होम Journal of the American Dietetic Association Concerns about calcium in hypertensive men: Author's reply

Concerns about calcium in hypertensive men: Author's reply

,
यह पुस्तक आपको कितनी अच्छी लगी?
फ़ाइल की गुणवत्ता क्या है?
पुस्तक की गुणवत्ता का मूल्यांकन करने के लिए यह पुस्तक डाउनलोड करें
डाउनलोड की गई फ़ाइलों की गुणवत्ता क्या है?
खंड:
93
साल:
1993
भाषा:
english
DOI:
10.1016/0002-8223(93)91518-U
फ़ाइल:
PDF, 263 KB
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आप पुस्तक समीक्षा लिख सकते हैं और अपना अनुभव साझा कर सकते हैं. पढ़ूी हुई पुस्तकों के बारे में आपकी राय जानने में अन्य पाठकों को दिलचस्पी होगी. भले ही आपको किताब पसंद हो या न हो, अगर आप इसके बारे में ईमानदारी से और विस्तार से बताएँगे, तो लोग अपने लिए नई रुचिकर पुस्तकें खोज पाएँगे.
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The role of carbohydrate counting in type 1 diabetes

साल:
2014
भाषा:
english
फ़ाइल:
PDF, 197 KB
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Editorial

साल:
1993
भाषा:
english
फ़ाइल:
PDF, 174 KB
LETsW TO TE
DITG EBITS OF
SOWBLIE FB
To the Editors:
The article "Intestinal fuels: Glutamine,
short-chain fatty acids, and dietary fiber"
(Evans MA, Shronts EP. JAm DietAssoc.
1992; 92:1239-1246, 1249) was read with
interest, as was the subsequent letter to
the editor (J Am Diet Assoc. 1992; 92:
1330). The original article accurately stated
the benefits of soluble, fermentable fibers,
such as pectin, and the need for further
study in this area.
We take exception with the statement
made in the letter recommending that
fiber supplements not be added to commercially available enteral formulas, because of changes in formula viscosity and
the potential for changes in tube patency.
Our facility has been blenderizing liquid
pectin with commercial enteral formulas
for the past 4 years without any tube
patency problems. A recent study (in publication by two of our staff members),
looked at viscosity changes in five enteral
products with the addition of one and two
cc pectin/100 cc products. This study found
that viscosity was not significantly increased in four of the five products.
As long as pectin is well dispersed in the
enteral formula, we recommended that
pectin can be added to 1.0 kcal/cc and 1.5
kcal/cc formulas without increasing formula viscosity or affecting tube patency.
DIANE JUSKELIS, MS, RD
LAURIE MILLS, RD
DENISE FRANCK, RD
Mercy Hospital Medical Center, Des
Moines, Iowa

CO1NC1 ABOUT C
HYPTTIESIVE ME

M
mLCM

To the Editors:
Although Kynast-Gales and Massey's (Effects of dietary calcium on ambulatory
blood pressure in hypertensive men. JAm
DietAssoc. 1992;92:14978-1501) discussion of factors that may have confounded
their results was thorough, a few additional factors should be considered.
Data from epidemiologic studies indicate a threshold effect of dietary calcium,
where elevations in blood pressure are
associated with calcium intakes of <400 to
500 mg/day (1-3). The high variability of
calcium intake during the low calcium period may have resulted in many subjects
having intakes ab; ove this threshold. Also,
water consumption may have increased
calcium consumption of many subjects
above this threshold. It would be interesting to determine if the three subjects that
responded to the high energy intake with
862 / AUGUST 1993 VOLUME 93 NUMBER 8

lower pressure had higher blood pressures
with low dairy intake.
Subjects' ages ranged from 46 to 75
years. Results of some studies indicate
that age may be important in determining
blood pressure response to dietary calciumn (4,5). Dietary calcium appears protective against development of high blood
pressure in younger (<50 years) individuals. Morphologic changes that may occur
as a result of untreated high blood pressure may prevent a response to high calcium intake in some older individuals.

Reducing cholesterol
and fat intake inthe
diet can lead to a
decrease incalcium,
causing osteporosis,
colon cancer, and
hypertension
Baseline weight of the subjects was not
reported in this study. It has been observed that body weight can influence
blood pressure responses to calcium intake (4,5). Lean individuals appear to be
most responsive to increases in calcium
intake. The negative effects of being overweight on blood pressure may mask any
potential effect of calcium.
Another confounding variable that can
influence blood pressure, but was not reported in this study, is alcohol consumption (4-6). A greater protective effect of
calcium in regulating blood pressure has
been observed in subjects who were low
alcohol consumers (4,6).
It is unknown if a "washout" period was

LEmIS TO TE BTORS
ARE WECOMB
Letters may have a maximum of 500
words; references should be kept to a
minimum, preferably five or fewer. Letters should be typed double-spaced
with wide margins. Submission of a
letter constitutes pernission for The
American Dietetic Association to use it
in the Journal, subject to editing and
abridgment. Financial associations or
other possible conflicts of interest
should always be disclosed. Letters relating to articles published in recent
Journal issues have priority. Send four
copies to: The Editor, Elaine R. Monsen,
PhD, RD, Journal of The American Dietetic Association, 216 WJackson Blvd,
7th Floor, Chicago, IL 60606-6995.

eTOIeS
included as part of the crossover experimental design. If not, effects of treatment
during one period could have carried over
to the next and confoundeded the effects
of the second treatment. This is particularly important in this study because of the
short treatment period.
The points raised in this letter are not
meant as criticisms, but to provide further
insights as to why a protective effect of
calcium may not have been observed. We
agree that dietary changes to reduce fat,
cholesterol, and/or sodium intake may inadvertently result in low calcium intake.
Low calcium intake may increase the risk
of osteoporosis, colon cancer, and hypertension. The authors' advice to consume
adequate calcium from appropriate food
sources is reasonable.
GREGORYD. MILLER, PhD
National Dairy Council, Rosemont, Ill
References
1. Sowers JR, Zemel MB, Zemel PC, Standley
PR. (,alcinni metabolism and dietary calcium in
salt sensitive hypertension. Am JHyperte.ns.
1991;4:557-563.
2. Wittermran JCM, Willett WC, Stampfer MJ,
Colditz GA, Sacks FM, Speizer FE, Rosner B,
Hennekens CH. A prospective study of nutritional factors and hypertension among US
women. Circulation. 1989;80:1320-1327.
3. Harlan WR, Harlan LC. An epidemiological
perspective on dietary electrolytes and hypertensioll. J [?fypertens. 1986;4 (suppl 5):S334S339.
4. Dwyer JH, Curtin LR, Davis IJ, Dwyer KM,
Feinleib M. Dietary calcium and 10 year incidence of treated hypertension in the NHANES
I epidemniologic follow-up. Circulation. 1992;
86(suppl 1):1678.
5. Ascherio A, Rimm EB, Giovannucci El,,
ColditzC A, Rosner B, Willet WC, Sacks F,
Stumpfer MJ. A prospective study of nutritionlal fl tors and hypertension among IJS men.
Circ/latio~n. 1992; 86:1475-1484.
6. Te Fifth Report of the Joint National
Corrmittee on Detection, Evaluation, and
T eatm
rroe t of High Blood Pressure.Washington, D(: National Institutes of Health;1992.
Authors' Reply:
As Miller indicates, the prediction of a
hypotensive response to dietary calcium
supplementation in hypertensive patients
is quite complex.
Of our 13 subjects, 3 had lower blood
pressures when consuming the high dairy
product intake vs the low. Our three responders did not exactly fit the responder
profile Miller outlined. They had ages of
46,52, and 49 years, BMIs of 25.0, 30.5, and
32.5, and basal blood pressures of 130/82
mm Hg, 138/85mm Hg, and 160/96 mm Hg,
respectively. Baseline calcium intakes were
428 mg, 764 mg, and 1,744 mg, while
respective calcium intakes during the lowcalcium diet were 432 mg, 504 mg, and 498

MLE...
T THE BT....................................................................................................

UETTY IlO I1E ED[ffi8

mg, respectively. Only one of the 13 subjects, a nonresponder, exceeded a mean
intake of 504 mg calcium during the low
calcium diet (684 mg). The two leanest
subjects with BMIs of 22 and 24 were
nonresponders as well. All three responders reported no alcohol consumption on
any diet record, baseline, or study.
In a study, of calcium responders vs
nonresponders, older persons wit h hypertension and higher blood pressure were
most responsive to 1,500 mg/day
pharmacologic calcium supplements (1).
Our experimental design incorporated
no "washout." period, as any washout period must include dietary calcium at some
level and therefore carrot be a neutral
control. An experimental design that can
control for previous dietary effects is to
add a third dietary period so that each
subject has both diet orders, HI-LO and
LO-HI; ie, one group of subjects alters
dairy products in the order of LO-HI-LO
and the other HI-LO-HI. We were unable to
do this because the subjects dlid not want
to keep diet records and wear the ambulatory monitor for more than the two consecutive 4-week periods.
Unfortunately, as our experience indicates, a hypertensive individual's blood
pressure response to dietary calcium in

the form of dairy product supplementation is not accurately predicted by typical
responder characteristics identified previously in epidemiologic surveys aIld clinical
trials. Therefore we continue to recommend that all hypertensive subjects be
counseled to consume the recommended
amounts of calcium.
We inadvertently failed to acknowledge
that this research was funded byt he Washington State Dairy Products Commission,
the Department of Food Science and Human Nutrition, and project 0610 of the
Agricultural Research Center, Washington State University.
SUSAN KYNAST-GALES, IMS, RD
LINDA K MASSEY, Phl), RI)
Food Sciences ad IIu m10i Nutrition,
Watshz qgtorlUnilloesity, Sttle
Reference
1. Lyle RM, Melby CL, Hyner GC. Metabolic
differences between subjects whose blood pressure did or did not respond to oral calcium
supplemelnltation. A J Cli Nanr,. 1988;47:
103()-1):35.

CORECTIONS
* In June's, "Nutrition for physical fitness
and athletic performance for adults" (p
696), the name of author Maureen Smith

Plombon was misspelled. The Journal
regrets the error.
* In the article "Food Labeling: Definition
of the term healthy" of the April issue, the
chart on page 404 should have read:
Individual Foods Should Have (per Reference Amount):
- low fat - 3 g or less
- low saturated fat - 1 g or less
- cholesterol - 60 mg or less
- sodium- 480 mg or less
Main Dishes Should Have:
- low fat- 3 g or less per 100 g and no
more than 30% energy from fat
- low saturated fat - 1 g or less per 100
g and less than 10% of its energy from
saturated fat
- cholesterol - 90 mg or less
- sodium - 720 mg or less
Meals Should Have:
- low fat - 3 g or less per 100 g and no
more than 30% energy from fat
-low saturated fat - 1 g or less per 100
g and less than 10% of its energy from
saturated fat
- cholesterol - 120 mg or less
-sodium - 960 mg or less

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.I(:)URNAL OF THE AMERICAN DIETETIC ASSOCIATION / 863