Elsevier

Bone Reports

Volume 12, June 2020, 100274
Bone Reports

The effects of vitamin K-rich green leafy vegetables on bone metabolism: A 4-week randomised controlled trial in middle-aged and older individuals

https://doi.org/10.1016/j.bonr.2020.100274Get rights and content
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Highlights

  • Habitual dietary vitamin K1 from green leafy vegetables reduces serum tOC and ucOC.

  • Vitamin K recommendations <100 μg/d do not support the maximal carboxylation of OC.

  • 200 g/d of green leafy vegetables over 4 weeks improves vitamin K status (ucOC:tOC).

Abstract

Background

High vegetable intake is associated with beneficial effects on bone. However, the mechanisms remain uncertain. Green leafy vegetables are a rich source of vitamin K1, which is known to have large effects on osteoblasts and osteocalcin (OC) metabolism.

Objective

To examine the effects of consumption of two to three extra serves of green leafy vegetables daily on bone metabolism.

Methods

Thirty individuals (mean age 61.8 ± 9.9 years, 67% male) completed three experimental phases in a randomised controlled crossover design, each lasting four weeks, with a washout period of four weeks between phases (clinical trial registration: ACTRN12615000194561). The three experimental phases were: (i) increased dietary vitamin K1 by consuming green leafy vegetables (H-K; ~200 g/d containing 164.3 [99.5–384.7] μg/d of vitamin K1); (ii) low vitamin K1 by consuming vitamin K1-poor vegetables (L-K; ~200 g/d containing 9.4 [7.7–11.6] μg/d of vitamin K1); and (iii) control (CON) where participants consumed an energy-matched non-vegetable control. OC forms, total OC (tOC), carboxylated OC (cOC) and undercarboxylated OC (ucOC), were measured in serum pre- and post-intervention for each experimental phase using a sandwich-electrochemiluminescence immunoassay.

Results

Pre-intervention tOC, ucOC and ucOC:tOC levels were similar between phases (P > .05). Following H-K, but not L-K, tOC, ucOC and ucOC:tOC levels were significantly lower compared to pre-intervention levels (P ≤ .001) and compared to CON (~14%, 31% and 19%, respectively, all P < .05), while cOC remained unchanged.

Conclusions

In middle-aged healthy men and women, an easily achieved increase in dietary intake of vitamin K1-rich green leafy vegetables substantially reduces serum tOC and ucOC suggesting increased entry of OC into bone matrix, where it may improve the material property of bone. In conjunction with previous epidemiological and randomised controlled trial data, these findings suggest that interventions to increase vegetable intake over extended periods should include bone end points including fracture risk.

Abbreviations

BMD
bone mineral density
GCMS
gas-chromatography mass spectrometry
cOC
carboxylated osteocalcin
CON
control
CTX
collagen type I C-terminal cross-linked telopeptide
FFQ
food frequency questionnaire
H-K
experimental phase with high vitamin K1 intake
L-K
experimental phase with low vitamin K1 intake
METs
metabolic equivalents
MK
menaquinones
PK
phylloquinone
P1NP
N-terminal propeptide of type I collagen
RCT
randomised controlled trial
OC
osteocalcin
tOC
total osteocalcin
ucOC
undercarboxylated osteocalcin
ucOC:tOC
fraction of undercarboxylated osteocalcin
USDA
United States Department of Agriculture
VIABP
Vegetable intake and blood pressure study
VKDP
vitamin K dependant proteins

Keywords

Ageing
Nutrition
Bone
Osteocalcin
Vitamin K

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1

Both authors contributed equally.