MS_K5- Nutrition and Bone Health (Gizi).ppt

Nutrition and Bone Health

Departemen Ilmu GiziBLOK DERMATOMUSKULOSKELETAL

• Adequate nutrition is essential for the development and maintenance of the skeleton

• Bone disease complex etiologies development of disease ↓ by providing adequate amounts of nutrients

• 65 years 25% of the population by 2020

• ↑ risk osteoporosis and (doubling or tripling) hip fracture

Bone Mass and Bone Density

• Bone massBone mass bone mineral content (BMC) assesing amount of bone accumulated before the cessation of growth

• Bone densityBone density describe bone after the developmental period is completed

Calcium Metabolism

Calcium Homeostasis

Peak Bone Mass (PBM)Peak Bone Mass (PBM)

• PBM reach 30 years• Long bone stop growing in length age 18

(females) and age 20 (males)• Man > woman• Hereditary • Dietary calcium intakes• Weight-bearing physical activity• Body weight

Loss of bone mass

• Age is important

• Age 40 BMD diminish gradually (both sexes)

• Loss after age 50 (women) or the time of the menopause 1-2% per year over the next decade

• Man lower rate than women (same age)

• But age 70 same for both

Difference between normal bone and osteoporotic bone

Nutrition and Bone

• Calcium, phosphat, and vitamin D

• Micronutrient

• Phytoestrogens

Recommended Intakes of Bone-Related Nutrition for Adults

• CalciumCalcium : 1500 mg/day for postmenopausal women, 1000-1200 for younger women

• Vitamin DVitamin D: 600-1000 units• MagnesiumMagnesium : 400-600 mg• ManganeseManganese: 2-5 mg• ZincZinc: 15 mg• BoronBoron: 3 mg• Copper:2-3Copper:2-3 mg• Vitamin KVitamin K: 500 mcg

Calcium Intake

• Food sources are recommended first for supplying calcium needs because of the coingestion of other essensial nutrients

Sources:

• Calcium from food

• Calcium from supplement

• Calcium from fortification food

Calcium from food

• Calcium from food is generally good, but from a few foods such as spinach it may be lower

• Wheat bread may be a good source of calcium

• Green leafy vegetables such as broccoli, kale, bok choy, and soy bean (lower with oxalate)

• Dairy products: high-calcium milk, cheeses, yoghurt (best) yoghurt (best)

• Calcium in selected foods:– Tofu– Yoghurt– Sardines – Collard greens,cooked– Cheese– Non-fat milk– Pudding, vanilla– Whole milk– Custard– Buttermilk– Ice-milk– Spinach

Calcium from supplement

• Significant increases in spinal and total body BMD

• Good but it seems more likely that keeping the gains in BMD accrued before age 20

• Best: combination of regular physical activity and a reasonable consistent daily calcium intakes

Calcium bioavailability from calcium supplement

• Depends on the anion used

• Calcium citrate malate absorbed efficient than calcium carbonate and other calcium supplements

• Calcium carbonate constipying effect (minimize by dividing dose and taking more fluids and fibers)

Effect of supplement

• High dose calcium supplement may reduce the absorption of nonheme iron and possibly zinc. Magnesium, and other divalent cations

Potential Risks Associated with Excessive Calcium Supplementation

• Contamination of bone meal or dolomite supplements with cadmium, mercury, arsenic, or lead

• Urinary tract or renal stones in susceptible individuals

• Hypercalcemia or milk alkali syndrome from Hypercalcemia or milk alkali syndrome from extremely high intakes (>4000 mg/day)extremely high intakes (>4000 mg/day)

• Deficiency of iron and other mineral divalent cations resulting from decreased absorption

• Constipation

Calcium fortification of food

• Another way to increase the consumption of calcium by females

• Orange juice and many brands of non-dairy milks at avout 300 mg/ cup of juice and to breadds and other foods

• Food preferable

Vitamin D

• Vitamin D intake: adequate vit D intake is important excess need is avoided

• Sun light exposure for skin

• Calcium and vitamin D supplements are often given

Rickets

Phosphat intake

• Calcium and Phosphat = 1:1 needed for mineralization

• High phosphorus bone loss

• Consumption 1000 mg to 1200 mg/day (females), 1200-1400 mg/day (male)

Protein intake

• Anabolic effect• High dietary proteinno effect• Low dietary protein Low serum albuminlow

IGF-1 and serum calcium vulnerable fracture• 1 g/kg per day• Animal protein rise urinary losses of calcium

(acid)• Plant proteinlittle effect (neutral or basic urin)

Magnesium intakeMagnesium intake

• Little effect, but suggest adequate intakes of Mg improves BMD

Vitamin K intakeVitamin K intake

• Osteocalcin needs vitamin K

• Vitamin K supplementation retard bone loss

Intakes of other dietary component

• Dietary fiber: excessive intake depression calcium absorption

• Potassium bicarbonatesufficient to neutralize endogenous acid

• Vegetarian diet beneficial effect by provides less calcium than animal protein

• Isoflavon (phytoestrogen) soybean lower lifetime exposure for estrogens

• Caffein and carbonated beverages excessive intakes deterious effect on BMD

• Intakes of colaslower BMD

• Alcoholadverse effect

Intakes of other dietary component

Osteopenia and Osteoporosis

• OsteopeniaOsteopenia: When BMD falls sufficiently below healthy values (1 SD) according WHO standard

• OsteoporosisOsteoporosis: When BMD becomes so low (greater than 2.5 SDs below healthy values)

Nutrition management

• Adequate calcium intake

• Adequatevitamin D intake from food, supplement, and sun exposure

• Avoidance of excess phophorus

• A balance diet that procides adequate protein, energy, and micronutrients

• Exercise

Prevention

• Three factors influenced (for women): diet, diet, exercise, and estrogenexercise, and estrogen

• Diet calcium from food (including fortified food), adequate intake of vitamin D either from sun exposure or foods or supplement

• Engaging in regular weight-bearing exercise

• Estrogen (before 50)

The end