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Torfadóttir JE, Uusi-Rasi K. Calcium - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10303. [PMID: 38187795 PMCID: PMC10770652 DOI: 10.29219/fnr.v67.10303] [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: 07/02/2021] [Revised: 04/13/2022] [Accepted: 10/18/2023] [Indexed: 01/09/2024] Open
Abstract
The aim of this scoping review was to conduct evidence-based documentations between calcium (Ca) intake and health outcomes for updating dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the sixth edition of Nordic Nutrient Recommendations (NNR2023). The systematic literature search was limited to reviews on human data published between 2011 and June 2021. Systematic reviews (SRs) and original publications of relevance for this scoping review were included. A common practice of designing studies on health outcomes related to Ca supplement intake is to examine combined Ca and vitamin D, and therefore, a combination of Ca with vitamin D (CaD) was included in this review. In total, 27 studies addressing the association between dietary or supplemental Ca on bone health, bone mineral density (BMD), pregnancy-related outcomes, cardiovascular diseases (CVD), cancers, obesity, and mortality were reviewed. SRs showed that both dietary and supplemental Ca intakes were positively associated with BMD, but evidence did not support the benefit in fracture prevention. Current evidence did not support that Ca or CaD supplementation increases risk of coronary heart disease or all-cause mortality in older adults, but that Ca may be beneficial for hypertension, especially in young people. Increasing Ca intake may be beneficial during pregnancy, especially for those at high risk of pre-eclampsia due to ethnicity, age, high BMI, and those with low baseline Ca intake. The associations between high Ca intake and cancers were varied, with strong evidence that high consumption of dairy products is protective against colorectal cancer and limited-suggestive evidence that dairy products and diets high in Ca might also be protective against breast cancer. Moreover, there is limited-suggestive evidence that dairy products and diets high in Ca increase the risk of prostate cancer. Based on current evidence, Ca intake is beneficial or neutral in relation to most of the outcomes evaluated in this review. Data from the Nordic countries show that average Ca intake is around the same as previously recommended by NNR. However, the average Ca intake in the Baltic countries is below the recommendations.
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Affiliation(s)
- Jóhanna E. Torfadóttir
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Directorate of Health, Reykjavik, Iceland
| | - Kirsti Uusi-Rasi
- The UKK Institute for Health Promotion Research, Tampere, Finland
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Naila NN, Das S, Mim Khandaker A, Alam R, Westcott J, Long J, Krebs NF, Islam MM, Ahmed T. Improving Calcium Status of Women: Results of a Study of Bio-Availability of Calcium From Slaked Lime Fortified Rice. Food Nutr Bull 2022; 43:429-438. [PMID: 36168746 DOI: 10.1177/03795721221117624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fortification of rice with slaked lime is an acceptable and inexpensive way to combat calcium (Ca) deficiency. However, bioavailability of calcium after intake of slaked lime fortified rice is yet to be investigated. OBJECTIVE To measure the fractional absorption of Ca (FAC) from slaked lime fortified cooked rice. DESIGN We conducted an experimental study using stable isotopes of Ca to measure FAC during a single morning test meal containing rice fortified with slaked lime. Participants (n = 22) were given slaked lime fortified rice 3 times a day for 4 days. On the morning of the fifth day, the participants were served the same amount of rice as previous the 4 days at the breakfast test meal with an accurately measured amount of 44Ca stable isotope oral tracer followed by an intravenous injection of 42Ca. Urine was collected over the next 24 hours in 3 consecutive 8-hour pools. Fractional absorption of Ca was calculated from the measurement of the relative enrichment of the of each administered tracer 44Ca and 42Ca using inductively coupled plasma mass spectrometry. RESULTS The mean Ca concentration in the test meal was 879.5 ± 152.9 µg/g with a coefficient of variance (CV) of 17.2%. Although Ca absorption efficiency decreases with higher calcium intake, the total amount of calcium absorbed from test meal using FAC = 0.391 calculated from the third 8-hour urine pool was 69.0 (CV of 15.6) mg. CONCLUSIONS We showed that one-fifth of daily calcium recommendation for women of reproductive age could be met by ingesting ∼200 g cooked slake fortified rice.
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Affiliation(s)
- Nurun Nahar Naila
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | - Rahvia Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie Long
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.,Department of Global Health, University of Washington, Seattle, WA, USA.,James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Grinman D, Athonvarungkul D, Wysolmerski J, Jeong J. Calcium Metabolism and Breast Cancer: Echoes of Lactation? ACTA ACUST UNITED AC 2020; 15:63-70. [PMID: 33299957 DOI: 10.1016/j.coemr.2020.11.006] [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] [Indexed: 12/19/2022]
Abstract
Lactation requires a series of adaptations in maternal calcium and bone metabolism to ensure a steady supply of calcium to the lactating mammary gland. The alterations in systemic metabolism are accompanied by alterations in the expression of calcium receptors, channels, binding proteins, pumps and transporters in mammary epithelial cells to increase the uptake of calcium from the extracellular fluid and to transport it into milk. Intracellular calcium regulates signaling pathways that mediate changes in cell proliferation, differentiation and death and many of the molecules involved in supporting and coordinating calcium secretion into milk are re-expressed and redeployed to support malignant behavior in breast cancer cells. In this article, we review adaptations of systemic calcium homeostasis during lactation, as well as the mechanisms of milk calcium transport. We then discuss how reactivation of these pathways contributes to the pathophysiology of breast cancer.
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Affiliation(s)
- Diego Grinman
- Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine
| | - Diana Athonvarungkul
- Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine
| | - John Wysolmerski
- Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine
| | - Jaekwang Jeong
- Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine
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Cao S, Cladis DP, Weaver CM. Use of Calcium Isotopic Tracers To Determine Factors That Perturb Calcium Metabolism. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:12886-12892. [PMID: 32299214 DOI: 10.1021/acs.jafc.0c01641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Calcium plays an important role in maintaining bone health. Ensuring adequate calcium intake throughout life is essential for reaching greater peak bone mass in young adulthood and lowering osteoporotic fracture risk when aging. Calcium homeostasis involves a complex interaction between three organ systems: intestine, kidney, and bone. Metabolic balance plus kinetic studies using calcium isotopic tracers can estimate calcium metabolism parameters and pinpoint how organs and processes are perturbed by internal and external modifiers. Both modifiable factors (e.g., vitamin D supplementations and dietary bioactives) and non-modifiable factors (e.g., age, sex, and race) influence calcium utilization. Current evidence suggests that prebiotic fibers may offer an alternative approach to enhance calcium absorption through altering gut microbiota to ultimately improve bone health.
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Affiliation(s)
- Sisi Cao
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana 47907, United States
| | - Dennis P Cladis
- Department of Food Science, Purdue University, West Lafayette, Indiana 47907, United States
| | - Connie M Weaver
- Department of Food Science, Purdue University, West Lafayette, Indiana 47907, United States
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Green MH, Green JB. Vitamin A Absorption Determined in Rats Using a Plasma Isotope Ratio Method. J Nutr 2020; 150:1977-1981. [PMID: 32271921 PMCID: PMC7330459 DOI: 10.1093/jn/nxaa092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/10/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Better methods are needed for determining vitamin A absorption efficiency. OBJECTIVE Our objective was to measure vitamin A absorption in rats by adapting a plasma isotope ratio method previously used to determine cholesterol absorption. METHODS Male Sprague-Dawley rats [n = 14; 340 ± 16 g (mean ± SD)] received an oral tracer dose of [3H]retinyl acetate in oil plus an intravenous dose of [14C]vitamin A-labeled lymph prepared in a donor rat that had received [14C]retinyl acetate intraduodenally. Blood samples were collected on days 1, 2, 3, 6, 9, and 12, and plasma was analyzed for 3H and 14C; vitamin A absorption was calculated for each sample as (fraction of oral dose/fraction of intravenous dose) × 100. Radioactivity was also measured in feces and urine collected as pools on days 3, 6, 9, and 12 and in liver and remaining carcass on day 12. RESULTS Vitamin A absorption calculated as the plasma isotope ratio was >100% on day 1, 78% ± 5% on day 6, 76% ± 5% on day 9, and 74% ± 5% on day 12; fitting the data to an exponential function plus a constant predicted an absorption of 75% by day 14. Recovery of the oral dose in feces (day 0 to day 6) was low (6.2% ± 0.84%, n = 10) and the mean isotope ratio in day 9-12 urine pool was lower than that in plasma. CONCLUSIONS The plasma isotope ratio holds promise for estimating vitamin A absorption, but additional work is needed to determine how long studies need to be and if the doses should be administered simultaneously. For application of this method in humans, artificial chylomicrons labeled with a stable isotope of retinyl acetate could be used for the intravenous dose, with a different isotope required for the oral dose.
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Affiliation(s)
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Beggs MR, Appel I, Svenningsen P, Skjødt K, Alexander RT, Dimke H. Expression of transcellular and paracellular calcium and magnesium transport proteins in renal and intestinal epithelia during lactation. Am J Physiol Renal Physiol 2017; 313:F629-F640. [DOI: 10.1152/ajprenal.00680.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/01/2017] [Accepted: 05/17/2017] [Indexed: 01/25/2023] Open
Abstract
Significant alterations in maternal calcium (Ca2+) and magnesium (Mg2+) balance occur during lactation. Ca2+ is the primary divalent cation mobilized into breast milk by demineralization of the skeleton and alterations in intestinal and renal Ca2+ transport. Mg2+ is also concentrated in breast milk, but the underlying mechanisms are not well understood. To determine the molecular alterations in Ca2+ and Mg2+ transport in the intestine and kidney during lactation, three groups of female mice consisting of either nonpregnant controls, lactating mice, or mice undergoing involution were examined. The fractional excretion of Ca2+, but not Mg2+, rose significantly during lactation. Renal 1-α hydroxylase and 24-OHase mRNA levels increased markedly, as did plasma 1,25 dihydroxyvitamin D levels. This was accompanied by significant increases in intestinal expression of Trpv6 and S100g in lactating mice. However, no alterations in the expression of cation-permeable claudin-2, claudin-12, or claudins-15 were found in the intestine. In the kidney, increased expression of Trpv5 and Calb1 was observed during lactation, while no changes in claudins involved in Ca2+ and Mg2+ transport (claudin-2, claudin-14, claudin-16, or claudin-19) were found. Consistent with the mRNA expression, expression of both calbindin-D28K and transient receptor potential vanilloid 5 (TRPV5) proteins increased. Colonic Trpm6 expression increased during lactation, while renal Trpm6 remained unaltered. In conclusion, proteins involved in transcellular Ca2+ and Mg2+ transport pathways increase during lactation, while expression of paracellular transport proteins remained unchanged. Increased fractional Ca2+ excretion can be explained by vitamin D-dependent intestinal hyperabsorption and bone demineralization, despite enhanced transcellular Ca2+ uptake by the kidney.
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Affiliation(s)
- Megan R. Beggs
- Membrane Protein Disease Research Group, Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Ida Appel
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Per Svenningsen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Karsten Skjødt
- Department of Cancer and Inflammation, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; and
| | - R. Todd Alexander
- Membrane Protein Disease Research Group, Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Henrik Dimke
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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UENISHI K, ISHIMI Y, NAKAMURA K, KODAMA H, ESASHI T. Dietary Reference Intakes for Japanese 2010: Macrominerals. J Nutr Sci Vitaminol (Tokyo) 2012. [DOI: 10.3177/jnsv.59.s83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Parra MD, Martínez de Morentin BE, Cobo JM, Lenoir-Wijnkoop I, Martínez JA. Acute Calcium Assimilation from Fresh or Pasteurized Yoghurt Depending on the Lactose Digestibility Status. J Am Coll Nutr 2007; 26:288-94. [PMID: 17634175 DOI: 10.1080/07315724.2007.10719613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The major aim of this trial was to evaluate the potential interaction of fresh or pasteurized yoghurt intake with lactose intolerance on calcium assimilation by means of the stable isotope 43Ca as a tracer. METHODS Forty volunteers (age: 32 +/- 7 years) participated in this parallel simple blind study (20 of them with moderate lactose intolerance). The protocol included the intake of a test meal consisting on 43Ca-labelled fresh or pasteurized yoghurt. Volunteers, in whom the calcium status was assessed, collected the 24-h urine before and after the test meal to measure the stable isotope output. The intake-related 43Ca enrichment in urine was measured by isotopic rate mass spectrometry. RESULTS In lactose tolerant and intolerant volunteers taken together, the fresh yoghurt consumption resulted in a statistically higher circulating calcium levels (p = 0.028) and urinary 43Ca output (p = 0.017) than after the pasteurized yoghurt intake. The lactose maldigestion status resulted in higher urinary 43Ca excretion (p = 0.013) after the fermented milk consumption, regardless of the nature of ingested product (p = 0.887). CONCLUSIONS This novel and non-aggressive protocol allowed the in vivo comparison of calcium utilization from two different dairy sources, revealing a higher acute calcium assimilation from fresh as compared to the pasteurized yoghurt, in both lactose digesting and maldigesting subjects.
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Affiliation(s)
- M Dolores Parra
- Department of Physiology and Nutrition. University of Navarra, C/ Irunlarrea s/n. 31008 Pamplona, Spain
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López-Huertas E, Teucher B, Boza JJ, Martínez-Férez A, Majsak-Newman G, Baró L, Carrero JJ, González-Santiago M, Fonollá J, Fairweather-Tait S. Absorption of calcium from milks enriched with fructo-oligosaccharides, caseinophosphopeptides, tricalcium phosphate, and milk solids. Am J Clin Nutr 2006; 83:310-6. [PMID: 16469989 DOI: 10.1093/ajcn/83.2.310] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adequate intakes of calcium are required for optimal bone health and protection against chronic disease. Dairy products are an excellent source of calcium. OBJECTIVE The absorption of calcium from a range of fortified milks was measured in humans with the use of stable isotopes. DESIGN Fifteen volunteers participated in a randomized, controlled, double-blind crossover study. Five types of semi-skimmed (1.9% fat) milk drinks were administered with a light breakfast: standard milk (control milk); milk enriched with calcium from milk solids and tricalcium phosphate [(TCP) MSS milk]; milk enriched with calcium from concentrated milk (CON milk); milk with added fructo-oligosaccharides [(FOSs) FOS milk]; and milk with added caseinophosphopeptides [(CPPs) CPP milk]. All the milks were labeled with 42Ca as CaCl2. The MSS milk was also labeled with 44Ca as TCP. The quantity of calcium in each drink was kept the same by varying the volume given. RESULTS Calcium absorption did not differ significantly between the control milk and the calcium-fortified milks (MSS and CON milk) or the FOS and CPP milks. However, calcium absorption from the TCP added to the MSS milk was significantly higher than that from the control milk (27.5 +/- 7.6% and 24.5 +/- 7.3%, respectively; P = 0.003). CONCLUSIONS Calcium-enriched milks are a valuable source of well-absorbed calcium. Absorption of added calcium as TCP was higher than that of calcium from the control milk, but the addition of FOSs or CPPs did not significantly increase calcium absorption. Further research is needed to ascertain the cost-effectiveness and public health benefits of consuming fortified milks.
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Beck AB, Bügel S, Stürup S, Jensen M, Mølgaard C, Hansen M, Krogsgaard OW, Sandström B. A novel dual radio- and stable-isotope method for measuring calcium absorption in humans: comparison with the whole-body radioisotope retention method. Am J Clin Nutr 2003; 77:399-405. [PMID: 12540400 DOI: 10.1093/ajcn/77.2.399] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dietary calcium absorption can be determined only with the use of isotope techniques. Currently used isotope techniques require exclusive equipment or are not true tracer approaches. OBJECTIVE The objective was to compare a dual-isotope method combining radioisotopes and stable isotopes with a whole-body radioisotope retention method for measuring calcium absorption. DESIGN Seven healthy adults aged 21-27 y consumed a test meal containing 63 +/- 14 (macro x +/- SD) mg Ca together with a water solution of (47)Ca (0.11 MBq). One hour after ingestion, 18 mg (44)Ca was administered intravenously. All feces and urine were collected for 5 and 6 d, respectively. Calcium absorption was estimated from whole-body retention of the radioisotope 12 times over 3 wk after ingestion and from the excretion of (47)Ca and (44)Ca in a 24-h urine sample collected on day 2. (44)Ca in urine was determined by inductively coupled plasma mass spectrometry. RESULTS Mean (+/- SD) calcium absorption was 75 +/- 9% with the dual-isotope method and was 74 +/- 8% with the whole-body radioisotope retention method. There was a high degree of agreement between the methods. CONCLUSION The dual-isotope method is a valid approach for measuring calcium absorption from a single meal.
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Affiliation(s)
- Anne B Beck
- Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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