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Terrell K, Choi S, Choi S. Calcium's Role and Signaling in Aging Muscle, Cellular Senescence, and Mineral Interactions. Int J Mol Sci 2023; 24:17034. [PMID: 38069357 PMCID: PMC10706910 DOI: 10.3390/ijms242317034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Calcium research, since its pivotal discovery in the early 1800s through the heating of limestone, has led to the identification of its multi-functional roles. These include its functions as a reducing agent in chemical processes, structural properties in shells and bones, and significant role in cells relating to this review: cellular signaling. Calcium signaling involves the movement of calcium ions within or between cells, which can affect the electrochemical gradients between intra- and extracellular membranes, ligand binding, enzyme activity, and other mechanisms that determine cell fate. Calcium signaling in muscle, as elucidated by the sliding filament model, plays a significant role in muscle contraction. However, as organisms age, alterations occur within muscle tissue. These changes include sarcopenia, loss of neuromuscular junctions, and changes in mineral concentration, all of which have implications for calcium's role. Additionally, a field of study that has gained recent attention, cellular senescence, is associated with aging and disturbed calcium homeostasis, and is thought to affect sarcopenia progression. Changes seen in calcium upon aging may also be influenced by its crosstalk with other minerals such as iron and zinc. This review investigates the role of calcium signaling in aging muscle and cellular senescence. We also aim to elucidate the interactions among calcium, iron, and zinc across various cells and conditions, ultimately deepening our understanding of calcium signaling in muscle aging.
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Affiliation(s)
| | | | - Sangyong Choi
- Department of Nutritional Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT 06269, USA
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Murata H, Zhang Q, Ito T, Kawakami R, Sakamoto S, Torii S, Shibata S, Tanisawa K, Higuchi M. The combined effect of rowing exercise and the intake of functional foods containing inulin on muscle mass and bone mineral density in older Japanese women. Geriatr Gerontol Int 2023; 23:779-787. [PMID: 37721114 DOI: 10.1111/ggi.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
AIM Aging decreases muscle mass and bone mineral density (BMD), especially in older women. It has been reported that rowing and inulin intake positively affect muscle and bone, respectively. We examined the synergistic effect of rowing and functional food intake, including inulin, on lean body mass, BMD, and physical function parameters in older Japanese women. METHODS Fifty women aged 65-79 years were divided into four groups with or without inulin intake and rowing. The interventions were carried out for 12 weeks in each group. We assessed lean body mass and BMD using dual-energy X-ray absorptiometry at baseline and after the intervention and examined the changes in the values in each group. RESULTS Lean body mass in all groups decreased, and the change in lean body mass in the group with rowing and inulin intake was significantly smaller than that in the group without them (-0.05 ± 0.61; -0.83 ± 0.59 kg; P = 0.030). The BMD in the three intervention groups increased after the 12-week intervention. The change in BMD in each of the three intervention groups showed significant differences compared with the control group (Rowing + Inulin: P = 0.03; Rowing + No inulin: P = 0.01; No rowing + Inulin: P < 0.01). CONCLUSIONS Rowing and the intake of functional foods, including inulin, synergistically prevented a decrease in lean body mass. These factors, individually and additively, might increase BMD in older Japanese women. Geriatr Gerontol Int 2023; 23: 779-787.
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Affiliation(s)
- Hiroko Murata
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Department of Health and Nutrition, Jumonji University, Niiza, Japan
| | - Qiwei Zhang
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Tomoko Ito
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Department of Food and Nutrition, Tokyo Kasei University, Itabashi, Japan
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Hachioji, Japan
| | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Faculty of Sport Science, Surugadai University, Hanno, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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Robinson S, Granic A, Cruz-Jentoft AJ, Sayer AA. The role of nutrition in the prevention of sarcopenia. Am J Clin Nutr 2023; 118:852-864. [PMID: 37657521 PMCID: PMC10636259 DOI: 10.1016/j.ajcnut.2023.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/06/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
Sarcopenia is a common skeletal muscle disorder characterized by a loss of muscle mass and impaired muscle function that is associated with poor health outcomes. Although nutrition is considered an important factor in the etiology of sarcopenia, the preventive potential of diet, specifically the extent to which differences in habitual patterns of diet and/or nutrient intakes impact risk of its development, is poorly understood. This narrative review considered research evidence on dietary patterns and nutrient intakes in mid- (<60 y) and young-older (60-70 y) adulthood to evaluate how they relate to age-related changes in muscle mass and function. A key finding was that current evidence on adult diet and sarcopenia risk in older age is limited and fragmented, with different outcomes reported across studies (for example, lean mass, strength) and few reporting links to incident diagnosed sarcopenia. As these outcomes are not interchangeable, it challenges collation of the evidence, leaving many gaps in understanding. There is also limited information about adult (<70 y) diet and few longitudinal studies with repeated dietary assessments to enable definition of cumulative exposures across adulthood. However, despite these limitations, findings from studies of dietary patterns already provide reasonably consistent messages about the benefits of diets of higher quality in earlier adulthood for later physical performance, although whole-diet intervention trials are urgently needed to understand their potential. In comparison, there is little evidence of benefits of higher intakes of individual nutrients in earlier adulthood for later muscle mass and function. Although these gaps need to be addressed in future research, there may already be sufficient data to promote messages about diet quality more widely - that healthier diets of higher quality across adulthood, with known benefits for a range of health outcomes, are also linked to the effective preservation of muscle mass and function.
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Affiliation(s)
- Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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van Dronkelaar C, Fultinga M, Hummel M, Kruizenga H, Weijs PJM, Tieland M. Minerals and Sarcopenia in Older Adults: An Updated Systematic Review. J Am Med Dir Assoc 2023:S1525-8610(23)00481-4. [PMID: 37355247 DOI: 10.1016/j.jamda.2023.05.017] [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: 02/22/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE This systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in community-dwelling and institutionalized older adults. DESIGN Systematic review. SETTING AND PARTICIPANTS In March 2022, a systematic search was performed in PubMed, Scopus, and Web of Sciences using predefined search terms. Original studies on dietary mineral intake or mineral serum blood concentrations on muscle mass, muscle strength, and physical performance or the prevalence of sarcopenia in older adults (average age ≥65 years) were included. METHODS Eligibility screening and data extraction was performed by 2 independent reviewers. Quality assessment was performed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Risk of bias was evaluated using the Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) tool. RESULTS From the 15,622 identified articles, a total of 45 studies were included in the review, mainly being cross-sectional and observational studies. Moderate quality of evidence showed that selenium (n = 8) and magnesium (n = 7) were significantly associated with muscle mass, strength, and physical performance as well as the prevalence of sarcopenia. For calcium and zinc, no association could be found. For potassium, iron, sodium, and phosphorus, the association with sarcopenic outcomes remains unclear as not enough studies could be included or were nonconclusive (low quality of evidence). CONCLUSIONS AND IMPLICATIONS This systematic review shows a potential role for selenium and magnesium on the prevention and treatment of sarcopenia in older adults. More randomized controlled trials are warranted to determine the impact of minerals on sarcopenia in older adults.
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Affiliation(s)
- Carliene van Dronkelaar
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Maaike Fultinga
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Mitchell Hummel
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Hinke Kruizenga
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Peter J M Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Gharpure M, Chen J, Nerella R, Vyavahare S, Kumar S, Isales CM, Hamrick M, Adusumilli S, Fulzele S. Sex-specific alteration in human muscle transcriptome with age. GeroScience 2023:10.1007/s11357-023-00795-5. [PMID: 37106281 PMCID: PMC10400750 DOI: 10.1007/s11357-023-00795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcopenia is a medical condition that progressively develops with age and results in reduced skeletal muscle mass, alteration in muscle composition, and decreased muscle strength. Several clinical studies suggested that sarcopenia disproportionally affects males and females with age. Despite this knowledge, the molecular mechanism governing the pathophysiology is not well understood in a sex-specific manner. In this study, we utilized human gastrocnemius muscles from males and females to identify differentially regulated genes with age. We found 269 genes with at least a twofold expression difference in the aged muscle transcriptome. Among the female muscle samples, there were 239 differentially regulated genes, and the novel protein-coding genes include KIF20A, PIMREG, MTRNR2L6, TRPV6, EFNA2, RNF24, and SFN. In aged male skeletal muscle, there were 166 differentially regulated genes, and the novel-protein coding genes are CENPK, CDKN2A, BHLHA15, and EPHA. Gene Ontology (GO) enrichment revealed glucose catabolism, NAD metabolic processes, and muscle fiber transition pathways that are involved in aged female skeletal muscle, whereas replicative senescence, cytochrome C release, and muscle composition pathways are disrupted in aged male skeletal muscle. Targeting these novels, differentially regulated genes, and signaling pathways could serve as sex-specific therapeutic targets to combat the age-related onset of sarcopenia and promote healthy aging.
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Affiliation(s)
- Mohini Gharpure
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
| | - Resheek Nerella
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA
- Augusta University, Augusta, GA, 30912, USA
| | - Sagar Vyavahare
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA
| | - Sandeep Kumar
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA
| | - Carlos M Isales
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
| | - Mark Hamrick
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
- Department of Cell Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Sadanand Fulzele
- Department of Medicine, Medical College of Georgia, Augusta University, GA, Augusta, USA.
- Center for Healthy Aging, Augusta University, Augusta, GA, USA.
- Department of Cell Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Huang CB, Lin DD, Huang JQ, Hu W. Based on CT at the third lumbar spine level, the skeletal muscle index and psoas muscle index can predict osteoporosis. BMC Musculoskelet Disord 2022; 23:933. [PMID: 36280811 PMCID: PMC9590212 DOI: 10.1186/s12891-022-05887-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely related to osteoporosis by dual-energy x-ray absorptiometry (DXA) measurement. However, few studies have explored whether the skeletal muscle and adipose tissue index measured at the lumbar spine 3 (L3) level are closely related to bone mineral density (BMD) and can even predict osteoporosis. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are closely related to BMD. Methods A total of 180 participants were enrolled in this study to obtain skeletal muscle index (SMI), psoas muscle index (PMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at L3 levels and divide them into osteoporotic and normal groups based on the T-score of DXA. Spearman rank correlation was used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and BMD. Similarly, spearman rank correlation was also used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and the fracture risk assessment tool (FRAX). Receiver operating characteristic (ROC) was used to analyze the efficacy of SMI, PMI, SFI, VFI, and VSR in predicting osteoporosis. Results BMD of L1-4 was closely correlated with SMI, PMI, VFI and VSR (r = 0.199 p = 0.008, r = 0.422 p < 0.001, r = 0.253 p = 0.001, r = 0.310 p < 0.001). BMD of the femoral neck was only correlated with PMI and SFI (r = 0.268 p < 0.001, r = − 0.164 p-0.028). FRAX (major osteoporotic fracture) was only closely related to PMI (r = − 0.397 p < 0.001). FRAX (hip fracture) was closely related to SMI and PMI (r = − 0.183 p = 0.014, r = − 0.353 p < 0.001). Besides, FRAX (major osteoporotic fracture and hip fracture) did not correlate with VFI, SFI, and VSR. SMI and PMI were statistically significant, with the area under the curve (AUC) of 0.400 (95% confidence interval 0.312-0.488 p = 0.024) and 0.327 (95% confidence interval 0.244-0.410 p < 0.001), respectively. VFI, SFI, and VSR were not statistically significant in predicting osteoporosis. Conclusions This study demonstrated that L3-based muscle index could assist clinicians in the diagnosis of osteoporosis to a certain extent, and PMI is superior to SMI in the diagnosis of osteoporosis. In addition, VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well.
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Affiliation(s)
- Cheng-bin Huang
- grid.417384.d0000 0004 1764 2632Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000 China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 China
| | - Duo-duo Lin
- grid.417384.d0000 0004 1764 2632The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Jian-qiang Huang
- grid.417384.d0000 0004 1764 2632The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Wei Hu
- grid.417384.d0000 0004 1764 2632Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000 China
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Sun D, Wang Z, Mou J, Tian F, Cao J, Guo L, Liu P. Characteristics of paraspinal muscle degeneration in degenerative diseases of the lumbar spine at different ages. Clin Neurol Neurosurg 2022; 223:107484. [DOI: 10.1016/j.clineuro.2022.107484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/03/2022]
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Kim HK, Chijiki H, Fukazawa M, Okubo J, Ozaki M, Nanba T, Higashi S, Shioyama M, Takahashi M, Nakaoka T, Shibata S. Supplementation of Protein at Breakfast Rather Than at Dinner and Lunch Is Effective on Skeletal Muscle Mass in Older Adults. Front Nutr 2022; 8:797004. [PMID: 34993224 PMCID: PMC8724572 DOI: 10.3389/fnut.2021.797004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The effects of different intake patterns of meal protein on muscle mass have not been clarified. We cross-sectionally and longitudinally examined the effect of different timing of protein intake on sarcopenia-related factors in older adults. Methods: This cross-sectional study 1 included 219 (male, n = 69, female, n = 150) elderly subjects aged ≥65 years. Subjects who consumed more protein at breakfast than at dinner were grouped into the morning group (MG, n = 76; male, n = 26; female, n = 50), and those who consumed more protein at dinner than at breakfast were grouped into the evening group (EG, n = 143; male, n = 43; female, n = 100). In cross-sectional study 2-1 (female, n = 125), the subjects were classified into four groups according to the number of meals with sufficient protein intake. In cross-sectional studies 2-2 (female, n = 125) and 2-3 (female, n = 27), the subjects were classified into eight groups and three groups according to whether they had consumed sufficient protein at three meals; sarcopenia-related factors were compared. The intervention study was a placebo-controlled, double-blind, randomized controlled trial that included 40 elderly women with low daily breakfast protein intake. The subjects were divided into four groups: morning protein and placebo intake groups and evening protein and placebo intake groups. Each group consumed the test food (containing 10 g milk protein) or placebo in the morning or evening for 12 weeks. Blood indices and physical function were assessed before and after the intervention. Results: Comparing all subjects, MG showed significantly higher handgrip strength than did EG (P < 0.05). The higher ratio of morning protein intake relative to the total protein intake, the better the muscle mass (r = 0.452, P < 0.05) and handgrip strength (r = 0.383, P < 0.05). The intervention study showed an increase in muscle mass with the intake of milk protein in the morning rather than in the evening (P < 0.05). Conclusions: Protein intake at breakfast might have relatively stronger effects on skeletal muscle mass than at lunch and dinner.
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Affiliation(s)
- Hyeon-Ki Kim
- Faculty of Science and Engineering, Waseda University, Shinjuku City, Japan
| | - Hanako Chijiki
- Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku City, Japan
| | - Mayuko Fukazawa
- Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku City, Japan
| | - Jin Okubo
- Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku City, Japan
| | - Mamiho Ozaki
- Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku City, Japan
| | - Takuya Nanba
- Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku City, Japan
| | | | | | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Meguro City, Japan
| | | | - Shigenobu Shibata
- Faculty of Science and Engineering, Waseda University, Shinjuku City, Japan
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An HJ, Seo YG. Differences in Fat-Free Mass According to Serum Vitamin D Level and Calcium Intake: Korea National Health and Nutrition Examination Survey 2008-2011. J Clin Med 2021; 10:jcm10225428. [PMID: 34830710 PMCID: PMC8623334 DOI: 10.3390/jcm10225428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022] Open
Abstract
We analyzed the differences in fat-free mass (FFM) according to serum vitamin D level (VitD) and daily calcium intake (Ca) in 14,444 adults aged over 19 years. We used data from the 4th and 5th Korea National Health and Nutrition Examination Surveys (2008–2011). FFM was measured using dual-energy X-ray absorptiometry. VitD was classified as insufficient or sufficient (cutoff: 20 ng/mL). Ca was classified as unsatisfactory or satisfactory (recommended daily intake: 700 mg). In men, the FFM of group 2 (VitD ≥ 20 ng/mL; Ca < 700 mg), group 3 (VitD < 20 ng/mL; Ca ≥ 700 mg) and group 4 (VitD ≥ 20 ng/mL; Ca ≥ 700 mg) was 0.50 kg (95% confidence interval (CI), 0.084–0.92), 0.78 kg (95% CI, 0.26–1.29) and 1.58 kg (95% CI, 0.95–2.21) higher than that of group 1 (VitD < 20 ng/mL; Ca < 700 mg), respectively. In women, a 1 ng/mL increase in VitD was associated with a 0.023 kg increase in FFM (95% CI, 0.003–0.043) and a 1 g increase in Ca was associated with a 0.62 kg increase in FFM (95% CI, 0.067–1.16). High VitD and Ca were associated with a high FFM.
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