Amanda Devine - Academia.edu (original) (raw)

Papers by Amanda Devine

International Journal of Environmental Research and Public Health

Large-scale food system practices have diminished soil and water quality and negatively impacted ... more Large-scale food system practices have diminished soil and water quality and negatively impacted climate change. Yet, numerous opportunities exist to harness food system practices that will ensure better outcomes for human health and ecosystems. The objective of this study was to consider food Production, Processing, Access and Consumption domains, and for each determine the challenges and successes associated with progressing towards a sustainable food system. A workshop engaging 122 participants including producers, consultants, consumers, educators, funders, scientists, media, government and industry representatives, was conducted in Perth, Western Australia. A thematic analysis of statements (Successes (n = 170) or Challenges (n = 360)) captured, revealed issues of scale, knowledge and education, economics, consumerism, big food, environmental/sustainability, communication, policies and legislation, and technology and innovations. Policy recommendations included greater investme...

Children's dietary exposure to metals has received limited attention in Australia. This study und... more Children's dietary exposure to metals has received limited attention in Australia. This study undertook a market basket survey and analysed 253 food and beverages for metals. This data was used in conjunction with recent average diet data for children in Western Australia to model dietary metals exposure, with mean metals intakes for boys and girls aged 8, 12, 13 and 16 years calculated. Results show that for some metals, including cadmium, nickel and manganese, dietary intake guidelines have been exceeded in younger children. The mean modelled cadmium intake in children aged 8 years was almost 60% of the World Health Organisation guideline and exceeded the European Food Safety Authority guideline. Nickel and manganese intake was higher in younger children than reported in international studies. Modelling based on the 95% percentile of dietary consumption exceeded the respective guidelines or upper level of intake for several of the metals studied. The findings from this study support the need for further investigation into the exposure of children to metals from diet and the health implications of exposure.

The American journal of clinical nutrition, 2017

Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in huma... more Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in humans. It is not known, however, whether increased consumption of nitrate-rich vegetables translates to a lower risk of atherosclerotic vascular disease (ASVD) mortality.Objective: The objective was to investigate the association of nitrate intake from vegetables with ASVD mortality.Design: A total of 1226 Australian women aged 70-85 y without prevalent ASVD and/or diabetes were recruited in 1998 and were studied for 15 y. We assessed demographic and ASVD risk factors at baseline (1998), and we used a validated food-frequency questionnaire to evaluate dietary intake. Nitrate intake from vegetables was calculated by use of a newly developed comprehensive database. The primary outcome was any death attributed to ASVD ascertained by using linked data that were provided via the Western Australian Data Linkage system. We used Cox proportional hazards modeling to examine the association between n...

International journal of hygiene and environmental health, Mar 26, 2017

Cadmium has been associated with increased risk of cardiovascular disease (CVD) in observational ... more Cadmium has been associated with increased risk of cardiovascular disease (CVD) in observational studies, however there has been a limited focus on this relationship in women. This study investigated the association of urinary cadmium (UCd) concentrations with CVD outcomes and all-cause mortality in elderly Western Australian (WA) women. UCd excretion was measured at baseline in 1359 women, mean age 75.2 ± 2.7 years and 14.5 years of atherosclerotic vascular disease (ASVD) hospitalisations and deaths, including both the principle cause of death and all associated causes of death. Health outcome data were retrieved from the Western Australian Data Linkage System. Cox regression analysis was used to estimate hazard ratios of ASVD and all-cause mortality. UCd was ln-transformed and models were adjusted for demographic and CVD risk factors. Median (IQR) concentration of UCd was 0.18 (0.09-0.32) μg/L. In multivariable-adjusted analyses per ln unit (equivalent to ∼2.7 fold) increase in UC...

The American journal of clinical nutrition, 2018

Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascul... more Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascular health. Nitrate is sequentially reduced to NO through an enterosalivary nitrate-nitrite-NO pathway that involves the oral microbiome. This pathway is considered an important adjunct pathway to the classical l-arginine-NO synthase pathway. The objective of this study was to systematically assess the evidence for dietary nitrate intake and improved cardiovascular health from both human and animal studies. A systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by using key search terms in Medline and EMBASE databases and defined inclusion and exclusion criteria. Thirty-seven articles on humans and 14 articles on animals were included from 12,541 screened references. Data on the effects of dietary nitrate on blood pressure, endothelial function, ischemic reperfusion injury, arterial stiffness, platel...

Med J Aust, 2009

• This position statement was prepared by the Working Group of the Australian and New Zealand Bon... more • This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia.

Stroke, Jul 1, 2017

A short-term increase in dietary nitrate (NO3(-)) improves markers of vascular health via formati... more A short-term increase in dietary nitrate (NO3(-)) improves markers of vascular health via formation of nitric oxide and other bioactive nitrogen oxides. Whether this translates into long-term vascular disease risk reduction has yet to be examined. We investigated the association of vegetable-derived nitrate intake with common carotid artery intima-media thickness (CCA-IMT), plaque severity, and ischemic cerebrovascular disease events in elderly women (n=1226). Vegetable nitrate intake, lifestyle factors, and cardiovascular disease risk factors were determined at baseline (1998). CCA-IMT and plaque severity were measured using B-mode carotid ultrasound (2001). Complete ischemic cerebrovascular disease hospitalizations or deaths (events) over 14.5 years (15 032 person-years of follow-up) were obtained from the West Australian Data Linkage System. Higher vegetable nitrate intake was associated with a lower maximum CCA-IMT (B=-0.015, P=0.002) and lower mean CCA-IMT (B=-0.012, P=0.006). ...

The American Journal of Clinical Nutrition, Dec 1, 2005

Presumably, the food-frequency questionnaire could also have provided estimates of dietary potass... more Presumably, the food-frequency questionnaire could also have provided estimates of dietary potassium intake for each subject, in which case the investigators could have used the Frassetto algorithm (dietary net acid load ҃ 0.91 ҂ protein intake in g/d Ҁ 0.57 ҂ potassium intake in mEq/d ѿ 21) (2) to obtain an estimated value for dietary net acid load for each subject. In performing such an analysis, Devine et al may contribute quantitative estimates of the degrees of opposing anabolic and catabolic bone effects of dietary protein in elderly subjects over the range of protein intakes observed, and they may confirm in adults the findings of Alexy et al (3) in children and adolescents, also recently reported in the Journal. In an editorial accompanying that article, we (4) further discussed the subject of the opposing anabolic and catabolic bone effects of dietary protein and suggested a way to maximize protein's anabolic effect by supplying diets that are both protein-rich and net base-producing. The author had no conflict of interest.

Journal of the American Heart Association, Jan 4, 2018

Dietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease p... more Dietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease presentation and are reported to be inversely associated with subclinical measures of atherosclerosis, such as carotid artery intima-media thickness (IMT) and plaque. However, the effect of vegetable intake alone, and relationships to specific types of vegetables containing different phytochemical profiles, is important. The aim of this study was to investigate the associations of total vegetable intake and specific vegetables grouped according to phytochemical constituents with common carotid artery IMT (CCA-IMT) and carotid plaque severity in a cohort of older adult women (aged ≥70 years). Total vegetable intake was calculated at baseline (1998) using a validated food frequency questionnaire. Vegetable types included cruciferous, allium, yellow/orange/red, leafy green, and legumes. In 2001, CCA-IMT (n=954) and carotid focal plaque (n=968) were assessed using high-resolution B-mode carot...

Journal of Bone and Mineral Research, 2009

Although women lose 30% of their skeletal mass after the menopause, the mechanism of this loss is... more Although women lose 30% of their skeletal mass after the menopause, the mechanism of this loss is uncertain. Clearly estrogen deficiency is important but whether this works only through direct effects on the skeleton is uncertain. To examine these mechanisms further we have evaluated calcium-related metabolic factors in 655 healthy women. Fasting blood samples were collected from all subjects who were up to 35 years past the menopause, and fasting urine and 24-h urine samples were collected in 365 women who were up to 25 years past the menopause. In the first 15 years postmenopause, there was a rise in total plasma calcium due to a rise in albumin. Bone resorption (hydroxyproline creatinine ratio), bone formation (alkaline phosphatase), and the urine calcium creatinine ratio all rose at menopause and remained elevated for the next 25 years. There was a transient further rise in bone resorption for the 10 years following menopause. Neither PTH nor the free calcitriol index changed for the first 10 years following menopause. Ten years past the menopause, although total calcitriol rose, the free calcitriol index fell due to a rise in vitamin D binding protein. PTH began to rise at 15 years past menopause. GFR fell gradually over the 25 years following menopause. Thus following menopause there is an increase in bone turnover and increased urine calcium loss independent of any effect of PTH or calcitriol, suggesting a direct effect of estrogen deficiency on bone and kidney. At 10 years postmenopause, the free calcitriol index fell and PTH began to rise, these changes being associated with persistent elevation of bone resorption perhaps due to increased PTH action on the bone. The cause of the fall in the free calcitriol ratio may be due to progressive renal deterioration and phosphate retention. The cause of the rise in PTH may be due to a negative external calcium balance due to a reduction in gut calcium absorption, a consequence of relative deficiency of 25 hydroxyvitamin D and the fall in calcitriol together with persistent renal calcium loss.

Osteoporosis International a Journal Established As Result of Cooperation Between the European Foundation For Osteoporosis and the National Osteoporosis Foundation of the Usa, May 1, 2007

Meaured spinal kyphosis, as a predictor of prevalent and incident vertebral deformity, was examin... more Meaured spinal kyphosis, as a predictor of prevalent and incident vertebral deformity, was examined in older women (>70 years) and found to not have sufficient sensitivity or specificity to justify its use as a predictor of present or future vertebral deformity risk. Introduction Kyphosis may be attributable to vertebral deformity and was investigated as a clinical tool for predicting the presence and future risk of vertebral deformity. Methods Kyphosis was measured in 434 women aged 70 years or older and the kyphosis index (KI) calculated. Prevalent and incident vertebral deformities were assessed by morphometric X-ray absorptiometry (MXA). The predictive value of KI was examined. Results Severity of kyphosis was categorised by tertile of KI; 65% of anterior thoracic deformities occurred in the 33% of subjects in the highest (most kyphotic) tertile. Using this tertile as a predictor of anterior thoracic deformity, the probability for a positive test rose from 14% for the whole population to 28% and for a negative test the probability fell to 8%. For any spinal deformity the highest tertile of KI increased the probability of a positive test from 34% to 42% and reduced the probability for a negative test to 30%. The incidence of new deformities was 6% over 4 years; a high KI tertile did not increase the probability of any vertebral deformity. Conclusions Severe kyphosis does not increase the probability of detection of a prevalent or incident spinal deformity sufficiently to make it a useful method of selecting patients for further evaluation of spinal deformity.

American Journal of Clinical Nutrition

ABSTRACT

International Psychogeriatrics, 2010

American Journal of Clinical Nutrition

The effect of different types of calcium supplements on total nutrient intake has not been studie... more The effect of different types of calcium supplements on total nutrient intake has not been studied. The effect of Am J Clin Nutr 1996:64:731-7.

Yearbook of Endocrinology, 2006

Osteoporosis is a disease that is strongly genetically determined. Aromatase converts androgens t... more Osteoporosis is a disease that is strongly genetically determined. Aromatase converts androgens to estradiol in postmenopausal women, therefore polymorphisms of the gene for this enzyme may be associated with bone mass and fracture. We investigated the association of the TTTA microsatellite polymorphism in intron 4 of the aromatase (CYP19) gene with bone mineral density (BMD) and fracture in 1,257 women aged 70 yr and greater. The data obtained were stratified based on the presence or absence of a [TTTA]n of 7 (A2), determined from a preliminary analysis of hip dual-energy X-ray absorptiometry BMD, which was present in 27% of the population. The presence of an A2 allele was associated with a higher free estradiol index (0.52 +/- 0.49, P = 0.049) compared with the absence of an A2 allele (0.47 +/- 0.45); higher BMD at all sites of the hip (3.4% total hip, 2.3% femoral neck, 3.6% intertrochanter, 4.1% trochanter) and the lumbar spine (12.7%); higher values for the calcaneal quantitative ultrasound parameters broadband ultrasound (1.3%), speed of sound (0.4%), and stiffness (3.7%); and higher peripheral quantitative computed tomography measures for total (3.4%), trabecular (3.3%), and cortical BMD (3.3%) and the derived stress strain index (SSI) parameters SSI polar (6.4%) and SSI x (6.8%) values. A lower deoxypryridinoline creatinine ratio was observed in subjects with an A2 allele (30.3 +/- 10.4 vs. 27.1 +/- 9.1, P = 0.03). The A2 allele was associated with a lower prevalence of vertebral fracture in subjects who were osteoporotic (odds ratio 0.27, confidence interval 0.09-0.79). Therefore, a common polymorphism of the aromatase gene, perhaps in linkage disequilibrium with a functionally significant CYP19 polymorphism, is associated with bone structure and bone turnover, either by local effects or by effects on circulating bioactive estrogen.

Consensus process: A working group commissioned by the ANZBMS and Osteoporosis Australia (OA) dev... more Consensus process: A working group commissioned by the ANZBMS and Osteoporosis Australia (OA) developed this position statement. Drafts were developed and circulated within the working group with expertise in bone health and osteoporosis. A consensus draft was then circulated to other experts in the area before a subsequent draft was posted on the ANZBMS website for widespread comment and feedback. Suggested revisions were incorporated with consensus from the working party. The scientific affairs committees of the ANZBMS and OA reviewed the final manuscript. This edited version of the full position statement has been reviewed by all members of the Working group and senior representatives of Osteoporosis Australia and ANZBMS.

Jbmr, 2009

Long-term effects of high dietary protein intake on muscle and bone structure in the elderly are ... more Long-term effects of high dietary protein intake on muscle and bone structure in the elderly are not clear. The aim of this study was to investigate the relationship between baseline protein intake and lean mass and BMC 5 yr later in a cohort of elderly postmenopausal women. A total of 862 community-dwelling women 75 +/- 3 yr of age provided baseline data including nutrient intake assessed by a food frequency questionnaire. At 5 yr, upper arm muscle area (UAMA) and body composition using DXA were measured. Baseline protein intake was 81 +/- 28 g/d (1.2 +/- 0.4 g/kg/d), contributing 19 +/- 3% of total energy intake. There were positive correlations between baseline protein intake and whole body and appendicular bone-free lean mass and BMC (r = 0.14-0.18, p < 0.001) and UAMA (r = 0.08, p < 0.05). Compared with those in the lowest tertile of protein intake (<66 g/d), women in the top tertile (>87 g/d) had 5.4-6.0% higher whole body and appendicular lean mass and UAMA and 5.3-6.0% higher whole body and appendicular BMC. These effects remained after adjusting for potential confounders. However, the effect on BMC disappeared after further adjustment for lean mass. This study shows that high protein intake is associated with long-term beneficial effects on muscle mass and size and bone mass in elderly women. The protein effect on bone may be partly mediated by its effects on muscle.

International journal of hygiene and environmental health, Jan 27, 2015

Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium ... more Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium has been associated with decreased bone density, an increased risk of osteoporotic fracture and possible renal dysfunction. Older women are a group at risk of renal and bone density impacts and exposure to metals may be an important risk factor for these health outcomes. This study was a cross sectional study of 77 women aged 50 years and above examining the relationship between metals exposure and renal and bone health. Urinary and blood metals concentrations, plasma creatinine, iron, ferritin and transferrin were measured in these subjects. Bone biomarkers assessed included the pyridinium crosslinks, pyridinoline and deoxypyridinoline measured by ELISA. Renal function was assessed using eGFR and KIM-1. Whole body, hip and lumbar spine bone mineral density was assessed using DEXA. Blood and urinary metals concentrations were generally low in the subjects, with a median urinary cadmium c...

The American Journal of Clinical Nutrition, Feb 1, 2002

Background: The relative importance of vitamin D metabolites in the regulation of gut calcium abs... more Background: The relative importance of vitamin D metabolites in the regulation of gut calcium absorption has not been well studied in elderly women living in an environment with abundant sunlight. Objective: The objective was to examine the determinants of active gut calcium absorption (x -± SD: 42 ± 11%) after an overnight fast with the use of a low (10 mg) calcium load. Design: One hundred twenty elderly women aged 74.7 ± 2.6 y underwent an active calcium absorption test with a radioactive calcium tracer, dietary analysis, and measurement of markers of bone turnover and calcium metabolism. Results: The mean serum 25-hydroxyvitamin D [25(OH)D] concentration at the time of the calcium absorption test was 68 ± 29 nmol/L. Gut calcium absorption was correlated with 25(OH)D but not 1,25-dihydroxyvitamin D (calcitriol), the free calcitriol index, or dietary calcium intake. After adjustment for age, calcitriol concentration, and dietary calcium intake, the significant determinant of fractional calcium absorption was the 25(OH)D concentration (r = 0.34, P = 0.001). When body weight was included in the regression, both 25(OH)D (␤ = 1.20 ϫ 10 Ϫ3 ) and calcitriol (␤ = 1.00 ϫ 10 Ϫ3 ) were significantly correlated with calcium absorption. Despite the strong relation between 25(OH)D and gut calcium absorption, there was no relation with other aspects of bone turnover or calcium metabolism. Conclusion: These data suggest that at low calcium loads, 25(OH)D is a more important determinant of gut calcium absorption than is calcitriol in elderly women exposed to abundant sunlight, but that this relation has little effect on overall calcium metabolism.

International Journal of Environmental Research and Public Health

Large-scale food system practices have diminished soil and water quality and negatively impacted ... more Large-scale food system practices have diminished soil and water quality and negatively impacted climate change. Yet, numerous opportunities exist to harness food system practices that will ensure better outcomes for human health and ecosystems. The objective of this study was to consider food Production, Processing, Access and Consumption domains, and for each determine the challenges and successes associated with progressing towards a sustainable food system. A workshop engaging 122 participants including producers, consultants, consumers, educators, funders, scientists, media, government and industry representatives, was conducted in Perth, Western Australia. A thematic analysis of statements (Successes (n = 170) or Challenges (n = 360)) captured, revealed issues of scale, knowledge and education, economics, consumerism, big food, environmental/sustainability, communication, policies and legislation, and technology and innovations. Policy recommendations included greater investme...

Children's dietary exposure to metals has received limited attention in Australia. This study und... more Children's dietary exposure to metals has received limited attention in Australia. This study undertook a market basket survey and analysed 253 food and beverages for metals. This data was used in conjunction with recent average diet data for children in Western Australia to model dietary metals exposure, with mean metals intakes for boys and girls aged 8, 12, 13 and 16 years calculated. Results show that for some metals, including cadmium, nickel and manganese, dietary intake guidelines have been exceeded in younger children. The mean modelled cadmium intake in children aged 8 years was almost 60% of the World Health Organisation guideline and exceeded the European Food Safety Authority guideline. Nickel and manganese intake was higher in younger children than reported in international studies. Modelling based on the 95% percentile of dietary consumption exceeded the respective guidelines or upper level of intake for several of the metals studied. The findings from this study support the need for further investigation into the exposure of children to metals from diet and the health implications of exposure.

The American journal of clinical nutrition, 2017

Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in huma... more Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in humans. It is not known, however, whether increased consumption of nitrate-rich vegetables translates to a lower risk of atherosclerotic vascular disease (ASVD) mortality.Objective: The objective was to investigate the association of nitrate intake from vegetables with ASVD mortality.Design: A total of 1226 Australian women aged 70-85 y without prevalent ASVD and/or diabetes were recruited in 1998 and were studied for 15 y. We assessed demographic and ASVD risk factors at baseline (1998), and we used a validated food-frequency questionnaire to evaluate dietary intake. Nitrate intake from vegetables was calculated by use of a newly developed comprehensive database. The primary outcome was any death attributed to ASVD ascertained by using linked data that were provided via the Western Australian Data Linkage system. We used Cox proportional hazards modeling to examine the association between n...

International journal of hygiene and environmental health, Mar 26, 2017

Cadmium has been associated with increased risk of cardiovascular disease (CVD) in observational ... more Cadmium has been associated with increased risk of cardiovascular disease (CVD) in observational studies, however there has been a limited focus on this relationship in women. This study investigated the association of urinary cadmium (UCd) concentrations with CVD outcomes and all-cause mortality in elderly Western Australian (WA) women. UCd excretion was measured at baseline in 1359 women, mean age 75.2 ± 2.7 years and 14.5 years of atherosclerotic vascular disease (ASVD) hospitalisations and deaths, including both the principle cause of death and all associated causes of death. Health outcome data were retrieved from the Western Australian Data Linkage System. Cox regression analysis was used to estimate hazard ratios of ASVD and all-cause mortality. UCd was ln-transformed and models were adjusted for demographic and CVD risk factors. Median (IQR) concentration of UCd was 0.18 (0.09-0.32) μg/L. In multivariable-adjusted analyses per ln unit (equivalent to ∼2.7 fold) increase in UC...

The American journal of clinical nutrition, 2018

Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascul... more Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascular health. Nitrate is sequentially reduced to NO through an enterosalivary nitrate-nitrite-NO pathway that involves the oral microbiome. This pathway is considered an important adjunct pathway to the classical l-arginine-NO synthase pathway. The objective of this study was to systematically assess the evidence for dietary nitrate intake and improved cardiovascular health from both human and animal studies. A systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by using key search terms in Medline and EMBASE databases and defined inclusion and exclusion criteria. Thirty-seven articles on humans and 14 articles on animals were included from 12,541 screened references. Data on the effects of dietary nitrate on blood pressure, endothelial function, ischemic reperfusion injury, arterial stiffness, platel...

Med J Aust, 2009

• This position statement was prepared by the Working Group of the Australian and New Zealand Bon... more • This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia.

Stroke, Jul 1, 2017

A short-term increase in dietary nitrate (NO3(-)) improves markers of vascular health via formati... more A short-term increase in dietary nitrate (NO3(-)) improves markers of vascular health via formation of nitric oxide and other bioactive nitrogen oxides. Whether this translates into long-term vascular disease risk reduction has yet to be examined. We investigated the association of vegetable-derived nitrate intake with common carotid artery intima-media thickness (CCA-IMT), plaque severity, and ischemic cerebrovascular disease events in elderly women (n=1226). Vegetable nitrate intake, lifestyle factors, and cardiovascular disease risk factors were determined at baseline (1998). CCA-IMT and plaque severity were measured using B-mode carotid ultrasound (2001). Complete ischemic cerebrovascular disease hospitalizations or deaths (events) over 14.5 years (15 032 person-years of follow-up) were obtained from the West Australian Data Linkage System. Higher vegetable nitrate intake was associated with a lower maximum CCA-IMT (B=-0.015, P=0.002) and lower mean CCA-IMT (B=-0.012, P=0.006). ...

The American Journal of Clinical Nutrition, Dec 1, 2005

Presumably, the food-frequency questionnaire could also have provided estimates of dietary potass... more Presumably, the food-frequency questionnaire could also have provided estimates of dietary potassium intake for each subject, in which case the investigators could have used the Frassetto algorithm (dietary net acid load ҃ 0.91 ҂ protein intake in g/d Ҁ 0.57 ҂ potassium intake in mEq/d ѿ 21) (2) to obtain an estimated value for dietary net acid load for each subject. In performing such an analysis, Devine et al may contribute quantitative estimates of the degrees of opposing anabolic and catabolic bone effects of dietary protein in elderly subjects over the range of protein intakes observed, and they may confirm in adults the findings of Alexy et al (3) in children and adolescents, also recently reported in the Journal. In an editorial accompanying that article, we (4) further discussed the subject of the opposing anabolic and catabolic bone effects of dietary protein and suggested a way to maximize protein's anabolic effect by supplying diets that are both protein-rich and net base-producing. The author had no conflict of interest.

Journal of the American Heart Association, Jan 4, 2018

Dietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease p... more Dietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease presentation and are reported to be inversely associated with subclinical measures of atherosclerosis, such as carotid artery intima-media thickness (IMT) and plaque. However, the effect of vegetable intake alone, and relationships to specific types of vegetables containing different phytochemical profiles, is important. The aim of this study was to investigate the associations of total vegetable intake and specific vegetables grouped according to phytochemical constituents with common carotid artery IMT (CCA-IMT) and carotid plaque severity in a cohort of older adult women (aged ≥70 years). Total vegetable intake was calculated at baseline (1998) using a validated food frequency questionnaire. Vegetable types included cruciferous, allium, yellow/orange/red, leafy green, and legumes. In 2001, CCA-IMT (n=954) and carotid focal plaque (n=968) were assessed using high-resolution B-mode carot...

Journal of Bone and Mineral Research, 2009

Although women lose 30% of their skeletal mass after the menopause, the mechanism of this loss is... more Although women lose 30% of their skeletal mass after the menopause, the mechanism of this loss is uncertain. Clearly estrogen deficiency is important but whether this works only through direct effects on the skeleton is uncertain. To examine these mechanisms further we have evaluated calcium-related metabolic factors in 655 healthy women. Fasting blood samples were collected from all subjects who were up to 35 years past the menopause, and fasting urine and 24-h urine samples were collected in 365 women who were up to 25 years past the menopause. In the first 15 years postmenopause, there was a rise in total plasma calcium due to a rise in albumin. Bone resorption (hydroxyproline creatinine ratio), bone formation (alkaline phosphatase), and the urine calcium creatinine ratio all rose at menopause and remained elevated for the next 25 years. There was a transient further rise in bone resorption for the 10 years following menopause. Neither PTH nor the free calcitriol index changed for the first 10 years following menopause. Ten years past the menopause, although total calcitriol rose, the free calcitriol index fell due to a rise in vitamin D binding protein. PTH began to rise at 15 years past menopause. GFR fell gradually over the 25 years following menopause. Thus following menopause there is an increase in bone turnover and increased urine calcium loss independent of any effect of PTH or calcitriol, suggesting a direct effect of estrogen deficiency on bone and kidney. At 10 years postmenopause, the free calcitriol index fell and PTH began to rise, these changes being associated with persistent elevation of bone resorption perhaps due to increased PTH action on the bone. The cause of the fall in the free calcitriol ratio may be due to progressive renal deterioration and phosphate retention. The cause of the rise in PTH may be due to a negative external calcium balance due to a reduction in gut calcium absorption, a consequence of relative deficiency of 25 hydroxyvitamin D and the fall in calcitriol together with persistent renal calcium loss.

Osteoporosis International a Journal Established As Result of Cooperation Between the European Foundation For Osteoporosis and the National Osteoporosis Foundation of the Usa, May 1, 2007

Meaured spinal kyphosis, as a predictor of prevalent and incident vertebral deformity, was examin... more Meaured spinal kyphosis, as a predictor of prevalent and incident vertebral deformity, was examined in older women (>70 years) and found to not have sufficient sensitivity or specificity to justify its use as a predictor of present or future vertebral deformity risk. Introduction Kyphosis may be attributable to vertebral deformity and was investigated as a clinical tool for predicting the presence and future risk of vertebral deformity. Methods Kyphosis was measured in 434 women aged 70 years or older and the kyphosis index (KI) calculated. Prevalent and incident vertebral deformities were assessed by morphometric X-ray absorptiometry (MXA). The predictive value of KI was examined. Results Severity of kyphosis was categorised by tertile of KI; 65% of anterior thoracic deformities occurred in the 33% of subjects in the highest (most kyphotic) tertile. Using this tertile as a predictor of anterior thoracic deformity, the probability for a positive test rose from 14% for the whole population to 28% and for a negative test the probability fell to 8%. For any spinal deformity the highest tertile of KI increased the probability of a positive test from 34% to 42% and reduced the probability for a negative test to 30%. The incidence of new deformities was 6% over 4 years; a high KI tertile did not increase the probability of any vertebral deformity. Conclusions Severe kyphosis does not increase the probability of detection of a prevalent or incident spinal deformity sufficiently to make it a useful method of selecting patients for further evaluation of spinal deformity.

American Journal of Clinical Nutrition

ABSTRACT

International Psychogeriatrics, 2010

American Journal of Clinical Nutrition

The effect of different types of calcium supplements on total nutrient intake has not been studie... more The effect of different types of calcium supplements on total nutrient intake has not been studied. The effect of Am J Clin Nutr 1996:64:731-7.

Yearbook of Endocrinology, 2006

Osteoporosis is a disease that is strongly genetically determined. Aromatase converts androgens t... more Osteoporosis is a disease that is strongly genetically determined. Aromatase converts androgens to estradiol in postmenopausal women, therefore polymorphisms of the gene for this enzyme may be associated with bone mass and fracture. We investigated the association of the TTTA microsatellite polymorphism in intron 4 of the aromatase (CYP19) gene with bone mineral density (BMD) and fracture in 1,257 women aged 70 yr and greater. The data obtained were stratified based on the presence or absence of a [TTTA]n of 7 (A2), determined from a preliminary analysis of hip dual-energy X-ray absorptiometry BMD, which was present in 27% of the population. The presence of an A2 allele was associated with a higher free estradiol index (0.52 +/- 0.49, P = 0.049) compared with the absence of an A2 allele (0.47 +/- 0.45); higher BMD at all sites of the hip (3.4% total hip, 2.3% femoral neck, 3.6% intertrochanter, 4.1% trochanter) and the lumbar spine (12.7%); higher values for the calcaneal quantitative ultrasound parameters broadband ultrasound (1.3%), speed of sound (0.4%), and stiffness (3.7%); and higher peripheral quantitative computed tomography measures for total (3.4%), trabecular (3.3%), and cortical BMD (3.3%) and the derived stress strain index (SSI) parameters SSI polar (6.4%) and SSI x (6.8%) values. A lower deoxypryridinoline creatinine ratio was observed in subjects with an A2 allele (30.3 +/- 10.4 vs. 27.1 +/- 9.1, P = 0.03). The A2 allele was associated with a lower prevalence of vertebral fracture in subjects who were osteoporotic (odds ratio 0.27, confidence interval 0.09-0.79). Therefore, a common polymorphism of the aromatase gene, perhaps in linkage disequilibrium with a functionally significant CYP19 polymorphism, is associated with bone structure and bone turnover, either by local effects or by effects on circulating bioactive estrogen.

Consensus process: A working group commissioned by the ANZBMS and Osteoporosis Australia (OA) dev... more Consensus process: A working group commissioned by the ANZBMS and Osteoporosis Australia (OA) developed this position statement. Drafts were developed and circulated within the working group with expertise in bone health and osteoporosis. A consensus draft was then circulated to other experts in the area before a subsequent draft was posted on the ANZBMS website for widespread comment and feedback. Suggested revisions were incorporated with consensus from the working party. The scientific affairs committees of the ANZBMS and OA reviewed the final manuscript. This edited version of the full position statement has been reviewed by all members of the Working group and senior representatives of Osteoporosis Australia and ANZBMS.

Jbmr, 2009

Long-term effects of high dietary protein intake on muscle and bone structure in the elderly are ... more Long-term effects of high dietary protein intake on muscle and bone structure in the elderly are not clear. The aim of this study was to investigate the relationship between baseline protein intake and lean mass and BMC 5 yr later in a cohort of elderly postmenopausal women. A total of 862 community-dwelling women 75 +/- 3 yr of age provided baseline data including nutrient intake assessed by a food frequency questionnaire. At 5 yr, upper arm muscle area (UAMA) and body composition using DXA were measured. Baseline protein intake was 81 +/- 28 g/d (1.2 +/- 0.4 g/kg/d), contributing 19 +/- 3% of total energy intake. There were positive correlations between baseline protein intake and whole body and appendicular bone-free lean mass and BMC (r = 0.14-0.18, p < 0.001) and UAMA (r = 0.08, p < 0.05). Compared with those in the lowest tertile of protein intake (<66 g/d), women in the top tertile (>87 g/d) had 5.4-6.0% higher whole body and appendicular lean mass and UAMA and 5.3-6.0% higher whole body and appendicular BMC. These effects remained after adjusting for potential confounders. However, the effect on BMC disappeared after further adjustment for lean mass. This study shows that high protein intake is associated with long-term beneficial effects on muscle mass and size and bone mass in elderly women. The protein effect on bone may be partly mediated by its effects on muscle.

International journal of hygiene and environmental health, Jan 27, 2015

Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium ... more Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium has been associated with decreased bone density, an increased risk of osteoporotic fracture and possible renal dysfunction. Older women are a group at risk of renal and bone density impacts and exposure to metals may be an important risk factor for these health outcomes. This study was a cross sectional study of 77 women aged 50 years and above examining the relationship between metals exposure and renal and bone health. Urinary and blood metals concentrations, plasma creatinine, iron, ferritin and transferrin were measured in these subjects. Bone biomarkers assessed included the pyridinium crosslinks, pyridinoline and deoxypyridinoline measured by ELISA. Renal function was assessed using eGFR and KIM-1. Whole body, hip and lumbar spine bone mineral density was assessed using DEXA. Blood and urinary metals concentrations were generally low in the subjects, with a median urinary cadmium c...

The American Journal of Clinical Nutrition, Feb 1, 2002

Background: The relative importance of vitamin D metabolites in the regulation of gut calcium abs... more Background: The relative importance of vitamin D metabolites in the regulation of gut calcium absorption has not been well studied in elderly women living in an environment with abundant sunlight. Objective: The objective was to examine the determinants of active gut calcium absorption (x -± SD: 42 ± 11%) after an overnight fast with the use of a low (10 mg) calcium load. Design: One hundred twenty elderly women aged 74.7 ± 2.6 y underwent an active calcium absorption test with a radioactive calcium tracer, dietary analysis, and measurement of markers of bone turnover and calcium metabolism. Results: The mean serum 25-hydroxyvitamin D [25(OH)D] concentration at the time of the calcium absorption test was 68 ± 29 nmol/L. Gut calcium absorption was correlated with 25(OH)D but not 1,25-dihydroxyvitamin D (calcitriol), the free calcitriol index, or dietary calcium intake. After adjustment for age, calcitriol concentration, and dietary calcium intake, the significant determinant of fractional calcium absorption was the 25(OH)D concentration (r = 0.34, P = 0.001). When body weight was included in the regression, both 25(OH)D (␤ = 1.20 ϫ 10 Ϫ3 ) and calcitriol (␤ = 1.00 ϫ 10 Ϫ3 ) were significantly correlated with calcium absorption. Despite the strong relation between 25(OH)D and gut calcium absorption, there was no relation with other aspects of bone turnover or calcium metabolism. Conclusion: These data suggest that at low calcium loads, 25(OH)D is a more important determinant of gut calcium absorption than is calcitriol in elderly women exposed to abundant sunlight, but that this relation has little effect on overall calcium metabolism.