Higher protein intake benefits adult bone health

In seniors with osteoporosis, dietary protein intake above currently recommended levels may help to reduce bone loss and fracture risk, especially at the hip, provided calcium intakes are adequate

International Osteoporosis Foundation

A new expert consensus endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF) has reviewed the benefits and safety of dietary protein for bone health, based on analyses of major research studies.

The review, published in Osteoporosis International, found that a protein-rich diet, provided there is adequate calcium intake, is in fact beneficial for adult bone health. (1) It also found no evidence that acid load due to higher dietary protein intakes, whether of animal or vegetable origin, is damaging to bone health.

The key findings of the extensive literature review include:

• Hip fracture risk is modestly decreased with higher dietary protein intakes, provided calcium intakes are adequate;
• Bone mineral density (BMD), which is an important determinant of bone strength, appears to be positively associated with dietary protein intakes;
• Protein and calcium combined in dairy products have beneficial effects on calciotropic hormones, bone turnover markers and BMD. The benefit of dietary proteins on bone outcomes seems to require adequate calcium intakes;
• There appears to be no direct evidence of osteoporosis progression, fragility fractures or altered bone strength with the acid load originating from a balanced diet.

Professor René Rizzoli, Professor at the Division of Bone Diseases of the Geneva University Hospitals and Faculty of Medicine, stated:

"Adequate intake of dietary protein, together with calcium, is needed for optimal bone growth in children and the maintenance of healthy bone at all ages. This message needs to be reinforced in view of currently circulating myths suggesting that too much protein causes 'acid load' and is damaging to bone health. In fact, in the elderly, we find that a common problem is not too much protein, but too little. This review of the literature confirms that a balanced diet with sufficient protein intake, regardless whether of animal or vegetable source, clearly benefits bone health when accompanied by adequate calcium intake. This is particularly important for seniors with osteoporosis, and individuals at risk of malnutrition due to acute or chronic illness, or recovering from an injury."

Sugar-sweetened beverages increase risk of disease

While calories from any food have the potential to increase the risk of obesity and other cardiometabolic diseases, 22 nutrition researchers agree that sugar-sweetened beverages play a unique role in chronic health problems. The disease risk increases even when the beverages are consumed within diets that do not result in weight gain.
It's just one of the conclusions published today in Obesity Reviews in a position paper by a group of researchers who participated in the 2017 CrossFit Foundation Academic Conference. The task of researchers was to deliberate the question: Are all calories equal with regards to effects on cardiometabolic disease and obesity? The paper provides an extensive review of the current science on diets that can lead to obesity, cardiovascular disease and Type 2 diabetes.
The paper's sugar-sweetened beverage consensus is particularly relevant in light of a recent legal battle over warning labels on soda, which hinged on the 9th Circuit Court's determination of whether soda and other sweetened beverages are uniquely harmful to human health or one source of calories among many.
"What's new is that this is an impressive group of scientists with vast experience in nutrition and metabolism agreeing with the conclusion that sugar-sweetened beverages increase cardiometabolic risk factors compared to equal amounts of starch," said lead author Kimber Stanhope, a research nutritional biologist with the School of Veterinary Medicine at the University of California, Davis.
SUGAR SUBSTITUTE WON'T MAKE YOU FAT
Another interesting point of consensus among researchers is the role of the sugar substitute aspartame. The authors agreed that aspartame does not promote weight gain in adults. Stanhope said this might come as a surprise to most people.
"If you go on the internet and look up aspartame, the layperson would be convinced that aspartame is going to make them fat, but it's not," said Stanhope. "The long and short of it is that no human studies on noncaloric sweeteners show weight gain."
The authors also agreed that consumption of polyunsaturated (n-6) fats, such as those found in some vegetable oils, seeds and nuts, lowers disease risk when compared with equal amounts of saturated fats. However, that conclusion comes with a caveat. Dairy foods such as cheese and yogurts, which can be high in saturated fats, have been associated with reduced cardiometabolic risk.
The paper reviews the significant challenges involved in conducting and interpreting nutrition research.
"We have a long way to go to get precise answers on a lot of different nutrition issues," said Stanhope. "Nevertheless, we all agree that a healthy diet pattern consisting of minimally processed whole grains, fruit, vegetables, and healthy fats promotes health compared with the refined and palatable typical Western diet pattern."

Mediterranean diet may slow development of Alzheimer’s disease

Alzheimer’s disease is the most common type of dementia that occurs with aging. Experts estimate that more than 5 million Americans are currently living with the disease. But scientists know little about what lifestyle factors might protect people against developing Alzheimer’s disease. They do know that brain changes associated with the disease can occur decades before symptoms are seen.

In previous work, a research team led by Dr. Lisa Mosconi from Weill Cornell Medicine found differences in brain imaging scans between people who reported eating a Mediterranean diet and those who ate a standard Western diet. A Mediterranean diet is high in foods such as fruits, vegetables, and lean protein. In contrast, a standard Western diet contains an excess of red meat, saturated fats, and refined sugar. The differences that the research team found may signal early Alzheimer’s disease.

In a new study, Mosconi and her colleagues measured changes in brains over time. They performed baseline brain imaging in 34 people who ate a Mediterranean diet and 36 people who ate a Western diet. The volunteers ranged in age from 30 to 60 and showed no symptoms of dementia when the study began. The researchers then repeated the scans at least two years later. The study was supported by NIH’s National Institute on Aging (NIA). Results were published online in Neurology on April 13, 2018.

The brain scans taken at the beginning showed that the people who ate a Western diet already had more beta-amyloid deposits than those who ate a Mediterranean diet. Beta-amyloid is a protein known to collect in the brains of people with Alzheimer’s disease. The brains of those who ate a Western diet also showed lower energy use—a sign of brain activity—at the beginning of the study than those who ate a Mediterranean diet. Both these differences suggest the early development of dementia.

In the follow-up scans, people in the Western diet group showed even greater beta-amyloid deposits and reductions in energy use than the Mediterranean diet group. Factors such as age, sex, and a gene linked to Alzheimer’s risk didn’t account for the differences.

“We’re seeing these changes only in parts of the brain specifically affected by Alzheimer’s, and in relatively young adults,” Mosconi says. “It all points to the way we eat putting us at risk for Alzheimer’s down the line. If your diet isn’t balanced, you really need to make an effort to fix it, if not for your body, then for your brain.”

The researchers estimate that there may be as much as a three-and-a-half-year delay in progression of Alzheimer’s disease in people who have eaten a Mediterranean diet for many years, rather than a standard Western diet. Research that involves larger and more diverse groups of people over longer periods of time is needed to confirm these findings. More work is also needed to understand exactly how a Mediterranean diet may protect people from harmful brain changes.

Oral antibiotics may raise risk of kidney stones, particularly in children

Pediatric researchers have found that children and adults treated with some oral antibiotics have a significantly higher risk of developing kidney stones. This is the first time that these medicines have been linked to this condition. The strongest risks appeared at younger ages and among patients most recently exposed to antibiotics.

"The overall prevalence of kidney stones has risen by 70 percent over the past 30 years, with particularly sharp increases among adolescents and young women," said study leader Gregory E. Tasian, MD, MSCE, a pediatric urologist at Children's Hospital of Philadelphia (CHOP). Tasian noted that kidney stones were previously rare in children.
Study co-author Michelle Denburg, MD, MSCE, a pediatric nephrologist at CHOP, added, "The reasons for the increase are unknown, but our findings suggest that oral antibiotics play a role, especially given that children are prescribed antibiotics at higher rates than adults."
Tasian, Denburg and colleagues published their study today in the Journal of the American Society of Nephrology.
The study team drew on electronic health records from the United Kingdom, covering 13 million adults and children seen by general practitioners in the Health Improvement Network between 1994 and 2015. The team analyzed prior antibiotic exposure for nearly 26,000 patients with kidney stones, compared to nearly 260,000 control subjects.
They found that five classes of oral antibiotics were associated with a diagnosis of kidney stone disease. The five classes were oral sulfas, cephalosporins, fluoroquinolones, nitrofurantoin, and broad-spectrum penicillins. After adjustments for age, sex, race, urinary tract infection, other medications and other medical conditions, patients who received sulfa drugs were more than twice as likely as those not exposed to antibiotics to have kidney stones; for broad-spectrum penicillins, the increased risk was 27 percent higher.
The strongest risks for kidney stones were in children and adolescents. The risk of kidney stones decreased over time but remained elevated several years after antibiotic use.
Scientists already knew that antibiotics alter the composition of the human microbiome -- the community of microorganisms in the body. Disruptions in the intestinal and urinary microbiome have been linked to the occurrence of kidney stones, but no previous studies revealed an association between antibiotic usage and stones.
Tasian pointed out that other researchers have found that roughly 30 percent of antibiotics prescribed in office visits are inappropriate, and children receive more antibiotics than any other age group, so the new findings reinforce the need for clinicians to be careful in prescribing correct antibiotics. He added, "Our findings suggest that antibiotic prescription practices represent a modifiable risk factor -- a change in prescribing patterns might decrease the current epidemic of kidney stones in children."
One co-author of the current paper, Jeffrey Gerber, MD, PhD, is an infectious diseases specialist at CHOP who leads programs in antibiotic stewardship -- an approach that guides healthcare providers in prescribing the most appropriate antibiotic for each patient's specific infection, with the aims of improving individual outcomes and reducing the overall risk of antibiotic resistance.
Tasian and colleagues are continuing to investigate the microbiomes of children and adolescents with kidney stones in a single-center study at CHOP. Their goal is to expand this research into broader, population-based studies to better understand how variations in microbiome composition may influence the development of kidney stones.
 

 

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Journal Reference:

1. Gregory E. Tasian, Thomas Jemielita, David S. Goldfarb, Lawrence Copelovitch, Jeffrey S. Gerber, Qufei Wu, Michelle R. Denburg. Oral Antibiotic Exposure and Kidney Stone Disease. Journal of the American Society of Nephrology, 2018; ASN.2017111213 DOI: 10.1681/ASN.2017111213

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Effects of physical activity during pregnancy

In a recent Acta Obstetricia et Gynecologica Scandinavica study, a combined lifestyle intervention including dietary counseling and twice-weekly exercise classes during pregnancy resulted in a slightly longer first stage of labor, without any other effects during labor or delivery.

Women reporting to have high physical activity level (>35 minutes of moderate-to-vigorous physical activity/day) in late pregnancy had a reduced risk of having an acute cesarean section compared with those with the lowest physical activity level.

The Norwegian Fit for Delivery study included 303 pregnant women who participated in dietary counseling and twice-weekly exercise classes and 303 who received standard care.

"The association between physical activity level and mode of delivery might help motivate more women to engage in regular physical activity before and during pregnancy, which in turn will give additional health benefits for the women and their babies," said lead author Dr. Birgitte Sanda, of the University of Agder, in Norway.

Prenatal marijuana use can affect infant size, behavior

 Smoking during pregnancy has well-documented negative effects on birth weight in infants and is linked to several childhood health problems. Now, researchers at the University at Buffalo Research Institute on Addictions have found that prenatal marijuana use also can have consequences on infants' weight and can influence behavior problems, especially when combined with tobacco use.

"Nearly 30 percent of women who smoke cigarettes during pregnancy also report using marijuana," says Rina Das Eiden, PhD, RIA senior research scientist. "That number is likely to increase with many states moving toward marijuana legalization, so it's imperative we know what effects prenatal marijuana use may have on infants."

Through a grant from the National Institute on Drug Abuse, Eiden studied nearly 250 infants and their mothers. Of these, 173 of the infants had been exposed to tobacco and/or marijuana during their mothers' pregnancies. None were exposed to significant amounts of alcohol.

Eiden found that infants who had been exposed to both tobacco and marijuana, especially into the third trimester, were smaller in length, weight and head size, and were more likely to be born earlier, compared to babies who were not exposed to anything. They also were more likely to be smaller in length and weight compared to babies exposed only to tobacco in the third trimester. The results were stronger for boys compared to girls.

"We also found that lower birth weight and size predicted a baby's behavior in later infancy," Eiden says. "Babies who were smaller were reported by their mothers to be more irritable, more easily frustrated and had greater difficulty calming themselves when frustrated. Thus, there was an indirect association between co-exposure to tobacco and marijuana and infant behavior via poor growth at delivery."

Furthermore, women who showed symptoms of anger, hostility and aggression reported more stress in pregnancy and were more likely to continue using tobacco and marijuana throughout pregnancy. Therefore, due to the co-exposure, they were more likely to give birth to infants smaller in size and who were more irritable and easily frustrated. The infants' irritability and frustration is also linked to mothers who experienced higher levels of stress while pregnant.

"Our results suggest that interventions with women who smoke cigarettes or use marijuana while pregnant should also focus on reducing stress and helping them cope with negative emotions," Eiden says. "This may help reduce prenatal substance exposure and subsequent behavior problems in infants."

Increased overweight in children of mothers who drank coffee while pregnant

A study published in the BMJ Open journal shows that even moderate coffee consumption during pregnancy, one to two cups per day, is related to a risk of overweight or obesity in school age children. It has not been clearly shown if caffeine is the direct cause of the overweight, but the relationship, alone, has caused researchers to encourage increased caution.

"There may be good cause to increase the restriction of the recommended maximum of three cups of coffee per day. Caffeine is not a medicine that needs to be consumed," says Verena Sengpiel, Associate Professor in obstetrics and gynecology at Sahlgrenska Academy, Sweden, and specialist physician at the Department of Obstetrics and Gynecology at Sahlgrenska University Hospital.
Researchers at Sahlgrenska Academy, in collaboration with the Norwegian Institute of Public Health, studied information on 50 943 pregnant women, in one of the world's largest health surveys of pregnant women, the Norwegian Mother and Child Cohort Study (MoBa).

The results show that children born to mothers who consumed caffeine during pregnancy are at greater risk of being overweight at preschool and school ages. Children were followed until eight years of age. Being overweight in childhood has previously been linked to increased risk of cardiovascular disease and Type 2 diabetes later in life.

For example, at age five, the share of children who were overweight or obese was five percent greater in the group whose mothers had the highest caffeine consumption in the study, compared to those whose mothers had the lowest caffeine consumption.

The association between caffeine consumption during pregnancy and the risk of excess growth and overweight or obesity in children could also be seen in women who had followed the recommended amount for pregnant women. According to the National Food Agency, Sweden, pregnant women should not consume more than 300 milligrams of caffeine per day, which is equivalent to three cups of coffee (1.5 dl each) or six mugs of black tea (2 dl each).

The results of the current study are supported by at least two other studies; however, these included significantly fewer subjects and fewer sources of caffeine. This time, coffee, tea, chocolate, energy drinks and other sources were included.

"In the Nordic countries, coffee is the primary source, while, women in, for example, England receive the greatest amount of caffeine from black tea. If you look at mothers in the younger age group, it comes from energy drinks. We included different sources in the study and found a similar association between caffeine consumption from these different sources and children's growth," says Verena Sengpiel.

In general, the gestational environment is viewed as being important in the turning off and on of genes and metabolic programming for the duration of life. Previous animal studies, where embryos were exposed to caffeine in the womb, were also followed by excess growth and cardiometabolic disease in the offspring.

"Even if more studies are needed before we can say what this finding really means, caffeine is a substance that you can choose to reduce consumption of or completely refrain from during pregnancy," notes Verena Sengpiel.