Calcium intestinal absorption

Contraction of muscle follows an increase of Ca " in the muscle cell as a result of nerve stimulation. This initiates processes which cause the proteins myosin and actin to be drawn together making the cell shorter and thicker. The return of the Ca " to its storage site, the sarcoplasmic reticulum, by an active pump mechanism allows the contracted muscle to relax (27). Calcium ion, also a factor in the release of acetylcholine on stimulation of nerve cells, influences the permeabiUty of cell membranes activates enzymes, such as adenosine triphosphatase (ATPase), Hpase, and some proteolytic enzymes and facihtates intestinal absorption of vitamin B 2 [68-19-9] (28). 

Parathyroid hormone, a polypeptide of 83 amino acid residues, mol wt 9500, is produced by the parathyroid glands. Release of PTH is activated by a decrease of blood Ca " to below normal levels. PTH increases blood Ca " concentration by increasing resorption of bone, renal reabsorption of calcium, and absorption of calcium from the intestine. A cAMP mechanism is also involved in the action of PTH. Parathyroid hormone induces formation of 1-hydroxylase in the kidney, requited in formation of the active metabolite of vitamin D (see Vitamins, vitamin d). 

Although it is being found that vitamin D metaboUtes play a role ia many different biological functions, metaboHsm primarily occurs to maintain the calcium homeostasis of the body. When calcium semm levels fall below the normal range, 1 a,25-dihydroxy-vitainin is made when calcium levels are at or above this level, 24,25-dihydroxycholecalciferol is made, and 1 a-hydroxylase activity is discontiaued. The calcium homeostasis mechanism iavolves a hypocalcemic stimulus, which iaduces the secretion of parathyroid hormone. This causes phosphate diuresis ia the kidney, which stimulates the 1 a-hydroxylase activity and causes the hydroxylation of 25-hydroxy-vitamin D to 1 a,25-dihydroxycholecalciferol. Parathyroid hormone and 1,25-dihydroxycholecalciferol act at the bone site cooperatively to stimulate calcium mobilization from the bone (see Hormones). Calcium blood levels are also iafluenced by the effects of the metaboUte on intestinal absorption and renal resorption. 

The overall effect in most animals is to stimulate intestinal absorption of calcium with a concomitant increase in semm calcium and a reduction in parathyroid hormone (PTH). Modest hypercalcemia allows the glomerular filtration rate to remain stable and hypercalciuria to occur because of increased filtered load of calcium and reduction of tubular resorption of calcium with reduced PTH. However, with further increases in semm calcium, the glomerular filtration rate decreases, resulting in an even more rapid increase in semm calcium and the subsequent fall in urinary calcium. 

Vitamin D is a family of closely related molecules that prevent rickets, a childhood disease characterized by inadequate intestinal absorption and kidney reabsorption of calcium and phosphate. These inadequacies eventually lead to the demineralization of bones. The symptoms of rickets include bowlegs,... 

A major regulator of bone metabolism and calcium homeostasis, parathyroid hormone (PTH) is stimulated through a decrease in plasma ionised calcium and increases plasma calcium by activating osteoclasts. PTH also increases renal tubular calcium re-absorption as well as intestinal calcium absorption. Synthetic PTH (1-34) has been successfully used for the treatment of osteoporosis, where it leads to substantial increases in bone density and a 60-70% reduction in vertebral fractures. 

In addition to its role in regulating calcium homeostasis, vitamin D is required for the intestinal absorption of calcium. Synthesis of the intracellular calciumbinding protein, calbindin, required for calcium absorption, is induced by vitamin D, which also affects the permeability of the mucosal cells to calcium, an effect that is rapid and independent of protein synthesis. 

D Calciferol Maintenance of calcium balance enhances intestinal absorption of Ca and mobilizes bone mineral Rickets = poor mineralization of bone osteomalacia = bone demineralization... 

MORAis M B, FESTE A, MILLER R G, LiFSCHiTZ c H (1996) Effect of resistant and digestible starch on intestinal absorption of calcium, iron, and zinc in infant pigs. Pediatr Res. 39 872-6. 

Most of the interactions with mycophenolate mofetil and enteric-coated MPA are due to reductions in intestinal absorption. Aluminum-, magnesium-, or calcium-containing antacids decrease the peak level and overall exposure of MPA from either of the preparations.11 If a patient requires liquid antacids, they should be administered at least 4 hours before... 

Mykkanen HM, Wasserman RH. 1981. Gastro-intestinal absorption of lead (203Pb) in chicks Influence of lead, calcium and age. JNutr 111 1757-1765. 

Kostic, D. et al. (1995). Intestinal absorption, serum clearance, and interactions between lutein and beta-carotene when administered to human adults in separate or combined oral doses. Am. J. Clin. Nutr. 62 604—610. Kuo, S. M. et al. (2001). Dihydropyridine calcium channel blockers inhibit ascorbic acid accumulation in human intestinal Caco-2 cells. Life Sci. 68(15) 1751-1760. 

Both lipases and lipoxygenases are present in the bran and the germ. Phytases are nutritionally important as they liberate the phosphorus, of which approximately 70% is in the kernel bound to phytin. Phytin blocks the intestinal absorption of both iron and calcium. Phytase is also present in yeast, which is why leavened bread is nutritionally superior to unleavened bread. There have been concerns about the incidence of rickets among those of South Asian origin who eat chapattis, live in the UK, and have a tendency to keep their skin covered up from the sun. 

Human parathyroid hormone (hPTH) is an 84 amino acid polypeptide that functions as a primary regulator of calcium and phosphate metabolism in bones. It stimulates bone formation by osteoblasts, which display high-affinity cell surface receptors for the hormone. PTH also increases intestinal absorption of calcium. 

During the last decade, a number of investigators have attempted to elucidate the mechanism by which protein consumption induces hypercalciuria. In our previous research, the calciuria could not be explained by increased intestinal absorption of calcium, complexing with sulfur amino acids, or urinary acid production. 

Since the early 1970 s, research has been directed at identifying the mechanism by which the calciuria is induced. Attention was given first to the question of whether the elevated urinary calcium excretion was caused by an increase in the intestinal absorption of calcium. Results of calcium balance studies in human subjects showed that protein ingestion either had no effect on calcium absorption (4) or that the effect was insufficient to account for the calciuria (5j. Consequently, negative calcium balance is a frequent observation in human studies when high protein diets are fed, and this situation is not improved by high calcium intakes (4 ). 

These studies have shown that phosphorus, magnesium and fluoride In the doses used had no effect on the bloavailablllty of calcium, while large doses of zinc given during a low calcium Intake Inhibited the Intestinal absorption of calcium The effect of protein and of certain drugs on calcium metabolism Is also described ... 

The recommended dietary allowance, RDA, for calcium In the United States Is 800 mg per day (1) However, this amount of calcium may not be adequate throughout adult life for maintaining the normal skeletal structure and for preventing bone loss with aging, particularly In females Recent studies Indicate that this amount of calcium may not be adequate for maintaining the optimal bone mass which reaches Its peak at the age of 30 to 35 years (2) and decreases thereafter Even If the calcium Intake Is adequate, one has to consider to which extent this amount of calcium Is utilized There may be a decrease In the Intestinal absorption of calcium (3) or the... 

In extensive studies of the effect of fluoride In patients with osteoporosis carried out In this Research Unit, a therapeutic dally dose of 45 mg fluoride per day was used as sodium fluoride. The main effect of fluoride on calcium metabolism was a decrease of the urinary calcium, while the fecal calcium did not change and the calcium balance also remained unchanged. Also, the Intestinal absorption of calcium remained unchanged during the high fluoride Intake (Table I), The decrease In urinary calcium, Induced by sodium fluoride, may be due to decreased bone resorption, a very desirable effect for patients with osteoporosis. 

Zinc, A great deal of Information Is available on the effect of calcium on zinc metabolism, particularly In animals (30,31), but only a few studies have been carried out In man (32,33), On the other hand, to our knowledge, no studies have been reported on the effect of zinc on calcium metabolism In man. In studies carried out In this Research Unit, It has been demonstrated that large amounts of zinc significantly decrease the Intestinal absorption of calcium If the zinc supplements are given during a low calcium Intake (34),... 

Table I shows that the addition of 140 mg of zinc as zinc sulfate per day, during a low calcium Intake of 230 mg/day, decreased the urinary calcium, Increased the fecal calcium and the calcium balance remained unchanged. In nine patients studied during a low calcium Intake, the Intestinal absorption of calcium decreased significantly during the high zinc Intake, the absorption values averaging 61 + 6,6% In the control study and 39 + 4,6% during zinc supplementation, However, the decrease In calcium absorption was abolished...

These observations were explained by decreased Intestinal absorption of calcium and by subsequent Increased stimulation of the secretion of PTH and removal of calcium from bone. 

More than 40 years ago, calcium absorption from brown (whole wheat) bread which was fed to human subjects was found to be poorer than was that when white (extracted wheat flour) was fed 04,5). Since then, many studies have sought to define the extent of inhibition of calcium intestinal bioavailability by various forms of dietary fiber with mixed results and conclusions (6-18). 

Water-holding capacity of hemicelluloses (contained in wheat brans and psyllium fiber) and celluloses may decrease mouth to rectum transit time, increase fecal weight, and decrease intraluminal pressure (36). These characteristics might be expected to interfere with calcium absorption decreasing time allowed for intestinal absorption, by diluting the concentration of calcium and... 

CalcitrioPs action primary function is in regulating plasma calcium concentration. In health, the plasma total calcium concentration is tightly controlled at 2.35-2.55 mmol/1. Only the ionized or free fraction, amounting to about 50% of the total, is physiologically active in for example, maintenance of membrane electrical potential and bone formation. The hormone causes increased bone resorption via activation of osteoclasts (see Section 9.4) and increased intestinal absorption of calcium following the synthesis of a specific binding protein in mucosal cells. As described in Section 4.7, some... 

Dursun, N., and Aydogan, S. (1994). Comparative effects of calcium deficiency and supplements on the intestinal absorption of zinc in rats. Jpn. J. Physiol. 44,157-166. 

Mechanism of Action A nonabsorbable compound that alters urinary composition of calcium, magnesium, phosphate, and oxalate. Calcium binds to cellulose sodium phosphate, thus preventing intestinal absorption of it. Therapeutic Effect Prevents the formation of kidney stones. 

Contraindications Primary or secondary hyperparathyroidism, including hypercalci-uria (renal calcium leak), hypomagnesemic states (serum magnesium less than 1.5 mg/dl), bone disease (osteoporosis, osteomalacia, osteitis), hypocalcemic states (e.g., hypoparathyroidism, intestinal malabsorption), normal or low intestinal absorption and renal excretion of calcium, enteric hyperoxaluria, and patients with high fasting urinary calcium or hypophosphatemia. 

Calcium is present in three forms e.g., as free calcium ion, bound to plasma protein albumin and in diffusable complexes. The endocrine system, through parathyroid hormone and calcitonin, helps in keeping the concentration of ionized plasma calcium in normal level. Decrease in plasma levels of ionized calcium leads to increased parathyroid hormone secretion. Parathyroid hormone tends to increase plasma calcium level by increasing bone resorption, increasing intestinal absorption and increasing reabsorption of calcium in kidney. Vitamin D acts by stimulating... 

Approximately two thirds of kidney stones contain Ca2+ phosphate or Ca2+ oxalate. Many patients with such stones exhibit a defect in proximal tubular Ca2+ reabsorption that causes hypercalciuria. This can be treated with thiazide diuretics, which enhance Ca2+ reabsorption in the distal convoluted tubule and thus reduce the urinary Ca2+ concentration. Salt intake must be reduced in this setting, since excess dietary NaCI will overwhelm the hypocalciuric effect of thiazides. Calcium stones may also be caused by increased intestinal absorption of Ca2+, or they may be idiopathic. In these situations, thiazides are also effective, but should be used as adjunctive therapy with other measures. 

Calcium and phosphate enter the body from the intestine. The average American diet provides 600-1000 mg of calcium per day, of which approximately 100-250 mg is absorbed. This figure represents net absorption, because both absorption (principally in the duodenum and upper jejunum) and secretion (principally in the ileum) occur. The amount of phosphorus in the American diet is about the same as that of calcium. However, the efficiency of absorption (principally in the jejunum) is greater, ranging from 70% to 90%, depending on intake. In the steady state, renal excretion of calcium and phosphate balances intestinal absorption. In general, over 98% of filtered calcium and 85% of filtered phosphate is reabsorbed by the kidney. The movement of calcium and phosphate across the intestinal and renal epithelia is closely regulated. Intrinsic disease of the intestine (eg, nontropical sprue) or kidney (eg, chronic renal failure) disrupts bone mineral homeostasis. 

Three hormones serve as the principal regulators of calcium and phosphate homeostasis parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and the steroid vitamin D (Figure 42-2). Vitamin D is a prohormone rather than a true hormone, because it must be further metabolized to gain biologic activity. PTH stimulates the production of the active metabolite of vitamin D, l,25(OH)2D. l,25(OH)2D, on the other hand, suppresses the production of PTH. l,25(OH)2D stimulates the intestinal absorption of calcium and phosphate. l,25(OH)2D and PTH promote both bone formation and resorption in part by stimulating the proliferation and differentiation of osteoblasts and osteoclasts. Both... 

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