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Storz MA, Ronco AL. Citrate-based dietary alkali supplements available in Germany: an overview. J Pharm Health Care Sci 2024; 10:22. [PMID: 38730472 PMCID: PMC11084099 DOI: 10.1186/s40780-024-00342-0] [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: 02/29/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Fruits and vegetables are abundant in alkali precursors and effectively reduce the Potential Renal Acid Load (PRAL) from diet. Oral alkali supplements are supposed to exert comparable alkalizing effects on the human body, and have been shown to beneficially affect bone and kidney health. A comparative analysis of the available dietary alkali supplements in Germany was performed, contrasting their potential PRAL-lowering potential. METHODS We reviewed the currently available dietary citrate-based alkali supplements sold in Germany with a special focus on their mineral content, their PRAL-lowering potential and other characteristics inherent to each product. Supplements containing either potassium-, calcium- or magnesium citrate or any combination of these organic salts were reviewed. The total alkali load (TAL) was calculated based on the recommended daily dosage (RDD). RESULTS Sixteen supplements with a mean alkali powder content of 220.69 ± 111.02 g were identified. The mean magnesium content per RDD was 239.93 ± 109.16 mg. The mean potassium and median calcium content were 550 ± 325.58 mg and 280 (240) mg, respectively. Median TAL was 1220 (328.75) mg. The PRAL-lowering potential from a single RDD ranged from - 51.65 mEq to -8.32 mEq. Substantial price differences were found, and the mean price of the examined supplements was 16.67 ± 5.77 Euros. The median price for a 1 mEq PRAL-reduction was 3.01 (3.14) cents, and ranged from 0.77 cents to 10.82 cents. CONCLUSIONS Noticeable differences between the identified alkali supplements were encountered, warranting an individual and context-specific approach in daily clinical practice.
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Affiliation(s)
- Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, Montevideo, 11600, Uruguay
- Biomedical Sciences Center, University of Montevideo, Puntas de Santiago 1604, Montevideo, 11500, Uruguay
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Lewiecki EM, Bellido T, Bilezikian JP, Brown JP, Farooki A, Kovacs CS, Lee B, Leslie WD, McClung MR, Prasarn ML, Sellmeyer DE. Proceedings of the 2023 Santa Fe Bone Symposium: Progress and Controversies in the Management of Patients with Skeletal Diseases. J Clin Densitom 2023; 26:101432. [PMID: 37944445 PMCID: PMC10900844 DOI: 10.1016/j.jocd.2023.101432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
The Santa Fe Bone Symposium (SFBS) held its 23rd annual event on August 5-6, 2023, in Santa Fe, New Mexico, USA. Attendees participated in-person and remotely, representing many states and countries. The program included plenary presentations, panel discussions, satellite symposia, a Project ECHO workshop, and a session on healthcare policy and reimbursement for fracture liaison programs. A broad range of topics were addressed, including transitions of osteoporosis treatments over a lifetime; controversies in vitamin D; update on Official Positions of the International Society for Clinical Densitometry; spine surgery and bone health; clinical applications of bone turnover markers; basic bone biology for clinicians; premenopausal-, pregnancy-, and lactation-associated osteoporosis; cancer treatment induced bone loss in patients with breast cancer and prostate cancer; genetic testing for skeletal diseases; and an update on nutrition and bone health. There were also sessions on rare bone diseases, including managing patients with hypophosphatasia; treatment of X-linked hypophosphatemia; and assessment and treatment of patients with hypoparathyroidism. There were oral presentations of abstracts by endocrinology fellows selected from those who participated in the Santa Fe Fellows Workshop on Metabolic Bone Diseases, held the 2 days prior to the SFBS. These proceedings of the 2023 SFBS present the clinical highlights and insights generated from many formal and informal discussions in Santa Fe.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, United States.
| | - Teresita Bellido
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John P Bilezikian
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | | | - Azeez Farooki
- Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, United States
| | - Christopher S Kovacs
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Brendan Lee
- Baylor College of Medicine, Houston, Texas, United States
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A path analysis to investigate the interaction between serum, urinary and demographic factors influencing urine calcium in kidney stone formers. Int Urol Nephrol 2023:10.1007/s11255-023-03461-z. [PMID: 36780048 DOI: 10.1007/s11255-023-03461-z] [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: 12/21/2021] [Accepted: 01/08/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Hypercalciuria is one of the most important urinary risk factors in kidney stone formers. This study aimed to delineate the interaction of some demographic, serum, and urinary risk factors influencing 24-h urinary (24-U) calcium excretion. METHODS This study was secondary data analysis, using data from 593 kidney stone patients referred to the Labbafinejad kidney stone prevention clinic from March 2015 to May 2019. The study considered serum, urinary and demographic factors that interact to influence 24-U calcium using path analysis. In addition to the direct impact of predictors on the 24-U calcium, this analysis considered the effects of the predictors on the 24-U calcium transmitted by a mediating variable named indirect effects. RESULTS The results showed that age indirectly affected on 24-U calcium through 25-hydroxy vitamin D (25(OH)D), serum and 24-U creatinine. As well, weight had an indirect effect through 24-urine metabolites (creatinine, citrate, urea, and sodium). Among serum variables, PTH and creatinine significantly directly affected on 24-U calcium. In comparison, 25(OH)D and phosphorus appeared to influence 24-U calcium indirectly through serum parathormone. Regarding 24-U metabolites, sodium, urea, and citrate had a significant direct effect on 24-U calcium. Moreover, 24-U creatinine has a significant direct and indirect effect on 24-U calcium through citrate and urea as mediator variables. CONCLUSION Serum 25(OH)D and phosphorus, along with age and weight, indirectly affected urinary calcium through a third variable. Other variables (PTH, serum creatinine, and 24-U sodium, urea, and citrate) showed a direct effect on 24-U calcium excretion.
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Choi SS, Kim YA, Kim HJ, Cho YJ, Lee GH. The Relationship between Dietary Na/K Ratio and Bone Mineral Density in Korean Middle-Aged Women. Korean J Fam Med 2023; 44:21-27. [PMID: 36709957 PMCID: PMC9887444 DOI: 10.4082/kjfm.21.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dietary Na+ or Na+/K+ ratio has been reported to be associated with bone mineral density (BMD). However, this remains unclear, and only a few studies have been reported on the Korean population. Therefore, this study aimed to determine the association between dietary Na+, K+, and Na+/K+ ratios and BMD in middle-aged Korean women. METHODS This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011. A total of 3,690 women aged >50 years were included. Study participants were classified into quartiles (lowest quartile Q1-highest quartile Q4) according to dietary Na+, K+, and Na+/K+ ratio, and we examined the association of these parameters with BMD. Total femur and lumbar spine BMD were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed using IBM SPSS ver. 19.0. RESULTS The mean age was 62 years, and a significant negative trend in the β-coefficient regarding dietary Na+ was only observed in the total femur BMD. However, the total femur and lumbar spine BMD decreased from Q1 to Q4 regarding the dietary Na+/K+ ratio (P-value for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). CONCLUSION A significant negative trend in the β-coefficient for both total femur and lumbar spine BMD was observed regarding the Na+/K+ ratio. Therefore, based on the results of this study, a higher dietary Na+/K+ ratio may be associated with a lower BMD.
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Affiliation(s)
- Seong Su Choi
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun-A Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Ji Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Geon Ho Lee
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea,Corresponding Author: Geon Ho Lee https://orcid.org/0000-0003-0696-3804 Tel: +82-53-650-4696, Fax: +82-53-650-4122, E-mail:
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Naude, MTech (Hom) DF. Chronic Sub-Clinical Systemic Metabolic Acidosis - A Review with Implications for Clinical Practice. J Evid Based Integr Med 2022; 27:2515690X221142352. [PMID: 36448194 PMCID: PMC9716591 DOI: 10.1177/2515690x221142352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic 'Westernized' diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.
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Affiliation(s)
- David Francis Naude, MTech (Hom)
- Irma Schutte Foundation, Drummond, South Africa,David Francis Naude, Irma Schutte Foundation, 42 Protea Hill Rd, Drummond, KwaZulu Natal, 3626, South Africa. Postal address: P.O Box 8, Hillcrest, KwaZulu Natal, 3650, South Africa.
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6
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Moe OW, Maalouf NM, Sakhaee K, Lederer E. Preclinical and Clinical Evidence of Effect of Acid on Bone Health. Adv Chronic Kidney Dis 2022; 29:381-394. [PMID: 36175076 DOI: 10.1053/j.ackd.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acid can have ill effect on bone health in the absence of frank clinical acidosis but affecting the bone mioneral matrix and bone cells via complex pathways botyh ascute;y and chronically. While the reaction of bone to an acid load is conserved in evolution and is adaptive, the capacity can be overwhelmed resulting in dire consequences. The preclinical an clincl evidence of the acdi effect on bone is very convincing and the clinical evidence in both association and interventiopn studies are also quite credible, The adverse effects of acid on bone is underappreoicated, under-investigated, and the potential benefits of alkali therapy is not generrally known.
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Affiliation(s)
- Orson W Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Department of Physiology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khashayar Sakhaee
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eleanor Lederer
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Medical Service, VA North Texas Health Care System, Dallas, TX
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7
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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8
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Zhong L, Yang P, Zhang C, Wang Z, Jiang T, Chen B, Shan X, Qiu X. Long-term adjuvant administration of temozolomide impacts serum ions concentration in high-grade glioma. Chin Neurosurg J 2022; 8:6. [PMID: 35216639 PMCID: PMC8876447 DOI: 10.1186/s41016-022-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adjuvant temozolomide (TMZ) chemotherapy with standard regimen remarkably improves survival in patients with high-grade glioma (HGG). However, the influence of long-term TMZ chemotherapy on serum ions concentration is unclear. Methods One hundred and thirty-eight patients with HGG were included. Their blood samples were collected for blood biochemistry and routine test. The alteration in serum ions concentration, total protein, albumin, globin, and blood cells counts were used to identify the impact of long-term TMZ chemotherapy. Results Through the comparation of quantitative value of diverse parameters among different chemotherapy cycles, we identified that serum potassium concentration had a downward trend after TMZ administration (1st vs. 6th, p < 0.001; 1st vs. 12th, p < 0.001). Additionally, the correlation analysis showed that platelets was negatively correlated with chemotherapy cycles (r = − 0.649, p = 0.023). The hematological adverse events mainly centered on grade 1 to 2. Conclusion Long-term administration of TMZ may lead to serum ions disturbance. Besides the myelosuppression, we should pay attention to the alteration in serum ions concentration, and give patients proper symptomatic treatment when necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s41016-022-00271-7.
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Affiliation(s)
- Liyun Zhong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China
| | - Chuanbao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China
| | - Zheng Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, 119 South 4th Ring Road West, Beijing, 100070, China
| | - Baoshi Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Shan
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China. .,Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring Road West, Beijing, 100070, China.
| | - Xiaoguang Qiu
- Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring Road West, Beijing, 100070, China.
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Short-Term Supplemental Dietary Potassium from Potato and Potassium Gluconate: Effect on Calcium Retention and Urinary pH in Pre-Hypertensive-to-Hypertensive Adults. Nutrients 2021; 13:nu13124399. [PMID: 34959951 PMCID: PMC8707887 DOI: 10.3390/nu13124399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Potassium supplementation has been associated with reduced urinary calcium (Ca) excretion and increased Ca balance. Dietary interventions assessing the impact of potassium on bone are lacking. In this secondary analysis of a study designed primarily to determine blood pressure effects, we assessed the effects of potassium intake from potato sources and a potassium supplement on urinary Ca, urine pH, and Ca balance. Thirty men (n = 15) and women (n = 15) with a mean ± SD age and BMI of 48.2 ± 15 years and 31.4 ± 6.1 kg/m2, respectively, were enrolled in a cross-over, randomized control feeding trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300 mg/day (~60 mmol/day) of potassium, and three phases of an additional 1000 mg/day (3300 mg/day(~85 mmol/day) total) of potassium in the form of potatoes (baked, boiled, or pan-heated), French fries (FF), or a potassium (K)-gluconate supplement. Calcium intake for all diets was approximately 700–800 mg/day. Using a mixed model ANOVA there was a significantly lower urinary Ca excretion in the K-gluconate phase (96 ± 10 mg/day) compared to the control (115 ± 10 mg/day; p = 0.027) and potato (114 ± 10 mg/day; p = 0.033). In addition, there was a significant difference in urinary pH between the supplement and control phases (6.54 ± 0.16 vs. 6.08 ± 0.18; p = 0.0036). There were no significant differences in Ca retention. An increased potassium intake via K-gluconate supplementation may favorably influence urinary Ca excretion and urine pH. This trial was registered at ClinicalTrials.gov as NCT02697708.
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10
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Romero-Márquez JM, Varela-López A, Navarro-Hortal MD, Badillo-Carrasco A, Forbes-Hernández TY, Giampieri F, Domínguez I, Madrigal L, Battino M, Quiles JL. Molecular Interactions between Dietary Lipids and Bone Tissue during Aging. Int J Mol Sci 2021; 22:ijms22126473. [PMID: 34204176 PMCID: PMC8233828 DOI: 10.3390/ijms22126473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 01/06/2023] Open
Abstract
Age-related bone disorders such as osteoporosis or osteoarthritis are a major public health problem due to the functional disability for millions of people worldwide. Furthermore, fractures are associated with a higher degree of morbidity and mortality in the long term, which generates greater financial and health costs. As the world population becomes older, the incidence of this type of disease increases and this effect seems notably greater in those countries that present a more westernized lifestyle. Thus, increased efforts are directed toward reducing risks that need to focus not only on the prevention of bone diseases, but also on the treatment of persons already afflicted. Evidence is accumulating that dietary lipids play an important role in bone health which results relevant to develop effective interventions for prevent bone diseases or alterations, especially in the elderly segment of the population. This review focuses on evidence about the effects of dietary lipids on bone health and describes possible mechanisms to explain how lipids act on bone metabolism during aging. Little work, however, has been accomplished in humans, so this is a challenge for future research.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Alfonso Varela-López
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - María D. Navarro-Hortal
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Alberto Badillo-Carrasco
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Tamara Y. Forbes-Hernández
- Nutrition and Food Science Group, Department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo, 36310 Vigo, Spain;
| | - Francesca Giampieri
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy; (F.G.); (M.B.)
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Irma Domínguez
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain;
- Universidad Internacional Iberoamericana, Calle 15 Num. 36, Entre 10 y 12 IMI III, Campeche 24560, Mexico;
| | - Lorena Madrigal
- Universidad Internacional Iberoamericana, Calle 15 Num. 36, Entre 10 y 12 IMI III, Campeche 24560, Mexico;
| | - Maurizio Battino
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy; (F.G.); (M.B.)
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
| | - José L. Quiles
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain;
- Correspondence:
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Osteosarcopenic adiposity syndrome update and the role of associated minerals and vitamins. Proc Nutr Soc 2021; 80:344-355. [DOI: 10.1017/s0029665121000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The objectives are to present an updated synopsis on osteosarcopenic adiposity (OSA) syndrome and evaluate the roles of selected micronutrients in its prevention and management. OSA refers to the concurrent deterioration of bone (osteopenia/osteoporosis), muscle (sarcopenia) and adipose tissue expansion. It portrays the most advanced stage in a continuum of body composition disorders. Although OSA has been widely studied involving the populations of different backgrounds, its prevalence is hard to collate because different methodologies and criteria were used for its diagnosis. Another critical health aspect is the presence of low-grade chronic inflammation (LGCI) which contributes to OSA and vice versa. Nutrition is important in the prevention and management of both OSA and LGCI. Although micronutrients act in numerous metabolic and physiological processes, their roles here are presented in relation to OSA (and its components) and LGCI in general and relevant to the COVID-19 pandemic. These include calcium, magnesium, phosphorus, potassium, sodium and vitamins D and K; their interactions, physiological ratios and synergism/antagonism are discussed as well. In conclusion, calcium, magnesium and vitamin D have a profound impact on OSA and its components, and the latter two also on LGCI. Potassium and vitamin K are vital in bone, muscle functioning and possibly adipose tissue modification. Both, but particularly vitamin D, surfaced as important modulators of immune system with application in COVID-19 infections. While both phosphorus and sodium have important roles in bone, muscle and can impact adiposity, due to their abundance in food, their intake should be curbed to prevent possible damaging effects.
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Han Y, An M, Yang L, Li L, Rao S, Cheng Y. Effect of Acid or Base Interventions on Bone Health: A Systematic Review, Meta-Analysis, and Meta-Regression. Adv Nutr 2021; 12:1540-1557. [PMID: 33684217 PMCID: PMC8321841 DOI: 10.1093/advances/nmab002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
Osteoporosis is a global health issue among the aging population. The effect of the acid or base interventions on bone health remains controversial. This study performed a systematic review and meta-analysis to investigate effects of acidic diets and alkaline supplements on bone health simultaneously. We conducted a comprehensive literature search in 5 available databases and 1 registered clinical trial system to identify randomized controlled trials (RCTs) that assessed effects of the acid-base intervention on bone health. Depending on heterogeneity across studies, the pooled effects were calculated by fixed-effects or random-effects models. The present study included 13 acidic diet intervention studies and 13 alkaline supplement studies for final quantitative assessments. The meta-analysis showed that acidic diets significantly increased net acid excretion [NAE; standardized mean difference (SMD) = 2.99; P = 0.003] and urinary calcium excretion (SMD = 0.47, P < 0.00001) but had no significant effect on bone turnover markers and bone mineral density (BMD). On the other hand, alkaline supplement intervention significantly reduced NAE (SMD = -1.29, P < 0.00001), urinary calcium excretion (SMD = -0.44, P = 0.007), bone resorption marker aminoterminal cross-linking telopeptide (NTX; SMD = -0.29, P = 0.003), and bone formation marker osteocalcin (OC; SMD = -0.23, P = 0.02), but did not affect the other bone turnover markers. Furthermore, alkaline supplements significantly increased BMD in femoral neck [mean difference (MD) = 1.62, P < 0.00001, I2 = 0%], lumbar spine (MD = 1.66, P < 0.00001, I2 = 87%), and total hip (MD = 0.98, P = 0.02, I2 = 99%). Subsequently, meta-regression analyses identified 1 study that substantially contributed to the high heterogeneity of BMD in the latter 2 sites, but sensitivity analysis suggested that this study did not affect the significant pooled effects. Despite that, the results should be interpreted with caution and need to be further validated by a larger RCT. In summary, through integrating evidence from RCTs, the present meta-analysis initially suggests that alkaline supplements may be beneficial to bone metabolism and acidic diets may not be harmful to bone health. This work may be clinically useful for both clinicians and patients with osteoporosis.
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Affiliation(s)
- Yibing Han
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Min An
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Li Yang
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Liuran Li
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
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13
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Abstract
PURPOSE OF REVIEW Nutrition influences skeletal health throughout the lifespan, from the impact of maternal intakes during development, through the development of peak bone mass, to the rate of bone loss during aging. However, there are limited data available on the effects of nutritional supplements on bone density, let alone fracture risk. This review will assess the current literature, focusing on human studies, and emphasizing nutrients where bone density or fracture data are available. RECENT FINDINGS Calcium and vitamin D supplements, in combination, reduce fracture risk, particularly in populations with low intakes. Extensive recent analyses have supported the safety of these interventions at recommended intakes. There is growing evidence that specific isoflavones may improve bone density although fracture data are lacking. Multiple other nutrient supplements may benefit skeletal health, but data are limited. The effect size of nutrient interventions are relatively small, requiring large sample sizes for trials with bone outcomes, may be difficult to blind, and the impact of supplementation may depend on baseline intake. However, nutrition is the only intervention that can be implemented life long and on a population wide basis. Further investigation is needed into the potential benefits of nutritional supplements to determine in which settings supplements may add benefit in addition to dietary intakes.
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Affiliation(s)
- Laila S Tabatabai
- Division of Endocrinology, Houston Methodist Hospital, Houston, TX, USA
| | - Deborah E Sellmeyer
- Division of Endocrinology, Gerontology, and Metabolism, School of Medicine, Stanford University, 300 Pasteur Drive, Room S025, Palo Alto, Stanford, CA, 94305-5103, USA.
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Perut F, Graziani G, Columbaro M, Caudarella R, Baldini N, Granchi D. Citrate Supplementation Restores the Impaired Mineralisation Resulting from the Acidic Microenvironment: An In Vitro Study. Nutrients 2020; 12:E3779. [PMID: 33317151 PMCID: PMC7763163 DOI: 10.3390/nu12123779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 12/25/2022] Open
Abstract
Chronic metabolic acidosis leads to bone-remodelling disorders based on excessive mineral matrix resorption and inhibition of bone formation, but also affects the homeostasis of citrate, which is an essential player in maintaining the acid-base balance and in driving the mineralisation process. This study aimed to investigate the impact of acidosis on the osteogenic properties of bone-forming cells and the effects of citrate supplementation in restoring the osteogenic features impaired by the acidic milieu. For this purpose, human mesenchymal stromal cells were cultured in an osteogenic medium and the extracellular matrix mineralisation was analysed at the micro- and nano-level, both in neutral and acidic conditions and after treatment with calcium citrate and potassium citrate. The acidic milieu significantly decreased the citrate release and hindered the organisation of the extracellular matrix, but the citrate supplementation increased collagen production and, particularly calcium citrate, promoted the mineralisation process. Moreover, the positive effect of citrate supplementation was observed also in the physiological microenvironment. This in vitro study proves that the mineral matrix organisation is influenced by citrate availability in the microenvironment surrounding bone-forming cells, thus providing a biological basis for using citrate-based supplements in the management of bone-remodelling disorders related to chronic low-grade acidosis.
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Affiliation(s)
- Francesca Perut
- Biomedical Science and Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy; (F.P.); (N.B.)
| | - Gabriela Graziani
- Laboratory of Nanobiotechnology, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Marta Columbaro
- Electron Microscopy Platform, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Renata Caudarella
- Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1, 48033 Cotignola (RA), Italy;
| | - Nicola Baldini
- Biomedical Science and Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy; (F.P.); (N.B.)
- Department of Biomedical and Neuromotor Sciences, Via Pupilli 1, University of Bologna, 40136 Bologna, Italy
| | - Donatella Granchi
- Biomedical Science and Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy; (F.P.); (N.B.)
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15
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16
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Humalda JK, Yeung SMH, Geleijnse JM, Gijsbers L, Riphagen IJ, Hoorn EJ, Rotmans JI, Vogt L, Navis G, Bakker SJL, de Borst MH. Effects of Potassium or Sodium Supplementation on Mineral Homeostasis: A Controlled Dietary Intervention Study. J Clin Endocrinol Metab 2020; 105:5854371. [PMID: 32506135 PMCID: PMC7365698 DOI: 10.1210/clinem/dgaa359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Although dietary potassium and sodium intake may influence calcium-phosphate metabolism and bone health, the effects on bone mineral parameters, including fibroblast growth factor 23 (FGF23), are unclear. OBJECTIVE Here, we investigated the effects of potassium or sodium supplementation on bone mineral parameters. DESIGN, SETTING, PARTICIPANTS We performed a post hoc analysis of a dietary controlled randomized, blinded, placebo-controlled crossover trial. Prehypertensive individuals not using antihypertensive medication (n = 36) received capsules containing potassium chloride (3 g/d), sodium chloride (3 g/d), or placebo. Linear mixed-effect models were used to estimate treatment effects. RESULTS Potassium supplementation increased plasma phosphate (from 1.10 ± 0.19 to 1.15 ± 0.19 mmol/L, P = 0.004), in line with an increase in tubular maximum of phosphate reabsorption (from 0.93 ± 0.21 to 1.01 ± 0.20 mmol/L, P < 0.001). FGF23 decreased (114.3 [96.8-135.0] to 108.5 [93.5-125.9] RU/mL, P = 0.01), without change in parathyroid hormone and 25-hydroxy vitamin D3. Fractional calcium excretion decreased (from 1.25 ± 0.50 to 1.11 ± 0.46 %, P = 0.03) without change in plasma calcium. Sodium supplementation decreased both plasma phosphate (from 1.10 ± 0.19 to 1.06 ± 0.21 mmol/L, P = 0.03) and FGF23 (from 114.3 [96.8-135.0] to 108.7 [92.3-128.1] RU/mL, P = 0.02). Urinary and fractional calcium excretion increased (from 4.28 ± 1.91 to 5.45 ± 2.51 mmol/24 hours, P < 0.001, and from 1.25 ± 0.50 to 1.44 ± 0.54 %, P = 0.004, respectively). CONCLUSIONS Potassium supplementation led to a decrease in FGF23, which was accompanied by increase in plasma phosphate and decreased calcium excretion. Sodium supplementation reduced FGF23, but this was accompanied by decrease in phosphate and increase in fractional calcium excretion. Our results indicate distinct effects of potassium and sodium intake on bone mineral parameters, including FGF23. CLINICAL TRIAL REGISTRATION NUMBER NCT01575041.
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Affiliation(s)
- Jelmer K Humalda
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Stanley M H Yeung
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, HB Wageningen, the Netherlands
| | - Lieke Gijsbers
- Division of Human Nutrition and Health, Wageningen University, HB Wageningen, the Netherlands
| | - Ineke J Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, CA Rotterdam, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, DD Amsterdam Zuidoost, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, RB Groningen, the Netherlands
- Correspondence and Reprint Requests: Martin H. de Borst, MD, PhD, Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands. E-mail:
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Stroup BM, Murali SG, Schwahn DJ, Sawin EA, Lankey EM, Bächinger HP, Ney DM. Sex effects of dietary protein source and acid load on renal and bone status in the Pah enu2 mouse model of phenylketonuria. Physiol Rep 2020; 7:e14251. [PMID: 31650703 PMCID: PMC6813258 DOI: 10.14814/phy2.14251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 01/17/2023] Open
Abstract
The low‐phenylalanine (Phe) diet with amino acid (AA) medical foods is associated with low bone mineral density (BMD) and renal dysfunction in human phenylketonuria (PKU). Our objective was to determine if diets differing in dietary protein source and acid load alter bone and renal outcomes in Pah−/− and wild‐type (WT) mice. Female and male Pah−/− (Pahenu2/enu2) and WT littermates (C57BL/6 background) were fed high‐acid AA, buffered AA (BAA), glycomacropeptide (GMP), or high‐Phe casein diets from 3 to 24 weeks of age. The BAA diet significantly reduced the excretion of renal net acid and ammonium compared with the AA diet. Interestingly, the BAA diet did not improve renal dilation in hematoxylin and eosin (H&E) stained renal sections, femoral biomechanical parameters, or femoral bone mineral content (BMC). Significantly lower femoral BMC and strength occurred in Pah−/− versus WT mice, with greater decline in female Pah−/− mice. Polyuria and mild vacuolation in the proximal convoluted tubules were observed in male Pah−/− and WT mice fed the high‐acid AA diet versus absent/minimal cortical vacuolation in males fed the GMP, BAA, or casein diets. Vacuole contents in male mice were proteinaceous. Cortical vacuolation was absent in female mice. Dilated medullary tubules were observed in all Pah−/− mice, except for male Pah−/− mice fed the GMP diet. In summary, the PKU genotype and diet showed differential effects on renal and bone status in male and female mice. Renal status improved in male Pah−/− mice fed the GMP diet.
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Affiliation(s)
- Bridget M Stroup
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Sangita G Murali
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Emily A Sawin
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Emma M Lankey
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hans Peter Bächinger
- Department of Biochemistry and Molecular Biology, Oregon Health Sciences University, Portland, Oregon
| | - Denise M Ney
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin
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18
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Schiara LAM, Moirano G, Grosso E, Richiardi L, Tibaldi M, Spertino E, Vezza C, Isaia GC, Massaia M, D'Amelio P. Hyponatremia, Hypokalemia, and Fragility Fractures in Old Patients: More than an Association? Calcif Tissue Int 2020; 106:599-607. [PMID: 32076748 DOI: 10.1007/s00223-020-00675-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Hyponatremia and hypokalemia are common among elderly and have been associated with osteoporosis, we evaluate the role of these electrolytes as risk for fragility fractures. METHODS This study is divided in two parts: one retrospective and one prospective. We retrospectively collected data on urgently admitted patients for femoral fragility fractures (Fx) or for acute myocardial infarction (AMI), and patients admitted for elective hip/knee replacement surgery for osteoarthrosis (OA). Age, sex, serum sodium, potassium, creatinine, and comorbidities were recorded. We enrolled prospectively in-patients from our unit: age, sex, comorbidities, drugs, and fragility fractures were recorded. Blood electrolytes were measured. Cognitive function, nutrition, muscular strength, and balance were evaluated by standard tests. The mortality rate was recorded with a follow-up after hospital discharge. RESULTS The retrospective study included 2166 subjects: 702 Fx and 1464 controls (907 AMI, 557 OA): the prevalence of hyponatremia was similar in Fx and AMI, whereas it was higher in Fx with respect to OA (p < 0.001) as well as hypokalemia (p < 0.001). Sodium decrease was associated with higher fracture risk. Among the 284 subjects included in the prospective study, 50 patients were hyponatremic, more likely malnourished, and presented a higher prevalence of fragility fractures (p = 0.008). They had a higher mortality after hospital discharge (HR = 1.80, p = 0.005), however, this association disappears after correction for confounding variables. CONCLUSIONS We suggest that hyponatremia and hypokalemia have to be considered as a marker of poor health more than an independent fracture risk.
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Affiliation(s)
- Laura Anna Maria Schiara
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Elena Grosso
- Department of Orthopedics, Traumatology, City of Health and Science Hospitals, Via Zuretti 29, 10126, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Michela Tibaldi
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Elena Spertino
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Carlotta Vezza
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovanni Carlo Isaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Massimiliano Massaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy.
- Centre Hospitalier Universitaire Vaudoise (CHUV) Service de Gériatrie, Mont Paisible 16 CH, 1011, Lausanne, Switzerland.
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19
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Abstract
The maintenance of extracellular calcium levels within a narrow range is necessary for normal function of the nervous system, muscle, and coagulation, to maintain mineralization of the skeleton but to avoid calcification of soft tissues. Accordingly, absorption and excretion of calcium is closely regulated, and adult humans can adapt to a wide range of calcium intakes from 300 to 2,000 mg/day. The evidence that low calcium intakes contribute to osteoporosis development is weak, as is evidence that increasing these intakes significantly changes fracture risk. Consistent with this view, the United States Preventive Services Task Force does not support the use of calcium supplements in healthy community-dwelling adults. While some groups continue to recommend that supplements of calcium and vitamin D are given with drug treatments for osteoporosis, this view is not supported by clinical trials which demonstrate anti-fracture efficacy of estrogens and bisphosphonates in the absence of such supplementation. Thus, calcium supplements have only a minor place in contemporary medical practice.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- Auckland District Health Board, Auckland, New Zealand.
| | - Sarah M Bristow
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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20
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Wang X, Kim D, Tucker KL, Weisskopf MG, Sparrow D, Hu H, Park SK. Effect of Dietary Sodium and Potassium Intake on the Mobilization of Bone Lead among Middle-Aged and Older Men: The Veterans Affairs Normative Aging Study. Nutrients 2019; 11:nu11112750. [PMID: 31766133 PMCID: PMC6893449 DOI: 10.3390/nu11112750] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 01/25/2023] Open
Abstract
Bone is a major storage site as well as an endogenous source of lead in the human body. Dietary sodium and potassium intake may play a role in the mobilization of lead from bone to the circulation. We examined whether association between bone lead and urinary lead, a marker of mobilized lead in plasma, was modified by dietary intake of sodium and potassium among 318 men, aged 48–93 years, in the Veterans Affairs (VA) Normative Aging Study. Dietary sodium and potassium were assessed by flame photometry using 24-h urine samples, and a sodium-to-potassium ratio was calculated from the resulting measures. Patella and tibia bone lead concentrations were measured by K-shell-x-ray fluorescence. Urinary lead was measured by inductively coupled plasma mass spectroscopy in 24-h urine samples. Linear regression models were used to regress creatinine clearance-corrected urinary lead on bone lead, testing multiplicative interactions with tertiles of sodium, potassium, and sodium-to-potassium ratio, separately. After adjustment for age, body mass index, smoking, vitamin C intake, calcium, and total energy intake, participants in the highest tertile of sodium-to-potassium ratio showed 28.1% (95% CI: 12.5%, 45.9%) greater urinary lead per doubling increase in patella lead, whereas those in the second and lowest tertiles had 13.8% (95% CI: −1.7%, 31.7%) and 5.5% (95% CI: −8.0%, 21.0%) greater urinary lead, respectively (p-for-interaction = 0.04). No statistically significant effect modification by either sodium or potassium intake alone was observed. These findings suggest that relatively high intake of sodium relative to potassium may play an important role in the mobilization of lead from bone into the circulation.
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Affiliation(s)
- Xin Wang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
| | - Douglas Kim
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
| | - Katherine L. Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, Lowell, MA 01854, USA;
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - David Sparrow
- Normative Aging Study, Veterans Affairs Boston Healthcare System, and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Howard Hu
- School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-(734)-936-1719; Fax: +1-(734)-936-2084
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Granchi D, Baldini N, Ulivieri FM, Caudarella R. Role of Citrate in Pathophysiology and Medical Management of Bone Diseases. Nutrients 2019; 11:E2576. [PMID: 31731473 PMCID: PMC6893553 DOI: 10.3390/nu11112576] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Citrate is an intermediate in the "Tricarboxylic Acid Cycle" and is used by all aerobic organisms to produce usable chemical energy. It is a derivative of citric acid, a weak organic acid which can be introduced with diet since it naturally exists in a variety of fruits and vegetables, and can be consumed as a dietary supplement. The close association between this compound and bone was pointed out for the first time by Dickens in 1941, who showed that approximately 90% of the citrate bulk of the human body resides in mineralised tissues. Since then, the number of published articles has increased exponentially, and considerable progress in understanding how citrate is involved in bone metabolism has been made. This review summarises current knowledge regarding the role of citrate in the pathophysiology and medical management of bone disorders.
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Affiliation(s)
- Donatella Granchi
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Nicola Baldini
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Via Pupilli 1, University of Bologna, 40136 Bologna, Italy
| | - Fabio Massimo Ulivieri
- Nuclear Medicine, Bone Metabolic Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milano, Italy;
| | - Renata Caudarella
- Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1, 48033 Cotignola (RA), Italy;
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Banga S, Kumar V, Suri S, Kaushal M, Prasad R, Kaur S. Nutraceutical Potential of Diet Drinks: A Critical Review on Components, Health Effects, and Consumer Safety. J Am Coll Nutr 2019; 39:272-286. [DOI: 10.1080/07315724.2019.1642811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shareen Banga
- Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Vikas Kumar
- Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Sheenam Suri
- Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Manisha Kaushal
- Department of Food Science and Technology, Dr. Y. S. Parmar University of Horticulture and Forestry, Solan, Himachal Pradesh, India
| | - Rasane Prasad
- Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Sawinder Kaur
- Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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23
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Burton DGA, Wilmot C, Griffiths HR. Personalising nutrition for older adults: The InCluSilver project. NUTR BULL 2018. [DOI: 10.1111/nbu.12356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study. Nutrients 2018; 10:nu10091293. [PMID: 30213095 PMCID: PMC6164684 DOI: 10.3390/nu10091293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022] Open
Abstract
The relationship involving acid-base imbalance, mineral metabolism and bone health status has previously been reported but the efficacy of the alkalizing supplementation in targeting acid overload and preventing bone loss has not yet been fully elucidated. In this randomized, double-blind, placebo-controlled study, the hypothesis that potassium citrate (K citrate) modifies bone turnover in women with postmenopausal osteopenia was tested. Three hundred and ten women were screened; 40 women met the inclusion criteria and were randomly assigned to the treatment or the placebo group. They were treated with K citrate (30 mEq day−1) or a placebo in addition to calcium carbonate (500 mg day−1) and vitamin D (400 IU day−1). At baseline and time points of 3 and 6 months, serum indicators of renal function, electrolytes, calciotropic hormones, serum bone turnover markers (BTMs) (tartrate-resistant acid phosphatase 5b (TRACP5b), carboxy-terminal telopeptide of type I collagen (CTX), bone alkaline phosphatase (BAP), procollagen type 1 N terminal propeptide (PINP)), and urine pH, electrolytes, and citrate were measured. The follow-up was completed by 17/20 patients in the “K citrate” group and 18/20 patients in the “placebo” group. At baseline, 90% of the patients exhibited low potassium excretion in 24 h urine samples, and 85% of cases had at least one urine parameter associated with low-grade acidosis (low pH, low citrate excretion). After treatment, CTX and BAP decreased significantly in both groups, but subjects with evidence of low-grade acidosis gained significant benefits from the treatment compared to the placebo. In patients with low 24h-citrate excretion at baseline, a 30% mean decrease in BAP and CTX was observed at 6 months. A significant reduction was also evident when low citrate (BAP: −25%; CTX: −35%) and a low pH (BAP: −25%; CTX: −30%) were found in fasting-morning urine. In conclusion, our results suggested that K citrate supplementation improved the beneficial effects of calcium and vitamin D in osteopenic women with a documented potassium and citrate deficit, and a metabolic profile consistent with low-grade acidosis.
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Weaver CM, Stone MS, Lobene AJ, Cladis DP, Hodges JK. What Is the Evidence Base for a Potassium Requirement? NUTRITION TODAY 2018; 53:184-195. [PMID: 30369637 PMCID: PMC6181280 DOI: 10.1097/nt.0000000000000298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increased intake of potassium should be promoted to reduce the risk of cardiovascular disease and stroke and to protect against bone loss, but confidence in recommended intakes depends on the strength of the evidence. All public health recommendations are considerably higher than current average intakes. Evidence on which current potassium intake recommendations for the United States, Europe, and globally have limitations. More recent evidence reviewed by the Agency for Healthcare Research and Quality affirms that more evidence is needed to define specific values for optimal potassium intakes. Potassium requirements undoubtedly vary with a number of factors including energy needs, race, and intake of sodium.
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Affiliation(s)
- Connie M Weaver
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Michael S Stone
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Andrea J Lobene
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Dennis P Cladis
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Joanna K Hodges
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
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Rizzoli R, Biver E, Bonjour JP, Coxam V, Goltzman D, Kanis JA, Lappe J, Rejnmark L, Sahni S, Weaver C, Weiler H, Reginster JY. Benefits and safety of dietary protein for bone health-an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteopororosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation. Osteoporos Int 2018; 29:1933-1948. [PMID: 29740667 DOI: 10.1007/s00198-018-4534-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/12/2018] [Indexed: 01/25/2023]
Abstract
A summary of systematic reviews and meta-analyses addressing the benefits and risks of dietary protein intakes for bone health in adults suggests that dietary protein levels even above the current RDA may be beneficial in reducing bone loss and hip fracture risk, provided calcium intakes are adequate. Several systematic reviews and meta-analyses have addressed the benefits and risks of dietary protein intakes for bone health in adults. This narrative review of the literature summarizes and synthesizes recent systematic reviews and meta-analyses and highlights key messages. Adequate supplies of dietary protein are required for optimal bone growth and maintenance of healthy bone. Variation in protein intakes within the "normal" range accounts for 2-4% of BMD variance in adults. In older people with osteoporosis, higher protein intake (≥ 0.8-g/kg body weight/day, i.e., above the current RDA) is associated with higher BMD, a slower rate of bone loss, and reduced risk of hip fracture, provided that dietary calcium intakes are adequate. Intervention with dietary protein supplements attenuate age-related BMD decrease and reduce bone turnover marker levels, together with an increase in IGF-I and a decrease in PTH. There is no evidence that diet-derived acid load is deleterious for bone health. Thus, insufficient dietary protein intakes may be a more severe problem than protein excess in the elderly. Long-term, well-controlled randomized trials are required to further assess the influence of dietary protein intakes on fracture risk.
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Affiliation(s)
- R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland.
| | - E Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - J-P Bonjour
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - V Coxam
- INRA, Unité de Nutrition Humaine, CRNH Auvergne, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - D Goltzman
- McGill University Health Center, Montreal, Canada
| | - J A Kanis
- University of Sheffield, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | - J Lappe
- College of Nursing, Creighton University, Creighton, NE, USA
| | - L Rejnmark
- Aarhus University Hospital, Aarhus, Denmark
| | - S Sahni
- Hebrew SeniorLife and Harvard Medical School, Institute for Aging Research, Boston, MA, USA
| | - C Weaver
- Women's Global Health Institute, Department of Nutrition Science, Purdue University, Purdue, West Lafayette, IN, USA
| | - H Weiler
- School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Perinpam M, Ware EB, Smith JA, Turner ST, Kardia SLR, Lieske JC. Association of urinary citrate excretion, pH, and net gastrointestinal alkali absorption with diet, diuretic use, and blood glucose concentration. Physiol Rep 2017; 5:5/19/e13411. [PMID: 29038354 PMCID: PMC5641929 DOI: 10.14814/phy2.13411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
Urinary citrate (Ucit) protects against urinary stone formation. Acid base status and diet influence Ucit. However, the effect of demographics, diet, and glucose metabolism on Ucit excretion, urinary pH (U‐pH) and net gastrointestinal alkali absorption (NAA) are not known. Twenty‐four hour urine samples, blood glucose, creatinine, and cystatin C were obtained from non‐Hispanic white sibships in Rochester, MN (n = 446; 64.5 ± 9 years; 58% female). Diet was assessed by a food frequency questionnaire. The impact of blood glucose, demographics and dietary elements on Ucit excretion, U‐pH, and NAA were evaluated in bivariate and multivariable models and interaction models that included age, sex, and weight. NAA significantly associated with Ucit and U‐pH. In multivariate models Ucit increased with age, weight, eGFRCys, and blood glucose, but decreased with loop diuretic and thiazide use. U‐pH decreased with serum creatinine, blood glucose, and dietary protein but increased with dietary potassium. NAA was higher in males and increased with age, weight, eGFRCys and dietary potassium. Significant interactions were observed for Ucit excretion with age and blood glucose, weight and eGFRCys, and sex and thiazide use. Blood glucose had a significant and independent effect on U‐pH and also Ucit. This study provides the first evidence that blood glucose could influence urinary stone risk independent of urinary pH, potentially providing new insight into the association of obesity and urinary stone disease.
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Affiliation(s)
- Majuran Perinpam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Erin B Ware
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Strohm D, Ellinger S, Leschik-Bonnet E, Maretzke F, Heseker H. Revised Reference Values for Potassium Intake. ANNALS OF NUTRITION & METABOLISM 2017; 71:118-124. [PMID: 28803230 PMCID: PMC5639605 DOI: 10.1159/000479705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nutrition societies of Germany, Austria and Switzerland have revised the reference values for potassium intake in January 2017. METHODS For adults, the estimated value was based on the 24-h urinary potassium excretion and on preventive considerations regarding hypertension and stroke. The estimated values for children and adolescents were extrapolated from the adult estimated value considering differences in body mass. For infants aged 0 to under 4 months, the estimated value was set based on the potassium intake via breast milk. From this reference value, the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the potassium loss via breast milk. RESULTS The estimated values for potassium intake are set at 400 mg/day for breastfed infants aged 0 to under 4 months, 600 mg/day for infants aged 4 to under 12 months, 1,100-4,000 mg/day for children and adolescents, 4,000 mg/day for adults and pregnant women and 4,400 mg/day for lactating women. CONCLUSIONS The consumption of potassium-rich foods should be generally increased. Supplemental intake beyond the estimated values has no health benefit and is therefore not recommended.
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Affiliation(s)
| | - Sabine Ellinger
- Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Moenchengladbach, Germany
| | | | | | - Helmut Heseker
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
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Granchi D, Torreggiani E, Massa A, Caudarella R, Di Pompo G, Baldini N. Potassium citrate prevents increased osteoclastogenesis resulting from acidic conditions: Implication for the treatment of postmenopausal bone loss. PLoS One 2017; 12:e0181230. [PMID: 28715463 PMCID: PMC5513456 DOI: 10.1371/journal.pone.0181230] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022] Open
Abstract
The extracellular acidic milieu in bones results in activation of osteoclasts (OC) and inhibition of osteoblasts (OB) causing a net loss of calcium from the skeleton and the deterioration of bone microarchitecture. Alkalinization through supplementation with potassium citrate (K citrate) has been proposed to limit the osteopenia progression, even though its pharmacological activity in bone microenvironment is not well defined. We evaluated if K citrate was able to prevent the adverse effects that acidic milieu induces on bone cells. OC and OB were maintained in neutral (pH 7.4) versus acidic (pH 6.9) culture medium, and treated with different K citrate concentrations. We evaluated the OC differentiation at seven days, by counting of multinucleated cells expressing tartrate-resistant acid phosphatase, and the activity of mature OC at 14 days, by quantifying of collagen degradation. To evaluate the effects on OB, we analyzed proliferation, mineralization, and expression of bone-related genes. We found that the low pH increased OC differentiation and activity and decreased OB function. The osteoclastogenesis was also promoted by RANKL concentrations ineffective at pH 7.4. Non-cytotoxic K citrate concentrations were not sufficient to steadily neutralize the acidic medium, but a) inhibited the osteoclastogenesis, the collagen degradation, and the expression of genes involved in RANKL-mediated OC differentiation, b) enhanced OB proliferation and alkaline phosphatase expression, whereas it did not affect the in vitro mineralization, and c) were effective also in OC cultures resistant to alendronate, i.e. the positive control of osteoclastogenesis inhibition. In conclusion, K citrate prevents the increase in OC activity induced by the acidic microenvironment, and the effect does not depend exclusively on its alkalizing capacity. These data provide the biological basis for the use of K citrate in preventing the osteopenia progression resulting from low-grade acidosis.
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Affiliation(s)
- Donatella Granchi
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- * E-mail:
| | - Elena Torreggiani
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Annamaria Massa
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Gemma Di Pompo
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Nicola Baldini
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Margolis LM, Dawson-Hughes B, Rivas DA, Ezzyat Y, Fielding RA, Ceglia L. Effects of Potassium Bicarbonate Supplements on Circulating microRNA Expression. J Endocr Soc 2017; 1:1015-1026. [PMID: 29264553 PMCID: PMC5686674 DOI: 10.1210/js.2017-00106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/08/2017] [Indexed: 01/31/2023] Open
Abstract
Several studies suggest that neutralizing acid load in the diet with alkali had favorable effects on intermediate markers of musculoskeletal health. We examined whether alkali supplementation with potassium bicarbonate [(KHCO3); 81 mmol/d; n = 12] vs placebo (n = 12) for 84 days altered serum microRNAs, potential biomarkers associated with innumerable biological processes including bone and muscle metabolism. Serum microRNAs, urinary net acid excretion (UNAE), urinary N-telopeptide (UNTX), urinary calcium (UCa), urinary nitrogen (UN), glomerular filtration rate, serum procollagen type 1 amino-terminal propeptide (P1NP), serum insulin-like growth factor-1 (IGF-1), and its serum binding protein IGFBP3 were measured at baseline and day 84. Baseline characteristics and measurements were similar in the two treatment groups. Eighty-four-day changes in UNAE differed by group (KHCO3, -47 ± 9 mmol; placebo, -5 ± 5 mmol; P < 0.01). KHCO3 significantly reduced UNTX, UCa, and serum P1NP but did not affect UN, serum IGF-1, or IGFBP3 levels compared with placebo over 84 days. Fold change in serum circulating microRNA (c-miR)-133b differed significantly by group (KHCO3, 2.26 ± 0.85; placebo, -1.23 ± 0.69; P < 0.01); there was a similar trend in c-miR-21-5p. Fold changes in c-miR-133b and c-miR-21-5p were inversely associated with changes in UNAE and UNTX; fold change in c-miR-21-5p was inversely associated with change in UCa, with a similar trend with c-miR-133b. In summary, reducing renal acid load with KHCO3 was associated with increased expressions of c-miR-133b and c-miR-21-5p. Furthermore, increases in c-miRNA-133b and c-miR-21-5p were inversely associated with bone resorption markers UNTX and UCa consistent with potential beneficial effects on bone in older adults. However, the broader significance of c-miRNAs as musculoskeletal biomarkers is still under investigation, and larger studies are needed to verify these preliminary results.
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Affiliation(s)
- Lee M Margolis
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
| | - Donato A Rivas
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
| | - Yassine Ezzyat
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
| | - Roger A Fielding
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
| | - Lisa Ceglia
- Bone Metabolism Laboratory, Jean Mayer Human Nutrition Research Center on Aging, US Department of Agriculture, Tufts University, Boston, Massachusetts 02111
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Carnauba RA, Baptistella AB, Paschoal V, Hübscher GH. Diet-Induced Low-Grade Metabolic Acidosis and Clinical Outcomes: A Review. Nutrients 2017; 9:E538. [PMID: 28587067 PMCID: PMC5490517 DOI: 10.3390/nu9060538] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/05/2017] [Accepted: 05/17/2017] [Indexed: 01/04/2023] Open
Abstract
Low-grade metabolic acidosis is a condition characterized by a slight decrease in blood pH, within the range considered normal, and feeding is one of the main factors that may influence the occurrence of such a condition. The excessive consumption of acid precursor foods (sources of phosphorus and proteins), to the detriment of those precursors of bases (sources of potassium, calcium, and magnesium), leads to acid-base balance volubility. If this condition occurs in a prolonged, chronic way, low-grade metabolic acidosis can become significant and predispose to metabolic imbalances such as kidney stone formation, increased bone resorption, reduced bone mineral density, and the loss of muscle mass, as well as the increased risk of chronic diseases such as type 2 diabetes mellitus, hypertension, and non-alcoholic hepatic steatosis. Considering the increase in the number of studies investigating the influence of diet-induced metabolic acidosis on clinical outcomes, this review gathers the available evidence evaluating the association of this disturbance and metabolic imbalances, as well as related mechanisms. It is necessary to look at the western dietary pattern of most countries and the increasing incidence of non-comunicable diseases for the balance between fruit and vegetable intake and the appropriate supply of protein, mainly from animal sources, so that it does not exceed the daily recommendations.
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Affiliation(s)
| | | | - Valéria Paschoal
- VP Research Institute, 287, Carlos Petit St, São Paulo 04110-000, Brazil.
| | - Gilberti Helena Hübscher
- Departament of Food Science and Technology, Federal University of Santa Maria, Rio Grande do Sul 97105-900, Brazil.
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Amino Acid Medical Foods Provide a High Dietary Acid Load and Increase Urinary Excretion of Renal Net Acid, Calcium, and Magnesium Compared with Glycomacropeptide Medical Foods in Phenylketonuria. J Nutr Metab 2017; 2017:1909101. [PMID: 28546877 PMCID: PMC5436062 DOI: 10.1155/2017/1909101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/10/2017] [Indexed: 12/31/2022] Open
Abstract
Background. Skeletal fragility is a complication of phenylketonuria (PKU). A diet containing amino acids compared with glycomacropeptide reduces bone size and strength in mice. Objective. We tested the hypothesis that amino acid medical foods (AA-MF) provide a high dietary acid load, subsequently increasing urinary excretion of renal net acid, calcium, and magnesium, compared to glycomacropeptide medical foods (GMP-MF). Design. In a crossover design, 8 participants with PKU (16-35 y) provided food records and 24-hr urine samples after consuming a low-Phe diet in combination with AA-MF and GMP-MF for 1-3 wks. We calculated potential renal acid load (PRAL) of AA-MF and GMP-MF and determined bone mineral density (BMD) measurements using dual X-ray absorptiometry. Results. AA-MF provided 1.5-2.5-fold higher PRAL and resulted in 3-fold greater renal net acid excretion compared to GMP-MF (p = 0.002). Dietary protein, calcium, and magnesium intake were similar. GMP-MF significantly reduced urinary excretion of calcium by 40% (p = 0.012) and magnesium by 30% (p = 0.029). Two participants had low BMD-for-age and trabecular bone scores, indicating microarchitectural degradation. Urinary calcium with AA-MF negatively correlated with L1-L4 BMD. Conclusion. Compared to GMP-MF, AA-MF increase dietary acid load, subsequently increasing urinary calcium and magnesium excretion, and likely contributing to skeletal fragility in PKU. The trial was registered at clinicaltrials.gov as NCT01428258.
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Kong SH, Kim JH, Hong AR, Lee JH, Kim SW, Shin CS. Dietary potassium intake is beneficial to bone health in a low calcium intake population: the Korean National Health and Nutrition Examination Survey (KNHANES) (2008-2011). Osteoporos Int 2017; 28:1577-1585. [PMID: 28093633 DOI: 10.1007/s00198-017-3908-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED Dietary potassium may neutralize acid load and reduce calcium loss from the bone, leading to beneficial effect on bone mineral density. In this nationwide Korean population study, dietary potassium intake was associated with improved bone mineral density in older men and postmenopausal women. INTRODUCTION Nutrition is a major modifiable factor that affects bone health. The accompanying anion in dietary potassium may act as an alkaline source by neutralizing the acid load and reducing calcium loss from the bone. We aimed to evaluate the association between dietary potassium intake and bone mineral density (BMD) in the Korean population. METHODS We analyzed a total of 3135 men aged >50 years and 4052 postmenopausal women from the Korean National Health and Nutrition Examination Survey (KNHANES). Lumbar spine, total hip, and femur neck BMD were measured using dual energy X-ray absorptiometry. The daily food intake was assessed using a food frequency questionnaire. RESULTS When we divided the participants into tertiles based on the intake of potassium intake, the highest potassium intake tertile group showed a significantly higher total hip and femur neck BMD as compared to lower tertile groups (0.914 ± 0.004, 0.928 ± 0.003, 0.925 ± 0.004 mg/day across the tertiles, P = .014 for total hip; 0.736 ± 0.003, 0.748 ± 0.003, 0.750 ± 0.004 mg/day, P = .012 for femur neck). Postmenopausal women in the highest potassium intake tertile group showed significantly higher lumbar, total hip, and femur neck BMD as compared to those in lower potassium intake tertile groups (0.793 ± 0.004, 0.793 ± 0.003, 0.805 ± 0.004 mg/day across the tertiles, P = .029 for lumbar spine; 0.766 ± 0.003, 0.770 ± 0.002, 0.780 ± 0.003 mg/day, P = .002 for total hip; 0.615 ± 0.003, 0.619 ± 0.002, 0.628 ± 0.003 mg/day, P = .002 for femur neck). CONCLUSIONS Dietary potassium intake was positively associated with BMD in men aged >50 years and postmenopausal women, indicating the beneficial effects of dietary potassium intake on bone health.
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Affiliation(s)
- S H Kong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - A R Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - J H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - S W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - C S Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
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Cao WT, He J, Chen GD, Wang C, Qiu R, Chen YM. The association between urinary sodium to potassium ratio and bone density in middle-aged Chinese adults. Osteoporos Int 2017; 28:1077-1086. [PMID: 27896362 DOI: 10.1007/s00198-016-3835-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED The joint effect of sodium and potassium on bone health remains uncertain. We examined the associations between urinary excretion of sodium, potassium, and their ratio and bone mineral density (BMD), and reported an inverse association between urinary sodium-to-potassium ratio and BMD in women, but not in men. INTRODUCTION Several studies have suggested that a higher sodium or lower potassium intake is associated with poor bone health. However, few studies have examined their joint effects. We examined the associations of urinary excretion of sodium, potassium, and the sodium-to-potassium ratio with BMD in Chinese adults. METHODS This community-based, cross-sectional study included 2202 women and 1063 men (40-75 years) in Guangzhou, China. The BMD of the whole body, lumbar spine, and hip sites were measured by dual-energy x-ray absorptiometry. The concentrations of sodium, potassium, and creatinine of the fasting morning first-void urine sample were measured, and creatinine-adjusted values were then used for further analyses. General information was collected via face-to-face interviews. RESULTS For women, after multivariable adjustment, the urinary sodium-to-potassium ratio was inversely associated with BMD at the whole body, total hip, trochanter, and intertrochanter (all p trend <0.05). The mean BMD differences between extreme quartiles ranged from 1.50 to 2.98 % at these sites (all p < 0.05). Similar, but less significant, associations were observed for urinary sodium/creatinine, for which the only significant difference was found at the trochanter (2.00 %, p = 0.016). We did not find any significant associations of BMD with urinary potassium in women and with urinary sodium/creatinine, potassium/creatinine, or their ratio in men. CONCLUSION Our findings suggest that the urinary sodium-to-potassium ratio, but not individual creatinine-adjusted values of sodium or potassium, is a good predictor of BMD in women, but not in men.
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Affiliation(s)
- W T Cao
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - J He
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - G D Chen
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - C Wang
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - R Qiu
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Y M Chen
- Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
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Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
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Dawson-Hughes B, Mitchell PJ, Cooper C, Gordon CM, Rizzoli R. Response to Fenton and Fenton: evidence does not support the alkaline diet. Osteoporos Int 2016; 27:2389-2390. [PMID: 26856583 DOI: 10.1007/s00198-016-3505-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/25/2022]
Affiliation(s)
- B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St., Boston, MA, 02111, USA.
| | - P J Mitchell
- Synthesis Medical NZ Ltd, Auckland, New Zealand
- University of Notre Dame Australia, Sydney, Australia
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield, Department of Orthopaedics, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - C M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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37
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Abstract
Western diet, high in protein-rich foods and poor in vegetables, is likely to be responsible for the development of a moderate acid excess leading to metabolism deregulation and the onset or worsening of chronic disturbances. Available findings seem to suggest that diets with high protein/vegetables ratio are likely to induce the development of calcium lithiasis, especially in predisposed subjects. Moreover, some evidence supports the hypothesis of bone metabolism worsening and enhanced bone loss following acid-genic diet consumption although available literature seems to lack direct and conclusive evidence demonstrating pathological bone loss. According to other evidences, diet-induced acidosis is likely to induce or accelerate muscle wasting or sarcopenia, especially among elderlies. Furthermore, recent epidemiological findings highlight a specific role of dietary acid load in glucose metabolism deregulation and insulin resistance. The aim of this review is to investigate the role of acid-genic diets in the development of the mentioned metabolic disorders focusing on the possible clinical improvements exerted by alkali supplementation.
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Affiliation(s)
- Lucio Della Guardia
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
| | - Carla Roggi
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
| | - Hellas Cena
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
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Carbone L, Johnson KC, Huang Y, Pettinger M, Thomas F, Cauley J, Crandall C, Tinker L, LeBoff MS, Wactawski-Wende J, Bethel M, Li W, Prentice R. Sodium Intake and Osteoporosis. Findings From the Women's Health Initiative. J Clin Endocrinol Metab 2016; 101:1414-21. [PMID: 26863423 PMCID: PMC4880174 DOI: 10.1210/jc.2015-4017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this large, prospective, observational cohort study of postmenopausal women in the WHI, Cox proportional hazard regression models showed that sodium intake at or near recommended levels is not likely to impact bone metabolism.
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Affiliation(s)
- Laura Carbone
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Karen C Johnson
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Ying Huang
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Mary Pettinger
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Fridjtof Thomas
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Jane Cauley
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Carolyn Crandall
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Lesley Tinker
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Meryl Susan LeBoff
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Jean Wactawski-Wende
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Monique Bethel
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Wenjun Li
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Ross Prentice
- Department of Medicine, Division of Rheumatology (L.C., M.B.), Medical College of Georgia-Augusta University and Charlie Norwood Veterans Affairs Medical Center (L.C., M.B.), Augusta, GA 30912; Department of Preventive Medicine (K.C.J., F.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Division of Public Health Sciences (Y.H., M.P., L.T., R.P.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; David Geffen School of Medicine (C.C.), University of California, Los Angeles, Los Angeles, California 90095; Department of Medicine (M.S.L.), Harvard University, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, The State University of New York, Buffalo, New York 14214; and Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655
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39
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Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. Life-course approach to nutrition. Osteoporos Int 2015; 26:2723-42. [PMID: 26412214 PMCID: PMC4656714 DOI: 10.1007/s00198-015-3288-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/11/2015] [Indexed: 01/12/2023]
Abstract
This narrative review summarizes the role that nutrition plays in the development and maintenance of a healthy skeleton throughout the life-course. Nutrition has a significant influence on bone health throughout the life cycle. This narrative review summarizes current knowledge and guidance pertaining to the development and maintenance of a healthy skeleton. The primary objectives proposed for good bone health at the various stages of life are the following: Children and adolescents: achieve genetic potential for peak bone mass Adults: avoid premature bone loss and maintain a healthy skeleton Seniors: prevention and treatment of osteoporosis Findings from cohort studies, randomized controlled trials, systematic reviews and meta-analyses, in addition to current dietary guidelines, are summarized with the intention of providing clear nutritional guidance for these populations and pregnant women.
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Affiliation(s)
- P J Mitchell
- Synthesis Medical NZ Ltd, Auckland, New Zealand
- University of Notre Dame Australia, Sydney, Australia
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - C M Gordon
- Divisions of Adolescent Medicine and Endocrinology, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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40
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41
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Citarda S, Hanf W, Vrigneaud L, Bataille S, Gosselin M, Beaume J, Dariane C, Madec FX, Larceneux F, Fiard G, Bertocchio JP. [Mineral-based alkaline waters' prescription in France: Patients are the key point for both nephrologists and urologists]. Nephrol Ther 2015; 12:38-47. [PMID: 26563589 DOI: 10.1016/j.nephro.2015.07.471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified.
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Affiliation(s)
- Salvatore Citarda
- Centre associatif lyonnais de dialyse (CALYDIAL), 51, rue Yvours, 69540 Irigny, France; Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France
| | - William Hanf
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie, centre hospitalier Alpes-Léman, 74130 Contamine-sur-Arve, France
| | - Laurence Vrigneaud
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de médecine interne et néphrologie, centre hospitalier de Valenciennes, avenue Desandrouin, 59300 Valenciennes, France
| | - Stanislas Bataille
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Institut phocéen de néphrologie, clinique Bouchard, 13006 Marseille, France
| | - Morgane Gosselin
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie et transplantation rénale, CHRU La Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Julie Beaume
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de dialyse, HIA Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - Charles Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France; Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - François-Xavier Madec
- Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie infantile, hôpital Mère-Enfant, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Fabrice Larceneux
- Dauphine recherches en management, UMR CNRS 7088, université Paris Dauphine, place du Maréchal-de-Lattre-de-Tassigny, 75016 Paris, France
| | - Gaëlle Fiard
- Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Grenoble, laboratoire TIMC-IMAG, CNRS, université Grenoble-Alpes, 38000 Grenoble, France
| | - Jean-Philippe Bertocchio
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service d'explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France.
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Dawson-Hughes B, Harris SS, Palermo NJ, Gilhooly CH, Shea MK, Fielding RA, Ceglia L. Potassium Bicarbonate Supplementation Lowers Bone Turnover and Calcium Excretion in Older Men and Women: A Randomized Dose-Finding Trial. J Bone Miner Res 2015; 30:2103-11. [PMID: 25990255 PMCID: PMC4817273 DOI: 10.1002/jbmr.2554] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 01/21/2023]
Abstract
The acid load accompanying modern diets may have adverse effects on bone and muscle metabolism. Treatment with alkaline salts of potassium can neutralize the acid load, but the optimal amount of alkali is not established. Our objective was to determine the effectiveness of two doses of potassium bicarbonate (KHCO3 ) compared with placebo on biochemical markers of bone turnover, and calcium and nitrogen (N) excretion. In this double-blind, randomized, placebo-controlled study, 244 men and women age 50 years and older were randomized to placebo or 1 mmol/kg or 1.5 mmol/kg of KHCO3 daily for 3 months; 233 completed the study. The primary outcomes were changes in 24-hour urinary N-telopeptide (NTX) and N; changes in these measures were compared across the treatment groups. Exploratory outcomes included 24-hour urinary calcium excretion, serum amino-terminal propeptide of type I procollagen (P1NP), and muscle strength and function assessments. The median administered doses in the low-dose and high-dose groups were 81 mmol/day and 122 mmol/day, respectively. When compared with placebo, urinary NTX declined significantly in the low-dose group (p = 0.012, after adjustment for baseline NTX, gender, and change in urine creatinine) and serum P1NP declined significantly in the low-dose group (p = 0.004, adjusted for baseline P1NP and gender). Urinary calcium declined significantly in both KHCO3 groups versus placebo (p < 0.001, adjusted for baseline urinary calcium, gender, and changes in urine creatinine and calcium intake). There was no significant effect of either dose of KHCO3 on urinary N excretion or on the physical strength and function measures. KHCO3 has favorable effects on bone turnover and calcium excretion and the lower dose appears to be the more effective dose. Long-term trials to assess the effect of alkali on bone mass and fracture risk are needed.
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Affiliation(s)
- Bess Dawson-Hughes
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Susan S Harris
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Nancy J Palermo
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Cheryl H Gilhooly
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - M Kyla Shea
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Roger A Fielding
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Lisa Ceglia
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Felsenfeld AJ, Levine BS, Rodriguez M. Pathophysiology of Calcium, Phosphorus, and Magnesium Dysregulation in Chronic Kidney Disease. Semin Dial 2015; 28:564-77. [DOI: 10.1111/sdi.12411] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Arnold J. Felsenfeld
- Department of Medicine; VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA; Los Angeles California
| | - Barton S. Levine
- Department of Medicine; VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA; Los Angeles California
| | - Mariano Rodriguez
- Nephrology Service; IMIBIC; Hospital Universitario Reina Sofia; University of Cordoba; Cordoba Spain
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Hayhoe RPG, Lentjes MAH, Luben RN, Khaw KT, Welch AA. Dietary magnesium and potassium intakes and circulating magnesium are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the EPIC-Norfolk cohort study. Am J Clin Nutr 2015; 102:376-84. [PMID: 26135346 DOI: 10.3945/ajcn.114.102723] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In our aging population, maintenance of bone health is critical to reduce the risk of osteoporosis and potentially debilitating consequences of fractures in older individuals. Among modifiable lifestyle and dietary factors, dietary magnesium and potassium intakes are postulated to influence bone quality and osteoporosis, principally via calcium-dependent alteration of bone structure and turnover. OBJECTIVE We investigated the influence of dietary magnesium and potassium intakes, as well as circulating magnesium, on bone density status and fracture risk in an adult population in the United Kingdom. DESIGN A random subset of 4000 individuals from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort of 25,639 men and women with baseline data was used for bone density cross-sectional analyses and combined with fracture cases (n = 1502) for fracture case-cohort longitudinal analyses (mean follow-up 13.4 y). Relevant biological, lifestyle, and dietary covariates were used in multivariate regression analyses to determine associations between dietary magnesium and potassium intakes and calcaneal broadband ultrasound attenuation (BUA), as well as in Prentice-weighted Cox regression to determine associated risk of fracture. Separate analyses, excluding dietary covariates, investigated associations of BUA and fractures with serum magnesium concentration. RESULTS Statistically significant positive trends in calcaneal BUA for women (n = 1360) but not men (n = 968) were apparent across increasing quintiles of magnesium plus potassium (Mg+K) z score intake (P = 0.03) or potassium intake alone (P = 0.04). Reduced hip fracture risk in both men (n = 1958) and women (n = 2755) was evident for individuals in specific Mg+K z score intake quintiles compared with the lowest. Statistically significant trends in fracture risk in men across serum magnesium concentration groups were apparent for spine fractures (P = 0.02) and total hip, spine, and wrist fractures (P = 0.02). None of these individual statistically significant associations remained after adjustment for multiple testing. CONCLUSIONS These findings enhance the limited literature studying the association of magnesium and potassium with bone density and demonstrate that further investigation is warranted into the mechanisms involved and the potential protective role against osteoporosis.
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Affiliation(s)
- Richard P G Hayhoe
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; and
| | - Marleen A H Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; and
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Gunn CA, Weber JL, McGill AT, Kruger MC. Increased intake of selected vegetables, herbs and fruit may reduce bone turnover in post-menopausal women. Nutrients 2015; 7:2499-517. [PMID: 25856221 PMCID: PMC4425157 DOI: 10.3390/nu7042499] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/26/2022] Open
Abstract
Increased consumption of vegetables/herbs/fruit may reduce bone turnover and urinary calcium loss in post-menopausal women because of increased intake of polyphenols and potassium, but comparative human studies are lacking. The main aim was to compare bone turnover markers and urinary calcium excretion in two randomised groups (n = 50) of healthy post-menopausal women consuming ≥9 servings of different vegetables/herbs/fruit combinations (three months). Group A emphasised a generic range of vegetables/herbs/fruit, whereas Group B emphasised specific vegetables/herbs/fruit with bone resorption-inhibiting properties (Scarborough Fair Diet), with both diets controlled for potential renal acid load (PRAL). Group C consumed their usual diet. Plasma bone markers, urinary electrolytes (24 h) and estimated dietary PRAL were assessed at baseline and 12 weeks. Procollagen type I N propeptide (PINP) decreased (−3.2 μg/L, p < 0.01) in the B group only, as did C-terminal telopeptide of type I collagen (CTX) (−0.065 μg/L, p < 0.01) in women with osteopenia compared to those with normal bone mineral density (BMD) within this group. Intervention Groups A and B had decreased PRAL, increased urine pH and significantly decreased urinary calcium loss. Urinary potassium increased in all groups, reflecting a dietary change. In conclusion, Group B demonstrated positive changes in both turnover markers and calcium conservation.
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Affiliation(s)
- Caroline Ann Gunn
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Janet Louise Weber
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
| | - Anne-Thea McGill
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Marlena Cathorina Kruger
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
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Lambert H, Frassetto L, Moore JB, Torgerson D, Gannon R, Burckhardt P, Lanham-New S. The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis. Osteoporos Int 2015; 26:1311-8. [PMID: 25572045 DOI: 10.1007/s00198-014-3006-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 12/12/2014] [Indexed: 12/26/2022]
Abstract
UNLABELLED The role of acid-base metabolism in bone health is controversial. In this meta-analysis, potassium bicarbonate and potassium citrate lowered urinary calcium and acid excretion and reduced the excretion of the bone resorption marker NTX. These salts may thus be beneficial to bone health by conserving bone mineral. INTRODUCTION The role of acid-base homeostasis as a determinant of bone health and the contribution of supplemental alkali in promoting skeletal integrity remain a subject of debate. The objective of this study was, therefore, to conduct a meta-analysis to assess the effects of supplemental potassium bicarbonate (KHCO3) and potassium citrate (KCitr) on urinary calcium and acid excretion, markers of bone turnover and bone mineral density (BMD) and to compare their effects with that of potassium chloride (KCl). METHODS A total of 14 studies of the effect of alkaline potassium salts on calcium metabolism and bone health, identified by a systematic literature search, were analysed with Review Manager (Version 5; The Cochrane Collaboration) using a random-effects model. Authors were contacted to provide missing data as required. Results are presented as the standardised (SMD) or unstandardized mean difference (MD) (95 % confidence intervals). RESULTS Urinary calcium excretion was lowered by intervention with both KHCO3 (P = 0.04) and KCitr (P = 0.01), as was net acid excretion (NAE) (P = 0.002 for KHCO3 and P = 0.0008 for KCitr). Both salts significantly lowered the bone resorption marker NTX (P < 0.00001). There was no effect on bone formation markers or BMD. KHCO3 and KCitr lowered calcium excretion to a greater extent than did KCl. CONCLUSIONS This meta-analysis confirms that supplementation with alkaline potassium salts leads to significant reduction in renal calcium excretion and acid excretion, compatible with the concept of increased buffering of hydrogen ions by raised circulating bicarbonate. The observed reduction in bone resorption indicates a potential benefit to bone health.
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Affiliation(s)
- H Lambert
- Nutritional Sciences Department, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK,
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Tabatabai LS, Cummings SR, Tylavsky FA, Bauer DC, Cauley JA, Kritchevsky SB, Newman A, Simonsick EM, Harris TB, Sebastian A, Sellmeyer DE. Arterialized venous bicarbonate is associated with lower bone mineral density and an increased rate of bone loss in older men and women. J Clin Endocrinol Metab 2015; 100:1343-9. [PMID: 25642590 PMCID: PMC4399281 DOI: 10.1210/jc.2014-4166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Higher dietary net acid loads have been associated with increased bone resorption, reduced bone mineral density (BMD), and increased fracture risk. OBJECTIVE The objective was to compare bicarbonate (HCO3) measured in arterialized venous blood samples to skeletal outcomes. DESIGN Arterialized venous samples collected from participants in the Health, Aging and Body Composition (Health ABC) Study were compared to BMD and rate of bone loss. SETTING The setting was a community-based observational cohort. PARTICIPANTS A total of 2287 men and women age 74 ± 3 years participated. INTERVENTION Arterialized venous blood was obtained at the year 3 study visit and analyzed for pH and pCO2. HCO3 was determined using the Henderson-Hasselbalch equation. MAIN OUTCOME MEASURE BMD was measured at the hip by dual-energy x-ray absorptiometry at the year 1 (baseline) and year 3 study visits. RESULTS Plasma HCO3 was positively associated with BMD at both year 1 (P = .001) and year 3 (P = .001) in models adjusted for age, race, sex, clinic site, smoking, weight, and estimated glomerular filtration rate. Plasma HCO3 was inversely associated with rate of bone loss at the total hip over the 2.1 ± 0.3 (mean ± SD) years between the two bone density measurements (P < .001). Across quartiles of plasma HCO3, the rate of change in BMD over the 2.1 years ranged from a loss of 0.72%/y in the lowest quartile to a gain of 0.15%/y in the highest quartile of HCO3. CONCLUSIONS Arterialized plasma HCO3 was associated positively with cross-sectional BMD and inversely with the rate of bone loss, implying that systemic acid-base status is an important determinant of skeletal health during aging. Ongoing bone loss was linearly related to arterialized HCO3, even after adjustment for age and renal function. Further research in this area may have major public health implications because reducing dietary net acid load is possible through dietary intervention or through supplementation with alkaline potassium compounds.
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Affiliation(s)
- L S Tabatabai
- Division of Endocrinology (L.S.T., D.E.S.), Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland 21224; California Pacific Medical Center Research Institute (S.R.C.), San Francisco, California 94118; Department of Preventive Medicine (F.A.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Department of Medicine (D.C.B., A.S.), School of Medicine, University of California, San Francisco, San Francisco, California 94143; Department of Epidemiology (J.A.C., A.N.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.B.K.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; Translational Gerontology Branch (E.M.S.), National Institute on Aging, Baltimore, Maryland 21224; and Laboratory of Epidemiology and Population Science (T.B.H.), National Institute on Aging, Bethesda, Maryland 20892
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48
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Hohman EE, Weaver CM. A grape-enriched diet increases bone calcium retention and cortical bone properties in ovariectomized rats. J Nutr 2015; 145:253-9. [PMID: 25644345 DOI: 10.3945/jn.114.198598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Grapes and their associated phytochemicals have been investigated for beneficial effects on cardiovascular health, cancer prevention, and other chronic diseases, but the effect of grape consumption on bone health has not been fully determined. We previously found short-term benefits of grape products on reducing bone turnover in ovariectomized rats. OBJECTIVE The objective of this study was to determine the long-term benefits of a grape-enriched diet on bone in ovariectomized rats. METHODS Rats were ovariectomized at 3 mo of age and were administered a single dose of (45)Ca to prelabel bones at 4 mo of age. After a 1-mo equilibration period, baseline urinary (45)Ca excretion was determined. Rats (n = 22/group) were then randomly assigned to a modified AIN93M diet containing 25% freeze-dried grape powder or to a control diet for 8 wk. Urinary (45)Ca excretion was monitored throughout the study to determine changes in bone (45)Ca retention. Calcium balance was assessed after 1 and 8 wk of consuming the experimental diets, and a calcium kinetic study was performed at 8 wk. After 8 wk, femurs were collected for micro-computed tomographic imaging, 3-point bending, and reference point indentation. RESULTS Rats fed the grape-enriched diet had 44% greater net bone calcium retention than did rats fed the control diet. There were no differences in calcium balance due to diet at either week 1 or week 8, but there was a significant increase in net calcium absorption (10.6%) and retention (5.7%) from week 1 to week 8 in the grape-enriched diet group only. Grape-enriched diet-fed rats had 3% greater cortical thickness and 11% greater breaking strength. There were no differences in femur bone mineral density, trabecular microarchitecture, or reference point indentation variables due to diet. CONCLUSION This study of ovariectomized rats indicates that the consumption of grape products may improve calcium utilization and suppress bone turnover, resulting in improvements in bone quality.
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Affiliation(s)
- Emily E Hohman
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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49
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Nicoll R, McLaren Howard J. The acid-ash hypothesis revisited: a reassessment of the impact of dietary acidity on bone. J Bone Miner Metab 2014; 32:469-75. [PMID: 24557632 DOI: 10.1007/s00774-014-0571-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 01/16/2014] [Indexed: 12/11/2022]
Abstract
The acid-ash hypothesis states that when there are excess blood protons, bone is eroded to provide alkali to buffer the net acidity and maintain physiologic pH. There is concern that with the typical Western diet, we are permanently in a state of net endogenous acid production, which is gradually reducing bone. While it is clear that a high acid-producing diet generates increased urinary acid and calcium excretion, the effect of diet does not always have the expected results on BMD, fracture risk and markers of bone formation and resorption, suggesting that other factors are influencing the effect of acid/alkali loading on bone. High dietary protein, sodium and phosphorus intake, all of which are necessary for bone formation, were thought to be net acid forming and contribute to low BMD and fracture risk, but appear under certain conditions to be beneficial, with the effect of protein being driven by calcium repletion. Dietary salt can increase short-term markers of bone resorption but may also trigger 1,25(OH)2D synthesis to increase calcium absorption; with low calcium intake, salt intake may be inversely correlated with BMD but with high calcium intake, salt intake was positively correlated with BMD. With respect to the effect of phosphorus, the data are conflicting. Inclusion of an analysis of calcium intake may help to reconcile the contradictory results seen in many of the studies of bone. The acid-ash hypothesis could, therefore, be amended to state that with an acid-producing diet and low calcium intake, bone is eroded to provide alkali to buffer excess protons but where calcium intake is high the acid-producing diet may be protective.
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Affiliation(s)
- Rachel Nicoll
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umeå, Sweden,
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50
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Abstract
The process of bone mineralization and resorption is complex and is affected by numerous factors, including dietary constituents. Although some dietary factors involved in bone health, such as calcium and vitamin D, are typically associated with dairy products, plant-based sources of these nutrients also supply other key nutrients involved in bone maintenance. Some research suggests that vegetarian diets, especially vegan diets, are associated with lower bone mineral density (BMD), but this does not appear to be clinically significant. Vegan diets are not associated with an increased fracture risk if calcium intake is adequate. Dietary factors in plant-based diets that support the development and maintenance of bone mass include calcium, vitamin D, protein, potassium, and soy isoflavones. Other factors present in plant-based diets such as oxalic acid and phytic acid can potentially interfere with absorption and retention of calcium and thereby have a negative effect on BMD. Impaired vitamin B-12 status also negatively affects BMD. The role of protein in calcium balance is multifaceted. Overall, calcium and protein intakes in accord with Dietary Reference Intakes are recommended for vegetarians, including vegans. Fortified foods are often helpful in meeting recommendations for calcium and vitamin D. Plant-based diets can provide adequate amounts of key nutrients for bone health.
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