Meta-Analysis of the Effect of the Acid-Ash Hypothesis of Osteoporosis on Calcium Balance
Meta-Analysis of the Effect of the Acid-Ash Hypothesis of Osteoporosis on Calcium Balance
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DOI：
10.1359/jbmr.090515
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发表时间：
2009-11-01
影响因子：
6.2
通讯作者：
Hanley, David A.
中科院分区：
文献类型：
--
作者：
Fenton, Tanis R.;Lyon, Andrew W.;Hanley, David A.
酸灰假说认为，钾摄入量低的蛋白质和谷物食品会产生饮食酸负荷、净酸排泄（NAE）、尿钙增加以及骨骼中钙的释放，从而导致骨质疏松症。这项荟萃分析的目的是通过控制健康成年受试者的酸碱摄入量来评估 NAE 变化对尿钙、钙平衡和骨代谢标志物 N-端肽的影响。该荟萃分析仅限于使用优质方法学质量来研究钙代谢的研究。我们系统地检索了文献，纳入了受试者随机接受干预措施的研究，并遵循医学研究所钙和相关营养素小组的建议进行钙研究。 16 项研究中有 5 项符合纳入标准。这些研究改变了蛋白质的数量和/或类型。尽管 NAE 的增加和尿钙之间存在显着的线性关系 (p < 0.0001)，但 NAE 的变化和钙平衡的变化之间没有关系 (p = 0.38；功效 = 94%)。 NAE 的变化与骨代谢标志物 N-端肽的变化之间没有关系 (p = 0.95)。总之，该荟萃分析并不支持与较高 NAE 相关的钙尿反映了全身钙的净损失这一概念。优质平衡研究没有证据表明增加饮食酸负荷会促进骨骼骨矿物质流失或骨质疏松。尿钙的变化并不能准确代表钙平衡。提倡“碱性饮食”来防止钙流失是没有道理的。骨矿工研究杂志 2009；24：1835-1840。 2009年5月4日在线发布；号码：10.1359/JBMR.090515
The acid-ash hypothesis posits that protein and grain foods, with a low potassium intake, produce a diet acid load, net acid excretion (NAE), increased urine calcium, and release of calcium from the skeleton, leading to osteoporosis. The objectives of this meta-analysis were to assess the effect of changes in NAE, by manipulation of healthy adult subjects' acid-base intakes, on urine calcium, calcium balance, and a marker of bone metabolism, N-telopeptides. This meta-analysis was limited to studies that used superior methodological quality for the study of calcium metabolism. We systematically searched the literature and included studies if subjects were randomized to the interventions and followed the recommendations of the Institute of Medicine's Panel on Calcium and Related Nutrients for calcium studies. Five of 16 studies met the inclusion criteria. The studies altered the amount and/or type of protein. Despite a significant linear relationship between an increase in NAE and urinary calcium (p < 0.0001), there was no relationship between a change of NAE and a change of calcium balance (p = 0.38; power = 94%). There was no relationship between a change of NAE and a change in the marker of bone metabolism, N-telopeptides (p = 0.95). In conclusion, this meta-analysis does not support the concept that the calciuria associated with higher NAE reflects a net loss of whole body calcium. There is no evidence from superior quality balance studies that increasing the diet acid load promotes skeletal bone mineral loss or osteoporosis. Changes of urine calcium do not accurately represent calcium balance. Promotion of the "alkaline diet" to prevent calcium loss is not justified. J Bone Miner Res 2009;24:1835-1840. Published online on May 4, 2009; doi: 10.1359/JBMR.090515