Association between dietary calcium and phosphorus intakes, dietary calcium/phosphorus ratio and bone mass in the Korean population

Nutrition Journal

Sang-Wook Song¹  Jin-A Seo¹  Ha-Na Kim¹  Kyung-Soo Kim²  Kyung-Jin Lee¹ 

[1] Department of Family Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbudaero, Paldal-gu, Suwon, Gyeonggi-do 442-723, Republic of Korea;Department of Family medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

关键词: Korean adults;    Bone mineral density;    Calcium/phosphorus ratio;    Phosphorus;    Calcium;   

Others  :  1132425
DOI  :  10.1186/1475-2891-13-114

 received in 2014-09-02, accepted in 2014-12-09,  发布年份 2014

【 摘 要 】

Background

Osteoporosis has become a major public health issue. Among various factors affected bone health, not only dietary calcium and phosphorus intakes, but also the dietary calcium/phosphorus ratio could relate to bone health. Therefore, we evaluated whether dietary calcium and phosphorus intakes, and dietary calcium/phosphorus ratio are associated with bone mass in Korean adults ≥ 20 years of age.

Methods

The analysis used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians, conducted from January to December 2010. A total of 4,935 participants (2,309 men and 2,626 women) were analyzed in this study. Dietary calcium and phosphorus intakes of the participants were estimated using 24-h dietary recall. Bone mass densities for the whole body, femoral neck, and lumbar spine were measured by dual-energy X-ray absorptiometry.

Results

Dietary calcium intake and dietary calcium/phosphorus ratio were positively related to bone mass density for femoral neck in men ≥ 50 years of age (p = 0.046 and 0.041, respectively). Dietary calcium intake showed positive associations with bone mass density for whole body in premenopausal women (p = 0.022).

Conclusions

Increased calcium intake and high dietary calcium/phosphorus ratio might have favorable effects on bone mass in Korean adults. Additional gender- and age-specific studies are needed to further identify the influence of calcium and phosphorus intakes, and the dietary calcium/phosphorus ratio on bone mass.

【 授权许可】

   
2014 Lee et al.; licensee BioMed Central.

【 参考文献 】

• [1]Peck WA, Burckhardt P, Christiansen C, Fleisch HA, Genant HK, Gennari C, Martin TJ, Martini L, Morita R, Ogata E, Rapado A, Shulman LE, Stern PH, Young RTT: Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993, 94:646-650.
• [2]Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A: Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007, 22:465-475.
• [3]Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA: Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013, 8:136.
• [4]Mithal A, Bansal B, Kyer CS, Ebeling P: The Asia-pacific regional audit-epidemiology, costs, and burden of osteoporosis in India 2013: a report of international osteoporosis foundation. Indian J Endocrinol Metab 2014, 18:449-454.
• [5]Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B: The recent prevalence of osteoporosis and low bone mass in the united states based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014, 29:2520-2526.
• [6]Cummings SR, Melton LJ: Epidemiology and outcomes of osteoporotic fractures. Lancet 2002, 359:1761-1767.
• [7]Cooper C, Campion G, Melton LJ 3rd: Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992, 2:285-289.
• [8]Korean Centers for Disease Control and Prevention: Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). [https://knhanes.cdc.go.kr/knhanes/index.do webcite]
• [9]Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, Suarez-Almazor M: Mortality and institutionalization following hip fracture. J Am Geriatr Soc 2000, 48:283-288.
• [10]Mora S, Gilsanz V: Establishment of peak bone mass. Endocrinol Metab Clin North Am 2003, 32:39-63.
• [11]Lane NE: Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 2006, 194:S3-S11.
• [12]Tanumihardjo SA: Vitamin A and bone health: the balancing act. J Clin Densitom 2013, 16:414-419.
• [13]Ahmadieh H, Arabi A: Vitamins and bone health: beyond calcium and vitamin D. Nutr Rev 2011, 69:584-598.
• [14]Iwamoto J: Vitamin K(2) therapy for postmenopausal osteoporosis. Nutrients 2014, 6:1971-1980.
• [15]Guralp O, Erel CT: Effects of vitamin K in postmenopausal women: mini review. Maturitas 2014, 77:294-299.
• [16]Park SM, Jee J, Joung JY, Cho YY, Sohn SY, Jin SM, Hur KY, Kim JH, Kim SW, Chung JH, Lee MK, Min YK: High dietary sodium intake assessed by 24-hour urine specimen increase urinary calcium excretion and bone resorption marker. J Bone Metab 2014, 21:189-194.
• [17]Nieves JW: Bone. Maximizing bone health–magnesium, BMD and fractures. Nat Rev Endocrinol 2014, 10:255-256.
• [18]Orchard TS, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD: Magnesium intake, bone mineral density, and fractures: results from the Women’s Health Initiative Observational Study. Am J Clin Nutr 2014, 99:926-933.
• [19]Aggarwal S, Nityanand : Calcium and vitamin D in post menopausal women. Indian J Endocrinol Metab 2013, 17:S618-S620.
• [20]Candido FG, Bressan J: Vitamin D: link between osteoporosis, obesity, and diabetes? Int J Mol Sci 2014, 15:6569-6591.
• [21]Calvo MS, Tucker KL: Is phosphorus intake that exceeds dietary requirements a risk factor in bone health? Ann N Y Acad Sci 2013, 1301:29-35.
• [22]Pinheiro MM, Schuch NJ, Genaro PS, Ciconelli RM, Ferraz MB, Martini LA: Nutrient intakes related to osteoporotic fractures in men and women–the Brazilian Osteoporosis Study (BRAZOS). Nutr J 2009, 8:6. BioMed Central Full Text
• [23]Macdonald HM, New SA, Golden MH, Campbell MK, Reid DM: Nutritional associations with bone loss during the menopausal transition: evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids. Am J Clin Nutr 2004, 79:155-165.
• [24]Hooshmand S, Chai SC, Saadat RL, Payton ME, Brummel-Smith K, Arjmandi BH: Comparative effects of dried plum and dried apple on bone in postmenopausal women. Br J Nutr 2011, 106:923-930.
• [25]Rizzoli R: Dairy products, yogurts, and bone health. Am J Clin Nutr 2014, 99:1256s-1262s.
• [26]Garcia-Martinez O, Rivas A, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C: The effect of olive oil on osteoporosis prevention. Int J Food Sci Nutr 2014, 65:834-840.
• [27]Boskey AL: Mineralization, structure, and function of bone. In Dynamics of Bone and Cartilage Metabolism: Principles and Clinical Applications. 2nd edition. Edited by Seibel MJ, Robins SP, Bilezikian JP. San Diego: Academic Press; 2006:201-209.
• [28]Ito S, Ishida H, Uenishi K, Murakami K, Sasaki S: The relationship between habitual dietary phosphorus and calcium intake, and bone mineral density in young Japanese women: a cross-sectional study. Asia Pac J Clin Nutr 2011, 20:411-417.
• [29]Metz JA, Anderson JJ, Gallagher PN Jr: Intakes of calcium, phosphorus, and protein, and physical-activity level are related to radial bone mass in young adult women. Am J Clin Nutr 1993, 58:537-542.
• [30]Brot C, Jorgensen N, Madsen OR, Jensen LB, Sorensen OH: Relationships between bone mineral density, serum vitamin D metabolites and calcium:phosphorus intake in healthy perimenopausal women. J Intern Med 1999, 245:509-516.
• [31]Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S: International society for clinical densitometry 2007 adult and pediatric official positions. Bone 2008, 43:1115-1121.
• [32]Mu M, Wang SF, Sheng J, Zhao Y, Wang GX, Liu KY, Hu CL, Tao FB, Wang HL: Dietary patterns are associated with body mass index and bone mineral density in Chinese freshmen. J Am Coll Nutr 2014, 33:120-128.
• [33]Huttunen MM, Pietila PE, Viljakainen HT, Lamberg-Allardt CJ: Prolonged increase in dietary phosphate intake alters bone mineralization in adult male rats. J Nutr Biochem 2006, 17:479-484.
• [34]Katsumata S, Masuyama R, Uehara M, Suzuki K: High-phosphorus diet stimulates receptor activator of nuclear factor-kappaB ligand mRNA expression by increasing parathyroid hormone secretion in rats. Br J Nutr 2005, 94:666-674.
• [35]Kemi VE, Karkkainen MU, Lamberg-Allardt CJ: High phosphorus intakes acutely and negatively affect Ca and bone metabolism in a dose-dependent manner in healthy young females. Br J Nutr 2006, 96:545-552.
• [36]Takeda E, Yamamoto H, Yamanaka-Okumura H, Taketani Y: Dietary phosphorus in bone health and quality of life. Nutr Rev 2012, 70:311-321.
• [37]Vicente-Rodriguez G, Ezquerra J, Mesana MI, Fernandez-Alvira JM, Rey-Lopez JP, Casajus JA, Moreno LA: Independent and combined effect of nutrition and exercise on bone mass development. J Bone Miner Metab 2008, 26:416-424.
• [38]Calvo MS: The effects of high phosphorus intake on calcium homeostasis. Adv Nutr Res 1994, 9:183-207.
• [39]Takeda E, Yamamoto H, Yamanaka-Okumura H, Taketani Y: Increasing dietary phosphorus intake from food additives: potential for negative impact on bone health. Adv Nutr 2014, 5:92-97.
• [40]Nordin BC: Calcium requirement is a sliding scale. Am J Clin Nutr 2000, 71:1381-1383.
• [41]Calvo MS: Dietary phosphorus, calcium metabolism and bone. J Nutr 1993, 123:1627-1633.
• [42]Fernando GR, Martha RM, Evangelina R: Consumption of soft drinks with phosphoric acid as a risk factor for the development of hypocalcemia in postmenopausal women. J Clin Epidemiol 1999, 52:1007-1010.
• [43]Lombardi-Boccia G, Aguzzi A, Cappelloni M, Di Lullo G, Lucarini M: Total-diet study: dietary intakes of macro elements and trace elements in Italy. Br J Nutr 2003, 90:1117-1121.
• [44]Salamoun MM, Kizirian AS, Tannous RI, Nabulsi MM, Choucair MK, Deeb ME, El-Hajj Fuleihan GA: Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr 2005, 59:177-184.
• [45]Calvo MS, Park YK: Changing phosphorus content of the U.S. diet: potential for adverse effects on bone. J Nutr 1996, 126:1168s-1180s.
• [46]Takeda E, Sakamoto K, Yokota K, Shinohara M, Taketani Y, Morita K, Yamamoto H, Miyamoto K, Shibayama M: Phosphorus supply per capita from food in Japan between 1960 and 1995. J Nutr Sci Vitaminol (Tokyo) 2002, 48:102-108.
• [47]Kemi VE, Karkkainen MU, Rita HJ, Laaksonen MM, Outila TA, Lamberg-Allardt CJ: Low calcium:phosphorus ratio in habitual diets affects serum parathyroid hormone concentration and calcium metabolism in healthy women with adequate calcium intake. Br J Nutr 2010, 103:561-568.
• [48]Calvo MS, Kumar R, Heath H 3rd: Elevated secretion and action of serum parathyroid hormone in young adults consuming high phosphorus, low calcium diets assembled from common foods. J Clin Endocrinol Metab 1988, 66:823-829.
• [49]Smerdely P, Seller M, Smith A, Day P, Diamond T: Predictors of bone mass in healthy older men in the community. Med J Aust 2000, 173:183-186.
• [50]Whiting SJ, Boyle JL, Thompson A, Mirwald RL, Faulkner RA: Dietary protein, phosphorus and potassium are beneficial to bone mineral density in adult men consuming adequate dietary calcium. J Am Coll Nutr 2002, 21:402-409.
• [51]Garton M, Martin J, New S, Lee S, Loveridge N, Milne J, Reid D, Reid I, Robins S: Bone mass and metabolism in women aged 45–55. Clin Endocrinol (Oxf) 1996, 44:563-570.
• [52]Prince RL, Dick I, Devine A, Price RI, Gutteridge DH, Kerr D, Criddle A, Garcia-Webb P, St John A: The effects of menopause and age on calcitropic hormones: a cross-sectional study of 655 healthy women aged 35 to 90. J Bone Miner Res 1995, 10:835-842.
• [53]Illner AK, Freisling H, Boeing H, Huybrechts I, Crispim SP, Slimani N: Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology. Int J Epidemiol 2012, 41:1187-1203.