Association between dietary conjugated linoleic acid and bone mineral density in postmenopausal women

OBJECTIVE: To determine if dietary conjugated linoleic acid (CLA) is associated with bone mineral density (BMD) of different skeletal sites in postmenopausal women. METHODS: A cross-sectional analysis in 136 Caucasian, healthy, postmenopausal women, mean age 68.6 years. BMD and soft tissue were assessed by dual energy x-ray absorptiometry (DXA). Energy, calcium, protein, fat, CLA and other relevant nutrients were estimated using 3 day dietary records. Supplement use was recorded as well. Current and past physical activity were determined using the Allied Dunbar National Fitness Survey for older adults. RESULTS: CLA (63.1 +/- 46.8 mg, mean +/- SD) was a significant predictor of Ward's triangle BMD (p = 0.040) in a multiple regression model containing years since menopause (18.5 +/- 8.4 y), lean tissue, energy intake (1691 +/- 382 kcal/day) dietary calcium (873 +/- 365 mg), protein (70.6 +/- 18.6 g), fat (57.9 +/- 23.9 g), zinc (19.2 +/- 13.6 mg), and current and past physical activity, with R(2)(adj) = 0.286. Subjects were also divided into groups below (Group 1) and above (Group 2) the median intake for CLA. Group 2 had higher BMD in the forearm, p = 0.042, and higher BMD in the hip, lumbar spine and whole body, however statistical significance was not reached. CONCLUSION: These findings indicate dietary CLA may positively benefit BMD in postmenopausal women. More studies are warranted examining the relationship between dietary CLA and BMD.     

Dietary Protein,Phosphorus and Potassium Are Beneficial to Bone Mineral Density in Adult Men Consuming Adequate Dietary Calcium

Objective: The purpose of this study was to determine relationships of calcium (Ca), protein (Pr), phosphorus (P) and potassium (K) to measures of bone mineral density in adult men.

Methods: Cross-sectional analysis of 57 men ages 39 to 42 years who were participants in an ongoing study. Dietary assessment was conducted using the Block food frequency questionnaire (FFQ). BMD of total body (TB), hip and lumbar spine (LS) were measured with dual X-ray absorptiometry (DXA).

Results: Ca, Pr, P and K, as well as lean body mass (LBM), showed significant correlation with BMD at the total body, hip and lumbar spine. Stepwise forward regression selection method identified LBM, height and fat mass as significant predictors of TB-BMD, LBM and height as significant predictors of hip BMD, and LBM as a significant predictor of LS-BMD. As the nutrients tested correlated significantly with each other, only one nutrient was entered into the regression model at a time to accommodate the potential for multicollinearity. In regression analysis, adjusted for site-specific anthropometric variables and energy intake, K, Pr and P intake accounted for significant (p < 0.05) prediction of TB-BMD and LS-BMD values by 7% to 13%. No bone-related nutrient added significantly to the prediction of hip BMD. Ca intake was not significantly associated with BMD at any site in the adjusted models.

Conclusions: Our analysis provides support that a moderate protein (1.2 g/kg) diet, plentiful in potassium (>100 mmol/day) and phosphorus (1741 ± 535 mg) is beneficial for maintaining bone mineral density in adult men when Ca intake was adequate (1200 ± 515 mg).     

Components of the Diet Associated with Child Adiposity: A Cross-Sectional Study

Objectives: To determine relationship between alcohol, caffeine, past smoking and bone mineral density of different skeletal sites in elderly women, accounting for other biological and life-style variables.

Methods/Design: A cross-sectional study in 136 Caucasian women, mean ± SD age 68.6 ± 7.1 years, all healthy and free of medications affecting bones, including estrogen. Bone mineral density (BMD) of multiple skeletal regions and body composition were measured by dual X-ray absorptiometry. Serum vitamin D (25-OHD) and parathyroid hormone (PTH) were analyzed and used as confounders. Calcium (Ca) intake was assessed by food frequency questionnaire. Alcohol and caffeine consumption was assessed by questionnaires determining frequency, amount and source of each. There were no current smokers, but the history of smoking was recorded, including number of years and packages smoked/day. Past physical activity was assessed by Allied Dunbar National Fitness Survey and used as confounder. Statistical significance was considered at p ≤ 0.05.

Results: In the correlational analysis, alcohol was positively associated with spine BMD (r = 0.197, p = 0.02), 25-OHD and negatively with PTH. Smoking was negatively related to Ca intake, 25(OH)D and number of reproductive years. In subgroup (stratified by Ca intake) and multiple regression analyses, alcohol (average ～0.5–1 drinks/day or ～8 g alcohol/day) was favorably associated with BMD of spine and total body. Caffeine (average ～2.5 6-fl oz cups/day or 200–300 mg caffeine/day) had negative association with most of the skeletal sites, which was attenuated with higher Ca intake (≥median, 750 mg/day). The past smokers who smoked on average 24 years of ～1 pack cigarettes/day had lower BMD in total body, spine and femur than never-smokers when evaluated in subgroup analyses, and the association was attenuated in participants with ≥median Ca intake. There was no significant association between past smoking and BMD of any skeletal site in multiple regression analyses.

Conclusion: The results support the notion that consumption of small/moderate amount of alcohol is positively, while caffeine and past smoking are negatively associated with most of the skeletal sites, which might be attenuated with Ca intake above 750 mg/day.     

Association of Calcium Intake and Adiposity in Postmenopausal Women

Objective: The purpose of this study was to examine the relationship between calcium intake and 1) body composition and 2) body fat distribution in postmenopausal women.

Methods: Archived data from a previous study including forty-nine Caucasian women, aged 51–73 and at least three years postmenopausal, were used for analysis. Data included medical and diet history from a questionnaire, average nutrient intake from computerized analysis of a 3-day diet record, anthropometric measures including height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Calcium intake represented both food and supplement sources of calcium. Lean and fat mass were determined from dual energy x-ray absorptiometry (DXA) total body scans, and abdominal fat mass was defined as fat mass between the top of the iliac crest and L1 on the DXA scan.

Results: Subjects were 60.5 ± 0.9 y/o with an average BMI of 26.9 ± 0.7 and percent body fat of 42.8 ± 1.2. Average calcium intake was 1151 ± 83 g/d. There was a significant inverse relationship between calcium intake and percent body fat (r = ?0.36, p < 0.01) and abdominal fat mass (r = ?0.25, p < 0.05), but there was no significant correlation between calcium intake and body mass index, fat mass, lean mass, waist circumference, or WHR. When kcalories were controlled, the inverse correlation between dietary calcium intake and percent body fat remained (r = ?0.24, p < 0.05). Total fat was significantly greater (p < 0.05) in the low dairy intake (1–2 servings/d) vs. high dairy intake group (3–4 servings/d), but there were no significant differences between the groups in other body composition variables.

Conclusions: Increased calcium intake was associated with lower percent body fat and higher dairy intake was associated with lower fat mass in postmenopausal women, but there was no association between calcium intake and body fat distribution measures in this population.     

Healthier Dietary Pattern and Lower Risk of Metabolic Syndrome in Physically Active Postmenopausal Women

Objectives: To investigate the relationship between habitual physical activity and dietary intake, body composition, metabolic and hormonal variables, and cardiovascular risk factors in postmenopausal women with no evidence of cardiovascular disease.

Methods: In this cross-sectional study, 105 women (mean age: 55.2 ± 4.9 years) consulting for climacteric symptoms underwent anthropometric and hormonal assessment. Usual dietary intake was assessed with a food frequency questionnaire and habitual physical activity was assessed with a digital pedometer. Participants were classified as physically inactive (<6000 steps daily) or physically active (≥6000 steps daily).

Results: Compared to the inactive group, active women had higher protein, total fat, cholesterol, iron, calcium, and the antioxidant micronutrients zinc and selenium intake as well as differences on food groups: higher meat, egg, and whole-dairy intake and lower intake of chips. Active participants also presented lower diastolic blood pressure (p = 0.012), ultrasensitive C-reactive protein (us-CRP; p = 0.011), fasting glucose (p = 0.003), fasting insulin (p = 0.019), and homeostasis model assessment index (p = 0.017). After adjustment for age and time since menopause, the risk for metabolic syndrome increased with physical inactivity (odds ratio [OR] = 3.55, 95% confidence interval [CI], 1.08–11.66), us-CRP (OR = 6.57, 95% CI, 2.20–19.56), and percentage body fat (OR = 5.65, 95% CI, 1.19–28.89).

Conclusion: Both physical activity and dietary choices may have contributed toward a more favorable cardiovascular profile and lower risk of metabolic syndrome in postmenopausal women.     

The Association of Dietary and Urinary Sodium With Bone Mineral Density and Risk of Osteoporosis: A Systematic Review and Meta-Analysis

Objective: Although some earlier studies have indicated an association between dietary/urinary sodium and bone mass density (BMD), bone mass content (BMC), and the risk of osteoporosis (OS), findings are still conflicting. The aim of this study was to summarize the relation of dietary/urinary sodium with BMD, BMC, and the risk of OS.

Methods: We conducted a systematic search up to April 2017 in PubMed/MEDLINE, SCOPUS, and Web of Science to find relevant studies. Articles with cross-sectional and cohort designs in which odds ratios (ORs), correlations (r), or beta coefficients were reported for the association between dietary/urinary sodium and OS, BMD, or BMC were included.

Results: Pooling 11 effect sizes with a total of 39,065 people showed that higher sodium consumption significantly increased the risk of OS (OR = 1.20; 95% confidence interval [CI], 1.02–1.41; p = 0.026), with high heterogeneity among studies (I² = 68.0%; p = 0.001). Subgroup analyses showed significantly higher risk of OS in premenopausal women (OR = 1.31; 95% CI, 1.01–1.69; p = 0.036), in participants with a mean age older than 50 years (OR = 1.15; 95% CI, 1.04–1.28; p = 0.005), in dietary sodium intake subgroup (OR = 1.45; 95% CI, 1.19–1.77; p < 0.001), and in individuals with adjustment for energy (OR = 1.77; 95% CI, 1.38–2.27; p < 0.001). The correlation coefficients showed no significant association between urinary sodium and BMD (r = ?0.46; 95% CI, ?0.74 to ?0.18; p = 0.02).

Conclusions: We found a positive association between sodium intake and the risk of OS, while no association was found with urinary sodium. Furthermore, there was no significant correlation between sodium intake and BMD. Due to high heterogeneity in this research, more studies are suggested.     

The relationship between osteoporosis and body composition in pre- and postmenopausal women from different ethnic groups in China

Objective: To investigate the ethnic differences in osteoporosis (OP) and body composition (BC) and their relationship in the Maonan, Mulam, Hmong, and Yao minorities in China.

Design: A total of 860 Maonan, Mulam, Hmong, and Yao women were included in this cross-sectional study. Demographic, health history, and lifestyle information was collected using questionnaires. BC was measured through bioelectrical impedance analysis, and bone mineral density (BMD) was assessed via calcaneal quantitative ultrasound.

Results: Compared with premenopausal women, postmenopausal women exhibited a lower fat-free mass (FFM), muscle mass (MM), limb muscle mass, and T-score but a higher waist-to-hip ratio and prevalence of OP in each minority (p?T-scores and lowest prevalence of OP among the four minorities (p?p??1). In addition, our results revealed that FFM and MM exhibited exactly the same weak positive relationship with the T-score (r?=?0.081, p?T-score existed in the four minorities studied here.

Conclusions: BC and OP prevalence varied by menopausal status and ethnic group, and ethnic-specific relationships between BC and BMD were present in the four minorities. More research is needed to further investigate the ethnic differences in BC, OP, and risk factors for lower BMD to develop targeted prevention strategies to reduce the burden of OP across different ethnic groups in China.     

Basal Urinary Zinc/Creatinine Ratio as an Indicator of Dietary Zinc Intake in Healthy Adult Women

Objective: To study, in healthy women, the correlation between the basal urinary zinc/creatinine ratio and dietary zinc intake.

Subjects: A group of 36 healthy female University students was evaluated. Mean age and body weight were, respectively, 25.6±3.3 years and 54.4±7.0 kg.

Methods: Basal urine was collected; Zn was determined by AAS and Creatinine (Creat) by the Jaffe method. A nutritional survey of seven days was recorded. Mean daily dietary intake of energy (DE) and zinc (DZn) were calculated according to the INCAP and English or German Food Composition Tables, respectively.

Results: Mean dietary daily intake were as follows (±SD): Energy (kcal): 1606±570; zinc (mg): 9.1±3.8; basal urine Zn/Creat ratio: 0.41±0.24. Individual values of the Zn/Creat ratio correlated with dietary Zn (r=0.481, p=0.0339); data grouped according to ranges of dietary Zn fit the following equation: Zn/Creat=0.160±0.034 DZn (mg/day); (r=0.870, p=0.00497).

Conclusions: These results showed that the basal urinary Zn/Creat ratio could be a useful indicator of dietary Zn intake in healthy adult women.     

孕期不同钙摄入量对孕产妇骨健康的影响

目的：　探讨我国传统膳食所致低钙摄入对母体骨健康及胎儿生长发育的影响。方法：　经膳食指导和干预，使能量、蛋白质、脂肪和碳水化物摄入一致，根据随机的原则将怀孕１８ 周的３６ 名健康妇女分为传统膳食组、膳食钙干预组和膳食加钙剂联合干预组，从孕２０ 周至产后４５ 天进行干预和追踪研究。结果：　孕妇和新生儿体格指标三组间无差异（ Ｐ＞ ０ ．０５） ，但传统膳食组高危评分明显低于其它组，差异显著（ Ｐ＜ ０ ．０５） ，钙摄入量与高危评分、妊娠和分娩时血压、妊娠浮肿正相关（ ｒ＞ ０ ．５７ ， Ｐ＜ ０ ．０１） ，各组对象产后４５ 天腰椎骨密度以传统膳食组最差，组间差异显著（ Ｐ＜ ０ ．０５） ，与同龄非孕妇女的骨密度峰值相比，传统膳食仅能维持在（８５ ．１ ±６ ．６１） ％ 。结论：　我国传统膳食所致的低钙摄入状况对孕妇胎儿的一般体格无不良影响，但增加孕产期的危险因素，尤其增加妊高征的发病机会和分娩时血压，并影响孕妇骨健康。     

Soy isoflavones attenuate bone loss in early postmenopausal Chinese women

Background Previous studies show that daily doses of 40–99 mg soy isoflavones produce inconsistent effects on preventing estrogen-related bone loss in postmenopausal women. Aim of the study To examined the bone-sparing effect of isoflavones at a higher dose in early Chinese postmenopausal women. Methods A total of 90 eligible women aged 45–60 years were randomly assigned to three treatment groups (30 subjects/group) with daily dosages of 0 (placebo), 84 and 126 mg isoflavones for 6 months. Further inclusion criteria included body mass index <30 kg/m² and Kuppermann Climacteric Scale >15. Bone mineral density (BMD) of the spine and hip were measured using dual- energy X-ray absorptiometry at 0 and 6 months. Serum osteocalcin, bone-specific alkaline phosphatase (BAP) and urinary deoxypyridinoline were examined at 0, 3 and 6 months. Results Mean percent changes in BMD at the lumbar spine (p = 0.114) and femoral neck (p = 0.053) increased with the supplementations of soy isoflavones after adjusting for age, years since menopause, body weight and height, dietary intakes of isoflavones, calcium and protein, physical activities and baseline BMD at the relevant sites. We observed significantly dose-dependent linear relationship between the supplemental isoflavones and percent changes of BMD at the spine (p = 0.042) and femoral neck (p = 0.016) post-treatment, and urinary total deoxypyridinoline (p = 0.014) at 12 weeks but not at 24 weeks after adjusting for the above factors. No significant difference in percent changes in serum osteocalcin (p > 0.05) and BAP (p > 0.05) was found among the three treatment groups at 12-week and 24-week post-treatment. Conclusion There is a significantly dose-dependent effect of soy isoflavones on attenuating bone loss at the spine and femoral neck possibly via the inhibition of bone resorption in non-obese postmenopausal Chinese women with high Kuppermann Scale.     

Soy Isoflavones: No Effects on Bone Mineral Content and Bone Mineral Density in Healthy,Menstruating Young Adult Women after One Year

Background: The effects of isoflavone-enriched soy protein on human bone mineral content (mass) and density in healthy, menstruating young adult females have not been examined in a comparative prospective investigation. Peri- and post-menopausal women have been reported to show beneficial effects of isoflavones on bone measurements. Therefore, young women may also be able to improve their accrual of peak bone mineral content (BMC) and bone mineral density (BMD) during the early adult years of bone consolidation with an isoflavone-enriched diet.

Objectives: In this controlled, double-blind intervention, we tested the hypothesis that an isoflavone-rich soy protein diet increases BMC and BMD in young adult females over a period of one year in comparison to a control group receiving soy protein that has isoflavones removed.

Design: Young healthy women of any ethnic background, 21 to 25 years of age, were divided into two groups, placebo (n = 13) and supplement (n = 15). The soy protein supplement was enriched with isoflavones (～90 mg of total isoflavones/day), whereas the control protein diet was isoflavone-deficient, even though it contained the same amount of soy protein and other ingredients as the isoflavone-rich diet. Dual-energy x-ray absorptiometric (DXA) measurements of BMC and BMD were made at baseline and at 6 and 12 months. DXA estimates of body composition, including fat mass and lean body mass, were generated from whole-body BMC measurements. BMI was calculated as weight (kg) over height (m) squared. Physical activity was assessed, and three-day dietary records were taken at entry (baseline) and at 6 and 12 months.

Results: No changes in BMD after 12 months were found in either the isoflavone-treated (treatment) group or the isoflavone-deficient (control) group. Other variables also remained essentially constant over the 12-month period, including normal menstrual patterns in both the treatment and control groups.

Conclusions: The isoflavone-rich soy preparation had no effects on BMC and BMD over a 12-month period in young healthy adult females with normal menses. An isoflavone-rich supplement appears to have little or no effect on bone in young adult women with normal ovarian function, at least over this 12-month study period.     

Daily Intake of Milk Enriched with n-3 Fatty Acids,Oleic Acid,and Calcium Improves Metabolic and Bone Biomarkers in Postmenopausal Women

Objective: Nutritional strategies can be effective for the prevention of menopause-related diseases, such as osteoporosis and cardiovascular disease. Our aim was to evaluate the effects of a dairy product enriched in polyunsaturated fatty acids, calcium, oleic acid, and vitamins on cardiovascular markers and bone metabolism in postmenopausal women with moderate cardiovascular risk.

Methods: One hundred seventeen healthy postmenopausal women (aged 45 ± 7.7 years) were allocated to 2 groups: the intervention group (IG; n = 63), who consumed 0.5 L/day of a low-lactose skimmed milk enriched with 40 mg/100 mL of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), 0.54 g/100 mL oleic acid, and vitamins, and the control group (CG; n = 54), who consumed 0.5 L/day of semiskimmed milk 0.5 L/day enriched with vitamins A and D.

Results: After 12 months, in the IG there was an improvement in lipid profile: a ?5.78% decrease in total cholesterol (p = 0.010), ?9.79% (p = 0.004) in low-density lipoprotein (LDL) cholesterol, ?9.56% (p < 0.001) in total cholesterol (TC)/high-density lipoprotein (HDL) ratio, and ?3.38% in LDL/HDL ratio (p < 0.001). No changes were observed in the CG. In the IG we observed a decrease of ?28.20% in high-sensitivity C-reactive protein (hs-CRP; p = 0.012). There was no effect on bone turnover markers or serum osteoprotegerin (OPG) in either of the study groups. In the IG, receptor activator of nuclear factor κB ligand (RANKL) was reduced ?17.64% (p = 0.003), with no effect in the CG.

Conclusion: In postmenopausal women with moderate cardiovascular risk, dietary supplementation with a dairy drink enriched with fatty acids (EPA+DHA), oleic acid, minerals, and vitamins induces a positive effect on cardiovascular risk and parameters of bone metabolism. Its regular consumption may be a useful nutritional support for postmenopausal women.     

Bone Mineral Density and Metabolism at an Early Stage of Menopause When Estrogen and Calcium Supplement Are Not Used and without the Interference of Major Confounding Variables

Objectives: To measure bone mineral density (BMD) and to screen for early biochemical abnormalities in bone mineral metabolism in the first five years of natural menopause when estrogen and calcium supplement are not used and in the absence of major confounding variables.

Setting: Two homogeneous and comparable groups (n = 30) of healthy pre- and postmenopausal Caucasian women living in a northern region (latitude 46° N) were recruited during the mid-Spring/Summer season in a cross-sectional design.

Methods: Volumetric apparent BMAD (g/cm³) was calculated from areal BMD (g/cm²) which was evaluated by dual energy X-ray absorptiometry (Lunar®) at both axial and peripheric (femur) sites using two sets of reference values (WHO criterion expressed as T-score and absolute values of areal density) in combination to bone specific biochemical measurements.

Results: BMD and BM(A)D were significantly lower in postmenopausal women for all lumbar sites, but not for Ward’s triangle and any other femoral sites whereas free deoxypyridinoline (Dpd), urinary biochemical marker of bone resorption, was markedly (p < 0.0001) greater. Their serum calcium and phosphate were significantly higher without a difference in 1,25(OH)₂D₃ and PTH. The prevalence of osteopenia in pre- and postmenopausal women was about 2-fold lower in both groups (26.6 and 46.9%, respectively) when lumbar (L) spine and femur neck were combined and using the criteria based on reference values of areal density instead of T-scores.

Conclusions: The present study showed that the negative effects of estrogen deficiency on BMD and bone metabolism in early menopause occurred independently of the effect of major calcitropic hormones. Bone loss affects a non negligible proportion of premenopausal women. The prevalence of osteopenia in pre- and postmenopausal women varied according to the criterion used and anatomic site.     

中国10个地区成年人跟骨骨密度的描述性分析

目的 描述中国慢性病前瞻性研究（CKB）10个地区人群跟骨骨密度的地区和人群分布差异。方法 在参与第二次重复调查的研究对象中,剔除重要指标缺失者后,分析10个地区38~87岁24 677人经定量超声骨密度仪测定的跟骨骨密度的地区和人群差异。结果 研究人群中,跟骨骨密度指标平均水平：宽带超声衰减（109.7±12.6）dB/MHz,超声声速（1 554.7±45.6）m/s,强度指数（88.3±18.8）,T值（-0.74±1.28）。城市人群跟骨骨密度高于农村;男性高于女性。跟骨骨密度随着年龄增加而降低,女性随年龄降低的幅度比男性更为明显。吸烟者、绝经后妇女的跟骨骨密度更低;常饮牛奶和/或酸奶者、高体力活动水平者的跟骨骨密度更高。结论 CKB的10个项目地区人群的跟骨骨密度存在明显的地区和人群差异。     

绝经后妇女营养状况与骨质疏松

目的:探讨绝经后妇女膳食营养素摄入对骨密度的影响。方法:对159例健康的绝经后妇女进行膳食调查及超声骨密度仪测定桡骨远端骨密度。结果:非骨质疏松者平均每日蛋白质、脂肪、维生素A、硫胺素、核黄素、维生素C、维生素E以及钾、钙、镁、锌、磷、铁、锰、硒的摄入量均显著高于骨质疏松者(P0.05或P0.01)。结论:膳食中多种营养素与妇女的骨密度(BMD)存在一定的关系,预防骨质疏松应注意全面而合理的膳食。     

Bone density,calcium intake and vitamin D status in South Asian women living in Auckland,New Zealand

Aim: To investigate the bone health and associated risk factors of a group of South Asian women living in New Zealand. Studies on the Indian subcontinent suggest a high incidence of low bone mineral density in women with poor vitamin D status and low dietary calcium intake. Methods: Subjects were women of South Asian origin (n = 91) living in Auckland, New Zealand. Subjects were stratified by menopausal status. They completed a 4-day food diary, and provided a fasting blood sample. Bone mineral density was measured in the lumbar spine and proximal femur using dual X-ray densitometry. Results: Mean age of premenopausal (n = 71) and postmenopausal (n = 20) women was 39.8 ± 7.8 and 55.3 ± 5.4 years, respectively. Osteoporosis (T-score ≤−2.5) was present in 32% of postmenopausal and 3% of premenopausal subjects, but only in the lumbar spine. Adequate 25(OH)D levels (>50 nmol/L) were found in only 22% of premenopausal, and 26% of postmenopausal women. A body mass index in the overweight or obese category was found in 61% of premenopausal and 75% of postmenopausal women. Conclusion: The high incidence of osteoporosis in the postmenopausal group could be associated with the early age of oophorectomy or menopause together with low vitamin D status.     

China: transformations of its cuisine,a prelude to understanding its people.

Objective:Familial hypercholesterolemia (FH) is a predominantly inherited disorder, which contributes to a defect of the LDL-cholesterol receptor. For adults with familial hypercholesterolemia (FH), it is known that a supplementary diet of monounsaturated fatty acids reduces elevated levels of total cholesterol and LDL-cholesterol and may further increase HDL-cholesterol. In particular the reduced intake of dietary fat reduces total serum cholesterol and LDL-cholesterol in the range of 10% to 15% and inhibits LDL-oxidation. Once the diagnosis of familial hypercholesterolemia is made in early childhood a supplementary diet with rapeseed oil should be started as early as possible to prevent development of atherosclerosis and subsequent complications. So far there are no reports of a lipid lowering diet enriched with rapeseed oil in children and adolescents.

Methods:Seventeen children and young adolescents (male = 6, female = 11, ages 4 to 19 years) diagnosed with FH were enrolled in this study. They received dietary training and a classical low fat/low cholesterol diet enriched with rapeseed oil over five months. In the first two months they received orally mean 15 g/day (8–23 g/day), for the remaining three months mean 22 g/day (15–30 g/day) rapeseed oil. The calculation of the three-days dietary protocols showed the following characteristics: 29.5% calories from fat, 14.3% calories from protein and 54.6% calories from carbohydrates. The subjects had six sessions of dietary counseling, and serum lipids levels and lipoprotein(a) were estimated; each month’s diet adherence was controlled by a dietitian and discussed with the patients and their families during this five-month study.

Result:During five months of rapeseed oil diet serum triglycerides decreased by 29% (119.2 ± 62.8 mg/dL vs. 84.9 mean ± 39.7 mg/dL), VLDL-cholesterol by 27% (23 ± 12 mg/dL vs. 17 ± 8 mg/dL), total cholesterol by 10% (233 ± 35 mg/dL vs. 213 ± 36 mg/dL), LDL-cholesterol by 7% (151 ± 31 mg/dL vs. 142 ± 31 mg/dL). HDL-cholesterol (59 ± 15 mg/dL vs. 57 ± 11 mg/dL) and Lp(a) (29.8 ± 36.3 mg/dL vs. 32.6 ± 40.7 mg/dL) were not changed significantly. The diet was well accepted; in most families a sustained change was reported.

Conclusions:Our results indicate that in children and adolescents with FH a lipid-lowering diet with rapeseed oil has a similar effect on total serum cholesterol and LDL-cholesterol compared to classical cholesterol reduction diets (step I). However, an additional pronounced effect on lowering of triglycerides and VLDL-cholesterol can be observed.     

The Influence of Calcium Consumption on Weight and Fat Following 9 Months of Exercise in Men and Women

Background: There is some evidence that calcium consumption improves weight loss during energy restriction but the effects of calcium consumption in conjunction with chronic exercise are unknown.

Objective: The purpose of the study was to determine the degree to which calcium consumption influences weight and fat weight change as a result of 9 months of verified supervised exercise in the absence of energy restriction.

Methods: Participants were 50 previously sedentary, overweight and moderately obese men (n=20) and women (n=30). Exercise of moderate intensity was performed for 45 min/d, 5 d/wk, under supervision. Diet intake was ad libitum and was measured for energy, macronutrient and micronutrient composition at baseline, 4 and 9 months by use of observer recorded weighed plate waste and multiple-pass 24-h dietary recall procedures.

Results: Average calcium consumption was 987 ± 389 mg/day for men and 786 ± 276 mg/day for women. Weight change over the 9 months was ?4.6 ± 4.6 kg for men and 0.2 ± 3.3 kg for women. Calcium consumption was associated with weight change (r =?0.47, p<0.05) in men. The calcium to protein ratio was associated with weight change (r=0.56) and fat weight change (r=?0.53) in men. There was no observed association between calcium and weight or fat weight change in women.

Conclusion: Weight and fat weight loss as a result of nine months of moderate intensity exercise may be improved by increased calcium consumption in men but was not observed in women.     

Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis

Dietary intake of protein is fundamental for optimal acquisition and maintenance of bone across all life stages; however, it has been hypothesized that intakes above the current recommended dietary allowance (RDA) might be beneficial for bone health. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when preparing and reporting this systematic review and meta-analysis. A literature search strategy through April 11, 2017, was developed for the following 3 databases: PubMed, Ovid Medline, and Agricola. Included studies were those randomized controlled trials and prospective cohort studies among healthy adults ages 18 and older that examined the relationships between varying doses of protein intake at or above the current U.S. RDA (0.8 g/kg/d or 10%–15% of total caloric intake) from any source on fracture, bone mineral density (BMD)/bone mineral content (BMC), and/or markers of bone turnover. Twenty-nine articles were included for data extraction (16 randomized controlled trials [RCTs] and 13 prospective cohort studies). Meta-analysis of the prospective cohort studies showed high vs low protein intakes resulted in a statistically significant 16% decrease in hip fractures (standardized mean difference [SMD] = 0.84, 95% confidence interval [CI], 0.73, 0.95; I² = 36.8%). Data from studies included in these analyses collectively lean toward the hypothesis that protein intake above the current RDA is beneficial to BMD at several sites. This systematic review supports that protein intakes above the current RDA may have some beneficial role in preventing hip fractures and BMD loss. There were no differences between animal or plant proteins, although data in this area were scarce. Larger, long-term, and more well-controlled clinical trials measuring fracture outcomes and BMD are needed to adequately assess whether protein intake above the current RDA is beneficial as a preventative measure and/or intervention strategy for osteoporosis.

Key teaching points: ? ? Bone health is a multifactorial musculoskeletal issue, and optimal protein intakes are key in developing and maintaining bone throughout the life span.

? ? Dietary protein at levels above the current RDA may be beneficial in preventing hip fractures and BMD loss.

? ? Plant vs animal proteins do not seem to differ in their ability to prevent bone loss; however, data in this area are scarce.

? ? Larger, long-term RCTs using women not using hormone replacement therapy (HRT) are needed to adequately assess the magnitude of impact that protein intakes above the RDA have on preventing bone loss.