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Special Issue "Calcium Needs of Older Adults"

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 December 2012)

Special Issue Editors

Guest Editor
Prof. Dr. John J.B. Anderson (Website)

Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina, 2218 Mcgavran-Greenberg Hl, 135 Dauer Drive, Campus Box 7461, Chapel Hill 27599-7461, USA
Fax: +1 919 966 7216
Interests: nutrition and bone; nutrition and the metabolic syndrome; nutrition and renal function
Guest Editor
Dr. Martha E. Payne (Website)

Neuropsychiatric Imaging Research Laboratory, Department of Psychiatry and Behavioral Sciences, Duke University, Box 104000, Durham, NC 27710, USA
Fax: +1 919 416-7547

Special Issue Information

Dear Colleagues,

Twenty % or more of US citizens have calcium intakes that exceed the Recommended Dietary Allowances (IOM, 2011).   Spinal and hip NHANES data on bone mineral density (BMD) of older male and female adults of different ethnicities in the USA do not show differences in BMD of the spine and hip across quintiles of calcium intakes in this 2005-2006 analysis.  Assuming calcium retention occurs at higher levels of intake, the question becomes:  Where does the extra calcium go in the bodies of subjects in the highest quintiles?  Certainly, some small amounts of calcium enter bone as part of the normal turnover of the mineral phase.  Some is excreted in urine, more typically in those with higher quintiles of calcium intake than those in the lower quintiles.  Recently, several researchers have suggested that a substantial portion of the retained calcium following dietary intake is deposited as new ectopic bone in arterial walls throughout the body, but especially in specific organs, most notably coronary arteries, heart valves, and the aorta.  Measurement of coronary artery calcification measured by electron beam or spiral-computerized tomography provides a research tool to investigate the relationship between differing levels of calcium intake and total atherosclerotic burden.  The adverse effects of ectopic vascular calcification include events related to ischemia (atherosclerosis) and arterial stiffening (arteriosclerosis).  Both of these processes are associated with higher rates of morbidity and mortality in normal subjects and in patients with diabetes and chronic kidney diseases.  To date, two reports have been published that suggest increased cardiovascular disease morbidity and mortality among high-calcium consumers, especially older women.  Older adults may also develop brain lesions from excessive calcium intake.  Ongoing efforts are aimed at understanding the initiating events in ectopic vascular calcification and relationships with established atherosclerosis in major arteries of the body.  Another major question is whether optimal intake range of calcium, at or even slightly below the RDA, may lower the risk of arterial calcification and organ dysfunction.

Prof. Dr. John J.B. Anderson
Dr. Martha E. Payne
Guest Editors

Keywords

  • dietary and supplemental calcium
  • bone
  • arterial calcification
  • heart disease
  • optimal calcium intake
  • atherosclerosis
  • arteriosclerosis
  • mechanisms of bone formation

Published Papers (8 papers)

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Research

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Open AccessArticle Hormonal Relationships to Bone Mass in Elderly Spanish Men as Influenced by Dietary Calcium and Vitamin D
Nutrients 2013, 5(12), 4924-4937; doi:10.3390/nu5124924
Received: 9 July 2013 / Revised: 19 November 2013 / Accepted: 21 November 2013 / Published: 4 December 2013
Cited by 3 | PDF Full-text (644 KB) | HTML Full-text | XML Full-text
Abstract
We aim to evaluate whether calcium and vitamin D intake is associated with 25-hydroxyvitamin D (25-OH-Vitamin D3) and parathyroid hormone (PTH) serum concentrations or is associated with either the phalangeal dual energy X-ray absorptiometry (pDXA) or the quantitative bone ultrasound [...] Read more.
We aim to evaluate whether calcium and vitamin D intake is associated with 25-hydroxyvitamin D (25-OH-Vitamin D3) and parathyroid hormone (PTH) serum concentrations or is associated with either the phalangeal dual energy X-ray absorptiometry (pDXA) or the quantitative bone ultrasound (QUS) in independent elderly men. Serum PTH and 25-OH-Vitamin D3 were measured in 195 healthy elderly men (mean age: 73.31 ± 5.10 year). Food intake was quantified using a dietetic scale. Participants with 25-OH-Vitamin D3 levels ≥ 30 ng/mL (75 nmol/L) and a calcium intake of 800–1200 mg/day exhibited the lowest PTH levels (41.49 ± 16.72 ng/mL). The highest PTH levels (75.60 ± 14.16 ng/mL) were observed in the <30 ng/mL group 25-OH-Vitamin D3 with a calcium intake >1200 mg/day. No significant differences in the serum PTH levels based on the serum 25-OH-Vitamin D3 levels were observed among participants with a calcium intake of 800–1200 mg/day. Serum PTH was inversely correlated with serum 25-OH-Vitamin D3 in the entire patient sample (r = −0.288, p = 0.019). No differences in any of the three densitometry techniques were observed between any of the age groups in the 800–1200 mg/day and >1200 mg/day calcium intake groups. PTH levels correlate negatively with serum 25-OH-Vitamin D3 levels, and neither calcium nor vitamin D intake exert a strong influence on either of the two parameters. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessArticle Serum Ionized Calcium May Be Related to White Matter Lesion Volumes in Older Adults: A Pilot Study
Nutrients 2013, 5(6), 2192-2205; doi:10.3390/nu5062192
Received: 12 April 2013 / Revised: 5 June 2013 / Accepted: 6 June 2013 / Published: 18 June 2013
Cited by 3 | PDF Full-text (527 KB) | HTML Full-text | XML Full-text
Abstract
White matter lesions have detrimental effects upon older adults, while serum calcium levels have been associated with elevated vascular risk and may be associated with these lesions. Depression, a serious mental disorder characterized by disturbances in calcium metabolism, may be an important [...] Read more.
White matter lesions have detrimental effects upon older adults, while serum calcium levels have been associated with elevated vascular risk and may be associated with these lesions. Depression, a serious mental disorder characterized by disturbances in calcium metabolism, may be an important contributor to any calcium-lesion relationship. This cross-sectional pilot study examined the association between serum ionized calcium (the physiologically active form of calcium) and white matter lesion volumes in a sample of depressed and non-depressed older adults (N = 42; 60 years and older). Serum ionized calcium was determined using an ion-selective electrode technique, while lesion volumes were estimated from magnetic resonance imaging using an automated expectation-maximization segmentation. A linear regression model, controlling for age and group (depression vs. comparison), showed a trend for a positive relationship between serum ionized calcium and white matter lesion volume (β = 4.34, SE = 2.27, t = 1.91, p = 0.063). Subsample analyses with depressed participants showed a significant positive relationship between higher ionic calcium and greater lesion volume (β = 6.41, SE = 2.53, t = 2.53, p = 0.018), but no association was found for non-depressed participants. Sex-specific subsample analyses showed a significant positive relationship between higher calcium and greater lesion volume in men only (β = 7.49, SE = 3.42, t = 2.19, p = 0.041). These preliminary results indicate that serum ionized calcium may be associated with white matter lesions in older adults, particularly among men and individuals with depression. Larger studies are needed to confirm these findings. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessArticle A Diet Pattern with More Dairy and Nuts, but Less Meat Is Related to Lower Risk of Developing Hypertension in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Nutrients 2013, 5(5), 1719-1733; doi:10.3390/nu5051719
Received: 31 January 2013 / Revised: 22 April 2013 / Accepted: 9 May 2013 / Published: 21 May 2013
Cited by 13 | PDF Full-text (490 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Dietary intake among other lifestyle factors influence blood pressure. We examined the associations of an ―a priori‖ diet score with incident high normal blood pressure (HNBP; systolic blood pressure (SBP) 120–139 mmHg, or diastolic blood pressure (DBP) 80–89 mmHg and no antihypertensive [...] Read more.
Dietary intake among other lifestyle factors influence blood pressure. We examined the associations of an ―a priori‖ diet score with incident high normal blood pressure (HNBP; systolic blood pressure (SBP) 120–139 mmHg, or diastolic blood pressure (DBP) 80–89 mmHg and no antihypertensive medications) and hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or taking antihypertensive medication). We used proportional hazards regression to evaluate this score in quintiles (Q) and each food group making up the score relative to incident HNBP or hypertension over nine years in the Atherosclerosis Risk of Communities (ARIC) study of 9913 African-American and Caucasian adults aged 45–64 years and free of HNBP or hypertension at baseline. Incidence of HNBP varied from 42.5% in white women to 44.1% in black women; and incident hypertension from 26.1% in white women to 40.8% in black women. Adjusting for demographics and CVD risk factors, the ―a priori‖ food score was inversely associated with incident hypertension; but not HNBP. Compared to Q1, the relative hazards of hypertension for the food score Q2–Q5 were 0.97 (0.87–1.09), 0.91 (0.81–1.02), 0.91 (0.80–1.03), and 0.86 (0.75–0.98); ptrend = 0.01. This inverse relation was largely attributable to greater intake of dairy products and nuts, and less meat. These findings support the 2010 Dietary Guidelines to consume more dairy products and nuts, but suggest a reduction in meat intake. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)

Review

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Open AccessReview Calcium-Alkali Syndrome in the Modern Era
Nutrients 2013, 5(12), 4880-4893; doi:10.3390/nu5124880
Received: 24 September 2013 / Revised: 31 October 2013 / Accepted: 14 November 2013 / Published: 27 November 2013
Cited by 7 | PDF Full-text (188 KB) | HTML Full-text | XML Full-text
Abstract
The ingestion of calcium, along with alkali, results in a well-described triad of hypercalcemia, metabolic alkalosis, and renal insufficiency. Over time, the epidemiology and root cause of the syndrome have shifted, such that the disorder, originally called the milk-alkali syndrome, is now [...] Read more.
The ingestion of calcium, along with alkali, results in a well-described triad of hypercalcemia, metabolic alkalosis, and renal insufficiency. Over time, the epidemiology and root cause of the syndrome have shifted, such that the disorder, originally called the milk-alkali syndrome, is now better described as the calcium-alkali syndrome. The calcium-alkali syndrome is an important cause of morbidity that may be on the rise, an unintended consequence of shifts in calcium and vitamin D intake in segments of the population. We review the pathophysiology of the calcium-alkali syndrome. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessReview Risk of High Dietary Calcium for Arterial Calcification in Older Adults
Nutrients 2013, 5(10), 3964-3974; doi:10.3390/nu5103964
Received: 2 July 2013 / Revised: 23 August 2013 / Accepted: 10 September 2013 / Published: 30 September 2013
Cited by 3 | PDF Full-text (176 KB) | HTML Full-text | XML Full-text
Abstract
Concern has recently arisen about the potential adverse effects of excessive calcium intakes, i.e., calcium loading from supplements, on arterial calcification and risks of cardiovascular diseases (CVD) in older adults. Published reports that high calcium intakes in free-living adults have relatively [...] Read more.
Concern has recently arisen about the potential adverse effects of excessive calcium intakes, i.e., calcium loading from supplements, on arterial calcification and risks of cardiovascular diseases (CVD) in older adults. Published reports that high calcium intakes in free-living adults have relatively little or no beneficial impact on bone mineral density (BMD) and fracture rates suggest that current recommendations of calcium for adults may be set too high. Because even healthy kidneys have limited capability of eliminating excessive calcium in the diet, the likelihood of soft-tissue calcification may increase in older adults who take calcium supplements, particularly in those with age or disease-related reduction in renal function. The maintenance of BMD and bone health continues to be an important goal of adequate dietary calcium consumption, but eliminating potential risks of CVDs from excessive calcium intakes needs to be factored into policy recommendations for calcium by adults. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessReview Cardiovascular Effects of Calcium Supplements
Nutrients 2013, 5(7), 2522-2529; doi:10.3390/nu5072522
Received: 30 May 2013 / Accepted: 14 June 2013 / Published: 5 July 2013
Cited by 8 | PDF Full-text (330 KB) | HTML Full-text | XML Full-text
Abstract
Calcium supplements reduce bone turnover and slow the rate of bone loss. However, few studies have demonstrated reduced fracture incidence with calcium supplements, and meta-analyses show only a 10% decrease in fractures, which is of borderline statistical and clinical significance. Trials in [...] Read more.
Calcium supplements reduce bone turnover and slow the rate of bone loss. However, few studies have demonstrated reduced fracture incidence with calcium supplements, and meta-analyses show only a 10% decrease in fractures, which is of borderline statistical and clinical significance. Trials in normal older women and in patients with renal impairment suggest that calcium supplements increase the risk of cardiovascular disease. To further assess their safety, we recently conducted a meta-analysis of trials of calcium supplements, and found a 27%–31% increase in risk of myocardial infarction, and a 12%–20% increase in risk of stroke. These findings are robust because they are based on pre-specified analyses of randomized, placebo-controlled trials and are consistent across the trials. Co-administration of vitamin D with calcium does not lessen these adverse effects. The increased cardiovascular risk with calcium supplements is consistent with epidemiological data relating higher circulating calcium concentrations to cardiovascular disease in normal populations. There are several possible pathophysiological mechanisms for these effects, including effects on vascular calcification, vascular cells, blood coagulation and calcium-sensing receptors. Thus, the non-skeletal risks of calcium supplements appear to outweigh any skeletal benefits, and are they appear to be unnecessary for the efficacy of other osteoporosis treatments. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessReview Calcium Regulation and Bone Mineral Metabolism in Elderly Patients with Chronic Kidney Disease
Nutrients 2013, 5(6), 1913-1936; doi:10.3390/nu5061913
Received: 18 February 2013 / Revised: 25 April 2013 / Accepted: 8 May 2013 / Published: 29 May 2013
Cited by 8 | PDF Full-text (814 KB) | HTML Full-text | XML Full-text
Abstract
The elderly chronic kidney disease (CKD) population is growing. Both aging and CKD can disrupt calcium (Ca2+) homeostasis and cause alterations of multiple Ca2+-regulatory mechanisms, including parathyroid hormone, vitamin D, fibroblast growth factor-23/Klotho, calcium-sensing receptor and Ca2+ [...] Read more.
The elderly chronic kidney disease (CKD) population is growing. Both aging and CKD can disrupt calcium (Ca2+) homeostasis and cause alterations of multiple Ca2+-regulatory mechanisms, including parathyroid hormone, vitamin D, fibroblast growth factor-23/Klotho, calcium-sensing receptor and Ca2+-phosphate product. These alterations can be deleterious to bone mineral metabolism and soft tissue health, leading to metabolic bone disease and vascular calcification and aging, termed CKD-mineral and bone disorder (MBD). CKD-MBD is associated with morbid clinical outcomes, including fracture, cardiovascular events and all-cause mortality. In this paper, we comprehensively review Ca2+ regulation and bone mineral metabolism, with a special emphasis on elderly CKD patients. We also present the current treatment-guidelines and management options for CKD-MBD. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)
Open AccessReview Mineral Metabolic Abnormalities and Mortality in Dialysis Patients
Nutrients 2013, 5(3), 1002-1023; doi:10.3390/nu5031002
Received: 10 January 2013 / Revised: 19 February 2013 / Accepted: 7 March 2013 / Published: 22 March 2013
Cited by 8 | PDF Full-text (480 KB) | HTML Full-text | XML Full-text
Abstract
The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated [...] Read more.
The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated with cardiovascular disease and fracture in dialysis patients. Hyperphosphatemia is an important risk factor of, not only secondary hyperparathyroidism, but also cardiovascular disease. On the other hand, the risk of death reportedly increases with an increase in adjusted serum calcium level, while calcium levels below the recommended target are not associated with a worsened outcome. Thus, the significance of target levels of serum calcium in dialysis patients is debatable. The consensus on determining optimal parathyroid function in dialysis patients, however, is yet to be established. Therefore, the contribution of phosphorus and calcium levels to prognosis is perhaps more significant. Elevated fibroblast growth factor 23 levels have also been shown to be associated with cardiovascular events and death. In this review, we examine the associations between mineral metabolic abnormalities including serum phosphorus, calcium, and parathyroid hormone and mortality in dialysis patients. Full article
(This article belongs to the Special Issue Calcium Needs of Older Adults)

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