Role of Diet in Preventing Osteoporosis
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1 Role of Diet in Preventing Osteoporosis What is enough and what is too little? Connie M. Weaver, Ph.D. Purdue University
2 Women s Global Health Institute at Purdue Discovery with Delivery for Women s Health Research Connie M. Weaver, Ph.D. Director of the Women s Global Health Institute Distinguished Professor of Nutrition Science
3 To improve the health and quality of women worldwide through: Research Training future investigators Vision
4 Women s Global Health Institute Focus on Wellness and disease Prevention, early detection and effective interventions Bone Health Wellness Women s Cancers Neurodegenerative Disorders Combine strong technology, engineering, natural and social sciences a hub for interdisciplinary research Four research platforms Bone Health Women s Cancers Neurodegenerative Disorders Wellness
5 2017 WGHI Mildred Elizabeth Edmundson Research Pilot Grant Awards: Women s Global Health Institute Sonak Pastakia, Pharmacy Practice Proposal Title: A Contextualized Community Based Approach for the Early Identification and Treatment of Breast and Cervical Cancer in Rural Western Kenya (in partnership with the Indiana CTSI): Graham Cooks, Chemistry Proposal Title: ZIKV Diagnostic Approach in Human Semen by MRM- Profiling Mass Spectrometry Kathleen Hill Gallant, Nutrition Science Proposal Title: Effect of Ovariectomy on the Progression of Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) in Rats WGHI Mildred Elizabeth Edmundson Research Pilot Grant Program is established by Bill and Diane Edmundson in To date, it has funded 10 pilot projects in women s health and generated more than $4.6 million external funds
6 Women s Global Health Institute 2017 WGHI Student Poster Award Winner: Honorable Mention: Farzaneh Atrian, Basic Medical Sciences Poster title: Enhancing the effect of anticancer drugs through modifications of nuclear morphology (This award helped supporting her presenting at Society of Toxicology annual meeting March 12-16, Baltimore, Maryland) Tomasz Wilmanski, Nutrition Science Poster title: 1,25-Dihydroxyvitamin D3 inhibits de novo fatty acid synthesis and metastatic capability of breast cancer cells Purdue alumnus Roberta Gleiter is the sponsor of the WGHI Student Travel award. Three Purdue students have received the award since 2016
7 Community Luncheon Series on Women s Health Women s Global Health Institute Engage community Deliver new discoveries Address questions and concerns in women s health Two speakers: Research Clinical management Neurodegenerative Disorders Co-host: IU National Center for Excellence of Women s Health Speakers: Jessica Huber, PU Osteoporosis Prevention Sarah Elizabeth Zauber, IUSM Sponsor: American Dairy Association Indiana Speakers: Connie Weaver, PU Linda DiMeglio, IUSM
8 Prevalence of Bone Health Categories: Females 50+ years, NHANES NHW % 30 NHB MA Osteoporosis Low Bone Mass 8 Wright et al. JBMR; 2014:
9 Bone Health: A Lifelong Concern Peak skeletal mass achieved by ages Adult skeleton remodeled and replaced every 10 years Growth Peak bone mass Maintenance Menopause Puberty Frailty Old Age Strategies to prevent fracture are to build peak bone mass early in life and to reduce bone loss later in life
10 Why is peak bone mass important? 30 to 50% of children have at least one fracture by the end of teenage years a 5 10% difference in PBM may result in a 25 50% difference in hip fracture rate later in life Estimated annual costs exceed $131 billion for hip fractures worldwide.
11 Bone Mass NOF Position on Lifestyle Factors and Peak Bone Mass Peak Bone Mass Calcium A Vitamin D B Dairy B Physical Activity A Most others C/D Normal BMC Accrual Suboptimal BMC Accrual Orthopedic Complications Low bone mass Osteoporosis Fracture Age (years) Weaver et al., Osteoporosis International 27: , 2016
12 Camp Calcium:11 metabolic studies in adolescents from 1990 We have studied Whites, Blacks, Asians, and Hispanics; boys and girls.
13
14 Study Design Controlled diet High or Low Ca or Salt Crossover Controlled diet High or Low Ca or Salt Washout Metabolic Balance Metabolic Balance
15 Estimated bone gain from our model increasing Ca intake from mg/d: 10 % increase in peak bone mass, this could delay onset of osteoporosis by 13 years and decrease risk of fracture in postmenopausal women by 50 %. Bonjour et al., Med Sport Sci 2007; 51: 64; WHO 1994
16 Sodium Retention in Black and White Female Adolescents in Response to Salt Intake
17 Dietary salt varied Low Na diet 1.3 g/d High Na diet 4 g/d
18 UNa (mg/d) Urinary sodium excretion (Mean±SEM) * Whites Blacks Low Na diet (1.3 g/d) * Significantly different from whites at p<0.05 High Na diet (4 g/d) Palacios, et al. JCEM 89(4): , 2004.
19 Effects of Salt intake on Calcium Excretion and Balance in Black and White Adolescents Wigertz et al., AJCN 81:845-50, 2005
20 Conclusions from Camp Calcium Calcium requirements for North America set at 1300 mg/d for adolescents based on Camp Calcium data. Dietary salt decreases Ca retention. Whites are more vulnerable to osteoporosis and blacks are more vulnerable to hypertension starting with differences in sodium and calcium metabolism in adolescence. Supplementing with vitamin D has no effect on calcium absorption in American children.
21 Maximizing Bone Mineral Content Reduces Risk of Fracture Calcium storage in bone is a functional reserve
22 Meta analysis shows Calcium plus vitamin D reduces risk of hip fractures by 30% Weaver et al., OI 27: , 2016
23 Are Calcium Supplements Safe?
24 Ossabaw Pig: Model for Soft Tissue Calcification Research Goal: To examine the impact of high dietary calcium from supplement (calcium carbonate) or dairy (non-fat dry milk) on cardiovascular function, vascular calcification and the progression of coronary artery disease. Funding from Dairy Research Institute, Dairy Australia, Nestle, Fonterra, Kraft, Pharmavite Phillips-Eakley et al., JAHA e001620, 2015
25 Conclusions 6-month feeding of high calcium from calcium carbonate or dairy did not alter cardiovascular function, coronary artery disease burden or coronary artery calcification in Ossabaw miniature swine.
26 Combined Effort to Elucidate Role of Calcium in Cardiovascular Disease Calcium intake and CV disease risk: Updated systematic review and metaanalysis Tufts University Position Statement : National Osteoporosis Foundation (NOF) and American Society for Preventive Cardiology (ASPC) Kopecky et al. Annals of Internal Medicine 2016; 165:
27 Position Statement : NOF and ASPC B-level or moderate evidence that calcium w/ or w/o Vit D intake from food or supplements has no relationship (beneficial or detrimental) to the risk of CV and cerebrovascular disease incidence, mortality, and all-cause mortality in generally healthy adults. Calcium from food and supplements mg/d [tolerable upper intake levels (UL) defined by National Academy of Medicine] should be considered safe from a CV standpoint
28 Variety of Sources Provide Essential Nutrients Calcium Vitamin D Calcium Vitamin D Potassium Calcium Vitamin D Magnesium Riboflavin Vitamin A Phosphorus Potassium
29 Intake Compared to Recommendations: Average dairy food group intakes by age-sex groups, compared to ranges of recommended intake Recommended Intake Range Average Intake Dietary Guidelines for Americans
30 Food sources of bioavailable calcium Calcium Estimated # Servings Content Fractional Absorbable needed to Food Serving Absorption Ca/serving = 1 c. milk (mg) (%) (mg) Milk, yogurt Beans, dried Broccoli Cabbage Kale Spinach Tofu, calcium set
31 Calcium absorption varies by lifestage Calcium Absorption ~30% Calcium Absorption ~40% Calcium Absorption ~25% Calcium Absorption ~80%
32 Soluble Corn Fiber s Effect on Bone Health in Postmenopausal women Hypothesis: SCF will increase bone calcium retention in a dose-dependent manner in postmenopausal women. Jakeman et al. Am J Clin Nutr 104: , 2016.
33 Rapid Screening Method Accelerator Mass Spectrometry for Tracer Quantification Measures atom level quantities 14 C, 41 Ca, 129 I, 26 Al, 10 Be Purdue University Cooperative Extension Service is an equal access/equal opportunity institution.
34 STUDY: DESIGN Healthy Postmenopausal Women N = 14 Intervention Period 1 (1 subj. withdrew) 0, 10, 20 g/d PROMITOR SCF randomized order Intervention Period 2 Intervention Period 3 (1 subj. withdrew) 50 day baseline 50 Day intervention 50 day washout 50 Day intervention 50 day washout 50 Day intervention 50 day washout 24 h Urine / 10 d
35 Change in Net Bone Calcium Retention Compared to Predicted Values (%) Effect of Added Soluble Corn Fiber on Net Bone Calcium Retention in Postmenopausal Women (Mean ± 95% CI) 10 9 * 8 7 * Added Soluble Corn Fiber (g/d) Different from predicted values determined at baseline and recovery periods Jakeman et al. Am J Clin Nutr 104: , 2016.
36 SCF - Weaver lab - 3 trials: 2 in adolescents and 1 in postmenopausal women FDA Guidance -SCF meets dietary fiber definition for nutrient facts label based on Ca absorption and retention 1 year RCT in children Malaysia Winnie Chee, PI RCT (NIH) in bariatric patients UCSF Anne Schafer, PI SCF pathogenesis in T1D Mice Michigan State Laura McCabe, PI
37 Berries and Bone Project NCCIH Connie Weaver, PI Nutrition George McCabe, Co-PI Statistics Mario Ferruzzi, Bruce Copper, Mary Ann Lila (NCSU), Elsa Janle Berry procurement, bioactive analysis, and bioavailability Teresita Bellido, David Burr (IUSM) Cell Culture/Animal Studies Munro Peacock (IUSM) Clinical Investigator
38 Methods 41 Ca technology Treatment Half-life of 100,000 years Dose 50 nci Blueberry powder incorporated into 3 products Three dose levels Low 17.5 g (0.75 cup of blueberries) Medium 35 g (1.5 cups) High 70 g (3 cups) J. Kalina Hodges
39 Overall Conclusions Building peak bone mass and reducing bone loss later in life are two strategies to reduce osteoporosis Increasing peak bone mass by 5-10% can reduce fracture risk substantially Lifestyle choices can modify both peak bone mass and bone loss Several of the essential nutrients important to bone are shortfall nutrients, i.e., calcium, vitamin D, magnesium
40 Funding: NIH Alliance for Potato Research & Education Acknowledgements Weaver Lab: Dr. Connie Weaver Dr. Berdine Martin Pam Lachcik Kalina Hodges Andrea Lobene Maria Maiz Mike Stone Dennis Cladis Omer Sermet Collaborators: Purdue George McCabe Cindy Nakatsu IUSM Munro Peacock David Burr Teresita Bellido
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