Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-26T01:18:31.570Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of a high-protein, high-sodium diet on calcium and bone metabolism in postmenopausal women and its interaction with vitamin D receptor genotype

Published online by Cambridge University Press:  09 March 2007

Mary Harrington ,
Teresa Bennett ,
Jette Jakobsen ,
Lars Ovesen ,
Christine Brot ,
Albert Flynn  and
Kevin D. Cashman
Mary Harrington
Affiliation:
Department of Food and Nutritional Sciences, Cork, Republic of Ireland
Teresa Bennett
Affiliation:
Department of Food and Nutritional Sciences, Cork, Republic of Ireland
Jette Jakobsen
Affiliation:
Institute of Food Safety and Nutrition, Danish Veterinary and Food Administration, Soborg, Denmark
Lars Ovesen
Affiliation:
Institute of Food Safety and Nutrition, Danish Veterinary and Food Administration, Soborg, Denmark
Christine Brot
Affiliation:
Institute of Food Safety and Nutrition, Danish Veterinary and Food Administration, Soborg, Denmark
Albert Flynn
Affiliation:
Department of Food and Nutritional Sciences, Cork, Republic of Ireland
Kevin D. Cashman*
Affiliation:
Department of Food and Nutritional Sciences, Cork, Republic of Ireland Department of Medicine, University College, Cork, Republic of Ireland
*
*Corresponding author: Professor Kevin D. Cashman, fax +353 21 4270244, email k.cashman@ucc.ie
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The influence of a high-Na, high-protein (calciuric) diet on Ca and bone metabolism was investigated in postmenopausal women (aged 50–67 years) who were stratified by vitamin D receptor (VDR) genotype. In a crossover trial, twenty-four women were randomly assigned to a diet high in protein (90 g/d) and Na (180 mmol/d) or a diet adequate in protein (70 g/d) and low in Na (65 mmol/d) for 4 weeks, followed by crossover to the alternative dietary regimen for a further 4 weeks. Dietary Ca intake was maintained at usual intakes (about 20 mmol (800 mg)/d). Urinary Na, K, Ca, N and type I collagen cross-linked N-telopeptide (NTx; a marker of bone resorption), plasma parathyroid hormone (PTH), serum 25-hydroxycholecalciferol (25(OH)D3), 1,25-dihydroxycholecalciferol (1,25(OH)2D3), osteocalcin and bone-specific alkaline phosphatase (B-Alkphase) were measured in 24 h urine samples and fasting blood samples collected at the end of each dietary period. The calciuric diet significantly (P<0·05) increased mean urinary Na, N, K, Ca and NTx (by 19 %) compared with the basal diet, but had no effect on circulating 25(OH)D3, 1,25(OH)2D3, PTH, osteocalcin or B-Alkphase in the total group (n 24). There were no differences in serum markers or urinary minerals between the basal and calciuric diet in either VDR genotype groups. While the calciuric diet significantly increased urinary NTx (by 25·6 %, P<0·01) in the f+ VDR group (n 10; carrying one or more (f) Fok I alleles), it had no effect in the f− VDR group (n 14; not carrying any Fok I alleles). It is concluded that the Na- and protein-induced urinary Ca loss is compensated for by increased bone resorption and that this response may be influenced by VDR genotype.

Keywords

SodiumProteinBone metabolismVitamin D receptorPostmenopausal women
Type
Research Article
Information
British Journal of Nutrition , Volume 91 , Issue 1 , January 2004 , pp. 41 - 51
Copyright
Copyright © The Nutrition Society 2004

References

Allen, LH, Bartlett, RS & Block, GD (1979 a) Reduction of renal calcium reabsorption in man by consumption of dietary protein. J Nutr 109, 1345–1350.CrossRefGoogle Scholar
Allen, LH, Oddoye, EA & Margen, S (1979 b) Protein-induced hypercalciuria: a longer term study. Am J Clin Nutr 32, 741–749.CrossRefGoogle ScholarPubMed
Ames, SK, Ellis, KJ, Gunn, SK, Copeland, KC & Abrams, SA (1999) Vitamin D receptor gene Fok1 polymorphism predicts calcium absorption and bone mineral density in children. J Bone Miner Res 14, 740–746.CrossRefGoogle ScholarPubMed
Arai, H, Miyamoto, K & Taketani, Y, et al. (1997) A vitamin D receptor gene polymorphism in the translation initiation codon: effect on protein activity and relation to bone mineral density in Japanese women. J Bone Miner Res 12, 915–921.CrossRefGoogle ScholarPubMed
Association of Official Analytical Chemists (AOAC) (1995). Official Methods of Analysis of the AOAC [Cunniff, P, editor]. Arlington, VA: The Association of Official Analytical Chemists International.Google Scholar
Bell, RR, Eldrid, MM & Watson, FR (1992) The influence of NaCl and KCl on urinary calcium excretion in healthy young women. Nutr Res 12, 17–26.CrossRefGoogle Scholar
Breslau, NA, McGuire, JL, Zerwekh, JE & Pak, CY (1982) The role of dietary sodium on renal excretion and intestinal absorption of calcium and on vitamin D metabolism. J Clin Endocrinol Metab 55, 369–373.CrossRefGoogle ScholarPubMed
Breslau, NA, Sakhaee, K & Pak, CY (1985) Impaired adaptation to salt-induced urinary calcium losses in postmenopausal osteoporosis. Trans Assoc Am Physicians 98, 107–115.Google ScholarPubMed
Castenmiller, JJ, Mensink, RP, van der Heijden, L, et al. (1985) The effect of dietary sodium on urinary calcium and potassium excretion in normotensive men with different calcium intakes. Am J Clin Nutr 41, 52–60.CrossRefGoogle ScholarPubMed
Chan, EL, Ho, CS, MacDonald, D, Ho, SC, Chan, TY & Swaminathan, R (1992) Interrelationships between urinary sodium, calcium, hydroxyproline and serum PTH in healthy subjects. Acta Endocrinol 127, 242–245.Google ScholarPubMed
Chan, EL & Swaminathan, R (1994) The effect of high protein and high salt intake for 4 months on calcium and hydroxyproline excretion in normal and oophorectomized rats. J Lab Clin Med 124, 37–41.Google ScholarPubMed
Chan, W, Brown, J & Buss, DH (1994) Miscellaneous Foods. Fourth supplement to McCance & Widdowson's The Composition of Foods, 6th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Chan, W, Brown, J, Lee, SM & Buss, DH (1995) Meat, Poultry and Game. Supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Chan, W, Brown, J, Lee, SM & Buss, DH (1996) Meat Products and Dishes. Supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Cohen, AJ & Roe, FJC (2000) Review of risk factors for osteoporosis with particular reference to a possible aetiological role of dietary salt. Food Chem Toxicol 38, 237–253.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B & Harris, SS (2002) Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 75, 773–779.CrossRefGoogle ScholarPubMed
Draper, HH, Piche, LA & Gibson, RS (1991) Effects of a high protein intake from common foods on calcium metabolism in a cohort of postmenopausal women. Nutr Res 11, 273–281.CrossRefGoogle Scholar
Englyst, HN & Cummings, JH (1988) Improved method for measurement of dietary fibre as non-starch polysaccharides in plant foods. J Assoc Off Anal Chem 71, 808–814.Google ScholarPubMed
Eriksen, EF, Melsen, F & Mosekilde, L (1984) Reconstruction of the resorptive site in iliac trabecular bone: a kinetic model for bone resorption in 20 normal individuals. Metab Bone Dis Relat Res 5, 235–242.CrossRefGoogle ScholarPubMed
Evans, CEL, Chughtai, AY, Blumsohn, A, Giles, M & Eastell, R (1997) The effect of dietary sodium on calcium metabolism in premenopausal and postmenopausal women. Eur J Clin Nutr 51, 394–399.CrossRefGoogle ScholarPubMed
Garel, JM (1987) Hormonal control of calcium metabolism during the reproductive cycle in mammals. Physiol Rev 67, 1–66.CrossRefGoogle ScholarPubMed
Garnero, P, Sornay-Rendu, E, Claustrat, B & Delmas, PD (2000) Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women; the OFELY study. J Bone Mineral Res 15, 1526–1536.CrossRefGoogle ScholarPubMed
Garnero, P, Hausherr, E & Chapuy, MC, et al. (1996) Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Mineral Res 11, 1531–1538.CrossRefGoogle ScholarPubMed
Ginty, F, Cashman, KD & Flynn, A (1998 a) An investigation of the relationships between urinary potassium, sodium, calcium and deoxypyridinoline excretion in healthy young adults. Osteoporos Int 8, 74.Google Scholar
Ginty, F, Flynn, A & Cashman, KD (1998 b) The effect of dietary sodium intake on biochemical markers of bone metabolism in young women. Br J Nutr 79, 343–350.CrossRefGoogle ScholarPubMed
Goulding, A & Campbell, D (1984) Hypocalciuric effects of hydrochlorothiazide in the rat during NaHCO 3, NaCl and NH 4 Cl loading. Ren Physiol 7, 185–191.Google Scholar
Gross, C, Eccleshall, TR, Malloy, PJ, Villa, ML, Marcus, R & Feldman, D (1996) The presence of a polymorphism at the translation initiation site of the vitamin D receptor gene is associated with low bone mineral density in post-menopausal Mexican-American women. J Bone Mineral Res 11, 1850–1855.CrossRefGoogle Scholar
Heaney, RP (1993) Protein intake and the calcium economy. J Am Diet Assoc 93, 1259–1260.CrossRefGoogle ScholarPubMed
Heaney, RP (1998) Excess dietary protein may not adversely affect bone. J Nutr 128, 1054–1057.CrossRefGoogle Scholar
Heaney, RP & Recker, RR (1982) Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 99, 46–55.Google ScholarPubMed
Hegsted, M, Schuette, SA, Zemel, MB & Linkswiler, HM (1981) Urinary calcium and calcium balance in young men as affected by level of protein and phosphorus intake. J Nutr 111, 553–562.CrossRefGoogle ScholarPubMed
Holland, B, Brown, J & Buss, DH (1993) Fish and Fish Products. Third Supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Holland, B, Unwin, ID & Buss, DH (1988) Cereals and Cereal Products. Third Supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.Google Scholar
Holland, B, Unwin, ID & Buss, DH (1989) Milk Products and Eggs. Fourth Supplement to McCance & Widdowson's The Composition of Foods, 4th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.Google Scholar
Holland, B, Unwin, ID & Buss, DH (1991) Vegetables, Herbs and Spices. Fifth Supplement to McCance & Widdowson's The Composition of Foods, 4th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Holland, B, Unwin, ID & Buss, DH (1992) Fruits and Nuts. The First Supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.CrossRefGoogle Scholar
Holland, B, Welch, AA & Buss, DH (1996) Vegetable dishes. Second Supplement to McCance & Widdowson's The Composition of Foods 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office.Google Scholar
Holland, B, Welch, AA, Unwin, ID, Buss, DH, Paul, AA & Southgate, DAT (1995) McCance & Widdowson's The Composition of Foods, 5th ed. Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. London: H. M. Stationery Office Foods.Google Scholar
Itoh, R, Nishiyama, N & Suyama, Y (1998) Dietary protein intake and urinary excretion of calcium: a cross-sectional study in a healthy Japanese population. Am J Clin Nutr 67, 438–444.CrossRefGoogle Scholar
Itoh, R & Suyama, Y (1996) Sodium excretion in relation to calcium and hydroxyproline excretion in a healthy Japanese population. Am J Clin Nutr 63, 735–740.CrossRefGoogle Scholar
Jones, B & Kenward, MG (1989) Design and Analysis of Cross-Over Trials, [Cox, D, Hinkley, D, Rubin, D and Silverman, B, editors]. London: Chapman and Hall.CrossRefGoogle Scholar
Jubiz, W, Canterbury, JM, Reiss, E & Tyler, FH (1972) Circadian rhythm in serum parathyroid hormone concentration in human subjects: correlation with serum calcium, phosphate, albumin, and growth hormone levels. J Clin Invest 51, 2040–2046.CrossRefGoogle ScholarPubMed
Kerstetter, JE & Allen, LH (1990) Dietary protein increases urinary calcium. J Nutr 120, 134–136.CrossRefGoogle ScholarPubMed
Kerstetter, JE & Allen, LH (1994) Protein intake and calcium homeostasis. Adv Nutr Res 9, 167–181.Google ScholarPubMed
Kerstetter, JE, O'Brien, KO & Insogna, KL (1998) Dietary protein affects intestinal calcium absorption. Am J Clin Nutr 68, 859–865.CrossRefGoogle ScholarPubMed
Kerstetter, JE, Mitnick, ME, Gundberg, CM, et al. (1999) Changes in bone turnover in young women consuming different levels of dietary protein. J Clin Endocrinol Metab 84, 1052–1055.Google ScholarPubMed
Kim, Y & Linkswiler, HM (1979) Effect of level of protein intake on calcium metabolism and on parathyroid and renal function in the adult human male. J Nutr 109, 1399–1404.CrossRefGoogle ScholarPubMed
Kurtz, TW, Al-Bander, HA & Morris, RC Jr (1987) "Salt-sensitive" essential hypertension in men. Is the sodium ion alone important? N Engl J Med 317, 1043–1048.CrossRefGoogle ScholarPubMed
Lietz, G, Avenell, A & Robins, SP (1997) Short-term effects of dietary sodium intake on bone metabolism in postmenopausal women measured using urinary deoxypyridinoline excretion. Br J Nutr 78, 73–82.CrossRefGoogle Scholar
McCarron, DA, Rankin, LI, Bennett, WM, Krutzik, S, McClung, MR & Luft, FC (1981) Urinary calcium excretion at extremes of sodium intake in normal man. Am J Nephrol 1, 84–90.CrossRefGoogle ScholarPubMed
McParland, BE, Goulding, A & Campbell, AJ (1989) Dietary salt affects biochemical markers of resorption and formation of bone in elderly women. Br Med J 299, 834–835.CrossRefGoogle ScholarPubMed
Mahalko, JR, Sandstead, HH, Johnson, LK & Milne, DB (1983) Effect of a moderate increase in dietary protein on the retention and excretion of Ca, Cu, Fe, Mg, P, and Zn by adult males. Am J Clin Nutr 37, 8–14.CrossRefGoogle ScholarPubMed
Massey, LK (1998) Does excess dietary protein adversely affect bone? Symposium overview. J Nutr 128, 1048–1050.CrossRefGoogle ScholarPubMed
Massey, LK & Whiting, SJ (1996) Dietary salt, urinary calcium and bone loss. J Bone Miner Res 11, 731–736.CrossRefGoogle ScholarPubMed
Massey, LK & Wise, KJ (1984) The effect of dietary caffeine on urinary excretion of calcium, magnesium, sodium and potassium in healthy young females. Nutr Res 4, 43–50.CrossRefGoogle Scholar
Ministry of Agriculture, Fisheries and Food (1997) Food Portion Sizes London: H. M. Stationery Office.Google Scholar
Morris, RC Jr, Sebastian, A, Forman, A, Tanaka, M & Schmidlin, O (1999) Normotensive salt sensitivity: effects of race and dietary potassium. Hypertension 33, 18–23.CrossRefGoogle ScholarPubMed
Nordin, BEC, Need, AG, Morris, HA & Horowitz, M (1993) The nature and significance of the relationship between urinary sodium and urinary calcium in women. J Nutr 123, 1615–1622.CrossRefGoogle ScholarPubMed
Pannemans, DLE, Schafsma, G & Westerterp, KR (1997) Calcium excretion, apparent calcium absorption and calcium balance in young and elderly subjects: influence of protein intake. Br J Nutr 77, 721–729.CrossRefGoogle Scholar
Rapuri, PB, Gallagher, JC, Kinyamu, HK & Ryschon, KL (2001) Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 74, 694–700.CrossRefGoogle ScholarPubMed
Rosen, HN, Dresner-Pollak, R, Moses, AC, et al. (1994) Specificity of urinary excretion of cross-linked N-telopeptides of type I collagen as a marker of bone turnover. Calcif Tissue Int 54, 26–29.CrossRefGoogle ScholarPubMed
Schuette, SA, Hegsted, M, Zemel, MB & Linkswiler, HM (1981) Renal acid, urinary cyclic AMP, and hydroxyproline excretion as affected by level of protein, sulfur amino acid, and phosphorus intake. J Nutr 111, 2106–2116.CrossRefGoogle ScholarPubMed
Schuette, SA & Linkswiler, HM (1982) Effects on Ca and P metabolism in humans by adding meat, meat plus milk, or purified proteins plus Ca and P to a low protein diet. J Nutr 112, 338–349.CrossRefGoogle ScholarPubMed
Schuette, SA, Zemel, MB & Linkswiler, HM (1980) Studies on the mechanism of protein-induced hypercalciuria in older men and women. J Nutr 110, 305–315.CrossRefGoogle ScholarPubMed
Sellmeyer, DE, Schloetter, M & Sebastian, A (2002) Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 87, 2008–2012.CrossRefGoogle ScholarPubMed
Shapses, SA, Robins, SP, Schwartz, EI & Chowdhury, H (1995) Short-term changes in calcium but not protein intake alter the rate if bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion. J Nutr 125, 2814–2821.Google Scholar
Shortt, C & Flynn, A (1990) Sodium-calcium inter-relationships with specific reference to osteoporosis. Nutr Res Rev 3, 101–115.CrossRefGoogle ScholarPubMed
Shortt, C, Madden, A, Flynn, A & Morrissey, PA (1988) Influence of dietary sodium intake on urinary calcium excretion in selected Irish individuals. Eur J Clin Nutr 42, 595–603.Google ScholarPubMed
Slatopolsky, E, Martin, K, Morrissey, J & Hruska, K (1982) Current concepts of the metabolism and radioimmunoassay of parathyroid hormone. J Lab Clin Med 99, 309–316.Google Scholar
Tofteng, CL, Jensen, JEB, Abrahamsen, B, Odum, L & Brot, C (2002) Two polymorphisms in the vitamin D receptor gene-association with bone mass and 5-year change in bone mass with or without hormone-replacement therapy in postmenopausal women: the Danish Osteoporosis Prevention Study. J Bone Miner Res 17, 1535–1544.CrossRefGoogle ScholarPubMed
Walker, RM & Linkswiler, HM (1972) Calcium retention in the adult human male as affected by protein intake. J Nutr 102, 1297–1302.CrossRefGoogle ScholarPubMed
Zarkadas, M, Gougeon-Reyburn, R, Marliss, EB, Block, E & Alton-Mackey, M (1989) Sodium chloride supplementation and urinary calcium excretion in postmenopausal women. Am J Clin Nutr 50, 1088–1094.CrossRefGoogle ScholarPubMed