Low Calcium Diet Research Articles

A Pharmacovigilance Study on Steroid Induced Osteoporosis

Background: In elderly people, osteoporosis and low bone density are significant risk factors for morbidity and death. Low bone strength distinguishes these illnesses, which are correlated to an increased risk of fractures from even minor traumas. Objectives: To study pharmacovigilance on steroid induced osteoporosis. Methods: A total of 950 individual who were diagnosed with osteoporosis. These individuals were deemed to be at a high risk of osteoporosis. Patients were given information regarding the risks of steroid-induced osteoporosis, as well as a handout. The patient's steroid duration and any medicines used to control the risks of steroid-induced osteoporosis were the focus of the initial evaluation. Following that, evaluations of the pharmacological therapy being examined. Any problems found were discussed with the patient and/or the prescribing practitioner. Data was gathered at the start of the study and again after 6 months of observation. Results: Glucocorticoids (prednisolone) was the main prescription drug of the entire study sample. Family history of Osteoporosis was reported in 20% of the cases. The history of fracture was reported in 30% of the cases. Low calcium diet was reported in 35% of the cases. Osteoporosis was diagnosed in 17% of the cases, Osteopenia in 22% of the cases. In 88% of the cases the drug prescribed was >5mg daily. The duration of CS intake was high. This shows that the CS drug is being abused mostly in history of allergies and asthma as its easily available OTC leading to an increased risk of osteoporosis. Around 26% were prescribed antiosteoporosis treatment with Bisphosphonate. Estrogen therapy was prescribed in 16% of the cases. Calcium supplement consumption was increased by 17%. There was significant reduction in BMD, Glucocorticoid’s usage and daily dosage and result was statistically significant. Conclusion: Because all cells employ the same glucocorticoid receptor, corticosteroids' antiinflammatory effects cannot be distinguished from their metabolic effects; thus, precautions should be taken when corticosteroids are given. Clearly, the risk of serious adverse effects rises as the amount and duration of therapy increases, thus the smallest dose required to control the condition should be provided.

Comparison of Estimated Wild Giant Anteater (Myrmecopahaga tridactyla Linnaeus, 1758) Diets with Commercial Diets for Insectivores: Implications for Anteater Health

Using the stomach contents of 24 wild road-killed giant anteaters as proxies for their diet, we found that estimated wild diets were much lower in calcium (about ten times less) and phosphorus compared with manufactured feeds commonly fed to anteaters under human care. Indicators of soil consumption, such as ash, iron, and manganese were higher in the stomach contents than in either wild termites or manufactured diets, likely due to high levels of soil ingestion during feeding in the wild. Protein and fat levels in insects, stomach contents, and commercial diets all met carnivore recommendations. Both giant anteaters and tamanduas in managed care often develop hypercalcemia, perhaps because these taxa have an enhanced ability to retain calcium allowing them to survive on such low calcium diets. Results from this study indicate that, for anteaters in managed care, it is important to keep dietary calcium and vitamins D and K within recommended levels to prevent nutritional diseases such as hyper- and hypocalcemia and vitamin K deficiency.

Effects of Lower Dietary Calcium and Phosphorus on Growth Performance and Bone Mineralizatıon of Broilers

This experiment was carried out to investigate the effects of reduced dietary calcium (Ca) and non-phytate-phosphorus (NPP) levels at 2:1 constant ratio on performance, carcase parameters and bone mineralization of Ross-308 broilers. A total of 11400 one-day-old chicks were randomly allocated to five dietary treatments with twelve replicates and were fed starter diets including either recommended (control treatment, T1) or a 6.25% lower level of both Ca and NPP according to breeder’s recommendations during starter period (SP). After SP, control treatment (T1) continued to be provided through diets containing 0.87 and 0.78 % Ca for grower (GP) and finisher periods (FP), respectively, while 6.25 % reduced group was divided into 4 dietary treatments regarding extent of decrease in Ca and NPP levels and provided by diets containing 0.79;0.65 (T2), 0.79;0.60 (T3), 0.75;0.65 (T4), and 0.75;0.60 (T5) % Ca for GP and FP, respectively. After SP, moderate and even substantial reduction of Ca and NPP significantly decreased feed intake (FI) (quadratic, P<0.05), but obtained similar body weight gain (BWG) and FCR compared to the control (P>0.05). On the other hand, reduced dietary Ca through T1 to T5 significantly decreased the total Ca and NPP intake of broilers (linear and quadratic, P<0.01), and accompanied to significant linear and quadratic relationship between Ca intake and FCR and BWG respectively. It can be concluded that reducing Ca level down to 0.75 and 0.60 % in grower and finisher phase, respectively are possible without compromising the growth performance and bone mineralization of modern broilers.

Comparison of two different anionic supplements and a low calcium diet fed to transition cows prepartum on DM intake, mineral homoeostasis and performance.

This study evaluates the effects of two rations with a positive dietary cation-anion difference (DCAD) and varying Ca content and two anionic diets on mineral homoeostasis and performance in early lactation cows. For this purpose, 48 pregnant dairy cows stratified for mature equivalent milk production, parity, body condition score (BCS), and BW were randomly assigned to four treatment groups and fed the following rations during the last 3weeks of gestation: LC: low Ca (0.24% Ca, 1.14% K, DCAD: +86mEq/kg DM), HC: high Ca (1.23% Ca, 1.17% K, DCAD: +95mEq/kg DM), AS: Anionic salt (1.21% Ca, 1.21% K, DCAD: -112mEq/kg DM, and SC: SoyChlor (1.28% Ca, 1.16% K, DCAD: -115mEq/kg DM). After parturition, all animals were fed a common postpartum diet. Data were collected until 21days in milk. Urinary pH was significantly decreased with the AS and SC treatment in comparison to the LC and HC groups. The highest prepartum DM intake (DMI) was found in the LC group, while DMI in AS cows was lowest. Postpartum, DMI was significantly greater in LC and SC cows than in animals fed the HC and AS rations. Prepartum serum concentrations of Ca, P, and Mg as well as postpartum serum concentrations of P and Mg did not differ, while postpartum Ca was lower in the HC group, especially 24 and 48h after parturition. The greatest energy-corrected milk (ECM) yield was observed in cows fed the LC ration prepartum. Interestingly, milk protein production was lower in SC cows compared to LC, HC and AS. This study indicates that a ration containing a restricted Ca content fed prepartum is as suitable as a low DCAD diet to improve Ca balance without compromising DMI and performance.

The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study

SummaryProton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08–2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults.PurposeProton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults.MethodsParticipants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism.ResultsA total of 4139 participants met the inclusion criteria, of whom 37.8% (n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08–2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities.DiscussionThe results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.

Calcium and boron alone or in combination influence performances and mineral metabolism in broilers

An experiment was conducted to study the effect of dietary boron supplementation on performance and mineral metabolism in broilers fed a diet with optimal or sub-optimal levels of calcium. A total of 216 one-day old broiler chicks (Vencob) of mixed sex (mean BW 43.79±0.83 g) were distributed in completely randomized design into six treatments each with three replicates of 12 birds (6 of each sex). The six dietary treatment groups comprised of B0C0 (basal diet with normal calcium (10 g Ca/kg)), B0C1 (Basal diet of 20% calcium deficiency (8 g Ca/kg)), B0C2 (Basal diet of 40% calcium deficiency (6 g Ca/kg)), B1C0 (Basal diet with normal calcium + 25 mg/kg boron), B1C1 (Basal diet of 20% calcium deficiency + 25 mg/kg boron) and B1C2 (Basal diet of 40% calcium deficiency + 25 mg/kg boron). The performance indices like body weight (BW), weekly body weight gain, feed intake (FI) and feed conversion ratio (FCR) were recorded till 42 d of age. A metabolism trial was conducted at the end to determine the balance of minerals. Lower than the recommended level of calcium alone or with supplemental boron significantly increased the BW, feed intake, and FCR in commercial broilers at six weeks of age. Low dietary calcium significantly increased the retention of calcium, phosphorous, magnesium, iron and manganese. Dietary boron supplementation significantly increased the excreta concentration of iron and manganese. However, the absolute and relative retention of manganese and iron were unaffected when boron was supplemented into a low calcium diet; indicating the negative effect of boron on manganese, and iron metabolism can be compensated by low dietary Ca concentration.

Running exercise with and without calcium supplementation from tuna bone reduced bone impairment caused by low calcium intake in young adult rats

Inadequate calcium intake during childhood and adolescence is detrimental to bone metabolism. Here, we postulated that calcium supplement prepared from tuna bone with tuna head oil should benefit for skeletal development than CaCO3. Forty female 4-week-old rats were divided into calcium-replete diet (0.55% w/w, S1, n = 8) and low-calcium groups (0.15% w/w for 2 weeks; L; n = 32). Then L were subdivided into 4 groups (8/group), i.e., remained on L, L + tuna bone (S2), S2 + tuna head oil + 25(OH)D3 and S2 + 25(OH)D3. Bone specimens were collected at week 9. We found that 2 weeks on low calcium diet led to low bone mineral density (BMD), reduced mineral content, and impaired mechanical properties in young growing rats. Intestinal fractional calcium absorption also increased, presumably resulting from higher plasma 1,25(OH)2D3 (1.712 ± 0.158 in L vs. 1.214 ± 0.105 nM in S1, P < 0.05). Four-week calcium supplementation from tuna bone further increased calcium absorption efficacy, which later returned to the basal level by week 9. Calcium supplementation successfully restored BMD, bone strength and microstructure. However, 25(OH)D3 + tuna head oil + tuna bone showed no additive effect. Voluntary running also effectively prevented bone defects. In conclusion, both tuna bone calcium supplementation and exercise are effective interventions for mitigating calcium-deficient bone loss.

Calcium supplementation to prevent pre-eclampsia: protocol for an individual participant data meta-analysis, network meta-analysis and health economic evaluation

IntroductionLow dietary calcium intake is a risk factor for pre-eclampsia, a major contributor to maternal and perinatal mortality and morbidity worldwide. Calcium supplementation can prevent pre-eclampsia in women with low...

Interaction between Vitamin D Status and Calcium Intake in Association with Blood Pressure and Hypertension.

Vitamin D deficiency and inadequate calcium intake are supposed to be potentially related to cardiovascular outcomes, however, their combined association with hypertension remains unclear. In this cross-sectional study among 2,352 subjects, dietary calcium intake was assessed by using a valid food frequency questionnaire, and serum 25-hydroxyvitamin D (25OHD) was measured by the Ultra Performance Liquid Chromatography system. Hypertension was defined as a level of systolic pressure ≥140 mmHg or diastolic pressure ≥90 mmHg, or both, or administration of antihypertensive medications. Vitamin D status was classified into deficiency (25OHD<20 ng/mL), insufficiency (20 ng/mL≤25OHD<30 ng/mL) and sufficiency (25OHD≥30 ng/mL), while dietary calcium intake was divided into tertiles as low, medium, and high. Two-way analysis of variance (ANOVA) and multivariable logistic regression models were adopted. A significant interaction between vitamin D status and dietary calcium intake in relations to systolic blood pressure (p=0.042) and hypertension (p=0.029) indicates the associations of dietary calcium intake with systolic blood pressure and hypertension depend on the vitamin D status, and vice versa. Only in the vitamin D deficiency group, dietary calcium intake was significantly associated with systolic blood pressure level (β=-0.162, p<0.001) and prevalence of hypertension (odd ratio=2.20, p<0.001). The significance was not substantially compromised after further adjustment for confounding factors. In conclusion, the combination of vitamin D deficiency and low dietary calcium intake, rather than alone, is associated with hypertension.

Dietary Calcium and Lead Interact to Modify Maternal Blood Pressure, Erythropoiesis, and Fetal and Neonatal Growth in Rats during Pregnancy and Lactation

We studied the effects of dietary calcium and lead exposure on lead toxicity, fetal and neonatal growth, erythropoiesis and blood pressure during pregnancy and lactation in rats. Pregnant Sprague-Dawley rats (n = 43) were randomly assigned to one of six treatment groups of 7–8 rats each. Half of the rats were fed diets of low (0.1%), normal (0.5%) or high (2.5%) calcium as calcium carbonate and exposed to 250 mg/L of lead in their drinking water for the duration of the pregnancy and for 1 wk of lactation. Three control groups were fed the same diets without lead exposure. Pups were studied at 1 d and 1 wk of age. Maternal and fetal blood and organ samples from the groups fed the low calcium diet had the highest lead concentrations, whereas the lowest lead concentrations were found in the groups fed the high calcium diet. Dam and pup hemoglobin concentrations, hematocrits, and body weights and lengths were reduced by lead exposure and by the high calcium diet. The latter also reduced organ iron concentrations and prevented lead-induced increases in free erythrocyte protoporphyrin. Dam systolic blood pressures during the third trimester of gestation were significantly higher in rats exposed to lead and fed the low calcium diet than in rats in the other five treatment groups. The results demonstrate that dietary calcium and lead exposure interact in rats to influence maternal blood pressure, erythropoiesis, and fetal and neonatal growth during pregnancy and lactation.

Serum 1,25-dihydroxyvitamin D levels in the diagnosis and pathogenesis of nutritional rickets – a multivariable re-analysis of a case-control study

BackgroundA multivariable logistic regression model resulting from a case-control study of nutritional rickets in Nigerian children suggested that higher levels of serum 25(OH)D may be required to prevent nutritional rickets in populations with low-calcium intakes. ObjectivesThis current study evaluates if adding serum 1,25-dihydroxyvitamin D [1,25(OH)2D] to that model shows that increased levels of serum 1,25(OH)2D are independently associated with risk of children on low-calcium diets having nutritional rickets. MethodsMultivariable logistic regression analysis was used to model the association between serum 1,25(OH)2D and risk of having nutritional rickets in cases (n = 108) and controls (n = 115) after adjusting for age, sex, weight-for age z-score, religion, phosphorus intake and age began walking and the interaction between serum 25(OH)D and dietary calcium intake (Full Model). ResultsSerum 1,25(OH)2D levels were significantly higher (320 pmol/L vs. 280 pmol/L) (P = 0.002), and 25(OH)D levels were lower (33 nmol/L vs. 52 nmol/L) (P < 0.0001) in children with rickets than in control children. Serum calcium levels were lower in children with rickets (1.9 mmol/L) than in control children (2.2 mmol/L) (P < 0.001). Dietary calcium intakes were similarly low in both groups (212 mg/d) (P = 0.973). In the multivariable logistic model, 1,25(OH)2D was independently associated with risk of having rickets [coefficient = 0.007 (95% confidence limits: 0.002–0.011)] after adjusting for all variables in the Full Model. ConclusionsResults confirmed theoretical models that in children with low dietary calcium intake, 1,25(OH)2D serum concentrations are higher in children with rickets than in children without rickets. The difference in 1,25(OH)2D levels is consistent with the hypothesis that children with rickets have lower serum calcium concentrations which prompt the elevation of PTH levels resulting in an elevation of 1,25(OH)2D levels. These results support the need for additional studies to identify dietary and environmental risks for nutritional rickets.

Chondroitin sulfate alleviates osteoporosis caused by calcium deficiency by regulating lipid metabolism

The use of non-drug intervention for calcium deficiency has attracted attention in recent years. Although calcium carbonate is the preferred raw material for calcium supplementation, there are few reports on the mechanism of the combined action of chondroitin sulfate and calcium to alleviate osteoporosis from the perspective of gut microbiota and metabolomics. In this study, a rat model of osteoporosis was established by feeding a low-calcium diet. The intestinal microbiota abundance, fecal and plasma metabolite expression levels of rats fed a basal diet, a low-calcium diet, a low-calcium diet plus calcium carbonate, and a low-calcium diet plus chondroitin sulfate were compared. The results showed that compared with the low calcium group, the calcium content and bone mineral density of femur were significantly increased in the calcium carbonate and chondroitin sulfate groups. 16 S rRNA sequencing and metabolomics analysis showed that chondroitin sulfate intervention could reduce short-chain fatty acid synthesis of intestinal flora, slow down inflammatory response, inhibit osteoclast differentiation, promote calcium absorption and antioxidant mechanism, and alleviate osteoporosis in low-calcium feeding rats. Correlation analysis showed that the selected intestinal flora was significantly correlated with metabolites enriched in feces and plasma. This study provides scientific evidence of the potential impact of chondroitin sulfate as a dietary supplement for patients with osteoporosis.

Chemical Composition, but Not Specific Surface Area, Affects Calcium Retention of Nanostructured Calcium Compounds in Growing Rats

Background: Low dietary calcium intake and bioavailability may adversely affect bone health. Reducing the size of calcium compounds increases their specific surface area (SSA, expressed as m2/g) and may increase calcium dissolution and bioavailability.Objective: We investigated the influence of SSA and chemical composition on the bioavailability of calcium and compared in vitro calcium dissolution with in vivo absorption.Methods: Calcium dissolution was measured in 0.1 M phosphoric acid, whereas color and pH changes of foods were assessed as indicators for potential sensory performance. Calcium absorption, retention, and fractional retention were measured over a 5-d balance study in growing Sprague-Dawley male rats after 21 d of feeding. Femoral and vertebral bone mineral density (BMD) and extensive tissue histology were assessed at study end. The influence of SSA on calcium bioavailability was assessed by comparing the groups fed pure calcium carbonate (CaCO3) with increasing SSAs of 3, 36, and 64 m2/g (CaCO3_3, CaCO3_36 and CaCO3_64), whereas chemical composition was assessed by comparing the smallest CaCO3_64, a 50:50 wt:wt percent solution mixture of CaCO3 and hydroxyapatite_94, and pure hydroxyapatite_100.Results: In vivo, fractional calcium retention from hydroxyapatite_100 (mean ± SEM: 54.86% ± 0.95%/5 d) was significantly greater than from CaCO3_64 (49.66% ± 1.15%/5 d) (P = 0.044). Increasing SSA of the pure CaCO3 did not significantly improve calcium retention. Across all 5 groups, there were no significant differences in BMD or tissue calcification by histology. In vitro calcium dissolution did not correlate with SSA or calcium absorption. In selected food matrixes, hydroxyapatite_100 caused less color change and/or smaller pH increase than did the other calcium compounds.Conclusions: Our findings suggest that chemical composition rather than SSA is a predictor of nanostructured calcium bioavailability and that in vitro dissolution of nanostructured calcium does not predict in vivo absorption. Although its phosphorus content may limit use in some populations, nanostructured hydroxyapatite may be a promising calcium compound for food fortification.

Analysis of pattern of anti-osteoarthritic drugs in a tertiary care hospital of central India – A drug utilization study

Background: Osteoarthritis (OA) is the most common kind of arthritis and symptomatic OA is recognized as a significant cause of disability and participation limitation in middle-aged and older persons. Aims and Objectives: The present study was done to evaluate drug utilization pattern of drugs used in treatment of OA at tertiary care center in central India. Materials and Methods: The present study was observational and prospective research carried out at NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, a tertiary care hospital. The necessary information was collected from the orthopedics department. The investigation lasted 6 months, from July 2022 to December 2022. The present research included 108 patients diagnosed with OA. Results: The research included a total of 104 patients comprising of 58 females and 44 men. The majority of the patients were found to be 60 years old or older, with OA impacting their knee joint considerably (45%). NSAIDs were the most regularly given class of medicines in OA which was prescribed to 81% of the patients. Combined treatment of NSAIDs, calcium, and Vitamin D3. It was found that 52% of patients were adhering to OA medication. Conclusion: The patient’s uncontrolled pain was brought on by medicines, a low-calcium diet, increased stress, obesity, and advanced age, as well as a lack of knowledge about the challenges associated with OA.

Dietary calcium intake was related to the onset of pre-eclampsia: The TMM BirThree Cohort Study.

This study aimed to explore the relationship between dietary electrolyte intake and the prevalence of hypertensive disorders of pregnancy (HDP) subtypes. Our analysis included 19914 pregnant women from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. A food frequency questionnaire was used to estimate dietary calcium, potassium, sodium, and magnesium intakes. HDP was determined based on the medical records during regular antenatal care. Logistic regression analysis assessed the relationship between dietary electrolytes intake quintiles, and HDP subtypes with adjustment for basic characteristics. Dietary electrolyte intakes were applied for the prediction model. Of the cohort, 547 participants delivered with pre-eclampsia (PE), 278 with superimposed PE (SP), and 896 with gestational hypertension (GH). PE was associated with low crude calcium intake (odds ratio of the first quintile [<251mg/day] to the fifth quintile [>623mg/day] and 95% confidence interval, 1.31 [1.00-1.70]) and P for trend was .02. SP was not associated with any nutritional intake; however, the combined outcome of PE and SP was related to low crude calcium and potassium and energy-adjusted calcium, potassium, and magnesium intakes (P for trend, .01, .048, .02, .04, and .02, respectively). The same tendency was observed for GH. A prediction model that included crude calcium and potassium intakes performed better than a model without them. In conclusion, low dietary calcium, potassium, and magnesium were associated with higher HDP subtypes prevalence. The prediction model implied that crude calcium and potassium intakes might play a critical role in PE and SP pathogenesis.

Hypercrystalluria as a Factor in the Development of Urine Stone Disease, Diagnosis and Directions of Treatment

Under the action of exogenous, androgenic, genetically determined factors, the metabolism of stone-forming salts of calcium, phosphorus, magnesium, oxalates, uric acid in the blood serum and their active excretion by the kidneys to the state of hypersaturation (oversaturation) is disturbed) urine is formed. When the level of crystallization inhibitors is disturbed, a saturated salt solution crystallizes with the formation of microliths. The formation of stones in the kidneys is possible only in the presence of «building material» – supersaturated saturated urine, therefore, hyperoxaluria is a pre-stone condition. Treatment measures should be aimed at correcting mineral metabolism in the body after establishing the type of hyperoxaluria using laboratory tests: salt transport, calcium load, dietary test – low-calcium diet, thiazide test and determination of the mineral composition of the removed (removed) stone. Genetically consequential conditions (10–15%) count about 30 varieties in which the main sign or symptom in the manifestation of the disease is urolithiasis. Unfortunately, congenital tubulopathies are not sufficiently studied, so the treatment is symptomatic, in some cases simultaneous kidney and liver transplantation options are possible. Clinically, 4 main forms of hypercrystalluria are distinguished: hypercalciuria, hyperoxaluria, hyperuricuria, phosphaturia and mixed forms of crystalluria. Acquired forms of hypercrystalluria, of which they are absorptive (type II intestinal hyperabsorption – absorptive hypercalciuria and absorptive hyperoxaluria), are of main clinical interest, which is characteristic of the course of calcium-oxalate urolithiasis. Metaphylaxis of calcium-oxalate urolithiasis is formed on the basis of these data.

Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient

Introduction: Lower extremity ulcers often create diagnostic challenges and influence patient morbidity and mortality. The most common causes are venous insufficiency, arterial insufficiency, and neuropathic. Ulcers associated with systemic condition often face diagnostic and therapeutic challenge. We report a necrotic lower extremity ulcer caused by calciphylaxis in a patient with chronic renal failure.&#x0D; Case: We reported a 48-year-old Javanese woman, complained of painful lower extremities ulcers since 1.5 months ago. The patient had a history of renal failure and hypertension, undergone routine hemodialysis since 13 years ago, and used Continuous Ambulatory Peritoneal Dialysis (CAPD) since one year ago. Dermatology status on dorsum pedis sinister as well as cruris dexter and sinister showed multiple ulcers on livid skin covered by black eschar, accompanied by tenderness. Laboratory results showed anemia (Hb 7.6), hypoalbuminemia (2.7), increased serum urea level (170.4 mg/dl), increased serum creatinine (11.23 mg/dl), increased calcium (10.4 mg/dl), high inorganic phosphorus (8.5 mg/dl) and high parathyroid hormone (2,164). BOF examination showed abdominal calcification, while radiographic examination on cruris dexter et sinister showed soft tissue calcification and osteoporosis. Histopathology result supported the presence of calciphylaxis. The patient was diagnosed with stage V chronic renal failure, hypertension, and calciphylaxis caused by secondary hyperparathyroidism. She was managed by low calcium and phosphate diet, lanthanum, paracetamol, folic acid, adalat oros, captopril and wound debridement.&#x0D; Conclusion: Calciphylaxis is rare phenomenon of cutaneous necrosis associated with end-stage renal disease. Control of end-stage renal disease may be an important factor for treatment of calciphylaxis and patient with calciphylaxis usually had a poor prognosis.

Lower Dietary Calcium Intake is Associated with a Higher Risk of Mortality in Korean Adults.

Calcium, one of the most abundant minerals in the human body, has a pivotal role in human physiology. However, only a few studies have examined the association of dietary calcium intake with mortality in a population with low calcium intake. The aim of this study was to examine the association of dietary calcium intake with risk of all-cause and cause-specific mortality among Korean adults with low calcium intake. This study was a prospective cohort study. The analysis was conducted using data from 44,327 eligible Korean adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey 2007-2015. Dietary calcium intake was assessed using 1-day 24-hour recall data. The main outcomes of this study were mortality from all causes, cancer, cardiovascular disease, respiratory disease, and all other causes combined. The outcome was ascertained through linkage to the death registry compiled by Statistics Korea with the use of the resident registration number. Weighted Cox proportional hazard models were used to estimate the hazard ratios and 95% CIs of the all-cause and cause-specific mortality according to dietary calcium intake. During a mean follow-up of 7.28 person-years, 1,889 deaths were ascertained. After multivariable adjustment, the hazard ratios for all-cause mortality for the second quintile to the highest quintile of dietary calcium intake, respectively, compared with the first quintile were 0.86 (95% CI 0.73 to 1.00), 0.82 (95% CI 0.69 to 0.98), 0.85 (95% CI 0.69 to 1.03), and 0.78 (95% CI 0.64 to 0.96) (P for trend from the lowest to the highest quintile= .04). There were no statistically significant associations between dietary calcium intake and risk of mortality from cancer, cardiovascular, or respiratory disease. In this large prospective cohort study of Korean adults, lower dietary calcium intake was associated with a higher risk of all-cause mortality.

Should all pregnant women take calcium supplements in Nepal? GRADE evidence to policy assessment

ABSTRACT Background The WHO recommends oral calcium supplementation (1.5–2.0 g) in pregnant women to reduce the risk of pre-eclampsia living in areas with low dietary calcium intake. Although maternal mortality is high in Nepal and eclampsia causes at least 20% of maternal deaths, implementing WHO recommendations would be a major undertaking. Objective This review aimed to assess whether the current evidence supports the blanket supplementation of calcium to prevent pre-eclampsia among pregnant women in Nepal. Methods We used a structured approach to appraise the evidence for calcium supplementation in Nepal. We identified what may influence the impact of calcium supplementation in Nepal and conducted a situation analysis in the country covering maternal mortality, pre-eclampsia occurrence, and existing government policy provisions for supplementation. We also consulted with experts and government officials to explore their perspectives and experience on supplementation. We then used AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) to appraise the Cochrane Systematic Review of calcium supplementation. Finally, we used these data in a GRADE (Grading of Recommendations Assessment, Development and Evaluation)–Evidence to Decision framework to reach a policy recommendation. Results Our assessment of the Cochrane Review showed that the recommendation made by the WHO is based on weak evidence and trial findings that are not consistent between studies. The Cochrane Review found low certainty of the evidence for benefit (reduction in pre-eclampsia and maternal mortality). Conversely, there is a high certainty of the evidence of undesirable effects (HELLP [haemolysis, elevated liver enzymes and low platelets] syndrome) although this is uncommon. The likely absolute reduction in maternal deaths projected to Nepal was estimated to be low, while the implementation costs were high. Stakeholders also raised several concerns regarding feasibility, acceptability, appropriate dosing, and risk communication. Conclusions This review concludes that the blanket supplementation of calcium cannot be recommended in Nepal. A better approach may be to identify high-risk pregnant women and manage their antenatal visits and delivery to prevent mortality from pre-eclampsia.

Effects of limestone solubility on the efficacy of a novel consensus bacterial 6-phytase variant to improve mineral digestibility, retention, and bone ash in young broilers fed low-calcium diets containing no added inorganic phosphate.

This study evaluated the effect of limestone solubility on the capacity of a novel consensus bacterial 6-phytase variant (PhyG) to improve phosphorus (P) and calcium (Ca) digestibility, retention, and utilization in low-Ca broiler diets containing no added inorganic phosphate (Pi). Male Ross 308 broilers (n = 1,152) were fed one of 16 experimental diets from 11 to 21 d of age in a randomized complete design (12 birds/cage, 6 cages/treatment). Diets comprised three positive controls (PC3, PC2, and PC1) containing 1.8, 1.2, or 0.6 g/kg MCP-P and 7.7, 7.0, or 6.2 g/kg Ca, respectively, and a negative control (NC) containing no added Pi (4.4 g/kg P; 2.8 g/kg phytate-P) and 5.5 g/kg Ca from either low or high solubility limestone (LSL or HSL, respectively, [with 42% and 97% solubility after 5 min at pH 3.0]), supplemented with 0, 250, 500, 1,000, or 2,000 FTU/kg of PhyG. Fecal samples collected on days 18 to 20 and ileal digesta collected on day 21 were analyzed for titanium dioxide, Ca, P, and phytate (IP6, inositol hexakisphosphate). Tibias (day 21) were analyzed for ash content. Data were analyzed by factorial analysis (2 limestone solubilities × 4 MCP-P levels and 2 limestone solubilities × 5 phytase dose levels) and exponential regression. Increasing dose levels of PhyG resulted in an exponential increase (P < 0.01) in the apparent ileal digestibility (AID) of P, ileal digestible P content of the diet, ileal IP6 content, and IP6 disappearance in birds fed either HSL or LSL diets, but AID Ca and ileal digestible Ca were exponentially increased by the phytase only in HSL diets (P < 0.01). Relative to HSL, the LSL increased AID P, ileal digestible P, and IP6 disappearance (P < 0.05) but reduced AID Ca, ileal digestible Ca, and retainable Ca (P < 0.05), resulting in reduced retainable P and tibia ash. Phytase exponentially increased the apparent total tract digestibility of P, retainable P, and tibia ash in HSL and LSL diets, but at or above 500 FTU/kg values were higher in HSL than LSL (interaction P < 0.05). The findings highlight that phytase dose-response effects on mineral digestibility and utilization are different for high- and low-solubility limestones, and it is therefore recommended to use digestible rather than total Ca content during diet formulation to ensure an optimal balance of Ca and P, especially in low-Ca diets. In diets containing HSL, higher phytase dose levels may be needed to compensate for the low digestible P content of the basal diet.