
| | | | - Seda Kozan
- Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Aylin Gökşen
- Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Mikail Özdemir
- Department of Public Health, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Emel Lüleci
- Department of Public Health, Marmara University Faculty of Medicine, İstanbul, Turkey
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24
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Pines A, Langer RD. The cardiovascular safety aspects of calcium supplementations: where does the truth lie? A personal perspective. Climacteric 2014; 18:6-10. [PMID: 25318377 DOI: 10.3109/13697137.2014.947947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical guidelines may change with time, as more information from topline studies emerges. Calcium plus vitamin D supplementation became routine decades ago, especially in the older population, based on the assumption that it may promote bone health and prevent fractures, and perhaps induce additional favorable health outcomes. During the past years, an ongoing debate defies this paradigm, mainly because of a potential cardiovascular risk on the one hand, and uncertainty in regard to the extent of the beneficial bone effects on the other hand. The following article summarizes the main recent developments, trying to put some order into the controversial information and opinions which have been published in the medical literature. We conclude that the best current evidence supports a primary strategy of obtaining recommended intakes of calcium and vitamin D from dietary sources. But, since most western diets are inadequate in that regard, and since there is no clear evidence of harm from modest supplementation (up to 1000 mg of elemental calcium and 400 IU of vitamin D3), supplementation is appropriate when dietary intake is inadequate.
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Affiliation(s)
- A Pines
- Sackler Faculty of Medicine, Tel-Aviv University , Israel
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25
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Raffield LM, Agarwal S, Cox AJ, Hsu FC, Carr JJ, Freedman BI, Xu J, Bowden DW, Vitolins MZ. Cross-sectional analysis of calcium intake for associations with vascular calcification and mortality in individuals with type 2 diabetes from the Diabetes Heart Study. Am J Clin Nutr 2014; 100:1029-35. [PMID: 25099552 PMCID: PMC4163793 DOI: 10.3945/ajcn.114.090365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of calcium supplements to prevent declines in bone mineral density and fractures is widespread in the United States, and thus reports of elevated cardiovascular disease (CVD) risk in users of calcium supplements are a major public health concern. Any elevation in CVD risk with calcium supplement use would be of particular concern in individuals with type 2 diabetes (T2D) because of increased risks of CVD and fractures observed in this population. OBJECTIVE In this study, we examined associations between calcium intake from diet and supplements and measures of subclinical CVD (calcified plaque in the coronary artery, carotid artery, and abdominal aorta) and mortality in individuals affected by T2D. DESIGN We performed a cross-sectional analysis in individuals affected by T2D from the family-based Diabetes Heart Study (n = 720). RESULTS We observed no significant associations of calcium from diet or supplements with any of our measures of calcified plaque, and no greater mortality risk was observed with increased calcium intake. Instead, calcium supplement use was modestly associated with reduced all-cause mortality in women (HR: 0.62; 95% CI: 0.42, 0.92; P = 0.017). CONCLUSION Our results do not support a substantial association between calcium intake from diet or supplements and CVD risk in individuals with T2D.
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Affiliation(s)
- Laura M Raffield
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Subhashish Agarwal
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Amanda J Cox
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Fang-Chi Hsu
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - J Jeffrey Carr
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Barry I Freedman
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Jianzhao Xu
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Donald W Bowden
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Mara Z Vitolins
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
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26
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Wang X, Chen H, Ouyang Y, Liu J, Zhao G, Bao W, Yan M. Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med 2014; 12:158. [PMID: 25252963 PMCID: PMC4199062 DOI: 10.1186/s12916-014-0158-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the association between dietary calcium intake and risk of mortality from cardiovascular disease and all causes. Therefore, we performed a meta-analysis of prospective cohort studies to examine the controversy. METHODS We identified relevant studies by searching MEDLINE, Embase, and the Cochrane Library databases between 1 September 2013 and 30 December 2013. Reference lists of relevant articles were also reviewed. Observational prospective studies that reported relative risks and 95% confidence intervals for the association of calcium intake with cardiovascular and all-cause mortality were eligible. Study-specific relative risks were pooled using a random-effects model. RESULTS In this meta-analysis, 11 prospective studies with 12 independent cohorts, involving 757,304 participants, were eligible. There was evidence of a non-linear association between dietary calcium intake and risk of mortality from cardiovascular disease (P for non-linearity <0.01) and all causes (P for non-linearity <0.01). A dose-response analysis showed a U-shaped relationship between dietary calcium intake and cardiovascular mortality. Intakes that were lower and higher than around 800 mg/day were gradually associated with a higher risk of cardiovascular mortality. For all-cause mortality, we also observed a threshold effect at intakes around 900 mg/day. The risk of all-cause mortality did not decrease further at intakes above 900 mg/day. CONCLUSIONS This meta-analysis of prospective cohort studies suggests that dietary calcium intake is associated with cardiovascular mortality in a U-shaped manner and that high dietary calcium intake (>900 mg/day) is not associated with a decreased risk of all-cause mortality.
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Affiliation(s)
| | | | | | | | | | - Wei Bao
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
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27
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Lima GAC, Paranhos Neto FDP, Pereira GRM, Gomes CP, Farias MLF. Osteoporosis management in patient with renal function impairment. ACTA ACUST UNITED AC 2014; 58:530-9. [DOI: 10.1590/0004-2730000003360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023]
Abstract
Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, osteoporosis and chronic kidney disease (CKD) are common comorbid conditions in the elderly, and often coexist. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease. The ability of DXA (dual energy X-ray absorptiometry) to diagnose osteoporosis and to predict fractures in this population remains unclear. The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease. Furthermore, safety and effectiveness of osteoporosis drugs are not established in patients with CKD. Thus, risks and benefits of antiosteoporosis treatment must be considered individually.
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28
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Weaver CM. Calcium supplementation: is protecting against osteoporosis counter to protecting against cardiovascular disease? Curr Osteoporos Rep 2014; 12:211-8. [PMID: 24671370 DOI: 10.1007/s11914-014-0208-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Calcium is the dominant mineral in bone and is a shortfall nutrient in the diet. For those consuming inadequate dietary calcium, calcium supplements have been a standard strategy for prevention of osteoporosis. Recently, calcium supplementation has been linked to both increased and decreased cardiovascular disease risk creating considerable uncertainty. Moreover, recent reports have shed uncertainty over the effectiveness of calcium supplements to reduce risk of fracture. The evidence for calcium supplementation effects to both reduce risk of fracture and increase coronary heart disease and mortality are reviewed. Although the importance of good calcium nutrition is well known, determining the advantage of calcium supplementation to either bone or heart health has been hampered by poor subject compliance and study design flaws. At present, the current Recommended Dietary Allowances for calcium still appear to be a good target with potential risks for chronic disease if intakes fall too short or greatly exceed these recommendations.
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Affiliation(s)
- Connie M Weaver
- Department of Nutrition Science, Purdue University, 700 W State Street, West Lafayette, IN, 47907, USA,
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29
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Lewis JR, Zhu K, Thompson PL, Prince RL. The effects of 3 years of calcium supplementation on common carotid artery intimal medial thickness and carotid atherosclerosis in older women: an ancillary study of the CAIFOS randomized controlled trial. J Bone Miner Res 2014; 29:534-41. [PMID: 24155106 DOI: 10.1002/jbmr.2117] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/07/2013] [Accepted: 10/14/2013] [Indexed: 01/22/2023]
Abstract
Calcium is an essential nutrient for skeletal health; however, it has been suggested that supplemental calcium may be associated with adverse cardiovascular effects, raising widespread concern about their use. One suggested mechanism is via increasing carotid atherosclerosis, however few randomized controlled trials (RCT) of calcium supplements have assessed these mechanisms. The calcium intake fracture outcome study (CAIFOS) was a 5-year RCT (1998 to 2003) of 1.2 g of elemental calcium in the form of calcium carbonate in 1460 elderly women. An ancillary study of 1103 women assessed common carotid artery intimal medial thickness (CCA-IMT) and carotid atherosclerosis at year 3 (2001). The effects of supplementation were studied in intention-to-treat (ITT) and per-protocol (PP) analyses before and after adjustment for baseline cardiovascular risk factors. The mean age of participants at baseline was 75.2 ± 2.7 years. In ITT analyses, women randomized to calcium supplementation had no difference in multivariable-adjusted mean CCA-IMT (calcium 0.778 ± 0.006 mm, placebo 0.783 ± 0.006 mm, p = 0.491) and maximum CCA-IMT (calcium 0.921 ± 0.007 mm, placebo 0.929 ± 0.006 mm, p = 0.404). Women randomized to calcium did not have increased carotid atherosclerosis (calcium 47.2%, placebo 52.7%, p = 0.066). However, in women taking at least 80% of the supplements, a significant reduction in carotid atherosclerosis was observed in unadjusted but not in multivariate-adjusted models (p = 0.033 and p = 0.064, respectively). Participants in the highest tertile of total calcium (diet and supplements) had reduced carotid atherosclerosis in unadjusted and multivariable-adjusted analyses compared with participants in the lowest tertile (odds ratio [OR] = 0.67 [95% confidence interval (CI) 0.50-0.90], p = 0.008, and OR = 0.70 [95% CI 0.51-0.96], p = 0.028, respectively). In conclusion, these findings do not support the hypothesis that calcium supplementation increases carotid artery intimal medial thickness or carotid atherosclerosis, and high calcium intake may reduce this surrogate cardiovascular risk factor.
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Affiliation(s)
- Joshua R Lewis
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Nedlands, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
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30
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Abstract
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A 62-year-old healthy woman presents for routine care. She has no history of fracture, but she is worried about osteoporosis because her mother had a hip fracture at 72 years of age. She exercises regularly and has taken over-the-counter calcium carbonate at a dose of 1000 mg three times a day since her menopause at 54 years of age. This regimen provides 1200 mg of elemental calcium per day. She eats a healthy diet with multiple servings of fruits and vegetables and consumes one 8-oz serving of low-fat yogurt and one glass of low-fat milk almost every day. She recently heard that calcium supplements could increase her risk of cardiovascular disease and wants your opinion about whether or not she should receive them. What would you advise?
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Affiliation(s)
- Douglas C Bauer
- Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA 94105, USA.
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31
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Affiliation(s)
- Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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