Use of calcium or calcuim in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis

Background:  Whether calcium supplementation can reduce osteoporotic fractures is uncertain. We did a meta-analysis to include all the randomised trials in which calcium, or calcium in combination with vitamin D, was used to prevent fracture and osteoporotic bone loss.

Methods:  We identified 29 randomised trials (n=63 897) using electronic databases, supplemented by a hand-search of reference lists, review articles, and conference abstracts. All randomised trials that recruited people aged 50 years or older were eligible. The main outcomes were fractures of all types and percentage change of bone-mineral density from baseline. Data were pooled by use of a random-effect model.

Findings:  In trials that reported fracture as an outcome (17 trials, n=52 625), treatment was associated with a 12% risk reduction in fractures of all types (risk ratio 0·88, 95% CI 0·83–0·95; p=0·0004). In trials that reported bone-mineral density as an outcome (23 trials, n=41 419), the treatment was associated with a reduced rate of bone loss of 0·54% (0·35–0·73; p<0·0001) at the hip and 1·19% (0·76–1·61%; p<0·0001) in the spine. The fracture risk reduction was significantly greater (24%) in trials in which the compliance rate was high (p<0·0001). The treatment effect was better with calcium doses of 1200 mg or more than with doses less than 1200 mg (0·80 vs 0·94; p=0·006), and with vitamin D doses of 800 IU or more than with doses less than 800 IU (0·84 vs 0·87; p=0·03).

Interpretation:  Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation).

Feed intake, growth, plasma glucose and urea nitrogen concentration, and cacass traits of lambs fed isoenergetic amounts of canola meal, soybean meal, and fish meal with forage based diet.

This experiment was conducted to examine the effect of feeding small, isoenergetic amounts of supplements containing high protein and functional lipid components, rather than the greater amounts of cereal and/or legume grains usually fed during the dry season in Australia, on dry matter intake (DMI), growth performance, plasma metabolites, and fat deposition in lambs consuming low quality roughage. Thirty two crossbred wether lambs ([Merino × Border Leicester] × Poll Dorset) were divided into four groups by stratified randomization according to liveweight (26–33 kg). After a 7-day adaptation to a hay diet (lucerne hay:oaten hay; 30:70), lambs were allocated to four treatments consisting of (1) basal diet of lucerne hay:oat hay (20:80; metabolizable energy (ME) = 7.0 MJ/kg DM), Basal; (2) basal + canola meal (84 g per day), CM; (3) basal + soymeal (75 g per day), SM; or (4) basal + fishmeal (80 g per day), FM. Daily hay and supplement DMI, and weekly liveweight were recorded during a 53-day experimental study. Blood samples were taken on day 1 and pre- and post-feeding on days 30 and 53 to measure changes in plasma glucose and plasma urea nitrogen (PUN) concentration. At the end of the experiment, lambs were slaughtered and hot carcass weight (HCW) recorded; cold carcass fatness (total muscle and adipose tissue depth at 12th rib, 110 mm from midline; GR) was determined at 24 h postmortem. Total DMI was increased (P < 0.001) in CM, SM and FM treatments, but basal hay DMI intake was only increased (P < 0.01) in CM and FM treatments compared with Basal treatment. This resulted in significant (P < 0.01) increases in metabolizable energy (ME) and crude protein (CP) intakes in all supplemented treatments, with the highest intakes recorded in the FM treatment. Liveweight gain (LWG) was significantly increased in CM and SM (P < 0.05) and FM (P < 0.01) treatments but HCW was significantly (P < 0.01) heavier slaughter only in the FM treatment. Feed conversion efficiency (P < 0.001) and GR fat at depth (P < 0.05) was reduced in all supplement treatments compared with Basal. Plasma glucose concentration was significantly (P < 0.05) increased after feeding in all treatments but there was no treatment effect. PUN was significantly increased over time in the supplemented treatments compared with the Basal treatment; there was no significant difference between supplement treatments by day 53. Results show that feeding small amounts of high protein and lipid-containing supplements improves production responses and are beneficial in producing carcasses with more lean compared with carcasses from lambs fed a low quality hay diet.

Lean meat and heart health

The general health message to the public about meat consumption is both confusing and misleading. It is stated that meat is not good for health because meat is rich in fat and cholesterol and high intakes are associated with increased blood cholesterol levels and coronary heart disease (CHD). This paper reviewed 54 studies from the literature in relation to red meat consumption and CHD risk factors. Substantial evidence from recent studies shows that lean red meat trimmed of visible fat does not raise total blood cholesterol and LDL-cholesterol levels. Dietary intake of total and saturated fat mainly comes from fast foods, snack foods, oils, spreads, other processed foods and the visible fat of meat, rather than lean meat. In fact, lean red meat is low in saturated fat, and if consumed in a diet low in SFA is associated with reductions in LDL-cholesterol in both healthy and hypercholesterolemia subjects. Lean red meat consumption has no effect on in vivo and ex vivo production of thromboxane and prostacyclin or the activity of haemostatic factors. Lean red meat is also a good source of protein, omega-3 fatty acids, vitamin B12, niacin, zinc and iron. In conclusion, lean red meat, trimmed of visible fat, which is consumed in a diet low in saturated fat does not increase cardiovascular risk factors (plasma cholesterol levels or thrombotic risk factors).

The influence of fish, meat and polyunsaturated fat intakes on platelet phopholipid polyunsaturated fatty acid in male Melbourne Chinese and Caucasian

Objective: The aims of this study were to investigate (1) platelet phospholipid (PL) polyunsaturated fatty acid (PUFA) composition in subjects who were the Melbourne Chinese migrants, compared with those who were the Melbourne Caucasians and (2) the relationship between platelet PL PUFA and intake of fish, meat and PUFA.

Design: Cross-sectional comparison of the Melbourne Chinese and Caucasians.

Setting: Free-living male subjects.

Subjects: Ninety-seven Melbourne Chinese migrants and 78 Melbourne Caucasians who were recruited in Melbourne.

Outcome measures: Dietary intake was assessed using a semi-quantitative food frequency questionnaire. The platelet PUFA was measured by gas-liquid chromatography.

Results: The Melbourne Chinese had significantly higher proportions of platelet PL 20:5n-3 (P=0.006), 22:6n-3 (P<0.0001), total n-3 (P=0.027) and 22:5n-6 (P=0.0002), and a significantly higher intake of fish (P=0.012) and white meat (P=0.0045) compared with the Melbourne Caucasians. In addition, the Melbourne Chinese had significantly lower proportions of 20:3n-6 (P=0.023), 20:4n-6 (P<0.002), 22:4n-6 (P<0.0001), total n-6 (P=0.037), 22:5n-3 (P<0.0001) and ratio of n-6/n-3 (P=0.011), and a significantly lower intake of red and total meat (P<0.0001) than the Melbourne Caucasians. Fish consumption was significantly positively correlated with platelet PL 20:5n-3 and 22:6n-3, and significantly negatively correlated with 22:5n-3 (P<0.05). Meat consumption was significantly positively correlated with 22:5n-3 and significantly negatively correlated with 22:5n-6, 20:5n-3 and 22:6n-3 (P<0.05). Dietary PUFA intake was significantly positively correlated with 20:3n-6, 22:4n-6 and 22:5n-3, and significantly negatively correlated with 22:5n-6, 20:5n-3 and 22:6n-3 (P<0.05).

Conclusions: Compared with Caucasians, the Melbourne Chinese had a significantly higher level of platelet PL n-3 PUFA, which might contribute to the low CVD mortality in this population. Platelet PL 20:5n-3 and 22:6n-3 were significantly positively correlated with fish intake, and negatively significantly correlated with dietary intake of meat and PUFA, while 22:5n-3 was significantly positively correlated with dietary meat and PUFA intake, and significantly negatively correlated with fish intake. Dietary intake of PUFA and fish are potential confounding factors for assessing the effects of meat consumption on platelet PL individual PUFA. Dietary intake of PUFA and meat did not influence the incorporation of fish long chain n-3 PUFA to platelet PL in this study population.

Effect of vitamin D supplementation on vitamin D status and bone turnover markers in young adults

Objective: To assess the vitamin D status of healthy young people living in Northern Ireland and the effect of vitamin D supplementation on vitamin D status and bone turnover.

Design: Double-blinded randomised controlled intervention study.

Setting: University of Ulster, Coleraine, Northern Ireland.

Subjects: In total, 30 apparently healthy students (15 male and 15 female subjects), aged 18–27 years, were recruited from the university, with 27 completing the intervention.

Interventions: Subjects were randomly assigned, to receive either 15 mug (600 IU) vitamin D3 and 1500 mg calcium/day (vitamin D group), or 1500 mg calcium/day (control group) for 8 weeks between January and March. Vitamin D status, bone turnover markers, serum calcium and parathyroid hormone concentrations were measured at baseline and post intervention.

Results: At baseline, vitamin D status was low in both the vitamin D group (47.9 (s.d. 16.0)) and the control group (55.5 (s.d. 18.6) nmol/l 25(OH)D). Post intervention vitamin D status was significantly higher in the vitamin D-treated group (86.5 (s.d. 24.5)) compared to the control group (48.3 (s.d. 16.8) nmol/l) (P<0.0001). There was no significant effect of supplementation on bone turnover markers or PTH concentrations.

Conclusions: This study suggests that young adults in Northern Ireland do not consume an adequate daily dietary intake of vitamin D to maintain plasma vitamin D concentrations in the wintertime. A daily supplement of 15 mug vitamin D3 significantly increased vitamin D status in these individuals to levels of sufficiency. Achievement of an optimum vitamin D status among young adults may have future positive health implications.

Calcium and bone health : position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia

This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia.

Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women.

Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling.

In adults with a baseline calcium intake of 500–900 mg/day, increasing or supplementing this intake by a further 500–1000 mg/day has a beneficial effect on bone mineral density.

Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.

Multivitamin supplementation improves nutritional status and bone quality in aged care residents

Objectives: To assess the effectiveness of a multivitamin (MV) tablet on nutritional status, quantitative heel ultrasound (QUS), mobility, muscle strength and falls. The design comprised two groups matched on mobility levels, randomized to receive a daily MV or placebo (P) tablet for 6 months. The setting was an Australian residential care facility.

Subjects: A total of 92 aged care residents. Serum micronutrients, body weight, QUS, rate of falls, hand grip strength, and the timed up and go test were assessed at baseline and 6 months.

Results: A total of 49 participants consumed a MV and 43, a matched P for 6 months. There was a greater increase in the MV vs P group for serum 25(OH)D (mean differencestandard error, 33.42.6 nmol l-1), folate (13.42.8 nmol l-1), and vitamin B12 (178.040.3 pmol l-1) (all P<0.001). Adequate 25(OH)D concentrations (50 nmol l-1) were found among 77% of participants in the MV group vs 10% taking P (P<0.001). Adjusting for baseline levels, the increase in QUS was greater in the MV vs P group (3.02.0 dB MHz-1 vs -2.92.1 dB MHz-1, respectively, P=0.041). There was a trend towards a 63% lower mean number of falls in the MV vs P group (0.30.1 falls vs 0.80.3 falls, P=0.078).

Conclusions: MV supplementation raised serum vitamin B12 and folate concentrations and increased serum 25(OH)D, which was accompanied by an apparent positive effect on bone density. We also found a trend towards a reduction in falls and this could contribute to a reduction in fractures.

Effects of diets high in whey, soy, red meat and milk protein on body weight maintenance in diet-induced obesity in mice

This study examined the effects of different food sources of protein on energy intake, body weight maintenance, and on the responses of plasma leptin, insulin and adiponectin in chronic high-fat diet-induced obese mice. Obesity was induced in 47 mice with a high-fat diet for 20 weeks. They were divided into five diet groups to test the effects of a higher protein proportion (30% energy), achieved at the expense of carbohydrate. For the next eight weeks, four of the groups were fed diets of chow formulated with whey, soy, red meat or milk while the control group continued on their high-fat diet. The results showed that: (i) increasing the protein : carbohydrate ratio (both at 30% energy) in a high-fat diet did not reduce the level of obesity; (ii) the type of protein added, however, did have a significant effect on the level of obesity attained; (iii) whey protein stabilised weight gain the most, had the strongest satiety effects and also stimulated the highest production of adiponectin; and (iv) whey protein also was associated with the lowest insulin values among all proteins tested. Plasma leptin levels were not affected by any of the diets. Dietary fat remains a potent factor in weight management, but the type and amount of protein may also be important through its effects on food intake. In particular, the apparent decreased appetite associated with increased adiponectin in the whey-based high-protein diet may contribute to stabilised body mass in chronic high-fat diet-induced obesity.

Depression and bone mineral density in a community sample of perimenopausal women: Geelong Osteoporosis Study

Objective: Reduced bone mineral density (BMD) in women with a history of depressive disorders has been shown in some, but not all studies. This study investigated the association between self-reported depression and BMD in an age-stratified community sample of perimenopausal women residing in the South-Eastern region of Australia.

Design: Symptoms of depression in the year between July 2000 and July 2001 were ascertained by a self-report questionnaire based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Women in the perimenopausal group who had undergone a BMD total hip and spine assessment within the 12-month period after the depression assessment were included in the analysis, resulting in a sample of 78 women aged 45 to 60 years.

Results: In this sample, 14 women were identified as depressed. There was no difference in age, hormone therapy (HT) use, or unadjusted BMD at the total hip or spine between the depressed and nondepressed women (P = 0.14, 0.89, 0.57, and 0.70, respectively), but the depressed women tended to be heavier [depressed (median weight, interquartile range = 80 kg, 66-94) vs nondepressed (72 kg, 61-80) P = 0.06]. Whereas there was no significant difference in age-, HT-, and weight-adjusted BMD at the spine [depressed (mean ± SE = 1.21 ± 0.05) vs nondepressed (1.28 ± 0.03 g/cm2) P = 0.18], adjusted BMD at the total hip for the depressed women was 7.8% lower than for the nondepressed [depressed (mean ± SE = 0.957 ± 0.038) vs nondepressed (1.038 ± 0.023 g/cm2) P = 0.04].

Conclusions: These results suggest that in perimenopausal women, self-reported depression is associated with lower BMD at the hip.

Depression and bone mineral density in a community sample of men : Geelong Osteoporosis Study

Background : Previous research in psychiatric and community samples has demonstrated reduced bone mineral density (BMD) in individuals with both clinical depression and depressive symptoms, although the findings are equivocal. This study aimed to investigate the association between self-reported depression and BMD in a community sample of men aged 20–96 years enrolled in the Geelong Osteoporosis Study.

Methods : A self-report questionnaire based on DSM-IV criteria was used to determine lifetime prevalence rates of depression within the study sample at baseline. Those currently taking oral glucocorticoids, testosterone or bisphosphonates were excluded from the analysis (n = 23) resulting in a sample of 1279 men.

Results : In this sample, 155 men reported a lifetime history of depression (LHX). There were no differences in age, weight, height, calcium intake, smoking rates or unadjusted BMD at the femoral neck between the cases and the controls, whereas unadjusted BMD at the spine was significantly lower in those with a LHX (1.254 ± 0.187 vs 1.293 ± 0.194 g/cm2). BMD adjusted for age, weight, calcium intake and smoking was 3.6% lower at the spine (1.255 ± 0.016 vs 1.295 ± 0.006 g/cm2) and 3.4% lower at the femoral neck (0.973 ± 0.011 vs 1.007 ± 0.004 g/cm2) in those with a LHX compared to controls.

Conclusion : These data are consistent with previous findings of diminished BMD in people with depressive disorders and symptoms and suggest that depression may be a risk factor for reduced BMD in community-dwelling adult men.