Vitamina D y embarazo: una experiencia piloto / Vitamin D and pregnancy: a pilot experience

La insuficiencia de vitamina D (VD) en el embarazo se relaciona con una mayor incidencia de cesáreas, preeclampsia y partos prematuros. Objetivo: evaluar si el grado de insuficiencia de VD se asocia a mayor número de cesáreas y evaluar la correlación entre la 25 hidroxivitamina D (25OHD) materna y en sangre del cordón del recién nacido. Las mujeres (n=127) se dividieron según sus niveles de 25OHD (ng/mL):G1:<20 (deficiencia), G2:20-30 (insuficiencia), G3:>30 (suficiencia). Se registraron edad; edad gestacional (EG); índice de masa corporal (IMC); tensión arterial sistólica y diastólica; tipo de parto y la estación del año en que se tomó la muestra. Se determinaron calcemia (ng/mL); 25OHD; parathormona intacta (pg/mL); fosfatasa alcalina ósea (UI/L) y crosslaps (pg/mL). La edad media fue de 26±6 años y la EG de 35,8±2,7 semanas, sin diferencias entre grupos. El porcentaje de cesáreas fue mayor en G1 que en G2 y G3 (31,3%, 21,4% y 25%, respectivamente; p<0,05). El mayor porcentaje de muestras se tomó en primavera (p<0,05). No se observaron diferencias en las demás variables maternas estudiadas. La 25OHD materna correlacionó positivamente con los valores de la sangre de cordón de sus respectivos recién nacidos (r= 0,67; p<0,0001). Independientemente de la época del año y del IMC, se observó que un porcentaje significativo de las mujeres embarazadas estudiadas tenía niveles de 25OHD inferiores a 30 ng/mL. Conclusión: evidenciamos que la deficiencia de VD materna se asoció al número de cesáreas. Asimismo, los niveles séricos de 25OHD en sangre de cordón umbilical correlacionaron significativamente con los maternos. (AU)

Vitamin D (VD) insufficiency in pregnancy is associated with a higher incidence of cesarean section, preeclampsia, and preterm delivery. Objective: to evaluate if the degree of VD insufficiency is associated with the incidence of cesarean section and to determine the correlation between maternal and newborn cord blood 25-hydroxy VS (25OHD). Women (n=127) were divided according to their 25OHD levels (ng/mL): G1:<20 (deficiency), G2:20-30 (insufficiency), G3:>30 (sufficiency). Age; gestational age (GA); body mass index (BMI); systolic and diastolic blood pressure (mmHg); type of delivery and the season of the year in which the sample was taken were recorded. Calcemia (ng/mL); 25OHD; intact parathormone (pg/mL); bone alkaline phosphatase (IU/L) and Crosslaps (pg/mL) levels were determined. Mean age was 26±6 years and GA was 35.8±2.7 weeks with no differences among groups. The % of cesarean sections was higher in G1 than in G2 and G3 (31.3%, 21.4% and 25%; p<0.05). The highest % of samples were taken in spring (p<0.05). No differences were observed in the other maternal variables studied. Maternal serum 25OHD levels correlated positively with those of cord blood from their respective newborns (r=0.67; p<0.0001). Regardless the season of the year and BMI, a high % of the studied pregnant women presented 25OHD levels lower than 30 ng/ml. Conclusion: we found that maternal VD deficiency is associated with the number of cesarean sections. In addition, 25OHD levels in the newborn significantly correlate with maternal serum levels. (AU)

Evaluación de la ingesta de calcio en mujeres pre-menopáusicas consumidoras de alimentación basada en plantas correspondiente al área metropolitana de Buenos Aires / Evaluation of calcium intake in pre-menopausal women consuming a plant-based diet in the Buenos Aires metropolitan area

El calcio es uno de los nutrientes esenciales para la salud ósea. Objetivos: evaluar la ingesta de calcio en un grupo de mujeres pre-menopáusicas consumidoras de alimentación basada en plantas (ABP). Materiales y métodos: un grupo de mujeres premenopáusicas entre 30 y 45 años consumidoras de ABP fueron invitadas a participar. Para la evaluación de ingesta se empleó un recordatorio alimentario de 24 horas. Se utilizó la Encuesta Nacional de Nutrición y Salud (ENNyS, 2007) como información relevada disponible de ingesta de calcio en nuestra población. En un subgrupo de participantes se evaluó la densidad mineral ósea (DMO) de columna lumbar (L1-L4) por el método de absorciometría de rayos X (DXA), mientras que la microarquitectura fue estudiada a través del trabecular bone score (TBS). Resultados: se incluyeron 30 mujeres con un tiempo de adherencia promedio (X±DS) a la ABP 5,6±4 años, edad de 35,6±4 años, y un índice de masa corporal (IMC) de 23.,7±3 kg/m2. Una ingesta diaria de calcio promedio (IC al 95%) de 980 mg (639 mg-1320 mg) fue observada en las mujeres vegetarianas, mientras que en las veganas fue de 772 mg (460 mg-1085 mg), lo que resulta superior a la de la población general (406 mg). Una correlación positiva fue observada entre DMO e IMC (r=0,990; p=0,01) pero no entre DMO e ingesta de calcio. Conclusiones: en esta cohorte de mujeres premenopáusicas consumidoras de ABP, las vegetarianas y el 96,5% de las veganas cubrieron el requerimiento promedio estimado. La adecuada planificación de la ABP permite evitar deficiencias nutricionales que afecten la salud ósea. (AU)

Calcium is one of the essential nutrients intervening in bone health. Objective: To assess calcium intake in a group of premenopausal women consumers of a plant-based diet (PBD). Materials and methods: Premenopausal women between 30 and 45 y/o consumers of a PBD were invited to participate. A 24-hour food reminder was provided for the intake evaluation. Argentina's National Nutrition and Health Survey (ENNyS, 2007) was used as available information on calcium intake in our population. In a participants' subset, the bone mineral density (BMD) of the lumbar spine (L1-L4) was evaluated by dual-energy X-ray absorptiometry (DXA), while the trabecular bone score (TBS) was used to study the microarchitecture. Results: The study included 30 women with an average adherence time (X±DS) to PBD of 5.6±4 years, of 35.6±4 years and a body mass index (BMI) of 23.7±3kg/m2. An average daily calcium intake (95% CI) of 980mg (639 mg-1.320mg) was observed in vegetarian women, while in vegan women it was 772 mg (460mg-1.085mg), higher than the general population (406 mg). A positive correlation was observed between BMD and BMI (r=0.990; p=0.01), though not between BMD and calcium intake. Conclusions: In this cohort of premenopausal women consuming a PBD, the vegetarians and 96.5% of vegans met the estimated average requirement. An appropriate planning of the PBD prevents nutritional deficiencies that may affect bone health. (AU)

Mechanism of action and exogenous supplementation of vitamin D in Crohn's disease / 中国当代儿科杂志

Vitamin D can not only regulate calcium and phosphorus metabolism, but also exert an immunoregulatory effect. Vitamin D deficiency is common in patients with Crohn's disease (CD). Studies have shown that vitamin D is associated with CD and other autoimmune diseases and can improve the condition of patients with CD and promote their recovery by regulating intestinal immunity, repairing the intestinal mucosal barrier, inhibiting intestinal fibrosis, enhancing the response to infliximab, and regulating intestinal microbiota. Exogenous vitamin D supplementation can induce disease remission while increasing the serum level of vitamin D. However, only a few randomized, double-blind, and placebo-controlled trials have investigated the therapeutic effect of vitamin D in CD, and the optimal form of vitamin D supplementation, the specific dosage of vitamin D supplementation, and the optimal serum maintenance concentration of vitamin D remain to be clarified. This article mainly discusses the mechanism of action of vitamin D in CD and the beneficial effect of exogenous vitamin D supplementation on CD.

Absorción mineral y retención ósea en ratas normales en crecimiento por el consumo de un yogur experimental reducido en lactosa que contiene galactooligosacáridos (GOS) / Mineral absorption and bone retention in normal growing rats by consumption of an experimental lactose-reduced yogurt containing galactooligosaccharides (GOS)

Introducción: Los GOS son prebióticos naturales presentes en la leche materna que pue-den obtenerse enzimáticamente a partir de la lactosa de leche de vaca durante la fabricación de yogur. El producto lácteo resultante será reducido en lactosa y contendrá prebióticos y bacterias potencialmente probióticas. Sin embargo, mantendrá la baja relación Ca/Pi que aporta la leche de vaca, lo que podría alterar el remodelamiento óseo y la mineralización. Objetivo: comparar si un yogur reducido en lactosa que contiene GOS (YE) ofrece ventajas adicionales respecto de un yogur regular sin GOS (YR) sobre las absorciones (Abs) de Ca y Pi, retención y calidad ósea durante el crecimiento normal. Al destete, ratas machos fueron divididas en 3 grupos alimentados con AIN ́93-G (C), YE o YR durante 28 días. Resultados: YE mostró el mayor aumento de lactobacilos fecales; producción de ácidos grasos de cadena corta especialmente p, profundidad de las criptas colónicas y menor pH cecal. El %AbsCa y %AbsPi aumentó en el siguiente órden: YE> YR> C (p < 0,05). El contenido de Ca y Pi en fémur, la densidad y contenido mineral óseos y los parámetros biomecánicos fueron similares en YE y C, mientras que YR mostró valores significativa-mente menores (p < 0,05). Conclusiones: YE aumentó las Abs y biodisponibilidad de minerales, alcanzando la retención y calidad ósea de C. El aumento en las Abs observado en YR no logró obtener la retención y calidad ósea de C. Conclusión: YE habría contrarrestado el efecto negativo del mayor aporte de Pi de la leche de vaca y sería una buena estrategia para lograr el pico de masa ósea y calidad del hueso adecuados, especialmente en individuos intolerantes a la lactosa. (AU)

Breast milk contains an optimal calcium/phosphate (Ca/Pi) ratio and GOS. These natural prebiotics can be enzymatically produced via cow's milk lactose inyogurt manufacture. This milk product is low in lactose and contains prebiotics and potentially probiotic bacteria but maintains a low Ca/Pi ratio that could alter bone remodeling and mineralization. We evaluated if a lactose-reduced yogurt containing GOS (YE) offers additional advantages over regular yogurt without GOS (YR) on Ca and Pi absorption (Abs), bone retention and quality during normal growth. Weaning male rats were divided into 3 groups fed AIN'93-G (C), YE or YR for 28 days. Results: YE showed the highest increase in fecal lactobacilli; short-chain fatty acids production, especially propionate and butyrate; intestine crypt depth, and the lowest cecal pH. AbsCa% and AbsPi% increased in this order: YE> YR> C (p <0.05). Ca and Pi content in femur, bone density and mineral content, and biomechanical parameters were similar in YE and C, while YR showed the significantly lowest value (p < 0.05). Conclusions: YE increased mineral Abs reaching the retention and bone quality of C. Although YR increased Abs, bone retention and quality did not achieve C values. Seemingly, YE compensated for the negative effect of the higher Pi supply and would be a good strategy to achieve adequate peak bone mass and bone quality, especially in lactose intolerant individuals. (AU)

Reflections on Chinese residents' calcium intake and human health / 中华预防医学杂志

Calcium plays an important role in various physiological activities of the human body, and long-term insufficient or excessive intake of calcium will have a negative impact on the body's health. Existing data show that insufficient dietary calcium intake is closely related to bone health, but the non-bone effects are not clear. Increasing dietary calcium and supplementing calcium (with or without vitamin D) have a certain beneficial effect on the bone mineral density and its peak of adolescents and can delay the bone loss of the elderly, but it can't improve the height and bone mineral density of adults and fracture in the elderly. This article introduces the physiological functions of calcium, dietary sources, human intake, and methods for formulating recommended amounts, and summarizes the relationship between calcium and health effects. It also recommends that when formulating the reference intake of dietary calcium for Chinese residents, more consideration should be given to the data and information of the Chinese population, combined with the characteristics of Chinese residents' genetics, absorption and metabolism.

High dietary calcium intake and low adiposity: findings from a longitudinal study in Brazilian adolescents / Ingestão alta de cálcio na dieta e adiposidade baixa: achados de um estudo longitudinal em adolescentes brasileiros / Alta ingesta de calcio en la dieta y baja adiposidad: hallazgos de un estudio longitudinal en adolescentes brasileños

Epidemiological studies have supported the hypothesis that dietary calcium intake is protective for adiposity. This study aimed to estimate the association of dietary calcium with adiposity indicators during adolescence. This is a cohort study with high school adolescents (n = 962) from selected schools of the Metropolitan Region of Rio de Janeiro, Brazil, which were followed from 2010 to 2012. Calcium intake was assessed by a validated self-reported food frequency questionnaire. Cross-sectional and longitudinal analyses of dietary calcium intake were performed regarding body mass index (BMI), waist circumference (WC), body fat percentage (%BF), fat mass (FM), fat-free mass (FFM), fat mass index (FMI), and fat-free mass index (FFMI). The analysis of variance was used for cross-sectional analysis with baseline data and linear mixed models applied to assess changes across the follow-up. At baseline, BMI, %BF, fat mass, and FMI (p for trend < 0.05) had lower means at the highest quintile of calcium intake whereas FFM and FFMI had higher means (p for trend < 0.05), especially for boys. During follow-up, boys had decreased FMI at the 4th and 5th quintiles of calcium intake (p < 0.05); among girls, only WC was significantly lower at the 4th quintile than in the 1st. These results support the hypothesis that low calcium intake increases adiposity among adolescents.

Estudos epidemiológicos têm sustentado a hipótese que a ingestão de cálcio na dieta pode proteger contra a adiposidade. O estudo teve como objetivo estimar a associação entre ingestão de cálcio e indicadores de adiposidade durante a adolescência. O estudo de coorte analisou adolescentes do Ensino Médio (n = 962) de escolas selecionadas na Região Metropolitana do Rio de Janeiro, Brasil acompanhados entre 2010 e 2012. A ingestão de cálcio foi avaliada com um questionário validado de autorrelato de frequência alimentar. Foram realizadas análises transversais e longitudinais de ingestão de cálcio em relação ao índice de massa corporal (IMC), circunferência da cintura (CC), percentual de gordura corporal (%GC), massa gorda (MG), massa magra (MM), índice de massa gorda (IMG) e índice de massa magra (IMM). A análise transversal usou ANOVA com dados da linha de base, e modelos mistos lineares foram aplicados para avaliar as mudanças ao longo do seguimento. Na linha de base, foram observados valores médios mais baixos para IMC, %GC, MG e IMG (p para tendência < 0,05) no quintil mais alto de ingestão de cálcio, em que foram estimados valores médios mais altos de massa magra e índice de massa magra (p para tendência < 0,05), principalmente em meninos. Durante o seguimento, os meninos mostraram uma redução no IMG no quarto e quinto quintis de ingestão de cálcio comparado com o primeiro quintil (p < 0,05), enquanto nas meninas, apenas a CC foi significativamente mais baixa no quarto quintil de ingestão de cálcio comparado com o primeiro quintil. Os resultados corroboram a hipótese do papel da baixa ingestão de cálcio no aumento da adiposidade em adolescentes.

Los estudios epidemiológicos han apoyado la hipótesis de que la ingesta de calcio en la dieta puede ser protectora de la adiposidad. El objetivo del estudio fue estimar la asociación del calcio dietético con los indicadores de adiposidad durante la adolescencia. Se trata de un estudio de cohorte con adolescentes de secundaria (n = 962) de escuelas seleccionadas del Área Metropolitana de Río de Janeiro, Brasil, que fueron seguidas desde 2010 hasta 2012. La ingesta de calcio se evaluó mediante un cuestionario validado de frecuencia de alimentos autoinformado. Se realizaron análisis transversales y longitudinales de la ingesta de calcio en la dieta en relación con el índice de masa corporal (IMC), la circunferencia de la cintura (CC), el porcentaje de grasa corporal (%GC), la masa grasa (MG), la masa libre de grasa (MLG), el índice de masa grasa (IMG) y el índice de masa libre de grasa (IMLG). Se utilizó el ANOVA para el análisis transversal, utilizando los datos de referencia y se aplicaron modelos lineales mixtos para evaluar los cambios a lo largo del seguimiento. En la línea de base, se observaron medias más bajas de IMC, %GC, MG e IMLG (p para tendencia < 0,05) en el quintil más alto de ingesta de calcio, para el que se estimaron medias más altas de MLG y IMLG (p para tendencia < 0,05), especialmente para los chicos. Durante el seguimiento, los chicos presentaron una reducción del IMLG en el 4º y 5º quintiles de ingesta de calcio (p < 0,05), mientras que entre las chicas, sólo la CC fue significativamente menor en el 4º quintil de ingesta de calcio en comparación con el 1º. Estos resultados apoyan la hipótesis de que la baja ingesta de calcio puede tener un papel en el aumento de la adiposidad entre los adolescentes.

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.

Association of neonatal blood calcium levels with perinatal factors and neonatal urinary calcium levels measured by an intelligent urine test system / 中国当代儿科杂志

OBJECTIVE@#To study the association of neonatal blood calcium levels with perinatal factors and neonatal urinary calcium levels measured by an intelligent urine test system.@*METHODS@#The medical data of 96 full-term singleton neonates with mild diseases were collected by a cross-sectional survey, who were hospitalized in the Department of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, from June to August 2018. Urinary calcium levels measured by an intelligent urine test system, total blood calcium levels, ionized calcium levels, and the mother's calcium and vitamin D supplementation during pregnancy were recorded.@*RESULTS@#Compared with the group without vitamin D supplementation for the mother (17 neonates), the group with vitamin D supplementation for the mother (79 neonates) had significantly higher levels of total blood calcium and ionized calcium (@*CONCLUSIONS@#Vitamin D supplementation during pregnancy can increase the blood levels of total calcium and ionized calcium in neonates, and calcium supplementation alone cannot increase the blood levels of total calcium or ionized calcium in neonates. Hypothermia in neonates might cause the reduction in blood calcium levels. The urinary calcium level measured by the intelligent urine test system is positively correlated with the blood level of ionized calcium.

Estimación de la ingesta de calcio y fosfato a partir de bebidas analcohólicas / Calcium and phosphate intake from analcoholic beverages

El calcio (Ca) es un nutriente crítico para la salud, especialmente en los períodos de crecimiento. Sin embargo, la mayoría de los individuos argentinos no alcanzan la ingesta diaria recomendada. Por su parte, el fósforo (P) es un nutriente cuya ingesta suele estar por encima de la recomendada. Este tipo de desequilibrio en la ingesta de ambos nutrientes conlleva a una pérdida de masa ósea. El consumo de bebidas analcohólicas (BA) se ha incrementado en los últimos años, sobre todo en la población infantil, desplazando el consumo de agua y lácteos. El objetivo de este trabajo fue estimar el aporte de Ca y P a partir de BA diferentes de agua. Se evaluaron 59 muestras, cuya mediana y rango de Ca fue de 7,74 [0,00 a 111,29] mg/l y de P 55,17 [0,16 a 957,00] mg/l. Los jugos en polvo son los que mayor contenido de Ca presentaron y las bebidas deportivas aquellas donde se halló el mayor contenido de P. Considerando un consumo de 500 ml/día de BA se estarían incorporando 3,87 mg Ca y 27,59 mg P. El creciente consumo de BA, su bajo contenido de Ca y la concomitante reducción del consumo de lácteos contribuyen a una inadecuada ingesta de Ca. (AU)

Calcium (Ca) is a critical nutrient, especially during periods of growth. However, the majority of Argentine individuals do not reach the recommended daily intake. On the other hand, phosphorus (P) is a nutrient with an intake usually above the recommended values. This type of imbalance between the intake of the nutrients leads to loss of bone mass. Soft drinks consumption (BA) has increased in recent years, especially in children, displacing the consumption of water and dairy products. The aim of this work was to estimate the Ca and P content in BA other than water. 59 samples were evaluated, with a median and range of Ca of 7.74 [0.00 to 111.29] mg/l and of P of 55.17 [0.16 to 957.00] mg/l. Powdered juices are the ones with the highest Ca content, and sports drinks are the beverages in which the highest P content was found. Based on a BA consumption of 500 ml/day, 3.87 mg Ca and 27.59 mg P would be incorporated. Therefore, the increased consumption of BA, their low Ca content, and the concomitant reduction in dairy consumption contribute to an inadequate intake of Ca. (AU)

Analysis of Dietary Calcium and Phosphorus Intakes and Contribution Rates of Major Dish Groups according to Gender, Age, and Region in Korea / 대한지역사회영양학회지

OBJECTIVES: Calcium (Ca) is an insufficiently consumed nutrient, whereas phosphorus (P) intake has exceeded the recommended intake level in Korea over the past decade. The purpose of this study was to analyze dietary Ca and P intakes and their contribution rate according to dish groups.METHODS: A 24-hour dietary recall survey of 640 healthy adults (aged 19–69 years) was undertaken twice in four Korean provinces. Dietary Ca and P intakes and their rates of contribution from 31 major dish groups were analyzed and compared by gender, age group, and region.RESULTS: The average Ca and P intakes of the subjects were 542.1 ± 222.2 mg/d and 1,068.3 ± 329.0 mg/d, respectively. The intakes of Ca and P as percentages of recommended nutrients intake (RNI%) were 71.7 ± 29.8% and 152.6 ± 47%, respectively, and the percentages under the estimated average requirement were 60.3% for Ca and 3.8% for P. The RNI% of Ca was not significantly different between males and females, but was significantly higher in subjects in the sixties age group than in other age groups and was significantly lower in the Korean capital than in other regions. The RNI% of P did not significantly differ by gender or age groups, but it was significantly higher in the capital than in Gyeong-sang. The five major dish groups contributing to Ca intake (contribution rate) were milks/dairy products 69.2 ± 109.2 mg/d (12.6%), soups 55.6 ± 69.6 mg/d (10.1%), stir-fried foods 53.1 ± 70.7 mg/d (9.7%), stews 43.4 ± 85.4 mg/d (7.9%), and kimchi 38.4 ± 31.8 mg/d (7.0%). The five major dish group contributing to P intake (contribution rate) were cooked rice 160.7 ± 107.1 mg/d (14.9%), stir-fried foods 88.5 ± 89.4 mg/d (8.2%), soups 76.7 ± 85.8 mg/d (7.1%), one-dish meals 63.3 ± 94.4 mg/d (5.9%), and stews 62.6 ± 89.3 mg/d (5.8%). The dish groups contributing to Ca and P intakes differed somewhat by gender, age group, and region.CONCLUSIONS: Programs to improve the nutritional status of Ca and P intakes should consider the differences in Ca and P contribution rates by dish groups as well as by gender, age group, and region.

Osteomalacia. Diagnóstico y tratamiento / Osteomalacia. Diagnosis and treatment

Introducción: la osteomalacia se caracteriza por la falta de mineralización de la sustancia osteoide, que afecta al hueso cortical y al hueso esponjoso maduro. Es una enfermedad que se presenta en adultos y niños, aunque la causa es diferente en cada uno. Objetivo: exponer la generalidad de la osteomalacia por ser una enfermedad que produce serias afectaciones a la población que la padece, especialmente a los niños. Se enfatiza en el diagnóstico y su tratamiento. Desarrollo: a fin de resumir los elementos esenciales para establecer el diagnóstico de osteomalacia hay que plantear en primer lugar, la presencia de un trastorno de la mineralización ósea, de ahí que además de tener en cuenta las causas de la enfermedad, su curso clínico y la sintomatología. Conclusiones: una recomendación importante es no tener en cuenta la posibilidad de complicaciones en el curso de la enfermedad, como las fracturas, que, aunque sean parte del cuadro clínico, al producirse pueden ocasionar graves problemas, como el caso de las que aparecen en las costillas, que si se desplazan pueden interesar órganos vitales, de modo que en este tipo de pacientes no debe excluirse la posibilidad de emergencias o de urgencias reumatológicas tanto en los adultos como en los niños(AU)

Introduction: osteomalacia is characterized by the lack of mineralization of the osteoid substance, which affects cortical bone and mature cancellous bone. It is a disease that occurs in adults and children, although the cause is different in each. Objective: to expose the generality of osteomalacia for being a disease that causes serious affectations to the population that suffers it, especially to children. Emphasis is placed on the diagnosis and its treatment. Development: in order to summarize the essential elements to establish the diagnosis of osteomalacia, we must first consider the presence of a bone mineralization disorder, hence, in addition to taking into account the causes of the disease, its clinical course and the symptomatology. Conclusions: an important recommendation is not to take into account the possibility of complications in the course of the disease, such as fractures, which, although they are part of the clinical picture, can cause serious problems when they occur, as in the case of those that appear in the ribs, which if they move may involve vital organs, so that in this type of patients should not exclude the possibility of emergencies or rheumatological emergencies in both adults and children(AU)

Efecto de una intervención dietoterapéutica con diferentes aportes de calcio dietario sobre el estado nutricional en estudiantes universitarias con sobrepeso / Effect of an intervention with different contributions of calcium on nutritional status in overweight university students

RESUMEN Una baja ingesta de calcio se ha asociado con mayor prevalencia de sobrepeso y obesidad. El objetivo fue evaluar el efecto de una intervención dietoterapéutica con diferentes aportes de calcio dietario sobre el estado nutricional, en estudiantes universitarias con sobrepeso. El diseño fue cuasi-experimental (n= 18) en dos grupos intervenidos durante 8 semanas. El grupo 1 (n= 10) restringió su consumo de lácteos a <3 porciones, mientras que el grupo 2 (n= 8) consumieron 5 porciones diarias (leche fluida UHT descremada). La intervención consideró, para ambos grupos, una restricción de 500 kcal/día respecto de su gasto energético total. Se evaluó el estado nutricional por IMC (kg/m2), circunferencia de cintura (CC) y porcentaje de masa grasa (%MG). Como resultados se obtuvo que, la ingesta de calcio dietario, aumentó en 916,4 mg/día en el grupo de "5 porciones de lácteos", pero disminuyó en −28,9 mg/día en el grupo de "3 porciones de lácteos". Al comparar los grupos, ambos redujeron significativamente (p< 0.05) su peso corporal (-3,6 vs. −3,4 kg), IMC (-1,45 vs. −1,31 kg/m2), CC (-4,5 vs. −6,2 cm) y %MG (-2,5 vs. −2,7 %). Estos resultados sugieren que aumentar el consumo de lácteos a 5 porciones diarias no presenta beneficios adicionales para la mejora del estado nutricional después de 8 semanas de intervención.

ABSTRACT A low intake of calcium has been associated with greater risk of overweight and obesity. This work aimed to evaluate the effect of different levels of calcium intake on the nutritional status of overweight female university students. This 8-week intervention included two groups who restricted their calcium intake to <3 portions or 5 portions of dairy products per day (nonfat ultra-high temperature processed milk). Height, weight, body mass index (BMI), waist circumference (WC) and body fat percentage (BF) were measured at baseline and post-intervention. The intervention considered for both groups a 500 kcal/day restriction based on their total energy expenditure. The main result of this study showed that dietary calcium intake increased to 916.4 mg/day in the group consuming 5 portions per day but decreased (-28.9 mg/day) in the group consuming 3 daily portions. Both the 3 and 5 portion intake groups significantly reduced their body weight (-3.6 vs. −3.4 kg), BMI (-1.45 vs. −1.31 kg/m2), WC (-4.5 vs. −6.2 cm) and BF (-2.5 vs. −2.7%). These findings suggest that 5 dairy portions per day compared to 3 does not have additional benefits for improved nutritional status.

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.

Reference range of random urinary calcium creatinine ratio in North Indian children and adolescents

PURPOSE: Urinary calcium creatinine ratio (UCaCrR) is a reliable indicator for monitoring hypercalciuria following vitamin D supplementation. However, the reference range varies from region to region. Previous studies did not take vitamin D and parathyroid hormone status into account while evaluating UCaCrR. Hence, we undertook this study to establish the 95th percentile of UCaCrR as an indicator of hypercalciuria in North Indian children and adolescents. METHODS: Four hundred seventy-three participants (boys 62.2%, girls 37.8%) with adequate dietary calcium intake, normal serum levels of 25-hydroxy-vitamin D (>20 ng/mL), and without secondary hyperparathyroidism following supplementation were selected for evaluation of UCaCrR. RESULTS: The mean age and body mass index of subjects were 11.2±2.6 years and 18.0±3.6 kg/m2, respectively. The 95th percentile of UCaCrR in the study population was 0.126. The mean, median, and 95th percentile of UCaCrR was significantly higher in prepubertal children (age ≤10 years) (0.0586±0.0374, median=0.0548, 95th percentile=0.136) compared to those >10 years old (0.0503±0.0363, median=0.0407, 95th percentile=0.123, P=0.02). No significant difference in UCaCrR was observed between genders and different weight categories. CONCLUSIONS: UCaCrR of 0.13 defines the cutoff value for hypercalciuria in North Indian children and adolescents with adequate dietary intake of calcium and sufficient serum vitamin D levels.

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.

Effect of calcium sources in the diets of adult cats on urinary parameters and acid-base balance / Efeitos das fontes de cálcio na dieta de gatos adultos sobre parâmetros urinários e equilíbrio ácido-básico

Calcium is a macroelement that is part of the mineral composition of the diet of companion animals, and is considered a cation of strong alkalizing power, increasing urinary pH. Calcium salts have different solubilities and depending on the anion to which calcium is associated with, it can be more or less absorbed, modifying the pH of the urine. The aim of this study was to evaluate the efficiency of calcium sources on alkalinization of urinary pH, as well as excretion of urinary electrolytes and acid-base balance of adult cats. An extruded diet for cats was selected, and had 160mEq/kg of calcium from the sources of either calcium carbonate (CaCO3) or calcium gluconate (C12H22CaO14) added. In the control treatment there was no addition of calcium sources, resulting in three treatments. Nine adult cats were used, mixed breed, in two experimental periods, with six replicates per treatment. Animal average age was 4±1.3 years old and average weight was 3.96±0.71kg. The cats remained in metabolic cages for an adaptation period of seven days, followed by six days of urine total collection, with volume, density, pH and calcium concentration (g/d) measurements. The acid-base balance was studied by blood gas analysis of venous blood. The two sources of calcium alkalinized the urine (P<0.001). However, calcium gluconate had less alkalinization power compared to the calcium carbonate (P<0.05). Urinary calcium was not affected by treatments, and represented less than 0.5% of calcium intake. The experiment showed that calcium, although an alkaline cation and considered strong influencer of the EB of the diet, cannot be evaluated individually, because depending on its associated anion it may have greater or lesser influence on cats urine pH.(AU)

O cálcio (Ca) é um macroelemento que faz parte da composição mineral da dieta de animais de companhia. Este macroelemento é considerado um cátion de forte capacidade alcalinizante e, de acordo com a fonte e quantidade inclusa, pode aumentar o pH urinário. Os sais de cálcio têm diferentes solubilidades e dependendo do ânion ao qual o cálcio está associado, pode ser mais ou menos absorvido e assim, alterar o pH da urina. O objetivo deste estudo foi avaliar os efeitos de duas fontes de cálcio na alcalinização do pH urinário, bem como a excreção de eletrólitos urinários e o equilíbrio ácido-básico de felinos. Foi selecionada uma dieta extrusada para gatos e adicionados 160mEq/kg de cálcio das fontes carbonato de cálcio (CaCO3) ou gluconato de cálcio (C12H22CaO14). No tratamento controle, não houve adição de fontes de cálcio. Foram utilizados nove gatos adultos, de raças mistas, em dois períodos experimentais, com seis repetições por tratamento. Os animais apresentavam idade média de 4,0±1,3 anos e peso corporal médio de 3,96±0,71kg. Estes permaneceram em gaiolas metabólicas em período de adaptação durante sete dias, seguido de coleta total de urina durante seis dias. Nestas amostras foram aferidos o volume, densidade, pH e concentração de cálcio (g/d). O equilíbrio ácido-básico foi avaliado por hemogasometria em amostras de sangue venoso. As duas fontes de cálcio alcalinizaram a urina (P<0,001). No entanto, o gluconato de cálcio apresentou menor potencial de alcalinização em comparação ao carbonato de cálcio (P<0,05). O cálcio urinário não foi afetado pelos tratamentos e representou menos de 0,5% da ingestão de Ca. O experimento demonstrou que o cálcio, apesar de ser um cátion alcalinizante e influenciador do EB da dieta, não pode ser avaliado individualmente, porque dependendo do ânion associado, pode apresentar maior ou menor influência no pH da urina de gatos.(AU)

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.

Cálcio e vitamina D em adultos atendidos em ambulatório de nutrição / Calcium and vitamin D in adults attending an outpatient nutrition clinic / Calcio y vitamina D en adultos asistidos en ambulatorio de nutrición

Objetivo: Avaliar o consumo de cálcio e vitamina D de pacientes atendidos em um ambulatório de Nutrição de referência. Métodos: Estudo transversal quantitativo realizado no período de novembro de 2015 a junho de 2016 avaliou 1.000 recordatórios alimentares de pacientes na faixa etária de 20 a 59 anos do ambulatório de Nutrição de um centro universitário do interior do Rio Grande do Sul, Brasil. Excluíram-se os recordatórios com medidas caseiras incompletas. Para a padronização dessas medidas utilizou-se registro fotográfico de um livro de medidas caseiras. Utilizou-se como referência para análise de ingestão do cálcio e vitamina D a Dietary Reference Intakes. Os dados foram analisados por meio de estatística descritiva e inferencial com nível de significância de 5%. Resultados: O consumo de cálcio e de vitamina D foi simétrico, apresentando 89,5% (n=895) de inadequação do consumo de vitamina D e 86,6% (n=866) de inadequação do consumo de cálcio, portanto, abaixo da recomendação diária. Homens apresentaram ingestão significativamente maior de cálcio em comparação às mulheres (p<0,001), enquanto o consumo de vitamina D não apresentou diferença significativa entre os sexos (p=0,307). Conclusão: Verificou-se elevada inadequação quanto à ingestão de cálcio e vitamina D pela população estudada.

Objective: To assess calcium and vitamin D intake in patients attending a reference outpatient nutrition clinic. Methods: Quantitative cross-sectional study carried out from November 2015 to June 2016 to analyze 1,000 dietary recalls of patients aged 20 to 59 years attending an outpatient nutrition clinic of a university center in the countryside of Rio Grande do Sul. Recalls with incomplete household measures were excluded. Measures were standardized using pictures from a household measures book. The analysis of calcium and vitamin D intake was based on the Dietary Reference Intakes. Data were analyzed using descriptive and inferential statistics with a significance level of 5%. Results: Calcium and vitamin D intake was symmetrical, with 89.5% (n=895) of inadequate vitamin D intake and 86.6% (n=866) of inadequate calcium intake, i.e., below the daily recommendation. Men presented significantly higher calcium intake compared to women (p<0.001), while vitamin D intake showed no significant differences between genders (p=0.307). Conclusion: There was a high inadequacy of calcium and vitamin D intake in the population analyzed.

Objetivo: Evaluar el consumo de calcio y vitamina D de pacientes asistidos en un ambulatorio de nutrición de referencia. Métodos: Estudio transversal cuantitativo realizado en el período entre noviembre de 2015 y junio de 2016 evaluó 1.000 recordatorios alimentarios de pacientes en la franja de edad entre 20 y 59 años del ambulatorio de nutrición de un centro universitario de un pueblo de Rio Grande do Sul, Brasil. Se excluyeron los recordatorios con las medidas caseras incompletas. Para la estandarización de esas medidas se utilizó el registro fotográfico de un libro de medidas caseras. Se utilizó como referencia para el análisis de la ingesta de calcio y vitamina D la Dietary Reference Intakes. Los datos fueron analizados a través de la estadística descriptiva e inferencial con el nivel de significación del 5%. Resultados: El consumo de calcio y vitamina D ha sido simétrico presentando el 89,5% (n=895) de inadecuación para el consumo de vitamina D y el 86,6% (n=866) de inadecuación para el consumo de calcio, por lo tanto, abajo de la recomendación diaria. Los hombres presentaron ingesta significativamente mayor de calcio en comparación con las mujeres (p<0,001) mientras el consumo de vitamina D no ha presentado diferencia significativa entre los sexos (p=0,307). Conclusión: Se verificó una elevada inadecuación de la ingesta de calcio y vitamina D de parte de la población estudiada.

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)

Parâmetros clínicos, hematológicos e bioquímicos de novilhas com hipocalcemia subclínica pré-parto suplementadas com dieta aniônica / Anionic diet on clinical, haematological and biochemical parameters of heifers with subclinical hypocalcemia prepartum

A hipótese do presente estudo consiste em que uma dieta aniônica prolongada acarretaria uma mobilização mais rápida do cálcio sanguíneo. O objetivo proposto foi avaliar parâmetros clínicos, hematológicos e bioquímicos de novilhas, com hipocalcemia subclínica, submetidas a diferentes períodos de fornecimento de dieta aniônica no pré-parto. Foram utilizadas nove novilhas da raça Holandês induzidas à hipocalcemia subclínica no pré-parto, divididas em três grupos: G0 = sem dieta aniônica antes da indução; G11 = 11 dias de dieta aniônica pré-indução; e G15 = 15 dias de dieta aniônica pré-indução. Foi realizado exame clínico antes e depois da indução, e avaliaram-se cálcio total e ionizado, magnésio e albumina nos dias -2, 0, 1, 2 e 3 (dia 0 = momento da indução) e parâmetros hematológicos nos dias 0, 1, 2 e 3. O G11 apresentou maiores concentrações de cálcio total e ionizado que o G0 e maiores níveis de cálcio total que o G15 (P<0,01). O magnésio teve maiores valores no G15 quando comparado aos outros grupos (P<0,01). O G0 apresentou os maiores valores de monócitos e neutrófilos bastonetes (P<0,01). A dieta aniônica por 11 dias é suficiente para manter a homeostase do cálcio e a resposta leucocitária em novilhas desafiadas a uma diminuição do cálcio sanguíneo.(AU)

This study's hypothesis is that cows receiving anionic diet for a longer period respond more quickly to decreased blood calcium. The aim was to evaluate the heifers' clinical, hematological, and biochemical parameters, with subclinical hypocalcemia, subjected to different periods of anionic diet supply during antepartum. Nine heifers were induced to subclinical hypocalcemia during antepartum, sorted in 3 groups: G0 = no anionic diet before induction; G11= eleven days of anionic diet before induction; and G15 = fifteen days of anionic diet before induction. Examinations were held before and after induction and total and ionized calcium, magnesium and albumin were evaluated from days -2, 0, 1, 2 and 3, day 0 being the moment of induction; hematologic parameters were evaluated at days 0, 1, 2 and 3. G11 presented a higher total and ionized calcium concentration than G0 and higher total calcium concentration than G15 (P < 0.01). Magnesium had its highest values at G15 when compared to the other two groups (P < 0.01). G0 presented its highest values of monocytes and neutrophils rods (P<0.01). The eleven days of anionic diet supply were enough to maintain calcium homeostasis and leukocyte response in heifers challenged to reduction in blood calcium.(AU)