Bone mineral density parameters and related nutritional factors in vegans, lacto-ovo-vegetarians, and omnivores: a cross-sectional study

Introduction

The growing prevalence of vegetarianism determines the need for comprehensive study of the impact of these diets on health and particularly on bone metabolism. We hypothesized that significant dietary differences between vegans, lacto-ovo-vegetarians, and omnivores also cause significant differences in their nutrient status, which may affect bone health.

Methods

The study assessed dual-energy X-ray absorptiometry parameters in lumbar spine and femoral neck, average nutrient intake, serum nutrient concentrations, serum PTH levels, and urinary pH among 46 vegans, 38 lacto-ovo-vegetarians, and 44 omnivores.

Results

There were no differences in bone mineral density (BMD) between the groups. However, the parathyroid hormone (PTH) levels were still higher in vegans compared to omnivores, despite the same prevalence of hyperparathyroidism in all groups. These findings may probably be explained by the fact that each group had its own "strengths and weaknesses." Thus, vegans and, to a lesser extent, lacto-ovo-vegetarians consumed much more potassium, magnesium, copper, manganese, and vitamins B6, B9, and C. At the same time, the diet of omnivores contained more protein and vitamins D and B12. All the subjects consumed less vitamin D than recommended. More than half of vegans and omnivores had insufficiency or even deficiency of vitamin D in the blood. Low serum concentrations of manganese with its quite adequate intake are also noteworthy: its deficiency was observed in 57% of vegans, 79% of lacto-ovo-vegetarians, and 63% of omnivores.

Discussion

Currently, it is no longer possible to conclude that lacto-ovo-vegetarians have lower BMD than omnivores, as our research supported. Vegans in our study also did not demonstrate lower BMD values, only higher PTH blood concentrations, compared to omnivores, however, a large number of studies, including recent, show the opposite view. In this regard, further large-scale research is required. Vegans and lacto-ovo-vegetarians now have a variety of foods fortified with vitamins D and B12, as well as calcium. There is also a great diversity of ethically sourced dietary supplements. The found low concentrations of manganese require further investigation.

Recommended calcium intake in adults and children with chronic kidney disease-a European consensus statement

Mineral and bone disorders (MBD) are common in patients with chronic kidney disease (CKD), contributing to significant morbidity and mortality. For several decades, the first-line approach to controlling hyperparathyroidism in CKD was by exogenous calcium loading. Since the turn of the millennium, however, a growing awareness of vascular calcification risk has led to a paradigm shift in management and a move away from calcium-based phosphate binders. As a consequence, contemporary CKD patients may be at risk of a negative calcium balance, which, in turn, may compromise bone health, contributing to renal bone disease and increased fracture risk. A calcium intake below a certain threshold may be as problematic as a high intake, worsening the MBD syndrome of CKD, but is not addressed in current clinical practice guidelines. The CKD-MBD and European Renal Nutrition working groups of the European Renal Association (ERA), together with the CKD-MBD and Dialysis working groups of the European Society for Pediatric Nephrology (ESPN), developed key evidence points and clinical practice points on calcium management in children and adults with CKD across stages of disease. These were reviewed by a Delphi panel consisting of ERA and ESPN working groups members. The main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/day and not exceeding 1500 mg/day to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the age-appropriate normal range. These statements provide information and may assist in decision-making, but in the absence of high-level evidence must be carefully considered and adapted to individual patient needs.

Exploring the Potential Benefits of Natural Calcium-Rich Mineral Waters for Health and Wellness: A Systematic Review

This systematic review investigates the potential health and wellness benefits of natural calcium-rich mineral waters. It emphasizes the importance of dietary calcium sourced from natural mineral waters in promoting bone health, maintaining cardiovascular function, aiding in weight management, and enhancing overall well-being. The review process involved the comprehensive analysis of peer-reviewed articles, clinical trials, and experimental studies published within the last decade. Findings reveal that consuming calcium-rich mineral water can contribute significantly to daily calcium intake, particularly for those with lactose intolerance or individuals adhering to plant-based diets. The unique bioavailability of calcium from such waters also appears to enhance absorption, thus potentially offering an advantage over other calcium sources. The potential benefits extend to the cardiovascular system, with some studies indicating a reduction in blood pressure and the prevalence of cardiovascular diseases. Emerging evidence suggests that calcium-rich mineral water might have a role in body weight management, though further research is needed. The review identifies several areas requiring additional research, such as the potential interaction between calcium-rich mineral water and other dietary components, the effects on populations with specific health conditions, and the long-term effects of consumption. In conclusion, natural calcium-rich mineral waters show promise as a readily accessible and bioavailable sources of dietary calcium, potentially beneficial for a broad range of individuals. However, further investigation is required to fully understand its range of health impacts and define optimal intake levels.

A food pyramid for adult patients with phenylketonuria and a systematic review on the current evidences regarding the optimal dietary treatment of adult patients with PKU

Early dietary treatment is mind-saving in patients with phenylketonuria. A "diet-for-life" is advocated, aimed to prevent effects of chronic exposure to hyperphenylalaninemia. While adherence to diet is significant during childhood as patients are followed-up at specialized metabolic centers, during adolescence and adulthood percentage of patients discontinuing diet and/or lost at follow-up is still high. The process of passing skills and responsibilities from pediatric team to adult team is defined "transition". The goal of transition clinics is to set up specific multidisciplinary care pathways and guarantee continuity of care and compliance of patients to care. In 2017, "The complete European guidelines on phenylketonuria" were published. These guidelines, however, do not provide an easy way to illustrate to adult patients how to follow correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of adults with phenylketonuria and to provide food pyramid for this population. The pyramid built shows that carbohydrates should be consumed every day (3 portions), together with fruits and vegetables (5 portions), extra virgin olive oil, and calcium water (almost 1 L/day); weekly portions can include 150 g potatoes walnuts and hazelnuts (20 g). At top of pyramid, there are two pennants. The green means that, based on individual metabolic phenotype and daily phenylalanine tolerance, patients need personalized supplementation (specific phenylalanine free amino acid mixtures, vitamins and omega 3 fatty acids); the one red indicates foods that are banned from diet (aspartame and protein foods exceeding individual dietary phenylalanine tolerance).

Calcium and vitamin D supplementation: when and why

Osteoporosis is a common disease, with fragility fractures representing its dreaded complications. The role of calcium and vitamin D supplementation needs to be addressed in the context of a heavy health burden, with a massive impact on individuals, healthcare systems, and societies as a whole. Calcium and vitamin D are often discussed together as interventions for promoting bone health. Still, it is essential to remember that they are quite distinct entities that play different roles in mineral metabolism. Insufficient calcium intake and vitamin D deficiency are common and widespread. Furthermore, a strong association between vitamin D deficiency and extra-skeletal outcomes has emerged over the last decades. When dietary intake is insufficient, with little room for improvement, several supplementation strategies have proved to be effective and safe. Adequate calcium intake and vitamin D serum levels should be pursued efficiently in the general population, and deficiency should be considered unacceptable in subsets particularly at risk. The aim of this narrative review was to present an overview of calcium and vitamin D intake and their supplementation.

Additional costs of lactose-reduced diets: lactose-free dairy product substitutes are a cost-effective alternative for people with lactose intolerance

OBJECTIVE

People with lactose intolerance have to limit their consumption of lactose-containing dairy products which are a main source of Ca. In particular, for low-income people it is of interest which alternative diet form rich in Ca leads to the lowest additional costs. This study aims to calculate the additional costs of lactose-reduced diets and to show which of different options represent the most cost-effective alternative within a lactose-reduced diet.

DESIGN

Using linear programming, food baskets with different lactose contents were calculated and were compared to a basic model, reflecting a normal diet without a limitation of lactose. By comparing the costs and the composition of the food baskets, recommendations for a lactose-reduced diet were derived.

SETTING

Germany.

PARTICIPANTS

A consumer panel dataset representative for Germany is used for the calculations. Information on prices and nutrients is derived from the 9429 adult households without children, and information on consumed food quantities from the 3046 single households.

RESULTS

The minimum additional food costs depend on the severity of lactose intolerance and range from 0·2 % to 6·1 % per month. It was found that the greatest adjustments due to lactose reduction could be observed within the dairy product group. In this group, with a rising lactose limit, normal milk was increasingly replaced by lactose-free milk.

CONCLUSION

It was shown that a lactose-reduced diet is generally associated with higher food costs. When suffering from lactose intolerance, switching to lactose-free milk seems to be the most cost-effective way to cover nutrient requirements.

Link between Viral Infections, Immune System, Inflammation and Diet

The strong spread of COVID-19 and the significant number of deaths associated with it could be related to improper lifestyles, which lead to a low-grade inflammation (LGI) that not only increases the risk of chronic diseases, but also the risk of facing complications relating to infections and a greater susceptibility to infections themselves. Recently, scientific research has widely demonstrated that the microbiota plays a fundamental role in modulating metabolic responses in the immune system. There is, in fact, a two-way interaction between lifestyle, infection, and immunity. The immune response is compromised if nutrition is unbalanced or insufficient, because diet affects the intestinal flora predisposing people to infections and, at the same time, the nutritional state can be aggravated by the immune response itself to the infection. We evaluate the link between balanced diet, the efficiency of the immune system, and microbiota with the aim of providing some practical advice for individuals, with special attention to the elderly. A correct lifestyle that follows the Mediterranean model, which is especially rich in plant-based foods along with the use of extra-virgin olive oil, are the basis of preventing LGI and other chronic pathologies, directly influencing the intestinal microbiota and consequently the immune response.

Calcium intake from different food sources in Italian women without and with non-previously diagnosed osteoporosis

An adequate calcium and vitamin D intake may play a role in preventing osteoporosis, but the contribution of the different food sources of calcium with regards to the risk of osteoporosis been barely explored. This observational study evaluated the calcium intake through a food frequency questionnaire in 126 adult women with not previously diagnosed osteoporosis undergoing Dual-energy X-ray Absorptiometry (DXA) to screen for osteoporosis, and to correlate the calcium intake with parameters of bone density, measured by DXA. Total daily calcium intake and daily intake from food were similar among women found to have osteoporosis, osteopenia or normal condition. The main food source was milk and dairy products, while calcium supplementation was consumed by only 14% of subjects, irrespectively from osteoporosis conditions. DXA parameters were not significantly correlated with total daily calcium intake and calcium from food. The present study highlighted no qualitative and quantitative differences in the consumption of food groups contributing to calcium intakes in women with and without osteoporosis.

Association between pre-pregnancy calcium intake and hypertensive disorders during the first pregnancy: the Japan environment and children's study

BACKGROUND

Determining the appropriate preconception care to reduce the occurrence of hypertensive disorder of pregnancy (HDP) remains a challenge in modern obstetrics. This study aimed to examine the association between pre-pregnancy calcium (Ca) intake and HDP in normotensive primiparas.

METHODS

We used data from the Japan Environment Children's study (JECS), which is the largest birth cohort study. A total of 33,894 normotensive Japanese primiparas were recruited for JECS between January 2011 and March 2014. Participants were categorized into five groups according to pre-pregnancy Ca intake quintiles (Q1 and Q5 were the lowest and highest Ca intake groups, respectively) to compare their basic background and obstetrics outcome. Multiple logistic regressions were performed to identify the effect of pre-pregnancy Ca intake on HDP, early onset HDP, and late-onset HDP, using Ca intake thresholds of 500, 550, 650, 700, 1000, 1500, and 1500 mg.

RESULTS

We found significant differences in maternal background among the Ca intake groups; in particular, there were more participants with low socioeconomic status, indicated by low education level and low household income, and smokers in the lowest Ca intake group. Multiple logistic regression did not show any significant difference with regard to HDP, early onset HDP, and late-onset HDP in each Ca intake threshold.

CONCLUSIONS

Despite considerable recommendations concerning Ca intake for women of reproductive age, the present study indicates that pre-pregnancy Ca intake was not associated with an increased risk of new-onset hypertension among primiparas during pregnancy. Further studies examining the effect of other pre-pregnancy dietary factors on obstetric outcomes should be considered in the formulation of earlier preventive strategies for primiparas.

Calcium Intake and Health

There are striking inequities in calcium intake between rich and poor populations. Appropriate calcium intake has shown many health benefits, such as reduction of hypertensive disorders of pregnancy, lower blood pressure particularly among young people, prevention of osteoporosis and colorectal adenomas, lower cholesterol values, and lower blood pressure in the progeny of mothers taking sufficient calcium during pregnancy. Studies have refuted some calcium supplementation side effects like damage to the iron status, formation of renal stones and myocardial infarction in older people. Attention should be given to bone resorption in post-partum women after calcium supplementation withdrawal. Mechanisms linking low calcium intake and blood pressure are mediated by parathyroid hormone raise that increases intracellular calcium in vascular smooth muscle cells leading to vasoconstriction. At the population level, an increase of around 400-500 mg/day could reduce the differences in calcium intake between high- and middle-low-income countries. The fortification of food and water seems a possible strategy to reach this goal.

Metabolic Syndrome Features: Is There a Modulation Role by Mineral Water Consumption? A Review

Metabolic syndrome (MetSyn) promotes, among others, the development of atherosclerotic cardiovascular disease and diabetes. Its prevalence increases with age, highlighting the relevance of promoting precocious MetSyn primary prevention and treatment with easy-to-implement lifestyle interventions. MetSyn features modulation through mineral water consumption was reviewed on Pubmed, Scopus and Google Scholar databases, using the following keywords: metabolic syndrome, hypertension, blood pressure (BP), cholesterol, triglycerides, apolipoprotein, chylomicron, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein (HDL), glucose, insulin, body weight, body mass index, waist circumference (WC), obesity and mineral(-rich) water. Twenty studies were selected: 12 evaluated BP, 13 assessed total-triglycerides and/or HDL-cholesterol, 10 analysed glucose and/or 3 measured WC. Mineral waters were tested in diverse protocols regarding type and composition of water, amount consumed, diet and type and duration of the study. Human and animal studies were performed in populations with different sizes and characteristics. Distinct sets of five studies showed beneficial effects upon BP, total-triglycerides, HDL-cholesterol and glucose. WC modulation was not reported. Minerals/elements and active ions/molecules present in mineral waters (and their pH) are crucial to counterbalance their inadequate intake and body status as well as metabolic dysfunction and increased diet-induced acid-load observed in MetSyn. Study characteristics and molecular/physiologic mechanisms that could explain the different effects observed are discussed. Further studies are warranted for determining the mechanisms involved in the putative protective action of mineral water consumption against MetSyn features.

Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers

As the number of subjects choosing vegan diets increases, healthcare providers must be prepared to give the best advice to vegan patients during all stages of life. A completely plant-based diet is suitable during pregnancy, lactation, infancy, and childhood, provided that it is well-planned. Balanced vegan diets meet energy requirements on a wide variety of plant foods and pay attention to some nutrients that may be critical, such as protein, fiber, omega-3 fatty acids, iron, zinc, iodine, calcium, vitamin D, and vitamin B12. This paper contains recommendations made by a panel of experts from the Scientific Society for Vegetarian Nutrition (SSNV) after examining the available literature concerning vegan diets during pregnancy, breastfeeding, infancy, and childhood. All healthcare professionals should follow an approach based on the available evidence in regard to the issue of vegan diets, as failing to do so may compromise the nutritional status of vegan patients in these delicate periods of life.

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow’s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable.

Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition

BACKGROUND

Interest in vegetarian diets is growing in Italy and elsewhere, as government agencies and health/nutrition organizations are emphasizing that regular consumption of plant foods may provide health benefits and help prevent certain diseases.

METHODS AND RESULTS

We conducted a Pubmed search, up to September, 2015, for studies on key nutrients (proteins, vitamin B12, iron, zinc, calcium, vitamin D, and n-3 fatty acids) in vegetarian diets. From 295 eligible publications the following emerged: Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements). Since the plant protein digestibility is lower than that of animal proteins it may be appropriate for vegetarians to consume more proteins than recommended for the general population. Vegetarians should also be encouraged to habitually consume good sources of calcium, iron and zinc - particularly vegetables that are low in oxalate and phytate (e.g. Brassicaceae), nuts and seeds, and calcium-rich mineral water. Calcium, iron, and zinc bioavailability can be improved by soaking, germination, and sour-dough leavening that lower the phytate content of pulses and cereals. Vegetarians can ensure good n-3 fatty acid status by habitually consuming good sources of a-linolenic acid (walnuts, flaxseeds, chia seeds, and their oils) and limiting linoleic acid intake (corn and sunflower oils).

CONCLUSIONS

Well-planned vegetarian diets that include a wide variety of plant foods, and a reliable source of vitamin B12, provide adequate nutrient intake. Government agencies and health/nutrition organizations should provide more educational resources to help Italians consume nutritionally adequate vegetarian diets.

Types and characteristics of drinking water for hydration in the elderly

The role of hydration in the maintenance of health is increasingly recognized. Hydration requirements vary for each person, depending on physical activity, environmental conditions, dietary patterns, alcohol intake, health problems, and age. Elderly individuals have higher risk of developing dehydration than adults. Diminution of liquid intake and increase in liquid losses are both involved in causing dehydration in the elderly. The water used for drinking is provided through regular public water supply and the official sanitary controls ensure their quality and hygiene, granting a range of variation for most of its physical and chemical characteristics, being sometimes these differences, though apparently small, responsible for some disorders in sensitive individuals. Hence, the advantages of using bottled water, either natural mineral water or spring water, are required by law to specify their composition, their major components, and other specific parameters. It is essential to take this into account to understand the diversity of indications and favorable effects on health that certain waters can offer.

Calcium revisited, part III: effect of dietary calcium on BMD and fracture risk

Food can be an excellent source of calcium. Dietary calcium is in general as well absorbed as calcium supplements, and exerts the same effects on bone. The main sources are dairy products, but also some vegetables and fruits contain considerable amounts of calcium. Mineral water can serve as a supplement. Cross-sectional, longitudinal and some interventional trials have shown positive effects on bone metabolism, bone density and bone loss. But the effect on fracture incidence is less certain, and that of milk, the most studied dairy product, still unproven.

Healthy diet to prevent cardiovascular diseases and osteoporosis: the experience of the 'ProSa' project

The ProSa (PROmozione e tutela della SAlute) Project ('Health Promotion Project') is a workplace programme geared to promote health among the Roman staff of the National Research Council of Italy. 789 employees of both genders (450 men, 339 women) have participated in the cardiovascular prevention programme (screening, computerized calculation of the risk level, dietary and pharmacological intervention) and 245 women have participated in the osteoporosis programme (calcaneal ultrasonometer test, dietary and pharmacological intervention). Menopause increases the risk of cardiovascular diseases and osteoporosis. In order to lower dietary fat content, dietary intake of calcium and vitamin D could be reduced. However, supplementation of both may not be necessary if we follow an integrated dietary approach. Therefore, for women in menopause with mixed hyperlipidaemia (hypercholesterolaemia and/or hypertriglyceridaemia) and/or overweight/obesity, dietary intervention was aimed at promoting the choice of foods low in fats and rich in calcium based on a list of recommended products distributed to all the participants. The dietary intervention was accompanied by a programme of regular physical activity with adequate exposure to sunlight. By following a balanced diet it is possible to improve the prognosis not only for hyperlipidaemic patients, but also for patients with signs of osteopaenia or osteoporosis.

Bone mineral density in postmenopausal Chinese women treated with calcium fortification in soymilk and cow's milk

Eighteen months of daily consumption of milk containing 250 mg calcium prevented bone mineral density (BMD) loss at the hip and the femoral neck in postmenopausal Chinese women aged 45 to 65.

INTRODUCTION

Estrogen-related bone loss in postmenopausal women can be prevented by the consumption of milk with high doses of calcium and soymilk with high doses of isoflavones. However, high doses of calcium and isoflavones may not be necessary to attain a beneficial effect of milk and soymilk on BMD. We hypothesized that BMD will increase in postmenopausal Chinese women who consume daily 250 mg calcium in milk or soymilk. Milk prevented bone loss at the hip and the femoral neck in postmenopausal Chinese women.

METHODS

A total of 141 eligible Chinese women without osteoporosis, aged 45-65, and postmenopausal for more than 2 years were randomized into groups receiving for 18 months (A) milk with 250 mg calcium daily, (B) soymilk with 250 mg calcium daily, or (C) neither milk nor soymilk. Dual-energy X-ray absorptiometry measured the BMD of the spine and hip at 0, 6, 12, and 18 months.

RESULTS

The BMD in the hip (2.52%) and the femoral neck (2.82%) of the women consuming milk was significantly higher (hip, P = 0.01; femoral neck, P < 0.0000001). The women in the control group experienced a reduction in BMD at all sites; the reduction in BMD was only significant at the hip during 12 months (P = 0.008) and at the femoral neck during 18 months (P = 0.005).

CONCLUSIONS

Daily consumption of milk containing 250 mg calcium over 18 months prevents BMD loss at the hip and the femoral neck in postmenopausal Chinese women.

[Health-related effects of natural mineral waters]

The medical importance of mineral waters depends on the contained amount of minerals and trace elements. Calcium and magnesium in mineral waters are of greatest interest with respect to their potential relevance for the health status; iodine, fluorine and lithium are the most important trace elements. The bioavailability of minerals from mineral water is good and can be compared with the values derived from milk. A positive effect of the minerals in mineral water on health status is especially apparent in the case of insufficient intake by nutrition. The apprehension that there might be an undesired hypertensinogenic effect due to the sodium content in mineral waters is not justified. Sodium is present in mineral water in small amounts only, and mainly as sodium bicarbonate, which has no effect on blood pressure. A certain advantage of a delivery of minerals and trace elements by regular drinking of mineral waters is the simultaneous intake of water, without supply of energy. Studies giving direct evidence of the health value of a regular consumption of mineral waters are, however, up to now rather scarce.

Milk, rather than other foods, is associated with vertebral bone mass and circulating IGF-1 in female adolescents

SUMMARY

Low calcium intake hampers bone mineral acquisition in adolescent girls. This study explores dietary calcium sources and nutrients possibly associated with vertebral mass. Milk intake is not influenced by genetic variants of the lactase gene and is positively associated with serum IGF-1 and with lumbar vertebrae mineral content and density.

INTRODUCTION

Low calcium intake hampers bone mineral acquisition during adolescence. We identified calcium sources and nutrients possibly associated with lumbar bone mineralization and calcium metabolism in adolescent girls and evaluated the possible influence of a genetic polymorphic trait associated with adult-type hypolactasia.

METHODS

Lumbar bone mineral content (BMC), bone mineral density (BMD), and area, circulating IGF-1, markers of bone metabolism, and -13910 LCT (lactase gene) polymorphism; and intakes of milk, dairy products, calcium, phosphorus, magnesium, proteins, and energy were evaluated in 192 healthy adolescent girls.

RESULTS

After menarche, BMC, BMD, serum IGF-1, and serum PTH were tightly associated with milk consumption, but not with other calcium sources. All four parameters were also associated with phosphorus, magnesium, protein, and energy from milk, but not from other sources. Girls with milk intakes below 55 mL/day have significantly lower BMD, BMC, and IGF-1 and higher PTH compared to girls consuming over 260 mL/day. Neither BMC, BMD, calcium intakes, nor milk consumption were associated with -13910 LCT polymorphism.

CONCLUSIONS

Milk consumption, preferably to other calcium sources, is associated with lumbar BMC and BMD in postmenarcheal girls. Aside from being a major source of calcium, milk provides phosphates, magnesium, proteins, and as yet unidentified nutrients likely to favor bone health.

Alkaline mineral water lowers bone resorption even in calcium sufficiency: alkaline mineral water and bone metabolism

BACKGROUND

Dietary acid charge enhances bone loss. Bicarbonate or alkali diet decreases bone resorption in humans. We compared the effect of an alkaline mineral water, rich in bicarbonate, with that of an acid one, rich in calcium only, on bone markers, in young women with a normal calcium intake.

METHODS

This study compared water A (per litre: 520 mg Ca, 291 mg HCO(3)(-), 1160 mg SO(4)(-), Potential Renal Acid load (PRAL) +9.2 mEq) with water B (per litre: 547 mg Ca, 2172 mg HCO(3)(-), 9 mg SO(4)(-), PRAL -11.2 mEq). 30 female dieticians aged 26.3 yrs (SD 7.3) were randomized into two groups, followed an identical weighed, balanced diet (965 mg Ca) and drank 1.5 l/d of the assigned water. Changes in blood and urine electrolytes, C-telopeptides (CTX), urinary pH and bicarbonate, and serum PTH were measured after 2 and 4 weeks.

RESULTS

The two groups were not different at baseline, and showed a similar increase in urinary calcium excretion. Urinary pH and bicarbonate excretion increased with water B, but not with water A. PTH (p=0.022) and S-CTX (p=0.023) decreased with water B but not with water A.

CONCLUSION

In calcium sufficiency, the acid calcium-rich water had no effect on bone resorption, while the alkaline water rich in bicarbonate led to a significant decrease of PTH and of S-CTX.

The composition of mineral waters sourced from Europe and North America in respect to bone health: composition of mineral water optimal for bone

The consumption of mineral waters is increasing in industrialised countries. High intakes of Ca and other alkalising cations as well as a low acid intake are beneficial to bone. We examined which components of mineral waters are conditioning their Ca content and their alkalinising power, in order to define the optimal profile. European mineral waters were randomly selected on the Internet: 100 waters with less than 200 mg Ca/l (9.98 mEq/l) and fifty with more than 200 mg/l, all with complete data for SO4, P, Cl, Na, K, Mg and Ca, and most also for HCO3. For comparison, forty North American mineral waters were randomly chosen. The potential renal acid load (PRAL) was calculated for each mineral water. North American waters did not reveal significant results because of their low mineralisation. We performed correlations between all eight components in order to explore the properties of the mineral waters. In the European waters, twenty-six out of twenty-eight correlations showed a P value of <or= 0.01. In waters with PRAL >0 (acidifying waters), PRAL was positively correlated with SO4, Ca, K and Mg (P < 0.001). In those with PRAL < 0 (alkalinising waters), PRAL was negatively correlated with HCO3, Na, Mg, Ca, K, Cl and SO4 (P < 0.001). SO4 and HCO3 were not found together in high quantities in the same water for geochemical reasons. A high Ca content is associated with either a high SO4 or a high HCO3 content. SO4 theoretically increases Ca excretion, while HCO3 and low PRAL values are associated with positive effects on bone. Therefore, the best waters for bone health are rich in both HCO3 and Ca, and by consequence low in SO4.

Calcium fortificants: overview and strategies for improving calcium nutriture of the U.S. population

Despite more than 20 y of awareness of the importance of calcium to health, U.S. calcium intakes remain suboptimal. Fortification of foods with shortfall nutrients is probably the optimal strategy for dealing with widespread nutrient deficiencies, as it has the best chance of reaching the population segments most at risk, as contrasted with attempts at changing individuals' food choices or relying on voluntary supplement taking. Given the wide array of potential calcium fortificants and fortification levels, there is not much to guide manufacturers interested in improving the nutritional value of their products. In this review, we assemble the calcium salts/complexes that have been used or proposed for use as fortificants and describe certain of their measured characteristics that relate to incorporation into foods, particularly what is known of their absorbability. The calcium salts most commonly used as supplements or fortificants exhibit similar absorbability when tested in pure chemical form. Choice of salt will depend mainly upon cost, compatability with the manufacturing process, and consumer acceptability. However, interaction with food, tablet, or beverage matrices can degrade intrinsic absorbability substantially. As a consequence, each product must be explicitly tested to establish the degree to which its calcium is available to consumers.

Non-pharmacological control of plasma cholesterol levels

The importance of non-pharmacological control of plasma cholesterol levels in the population is increasing, along with the number of subjects whose plasma lipid levels are non-optimal, or frankly elevated, according to international guidelines. In this context, a panel of experts, organized and coordinated by the Nutrition Foundation of Italy, has evaluated the nutritional and lifestyle interventions to be adopted in the control of plasma cholesterol levels (and specifically of LDL cholesterol levels). This Consensus document summarizes the view of the panel on this topic, with the aim to provide an updated support to clinicians and other health professionals involved in cardiovascular prevention.

Higher calcium urinary loss induced by a calcium sulphate-rich mineral water intake than by milk in young women Comments by Arnaud

I did not intend to revisit the discussion of the publication of Brandolini et al.1 on Ca urinary excretion attributed to the sulfate content of water but in their answers2 to my comments3, they said that ‘I accept their experimental results’ and that ‘I do not contest the difference in calciuria between milk and sulfate-rich water’. I never wrote that I agree with their results and even more with their conclusions but questioned how is it possible to evaluate a 20 mg difference in daily Ca urinary excretion from a study with subjects under uncontrolled dietary intakes, unbalanced experimental study design and without analytical results on acid–base balance and sulfate to support their acidogenic hypothesis of sulfate. I did not find any convincing explanations in their answers but I want to raise several points of disagreement, which are either repeated or new.