Citrate-based dietary alkali supplements available in Germany: an overview.

BACKGROUND: Fruits and vegetables are abundant in alkali precursors and effectively reduce the Potential Renal Acid Load (PRAL) from diet. Oral alkali supplements are supposed to exert comparable alkalizing effects on the human body, and have been shown to beneficially affect bone and kidney health. A comparative analysis of the available dietary alkali supplements in Germany was performed, contrasting their potential PRAL-lowering potential. METHODS: We reviewed the currently available dietary citrate-based alkali supplements sold in Germany with a special focus on their mineral content, their PRAL-lowering potential and other characteristics inherent to each product. Supplements containing either potassium-, calcium- or magnesium citrate or any combination of these organic salts were reviewed. The total alkali load (TAL) was calculated based on the recommended daily dosage (RDD). RESULTS: Sixteen supplements with a mean alkali powder content of 220.69 ± 111.02 g were identified. The mean magnesium content per RDD was 239.93 ± 109.16 mg. The mean potassium and median calcium content were 550 ± 325.58 mg and 280 (240) mg, respectively. Median TAL was 1220 (328.75) mg. The PRAL-lowering potential from a single RDD ranged from - 51.65 mEq to -8.32 mEq. Substantial price differences were found, and the mean price of the examined supplements was 16.67 ± 5.77 Euros. The median price for a 1 mEq PRAL-reduction was 3.01 (3.14) cents, and ranged from 0.77 cents to 10.82 cents. CONCLUSIONS: Noticeable differences between the identified alkali supplements were encountered, warranting an individual and context-specific approach in daily clinical practice.

Serum levels of copper but not zinc are associated with head and chest cold in the NHANES.

BACKGROUND: Common colds are among the top reasons children miss school and adults miss work. The Centers for Disease Control and Prevention estimates that there are millions of cases of the common cold in the United States each year. The essential trace elements zinc and copper have immunomodulatory functions, and zinc has been reported to reduce the general risk of infection, whereas the copper-to-zinc ratio has been associated with an increased risk of incident infections in middle-aged men. Studies involving these two trace elements are generally scarce and were often limited to men. MATERIAL AND METHODS: We used data from the National Health and Nutrition Examination Surveys (NHANES) to examine potential associations between head or chest cold events and serum levels of copper and zinc in n = 2795 NHANES participants enrolled between 2011 and 2016. RESULTS: Comparing participants with and without an event of head or chest cold in the last 30 days, no significant differences were found in the serum levels of both trace elements. Notably, copper levels tended to be slightly higher in participants with a recent infection (121.56 (2.69) µg/dl) as compared to participants without infection (117.755 (1.04) µg/dl; p = 0.119). In multivariate logistic regression models adjusting for confounders, copper levels were significantly associated with increased odds for a previous head/chest cold (OR: 1.93 (CI: 1.07-3.47), p = 0.028). Notably, no significant associations were found for zinc and the copper-to-zinc ratio. CONCLUSIONS: Elevated copper levels were associated with head and chest cold events in the past 30 days. Whether elevated copper levels reflect a pro-inflammatory infection-predisposing status or whether they were elevated subsequent to the infectious event in some individuals in the sense of a reversed causality remains subject to future research.

Dietary Acid Load and Cancer Risk: A Review of the Uruguayan Experience.

Dietary acid load (DAL) is recognized as a risk factor for several chronic disorders, including obesity, diabetes, and osteoporosis. Recent evidence suggests that an elevated DAL, as measured by the validated potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores, could also increase the risk for several cancers. This narrative review summarizes the potential role of DAL in Uruguayan cancer patients and outlines the potentially involved pathophysiological pathways that mediate the role of DAL in both cancer development and growth. Although Uruguay is a developing country, its average diet is a heavily meat-based Western one, translating into a supraphysiological acid burden from diet. In recent years, we have published epidemiologic evidence based on ten case-control studies involving 3736 cancer cases and 9534 hospital-based controls. Odds ratios and 95% confidence intervals were estimated for each interest variable to analyze the association between the exposure levels of DAL scores and cancer, calculated by unconditional logistic regression. In a majority of the cases, the highest DAL scores tended to double the cancer risk as compared to the lowest category. We also found high risks for methionine intake, an acidifying amino acid found in higher concentrations in animal-based foods, which may increase cancer risks at least by a joint action based on the pH and the proliferation enhancing properties of the amino acid itself.

Dietary acid load decreases with age and is associated with sagittal abdominal diameter: a nationally representative quantification study in US adults.

BACKGROUND: Dietary acid load (DAL) has been associated with frailty and hip fractures in older adults, who often have a reduced kidney function and thus compromised buffering capacities. Studies to quantify DAL in older adults are scarce and controversies persist as to whether DAL in- or decreases with age. AIM: To enhance the understanding of DAL in older individuals, we examined its relationship with increasing age and selected anthropometric data in a well-characterized sample of US adults. METHODS: Secondary data analysis of nationally representative data from the National Health and Nutrition Examination Surveys data (NHANES 2011-2016). The sample included n = 3018 adults aged 60+, which may be extrapolated to represent n = 45,113,471 Americans. DAL was estimated using 4 formulas, including Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP). RESULTS: All employed DAL scores tended to decline with increasing age. Participants aged 80 years or older yielded the lowest DAL scores. The average US citizen aged 60+ consumed an acidifying diet, yet there were sex-specific differences in the adjusted means for some scores. NEAP was positively correlated with both body mass index (r = 0.26, p < 0.001) and the sagittal abdominal diameter (r = 0.31, p < 0.001) in this nationally representative sample. CONCLUSION: The previously reported phenomenon of increasing DAL values in older people in non-Western countries may not apply to the US. Our findings may constitute an important step towards a better understanding of DAL in older US adults, and highlight the need for additional population-specific research in the field.

Dietary Acid Load Correlates with Serum Amino Acid Concentrations after a Four-Week Intervention with Vegan vs. Meat-Rich Diets: A Secondary Data Analysis.

Chronic low-grade metabolic acidosis is now a common phenomenon in the Western world. The high dietary intake of sulfur-containing amino acids in the form of processed meats results in an excessive release of acid in the form of protons and non-metabolizable acidic anions. The kidneys produce increasing amounts of ammonia to excrete this acid. This process requires the breakdown of the nitrogenous amino acid glutamine, which the body provides by breaking down muscle tissue. Hitherto not examined, we hypothesized that a high dietary acid load (DAL) could alter the serum concentrations of selected amino acids. Using secondary data from a 4-week dietary intervention study conducted in 2017, we examined the associations between various amino acids and DAL in n = 42 individuals who either consumed a meat-rich or vegan diet. Results from this secondary data analysis suggested that DAL (as measured by the potential renal acid load and net endogenous acid production) is positively correlated with higher serum concentrations of lysine and 1-methyl-histidine (r = 0.50 and 0.43, respectively) and negatively correlated with glutamine and glycine (r = -0.43 and -0.47, respectively). The inverse association with glycine and glutamine warrants special attention, as both play an important role in many metabolic disorders and the immune system.

Dietary Acid Load Is Not Associated with Serum Testosterone in Men: Insights from the NHANES.

The dietary acid load (DAL) is a novel marker of overall diet quality, which has been associated with overweight, type 2 diabetes and altered glucocorticoid secretion. A potential association with sex hormones is thus not inconceivable. We investigated whether DAL was associated with serum total testosterone concentrations of men in the National Health and Nutrition Examination Survey. The DAL scores, including the potential renal acid load (PRAL) and net endogenous acid production (NEAP), were estimated and compared between participants with low and normal testosterone levels. The investigated sample encompassed n = 377 males with a mean age of 49.50 years. Approximately 73% of the sample were of Non-Hispanic White origin. None of the examined DAL scores showed significant associations with serum testosterone levels. We observed no significant differences in the crude DAL scores between individuals with low testosterone levels and individuals with normal testosterone levels. Multivariate regression models adjusting for covariates confirmed the lack of associations between the PRAL and serum testosterone. Our results are of particular importance for those individuals who wish to lower their DAL in light of the presumable health effects of a more alkaline diet. Our data suggest that diet modifications toward a lower intake of animal protein and refined grains (which consecutively translates into a lower DAL) may not negatively affect men's testosterone levels.

Adherence to a Vegetarian Diet is not Associated With Depression: Results From the National Health and Nutrition Examination Surveys.

OBJECTIVE: Adherence to vegetarian diets has been associated with physical health benefits, whereas vegetarian mental health is less well documented. We sought to investigate whether adherence to a vegetarian diet was associated with depression in a nationally-representative sample of US adults. METHODS: We used population-based data from the US National Health and Nutrition Examination Surveys to examine said associations. Depression was assessed using the Patient Health Questionnaire (PHQ-9), vegetarian status was self-reported. Multivariate regression was used to measure the magnitude of associations, controlling for a range of covariables known to be associated with depressive symptoms. RESULTS: Our analysis included 9,584 individuals, of which 910 individuals had PHQ-9 scores suggestive of depression. Vegetarian diet was associated with reduced odds of PHQ-9 defined depression (odds ratio [OR]: 0.49 [95% confidence interval {CI}: 0.24-0.98], p=0.047) in a model adjusting for sex, age, ethnicity, income, and marital status. When adjusting for additional factors (educational level, smoking status, serum C-reactive protein, and body mass index) in a second model, the previously observed association was no longer significant (OR: 0.66 [CI: 0.34-1.26], p=0.203). CONCLUSION: Vegetarian diet was not associated with PHQ-9 defined depression in this nationally-representative sample of adults. Additional longitudinal examinations are warranted to evolve the understanding of the role of vegetarian diets in mental health.

The 1995 potential renal acid load (PRAL) values may no longer adequately reflect the actual acid-base impact of certain foods: A hypothesis.

Background: In 1995, Remer and Manz reported potential renal acid load (PRAL) values of various foods, quantifying their estimated impact on acid-base balance. Their estimation considered ionic dissociation, sulphur metabolism and intestinal absorption rates for several micronutrients and proteins. Notably, PRAL values are based on food content data from the early 1990s and may nowadays no longer adequately reflect accurate estimates. Some foods' macronutrient and mineral content has declined over the past three decades due to changes in soil mineral health. Aim: We hypothesize that the 1995 PRAL values no longer adequately reflect reliable estimates of the current acid-base impact of some foods. Methods: Based on specific examples, we argue that these values overestimate the alkalizing effects of various fruits and vegetables. Conclusion: Discussing evidence in favour of (and against) our hypothesis, we conclude that the 1995 PRAL estimates should nowadays rather be used as a relative guidance and reviewed carefully.

How Well Do Low-PRAL Diets Fare in Comparison to the 2020-2025 Dietary Guidelines for Americans?

The regular consumption of net acid-producing diets can produce "acid stress" detrimental to human health. Alkalizing diets characterized by a negative potential renal acid load (also called low-PRAL diets (LPD)) enjoy uninterrupted popularity. However, the nutritional adequacy of said diets has rarely been assessed in large populations. Using data from the National Health and Nutrition Examination Surveys, we estimated nutrient intake in individuals consuming an LPD and contrasted the results in an age- and sex-specific manner to individuals on an acidifying diet (high-PRAL diet, HPD). Both groups were compared with the daily nutritional goals (DNG) specified in the 2020-2025 Dietary Guidelines for Americans (DGA). Our analysis included 29,683 individuals, including 7234 participants on an LPD and 22,449 participants on an HPD. Individuals on an LPD numerically met more nutritional goals than individuals on an HPD, yet both failed to meet the goals for several nutrients of public health concern (vitamin D and calcium). As opposed to individuals on an HPD, LPD consumers met the DGA recommendations for saturated fat and potassium. Individuals on an LPD consumed significantly more fiber than individuals on an HPD, as well as yielded a more favorable potassium-to-sodium intake ratio.

Observational and clinical evidence that plant-based nutrition reduces dietary acid load.

Contemporary diets in Western countries are largely acid-inducing and deficient in potassium alkali salts, resulting in low-grade metabolic acidosis. The chronic consumption of acidogenic diets abundant in animal-based foods (meats, dairy, cheese and eggs) poses a substantial challenge to the human body's buffering capacities and chronic retention of acid wherein the progressive loss of bicarbonate stores can cause cellular and tissue damage. An elevated dietary acid load (DAL) has been associated with systemic inflammation and other adverse metabolic conditions. In this narrative review, we examine DAL quantification methods and index observational and clinical evidence on the role of plant-based diets, chiefly vegetarian and vegan, in reducing DAL. Quantitation of protein and amino acid composition and of intake of alkalising organic potassium salts and magnesium show that plant-based diets are most effective at reducing DAL. Results from clinical studies and recommendations in the form of expert committee opinions suggest that for a number of common illnesses, wherein metabolic acidosis is a contributing factor, the regular inclusion of plant-based foods offers measurable benefits for disease prevention and management. Based on available evidence, dietary shifts toward plant-based nutrition effectively reduces dietary-induced, low-grade metabolic acidosis.

Dietary acid load and esophageal cancer risk: A case-control study.

BACKGROUND: A high dietary acid load (DAL) can produce metabolic acidosis, which is linked to cancer development through mechanisms of inflammation and cell transformation. There is limited epidemiological evidence linking DAL and cancer risk; however, none of the published studies focused on DAL and esophageal cancer (EC) risk in particular. Therefore, we sought to explore this association in the present study. METHODS: A case-control study was performed in 1295 male patients (185 squamous cell EC cases and 1110 age-frequency and urban/rural residence matched controls) through a multitopic inquiry, including a food frequency questionnaire. Food-derived nutrients were calculated from available databases. The DAL was calculated based on two validated measures: Potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. Odds ratios (OR) and their 95% confidence intervals (95% CI) were estimated by unconditional logistic regression, adjusting for confounders. RESULTS: We found direct, significant associations between dietary acid load and EC risk: (OR = 2.28, 95% CI: 1.44-3.61, ptrend <0.0001) and (OR = 2.17, 95% CI: 1.38-3.41, ptrend <0.0001) for highest PRAL and NEAP tertiles, respectively. Our data raise the possibility that a high DAL may contribute to EC development. Both acid load scores were directly associated with animal-based foods (mainly meat) and inversely associated with the intake of plant-based foods. CONCLUSION: To the best of our knowledge, this is the first epidemiological case-control study analyzing associations of DAL and squamous cell EC risk. Further research is warranted to confirm our findings.

Dietary Acid Load in Gluten-Free Diets: Results from a Cross-Sectional Study.

The gluten-free diet (GFD) ensures improvement of clinical symptoms in the vast majority of celiac disease (CD) patients. Despite stable CD rates in many countries, an increasing number of healthy individuals are adopting gluten-free diets, believing that this diet is an inherently healthier choice. The health effects of gluten-free diets are controversial, and a recent study added to the debate by reporting a lower acidogenic potential of this diet. The effects of the GFD on potential renal acid load (PRAL) and net endogenous acid production (NEAP)-two important markers of dietary acid load (DAL)-are poorly understood, and have never been examined in a Western population. Using cross-sectional data from the National Health and Nutrition Examination Surveys, we estimated DAL in U.S. individuals reporting a GFD and contrasted the results to the general U.S. population consuming gluten and denying special diets. The GFD was associated with significantly lower crude DAL scores, and after adjustments for confounders in multivariate regression, the results remain significant. Yet, our study could not confirm the reported alkalizing properties of the GFD. Although overall DAL scores were significantly lower in the GFD group, they were comparable to Western diets producing 50-75 mEq of acid per day.

Nutrient intake in low-carbohydrate diets in comparison to the 2020-2025 Dietary Guidelines for Americans: a cross-sectional study.

The percentage of US adults following low-carbohydrate diets (LCD) doubled in the last decade. Some researchers observed this trend with concern and highlighted the potential for nutritional deficiencies and impaired overall diet quality with LCD. The present study investigated nutrient intake in a nationally representative sample of 307 US adults following an LCD. Using cross-sectional data from the National Health and Nutrition Examination Surveys, we compared nutrient intake profiles in said individuals with the daily nutritional goals specified in the current 2020-2025 Dietary Guidelines for Americans (DGA). Results were then compared with the general population consuming a standard American diet. Almost 57 % of low-carbohydrate dieters were female, and the mean age was 48·67 (1·35) years. Individuals consuming LCD exceeded the recommendations for saturated fat, total lipid and sodium intake (both sexes). An insufficient intake was observed for fibre, Mg, potassium and several other vitamins (vitamins A, E, D in both sexes as well as vitamin C in men and folate in women). Neither men nor women met the recommendations for fibre intake. A comparable picture was found for the general population. The potentially insufficient intake of several essential nutrients in LCD warrants consideration and a careful assessment with regard to the current DGA.

Reduced dietary acid load in U.S. vegetarian adults: Results from the National Health and Nutrition Examination Survey.

Dietary acid load (DAL) is an important determinant of systemic pH and acid-base homeostasis. Diets abundant in acidogenic foods, such as meat and meat products, induce a low-grade metabolic acidosis state that has been associated with cardiovascular disease, type-2-diabetes, and an increased cancer risk. Fruits and vegetables have alkalizing properties and beneficially affect DAL. It has thus been suggested that a plant-based diet (restricting or excluding animal products) may be a powerful tool in reducing DAL; yet studies in that particular field are scarce. To explore these associations in greater detail, we examined DAL in self-identified vegetarians from the United States National Health and Nutrition Examination Survey (2007-2010). We compared dietary intake and two widely used markers of DAL (PRAL (potential renal acid load) and NEAP (net endogenous acid production; NEAPF and NEAPR)) among 8,398 nonvegetarians and 191 lacto-ovo-vegetarians with reliable dietary intake aged 18 years or older. Vegetarians had a more favorable body mass index and consumed fewer calories (1862.31 kcal/d) than nonvegetarians (2041.12 kcal/d). Vegetarians consumed fewer protein (34.17 g/1000 kcal) and phosphorus compared to nonvegetarians (39.50 g of protein/1000 kcal) but had a higher intake of magnesium and potassium. Nonvegetarians exhibited higher median DAL scores (PRAL: 11.90 mEq/d, NEAPF: 53.59 mEq/d, NEAPR: 55.67 mEq/d) than vegetarians (PRAL: -0.44 mEq/d, NEAPF: 39.60 mEq/d, NEAPR: 41.30 mEq/d). Vegetarians had more favorable DAL scores compared to nonvegetarians in this descriptive epidemiologic study. Future (interventional) trials are warranted to examine the varying acid load in different plant-based dietary patterns.

Nutrient Intake and Dietary Acid Load of Special Diets in the NHANES: A Descriptive Analysis (2009-2018).

Western diets are characterized by a high dietary acid load (DAL), which has been associated with adverse clinical outcomes, including type-2-diabetes and metabolic syndrome. Effective dietary strategies to lower DAL are urgently warranted. Plant-based diets (PBD), including vegetarian and vegan diets, are an effective measure to reduce DAL. Notably, not every individual wishes to adopt a PBD. Instead, many people rely on special diets promising comparable health benefits. The effects of those diets on DAL have rarely been investigated. Using data from the National Health and Nutrition Examination Surveys, we aimed to quantify DAL and nutrient intake in the most popular special diets in the United States, including weight-loss, low fat, low salt, low sugar, and diabetic diets. Our analysis included 3552 individuals on a special diet. The most popular diets were the weight-loss diet (n = 1886 individuals) and the diabetic diet (n = 728). Energy intake was below 2000 kcal/d for all diets; however, there were no statistically significant intergroup differences. DAL scores were positive for all special diets (>9 mEq/d), suggesting acidifying properties. Acid load scores of special diets did not differ significantly and were comparable to a standard Western diet. None of the examined diets was associated with alkaline properties.

Quantifying dietary acid load in U.S. cancer survivors: an exploratory study using NHANES data.

BACKGROUND: Diet is an important determinant of systemic pH and acid-base regulation. A frequent consumption of acid-inducing foods (including processed meats and cheese) combined with a low intake of base-inducing foods (such as fruits, legumes and vegetables) increases Dietary Acid Load (DAL), which has been associated with an increased risk for certain cancers. DAL also appears to be of paramount importance in cancer survivors, in whom it was associated with increased mortality and poor overall physical health. Literature on DAL in cancer survivors, however, is scarce and limited to a few studies. METHODS: Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES), we sought to quantify DAL in U.S. cancer survivors and contrasted the results to the general population. DAL was estimated using established formulas (Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP)). RESULTS: Our study comprised 19,413 participants, of which 1444 were self-reported cancer survivors. Almost 63% of cancer survivors were female (weighted proportion) with a mean age of 61.75 (0.51) years. DAL scores were consistently higher in cancer survivors (as compared to the general population) after adjustment for confounders in multivariate regression models. These differences, however, were not statistically significant (p = 0.506 for NEAPF, 0.768 for PRALR and 0.468 for NEAPR, respectively). Notably, DAL scores were positive throughout (> 0 mEq/d) in cancer survivors, suggesting an acidifying diet. Specific examples include mean PRALR scores > 11 mEq/d in cancer survivors aged 55 years and mean NEAPF scores > 50 mEq/d in cancer survivors aged 40-60 years). CONCLUSIONS: The acidifying diet in this sample of cancer survivors warrants caution and requires further investigation. Comparably high DAL scores have been associated with adverse health outcomes and an increased mortality in previous studies in breast cancer survivors. Thus, increased awareness as well as additional clinical trials in this field are urgently warranted.

Incidencia de hipocalcemia e hipoparatiroidismo en cirugías de cuello / Hypocalcaemia and hypoparathyroidism' incidence in neck surgeries

INTRODUCCIÓN: el hipoparatiroidismo es la alteración causada por hipofunción de las glándulas paratiroides y la causa más común es la posquirúrgica. OBJETIVO: conocer la incidencia de hipocalcemia dentro de las 72 horas del postoperatorio y de hipoparatiroidismo permanente de tiroidectomías en nueve años. SUJETOS Y MÉTODO: estudio observacional, descriptivo y retrospectivo de pacientes con tiroidectomías entre enero de 2011 y diciembre de 2019 en el Hospital de Clínicas. Se dividió la muestra por grupos etarios, se consideró hipocalcemia a valores ≤8,5 mg/dl e hipoparatiroidismo permanente cuando persistían por lo menos un año luego de cirugía. RESULTADOS: fueron 202 pacientes, 182 mujeres y 20 hombres, media de edad ± ES para mujeres 47.3±1.2 años y para hombres 55.1±3.4. El 61,5% presentó hipocalcemia en las primeras 72 horas del postoperatorio: 60,2% de mujeres y 71,4% de hombres (p=0.42). El 79% fueron hipocalcemias asintomáticas, 7,5% tuvo síntomas y 13,5% sin datos. El signo de Trousseau fue negativo 68% y positivo en 9%. Respecto a la patología hubo 107 resultados benignos, 94 malignos. CONCLUSIONES: el 90% fueron mujeres, 6 de cada 10 presentaron hipocalcemia en las primeras 72hs, en la gran mayoría fueron asintomáticas y tuvieron signo de Trousseau negativo. No hubo correlación entre hipocalcemia con edad, sexo, duración o tiempo de la cirugía, ni resultado de patología. La incidencia de hipoparatiroidismo transitorio fue 75,7% y permanente 7,3%. Cuando no hubo hipoparatiroidismo transitorio tampoco hubo hipoparatiroidismo permanente.

INTRODUCTION: hypoparathyroidism is the alteration caused by hypofunction of the parathyroid glands and the most common cause is post-surgery. OBJECTIVE: to know the incidence of hypocalcaemia within 72 hours of the postoperative period and of permanent hypoparathyroidism of thyroidectomies in nine years. SUBJECTS AND METHOD: observational, descriptive and retrospective study of patients with thyroidectomies between January 2011 and December 2019 at Clinical's Hospital. The sample was divided by age groups, hypocalcemia was considered at values ≤8.5 mg/dl and permanent hypoparathyroidism when they persisted for at least one year after surgery. RESULTS: there were 202 patients, 182 women and 20 men, mean age ± SE for women 47.3±1.2 years and for men 55.1±3.4. 61.5% presented hypocalcaemia in the first 72 hours after surgery: 60.2% of women and 71.4% of men (p=0.42). 79% were asymptomatic hypocalcemia, 7.5% had symptoms and 13.5% without data. Trousseau's sign was negative in 68% and positive in 9%. Regarding the pathology, there were 107 benign results, 94 malignant. CONCLUSIONS: 90% were women, 6 out of 10 presented hypocalcemia in the first 72 hours, the vast majority were asymptomatic and had a negative Trousseau sign. There was no correlation between hypocalcaemia with age, sex, duration or time of surgery, or pathology result. The incidence of transient hypoparathyroidism was 75.7% and permanent 7.3%. When there was no transient hypoparathyroidism, there was also no permanent hypoparathyroidism.

Dietary acid load and lung cancer risk: A case-control study in men.

BACKGROUND: Dysregulation of the endogenous acid-base balance can contribute to inflammation and cancer development if metabolic acidosis is sustained. The epidemiologic evidence on the association between diet-dependent acid load and cancer risk is scarce and inconsistent. We aim to explore the possible role of dietary acid load in lung cancer (LC) risk. METHODS: A case-control study was performed on 843 LC cases and 1466 controls by using a multi-topic questionnaire, including a food frequency questionnaire. Controls were matched to cases by age-frequency, urban/rural residence, and region. Food-derived nutrients were calculated from available databases. The dietary acid load was calculated using validated measures as potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. Odds ratios (ORs) were estimated by logistic regression. RESULTS: We found direct associations between dietary acid load and LC risk. The highest quartile of the NEAP score was significantly associated (OR=2.22, ptrend<0.001). The PRAL score displayed similar associations in simpler regression models, but there was no association when a more complex one was used (OR=0.99, ptrend =0.94). The NEAP score was associated with a significant risk increase in all cell types, except for small cell cancers, but the PRAL score did not show any association. CONCLUSIONS: The NEAP scores, directly associated with meat intake and inversely associated with plant-based foods intake, suggest that a high acid load dietary style may increase LC risk. Studies focused on food groups, and nutritional patterns are in line with our findings. Although the data shown here represent the first one to be published on this issue, further studies are needed to confirm these findings.

Tumor neuroendocrino y terapia con lutecio / Neuroendocrine tumor and lutetium therapy / Tumor neuroendócrino e terapia com lutecio

Resumen: Introducción: los tumores neuroendocrinos gastroenteropancreáticos (GEP-NET) son un grupo diversos de tumores de origen en las células neuroendocrinas, la mayoría son esporádicos. Se clasifican según origen, secreción hormonal y diferenciación celular. El tratamiento con péptidos radiomarcados o Peptide Receptor Radionuclide Therapy (PRRT) con lutecio 177-DOTATATE fue aprobado por la FDA en el 2018, ya que ha mostrado buenos resultados en tumores avanzados comparado con otras terapias. Presentamos un caso de una paciente con tumor neuroendocrino pancreático con secundarismo hepático tratada con este fármaco. Caso clínico: paciente de sexo femenino de 65 años, portadora de un tumor neuroendocrino pancreático con secundarismo hepático diagnosticado por biopsia y con expresión de receptores de somatostatina. Por su extensión lesional se indica tratamiento médico con análogos de somatostatina que son mal tolerados, tras lo cual se plantea quimioterapia (QT), con progresión tumoral bajo tratamiento. Dada la mala evolución se inicia tratamiento con PRRT como es lutecio 177-DOTATATE. Se observó que los ciclos con lutecio 177-DOTATATE lograron una disminución mínima del tamaño y de la captación tumoral a nivel pancreático, las metástasis hepáticas no presentaron cambios, y la paciente persistió clínicamente estable. Conclusión: El tratamiento con lutecio 177-DOTATATE en una paciente con un tumor neuroendocrino no funcionante con metástasis, irresecable quirúrgicamente, produjo una respuesta aceptable para un tratamiento paliativo, ya que no se produjo progresión tumoral. La paciente persiste clínicamente estable, asintomática, con un seguimiento a 8 años. El tratamiento con lutecio 177-DOTATATE es una opción efectiva con efectos adversos limitados en tumores GEP-NET irresecables o con metástasis.

Summary: Introduction: gastroenteropancreatic neuroendocrine neoplasms (GEP-NET) are a group of several tumors originated in neuroendocrine cells, most of which are sporadic. These tumors are classified according to hormone secretion and cell differentiation. Treatment with radiomarked peptides or Peptide Receptor Radio- nuclide Therapy (PRRT) with lutetium 177-DOTATATE was approved by the FDA in 2018, since it has evidenced good results in advanced tumors compared to other therapies. The study presents the case of a patient with a pancreatic neuroendocrine tumor with secondary hepa tic disease who was treated with this drug. Clinical case: 65-year-old female patient carrier of a pancreatic neuroendocrine tumor with secondary hepatic disease who was diagnosed with a biopsy and presented somatostatin receptor (SSTR) expression. Given the extension of the lesion, medical treatment is indicated with somatostatin analogues that are poorly tolerated. Consequently, chemotherapy is indicated, with low performance tumor progression. Given the poor outcome, PRRT treatment as lutetium 177-DOTATATE is initiated. Cycles with lutetium 177-DOTATATE were observed to cause a minimum reduction in size and tumor uptake in the liver. Liver metastases evidenced no change and the patient remained clinically stable. Conclusion: lutetium 177-DOTATATE therapy in a patient with a metastatic nonfunctioning neuroendocrine tumor, that could not be surgically resected produced an acceptable response for palliative treatment, since the tumor failed to progress. The patient continues to be clinically stable, asymptomatic, after 8 years of follow-up. Lutetium 177-DOTATATE therapy constitutes an effective option with limited side effects in unresectable GEP-NET tumors, or in the presence of metas tases.

Resumo: Introdução: os tumores neuroendócrinos gastroenteropancreáticos (GEP-NET) são um grupo diverso de tumores de origem em células neuroendócrinas, a maioria das quais esporádicos. São classificados de acordo com a origem, secreção hormonal e diferenciação celular. O tratamento com peptídeos radiomarcados ou terapia com radionuclídeos com receptor de peptídeos (PRRT) com 177 Lutecio-Dotatate foi aprovado pela FDA em 2018, pois mostrou bons resultados em tumores avançados em comparação com outras terapias. Apresentamos o caso de um paciente com tumor neuroendócrino pancreático com secundarismo hepático tratado com esse medicamento. Caso clínico: paciente do sexo feminino, 65 anos, portadora de tumor neuroendócrino pancreático com doença hepática secundária diagnosticada por biópsia e com expressão de receptores de somatostatina. Devido à extensão da lesão, o tratamento clínico é indicado com análogos da somatostatina que são pouco tolerados, após o que se considera a quimioterapia (TC), com progressão do tumor em tratamento. Dada a má evolução, foi iniciado tratamento com PRRT, como o 177 Lutecio-Dotatate. Observou-se que os ciclos com 177 Lutecio-Dotatate obtiveram diminuição mínima no tamanho e captação do tumor em nível pancreático, as metástases hepáticas não apresentaram alterações e o paciente manteve-se clinicamente estável. Conclusão: o tratamento com 177Lutecio-Dotatate em um paciente com tumor neuroendócrino não funcionante com metástases, não ressecável cirurgicamente, produziu uma resposta aceitável para o tratamento paliativo, uma vez que não ocorreu progressão do tumor. O paciente permanece clinicamente estável, assintomático, com seguimento de 8 anos. O tratamento com 177Lu-Dotatate é uma opção eficaz com efeitos adversos limitados em tumores GEP-NET não ressecáveis ou metastáticos.

Vitamina D, magnesio y parámetros seleccionados de laboratorio en hombres uruguayos / Vitamin D, magnesium, and selected laboratory parameters in Uruguayan men / Vitamina D, magnésio e parâmetros selecionados de laboratório em homens uruguaios

Resumen: Introducción: los niveles de vitamina D (VD) plasmática se han investigado sobre todo en mujeres, no obstante también son relevantes en hombres, y no sólo en relación al estado de salud ósea. Un estudio previo realizado hace dos décadas en una pequeña muestra de hombres y mujeres uruguayos reveló serias deficiencias de VD. Por otra parte, el magnesio posee importantes efectos no solo relacionados a los niveles de VD, también afecta el hueso directa e indirectamente. Objetivos: analizar posibles interrelaciones entre valores de VD plasmática, testosterona plasmática, densitometría ósea, y otros parámetros en una población de jóvenes varones uruguayos. Métodos: durante julio-agosto de 2015, cien hombres uruguayos afiliados al sistema prepago de salud fueron invitados a participar en nuestra Unidad de Metabolismo Fosfocálcico, para ser estudiados con técnicas de antropometría, laboratorio y densitométricas. Los datos colectados fueron analizados estadísticamente. Resultados: los hombres estudiados mostraron bajos niveles de VD plasmática (96% insuficientes-deficientes), que no mostraron correlaciones significativas con ninguno de los parámetros estudiados. El magnesio plasmático se correlacionó significativa e inversamente con los z-scores densitométricos, lo que fue más intenso en hombres con sobrepeso y con VD ≥15 ng/ml. Conclusiones: a pesar de lo pequeño de la muestra, los resultados confirman la presencia de bajos niveles de VD en hombres aparentemente saludables. Los hallazgos dan razones para pensar en posibles recomendaciones para mejorar el espectro preventivo enfocado en osteoporosis y cáncer colorrectal.

Summary: Background: serum vitamin D (VD) levels have been mainly studied in women, but they are relevant also among men, not only regarding bone health status. A previous small-size study performed two decades ago in Uruguayan women and men revealed serious deficiencies of VD. On the other hand, magnesium has important effects not only related to vitamin D levels but directly and indirectly affect bone. Purpose: to analyze possible interrelationships among values of serum VD, magnesium, testosterone, bone densitometry and other parameters in young Uruguayan male population. Methods: during July-August 2015, one hundred Uruguayan men affiliated to the prepaid healthcare system, invited to participate by our Unit of Bone Metabolism, were studied with anthropometry, laboratory and, densitometry techniques. Collected data were statistically analyzed. Results: the studied men showed low serum VD levels (96% insufficient-deficient), which did not show significant correlations with any of the studied parameters. Serum magnesium was significantly and inversely correlated with densitometric z-scores, even stronger among men with overweight and with VD≥15 ng/ml. Conclusions: despite the sample size, results confirm the presence of low serum VD levels in apparently healthy men. Findings give reasons to think about possible recommendations to improve the preventive scope regarding osteoporosis and colorectal cancer.

Resumo: Introdução: os níveis plasmáticos de vitamina D (DV) têm sido investigados principalmente em mulheres, porém também são relevantes em homens, e não apenas em relação à saúde óssea. Um estudo anterior realizado há duas décadas em uma pequena amostra de homens e mulheres uruguaios revelou graves deficiências de VD. Por outro lado, o magnésio tem efeitos importantes não apenas relacionados aos níveis de VD, mas também afeta o osso direta e indiretamente. Objetivos: analisar as possíveis relações entre os valores plasmáticos de VD, testosterona plasmática, densitometria óssea e outros parâmetros em uma população de jovens uruguaios. Métodos: durante o período de julho a agosto de 2015, cem uruguaios filiados ao sistema de saúde pré-pago foram convidados a participar de nossa Unidade de Metabolismo Fosfocálcico, para serem estudados com técnicas antropométricas, laboratoriais e densitométricas. Os dados coletados foram analisados estatisticamente. Resultados: os homens estudados apresentaram baixos níveis de VD plasmático (96% insuficiente-deficiente), que não apresentou correlações significativas com nenhum dos parâmetros estudados. O magnésio plasmático foi significativa e inversamente correlacionado com os escores z densitométricos, que foi mais intenso em homens com sobrepeso e VR ≥15 ng / ml. Conclusões: porém, na pequena amostra, os resultados confirmam a presença de baixos níveis de VD em homens aparentemente saudáveis. Estes achados propõem pensar sobre possíveis recomendações para melhorar o espectro preventivo com foco na osteoporose e no câncer colorretal.