Vitamin D supplementation and calcium absorption during caloric restriction: a randomized double-blind trial

Shapses, Sue A.; Sukumar, Deeptha; Schneider, Stephen H.; Schlussel, Yvette; Sherrell, Robert M.; Field, M. Paul; Ambia-Sobhan, Hasina

doi:10.3945/ajcn.112.044909

Cited by 49 publications

(39 citation statements)

References 39 publications

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“…This association might be confounded by surgical approach, if those with more intestine bypassed experienced more weight loss and also a greater impact on calcium absorption. Alternatively, this finding may be consistent with studies demonstrating that nonsurgical weight loss results in a decline in fractional calcium absorption compared to weight maintenance [88,89]. For example, in one study, 82 overweight or obese postmenopausal women were recruited for diet protocols designed for weight maintenance or weight loss (with a mean achieved weight loss of 3.8% over 6 months) [89].…”

Section: Intestinal Calcium Transport After Bariatric Surgerysupporting

confidence: 73%

Vitamin D and intestinal calcium transport after bariatric surgery

Schafer

2017

The Journal of Steroid Biochemistry and Molecular Biology

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Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients.

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Section: Intestinal Calcium Transport After Bariatric Surgerysupporting

confidence: 73%

Vitamin D and intestinal calcium transport after bariatric surgery

Schafer

2017

The Journal of Steroid Biochemistry and Molecular Biology

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“…Em relação à saúde óssea, a investigação científica já nos permite reter alguns dados que podem determinar as escolhas nutricionais e evitar a suplementação excessiva: (i) a diferenciação osteogénica é inibida pela suplementação de cobre (30) , (ii) a suplementação conjunta de cálcio e vitamina D aumenta a prevalência de nefrolitíase (53) , (iii) em situações de normalidade nutricional em que se não verifica deficiência em vitamina D a suplementação desta vitamina é inapropriada (41) , (iv) a suplementação de magnésio com uma adequada ingestão de cálcio nos estádios de crescimento pode aumentar a densidade mineral óssea e o tamanho do osso através da melhoria do metabolismo ósseo (7) , (v) em sujeitos omnívoros sem défices alimentares, a suplementação diária de 10 g de vitamina D3, conjuntamente com 1 g de fosfato tricálcico, aumenta a concentração sérica de 25(OH)D e a excreção fecal de cálcio e fósforo mas não exerce qualquer efeito benéfico nos marcadores de remodelação óssea (49) , (vi) a elevada ingestão de vitamina A pré-formada (alimentos de origem animal, alimentos fortificados em vitamina A, suplementos) está associada a uma pobre saúde óssea, enquanto a ingestão de carotenoides pro-vitamina A parece ter um efeito protetivo do osso (48) , (vii) embora a vitamina K esteja implicada no metabolismo do osso, faltam estudos que comprovem a eficácia da suplementação desta vitamina na prevenção da osteoporose (23) , (viii) durante períodos de perda de peso, verifica-se a redução da absorção de cálcio e a consequente perda de osso. Nestes casos, a ingestão simultânea de cálcio (1.2 g/dia) e vitamina D (10 ou 63 μg/dia) pode manter o equilíbrio de cálcio e atenuar as perdas ósseas (45) .…”

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Desafios nutricionais de bailarinos profissionais

Santos¹,

Amorim²

2014

RPCD

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Desafios nutricionais de bailarinos profissionais PALAVRAS CHAVE:Dança. Nutrição. Controlo ponderal. RESUMOA dança caracteriza-se pela acentuada solicitação dos vários sistemas orgânicos na procura e manutenção de corpos funcionalmente aptos e esteticamente belos. A dança, embora seja essencialmente arte, ao procurar a máxima expressão visual e artística determina um grau de solicitação neuro-motora que obriga o corpo a elevadas exigências fisiológicas e biomecânicas. Quanto mais pesado o corpo do bailarino/a, maiores serão as forças de impacto ao solo, sendo que muitas lesões de overuse resultam de microtraumatismos frequentes que são acentuados quer pela fragilidade das estruturas mio-articulares quer pelo excessivo peso corporal. Assim, os bailarinos tendem a procurar um baixo peso corporal, o que pode promover certos comportamentos nutricionais energeticamente deficitários e tendencialmente patológicos. Défices calóricos constantes e consumos inadequados de alguns micronutrientes podem induzir estados hormonais incompatíveis quer com o rendimento funcional quer com a saúde óssea. De facto, corpos esbeltos, magros e longilíneos não podem ser procurados através de práticas nutricionais que afetem quer o rendimento quer a saúde. O bom senso, também para os bailarinos/as, é a regra de ouro nutricional. ABSTRACTDancing request different organic systems to allow the search and maintenance of an aesthetic and fully developed body. Although dance is essentially art, dancing request a high neuromotor activity, which places the body to high physiological and biomechanical demands. As much heavier the dancer's body is, higher will be not only the impact forces on the ground, but also the shock waves reverberating throughout the body.Many overuse injuries result from frequent microtrauma that are emphasised by the fragility of the myo-articular structures and excessive body weight. Therefore, dancers struggle for a low body weight that can lead to nutrition disorders and other nutritional behaviours eventually pathologic. Low energy and nutrient intakes can induce hormonal dysfunction with consequently negative impact on bone health and performance.Dance aesthetic and artistic demands emphasise on slenderness, leanness and lankiness forms of the body. These special bodies cannot be searched through deleterious nutritional practices that affect either the performance or health. Common sense is the golden rule for dancers' nutrition.

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“…If subjects with severe deficiency had been included in our study, the response curve would undoubtedly be curvilinear with a decline in calcium absorption with concentrations ,30 nmol/L (3). However, the hypothesis that there is a threshold at a higher serum 25(OH)D concentration (80 nmol/L) has now been shown from our study and others to be false (4)(5)(6)(7)(8)(9). This finding is important for public policy in vitamin D recommendations.…”

Section: Reply To J Huang Et Almentioning

confidence: 59%

Reply to J Huang et al

Aloia

Fazzari

2014

The American Journal of Clinical Nutrition

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tamin D on calcium absorption or diminished increases in calcium absorption as vitamin D intake increases would provide a scientific rationale against excessive vitamin D supplementation and avoid pushing serum 25(OH)D concentrations to unnecessarily high levels.None of the authors had any conflicts of interest with respect to the work presented. Jean HuangDepartment of Clinical Diabetes, Endocrinology, and Metabolism City of Hope National Medical Center Duarte, CA Reply to J Huang et alDear Sir:We thank Huang et al for their interest in our work and for their stimulating comments regarding the evidence of a vitamin D threshold on calcium absorption. The exploration or discovery of a threshold effect is statistically complex. Generally, there is no single approach that is sufficient (1). We presented several approaches to exploring the question of threshold, and nonlinearity in general. First (and most important), we visually examined and presented raw data via scatterplots and evaluated the nature of the relation via smoothing (loess) techniques to determine heuristically whether there was any evidence of a nonlinear effect. Second, linear, quadratic, and cubic spline models with a priori knots selected were fitted. The results from these models were not treated as sufficient to conclude a lack of a threshold, but rather they provided additional evidence that a nonlinear relation was not supported by the data at hand. Although the authors provide 2 references where polynomial parameterization and spline methods were not used, this clearly does not preclude the usefulness of this type of approach in exploring nonlinearity (2).We state in the article that our data do not support a threshold effect, not that there is no threshold effect. There are factors in any study that hinder the detection of effects. Sample size is one such factor, and we acknowledge this. Small samples increase the probability of type II error and restrict the exploration of effects in certain subgroups of interest. Furthermore, as the authors point out, our range of vitamin D dose and concentration of 25-hydroxyvitamin D [25(OH)D] was limited to a specific range; thus, we cannot be certain whether a threshold effect may indeed exist on the edge or outside of this range. These kinds of limitations are shared across most studies of this type.As we described in our methods, we examined piecewise linear models for calcium absorption, treating a 10-wk 25(OH)D concentration of 80 nmol/L as our a priori threshold and examining whether the relation between calcium absorption and 25(OH)D changes at this threshold. On the basis of the results of this exploration and the fact that the P values corresponding to the test for a change in slope at 80 nmol/L in both unadjusted and adjusted models were insignificant (P ¼ 0.20 and 0.17, respectively), we strongly stand by our original reported model: 10-wk calcium absorption was observed to be a linear function of 10-wk 25(OH)D in our measured range of 25(OH)D.As the authors correctly point out, the estima...

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Vitamin D supplementation and calcium absorption during caloric restriction: a randomized double-blind trial

Abstract: These data show that vitamin D supplementation increases TFCA and that WL decreases TFCA and suggest that, when calcium intake is 1.2 g/d, either 10 or 63 μg vitamin D/d is sufficient to maintain the calcium balance. This trial was registered at clinicaltrials.gov as NCT00473031.

Cited by 49 publications

References 39 publications

Vitamin D and intestinal calcium transport after bariatric surgery

Vitamin D and intestinal calcium transport after bariatric surgery

Desafios nutricionais de bailarinos profissionais

Reply to J Huang et al

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