Article

The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia

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Abstract

Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis. Therefore, the objective of this study was to examine the effectiveness of high calcium skimmed milk (Anlene Gold, New Zealand Milk, Wellington, New Zealand) to reduce bone loss in Chinese postmenopausal women. Two hundred subjects aged 55-65 years and who were more than 5 years postmenopausal were randomized to a milk group and control group. The milk group consumed 50 g of high calcium skimmed milk powder daily, which contained 1200 mg calcium (taken as two glasses of milk a day). The control group continued with their usual diet. Using repeated measures ANCOVA, the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months (control -1.04%, milk -0.13%; P<0.001). At the lumbar spine, the percentage of bone loss in the control group was significantly higher (-0.90%) when compared to the milk (-0.13%) supplemented group at 24 months (P<0.05). Similarly, milk supplementation reduced the percentage of bone loss at the femoral neck (control -1.21%, milk 0.51%) (P<0.01) and total hip (control -2.17%, milk -0.50%) (P<0.01). The supplemented group did not experience any significant weight gain over the 24 months. The serum 25-hydroxy vitamin D level improved significantly (P<0.01) from 69.1 +/- 16.1 nmol/l at baseline to 86.4 +/- 22.0 nmol/l at 24 months in the milk group. In conclusion, ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinically important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia. Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects.

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... Dairy intake and bone health in Middle-aged to older adults (!50-years) Data from 50 studies, including 14 RCTs (Chee et al. 2003;Chen et al. 2015;Daly et al. 2005Daly et al. , 2008Gui et al. 2012;Ilich et al. 2019;Lau et al. 2001Lau et al. , 2002Manios et al. 2007;Moschonis et al. 2011;Prince et al. 2009;Storm et al. 1998;Ting et al. 2007;Tu et al. 2015), 17 prospective cohort studies (Aslam et al. 2019;Benetou et al. 2011;Biver et al. 2018;Cumming et al. 1997;Feart et al. 2013;Feskanich et al. 2014Feskanich et al. , 2018Fujiwara et al. 1997;Holvik et al. 2019;Michaelsson et al. 2014Michaelsson et al. , 2018Nevitt et al. 2005;Owusu et al. 1997;Roy et al. 2003;Sahni et al. 2013Sahni et al. , 2014Sahni et al. , 2017, 10 cross-sectional studies (Chan et al. 2020;Eysteinsdottir et al. 2014;Lanyan et al. 2020;Lunt et al. 2001;Opotowsky and Bilezikian 2003;Mangano et al. 2019;McCabe et al. 2004;Murphy et al. 1994;Sato et al. 2015;Zhu et al. 2018), and 8 case-controlled studies (Cumming and Klineberg 1994;Jha et al. 2010;Jitapunkul, Yuktananandana, and Parkpian 2001;Johnell et al. 1995;Kanis et al. 1999;Lan et al. 2010;Nieves, Grisso, and Kelsey 1992;Tavani, Negri, and Vecchia 1995) were identified in the literature search (Table 7). ...
... RCTs Chee et al. (2003) found high-calcium skimmed milk powder (1200 mg calcium and 10 lg vitamin D taken as 2-glasses daily) versus the control to be effective in reducing BMD loss at the total body, lumbar spine, femoral neck, and total hip, after a 2-year RCT of postmenopausal Malaysian women age 55-to 65-years. Chen et al. (2015) found consumption of high-calcium milk powder (450 mg calcium and 400 IU vitamin D) versus the control to be effective in reducing BMD loss at the lumbar spine, but not hip, after 2years in an RCT of postmenopausal Chinese women age 50to 65-years. ...
... Ting et al. (2007) found beneficial effects of a high-calcium milk supplement on percent change in total body, spine L2-L4, femoral neck, and total hip BMD to still be evident in a 21-month RCT of postmenopausal Chinese females age 55-to 70-years (n ¼ 139 of the original 173 subjects). The group had previously reported high-calcium milk to increase total body, spine L2-L4, femoral neck, and total hip BMD in this group over a 24-month duration (Chee et al. 2003). Tu et al. (2015) found that kefir-fermented milk therapy was not associated with significant short-term changes in total hip, femoral neck, or spine BMD in an RCT of Taiwanese male and female osteoporotic patients (mean age 64-and 67years, respectively) over a 6-month duration. ...
Article
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Over the past 30-years, the U.S. Dietary Guidelines for Americans have included recommendations around dairy consumption, largely based on meeting recommendations for calcium intake with the intended purpose of osteoporosis prevention. Although dairy products provide more bone-beneficial nutrients (e.g., calcium, magnesium, potassium, zinc, phosphorus, and protein) per unit of energy than any other food group, the relevance of dairy products for long-term bone health and fracture prevention has resurged as some observational studies have suggested consumption to be associated with a greater risk of fractures. Given this controversy, we sought to synthesize the evidence on dairy consumption and bone health across the lifespan. We searched the PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases for English-language publications through June 2, 2020. Case-controlled, cross-sectional, prospective cohort or nestled case-control (or case cohort), and clinical trials reporting the effect of dairy products on bone mineral density, bone mineral content, and/or fractures were included in the systematic review. Two reviewers independently performed data extractions. Data from 91 publications, including 30 RCTs, 28 prospective cohorts, 23 cross-sectional studies, and 10 case-control studies were included in the systematic review. We assigned a "D" grade or "insufficient evidence" for the effect of dairy in infants and toddlers (0- to <36-months), children (3- to <10-years), and young adults (19- to <50-years). A "C" grade or "limited evidence" was assigned for the effect of dairy in adolescents (10- to <19-years). A "B" grade or "moderate" evidence was assigned for the effect of dairy in middle aged to older adults (≥50-years). Research on bone mass in adults between the ages of 20- to 50-years and individuals from other ethnic groups apart from Chinese females and Caucasians is greatly needed. Daily intake of low or nonfat dairy products as part of a healthy habitual dietary pattern may be associated with improved BMD of the total body and at some sites and associated with fewer fractures in older adults.
... Daily consumption of milk fortified with 800 mg calcium was shown to reduce bone loss in a study of Chinese women living in Hong Kong [20,21]. An intervention with Chinese women in Malaysia supplying a higher dose of calcium, 1200 mg, in fortified milk, significantly reduced the percentage total body, femoral neck and total hip bone loss over 24 months, compared to the control group [22]. The fortified milk also contained vitamin D 10 µg/day, which resulted in improved vitamin D status even though the average serum 25 (OH)D3 for these women was 69 nmol/L at baseline. ...
... The improvement in vitamin D status in the Int group could be an indication of study adherence and results and further relationships should be interpreted with caution. The levels we measured in the women compare well with those reported for Chinese women living in Malaysia [7,22], where both studies reported a mean of 68.8 nmol/L and as well as a significant inverse relationship between vitamin D status and PTH levels. In our study, we did not observe a significant inverse relationship between 25(OH)D3 levels and PTH. ...
... Huang et al. [37] reported a reduction in PTH levels, bone resorption and bone loss in postmenopausal Chinese women in response to 1000 mg calcium and 10 µg of vitamin D for 12 months. Chee et al. [22] reported significantly less bone loss at the femoral neck as well as total hip over 2 years of supplementation of postmenopausal Chinese women with fortified milk. Femoral neck BMD indeed increased in the intervention group at months 18 and 24 of supplementation. ...
Article
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PurposeIn Malaysia, hip fracture incidence is higher in Chinese women than other ethnic groups. This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-inulin versus regular milk over 1 year on aspects of bone health in Chinese postmenopausal women in Malaysia. Methods One-hundred and twenty-one women (mean age 59 (± 4) years) were randomized into two groups: control (n = 60; regular milk, 428 mg calcium per day) or intervention (n = 61; fortified milk at 1200 mg calcium, 96 mg magnesium, 2.4 mg zinc, 15 μg vitamin D and 4 g FOS-inulin per day). At baseline, weeks 12, 24, 36 and 52, parathyroid hormone (PTH), C-Telopeptide of Type I Collagen (CTx-1), Procollagen I Intact N-Terminal propeptide (PINP) and vitamin D levels were assessed. Bone density (BMD) was measured at baseline and week 52 using a GE Lunar iDXA. ResultsBody mass index, lumbar spine and femoral neck BMD did not differ between groups at baseline. Over 52 weeks, mean plasma 25 (OH) D3 levels increased to 74.8 nmol/L (intervention group) or remained at 63.1 nmol/L (control group) (p < 0.001 between groups). PTH levels increased in the control group (p = 0.001). The intervention resulted in a significant suppression of CTx-1 and PINP at p = 0.018 and p = 0.004. Femoral neck BMD remained stable in the intervention group but decreased significantly in the controls, with a borderline treatment effect (p = 0.07). Conclusion Compared with regular milk, the fortified milk suppressed bone turnover markers and tended to increase femoral neck BMD.
... The Asian dietary pattern is different from Western diets, which may require other nutritional strategies. A limited number of studies in Chinese women have shown that milk supplementation for 24 mo increased calcium intake and led to less bone loss (17)(18)(19). In addition, men should not be overlooked. ...
... The intervention group met this level as well; mean serum concentrations increased to 80 nmol/L. A similar improvement in serum 25(OH)D concentrations after milk supplementation was also found in other studies in postmenopausal Chinese women (17,18). ...
... In the study of Lau et al. (17), milk supplementation for 2 y in apparently healthy postmenopausal Chinese women aged 55-59 y resulted in less bone loss at different sites. This was also found in the study of Chee et al. (18), who performed a 2-y milk supplementation study in apparently healthy postmenopausal Chinese women aged 50-65 y in Malaysia. Unfortunately, we had only indirect measures of bone health and no information about BMD. ...
Article
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Background. Hong Kong faces several public health problems including malnutrition and osteoporosis. Considering the typical Chinese diet and overall low physical activity levels of Chinese adults, timely interventions to improve nutritional status and bone health are needed. Objectives. We examined the effects of a nutrition plus exercise intervention on serum vitamin B-12 and 25-hydroxyvitamin D [25(OH)D], bone turnover markers, and parathyroid hormone (PTH) concentrations in apparently healthy Chinese middle-aged and older adults. Methods. In this 24-wk randomized controlled trial, 180 Chinese adults (85 women, mean ± SD age: 61 ± 6 y) were randomly assigned to receive a fortified milk supplement (2 × 30 g/d) and an exercise program (2 × 1 h/wk including resistance, balance, and aerobic training) or no intervention. The primary outcome was physical performance. In this article we analyzed the secondary outcomes serum vitamin B-12 and 25(OH)D concentrations, assessed at baseline, 12 wk, and 24 wk. Also, bone turnover markers and PTH concentrations were studied. Linear mixed models evaluated group differences over time. Results. A significant time × group interaction (P < 0.001) was found for serum vitamin B-12 and 25(OH)D concentrations and the bone turnover markers, but not for serum PTH concentrations (P = 0.09). The intervention increased mean ± SD vitamin B-12 concentrations from baseline (345 ± 119 pmol/L) to 24 wk (484 ± 136 pmol/L), whereas concentrations remained stable within the control. For 25(OH)D concentrations, the intervention group had a greater increase from baseline (54.7 ± 14.2 nmol/L) to 24 wk (80.1 ± 19.2 nmol/L) than the control (60.6 ± 15.2 compared with 65.6 ± 14.6 nmol/L). The ratio of the net effect of bone formation and resorption was greater in the intervention group, suggesting less bone remodeling, irrespective of sex. Conclusions. A fortified milk supplement and exercise intervention successfully improved vitamin B-12 and 25(OH)D concentrations as well as the balance of bone turnover markers of Chinese middle-aged and older adults. This trial was registered at trialregister.nl as NTR6214.
... Randomized controlled trials (RCT) using dairy foods have reported a beneficial impact on markers of bone turnover (Heaney et al., 2002;Bonjour et al., 2008) as well as on bone mineral density (BMD) (Chee et al., 2003;Moschonis et al., 2010) in postmenopausal women, but very limited work has compared equivalent amounts of calcium from dairy foods vs. supplements on the same bone outcome variables (Recker and Heaney, 1985;Prince et al., 1995;Manios et al., 2007). ...
... This 16-week crossover trial compared treatment with 1200 mg/day calcium from semi skimmed milk vs. no milk supplement and found significant changes in bone formation markers amino-terminal propeptide of type 1 procollagen (P1NP) and osteocalcin, but not in BAP. Likewise, no significant PTH change during either treatment is consistent with previous reports that calcium intake prevents increases in PTH over time (Chee et al., 2003;Manios et al., 2007). Calcium tablets have been shown to significantly decrease PTH after 6 months (Prince et al., 1995), but the six week treatment duration in the present study may have been insufficient to observe this suppressive effect. ...
Article
Background: Few interventions directly compare equivalent calcium and vitamin D from dairy vs. supplements on the same bone outcomes. The radioisotope calcium-41 ((41)Ca) holds promise as a tracer method to directly measure changes in bone resorption with differing dietary interventions. Objective: Using (41)Ca tracer methodology, determine if 4 servings/day of dairy foods results in greater (41)Ca retention than an equivalent amount of calcium and vitamin D from supplements. Secondary objective was to evaluate the time course for the change in (41)Ca retention. Methods: In this crossover trial, postmenopausal women (n = 12) were dosed orally with 100 nCi of (41)Ca and after a 180 day equilibration period received dairy (4 servings/day of milk or yogurt; ~ 1300 mg calcium, 400 IU cholecalciferol (vitamin D3/day)) or supplement treatments (1200 mg calcium carbonate/day and 400 IU vitamin D3/day) in random order. Treatments lasted 6 weeks separated by a 6 week washout (WO). Calcium was extracted from weekly 24 h urine collections; accelerator mass spectrometry (AMS) was used to determine the (41/40)Ca ratio. Primary outcome was change in (41/40)Ca excretion. Secondary outcome was the time course for change in (41)Ca excretion during intervention and WO periods. Results: The (41/40)Ca ratio decreased significantly over time during both treatments; there was no difference between treatments. Both treatments demonstrated a significant retention of (41)Ca within 1-2 weeks (p = 0.0007 and p < 0.001 for dairy and supplements, respectively). WO demonstrated a significant decrease (p = 0.0024) in (41)Ca retention within 1-2 weeks, back to pre-intervention levels. Conclusion: These data demonstrate that urinary (41)Ca retention is increased with an increase in calcium and vitamin D intake regardless of the source of calcium, and the increased retention occurs within 1-2 weeks.
... Randomized controlled trials (RCT) using dairy foods have reported a beneficial impact on markers of bone turnover (Heaney et al., 2002;Bonjour et al., 2008) as well as on bone mineral density (BMD) (Chee et al., 2003;Moschonis et al., 2010) in postmenopausal women, but very limited work has compared equivalent amounts of calcium from dairy foods vs. supplements on the same bone outcome variables (Recker and Heaney, 1985;Prince et al., 1995;Manios et al., 2007). ...
... This 16-week crossover trial compared treatment with 1200 mg/day calcium from semi skimmed milk vs. no milk supplement and found significant changes in bone formation markers amino-terminal propeptide of type 1 procollagen (P1NP) and osteocalcin, but not in BAP. Likewise, no significant PTH change during either treatment is consistent with previous reports that calcium intake prevents increases in PTH over time (Chee et al., 2003;Manios et al., 2007). Calcium tablets have been shown to significantly decrease PTH after 6 months (Prince et al., 1995), but the six week treatment duration in the present study may have been insufficient to observe this suppressive effect. ...
Article
Few interventions directly compare equivalent calcium and vitamin D from dairy vs supplements on the same bone outcomes. Objectives and Methods: Using ⁴¹Ca tracer techniques, determine if 4 servings/d of dairy foods reduces Ca excretion more than an equivalent amount of Ca and vitamin D from supplements. Secondary objective was to evaluate the time course for change in Ca excretion. Design: In this crossover trial, postmenopausal women (n=12) were dosed orally with 100nCi of ⁴¹Ca and received dairy (4 servings/d dairy foods; ~1300 mg Ca, 400 IU vitamin D3/d) or supplements (1200 mg Ca carbonate/d, 400 IU vitamin D3/d) in random order. Treatments lasted 6 weeks separated by a 6 week washout (WO). Ca was extracted from weekly 24 h urine collections; accelerator mass spectrometry (AMS) was used to determine the urinary 41/40Ca ratio. Results: Urinary 41/40Ca ratio decreased significantly with treatment, but there was no difference between treatments. The reduction in ⁴¹Ca excretion was observed in 1–2 weeks (P=0.0007 and P<0.001 for dairy and supplements, respectively). Return to pre-treatment excretion levels was observed within 1–2 weeks WO (P=0.0024). Conclusion: These data suggest that changes in urinary Ca excretion with increases or decreases in Ca intake occur within 1–2 weeks; most likely via the miscible pool to maintain Ca homeostasis.
... However, studies suggested that current fortification programs in Canada are not successful in preventing undesirable status of vitamin D, particularly among at risk populations during winter time (28)(29). In fortification programs Nutrition and Food Sciences Research milk products, bread, orange juice, vegetable oils and margarine have been used as a fortification vehicle for vitamin D (26)(27)30). Some evidence showed that milk can be an effective vehicle for fortification (30). ...
... In fortification programs Nutrition and Food Sciences Research milk products, bread, orange juice, vegetable oils and margarine have been used as a fortification vehicle for vitamin D (26)(27)30). Some evidence showed that milk can be an effective vehicle for fortification (30). However, several national and sporadic reports have shown that milk is not adequately consumed in Iran (31). ...
... 10,22 Some narrative reviews suggest that adequate dairy product consumption helps maintain weight during caloric excess and facilitates weight loss when hypocaloric diets are followed. 10,11,23 However, some authors who implemented interventions to investigate the associations between dairy product consumption and body weight and body composition have reported no benefit, [24][25][26][27][28][29] while others have indicated that higher levels of dairy product consumption are associated with increased weight. 30 Some meta-analyses suggest that dairy consumption may not influence body weight or body composition in the absence of energy restriction, 31,32 but others suggest that dairy consumption leads to an increase in weight 33 ; furthermore, some metaanalyses, [31][32][33] but not all, 34 suggest that dairy consumption may reduce body weight and fat mass in the context of energy restriction (defined as a reduction of almost 500 kcal per day less than the estimated energy requirement). ...
... Some RCTs have shown that interventions with non-energy-restricted diets imply higher energy intake in control groups, which does not always translate into an increase in weight or body fat. [25][26][27]55 Geng et al 33 suggested that the positive effect of dairy consumption may be masked by the effect of adding energy to the diet if the dairy products added do not replace other foods in the diet. However, this suggestion should be considered with caution, because the RCTs used self-reported energy intake to estimate differences in energy consumption, which is an invalid method of estimating actual energy intake. ...
Article
Context: Some studies suggest that consumption of dairy products can aid in weight loss, while others suggest a negative effect or no effect. Objective: An overview of systematic reviews and meta-analyses was conducted to examine the effect of dairy product consumption on changes in body composition. Data sources: PRISMA guidelines were followed to ensure transparent reporting of evidence. The MEDLINE, Embase, Cochrane Central Database of Systematic Reviews, and Web of Science databases were searched from inception to April 2018. Study selection: Six systematic reviews and 47 associated meta-analyses (which included the results of 58 different randomized controlled trials) published in English or Spanish and reporting data on dairy intake and changes in weight, fat mass, lean mass, or waist circumference were included. Data extraction: Two authors independently extracted the data and assessed the risk of bias using the AMSTAR2 tool. Results: Dairy consumption interventions without dietary energy restriction had no significant effects on weight, fat mass, lean mass, or waist circumference. Interventions in energy-restricted settings had significant effects on fat mass and body weight. Conclusions: Increasing total dairy intake without energy restriction in adults does not affect body composition. In the context of an energy-restricted diet, however, increased dairy intake results in lower fat mass and body weight but has no conclusive effects on waist circumference or lean mass. Systematic review registration: PROSPERO registration number CRD42018094672.
... The study also confirmed that milk might affect on bone density in other parts of the body (15). Consumption of highcalcium skim milk can effectively reduce bone loss in the hip in postmenopausal Chinese women in Malaysia, which is consistent with our study (27). A review study of older women using regular or fortified milk reports significant changes in bone biomarkers and some changes in bone density but no reduction in fracture risk (28). ...
Article
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Background Cow milk contains more calcium, magnesium, potassium, zinc, and phosphorus minerals. For a long time, people have believed that increasing milk intake is beneficial to increasing bone density. Many confounding factors can affect milk consumption, and thus the association described to date may not be causal. We explored the causal relationship between genetically predicted milk consumption and Bone Mineral Density (BMD) of the femoral neck and lumbar spine based on 53,236 individuals from 27 studies of European ancestry using the Mendelian randomization (MR) study. 32,961 individuals of European and East Asian ancestry were used for sensitivity analysis. Methods A genetic instrument used for evaluating milk consumption is rs4988235, a locus located at 13,910 base pairs upstream of the LCT gene. A Mendelian randomization (MR) analysis was conducted to study the effect of selected single nucleotide polymorphisms (SNPs) and BMD. The summary-level data for BMD of the femoral neck and lumbar spine were obtained from two GWAS meta-analyses [‘Data Release 2012’ and ‘Data Release 2015’ in the GEnetic Factors for OSteoporosis Consortium (GEFOS)]. Results we found that genetically predicted milk consumption was not associated with FN-BMD(OR 1.007; 95% CI 0.991–1.023; P = 0.385), LS-BMD(OR 1.003; 95% CI 0.983–1.024; P = 0.743) by performing a meta-analysis of several different cohort studies. High levels of genetically predicted milk intake were positively associated with increased FN-BMD in Women. The OR for each additional milk intake increasing allele was 1.032 (95%CI 1.005–1.059; P = 0.014). However, no causal relationship was found between milk consumption and FN-BMD in men (OR 0.996; 95% CI 0.964–1.029; P = 0.839). Genetically predicted milk consumption was not significantly associated with LS-BMD in women (OR 1.017; 95% CI 0.991–1.043; P = 0.198) and men (OR 1.011; 95% CI 0.978–1.045; P = 0.523). Conclusion Our study found that women who consume more milk have a higher FN-BMD. When studying the effect of milk consumption on bone density in further studies, we need to pay more attention to women.
... Un estudio en China en el que se suplementó durante tres años con leche en polvo adicionada con calcio a mujeres postmenopáusicas encontró una disminución sustancial de la pérdida ósea 24 . Resultados semejantes se observaron en mujeres postmenopáusicas en Malasia 25 . ...
Article
Calcium intake has a role on the development of peak bone mass, and has a mild impact on the maintenance of bone mass during adulthood and the reduction of bone loss rate in postmenopausal women and the elderly in both genders. Calcium dietary intake should be privileged over supplementation. Dairy products are the main calcium dietary sources. Prospective studies have not clearly demonstrated an effect on the prevention of fractures, because of the practical difficulties of a long follow-up in order to get to solid conclusions; however the physiological rationale is that an adequate calcium intake and 25(OH) vitamin D levels exceeding 20 ng/ml is beneficial for bone health and may decrease to certain extent the risk of fractures.
... Bioactive peptides are specific fragments of parent protein containing 2-20 amino acids sequence (Di Bernardini et al. 2011). Previous studies have demonstrated that milk and dairy products prevents bone loss by increasing bone mineral density in pre-and postmenopausal women (Matkovic et al. 2004;Chee et al. 2003). In addition, several studies have reported bone health promoting effects milk derived bioactive peptides in vitro Huttunen et al. 2008). ...
Article
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In the last decade, several studies have reported health beneficial effects of milk derived bioactive peptides in several degenerative diseases including postmenopausal osteoporosis. Here in the present study we investigate antiosteopenic effect of buffalo milk casein-derived peptide (NAVPITPTL) in ovariectomized (OVX) rats. The animals were divided into four groups (n = 8): Sham, OVX, OVX + peptide (100 µg/kg), and OVX + PTH (30 µg/kg). At the end of 8 weeks of respective treatments, femur anthropometric, bone mineral density (BMD), biochemical and immunological parameters were analyzed. The results indicated that daily treatment of peptide at 100 µg/kg to OVX rats partially prevented body weight gain, uterine weight loss and uterine atrophy. Moreover, micro-CT 3D image data showed that OVX induced significant (P < 0.05) alteration in bone microarchitecture and subsequent bone loss. Interestingly, peptide significantly (P < 0.05) increased BMD and restored femur microarchitectural parameters altered by OVX. In addition, peptide treatment significantly (P < 0.05) improved the biomechanical bone strength as revealed by three-point bending test of femur mid-diaphysis in OVX rats. Furthermore, peptide treatment significantly (P < 0.05) suppressed RANKL, IL-6, TNF-α and increased TGF-β expression. Altogether, this peptide exhibits osteoprotective effects and could be a beneficial agent in the prevention and management of postmenopausal osteoporosis.
... Chee et al. [25] 2003 Habitual diet Extra 50 g high-calcium skimmed-milk powder with 400 mL H 2 O ...
Article
Scope: Effects of dairy consumption on body weight and body composition have been inconsistently observed in randomized control trials (RCTs). Our meta-analysis aimed to systematically evaluate the effects of dairy consumption on body weight and body composition among the adults. Methods and results: We conducted a comprehensive search of the Cochrane Library, PubMed and Embase databases of the relevant studies from 1966 to Mar 2017 regarding dairy consumption on body weight and body composition including of body fat, lean mass and waist circumference (WC). The summary results were pooled by using a random-effects meta-analysis. 37 RCTs with 184,802 participants were included in this meta-analysis. High dairy intervention increased body weight (0.01, 95% CI: -0.25, 0.26, I(2) = 78.3%) and lean mass (0.37, 95% CI: 0.11, 0.62, I(2) = 83.4%); decreased body fat (-0.23, 95% CI: -0.48, 0.02, I(2) = 78.2%) and WC (-1.37, 95% CI: -2.28, -0.46, I(2) = 98.9%) overall. In the subgroup analysis, consumption of dairy products increased body weight (0.36, 95% CI: 0.01, 0.70, I(2) = 83.1%) among participants without energy restriction. Dairy consumption decreased body weight (-0.64, 95% CI: -1.05, -0.24, I(2) = 60.2%), body fat (-0.56, 95%CI: -0.95, -0.17, I(2) = 66.6%) and waist circumference (-2.18, 95%CI: -4.30, -0.06, I(2) = 99.0%) among the adults with energy restriction. Conclusions: This meta-analysis suggests a beneficial effect of energy-restricted dairy consumption on body weight and body composition. However, high dairy consumption in the absence of caloric restriction may increase body weight. This article is protected by copyright. All rights reserved.
... Long-term (24 months) administration of milk fortified with vitamin D 3 (at least 10 µg of vitamin per day) resulted in increased (from +7.4 to +25.0%) c02-2a.indd 226 6/20/2017 7:28:59 PM concentrations of calcitriol, the biologically active form of vitamin D, compared to baseline (Chee et al., 2003;Daly et al., 2006). Diabetic patients fed for 12 weeks with a yogurt drink fortified with vitamin D 3 (25 µg/die) showed more than 67% increase of calcitriol (Nikooyeh et al., 2011). ...
Chapter
The term functional food was first proposed in Japan in the last decade of the twentieth century. Apart from functional food available in nature, at least four categories of functional food should be considered: fortified food; enriched foods; altered foods; and enhanced commodities. A huge number of nutrients/components may be exploited for obtaining functional dairy foods. This chapter focuses on probiotic microorganisms and related food components, bioactive peptides, γ-aminobutyric acid (GABA), phytochemicals, and dairy products with altered lipid composition. One way in which foods are modified to become functional is by incorporating probiotics, prebiotics, or synbiontics. Antihypertensive and antioxidant peptides are among the most studied bioactive peptides. Vegetable extracts contain vast amount of plant secondary metabolites, among which phenolic compounds and phytosterols may positively affect human health. Fortification/enrichment of food with micronutrients represents an alternative or complementary strategy to supplementation (defined as the provision of micronutrients in capsule, tablet, or syrup form).
... Several of these bioactive peptides derived from milk proteins have been characterized by a wide range of beneficial health effects including antioxidative, mineral binding, antimicrobial, antithrombotic, immunomodulatory, opioid, and antihypertensive [12,13]. Epidemiologic and intervention studies have shown that milk and milk-derived peptides prevented the loss of BMD in pre-and postmenopausal women [14]. In addition to increasing bone growth, dairy products have been shown to improve BMD [15]. ...
Article
Background Oxidative stress has been implicated as a crucial pathogenic factor in the development of postmenopausal osteoporosis. Milk-derived antioxidative peptides are gaining much attention towards the development of pro-drugs for alleviating several human diseases including osteoporosis. Objectives The present study hypothesized that antioxidant peptides can be good candidates for alleviating postmenopausal osteoporosis. Research Methods & Procedures In the present study, an ovariectomized (OVX) osteoporotic rat model has been used to investigate the protective effects of buffalo milk casein-derived novel peptide VLPVPQK (PEP) against OVX-induced on bone loss and the related mechanisms. Results: Our results indicated that daily administration of antioxidative peptide PEP at 50 and 100μg/kg for eight weeks prevents body weight gain, uterine weight loss and atrophy of endometrial lumen. Moreover, PEP increased femur dry weight, ash weight, bone ash-calcium, and serum calcium and phosphorus level. Interestingly, PEP increased bone mineral density (BMD) and improved trabecular micro-architecture in both femur and tibia of OVX rats. In addition, PEP increased bone strength, reduced serum bone turnover markers, inhibited bone resorbing cytokines and decreased malondialdehyde (MDA) level in OVX rat. Furthermore, PEP elevated serum transforming growth factor (TGF-β), increased, reduced-glutathione (GSH) level, superoxide dismutase (SOD) and catalase (CAT) activity altered by OVX. Conclusion Altogether, we demonstrated that PEP exhibits anti-osteopenic effects via enhancement of antioxidant activity and reduction of bone-resorbing cytokines expression.
... Interventional studies of milk intake are methodologically more robust than case-control studies. They are few in number, however, and focused on postmenopausal women, in whom milk intake prevented bone loss at specific sites [22][23][24][25][26]. ...
Article
Cow's milk is often severely criticized as a cause of multiple health problems, including an increased risk of fractures. A close look at the scientific literature shows a striking contradiction. On the one hand, experimental studies of surrogate markers (e.g., bone turnover markers and bone mineral density [BMD]) usually indicate benefits from drinking cow's milk. On the other, the findings from epidemiological studies are conflicting and disconcerting. In all age groups, including children and postmenopausal women, consuming cow's milk, powdered milk supplements, or whey protein is associated with a slower bone turnover and unchanged or higher BMD values. These benefits are particularly marked in populations where calcium deficiency is prevalent, for instance in Asian countries. No interventional studies have addressed the fracture risk potentially associated with drinking cow's milk. The only available data come from epidemiological observational studies, whose results are conflicting, with a lower fracture risk in some cases and no difference or a higher risk in others. Several hypotheses have been offered to explain these findings, such as a deleterious effect of D-galactose, lactose intolerance, and acid overload. Epidemiological studies face many obstacles when seeking to detect effects of a single food, particularly the multiplicity of interactions among foods. Furthermore, reliable dietary intake data must be collected over prolonged periods, often long before the occurrence of a fracture, and defective recall may therefore introduce a major yet often unrecognized bias, particularly in populations where calcium deficiency is uncommon. To date, there is no conclusive evidence that we should modify our currently high level of consumption of cow's milk.
... In a study of 200 postmenopausal Chinese women in Malaysia (aged 55-65 y), those randomly assigned to a high-calcium skimmed-milk group (1200 mg calcium) had a reduced rate of bone loss at the hip and LS compared with the placebo group. This study further reported significant improvements in the serum 25-hydroxy vitamin D concentration in the milk group (P < 0.01) (37). Taken together, these studies suggest a protective role for dairy intake with hip and LS BMD. ...
Article
Background: Previous studies showed beneficial effects of specific dairy foods on bone health in middle-aged adults.Objective:We examined the association of milk, yogurt, cheese, cream, fluid dairy (milk + yogurt), and milk + yogurt + cheese intakes with bone mineral density (BMD) and 4-y percentage of change in BMD [▵%BMD; femoral neck, trochanter, and lumbar spine (LS)]. We further assessed whether these associations were modified by vitamin D supplement use in this cohort of older adults.Methods:Food-frequency questionnaire responses, baseline BMD (hip and spine,n= 862 in 1988-1989), and follow-up BMD (n= 628 in 1992-1993) were measured in the Framingham study, a prospective cohort study of older Caucasian men and women aged 67-93 y. Outcomes included baseline BMD and ▵%BMD. Dairy-food intakes (servings per week) were converted to energy-adjusted residuals, and linear regression was used, adjusting for covariates. These associations were further examined by vitamin D supplement use.Results:The mean age of the participants was 75 y. In the full sample, dairy-food items were not associated with BMD (P= 0.11-0.99) or with ▵%BMD (P= 0.29-0.96). Among vitamin D supplement users, but not among nonusers, higher milk, fluid dairy, and milk + yogurt + cheese intakes were associated with higher LS BMD (P= 0.011-0.009). Among vitamin D supplement users, but not among nonusers, higher milk + yogurt + cheese intakes were protective against trochanter BMD loss (P= 0.009).Conclusions:In this population of older adults, higher intakes of milk, fluid dairy, and milk + yogurt + cheese were associated with higher LS BMD, and a higher intake of milk + yogurt + cheese was protective against trochanter BMD loss among vitamin D supplement users but not among nonusers. These findings underscore that the benefits of dairy intake on the skeleton may be dependent on vitamin D intake.
... Due to these health benefits along with its nutritional value, milk is said to be a very good "Nutraceutical." Interventional studies have shown that milk and milk products prevent bone loss in pre-and postmenopausal women [25]. Dairy products are also known to increase bone mineral density besides bone growth [26]. ...
Article
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PurposeEpidemiological and intervention studies show that milk consumption in childhood and during adolescence is related to higher bone mineral density. Milk and milk products prevent the bone loss in pre- and postmenopausal women. Apart from calcium, there are other biologically active compounds in milk such as bioactive peptides which may play a role in promoting bone health. Casein is the major protein in milk which has also been reported to have numerous biological active peptides within it. The hypothesis of the present study was to identify the key peptides behind osteoanabolic nature of the milk protein, which further can be used to prepare functional foods to alleviate bone diseases like osteoporosis. Hence, this study was carried out to investigate osteogenic nature of four novel bioactive peptides [PEP1 (EDVPSER), PEP2 (NAVPITPTL), PEP3 (VLPVPQK) and PEP4 (HPHPHLSF)] derived from buffalo casein by in vitro osteoblast differentiation model. Methods Calvaria cells were isolated from 3-day-old rat pups, cultured under in vitro conditions till confluence and further used for experiments. Calvarial osteoblast cells were cultured in the presence or absence of peptides including positive controls up to 21 days. Effect of peptides was checked at regular intervals by quantifying osteoblast differentiation marker genes (ALP, OCN and COL-1) expression, alkaline phosphatase activity, osteocalcin level in culture supernatants, mineral deposition by alizarin red staining and caspase-3 and 9 assays. ResultsThe osteoblast differentiation marker genes (ALP, OCN and COL-1) expression was significantly [(p < 0.01) (p < 0.001)] up-regulated in the presence of these peptides. The peptides also significantly induced alkaline phosphatase activity, osteocalcin level and mineral deposition in comparison with the control. It was also observed that all the four peptides did not show any cytotoxic effect during 21-day treatment period. Conclusion All peptides enhanced osteoblast differentiation along with the positive controls. These results hold an immense scope to use peptides as preventive measure for reducing incidence of osteoporosis. These peptides can also be used as drugs and can be utilized as functional ingredients in functional foods preparation for osteoporosis therapy, but in vivo studies are required for further confirmation.
... Les études d'intervention avec le lait sont moins critiquables méthodologiquement que les études cas témoins mais sont peu nombreuses et menées chez la femme ménopausée où elles montrent que le lait protège de la perte osseuse à certains sites [22][23][24][25][26]. ...
Article
Le lait de vache fait régulièrement l’objet d’attaques répétées l’accusant d’être la cause de très nombreux problèmes de santé parmi lesquels on retrouve un risque augmenté de fractures. Lorsqu’on examine attentivement la littérature scientifique concernant le lait et la santé osseuse, on est frappé par la discordance qui existe entre les études expérimentales portant sur des critères intermédiaires : marqueurs du remodelage osseux, densité minérale osseuse (DMO), qui donnent la plupart du temps des résultats favorables à la consommation de lait de vache alors que les études épidémiologiques offrent des résultats contradictoires et déstabilisants. À tous les âges de la vie, notamment chez l’enfant et la femme ménopausée, la consommation de lait de vache ou la supplémentation de l’alimentation habituelle en poudre de lait ou bien encore en protéines du petit-lait réduit le remodelage osseux et améliore ou protège la DMO. Ces effets bénéfiques sont d’autant plus importants qu’ils se produisent au sein de populations carencées en calcium comme les populations asiatiques. Il n’y a pas d’études d’intervention évaluant le risque fracturaire lié à la consommation de lait de vache, mais seulement des études épidémiologiques, observationnelles. Les résultats de ces dernières montrent des résultats contradictoires ne permettant pas de conclure : tantôt protection contre les fractures, ou bien absence d’effet ou encore augmentation du risque fracturaire. Les auteurs de ces publications mettent en avant plusieurs mécanismes possibles : effet nocif du d-galactose, intolérance au lactose, augmentation de la charge acide, entre autres. Les études épidémiologiques rencontrent des difficultés pour mettre en évidence des effets d’un seul composant alimentaire en raison du grand nombre d’interactions nutritionnelles, des difficultés à recueillir sur de longues périodes les habitudes alimentaires des sujets, parfois très antérieures au recueil des données fracturaires, ce qui est à l’origine de nombreux biais, pas toujours identifiés, au sein de populations qui ne sont pas forcément carencées en apports calciques. En l’état actuel de nos connaissances scientifiques, il n’existe pas d’argument incontestable justifiant qu’on se passe d’un aliment aussi largement consommé que le lait de vache.
... Several bioactive peptides have been characterized from milk with wide range of activities such as antioxidative, antimicrobial, antithrombotic, immunomodulatory, opioid and antihypertensive [11][12][13][14]. Epidemiological and interventional studies have demonstrated that milk and milk products prevented the loss of bone mineral density in pre-and postmenopausal women [15]. Apart from bone growth, dairy products have also shown to elevate bone mineral density [16]. ...
... Osteoporosis and its associated morbidity/mortality is a major public-health issue in the rapidly aging demographic of East and Southeast-Asia. 1 Subjects of Chinese ethnicity are especially vulnerable to osteoporosis as corroborated by the fact that hip-fracture incidence in Malaysian women >age 50 years is highest amongst those of Chinese descent. 2 Vitamin D supplementation, coupled with antiresorptive therapy and adequate calcium intake, form the cornerstones of postmenopausal osteoporosis (PMO) management. Vitamin-D plays an important role in calcium metabolism, bone health and muscle strength. ...
Article
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Background and objectives: Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics. Methods and study design: 90 Chinese Malaysian PMO women in Kuala Lumpur, Malaysia (2°30'N) with baseline serum 25(OH)D levels >=50 nmol/L were recruited. Prior vitamin D supplements were discontinued and subjects randomized to oral cholecalciferol 25,000 IU/4-weekly (Group-A) or 50,000 IU/4-weekly (Group- B) for 16 weeks, administered under direct observation. Serum 25(OH)D, PTH, serum/urinary calcium were measured at baseline, 8 and 16 weeks. Results: Baseline characteristics, including osteoporosis severity, sun exposure (~3 hours/week), and serum 25(OH)D did not differ between treatment arms. After 16 weeks, 91% of women sufficient at baseline, remained sufficient on 25,000 IU/4-weekly compared with 97% on 50,000 IU/4-weekly with mean serum 25(OH)D 108.1±20.4 and 114.7±18.4 SD nmol/L respectively (p=0.273). At trial's end, 39% and 80% of insufficient women at baseline attained sufficiency in Group A and Group B (p=0.057). Neither dose was associated with hyperparathyroidism or toxicity. Conclusions: Despite pretrial vitamin D supplementation and adequate sun exposure, 25.6% Chinese Malaysian PMO women were vitamin D insufficient indicating sunshine alone cannot ensure sufficiency in the tropics. Both ~900 IU/day and ~1800 IU/day cholecalciferol can safely maintain vitamin D sufficiency in >90% of Chinese Malaysian PMO women. Higher doses are required with baseline concentration <75 nmol/L.
... A great deal of the previous work on the impact of calcium intake and activity corroborate our findings. Also agreeing with our findings, a positive correlation between calcium intake (an essential mineral for bone formation) and BMD was underlined by several studies (Wenya, 2008;Chee, 2003;Lau, 2001;Hejazee, 2009;Nakamura, 2009;Islam, 2003;and Shea, 2002). In contrast to our findings and contrary to expectations, in a study of French women, no association was found between calcium intake and osteoporosis or the presence of fractures (Fardellone, 2010). ...
Article
Full-text available
Reduced bone mineral density (BMD) and subsequent osteoporosis is a major public health problem affecting millions of people, especially elderly and postmenopausal women worldwide. Although the key role of a healthy lifestyle on chronic diseases has been established, the importance of these characteristics along with other factors influencing BMD is still controversial. Further, previous studies addressing this issue in postmenopausal Malaysian women are very limited. This study aimed to determine the lifestyle habits that may affect BMD in postmenopausal Malaysian women. In a cross-sectional study, a total of 201 healthy postmenopausal women were interviewed to obtain information on their socio-demographic, reproductive, and lifestyle status. Calcaneal BMD was measured by quantitative ultra sonography (QUS) and was expressed in broadband ultrasound attenuation (BUA) as well as T-score. Food frequency questionnaire (FFQ) was used for calcium intake evaluation and visual analog scale (VAS) was applied for activity level assessment. Correlations of lifestyle factors with BMD were investigated using Pearson's correlation test and multiple regression analysis. A chi-square test and an independent-sample t-test were conducted to compare categorical and continuous lifestyle variables, respectively, in subjects. A hierarchical multiple regression analysis was employed to explore independent variables associated with BMD. All tests were two-tailed, and a 5 percent level of statistical significance was chosen. In a total of the 201 postmenopausal women, 28.4 percent of individuals were osteoporotic and 71.6 percent were normal. BMD was correlated with calcium intake and physical activity while there was no correlation between BMD and coffee consumption. Significant relationships were found between BMD and most investigated socio-demographic and reproductive factors. However, results from a two-step hierarchical multiple regression analysis revealed that the factors that remain significant after adjustment were age, BMI, osteoporosis history, lactation, calcium intake, and physical activity. On the basis of our data, calcium intake and physical activity seem to be major determinants of BMD in post-menopausal Malaysian women. [Fatemeh Mohammadi, Tengku Aizan Hamid, Zanariah Othman, Rozi Mahmud, Mohd Nazri Yazid. Lifestyle factors influencing bone mineral density in postmenopausal Malaysian women. Life Science Journal. 2011;8(2):132-139] (ISSN:1097-8135). http://www.lifesciencesite.com.
... Some studies have reported similar results, showing maintenance or slight reduction of PTH-I after the administration of calcium or dairy products during few months (26)(27)(28). In fact, the increment of calcium phosphorous ratio and the intake of protein from dairy beverages are inversely related to the increment of PTH-I in plasmatic serum (28)(29)(30). ...
Article
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Introduction: osteoporosis is a metabolic bone disease that leads to increased bone fragility and increased risk of fracture. Objectives: the aim of the present research was to determine the effectiveness of a diary intake of three different dairy products (250 ml) enriched with vitamins and calcium on decreasing bone mass. Methods: the present study is a comparative trial of three dairy products fortified with calcium and vitamin D, parallel, randomized, double-blind and single-center. Bone mass content (BMC), bone mass density (BMD), T-score and Z-score were measured in different locations, besides biochemical markers along 18 months in premenopausal women. Two hundred and ten volunteers from all the three groups were submitted to the same monitoring procedures, consisting on blood extraction, urine collection and energy X-ray absorptiometry (DEXA) done in the laboratory. The monitoring was carried on three times, first at month 0 (baseline), the second at month 9 (in the middle of the treatment) and, finally, at month 18 (the end of the treatment). Results: the majority of anatomical locations showed both BMC and BMD decrease ranging between 0.5% and 1.5%. The T-score and the Z-score increased in lumbar spine after the treatment with the dairy products. Moreover, the most noteworthy change on the biomarkers of bone resorption was showed by plasmatic tartrate-resistant acid phosphatase (TRAP), with and increase between 20.7% and 29.5% after the intake of the different products. Conclusions: therefore, the intake of the three dairy products improves the bone mass in lumbar spine, leading to important changes in the concentration of biomarkers of bone resorption. Especially, tartrate-resistant acid phosphatase seems to be strongly influenced by the intake of every dairy product. However, no significant differences were found between the different dairy products used in the present study. Therefore, the intake of dairy product seems to be more determinant than micronutrients supplementation.
... successfully increased 25(OH)D levels among Chinese women (Chee, Suriah, Chan, Zaitun & Chan, 2003). Further, a meta-analysis examining vitamin D food fortification reported a 1.2 nmol/L increase in serum vitamin D concentrations for every 1 mg of vitamin D consumed from fortified food, and concluded that vitamin D food fortification has the potential to raise serum vitamin D concentrations at the population level (Black et al., 2012). ...
Thesis
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Vitamin D aids in the maintenance of bone health by enabling calcium absorption, and low concentrations of vitamin D are implicated in a host of chronic disease states. Adequate vitamin D intake during adolescence and young adulthood is crucial, as peak bone mass is formed during this time. However, many young adults do not meet the recommended intakes for vitamin D. The studies described herein examined vitamin D knowledge, perceptions, intake and blood vitamin D3 concentrations among a total of 209 young adults aged 18-25 living in Canada. Qualitative focus groups examined vitamin D knowledge and beliefs among young adults (n=50). The mobile Vitamin D Calculator application (‘app’) was validated as a measure of dietary vitamin D intake in this population. The app was then used in testing effects of a behavioural intervention aimed at increasing vitamin D knowledge, intake and status among young adults (n=109). A theoretical model based on the Theory of Planned Behaviour and Prototype Willingness Model was used to predict behavioural intentions related to vitamin D intake in the same sample at baseline (n=109). Results indicated that vitamin D knowledge, intake, and status in this population were fairly low. The proportion of participants who met the recommended intake of vitamin D (i.e., Estimated Average Requirement) was greater among individuals who used vitamin D supplements than those who did not. The behavioural intervention led to modest increases in vitamin D knowledge, intake and perceived importance of vitamin D supplement use among those who completed the intervention study (n=90). Blood vitamin D3 levels increased from pre- to post-intervention in both groups; participation in the intervention did not improve vitamin D status. This research highlights the need for greater awareness and education regarding the importance of vitamin D among young adults, the utility of providing personalized nutrition information and use of self-monitoring to improve intake, and the potential for vitamin D supplementation to help individuals meet intake requirements. Potential policy implications (e.g., expanded vitamin D fortification of foods, increased national vitamin D intake recommendations) are discussed.
... However, this cannot be confirmed as the reported serum C-terminal telopeptide of type 1 collagen (CTX) (bone resorption) changes were for all participants, not just those included in the per protocol analysis. In those studies that fulfil the design criteria, the majority have supplemented using dairy foods fortified with Ca, vitamin D and/or other nutrients (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) . While some of these nutrients are inherently found in dairy foods, the amounts are greater than naturally occurring; therefore, difficulties arise when discerning the contribution of naturally occurring compared with added nutrients to skeletal changes observed. ...
Article
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The consumption of high-Ca, high-protein dairy foods (i.e. milk, cheese, yogurt) is advocated for bone health across the lifespan to reduce the risk of low-trauma fractures. However, to date, the anti-fracture efficacy of dairy food consumption has not been demonstrated in randomised controlled trials but inferred from cross-sectional and prospective studies. The anti-fracture efficacy of dairy food consumption is plausible, but testing this requires a robust study design to ensure outcomes are suitably answering this important public health question. The evidence of skeletal benefits of dairy food consumption is equivocal, not because it may not be efficacious but because the study design and execution are often inadequate. The key issues are compliance with dietary intervention, dropouts, sample sizes and most importantly lack of deficiency before intervention. Without careful appraisal of the design and execution of available studies, precarious interpretations of outcomes may be made from these poorly designed or executed studies, without consideration of how study design may be improved. Dairy food interventions in children are further hampered by heterogeneity in growth: in particular sex and maturity-related differences in the magnitude, timing, location and surface-specific site of bone accrual. Outcomes of studies combining children of different sexes and maturity status may be masked or exaggerated by these differences in growth, so inaccurate conclusions are drawn from results. Until these critical issues in study design are considered in future dairy food interventions, the anti-fracture efficacy of dairy food consumption may remain unknown and continue to be based on conjecture.
... Milk is the main fortified food in the U.S. and in Canada [72], but the amount of vitamin D added to milk (1 mg/100 g fluid milk) is not adequate to produce the desired increase or maintain circulating 25(OH)D. Vitamin D fortification at higher levels (10 mg/50 g powdered milk) showed significant effects in improving vitamin D status and bone mineralization in older women milk [79]. ...
Article
Full-text available
Background: Vitamin D and calcium are important dietary compounds that affect bone mass, even if other minerals (potassium, zinc, etc.) and vitamins (A, C and K) are also involved. Vitamin D and certain minerals, in fact, play an important role in calcium homeostasis and calcium absorption. Hip fracture incidence is higher in Europe and the United States, where calcium is frequently included in the human diet; while the occurrence of these fractures is lower in developing countries, where diets are often poor in calcium. This condition is named the "calcium paradox", and may be partially explained by phosphate toxicity, which can negatively affect mineral metabolism. It is important to maintain correct dietary calcium-phosphate balance in order to have a healthy life, reducing the risk of osteoporotic fractures in older people. Vitamin D can also act as a hormone; vitamin D2 (ergocalciferol) is derived from the UV-B radiation of ergosterol, the natural vitamin D precursor detected in plants, fungi, and invertebrates. Vitamin D3 (cholecalciferol) is synthesized by sunlight exposure from 7-dehydrocholesterol, a precursor of cholesterol that can also act as provitamin D3. Dietary intake of vitamin D3 is essential when the skin is exposed for short periods to ultraviolet B light (UV-B), a category of invisible light rays such as UV-A and UV-C. This can be considered the usual situation in northern latitudes during the winter season, or the typical lifestyle for older people and/or for people with very white delicate skin. The actual recommended daily intake of dietary vitamin D is strictly correlated with age, ranging from 5 μg for infants, children, teenagers, and adults-including pregnant and lactating women-to 15 μg for people over 65 years.
... Over the last two decades, epidemiologic and intervention studies have shown that milk and milk-derived peptides prevented bone loss in pre-and postmenopausal women (Chee et al., 2003). Also, several studies thereafter have reported that milk derived bioactive peptides can induce osteoblast cells differentiation, maturation and matrix mineralization in vitro and thus could have beneficial effect against postmenopausal osteoporosis Behera et al., 2013;Huttunen et al., 2008). ...
Article
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Postmenopausal osteoporosis is a global health problem characterized by decreased in bone mineral density (BMD) and progressive deterioration of microarchitecture and subsequent increase in bone fragility and susceptibility to fracture. More than 200 million people suffer from osteoporosis worldwide with about 8.9 million fractures and the prevalence rate of osteoporosis is expected to increase significantly in the future because of increased in life expectancy and aging population. Milk-derived bioactive peptides from cow, goat, sheep, buffalo, and camel exhibit several potential health promoting effect including antiosteoporosis, antihypertensive, antioxidative, antithrombotic, immunomodulatory and anti-inflammatory effects. Epidemiological and intervention studies have shown that milk and milk-derived peptides prevented bone loss in pre-and postmenopausal women. Moreover, quite a lot of studies have reported that milk-derived bioactive peptides can induce osteoblast cell proliferation, differentiation and also prevented bone loss in osteoporotic rats model. Thus, milk-derived peptides exhibits beneficial effect against bone-related diseases and can be of particular interest towards prevention and management of postmenopausal osteoporosis. Hence, the present review summarizes various studies using ISI, SCOPUS and PubMed indexed journals to elucidate the potential role of milk-derived bioactive peptides with in vitro and in vivo antiosteoporotic property.
... A two year RCT of 173 postmenopausal Chinese women compared effects on BMD of high calcium skim milk powder (1200 mg calcium/day) to a normal diet. [41]. Though both groups lost bone, the milk treatment significantly attenuated BMD loss for the total body, lumbar spine, femoral neck and hip. ...
Chapter
There are substantial pragmatic difficulties in assessing the impact of nutrition in osteoporosis. The focus of this chapter is the relationship between nutrition in the development and progression of osteoporosis. There is no ideal way to assess the impact of diet on bone health (or other outcomes). The assessment of causation should therefore be queried using different kinds of studies such as randomized controlled trials, cohort studies, and experimental animal studies as a means of triangulation so that strengths of a given design are weighed to support or refute a scientific hypothesis. We will briefly review the association between specific micronutrients and bone health and then review macronutrients and dietary patterns. Central to the review of specific nutrients are dietary reference intakes as established by the Institute of Medicine and Food and Nutrition Board.
... However, the consumption of milk and dairy products was associated with vitamin D status among the respondents when evaluating the intake of individual food groups. These results are supported by previous local interventions among older women that reported that milk supplementation significantly improved their mean level of serum 25(OH)D [51,60]. Milk and dairy products currently sold within the market are usually fortified with vitamin D to improve the intake of vitamin D among the people [15]. ...
Article
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Background Serum vitamin D insufficiency is a public health issue, especially among older women. Sun exposure is fundamental in the production of vitamin D, but older women have less optimal sun exposure. Therefore, factors such as body composition and diet become more essential in sustaining sufficient serum levels of vitamin D. The objective of the current study is to determine factors contributing towards serum vitamin D insufficiency among 214 older women. Methods The respondents had their body weight, height, waist circumference and body fat percentage measured, as well as interviewed for their socio-demographic characteristics, sun exposure and dietary intake. Fasting blood samples were obtained from the respondents to measure their serum 25-hydroxyvitamin D [25(OH)D] concentration. Results There were 82.7% (95% CI: 77.6%, 87.8%) of the respondents that had serum vitamin D insufficiency (< 50 nmol/L) with an average of 37.4 ± 14.3nmol/L. In stepwise multiple linear regression, high percentage of body fat (ß = -0.211, p <0.01) and low consumption of milk and dairy products (ß = 0.135, p <0.05) were the main contributors towards insufficient serum vitamin D levels, but not socio-demographic characteristics, other anthropometric indices, sun exposure and diet quality. Conclusion Older women with high body fat percentage and low dairy product consumption were more likely to have serum vitamin D insufficiency. Older women should ensure their body fat percentage is within a healthy range and consume more milk and dairy products in preventing serum vitamin D insufficiency.
... Elderly women face a higher risk of bone demineralization; thus, supplementing calcium rich food, such as milk, with more calcium for the elderly is useful to overcome bone demineralization. Chee, et al. (2003) found that supplements of high calcium skimmed milk to elderly Chinese women was effective in slowing bone loss at the clinically important lumbar spine and hips; milk supplementation also improved their serum calcium status. ...
... Elderly women face a higher risk of bone demineralization; thus, supplementing calcium rich food, such as milk, with more calcium for the elderly is useful to overcome bone demineralization. Chee, et al. (2003) found that supplements of high calcium skimmed milk to elderly Chinese women was effective in slowing bone loss at the clinically important lumbar spine and hips; milk supplementation also improved their serum calcium status. ...
... The authors who responded and provided data with the correct format were included in the meta-analysis ( Table 1). The remaining studies were discussed but not included in the meta-analysis (Supplement Table S1) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Thirty articles met inclusion criteria and were included in the meta-analysis as seen in Table 1. ...
Article
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The incidence of type 2 diabetes mellitus (DM) has increased in the US over the last several years. The consumption of low-fat dairy foods has been linked with decreasing the risk of DM but studies have yet to show a clear correlation. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the effects of dairy intake on homeostatic model assessment of insulin resistance (HOMA-IR), waist circumference, and body weight. In MEDLINE and Embase, we identified and reviewed 49 relevant RCTs: 30 had appropriate data format for inclusion in the meta-analysis. Using the Review Manager 5 software, we calculated the pooled standardized mean differences comparing dairy dietary interventions to control for our outcomes of interest. For HOMA-IR (794 individuals), we found a mean difference of −1.21 (95% CI −1.74 to −0.67; p-value < 0.00001; I2 = 92%). For waist circumference (1348 individuals), the mean difference was −1.09 cm (95% CI 1.68 to −0.58; p-value < 0.00001; I2 = 94%). For body weight (2362 individuals), the dairy intake intervention group weighed 0.42 kg less than control (p-value < 0.00001; I2 = 92%). Our findings suggest that dairy intake, especially low-fat dairy products, has a beneficial effect on HOMA-IR, waist circumference, and body weight. This could impact dietary recommendations to reduce DM risk.
... Its consumption in childhood and adolescence is associated with higher bone mineral density in adulthood (Murphy et al. 1994;Kalkwarf et al. 2003). Further, milk and its products have been shown to improve skeletal health and bone mineral density with prevention of bone loss in pre-and post-menopausal women (Chee et al. 2003;Matkovic et al. 2004;Hess et al. 2016). In the last decade, considerable interest has been shown in goat milk for its nutritional and biofunctional properties (Turkmen, 2017). ...
Article
Glucocorticoids exhibit a crucial role in the early onset of osteopenia. Milk and milk products have a beneficial influence on bone functioning. The study delineates the bone anabolic potential of three distinct milk varieties (goat, buffalo and cow) in reinstating the detrimental effects of dexamethasone (dex) in the mice models. The current findings report the prominent suppression in the glucocorticoid‐induced bone loss on feeding goat, buffalo and cow milk in mice. Interestingly, goat milk showed maximum relative reversal of dex‐driven bone loss. Hence, the study advocates the applied utility of milk and its exploitation in functional foods for the efficient check against glucocorticoid‐mediated bone loss. Bone protective effect of milk.
... This indicates that women are more aware of the health benefits of milk. According to Chee et al. (2003), milk drinking significantly lowers the risk of osteoporosis, thus explaining the high consumption among women. Keropok lekor is a traditional food in Terengganu. ...
Article
The Malaysian Nutrition Research Priorities for Malaysia’s 11th Plan noted the necessity to investigate in depth the consumption of ultra-processed food among the Malaysian population. No empirical research has focused on exploring the energy contribution of ultra-processed foods and the socio-demographic determinants of ultra-processed foods. Thus, this study was conducted to investigate the relationship between the increasing consumption of ultra-processed foods with socio-demographic factors particularly in Terengganu, Malaysia. This cross-sectional study provides a novel approach to quantifying energy contribution of 200 adults (living in Terengganu; aged 18 to 59 years) based on the ultra-processed food classification named as NOVA, via semi-quantitative Food Frequency Questionnaire, and to determine the association between energy contribution of ultra-processed foods and socio-demographic characteristics. The selfadministered questionnaire consists of three sections: socio-demographic profile, frequency of ultra-processed food consumption and energy contribution of NOVA food groups. All data were analysed using SPSS version 21. The findings show that the contribution of ultra-processed foods among respondents was lower (40.38%) compared to unprocessed and minimally processed foods (55.73%). The most frequent consumed ultraprocessed foods were noodles and fried chicken (fast food). Meanwhile, the least frequently consumed foods included frozen chicken pie and garlic spread. There were significant associations between the energy contribution of ultra-processed foods and marital status, educational level, monthly household income and occupational status meanwhile there was no significant association between age and gender at p<0.05. This study provides the first comprehensive assessment of ultra-processed foods consumption using NOVA classification via semi-quantitative FFQ in Malaysia.
... Actually in Canada vitamin D fortification is mandatory for milk and margarine, while the addition of vitamin D to eligible foods in the U.S. is optional, with the exception of fortified milk [78]. Milk is the major fortified staple in the U.S. and Canada milk [72], but the amount of vitamin D added to milk (1 mg/100g fluid milk) is not adequate to produce the desired increase or maintenance of circulating 25(OH)D, while fortification at higher levels (10 mg/50g powdered milk) has been shown to be effective in improving vitamin D status and bone mineralization in older women milk [79]. ...
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Background: Vitamin D and calcium are important dietary compounds that affect bone mass, even if other minerals (potassium, zinc, etc.) and other vitamins (A, C and K) are also involved. Vitamin D and other minerals, in fact, play an important role in calcium homeostasis and calcium absorption. Hip fractures incidence is higher in western countries, where calcium is frequently included in human diet, while the occurrence of these fractures is lower in developing countries, where diets are often poor in calcium. This situation is known as the “calcium paradox”, and may be partially explained considering phosphate toxicity, that can induce a disorder of mineral metabolism. It is important to maintain adequate dietary calcium-phosphate balance in order to perform a healthy life, reducing the risk of osteoporotic fracture in older people. Vitamin D can also act as a hormone; vitamin D2 (ergocalciferol) is derived from the UV-B radiation of ergosterol, the vitamin D precursor naturally found in plants, fungi, and invertebrates. Vitamin D3 (cholecalciferol) is originated by sunlight exposure from 7-dehydrocholesterol, a precursor of cholesterol that can also act as a provitamin D3. Dietary intake of vitamin D3 is very important when skin is exposed for short times to ultraviolet B light (UV-B) one of the three kinds of invisible light rays together with UV-A and UV-C. This can be considered the usual situation in northern latitudes and in winter season, or the typical condition for older people and/or for people with very white delicate skin. Actually, the recommended daily intake of dietary vitamin D is strictly correlated with age, ranging from 5 μg for infants, children, teen-agers and adults, including women during pregnancy and lactation, to 15 μg for people over 65 years.
Article
Background: Hypovitaminosis D is associated with adverse surgical outcomes. We quantified the environmental, demographic, and modifiable determinants of serum 25-hydroxyvitamin D (25-OHD) concentration and assessed the potential impact of a preoperative screening questionnaire for moderate-to-severe hypovitaminosis D (25-OHD <30 nmol/L). Methods: In a retrospective cohort study of 227 Chinese patients (69 males and 158 females) undergoing 261 joint arthroplasty, we collected information on recent sun exposure, dietary vitamin D intake, vitamin D supplementation, and Western Ontario and McMaster Universities osteoarthritis index using a questionnaire and measured a fasting 25-OHD concentration using a liquid chromatography-tandem mass spectrometry before surgery. Results: The multiple regression model on the determinants of 25-OHD concentration described 14% of the total variance, with the greatest relative contribution from ambient ultraviolet radiation (42%). A 4-item screening test for moderate-to-severe hypovitaminosis D had acceptable discrimination (area under receiver operating characteristic curve = 0.76, 95% CI, 0.65-0.87), good calibration (Hosmer-Lemeshow goodness-of-fit; P = .93). Decision curve analysis showed that the screening test can potentially reduce unnecessary 25-OHD testing by 390 per 1000 patients at a threshold probability of 10%. Conclusion: The screening test appears moderately useful in avoiding a substantial number of unnecessary 25-OHD testing in a setting where the prevalence of moderate-to-severe hypovitaminosis D is less than 10%.
Article
Context Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover. Objective To discuss effects of the intake of vitamin D–fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women. Data Sources PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as “grey literature”. Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used. Data Extraction Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations. Data Analysis Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (−0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL. Conclusions The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women. PROSPERO registration number CRD42019131976.
Article
Objective: The aim of the present study was to explore whether combined calcium and vitamin D supplementation is beneficial for osteoporosis in postmenopausal women. Methods: We searched the PubMed, Cochrane library, Web of science and Embase databases and reference lists of eligible articles up to Feb, 2020. Randomized controlled trials (RCTs) evaluating the effect of combined calcium and vitamin D on osteoporosis in postmenopausal women were included in the present study. Results: Combined calcium and vitamin D significantly increased total bone mineral density (BMD) (standard mean differences (SMD) = 0.537; 95% confidence interval (CI): 0.227 to 0.847), lumbar spine BMD (SMD = 0.233; 95% CI: 0.073 to 0.392; P < 0.001), arms BMD (SMD = 0.464; 95% CI: 0.186 to 0.741) and femoral neck BMD (SMD = 0.187; 95% CI: 0.010 to 0.364). It also significantly reduced the incidence of hip fracture (RR = 0.864; 95% CI: 0.763 to 0.979). Subgroup analysis showed that combined calcium and vitamin D significantly increased femoral neck BMD only when the dose of the vitamin D intake was no more than 400 IU d-1 (SMD = 0.335; 95% CI: 0.113 to 0.558), but not for a dose more than 400 IU d-1 (SMD = -0.098; 95% CI: -0.109 to 0.305), and calcium had no effect on the femoral neck BMD. Subgroup analysis also showed only dairy products fortified with calcium and vitamin D had a significant influence on total BMD (SMD = 0.784; 95% CI: 0.322 to 1.247) and lumbar spine BMD (SMD = 0.320; 95% CI: 0.146 to 0.494), but not for combined calcium and vitamin D supplement. Conclusion: Dairy products fortified with calcium and vitamin D have a favorable effect on bone mineral density. Combined calcium and vitamin D supplementation could prevent osteoporosis hip fracture in postmenopausal women.
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Osteoblast cells are the building blocks of bone architecture and most suitable cells for screening osteoanabolic agents. As bone formation begins with osteoblast proliferation, it is the essential stage for screening osteoanbolics. LC–MS/MS analysis of the 11th RP–HPLC fraction of pepsin–trypsin (PT) hydrolysates of buffalo casein showed 15 peptides. Out of these 15 peptides, four peptides of less than 1 kDa were custom-synthesized and evaluated for osteoblast proliferating ability. Proliferation effect of the peptides was studied by formazan crystal formation (MTT method) and relative expression of proliferation marker genes (clay and cdk2). PT hydrolysates and all the four peptides significantly induced osteoblast proliferation indicated by both MTT and relative gene expression studies. This study showed the osteoblast-promoting property of peptides derived from milk proteins, thereby further substantiating the earlier epidemiological data regarding bone health-promoting effect of milk.
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Aim: To investigate the effects of dietary calcium intake on biochemical markers of bone and quality of life in postmenopausal women. Materials and Methods: This study comprised 61 postmenopausal women, ages were ranged between 48-65 (mean age= 57.8 ± 4.5). Number of pregnancy, menopause age and duration, used drugs and body mass index (BMI) of all women, serum levels of parathormon (PTH), 25-hidroxyvitamin D (25-OHD), total calcium and phosphate, osteocalcine, bone-specific alkalen phosphates, urine level of deoksipyridinolin and T-scores of femur neck and lumbar spine were measured. Dietary calcium intake of the patients was evaluated by a food frequency questionnaire (FFQ). Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) was used to asses the quality of life of patients. Results: Mean dietary calcium intake ± SD was 861.7 ± 246.9 mg/ day (range 314-1704 mg/day). The amount of calcium intake with dietary statistical significantly correlated with BMI (r=0.-491, p=0.007), level of urine deoxpyridinolin (r=0.455, p=0.013), physical function and general health domains of QUALEFFO (r=0.440, p=0.017; r=0.468, p=0.010; respectively). Conclusions: Dietary calcium intake effects the bone health and quality of life in postmenopausal women. Thus, dietary calcium intake should be increased throughout lifespan in women.
Chapter
Toward the end of last century a major lifestyle trend emerged in the Western world, emphasizing wellness and disease prevention in the human population rather than treatment therapies-a development not lost on approaches to food and nutrition [1]. This focus is expected to strengthen as the relatively affluent and well educated “baby boomers” of the 1950s and 1960s progressively reach middle age and begin to contemplate their retirement years. It has been calculated that in the U.S. alone, in the period from 1996 through to 2006, a “baby boomer” (defined as someone born between 1946 and 1964) will turn 50 years of age every seven and a half seconds [2]. Such individuals are acutely aware of health and lifestyle issues. A further significant driver of this trend is the escalating cost of traditional disease treatment. Allied to this, there has been a growing realisation of the pivotal role of nutrition in disease prevention and the maintenance of human health [3]. Epidemiological studies have exposed statistical correlations between the intake of certain dietary constituents and the development or prevention of various non-communicable diseases. In many cases, controlled human intervention studies have supported the epidemiological observations and a considerable body of knowledge has developed around the nexus of nutrition, health, and longevity. It has been postulated (the Barker hypothesis), and considerable supportive evidence has been amassed, that a propensity to develop certain diseases in later life may be related to maternal nutrition and subsequently modified by the nutritional habits of the individual [4,5].
Article
PurposeTo investigate the effects of dairy products on bone mineral density (BMD) in healthy postmenopausal women.Methods The EMBASE, Cochrane Library, Medline, and Web of Science databases were systematically searched for relevant studies. The pooled standardized mean difference (SMD) with its 95% confidence interval (CI) was used as the effect size. Subgroup analysis and Begg’s test were conducted.ResultsSix studies with a total of 618 participants were included in the meta-analysis. Milk was the main dairy product used in the trials. There was a significant association between dairy product consumption and BMD of the lumbar spine (SMD 0.21, 95% CI 0.05–0.37, P = 0.009), femoral neck (SMD 0.36, 95% CI 0.19–0.53, P < 0.001), total hip (SMD 0.37, 95% CI 0.20–0.55, P < 0.001), and total body (SMD 0.58, 95% CI 0.39–0.77, P < 0.001). Subgroup analysis suggested that there was a positive effect of dairy product consumption on the BMD of the total hip starting from 12 months and the femoral neck starting from 18 months. There was also a positive association with the BMD in the four sites in people living in low-calcium intake countries.Conclusion This meta-analysis provides evidence that dairy products can increase BMD in healthy postmenopausal women. Dairy product consumption should be considered an effective public health measure to prevent osteoporosis in postmenopausal women.
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SummaryA model-based meta-analysis method was performed to quantitatively analyze the efficacy characteristics of calcium intake in BMD increase among postmenopausal women. We found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change, and daily 1200 mg calcium was suggested to be a beneficial dosage. IntroductionThis paper aims to quantify the efficacy of calcium intake in preventing bone mineral density (BMD) decrease among postmenopausal women and to investigate the factors that may affect the efficacy. Methods Comprehensive literature search was conducted in PubMed and EMBASE from January 2016. Placebo-controlled or no-treatment controlled randomized trials focused on calcium intake for the management of osteoporosis in postmenopausal women were included. The clinical and demographic characteristics of participants and efficacy data, defined as the mean percentage change of spine BMD (L2–L4) at each observation time point compared with that of baseline, were extracted from the studies. Model-based meta-analysis (MBMA) was used to describe the time course of BMD change by calcium intake and identify the related factors. ResultsThis study includes 17 trials involving 2537 subjects. The results showed that a classic pharmacodynamic maximal effect (Emax) model could describe the time course of BMD change by calcium intake. Using this model, we found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change. A 60-year-old woman administered with 800 mg/day calcium can achieve a maximum BMD increasing rate of 2.38%, and the time to reach 50% of this maximum (known as onset time) was 9.44 months. An increase of 0.0817% per year was noted in the maximal effect value for women aged between 50 and 83 years. For calcium dose interval from 250 to 2000 mg/day, the onset time was expressed as 9.44 × (dose/800)−1.33 months. Two-year calcium intake of 700, 1200, and 2000 mg/day resulted in a maximum efficacy of BMD of 68.0, 81.3, and 89.6%, respectively. This indicates that the final efficacy had already reached the plateau (>80% Emax) under the 1200-mg/day dose. Conclusion Calcium intake can effectively postpone the tendency of BMD decrease in postmenopausal women. An increased calcium dose contributes to the shortening of the onset time. Considering the drug-acting rate and safety into account, menopausal women can be administered with a rational dose of 1200 mg/day to reduce bone loss.
Chapter
The prevalence of obesity has reached epidemic proportions globally, and the trend is especially alarming in children and adolescents. Dairy products provide a range of nutrients that are important to health but contribute to overconsumed nutrients such as fat and saturated fat. Data from existing reviews on the role of dairy products in the development of obesity in childhood and adulthood are inconsistent. This chapter reviews the totality of evidence and the justification for the current approach of limiting dairy in the diet to reduce or prevent obesity or weight gain. The majority of data available from longitudinal and intervention studies in adults provide evidence of neutral associations between intakes of milk and other dairy products, and body weight and adiposity measures. Similar results were found for children and adolescents, while there is limited data for older adults. Although the mechanisms have not been clearly elucidated, they include effects on energy and fat balance, fatty acid absorption, appetite, and the metabolic activity of gut microbiota. In conclusion, although inconsistencies exist, there is little evidence to support the justification for limiting dairy in the diet on the grounds that they may promote obesity.
Article
A summary of systematic reviews and meta-analyses addressing the benefits and risks of dietary protein intakes for bone health in adults suggests that dietary protein levels even above the current RDA may be beneficial in reducing bone loss and hip fracture risk, provided calcium intakes are adequate. Several systematic reviews and meta-analyses have addressed the benefits and risks of dietary protein intakes for bone health in adults. This narrative review of the literature summarizes and synthesizes recent systematic reviews and meta-analyses and highlights key messages. Adequate supplies of dietary protein are required for optimal bone growth and maintenance of healthy bone. Variation in protein intakes within the “normal” range accounts for 2–4% of BMD variance in adults. In older people with osteoporosis, higher protein intake (≥ 0.8-g/kg body weight/day, i.e., above the current RDA) is associated with higher BMD, a slower rate of bone loss, and reduced risk of hip fracture, provided that dietary calcium intakes are adequate. Intervention with dietary protein supplements attenuate age-related BMD decrease and reduce bone turnover marker levels, together with an increase in IGF-I and a decrease in PTH. There is no evidence that diet-derived acid load is deleterious for bone health. Thus, insufficient dietary protein intakes may be a more severe problem than protein excess in the elderly. Long-term, well-controlled randomized trials are required to further assess the influence of dietary protein intakes on fracture risk.
Chapter
Nutrients are essential to the viability of all cells, including those in bone. Osteoporosis has been called a pediatric disorder because adult peak bone mass is largely determined during childhood. Bone mass is ultimately determined by genetics as modified by current and past mechanical loading and limited or permitted by nutrition. Recommended food patterns around the world attempt to meet national nutrient requirements and to promote health and reduce risk of disease. Bone health rests on a combination of mechanical loading and adequate intakes of a broad array of macro‐ and micronutrients. Three important essential nutrients for bone health are calcium, vitamin D, and protein. Optimal protection of bone requires a diet rich in all the essential nutrients. Mononutrient supplementation regimens will often be inadequate to ensure optimal nutritional protection of bone health. Some bioactive ingredients may improve bone health by reducing chronic inflammation.
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Bone mineral mass, geometry and microstructure, hence determinants of fracture risk, result bone accrual during growth and bone loss later in life. Peak bone mass, which is reached by the end of the second decade of life, is mainly determined by genetic factors. Among other factors influencing bone capital, dietary intakes, particularly calcium and protein, play a significant role in peak bone mass attainment. Both nutrients are provided in dairy products, which accounts for 50–60% and 20–30% of the daily calcium and protein intakes, respectively. Children avoiding dairy products are at higher risk of fracture, as are adults or older individuals following a diet devoid of dairy products, like vegans. Various intervention trials have shown some beneficial effects of dairy products on bone capital accumulation during growth and on bone turnover in adults. In observational studies, dairy products intake, particularly the fermented ones, which also provide probiotics in addition to calcium, phosphorus and protein, appear to be associated with a lower risk of hip fracture.
Article
Background: Osteoporosis is a disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and a consequent increase in fracture risk, especially among postmenopausal women. Management strategies for osteoporosis focus on reducing modifiable risk factors such as poor nutrition, insufficient physical activity, smoking, and heavy alcohol consumption. Objective: The aim of this systematic review is to examine the effects of lifestyle interventions on bone health in women at high risk of osteoporosis INCLUSION CRITERIA: We included randomised controlled trials that examined the effectiveness of lifestyle interventions. The participants consisted of adult women who have had osteoporosis, osteopenia, or were at high-risk of developing osteoporosis. Lifestyle interventions included exercise, diet, and education. The outcomes of bone health were bone mineral density, event (fall, fracture), balance, and quality of life. Search strategy: We conducted a comprehensive search of the published literature using a three-phase approach in English and Korean languages up until September 2009. Methodological quality: Two independent reviewers appraised all reports using standardised critical appraisal tools from the Joanna Briggs Institute that were specific to experimental research designs. Data collection: Quantitative data was extracted from papers using the standardised data extraction tool from Joanna Briggs Institute. Data synthesis: Quantitative papers were pooled wherever possible to a statistical meta-analysis using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Results: The search identified 700 unique studies; we appraised 28 studies and included a total of 25 randomised controlled trials in the final study; three studies were excluded because of poor methodological quality. Strength exercises had a positive effect on fracture. Aerobic exercises had a positive impact on lumbar bone mineral density, fall, and balance. Soy protein supplementation was effective for improving lumbar bone mineral density while vitamin K supplementation had a positive effect on of femur bone mineral density. Calcium supplementation had a positive impact on femur and lumbar bone mineral density. The combination of exercise, calcium, and vitamin D supplementation was effective for improving lumbar bone mineral density, risk of fall, and balance. Self-management programs for better bone health had a positive effect on balance and quality of life. Conclusion: The results indicate that lifestyle interventions including exercise and taking daily calcium and vitamin D supplementation are beneficial for improving bone health in women at high risk of osteoporosis. However, additional carefully designed randomised controlled trials studies with larger patient populations are needed to more precisely identify the effects of intervention. Implications for practice: It is recommended to engage in a combination of regular exercise and daily calcium and vitamin D supplementation with consideration of age, menopausal status, and bone mineral density for women with a high risk of developing osteoporosis. Implications for research: Effects of combined intervention of lifestyle components should be evaluated in large, carefully designed randomised controlled trials.
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An assessment of the daily intake of major nutrients among 409 adults (males and females aged between 18-60 years, normal body mass index) residing in four regions in Malaysia was carried out as part of a major study on energy requirement. Subjects from both urban and rural areas completed a 3-day food record during the study. Mean energy intake among the men and women were 9.05 ± 2.21 MJ/day (2163 kcal/day) and 7.19 ± 1.60 MJ/day (1718 kcal/day) respectively, corresponding to 90% of the Malaysian RDA. A mean of 14% of the total energy was derived from protein, 23% from fat and 63% from carbohydrate. Energy intake amongst male subjects in the rural area (8.47 MJ/day, 2024 kcal) was significantly lower than their urban counterparts (9.52 MJ/day, 2275 kcal). There was no difference in mean energy intake in both the urban (7. 19 MJ/day, 1718 kcal) as well as rural women (7.16 MJ/day, 1711 kcal) corresponding to 86% of the RDA. The distribution of nutrients to the total energy intake amongst rural subjects were 13% for protein in both males and females, 65% for carbohydrate in males and 66% in females and 19% for fat in males and 21% for females. In the urban male and female subjects, the distribution of protein, carbohydrate and fat to the total energy intake were 14%, 55% and 29% and 30% respectively. The rural subjects showed a poorer mean intake of vitamins and minerals compared to the urban subjects. The diets of the male subjects in the rural area were deficient, less than two-third RDA in calcium, riboflavin and niacin. Calcium and iron intakes were less than two-third RDA in both the rural as well as the urban women. The rural women also had a poor intake of vitamin A and niacin. Overall, only protein and vitamin C intake met the RDA in most subjects from rural and urban areas.
Article
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Rapid and marked socioeconomic advancements in Malaysia for the past two decades have brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns of Malaysians, eg the increase in consumption of fats and oils and refined carbohydrates and a decreased intake of complex carbohydrates. This resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed. Changes in meal patterns are also evident: more families eat out, busy executives skip meals, the younger generation miss breakfasts and rely too much on fast foods. Many Malaysians have the mistaken belief that the taking of vitamin and mineral supplements can make up for the lack of these nutrients in their daily diets. In addition, communities have become generally more sedentary. All these changes have brought about undesirable effects with significant proportions of the affluent segments of the population being afflicted with various non-communicable diseases associated with overnutrition, namely obesity, hypertension, coronary heart disease and cancers. Nutrition activities and programmes are now being directed to tackle this increasing trend, whilst still attempting to eliminate the undernutrition problems. The ultimate strategy towards achieving a healthy nation is the promotion of a healthy lifestyle, including inculcating a culture of healthy eating. Comprehensive long term programmes, including a series of Healthy Lifestyle (HLS) Programmes have been carried out by the government. Launched in 1991 for six consecutive years, the first phase of the Programme comprised one thematic campaign each year, commencing with coronary heart disease and ending with diabetes mellitus. To further strengthen this long-term strategy, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. The implementation of these programmes is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, "western" dietary pattern influence, a whole barrage of convenience and "health" foods and nutrition misinformation. Malaysia continues to march ahead with its development plans to elevate the nation and its people to an even higher level of socio-economic status. The crucial question is: are we able to arrest the increase in these diet-related chronic diseases ? Or are we heading towards further deterioration in dietary pattern and increase in these diseases ? It will be a difficult and challenging journey ahead, requiring the concerted effort of all in the country. It is hoped that through this conference of sharing experiences with other Asian countries, a better understanding and improved strategies could be arrived at.
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Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures. A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites, bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a randomized, double-blind, placebo-controlled trial. Bone mineral density (BMD) was measured by dual x-ray absorptiometry and bone structure by radiographs. Calcium biochemistry and bone turnover markers were measured in blood and urine. The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr. Baseline median calcium intake was 546 mg/day, and median serum 25OH vitamin D3 was 59 nmol/L. On placebo, loss of BMD at total hip was 2% and femoral medulla expansion was 3% over 4 yr. Calcium reduced bone loss, secondary hyperparathyroidism, and bone turnover. 25OH vitamin D3 was intermediate between placebo and calcium. Fracture rates and drop-out rates were similar among groups, and there were no serious adverse events with either supplement. A calcium supplement of 750 mg/day prevents loss of BMD, reduces femoral medullary expansion, secondary hyperparathyroidism, and high bone turnover. A supplement of 15 microg/day 25OH vitamin D3 is less effective, and because its effects are seen only at low calcium intakes, suggests that its beneficial effect is to reverse calcium insufficiency.
Article
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Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly. Other nutrients also affect bone health, and adequate intakes may influence bone turnover and balance. We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement, a calcium and vitamin D supplement, and dietary instruction aimed at increasing calcium intake through foods. Ninety-nine healthy postmenopausal women participated in a 3-y, randomized trial, receiving either 1) supplemental calcium (1450 mg/d) and vitamin D [10 microg (400 IU)/d], 2) calcium, vitamin D, and other nutrients (multinutrient supplement), or 3) dietary instruction (dietary control group). Data are from 83 subjects who completed the trial. Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups. Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter. Bone turnover markers followed a similar pattern, and none of the changes in biochemical concentrations differed significantly between groups. All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations. The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone. The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates.
Article
In a rapidly developing country like Malaysia problems related to nutrition present themselves with contrasting features. While health indicators such as the toddler mortality rate, incidence of low birth weight and food balance sheet data suggest an improving nutritional situation, direct nutrition assessment indicates that chronic protein energy malnutrition is still common amongst children in rural areas and urban slums. Initial surveys of the adult urban population indicate about 10% prevalence of chronic energy deficiency in both sexes. Food consumption data revealed an average energy intake below the recommended daily intake for Malaysia in most age groups. Although death due to malnutrition is rare in Malaysia, it is known to cause considerable ill-health, impaired mental performance in children, loss of productivity in adults and an overall decline in quality of life. This paper reports the prevalence of malnutrition in the last two decades, the possible contributing factors and recommendations for alleviating the problems in Malaysia.
Article
Background. The effectiveness of calcium in retarding bone loss in older postmenopausal women is unclear. Earlier work suggested that the women who were most likely to benefit from calcium supplementation were those with low calcium intakes. Methods. We undertook a double-blind, placebo-controlled, randomized trial to determine the effect of calcium on bone loss from the spine, femoral neck, and radius in 301 healthy postmenopausal women, half of whom had a calcium intake lower than 400 mg per day and half an intake of 400 to 650 mg per day. The women received placebo or either calcium carbonate or calcium citrate malate (500 mg of calcium per day) for two years. Results. In women who had undergone menopause five or fewer years earlier, bone loss from the spine was rapid and was not affected by supplementation with calcium. Among the women who had been postmenopausal for six years or more and who were given placebo, bone loss was less rapid in the group with the higher dietary calcium intake. In those with the lower calcium intake, calcium citrate malate prevented bone loss during the two years of the study; its effect was significantly different from that of placebo (P<0.05) at the femoral neck (mean change in bone density [±SE], 0.87±1.01 percent vs. −2.11±0.93 percent), radius (1.05±0.75 percent vs. −2.33±0.72 percent), and spine (−0.38±0.82 percent vs. −2.85±0.77 percent). Calcium carbonate maintained bone density at the femoral neck (mean change in bone density, 0.08±0.98 percent) and radius (0.24±0.70 percent) but not the spine (−2.54±0.85 percent). Among the women who had been postmenopausal for six years or more and who had the higher calcium intake, those in all three treatment groups maintained bone density at the hip and radius and lost bone from the spine. Conclusions. Healthy older postmenopausal women with a daily calcium intake of less than 400 mg can significantly reduce bone loss by increasing their calcium intake to 800 mg per day. At the dose we tested, supplementation with calcium citrate malate was more effective than supplementation with calcium carbonate. (N Engl J Med 1990; 323:878–83.)
Article
The effect of dietary calcium on vertebral bone mass in women is controversial. In a randomized study we have investigated the effect of dietary modification in the form of dairy products on vertebral bone mass in 30- to 42-yr-old premenopausal women over a 3-yr period. Twenty women increased their dietary calcium intake by an average of 610 mg/day (P less than 0.03) for 3 yr, while 17 age- and weight-matched women served as controls. Calcium intake was monitored by 3-day diet histories and 24-h urinary calcium excretion. The consumption of the dairy products did not alter serum calcium or PTH levels or the fasting urinary calcium to creatinine ratio. Twenty-four-hour urinary calcium excretion increased by 28% (P less than 0.03) in the supplemented women. Dairy product intake was accompanied by increased dietary fat intake, but there were no statistically significant changes in serum cholesterol, low density lipoprotein cholesterol, or high density lipoprotein cholesterol levels. The vertebral bone density in the women consuming increased calcium did not change over the 3-yr period (-0.4 +/- 0.9%). In contrast, the vertebral bone density in the control women declined (-2.9 +/- 0.8%; P less than 0.001) and was significantly lower than that in the supplemented group at 30 and 36 months. The study suggests that dietary modification in the form of dairy products retards vertebral bone loss in premenopausal women. Therefore, increased calcium intake in estrogen-replete premenopausal women may prevent age-related bone loss.
Article
To determine the long-term effects of calcium supplements or placebo on bone density in healthy women at least 3 years postmenopause. Eighty-six women from our previously reported 2-year study agreed to continue on their double-blind treatment allocation (1 g elemental calcium or placebo) for a further 2 years, with 78 women (40 on placebo) reaching the 4-year end point. Median (interquartile range) dietary calcium intakes for the whole group were 700 mg (range 540 to 910) per day at baseline, 670 mg (range 480 to 890) per day at 2 years, and 640 mg (range 460 to 880) per day at 4 years. The bone mineral density (BMD) of the total body, lumbar spine, and proximal femur was measured every 6 months by dual-energy, x-ray absorptiometry. There was a sustained reduction in the rate of loss of total body BMD in the calcium group throughout the 4-year study period (P = 0.002), and bone loss was significantly less in the calcium-treated subjects in years 2 through 4 also (difference between groups 0.25% +/- 0.11% per year, P = 0.02). In the lumbar spine, bone loss was reduced in the calcium group in year 1 (P = 0.004), but not subsequently. There was, however, a significant treatment effect at this site over the whole 4-year period (P = 0.03). In the proximal femur, the benefit from calcium treatment also tended to be greater in the first year and was significant over the 4-year study period in the femoral neck (P = 0.03) and the trochanter (P = 0.01). Nine symptomatic fractures occurred in 7 subjects in the placebo group and 2 fractures in 2 subjects receiving calcium (P = 0.037). Calcium supplementation produces a sustained reduction in the rate of loss of total body BMD in healthy postmenopausal women.
Article
Bone resorption shows a circadian rhythm in human subjects, but the physiological mechanisms underlying this rhythm are unknown. We compared the circadian rhythm of bone collagen degradation in 18 premenopausal women before and after oral calcium supplementation (1000 mg calcium for 14 days). Subjects were randomized to receive calcium at either 0800 h or 2300 h. Continuous 48-h urine collections and 1 day of 4-h urine collections were obtained before and after the 14-day supplementation period. We measured urinary deoxypyridinoline (Dpd) and the cross-linked N-telopeptide of type I collagen (NTx) as biochemical markers of bone resorption. There was a significant effect of time of day on excretion of Dpd and NTx (analysis of variance, P < 0.001) with peak excretion between 0300-0700 h and a nadir between 1500-1900 h. The mean amplitude (peak to trough) was similar for Dpd and NTx (70.3% and 63.3%, respectively). Evening calcium supplementation resulted in marked suppression of the nocturnal increase in Dpd and NTx and reversed the usual nocturnal increase in the level of parathyroid hormone. In contrast, morning calcium supplementation had no significant effect on the circadian rhythm of Dpd or NTx. Evening calcium supplementation suppressed overall daily excretion of Dpd by 20.1% (P = 0.03) and NTx by 18.1% (P = 0.03). Morning calcium supplementation had no significant effect on overall daily excretion of either Dpd or NTx. We conclude that evening calcium supplementation suppresses the circadian rhythm of bone resorption. The daily rhythm of PTH secretion or calcium intake is likely to be an important determinant of this rhythm. Experimental protocols designed to investigate the effect of calcium supplementation on bone mineral density should take the timing of supplementation into account.
Article
In the past 3 decades, the incidence of osteoporotic hip fracture increased in Hong Kong Chinese by 2-fold to reach an incidence of approximately 10 per 1000 in women and men who are 70 years of age or older. It has been projected that 50% of all hip fractures in the world will occur in Asia by the next century. The bone mineral density of Asian populations is comparable to that of whites after adjusting for height and weight. Physical inactivity, a low dietary calcium intake, and falls have been found to be major risk factors for hip fractures in Asia. Other risk factors are cigarette smoking, heavy alcohol consumption, and multiparity. Population strategies to increase physical activity and calcium intake and to prevent falls in Oriental populations will be effective in the prevention of osteoporosis and hip fracture because of the high attributable risk for these factors.
Article
We report a 4-year randomized, double-blind, placebo-controlled clinical trial in 236 normal postmenopausal women (mean age +/- SE, 66.3+/-0.2 years) who were randomized to a calcium (1600 mg/day as the citrate) or placebo group. The women were seen every 6 months; 177 completed the trial. Net percentage changes in each group are given relative to baseline. The differences in net percentage changes (calcium group minus placebo group) in medians were: for lumbar spine bone density, 2.0% (p < 0.001) at year 1 and 0.3% (not significant) at year 4; for proximal femur bone density, 1.3% (p = 0.003) at year 1 and 1.3% (p = 0.015) at year 4; and for total body bone mineral, 0.4% (p = 0.002) at year 1 and 0.9% (p = 0.017) at year 4. Similar differences at year 4 were: -18.9% (p = 0.002) for parathyroid hormone (PTH), -11.9% (p = 0.026) for serum osteocalcin, and -32.2% (p = 0.003) for urine free pyridinoline. We conclude that long-term administration of calcium supplements to elderly women partially reverses age-related increases in serum PTH level and bone resorption and decreases bone loss. However, the effects on bone loss were weaker than those reported for estrogen, bisphosphonates, or calcitonin therapy, indicating that calcium supplements alone cannot substitute for these in treating established osteoporosis. Nonetheless, because of their safety, high tolerance, and low expense, calcium supplements may be a useful preventive measure for elderly postmenopausal women whose bone mineral density values are normal for their age.
Article
Elderly women are at increased risk for bone loss and fractures. In previous cross-sectional and longitudinal studies of women residing in northern latitudes, bone loss was most pronounced during winter months and in those consuming less than 1 g calcium per day. In this study we sought to test the hypothesis that calcium supplementation by either calcium carbonate or dietary means would prevent seasonal bone loss and preserve bone mass. Sixty older postmenopausal women without osteoporosis were randomized to one of three treatment arms: Dietary milk supplementation (D-4 glasses of milk/day), Calcium carbonate (CaCO3-1000 mg/day in two divided doses), or placebo (P). After 2 yr, placebo-treated women consumed a mean of 683 mg/day of calcium and lost 3.0% of their greater trochanteric (GT) bone mineral density (BMD) (P < 0.03 vs. baseline); Dietary supplemented women averaged a calcium intake of 1028 mg/day and sustained minimal loss from the GT (-1.5%; P = 0.30), whereas CaCO3-treated women (total Ca intake, 1633 mg/day) suffered no bone loss from the GT and showed a significant increase in spinal and femoral neck BMD (P < 0.05). Femoral bone loss occurred exclusively during the two winters of the study (i.e. total loss, -3.2%; P < 0.02 in placebo-treated women) with virtually no change in GT BMD during summer. Serum 25-OH vitamin D declined by more than 20% (P < 0.001) in all groups during the winter months but returned to baseline in summer; PTH levels rose approximately 20% (P < 0.001) during winter but did not return to baseline during the summers. Urine N-telopeptide and osteocalcin levels increased significantly but only in the P-treated women and only during winter. Serum insulin growth factor binding protein 4, an inhibitory insulin growth factor binding protein, rose 15% (P < 0.03) from summer to winter, but this increase was significant only in those women consuming <1000 mg/day of calcium. By multivariate analysis, total calcium intake was the strongest predictor of bone loss from the hip. Urinary N-telopeptide also closely correlated with GT BMD but only during winter (P = 0.003). We conclude that calcium supplementation prevents bone loss in elderly women by suppressing bone turnover during the winter when serum 25-OH vitamin D declines and serum PTH increases. The precise amount of calcium necessary to preserve BMD in elderly women requires further studies, although in this study, at least 1000 mg/day of supplemental calcium was adequate prophylaxis against femoral bone loss.
Article
To determine whether dietary counseling to increase milk intake could produce useful changes in the calcium economy and what, if any, other nutrition-related changes might be produced. Randomized, open trial. Two hundred four healthy men and women, aged 55 to 85 years, who habitually consumed fewer than 1.5 servings of dairy foods per day. Six academic health centers in the United States. Subjects were instructed to consume 3 servings per day of nonfat milk or 1% milk as a part of their daily diets, or to maintain their usual diets, for a 12-week intervention period, which followed 4 weeks of baseline observations. Energy and nutrient intake assessed from milk intake logs and 3-day food records; serum calciotrophic hormone levels at baseline and at 8 and 12 weeks; urinary excretion of calcium and N-telopeptide at 12 weeks. Repeated-measures analysis of variance. In the milk-supplemented group, calcium intake increased by 729 +/- 45 mg/day (mean +/- standard error), serum parathyroid hormone level decreased by approximately 9%, and urinary excretion of N-telopeptide, a bone resorption marker, decreased by 13%. Urine calcium excretion increased in milk-supplemented subjects by 21 +/- 7.6 mg/day (mean +/- standard error), less than half the amount predicted to be absorbed from the increment in calcium intake. All of these changes were significantly different from baseline values in the milk group and from the corresponding changes in the control group. Bone-specific alkaline phosphatase level (a bone formation marker) fell by approximately 9% in both groups. Serum level of insulin-like growth factor-1 (IGF-1) rose by 10% in the milk group (P < .001), and the level of insulin-like growth factor binding protein-4 (IGFBP-4) fell slightly (1.9%) in the milk group and rose significantly (7.9%) in the control group (P < .05). The changes observed in the calcium economy through consumption of food sources of calcium are similar in kind and extent to those reported previously for calcium supplement tablets. The increase in IGF-1 level and the decrease in IBFBP-4 level are new observations that are beneficial for bone health. Important improvements in skeletal metabolism can feasibly occur in older adults by consumption of food sources of calcium. Dietitians can be confident that food works, and that desired calcium intakes can be achieved using food sources.
Article
The objectives of the Asian Osteoporosis Study (AOS) were to determine risk factors for hip fracture in men and women in four Asian countries, that is, Singapore, Malaysia, Thailand, and the Philippines. A total of 451 men and 725 women (aged 50 years and over) with hip fractures were compared with an equal number of community controls. A standardized questionnaire was administered by interview. The following relative risks (RRs) were found in women and men by multiple logistic regression: dietary calcium intake < 498 mg/day, 2.0 for women (95% CI, 1.5-2.8) and 1.5 for men (95% CI, 1.0-2.2); no load bearing activity in the immediate past, 2.0 for women (95% CI, 1.4-2.7) and 3.4 for men (95% CI, 2.3-5.1); no vigorous sport activities in young adulthood, 7.2 for women (95% CI, 4.0-13.0) and 2.4 for men (95% CI, 1.6-3.6); cigarette smoking, 1.5 for men (95% CI, 1.0-2.1); alcohol consumption 7 days a week, 2.9 for women (95% CI, 1.0-8.6) and 1.9 for men (95% CI, 1.1-3.2); fell twice or more in the last 12 months, 3.0 for women (95% CI, 1.8-4.8) and 3.4 for men (95% CI, 1.8-6.6); a history of fractures after 50 years of age, 1.8 for women (95% CI, 1.1-2.9) and 3.0 for men (95% CI, 1.6-5.6); a history of stroke, 3.8 for women (95% CI, 2.0-7.1) and 3.6 for men (95% CI, 1.8-7.1); use of sedatives, 2.5 for women (95% CI, 1.0-6.3) and 3.0 for men (95% CI, 1.0-9.7); and use of thyroid drugs, 7.1 for women (95% CI, 2.0-25.9) and 11.8 for men (95% CI, 1.3-106.0). Women who were 1.56 m or taller had an RR of 2.0 (95% CI, 1.3-3.0) for hip fracture and men who were 1.69 m or taller had an RR of 1.9 (95% CI, 1.2-3.1) for hip fracture. Based on these findings, primary preventive programs for hip fracture could be planned in Asia.
Article
The Chinese diet is low in calcium (less than 500 mg/day on average), and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture. In this study, we randomly assigned 200 postmenopausal Chinese women (age range, 55-59 years) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group. The following are the mean percentage changes (and SEs) in height and bone mineral density (BMD) over 24 months: for height, -0.1 +/- 0.2 cm in the milk supplementation group and -0.2 +/- 0.1 cm in the control group; for BMD at the total hip, -0.06 +/- 0.22% in the milk supplementation group and -0.88 +/- 0.26% in the control group; for BMD at the spine (L1-L4), -0.56 +/- 0.29% in the milk supplementation group and -1.5 +/- 0.29% in the control group; for total body BMD, -0.32 +/- 0.16% in the milk supplementation group and -1.2 +/- 0.19% in the control group (p < 0.05 by analysis of covariance [ANCOVA] for repeated measures for height and BMD at all sites). The milk supplementation group had less loss in terms of both height and BMD than the control group (p < 0.05 by ANCOVA for repeated measures). Serum parathyroid hormone (PTH) concentration was lower and serum 25-hyroxyvitamin D [25(OH)D] level was higher in the milk supplementation group than the control group at 12 months (p < 0.05 by paired t-test). We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss.
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