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Zeraattalab-Motlagh S, Mortazavi AS, Ghoreishy SM, Mohammadi H. Association between total and animal proteins with risk of fracture: A systematic review and dose-response meta-analysis of cohort studies. Osteoporos Int 2024; 35:11-23. [PMID: 37855886 DOI: 10.1007/s00198-023-06948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
Previous cohort studies have indicated that consumption of total and animal proteins are related to fracture risk; however, results were inconclusive. This dose-dependent review sought to summarize the earlier evidence regarding the relation between total and animal proteins and fracture risk. We searched Scopus, PubMed, and Web of Science until July 2023 for original research articles examining the association of certain types of proteins and the incidence of all fractures in general adults. Summary relative risks (RRs) were calculated using random effects analysis to examine the relation between each certain amount (g/day) increment of total and animal protein and fracture risk. Twenty cohort studies with serious to moderate risk of bias involving 780,322 individuals were included. There was a non-statistically significant relation between intake of animal proteins and dairy products and all fracture risk. However, 43% and 5% decreased incidence of fracture was obtained with total protein (RR, 0.57; 95%CI, 0.36 to 0.93; per 100 g/day) and fish (RR, 0.95; 95%CI, 0.91 to 0.99; per 15 g/day) intake. Every 100 g/day total and animal protein consumption and every 15 g/day fish consumption were linked to 48%, 50%, and 5% lower hip fracture risk. Greater dietary animal protein intake might reduce risk of hip but not fracture at any site. We obtained a lower risk of any or hip fracture with greater total protein (per 100 g/day) and fish (per 15 g/day) intake. No evidence was obtained that higher intake of dairy could decrease risk of fracture.
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Affiliation(s)
- Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Mortazavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Hounkpêvi JA, Adjei-Mensah B, Adjibodé AG, Tona K, Koutinhouin B, Pitala W. Dietary protein levels during 12 to 26 wk improve the growth performance, bone quality, and testosterone in Pearl Gray male guinea fowl (Numida meleagris). Poult Sci 2024; 103:103173. [PMID: 37939585 PMCID: PMC10665940 DOI: 10.1016/j.psj.2023.103173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Guinea fowl (Numida meleagris), although native to Africa and despite its many potentials, does not represent the dominant species on the continent because of its seasonal reproductive nature and high keets mortality. This study was conducted to assess the effect of crude protein levels on growth performance, bone characteristics and reproductive activity of Pearl Gray male breeder guinea fowl from 12 to 26 wk of age. A total of 120 twelve-wk-old guinea fowls were randomly allotted to 3 dietary treatments with 8 replicates each and 5 birds per replicate using a completely randomized design. The dietary treatments comprised low level (LL), normal level (NL), and high level (HL) with diets respectively containing 15, 17, and 19% crude protein (CP). The results showed that guinea fowl in the HL treatment had a significantly lower feed conversion ratio (P = 0.008) than those in the other treatments. The birds fed the HL diet had significantly higher concentrations of testosterone (P < 0.05) than in the other treatments. High levels of calcium and phosphorus were observed in the femur of the HL group relative to the LL group. The birds in the LL treatment had a significantly higher (P = 0.007) femur robusticity index than those in the HL treatment. In conclusion, feeding 19% crude protein to Pearl Gray male guinea fowl from 12 to 26 wk of age improves growth performance, the density and strength of the femur and tibia and the reproductive tract. The CP level for the best performance of male guinea fowl from 12 to 26 wk of age is 19%.
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Affiliation(s)
- J A Hounkpêvi
- Department of Animal Science and Veterinary, Laboratory of Regional Center of Excellence in Poultry Science, University of Lome, Lome, Togo.
| | - B Adjei-Mensah
- Department of Animal Science and Veterinary, Laboratory of Regional Center of Excellence in Poultry Science, University of Lome, Lome, Togo
| | - A G Adjibodé
- Department of Animal Science and Veterinary, Laboratory of Regional Center of Excellence in Poultry Science, University of Lome, Lome, Togo
| | - K Tona
- Department of Animal Science and Veterinary, Laboratory of Regional Center of Excellence in Poultry Science, University of Lome, Lome, Togo
| | - B Koutinhouin
- Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - W Pitala
- Department of Animal Science and Veterinary, Laboratory of Regional Center of Excellence in Poultry Science, University of Lome, Lome, Togo
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Je M, Kang K, Yoo JI, Kim Y. The Influences of Macronutrients on Bone Mineral Density, Bone Turnover Markers, and Fracture Risk in Elderly People: A Review of Human Studies. Nutrients 2023; 15:4386. [PMID: 37892460 PMCID: PMC10610213 DOI: 10.3390/nu15204386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Osteoporosis is a health condition that involves weak bone mass and a deteriorated microstructure, which consequently lead to an increased risk of bone fractures with age. In elderly people, a fracture attributable to osteoporosis elevates mortality. The objective of this review was to examine the effects of macronutrients on bone mineral density (BMD), bone turnover markers (BTMs), and bone fracture in elderly people based on human studies. A systematic search was conducted in the PubMed®/MEDLINE® database. We included human studies published up to April 2023 that investigated the association between macronutrient intake and bone health outcomes. A total of 11 meta-analyses and 127 individual human studies were included after screening the records. Carbohydrate consumption seemed to have neutral effects on bone fracture in limited studies, but human studies on carbohydrates' effects on BMD or/and BTMs are needed. The human studies analyzed herein did not clearly show whether the intake of animal, vegetable, soy, or milk basic proteins has beneficial effects on bone health due to inconsistent results. Moreover, several individual human studies indicated an association between eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and osteocalcin. Further studies are required to draw a clear association between macronutrients and bone health in elderly people.
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Affiliation(s)
- Minkyung Je
- Department of Food and Nutrition, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea; (M.J.); (K.K.)
| | - Kyeonghoon Kang
- Department of Food and Nutrition, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea; (M.J.); (K.K.)
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, 27 Inhang-Ro, Incheon 22332, Republic of Korea;
| | - Yoona Kim
- Department of Food and Nutrition, Institute of Agriculture and Life Science, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea
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Micun Z, Falkowska M, Młynarczyk M, Kochanowicz J, Socha K, Konopińska J. Levels of Trace Elements in the Lens, Aqueous Humour, and Plasma of Cataractous Patients-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10376. [PMID: 36012010 PMCID: PMC9408557 DOI: 10.3390/ijerph191610376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Cataracts are one of the most common causes of effective vision loss. Although most cases of cataracts are related to the ageing process, identifying modifiable risk factors can prevent their onset or progression. Many studies have suggested that micro and macroelement levels, not only in blood serum but also in the lens and aqueous humour, may affect the risk of the occurrence and severity of cataracts. This systematic review aims to summarise existing scientific reports concerning the importance of trace elements in cataractogenesis. Many authors have pointed out elevated or decreased levels of particular elements in distinct ocular compartments. However, it is not known if these alterations directly affect the increased risk of cataract occurrence. Further studies are needed to show whether changes in the levels of these elements are correlated with cataract severity and type. Such information would be useful for determining specific recommendations for micronutrient supplementation in preventing cataractogenesis.
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Affiliation(s)
- Zuzanna Micun
- Department of Ophthalmology, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Martyna Falkowska
- Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, Mickiewicza 2D, 15-222 Bialystok, Poland
| | - Maryla Młynarczyk
- Department of Ophthalmology, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Katarzyna Socha
- Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, Mickiewicza 2D, 15-222 Bialystok, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland
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Effects of Dietary Protein Source and Quantity on Bone Morphology and Body Composition Following a High-Protein Weight-Loss Diet in a Rat Model for Postmenopausal Obesity. Nutrients 2022; 14:nu14112262. [PMID: 35684064 PMCID: PMC9183012 DOI: 10.3390/nu14112262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
Higher protein (>30% of total energy, HP)-energy restriction (HP-ER) diets are an effective means to improve body composition and metabolic health. However, weight loss (WL) is associated with bone loss, and the impact of HP-ER diets on bone is mixed and controversial. Recent evidence suggests conflicting outcomes may stem from differences in age, hormonal status, and the predominant source of dietary protein consumed. Therefore, this study investigated the effect of four 12-week energy restriction (ER) diets varying in predominate protein source (beef, milk, soy, casein) and protein quantity (normal protein, NP 15% vs. high, 35%) on bone and body composition outcomes in 32-week-old obese, ovariectomized female rats. Overall, ER decreased body weight, bone quantity (aBMD, aBMC), bone microarchitecture, and body composition parameters. WL was greater with the NP vs. HP-beef and HP-soy diets, and muscle area decreased only with the NP diet. The HP-beef diet exacerbated WL-induced bone loss (increased trabecular separation and endocortical bone formation rates, lower bone retention and trabecular BMC, and more rod-like trabeculae) compared to the HP-soy diet. The HP-milk diet did not augment WL-induced bone loss. Results suggest that specific protein source recommendations may be needed to attenuate the adverse alterations in bone quality following an HP-ER diet in a model of postmenopausal obesity.
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Oluwabiyi C, Zhao J, Jiao H, Wang X, Lin H. Dietary protein levels during the pullet phase (8–18 week) influence the mortality during laying stage. J APPL POULTRY RES 2022. [DOI: 10.1016/j.japr.2021.100223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mi H, Li H, Jiang W, Song W, Yan Q, He Z, Tan Z. Calcium Homeostasis and Bone Metabolism in Goats Fed a Low Protein Diet. Front Vet Sci 2022; 8:829872. [PMID: 35187142 PMCID: PMC8850410 DOI: 10.3389/fvets.2021.829872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to investigate the effects of low-protein diets on blood calcium (Ca) level, bone metabolism, and the correlation between bone metabolism and blood calcium in goats. Twenty-four female Xiangdong black goats with similar body weight (19.55 ± 3.55 kg) and age (8.0 ± 0.3 months) were selected and allocated into two groups: control group (CON, 10.77% protein content) and low-protein group (LP, 5.52% protein content). Blood samples were collected on days 1, 4, 7, 16 and 36 before morning feeding to determine the concentration of calcium (Ca), parathyroid hormone (PTH), bone gla protein (BGP), C-terminal telopeptide of type 1 collagen (CTX-1), bone alkaline phosphatase (BALP), and 1, 25-dihydroxyvitamin D3 [1,25(OH)2D3]. Liver samples were collected to determine the expression of bone metabolism-related genes. There was no difference observed between LP and CON in concentration of plasma Ca or any of bone metabolism markers (P > 0.05). In the liver, the mRNA expression of bone gamma carboxyglutamate protein (BGLAP), alkaline phosphatase (ALPL), and mothers against decapentaplegic homolog-1 (SMAD1) were increased (P < 0.05) in LP as compared with CON. The correlation analysis of Ca and bone metabolism markers showed no significant correlation between Ca and bone metabolism. These results suggest that the blood Ca concentration in mature goats may keep at a stable level through nitrogen cycling when the providing protein is not enough.
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Affiliation(s)
- Hui Mi
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Haobang Li
- Hunan Institute of Animal and Veterinary Science, Changsha, China
- Haobang Li
| | - Weimin Jiang
- Hunan Institute of Animal and Veterinary Science, Changsha, China
| | - Wu Song
- Hunan Institute of Animal and Veterinary Science, Changsha, China
| | - Qiongxian Yan
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, China
- Hunan Co-innovation Center of Animal Production Safety (CICAPS), Changsha, China
| | - Zhixiong He
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
- Hunan Co-innovation Center of Animal Production Safety (CICAPS), Changsha, China
- *Correspondence: Zhixiong He
| | - Zhiliang Tan
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
- Hunan Co-innovation Center of Animal Production Safety (CICAPS), Changsha, China
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Hidayat K, Chen JS, Wang TC, Liu YJ, Shi YJ, Su HW, Liu B, Qin LQ. The Effects of Milk Supplementation on Bone Health Indices in Adults: A Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2021; 13:1186-1199. [PMID: 34792092 PMCID: PMC9340984 DOI: 10.1093/advances/nmab136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 01/23/2023] Open
Abstract
Milk contains a number of bone-beneficial nutrients. However, milk, due to the D-galactose content, might have unfavorable effects on bone health. A meta-analysis of randomized controlled trials (RCTs) was performed to clarify the effects of milk supplementation on bone mineral density (BMD), bone turnover markers [N-terminal telopeptide of type I collagen (NTx), C-terminal telopeptide of type 1 collagen (CTx), osteocalcin, bone alkaline phosphatase (BALP), and procollagen type 1 N-propeptide (P1NP)], and hormonal indices related to bone metabolism [parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], and insulin-like growth factor 1 (IGF-1)] in adults. The PubMed and Web of Science databases were searched. A random-effects model was used to estimate the pooled effect sizes. A total of 20 RCTs were included. The trial duration ranged from 1 mo to 36 mo. Milk supplementation resulted in a small but significant increase in BMD at the hip (+0.004 g/cm2; n = 9 RCTs) and lumbar spine (+0.025 g/cm2; n = 7), but did not significantly affect whole-body BMD (n = 3) and femoral neck BMD (n = 7). Milk supplementation reduced the concentrations of P1NP (-5.20 ng/mL; n = 9), CTx (-0.16 ng/mL; n = 9), and NTx (-8.66 nmol bone collagen equivalents/mmol creatinine; n = 3). The concentrations of osteocalcin (n = 9) and BALP (n = 3) were not affected by milk supplementation. Reduced parathyroid hormone PTH (-1.01 pg/mL; n = 13) concentrations and increased IGF-1 (+1.79 nmol/l; n = 4) concentrations were observed with milk supplementation. 25(OH)D (+3.73 ng/mL; n = 11) concentrations were increased with vitamin-D fortified milk supplementation. The addition of milk to the diet may potentially increase the likelihood of preventing bone loss by restoring bone homeostasis through the modulation of the calcium-vitamin D-PTH axis, bone remodeling rate, and growth hormone/IGF-1 axis.
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Affiliation(s)
| | - Jing-Si Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Tian-Ci Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yu-Jie Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yu-Jie Shi
- Branch Company, Inner Mongolia Yili Industrial Group Co. Ltd., Hohhot, China
| | - Hong-Wen Su
- Branch Company, Inner Mongolia Yili Industrial Group Co. Ltd., Hohhot, China
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Liu ZM, Huang Q, Li SY, Liu YP, Wu Y, Zhang SJ, Li BL, Chen YM. A 1:1 matched case-control study on dietary protein intakes and hip fracture risk in Chinese elderly men and women. Osteoporos Int 2021; 32:2205-2216. [PMID: 33890124 DOI: 10.1007/s00198-021-05960-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED The role of protein intake in bone has been controversial. Our case-control study among Chinese elderly concluded that a higher consumption of protein, even substituted for fat, is associated with lowered hip fracture risk. Differences in protein sources, amino acids composition, gender, and calcium sufficiency may explain the inconsistency. PURPOSE The aim of the study was to investigate the association of dietary protein intakes with hip fracture risk among Chinese elderly. METHODS This was a 1:1 age and sex matched cross-sectional study of case-control design among 1070 pairs of elderly Chinese people aged 55 to 80 years. Patients who were newly diagnosed (within 2-week) hip fracture by X-ray were recruited from four hospitals in Guangdong Province of China. Dietary intakes were evaluated by a validated food frequency questionnaire for total protein, protein from different sources, amino acids profiles, and estimated renal acid load in diet. RESULTS Daily average intakes of total protein were 58.1±27.0 (women) and 65.7±31.8 (men) g/d for cases, and 66.8±21.5 (women) and 72.1±24.4 (men) for controls (p<0.001). Multivariable regression indicated that, compared with the lowest quartile, the highest quartile of consumption of energy adjusted total protein [OR: 0.360 (0.206~0.630) for women and 0.381 (0.153~0.949) for men] and animal protein [0.326 (0.183, 0.560) for women and 0.335 (0.136~0.828) for men] was significantly associated with the lowered risk of hip fracture in a dose-response manner (all p for trend <0.05). A significant hip fracture risk reduction was observed in women with higher intakes of sulfur amino acids [OR: 0.464 (0.286~0.753)] and aromatic amino acids [0.537 (0.326~0.884)] but not in men. Subgroup analysis suggested that these associations were more evident in elderly with lower body mass index and dietary calcium intake less than 400 mg/d. CONCLUSIONS A higher level of protein intake, even substituted for fat, is associated with lowered hip fracture risk.
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Affiliation(s)
- Z-M Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Q Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - S-Y Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Y-P Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, China
| | - Y Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - S-J Zhang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - B-L Li
- Guangzhou Orthopaedics Trauma Hospital, Guangzhou, China
| | - Y-M Chen
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, China.
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The Role of Diet in Bone and Mineral Metabolism and Secondary Hyperparathyroidism. Nutrients 2021; 13:nu13072328. [PMID: 34371838 PMCID: PMC8308808 DOI: 10.3390/nu13072328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
Bone disorders are a common complication of chronic kidney disease (CKD), obesity and gut malabsorption. Secondary hyperparathyroidism (SHPT) is defined as an appropriate increase in parathyroid hormone (PTH) secretion, driven by either reduced serum calcium or increased phosphate concentrations, due to an underlying condition. The available evidence on the effects of dietary advice on secondary hyperparathyroidism confirms the benefit of a diet characterized by decreased phosphate intake, avoiding low calcium and vitamin D consumption (recommended intakes 1000-1200 mg/day and 400-800 UI/day, respectively). In addition, low protein intake in CKD patients is associated with a better control of SHPT risk factors, although its strength in avoiding hyperphosphatemia and the resulting outcomes are debated, mostly for dialyzed patients. Ultimately, a consensus on the effect of dietary acid loads in the prevention of SHPT is still lacking. In conclusion, a reasonable approach for reducing the risk for secondary hyperparathyroidism is to individualize dietary manipulation based on existing risk factors and concomitant medical conditions. More studies are needed to evaluate long-term outcomes of a balanced diet on the management and prevention of secondary hyperparathyroidism in at-risk patients at.
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Han Y, An M, Yang L, Li L, Rao S, Cheng Y. Effect of Acid or Base Interventions on Bone Health: A Systematic Review, Meta-Analysis, and Meta-Regression. Adv Nutr 2021; 12:1540-1557. [PMID: 33684217 PMCID: PMC8321841 DOI: 10.1093/advances/nmab002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
Osteoporosis is a global health issue among the aging population. The effect of the acid or base interventions on bone health remains controversial. This study performed a systematic review and meta-analysis to investigate effects of acidic diets and alkaline supplements on bone health simultaneously. We conducted a comprehensive literature search in 5 available databases and 1 registered clinical trial system to identify randomized controlled trials (RCTs) that assessed effects of the acid-base intervention on bone health. Depending on heterogeneity across studies, the pooled effects were calculated by fixed-effects or random-effects models. The present study included 13 acidic diet intervention studies and 13 alkaline supplement studies for final quantitative assessments. The meta-analysis showed that acidic diets significantly increased net acid excretion [NAE; standardized mean difference (SMD) = 2.99; P = 0.003] and urinary calcium excretion (SMD = 0.47, P < 0.00001) but had no significant effect on bone turnover markers and bone mineral density (BMD). On the other hand, alkaline supplement intervention significantly reduced NAE (SMD = -1.29, P < 0.00001), urinary calcium excretion (SMD = -0.44, P = 0.007), bone resorption marker aminoterminal cross-linking telopeptide (NTX; SMD = -0.29, P = 0.003), and bone formation marker osteocalcin (OC; SMD = -0.23, P = 0.02), but did not affect the other bone turnover markers. Furthermore, alkaline supplements significantly increased BMD in femoral neck [mean difference (MD) = 1.62, P < 0.00001, I2 = 0%], lumbar spine (MD = 1.66, P < 0.00001, I2 = 87%), and total hip (MD = 0.98, P = 0.02, I2 = 99%). Subsequently, meta-regression analyses identified 1 study that substantially contributed to the high heterogeneity of BMD in the latter 2 sites, but sensitivity analysis suggested that this study did not affect the significant pooled effects. Despite that, the results should be interpreted with caution and need to be further validated by a larger RCT. In summary, through integrating evidence from RCTs, the present meta-analysis initially suggests that alkaline supplements may be beneficial to bone metabolism and acidic diets may not be harmful to bone health. This work may be clinically useful for both clinicians and patients with osteoporosis.
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Affiliation(s)
- Yibing Han
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Min An
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Li Yang
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Liuran Li
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China
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Bu T, Zheng J, Liu L, Li S, Wu J. Milk proteins and their derived peptides on bone health: Biological functions, mechanisms, and prospects. Compr Rev Food Sci Food Saf 2021; 20:2234-2262. [PMID: 33522110 DOI: 10.1111/1541-4337.12707] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bone is a dynamic organ under constant metabolism (or remodeling), where a delicate balance between bone resorption and bone formation is maintained. Disruption of this coordinated bone remodeling results in bone diseases, such as osteoporosis, the most common bone disorder characterized by decreased bone mineral density and microarchitectural deterioration. Epidemiological and clinical evidence support that consumption of dairy products is beneficial for bone health; this benefit is often attributed to the presence of calcium, the physiological contributions of milk proteins on bone metabolism, however, are underestimated. Emerging evidence highlighted that not only milk proteins (including individual milk proteins) but also their derived peptides positively regulate bone remodeling and attenuate bone loss, via the regulation of cellular markers and signaling of osteoblasts and osteoclasts. This article aims to review current knowledge about the roles of milk proteins, with an emphasis on individual milk proteins, bioactive peptides derived from milk proteins, and effect of milk processing in particular fermentation, on bone metabolism, to highlight the potential uses of milk proteins in the prevention and treatment of osteoporosis, and, to discuss the knowledge gap and to recommend future research directions.
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Affiliation(s)
- Tingting Bu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China.,ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China
| | - Jiexia Zheng
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China.,ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China
| | - Ling Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China.,ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China
| | - Shanshan Li
- College of Animal Sciences, Zhejiang University, Hangzhou, P. R. China
| | - Jianping Wu
- ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, P. R. China.,Department of Agricultural, Food and Nutritional Science, 4-10 Ag/For Building, University of Alberta, Edmonton, Alberta, Canada
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13
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Zhang YY, Stockmann R, Ng K, Ajlouni S. Opportunities for plant-derived enhancers for iron, zinc, and calcium bioavailability: A review. Compr Rev Food Sci Food Saf 2020; 20:652-685. [PMID: 33443794 DOI: 10.1111/1541-4337.12669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022]
Abstract
Understanding of the mechanism of interactions between dietary elements, their salts, and complexing/binding ligands is vital to manage both deficiency and toxicity associated with essential element bioavailability. Numerous mineral ligands are found in both animal and plant foods and are known to exert bioactivity via element chelation resulting in modulation of antioxidant capacity or micobiome metabolism among other physiological outcomes. However, little is explored in the context of dietary mineral ligands and element bioavailability enhancement, particularly with respect to ligands from plant-derived food sources. This review highlights a novel perspective to consider various plant macro/micronutrients as prospective bioavailability enhancing ligands of three essential elements (Fe, Zn, and Ca). We also delineate the molecular mechanisms of the ligand-binding interactions underlying mineral bioaccessibility at the luminal level. We conclude that despite current understandings of some of the structure-activity relationships associated with strong mineral-ligand binding, the physiological links between ligands as element carriers and uptake at targeted sites throughout the gastrointestinal (GI) tract still require more research. The binding behavior of potential ligands in the human diet should be further elucidated and validated using pharmacokinetic approaches and GI models.
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Affiliation(s)
- Yianna Y Zhang
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.,CSIRO Agriculture & Food, Werribee, VIC, Australia
| | | | - Ken Ng
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Said Ajlouni
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
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14
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Zhang YY, Stockmann R, Ng K, Ajlouni S. Revisiting phytate-element interactions: implications for iron, zinc and calcium bioavailability, with emphasis on legumes. Crit Rev Food Sci Nutr 2020; 62:1696-1712. [PMID: 33190514 DOI: 10.1080/10408398.2020.1846014] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myo-Inositol hexakisphosphate or phytic acid concentration is a prominent factor known to impede divalent element bioavailability in vegetal foods including legumes. Both in vivo and in vitro studies have suggested that phytic acid and other plant-based constituents may synergistically form insoluble complexes affecting bioavailability of essential elements. This review provides an overview of existing investigations on the role of phytic acid in the binding, solubility and bioavailability of iron, zinc and calcium with a focus on legumes. Given the presence of various interference factors within legume matrices, current findings suggest that the commonly adapted approach of using phytic acid-element molar ratios as a bioavailability predictor may only be valid in limited circumstances. In particular, differences between protein properties and molar concentrations of other interacting ions are likely responsible for the observed poor correlations. The role of phytate degradation in element bioavailability has been previously examined, and in this review we re-emphasize its importance as a tool to enhance mineral bioavailability of mineral fortified legume crops. Food processing strategies to achieve phytate reduction were identified as promising tools to increase mineral bioavailability and included germination and fermentation, particularly when other bioavailability promoters (e.g. NaCl) are simultaneously added.
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Affiliation(s)
- Yianna Y Zhang
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia.,CSIRO Agriculture & Food, Werribee, Victoria, Australia
| | | | - Ken Ng
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Said Ajlouni
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
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15
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Abstract
The present paper reviews published literature on the relationship between dietary protein and bone health. It will include arguments both for and against the anabolic and catabolic effects of dietary protein on bone health. Adequate protein intake provides the amino acids used in building and maintaining bone tissue, as well as stimulating the action of insulin-like growth factor 1, which in turn promotes bone growth and increases calcium absorption. However, the metabolism of dietary sulphur amino acids, mainly from animal protein, can lead to increased physiological acidity, which may be detrimental for bone health in the long term. Similarly, cereal foods contain dietary phytate, which in turn contains phosphate. It is known that phosphate consumption can also lead to increased physiological acidity. Therefore, cereal products may produce as much acid as do animal proteins that contain sulphur amino acids. The overall effect of dietary protein on physiological acidity, and its consequent impact on bone health, is extremely complex and somewhat controversial. The consensus is now moving towards a synthesised approach. Particularly, how anabolic and catabolic mechanisms interact; as well as how the context of the whole diet and the type of protein consumed is important.
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16
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Wallace TC, Bailey RL, Lappe J, O’Brien KO, Wang DD, Sahni S, Weaver CM. Dairy intake and bone health across the lifespan: a systematic review and expert narrative. Crit Rev Food Sci Nutr 2020; 61:3661-3707. [DOI: 10.1080/10408398.2020.1810624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Taylor C. Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
- Think Healthy Group, Inc, Washington, DC, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Joan Lappe
- College of Nursing, Creighton University, Omaha, Nebraska, USA
| | - Kimberly O. O’Brien
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | | | - Shivani Sahni
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts, USA
| | - Connie M. Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
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17
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Hidayat K, Du X, Shi BM, Qin LQ. Systematic review and meta-analysis of the association between dairy consumption and the risk of hip fracture: critical interpretation of the currently available evidence. Osteoporos Int 2020; 31:1411-1425. [PMID: 32383066 DOI: 10.1007/s00198-020-05383-3] [Citation(s) in RCA: 11] [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: 11/04/2019] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED In the present meta-analysis, reductions in the risk of hip fracture with milk consumption were only observed among American adults, but not among Scandinavian adults, possibly because milk products are more commonly fortified with vitamin D in the former population than in Scandinavian countries. The reduction in the risk of hip fracture was also observed with yogurt consumption, which is often associated with healthy lifestyles and dietary patterns that contribute to improved bone health. INTRODUCTION Although dairy products contain bone-beneficial nutrients, the association between dairy consumption and the risk of hip fracture remains equivocal. Fueling this uncertainty, the elevated risk of hip fracture in association with milk consumption was observed in a cohort of Swedish women. A systematic review and meta-analysis of prospective cohort studies was performed to critically evaluate the association, or lack thereof, between dairy consumption (milk, yogurt, and cheese) and the risk of hip fracture. METHODS A random effects model was used to generate the summary relative risks (RRs) with their 95% confidence intervals (CIs) for the associations of interest. RESULTS In the meta-analysis of the highest versus lowest category of consumption, higher consumption of yogurt (RR 0.78, 95% CI 0.68, 0.90), but not milk (RR 0.86, 95% CI 0.73, 1.02) or cheese (RR 0.85, 95% CI 0.66, 1.08), was associated with a lower risk of hip fracture. For milk, the reduced risk of fracture with higher milk consumption was observed in the USA (RR 0.75, 95% CI 0.65, 0.87), but not in Scandinavian countries (RR 1.00, 95% CI 0.85, 1.17). These findings were further supported by the fact that American studies (RR 0.93, 95% CI 0.88, 0.98; per 1 glass/day), but not Scandinavian studies (RR 1.01, 95% CI 0.95, 1.07; per 1 glass/day), demonstrated a linear association between milk consumption and the risk of hip fracture. CONCLUSIONS The cumulative evidence from prospective cohort studies reassuringly suggests that the risk of hip fracture may not be elevated among people who consume milk, yogurt, and cheese, and that a greater consumption of milk or yogurt may even be associated with a lower risk of hip fracture depending on the factors that may differ across the population of interest.
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Affiliation(s)
- K Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
| | - X Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China
| | - B-M Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
| | - L-Q Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
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18
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Kazemi A, Speakman JR, Soltani S, Djafarian K. Effect of calorie restriction or protein intake on circulating levels of insulin like growth factor I in humans: A systematic review and meta-analysis. Clin Nutr 2020; 39:1705-1716. [DOI: 10.1016/j.clnu.2019.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
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19
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Wright CS, Li J, Campbell WW. Effects of Dietary Protein Quantity on Bone Quantity following Weight Loss: A Systematic Review and Meta-analysis. Adv Nutr 2019; 10:1089-1107. [PMID: 31301138 PMCID: PMC6855958 DOI: 10.1093/advances/nmz058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/09/2019] [Accepted: 05/17/2019] [Indexed: 01/02/2023] Open
Abstract
Research supports the hypothesis that higher total protein intake during weight loss promotes retention of lean soft tissue, but the effect of dietary protein quantity on bone mass, a lean hard tissue, is inconsistent. The purpose of this systematic review and meta-analysis was to assess the effect of dietary protein quantity [higher protein (HP): ≥25% of energy from protein or ≥1.0 g · kg body wt-1 · d-1; normal protein (NP): <25% of energy from protein or <1.0 g · kg body wt-1 · d-1] on changes in bone mineral density (BMD) and content (BMC; total body, lumbar spine, total hip, femoral neck) following a prescribed energy restriction. We hypothesized that an HP diet would attenuate the loss of BMD/BMC following weight loss in comparison to an NP diet. Two researchers systematically and independently screened 2366 publications from PubMed, Cochrane, Scopus, CINAHL, and Web of Science Core Collection and extracted data from 34 qualified publications. Inclusion criteria included the following: 1) healthy subjects ≥19 y; 2) a prescribed energy restriction; 3) measurements of total protein intake, BMD, and BMC; and 4) an intervention duration of ≥3 mo. Data from 10 of the 34 publications with 2 groups of different total protein intakes were extracted and used to conduct a random-effects model meta-analysis. A majority of publications (59%) showed a decrease in bone quantity following active weight loss, regardless of total protein intake. Statistically, the loss of total BMD (P = 0.016; weighted mean difference: +0.006 g/cm2; 95% CI: 0, 0.011 g/cm2) and lumbar spine BMD (P = 0.019; weighted mean difference: +0.017 g/cm2; 95% CI: 0.001, 0.033 g/cm2) was attenuated with an HP versus an NP weight-loss diet. However, the clinical significance is questionable given the modest weighted mean difference and study duration. Higher total protein intake does not exacerbate but may attenuate the loss of bone quantity following weight loss.
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Affiliation(s)
- Christian S Wright
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Jia Li
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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20
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21
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Carbone JW, Pasiakos SM. Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients 2019; 11:nu11051136. [PMID: 31121843 PMCID: PMC6566799 DOI: 10.3390/nu11051136] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
Adequate consumption of dietary protein is critical for the maintenance of optimal health during normal growth and aging. The current Recommended Dietary Allowance (RDA) for protein is defined as the minimum amount required to prevent lean body mass loss, but is often misrepresented and misinterpreted as a recommended optimal intake. Over the past two decades, the potential muscle-related benefits achieved by consuming higher-protein diets have become increasingly clear. Despite greater awareness of how higher-protein diets might be advantageous for muscle mass, actual dietary patterns, particularly as they pertain to protein, have remained relatively unchanged in American adults. This lack of change may, in part, result from confusion over the purported detrimental effects of higher-protein diets. This manuscript will highlight common perceptions and benefits of dietary protein on muscle mass, address misperceptions related to higher-protein diets, and comment on the translation of academic advances to real-life application and health benefit. Given the vast research evidence supporting the positive effects of dietary protein intake on optimal health, we encourage critical evaluation of current protein intake recommendations and responsible representation and application of the RDA as a minimum protein requirement rather than one determined to optimally meet the needs of the population.
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Affiliation(s)
- John W Carbone
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI 48197, USA.
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, USA.
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22
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Darling AL, Manders RJF, Sahni S, Zhu K, Hewitt CE, Prince RL, Millward DJ, Lanham-New SA. Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years. Osteoporos Int 2019; 30:741-761. [PMID: 30903209 DOI: 10.1007/s00198-019-04933-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
We undertook a systematic review and meta-analysis of published papers assessing dietary protein and bone health. We found little benefit of increasing protein intake for bone health in healthy adults but no indication of any detrimental effect, at least within the protein intakes of the populations studied. This systematic review and meta-analysis analysed the relationship between dietary protein and bone health across the life-course. The PubMed database was searched for all relevant human studies from the 1st January 1976 to 22nd January 2016, including all bone outcomes except calcium metabolism. The searches identified 127 papers for inclusion, including 74 correlational studies, 23 fracture or osteoporosis risk studies and 30 supplementation trials. Protein intake accounted for 0-4% of areal BMC and areal BMD variance in adults and 0-14% of areal BMC variance in children and adolescents. However, when confounder adjusted (5 studies) adult lumbar spine and femoral neck BMD associations were not statistically significant. There was no association between protein intake and relative risk (RR) of osteoporotic fractures for total (RR(random) = 0.94; 0.72 to 1.23, I2 = 32%), animal (RR (random) = 0.98; 0.76 to 1.27, I2 = 46%) or vegetable protein (RR (fixed) = 0.97 (0.89 to 1.09, I2 = 15%). In total protein supplementation studies, pooled effect sizes were not statistically significant for LSBMD (total n = 255, MD(fixed) = 0.04 g/cm2 (0.00 to 0.08, P = 0.07), I2 = 0%) or FNBMD (total n = 435, MD(random) = 0.01 g/cm2 (-0.03 to 0.05, P = 0.59), I2 = 68%). There appears to be little benefit of increasing protein intake for bone health in healthy adults but there is also clearly no indication of any detrimental effect, at least within the protein intakes of the populations studied (around 0.8-1.3 g/Kg/day). More studies are urgently required on the association between protein intake and bone health in children and adolescents.
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Affiliation(s)
- A L Darling
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| | - R J F Manders
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - S Sahni
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St, Boston, MA, 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - K Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - C E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - R L Prince
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - D J Millward
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - S A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
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Gaffney-Stomberg E, Marszewski P, MacArthur M, McClung JP, Matheny RW. Paracellular calcium flux across Caco-2 cell monolayers: Effects of individual amino acids. J Nutr Biochem 2018; 59:114-122. [DOI: 10.1016/j.jnutbio.2018.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/31/2022]
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Yackobovitch-Gavan M, Phillip M, Gat-Yablonski G. How Milk and Its Proteins Affect Growth, Bone Health, and Weight
. Horm Res Paediatr 2018; 88:63-69. [PMID: 28253494 DOI: 10.1159/000456662] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
Milk has long been recognized to constitute a complete, well-balanced source of the nutrients and energy required to ensure the proper postnatal growth and development of infants. A growing body of evidence suggests the positive effects of dairy products and particularly of milk proteins on linear growth also in older children, both healthy or during recovery from malnutrition. This evidence led the way to the performance of extensive research aimed to delineate the components of milk and the mechanisms acting to make milk so effective. The present review summarizes the current knowledge regarding the influence of milk and its proteins on linear growth in healthy and malnourished children, focusing also on other important aspects of healthy growth, including bone health, weight status, and body composition.
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Affiliation(s)
- Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Galia Gat-Yablonski
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
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25
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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.
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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
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26
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Shams-White MM, Chung M, Fu Z, Insogna KL, Karlsen MC, LeBoff MS, Shapses SA, Sackey J, Shi J, Wallace TC, Weaver CM. Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation. PLoS One 2018; 13:e0192459. [PMID: 29474360 PMCID: PMC5825010 DOI: 10.1371/journal.pone.0192459] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
Background Protein may have both beneficial and detrimental effects on bone health depending on a variety of factors, including protein source. Objective The aim was to conduct a systematic review and meta-analysis evaluating the effects of animal versus plant protein intake on bone mineral density (BMD), bone mineral content (BMC) and select bone biomarkers in healthy adults. Methods Searches across five databases were conducted through 10/31/16 for randomized controlled trials (RCTs) and prospective cohort studies in healthy adults that examined the effects of animal versus plant protein intake on 1) total body (TB), total hip (TH), lumbar spine (LS) or femoral neck (FN) BMD or TB BMC for at least one year, or 2) select bone formation and resorption biomarkers for at least six months. Strength of evidence (SOE) was assessed and random effect meta-analyses were performed. Results Seven RCTs examining animal vs. isoflavone-rich soy (Soy+) protein intake in 633 healthy peri-menopausal (n = 1) and post-menopausal (n = 6) women were included. Overall risk of bias was medium. Limited SOE suggests no significant difference between Soy+ vs. animal protein on LS, TH, FN and TB BMD, TB BMC, and bone turnover markers BSAP and NTX. Meta-analysis results showed on average, the differences between Soy+ and animal protein groups were close to zero and not significant for BMD outcomes (LS: n = 4, pooled net % change: 0.24%, 95% CI: -0.80%, 1.28%; TB: n = 3, -0.24%, 95% CI: -0.81%, 0.33%; FN: n = 3, 0.13%, 95% CI: -0.94%, 1.21%). All meta-analyses had no statistical heterogeneity. Conclusions These results do not support soy protein consumption as more advantageous than animal protein, or vice versa. Future studies are needed examining the effects of different protein sources in different populations on BMD, BMC, and fracture.
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Affiliation(s)
- Marissa M. Shams-White
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA United States of America
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA United States of America
| | - Zhuxuan Fu
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA United States of America
| | - Karl L. Insogna
- Yale Bone Center at the Yale School of Medicine, Yale University, New Haven, CT United States of America
| | - Micaela C. Karlsen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA United States of America
| | - Meryl S. LeBoff
- Skeletal Health and Osteoporosis Center and Bone Density Unit; Harvard Medical School, Boston, MA United States of America
- Endocrine, Diabetes and Hypertension Division, Brigham and Women's Hospital, Boston, MA United States of America
| | - Sue A. Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ United States of America
| | - Joachim Sackey
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA United States of America
- Department of Nutritional Sciences, Rutgers School of Health Professions, Newark, NJ United States of America
| | - Jian Shi
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA United States of America
| | - Taylor C. Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA United States of America
- Think Healthy Group, Inc, Washington DC United States of America
- * E-mail:
| | - Connie M. Weaver
- Department of Nutrition Science, Women’s Global Health Institute, Purdue University, Nutrition Science, West Lafayette, IN United States of America
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Koutsofta I, Mamais I, Chrysostomou S. The effect of protein diets in postmenopausal women with osteoporosis: Systematic review of randomized controlled trials. J Women Aging 2018; 31:117-139. [DOI: 10.1080/08952841.2018.1418822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Ioanna Koutsofta
- Department of Life Sciences, European University Cyprus, Nicosia, Cyprus
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavri Chrysostomou
- Department of Life Sciences, School of Science, European University Cyprus, Nicosia, Cyprus
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Langsetmo L, Shikany JM, Burghardt AJ, Cawthon PM, Orwoll ES, Cauley JA, Taylor BC, Schousboe JT, Bauer DC, Vo TN, Ensrud KE. High dairy protein intake is associated with greater bone strength parameters at the distal radius and tibia in older men: a cross-sectional study. Osteoporos Int 2018; 29:69-77. [PMID: 29063213 PMCID: PMC5772967 DOI: 10.1007/s00198-017-4261-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
Dairy protein but not plant protein was associated with bone strength of the radius and tibia in older men. These results are consistent with previous results in women and support similar findings related to fracture outcomes. Bone strength differences were largely due to thickness and area of the bone cortex. INTRODUCTION Our objective was to determine the association of protein intake by source (dairy, non-dairy animal, plant) with bone strength and bone microarchitecture among older men. METHODS We used data from 1016 men (mean 84.3 years) who attended the Year 14 exam of the Osteoporotic Fractures in Men (MrOS) study, completed a food frequency questionnaire (500-5000 kcal/day), were not taking androgen or androgen agonists, and had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal or diaphyseal tibia. Protein was expressed as percentage of total energy intake (TEI); mean ± SD for TEI = 1548 ± 607 kcal/day and for total protein = 16.2 ± 2.9%TEI. We used linear regression with standardized HR-pQCT parameters as dependent variables and adjusted for age, limb length, center, education, race/ethnicity, marital status, smoking, alcohol intake, physical activity level, corticosteroids use, supplement use (calcium and vitamin D), and osteoporosis medications. RESULTS Higher dairy protein intake was associated with higher estimated failure load at the distal radius and distal tibia [radius effect size = 0.17 (95% CI 0.07, 0.27), tibia effect size = 0.13 (95% CI 0.03, 0.23)], while higher non-dairy animal protein was associated with higher failure load at only the distal radius. Plant protein intake was not associated with failure load at any site. CONCLUSION The association between protein intake and bone strength varied by source of protein. These results support a link between dairy protein intake and skeletal health, but an intervention study is needed to evaluate causality.
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Affiliation(s)
- L Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - P M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health Sciences University, Portland, OR, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - B C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - J T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D C Bauer
- Departments of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - T N Vo
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
| | - K E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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Abstract
PURPOSE OF REVIEW Consumption of high-protein diets is increasingly popular due to the benefits of protein on preserving lean mass and controlling appetite and satiety. The paper is to review recent clinical research assessing dietary protein on calcium metabolism and bone health. RECENT FINDINGS Epidemiological studies show that long-term, high-protein intake is positively associated with bone mineral density and reduced risk of bone fracture incidence. Short-term interventional studies demonstrate that a high-protein diet does not negatively affect calcium homeostasis. Existing evidence supports that the negative effects of the acid load of protein on urinary calcium excretion are offset by the beneficial skeletal effects of high-protein intake. Future research should focus on the role and the degree of contribution of other dietary and physiological factors, such as intake of fruits and vegetables, in reducing the acid load and further enhancing the anabolic effects of protein on the musculoskeletal system.
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Affiliation(s)
- Jay J Cao
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND, 58202, USA.
- USDA ARS Grand Forks Human Nutrition Research Center, 2420 2nd Ave N, Grand Forks, ND, 58202-9034, USA.
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Siddique N, O'Donoghue M, Casey MC, Walsh J. Malnutrition in the elderly and its effects on bone health – A review. Clin Nutr ESPEN 2017; 21:31-39. [DOI: 10.1016/j.clnesp.2017.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/14/2017] [Accepted: 06/07/2017] [Indexed: 01/04/2023]
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Wallace TC, Frankenfeld CL. Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2017; 36:481-496. [PMID: 28686536 DOI: 10.1080/07315724.2017.1322924] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dietary intake of protein is fundamental for optimal acquisition and maintenance of bone across all life stages; however, it has been hypothesized that intakes above the current recommended dietary allowance (RDA) might be beneficial for bone health. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when preparing and reporting this systematic review and meta-analysis. A literature search strategy through April 11, 2017, was developed for the following 3 databases: PubMed, Ovid Medline, and Agricola. Included studies were those randomized controlled trials and prospective cohort studies among healthy adults ages 18 and older that examined the relationships between varying doses of protein intake at or above the current U.S. RDA (0.8 g/kg/d or 10%-15% of total caloric intake) from any source on fracture, bone mineral density (BMD)/bone mineral content (BMC), and/or markers of bone turnover. Twenty-nine articles were included for data extraction (16 randomized controlled trials [RCTs] and 13 prospective cohort studies). Meta-analysis of the prospective cohort studies showed high vs low protein intakes resulted in a statistically significant 16% decrease in hip fractures (standardized mean difference [SMD] = 0.84, 95% confidence interval [CI], 0.73, 0.95; I2 = 36.8%). Data from studies included in these analyses collectively lean toward the hypothesis that protein intake above the current RDA is beneficial to BMD at several sites. This systematic review supports that protein intakes above the current RDA may have some beneficial role in preventing hip fractures and BMD loss. There were no differences between animal or plant proteins, although data in this area were scarce. Larger, long-term, and more well-controlled clinical trials measuring fracture outcomes and BMD are needed to adequately assess whether protein intake above the current RDA is beneficial as a preventative measure and/or intervention strategy for osteoporosis. Key teaching points: • • Bone health is a multifactorial musculoskeletal issue, and optimal protein intakes are key in developing and maintaining bone throughout the life span. • • Dietary protein at levels above the current RDA may be beneficial in preventing hip fractures and BMD loss. • • Plant vs animal proteins do not seem to differ in their ability to prevent bone loss; however, data in this area are scarce. • • Larger, long-term RCTs using women not using hormone replacement therapy (HRT) are needed to adequately assess the magnitude of impact that protein intakes above the RDA have on preventing bone loss.
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Affiliation(s)
- Taylor C Wallace
- a Department of Nutrition and Food Studies , George Mason University , Fairfax , Virginia , USA.,b Think Healthy Group, Inc. , Washington , DC
| | - Cara L Frankenfeld
- c Department of Global and Community Health , George Mason University , Fairfax , Virginia , USA
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32
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Curneen JMG, Casey M, Laird E. The relationship between protein quantity, BMD and fractures in older adults. Ir J Med Sci 2017; 187:111-121. [PMID: 28674746 DOI: 10.1007/s11845-017-1642-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previously, no large-scale literature reviews have focussed on the relationship between dietary protein and its impact on bone mineral density (BMD) and fracture risk-as measures of bone health-in older adults and its potential impact as a primary prevention tool. AIMS The aim of this study was to assess the impact of varying dietary protein levels on bone health. METHODS A literature review of trials concerning older adults' (>50 years of age) and animals' varying protein intake in the diet and its effect on BMD (human and animal) and fracture risk (human only) was carried out. Additionally, a review of dietary assessment tools used in these studies was also analysed. RESULTS Ten out of fourteen trials assessing BMD and dietary protein quantity in humans and 3/4 in animal trials found a positive relationship between these two parameters. Four out of seven trials investigating the relationship between dietary protein quantity and fracture risk displayed a positive, protective effect of dietary protein levels on fracture risk. Sixty-two percent of studies used the Food-Frequency Questionnaire assessment method. DISCUSSION Increased protein intake in the diet is beneficial to bone health and reduces morbidity and mortality. The importance of using dietary protein, along with calcium and vitamin D, as a primary preventative strategy should be stressed, given the health and cost benefits that this would deliver, with a possible need for a higher level of protein in the diet of an elderly person than what is currently recommended.
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Affiliation(s)
- J M G Curneen
- University College Dublin, Belfield, Dublin 4, County Dublin, Ireland.
| | - M Casey
- Department of Geriatric Medicine, St James' Hospital, James' Street, Dublin 8, County Dublin, Ireland.
| | - E Laird
- Trinity College School of Biochemistry and Immunology, St James' Hospital, James' Street, Dublin 8, County Dublin, Ireland
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Shams-White MM, Chung M, Du M, Fu Z, Insogna KL, Karlsen MC, LeBoff MS, Shapses SA, Sackey J, Wallace TC, Weaver CM. Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation. Am J Clin Nutr 2017; 105:1528-1543. [PMID: 28404575 DOI: 10.3945/ajcn.116.145110] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Considerable attention has recently focused on dietary protein's role in the mature skeleton, prompted partly by an interest in nonpharmacologic approaches to maintain skeletal health in adult life.Objective: The aim was to conduct a systematic review and meta-analysis evaluating the effects of dietary protein intake alone and with calcium with or without vitamin D (Ca±D) on bone health measures in adults.Design: Searches across 5 databases were conducted through October 2016 including randomized controlled trials (RCTs) and prospective cohort studies examining 1) the effects of "high versus low" protein intake or 2) dietary protein's synergistic effect with Ca±D intake on bone health outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments. Strength of evidence was rated by group consensus. Random-effects meta-analyses for outcomes with ≥4 RCTs were performed.Results: Sixteen RCTs and 20 prospective cohort studies were included in the systematic review. Overall ROB was medium. Moderate evidence suggested that higher protein intake may have a protective effect on lumbar spine (LS) bone mineral density (BMD) compared with lower protein intake (net percentage change: 0.52%; 95% CI: 0.06%, 0.97%, I2: 0%; n = 5) but no effect on total hip (TH), femoral neck (FN), or total body BMD or bone biomarkers. Limited evidence did not support an effect of protein with Ca±D on LS BMD, TH BMD, or forearm fractures; there was insufficient evidence for FN BMD and overall fractures.Conclusions: Current evidence shows no adverse effects of higher protein intakes. Although there were positive trends on BMD at most bone sites, only the LS showed moderate evidence to support benefits of higher protein intake. Studies were heterogeneous, and confounding could not be excluded. High-quality, long-term studies are needed to clarify dietary protein's role in bone health. This trial was registered at www.crd.york.ac.uk as CRD42015017751.
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Affiliation(s)
- Marissa M Shams-White
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, and
| | - Mengxi Du
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhuxuan Fu
- Department of Public Health and Community Medicine, School of Medicine, and
| | - Karl L Insogna
- Yale Bone Center at the Yale School of Medicine, Yale University, New Haven, CT
| | - Micaela C Karlsen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Meryl S LeBoff
- Skeletal Health and Osteoporosis Center and Bone Density Unit, Harvard Medical School, Boston, MA.,Endocrine, Diabetes and Hypertension Division, Brigham and Women's Hospital, Boston, MA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
| | - Joachim Sackey
- Department of Public Health and Community Medicine, School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Taylor C Wallace
- National Osteoporosis Foundation, Arlington, VA; .,Department of Nutrition and Food Studies, George Mason University, Fairfax, VA; and
| | - Connie M Weaver
- Department of Nutrition Science, Women's Global Health Institute, Purdue University, West Lafayette, IN
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34
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Heer M, Baecker N, Frings-Meuthen P, Graf S, Zwart SR, Biolo G, Smith SM. Effects of high-protein intake on bone turnover in long-term bed rest in women. Appl Physiol Nutr Metab 2017; 42:537-546. [DOI: 10.1139/apnm-2016-0292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bed rest (BR) causes bone loss, even in otherwise healthy subjects. Several studies suggest that ambulatory subjects may benefit from high-protein intake to stimulate protein synthesis and to maintain muscle mass. However, increasing protein intake above the recommended daily intake without adequate calcium and potassium intake may increase bone resorption. We hypothesized that a regimen of high-protein intake (HiPROT), applied in an isocaloric manner during BR, with calcium and potassium intake meeting recommended values, would prevent any effect of BR on bone turnover. After a 20-day ambulatory adaptation to a controlled environment, 16 women participated in a 60-day, 6° head-down-tilt (HDT) BR and were assigned randomly to 1 of 2 groups. Control (CON) subjects (n = 8) received 1 g/(kg body mass·day)−1 dietary protein. HiPROT subjects (n = 8) received 1.45 g protein/(kg body mass·day)−1 plus an additional 0.72 g branched-chain amino acids per day during BR. All subjects received an individually tailored diet (before HDTBR: 1888 ± 98 kcal/day; during HDTBR: 1604 ± 125 kcal/day; after HDTBR: 1900 ± 262 kcal/day), with the CON group’s diet being higher in fat and carbohydrate intake. High-protein intake exacerbated the BR-induced increase in bone resorption marker C-telopeptide (>30%) (p < 0.001) by the end of BR. Bone formation markers were unaffected by BR and high-protein intake. We conclude that high-protein intake in BR might increase bone loss. Further long-duration studies are mandatory to show how the positive effect of protein on muscle mass can be maintained without the risk of reducing bone mineral density.
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Affiliation(s)
- Martina Heer
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Natalie Baecker
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Petra Frings-Meuthen
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Sonja Graf
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Sara R. Zwart
- University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Gianni Biolo
- Department of Clinical, Technological and Morphological Sciences, Division of Internal Medicine, University of Trieste, 34127 Trieste, Italy
| | - Scott M. Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA
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35
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Langsetmo L, Shikany JM, Cawthon PM, Cauley JA, Taylor BC, Vo TN, Bauer DC, Orwoll ES, Schousboe JT, Ensrud KE. The Association Between Protein Intake by Source and Osteoporotic Fracture in Older Men: A Prospective Cohort Study. J Bone Miner Res 2017; 32:592-600. [PMID: 27943394 PMCID: PMC5426558 DOI: 10.1002/jbmr.3058] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022]
Abstract
Dietary protein is a potentially modifiable risk factor for fracture. Our objectives were to assess the association of protein intake with incident fracture among older men and whether these associations varied by protein source or by skeletal site. We studied a longitudinal cohort of 5875 men (mean age 73.6 ± 5.9 years) in the Osteoporotic Fractures in Men (MrOS) study. At baseline, protein intake was assessed as percent of total energy intake (TEI) with mean intake from all sources = 16.1%TEI. Incident clinical fractures were confirmed by physician review of medical records. There were 612 major osteoporotic fractures, 806 low-trauma fractures, 270 hip fractures, 193 spine fractures, and 919 non-hip non-spine fractures during 15 years of follow-up. We used Cox proportional hazards models with age, race, height, clinical site, TEI, physical activity, marital status, osteoporosis, gastrointestinal surgery, smoking, oral corticosteroids use, alcohol consumption, and calcium and vitamin D supplements as covariates to compute hazard ratios (HRs) with 95% confidence intervals (CIs), all expressed per unit (SD = 2.9%TEI) increase. Higher protein intake was associated with a decreased risk of major osteoporotic fracture (HR = 0.92; 95% CI, 0.84 to 1.00) with a similar association found for low-trauma fracture. The association between protein and fracture varied by protein source; eg, increased dairy protein and non-dairy animal protein were associated with a decreased risk of hip fracture (HR = 0.80 [95% CI, 0.65 to 0.98] and HR = 0.84 [95% CI, 0.72 to 0.97], respectively), whereas plant-source protein was not (HR = 0.99 [95% CI, 0.78 to 1.24]). The association between protein and fracture varied by fracture site; total protein was associated with a decreased risk of hip fracture (HR = 0.84 [95% CI, 0.73 to 0.95]), but not clinical spine fracture (HR = 1.06 [95% CI, 0.92 to 1.22]). In conclusion, those with high protein intake (particularly high animal protein intake) as a percentage of TEI have a lower risk of major osteoporotic fracture. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Peggy M. Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Brent C. Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | - Tien N. Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Douglas C. Bauer
- Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Eric S. Orwoll
- Bone and Mineral Unit, Oregon Health Sciences University, Portland, OR
| | - John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
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36
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Wright CS, McMorrow AM, Weinheimer-Haus EM, Campbell WW. Whey Protein Supplementation and Higher Total Protein Intake Do Not Influence Bone Quantity in Overweight and Obese Adults Following a 36-Week Exercise and Diet Intervention. J Nutr 2017; 147:179-186. [PMID: 28003538 PMCID: PMC5265694 DOI: 10.3945/jn.116.240473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/02/2016] [Accepted: 11/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Controversy exists concerning the effects of higher total protein intake (TPro) on bone health, which may be associated with reduced bone mineral density (BMD). However, whey protein (WP) may induce bone formation because of its basic component, milk basic protein. OBJECTIVE This study assessed the effects of WP supplementation, TPro, and change in TPro (postsupplementation - presupplementation) on BMD and bone mineral content (BMC; total body, lumbar spine, total femur, and femoral neck) in overweight and class I obese middle-aged adults following an exercise intervention. METHODS This analysis used data from a double-blind, randomized, placebo-controlled 36-wk WP supplementation trial, wherein participants consumed a 1.7-MJ (400-kcal) supplement (0, 20, 40, or 60 g WP/d) along with their otherwise unrestricted diet while participating in a resistance and aerobic exercise intervention (3 d/wk). TPro was the summation of WP and habitual dietary intakes (4-d food record). Statistical analyses for WP were based on group and bone data [n = 186, 108 women; mean ± SD age: 49 ± 8 y; body mass index (BMI; in kg/m2): 30.1 ± 2.8], whereas TPro was based on dietary and bone data (n = 113, 70 women; age 50 ± 8 y; BMI 30.1 ± 2.9). RESULTS WP supplementation, regardless of dose, did not influence BMD or BMC following the intervention. By using a multiple linear regression model, TPro (expressed as g/d or g · kg-1 · d-1) and change in TPro (expressed as g/d) were not associated with responses over time in total or regional BMD or BMC. By using a cluster analysis approach [<1.0 (n = 41), 1.0-1.2 (n = 28), and ≥1.2 g · kg-1 · d-1 (n = 44)], TPro was also not associated with responses in total or regional BMD or BMC over time. CONCLUSION WP supplementation and total dietary protein intake did not negatively or beneficially influence bone quantity in overweight and obese adults during a 9-mo exercise intervention. This trial was registered at clinicaltrials.gov as NCT00812409.
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Affiliation(s)
- Christian S Wright
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
| | | | | | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
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37
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Mangano KM, Kenny AM. The Role of Diet and Nutritional Status in Recovery from Hip Fracture in the Elderly. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0164-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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38
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LEE WANGHEE, OKOS MARTINR. MODEL-BASED ANALYSIS OF IGF-1 EFFECT ON OSTEOBLAST AND OSTEOCLAST REGULATION IN BONE TURNOVER. J BIOL SYST 2016. [DOI: 10.1142/s0218339016500042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The main determinant of bone Ca accretion is a bimolecular regulatory network on osteoblast (OB) and osteoclast (OC). Even though IGF-1 is known as an important regulator in bone cell cycle, little has been done to model IGF-1 action in bone cell regulation. Thus, the objective is to develop a mathematical model that depicts the regulatory action of IGF-1 onto the OB and OC interaction, and to evaluate adolescent and adult bone Ca accretion in response to differences in IGF-1 levels. As a result, a dynamic model of OB and OC with two main regulatory systems, i.e., Receptor Activator for Nuclear Factor [Formula: see text]B (RANK)-RANK Ligand (RANKL)-osteoprogerin (OPG) system, and TGF-[Formula: see text], was augmented with the IGF-1, and incorporated into Ca kinetic data to predict exchangeable bone Ca. The developed model could predict a change in OB and OC levels in response to perturbations in regulators, producing results consistent with bone physiology and published experimental data. The model also estimated parametric difference in regulators between adults and adolescents, suggesting that RANKL/OPG in adolescents was about 4 times higher than in adults, while adolescent serum PTH and IGF-1 concentrations were 60% and 220% of those of adults, respectively. This study highlighted the influence of IGF-1 on the regulation of bone cells in positively modulating bone Ca, suggesting that IGF-1 may be an effective target for reducing bone loss by promoting mature OB.
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Affiliation(s)
- WANG-HEE LEE
- Department of Agricultural and Biological Engineering, Purdue University, 225 South University Street, West Lafayette, IN 47907-2093, USA
| | - MARTIN R. OKOS
- Department of Agricultural and Biological Engineering, Purdue University, 225 South University Street, West Lafayette, IN 47907-2093, USA
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Pasiakos SM. Metabolic advantages of higher protein diets and benefits of dairy foods on weight management, glycemic regulation, and bone. J Food Sci 2015; 80 Suppl 1:A2-7. [PMID: 25757894 DOI: 10.1111/1750-3841.12804] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 01/23/2023]
Abstract
The Inst. of Medicine and World Health Organization have determined that 0.8 to 0.83 g protein·kg(-1) ·d(-1) is the quantity of protein required to establish nitrogen balance in nearly all healthy individuals. However, consuming higher protein diets may be metabolically advantageous, particularly for overweight and obese adults attempting weight loss, and for physically active individuals such as athletes and military personnel. Studies have demonstrated that higher protein diets may spare lean body mass during weight loss, promote weight management, enhance glycemic regulation, and increase intestinal calcium absorption, which may result in long-term improvements in bone health. The extent to which higher protein diets are beneficial is largely attributed to the digestive and absorptive properties, and also to the essential amino acid (EAA) content of the protein. Proteins that are rapidly digested and absorbed likely contribute to the metabolic advantages conferred by consuming higher protein diets. The EAA profiles, as well as the digestive and absorptive properties of dairy proteins, such as whey protein and casein, are particularly advantageous because they facilitate a rapid, robust, and sustained delivery of EAAs to the periphery. This article reviews the scientific literature assessing metabolic advantages associated with higher protein diets on weight management, glycemic regulation, and bone, with emphasis given to studies evaluating the potential benefits associated with dairy.
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Affiliation(s)
- Stefan M Pasiakos
- Military Nutrition Div, US Army Research Inst. of Environmental Medicine, Natick, MA, U.S.A
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Kerstetter JE, Bihuniak JD, Brindisi J, Sullivan RR, Mangano KM, Larocque S, Kotler BM, Simpson CA, Cusano AM, Gaffney-Stomberg E, Kleppinger A, Reynolds J, Dziura J, Kenny AM, Insogna KL. The Effect of a Whey Protein Supplement on Bone Mass in Older Caucasian Adults. J Clin Endocrinol Metab 2015; 100:2214-22. [PMID: 25844619 PMCID: PMC4454800 DOI: 10.1210/jc.2014-3792] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT It has been assumed that the increase in urine calcium (Ca) that accompanies an increase in dietary protein was due to increased bone resorption. However, studies using stable Ca isotopes have found that dietary protein increases Ca absorption without increasing bone resorption. OBJECTIVE The objective of the study was to investigate the impact of a moderately high protein diet on bone mineral density (BMD). DESIGN This was a randomized, double-blind, placebo-controlled trial of protein supplementation daily for 18 months. SETTING The study was conducted at two institutional research centers. PARTICIPANTS Two hundred eight older women and men with a body mass index between 19 and 32 kg/m(2) and a self-reported protein intake between 0.6 and 1.0 g/kg participated in the study. INTERVENTION Subjects were asked to incorporate either a 45-g whey protein or isocaloric maltodextrin supplement into their usual diet for 18 months. MAIN OUTCOME MEASURE BMD by dual-energy x-ray absorptiometry, body composition, and markers of skeletal and mineral metabolism were measured at baseline and at 9 and 18 months. RESULTS There were no significant differences between groups for changes in L-spine BMD (primary outcome) or the other skeletal sites of interest. Truncal lean mass was significantly higher in the protein group at 18 months (P = .048). C-terminal telopeptide (P = .0414), IGF-1 (P = .0054), and urinary urea (P < .001) were also higher in the protein group at the end of the study period. There was no difference in estimated glomerular filtration rate at 18 months. CONCLUSION Our data suggest that protein supplementation above the recommended dietary allowance (0.8 g/kg) may preserve fat-free mass without adversely affecting skeletal health or renal function in healthy older adults.
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Mangano KM, Sahni S, Kiel DP, Tucker KL, Dufour AB, Hannan MT. Bone Mineral Density and Protein-Derived Food Clusters from the Framingham Offspring Study. J Acad Nutr Diet 2015; 115:1605-1613.e1. [PMID: 26038297 DOI: 10.1016/j.jand.2015.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 04/01/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dietary protein is beneficial to bone health; however, dietary patterns of protein intake and their relationship with bone mineral density (BMD) have not been evaluated. OBJECTIVE To examine the relationship of dietary protein food clusters with BMD at the femoral neck, trochanter, total femur, and lumbar spine among middle-aged and older men and women. DESIGN Cross-sectional study. PARTICIPANTS AND SETTING Two thousand seven hundred fifty-eight community-dwelling individuals from the Framingham Offspring Study. METHODS BMD was measured by Lunar DPX-L (Lunar Radiation Corporation) in 1996-2001. Dietary intakes were estimated using the Willett food frequency questionnaire in either 1995-1998 or 1998-2001, and the exam closest to a participant's BMD measurement was used. Cluster analysis (FASTCLUS procedure, k-means method) was used to classify participants into groups, determined by major sources of protein. Generalized linear regression was used to compare adjusted least-squares mean BMD across protein food clusters for all pairwise comparisons. RESULTS From 2,758 participants (44% men; mean age 61±9 years, range=29 to 86 years), five protein food clusters were identified (chicken, fish, processed foods, red meat, and low-fat milk). Three of these food clusters showed associations with BMD. The red meat protein food cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (red meat 0.898±0.005 g/cm(2) vs low-fat milk 0.919±0.007 g/cm(2); P=0.04). Further, the processed foods protein cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (processed foods 0.897±0.004 g/cm(2) vs low-fat milk 0.919±0.007 g/cm(2); P=0.02). A similar, yet nonsignificant, trend was observed for other BMD sites examined. CONCLUSIONS Diets with the greatest proportion of protein intake from red meat and processed foods may not be as beneficial to the skeleton compared with dietary patterns where the highest proportion of protein is derived from low-fat milk.
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Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V. Muscle and bone, two interconnected tissues. Ageing Res Rev 2015; 21:55-70. [PMID: 25804855 DOI: 10.1016/j.arr.2015.03.002] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 12/31/2022]
Abstract
As bones are levers for skeletal muscle to exert forces, both are complementary and essential for locomotion and individual autonomy. In the past decades, the idea of a bone-muscle unit has emerged. Numerous studies have confirmed this hypothesis from in utero to aging works. Space flight, bed rest as well as osteoporosis and sarcopenia experimentations have allowed to accumulate considerable evidence. Mechanical loading is a key mechanism linking both tissues with a central promoting role of physical activity. Moreover, the skeletal muscle secretome accounts various molecules that affect bone including insulin-like growth factor-1 (IGF-1), basic fibroblast growth factor (FGF-2), interleukin-6 (IL-6), IL-15, myostatin, osteoglycin (OGN), FAM5C, Tmem119 and osteoactivin. Even though studies on the potential effects of bone on muscle metabolism are sparse, few osteokines have been identified. Prostaglandin E2 (PGE2) and Wnt3a, which are secreted by osteocytes, osteocalcin (OCN) and IGF-1, which are produced by osteoblasts and sclerostin which is secreted by both cell types, might impact skeletal muscle cells. Cartilage and adipose tissue are also likely to participate to this control loop and should not be set aside. Indeed, chondrocytes are known to secrete Dickkopf-1 (DKK-1) and Indian hedgehog (Ihh) and adipocytes produce leptin, adiponectin and IL-6, which potentially modulate bone and muscle metabolisms. The understanding of this system will enable to define new levers to prevent/treat sarcopenia and osteoporosis at the same time. These strategies might include nutritional interventions and physical exercise.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Relevance of dietary protein concentration and quality as risk factors for the formation of calcium oxalate stones in cats. J Nutr Sci 2014; 3:e51. [PMID: 26101619 PMCID: PMC4473174 DOI: 10.1017/jns.2014.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 11/17/2022] Open
Abstract
The role of dietary protein for the development of feline calcium oxalate (CaOx) uroliths has not been conclusively clarified. The present study evaluated the effects of a varying dietary protein concentration and quality on critical indices for the formation of CaOx uroliths. Three diets with a high protein quality (10–11 % greaves meal/diet) and a varying crude protein (CP) concentration (35, 44 and 57 % in DM) were compared. Additionally, the 57 % CP diet was compared with a fourth diet that had a similar CP concentration (55 % in DM), but a lower protein quality (34 % greaves meal/diet). The Ca and oxalate (Ox) concentrations were similar in all diets. A group of eight cats received the same diet at the same time. Each feeding period was divided into a 21 d adaptation period and a 7 d sampling period to collect urine. There were increases in urinary volume, urinary Ca concentrations, renal Ca and Ox excretion and urinary relative supersaturation (RSS) with CaOx with increasing dietary protein concentrations. Urinary pH ranged between 6·34 and 6·66 among all groups, with no unidirectional effect of dietary protein. Lower renal Ca excretion was observed when feeding the diet with the lower protein quality, however, the underlying mechanism needs further evaluation. In conclusion, although the observed higher urinary volume is beneficial, the increase in urinary Ca concentrations, renal Ca and Ox excretion and urinary RSS CaOx associated with a high-protein diet may be critical for the development of CaOx uroliths in cats.
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Protein intake and lumbar bone density: the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Nutr 2014; 112:1384-92. [PMID: 25192416 DOI: 10.1017/s0007114514002220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dietary protein has been shown to increase urinary Ca excretion in randomised controlled trials, and diets high in protein may have detrimental effects on bone health; however, studies examining the relationship between dietary protein and bone health have conflicting results. In the present study, we examined the relationship between dietary protein (total, animal and vegetable protein) and lumbar spine trabecular volumetric bone mineral density (vBMD) among participants enrolled in the Multi-Ethnic Study of Atherosclerosis (n 1658). Protein intake was assessed using a FFQ obtained at baseline examination (2000-2). Lumbar spine vBMD was measured using quantitative computed tomography (2002-5), on average 3 years later. Multivariable linear and robust regression techniques were used to examine the associations between dietary protein and vBMD. Sex and race/ethnicity jointly modified the association of dietary protein with vBMD (P for interaction = 0·03). Among white women, higher vegetable protein intake was associated with higher vBMD (P for trend = 0·03), after adjustment for age, BMI, physical activity, alcohol consumption, current smoking, educational level, hormone therapy use, menopause and additional dietary factors. There were no consistently significant associations for total and animal protein intakes among white women or other sex and racial/ethnic groups. In conclusion, data from the present large, multi-ethnic, population-based study suggest that a higher level of protein intake, when substituted for fat, is not associated with poor bone health. Differences in the relationship between protein source and race/ethnicity of study populations may in part explain the inconsistent findings reported previously.
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Nicoll R, McLaren Howard J. The acid-ash hypothesis revisited: a reassessment of the impact of dietary acidity on bone. J Bone Miner Metab 2014; 32:469-75. [PMID: 24557632 DOI: 10.1007/s00774-014-0571-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 01/16/2014] [Indexed: 12/11/2022]
Abstract
The acid-ash hypothesis states that when there are excess blood protons, bone is eroded to provide alkali to buffer the net acidity and maintain physiologic pH. There is concern that with the typical Western diet, we are permanently in a state of net endogenous acid production, which is gradually reducing bone. While it is clear that a high acid-producing diet generates increased urinary acid and calcium excretion, the effect of diet does not always have the expected results on BMD, fracture risk and markers of bone formation and resorption, suggesting that other factors are influencing the effect of acid/alkali loading on bone. High dietary protein, sodium and phosphorus intake, all of which are necessary for bone formation, were thought to be net acid forming and contribute to low BMD and fracture risk, but appear under certain conditions to be beneficial, with the effect of protein being driven by calcium repletion. Dietary salt can increase short-term markers of bone resorption but may also trigger 1,25(OH)2D synthesis to increase calcium absorption; with low calcium intake, salt intake may be inversely correlated with BMD but with high calcium intake, salt intake was positively correlated with BMD. With respect to the effect of phosphorus, the data are conflicting. Inclusion of an analysis of calcium intake may help to reconcile the contradictory results seen in many of the studies of bone. The acid-ash hypothesis could, therefore, be amended to state that with an acid-producing diet and low calcium intake, bone is eroded to provide alkali to buffer excess protons but where calcium intake is high the acid-producing diet may be protective.
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Affiliation(s)
- Rachel Nicoll
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umeå, Sweden,
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Abstract
The process of bone mineralization and resorption is complex and is affected by numerous factors, including dietary constituents. Although some dietary factors involved in bone health, such as calcium and vitamin D, are typically associated with dairy products, plant-based sources of these nutrients also supply other key nutrients involved in bone maintenance. Some research suggests that vegetarian diets, especially vegan diets, are associated with lower bone mineral density (BMD), but this does not appear to be clinically significant. Vegan diets are not associated with an increased fracture risk if calcium intake is adequate. Dietary factors in plant-based diets that support the development and maintenance of bone mass include calcium, vitamin D, protein, potassium, and soy isoflavones. Other factors present in plant-based diets such as oxalic acid and phytic acid can potentially interfere with absorption and retention of calcium and thereby have a negative effect on BMD. Impaired vitamin B-12 status also negatively affects BMD. The role of protein in calcium balance is multifaceted. Overall, calcium and protein intakes in accord with Dietary Reference Intakes are recommended for vegetarians, including vegans. Fortified foods are often helpful in meeting recommendations for calcium and vitamin D. Plant-based diets can provide adequate amounts of key nutrients for bone health.
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Friedlander JI, Antonelli JA, Pearle MS. Diet: from food to stone. World J Urol 2014; 33:179-85. [DOI: 10.1007/s00345-014-1344-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
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Bihuniak JD, Sullivan RR, Simpson CA, Caseria DM, Huedo-Medina TB, O’Brien KO, Kerstetter JE, Insogna KL. Supplementing a low-protein diet with dibasic amino acids increases urinary calcium excretion in young women. J Nutr 2014; 144:282-8. [PMID: 24431325 PMCID: PMC3927545 DOI: 10.3945/jn.113.185009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/10/2013] [Accepted: 12/23/2013] [Indexed: 11/14/2022] Open
Abstract
Increasing dietary protein within a physiologic range stimulates intestinal calcium absorption, but it is not known if specific amino acids or dietary protein as a whole are responsible for this effect. Therefore, we selectively supplemented a low-protein (0.7 g/kg) diet with either the calcium-sensing receptor-activating amino acids (CaSR-AAAs) L-tryptophan, L-phenylalanine, and L-histidine, or the dibasic amino acids (DAAs) L-arginine and L-lysine, to achieve intakes comparable to the content of a high-protein diet (2.1 g/kg) and measured intestinal calcium absorption. Fourteen young women took part in a placebo-controlled, double-blind, crossover feeding trial in which each participant ingested a 6-d low-protein diet supplemented with CaSR-AAAs, DAAs, or methylcellulose capsules (control) after an 11-d adjustment period. All participants ingested all 3 diets in random order. Intestinal calcium absorption was measured between days 5 and 6 using dual-stable calcium isotopes ((42)Ca, (43)Ca, and (44)Ca). There was no difference in calcium absorption between the diet supplemented with CaSR-AAAs (22.9 ± 2.0%) and the control diet (22.3 ± 1.4%) (P = 0.64). However, calcium absorption tended to be greater during the DAA supplementation period (25.2 ± 1.4%) compared with the control diet period (22.3 ± 1.4%) (P < 0.10). Larger and longer clinical trials are needed to clarify the possible benefit of arginine and lysine on calcium absorption.
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Affiliation(s)
| | | | | | | | | | | | - Jane E. Kerstetter
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Karl L. Insogna
- Department of Internal Medicine, Section of Endocrinology and
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