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Costa Lemos da Silva AG, da Silva Ribeiro KD, Alves de Araújo GE, da Silva Oliveira L, de Oliveira Lyra C. Vitamin E and cardiovascular diseases: an interest to public health? Nutr Res Rev 2024; 37:131-140. [PMID: 37382196 DOI: 10.1017/s0954422423000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide. From this perspective, the role of vitamin E and its metabolites in preventing CVD has been studied, being supported by the findings that low vitamin E concentrations are associated with an increased risk of cardiovascular events. Despite this, no studies have analysed the co-existence of vitamin E deficiency (VED) and CVD on the basis of population studies. Facing that, this study summarises information on the relationship between vitamin E status and CVD, providing a basis for understanding the determining and protective factors for its development. VED may be a public health problem since it has been observed to vary from 0·6% to 55·5% worldwide, with higher percentages in Asia and Europe, where CVD mortality rates stand out. Intervention studies with α-tocopherol supplementation do not confirm cardioprotective action of vitamin E, which may reflect that α-tocopherol alone does not provide cardiovascular protection to individuals, but the consumption of all isomers found in food. Considering that low concentrations of α-tocopherol can lead to a higher susceptibility to diseases involving oxidative stress in the population, in addition to the high and growing prevalence of CVD and VED, it is essential to investigate or reinterpret the mechanisms of action of vitamin E and its metabolites in the cardiovascular process to better understand the co-existence of CVD and VED. It is also important to implement public health policies and programmes aimed at promoting the consumption of natural food sources of vitamin E and healthy fats.
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Affiliation(s)
| | | | | | - Letícia da Silva Oliveira
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Clélia de Oliveira Lyra
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Ja'afar MH, Mat Nasir N, Md Isa Z, Ismail R, Mohd Tamil A, Ismail NH, Ariffin F, Ab Razak NH, Zainol Abidin N, Yusof KH. Dietary nutrient intake study among older adults: baseline Malaysian pure study. BMC Geriatr 2024; 24:441. [PMID: 38769498 PMCID: PMC11103826 DOI: 10.1186/s12877-024-05042-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The older adults (OA) is vulnerable to malnutrition, which may affect their health and quality of life. This study assesses the prevalence of deficiencies in dietary nutrients among the Malaysian OA stratified by residency, genders, socioeconomic status (SES) and body mass index (BMI). METHODOLOGY A cross-sectional study was conducted, utilizing purposive sampling, recruiting 2,299 Malaysian people aged 60 years old and above who agreed to be interviewed via a comprehensive semi-quantitative food frequency questionnaire. The nutrients intake was calculated based on the Malaysian food composition and US Department of Agriculture food composition databases. Then, the nutrients intake was compared with the Malaysian Recommended Nutrients Intake guidelines, and the prevalence of deficiencies in dietary nutrients were calculated. The median (interquartile ranges) intakes of nutrients were compared between residency (urban and rural), genders (male and female), and SES (low and middle-high) using the Mann-Whitney U test. The differences in nutrient intake between BMI categories (underweight, normal, and overweight) were identified using the Kruskal-Wallis test followed by Dunn's post hoc test. RESULTS The response rate was 70.3% (n = 2,299), predominantly were females (50.8%), received primary education (76.6%), were currently married (84.3%), were middle-high SES (57.7%), and had a normal BMI (59.8%). There was a notable inadequate intake prevalence of magnesium (100.0%), manganese (97.9%), zinc (95.6%), vitamin B6 (98.4%), potassium (91.0%), calcium (89.3%), vitamin B12 (80.2%), vitamin E (91.2%), and vitamin K (81.5%) among Malaysian OA. Additionally, significant differences were observed in nutrients intake levels across gender, residency, SES, and BMI within this population. CONCLUSIONS This study shows a high prevalence of dietary nutrients deficiency (> 80%) among the Malaysian OA, particularly for magnesium, manganese, potassium, zinc, vitamin B6, vitamin E, calcium, vitamin B12, and vitamin K. To improve the nutritional status of OA and safeguard against adverse health effects, it is necessary to formulate and execute strategies to enhance their dietary nutrient intakes. The strategies may involve intervention such as nutrient supplementation and promotion of consuming nutrient-rich foods.
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Affiliation(s)
- Mohd Hasni Ja'afar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Selangor Branch, Universiti Teknologi MARA (UiTM), Jalan Hospital, Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia.
| | - Zaleha Md Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Noor Hassim Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Farnaza Ariffin
- Department of Primary Care Medicine, Faculty of Medicine, Selangor Branch, Universiti Teknologi MARA (UiTM), Jalan Hospital, Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia
| | - Nurul Hafiza Ab Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Najihah Zainol Abidin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
- Department of Diagnostic and Allied Health Science, Faculty of Health and Life Sciences, Management and Science University, Shah Alam, Selangor, 40100, Malaysia
| | - Khairul Hazdi Yusof
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
- Risk Management Unit, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
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Pedroza-García KA, Careaga-Cárdenas G, Díaz-Galindo C, Quintanar JL, Hernández-Jasso I, Ramírez-Orozco RE. Bioactive role of vitamins as a key modulator of oxidative stress, cellular damage and comorbidities associated with spinal cord injury (SCI). Nutr Neurosci 2023; 26:1120-1137. [PMID: 36537581 DOI: 10.1080/1028415x.2022.2133842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Spinal cord injury (SCI) cause significant disability and impact the quality of life of those affected by it. The nutritional status and diet are fundamental to diminish the progression of complications; vitamins modulate the inflammatory response and oxidative stress, promote blood-spinal cord barrier preservation and the prompt recovery of homeostasis. A deep knowledge of the benefits achieved from vitamins in patients with SCI are summarized. Information of dosage, time, and effects of vitamins in these patients are also displayed. Vitamins have been extensively investigated; however, more clinical trials are needed to clarify the scope of vitamin supplementation.Objective: The objective of this review was to offer relevant therapeutic information based on vitamins supplementation for SCI patients.Methods: Basic and clinical studies that have implemented the use of vitamins in SCI were considered. They were selected from the year 2000-2022 from three databases: PubMed, Science Direct and Google Scholar.Results: Consistent benefits in clinical trials were shown in those who were supplemented with vitamin D (prevents osteoporosis and improves physical performance variables), B3 (improves lipid profile) and B12 (neurological prophylaxis of chronic SCI damage) mainly. On the other hand, improvement related to neuroprotection, damage modulation (vitamin A) and its prophylaxis were associated to B complex vitamins supplementation; the studies who reported positive results are displayed in this review.Discussion: Physicians should become familiar with relevant information that can support conventional treatment in patients with SCI, such as the use of vitamins, a viable option that can improve outcomes in patients with this condition.
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Affiliation(s)
- Karina A Pedroza-García
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Gabriela Careaga-Cárdenas
- Biomedical Research, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Carmen Díaz-Galindo
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - J Luis Quintanar
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Irma Hernández-Jasso
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Ricardo E Ramírez-Orozco
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
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Blampied M, Tylianakis JM, Bell C, Gilbert C, Rucklidge JJ. Efficacy and safety of a vitamin-mineral intervention for symptoms of anxiety and depression in adults: A randomised placebo-controlled trial "NoMAD". J Affect Disord 2023; 339:954-964. [PMID: 37268087 DOI: 10.1016/j.jad.2023.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Anxiety and depression are increasingly burdening society. We investigated whether micronutrients (vitamins and minerals), improve anxiety and depression symptoms in an adult community setting. METHODS Participants (n = 150) describing functionally-impairing symptoms of anxiety/depression randomly received micronutrients or placebo for 10 weeks. Primary outcome measures were Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder Scale-7 (GAD-7), and Clinical Global Impression-Improvement scale (CGII). They were monitored online with regular phone contact with a clinical psychologist. RESULTS Linear mixed-effects modelling showed significant improvements in both groups, with the micronutrient group improving significantly more quickly on both the PHQ-9 (t = -2.17, p = 0.03) and the GAD-7 (t = -2.23, p = 0.03). Subsequent models with covariates showed that participant characteristics moderated time-by-group interactions; micronutrients provided fastest improvement relative to placebo for younger participants, those from lower socioeconomic groups and those who had previously tried psychiatric medication. On the CGII, there were no group differences at end-point ((F1,148) = 1.36, p = 0.25, d = 0.19, 95 % CI [-0.13 to 0.51]), with 49 % of the micronutrient and 44 % of the placebo groups being identified responders. Participants on micronutrients had significantly increased bowel motions compared with placebo. There was no increased suicidal ideation, no serious adverse events and the blind was adequately maintained. Drop out was low at 8.7 %. LIMITATIONS The improvement under placebo and lack of formal diagnoses limit generalizability. CONCLUSIONS Despite limited clinician contact, all participants improved significantly, though improvements were faster with micronutrients. Participants in some subgroups demonstrated a lower response to placebo, identifying where micronutrients may offer greatest potential as an intervention.
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Zhu Y, Frank J, Riphagen IJ, Minović I, Vos MJ, Eggersdorfer ML, Navis GJ, Bakker SJL. Associations of 24 h urinary excretions of α- and γ-carboxyethyl hydroxychroman with plasma α- and γ-tocopherol and dietary vitamin E intake in older adults: the Lifelines-MINUTHE Study. Eur J Nutr 2022; 61:3755-3765. [PMID: 35718823 PMCID: PMC9464128 DOI: 10.1007/s00394-022-02918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urinary metabolites of vitamin E, i.e., α- and γ-carboxyethyl hydroxychroman (α- and γ-CEHC), have gained increasing attention and have been proposed as novel biomarkers of vitamin E intake and status. However, there are insufficient data on the relationship of plasma α-tocopherol and γ-tocopherol and dietary vitamin E intake with 24 h urinary excretions of α- and γ-CEHC. OBJECTIVES We aimed to (1) investigate the associations of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC with plasma α- and γ-tocopherol, respectively; (2) investigate the associations of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC with dietary vitamin E intake, and we hypothesize that 24 h urinary excretions of α- and γ-CEHC will better correlate with vitamin E intake than urinary α- and γ-CEHC/creatinine ratios. DESIGN 24 h Urine and plasma samples were collected from 1519 participants (60-75 years, male: 50%) included in the Lifelines-MINUTHE Study for the assessments of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC, and plasma α- and γ-tocopherol. Among those participants, dietary vitamin E intake data from 387 participants were available from an externally validated Flower-Food Frequency Questionnaire (FFQ). The associations of plasma α- and γ-tocopherol, dietary vitamin E intake, with urinary α- and γ-CEHC were assessed using multivariate linear regressions. RESULTS 24 h Urinary excretion of α-CEHC (median (IQR): 0.9 (0.3-2.4) µmol) was less than that of γ-CEHC (median (IQR): 1.5 (0.5-3.5) µmol). After adjustment for covariates, we found that 24 h urinary α-CEHC excretion and urinary α-CEHC/creatinine ratio were both positively associated with plasma α-tocopherol (std.beta: 0.06, p = 0.02; std.beta: 0.06, p = 0.01, respectively). Furthermore, the sum of 24 h urinary α- and γ-CEHC excretions was positively associated with dietary vitamin E intake (std.beta: 0.08; p = 0.03), whereas there was no relation between urinary α- and γ-CEHC/creatinine ratios and vitamin E intake. No association was observed neither between plasma α- and γ-tocopherol and dietary vitamin E intake, nor between urinary γ-CEHC and plasma γ-tocopherol. CONCLUSION Our study confirmed our hypothesis that 24 h urinary α- and γ-CEHC excretions would be a better marker for dietary vitamin E intake than urinary α- and γ-CEHC/creatinine ratios. Considering that both 24 h urinary α- and γ-CEHC excretions and α- and γ-CEHC/creatinine ratios were also associated with plasma α-tocopherol status, we suggest that 24 h urinary α- and γ-CEHC excretions could be used to assess overall vitamin E status.
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Affiliation(s)
- Yinjie Zhu
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Jan Frank
- Department of Food Biofunctionality (140B), Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Ineke J Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Certe Medical Diagnostics and Advice, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Isidor Minović
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michel J Vos
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mangel N, Fudge JB, Gruissem W, Fitzpatrick TB, Vanderschuren H. Natural Variation in Vitamin B 1 and Vitamin B 6 Contents in Rice Germplasm. Front Plant Sci 2022; 13:856880. [PMID: 35444674 PMCID: PMC9014206 DOI: 10.3389/fpls.2022.856880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/24/2022] [Indexed: 05/03/2023]
Abstract
Insufficient dietary intake of micronutrients contributes to the onset of deficiencies termed hidden hunger-a global health problem affecting approximately 2 billion people. Vitamin B1 (thiamine) and vitamin B6 (pyridoxine) are essential micronutrients because of their roles as enzymatic cofactors in all organisms. Metabolic engineering attempts to biofortify rice endosperm-a poor source of several micronutrients leading to deficiencies when consumed monotonously-have led to only minimal improvements in vitamin B1 and B6 contents. To determine if rice germplasm could be exploited for biofortification of rice endosperm, we screened 59 genetically diverse accessions under greenhouse conditions for variation in vitamin B1 and vitamin B6 contents across three tissue types (leaves, unpolished and polished grain). Accessions from low, intermediate and high vitamin categories that had similar vitamin levels in two greenhouse experiments were chosen for in-depth vitamer profiling and selected biosynthesis gene expression analyses. Vitamin B1 and B6 contents in polished seeds varied almost 4-fold. Genes encoding select vitamin B1 and B6 biosynthesis de novo enzymes (THIC for vitamin B1, PDX1.3a-c and PDX2 for vitamin B6) were differentially expressed in leaves across accessions contrasting in their respective vitamin contents. These expression levels did not correlate with leaf and unpolished seed vitamin contents, except for THIC expression in leaves that was positively correlated with total vitamin B1 contents in polished seeds. This study expands our knowledge of diversity in micronutrient traits in rice germplasm and provides insights into the expression of genes for vitamin B1 and B6 biosynthesis in rice.
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Affiliation(s)
- Nathalie Mangel
- Plant Biotechnology, Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Jared B. Fudge
- Vitamin & Environmental Stress Responses in Plants, Department of Botany and Plant Biology, Université de Genève, Geneva, Switzerland
| | - Wilhelm Gruissem
- Plant Biotechnology, Department of Biology, ETH Zurich, Zurich, Switzerland
- Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Wilhelm Gruissem,
| | - Teresa B. Fitzpatrick
- Vitamin & Environmental Stress Responses in Plants, Department of Botany and Plant Biology, Université de Genève, Geneva, Switzerland
- Teresa B. Fitzpatrick,
| | - Hervé Vanderschuren
- Plant Biotechnology, Department of Biology, ETH Zurich, Zurich, Switzerland
- Plant Genetics Laboratory, TERRA Teaching and Research Center, Gembloux Agro-Bio Tech, Université de Liège, Gembloux, Belgium
- Hervé Vanderschuren,
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Sijtsma A, Rienks J, van der Harst P, Navis G, Rosmalen JGM, Dotinga A. Cohort Profile Update: Lifelines, a three-generation cohort study and biobank. Int J Epidemiol 2021; 51:e295-e302. [PMID: 34897450 PMCID: PMC9558073 DOI: 10.1093/ije/dyab257] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/25/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | - Pim van der Harst
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Departments of Psychiatry and Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Leung DYP, Cheng HL, Tyrovolas S, Tang ASK, Liu JYW, Tse MMY, Lai CKY, Molassiotis A. Magnitude, Temporal Trends, and Inequalities in the DALYs and YLDs of Nutritional Deficiency among Older Adults in the Western Pacific Region: Findings from the Global Burden of Disease Study 1990-2019. Nutrients 2021; 13:nu13124421. [PMID: 34959973 PMCID: PMC8706447 DOI: 10.3390/nu13124421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < −5.0). Tonga had the least decline in DALYs (AAPC = −0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.
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Affiliation(s)
- Doris Y. P. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Hui-Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Stefanos Tyrovolas
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, 08007 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Angel S. K. Tang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Justina Y. W. Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Mimi M. Y. Tse
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Claudia K. Y. Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; (D.Y.P.L.); (H.-L.C.); (S.T.); (A.S.K.T.); (J.Y.W.L.); (M.M.Y.T.); (C.K.Y.L.)
- Correspondence: ; Tel.: +852-2766-6396
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9
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Warendorf JK, van Doormaal PTC, Vrancken AFJE, Verhoeven-Duif NM, van Eijk RPA, van den Berg LH, Notermans NC. Clinical relevance of testing for metabolic vitamin B12 deficiency in patients with polyneuropathy. Nutr Neurosci 2021; 25:2536-2546. [PMID: 34693890 DOI: 10.1080/1028415x.2021.1985751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Determine vitamin B12 threshold levels below which additional testing of methylmalonic acid (MMA) and/or homocysteine (Hcy) is useful to diagnose metabolic vitamin B12 deficiency in patients with polyneuropathy, and how vitamin B12, MMA and Hcy levels relate to the effect of supplementation therapy. METHODS In a retrospective cohort study of 331 patients with polyneuropathy, vitamin B12, MMA and Hcy were measured. Linear regression models with vitamin B12 as dependent and Hcy or MMA as covariate were compared, to assess which was best related to vitamin B12. Threshold vitamin B12 levels for metabolic deficiency (defined as elevatede metabolites) were determined using logistic regression with elevated metabolites as dependent and vitamin B12 as covariate.. A structured interview was conducted in 42 patients to evaluate response to vitamin B12 supplementation. RESULTS MMA was best related to vitamin B12. Using elevated MMA for metabolic deficiency, we found 90% sensitivity at a vitamin B12 threshold level <264 pmol/L (358 pg/mL) and 95% sensitivity at <304 pmol/L (412 pg/mL). Improvement after supplementation was reported by 19% patients and stabilization by 24%. 88% of patients with improvement and 90% with stabilization either had absolute deficiency (Vitamin B12 < 148 pmol/L) or metabolic deficiency (elevated MMA and vitamin B12 ≥ 148 pmol/L). There were no additional patients with improvement or stabilization with isolated elevated Hcy. CONCLUSION Testing of MMA has additional value in identifying patients with clinically relevant metabolic deficiency when vitamin B12 is below 304 pmol/L (412 pg/mL). Supplementation can be effective in patients with absolute and metabolic deficiency.
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Affiliation(s)
- Janna K Warendorf
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Perry T C van Doormaal
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, Tergooi Hospital, Hilversum, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nanda M Verhoeven-Duif
- Metabolic Diagnostics, Division Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Rapp N, Brandenburg VM, Kaesler N, Bakker SJL, Stöhr R, Schuh A, Evenepoel P, Schurgers LJ. Hepatic and Vascular Vitamin K Status in Patients with High Cardiovascular Risk. Nutrients 2021; 13:3490. [PMID: 34684491 PMCID: PMC8539359 DOI: 10.3390/nu13103490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 01/17/2023] Open
Abstract
Vitamin K dependent proteins (VKDP), such as hepatic coagulation factors and vascular matrix Gla protein (MGP), play key roles in maintaining physiological functions. Vitamin K deficiency results in inactive VKDP and is strongly linked to vascular calcification (VC), one of the major risk factors for cardiovascular morbidity and mortality. In this study we investigated how two vitamin K surrogate markers, dephosphorylated-undercarboxylated MGP (dp-ucMGP) and protein induced by vitamin K absence II (PIVKA-II), reflect vitamin K status in patients on hemodialysis or with calcific uremic arteriolopathy (CUA) and patients with atrial fibrillation or aortic valve stenosis. Through inter- and intra-cohort comparisons, we assessed the influence of vitamin K antagonist (VKA) use, vitamin K supplementation and disease etiology on vitamin K status, as well as the correlation between both markers. Overall, VKA therapy was associated with 8.5-fold higher PIVKA-II (0.25 to 2.03 AU/mL) and 3-fold higher dp-ucMGP (843 to 2642 pM) levels. In the absence of VKA use, non-renal patients with established VC have dp-ucMGP levels similar to controls (460 vs. 380 pM), while in HD and CUA patients, levels were strongly elevated (977 pM). Vitamin K supplementation significantly reduced dp-ucMGP levels within 12 months (440 to 221 pM). Overall, PIVKA-II and dp-ucMGP showed only weak correlation (r2 ≤ 0.26) and distinct distribution pattern in renal and non-renal patients. In conclusion, VKA use exacerbated vitamin K deficiency across all etiologies, while vitamin K supplementation resulted in a vascular VKDP status better than that of the general population. Weak correlation of vitamin K biomarkers calls for thoughtful selection lead by the research question. Vitamin K status in non-renal deficient patients was not anomalous and may question the role of vitamin K deficiency in the pathogenesis of VC in these patients.
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Affiliation(s)
- Nikolas Rapp
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands;
| | | | - Nadine Kaesler
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany;
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Robert Stöhr
- Department of Cardiology, University Hospital of the RWTH Aachen, 52074 Aachen, Germany; (R.S.); (A.S.)
| | - Alexander Schuh
- Department of Cardiology, University Hospital of the RWTH Aachen, 52074 Aachen, Germany; (R.S.); (A.S.)
| | - Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, KU Leuven and University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Leon J. Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands;
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, 52074 Aachen, Germany
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