Oral health in young women having a low calcium and vitamin D nutritional status.

OBJECTIVE: Oral health plays an important role in an individual's eating choices, which in turn ensure good nutrition throughout life. The deterioration in diet quality may partially explain the association between tooth loss and several systemic diseases, including osteoporosis. The study evaluated the association between oral health and calcium (Ca) and vitamin D nutritional status. The effect of several dietary and lifestyle habits was also evaluated. MATERIAL AND METHODS: One hundred six women aged 23.7 ± 0.4 years were evaluated. Ca intake (CaI) and protein intake were recorded, and 25-hydroxyvitamin D (25OHD) was evaluated. Dental status and caries risk were assessed by determining the number of decayed (D), missing (M), and filled (F) teeth and DMFT index, Löe Silness plaque index (PI), and sugar intake (SI). RESULTS: Deficient CaI was observed in 59% of women; 71% had 25OHD <30 ng/mL and 72% consumed soft drinks daily. M/T score was 3%, D/T score was 28.4%, and F/T score was 0%. Thirty-nine percent of women were missing at least one tooth. PI and SI were 2.0 ± 0.1 and 5.2 ± 0, respectively, and DMFT score was 6.6 ± 0.4. CaI adjusted by other risk factors was associated with higher percentage of caries (p < 0.0001), DMFT (p < 0.001), and PI (p < 0.007). One hundred percent of women presented gingivitis. When considering the one third of the studied group with the highest caries scores, DMFT reached 10.6 ± 0.5. This group had significantly lower CaI and 25OHD levels (p < 0.05) and significantly higher protein intake, daily consumption of soft drinks, and PI and SI values compared to the rest of the women (p < 0.05). CONCLUSION: The results of this cross-sectional report evidenced an association between high cariogenic risk and great severity of oral disease in the studied group of young women and low CaI. CLINICAL RELEVANCE: Although caries progression is a complex process involving multiple factors, an adequate nutritional status of Ca and vitamin D could be an additional factor that may help preserve a good oral health.

Body composition and bone metabolism in young Gaucher disease type I patients treated with imiglucerase.

UNLABELLED: Bone involvement is one of the most disabling complications in patients with type 1 Gaucher disease (GDI) and its pathophysiology is yet to be fully understood. It is well known that body composition is a determinant of bone mass. Previous reports indicating disturbance in glucose and lipid metabolism in GDI patients suggested a posible alteration in body composition in this group of patients. OBJECTIVE: To analyze body composition, bone mass and turnover in young adults with GDI receiving enzyme replacement therapy (ERT). POPULATION: 5 women and 4 men with GDI aged (X +/- SD) 26.9 +/- 6.9 years, receiving imiglucerase in a mean dose of 53 +/- 13 IU/kg/2weeks, during 4.9 +/- 3.9 years; and 145 sex and age matched healthy adults agreed to participate in the study. All control subjects had a body mass index (BMI) between 20 and 25 kg/m2. METHODS: Total body dual X-ray absorptiometry (DXA) was used to measure body composition and bone mass. Serum creatinine, calcium, osteocalcin (BGP), and type I collagen beta carboxy-terminal telopeptide (betaCTX) were determined in patients and controls. In addition, 25 hydroxyvitamin D (25OHD), and chitotriosidase activity were measured in patients. RESULTS: GDI patients presented statistically significant (p<0.01) lower BMI, bone mineral density (BMD), bone mineral content (BMC), lean mass (LM), and fat mass (FM), compared to controls. LM correlated positively with BMC and BMD in both groups (p<0.01). GDI patients receiving the lower dose of ERT (<60 IU/kg/2weeks) presented lower BMD values than those receiving the higher dose (> or =60 IU/kg/2weeks) (0.968 +/- 0.032 vs 1.088 +/- 0.061 g/m2, respectively, p<0.001). Mean BGP levels were similar in patients and controls, whereas betaCTX levels were higher in GDI patients (p<0.02). All patients presented deficiency levels (<30ng/ml) of 25OHD. CONCLUSIONS: Although the patients had been receiving ERT, they presented a significant diminution in all body composition parameters, the decrease was more evident in those receiving the lower dose. The reduction in bone mass was associated with an imbalance in bone turnover (increased bone resorption). The correlation between LM and bone mass, suggests that metabolic disturbance occurring in GDI patients may be indirectly responsible for bone mass reduction in GDI patients, by altering body composition.

Telopeptido carboxilo terminal del colageno tipo i ( beta-ctx ) serico y / compromiso oseo en la insuficiencia renal cronica / Serum beta-type I collagen carboxyterminal telopeptide ( beta-CTXs ) and bone involvement in chronic renal failure

La osteodistrofia renal (ODR) se caracteriza por alteraciones óseas. Se evaluaron métodos bioquímicosalternativos a la biopsia ósea en pacientes renales para determinar cambios rápidos delremodelamiento óseo en 43 pacientes predialíticos (PD) y 49 hemodializados (HD). Los PD presentaronfosfatemia, fosfatasa alcalina ósea (FAO), hormona paratiroidea intacta (PTHi) y beta-telopéptido carboxilo terminaldel colágeno tipo I (betaCTXs) mayores y clearence de creatinina (Ccr) menores (p<0.001) que los controles.La fosfatemia de HD fue más elevada, significativamente respecto de controles (p<0.0001); FAO, PTHi y betaCTXsfueron mayores a los otros dos grupos (p<0.0001). En ambos grupos renales betaCTXs y FAO correlacionaroncon PTHi (p<0.002 y p<0.0001, respectivamente) y entre sí (p<0.0001). Los PD con Ccr <40 ml/min presentaronPTHi, FAO y bCTXs (p<0.004, p<0.05 y p<0.001, respectivamente) más elevados que aquellos con Ccr>40ml/min. En PD, betaCTXs (p<0.05) y en HD tanto betaCTXs como FAO (p<0.0001) estaban aumentados respecto decontroles, aun con PTHi normal. Los incrementos mayores en los marcadores óseos se observaron en los pacientescon mayores niveles de PTHi (p<0.001). En conclusión; aun sin PTHi elevada existe un aumento deresorción ósea (posiblemente por otros factores) y la medición de betaCTXs sería una herramienta apropiada notraumática para detectar tempranamente alteraciones óseas por IR que permitiría tomar medidas preventivaspara evitar dicha pérdida. Asimismo, instalada la ODR determinar el aumento del remodelamiento sería sumamenteútil para identificar pacientes que requieran biopsia ósea. El reemplazo de la misma por beta-CTX séricodeberá esperar estudios que demuestren la correlación existente entre ambas metodologías. (AU)

Telopeptido carboxilo terminal del colageno tipo i ( beta-ctx ) serico y / compromiso oseo en la insuficiencia renal cronica / Serum beta-type I collagen carboxyterminal telopeptide ( beta-CTXs ) and bone involvement in chronic renal failure

La osteodistrofia renal (ODR) se caracteriza por alteraciones óseas. Se evaluaron métodos bioquímicosalternativos a la biopsia ósea en pacientes renales para determinar cambios rápidos delremodelamiento óseo en 43 pacientes predialíticos (PD) y 49 hemodializados (HD). Los PD presentaronfosfatemia, fosfatasa alcalina ósea (FAO), hormona paratiroidea intacta (PTHi) y beta-telopéptido carboxilo terminaldel colágeno tipo I (betaCTXs) mayores y clearence de creatinina (Ccr) menores (p<0.001) que los controles.La fosfatemia de HD fue más elevada, significativamente respecto de controles (p<0.0001); FAO, PTHi y betaCTXsfueron mayores a los otros dos grupos (p<0.0001). En ambos grupos renales betaCTXs y FAO correlacionaroncon PTHi (p<0.002 y p<0.0001, respectivamente) y entre sí (p<0.0001). Los PD con Ccr <40 ml/min presentaronPTHi, FAO y bCTXs (p<0.004, p<0.05 y p<0.001, respectivamente) más elevados que aquellos con Ccr>40ml/min. En PD, betaCTXs (p<0.05) y en HD tanto betaCTXs como FAO (p<0.0001) estaban aumentados respecto decontroles, aun con PTHi normal. Los incrementos mayores en los marcadores óseos se observaron en los pacientescon mayores niveles de PTHi (p<0.001). En conclusión; aun sin PTHi elevada existe un aumento deresorción ósea (posiblemente por otros factores) y la medición de betaCTXs sería una herramienta apropiada notraumática para detectar tempranamente alteraciones óseas por IR que permitiría tomar medidas preventivaspara evitar dicha pérdida. Asimismo, instalada la ODR determinar el aumento del remodelamiento sería sumamenteútil para identificar pacientes que requieran biopsia ósea. El reemplazo de la misma por beta-CTX séricodeberá esperar estudios que demuestren la correlación existente entre ambas metodologías.

Dietas desequilibradas en niños preescolares: estudio en un jardín integral de la provincia de Buenos Aires, Argentina / Imbalance diets in preschool children: study in a day-care center in the Province of Buenos Aires, Argentina

The purpose of this study was to investigate the impact of low fat diets in children aged 2 to 5. Eighty two children (40 females and 42 males) attending a school cafeteria (Province of Buenos Aires, Argentina), in a cross sectional study, were evaluated. Body weight (W), height (H) and body composition (BC) by bioimpedance were recorded. The anthropometric raw data were processed as Z-score of the weight-for-age (WEZ) and of the height-for-age (HAZ). Serum insulin-like growth factor 1 (IGF-1) and Zinc/haemoglobin ratio (Zn/Hb) were also measured. Results showed that 73.2 per cent of children were adequate (A) according WEZ, 13.4 per cent were lean (L) and 13.4 per cent overweight (O). 8.5 per cent presented simultaneously impairment in WEZ and HAZ. Body fat percentage and energy metabolism were higher in O than in L and A (p < 0.05). Serum IGF-1's children--aged 4 to 5 years--with HAZ deficit were low than adequate HAZ ones. No statistical differences in Zn/Hb ratio between A, L and O were found. This cross sectional study suggests metabolic disorders in young children attending school cafeterias. These conclusions will allow to design balanced diets in order to optimize the resources, promote optimal growth and development and prevent adult diseases through dietary practices in childhood.

Bone mass changes during pregnancy and lactation in the rat.

We examined bone mass changes in the total, axial, and appendicular skeleton as well as in the different subareas of femur and tibia in rats fed on a normal calcium diet. A total of 16 virgin Wistar rats, approximately 5 months of age (270+/-30 g), were assigned to two groups of eight rats each. One group was mated and, for each pregnant rat, a nonpregnant control rat was studied simultaneously. Weaning was performed when the pups reached 38+/-3 g body weight. At the beginning (t = 0), on the first day postpartum (t = 22 days), and at weaning (t = 45 days), total skeleton bone mineral content (BMC), area, and bone mineral density (BMD) were determined by dual-energy X-ray absorptiometry (DXA) in vivo under anesthesia. Body weight increased significantly during pregnancy (p < 0.05) and decreased at weaning, whereas control rats showed a slow, gradual increment without reaching a significant difference. During pregnancy, BMC and area of the total skeleton increased significantly in pregnant rats, but the changes in BMD were not different compared with the control group. A completely different pattern was observed between groups during the 23 days of lactation. While the skeleton continued to grow in the control group (BMC and area increased), the total skeleton of lactating rats showed no change in area (size), small decreases in BMC, and a significant decrease in BMD (p < 0.05). Consequently, although BMC and BMD of both groups were similar at the time of delivery, BMC was 12.0% lower and BMD 4.9% lower at the end of lactation in the lactating rats compared with the control group. The contribution of the maternal skeleton to the lactation period was not similar; that is, the areas with the highest trabecular component showed the greater average differences in BMD at the time of weaning (proximal tibia -19.9%, distal femur -12.6%, spine -10.9%) (p < 0.05), compared with relatively minor, nonsignificant losses in areas where cortical bone predominates (distal tibia -5%, middle tibia -5.2%). Our experimental results demonstrated the usefulness of DXA in vivo to visualize changes in BMD during the reproductive cycle of the rat. Moreover, the data confirm that normal pregnancy in the rat appears to exert little influence on bone, whereas lactation induces significant bone loss, mainly in the areas of predominant trabecular bone.

[Olpadronate prevents cortical and trabecular bone loss induced by supraphysiological dosis of thyroxine in ovariectomized rats]. / El olpadronato previene la pérdida de hueso cortical y trabecular inducida por dosis suprafisiológicas de tiroxina en ratas ovariectomizadas.

The aim of the present report was to clarify the effect of excess T4 on axial and peripheral bone mineral density (BMD) in estrogen-depleted rats. The protective effect of olpadronate (Olpa) on axial and peripheral bone mass in thyroxine-treated rats was also investigated. Female Sprague-Dawley rats were used: SHAM, OVX + Vh, OVX + Olpa (0.3 mg/kg/week), OVX + T4 (250 micrograms/kg/day) and OVX + T4 + Olpa rats. OVX + Vh group presented a BMD lower than SHAM in the tibia (p < 0.01) but not in femur or lumbar spine; the middle tibia BMD did not change but it was lower at the distal (pns.) and proximal levels (p < 0.003) in OVX + Vh. OVX + T4 rats presented a BMD significantly lower than OVX + Vh rats in total tibia (p < 0.02), femur (p < 0.006) and lumbar spine (p < 0.006). Moreover the BMD was lower in all studied areas of the tibia, but it was statistically significant only at the middle level (p < 0.004). OVX + Olpa rats had a BMD higher than OVX + Vh rats in femur (p < 0.002), lumbar spine (p < 0.0001), total (p < 0.001) and proximal tibia (p < 0.001). Surprisingly, total and proximal tibia BMD values in OVX + Olpa rats presented a BMD significantly higher than OVX + T4 rats in femur (p < 0.001), lumbar spine (p < 0.001), tibia (p < 0.001) and proximal tibia (p < 0.0001). It is important to point out that OVX + T4 + Olpa BMD was significantly higher than in SHAM rats at the lumbar spine, total and proximal tibia (p < 0.01). The present study suggests that although supraphysiological thyroid hormone affected both cortical and trabecular bone, under estrogen-depleted conditions, the cortical bone appears to be more sensitive than the trabecular bone to T4 treatment. We also found that Olpa could prevent the peripheral and axial bone loss induced by thyroid hormone excess.

Calcium metabolism and its regulating hormones in patients with leprosy.

Calcium metabolism was studied in 47 patients with borderline or lepromatous leprosy. Total and ionized calcium, phosphorus, creatinine, total alkaline phosphatase, parathyroid hormone (PTH), 25-hydroxy vitamin D [25(OH)D], and 1,25-dihydroxy vitamin D [1,25(OH)2D] were measured in serum; calcium and total hydroxyproline were determined in urine. Total subperiosteal diameter and medullar cavity diameter were measured on an X-ray of the hand of all patients. Average values were within normal ranges for all of the biochemical determinations. Total serum calcium was moderately below the normal range in eight patients but ionized calcium levels were within the normal ranges in all of the patients. Four patients, all of them with lepromatous leprosy, had levels of 1,25(OH)2D higher than normal but none of them was hypercalcemic and PTH levels were within normal range. Although all values were within the normal ranges, lepromatous leprosy patients had lower total calcium, higher alkaline phosphatase, and higher urinary hydroxyproline than borderline leprosy patients (9.1 +/- 0.4 vs 9.4 +/- 0.3 mg%, p < 0.001; 10.3 +/- 2.9 vs 7.4 +/- 2.3 King-Armstrong units, p < 0.02 and 27.2 +/- 12 vs 19.4 +/- 5.6 mg/24 hr, p < 0.02, respectively). No differences were found between patients and controls in the average micrometric measurements of the second metacarpal bone but significant osteopenia was found in 19% of the patients. The main finding of the present study in a representative sample of leprosy patients is that the average total serum calcium was in the lowest limit of the normal range, but the ionized serum calcium was in the middle of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Precise measurement of bone mineral density in rats using dual-energy X-ray absorptiometry.

The dual X-ray absorptiometer (DEXA, Hologic ZDR-1000) in a high resolution mode was evaluated for measuring: Area (A), Bone Mineral Content (BMC) and Bone Mineral Density (BMD) in femur and tibia of adults rats at four regions: proximal (L1), diaphysis (L2-L3) and distal (L4). Reproducibility with and without repositioning was evaluated in femur after ten measurements in a water bath at depths between 2.0 and 2.5 cm. The whole coefficient of variation (CV = 100 x SD/mean) of BMD was 0.52% and 0.47% respectively. Accuracy was evaluated by comparing the BMC to bone ash weight. BMC was highly correlated with chemical analysis (r = 0.98, p < 0.001) for femur. The ability to detect changes in BMD was studied by comparing BMD of the right and left femurs and tibias of adult normal males and females rats. No significant differences were found between both sides. Nevertheless, when BMD (X +/- SE) of male and female rats were compared, female rats presented lower BMD at distal femur (0.263 +/- 0.021 vs. 0.315 +/- 0.009, p < 0.05) and proximal tibia (0.259 +/- 0.016 vs. 0.315 +/- 0.013 p < 0.02) than male rats. We also studied the ability to detect BMD changes in abnormal metabolic conditions. SHAM operated rats were compared to ovariectomized (OVX) rats and it was observed that femur of OVX showed a lower distal BMD than SHAM (0.217 +/- 0.005 vs. 0.263 +/- 0.021, p < 0.05). In summary, DEXA is a technique accurate and precise enough to detect changes on BMC and BMD in small animals permitting the experimental study of different metabolic bone conditions.

Precise measurement of bone mineral density in rats using dual-energy X-ray absorptiometry.

The dual X-ray absorptiometer (DEXA, Hologic ZDR-1000) in a high resolution mode was evaluated for measuring: Area (A), Bone Mineral Content (BMC) and Bone Mineral Density (BMD) in femur and tibia of adults rats at four regions: proximal (L1), diaphysis (L2-L3) and distal (L4). Reproducibility with and without repositioning was evaluated in femur after ten measurements in a water bath at depths between 2.0 and 2.5 cm. The whole coefficient of variation (CV = 100 x SD/mean) of BMD was 0.52

and 0.47

respectively. Accuracy was evaluated by comparing the BMC to bone ash weight. BMC was highly correlated with chemical analysis (r = 0.98, p < 0.001) for femur. The ability to detect changes in BMD was studied by comparing BMD of the right and left femurs and tibias of adult normal males and females rats. No significant differences were found between both sides. Nevertheless, when BMD (X +/- SE) of male and female rats were compared, female rats presented lower BMD at distal femur (0.263 +/- 0.021 vs. 0.315 +/- 0.009, p < 0.05) and proximal tibia (0.259 +/- 0.016 vs. 0.315 +/- 0.013 p < 0.02) than male rats. We also studied the ability to detect BMD changes in abnormal metabolic conditions. SHAM operated rats were compared to ovariectomized (OVX) rats and it was observed that femur of OVX showed a lower distal BMD than SHAM (0.217 +/- 0.005 vs. 0.263 +/- 0.021, p < 0.05). In summary, DEXA is a technique accurate and precise enough to detect changes on BMC and BMD in small animals permitting the experimental study of different metabolic bone conditions.

[Nutritional status with regard to calcium in Argentina]. / Estado nutricional con respecto al calcio en la Argentina.

Knowledge about calcium nutritional status in Argentina is scarce, due to the lack of systematic studies carried out in the country. For this reason, in the present report we have gathered information from data of food availability, nutritional surveys and the biochemical indicator Ca/Creatinine ratio in basal urine. All these data, jointly analyzed, allow certain extrapolations, based on which it is feasible to deduce conclusions as to the nutritional status in regard to such nutrient. Food availability data reveal an inadequate supply of calcium. On the other hand, the surveys, carried out for different purposes but with similar methodology, reveal a high percentage of deficient individuals, with reference to the Recommended Dietary Allowances (RDA) of the NRC (800 mg/day for adults). The use of the Ca/Creatinine ratio, in basal urine, confirms the high prevalence of Ca nutritional deficiency. Therefore, in our population which has a high protein consumption, Ca requirements are better reflected by NRC's RDA than FAO's (400 mg/day). These results clearly show that Ca deficiency is a generalized nutritional problem in the country. The causes seem to be not dependent on socioeconomic level, but would be closely related to dietary imbalance derived from the alimentary habits common to the Argentine population.