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Biomedical subjects

S A Abrams

Publications and source records attributed to S A Abrams.

At least 91 records · Page 5Linked to original sources
PubMed1993

Mineral balance and bone turnover in adolescents with anorexia nervosa.

We evaluated seven female adolescents with anorexia nervosa to determine whether calcium metabolism was affected by their disorder. We measured calcium absorption, urinary calcium excretion, and calcium kinetics, using a dual-tracer, stable-isotope technique during the first weeks of an inpatient nutritional rehabilitation program. Results were compared with those from a control group of seven healthy adolescent girls of similar ages. The percentage of absorption of calcium was lower in subjects with anorexia nervosa than in control subjects (16.2% +/- 6.3% vs 24.6% +/- 7.2%; p < 0.05). Urinary calcium excretion was greater in subjects with anorexia nervosa than in control subjects (6.4 +/- 2.5 vs 1.6 +/- 0.7 mg.kg-1 x day-1; p < 0.01) and was associated with bone resorption rather than calcium hyper-absorption. Calcium kinetic studies demonstrated a decreased rate of bone formation and an increased rate of bone resorption. These results suggest marked abnormalities in mineral metabolism in patients with anorexia nervosa. From these results, we hypothesize that improvement in bone mineralization during recovery from anorexia nervosa will require resolution of hormonal abnormalities, including hypercortisolism, in addition to increased calcium intake.

Absorption↗
PubMed1993

Calcium kinetics in the hyperprostaglandin E syndrome.

Metabolic investigations, including the use of stable isotopes of calcium, were used to study calcium kinetics in three children with the hyperprostaglandin E syndrome. The studies were performed both during indomethacin treatment and in the absence of therapy. Off therapy, each child had hypercalciuria (mean urinary calcium excretion 0.478 mM/kg/d), hyperprostaglandinuria, and elevated serum calcitriol concentration. All had diminished bone density and were euparathyroid. Indomethacin treatment was associated with a marked reduction in serum calcitriol concentration, as well as decreased prostaglandin E excretion. Mean urinary calcium excretion fell to 0.135 mM/kg/d. The stable isotope studies defined two components to the hypercalciuria of this disease: an indomethacin-sensitive dietary contribution and a relatively indomethacin-resistant bone resorptive element. Bone densitometry confirmed the presence of the resorptive element by demonstrating skeletal demineralization.

Bone Density↗
PubMed1993

Pubertal changes in calcium kinetics in girls assessed using 42Ca.

The rate of calcium deposition in bone (Vo+) and the size of the exchangeable calcium pool in bone (EP) were measured in 50 girls aged 4.9 to 16.7 y using i.v. administered 42Ca. Both Vo+ and EP reached a maximum during early puberty and decreased in late puberty and more than 2 y postmenarche. In contrast, the initial mass of calcium distribution did not decrease in late puberty. The ratio of calcium deposition in bone to the exchangeable pool size, i.e. ko+ = Vo+/EP, was more closely correlated with length of time since menarche (r = 0.83, p < 0.001) than with age (r = 0.65, p < 0.001), weight (r = 0.51, p < 0.001), or body mass index (r = 0.28, p = 0.05). The lower ko+ in late puberty indicates that as bone matures the fraction of the calcium pool that enters bone decreases.

Adolescent↗
PubMed1993

Calcium absorption and metabolism in children with juvenile rheumatoid arthritis assessed using stable isotopes.

OBJECTIVE: To assess calcium intake, absorption, urinary excretion and the fraction of urinary calcium originating from bone and diet in patients with juvenile rheumatoid arthritis (JRA). METHODS: A dual tracer stable isotope technique was used to study 6 girls and 3 boys with JRA. RESULTS: Fractional absorption in the 6 girls, ages 4-9, with JRA was significantly lower than that in 10 similar, healthy girls (22.6 +/- 4.7% vs 30.4 +/- 8.4%, p = 0.033). Urinary calcium excretion tended to be higher in the girls with JRA than in controls, (2.9 +/- 1.5 vs 1.6 +/- 1.7, p = 0.15). The urinary calcium in patients with JRA was derived principally from bone, and there was no increase in diet derived urinary calcium. One of the boys with new onset JRA was markedly hypercalciuric and in negative calcium balance (-222 mg/day). CONCLUSION: Our data show that hypercalciuria in patients with JRA results from bone resorption, not hyperabsorption of dietary calcium and suggest that increases in calcium intake may benefit children with JRA.

Adolescent↗
PubMed1992

Developmental changes in calcium kinetics in children assessed using stable isotopes.

Total exchangeable calcium pool size (TEP) and bone calcium accretion rate (Vo+) were measured using stable isotopes in healthy children and young adults. 42Ca or 46Ca was given intravenously to 10 children aged 10 months to 14 years and 3 women aged 23-33 years. Calcium kinetic parameters were determined using a two- or three-exponential curve of the resultant serum and urine tracer excesses. These data were compared with previously reported (radiotracer) kinetic studies of 21 children and 5 adults without known bone disease. Current results are comparable to those previously obtained, and the data from all studies were analyzed together. Total Vo+ was significantly greater in children aged 3-16 years than in adults (2.8 +/- 1.6 versus 0.7 +/- 0.2 g/day, p less than 0.01). Both TEP and Vo+ were significantly correlated to age independently of variations in body weight (p less than 0.01 for each). The ratio ko+ = Vo+/TEP was greater in children than adults (0.36 +/- 0.15 versus 0.12 +/- 0.03 day-1, p less than 0.001). These data demonstrate increased bone flow of calcium associated with increases in exchangeable calcium pools in children compared to adults. Vo+ and TEP may be maximum in early adolescence, associated with peak rates of net calcium accretion. The use of stable isotopes permits the safe evaluation of calcium kinetics in patients of all ages.

Adolescent↗
PubMed1992

Bone mineralization outcomes in human milk-fed preterm infants.

We evaluated bone mineralization by single photon absorptiometry at 2 y in a cohort of preterm infants studied since birth. Infants were fed human milk fortified with Ca [to achieve 80 mg/dL (19.96 mmol/L)] and P [40 mg/dL (12.91 mmol/L)] from wk 2 through 8 after birth. After hospital discharge, infants were divided into two groups (HM and F) determined by the timing of the introduction of cow milk-based formula. Mid-radius bone mineral content (BMC) was assessed in 10 infants who were breast-fed (HM) for a minimum of 2 mo after hospital discharge and 11 who were bottle-fed (F). The mean duration of human milk-feeding differed by design between HM and F groups (31 +/- 15 versus 11 +/- 3 wk, respectively). Although we had observed previously that group F had significantly greater BMC values at 16, 25, and 52 wk compared with values in group HM, we found similarities in BMC values (180 +/- 30 mg/cm) between groups at 2 y. The 2-y cohort comprised healthy infants and the groups had similar birth weights, lengths of gestation, and values for weight (10.8 +/- 1.1 kg), length (82 +/- 2 cm), and bone width (7.8 +/- 1.1 mm). Follow-up outcomes at 2 y in preterm infants fed fortified human milk in hospital suggest that if they continue to receive human milk after hospital discharge, radius BMC will "catch-up" to that of similar infants given formula in the posthospitalization period.

Bone Density↗
PubMed1991

Calcium and phosphorus deficiencies affect mineral distribution in neonatal miniature piglets.

Current efforts to monitor the mineral status of preterm infants fed human milk may not provide sufficient information on the distribution of body minerals. To investigate the body distribution of calcium and phosphorus during various degrees of mineral deficiency, neonatal miniature piglets were raised for 2 wk on diets differing only in calcium and phosphorus. Groups A, B, and C were fed 100%, 60%, and 20%, respectively, of the recommended amounts of calcium and phosphorus that, when adjusted for rates of growth, approximated the range of dietary intakes of preterm infants. Group C manifested biochemical and body-composition evidence of mineral deficiency when compared with group A: lower serum phosphorus; higher serum alkaline phosphatase activity; less fat-free tissue, calcium, and phosphorus in tibiae, vertebrae, and whole carcasses. Neonatal miniature piglets are useful for studying mineral deposition during mineral deficiency in preterm infants.

Alkaline Phosphatase↗
PubMed1991

Stable isotopic measurement of endogenous fecal calcium excretion in children.

Using a stable isotopic technique in which 42Ca was administered via a bolus injection, we measured endogenous fecal calcium excretion, Vf, in five healthy children, aged 3-14 years. The Vf averaged 1.4 +/- 0.4 mg/kg/day, and was lower than urinary Ca excretion (Vu) in four of the five children. These results for Vf are consistent with previously reported results for Vf in healthy adults and much lower than those reported in premature infants. These results may be useful in understanding developmental changes in Ca metabolism and in interpreting dual tracer Ca isotope studies in children.

Adolescent↗
PubMed1991

Dual tracer stable isotopic assessment of calcium absorption and endogenous fecal excretion in low birth weight infants.

Using a dual tracer (44Ca orally and 46Ca i.v.) stable isotope technique, true dietary Ca absorption, endogenous fecal Ca excretion, and net Ca retention were measured in 12 low birth weight (1426 +/- 260 g) infants fed a high Ca-containing formula. Endogenous fecal Ca excretion averaged 7.2 +/- 4.1% of intake, and exceeded 10% of intake in three infants. Net Ca retention, 103 +/- 38 mg/kg/d, was consistent with previous studies of Ca retention obtained using mass balance techniques and correlated closely (r = 0.98, p less than 0.001) with true Ca absorption but not with endogenous fecal excretion (r = -0.40, p = 0.19). Although endogenous fecal excretion may represent a significant source of Ca loss for some low birth weight infants, these data suggest that net Ca retention in low birth weight infants fed a high Ca-containing formula is primarily determined by the total dietary Ca absorbed.

Calcium Isotopes↗
PubMed1990

Unequal distribution of a stable isotopic calcium tracer between casein and whey fractions of infant formulas, human milk and cow's milk.

Measurement of calcium absorption with tracers assumes a complete equilibration of tracer with milk calcium. In this study, the equilibration of tracer between the micellar casein and soluble fractions (primarily whey) of infant formulas, human milk and cow's milk was measured in vitro using milk samples enriched with 42Ca and analyzed by thermal ionization mass spectrometry. Incomplete equilibration of tracer occurred with the micellar casein fraction of all milks. The least equilibration with micellar casein was found with premature infant formula, for which the ratio of slopes of the equilibration lines (whey/casein) was 8.5/1. These differences may be due to Ca-casein binding in cow's milk-based formulas. The effects of the lack of tracer equilibration in vivo cannot be determined. However, unequal bioavailability of casein- vs. whey-bound Ca may exist.

Absorption↗
PubMed1990

Recent studies of human calcium metabolism using stable isotopic tracers.

Stable isotopes of calcium are used safely as tracers for calcium in human populations ranging in age from infants to postmenopausal women. Thermal ionization mass spectrometry is used to measure calcium isotope ratios with relative accuracies of about 1% for natural abundance ratios at precisions of about 1% relative to the mean. Perturbations of natural abundance ratios are determined for the calcium in blood, urine, and feces with a limit of detection of about 2 delta % excess. The mathematical rationale for clinical studies of fractional absorption of dietary calcium and the kinetics of calcium's internal distribution are presented.

Animals↗
PubMed1988

Bone mineralization in former very low birth weight infants fed either human milk or commercial formula.

The bone mineral status of former very low birth weight infants previously fed fortified human milk was evaluated during the posthospitalization period. Anthropometric measurements, bone mineral content, bone width, serum calcium, phosphorus, and albumin concentrations, and alkaline phosphatase activity were evaluated at 10, 16, and 25 postnatal weeks. Infants were fed either commercial formula or unfortified human milk after their hospital discharge. At 16 and 25 weeks postnatally, human milk-fed infants (group HM) had lower bone mineral content (P less than 0.01), bone mineral content/bone width ratio (p less than 0.01), serum phosphorus concentration (p less than 0.03), and higher alkaline phosphatase activity (p less than 0.01) than commercial formula-fed infants (group CM). Growth was similar in both groups. Bone mineral content was correlated positively to serum phosphorus (r = 0.52, p less than 0.05) and inversely to alkaline phosphatase activity (r = -0.63, p less than 0.01) at 25 weeks postnatally. The use of serum biochemical markers, however, could account for only 44% of the variability in bone mineral content. The exclusive feeding of human milk to very low birth weight infants after hospital discharge may place them at risk for mineral deficiencies.

Alkaline Phosphatase↗
PubMed1988

Bioavailability of calcium and phosphorus in human milk fortifiers and formula for very low birth weight infants.

Growth, 96-hour balance of nutrients (nitrogen, fat, calcium (Ca), phosphorus (P), and magnesium), metabolizable energy, and serum biochemical markers of mineral status (Ca and P concentrations and alkaline phosphatase activity) were measured in 22 very low birth weight infants to investigate the bioavailability of minerals from specialized formula and from human milk fortifiers. The intakes of Ca and P were similar between group FORM ("Preemie" SMA) and group CMF (1:1 wt/wt, human milk and Similac Natural Care or Similac Special Care). The intakes of nitrogen, energy, fat, and magnesium differed between groups. Group CMF had significantly greater fecal losses and significantly lower absorption and retention of Ca and P in comparison with those of group FORM. Retention of Ca and P in both groups, however, was greater than 25% below intrauterine estimates of accretion. Retention rates of Ca, P, and magnesium were not correlated with their respective intakes. Weight gain during the balance study and during the entire study interval was significantly less in group CMF. The ratio of Ca retention to either weight gained or nitrogen retained was lower in group CMF, which suggested that the low retention of Ca was related less to the slower rate of growth in these infants than to their greater fecal losses of Ca. Although the cause of the greater fecal losses of Ca and P in this group is unclear, the data suggest an insolubility of the mineral sources. Our results indicate that sole reliance on the absolute mineral concentrations of the milk selected for very low birth weight infants may be unrealistic; the bioavailability of Ca and P from particular mineral sources should be evaluated.

Absorption↗
PubMed1988

Mineral balance studies in very low birth weight infants fed human milk.

Mineral homeostasis often is disrupted in the very low birth weight (VLBW) infant fed either human milk or commercial formula that contains insufficient quantities of available calcium (Ca) and phosphorus (P). Alterations in mineral homeostasis include abnormal patterns of serum (Ca and P concentrations and alkaline phosphatase activity) and urine (Ca and P) biochemical markers, low net Ca and P retentions in comparison with intrauterine estimates of mineral accretion, and decreased bone mineral content. A two-phase study was conducted in our laboratory to test for these alterations in mineral homeostasis. In phase 1, VLBW infants fed a preparation of fortified human milk (either human milk-derived fortifier I or II or cow milk-derived fortifier) or cow milk-based formula specially designed for VLBW infants were evaluated during their hospitalization. In phase 2, after hospitalization, these infants were evaluated during the first 6 months of life when fed either their mother's milk or routine formula exclusively. The bioavailability of Ca and P from the tested preparations varied widely. Although the fortification of human milk resulted in both an improved biochemical pattern and net retention of Ca and P, optimal intrauterine mineral accretion was not achieved in any group tested. Longitudinal assessments of bone mineralization, by single photon absorptiometry, demonstrated that human milk-fed former VLBW infants had reduced bone mineral content. These investigations suggest that former VLBW infants fed human milk exclusively may be at risk for Ca and P deficiencies.

Animals↗