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Gholami F, Bahrampour N, Samadi M, Rasaei N, Yarizadeh H, Naghshi S, Mirzaei K. The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study. BMC Nutr 2023; 9:31. [PMID: 36788599 PMCID: PMC9926757 DOI: 10.1186/s40795-022-00658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND & AIMS Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone and muscle, and a high dietary acid load (DAL) may be detrimental to skeletal muscle mass and bone mineral content. However, the association between skeletal muscle mass and bone mineral content with dietary acid load has not been consistently reported in previous studies. The objective of the study was to evaluate the association of potential renal net acid load (PRAL) and net endogenous acid production (NEAP) with bone mineral content and skeletal muscle mass in pre-menopause women with overweight or obesity in Iran. METHOD Three hundred and ninety women with a body mass index (BMI) of 25 were included in this cross-sectional study. We used a validated 147-item semi-quantitative food frequency questionnaire (FFQ) for evaluating the dietary intake. Based on the dietary data, potential renal net acid load (PRAL) and net endogenous acid production (NEAP) were calculated. Muscle mass and bone mineral content were estimated by a bioelectrical impedance analyzer (BIA). RESULTS After controlling for potential confounders, we discovered a significant linear relationship between PRAL (β = -0.027, 95%CI = -0.049 to -0.004, P = 0.02) and NEAP (β = -0.05, 95%CI = -0.097 to -0.003, P = 0.03) and skeletal muscle mass index. However, there was no significant difference between SMM and BMC across PRAL and NEAP tertiles. CONCLUSION PRAL and NEAP were found to be inversely related to skeletal muscle mass index among overweight/obese women. Further research is required to establish whether this relationship is important for musculoskeletal health in these populations.
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Affiliation(s)
- Fatemeh Gholami
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Niki Bahrampour
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University (SRBIAU), Tehran, Iran
| | - Mahsa Samadi
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Niloufar Rasaei
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Habib Yarizadeh
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Sina Naghshi
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155, Iran.
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Naude, MTech (Hom) DF. Chronic Sub-Clinical Systemic Metabolic Acidosis - A Review with Implications for Clinical Practice. J Evid Based Integr Med 2022; 27:2515690X221142352. [PMID: 36448194 PMCID: PMC9716591 DOI: 10.1177/2515690x221142352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic 'Westernized' diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.
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Affiliation(s)
- David Francis Naude, MTech (Hom)
- Irma Schutte Foundation, Drummond, South Africa,David Francis Naude, Irma Schutte Foundation, 42 Protea Hill Rd, Drummond, KwaZulu Natal, 3626, South Africa. Postal address: P.O Box 8, Hillcrest, KwaZulu Natal, 3650, South Africa.
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Wakolbinger-Habel R, Reinweber M, König J, Pokan R, König D, Pietschmann P, Muschitz C. Self-reported Resistance Training Is Associated With Better HR-pQCT-derived Bone Microarchitecture in Vegan People. J Clin Endocrinol Metab 2022; 107:2900-2911. [PMID: 35924941 DOI: 10.1210/clinem/dgac445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT A plant-based lifestyle is a global trend; lower bone mineral density and increased fracture risk in vegan people are reported. OBJECTIVE The primary objective was to assess trabecular and cortical bone microarchitecture in vegans and omnivores. Secondary objectives were to evaluate relationships between bone microarchitecture, nutrition parameters, and physical activity. METHODS This was an observational study at the Medical Department II, St. Vincent Hospital (tertiary referral center for gastrointestinal, metabolic, and bone diseases, and teaching hospital of the Medical University of Vienna), including 43 healthy nonobese female and male subjects on a plant-based diet for at least 5 years, and 45 healthy nonobese female and male subjects on an omnivore diet for at least 5 years. The main outcome measures were the parameters of trabecular and cortical bone microarchitecture (high-resolution peripheral quantitative computed tomography), serum markers of bone turnover, nutrient intake (nutrition protocol), and self-reported resistance training (physical activity questionnaires). RESULTS In the vegan group, trabecular and cortical structure were altered compared with omnivores. Vegans not reporting resistance training had diminished bone microarchitecture compared with omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar. In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrient intake and bone microarchitecture were observed without a conclusive pattern. CONCLUSION Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrient uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.
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Affiliation(s)
- Robert Wakolbinger-Habel
- Department of Physical and Rehabilitation Medicine (PRM), Vienna Healthcare Group - Clinic Donaustadt, Academic Teaching Hospital of the Medical University of Vienna, A-1220 Vienna, Austria
- Medical Department II-VINFORCE, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, A-1060 Vienna, Austria
| | | | - Jürgen König
- Department of Nutritional Sciences, University of Vienna, A-1090 Vienna, Austria
| | - Rochus Pokan
- Division of Sports Medicine, Exercise Physiology and Prevention, Center for Sport Science and University Sports, University of Vienna, A-1150 Vienna, Austria
| | - Daniel König
- Division of Sports Medicine, Exercise Physiology and Prevention, Center for Sport Science and University Sports, University of Vienna, A-1150 Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Christian Muschitz
- Medical Department II-VINFORCE, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, A-1060 Vienna, Austria
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Dietary Acid Load Was Positively Associated with the Risk of Hip Fracture in Elderly Adults. Nutrients 2022; 14:nu14183748. [PMID: 36145124 PMCID: PMC9503794 DOI: 10.3390/nu14183748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
Previous studies have shown that dietary acid load (DAL) harms bone health, but the evidence is inconsistent and insufficient. This study examined the relationships between DAL and the risk of hip fracture. This case−control study contained 1070 pairs of 1:1 age-, city-, and gender-matched incident cases and controls (mean age, 71 years) recruited in Guangdong, China. Dietary information was collected using a validated 79-item food frequency questionnaire through face-to-face interviews. DAL was estimated based on established algorithms for the potential renal acid load (PRAL) and net endogenous acid production (NEAP). Higher PRAL and NEAP were dose-dependently associated with a higher risk of hip fracture in both the conditional logistic regression model and restricted cubic spline analysis after adjusting for potential covariates. The multivariate-adjusted odds ratios and 95% CI of hip fracture for tertiles 2 and 3 (vs. 1) of DAL were 1.63 (1.18, 2.25) and 1.92 (1.36, 2.71) for PRAL and 1.81 (1.30, 2.53) and 2.55 (1.76, 3.71) for NEAP in all participants (all p-trends < 0.001), respectively. Subgroup analyses showed more pronounced associations in participants with a lower body mass index. Our findings suggested positive associations between the estimated DAL and the risk of hip fractures in the elderly Chinese population.
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Gholami F, Naghshi S, Samadi M, Rasaei N, Mirzaei K. Dietary Acid Load and Bone Health: A Systematic Review and Meta-Analysis of Observational Studies. Front Nutr 2022; 9:869132. [PMID: 35600825 PMCID: PMC9120865 DOI: 10.3389/fnut.2022.869132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Findings on the association between dietary acid load (DAL) and bone health are conflicting. This study aimed to summarize available studies on the association between DAL and risk of fractures or bone mineral density (BMD) in adults. Online databases including PubMed, Scopus, and Embase were searched for relevant studies published up to June 2021, using pertinent keywords. We identified observational studies (cohort, case-control, and cross-sectional) investigating the association between DAL and risk of fractures or BMD, then selected studies following these reported criteria: RRs with corresponding 95% CIs for the relationship between DAL and fracture risk; correlation coefficients for the association between DAL and BMD; and mean ± SD of BMD values across the categories of DAL. Overall, 17 studies with 80545 individuals were included. There was no significant relationship between the PRAL and fracture risk (Pooled RR: 1.18; 95% confidence interval 0.98 to 1.41, I2 = 60.6%). Moreover, a similar association was observed between the NEAP and fracture risk (Pooled RR: 1.41, 95% CI: 0.79 to 2.52, I2 = 54.1%). The results of five studies from four publications revealed no significant association between dietary PRAL score and femoral and spinal BMD (WMD femoral = −0.01, 95% confidence interval: −0.02 to 0.01, I2 = 76.5%; WMD spinal = −0.01, 95% CI: −0.03 to 0.01, I2 = 56.7%). However, being in the highest category of NEAP was significantly associated with a lower femoral and spinal BMD (WMD femoral = −0.01, 95% CI: −0.02 to −0.00, I2 = 82.1%; WMD spinal = −0.02, 95% CI: −0.03 to −0.01, I2 = 93%). It was showed that adopting diets high in acidity was not associated with risk of fractures. We also found a significant negative relationship between NEAP and BMD. However, DAL based on PRAL was not associated with BMD.
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Galchenko A, Gapparova K, Sidorova E. The influence of vegetarian and vegan diets on the state of bone mineral density in humans. Crit Rev Food Sci Nutr 2021; 63:845-861. [PMID: 34723727 DOI: 10.1080/10408398.2021.1996330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There are so many literatures about vegetarians being less prone to chronic, noninfectious diseases, which are, however, the main cause of the decline in quality of life and mortality in developed countries.However, according to various scientific sources, vegetarian and especially vegan diets often contain less saturated fats, protein, calcium, vitamins D and B12, or long-chain ω-3 PUFAs. One of the most common pathology associated with a predominantly plant diet is osteopenia and osteoporosis. An analysis of 13 studies has shown that vegetarians and vegans are at a higher risk of reducing of bone mineral density, thereby increasing the incidence of fractures.At the same time, plant-based diets are usually richer in many other micronutrients important for bone health: vitamins C and K, carotenoids, potassium, magnesium, manganese, copper, or silicon. Moreover, with the deepening of our knowledge about the role of nutrients in the body and the features of the nutritional status of the population, the quality of vegetarian and vegan diets also increases. They are less and less prone to micronutrient deficiencies. Recent studies show that BMD, as well as the risk of osteoporotic fractures, at least in vegetarians, equaled these indicators in omnivores.
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Affiliation(s)
- Alexey Galchenko
- Department of preventive diet therapy, Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation.,Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - K Gapparova
- Department of preventive diet therapy, Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation
| | - E Sidorova
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
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No Interaction Effect between Interleukin-6 Polymorphisms and Acid Ash Diet with Bone Resorption Marker in Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020827. [PMID: 33478001 PMCID: PMC7835771 DOI: 10.3390/ijerph18020827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022]
Abstract
Background: Evidence is growing that a high-acid diet might accelerate the rate of bone loss, and gene polymorphisms such as Interleukin 6 (IL6) -174G/C and -572G/C are related to bone deterioration. However, no study of the interaction between diet and IL6 polymorphisms has been conducted among Asians. Thus, the objective of this study was to determine whether IL6 gene polymorphisms modified the association between dietary acidity and the rate of bone resorption. Methods: This cross-sectional study recruited 203 postmenopausal women (age ranged from 51 to 85 years old) in community settings. The dietary intakes of the participants were assessed using a validated interviewer-administered semi-quantitative food frequency questionnaire (FFQ), while dietary acid load (DAL) was estimated using net endogenous acid production (NEAP). Agena® MassARRAY genotyping analysis and serum collagen type 1 cross-linked C-telopeptide (CTX1) were used to identify the IL6 genotype and as a bone resorption marker, respectively. The interactions between diet and single-nucleotide polymorphisms (SNPs) were assessed using linear regressions. Results: A total of 203 healthy postmenopausal women aged between 51 and 85 years participated in this study. The mean BMI of the participants was 24.3 kg/m2. In IL6 -174 G/C, all the participants carried the GG genotype, while the C allele was absent. Approximately 40% of the participants had a high dietary acid load. Dietary acid load (B = 0.15, p = 0.031) and the IL6 -572 CC genotype group (B = 0.14, p = 0.044) were positively associated with a higher bone resorption. However, there was no moderating effect of the IL6 genetic polymorphism on the relationship between and acid ash diet and bone resorption markers among the postmenopausal women (p = 0.79). Conclusion: High consumption of an acid ash diet and the IL6 -572 C allele seem to attribute to high bone resorption among postmenopausal women. However, our finding does not support the interaction effect of dietary acidity and IL6 (-174G/C and -572G/C) polymorphisms on the rate of bone resorption. Taken together, these results have given scientific research other candidate genes to focus on which may interact with DAL on bone resorption, to enhance planning for preventing or delaying the onset of osteoporosis among postmenopausal women.
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Papageorgiou M, Merminod F, Chevalley T, van Rietbergen B, Ferrari S, Rizzoli R, Biver E. Associations between age-related changes in bone microstructure and strength and dietary acid load in a cohort of community-dwelling, healthy men and postmenopausal women. Am J Clin Nutr 2020; 112:1120-1131. [PMID: 32678420 DOI: 10.1093/ajcn/nqaa191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/17/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The importance of dietary acid load (DAL) in the pathogenesis of osteoporosis is still debated. Age-related changes in bone microstructure and strength in relation to DAL remain largely unexplored. OBJECTIVES We investigated the associations between changes in areal and volumetric bone mineral density (BMD), bone microstructure and strength, fracture risk, and DAL in a prospective cohort of 65-y-old healthy men and postmenopausal women. METHODS Potential renal acid load (PRAL; mEq/d) was calculated as a DAL proxy to characterize participants' diet as alkaline (Alk-D; PRAL < -5), neutral (Neut-D; -5 ≤ PRAL ≤ 5), or acidic (Acid-D; PRAL >5). We measured areal BMD (aBMD) by DXA, and distal radius and tibia bone microstructure using high-resolution peripheral quantitative computed tomography, at baseline (n = 853) and after 6.1 ± 1.4 y (n = 708). Bone strength was estimated using finite element analyses at baseline and after 3.0 ± 0.5 y (n = 613). Prevalent and incident fractures were recorded. RESULTS The majority of the participants (59%) had an Alk-D, while 23% had a Neut-D, and 18% an Acid-D. Baseline aBMD and bone microstructure and strength did differ or were slightly better in women or men with an Acid-D versus those consuming an Alk-D or Neut-D. Indeed, women with an Acid-D had higher trabecular number (P = 0.010 vs. Alk-D; P = 0.001 vs. Neut-D), while men had higher hip and radius aBMD (P = 0.008 and 0.024 vs. Neut-D, respectively) and radius strength (P = 0.026 vs. Neut-D). Over the follow-up, women in the Acid-D group experienced lower cortical and endocortical bone loss at the radius than did the Alk-D and Neut-D groups (cortical thickness, P = 0.008 and < 0.001; trabecular area, P = 0.001 and < 0.001, respectively). No association between fractures and PRAL was observed. CONCLUSIONS These null or favourable associations between baseline values or changes in aBMD, bone microstructure and strength, and DAL in this cohort of 65-y-old healthy individuals do not support adverse DAL-mediated effects on bone. This trial was registered at http://www.isrctn.com as ISRCTN11865958.
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Affiliation(s)
- Maria Papageorgiou
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fanny Merminod
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Serge Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Dietary acid-base load and its association with risk of osteoporotic fractures and low estimated skeletal muscle mass. Eur J Clin Nutr 2020; 74:33-42. [PMID: 32873955 DOI: 10.1038/s41430-020-0686-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND/OBJECTIVES Age-related decline in skeletal muscle mass and strength, loss of bone density, and increased risk of osteoporotic fractures are important public health issues. Systemic acid-base balance is affected by dietary intake and may be relevant to these conditions. We therefore investigated associations of dietary acid-base load with skeletal muscle mass, bone density status, and fracture risk. SUBJECTS/METHODS We analysed the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort of >25,000 individuals, 39-79 years at baseline. Potential renal acid load (PRAL) was calculated from 7-day food diary data. As a proxy for skeletal muscle mass, we estimated fat-free mass from bioelectrical impedance analysis and scaled this for BMI (FFMBMI). Bone density status was assessed by heel-bone broadband ultrasound attenuation (BUA), and fracture rates were obtained from health-care records. Multivariable regression was used to test musculoskeletal outcomes across sex-specific quintiles of PRAL. RESULTS PRAL in quintiles was negatively associated with FFMBMI in men (n = 6350, p < 0.001) and women (n = 7989, p < 0.001), with quintile 5 vs 1 differences of -1.5% and -3.2% (both p < 0.001). PRAL was also negatively associated with BUA in women (n = 8312, p = 0.016; quintile 5 vs 1 difference -1.5%, p = 0.024). The combined hazard of hip, wrist and spine fractures (mean ± SD follow-up 17.9 ± 4.9 years) was higher with increasing quintiles of PRAL in men (610 fractures; n = 11,511; p = 0.013) and women (1583 fractures; n = 13,927; p = 0.009), with quintile 5 vs 1 hazard ratios of 1.33 (95% CI: 1.03-1.72, p = 0.029) and 1.21 (95% CI: 1.03-1.42, p = 0.022), but associations were not consistent for all fractures sites and age groups tested. CONCLUSIONS This study provides strong evidence, albeit observational, for a negative association between PRAL and musculoskeletal health in middle to older age men and women, and thus supports the rationale for a less acidic dietary load.
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Liphardt A, Bolte V, Eckstein F, Wirth W, Brüggemann G, Niehoff A. Response of thigh muscle cross‐sectional area to 21‐days of bed rest with exercise and nutrition countermeasures. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Anna‐Maria Liphardt
- Institute of Biomechanics and Orthopaedics German Sport University Cologne Köln Germany
- Department of Internal Medicine 3 – Rheumatology and Immunology Universitätsklinikum ErlangenFriedrich‐Alexander‐University (FAU) Erlangen‐Nuremberg Erlangen Germany
| | - Vera Bolte
- Institute of Biomechanics and Orthopaedics German Sport University Cologne Köln Germany
| | - Felix Eckstein
- Institute of Anatomy Paracelsus Medical University Salzburg & Nuremberg Salzburg Austria
- Chondrometrics GmbH Ainring Germany
| | - Wolfgang Wirth
- Institute of Anatomy Paracelsus Medical University Salzburg & Nuremberg Salzburg Austria
- Chondrometrics GmbH Ainring Germany
| | - Gert‐Peter Brüggemann
- Institute of Biomechanics and Orthopaedics German Sport University Cologne Köln Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB) Faculty of Medicine, University of Cologne Köln Germany
| | - Anja Niehoff
- Institute of Biomechanics and Orthopaedics German Sport University Cologne Köln Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB) Faculty of Medicine, University of Cologne Köln Germany
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Abbasalizad Farhangi M, Vajdi M, Najafi M. Dietary acid load significantly predicts 10-years survival in patients underwent coronary artery bypass grafting (CABG) surgery. PLoS One 2019; 14:e0223830. [PMID: 31622378 PMCID: PMC6797202 DOI: 10.1371/journal.pone.0223830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDS Numerous studies have revealed the role of dietary acid load as a potential risk factor for cardiovascular events and blood pressure. However, its role in predicting the mortality rate in patients underwent coronary artery bypass grafting surgery (CABG) has not been reported. In the current study we aimed to evaluate the relationship of dietary acid load and cardio-metabolic risk factors with ten year survival among patients underwent CABG. METHODS The current prospective cohort study comprises 454 patients underwent CABG. Anthropometric, clinical and biochemical measurements were performed. Dietary acid load was calculated as either potential renal acid load (PRAL) or net endogenous acid production (NEPA) using the data obtained from a semi-quantitative food frequency questionnaire (FFQ). Survival analysis was performed using Kaplan-Meier method followed by log-rank test. The association between all-cause mortality and study parameters was performed with Cox-proportional hazard model. RESULTS Patients in the higher PRAL and NEAP quartiles had lower BMI and lower ejection fraction rate (P <0.05). Moreover, lower hematocrit values were observed in patients of higher PRAL quartiles. Higher PRAL scores were associated with higher mortality rate and reduced survival days (adjusted hazard ratio: 1.023 (1.00-1.04; P-value = 0.01). However, there was no relationship between NEAP and survival. CONCLUSIONS We revealed that high PRAL scores are positive predictors of 10-year mortality in patients underwent CABG. The results of our study suggest that maintaining an adequate acid-base balance can contribute to longevity by reducing the risk of mortality.
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Affiliation(s)
- Mahdieh Abbasalizad Farhangi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Vajdi
- Student Research Committee, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Najafi
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty Research Associate, Western University, London, ON, Canada
- Cardiac Outcome Research and Education (CORE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- * E-mail:
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Frings-Meuthen P, Bernhardt G, Buehlmeier J, Baecker N, May F, Heer M. The negative effect of unloading exceeds the bone-sparing effect of alkaline supplementation: a bed rest study. Osteoporos Int 2019; 30:431-439. [PMID: 30255228 DOI: 10.1007/s00198-018-4703-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Potassium bicarbonate was administrated to an already alkaline diet in seven male subjects during a 21-day bed rest study and was able to decrease bed rest induced increased calcium excretion but failed to prevent bed rest-induced bone resorption. INTRODUCTION Supplementation with alkali salts appears to positively influence calcium and bone metabolism and, thus, could be a countermeasure for population groups with an increased risk for bone loss. However, the extent to which alkalization counteracts acid-induced bone resorption or whether it merely has a calcium and bone maintenance effect is still not completely understood. In the present study, we hypothesized that additional alkalization to an already alkaline diet can further counteract bed rest-induced bone loss. METHODS Seven healthy male subjects completed two parts of a crossover designed 21-day bed rest study: bed rest only (control) and bed rest supplemented with 90 mmol potassium bicarbonate (KHCO3) daily. RESULTS KHCO3supplementation during bed rest resulted in a more alkaline status compared to the control intervention, demonstrated by the increase in pH and buffer capacity level (pH p = 0.023, HCO3p = 0.02, ABE p = 0.03). Urinary calcium excretion was decreased during KHCO3 supplementation (control 6.05 ± 2.74 mmol/24 h; KHCO3 4.87 ± 2.21 mmol/24 h, p = 0.03); whereas, bone formation was not affected by additional alkalization (bAP p = 0.58; PINP p = 0.60). Bone resorption marker UCTX tended to be lower during alkaline supplementation (UCTX p = 0.16). CONCLUSIONS The more alkaline acid-base status, achieved by KHCO3 supplementation, reduced renal calcium excretion during bed rest, but was not able to prevent immobilization-induced bone resorption. However, advantages of alkaline salts on bone metabolism may occur under acidic metabolic conditions or with respect to the positive effect of reduced calcium excretion within a longer time frame. TRIAL REGISTRATION Trial number: NCT01509456.
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Affiliation(s)
- P Frings-Meuthen
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany.
| | - G Bernhardt
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Novartis AG, Basel, Switzerland
| | - J Buehlmeier
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - N Baecker
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - F May
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
| | - M Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
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Abstract
Bone health is determined by the rate of accrual in early life, followed by the rate of age-associated bone loss. Dietary protein intake might have a role in bone health across both of these phases via pleiotropic mechanistic pathways. Herein we summarise the pathways through which protein may exert either a positive or negative influence on bone. In the introduction, we describe the acid-ash hypothesis, which states that a high-protein intake may lead to an acidic residue that must be neutralised through the leaching of calcium and other minerals from the bone, subsequently leading to demineralisation and bone weakening. Conversely, and as described in the 'Against: mechanisms through which protein may negatively impact bone' section, protein intake may act to strengthen the bone by stimulating the activity of various anabolic hormones and growth factors, or by optimising muscle mass and functionality, which itself has an osteogenic influence. The net effect of these contrasting pathways is described in the 'For: mechanisms through which protein may positively impact bone' section, where a number of meta-analyses have demonstrated that higher protein intakes have a small positive impact on bone mass and fracture risk. Sometimes higher than recommended protein intakes are advised, e.g. during the earlier and later phases of the lifespan or during reduced energy availability. We conclude that protein is an essential nutrient for bone health, although further research is required to clarify the mechanistic pathways through which it exerts its influence, along with the clarification of the quantities, food sources and timing to allow for the optimisation of this protective influence and ultimately a reduction in fracture risk.
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Rogers TS, Harrison S, Judd S, Orwoll ES, Marshall LM, Shannon J, Langsetmo L, Lane NE, Shikany JM. Dietary patterns and longitudinal change in hip bone mineral density among older men. Osteoporos Int 2018; 29:1135-1145. [PMID: 29450584 PMCID: PMC6842326 DOI: 10.1007/s00198-018-4388-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/05/2018] [Indexed: 01/15/2023]
Abstract
UNLABELLED Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss. INTRODUCTION This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time. METHODS Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors. RESULTS Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed. CONCLUSIONS Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.
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Affiliation(s)
- T S Rogers
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
| | - S Harrison
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - S Judd
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - E S Orwoll
- Oregon Health and Science University, Portland, OR, USA
| | - L M Marshall
- Oregon Health and Science University, Portland, OR, USA
| | - J Shannon
- Oregon Health and Science University, Portland, OR, USA
| | - L Langsetmo
- University of Minnesota Epidemiology and Community Health, Minneapolis, MN, USA
| | - N E Lane
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA
| | - J M Shikany
- University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Shea MK, Dawson-Hughes B. Association of Urinary Citrate With Acid-Base Status, Bone Resorption, and Calcium Excretion in Older Men and Women. J Clin Endocrinol Metab 2018; 103:452-459. [PMID: 29211866 PMCID: PMC5800838 DOI: 10.1210/jc.2017-01778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Elevated urine net acid excretion (NAE), indicative of subclinical metabolic acidosis, has been associated with higher bone turnover. Urine citrate, which is a common clinical measure, changes in response to acid-base status but its association with bone turnover is uncertain. OBJECTIVE We evaluated the association between change in urine citrate and change in bone turnover and calcium excretion. DESIGN, INTERVENTION, AND PARTICIPANTS A total of 233 healthy men and women ≥60 years old were randomly assigned to 1.0 mmol/kg/d potassium bicarbonate (KHCO3), 1.5 mmol/kg/d KHCO3, or placebo for 84 days. OUTCOME MEASURES Urine citrate, NAE, N-telopeptide of collagen type-I (NTX), calcium excretion, and serum amino-terminal propeptide of type 1 procollagen (P1NP) were measured before and after intervention. RESULTS Urine citrate increased dose dependently after KHCO3 supplementation (P trend < 0.001). The urine citrate change was significantly inversely associated with P1NP change (P = 0.021) but not with change in NTX (P = 0.051) or calcium excretion (P = 0.652). The NAE change was positively associated with change in NTX and calcium excretion (P ≤ 0.003) but not with change in P1NP (P = 0.051). When the urine citrate change and NAE change were included in the same model, the urine citrate change was not associated with change in NTX, calcium excretion, or serum P1NP (P ≥ 0.086), whereas change in NAE remained associated with change in NTX and calcium excretion (P ≤ 0.003). CONCLUSION Urine citrate may not be a suitable alternative to NAE when assessing acid-base status in relation to bone turnover in older adults.
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Affiliation(s)
- M Kyla Shea
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Bess Dawson-Hughes
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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16
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Chauveau P, Lasseur C, Nodimar C, Prezelin-Reydit M, Trolonge S, Combe C, Aparicio M. [Dietary acid load: A novel target for the nephrologist?]. Nephrol Ther 2018; 14:240-246. [PMID: 29289517 DOI: 10.1016/j.nephro.2017.10.003] [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: 06/27/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
The acid production of endogenous origin depends mainly on the metabolism of the food and varies with the nature of these. Of the order of 1mEq/kg/day for contemporary food in industrialized countries, it is reduced by more than one third among vegetarians and close to neutrality among vegans. The dietary acid load is eliminated by the normal kidneys, thus maintaining the acid-base equilibrium. In the setting of CKD, it will overflow the capacities of the nephrons, generating a retention of H+ ions, promoting subclinical acidosis. This tissue retention of H+ ions was confirmed by direct techniques in animal models and indirect techniques in humans. The systemic retention of H+ ions and the accompanying compensatory mechanisms have negative consequences on bone tissue, skeletal muscle, cardiovascular risk and renal function. In the animal, the substitution of casein (acid) by soy (alkaline) prevents metabolic acidosis and slows the progression of renal insufficiency. In man, various prospective studies have confirmed that the risk of renal insufficiency was positively correlated with the dietary acid load. Conversely, bicarbonate supplementation and/or a diet enriched with fruits and vegetables, have a favorable effect on renal insufficiency, including in subjects with normal bicarbonate. These results lead to reconsider the K/DOQI recommendations to correct acidosis when the bicarbonate level falls below 22mEq/L, since tissue retention of H+ ions and its negative consequences appear at higher or even normal levels of bicarbonates.
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Affiliation(s)
- Philippe Chauveau
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France.
| | - Catherine Lasseur
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | - Céline Nodimar
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | - Mathilde Prezelin-Reydit
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | | | - Christian Combe
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Unité Inserm 1026, université Bordeaux, 33076 Bordeaux, France
| | - Michel Aparicio
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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17
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Akter S, Nanri A, Mizoue T, Noda M, Sawada N, Sasazuki S, Tsugane S. Dietary acid load and mortality among Japanese men and women: the Japan Public Health Center-based Prospective Study. Am J Clin Nutr 2017; 106:146-154. [PMID: 28539378 DOI: 10.3945/ajcn.117.152876] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Diet-induced metabolic acidosis has been linked to cardiometabolic abnormalities including hypertension and type 2 diabetes. However, there are limited data on its association with other chronic diseases and mortality.Objective: The present study aimed to examine the association between dietary acid load and total and cause-specific mortality.Design: This study was a large-scale, population-based, prospective cohort study in Japan involving 42,736 men and 49,742 women, aged 45-75 y, who had no history of cancer, stroke, ischemic heart disease (IHD), or chronic liver disease at baseline. Dietary intake was assessed by using a validated 147-item food-frequency questionnaire. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were derived from nutrient intake. Death and cause of death were identified by using the residential registry and death certificates. Cox proportional hazards regression was used to estimate HRs and 95% CIs for total and cause-specific mortality with adjustment for potential confounding variables.Results: During a median follow-up of 16.9 y, 12,993 total deaths occurred. A higher PRAL score was associated with higher total mortality: the multivariable-adjusted HR for total mortality for the highest compared with the lowest quartiles of PRAL scores was 1.13 (95% CI: 1.07, 1.18; P-trend < 0.001). This score was positively associated with mortality from cardiovascular disease (CVD) and particularly from IHD; the HRs (95% CIs) for the highest compared with the lowest quartile of PRAL score were 1.16 (1.06, 1.28) and 1.16 (1.02, 1.33) for CVD and IHD mortality, respectively. There was no association between PRAL score and cancer mortality. Similar associations were observed between NEAP score and total and cause-specific mortality.Conclusion: A high dietary acid load score was associated with a higher risk of total mortality and mortality from CVD, particularly from IHD, in Japanese adults.
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Affiliation(s)
- Shamima Akter
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan;
| | - Akiko Nanri
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan; and
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shizuka Sasazuki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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18
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Carnauba RA, Baptistella AB, Paschoal V, Hübscher GH. Diet-Induced Low-Grade Metabolic Acidosis and Clinical Outcomes: A Review. Nutrients 2017; 9:E538. [PMID: 28587067 PMCID: PMC5490517 DOI: 10.3390/nu9060538] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/05/2017] [Accepted: 05/17/2017] [Indexed: 01/04/2023] Open
Abstract
Low-grade metabolic acidosis is a condition characterized by a slight decrease in blood pH, within the range considered normal, and feeding is one of the main factors that may influence the occurrence of such a condition. The excessive consumption of acid precursor foods (sources of phosphorus and proteins), to the detriment of those precursors of bases (sources of potassium, calcium, and magnesium), leads to acid-base balance volubility. If this condition occurs in a prolonged, chronic way, low-grade metabolic acidosis can become significant and predispose to metabolic imbalances such as kidney stone formation, increased bone resorption, reduced bone mineral density, and the loss of muscle mass, as well as the increased risk of chronic diseases such as type 2 diabetes mellitus, hypertension, and non-alcoholic hepatic steatosis. Considering the increase in the number of studies investigating the influence of diet-induced metabolic acidosis on clinical outcomes, this review gathers the available evidence evaluating the association of this disturbance and metabolic imbalances, as well as related mechanisms. It is necessary to look at the western dietary pattern of most countries and the increasing incidence of non-comunicable diseases for the balance between fruit and vegetable intake and the appropriate supply of protein, mainly from animal sources, so that it does not exceed the daily recommendations.
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Affiliation(s)
| | | | - Valéria Paschoal
- VP Research Institute, 287, Carlos Petit St, São Paulo 04110-000, Brazil.
| | - Gilberti Helena Hübscher
- Departament of Food Science and Technology, Federal University of Santa Maria, Rio Grande do Sul 97105-900, Brazil.
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19
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Heer M, Baecker N, Frings-Meuthen P, Graf S, Zwart SR, Biolo G, Smith SM. Effects of high-protein intake on bone turnover in long-term bed rest in women. Appl Physiol Nutr Metab 2017; 42:537-546. [DOI: 10.1139/apnm-2016-0292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bed rest (BR) causes bone loss, even in otherwise healthy subjects. Several studies suggest that ambulatory subjects may benefit from high-protein intake to stimulate protein synthesis and to maintain muscle mass. However, increasing protein intake above the recommended daily intake without adequate calcium and potassium intake may increase bone resorption. We hypothesized that a regimen of high-protein intake (HiPROT), applied in an isocaloric manner during BR, with calcium and potassium intake meeting recommended values, would prevent any effect of BR on bone turnover. After a 20-day ambulatory adaptation to a controlled environment, 16 women participated in a 60-day, 6° head-down-tilt (HDT) BR and were assigned randomly to 1 of 2 groups. Control (CON) subjects (n = 8) received 1 g/(kg body mass·day)−1 dietary protein. HiPROT subjects (n = 8) received 1.45 g protein/(kg body mass·day)−1 plus an additional 0.72 g branched-chain amino acids per day during BR. All subjects received an individually tailored diet (before HDTBR: 1888 ± 98 kcal/day; during HDTBR: 1604 ± 125 kcal/day; after HDTBR: 1900 ± 262 kcal/day), with the CON group’s diet being higher in fat and carbohydrate intake. High-protein intake exacerbated the BR-induced increase in bone resorption marker C-telopeptide (>30%) (p < 0.001) by the end of BR. Bone formation markers were unaffected by BR and high-protein intake. We conclude that high-protein intake in BR might increase bone loss. Further long-duration studies are mandatory to show how the positive effect of protein on muscle mass can be maintained without the risk of reducing bone mineral density.
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Affiliation(s)
- Martina Heer
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Natalie Baecker
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Petra Frings-Meuthen
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Sonja Graf
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Sara R. Zwart
- University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Gianni Biolo
- Department of Clinical, Technological and Morphological Sciences, Division of Internal Medicine, University of Trieste, 34127 Trieste, Italy
| | - Scott M. Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA
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20
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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21
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Xu H, Åkesson A, Orsini N, Håkansson N, Wolk A, Carrero JJ. Modest U-Shaped Association between Dietary Acid Load and Risk of All-Cause and Cardiovascular Mortality in Adults. J Nutr 2016; 146:1580-5. [PMID: 27385761 DOI: 10.3945/jn.116.231019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/31/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Conflicting evidence associates diet acidity with the incidence of chronic diseases such as hypertension, diabetes, kidney disease, and bone-mineral disorders. It is currently unknown whether dietary acidity is associated with death. OBJECTIVE We investigated the association of dietary acid load with the risk of all-cause and cardiovascular disease (CVD) mortality. METHODS We used data from 2 prospective cohorts, the Swedish Mammography Cohort and the Cohort of Swedish Men, which included 36,740 women and 44,957 men aged 45-84 y at the start of a 15-y follow-up period (1998-2012). Acid load was estimated from food-frequency questionnaires by use of the validated potential renal acid load (PRAL) algorithm. Deaths were ascertained via record linkage. Associations of PRAL with mortality were modeled by use of restricted cubic splines. RESULTS The median PRAL was 0.65 mEq/d (range: -109 to 81.5 mEq/d) in women and 12.3 mEq/d (-111 to 121 mEq/d) in men. During a mean of 13.5 ± 3.3 y of follow-up, there were 8576 and 13,332 deaths, of which 3203 and 5427 were attributed to cardiovascular causes in woman and men, respectively. In both sexes, a nonlinear U-shaped relation was observed, with higher mortality rates for both dietary acid and alkali excess. Compared with neutral PRAL (0 mEq/d), the HRs for all-cause mortality for the 10th and 90th percentiles of PRAL were 1.05 (95% CI: 1.01, 1.10) and 1.03 (95% CI: 0.98, 1.08), respectively, in women. The corresponding results for men were HRs 1.01 (95% CI: 1.00, 1.02) and 1.04 (95% CI: 1.00, 1.08) respectively. This relation was slightly stronger for CVD mortality. CONCLUSIONS Excess diet alkalinity and acidity both showed weak associations with higher mortality in Swedish adults. An acid-base balanced diet was associated with the lowest mortality, but the magnitude of mortality reduction was modest. The Swedish Mammography Cohort was registered at clinicaltrials.gov as NCT01127698 The Cohort of Swedish Men was registered at clinicaltrials.gov as NCT01127711.
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Affiliation(s)
- Hong Xu
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology
| | - Agneta Åkesson
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, and
| | - Nicola Orsini
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, and
| | - Niclas Håkansson
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, and
| | - Alicja Wolk
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, and
| | - Juan Jesús Carrero
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Gore E, Mardon J, Lebecque A. Draining and salting as responsible key steps in the generation of the acid-forming potential of cheese: Application to a soft blue-veined cheese. J Dairy Sci 2016; 99:6927-6936. [PMID: 27344382 DOI: 10.3168/jds.2016-11094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/15/2016] [Indexed: 11/19/2022]
Abstract
A disregarded nutritional feature of cheeses is their high acid-forming potential when ingested, which is associated with deleterious effects on consumers' health. This work aimed to characterize the acid-forming potential of a blue-veined cheese during manufacturing to identify the main steps of the process involved in this phenomenon. Sampling was performed on 3 batches at 10 steps of the cheese-making process: reception of raw milk, pasteurization, maturation of milk, coagulation, stirring, draining of the curds, and 4 ripening stages: 21, 28, 42, and 56d. The acid-forming potential of each sample was evaluated by (1) the calculation of the potential renal acid load (PRAL) index (considering protein, Cl, P, Na, K, Mg, and Ca contents), and (2) its organic anion content (lactate and citrate), considered as alkalinizing elements. Draining and salting were identified as the main steps responsible for generation of the acid-forming potential of cheese. The draining process induced an increase in the PRAL index from 1.2mEq/100g in milk to 10.4mEq/100g in drained curds due to the increase in dry matter and the loss of alkaline minerals into the whey. The increase in PRAL value (20.3mEq/100g at d 56) following salting resulted from an imbalance between the strong acidogenic elements (Cl, P, and proteins) and the main alkalinizing ones (Na and Ca). Particularly, Cl had a major effect on the PRAL value. Regarding organic anions, draining induced a loss of 93% of the citrate content in initial milk. The lactate content increased as fermentation occurred (1,297.9mg/100g in drained curds), and then decreased during ripening (519.3mg/100g at d 56). This lactate level probably helps moderate the acidifying potential of end products. Technological strategies aimed at limiting the acid-forming potential of cheeses are proposed and deserve further research to evaluate their nutritional relevance.
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Affiliation(s)
- Ecaterina Gore
- Clermont University, VetAgro Sup, UPSP n°2011-03-100, CALITYSS, 89 avenue Europe, F-63370 Lempdes, France
| | - Julie Mardon
- Clermont University, VetAgro Sup, UPSP n°2011-03-100, CALITYSS, 89 avenue Europe, F-63370 Lempdes, France.
| | - Annick Lebecque
- Clermont University, VetAgro Sup, UPSP n°2011-03-100, CALITYSS, 89 avenue Europe, F-63370 Lempdes, France
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Abstract
Western diet, high in protein-rich foods and poor in vegetables, is likely to be responsible for the development of a moderate acid excess leading to metabolism deregulation and the onset or worsening of chronic disturbances. Available findings seem to suggest that diets with high protein/vegetables ratio are likely to induce the development of calcium lithiasis, especially in predisposed subjects. Moreover, some evidence supports the hypothesis of bone metabolism worsening and enhanced bone loss following acid-genic diet consumption although available literature seems to lack direct and conclusive evidence demonstrating pathological bone loss. According to other evidences, diet-induced acidosis is likely to induce or accelerate muscle wasting or sarcopenia, especially among elderlies. Furthermore, recent epidemiological findings highlight a specific role of dietary acid load in glucose metabolism deregulation and insulin resistance. The aim of this review is to investigate the role of acid-genic diets in the development of the mentioned metabolic disorders focusing on the possible clinical improvements exerted by alkali supplementation.
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Affiliation(s)
- Lucio Della Guardia
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
| | - Carla Roggi
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
| | - Hellas Cena
- a Department of Public Health Experimental and Forensic Medicine , Unit of Human Nutrition University of Pavia , Pavia , Italy
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Ward KA, Prentice A, Kuh DL, Adams JE, Ambrosini GL. Life Course Dietary Patterns and Bone Health in Later Life in a British Birth Cohort Study. J Bone Miner Res 2016; 31:1167-76. [PMID: 26817442 PMCID: PMC4982044 DOI: 10.1002/jbmr.2798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 01/16/2023]
Abstract
Evidence for the contribution of individual foods and nutrients to bone health is weak. Few studies have considered hypothesis-based dietary patterns and bone health. We investigated whether a protein-calcium-potassium-rich (PrCaK-rich) dietary pattern over the adult life course, was positively associated with bone outcomes at 60 to 64 years of age. Diet diaries were collected at ages 36, 46, 53, and 60 to 64 years in 1263 participants (661 women) from the MRC National Survey of Health and Development. DXA and pQCT measurements were obtained at age 60 to 64 years, including size-adjusted bone mineral content (SA-BMC) and volumetric bone mineral density (vBMD). A food-based dietary pattern best explaining dietary calcium, potassium, and protein intakes (g/1000 kcal) was identified using reduced rank regression. Dietary pattern Z-scores were calculated for each individual, at each time point. Individual trajectories in dietary pattern Z-scores were modeled to summarize changes in Z-scores over the study period. Regression models examined associations between these trajectories and bone outcomes at age 60 to 64 years, adjusting for baseline dietary pattern Z-score and other confounders. A consistent PrCaK-rich dietary pattern was identified within the population, over time. Mean ± SD dietary pattern Z-scores at age 36 years and age 60 to 64 years were -0.32 ± 0.97 and 2.2 ± 1.5 (women) and -0.35 ± 0.98 and 1.7 ± 1.6 (men), respectively. Mean trajectory in dietary pattern Z-scores ± SD was 0.07 ± 0.02 units/year. Among women, a 0.02-SD unit/year higher trajectory in dietary pattern Z-score over time was associated with higher SA-BMC (spine 1.40% [95% CI, 0.30 to 2.51]; hip 1.35% [95% CI, 0.48 to 2.23]), and vBMD (radius 1.81% [95% CI, 0.13 to 3.50]) at age 60 to 64 years. No statistically significant associations were found in men. During adulthood, an increasing score for a dietary pattern rich in protein, calcium, and potassium was associated with greater SA-BMC at fracture-prone sites in women. This study emphasizes the importance of these nutrients, within the context of the whole diet, to bone health. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | | | - Diana L Kuh
- MRC Unit for Lifelong Healthy Ageing at University College London, London, UK
| | - Judith E Adams
- Manchester Academic Health Sciences & University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Gina L Ambrosini
- MRC Human Nutrition Research, Cambridge, UK.,School of Population Health, The University of Western Australia, Perth, Australia
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Garcia AH, Franco OH, Voortman T, de Jonge EAL, Gordillo NG, Jaddoe VWV, Rivadeneira F, van den Hooven EH. Dietary acid load in early life and bone health in childhood: the Generation R Study. Am J Clin Nutr 2015; 102:1595-603. [PMID: 26537942 DOI: 10.3945/ajcn.115.112821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary contribution to acid-base balance in early life may influence subsequent bone mineralization. Previous studies reported inconsistent results regarding the associations between dietary acid load and bone mass. OBJECTIVE We examined the associations of dietary acid load in early life with bone health in childhood. DESIGN In a prospective, multiethnic, population-based cohort study of 2850 children, we estimated dietary acid load as dietary potential renal acid load (dPRAL), based on dietary intakes of calcium, magnesium, phosphorus, potassium, and protein, and as a protein intake to potassium intake ratio (Pro:K) at 1 y of age and in a subgroup at 2 y of age : Bone mineral density, bone mineral content (BMC), area-adjusted BMC, and bone area were assessed by dual-energy X-ray absorptiometry at the median age of 6 y. Data were analyzed by using multivariable linear regression models. RESULTS After adjusting for relevant maternal and child factors, dietary acid load estimated as either dPRAL or Pro:K ratio was not consistently associated with childhood bone health. Associations did not differ by sex, ethnicity, weight status, or vitamin D supplementation. Only in those children with high protein intake in our population (i.e., >42 g/d), a 1-unit increase in dPRAL (mEq/d) was inversely associated with BMC (difference: -0.32 g; 95% CI: -0.64, -0.01 g). CONCLUSIONS Dietary acid load in early life was not consistently associated with bone health in childhood. Further research is needed to explore the extent to which dietary acid load in later childhood may affect current and future bone health.
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Affiliation(s)
- Audry H Garcia
- Department of Epidemiology, The Generation R Study Group
| | | | - Trudy Voortman
- Department of Epidemiology, The Generation R Study Group
| | - Ester A L de Jonge
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Vincent W V Jaddoe
- Department of Epidemiology, The Generation R Study Group, Department of Pediatrics, and
| | - Fernando Rivadeneira
- Department of Epidemiology, The Generation R Study Group, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Gunn CA, Weber JL, McGill AT, Kruger MC. Increased intake of selected vegetables, herbs and fruit may reduce bone turnover in post-menopausal women. Nutrients 2015; 7:2499-517. [PMID: 25856221 PMCID: PMC4425157 DOI: 10.3390/nu7042499] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/26/2022] Open
Abstract
Increased consumption of vegetables/herbs/fruit may reduce bone turnover and urinary calcium loss in post-menopausal women because of increased intake of polyphenols and potassium, but comparative human studies are lacking. The main aim was to compare bone turnover markers and urinary calcium excretion in two randomised groups (n = 50) of healthy post-menopausal women consuming ≥9 servings of different vegetables/herbs/fruit combinations (three months). Group A emphasised a generic range of vegetables/herbs/fruit, whereas Group B emphasised specific vegetables/herbs/fruit with bone resorption-inhibiting properties (Scarborough Fair Diet), with both diets controlled for potential renal acid load (PRAL). Group C consumed their usual diet. Plasma bone markers, urinary electrolytes (24 h) and estimated dietary PRAL were assessed at baseline and 12 weeks. Procollagen type I N propeptide (PINP) decreased (−3.2 μg/L, p < 0.01) in the B group only, as did C-terminal telopeptide of type I collagen (CTX) (−0.065 μg/L, p < 0.01) in women with osteopenia compared to those with normal bone mineral density (BMD) within this group. Intervention Groups A and B had decreased PRAL, increased urine pH and significantly decreased urinary calcium loss. Urinary potassium increased in all groups, reflecting a dietary change. In conclusion, Group B demonstrated positive changes in both turnover markers and calcium conservation.
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Affiliation(s)
- Caroline Ann Gunn
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Janet Louise Weber
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
| | - Anne-Thea McGill
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Marlena Cathorina Kruger
- School of Food and Nutrition, Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
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Lambert H, Frassetto L, Moore JB, Torgerson D, Gannon R, Burckhardt P, Lanham-New S. The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis. Osteoporos Int 2015; 26:1311-8. [PMID: 25572045 DOI: 10.1007/s00198-014-3006-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 12/12/2014] [Indexed: 12/26/2022]
Abstract
UNLABELLED The role of acid-base metabolism in bone health is controversial. In this meta-analysis, potassium bicarbonate and potassium citrate lowered urinary calcium and acid excretion and reduced the excretion of the bone resorption marker NTX. These salts may thus be beneficial to bone health by conserving bone mineral. INTRODUCTION The role of acid-base homeostasis as a determinant of bone health and the contribution of supplemental alkali in promoting skeletal integrity remain a subject of debate. The objective of this study was, therefore, to conduct a meta-analysis to assess the effects of supplemental potassium bicarbonate (KHCO3) and potassium citrate (KCitr) on urinary calcium and acid excretion, markers of bone turnover and bone mineral density (BMD) and to compare their effects with that of potassium chloride (KCl). METHODS A total of 14 studies of the effect of alkaline potassium salts on calcium metabolism and bone health, identified by a systematic literature search, were analysed with Review Manager (Version 5; The Cochrane Collaboration) using a random-effects model. Authors were contacted to provide missing data as required. Results are presented as the standardised (SMD) or unstandardized mean difference (MD) (95 % confidence intervals). RESULTS Urinary calcium excretion was lowered by intervention with both KHCO3 (P = 0.04) and KCitr (P = 0.01), as was net acid excretion (NAE) (P = 0.002 for KHCO3 and P = 0.0008 for KCitr). Both salts significantly lowered the bone resorption marker NTX (P < 0.00001). There was no effect on bone formation markers or BMD. KHCO3 and KCitr lowered calcium excretion to a greater extent than did KCl. CONCLUSIONS This meta-analysis confirms that supplementation with alkaline potassium salts leads to significant reduction in renal calcium excretion and acid excretion, compatible with the concept of increased buffering of hydrogen ions by raised circulating bicarbonate. The observed reduction in bone resorption indicates a potential benefit to bone health.
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Affiliation(s)
- H Lambert
- Nutritional Sciences Department, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK,
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Tabatabai LS, Cummings SR, Tylavsky FA, Bauer DC, Cauley JA, Kritchevsky SB, Newman A, Simonsick EM, Harris TB, Sebastian A, Sellmeyer DE. Arterialized venous bicarbonate is associated with lower bone mineral density and an increased rate of bone loss in older men and women. J Clin Endocrinol Metab 2015; 100:1343-9. [PMID: 25642590 PMCID: PMC4399281 DOI: 10.1210/jc.2014-4166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Higher dietary net acid loads have been associated with increased bone resorption, reduced bone mineral density (BMD), and increased fracture risk. OBJECTIVE The objective was to compare bicarbonate (HCO3) measured in arterialized venous blood samples to skeletal outcomes. DESIGN Arterialized venous samples collected from participants in the Health, Aging and Body Composition (Health ABC) Study were compared to BMD and rate of bone loss. SETTING The setting was a community-based observational cohort. PARTICIPANTS A total of 2287 men and women age 74 ± 3 years participated. INTERVENTION Arterialized venous blood was obtained at the year 3 study visit and analyzed for pH and pCO2. HCO3 was determined using the Henderson-Hasselbalch equation. MAIN OUTCOME MEASURE BMD was measured at the hip by dual-energy x-ray absorptiometry at the year 1 (baseline) and year 3 study visits. RESULTS Plasma HCO3 was positively associated with BMD at both year 1 (P = .001) and year 3 (P = .001) in models adjusted for age, race, sex, clinic site, smoking, weight, and estimated glomerular filtration rate. Plasma HCO3 was inversely associated with rate of bone loss at the total hip over the 2.1 ± 0.3 (mean ± SD) years between the two bone density measurements (P < .001). Across quartiles of plasma HCO3, the rate of change in BMD over the 2.1 years ranged from a loss of 0.72%/y in the lowest quartile to a gain of 0.15%/y in the highest quartile of HCO3. CONCLUSIONS Arterialized plasma HCO3 was associated positively with cross-sectional BMD and inversely with the rate of bone loss, implying that systemic acid-base status is an important determinant of skeletal health during aging. Ongoing bone loss was linearly related to arterialized HCO3, even after adjustment for age and renal function. Further research in this area may have major public health implications because reducing dietary net acid load is possible through dietary intervention or through supplementation with alkaline potassium compounds.
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Affiliation(s)
- L S Tabatabai
- Division of Endocrinology (L.S.T., D.E.S.), Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland 21224; California Pacific Medical Center Research Institute (S.R.C.), San Francisco, California 94118; Department of Preventive Medicine (F.A.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Department of Medicine (D.C.B., A.S.), School of Medicine, University of California, San Francisco, San Francisco, California 94143; Department of Epidemiology (J.A.C., A.N.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.B.K.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; Translational Gerontology Branch (E.M.S.), National Institute on Aging, Baltimore, Maryland 21224; and Laboratory of Epidemiology and Population Science (T.B.H.), National Institute on Aging, Bethesda, Maryland 20892
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Jia T, Byberg L, Lindholm B, Larsson TE, Lind L, Michaëlsson K, Carrero JJ. Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women. Osteoporos Int 2015; 26:563-70. [PMID: 25224295 DOI: 10.1007/s00198-014-2888-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
SUMMARY Because kidney dysfunction reduces the ability to excrete dietary acid excess, we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community. In a relatively large survey of elderly men and women, we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk. Underlying kidney function did not modify these null findings. Our results do not support the dietary acid-base hypothesis of bone loss. INTRODUCTION Impaired renal function reduces the ability to excrete dietary acid excess. We here investigate the association between dietary acid load and bone mineral density (BMD), osteoporosis, and fracture risk by renal function status. METHODS An observational study was conducted in 861 community-dwelling 70-year-old men and women (49% men) with complete dietary data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production (NEAP) and potential renal acid load (PRAL) algorithms. Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21% of the individuals. Study outcomes were BMD and osteoporosis state (assessed by DEXA) and time to fracture (median follow-up of 9.2 years). RESULTS In cross-section, dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis. During follow-up, 131 fractures were validated. Neither NEAP (adjusted hazard ratios (HR) (95% confidence interval (CI)), 1.01 (0.85-1.21), per 1 SD increment) nor PRAL (adjusted HR (95% CI), 1.07 (0.88-1.30), per 1 SD increment) associated with fracture risk. Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations. CONCLUSIONS The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals. Renal function did not influence on this null finding.
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Affiliation(s)
- T Jia
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Gupta A, Atoria CL, Ehdaie B, Shariat SF, Rabbani F, Herr HW, Bochner BH, Elkin EB. Risk of fracture after radical cystectomy and urinary diversion for bladder cancer. J Clin Oncol 2014; 32:3291-8. [PMID: 25185104 DOI: 10.1200/jco.2013.54.3173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture. PATIENTS AND METHODS Population-based study using SEER-Medicare-linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics. RESULTS The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage. CONCLUSION Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture.
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Affiliation(s)
- Amit Gupta
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
| | - Coral L Atoria
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Behfar Ehdaie
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Shahrokh F Shariat
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Farhang Rabbani
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Harry W Herr
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Bernard H Bochner
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
| | - Elena B Elkin
- Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY
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Nicoll R, McLaren Howard J. The acid-ash hypothesis revisited: a reassessment of the impact of dietary acidity on bone. J Bone Miner Metab 2014; 32:469-75. [PMID: 24557632 DOI: 10.1007/s00774-014-0571-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 01/16/2014] [Indexed: 12/11/2022]
Abstract
The acid-ash hypothesis states that when there are excess blood protons, bone is eroded to provide alkali to buffer the net acidity and maintain physiologic pH. There is concern that with the typical Western diet, we are permanently in a state of net endogenous acid production, which is gradually reducing bone. While it is clear that a high acid-producing diet generates increased urinary acid and calcium excretion, the effect of diet does not always have the expected results on BMD, fracture risk and markers of bone formation and resorption, suggesting that other factors are influencing the effect of acid/alkali loading on bone. High dietary protein, sodium and phosphorus intake, all of which are necessary for bone formation, were thought to be net acid forming and contribute to low BMD and fracture risk, but appear under certain conditions to be beneficial, with the effect of protein being driven by calcium repletion. Dietary salt can increase short-term markers of bone resorption but may also trigger 1,25(OH)2D synthesis to increase calcium absorption; with low calcium intake, salt intake may be inversely correlated with BMD but with high calcium intake, salt intake was positively correlated with BMD. With respect to the effect of phosphorus, the data are conflicting. Inclusion of an analysis of calcium intake may help to reconcile the contradictory results seen in many of the studies of bone. The acid-ash hypothesis could, therefore, be amended to state that with an acid-producing diet and low calcium intake, bone is eroded to provide alkali to buffer excess protons but where calcium intake is high the acid-producing diet may be protective.
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Affiliation(s)
- Rachel Nicoll
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umeå, Sweden,
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32
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GCN2 and FGF21 are likely mediators of the protection from cancer, autoimmunity, obesity, and diabetes afforded by vegan diets. Med Hypotheses 2014; 83:365-71. [DOI: 10.1016/j.mehy.2014.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/14/2014] [Indexed: 12/20/2022]
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Karamati M, Yousefian-Sanni M, Shariati-Bafghi SE, Rashidkhani B. Major nutrient patterns and bone mineral density among postmenopausal Iranian women. Calcif Tissue Int 2014; 94:648-58. [PMID: 24687522 DOI: 10.1007/s00223-014-9848-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/07/2014] [Indexed: 11/27/2022]
Abstract
Our understanding of the influence of overall nutrient intake on bone mineral density (BMD) is limited because most studies to date have focused on the intakes of calcium, vitamin D, or a few isolated nutrients. Therefore, we examined the association of major nutrient patterns with BMD in a sample of postmenopausal Iranian women. In this cross-sectional study, 160 women aged 50-85 years were studied and their lumbar spine and femoral neck BMDs were measured using dual-energy X-ray absorptiometry. Dietary intakes were assessed using a validated 168-item food frequency questionnaire, and daily intakes of 30 nutrients were calculated. All nutrient intakes were energy adjusted by the residual method and were submitted to principal component factor analysis to identify major nutrient patterns. Overall, three major nutrient patterns were identified, among which only the first pattern, which was high in folate, total fiber, vitamin B6, potassium, vitamin A (as retinol activity equivalent), vitamin C, β-carotene, vitamin K, magnesium, copper, and manganese, had a significant association with BMD. After controlling for potential confounders, multivariate adjusted mean of the lumbar spine BMD of women in the highest tertile of the first pattern scores was significantly higher than those in the lowest tertile (mean difference 0.08; 95% confidence interval 0.02-0.15; P = 0.01). A nutrient pattern similar to pattern 1, which is associated with high intakes of fruits and vegetables, may be beneficial for bone health in postmenopausal Iranian women.
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Affiliation(s)
- Mohsen Karamati
- National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Neville CE, Young IS, Gilchrist SECM, McKinley MC, Gibson A, Edgar JD, Woodside JV. Effect of increased fruit and vegetable consumption on bone turnover in older adults: a randomised controlled trial. Osteoporos Int 2014; 25:223-33. [PMID: 23716039 DOI: 10.1007/s00198-013-2402-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Evidence suggests that increased fruit and vegetable (FV) intake may be associated with improved bone health, but there is limited evidence from intervention trials to support this. This 16-week study showed that increased FV consumption (five or more portions per day) does not have any effect on the markers of bone health in older adults. INTRODUCTION Observational evidence suggests that increased FV consumption may be associated with improved bone health. However, there is lack of evidence from intervention trials to support this. This study examined the effect of increased FV consumption on bone markers among healthy, free-living older adults. METHODS A randomised controlled trial was undertaken. Eighty-three participants aged 65-85 years, habitually consuming less than or equal to two portions of FV per day, were randomised to continue their normal diet or to consume five or more portions of FV per day for 16 weeks. FV were delivered to all participants each week, free of charge. Compliance was assessed at baseline and at 6, 12 and 16 weeks by diet histories and biomarkers of micronutrient status. Fasting serum bone markers (osteocalcin (OC) and C-terminal telopeptide of type 1 collagen (CTX)) were measured using enzyme-linked immunosorbent assay. RESULTS Eighty-two participants completed the intervention. The five portions per day group showed a significantly greater change in daily FV consumption compared to the two portions per day group (p < 0.001), and this was reflected in significant increases in micronutrient status. No significant differences were evident in change in bone markers between the two portions per day group and the five portions per day group over the 16 weeks (geometric mean of week 16 to baseline ratio (95% confidence interval): OC-0.95 (0.89-1.02) and 1.04 (0.91-1.18), respectively, p = 0.25; CTX-1.06 (0.95-1.19) and 0.98 (0.90-1.06) respectively, p = 0.20). CONCLUSIONS Increased FV consumption had no effect on bone markers in older adults. Larger intervention studies of longer duration are warranted to establish whether long-term FV consumption can benefit bone health.
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Affiliation(s)
- C E Neville
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
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Anton SD, Lu X, Bank G, Heekin K, Saha D, Dubyak PJ, Hausenblas HA. Effect of a novel dietary supplement on pH levels of healthy volunteers: a pilot study. JOURNAL OF INTEGRATIVE MEDICINE 2013; 11:384-388. [PMID: 24125056 PMCID: PMC4643844 DOI: 10.3736/jintegrmed2013049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the effects of a greens alkalizing dietary supplement on urinary pH levels in individuals with lower-than-average pH levels. METHODS The present study investigated the effects of an alkalizing formula (Reserveage Wholeganic Greens(TM)) on four individuals who had average urinary pH levels below 6.0 for three consecutive days. Following the three-day, baseline period, participants received Reserveage Wholeganic Greens(TM) for four consecutive days and were instructed to continue to measure their urine pH levels. Paired samples t-tests were used to examine pH levels before and after a four-day treatment period with Reserveage Wholeganic Greens(TM). RESULTS Compared to baseline, mean urine pH levels in all volunteers were significantly higher following the supplementation with Reserveage Wholeganic Greens(TM) (5.89 ± 0.20 vs 5.56 ± 0.23; P<0.01). Participants' pH levels were also significantly higher than baseline on days 5, 6, and 7 of the treatment period (P < 0.05). Noteworthy, on day 7, participants' mean pH levels were significantly higher than at the beginning of the treatment period (6.03 ± 0.15 at day 7 vs 5.65 ± 0.24 at day 4; P < 0.01). CONCLUSION The findings of this study suggest that supplementation with Reserveage Wholeganic Greens(TM) has an alkalizing effect on the body and can increase the urine pH levels in individuals with lower-than-average pH levels.
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Affiliation(s)
- Stephen Douglas Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida 32611, USA; E-mail:
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Increasing fruits and vegetables in midlife women: a feasibility study. Nutr Res 2013; 33:543-51. [DOI: 10.1016/j.nutres.2013.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 02/07/2023]
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Welch AA, MacGregor AJ, Skinner J, Spector TD, Moayyeri A, Cassidy A. A higher alkaline dietary load is associated with greater indexes of skeletal muscle mass in women. Osteoporos Int 2013; 24:1899-908. [PMID: 23152092 DOI: 10.1007/s00198-012-2203-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/12/2012] [Indexed: 12/15/2022]
Abstract
UNLABELLED Conservation of muscle mass is important for fall and fracture prevention but further understanding of the causes of age-related muscle loss is required. This study found a more alkaline diet was positively associated with muscle mass in women suggesting a role for dietary acid-base load in muscle loss. INTRODUCTION Conservation of skeletal muscle is important for preventing falls and fractures but age-related loss of muscle mass occurs even in healthy individuals. However, the mild metabolic acidosis associated with an acidogenic dietary acid-base load could influence loss of muscle mass. METHODS We investigated the association between fat-free mass (FFM), percentage FFM (FFM%) and fat-free mass index (FFMI, weight/height²), measured using dual-energy X-ray absorptiometry in 2,689 women aged 18-79 years from the TwinsUK Study, and dietary acid-base load. Body composition was calculated according to quartile of potential renal acid load and adjusted for age, physical activity, misreporting and smoking habit (FFM, FFMI also for fat mass) and additionally with percentage protein. RESULTS Fat-free mass was positively associated with a more alkalinogenic dietary load (comparing quartile 1 vs 4: FFM 0.79 kg P < 0.001, FFM% 1.06 % <0.001, FFMI 0.24 kg/m² P = 0.002), and with the ratio of fruits and vegetables to potential acidogenic foods. CONCLUSIONS We observed a small but significant positive association between a more alkaline diet and muscle mass indexes in healthy women that was independent of age, physical activity and protein intake equating to a scale of effect between a fifth and one half of the observed relationship with 10 years of age. Although protein is important for maintenance of muscle mass, eating fruits and vegetables that supply adequate amounts of potassium and magnesium are also relevant. The results suggest a potential role for diet in the prevention of muscle loss.
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Affiliation(s)
- A A Welch
- Department of Nutrition, Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK.
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Nutritional disturbance in acid-base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney. Br J Nutr 2013; 110:1168-77. [PMID: 23551968 PMCID: PMC3828631 DOI: 10.1017/s0007114513000962] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The nutritional acid load hypothesis of osteoporosis is reviewed from its historical
origin to most recent studies with particular attention to the essential but overlooked
role of the kidney in acid–base homeostasis. This hypothesis posits that foods associated
with an increased urinary acid excretion are deleterious for the skeleton, leading to
osteoporosis and enhanced fragility fracture risk. Conversely, foods generating neutral or
alkaline urine would favour bone growth and Ca balance, prevent bone loss and reduce
osteoporotic fracture risk. This theory currently influences nutrition research, dietary
recommendations and the marketing of alkaline salt products or medications meant to
optimise bone health and prevent osteoporosis. It stemmed from classic investigations in
patients suffering from chronic kidney diseases (CKD) conducted in the 1960s. Accordingly,
in CKD, bone mineral mobilisation would serve as a buffer system to acid accumulation.
This interpretation was later questioned on both theoretical and experimental grounds.
Notwithstanding this questionable role of bone mineral in systemic acid–base equilibrium,
not only in CKD but even more in the absence of renal impairment, it is postulated that,
in healthy individuals, foods, particularly those containing animal protein, would induce
‘latent’ acidosis and result, in the long run, in osteoporosis. Thus, a questionable
interpretation of data from patients with CKD and the subsequent extrapolation to healthy
subjects converted a hypothesis into nutritional recommendations for the prevention of
osteoporosis. In a historical perspective, the present review dissects out speculation
from experimental facts and emphasises the essential role of the renal tubule in systemic
acid–base and Ca homeostasis.
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Scialla JJ, Anderson CAM. Dietary acid load: a novel nutritional target in chronic kidney disease? Adv Chronic Kidney Dis 2013; 20:141-9. [PMID: 23439373 PMCID: PMC3604792 DOI: 10.1053/j.ackd.2012.11.001] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 02/07/2023]
Abstract
Nonvolatile acid is produced from the metabolism of organic sulfur in dietary protein and the production of organic anions during the combustion of neutral foods. Organic anion salts that are found primarily in plant foods are directly absorbed in the gastrointestinal tract and yield bicarbonate. The difference between endogenously produced nonvolatile acid and absorbed alkali precursors yields the dietary acid load, technically known as the net endogenous acid production, and must be excreted by the kidney to maintain acid-base balance. Although typically 1 mEq/kg/day, dietary acid load is lower with greater intake of fruits and vegetables. In the setting of CKD, a high dietary acid load invokes adaptive mechanisms to increase acid excretion despite reduced nephron number, such as increased per nephron ammoniagenesis and augmented distal acid excretion mediated by the renin-angiotensin system and endothelin-1. These adaptations may promote kidney injury. Additionally, high dietary acid loads produce low-grade, subclinical acidosis that may result in bone and muscle loss. Early studies suggest that lowering the dietary acid load can improve subclinical acidosis, preserve bone and muscle, and slow the decline of glomerular filtration rate in animal models and humans. Studies focusing on hard clinical outcomes are needed.
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Affiliation(s)
- Julia J Scialla
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Buehlmeier J, Frings-Meuthen P, Remer T, Maser-Gluth C, Stehle P, Biolo G, Heer M. Alkaline salts to counteract bone resorption and protein wasting induced by high salt intake: results of a randomized controlled trial. J Clin Endocrinol Metab 2012; 97:4789-97. [PMID: 23027921 DOI: 10.1210/jc.2012-2857] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
High sodium chloride (NaCl) intake can induce low-grade metabolic acidosis (LGMA) and may thus influence bone and protein metabolism. We hypothesized that oral potassium bicarbonate (KHCO(3)) supplementation may compensate for NaCl-induced, LGMA-associated bone resorption and protein losses. Eight healthy male subjects participated in a randomized trial with a crossover design. Each of two study campaigns consisted of 5 d of dietary and environmental adaptation followed by 10 d of intervention and 1.5 d of recovery. In one study campaign, 90 mmol KHCO(3)/d were supplemented to counteract NaCl-induced LGMA, whereas the other campaign served as a control with only high NaCl intake. When KHCO(3) was ingested during high NaCl intake, postprandial buffer capacity ([HCO(3)(-)]) increased (P = 0.002). Concomitantly, urinary excretion of free potentially bioactive glucocorticoids [urinary free cortisol (UFF) and urinary free cortisone (UFE)] was reduced by 14% [∑(UFF,UFE); P = 0.024]. Urinary excretion of calcium and bone resorption marker N-terminal telopeptide of type I collagen was reduced by 12 and 8%, respectively (calcium, P = 0.047; N-terminal bone collagen telopeptide, P = 0.044). There was a trend of declining net protein catabolism when high NaCl was combined with KHCO(3) (P = 0.052). We conclude that during high salt intake, the KHCO(3)-induced postprandial shift to a more alkaline state reduces metabolic stress. This leads to decreased bone resorption and protein degradation, which in turn might initiate an anticatabolic state for the musculoskeletal system in the long run.
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Affiliation(s)
- Judith Buehlmeier
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Linder Hoehe, 51147 Cologne, Germany.
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Engberink MF, Bakker SJL, Brink EJ, van Baak MA, van Rooij FJA, Hofman A, Witteman JCM, Geleijnse JM. Dietary acid load and risk of hypertension: the Rotterdam Study. Am J Clin Nutr 2012; 95:1438-44. [PMID: 22552032 DOI: 10.3945/ajcn.111.022343] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mild metabolic acidosis, which can be caused by diet, may result in elevated blood pressure (BP). DESIGN The analyses included 2241 participants aged ≥55 y who were free of hypertension at baseline (1990-1993) and who had complete dietary and BP data. Dietary data were obtained from a 170-item food-frequency questionnaire. We used 2 measures to characterize dietary acid load: (1) potential renal acid load (PRAL) by using an algorithm including protein, phosphorus, potassium, calcium, and magnesium, and (2) estimated net endogenous acid production (NEAP) based on protein and potassium. HRs for 6-y incidence of hypertension were obtained in tertiles of PRAL and NEAP with adjustment for age, sex, BMI, smoking, education, and intakes of alcohol, fiber, and total energy. RESULTS We identified 1113 incident cases of hypertension during 8707 person-years of follow-up. The median dietary acid load ranged from -14.6 to 19.9 mEq/d across categories of PRAL. Hypertension risk was not significantly associated with dietary acid load. The multivariate HRs (95% CIs) in consecutive tertiles of PRAL were 1.00 (reference), 1.01 (0.87, 1.17), and 1.02 (0.88, 1.18) (P trend = 0.83). The median dietary acid loads were 30.4, 36.7, and 43.7 mEq/d, respectively, in consecutive tertiles of NEAP. Corresponding HRs for NEAP were 1.00 (reference), 0.92 (0.80, 1.07), and 0.94 (0.81, 1.10) (P-trend = 0.46). CONCLUSION The findings from this prospective cohort study provided no evidence of an association between dietary acid load and risk of hypertension in older adults.
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Lim HJ. A Study on the Sodium and Potassium Intakes and Urinary Excretion of Adults in Busan. ACTA ACUST UNITED AC 2012. [DOI: 10.5720/kjcn.2012.17.6.737] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hwa-Jae Lim
- Department of Food and Nutrition, Dong-eui University, Busan, Korea
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Zhu K, Meng X, Kerr DA, Devine A, Solah V, Binns CW, Prince RL. The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal women. J Bone Miner Res 2011; 26:2298-306. [PMID: 21590739 DOI: 10.1002/jbmr.429] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effects of dietary protein on bone structure and metabolism have been controversial, with evidence for and against beneficial effects. Because no long-term randomized, controlled studies have been performed, a two-year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken. Participants were randomized to either a high-protein drink containing 30 g of whey protein (n = 109) or a placebo drink identical in energy content, appearance, and taste containing 2.1 g of protein (n = 110). Both drinks provided 600 mg of calcium. Dual-energy X-ray absorptiometric (DXA) hip areal bone mineral density (aBMD), 24-hour urinary calcium excretion, and serum insulin-like growth factor 1 (IGF-1) were measured at baseline and at 1 and 2 years. Quantitative computed tomographic (QCT) hip volumetric bone mineral density (vBMD) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years. Baseline average protein intake was 1.1 g/kg of body weight per day. There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between-group differences. Femoral neck strength was unchanged in either group over time. The 24-hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years, at which time the protein group had a marginally higher value. Compared with the placebo group, the protein group had significantly higher serum IGF-1 level at 1 and 2 years (7.3% to 8.0%, p < .05). Our study showed that in protein-replete healthy ambulant women, 30 g of extra protein increased IGF-1 but did not have beneficial or deleterious effects on bone mass or strength. The effect of protein supplementation in populations with low dietary protein intake requires urgent attention.
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Affiliation(s)
- Kun Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.
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Fenton TR, Tough SC, Lyon AW, Eliasziw M, Hanley DA. Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality. Nutr J 2011; 10:41. [PMID: 21529374 PMCID: PMC3114717 DOI: 10.1186/1475-2891-10-41] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 04/30/2011] [Indexed: 01/19/2023] Open
Abstract
Background Modern diets have been suggested to increase systemic acid load and net acid excretion. In response, alkaline diets and products are marketed to avoid or counteract this acid, help the body regulate its pH to prevent and cure disease. The objective of this systematic review was to evaluate causal relationships between dietary acid load and osteoporosis using Hill's criteria. Methods Systematic review and meta-analysis. We systematically searched published literature for randomized intervention trials, prospective cohort studies, and meta-analyses of the acid-ash or acid-base diet hypothesis with bone-related outcomes, in which the diet acid load was altered, or an alkaline diet or alkaline salts were provided, to healthy human adults. Cellular mechanism studies were also systematically examined. Results Fifty-five of 238 studies met the inclusion criteria: 22 randomized interventions, 2 meta-analyses, and 11 prospective observational studies of bone health outcomes including: urine calcium excretion, calcium balance or retention, changes of bone mineral density, or fractures, among healthy adults in which acid and/or alkaline intakes were manipulated or observed through foods or supplements; and 19 in vitro cell studies which examined the hypothesized mechanism. Urine calcium excretion rates were consistent with osteoporosis development; however calcium balance studies did not demonstrate loss of whole body calcium with higher net acid excretion. Several weaknesses regarding the acid-ash hypothesis were uncovered: No intervention studies provided direct evidence of osteoporosis progression (fragility fractures, or bone strength as measured using biopsy). The supporting prospective cohort studies were not controlled regarding important osteoporosis risk factors including: weight loss during follow-up, family history of osteoporosis, baseline bone mineral density, and estrogen status. No study revealed a biologic mechanism functioning at physiological pH. Finally, randomized studies did not provide evidence for an adverse role of phosphate, milk, and grain foods in osteoporosis. Conclusions A causal association between dietary acid load and osteoporotic bone disease is not supported by evidence and there is no evidence that an alkaline diet is protective of bone health.
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Affiliation(s)
- Tanis R Fenton
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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McLean RR, Qiao N, Broe KE, Tucker KL, Casey V, Cupples LA, Kiel DP, Hannan MT. Dietary acid load is not associated with lower bone mineral density except in older men. J Nutr 2011; 141:588-94. [PMID: 21289203 PMCID: PMC3056577 DOI: 10.3945/jn.110.135806] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
High dietary acid load may be detrimental to bone mineral density (BMD), although sufficient calcium intake might neutralize this effect. In observational studies, the association between BMD and dietary acid load, estimated by net endogenous acid production (NEAP) and potential renal acid load (PRAL), has been inconsistent, and the potential modifying effect of calcium intake has not been assessed. We therefore examined the cross-sectional associations of estimated NEAP and PRAL with BMD in the Framingham Osteoporosis Study. We hypothesized that higher estimated NEAP and PRAL would be associated with lower BMD, but only among those with total calcium intake < 800 mg/d. BMD of the femoral neck and lumbar spine was measured, and estimated NEAP and PRAL were calculated via FFQ among 1069 Framingham Original (1988-1989, 1992-1993; 62% women, mean age 76 y) and 2919 Offspring (1996-2001; 56% women, mean age 60 y) cohort participants. Cohort- and sex-specific ANCOVA was used to calculate multivariable-adjusted mean BMD for estimated NEAP and PRAL quartiles. Assuming no uncontrolled confounding, estimated NEAP, but not PRAL, was inversely associated with femoral neck BMD (P-trend = 0.04) in Original cohort men, whereas neither was associated with lumbar spine BMD. Estimated NEAP and PRAL were not associated with BMD at any site among Original cohort women or Offspring cohort men and women. There were no significant interactions between either estimated NEAP or PRAL and total calcium intake. These results suggest that, with a possible exception of older men, dietary acid load does not have a measureable negative effect on bone health, regardless of total calcium intake.
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Affiliation(s)
- Robert R. McLean
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 02131,Harvard Medical School, Boston, MA, 02115,To whom correspondence should be addressed. E-mail:
| | - Ning Qiao
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111
| | - Kerry E. Broe
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 02131
| | | | - Virginia Casey
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 02131
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118
| | - Douglas P. Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 02131,Harvard Medical School, Boston, MA, 02115
| | - Marian T. Hannan
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 02131,Harvard Medical School, Boston, MA, 02115
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Kraut JA, Madias NE. Consequences and therapy of the metabolic acidosis of chronic kidney disease. Pediatr Nephrol 2011; 26:19-28. [PMID: 20526632 PMCID: PMC2991191 DOI: 10.1007/s00467-010-1564-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 04/22/2010] [Accepted: 05/04/2010] [Indexed: 01/18/2023]
Abstract
Metabolic acidosis is common in patients with chronic kidney disease (CKD), particularly once the glomerular filtration rate (GFR) falls below 25 ml/min/1.73 m(2). It is usually mild to moderate in magnitude with the serum bicarbonate concentration ([HCO(3)(-)]) ranging from 12 to 23 mEq/l. Even so, it can have substantial adverse effects, including development or exacerbation of bone disease, growth retardation in children, increased muscle degradation with muscle wasting, reduced albumin synthesis with a predisposition to hypoalbuminemia, resistance to the effects of insulin with impaired glucose tolerance, acceleration of the progression of CKD, stimulation of inflammation, and augmentation of β(2)-microglobulin production. Also, its presence is associated with increased mortality. The administration of base to patients prior to or after initiation of dialysis leads to improvement in many of these adverse effects. The present recommendation by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) is to raise serum [HCO(3)(-)] to ≥ 22 mEq/l, whereas Caring for Australians with Renal Impairment (CARI) recommends raising serum [HCO(3)(-)] to >22 mEq/l. Base administration can potentially contribute to volume overload and exacerbation of hypertension as well as to metastatic calcium precipitation in tissues. However, sodium retention is less when given as sodium bicarbonate and sodium chloride intake is concomitantly restricted. Results from various studies suggest that enhanced metastatic calcification is unlikely with the pH values achieved during conservative base administration, but the clinician should be careful not to raise serum [HCO(3)(-)] to values outside the normal range.
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Affiliation(s)
- Jeffrey A. Kraut
- Medical and Research Services, VHAGLA Healthcare System, UCLA Membrane Biology Laboratory, Los Angeles, CA USA ,Division of Nephrology, VHAGLA Healthcare System, Los Angeles, USA ,David Geffen School of Medicine, Los Angeles, CA USA
| | - Nicolaos E. Madias
- Division of Nephrology, Department of Medicine, St. Elizabeth’s Medical Center, 736 Cambridge St., Boston, MA 02135 USA ,Department of Medicine, Tufts University School of Medicine, Boston, MA USA
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Ströhle A, Waldmann A, Koschizke J, Leitzmann C, Hahn A. Diet-Dependent Net Endogenous Acid Load of Vegan Diets in Relation to Food Groups and Bone Health-Related Nutrients: Results from the German Vegan Study. ANNALS OF NUTRITION AND METABOLISM 2011; 59:117-26. [DOI: 10.1159/000331572] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 08/09/2011] [Indexed: 11/19/2022]
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Martin-Bautista E, Martin-Matillas M, Martin-Lagos JA, Miranda-Leon MT, Muñoz-Torres M, Ruiz-Requena E, Rivero M, Quer J, Puigdueta I, Campoy C. A nutritional intervention study with hydrolyzed collagen in pre-pubertal spanish children: influence on bone modeling biomarkers. J Pediatr Endocrinol Metab 2011; 24:147-53. [PMID: 21648282 DOI: 10.1515/jpem.2011.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of the study was to investigate the influence of dietary intake of commercial hydrolyzed collagen (Gelatine Royal) on bone remodeling in pre-pubertal children. METHODS A randomized double-blind study was carried out in 60 children (9.42 +/- 1.31 years) divided into three groups according to the amount of partially hydrolyzed collagen taken daily for 4 months: placebo (G-I, n=18), collagen (G-II, n=20) and collagen+calcium (G-III, n=22) groups. Analyses of the following biochemical markers were carried out: total and bone alkaline phosphatase (tALP and bALP), osteocalcin, tartrate-resistant acid phosphatase (TRAP), type I collagen carboxy-terminal telopeptide, lipids, calcium, 25-hydroxyvitamin D, insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone, free thyroxin and intact parathormone. RESULTS There was a significantly greater increase in serum IGF-1 in G-III than in G-II (p < 0.01) or G-I (p < 0.05) during the study period, and a significantly greater increase in plasma tALP in G-III than in G-I (p < 0.05). Serum bALP behavior significantly (p < 0.05) differed between G-II (increase) and G-I (decrease). Plasma TRAP behavior significantly differed between G-II and G-I (p < 0.01) and between G-III and G-II (p < 0.05). CONCLUSION Daily dietary intake of hydrolyzed collagen seems to have a potential role in enhancing bone remodeling at key stages of growth and development.
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Comparison of the effects of dietary protein, androstenediol and forearm muscle area on radial bone variables in healthy prepubertal children. Br J Nutr 2010; 105:428-35. [PMID: 20854701 DOI: 10.1017/s0007114510003508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Adequate dietary habits are supposed to be one of the most important modifiable factors in osteoporosis prevention. However, the importance of specific nutrients is controversial. We examined relevant nutrients which are supposed to have an impact on bone parameters and compared their effect sizes with those of two known predictors of bone development: bone-related muscle mass and androgen levels. We analysed nutritional, hormonal and anthropometric data from 107 prepubertal children participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Diaphyseal bone mineral content (BMC), cortical area (CA), periosteal circumference, strength strain index and muscle area of the non-dominant forearm were measured by peripheral quantitative computed tomography. Data on long-term nutrient intakes (e.g. protein, Ca and vitamin D) were derived from 3 d weighed dietary records. Twenty-four hour urinary excretion rates of androgen metabolites including the sex steroid androstenediol were measured using GC-MS. Of all considered nutrients, only protein showed a trend for an association with BMC (β = +0·11; P = 0·073) and CA (β = +0·11; P = 0·056) in stepwise linear regression models. None of the other considered dietary variables was associated with bone parameters. The size of the bone anabolic effect of protein was partly comparable with that of androstenediol. Even though boys gained more bone mass in comparison with girls, the protein effect did not differ between sexes. Bone-related muscle area and sex steroids have the strongest effects on prepubertal diaphyseal bone. However, dietary protein may have a similar bone anabolic influence compared with androstenediol. In children without explicit nutrient deficits, protein seems to be the most important dietary component for diaphyseal bone status.
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