466 results on '"Robert P. Heaney"'
Search Results
2. Correction: Low Vitamin D Status and Suicide: A Case-Control Study of Active Duty Military Service Members.
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John C. Umhau, David T. George, Robert P. Heaney, Michael D. Lewis, Robert J. Ursano, Markus Heilig, Joseph R. Hibbeln, and Melanie L. Schwandt
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Medicine ,Science - Published
- 2013
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3. Calcium
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Connie M. Weaver and Robert P. Heaney
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- 2020
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4. List of Contributors
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David Abraham, Maria Almeida, Elena Ambrogini, Andrew Arnold, Bence Bakos, Clemens Bergwitz, Daniel D. Bikle, John P. Bilezikian, Neil Binkley, Alessandro Bisello, L.F. Bonewald, George Bou-Gharios, Roger Bouillon, Mary L. Bouxsein, Brendan F. Boyce, Steven Boyd, Maria Luisa Brandi, David B. Burr, Laura M. Calvi, Ernesto Canalis, Xu Cao, Geert Carmeliet, Thomas O. Carpenter, Wenhan Chang, Shek Man Chim, Shilpa Choudhary, Sylvia Christakos, Yong-Hee Patricia Chun, Cristiana Cipriani, Roberto Civitelli, Thomas L. Clemens, Michael T. Collins, Caterina Conte, Mark S. Cooper, Jillian Cornish, Serge Cremers, Bess Dawson-Hughes, Benoit de Crombrugghe, Hector F. DeLuca, David W. Dempster, Matthew T. Drake, Patricia Ducy, Frank H. Ebetino, Klaus Engelke, Reinhold G. Erben, David R. Eyre, Charles R. Farber, Marina Feigenson, Mathieu Ferron, Pablo Florenzano, Francesca Fontana, Brian L. Foster, Peter A. Friedman, Seiji Fukumoto, Laura W. Gamer, Thomas J. Gardella, Patrick Garnero, Harry K. Genant, Francesca Giusti, Andy Göbel, David Goltzman, Jeffrey P. Gorski, James Griffith, R. Graham G Russell, Kurt D. Hankenson, Fadil M. Hannan, Stephen E. Harris, Iris R. Hartley, Christine Hartmann, Robert P. Heaney, Geoffrey N. Hendy, Matthew J. Hilton, Lorenz C. Hofbauer, Gill Holdsworth, Yi-Hsiang Hsu, David M. Hudson, Marja Hurley, Karl L. Insogna, Robert L. Jilka, Mark L. Johnson, Rachelle W. Johnson, Glenville Jones, Stefan Judex, Harald Jüppner, Ivo Kalajzic, Gérard Karsenty, Hua Zhu Ke, Sundeep Khosla, Douglas P. Kiel, J. Klein-Nulend, Frank C. Ko, Yasuhiro Kobayashi, Martin Konrad, Paul J. Kostenuik, Christopher S. Kovacs, Richard Kremer, Venkatesh Krishnan, Henry M. Kronenberg, Peter A. Lakatos, Uri A. Liberman, Joseph A. Lorenzo, Conor C. Lynch, Karen M. Lyons, Y. Linda Ma, Christa Maes, Michael Mannstadt, Stavros Manolagas, Robert Marcus, David E. Maridas, Pierre J. Marie, Francesca Marini, Jasna Markovac, T. John Martin, Brya G. Matthews, Antonio Maurizi, Sasan Mirfakhraee, Sharon M. Moe, David G. Monroe, Carolina A. Moreira, Ralph Müller, David S. Musson, Teruyo Nakatani, Dorit Naot, Nicola Napoli, Tally Naveh-Many, Edward F. Nemeth, Thomas L. Nickolas, Michael S. Ominsky, Noriaki Ono, David M. Ornitz, Nicola C. Partridge, Vihitaben S. Patel, J. Wesley Pike, Carol Pilbeam, Lori Plum, John T. Potts, J. Edward Puzas, Tilman D. Rachner, Audrey Rakian, Rubie Rakian, Nora E. Renthal, Julie A. Rhoades (Sterling), Mara Riminucci, Scott J. Roberts, Pamela Gehron Robey, Michael J. Rogers, G. David Roodman, Clifford J. Rosen, Vicki Rosen, David W. Rowe, Janet Rubin, Clinton T. Rubin, Karl P. Schlingmann, Ego Seeman, Markus J. Seibel, Chris Sempos, Dolores M. Shoback, Caroline Silve, Justin Silver, Natalie A. Sims, Frederick R. Singer, Joseph P. Stains, Steve Stegen, Paula H. Stern, Gaia Tabacco, Istvan Takacs, Naoyuki Takahashi, Donovan Tay, Anna Teti, Rajesh V. Thakker, Ryan E. Tomlinson, Francesco Tonelli, Dwight A. Towler, Elena Tsourdi, Chia-Ling Tu, Nobuyuki Udagawa, Connie M. Weaver, Marc N. Wein, Lee S. Weinstein, MaryAnn Weis, Michael P. Whyte, Bart O. Williams, Xin Xu, Shoshana Yakar, Yingzi Yang, Stefano Zanotti, and Hong Zhou more...
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- 2020
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5. Nutritional Support for Osteoporosis
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René Rizzoli, Connie M. Weaver, Robert P. Heaney, and Bess Dawson-Hughes
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ddc:616 ,Gerontology ,business.industry ,Osteoporosis ,030209 endocrinology & metabolism ,medicine.disease ,Micronutrient ,03 medical and health sciences ,Institutional repository ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,business ,Bone mass - Published
- 2018
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6. Remodeling and skeletal fragility
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Robert P. Heaney
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- 2003
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7. Is Vitamin D Inadequacy in Early Life an Instance of the 'Barker Hypothesis'?
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Robert P. Heaney
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0301 basic medicine ,Vitamin ,Pediatrics ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,030209 endocrinology & metabolism ,Rickets ,Nutrient Intake ,Disease ,medicine.disease ,Iodine deficiency ,Developmental psychology ,03 medical and health sciences ,chemistry.chemical_compound ,Malnutrition ,030104 developmental biology ,0302 clinical medicine ,chemistry ,medicine ,Etiology ,Vitamin D and neurology ,Thyroid function ,business - Abstract
In 1986, David Barker, a British epidemiologist, noted a connection between small infant birth size and risk of heart disease later in adult life.1 The theory that certain adult-onset diseases might have their roots in nutritional insults sustained in the perinatal period (either in utero or in the early months of infancy—or perhaps both) has since been known as “the Barker hypothesis” or sometimes “The Fetal Origins Hypothesis.” The original association between undernutrition in utero and late-life heart disease has been difficult to confirm, but the idea that early-life influences can have important downstream consequences is intuitively attractive and is supported by such concrete instances as perinatal thyroid function (and, its cognate, adequate dietary iodine), which is absolutely essential for early-life brain development and maturation. Perinatal iodine deficiency and hypothyroidism from any cause are recognized as important contributors worldwide to mental retardation and learning disabilities during childhood and adult life. In this example, iodine deficiency and its consequences certainly qualify as an outspoken instance of the Barker hypothesis in operation. A critical feature of diseases occurring by way of the Barker hypothesis is the nutritional irreversibility of the long-latency disorders that result. Beyond certain critical points in development, full nutrient repletion is not able to offset or reverse the early inadequacy. This irreversibility is the major stimulus for the better elucidation of these disorders, leading to emphasis on the imperative of early-life preventive nutrition. The Barker hypothesis has been elaborated and evaluated in several reviews,2–4 but to the best of my knowledge, there has been no attempt to evaluate the hypothesis specifically for vitamin D. Thus, what I propose to explore in this very brief review is the evidence relating unrecognized, perinatal vitamin D inadequacy to increased risk of certain chronic diseases later in life, that is, to ascertain whether any such effects might be an instance of the “Barker hypothesis.” I deliberately avoid use of labels such as “deficient” or “insufficient” in characterizing vitamin D status, as these terms are often linked to specific values for serum 25-hydroxyvitamin D [25(OH)D], about which there is considerable controversy. Instead, I use terms such as “low” or “inadequate,” referencing in each such use prevailing values for vitamin D status or input relative to values found in those individuals who do not manifest the disorders concerned. I defer until the end of this review consideration of the actual, numerical range of vitamin D status values that appears to permit avoidance of the Barker effect if it is present. Also, it is important to be clear that I am not including in this exploration the well-known downstream skeletal effects of classic rickets, for example, the pelvic deformation that is considered to have been a major factor in the evolution of pale skin for populations living in, or migrating to, high latitudes. Rickets in childhood is a serious disorder and fortunately is evident and both preventable and treatable. Instead, where I focus here is on the nonskeletal consequences both of untreated rickets and of lesser degrees of vitamin D inadequacy, often not clinically apparent and occurring at critical periods during maturation, in some instances well before the life stages when rickets is typically manifest. For most of the disorders concerned, etiology is almost always multi-factorial. The relation to vitamin D inadequacy should be understood simply as just one of the conditions that, when met, together lead to expression of the diseases concerned. Removing that single factor will not usually be expected completely to eradicate the disease of interest, but will reduce its expression at a population level. For the handful of diseases discussed in what follows, the extent of that risk reduction appears to be large enough to demand serious attention, including more research. more...
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- 2016
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8. Incidence rate of type 2 diabetes is >50% lower in GrassrootsHealth cohort with median serum 25–hydroxyvitamin D of 41ng/ml than in NHANES cohort with median of 22ng/ml
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Robert Scragg, Cedric F. Garland, Sharon L. McDonnell, Edward D. Gorham, Michael F. Holick, Christine B. French, Leo L. Baggerly, and Robert P. Heaney
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Adult ,Male ,Risk ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Population ,Serum 25–hydroxyvitamin D ,030209 endocrinology & metabolism ,Type 2 diabetes ,Lower risk ,Biochemistry ,Gastroenterology ,vitamin D deficiency ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Vitamin D ,education ,Molecular Biology ,Aged ,education.field_of_study ,business.industry ,Incidence ,Cell Biology ,Middle Aged ,Nutrition Surveys ,Vitamin D Deficiency ,medicine.disease ,United States ,Confidence interval ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Cohort ,Molecular Medicine ,Female ,business ,Cohort study - Abstract
Higher serum 25–hydroxyvitamin D [25(OH)D] concentrations have been associated with lower risk of type 2 diabetes. This study compared incidence rates of type 2 diabetes among participants aged ≥20 years in two U.S. cohorts with markedly different median 25(OH)D concentrations. The median 25(OH)D concentration in the GrassrootsHealth (GRH) cohort was 41ng/ml (N=4933) while in the 2005–6 National Health and Nutrition Examination Survey (NHANES) it was 22ng/ml (N=4078) (P more...
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- 2016
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9. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study
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Sharon L. McDonnell, Robert P. Heaney, Edward D. Gorham, Carole A. Baggerly, Joan M. Lappe, Cedric F. Garland, Christine French, and Leo L. Baggerly
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Cancer Treatment ,Organic chemistry ,lcsh:Medicine ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,Neoplasms ,Breast Tumors ,Medicine and Health Sciences ,Prospective Studies ,Serum 25 hydroxyvitamin d ,Vitamin D ,Prospective cohort study ,lcsh:Science ,Multidisciplinary ,Cancer Risk Factors ,Incidence ,Vitamins ,Middle Aged ,Physical sciences ,Chemistry ,Pooled analysis ,Oncology ,030220 oncology & carcinogenesis ,Female ,Cancer Prevention ,Statistics (Mathematics) ,Research Article ,medicine.medical_specialty ,Drug Research and Development ,030209 endocrinology & metabolism ,Research and Analysis Methods ,Chemical compounds ,03 medical and health sciences ,Internal medicine ,Organic compounds ,Breast Cancer ,Cancer Detection and Diagnosis ,Confidence Intervals ,medicine ,Humans ,Clinical Trials ,Aged ,Pharmacology ,business.industry ,lcsh:R ,Cancers and Neoplasms ,Correction ,Randomized Controlled Trials ,lcsh:Q ,Clinical Medicine ,Cancer risk ,business ,Mathematics - Abstract
Background Higher serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with a lower risk of multiple cancer types across a range of 25(OH)D concentrations. Objectives To investigate whether the previously reported inverse association between 25(OH)D and cancer risk could be replicated, and if a 25(OH)D response region could be identified among women aged 55 years and older across a broad range of 25(OH)D concentrations. Methods Data from two cohorts representing different median 25(OH)D concentrations were pooled to afford a broader range of 25(OH)D concentrations than either cohort alone: the Lappe cohort (N = 1,169), a randomized clinical trial cohort (median 25(OH)D = 30 ng/ml) and the GrassrootsHealth cohort (N = 1,135), a prospective cohort (median 25(OH)D = 48 ng/ml). Cancer incidence over a multi-year period (median: 3.9 years) was compared according to 25(OH)D concentration. Kaplan-Meier plots were developed and the association between 25(OH)D and cancer risk was examined with multivariate Cox regression using multiple 25(OH)D measurements and spline functions. The study included all invasive cancers excluding skin cancer. Results Age-adjusted cancer incidence across the combined cohort (N = 2,304) was 840 cases per 100,000 person-years (1,020 per 100,000 person-years in the Lappe cohort and 722 per 100,000 person-years in the GrassrootsHealth cohort). Incidence was lower at higher concentrations of 25(OH)D. Women with 25(OH)D concentrations ≥40 ng/ml had a 67% lower risk of cancer than women with concentrations more...
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- 2018
10. Calcium and Vitamin D in Human Nutrition
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A. John and Robert P. Heaney
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Osteomalacia ,chemistry.chemical_element ,Zoology ,Rickets ,Calcium ,Biology ,medicine.disease ,chemistry.chemical_compound ,Human nutrition ,chemistry ,Fresh water ,medicine ,Vitamin D and neurology ,Cholecalciferol ,Natural state - Abstract
Calcium is the fifth most abundant element in the earth's crust and is always found in relative excess in environments in which life exists or has evolved. Sea water, contains about 10 mmol calcium, and fresh water lakes and streams that support varied life forms typically exhibit 0.5–2 mmol concentrations. Vitamin D, like calcium, was also present in abundance for primitive humans. Its source was synthesis in the skin by photochemical conversion of a precursor molecule, 7-dehydrocholesterol, to cholecalciferol. It is a peculiar conceit of twentieth century biology that we look at contemporary low intakes of calcium and vitamin D as somehow the natural state of things. The vitamin D story is less clear. Rickets and osteomalacia were recognized pathologic entities long before their pathogenesis was known. While high intakes may ultimately prove not to be necessary for health, still they can hardly be considered as "treatment" for a disease, not even as nutritional "therapy." They are simply natural nutrition. more...
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- 2018
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11. List of Contributors
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John S. Adams, Judith E. Adams, Jawaher A. Alsalem, Paul H. Anderson, Panagiota Andreopoulou, Edith Angellotti, Leggy A. Arnold, Gerald J. Atkins, Antonio Barbáchano, Shari S. Bassuk, Sarah Beaudin, Anna Y. Belorusova, Nancy A. Benkusky, Carlos Bernal-Mizrachi, Ishir Bhan, Harjit P. Bhattoa, Daniel D. Bikle, John P. Bilezikian, Neil C. Binkley, Heike A. Bischoff-Ferrari, Charles W. Bishop, Ida M. Boisen, Fabrizio Bonelli, Adele L. Boskey, Barbara J. Boucher, Roger Bouillon, Manuella Bouttier, Barbara D. Boyan, Danny Bruce, Laura Buburuzan, Andrew J. Burghardt, Thomas H.J. Burne, Mona S. Calvo, Carlos A. Camargo, Jorge B. Cannata-Andia, Margherita T. Cantorna, Carsten Carlberg, Geert Carmeliet, Thomas O. Carpenter, Graham D. Carter, Kevin D. Cashman, Lisa Ceglia, Sylvia Christakos, Kenneth B. Christopher, Rene F. Chun, Fredric L. Coe, Frederick Coffman, Juliet Compston, Cyrus Cooper, Elizabeth M. Curtis, Natalie E. Cusano, Michael Danilenko, G. David Roodman, Bess Dawson-Hughes, Pierre De Clercq, Hector F. DeLuca, Julie Demaret, Marie B. Demay, David W. Dempster, Elaine M. Dennison, Puneet Dhawan, Vassil Dimitrov, Katie M. Dixon, Maryam Doroudi, Shevaun M. Doyle, Adriana S. Dusso, Aleksey Dvorzhinskiy, Peter R. Ebeling, John A. Eisman, Gregory R. Emkey, Ervin H. Epstein Jr., Sol Epstein, Darryl Eyles, Murray J. Favus, David Feldman, Gemma Ferrer-Mayorga, David M. Findlay, James C. Fleet, Brian L. Foster, Renny T. Franceschi, David R. Fraser, Jessica M. Furst, Rachel I. Gafni, Edward Giovannucci, Christian M. Girgis, James L. Gleason, Francis H. Glorieux, Elzbieta Gocek, David Goltzman, José Manuel González-Sancho, Laura A. Graeff-Armas, William B. Grant, Natalie J. Groves, Conny Gysemans, Lasse Bøllehuus Hansen, Nicholas C. Harvey, Catherine M. Hawrylowicz, Colleen E. Hayes, Robert P. Heaney, Geoffrey N. Hendy, Pamela A. Hershberger, Martin Hewison, Michael F. Holick, Bruce W. Hollis, Philippe P. Hujoel, Elina Hyppönen, Karl L. Insogna, Nina G. Jablonski, Martin Blomberg Jensen, David A. Jolliffe, Glenville Jones, Kerry S. Jones, Harald Jüppner, Enikö Kallay, Andrew C. Karaplis, Martin Kaufmann, Mairead Kiely, Tiffany Y, Kim, Martin Konrad, Christopher S. Kovacs, Richard Kremer, Roland Krug, Rajiv Kumar, Noriyoshi Kurihara, Emma Laing, Joseph M. Lane, Dean P. Larner, María Jesús Larriba, Gilles Laverny, Nathalie Le Roy, Seong M. Lee, Michael A. Levine, Richard Lewis, Paul Lips, Thomas S. Lisse, Eva S. Liu, Philip T. Liu, Yan Li, Yan Chun Li, James G. MacKrell, Leila J. Mady, Sharmila Majumdar, Makoto Makishima, Peter J. Malloy, Elizabeth H. Mann, JoAnn E. Manson, Adrian R. Martineau, Rebecca S. Mason, Chantal Mathieu, Toshio Matsumoto, Donald G. Matthews, John J. McGrath, Daniel Metzger, Mark B. Meyer, Denshun Miao, Mathew T. Mizwicki, Rebecca J. Moon, Howard A. Morris, Li J. Mortensen, Alberto Muñoz, Yuko Nakamichi, Carmen J. Narvaez, Faye E. Nashold, Tally Naveh-Many, Carrie M. Nielson, Anthony W. Norman, Yves Nys, Melda Onal, Lubna Pal, Kristine Y. Patterson, Steven Pauwels, Pamela R. Pehrsson, Martin Petkovich, John M. Pettifor, Paul E. Pfeffer, Katherine M. Phillips, J. Wesley Pike, Stefan Pilz, Anastassios G. Pittas, Pawel Pludowski, David E. Prosser, Sri Ramulu N. Pullagura, L. Darryl Quarles, Rithwick Rajagopal, Katherine J. Ransohoff, Saaeha Rauz, Brian J. Rebolledo, Jörg Reichrath, Sandra Rieger, Amy E. Riek, Natacha Rochel, Jeffrey D. Roizen, Janet M. Roseland, Cliff Rosen, Mark S. Rybchyn, Hiroshi Saitoh, Reyhaneh Salehi-Tabar, Anne L. Schafer, Karl P. Schlingmann, Inez Schoenmakers, Zvi Schwartz, Kayla Scott, Christopher T. Sempos, Lusia Sepiashvili, Mukund Seshadri, Elizabeth Shane, Tatiana Shaurova, Irene Shui, Justin Silver, Ravinder J. Singh, Linda Skingle, René St-Arnaud, Jessica Starr, Keith R. Stayrook, Emily M. Stein, Ryan E. Stites, George P. Studzinski, Tatsuo Suda, Fumiaki Takahashi, Naoyuki Takahashi, Jean Y. Tang, Christine L. Taylor, Hugh S. Taylor, Peter J. Tebben, Thomas D. Thacher, Ravi Thadhani, Kebashni Thandrayen, Susan Thys-Jacobs, Dov Tiosano, Roberto Toni, Dwight A. Towler, Donald L. Trump, Nobuyuki Udagawa, André G. Uitterlinden, Aasis Unnanuntana, Jeroen van de Peppel, Bram C.J. van der Eerden, Marjolein van Driel, Johannes P.T.M. van Leeuwen, Natasja van Schoor, An-Sofie Vanherwegen, Aria Vazirnia, Lieve Verlinden, Annemieke Verstuyf, Reinhold Vieth, Carol L. Wagner, Graham R. Wallace, Connie Weaver, JoEllen Welsh, John H. White, Susan J. Whiting, Michael P. Whyte, John J. Wysolmerski, Sachiko Yamada, Olivia B. Yu, Kathryn Zavala, Christoph Zechner, Meltem Zeytinoglu, and Hengguang Zhao more...
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- 2018
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12. Sunlight and Vitamin D: Necessary for Public Health
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Cedric F. Garland, Michael F. Holick, Christine B. French, Paul Seaton, Edward D. Gorham, Carol L. Wagner, Carole A. Baggerly, Sharon L. McDonnell, Raphael E. Cuomo, Robert P. Heaney, Mary Pittaway, Alexander Wunsch, William B. Grant, and Bruce W. Hollis more...
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Vitamin ,Surgeon general ,medicine.medical_specialty ,Ultraviolet Rays ,media_common.quotation_subject ,Medicine (miscellaneous) ,vitamin D ,multiple sclerosis ,vitamin D deficiency ,Neglect ,chemistry.chemical_compound ,Pregnancy ,Environmental health ,Neoplasms ,medicine ,Vitamin D and neurology ,cancer ,Humans ,media_common ,Sunlight ,Nutrition and Dietetics ,integumentary system ,diabetes ,business.industry ,Public health ,public health ,heliotherapy ,Vitamins ,medicine.disease ,Vitamin D Deficiency ,Surgery ,Pregnancy Complications ,Diabetes Mellitus, Type 1 ,chemistry ,UVA ,Commentary ,Female ,Skin cancer ,business ,UVB - Abstract
The World Health Organization's International Agency for Research on Cancer recommends avoiding outdoor activities at midday, wearing clothing to cover the whole body, and daily use of sunscreen on usually exposed skin [1]. The American Cancer Society advocates Slip! Slop! Slap! and Wrap! to make sure skin is covered in clothing or sunscreen and to avoid exposure to the sun between 10 am and 4 pm [2]. The U.S. Surgeon General has issued a Call to Action focused on reducing ultraviolet (UV) exposure, whether from indoor UV or from the sun [3]. Though these recommendations, all focused on reduction of skin cancer, are accompanied by brief acknowledgement of the importance of vitamin D for health, they persist in urging avoidance of the sun at the precise times when vitamin D can be synthesized in the skin—the hours between 10 am and 3 pm—and suggest that all necessary vitamin D can be obtained through food and dietary supplements. These recommendations are understandable from the viewpoint of preventing the 3.5 million new cases of and 2000 deaths from nonmelanoma skin cancer in the United States each year [4], but they neglect the fact that we have a long cultural history of appreciation of the sun and use of UV radiation for healing purposes. Moreover, they neglect that we have evolved with physiological adaptations to help protect the skin from the sun [5] when we are mindful of our exposure and do not burn. They neglect the fact that increased sun exposure, based on latitude, has been associated with protection from several different types of cancer [6–15], type 1 diabetes [16], multiple sclerosis [17,18], and other diseases [19–23]. They also neglect the fact that exposure to the sun induces beneficial physiological changes beyond the production of vitamin D. Though adherence to the current sun-protective recommendations would likely result in the reduction of nonmelanoma skin cancer, that reduction would likely be overshadowed by the potential reduction in deaths from other cancers and from cardiovascular disease, which could be achieved by doubling average blood concentrations of 25-hydroxyvitamin D (25(OH)D) to 40 ng/mL through a combination of sun exposure and supplements [24]. The potential harm of sun avoidance and the neglect of its positive effects on human health led to a seminar, Vitamin D for Public Health: Integrating Sunshine, Supplements and Measurement for Optimal Health, presented by GrassrootsHealth at the University of California San Diego to inform and to help initiate an action plan to restore a more balanced approach to solar radiation based on input by the conference speakers. more...
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- 2015
13. 25-Hydroxyvitamin D in the Range of 20 to 100 ng/mL and Incidence of Kidney Stones
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Stacie Nguyen, Christine B. French, Cedric F. Garland, Edward D. Gorham, Leo L. Baggerly, and Robert P. Heaney
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Adult ,Male ,medicine.medical_specialty ,Research and Practice ,Logistic regression ,Gastroenterology ,Body Mass Index ,Kidney Calculi ,Sex Factors ,Risk Factors ,Internal medicine ,Vitamin D and neurology ,Humans ,Medicine ,Vitamin D ,Kidney ,business.industry ,Incidence ,Incidence (epidemiology) ,Age Factors ,Public Health, Environmental and Occupational Health ,Liter ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,medicine.anatomical_structure ,Dietary Supplements ,Female ,Kidney stones ,business ,Body mass index - Abstract
Objectives. Increasing 25-hydroxyvitamin D serum levels can prevent a wide range of diseases. There is a concern about increasing kidney stone risk with vitamin D supplementation. We used GrassrootsHealth data to examine the relationship between vitamin D status and kidney stone incidence. Methods. The study included 2012 participants followed prospectively for a median of 19 months. Thirteen individuals self-reported kidney stones during the study period. Multivariate logistic regression was applied to assess the association between vitamin D status and kidney stones. Results. We found no statistically significant association between serum 25-hydroxyvitamin D and kidney stones (P = .42). Body mass index was significantly associated with kidney stone risk (odds ratio = 3.5; 95% confidence interval = 1.1, 11.3). Conclusions. We concluded that a serum 25-hydroxyvitamin D level of 20 to 100 nanograms per milliliter has no significant association with kidney stone incidence. more...
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- 2014
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14. Osteoporosis Update: Proceedings of the 2013 Santa Fe Bone Symposium
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John T. Schousboe, Douglas P. Kiel, Paul D. Miller, John P. Bilezikian, Lynda F. Bonewald, Juliet E. Compston, E. Michael Lewiecki, and Robert P. Heaney
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Bone mineral ,medicine.medical_specialty ,Pathology ,Bone disease ,business.industry ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Alternative medicine ,medicine.disease ,Bone remodeling ,Metabolic bone disease ,Medical evidence ,medicine ,Radiology, Nuclear Medicine and imaging ,Orthopedics and Sports Medicine ,Intensive care medicine ,business ,Kidney disease - Abstract
The 2013 Santa Fe Bone Symposium included plenary sessions on new developments in the fields of osteoporosis and metabolic bone disease, oral presentations of abstracts, and faculty panel discussions of common clinical conundrums: scenarios of perplexing circumstances where treatment decisions are not clearly defined by current medical evidence and clinical practice guidelines. Controversial issues in the care of osteoporosis were reviewed and discussed by faculty and participants. This is a review of the proceedings of the Santa Fe Bone Symposium, constituting in its entirety an update of advances in the understanding of selected bone disease topics of interest and the implications for managing patients in clinical practice. Topics included the associations of diabetes and obesity with skeletal fragility, the complexities and pitfalls in assessing the benefits and potential adverse effects of nutrients for treatment of osteoporosis, uses of dual-energy X-ray absorptiometry beyond measurement of bone mineral density, challenges in the care of osteoporosis in the very elderly, new findings on the role of osteocytes in regulating bone remodeling, and current concepts on the use of bone turnover markers in managing patients with chronic kidney disease who are at high risk for fracture. more...
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- 2014
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15. Letter to Veugelers, P.J. and Ekwaru, J.P., A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D. Nutrients 2014, 6, 4472–4475; doi:10.3390/nu6104472
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Robert P. Heaney, Christine B. French, Cedric F. Garland, Carole A. Baggerly, and Edward D. Gorham
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medicine.medical_specialty ,Letter ,Calculation error ,Statistics as Topic ,lcsh:TX341-641 ,Institute of medicine ,Recommended Dietary Allowances ,chemistry.chemical_compound ,Animal science ,Nutrient ,Internal medicine ,Vitamin D and neurology ,Medicine ,Humans ,Vitamin D ,Calcifediol ,Nutrition and Dietetics ,business.industry ,digestive, oral, and skin physiology ,Nutritional Requirements ,Endocrinology ,n/a ,chemistry ,Dietary Reference Intake ,Data Interpretation, Statistical ,Statistical error ,business ,lcsh:Nutrition. Foods and food supply ,Food Science - Abstract
Recently Veugelers and Ekwaru published data [1] indicating that, in its dietary reference intakes for calcium and vitamin D, the Institute of Medicine (IOM) had made a serious calculation error [2]. Using the same data set as had the IOM panel, these investigators showed that the Recommended Dietary Allowance (RDA) for vitamin D had been underestimated by an order of magnitude. Veugelers and Ekwaru, using the IOM’s data, calculated an RDA of 8895 IU per day. They noted that there was some uncertainty in that estimate, inasmuch as this value required an extrapolation from the available data, which did not include individuals receiving daily vitamin D inputs above 2400 IU/day.[...] more...
- Published
- 2015
16. Guidelines for optimizing design and analysis of clinical studies of nutrient effects
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Robert P. Heaney
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Evidence-Based Medicine ,Nutrition and Dietetics ,business.industry ,Management science ,Pooling ,Medicine (miscellaneous) ,Guidelines as Topic ,Bioinformatics ,Review Literature as Topic ,Nutrient ,Systematic review ,Clinical Protocols ,Research Design ,Meta-analysis ,Humans ,Medicine ,business - Abstract
Presented here is a system to standardize clinical studies of nutrient effects, using nutrient-specific physiological criteria. These guidelines are based mainly on analysis of the typical sigmoid curve of biological response to nutrients and are intended for design, interpretation, and pooling of studies of nutrient effects. Five rules have been articulated for individual studies of nutrients, and six for systematic reviews and/or meta-analyses. more...
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- 2013
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17. 25-Hydroxyvitamin D Response to Graded Vitamin D3Supplementation Among Obese Adults
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Robert P. Heaney, Eileen Fuller, Laura A.G. Armas, and Andjela Drincic
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Vitamin ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Biochemistry (medical) ,Clinical Biochemistry ,Context (language use) ,medicine.disease ,Biochemistry ,vitamin D deficiency ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Pharmacokinetics ,Internal medicine ,Vitamin D and neurology ,Medicine ,Hypercalciuria ,business ,Cholecalciferol ,Body mass index - Abstract
Context: Guidelines have suggested that obese adults need 2 to 3 times more vitamin D than lean adults to treat vitamin D deficiency, but few studies have evaluated the vitamin D dose response in obese subjects. Objective: The purpose of this study was to characterize the pharmacokinetics of 25-hydroxyvitamin D [25(OH)D] response to 3 different doses of vitamin D3 (cholecalciferol) in a group of obese subjects and to quantify the 25(OH)D dose-response relationship. Design, Setting, Intervention, Patients: This was a randomized, single-blind study of 3 doses of oral vitamin D3 (1000, 5000, or 10,000 IU) given daily to 67 obese subjects for 21 weeks during the winter months. Main Outcome Measures: Serum 25(OH)D levels were measured at baseline and after vitamin D replacement, and 25(OH)D pharmacokinetic parameters were determined, fitting the 25(OH)D concentrations to an exponential model. Results: Mean measured increments in 25(OH)D at week 21 were 12.4 ± 9.7 ng/mL in the 1000 IU/d group, 27.8 ± 10.2 ng/mL... more...
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- 2013
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18. Health is better at serum 25(OH)D above 30ng/mL
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Robert P. Heaney
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Nutritional Status ,Health benefits ,Biochemistry ,law.invention ,Endocrinology ,Randomized controlled trial ,law ,Vitamin D and neurology ,Humans ,Medicine ,Vitamin D ,Molecular Biology ,Randomized Controlled Trials as Topic ,Actuarial science ,business.industry ,Nutritional Requirements ,Cell Biology ,Vitamin D Deficiency ,Surgery ,Systematic review ,Harm ,Molecular Medicine ,business ,Recommended Intake - Abstract
There is clear evidence of health benefit in studies raising serum 25(OH)D in the range of 20–50 ng/mL. However, the results have not been consistent. The likely reasons include the intrinsic smallness of nutrient effects, as well as failure of trial designers to give adequate attention to starting vitamin D status and to adequacy of dose. Similarly, systematic reviews have also usually failed to use dose or starting level as criteria for study inclusion. The result is null studies, on the one hand, and, on the other, meta-analytic aggregate effects that are artifactually minimized. At a more fundamental level, the issue with vitamin D (as with most nutrients) is not the demonstration of efficacy but the defining of intake. Randomized controlled trials are poorly suited to answer such a quantitative question. Alternative approaches to defining nutrient requirements based on physiological grounds are needed (and possible). Alternatively, requirements can be based on a calculus of harm, recognizing that any selected level carries two risks: possible benefits foregone and possible harm risked. The decision should be for the nutrient status level that minimizes those inescapable risks. This article is part of a Special Issue entitled ‘Vitamin D workshop’. more...
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- 2013
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19. A Novel Approach Localizes the Association of Vitamin D Status With Insulin Resistance to One Region of the 25-Hydroxyvitamin D Continuum
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Mia Ferreira, Christine B. French, Ludovic Brunel, Leo L. Baggerly, Paul J. Veugelers, Robert P. Heaney, and Stacie Nguyen
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Adult ,Male ,Canada ,medicine.medical_specialty ,Waist ,Adolescent ,medicine.medical_treatment ,Reviews ,Medicine (miscellaneous) ,Blood Pressure ,Body Mass Index ,Young Adult ,Sex Factors ,Insulin resistance ,Risk Factors ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Insulin ,Vitamin D ,Prospective cohort study ,Aged ,Aged, 80 and over ,Nutrition and Dietetics ,business.industry ,Body Weight ,Age Factors ,Type 2 Diabetes Mellitus ,Middle Aged ,medicine.disease ,Endocrinology ,Blood pressure ,Regression Analysis ,Female ,Insulin Resistance ,Waist Circumference ,business ,Body mass index ,Food Science - Abstract
Vitamin D status has been implicated in insulin resistance, type 2 diabetes mellitus, and hypertension, but the range of vitamin D status values over which the association can be found is unknown. Our objective was to define this range in a cohort of nondiabetic adult Canadians. We used a regression modeling strategy, first adjusting insulin-response variables and systolic and diastolic blood pressure for BMI, waist circumference, weight, age, and sex. The resulting residuals were regressed against serum 25-hydroxyvitamin D [25(OH)D] concentration using successive 40% data blocks ranging from the 0th to the 60th percentile of 25(OH)D values. All of the predictor variables were significantly associated with each of the dependent variables, with BMI and waist circumference accounting for >98% of the explained variance. The vitamin D association was localized to the serum 25(OH)D range extending from ∼40 to ∼90 nmol/L (16–36 μg/L). We conclude that vitamin D status is inversely associated with insulin responsiveness and blood pressure. Consistent with the threshold response characteristic typical of nutrients, the association was strongest in a circumscribed region of the range of 25(OH)D values. There was no association at 25(OH)D values >80–90 nmol/L (32–36 μg/L), indicating that the vitamin D association applied principally to values below that level. The differences observed, if they can be further confirmed in prospective studies, are of a magnitude that would be clinically important. more...
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- 2013
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20. All-Source Basal Vitamin D Inputs Are Greater Than Previously Thought and Cutaneous Inputs Are Smaller
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Laura A.G. Armas, Robert P. Heaney, and Christine B. French
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Sunlight ,medicine.medical_specialty ,Nutrition and Dietetics ,Medicine (miscellaneous) ,medicine.disease ,vitamin D deficiency ,chemistry.chemical_compound ,Basal (phylogenetics) ,Dose–response relationship ,Endocrinology ,chemistry ,Individual study ,Internal medicine ,medicine ,Vitamin D and neurology ,In patient ,Cholecalciferol - Abstract
The magnitude of vitamin D inputs in individuals not taking supplements is unknown; however, there is a great deal of information on quantitative response to varying supplement doses. We reanalyzed individual 25-hydroxyvitamin D [25(OH)D] concentration data from 8 studies involving cholecalciferol supplementation (total sample size = 3000). We extrapolated individual study dose-response curves to zero concentration values for serum 25(OH)D by using both linear and curvilinear approaches and measured seasonal oscillation in the serum 25(OH)D concentration. The total basal input (food plus solar) was calculated to range from a low of 778 iu/d in patients with end-stage renal disease to a high of 2667 iu/d in healthy Caucasian adults. Consistent with expectations, obese individuals had lower baseline, unsupplemented 25(OH)D concentrations and a smaller response to supplements. Similarly, African Americans had both lower baseline concentrations and lower calculated basal, all-source inputs. Seasonal oscillation in 4 studies ranged from 5.20 to 11.4 nmol/L, reflecting a mean cutaneous synthesis of cholecalciferol ranging from 209 to 651 iu/d at the summer peak. We conclude that: 1) all-source, basal vitamin D inputs are approximately an order of magnitude higher than can be explained by traditional food sources; 2) cutaneous, solar input in these cohorts accounts for only 10-25% of unsupplemented input at the summer peak; and 3) the remainder must come from undocumented food sources, possibly in part as preformed 25(OH)D. more...
- Published
- 2013
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21. Correction of vitamin D deficiency using sublingually administered vitamin D2 in a Crohn's disease patient with mal-absorption and a new ileostomy
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Robert P. Heaney and Patrick J. McCullough
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Vitamin ,medicine.medical_specialty ,Malabsorption ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,Biochemistry ,Gastroenterology ,vitamin D deficiency ,Intestinal absorption ,Sublingual administration ,03 medical and health sciences ,chemistry.chemical_compound ,Ileostomy ,0302 clinical medicine ,Endocrinology ,Crohn Disease ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,030212 general & internal medicine ,Vitamin D ,Molecular Biology ,Crohn's disease ,business.industry ,Cell Biology ,Vitamins ,Middle Aged ,medicine.disease ,Vitamin D Deficiency ,Surgery ,chemistry ,Intestinal Absorption ,Ergocalciferols ,Quality of Life ,Molecular Medicine ,Female ,business ,030217 neurology & neurosurgery - Abstract
Vitamin D deficiency has been shown to be associated with many adverse health problems. Studies have shown that patients with Crohn’s disease who have low vitamin D levels have a poorer quality of life than those with more adequate levels. It has also been shown that patients with mal-absorption problems have a difficult time achieving normal vitamin D levels in spite of aggressive supplementation, and that exposure to UVB radiation may be the most effective treatment option for these patients. We present a case in which 25-hydroxyvitamin D levels were normalized within 2 weeks in a severely vitamin D deficient patient with Crohn’s disease with mal-absorption and a new ileostomy, utilizing sublingually administered vitamin D2. A 58 year-old white female was admitted with a new ileostomy following partial bowel resection due to complications from Crohn’s disease. She was found to be severely vitamin D deficient at the time of admission, with a level of 6.1 ng/ml on hospital day 3. Her treatment with vitamin D was delayed for a few days. She was initially treated with 5000 units of vitamin D3 orally twice a day for 3 days (days 7–10). After discussion with the patient and obtaining her consent, vitamin D3 was stopped, and she was then treated with a total of 8 doses of 50,000 units of vitamin D2 administered sublingually. She was given the first 3 doses on alternating days (days 11, 13, 15), and then 5 more doses on consecutive days (days 17–21). The rise in her 25-hydroxyvitamin D level in response to treatment with sublingual vitamin D2 was significant. On day 10, after receiving 3 days of orally administered vitamin D3, her level was 9.8 ng/ml. One week later, after receiving 3 sublingual doses of vitamin D2, it rose to 20.3 ng/ml. It was then measured on alternating days twice over the next 4 days, and it rose to 45.5 ng/ml, and then to 47.4 ng/ml on the day of discharge to home. The major finding of this study is that sublingual administration of vitamin D2 appears to work effectively when intestinal absorption is impaired. The optimal dosing regimen still needs to be determined for the average Crohn’s disease patient. more...
- Published
- 2016
22. Effect of Cow’s Milk on Human Health
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Robert P. Heaney, Cary P. Frye, and Laura A.G. Armas
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Lactose intolerance ,education.field_of_study ,Pastoralism ,Population ,Consumption (sociology) ,medicine.disease ,Agricultural economics ,food.food ,Human health ,food ,Geography ,Agricultural revolution ,Agronomy ,medicine ,Chocolate milk ,education ,Islamic medicine - Abstract
Milk has been a staple of the diet of Old World temperate zone people since the agricultural revolution, approx 8000 bc. Milk is mentioned more than 20 times in the Hebrew scriptures (“... a land flowing with milk and honey...”) as a metaphor for abundance and wholesomeness. Also, in one of the Islamic medicine tomes, we read “Drink milk, for it wipes away heat from the heart, strengthens the back, increases the brain, augments the intelligence, renews vision, and drives away forgetfulness” (1). Although they are not supported by contemporary standards, those claims, nevertheless, illustrate the generally high esteem that milk has enjoyed throughout its history. Milk is a thirst-quenching nourishing beverage. For some segments of the population (i.e., nomadic pastoralists) milk became, and is still today, the principal source of almost all nutrients, with daily consumption of approx 5–7 L. more...
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- 2016
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23. A Review of Calcium Supplements and Cardiovascular Disease Risk
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John N. Hathcock, Kevin C. Maki, Robert P. Heaney, Taylor C. Wallace, Stephen L. Kopecky, and Douglas MacKay
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medicine.medical_specialty ,Pathology ,Nutrition and Dietetics ,business.industry ,Confounding ,Medicine (miscellaneous) ,Clinical trial ,Causal inference ,Epidemiology ,medicine ,Bradford Hill criteria ,Integrative medicine ,Biological plausibility ,Intensive care medicine ,business ,Food Science ,Cohort study - Abstract
A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women's Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources. more...
- Published
- 2012
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24. Volumetric Dilution, Rather Than Sequestration Best Explains the Low Vitamin D Status of Obesity
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Eileen E. Van Diest, Robert P. Heaney, Laura A.G. Armas, and Andjela T Drincic
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Indicator Dilution Techniques ,Medicine (miscellaneous) ,Body weight ,Body Mass Index ,Cohort Studies ,chemistry.chemical_compound ,Endocrinology ,Predictive Value of Tests ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Obesity ,Vitamin D ,Aged ,Nutrition and Dietetics ,Chemistry ,Body Weight ,Total body ,Baseline data ,Vitamin D Deficiency ,medicine.disease ,Dilution ,Cross-Sectional Studies ,Female ,Cholecalciferol ,Body mass index - Abstract
Vitamin D status is known to be poor in obese individuals; there is no consensus as to the reason. Cross-sectional study of the relation between serum 25-hydroxyvitamin D (25(OH)D) concentration and body size in the baseline data from unsupplemented adults entering two study cohorts in our research unit, N = 686. Regression analyses of body size variables against serum 25(OH)D concentration, using both linear and hyperbolic models. The fit to a hyperbolic model of 25(OH)D against body weight completely removed the obesity-related component of inter-individual variability in serum 25(OH)D concentration. The hyperbolic fit using total body weight was significantly better than any linear model, and specifically better than any using BMI. Dilution of ingested or cutaneously synthesized vitamin D in the large fat mass of obese patients fully explains their typically low vitamin D status. There is no evidence for sequestration of supplemental or endogenous cholecalciferol. Vitamin D replacement therapy needs to be adjusted for body size if desired serum 25(OH)D concentrations are to be achieved. more...
- Published
- 2012
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25. Phosphorus
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Robert P. Heaney
- Published
- 2012
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26. Guidelines for Preventing and Treating Vitamin D Deficiency and Insufficiency Revisited
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Connie M. Weaver, David A. Hanley, M. Hassan Murad, Catherine M. Gordon, Michael F. Holick, Neil Binkley, Heike A. Bischoff-Ferrari, and Robert P. Heaney
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Male ,Societies, Scientific ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,MEDLINE ,Guidelines as Topic ,Health Promotion ,Severity of Illness Index ,Biochemistry ,vitamin D deficiency ,Adolescent medicine ,Endocrinology ,Internal medicine ,Health science ,Humans ,Medicine ,Vitamin D ,Calcifediol ,25-Hydroxyvitamin D 2 ,National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division ,Vitamin D metabolism ,business.industry ,Biochemistry (medical) ,Age Factors ,Nutritional Requirements ,Vitamin D Deficiency ,University hospital ,medicine.disease ,United States ,Health promotion ,Dietary Supplements ,Practice Guidelines as Topic ,Female ,business - Abstract
Boston University School of Medicine (M.F.H.), Boston, Massachusetts 02118-2526; Osteoporosis Research Program (N.C.B.), University of Wisconsin, Madison, Wisconsin 53706; Department of Rheumatology and Institute for Physical Medicine (H.A.B.-F.), University Hospital Zurich, 8091 Zurich, Switzerland; Divisions of Adolescent Medicine and Endocrinology (C.M.G.), Childrens Hospital, Boston, Massachusetts 02115; Division of Endocrinology and Metabolism (D.A.H.), Health Science Centre, University of Calgary Faculty of Medicine (R.P.H.), Calgary, Canada AB T2N 4N1; Creighton University (R.P.H.), Omaha, Nebraska 68131; Division of Preventative, Occupational, and Aerospace Medicine Mayo Clinic (M.H.M.), Rochester, Minnesota 55905; and Department of Foods and Nutrition (C.M.W.), Purdue University, West Lafayette, Indiana 47907 more...
- Published
- 2012
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27. Why randomized controlled trials of calcium and vitamin D sometimes fail
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Joan M. Lappe and Robert P. Heaney
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medicine.medical_specialty ,Pathology ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,systematic reviews ,Alternative medicine ,Review ,Dermatology ,Disease ,law.invention ,Promotion (rank) ,Randomized controlled trial ,law ,Intervention (counseling) ,medicine ,Clinical endpoint ,Intensive care medicine ,media_common ,business.industry ,Evidence-based medicine ,design flaws ,nutrient dose response ,Systematic review ,meta-analyses ,evidence-based medicine ,business ,chronic disease - Abstract
The importance of nutrients for promotion of health and prevention of disease has long been recognized. Nonetheless, scientists are still trying to delineate the optimal intakes of various nutrients and their potential benefits for different populations. To that end, evidence-based medicine (EBM) has been applied to the study of nutrition. EBM methods basically call for the use of randomized controlled trials (RCTs) to establish causal connection between the intervention and any particular endpoint. This paper focuses on problems that arise in the use of RCTS to establish a causal link between nutrients and various clinical endpoints. While many RCTS of calcium and vitamin D have been positive, many others have been null. In this paper, we discuss the reasons why effective nutrient agents may be found to be ineffective in particular studies, giving examples of such null results, and focusing on the nearly universal failure to consider biological criteria in designing RCTs. Our purpose is (1) to inform future study design so as to ensure that relevant biological facts are considered and (2) to aid in the interpretation of the abundant, but often inconsistent literature on this topic. more...
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- 2012
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28. The nutrient problem
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Robert P. Heaney
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medicine.medical_specialty ,Hormone replacement ,Nutritional Status ,Medicine (miscellaneous) ,Nutrient intake ,Referent ,Models, Biological ,Nutrition Policy ,law.invention ,Randomized controlled trial ,Reference Values ,law ,Internal medicine ,Humans ,Medicine ,Hormone replacement therapy ,Nutrition and Dietetics ,Nutrition assessment ,business.industry ,Nutritional Requirements ,Nutritional status ,Nutrition Assessment ,Endocrinology ,Risk analysis (engineering) ,Reference values ,business - Abstract
Nutrient intake recommendations, unlike hormone replacement standards, are based empirically, rather than physiologically, i.e., they lack an a priori normal referent. Randomized controlled trials do not provide the needed referent and are unlikely to distinguish between fully normal and various suboptimal nutritional states. Several alternative approaches, each providing an a priori normal, are described and briefly discussed. more...
- Published
- 2012
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29. Bone Mineral Density Discordance and Exploration of One of its Causes
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Robert P. Heaney and K. Michael Davies
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musculoskeletal diseases ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Dentistry ,Bone strength ,Bone Density ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Orthopedics and Sports Medicine ,Pelvic Bones ,Aged ,Femoral neck ,Bone mineral ,Postmenopausal women ,business.industry ,Age Factors ,Middle Aged ,musculoskeletal system ,medicine.disease ,Spine ,Postmenopause ,medicine.anatomical_structure ,Cohort ,Female ,business ,Bone mass - Abstract
Discordances between hip and spine areal density T-score values are common and incompletely understood. In a cohort of 1157 postmenopausal women, discordances of greater than 10% occurred in 91%, with spine bone mineral density (BMD) T-scores significantly less negative than femoral neck (FN) T-scores (p0.001). However, when T-scores based on bone mineral content (BMC) rather than BMD were used, the mean discordance was not significantly different from 0. This was largely because BMC at the FN had seemingly declined with age less rapidly than had BMD at that site. This can be explained by age-related areal expansion at the hip, which would be missed in the reported BMD output. One consequence is that if BMC-based T-scores are used to classify patients, substantially fewer individuals would have been judged osteoporotic in this cohort (two-thirds fewer for spine and three-fourths fewer for hip). more...
- Published
- 2011
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30. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline
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Robert P. Heaney, Michael F. Holick, Neil Binkley, Connie M. Weaver, Heike A. Bischoff-Ferrari, David A. Hanley, M. Hassan Murad, and Catherine M. Gordon
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medicine.medical_specialty ,Evidence-Based Medicine ,business.industry ,Endocrinology, Diabetes and Metabolism ,Biochemistry (medical) ,Clinical Biochemistry ,Evaluation treatment ,Guideline ,Vitamin D Deficiency ,medicine.disease ,Biochemistry ,vitamin D deficiency ,Clinical Practice ,Endocrinology ,Systematic review ,Risk Factors ,Internal medicine ,medicine ,Vitamin D and neurology ,Remuneration ,Humans ,Endocrine system ,Vitamin D ,business - Abstract
The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection. more...
- Published
- 2011
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31. EBN (Evidence-Based Nutrition) Ver. 2.0
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Connie M. Weaver, Robert P. Heaney, and Jeffrey B. Blumberg
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Nutrition and Dietetics ,Evidence-based practice ,business.industry ,Environmental health ,Medicine ,business - Published
- 2011
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32. Quantifying the non-food sources of basal vitamin D input
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Robert P. Heaney, Christine B. French, and Sharon L. McDonnell
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Adult ,Chemistry ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Cell Biology ,Biochemistry ,Body Mass Index ,Basal (phylogenetics) ,Endocrinology ,Negatively associated ,Sunlight ,Vitamin D and neurology ,Humans ,Molecular Medicine ,Seasons ,Sun exposure ,Food science ,Vitamin D ,Serum 25 hydroxyvitamin d ,Molecular Biology ,Body mass index - Abstract
Unsupplemented vitamin D status is determined by cutaneous synthesis and food inputs; however, their relative magnitudes are largely unknown. In a cohort of 780 non-supplement-taking adults with a mean serum 25-hydroxyvitamin D [25(OH)D] of 33 (±14)ng/ml we assessed the relationship between serum 25(OH)D and non-food environmental variables. Serum 25(OH)D concentration was adjusted for seasonal influence (which removed 2% of the total variance) and these adjusted values were regressed against factors involved in cutaneous synthesis. Indoor tanning use, sun exposure, and percent of work performed outdoors were significantly positively associated and body mass index (BMI) was significantly negatively associated with 25(OH)D values (P0.03 for each). Latitude, gender, and age were not significantly correlated (P0.10). Season and non-food predictors together explained 13% of the total variance in serum 25(OH)D concentration. Non-traditional food sources need to be investigated as possible vitamin D inputs. This article is part of a Special Issue entitled 'Vitamin D Workshop'. more...
- Published
- 2014
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33. Older Mayan residents of the western highlands of Guatemala lack sufficient levels of vitamin D
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Noel W. Solomons, Robert P. Heaney, Laura A.G. Armas, Sohil R. Sud, Odilia I. Bermudez, and Gabriela Montenegro-Bethancourt
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Adult ,Male ,Rural Population ,Gerontology ,Urban Population ,Endocrinology, Diabetes and Metabolism ,Population ,Endocrinology ,Animal science ,Ethnicity ,Vitamin D and neurology ,Humans ,Medicine ,Vitamin D ,education ,Aged ,education.field_of_study ,Nutrition and Dietetics ,business.industry ,Altitude ,Estudio transversal ,Mean age ,Vitamina d ,Middle Aged ,Guatemala ,Vitamin D Deficiency ,Cross-Sectional Studies ,Sunlight ,Regression Analysis ,Female ,business ,Rural population - Abstract
Vitamin D (VitD) levels in older Mayans are currently unknown. Geographic factors, for example, residences in areas receiving ample sunlight at high altitudes and latitudes near the equator, would favor optimum VitD levels, whereas demographic factors, for example, darker skin pigmentation, clothing practices, and older age, would favor low 25-hydroxy-vitamin D, or 25(OH)D, levels. Conjecturing that demographic factors affecting VitD status might outweigh geographic factors in this population, we hypothesized that older Mayans have suboptimal values of 25(OH)D. We also hypothesized that older Mayans in rural areas would have higher VitD levels than would their urban counterparts. Blood samples were collected from 108 healthy older Mayans (mean age, 69 years) from urban (n = 84, 50% male) and rural settings (n = 24, 50% male) during the summer of 2008 in the highlands of Quetzaltenango, Guatemala. We assessed 25(OH)D concentrations by radioimmunoassay in a US-based laboratory. Mean (SD) serum 25(OH)D values were 53.3 (15.0) nmol/L, and lower 25(OH)D values were associated with increasing age (r = −0.58, P = .004). Of all subjects, 3.7% (n = 4) maintained an optimal status of 25(OH)D (>80 nmol/L), 50% (n = 54) had values between 50 and 80 nmol/L, and 46.3% (n = 50) had levels less than 50 nmol/L. Urban subjects had nonsignificantly higher 25(OH)D values (55.0 ± 15.3 nmol/L) than did rural subjects (47.4 ± 12.4 nmol/L, P = .228). Men had significantly higher values (58.2 ± 16.5 nmol/L) than did women (48.4 ± 11.6 nmol/L, P = .001). We conclude that despite residing in an optimal geographic location to receive adequate sunlight exposure, most older Guatemalan Mayans in Quetzaltenango have suboptimal levels of VitD. more...
- Published
- 2010
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34. Variability in the measured response of bone to teriparatide
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Robert P. Heaney and P. Watson
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Context (language use) ,Collagen Type I ,Bone resorption ,Bone Density ,Teriparatide ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Osteoporosis, Postmenopausal ,Aged ,Bone mineral ,Lumbar Vertebrae ,Bone Density Conservation Agents ,business.industry ,Middle Aged ,musculoskeletal system ,medicine.disease ,Rheumatology ,Hydroxyproline ,Treatment Outcome ,Endocrinology ,Orthopedic surgery ,Biomarker (medicine) ,Female ,Hip Joint ,Bone Remodeling ,Peptides ,business ,Biomarkers ,medicine.drug - Abstract
Apparent failures of bone mineral density (BMD) response to teriparatide at spine or hip occur even in a high compliance context (15% spine and 55% hip). Apparent non-responders nevertheless show good biomarker response, suggesting that apparent BMD non-response is due to measurement imprecision. Calcium intake may be an important determinant of hip response.Individuals vary in response to bone active agents, but that variability is poorly quantified and its basis is not well understood. The study included 203 postmenopausal women with moderately severe osteoporosis, all treated with teriparatide, calcium, and vitamin D. The study was performed at the Creighton University Medical Center, a single site.This is a prospective study of change in bone mineral density and resorption biomarkers over a 12-month treatment period. BMD response at spine and total hip was quantified by computing slopes for each participant's values, and biomarker change by the difference in values across the 12-month study period.Of the total number of participants, 85.2% exhibited a significant spine BMD response, while only 44.8% had a significant change at the hip. However, mean biomarker response was marginally larger for the BMD non-responders at either site than for the responders, indicating biological, if not measurable densitometric, activity of teriparatide in essentially all participants.Occasional apparent failures of BMD response in patients receiving teriparatide are probably not due to failure of response at the level of the bone remodeling apparatus, but instead reflect a combination of measurement imprecision and variable bone remodeling balance. The reason for the latter remains unclear. more...
- Published
- 2010
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35. Evidence-based criteria in the nutritional context
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Theresa O. Scholl, Connie M. Weaver, Steven H. Zeisel, Jeffrey B. Blumberg, Meir J. Stampfer, Reinhold Vieth, Michael Huncharek, and Robert P. Heaney
- Subjects
Research design ,medicine.medical_specialty ,Pathology ,Nutrition and Dietetics ,Evidence-based practice ,business.industry ,MEDLINE ,Psychological intervention ,Medicine (miscellaneous) ,Context (language use) ,Evidence-based medicine ,law.invention ,Clinical trial ,Randomized controlled trial ,law ,Medicine ,business ,Intensive care medicine - Abstract
During the last decade, approaches to evidence-based medicine, with its heavy reliance on the randomized clinical trial (RCT), have been adapted to nutrition science and policy. However, there are distinct differences between the evidence that can be obtained for the testing of drugs using RCTs and those needed for the development of nutrient requirements or dietary guidelines. Although RCTs present one approach toward understanding the efficacy of nutrient interventions, the innate complexities of nutrient actions and interactions cannot always be adequately addressed through any single research design. Because of the limitations inherent in RCTs, particularly of nutrients, it is suggested that nutrient policy decisions will have to be made using the totality of the available evidence. This may mean action at a level of certainty that is different from what would be needed in the evaluation of drug efficacy. Similarly, it is judged that the level of confidence needed in defining nutrient requirements or dietary recommendations to prevent disease can be different from that needed to make recommendations to treat disease. In brief, advancing evidence-based nutrition will depend upon research approaches that include RCTs but go beyond them. Also necessary to this advance is the assessing, in future human studies, of covariates such as biomarkers of exposure and response, and the archiving of samples for future evaluation by emerging technologies. more...
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- 2010
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36. Phosphate and carbonate salts of calcium support robust bone building in osteoporosis
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Robert P. Heaney, Robert R. Recker, Joan M. Lappe, and Patrice Watson
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Bone mineral ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Phosphorus ,Osteoporosis ,Urine Calcium Measurement ,Medicine (miscellaneous) ,chemistry.chemical_element ,Calcium ,medicine.disease ,Bone resorption ,Endocrinology ,Blood serum ,chemistry ,Internal medicine ,Teriparatide ,Medicine ,business ,medicine.drug - Abstract
Background: Calcium is an essential cotherapy in osteoporosis treatment. The relative effectiveness of various calcium salts for this purpose is uncertain. Many older women with osteoporosis have phosphorus intakes of ,70% of the Recommended Dietary Allowance. Objective: Our objective was to test the hypothesis that calcium phosphate would better support anabolic bone building than would calcium carbonate. Design: This study was a 12-mo, randomized, positive-comparator, 2-arm, single-blind clinical trial in 211 patients treated with teriparatide who consumed ,1000 mg phosphorus/d. Participants were randomly assigned to receive, in addition to teriparatide and 1000 IU cholecalciferol, 1800 mg calcium/d as either tricalcium phosphate or calcium carbonate. The primary endpoints were changes in lumbar spine and total hip bone mineral densities (BMDs); secondary endpoints were changes in bone resorption biomarkers and serum and urine calcium and phosphorus concentrations. Results: In the combined group, the lumbar spine BMD increased by 7.2%, and total hip BMD increased by 2.1% (P , 0.01 for both). However, there was no significant difference between calcium-treatment groups, and there were no significant between-group differences in serum calcium and phosphorus concentrations or in urine calcium concentrations. Bone resorption biomarkers increased in both groups, as expected with teriparatide, but the increases in the 2 calcium groups did not differ significantly. Conclusions: Tricalcium phosphate and calcium carbonate appear to be approximately equally effective in supporting bone building with a potent anabolic agent; phosphate salt may be preferable in patients with restricted phosphorus intakes. This trial was registered at clinicaltrials.gov as NCT00074711. Am J Clin Nutr doi: 10. 3945/ajcn.2009.29085. more...
- Published
- 2010
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37. Tallness versus shrinkage: Do women shrink with age or grow taller with recent birth date?
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Mary Ruth Stegman, Robert R. Recker, K. Michael Davies, and Robert P. Heaney
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Adult ,Longitudinal study ,Adolescent ,Bone density ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,White People ,Bone Density ,Cohort Effect ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Middle Aged ,Anthropometry ,Height loss ,Body Height ,United States ,Cross-Sectional Studies ,Cohort effect ,Birth date ,Regression Analysis ,Female ,business ,Demography - Abstract
This paper presents evidence that much of the high rate of age-related height loss in women reported in cross-sectional studies is actually a cohort effect rather than an aging effect. Data from a large cross-sectional study of healthy, white American women indicate that there has been a gain in peak adult height of 1.0 cm per decade for several decades from 1900 through 1965. Data from the HES, HANES I, and HANES II studies concur on this point. By contrast, data from a longitudinal study of 191 healthy white U.S. women show only a trivial rate of decline from peak adult height in the fifth and sixth decades of life. In an unselected population, some apparent height loss with age is probably due to disease processes, such as vertebral collapse. Caution is needed in using aging to interpret differences in height and in height-dependent variables, such as bone density, in cross-sectional studies. more...
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- 2009
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38. The bone-remodeling transient: Implications for the interpretation of clinical studies of bone mass change
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Robert P. Heaney
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Tracer kinetic ,Pathology ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Models, Biological ,Bone remodeling ,Bone Density ,Reference Values ,Clinical investigation ,medicine ,Humans ,Computer Simulation ,Orthopedics and Sports Medicine ,Osteoporosis, Postmenopausal ,Calcium metabolism ,Chemistry ,medicine.disease ,Reference values ,Calcium ,Female ,Bone Remodeling ,Transient (oscillation) ,Neuroscience ,Algorithms ,Bone mass - Abstract
A computer simulation of the bone-remodeling transient is described, in which the focus is explicitly on changes in clinically measurable bone mass (or density). Based upon quantitative remodeling data accumulated by histomorphometry and calcium tracer kinetics, the simulation shows that much of the apparent gain in bone produced by several agents currently employed to treat osteoporosis can be explained as a remodeling transient rather than as a fundamental alteration of remodeling balance. Even gains as large as 30% or more can be produced by nothing more than the remodeling transient under certain plausible combinations of basal remodeling rate, remodeling period, and degree of bone loss. The simulation further highlights the importance, in evaluating bone-active agents, of separating the response across the first remodeling period from bone changes that may ensue thereafter. more...
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- 2009
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39. Comparison of speed of sound ultrasound with single photon absorptiometry for determining fracture odds ratios
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Robert P. Heaney, Mary Ruth Stegman, and Robert R. Recker
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Male ,medicine.medical_specialty ,Bone disease ,Endocrinology, Diabetes and Metabolism ,Population ,Ulna ,Risk Assessment ,Odds ,Cohort Studies ,Fractures, Bone ,Absorptiometry, Photon ,Bone Density ,Confidence Intervals ,Odds Ratio ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Radionuclide Imaging ,education ,Aged ,Ultrasonography ,Bone mineral ,Analysis of Variance ,education.field_of_study ,business.industry ,Ultrasound ,Patella ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Radius ,medicine.anatomical_structure ,Osteoporosis ,Female ,Nuclear medicine ,business - Abstract
The purpose of this study was to compare the ability of ultrasound velocity measurement with that of single photon absorptiometry to determine the odds of history of fracture since age 40, for a population-based study. To do this we computed odds ratios and 95% confidence intervals for 809 women and 502 men, aged 50 years and older, who are participants in the prospective phase of the Saunders County Bone Quality Study. These participants received both the ultrasound and single photon absorptiometry bone measurements at the initiation of the study. In addition, a history of all fractures that had occurred to participants since age 40 was obtained. The two bone assessment methods were compared by examining the magnitude of the odds ratios, to determine which produces the highest estimate of the probability of odds of fracture, and by examining widths of the respective confidence intervals to show which estimate of odds ratio is the most precise. Ultrasound velocity estimates a higher probability of odds of both low-trauma fractures and all fractures than distal radius and ulna bone mineral content, but lower than bone mineral density at the same sites for both women and men. However, the ultrasound measure is more precise than bone mineral density, but less precise than bone mineral content. We conclude that ultrasound velocity is as good as single photon absorptiometry in estimating odds of fracture. more...
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- 2009
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40. Ultrasound velocity through bone predicts incident vertebral deformity
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G.H. Brandenburger, Robert R. Recker, Charles H. Chesnut, Joan M. Lappe, Robert P. Heaney, and Louis V. Avioli
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Adult ,medicine.medical_specialty ,Bone density ,Bone disease ,Endocrinology, Diabetes and Metabolism ,Radiography ,Osteoporosis ,Risk Assessment ,Standard deviation ,Bone Density ,medicine ,Humans ,Orthopedics and Sports Medicine ,Longitudinal Studies ,Osteoporosis, Postmenopausal ,Rachis ,Aged ,Ultrasonography ,Aged, 80 and over ,Orthodontics ,VERTEBRAL DEFORMITY ,business.industry ,Incidence ,Ultrasound ,Age Factors ,Patella ,Middle Aged ,medicine.disease ,Elasticity ,Spine ,Surgery ,Spinal Fractures ,Female ,business ,Follow-Up Studies - Abstract
We followed 130 postmenopausal women without evidence of vertebral deformity by lateral spine radiographs on entry into study for 2 years, and repeat spine radiographs were taken at the end of that time. Incident deformities occurring within this 2 year period were detected by two methods, a level-specific radiogrammetric approach and visual inspection by skilled clinicians. Fourteen incident deformities were detected by the radiogrammetric method, and 19 by the clinicians. Ultrasound transmission velocity was measured at the patella in each subject on entry. Values for ultrasound velocity were significantly correlated with incident fracture occurrence, with individuals having velocity values more than one standard deviation below the mean for the group exhibiting from 3.3 to 4.6 times the probability of incident fracture as individuals with velocity values more than one standard deviation above the mean. Thus, low values for ultrasound transmission velocity at the patella detect yet-unexpressed bony fragility at the spine and predict future fracture. more...
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- 2009
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41. Menopausal changes in calcium balance performance
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Robert R. Recker, Robert P. Heaney, and Paul D. Saville
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Calcium metabolism ,medicine.medical_specialty ,Nutrition and Dietetics ,Calcium Metabolism Disorders ,Calcium balance ,business.industry ,Osteoporosis ,Medicine (miscellaneous) ,Physiology ,chemistry.chemical_element ,Calcium ,medicine.disease ,Menopause ,Endocrinology ,chemistry ,Internal medicine ,medicine ,business - Abstract
Editor's Note: This paper is one of the first suggesting that idiapathic osteoporosis may be n disorder of calcium metabolism for which increased intakes calcium mas be preventative.
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- 2009
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42. Methods in Nutrition Science
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Robert P. Heaney
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Calcium metabolism ,medicine.medical_specialty ,Nutrition and Dietetics ,Bone disease ,business.industry ,Osteoporosis ,Regulator ,Medicine (miscellaneous) ,chemistry.chemical_element ,Parathyroid hormone ,Calcium ,medicine.disease ,Bone resorption ,Bone remodeling ,Endocrinology ,chemistry ,Internal medicine ,medicine ,business - Abstract
The bone remodeling transient is a temporary alteration in the balance between bone formation and bone resorption, brought about by any agency that affects bone remodeling. Ascertaining the steady state effect of an intervention requires factoring the component of the change due to the transient out of the total bony response. Since parathyroid hormone (PTH) is the principal regulator of the quantity of remodeling activity, and since calcium intake influences PTH secretion, it follows that altering calcium intake will always induce a remodeling transient. Worked examples from three published calcium intervention studies are presented, and the errors that can be made by ignoring the transient and simply measuring change in bone mass across treatment are described. more...
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- 2009
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43. Targeting Bone Remodeling for the Treatment of Osteoporosis: Summary of the Proceedings of an ASBMR Workshop
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Socrates E. Papapoulos, Robert R. Recker, John P. Bilezikian, Ego Seeman, Steven R. Goldring, Jack Martin, Robert P. Heaney, Toshio Matsumoto, Sundeep Khosla, and Teresita Bellido
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Parathyroid hormone ,RANK Ligand ,Bioinformatics ,medicine.disease ,Bone resorption ,Bone remodeling ,medicine.anatomical_structure ,Mineral density ,Osteoclast ,medicine ,Orthopedics and Sports Medicine ,business - Published
- 2009
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44. Dairy and Bone Health
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Robert P. Heaney
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Vitamin ,medicine.medical_specialty ,Potassium ,Osteoporosis ,Medicine (miscellaneous) ,chemistry.chemical_element ,Calcium ,Bone and Bones ,chemistry.chemical_compound ,Nutrient ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Nutritional Physiological Phenomena ,Cyanocobalamin ,Vitamin B12 ,Food science ,Nutrition and Dietetics ,Nutritional Requirements ,Potassium, Dietary ,medicine.disease ,Calcium, Dietary ,Endocrinology ,chemistry ,Dairy Products ,Dietary Proteins - Abstract
Bone health is the resultant of bone mass, bone architecture, and body mechanics. Nutrition supports all three components, with the principal nutrients concerned being calcium, protein, and vitamin D. Potassium, magnesium, zinc, and several vitamins are also involved to varying extents. Given modern food sources, it is difficult to devise a diet that is "bone healthy" without including three servings of dairy per day, not just because of dairy calcium, but dairy protein and potassium as well. more...
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- 2009
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45. Preponderance of the evidence: an example from the issue of calcium intake and body composition
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Robert P. Heaney and Karen Rafferty
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medicine.medical_specialty ,Evidence-Based Medicine ,Nutrition and Dietetics ,business.industry ,Body Weight ,Medicine (miscellaneous) ,Evidence-based medicine ,Nutrition Surveys ,Weight Gain ,Body weight ,Calcium, Dietary ,Endocrinology ,Internal medicine ,Body Composition ,medicine ,Humans ,Nutritional Physiological Phenomena ,Obesity ,business ,Composition (language) ,Adiposity ,Randomized Controlled Trials as Topic ,Cognitive psychology - Abstract
Meta-analysis is typically applied to studies developed in fairly mature fields, but may be ill-suited for younger fields in which most of the evidence comes from studies that were designed for other endpoints entirely and that are often significantly underpowered for the effect in question. Here, there are no generally accepted methods for getting a grasp on the preponderance of the evidence. In this review, one way of doing so is proposed and the recently emergent literature concerning calcium intake and body composition is used as an illustration of how such an approach might be used. more...
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- 2009
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46. Calcium Supplementation and Incident Kidney Stone Risk: A Systematic Review
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Robert P. Heaney
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medicine.medical_specialty ,Population ,MEDLINE ,Medicine (miscellaneous) ,Nephrolithiasis ,Kidney Calculi ,Calcium supplementation ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Humans ,Risk factor ,Adverse effect ,education ,education.field_of_study ,Nutrition and Dietetics ,business.industry ,Incidence ,Incidence (epidemiology) ,medicine.disease ,Surgery ,Postmenopause ,Dietary Supplements ,Calcium ,Female ,Kidney stones ,business - Abstract
A report of a small increase in kidney stone risk in the calcium treatment arm of the Women's Health Initiative (WHI) led to a reduction in U.S. calcium supplement sales.To reassess kidney stone risk in postmenopausal women using data accumulated in calcium supplement trials, bone active agent registration trials, and in unpublished WHI data available online; and to compare these estimates with formal published epidemiological studies of stone risk.Literature review of published studies relating calcium intake to stone risk; adverse event report data from pharmaceutical industrial trials designed to evaluate bone active agents.Stone risk in postmenopausal women has increased substantially in the past 40 years, but absolute population incidence estimates vary widely from a low of about 70 incidents/100,000/yr for Olmsted County, MN, today, to a concurrent high of approximately 190/100,000/yr for the Nurses' Health Study II. Reported WHI incidence rates are higher still, with values around 300/100,000/yr for various WHI subgroupings. The reasons for these discordances are unclear. Despite this uncertainty about background rate, most of the studies show no increase in stone risk with high calcium intake (from either diet or supplements). Contrariwise there is a substantial body of evidence, both from controlled trials and from observational studies, indicating that there is an inverse relationship between calcium intake and stone risk. more...
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- 2008
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47. Vitamin D: criteria for safety and efficacy
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Robert P. Heaney
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Calcium metabolism ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Surrogate endpoint ,Insulin ,medicine.medical_treatment ,Metabolic disorder ,Medicine (miscellaneous) ,Pharmacology ,medicine.disease ,chemistry.chemical_compound ,Dose–response relationship ,Endocrinology ,chemistry ,Internal medicine ,Toxicity ,Vitamin D and neurology ,Medicine ,business ,Cholecalciferol - Abstract
The functional status indicator for vitamin D, for both safety and efficacy, is serum 25-hydroxyvitamin D concentration. Efficacy for several health endpoints requires levels of 80 nmol/L or higher. Toxicity occurs at levels of 500 nmol/L or higher. The input needed for efficacy, in addition to typical food and cutaneous inputs, will usually be 1000-2000 IU/day of supplemental cholecalciferol. Toxicity is associated only with excessive supplemental intake (usually well above 20,000 IU/day). more...
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- 2008
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48. 22nd Marabou Symposium: the changing faces of vitamin D
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Margherita T. Cantorna, Ann Prentice, Leif Moskilde, Hector F. DeLuca, Hisashi Takasu, Christel Lamberg-Allardt, Michael D. Sitrin, Bo Angelin, Mark R. Haussler, Haakon E. Meyer, Heide S. Cross, Robert P. Heaney, Moray J. Campbell, Olle Hernell, Cutberto Garza, David J. Mangelsdorf, Johan Emelian Moan, Steve A Abrams, Pentti Tuohimaa, Chantal Mathieu, Philip James, Irv Rosenberg, Michael F. Holick, and Jan I. Pedersen more...
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Nutrition and Dietetics ,Vitamin D and neurology ,Medicine (miscellaneous) ,Physiology ,Sun exposure ,Biology ,Calcitriol receptor - Abstract
The classic role of vitamin D has involved its function in calcium metabolism. However, a much broader perspective of the importance of vitamin D is now emerging. Therefore, a new approach is needed based on a combination of molecular biological, physiological, and clinical/epidemiological studies. The remarkable range of the effects of vitamin D relates to our new understanding of both the role of the vitamin D receptor and analyses of what might be considered an optimum vitamin D status in populations exposed to very different diets and levels of sun exposure. Assessing the breadth of the current approaches was the basis of the 22nd Marabou Symposium that took place in Stockholm in June 2007. The complete proceedings will be presented in this journal as a supplement to an upcoming issue. more...
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- 2008
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49. Vitamin D in Health and Disease
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Robert P. Heaney
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Vitamin ,medicine.medical_specialty ,Calcitriol ,Epidemiology ,Administration, Oral ,Critical Care and Intensive Care Medicine ,Communicable Diseases ,vitamin D deficiency ,Nutrition Policy ,chemistry.chemical_compound ,Neoplasms ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,medicine ,Vitamin D and neurology ,Animals ,Humans ,Vitamin D ,Cholecalciferol ,Calcium metabolism ,Transplantation ,business.industry ,Vitamins ,Vitamin D Deficiency ,medicine.disease ,Ergocalciferol ,Endocrinology ,chemistry ,Cardiovascular Diseases ,Nephrology ,Ergocalciferols ,Kidney Failure, Chronic ,Osteoporosis ,Receptors, Calcitriol ,business ,Moving Points in Nephrology ,Signal Transduction ,medicine.drug - Abstract
Vitamin D functions in the body through both an endocrine mechanism (regulation of calcium absorption) and an autocrine mechanism (facilitation of gene expression). The former acts through circulating calcitriol, whereas the latter, which accounts for more than 80% of the metabolic utilization of the vitamin each day, produces, uses, and degrades calcitriol exclusively intracellularly. In patients with end-stage kidney disease, the endocrine mechanism is effectively disabled; however, the autocrine mechanism is able to function normally so long as the patient has adequate serum levels of 25(OH)D, on which its function is absolutely dependent. For this reason, calcitriol and its analogs do not constitute adequate replacement in managing vitamin D needs of such patients. Optimal serum 25(OH)D levels are greater than 32 ng/mL (80 nmol/L). The consequences of low 25(OH)D status include increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well.) Serum 25(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. Recent data indicate that cholecalciferol (vitamin D(3)) is substantially more potent than ergocalciferol (vitamin D(2)) and that the safe upper intake level for vitamin D(3) is 10,000 IU/d. more...
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- 2008
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50. Nutrients, Endpoints, and the Problem of Proof
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Robert P. Heaney
- Subjects
Gerontology ,Osteomalacia ,Nutrition and Dietetics ,Medicine (miscellaneous) ,Rickets ,Disease ,medicine.disease ,Beriberi ,Dietary Reference Intake ,Pellagra ,medicine ,Vitamin D and neurology ,Observational study ,Psychology - Abstract
The early days of nutritional science were a heady time. Working out the metabolic roles and many benefits of specific nutrients was both exciting and clearly important. In more recent times, emphasis has shifted somewhat from metabolism to policy. In a sense, this represents a major victory for nutrition. Less than a century ago, E. V. McCollum had to struggle with the prevailing notion that food was primarily fuel. The idea that not eating something could make one sick was considered laughable. Now, it is taken for granted that the quality of what we eat is at least as important as the quantity, an understanding that leads naturally to the determining of nutrient intake requirements. It is not surprising, therefore, that 7 of the last 14 Atwater lectures dealt more or less explicitly with the issue of requirements. This one will be no exception to that pattern. In my McCollum lecture of 5 y ago (1), I called attention to what I perceived as a broadening of the way deficiency disease might be conceptualized. The original nutrient deficiency diseases were all of short latency and involved discrete body systems and dysfunctions. Rickets, pellagra, and beriberi are good cases in point. And, while the working science has progressed far beyond these beginnings, these short latency diseases have remained the implicit model for much of our thinking about nutritional deficiency and, to a substantial extent, our determination of nutrient intake requirements. For example, in the first of the dietary reference intake books, that for bone-related nutrients (2), the intake requirement for vitamin D was explicitly pegged solely to the prevention of rickets/osteomalacia. As is evident on a moment’s reflection, short latency was a prerequisite for the discovery of a connection between nutrient intake and disease. Had the outcome of an inadequate intake not been discrete and not been manifested promptly, it is doubtful that we ever would have recognized the connection between cause and effect (i.e. nutrient intake and health or disease). But the science has gone far beyond that point, and it seems that there is no inherent reason why inadequate intake of the same nutrients involved in short-latency diseases could not be producing long latency deficiency disease as well. Moreover, as is now generally recognized, nutrients act through multiple mechanisms, and low intakes might be expected to lead to disorders quite distinct from the disease originally connected with the nutrient. Vitamin D is a good case in point. Total body inputs closer to those that must have prevailed during hominid evolution are associated with reduced risk of disorders as varied as Type I diabetes, hypertension, osteoporosis, various cancers, multiple sclerosis, and periodontal disease, to name only some (3–24). (For several of these disorders there is now what is referred to as ‘‘level I evidence,’’ i.e. randomized controlled trials, confirming what had been found both in observational studies and in extensive bench and small animal studies.) This broadened scheme is illustrated graphically in Figure 1. more...
- Published
- 2008
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