Effects of dietary protein on urinary calcium in normal subjects and in patients with nephrolithiasis

Licata, Angelo A.; Bou, Ernestina; Bartter, Frederic C.; Cox, James W.

doi:10.1016/0026-0495(79)90088-x

Cited by 54 publications

(16 citation statements)

References 13 publications

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“…All subjects were given diets containing 0.5 g protein/kg/day, while, during the experimental phase, each person received an additional 1.5 g protein/kg/day. There was a consistent increase in urinary calcium with the high-protein diet averaging 88% above control in the normals and 82% in the patients [13]. Moreover, in a study where protein intake was varied from 47 g/day (low protein diet) to 95 g/day (medium protein diet) and to 142 g/day (high protein diet) the urinary calcium increased significantly with each increase in protein (168, 240, and 301 mg, resp.)…”

Section: Disorders Of Bone and Calcium Homeostasismentioning

confidence: 92%

Adverse Effects Associated with Protein Intake above the Recommended Dietary Allowance for Adults

Delimaris

2013

ISRN Nutrition

103

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Background. While high-protein consumption—above the current recommended dietary allowance for adults (RDA: 0.8 g protein/kg body weight/day)—is increasing in popularity, there is a lack of data on its potential adverse effects. Objective. To determine the potential disease risks due to high protein/high meat intake obtained from diet and/or nutritional supplements in humans. Design. Review. Subjects. Healthy adult male and female subjects. Method. In order to identify relevant studies, the electronic databases, Medline and Google Scholar, were searched using the terms:“high protein diet,” “protein overconsumption,” “protein overuse,” and “high meat diet.” Papers not in English were excluded. Further studies were identified by citations in retrieved papers. Results. 32 studies (21 experimental human studies and 11 reviews) were identified. The adverse effects associated with long-term high protein/high meat intake in humans were (a) disorders of bone and calcium homeostasis, (b) disorders of renal function, (c) increased cancer risk, (d) disorders of liver function, and (e) precipitated progression of coronary artery disease. Conclusions. The findings of the present study suggest that there is currently no reasonable scientific basis in the literature to recommend protein consumption above the current RDA (high protein diet) for healthy adults due to its potential disease risks. Further research needs to be carried out in this area, including large randomized controlled trials.

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Section: Disorders Of Bone and Calcium Homeostasismentioning

confidence: 92%

Adverse Effects Associated with Protein Intake above the Recommended Dietary Allowance for Adults

Delimaris

2013

ISRN Nutrition

103

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“…This is a risk factor for the development of uric acid stones and may play a role in calcium stone formation. (5) Chronic metabolic acidosis induced by the increased acid load decreases calcium reabsorption within the nephron [85–87]. (6) The decreased urinary pH may potentiate uric acid lithiasis, and it enhances citrate reabsorption in the proximal tubules, thus decreasing the excretion of this important inhibitor of crystallization [88].…”

Section: Differences In Epidemiologymentioning

confidence: 99%

History, epidemiology and regional diversities of urolithiasis

2010

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Archeological findings give profound evidence that humans have suffered from kidney and bladder stones for centuries. Bladder stones were more prevalent during older ages, but kidney stones became more prevalent during the past 100 years, at least in the more developed countries. Also, treatment options and conservative measures, as well as 'surgical' interventions have also been known for a long time. Our current preventive measures are definitively comparable to those of our predecessors. Stone removal, first lithotomy for bladder stones, followed by transurethral methods, was definitively painful and had severe side effects. Then, as now, the incidence of urolithiasis in a given population was dependent on the geographic area, racial distribution, socio-economic status and dietary habits. Changes in the latter factors during the past decades have affected the incidence and also the site and chemical composition of calculi, with calcium oxalate stones being now the most prevalent. Major differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations. Extensive epidemiological observations have emphasized the importance of nutritional factors in the pathogenesis of urolithiasis, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis.

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“…Increased protein intake reduces the reabsorption of calcium in the kidney, 52–55 based on the difference between observed calcium excretion and that expected given glomerular filtration rate (GFR) and plasma calcium. An older microperfusion study in dogs found that experimentally induced acidosis led to reduced reabsorption of calcium in the distal tubule of the nephron 52 .…”

Section: Mechanisms For Urine Calcium Lossmentioning

confidence: 99%

Dietary protein and bone health: harmonizing conflicting theories

Thorpe

Evans

2011

Nutrition Reviews

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No clear consensus on the role of higher protein intakes has emerged, in spite of many decades of research. Protein unambiguously increases urinary calcium losses, which is completely attributable to the dietary acid load imposed by metabolism of sulfur containing amino acids into acid equivalents. Although alternate dietary sources of fixed acid cause demineralization of bone and apparent osteoporosis, this effect has not been consistently observed for protein, suggesting opposing, beneficial effects on bone. Specifically, protein may improve bone health through improving calcium absorption, increasing total circulating insulin-like growth factor 1 or by improving lean body mass which in turn increases bone growth. Although the notion of competing positive and negative pathways has been articulated theoretically, statistical mediation models of this "dual pathways" relationship have not been employed to quantify these relationships.In a cross-sectional investigation of postmenopausal women, protein intake is positively related to bone mineral density of the lumbar spine following adjustment for an accompanying negative effect mediated by the sulfur containing fraction of protein. In growing rats, an analogous and complementary pattern emerged: A negative association of protein intake with bone strength was suppressed by an opposing, positive effect of protein mediated by insulin-like growth factor 1. A second animal study assessed the influence of protein source on bone strength and bone mineral content of growing rats consuming isoenergetic, isonitrogenous diets. The influence of protein source was completely mediated by the corresponding changes in lean body mass.ii iii A randomized, controlled trial indicated a higher protein diet preserved bone density during weight loss compared to a conventional, MyPyramid based diet; however the protein diet also contained more calcium. A mathematical model of calcium availability in this trial suggested that this additional dietary calcium was not sufficient to explain differences in calcium accrual between groups unless calcium availability was also improved in the higher protein diet. Also, within this study, urine calcium (a surrogate of the diet acid load) exhibited a negative association with bone density change, in spite of its positive association with protein intake.The striking consistency of a dual pathway model across populations and experimental models lends credence to the notion that dietary protein may hold a positive or negative effect on bone health, depending on other factors in the diet. Specifically, we find support that the sulfur containing amino acid induced dietary acid load holds negative effects that may be opposed by positive influences of insulin-like growth factor 1, calcium availability or lean body mass. On average, this effect is probably null or too small to be of clinical importance.The effect may be of public health relevance, however, if the diet can be manipulated in order to uncouple positive and negative pathways. If correc...

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Effects of dietary protein on urinary calcium in normal subjects and in patients with nephrolithiasis

Cited by 54 publications

References 13 publications

Adverse Effects Associated with Protein Intake above the Recommended Dietary Allowance for Adults

Adverse Effects Associated with Protein Intake above the Recommended Dietary Allowance for Adults

History, epidemiology and regional diversities of urolithiasis

Dietary protein and bone health: harmonizing conflicting theories

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