Dietary calcium and chronic diseases

Anti-Tumor Effect of Vitamin D Combined with Calcium on Lung Cancer: A Systematic Review and Meta-Analysis

Although many studies have demonstrated the impact of vitamin D and calcium on lung cancer, it remains the discrepancy for the effect of vitamin D and calcium on lung cancer. In this study, we aimed to verify the roles of vitamin D and calcium in the incidence and prognosis of lung cancer. A systematic literature search was performed by February 29, 2020. The relative risks (RRs) and hazard ratio (HRs) were pooled to evaluate the risk for the incidence and mortality of lung cancer. A total of 58,625 lung cancer cases from 40 studies were included. The risk (RR: 0.915, 95% Cl: 0.849-0.986) and mortality (RR: 0.718, 95% Cl: 0.530-0.973) of lung cancer were significantly decreased due to high circulating 25(OH)D level. Although the separate intake of vitamin D (RR: 0.909, 95% Cl: 0.801-1.031) and calcium (RR: 0.890, 95% Cl: 0.741-1.070) did not exhibit a protective effect on lung cancer, the combination supplement of vitamin D and calcium significantly decreased the incidence of lung cancer (RR: 0.811, 95% Cl: 0.659-0.999). High level of serum 25(OH)D could play the preventive role in lung cancer. Furthermore, vitamin D could be supplemented together with calcium against lung cancer.

Nutrient intakes linked to better health outcomes are associated with higher diet costs in the US

PURPOSE

Degrees of nutrient intake and food groups have been linked to differential chronic disease risk. However, intakes of specific nutrients may also be associated with differential diet costs and unobserved differences in socioeconomic status (SES). The present study examined degrees of nutrient intake, for every key nutrient in the diet, in relation to diet cost and SES.

METHODS

Socio-demographic data for a stratified random sample of adult respondents in the Seattle Obesity Study were obtained through telephone survey. Dietary intakes were assessed using food frequency questionnaire (FFQ) (n = 1,266). Following standard procedures, nutrient intakes were energy-adjusted using the residual method and converted into quintiles. Diet cost for each respondent was estimated using Seattle supermarket retail prices for 384 FFQ component foods.

RESULTS

Higher intakes of dietary fiber, vitamins A, C, D, E, and B12, beta carotene, folate, iron, calcium, potassium, and magnesium were associated with higher diet costs. The cost gradient was most pronounced for vitamin C, beta carotene, potassium, and magnesium. Higher intakes of saturated fats, trans fats and added sugars were associated with lower diet costs. Lower cost lower quality diets were more likely to be consumed by lower SES.

CONCLUSION

Nutrients commonly associated with a lower risk of chronic disease were associated with higher diet costs. By contrast, nutrients associated with higher disease risk were associated with lower diet costs. The cost variable may help somewhat explain why lower income groups fail to comply with dietary guidelines and have highest rates of diet related chronic disease.

Vitamin D and calcium deficits predispose for multiple chronic diseases

There is evidence from both observational studies and clinical trials that calcium malnutrition and hypovitaminosis D are predisposing conditions for various common chronic diseases. In addition to skeletal disorders, calcium and vitamin D deficits increase the risk of malignancies, particularly of colon, breast and prostate gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel disease, multiple sclerosis), as well as of metabolic disorders (metabolic syndrome, hypertension). The aim of the present review was to provide improved understanding of the molecular and cellular processes by which deficits in calcium and vitamin D cause specific changes in cell and organ functions and thereby increase the risk for chronic diseases of different aetiology. 1,25-Dihydroxyvitamin D(3) and extracellular Ca(++) are both key regulators of proliferation, differentiation and function at the cellular level. However, the efficiency of vitamin D receptor-mediated intracellular signalling is limited by the negative effects of hypovitaminosis D on extrarenal 25-hydroxyvitamin D-1alpha-hydroxylase activity and thus on the production of 1,25-dihydroxyvitamin D(3). Calcium malnutrition eventually causes a decrease in calcium concentration in extracellular fluid compartments, resulting in organ-specific modulation of calcium-sensing receptor activity. Hence, attenuation of signal transduction from the ligand-activated vitamin D receptor and calcium-sensing receptor seems to be the prime mechanism by which calcium and vitamin D insufficiencies cause perturbation of cellular functions in bone, kidney, intestine, mammary and prostate glands, endocrine pancreas, vascular endothelium, and, importantly, in the immune system. The wide range of diseases associated with deficits in calcium and vitamin D in combination with the high prevalence of these conditions represents a special challenge for preventive medicine.

Calcium or resistant starch does not affect colonic epithelial cell proliferation throughout the colon in adenoma patients: a randomized controlled trial

Patients with a history of sporadic adenomas have increased epithelial cell proliferative activity, an intermediate risk marker for colorectal cancer. Reduction of proliferation by dietary intervention may reflect a decreased colorectal cancer risk. To evaluate whether calcium or resistant starch could reduce proliferative activity throughout the colon, we performed a randomized controlled trial in 111 sporadic adenoma patients. Patients received two placebos, 1 g of calcium + placebo, or 30 g of amylomaize (19 g of resistant starch) + placebo. After 2 mo, biopsies were collected from the cecum, transverse and sigmoid colon, and rectum during colonoscopy. Epithelial cell proliferation was determined by dividing the number of 5-bromo-2-deoxyuridine-labeled nuclei by the total number of nuclei x 100 (labeling index, LI). LI of luminal, mid, and basal compartments was determined. Twenty-five patients dropped out. In the remaining 86 patients (28 treated with placebo, 30 with calcium + placebo, and 28 with resistant starch + placebo), no difference was observed in total LI, the LI of the three compartments, or the crypt length in the four areas of the colorectum. Colonic epithelial cell proliferative activity throughout the colon of sporadic adenoma patients is not affected by supplementation with 1 g of calcium or 19 g of resistant starch.

Calcium affects biomarkers of colon carcinogenesis after right hemicolectomy

BACKGROUND

In Western societies colonic cancer most frequently develops in the distal colon, largely as a result of the composition of the diet. Modulation of dietary factors is therefore an attractive modality to reduce colorectal cancer risk. This study aims to evaluate the potentially protective effects of calcium in right hemicolectomy patients.

MATERIALS AND METHODS

A randomized controlled cross-over intervention trial was performed with 1000 mg of elemental calcium per day for 2 months in 15 right hemicolectomy patients. Primary endpoints were proliferative activity, determined by immunohistochemical detection of BrdU-labeled cells (LI) in rectal biopsies, and cytotoxicity and alkaline phosphatase activity of faecal water. Secondary endpoints were bile acid composition in faeces.

RESULTS

Calcium-reduced LI in the superficial one-third of the crypt (from 0.84 +/- 0.27% to 0.37 +/- 0.08%, P = 0.04) and a trend towards a lower total LI and LI in the mid one-third of the crypt was observed. Alkaline phosphatase activity was reduced from 6.2 +/- 2.6 U mL-1 in the placebo period to 4.6 +/- 2.2 in the calcium period (P = 0.02), and a trend toward a lower cytotoxicity of faecal water was observed. No effect on total bile acids in faeces was observed, but calcium increased the percentage of deoxycholic acid (from 49.6 +/- 7.0% to 56.5 +/- 6.2%, P = 0.03) and decreased the percentages of cholic acid (from 10.3 +/- 4.7% to 5.8 +/- 2.7%, P = 0.05) and lithocholic acid (from 26.7 +/- 3.4% to 23.9 +/- 2.9%, P = 0.04).

CONCLUSION

Calcium may have a protective effect against colorectal cancer risk in right hemicolectomy patients.

Calcium: taste, intake, and appetite

This review summarizes research on sensory and behavioral aspects of calcium homeostasis. These are fragmented fields, with essentially independent lines of research involving gustatory electrophysiology in amphibians, ethological studies in wild birds, nutritional studies in poultry, and experimental behavioral studies focused primarily on characterizing the specificity of the appetite in rats. Recently, investigators have begun to examine potential physiological mechanisms underlying calcium intake and appetite. These include changes in the taste perception of calcium, signals related to blood calcium concentrations, and actions of the primary hormones of calcium homeostasis: parathyroid hormone, calcitonin, and 1,25-dihydroxyvitamin D. Other influences on calcium intake include reproductive and adrenal hormones and learning. The possibility that a calcium appetite exists in humans is discussed. The broad range of observations documenting the existence of a behavioral limb of calcium homeostasis provides a strong foundation for future genetic and physiological analyses of this behavior.

Pentadecanoic acid in serum as a marker for intake of milk fat: relations between intake of milk fat and metabolic risk factors

BACKGROUND

The fatty acid composition of the diet is known to be partially reflected by the fatty acid composition of serum lipids.

OBJECTIVE

We examined whether pentadecanoic acid (15:0) in serum lipids can be used as a marker for intake of milk fat, the major dietary source of 15:0. We also investigated the relations between intake of milk fat and cardiovascular disease risk factors.

DESIGN

Sixty-two 70-y-old men completed 7-d dietary records. The intake of milk products was studied in relation to the proportions of 15:0 in serum cholesterol esters and phospholipids, as well as to the clinical characteristics of these men, by using Spearman's rank correlation.

RESULTS

The proportions of 15:0 in serum cholesterol esters were positively related to butter intake (r = 0.36. P = 0.004) and to the total amount of fat from milk products (r = 0.46, P < 0.0001): 15:0 in phospholipids was related to the amount of fat from milk and cream (r = 0.34, P = 0.008) and to the total amount of fat from milk products (r = 0.34, P = 0.008). Inverse associations were found between intake of milk products and body mass index, waist circumference, LDL-HDL ratio, HDL triacylglycerols, and fasting plasma glucose, whereas relations to HDL cholesterol and apolipoprotein A-I tended to be positive.

CONCLUSIONS

The results suggest that 15:0 in serum can be used as a marker for intake of milk fat. The explanation for the inverse associations between the intake of milk products and certain cardiovascular risk factors is not known.

Influence of calcium on proliferation and phenotype alteration of cardiomyocyte in vitro

An accelerated weight gain is noted in the heart of Ca-deficient, hypertensive chick embryos maintained in a shell-less culture in vitro. We previously observed that the Ca handling property of cardiomyocytes isolated from the shell-less embryo is altered, i.e., faster Ca uptake, suggesting a requirement for adequate Ca supply and/or proper Ca handling in embryonic cardiac development. In this study, we have examined the function of Ca on cardiomyocytes by analyzing the effects of 1) various Ca concentration in the culture medium (NCa, 1.8 mmol/ L; HCa, 2.8 mmol/L; LCa, 0.9 mmol/L), and 2) various modulators of Ca handling on cell proliferation and phenotype regulation in chick embryonic cardiomyocytes. The analytical parameters included cell number, DNA content, expression of cell cycle-specific and cardiomyocyte-specific proteins, and creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) enzyme activities. Cell number and total DNA were significantly larger (P < 0.01) in LCa cultures compared with those in NCa. The level of LDH was elevated (P < 0.01), but that of CPK was lowered in LCa. Expression of the G1-S-specific protein PCNA was raised, but that of the contractile proteins myosin and tropomyosin was substantially suppressed in LCa; in HCa, the cells did not proliferate as well, whereas the level of contractile proteins was higher. Thapsigargin, a sarcoplasmic reticulum (SR)-specific, Ca-ATPase inhibitor, simulated the effects of LCa by enhancing cell proliferation and lowering the expression of tropomyosin. These results suggest that culturing in low Ca concentration and inhibition of SR Ca pumping enhance myocardial cell proliferation and suppress sarcomeric protein expression, perhaps by inducing cellular de-differentiation. The in vitro effects of medium Ca concentration and Ca handling modulators on cardiomyocytes also suggest that the in vivo cardiomegaly of the SL embryos is a direct result of Ca-deficiency, and that Ca is important in the phenotype regulation of cardiomyocytes.

Bioavailability of calcium of fresh cheeses, enteral food and mineral water. A study with stable calcium isotopes in young adult women

True fractional Ca absorption from six foods was measured in twelve normal healthy women, aged 20-29 years. The tested foods were commercially available fresh cheese, fresh cheese prepared by new technology and rich in Ca, similar cheese with added Fe, enteral food, mineral water alone and combined with a spaghetti meal. The aim of the study was to investigate: (1) Ca absorption from a new Ca-rich fresh cheese and to compare it with that from the traditional commercial type of fresh cheese; (2) the effect of Fe enrichment of the new cheese on Ca absorption; (3) Ca absorption from the mineral water and the enteral product and to compare it with that from the dairy products; (4) the effect of a meal combined with the mineral water on Ca absorption. All test foods were consumed by all subjects according to a design with two Latin squares. Each treatment of 2 d was followed by a wash-out period of 2 weeks. Ca absorption was measured using a double stable-isotope (44Ca and 48Ca) extrinsic labelling technique. Mean fractional Ca absorption from the new fresh cheese was not significantly different from that from the traditional type (37.7 (SD 10.2)% v. 42.2 (SD 11.6)%). The addition of Fe to the new cheese did not significantly influence Ca absorption. Ca-absorption values from the mineral water (37.0 (SD 9.8)%) and from the enteral product (42.6 (SD 11.4)%) were not significantly different from those from the dairy products (37.7-42.2%, SD 10.2-11.6%). The co-ingestion of a spaghetti meal with the mineral water significantly enhanced Ca absorption from 37 (SD 9.8)% to 46.1 (SD 11.7)%. It is concluded that a new process leading to a fresh cheese with a higher Ca concentration does not alter Ca bioavailability compared with the standard technology and for a constant Ca supply. Thus this new fresh cheese would probably provide more Ca than the standard one. The fractional Ca-absorption values for mineral water and the enteral product indicate that these products can make an interesting contribution to Ca supply for populations with a low Ca intake and patients with specific diseases respectively.

Measurement of the daily dietary calcium and magnesium intake in Belgium, using duplicate portion sampling

The daily dietary calcium and magnesium intakes in Belgium were evaluated by sampling duplicate portions of food, destruction in a microwave oven and their calcium and magnesium contents determined by atomic absorption spectroscopy. The mean intake value for calcium (618 +/- 125 mg/day) was found to be less than those values measured in most other countries and was below the recommended daily allowance (RDA). The mean intake value for magnesium (271 +/- 44 mg/day) was similar to levels found in most other countries, but was below the RDA value for healthy adult men (350 mg/day) whilst being adequate for healthy women (280 mg/day).

A review of calcium preparations

There are more than a dozen commonly prescribed calcium supplements and hundreds of different formulations commercially available. Numerous factors need to be considered when selecting a calcium preparation. Physical properties such as solubility, interference from coingested medications or foodstuffs, dosage, and timing can all affect the bioavailability of calcium. Medical conditions such as lactose intolerance, impaired gastric acid secretion, and high risk profile for kidney stone formation may impact on selection of a calcium supplement. This article will review the available literature and make general recommendations for the optimal use of calcium preparations.

Alterations in cellular calcium handling as a result of systemic calcium deficiency in the developing chick embryo: I. Erythrocytes

Chick embryos rendered calcium (Ca) deficient by shell-less (SL) culture develop hypertension and tachycardia. Since hypocalcemia is accompanied by hypernatremia systemically but not by lower cellular Ca (Koide and Tuan, 1989), we speculate that cellular Ca handling may be altered in the SL embryo, perhaps involving Na transport. Using erythrocytes (RBC) from day-14 SL and normal (NL) embryos as the experimental cell, cellular Ca handling was studied under varying extracellular osmotic and ionic conditions by analyzing 45Ca uptake and cell volume regulation. Two agents, p-chloromercuriphenylsulfonate (PCM), and inosine/iodoacetamide (INI) were used to treat the RBCs to modify plasma membrane ion permeability and to deplete cellular ATP, respectively. Other cellular functions and activities related to Ca homeostasis, including ATP content and Ca(2+)-ATPase activity, were also analyzed. These analyses showed: (1) in NaCl, Ca uptake was similar in NL and SL cells, except after INI treatment, which resulted in slower Ca uptake by the SL cells, (2) in choline and sucrose, Ca uptake by SL RBCs was higher, (3) Ca uptake by RBCs of both embryos changed depending on the osmotic agent (Na < K < or = choline < sucrose), (4) Ca(2+)-ATPase activity was higher in SL RBC, although there was no change in the size or charge of the enzyme, and (5) in any osmotic agent, cellular Na was significantly lower, whereas cellular K was higher, in SL RBC. Based on these results, three features of RBC Ca handling were apparent: (1) Na-Ca exchange was functional and was more active in SL RBCs, (2) Ca uptake was dependent on the total ionic electrochemical gradient but not on bulk H2O movement, and (3) Ca pumping out capacity was directly correlated with Ca(2+)-ATPase activity. Elevated Ca uptake in sucrose-treated SL RBC is therefore indicative of its greater ion permeability. Taken together, these findings indicate that cellular Ca handling of the RBCs of SL chick embryos is characterized by a more active Na-Ca exchange system, greater ion permeability, and higher Ca pumping out capacity, thereby suggesting an up-regulated Ca handling function in the SL RBCs. The abnormal cellular Ca handling may be a direct result of the systemic Ca deficiency of the SL chick embryo and may be functionally related to its hypertension and tachycardia.

Calcium intake in youth: sex, age, and racial differences in NHANES II

METHODS

Data from the NHANES II survey were used to determine whether the calcium intake of children ages 3-18 met the minimum recommended daily allowance. In addition, the impact of age, race, sex, and socioeconomic status on calcium intake and the density of calcium intake was explored.

RESULTS

The results indicated significant differences between groups of children based on age, sex, and race (P less than 0.05). Males across all age groups (3-5, 6-7, 8-10, 11-12, 13-18) had a higher calcium intake than females. In addition, calcium intake levels among males always met or exceeded the minimum RDA. Levels among all blacks started below the minimum RDA in the age group 3-5. During the adolescent years, calcium intake again fell below the RDA for black males and for females of both races, with the calcium intake of the adolescent females resembling that of the group ages 3-5. In a multiple regression model sex, age, race, and total energy intake predicted 49% (P less than 0.0001) of the variance in calcium intake. Socioeconomic status (using parents' reported income) was not a significant predictor. Another regression model was used to examine the relationship among age, race, sex, and socioeconomic status and its effect on the density of calcium intake (mg/kcal). While the overall model was significant (P less than 0.0001) it accounted for only 3.5% of the variance.

CONCLUSION

Age, sex, and race of the child significantly predicted the density of calcium (P less than 0.05); however, parents' gross income did not (P less than 0.81), indicating that income level does not contribute to explaining these differences.

The scientific basis of recommended dietary allowances for calcium

Dietary calcium is required for bone development during growth (attainment of peak bone mass), for maintenance of skeletal integrity during adult life, and thus for prevention of osteoporosis. The Recommended Dietary Allowance (RDA) of a nutrient for a particular group is considered to cover the needs of 98% of all individuals of that group, and thus takes into account a margin of safety to allow for interindividual variation in minimum requirements. It appears to be possible, on the basis of the available scientific literature, to calculate the daily amount of calcium that must be absorbed from the diet to compensate for the endogenous calcium losses (through urine, faeces and skin) and the calcium retention in bone. Similarly, it seems to be possible to obtain a reasonable estimate of calcium absorption for the different groups of the population. From these data, and taking into account a margin of safety, figures are obtained for calcium intake that are in reasonably close agreement with the authoritative 1989 RDAs of the USA Food and Nutrition Board, with the exception of the USA allowance for girls aged 19-25 years (probably too high) and older adults (possibly too low). With regard to optimal calcium intake, some important questions still remain unanswered. These bear upon the issue of calcium intake and peak bone mass development, and upon the effects of non-nutritional factors (e.g. genetics and physical activity) and nutritional factors (e.g. sodium, protein, alcohol and caffeine) on calcium requirements. Furthermore, it would appear that bone development and maintenance of bone health may not be the sole criteria for setting RDAs in the near future. These issues are briefly discussed.