The Dietary Intakes of Calcium and Bone Health Related Nutrients Among Individuals with and without Spinal Cord Injury

Masae Miyatani; B. Cathy Craven; Eva Loewenberger; Colleen F. McGillivray; Jonathan D. Adachi

doi:10.6000/1929-5634.2014.03.02.9

Authors

Masae Miyatani Toronto Rehabilitation Institute – University Health Network, Lyndhurst Centre, Toronto, Ontario, Canada
B. Cathy Craven Toronto Rehabilitation Institute – University Health Network, Lyndhurst Centre, Toronto, Ontario, Canada
Eva Loewenberger Region of Peel Public Health, Mississauga, Ontario, Canada
Colleen F. McGillivray Toronto Rehabilitation Institute – University Health Network, Lyndhurst Centre, Toronto, Ontario, Canada
Jonathan D. Adachi St Joseph’s Hospital Hamilton, Ontario, Canada

DOI:

https://doi.org/10.6000/1929-5634.2014.03.02.9

Keywords:

Calcium, 24 hour recall, spinal cord injury, dietary assessment, osteoporosis

Abstract

Objectives: The purposes of this observational study were to: 1) describe and compare the intakes of nutrients related to bone health among a group of individuals with traumatic spinal cord injury (SCI) versus a group of age, gender and weight matched non–SCI peers; and 2) contrast the participant’s nutrient intakes against current dietary reference intakes (DRIs).

Methods: Consenting participants included: 87 individuals with SCI (C2-T10 AIS A-D) aged 18-68 years and 85 non-SCI individuals. Participants’ nutrient intakes were determined using a 24-hour dietary recall. Participants were grouped by gender, age (19-30yrs, 31-50yrs, 51-68yrs), and impairment (SCI and non-SCI). Additionally, the nutrient intakes were contrasted with the DRIs parameters.

Results: The range for mean calcium intakes across all age strata was 870-1087mg/day for SCI men and 848-1087mg/day for SCI women. The range for mean calcium intakes of the non-SCI participants were similar (men: 900-909mg/day; women: 796-1160mg/day). The majority of SCI and non-SCI men (64 - 86% of participants) in all age groups and SCI and non-SCI women in the 52-68 yrs group (72 and 73% of participants) did not meet the DRIs recommendation for calcium. Additionally many participants did not meet the DRIs recommendation for magnesium (38-55%) and potassium (71-95%) regardless of gender and impairment. The majority (60-70%) of participants consumed excessive amounts of sodium with the exception of non-SCI women.

Conclusions: Dietary calcium intakes among SCI and non-SCI participants were not significantly different from each other. However, the dietary calcium intakes of both impairment groups were less than the recommended DRIs; SCI men and women are a target for nutritional interventions based on their calcium, magnesium potassium and sodium intakes.

References

Demirel G, Yilmaz H, Paker N, Onel S. Osteoporosis after spinal cord injury. Spinal Cord 1998; 36(12): 822-5. http://dx.doi.org/10.1038/sj.sc.3100704 DOI: https://doi.org/10.1038/sj.sc.3100704

Freehafer AA, Hazel CM, Becker CL. Lower extremity fractures in patients with spinal cord injury. Paraplegia 1981; 19(6): 367-72. http://dx.doi.org/10.1038/sc.1981.69 DOI: https://doi.org/10.1038/sc.1981.69

Lee TQ, Shapiro TA, Bell DM. Biomechanical properties of human tibias in long-term spinal cord injury. Journal of Rehabilitation Research and Development 1997; 34(3): 295-302.

Roberts D, Lee W, Cuneo RC, Wittmann J, Ward G, Flatman R, et al. Longitudinal study of bone turnover after acute spinal cord injury. J Clin Endocrinol Metab 1998; 83(2): 415-22. DOI: https://doi.org/10.1210/jc.83.2.415

Zehnder Y, Luthi M, Michel D, Knecht H, Perrelet R, Neto I, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int 2004; 15(3): 180-9. http://dx.doi.org/10.1007/s00198-003-1529-6 DOI: https://doi.org/10.1007/s00198-003-1529-6

Eser P, Frotzler A, Zehnder Y, Wick L, Knecht H, Denoth J, et al. Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals. Bone 2004; 34(5): 869-80. http://dx.doi.org/10.1016/j.bone.2004.01.001 DOI: https://doi.org/10.1016/j.bone.2004.01.001

Szollar SM, Martin EM, Parthemore JG, Sartoris DJ, Deftos LJ. Densitometric patterns of spinal cord injury associated bone loss. Spinal Cord 1997; 35(6): 374-82. http://dx.doi.org/10.1038/sj.sc.3100394 DOI: https://doi.org/10.1038/sj.sc.3100394

Uebelhart D, Demiaux-Domenech B, Roth M, Chantraine A. Bone metabolism in spinal cord injured individuals and in others who have prolonged immobilisation. A review. Paraplegia 1995; 33(11): 669-73. http://dx.doi.org/10.1038/sc.1995.140 DOI: https://doi.org/10.1038/sc.1995.140

Pak CY, Oata M, Lawrence EC, Snyder W. The hypercalciurias. Causes, parathyroid functions, and diagnostic criteria. J Clin Invest 1974; 54(2): 387-400. http://dx.doi.org/10.1172/JCI107774 DOI: https://doi.org/10.1172/JCI107774

Freeman LW. The Metabolism of Calcium in Patients with Spinal Cord Injuries. Annals of Surgery 1949; 129(2): 177-84. http://dx.doi.org/10.1097/00000658-194902000-00002 DOI: https://doi.org/10.1097/00000658-194902000-00002

Maimoun L, Couret I, Micallef JP, Peruchon E, Mariano-Goulart D, Rossi M, et al. Use of bone biochemical markers with dual-energy x-ray absorptiometry for early determination of bone loss in persons with spinal cord injury. Metabolism 2002; 51(8): 958-63. http://dx.doi.org/10.1053/meta.2002.34013 DOI: https://doi.org/10.1053/meta.2002.34013

Stewart AF, Adler M, Byers CM, Segre GV, Broadus AE. Calcium homeostasis in immobilization: an example of resorptive hypercalciuria. N Engl J Med 1982; 306(19): 1136-40. http://dx.doi.org/10.1056/NEJM198205133061903 DOI: https://doi.org/10.1056/NEJM198205133061903

Craven LAR, McGillivray CF, Adachi JD. Detection and Treatment of Sublesional Osteoporosis Among Patients with Chronic Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation 2009; 14(4): 1-22. http://dx.doi.org/10.1310/sci1404-1

Eser P, Frotzler A, Zehnder Y, Denoth J. Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography. Arch Phys Med Rehabil 2005; 86(3): 498-504. http://dx.doi.org/10.1016/j.apmr.2004.09.006 DOI: https://doi.org/10.1016/j.apmr.2004.09.006

Frisbie JH. Fractures after myelopathy: the risk quantified. J Spinal Cord Med 1997; 20(1): 66-9. DOI: https://doi.org/10.1080/10790268.1997.11719458

Ingram RR, Suman RK, Freeman PA. Lower limb fractures in the chronic spinal cord injured patient. Paraplegia 1989; 27(2): 133-9. http://dx.doi.org/10.1038/sc.1989.20 DOI: https://doi.org/10.1038/sc.1989.20

Lazo MG, Shirazi P, Sam M, Giobbie-Hurder A, Blacconiere MJ, Muppidi M. Osteoporosis and risk of fracture in men with spinal cord injury. Spinal Cord 2001; 39(4): 208-14. http://dx.doi.org/10.1038/sj.sc.3101139 DOI: https://doi.org/10.1038/sj.sc.3101139

Ragnarsson KT, Sell GH. Lower extremity fractures after spinal cord injury: a retrospective study. Arch Phys Med Rehabil 1981; 62(9): 418-23.

Vestergaard P, Krogh K, Rejnmark L, Mosekilde L. Fracture rates and risk factors for fractures in patients with spinal cord injury. Spinal Cord 1998; 36(11): 790-6. http://dx.doi.org/10.1038/sj.sc.3100648 DOI: https://doi.org/10.1038/sj.sc.3100648

Bauman WA, Spungen AM, Flanagan S, Zhong YG, Alexander LR, Tsitouras PD. Blunted growth hormone response to intravenous arginine in subjects with a spinal cord injury. Horm Metab Res 1994; 26(3): 152-6. http://dx.doi.org/10.1055/s-2007-1000798 DOI: https://doi.org/10.1055/s-2007-1000798

Naftchi NE, Viau AT, Sell GH, Lowman EW. Pituitary-testicular axis dysfunction in spinal cord injury. Arch Phys Med Rehabil 1980; 61(9): 402-5.

Shetty KR, Sutton CH, Mattson DE, Rudman D. Hyposomatomedinemia in quadriplegic men. Am J Med Sci 1993; 305(2): 95-100. http://dx.doi.org/10.1097/00000441-199302000-00006 DOI: https://doi.org/10.1097/00000441-199302000-00006

Vico L, Collet P, Guignandon A, Lafage-Proust MH, Thomas T, Rehaillia M, et al. Effects of long-term microgravity exposure on cancellous and cortical weight-bearing bones of cosmonauts. Lancet 2000; 355(9215): 1607-11. http://dx.doi.org/10.1016/S0140-6736(00)02217-0 DOI: https://doi.org/10.1016/S0140-6736(00)02217-0

Bergmann P, Heilporn A, Schoutens A, Paternot J, Tricot A. Longitudinal study of calcium and bone metabolism in paraplegic patients. Paraplegia 1977; 15(2): 147-59. http://dx.doi.org/10.1038/sc.1977.20 DOI: https://doi.org/10.1038/sc.1977.20

Chantraine A, van Ouwenaller C, Hachen HJ, Schinas P. Intra-medullary pressure and intra-osseous phlebography in paraplegia. Paraplegia 1979; 17(4): 391-9. http://dx.doi.org/10.1038/sc.1979.75 DOI: https://doi.org/10.1038/sc.1979.75

Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr 1995; 62(4): 740-5. DOI: https://doi.org/10.1093/ajcn/62.4.740

Heaney RP. Bone mass, nutrition, and other lifestyle factors. Nutr Rev 1996; 54(4 Pt 2): S3-10. DOI: https://doi.org/10.1111/j.1753-4887.1996.tb03891.x

New SA, Robins SP, Campbell MK, Martin JC, Garton MJ, Bolton-Smith C, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 2000; 71(1): 142-51. DOI: https://doi.org/10.1093/ajcn/71.1.142

Rude RK, Gruber HE. Magnesium deficiency and osteoporosis: animal and human observations. J Nutr Biochem 2004; 15(12): 710-6. http://dx.doi.org/10.1016/j.jnutbio.2004.08.001 DOI: https://doi.org/10.1016/j.jnutbio.2004.08.001

Sasaki S, Yanagibori R. Association between current nutrient intakes and bone mineral density at calcaneus in pre- and postmenopausal Japanese women. J Nutr Sci Vitaminol (Tokyo) 2001; 47(4): 289-94. http://dx.doi.org/10.3177/jnsv.47.289 DOI: https://doi.org/10.3177/jnsv.47.289

Schaafsma A, de Vries PJ, Saris WH. Delay of natural bone loss by higher intakes of specific minerals and vitamins. Crit Rev Food Sci Nutr 2001; 41(4): 225-49. http://dx.doi.org/10.1080/20014091091805 DOI: https://doi.org/10.1080/20014091091805

Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999; 69(4): 727-36. DOI: https://doi.org/10.1093/ajcn/69.4.727

Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993; 328(7): 460-4. http://dx.doi.org/10.1056/NEJM199302183280702 DOI: https://doi.org/10.1056/NEJM199302183280702

Baran D, Sorensen A, Grimes J, Lew R, Karellas A, Johnson B, et al. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. J Clin Endocrinol Metab 1990; 70(1): 264-70. http://dx.doi.org/10.1210/jcem-70-1-264 DOI: https://doi.org/10.1210/jcem-70-1-264

Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990; 323(13): 878-83. http://dx.doi.org/10.1056/NEJM199009273231305 DOI: https://doi.org/10.1056/NEJM199009273231305

Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK, et al. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 1991; 325(17): 1189-95. http://dx.doi.org/10.1056/NEJM199110243251701 DOI: https://doi.org/10.1056/NEJM199110243251701

Welten DC, Kemper HC, Post GB, van Staveren WA. A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J Nutr 1995; 125(11): 2802-13.

Medicine Io. Dietary Reference Intakes: The Essential Guide to Nurient Requirements. Washington, DC: National Academy Press; 2006.

Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010; 182(17): 1864-73. http://dx.doi.org/10.1503/cmaj.100771 DOI: https://doi.org/10.1503/cmaj.100771

Levine AM, Nash MS, Green BA, Shea JD, Aronica MJ. An examination of dietary intakes and nutritional status of chronic healthy spinal cord injured individuals. Paraplegia 1992; 30(12): 880-9. http://dx.doi.org/10.1038/sc.1992.165 DOI: https://doi.org/10.1038/sc.1992.165

Ribeiro SML, da Silva RC, de Castro IA, Tirapegui J. Assessment of nutritional status of active handicapped individuals. Nutrition Research 2005; 25(3): 239-49. http://dx.doi.org/10.1016/j.nutres.2004.12.006 DOI: https://doi.org/10.1016/j.nutres.2004.12.006

Tomey KM, Chen DM, Wang X, Braunschweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005; 86(4): 664-71. http://dx.doi.org/10.1016/j.apmr.2004.10.023 DOI: https://doi.org/10.1016/j.apmr.2004.10.023

Walters JL, Buchholz AC, Martin Ginis KA. Evidence of dietary inadequacy in adults with chronic spinal cord injury. Spinal Cord 2009; 47(4): 318-22. http://dx.doi.org/10.1038/sc.2008.134 DOI: https://doi.org/10.1038/sc.2008.134

Perret C, Stoffel-Kurt N. Comparison of nutritional intake between individuals with acute and chronic spinal cord injury. J Spinal Cord Med 2011; 34(6): 569-75. http://dx.doi.org/10.1179/2045772311Y.0000000026 DOI: https://doi.org/10.1179/2045772311Y.0000000026

Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, et al. Mortality after lower extremity fractures in men with spinal cord injury. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2014; 29(2): 432-9. http://dx.doi.org/10.1002/jbmr.2050 DOI: https://doi.org/10.1002/jbmr.2050

Craven BC, Robertson LR, McGillivray CF, Bugaresti JM, Adachi JD. Treatment of Sublesional Osteoporosis Among Patients with SCI: A Proposed Treatment Paradigm. Topics in Spinal cord injury rehabilitation 2009; 14(4): 1-22. http://dx.doi.org/10.1310/sci1404-1 DOI: https://doi.org/10.1310/sci1404-1

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337(10): 670-6. http://dx.doi.org/10.1056/NEJM199709043371003 DOI: https://doi.org/10.1056/NEJM199709043371003

Murray TM. Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis. Cmaj 1996; 155(7): 935-9.

Baker MJ, Longyhore DS. Dietary calcium, calcium supplements, and the risk of calcium oxalate kidney stones. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 2006; 63(8): 772-5. http://dx.doi.org/10.2146/ajhp050410 DOI: https://doi.org/10.2146/ajhp050410

Moyad MA. Calcium oxalate kidney stones: another reason to encourage moderate calcium intakes and other dietary changes. Urologic nursing 2003; 23(4): 310-3.

Chen Y, DeVivo MJ, Stover SL, Lloyd LK. Recurrent kidney stone: a 25-year follow-up study in persons with spinal cord injury. Urology 2002; 60(2): 228-32. http://dx.doi.org/10.1016/S0090-4295(02)01734-X DOI: https://doi.org/10.1016/S0090-4295(02)01734-X

Kuhlemeier KV, Lloyd LK, Stover SL. Long-term followup of renal function after spinal cord injury. The Journal of urology 1985; 134(3): 510-3. DOI: https://doi.org/10.1016/S0022-5347(17)47267-3

Garriguet D. Sodium consumption at all ages: Statistics Canada – Health Reports, Vol 18, No 22007.

Opperman EA, Buchholz AC, Darlington GA, Martin Ginis KA, Group S-SR. Dietary supplement use in the spinal cord injury population. Spinal Cord 2010; 48(1): 60-4. http://dx.doi.org/10.1038/sc.2009.86 DOI: https://doi.org/10.1038/sc.2009.86

Bauer DC. The calcium supplement controversy: now what? Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2014; 29(3): 531-3. http://dx.doi.org/10.1002/jbmr.2184 DOI: https://doi.org/10.1002/jbmr.2184

Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal cord 2005; 43(7): 408-16. http://dx.doi.org/10.1038/sj.sc.3101729 DOI: https://doi.org/10.1038/sj.sc.3101729

Phillips WT, Kiratli BJ, Sarkarati M, Weraarchakul G, Myers J, Franklin BA, et al. Effect of spinal cord injury on the heart and cardiovascular fitness. Current problems in cardiology 1998; 23(11): 641-716. http://dx.doi.org/10.1016/S0146-2806(98)80003-0 DOI: https://doi.org/10.1016/S0146-2806(98)80003-0

DeVivo MJ, Shewchuk RM, Stover SL, Black KJ, Go BK. A cross-sectional study of the relationship between age and current health status for persons with spinal cord injuries. Paraplegia 1992; 30(12): 820-7. http://dx.doi.org/10.1038/sc.1992.158 DOI: https://doi.org/10.1038/sc.1992.158