Calcium Supplementation in Clinical Practice: A Review of Forms, Doses, and Indications

Calcium Intake Is Inversely Related to Risk of Obesity among American Young Adults over a 30-Year Follow-Up

BACKGROUND

Calcium (Ca) is an essential nutrient that may play an important role in weight maintenance through its involvement in energy or lipid metabolism. However, little is known about the long-term associations of Ca intake with obesity risk.

OBJECTIVES

We aimed to prospectively examine the association between cumulative Ca intake and the incidence of obesity among American young adults over 30 y of follow-up.

METHODS

Participants were from the CARDIA (Coronary Artery Risk Development in Young Adults) study. A total of 4097 of 5115 black and white individuals aged 18-30 y at baseline in 1985-1986 were included in the current analysis. Dietary and supplemental Ca intake was assessed by the validated interview-based CARDIA diet history at baseline and exam years 7 and 20. Incident cases of obesity were identified when BMI was ≥30 kg/m2 for the first time since baseline. A survival analysis was performed using Cox proportional hazards regression models to estimate the HRs and corresponding 95% CIs for obesity incidence during follow-up.

RESULTS

During a 30-y follow-up (mean ± SD: 20 ± 10 y), 1675 participants developed obesity. Cumulative total Ca intake (dietary plus supplemental Ca) was inversely associated with incidence of obesity in multivariable-adjusted analysis [quintile (Q)5 (highest intake) compared with Q1 (lowest intake): HR: 0.68; 95% CI: 0.56, 0.82; P-trend < 0.01]. This inverse association persisted among Ca supplement users (Q5 compared with Q1: HR: 0.53; 95% CI: 0.40, 0.70; P-trend < 0.01), but was not seen among nonusers.

CONCLUSIONS

Following a cohort of Americans from young adulthood to midlife, an inverse association between calcium intake and obesity incidence was observed. Further studies are needed to confirm our findings.

Preparation of Sterile Raw Material - Chicken Eggshells in the Process of their Transformation into Selected Calcium Salts

BACKGROUND

The chicken eggshells and their subcrustal membranes are a valuable source of calcium, but they are not further processed but disposed of as waste from the food industry. Chicken eggshells have high content (>95%) of calcium carbonate. Some properties suggest that eggshells may be a promising alternative to the present calcium sources used in the pharmaceutical industry.

METHODS

The effect of roasting chicken eggshells with a selected organic acid (citric or fumaric or lactic acid) on microbiological purity, including the presence of fungi and bacteria Salmonella spp., Staphylococcus aureus, Escherichia coli of obtained calcium salts, was investigated. In this study, chicken eggshells were subjected to chemical reactions with organic acids (citric, fumaric or lactic acid) at two different calcium-acid molar ratios (1:1 or 1:3) and the mixture was heat-treated for 1 or 3 hours at a temperature of 100°C or 120°C.

RESULTS AND DISCUSSION

It was found that lactic acid was 100% effective against fungi, and the remaining citric and fumaric acids were -50% (regardless of the other examined conditions). The type of acid used has a significant effect on fungal growth inhibition (p<0.05). Fumaric acid and lactic acid will be nearly 100% effective against bacteria (100% fumaric acid and 97% lactic acid effectiveness), regardless of other factors.

CONCLUSION

Lactic acid is the most effective against pathogenic flora - fungi and bacteria. The transformation of chicken eggshells into calcium lactate can provide us with sterile calcium salt, free of 100% fungi and 97% of all bacteria.

Comparison of the In Vitro Bioavailability of Selected Minerals from Gluten-Free Breads Enriched with Grains and Synthetic Organic and Non-Organic Compounds

Introduction: Despite the constant efforts of scientists to improve the texture, sensory properties, and nutritional value of gluten-free bread, obtaining high bioavailability of minerals is still a huge challenge. Gluten-free bakery products are characterized by a low bioavailability of minerals. The aim of this study was to design gluten-free bread with high bioavailability of minerals commonly found in deficiencies in people struggling with gluten intolerance. Material and methods: The material consisted of gluten-free breads designed to obtain the highest possible content of minerals in the bread while maintaining a good structure and taste. Results: Higher contents of all the analyzed minerals were obtained in breads with natural and synthetic additives, both in rice and buckwheat bread, compared to basic bread. There was also a higher content of the analyzed minerals in buckwheat bread in comparison to rice bread for each type of additive. Higher bioavailability of iron, copper, calcium, and magnesium was noted in rice bread, while the bioavailability of zinc was higher in buckwheat bread. Conclusion: The additives used increased the bioavailability of the analyzed minerals from the gluten-free breads. The use of various variants of flour (rice, buckwheat) influenced the bioavailability of iron, zinc, copper, calcium, and magnesium. The release of minerals from gluten-free bread depends on the element and added components (seeds or synthetic additives).

Calcium prescription by Indian orthopaedic surgeons: A survey and a review of literature

BACKGROUND

Orthopaedic surgeons prefer calcium supplement for various pathologies like fracture, osteoporosis, chronic musculoskeletal pain, yet there is no proper evidence to support the benefits of taking them regularly. The average requirement for calcium is around 500-1000 mg/day for a healthy adult, this amount of calcium is not achieved by diet, especially in developing countries like India. Despite this, the serum calcium level remains unaltered, due to the well-controlled absorption and excretion of calcium by the human body. As there is no clarity over the dose, duration and the prefered calcium salts, we constructed a survey to find the preferred dose, duration, the preferred calcium salts among orthopaedic surgeons, and to give an in-depth review of literature about dose, duration, timing, preferred calcium salt and various other calcium-related queries.

MATERIALS AND METHOD

The survey included 15 pre-structured questionnaires; these questions were formatted and validated by senior surgeons and other specialists after a through a review of calcium-related literature. These questionnaires were used in a pilot study conducted within the department and were later modified and separated into 7 sections. Data were collected by both online survey (google forms) and direct interviews.

RESULT AND CONCLUSION

128 Orthopedic surgeons responded. The total number of response obtained was 2355. Unanswered questions were 152. From the survey, it was found that most orthopaedic surgeons prefer to prescribe calcium routinely (55.46%). The commonly used calcium salt was calcium carbonate (47.65%), followed by citrate (32.8%). 42.18% were not aware of the efficiency of prescribing calcium in divided doses. Most responded that calcium is not to be given for patients with renal stones, but literature shows that calcium prescribed reduces the recurrence of commonest kidney stones, calcium oxalate stones.

The Safety of TheVegan Diet During Pregnancy

There is an increasing number of people who go vegetarian. Some young parents also switch to this diet. The safety of vegetarian diets, especially ve-gan diets, is very important, especially during pregnancy. Unfortunately, reference publications do not provide coherent data on the safety of vegetar-ian diets during pregnancy. On the one hand, the vegan diet has advantages because it reduces the risk of heart disease and gestational diabetes. On the other hand, vegetarians/vegans should be aware of potential deficiencies of some nutrients (iron, zinc, vitamin B12, vitamin D, omega-3 fatty acids, cal-cium, iodine) and the clinical consequences for the foetus. For example, iron deficiency may affect cognitive abilities, behaviour, intelligence and increase the risk of preterm birth and low birth weight of infants. Plant food contains non-haem iron with variable absorption. Therefore, the vegan diet should include nutrients increasing the bioavailability of iron, e.g. ascorbic acid, carotene and retinol. Due to the fact that animal food is the main source of vitamin B12, vegans are at very high risk of vitamin B12 deficiency, which will affect the infant’s weight at birth. Low level of vitamin D, which is prevalent in animal food, is the most common deficiency among vegans and lacto-ovo vegetarians. This vitamin prevents gestational diabetes, reduces insulin resistance and guarantees normal function of the musculoskeletal system. Zinc deficiency during pregnancy may lead to preterm birth, neural tube defects or even miscarriage. In view of the clinical consequences of po-tential deficiencies of nutrients, the vegetarian/vegan diet should be well balanced.

Promoting bone health in children and adolescents following solid organ transplantation

Solid organ transplantation in children and adolescents provides many benefits through improving critical organ function, including better growth, development, cardiovascular status, and quality of life. Unfortunately, bone status may be adversely affected even when overall status is improving, due to issues with pre-existing bone disease as well as medications and nutritional challenges inherent post-transplantation. For all children and adolescents, bone status entering adulthood is a critical determinant of bone health through adulthood. The overall health and bone status of transplant recipients benefits from attention to regular physical activity, good nutrition, adequate calcium, phosphorous, magnesium and vitamin D intake and avoidance/minimization of soda, extra sodium, and obesity. Many immunosuppressive agents, especially glucocorticoids, can adversely affect bone function and development. Minimizing exposure to "bone-toxic" medications is an important part of promoting bone health in children post-transplantation. Existing guidelines detail how regular monitoring of bone status and biochemical markers can help detect bone abnormalities early and facilitate valuable bone-directed interventions. Attention to calcium and vitamin D supplementation, as well as tapering and withdrawing glucocorticoids as early as possible after transplant, can provide best bone outcomes for these children. Dual-energy X-ray absorptiometry can be useful to detect abnormal bone mass and fracture risk in this population and newer bone assessment methods are being evaluated in children at risk for poor bone outcomes. Newer bone therapies being explored in adults with transplants, particularly bisphosphonates and the RANKL inhibitor denosumab, may offer promise for children with low bone mass post-transplantation.

Structural characterization of calcium-binding sunflower seed and peanut peptides and enhanced calcium transport by calcium complexes in Caco-2 cells

BACKGROUND

Peptide-Ca complexes can promote Ca absorption. The present study aimed to determine the transport mechanism and structural characteristics of sunflower seed and peanut peptides with high Ca binding capacity with respect to developing third-generation Ca supplements and functional food ingredients.

RESULTS

High Ca-binding fractions of 1-3 kDa sunflower seed peptide (SSP₄ ) and ≥ 10 kDa peanut peptide (PP₁ ) had higher amount of Ca transported than CaCl₂ and two hydrolyzed proteins in Caco-2 cells. SSP₄ and PP₁ were separated by Ca ion metal chelate affinity chromatography, and high Ca-binding fractions were observed for SSP₄ -P₂ and PP₁ -P₂ . The amino acid sequences of SSP₄ -P₂ and PP₁ -P₂ were characterized by high-performance liquid chromatography-electrospray ionization-time of flight mass spectrometry. Seven and eight peptides were identified from SSP₄ -P₂ and PP₁ -P₂ , respectively. These peptides had molecular weights ranging from 1500 Da to 2500 Da and a large number of characteristic amino acid sequences, such as EEEQQQ, EQ-QQQ-QQ, QQ-QQQQQ, E-EEE, EE-EEQ, RR, Q-QQ-QQQ, EE-EQ-EE-Q, QQ-QQQQ, and Q-QQQQ, where 'E' is glutamic acid and 'Q' is glutamine.

CONCLUSION

SSP₄ and PP₁ can promote Ca transport in Caco-2 cells without affecting cell permeability. The amino acid sequences of SSP₄ -P₂ and PP₁ -P₂ with high Ca-binding abilities contain characteristic sequences, such as continuous glutamic acid and glutamine, and have low molecular weights. © 2020 Society of Chemical Industry.

Mechanical study of a copper dietary supplement, copper glycinate hydrate

Here, the mechanical properties of a copper-based dietary supplement were systematically investigated via a combined theoretical–experimental approach.

Effect of in ovo application of hydroxyapatite nanoparticles on chicken embryo development, oxidative status and bone characteristics

Intensive selection in modern lines of fast-growing chickens has caused several skeletal disorders. Therefore, current research is focused on methods to improve the bones of birds. A new potential solution is in ovo technology using nanoparticles with a high specificity for the bone tissue. Thus, the objective of the present study was to evaluate the effect of in ovo application of hydroxyapatite nanoparticles (HA-NP) in different concentrations (50, 100 and 500 μg/ml colloids) on chicken embryo development, with a particular focus on the oxidative status and bone characteristics of the embryo. The results showed that in ovo treatment with HA-NP did not negatively affect hatchability and body weight. However, bone weight was reduced in 500 μg/ml group. The concentrations of calcium, phosphorus and crude ash were not affected. The modulatory effect of HA-NP was observed on the basis of antioxidative markers - superoxide dismutase, total antioxidant status, malondialdehyde in serum and selected tissues. Glutathione concentration in serum suggested higher metabolic stress. Among bone turnover markers, the concentration of osteocalcin was found to be significantly affected by HA-NP injection. Thus, the in ovo application of HA-NP could modify the molecular responses at the stage of embryogenesis but these changes were not reflected in embryo growth and even slowed down bone development. Nevertheless, the question for the follow-up research is whether in ovo administration of HA-NP would affect the antioxidative status and bone turnover resulting in improved bone conditions and body gain in post hatch chickens.

Lime Juice Enhances Calcium Bioaccessibility from Yogurt Snacks Formulated with Whey Minerals and Proteins

Yogurt-based snacks originally with a calcium content between 0.10 and 0.17 mmol/g dry matter were enriched with a whey mineral concentrate and whey protein isolate or hydrolysate. Whey mineral concentrate was added to increase the total amount of calcium by 0.030 mmol/g dry matter. Calcium bioaccessibility was determined following an in vitro protocol including oral, gastric, and intestinal digestion, with special focus on the effect of lime juice quantifying calcium concentration and activity. Calcium bioaccessibility, defined as soluble calcium divided by total calcium after intestinal digestion amounted to between 17 and 25% for snacks without lime juice. For snacks with lime juice, the bioaccessibility increased to between 24 and 40%, an effect attributed to the presence of citric acid. Citric acid increased the calcium solubility both from whey mineral concentrate and yogurt, and the citrate anion kept supersaturated calcium soluble in the chyme. The binding of calcium in the chyme from snacks with or without lime juice was compared electrochemically, showing that citrate increased the amount of bound calcium but with lower affinity. The results indicated that whey minerals, a waste from cheese production, may be utilized in snacks enhancing calcium bioaccessibility when combined with lime juice.

Impact of acidity regulator and excipient nutrients on digestive solubility and intestinal transport of calcium from calcium phosphate and carbonate

The aim of the current study was to investigate the effect of an acidity regulator (SPORIX®), lactose, and vitamin D₃ as excipient ingredients on digestive solubility and intestinal transport of calcium from four different calcium materials (tricalcium phosphate (TCP), fish bone (FB), nano-fish bone (NFB), and algae calcium (AC)) through an in vitro digestion model system combined with Caco-2 cells. The concentration of ionized calcium (Ca²⁺) in an aqueous fraction after in vitro digestion increased with the addition of SPORIX®, and it was further enhanced by adding SPORIX® + lactose + vitamin D₃ into TCP, FB, NFB, and AC, respectively. In particular, FB with SPORIX® + lactose + vitamin D₃ enhanced calcium ionization to 33.89 ± 0.69 mg g^-1, which was about 11.76 times higher than that of FB only. In the case of intestinal cellular uptake of calcium, there was no significant difference in all the tested calcium materials with SPORIX® + lactose + vitamin D₃. However, the absolute amount of intestinal transport of calcium in FB (43.95 ± 3.29 μg) was significantly higher than other calcium materials with the addition of SPORIX® + lactose + vitamin D₃ (p < 0.05). This study suggests that the co-consumption of SPORIX®, lactose, and vitamin D₃ with FB could enhance the calcium bioavailability by lowering pH as well as improving calcium intestinal transport by modulating the paracellular and transcellular uptake mechanism.

Management of parathyroid disorders: recommendations of the working group of the Bone Section of the Hellenic Endocrine Society

The Bone Section of the Hellenic Endocrine Society has issued the recommendations herein presented with the aim of providing guidance on optimal management of patients with parathyroid disorders in everyday clinical practice within the Greek health care setting. Although the methodology followed to formulate these recommendations was not strictly based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principles, they were drawn up after an extensive review of the literature and of the currently available guidelines for the management of parathyroid disorders worldwide. Specifically for primary hyperparathyroidism (PHPT), the 2011 guidelines of the Greek National Organization of Medicines were updated accordingly. In particular, definitions, etiologies, and recommended and optional laboratory and imaging examinations are provided both for PHPT and chronic hypoparathyroidism (HypoPT). Finally, treatment algorithms are provided for the management of both PHPT and HypoPT. Specifically for HypoPT, the treatment algorithm describes the recommended steps that should be followed to achieve optimal management of chronic hypocalcemia and the complications of HypoPT through the conventional treatment available in Greece and the use of recombinant human PTH(1-84).

Improved in vitro bioavailability of a newly developed functionalized calcium carbonate salt as a food ingredient and its comparison with available commercial calcium salts

The bioaccessibility and bioavailability of a functionalized Calcium (Ca) salt as food ingredient, based on modified Ca carbonate and hydroxyapatite (FCC), was determined and compared with frequently used Ca sources (Ca citrate tetrahydrate (CCT), tri-Ca phosphate (triCP) and Ca carbonate (CC). Results showed a similar Ca bioaccessibility for CCT (76.44 ± 9.73%), CC (73.7 ± 8.18%) and FCC (74.4 ± 1.87%) and a lower value for tri-CP (46.07 ± 8.68%). FCC showed the highest bioavailability, 5.68 ± 0.26%, compared to CC, CCT and tri-CP (3.93 ± 0.99%, 3.41 ± 0.33%, 1.85 ± 0.34%, respectively). The innovative chemical composition and structure of FCC based on amorphous hydroxyapatite combined with Ca carbonate, a greater porosity, lower agglomerates and particle size, improve the Ca solubility in the intestinal media, explaining the similar bioaccessibility but higher bioavailability of FCC compared to CCT, tri-CP and CC.

Calcium physiology, metabolism and supplementation: a glance at patients with ankylosing spondylitis

The aim of this review is to describe the metabolism of calcium in ankylosing spondylitis compared to physiologic conditions, and to present the current evidence on the benefits and disadvantages of calcium supplementation in these patients. A narrative review of the literature was conducted using the PubMed database and a total of 65 articles were selected. Calcium is involved in many physiopathological processes, including inflammation, bone loss and bone formation, all of which occur in ankylosing spondylitis. Many ankylosing spondylitis patients suffer from concomitant osteopenia or osteoporosis, which represent indications for calcium supplementation. Conversely, there are still concerns about the use of calcium salts for the prevention of bone fragility in non-osteoporotic or non-osteopenic patients. In these cases, biologic agents may indirectly normalize calcium dysmetabolism by rebalancing the cytokine milieu, in turn associated with bone remodeling. Calcium supplements may be disadvantageous for entheseal calcifications, but so far there are no clear data confirming that such an association exists.

Different elemental infant formulas show equivalent phosphorus and calcium bioavailability in healthy volunteers

Retrospective chart reviews have reported hypophosphatemia associated with elemental formula use in infants and children with systemic disease involving multiple diagnoses. The present study aims to evaluate the bioavailability of phosphorus from 2 commercial elemental formulas and to test our hypothesis of bioequivalence of the 2 products in healthy volunteers receiving gastric acid-suppressive medication. A single-center, double-blind, randomized, cross-over study was conducted in healthy volunteers with esomeprazole-induced hypochlorhydria. After a standardized low phosphorus meal followed by overnight fasting, subjects consumed 1 gram of phosphorus in a single oral dose of 1217 kcal of Product A (Neocate) or Product B (Elecare). The alternate product was given following a 1-week washout period. Blood and urine were collected at baseline and different time-points for up to 6 hours after product consumption. Area-under-the-curve (AUC) and peak values (C_peak) for serum phosphate and calcium and urinary creatinine-corrected phosphate and calcium were assessed for bioequivalence of Products A and B. Results show that the geometric mean ratio (GMR) and 90% CI for serum phosphate were 1.041 (0.998-1.086) and 1.020 (0.963-1.080) for AUC_0-360 and C_peak, respectively, meeting the predetermined criteria for bioequivalence. Urinary creatinine-corrected phosphate followed a similar pattern after intake of Product A and B, but did not reach bioequivalence criteria (GMR: AUC_70-370 = 1.105 (0.918-1.330); C_peak = 1.182 (1.040-1.343)). Serum calcium concentrations (GMR: AUC_0-360 = 1.002 (0.996-1.009); C_peak = 0.991 (0.983-0.999)) and urinary creatinine-corrected calcium excretion (GMR: AUC_70-370 = 1.117 (1.023-1.219); C_peak = 1.157 (1.073-1.247)) demonstrated bioequivalence of the products. In conclusion, both elemental infant formulas showed equivalent serum phosphorus and calcium bioavailability in healthy volunteers even if combined with treatment with acid-suppressive medication.

Research progress on applications of calcium derived from marine organisms

Calcium is an important mineral that plays an integral role in human health, especially bone health. Marine biological calcium is an abundant resource that is generally accepted and has a complex active structure. This review evaluates research progress on marine biological calcium with regards to its sources, use of calcium supplements, calcium bioavailability, and novel applications of marine calcium. The potential for future development and the use of products incorporating marine biological calcium in biomedical research and the pharmaceutical, health care, and food industries are also reviewed. The goal of this review is to provide a comprehensive documentation on resource utilization and product development from marine organisms.

Investigating the calcium binding characteristics of black bean protein hydrolysate

The black bean protein has been widely utilized to prepare hydrolysates with different bioactive properties. Herein, we hydrolyzed the black bean protein to prepare hydrolysate with calcium binding activity and characterized its behavior. Our results showed that ficin was superior in obtaining hydrolysate with calcium binding capacity in comparison with trypsin, alcalase and bromelain. In particular, the optimal capacity of ficin hydrolysate reached 77.54 ± 1.61 μg mg-1, where the optimal hydrolysis conditions of ficin were a temperature of 70 °C, a pH value of 6.2, an enzyme concentration of 1.61% and a time of 3 h. This might be due to high proportions of aspartic acid and glutamic acid (35.59%). Further spectral analysis evidenced the formation of hydrolysate-calcium complexes, demonstrating that the interaction between hydrolysate and calcium ions primarily occur on carboxyl oxygen atoms and amino nitrogen atoms. These findings provide a possible utilization of black bean hydrolysate to serve as a calcium supplement nutraceutical to enhance the absorption and bioavailability.

A Review of Analytical Methods for Calcium Salts and Cholecalciferol in Dietary Supplements

Dietary supplements composed by the combination of a calcium salt with cholecalciferol (vitamin D₃) are widely used for improving bone health in conditions caused by the deficiency of these compounds in the body. Historically, these supplements have been linked to quality and safety issues. In the case of calcium salts, the presence of potentially toxic contaminants such as lead (Pb) has already been alerted by health authorities from different countries. Meanwhile, cholecalciferol is very unstable under inadequate manufacturing and storage conditions. The content of both compounds in commercial dietary supplements is often found to be in disagreement with the label claims, which can lead to a deficient or excessive nutrient intake by consumers. In this scenario, analyzing these compounds is still a difficult and time-consuming task, which usually requires specific pretreatment procedures and multiple analytical methods due to the inorganic nature of calcium and the organic nature of cholecalciferol. Therefore, this article reviews the analytical methods, described in official compendia and scientific literature, for the determination of calcium salts and cholecalciferol in dietary supplement formulations. We also approached the sample preparation procedures highly required due to the matrix complexity of these materials.

In Situ Biological Transmutation of Catalytic Lactic Acid Waste into Calcium Lactate in a Readily Processable Three-Dimensional Fibrillar Structure for Bone Tissue Engineering

A bioinspired three-dimensional (3D) fibrous structure possesses biomimicry, valuable functionality, and performance to scaffolding in tissue engineering. In particular, an electrospun fibrous mesh has been studied as a scaffold material in various tissue regeneration applications. We produced a low-density 3D polycaprolactone/lactic acid (LA) fibrous mesh (3D-PCLS) via the novel lactic-assisted 3D electrospinning technique exploiting the catalytic properties of LA as we reported previously. In the study, we demonstrated a strategy of recycling the LA component to synthesize the osteoinductive biomolecules in situ, calcium lactate (CaL), thereby forming a 3D bioactive PCL/CaL fibrous scaffold (3D-SCaL) for bone tissue engineering. The fiber morphology of 3D-PCLS and its packing degree could have been tailored by modifying the spinning solution and the collector design. 3D-SCaL demonstrated successful conversion of CaL from LA and exhibited the significantly enhanced biomineralization capacity, cell infiltration and proliferation rate, and osteoblastic differentiation in vitro with two different cell lines, MC3T3-e1 and bone marrow stem cells. In conclusion, 3D-SCaL proves to be a highly practical and accessible strategy using a variety of polymers to produce 3D fibers as a potential candidate for future regenerative medicine and tissue engineering applications.

Relative bioavailability and pharmacokinetic comparison of calcium glucoheptonate with calcium carbonate

Adequate calcium intake is important for the prevention of bone loss and osteoporosis. For some populations such as those of Southeast Asia where calcium intake is very low, supplements represent a suitable dietary source of calcium. The objective of this study was to compare the relative oral bioavailability of calcium from calcium glucoheptonate, a highly soluble calcium salt containing 8.2% of elemental calcium, to that of calcium carbonate. A single-dose, randomized-sequence, open-label, two-period crossover study, with a 7-day washout period, was conducted in 24 Indonesian healthy adult volunteers. After a 12-hour (overnight) fast, subjects received either two oral ampoules of 250 mg/10 mL of calcium glucoheptonate each or one effervescent tablet of calcium carbonate containing 500 mg of elemental calcium. The relative oral bioavailability of calcium from calcium glucoheptonate as compared to calcium carbonate was 92% within 6 hours and 89% within 12 hours after study drug administration. The 90% confidence intervals for the mean test/reference ratios of the maximum plasma concentration and the area under the concentration-time curve at 12 hours post-administration were 77.09%-120.31% and 60.58%-122.30%, respectively. Five subjects experienced a total of eight adverse events which were all mild and transient; no serious adverse events or deaths were reported. These results indicate that calcium glucoheptonate is associated with a high relative bioavailability of calcium compared to calcium carbonate, and is well-tolerated. Calcium glucoheptonate might thus be a potential choice for calcium supplementation in Southeast Asian populations.

Preparation of sheep bone collagen peptide-calcium chelate using enzymolysis-fermentation methodology and its structural characterization and stability analysis

In this study, enzymatic hydrolysis and Lactobacillus fermentation were used in combination to prepare collagen peptide with high free calcium content, followed by the addition of anhydrous ethanol to obtain peptide-calcium chelate. The optimal conditions for the fermentation of enzymatic hydrolysate (glucose 3%, inoculum size 6%, 24.5 h, 37 °C and pH 6.5) were determined by response surface methodology (RSM), under which a free calcium content of 2212.58 mg/100 g was obtained. The calcium-chelating capacity was 42.57 ± 0.09%. The results of ultraviolet absorption spectrum, Fourier transform infrared (FT-IR) spectra, differential scanning calorimeter (DSC), X-ray diffraction and amino acid analysis indicated that calcium could be chelated through carboxyl oxygen and amino nitrogen atoms of collagen peptides, forming peptide-calcium chelate. The chelate is stable at 30-80 °C of temperatures and during in simulated gastrointestinal digestion, which could promote calcium absorption in human. The test intended to provide a basis for developing a novel calcium supplement and promoting utilization of sheep bone.

Proximate composition, phytochemicals, minerals and antioxidant activities of Vigna mungo L.seed coat

Vigna mungo L. seed coat is an agro by-product, available in substantial quantity, with no clear evidence to prove its economic importance. In the present study, the phytochemicals, proximate content, minerals and in vitro antioxidant activities of aqueous (AE), ethanol (EE) and 80% ethanolic extract (80% EE) of Vigna mungo L. seed coat were determined. The total carbohydrate, total protein, crude fibre, ash and moisture content of the seed coat were found to be 27.52±2.71%, 10.07±0.92%, 48.67±1.96%, 4.87±0.29% and 11.03±0.49% respectively. The content of total phenolics and flavonoids were significantly higher in 80% EE than other extracts. The mineral composition showed that seed coat was rich in calcium, sodium, potassium, magnesium, iron, copper, zinc and manganese. The higher antioxidant potential was shown by 80% EE in DPPH and SOD assay whereas AE shows more scavenging activity in H2O2 assay. So it can be used as neutraceuticals in food supplements.

Calcium citrate: from biochemistry and physiology to clinical applications

Adequate daily calcium intake should normally be achieved by dietary sources. Since low calcium diets are quite common in subjects that do not reach the recommended intake and particularly those at risk of fractures, calcium supplements may become necessary. Different forms of calcium salts are available, but products containing calcium citrate and calcium carbonate complexes are the most frequently used. Although only limited evidence on the efficacy and long-term safety of calcium citrate is available, these supplements may represent a valuable product for the management of different chronic pathological conditions. The aim of this review was to evaluate the current and potential clinical applications of calcium citrate. In particular, we focused on the use of calcium citrate supplementation in subjects with osteoporosis or in bariatric patients. Other pathological conditions that could benefit calcium citrate supplementation may include achloridria, chronic hypoparathyroidism and hypocitraturic subjects with moderate/high risk of nephrolithiasis. Indeed, citrate salts are widely used in the treatment of nephrolithiasis, since they have shown an inhibitory effect on kidney stone formation and recurrence.

Is calcium supplementation always needed in patients with hypoparathyroidism?

Oral calcium salts are recommended for the treatment of chronic hypoparathyroidism (HypoPT), although dosimetry is variable between individual patients and clinicians. However, patient feedback on calcium salts can be negative, particularly due to gastrointestinal side effects and hypercalciuria-related complications. We begin with a clinical case of a HypoPT patient taking oral calcium salts following thyroid surgery, who requested support in reducing her dose of these with a view to stopping entirely. To evaluate her request, we first describe the usual treatment of HypoPT according to current guidance and then present data from (a) a case note review of a cohort of 24 HypoPT patients managed with a "no calcium" treatment regimen by single physician (b) a comprehensive online survey of HypoPT patients' treatment and experiences (n = 330). The case note review found that target range serum calcium levels were successfully achieved in all 24 patients since transitioning to a "no calcium" regimen, without any breakthrough hypocalcaemia-related symptoms, the development of new renal stones, the occurrence of calcium-related hospital admissions or the finding of significant hypercalciuria. The online survey identified 36% of HypoPT patients who continued to take activated vitamin D, but had discontinued calcium supplements. HypoPT patients not currently taking calcium reported a significantly lower prevalence of adverse effects and outcomes, both compared with their previous experiences whilst taking calcium and also compared with the 64% of patients who continued to take oral calcium. We conclude that, subject to methodological limitations, there are significant issues of tolerability arising from conventional calcium-based treatment regimens for patients with chronic HypoPT. For selected patients, it may be reasonable to facilitate a managed therapeutic transition to "no calcium" regimen, and we also propose that calcium-based regimes be prospectively evaluated against calcium-free (or calcium-low) alternatives.

Elastic and hydrostatic behaviour of a zinc dietary supplement, zinc glycinate hydrate

Coordination polymer based dietary supplement tablets are commonly consumed in our daily life and play an important role in the pharmaceutical industry. To fully understand their tableting process, their mechanical properties need to be comprehensively studied. In this work, the elastic and hydrostatic behaviour of a zinc supplement, zinc glycinate hydrate (Zn[O2CCH2NH2]2·H2O), have been studied via density functional theory (DFT) calculations and high-pressure synchrotron powder X-ray diffraction. This material has a pseudo-layered structure and can be successfully exfoliated into nanosheets. The DFT calculated elastic moduli along the principal axes (13.84-36.11 GPa) indicate a significant elastic anisotropy of ZnG as expected for a layered system, and the directional dependent elastic modulus can be corroborated with the underlying atomic structure. In addition, the calculated B/G ratios (1.30-3.83) according to Pugh's criterion reveal that ZnG could be brittle under uniaxial stress (B and G are bulk modulus and shear modulus, respectively). Furthermore, the measured B is ∼31 GPa, which lies in the middle of the values between inorganic dietary supplements and small organic drug crystals. These results provide some quantitative information about the tableting process of the hybrid dietary supplement which could be different from their inorganic and organic pharmaceutical counterparts.

The Bone-Vasculature Axis: Calcium Supplementation and the Role of Vitamin K

Calcium supplements are broadly prescribed to treat osteoporosis either as monotherapy or together with vitamin D to enhance calcium absorption. It is still unclear whether calcium supplementation significantly contributes to the reduction of bone fragility and fracture risk. Data suggest that supplementing post-menopausal women with high doses of calcium has a detrimental impact on cardiovascular morbidity and mortality. Chronic kidney disease (CKD) patients are prone to vascular calcification in part due to impaired phosphate excretion. Calcium-based phosphate binders further increase risk of vascular calcification progression. In both bone and vascular tissue, vitamin K-dependent processes play an important role in calcium homeostasis and it is tempting to speculate that vitamin K supplementation might protect from the potentially untoward effects of calcium supplementation. This review provides an update on current literature on calcium supplementation among post-menopausal women and CKD patients and discusses underlying molecular mechanisms of vascular calcification. We propose therapeutic strategies with vitamin K2 treatment to prevent or hold progression of vascular calcification as a consequence of excessive calcium intake.

Preparation of a fermentation solution of grass fish bones and its calcium bioavailability in rats

In this study, with grass fish bones as the substrate, after flavourzyme treatment, and fermentation with Leuconostoc mesenteroides, a fermentation solution with a high content of soluble calcium was obtained. High performance liquid chromatography and GC-MS analysis indicated that free calcium (11.29 mmol L-1) in the fermentation solution was composed of calcium lactate (3.89 mmol L-1), calcium acetate (6.21 mmol L-1), calcium amino acids and small peptide calcium. Animal experiments show that the fermentation solution of grass fish bones could promote the growth and development of calcium-deficient rats. Complex organic calcium could be well absorbed and utilized by rats so that serum calcium, alkaline phosphatase levels, femur weight and other indicators in calcium-deficient rats could be returned to normal levels. The fermentation solution of grass fish bones can avoid the waste of aquatic proteins and fish bone calcium, and it exhibited high calcium bioavailability. Therefore, the fermentation solution of grass fish bones might be used as a new efficient calcium supplement.

The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health

Calcium is an important integrative component of the human body and critical for human health. It has been well established that calcium intake is helpful in the prevention and treatment of osteoporosis, which has become one of the most serious public health problems across the world. However, community-dwelling adults with and without osteoporosis are rarely concerned or even not aware of the potential side effects of high or inappropriate doses of calcium intake. Some recent studies have revealed that excessive calcium intake might increase the risks of cardiovascular diseases. The purpose of this article was to review the health benefits, costs, and consequences of calcium supplementation on osteoporosis/osteoporotic fractures, cardiovascular events, kidney stones, gastrointestinal diseases, and other important diseases. In the end, we suggest that calcium supplementation should be prescribed and taken cautiously, accounting for individual patients' risks and benefits. Clearly, further studies are needed to examine the health effects of calcium supplementation to make any solid recommendations for people of different genders, ages, and ethnicities.

Bone Health in Women

Bone health is critical to overall health and quality of life. Although genetic factors play a key role in bone formation, there are several external factors that can be modified to preserve bone health. Diet, exercise, menstrual irregularities, medications, disease states, weight, and environmental factors can all affect fracture risk. Osteoporosis is characterized by decrease in bone mass and microarchitectural changes in the bone that increases fracture risk. Screening for osteoporosis may help facilitate treatment before fractures occur. Preventing fractures needs patient and physician understanding of bone health to improve and requires a team effort.

Impact of admission serum calcium levels on mortality in hospitalized patients

OBJECTIVES

To assess the relationship between admission serum calcium levels and in-hospital mortality in all hospitalized patients.

METHODS

All adult hospitalized patients who had admission serum calcium levels available between years 2009 and 2013 were enrolled. Admission serum calcium was categorized based on its distribution into six groups (<7.9, 7.9 to <8.4, 8.4 to <9.0, 9.0 to <9.6, 9.6 to <10.1, and ≥10.1 mg/dL). The odds ratio (OR) of in-hospital mortality by admission serum calcium, using the calcium category of 9.6-10.1 mg/dL as the reference group, was obtained by logistic regression analysis.

RESULTS

18,437 patients were studied. The lowest incidence of in-hospital mortality was associated with admission serum calcium within 9.6 to <10.1 mg/dL. A higher in-hospital mortality rate was observed in patients with serum calcium <9.6 and ≥10.1 mg/dL. Also, 38% and 33% of patients with admission serum calcium <7.9 and ≥10.1 mg/dL were on calcium supplements before admission, respectively. After adjusting for potential confounders, both serum calcium <8.4 and ≥10.1 mg/dL were associated with an increased risk of in-hospital mortality with ORs of 2.86 [95% confidence interval (CI) 1.98-4.17], 1.74 (95% CI 1.21-2.53), and 1.69 (95% CI 1.10-2.59) when serum calcium were within <7.9, 7.9 to <8.4, and ≥10.1 mg/dL, respectively.

CONCLUSION

Hypocalcemia and hypercalcemia on admission were associated with in-hospital mortality. Highest mortality risk is observed in patients with admission hypocalcemia (<7.9 mg/dL). One-third of patients with hypercalcemia on admission were on calcium supplements.

Consequences of Inadequate Intakes of Vitamin A, Vitamin B12, Vitamin D, Calcium, Iron, and Folate in Older Persons

Purpose of Review

This review broadly discusses the consequences of inadequate consumption, by deficit or excess, of selected micronutrients on the quality of life and morbidity during aging, specifically considering increases in life expectancy and the costs of care in the older persons.

Recent Findings

A literature review of the periods 2012 to 2018, focusing on vitamins A, B₁₂, and D, calcium, iron and folate, was completed as these micronutrients are found to significantly affect the aging process. Causation and application of these micronutrients to disorders related to aging are controversial and mixed. This review highlights research needs and controversial points on the role of these micronutrients.

Summary

Micronutrient deficiencies are a common and avoidable contributor to decreased quality of life and healthcare costs in the older persons. Further research is needed to determine adequate intakes and innovative uses, including appropriate thresholds for improved health outcomes for this population.

Physicochemical and sensory qualities of complemenatry meal made from sprouted and unsprouted sorghum, Irish potato and groundnut

Weaning food was produced from the blends of sprouted and unsprouted sorghum-Irish potato, and groundnut flour. In the developed weaning foods, moisture content ranged from 8.44% to 12.70%, crude protein (7.40%-14.53%) crude ash (1.53%-1.77%), crude fiber (6.65%-6.88%), crude fat (3.31%-3.73%) and carbohydrate content (65.10%-69.15%). Sprouting and protein supplementation with groundnut improved the protein content of the formulated meals with values comparable to commercial sample (cereals). Mineral content reduced with sprouting, whereas the addition of Irish potato and groundnut increased the mineral content. Calcium ranged from 91.00% to 121.33% and potassium (487.33%-956.67%). Sample NSIG2 had the highest potassium. Tannin ranged from 0.11 to 0.64 mg/100 g; phytate (4.98-7.42 mg/100 g); and oxalate (0.36-0.98 mg/100 g). Peak viscosity ranged from 43.08 to 23.57 RVU, trough (41.08-22.50 RVU), breakdown viscosity (61-14), final viscosity (84.33-52.53 RVU), setback viscosity (41.33-89.00 RVU), and peak time (5.07-7.00) in both the sprouted and unsprouted sorghum-irish potato-groundnut flour, respectively. The pasting temperature of the weaning food blends ranged between 87.25 and 89.60°C with SIG0 and NSIG2 having the lowest and highest values, respectively. The study showed that complementary food products formulated from this locally available food commodities is a promising food and has good nutritive value.

Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss

Bariatric surgery (BS) is an effective treatment for morbid obesity and its associated comorbidities. Following such a procedure, however, patients are at risk of developing metabolic bone disease owing to the combination of rapid weight loss, severely restricted dietary intake, and reduced intestinal nutrient absorption. Patients undergoing malabsorptive procedures are at a higher risk of postoperative bone health deterioration than those undergoing restrictive procedures; however, studies have demonstrated negative skeletal consequences of restrictive procedures as well. The clinical practice guidelines of some international associations have previously addressed preoperative evaluation and postoperative clinical care in order to maintain bone health in BS patients. Nevertheless, some issues regarding bone health in BS patients remain unclear owing to the lack of relevant randomized clinical trials, including doses of nutritional supplements pre- and post-BS. This review summarizes the current data regarding the skeletal consequences of BS and its mechanisms, with an emphasis on the preventive strategies and nutritional care that may be warranted in order to attenuate bone deterioration following BS.

Association between Drug Usage and Constipation in the Elderly Population of Greater Western Sydney Australia

The low socioeconomic region of Greater Western Sydney (GWS) has higher than average rates of gastrointestinal symptoms. The relationship between prescription drug usage and constipation has not been explored. The aim of this study was to investigate the impact of drug use on constipation in the elderly population of GWS (NSW, Australia). A random selection of elderly residents completed a postal questionnaire for constipation and drug use (response 30.7%). Bivariate associations between constipation and number of drug use and number of drug use with constipation adverse effect were compared. For multivariate analysis multiple logistic regression was performed for constipation with the number of drugs, use of drugs with known constipation side effects, and each drug class (Anatomical Therapeutic Chemical Classification System (ATC) level 4) as independent variables. The prevalence of constipation was 33.9%. There was a dose-response relationship between constipation and the number of drugs used (odds ratio 1.24, p < 0.001) and the usage of drugs with known constipation adverse effects (odds ratio 2.21, p = 0.009). These findings suggest that constipation is associated with the number of drugs used, particularly those with constipation adverse-effects, in the elderly of GWS.

Collagen Peptides from Crucian Skin Improve Calcium Bioavailability and Structural Characterization by HPLC-ESI-MS/MS

The effects of collagen peptides (CPs), which are derived from crucian skin, were investigated in a retinoic acid-induced bone loss model. The level of serum bone alkaline phosphatase (BALP) in the model group (117.65 ± 4.66 units/L) was significantly higher than those of the other three groups (P < 0.05). After treatment with 600 and 1200 mg of CPs/kg, the level of BALP decreased to 85.26 ± 7.35 and 97.03 ± 7.21 units/L, respectively. After treatment with 600 mg of CPs/kg, the bone calcium content significantly increased by 22% (femur) and 12.38% (tibia) compared to those of the model group. In addition, the bone mineral density in the 600 mg of CPs/kg group was significantly higher (femur, 0.37 ± 0.02 g/cm²; tibia, 0.33 ± 0.02 g/cm²) than in the model group (femur, 0.26 ± 0.01 g/cm²; tibia, 0.23 ± 0.02 g/cm²). The morphology results indicated bone structure improved after the treatment with CPs. Structural characterization demonstrated that Glu, Lys, and Arg play important roles in binding calcium and promoting calcium uptake. Our results indicated that CPs could promote calcium uptake and regulate bone formation.

Characterization of sea cucumber (stichopus japonicus) ovum hydrolysates: calcium chelation, solubility and absorption into intestinal epithelial cells

BACKGROUND

Sea cucumber (Stichopus japonicus) ovum hydrolysates (SCOHs) chelated with calcium were produced to investigate the characteristics of calcium binding and solubility, as well as to study any effects on calcium absorption by human intestinal epithelial cells.

RESULTS

The results of the present study show that the calcium-binding capacity of SCOHs depended greatly on the type of proteases. The maximum level of Ca binding (0.38 mmol L^-1 ) occurred when trypsin was used, with a peptide yield of 85.7%. Investigation of the possible chelating modes between SCOHs and calcium ions indicated that calcium ions bound to SCOHs primarily via interactions with carboxyl oxygen and amino nitrogen atoms of Glu and Asp and also that the phosphoserine residues might be also responsible for SCOH-calcium chelation. Moreover, SCOH-calcium complexes maintained the solubility of calcium under simulated gastrointestinal digestion, regardless of the presence of dietary components such as oxalate. Furthermore, SCOH-Ca led to higher peak intracellular [Ca²⁺ ]_i in both Caco-2 cells (338.3 nmol L^-1 versus 269.6 nmol L^-1 ) and HT-29 cells (373.9 nmol L^-1 versus 271.7 nmol L^-1 ) than casein phosphopeptide-Ca.

CONCLUSION

Carboxyl oxygen and amino nitrogen atoms in the SCOHs could bind calcium ions, forming SCOH-calcium complexes. These complexes improved calcium solubility under simulated gastrointestinal digestion and also promoted calcium absorption in Caco-2 and HT-29 cells. © 2017 Society of Chemical Industry.

The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).