J Sokoll
Lori
and
ABSTRACT stores living.
healthy,
premenopausal
the study. containing
two
daily
meals
P
(r
0.2
=
0.04), hemoglobin
1.
with
women.
for
12 wk.
P
were 0.04).
=
transferrin concentration
correlated
total
TIBC,
tions,
groups.
as the
carbonate to
KEY
WORDS
(r
saturation
(r
109
women
capacity
n saturation,
were over
daily
at baseline,
plasma
in
r
serum
or percent iron concen-
inabsolute
does
iron.
P
-0.42,
=
and mg Ca
appear
to be detri-
premenopausal
calcium
carbonate.
bone
In light
ofthe
recent
an
An
investigated
important
body
retention ingestion
and
calcium
in orange
source
between
dietary
variable
results.
to reduce
iron
with reported
by
of59Fe
juice
An
and
United
of impaired
.,lfll
y to pre-
a test
meal
However,
States,
undergoing
blood
was
oral
nated
blood the
starting
tablets
the effect
and
iron
status and
and 4.9%,
1992:56:1045-8.
of calcium
women
Lahol’atorl’
iron-deficiency respectively, Printed
in USA.
I
supplemen-
ofchildbearing The anemia in children
Written
aged area
informed
this
study
had
a usual
urinary calcium red blood cell
< 6.2 indices.
any ofthe following diseases: infection history of metabolically active nephgastritis, resection,
peptic ulcer, or parathyroid
treatment
with
contraceptives,
and
none
or calcium-containing
or during
the
during
the
and
or had > 50 mL study. In addition,
sprue, previous disease. No
glucocorticoids
or iron-
before
assays tests
and
study
blood drawn no subjects
cIi’tarj’
ofblood
laboratory
age
prevalence has
been
ages
© 1992 American
From
or policies
milk, by CCM
of childbearing
anemia.
for a 24-h normal
allowed
the
US
Center on Aging 2 The contents
lowered
phosphate,
women
women Boston
study.
Donation
no subject
of
had
in the 2 mo were known
do-
before to be
methods.
assess?nt’nt
and
urine Urinary
were
performed
calcium
was
by standard measured
by
been
whole-
not
the
intake
women.
(2, 3) but
study.
for 2 mo not
Screening
in humans
was significantly
risk for iron-deficiency
to be 9.6%
J C/in Nutr
children
calcium
calcium
(CCM)
has
by 0-73%
from
carbonate.
be at
pregnant.
for
calcium
elevated
utilization
in postmenopausal
malate
(3).
are at the greatest reported
of calcium
study
of calcium citrate
iron
tation on the iron status of free-living age has yet to be determined. In the
was
clinical
In a controlled
(2-9).
in the recommended
women.
interaction
has been
increase
for both loss of
for calcium for women ages 19-24 ( 1 ). supplements can be expected
increasingly
menopausal
women
therefore
and the research protocol Human Investigation Re-
selected
mg/d, 32%, and
subjects had inflammation,
estrogen.
this
each subject University
1000
were
treatment
healthy, free-living, 1992;56:1045-8.
Ferritin,
and taking
premenopausal
Subjects
n concentra-
the
period,
meals
20.0%
even greater risk for iron-deficiency anemia. In this study we examined the effect ofdaily supplementation with 1000 mg elemental Ca, as calcium carbonate, on iron stores in
heme-iron (r = 0.19,
(TIBC,
between
a 12-wk
with
iron stores AinJC/inNutr
and 57 took with each of
hemoglobi
observed
who
0.31, P = 0.001), and P = 0.02), and negatively
0.22,
=
1 1 y and
( 10). Women
in free-
=
differences concentrations,
transferri Thus,
mental women.
Of
In all subjects
iron-binding
or hematocrit
control
use on iron study
positively correlated with serum iron concentration
< 0.001). No significant changes in plasma ferritin
trations.
supplement controlled
52 were in the control group 250 mg Ca as the carbonate
concentrations
=
ofcalcium
in a randomized
completed two tablets femtin intake
effect
examined
concentrations
Davison-Hughes
Bess
The
was
ferritin
5-
Society
of the
Department
ofAgriculture
at Tufts University, ofthis publication US
Department
Human
Nutrition
Boston. do not necessarily of Agriculture.
nor
reflect does
Research
the views mention
of
trade names. commercial products. or organizations imply endorsement by the US Government. 3 Supported by the USDA Human Nutrition Research Center on Aging at Tufts University (contract no. 53-3K06-5-lO). 4 Address reprint requests to B Dawson-Hughes. USDA Human Nutrition Research Center on Aging at Tufts University. 7 1 1 Washington Street. Boston. MA 021 I 1. Received January 21. 1992. Accepted for publication July 9. 1992. for Clinical
Nutrition
1045
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Calcium supplementation and plasma in premenopausal women4
SOKOLL
1046 TABLE Clinical
AND
DAWSON-HUGHES Elkhart,
1
characteristics
and dietary
intakes
ofcontrol
and treatment
IN)
groups5
tablet. to the 33
31 ± 9 [52]
610
± 21 1 [49]
15.4
±
0.69
±
10.0
14.7 ±
(mg/d)
Protein
intake (g/d) Fiber intake (g/d) Ascorbic acid intake (mg/d)
7 1.6 20.1 239.5
14.8 0.59
10.3 [53] 0.45 [53]
± ±
14.2
[46]
10.2 [53]
±
Sample
6 (Beckman
Instruments,
measured from
with
Immo
TIBC
Chemicals
CA).
Magic
Phase
[53]
P
Magic
the
were
measured
with
(Monroe,
CT),
assay
kits
which
nutrients
Diagnostic
adapted
(Roche calculated
TABLE Baseline
assessed
questionnaire
with
the
for use
Instruments, by dividing
randomly Ca
assigned
mean were ofO
group. Those as calcium
subjects (two ment test
differences
performed for heme
per group
and with
Tukey
in the control group, group, 155%) were ( I 4) and
were
estimated
the two transformed to 0.019 the
the
whether
groups.
Sta-
data. according
Two to
3 mo
analyses.
Three of
was
the three
and percent
change
over
Characteristics in
Table
between in which
.
the two groups or in calcium intakes intake was quantitated. In those
the Willett in
intakes Baseline
ofthe control and treatment groups are shown was no significant difference in mean ages
1 There
food
frequency
ofprotein, plasma
questionnaire
for the subjects
(ii
99),
=
102 subjects completing no differences
iron, fiber, or ascorbic acid were femtin and serum iron concentrations.
semiquan-
tocrit were
were
not different
Hemoglobin
values in the 107 subjects also not different (Table
between
concentrations
observed. TIBC, the control and
hema-
in whom data were available 2). In all subjects, there was
Plasma ferritin (g/L) Serum iron (j.imol/L) Total-iron-binding capacity (Mmol/L) Transferrin saturation Hemoglobin (g/L) Hematocrit SD: percent
change
in
parentheses.
47.2
± 42.3
16.7
± 7.8
(14.8
(2.6
56.1
± 7.7
(0.9
relationship between baseline plasma ferritin concenand heme-iron intake (r - 0.2 1 P = 0.04), but not ferritin and any other dietary component measured.
Baseline
plasma
,
positively
correlated
ferritin
concentrations
with
baseline
were serum
iron
found
to be
concentrations
also
(r
Treatment
0.30 136 0.40
± 0.15 ± 8 (0.6 ±
n
(14.0
39,7)5
52
34.9
± 27.6
±
61.3)
52
15.4
±
52
58.2
± 7.8
52
0.27
±
± 61.7)
± 4.7)
0.03 (-0.8
Baseline
±
± 10.5)
50 ± 6.2)
a
positive trations between
12 wk
Baseline
no
subjects
2
iron status
150
>
in the treatby Grubb’s
There
or not
a
control used to
was taken.
over
a the
assuming Unpaired
200%, and one to be outliers
from
for a
of detecting of I 5% in
Results
saturation
500 Inc.
and determined
Control
S
and blinded
between 1 test was
the logarithm
220
excluded
groups.
in the calcium group took carbonate (BioCal, Miles,
within
in ferritin
difference in the study results were included in the analyses.
treatment
or a cal-
differences Student’s
time
changes
transfemn
a control
over
( 1 3) before
percent
and
( 12).
were
an 80% chance concentrations
on logarithmically iron were changed
and
Willett
to either
subjects
question( 1 1 ). Intake
dt’.tvi were
cium-supplement mg elemental
was
frequency
Lvp(’rinu’?ual Women
regression
from
were
serum iron concentration by TIBC. Calcium intake was assessed with a food frequency naire specific for calciumand vitamin D-rich foods food
the
38 plasma 4 to 667 g/ The two kits
and
on the Cobas-Fara centrifugal analyzer Belleville, NJ). Transferrmn saturation was
titative
assess
Kits, from kits.
0.0001)
kits
To
determined to be Magic Ferritin = 0.803 zg/L Phase femtin. The two samples from each subject and analyzed in the same assay run. Serum iron
Limited
ofadditional
was
Radioimmunoassay
and
=
Span
ferritin
MA).
of 60
Student’s t test was used to compare and treatment groups and paired
a Spectra
Plasma
concentration by using both
0.998,
=
with
(Medfield,
Immo
(r
correlated
equation was + 1.01 5 Immo were batched and
and
ranging in ferritin Kit), were assayed
strongly
Alto.
Diagnostics of the
specimens, L (Magic
Palo Phase
Ciba-Corning
comparability
spectroscopy
sizes
group as compared with control subjects, of 0.3 1 in log of ferritin concentrations.
tistics values emission
were
test to have at least decrease in ferritin
Mosteller plasma
at baseline
analyses
0.05-level significant
186.7
[53]
#{149}#{231} ± SD: ii in brackets.
direct-current
daily placebo
Statistics
evaluate S
evaluated
meals any
assignments.
±
22.6 215.3
were
treatment variability
± 8.3
[49]
treatment-group
of two
did not take
laboratory
I 1.8 [53]
70.3 ± 30.5
± 329.7
status
conducting
±
± 2 1.9 [49]
[49]
of iron
Staff
at each
group
8 [57]
±
559 ± 229 [53]
10.0 [46] 0.49 [46]
tablets
50
135 0.40
± ±
ii
(-2.2
5.5 (8.5 (1.8
± 38.4)
57
±
61.9)
57
±
10.5)
57
0.10 (6.3 ± 56.5) 9 (1.0 ± 4.7) 0.03 (-0.4 ± 6.1)
57 57 57
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Age (y) Calcium intake (mg/d) Total iron intake (mg/d) Heme-iron intake (mg/d) Nonheme iron intake
250-mg
in the control
Measures
1 2 wk later.
Treatment
Control
in two
for 12 wk. Women
CALCIUM =
P
0.19.
0.04),
=
and hemoglobin with TIBC (r Percent
transferrin
-
changes
in Table control
and
were