Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-25T03:52:29.977Z Has data issue: false hasContentIssue false
  • English
  • Français

Intake of fruit and vegetables: implications for bone health

Published online by Cambridge University Press:  07 March 2007

Susan A. New
Susan A. New*
Affiliation:
Centre for Nutrition & Food Safety, School of Biomedical & Molecular Sciences, University of Surrey, Guildford, GU2 7XH, Surrey, UK
*
Corresponding author: Dr Susan New,fax +44 1483 576978, S.new@surrey.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

These famous words by Mencken in the early 20th century about the meaning of life and death, may also apply to the struggle of the healthy skeleton against the deleterious effects of retained acid!’ ( Kraut & Coburn, 1994). The health-related benefit of a high consumption of fruit and vegetables and the influence of this food group on a variety of diseases has been gaining increasing prominence in the literature over a number of years. Of considerable interest to the osteoporosis field is the role that bone plays in acid–base balance. Natural, pathological and experimental states of acid loading and acidosis have been associated with hypercalciuria and negative Ca balance, and more recently the detrimental effects of ‘acid’ from the diet on bone mineral have been demonstrated. Suprisingly, consideration of the skeleton as a source of ‘buffer’ contributing to both the preservation of the body's pH and defence of the system against acid–base disorders has been ongoing for over three decades. However, it is only more recently that the possibility of a positive link between a high consumption of fruit and vegetables and indices of bone health has been more fully explored. A number of population-based studies published in the last decade have demonstrated a beneficial effect of fruit and vegetable and K intake on axial and peripheral bone mass and bone metabolism in men and women across the age-ranges. Further support for a positive link between fruit and vegetable intake and bone health can be found in the results of the Dietary Approaches to Stopping Hypertension (DASH) and DASH-Sodium intervention trials. There is now an urgent requirement for the implementation of: (1) fruit and vegetable and alkali administration–bone health intervention trials, including fracture risk as an end point; (2) reanalysis of existing dietary–bone mass and metabolism datasets to look specifically at the impact of dietary ‘acidity’ on the skeleton.

Keywords

OsteoporosisAcid–base balanceFruit and vegetablesBone healthAlkali-forming foods
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 4 , November 2003 , pp. 889 - 899
Copyright
Copyright © The Nutrition Society 2003

References

Albright, F, Reifenstein, EC Jr (1948) The Parathyroid Glands and Metabolic Bone Disease, pp. 241–247. Baltimore, MD: Williams and Wilkins.Google Scholar
Appel, LJ, Moore, TJ, Obarzanek, E, Vallmer, WM, Svetkey, LP, Sacks, FM, Bray, GA, Vogt, TM & Cutler, JA (1997) A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine 336, 1117–1124.Google Scholar
Arnett, TR, Boyde, A, Jones, SL & Taylor, ML (1994) Effects of medium acidification by alteration of carbon dioxide or bicarbonate concentrations on the resorptive activity of rat osteoclasts. Journal of Bone and Mineral Research 9, 375–379.CrossRefGoogle ScholarPubMed
Arnett, TR & Dempster, DW (1986) Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 119, 119–124.CrossRefGoogle Scholar
Arnett, TR & Dempster, DW (1990) Perspectives: protons andosteoclasts. Journal of Bone and Mineral Research 5, 1099–1103.CrossRefGoogle Scholar
Arnett, TR & Spowage, M (1996) Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 18, 277–279.CrossRefGoogle ScholarPubMed
Barzel, US (1969) The effect of excessive acid feeding on bone. Calcified Tissue Research 4, 94–100.CrossRefGoogle ScholarPubMed
Barzel, US (1970) The role of bone in acid-base metabolism. In Osteoporosis, pp. 199–206. New York: Grune & Stration.Google ScholarPubMed
Barzel, US (1997) Dietary patterns and blood pressure (letter). New England Journal of Medicine 337 637 Google Scholar
Barzel, US & Jowsey, J (1969) The effects of chronic acid and alkali administration on bone turnover in adult rats. Clinical Science 36, 517–524.Google Scholar
Barzel, US & Massey, LK (1998) Excess dietary protein can adversely affect bone. Journal of Nutrition 128, 1051–1053.CrossRefGoogle ScholarPubMed
Bernstein, DS, Wachman, A & Hattner, RS (1970) Acid-base balance in metabolic bone disease. In Osteoporosis, 207–216 [Barzel, US, editors]. New York: Grune & Stratton.Google Scholar
Buclin, T, Cosma, M, Appenzeller, M, Jacquet, AF, Decosterd, La, Biollaz, J & Burckhardt, P (2001) Diet acids and alkalis influence Calcium Retention In Bone. Osteoporosis International 12, 493–499.CrossRefGoogle ScholarPubMed
Burckhardt, P (2003) In Nutritional Aspects of Bone Health, pp. 313–321 [New, SA, Bonjour, J-P, editors]. Cambridge: Royal Society of Chemistry (in The Press).Google Scholar
Bushinsky, Da (1996) Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. American Journal of Physiology 271, F216–F222.Google ScholarPubMed
Bushinsky, Da (1997) Decreased potassium stimulates bone resorption. American Journal of Physiology 272, F774–F780.Google ScholarPubMed
Bushinsky Da, , Gavrilov, K, Chabala, JM & Levi-Setti, R (1997) Metabolic acidosis decreases potassium content of bone. Journal of the American Society of Nephrology 7, 1787.Google Scholar
Bushinsky, DA, Kreiger, NS, Geisser, DI, Grossman, EB & Coe, FL (1983) Effects of bone calcium and proton fluxes in vitro. American Journal of Physiology 245, F204–F209.Google ScholarPubMed
Bushinsky, Da, Lam, BC, Nespeca, R, Sessler, NE & Grynpas, MD (1993) Decreased bone carbonate content in response to metabolic, but not respiratory, acidosis. American Journal of Physiology 265, F530–F536.Google Scholar
Bushinsky, Da & Sessler, Ne (1992) Critical role of bicarbonate in calcium release from bone. American Journal of Physiology 263, F510–F515.Google ScholarPubMed
Bushinsky, Da, Sessler, Ne, Glena, RE & Featherstone, JDB (1994) Proton-induced physicochemical calcium release from ceramic apatite disks. Journal of Bone and Mineral Research 9, 213–220.CrossRefGoogle ScholarPubMed
Chen, Y, Ho, SC, Lee, R, Lam, S & Woo, J (2001) Fruit intake is associated with better bone mass among Hong Kong Chinese early postmenopausal women. Journal of Bone and Mineral Research 16, Suppl. 1, S386.Google Scholar
Dawson-Hughes, B & Harris, SS (2002) Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. American Journal of Clinical Nutrition 75, 773–779.CrossRefGoogle ScholarPubMed
Department Health (1998) Nutrition and Bone Health: With Particular Reference to Calcium and Vitamin D. Report on Health and Social Subjects no. 49 London: H.M. Stationery Office.Google Scholar
Eaton, BS & Konner, M (1985) Paleolithic nutrition. A consideration of its nature and current implications. New England Journal of Medicine 312, 283–290.CrossRefGoogle ScholarPubMed
Eaton-Evans, J, McIlrath, EM, Jackson, WE, Bradley, P & Strain, JJ (1993) Dietary factors and vertebral bone density in perimenopausal women from a general medical practice in Northern Ireland. Proceedings of the Nutrition Society 52, 44A.Google Scholar
Fox, D (2001) Hard cheese. New Scientist 15, December issue 42–45.Google Scholar
Frassetto, La, Morris, RC Jr & Sebastian, A (1996) Effect of age on blood acid-base composition in adult humans: role of age-related renal functional decline. American Journal of Physiology 271, F1114–F1122.Google Scholar
Frassetto, La & Sebastian, A (1996) Age and systemic acid-base equilibrium: analysis of published data. Journal of Gerontology 51A, B91–B99.Google Scholar
Frassetto, L, Todd, K, Morris, RC & Sebastian, A (1998) Estimation of net endogenous noncarbonic acid production in humans from dietary protein and potassium contents. American Journal of Clinical Nutrition 68, 576–583.Google Scholar
Gastineau, CF, Power, MH & Rosevear, JW (1960) Metabolic studies of a patient with osteoporosis and diabetes mellitus: effects of testosterone enanthate and strontium lactate. Proceedings of the Mayo Clinic 35, 105–111.Google Scholar
Goto, K (1918) Mineral metabolism in experimental acidosis. Journal of Biological Chemistry 36, 355–376.Google Scholar
Green, J & Kleeman, R (1991) Role of bone in regulation of systematic acid-base balance (editorial review). Kidney International 39, 9–26.CrossRefGoogle Scholar
Gregory, J, Foster, K, Tyler, H & Wiseman, M (1990) The Dietary and Nutritional Survey of British Adults. London: H.M. Stationery Office.Google Scholar
Hammond, RH & Storey, E (1970) Measurement of growth and resorption of bone in rats fed meat diet. Calcified Tissue Research 4, 291.CrossRefGoogle ScholarPubMed
Heaney, RP (1998) Excess dietary protein may not adversely affect bone. Journal of Nutrition 128, 1054–1057.CrossRefGoogle Scholar
Heaney, RP (2002) Protein and calcium: antagonists or synergists. American Journal of Clinical Nutrition 75, 609.Google Scholar
Irving, L & Chute, AL (1933) The participation of the carbonates of bone in the neutralisation of ingested acid. Journal of Cellular Physiology 2, 157.CrossRefGoogle Scholar
Jones, G, Riley, MD & Whiting, S (2001) Association between urinary potassium, urinary sodium, current diet, and bone density in prepubertal children. American Journal of Clinical Nutrition 73, 839–844.CrossRefGoogle ScholarPubMed
Kearney, J & Gibney, M (1998) A pan-European survey of consumer attitudes to food, nutrition and health overview. Food Quality and Preference 9, 467–478.Google Scholar
Kraut, Ja & Coburn, JW (1994) Bone, acid and osteoporosis. New England Journal of Medicine 330, 1821–1822.CrossRefGoogle ScholarPubMed
Kreiger, Na, Sessler, Ne & Bushinsky, Da (1992) Acidosis inhibits osteoblastic and stimulates osteoclastic activity in vitro. American Journal of Physiology 262, F442–F448.Google Scholar
Kurtz, I, Maher, T, Hulter, HN, Schambelan, M & Sebastian, A (1983) Effect of diet on plasma acid-base composition in normal humans. Kidney International 24, 670–680.CrossRefGoogle ScholarPubMed
Lemann, J Jr, Adams, ND & Gray, RW (1979) Urinary calcium excretion in humans. New England Journal of Medicine 301, 535–541.Google Scholar
Lemann, J Jr, Gray, RW, Maierhofer, WJ & Cheung, HS (1986) The importance of renal net acid excretion as a determinant of fasting urinary calcium excretion. Kidney International 29, 743–746.CrossRefGoogle ScholarPubMed
Lemann, J, Gray, RW & Pleuss, JA (1989) Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney International 35, 688–695.Google Scholar
Lemann, J Jr, Litzow, JR & Lennon, EJ (1966) The effects of chronic acid load in normal man: Further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. Journal of Clinical Investigation 45, 1608–1614.Google Scholar
Lemann, J, Litzow, JR & Lennon, EJ (1967) Studies of the mechanisms by which chronic metabolic acidosis augments urinary calcium excretion in man. Journal of Clinical Investigation 46, 1318–1328.Google Scholar
Lemann, J Jr, Pleuss, JA, Gray, RW & Hoffmann, RG (1991) Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults. Kidney International 39, 973–983.Google Scholar
Lin, P, Ginty, F, Appel, L, Svetky, L, Bohannon, A, Barclay, D, Gannon, R & Aickin, M (2001) Impact of sodium intake and dietary patterns on biochemical markers of bone and calcium metabolism. Journal of Bone and Mineral Research 16, Suppl. 1, S511.Google Scholar
Macdonald, HM, New, SA, Fraser, WD, Black, AJ, Grubb Da, & Reid, DM (2002) Increased fruit and vegetable intake reduces bone turnover in early postmenopausal Scottish women. Osteoporosis International.Google Scholar
Macdonald, HM, Downie, FH, Moore, F, New, SA, Grubb Da, , Reid, DM (2001) Higher intakes of fruit and vegetables are associated with higher bone mass in perimenopausal Scottish women. Proceedings of the Nutrition Society 60, 202A.Google Scholar
Macdonald, HM, New, SA, McGuigan, Fe, Golden, MHN, Ralston, SH, Grubb, Da & Reid, DM (2000) Femoral neck bone loss and dietary Ca intake in peri and early post-menopausal women: an association dependent on VDR genotype. Journal of Bone and Mineral Research 15, S202.Google Scholar
Macdonald, HM, New, SA, McGuigan, FE, Goldenm, HN, Ralston, SH, Grubb, DA, Reid, DM, (2001 c) Modest alcohol intake reduces bone loss in peri and early postmenopausal Scottish women: an effect dependent on estrogen receptor genotype?. Bone 28, S95.Google Scholar
Mazess, RB & Mather, WE (1974) Bone mineral content of NorthAlaskan Eskimos. American Journal of Clinical Nutrition 27, 916–925.Google Scholar
Mazess, RB & Mather, WE (1975 a) Bone mineral content in Canadian Eskimos. Human Biology 47, 45.Google ScholarPubMed
Mazess, RB & Mather, WE (1975b) Bone mineral content of North Alaskan Eskimos (letter). American Journal of Clinical Nutrition 28, 567.Google Scholar
Meghji, S, Morrison, MS, Henderson, B & Arnett, TR (2001) PH dependence of bone resorption: mouse calvarial osteoclasts are activated by acidosis. American Journal of Physiology 280, E112–E119.Google ScholarPubMed
Michaelsson, K, Holmberg, L, Maumin, H, Wolk, A, Bergstrom, R & Ljunghall, S (1995) Diet, bone mass and osteocalcin; a crosssectional study. Calcified Tissue International 57, 86–93.CrossRefGoogle Scholar
Miller, DR, Krall, EA, Anderson, JJ, Rich, SE, Rourke, A & Chan, J (2001) Dietary mineral intake and low bone mass in men: The VALOR Study. Journal of Bone and Mineral Research 16, Suppl.1, S395.Google Scholar
Ministry Agriculture Fisheries Food (1995) Manual of Nutrition, 10th ed. London: H.M. Stationery Office.Google Scholar
Morris, RC (2001) Acid-base, sodium and potassium as determinants of bone and calcium economy. In Nutritional Aspects of Osteoporosis, pp. 357–378 [Burckhardt, P, DawsonHughes, B, Heaney, RP,editors]. San Diego, CA: Academic Press.Google Scholar
Muhlbauer, RC, Felix, R, Lozano, A, Palacio, S & Reinli, A (2003) Common herbs, essential oils and monoterpenes Potently modulate bone metabolism. Bone (In the press).CrossRefGoogle Scholar
Muhlbauer, RC, Lozano, AM & Reinli, A (2002) Onion and a mixture of vegetables, salads and herbs affect bone resorption in the rat by a mechanism independent of their base excess. Journal of Bone and Mineral Research 17, 1230–1236.Google Scholar
New, Sa(1999) Bone health: the role of micronutrients. British Medical Bulletin 55, 619–633.CrossRefGoogle ScholarPubMed
New, Sa (2000) Nutrition, exercise and bone health. Proceedings of the Nutrition Society 60, 265–274.Google Scholar
New, Sa (2002) The role of the skeleton in acid-base homeostasis. Proceedings of the Nutrition Society 61, 151–164.Google Scholar
New, Sa, Bolton-Smith, C, Grubb, Da & Reid, DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. American Journal of Clinical Nutrition 65, 1831–1839.CrossRefGoogle Scholar
New, Sa & Francis, RF (2003) Book review. Science in Parliament (In the Press).Google Scholar
New, Sa, Macdonald, HM, Grubb, DA & Reid, DM (2001) Positive association between net endogenous non-carbonic acid production (NEAP) and bone health: further support for the importance of the skeleton to acid-base balance. Bone 28, Suppl., S94.Google Scholar
New, Sa, Macdonald, HM, Dixon, ASJ & Reid, DM (2002 a) Hard cheese but not so soft veg (letter). New Scientist 2330, 54–55.Google Scholar
New, SA & Millward, DJ (2003) Calcium, protein and fruit and vegetables as dietary determinants of bone health (letter). American Journal of Clinical Nutrition 77, 1340–1341.Google Scholar
New, Sa, Robins, SP, Campbell, MK, Martin, JC, Garton, MJ, Bolton-Smith, C, Grubb, DA, Lee, SJ & Reid, DM (2000) Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health. American Journal of Clinical Nutrition 71, 142–151.CrossRefGoogle Scholar
New, Sa, Smith, R, Brown, JC, Reid, DM, (2002 b) Positive associations between fruit and vegetable consumption and bone mineral density in late postmenopausal and elderly women. Osteoporosis International 13, 577.Google Scholar
Oh, MS & Uribarri, J (1996) Bone buffering of acid: fact or fancy. Journal of Nephrology 9, 261–262.Google Scholar
Patterson, BH, Block, G & Rosenberger, WF (1990) Fruit and vegetables in the American diet: data from the NHANES II Survey. American Journal of Public Health 80, 1443–1449.CrossRefGoogle ScholarPubMed
Plant, J & Tidey, G (2003) Understanding, Preventing and Overcoming Osteoporosis. London: Virgin Books Ltd.Google Scholar
Reidenberg, MM, Haag, BL, Channick, BJ, Schuman, CR & Wilson, TGG (1966) The response of bone to metabolic acidosis in man. Metabolism 15, 236–241.Google Scholar
Remer, T & Manz, F (1995) Potential renal acid load of foods and its influence on urine pH. Journal of the American Dietetic Association 95, 791–797.CrossRefGoogle ScholarPubMed
Sebastian, A, Harris, ST, Ottaway, JH, Todd, KM & Morris, RC (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. New England Journal of Medicine 330, 1776–1781.Google Scholar
Stone, KL, Blackwell, T, Orwoll, ES, Cauley, JC, Barrett-Connor, E, Marcus, R, Nevitt, MC & Cummings, SR (2001) The relationship between diet and bone mineral density in older men. Journal of Bone and Mineral Research 16, Suppl. 1, S388.Google Scholar
Tucker, KL, Hannan, MT, Chen, H, Cupples, A, Wilson, PWF & Kiel, DP (1999) Potassium and fruit and vegetables are asso ciated with greater bone mineral density in elderly men and women. American Journal of Clinical Nutrition 69, 727–736.Google Scholar
Wachman, A & Bernstein, DS (1968) Diet and osteoporosis. Lancet i, 958–959.Google Scholar
Widdowson, EM, McCance, Ra & Spray, CM (1951) The chemical composition of the human body. Clinical Science 10, 113–125.Google Scholar
Wood, RJ (1994) Potassium bicarbonate supplementation and calcium metabolism in postmenopausal women: are we barking up the wrong tree. Nutrition Reviews 52, 278–280.Google Scholar