title: Effect of calcium supplementation on rectal epithelial hyperproliferation in intestinal bypass subjects.
abstract: OBJECTIVE
  Fatty acids and bile acids are tumor promoters of experimental colon cancer in rats. Calcium can inhibit their effects. After intestinal bypass (IB), fecal bile acid and lipid levels increase markedly. In rats, IB increases colonic cell proliferation and carcinogen-induced colon tumor incidence. Whether fecal bile acids and lipids influence rectal epithelial proliferation in humans is uncertain. This study compared rectal epithelial proliferation in IB subjects and in controls matched for age, sex, and body mass index and investigated the effects of calcium carbonate supplementation (2400 or 3600 mg Ca2+/day for 12 weeks) on proliferation indices in IB subjects.
  
  
  METHODS
  Epithelial proliferation was studied by in vitro incubation of rectal biopsy specimens with [3H] thymidine. Twenty-four-hour stool collections were assayed for bile acids, lipids, and calcium.
  
  
  RESULTS
  Whole crypt labeling index (LI) and upper crypt LI were increased in IB subjects compared with controls (P < 0.005). Calcium reduced whole crypt LI by 38% (P < 0.001) and upper crypt LI by 56% (P < 0.05). Levels of fecal bile acids (4.5 mmol/day) and lipids (131.9 g/day) were markedly elevated in IB subjects (P < 0.005).
  
  
  CONCLUSIONS
  IB induces rectal hyperproliferation and expansion of the proliferative zone in association with excessive output of fecal bile acids and lipids. Oral calcium reverses the proliferative changes.
authors.affiliation: Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: G
authors.initials: G
authors.lastname: Steinbach
authors.forename: J
authors.initials: J
authors.lastname: Lupton
authors.forename: B S
authors.initials: BS
authors.lastname: Reddy
authors.forename: J G
authors.initials: JG
authors.lastname: Kral
authors.forename: P R
authors.initials: PR
authors.lastname: Holt
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001647:Bile Acids and Salts / Q000032:analysis; D015992:Body Mass Index; D002118:Calcium / Q000008:administration & dosage / Q000032:analysis / Q000494:pharmacology*; D002455:Cell Division / Q000187:drug effects; D004247:DNA / Q000378:metabolism; D004847:Epithelial Cells; D005243:Feces / Q000737:chemistry; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007581:Jejunoileal Bypass; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000166:cytology*; D013936:Thymidine / Q000378:metabolism; D014316:Tritium
chemical_list: D001647:Bile Acids and Salts; D008055:Lipids; D014316:Tritium; D004247:DNA; D002118:Calcium; D013936:Thymidine