1
|
Olde Engberink RHG, van Oosten PJ, Weber T, Tabury K, Baatout S, Siew K, Walsh SB, Valenti G, Chouker A, Boutouyrie P, Heer M, Jordan J, Goswami N. The kidney, volume homeostasis and osmoregulation in space: current perspective and knowledge gaps. NPJ Microgravity 2023; 9:29. [PMID: 37005397 PMCID: PMC10067832 DOI: 10.1038/s41526-023-00268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Although we have sent humans into space for more than 50 years crucial questions regarding kidney physiology, volume regulation and osmoregulation remain unanswered. The complex interactions between the renin-angiotensin-aldosterone system, the sympathetic nervous system, osmoregulatory responses, glomerular function, tubular function, and environmental factors such as sodium and water intake, motion sickness and ambient temperature make it difficult to establish the exact effect of microgravity and the subsequent fluid shifts and muscle mass loss on these parameters. Unfortunately, not all responses to actual microgravity can be reproduced with head-down tilt bed rest studies, which complicates research on Earth. Better understanding of the effects of microgravity on kidney function, volume regulation and osmoregulation are needed with the advent of long-term deep space missions and planetary surface explorations during which orthostatic intolerance complaints or kidney stone formation can be life-threatening for astronauts. Galactic cosmic radiation may be a new threat to kidney function. In this review, we summarise and highlight the current understandings of the effects of microgravity on kidney function, volume regulation and osmoregulation and discuss knowledge gaps that future studies should address.
Collapse
Affiliation(s)
- Rik H G Olde Engberink
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
| | - Paula J van Oosten
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre (EAC), Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Kevin Tabury
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Keith Siew
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Giovanna Valenti
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, Bari, Italy
| | - Alexander Chouker
- Laboratory of Translational Research Stress and Immunity, Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University (LUM), Munich, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Service de Pharmacologie, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, FR-75015, Paris, France
| | - Martina Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Institute of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR) and University of Cologne, Cologne, Germany
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Löwi Research Center of Vascular Biology, Inflammation, and Immunity, Medical University of Graz, Graz, Austria
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
2
|
Tang H, Rising HH, Majji M, Brown RD. Long-Term Space Nutrition: A Scoping Review. Nutrients 2021; 14:nu14010194. [PMID: 35011072 PMCID: PMC8747021 DOI: 10.3390/nu14010194] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 01/30/2023] Open
Abstract
This scoping review aimed to identify current evidence and gaps in the field of long-term space nutrition. Specifically, the review targeted critical nutritional needs during long-term manned missions in outer space in addition to the essential components of a sustainable space nutrition system for meeting these needs. The search phrase "space food and the survival of astronauts in long-term missions" was used to collect the initial 5432 articles from seven Chinese and seven English databases. From these articles, two independent reviewers screened titles and abstracts to identify 218 articles for full-text reviews based on three themes and 18 keyword combinations as eligibility criteria. The results suggest that it is possible to address short-term adverse environmental factors and nutritional deficiencies by adopting effective dietary measures, selecting the right types of foods and supplements, and engaging in specific sustainable food production and eating practices. However, to support self-sufficiency during long-term space exploration, the most optimal and sustainable space nutrition systems are likely to be supported primarily by fresh food production, natural unprocessed foods as diets, nutrient recycling of food scraps and cultivation systems, and the establishment of closed-loop biospheres or landscape-based space habitats as long-term life support systems.
Collapse
Affiliation(s)
- Hong Tang
- College of Landscape and Tourism, Gansu Agricultural University, Lanzhou 730070, China;
| | - Hope Hui Rising
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA;
- Correspondence:
| | - Manoranjan Majji
- Department of Aerospace Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Robert D. Brown
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA;
| |
Collapse
|
3
|
Patel ZS, Brunstetter TJ, Tarver WJ, Whitmire AM, Zwart SR, Smith SM, Huff JL. Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars. NPJ Microgravity 2020; 6:33. [PMID: 33298950 PMCID: PMC7645687 DOI: 10.1038/s41526-020-00124-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022] Open
Abstract
NASA's plans for space exploration include a return to the Moon to stay-boots back on the lunar surface with an orbital outpost. This station will be a launch point for voyages to destinations further away in our solar system, including journeys to the red planet Mars. To ensure success of these missions, health and performance risks associated with the unique hazards of spaceflight must be adequately controlled. These hazards-space radiation, altered gravity fields, isolation and confinement, closed environments, and distance from Earth-are linked with over 30 human health risks as documented by NASA's Human Research Program. The programmatic goal is to develop the tools and technologies to adequately mitigate, control, or accept these risks. The risks ranked as "red" have the highest priority based on both the likelihood of occurrence and the severity of their impact on human health, performance in mission, and long-term quality of life. These include: (1) space radiation health effects of cancer, cardiovascular disease, and cognitive decrements (2) Spaceflight-Associated Neuro-ocular Syndrome (3) behavioral health and performance decrements, and (4) inadequate food and nutrition. Evaluation of the hazards and risks in terms of the space exposome-the total sum of spaceflight and lifetime exposures and how they relate to genetics and determine the whole-body outcome-will provide a comprehensive picture of risk profiles for individual astronauts. In this review, we provide a primer on these "red" risks for the research community. The aim is to inform the development of studies and projects with high potential for generating both new knowledge and technologies to assist with mitigating multisystem risks to crew health during exploratory missions.
Collapse
Affiliation(s)
- Zarana S Patel
- KBR, Houston, TX, USA.
- NASA Lyndon B. Johnson Space Center, Houston, TX, USA.
| | | | | | | | - Sara R Zwart
- NASA Lyndon B. Johnson Space Center, Houston, TX, USA
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Scott M Smith
- NASA Lyndon B. Johnson Space Center, Houston, TX, USA
| | | |
Collapse
|
4
|
Rendina D, De Filippo G, Iannuzzo G, Abate V, Strazzullo P, Falchetti A. Idiopathic Osteoporosis and Nephrolithiasis: Two Sides of the Same Coin? Int J Mol Sci 2020; 21:ijms21218183. [PMID: 33142950 PMCID: PMC7662860 DOI: 10.3390/ijms21218183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022] Open
Abstract
Idiopathic osteoporosis and nephrolithiasis are formidable health problems showing a progressive increase in their incidence and prevalence in the last decades. These temporal trends were observed in both pediatric and adult populations worldwide. Epidemiological and experimental studies indicate that both disorders show several common pathogenic environmental and genetic factors. In this review, we analyzed the clinical characteristics common to the two disorders and the state-of-the-art knowledge regarding the genetic predisposition and the environmental factors recognized as triggers in adult and pediatric ages. As a result of this work, we propose to consider idiopathic nephrolithiasis and osteoporosis as two possible expressions of a unique clinical syndrome. Accordingly, the clinical approach to both disorders should be modified in order to program an efficient primary and secondary prevention strategy.
Collapse
Affiliation(s)
- Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (D.R.); (G.I.); (V.A.); (P.S.)
| | - Gianpaolo De Filippo
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie et Diabétologie Pédiatrique, 75019 Paris, France;
- French Clinical Research Group in Adolescent Medicine and Health, 75014 Paris, France
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (D.R.); (G.I.); (V.A.); (P.S.)
| | - Veronica Abate
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (D.R.); (G.I.); (V.A.); (P.S.)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (D.R.); (G.I.); (V.A.); (P.S.)
| | - Alberto Falchetti
- Unit of Bone and Mineral Metabolic Diseases, Istituto Auxologico Italiano, San Giuseppe Hospital, Piancavallo, 28824 Verbania, Italy
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, 20145 Milan, Italy
- Correspondence: ; Tel.: +39-33-1689-2204
| |
Collapse
|
5
|
Bansal V, Mishra SK. Reduced-sodium cheeses: Implications of reducing sodium chloride on cheese quality and safety. Compr Rev Food Sci Food Saf 2020; 19:733-758. [PMID: 33325171 DOI: 10.1111/1541-4337.12524] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
Sodium chloride (NaCl) universally well-known as table salt is an ancient food additive, which is broadly used to increase the storage stability and the palatability of foods. Though, in recent decades, use of table salt in foods is a major concern among the health agencies of the world owing to ill effects of sodium (Na) that are mostly linked to hypertension and cardiovascular diseases. As a result, food scientists are working to decrease the sodium content in food either by decreasing the rate of NaCl addition or by partial or full replacement of NaCl with other suitable salts like potassium chloride (KCl), calcium chloride (CaCl2 ), or magnesium chloride (MgCl2 ). However, in cheese, salt reduction is difficult to accomplish owing to its multifaceted role in cheese making. Considering the significant contribution in dietary salt intake (DSI) from cheese, researchers across the globe are exploring various technical interventions to develop reduced-sodium cheeses (RSCs) without jeopardizing the quality and safety of cheeses. Thus, the purpose of this study is to provide an insight of NaCl reduction on sensory, physicochemical, and technofunctional attributes of RSCs with an aim to explore various strategies for salt reduction without affecting the cheese quality and safety. The relationship between salt reduction and survival of pathogenic and spoilage-causing microorganisms and growth of RSCs microflora is also discussed. Based on the understanding of conceptual and applied information on the complex changes that occur in the development of RSCs, the quality and safety of RSCs can be accomplished effectively in order to reduce the DSI from cheese.
Collapse
Affiliation(s)
- Venus Bansal
- Department of Dairy Technology, College of Dairy Science & Technology, Guru Angad Dev Veterinary & Animal Sciences University, Ludhiana, India
| | - Santosh Kumar Mishra
- Department of Dairy Microbiology, College of Dairy Science & Technology, Guru Angad Dev Veterinary & Animal Sciences University, Ludhiana, India
| |
Collapse
|
6
|
Oliveira CM, Teixeira H, Alves SM, Pina MF. Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-12902020200094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Geographical variation on hip fractures (HF) may be related to the geographical variation of drinking water composition (DWC); minerals in drinking water may contribute to its fragility. We aim to investigate the effects of DWC on HF risk in Portugal (2000-2010). From National Hospital Discharge Register we selected admissions of patients aged ≥50 years, diagnosed with HF caused by low/moderate energy traumas. Water components and characteristics were selected at the municipality level. A spatial generalized additive model with a negative binomial distribution as a link function was used to estimate the association of HF with variations in DWC. There were 96,905HF (77.3% in women). The spatial pattern of HF risk was attenuated after being adjusted for water parameters. Results show an indirect association between calcium, magnesium, and iron and HF risk but no clear relation between aluminum, cadmium, fluoride, manganese, or color and HF risk. Regarding pH, the 6.7pH and 7pH interval seems to pose a lower risk. Different dose-response relationships were identified. The increase of calcium, magnesium, and iron values in DWC seems to reduce regional HF risk. Long-term exposure to water parameters, even within the regulatory limits, might increase the regional HF risk.
Collapse
Affiliation(s)
- Carla Maria Oliveira
- Universidade do Porto, Portugal; Universidade do Porto, Portugal; Instituto Politécnico do Porto, Portugal
| | - Hugo Teixeira
- Universidade do Porto, Portugal; Universidade do Porto, Portugal
| | - Sandra Maria Alves
- Universidade do Porto, Portugal; Universidade do Porto, Portugal; Instituto Politécnico do Porto, Portugal
| | - Maria Fátima Pina
- Universidade do Porto, Portugal; Universidade do Porto, Portugal; Fundação Oswaldo Cruz, Brasil
| |
Collapse
|
7
|
Schröder A, Neubert P, Titze J, Bozec A, Neuhofer W, Proff P, Kirschneck C, Jantsch J. Osteoprotective action of low-salt diet requires myeloid cell-derived NFAT5. JCI Insight 2019; 4:127868. [PMID: 31801906 DOI: 10.1172/jci.insight.127868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Dietary salt consumption leads to cutaneous Na+ storage and is associated with various disorders, including osteopenia. Here, we explore the impact of Na+ and the osmoprotective transcription factor nuclear factor of activated T cell 5 (NFAT5) on bone density and osteoclastogenesis. Compared with treatment of mice with high-salt diet, low-salt diet (LSD) increased bone density, decreased osteoclast numbers, and elevated Na+ content and Nfat5 levels in the BM. This response to LSD was dependent on NFAT5 expressed in myeloid cells. Simulating in vivo findings, we exposed osteoclast precursors and osteoblasts to elevated Na+ content (high-salt conditions; HS¢), resulting in increased NFAT5 binding to the promotor region of RANKL decoy receptor osteoprotegerin (OPG). These data not only demonstrate that NFAT5 in myeloid cells determines the Na+ content in BM, but that NFAT5 is able to govern the expression of the osteoprotective gene OPG. This provides insights into mechanisms of Na+-induced cessation of osteoclastogenesis and offers potentially new targets for treating salt-induced osteopenia.
Collapse
Affiliation(s)
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Jens Titze
- Duke-National University of Singapore, Singapore
| | - Aline Bozec
- Department of Internal Medicine, FAU Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
8
|
McDonnell AC, Eiken O, Frings-Meuthen P, Rittweger J, Mekjavic IB. The LunHab project: Muscle and bone alterations in male participants following a 10 day lunar habitat simulation. Exp Physiol 2019; 104:1250-1261. [PMID: 31273869 DOI: 10.1113/ep087482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 12/24/2022]
Abstract
NEW FINDINGS What is the central question of this study? It is well established that muscle and bone atrophy in conditions of inactivity or unloading, but there is little information regarding the effect of a hypoxic environment on the time course of these deconditioning physiological systems. What is the main finding and its importance? The main finding is that a horizontal 10 day bed rest in normoxia results in typical muscle atrophy, which is not aggravated by hypoxia. Changes in bone mineral content or in metabolism were not detected after either normoxic or hypoxic bed rest. ABSTRACT Musculoskeletal atrophy constitutes a typical adaptation to inactivity and unloading of weightbearing bones. The reduced-gravity environment in future Moon and Mars habitats is likely to be hypobaric hypoxic, and there is an urgent need to understand the effect of hypoxia on the process of inactivity-induced musculoskeletal atrophy. This was the principal aim of the present study. Eleven males participated in three 10 day interventions: (i) hypoxic ambulatory confinement; (ii) hypoxic bed rest; and (iii) normoxic bed rest. Before and after the interventions, the muscle strength (isometric maximal voluntary contraction), mass (lean mass, by dual-energy X-ray absorptiometry), cross-sectional area and total bone mineral content (determined with peripheral quantitative computed tomography) of the participants were measured. Blood and urine samples were collected before and on the 1st, 4th and 10th day of the intervention and analysed for biomarkers of bone resorption and formation. There was a significant reduction in thigh and lower leg muscle mass and volume after both normoxic and hypoxic bed rests. Muscle strength loss was proportionately greater than the loss in muscle mass for both thigh and lower leg. There was no indication of bone loss. Furthermore, the biomarkers of resorption and formation were not affected by any of the interventions. There was no significant effect of hypoxia on the musculoskeletal variables. Short-term normoxic (10 day) bed rest resulted in muscular deconditioning, but not in the loss of bone mineral content or changes in bone metabolism. Hypoxia did not modify these results.
Collapse
Affiliation(s)
- Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Institute Jozef Stefan, Ljubljana, Slovenia
| | - Ola Eiken
- Department of Environmental Physiology, School of Technology and Health, Royal Institute of Technology, Solna, Sweden
| | - Petra Frings-Meuthen
- Institute for Aerospace Medicine, German Aerospace Centre (DLR), Cologne, Germany
| | - Joern Rittweger
- Institute for Aerospace Medicine, German Aerospace Centre (DLR), Cologne, Germany.,Department of Paediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Institute Jozef Stefan, Ljubljana, Slovenia.,Department of Biomedical Sciences and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.
Collapse
|
11
|
Zwart SR, Rice BL, Dlouhy H, Shackelford LC, Heer M, Koslovsky MD, Smith SM. Dietary acid load and bone turnover during long-duration spaceflight and bed rest. Am J Clin Nutr 2018; 107:834-844. [PMID: 29722847 PMCID: PMC6862931 DOI: 10.1093/ajcn/nqy029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background Bed rest studies document that a lower dietary acid load is associated with lower bone resorption. Objective We tested the effect of dietary acid load on bone metabolism during spaceflight. Design Controlled 4-d diets with a high or low animal protein-to-potassium (APro:K) ratio (High and Low diets, respectively) were given to 17 astronauts before and during spaceflight. Each astronaut had 1 High and 1 Low diet session before flight and 2 High and 2 Low sessions during flight, in addition to a 4-d session around flight day 30 (FD30), when crew members were to consume their typical in-flight intake. At the end of each session, blood and urine samples were collected. Calcium, total protein, energy, and sodium were maintained in each crew member's preflight and in-flight controlled diets. Results Relative to preflight values, N-telopeptide (NTX) and urinary calcium were higher during flight, and bone-specific alkaline phosphatase (BSAP) was higher toward the end of flight. The High and Low diets did not affect NTX, BSAP, or urinary calcium. Dietary sulfur and age were significantly associated with changes in NTX. Dietary sodium and flight day were significantly associated with urinary calcium during flight. The net endogenous acid production (NEAP) estimated from the typical dietary intake at FD30 was associated with loss of bone mineral content in the lumbar spine after the mission. The results were compared with data from a 70-d bed rest study, in which control (but not exercising) subjects' APro:K was associated with higher NTX during bed rest. Conclusions Long-term lowering of NEAP by increasing vegetable and fruit intake may protect against changes in loss of bone mineral content during spaceflight when adequate calcium is consumed, particularly if resistive exercise is not being performed. This trial was registered at clinicaltrials.gov as NCT01713634.
Collapse
Affiliation(s)
- Sara R Zwart
- Universities Space Research Association, Houston, TX
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Barbara L Rice
- Enterprise Advisory Services, Inc., Houston, TX
- KBRwyle, Houston, TX
| | - Holly Dlouhy
- Enterprise Advisory Services, Inc., Houston, TX
- KBRwyle, Houston, TX
| | - Linda C Shackelford
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX
| | - Martina Heer
- Institute of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | | | - Scott M Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX
| |
Collapse
|
12
|
Goraya N, Simoni J, Sager LN, Pruszynski J, Wesson DE. Acid retention in chronic kidney disease is inversely related to GFR. Am J Physiol Renal Physiol 2018; 314:F985-F991. [PMID: 29357423 DOI: 10.1152/ajprenal.00463.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Greater H+ retention in animal models of chronic kidney disease (CKD) mediates faster glomerular filtration rate (GFR) decline and dietary H+ reduction slows eGFR decline in CKD patients with reduced eGFR and H+ retention due to the high acid (H+) diets of developed societies. We examined if H+ retention in CKD is inversely associated with estimated GFR (eGFR) using cross-sectional and longitudinal analysis of individuals with CKD stage 1 (>90 ml·min- 1·1.73 m-2), CKD stage 2 (60-89 ml/min per 1.73 m2), and CKD stage 3 (30-59 ml·min- 1·1.73 m-2) eGFR. H+ retention was assessed using the difference between observed and expected plasma total CO2 2 h after 0.5 meq/kg body wt oral NaHCO3. H+ retention was higher in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.02) at baseline and 5 yr, and was higher in CKD 2 vs. CKD 1 ( P < 0.01) at 10 yr. All groups had lower eGFR at subsequent time points ( P < 0.01) but H+ retention was not different among the three time points for CKD 1. By contrast, eGFR decrease was associated with higher H+ retention in CKD 2 at 5 yr ( P = 0.04) and 10 yr ( P < 0.01) and with higher H+ retention in CKD 3 at 5 yr ( P < 0.01). Yearly eGFR decline rate was faster in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.01). The data show that H+ retention is inversely associated with eGFR, with faster eGFR decline, and support the need for greater dietary H+ reduction therapy for CKD individuals with lower eGFR.
Collapse
Affiliation(s)
- Nimrit Goraya
- Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas.,Department of Internal Medicine, Baylor Scott & White Health, Temple, Texas
| | - Jan Simoni
- Department of Surgery, Texas Tech University Health Sciences Center , Lubbock, Texas
| | - Lauren N Sager
- Department of Biostatistics, Baylor Scott & White Health, Temple, Texas
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern , Dallas, Texas
| | - Donald E Wesson
- Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine , Dallas, Texas.,Baylor Scott & White Health and Wellness Center, Dallas, Texas
| |
Collapse
|
13
|
Lecocq M, Bernard C, Felix MS, Linares JM, Chaves-Jacob J, Decherchi P, Dousset E. Biocompatibility of Four Common Orthopedic Biomaterials Following a High-Salt Diet: An In Vivo Study. Int J Mol Sci 2017; 18:ijms18071489. [PMID: 28696371 PMCID: PMC5535979 DOI: 10.3390/ijms18071489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/03/2017] [Accepted: 07/08/2017] [Indexed: 01/13/2023] Open
Abstract
Nowadays, salt consumption appears to be drastically above the recommended level in industrialized countries. The health consequences of this overconsumption are heavy since high-salt intake induces cardiovascular disease, kidney dysfunction, and stroke. Moreover, harmful interaction may also occur with orthopaedic devices because overconsumption of salt reinforces the corrosive aspect of biological tissues and favors bone resorption process. In the present study, we aimed to assess the in vivo effect of three weeks of a high-salt diet, associated (or not) with two weeks of the neuro-myoelectrostimulation (NMES) rehabilitation program on the biocompatibility of four biomaterials used in the manufacture of arthroplasty implants. Thus, two non-metallic (PEEK and Al2O3) and two metallic (Ti6Al4V and CrCo) compounds were implanted in the rat tibial crest, and the implant-to-bone adhesion and cell viability of two surrounded muscles, the Flexor Digitorum (FD) and Tibialis Anterior (TA), were assessed at the end of the experiment. Results indicated lower adhesion strength for the PEEK implant compared to other biomaterials. An effect of NMES and a high-salt diet was only identified for Al2O3 and Ti6Al4V implants, respectively. Moreover, compared to a normal diet, a high-salt diet induced a higher number of dead cells on both muscles for all biomaterials, which was further increased for PEEK, Al2O3, and CrCo materials with NMES application. Finally, except for Ti6Al4V, NMES induced a higher number of dead cells in the directly stimulated muscle (FD) compared to the indirectly stimulated one (TA). This in vivo experiment highlights the potential harmful effect of a high-salt diet for people who have undergone arthroplasty, and a rehabilitation program based on NMES.
Collapse
Affiliation(s)
- Mathieu Lecocq
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Faculté des Sciences du Sport, CC910, 163, Avenue de Luminy, 13288 Marseille CEDEX 09, France.
| | - Cécile Bernard
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Faculté des Sciences du Sport, CC910, 163, Avenue de Luminy, 13288 Marseille CEDEX 09, France.
| | - Marie Solenne Felix
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Faculté des Sciences du Sport, CC910, 163, Avenue de Luminy, 13288 Marseille CEDEX 09, France.
| | - Jean-Marc Linares
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Conception Bio-Inspirée (CBI), IUT d'Aix-en-Provence 413, avenue Gaston Berger, 13625 Aix-en-Provence CEDEX, France.
| | - Julien Chaves-Jacob
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Conception Bio-Inspirée (CBI), IUT d'Aix-en-Provence 413, avenue Gaston Berger, 13625 Aix-en-Provence CEDEX, France.
| | - Patrick Decherchi
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Faculté des Sciences du Sport, CC910, 163, Avenue de Luminy, 13288 Marseille CEDEX 09, France.
| | - Erick Dousset
- Aix-Marseille Université, CNRS, Institut des Sciences du Mouvement: Etienne-Jules MAREY (UMR 7287), Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Faculté des Sciences du Sport, CC910, 163, Avenue de Luminy, 13288 Marseille CEDEX 09, France.
| |
Collapse
|
14
|
Schopen K, Ewald AC, Johannes BW, Bloch W, Rittweger J, Frings-Meuthen P. Short-Term Effects of Lupin vs. Whey Supplementation on Glucose and Insulin Responses to a Standardized Meal in a Randomized Cross-Over Trial. Front Physiol 2017; 8:198. [PMID: 28443026 PMCID: PMC5385353 DOI: 10.3389/fphys.2017.00198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/16/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Whey protein is known to reduce postprandial glycaemia in people with type 2 diabetes mellitus. Lupin as a vegetable source of protein could be considered as an alternative, as the percentage of vegetarian and vegan consumers is raising. The present study compares the acute glycemic effects of whey and lupin in healthy volunteers following a carbohydrate-rich reference meal. Methods In cross-over design, three standardized meals (reference meal; reference meal + whey; reference meal + lupin) were provided to 12 healthy male and female volunteers, aged between 23 and 33, in a balanced, randomized order. Volunteers' blood glucose and insulin concentrations were analyzed at baseline and at seven time points following the ingestion of the meals. Results: The supplementation of whey or lupin significantly blunted the postprandial increase in blood glucose concentrations compared to the reference meal (p < 0.001). In the overall statistical analysis, this effect was comparable for whey and lupin [Δ AUC whey-lupin = 8%, 0-60 min area under the curve (0-60 min AUC), p = 0.937], with a blunting effect of -46% by whey (p = 0.005, 0-60 min AUC) and of -54% by lupin (p < 0.001, 0-60 min AUC). When comparing whey and lupin data only, the insulin increase was found to be more pronounced for whey protein than for lupin supplementation (Δ AUC whey-lupin = 39%, 0-60 min AUC, p = 0.022). However, when comparing the insulin response of each supplementation to the one of the reference meal, no differences could be detected (whey p = 0.259, 0-60 min AUC; lupin p = 0.275, 0-60 min AUC). Conclusions: Results suggest that lupin and whey can both lower the increase of postprandial blood glucose concentrations to a comparable extent, implying the usability of lupin to reduce postprandial glycaemia. However, the insulin response following the supplementations to a carbohydrate-rich meal seems to differ for these two protein sources.
Collapse
Affiliation(s)
- Kathrin Schopen
- Department of Space Physiology, Institute of Aerospace Medicine, German Aerospace CenterCologne, Germany.,Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University CologneCologne, Germany
| | - Ann C Ewald
- Department of Space Physiology, Institute of Aerospace Medicine, German Aerospace CenterCologne, Germany
| | - Bernd W Johannes
- Department of Space Physiology, Institute of Aerospace Medicine, German Aerospace CenterCologne, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University CologneCologne, Germany
| | - Jörn Rittweger
- Department of Space Physiology, Institute of Aerospace Medicine, German Aerospace CenterCologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of CologneCologne, Germany
| | - Petra Frings-Meuthen
- Department of Space Physiology, Institute of Aerospace Medicine, German Aerospace CenterCologne, Germany
| |
Collapse
|
15
|
Zange J, Schopen K, Albracht K, Gerlach DA, Frings-Meuthen P, Maffiuletti NA, Bloch W, Rittweger J. Using the Hephaistos orthotic device to study countermeasure effectiveness of neuromuscular electrical stimulation and dietary lupin protein supplementation, a randomised controlled trial. PLoS One 2017; 12:e0171562. [PMID: 28207840 PMCID: PMC5313207 DOI: 10.1371/journal.pone.0171562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/16/2016] [Indexed: 01/10/2023] Open
Abstract
Purpose The present study investigated whether neuromuscular electrical stimulation for 20 min twice a day with an electrode placed over the soleus muscle and nutritional supplementation with 19 g of protein rich lupin seeds can reduce the loss in volume and strength of the human calf musculature during long term unloading by wearing an orthotic unloading device. Methods Thirteen healthy male subjects (age of 26.4 ± 3.7 years) wore a Hephaistos orthosis one leg for 60 days during all habitual activities. The leg side was randomly chosen for every subject. Six subjects only wore the orthosis as control group, and 7 subjects additionally received the countermeasure consisting of neuromuscular electrical stimulation of the soleus and lateral gastrocnemius muscles and lupin protein supplementation. Twenty-eight days before and on the penultimate day of the intervention cross-sectional images of the calf muscles were taken by magnetic resonance imaging (controls n = 5), and maximum voluntary torque (controls n = 6) of foot plantar flexion was estimated under isometric (extended knee, 90° knee flexion) and isokinetic conditions (extended knee), respectively. Results After 58 days of wearing the orthosis the percentage loss of volume in the entire triceps surae muscle of the control subjects (-11.9 ± 4.4%, mean ± standard deviation) was reduced by the countermeasure (-3.5 ± 7.2%, p = 0.032). Wearing the orthosis generally reduced plantar flexion torques values, however, only when testing isometric contraction at 90° knee ankle the countermeasure effected a significantly lower percentage decrease of torque (-9.7 ± 7.2%, mean ± SD) in comparison with controls (-22.3 ± 11.2%, p = 0.032). Conclusion Unloading of calf musculature by an orthotic device resulted in the expected loss of muscle volume and maximum of plantar flexion torque. Neuromuscular electrical muscle stimulation and lupin protein supplementation could significantly reduce the process of atrophy. Trial registration ClinicalTrials.gov, identifier NCT02698878
Collapse
Affiliation(s)
- Jochen Zange
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kathrin Schopen
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Kirsten Albracht
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Darius A. Gerlach
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Petra Frings-Meuthen
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | | | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Jörn Rittweger
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Paediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
- * E-mail:
| |
Collapse
|
16
|
Effects of Different Oral Doses of Sodium Chloride on the Basal Acid-Base and Mineral Status of Exercising Horses Fed Low Amounts of Hay. PLoS One 2017; 12:e0168325. [PMID: 28045916 PMCID: PMC5207637 DOI: 10.1371/journal.pone.0168325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022] Open
Abstract
The provision of NaCl, according to current recommendations, to horses in moderate work has been shown to induce immediate postprandial acidosis. The present study aimed to clarify whether this NaCl induced acidosis i) persists beyond the immediate postprandial period, and ii) is still present after a 2 week adaptation period. Six adult warmblood mares in moderate work received daily 1.00 kg hay per 100 kg body weight (bwt) only together with 0.64 kg unprocessed cereal grains/100 kg bwt.d as fed basis. Using a 3x3 Latin Square, either 0 (NaCl-0), 50 (NaCl-50) or 100 (NaCl-100) g NaCl/d were fed together with the concentrates in two equal doses for 3 weeks. During the final week, a mineral digestibility trial was undertaken. The middle sodium and chloride intake (NaCl-50) at least met the most common recommendations for moderate work. Morning (7:00 AM) urine and venous blood samples were collected on days 0, 1-4, 8, and 15, and analysed for pH, acid-base status, creatinine and electrolyte concentrations. Fractional electrolyte clearances (FC) were determined. Mean apparent sodium digestibility ranged between 60-62% whereas chloride digestibility was consistently above 94%. Supplementing 100 g but not 50 g of NaCl resulted in significant reduction of blood pH and base excess as well as urinary pH and urine acid excretion. Both 50 g and 100 g NaCl supplementation caused a significant reduction in base and net acid-base excretion, urine density and potassium concentration, but increased urine sodium concentration and the FC of sodium and chloride (P < 0.05). This suggests that a high proportion of the recommended salt doses is excreted renally. The above effects of NaCl supplementation persisted over the 2 week measurement period. Results suggest that feeding 100 g NaCl to moderately exercising horses results in mild metabolic acidosis, whereas feeding 50 g according to current recommendations resulted in compensated acidosis.
Collapse
|
17
|
Afsar B, Kiremit MC, Sag AA, Tarim K, Acar O, Esen T, Solak Y, Covic A, Kanbay M. The role of sodium intake in nephrolithiasis: epidemiology, pathogenesis, and future directions. Eur J Intern Med 2016; 35:16-19. [PMID: 27444735 DOI: 10.1016/j.ejim.2016.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/20/2016] [Accepted: 07/01/2016] [Indexed: 12/23/2022]
Abstract
The prevalence of nephrolithiasis has doubled over the last decade and the incidence in females now approaches that of males. Since dietary salt is lithogenic, a purported mechanism common to both genders is excess dietary sodium intake vis-a-vis processed and fast foods. Nephrolithiasis has far-reaching societal implications such as impact on gross domestic product due to days lost from work (stone disease commonly affects working adults), population-wide carcinogenic diagnostic and interventional radiation exposure (kidney stone disease is typically imaged with computed tomographic imaging and treated under imaging guidance and follow-up), and rising healthcare costs (surgical treatment will be indicated for a number of these patients). Therefore, primary prevention of kidney stone disease via dietary intervention is a low-cost public health initiative with massive societal implications. This primer aims to establish baseline epidemiologic and pathophysiologic principles to guide clinicians in sodium-directed primary prevention of kidney stone disease.
Collapse
Affiliation(s)
- Baris Afsar
- Division of Nephrology, Department of Medicine, Konya Numune State Hospital, Konya, Turkey
| | - Murat C Kiremit
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Interventional Radiology, Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Kayhan Tarim
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Yalcin Solak
- Department of Nephrology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
| |
Collapse
|
18
|
Rittweger J, Debevec T, Frings-Meuthen P, Lau P, Mittag U, Ganse B, Ferstl PG, Simpson EJ, Macdonald IA, Eiken O, Mekjavic IB. On the combined effects of normobaric hypoxia and bed rest upon bone and mineral metabolism: Results from the PlanHab study. Bone 2016; 91:130-8. [PMID: 27443510 DOI: 10.1016/j.bone.2016.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/10/2023]
Abstract
Bone losses are common as a consequence of unloading and also in patients with chronic obstructive pulmonary disease (COPD). Although hypoxia has been implicated as an important factor to drive bone loss, its interaction with unloading remains unresolved. The objective therefore was to assess whether human bone loss caused by unloading could be aggravated by chronic hypoxia. In a cross-over designed study, 14 healthy young men underwent 21-day interventions of bed rest in normoxia (NBR), bed rest in hypoxia (HBR), and hypoxic ambulatory confinement (HAmb). Hypoxic conditions were equivalent to 4000m altitude. Bone metabolism (NTX, P1NP, sclerostin, DKK1) and phospho-calcic homeostasis (calcium and phosphate serum levels and urinary excretion, PTH) were assessed from regular blood samples and 24-hour urine collections, and tibia and femur bone mineral content was assessed by peripheral quantitative computed tomography (pQCT). Urinary NTX excretion increased (P<0.001) to a similar extent in NBR and HBR (P=0.69) and P1NP serum levels decreased (P=0.0035) with likewise no difference between NBR and HBR (P=0.88). Serum total calcium was increased during bed rest by 0.059 (day D05, SE 0.05mM) to 0.091mM (day D21, P<0.001), with no additional effect by hypoxia during bed rest (P=0.199). HAmb led, at least temporally, to increased total serum calcium, to reduced serum phosphate, and to reduced phosphate and calcium excretion. In conclusion, hypoxia did not aggravate bed rest-induced bone resorption, but led to changes in phospho-calcic homeostasis likely caused by hyperventilation. Whether hyperventilation could have mitigated the effects of hypoxia in this study remains to be established.
Collapse
Affiliation(s)
- Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany; Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany.
| | - Tadej Debevec
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Bergita Ganse
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Philip G Ferstl
- Medizinische Klinik I, University of Frankfurt, Frankfurt, Germany
| | - Elizabeth J Simpson
- MRC/Arthritis UK Centre for Musculoskeletal Aging Research, University of Nottingham Medical School, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ian A Macdonald
- MRC/Arthritis UK Centre for Musculoskeletal Aging Research, University of Nottingham Medical School, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
19
|
Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
Collapse
Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
| |
Collapse
|
20
|
Buehlmeier J, Remer T, Frings-Meuthen P, Maser-Gluth C, Heer M. Glucocorticoid activity and metabolism with NaCl-induced low-grade metabolic acidosis and oral alkalization: results of two randomized controlled trials. Endocrine 2016; 52:139-47. [PMID: 26349936 DOI: 10.1007/s12020-015-0730-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/27/2015] [Indexed: 01/09/2023]
Abstract
Low-grade metabolic acidosis (LGMA), as induced by high dietary acid load or sodium chloride (NaCl) intake, has been shown to increase bone and protein catabolism. Underlying mechanisms are not fully understood, but from clinical metabolic acidosis interactions of acid-base balance with glucocorticoid (GC) metabolism are known. We aimed to investigate GC activity/metabolism under alkaline supplementation and NaCl-induced LGMA. Eight young, healthy, normal-weight men participated in two crossover designed interventional studies. In Study A, two 10-day high NaCl diet (32 g/d) periods were conducted, one supplemented with 90 mmol KHCO3/day. In Study B, participants received a high and a low NaCl diet (31 vs. 3 g/day), each for 14 days. During low NaCl, the diet was moderately acidified by replacement of a bicarbonate-rich mineral water (consumed during high NaCl) with a non-alkalizing drinking water. In repeatedly collected 24-h urine samples, potentially bioactive-free GCs (urinary-free cortisol + free cortisone) were analyzed, as well as tetrahydrocortisol (THF), 5α-THF, and tetrahydrocortisone (THE). With supplementation of 90 mmol KHCO3, the marker of total adrenal GC secretion (THF + 5α-THF + THE) dropped (p = 0.047) and potentially bioactive-free GCs were reduced (p = 0.003). In Study B, however, GC secretion and potentially bioactive-free GCs did not exhibit the expected fall with NaCl-reduction as net acid excretion was raised by 30 mEq/d. Diet-induced acidification/alkalization affects GC activity and metabolism, which in case of long-term ingestion of habitually acidifying western diets may constitute an independent risk factor for bone degradation and cardiometabolic diseases.
Collapse
Affiliation(s)
- Judith Buehlmeier
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany.
- Institute of Nutrition and Food Science, University of Bonn, Endenicher Straße 11-13, 53115, Bonn, Germany.
| | - Thomas Remer
- Department of Nutritional Epidemiology, DONALD Study Center at the Research Institute of Child Nutrition, University of Bonn, Heinstück 11, 44225, Dortmund, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Christiane Maser-Gluth
- Department of Pharmacology, University of Heidelberg, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - Martina Heer
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Institute of Nutrition and Food Science, University of Bonn, Endenicher Straße 11-13, 53115, Bonn, Germany
| |
Collapse
|
21
|
Bloomfield SA, Martinez DA, Boudreaux RD, Mantri AV. Microgravity Stress: Bone and Connective Tissue. Compr Physiol 2016; 6:645-86. [PMID: 27065165 DOI: 10.1002/cphy.c130027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The major alterations in bone and the dense connective tissues in humans and animals exposed to microgravity illustrate the dependency of these tissues' function on normal gravitational loading. Whether these alterations depend solely on the reduced mechanical loading of zero g or are compounded by fluid shifts, altered tissue blood flow, radiation exposure, and altered nutritional status is not yet well defined. Changes in the dense connective tissues and intervertebral disks are generally smaller in magnitude but occur more rapidly than those in mineralized bone with transitions to 0 g and during recovery once back to the loading provided by 1 g conditions. However, joint injuries are projected to occur much more often than the more catastrophic bone fracture during exploration class missions, so protecting the integrity of both tissues is important. This review focuses on the research performed over the last 20 years in humans and animals exposed to actual spaceflight, as well as on knowledge gained from pertinent ground-based models such as bed rest in humans and hindlimb unloading in rodents. Significant progress has been made in our understanding of the mechanisms for alterations in bone and connective tissues with exposure to microgravity, but intriguing questions remain to be solved, particularly with reference to biomedical risks associated with prolonged exploration missions.
Collapse
Affiliation(s)
- Susan A Bloomfield
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Daniel A Martinez
- Department of Mechanical Engineering, University of Houston, Houston, Texas, USA
| | - Ramon D Boudreaux
- Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Anita V Mantri
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA.,Health Science Center School of Medicine, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
22
|
Titanium Implant Impairment and Surrounding Muscle Cell Death Following High-Salt Diet: An In Vivo Study. PLoS One 2016; 11:e0146873. [PMID: 26761710 PMCID: PMC4711999 DOI: 10.1371/journal.pone.0146873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/25/2015] [Indexed: 12/04/2022] Open
Abstract
Aim of the study High-salt consumption has been widely described as a risk factor for cardiovascular, renal and bone functions. In the present study, the extent to which high-salt diet could influence Ti6Al4V implant surface characteristic, its adhesion to rat tibial crest, and could modify muscle cell viability of two surrounding muscles, was investigated in vivo. These parameters have also been assessed following a NMES (neuro-myoelectrostimulation) program similar to that currently used in human care following arthroplasty. Results After a three-week diet, a harmful effect on titanium implant surface and muscle cell viability was noted. This is probably due to salt corrosive effect on metal and then release of toxic substance around biologic tissue. Moreover, if the use of NMES with high-salt diet induced muscles damages, the latter were higher when implant was added. Unexpectedly, higher implant-to-bone adhesion was found for implanted animals receiving salt supplementation. Conclusion Our in vivo study highlights the potential dangerous effect of high-salt diet in arthroplasty based on titanium prosthesis. This effect appears to be more important when high-salt diet is combined with NMES.
Collapse
|
23
|
Smith S, Abrams S, Davis-Street J, Heer M, O'Brien K, Wastney M, Zwart S. Fifty Years of Human Space Travel: Implications for Bone and Calcium Research. Annu Rev Nutr 2014; 34:377-400. [DOI: 10.1146/annurev-nutr-071813-105440] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S.M. Smith
- Biomedical Research and Environmental Sciences Division, NASA Lyndon B. Johnson Space Center, Houston, Texas 77058;
| | - S.A. Abrams
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030;
| | - J.E. Davis-Street
- Chevron Services Company, Corporate Health and Medical, Houston, Texas 77002;
| | - M. Heer
- Profil, 41460 Neuss, Germany;
- University of Bonn, Department of Nutrition and Food Science, Nutrition Physiology, 53115 Bonn, Germany
| | - K.O. O'Brien
- Cornell University, Division of Nutritional Sciences, Ithaca, New York 14853;
| | - M.E. Wastney
- Metabolic Modeling Services, West Lafayette, Indiana 47906;
| | - S.R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, Texas 77058;
| |
Collapse
|
24
|
Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T. Salt and nephrolithiasis. Nephrol Dial Transplant 2014; 31:39-45. [PMID: 25031016 DOI: 10.1093/ndt/gfu243] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/18/2014] [Indexed: 12/17/2022] Open
Abstract
Dietary sodium chloride intake is nowadays globally known as one of the major threats for cardiovascular health. However, there is also important evidence that it may influence idiopathic calcium nephrolithiasis onset and recurrence. Higher salt intake has been associated with hypercalciuria and hypocitraturia, which are major risk factors for calcium stone formation. Dietary salt restriction can be an effective means for secondary prevention of nephrolithiasis as well. Thus in this paper, we review the complex relationship between salt and nephrolithiasis, pointing out the difference between dietary sodium and salt intake and the best methods to assess them, highlighting the main findings of epidemiologic, laboratory and intervention studies and focusing on open issues such as the role of dietary salt in secondary causes of nephrolithiasis.
Collapse
Affiliation(s)
- Andrea Ticinesi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Loris Borghi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Tiziana Meschi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| |
Collapse
|
25
|
Dahl C, Søgaard AJ, Tell GS, Flaten TP, Krogh T, Aamodt G. Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway. Osteoporos Int 2013; 24:541-51. [PMID: 22569744 DOI: 10.1007/s00198-012-1989-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
SUMMARY Compared to pH ≥7.0 in Norwegian municipal drinking water, pH <7.0 increased the risk of forearm fractures in the population-based Cohort of Norway (CONOR; n = 127,272). The association was attenuated (p > 0.05) after adjustments for indicators of bacteria and organic matter, which may signify an association between poor drinking water and bone health. INTRODUCTION The Norwegian population has the highest rate of fractures ever reported. A large variation in fracture rate both between and within countries indicates that an environmental factor, such as the quality of drinking water, could be one of the causes of the disparities. Our aim was to investigate a possible association between pH (an important parameter for water quality) and self-reported forearm fracture and to examine whether other water quality factors could account for this association. METHODS Using Geographic Information Systems, information on the quality of drinking water was linked to CONOR (n = 127,272; mean age, 50.2 ± 15.8 years), a database comprising ten regional epidemiological health surveys from across the country in the time period 1994-2003. RESULTS The highest risk of forearm fracture was found at a pH of around 6.75, with a decreasing risk toward both higher and lower pH values. The increased adjusted odds of forearm fracture in men consuming municipal drinking water with pH <7.0 compared to water with pH ≥7.0 was odds ratio (OR) = 1.19 (95 % CI, 1.14, 1.25), and the corresponding increased odds in women was OR = 1.14 (95 % CI, 1.08, 1.19). This association was attenuated (p > 0.05) after further adjustments for other water quality factors (color grade, intestinal enterococci, and Clostridium perfringens). CONCLUSIONS Our findings indicate a higher risk of fracture when consuming water of an acidic pH; however, the risk does not only seem to be due to the acidity level per se, but also to other aspects of water quality associated with pH.
Collapse
Affiliation(s)
- C Dahl
- Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
26
|
Smith S, Rice B, Dlouhy H, Zwart S. Assessment of Nutritional Intake During Space Flight and Space Flight Analogs. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.profoo.2013.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
27
|
Smith SM, McCoy T, Gazda D, Morgan JLL, Heer M, Zwart SR. Space flight calcium: implications for astronaut health, spacecraft operations, and Earth. Nutrients 2012; 4:2047-68. [PMID: 23250146 PMCID: PMC3546622 DOI: 10.3390/nu4122047] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/13/2012] [Accepted: 12/10/2012] [Indexed: 11/21/2022] Open
Abstract
The space flight environment is known to induce bone loss and, subsequently, calcium loss. The longer the mission, generally the more bone and calcium are lost. This review provides a history of bone and calcium studies related to space flight and highlights issues related to calcium excretion that the space program must consider so that urine can be recycled. It also discusses a novel technique using natural stable isotopes of calcium that will be helpful in the future to determine calcium and bone balance during space flight.
Collapse
Affiliation(s)
- Scott M. Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Torin McCoy
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Daniel Gazda
- Wyle Science, Technology & Engineering Group, Houston, TX 77058, USA; E-Mail:
| | - Jennifer L. L. Morgan
- Oak Ridge Associated Universities/NASA Post-Doctoral Fellow, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Martina Heer
- Profil, 41460 Neuss, Germany; E-Mail:
- University of Bonn, 53115 Bonn, Germany
| | - Sara R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, TX 77058, USA; E-Mail:
| |
Collapse
|
28
|
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.
Collapse
Affiliation(s)
- Judith Buehlmeier
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Linder Hoehe, 51147 Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
29
|
No evidence that the skeletal non-response to potassium alkali supplements in healthy postmenopausal women depends on blood pressure or sodium chloride intake. Eur J Clin Nutr 2012; 66:1315-22. [PMID: 23093337 DOI: 10.1038/ejcn.2012.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES In vitro studies demonstrate that bone is degraded in an acidic environment due to chemical reactions and through effects on bone cells. Clinical evidence is insufficient to unequivocally resolve whether the diet net acid or base load bone affects breakdown in humans. Increasing dietary salt (sodium chloride, NaCl) mildly increases blood acidity in humans and in rats with increased sensitivity to the blood pressure effects of salt, whereas increased potassium (K) intake can decrease blood pressure. Blood pressure responses to NaCl or K may potentially be a marker for increased bone turnover or lower bone mineral density (BMD) in women at higher risk for osteoporosis and fracture. SUBJECTS/METHODS We retrospectively analysed data from two data sets (California and NE Scotland) of postmenopausal women (n=266) enrolled in long-term randomized, placebo-controlled studies of the effects of administration of low- or high-dose dietary K alkali supplementation on bone turnover in relation to sodium or chloride excretion (a marker of dietary salt intake). Mean arterial pressure (MAP) was calculated from blood pressure measures, MAP was divided into tertiles and its influence on the effect of dietary NaCl and K alkali supplementation on deoxypyridinoline markers of bone resorption and BMD by DEXA was tested. Data was analysed for each data set separately and then combined. RESULTS Percentage change in BMD after 24 months was less for California compared with North East Scotland (hip: -0.6 ± 2.8% and -1.5 ± 2.4%, respectively (P=0.027); spine: -0.5 ± 3.4% and -2.6 ± 3.5%, (P<0.001). We found no effect of dietary alkali treatment on BMD change or bone resorption for either centre. Adjusting for the possible calcium- or potassium-lowering effects on blood pressure did not alter the results. CONCLUSIONS Blood pressure responses to Na, Cl or K intake did not help predict a BMD response to diet alkali therapy.
Collapse
|
30
|
Frings-Meuthen P, Buehlmeier J, Baecker N, Stehle P, Fimmers R, May F, Kluge G, Heer M. High sodium chloride intake exacerbates immobilization-induced bone resorption and protein losses. J Appl Physiol (1985) 2011; 111:537-42. [DOI: 10.1152/japplphysiol.00454.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We examined, in immobilization, the effect of a diet high in sodium chloride (NaCl) on bone markers, nitrogen balance, and acid-base status. Eight healthy male test subjects participated in a 14-day head-down-tilt bed rest (HDBR) study. During the bed rest period they received, in a randomized crossover design, a high (7.7 meq Na+/kg body wt per day) and a low (0.7 meq Na+/kg body wt per day) NaCl diet. As expected, 24-h excretion of urinary calcium was significantly greater in the high-NaCl-intake HDBR phase than in the low-NaCl-intake HDBR phase ( P < 0.001). High NaCl intake caused a 43–50% greater excretion of the bone resorption markers COOH- (CTX) and NH2- (NTX) terminal telopeptide of type I collagen in HDBR than low NaCl in HDBR (CTX/NTX: P < 0.001). Serum concentrations of the bone formation markers bone-specific alkaline phosphatase (bAP) and NH2-terminal propeptide of type I procollagen (PINP) were identical in both NaCl intake phases. High NaCl intake led to a more negative nitrogen balance in HDBR ( P < 0.001). Changes were accompanied by increased serum chloride concentration ( P = 0.008), reduced blood bicarbonate ( P = 0.017), and base excess ( P = 0.009) whereas net acid excretion was lower during high than during low NaCl intake in immobilization ( P < 0.001). High NaCl intake during immobilization exacerbates disuse-induced bone and muscle loss by causing further protein wasting and an increase in bone resorption. Changes in the acid-base status, mainly caused by disturbances in electrolyte metabolism, seem to determine NaCl-induced degradation processes.
Collapse
Affiliation(s)
| | - Judith Buehlmeier
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne
| | - Natalie Baecker
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne
| | - Peter Stehle
- University of Bonn, Department of Nutrition and Food Science, Bonn; and
| | - Rolf Fimmers
- University of Bonn, Institute for Medical Biometry, Informatics and Epidemiology, Bonn, Germany
| | - Francisca May
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne
| | - Goetz Kluge
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne
| | - Martina Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne
| |
Collapse
|
31
|
Abstract
Nephrolithiasis remains a formidable health problem in the United States and worldwide. A very important but underaddressed area in nephrolithiasis is the accompanying bone disease. Epidemiologic studies have shown that osteoporotic fractures occur more frequently in patients with nephrolithiasis than in the general population. Decreased bone mineral density and defects in bone remodeling are commonly encountered in patients with calcium nephrolithiasis. The pathophysiologic connection of bone defects to kidney stones is unknown. Hypercalciuria and hypocitraturia are two important risk factors for stone disease, and treatments with thiazide diuretics and alkali, respectively, have been shown to be useful in preventing stone recurrence in small prospective trials. However, no studies have examined the efficacy of these agents or other therapies in preventing continued bone loss in calcium stone formers. This manuscript reviews the epidemiology, pathophysiology, and potential treatments of bone disease in patients with nephrolithiasis.
Collapse
|
32
|
Arnett TR. Acidosis, hypoxia and bone. Arch Biochem Biophys 2010; 503:103-9. [PMID: 20655868 DOI: 10.1016/j.abb.2010.07.021] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/17/2010] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
Abstract
Bone homeostasis is profoundly affected by local pH and oxygen tension. It has long been recognised that the skeleton contains a large reserve of alkaline mineral (hydroxyapatite), which is ultimately available to neutralise metabolic H(+) if acid-base balance is not maintained within narrow limits. Bone cells are extremely sensitive to the direct effects of pH: acidosis inhibits mineral deposition by osteoblasts but it activates osteoclasts to resorb bone and other mineralised tissues. These reciprocal responses act to maximise the availability of OH(-) ions from hydroxyapatite in solution, where they can buffer excess H(+). The mechanisms by which bone cells sense small pH changes are likely to be complex, involving ion channels and receptors in the cell membrane, as well as direct intracellular effects. The importance of oxygen tension in the skeleton has also long been known. Recent work shows that hypoxia blocks the growth and differentiation of osteoblasts (and thus bone formation), whilst strongly stimulating osteoclast formation (and thus bone resorption). Surprisingly, the resorptive function of osteoclasts is unimpaired in hypoxia. In vivo, tissue hypoxia is usually accompanied by acidosis due to reduced vascular perfusion and increased glycolytic metabolism. Thus, disruption of the blood supply can engender a multiple negative impact on bone via the direct actions of reduced pO(2) and pH on bone cells. These observations may contribute to our understanding of the bone disturbances that occur in numerous settings, including ageing, inflammation, fractures, tumours, anaemias, kidney disease, diabetes, respiratory disease and smoking.
Collapse
Affiliation(s)
- Timothy R Arnett
- Department of Cell & Developmental Biology, University College London, London WC1E 6BT, UK.
| |
Collapse
|
33
|
Higher habitual sodium intake is not detrimental for bones in older women with adequate calcium intake. Eur J Appl Physiol 2010; 109:745-55. [PMID: 20217116 DOI: 10.1007/s00421-010-1412-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
Based on the calciuric effect of sodium (Na), it has been speculated, although not proven, that higher Na intake might have a detrimental effect on bone health. The objective was to determine the relationship between Na intake (expressed as urinary Na) and bone mineral density/content (BMD/BMC) during a 3-year study. Participants were healthy, postmenopausal, Caucasian women (n = 136 at baseline) with no medications affecting bone. After baseline screening, half were instructed to reduce sodium intake to approximately 1,500 mg/day (intervention). The other half remained on habitual intake of approximately 3,000 mg/day (control). All subjects were given calcium and vitamin D supplements to achieve recommended levels. Anthropometries, densitometry, blood and 24-h urine analyses, and dietary and activity records were assessed every 6 months. Data were analyzed as a continuum, irrespective of the initial assignment to a control or intervention group, using random effects regressions with repeated measures analysis of variance to examine changes over time. Results showed that subjects with higher Na intake had higher BMD in the forearm and spine at baseline and all subsequent time-points (p < 0.01). In the forearm, time and higher urinary calcium modified results, producing a curvilinear decrease in BMD (p < 0.01). In the spine, more active individuals had higher BMD at all time-points. We conclude that higher sodium intake, within the range consumed, had a positive effect on some skeletal sites and no adverse effect on bone in women who had adequate calcium and vitamin D intake.
Collapse
|
34
|
Doyle ME, Glass KA. Sodium Reduction and Its Effect on Food Safety, Food Quality, and Human Health. Compr Rev Food Sci Food Saf 2010; 9:44-56. [DOI: 10.1111/j.1541-4337.2009.00096.x] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
35
|
Abstract
The concept of diet-induced ‘acidosis’ as a cause of disease has been a subject of interest for more than a century. The present article reviews the history of our evolving understanding of physiological pH, the physiological support for the concept of ‘acidosis’, the causes of acidosis, how it is recognised, its short-term effects as well as the long-term clinical relevance of preventative measures, and the research support for normalisation of pH. Further, we suggest differentiation of the terms ‘acidosis’ and ‘acidaemia’ as a way to resolve the conflation of these topics which has led to confusion and controversy. The available research makes a compelling case that diet-induced acidosis, not diet-induced acidaemia, is a real phenomenon, and has a significant, clinical, long-term pathophysiological effect that should be recognised and potentially counterbalanced by dietary means.
Collapse
|