The WCO continues to be the primary forum for scientists to focus on the impact of lifestyle on bone health in general. The satellite symposium organized by YINI in particular featured many global comparisons in diet and the effect on bone. As Western diet permeates more of the globe and the population continues to grow, it is meaningful to study the impact of these changes on bone health as diet is one of the few major modifiable factors which in turn affects healthcare costs. Calcium, vitamin D, and protein intake continued to dominate the discussion. The symposium offered an opportunity to learn about theories and data in nutritional research concerning bone as well as methodological approaches to classify diets. The slideshow allow the reader to capture the new messages and to analyze the new scientific data presented by Professor Rene Rizzoli (Switzerland) in this field.

1. 16.04.15
1
René Rizzoli
Division of Bone Diseases
Geneva University Hospitals and Faculty of Medicine
Geneva, Switzerland
Milan, March 28th 2015
Nutritional Recommendations for a
Sustainable Bone and Muscle Health
Keaveny, JBMR 2010
Age-­‐Related
Altera2ons
in
Muskuloskeletal
Health

2. 16.04.15
2
Keaveny, JBMR 2010
Age-­‐Related
Altera2ons
in
Muskuloskeletal
Health
-­‐>
Fracture
-­‐>
Disability
-­‐>
Loss
of
Independence
-­‐>
Decreased
Quality
of
Life
-­‐>
Increased
Mortality
Keaveny, JBMR 2010
Preven2on/AKenua2on
of
Age-­‐Related
Altera2ons
in
Muskuloskeletal
Health
by
Dietary
Protein
and
Calcium,
components
of
dairy
products?

3. 16.04.15
3
GH
Dietary
Protein
mTOR
Muscle
IGF-­‐I
Bone
Growth
1,25-­‐(OH)2D3
TmPi/GFR
Intes2nal
Abs.
pPi
Ca++
and
Pi
Dietary Protein and Lean Mass
Median Protein Intake 0.7 1.1 g/kg BW
Health ABC
Study
3 Years of
Follow-up
Houston et al
AJCN
2008
Whole
Body
Appendicular

4. 16.04.15
4
Physical performance over time according to
quintile of protein intake:
Chair stands
Beasley J et al, J Am Geriatr Soc 2013
Women’s Health Initiative (WHI) Clinical Trials (CT) and Observational Study (OS)
Women aged 50 to 79 (N = 134,961)
Effect
of
Dietary
Protein
on
Bone
Loss
in
Elderly
Men
and
Women:
the
Framingham
Osteoporosis
Study
Hannan
et
al,
JBMR
2000
391
women
and
224
men,
mean
age
75.0
±
4.5
yrs
Dietary
protein
68.0
±
36.0
(food
frequency
ques2onnaire)
Femoral
Neck
BMD,
percent
change
over
4
yrs
Protein
Intake
Q1
Q2
Q3
Q4
Women
-­‐
5.1
-­‐
3.2
-­‐
2.9
-­‐
2.6
Men
-­‐
2.6
-­‐
2.9
-­‐
1.8
+
0.8

5. 16.04.15
5
A Threshold for Low-Protein-Diet Induced
Elevations in Parathyroid Hormone
Kerstetter et al, AJCN 2000
Osteoporo2c
Fracture
and
Protein
Intake
Posi2ve
Associa2on
(High
Intake
-­‐>
Higher
Incidence)
Abelow
(1992)
Cross
cultural
Study
Hip
(Animal)
Feskanich
(1996)
85900
W,
12
yrs
Forearm
1.2x
(Animal)
FrasseCo
(2000)
Cross
cultural
Study
Hip
Meyer
(1997)
39787
M
+
W
Hip
(if
Low
Ca
in
W)
Sahni
(2010)
3724
M
+
W,
12
yrs
Hip
(if
Low
Ca)
Sellmeyer
(2001)
1035
W
7
yrs
Hip
(Animal/Vegetable)
Inverse
Rela2onship
(High
Intake
-­‐>
Lower
Incidence)
Huang
(1996)
2565,
16
yrs
Hip
Misra
(2010)
946,
16
yrs
Hip
Munger
(1999)
32050
W,
3
yrs
Hip
(Animal>Vegetable)
Sahni
(2010)
3724
M
+
W,
12
yrs
Hip
(if
Ca
>
800)
Thorpe
(2008)
1865
W,
25
yrs
Wrist
(Animal–Vegetable)
Wengreen
(2004)
2501
W+M,
4
yrs
Hip
No
Associa2on
Feskanich
(1996)
85900
W,
12
yrs
Hip
(Animal)
Dargent-­‐Molina
(2008)
36217
W,
8.4
yrs
Any
BUT
1.5
OR
if
Ca<
400mg/1000kcal

6. 16.04.15
6
IOM 2010
+
50%
*
+
56%*
*
AddiEon
of
milk
powder,
not
done
everywhere

7. 16.04.15
7
Calcium Absorption
Absorption (%)
Calcium
Acetate 32 ±4
Lactate 32 ±4
Gluconate 27 ±3
Citrate 30 ±3
Carbonate 39 ±3
Whole Milk 31 ±3
Sheikh et al NEJM 1987 From Nickel et al J Nutr 1996
Servings for 250 mg Calcium
Servings
Vegetables
Dark-Green Leafy 5
Legumes 6
Grain Group
Whole Grain Foods 12
Refined Grain Foods 10
Fulgoni et al AJCN 2004

8. 16.04.15
8
JBMR 2014
JBMR 2014
BMJ 2014
Am J Clin Nutr 2014
Milk vs Cheese/Yoghurt
Osteoporos Int 2014

9. 16.04.15
9
Dietary Protein and Bone Health
Conigrave et al, 2000, 2002, 2006
• L-Amino Acids Interact with Calcium-Sensing Receptor
Dawson-­‐Hughes
et
al,
2007
• Aromatic (PHE, TYR, TRY)
(but no Branched-chain,) Amino Acids
-> Increased IGF-I
-> Increased Intestinal Calcium Absorption
Parmesan, Gruyère, Emmental, Milk are particularly rich in Aromatic Amino
Acids (Relatively poor in sulfur-containing Amino Acids)
Low=0.7 g/kg High=2.1 g/kg
AJCN 1997 AJCN 1998
Effects of Dietary Protein
Intakes on Urinary Calcium
Excretion & Intestinal
Calcium Absorption
(Kerstetter et al)
UCa
Ca Abs.
Low=0.7 g/kg High=2.1 g/kg

10. 16.04.15
10
Contribution of Dairy Products to Total Intakes of
Children Adults
Calcium 65 – 73 % 52 – 65 %
Protein - > 49 % 20 – 28 %
Smit 1999, Chevalley 2008, Vissers 2011,Fiorito 2008, Feskanich
2003, Skinner 2011, unpublished 2012
Tieland et al., JAMDA, 2012-A
n=65
Frail
Elderly,
79
Yrs
±
15
g/d
Protein
Dietary
Protein
Supplements
and
Muscle
Func2on
Neelemaa et al JAGS 2012
N=210
Frail
Elderly,
74
Yrs
±
24
g/d
Protein
+
Counseling
SPPB
Falls

11. 16.04.15
11
Cermak et al., Am J Clin Nutr,
2012.
Exercise training and protein supplementation
Fat-free Mass
Cermak et al., Am J Clin Nutr, 2012.
Exercise training and protein supplementation
1-Repetition Maximum Leg Press

12. 16.04.15
12
Moore et al, J Physiol 2009
Myofibrillar
Protein
Synthesis
±
25
g
Whey
Protein
Controlled Intervention Trials
with Dairy Products in Adults
Adolphi 2008 Milk -> Reduction Dpd Excretion during the Night
Bonjour 2008 Milk -> Reduction PTH, BTM
Bonjour 2009 # Cheese -> Reduction PTH, CTX, Increase in IGF-I
Bonjour 2013 # Cheese -> Reduction PTH, CTX, Increase in IGF-I
Daly 2006 Fortified Milk -> Attenuation Hip BMD Decrease
Josse 2010 Milk -> Reduction PTH, CTX
Josse 2012 Milk -> Reduction PTH, CTX
Kruger 2010 Fortified Milk -> Reduction PTH, BTM
Kruger 2012 Fortified Milk -> Reduction PTH, BTM
Moschonis 2007 # Fortified Dairy -> Reduction PTH, BTM
Moschonis 2011 # Fortified Dairy -> Increase LS BMD
Thorpe 2008 High Protein Dairy -> Attenuated Bone Loss
# fermented dairy products

13. 16.04.15
13
Effects of protein supplements
(Whey + EAA) on serum IGF-I
0
7
14
28
Time
(days)
Serum
IGF-­‐I
(ug/l)
25
45
65
85
105
125
145
*
Zn+
Zn-­‐
controls
Protein
+
zinc
Protein
without
zinc
untreated
controls
Rodondi et al, 2009
0
10
20
30
40
50
60
Delta
IGF-­‐I
(µg/L)
Proteins
Controls
0
7
14
28
Days
*
&
Chevalley et al, 2009
Frail Fracture
Women Men
JBMR 2011
RR / + 1 Glass of Milk per Day

14. 16.04.15
14
Favorable
Economic
Impact
of
Higher
Dairy
Intake
on
the
Burden
of
Osteoporosis
Freek Lötters, Irene Lenoir-Wijnkoop, Patrice Fardellone, René Rizzoli, Emilie Rocher, Marten Poley
Osteoporos
Int
2012
• Daily costs of additional dairy products, derived from local
market prices, were calculated at €0.44, €0.64, and €0.68, for
the Netherlands, France, and Sweden, respectively.
• Total costs that might be potentially avoided per year were
largest in France (≈ €129 million), followed by Sweden (≈ €34
million) and The Netherlands (≈ €6 million).

15. 16.04.15
15
Earliest
Evidence
of
Cheese
Making
in
the
Sixth
Millenium
BC
in
Northern
Europe
Salque
et
al,
Nature
2013
Milk
Processing
(Cheese
Produc2on)
-­‐>
Preserva2on
of
Milk
Products
-­‐>
Non-­‐Perishable
and
Transportable
Form
-­‐>
Readily
Availability
-­‐>
More
Diges2ble
Form
(Less
Lactose)
GOS
supplementa2on
significantly
increased
bifidobacteria
numbers
in
vivo
and
in
vitro.
Increased
butyrate
produc2on
and
elevated
bifidobacteria
numbers
may
cons2tute
beneficial
modula2on
of
the
gut
microbiota
in
a
maturing
popula2on.
Walton
et
al
Br
J
Nutr
2012

16. 16.04.15
16
Galacto-­‐Oligosaccharides
(GOS)
Increase
Calcium
Absorp2on
and
Gut
Bifidobacteria
in
Young
Girls:
a
Double-­‐Bind
Cross-­‐Over
Trial
Whisner
et
al
Br
J
Nutr
2013
31
(25
Completers)
10-­‐13
Years
Old
Girls
±
3
Weeks
GOS
(2x/d)
-­‐>
Increased
Intes2nal
Calcium
Absorp2on
(double
stable
Isotopes)
Frac2onal
Absorp2on:
0.444
and
0.419
vs
0.393
over
48
hr
-­‐>
Increased
Faecal
Bifidobacteria
-­‐>
No
GI
Symptoms
5
10
0
g/d
The
Impact
of
a
Consor2um
of
Fermented
Milk
Strains
on
the
Gut
Microbiome
of
Gnotobio2c
Mice
and
Monzygo2c
Twins
McNulty
et
al
Sci
Transl
Med
2011
In
adult
Monozygo2c
Female
Twins:
2
Servings/Day
of
Fermented
Milk
Product
(5
Different
Bacteriae)
-­‐>
No
change
in
Bacterial
Species
Composi2on
or
Propor2onal
Representa2on
of
Genes
Encoding
Known
Enzyms,
in
Feces
In
Gnotobio2c
Mice:
Gavage
of
Fermented
Milk
Product
Bacteriae
Consor2um
-­‐>
Rapid
Changes
(24
hr)
in
Expression
of
Microbiome
Encoded
Enzyms
(Involved
in
Carbohydrate
Metabolism)
in
Feces
Bifidobacterium
Animalis,
subsp.
Lac2s
-­‐>
Upregula2on
of
a
Locus
Involved
in
Xylooligosaccaharides
Catabolism
(Mice
&
Human
Meta-­‐transcriptomes)

17. 16.04.15
17
Weaver
AJCN
2014