Association between Dietary Carotenoid Intake and Bone Mineral Density in Korean Adults Aged 30-75 Years Using Data from the Fourth and Fifth Korean National Health and Nutrition Examination Surveys (2008-2011)

The potential of Pavlovophyceae species as a source of valuable carotenoids and polyunsaturated fatty acids for human consumption

Microalgae are a group of microorganisms, mostly photoautotrophs with high CO2 fixation capacity, that have gained increased attention in the last decades due to their ability to produce a wide range of valuable metabolites, such as carotenoids and polyunsaturated fatty acids, for application in food/feed, pharmaceutical, and cosmeceutical industries. Their increasing relevance has highlighted the importance of identifying and culturing new bioactive-rich microalgae species, as well as of a thorough understanding of the growth conditions to optimize the biomass production and master the biochemical composition according to the desired application. Thus, this review intends to describe the main cell processes behind the production of carotenoids and polyunsaturated fatty acids, in order to understand the possible main triggers responsible for the accumulation of those biocompounds. Their economic value and the biological relevance for human consumption are also summarized. In addition, an extensive review of the impact of culture conditions on microalgae growth performance and their biochemical composition is presented, focusing mainly on the studies involving Pavlovophyceae species. A complementary description of the biochemical composition of these microalgae is also presented, highlighting their potential applications as a promising bioresource of compounds for large-scale production and human and animal consumption.

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

Introduction

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

Methods

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

Results

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

Discussion

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

Positive relation between dietary inflammatory index and osteoporosis in postmenopausal women

Background: Previous studies have shown that some dietary components may be implicated in the aetiology of postmenopausal osteoporosis. Objective: We examined the relationship between Dietary Inflammatory Index (DII®) and osteoporosis in postmenopausal women. Study design: Eight hundred and fifty postmenopausal women aged 50-65 years were randomly selected from 87 health care centers. Bone mineral density (BMD) was measured using the anterior-posterior lumbar spine (L1-L4) and proximal femur neck through Hologic QDR 4500W (S/N 50266) dual-energy X-ray absorptiometry device. After checking inclusion and exclusion criteria and diagnosis of osteoporosis, 124 women with normal bone mineral density (normal-BMD) and 108 women with osteoporosis were selected. Demographic, anthropometric, physical activity, midwifery, and dietary intake questionnaires were completed. DII was calculated based on a valid and reliable 168-item semi-quantitative food frequency questionnaire using 37 (out of 45) food parameters. A Logistic regression model adjusted for confounders was applied to estimate osteoporosis's odds ratio (OR) based on modeling DII as a continuous and dichotomous variable. Results: In this study, DII scores ranged from -3.71 (the most anti-inflammatory score) to +4.16 (the most pro-inflammatory score). The median DII value among the osteoporosis group was 0.97, among the normal group it was -0.31, indicating a more pro-inflammatory diet for osteoporosis. There were positive associations between osteoporosis and DII based on both continuous (Adjusted OR=3.467, 95% confidence interval (CI): 2.280-5.272, P-value<0.001) and dichotomous (Adjusted OR: DII ≤-0.31 / >-0.31=0.248, 95% CI: 0.110-0.561, P-value=0.001) measures in modeling adjusted for age, BMI, post-menopausal years, parity, education, total energy intake, and physical activity. Conclusions: These data suggest a pro-inflammatory diet, as indicated by increasing the DII score, may be a risk factor for osteoporosis in postmenopausal Iranian women.

The role of carotenoids in bone health-A narrative review

Osteoporosis constitutes a serious challenge for public health. Dietary patterns belong to important, modifiable risk factors of this disease. Therefore, what and in what quantities we consume on a daily basis are extremely relevant. It is commonly known that bone health is positively affected by vitamins (e.g., vitamin D and vitamin K) as well as mineral components (e.g., calcium and magnesium). However, the human diet consists of many other groups of compounds that exhibit a potential antiosteoporotic and supporting bone-building effect. These dietary components include carotenoids. This paper presents a broad review of studies on the influence of particular carotenoids (β-carotene, lutein, zeaxanthin, β-cryptoxanthin, and lycopene) on bones. The paper discusses up-to-date in vitro experiments and research on animal models and presents how the results translate into clinical effect in humans.

Intake of dietary flavonoids in relation to bone loss among U.S. adults: a promising strategy for improving bone health

Dietary flavonoids have been recommended for improving bone health due to their antioxidant, anti-inflammatory and osteogenic properties. However, the effectiveness of each flavonoid subclass in the prevention and treatment of osteoporosis remains controversial. The objective of the current study was to examine the association between the intake of flavonoid subclasses and bone loss in 10 480 U.S. adults in the National Health and Nutrition Examination Survey. We employed a multinomial logistic regression model to calculate the odds ratios (OR) and 95% confidence intervals (95% CI). The intake of flavones, isoflavones, and flavanones was beneficially associated with osteoporosis (ORQ5 vs. Q1 = 0.44; 95% CI: 0.30-0.64 for flavones; ORQ5 vs. Q1 = 0.53; 95% CI: 0.37-0.77 for isoflavones; ORQ5 vs. Q1 = 0.66; 95% CI: 0.45-0.97 for flavanones). A higher intake of flavones and flavanones was significantly associated with a lower risk of bone loss at the femoral neck rather than the lumbar spine. Notably, stratified analysis showed that genistein had a harmful association with osteopenia in the population with lower serum calcium levels, whereas it had a beneficial association with osteoporosis in the population with higher serum calcium levels. Multiple sensitivity analyses were performed to test the robustness of the results, including subgroup analysis, exclusion of individuals' use of anti-osteoporosis, corticosteroid, and estrogenic medications, adjusting more potential confounders and calculation of the E-value. Overall, incorporating this modifiable diet into an individual's lifestyle could provide potential possibilities to prevent and ameliorate osteoporosis.

Bone mineral density is associated with composite dietary antioxidant index among US adults: results from NHANES

This cross-sectional study investigated the relationship between composite dietary antioxidant index (CDAI) and individual dietary antioxidant intakes, including vitamins A, C, and E, zinc, selenium, and carotenoids, and bone mineral density (BMD) in the US population aged 20 years older. We found a positive correlation between CDAI and femoral BMD. Moreover, higher intakes of vitamin C, vitamin E, selenium, zinc, and carotenoids were associated with higher femoral BMD.

INTRODUCTION

While individual dietary antioxidants have shown beneficial effects on bone metabolism, the diverse and potentially interacting nature of dietary components may limit the accuracy of evaluating their impact on bone health. Thus, this study aims to investigate the association between CDAI and BMD. Additionally, we explore the relationship between the intake of individual components of the CDAI and BMD.

METHODS

The CDAI is a novel index evaluating total dietary antioxidant intake, considering vitamins A, C, and E, zinc, selenium, and carotenoids. A cross-sectional analysis was conducted using data from participants aged ≥ 20 in the National Health and Nutrition Examination Survey (2005-2010, 2013-2014, and 2017-2018). We utilized multivariate linear regression models to examine the relationship between CDAI, individual dietary antioxidants, including vitamins A, C, and E, zinc, selenium, carotenoids, and femoral BMD.

RESULTS

The final analysis included 10,584 participants with a mean age of 50.73 ± 16.65 years. After multivariate adjustment, the second to fourth quartiles of CDAI (- 2.00-0.04, 0.04-2.54, and 2.54-70.78) exhibited higher femoral BMD compared to the first quartile of CADI (- 7.34 to - 2.00). Multiple regression analysis revealed that higher intakes of vitamin C, vitamin E, selenium, zinc, and carotenoids were associated with higher femoral BMD.

CONCLUSIONS

CDAI serves as a comprehensive tool for evaluating the overall antioxidant capacity of antioxidants in diets. Additionally, our study shows a positive correlation between CDAI and BMD, which indicates that the combined intake of dietary antioxidants may help reduce the risk of osteoporosis in adults.

Comprehensive Update on Carotenoid Colorants from Plants and Microalgae: Challenges and Advances from Research Laboratories to Industry

The substitution of synthetic food dyes with natural colorants continues to be assiduously pursued. The current list of natural carotenoid colorants consists of plant-derived annatto (bixin and norbixin), paprika (capsanthin and capsorubin), saffron (crocin), tomato and gac fruit lycopene, marigold lutein, and red palm oil (α- and β-carotene), along with microalgal Dunaliella β-carotene and Haematococcus astaxanthin and fungal Blakeslea trispora β-carotene and lycopene. Potential microalgal sources are being sought, especially in relation to lutein, for which commercial plant sources are lacking. Research efforts, manifested in numerous reviews and research papers published in the last decade, have been directed to green extraction, microencapsulation/nanoencapsulation, and valorization of processing by-products. Extraction is shifting from conventional extraction with organic solvents to supercritical CO2 extraction and different types of assisted extraction. Initially intended for the stabilization of the highly degradable carotenoids, additional benefits of encapsulation have been demonstrated, especially the improvement of carotenoid solubility and bioavailability. Instead of searching for new higher plant sources, enormous effort has been directed to the utilization of by-products of the fruit and vegetable processing industry, with the application of biorefinery and circular economy concepts. Amidst enormous research activities, however, the gap between research and industrial implementation remains wide.

The role of hypertension in bone mineral density among males older than 50 years and postmenopausal females: evidence from the US National Health and Nutrition Examination Survey, 2005-2010

Background

Hypertension is a significant chronic disease that has been linked with bone mineral density (BMD) in various studies. However, the conclusions are contradictory. The purpose of our study was to identify the bone mineral density (BMD) of postmenopausal females and males older than 50 years with hypertension.

Methods

This cross-sectional study of 4,306 participants from the 2005-2010 US National Health and Nutrition Examination Survey explored the relationship between BMD and hypertension. Participants who had a mean systolic blood pressure (SBP) ≥140 mmHg, or a mean diastolic blood pressure (DBP) ≥90 mmHg, or were taking any prescribed medicine for high blood pressure were defined as having hypertension. BMD values were measured at the femoral neck and lumbar vertebrae as the primary outcome. Weight general linear model was used to describe the status of BMD in patients with hypertension. Weighted multivariate regression analysis was conducted to demonstrate the association between hypertension and BMD. Weighted restricted cubic spline (RCS) was used to assess the relationship between BMD and SBP and DBP.

Results

Our study found that there was a positive association between hypertension and lumbar BMD and the lumbar BMD was significantly higher in the presence of hypertension than in the control group in both males (1.072 vs. 1.047 g/cm²) and females (0.967 vs. 0.938 g/cm²; both p < 0.05), but a similar pattern was not found in the femoral neck. Meanwhile, lumbar BMD was positively associated with SBP and negatively associated with DBP both in males and females. The prevalence of low bone mass and osteoporosis at the lumbar vertebrae was lower in male patients with hypertension than in the control group. However, no difference was observed among postmenopausal females between the hypertension and control groups.

Conclusions

Hypertension was associated with higher BMD at the lumbar vertebrae in both males older than 50 years and postmenopausal females.

Associations between blood antioxidant levels and femoral neck strength

BACKGROUND

Studies have confirmed that antioxidants contribute to a lower risk of osteoporosis, which is an independent factor for femoral neck fracture (FNF). However, the associations between blood antioxidant levels and femoral neck strength remain unclear.

OBJECTIVE

Our aim was to test the hypothesis that levels of blood antioxidants are positively associated with composite indices of bone strength in femoral neck, which integrate the bending strength index (BSI), compressive strength index (CSI), and impact strength index (ISI), in a population of middle-aged and elderly individuals.

METHODS

This cross-sectional study utilized data from the Midlife in the United States (MIDUS) study. Blood levels of antioxidants were measured and analyzed.

RESULTS

In total, data from 878 participants were analyzed. Results of Spearman correlation analyses indicated that blood levels of 6 antioxidants (total lutein, zeaxanthin, alpha-carotene, 13-cis-beta-carotene, trans-beta-carotene and total lycopene) were positively associated with CSI, BSI, or ISI in middle-aged and elderly individuals. Conversely, blood gamma-tocopherol and alpha-tocopherol levels were negatively associated with CSI, BSI, or ISI scores. Furthermore, linear regression analyses suggested that only blood zeaxanthin levels remained positively associated with CSI (odds ratio, OR 1.27; 95% CI: 0.03, 2.50; p = 0.045), BSI (OR, 0.54; 95% CI: 0.03-1.06; p = 0.037), and ISI (OR, 0.06; 95% CI: 0.00, 0.13; p = 0.045) scores in the study population after adjusting for age and sex.

CONCLUSIONS

Our results indicated that elevated blood zeaxanthin levels were significantly and positively associated with femoral neck strength (CSI, BSI, or ISI) in a population of middle-aged and elderly individuals. These findings suggest that zeaxanthin supplementation may reduce FNF risk independently.

Energy Balance and Bone Health: a Nutrient Availability Perspective

PURPOSE OF REVIEW

Obesity is highly prevalent and is associated with bone fragility and fracture. The changing nutrient availability to bone in obesity is an important facet of bone health. The goal of this article is to summarize current knowledge on the effects of carbohydrate and dietary fat availability on bone, particularly in the context of other tissues.

RECENT FINDINGS

The skeleton is a primary site for fatty acid and glucose uptake. The trafficking of carbohydrates and fats into tissues changes with weight loss and periods of weight gain. Exercise acutely influences nutrient uptake into bone and may affect nutrient partitioning to bone. Bone cells secrete hormones that signal to the brain and other tissues information about its energetic state, which may alter whole-body nutrient trafficking. There is a critical need for studies to address the changes that metabolic perturbations have on nutrient availability in bone.

Composite dietary antioxidant index negatively correlates with osteoporosis among middle-aged and older US populations

OBJECTIVE

To assess whether the composite dietary antioxidant index (CDAI) is associated with osteoporosis (OP) in middle-aged and older US populations.

METHODS

We conducted a cross-sectional survey and identified individuals aged 40-85 years (n=11,664) from secondary datasets from the 2007-2010, 2013-2014, and 2017-2018 National Health and Nutrition Examination Survey (NHANES). Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD), and OP was defined as a BMD T-score ≤-2.5 at the femoral neck or lumbar spine. The CDAI score was calculated based on dietary data from the first NHANES 24-hour dietary recall. Multivariate logistic regression models were used to evaluate the association between CDAI and OP.

RESULTS

Among the 11,664 participants, the average age was 60.3 (11.8), 5,898 (50.6%) were female, and 925 (7.9%) had OP. The median CDAI was -2.0 (interquartile range, -6.9 to 4.2). After adjusting for age, sex, race, family income, body mass index, physical activity, calorie intake, estimated glomerular filtration rate, smoking and drinking status, hypertension, and diabetes, the CDAI was associated with OP (odds ratio (OR), 0.98; 95% CI: 0.96-0.99). Participants in the highest CDAI quantile were at low risk of osteoporosis (OR, 0.61; 95% CI: 0.44-0.85) versus those in the lowest quantile. Moreover, this association was stable in the subgroup and sensitivity analyses.

CONCLUSION

Dietary antioxidant ability assessed by using the CDAI was inversely associated with OP among US adults aged 40-85 years.

The effects of β-carotene on osteoporosis: a systematic review and meta-analysis of observational studies

PURPOSE

The aim is to evaluate the effect of β-carotene for osteoporosis and provide quantitative evidence.

METHOD

PubMed, Embase, Web of Science, and Cochrane Library were searched for eligible studies. Fifteen studies were included. Random-effect model was applied to pool the odds ratio (OR). The risk of osteoporosis and fracture were compared between low β-carotene intake group and high β-carotene intake group.

RESULT

The intake of β-carotene was unassociated with the overall risk of osteoporosis [OR = 0.733, 95% Cl (0.528, 1.018), p = 0.064]. Subgroup analysis showed that the intake of β-carotene was negatively associated with the risk of osteoporosis in both male subgroup [OR = 0.7, 95% Cl (0.549, 0.893), I² = 40.40%, p = 0.004] and female subgroup [OR = 0.684, 95% Cl (0.487, 0.960), I² = 86.40%, p = 0.028]. There was also a negative association between β-carotene intake and osteoporosis in Asia subgroup [OR = 0.512, 95% Cl (0.403, 0.650), I² = 0.00%, p = 0], whereas no association was observed in Western subgroup [OR = 1.107, 95% Cl (0.908, 1.350), I² = 2.30%, p = 0.314]. In addition, random-effect model was adopted to pool the standard mean difference (SMD), and the results showed that β-carotene intake was positively associated with overall bone mineral density (BMD) [SMD =  - 0.213, 95% Cl (- 0.391, - 0.034), I² = 87.30%, p = 0.019]. Subgroup analysis showed that β-carotene intake was positively associated with BMD in Asian participants [SMD =  - 0.394, 95% Cl (- 0.461, - 0.328), I² = 0, p = 0], while unassociated in Western participants [SMD =  - 0.047, 95% Cl (- 0.314, 0.219), I² = 78.9%, p = 0.727].

CONCLUSION

β-carotene may improve BMD and reduce the risk of osteoporosis and fracture. However, these effects could vary by gender and race and need to be further validated by longitudinal studies.

Vitamin A Nutritional Status Is a Key Determinant of Bone Mass in Children

The bone mass increases that occur during the period of childhood are of great significance for maximizing the peak bone mass in adults and preventing for osteoporosis. Studies have reported that VA can improve the bone health in adults. Moreover, limited studies have assessed such associations in children. In this cross-sectional study including 426 children, we assessed the children’s plasma retinol concentration by liquid chromatography–mass spectrometry and the dietary intake of VA and carotenoids using a structured Food Frequency Questionnaire. Their bone mineral content and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry. After adjusting for potential confounders, the restricted cubic spline revealed an inverted U-shaped association between plasma retinol concentration and BMD; the estimated effects on the TBLH BMD per μmol/L increase in the plasma retinol concentration were 1.79 × 10⁻² g/cm² below 1.24 μmol/L and −5.78 × 10⁻³ g/cm² above this point (p for non-linearity = 0.046). A multiple linear regression analysis revealed a positive association between the plasma retinol concentration and the TBLH BMC (β = 1.89, 95% CI: 1.64 × 10⁻¹–3.62, p = 0.032). In conclusion, an appropriate plasma retinol concentration and greater intakes of dietary VA and β-carotene may enhance the bone mineral status of children who are aged 6–9 years.

Assessment of in vitro bioaccessibility of carotenoids and phenolic compounds in a model milk-mandarine beverage

Mandarine juice is one of the richest sources of β-cryptoxanthin and flavonoids, which have been positively associated with bone mineral density. Carotenoids are lipophilic isoprenoid compounds with a complex absorption process that can be affected by different factors. In this study, we have evaluated the effect of the food matrix on the in vitro bioaccessibility of carotenoids and phenolic compounds in a model milk-mandarine beverage (MMB). MMBs were formulated with mandarine juice and different dairy products to achieve three fat levels (0.2%, 1.7% and 3.2%) and three calcium levels (120, 310 and 500 mg Ca²⁺ per 100 ml). The bioaccessibility was evaluated using a harmonised in vitro digestion method. The results showed that the content of milk fat increased the bioaccessibility in vitro of phenolic compounds (p < 0.05), while a moderate fat level (1.7%) resulted in the highest bioaccessibility for bioactive carotenoids. On the other hand, calcium fortification at the highest level (500 mg Ca²⁺ per 100 mL) decreased the bioaccessibility of bioactive carotenoids from 76% to 43% (66% for the major β-cryptoxanthin) compared to the lower calcium fortification level (120 mg Ca²⁺ per 100 mL). The bioaccessibility of hesperidin, the main flavanone in mandarine juice, was significantly (p < 0.05) reduced in the MMB with the highest calcium level. The bioaccessibility of carotenoids and phenolic compounds is affected by fat and calcium levels. When formulating functional beverages, the impact of the formulation should be carefully considered to optimize the bioaccessibility of the bioactive compounds.

Dietary carotenoid intake and osteoporosis: the National Health and Nutrition Examination Survey, 2005-2018

Higher intake of β-carotene and β-cryptoxanthin were associated with lower risk of osteoporosis. A very high intake of lutein + zeaxanthin was also associated with lower risk of osteoporosis. These results support the beneficial role of carotenoids on bone health.

PURPOSE

To examine the associations of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin intake with the risk of osteoporosis based on the cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2005-2018.

METHODS

This study identified individuals ≥ 50 years old with valid and complete data on carotenoid intake and bone mineral density (BMD). Intake of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin was averaged from two 24-h recall interviews. BMD was measured by dual-energy X-ray absorptiometry (DXA) and converted to T-scores; osteoporosis was defined as a T-score ≤  - 2.5. We used logistic regression models to test the associations between carotenoids and osteoporosis, adjusting for factors such as age, sex, race, and education.

RESULTS

Participants were on average 61.9 years of age, with 57.5% identifying as females. Higher quintiles of β-carotene (odds ratio [OR] for quintile 5 vs. 1:0.33; 95% CI: 0.19-0.59; P for trend = 0.010) and β-cryptoxanthin intake (OR for quintile 5 vs. 1:0.61; 95% CI: 0.39-0.97; P for trend = 0.037) were associated with reduced risk of osteoporosis. Similar and marginally significant results for lutein + zeaxanthin intake was found (OR for quintile 5 vs. 1:0.53; 95% CI: 0.30-0.94; P for trend = 0.076). There was no association of α-carotene and lycopene intake with osteoporosis. These associations did not differ by sex (all P_interaction > 0.05).

CONCLUSIONS

Higher β-carotene and β-cryptoxanthin intake was associated with decreased osteoporosis risk. A very high intake of lutein + zeaxanthin was also associated with lower risk of osteoporosis.

Oxidative Stress and Osteoporosis

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Oxidative stress has been implicated as a causative factor in many disease states, possibly including the diminished bone mineral density in osteoporosis.

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Understanding the effects of oxidative stress on the development of osteoporosis may lead to further research improving preventative and therapeutic measures that can combat this important contributor to morbidity and mortality worldwide.

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A diet rich in whole plant foods with high antioxidant content along with antioxidant-preserving lifestyle changes may improve bone mineral density and reduce the risk of fragility-related fractures. While it is not explicitly clear if antioxidant activity is the effector of this change, the current evidence supports this possibility.

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Supplementation with isolated antioxidants may also provide some osteoprotective benefits, but whole plant food-derived antioxidants potentially have more overall benefits. Larger-scale clinical trials are needed to give credence to definitive clinical recommendations.

Roles of Sex Hormones and Gender in the Gut Microbiota

The distribution of gut microbiota varies according to age (childhood, puberty, pregnancy, menopause, and old age) and sex. Gut microbiota are known to contribute to gastrointestinal (GI) diseases such as irritable bowel syndrome, inflammatory bowel disease, and colon cancer; however, the exact etiology remains elusive. Recently, sex and gender differences in GI diseases and their relation to gut microbiota has been suggested. Furthermore, the metabolism of estrogen and androgen was reported to be related to the gut microbiome. As gut microbiome is involved in the excretion and circulation process of sex hormones, the concept of “microgenderome” indicating the role of sex hormone on the gut microbiota has been suggested. However, further research is needed for this concept to be universally accepted. In this review, we summarize sex- and gender-differences in gut microbiota and the interplay of microbiota and GI diseases, focusing on sex hormones. We also describe the metabolic role of the microbiota in this regard. Finally, current subjects, such as medication including probiotics, are briefly discussed.

Nutrition in Menopausal Women: A Narrative Review

Among the various aspects of health promotion and lifestyle adaptation to the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life. In this narrative review, we discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women, such as body composition, bone mass, and risk markers for cardiovascular disease. Current evidence suggests that low-fat, plant-based diets are associated with beneficial effects on body composition, but further studies are needed to confirm these results in postmenopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists on the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels. These effects remain to be evaluated over a longer period of time, with the assessment of hard outcomes such as bone fractures, diabetes, and coronary ischemia.

Association of Dietary Total Antioxidant Capacity with Bone Mass and Osteoporosis Risk in Korean Women: Analysis of the Korea National Health and Nutrition Examination Survey 2008-2011

Antioxidant intake has been suggested to be associated with a reduced osteoporosis risk, but the effect of dietary total antioxidant capacity (TAC) on bone health and the risk of osteoporosis remains unclear. We aimed to assess the hypothesis that dietary TAC is positively associated with bone mass and negatively related to the risk of osteoporosis in Korean women. This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. Dietary TAC was estimated using task automation and an algorithm with 24-h recall data. In total, 8230 pre- and postmenopausal women were divided into four groups according to quartiles of dietary TAC. Dietary TAC was negatively associated with the risk of osteoporosis (odds ratio, 0.73; 95% confidence interval, 0.54-0.99; p-value = 0.045) in postmenopausal women, but not in premenopausal women. Dietary TAC was positively associated with bone mineral content (BMC) and bone mineral density of the femoral neck and lumbar spine in postmenopausal women and BMC of the total femur and lumbar spine in premenopausal women. Our study suggests that dietary TAC is inversely associated with the risk of osteoporosis in postmenopausal women and positively associated with bone mass in both pre- and postmenopausal women.

Vitamin A and Bone Health: A Review on Current Evidence

Vitamin A is a fat-soluble micronutrient essential for growth, immunity, and good vision. The preformed retinol is commonly found in food of animal origin whereas provitamin A is derived from food of plant origin. This review summarises the current evidence from animal, human and cell-culture studies on the effects of vitamin A towards bone health. Animal studies showed that the negative effects of retinol on the skeleton were observed at higher concentrations, especially on the cortical bone. In humans, the direct relationship between vitamin A and poor bone health was more pronounced in individuals with obesity or vitamin D deficiency. Mechanistically, vitamin A differentially influenced the stages of osteogenesis by enhancing early osteoblastic differentiation and inhibiting bone mineralisation via retinoic acid receptor (RAR) signalling and modulation of osteocyte/osteoblast-related bone peptides. However, adequate vitamin A intake through food or supplements was shown to maintain healthy bones. Meanwhile, provitamin A (carotene and β-cryptoxanthin) may also protect bone. In vitro evidence showed that carotene and β-cryptoxanthin may serve as precursors for retinoids, specifically all-trans-retinoic acid, which serve as ligand for RARs to promote osteogenesis and suppressed nuclear factor-kappa B activation to inhibit the differentiation and maturation of osteoclasts. In conclusion, we suggest that both vitamin A and provitamin A may be potential bone-protecting agents, and more studies are warranted to support this hypothesis.

Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies

Many studies have analyzed the effects of β-cryptoxanthin (BCX) on osteoporosis and bone health. This systematic review and meta-analysis aimed at providing quantitative evidence for the effects of BCX on osteoporosis. Publications were selected and retrieved from three databases and carefully screened to evaluate their eligibility. Data from the final 15 eligible studies were extracted and uniformly summarized. Among the 15 studies, seven including 100,496 individuals provided information for the meta-analysis. A random effects model was applied to integrate the odds ratio (OR) to compare the risk of osteoporosis and osteoporosis-related complications between the groups with high and low intake of BCX. A high intake of BCX was significantly correlated with a reduced risk of osteoporosis (OR = 0.79, 95% confidence interval (CI) 0.70–0.90, p = 0.0002). The results remained significant when patients were stratified into male and female subgroups as well as Western and Asian cohorts. A high intake of BCX was also negatively associated with the incidence of hip fracture (OR = 0.71, 95% CI 0.54–0.94, p = 0.02). The results indicate that BCX intake potentially reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

Nutritional Supplements and Skeletal Health

PURPOSE OF REVIEW

Nutrition influences skeletal health throughout the lifespan, from the impact of maternal intakes during development, through the development of peak bone mass, to the rate of bone loss during aging. However, there are limited data available on the effects of nutritional supplements on bone density, let alone fracture risk. This review will assess the current literature, focusing on human studies, and emphasizing nutrients where bone density or fracture data are available.

RECENT FINDINGS

Calcium and vitamin D supplements, in combination, reduce fracture risk, particularly in populations with low intakes. Extensive recent analyses have supported the safety of these interventions at recommended intakes. There is growing evidence that specific isoflavones may improve bone density although fracture data are lacking. Multiple other nutrient supplements may benefit skeletal health, but data are limited. The effect size of nutrient interventions are relatively small, requiring large sample sizes for trials with bone outcomes, may be difficult to blind, and the impact of supplementation may depend on baseline intake. However, nutrition is the only intervention that can be implemented life long and on a population wide basis. Further investigation is needed into the potential benefits of nutritional supplements to determine in which settings supplements may add benefit in addition to dietary intakes.

Effects of paprika carotenoid supplementation on bone turnover in postmenopausal women: a randomized, double-blind, placebo-controlled, parallel-group comparison study

Background

Paprika (Capsicum annuum L.) is a good source of carotenoids, including capsanthin, β-carotene, β-cryptoxanthin, and zeaxanthin. Several epidemiological studies have shown a beneficial association of intake of these carotenoids or their blood concentration with bone mineral density (BMD) and fracture risk. However, little information is available regarding the effect of intake of these carotenoids on bone metabolism in postmenopausal women.

Objective

The objective of the present study was to investigate the effects of paprika carotenoid extract (PCE) on bone turnover in healthy, postmenopausal women.

Design

We conducted a randomized, double-blind, placebo-controlled, parallel-group comparison study. One hundred participants were randomly assigned to PCE or placebo groups. Each group was given a 20 mg PCE (equivalent to 1.4 mg of carotenoids) a day or a placebo for 24 weeks. We measured bone resorption markers (tartrate-resistant acid phosphatase 5b [TRACP-5b] and serum type I collagen cross-linked N-telopeptide [sNTX]) at 12 and 24 weeks and bone formation markers (bone alkaline phosphatase and osteocalcin) at 24 weeks.

Results

The percentage decrease of TRACP-5b at 24 weeks was significantly higher for PCE than the placebo. There were no significant differences in sNTX or bone formation markers, although PCE decreased each marker compared with the placebo.

Conclusion

Our findings suggest that PCE supplementation suppresses bone resorption and contributes to maintaining bone quality in postmenopausal women.

Managing acute cancer pain

Cancer-related pain is an ongoing concern for patients and families. Clinicians should include pain management or palliative care specialists who have advanced knowledge in pharmacotherapy and who have the ability to perform interventional procedures to help alleviate patients' pain and reduce opioid use. This article discusses available interventions for patients with cancer pain.

Mitochondrial DNA mutation m.3243A>G is associated with altered mitochondrial function in peripheral blood mononuclear cells, with heteroplasmy levels and with clinical phenotypes

AIMS

To investigate the associations among heteroplasmy levels (i.e. the proportions of mutant and wild-type mitochondrial DNA in the same cell), mitochondrial function and clinical severity of the m.3243A>G mutation.

METHODS

A total of 17 participants carrying the m.3243A>G mutation and 17 sex- and age-matched healthy controls were included in this study. Heteroplasmy levels of the m.3243A>G mutation in leukocytes, saliva and urine sediment were determined by pyrosequencing. The clinical evaluation included endocrinological, audiological and ophthalmological examinations. Mitochondrial function was determined in peripheral blood mononuclear cells isolated from participants.

RESULTS

Heteroplasmy levels in urine sediment were higher than those in leukocytes and saliva. Reduced levels of adenosine triphosphate and mitochondrial membrane potential, and increased reactive oxygen species production were observed in mutant peripheral blood mononuclear cells (all P < 0.05). Linear regression analysis indicated that higher heteroplasmy levels in peripheral blood leukocytes were associated with increased levels of glycated albumin and HbA_1c , and decreased total hip bone mineral density T-score after adjustment for age and sex (all P < 0.05). Furthermore, mitochondrial membrane potential was independently associated with bone mineral density T-score at the femoral neck (P < 0.05).

CONCLUSIONS

Heteroplasmy levels in peripheral blood leukocytes and mitochondrial membrane potential in peripheral blood mononuclear cells were closely associated with clinical manifestations and were valuable for evaluation of the clinical severity of the m.3243A>G mutation.

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

BACKGROUND

The aim of this study was to investigate the trends of atrophy and intestinal metaplasia (IM) in 2002 subjects without significant gastroduodenal diseases.

MATERIALS AND METHODS

A total of 2002 subjects were prospectively enrolled and divided into three periods (2003-2007, 2008-2012, and 2013-2018). Trends of H pylori and atrophy/IM scored by Updated Sydney System were analyzed according to sex, and multivariate logistic analysis was performed for the risk factors for atrophy/IM.

RESULTS

H pylori-negative and H pylori-positive subjects were 1220 (61.0%) and 782 (38.0%), respectively. H pylori positivity decreased from 149/303 (49.2%), 207/515 (40.2%) and 426/1184 (36.0%), in the three periods, respectively (P < 0.001). The prevalence of atrophy (P < 0.001) and IM in the corpus (P < 0.001) significantly decreased over 15 years in females, but not in males. The mean grade of atrophy and IM was higher in males (0.36 and 0.51) than in females (0.28 and 0.41) in the corpus (P = 0.027) and in the antrum (P = 0.006), respectively. Similarly, the mean grade of IM in males (0.34) was higher in females (0.19; P < 0.001) in the corpus. Multivariate analysis showed that old age, study period, and H pylori were statistically significant in atrophy of antrum and corpus, and IM in the corpus. In cases of IM of antrum, old age, H pylori, and smoking were statistically significant.

CONCLUSION

A significant decrease in atrophy and IM in the corpus in females over 15 years suggests sex- or gender-specific characteristics.

Dietary Lutein Plus Zeaxanthin Intake and DICER1 rs3742330 A > G Polymorphism Relative to Colorectal Cancer Risk

It is unclear whether dietary lutein/zeaxanthin intake in colorectal cancer is associated with microRNA processing involved in DICER1 cleavage for messenger RNA translation. We investigated whether dietary lutein/zeaxanthin intake affects colorectal cancer risk in patients with a DICER1 rs3742330 polymorphism. In this hospital-based case-control study, we recruited 923 colorectal cancer patients and 1,846 controls based on eligibility criteria, a semiquantitative food frequency questionnaire and the DICER1 rs3742330 genotype. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression adjusted for confounders. The highest quartile of lutein/zeaxanthin consumption was inversely associated with a reduced colorectal cancer risk (OR, 95% CI = 0.25, 0.18-0.36). Carrying G allele (AG + GG) showed a significantly reduced colorectal cancer incidence compared with that of AA carriers (OR, 95% CI = 0.71, 0.55-0.91). Those carrying the G allele (AG + GG) along with high lutein/zeaxanthin consumption were markedly associated with a decreased colorectal cancer risk (OR, 95% CI = 0.32, 0.22-0.46, P for interaction = 0.018), particularly for rectal cancer (OR, 95% CI = 0.24, 0.15-0.39, P for interaction = 0.004), compared with that of AA carriers with low lutein/zeaxanthin intakes. In conclusion, colorectal cancer risk was related to an interactive effect between dietary lutein/zeaxanthin intake and the DICER1 rs3742330 polymorphism.

The Osteogenic Potential of Brown Seaweed Extracts

Marine drugs hold significantly more promise than their terrestrial counterparts, which could help to solve the current shortfall in treatments for osteoporosis and other bone related diseases. Fucoxanthin is the main carotenoid found in brown seaweed, and has many perceived health benefits, including potential bone therapeutic properties. This study assessed the osteogenic potential of pure fucoxanthin and crude extracts containing both fucoxanthin and phenolic fractions (also cited to have osteogenic potential) isolated from two intertidal species of brown seaweed, Laminaria digitata and Ascophyllum nodosum. In vitro studies were performed using a human foetal osteoblast cell line (hFOBs) and primary human bone marrow stromal cells (hBMSCs). The results found pure fucoxanthin inhibitory to cell proliferation in hFOBs at higher concentrations, whereas, the crude extracts containing both polyphenols and fucoxanthin showed the ability to scavenge free radicals, which masked this effect. None of the extracts tested showed strong pro-osteogenic effects in either cell type tested, failing to support previously reported positive effects.

The Effect of Lutein on Eye and Extra-Eye Health

Lutein is a carotenoid with reported anti-inflammatory properties. A large body of evidence shows that lutein has several beneficial effects, especially on eye health. In particular, lutein is known to improve or even prevent age-related macular disease which is the leading cause of blindness and vision impairment. Furthermore, many studies have reported that lutein may also have positive effects in different clinical conditions, thus ameliorating cognitive function, decreasing the risk of cancer, and improving measures of cardiovascular health. At present, the available data have been obtained from both observational studies investigating lutein intake with food, and a few intervention trials assessing the efficacy of lutein supplementation. In general, sustained lutein consumption, either through diet or supplementation, may contribute to reducing the burden of several chronic diseases. However, there are also conflicting data concerning lutein efficacy in inducing favorable effects on human health and there are no univocal data concerning the most appropriate dosage for daily lutein supplementation. Therefore, based on the most recent findings, this review will focus on lutein properties, dietary sources, usual intake, efficacy in human health, and toxicity.

The relationship between pulmonary function and suicidal ideation in Korean adults: a nationwide survey

Controversy surrounds the association between lung function and mental health in the general population, and previous reported results were confounded by the effect of other chronic illnesses. This study aimed to investigate whether reduced lung function was related to mental health issues, taking into consideration the relevant potential confounders. We used data from the 2008-2013 Korean National Health and Nutrition Examination Survey to examine the relationship between lung function and three mental issues (recognized stress, depressive mood, and suicidal ideation) among 22,068 Korean adults. A multiple logistic regression with adjustment for potential covariates including chronic illnesses revealed that a .5-L decrement of forced vital capacity increased the risk for suicidal ideation in both genders, but there was no significant association with recognized stress or depressive mood. We found an inverse relationship between lung function and suicidal ideation in the Korean general population.