Skip to main content

Dietary potassium intake is beneficial to bone health in a low calcium intake population: the Korean National Health and Nutrition Examination Survey (KNHANES) (2008–2011)

Abstract

Summary

Dietary potassium may neutralize acid load and reduce calcium loss from the bone, leading to beneficial effect on bone mineral density. In this nationwide Korean population study, dietary potassium intake was associated with improved bone mineral density in older men and postmenopausal women.

Introduction

Nutrition is a major modifiable factor that affects bone health. The accompanying anion in dietary potassium may act as an alkaline source by neutralizing the acid load and reducing calcium loss from the bone. We aimed to evaluate the association between dietary potassium intake and bone mineral density (BMD) in the Korean population.

Methods

We analyzed a total of 3135 men aged >50 years and 4052 postmenopausal women from the Korean National Health and Nutrition Examination Survey (KNHANES). Lumbar spine, total hip, and femur neck BMD were measured using dual energy X-ray absorptiometry. The daily food intake was assessed using a food frequency questionnaire.

Results

When we divided the participants into tertiles based on the intake of potassium intake, the highest potassium intake tertile group showed a significantly higher total hip and femur neck BMD as compared to lower tertile groups (0.914 ± 0.004, 0.928 ± 0.003, 0.925 ± 0.004 mg/day across the tertiles, P = .014 for total hip; 0.736 ± 0.003, 0.748 ± 0.003, 0.750 ± 0.004 mg/day, P = .012 for femur neck). Postmenopausal women in the highest potassium intake tertile group showed significantly higher lumbar, total hip, and femur neck BMD as compared to those in lower potassium intake tertile groups (0.793 ± 0.004, 0.793 ± 0.003, 0.805 ± 0.004 mg/day across the tertiles, P = .029 for lumbar spine; 0.766 ± 0.003, 0.770 ± 0.002, 0.780 ± 0.003 mg/day, P = .002 for total hip; 0.615 ± 0.003, 0.619 ± 0.002, 0.628 ± 0.003 mg/day, P = .002 for femur neck).

Conclusions

Dietary potassium intake was positively associated with BMD in men aged >50 years and postmenopausal women, indicating the beneficial effects of dietary potassium intake on bone health.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Health Behavior and Chronic Disease Statistics (2012). Korean center of disease control and prevention

  2. Seeman E, Hopper JL, Young NR, Formica C, Goss P, Tsalamandris C (1996) Do genetic factors explain associations between muscle strength, lean mass, and bone density? A twin study. Am J Physiol Endocrinol Metab 270(2):E320–E327

    CAS  Google Scholar 

  3. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis F (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Kim KM, Choi SH, Lim S, Moon JH, Kim JH, Kim SW, Jang HC, Shin CS (2014) Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008-2010). J Clin Endocrinol Metab 99(7):2409–2417

    CAS  Article  PubMed  Google Scholar 

  5. Heaney RP (1993) Nutritional factors in osteoporosis. Annu Rev Nutr 13:287–316

    CAS  Article  PubMed  Google Scholar 

  6. Iwase H, Tanaka M, Kobayashi Y, Wada S, Kuwahata M, Kido Y, Hamaguchi M, Asano M, Yamazaki M, Hasegawa G, Nakamura N, Fukui M (2015) Lower vegetable protein intake and higher dietary acid load associated with lower carbohydrate intake are risk factors for metabolic syndrome in patients with type 2 diabetes: post-hoc analysis of a cross-sectional study. J Diabetes Investig 6(4):465–472

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Chatterjee R, Biggs ML, de Boer IH, Brancati FL, Svetkey LP, Barzilay J, Djoussé L, Ix JH, Kizer JR, Siscovick DS (2015) Potassium and glucose measures in older adults: the cardiovascular health study. J Gerontol Series A: Biological Sciences and Medical Sciences 70(2):255–261

    Article  Google Scholar 

  8. Lee H, Lee J, Hwang SS, Kim S, Chin HJ, Han JS, Heo NJ (2013) Potassium intake and the prevalence of metabolic syndrome: the Korean National Health and Nutrition Examination survey 2008-2010. PLoS One 8(1):e55106

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Zhu K, Devine A, Prince RL (2008) The effects of high potassium consumption on bone mineral density in a prospective cohort study of elderly postmenopausal women. Osteoporos Int 20(2):335–340

    Article  PubMed  Google Scholar 

  10. Jehle S, Hulter HN, Krapf R (2013) Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 98(1):207–217

    CAS  Article  PubMed  Google Scholar 

  11. Lemann J Jr, Litzow JR, Lennon EJ (1966) The effects of chronic acid loads in normal man: further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Investig 45(10):1608–1614

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Maurer M, Riesen W, Muser J, Hulter HN, Krapf R (2003) Neutralization of western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Physiol Renal physiology 284(1):F32–F40

    CAS  Article  Google Scholar 

  13. Barzel US (1995) The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. J Bone Miner Res 10(10):1431–1436

    CAS  Article  PubMed  Google Scholar 

  14. Arnett TR (2008) Extracellular pH regulates bone cell function. J Nutr 138(2)

  15. Muzylak M, Arnett TR, Price JS, Horton MA (2007) The in vitro effect of pH on osteoclasts and bone resorption in the cat: implications for the pathogenesis of FORL. J Cell Physiol 213(1):144–150

    CAS  Article  PubMed  Google Scholar 

  16. Dawson-Hughes B, Harris SS, Palermo NJ, Gilhooly CH, Shea KM, Fielding RA, Ceglia L (2015) Potassium bicarbonate supplementation lowers bone turnover and calcium excretion in older men and women: a randomized dose-finding trial. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 30(11):2103–2111

    CAS  Article  Google Scholar 

  17. Sellmeyer DE, Schloetter M, Sebastian A (2002) Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 87(5):2008–2012

    CAS  Article  PubMed  Google Scholar 

  18. Moseley KF, Weaver CM, Appel L, Sebastian A, Sellmeyer DE (2013) Potassium citrate supplementation results in sustained improvement in calcium balance in older men and women. J Bone Miner Re 28(3)

  19. Frassetto L, Morris CR, Sebastian A (2004) Long-term persistence of the urine calcium-lowering effect of potassium bicarbonate in postmenopausal women. J Clin Endocrinol Metab 90(2):831–834

    Article  PubMed  Google Scholar 

  20. Hanley DA, Whiting SJ (2013) Does a high dietary acid content cause bone loss, and can bone loss be prevented with an alkaline diet? J Clin Densitom 16(4):420–425. doi:10.1016/j.jocd.2013.08.014

    Article  PubMed  Google Scholar 

  21. Fitzpatrick LA (2002) Secondary causes of osteoporosis. Mayo Clin Proc 77(5):453–468

    Article  PubMed  Google Scholar 

  22. Lambert H, Frassetto L, Moore JB, Torgerson D, Gannon R, Burckhardt P, Lanham-New S (2015) The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis. Osteoporos Int 26(4):1311–1318

    CAS  Article  PubMed  Google Scholar 

  23. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP (1999) Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 69(4):727–736

    CAS  PubMed  Google Scholar 

  24. Whiting SJ, Boyle JL, Thompson A, Mirwald RL, Faulkner RA (2002) Dietary protein, phosphorus and potassium are beneficial to bone mineral density in adult men consuming adequate dietary calcium. J Am Coll Nutr 21(5):402–409

    CAS  Article  PubMed  Google Scholar 

  25. Ahn Y, Lee JE, Paik HY, Lee HK, Jo I, Kimm K (2003) Development of a semi-quantitative food frequency questionnaire based on dietary data from the Korea National Health and Nutrition Examination Survey. Nutr Sci 6(3):173–184

    Google Scholar 

  26. Ahn Y, Kwon E, Shim J, Park M, Joo Y, Kimm K, Park C, Kim D (2007) Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr 61(12):1435–1441

    CAS  Article  PubMed  Google Scholar 

  27. The Korean Nutrition Society (2000) Recommended dietary allowances for Koreans, 7th ed

  28. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sport Exerc 25(1):71–80

    CAS  Article  Google Scholar 

  29. Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM (2005) Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr 81(4):923–933

    CAS  PubMed  Google Scholar 

  30. Remer T, Manz F (1995) Potential renal acid load of foods and its influence on urine pH. J Am Dietetic Assoc 95(7):791–797

    CAS  Article  Google Scholar 

  31. Sebastian A, Harris ST, Ottaway JH, Todd KM, Morris RC (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330(25):1776–1781

    CAS  Article  PubMed  Google Scholar 

  32. Dawson-Hughes B, Harris SS, Palermo NJ, Castaneda-Sceppa C, Rasmussen HM, Dallal GE (2008) Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab 94(1):96–102

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rafferty K, Davies KM, Heaney RP (2005) Potassium intake and the calcium economy. J Am Coll Nutr 24(2):99–106

    CAS  Article  PubMed  Google Scholar 

  34. 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. Am J Phys 271(6):F1114–F1122

    CAS  Google Scholar 

  35. Sakhaee K, Nicar M, Hill K, Pak CY (1983) Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int 24(3):348–352

    CAS  Article  PubMed  Google Scholar 

  36. Lemann J Jr, Gray RW, Pleuss JA (1989) Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int 35(2):688–695

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. H. Kim.

Ethics declarations

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Electronic supplementary material

ESM 1

(DOCX 26 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kong, S.H., Kim, J.H., Hong, A.R. et al. Dietary potassium intake is beneficial to bone health in a low calcium intake population: the Korean National Health and Nutrition Examination Survey (KNHANES) (2008–2011). Osteoporos Int 28, 1577–1585 (2017). https://doi.org/10.1007/s00198-017-3908-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-3908-4

Keywords

  • DXA
  • General population studies
  • Menopause
  • Nutrition
  • Osteoporosis