la proteína dietética aumenta el calcio urinario
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8/17/2019 La proteína dietética aumenta el calcio urinario
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Issues and O pinions in nutrition
T he v iews e xp re sse d in th is se ctio n a re th ose o f t he a uth ors a nd n ot n ec essa rily th ose o f t he E dito r, th e E dito ria l B oa rd o f T he
J ou rn al , o r th e Americ an In stitu te o fNu tritio n. R e ad ers a re in vite d to re sp on d to th es e e ss ay s b y L et te rs to th e Edit or, s o th at T he
Jo urn al c an se rv e a s a fo rum fo r th e d isc ussio n o f t he se to pic s.
Dietary Protein Increases urinary Calcium
JANE E. K ER STE TTER A riD L INDSA Y H . A LLEN
School o f A ll ied Heal th Profes sions and Department o f Nutr it ional Sciences The Universi ty o f
Connecticut Storrs CT 06269-4017
An increase in dietary protein has been shown by
several investigators to increase urinary losses of cal
cium , resulting in negative calcium balance (1-7). This
has been review ed in detail by Yuen et al. (8). However,
Spencer and colleagues have observed that a high pro
tein diet has little effect on urinary calcium excretion,
and they attributed this to the phosphorus content of
the diet (9-11). Recently, they concluded that com
m only used complex proteins, which have a high phos
phorus content, do not cause urinary calcium loss in
adult hum ans (12). B ecause excess urinary calcium and
negative calcium balance are thought to result in an
increased risk for osteoporosis and nephrolithiasis, it is
im portant to address this discrepancy of opinion. This
paper w ill summarize the available data in adults regard
ing the effects of dietary protein, calcium , and phospho
rus on calcium balance. From the available literature,
we conclude that at calcium and phosphorus intakes
500
400
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10 0
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o
o
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100 200 300 400
Die taryrotei n0/d
5 6
FIGUR Rela tionship b etw een p ro te in in ta ke and u ri
nary calcium . Each point represents the m ean of a group of
subjects from one o f t he 16 stu dies cited in the text. T he data
re pre se nt 1 54 adu lt ma le a nd female s ub je cts .
typically consum ed by the American adult, increases in
dietary protein do increase urinary calcium , resulting in
a shift of calcium balance in a negative direction.
F igu re summarizes sep arate h um an stu dies an d
illustrates the relationship betw een dietary protein in
take and urinary calcium excretion in 154 adult subjects(1-7, 9, 10, 13-19). The protein was supplied as wheat
gluten, beef, m ilk, egg, soy, lactalbum in or casein in the
form of purified proteins or m ixed foods. Study periods
lasted from 12 to 60 d. A t protein intakes below 200 g/d
the relationship between dietary protein and urinary
calcium is liner (r = 0.67) such that for each 50-g incre
ment of dietary protein an extra 60 mg of urinary cal
cium is lost.
T he relationsh ip betw een dieta ry pro tein a nd u rinary
calcium has also been well documented in rat models
(20-24) and in dairy cows (25). Hypercalciuria from
excessive dietary protein increases the risk of renal
calcium oxalate stones (26-31).
The renal response of humans to dietary protein is
rapid; that is, hypercalciuria is observed within 2 to 4 h
after protein ingestion (32). In hum ans, the calciuria
does not dim inish in long-term experimental periods
lasting from 45 to 60 d (1, 4, 7). The mechanism by
w hich dietary protein influences urinary calcium prob
ably involves several factors. D ietary protein clearly
increases the glomerular filtration rate and thus the
filtered calcium load (4-7, 14, 15, 17, 33). In addition,
the renal fractional reabsorption of calcium is de pressed
by a higher protein diet compared to one with a lower
protein content (4, 5, 7 , 15, 17, 32). The change in
reabsorption has been attributed to the sulfur and acid
load from th e protein (5,17,34,3 5) o r the hyperinsu line-
m ic effect of protein (36).
The protein-induced increase in urinary calcium re
sults in negative calcium balance. Figure 2 illustrates
calcium balance data from 13 separate hum an studies
in which dietary protein was m anipulated in 104 adults
0 02 2-3 166 /9 0 3 .0 0 ©1 990 Ame rica n In stitu te o f N utritio n. R ece iv ed 1 3 J an uary 1 98 9. /. à ‘u tà .120:134-136.
13 4
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DIET A RY PR OT EIN IN CR EA S ES UR IN A RY CA L CIUM
13 5
100-50-X e
o —50j-100-o °-150--20 0--O ift
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0.4 0.6 0 .8 1
Dieta r y C a a
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F IGURE Rel ati on sh ip of pr otei n and cal ci um i ntak es to
calcium retention. E ach point represents the m ean of a group
of subjects f rom the 13 studies cited in the tex t. T he data
re presen t 1 04 ad ult m ale an d f em ale su bjects. Pro tein in tak es
are as follow s: 25-74 g/d (open circles), 75-124 g/d (stars),
12 5-1 74 g /d (o pen b ox es) and >1 75 g /d (o pen trian gles).
(1-7, 10, 14-16, 19). A t low protein intak es (25-74 g/d),
calcium balance is close to equilibrium at calcium in
tak es betw een 500 and 1400 m g/d. For healthy indiv id
uals w eighing less than 91/k g, the R DA for protein is
included in this low protein range. A t the ty pical
calcium intak e for adults in W estern populations (400-
1300 m g/d) (37), protein intak es higher than 75 g/d tend
to result in negativ e calcium balance. Figure 2, how ev er,
does not address the issue of phosphorus intak e.
F igu r e 3 illu st r at es ca lciu m b a la n ce d a ta a s a fu n ct ion
of phosphorus intak e from the sam e 13 studies repre
sented in Fig ure 2. A t the ty pical am o unts of phosph orus
consum ed by adults (0.8-1.5 g/d) (37), calcium balance
does appear to be largely dependent on protein intak e.
W e k now that phosphorus clearly decreases urinary
calcium losses (6 , 18) either b y increasing parathy roid
horm one sy nthesis (38) or m ore directly by af fecting
calcium tubular reabsorption (39). S pencer and col
leagues hav e conclu ded that increasing dietary protein
from com monly consum ed com plex proteins also in
creases dietary phosphorus, w hich negates the urinary
calcium losses (9-12). T hese conclusions w ere based on
studies in w hich the addition of red m eat or dairy
products failed to af fect urinary calcium . A lthough in
creased dietary phosphorus can clearly blunt the
hy percalciuretic response to protein and im prov e cal
cium balance, Figure 3 rev eals that the ability to restore
calcium balance to equilibrium is not clear.
For ex am ple, Hegsted et al. (6) m easured calcium
balance in adults at tw o lev els of protein (50 and 150 g)
and phosphorus (1010 and 2525 m g) intak e. A t both
lev els of protein intak e, phosphorus reduced urinary
calcium losses by approx im ately 40% and shif ted cal
cium balance in the positiv e direction. Y e t, calcium
balance w as still negativ e (-25 m g/d) w ith the high
100-50-ç0
0I
g60-¡-100-aU
-150--200-17 5 g /d (op en trian gles).
protein, high pho sphorus diet and urinary hy drox yprol-
ine w as higher, suggesting an increase in bone rà © sorp
tion (6, 19). In addition, there are other ex am ples in
w hich a protein and phosphorus load giv en as anim al
f lesh w ere associated w ith sm all but signif icant in
creases in urinary calcium losses (26, 28, 40).
In sum m ary , strong ev idence link s the intak e of com
m only consum ed dietary proteins to urinary calcium
and calcium balance at ty pical lev els of dietary calcium
and phosphorus. W h en there is an abundance of dietary
calcium and p hosphorus (as w ith a lib eral intak e of dairy
pro ducts), the d ependence of calciu m balance on dietary
pro tein is less pron ounced (19). A t protein intak es abov e
the R DA , m ore calcium is lost in the urine, so calcium
balances tend to be n egativ e.
LITE R A T U R E C ITE D
1. JO HN SO N,N . E., A L CA N T A R A ,. N . & L IN K SW I LER ,.M . (1970)
E ff ect of lev el of protein intak e on urinary and f ecal calcium and
calc iu m reten tio n in y ou ng ad ult m ale s. /. N u tr. 1 00: 1 425 -1 43 0.
2. W A L K ER ,R . M . & L IN K SW T LER ,. M . (1972) C alcium retention
in the adult hum an m ale as af fected by protein intak e. /. N utr.
102: 1297-1302.
3. A N A N D, C. R . & L IN KS W IL ER ,. M . (1974) Ef fect of protein
intak e on calcium balance of y oung m en giv en 500 m g calcium
d ai ly . /. N u tr. 1 04 : 6 95 -7 00 .
4. A L L EN ,L . H ., O DD OY E ,E . A . & M A R G EN ,S . (1979) Protein-in
d uce d h yp ercalc iu ria: a lo nge r term stu dy . A m . Â ¡.C lin . N u tr. 32 :
741-749.
5 . S C HU ET T E,. A . , Z E M EL ,M . B . & L IN K S W I L ER ,. M . (1980) S tud
ies o n the m e ch an ism o f pro tein -in duc ed h yp erc alciu ria in o ld er
m en and w om en. /. N utr. 110: 305^ 15.
6. H EG ST ED ,M ., S C HU ET T E, . A ., Z EM E L ,M . B . & L IN K S W IL ER ,. M .
(1981) U rinary calcium and calcium balance in y oung m en as
af fected by lev el of protein and phosphorus intak e. /. N utr. 111 :
553-562.
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KER ST ET TE R AND A LL EN
7. H EG ST ED ,M . L IN KSWIL ER ,. M . (1981) L ong-term effects of
level of protein intake on calcium metabolism in young adult
w om en. /. N utr. Ill: 244-251.
8 . YUEN,D . E ., DRAPER,H .H . .TR ILOK,G . (1984) E ffect of dietary
protein on calcium metabolism in man. Nutr. Abs. Rev. 54:
447-459.
9. S PENC ER ,H ., KRAMER ,L , O sis, D . MORRIS ,C. (1978) Effect of
a high protein (m eat) intake on calcium m etabolism in m an. Am.
¡.lin. N utr. 31: 2167-2180.
1 0. S PENCER ,H ., KRAMER ,L ., DEBARTOLO,M ., MORRIS,C . . O sis, D .
(1983) F urther studies of the effect of a high protein diet as m eat
on calcium m etabolism . Am. J. C lin. N utr. 37: 924-929.
1 1. S PENCER ,H ., D ERLER, . O sis, D . (19 88 ) C alciu m b ioa vaila bil-
ity studies in m an. F AS EB . f . 2: 429 (abs. 774).
1 2. S PENCER ,H ., KRAMER ,L . O sis, D . (1988) D o protein and phos
ph oru s ca use ca lc iu m lo ss? /. N utr. 1 18 : 6 57-6 60 .
1 3. MARGEN ,S ., CHU, J .-Y., KAUFMANN ,N . A . G ALL OWAY ,. H .
1 97 4) S tu die s in c alciu m m eta bolism . I. T he c alciu retic e ffec t o f
d ietary pro tein . Am. f. C lin. N utr. 2 7: 5 84-5 89 .
1 4. CHU, J .-Y.,MARGEN ,S . COSTA ,F .M . ( 19 75 ) S tu di es i n c alc ium
met ab ol ism. I I. E ff ec ts o f low c al ci um a nd v ar ia ble p ro te in in ta ke
o n h um an c alciu m m etab olism . Am . J. C lin . N utr. 28 :1 02 8-1 035 .
15. K IM , Y . L IN KSW ILE R,. M . (1979) E ffect of level of protein
intake on calcium metabolism and on parathyroid and renal
function in the adult hum an m ale. /. N utr. 109: 1399-1404.
16. L UTZ , J. LIN KSW ILER ,. M . (1981) C alcium m etabolism in
postm enopausal and osteoporotic w om en consum ing tw o levels
o f d ietary p ro te in . Am . ]. C lin. N utr. 3 4: 2 178 -2 18 6.
1 7. ZEMEL ,M . B ., SCHUETTE , . A ., HEGSTED ,M. LINKSWILER ,. M.
(1981) R ole of the sulfur-containing am ino acids in protein-in
duced hypercalciuria in m en. /. N utr. Ill: 545-552.
1 8. SCHUETTE , . A ., HEGSTED ,M. , ZEMEL,M. B . L INKSWILER ,. M.
(1981) R enal acid, urinary cyclic AMP , and hydroxyproline ex
cretion as affected by level of protein, sulfur am ino acid, and
p ho sp ho ru s in tak e. /. N utr. Ill: 2 10 6-2 11 6.
19. S CHUE TT E, . A . L IN KSWIL ER ,. M . (1982) E ffects on C a and P
metabolism in humans by adding meat, meat plus milk, or
purified proteins plus C a and P to a low protein diet. /. N utr. 112:
338-349.
2 0. BELL ,R . R ., ENGELMANN , . T ., S IE ,T .- L. DRAPER ,H. H. (1975)
E ffect of a high protein intake on calcium m etabolism in the rat.
/ . N ut r. 1 05 : 4 75 -4 83 .
21 . A LLEN ,L . H . HALL ,T . E . (1 97 8) C alciu m m etab olism , in te sti
nal calcium -binding protein, and bone grow th of rats fed high
p ro te in d iets. /. N utr. 1 08 : 9 67 -9 72 .
22. W HIT IN G,S. J. D RA PE R,H . H . (1981) E ffect of chronic high
protein feeding on bone com position in the adult rat. /. N utr. 111 :
178-183.
23. CALV O,M . S., BELL,R. R. FORBES,R. M . (1982) Effect of
p ro te in -i nd uc ed c alc iu ri a o n c al ci um met ab oli sm a nd b on e s ta tu s
in ad ult rats. /. N utr. 1 12 : 1 40 1-14 13 .
24 . YUEN,D . E . DRAPER,H .H . (1983) L ong-term effects of excess
protein and phosphorus on bone homeostasis in adult mice. /.
Nu t r. 113:1374-1380 .
2 5. V IS EK ,W . f., MONROE ,R . A ., SWANSON,E. W . COM AR,C. L
(1953) C alcium m etabolism in dairy cow s as studied w ith 45C a.
/ . D ai ry S ci . 3 6: 3 73 ^3 84 .
2 6. ROBERTSON ,W . G ., H EYBURN ,P . J ., PEACOCK ,M ., H AN ES ,F . A .
SWAMINATHAN,. (1979) The effect of high anim al protein in
take on the risk of calcium stone-form ation in the urinary tract.
C lin. Sci. 57:285-288.
2 7. ROBERTSON , . G . P EACOCK ,M . (1982) The pattern of urinary
stone disease in Leeds and in the U nited K ingdom in relation to
a nim al p rotein in tak e du ring the p erio d 1 96 0-1 98 0. U ro l. In t. 37 :
394-399.
2 8. BROCK IS ,.G . , LEVITT ,A . J . .CRUTHERS ,.M . ( 19 82 ) The ef fe ct s
of vegetable and anim al protein diets on calcium, urate and
o xa la te e xc re ti on . B r. ] . U ro l. 5 4: 5 90 -5 93 .
29. IG UCH, M ., K ATAOKA ,K ., KOHRI,K. , YACHIKU ,S. KURITA,T.
( 19 84) N utritio nal risk fa cto rs in c alciu m sto ne d ise ase in Ja pa n.
U rol.Int. 39:32^5.
3 0. BRESLAU , . A ., BRINKLEY ,., H IL L, K. D . PAK ,C . Y . C . (1 98 8)
R elationship of anim al protein-rich diet to kidney stone form a
tion and calcium m etabolism . ]. C lin. Endocrinol. M etab. 66:
140-146.
31. G OLD FA RB ,. (1988) D ietary factors in the pathogenesis and
p ro ph yl ax is o f c alc ium n ep hr ol it hia si s. K id ne y I nt . 3 4: 5 44 -5 55 .
3 2. ALLEN ,L . H ., BARTLETT ,. S . BLOCK ,G . D . (1979) R eduction
of renal calcium reabsorption in m an by consum ption of dietary
p ro te in . / . N ut r. 1 09 : 1 34 5- 13 50 .
33. H OST ETT ER ,. H . (1986) H um an renal response to a m eat m eal.
Am . J.Physiol, 250: F613-F618.
34. WHITING ,S . J . .DRAPER,H. H. (1980) The role of sulfate in the
ca lc iu ria of h igh pro tein d ie ts in a du lt ra ts. /. N utr. 1 10 : 2 12-2 22 .
3 5. T SCHOPE ,W . R ITZ,E . (19 85 ) S ulfur-c on tain in g am in o a cid s a re
a m ajor determ inant of urinary calcium . M iner. E lectrolyte
M etab. 11:137-139.
36. A LL EN ,L .H ., BLOCK ,G .D ., WOOD ,R .J . .BRYCE ,G .F . ( 19 81 ) The
ro le of ins ulin a nd p arathy ro id h orm on e in th e pro tein -in duc ed
ca lc iu ria o f m an . N utr. R es. 1 : 3-1 1.
3 7. A viO Li,L .V . (1 988 ) C alc iu m an d p ho sp ho ru s. In : Mode rn N utri
tion in H ealth and D isease Shils, M .E. .Young, V.R .,eds.|,pp
1 42 -1 58 , L ea F eb ig er , P hil ad el ph ia , PA .
3 8. RE ISS,E ., CANTERBURY ,. M . K APL AN ,L. (1970) The role of
p ho sph ate in the s ecre tio n o f para th yro id h orm on e in m an . /. C lin .
Invest. 49:2146-2149.
3 9. LAU,K ., GOLDFARB ,., GOLDBERG ,M . AGUS,Z. S. (1982) Ef
fe cts o f ph osp hate admin istra tio n o n tu bu la r ca lc iu m tran spo rt.
/. L ab . C lin. M ed . 9 9: 3 17 ^2 4.
4 0. CUMMINGS,. H ., H ILL ,M . J ., J IVRAI ,T ., HOUSTON,H ., BRANCH,W
J. J ENKIN S, . J.A . (1 97 9) T he effec t o f m ea t p ro tein an d die ta ry
fiber on colonie function and m etabolism . I. C hanges in bow el
habit, bile acid excretion, and calcium absorption. Am. J. C lin.
Nutr. 32: 2086-2093.
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