Partial neutralization of the acidogenic western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia
Partial neutralization of the acidogenic western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia
复制标题
DOI：
10.1681/asn.2006030233
复制
发表时间：
2006-11-01
影响因子：
13.6
通讯作者：
Krapf, Reto
中科院分区：
文献类型：
--
作者：
Jehle, Sigrid;Zanetti, Antonella;Krapf, Reto
慢性酸负荷是西方饮食中高动物/谷物蛋白质含量的必然结果。这种饮食诱导的代谢性酸中毒对骨量的影响存在争议。在一项随机、前瞻性、对照、双盲试验中，将161名低骨量（T评分-1至-4）绝经后妇女（年龄58.6 ± 4.8岁）随机分配至每日口服30 mEq柠檬酸钾（K）（Kcitrate）或30 mEq氯化钾（KCl）。主要终点是12个月后腰椎（L2至L4）骨密度（BMD）平均百分比变化的组间差异。与接受KCl的女性相比，接受Kcitrate的女性在L2至L4的BMD（+/- SE）增加1.87 +/- 0.50%（P < 0.001），股骨颈增加1.39 +/- 0.48%（P < 0.001），全髋增加1.98 +/- 0.51%（P < 0.001）。还发现了组内次要终点的显著变化：柠檬酸钾在第3、9和12个月时使L2至L4 BMD较基线显著增加，第12个月时增加0.89 +/- 0.30%（P < 0.05），而KCl组显示L2至L4 BMD降低-0.98 +/-0.38%（P < 0.05），仅在第12个月时具有显著性。桡骨远端和全身的组间差异为NS。枸橼酸钾治疗组显示尿钙排泄持续显著减少，尿柠檬酸盐排泄显著增加，柠檬酸盐排泄增加表明持续全身碱化。枸橼酸钾显著降低尿骨吸收标志物排泄率，而对于脱氧吡啶啉，组间差异具有显著性。尿酸净排泄与一部分患者的BMD变化呈显著负相关。在整个12个月期间，两种钾补充剂均观察到BP大幅显著降低。通过增加每日碱摄入量（如柠檬酸盐）可显著增加绝经后骨质减少妇女的骨量，且该效应与已报道的钾对骨骼的影响无关。
Chronic acid loads are an obligate consequence of the high animal/grain protein content of the Western diet. The effect of this diet-induced metabolic acidosis on bone mass is controversial. In a randomized, prospective, controlled, double-blind trial, 161 postmenopausal women (age 58.6 +/- 4.8 yr) with low bone mass (T score -1 to -4) were randomly assigned to 30 mEq of oral potassium (K) citrate (Kcitrate) or 30 mEq of K chloride (KCl) daily. The primary end point was the intergroup difference in mean percentage change in bone mineral density (BMD) at lumbar spine (L2 through L4) after 12 mo. Compared with the women who received KCl, women who received Kcitrate exhibited an intergroup increase in BMD (+/- SE) of 1.87 +/- 0.50% at L2 through L4 (P < 0.001), of 1.39 +/- 0.48% (P < 0.001) at femoral neck, and of 1.98 +/- 0.51% (P < 0.001) at total hip. Significant secondary end point intragroup changes also were found: Kcitrate increased L2 through L4 BMD significantly from baseline at months 3, 9, and 12 and reached a month 12 increase of 0.89 +/- 0.30% (P < 0.05), whereas the KCl arm showed a decreased L2 through L4 BMD by -0.98 +/- 0.38% (P < 0.05), significant only at month 12. Intergroup differences for distal radius and total body were NS. The Kcitrate-treated group demonstrated a sustained and significant reduction in urinary calcium excretion and a significant increase in urinary citrate excretion, with increased citrate excretion indicative of sustained systemic alkalization. Urinary bone resorption marker excretion rates were significantly reduced by Kcitrate, and for deoxypyridinoline, the intergroup difference was significant. Urinary net acid excretion correlated inversely and significantly with the change in BMD in a subset of patients. Large and significant reductions in BP were observed for both K supplements during the entire 12 mo. Bone mass can be increased significantly in postmenopausal women with osteopenia by increasing their daily alkali intake as citrate, and the effect is independent of reported skeletal effects of K.