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Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial

Mark Bolland — 2008-01-22T09:23:25-00:00

BMJ (15 January 2008), bmj.39440.525752.BE.

Objective To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women. Design Randomised, placebo controlled trial. Setting Academic medical centre in an urban setting in New Zealand. Participants 1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo. Main outcome measures Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death. Results Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49). Conclusion Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone. Trial registration Australian Clinical Trials Registry ACTRN 012605000242628. 10.1136/bmj.39440.525752.BE

Improvement of Ca balance by Fructus Ligustri Lucidi extract in aged female rats

Y Zhang — 2008-01-24T15:27:41-00:00

Osteoporosis International, Vol. 19, No. 2. (4 February 2008), pp. 235-242.

Abstract Summary This study aimed to demonstrate and delineate the mechanism of action of Fructus Ligustri Lucidi (FLL) involved in improving Ca balance in aged female rats. FLL could enhance the apparent Ca absorption rate and reduce Ca excretion, via its actions on modulating the levels of calciotropic hormones and CaBPs expression. Introduction Fructus Ligustri Lucidi (FLL) is a herb classically used for the treatment of age-related symptoms in China. The present study aimed to determine if FLL could improve calcium balance in aged female rats and delineate its mechanism of action in vivo. Methods Aged Sprague-Dawley rats (11 months of age) were orally administered with ethanol extract of FLL or its vehicle and fed with diets containing different levels of Ca (low Ca diet, LCD, 0.1% Ca; medium Ca diet, MCD, 0.6% Ca; high Ca diet, HCD, 1.2% Ca) for 12 weeks. Serum, urine and feces were collected for biochemical markers and Ca balance determination. mRNA expressions of calcium binding proteins (CaBPs) were determined by real time RT-PCR. The effects of diets and herb were analyzed by both one-way and two-way ANOVA. Results FLL significantly reduced fecal Ca excretion and induced apparent Ca absorption rate in rats fed with MCD and HCD. FLL increased serum 1,25(OH)2D3 level and duodenal CaBP-9k mRNA expressions in all rats. Renal CaBP-28k mRNA expressions were induced in rats fed with MCD and HCD upon FLL treatment. Conclusions Our study demonstrated that FLL improved Ca balance in aged female rats by increasing serum 1,25 (OH)2D3 level and vitamin D-dependent CaBPs expression.

Effect of dairy calcium or supplementary calcium intake on postprandial fat metabolism, appetite, and subsequent energy intake

Janne Lorenzen — 2008-01-23T14:09:21-00:00

Am J Clin Nutr, Vol. 85, No. 3. (1 March 2007), pp. 678-687.

Background: High calcium intake has been shown to increase fecal fat excretion. Objective: Our aim was to examine whether a high calcium intake from dairy products or from supplements affects postprandial fat metabolism and appetite through fat malabsorption. Design: Four different isocaloric meals were tested in 18 subjects according to a randomized crossover design. The test meals contained high (HC meal: 172 mg/MJ), medium (MC meal: 84 mg/MJ), or low (LC meal: 15 mg/MJ) amounts of calcium from dairy products or a high amount of calcium given as a calcium carbonate supplement (Suppl meal: 183 mg/MJ). Concentrations of plasma total triacylglycerol, chylomicron triacylglycerol, serum total cholesterol, HDL cholesterol, cholecystokinin, glucagon-like peptide 1, ghrelin, peptide YY, glucose, and insulin and appetite sensation were measured before and at regular intervals until 420 min postprandially. Results: Dairy calcium significantly diminished the postprandial lipid response. The baseline adjusted area under the curve for chylomicron triacylglycerol was approx17% lower after the MC meal (P = 0.02) and approx19% lower after the HC meal (P = 0.007) than after the LC meal and approx15% lower after the MC meal (P = 0.0495) and approx17% lower after the HC meal (P = 0.02) than after the Suppl meal. No consistent effects of calcium on appetite sensation, or on energy intake at the subsequent meal, or on the postprandial responses of cholecystokinin, glucagon-like peptide 1, ghrelin, peptide YY, insulin, or glucose were observed. Conclusions: Increased calcium intakes from dairy products attenuate postprandial lipidemia, most probably because of reduced fat absorption, whereas supplementary calcium carbonate does not exert such an effect. This may be due to differences in the chemical form of calcium or to cofactors in dairy products. Calcium did not affect appetite sensation, glucose metabolism, or gut hormone secretion.