Dietary calcium intake and obesity in adult women : the POWIRS study
Rautenbach, Petro Hannie
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Background: The role of dietary calcium in weight management is gaining support in the nutrition research community. It has been hypothesized that high calcium diets protect against fat gain by creating a balance of lipolysis over lipogenesis in adipocytes (Zemel et al., 2000) and that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance fat loss (Shapses et al., 2004). Objectives: A lack of baseline data on the physical, physiological and mental effects of obesity on urban African women was the motivation for the POWIRS (Profiles of Obese Women with Insulin Resistance Syndrome) study. The aim of the study was to assess the effects of obesity on health determinants of urban African and white women by comparing the lifestyle and risk factors for non-communicable diseases (NCDs) of lean, overweight and obese subjects. This led to a multi-disciplinary cross-sectional case-control study in which health determinants and health status, as well as the underlying mechanistic relationships between these factors were measured in a sample of African women volunteers. The study was repeated a year later, done in a sample of white women volunteers, POWIRS II. The effect of calcium intake on body composition was assessed during this study. Methods: One hundred and two apparently healthy urban African women, between the ages of 20 and 50 years participated in the first phase of this case-control cross-sectional survey. For a period of about three weeks, each afternoon ten subjects were to report at a Metabolic Unit Facility (consisting of 10 single bedrooms, 2 bathrooms, a living room and kitchen). Each subject received a "participant sheet" which guided them through the different research 'stations' where the various measurements were done. During the course of the evening demographic questionnaires were filled in and all anthropometric measurements were taken, except weight and height measurements. All participants received an identical light supper which excluded alcohol and caffeine at 20h00, went to sleep before 23h00 and fasted overnight. From 06h00 in the morning weight, height and blood pressure measurements were taken. After a fasting blood sample was taken, a two-hour glucose tolerance test commenced. Subjects received a breakfast and afterwards habitual dietary intake questionnaires were completed. Results: Mean total dietary calcium intake as significantly higher in white women (POWIRS II), with a mean intake 1053.8 mg per day, as opposed to a mean intake of 494.8 mg calcium per day in the blacks subjects (POWIRS I). Mean fat intake in the black subjects was 59.3 g per day, and in the white women 103.1 g per day. Thus the calcium:fat ratio in white women was higher than in black women (11.0 and 8.4 respectively). After adjustment for age and total dietary energy intake, significant negative correlations were found between dietary calcium intake and various variables, only in the white subjects. These were BMI (r=-0.255, p=0.01), percentage body fat (r=-0.252, p=0.01), fasting insulin (r=-0.205, p=0.05) and fasting glucose (r=-0.199, p=0.046). The calcium:fat ratio correlated negatively with BMI (r=-0.378, p<0.0001), percentage body fat (r=-0.401, p<0.0001), fasting glucose (r=-0.229, p=0.02), fasting insulin (r=-0.212, p=0.04) and plasma leptin (r=-0.284, p=0.004). Adjustment for smoking resulted in slightly different correlation coefficients, but similar significant correlations were still found. The only significant association that was found in the black population, was a negative correlation between dietary calcium intake and systolic blood pressure (p=0.03) as well as diastolic blood pressure (p=0.04). After adjustment for age, smoking and dietary energy intake no significant correlations were found in the black subjects. Conclusion: The results from the POWIRS study in white women are consistent with the hypothesis that there may be an inverse relationship between adiposity and calcium intake. In our study higher calcium intakes were associated with lower body fat, lower BMI, lower fasting glucose and insulin, as well as plasma leptin in white women. The association seems to be significant in subjects with high intakes of fat and calcium (as seen in the white women).
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