Low urine pH and acid excretion do not predict bone fractures or the loss of bone mineral density: a prospective cohort study Renal response to acute acid loadingAn organ physiological approach Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women Established dietary estimates of net acid production do not predict measured net acid excretion in patients with Type 2 diabetes on Paleolithic–Hunter–Gatherer-type diets Comparative effects of potassium chloride and bicarbonate on thiazide-induced reduction in urinary calcium excretion. Acid-base status affects renal magnesium losses in healthy, elderly persons. Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. Dietary Acid Load and Incident Chronic Kidney Disease: Results from the ARIC Study A diet high in meat protein and potential renal acid load increases fractional calcium absorption and urinary calcium excretion without affecting markers of bone resorption or formation in postmenopausal women. Dietary acid load and risk of hypertension: the Rotterdam Study. Dietary acid load is associated with lower bone mineral density in men with low intake of dietary calcium. A comparison of the effects of feeding sulfur amino acids and protein on urine calcium in man. Potassium citrate supplementation results in sustained improvement in calcium balance in older men and women. The influence of a high dietary intake of purine-rich animal protein on urinary urate excretion and supersaturation in renal stone disease. Quality of diet and potential renal acid load as risk factors for reduced bone density in elderly women. Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins. Effect of cranberry juice consumption on urinary stone risk factors. The effects of a low-sodium base-producing diet including red meat compared with a high-carbohydrate, low-fat diet on bone turnover markers in women aged 45-75 years. Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: A preliminary study Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. Plant-Based Diet, Serum Fatty Acid Profile, and Free Radicals in Postmenopausal Women: The Diet and Androgens (DIANA) Randomized Trial More acidic dietary acid-base load is associated with reduced calcaneal broadband ultrasound attenuation in women but not in men: results from the EPIC-Norfolk cohort study. Effect of dairy calcium on fecal fat excretion: a randomized crossover trial Are Hill's criteria for causality satisfied for vitamin D and periodontal disease? Olive oil instead of butter increases net cholesterol excretion from the small bowel. Effect of modified dairy fat on postprandial and fasting plasma lipids and lipoproteins in healthy young men The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Effect of dietary salt restriction on urinary serotonin and 5-hydroxyindoleacetic acid excretion in man Effect of increased protein intake on renal acid load and renal hemodynamic responses Risk of postpartum depression in relation to dietary fish and fat intake in Japan: the Osaka Maternal and Child Health Study. Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Potassium Bicarbonate Supplementation Lowers Bone Turnover and Calcium Excretion in Older Men and Women: A Randomized Dose-Finding Trial. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion Reduced oxidation of dietary fat after a short term high-carbohydrate diet. Increasing the dietary polyunsaturated fat content alters whole-body utilization of 16:0 and 10:0. Dietary intake of palmitate and oleate has broad impact on systemic and tissue lipid profiles in humans. Antithetic relationship of dietary arachidonic acid and eicosapentaenoic acid on eicosanoid production in vivo. Comparative effects of oral aromatic and branched-chain amino acids on urine calcium excretion in humans Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. Effects of supplementation with essential amino acids on intrahepatic lipid concentrations during fructose overfeeding in humans. Effect of gastric acid secretion on intestinal phosphate and calcium absorption in normal subjects. Dietary protein and calcium interact to influence calcium retention: a controlled feeding study. Gut bacteria profiles of Mus musculus at the phylum and family levels are influenced by saturation of dietary fatty acids. Vitamin D2-Enriched Button Mushroom (Agaricus bisporus) Improves Memory in Both Wild Type and APPswe/PS1dE9 Transgenic Mice Long-term effects of linoleic-acid-enriched diet on albuminuria and lipid levels in Type 1 (insulin-dependent) diabetic patients with elevated urinary albumin excretion Usefulness of omega-3 fatty acids and the prevention of coronary heart disease. Vitamin and Mineral Supplements: What Clinicians Need to Know. Gastric acidity and duodenogastric reflux during nasojejunal tube feeding in mechanically ventilated patients Effects of dietary protein intake on vasoactive hormones. Ascorbic acid prevents vascular dysfunction induced by oral glucose load in healthy subjects. Dietary alpha-linolenic acid inhibits proinflammatory cytokine production by peripheral blood mononuclear cells in hypercholesterolemic subjects. Effect of dietary interventions in mild cognitive impairment: a systematic review. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. Prevention of asthma during the first 5 years of life: a randomized controlled trial. The Mediterranean diet in secondary prevention of coronary heart disease. Dietary (n-3) polyunsaturated fatty acids up-regulate plasma leptin in insulin-resistant rats. Postoperative Nitrogen Excretion After Amino Acid-Induced Thermogenesis Under Anesthesia Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia. Low-sodium Dietary Approaches to Stop Hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women. Dietary modification of omega 6 fatty acid intake and its effect on urinary eicosanoid excretion. Effects of α-lipoic acid and eicosapentaenoic acid in overweight and obese women during weight loss. Three-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study. Effect of fruit on net acid and urinary calcium excretion in an acute feeding trial of women. Effect of soy protein from differently processed products on cardiovascular disease risk factors and vascular endothelial function in hypercholesterolemic subjects.
Background The acid-ash hypothesis , the alkaline diet , and related products are marketed to the general public . Websites , lay literature , and direct mail marketing encourage people to measure their urine pH to assess their health status and their risk of osteoporosis . The objectives of this study were to determine whether 1 ) low urine pH , or 2 ) acid excretion in urine [ sulfate + chloride + 1.8x phosphate + organic acids ] minus [ sodium + potassium + 2x calcium + 2x magnesium mEq ] in fasting morning urine predict : a ) fragility fractures ; and b ) five-year change of bone mineral density ( BMD ) in adults . Methods Design : Cohort study : the prospect i ve population -based Canadian Multicentre Osteoporosis Study .  Multiple logistic regression was used to examine associations between acid excretion ( urine pH and urine acid excretion ) in fasting morning with the incidence of fractures ( 6804 person years ) . Multiple linear regression was used to examine associations between acid excretion with changes in BMD over 5-years at three sites : lumbar spine , femoral neck , and total hip ( n = 651 ) . Potential confounders controlled included : age , gender , family history of osteoporosis , physical activity , smoking , calcium intake , vitamin D status , estrogen status , medications , renal function , urine creatinine , body mass index , and change of body mass index . Results There were no associations between either urine pH or acid excretion and either the incidence of fractures or change of BMD after adjustment for confounders . Conclusion Urine pH and urine acid excretion do not predict osteoporosis risk Objective : In previous studies of the renal response to acute NH 4 Cl acidosis no correlation was found between systemic acid – base status and the traditionally used quantity , renal net acid excretion ( NAE ) . If NAE is to be considered a physiologically meaningful quantity then this is surprising , as the extracellular acid – base status would be expected to be the key physiological trigger for renal NAE . The object of this study was to investigate the renal response to acute non‐carbonic acid loading using a quantitative organ physiological approach . Material and Methods : Five‐h NH 4 Cl loading studies were performed in 10 healthy men using a r and omized , placebo‐controlled , crossover design . Arterialized capillary blood , serum and urine were collected hourly during the loading studies for the measurement of electrolytes and acid – base status . Concentrations of non‐metabolizable base ( NB ) and acid ( NA ) were calculated from measured concentrations of non‐metabolizable ions according to Kildeberg . Results : In the steady state ( placebo ) the rate of renal excretion of NA ( = −NB ) was close to zero , indicating that the net extrarenal input of NA ( endogeneous production , gastrointestinal absorption , skeletal release , etc . ) was likewise about zero . An inverse correlation was found between blood pH and the rate of renal excretion of NA . Only a small amount of the acid load ( ≈8 % ) was excreted during the 5‐h study period and this was accompanied by massive calciuria , indicating that mobilization of NB from bone contributed substantially to the current net extrarenal NA input . Conclusion : From a physiological point of view , NB can be regarded as the actual substrate for renal acid – base control , and measurement of renal turnover of NB may give a more precise description of renal acid – base metabolism during acid loading than previously described methods Summary Because kidney dysfunction reduces the ability to excrete dietary acid excess , we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community . In a relatively large survey of elderly men and women , we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk . Underlying kidney function did not modify these null findings . Our results do not support the dietary acid-base hypothesis of bone loss . Introduction Impaired renal function reduces the ability to excrete dietary acid excess . We here investigate the association between dietary acid load and bone mineral density ( BMD ) , osteoporosis , and fracture risk by renal function status . Methods An observational study was conducted in 861 community-dwelling 70-year-old men and women ( 49 % men ) with complete dietary data from the Prospect i ve Investigation of the Vasculature in Uppsala Seniors ( PIVUS ) . The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production ( NEAP ) and potential renal acid load ( PRAL ) algorithms . Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21 % of the individuals . Study outcomes were BMD and osteoporosis state ( assessed by DEXA ) and time to fracture ( median follow-up of 9.2 years ) . Results In cross-section , dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis . During follow-up , 131 fractures were vali date d. Neither NEAP ( adjusted hazard ratios ( HR ) ( 95 % confidence interval ( CI ) ) , 1.01 ( 0.85–1.21 ) , per 1 SD increment ) nor PRAL ( adjusted HR ( 95 % CI ) , 1.07 ( 0.88–1.30 ) , per 1 SD increment ) associated with fracture risk . Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations . Conclusions The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals . Renal function did not influence on this null finding Background / objectives : Formulas developed to estimate diet-dependent net acid excretion ( NAE ) generally agree with measured values for typical Western diets . Whether they can also appropriately predict NAE for ‘ Paleolithic-type ’ ( Paleo ) diets — which contain very high amounts of fruits and vegetables ( F&V ) and concurrent high amounts of protein is unknown . Here , we compare measured NAEs with established NAE estimates in subjects with Type 2 diabetes (T2D).Subjects/ methods : Thirteen subjects with well-controlled T2D were r and omized to either a Paleo or American Diabetes Association ( ADA ) diet for 14 days . Twenty-four hour urine collection s were performed at baseline and end of the diet period , and analyzed for titratable acid , bicarbonate and ammonium to calculate measured NAE . Three formulas for estimating NAE from dietary intake were used ; two ( NAE_diet R or L ) that include dietary mineral intake and sulfate- and organic acid ( OA ) production , and one that is empirically derived ( NAE_diet F ) only considering potassium and protein intake . Results : Measured NAE on the Paleo diet was significantly lower than on the ADA-diet ( + 31±22 vs 112±52 mEq/day , P=0.002 ) . Although all formula estimates showed similar and reasonable correlations ( r=0.52–0.76 ) with measured NAE , each one underestimated measured values . The formula with the best correlation did not contain an estimate of dietary OA production . Conclusions : Paleo-diets are lower in NAE than typical Western diets . However , commonly used formulas clearly underestimate NAE , especially for diets with very high F&V ( as the Paleo diet ) , and in subjects with T2D . This may be due to an inappropriate estimation of proton loads stemming from OAs , underlining the necessity for improved measures of OA-related proton sources BACKGROUND The chronic low- grade metabolic acidosis that occurs in various renal disorders and in normal people , and that is related both to dietary net acid load and age-related renal functional decline , may contribute to osteoporosis by increasing urine calcium excretion . Administration of potassium ( K ) alkali salts neutralizes acid and lowers urine calcium excretion . Urine calcium excretion also can be reduced by the administration of thiazide diuretics , which are often given with supplemental K to avoid hypokalemia . We determined whether the K alkali salt potassium bicarbonate ( KHCO3 ) and the thiazide diuretic hydrochlorothiazide ( HCTZ ) combined is more effective in reducing urinary calcium than KHCO3 alone or HCTZ combined with the conventionally coadministered nonalkalinizing K salt potassium chloride ( KCl ) . METHODS Thirty-one healthy men and women aged 50 or greater were recruited for a four-week , double-blind , r and omized study . After a baseline period of 10 days with three 24-hour urine and arterialized blood collection s , subjects were r and omized to receive either HCTZ ( 50 mg ) plus potassium ( 60 mmol daily ) as either the chloride or bicarbonate salt . Another 19 women received potassium bicarbonate ( 60 mmol ) alone . After two weeks , triplicate collection s of 24-hour urines and arterialized bloods were repeated . RESULTS Urinary calcium excretion decreased significantly in all groups . KHCO3 alone and HCTZ + KCl induced similar decreases ( -0.70 + /- 0.60 vs. -0.80 + /- 1 . 0 mmol/day , respectively ) . Compared with those treatments , the combination of HCTZ + KHCO3 induced more than a twofold greater decrease in urinary calcium excretion ( -1.8 + /- 1.2 mmol/day , P < 0 . 05 ) . Both HCTZ + KHCO3 and KHCO3 alone reduced net acid excretion significantly ( P < 0.05 ) to values of less than zero . CONCLUSIONS KHCO3 was superior to KCl as an adjunct to HCTZ , inducing a twofold greater reduction in urine calcium excretion , and completely neutralizing endogenous acid production so as to correct the pre-existing mild metabolic acidosis that an acid-producing diet usually induces in older people . Accordingly , for reducing urine calcium excretion in stone disease and osteoporosis , the combination of HCTZ + KHCO3 may be preferable to that of HCTZ + KCl Magnesium and calcium deficiency in humans is related to a number of pathological phenomena such as arrhythmia , osteoporosis , migraine , and fatal myocardial infa rct ion . Clinical ly established metabolic acidosis induces renal losses of calcium . In normal subjects , even moderate increases in net endogenous acid production ( NEAP ) impair renal calcium reabsorption but no information is available whether this also influences renal magnesium h and ling . The aim of the study was to examine the relation between NEAP and renal magnesium excretion in healthy , free-living , elderly subjects . The subjects ( age 64 + /- 4.7 y , n = 85 ) were r and omly selected from the population register in Gothenburg ( Sweden ) .  Magnesium , calcium , and potassium  were measured in 24-h urine sample s and NEAP was quantified as renal net acid excretion ( NAE ) . NAE was positively correlated with excretions of magnesium ( R(2 ) = 0.27 , P < 0.0001 ) and calcium ( R(2 ) = 0.30 , P < 0.0001 ) but not potassium . When 24-h urinary magnesium excretion was adjusted for 24-h urinary potassium excretion , a biomarker for dietary potassium intake , the association between magnesium excretion and NAE remained significant ( R(2 ) = 0.21 , P < 0.0001 ) . The significant association between potassium-adjusted magnesiuria and NAE suggests that the acid-base status affects renal magnesium losses , irrespectively of magnesium intake . Magnesium deficiency could thus , apart from an insufficient intake , partly be caused by the acid load in the body A  Western-type diet  is associated with osteoporosis and calcium nephrolithiasis . On the basis of observations that calcium retention and inhibition of bone resorption result from alkali administration , it is assumed that the acid load inherent in this diet is responsible for increased bone resorption and calcium loss from bone . However , it is not known whether the dietary acid load acts directly or indirectly ( i.e. , via endocrine changes ) on bone metabolism . It is also unclear whether alkali administration affects bone resorption/calcium balance directly or whether alkali-induced calcium retention is dependent on the cation ( i.e. , potassium ) supplied with administered base . The effects of neutralization of dietary acid load ( equimolar amounts of NaHCO(3 ) and KHCO(3 ) substituted for NaCl and KCl ) in nine healthy subjects ( 6 men , 3 women ) under metabolic balance conditions on calcium balance , bone markers , and endocrine systems relevant to bone [ glucocorticoid secretion , IGF-1 , parathyroid hormone (PTH)/1,25(OH)(2 ) vitamin D and thyroid hormones ] were studied . Neutralization for 7 days induced a significant cumulative calcium retention ( 10.7 + /- 0.4 mmol ) and significantly reduced the urinary excretion of deoxypyridinoline , pyridinoline , and n-telopeptide . Mean daily plasma cortisol decreased from 264 + /- 45 to 232 + /- 43 nmol/l ( P = 0.032 ) , and urinary excretion of tetrahydrocortisol ( THF ) decreased from 2,410 + /- 210 to 2,098 + /- 190 microg/24 h ( P = 0.027 ) . No significant effect was found on free IGF-1 , PTH/1,25(OH)(2 ) vitamin D , or thyroid hormones . An acidogenic Western diet results in mild metabolic acidosis in association with a state of cortisol excess , altered divalent ion metabolism , and increased bone resorptive indices . Acidosis-induced increases in cortisol secretion and plasma concentration may play a role in mild acidosis-induced alterations in bone metabolism and possibly in osteoporosis associated with an acidogenic Western diet Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) Background : Higher dietary acid load can result in metabolic acidosis and is associated with faster kidney disease progression in patients with chronic kidney disease ( CKD ) . However , the relationship between dietary acid load and incident CKD has not been evaluated . Methods : We conducted prospect i ve analyses of the Atherosclerosis Risk in Communities study participants without CKD at baseline ( 1987 - 1989 , n = 15,055 ) .  Dietary acid load was estimated using the equation for potential renal acid load by Remer and Manz , incorporating dietary intake data from a food frequency question naire . Incident CKD was assessed from baseline through 2010 and defined as estimated glomerular filtration rate ( eGFR ) < 60 ml/min/1.73 m2 accompanied by 25 % eGFR decline , CKD-related hospitalization or death or end-stage renal disease identified by linkage to the US Renal Data System registry . Results : In the overall study population , 55 % were female , 26 % were African-American and mean age at baseline was 54 years . During a median follow-up of 21 years , there were 2,351 ( 15.6 % ) incident CKD cases . After adjusting for demographics ( age , sex , race-center ) , established risk factors ( diabetes status , hypertension status , overweight/obese status , smoking status , education level , physical activity ) , caloric intake and baseline eGFR , higher dietary acid load were associated with higher risk of incident CKD ( hazard ratio [ HR ] for quartile 4 vs. 1 : 1.13 , 95 % CI 1.01 - 1.28 , p for trend = 0.02 ; HR per interquartile range increase : 1.06 , 95 % CI 1.00 - 1.11 , p = 0.04 ) . Conclusion : Dietary acid load is associated with incident CKD in a population -based sample . These data suggest a potential avenue for CKD risk reduction through diet Our objective in this study was to determine the effects of a high-protein and high-potential renal acid load ( PRAL ) diet on calcium ( Ca ) absorption and retention and markers of bone metabolism . In a r and omized crossover design , 16 postmenopausal women consumed 2 diets : 1 with low protein and low PRAL ( LPLP ; total protein : 61 g/d ; PRAL : -48 mEq/d ) and 1 with high protein and high PRAL ( HPHP ; total protein : 118 g/d ; PRAL : 33 mEq/d ) for 7 wk each separated by a 1-wk break . Ca absorption was measured by whole body scintillation counting of radio-labeled (47)Ca . Compared with the LPLP diet , the HPHP diet increased participants ' serum IGF-I concentrations ( P < 0.0001 ) , decreased serum intact PTH concentrations ( P < 0.001 ) , and increased fractional (47)Ca absorption ( mean ± pooled SD : 22.3 vs. 26.5 ± 5.4 % ; P < 0.05 ) and urinary Ca excretion ( 156 vs. 203 ± 63 mg/d ; P = 0.005 ) . The net difference between the amount of Ca absorbed and excreted in urine did not differ between 2 diet periods ( 55 vs. 28 ± 51 mg/d ) . The dietary treatments did not affect other markers of bone metabolism . In summary , a diet high in protein and PRAL  increases the fractional absorption of dietary Ca , which partially compensates for increased urinary Ca , in postmenopausal women . The increased IGF-I and decreased PTH concentrations in serum , with no change in biomarkers of bone resorption or formation , indicate a high-protein diet has no adverse effects on bone health BACKGROUND Mild metabolic acidosis , which can be caused by diet , may result in elevated blood pressure ( BP ) . DESIGN The analyses included 2241 participants aged ≥55 y who were free of hypertension at baseline ( 1990 - 1993 ) and who had complete dietary and BP data .  Dietary data were obtained from a 170-item food-frequency question naire . We used 2 measures to characterize dietary acid load : ( 1 )  potential renal acid load ( PRAL ) by using an algorithm including protein , phosphorus , potassium , calcium , and magnesium , and ( 2 ) estimated  net endogenous acid production ( NEAP ) based on protein and potassium . HRs for 6-y incidence of hypertension were obtained in tertiles of PRAL and NEAP with adjustment for age , sex , BMI , smoking , education , and intakes of alcohol , fiber , and total energy . RESULTS We identified 1113 incident cases of hypertension during 8707 person-years of follow-up .  The median dietary acid load ranged from -14.6 to 19.9 mEq/d across categories of PRAL . Hypertension risk was not significantly associated with dietary acid load . The multivariate HRs ( 95 % CIs ) in consecutive tertiles of PRAL were 1.00 ( reference ) , 1.01 ( 0.87 , 1.17 ) , and 1.02 ( 0.88 , 1.18 ) ( P trend = 0.83 ) . The median dietary acid loads were 30.4 , 36.7 , and 43.7 mEq/d , respectively , in consecutive tertiles of NEAP . Corresponding HRs for NEAP were 1.00 ( reference ) , 0.92 ( 0.80 , 1.07 ) , and 0.94 ( 0.81 , 1.10 ) ( P-trend = 0.46 ) . CONCLUSION The findings from this prospect i ve cohort study provided no evidence of an association between dietary acid load and risk of hypertension in older adults High dietary acid load ( DAL ) may be detrimental to bone mineral density ( BMD ) . The objectives of the study were to : ( 1 ) evaluate the cross-sectional relation between DAL and BMD ; and ( 2 ) determine whether calcium intake modifies this association . Men ( n = 1218 ) and women ( n = 907 ) aged ≥60 years were included from the National Health and Nutrition Examination Survey 2005 - 2008 .  Nutrient intake from 2 , 24-hour recalls was used to calculate net endogenous acid production ( NEAP ) and potential renal acid load  ( PRAL ) ( mEq/d ) . PRAL was calculated from dietary calcium ( PRALdiet ) and diet + supplemental calcium ( PRALtotal ) . Tests for linear trend in adjusted mean BMD of the hip and lumbar spine were performed across energy-adjusted NEAP and PRAL quartiles . Modification by calcium intake ( dietary or total ) above or below 800 mg/d was assessed by interaction terms . Overall , mean age was 69 ± 0.3 years . Among women , there was no association between NEAP and BMD  . PRALdiet was positively associated with proximal femur BMD ( p trend = 0.04 ) . No associations were observed with PRALtotal at any BMD site ( p range , 0.38 - 0.82 ) . Among men , no significant associations were observed between BMD and NEAP or PRAL . However , an interaction between PRALdiet and calcium intake was observed with proximal femur BMD ( p = 0.08 ) . An inverse association between PRALdiet and proximal femur BMD was detected among men with < 800 mg/d dietary calcium ( p = 0.02 ) ; no associations were found among men with ≥800 mg/d ( p = 0.98 ) . A significant interaction with PRALtotal was not observed . In conclusion , when supplemental calcium is considered , there is no association between DAL and  BMD among adults . Men with low dietary calcium showed an inverse relation with PRAL at the proximal femur ; in women no interaction was observed . This study highlights the importance of calcium intake in counteracting the adverse effect of DAL on bone health . Further research should determine the relation between DAL and change in BMD with very low calcium intake It has been suggested that the sulfur amino acids in protein are responsible for the calciuria observed after protein ingestion . This hypothesis was tested by feeding meals containing either 15 g protein ( control ) , 45 g protein ( high protein ) , or 15 g protein plus sulfur amino acids equivalent to those in the high protein diet . Compared to the control , the high protein diet caused an increase in urinary calcium and sulfate and a decrease in the renal reabsorption of calcium . In contrast , the sulfur amino acid supplement had no effect on calcium excretion or reabsorption . Net acid excretion was unaffected by dietary treatment The dietary acid load created by the typical Western diet may adversely impact the skeleton by disrupting calcium metabolism . Whether neutralizing dietary acid with alkaline potassium salts results in sustained improvements in calcium balance remains controversial . In this r and omized , double-blind , placebo-controlled study , 52 men and women ( mean age 65.2 ± 6.2 years ) were r and omly assigned to potassium citrate 60 mmol/d , 90 mmol/d , or placebo daily with measurements of bone turnover markers , net acid excretion , and calcium metabolism , including intestinal fractional calcium absorption and calcium balance , obtained at baseline and at 6 months . At 6 months , net acid excretion was significantly lower in both treatment groups compared to placebo and it was negative , meaning subjects ' dietary acid was completely neutralized ( -11.3 mmol/d on 60 mmol/d ; -29.5 mmol/d on 90 mmol/d , p < 0.001 compared to placebo ) . At 6 months , 24-hour urine calcium was significantly reduced in persons taking potassium citrate 60 mmol/d ( -46 ± 15.9 mg/d ) and 90 mmol/d ( -59 ± 31.6 mg/d ) compared with placebo ( p < 0.01 ) . Fractional calcium absorption was not changed by potassium citrate supplementation . Net calcium balance was significantly improved in participants taking potassium citrate 90 mmol/d compared to placebo ( 142 ± 80 mg/d on 90 mmol/d versus -80 ± 54 mg/d on placebo ; p = 0.02 ) . Calcium balance was also improved on potassium citrate 60 mmol/d , but this did not reach statistical significance ( p = 0.18 ) . Serum C-telopeptide decreased significantly in both potassium citrate groups compared to placebo ( -34.6 ± 39.1 ng/L on 90 mmol/d , p = 0.05 ; -71.6 ± 40.7 ng/L on 60 mmol/d , p = 0.02 ) whereas bone-specific alkaline phosphatase did not change . Intact parathyroid hormone was significantly decreased in the 90 mmol/d group ( p = 0.01 ) . Readily available , safe , and easily administered in an oral form , potassium citrate has the potential to improve skeletal health . Longer-term trials with definitive outcomes such as bone density and fracture are needed 1 . Eight recurrent renal stone-forming patients were housed in a metabolic ward and fed on a low ( LPD ) and a high ( HPD ) animal protein diet , which were isoenergetic . Metabolic studies were made after 2 weeks on each diet . 2 . There was a 90 % increase in urinary urate on HPD compared with LPD , whereas serum urate did not change consistently . 3 . The urinary acid excretion increased by 200 % , including a 100 % increase in ammonium ion excretion . A fall in urine pH by 0.9 unit was also seen . 4 . The calculated ion activities of the urines revealed a profound increase in the uric acid supersaturation , from undersaturation to supersaturation , and in some cases even surpassing the formation product ratio . The ammonium urate supersaturation also increased . The sodium urate supersaturation was unchanged , despite an induced natriuresis . 5 . The risk of forming uric acid or ammonium urate crystals or stones in the urine was increased on a high protein diet , whereas the risk of forming sodium urate crystals was no greater than on a low protein diet . 6 . As uric acid and ammonium urate crystals under certain conditions may adsorb a macromolecular fraction of the human urine , which inhibits calcium oxalate crystal growth , it is proposed that this mechanism , along with a decrease in urine pH , may also interfere with the inhibitory activity of calcium oxalate crystal growth and aggregation BACKGROUND Bone mineral density ( BMD ) may be influenced by the general dietary pattern and the potential renal acid load ( PRAL ) . METHODS We compared the dietary intake ( estimated using the European Prospect i ve Investigation into Cancer and nutrition question naire ) of 497 community-living women ( 60 years of age and older ) grouped according to tertiles of baseline total , trabecular and cortical BMD estimated using tibial peripheral quantitative computed tomography ( pQCT ) , and of BMD variation over 6 years . RESULTS None of the nutrients taken into account nor PRAL was associated with total BMD , with the exception that the intake of polyunsaturated fatty acids ( PUFA ) was slightly higher among women with the highest total BMD . Similar results were found for trabecular BMD . Cortical BMD was associated with serum 25-OH vitamin D ( 38.8 , 43.2 , and 49.5 nmol/L in the first , second , and third tertiles , respectively ; P=0.042 ) . In the longitudinal analysis , a lower BMI was associated with greater loss of total BMD , while lower serum 25-OH vitamin D at baseline was associated with smaller loss of cortical BMD . CONCLUSIONS We found no relationship between dietary acid load and BMD . We also confirmed the role of well-recognized risk factor for osteoporosis Supine weight-bearing exercise within lower body negative pressure ( LBNP ) alleviates some of the skeletal deconditioning induced by simulated weightlessness in men . We examined this potential beneficial effect in women . Because dietary acid load affected the degree of bone resorption in men during bed rest , we also investigated this variable in women . Subjects were 7 pairs of female identical twins assigned at r and om to 2 groups , sedentary bed rest ( control ) or bed rest with supine treadmill exercise within LBNP .  Dietary intake was controlled and monitored . Urinary calcium and markers of bone resorption were measured before bed rest and on bed rest days 5/6 , 12/13 , 19/20 , and 26/27 . Bone mineral content was assessed by dual-energy X-ray absorptiometry before and after bed rest . Data were analyzed by repeated- measures two-way analysis of variance . Pearson correlation coefficients were used to define the relationships between diet and markers of bone metabolism and to estimate heritability of markers . During bed rest , all markers of bone resorption and urinary calcium and phosphorus increased ( P<0.001 ) ; parathyroid hormone ( P=0.06 ) , bone-specific alkaline phosphatase ( P=0.06 ) , and 1,25-dihydroxyvitamin D ( P=0.09 ) tended to decrease . LBNP exercise tended to mitigate bone density loss . The ratio of dietary animal protein to potassium was positively correlated with urinary calcium excretion for all weeks of bed rest in the control group , but only during weeks 1 and 3 in the exercise group . Pre-bed rest data suggested that many markers of bone metabolism have strong genetic determinants . Treadmill exercise within LBNP had less of a protective effect on bone resorption during bed rest in women than previously published results had shown for its effect in men , but the same trends were observed for both sexes . Dietary acid load of these female subjects was significantly correlated with calcium excretion but not with other bone resorption markers PURPOSE We evaluated the effect of cranberry juice on urinary stone risk factors . MATERIAL S AND METHODS A total of 12 normal subjects and 12 calcium oxalate stone formers underwent 2 , 7-day phases of study in r and om order while on a controlled metabolic diet . Subjects ingested 1 l of cranberry juice ( CBJ ) daily in 1 phase and 1 l of deionized water in the other phase . On the last 2 days of each phase 2 , 24-hour urine collection s and blood sample s were obtained for stone risk factors and serum chemistries . RESULTS No significant differences were found between normal subjects and stone formers in response to CBJ and , therefore , the groups were combined . CBJ significantly increased urinary calcium ( from 154 to 177 mg per day , p = 0.0008 ) and urinary oxalate ( from 26.4 to 29.2 mg per day , p = 0.04 ) , thereby increasing urinary saturation of calcium oxalate by 18 % . Urinary citrate was unchanged and urinary magnesium increased slightly . Urinary pH decreased ( from 5.97 to 5.67 , p = 0.0005 ) , and urinary ammonium , titratable acidity and net acid excretion increased during CBJ ingestion . Urinary uric acid decreased ( from 544 to 442 mg per day , p < 0.0001 ) as did serum uric acid . Thus , the urinary saturation of brushite and monosodium urate was reduced by CBJ but the amount of undissociated uric acid increased . CONCLUSIONS CBJ exerts a mixed effect on urinary stone forming propensity . It reduces urinary pH likely by providing an acid load and decreases urinary uric acid perhaps by retarding urate synthesis . Overall CBJ increases the risk of calcium oxalate and uric acid stone formation but decreases the risk of brushite stones A r and omised , parallel- design dietary intervention study was conducted in women ( aged 45 - 75 years ) with prehypertension or stage 1 hypertension . The aim was to compare the effects on bone turnover of a low-Na base-producing ( LNAB ) Dietary Approaches to Stop Hypertension (DASH)-type diet ( including six serves lean red meat/week ) with a high-carbohydrate low-fat ( HCLF ) diet with a higher acid load ( both > 800 mg dietary Ca/d ) . Fasting serum bone markers ( baseline and week 14 ) and 24 h urinary electrolyte excretion ( baseline , weeks 4 , 8 , 12 and 14 ) were measured . After the intervention period , the LNAB group ( n 46 ) had a fall of 26 ( sem 6 ) % ( P < 0.0001 ) in urinary Na , an increase in K excretion ( 6.8 ( sem 3.6 ) mmol/d ; P = 0.07 ) and , compared with the HCLF group ( n 49 ) , a greater reduction in urinary Ca excretion by 0.7 ( sem 0.3 ) mmol/d . Serum 25-hydroxyvitamin D , intact parathyroid hormone and osteocalcin did not change , and both groups had a similar increase of 23 ( sem 5 ) % ( P < 0.0001 ) in C-terminal telopeptide of type I collagen . The HCLF group had an 11 ( sem 4 ) % increase ( P = 0.003 ) in N-terminal propeptide , type I procollagen , which could indicate an increased rate of bone turnover . The fall in urinary Ca with the lower-Na lower-acid load diet is likely to have long-term beneficial effects on bone . As bone resorption was not different between the two dietary patterns with relatively high Ca intake , the effect on bone health of a dietary pattern with a lower acid load warrants further study on a lower Ca intake Abstract Excess protein intake can adversely affect the bone via an increase in calcium excretion , while suitable mechanical loading promotes osteogenesis . We therefore investigated whether vibration exposure could alleviate the bone mineral losses associated with a metabolic acidosis . Ten healthy individuals aged 22 – 29 years ( median = 25 ) underwent three 5-day study periods while monitoring their dietary intake . The study consisted of recording the participants ' usual dietary intake for 5 consecutive days . Participants were then r and omly divided into two groups , one of which received a protein supplement ( 2 g · kg−1 body mass · day−1 ; n = 5 ) and the other whole-body low-magnitude ( 3.5 g ) , low-frequency ( 30 Hz ) mechanical vibration ( WBV ) delivered through a specially design ed vibrating plate for 10 min each day ( n = 5 ) . Finally , for the third treatment period , all participants consumed the protein supplement added to their normal diet and were exposed to WBV exercise for 10 min per day . Daily urine sample s were collected throughout the experimental periods to determine the excretion of calcium , phosphate , titratable acid , urea , and C-telopeptide . As expected , when the participants underwent the high protein intake , there was an increase in urinary excretion rates of calcium ( P < 0.001 ) , phosphate ( P < 0.003 ) , urea ( P < 0.001 ) , titratable acid ( P < 0.001 ) , and C-telopeptide ( P < 0.05 ) compared with baseline values . However , high protein intake coupled with vibration stimulation result ed in a significant reduction in urinary calcium ( P = 0.006 ) , phosphate excretion ( P = 0.021 ) , and C-telopeptide ( P < 0.05 ) compared with protein intake alone , but did not affect titratable acid and urea output . The participants showed no effect of WBV exercise alone on urinary excretion of calcium , phosphate , urea , titratable acid , or C-telopeptide . The results indicate that vibration stimulation can moderate the increase in bone resorption and reduction in bone formation caused by a metabolic acidosis CONTEXT Protein is an essential component of muscle and bone . However , the acidic byproducts of protein metabolism may have a negative impact on the musculoskeletal system , particularly in older individuals with declining renal function . OBJECTIVE We sought to determine whether adding an alkaline salt , potassium bicarbonate ( KHCO3 ) , allows protein to have a more favorable net impact on intermediary indices of muscle and bone conservation than it does in the usual acidic environment . DESIGN We conducted a 41-d r and omized , placebo-controlled , double-blind study of KHCO3 or placebo with a 16-d phase-in and two successive 10-d metabolic diets containing low ( 0.5 g/kg ) or high ( 1.5 g/kg ) protein in r and om order with a 5-d washout between diets . SETTING The study was conducted in a metabolic research unit . PARTICIPANTS Nineteen healthy subjects ages 54 - 82 yr participated . INTERVENTION KHCO3 ( up to 90 mmol/d ) or placebo was administered for 41 d. MAIN OUTCOME MEASURES We measured 24-h urinary nitrogen excretion , IGF-I , 24-h urinary calcium excretion , and fractional calcium absorption . RESULTS KHCO3 reduced the rise in urinary nitrogen excretion that accompanied an increase in protein intake ( P = 0.015 ) and was associated with higher IGF-I levels on the low-protein diet ( P = 0.027 ) with a similar trend on the high-protein diet ( P = 0.050 ) . KHCO3 was also associated with higher fractional calcium absorption on the low-protein diet ( P = 0.041 ) with a similar trend on the high-protein diet ( P = 0.064 ) . CONCLUSIONS In older adults , KHCO3 attenuates the protein-induced rise in urinary nitrogen excretion , and this may be mediated by IGF-I. KHCO3 may also promote calcium absorption independent of the dietary protein content High calorie and fat consumption and the production of free radicals are two major mechanistic pathways between diet and disease . In this study we evaluated the effect of a plant-based diet poor in animal fat and rich in ( n-3 ) fatty acids on fatty acids of serum phospholipids and on the production of reactive oxygen metabolites ( ROMs ) .  One hundred and four healthy female postmenopausal volunteers were recruited and r and omized to a dietary intervention or a control group . Dietary intervention included a program of food education and biweekly common meals for 18 weeks . When the intervention and control groups were compared , it was seen that dietary intervention result ed in a significant reduction of saturated fatty acids ( -1.5 % ) and a significant increase in ( n-3 ) fatty acids ( + 20.6 % ) , in particular docosahexaenoic acid ( + 24.8 % ) . We observed that arachidonic acid decreased ( –7.7 % ) , while ( n-6 ) fatty acids did not , and the (n-3)/(n-6 ) polyunsaturated ratio increased significantly ( + 24.1 % ) . As expected , ROMs decreased significantly in the intervention group ( -6 % ) . The results indicated that a plant-based diet can improve the serum fatty acid profile and decrease ROMs production . These results suggest that a plant-based diet may reduce the body 's exposure to oxidative stress BACKGROUND Dietary patterns that promote mild metabolic acidosis may have a negative effect on  bone density .  OBJECTIVE We investigated the relation between a measure of  dietary acid-base load , potential renal acid load ( PRAL ) , and calcaneal broadb and ultrasound attenuation ( BUA ) after adjustment for confounders and also compared the results with different estimates of acid-base load . DESIGN A cross-sectional study was conducted in 14 563 men and women aged 42 - 82 y living in Norfolk , United Kingdom , in which measures of calcaneal BUA  and dietary PRAL were estimated by using the European Prospect i ve Investigation into Cancer and Nutrition Norfolk ( EPIC-Norfolk ) food-frequency question naire . RESULTS A more acidic dietary intake ( high PRAL ) was significantly associated with lower calcaneal BUA in women but not in men ; there was a difference of approximately 2 % in BUA between the highest and lowest quintiles of PRAL , independent of age , body mass index , smoking habit , physical activity , diagnosed osteoporosis , and history of fracture , and ( in women ) hormone replacement therapy . No relation was observed between history of fracture or incident fracture and PRAL . Those with the greatest PRAL had higher intakes of meat , fish , eggs , and cereal and cereal products and lower intakes of fruit and vegetables , tea , and coffee . CONCLUSION PRAL was inversely associated with bone ultrasound measures in women , but the magnitude of the association was relatively small compared with other known risk factors . Further longitudinal studies are required to establish whether , in the long term , these small effects are important in overall fracture risk in population Background : Evidence suggests that dietary calcium intake may be inversely related to body weight . One explanatory mechanism is that dietary calcium increases fecal fat excretion , due to either calcium soap formation and /or binding of bile acids ( BAs ) in the intestine . Objective : To examine the effect of calcium from low-fat dairy products on fecal fat excretion . Design : A r and omized crossover study with 11 subjects , comparing two 7-d diets : one high in calcium from low-fat dairy products ( high-Ca ; 2300 mg Ca per d ) and one low in calcium ( low-Ca ; 700 mg Ca per d ) . Measurements : All feces were collected during the last 5 days of each diet period and analyzed for fat , energy and calcium content and fatty acid ( FA ) and BA composition . Results : Dairy calcium significantly increased the total fecal fat excretion from 5.4±0.5 g d−1 on the low-Ca diet to 11.5±1.4 g d−1 on the high-Ca diet ( P<0.001 ) . The fecal energy excretion increased almost correspondingly . Saturated , monounsaturated and polyunsaturated FAs were all excreted in larger amounts on the high-Ca diet ( P<0.001 for all ) , with the effect of calcium being greater for monounsaturated than for saturated FAs . The fecal excretion of BAs was unaffected of calcium intakes . Conclusions : Increasing the intake of calcium from low-fat dairy products by 1600 mg d−1 for 7 days doubled total fecal fat excretion , but did not affect the excretion of BAs . The results may partially explain why a high-calcium diet can produce weight loss There is mounting evidence that periodontal disease ( PD ) is linked to low serum 25-hydroxyvitamin D [ 25(OH)D ] concentrations in addition to recognized risk factors like diet and smoking . This paper review s this evidence using Hill 's criteria for causality in a biological system . Evidence for strength of association , consistency , cohesion and ' dose-effects ' [ biological ' gradients ' ] include strong inverse correlations between serum 25(OH ) and both PD cross-sectionally and that PD is consistently more prevalent in darker vs. lighter skinned people and increases at higher latitudes with analogy for gingivitis and for disorders associated with PD whose risks increase with hypovitaminosis D. Evidence for plausibility includes that vitamin D increases calcium absorption and protects bone strength ; induces formation of cathelicidin and other defensins that combat bacterial infection ; reduces tissue production of destructive matrix metalloproteinases actively associated with PD and that prevalence of PD varies with common vitamin D receptor polymorphisms . Experimental evidence from limited supplementation studies [ using calcium and vitamin D ] shows that supplementation reduces tooth loss . Thus , existing evidence for hypovitaminosis D as a risk factor for PD to date meets Hill 's criteria for causality in a biological system . Further experimental evidence for effectiveness and temporality , preferably from r and omized controlled trials of vitamin D supplementation [ adjusting for other PD risk factors including diet and smoking to reduce confounding ] are necessary to confirm causality . If confirmed , dentists and periodontists could perform a valuable service to their patients by discussing the importance of adequate vitamin D status and on how to avoid deficiency Butter was replaced by olive oil in a controlled 100 g fat diet in order to study the effect of saturated fats ( SAFA ) versus monounsaturated fats ( MUFA ) on small-bowel sterol excretion in eleven healthy ileostomates .  Bile acids and neutral sterols were measured by gas-liquid chromatography . Net cholesterol excretion ( excretion minus intake ) was 84 + /- 25 mg/24 h ( mean + /- SE ) on the SAFA diet and increased to 218 + /- 32 mg/24 h on the MUFA diet ( P less than 0.01 ) . The bile acid excretion tended to be somewhat lower on the MUFA diet , but this was significant only for chenodeoxycholic acid . Net sterol excretion ( the sum of excretion of net cholesterol and bile acids ) was significantly lower on the SAFA diet than on the MUFA diet ( 443 + /- 60 and 529 + /- 58 mg/24 h , respectively ) . The immediately increased excretion of cholesterol from the small bowel could thus explain the serum cholesterol-lowering effect of a change from a SAFA-rich to a MUFA-rich diet , though the mechanism for this change is still unclear Fatty acid profile of milk fat can be modified by cow feeding strategies . Our aim was postpr and ially and after 4 wk to compare the effect of a modified milk fat ( M diet ) [ with 16 % of the cholesterolemic saturated fatty acid ( C12–16 ) replaced by mainly oleic and stearic acids ] with the effect of D diet , including a conventional Danish milk fat on plasma lipids and lipoproteins . A side effect of the cow feeding regime was a 5 % ( w/w ) increase in trans fatty acid in M diet . Eighteen subjects were fed for two periods of 4 wk strictly controlled isoenergetic test diets with 40 % of energy from total fat and the same content of dietary cholesterol in a r and omized study with cross-over design . Contrary to expectations , fasting low density lipoprotein ( LDL ) cholesterol concentration did not differ after the experimental periods . However , M diet result ed in a higher fasting total triacylglycerol concentration compared to D diet ( P=0.009 ) . Postpr and ial sample s were taken at two different occasions ( i ) at day 21 , after breakfast and lunch and ( ii ) on the last day of the study 2 , 4 , 6 , and 8 h after a fat load . Postpr and ial plasma triacylglycerol and chylomicron triacylglycerol showed higher peak values after D diet than M diet ( interaction effect , diet × times P<0.05 ) . In conclusion , M diet did not lower LDL cholesterol compared to D diet . Thus any cholesterol-lowering effect of oleic and stearic acids may have been obscured by the high content of cholesterol-raising saturated fatty acids in milk fat . A higher content of the trans fatty acids in M diet might have counteracted the cholesterol neutral/decreasing effect and increased plasma triacylglycerol BACKGROUND & AIMS The effects of diet on gastroesophageal reflux disease are not well understood . This study assessed the effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms in patients with reflux symptoms . METHODS Patients referred for the investigation of reflux symptoms were recruited ( most with nonerosive disease ) . A catheter-free system provided esophageal pH monitoring over 4 days in 4 dietary conditions . A high-fat ( 50 % ) vs low-fat ( 25 % ) diet ( calorie-controlled ) , and a high-calorie ( 1000 kcal ) vs low-calorie ( 500 kcal ) diet ( fat-controlled ) were provided in r and omized order , and meal volume was controlled . The effects of meal consistency also were studied . RESULTS Complete data were available for 15 patients ( 6 men , 9 women ; age , 48 y ; range , 26 - 70 y ; body mass index , 26 kg/m2 ; body mass index range , 21 - 35 kg/m2 ) . Demographic variables and meal sequence had no effect on reflux parameters . Dietary composition had effects on esophageal acid exposure ( F statistic [ analysis of variance ] = 7.4 , P < .005 ) and symptoms ( Friedman test = 24.2 , P < .001 ) . No effect of meal consistency was present . Esophageal acid exposure was greater during the high-calorie than the low-calorie diet ( mean , 8.6 % + /- 2.0 % vs 5.2 % + /- 1.4 % time pH < 4/24 h ; P < .01 ) . No difference was observed between the high-fat and low-fat diets ( mean , 8.6 % + /- 2.0 % vs 8.2 % + /- 1.6 % time pH < 4/24 h ; P = NS ) . In contrast , the frequency of reflux symptoms was not affected by calorie density ( median , 6 ; range , 2 - 12 vs median , 8 ; range , 2 - 13 ; P = NS ) but was increased by the high-fat compared with the low-fat diet ( median , 11 ; range , 5 - 18 vs median , 6 ; range , 2 - 12 ; P < .05 ) . CONCLUSIONS Calorie density determines the severity of esophageal acid exposure in gastroesophageal reflux disease after a meal ; however , the percentage fat content of the diet has important effects on the frequency of reflux symptoms Objective : To determine the effect of dietary salt restriction on urinary excretion of serotonin and its principal metabolite 5-hydroxyindoleacetic acid ( 5-HIAA ) in man Design : We studied 16 healthy male volunteers ( age range 20 - 28 years ) who ate a st and ard diet containing 20mmol/day NaCl  , to which either 220mmol/day NaCl or placebo was added as a supplement for 1 week each , according to a r and omized , single-blind crossover design Methods : Urinary excretion of serotonin , 5-HIAA , noradrenaline and vanillylm and elic acid ( VMA ) were measured during the low- and high-salt periods using reverse-phase high-performance liquid chromatography Results : During the low-salt diet , 24-h urinary excretion of serotonin increased by 42 % , accompanied by a 52 % rise in the excretion of 5-HIAA . Salt restriction also increased noradrenaline excretion by 77 % and VMA excretion by 40 % . Regression analysis revealed a strong positive relationship between the excretion of serotonin and of noradrenaline ( r=0.84 , P < 0.001 ) and between that of 5-HIAA and of VMA ( r=0.74 , P < 0.001 ) Conclusions : Salt restriction stimulates the serotonergic system in man . Stimulation of this system , in conjunction with the sympathetic nervous system , may contribute to renal sodium conservation during dietary salt restriction in Abstract Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure . Concerns exist that high‐protein diets reduce renal function . Effects of acute and 4‐week protein intake versus maltodextrin intake on renal acid load , glomerular filtration rate and related parameters were compared in this study . Seventy‐nine overweight individuals with untreated elevated blood pressure and normal kidney function were r and omized to consume a mix of protein isolates ( 60 g/day ) or maltodextrin ( 60 g/day ) for 4 weeks in energy balance . Twenty‐four‐hour urinary potential renal acid load ( uPRAL ) was compared between groups . A subgroup ( maltodextrin N = 27 , protein mix N = 25 ) participated in extra test days investigating fasting levels and postpr and ial effects of meals supplemented with a moderate protein‐ or maltodextrin‐load on glomerular filtration rate , effective renal plasma flow , plasma renin , aldosterone , pH , and bicarbonate . uPRAL was significantly higher in the protein group after 4 weeks ( P ≤ 0.001 ) . Postpr and ial filtration fraction decreased further after the protein‐supplemented breakfast than after the maltodextrin‐supplemented breakfast after 4 weeks of supplementation ( P ≤ 0.001 ) . Fasting and postpr and ial levels of glomerular filtration rate , effective renal plasma flow , renin , aldosterone , angiotensin‐converting enzyme , pH and bicarbonate did not differ between groups . In conclusion , 4 weeks on an increased protein diet ( 25 % of energy intake ) increased renal acid load , but did not affect renal function . Postpr and ial changes , except for filtration fraction , also did not differ between groups . These data suggest that a moderate increase in protein intake by consumption of a protein mix for 4 weeks causes no ( undesirable ) effects on kidney function in overweight and obese individuals with normal kidney function BACKGROUND An ecological analysis found that the docosahexaenoic acid content in mother 's milk and seafood intake were inversely correlated with postpartum depression . This prospect i ve study investigated the relationship of consumption of selected high-fat foods and specific types of fatty acids with the risk of postpartum depression . METHOD The subjects were 865 Japanese women .  Dietary data were obtained from a self-administered diet history question naire during pregnancy . The Edinburgh Postnatal Depression Scale ( EPDS ) was used for the evaluation of postpartum depression . Adjustment was made for age , gestation , parity , cigarette smoking , family structure , family income , education , changes in diet in the previous month , season when data at baseline were collected , body mass index , time of delivery before the second survey , medical problems in pregnancy , baby 's sex and baby 's birthweight . RESULTS The percentage of women with high depression scores was 14.0 % . No evident dose-response associations were observed between intake of fish , meat , eggs , dairy products , total fat , saturated fatty acids , monounsaturated fatty acids , n-3 polyunsaturated fatty acids , n-6 polyunsaturated fatty acids , linoleic acid , alpha-linolenic acid , arachidonic acid , eicosapentaenoic acid or docosahexaenoic acid and the ratio of n-3 to n-6 polyunsaturated fatty acids and the risk of postpartum depression . However , there was an inverted J-shaped relationship between intake of n-3 polyunsaturated fatty acids and docosahexaenoic acid and the risk of postpartum depression . CONCLUSIONS This study failed to substantiate a clear inverse relationship between fish and n-3 polyunsaturated fatty acid intake and postpartum depression . Further investigations are needed to determine whether fish and n-3 polyunsaturated fatty acid consumption is preventive against postpartum depression BACKGROUND Protein and alkalizing minerals are increasingly described as playing a major role in influencing bone status , not only in the elderly but also in children and adolescents . OBJECTIVE We examined whether the long-term dietary protein intake and diet net acid load are associated with bone status in children . DESIGN In a prospect i ve study design in 229 healthy children and adolescents aged 6 - 18 y , long-term dietary intakes were calculated from 3-d weighed dietary records that were collected yearly over the 4-y period before a one-time bone analysis . Dietary acid load was characterized as potential renal acid load ( PRAL ) by using an algorithm including dietary protein , phosphorus , magnesium , and potassium . Proximal forearm bone variables were measured by peripheral quantitative computed tomography . RESULTS After adjustment for age , sex , and energy intake and control for forearm muscularity , BMI , growth velocity , and pubertal development , we observed that long-term  dietary protein intake  was significantly positively associated with periosteal circumference ( P < 0.01 ) , which reflected bone modeling , and with cortical area ( P < 0.001 ) , bone mineral content ( P < 0.01 ) , and polar strength strain index ( P < 0.0001 ) , which reflected a combination of modeling and remodeling . Children with a higher dietary PRAL had significantly less cortical area ( P < 0.05 ) and bone mineral content ( P < 0.01 ) . Long-term calcium intake had no significant effect on any bone variable . CONCLUSIONS Long-term dietary protein intake appears to act anabolically on diaphyseal bone strength during growth , and this may be negated , at least partly , if dietary PRAL is high , ie , if the intake of alkalizing minerals is low The acid load accompanying modern diets may have adverse effects on bone and muscle metabolism . Treatment with alkaline salts of potassium can neutralize the acid load , but the optimal amount of alkali is not established . Our objective was to determine the effectiveness of two doses of potassium bicarbonate ( KHCO3 ) compared with placebo on biochemical markers of bone turnover , and calcium and nitrogen ( N ) excretion . In this double-blind , r and omized , placebo-controlled study , 244 men and women age 50 years and older were r and omized to placebo or 1 mmol/kg or 1.5 mmol/kg of KHCO3 daily for 3 months ; 233 completed the study . The primary outcomes were changes in 24-hour urinary N-telopeptide ( NTX ) and N ; changes in these measures were compared across the treatment groups . Exploratory outcomes included 24-hour urinary calcium excretion , serum amino-terminal propeptide of type I procollagen ( P1NP ) , and muscle strength and function assessment s. The median administered doses in the low-dose and high-dose groups were 81 mmol/day and 122 mmol/day , respectively . When compared with placebo , urinary NTX declined significantly in the low-dose group ( p = 0.012 , after adjustment for baseline NTX , gender , and change in urine creatinine ) and serum P1NP declined significantly in the low-dose group ( p = 0.004 , adjusted for baseline P1NP and gender ) . Urinary calcium declined significantly in both KHCO3 groups versus placebo ( p < 0.001 , adjusted for baseline urinary calcium , gender , and changes in urine creatinine and calcium intake ) . There was no significant effect of either dose of KHCO3 on urinary N excretion or on the physical strength and function measures .  KHCO3 has favorable effects on bone turnover and calcium excretion and the lower dose appears to be the more effective dose . Long-term trials to assess the effect of alkali on bone mass and fracture risk are needed BACKGROUND : Observational studies have shown an inverse association between  dietary calcium intake and body weight , and a causal relation is likely . However , the underlying mechanisms are not understood . OBJECTIVE : We examined whether high and low calcium intakes from mainly low-fat dairy products , in diets high or normal in protein content , have effects on 24-h energy expenditure ( EE ) and substrate oxidation , fecal energy and fat excretion , and concentrations of substrates and hormones involved in energy metabolism and appetite . DESIGN : In all , 10 subjects participated in a r and omized crossover study of three isocaloric 1-week diets with : low calcium and normal protein ( LC/NP : 500 mg calcium , 15 % of energy ( E% ) from protein ) , high calcium and normal protein ( HC/NP : 1800 mg calcium , 15E% protein ) , and high calcium and high protein ( HC/HP : 1800 mg calcium , 23E% protein ) . RESULTS : The calcium intake had no effect on 24-h EE or fat oxidation , but fecal fat excretion increased ∼2.5-fold during the HC/NP diet compared with the LC/NP and the HC/HP diets ( 14.2 vs 6.0 and 5.9 g/day ; P<0.05 ) . The HC/NP diet also increased fecal energy excretion as compared with the LC/NP and the HC/HP diets ( 1045 vs 684 and 668 kJ/day ; P<0.05 ) . There were no effects on blood cholesterol , free fatty acids , triacylglycerol , insulin , leptin , or thyroid hormones . CONCLUSIONS : A short-term increase in dietary calcium intake , together with a normal protein intake , increased fecal fat and energy excretion by ∼350 kJ/day . This observation may contribute to explain why a high-calcium diet produces weight loss , and it suggests that an interaction with dietary protein level may be important BACKGROUND Short-term high-carbohydrate ( HC ) diets induce metabolic alterations , including hypertriacylglycerolemia , in both the fasting and postpr and ial states . The underlying tissue-specific alterations in fatty acid metabolism are not well understood . OBJECTIVE We investigated alterations in exogenous and endogenous fatty acid metabolism by using stable isotope tracers to label meal triacylglycerol and plasma fatty acids . DESIGN Eight healthy subjects consumed isocaloric diets containing a high percentage of energy from carbohydrates or a higher percentage of energy from fat for 3 d in a r and omized crossover dietary intervention study . A test meal containing [ U-13C ] palmitate was combined with intravenous infusion of [ 2H2 ] palmitate to label plasma fatty acids and VLDL triacylglycerol . Blood and breath sample s were taken before the meal and for 6 h postpr and ially . Blood sample s were drawn from the femoral artery and from veins draining subcutaneous adipose tissue and forearm muscle for monitoring of tissue-specific metabolic substrate partitioning . RESULTS Systemic triacylglycerol concentrations were increased in both fasting ( P = 0.02 ) and postpr and ial ( P = 0.02 ) periods , and a greater amount of infused labeled fatty acid appeared in VLDL triacylglycerol after the HC diet than after the higher-fat diet ( P = 0.05 ) . Significantly less 13CO2 was exhaled after the HC diet ( P = 0.04 ) and significantly less production of 13CO2 was seen across forearm muscle ( P = 0.04 ) . Systemic 3-hydroxybutyrate was significantly lower , postpr and ially , after the HC diet ( P = 0.02 ) . CONCLUSION Metabolic alterations suggestive of repartitioning of fatty acids away from oxidation toward esterification in both liver and muscle occur in response to short-term adaptation to a HC diet Six healthy adult males were fed four different diets to determine the effects of the quantity of fat ( 30 % or 40 % of energy as fat ) and type of fat ( polyunsaturated or saturated ) on utilization of fatty acids . Each diet was fed for 15 d. The ratio of dietary polyunsaturated to saturated fat ( P : S ) was formulated at either 0.2 or 1.0 at both fat intakes . Subjects provided breath tests to measure background 13C and response to [1 - 13C]10:0 and [1 - 13C]16:0 fed with a test meal . Increasing the P : S increased whole-body oxidation of labeled 10:0 by 30 % after consumption of both low- and high-fat diets . When labeled 16:0 was fed , the amount of 13C excreted in breath increased by a factor of 2.4 after the low-fat diet with a high P : S compared with the diet with a low P : S. The results suggest that the amount and type of fat in the diet affect utilization of individual fatty acids in normal subjects BACKGROUND Epidemiologic evidence has suggested that diets with a high ratio of palmitic acid ( PA ) to oleic acid ( OA ) increase risk of cardiovascular disease ( CVD ) . OBJECTIVE To gain additional insights into the relative effect of dietary fatty acids and their metabolism on CVD risk , we sought to identify a metabolomic signature that tracks with diet-induced changes in blood lipid concentrations and whole-body fat oxidation . DESIGN We applied comprehensive metabolomic profiling tools to biological specimens collected from 18 healthy adults enrolled in a crossover trial that compared a 3-wk high-palmitic acid ( HPA ) with a low-palmitic acid and high-oleic acid ( HOA ) diet . RESULTS A principal components analysis of the data set including 329 variables measured in 15 subjects in the fasted state identified one factor , the principal components analysis factor in the fasted state ( PCF1-Fasted ) , which was heavily weighted by the PA : OA ratio of serum and muscle lipids , that was affected by diet ( P < 0.0001 ; HPA greater than HOA ) . One other factor , the additional principal components analysis factor in the fasted state ( PCF2-Fasted ) , reflected a wide range of acylcarnitines and was affected by diet in women only ( P = 0.0198 ; HPA greater than HOA ) . HOA lowered the ratio of serum low-density lipoprotein to high-density lipoprotein ( LDL : HDL ) in men and women , and adjustment for the PCF1-Fasted abolished the effect . In women only , adjustment for the PCF2-Fasted eliminated the  HOA-diet  effect on serum total- and LDL-cholesterol concentrations . The respiratory exchange ratio in the fasted state was lower with the HPA diet ( P = 0.04 ) , and the diet effect was eliminated after adjustment for the PCF1-Fasted . The messenger RNA expression of the cholesterol regulatory gene insulin-induced gene-1 was higher with the HOA diet ( P = 0.008 ) . CONCLUSIONS These results suggest that replacing dietary PA with OA reduces the blood LDL concentration and whole-body fat oxidation by modifying the saturation index of circulating and tissue lipids . In women , these effects are also associated with a higher production and accumulation of acylcarnitines , possibly reflecting a shift in fat catabolism Eicosanoids are oxidative derivatives of arachidonic acid . When produced in excessive amounts , many are proinflammatory and /or prothrombotic agents . N-3 polyunsaturated fatty acids ( PUFA ) have been used to attenuate tissue arachidonic acid ( AA , 20:4 n-6 ) levels and thus modulate eicosanoid production . However , there is growing evidence that dietary arachidonic acid may also be able to modulate eicosanoid formation by enriching tissue phospholipids with AA . Therefore , the effects of dietary AA and n-3 PUFA are in diametric opposition . This study investigates the antithetic relationship of dietary AA and eicosapentaenoic acid ( EPA , 20:5 n-3 ) on fatty acid composition of hepatic phospholipids and eicosanoid production in vivo . Forty-nine CD-1 male mice were r and omly divided into four dietary groups . Identical diets were supplemented with ethyl esters ( 1.5 % w/w ) of the following fatty acids : oleic acid ( OA , 18:1 n-9 ) , AA , EPA or AA+EPA . After 4 weeks on diet , peritoneal cells were stimulated in vivo with opsonized zymosan and the peritoneal exu date s were analyzed for eicosanoid production ( PGE2 , 6-keto-PGF1 alpha , TXB2 , LTB4 , LTE4 , and LTE5 ) . Hepatic phospholipids were enriched with AA when AA was included in the diet , and EPA was enriched at the expense of AA when EPA was added to the diet . However , when AA was added to the diet containing equivalent amounts of EPA ( AA+EPA ) , any effect EPA had on modulating hepatic phospholipid fatty acid composition was almost completely eliminated . Similar effects were observed with eicosanoid production . The pooled eicosanoid production in the AA group was 41 % and 300 % higher compared to the OA ( control ) and EPA groups , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS Summary In 30 adults , increasing intake of aromatic amino acids increased calcium excretion and serum IGF-1 , but not indices of bone turnover , when compared with similar increases in intake of branched-chain amino acids . The mechanisms involved are not certain but these findings suggest a role for the calcium sensor receptor . Introduction In contrast to branched-chain amino acids ( BCAAs ) , aromatic amino acids ( AAAs ) bind to the calcium sensing receptor ( CaR ) and thus have an increased potential to affect calcium homeostasis . In this study we compare the effects of increased intake of AAAs versus BCAAs on calcium excretion , serum IGF-1 , markers of bone turnover , and 4-hr calcium excretion after an oral calcium load . Methods After two weeks on low-protein metabolic diets , 30 healthy subjects were r and omized to a fivefold increase in intake of AAAs or BCAAs for two weeks . Changes in calcium excretion and other measures were compared in the two groups . Results With the increase in amino acid intake , 24-hr calcium excretion ( P = 0.027 ) , IGF-1 ( P = 0.022 ) , and 4-hr calcium excretion after an oral load ( P = 0.023 ) increased significantly in the AAA relative to the BCAA group . Group changes in turnover markers did not differ significantly . Conclusion In comparison with BCAAs , AAAs promoted calcium excretion . The calciuria does not appear to result from increases in bone resorption and may occur by increasing calcium absorption . The AAAs also increased circulating levels of IGF-1 . Collectively these findings raise the possibility that AAAs may selectively influence calcium homeostasis through their interactions with the CONTEXT The acid load imposed by a modern diet may play an important role in the pathophysiology of osteoporosis . OBJECTIVE Our objective was to evaluate the skeletal efficacy and safety and the effect on fracture prediction of K-citrate to neutralize diet-induced acid loads . DESIGN AND SETTING We conducted a r and omized , double-blind , placebo-controlled trial at a teaching hospital . SUBJECTS Subjects included 201 elderly ( > 65 yr old ) healthy men and women ( t-score of -0.6 at lumbar spine ) . INTERVENTION Intervention was 60 mEq of K-citrate daily or placebo by mouth . All subjects received calcium and vitamin D. OUTCOME MEASURES The primary outcome was change in areal bone mineral density ( aBMD ) at the lumbar spine by dual-energy x-ray absorptiometry after 24 months . Secondary endpoints included changes in volumetric density and microarchitectural parameters by high-resolution peripheral quantitative computed tomography in both radii and both tibiae and fracture risk assessment by FRAX ( Switzerl and ) . RESULTS K-citrate  increased aBMD at lumbar spine from baseline by 1.7 ± 1.5 % [ 95 % confidence interval ( CI ) = 1.0 - 2.3 , P < 0.001 ] net of placebo after 24 months . High-resolution peripheral quantitative computed tomography-measured trabecular densities increased at nondominant tibia ( 1.3 ± 1.3 % , CI = 0.7 - 1.9 , P < 0.001 ) and nondominant radius ( 2.0 ± 2.0 % , CI = 1.4 - 2.7 , P < 0.001 ) . At nondominant radius , trabecular bone volume/tissue volume increased by 0.9 ± 0.8 % , ( CI = 0.1 - 1.7 ) , trabecular thickness by 1.5 ± 1.6 % ( CI = 0.7 - 2.3 ) , and trabecular number by 1.9 ± 1.8 % ( CI = 0.7 - 3.1 , for all , P < 0.05 ) . K-citrate  diminished fracture prediction score by FRAX significantly in both sexes . CONCLUSIONS Among a group of healthy elderly persons without osteoporosis , treatment with K-citrate for 24 months result ed in a significant increase in aBMD and volumetric BMD at several sites tested , while also improving bone microarchitecture . Based on the effect on fracture prediction , an effect on future fractures by K-citrate is possible BACKGROUND A high dietary protein intake has been shown to blunt the deposition of intrahepatic lipids in high-fat- and high-carbohydrate-fed rodents and humans . OBJECTIVE The aim of this study was to evaluate the effect of essential amino acid supplementation on the increase in hepatic fat content induced by a high-fructose diet in healthy subjects . DESIGN Nine healthy male volunteers were studied on 3 occasions in a r and omized , crossover design after 6 d of dietary intervention . Dietary conditions consisted of a weight-maintenance balanced diet ( control ) or the same balanced diet supplemented with 3 g fructose · kg(-1 ) · d(-1 ) and 6.77 g of a mixture of 5 essential amino acids 3 times/d ( leucine , isoleucine , valine , lysine , and threonine ) ( HFrAA ) or with 3 g fructose · kg(-1 ) · d(-1 ) and a maltodextrin placebo 3 times/d ( HFr ) ; there was a washout period of 4 to 10 wk between each condition . For each condition , the intrahepatocellular lipid ( IHCL ) concentration , VLDL-triglyceride concentration , and VLDL-[(13)C]palmitate production were measured after oral loading with [(13)C]fructose . RESULTS HFr increased the IHCL content ( 1.27 ± 0.31 compared with 2.74 ± 0.55 vol % ; P < 0.05 ) and VLDL-triglyceride ( 0.55 ± 0.06 compared with 1.40 ± 0.15 mmol/L ; P < 0.05 ) . HFr also enhanced VLDL-[(13)C]palmitate production . HFrAA significantly decreased IHCL compared with HFr ( to 2.30 ± 0.43 vol% ; P < 0.05 ) but did not change VLDL-triglyceride concentrations or VLDL-[(13)C]palmitate production . CONCLUSIONS Supplementation with essential amino acids blunts the fructose-induced increase in IHCL but not hypertriglyceridemia . This is not because of inhibition of VLDL-[(13)C]palmitate production . This trial was registered at www . clinical trials.gov as NCT01119989 BACKGROUND Phosphate-induced hyperparathyroidism still represents an intriguing problem in dialysis patients . Postpr and ial hyperphosphataemia is considered to be the main stimulus to parathyroid hyperfunction , and therefore many efforts have focused on the use of phosphate binders to prevent phosphate absorption . METHODS We investigated whether the pH-mediated gastric ionization of calcium phosphate dietary salts is necessary for its intestinal absorption . In eight normal subjects we measured 24-h urinary calcium phosphate excretion and the postpr and ial blood calcium phosphate profile after a meal containing 1 g of calcium and 2 g of phosphate salts in a crossover placebo-omeprazole study . On two occasions the subjects received either placebo or omeprazole 60 mg/day 2 days before and during the day test . RESULTS Serum gastrin levels were measured as an indicator of achlorhydria and were 13.7 + /- 1 pg/ml after placebo and 30.4 + /- 4.7 after omeprazole ( P < 0.003 ) . Postpr and ial plasma phosphate profiles were not significantly different between the two studies ( + 36 + /- 8 % after placebo and + 24 + /- 8 % after omeprazole , NS ) , while plasma calcium increased by + 6.1 + /- 1 % after placebo and decreased by -4.2 + /- 0.7 % after omeprazole ( P < 0.01 ) . The 24-h urinary phosphate excretion was 1068 + /- 85 mg after placebo and 773 + /- 55 after omeprazole ( P < 0.002 ) , while the 24-h urinary calcium excretion was 360 + /- 21 after placebo and 238 + /- 15 after omeprazole ( P < 0.0001 ) . A negative relationship was observed between absolute changes in plasma gastrin and those in urinary calcium ( P < 0.009 ) and phosphate ( P < 0.05 ) . CONCLUSIONS The inhibition of gastric acid secretion by omeprazole significantly reduces both urinary phosphate and calcium excretion after an oral load . The behaviour of the postpr and ial calcium-phosphate plasma profile suggests that gastric acid inhibition is more effective in reducing calcium rather than phosphate dietary salts absorption in normal subjects BACKGROUND The effect of meat protein on calcium retention at different calcium intakes is unresolved . OBJECTIVE The objective was to test the effect of dietary protein on calcium retention at low and high intakes of calcium . DESIGN In a r and omized controlled feeding study with a 2 x 2 factorial crossover design , healthy postmenopausal women ( n = 27 ) consumed either approximately 675 or approximately 1510 mg Ca/d , with both low and high protein ( providing 10 % and 20 % energy ) for 7 wk each , separated by a 3-wk washout period . After 3 wk , the entire diet was extrinsically labeled with (47)Ca , and isotope retention was monitored by whole-body scintillation counting . Clinical markers of calcium and bone metabolism were measured . RESULTS High compared with low dietary protein significantly increased calcium retention from the low-calcium ( 29.5 % compared with 26.0 % absorbed ) but not the high-calcium diet ( 18 % absorbed ) . For the low-calcium diet , this effect nearly balanced a protein-related 0.5-mmol/d greater urinary calcium excretion . Protein-related calciuretic effects were independent of dietary calcium . Testing at 1 , 2 , 3 , 5 , and 7 wk showed no long-term adaptation in urinary acidity or urinary calcium excretion . High compared with low dietary protein decreased urinary deoxypyridinoline and increased serum insulin-like growth factor I without affecting parathyroid hormone , osteocalcin , bone-specific alkaline phosphatase , or tartrate-resistant acid phosphatase . CONCLUSIONS In healthy postmenopausal women , a moderate increase in dietary protein , from 10 % to 20 % of energy , slightly improved calcium absorption from a low-calcium diet , nearly compensating for a slight increase in urinary calcium excretion . Under practical dietary conditions , increased dietary protein from animal sources was not detrimental to calcium balance or short-term indicators of bone health BACKGROUND Mammalian gut microbiota have been implicated in a variety of functions including the breakdown of ingested nutrients , the regulation of energy intake and storage , the control of immune system development and activity , and the synthesis of novel chemicals . Previous studies have shown that feeding mammalian hosts a high-fat diet shifts gut bacteria at the phylum level to reduce the ratio of Bacteroidetes-to-Firmicutes , while feeding hosts a fat-restricted diet increases this ratio . However , few studies have investigated the differential effects of fatty acid type on gut bacterial profile . METHODS Over a 14-week period , Mus musculus were fed a diet rich in omega-3 polyunsaturated fatty acids ( n-3 PUFAs ) , omega-6 polyunsaturated fatty acids ( n-6 PUFAs ) , or saturated fatty acids ( SFAs ) . Fecal pellets were collected before and after the treatment period from 12 r and omly selected mice ( 4 per treatment group ) . Bacterial DNA was extracted from the pellets and characterized by analysis of the hypervariable V3 region of the 16S rRNA . Nominal logistic regression models were used to assess shifts in microbial profile at the phylum and family levels in response to diet . RESULTS A significant decrease in the proportion of phylum Bacteroidetes species was observed for mice fed any of the three diets over time . However , the SFA-rich diet group showed a significantly greater decrease in Bacteroidetes proportion ( -28 % ) than did either the n-3 PUFA group ( -10 % ) or the n-6 PUFA group ( -12 % ) . At the family level , a significant decrease in proportion of Porphyromonadaceae was observed for mice fed the n-6 PUFA-rich diet , and a significant decrease in proportion of Lachnospiraceae was observed for mice fed the SFA-rich diet . There was no significant effect of diet type on body mass change . CONCLUSION Our results indicate that SFAs have stronger effects than PUFAs in shifting gut microbiota profiles toward those typical of obese individuals , and that dietary fatty acid saturation influences shifts in gut microbiota independently of changes in body mass Vitamin D deficiency is widespread , affecting over 30 % of adult Australians , and increasing up to 80 % for at-risk groups including the elderly ( age>65 ) . The role for Vitamin D in development of the central nervous system is supported by the association between Vitamin D deficiency and incidence of neurological and psychiatric disorders including Alzheimer ’s disease ( AD ) . A reported positive relationship between Vitamin D status and cognitive performance suggests that restoring Vitamin D status might provide a cognitive benefit to those with Vitamin D deficiency . Mushrooms are a rich source of ergosterol , which can be converted to Vitamin D2 by treatment with UV light , presenting a new and convenient dietary source of Vitamin D2 . We hypothesised that Vitamin D2-enriched mushrooms ( VDM ) could prevent the cognitive and pathological abnormalities associated with dementia . Two month old wild type ( B6C3 ) and AD transgenic ( APPSwe/PS1dE9 ) mice were fed a diet either deficient in Vitamin D2 or a diet which was supplemented with VDM , containing 1±0.2 µg/kg ( ∼54 IU/kg ) vitamin D2 , for 7 months . Effects of the dietary intervention on memory were assessed pre- and post-feeding . Brain sections were evaluated for amyloid β ( Aβ ) plaque loads and inflammation biomarkers using immuno-histochemical methods . Plasma vitamin D metabolites , Aβ40 , Aβ42 , calcium , protein and cholesterol were measured using biochemical assays . Compared with mice on the control diet , VDM-fed wild type and AD transgenic mice displayed improved learning and memory , had significantly reduced amyloid plaque load and glial fibrillary acidic protein , and elevated interleukin-10 in the brain . The results suggest that VDM might provide a dietary source of Vitamin D2 and other bioactives for preventing memory-impairment in dementia . This study supports the need for a r and omised clinical trial to determine whether or not VDM consumption can benefit cognitive performance in the wider population Summary We conducted a 2-year prospect i ve r and omised study to investigate the effects of a linoleic-acid-enriched diet on albuminuria and lipid levels in Type 1 ( insulin-dependent ) diabetic patients with elevated urinary albumin excretion ( overnight urinary albumin excretion rate between 10 and 200 μg/min ) . Thirty-eight patients were r and omly assigned to increase dietary polyunsaturated : saturated fatty acids ratio to 1.0 by replacement of saturated fat with linoleic-acid-rich products ( n=18 , two dropouts , analysis was performed in n=16 ) or to continue their usual diet ( n=20 ) . The total fat and protein content of the diet was unaltered . Clinical characteristics , albuminuria , blood pressure , glomerular filtration rate , metabolic control and dietary composition were similar in the two groups at baseline . In the high linoleic acid diet group , linoleic intake rose from 7±4 to 11±2 energy % and polyunsaturated : saturated fatty acids ratio rose from 0.60±0.28 to 0.96±0.16 ( p<0.001 compared to usual diet group ) . The median increase albuminuria was 58 % ( 95 % confidence interval , 13 to 109 ) during the first year ( p<0.02 ) and 55 % ( 95 % confidence interval , 11 to 127 ) ( p<0.01 ) during the second year . Glomerular filtration rate remained unaltered and filtration fraction tended to rise ( p<0.05 compared to usual diet group ) . In the usual diet group , albuminuria did not significantly increase by 16 % ( 95 % confidence interval , -17 to 38 ) and glomerular filtration rate declined during the second year . Blood pressure tended to rise similarly in both groups . Multiple regression analysis showed an independent effect of the high linoleic acid diet on the progression of albuminuria as well as the lack of decrease in glomerular filtration rate . Low density lipoprotein cholesterol and apolipoprotein B levels decreased in the high linoleic acid diet group ( p<0.05 ) . High density lipoprotein cholesterol declined in both groups ( p<0.05 ) . It is concluded that a linoleic-acid-enriched diet reduces atherogenic lipoproteins but does not have a beneficial effect on and might even promote renal functional abnormalities in Type 1 diabetic patients with elevated urinary albumin excretion Clinical trial evidence exists that supports a role for the omega-3 polyunsaturated fatty acids in coronary heart disease prevention . However , the results from these clinical trials have varied and were conducted in diverse population groups using several different types of omega-3 polyunsaturated fatty acids , including eicosapentaenoic acid , docosahexaenoic acid , and alpha-linolenic acid ( ALA ) . Thus , we systematic ally review ed previously published reports assessing the different types of omega-3 polyunsaturated fatty acid interventions and cardiovascular outcomes . Fourteen r and omized clinical trials were included in the review . Six trials were included with fish oil , with 1 large trial ( 10,000 patients ) dominating the analysis . In aggregate , the fish oil trials demonstrated a reduction in total mortality and sudden death without a clinical ly significant reduction in nonfatal myocardial infa rct ion . The 6 trials with ALA supplements or an ALA-enriched diet were of poorer design than the fish oil trials and had limited power . Many of the trials with ALA involved other changes in dietary components . In aggregate , the ALA trials demonstrated possible benefits in reducing sudden death and nonfatal myocardial infa rct ion , but with wider confidence intervals than in the fish oil trials . In conclusion , the evidence suggests a role for fish oil ( eicosapentaenoic acid , docosahexaenoic acid ) or fish in secondary prevention because recent clinical trial data have demonstrated a significant reduction in total mortality , coronary heart disease death , and sudden death . The data on ALA have been limited by studies of smaller sample size and limited quality Dietary supplementation is approximately a $ 30 billion industry in the United States , with more than 90 000 products on the market . In recent national surveys , 52 % of US adults reported use of at least 1 supplement product , and 10%reporteduseofatleast4suchproducts.1 Vitamins and minerals are among the most popular supplements and are taken by 48 % and 39 % of adults , respectively , typically to maintain health and prevent disease . Despite this enthusiasm , most r and omized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency . Indeed , some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg , high doses of beta carotene , folic acid , vitamin E , or selenium — may have harmful effects , including increased mortality , cancer , and hemorrhagic stroke.2 In this Viewpoint , we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients , as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals . Importantly , clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and , in most cases , provides little if any benefit beyond that conferred by such a diet . Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements . Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects.2,3 A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form . Indeed , research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.3 Although routine micronutrient supplementation is not recommended for the general population , targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone , including people at certain life stages and those with specific risk factors ( discussed in the next 3 sections and in the Box ) Objective : In order to prevent gastric microbial overgrowth , which may complicate nasogastric feeding , administration of nutrients more distally into the gut has been advocated in intensive care patients , as it offers the advantage of keeping the stomach empty and acid . In this study , we assessed the impact of jejunal feeding upon gastic pH in a group of mechanically ventilated , critically ill patients , with special focus on duodenogastric reflux as a possible cause of gastric alkalinization during jejunal nutrition . Design : Prospect i ve experimental study . Setting : Multidisciplinary intensive care unit of a university hospital . Patients and methods : Gastric pH was recorded by continuous pHmetry over a 4-h period of fasting followed by a 4-h period of nasojejunal feeding at 100 kcal/h in 21 mechanically ventilated , critically ill patients . To determine the contribution of duodenogastric reflux to modifications of gastric acidity , the diet was traced with [ 111In ] DTPA ( pentetic acid ) in 11 of these 21 patients ; gastric contents were aspirated every 30 min , then analysed for measurement of radioactivity , glucose , and bile acid concentration . Measurements and results : Median intragastric pH increased slightly from 1.59 ( 1.20–2.73 ; interquartile range ) ( fasting ) to 2.33 ( 1.65–4.64 ) ( feeding ) ( p = 0.013 ) , and the length of time that the pH was 4 or above increased from 1 ( 0–24 ) to 9 ( 0–142 ) min ( p = 0.026 ) . The variability of pH values and the number of acute alkalinization episodes did not change between the two phases . In 10 of 11 patients in which the diet was labeled with [ 111In ] DTPA , reflux was documented at a given time of the feeding period . Bile acid concentrations in the stomach increased from 392 ( 61–1076 ) ( fasting ) to 1446 ( 320–2770 ) μmol/l ( feeding ) ( p = 0.010 ) and mean glucose concentration increased from 59 ( 28–95 ) to 164 ( 104–449 ) mg/dl ( p = 0.006 ) . Conclusion : Duodenogastric reflux is common in mechanically ventilated critically ill patients with nasojejunal feeding tubes . It occurs both during fasting and during nasojejunal feeding . During nasojejunal feeding , moderate alkalinization of the gastric contents occurs as a result of bile and nutrient reflux Vasoactive hormonal response to two levels of dietary protein intake was studied in seven healthy adult volunteers . The subjects were r and omly placed on a 2-g.kg-1.day-1 ( high ) or 0.55-g.kg-1.day-1 ( low ) diet using a crossover design and were studied on the morning of the 5th day and again after 24 h of indomethacin treatment .  Plasma renin activity ( PRA ) , aldosterone , vasopressin , and urinary excretion of 6-ketoprostagl and in F1 alpha ( PGF1 alpha ) were significantly higher on the high-protein diet despite constancy of body weight , blood pressure , pulse , urinary sodium and potassium excretion , and plasma amino acid levels . After treatment with cyclooxygenase inhibitor indomethacin , 6-keto-PGF1 alpha excretion was equalized , but the elevated PRA and aldosterone levels persisted on the high-protein diet , suggesting that PRA and aldosterone elevations do not depend entirely on prostanoid release . We conclude that chronic augmentation of dietary protein intake is accompanied by alterations of vasoactive hormones , which persist for up to 10 h postpr and ially and are independent of elevated plasma amino acid levels . Such hormonal alterations may mediate some of the dietary protein-mediated changes in renal hemodynamics OBJECTIVES To examine the effects of oral glucose load on forearm circulatory regulation before and after ascorbic acid administration in healthy subjects . DESIGN Microcirculation study with laser Doppler was performed at the h and in basal conditions , after ischemia and after acetylcholine and nitroprusside ; strain gauge plethysmography was performed at basal and after ischemia . The tests were repeated in the same sequence 2 hour after oral administration of glucose ( 75 g ) . The subjects were r and omised for administration of ascorbic acid ( 1 g bid ) or placebo ( sodium bicarbonate 1 g bid ) for 10 days . After that , the tests were repeated before and after a new oral glucose load .  Blood pressure and heart rate were monitored . RESULTS Macrocirculatory flux , pressure values and heart rate were unvaried throughout the study . The glucose load caused a reduction in the hyperemic peak flow with laser Doppler and plethysmography ; it reduced flux recovery time and hyperemic curve area after ischemia ; acetylcholine elicited a minor increase in flux with laser Doppler . The response to nitroprusside was unvaried after glucose load as compared to basal conditions . Treatment with ascorbic acid prevented the decrease in hyperemia after glucose , detected with laser Doppler and plethysmography . Ascorbic acid prevented the decreased response to acetylcholine after glucose , the response to nitroprusside was unaffected by ascorbic acid . Results after placebo were unvaried . CONCLUSIONS Oral glucose load impairs endothelium dependent dilation and hyperaemia at microcirculation , probably via oxidative stress ; ascorbic acid can prevent it BACKGROUND Atherosclerosis is a chronic inflammatory disease . We previously reported that a diet high in alpha-linolenic acid ( ALA ) reduces lipid and inflammatory cardiovascular disease risk factors in hypercholesterolemic subjects . OBJECTIVE The objective was to evaluate the effects of a diet high in ALA on serum proinflammatory cytokine concentrations and cytokine production by cultured peripheral blood mononuclear cells ( P BMC s ) from subjects fed the experimental diets . DESIGN A r and omized , controlled , 3-diet , 3-period crossover study design was used . Hypercholesterolemic subjects ( n = 23 ) were assigned to 3 experimental diets : a diet high in ALA ( ALA diet ; 6.5 % of energy ) , a diet high in linoleic acid ( LA diet ; 12.6 % of energy ) , and an average American diet ( AAD ) for 6 wk . Serum interleukin (IL)-6 , IL-1beta , and tumor necrosis factor-alpha ( TNF-alpha ) concentrations and the production of IL-6 , IL-1beta , and TNF-alpha by P BMC s were measured . RESULTS IL-6 , IL-1beta , and TNF-alpha production by P BMC s and serum TNF-alpha concentrations were lower ( P < 0.05 and P < 0.08 , respectively ) with the ALA diet than with the LA diet or AAD .  P BMC production of TNF-alpha was inversely correlated with ALA ( r = -0.402 , P = 0.07 ) and with eicosapentaenoic acid ( r = -0.476 , P = 0.03 ) concentrations in P BMC lipids with the ALA diet . Changes in serum ALA were inversely correlated with changes in TNF-alpha produced by P BMC s ( r = -0.423 , P < 0.05 ) . CONCLUSIONS Increased intakes of dietary ALA elicit antiinflammatory effects by inhibiting IL-6 , IL-1beta , and TNF-alpha production in cultured P BMC s. Changes in P BMC ALA and eicosapentaenoic acid ( derived from dietary ALA ) are associated with beneficial changes in TNF-alpha release . Thus , the cardioprotective effects of ALA are mediated in part by a reduction in the production of inflammatory cytokines Diet has been investigated in relation to its ability to promote cognitive function . However , evidence is currently limited and has rarely been systematic ally review ed , particularly in a mild cognitive impairment ( MCI ) population . This review examined the effect of diet on cognitive outcomes in MCI patients . A total of five data bases were search ed to find r and omised controlled trial ( RCT ) studies , with diet as the main focus , in MCI participants . The primary outcome was incident dementia and /or Alzheimer 's disease ( AD ) and secondary outcomes included cognitive function across different domains using vali date d neuropsychological tests .  Sixteen studies met the inclusion criteria . There was a high degree of heterogeneity relating to the nature of the dietary intervention and cognitive outcomes measured , thus making study comparisons difficult . Supplementation with vitamin E ( one study , n 516 ) , ginkgo biloba ( one study , n 482 ) or Fortasyn Connect ( one study , n 311 ) had no significant effect on progression from MCI to dementia and /or AD . For cognitive function , the findings showed some improvements in performance , particularly in memory , with the most consistent results shown by B vitamins , including  folic acid  ( one study , n 266 ) ,  folic acid alone  ( one study , n 180 ) ,  DHA and EPA  ( two studies , n 36 and n 86 ) ,  DHA  ( one study , n 240 ) and  flavonol supplementation  ( one study , n 90 ) . The findings indicate that dietary factors may have a potential benefit for cognitive function in MCI patients . Further well- design ed trials are needed , with st and ardised and robust measures of cognition to investigate the influence of diet on cognitive status OBJECTIVE To determine the efficacy of fish oil derived ( n-3 ) fatty acid supplementation ( 3 - 6 capsules/day ) in subjects with rheumatoid arthritis ( RA ) whose ( n-6 ) fatty acid intake in the background diet was < 10 g/day , compared to olive/corn oil capsule supplement over a 15 week period . METHODS A placebo controlled , double blind , r and omized 15 week study to determine the effect of supplementation on clinical variables in 50 subjects with RA whose background diet was naturally low in ( n-6 ) fatty acids .  Fish oil containing 60 % ( n-3 ) fatty acids was supplemented at a rate of 40 mg/kg body weight . RESULTS Analysis of 9 clinical variables indicated there was a significant difference ( p < 0.02 ) between control and treatment groups . Five subjects in the treatment group and 3 in the control group met the American College of Rheumatology 20 % improvement criteria . Dietary supplementation result ed in a significant increase in eicosapentaenoic acid in plasma and monocyte lipids in the supplemented group . CONCLUSION The findings suggest that fish oil supplementation that delivers ( n-3 ) fatty acids at a dose of 40 mg/kg body weight/day , with dietary ( n-6 ) fatty acid intake < 10 g/day in the background diet , results in substantial cellular incorporation of ( n-3 ) fatty acids and improvements in clinical status in patients with RA BACKGROUND Early life exposures may be important in the development of asthma and allergic disease . OBJECTIVE To test house dust mite ( HDM ) avoidance and dietary fatty acid modification , implemented throughout the first 5 years of life , as interventions to prevent asthma and allergic disease . METHODS We recruited newborns with a family history of asthma antenatally and r and omized them , separately , to HDM avoidance or control and to dietary modification or control . At age 5 years , they were assessed for asthma and eczema and had skin prick tests for atopy . RESULTS Of 616 children r and omized , 516 ( 84 % ) were evaluated at age 5 years . The HDM avoidance intervention result ed in a 61 % reduction in HDM allergen concentrations ( microg/g dust ) in the child 's bed but no difference in the prevalence of asthma , wheeze , or atopy ( P > .1 ) . The prevalence of eczema was higher in the active HDM avoidance group ( 26 % vs 19 % ; P = .06 ) . The ratio of omega-6 to omega-3 fatty acids in plasma was lower in the active diet group ( 5.8 vs 7.4 ; P < .0001 ) . However , the prevalence of asthma , wheezing , eczema , or atopy did not differ between the diet groups ( P > .1 ) . CONCLUSION Further research is required to establish whether other interventions can be recommended for the prevention of asthma and allergic disease . CLINICAL IMPLICATION S House dust mite avoidance measures and dietary fatty acid modification , as implemented in this trial during infancy and early childhood , did not prevent the onset of asthma , eczema , or atopy in high-risk children Epidemiological studies as well as r and omised dietary trials suggest that Mediterranean diet may be important in relation to the pathogenesis and prevention of  coronary heart disease ( CHD ) . A striking protective effect of a Mediterranean diet rich in alpha-linolenic acid ( ALA ) was reported in the Lyon Diet Heart Study with a 50 to 70 % reduction of the risk of recurrence after four years of follow-up in CHD patients . According to current knowledge , dietary ALA should represent about 0.6 to 1 % of total daily energy or about 2 g per day in patients who follow a traditional Mediterranean diet . Supplementation with very long chain omega-3 fatty acids ( c.1 g per day ) in patients following a Mediterranean type of diet  was shown to decrease the risk of cardiac death by 30 % and of sudden cardiac death by 45 % in the GISSI trial . Thus , in the context of a diet rich in oleic acid , poor in saturated fats and not high in omega-6 fatty acids ( a dietary pattern characterizing the traditional Mediterranean diet ) , even a small dose of very long chain omega-3 fatty acids ( one gram under the form of capsules ) might be very protective . These data underline the importance of the accompanying diet in any dietary strategy using fatty acid complements The study was design ed to evaluate the chronic regulation of plasma leptin by dietary ( n-3 ) polyunsaturated fatty acids ( PUFA ) in insulin-resistant , sucrose-fed rats . Male Sprague-Dawley rats were r and omly assigned to consume for 3 or 6 wk a diet containing 57.5 % ( g/100 g ) sucrose and 14 % lipids as either fish oil ( SF ) or control oils ( SC ) . After 3 and 6 wk of consuming the SF diet , plasma leptin was 70 % ( P < 0.001 ) and 75 % ( P < 0.05 ) greater , respectively , than in rats fed the SC diet . The same result was found when plasma leptin was adjusted by total fat mass , as measured by dual-energy X-ray absorptiometry . Despite high leptin levels , food intake of rats fed the SF diet was greater than in SC-fed rats without any difference in body weight or total fat mass . After 3 wk , accumulated leptin in epididymal and retroperitoneal adipose tissue was higher in the SF-fed rats than in the SC-fed rats . However , after 6 wk , tissue leptin in the SF-fed rats did not differ from that of the SC-fed rats . The SF diet increased adipose tissue glucose transporter-4 protein quantity and prevented the sucrose-induced elevations in plasma triglycerides and free fatty acids . When all SC- and SF-fed rats ( both diets and feeding duration s ) were considered , plasma leptin levels were positively correlated with body weight ( r = 0.5 , P < 0.0001 ) and with total fat mass ( r = 0.5 , P < 0.0005 ) . These results suggest that plasma leptin at a given time could be inappropriately high for a given fat mass in insulin-sensitive rats fed ( n-3 ) PUFA Amino acid infusions during general anesthesia induce thermogenesis and prevent postoperative hypothermia . The effects of increased heat production during anesthesia on postoperative nitrogen balance have not been examined . Therefore , we studied the effect of perioperative amino acid infusions on postoperative nitrogen excretion in 24 patients scheduled for hysterectomy . Seven volunteers not subjected to anesthesia or surgery were used as awake controls . During isoflurane anesthesia , 8 patients received acetated Ringer 's solution , and 16 patients received an IV amino acid mixture , 240 kJ/h , before and during anesthesia . Rectal temperature and energy expenditure were measured . The urinary nitrogen content was calculated from urea , creatinine , and urate the day before surgery and for 4 days postoperatively . Diets were recorded . In anesthetized control patients , postoperative nitrogen excretion was less than preoperative levels . Those patients also experienced the largest decrease in core body temperature during anesthesia ( 1.7 + /- 0.1[degree sign]C ) . All had postoperative shivering . In the  amino acid-treated  patients , the temperature decrease during anesthesia was less pronounced ( 1.0 + /- 0.1[degree sign]C ; P < 0.001 ) and postoperative shivering disappeared . In addition , the nitrogen excretion was unchanged postoperatively , perhaps indicating an increase in protein turnover known to generate heat . In conclusion , the increase in heat production induced by amino acids reduced hypothermia , abolished shivering , and attenuated/normalized the postoperative nitrogen saving that occurred in patients who did not receive amino acids .  Implication s : We compared nitrogen excretion before and after surgery in patients who received a saline or amino acid infusion during isoflurane anesthesia . The increase in heat production induced by amino acids reduced hypothermia , abolished shivering , and attenuated/normalized the postoperative nitrogen saving that occurred in patients who did not receive  amino acids . ( Anesth Analg 1998;87:641 - 6 Chronic acid loads are an obligate consequence of the high animal/grain protein content of the Western diet . The effect of this diet-induced metabolic acidosis on bone mass is controversial . In a r and omized , prospect i ve , controlled , double-blind trial , 161 postmenopausal women ( age 58.6 + /- 4.8 yr ) with low bone mass ( T score -1 to -4 ) were r and omly assigned to 30 mEq of oral potassium ( K ) citrate ( Kcitrate ) or 30 mEq of K chloride ( KCl ) daily . The primary end point was the intergroup difference in mean percentage change in bone mineral density ( BMD ) at lumbar spine ( L2 through L4 ) after 12 mo . Compared with the women who received KCl , women who received Kcitrate exhibited an intergroup increase in BMD ( + /-SE ) of 1.87 + /- 0.50 % at L2 through L4 ( P < 0.001 ) , of 1.39 + /- 0.48 % ( P < 0.001 ) at femoral neck , and of 1.98 + /- 0.51 % ( P < 0.001 ) at total hip . Significant secondary end point intragroup changes also were found : Kcitrate increased L2 through L4 BMD significantly from baseline at months 3 , 9 , and 12 and reached a month 12 increase of 0.89 + /- 0.30 % ( P < 0.05 ) , whereas the KCl arm showed a decreased L2 through L4 BMD by -0.98 + /- 0.38 % ( P < 0.05 ) , significant only at month 12 . Intergroup differences for distal radius and total body were NS . The Kcitrate-treated group demonstrated a sustained and significant reduction in urinary calcium excretion and a significant increase in urinary citrate excretion , with increased citrate excretion indicative of sustained systemic alkalization . Urinary bone resorption marker excretion rates were significantly reduced by Kcitrate , and for deoxypyridinoline , the intergroup difference was significant . Urinary net acid excretion correlated inversely and significantly with the change in BMD in a subset of patients . Large and significant reductions in BP were observed for both K supplements during the entire 12 mo . Bone mass can be increased significantly in postmenopausal women with osteopenia by increasing their daily alkali intake as citrate , and the effect is independent of reported skeletal effects of Low-sodium Dietary Approaches to Stop Hypertension ( DASH ) diets are base producing but restrict red meat without clear justification . We hypothesized that a vitality diet ( VD ) , a low-sodium DASH-type diet with a low dietary acid load containing 6 servings of 100 g cooked lean red meat per week , would be more effective in reducing blood pressure ( BP ) compared with a higher acid load reference healthy diet ( RHD ) based on general dietary guidelines to reduce fat intake and increase intake of breads and cereals . A r and omized , parallel dietary intervention study was conducted to compare the BP-lowering effect of these 2 diets in postmenopausal women with high/normal BP . Women were r and omly assigned to follow either VD or RHD for 14 weeks . Home BP was measured daily with an automated BP monitor under st and ard conditions . Of 111 women commencing the study , 95 completed ( 46 VD , 49 RHD ) . Systolic BP ( SBP ) throughout the intervention was lower in the VD group compared to the RHD group ( repeated- measures analysis of variance time by diet , P = .04 ) , such that at the end of the study , the VD had a fall of SBP by 5.6 + /- 1.3 mm Hg ( mean + /- SEM ) compared with a fall of 2.7 + /- 1.0 mm Hg in the RHD ( group difference , P = .08 ) . When only those taking antihypertensive medications were assessed , the VD ( n = 17 ) had a significant fall of 6.5 + /- 2.5 mm Hg SBP ( P = .02 ) and 4.6 + /- 1.4 mm Hg diastolic BP ( P = .005 ) after 14 weeks , and their BP was lower than that of the RHD group ( n = 18 ) throughout the study ( P < .05 ) . We concluded that a low-sodium DASH diet with a low dietary acid load , which also included lean red meat on most days of the week , was effective in reducing  BP in older women , particularly in those taking antihypertensive medications A group of women were fed two separate diets in a crossover study and urinary eicosanoids were quantified . One diet contained 3.1 % of total energy ( en% ) as polyunsaturated fatty acids ( 3.0 en% linoleic acid ) and the other contained 8.4 en% polyunsaturated fatty acids ( 8.3 en% linoleic acid ) . Carbohydrate replaced fat in the low-polyunsaturated-fat diet . No changes were observed in the urinary excretion of 6-oxo-prostagl and in F1 alpha , its 2,3-dinor metabolite or thromboxane B2 by subjects on either of the diets . Urinary 2,3-dinor-thromboxane B2 excretion was lower ( 206.5 ng/24 h ) when subjects were fed the high-omega 6 polyunsaturated fatty acid diet when compared with the lower-omega 6 polyunsaturated fatty acid diet ( 275.3 ng/24 h ) . Conversely , urinary prostagl and in E2 was higher ( 139.2 ng/g creatinine ) during the higher-omega 6 polyunsaturated fatty acid diet when compared with the lower-omega 6 polyunsaturated fatty acid diet ( 94.4 ng/g creatinine ) OBJECTIVE To evaluate the potential body weight-lowering effects of dietary supplementation with eicosapentaenoic acid ( EPA ) and α-lipoic acid separately or combined in healthy overweight/obese women following a hypocaloric diet . METHODS This is a short-term double-blind placebo-controlled study with parallel design that lasted 10 weeks . Of the r and omized participants , 97 women received the allocated treatment  [ Control , EPA ( 1.3 g/d ) , α-lipoic acid ( 0.3 g/d ) , and EPA+α-lipoic acid ( 1.3 g/d+0.3 g/d ) ] , and 77 volunteers completed the study . All groups followed an energy-restricted diet of 30 % less than total energy expenditure . Body weight , anthropometric measurements , body composition , resting energy expenditure , blood pressure , serum glucose , and insulin and lipid profile , as well as leptin and ghrelin levels , were assessed at baseline and after nutritional intervention . RESULTS Body weight loss was significantly higher ( P<0.05 ) in those groups supplemented with α-lipoic acid . EPA supplementation significantly attenuated ( P<0.001 ) the decrease in leptin levels that occurs during weight loss . Body weight loss improved lipid and glucose metabolism parameters but without significant differences between groups . CONCLUSIONS The intervention suggests that α-lipoic acid supplementation alone or in combination with EPA may help to promote body weight loss in healthy overweight/obese women following energy-restricted diets BACKGROUND Two factors thought to influence the risk of asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids . Although house dust mite allergen avoidance has been used as a preventive strategy in several trials , the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known . OBJECTIVE To measure the effects of dietary supplementation with omega-3 fatty acids and house dust mite allergen avoidance in children with a family history of asthma . METHODS A total of 616 children at high risk of asthma were enrolled antenatally in a r and omized controlled trial , and 526 children remained in the trial at age 3 years . The outcomes were symptoms of allergic disease and allergen sensitization . RESULTS There was a significant 10.0 % ( 95 % CI , 3.7 - 16.4 ) reduction in the prevalence of cough in atopic children in the active diet group ( P=.003 ; number needed to treat , 10 ) but a negligible 1.1 % ( 95 % CI , -7.1 to 9.5 ) reduction cough among nonatopic children . There was a 7.2 % ( 95 % CI , 10.11 - 14.3 ) reduction in sensitization to house dust mite in the active allergen avoidance group ( P=.05 ; number needed to treat , 14 ) . No significant differences in wheeze were found with either intervention . CONCLUSION These results suggest that our interventions , design ed to be used in simple public health campaigns , may have a role in preventing the development of allergic sensitization and airways disease in early childhood . This offers the prospect of reducing allergic disease in later life OBJECTIVE Consumption of fruits and vegetables has been implicated in lowering net acid excretion ( NAE ) , but few studies have directly examined NAE and urinary calcium effects . Further , there is no evidence that only fresh fruits and vegetables must be consumed for a beneficial effect on bone . METHODS A crossover , acute-load study was design ed to investigate whether processed fruit was as effective as fresh fruit in reducing NAE and protein-induced hypercalciuria .  Fifteen women completed three dietary treatments on three different mornings . A fasting urine sample was collected before consuming one of the following three isocaloric high-protein treatments : control , fresh apples , and processed applesauce . The serving size for the applesauce treatment was 2.5 times that for fresh apples . Urine was collected at baseline ( 0 h ) and at 1.5 , 3.0 , and 4.5 h. RESULTS Compared with baseline , NAE increased after control treatment but decreased after fresh or processed apple treatment ( P = 0.041 ) . Calcium excretion increased with all treatments by 3 h ; however , the increase was less for fresh apple and applesauce ( P = 0.024 ) . CONCLUSIONS In an acute feeding model , fruit intake reduced NAE and urinary calcium excretion . Processed fruit appears to be effective , although a larger serving size was needed than with fresh fruit BACKGROUND The magnitude of the effect of soy protein on lipoprotein concentrations is variable . This discordance is likely attributable to the various forms of soy protein used and to unrecognized shifts in dietary fatty acid , cholesterol , and fiber . OBJECTIVE The objective was to evaluate the effect of soybean processing as well as soy consumption relative to animal protein , independent of alterations in major dietary variables , on cardiovascular disease risk factors and vascular endothelial function . DESIGN Twenty-eight hypercholesterolemic subjects ( LDL cholesterol > /=3.36 mmol/L ) aged > 50 y consumed each of 4 diets for 6-wk periods according to a r and omized crossover design . The diets [ 55 % of energy as carbohydrate , 30 % of energy as fat , and 15 % of energy as protein-7.5 % of energy as experimental protein ( 37.5 g/d ) ] were design ed to contain products made from either whole soybeans , soyflour , or soymilk and were compared with a diet containing an equivalent amount of animal protein ( meat , chicken , and dairy products ) . The  cholesterol , fiber , and fatty acid profiles of the diets were equalized . All food and drink were provided , and body weight was maintained throughout the study . RESULTS No significant differences in blood pressure , vascular endothelial function , or total cholesterol , VLDL-cholesterol , triacylglycerol , apolipoprotein B , or C-reactive protein concentrations were observed between the diets . Consumption of the soymilk diet result ed in a modest decrease ( 4 % ) in LDL-cholesterol concentrations compared with the animal-protein and soyflour diets ( P < 0.05 ) and higher HDL-cholesterol ( 1 % ) and apolipoprotein A-I ( 2 % ) concentrations compared with the soybean and soyflour diets ( P < 0.05 ) . CONCLUSIONS The results suggest that the consumption of differently processed soy-based products and different types of protein ( animal and soy ) has little clinical effect on cardiovascular disease risk factors , including peripheral endothelial function , when other major dietary variables are held constant
Urine calcium excretion rates were consistent with osteoporosis development ; however calcium balance studies did not demonstrate loss of whole body calcium with higher net acid excretion .
No study revealed a biologic mechanism functioning at physiological pH. Finally , r and omized studies did not provide evidence for an adverse role of phosphate , milk , and grain foods in osteoporosis .
Conclusions A causal association between dietary acid load and osteoporotic bone disease is not supported by evidence and there is no evidence that an alkaline diet is protective of bone health
Background Modern diets have been suggested to increase systemic acid load and net acid excretion .
In response , alkaline diets and products are marketed to avoid or counteract this acid , help the body regulate its pH to prevent and cure disease .
The objective of this systematic review was to evaluate causal relationships between dietary acid load and osteoporosis using Hill 's criteria .