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Calcium, phosphorus and magnesium balance: FM 85 fortification of human milk does not meet mineral needs of extremely low birthweight infants.

OBJECTIVE: Extremely low birthweight (<1000 g) infants are growing rapidly and their nutritional requirements for calcium, phosphorus, magnesium are high. DESIGN: Prospective, mineral balance. SETTING: The study was carried out at the Department of Neonatology, Virchow-Hospital, Charité Berlin and the Department of Molecular Trace Element Research, Hahn-Meitner-Institute Berlin. SUBJECTS: Nineteen infants <1000 g birthweight were admitted, nine infants dropped out and 10 infants (birthweight 730-995 g), fed fortified human milk were included. INTERVENTION: We collected infant's urine and feces for 72 h, a sample of human milk and infant's blood at 7 and 12 weeks of age. Elements were measured by inductively coupled plasma atomic emission spectrophotometry. RESULTS: Mean (s.d.) mineral concentration in milk was low especially at 12 weeks: calcium 9.88 (+/-3.58) mmol/l, phosphorus 7.02 (+/-3.81) mmol/l, magnesium 1.59 (+/-0.54) mmol/l. Calcium retention was minimal or negative during the study, whereas phosphorus and magnesium balances were positive. Caffeine and diuretics increased mineral excretion. Serum alkaline phosphatase was mostly <800 U/l, and 162 U/l in one infant with zinc deficiency at 12 weeks. Alkaline phosphatase correlated with absorption and retention of phosphorus, and with longitudinal growth. CONCLUSIONS: Infants <1000 g have high nutritional needs for calcium, phosphorus and magnesium, which are not met by a human milk fortifier widely used in Europe. Controlled trials are needed to assess requirements, duration and risks of mineral supplementation.

Calcium↗

The calcimimetic AMG 073 reduces parathyroid hormone and calcium x phosphorus in secondary hyperparathyroidism.

BACKGROUND: A need exists for a therapy that lowers parathyroid hormone (PTH) without increasing calcium x phosphorus in patients with secondary hyperparathyroidism. The calcimimetic AMG 073 increases the sensitivity of the parathyroid calcium-sensing receptor to extracellular calcium, thereby reducing PTH secretion. Consequently, AMG 073 may provide a novel therapy for secondary hyperparathyroidism. METHODS: Seventy-eight hemodialysis patients with secondary hyperparathyroidism were enrolled into this 18-week, double-blind, randomized, placebo-controlled, dose titration study. Daily oral AMG 073 doses were administered to determine the effect on PTH, serum calcium, phosphorus, and calcium x phosphorus. RESULTS: The mean baseline PTH was similar in patients administered AMG 073 or placebo (632 +/- 280.1 pg/mL vs. 637 +/- 455.9 pg/mL, respectively). PTH decreased by 26.0% in the AMG 073-treated group, compared with an increase of 22.0% in the placebo group (P < 0.001). A greater proportion in the AMG 073 group (38%) had a decrease in PTH >or=30%, compared with the placebo group (8%) (P = 0.001). Decreases in PTH were independent of baseline vitamin D usage. Patients receiving AMG 073 had an 11.9% decrease in calcium x phosphorus compared with a 10.9% increase in the placebo group (P < 0.001). Use of vitamin D sterols, as well as both calcium and noncalcium-containing phosphate binders. were similar between treatment groups. Administration of AMG 073 was safe and well tolerated in this 18-week study. CONCLUSIONS: The calcimimetic AMG 073 decreases both PTH and calcium x phosphorus levels in hemodialysis patients with secondary hyperparathyroidism.

Adult↗

Utilisation of phytate phosphorus by rumen bacteria in a semi-continuous culture system (Rusitec) in lactating goats fed on different forage to concentrate ratios.

Experimental data on phytate phosphorus utilisation by ruminants are scarce. The aim of this study was to estimate the phytase activity of rumen micro-organisms when phytate phosphorus supply is high. A semi-continuous culture system fermentor (RUSITEC) was used. The inoculum was obtained from eight goats fed on either high or low forage level diets. Experimental buffers only differed by the nature of phosphorus monosodium phosphate vs. corn sodium phytate. The nylon bags containing 15 g DM of substrate were removed after a 48-hour incubation period. The system was maintained for 15 days: 5 days for adaptation, in order to obtain a steady state, and 10 days for sampling and recording. No significant differences were observed for DM digestibility, gas production, pH, N-NH3, and SCFA for the different treatments. Bacterial efficiency of phytate phosphorus utilisation was significantly higher (p < 0.001) with organic P, but remained lower than the data usually reported in the literature. These results may be explained by the relative saturation of bacterial phytase activity when the buffer contains a high level of phytate phosphorus.

Animal Feed↗

Differential effects of acute administration of 19-Nor-1,25-dihydroxy-vitamin D2 and 1,25-dihydroxy-vitamin D3 on serum calcium and phosphorus in hemodialysis patients.

BACKGROUND: Treatment of hyperparathyroidism includes the use of 1,25-dihydroxy-vitamin D3 (1,25D3) to suppress parathyroid hormone (PTH), but dosing of 1,25D3 is limited by the development of hypercalcemia and a high calcium x phosphorus (Ca x P) product because of gut absorption of calcium and phosphorus and enhanced bone resorption. The vitamin D analogue 19-nor-1,25(OH)2-vitamin D2 (19-Nor) causes less hypercalcemia and elevated Ca x P, whereas it still suppresses PTH in rats. METHODS: To determine whether 19-Nor had similar effects in humans, we performed a prospective crossover study to assess bone mobilization. Ten hemodialysis patients on a low-calcium low-phosphorus diet were administered 20 microg of 1,25D3 and 120 and 160 microg of 19-Nor, and changes in calcium, phosphorus, and intact and whole PTH levels were measured over 36 hours. RESULTS: Ca x P product increased more after 1,25D3 administration than after a six- or eightfold greater dose of 19-Nor and was significantly greater at 6, 12, and 24 hours. Ca x P product at 36 hours was 60.9 +/- 3.4 (4.91 +/- 0.27 mmol2/2) after 1,25D3 administration, 53.2 +/- 2.7 (4.29 +/- 0.22 mmol2/L2) after administration of 120 microg of 19-Nor, and 54.2 +/- 2.7 (4.37 +/- 0.22 mmol2/L2) after administration of 160 microg of 19-Nor. Suppression of intact PTH at 36 hours was similar after administration of 1,25D3 (54.1% +/- 6.0%) and 120 microg of 19-Nor (54.4% +/- 3.4%) and significantly greater after administration of 160 microg of 19-Nor (63.6% +/- 2.3%). The whole PTH assay yielded values approximately 25% to 30% lower than the intact PTH assay, and the percentage of suppression was virtually identical. CONCLUSION: Consistent with animal studies, 19-Nor provides profound PTH suppression while stimulating bone resorption and/or intestinal absorption less than 1,25D3, resulting in less elevation of serum calcium and phosphorus levels.

Adult↗

Effects of dietary calcium and phosphorus on mineral retention, growth, feed efficiency and walking ability in growing turkeys.

1. Large White male turkeys from a heavy commercial male-line were fed on 16 diets containing 4 concentrations of calcium (6, 10, 14 and 18 g/kg) and available phosphorus (3, 5, 7, 9 g/kg) in a 4 x 4 factorial experiment with three replicates (pens). Turkeys were weighed and food intakes recorded from 4 to 7, 8 to 10 and 11 to 13 weeks of age. 2. The diets containing 6 g/kg calcium and 5, 7 or 9 g/kg available phosphorus concentrations were associated with lower body weighs at 10 and 13 weeks of age. 3. Fewer than 6% of the turkeys had an abnormal gait at 13 weeks of age. 4. The optimum dietary concentrations were 10 g/kg of calcium and 3 g/kg of available phosphorus. It was concluded that these concentrations should be fed at least to 13 weeks of age. 5. Retentions of dietary calcium and phosphorus averaged 300 g/kg of intake. 6. Utilisation of dietary phytate ranged from 5 to 11 g/kg and it is recommended that organic phosphorus should be ignored in the formulation of diets for growing turkeys unless they are supplemented with a phytase enzyme.

6-Phytase↗

Effect of dietary phosphorus concentration and electrolyte balance on the growth performance of broiler chickens.

The performance of 1680 male and female broiler chickens given diets with either a low (4.7-4.3 g/kg) or high (8.9-8.2 g/kg) content of inorganic phosphorus and four (150, 200, 250 and 300 mEq/kg) electrolyte balances (Na+K-Cl) was measured from 1-d-old to 49 d of age. Diets with the higher concentration of inorganic phosphorus reduced body weight gains in the starter (P less than 0.01) and finisher (P less than 0.05) phases but the efficiency of food utilisation was reduced only in the starter phase (P less than 0.05). The reduction in body weight gain was greater in males than in females. The growth depression caused by the higher concentration of inorganic phosphorus in the finisher diets was partially alleviated by increasing the electrolyte balance to either 250 or 300 mEq/kg diet. The higher concentration of inorganic phosphorus significantly reduced the dressing percentage and increased the abdominal fat pad weight and litter moisture content. Electrolyte balance had no significant effects on efficiency of food utilisation, abdominal fat pad weights or litter moisture content. Neither the dietary concentration of phosphorus nor the electrolyte balance had a significant effect on mortality or ash content of the tibia.

Animal Nutritional Physiological Phenomena↗

Efficiencies of induction of DNA double strand breaks in solution by photoabsorption at phosphorus and platinum.

PURPOSE: This paper aims at determining and comparing the cross sections and quantum yields for DNA strand break induction by the Auger effect at the K-shell of phosphorus and at the LIII-shell of platinum. MATERIALS AND METHODS: Using synchrotron radiation, free and Pt-bound pBR322 plasmid DNA were irradiated in solution with monochromatic X-rays, the energies of which were 2.153 and 2.147 keV, corresponding to "on" and "below" the phosphorus K-shell photoabsorption, and 11.566 and 11.542 keV for "above" and "below" the L(III)-shell photoabsorption of platinum, respectively. To suppress indirect effects by hydroxyl radicals, DMSO (1M) was used as a scavenger. RESULTS: The inner-shell photoabsorption of phosphorus and of platinum significantly increased the induction of DNA double strand breaks (DSB), whereas it had little effect on single strand break (SSB) induction. The quantum yields for the induction of DSB were calculated to be 0.017 and 1.13, in the case of phosphorus and platinum, respectively. CONCLSIONS: The value of the quantum yield for the DSB induction of platinum was about 66-fold larger than that for the phosphorus. These results clearly demonstrate that the quantum yield of DSB depends upon the magnitude of the Auger cascade.

DNA↗

Effects of the K-shell X-ray absorption of phosphorus on the scission of the pentadeoxythymidylic acid.

The scission of pentadeoxythymidylic acid, d(pT)5, by monochromatic soft X-rays on (2153 eV) and below (2147 eV) the K-shell absorption peak of phosphorus was studied as a model of strand breakage in DNA. Samples dried on glass plates were irradiated by monochromatic soft X-rays in vacuo, and the products were analysed by HPLC. The main products, in ascending order of the retention time, were thymine, 5'-dTMP, d(pT)2, d(pT)3, d(pT)4, d(pTp) and three unknown products (UK 1, 2 and 3), which were presumed to be d(pTpTp), d(pTpTpTp) and d(pTpTpTpTp), respectively. No difference between 2147 and 2153 eV irradiation in the nature of the induced products was detected, indicating that the K-shell absorption of phosphorus and the following Auger process produced the same types of products as those produced by photoabsorption at the other shells of phosphorus and at other atoms. The cross-sections for the induction of products at 2153 eV were 3.3-4.0 times larger than those at 2147 eV, the ratios of these values being scattered around the ratio (3.65) of absorbance of the sample between 2153 and 2147 eV. The dependence on the X-ray energy, however, almost disappeared after conversion from exposure to absorbed dose; the ratios of the G-values (number of products per 100 eV) of the products were 0.92-1.11. Photoabsorption at the K-shell of phosphorus induced products comparable or slightly less effectively than photoabsorption at the others. These results indicate that the K-shell absorption of phosphorus and the following Auger process do not have any characteristic effect on strand breakage in dry DNA, either qualitatively or quantitatively.

Absorption↗

Removal of phosphorus from water using lignocellulosic material modified with iron species from acid mine drainage.

Lignocellulosic biosorbents, including juniper fiber, show promise as sorbents for removing pollutants from wastewater run-off because of their low cost. In this study, juniper fiber modified with iron species from acid mine drainage (AMD) was tested for its capacity to remove phosphorus from water compared to unmodified juniper fiber. In batch tests, the maximum adsorbate loading (Qmax) of phosphorus onto the modified adsorbent was 1.83 mg g(-1) at pH 4.0, obtained by fitting the isotherm results to the Langmuir isotherm model. This value is similar to the sorption capacity of other conventional adsorbents such as goethite, which implies that the modified lignocellulosic material would be effective as a sorbent for removing phosphorus from water. In the kinetic test, the pseudo-second order kinetic model fitted well the sorption of phosphorus onto the modified filter medium, showing the kinetic constant (k) of 8.09 x 10(-2) g(mg min)(-1) at initial phosphorus concentration of 10 mg l(-1).

Cellulose↗

Effect of different operational parameters in the enhanced biological phosphorus removal process. Experimental design and results.

The uncontrolled dumping of phosphorus into a water environment creates serious problems of eutrophication, affecting water quality and causing grave problems in the aquatic ecosystem. European legislation demands drastic reduction of phosphorus dissolved in wastewater. Enhanced Biological Phosphorus Removal (EBPR) is the current tendency in wastewater treatment. This biological process depends on a multiplicity of variables, but its three main factors are: influent COD/P ratio, anaerobic fraction and sludge retention time (SRT). The aim of this work is to statistically determine the effect of these three parameters in EBPR through a response surface methodology. The objective function that has been chosen is phosphorus removed per unit biomass formed. This function provides ample information on BPR, since the quantity of phosphorus removed depends on the accumulative capacity of the microorganisms present. Two levels were chosen for the SRT (5 and 10 days), two for the anaerobic fraction (0.1 and 0.2), and six for levels of the influent COD/P ratio (between 16 and 87). The experiments were undertaken at pilot scale (100 litres) with an A2/O configuration, with simultaneous nitrogen and phosphorous removaL The wastewater used is a synthetic mixture of complex sources of carbon and nitrogenwithout volatile fatty acids. The empirical model obtained indicates that the factor most influencing the EBPR process is the influent COD/P ratio, whilst the anaerobic fraction is that which has least influence. Additionally, there is an optimum in the influent COD/P ratio that is to be found between 41 and 48.

Biodegradation, Environmental↗

Excess sludge production and costs due to phosphorus removal.

Based on data collected from 35 French wastewater treatment plants and on published data, excess sludge production and chemical consumption associated with phosphorus removal is estimated for the three following phosphorus removal processes: chemical precipitation, Enhanced Biological Phosphorus Removal and hybrid process. The influence of wastewater characteristics on excess sludge production are assessed. Chemical costs and costs associated with sludge disposal were calculated and results for the three phosphorus removal processes are compared. The global costs for phosphorus removal are then estimated.

Biodegradation, Environmental↗

Phosphorus removal characteristics in hydroxyapatite crystallization using converter slag.

This study was performed to investigate the phosphorus removal characteristics in hydroxyapatite (HAP) crystallization using converter slag as a seed crystal and the usefulness of a slag column reactor system. The effects of alkalinity, and the isomorphic-substitutable presence of ionic magnesium, fluoride, and iron on HAP crystallization seeded with converter slag, were examined using a batch reactor system. The phosphorus removal efficiencies of the batch reactor system were found to increase with increases in the iron and fluoride ion concentrations, and to decrease with increases in the alkalinity and magnesium ion concentration. A column reactor system for HAP crystallization using converter slag was found to achieve high, stable levels of phosphorus elimination: the average PO4-P removal efficiency over 414 days of operation was 90.4%, in which the effluent phosphorus concentration was maintained at less than 0.5 mg/L under the appropriate phosphorus crystallization conditions. The X-ray diffraction (XRD) patterns and Fourier transform infrared (FTIR) spectra of the crystalline material deposited on the seed particles exhibited peaks consistent with HAP. Scanning electron micrograph (SEM) images showed that finely distributed crystalline material was formed on the surfaces of the seed particles. Energy dispersive X-ray spectroscopy (EDS) mapping analysis revealed that the molar Ca/P composition ratio of the crystalline material was 1.72.

Alkalies↗

Calcium, magnesium, phosphorus, copper, and manganese balance in adolescent females.

Calcium, magnesium, phosphorus, copper, and manganese balances were determined in 14 girls (12.5 to 14.5 years of age) during a 30-day period. Menus were composed of ordinary foods and were typical of subjects' usual dietary habits. The diets contained 1.07 g calcium, 193 mg magnesium, 0.85 g phosphorus, 2.8 mg copper, 3.0 mg manganese, and 7.4 or 13.4 mg zinc daily. Defatted soy was substituted for 0, 15, or 30% of the meat in lunch menus. Neither the alteration of dietary zinc levels or the partial substitution of soy for meat significantly affected retention of the five minerals. Retentions of calcium (r = 0.654), magnesium (r = 0.786), phosphorus (r = 0.560), copper (r - 0.805), and manganese (r = 0.855) by subjects were all significantly (P less than 0.001) correlated to retention of zinc. These correlations probably reflect the correlations between fecal losses of calcium (r = 0.438), magnesium (r = 0.434), phosphorus (r = 0.377), copper (r = 0.318), and manganese (r = 0.318) and the volume of feces. On these dietary regimes adolescents were in positive balances for calcium, phosphorus, and copper, but were in negative balances for magnesium and managenese.

Adolescent↗

Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism.

The effect of small doses of four commercially available aluminum-containing antacids on calcium and phosphorus metabolism was investigated in adult males in 20 studies. During the use of these doses of antacids, urinary and fecal calcium increased significantly during a low calcium intake averaging 252 mg/day, and the calcium balances became distinctly more negative. There was a reversal of the normal pattern of phosphorus excretions, namely, the fecal phosphorus was high and the urinary phosphorus was low. During a normal calcium intake of 800 mg/day, these doses of antacids did not result in significant changes of the calcium excretions or balance. Despite the decrease in net intestinal absorption of calcium, the average 47Ca absorption remained unchanged, irrespective of the type and dose of antacid used. In three patients who received large therapeutic doses of antacids, 240 to 450 ml/day, the changes of calcium and phosphorus metabolism were intensified.

Adult↗

Effect of calcium and phosphorus on zinc metabolism in man.

Calcium and phosphorus have been shown to inhibit the availability of zinc for absorption in animal studies, but limited information is available on this subject in man. In the present study, the effect of both calcium and phosphorus on zinc metabolism was investigated in adult men by determining metabolic balances of zinc during three intake levels of calcium of 200, 800, and 2000 mg/day, and during two intake levels of phosphorus of 800 and 2000 mg/day. The analyzed dietary zinc intake was normal and was kept constant throughout all study phases. Increasing the calcium intake from 200 mg to two higher intake levels up to 2000 mg/day did not significantly change the urinary or fecal zinc excretions or the zinc balance. Also, increasing the phosphorus intake from 800 to a high intake of 2000 mg/day did not have any effect. The simultaneous use of the high calcium and high phosphorus intake also had no effect on zinc excretions and on the zinc balance.

Adult↗

Calcium and phosphorus deficiencies affect mineral distribution in neonatal miniature piglets.

Current efforts to monitor the mineral status of preterm infants fed human milk may not provide sufficient information on the distribution of body minerals. To investigate the body distribution of calcium and phosphorus during various degrees of mineral deficiency, neonatal miniature piglets were raised for 2 wk on diets differing only in calcium and phosphorus. Groups A, B, and C were fed 100%, 60%, and 20%, respectively, of the recommended amounts of calcium and phosphorus that, when adjusted for rates of growth, approximated the range of dietary intakes of preterm infants. Group C manifested biochemical and body-composition evidence of mineral deficiency when compared with group A: lower serum phosphorus; higher serum alkaline phosphatase activity; less fat-free tissue, calcium, and phosphorus in tibiae, vertebrae, and whole carcasses. Neonatal miniature piglets are useful for studying mineral deposition during mineral deficiency in preterm infants.

Alkaline Phosphatase↗

Effect of calcium and phosphorus on fluoride metabolism in man.

The effect of orally administered calcium and phosphorus on the fluoride balance was studied in man during a low fluoride intake of about 4 mg/day and a high fluoride intake of 14 mg/day. Three calcium intake levels averaging 223, 1,481, and 2,312 mg and two phosphorus intakes averaging 915 and 1,430 mg/day were used. Calcium or phosphorus used singly or combined did not affect the urinary fluoride. Increasing the calcium intake from an average of 223 to 1,481 and to 2,312 mg/day during the low fluoride intake increased the fecal fluoride only slightly, from 0.13 to 0.17 and 0.20 mg/day, respectively, and during high fluoride intake from 0.31 to 0.58 and 0.56 mg/day, respectively. The addition of phosphorus to the low calcium intake did not change the fecal fluoride excretion during either low or high fluoride intake, but the fecal fluoride increased during the two higher calcium intakes by a factor of 1.5. As the fecal fluoride was very low in the control study and was still relatively low in the experimental studies, the increase in fecal fluoride did not change the fluoride balances. The studies have shown that the increased levels of calcium and phosphorus used had little effect on fluoride metabloism in man.

Adult↗

Renal acid, urinary cyclic AMP, and hydroxyproline excretion as affected by level of protein, sulfur amino acid, and phosphorus intake.

Two 51-day human studies were conducted to investigate the effects of level of protein and phosphorus intake on the various components of renal acid excretion and on urinary sulfate, cyclic AMP and hydroxyproline; the role of the sulfur amino acids (Saa) of the protein was also evaluated. Dietary treatments included: 1) a 50 g protein diet; 2) a 150 g protein diet; and 3) a 50 g protein diet plus Saa to equal that of the 150 g protein diet, each given at 2 levels of phosphorus (1010 and 2525 mg). Calcium intake was 500 mg. Subjects were 16 young adult males. The results are discussed in relationship to calcium data previously reported (1, 2). Changes in renal acid and calcium excretion are not directly related for these reasons: a) the Saa accounted for all of the protein-induced increase in urinary sulfate and acid but for only 43% of the increase in urinary calcium and b) the acid phosphate supplement decreased urinary calcium but increased total acid excretion. The phosphorus supplement increased cyclic AMP but not hydroxyproline excretion. In fact, protein and Saa caused increases in hydroxyproline that were greatly reduced by the phosphorus supplement. Increases in urinary hydroxyproline and calcium were well correlated indicating that, at low calcium intakes, protein or Saa-induced increases in urinary calcium result in increased bone resorption which is reduced by the administration of phosphorus.

Acids↗