Date of Award

8-1973

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nutrition

Major Professor

Roy E. Beauchene

Committee Members

Jane R. Savage, Mary Rose Gram, Grayce E. Goertz, Rossie L. Mason

Abstract

Seventy-six ambulatory women with a mean age of 68 years participated in a 12-month study of the effects of fluoride, with and without multivitamin and calcium phosphate supplements, on nutritional status including bone density. Mean daily nutrient intakes calculated from 4- to 7-day weighed food intakes were 15 19 kcal including 15% from protein and 36% from fat; others were 797 mg calcium, 1000 mg phosphorus, and 8.6 mg iron. Mean intakes by 59 women who were not receiving vitamin supplements were 5800 IU of vitamin A and 35 mg of ascorbic acid. Mean blood hemoglobin was 13.9 g/100 ml; serum calcium and phosphorus level means were 9.60 and 3.35 mg/100 ml, respectively. A mean of 1.92 mg of phosphorus was released by alkaline phosphatase, while the mean cholesterol level was 222 mg/100 ml. Mean serum levels of total protein and albumin were 6. 77 and 3.67 g/100 ml, respectively, and the A/G ratio was 1.22. Plasma ascorbic acid averaged 0.34 mg/100 ml and serum vitamin A, 50.4 ug/100 ml for the women who were not receiving vitamin supplements.

The mean bone density index of the left phalanx 5-2 was 0.8 19 g equivalents of alloy per cc of bone, while mean height and weight were 156.3 cm and 65.4 kg, respectively. Canonical correlation showed an age-associated decrease in bone density, height, weight, and intake of protein, calcium, phosphorus, and ascorbic acid.

The group of 76 women was divided into 4 groups, approximately equal in number, matched for bone density, age, and weight. Fluoride was administered at a level of 0.25 mg/kg body weight/day as a single therapeutic agent to one group and in combination with 464 mg calcium and 360 mg phosphorus as calcium phosphate and 25, 000 IU vitamin A and 200 mg ascorbic acid in a multivitamin capsule to another group. The diets of another group of women were supplemented with 464 mg calcium and 360 mg phosphorus, while the diets of 19 of the women were not supplemented. Subgroups of 4 subjects from each experimental group participated in metabolic balance studies. Metabolic studies and bone density measurements were repeated after 4 months of supplementation and all tests were repeated after 12 months.

After supplementation, minor differences in nutrient intakes and blood levels occurred in the groups receiving fluoride. Consumption of calcium decreased in the group which received fluoride, although the final mean intake was 76 1 mg per day. In the group receiving fluoride in combination with calcium phosphate and vitamin supplements, increases in plasma ascorbic acid and serum vitamin A and decreases in serum total protein, calcium, and phosphorus were obtained. Nevertheless, all values remained within normal ranges.

Supplementation with fluoride alone resulted in a significant increase (10%) in bone density, and fluoride in combination with calcium phosphate and vitamins produced a 4% increase. Insignificant increases in bone density were observed when the diet was unsupplemented (2%) or supplemented with calcium phosphate (2.5%).

Nitrogen balances remained positive throughout the study. An age-associated defect in calcium absorption was indicated in all experimental groups. Changes in neither calcium nor phosphorus balances correlated with those in bone density. Positive balances of these nutrients were shown when fluoride accompanied the supplements of calcium, phosphorus, and vitamins but bone density decreased in 2 of the 4 subjects in that subgroup. All members of the balance group receiving fluoride alone exhibited negative balances of calcium and phosphorus while bone density increased.

No adverse effects of fluoride supplementation were observed in any of the women during the study. The biological significance of a decrease in serum calcium has not been elucidated; a shift of serum calcium to bone, or a reduction in calcium mobilized from bone (possibly lowering serum calcium), may be advantageous. Increases in bone density in response to fluoride without alterations in dietary intake or blood constituents, other than serum calcium, tends to encourage further exploration of the prophylactic as well as therapeutic benefits of low-level fluoride supplementation.

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