A Call to Evaluate the Impact of Calcium-Fortified Foods and Beverages:

Bile composition, plasma lipids and oxidative hepatic damage induced by calcium supplementation; effects of goat or cow milk consumption

Calcium-fortified foods, especially milk and dairy products are recommended to be consumed daily for groups in risk of nutritional deficiency, including children, young adults, menopausal women, pregnant women and the elderly, however Ca-supplementation promotes gallstone formation because Ca is a nucleating factor. The objective of the current study was to assess the influence of cow or goat milk-based diets, either normal or Ca-supplemented, on bile composition, biochemical parameters and hepatic antioxidant status. Weanling male rats were randomly divided into six groups, fed standard, goat or cow milk-based diets, either with normal Ca content (5·0 g/kg), or Ca-supplemented (10·0 g/kg), for 2 weeks. Bile cholesterol concentration and output was higher in rats fed goat milk in comparison with those fed with standard and cow-milk-based diet. Ca-supplementation increased lithogenic index with the standard and cow-milk based diets, this change was not observed with the goat milk diet. Activities of plasma transaminases were also lower in the animals fed Ca-supplemented goat milk, in comparison with the other diets assayed. In general, Ca-supplement in the diet led to an increase in the hepatic oxidative damage, with an increase in the activities of all the antioxidant enzymes studied in the standard and cow milk diet, but not with goat milk. The habitual consumption of goat milk has positive effects on the plasma lipid profile, biliary composition and hepatic antioxidant defence. In addition, under our experimental conditions, Ca-supplementation of this type of milk does not increase the lithogenic index, or hepatic oxidative damage.

Nutrients from dairy foods are difficult to replace in diets of Americans: food pattern modeling and an analyses of the National Health and Nutrition Examination Survey 2003-2006

Because dairy products provide shortfall nutrients (eg, calcium, potassium, and vitamin D) and other important nutrients, this study hypothesized that it would be difficult for Americans to meet nutritional requirements for these nutrients in the absence of dairy product consumption or when recommended nondairy calcium sources are consumed. To test this hypothesis, MyPyramid dietary pattern modeling exercises and an analyses of data from the National Health and Nutrition Examination Survey 2003-2006 were conducted in those aged at least 2 years (n = 16 822). Impact of adding or removing 1 serving of dairy, removing all dairy, and replacing dairy with nondairy calcium sources was evaluated. Dietary pattern modeling indicated that at least 3 servings of dairy foods are needed to help individuals meet recommendations for nutrients, such as calcium and magnesium, and 4 servings may be needed to help some groups meet potassium recommendations. A calcium-equivalent serving of dairy requires 1.1 servings of fortified soy beverage, 0.6 serving of fortified orange juice, 1.2 servings of bony fish, or 2.2 servings of leafy greens. The replacement of dairy with calcium-equivalent foods alters the overall nutritional profile of the diet and affects nutrients including protein, potassium, magnesium, phosphorus, riboflavin, vitamins A, D and B(12). Similar modeling exercises using consumption data from the National Health and Nutrition Examination Survey also demonstrated that nondairy calcium replacement foods are not a nutritionally equivalent substitute for dairy products. In conclusion, although it is possible to meet calcium intake recommendations without consuming dairy foods, calcium replacement foods are not a nutritionally equivalent substitute for dairy foods and consumption of a calcium-equivalent amount of some nondairy foods is unrealistic.

Should dairy be recommended as part of a healthy vegetarian diet? Point

A benefit-risk evaluation of the evidence for including dairy foods in the diet is presented. For many persons dairy products provide a substantial portion of essential nutrients, but especially calcium, potassium, and magnesium. Dietary supplements and fortified foods can be alternative sources of these nutrients, although other components of dairy foods such as amino acid composition and conjugated linoleic acid may be instrumental in the benefits associated with dairy product consumption for bone health and reduced risk of stroke, metabolic syndrome, and some cancers. Newer evidence shows that protein-induced calciuria does not have a detrimental effect on net calcium retention, and the concentrations of hormones in milk are not outside of the range of endogenous concentrations. Increased dietary protein, including from milk, can elevate serum concentrations of insulin-like growth factor I, which has an unknown relation to cancer. The concern over consumption of milk leading to increased risk of prostate cancer through reduction of serum 1,25-dihydroxyvitamin D, a potent anti-prostate cancer hormone, has been resolved with new evidence that local production of this hormone is independent of diet. Overall, evidence suggests that being a lactovegetarian has greater health benefits and reduced health risks than being a vegan.

The health benefits of calcium citrate malate: a review of the supporting science

There has been considerable investigation into the health benefits of calcium citrate malate (CCM) since it was first patented in the late 1980s. This chapter is a comprehensive summary of the supporting science and available evidence on the bioavailability and health benefits of consuming CCM. It highlights the important roles that CCM can play during various life stages. CCM has been shown to facilitate calcium retention and bone accrual in children and adolescents. In adults, it effectively promotes the consolidation and maintenance of bone mass. In conjunction with vitamin D, CCM also decreases bone fracture risk in the elderly, slows the rate of bone loss in old age, and is of benefit to the health and well-being of postmenopausal women. CCM is exceptional in that it confers many unique benefits that go beyond bone health. Unlike other calcium sources that necessitate supplementation be in conjunction with a meal to ensure an appreciable benefit is derived, CCM can be consumed with or without food and delivers a significant nutritional benefit to individuals of all ages. The chemistry of CCM makes it a particularly beneficial calcium source for individuals with hypochlorydia or achlorydia, which generally includes the elderly and those on medications that decrease gastric acid secretion. CCM is also recognized as a calcium source that does not increase the risk of kidney stones, and in fact it protects against stone-forming potential. The versatile nature of CCM makes it a convenient and practical calcium salt for use in moist foods and beverages. The major factor that may preclude selection of CCM as a preferred calcium source is the higher cost compared to other sources of calcium commonly used for fortification (e.g., calcium carbonate and tricalcium phosphate). However, formation of CCM directly within beverages or other fluid foods and/or preparations, and the addition of a concentrated CCM solution or slurry, are relatively cost-effective methods by which CCM can be incorporated into finished food and beverage products.

Measuring calcium absorption and utilization in humans

PURPOSE OF REVIEW

Calcium metabolism is comprised primarily of absorption, urinary excretion, endogenous secretion and bone turnover. This review evaluates recent findings relating to the role of genetic and environmental factors, especially diet, on perturbing parameters of calcium metabolism. Calcium dynamics are studied with the use of isotopic tracers. We also cover state-of-the-art methods for stable calcium isotope ratio analysis and offer insights on experimental design.

RECENT FINDINGS

Some progress has been made identifying genetic and hormonal regulators of calcium absorption. Much progress has been made in understanding the role of diet on influencing calcium retention, especially with regard to dietary protein and salt. Long-held views on dietary factors thought to contribute to bone loss through urinary calcium loss have been shown to have no impact on net calcium retention because of compensatory changes in other aspects of calcium metabolism.

SUMMARY

Much more work needs to be done on understanding genetic regulators of calcium metabolism. Despite recent advances in our knowledge of dietary influences on calcium metabolism, more studies are needed on the role of environmental factors, especially physical activity.