Particle size of oyster shell meal and calcium: phosphorus ratios in broiler diets / Efeito do tamanho de partícula da farinha de ostras e relações cálcio: fósforo em dietas para frangos de corte

The effects of Ca:P total ratio and particle size of oyster shell meal (OSM) were evaluated in broiler diets. In Experiment 1, 800 broilers (22-42 days old) were distributed in a 2×2 factorial design, with two Ca:P ratios (1.7 and 2.0:1) and two OSM particle sizes (coarse = 1,354 µm and fine = 428 µm), totaling four treatments with 10 repetitions with 20 broilers. Feed intake, weight gain, and feed conversion ratio were calculated. In Experiment 2, 1,280 broilers were distributed in a 2×2×2 factorial design (1.7 and 2.0:1 Ca:P ratios; coarse and fine OSM; male and female broilers), with eight treatments and 16 repetitions with 10 broilers. Apparent metabolizability of dry matter, Ca, P, and apparent metabolizable energy (AME), as well as bone resistance, bone weight, ash, Ca, and P content in the tibia were assessed. Growth performance was not affected (P > 0.05). Coarse OSM increased tibia Ca content in male broilers (P < 0.001), and higher Ca:P ratio improved bone ash and bone resistance in both sexes (P < 0.001), but reduced P content in male broilers (P < 0.05); male broilers displayed heavier bones with higher ash content than females (P < 0.05). Metabolizability of Ca was improved with coarse OSM (P < 0.05); whereas metabolizability of DM, P, and AME was not affected (P > 0.05). In conclusion, diets with a Ca:P total ratio of 2.0:1 containing coarser OSM improved bone mineral composition, particularly in male broilers, and coarse OSM improved the metabolizability of Ca in broilers regardless of the Ca:P total ratio or broiler sex.

Dois experimentos foram conduzidos para avaliar os efeitos do tamanho de partícula da farinha de ostras (FO) e relação Ca:P total em dietas para frangos de corte. No primeiro experimento, 800 frangos (22 a 42 dias) foram distribuídos em um delineamento fatorial 2x2: 2 relações Ca:P (1,7 e 2,0:1) e dois tamanhos de partícula da FO (grossa = 1354 µm e fina = 428 µm), totalizando quatro tratamentos com 10 repetições de 20 aves. O consumo de ração, o ganho de peso e a conversão alimentar foram calculados. No segundo experimento, 1.280 frangos foram distribuídos em um fatorial 2x2x2 (relações Ca:P 1,7 e 2,0:1; FO grossa e fina; aves machos e fêmeas) com oito tratamentos e 16 repetições de 10 aves. Foram avaliados: metabolizabilidade aparente da matéria seca, Ca e P, energia metabolizável aparente (EMA), peso e resistência óssea, conteúdo de cinzas, Ca e P na tíbia. As variáveis de desempenho não foram afetadas (P > 0,05). O uso de FO grossa aumentou o conteúdo de Ca na tíbia de frangos machos (P < 0,001), e a relação Ca:P de 2,0:1 aumentou o conteúdo de cinzas e aprimorou resistência óssea em ambos os sexos (P < 0,001), porém reduziu P na tíbia dos machos (P < 0,05); frangos machos também tiveram ossos mais pesados e maior conteúdo de cinzas do que fêmeas (P < 0,05). A metabolizabilidade de Ca foi melhorada com FO grossa, enquanto a metabolizabilidade da matéria seca, P, e EMA não foram afetadas (P > 0,05). Conclui-se que as dietas com relação Ca:P de 2,0:1 e com FO grossa resultaram em melhor composição mineral óssea - particularmente em frangos machos - e a FO grossa melhorou a metabolizabilidade de Ca independentemente da relação Ca:P ou do gênero das aves.

Tipos de leite e sua contribuição na ingestão diária de sódio e cálcio / Milk types and their contribution to daily sodium and calcium intake

Resumo O baixo consumo de cálcio e elevado de sódio por adolescentes configura um sério problema de saúde pública. A biodisponibilidade e o teor de cálcio contido no leite fazem dele a melhor opção no atendimento a Ingestão Dietética Recomendada (IDR) desse nutriente. Como o leite pode contribuir para a ingestão de sódio, a realização de programas que visem aumentar o seu consumo deve ser precedida de ações para diminuir o teor de sódio nele presente. O conhecimento dos teores de cálcio e sódio presentes nos leites industrializados é fundamental para que se estabeleça a quantidade adequada a ser consumida. O estudo realizado visou quantificar o cálcio e o sódio de leites em pó e ultrapasteurizados comercializados em supermercados da cidade do Rio de Janeiro e estimar a quantidade a ser consumida para atingir as necessidades diárias de cálcio e o impacto sobre a ingestão de sódio. O cálcio foi quantificado por volumetria e o sódio por fotometria de chama. Os teores médios de cálcio e sódio do leite em pó (mg/26g) foram, respectivamente, 262,5 ± 5,1mg e 116,8 ± 3,1mg, e do leite ultrapasteurizado (mg/200mL) foram, respectivamente, 246,0 ± 10,3mg e 162,5 ± 16,3mg. Para atingir a IDR do cálcio, pelo consumo de leite, os adolescentes consumiriam 584mg de sódio pelo leite em pó (39% da IDR) e 812,5mg pelo ultrapasteurizado (54% da IDR).

Abstract Low calcium consumption and high sodium intake among adolescents is a serious public health problem. Thehigh content and bioavailability of calcium in milk makes it the best choice for meeting the Dietary Reference Intakes (DRIs) for calcium. Since milk also contributes to sodium intake, programs promoting milk consumption should be preceded by initiatives to reduce its sodium content. Knowing the calcium and sodium content of processed milk is essential for establishing the adequate consumption of milk. The aim of this study was to estimate the calcium and sodium content of different brands of powdered and ultra heat treated (UHT) milk sold in supermarkets in Rio de Janeiro and calculate the amount of these milks that should be consumed by adolescents to meet daily calcium needs and the impact of this consumption on sodium intake. Volumetric analysis was used to measure calcium content and sodium content was determined using flame photometry. The mean calcium and sodium concentrations of powdered (mg/26g) and UHT milk (mg/200ml) were 262.5 ± 5.1 mg and 116.8 ± 3.1 mg and 246.0 ± 10.3 mg and 162.5 ± 16.3 mg, respectively. Milk intake sufficient to meet the DRI for calcium among adolescents would result in a sodium intake of 584 mg (39% of the AI) from the consumption of powdered milk and 812.5 mg (54% of the AI) from the consumption of UHT milk.

Milk consumption, dietary calcium intake and nutrient patterns from adolescence to early adulthood and its effect on bone mass: the 1993 Pelotas (Brazil) birth cohort / Consumo de leite, ingestão dietética de cálcio e padrões de nutrientes desde a adolescência até o início da idade adulta e o efeito sobre a massa óssea: a coorte de nascimento de 1993 de Pelotas, Rio Grande do Sul, Brasil / Consumo de leche, ingestión dietética de calcio y patrones nutricionales desde la adolescencia hasta el inicio de la edad adulta y su efecto en la masa ósea: cohorte de nacimiento de 1993 en Pelotas, Rio Grande do Sul, Brasil

The objective of this study is to evaluate the effect of milk consumption, dietary calcium intake and nutrient patterns (bone-friendly and unfriendly patterns) from late adolescence to early adulthood, on bone at 22 years of age. Cross-sectional analysis was performed with 3,109 participants from 1993 Pelotas (Brazil) birth cohort in the follow-ups of 18 and 22 years of age. Bone mineral density (BMD) of the lumbar spine, right femur and whole body were assessed at 22 years using a dual-energy X-ray absorptiometry (DXA). The exposure variables (dietary calcium, milk and nutrient patterns) were created by combining the consumption frequencies between the two follow-ups (always low, moderate, high, increase or decrease). Multiple linear regressions were performed, stratified by sex. In the right femur site, men classified into the "always high" (mean = 1.148g/cm²; 95%CI: 1.116; 1.181) and "increased" categories of milk consumption (mean = 1.154g/cm²; 95%CI: 1.135; 1.174) presented a slightly low BMD comparing with low (mean = 1.190g/cm²; 95%CI: 1.165; 1.215) and moderate (mean = 1.191g/cm²; 95%CI: 1.171; 1.210) categories. In addition, men always classified in the highest tertile of the "bone-unfriendly" pattern presented the lowest mean of whole body BMD (mean = 1.25g/cm²; 95%CI: 1.243; 1.266). No associations were observed between the categories of dietary calcium intake and "bone-friendly" pattern and each of the three BMD outcomes. These results point to the fact that diets composed of inhibiting foods/nutrients can contribute negatively to bone health.

O estudo teve como objetivo avaliar o consumo de leite, a ingestão dietética de cálcio e os padrões de nutrientes (favoráveis e desfavoráveis à saúde óssea) do final da adolescência até o início da idade adulta sobre a massa óssea aos 22 anos de idade. Foram realizadas análises transversais em 3.109 participantes da coorte de nascimentos de 1993 de Pelotas, Rio Grande do Sul, Brasil, nos acompanhamentos realizados aos 18 e 22 anos de idade. Aos 22 anos, foi avaliada a densidade mineral óssea (DMO) da coluna lombar, do fêmur direito e do corpo inteiro, utilizando absorciometria de raios-x de dupla energia (DXA). As variáveis de exposição (cálcio dietético, leite e padrões de nutrientes) foram criadas pela combinação das frequências de consumo entre os dois acompanhamentos (sempre baixo, moderado, sempre alto, aumentado ou diminuído). Foram realizadas análises de regressão linear múltipla, estratificadas por sexo. No fêmur direito, homens classificados nas categorias de consumo de leite "sempre alto" (média = 1,148g/cm²; IC95%: 1,116; 1,181) e "aumentado" (média = 1,154g/cm²; IC95%: 1,135; 1,174) apresentaram DMO ligeiramente baixa, comparado com as categorias de consumo "sempre baixo" (média = 1,190 g/cm²; IC95%: 1,165; 1,215) e "moderado" (média = 1,191g/cm²; IC95%: 1,171; 1,210). Além disso, os homens sempre classificados no tercil mais alto do padrão "favorável à saúde óssea" apresentaram a média mais baixa de DMO de corpo inteiro (média = 1,254g/cm²; IC95%: 1,243; 1,266). Não foram observadas associações entre as categorias de ingestão de cálcio dietético e do padrão "favorável à saúde óssea" e cada um dos três desfechos de DMO. Os resultados corroboram o fato de que dietas constituídas de alimentos e nutrientes inibidores podem afetar negativamente a saúde óssea.

El objetivo de este estudio es evaluar el efecto del consumo de leche, ingesta dietética de calcio y patrones nutricionales (beneficiosos y no beneficiosos para los huesos), desde la adolescencia tardía hasta la etapa adulta temprana, en huesos con 22 años de edad. Se realizó un análisis transversal con 3.109 participantes procedentes de la cohorte de nacimiento de 1993 en Pelotas, Rio Grande do Sul, Brasil, con seguimientos a los 18 y 22 años de edad. Se evaluó la densidad mineral ósea de la columna lumbar, fémur derecho y todo el cuerpo a los 22 años, utilizando densitometría ósea por absorción de rayos X (DXA). Las variables de exposición (calcio dietético, leche y patrones nutricionales) se crearon mediante la combinación de las frecuencias de consumo entre los dos seguimientos (siempre bajo, moderado, alto, incremento o disminución). Se realizaron regresiones múltiples lineales, estratificadas por sexo. En la zona del fémur derecho, los hombres fueron clasificados en "siempre alto" (media = 1,148g/cm²; IC95%: 1,116; 1,181) e "incrementado" en las categorías de consumo de leche (media = 1,154g/cm²; IC95%: 1,135; 1,174) presentó una ligeramente baja densidad mineral ósea (DMO), comparándolas con las categorías bajas (media = 1,190g/cm²; IC95%: 1,165; 1,215) y moderadas (media = 1,191g/cm²; IC95%: 1,171; 1,210). Asimismo, los hombres siempre fueron clasificados en el tercil más alto del patrón "no beneficioso para los huesos", puesto que presentaron la media más baja de todo el cuerpo de DMO (media = 1,254g/cm²; IC95%: 1,243; 1,266). No se observaron asociaciones entre las categorías de ingesta de calcio dietético y los patrones "beneficiosos para los huesos" en cada uno de los tres resultados de DMO. Estos resultados indican el hecho de que las dietas que inhiben alimentos/nutrientes pueden contribuir negativamente en la salud de los huesos.

Respuesta de la calciuria a suplementos de vitamina D / Calcium response to vitamin D supplementation

Múltiples estudios muestran la importancia de mantener niveles suficientes de vitamina D para prevenir varias enfermedades crónicas. Sin embargo, la suplementación de vitamina D sobre la calciuria es controvertida. El objetivo de este trabajo prospectivo, intervencionista, fue evaluar la respuesta de la calciuria en mujeres con hipercalciuria y normocalciuria, luego de conseguir niveles adecuados de 25 OH D. Se estudiaron 63 mujeres con hipercalciuria idiopática (9 con litiasis renal) y 50 mujeres normocalciúricas. Ambos grupos presentaron déficit/insuficiencia de 25 OH D y fueron suplementadas con vitamina D2 o D3 semanales o vitamina D3 en dosis de 100 000 UI mensuales. A todas se les midió la calciuria basal y final al alcanzar el valor de 25 OH D deseado (> 30 ng/dl). No observamos cambios significativos en los valores de la calciuria inicial y final en las que recibieron vitamina D2 o D3 semanal ni en las que recibieron dosis mensuales. Sin embargo, un subgrupo de mujeres: 19% (n = 12) de las hipercalciúricas y 12% (n = 6) de las normocalciúricas (con vitamina D semanal) aumentaron la calciuria en forma significativa. Mientras que, con dosis mensuales, un 40% (n = 4/10) de las hipercalciúricas y 44% (n = 4/9) de las hipercalciúricas con litiasis renal aumentaron la calciuria. En conclusión, niveles adecuados de 25 OH D son seguros en la mayoría de las pacientes. En aquellas que requieren dosis de carga mensuales podrían observarse aumentos de la calciuria en forma significativa con riesgo de formar cálculos renales o perder masa ósea, cuando están genéticamente predispuestas.

Several studies show the importance of serum vitamin D sufficient levels to prevent multiple chronic diseases. However, vitamin D supplementation and its effects on urine calcium excretion remain controversial. The objective of this prospective and interventional study was to evaluate urine calcium excretion in women with normal calciuria or hypercalciuria, once serum vitamin D sufficiency was achieved. We studied 63 women with idiopathic hypercalciuria, (9 with renal lithiasis) and 50 normocalciuric women. Both groups had serum vitamin D levels low (deficiency or insufficiency). Baseline urine calcium excretion was measured before being supplemented with vitamin D2 or D3 weekly or vitamin D3 100.000 IU monthly. Once serum vitamin D levels were corrected achieving at least 30 ng/ml, a second urine calcium excretion was obtained. Although in the whole sample we did not observe significant changes in urine calcium excretion according to the way of supplementation, some of those with weekly supplementation had significant higher urine calcium excretion, 19% (n = 12) of hypercalciuric women and 12% (n = 6) of the normocalciuric group. Monthly doses, also showed higher urine calcium excretion in 40% of hypercalciuric women (n = 4/10) and in 44% (n = 4/9) of the renal lithiasis hypercalciuric patients. In conclusion, different ways of vitamin D supplementation and adequate serum levels are safe in most patients, although it should be taken into account a subgroup, mainly with monthly loading doses, that could increase the calciuria significantly eventually rising renal lithiasis risk or bone mass loss, if genetically predisposed.

Dieta com restrição de cálcio ou aniônica em vacas leiteiras no pré-parto / Calcium-restriction or anionic diet in dairy cows during pre-partum / Dieta con restricción de calcio o aniónica en vacas lecheras en preparto

Várias são as enfermidades metabólicas que acometem vacas leiteiras, entre elas a hipocalcemia, conhecida também como febre do leite, paresia puerperal ou síndrome da vaca caída. Essa patologia pode acometer animais em até 72 horas após o parto, devido a uma falha no metabolismo nutricional de cálcio, que ocorre após uma demanda súbita desse mineral para o início da lactação. Esta tem sua maior ocorrência em animais de alta produção de leite e principalmente com mais de duas lactações. Assim, o objetivo deste trabalho, por meio de revisão de literatura, foi cogitar sobre as metodologias de fornecimento de dieta aniônica e dietas deficientes em cálcio, fornecidas no período de pré-parto das vacas, a fim de evitar ou minimizar problemas futuros em decorrência da hipocalcemia, o que tem apresentados resultados positivos.(AU)

Hypocalcemia is one of several metabolic diseases affecting dairy cows. It is also known as milk fever, puerperal paresis or fallen cow syndrome. The pathology can affect animals up to 72 hours after calving, due to a failure in the nutritional metabolism of calcium, which occurs after the sudden demand of this mineral in order to start lactation. The highest prevalence of this disease is in animals of high dairy production and especially those with more than two lactations. Thus, the purpose of this paper is develop a literature review in order to muse on the methodologies of supplying anionic and calcium deficient diets in the pre-calving period in order to mitigate or minimize future problems due to hypocalcemia.(AU)

Varias son las enfermedades metabólicas que acometen vacas lecheras, entre ellas la hipocalcemia, conocida también como fiebre de la leche, paresia puerperal o síndrome de la vaca caída. Esa patología puede acometer animales en hasta 72 horas después del parto, debido a una falla en el metabolismo nutricional de calcio, que ocurre después de una demanda súbita de ese mineral para el inicio de la lactancia. Esta tiene su mayor ocurrencia en animales de alta producción de leche y principalmente con más de dos lactaciones. Así, el objetivo de este trabajo, por medio de revisión de literatura, fue reflexionar sobre las metodologías de suministro de dieta aniónica y dietas deficientes en calcio, suministradas en el período de preparto de las vacas, a fin de evitar o minimizar futuros problemas en consecuencia de la hipocalcemia, lo que ha dado resultados positivos.(AU)

Changes in energetic metabolism of Biomphalaria glabrata (Mollusca, Planorbidae) in response to exogenous calcium / Alterações no metabolismo energético de Biomphalaria glabrata em resposta ao cálcio exógeno

Abstract Calcium is considered an essential element for the metabolism of aquatic snail Biomphalaria glabrata (Say, 1818), intermediate host of Schistosoma mansoni Sambon, 1907 in Brazil, and represents a limiting factor to its distribution and adaptation to the environment. This study investigated the effect of different concentrations of exogenous CaCO3 on the energetic metabolism of B. glabrata for better understanding the physiological interference of chemical elements dissolved in the environment with the physiology of this species. Sixty-day-old snails were distributed into six groups, five exposed to different concentrations of CaCO3 (20, 40, 60, 80 and 100 mg/L) and a control group. The exposure to CaCO3 was assessed over time, with analysis of 15 snails of each group in the following intervals: 1, 14, 21 or 30 days for hemolymph extraction. Concentrations of calcium and glucose in the hemolymph were determined by commercial kits, and organic acids were extracted using an ion exchange column and analyzed by high-performance liquid chromatography. Concentration of calcium in the hemolymph showed no significant difference (p>0.05) from the control group and between the concentrations tested. Concentration of glucose decreased (p<0.05) in the treatments of exposure to 20 and 40 mg/L and increased when exposed to 80 and 100 mg/L CaCO3 compared to control and to other concentrations tested over 30 days. The organic acids pyruvate, oxaloacetate, citrate, succinate, fumarate, beta-hydroxybutyrate and lactate presented increased concentrations, while propionate and acetoacetate, decreased concentrations, when exposed to CaCO3 compared to control. Considering the influence of different periods of exposure to CaCO3, on the 14th day, there were stronger alterations in the metabolism of B. glabrata. In conclusion, exposure to CaCO3 reduced the concentration of glucose, which is metabolized into pyruvate, the final product of glycolysis, and also influenced the energetic metabolism pathways, indicating an aerobic or partially anaerobic functioning.

Resumo O cálcio é considerado um elemento essencial no metabolismo do molusco aquático Biomphalaria glabrata (Say, 1818), principal hospedeiro intermediário de Schistosoma mansoni Sambon, 1907 no Brasil e, tem sido descrito como um fator limitante na distribuição e adaptação desse molusco no ambiente. O presente trabalho avaliou o efeito de diferentes concentrações de carbonato de cálcio (CaCO3) exógeno ao metabolismo energético de B. glabrata, a fim de subsidiar uma melhor compreensão da interferência de elementos químicos dissolvidos no meio aquático na fisiologia destes moluscos. Foram utilizados moluscos com sessenta dias de vida, distribuídos em seis grupos, cinco expostos a diferentes concentrações de CaCO3 (20, 40, 60, 80 e 100mg/L) e um controle. A exposição ao CaCO3 foi avaliada em função do tempo, sendo retirados 15 moluscos de cada grupo nos seguintes intervalos: 1, 14, 21 ou 30 dias para extração da hemolinfa. As concentrações de cálcio e glicose na hemolinfa foram determinadas usando-se kits comercial e os ácidos orgânicos foram extraídos por meio da coluna de troca iônica e analisados através cromatografia líquida de alta eficiência. Os resultados demonstraram que a concentração de cálcio na hemolinfa não apresentou diferença significativa (p>0,05) em relação ao controle e nas concentrações testadas. A concentração de glicose diminuiu (p<0,05) nas exposições a 20 mg e 40 mg/L e aumentou nas exposições a 80 mg e 100 mg/L de CaCO3 em relação ao controle e demais concentrações testadas ao longo de 30 dias. Os ácidos orgânicos piruvato, oxaloaceato, citrato, succinato, fumarato, β-hidroxibutirato e lactato tiveram suas concentrações aumentadas, enqunato, propionato e acetoacetato tiveram suas concentrações diminuídas na exposição ao CaCO3 comparada ao controle. Quanto a influência dos diferentes períodos de exposição ao CaCO3, aos 14 dias, as alterações no metabolismo de B. glabrata foram mais expressivas. Conclui-se que as exposições ao CaCO3 influenciaram na redução de glicose, sendo esta metabolizada a piruvato, produto final da glicólise e alteraram as vias de metabolismo energético, indicando um funcionamento aeróbio ou parcialmente anaeróbio.

Calcium intake by adolescents: a population-based health survey / Ingestão de cálcio por adolescentes: inquérito de saúde de base populacional

Abstract Objective To analyze calcium intake in adolescents according to sociodemographic variables, health-related behaviors, morbidities, and body mass index. Methods This was a cross-sectional population-based study, with a two-stage cluster sampling that used data from a survey conducted in Campinas, São Paulo, Brazil, between 2008 and 2009. Food intake was assessed using a 24-hour dietary recall. The study included 913 adolescents aged 10-19 years. Results Average nutrient intake was significantly lower in the segment with lower education of the head of the family and lower per capita family income, in individuals from other cities or states, those who consumed fruit less than four times a week, those who did not drink milk daily, those who were smokers, and those who reported the occurrence of headaches and dizziness. Higher mean calcium intake was found in individuals that slept less than seven hours a day. The prevalence of calcium intake below the recommendation was 88.6% (95% CI: 85.4-91.2). Conclusion The results alert to an insufficient calcium intake and suggest that certain subgroups of adolescents need specific strategies to increase the intake of this nutrient.

Resumo Objetivos Analisar a ingestão de cálcio em adolescentes segundo variáveis sociodemográficas, de comportamentos relacionados à saúde, morbidades e índice de massa corporal. Métodos Trata-se de estudo transversal de base populacional, com amostra por conglomerados, tomada em dois estágios e que usou dados de inquérito feito em Campinas, São Paulo, Brasil, em 2008/09. O consumo alimentar foi estimado pelo Recordatório de 24 horas. Foram analisados 913 adolescentes de 10 a 19 anos. Resultados Médias significativamente inferiores de ingestão do nutriente foram verificadas nos segmentos de menor escolaridade do chefe da família, de menor renda familiar per capita, nos naturais de outros municípios ou estados, nos que consomem frutas menos do que quatro vezes na semana, nos que não bebem leite diariamente, nos fumantes e nos que referiram presença de dor de cabeça e tontura. Média superior de ingestão de cálcio foi encontrada nos indivíduos que dormem menos de sete horas por dia. A prevalência de ingestão de cálcio inferior ao recomendado foi de 88,6% (IC95%: 85,4-91,2). Conclusões Os resultados deste estudo alertam para o consumo insuficiente de cálcio e sugerem que determinados subgrupos de adolescentes necessitam de estratégias mais específicas para aumentar a ingestão desse nutriente.

Calcium intake: good for the bones but bad for the heart? An analysis of clinical studies

ABSTRACT The proper dietary calcium intake and calcium supplementation, when indicated, are important factors in the acquisition of peak bone mass during youth and in the prevention of fractures in old age. In addition to its deposition in bone, calcium confers an increase in its resistance and exhibits important activities in different enzymatic pathways in the body (e.g., neural, hormonal, muscle-related and blood clotting pathways). Thus, calcium supplementation can directly or indirectly affect important functions in the body, such as the control of blood pressure, plasma glucose, body weight, lipid profile and endothelial function. Since one publication reported increased cardiovascular risk due to calcium supplementation, many researchers have studied whether this risk actually exists; the results are conflicting, and the involved mechanisms are uncertain. However, studies that have evaluated the influence of the consumption of foods rich in calcium have reported no increase in the cardiovascular risk, which suggests that nutritional intake should be prioritized as a method for supplementation and that the use of calcium supplements should be reserved for patients who truly need supplementation and are unable to achieve the recommended daily nutritional intake of calcium.

Vitamin D supplementation for women during pregnancy

ABSTRACT BACKGROUND: Vitamin D deficiency or insufficiency is thought to be common among pregnant women. Vitamin D supplementation during pregnancy has been suggested as an intervention to protect against adverse pregnancy outcomes. OBJECTIVES: To examine whether oral supplements with vitamin D alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. METHODS: Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2015), the International Clinical Trials Registry Platform (31 January 2015), the Networked Digital Library of Theses and Dissertations (28 January 2015) and also contacted relevant organisations (31 January 2015). Selection criteria: Randomized and quasi-randomized trials with randomization at either individual or cluster level, evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy. Data collection and analysis: Two review authors independently i) assessed the eligibility of studies against the inclusion criteria ii) extracted data from included studies, and iii) assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: In this updated review we included 15 trials assessing a total of 2833 women, excluded 27 trials, and 23 trials are still ongoing or unpublished. Nine trials compared the effects of vitamin D alone versus no supplementation or a placebo and six trials compared the effects of vitamin D and calcium with no supplementation. Risk of bias in the majority of trials was unclear and many studies were at high risk of bias for blinding and attrition rates. Vitamin D alone versus no supplementation or a placebo Data from seven trials involving 868 women consistently show that women who received vitamin D supplements alone, particularly on a daily basis, had higher 25-hydroxyvitamin D than those receiving no intervention or placebo, but this response was highly heterogeneous. Also, data from two trials involving 219 women suggest that women who received vitamin D supplements may have a lower risk of pre-eclampsia than those receiving no intervention or placebo (8.9% versus 15.5%; risk ratio (RR) 0.52; 95% CI 0.25 to 1.05, low quality). Data from two trials involving 219 women suggest a similar risk of gestational diabetes among those taking vitamin D supplements or no intervention/placebo (RR 0.43; 95% CI 0.05, 3.45, very low quality). There were no clear differences in adverse effects, with only one reported case of nephritic syndrome in the control group in one study (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women, low quality). Given the scarcity of data for this outcome, no firm conclusions can be drawn. No other adverse effects were reported in any of the other studies. With respect to infant outcomes, data from three trials involving 477 women suggest that vitamin D supplementation during pregnancy reduces the risk preterm birth compared to no intervention or placebo (8.9% versus 15.5%; RR 0.36; 95% CI 0.14 to 0.93, moderate quality). Data from three trials involving 493 women also suggest that women who receive vitamin D supplements during pregnancy less frequently had a baby with a birthweight below 2500 g than those receiving no intervention or placebo (RR 0.40; 95% CI 0.24 to 0.67, moderate quality). In terms of other outcomes, there were no clear differences in caesarean section (RR 0.95; 95% CI 0.69 to 1.31; two trials; 312 women); stillbirths (RR 0.35 95% CI 0.06, 1.99; three trials, 540 women); or neonatal deaths (RR 0.27; 95% CI 0.04, 1.67; two trials, 282 women). There was some indication that vitamin D supplementation increases infant length (mean difference (MD) 0.70, 95% CI -0.02 to 1.43; four trials, 638 infants) and head circumference at birth (MD 0.43, 95% CI 0.03 to 0.83; four trials, 638 women). Vitamin D and calcium versus no supplementation or a placebo Women who received vitamin D with calcium had a lower risk of pre-eclampsia than those not receiving any intervention (RR 0.51; 95% CI 0.32 to 0.80; three trials; 1114 women, moderate quality), but also an increased risk of preterm birth (RR 1.57; 95% CI 1.02 to 2.43, three studies, 798 women, moderate quality). Maternal vitamin D concentration at term, gestational diabetes, adverse effects and low birthweight were not reported in any trial or reported only by one study. AUTHORS CONCLUSIONS: New studies have provided more evidence on the effects of supplementing pregnant women with vitamin D alone or with calcium on pregnancy outcomes. Supplementing pregnant women with vitamin D in a single or continued dose increases serum 25-hydroxyvitamin D at term and may reduce the risk of pre-eclampsia, low birthweight and preterm birth. However, when vitamin D and calcium are combined, the risk of preterm birth is increased. The clinical significance of the increased serum 25-hydroxyvitamin D concentrations is still unclear. In light of this, these results need to be interpreted with caution. Data on adverse effects were lacking in all studies. The evidence on whether vitamin D supplementation should be given as a part of routine antenatal care to all women to improve maternal and infant outcomes remains unclear. While there is some indication that vitamin D supplementation could reduce the risk of pre-eclampsia and increase length and head circumference at birth, further rigorous randomized trials are required to confirm these effects.

Alta prevalência de inadequação da ingestão dietética de cálcio e vitamina D em duas coortes de gestantes / High prevalence of inadequate calcium and vitamin D dietary intake in two cohorts of pregnant women / Alta prevalencia de inadecuación en la ingestión dietética de calcio y vitamina D en dos cohortes de gestantes

Este estudo objetivou identificar a prevalência de inadequação da ingestão, por trimestre, de cálcio e vitamina D, em duas coortes de gestantes e fatores correlacionados a esta ingestão. Foram coletados dois recordatórios alimentares de 24 horas em cada trimestre, um relativo a final de semana. Variáveis com correlação significativa com a ingestão desses nutrientes foram incluídas em modelo de regressão linear multivariada, com ajuste por energia. A frequência de inadequação foi estimada pelo método do National Cancer Institute (Estados Unidos). Na coorte A, a inadequação da ingestão de vitamina D não diferiu entre os trimestres; na B, houve redução: 99,7% no 1º para 97,1% no 3º trimestre. Nas coortes A e B, a inadequação da ingestão de cálcio esteve acima de 70%, caindo discretamente do 1º (89,2% e 81,4%) para o 2º (79,7 e 69,1%) e 3º trimestres (82,7% e 72,6%). Não houve correlação entre as variáveis maternas e a ingestão desses micronutrientes. Conclui-se que há um quadro grave de inadequação da ingestão de vitamina D e cálcio, homogeneamente distribuído entre as gestantes assistidas na rede básica de saúde.

This study aimed to identify the prevalence of inadequate calcium and vitamin D dietary intake and related factors in two cohorts of pregnant women according to trimester of pregnancy. Two 24-hour dietary recall tests were taken in each trimester, one pertaining to weekends. Variables significantly correlated with intake of these nutrients were included in a multivariate linear regression model, adjusted for energy. Prevalence of inadequate intake was estimated according to the National Cancer Institute method (United States). In cohort A, inadequate vitamin D did not differ between trimesters; in B there was a reduction: from 99.7% in the first trimester to 97.1% in the third. In cohorts A and B, inadequate calcium intake exceeded 70%, falling slightly from the first (89.2% and 81.4%) to the second (79.7% and 69.1%) and third trimesters (82.7% and 72.6%). There was no correlation between maternal variables and the intake of these micronutrients. In conclusion, intake of vitamin D and calcium is seriously inadequate and distributed homogeneously among pregnant women in the primary healthcare network.

Este estudio tuvo como objetivo identificar la prevalencia de inadecuación en la ingestión, por trimestre, de calcio y vitamina D, en dos cohortes de gestantes, además de los factores correlacionados con esta ingestión. Se recogieron dos recordatorios alimentarios de 24 horas durante cada trimestre, uno de ellos relativo al fin de semana. Se incluyeron variables en correlación significativa con la ingestión de esos nutrientes, en el modelo de regresión lineal multivariante, con ajuste por energía. La frecuencia de inadecuación fue estimada por el método del National Cancer Institute (Estados Unidos). En la cohorte A, la inadecuación de la ingestión de vitamina D no difirió entre los trimestres; en la B, hubo reducción: un 99,7% durante el 1º, frente a un 97,1% en el 3º trimestre. En las cohortes A y B, la inadecuación en la ingestión de calcio estuvo por encima de un 70%, cayendo discretamente del 1º (89,2% y 81,4%), al 2º (79,7 y 69,1%) y 3º trimestres (82,7% e 72,6%). No hubo correlación entre las variables maternas y la ingestión de esos micronutrientes. Se concluye que existe un cuadro grave de inadecuación en la ingestión de vitamina D y calcio, homogéneamente distribuido entre las gestantes asistidas por la red básica de salud.

Comparison of feeding habits and physical activity between eutrophic and overweight/obese children and adolescents: a cross sectional study / Comparação de hábitos alimentares e atividade física entre crianças e adolescentes eutróficos e portadores de sobrepeso/ obesidade: estudo transversal.

Summary Objective: it is broadly accepted, but little explored, that obese children practice less physical activity and eat more. This study has the objective of comparing feeding habits and physical activity between eutrophic and overweight/obese children and adolescents. Methods: 126 students with ages ranging from 6 to 18 years were evaluated. Eutrophic and overweight/obese students were compared according to calorie intake, macro and micronutrients, prevalence of physical inactivity and ingestion of micronutrients. Results: differences were observed in the amount of calories ingested per unit of BMI (eutrophic, 97.6, and overweight/obese, 70.5, p=0.0061), as well as in calcium intake (eutrophic, 546.2, and overweight/obese, 440.7, p=0.0366). Both groups presented sedentarism, as well as a high prevalence of micronutrient intake deficiency, especially calcium and vitamins A, E, and C, but with no difference observed between eutrophic and overweight/obese subjects. Conclusion: energy and macronutrients consumption, as well as physical activity, were similar between eutrophic and overweight/obese. Calcium intake was lower in the overweight/obese group and the ingestion of vitamin C was lower in the eutrophic group. These results demonstrate the importance of considering all etiologic factors that may lead to obesity, so that new strategies for prevention and control may be added to traditional interventions. .

Resumo Objetivos: considera-se, em geral, que crianças obesas praticam menos atividade física e consomem mais alimentos, mas esse aspecto tem sido muito pouco explorado. O presente estudo objetivou comparar a alimentação e o padrão de atividade física de crianças e adolescentes eutróficos e portadores de sobrepeso/obesidade. Métodos: 126 estudantes com idades entre 6 e 18 anos foram avaliados por meio de antropometria, registro alimentar e grau de atividade física. Eutróficos e portadores de sobrepeso/obesidade foram comparados de acordo com a ingestão de calorias, macro e micronutrientes e de acordo com as prevalências de inatividade física e de ingestão deficiente de micronutrientes. Resultados: observou-se diferença na quantidade de calorias ingeridas por unidade de IMC (eutróficos 97,6 [92,2 - 112,5] e sobrepeso/obesidade 70,5 [72,2 - 90,8], p = 0,0061) e na ingestão de cálcio (eutróficos 546,2 [517,2 - 673,9] e sobrepeso/obesidade 440,7 [404,4 - 523,4], p = 0,0366). Os dois grupos apresentaram sedentarismo e elevada prevalência de deficiência na ingestão de micronutrientes, especialmente cálcio e vitaminas A, E e C, mas sem diferença entre eutróficos e portadores de sobrepeso/obesidade. Conclusões: consumo de energia e de macronutrientes e grau de atividade física foram semelhantes, quando comparados indivíduos eutróficos com portadores de sobrepeso/obesidade. O consumo de cálcio foi menor no grupo sobrepeso/obesidade e o de vitamina C menor no grupo eutróficos. Esses resultados mostram a importância de considerar todos os fatores etiológicos que podem levar à obesidade a fim de que possam associar-se novas estratégias de prevenção e controle às intervenções tradicionais. .

Dietary Calcium and Framingham Risk Score in Vitamin D Deficient Male (KNHANES 2009-2011)

PURPOSE: The association between excess calcium intake and cardiovascular mortality has already been reported. In the present study, we investigated the relation between dietary calcium intake and Framingham Risk Score (FRS) according to serum 25-hydroxyvitamin D [25(OH)D] status. MATERIALS AND METHODS: A total of 7809 subjects (3452 males and 4357 female) aged over 40 years were selected for this cross-sectional study from data obtained from the Korea National Health and Nutrition Examination Survey (2008-2011). Daily dietary calcium intake was categorized into 1200 mg/day and serum 25(OH)D concentration classified into 75 mmol/L. The FRS was compared by the daily dietary calcium intake categories according to 25(OH)D concentration after adjustment with relevant variables in both genders. RESULTS: Higher FRS was observed in males with both 1200 mg of dietary calcium intake and females with 1200 mg of dietary calcium intake groups in both genders after adjustments for relevant variables. FRS was significantly higher in the group with >1200 mg of dietary calcium intake and serum 25(OH)D 1200 mg/day) dietary calcium intake were related with higher FRS in both genders. In particular, higher FRS was observed in the excess (>1200 mg/day) dietary calcium intake male group under vitamin D deficiency (<50 nmol/L).

Milk improved the metabolic syndrome in obese ß rats / La leche mejoró el síndrome metabólico en ratas obesas ß

The response of adult spontaneously obese rats from the IIMb/Beta strain fed a high calcium skimmed milk diet (MHCa), high calcium from carbonate (HCa) and a normal AIN 93 diet during 45 days was evaluated. Body weight, food intake and fecal fat excretion were measured. At the end of the experiment rats were euthanized, abdominal fat pads and livers were excised and weighed. Blood and liver triacylglycerols, total cholesterol and fractions were quantified. Body weight increase and abdominal fat pads in the MHCa group were significantly lower than in the other two. Plasma triacylglycerols, total and LDL-cholesterol were diminished in the MHCa group. Fecal lipid excretion was increased in the adult MHCa group. Total liver lipids and triacylglycerols showed a significant diminution in the MHCa group. These results suggest that calcium and other bioactive compounds from milk, most probably present in whey fraction, and not calcium carbonate exerted an "anti-obesity" effect on these rats.

Se evaluaron los efectos de dietas con distintos niveles y fuente de calcio sobre parámetros relacionados con el síndrome metabólico en ratas adultas espontáneamente obesas de la línea IIMb/Beta. Se suministraron durante 45 días tres dietas: alto nivel de calcio proveniente de leche descremada (MHCa); alto calcio proveniente de carbonato (HCa) y como referencia AIN 93, normocálcica. Se midieron peso corporal, ingesta de alimento y excreción fecal de grasa. Los animales se sacrificaron y se extrajeron y pesaron los panículos adiposos abdominales y el hígado. Se determinaron triacilgliceroles, colesterol total y fracciones en plasma y en hígado. El aumento de peso corporal, los panículos adiposos abdominales y los valores plasmáticos de triacilgliceroles y de colesterol y fracciones fueron significativamente menores en el grupo MHCa. La excreción fecal de grasa resultó aumentada en el grupo MHCa. Los lípidos totales y los triacilgliceroles hepáticos mostraron una disminución significativa en el grupo MHCa. Los resultados evidencian efectos beneficiosos del calcio de la leche y no del suplemento mineral, sugiriendo que una acción sinérgica con otros compuestos bioactivos, probablemente presentes en el suero de la leche, produciría los efectos "antiobesidad" en estas ratas.

Diet micronutrient adequacy of women after 1 year of gastric bypass / Adequação de micronutrientes da dieta de mulheres após um ano de bypass gástrico

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. .

RACIONAL: O tratamento considerado mais eficiente para o grau severo da obesidade é a cirurgia bariátrica. O bypass gástrico é a técnica cirúrgica mais utilizada no mundo; porém, assim como as outras técnicas, oferece riscos no pós-operatório, incluindo a deficiência de nutrientes. OBJETIVO: Determinar as quantidades de ferro, cálcio, vitamina D e vitamina B12 dietéticas ingeridas por pacientes atendidos em um hospital público após um ano de bypass gástrico, e comparar com as recomendações da Recommended Dietary Allowances. MÉTODOS: Estudo transversal descritivo com amostra composta por 36 mulheres com mais de um ano de bypass gástrico. Foram coletados dados sociodemográficos, antropométricos e alimentares. Estes últimos foram realizados por meio de Questionário de Frequência Alimentar validado. Foi feita comparação da ingestão de ferro, cálcio, vitamina D e vitamina B12 com as Recommended Dietary Allowances, assim como a correlação do tempo de pós-operatório com o consumo desses micronutrientes. RESULTADOS: Houve inadequação no consumo de ferro, cálcio e vitamina D. A ingestão de vitamina B12 mostrou-se adequada. Foi encontrada correlação positiva estatisticamente significativa entre o tempo de operação e o consumo de ferro, vitamina B12 e vitamina D. CONCLUSÃO: A ingestão de ferro, cálcio e vitamina D de mulheres um ano após o bypass gástrico foi inadequada, enfatizando a importância do acompanhamento multiprofissional no pós-operatório para prevenção de carências de nutrientes. .

The effect of high-dose vitamin D supplementation on insulin resistance and arterial stiffness in patients with type 2 diabetes

BACKGROUND/AIMS: Recent epidemiological studies revealed a striking inverse relationship between vitamin D levels, glucose intolerance/insulin resistance (IR), and cardiovascular disease. However, few interventional studies have evaluated the effect of vitamin D supplementation on cardiovascular risk, such as IR and arterial stiffness, in diabetes. We investigated the role of vitamin D supplementation on cardiovascular risk in type 2 diabetes patients, including metabolic parameters, IR, and arterial stiffness. METHODS: We enrolled patients who were taking antidiabetic medications or managed their diabetes using lifestyle changes. We excluded patients who were taking vitamin D or calcium supplements. We randomized participants into the vitamin D group (cholecalciferol 2,000 IU/day + calcium 200 mg/day, n = 40) or the placebo group (calcium 200 mg/day, n = 41). We compared their IR (homeostasis model of assessment [HOMA]-IR) and arterial stiffness (brachial-ankle pulse wave velocity and radial augmentation index) before and after 24 weeks of intervention. RESULTS: The baseline characteristics of the two groups were similar. A total of 62 participants (placebo, 30; vitamin D, 32) completed the study protocol. At the end of the study period, the 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in the vitamin D group than in the placebo group (35.4 +/- 8.5 ng/mL vs. 18.4 +/- 7.3 ng/mL, p < 0.001). There was no difference in HOMA-IR or changes in arterial stiffness (placebo, 21, vitamin D, 24) between the groups. CONCLUSIONS: Our data suggest that high-dose vitamin D supplementation might be effective in terms of elevating 25(OH)D levels. However, we identified no beneficial effects on cardiovascular risk in type 2 diabetes, including IR and arterial stiffness.

Ingestión de calcio y adiposidad en adolescentes de 12 a 16 años en Guadalajara, México / Calcium intake and adiposity in adolescents aged 12- 16 years in Guadalajara, Mexico

El objetivo del trabajo fue evaluar la asociación entre el consumo de calcio (Ca) y adiposidad en un grupo de adolescentes. Se realizó un estudio transversal en 125 adolescentes de 12 a 16 años. El consumo de Ca se evaluó por encuestas alimentarias de recordatorio de 24 horas y frecuencia de consumo de alimentos. Se midió la adiposidad por métodos antropométricos e impedancia bioeléctrica (IBE). Se identificó la relación entre el consumo de Ca y adiposidad mediante correlación simple; se realizaron modelos multivariados ajustados al consumo de energía, edad, sexo y menarquía. El promedio de edad fue de 13.5 ± 0.8 años. Se identificó correlación negativa entre el consumo de Ca y los indicadores antropométricos peso, pliegues cutáneos, índice de masa corporal, masa grasa y porcentaje de grasa (los dos últimos por IBE y solamente en mujeres). El análisis multivariado, que incluyó el consumo de energía, no demostró asociación entre el consumo de Ca y adiposidad. En conclusión, el consumo de Ca no se asocia a adiposidad en adolescentes; los modelos multivariados mostraron que el consumo total de energía y la menarquía son las variables que muestran mayor asociación con adiposidad en esta etapa de la vida.

The purpose was to evaluate the association between calcium (Ca) intake and adiposity in adolescents. A cross-sectional study of 125 adolescents 12 to 16 years. Ca intake was evaluated by 24-hour recall dietary surveys and food frequency consumption. Adiposity was measured by anthropometric methods and bioelectrical impedance (BIA). The association between Ca intake and adiposity was identified by simple correlation and multivariate models adjusted to energy consumption, age, sex and menarche. Mean age of adolescents was 13.5 ± 0.8 years. A negative correlation was identified between Ca intake and anthropometric indicators weight, skinfolds, body mass index, fat mass and percentage of fat (the latter two by BIA and only in women). Multivariate analysis, including energy consumption showed no association between Ca intake and adiposity. In conclusion, Ca consumption does not associate with adiposity in adolescents; multivariate models showed that energy intake and menarche are the variables that show a higher association with adiposity at this stage of life.

Calcium and caffeine interaction in increased calcium balance in ovariectomized rats / Interação cálcio e cafeína no aumento do balanço de cálcio em ratas ovariectomizadas

OBJECTIVE: This study investigated the effects of caffeine intake associated with inadequate or adequate calcium intake in laparotomized or ovariectomized rats by means of the calcium balance. Forty adults Wistar rats were ovariectomized or laparotomized. METHODS: The animals (n=40) were randomly placed in eight groups receiving the AIN-93 diet with 100% or 50% of the recommended calcium intake with or without added caffeine (6mg/kg/day). The animals were kept in individuals metabolic cages at a temperature of 24°±2ºC, light/dark cycles of 12/12 hours, and deionized water available ad libitum. On the 8th week of the experiment, food consumption was measured and 24-hour urine and 4-day feces were collected to determine calcium balance [Balance=Ca intake-(Urinary Ca+Fecal Ca)]. RESULTS: Animals with adequate calcium intake presented higher balances and rates of calcium absorption and retention (p<0.05) than those with inadequate calcium intake, regardless of caffeine intake (p<0.05). Caffeine intake did not affect urinary calcium excretion but increased balance (p<0.05) in the groups with adequate calcium intake. CONCLUSION: Adequate calcium intake attenuated the negative effects of estrogen deficiency and improved calcium balance even in the presence of caffeine.

OBJETIVO: Investigar a relação entre a ingestão de cafeína e a adequação de cálcio dietético em ratas ovariectomizadas ou inteiras, por meio do balanço de cálcio. Foram utilizadas 40 ratas Wistar adultas submetidas à cirurgia de ovariectomia ou laparotomia. MÉTODOS: Os animais foram alocados em grupos (n=5) e receberam dieta AIN-93M contendo 100 ou 50% da recomendação de cálcio com ou sem adição de cafeína (6mg/kg/dia). As fêmeas foram alojadas em gaiolas metabólicas individuais, à temperatura de 24±2ºC e ciclo de 12 horas claro/escuro e receberam água deionizada ad libitum. Na oitava semana de experimento, quantificou-se a ingestão da dieta e coletaram-se fezes de 4 dias e urina dos animais por 24 horas para determinação do balanço [Balanço=Ca Ingerido - (Ca Fecal+Ca Urinário)]. RESULTADOS: Por meio de interação entre fatores, foi observado que o consumo de 100% de cálcio elevou o balanço e os teores de cálcio absorvido e retido (p<0,05) quando comparados aos grupos 50%. As ratas com adequação no consumo de cálcio aumentaram o balanço (p<0,05), independentemente da suplementação de cafeína. A ingestão de cafeína não afetou a excreção urinária de cálcio e elevou (p<0,05) o balanço nas ratas com 100% de cálcio, mas não nas com 50%. CONCLUSÃO: A adequação no consumo de cálcio atenuou os efeitos deletérios da redução estrogênica e proporcionou maior balanço de cálcio mesmo com ingestão de cafeína.

La dieta en el tratamiento de la litiasis renal. Bases fisiopatológicas / [Diet in the treatment of renal lithiasis. Pathophysiological basis].

The composition of urine is influenced by diet and changes in dietary factors have been proposed to modify the risk of recurrent nephrolithiasis. Nutrients that have been implicated include calcium, oxalate, sodium, animal protein, magnesium and potassium. There is significant evidence showing that a high calcium diet is associated with a reduction of lithogenic risk. One of the possible mechanisms to explain this apparent paradox is that the higher intake of calcium in the intestine binds with dietary oxalate, reducing its absorption and urinary excretion. Oxalate from the diet seems to provide only a small contribution to excretion and dietary restriction is appropriate only in those with hyperoxaluria and hyperabsorption. Observational studies have shown a positive and independent association between sodium intake and the formation of new kidney stones. Consumption of animal protein creates an acid load that increases urinary excretion of calcium and uric acid and reduced citrate, all factors that could participate in the genesis of stones. Potassium-rich foods increase urinary citrate because of its alkali content. In prospective observational studies, diets rich in magnesium were associated with a lower risk of kidney stone formation in men. In conclusion, diet is a key element in the management of the patient with kidney stones but always subordinated to present metabolic risk factors.

Massa óssea em crianças e adolescentes que vivem com vírus da imunodeficiência humana / Bone mass in children and adolescents infected with human immunodeficiency virus

OBJETIVO: Descrever a densidade mineral óssea (DMO) e conteúdo mineral ósseo (CMO) de crianças e adolescentes que vivem com o vírus da imunodeficiência humana e comparar com os dados do National Health and Nutrition Examination Survey IV (NHANES IV). MÉTODO: Participaram do estudo48 crianças e adolescentes (sete a 17 anos de idade) com infecção pelo vírus da imunodeficiência humana adquirida por transmissão vertical. A DMO e o CMO foram mensurados pela absorciometria por dupla emissão de raios-X, calculando-se escores-z com base nos dados do NHANES IV. Nos prontuários médicos foram obtidas as informações dos parâmetros clínicos e laboratoriais da infecção pelo vírus da imunodeficiência humana. Foram ainda avaliada a atividade física, a ingestão de cálcio e a maturação esquelética. Utilizaram-se procedimentos da estatística descritiva e inferencial, estabelecendo níveis de significância de 5%. RESULTADOS :Os pacientes soropositivos demonstraram valores inferiores comparados aos dados do NHANES IV em todos os escores-z da massa óssea (média = -0,52 a -1,22, dp = 0,91 e 0,84, respectivamente). Com base no z-DMOsubtotal, há uma prevalência de 16,7% de crianças e adolescentes com massa óssea reduzida para a idade. Indivíduos que utilizaram inibidores de protease apresentaram um z-DMOtotal inferior, comparado ao grupo que não utilizou (-1,31 vs. -0,79; p = 0,02). Não foram encontradas diferenças na massa óssea em relação ao nível de atividade física e ingestão de cálcio. CONCLUSÕES: Na presente amostra, crianças e adolescentes que vivem com o vírus da imuno deficiência humana possuem baixa massa óssea para idade, e o uso de inibidores de protease parece estar relacionado a tais reduções.

OBJECTIVE: To describe bone mineral density (BMD) and bone mineral content (BMC) in children and adolescents infected with the human immunodeficiency virus (HIV), and to compare them with data from the National Health and Nutrition Examination Survey IV (NHANES IV). METHOD: The study included 48 children and adolescents (7 to 17 years old) infected with HIV through vertical transmission. BMC and BMD were measured by dual energy absorptiometry X-ray, by calculating z-scores based on data from NHANES IV. The information on clinical and laboratory parameters of infection by HIV was obtained from medical records. Physical activity, calcium intake, and skeletal maturation were also assessed. Descriptive and inferential statistical procedures were used, with levels of significance set at 5%. RESULTS: Seropositive patients presented lower values compared to data from NHANES IV in all z-scores of bone mass (mean = -0.52 to -1.22, SD = 0.91 and 0.84, respectively). Based on the subtotal z-BMD, there was a prevalence of 16.7% of children and adolescents with low bone mass for age. Individuals using protease inhibitors presented a lower total z-BMD when compared to the group that did not use (-1.31 vs. -0.79, p = 0.02). There were no bone mass differences in relation to physical activity and calcium intake. CONCLUSIONS: In the present sample children and adolescents living with HIV have low bone mass for age, and the use of protease inhibitors appears to be related to such decreases.