Dietary acid load and bone turnover during long-duration spaceflight and bed rest
Open accessAbstract
Background Bed rest studies document that a lower dietary acid load is associated with lower bone resorption.Objective We tested the effect of dietary acid load on bone metabolism during spaceflight.Design Controlled 4-d diets with a high or low animal protein-to-potassium (APro:K) ratio (High and Low diets, respectively) were given to 17 astronauts before and during spaceflight. Each astronaut had 1 High and 1 Low diet session before flight and 2 High and 2 Low sessions during flight, in addition to a 4-d session around flight day 30 (FD30), when crew members were to consume their typical in-flight intake. At the end of each session, blood and urine samples were collected. Calcium, total protein, energy, and sodium were maintained in each crew member's preflight and in-flight controlled diets.Results Relative to preflight values, N-telopeptide (NTX) and urinary calcium were higher during flight, and bone-specific alkaline phosphatase (BSAP) was higher toward the end of flight. The High and Low diets did not affect NTX, BSAP, or urinary calcium. Dietary sulfur and age were significantly associated with changes in NTX. Dietary sodium and flight day were significantly associated with urinary calcium during flight. The net endogenous acid production (NEAP) estimated from the typical dietary intake at FD30 was associated with loss of bone mineral content in the lumbar spine after the mission. The results were compared with data from a 70-d bed rest study, in which control (but not exercising) subjects' APro:K was associated with higher NTX during bed rest.Conclusions Long-term lowering of NEAP by increasing vegetable and fruit intake may protect against changes in loss of bone mineral content during spaceflight when adequate calcium is consumed, particularly if resistive exercise is not being performed. This trial was registered at clinicaltrials.gov as NCT01713634.
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Acidogenic potential of diet correlated with post-flight bone losses in an ISS diet and bone health study.
“This effect was recently documented in a diet and bone health study on ISS, where the acidogenic potential of the diet correlated with post-flight bone losses93.”
From Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars (2020) · cites this paper as [93]
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Lecerf, J., & Coxam, V. (2022) · Pratiques en nutrition · doi:10.1016/j.pranut.2022.09.007
Human Health Risks Relevant to Deep Space Mars Exploration Missions
Patel, Z. S., Gibson, C. R., Mader, T. H., Whitmire, A. M., Norcross, J. R., Thompson, M. S., Nemec-Bakk, A. S., Boerma, M., & Huff, J. L. (2023) · American Institute of Aeronautics and Astronautics eBooks · doi:10.2514/5.9781624106545.0487.0542
Effects of different interventions on microgravity-induced bone loss
Weng, K., He, Y., Yuan, Y. J., & Weng, X. (2025) · Translational Exercise Biomedicine · doi:10.1515/teb-2025-0023
The effect of spaceflight on tissues of the spinal column
Veres, J. E., Almeida, E. A. C., Bailey, J., & O’Connell, G. D. (2026) · Bone Reports · doi:10.1016/j.bonr.2025.101895
Gomes, L. R., Magalhães, I., & Silva, M.-R. G. (2026) · Athena health & research journal. · doi:10.62741/ahrj.v3isuppl.97
Schmidt, S., Fisk, I. D., Yang, N., Saarela, M., & Hessel, V. (2026) · Comprehensive Reviews in Food Science and Food Safety · doi:10.1111/1541-4337.70598
Urinary oxalate excretion in astronauts during long‐duration spaceflight: an exploratory analysis
Villanueva-Congote, J., Smith, S., Hansen, N. F., Dalton, R. M., James, E., Buckey, J. C., Wollin, D. A., & Sobel, D. W. (2026) · British Journal of Urology · doi:10.1111/bju.70484
Self-citation
- Authors
- Zwart, S. R., Rice, B. L., Dlouhy, H., Shackelford, L. C., Heer, M., Koslovsky, M. D., & Smith, S. M.
- Affiliations
- Universities Space Research Association (US)
- Wyle (United States) (US)
- National Aeronautics and Space Administration (US)
- University of Bonn (DE)
- Corresponding author
- Smith, Scott M
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 107
- Issue
- 5
- Pages
- 834-844
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC6862931
- OpenAlex
- W2802744438
- Cited by
- 42
- References
- 56
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 7 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 1
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Human Health Countermeasures Element of the NASA Human Research Program (psychoceramics-1152342)
- Institute for Translational Sciences at the University of Texas Medical Branch (abc-001, abc-002)
- National Center for Advancing Translational Sciences (UL1TR000071)
- German Aerospace Center DLR, Space Program (50WB1231)
- Topics
- Health Sciences › Medicine › Physiology › Spaceflight effects on biology
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Keywords
- dietary acid load, bone turnover, spaceflight, bed rest, bone resorption, net endogenous acid production, N-telopeptide, bone-specific alkaline phosphatase, urinary calcium, bone mineral content, astronauts, dietary sulfur, dietary sodium, resistance training, bone loss
- MeSH terms
- Acids, Adult, Bed Rest, Bone and Bones, Calcium, Diet, Dietary Proteins, Female, Food Analysis, Humans, Male, Middle Aged, Peptides, Potassium, Space Flight, Bone Density, Collagen Type I
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