Space Nutrition:
Clinical, Operational,
and Research
Implications
Clinical Nutritional Assessment/MedB8.1
Nutritional Status Assessment Experiment
(aka Nutrition SMO)
Bone and Calcium
Human Body
Diet
Stomach
and
Intestines
Excretion
Feces
Secretion
Absorption
Calcium
Pools
Deposition
Bone
Urine
Excretion
Resorption
+49%
+24%
URINE PROCESSOR
ASSEMBLY
Recycle Filter
Tank Assembly
Distillation
Assembly
H2O
Recovery (%)
85
RFTA
Throughput (L)
273
Recovered
Water (L)
232
Urine → Water
In 2010, SSP opted to reduce water recovery from 85% to 70%.
H 2O
RFTA
Recovered
Throughput (L)
Water (L)
85
273
232
80
204
164
75
164
123
70
136
95
Recovery (%)

We have reevaluated Nutrition SMO data in light of 10
additional crewmembers…
Ca excretion
6000
24 h urine volume (ml)
600
550
400
300
200
100
5000
4000
3000
2000
1000
0
P
re
flig
h
t
0
In
flig
h
t
Urine Ca Concentration
(mg/dL)
Calcium Excretion
(mg/day)
Urine Volume
40
Preflight
Ca Concentration
30
70%
20
85%
10
0
P
re
flig
h
t
In
flig
h
t
Inflight
Urine volume (ml/d)
5000
400
200
4000
3000
2000
1000
0
0
2006
2007
2008
Urine calcium concentration
(mg/dl)
Urine calcium (mg/d)
600
2009
2010
2011
2006
2007
2008
40
30
70%
20
85%
10
0
206
207
208
209
2010
Year of collection
201
2009
2010
2011
Fluid Intake
Inflight urine Ca (mg/dl)
40
30
70%
75%
20
10
0
0
10
20
30
40
50
Inflight mean fluid intake (ml/kg BW)
With one exception, all voids were below 23.7 mg/dl when fluid
consumption was >32 ml fluid/kg BW. For these 23
crewmembers = 2.5 L/day fluid consumption (food/beverages).
13
13
14
15
23
12
12
22
11
11
23
9
10
9
10
20
21
22
8
8
18
19
20
21
7
7
17
6
6
5000
2500
2500
14
15
16
5
4
3
5
Urine volume (ml/d)
1
600
550
500
450
400
350
300
250
200
150
100
50
0
2
mg/day
Renal Stone Risk
2000
1500
1000
500
17
18
19
16
4
3
2
1
0
Increased fluid intake (and increased urine volume)
will reduce risks to the crew and the UPA.
Recovery Plan
• 70% → 74% shift would increase water recovery by
more than 200 L (or kg) per year…and > 7 hours
crew time/year not changing tanks as often
• Forward work:
• Continue to educate crews on importance of fluid
intake relative to renal stone and UPA risks.
• Continue to monitor urine data to track changes
Bone and Calcium
Human Body
Diet
Stomach
and
Intestines
Excretion
Feces
Secretion
Absorption
Calcium
Pools
Deposition
Bone
Urine
Excretion
Resorption
Calcium Isotopes
48Ca
Bone formation favors
light Ca isotopes
46Ca
44Ca
43Ca
42Ca
40Ca
Calcium Isotopes
48Ca
46Ca
44Ca
Higher δ44Ca = “heavier”
Lower δ44Ca = “lighter”
Skulan and DePaolo (1999); PNAS
43Ca
42Ca
40Ca
Calcium Isotopes
48Ca
46Ca
44Ca
43Ca
42Ca
Bone formation favors
light Ca isotopes
No isotope discrimination
during bone resorption
40Ca
Calcium Isotopes
Change in δ 44/42Ca vs. pre
2
1
0
-1
-2
-3
-4
-5
-10
0
10
20
30
40
Days
30-d bed rest: -0.25 ± 0.07%
119-d bed rest: -1.36 ± 0.38%
DXA 119-d bed rest: -1.5 ± 1.0%
Morgan et al., PNAS, 2012
Mir E1-13/iRED
iRED
Nutrition SMO 8
ARED
5
Vitamin D Stores
110
100
90
80
70
60
50
40
30
20
10
0
(25(OH)Vitamin D)
125
100
nmol/L
75
50
25
0
iRED (early) iRED
ARED
Pr
e
M
Mir
ea
n
L10
FD
15
FD
30
FD
6
FD 0
12
FD 0
18
0
R
+0
R
+3
0
Energy Intake
(% WHO Requirement)
Energy Intake/Vitamin D
Smith et al, J Bone Miner Res, 2012
Body Composition
Lean Body Mass
Total Body Fat
10
2
% change/month
% change/month
3
1
0
-1
-2
Mir
iRED
iRED
(E1-13) (E14-18)
Smith et al, J Bone Miner Res, 2012
ARED
5
0
-5
-10
Mir
iRED
iRED
(E1-13) (E14-18)
ARED
+0
R
+
R 2
+3
0
R
26
17
12
9
6
4
2
+3
0
160
140
120
100
80
60
40
20
0
-20
-40
-60
R
+0
R
FD
60
FD
12
0
FD
18
0
FD
30
FD
15
BSAP (% change)
180
160
140
120
100
80
60
40
20
0
0
ARED
iRED
Mir
Pr
e
Urine NTX (% change)
Bone Metabolism
Week
Bone resorption is increased during flight, and unaffected by exercise.
Bone formation tended (P<0.06) to be increased in RE crews.
120
100
80
60
40
20
0
-20
-40
-60
-80
Smith et al, J Bone Miner Res, 2012
ARED
iRED
Mir
FD
15
FD
30
FD
60
FD
12
FD 0
18
0
R
+0
R
+3
0
Pr
e
PTH (% change)
Parathyroid Hormone
Bone Mineral Density
BMD Spine
% change/month
1
0
-1
Whole Body BMD
-2
-3
0.5
-4
Mir
iRED
iRED
ARED
BMD Pelvis
% change/month
0
-1
-2
-3
Mir
iRED
iRED
ARED
(E1-13) (E14-18)
% change/month
(E1-13) (E14-18)
0.0
-0.5
-1.0
BMD Trochanter
% change/month
0
-1.5
Mir
-1
iRED
iRED
ARED
(E1-13) (E14-18)
-2
-3
Mir
iRED
iRED
ARED
(E1-13) (E14-18)
Smith et al, J Bone Miner Res, 2012
Forward Work
Bone Strength?
Fracture risk?
↑ resorption
↑ formation
Optimization
Exercise
Diet
One-Carbon Metabolism
Enzymes
 Proteins, amino acid strings
 assembled from amino acids
based on “blueprints”
Enzyme Polymorphisms
 poly = multiple, “morph” = forms
 For many (all?) enzymes, there are
small differences in blueprints across
the population (e.g., blood types)
MTHFR
MTHFR C677T Polymorphism
Everybody has 2 sets of blueprints (mom and dad),
resulting in four possibilities of this polymorphism.
% Pop
C/C
~35%
C/T(T/C) ~50%
T/T
~15%
Enz Act.
100%
~66%
~50%
% Pop
C/C
~35%
C/T(T/C) ~50%
T/T
~15%
Enz Act.
100%
~66%
~50%
Homocysteine, µmol/L
14
12
10
8
6
4
2
0
-180 -45
-10
Preflight
Zwart et al., J Nutrition , 2012
OC+
OC-
P < 0.001, sig. group effect
15
30
60
120 180 R+0 R+30
In-fight day
Postflight
Cystathionine, nmol/L
550
500
350
300
250
200
150
100
50
0
P < 0.001, sig. group effect
-180
-45
-10
Preflight
Zwart et al., J Nutrition , 2012
15
30
60
120
In-fight day
180
R+0
R+30
Postflight
300
2-MCA, nmol/L
250
200
150
100
50
0
-180
-45
-10
Preflight
Zwart et al., J Nutrition , 2012
OC+
OC-
P < 0.001, sig. group effect
15
30
60
120
In-fight day
180
R+0
R+30
Postflight
350
MMA, nmol/L
300
250
200
150
100
50
0
-180
-45
-10
Preflight
Zwart et al., J Nutrition , 2012
OC+
OC-
P < 0.001, sig. group effect
15
30
60
120
In-fight day
180
R+0
R+30
Postflight
Homocysteine, µmol/L
14
12
10
8
6
4
2
0
OC+
OC-
P < 0.001, sig. group effect
-180
-45
-10
Preflight
15
30
60
120
In-fight day
180
R+0
R+30
Postflight
Davis et al., J Nutr 2005
Shelnutt et al., J Nutr 2003
Kluijtmans et al., Blood 2003
These data suggest that one carbon
polymorphism(s) may have a role in
spaceflight-related vision changes.
1C polymorphisms are associated with:
 Increased risk of stroke
 Increased risk of migraine
 Follow-on project underway…
 Results will:
 Inform risks of human space flight
 Inform research
 Inform countermeasure options
Zwart SR, et al. Vision changes
after spaceflight are related to
alterations in folate- and vitamin
B12-dependent one-carbon
metabolism. J Nutrition 142:42731, 2012.
Smith SM, et al. Benefits for bone
from resistance exercise and
nutrition in long-duration
spaceflight: Evidence from
biochemistry and densitometry.
J Bone Mineral Research
27:1896-1906, 2012
Morgan JLL, et al. Rapidly
assessing changes in bone
mineral balance using natural
stable calcium isotopes. PNAS
109:25:9989-94, 2012.
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