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Osteoporosis is a problem in elderly, adolescence and adult. Osteoporosis can be overcome by high intake of calcium, vitamin, and fiber. Chinese cabbage (Brassica rapa) is composed of rich in fiber, high calcium, and flavonoid. Key lime (Citrus aurantifolia) is rich in vitamin C. The objective aimed to evaluate Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice on bone mass density (BMD) in menopausal women. The study was pre-post control group design conducted in integrated health post. The samples were 32 menopausal women recruited by purposive sampling. The beverage can be prepared of 400 g Chinese cabbage (B. rapa), 2 key lime (C. aurantifolia), water, and salt. The juice was taken once for 2 days during 7 weeks to enhance BMD in menopausal women (p = 0.003). This suggestion is take it before a meal at least 30 days. The advantage of the juice is important to enhance BMD, particularly extremity. The fiber is as prebiotics to improve the gut microbiome as probiotics and as a laxative to help defecation. The juice is rich in vitamin C and flavonoid as an antioxidant on reactive oxygen species and acidosis in adolescence, adult, and elderly.
Poltekkes Kemenkes Semarang, Semarang, Central Java, Indonesia
*Address all correspondence to: muh.mardiyono@gmail.com
1. Introduction
Osteoporosis as a systemic bone disease is always accompanied by low BMD and causes the decrease of bone-forming substances in bone tissue with the consequence of rapid fracture and damage. Based on the United States National Institutes of Health Osteoporosis is defined as a bone disorder with decreased bone strength characteristics that can trigger an increased risk of fracture in a person [1]. By projection, 200 million people will suffer from bone hip fractures due to osteoporosis in China [2]. In the year 2050, the number of people with osteoporosis will increase by two times as much in women and three times as much in men. Women aged 40–60 years of premenopause and menopause lack the intake of foods containing vitamins C, D, calcium minerals, and do not consume calcium supplements. In women, premenopause and menopause osteoporosis is due to multifactorial due to less intake of foods rich in calcium and elderly age factor. Elderly women also experience a lack of intake of vitamins C and D, affecting the absorption of calcium minerals, let alone calcium intake deficiency which results in type II osteoporosis [3].
Women who have experienced menopause and reproductive organ dysfunction undergo a decline in function. In particular, estrogen and progesterone hormone cannot work properly to stimulate osteoblast, which leads to osteoporosis. Bone mass loss can occur due to several factors that might contribute to osteoporosis, including lack of minerals, exercise, vitamin D, nutrition, and hormonal changes [4]. Intake of calcium that is recommended for age > 50 years (women post-menopause) is 1300–1500 mg calcium/day [5].
Osteoporosis is one of the most dominant problems that is often found in the elderly over 50 years, especially commonly found in menopausal women [6]. There is an association between the intake of calcium, physical activity, parity, body mass index, and bone mass density in postmenopausal females [7]. Metabolism calcium during advanced age is a gradual decline.
Prevention of osteoporosis in menopausal women can be done by consuming vegetables high in calcium and vitamins. In general, people have a calcium average of 254 mg/day, one-fourth of the normal intake in older people. Insufficiency of calcium can be overcome by calcium supplements and adequate intake of food and drink, meat, milk, egg, and rich in calcium. Green vegetables, including papaya (Carica papaya), sweet leaf (Sauropus androgynus), moringa leaf (Moringa oliefera), and Chinese cabbage (Brassica rapa) leaves contain high calcium. Calcium requires vitamin D metabolism and vitamin C to enhance bone mass density. Prevention of osteoporosis physical activity and sedentary behavior based on WHO guidelines [8].
Osteoporosis is a disease that can be treated and overcome by both consumption of supplements and high calcium foods. The consumption of food is a source of high calcium, among other things: milk, cheese, yogurt or broccoli, salmon, tofu, almonds, and vegetable mustard. One of the ways increases bone mass density is by consuming high calcium in beverage, vegetable, food, and in adolescence, adulthood, and the elderly, in particular menopause.
Osteoporosis is dubbed as the Silent Epidemic Disease because it silently attacks without any signs, in particular the process of osteopenia, which is a condition of the loss of bone mass density.
Osteoporosis is categorized into primary and secondary. Primary osteoporosis is the most common form of the disease, including postmenopausal osteoporosis (type I) and senile osteoporosis (type II). Postmenopausal osteoporosis (type I) occurs in women within 15–20 years after menopause and is thought to result from factors related to or exacerbated by estrogen deficiency. Age-related osteoporosis (type II) occurs in men and women over 75 years of age and may be more directly related to aging [3].
The causes of osteoporosis are genetics, hypocalcemia, deficiency of vitamins, lack of activities, advanced age, and constitutional (race, type of sex, etc.). Because genetic and constitutional factors can be impossibly manipulated, the rest factors can possibly intervene, such as nutrition with sufficient calcium intake, physical activity, vitamin D, and sunshine. Intake of calcium that is recommended for age > 50 years is 1300–1500 mg calcium/day.
Osteoporosis is one of the most dominant problems that is often found in the elderly over 50 years, especially commonly found in menopausal women. Metabolism of calcium during elderly declines gradually. The occurrence of osteoporosis is increasing due to the peak period of bone formation until 30 years have been exceeded. After 30 years, men and women experience an average bone mass loss of about 0.5–1% per year and bone loss in women earlier and faster than men [9].
Osteoporosis can be caused by calcium insufficiency. Calcium is absorbed in the small intestines aided by vitamin C. Vitamin D also helps the absorption of calcium. If vitamin D in blood is low, it will be taken from bone. Lack of calcium lowers bone mass density, which is known as osteoporosis. Vitamin K helps osteocalcin compound, which plays the role of calcium formation to form mineral structures in bones.
Osteoporosis is also caused by a lack of fiber intake. Fibers provide probiotics in small intestines and function to enhance calcium absorption and bone indices. The influence of prebiotics on increasing mineral absorption and enhancing bone properties through shifts in gut microbiota offers a strategy to improve calcium nutrition and bone health [10]. The effects of probiotics can increase bone mass density and bone mineral content, which help reduce osteoporosis [11].
Measurement of bone mass density is to calculate the density of calcium by using a beam X, CT scan, and ultrasound. Examinations can be taken by tools:
3.1 Dual-energy X-ray absorptiometry (DEXA)
This is the best method for determining bone mass density. The test is truly non-invasive and does not require needles or liquid. The tool consisting of two different X-rays can be used to measure spinal mass and groin mass. DEXA is the most accurate method for measuring bone mineral density. This tool is very fast and only uses radiation with low doses [12].
It is a modification of DEXA. P-DEXA machine is easy to be carried, uses X-ray radiation in very small doses, and the results are faster than conventional DEXA. P-DEXA is a measure for bone mass density of limbs such as wrists but cannot be measured for bone mass density at risk of fractures such as the spine or groin [13].
3.3 Dual Photon Absorptiometry (DPA)
DPA is a very low radiation and takes a long time to increase bone mass density [14].
3.4 Quantitative computed tomography (QTC)
Models from CT scans can measure the density of the mass of backbone. One of the models of QTC is the so-called peripheral QCT (pQCT), which can be measured bone mass density, such as wriest and hand. In general, measurement with QCT is not recommended because it is very expensive and the use of radiation is a dose higher and less accurate than with DEXA, PDEXA, or DPA [15].
3.5 Hand radiography
In engineering-based beams of X‘s, hand radiography can be measured for bone mass density. The images are sent to a data processing center to determine bone mass density. The results are available as quickly as techniques on top of the compute bome mass density [16].
3.6 Quantitative ultrasound bone densitometry
Quantitative ultrasound does not let a person expose to radiation because it uses sound instead of light X. The beam can penetrate bone and soft tissue, and the reduction of strong signals waves of sound can penetrate parts of the body and unstructured bone. It is usually to measure upper and lower limb bones, because the ultrasound is good for predicting a broken hip bone and all types of broken bones [17]. The measurement value consists of normal = Sd > −1, osteopenia = −2.5 ≤ Sd < −1 without fracture, osteoporosis = Sd < − 2.5 without bone fracture. Osteoporosis weight = Sd < − 2.5 with a broken bone.
The study was pre posttest control group design and conducted in the integrated health post in the community base to evaluate the consumption of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice in enhancing BMD in menopausal women. The samples were 32 subjects of menopausal women aged 40–60 years old recruited by purposive sampling. The juice can be prepared with 400 gr Chinese cabbage (B. rapa), 2 key lime (C. aurantifolia) and fresh water as well as little salt, which were mixed by blender. The subjects had Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice every 2 days for 7 weeks. Bone mass density in menopausal women was measured by quantitative ultrasound bone densitometry as a baseline and before and after 7 weeks in Figure 1. The data of bone mass density were analyzed by t-test.
Figure 1.
Beverage Chinese cabbage and key lime on bone mass density.
5. Chinese cabbage and key lime juice chemical and sensory characteristics
5.1 Chinese cabbage
Chinese cabbage (B. rapa) is a cheap vegetable and easy to obtain and contains lots rich in fiber, high calcium, flavonoid, and vitamin. Chinese cabbage (B. rapa) contains a lot of minerals and vitamins. Minerals in Chinese cabbage (B. rapa) are manganese, calcium, potassium, copper, iron, and magnesium. 100-gram of Chinese cabbage (B. rapa) contains 220 mg of calcium. Levels of vitamin A, C, E, K, and folate in Chinese cabbage (B. rapa) classified in the category of excellent. Chinese cabbage (B. rapa) also excellent in terms of acidic amino tryptophan and fiber food, vitamin B6, B2, K, and protein. The content of vitamin K of vitamin reaches 419.3 mkg per 100 gr. Vitamin K is also related to the regulation of bone protein and calcium in bones and blood, so that it can protect bones from the process of osteoporosis. Without the role of vitamin K, osteocalcin as a protein bone cannot work normally. Vitamin K is very useful in helping the process of blood clotting, so it is referred to as vitamin coagulation. Vitamin K has the potential to prevent diseases such as stroke and heart disease. It can reduce the hardening of blood vessel by a factor of pile plaque calcium. Vitamin K also relates to the regulation of bone protein and calcium in bone and blood. Consumption of one cup of Chinese cabbage (B. rapa) has been able to meet the needs of the body will be vitamin K per day.
5.2 Key lime
Key lime (C. aurantifolia) contains calcium 40 mg/100 g and phosphate 22 mg, vitamin C 27 mg/100 g, acid citrate as much as 7 to 7.6%, acid amino (tryptophan, lysine), oil volatile (citral, limonene, felandren, lemon camphor, kadinen, geranil asetat, linali-lasetat, aktil aldehid, and nonildehid), resins, glycosides, acid citric, fats, iron, sulfur, vitamin B1 and C. Key lime (C. aurantifolia) also composes of saponins and flavonoids, such as hesperidin (hesperetin 7-rutinosida), tangeretin, naringin, eriocitrin, eriocitrocide. Hesperidin is useful for anti-inflammatory, antioxidant, and inhibits prostaglandin synthesis [18].
5.3 Juice of Chinese cabbage and key lime
Preparation of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice follows as materials and water: 1) 400 gr of Chinese cabbage (B. rapa) are cut in small then put it in a blender, 2) two key lime (C. aurantifolia), each of the one cut into two pieces and squeeze the piece of key lime (C. aurantifolia) into the blender, 3) pour little salt, 4) steer them for approximately 10 minutes up to juicy, 5) prepare a cup for the juice. The juice was served in fresh beverage juice taken every 2 days for 7 weeks.
6. Evidence of Chinese cabbage and key lime on bone mass density
It was studied in 40–60 years old and menopausal women, and there was no difference in bone mass density between intervention and control group at baseline (t = −0.29, p = 0.77). The intervention of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice every 2 days for 7 weeks. The finding reports that the beverage of juice could significantly improve bone mass density in menopausal women (t = 3.22, p = 0.003) in Table 1 [19].
Group
Before
After
t
p
Mean
Sd
mean
Sd
Intervention
−3.08
0.78
−2 5 4
0.69
3.22
0.003
Control
−3.22
0.54
−3.19
0.33
Table 1.
Difference in bone mass density in premenopausal and menopausal women between intervention and control groups (n = 32).
A previous study reports that the consumption of a Mediterranean diet containing vegetables and fruit effectively improves bone mineral density in postmenopausal women in Spain [20]. It can be discussed that green grapefruit juice composed of 100 gr, 50 gr strawberries, 1 sweet orange, and 1 star fruit consumed every day can prevent osteoporosis in the elderly. The preparation of mustard green juice 200 gr, 200 gr pineapple and honey consumed daily can also prevent osteoporosis in the elderly. Chinese cabbage (B. rapa), containing high calcium is good for preventing osteoporosis in women menopause in Korea [21].
Another article elaborates that mustard Greens 100 gr, strawberry 50 gr, 1 orange sweet, and one leatherback consumed every day can prevent the occurrence of osteoporosis in the elderly. The preparation of juice of mustard Greens 200 gr, 200 gr pineapple and honey consumed every day can prevent the occurrence of osteoporosis in elderly.
In general, people have calcium average of 254 mg/day, one-fourth of the normal intake in older people. Insufficiency of calcium can be overcome by calcium supplements and adequate intake of food and drink, meat, milk, egg, and rich in calcium. Green vegetables, including papaya (C. papaya), sweet leaf (S. androgynus), moringa leaf (Moringa oliefera), and Chinese cabbage (B. rapa) contain high calcium. Calcium requires vitamin D metabolism and vitamin C to enhance the bone mass density and bone mineral content [11].
7. Metabolism of Chinese cabbage and key lime juice
Absorption of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice occurs in small intestines, which are duodenum, jejunum, and ileum (see Figure 2). Pancreatic gland produces substances that can neutralize the acidity of food in the stomach. Liquid bile also flows through duct bile into the intestines to help fat emulsion. Absorption of macronutrients including glucose, lipid, protein, mineral, particular calcium, magnesium, potassium, phosphorus, and vitamin occurs in small intestines. Vitamin C of key lime (C. aurantifolia) can help with optimal absorption of calcium.
Figure 2.
Metabolism of fiber, calcium and vitamin on bone mass density.
Amino acids can also maximize the process of calcium absorption in the small intestine. Acidic amino lysine is required in the absorption of calcium in Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice. Vitamin D has the ability to regulate the balance of the composition of calcium and phosphorus in the process of bone formation. Vitamin D also can maintain muscle strength, build, and repair bone fractures. Vitamin K also enters the flow of blood through the walls of the intestine by entering a membrane semi-permeable to the process of diffusion and osmosis.
Vitamin K helps the compound osteocalcin, which plays a role in mineral absorption, form the mineral’s structure and become bones strong, so it can decrease the risk of osteoporosis. Potassium has the benefit of maintaining the health of bones and preventing bone loss. In addition, potassium has the ability to absorb and help restore calcium to bones.
In addition, magnesium plays an important role in helping the process of absorption of calcium into the bones. The process of absorption of calcium by magnesium is by stimulating calcitonin hormone, which is useful to attract calcium in the blood back toward the bone. Magnesium will also alter vitamin D into a compound that is more active in the absorption of calcium from blood to bones.
Parathyroid hormone functions to control the concentration of calcium in the fluid extracellular, which does not affect the place of transfer of calcium into the end of the bone, resorption in kidney, and the absorption of tract digestion. Calcitonin is a 32 amino acids polypeptide hormone secreted by parafollicular cells (C-cells) from the thyroid. Calcium concentration in extracellular fluid is the main stimulus for calcitonin secretion by C-cells. The rate of secretion of calcitonin increases rapidly with the discharge of hormones that are stored on the C-cells into the capillary interfollicular. When blood calcium is lowered, the stimulus for calcitonin secretion decreases. Storage of major hormone preforms in C-cells and releases rapidly in response to a rise moderately in circulation. Calcium may reflect the role of physiology in keeping homeostasis calcium. Phosphorus maintains the strength of the bone because the component of bone is salt calcium phosphate. The intake of less phosphorus will result in the production of calcium, so that bones become brittle [9].
Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice is also rich in fiber as prebiotics helping synthesis of vitamins. Vitamins like D, C, K, and folate are involved in the metabolism of calcium and are necessary for bone formation. Moreover, fiber promotes probiotics-Lactobacillus acid bacteria, which improve gut microbiome. Fiber also produces short-chain fatty acids, which decrease parathyroid hormone and increase mineral absorption via their solubilization [22]. High fiber intake significantly helps defecation.
8. The advantages of Chinese cabbage and key lime juice
The main advantage of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice is important to enhance bone mass density and prebiotics as follows:
Chinese cabbage (B. rapa) and Key lime (C. aurantifolia) juice, which is rich in calcium and vitamin C consumed every 2 days for 7 weeks, may increase the density of the mass of bone significantly in women aged 40–60 years of premenopausal and menopausal women.
Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice, also composed of fiber, is useful as prebiotics to improve gut microbiome to enhance vitamin synthesis.
Chinese Cabbage (B. rapa) and key lime (C. aurantifolia) juice is rich in fiber as a laxative to help with defecation.
The Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice is rich in flavonoid as an antioxidant of reactive oxygen species and acidosis in adolescents, adult, and elderly.
Consumption of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice every 2 days for 7 weeks may increase the density of the mass of bone in women aged 40–60 years of premenopausal and menopausal women in regard to the research (p = 0.003). Furthermore, the beverage can be prepared by ourselves at home, and the best time to drink it is before having breakfast or a meal.
The juice containing high calcium, vitamin C, and fiber can increase bone mass density for at least 7 weeks to prevent and recover osteoporosis in adolescence, adult, and the elderly, in particular premenopausal and menopausal women.
The acknowledgment is devoted to Ministry of Health of Indonesia to grant the research fund on the effect of Chinese cabbage (B. rapa) and key lime (C. aurantifolia) juice on bone mass density in menopausal women.
Conflict of interest
There is no conflict of interest to this book chapter.
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Written By
Mardiyono Mardiyono
Submitted: 25 January 2023Reviewed: 09 February 2023Published: 25 September 2024
Open access peer-reviewed chapter
