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Tedesco A, Sharma AK, Acharya N, Rublev G, Hashmi S, Wu HH, Lee YP, Scolaro J, Bhatia N. The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes. JBJS Rev 2024; 12:01874474-202404000-00004. [PMID: 38619394 DOI: 10.2106/jbjs.rvw.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
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Affiliation(s)
- Amanda Tedesco
- School of Medicine, University of California, Irvine, Irvine, California
| | - Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nischal Acharya
- School of Medicine, University of California, Irvine, Irvine, California
| | - George Rublev
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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2
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Lalayiannis AD, Soeiro EMD, Moysés RMA, Shroff R. Chronic kidney disease mineral bone disorder in childhood and young adulthood: a 'growing' understanding. Pediatr Nephrol 2024; 39:723-739. [PMID: 37624528 PMCID: PMC10817832 DOI: 10.1007/s00467-023-06109-3] [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: 04/19/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023]
Abstract
Chronic kidney disease (CKD) mineral and bone disorder (MBD) comprises a triad of biochemical abnormalities (of calcium, phosphate, parathyroid hormone and vitamin D), bone abnormalities (turnover, mineralization and growth) and extra-skeletal calcification. Mineral dysregulation leads to bone demineralization causing bone pain and an increased fracture risk compared to healthy peers. Vascular calcification, with hydroxyapatite deposition in the vessel wall, is a part of the CKD-MBD spectrum and, in turn, leads to vascular stiffness, left ventricular hypertrophy and a very high cardiovascular mortality risk. While the growing bone requires calcium, excess calcium can deposit in the vessels, such that the intake of calcium, calcium- containing medications and high calcium dialysate need to be carefully regulated. Normal physiological bone mineralization continues into the third decade of life, many years beyond the rapid growth in childhood and adolescence, implying that skeletal calcium requirements are much higher in younger people compared to the elderly. Much of the research into the link between bone (de)mineralization and vascular calcification in CKD has been performed in older adults and these data must not be extrapolated to children or younger adults. In this article, we explore the physiological changes in bone turnover and mineralization in children and young adults, the pathophysiology of mineral bone disease in CKD and a potential link between bone demineralization and vascular calcification.
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Affiliation(s)
- Alexander D Lalayiannis
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
| | | | - Rosa M A Moysés
- Sao Paulo University Faculty of Medicine, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
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Mak RH, Iyengar A, Lai WM, McAlister L, Oliveira EA, Xu H, Yap HK, Shroff R. Nutrition in Children With Chronic Kidney Disease: How to Thrive? J Ren Nutr 2023; 33:S49-S55. [PMID: 37558172 DOI: 10.1053/j.jrn.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/21/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
The nutritional status and management of children with chronic kidney disease (CKD) are complex and require a combined pediatric nephrology team work approach with physicians, nutritionists, nurses, and physical/occupational therapists. Prospective observational studies such as Children with CKD in the US, the 4C study in Europe and the International Pediatric Peritoneal Dialysis Network have advanced the field. However, most recommendations and guidelines from international task forces such as Kidney Diseases Improving Global Outcomes and Pediatric Renal Nutrition Taskforce are opinion-based rather than evidence-based. There is exciting ongoing research to improve nutrition in children with CKD to help them thrive.
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Affiliation(s)
- Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California San Diego, La Jolla.
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bangalore, India
| | - Wai Ming Lai
- Paediatric Nephrology Center, Hong Kong Children's Hospital, Hong Kong
| | | | - Eduardo A Oliveira
- Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Hong Xu
- Department of Pediatric Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Hui Kim Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rukshana Shroff
- Division of Paediatric Nephrology, Institute of Child Health, London, United Kingdom
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Saunders RK, Kilroe KM, Joseph TV, Caksa S, Bouxsein ML, Misra M, Mitchell DM. Total Calcium Intake Is Associated With Trabecular Bone Density in Adolescent Girls With Type 1 Diabetes. JBMR Plus 2023; 7:e10813. [PMID: 38025039 PMCID: PMC10652183 DOI: 10.1002/jbm4.10813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Type 1 diabetes (T1D) confers an increased risk of fracture and is associated with lower bone mineral density (BMD) and altered microarchitecture compared with controls. Adequate calcium (Ca) intake promotes bone mineralization, thereby increasing BMD. The objective of this analysis was to evaluate the associations of total daily Ca intake with bone outcomes among youth with T1D. This was a cross-sectional analysis of girls ages 10-16 years with (n = 62) and without (n = 60) T1D. We measured Ca intake with a validated food-frequency questionnaire and BMD, microarchitecture, and strength estimates with dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Total daily Ca intake did not differ between groups (950 ± 488 in T1D versus 862 ± 461 mg/d in controls, p = 0.306). Serum 25OHD was lower in T1D (26.3 ± 7.6 versus 32.6 ± 9.0 ng/mL, p = <0.001), and parathyroid hormone (PTH) was higher in T1D (38.9 ± 11 versus 33.4 ± 9.7 pg/mL, p = 0.004). Trabecular volumetric BMD and thickness at the tibia were lower in T1D (p = 0.013, p = 0.030). Ca intake correlated with trabecular BMD at the radius and tibia among T1D participants (β = 0.27, p = 0.047, and β = 0.28, p = 0.027, β = 0.28, respectively) but not among controls (pinteraction = 0.009 at the radius, pinteraction = 0.010 at the tibia). Similarly, Ca intake was associated with estimated failure load at the tibia in T1D but not control participants (p = 0.038, β = 0.18; pinteraction = 0.051). We observed the expected negative association of Ca intake with parathyroid hormone in controls (p = 0.022, β = -0.29) but not in T1D participants (pinteraction = 0.022). Average glycemia as measured by hemoglobin A1c did not influence the relationship of Ca and PTH among participants with T1D (pinteraction = 0.138). These data suggest that youth with T1D may be particularly vulnerable to dietary Ca insufficiency. Increasing Ca intake may be an effective strategy to optimize bone health in this population. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Rylee K Saunders
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Kathleen M Kilroe
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Taïsha V. Joseph
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Signe Caksa
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Mary L Bouxsein
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
- Center for Advanced Orthopaedic StudiesBeth Israel Deaconness Medical Center and Harvard Medical SchoolBostonMAUSA
| | - Madhusmita Misra
- Division of Pediatric EndocrinologyMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Deborah M Mitchell
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
- Division of Pediatric EndocrinologyMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
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Harriet G, Korula S, Rebekah G, Kapoor N, Cherian KE, Jose A, Mathai S, Paul TV. Bone Mineral Density and Serum Bone Turnover Markers among Post-Menarchal Girls from Rural South India. Indian J Endocrinol Metab 2023; 27:242-248. [PMID: 37583403 PMCID: PMC10424113 DOI: 10.4103/ijem.ijem_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 08/17/2023] Open
Abstract
Background The data on the bone mineral density (BMD) and bone turnover markers (BTMs) in Indian adolescents are limited. Objectives To assess BMD at lumbar spine (LS, L1-L4) and femoral neck (FN) in South Indian post-menarchal girls and correlate it with dietary calcium intake (mg/day), physical activity score and post-menarchal years. The study also assessed serum BTMs and their correlation with chronological age in the study population. Methods This cross-sectional study included apparently healthy post-menarchal adolescent girls aged 12-16 years randomly selected from the community. Participants with vitamin D deficiency were excluded. The data on calcium intake and physical activity were obtained using validated questionnaires. All participants were evaluated with serum calcium, 25-hydroxy vitamin D, parathyroid hormone, N-terminal propeptide of type 1 collagen (P1NP) and Beta-CrossLaps (CTx) and BMD at LS and FN using dual X-ray absorptiometry (DXA). Statistical Analysis EpiData version 3.1 was used for the data entry. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Continuous variables were expressed as mean ± SD. Pearson's correlation coefficient (r) was calculated, and two-tailed Kendall's tau-b test was used for assessing correlation of all nonparametric measures. Results A total of 103 participants were screened, and data from 77 were analysed. There was a significant positive correlation of BMD at LS with chronological age (r: +0.235, P = 0.036), but not at FN. Positive correlation of BMD with increase in post-menarchal years was also noted at LS (r: +0.276, P = 0.015). There was no significant association of BMD with calcium intake and physical activity scores at both sites. There was a significant negative correlation of serum BTMs with age CTx (r: -0.596, P = 0.0001) and P1NP (r: -0.505, P = 0.0001). Conclusion This study provides insight into the reference BMD range at LS spine and FN in South Indian rural post-menarchal adolescent girls. BMD positively correlated, whereas BTMs negatively correlated with age. The study also provides the first Indian reference range for serum BTMs in this age group.
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Affiliation(s)
- Gibeah Harriet
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Sophy Korula
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - Arun Jose
- Department of Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - Sarah Mathai
- Paeditaric Endocrinology and Metabolism Division, Paediatric Unit-1, Department of Paediatrics, Vellore, India
| | - Thomas V. Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
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Li BY, Mahe JL, Hao JY, Ye WH, Bai XF, Feng HT, Szeto IMY, Jing LP, Zhao ZF, Chen YM. Formula Milk Supplementation and Bone Acquisition in 4-6 Years Chinese Children: A 12-Month Cluster-Randomized Controlled Trial. Nutrients 2023; 15:nu15082012. [PMID: 37111231 PMCID: PMC10143222 DOI: 10.3390/nu15082012] [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: 02/25/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Dairy foods are crucial for adequate calcium intake in young children, but scarce data are available on the effects of formula milk on bone acquisition. This cluster-randomized controlled trial investigated the effects of the supplementation of formula milk on bone health in rural children accustomed to a low-calcium diet between September 2021 and September 2022. We recruited 196 healthy children aged 4-6 years from two kindergartens in Huining County, Northwest China. A class-based randomization was used to assign them to receive 60 g of formula milk powder containing 720 mg calcium and 4.5 µg vitamin D or 20-30 g of bread per day for 12 months, respectively. Bone mineral density (BMD) and bone mineral content (BMC) at the left forearm and calcaneus, bone biomarkers, bone-related hormones/growth factors, and body measures were determined at baseline, 6, and 12 months. A total of 174 children completed the trial and were included in the analysis. Compared with the control group, formula milk intervention showed significant extra increments in BMD (3.77% and 6.66%) and BMC (4.55% and 5.76%) at the left forearm at 6th and 12th months post-intervention (all p < 0.001), respectively. Similar trends were observed in BMD (2.83%) and BMC (2.38%) in the left calcaneus at 6 months (p < 0.05). The milk intervention (vs. control) also showed significant changes in the serum concentrations of osteocalcin level (-7.59%, p = 0.012), 25-hydroxy-vitamin-D (+5.54%, p = 0.001), parathyroid hormone concentration (-15.22%, p = 0.003), and insulin-like growth factor 1 (+8.36%, p = 0.014). The percentage increases in height were 0.34%, 0.45%, and 0.42% higher in the milk group than in the control group after 3-, 6-, and 9-month intervention, respectively (p < 0.05). In summary, formula milk supplementation enhances bone acquisition at the left forearm in young Chinese children.
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Affiliation(s)
- Bang-Yan Li
- Department of Epidemiology, School of Public Health, Sun Yet-sen University, Guangzhou 510080, China
| | - Jin-Li Mahe
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Jing-Yu Hao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Wen-Hui Ye
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Xue-Fei Bai
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Hao-Tian Feng
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Li-Peng Jing
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Zi-Fu Zhao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Yu-Ming Chen
- Department of Epidemiology, School of Public Health, Sun Yet-sen University, Guangzhou 510080, China
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Rong K, Lang Y, Zhou Y, Ni L, Wang L, Wang L, Zhang Y, Wen F, Wang Z, Chen P. Risk Genetic Variants ( IL-10) for Osteoporosis in Han Population from Northwest China. J Inflamm Res 2023; 16:1091-1102. [PMID: 36941985 PMCID: PMC10024466 DOI: 10.2147/jir.s396914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
Background Osteoporosis (OP) is a common metabolic bone disease characterized by loss of bone mass. IL-10 is considered to be a powerful immune and inflammatory suppressor. This study aimed to assess association between genetic loci in IL-10 and susceptibility to OP. Methods Association analysis between IL-10 genetic loci and OP risk through SNPStats online software. FPRP analysis (false-positive report probability) verified whether the positive results were noteworthy findings. Linkage disequilibrium (LD) and haplotype analysis were completed by Haploview 4.2 and SNPStats. Multi-factor dimensionality reduction (MDR) was used to assess interaction of SNP-SNP in susceptibility to OP. Results Allele "G" of IL-10-rs1554286 (OR = 1.21, p = 0.013), allele "C" of IL-10-rs1518111 (OR = 1.22, p = 0.011), allele "C" of IL-10-rs3024490 (OR = 1.20, p = 0.018), and allele "G" of IL-10-rs1800871 (OR = 1.21, p = 0.015) were risk factors for OP. In females, smoking, drinking, or aging ≤60 years old participants, the above genetic loci are also significantly associated with the increased risk of OP. FPRP analysis showed that all positive results are noteworthy findings. There are significant differences in serum levels of uric acid, mean hemoglobin concentration, or mean hemoglobin among different genotypes of IL-10 gene loci. MDR showed that four loci model composed rs1554286, rs1518111, rs3021094, and rs1800871 is the best model for predicting OP risk. Conclusion IL-10-rs1554286, -rs1518111, -rs3021094, and -rs1800871 are risk factors for susceptibility to OP.
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Affiliation(s)
- Kai Rong
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Yi Lang
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Yubo Zhou
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Liangtao Ni
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Lei Wang
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Long Wang
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Yaowu Zhang
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Fengli Wen
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Zhan Wang
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
| | - Pingbo Chen
- Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Wulumuqi, Xinjiang, People’s Republic of China
- Correspondence: Pingbo Chen, Department of Traumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, No. 116, Huanghe Street, Wulumuqi, Xinjiang, People’s Republic of China, Tel/Fax +86-13899907800, Email
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Liu Y, Le S, Liu Y, Jiang H, Ruan B, Huang Y, Ao X, Shi X, Fu X, Wang S. The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials. eLife 2022; 11:79002. [PMID: 36164828 PMCID: PMC9514846 DOI: 10.7554/elife.79002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of calcium supplementation on bone mineral accretion in people under 35 years old is inconclusive. To comprehensively summarize the evidence for the effect of calcium supplementation on bone mineral accretion in young populations (≤35 years). Methods: This is a systematic review and meta-analysis. The Pubmed, Embase, ProQuest, CENTRAL, WHO Global Index Medicus, Clinical Trials.gov, WHO ICTRP, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases were systematically searched from database inception to April 25, 2021. Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old. Results: This systematic review and meta-analysis identified 43 studies involving 7,382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (standardized mean difference [SMD] 0.627, 95% confidence interval [CI] 0.338–0.915; SMD 0.364, 95% CI 0.134–0.595; respectively) and total body (SMD 0.330, 95% CI 0.163–0.496; SMD 0.149, 95% CI 0.006–0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008–0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peripeak bone mass (PBM) population (20–35 years) than the pre-PBM population (<20 years). Conclusions: Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation significantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis. Funding: This work was supported by Wenzhou Medical University grant [89219029]. Osteoporosis and bone fractures are common problems among older people, particularly older women. These conditions cause disability and reduce quality of life. Progressive loss of bone mineral density is usually the culprit. So far, strategies to prevent bone weakening with age have produced disappointing results. For example, taking calcium supplements in later life only slightly reduces the risk of osteoporosis or fracture. New approaches are needed. Bone mass increases gradually early in life and peaks and plateaus around 20-35 years of age. After that period, bone mass slowly declines. Some scientists suspect that increasing calcium intake during this period of peak bone mass may reduce osteoporosis or fracture risk later in life. A meta-analysis by Liu, Le et al. shows that boosting calcium intake in young adulthood strengthens bones. The researchers analyzed data from 43 randomized controlled trials that enrolled 7,382 participants. About half the studies looked at the effects of taking calcium supplements and the other half analyzed the effects of a high calcium diet. Boosting calcium intake in people younger than age 35 improved bone mineral density throughout the body. It also increased bone mineral density at the femoral neck, where most hip fractures occur. Calcium supplementation produced larger effects in individuals between the ages of 20 and 35 than in people younger than 20. Both high calcium diets and calcium supplements with doses less than 1000 mg/d boosted bone strength. Higher dose calcium supplements did not provide any extra benefits. The analysis suggests people should pay more attention to bone health during early adulthood. Large randomized clinical trials are needed to confirm the long-term benefits of boosting calcium intake during early adulthood. But if the results are validated, taking calcium supplements, or eating more calcium-rich foods between the ages of 20 and 35 may help individuals build healthier bones and prevent fractures and osteoporosis later in life.
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Affiliation(s)
- Yupeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Siyu Le
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yi Liu
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Huinan Jiang
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Binye Ruan
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yufeng Huang
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xuemei Ao
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xudong Shi
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Fu
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Shuran Wang
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
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Association between Dietary Patterns and Physical Fitness among Chinese Children and Adolescents in Shaanxi Province. Nutrients 2022; 14:nu14183677. [PMID: 36145061 PMCID: PMC9503495 DOI: 10.3390/nu14183677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This study aims to investigate the associations between dietary patterns (breakfast, egg, dairy products, and sugared beverage intake frequencies) and physical fitness among Chinese children and adolescents in Shaanxi Province. METHODS: Data were extracted from the Chinese National Survey on Students’ Constitution and Health (CNSSCH). The study ultimately included 7305 participants (48.4% male, 51.6% female) aged 6–22 in Shaanxi Province, China. Multiple linear regression was used to examine the association of the frequency of breakfast, egg, dairy product, and sugared beverage intakes with physical fitness. RESULTS: The frequency of breakfast, egg, and dairy product intakes were all independently and positively associated with the level of physical fitness. The frequency of sugared beverage intake was negatively associated with the level of physical fitness. CONCLUSION: Healthier dietary patterns (i.e., higher breakfast, egg, and dairy product intakes and lower sugared beverage intake) were associated with greater physical fitness. Specifically, maintaining a healthy dietary pattern of breakfast, egg, and dairy product intakes can positively affect the strength and endurance performance of children and adolescents. Increased dairy product intake plays a crucial part in boosting the physical fitness total scores of children and adolescents.
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10
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Lee YA, Kwon A, Kim JH, Nam HK, Yoo JH, Lim JS, Cho SY, Cho WK, Shim KS. Clinical practice guidelines for optimizing bone health in Korean children and adolescents. Ann Pediatr Endocrinol Metab 2022; 27:5-14. [PMID: 35368191 PMCID: PMC8984748 DOI: 10.6065/apem.2244060.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Committee on Pediatric Bone Health of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for optimizing bone health in Korean children and adolescents. These guidelines present recommendations based on the Grading of Recommendations, which includes the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines include processes of bone acquisition, definition, and evaluation of low bone mineral density (BMD), causes of osteoporosis, methods for optimizing bone health, and pharmacological treatments for enhancing BMD in children and adolescents. While these guidelines provide current evidence-based recommendations, further research is required to strengthen these guidelines.
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Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University Hospital, Busan, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kye Shik Shim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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11
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Eid R, Abdelsalam M, Fathy AA, Abd-El Ghaffar DM, Elmarghany EB, El-Hanafy AA, Mostafa N, Hamdy N, Niazy NA, Hammad A, Abolenein HM. Predictors of decreased bone mineral density in childhood systemic lupus erythematosus: possible role of osteoprotegerin gene polymorphisms. J Pediatr Endocrinol Metab 2022; 35:79-87. [PMID: 34787382 DOI: 10.1515/jpem-2021-0496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to explore effects of osteoprotegerin (OPG) gene polymorphisms and other possible factors on bone mineral density (BMD) in children with systemic lupus erythematosus (SLE). METHODS Osteoprotegerin gene rs2073617 and rs3134069 were evaluated in 74 SLE patients and 100 controls then genotypes, alleles and haplotypes' frequencies were compared between cases and controls and between patients with BMD z-scores above and below -2 evaluated by dual energy X-ray absorptiometry (DEXA). Disease activity was evaluated by SLE disease activity index (SLEDAI). RESULTS The patients aged 14.01 ± 2.6 years and included 57 (77%) females and 27 (36%) patients with BMD z-score below -2. Genotypes, alleles, and haplotypes frequencies did not differ between patients and controls (p>0.05 for all). Rs3134069 GG genotype and G allele (p=0.001, 0.002) and rs2073617 TT genotype and T allele (p=0.01, 0.006) were significantly higher in patients with BMD below -2. Cumulative glucocorticoids dose, disease duration, and SLEDAI scores were higher in patients with BMD below -2 (p=0.01, 0.01, <0.001, respectively). Regression analysis showed T allele of rs2073617, duration of illness (above 36 months), and cumulative SLEDAI (above 10) as independent predictors of decreased BMD (p 0.02, 0.003, and 0.002, respectively). CONCLUSIONS This is the first study to demonstrate OPG gene influence on BMD in children with SLE. The studied SNPs are not risk for developing SLE but, rs2073617 T allele is a possible predictor for reduced BMD in SLE. Other predictors include long disease duration and high activity supporting that osteoporosis in SLE is multifactorial.
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Affiliation(s)
- Riham Eid
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha Abdelsalam
- Immunology Unit, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Immunology Department, Egypt Center for Research and Regenerative Medicine (ECRRM), Cairo, Egypt
| | - Aya A Fathy
- Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dena M Abd-El Ghaffar
- Rehabilitation and Physical Medicine Department, Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman B Elmarghany
- Rehabilitation and Physical Medicine Department, Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Aya A El-Hanafy
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nora Mostafa
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nashwa Hamdy
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nermeen A Niazy
- Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman Hammad
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hadil M Abolenein
- Pediatric Endocrinology and Diabetes Unit, Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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12
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Proia P, Amato A, Drid P, Korovljev D, Vasto S, Baldassano S. The Impact of Diet and Physical Activity on Bone Health in Children and Adolescents. Front Endocrinol (Lausanne) 2021; 12:704647. [PMID: 34589054 PMCID: PMC8473684 DOI: 10.3389/fendo.2021.704647] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
There is growing recognition of the role of diet and physical activity in modulating bone mineral density, bone mineral content, and remodeling, which in turn can impact bone health later in life. Adequate nutrient composition could influence bone health and help to maximize peak bone mass. Therefore, children's nutrition may have lifelong consequences. Also, physical activity, adequate in volume or intensity, may have positive consequences on bone mineral content and density and may preserve bone loss in adulthood. Most of the literature that exists for children, about diet and physical activity on bone health, has been translated from studies conducted in adults. Thus, there are still many unanswered questions about what type of diet and physical activity may positively influence skeletal development. This review focuses on bone requirements in terms of nutrients and physical activity in childhood and adolescence to promote bone health. It explores the contemporary scientific literature that analyzes the impact of diet together with the typology and timing of physical activity that could be more appropriate depending on whether they are children and adolescents to assure an optimal skeleton formation. A description of the role of parathyroid hormone (PTH) and gut hormones (gastric inhibitory peptide (GIP), glucagon-like peptide (GLP)-1, and GLP-2) as potential candidates in this interaction to promote bone health is also presented.
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Affiliation(s)
- Patrizia Proia
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Alessandra Amato
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Darinka Korovljev
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Sonya Vasto
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Sara Baldassano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
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13
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Rizzoli R, Biver E, Brennan-Speranza TC. Nutritional intake and bone health. Lancet Diabetes Endocrinol 2021; 9:606-621. [PMID: 34242583 DOI: 10.1016/s2213-8587(21)00119-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
Osteoporotic or fragility fractures affect one in two women and one in five men who are older than 50. These events are associated with substantial morbidity, increased mortality, and an impaired quality of life. Recommended general measures for fragility fracture prevention include a balanced diet with an optimal protein and calcium intake and vitamin D sufficiency, together with regular weight-bearing physical exercise. In this narrative Review, we discuss the role of nutrients, foods, and dietary patterns in maintaining bone health. Much of this information comes from observational studies. Bone mineral density, microstructure-estimated bone strength, and trabecular and cortical microstructure are positively associated with total protein intake. Several studies indicate that fracture risk might be lower with a higher dietary protein intake, provided that the calcium supply is sufficient. Dairy products are a valuable source of these two nutrients. Hip fracture risk appears to be lower in consumers of dairy products, particularly fermented dairy products. Consuming less than five servings per day of fruit and vegetables is associated with a higher hip fracture risk. Adherence to a Mediterranean diet or to a prudent diet is associated with a lower fracture risk. These various nutrients and dietary patterns influence gut microbiota composition or function, or both. The conclusions of this Review emphasise the importance of a balanced diet including minerals, protein, and fruit and vegetables for bone health and in the prevention of fragility fractures.
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Affiliation(s)
- René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Emmanuel Biver
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tara C Brennan-Speranza
- School of Medical Sciences and School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Barbosa JS, Pinto M, Barreiro S, Fernandes C, Mendes RF, Lavrador P, Gaspar VM, Mano JF, Borges F, Remião F, Braga SS, Paz FAA. Coordination Compounds As Multi-Delivery Systems for Osteoporosis. ACS APPLIED MATERIALS & INTERFACES 2021; 13:35469-35483. [PMID: 34284573 DOI: 10.1021/acsami.1c09121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Osteoporosis therapies leveraging bisphosphonates and mineral components (e.g., magnesium, calcium, and strontium) have been raising attention because of their potential for managing this ever-growing disease. The administration of multicomponent therapeutics (combined therapy) in elderly patients is complex and suffers from low patient adherence. Herein, we report an all-in-one combination of four antiosteoporotic components into a new family of coordination complexes: [M2(H4alen)4(H2O)2]·1.5H2O [where M2+ = Mg2+ (1), (Mg0.535Ca0.465)2+ (2) and (Mg0.505Ca0.450Sr0.045)2+ (3)]. These solid-state complexes were prepared, for the first time, through microwave-assisted synthesis. It is demonstrated that the compounds are capable of releasing their antiosteoporotic components, both in conditions that mimic the path along the gastrointestinal tract and in long periods under physiological conditions (pH ∼7.4). More importantly, when administered in low concentrations, the compounds did not elicit a cytotoxic effect toward liver, kidney, and osteoblast-like cell lines. Besides, it is important to highlight the unique coordination complex with four bone therapeutic components, [(Mg0.505Ca0.450Sr0.045)2(H4alen)4(H2O)2]·1.5H2O (3), which significantly promoted osteoblast metabolic activity up to ca. 1.4-fold versus the control group. These findings bring this type of compounds one-step closer to be considered as an all-in-one and more effective treatment for managing chronic bone diseases, prompting further research on their therapeutic properties.
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Affiliation(s)
- Jéssica S Barbosa
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Miguel Pinto
- CIQUP, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Sandra Barreiro
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Biological Sciences Department, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Carlos Fernandes
- CIQUP, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Ricardo F Mendes
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Pedro Lavrador
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Vítor M Gaspar
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - João F Mano
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fernanda Borges
- CIQUP, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Fernando Remião
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Biological Sciences Department, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Susana S Braga
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Filipe A Almeida Paz
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
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15
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Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study. Rev Bras Ortop 2021; 56:351-355. [PMID: 34239201 PMCID: PMC8249071 DOI: 10.1055/s-0040-1721362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objective
To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures.
Methods
The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups.
Results
The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B (
p
< 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012).
Conclusion
Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.
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16
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Guss CE, McAllister A, Gordon CM. DXA in Children and Adolescents. J Clin Densitom 2021; 24:28-35. [PMID: 32111573 DOI: 10.1016/j.jocd.2020.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
DXA plays a critical role in assessing skeletal health and disease, as well as, fat and muscle status in children and adolescents. Quality DXA requires training, expertise and attention to details, as in adults, but there are key differences in performing and interpretations in children. These include choice of measurement site, skills required, reference data and software, and considerations for indications and underlying disorders to facilitate correct interpretation. The International Society for Clinical Densitometry (ISCD) has been pivotal in establishing official positions and training for people who are interested in performing or interpreting such examinations, and guiding clinicians who may request such studies. However training in the performance and interpretation of scans of individuals with more complex needs falls outside the scope of this review, and consideration should be given to refer such examinations to a specialist pediatric DXA unit. Others may be scanned and reported by those with expertise in densitometry, as long as due diligence is paid to standard quality procedures, as well as knowledge of the special circumstances and training required for this field. In this invited review we outline some of these considerations, highlight key messages, and provide some appropriate references to help guide clinicians, technologists and scientists involved or interested in DXA use in children and adolescents.
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Affiliation(s)
- Carly E Guss
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Boston Children's Hospital, Division of Endocrinology, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA.
| | | | - Catherine M Gordon
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Boston Children's Hospital, Division of Endocrinology, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA; DXA Center and Bone Health Program, Boston, MA, USA
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17
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Yadav S, Pal S, Singh P, Porwal K, Sinha RA, Kumari N, Chattopadhyay N, Gupta SK. Calcium repletion to rats with calcipenic rickets fails to recover bone quality: A calcipenic "memory". Bone 2020; 141:115562. [PMID: 32730922 DOI: 10.1016/j.bone.2020.115562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
Calcipenic rickets is prevalent in underprivileged children in developing countries. Calcipenic rickets resulting from dietary calcium (Ca) deficiency decreases bone mass and deteriorates bone microstructure in humans. The effect of dietary Ca replenishment (CaR) on rachitic bones in animal models depends on the amount, critical period and duration of replenishment, however, the extent of recovery in various bone parameters including bone quality remains unclear. We investigated the effect of CaR in rat skeleton after inducing calcipenic rickets. Female SD rats (postnatal 28 days/P28) were rendered calcipenic by feeding calcium deficient (CaD) diet (0.1% Ca) till P70 while control SD rats were fed Ca sufficient diet (0.8% Ca). At P70, calcipenic rats were switched to 0.8% Ca diet till P150 for one group and P210 for another group (endpoint). The CaD groups received 0.1% Ca diet throughout the study (P210). In the CaD groups, serum Ca and phosphate, and bone mineral density (BMD) were significantly decreased whereas serum alkaline phosphatase (ALP), iPTH and CTX-1 were increased compared to age-matched controls. Moreover, at the endpoint, the CaD group had reduced bone mass, surface referent bone formation parameters, tissue mineralization and strength accompanied by the increased osteoid thickness and microarchitectural decay (measured by trabecular geometric parameters) with poor crystal packing. The CaR group showed complete recovery in serum Ca, iPTH, ALP and CTX-1, and BMD, however, the bone quality parameters including bone strength, microarchitectural decay, tissue mineralization, and crystallinity were incompletely restored. Decreased surface referent bone formation and increased unmineralized bones (osteoid) indicative of osteomalacia were also observed in the CaR group at P210 compared with control despite prolonged replenishment. We conclude that a prolonged Ca repletion following the induction of calcipenic rickets in rats although shows the recovery of biochemical measures of bone metabolism and bone mass, however, the bone quality remains compromised. This suggests that a "memory" of calcipenia occurring at the early growth stage persists in the skeleton of adult rats despite a prolonged Ca replenishment.
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Affiliation(s)
- Shivmurat Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Subhashis Pal
- Division of Endocrinology and Centre for ASTHI, CSIR-Central Drug Research Institute, (CSIR-CDRI), BS-10/1, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India
| | - Priya Singh
- Division of Endocrinology and Centre for ASTHI, CSIR-Central Drug Research Institute, (CSIR-CDRI), BS-10/1, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India
| | - Konica Porwal
- Division of Endocrinology and Centre for ASTHI, CSIR-Central Drug Research Institute, (CSIR-CDRI), BS-10/1, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India
| | - Rohit Anthony Sinha
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Niraj Kumari
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology and Centre for ASTHI, CSIR-Central Drug Research Institute, (CSIR-CDRI), BS-10/1, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India.
| | - Sushil Kumar Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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Regular intake of cow's milk with oral immunotherapy improves statures of children with milk allergies. World Allergy Organ J 2020; 13:100108. [PMID: 32226578 PMCID: PMC7090243 DOI: 10.1016/j.waojou.2020.100108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Children who avoid cow’s milk (CM) because of food allergy may show disturbed growth. Calcium insufficiency, in particular, was reported among those who completely avoided dairy products. We retrospectively examined whether oral immunotherapy (OIT) affected the stature of patients who had completely avoided CM owing to their severe CM allergy. Methods The CM-OIT group included subjects who had completely avoided milk their entire lives and were administered OIT between 2009 and 2013. The complete milk avoidance (CM-Avoid) group included subjects who were diagnosed with a CM allergy using oral food challenges between 2013 and 2014 who subsequently avoided CM completely. By examining clinical records and questionnaires, we investigated patient height changes over time. We calculated age- and sex-stratified height standard deviation scores (HtSDS) and analyzed changes in HtSDS retrospectively. The observation period was 1–2 years. To exclude pubertal growth spurts, we set the age criteria as less than 11 years in boys and less than 9 years in girls. Results We recruited 29 patients (19 boys) for the CM-OIT group and 20 (9 boys) for the CM-Avoid group. The patients’ median ages at the start of the observation period were 7.5 years (6.1–9.6) for boys and 6.8 years (5.8–7.8) for girls in the CM-OIT group, and 5.4 years (5.0–7.5) for boys and 5.7 years (5.0–7.1) for girls in the CM-Avoid group. The initial HtSDS in the CM-OIT group was −0.31 (median) and increased to −0.22 (median) after OIT (p = 0.016). In contrast, there was no significant change in HtSDS for the CM-Avoid group. Conclusions Physical growth of pediatric patients with severe CM allergies, who have avoided CM completely, could be improved by OIT for CM allergy.
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Key Words
- AD, atopic dermatitis
- BA, bronchial asthma
- CM, cow’s milk
- CM-Avoid, complete milk avoidance
- Ca, calcium
- Cow’s milk
- Diet
- FA, food allergy
- HtSDS, height standard deviation scores
- ICS, inhaled corticosteroid
- IgE, immunoglobulin E
- Immunotherapy
- Milk allergy
- OFC, oral food challenge
- OIT, oral immunotherapy
- Pediatrics
- SD, standard deviation
- SDS, standard deviation scores
- ΔHtSDS, difference in height standard deviation score between the start and end of the observation period
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Nozari Moshtaghin F, Moghadamnia AA, Kazemi S, Arbabzadegan N, Moudi E, Haghanifar S. Effect of hydroalcoholic extract of flaxseed on bone mineral density in Wistar rats using digital radiography. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:92-99. [PMID: 32042392 PMCID: PMC6992728 DOI: 10.22088/cjim.11.1.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Given that the world's population is aging, the problems associated with osteoporosis and related fractures are increasing. The aim of the study was to evaluate the effect of flaxseed extract on bone mineral density (BMD) in Wistar rats using digital radiography. Methods: In this experimental study, 25 male and 25 female Wistar rats were randomly divided into 5 groups: 1. Control, 2. Calcium and vitamin D (Ca/VitD), 3. 100 mg/kg flaxseed, 4. 200 mg/kg flaxseed, and 5. 400 mg/kg flaxseed. Then, the animals were kept for thirty days. Maxillary and mandibular BMD as well as serum levels of calcium, vitamin D and phosphorus were measured at baseline and after 30 days of keeping the rats. Results: The results showed that serum levels of calcium and phosphorus were not significantly different in all five groups before and after 30 days. Serum levels of vitamin D were significantly higher in the group receiving Ca/vit D (with a mean of 61.6±15.8 in the male group and 85±12.9 in the female group) as compared with other groups (P<0.001). The highest level of change in maxillary and mandibular bone density was in 200 mg/kg flaxseed group with a mean difference of 24.5±6.1 and 26.5±3.1, respectively, which was significant in comparison with the control and Ca/vit D groups (p<0.001) . Conclusion: Flaxseed extract is more effective in increasing bone density than the group receiving Ca/vit D. The mandibular and maxillary BMD was higher in the group receiving 200 mg/kg flaxseed compared to the group receiving Ca/vit D (p<0.001).
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Affiliation(s)
| | - Ali Akbar Moghadamnia
- Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Ehsan Moudi
- Oral Health Researche Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sina Haghanifar
- Oral Health Researche Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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20
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Calcium supplements: Good for the bone, bad for the heart? A systematic updated appraisal. Atherosclerosis 2020; 296:68-73. [PMID: 32033778 DOI: 10.1016/j.atherosclerosis.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/14/2020] [Indexed: 11/20/2022]
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Lalayiannis A, Crabtree N, Fewtrell M, Biassoni L, Milford D, Ferro C, Shroff R. Assessing bone mineralisation in children with chronic kidney disease: what clinical and research tools are available? Pediatr Nephrol 2020; 35:937-957. [PMID: 31240395 PMCID: PMC7184042 DOI: 10.1007/s00467-019-04271-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022]
Abstract
Mineral and bone disorder in chronic kidney disease (CKD-MBD) is a triad of biochemical imbalances of calcium, phosphate, parathyroid hormone and vitamin D, bone abnormalities and soft tissue calcification. Maintaining optimal bone health in children with CKD is important to prevent long-term complications, such as fractures, to optimise growth and possibly also to prevent extra-osseous calcification, especially vascular calcification. In this review, we discuss normal bone mineralisation, the pathophysiology of dysregulated homeostasis leading to mineralisation defects in CKD and its clinical consequences. Bone mineralisation is best assessed on bone histology and histomorphometry, but given the rarity with which this is performed, we present an overview of the tools available to clinicians to assess bone mineral density, including serum biomarkers and imaging such as dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. We discuss key studies that have used these techniques, their advantages and disadvantages in childhood CKD and their relationship to biomarkers and bone histomorphometry. Finally, we present recommendations from relevant guidelines-Kidney Disease Improving Global Outcomes and the International Society of Clinical Densitometry-on the use of imaging, biomarkers and bone biopsy in assessing bone mineral density. Given low-level evidence from most paediatric studies, bone imaging and histology remain largely research tools, and current clinical management is guided by serum calcium, phosphate, PTH, vitamin D and alkaline phosphatase levels only.
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Affiliation(s)
- A.D. Lalayiannis
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - N.J. Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - M. Fewtrell
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - L. Biassoni
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - D.V. Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - C.J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. Shroff
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
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23
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Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis. Pediatr Nephrol 2020; 35:1915-1923. [PMID: 32385527 PMCID: PMC7501104 DOI: 10.1007/s00467-020-04571-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adequate calcium (Ca) intake is required for bone mineralization in children. We assessed Ca intake from diet and medications in children with CKD stages 4-5 and on dialysis (CKD4-5D) and age-matched controls, comparing with the UK Reference Nutrient Intake (RNI) and international recommendations. METHODS Three-day prospective diet diaries were recorded in 23 children with CKD4-5, 23 with CKD5D, and 27 controls. Doses of phosphate (P) binders and Ca supplements were recorded. RESULTS Median dietary Ca intake in CKD4-5D was 480 (interquartile range (IQR) 300-621) vs 724 (IQR 575-852) mg/day in controls (p = 0.00002), providing 81% vs 108% RNI (p = 0.002). Seventy-six percent of patients received < 100% RNI. In CKD4-5D, 40% dietary Ca was provided from dairy foods vs 56% in controls. Eighty percent of CKD4-5D children were prescribed Ca-based P-binders, 15% Ca supplements, and 9% both medications, increasing median daily Ca intake to 1145 (IQR 665-1649) mg/day; 177% RNI. Considering the total daily Ca intake from diet and medications, 15% received < 100% RNI, 44% 100-200% RNI, and 41% > 200% RNI. Three children (6%) exceeded the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) upper limit of 2500 mg/day. None with a total Ca intake < RNI was hypocalcemic, and only one having > 2 × RNI was hypercalcemic. CONCLUSIONS Seventy-six percent of children with CKD4-5D had a dietary Ca intake < 100% RNI. Restriction of dairy foods as part of a P-controlled diet limits Ca intake. Additional Ca from medications is required to meet the KDOQI guideline of 100-200% normal recommended Ca intake. Graphical abstract.
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Tao Z, Wang J, Wen K, Yao R, Da W, Zhou S, Meng Y, Qiu S, Yang K, Zhu Y, Tao L. Pyroptosis in Osteoblasts: A Novel Hypothesis Underlying the Pathogenesis of Osteoporosis. Front Endocrinol (Lausanne) 2020; 11:548812. [PMID: 33488513 PMCID: PMC7821870 DOI: 10.3389/fendo.2020.548812] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022] Open
Abstract
Osteoporosis has become a worldwide disease characterized by a reduction in bone mineral density and the alteration of bone architecture leading to an increased risk of fragility fractures. And an increasing number of studies have indicated that osteoblasts undergo a large number of programmed death events by many different causes in osteoporosis and release NLRP3 and interleukin (e.g., inflammatory factors), which play pivotal roles in contributing to excessive differentiation of osteoclasts and result in exaggerated bone resorption. NLRP3 is activated during pyroptosis and processes the precursors of IL-1β and IL-18 into mature forms, which are released into the extracellular milieu accompanied by cell rupture. All of these compounds are the classical factors of pyroptosis. The cellular effects of pyroptosis are commonly observed in osteoporosis. Although many previous studies have focused on the pathogenesis of these inflammatory factors in osteoporosis, pyroptosis has not been previously evaluated. In this review, pyroptosis is proposed as a novel hypothesis of osteoporosis pathogenesis for the first time, thus providing a new direction for the treatment of osteoporosis in the future.
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Affiliation(s)
- Zhengbo Tao
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinpeng Wang
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Kaicheng Wen
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Renqi Yao
- Department of Burn Surgery, Changhai Hospital, the Naval Medical University, Shanghai, China
| | - Wacili Da
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Siming Zhou
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yan Meng
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shui Qiu
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Keda Yang
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lin Tao
- Department of Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Lin Tao,
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Lu JX, Pan H, Hu XQ, Huang ZW, Zhang Q. Effects of milk powder intervention on bone mineral density and indicators related to bone metabolism in Chinese adolescents. Osteoporos Int 2019; 30:2231-2239. [PMID: 31375874 PMCID: PMC6811668 DOI: 10.1007/s00198-019-05105-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/21/2019] [Indexed: 02/07/2023]
Abstract
UNLABELLED The study is to determine the effects of milk powder on bone density and metabolism in healthy adolescents. Vitamin D and calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention. INTRODUCTION Both calcium and vitamin D play an important role in bone mineralization in adolescents. METHODS In this one and a half-year randomized controlled trial, 232 participants (aged 12-15 years) were randomly assigned to three intervention groups receiving milk powder fortified with vitamin D 400 IU plus calcium 300, or 600, or 900 mg [Ca3D (n = 54), Ca6D (n = 56), and Ca9D (n = 49)], or one control group maintaining habitual diet [control (n = 73)]. Bone turnover markers, serum intact PTH, 25(OH)D, and IGF-1 levels were measured at baseline and one and a half years, and bone mineral contents and bone areal mineral density were measured by Dual-energy X-ray absorptiometry (DXA) at baseline, one year, and one and a half years. RESULTS Baseline average serum 25(OH)D level and calcium intake were 29.4 nmol/L and 363.5 mg/day, respectively. There was a significant increase in bone turnover, total body, hip, lumbar spine bone mineral density (BMD), and total body BMC as well as slight fluctuations in 25(OH)D levels over one and a half years without between-group differences. Significantly decreased serum PTH level was only observed in the Ca6D group (31%, p < 0.0001), in which the intervention effect was also significant (p = 0.0029) compared with the control group. IGF-1 levels increased significantly in all intervention groups (18.5 to 22.8%, p < 0.05) but decreased in the control group (16.5%, p < 0.05), and the group by time interaction was also significant (p = 0.0029). CONCLUSIONS Our study showed that in healthy adolescents with low vitamin D status and calcium intake, mild vitamin D and mild to modest calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention.
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Affiliation(s)
- J X Lu
- National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xi Cheng District, Beijing, 100050, China
| | - H Pan
- National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xi Cheng District, Beijing, 100050, China
| | - X Q Hu
- National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xi Cheng District, Beijing, 100050, China
| | - Z W Huang
- National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xi Cheng District, Beijing, 100050, China
| | - Q Zhang
- National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xi Cheng District, Beijing, 100050, China.
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A New Calcium Oral Controlled-Release System Based on Zeolite for Prevention of Osteoporosis. Nutrients 2019; 11:nu11102467. [PMID: 31618877 PMCID: PMC6835288 DOI: 10.3390/nu11102467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/28/2019] [Accepted: 10/11/2019] [Indexed: 12/21/2022] Open
Abstract
Osteoporosis, a systemic skeleton disease, can be prevented by increasing calcium levels in serum via administration of calcium salts. However, traditional calcium-based formulations have not appeared to be effective, hence the purpose of the present work has been to prepare and test in vitro/vivo a formulation able to gradually release calcium during transit over the GI tract, thus increasing bioavailability and reducing daily dose, and hence, side effects. Calcium controlled-release granules based on zeolite and Precirol® were prepared. In the best case, represented by granules sized 1.2 mm, containing 20% Precirol®, 19% zeolite, 60% calcium (granule), the release lasted ≈6 h. The release is controlled by diffusion of calcium ions through the aqueous channels forming within granules, once these come into contact with physiological fluids. Such a diffusion is hindered by the interaction of calcium ions with the negatively charged surface of the zeolite. Ovariectomy was used to make rats osteopenic. For in vivo studies, rats were divided into the following groups. Sham: not treated; ova: ovariectomized (ova); CaCl2 1.0 g: ova, treated with 1.0 g/die Ca2+; CaCl2 0.5 g: ova, treated with 0.5 g/die Ca2+; granule 1.0 g, or granule 0.5 g: ova, treated with granules equivalent to 1.0 g/die or 0.5 g/die Ca2+ in humans. Ca2+ amounts in femur bone and bone marrow, femur mechanical characteristics, and femur medullary canalicule diameter were measured and the same efficacy rank order was obtained: ova < CaCl2 0.5 g < CaCl2 1.0 g < granule 0.5 g ≈ granule 1.0 g ≈ sham. The results show promise of an effective prevention of osteoporosis, based on a controlled-rate administration of a calcium dose half that administered by the current therapy, with reduced side effects.
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Gil-Díaz MC, Raynor J, O'Brien KO, Schwartz GJ, Weber DR. Systematic review: associations of calcium intake, vitamin D intake, and physical activity with skeletal outcomes in people with Type 1 diabetes mellitus. Acta Diabetol 2019; 56:1091-1102. [PMID: 30989378 PMCID: PMC6751023 DOI: 10.1007/s00592-019-01334-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/25/2019] [Indexed: 12/18/2022]
Abstract
AIMS The skeletal complications of type 1 diabetes (T1D) include low bone density, poor bone quality and fractures. Greater calcium intake, vitamin D intake, and physical activity are commonly recommended to improve bone health in patients with T1D. However, it is not clear whether these factors are affected by T1D or improve clinical outcomes. METHODS The objective of this study was to systematically review the literature for evidence of associations between calcium intake, vitamin D intake, and physical activity and skeletal outcomes in T1D. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, twenty-two studies were included in this review. RESULTS The prevalence of calcium deficiency was high and encompassed greater than 50% of participants in the majority of studies. Despite this finding, there was no clear association between calcium intake and bone density in any study. Calcitriol use was associated with gains in bone density in one study but was not associated with changes in bone turnover markers in a second report. No studies specifically investigated the impact of vitamin D2 or D3 supplementation on bone health. Two studies reported a beneficial effect of physical activity interventions on bone accrual in children. The findings from observational studies of physical activity were mixed. CONCLUSION There are insufficient data to determine if deficient calcium intake, vitamin D intake, or physical activity contributes to the skeletal complications of T1D. Future studies specifically designed to assess the impact of these interventions on the skeleton in T1D participants are needed.
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Affiliation(s)
- María Cristina Gil-Díaz
- Golisano Children's Hospital, University of Rochester, 601 Elwood Ave, Box 690, Rochester, NY, 14642, USA
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Kimberly O O'Brien
- College of Human Ecology, Cornell University, 230 Savage Hall, Ithaca, NY, 14850, USA
| | - George J Schwartz
- Golisano Children's Hospital, University of Rochester, 601 Elwood Ave, Box 690, Rochester, NY, 14642, USA
| | - David R Weber
- Golisano Children's Hospital, University of Rochester, 601 Elwood Ave, Box 690, Rochester, NY, 14642, USA.
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Koops K, Wrangham RW, Cumberlidge N, Fitzgerald MA, van Leeuwen KL, Rothman JM, Matsuzawa T. Crab-fishing by chimpanzees in the Nimba Mountains, Guinea. J Hum Evol 2019; 133:230-241. [DOI: 10.1016/j.jhevol.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
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Wiedemann A, Renard E, Hernandez M, Dousset B, Brezin F, Lambert L, Weryha G, Feillet F. Annual Injection of Zoledronic Acid Improves Bone Status in Children with Cerebral Palsy and Rett Syndrome. Calcif Tissue Int 2019; 104:355-363. [PMID: 30554334 DOI: 10.1007/s00223-018-0505-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/07/2018] [Indexed: 12/27/2022]
Abstract
Osteoporosis is a common complication of cerebral palsy and Rett's syndrome. It is responsible for multiple fractures, bone pain, and impaired quality of life. In case of Rett's syndrome, a specific dysfunction of osteoblasts causes bone fragility. We observed the effects of annual zoledronic acid (ZA) infusion in a cohort of children with cerebral palsy and Rett's syndrome. 27 children under 18 years (19 with cerebral palsy and 8 girls with Rett syndrome confirmed by MCEP2 mutation) were treated with an annual injection of 0.1 mg/kg (max 4 mg) of ZA. Calcium and vitamin D were combined in all patients from the first injection of ZA. Dental examination was performed before treatment. Data were analyzed retrospectively. Bone mineral density was measured at diagnosis and yearly thereafter. Bone mass density (BMD) is decreased in patient with cerebral palsy and RS. One year after injection of ZA, we observe an increase of Lumbar spine BMD from - 2.99 to - 2.14 SD (p < 0.0001) and femoral BMD from - 4.26 to - 3.32 SD (p < 0.001) In the subgroup of patient with Rett syndrome, we also observe an increase from - 3.27 to 2.50 SD (p = 0.018) of Lumbar spine BMD. No fractures have been observed in our cohort since the first infusion. Side effects (flu-like syndrome and hypocalcemia) were more common in younger patients and after the first infusion. No serious complications were noticed. This study confirms the efficacy and the safety of an annual injection of ZA to improve bone status in children with cerebral palsy and Rett syndrome. No severe adverse effects were observed.
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Affiliation(s)
- Arnaud Wiedemann
- Centre de référence des erreurs innées du métabolisme, Hôpital d'Enfants, CHRU Nancy, Nancy, France.
- Réanimation pédiatrique spécialisée, Hôpital d'enfants, CHRU Nancy, Nancy, France.
- Faculté de médecine, INSERM U-1256, Vandoeuvre les Nancy, France.
| | - Emeline Renard
- Service de Médecine Infantile, Hôpital d'enfants, CHRU Nancy, Nancy, France
- Faculté de médecine, INSERM U-1256, Vandoeuvre les Nancy, France
| | | | | | - François Brezin
- Service de Médecine Infantile, Hôpital d'enfants, CHRU Nancy, Nancy, France
| | | | | | - François Feillet
- Centre de référence des erreurs innées du métabolisme, Hôpital d'Enfants, CHRU Nancy, Nancy, France
- Service de Médecine Infantile, Hôpital d'enfants, CHRU Nancy, Nancy, France
- Faculté de médecine, INSERM U-1256, Vandoeuvre les Nancy, France
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Berkhout ED, Malan M, Kram T. Better soils for healthier lives? An econometric assessment of the link between soil nutrients and malnutrition in Sub-Saharan Africa. PLoS One 2019; 14:e0210642. [PMID: 30653538 PMCID: PMC6336299 DOI: 10.1371/journal.pone.0210642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/29/2018] [Indexed: 12/29/2022] Open
Abstract
Malnutrition, the suboptimal consumption of essential nutrients like zinc, severely affects human health. This burden of malnutrition falls disproportionally heavy on developing countries, directly increasing child mortality and childhood stunting, or reducing people's ability mending diseases. One option to combat malnutrition is to blend missing nutrients in crop fertilizers, thereby increasing crop yields and possibly the nutrient density in harvested crop products, thus enriching crop products destined for human consumption. But, the effectiveness of so-called agronomic fortification remains ill-understood, primarily due to a paucity of field trials. We hypothesize that, if at all this is an effective strategy, there should exist a causal link between malnutrition and natural variation in the quality of soils to begin with. Until now, data limitations prevented the establishment of such a link, but new soil micronutrient maps for Sub-Saharan Africa allow for a detailed assessment. In doing so, we find statistically significant relations between soil nutrients and child mortality, stunting, wasting and underweight. For instance, a simultaneous increase in soil densities of copper, manganese and zinc by one standard deviation reduces child mortality by 4-6 per mille points, but only when malaria pressure is modest. The effects of soil nutrients on health dissipate when malaria pressure increases. Yet, the effects are fairly small in magnitude suggesting that except for a few regions, agronomic fortification is a relatively cost ineffective means to combat malnutrition.
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Affiliation(s)
- Ezra D. Berkhout
- PBL Netherlands Environmental Assessment Agency, The Hague, The Netherlands
| | - Mandy Malan
- International Institute of Tropical Agriculture (IITA), Kampala, Uganda
| | - Tom Kram
- PBL Netherlands Environmental Assessment Agency, The Hague, The Netherlands
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Hou HT, Wang YN, Shao SZ, Fu S, Huang XP, Wang XH. High calcium diet alleviates 5/6 nephrectomy-induced bone deteriorations of lumbar vertebrae in mice. Exp Ther Med 2018; 15:3483-3488. [PMID: 29545872 DOI: 10.3892/etm.2018.5866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/03/2017] [Indexed: 12/17/2022] Open
Abstract
Dietary calcium (Ca) supplementation has beneficial effects on bone health. However, it is not clear whether a high calcium diet (HCD) following 5/6 nephrectomy (5/6 Nx) is beneficial to bone health. The aim of the present study was to examine the effects of an HCD on bone metabolism using a chronic kidney disease (CKD) mouse model. Male C57BL/6J mice were divided into three groups: Sham group, 5/6 Nx group and 5/6 Nx + HCD group. Mice were sacrificed 12 weeks post-surgery. Calcium (Ca) and creatinine (Cr) were measured using standard colorimetric methods and picric acid methods, respectively. Bone metabolism-associated markers, FGF-23, PTH, ALP-b and TRAP-5b were measured using ELISA kits. Lumbar vertebrae histomorphological analysis was performed using hematoxylin and eosin staining. The expression of osteoprotegerin (OPG) and receptor activator of nuclear factor κB ligand (RANKL) mRNA was detected using reverse transcription-quantitative polymerase chain reaction. Impaired renal function and histopathological damage was indicated in 5/6 Nx mice. However, HCD had no significant effects on these changes in 5/6 Nx mice. Notably, mineral metabolism disorder and histopathological damage to lumbar vertebrae were markedly improved in HCD-treated 5/6 Nx mice. Compared with 5/6 Nx mice, HCD supplementation significantly elevated the ratio of OPG/RANKL and inhibited RANKL mRNA expression in lumbar vertebrae. To conclude, the present findings indicated that increased Ca intake is effective in increasing bone mineral content of the lumbar vertebrae in 5/6 Nx mice. These results may provide a basis for the clinical use of dietary Ca supplementation as a therapeutic approach to treat CKD-induced disturbance of mineral metabolism and bone loss.
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Affiliation(s)
- Hai-Tao Hou
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
| | - Ya-Nan Wang
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
| | - Shi-Ze Shao
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
| | - Song Fu
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
| | - Xiang-Peng Huang
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
| | - Xiao-Hui Wang
- Department of Spinal and Spinal Cord Surgery, Shandong Wendeng Orthopedic Hospital, Wendeng, Shandong 264400, P.R. China
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Fong CY, Kong AN, Noordin M, Poh BK, Ong LC, Ng CC. Determinants of low bone mineral density in children with epilepsy. Eur J Paediatr Neurol 2018; 22:155-163. [PMID: 29122496 DOI: 10.1016/j.ejpn.2017.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/15/2017] [Accepted: 10/15/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Children with epilepsy on long-term antiepileptic drugs (AEDs) are at risk of low bone mineral density (BMD). The aims of our study were to evaluate the prevalence and determinants of low BMD among Malaysian children with epilepsy. METHOD Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in a tertiary hospital in Malaysia from 2014 to 2015. Detailed assessment of anthropometric measurements; environmental lifestyle risk factors; serum vitamin D, calcium and parathyroid hormone levels; genotyping of single nucleotide polymorphisms of genes in vitamin D and calcium metabolism; and lumbar spine BMD were obtained. Low BMD was defined as BMD Z-score ≤ -2.0 SD. RESULTS Eighty-seven children with mean age of 11.9 years (56 males) participated in the study. The prevalence of low lumbar BMD was 21.8% (19 patients). Multivariate logistic regression analysis identified polytherapy >2 AEDs (OR: 7.86; 95% CI 1.03-59.96), small frame size with wrist breadth of <15th centile (OR 14.73; 95% CI 2.21-98.40), and body mass index Z-score < -2.0 (OR 8.73, 95% CI 1.17-65.19) as significant risk factors for low BMD. CONCLUSION One-fifth of Malaysian children with epilepsy on long-term AEDs had low BMD. Targeted BMD should be performed for those who are on >2 AEDs, underweight or with small frame size as they are at higher risk of having low BMD.
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Affiliation(s)
- Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ann Nie Kong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mazidah Noordin
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Paediatric Department, Universiti Institut Teknologi MARA, UiTM Medical Faculty, Sungai Buloh, Selangor, Malaysia
| | - Bee Koon Poh
- Nutritional Sciences Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lai Choo Ong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Ching Ng
- Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Shin J, Kang MJ, Kim KN. Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.4.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- JinShik Shin
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min Jae Kang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Nam Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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Liu X, Wang X, Tian Y, Yang Z, Lin L, Lin Q, Zhang Z, Li L. Reduced maternal calcium intake through nutrition and supplementation is associated with adverse conditions for both the women and their infants in a Chinese population. Medicine (Baltimore) 2017; 96:e6609. [PMID: 28471956 PMCID: PMC5419902 DOI: 10.1097/md.0000000000006609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Effective nutritional guidelines for pregnant women in China are lacking. The aim of this study was to investigate the effect of dietary nutrition on the health condition of pregnant women and infants in China.In total, 331 pregnant women who had prenatal examinations were included in this study. Data, including dietary nutrition questionnaires, the weight, height, age, and health condition of the pregnant women as well as the health condition of the infants, were recorded.The average intake of milk, poultry and meat, fish and prawns, eggs, and bean products were 297.28 ± 129.67 mL/day, 123.34 ± 52.04 g/day, 157.31 ± 70.04 g/day, 67.34 ± 45.28 g/day, and 1.21 ± 0.62 per day, respectively. Among the 331 pregnant women, the intake rates of supplemental calcium and VD were 86.7% and 69.8%, respectively. The intake of milk, bean products, and meats was obviously lower (all P < .05) in the pregnant women with systremma compared to those without it. In addition, the body weight before and after delivery was higher (all P < .05) in the pregnant women with systremma. The calcium intake of the pregnant women and the infants' BMD were remarkably lower in the infants with pillow baldness or a wider anterior fontanelle (P < .01) compared to those without the features.The intake of milk, poultry and meat, fish and prawns, eggs, and bean products by pregnant women should be monitored, and in particular, the proper intake of milk, bean products, and meats, as well as calcium supplements, might decrease the occurrence of systremma in pregnant women and reduce the rate pillow baldness and a wider anterior fontanelle in infants.
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Gómez-Bruton A, Matute-Llorente Á, González-Agüero A, Casajús JA, Vicente-Rodríguez G. Plyometric exercise and bone health in children and adolescents: a systematic review. World J Pediatr 2017; 13:112-121. [PMID: 28101776 DOI: 10.1007/s12519-016-0076-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/18/2015] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many jumping interventions have been performed in children and adolescents in order to improve bone-related variables and thus, ensure a healthy bone development during these periods and later in life. This systematic review aims to summarize and update present knowledge regarding the effects that jumping interventions may have on bone mass, structure and metabolism in order to ascertain the efficacy and durability (duration of the effects caused by the intervention) of the interventions. DATA SOURCES Identification of studies was performed by searching in the database MEDLINE/PubMed and SportDiscus. Additional studies were identified by contacting clinical experts and searching bibliographies and abstracts. Search terms included "bone and bones", "jump*", "weight-bearing", "resistance training" and "school intervention". The search was conducted up to October 2014. Only studies that had performed a specific jumping intervention in under 18-year olds and had measured bone mass were included. Independent extraction of articles was done by 2 authors using predefined data fields. RESULTS A total of 26 studies were included in this review. Twenty-four studies found positive results as subjects included in the intervention groups showed higher bone mineral density, bone mineral content and bone structure improvements than controls. Only two studies found no effects on bone mass after a 10-week and 9-month intervention. Moreover, those studies that evaluated the durability of the effects found that some of the increases in the intervention groups were maintained after several years. CONCLUSIONS Jumping interventions during childhood and adolescence improve bone mineral content, density and structural properties without side effects. These type of interventions should be therefore implemented when possible in order to increase bone mass in early stages of life, which may have a direct preventive effect on bone diseases like osteoporosis later in life.
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Affiliation(s)
- Alejandro Gómez-Bruton
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Grupo GENUD Edificio SAI 2a planta, Zaragoza, Spain.,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain
| | - Ángel Matute-Llorente
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Grupo GENUD Edificio SAI 2a planta, Zaragoza, Spain.,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain
| | - Alejandro González-Agüero
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Grupo GENUD Edificio SAI 2a planta, Zaragoza, Spain
| | - José A Casajús
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Grupo GENUD Edificio SAI 2a planta, Zaragoza, Spain.,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain
| | - Germán Vicente-Rodríguez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Grupo GENUD Edificio SAI 2a planta, Zaragoza, Spain. .,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain.
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Choi HS, Park JH, Kim SH, Shin S, Park MJ. Strong familial association of bone mineral density between parents and offspring: KNHANES 2008-2011. Osteoporos Int 2017; 28:955-964. [PMID: 27747365 DOI: 10.1007/s00198-016-3806-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/06/2016] [Indexed: 01/12/2023]
Abstract
UNLABELLED Bone mineral density (BMD) of offspring was significantly associated with their parents' BMD. Parental BMD Z-score ≤-1 was a significant predictor for BMD Z-score ≤-1 in their offspring. Peak bone mass acquisition during early adulthood is more substantially influenced by genetic factors rather than lifestyle or environmental factors. INTRODUCTION A person's BMD is affected by both genetic and environmental factors. Family history of osteoporosis or fragility fracture is a well-known risk factor for low bone mass or fracture. The purpose of the present study was to investigate the familial association of BMD between parents and offspring in Korean population. METHODS This is a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2011. A total of 5947 subjects (3135 parents and 2812 offspring) were included. RESULTS In age-adjusted partial correlation analyses, all BMD values acquired from the lumbar spine, femur neck, total hip, and whole body showed significant associations between parents and offspring. Among these associations, whole-body BMD showed the strongest relationship between offspring and parents. The narrow-sense heritability of BMD ranged from 0.203 to 0.542 in male offspring and from 0.396 to 0.689 in female offspring. Multiple linear regression analyses showed that offspring's BMD was independently associated with BMD of both parents after adjusting for covariates. Lifestyle or environmental factors including dietary calcium intake, serum 25-hydroxyvitamin D level, regular exercise, current smoking, and alcohol intake showed only moderate or no associations with BMD. In multiple logistic regression analyses in offspring aged 19-25 years, the son's risk of having BMD Z-score ≤-1 was associated with both parents' BMD Z-score ≤-1, while the daughter's risk was only associated with maternal BMD Z-score ≤-1. CONCLUSIONS Our findings confirm the strong familial association of BMD between parents and offspring in Korean population and suggest that peak bone mass acquisition during early adulthood is more substantially influenced by genetic factors rather than lifestyle or environmental factors.
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Affiliation(s)
- H S Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang, Gyeonggi-do, Korea
| | - J H Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - S H Kim
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye-7-dong, Nowon-gu, Seoul, 139-707, Korea
| | - S Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongro-gu, Seoul, 03080, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 102 Daehak-ro, Jongro-gu, Seoul, 03080, Korea
| | - M J Park
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye-7-dong, Nowon-gu, Seoul, 139-707, Korea.
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Building better bones in childhood: a randomized controlled study to test the efficacy of a dietary intervention program to increase calcium intake. Eur J Clin Nutr 2017; 71:788-794. [PMID: 28225052 PMCID: PMC5462896 DOI: 10.1038/ejcn.2017.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 12/15/2016] [Accepted: 01/04/2017] [Indexed: 12/25/2022]
Abstract
Background/Objectives Many children do not consume the recommended daily allowance of calcium. Inadequate calcium intake in childhood may limit bone accrual. The objective of this study was to determine if a behavioral modification and nutritional education (BM-NE) intervention improved dietary calcium intake and bone accrual in children. Subjects/Methods 139 (86 female) healthy children, 7–10 years of age, were enrolled in this randomized controlled trial conducted over 36 months. Participants randomized to the BM-NE intervention attended five sessions over a six-week period designed to increase calcium intake to 1500 mg/day. Participants randomized to the usual care (UC) group received a single nutritional counseling session. The Calcium Counts© Food Frequency Questionnaire was used to assess calcium intake; DXA was used to assess areal bone mineral density (aBMD) and bone mineral content (BMC). Longitudinal mixed effects models were used to assess for an effect of the intervention on calcium intake, BMC and aBMD. Results BM-NE participants had greater increases in calcium intake that persisted for 12 months following the intervention compared to UC. The intervention had no effect on BMC or aBMD accrual. Secondary analyses found a negative association between calcium intake and adiposity such that greater calcium intake was associated with lesser gains in BMI and fat mass index. Conclusions A family-centered BM-NE intervention program in healthy children was successful in increasing calcium intake for up to 12 months but had no effect on bone accrual. A beneficial relationship between calcium intake and adiposity was observed and warrants future study.
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Thacher TD, Smith L, Fischer PR, Isichei CO, Cha SS, Pettifor JM. Optimal Dose of Calcium for Treatment of Nutritional Rickets: A Randomized Controlled Trial. J Bone Miner Res 2016; 31:2024-2031. [PMID: 27311415 DOI: 10.1002/jbmr.2886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 02/05/2023]
Abstract
Calcium supplementation is indicated for the treatment of nutritional rickets. Our aim was to determine the optimal dose of calcium for treatment of children with rickets. Sixty-five Nigerian children with radiographically confirmed rickets were randomized to daily supplemental calcium intake of 500 mg (n = 21), 1000 mg (n = 23), or 2000 mg (n = 21). Venous blood, radiographs, and forearm areal bone density (aBMD) were obtained at baseline and at 8, 16, and 24 weeks after enrollment. The primary outcome was radiographic healing, using a 10-point radiographic severity score. The radiographic severity scores improved in all three groups, but the rate of radiographic healing (points per month) was significantly more rapid in the 1000-mg (-0.29; 95% confidence interval [CI] -0.13 to -0.45) and 2000-mg (-0.36; 95% CI -0.19 to -0.53) supplementation groups relative to the 500-mg group. The 2000-mg group did not heal more rapidly than the 1000-mg group. Of those who completed treatment for 24 weeks, 12 (67%), 20 (87%), and 14 (67%) in the 2000-mg, 1000-mg, and 500-mg groups, respectively, had achieved a radiographic score of 1.5 or less (p = 0.21). Serum alkaline phosphatase decreased and calcium increased similarly in all groups. Forearm diaphyseal aBMD improved significantly more rapidly in the 2000-mg group than in the 500-mg and 1000-mg groups (p < 0.001). Daily calcium intakes of 1000 mg or 2000 mg produced more rapid radiographic healing of rickets than 500 mg, but 2000 mg did not have greater benefit than 1000 mg. Some children require longer than 24 weeks for complete healing of nutritional rickets. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen S Cha
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ, USA
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Vitamin D and Calcium Intakes, Physical Activity, and Calcaneus BMC among School-Going 13-Year Old Malaysian Adolescents. Nutrients 2016; 8:nu8100666. [PMID: 27783041 PMCID: PMC5084052 DOI: 10.3390/nu8100666] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Dietary calcium and vitamin D are essential for bone development. Apart from diet, physical activity may potentially improve and sustain bone health. Objective: To investigate the relationship between the dietary intake of calcium and vitamin D, physical activity, and bone mineral content (BMC) in 13-year-old Malaysian adolescents. Design: Cross-sectional. Setting: Selected public secondary schools from the central and northern regions of Peninsular Malaysia. Participants: The subjects were from the Malaysian Health and Adolescents Longitudinal Research Team Cohort study (MyHeARTs). Methods: The data included seven-day diet histories, anthropometric measurements, and the BMC of calcaneal bone using a portable broadband ultrasound bone densitometer. Nutritionist Pro software was used to calculate the dietary calcium and vitamin D intakes from the diet histories, based on the Nutrient Composition of Malaysian Food Database guidance for the dietary calcium intake and the Singapore Energy and Nutrient Composition of Food Database for vitamin D intake. Results: A total of 289 adolescents (65.7% females) were recruited. The average dietary intakes of calcium and vitamin D were 377 ± 12 mg/day and 2.51 ± 0.12 µg/day, respectively, with the majority of subjects failing to meet the Recommended Nutrient Intake (RNI) of Malaysia for dietary calcium and vitamin D. All the subjects had a normal Z-score for the BMC (−2.00 or higher) with a mean of 0.55 ± 0.01. From the statistical analysis of the factors contributing to BMC, it was found that for those subjects with a higher intake of vitamin D, a higher combination of the intake of vitamin D and calcium resulted in significantly higher BMC quartiles. The regression analysis showed that the BMC might have been influenced by the vitamin D intake. Conclusions: A combination of the intake of vitamin D and calcium is positively associated with the BMC.
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Zhang Y, Zhou Z, Wu C, Zhao D, Wang C, Cheng X, Cai W, Wang L, Duanmu Y, Zhang C, Tian W. Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography. Korean J Radiol 2016; 17:581-9. [PMID: 27587947 PMCID: PMC5007385 DOI: 10.3348/kjr.2016.17.5.581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/23/2016] [Indexed: 01/22/2023] Open
Abstract
Objective To investigate the bone mineral density (BMD) of cervical vertebrae in a population-stratified manner and correlate with that of the lumbar vertebrae. Materials and Methods Five hundred and ninety-eight healthy volunteers (254 males, 344 females), ranging from 20 to 64 years of age, were recruited for volumetric BMD (vBMD) measurements by quantitative computed tomography. Basic information (age, height, weight, waistline, and hipline), and vBMD of the cervical and lumbar vertebrae (C2–7 and L2–4) were recorded. Comparisons among sex, age groups and different levels of vertebrae were analyzed using analysis of variance. Linear regression was performed for relevance of different vertebral levels. Results The vBMD of cervical and lumbar vertebrae was higher in females than males in each age group. The vBMD of the cervical and lumbar vertebrae in males and the vBMD of lumbar vertebrae in females decreased with aging. In each age group, the vBMD of the cervical vertebrae was higher than that of the lumbar vertebrae with gradual decreases from C2 to C7 except for C3; moreover, the vBMD of C6 and C7 was significantly different from that of C2–5. Correlations of vBMD among different cervical vertebrae (females: r = 0.62–0.94; males: r = 0.63–0.94) and lumbar vertebrae (males: r = 0.93–0.98; females: r = 0.82–0.97) were statistically significant at each age group. Conclusion The present study provided normative data of cervical vertebrae in an age- and sex-stratified manner. Sex differences in vBMD prominently vary with age, which can be helpful to design a more comprehensive pre-operative surgical plan.
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Affiliation(s)
- Yong Zhang
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhuang Zhou
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Cheng'ai Wu
- Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Danhui Zhao
- Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Chao Wang
- Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Xiaoguang Cheng
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Cai
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ling Wang
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yangyang Duanmu
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Chenxin Zhang
- Department of Radiology, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China
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Mailhot G, Perrone V, Alos N, Dubois J, Delvin E, Paradis L, Des Roches A. Cow's Milk Allergy and Bone Mineral Density in Prepubertal Children. Pediatrics 2016; 137:peds.2015-1742. [PMID: 27244780 DOI: 10.1542/peds.2015-1742] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent data suggest that cow's milk allergy (CMA) has become more persistent, prolonging treatment via strict elimination of cow's milk products into a period of skeletal growth. The objectives of this study were to compare bone mineral density (BMD), vitamin D status, and dietary intakes of calcium and vitamin D between prepubertal children with persistent CMA and those with non-cow's milk food allergies (NCMA) as control subjects and to assess the use of and compliance to calcium and vitamin D supplementation among children with persistent CMA. METHODS Fifty-two children with persistent CMA and 29 with NCMA were recruited. BMD was measured by using dual energy radiograph absorptiometry, and vitamin D status was assessed by using plasma 25-hydroxyvitamin D concentrations. Calcium and vitamin D intakes, as well as compliance to calcium and vitamin D supplementation, were recorded. RESULTS Lumbar spine BMD z scores were significantly lower in children with CMA. Low bone mass was detected in 6% of the CMA group compared with none in the NCMA group. Children with CMA displayed significantly lower calcium intakes than control subjects. Vitamin D status was not reduced in children with CMA compared with control subjects. Fewer than one-half of children with CMA reported the use of calcium and vitamin D supplements. However, adherence was high among supplement users, with a mean compliance rate of 5.5 days per week. CONCLUSIONS These prepubertal children with persistent CMA had lower lumbar spine BMD z scores than children with NCMA, which likely resulted from lower calcium intake.
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Affiliation(s)
- Genevieve Mailhot
- Department of Nutrition and Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada; and
| | | | - Nathalie Alos
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada; and Divisions of Endocrinology and
| | - Josée Dubois
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada; and Departments of Radiology, and
| | - Edgard Delvin
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada; and Clinical Biochemistry, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | | | - Anne Des Roches
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada; and Allergy, Department of Pediatrics,
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Pu F, Chen N, Xue S. Calcium intake, calcium homeostasis and health. FOOD SCIENCE AND HUMAN WELLNESS 2016. [DOI: 10.1016/j.fshw.2016.01.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Katsumata S, Matsuzaki H, Uehara M, Suzuki K. Effects of Dietary Calcium Supplementation on Bone Metabolism, Kidney Mineral Concentrations, and Kidney Function in Rats Fed a High-Phosphorus Diet. J Nutr Sci Vitaminol (Tokyo) 2016; 61:195-200. [PMID: 26052152 DOI: 10.3177/jnsv.61.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We investigated the effects of dietary calcium (Ca) supplementation on bone metabolism, kidney mineral concentrations, and kidney function in rats fed a high-phosphorus (P) diet. Wistar strain rats were randomly divided into 4 dietary groups and fed their respective diets for 21 d: a diet containing 0.3% P and 0.5% Ca (C), a diet containing 1.5% P and 0.5% Ca (HP), a diet containing 0.3% P and 1.0% Ca (HCa), or a diet containing 1.5% P and 1.0% Ca (HPCa). Compared to the C group, the high-P diet increased serum parathyroid hormone concentration, markers of bone turnover, receptor activator of NF-κB ligand mRNA expression of the femur, kidney Ca and P concentrations, urinary N-acetyl-β-D-glucosaminidase activity, and urinary β2-microglobulin excretion, and decreased bone mineral content and bone mineral density of the femur and tibia. Dietary Ca supplementation improved the parameters of bone metabolism and kidney function in rats fed the high-P diet, while there were no significant differences in kidney Ca or P concentrations between the HP and HPCa groups. These results suggest that dietary Ca supplementation prevented the bone loss and decline in kidney function induced by a high-P diet, whereas dietary Ca supplementation did not affect kidney mineral concentrations in rats fed the high-P diet.
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Affiliation(s)
- Shinichi Katsumata
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture
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Yanagida N, Minoura T, Kitaoka S. Does Terminating the Avoidance of Cow's Milk Lead to Growth in Height? Int Arch Allergy Immunol 2015; 168:56-60. [DOI: 10.1159/000441499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022] Open
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Zhang Y, Mukwaya E, Pan H, Li XM, Yang JL, Ge J, Wang HY. Combination therapy of Chinese herbal medicine Fructus Ligustri Lucidi with high calcium diet on calcium imbalance induced by ovariectomy in mice. PHARMACEUTICAL BIOLOGY 2015; 53:1082-1085. [PMID: 25495599 DOI: 10.3109/13880209.2014.950388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Our previous biological study demonstrated that Fructus Ligustri Lucidi (FLL), the fruit of Ligustrum lucidum Ait. (Oleaceae), could be used to maintain calcium balance and prevent age-related osteoporosis since it effectively decreased calcium loss and increased calcium retention in rats. OBJECTIVE This study investigates the combination effect of the Chinese herbal medicine FLL and a high calcium diet on calcium imbalance induced by ovariectomy in mice. MATERIALS AND METHODS The ovariectomized (OVX) mice were orally treated with vehicle, FLL extract (700 mg/kg), milk powder (5 g/mice) fortified with calcium (1.0% Ca) and the combination of FLL with milk powder. After 6 weeks of treatment, urine, serum, and tibia were preserved for biochemical analysis and kidneys were taken for gene expression analysis. RESULTS The combination treatment of FLL and a high calcium diet significantly increased bone calcium content (6.80 ± 0.34 mg) by 22% (p < 0.05) and decreased urine calcium excretion (0.099 ± 0.009 mg/mg) by 62% (p < 0.01) as compared with those of the OVX group (bone Ca, 5.57 ± 0.31 mg; urine Ca/Cr, 0.261 ± 0.017 mg/mg). The mRNA expression of renal calcium-binding protein-9k (CaBP-9k) and calcium-sensing receptor (CaSR) in combination treatment group was significantly up-regulated and down-regulated, respectively, as compared with those of the OVX group. CONCLUSION The beneficial effects of this combination therapy on calcium balance of OVX mice were, at least partially, attributed to its regulation on mRNA expression of CaBP-9k and CaSR in kidney.
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Affiliation(s)
- Yan Zhang
- State Key Laboratory of Dairy Biotechnology, Bright Dairy Research Institute , Shanghai , China
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Omidvar N, Neyestani TR, Hajifaraji M, Eshraghian MR, Rezazadeh A, Armin S, Haidari H, Zowghi T. Calcium Intake, Major Dietary Sources and Bone Health Indicators in Iranian Primary School Children. IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26199684 PMCID: PMC4505966 DOI: 10.5812/ijp.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Adequate calcium intake may have a crucial role with regards to prevention of many chronic diseases, including hypertension, hypercholesterolemia, different types of cancer, obesity and osteoporosis. In children, sufficient calcium intake is especially important to support the accelerated growth spurt during the preteen and teenage years and to increase bone mineral mass to lay the foundation for older age. Objectives: This study aimed to assess daily calcium intake in school-age children to ensure whether they fulfill the FGP dairy serving recommendations, the recommended levels of daily calcium intake and to assess the relationship between dietary calcium intake and major bone health indicators. Patients and Methods: A total of 501 Iranian school-age children were randomly selected. Calcium intake was assessed using a semi-quantitative food frequency questionnaire. Bone health indicators were also assessed. Results: Dairy products contributed to 69.3% of the total calcium intake of the children. Daily adequate intake of calcium was achieved by 17.8% of children. Only 29.8% met the Food guide pyramid recommendations for dairy intake. Dietary calcium intake was not significantly correlated with serum calcium and other selected biochemical indicators of bone health. Conclusions: The need for planning appropriate nutrition strategies for overcoming inadequate calcium intake in school age children in the city of Tehran is inevitable.
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Affiliation(s)
- Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Nasrin Omidvar, Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. E-mail:
| | | | - Majid Hajifaraji
- Department of Food and Nutrition Policy and Programming Research, Tehran, IR Iran
| | - Mohammad-Reza Eshraghian
- National Department of Epidemiology and Biostatistics, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Arezoo Rezazadeh
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saloumeh Armin
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Homa Haidari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Telma Zowghi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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47
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Deal CL, Abelson AG. Management of osteoporosis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lappe JM, Watson P, Gilsanz V, Hangartner T, Kalkwarf HJ, Oberfield S, Shepherd J, Winer KK, Zemel B. The longitudinal effects of physical activity and dietary calcium on bone mass accrual across stages of pubertal development. J Bone Miner Res 2015; 30:156-64. [PMID: 25130421 PMCID: PMC4280289 DOI: 10.1002/jbmr.2319] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022]
Abstract
Childhood and adolescence are critical periods of bone mineral content (BMC) accrual that may have long-term consequences for osteoporosis in adulthood. Adequate dietary calcium intake and weight-bearing physical activity are important for maximizing BMC accrual. However, the relative effects of physical activity and dietary calcium on BMC accrual throughout the continuum of pubertal development in childhood remains unclear. The purpose of this study was to determine the effects of self-reported dietary calcium intake and weight-bearing physical activity on bone mass accrual across the five stages of pubertal development in a large, diverse cohort of US children and adolescents. The Bone Mineral Density in Childhood study was a mixed longitudinal study with 7393 observations on 1743 subjects. Annually, we measured BMC by dual-energy X-ray absorptiometry (DXA), physical activity and calcium intake by questionnaire, and pubertal development (Tanner stage) by examination for up to 7 years. Mixed-effects regression models were used to assess physical activity and calcium intake effects on BMC accrual at each Tanner stage. We found that self-reported weight-bearing physical activity contributed to significantly greater BMC accrual in both sexes and racial subgroups (black and nonblack). In nonblack males, the magnitude of the activity effect on total body BMC accrual varied among Tanner stages after adjustment for calcium intake; the greatest difference between high- and low-activity boys was in Tanner stage 3. Calcium intake had a significant effect on bone accrual only in nonblack girls. This effect was not significantly different among Tanner stages. Our findings do not support differential effects of physical activity or calcium intake on bone mass accrual according to maturational stage. The study demonstrated significant longitudinal effects of weight-bearing physical activity on bone mass accrual through all stages of pubertal development.
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Abstract
Bone mass, geometry and microstructure, and bony tissue material level properties determine bone strength, hence the resistance to fracture. At a given age, all these variables are the consequence of the amount accumulated and of the structure developed during growth, up to the so-called peak bone mass, and of the bone loss and microstructure degradation occurring later in life. Genetic factors primarily contribute to the variance of the determinants of bone strength. Nutritional intakes are environmental factors that influence both processes, either directly by modifying modelling and remodelling, or indirectly through changes in calcitropic hormone secretion and action. Some effects of nutrition on the offspring bone could take place during foetal life. There are interplays between genetic factors, nutritional intakes and physical exercise. Among the nutrients, sufficient dietary intakes of calcium and protein are necessary for bone health in childhood and adolescence as well as later in life.
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Affiliation(s)
- René Rizzoli
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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50
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Viguet-Carrin S, Hoppler M, Membrez Scalfo F, Vuichoud J, Vigo M, Offord EA, Ammann P. Peak bone strength is influenced by calcium intake in growing rats. Bone 2014; 68:85-91. [PMID: 25102437 DOI: 10.1016/j.bone.2014.07.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/21/2014] [Accepted: 07/25/2014] [Indexed: 01/20/2023]
Abstract
In this study we investigated the effect of supplementing the diet of the growing male rat with different levels of calcium (from low to higher than recommended intakes at constant Ca/P ratio), on multiple factors (bone mass, strength, size, geometry, material properties, turnover) influencing bone strength during the bone accrual period. Rats, age 28days were supplemented for 4weeks with high Ca (1.2%), adequate Ca (0.5%) or low Ca level (0.2%). Bone metabolism and structural parameters were measured. No changes in body weight or food intake were observed among the groups. As anticipated, compared to the adequate Ca intake, low-Ca intake had a detrimental impact on bone growth (33.63 vs. 33.68mm), bone strength (-19.7% for failure load), bone architecture (-58% for BV/TV) and peak bone mass accrual (-29% for BMD) due to the hormonal disruption implied in Ca metabolism. In contrast, novel, surprising results were observed in that higher than adequate Ca intake resulted in improved peak bone strength (106 vs. 184N/mm for the stiffness and 61 vs. 89N for the failure load) and bone material properties (467 vs. 514mPa for tissue hardness) but these effects were not accompanied by changes in bone mass, size, microarchitecture or bone turnover. Hormonal factors, IGF-I and bone modeling were also evaluated. Compared to the adequate level of Ca, IGF-I level was significantly lower in the low-Ca intake group and significantly higher in the high-Ca intake group. No detrimental effects of high Ca were observed on bone modeling (assessed by histomorphometry and bone markers), at least in this short-term intervention. In conclusion, the decrease in failure load in the low calcium group can be explained by the change in bone geometry and bone mass parameters. Thus, improvements in mechanical properties can be explained by the improved quality of intrinsic bone tissue as shown by nanoindentation. These results suggest that supplemental Ca may be beneficial for the attainment of peak bone strength and that multiple factors linked to bone mass and strength should be taken into account when setting dietary levels of adequate mineral intake to support optimal peak bone mass acquisition.
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Affiliation(s)
- S Viguet-Carrin
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland.
| | - M Hoppler
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland
| | - F Membrez Scalfo
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland
| | - J Vuichoud
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland
| | - M Vigo
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland
| | - E A Offord
- Centre de Recherche Nestlé, Vers-chez-les-Blanc, 1000 Lausanne 26, Switzerland
| | - P Ammann
- Service des Maladies Osseuses, Hôpital Universitaire de Genève, Genève, Switzerland
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