Ca Supplementation Research Articles

The need to give calcium supplementation after total thyroidectomy.

Background: A prospective study was carried on female patients after total thyroidectomy to assess the need for calcium supplementation after surgery. Aim of work: To assess the need for routine calcium supplementation after total thyroidectomy. Patients and Methods: From 2017 to 2018, a total of 90 female patients with different thyroid disorders were conducted; thyroid cancer or previous neck surgery patients were excluded, neck ultrasound was done. Results: Study shows improvement in the level of serum calcium in the group already on supplementation. On the other hand it shows slight decrease in serum calcium level in the group without supplementation. The statistical analysis showed highly significant relationship between the Ca supplementation and hypocalcemia with P value of less than 0.05 Conclusion: Certain risk factors are associated with post-thyroidectomy hypocalcemia. Total thyroidectomy, thyroiditis and routine non calcium supplementation were found to be the main risk factors of post-thyroidectomy hypocalcemia in the present study.

P0893BONE EFFECTS AND SAFETY OF ONE YEAR DENOSUMAB THERAPY IN A COHORT OF RENAL TRANSPLANTED PATIENTS: AN OBSERVATIONAL MONOCENTRIC STUDY

Abstract Background and aims Bone and mineral metabolism (MM) disorders are relevant problems in renal transplanted patients (RTxp). In our observational monocentric study, we evaluated the effects on femoral and lumbar bone mineral density (BMD) and on MM parameters, and the safety of one year-treatment with Denosumab (DB) in a cohort of RTxp. Method We recorded data about 32 RTxp treated with DB in our Center in the last year. RTxp were evaluated for BMD and T-score (Ts) before the start (T0) and after 12 months (T12) of treatment. Osteopenia was defined, at femoral (F-OPN) and lumbar (L-OPN) sites as Ts:-1>Ts>-2.5 whereas osteoporosis, in the same sites (F-OPS and L-OPS) as Ts<-2.5. X ray evaluation for spontaneous vertebral fractures (sVF) was made at T0 and, in 25 RTxp repeated at T12. MM and renal function parameters (serum creatinine, sCr and daily urinary protein excretion, ProtU) were recorded at T0 and after 1,3,6, and 12 months of therapy. The clinical indications for DB therapy, in the presence of Ca>9.0 mg/dL were the finding at T0 of: 1) F-OPS and/or V-OPS; 2) sVF. During the year of treatment, hypocalcemic (HpCa=Ca<8.0 mg/dL) episodes, infections, graft rejections and loss and RTxp survival were monitored. Results The cohort was composed mainly by females (n=21). The time of RTx was 144[59-232]mths. Steroid therapy was prescribed in 30 RTxp (93%), 22(68%) and in 2 (6%) RTxp were taking 25OHD and 1-25OH. Three RTxp (9%) were receiving Ca supplements. Bisphosphonate therapy was reported in 15 RTxp (46%) in the year before DB start. At T0, 25(78%) and 7 (22%) RTxp had F-OPS and F-OPN. Twenty-three (71%) and 6 (20%) RTxp had L-OPS and L-OPN. In 3 RTxp normal lumbar T-score was found. sVF were present in 17 RTxp (53%). Ca and P were 9.6±0.6 mg/dL and 3.1±0.6 mg/dL whereas PTH, ALP and 25OHD were 64±32 pg/mL, 80±37 U/L and 28±16 mg/dL. SCr and Prot-U were 1,32±0,4 mg/dL and 0,23±0,16 g/24h. At T12, F-Ts increased significantly (T0: -3.0[-3.5/-2.5] vs T12:-2.8[-3.5/-2.4) as like as V-Ts (T0: -3.0[-3.7/-1.9] vs T12:-2.8[-3.0/-1.6) both p<0.0001. A significant increase was found also in BMD: F-BMD +2.4%[-1.1%/+13%] (p<0.0001), V-BMD +2.6%[-3.4%/+12%] (p=0.009). The prevalence of F-OPS reduced from 78% to 73% (p<0.0001) and 4 RTxp ameliorated their Ts category. Prevalence of V-OPS reduced to 53% at T12 from 71% (p<0.001), and 4 RTxp ameliorated their Ts category. In 2 RTxp were found novel sVF. During the treatment no significant modifications of Ca were found, with only a slight but significant difference between T0 and T12 (T12 Ca: 9.22±1.17, p=0.01). PTH and ALP were significantly higher at T3, T6 and T12 respect T0. No differences in 25OH, sCr and ProtU were found. During the year of treatment, in 3 RTxp 25OHD supplementation was started. No one required novel Ca supplementation. DB therapy wasn’t associated to HpCa episodes. Four RTxp had infections during the time of treatment (mean time of DB treatment:114 days). They had positive pathologic anamnesis for urinary tract infections (UTI). Two of them had symptomatic UTI and 2 required hospitalization for sepsis. No biopsy proven graft rejections were observed during the time of treatment and no graft loss or RTxp death were reported. Conclusions The preliminary results presented in our study, limited by the monocentric, not randomized design and by the smallness of the cohort, reported a good bone efficacy of DB in RTxp, especially at lumbar level. The therapy was characterized by a good general safety. Future longer and randomized studies, involving more RTxp might elucidate the possible primary role of DB in the treatment of bone disorders in RTxp.

P0902DAILY TERIPARATIDE TREATMENT AND PHARMACOKINETICS IN HEMODIALYSIS PATIENTS WITH LOW BONE MASS

Abstract Background and Aims Daily 20µg teriparatide (PTH1-34) is an osteoanabolic agent approved for use treating osteoporosis. However, there are few reports about concerning use of this agent in hemodialysis patients. Method We conducted an observational study, single centre study on 5 patients with low bone mineral density (BMD) and low iPTH levels defied as iPTH below 60 pg/mL, who were treated with recombinant human PTH1-34; teriparatide 20 µg 3 times per week between January 2012 and January 2015. All patients were 20 years of age or older, had undergone regular hemodialysis treatment and were without skeletal malignancies and bone metastasis. Low BMD in this study was defined either as BMD T-score -2.5 at the lumbar spine (LS) or /and femoral neck (FN) and distal one –third radius (RS) analyzed by dual-energy X-ray absorptiometry (DXA), or BMD T-score of -2.5 to -1.0 with history of fragility fractures. We analyzed the biochemical data including bone metabolic makers (intact amino-terminal propeptide of type I collagen (iP1NP), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase-5b (TRACP-5b) at baseline, and after 3, 6, and 12 months of teriparatide treatment. BMD at LS and FN were evaluated at 6months of treatment. Results Data from five patients (mean age: 69.2±7.4years; mean hemodialysis time: 23.2±6.2years) were reviewed. Laboratory data at baseline were iPTH: 34.2±24.2 pg/mL, BAP: 13.0±4.9 µg/L, iP1NP: 45.3±14.3 ng/mL, TRACP-5b: 350±201 mU/dL, corrected Ca (cCa): 9.7±0.3 mg/dL, and P:4.1±0.7 mg/dL. Baseline BMD T-score at LS and FN were -2.8±1.7 and -3.0±0.6, respectively. During a 12 month- teriparatide treatment, mean cCa levels significantly decreased from 9.7±0.3 to 9.1±0.2 mg/dL at 3 months (P < 0.05) and returned to 9.5±0.4 mg/dL at 12 months. As for bone metabolic markers, BAP and iP1NP significantly increased from baseline by 31.3±12.9 (P < 0.05) and 47.4±14.5% (P < 0.05) at 6 months of teriparatide treatment, while TRACP-5b significantly decreased by 10.5±2.5% at 3 months, which did not reach a statistical significance. BMD changes from baseline at LS and FN were 2.1±2.5% and 1.2±1.5% at 6 months of treatment with a significant change at LS. Pharmacokinetics of Teriparatide The time-course of changes in plasma teriparatide acetate concentration was evaluated in one patient who had undergone parathyroidectomy 20 years before enrollment in this study and her serum endogenous iPTH level was undetectable at baseline. After teriparatide injection, serum teriparatide acetate levels peaked at 30 minutes at 157.2 pg/mL, and then rapidly decreased to undetectable levels at 240 minutes. Conclusion We report that teriparatide improved LS and FN BMD in hemodialysis patients with low iPTH. Pharmacokinetics showed this agent might not accumulate in dialysis patients and can be used safely. Adequate Ca supplementation might be needed to adjust serum Ca levels.

Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health

Supplementation with calcium (Ca) and/or vitamin D (vitD) is key to the management of osteoporosis. Other supplements like vitamin K2 (VitK2) and magnesium (Mg) could contribute to the maintenance of skeletal health. This narrative review summarizes the most recent data on Ca, vitD, vitK2 and Mg supplementation and age-related bone and muscle loss. Ca supplementation alone is not recommended for fracture prevention in the general postmenopausal population. Patients at risk of fracture with insufficient dietary intake and absorption could benefit from calcium supplementation, but it needs to be customized, taking into account possible side-effects and degree of adherence. VitD supplementation is essential in patients at risk of fracture and/or vitD deficiency. VitK2 and Mg both appear to be involved in bone metabolism. Data suggest that VitK2 supplementation might improve bone quality and reduce fracture risk in osteoporotic patients, potentially enhancing the efficacy of Ca ± vitD. Mg deficiency could negatively influence bone and muscle health. However, data regarding the efficacy of vitK2 and Mg supplementation on bone are inconclusive.

Negative dietary cation-anion difference and amount of calcium in prepartum diets: Effects on milk production, blood calcium, and health

Acidogenic prepartum diets with negative dietary cation-anion difference (DCAD) induce compensated metabolic acidosis, which stimulates calcium (Ca) mobilization before calving and decreases clinical and subclinical hypocalcemia postpartum. This strategy is often combined with limiting dietary Ca concentrations, which historically has been used to mobilize Ca prepartum to prepare cows for lactation. Supplemental dietary Ca in combination with a negative DCAD formulation that does not reverse the effect of compensated metabolic acidosis may be beneficial. Our objective was to determine the effects of prepartum dietary strategies on dry matter intake (DMI), milk production, peripartal Ca status, and health during the transition period in multiparous Holstein cows (n = 81). Treatments during the last 28 d before calving were: (1) positive DCAD diet, +6 mEq/100 g of DM, target urine pH >7.5, low dietary Ca (0.40% DM; CON); (2) negative DCAD diet, -24 mEq/100 g of DM, target urine pH 5.5 to 6.0, low dietary Ca (0.40% DM; ND); or (3) negative DCAD diet, -24 mEq/100 g of DM, target urine pH 5.5 to 6.0, , high dietary Ca (2.0% DM; NDCA). Preplanned treatment contrasts were: (1) CON versus (ND and NDCA), and (2) ND versus NDCA. Individual DMI were recorded daily. Cows were milked 3 times daily, with individual DMI and milk yield summarized by week. Whole blood sampled at calving and 24 h, 48 h, and 4 d after calving was analyzed for ionized Ca concentration, and serum was analyzed for total Ca. Prepartum urine pH for cows fed ND or NDCA averaged 5.7, whereas cows fed CON remained >7.5. During the 3 wk before calving, cows fed CON had greater DMI than cows fed ND or NDCA, with NDCA greater than ND. Postpartum DMI (% of body weight) tended to be less for cows fed CON than for those fed ND or NDCA prepartum. Thresholds for subclinical hypocalcemia were ionized Ca <1.0 mM at 24 h, and total Ca ≤2.125 mM at 48 h after calving. On average, blood Ca for cows fed CON indicated subclinical hypocalcemia, whereas blood Ca for cows fed ND or NDCA was greater than subclinical hypocalcemia thresholds for both ionized Ca and total Ca. No milk production differences were detected. Cows fed CON had an elevated adverse health score (calculated by assigning numerical values to recorded health events) and tended to have an elevated somatic cell count during the fresh period compared with cows fed ND or NDCA. Overall, an acidogenic diet prepartum without or with high Ca improved postpartum Ca status and health. Supplementation of additional Ca to the acidogenic diet had little effect.

Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis

BackgroundAdequate calcium (Ca) intake is required for bone mineralization in children. We assessed Ca intake from diet and medications in children with CKD stages 4–5 and on dialysis (CKD4–5D) and age-matched controls, comparing with the UK Reference Nutrient Intake (RNI) and international recommendations.MethodsThree-day prospective diet diaries were recorded in 23 children with CKD4–5, 23 with CKD5D, and 27 controls. Doses of phosphate (P) binders and Ca supplements were recorded.ResultsMedian dietary Ca intake in CKD4–5D was 480 (interquartile range (IQR) 300–621) vs 724 (IQR 575–852) mg/day in controls (p = 0.00002), providing 81% vs 108% RNI (p = 0.002). Seventy-six percent of patients received < 100% RNI. In CKD4–5D, 40% dietary Ca was provided from dairy foods vs 56% in controls. Eighty percent of CKD4–5D children were prescribed Ca-based P-binders, 15% Ca supplements, and 9% both medications, increasing median daily Ca intake to 1145 (IQR 665–1649) mg/day; 177% RNI. Considering the total daily Ca intake from diet and medications, 15% received < 100% RNI, 44% 100–200% RNI, and 41% > 200% RNI. Three children (6%) exceeded the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) upper limit of 2500 mg/day. None with a total Ca intake < RNI was hypocalcemic, and only one having > 2 × RNI was hypercalcemic.ConclusionsSeventy-six percent of children with CKD4–5D had a dietary Ca intake < 100% RNI. Restriction of dairy foods as part of a P-controlled diet limits Ca intake. Additional Ca from medications is required to meet the KDOQI guideline of 100–200% normal recommended Ca intake.Graphical abstract

Assessment of exposure to toxic metals and measures to address deficiency of essential trace elements in young children in rural Hubei, China.

Children are exposed to toxic metals via diet and environment, which results in adverse health effects. Several trace elements are important for the nutritional status of children; however, little information is available for rural regions in Asia. Our goal was to assess the body burden of lead, cadmium, and aluminum (Al) as toxic metals and calcium (Ca), zinc, copper, selenium (Se), strontium, and boron as trace elements in children. Multiple environmental samples, including soil, dust, fine particulates, drinking water, and food, were collected for each family. A survey was conducted by trained personnel to record detailed information about children attending a rural school. Twenty-four-hour urine samples were collected. The levels of toxic and essential trace elements were determined by inductively coupled plasma mass spectrometry. We found that the daily intake of toxic metals was below the recommended maximum, suggesting low health risks. More attention should be given to the ingestion of Al by the hand-to-mouth pathway. Ca deficiency was discovered to be a serious health problem for rural children, with Ca inadequacies reaching 96%. The excessive intake of Se-rich products from industry suggests an increased risk of toxicity. This study highlights the health risks to children who live in rural regions and the importance of dietary Ca supplementation in school meals.

Using low-moisture molasses-based blocks to supplement Ca salts of soybean oil to forage-fed beef cows.

This experiment compared plasma fatty acid (FA) profile of forage-fed beef cows receiving a molasses-based supplement enriched with Ca salts of soybean oil [CSSO; 24.7% of dry matter (DM)] via a self-fed low-moisture block (LMB) or hand-fed granular concentrate daily (CONC). Thirty-six nonlactating, nonpregnant, multiparous beef cows were blocked by age (three blocks), ranked within blocks by body weight (BW) and body condition score (BCS), and allocated to 1 of three drylot pens (27 × 10 m) per block. Nine pens with four cows each were enrolled in a replicated 3 × 2 Latin square design with two periods of 42 d, and a 21-d washout interval. On day 0, pens within each block were randomly assigned to receive one of the three treatments, in a manner that pens did not receive the same treatment in both periods (total n = 6 pens per treatment). Cows received hay (Cynodon dactylon), water, and a mineral–vitamin mix for ad libitum consumption during the study. Hay intake was recorded daily from days 0 to 42, and LMB intake was recorded from days 14 to 42 to allow cows to adapt to supplement with minimal interference from days 0 to 13. The CONC was offered at 0.420 kg/cow daily (DM basis) from days 0 to 13 and then adjusted (days 14 to 42) to match LMB intake. Cow BW and BCS were recorded, and blood samples were collected on days 0, 14, 28, and 42. Average LMB intake during the initial 13 d was 0.846 ± 0.107 kg/cow daily (DM basis). Supplement DM intake did not differ (P = 0.39) between LMB and CONC cows from days 14 to 42 as designed (0.570 vs. 0.583 kg/d, respectively; SEM = 0.011), despite a greater variation in daily intake of LMB vs. CONC (treatment × day interaction; P < 0.01). No treatments effects were noted (P ≥ 0.40) for hay intake, BCS, and BW. Treatment × day interactions were detected (P ≤ 0.01) for plasma concentrations of ω-6 polyunsaturated FA and total FA. On day 0, plasma FA profile did not differ (P ≥ 0.20) between treatments. From days 14 to 42, plasma concentrations of linoleic acid, ω-6 polyunsaturated FA, and total FA were greater (P < 0.01) in CONC and LMB vs. NOSUPP cows. Plasma concentrations of these FA were also greater (P ≤ 0.03) in LMB vs. CONC cows on day 14, but did not differ (P ≥ 0.35) on days 28 and 42. These results indicate that CSSO inclusion into LMB resulted in similar incorporation of ω-6 polyunsaturated and total FA in the circulation compared with CONC offered at the same daily rate. Hence, the use of self-fed LMB appears to be a valid strategy to provide CSSO to forage-fed beef cattle with reduced labor needs.

Effect of postoperative hypoalbuminemia and supplement of human serum albumin on the development of poor wound healing following lumbar internal fixation surgery

Objective: To analyze the association between postoperative hypoalbuminemia and poor wound healing, and to evaluate whether postoperative supplementation of human serum albumin can improve postoperative wound healing after lumbar internal fixation surgery. Methods: From January 2014 to December 2018, 602 patients who underwent lumbar internal fixation surgery in the Department of Orthopedics, Zhujiang Hostiptal of Southern Medical University were identified. There were 250 males (41.5%) and 352 females (58.5%), with an average age of (60±12) years. All patients' clinical records were reviewed, including demographics data, comorbidity data, preoperative serum laboratory values, intraoperative factor, postoperative serum laboratory values and wound healing, and the incidence rate of poor wound healing was calculated. The statistical analyses were performed with R software and Empower(R) to analyze the factors related to poor wound healing. Multiple logistic regression models were performed with adjustment for the potential confounders to evaluate the effect of postoperative hypoalbuminemia and supplementation of human serum albumin on the development of poor wound healing. Results: Poor wound healing occurred in 51(8.47%) patients. After adjusting for the confounding factors, multiple regression analysis showed that there was no correlation between postoperative albumin levels and poor wound healing(OR=1.00, 95%CI: 0.91-1.10, P=1.000). Compared with patients with postoperative normal albumin level, postoperative hypoalbuminemia would increase the risk of poor wound healing by 13% (OR=1.13, 95%CI: 0.47-2.70, P=0.787). There was no correlation between supplementation of human serum albumin and poor wound healing in patients with normal albumin levels or postoperative hypoalbuminemia (P>0.05). Conclusions: There is no correlation between postoperative hypoalbuminemia and poor wound healing after lumbar internal fixation surgery. Postoperative supplementation of human serum albumin can't improve wound healing.

Research Note: Phosphorus digestibility in conventional canola meal determined using different balance assays

Three experiments were conducted to determine ileal P digestibility and excreta P retention values for canola meal (CM) using 3 different types of balance assays. The first experiment was an ad libitum–fed chick experiment which evaluated the effect of phytase on ileal P digestibility and excreta P retention values. Chicks were fed a P-deficient cornstarch–dextrose-45% CM basal diet (0.13% nonphytate P) as diet 1 or that diet plus 125 or 250 FTU/kg of phytase, respectively, from 8 to 21 D of age. The digestibility/retention of P was 38% and phytase linearly increased both ileal digestibility and excreta retention of P (P < 0.05). The second experiment was a precision-fed chick assay conducted to determine ileal digestibility of P in CM at 21 D. Mean ileal P digestibility was determined to be 47.5% in chicks fed 6 g and 40.0% in chicks fed 9 g of CM and the values were not significantly different. Experiment 3 was an ad libitum–fed chick assay to determine ileal P digestibility and excreta P retention for CM with and without increasing levels of dietary supplemental Ca. The chicks were fed P-deficient - dextrose - CM diets containing increasing levels of 13.5, 27, 40.5, or 54% CM, respectively, with Ca:nonphytate P ratio maintained at 2:1 in diets 1–4 and 6:1 in diets 5–8. Based on regression analysis of ileal digesta or excreta P output on dietary P concentration, digestibility/retention of P in CM was 30%. Ileal P digestibility (and to a lesser extent excreta P retention) at 21 D was reduced by increased Ca:P ratio. The results of this study indicated that the 3 balance assays yielded reasonably consistent values of 30–40% for P digestibility/retention and ileal P digestibility was greatly affected by Ca:P ratio.

Symposium review: Transition cow calcium homeostasis—Health effects of hypocalcemia and strategies for prevention

The effects of subclinical hypocalcemia have been explored in numerous observational and mechanistic studies in recent years. Besides obvious, well-known effects on muscle contractility, the role of Ca with respect to immune function and intermediary metabolism explains the contribution of subclinical hypocalcemia to the development of several diseases observed in early lactation and underlines its importance in high-performing dairy cows. The present review aims at integrating recent scientific progress, such as discoveries about the role of the mammary gland in regulating bone mobilization, into generally accepted aspects of the endocrine control of Ca homeostasis. We will discuss Ca transport mechanisms through absorption, resorption, secretion, and mobilization, as well as the physiological regulation of Ca through parathyroid hormone, 1,25-dihydroxyvitamin D, fibroblast growth factor 23, and serotonin, in addition to dietary mineral requirements. To improve hypocalcemia prevention strategies, our knowledge of the physiological mechanisms necessary to maintain normocalcemia and their endogenous regulation should be combined with data derived from herd-level studies. Using such studies, we will discuss prepartum nutritional strategies aimed at reducing the incidence of subclinical hypocalcemia, as well as options for postpartum Ca supplementation and their effects on early-lactation health and production. Especially in respect to approaches that might interfere with endogenous adaptation processes, such as supplementation with vitamin D metabolites or large doses of Ca, a thorough understanding of the underlying mechanisms that might induce unwanted hypocalcemia rebound effects will be crucial to ameliorate our future management of transition cows. Continued efforts by researchers to understand the interaction of Ca homeostasis with prevention strategies is necessary to optimize cow health and support copious milk production.

Vitamin D3 and calcium cosupplementation alleviates cadmium hepatotoxicity in the rat: Enhanced antioxidative and anti‐inflammatory actions by remodeling cellular calcium pathways

Although vitamin D (VD) and calcium (Ca) attenuate cadmium (Cd) metabolism, their combined antioxidant and anti-inflammatory actions against Cd toxicity have not been previously explored. Hence, this study measured the protective effects of VD ± Ca supplements against Cd hepatotoxicity. Forty adult male rats were distributed to: negative controls (NCs), positive controls (PCs), VD, Ca, and VD3 and Ca (VDC) groups. All groups, except NC, received CdCl2 in drinking water (44 mg/L) for 4 weeks individually or concurrently with intramuscular VD3 (600 IU/kg; three times per week) and/or oral Ca (100 mg/kg; five times per week). The PC group showed abnormal hepatic biochemical parameters and increase in cellular cytochrome C, caspase-9, and caspase-3 alongside the apoptotic/necrotic cell numbers by terminal deoxynucleotidyl transferase dUTP nick end labeling technique. The PC hepatic tissue also had substantially elevated pro-oxidants (malondialdehyde [MDA]/H2 O2 /protein carbonyls) and inflammatory cytokines (interleukin 1β [IL-1β]/IL-6/IL17A/tumor necrosis factor-α), whereas the anti-inflammatory (IL-10/IL-22) and antioxidants (glutathione [GSH]/GPx/catalase enzyme [CAT]) markers declined. Hypovitaminosis D, low hepatic tissue Ca, aberrant hepatic expression of VD-metabolizing enzymes (Cyp2R1/Cyp27a1/cyp24a1), receptor and binding protein alongside Ca-membrane (CaV 1.1/CaV 3.1), and store-operated (RyR1/ITPR1) channels, and Ca-binding proteins (CAM/CAMKIIA/S100A1/S100B) were observed in the PC group. Both monotherapies decreased serum, but not tissue Cd levels, restored the targeted hepatic VD/Ca molecules' expression. However, these effects were more prominent in the VD group than the Ca group. The VDC group, contrariwise, disclosed the greatest alleviations on serum and tissue Cd, inflammatory and oxidative markers, the VD/Ca molecules and tissue integrity. In conclusion, this report is the first to reveal boosted protection for cosupplementing VD and Ca against Cd hepatotoxicity that could be due to enhanced antioxidative, anti-inflammatory, and modulation of the Ca pathways.

Short- and long-term effects of postpartum oral bolus v. subcutaneous Ca supplements on blood metabolites and productivity of Holstein cows fed a prepartum anionic diet

Little information is available regarding the calcium (Ca) dynamics and how its concentration is influenced following the Ca treatment (injection or bolus) after calving in dairy cows. To evaluate the short- and long-term effects of different sources of Ca supplement to animals fed anionic diets during the pre-partum period, 36 multiparous Holstein cows were randomly assigned to 1 of 3 treatments: (1) control group without Ca supplement (CON); (2) subcutaneous injection of 500 ml of 40% w/v Ca borogluconate immediately post-calving (SUB) and (3) oral supplement of Ca bolus containing 45 g Ca immediately and 24 h post-calving (BOL). Serum concentrations of Ca, P and Mg were measured. Serum concentration of Ca was affected by treatments at 48 h of post-calving (P < 0.01). The mean Ca at 6 h was greater in SUB compared to CON group (2.34 v. 2.01 mmol/l; P < 0.002). The lowest Ca concentration at 12 h was related to CON cows compared with BOL and SUB cows (1.90, 2.16 and 2.14 mmol/l, respectively; P < 0.02); a similar trend was observed 24 h post-calving (P < 0.02). Serum concentrations of P and Mg were not influenced by treatments. Yield of milk, milk protein and fat-corrected milk were lowest (P < 0.05) in SUB cows within 3 weeks of lactation in comparison with CON and BOL cows. However, milk yield and milk composition did not show any difference among treatments throughout the first 3 months post-calving. In general, under conditions of this experiment, Ca supplements to fresh cows as an oral bolus are recommended in comparison with subcutaneous injection.

Organic trace minerals and calcium levels in broilers' diets to 21 days old

This study was undertaken to evaluate the effects of dietary calcium levels and supplementation with organic trace minerals selenium, copper, iron, zinc and manganese on performance, tissue deposition and litter mineral concentration. A total of 2,496 one-day-old male Cobb 500 broilers were randomly assigned to a 3 × 4 factorial experimental design with three levels of dietary Ca [8, 10 and 12 g kg–1, while maintaining the same Ca:nPP (non-phytate phosphorus) ratio (2:1)] and four levels of micromineral supplementation (0.62, 0.72, 0.82 and 0.92 g kg–1). There was a total of 12 treatments, with eight replicates of 26 birds per pen. Micromineral supplementation (MS) was achieved by adding different levels of the product Bioplex TR Se® and Ca supplementation was achieved by adding increasing levels of limestone and dicalcium phosphate. An interaction between Ca and MS levels was observed (p 0.05) for Ca, P or ash concentrations in the tibia, which were influenced only by dietary Ca levels (p < 0.05). The Ca level of 10 g kg–1 promoted higher Ca and P concentration in the tibia and lower micromineral excretion in the litter. The combination of MS level of 0.82 g kg–1 with Ca level of 10 g kg–1 led to the best BWG response. The supplementation conditions that led to higher micromineral levels in the liver and breast varied for each mineral.

Prophylactic administration of oral calcium carbonate during plateletpheresis: A bicentric prospective study

BACKGROUND:Administration of anticoagulant citrate and dextrose (ACD-A) chelates ionized calcium in blood and causes hypocalcemia in plateletpheresis donors. The aim of the study was to observe the effects of oral calcium (Ca) supplementation during plateletpheresis on various parameters related to calcium metabolism.MATERIALS AND METHODS:This study was performed between January 2014 and December 2014 on 200 plateletpheresis donors. They were divided into two groups. In group A donors (n=100), no prophylactic oral calcium supplementation was given. In group B (n=100) donors, 2000 mg of calcium was given one hour before the start of the procedure, 500 mg was given at the start of the procedure and 500 mg calcium was given just before the end of procedure. Biochemical parameters like serum total calcium (T Ca), serum total magnesium (T Mg) and ionized calcium level (iCa) were measured before and after the procedure. Relative risk of citrate toxicity was measured between the two groups.RESULTS:There was a significant fall in total calcium (pre 9.02 mg/dl, post 8.23 mg/dl,), ionized calcium level (pre 1.14 mmol/L, post 0.91 mmol/L) and total magnesium (pre 1.92 mg/dl, post 1.79 mg/dl) amongst the donors who did not receive prophylactic calcium supplementation. Despite calcium intake, in prophylactic calcium intake group, we did observe a significant drop in total magnesium (pre 2.04 mg/dl, post 1.94 mg/dl) and ionized calcium level (pre 1.25 mmol/L, post 1.12 mmol/L, p<0.01). We did observe a drop in total calcium level, however, this observation was not statistically significant. The risk (RR=5.44) of citrate toxicity was higher among group A donors.CONCLUSION:Prophylactic oral calcium carbonate supplementation would help in to reduce the risk of citrate toxicity. Therefore, we suggest for prophylactic oral administration of 3000 mg elemental calcium carbonate in three divided doses to make PP procedures uneventful.

Free-choice Feeding of Three Different Dietary Calcium Sources and their Influence on Egg Quality Parameters of Commercial Layers

Purpose: The study reported herein was conducted to determine the effects of choice feeding three different calcium (Ca) sources on external and internal egg quality parameters of commercial layers. Research Method: Three dietary Ca sources (oyster shells, limestone and bone meal) were choice fed ad libitumly along with a commercial layer feed. The birds fed only the commercial layer diet was used as the control. The experiment was conducted as a complete randomized design. A total of 128, 55 weeks old Hy-line white layer hens (1500 ±21g) were assigned into 16 cages of 8 birds each. Four replicate cages were randomly assigned to each of the four dietary treatments. Bird’s performances were tested weekly. Twenty eggs from each treatment were collected weekly over five weeks period and were assessed for shell and internal quality parameters. Findings: Daily Ca intakes of birds affected significantly (P&lt;0.05) by the Ca source. The birds fed oyster shells and limestone showed the highest (P&lt;0.05) daily Ca intakes. Feeding bone meal significantly (P&lt;0.05) reduced damaged shell percentage. Weekly body weight gain, weekly egg production and feed conversion ratio among treatments were similar (P&gt;0.05). Dietary supplementation of Ca significantly (P&lt;0.05) improved the egg weight. Shape index and shell ratios among treatments were similar (P&gt;0.05). Feeding bone meal significantly (P&lt;0.05) improved unit surface shell weight (USSW) and the shell thickness. Calcium supplementation had no effect (P&gt;0.05) on albumen and yolk quality parameters of eggs. Originality/value: The present study concluded that feeding bone meal to commercial layers improves USSW, shell thickness thereby reducing egg damages. Calcium source has no influence in improving internal quality parameters of chicken eggs.

Effects of dietary electrolyte balance and calcium supply on mineral and acid-base status of piglets fed a diversified diet.

Dietary electrolyte balance (dEB) is known to affect acid-base status and mineral metabolism, but is rarely considered in diet formulation for pigs. Yet, the use of a wide variety of local feedstuffs in Europe contributes to lowering the dEB and increasing the fibre content. Hence, mineral requirements may be modified and skeletal health affected. Therefore, the effects of a lower dEB and a higher dietary Ca level on acid-base balance and mineral status were assessed in young pigs fed a diversified diet. A total of twenty-four weaned pigs were fed a control moderate-dEB diet (C) or a diversified moderate-dEB (D), low-dEB (D-A) or low-dEB supplemented with Ca (D-CA) diet. Growth performance, venous blood gas and chemistry, urine pH, mineral balance and femur characteristics were determined. With an equivalent dEB compared with the C diet, the D diet caused an acidification of the urine and increased the excretion of P as a result of a higher dietary content of S. Low-grade metabolic acidosis occurred in piglets fed the D-A diet with changes at systemic and urine levels. A higher excretion of ammonia and P in urine was observed and some bone characteristics tended to be negatively affected. Ca supplementation partially counteracted the effects of low-grade acidosis. Urine excretion of P and ammonia was alleviated and bone characteristics improved. In conclusion, a higher Ca supply must be considered in more diversified diets to counteract the risk of evolving towards low-grade metabolic acidosis which can negatively affect bone.

Human Uptake of Eggshell Powder as an Alternate Source of Calcium

Calcium (Ca) plays important structural and physiological roles in our body. Usually, our body meets up its Ca need from dietary sources. In developing countries like Bangladesh, most of the people cannot afford Carich foods. So, Ca supplements are generally prescribed to deficient individual that usually costs high. It is, therefore, necessary to find out an alternative and cheap source of Ca supplement especially in Bangladesh. Considering the above facts, the main focus of this study was to explore the possibility of using the egg shell as a source of Ca. In his study, discarded eggshells were collected, washed, decontaminated properly and ground to a fine powder. Washing with tap water followed by 10 min boiling completely decontaminated the eggshells. On an average 3.45, 5.91, 4.5 and 4.55 g of eggshell powder (ESP) per shell were obtained from a domesticated fowl, domestic duck, white leghorn, and rhode island red, respectively. Particle size was measured using scanning electron microscope and the size ranged between 3.47-5.94 μm. The Ca contents were found as 38.65, 35.0, 24.85 and 35.73 g in domesticated fowl, domestic duck, white leghorn, and rhode island red, respectively per 100 g of ESP. Taking daily Ca requirements into account, we observed that powder from almost half of an eggshell is sufficient to fulfill the daily Ca need. The amount of magnesium (Mg) in 100 g ESPs was found to be 45.37, 32.48, 45.17 and 45.27 mg and that of iron (Fe) was 35.07, 33.47, 31.91 and 33.06 mg in domesticated fowl, domestic duck, white leghorn, and rhode island red, respectively. Various toxic heavy metals such as chromium (Cr), lead (Pb) and arsenic (As) contents remained below the detection level in ESP samples. Organoleptic tests revealed that the ESP does not have any objectionable effects on the texture and flavor of ESP-fortified foods and juice. These results suggested that the ESP can be used as an alternative and important cheap source of Ca and other beneficial micronutrients for human being. However, it is necessary to create the awareness and public perception regarding the use of EPS&#x0D; Dhaka Univ. J. Pharm. Sci. 18(2): 249-255, 2019 (December)

Association of supplemental calcium and dairy milk intake with all-cause and cause-specific mortality in the UK Biobank: a prospective cohort study.

Excessive Ca intakes have been proposed to associate with vascular calcification and a higher risk of prostate cancer. We investigated the associations of supplemental and dietary Ca intake with mortality using data from 497828 UK Biobank participants. The average follow-up was 4·2 years and 14255 participants died, 8297 from cancer, 2959 from CVD and 572 from respiratory disease. The use of Ca supplements and milk consumption were associated with differences in mortality in younger (≤65 years) but not in older participants (>65 years, Pinteraction ≤ 0·04 for all comparisons). Among participants <65 years, there was an inverse association between Ca supplementation (OR 0·91, 95 % CI 0·83, 0·99) and milk consumption (OR 0·93, 95 % CI 0·86, 1·00) with respect to all-cause mortality. In the same age group, milk drinkers had lower odds of cancer mortality (OR 0·89, 95 % CI 0·80, 0·98) but Ca supplement use was associated with increased odds of respiratory mortality (OR 1·69, 95 % CI 1·16, 2·74). All associations in participants aged ≥65 years were null after full adjustment. In sensitivity analyses stratified by hormone replacement therapy, Ca supplement use was associated with decreased odds of cancer mortality in users but increased risk in other women (OR 0·81, 95 % CI 0·69, 0·94 v. OR 1·17, 95 % CI 1·01, 1·35, respectively). To conclude, we saw little evidence for harm with dietary or supplemental Ca. Further studies are required to confirm the proposed interaction with hormone replacement therapy and to exclude reverse causation as a determinant in the association between Ca supplements and increased risk of respiratory diseases.

Effect of Supplemental Calcium Levels on Feedlot Growth Performance and Dietary Net Energy Utilization during the Receiving Feeding Period of Calf-Fed Holstein Steers

Ninety-six calf-fed Holstein steer (127 kg) were used to evaluate the influence of supplemental dietary calcium (Ca) on growth-performance, and dietary net energy (NE) utilization during the initial 112-d of receiving period. Treatments consisted of steam flake corn-based growing-finishing diets supplemented with limestone to achieve 0.60%, 0.70%, 0.80%, or 0.90% dietary Ca (DM basis). Morbidity was low (6.3%) and it was not affected (P > 0.87) by dietary treatments. During the initial 84-d period (181 kg average BW), increasing dietary Ca did not influence (P > 0.10) DMI, ADG, gain efficiency or observed/expected DMI. Observed DMI was 19% greater than expected based on diet formulation and growth. Estimated metabolizable protein and methionine supply during the initial 84-d period averaged 92% and 79% of the required, respectively. The apparent decrease in efficiency of energy utilization in the present study is in close agreement with previous studies involving calf-fed Holstein steers in the early growing phase fed conventional growing-finishing diet that is otherwise deficient in metabolizable amino acids. Thus, it is considered that the anticipated growth-performance responses to dietary Ca treatments may have been masked by expected inefficiencies due to metabolizable amino acid deficiency. During the final 28-d period (256 kg of average BW), increasing supplemental Ca reduced feed intake (linear effect, P = 0.04) and enhanced gain efficiency (linear effect, P = 0.03). During this period, predicted ([1] Level 1) metabolizable protein and methionine supply were 110% and 94% of the required, respectively. Nevertheless, improvements in gain efficiency during the final 28-d period with increasing levels of supplemental Ca were not sufficient to influence (P > 0.10) overall 112-d growth-performance. It is concluded dietary Ca requirements of calf-fed Holstein steers during the initial 112-d feeding period appear to be secondary to deficiencies of conventional steam-flaked corn-based diets in meeting metabolizable amino acid requirements. However, when those requirements are met during the early growing phase, gain efficiency responses are optimized at approximately 0.90% dietary Ca.