Dietary Calcium Research Articles

Total, dietary, and supplemental calcium intake and risk of all-cause, cardiovascular, and cancer mortality among U.S. adults: a prospective cohort study from the National Health and Nutrition Examination Survey.

The study aimed to investigate the association of total, dietary, or supplemental calcium intake with all-cause, cardiovascular, and cancer mortality in American adults. This prospective cohort study used the National Health and Nutrition Examination Survey from 2005 to 2018. Participants were categorized into tertiles based on calcium intake. Risks of all-cause, cancer, or cardiovascular mortality and the dose-response relationship were estimated using weighted Cox proportional hazard regression and restricted cubic splines, with adjustments for demographic characteristics, comorbidities, laboratory parameters, and dietary data. In total, 6172 participants were included (median age: 61 years), and 869 had died (CVD:217, cancer:224) during a median follow-up of 81 months. After adjusting for confounders, higher total calcium(≥ 1660mg/d) [HR, 95%CI: 0.867 (0.865-0.869)], dietary calcium(≥ 1075mg/d) [HR, 95%CI: 0.711 (0.709-0.713)], and supplemental calcium (≥ 600mg/d) [HR, 95%CI: 0.786 (0.784-0.787)] intake groups were associated with lower all-cause mortality risk compared to the lowest intake group. Similar beneficial associations were found for cardiovascular, cancer mortality, and across subgroups of various ages, genders, races and body mass indexes. In the dose-response analysis, a 'J-shaped' nonlinear relationship was observed between calcium intake and the risk of all-cause, cardiovascular, and cancer mortality. Higher levels of total, dietary, or supplemental calcium were associated with lower all-cause, cardiovascular, or cancer mortality. However, a nonlinear association between calcium intake and mortality suggested that excessive calcium intake beyond a certain threshold may increase mortality risk.

Persistent Calcium Inadequacy in Korean Adults over 20 Years: Analysis of the 1998–2018 Korea National Health and Nutrition Examination Survey

Calcium inadequacy in Asian populations has been well documented, but whether it has improved over time remains uncertain. We analyzed dietary calcium intake and its association with osteoporosis prevalence over a 20-year period in 48,653 adults (21,932 men and 26,721 women, aged 19 years and older) in Korea, using data from the first to the seventh Korea National Health and Nutrition Examination Survey (1998–2018). Over the past 20 years, Korean adults consistently fell short of the recommended dietary calcium intake, with women and older adults particularly affected, typically consuming only 40–80% of the recommended levels. The 30–49 age group had the highest calcium intake (497–568 mg/day), while those aged 75+ had the lowest (319–457 mg/day). A significant inverse relationship was found between calcium intake and osteoporosis risk, with lower calcium intake associated with higher odds of developing osteoporosis, as determined by both physician diagnoses and bone mineral density measurements (p < 0.001). Notably, over the past 20 years, 68–70% of dietary calcium consistently came from plant-based foods. This study strongly emphasizes the urgent need to enhance calcium-rich food availability and implement targeted interventions to increase calcium intake among those most affected by inadequacy, particularly the elderly and women. Further research with recent data would be valuable for understanding current intake levels and evolving nutritional needs.

Dietary Calcium Intake and Association with Serum Calcium in Healthy Urban North Indian Adults: The Calcium-Chandigarh Urban Bone Epidemiological Study

Abstract Introduction: Data on dietary calcium intake (DCI) from healthy North Indian adults are limited. Hence, the present study aims to assess DCI in healthy community-dwelling adults residing in an affluent North Indian city and correlate with serum biochemical parameters. Methods: Healthy men and women were recruited from the community by door-to-door surveys. Serum total calcium, phosphate, 25-hydroxyvitamin D, and iPTH were estimated. DCI was assessed by recalling the diet consumed in the previous 7 days. Results: A total of 291 participants were included (mean age = 39.4 ± 12.9 years). The mean (± standard deviation) and median (inter-quartile range) DCI were 392.6 ± 169.1 mg/day and 391 (274-518) mg/day, respectively. DCI was higher in men compared with women. Only 21.3% of participants had DCI more than RDA (600 mg/day). Serum calcium was found to be significantly higher across each quartile of DCI. On multiple linear regression analysis, DCI emerged as an independent positive predictor of serum total calcium. Conclusion: DCI is low in urban Indians. Promotion of consumption of dairy products and fortification of commonly consumed foods with calcium is needed.

Population-based dietary risks for kidney stones: Implications for dietary counseling and prevention.

In the context of the increasing incidence of kidney stones, we aimed to assess the percentage of the population who are eating an at-risk diet for kidney stones and to understand the baseline diet for future counseling. The 2015 Canadian Community Health Survey, a national, cross-sectional instrument administered by Statistics Canada and Health Canada, was queried. Intake of relevant nutrients was compared to dietary risk factors for kidney stone formation. Factors associated with nutrient intake were analyzed in a multivariable regression. Data for 14 275 participants was included, of whom 24% consumed >2.5 of fluid per day and 9.4% consumed 1000-1200 mg of dietary calcium; 53.9% consumed too much sodium but 61% of the population had the recommended protein intake. Ninety-nine percent (99%) of the population had at least one dietary risk factor for kidney stone formation, while 92% had two or more risk factors. Fluid, sodium, calcium, and protein intake increased significantly with education level, income, and if employed (p<0.05 for all); however, fluid, protein, and sodium intake were lower in patients with hypertension and heart disease (p<0.05 for all). While only a subset of the population will develop stones, this study shows that 99% of the population has a diet that elevates the risk of stone disease. As the incidence of kidney stones increases, population-based dietary interventions should be considered. Furthermore, clinicians may use these data to understand the average diet as a starting point for questioning and counseling patients.

Association between dietary calcium intake and constipation in a metabolic syndrome population: evidence from NHANES 2005-2010.

The global prevalence of Metabolic Syndrome (MetS) is increasing, primarily characterized by abdominal obesity, which significantly heightens the risk of cardiovascular diseases, gastrointestinal disorders, and cancers. Constipation is a common gastrointestinal issue that impacts both physiological and psychological health and worsens with age. Calcium, an essential mineral vital for human health, has been proven to be crucial not only for bone health but also beneficial for gastrointestinal health. However, the results regarding its impact on constipation are inconsistent. This study aimed to investigate the relationship between dietary calcium intake and constipation in individuals with MetS. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. Participants were assessed for MetS based on the International Diabetes Federation (IDF) criteria. Dietary calcium intake was evaluated through 24-h dietary recalls, and constipation was defined based on the frequency of bowel movements recorded in the bowel health questionnaire. The relationship between calcium intake and constipation was explored using logistic regression models with adjustment for covariates, and restricted cubic spline analyses were also used to investigate nonlinear relationships. The study included 4,838 adult participants with MetS. Adjusted logistic regression revealed that an increase in dietary calcium intake was significantly associated with a reduced risk of constipation (OR: 0.562, 95% CI: 0.379 to 0.835, p = 0.006). Compared to the lowest quartile, the highest quartile of dietary calcium intake significantly decreased the risk of constipation (OR: 0.282, 95% CI: 0.115 to 0.691, p = 0.008). Results from the restrictive cubic spline analysis indicated a negative linear association between dietary calcium intake and constipation risk (non-linearity p = 0.704). The findings suggested that increased dietary calcium intake is associated with a decreased risk of constipation among MetS patients, emphasizing dietary calcium as a potentially modifiable factor for managing gastrointestinal symptoms in this population.

Effects of calcium pidolate on performance, carcass traits, bone biomechanical properties and mineralisation and jejunum histomorphology in broilers

ABSTRACT 1. The current study was conducted to determine the effect of dietary calcium pidolate (CalP) on performance, slaughtering characteristics, bone biomechanical properties, mineralisation and jejunum histomorphology in male broilers. A total of 200 one-day-old Ross 308 male chicks were randomly assigned to one of four treatments as five pen replicates, each containing 10 chicks. The basal diet without CalP was formulated to supply the nutritional needs of broilers and the treatment diets contained 0.30, 0.45 and 0.60 g/kg CalP, with limestone meeting the remaining calcium requirement. 2. The addition of CalP had a quadratic effect on performance (P < 0.05) and the best performance was achieved in the group that included CalP at a dose of 0.45 g/kg but 0.60 g/kg level worsened performance. Supplementing with CalP linearly decreased carcass yield (P < 0.01) and relative breast weight (P ≤ 0.05) but the relative thigh weight increased quadratically (P < 0.05) and reached a maximum at 0.45 g/kg. 3. Tibia shear force and stress linearly increased with the use of CalP in the diet (P < 0.05). Supplementation had a quadratic effect on tibial calcium (P < 0.01), reaching a maximum at 0.30 g/kg, although tibial phosphorus levels decreased linearly (P < 0.01). 4. The effect of CalP on jejunum histomorphology fluctuated and, compared to the unsupplemented control group, the villus height/crypt depth ratio increased, while the other variables decreased (P < 0.05). Decrease in crypt depth with the addition of CalP was significant (P < 0.05). 5. Using Ca-pidolate at a rate of 0.45 g/kg in broiler diets is sufficient to increase performance and tibia strength but 0.60 g/kg level negatively affected performance. In addition, the results of jejunum histomorphology were variable, but the crypt depth decreased with CalP levels and this is an important effect. However, further research is needed to detail the effect of CalP on broilers.

Effect of coated calcium feeding on growth performance, carcass traits, immunity, blood biochemistry and tibial bone morphometry in commercial broiler chicken.

The bone abnormalities pose great concern in heavy, rapidly growing broilers, resulting in significant economic loss, and health issues in birds. To address these problems and prevent unnecessary mineral excretion into environment, it is crucial to optimise the inclusion level of dietary calcium in broiler's diet. The calcium utilisation by the bird is also affected by its source, particle size, bioavailability etc. Hence this study aimed to study the effect of partially replacing conventional dietary calcium source with coated calcium on growth performance, immune response, carcass traits, blood calcium and phosphorus, and mineral retention in broilers. About 416 broiler chicks were randomly distributed into four treatments, each with eight replicates of 13 birds and fed with iso-calcium, isocaloric, and isonitrogenous diet for 42 days. The T0 (control) was a basal diet while the T1, T2, and T3, were treatment diets in which conventional calcium source (limestone) was partially replaced with coated calcium by 10, 20, and 30% respectively. The birds of T3 group showed higher (P < 0.05) body weight gain, better feed conversion ratio and higher carcass yields compared to T0, T1, and T2 diet fed birds. Further the treatment groups exhibited higher (P < 0.05) cell-mediated and humoral immune responses and immune organ weights compared to control. The tibial bone weight, length and average diameter was highest (P < 0.05) in T3. Moreover, the T3 diet fed group also showed higher (P < 0.05) calcium and phosphorus content in serum and bone and lowest content of these minerals in the excreta followed by T2, T1 and control. These findings suggest that a 30% conventional calcium source with coated calcium may be used as a high-grade mineral source for broiler chicken feed.

Dietary calcium intake among Iranian adults: Iranian Multicenter Osteoporosis Study (IMOS-2021).

Adequate dietary consumption of calcium is crucial in the preservation of bone health and the prevention of osteoporosis. This study investigated the prevalence of insufficient dietary calcium intake among individuals aged ≥50 years in Iran. We analyzed data from the Iranian Multicenter Osteoporosis Study (IMOS-2021). Participants aged 50 years and older completed a 168-item food frequency questionnaire. Insufficient dietary calcium intake was characterized as a daily calcium intake of <1000 mg for men aged 50-70 years, and <1200 mg for men over 70 years and women over 50 years and older. Stata v17 statistical software facilitated a survey set analysis to estimate the population's mean and median dietary calcium intake and the prevalence of insufficient dietary calcium intake. The study included 1450 participants with a mean age of 60.7±7.9 years. The estimated mean dietary calcium intake in Iran was 1062.7 mg/day (95% CI: 1029.6-1095.8), with a median intake of 943.5 mg/d (95% CI: 910.5-976.4). The prevalence of insufficient dietary calcium intake in Iran was estimated to be 62.9% (95% CI: 60.0%-65.7%). Notably, the prevalence was higher among women at 75.5% (95% CI: 71.9%-78.8%), compared to men at 47.8% (95% CI: 43.4%-52.3%) with a significant difference (P<0.001). In age-related findings, individuals aged 65 years and older had a higher prevalence of insufficient intake, at 69.0% (95% CI: 63.9%-74.0%), versus those under 65 years, at 60.3% (95% CI: 56.9%-63.8%), with this difference being statistically significant (P = 0.007). Furthermore, a significant inverse relationship was identified between both educational years and socioeconomic status and the prevalence of insufficient dietary calcium intake (Ps for trends<0.001). Our findings revealed a significant prevalence of insufficient dietary calcium intake in women and those aged 65 and older. We advocate for targeted public health strategies to ensure sufficient dietary calcium intake across these populations.

Exploring the Role of Dietary Calcium Intake in Muscle and Cardiovascular Performance Among Young Athletes

The importance of dietary calcium intake in bone metabolism has been well established; however, it is still less investigated in health-related components, especially addressing muscle performance. This study aims to compare dietary calcium intake and its relationship with cardiovascular and muscular performance in young athletes (lacrosse, Baseball, and soccer players). In this cross-sectional study, 95 participants (ages 18 to 30) participated during two visits to the Human Performance Laboratory. Participants completed body composition, lower and upper body muscle performance, cardiorespiratory protocol, and questionnaires related to dietary calcium intake. One-way ANOVA was used to determine the difference in the calcium intake between groups. The Pearson Correlation Coefficient was used to investigate the relationship between dietary calcium intake and muscle performance variables. Further, linear regression was used to assess the predictive value of calcium variables on overall muscle performance. Lacrosse players had significantly higher calcium intake than Baseball and soccer players (p &lt; 0.05). There was a significant positive correlation between dietary calcium intake and the number of push-ups (r = 0.28; p = 0.03). CIBW and CI explained 4.3% and nearly 25% of the change in MPI, respectively (p &lt; 0.001). This suggests the possible role of dietary calcium intake in enhancing health-related fitness components and highlights the need to explore its involvement in muscle-bone crosstalk.

Relationship between emotional eating and nutritional intake in adult women with overweight and obesity: a cross-sectional study

BackgroundEmotional eating (EE) is particularly prevalent in overweight or obese women, who may turn to food as a way to cope with stress, sadness, or anxiety. Limited research has been conducted on the association between EE and nutritional intake. Therefore, present study was designed to explore this association in adult women with overweight and obesity.MethodsIn this cross-sectional study, the relationship between EE and nutritional intake in 303 overweight and obese women (aged 18–50 years) was examined. The researchers used the validated semi-quantitative Food Frequency Questionnaire (FFQ) to assess participants’ nutritional intake and the Dutch Eating Behavior Questionnaire (DEBQ) to evaluate their eating behavior. To determine the association between EE and nutritional intake, we employed the multiple linear regression analysis.ResultsThe frequency of high intensity EE was 64.4% among the study participants and the mean total score of EE subscale of DBEQ was 2.32 ± 0.81. The total score of EE was positively associated with the energy intake (β = 0.396, P = 0.007), even after adjusting for age and BMI. In addition, a significant inverse association was found between the score of EE and the daily intake of calcium (β= -0.219, P = 0.026), riboflavin (β= -0.166, P = 0.043), and vitamin B12 (β= -0.271, P = 0.035), independent from energy and age. Also the results showed a significant positive association between the score of EE and the frequency of daily intake of cracker, muffin, cake, cream cake, pastry, candy, ice cream, pickles, melon, hydrogenated vegetable oil, peanut, salted and roasted seeds, and corn-cheese puff snack.ConclusionThis study found that overweight or obese women with higher intensity of EE might have a higher intake of energy and a lower intake of dietary calcium, riboflavin and vitamin B12. Integrating a balanced diet with psychotherapy is suggested to help individuals with EE reducing the urge to eat in response to emotions.

Effects of feed particle size, calcium concentration and phytase supplementation on InsP6 degradation in broiler chickens fed pelleted diets

ABSTRACT 1. The objective of the trial was to study the single and interactive effects of feed particle size in pelleted feed, dietary calcium (Ca) concentration and microbial phytase supplementation in broiler chickens. The studied traits were myo-inositol (1,2,3,4,5,6) hexakis (dihydrogen phosphate) (InsP6) degradation, pre-caecal digestibility of phosphorus (P), Ca and amino acids (AA) and retention of P, Ca and nitrogen (N). 2. Male Ross 308 broiler chickens were housed in metabolism units in groups of 10 and allocated to one of eight diets with seven pen replicates per diet. The 2 × 2 × 2-factorial arrangement included coarse and fine feed particle size (309 or 222 µm), low and high Ca concentration (4.9 and 7.2 g/kg) and without or with phytase supplementation (1,000 FTU/kg). 3. Pre-caecal InsP6 disappearance was higher with coarse than fine feed particle size when no phytase was added (54 vs. 48%) but not when phytase was added (74%; p = 0.046). High dietary Ca feeds decreased pre-caecal InsP6 disappearance (67 to 59%) and P digestibility (65 to 55%; p < 0.001). Gizzard pH was lower with coarse than fine feed particle size and higher with high Ca than low Ca (p < 0.001). Pre-caecal digestibility of most AA was approximately 3.5%-points lower with high Ca without phytase compared to the other treatments (p ≤ 0.047). Coarse feed particle size caused higher pre-caecal AA digestibility than fine particle size (~2%-points; p ≤ 0.031). InsP6 disappearance in the crop increased at high Ca concentration when phytase was added (22 vs. 37%; p = 0.011). 4. Coarser feed particle size in pellets increased gastrointestinal InsP6 degradation and nutrient digestibility, likely owing to effects on the gizzard functions. Additional Ca supply exerted antinutritive effects that was not compensated for by using coarser feed particles.

Integrated transcriptomics and untargeted metabolomics reveal bone development and metabolism of newly weaned mice in response to dietary calcium and boron levels.

Epidemiological and animal studies have indicated that calcium and boron are essential for bone development and metabolism. However, limited information is available regarding the effects of boron supplementation on bone development and metabolism in newly weaned infants with either calcium deficiency or calcium sufficiency. This study assessed the effects of dietary boron supplementation (0 and 3 mg kg-1) on bone development and metabolism, in a newly weaned mouse model, under both calcium deficiency and sufficiency feeding conditions. The results show that mice fed a calcium sufficient diet exhibited lower fat percentage and final body weight than those fed a calcium deficient diet. Boron supplementation reduced the serum high-density lipoprotein cholesterol level and up-regulated the mRNA levels of FABP3, PPAR-γ, and CaMK in the intestinal mucosa. Importantly, boron supplementation increased the tibial weight in mice on a calcium-sufficient diet and enhanced the tibial volume in those on a calcium-deficient diet. Metabolomic analysis highlighted calcium and boron's impact on metabolites like carboxylic acids and derivatives, fatty acyls, steroids and steroid derivatives, benzene and substituted derivatives, organonitrogen compounds, organooxygen compounds, and phenols, and were related to lipid metabolism and the neural signaling pathway. Transcriptomic analysis corroborated the role of calcium and boron in modulating bone metabolism via the JAK-STAT, calcium signaling, lipid metabolism, and inflammatory pathways. Multi-omics analysis indicated a strong correlation between calcium signaling pathways, lipid metabolism signaling, and dietary calcium and boron contents. This research provides insights into these complex mechanisms, potentially paving the way for novel interventions against calcium and boron deficiencies and bone metabolism abnormalities in clinical settings.

Effect of dietary calcium and vitamin D supplements on plasma bone turnover biomarkers, bone mineralization, bone strength, and lameness score in gilts.

This study investigated the impact of calcium (Ca) and vitamin D supplements on bone metabolism, bone measurement, lameness, and selection rate in gilts fed five dietary treatments. Two Ca levels (6.85/6.42 [adequate; ACa] or 8.99/8.56 [high; HCa] g/kg) were combined with either 856 IU/kg vitamin D3 (Danish feeding standards; adequate; AD3) or 50 μg/kg 25-hydroxyvitamin D3 (high; HHyD) to create ACaAD3, HCaAD3, ACaHHyD, and HCaHHyD diets. The values 6.85/6.42 and 8.99/8.56g/kg correspond to adequate and high Ca supply for gilts weighing 32 to 100 and 100 to 180kg body weight (BW), respectively. The fifth diet was a combination of HCa and 2,000 IU/kg vitamin D3 (high; HD3) to create HCaHD3. Two hundred gilts were phase fed the dietary treatments from 32 to 100 and 100 to 180kg BW until they were slaughtered, either at 100 or 180kg BW. The gilts were weighed fortnightly, and plasma and urine samples were collected at 100 and 180kg BW. At slaughter, the 2nd and 3rd metacarpal bones were collected for bone parameters measurements. Lameness and selection rate were assessed within the last 7 d at 100 and 180kg BW. Dietary treatments did not affect gilts' growth performance and plasma concentration of Ca, but urinary concentration of Ca was greater in HCa-supplemented gilts at both 100 (P = 0.003) and 180 (P = 0.05) kg BW. Plasma concentration of vitamin D3 (P < 0.001) and 25-hydroxyvitamin D3 (P < 0.001) showed dose-dependent responses at both 100 and 180kg BW. Bone-specific alkaline phosphatase was greater (P = 0.02) in the plasma sample collected at 180kg BW in gilts fed the HCaHD3 diet and tended to be greater in gilts fed the ACaAD3 diet (P = 0.06). The bone ash content (P = 0.02) was greater in gilts fed the HCaAD3 diet and slaughtered at 100kg BW compared with gilts fed the ACaAD3 and ACaHHyD diets. However, bone weight, length, thickness, dry matter, and mineral content did not differ among the dietary treatments at both 100 and 180kg BW (P > 0.05). Neither lameness nor selection rate was affected by the dietary treatments. The average daily gain of gilts weighing 32 to 100 and 100 to 180kg BW showed a positive correlation with bone strength (r = 0.37; P < 0.001) and bone ash content (r = 0.24; P = 0.02), respectively. In conclusion, higher Ca and vitamin D3 supplementation slightly increased bone ash content but had no effect on lameness or selection rate of the gilts compared to those fed according to the Danish nutrient standards.

Dietary calcium intake in relation to metabolic syndrome in adults: A systematic review and dose-response meta-analysis of epidemiological studies with GRADE assessment.

Numerous studies have examined the relationship of calcium intake and metabolic syndrome (MetS) in adults in previous decades; but the results were inconsistent across different societies. This systematic review and dose-response meta-analysis assessed the relation between calcium consumption and MetS in adults. We did a systematic search of all articles published up to July 2023 in Scopus, PubMed/Medline, ISI Web of Science electronic databases, and Google Scholar. Observational studies investigated the association between dietary calcium (Ca) intake and MetS in adults were eligible to be included. For computing the estimates, a random effects model was applied. Combining 24 effect size from 17 investigations (15 cross-sectional and two cohort studies) with 74,720 participants and 18,200 cases showed that highest versus lowest level of dietary Ca intake was related to 23% significant decreased odds of MetS (OR = 0.77; 95% CI: 0.66, 0.89). Linear dose-response analysis of estimates from 12 investigations showed that each 100 mg/day increment in dietary Ca intake was associated with 3% marginally significant decreased odds in MetS (OR = 0.97; 95%CI: 0.93, 1.01). In nonlinear dose-response analysis of 12 studies with 67,896 participants, a significant association between dietary calcium intake and MetS was found (Pnonlinearity <0.001); such that 500 mg/day dietary calcium intake was related to maximum decrease in odds of MetS. According to this meta-analysis, the likelihood of MetS was significantly lower in adults with higher level of dietary calcium intake. Further large-scale prospective cohort investigations are needed to obtain stronger and more accurate results.

6487 Hypercalcemia In Pregnancy Due To An Ectopic Parathyroid Adenoma: A Diagnostic Dilemma

Abstract Disclosure: S.S. Patel: None. M.B. Sharma: None. Introduction: Hypercalcemia is a rare complication of pregnancy, with the most common cause being primary hyperparathyroidism due to a parathyroid adenoma. Ultrasound is the primary modality used for localization, as sestamibi and computed tomography (CT) carry the risk of potential harm to the fetus. We present the case of hypercalcemia in a pregnant female that failed to resolve after two gland parathyroidectomy, necessitating a sestamibi parathyroid scan to localize an ectopic parathyroid adenoma. Case: A 40-year-old pregnant woman at 12 weeks of gestation presented with hypercalcemia, with a corrected calcium level of 12.5 mg/dL (8.7-10.4 mg/dL). She complained of nausea and vomiting but denied any personal or family history of hypercalcemia. Further evaluation revealed primary hyperparathyroidism as the etiology, with Intact PTH of 429.2 pg/mL (18.5-88.0 pg/mL), ionized calcium of 1.45 mmol/L (1.12-1.32 mmol/L), 25-OH vitamin D of 16.4 ng/mL (30-100 ng/mL), phosphorus of 1.3 mg/dL (2.4-5.1 mg/dL), and creatinine of 0.71 mg/dL (0.5-0.8 mg/dL). Notably, her calcium level had been 19.2 mg/dL two weeks earlier during an episode of hyperemesis gravidarum. Hypercalcemia proved relatively resistant to treatment with intravenous hydration and subcutaneous calcitonin. Ultrasound of the neck failed to reveal a parathyroid adenoma. The patient then underwent surgical neck exploration, during which two parathyroid glands were removed, resulting in an intraoperative PTH drop from 440 to 340 pg/mL. Postoperative calcium levels remained elevated at 12.9 mg/dL, prompting the resumption of treatment. Oral sodium and potassium phosphate was added to bind dietary calcium. After an extensive multidisciplinary discussion, a 99mTc-sestamibi parathyroid scan with a lower dose of sestamibi and without CT was recommended. This revealed an ectopic parathyroid adenoma in the anterior mediastinum. Surgical removal of the ectopic parathyroid adenoma in the second trimester finally led to a significant intraoperative PTH drop from 315 to 28 pg/mL. The postoperative course was complicated by hypocalcemia and hypomagnesemia, requiring calcium, vitamin D, and magnesium supplements. These complications resolved over the following days. The patient remained normocalcemic for the remaining pregnancy and delivered a healthy male infant at 34 weeks. Conclusion: Hypercalcemia in pregnancy is associated with fetal and maternal complications, warranting adequate management and close follow-up. The use of 99mTc-sestamibi parathyroid scan is typically not recommended in pregnancy due to concern for fetal harm; however, there are a few studies showing no association with increased birth defects or adverse pregnancy outcomes at low radiotracer doses. Hence, a sestamibi parathyroid scan can be considered during pregnancy to localize an adenoma after a careful review of the benefits versus risks. Presentation: 6/2/2024

Comparative Study on Calcium-enriched Finger Millet Tisane: Optimizing Soaking and Roasting Methods

This study focuses on the development of a calcium-rich herbal tisane using finger millet, a grain known for its high calcium content, aimed at enhancing dietary calcium intake. Two distinct processing methods were employed to optimize the calcium content of the tisane. In Treatment 1, Finger millet was roasted and combined with spice powder, while in Treatment 2, Finger millet underwent soaking, cabinet drying, roasting, and then blending with spice powder. The calcium content and overall quality of both treatments were evaluated, revealing a marginal increase in calcium concentration in Treatment 2, attributed to the additional processing steps. Specifically, Treatment 2 yielded a maximum calcium content of 396 mg compared to 380 mg in Treatment 1, demonstrating the effectiveness of the additional soaking and drying steps in enhancing calcium bioavailability. The final product was further enriched with a blend of spices, including dry ginger, cinnamon, cardamom, Arjuna bark, fennel seeds, and Tulsi leaves, contributing to its healthful properties. Organoleptic evaluations, conducted to assess sensory attributes such as flavor, aroma, and overall acceptability, indicated that both treatments were well-received by consumers. This suggests the product's potential for consumer acceptance and market viability. The findings suggest that calcium-enriched Finger millet tisane could serve as a valuable functional beverage, particularly for populations at risk of calcium deficiency. Its nutrient profile, combined with favorable sensory attributes, positions it as a promising option for improving dietary calcium intake and promoting overall health. Further research on larger sample sizes and bioavailability studies could reinforce its potential as a functional health beverage.

Calcium carbonate supplementation for the prevention of preeclampsia in high-risk pregnant women: a randomized clinical trial protocol

BackgroundPreeclampsia (PE) is a significant cause of maternal mortality worldwide, affecting 2% to 8% of pregnancies. The World Health Organization recommends the use of low-dose acetylsalicylic acid (100 mg of aspirin) and 1.5 to 2 g of calcium carbonate during pregnancy to prevent PE. However, robust evidence supporting the efficacy of calcium supplementation is still needed. This study aims to assess the efficacy of calcium carbonate in preventing preeclampsia in high-risk pregnant women.MethodsA triple-blind, randomized clinical trial will be conducted at an outpatient clinic in Brazil between May 2024 and March 2026. Pregnant women at high risk of developing preeclampsia and with low dietary calcium intake will be randomly assigned to one of three groups: one group will receive calcium carbonate capsules (commercially available in Brazil) along with 100 mg of aspirin; the second group will receive calcium carbonate derived from Crassostrea sp. along with 100 mg of aspirin; and the control group will receive a placebo alongside 100 mg of aspirin. The primary outcome is the diagnosis of preeclampsia during pregnancy, while secondary outcomes evaluate maternal and fetal health indicators.DiscussionThis trial seeks to generate evidence on the efficacy of calcium carbonate in preeclampsia prevention, with a focus on comparing industrial calcium carbonate with calcium carbonate sourced from Crassostrea sp., a more sustainable alternative.Trial registrationThe study was approved by the Research Ethics Committee of the Federal University of Sergipe and registered in the Brazilian Registry of Clinical Trials (ReBEC), under the ID RBR-7hqhj3y. Registered on November 16, 2023.

Familial hypocalciuric hypercalcemia in an infant: diagnosis and management quandaries.

Familial hypocalciuric hypercalcemia (FHH) is typically a benign condition characterized by elevated serum calcium, low urinary calcium excretion, and non-suppressed circulating levels of parathyroid hormone (PTH), usually requiring no intervention. FHH is inherited in an autosomal-dominant manner. Three subtypes are described, representing variants in genes with critical roles in extracellular calcium-sensing. FHH1, due to heterozygous inactivating variants in the calcium-sensing receptor gene (CASR), accounts for the majority of cases. FHH2, due to variants in GNA11, encoding the α-subunit of the downstream signaling protein, G11, is the rarest form of FHH. FHH3, resulting from variants in AP2S1, may present with a more pronounced phenotype than FHH1 or FHH2. We describe herein a newborn girl presenting with in utero femoral fractures, hypercalcemia, hypophosphatemia, and elevated circulating PTH. She was diagnosed with mild hyperparathyroidism and provided supplemental phosphate upon hospital discharge. However, serum calcium and PTH remained elevated at 5mo of age. The combination of low-calcium formula and cinacalcet improved the biochemical profile. No pathogenic variants in the coding region of CASR were identified; subsequent whole exome sequencing revealed a G- > T transition at c.44 (p.R15L) in AP2S1. Family studies identified this variant in the father and an affected brother. The mother was unexpectedly found to be hypocalcemic and was diagnosed with idiopathic hypoparathyroidism. This case demonstrates successful treatment of FHH3 using a low-calcium formula to limit dietary calcium availability and cinacalcet to modify PTH levels.

Effects of dietary calcium and microbial phytase on the bioavailability of two sources of zinc in broilers

ABSTRACT 1. The objective of this study was to test the effect of microbial phytase and calcium (Ca) levels on the Zn bioavailability depending on the Zn source. 2. A total of 144, one-day-old broilers received a diet containing 40 mg Zn/kg for 1 week. They were then assigned to one of the eight experimental treatments during 2 weeks. Diets contained 27 mg native Zn and were formulated according to a 2 × 2 × 2 factorial design with two added Zn sources (23 mg Zn/kg), sulphate (ZnSO4) or oxide (ZnO); two dietary Ca levels of either 6 (low) or 10 g/kg (moderate); and two microbial phytase levels, of either 0 or 750 phytase unit/kg. 3. Moderate Ca plus phytase improved body weight gain (BWG) and low Ca level without microbial phytase decreased tibia weight (Ca × Phy; p = 0.049). Zinc oxide resulted in a higher tibia development (i.e. tibia weight and length; p < 0.05) and BWG (p = 0.009) and lower FCR (p < 0.001) compared to ZnSO4. 4. Phytase improved tibia Zn concentration especially in birds given ZnSO4 compared to ZnO (Zn × Phy; p = 0.049). Moderate Ca diets improved tibial characteristics and Zn deposition compared to low Ca diets (p < 0.05). 5. Soluble Zn in the gizzard increased in the presence of phytase (p = 0.011), while higher dietary Ca reduced this in birds receiving ZnO (p = 0.004). In the jejunum, Zn solubility was higher with phytase (p = 0.008). 6. Under the conditions of this study, dietary levels of Ca and microbial phytase affect Zn availability in broilers more than the Zn source.

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania.

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.