Robert P Heaney's research while affiliated with Creighton University and other places

Publications (507)

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 fo...
Article
Full-text available
Background: Higher serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with a lower risk of multiple cancer types across a range of 25(OH)D concentrations. Objectives: To investigate whether the previously reported inverse association between 25(OH)D and cancer risk could be replicated, and if a 25(OH)D response region could...
Data
Association between serum 25(OH)D and risk of cancer, Lappe cohort (N = 1169). (DOCX)
Data
Kaplan-Meier plot comparing the proportion of cancer-free participants by 25(OH)D concentration (allowing for participants switching groups), Lappe cohort (N = 1169). Four-year cumulative cancer-free proportion was 97% among participants with 25(OH)D concentrations ≥40 ng/ml compared to 93% for those with 25(OH)D concentrations <20 ng/ml (proportio...
Data
Association between serum 25(OH)D and risk of cancer adjusted for age, BMI, smoking status, and calcium supplement intake in the range of ≤50 ng/ml, Lappe cohort (N = 1169). Solid black line represents the estimated hazard ratio for the Cox regression model with restricted cubic splines with 3 knots and dashed lines represent the 95% confidence int...
Data
Cancer types for pooled, Lappe, and GrassrootsHealth cohorts. (DOCX)
Data
Frequency distribution and cancer incidence rates by 25(OH)D concentration, Lappe cohort (N = 1169). The bars represent the number of non-cases by groupings of 10 ng/ml, white dots represent the 25(OH)D concentration for each cancer case, black dots represent cancer incidence rates per 100,000 person-years for indicated 25(OH)D groupings (plotted a...
Chapter
Milk is a nutrient-dense, inexpensive food that improves the overall nutritional quality of the diet. Consumption of cow's milk is actually associated with numerous health benefits including reduced risk for osteoporosis, cardiovascular disease, hypertension, some cancers, stroke and kidney stones, as well as better weight control and less risk of...
Chapter
Parathyroid hormone (PTH), vitamin D, and magnesium interact at several levels at the whole organism level. The classical actions of PTH on bone, kidney, and gut are dependent upon adequate status of both vitamin D and magnesium. At the same time, high PTH activity increases the requirement for vitamin D and low vitamin D status is commonly associa...
Chapter
Bone health is not a mononutrient issue; not only calcium and vitamin D but many other nutrients (sodium, potassium, phosphorus, and magnesium) are also known to affect the calcium economy and bone status. The contemporary Western diet is generally thought to contain more sodium than our hunter-gatherer ancestors would have consumed, and substantia...
Article
Full-text available
Higher serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with lower risk of type 2 diabetes. This study compared incidence rates of type 2 diabetes among participants aged ≥20 years in two U.S. cohorts with markedly different median 25(OH)D concentrations. The median 25(OH)D concentration in the Grassroots Health (GRH) cohort...
Article
Full-text available
The amount of dietary protein needed to prevent deficiency in most individuals is defined in the United States and Canada by the Recommended Dietary Allowance and is currently set at 0.8 g protein · kg(-1) · d(-1) for adults. To meet this protein recommendation, the intake of a variety of protein food sources is advised. The goal of this article is...
Article
Full-text available
Recently Veugelers and Ekwaru published data [1] indicating that, in its dietary reference intakes for calcium and vitamin D, the Institute of Medicine (IOM) had made a serious calculation error [2]. Using the same data set as had the IOM panel, these investigators showed that the Recommended Dietary Allowance (RDA) for vitamin D had been underesti...
Article
Full-text available
Despite the Institute of Medicine's commitment to base its nutrient intake recommendations in evidence, the 2004/2005 Dietary Reference Intakes for sodium were not supported by evidence, as the subsequent 2013 Institute of Medicine review admitted. In this review, I suggest an approach to setting nutrient intake requirements based in physiology. Br...
Article
Vitamin D enters the body through multiple routes and in a variety of chemical forms. Utilization varies with input, demand, and genetics. Vitamin D and its metabolites are carried in the blood on a Gc protein that has three principal alleles with differing binding affinities and ethnic prevalences. Three major metabolites are produced, which act v...
Article
One of the reasons its promise has not been realized is that most studies of vitamin D efficacy have used a disease-avoidance model, which is the standard approach used by the Institute of Medicine (IOM) for most nutrients (2). Furthermore, disease prevention is the explicit focus of the USPSTF. Nevertheless, the IOM and USPSTF approaches effective...
Article
To the Editor Feskanich et al1 report that early-life milk consumption does not protect against late-life hip fractures in 2 health professions cohorts and, if anything, increased fracture risk in men. In her Editorial, Weaver2 describes a strong mechanistic basis for fracture protection but offers no explanation as to why Feskanich et al seem not...
Article
The 2013 Santa Fe Bone Symposium included plenary sessions on new developments in the fields of osteoporosis and metabolic bone disease, oral presentations of abstracts, and faculty panel discussions of common clinical conundrums: scenarios of perplexing circumstances where treatment decisions are not clearly defined by current medical evidence and...
Article
We examined the relationship between serum 25-hydroxyvitamin D (25[OH]D) and all-cause mortality. We searched biomedical databases for articles that assessed 2 or more categories of 25(OH)D from January 1, 1966, to January 15, 2013. We identified 32 studies and pooled the data. The hazard ratio for all-cause mortality comparing the lowest (0-9 nano...
Article
Both the establishing of nutrient intake recommendations and the ability of food producers to make health claims depend on development of an evidence base that links nutrient intake levels to specific health outcomes. The rules of evidence currently employed were developed for drugs and the treatment of disease. They are ill-suited to evaluating nu...
Article
Presented here is a system to standardize clinical studies of nutrient effects, using nutrient-specific physiological criteria. These guidelines are based mainly on analysis of the typical sigmoid curve of biological response to nutrients and are intended for design, interpretation, and pooling of studies of nutrient effects. Five rules have been a...
Article
Full-text available
Europe's push towards a single harmonised market that offers information on the benefits of foods is encapsulated in Regulation (EC) No 1924/2006, the Nutrition and Health Claims Regulation (NHCR). The NHCR will be the main focus of our contribution. Our contention is that this regulation not only stifles scientific research, limiting it to the rel...
Article
Unsupplemented vitamin D status is determined by cutaneous synthesis and food inputs; however, their relative magnitudes are largely unknown. In a cohort of 780 non-supplement-taking adults with a mean serum 25-hydroxyvitamin D [25(OH)D] of 33 (±14) ng/ml we assessed the relationship between serum 25(OH)D and non-food environmental variables. Serum...
Article
Full-text available
Objectives: Increasing 25-hydroxyvitamin D serum levels can prevent a wide range of diseases. There is a concern about increasing kidney stone risk with vitamin D supplementation. We used GrassrootsHealth data to examine the relationship between vitamin D status and kidney stone incidence. Methods: The study included 2012 participants followed p...
Article
Full-text available
Context: Guidelines have suggested that obese adults need 2 to 3 times more vitamin D than lean adults to treat vitamin D deficiency, but few studies have evaluated the vitamin D dose response in obese subjects. Objective: The purpose of this study was to characterize the pharmacokinetics of 25-hydroxyvitamin D [25(OH)D] response to 3 different...
Chapter
Nutrients are essential to the viability of all cells including those in bone. Nutrition is an important component for treating those with osteoporosis. The cumulative effect of diet over the life span influences development of peak bone mass and its subsequent maintenance. Osteoporosis has been called a pediatric disorder because adult peak bone m...
Article
Calcium seems to be an intuitively integral part of the treatment of osteoporosis. This is for several reasons. First, osteoporosis, in its original definition, is effectively a disease characterized by a reduced calcium nutrient reserve (i.e., bone mass). Second, animals reared on reduced calcium intakes fail to develop the full bone mass programm...
Article
Full-text available
Vitamin D status has been implicated in insulin resistance, type 2 diabetes mellitus, and hypertension, but the range of vitamin D status values over which the association can be found is unknown. Our objective was to define this range in a cohort of nondiabetic adult Canadians. We used a regression modeling strategy, first adjusting insulin-respon...
Article
The magnitude of vitamin D inputs in individuals not taking supplements is unknown; however, there is a great deal of information on quantitative response to varying supplement doses. We reanalyzed individual 25-hydroxyvitamin D [25(OH)D] concentration data from 8 studies involving cholecalciferol supplementation (total sample size = 3000). We extr...
Article
Despite repeated emphasis in the Dietary Guidelines for Americans on the importance of calcium in the adult American diet and the recommendation to consume 3 dairy servings a day, dairy intake remains well below recommendations. Insufficient health professional awareness of the benefits of calcium and concern for lactose intolerance are among sever...
Chapter
The standard model for regulation of calcium absorption identifies ­calcitriol as the vitamin D metabolite responsible for active transport of calcium across the intestinal mucosa, with 25-hydroxy vitamin D [25(OH)D] functioning as the substrate for renal synthesis of calcitriol. However, as experience with measurement of calcium absorption has acc...
Article
Background and objectives: Recent understanding of extrarenal production of calcitriol has led to the use of more vitamin D supplementation in CKD populations. This paper reports the effect of cholecalciferol supplementation on calcium absorption. Design, setting, participants, & measurements: Paired calcium absorption tests were done before and...
Article
Full-text available
Considering that epidemiological studies show that suicide rates in many countries are highest in the spring when vitamin D status is lowest, and that low vitamin D status can affect brain function, we sought to evaluate if a low level of 25-hydroxyvitamin D [25(OH)D] could be a predisposing factor for suicide. We conducted a prospective, nested, c...
Article
Full-text available
A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, do...
Article
There is clear evidence of health benefit in studies raising serum 25(OH)D in the range of 20-50ng/mL. However, the results have not been consistent. The likely reasons include the intrinsic smallness of nutrient effects, as well as failure of trial designers to give inadequate attention to starting vitamin D status and to adequacy of dose. Similar...
Article
Recent understanding of extrarenal production of calcitriol has led to the exploration of native vitamin D treatment in dialysis patients. This paper reports the pharmacokinetics of 25-hydroxyvitamin D response to 10,333 IU cholecalciferol given weekly in subjects on chronic dialysis. This randomized, double-blind, placebo-controlled trial of 15 we...
Article
There has been more ink spilled over the efficacy of vitamin D than over that of most nutrients, with the possible exception of sodium. Why is this? Dozens of randomized, controlled trials have been conducted — some large, and many small. Unfortunately, their results have been inconsistent — some positive, some null, and the odd one or two actually...
Article
The term nutrient "insufficiency," as commonly used, refers to a nutritional status intermediate between classical, severe deficiency, and full normal. As both "deficiency" and "insufficiency" are causes of dysfunction and disease, there is no biological basis for a distinction between them. What is important to note is that, in the case of vitamin...
Article
Full-text available
The importance of nutrients for promotion of health and prevention of disease has long been recognized. Nonetheless, scientists are still trying to delineate the optimal intakes of various nutrients and their potential benefits for different populations. To that end, evidence-based medicine (EBM) has been applied to the study of nutrition. EBM meth...
Article
Nutrient intake recommendations, unlike hormone replacement standards, are based empirically, rather than physiologically, i.e., they lack an a priori normal referent. Randomized controlled trials do not provide the needed referent and are unlikely to distinguish between fully normal and various suboptimal nutritional states. Several alternative ap...
Article
Full-text available
Purpose Many postmenopausal women desire non-pharmaceutical alternatives to hormone therapy for protection against osteoporosis. Soybean isoflavones, especially genistein, are being studied for this purpose. This study examined the effects of synthetic genistein in combination with other potential bone-protective dietary molecules on bone mineral d...
Article
Vitamin D status is known to be poor in obese individuals; there is no consensus as to the reason. Cross-sectional study of the relation between serum 25-hydroxyvitamin D (25(OH)D) concentration and body size in the baseline data from unsupplemented adults entering two study cohorts in our research unit, N = 686. Regression analyses of body size va...
Article
The 2011 Institute of Medicine recommendations for vitamin D-both the recommended daily amount (RDA) and the vitamin D status judged adequate for bone health-are too low. Calcium absorption, osteoporotic fracture risk reduction, and healing of histological osteomalacia all require values above 30 ng/ml, and probably even 40 ng/ml. Furthermore, the...
Article
This placebo-controlled, randomized, crossover clinical study examined the effect of chronic wheat dextrin intake on calcium and magnesium absorption. Forty premenopausal and post menopausal women (mean ± SD age 49.9 ± 9.8 years) consumed wheat dextrin or placebo (15 g/day) for 2 weeks prior to (45)calcium ((45)Ca) and (26)magnesium ((26)Mg) absorp...
Article
To characterize methods evaluating and to summarize studies linking various serum 25-hydroxyvitamin D [25(OH)D] concentrations with health status. Elucidation of the cell-biologic mechanism of vitamin D action, and numerous clinical trials and observational studies relating vitamin D status to health and disease. The distinction between deficiency...
Article
Discordances between hip and spine areal density T-score values are common and incompletely understood. In a cohort of 1157 postmenopausal women, discordances of greater than 10% occurred in 91%, with spine bone mineral density (BMD) T-scores significantly less negative than femoral neck (FN) T-scores (p<0.001). However, when T-scores based on bone...
Article
Full-text available
The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consen...
Article
Apparent failures of bone mineral density (BMD) response to teriparatide at spine or hip occur even in a high compliance context (15% spine and 55% hip). Apparent non-responders nevertheless show good biomarker response, suggesting that apparent BMD non-response is due to measurement imprecision. Calcium intake may be an important determinant of hi...
Article
The connection between calcium intake and body weight was first described by McCarron et al.,1 who found an inverse relationship between these two variables in the National Health and Nutrition Examination Survey (NHANES) data. This observation was largely ignored for the next 16 years, until Zemel et al.2 described the weight-loss effect of calciu...
Article
The understanding of vitamin D's role in human health has recently expanded. It is now recognized as more than a hormone activated in the kidney only for calcium homeostasis. It is metabolized and used by virtually every cell in the body. Patients with chronic kidney disease have a deficit in their kidney production of 1,25(OH)(2)D and have classic...
Article
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy.
Article
Full-text available
Studies indicate that intake of vitamin D in the range from 1,100 to 4,000 IU/d and a serum 25-hydroxyvitamin D concentration [25(OH)D] from 60-80 ng/ml may be needed to reduce cancer risk. Few community-based studies allow estimation of the dose-response relationship between oral intake of vitamin D and corresponding serum 25(OH)D in the range abo...
Article
In the July 12, 2010, issue of the Archives,1 Grey and Bolland1(p1099) opine “it seems intuitively unlikely that a single hormone could play a substantial role in . . . the diverse range of diseases” linked to vitamin D. Forgetting for a moment the multiform effects of hormones such as cortisol and thyroxine, we note that vitamin D (as calcitriol)...
Article
This article appears in The Journal of Clinical Endocrinology & Metabolism, published December 22, 2010, 10.1210/jc.2010-2230
Article
Vitamin D functions in many body systems, but perhaps the best attested of the nutrient's actions-and certainly the one first associated with human disease-is its role in transferring calcium (and phosphorus) from ingested food into the body fluids. In this capacity, vitamin D functions as a part of a control system that operates to maintain consta...
Article
The criteria used in evidence-based medicine provide a poor fit for decisions concerning nutrient intake recommendations. For many nutrient-disease relationships, level 1 evidence cannot be ethically obtained. The challenge is to design an approach that will allow responsible development of national policy in the absence of randomized clinical tria...
Chapter
Calcium is an important building block for bone. It is necessary for bone acquisition in childhood and bone maintenance in adulthood. Calcium can only be obtained from the diet, so nutrition plays a large part in bone health. This chapter focuses on calcium, but other nutritional elements such as vitamin D, phosphorus and protein are just as import...
Article
Full-text available
Current unitage for the calciferols suggests that equimolar quantities of vitamins D(2) (D2) and D(3) (D3) are biologically equivalent. Published studies yield mixed results. The aim of the study was to compare the potencies of D2 and D3. The trial used a single-blind, randomized design in 33 healthy adults. Calciferols were dosed at 50,000 IU/wk f...
Article
We tested the spine antifracture and bone sparing efficacy of 1.2 g/day of oral calcium as carbonate in two groups of elderly women, one with prevalent fractures (PF, n = 94) on entry and the other without (NPF, n = 103). It was a prospective randomized, double-blind, placebo-controlled trial in mostly rural communities in women over age 60 who wer...
Article
Vitamin D (VitD) levels in older Mayans are currently unknown. Geographic factors, for example, residences in areas receiving ample sunlight at high altitudes and latitudes near the equator, would favor optimum VitD levels, whereas demographic factors, for example, darker skin pigmentation, clothing practices, and older age, would favor low 25-hydr...
Article
Calcium is a divalent mineral cation that functions as an intracellular messenger in virtually all life forms. In multicellular organisms it functions also as an integrator tying body systems together, and in land-living vertebrates it provides the principal mineral component of the endoskeleton (bone). Calcium cannot be synthesized and must be ing...
Article
During the last decade, approaches to evidence-based medicine, with its heavy reliance on the randomized clinical trial (RCT), have been adapted to nutrition science and policy. However, there are distinct differences between the evidence that can be obtained for the testing of drugs using RCTs and those needed for the development of nutrient requi...
Chapter
Bone requires calcium, vitamin D, protein, and phosphorus for optimal growth and maintenance. Food is the best source for most of the nutrients required by bone. Many in the population are consuming diets with inadequate calcium Most adults require additional vitamin D supplementation, especially if they have little sun exposure. Improvements in nu...