Diet and the content of calcium and magnesium in serum of patients

572
Probl Hig Epidemiol 2010, 91(4): 572-575
Diet and the content of calcium and magnesium in serum
of patients with salivary gland tumors and inflammations
Dieta a zawartość wapnia i magnezu w surowicy pacjentów z guzami ślinianek pochodzenia
nowotworowego i zapalnego
Maria H. Borawska 1/, Jolanta Soroczyńska 1/, Katarzyna Socha 1/, Bogdan Łazarczyk 2/
1/
2/
Department of Bromatology, Medical University of Bialystok, Poland
Department of Otolaryngology, Regional Hospital in Bialystok, Poland
Cel. Ocena wpływu nawyków żywieniowych na stężenie wapnia (Ca)
i magnezu (Mg) w surowicy pacjentów z guzami ślinianek pochodzenia
nowotworowego (SGT) i zapalnego (SGID).
Aim. To determine the relationship between dietary habits and serum
levels of calcium (Ca) and magnesium (Mg) in patients with salivary glands
tumors (SGT) and salivary glands inflammatory diseases (SGID).
Materiał i metody. Zawartość Ca i Mg w surowicy oznaczono u 79
pacjentów w wieku 20-75 lat i u 18 osób zdrowych w wieku 20-58 lat.
Z badanymi pacjentami przeprowadzono ankietę dotyczącą częstości
spożycia poszczególnych grup produktów spożywczych. Stężenie Ca i Mg
w odbiałczonej surowicy oznaczono metodą atomowej spektrometrii
absorpcyjnej z atomizacją w płomieniu acetylenowo-powietrznym z korekcją
tła Zeemana.
Material and methods. The content of Ca and Mg in serum was
determined in 79 patients (aged 20-75 years, average age 49.1±14.8 years)
and in 18 healthy people – control group (aged 20-58 years, average age
37.1±10.9 years). Food-frequency questionnaires were implemented to
collect the dietary data. The content of Ca and Mg in deproteinated serum
was analyzed by flame atomic absorption spectrometry (FAAS) on a Z-5000
instrument (Hitachi, Japan) with Zeeman-effect background correction.
Wyniki. Średnia zawartość Ca w surowicy pacjentów z SGT i SGID wynosiła
odpowiednio 103,39±19,41 mg/l i 105,70±26,23 mg/l oraz była istotnie
wyższa w porównaniu do zawartości Ca w surowicy grupy kontrolnej
(85,84±11,38 mg/l). Średnia zawartość Mg w surowicy pacjentów z SGT
i z SGID wynosiła 20,77±2,84 mg/l, 20,93±2,37 mg/l; odpowiednio i nie
różniła się od stężenia Mg w surowicy osób zdrowych: 21,22±1,75 mg/l. Nie
stwierdzono korelacji pomiędzy zawartością Ca i Mg w surowicy badanych
pacjentów. Analiza regresji wielorakiej wykazała, że nawyki żywieniowe
mają wpływ w około 27% i 33% na stężenie Ca i Mg w surowicy badanych
pacjentów. Częste spożywanie mięsa ujemnie wpływało na poziom Ca,
natomiast na stężenie Mg w surowicy dodatnio wpływało częste spożycie
ryb, a ujemnie częste spożycie pieczywa białego.
Results. The average contents of Ca in serum of patients with SGT and
SGID: 103.39±19.41 mg/L and 105.70±26.23 mg/L respectively, were
statistically significantly higher than in the control group (85.84±11.38
mg/L). The average contents of Mg in serum of patients with SGT and SGID
were 20.77±2.84 mg/L and 20.93±2.37 mg/L respectively. The mean
content of Mg in serum of healthy people was 21.22±1.75 mg/L. We have
not observed significant differences between the serum levels of Mg of
the examined groups. We have not observed the correlation between the
content of Ca and Mg in serum of the examined patients. The independent
variables included in the model accounted for about 27% and 33% of the
variance for Ca and Mg respectively. Frequent consumption of meat was
inversely correlated with the serum content of Ca. Frequent consumption of
fish has the greatest influence on the content of Mg in serum of patients;
but frequent consumption of white bread was inversely correlated with
the serum content of Mg.
Wnioski. 1. Stężenie Ca w surowicy u pacjentów z guzami ślinianek
pochodzenia nowotworowego i zapalnego jest wyższe niż w surowicy osób
z grupy kontrolnej. 2. Nawyki żywieniowe mają wpływ na poziom Ca i Mg
w surowicy badanych pacjentów.
Słowa kluczowe: wapń, magnez, choroby ślinianek, nawyki żywieniowe
Conclusions. 1. The content of calcium in serum of patients with salivary
gland diseases was higher than in the control group. 2. Dietary habits have
influence on the content of calcium and magnesium in serum of patients
with salivary gland diseases.
Keywords: calcium, magnesium, salivary gland diseases, dietary habits
© Probl Hig Epidemiol 2010, 91(4): 572-575
www.phie.pl
Nadesłano: 08.10.2010
Zakwalifikowano do druku: 20.11.2010
Introduction
Calcium (Ca) deficiency is a global problem,
especially in the aging population. Ca deficiency
is connected with osteoporosis, but nutritional Ca
Adres do korespondencji / Address for correspondence
Maria H. Borawska
Department of Bromatology, Medical University of Bialystok
Kiliński 1 St., 15-089 Bialystok, Poland
e-mail address: [email protected]
deficiency may in consequence give rise to a number
of diseases common in old age: hypertension,
arteriosclerosis, neurodegenerative diseases and
malignancies [1, 2, 3, 4, 5]. Magnesium (Mg) plays
an important role in energy production (involved in
Borawska MH et al. Diet and the content of calcium and magnesium in serum of patients with salivary gland tumors ...
over 300 enzyme reactions, many related to ATP),
in the synthesis of nucleic acids and proteins (cell
reproduction), regulates Ca metabolism by affecting
parathyroid hormone and calcitonin, as well as
potassium and sodium. Mg is necessary for hormonal
activity, can help to prevent kidney and gall stones by
its effect on calcium levels, may help prevent diabetes
[6]. Low content of Mg in human body has influence
on oncogenic action of carcinogenic compounds. It
increases the number of mutations [7]. Thus Mg plays
an important role in the stimulation of the immune
system [8].
Aim
To estimate serum levels of Ca and Mg in patients
with salivary gland tumors (SGT) and salivary gland
inflammatory diseases (SGID) in comparison to healthy
people. We also estimated the influence of dietary habits
on Ca and Mg status in examined patients.
Material and Methods
Patients, aged 20-75 years, hospitalized in the
Department of Otolaryngology, Regional Hospital in
Bialystok, were examined. The content of Ca and Mg
in serum was determined in 79 patients with SGT and
SGID and in 18 healthy people – the control group,
aged 20-58 years (characteristics in Table I).
Table I. Patient characteristics
Tabela I. Charakterystyka pacjentów
Gender (M/F) / Płeć (M/K)
Age (years) – Mean (range)
/ wiek (lata) – Średnia (zakres)
Body Mass Index (BMI)
/ Wskaźnik masy ciała
29/50
49.1±14.8
(20-75)
26.37±4.19
(17.76-38.39)
M/M – males /mężczyźni
F/K – females /kobiety
Food-frequency questionnaires were implemented
to collect the dietary data. The patients were asked
to complete the questionnaire concerning the
consumption frequency of food products by the
National Food and Nutrition Institute and the National
Cardiology Institute. The list of food commodities
consisted of 36 foods items (white bread, wholegrain
bread, sweets, cereals products, grain products,
pulses, milk, cottage cheese, other sorts of cheese,
meat, poultry, offal, sausages, ham, meat products,
bacon, tinned meat, tinned fish, fresh fish, eggs,
butter, margarine, vegetable oils, potatoes, processed
vegetables, fresh vegetables, fruit, sugar added to
beverages, marmalade, honey, soft drinks, beer, wine,
spirit, coffee, tea). The consumption frequency of
different kinds of food was estimated according to
the following criteria: frequent consumption was
defined as an intake of certain food products twelve
573
to thirty days per month, except fish, that was eaten
four to twelve times a month. Food products eaten
less frequently were classified into the “sporadic
consumption” group [9].
We obtained the consent of the local Committee
of Ethics to perform the examinations.
The serum samples were deproteinated with 1
mol/L nitric acid and 1% Triton X-100 solution was
added. The content of Ca and Mg in serum (with
addition 1% La) was analyzed by flame atomic
absorption spectrometry (FAAS) on a Z-5000
instrument (Hitachi, Japan). The measurements were
performed at 422.7 nm – Ca and 285.2 nm – Mg and
the Zeeman – effect background correction.
Certified reference material – Seronorm Trace
Elements MIO181, Sero AS, Norway – human serum,
was used to test the accuracy of these methods. The
Department of Bromatology participates in a quality
control program of the estimation of trace elements
of the National Institute of Hygiene and Institute of
Nuclear Chemistry and Technology. The results of
the quality control analyses were in agreement with
reference values.
Statistical analyses were performed using Statistica
v. 6.0 software. Differences between independent
groups were tested by the Mann-Whitney U-test.
Correlation was calculated and tested by the Spearman
rank test. We used multiple linear regression analysis
for estimating the influence of dietary habits on Ca
and Mg status in examined patients. Values of p<0.05
were considered significantly different.
Results
The results of mean serum Ca and Mg concentration
in the healthy group and patients with SGT and SGID
are shown in Table II and Table III respectively.
Table II. Content of calcium in serum of patients with SGT and SGID and in
the control group
Tabela II. Stężenie wapnia w surowicy pacjentów z SGT, SGID i w grupie kontrolnej
Mean
/średnia
(mg/L)
No
/Nr
Subject /podmiot
badany
min-max
(mg/L)
1
Control group
/grupa kontrolna
(n = 18)
85.84
2
SGT patients
/pacjenci z SGT
(n = 42)
103.39
3
SGID patients
/pacjenci z SGID
( n = 37)
105.70 48.86-190.54 26.23
↑ n=14
↓ n=5
SD
p
70.39-108.64 11.38
35.2-129.5
↑ n=17
↓ n=5
19.41
P1/2 < 0.0007
p1/3 < 0.003
SD – Standard deviation / odchylenie standardowe
p – significance level / poziom istotności
↑ n – number of patients above reference levels of Ca (85 – 109mg/L)
/ liczba pacjentów ze stężeniem Ca powyżej normy
↓ n – number of patients below reference levels of Ca (85 – 109mg/L)
/ liczba pacjentów ze stężeniem Ca poniżej normy
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Probl Hig Epidemiol 2010, 91(4): 572-575
Table III. Content of magnesium in serum of patients with SGT and SGID and
in the control group
Tabela III. Stężenie magnezu w surowicy pacjentów z SGT, SGID i grupie
kontrolnej
mean
/średnia
(mg/L)
No
/Nr
Subject /podmiot
badany
1
Control group
/grupa kontrolna
(n=18)
21.22
SGT patients
/ pacjenci z SGT
(n=42)
20.77
SGID patients
/ pacjenci z SGID
(n=37)
20.93
2
3
min-max
(mg/L)
SD
p
P1/2 = 0.533
p1/3 = 0.647
15.32-24.54 2.37
↑ n=0
↓ n=7
SD – Standard deviation / odchylenie standardowe
p – significance level / poziom istotności
↑ n – number of patients above reference levels of Mg (19-25 mg/L) /liczba
pacjentów ze stężeniem Mg powyżej normy
↓ n – number of patients below reference levels of Mg (19-25 mg/L) /liczba
pacjentów ze stężeniem Mg poniżej normy
The average content of Ca in serum of patients
with SGT and SGID were statistically significantly
higher (p<0.00002, p<0.0003 respectively) than in
the control group. We have not observed significant
differences between the serum levels of Mg of the
examined groups compared with the control group.
We have not observed a correlation between
the content of Ca and Mg in serum of the examined
patients.
Frequent consumption of meat was inversely
correlated with the serum content of Ca. Frequent
consumption of fish has the greatest influence on
the content of Mg in serum of patients; but frequent
consumption of white bread was inversely correlated
with the serum content of Mg. The independent
variables included in the model accounted for
about 27% and 33% of the variance for Ca and Mg
respectively (Table IV and Table V).
Table IV. Stepwise multiple linear regression analysis of influence of frequency
consumption of food products on Ca serum content in patients with SGT and
SGID, b coefficients and significance of variables entered in the model
Tabela IV. Analiza regresji wielorakiej wpływu częstości spożycia poszczególnych grup produktów spożywczych na stężenie Ca w surowicy pacjentów
z SGT i SGID
Independent variables
/ zmienna niezależna
Significance level Model R2
b coefficient
/ wskaźnik b (SE) / poziom istotności /model R2
Meat /mięso
-0.341 (0.117)
0.0050
Potatoes /ziemniaki
0.227 (0.130)
0.0866
Jam /dżem
0.189 (0.121)
0.1241
Sweets /słodycze
0.185 (0.133)
0.1686
Bacon /boczek
-0.222 (0.119)
0.0665
Poultry /drób
-0.166 (0.121)
0.1756
SE – Standard error /błąd standardowy
b coefficient
/wskaźnik b (SE)
Significance level
/poziom istotności
Fish /ryby
0.275 (0.117)
0.0221
White bread
/pieczywo białe
-0.266 (0.112)
0.0212
Meat /mięso
0.222 (0.111)
0.0502
Meat products
/produkty mięsne
0.215 (0.183)
0.0544
Margarine
/margaryna
0.177 (0.110)
0.1133
Offal /podroby
-0.216 (0.112)
0.0583
Grain products
/kasze, ryż
-0.198 (0.115)
0.0909
Boiled vegetables
/warzywa gotowane
-0.192 (0.118)
0.1100
Cottage cheese
/sery twarogowe
-0.129 (0.112)
0.2545
Independent variable
/ zmienna niezależna
19.12-25.27 1.75
14.49-27.95 2.84
↑ n=1
↓ n=11
Table V. Stepwise multiple linear regression analysis of influence of frequency
consumption of food products on Mg serum content in patients with SGT
and SGID, b coefficients and significance of variables entered in the model
Tabela V. Analiza regresji wielorakiej wpływu częstości spożycia poszczególnych grup produktów spożywczych na stężenie Mg w surowicy pacjentów
z SGT i SGID
0.27
Model R2
/model R2
0.33
SE – Standard error /błąd standardowy
Discussion
Salivary gland tumors are relatively rare; 1%
to 3% of all head and neck cancers. Most of them
comprise benign tumors of parotid glands [10, 11].
This study comprised patients with benign SGT like:
pleomorphic adenoma and adenolymphma and with
SGID (sialoadenitis).
In our study we have not observed significant
differences between the serum levels of Mg in patients
with benign SGT and SGID compared with the
control group. In our earlier study [12] we observed
significantly lower (p<0.001) level of Mg in serum
of patients with larynx cancer (19.52±2.08 mg/L)
than in the control group (21.41±1.37 mg/L),
but within the reference range (16.8-24.0 mg/L)
[13]. According to Akcil et al. [14] there were no
significant differences between Mg concentrations in
patients with benign and malignant larynx tumors in
comparison with the control group. In patients with
different malignant tumors a statistically significant
increase in serum average levels of Mg was observed
[15, 16]. The same authors showed that there were no
difference between the serum level of Mg in the control
group and in patients with inflammatory diseases and
benign tumors [15].
In our study we observed statistically significantly
higher content of Ca in serum of patients with SGT
and SGID (p<0.0007, p<0.003 respectively) than
in the control group. Humoral hypercalcemia of
malignancy is one of the most common metabolic
complications associated with cancer [17]. Patients
with cancer-related hypercalcaemia have a poor
Borawska MH et al. Diet and the content of calcium and magnesium in serum of patients with salivary gland tumors ...
prognosis [18]. However the results of Gradinaru et
al. showed that Ca plasma concentrations were lower
in patients with parotid malignant tumors by 20-22%
in comparison with the control group (16). As a result
it needs further investigation.
The aetiological factors for salivary gland tumors
are not clear, but nutrition may be a risk factor.
According to Licitra et al. [11] and Horn-Roos et al.
[19] low intake of vitamins A and C influence high
incidence of tumors.
In the food chain magnesium is present in plant
products, mainly in almonds, nuts, wholegrain
products, green vegetables, pulse, fish (dory pollack,
sole), whereas meat, dairy products and fruits have
lower content of Mg [20]. In our studies frequent
consumption of fish had the greatest positive
influence on the content of Mg in serum but frequent
consumption of white bread was associated with the
decrease of serum Mg status. The Spearman rank test
showed that frequent consumption of white bread
significantly correlated with consumption of sugar
and sweet beverages. It is known that consumption
of sugar decreased bioavailability of Mg [21].
575
Dairy products are the main source of Ca.
Vegetables, nuts, beans and cereals products are also
rich in Ca, however bioavailability of Ca is low, because
of content of fiber and phytic acid [20]. Our study
showed that the frequent consumption of meat was
inversely correlated with the content of Ca in serum.
Conclusions
1. The level of Ca in serum of patients with SGT
and SGID is higher than in healthy people
and frequent consumption of meat is inversely
correlated with serum content of Ca.
2. The level of Mg in serum of the examined patients
is similar to that in healthy people and frequent
consumption of fish has the greatest influence
on the content of Mg in serum, but frequent
consumption of white bread is inversely correlated
with the serum content of Mg of the examined
patients.
Acknowledgements
Presented work was financially supported by the Polish
Ministry of Science and Higher Education (Grant project
No 3-16-557 F of Medical University in Bialystok).
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