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is due to osteoclast-activated bone resorption. 7 More
recently, isotope studies in humans have shown greater
calcium retention and absorption in individuals who
consume a high-protein diet. Many epidemiological
studies show a significant positive relationship between
bone mass and dietary protein intake; however, no
studies have found a positive relationship between pro-
tein intake and decreased incidence of fractures. 7 No
studies examining the role of protein intake on bone
mass specifically for persons with OI were found.
For a healthy person with OI, the DRI for protein is
likely to be adequate. A balanced diet that includes ani-
mal and/or plant proteins is likely to meet the DRI for
protein; in fact, the typical westernized diet provides
several times the DRI for protein.
activity lead to decreased energy needs. Individuals
with limited mobility or physical activity will need
to be careful to meet their total nutrient needs while
preventing unwanted weight gain. For persons on a
reduced kcalorie diet to treat overweight or obesity, the
assistance of a registered dietitian (RD) may be help-
ful to ensure adequate intake of protein, vitamins and
minerals.
Weight management strategies for individuals with
OI are the same as those for persons without OI. Some
suggestions include:
Choose low-fat, high-nutrient foods
Choose foods without added sugar
Avoid high-kcaloric drinks; choose non-kcaloric
drinks such as water, unsweetened tea and plain
coffee; use non-kcaloric sweeteners; add non-fat milk
to coffee, tea or hot chocolate
Choose low-fat or non-fat dairy foods
Consult with an RD about food choices that manage
kcalories while providing adequate nutrition
If kcaloric needs are low, a complete vitamin-mineral
supplement may be beneficial to ensure adequate
intake of micronutrients
Be as physically active as safely possible
Consult with a physician or physical therapist
regarding safe, appropriate ways to increase
physical activity.
Fats
Fat is an essential nutrient, used by the body as a
concentrated energy source to maintain and repair cell
membranes, as a component of organs including the
brain and as a building block for several hormones.
Dietary fat is the most energy dense of the macronu-
trients, providing approximately 9 kcalories/gram. In
general, foods of animal origin, such as meat, fish, eggs
and dairy, include a higher proportion of saturated fats,
while most plant oils are comprised of a greater per-
centage of unsaturated fats. As is well known, a higher
intake of saturated fat is associated with an increased
risk of several chronic diseases, included hypertension
and CVD.
The IOM has set acceptable macronutrient distri-
bution ranges (AMDR) for protein, carbohydrate and
fat. 3 For healthy adults, the AMDR for total dietary
fat is estimated to be 20-35% of kcalories. The Dietary
Guidelines for Americans 2010 (Chapter 3) 8 recommend
that no more than 10% of kcalories come from saturated
fat, with the remaining fat kcalories coming from poly-
unsaturated and monounsaturated fatty acids, found in
fish, nuts and vegetable oils. Other recommendations
are to keep trans fat intake as low as possible, and to
consume less than 300 mg of cholesterol daily.
Adults with OI face the same risks for coronary
heart disease, type 2 diabetes and other chronic dis-
ease as do all adults; therefore, it is prudent to follow
the same guidelines. There is clinical evidence that
individuals with OI severe enough to compromise
mobility may experience excess weight gain. 9 In that
context, it seems prudent to follow a diet low in total
fat and especially in saturated fat. The DASH (Dietary
Approaches to Stop Hypertension) diet 10 has been
shown to be effective in reducing blood pressure. It pro-
vides effective guidelines in a user-friendly format.
Information and diet plans can be found at http://
dashdiet.org/ . 11
Protein
The primary roles of dietary protein in the body
of a healthy human are growth and maintenance
of body tissues including enzymes, hormones and
antibodies, to assist in maintaining fluid and elec-
trolyte balance and acid-base balance, and to pro-
mote blood clotting. Although it is not primarily an
energy source, protein in a typical mixed diet may
provide about 15% of daily energy use. 5 The Institute
of Medicine has set DRIs for protein that meet the
protein needs of healthy people. The DRIs vary based
on age, gender and life-cycle stages where needs
are higher. Protein needs are increased during preg-
nancy and lactation, and with illness, after surgery or
with metabolic stress. Whether protein needs increase
with major fractures has not been established. The
DRI for protein for all life stage groups is available in
print 3 or online at http://fnic.nal.usda.gov/dietary-
guidance/dietary-reference-intakes/dri-tables 4 or at the
National Academy Press website at http://www.nap.
edu/topics.php/topic=380 . 6
The role of protein in bone health has been contro-
versial. Increased protein intake results in increased uri-
nary calcium excretion, and one school of thought has
been that calciuria associated with high protein intake
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