title: Diarrhea caused by enterotoxigenic Escherichia coli infection of humans is inhibited by dietary calcium.
abstract: OBJECTIVE
  In several rat infection experiments, we have shown that dietary calcium inhibits intestinal colonization and translocation of invasive salmonella. The aim of the present study was to find out whether calcium is also protective against enterotoxigenic Escherichia coli (ETEC) infection. This was first tested in our rat model and subsequently verified in a human infection study.
  
  
  METHODS
  Rats were fed a purified diet with either a low or a high amount of calcium phosphate and orally infected with ETEC. In addition, a parallel, double-blind, placebo-controlled intervention study of 3 weeks was performed with 32 healthy men. Subjects largely maintained their habitual diet and consumed either regular milk products (calcium supply, 1100 mg/day) or placebo milk products (calcium supply, 60 mg/day). On day 10, subjects ingested a live but attenuated ETEC strain (strain E1392/75-2A), able to induce mild although short-lived symptoms. Primary outcomes studied were infection-induced diarrhea (total fecal output and relative fecal dry weight) and fecal mucin excretion.
  
  
  RESULTS
  In humans, ETEC induced diarrhea in both groups, in that total fecal output doubled and mean relative fecal dry weight dropped from 25% to 20%. Additionally, fecal mucin excretion was increased in both groups. All these fecal parameters were completely normalized in the calcium group on the second infection day, in contrast to the placebo group, which recovered on the third infection day. Likewise, supplemental calcium inhibited ETEC colonization and diarrhea in rats.
  
  
  CONCLUSIONS
  Calcium in milk products improves human resistance to ETEC infection as it inhibits infectious diarrhea.
authors.affiliation: Nutrition and Health Program, Wageningen Center for Food Sciences/NIZO Food Research, P.O. Box 20, 6710 BA Ede, The Netherlands. Ingeborg.Bovee@nizo.nl
authors.forename: Ingeborg M J
authors.initials: IM
authors.lastname: Bovee-Oudenhoven
authors.forename: Mischa L G
authors.initials: ML
authors.lastname: Lettink-Wissink
authors.forename: Wim
authors.initials: W
authors.lastname: Van Doesburg
authors.forename: Ben J M
authors.initials: BJ
authors.lastname: Witteman
authors.forename: Roelof
authors.initials: R
authors.lastname: Van Der Meer
mesh_terms: D000328:Adult; D000818:Animals; D002136:Calcium, Dietary / Q000008:administration & dosage*; D003967:Diarrhea / Q000517:prevention & control*; D004311:Double-Blind Method; D004927:Escherichia coli Infections / Q000517:prevention & control*; D005243:Feces / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D051381:Rats; D017208:Rats, Wistar
chemical_list: D002136:Calcium, Dietary; D009077:Mucins