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Smith TJ, Arnold CD, Fischer PR, Trehan I, Hiffler L, Sitthideth D, Stein-Wexler R, Yeh J, Jones KS, Hampel D, Tancredi DJ, Schick MA, McBeth CN, Tan X, Allen LH, Sayasone S, Kounnavong S, Hess SY. A Predictive Model for Thiamine Responsive Disorders among Infants and Young Children: Results from a Prospective Cohort Study in Lao People's Democratic Republic. J Pediatr 2024:113961. [PMID: 38369233 DOI: 10.1016/j.jpeds.2024.113961] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To develop a predictive model for thiamine responsive disorders (TRD) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDD) based on response to therapeutic thiamine in a high-risk setting. STUDY DESIGN Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao PDR were treated with parenteral thiamine (100mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve (AUROC). RESULTS 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact and no diarrhea in the previous 2 weeks. The AUROC (95% CI) was 0.82 (0.78, 0.86). CONCLUSIONS In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;.
| | - Charles D Arnold
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA;; Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE;; Khalifa University, Abu Dhabi, UAE
| | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA;; Lao Friends Hospital for Children, Luang Prabang, Lao PDR
| | | | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Rebecca Stein-Wexler
- Department of Radiology, University of California Davis Health System, Sacramento, California, USA
| | - Jay Yeh
- Department of Pediatrics, Division of Cardiology, University of California Davis Health System, Sacramento, California, USA
| | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Daniela Hampel
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Michael A Schick
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Christine N McBeth
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Xiuping Tan
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Lindsay H Allen
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
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Hess SY, Smith TJ, Sitthideth D, Arnold CD, Tan X, Jones KS, Brown KH, Alayon S, Kounnavong S. Risk factors for anaemia among women and their young children hospitalised with suspected thiamine deficiency in northern Lao PDR. Matern Child Nutr 2024; 20:e13565. [PMID: 37803889 PMCID: PMC10749997 DOI: 10.1111/mcn.13565] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
Anaemia among women and young children remains a major public health concern. This secondary study describes the anaemia prevalence among young hospitalised children and their mothers in northern Lao People's Democratic Republic and explores possible nutritional causes and risk factors for anaemia. Hospitalised children (ages 21 days to <18 months) with clinical symptoms suggestive of thiamine deficiency disorders were eligible along with their mothers. Venous blood was collected for determination of haemoglobin, ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), erythrocyte glutathione reductase activation coefficient (EGRac), thiamine diphosphate (ThDP) and acute phase proteins. Risk factors for anaemia were modelled using minimally adjusted logistic regression controlling for age. Haemoglobin results were available for 436 women (mean ± SD age 24.7 ± 6.4 years; 1.6% pregnant) and 427 children (4.3 ± 3.5 months; 60.3% male). Anaemia prevalence (Hb < 120 g/L for nonpregnant women and <110 g/L for pregnant women and children) was 30.7% among women and 55.2% among children. In bivariate analyses, biomarkers significantly associated with anaemia in women were ferritin, sTfR, RBP, EGRac and ThDP. Other risk factors for women were lower BMI, mid-upper arm circumference < 23.5 cm, lower education, lower socioeconomic index, food insecurity, Hmong ethnicity, not/rarely having attended antenatal care, not having taken antenatal iron-containing supplements and not meeting minimum dietary diversity. Risk factors for anaemia among children were older age, male sex, stunting, sTfR, ThDP and alpha-1-acid-glycoprotein. Anaemia was common among women and their hospitalised children and was associated with micronutrient deficiencies and socioeconomic, dietary and health care-seeking risk factors, suggesting that multiple strategies are required to prevent anaemia among women and children.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Taryn J. Smith
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health InstituteVientianeLao People's Democratic Republic
| | - Charles D. Arnold
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Xiuping Tan
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Kerry S. Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Kenneth H. Brown
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Silvia Alayon
- USAID Advancing NutritionArlingtonVirginiaUSA
- Save the ChildrenWashingtonWashington, D.C.USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health InstituteVientianeLao People's Democratic Republic
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Parkington DA, Koulman A, Jones KS. Protocol for measuring erythrocyte glutathione reductase activity coefficient to assess riboflavin status. STAR Protoc 2023; 4:102726. [PMID: 37988268 PMCID: PMC10696246 DOI: 10.1016/j.xpro.2023.102726] [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: 07/10/2023] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023] Open
Abstract
Riboflavin (vitamin B2) is a component of the co-enzyme flavin adenine dinucleotide (FAD). The activity coefficient of erythrocyte glutathione reductase (EGRAC), a FAD-dependent enzyme, is a biomarker of riboflavin status. Here, we describe a protocol for measuring unstimulated (basal) and FAD-stimulated (activated) erythrocyte glutathione reductase activity to calculate EGRAC. We describe the steps for preparing washed red blood cells and hemolysates; preparing reagents; loading, incubating, and reading the 96-well plate; and calculating the results. For complete details on the use and execution of this protocol, please refer to Hess et al.1.
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Affiliation(s)
- Damon A Parkington
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK.
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK
| | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK.
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Jones KS, Collins D, Meadows SR, Koulman A, Page P. National Diet and Nutrition Survey data reveal a decline in folate status in the United Kingdom population between 2008 and 2019. Am J Clin Nutr 2023; 118:1182-1191. [PMID: 37839706 PMCID: PMC10739772 DOI: 10.1016/j.ajcnut.2023.10.006] [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: 06/07/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Folate is essential for healthy growth and development. Fortification of foods with folic acid can improve folate status and reduce risk of neural tube defects (NTD). Following concern around folate status in the United Kingdom, the United Kingdom government announced in 2021 the intention to introduce mandatory folic acid fortification. OBJECTIVE This study aimed to describe folate status in the United Kingdom population prior to the implementation of mandatory folic acid fortification of non-whole wheat (non-wholemeal) flour and to assess trends in folate status, including in females of reproductive age (FRA). METHODS Data were from the United Kingdom National Diet and Nutrition Survey Rolling Program (2008-2019), a cross-sectional, nationally representative survey of children and adults aged 1.5+ (n = 5792 with folate result). Serum folate concentration was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) and red blood cell (RBC) folate concentration by microbiological assay. Concentration data were compared against method-specific cut-offs and thresholds, and relationships were explored against demographic and lifestyle characteristics. RESULTS RBC and serum folate concentration significantly decreased by ∼3 percentage points per year between 2008 and 2019 in all age/sex groups. Prevalence of deficiency (RBC folate < 305 nmol/L) was highest in children aged 11 to 18 y (17% in 2016-2019). The proportion of FRA below the cut-off for increased risk of NTD (RBC folate < 748 nmol/L) increased from 69% to 89% between 2008 and 2019. Ethnicity, smoking status, and income were significant determinants of RBC and serum folate concentrations. CONCLUSIONS These data reveal a decline in population folate status in the United Kingdom between 2008 and 2019 and a high prevalence of folate deficiency. A high proportion of FRA had RBC folate concentrations below the cut-off for increased risk of NTD. These data provide information on folate status in a population not currently exposed to mandatory folic acid fortification and are essential to model and assess its impact.
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Affiliation(s)
- Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
| | - David Collins
- Nutrition Measurement Platform, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sarah R Meadows
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Polly Page
- Nutrition Measurement Platform, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Jones KS, Meadows SR, Koulman A. Quantification and reporting of vitamin D concentrations measured in human milk by LC-MS/MS. Front Nutr 2023; 10:1229445. [PMID: 38035362 PMCID: PMC10687194 DOI: 10.3389/fnut.2023.1229445] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Vitamin D is essential for optimal bone health, and vitamin D deficiency has been associated with an increased risk of adverse pregnancy, growth and developmental outcomes. In early life, and in the absence of endogenous vitamin D production from UVB light, infants are reliant on vitamin D stores established in utero and the vitamin D supply from human milk (HM). However, comprehensive data on vitamin D in HM is lacking. Thus, in this review we explore the application of liquid-chromatography tandem mass spectrometry (LC-MS/MS) to the assessment of vitamin D in HM. We discuss the challenges of extracting and measuring multiple vitamin D metabolites from HM including the frequent requirement for a large sample volume, and inappropriate poor sensitivity. Shortcomings in the reporting of experimental procedures and data analysis further hinder advances in the field. Data collated from all studies that have applied LC-MS/MS reveal that, in general, cholecalciferol concentration is greater and more variable than 25-hydroxyvitamin D concentration, and that the vitamin D content of HM is low and less than the currently recommended dietary requirement of infants, although maternal supplementation can increase the vitamin D content of HM. Improvements in analytical methods and their validation and larger, more representative studies are required to better characterize HM milk vitamin D metabolite concentrations and their relationship with maternal status. These data are essential to understand relationships with infant health and to inform public health policies around vitamin D fortification and supplementation.
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Affiliation(s)
- Kerry S. Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Mba CM, Jones KS, Forouhi NG, Imamura F, Assah F, Mbanya JC, Wareham NJ. The association between plasma zinc concentrations and markers of glucose metabolism in adults in Cameroon. Br J Nutr 2023; 130:1220-1227. [PMID: 36693633 PMCID: PMC7615052 DOI: 10.1017/s0007114523000223] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An abnormal Zn status has been suggested to play a role in the pathogenesis of type 2 diabetes. However, epidemiological studies of the relationship between plasma Zn concentrations and diabetes are sparse and inconclusive. We aimed to investigate the association between plasma Zn concentrations and glycaemic markers (fasting glucose, 2-h glucose and homeostatic model assessment of insulin resistance) in rural and urban Cameroon. We studied 596 healthy adults (63·3 % women) aged 25-55 years in a population-based cross-sectional study. The mean plasma Zn concentration was 13·7 ± 2·7 µmol/L overall, with higher levels in men (14·4 ± 2·9 µmol/l) than in women (13·2 ± 2·6 µmol/l), P-value < 0·0001. There was an inverse relationship between tertiles of plasma Zn and 2-h glucose concentrations (P-value for linear trend = 0·002). The difference in 2-h glucose between those in the highest tertile of plasma Zn compared to the lowest was -0·63 (95 % CI - 1·02, -0·23) mmol/l. This remained significant after adjusting for age, sex, smoking status, alcohol intake, education level, area of residence, adiposity and objectively measured physical activity -0·43(-0·82, -0·04). Similar inverse associations were observed between plasma Zn concentrations and fasting glucose and homeostatic model assessment of insulin resistance when adjusted for socio-demographic and health-related behavioural characteristics. The current findings of an inverse association between plasma Zn concentrations and several markers of glucose homeostasis, together with growing evidence from intervention studies, suggest a role for Zn in glucose metabolism. If supported by further evidence, strategies to improve Zn status in populations may provide a cheap public health prevention approach for diabetes.
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Affiliation(s)
- Camille M. Mba
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Kerry S. Jones
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- National Institute for Health Research Biomedical Research Centre Nutritional Biomarker Laboratory, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Nita G. Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Kumari M, Andrayas A, Al Baghal T, Burton J, Crossley TF, Jones KS, Parkington DA, Koulman A, Benzeval M. A randomised study of nurse collected venous blood and self-collected dried blood spots for the assessment of cardiovascular risk factors in the Understanding Society Innovation Panel. Sci Rep 2023; 13:13008. [PMID: 37563249 PMCID: PMC10415328 DOI: 10.1038/s41598-023-39674-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
Dried blood spot (DBS) sample collection has been suggested as a less invasive, cheaper and more convenient alternative to venepuncture, which requires trained personnel, making it a potentially viable approach for self-collection of blood on a large scale. We examine whether participants in a longitudinal survey were willing to provide a DBS sample in different interview settings, and how resulting cardiovascular risk biomarkers compared with those from venous blood to calculate clinical risk. Participants of the Understanding Society Innovation Panel, a representative sample of UK households, were randomly assigned to three modes of interview. Most participants (84%) were interviewed in their allocated mode. Participants (n = 2162) were interviewed by a nurse who collected both a blood sample by venepuncture and a DBS card ('nurse collection') or participants were seen by an interviewer or took part in the survey online to self-collect a DBS card ('self-collection'). All DBS cards were returned in the post after the sample had dried. Lipids (total cholesterol, HDL-cholesterol, triglycerides), HbA1c and C-reactive protein were measured in venous and DBS samples and equivalence was calculated. The resultant values were used to confirm equivalent prevalence of risk of cardiovascular disease in each type of blood sample by mode of participation. Of participants interviewed by a nurse 69% consented to venous blood sample and 74% to a DBS sample, while in the self-collection modes, 35% consented to DBS collection. Demographic characteristics of participants in self-collection mode was not different to those in nurse collection mode. The percentage of participants with clinically raised biomarkers did not significantly differ between type of blood collection (for example, 62% had high cholesterol (> 5 mmol/l) measured by venepuncture and 67% had high cholesterol within the self-collected DBS sample (p = 0.13)). While self-collected DBS sampling had a lower response rate to DBS collected by a nurse, participation did not vary by key demographic characteristics. This study demonstrates that DBS collection is a feasible method of sample collection that can provide acceptable measures of clinically relevant biomarkers, enabling the calculation of population levels of cardiovascular disease risk.
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Affiliation(s)
- Meena Kumari
- Institute for Social and Economic Research, University of Essex, Colchester, UK.
| | - Alexandria Andrayas
- Institute for Social and Economic Research, University of Essex, Colchester, UK
- School of Life Sciences, University of Essex, Colchester, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Tarek Al Baghal
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Jonathan Burton
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | | | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Damon A Parkington
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, UK
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Jones KS, Parkington DA, Bourassa MW, Cerami C, Koulman A. Protocol and application of basal erythrocyte transketolase activity to improve assessment of thiamine status. Ann N Y Acad Sci 2023; 1521:104-111. [PMID: 36719404 DOI: 10.1111/nyas.14962] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Thiamine (vitamin B1) is an essential micronutrient required as a cofactor in many metabolic processes. Clinical symptoms of thiamine deficiency are poorly defined, hence biomarkers of thiamine status are important. The erythrocyte transketolase activity coefficient (ETKac) is a sensitive measure of thiamine status, but its interpretation may be confounded where the availability of the transketolase enzyme is limited. Basal ETK activity per gram of hemoglobin provides a complementary biomarker of thiamine status; however, its measurement and calculation are poorly described. Here, we describe in detail the assessment of basal ETK activity, including the calculation of path length in microplates and the molar absorption coefficient of NADH specific to the assay, and the measurement of hemoglobin in sample hemolysates. To illustrate the application of the methods, we present ETKac and basal ETK activity from women in The Gambia and UK. In conclusion, we present a clear protocol for the measurement of basal ETK activity that will permit the harmonization of methods to improve replication between laboratories.
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Affiliation(s)
- Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Damon A Parkington
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Carla Cerami
- Faculty of Epidemiology and Population Health, Nutrition and Planetary Health Theme, MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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9
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Venables MC, Roberts C, Nicholson S, Bates B, Jones KS, Ashford R, Hill S, Farooq A, Koulman A, Wareham NJ, Page P. Data Resource Profile: United Kingdom National Diet and Nutrition Survey Rolling Programme (2008-19). Int J Epidemiol 2022; 51:e143-e155. [PMID: 35640141 PMCID: PMC9365634 DOI: 10.1093/ije/dyac106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/10/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Michelle C Venables
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | - Caireen Roberts
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | - Sonja Nicholson
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | | | - Kerry S Jones
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Anila Farooq
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | - Albert Koulman
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Polly Page
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
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10
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Bourassa MW, Gomes F, Jones KS, Koulman A, Prentice AM, Cerami C. Thiamine deficiency in Gambian women of reproductive age. Ann N Y Acad Sci 2022; 1507:162-170. [PMID: 34542918 PMCID: PMC9292991 DOI: 10.1111/nyas.14695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/11/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
Thiamine deficiency disorders are associated with a variety of clinical symptoms affecting the nervous and cardiovascular systems. There is growing recognition that thiamine deficiency can occur in populations well beyond the classical region of South Asia, and at-risk populations include those who receive a large proportion of their energy from polished white rice (or other low-thiamine staple foods) and with low dietary diversity. Reports of thiamine deficiency in West Africa over the last century have suggested that this has historically been an issue in this population, but in more recent decades, these reports have been limited to prison populations. To understand if thiamine deficiency might be an unrecognized problem in the communities of this region, erythrocyte samples collected during the wet and dry seasons from 226 women of reproductive age (mean age = 28 years old) were assessed for thiamine status by measuring the erythrocyte transketolase activity coefficient (ETKac). Overall, 35.8% of the sample was at high risk of thiamine deficiency (ETKac ≥ 1.25). Risk of thiamine deficiency was significantly higher in the wet (47.9%) compared with the dry season (22.9%) (P < 0.001). To our knowledge, this is the first report of biochemical thiamine deficiency in a free-living population in West Africa in the 21st century and suggests that further investigation is warranted.
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Affiliation(s)
| | - Filomena Gomes
- Nutrition ScienceThe New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolLisbonPortugal
| | - Kerry S. Jones
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Andrew M. Prentice
- MRC Unit The Gambia at London School of Hygiene & Tropical MedicineBanjulThe Gambia
| | - Carla Cerami
- MRC Unit The Gambia at London School of Hygiene & Tropical MedicineBanjulThe Gambia
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Ashley B, Simner C, Manousopoulou A, Jenkinson C, Hey F, Frost JM, Rezwan FI, White CH, Lofthouse EM, Hyde E, Cooke LDF, Barton S, Mahon P, Curtis EM, Moon RJ, Crozier SR, Inskip HM, Godfrey KM, Holloway JW, Cooper C, Jones KS, Lewis RM, Hewison M, Garbis SDD, Branco MR, Harvey NC, Cleal JK. Placental uptake and metabolism of 25(OH)vitamin D determine its activity within the fetoplacental unit. eLife 2022; 11:71094. [PMID: 35256050 PMCID: PMC8903835 DOI: 10.7554/elife.71094] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Pregnancy 25-hydroxyvitamin D [25(OH)D] concentrations are associated with maternal and fetal health outcomes. Using physiological human placental perfusion and villous explants, we investigate the role of the placenta in regulating the relationships between maternal 25(OH)D and fetal physiology. We demonstrate active placental uptake of 25(OH)D3 by endocytosis, placental metabolism of 25(OH)D3 into 24,25-dihydroxyvitamin D3 and active 1,25-dihydroxyvitamin D [1,25(OH)2D3], with subsequent release of these metabolites into both the maternal and fetal circulations. Active placental transport of 25(OH)D3 and synthesis of 1,25(OH)2D3 demonstrate that fetal supply is dependent on placental function rather than simply the availability of maternal 25(OH)D3. We demonstrate that 25(OH)D3 exposure induces rapid effects on the placental transcriptome and proteome. These map to multiple pathways central to placental function and thereby fetal development, independent of vitamin D transfer. Our data suggest that the underlying epigenetic landscape helps dictate the transcriptional response to vitamin D treatment. This is the first quantitative study demonstrating vitamin D transfer and metabolism by the human placenta, with widespread effects on the placenta itself. These data demonstrate a complex interplay between vitamin D and the placenta and will inform future interventions using vitamin D to support fetal development and maternal adaptations to pregnancy.
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Affiliation(s)
- Brogan Ashley
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Claire Simner
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Antigoni Manousopoulou
- Beckman Research Institute, City of Hope National Medical CenterDuarteUnited States,Proteas Bioanalytics Inc, BioLabs at the Lundquist InstituteTorranceUnited States
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research, The University of BirminghamBirminghamUnited Kingdom
| | - Felicity Hey
- NIHR Cambridge Biomedical Research Centre, Nutritional Biomarker Laboratory. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Clifford Allbutt Building, Cambridge Biomedical CampusCambridgeUnited Kingdom,Formerly at MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL l Merck Exploratory Science Center, Merck Research LaboratoriesCambridgeUnited States
| | - Jennifer M Frost
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUnited Kingdom
| | - Faisal I Rezwan
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom,School of Water, Energy and Environment, Cranfield UniversityCranfieldUnited Kingdom
| | - Cory H White
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom,Merck Exploratory Science Center, Merck Research LaboratoriesCambridgeUnited States
| | - Emma M Lofthouse
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Emily Hyde
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Laura DF Cooke
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Sheila Barton
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Pamela Mahon
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom,NIHR Applied Research Collaboration Wessex, Southampton Science ParkSouthamptonUnited Kingdom
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - John W Holloway
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom,NIHR Oxford Biomedical Research Center, University of OxfordOxfordUnited Kingdom
| | - Kerry S Jones
- NIHR Cambridge Biomedical Research Centre, Nutritional Biomarker Laboratory. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Clifford Allbutt Building, Cambridge Biomedical CampusCambridgeUnited Kingdom,Formerly at MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL l Merck Exploratory Science Center, Merck Research LaboratoriesCambridgeUnited States
| | - Rohan M Lewis
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
| | - Martin Hewison
- Institute of Metabolism and Systems Research, The University of BirminghamBirminghamUnited Kingdom
| | - Spiros DD Garbis
- Proteas Bioanalytics Inc, BioLabs at the Lundquist InstituteTorranceUnited States
| | - Miguel R Branco
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUnited Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of SouthamptonSouthamptonUnited Kingdom,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - Jane K Cleal
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine University of SouthamptonSouthamptonUnited Kingdom
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12
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Jones KS, Meadows SR, Chamberlain K, Parkington DA, Collins D, Page P, Koulman A. Delayed Processing of Chilled Whole Blood for 24 Hours Does Not Affect the Concentration of the Majority of Micronutrient Status Biomarkers. J Nutr 2021; 151:3524-3532. [PMID: 34302347 PMCID: PMC8564691 DOI: 10.1093/jn/nxab267] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/07/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The measurement of micronutrient status is essential to understand the health of individuals and populations, but there are limited data on the stability of micronutrients in whole blood. OBJECTIVES The objective was to investigate the effects of delayed processing of whole blood on the stability of 25 micronutrient and selected clinical biomarkers. METHODS Blood from 16 healthy adults was collected into EDTA, lithium heparin (LH), or serum tubes. Samples were processed within 2 hours of collection ("2-hour processed") or mailed overnight (boxed with frozen cold packs) before processing ("24-hour processed"). Micronutrient and clinical biomarker concentrations were quantified with validated methods. The concentration percentage difference between the 2- and 24-hour processed samples was calculated and was compared against quality specifications determined from intra- and interindividual variations. RESULTS All analytes had a sample type where the percentage difference concentration between 2-hour and 24-hour processed samples was ≤4% and was acceptable based on calculated limits, including for biomarkers of vitamin A, vitamin D, thiamin, folate, vitamin B-12, iron (ferritin), and zinc status and for selected clinical markers, C-reactive protein, HDL and total cholesterol, and triglycerides. EDTA plasma vitamin C was lower compared to the 2-hour processed sample (geometric mean, 43%; 95% CI: 36%-49%). Pyridoxal-5-phosphate (vitamin B-6 biomarker) decreased, with differences from the 2-hour processed samples of -8% (95% CI: -13% to -2%) and -14% (95% CI: -18% to -9%) in LH plasma and serum, respectively. CONCLUSIONS In blood collected from adult participants, delayed processing of chilled whole blood for 24 hours did not materially affect the measured concentrations of the majority of micronutrients and selected clinical biomarkers. This suggests that for these analytes, adherence to a 2-hour processing protocol may be unnecessary. This knowledge is valuable and may help to simplify logistics for sample transport and processing of blood samples for micronutrient status assessment.
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Affiliation(s)
| | - Sarah R Meadows
- Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK,Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | | | - Damon A Parkington
- Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Dave Collins
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Polly Page
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Albert Koulman
- Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
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13
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Brown KH, Moore SE, Hess SY, McDonald CM, Jones KS, Meadows SR, Manger MS, Coates J, Alayon S, Osendarp SJM. Increasing the availability and utilization of reliable data on population micronutrient (MN) status globally: the MN Data Generation Initiative. Am J Clin Nutr 2021; 114:862-870. [PMID: 34036318 PMCID: PMC8408880 DOI: 10.1093/ajcn/nqab173] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Micronutrient (MN) deficiencies can produce a broad array of adverse health and functional outcomes. Young, preschool children and women of reproductive age in low- and middle-income countries are most affected by these deficiencies, but the true magnitude of the problems and their related disease burdens remain uncertain because of the dearth of reliable biomarker information on population MN status. The reasons for this lack of information include a limited understanding by policy makers of the importance of MNs for human health and the usefulness of information on MN status for program planning and management; insufficient professional capacity to advocate for this information and design and implement related MN status surveys; high costs and logistical constraints involved in specimen collection, transport, storage, and laboratory analyses; poor access to adequately equipped and staffed laboratories to complete the analyses reliably; and inadequate capacity to interpret and apply this information for public health program design and evaluation. This report describes the current situation with regard to data availability, the reasons for the lack of relevant information, and the steps needed to correct this situation, including implementation of a multi-component MN Data Generation Initiative to advocate for critical data collection and provide related technical assistance, laboratory services, professional training, and financial support.
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Affiliation(s)
- Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Sophie E Moore
- Department of Women's and Children's Health, Kings College London, London, United Kingdom
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sonja Y Hess
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Christine M McDonald
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Kerry S Jones
- National Institute for Health Research Biomedical Research Centre Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sarah R Meadows
- National Institute for Health Research Biomedical Research Centre Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mari S Manger
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Jennifer Coates
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Silvia Alayon
- United States Agency for International Development Advancing Nutrition, Arlington, VA, USA
- Save the Children, Washington, DC, USA
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14
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James PT, Ali Z, Armitage AE, Bonell A, Cerami C, Drakesmith H, Jobe M, Jones KS, Liew Z, Moore SE, Morales-Berstein F, Nabwera HM, Nadjm B, Pasricha SR, Scheelbeek P, Silver MJ, Teh MR, Prentice AM. The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. J Nutr 2021; 151:1854-1878. [PMID: 33982105 PMCID: PMC8194602 DOI: 10.1093/jn/nxab059] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 11/03/2020] [Revised: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
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Affiliation(s)
- Philip T James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zakari Ali
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Bonell
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Carla Cerami
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Modou Jobe
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kerry S Jones
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie E Moore
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Fernanda Morales-Berstein
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Behzad Nadjm
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Pauline Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matt J Silver
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Megan R Teh
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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15
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Gallant J, Chan K, Green TJ, Wieringa FT, Leemaqz S, Ngik R, Measelle JR, Baldwin DA, Borath M, Sophonneary P, Yelland LN, Hampel D, Shahab-Ferdows S, Allen LH, Jones KS, Koulman A, Parkington DA, Meadows SR, Kroeun H, Whitfield KC. Low-dose thiamine supplementation of lactating Cambodian mothers improves human milk thiamine concentrations: a randomized controlled trial. Am J Clin Nutr 2021; 114:90-100. [PMID: 33829271 PMCID: PMC8246599 DOI: 10.1093/ajcn/nqab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Infantile beriberi-related mortality is still common in South and Southeast Asia. Interventions to increase maternal thiamine intakes, and thus human milk thiamine, are warranted; however, the required dose remains unknown. OBJECTIVES We sought to estimate the dose at which additional maternal intake of oral thiamine no longer meaningfully increased milk thiamine concentrations in infants at 24 wk postpartum, and to investigate the impact of 4 thiamine supplementation doses on milk and blood thiamine status biomarkers. METHODS In this double-blind, 4-parallel arm randomized controlled dose-response trial, healthy mothers were recruited in Kampong Thom, Cambodia. At 2 wk postpartum, women were randomly assigned to consume 1 capsule, containing 0, 1.2 (estimated average requirement), 2.4, or 10 mg of thiamine daily from 2 through 24 weeks postpartum. Human milk total thiamine concentrations were measured using HPLC. An Emax curve was plotted, which was estimated using a nonlinear least squares model in an intention-to-treat analysis. Linear mixed-effects models were used to test for differences between treatment groups. Maternal and infant blood thiamine biomarkers were also assessed. RESULTS In total, each of 335 women was randomly assigned to1 of the following thiamine-dose groups: placebo (n = 83), 1.2 mg (n = 86), 2.4 mg (n = 81), and 10 mg (n = 85). The estimated dose required to reach 90% of the maximum average total thiamine concentration in human milk (191 µg/L) is 2.35 (95% CI: 0.58, 7.01) mg/d. The mean ± SD milk thiamine concentrations were significantly higher in all intervention groups (183 ± 91, 190 ± 105, and 206 ± 89 µg/L for 1.2, 2.4, and 10 mg, respectively) compared with the placebo group (153 ± 85 µg/L; P < 0.0001) and did not significantly differ from each other. CONCLUSIONS A supplemental thiamine dose of 2.35 mg/d was required to achieve a milk total thiamine concentration of 191 µg/L. However, 1.2 mg/d for 22 wk was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi. This trial was registered at clinicaltrials.gov as NCT03616288.
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Affiliation(s)
- Jelisa Gallant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS Canada
| | - Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS Canada
| | - Tim J Green
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Frank T Wieringa
- UMR-204, Institut de recherche pour le développement, UM/IRD/SupAgro, Montpellier, France
| | - Shalem Leemaqz
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Rem Ngik
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | | | - Dare A Baldwin
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Mam Borath
- National Subcommittee for Food Fortification, Cambodia Ministry of Planning, Phnom Penh, Cambodia
| | - Prak Sophonneary
- National Nutrition Programme, Maternal and Child Health Centre, Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Lisa N Yelland
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia,School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Setareh Shahab-Ferdows
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Kerry S Jones
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Damon A Parkington
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sarah R Meadows
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, Cambodia
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16
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Braithwaite VS, Mwangi MN, Jones KS, Demir AY, Prentice A, Prentice AM, Andang'o PEA, Verhoef H. Antenatal iron supplementation, FGF23, and bone metabolism in Kenyan women and their offspring: secondary analysis of a randomized controlled trial. Am J Clin Nutr 2021; 113:1104-1114. [PMID: 33675347 PMCID: PMC8106766 DOI: 10.1093/ajcn/nqaa417] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fibroblast growth factor-23 (FGF23) regulates body phosphate homeostasis primarily by increasing phosphaturia. It also acts as a vitamin D-regulating hormone. Maternal iron deficiency is associated with perturbed expression and/or regulation of FGF23 and hence might be implicated in the pathogenesis of hypophosphatemia-driven rickets in their offspring. OBJECTIVES We aimed to determine the effect of antenatal oral iron supplementation on FGF23 concentration and maternal and infant markers of bone-mineral regulation. METHODS We performed a secondary analysis of a trial in which 470 rural Kenyan women with singleton pregnancies and hemoglobin concentrations ≥ 90 g/L were randomly allocated to daily, supervised supplementation with 60 mg elemental iron as ferrous fumarate or placebo from 13-23 weeks of gestation until 1 mo postpartum. As previously reported, iron supplementation improved iron status in mothers and neonates. For the present study, we reanalyzed all available plasma samples collected in mothers and neonates at birth, with primary outcomes being concentrations of FGF23, measured by 2 assays: 1 that detects intact hormone and C-terminal cleavage products (total-FGF23) and another that detects the intact hormone only (intact-FGF23). RESULTS Analysis was performed on 433 women (n = 216, iron group; n = 217, placebo group) and 414 neonates (n = 207, iron group; n = 207, placebo group). Antenatal iron supplementation reduced geometric mean total-FGF23 concentrations in mothers and neonates by 62.6% (95% CI: 53.0%, 70.3%) and 15.2% (95% CI: -0.3%, 28.4%, P = 0.06), respectively. In addition, it increased geometric mean neonatal intact-FGF23 concentrations by 21.6% (95% CI: 1.2%, 46.1%), increased geometric mean maternal hepcidin concentrations by 136.4% (95% CI: 86.1%, 200.3%), and decreased mean maternal 25-hydroxyvitamin D concentrations by 6.1 nmol/L (95% CI: -11.0, -1.2 nmol/L). CONCLUSIONS Analysis of this randomized trial confirms that iron supplementation can reverse elevated FGF23 production caused by iron deficiency in iron-deficient mothers and their neonates. Further investigations are warranted to assess to what extent iron supplementation can prevent FGF23-mediated hypophosphatemic rickets or osteomalacia.
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Affiliation(s)
| | - Martin N Mwangi
- Wageningen University, Division of Human Nutrition and Health, P.O. Box 17, 6700 AA Wageningen, The Netherlands,University of Malawi, College of Medicine, Training and Research Unit of Excellence, Private Bag 360, BT 3, Chichiri, Blantyre, Malawi
| | - Kerry S Jones
- National Institute for Health Research (NIHR) Biomedical Research Centre Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AH, United Kingdom
| | - Ayşe Y Demir
- Meander Medical Centre, Laboratory for Clinical Chemistry and Hematology, P.O. Box 1502, 3800 BM Amersfoort, The Netherlands
| | - Ann Prentice
- Medical Research Council (MRC) Nutrition and Bone Health Research Group, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AH, United Kingdom (formerly the MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, United Kingdom),Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Pauline E A Andang'o
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Hans Verhoef
- Wageningen University, Division of Human Nutrition and Health, P.O. Box 17, 6700 AA Wageningen, The Netherlands,Wageningen University, Cell Biology and Immunology Group, P.O. Box 338, 6708 WD Wageningen, The Netherlands
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17
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Jones KS, Parkington DA, Cox LJ, Koulman A. Erythrocyte transketolase activity coefficient (ETKAC) assay protocol for the assessment of thiamine status. Ann N Y Acad Sci 2020; 1498:77-84. [PMID: 33354793 PMCID: PMC8451777 DOI: 10.1111/nyas.14547] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
Vitamin B1 (thiamine) is an essential nutrient that acts as a cofactor for a number of metabolic processes, particularly in energy metabolism. Symptoms of classic thiamine deficiency are recognized as beriberi, although clinical symptoms are nonspecific and recognition of subclinical deficiency is difficult. Therefore, reliable biomarkers of thiamine status are required. Thiamine diphosphate is a cofactor for transketolase, including erythrocyte transketolase (ETK). The ETK activity assay as an indirect, functional marker of thiamine status has been used for over 50 years. The ETK activity assay provides a sensitive and specific biomarker of thiamine status; however, there is a lack of consensus over the cutoffs for deficiency, partly due to a lack of assay harmonization. Here, we provide a step‐by‐step protocol for the measurement of ETK activity and the calculation of the ETK activity coefficient, including detailed explanations of equipment and chemicals required and guidance for quality control procedures. Harmonization of the protocol will provide the basis for the development of internationally recognized cutoffs for thiamine insufficiency. The establishment of quality control materials and a quality assurance scheme are recommended to provide reliability. This will ensure that the ETK activity assay remains an important method for the assessment of thiamine status.
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Affiliation(s)
- Kerry S Jones
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Damon A Parkington
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Lorna J Cox
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Braithwaite VS, Demir AY, Mwangi MN, Jones KS, Prentice A, Prentice AM, Andang’o PEA, Verhoef H. SUN-359 Antenatal Oral Iron Supplementation, FGF23 and Bone Metabolism in Kenyan Women and Their Offspring: A Randomised Controlled Trial. J Endocr Soc 2020. [PMCID: PMC7208496 DOI: 10.1210/jendso/bvaa046.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: FGF23 decreases reabsorption and increases phosphate excretion in the kidney and regulates vitamin D metabolism. Maternal iron deficiency may be implicated in the pathogenesis of hypophosphataemia-driven rickets in offspring through perturbed FGF23 expression. We aimed to determine the effect of antenatal oral iron supplementation on maternal and neonatal markers of bone mineral regulation. Methods: 470 rural Kenyan women with singleton pregnancies and haemoglobin concentrations ≥90g/L were randomly allocated to daily, supervised supplementation iron (60mg as ferrous fumarate) or placebo from 13–23 weeks gestational age until 1 month postpartum. We analysed maternal and neonatal plasma samples collected at birth, with primary outcomes being concentrations of FGF23 in its intact form (I-FGF23, the phosphate- and vitamin D-regulating hormone) and its C-terminal fragment (C-FGF23). Results: In mothers and neonates, antenatal iron supplementation reduced C-FGF23 concentration by 62.6% (95%CI: -70.3% to -53.0%) and 15.2% (-28.4% to 0.3%), respectively; increased neonatal I-FGF23 concentration by 21.6% (1.2% to 46.1%); increased maternal hepcidin concentration by 136%, (86% to 200%); and decreased maternal 25-hydroxyvitamin D concentrations by 6.1nmol/L (1.2 to 11.0nmol/L). We found no effect on markers of bone turnover in either mothers or neonates. The magnitude of the effect of antenatal iron supplementation on concentrations of C-FGF23, I-FGF23 and phosphate, and on estimated glomerular filtration rate (a measure of kidney glomerular function) depended on maternal iron status at baseline Conclusions: Antenatal iron supplementation may provide health benefits to pregnant women and their offspring beyond increasing iron status. Whether iron supplementation reduces present and future infant risk of rickets remains unclear.
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Affiliation(s)
| | | | - Martin N Mwangi
- Wageningen University, Division of Human Nutrition and Health, Wageningen, Netherlands
| | - Kerry S Jones
- NIHR BRC Nutritional Biomarker Laboratory, Cambridge, United Kingdom
| | - Ann Prentice
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, United Kingdom
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pauline E A Andang’o
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Hans Verhoef
- Wageningen University, Cell Biology and Immunology Group, Wageningen, Netherlands
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19
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Jones KS, Meadows SR, Schoenmakers I, Prentice A, Moore SE. Vitamin D Status Increases During Pregnancy and in Response to Vitamin D Supplementation in Rural Gambian Women. J Nutr 2020; 150:492-504. [PMID: 31834380 PMCID: PMC7056615 DOI: 10.1093/jn/nxz290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Vitamin D is important to maternal, fetal, and infant health, but quality data on vitamin D status in low- and middle-income countries and response to cholecalciferol supplementation in pregnancy are sparse. OBJECTIVE We characterized vitamin D status and vitamin D metabolite change across pregnancy and in response to cholecalciferol supplementation in rural Gambia. METHODS This study was a secondary analysis of samples collected in a 4-arm trial of maternal nutritional supplementation [iron folic acid (FeFol); multiple micronutrients (MMN); protein energy (PE) as lipid-based supplement; PE + MMN]; MMN included 10 μg/d cholecalciferol. Plasma 25-hydroxycholecalciferol [25(OH)D3], 24,25-dihydroxycholecalciferol [24,25(OH)2D3], and C3-epimer-25-hydroxycholecalciferol [3-epi-25(OH)D3] were measured by LC-MS/MS in 863 women [aged 30 ± 7 y (mean ± SD)] in early pregnancy (presupplementation) and late pregnancy, (gestational age 14 ± 3 and 30 ± 1 wk). Changes in 25(OH)D3 and vitamin D metabolite concentrations and associations with pregnancy stage and maternal age and anthropometry were tested. RESULTS Early pregnancy 25(OH)D3 concentration was 70 ± 15 nmol/L and increased according to pregnancy stage (82 ± 18 and 87 ± 17 nmol/L in the FeFol and PE-arms) and to cholecalciferol supplementation (95 ± 19 and 90 ± 20 nmol/L in the MMN and PE + MMN-arms) (P < 0.0001). There was no difference between supplemented groups. Early pregnancy 25(OH)D3 was positively associated with maternal age and gestational age. Change in 25(OH)D3 was negatively associated with late pregnancy, but not early pregnancy, triceps skinfold thickness. The pattern of change of 24,25(OH)2D3 mirrored that of 25(OH)D3 and appeared to flatten as pregnancy progressed, whereas 3-epi-25(OH)D3 concentration increased across pregnancy. CONCLUSION This study provides important data on the vitamin D status of a large cohort of healthy pregnant women in rural Africa. Without supplementation, vitamin D status increased during pregnancy, demonstrating that pregnancy stage should be considered when assessing vitamin D status. Nutritionally relevant cholecalciferol supplementation further increased vitamin D status. These data are relevant to the development of fortification and supplementation policies in pregnant women in West Africa.
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Affiliation(s)
- Kerry S Jones
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK,Address correspondence to KSJ (e-mail: )
| | - Sarah R Meadows
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Inez Schoenmakers
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ann Prentice
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia,Department of Women and Children's Health, King's College London, UK
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20
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Hengist A, Perkin O, Gonzalez JT, Betts JA, Hewison M, Manolopoulos KN, Jones KS, Koulman A, Thompson D. Mobilising vitamin D from adipose tissue: The potential impact of exercise. NUTR BULL 2019; 44:25-35. [PMID: 34853551 PMCID: PMC8609434 DOI: 10.1111/nbu.12369] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Vitamin D is lipophilic and accumulates substantially in adipose tissue. Even without supplementation, the amount of vitamin D in the adipose of a typical adult is equivalent to several months of the daily reference nutrient intake (RNI). Paradoxically, despite the large amounts of vitamin D located in adipose tissue, individuals with obesity are often vitamin D deficient according to consensus measures of vitamin D status (serum 25-hydroxyvitamin D concentrations). Thus, it appears that vitamin D can become 'trapped' in adipose tissue, potentially due to insufficient lipolytic stimulation and/or due to tissue dysfunction/adaptation resulting from adipose expansion. Emerging evidence suggests that exercise may mobilise vitamin D from adipose (even in the absence of weight loss). If exercise helps to mobilise vitamin D from adipose tissue, then this could have important ramifications for practitioners and policymakers regarding the management of low circulating levels of vitamin D, as well as chronically low levels of physical activity, obesity and associated health conditions. This perspective led us to design a study to examine the impact of exercise on vitamin D status, vitamin D turnover and adipose tissue vitamin D content (the VitaDEx project). The VitaDEx project will determine whether increasing physical activity (via exercise) represents a potentially useful strategy to mobilise vitamin D from adipose tissue.
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Affiliation(s)
- A Hengist
- Department for Health University of Bath Bath UK
| | - O Perkin
- Department for Health University of Bath Bath UK
| | - J T Gonzalez
- Department for Health University of Bath Bath UK
| | - J A Betts
- Department for Health University of Bath Bath UK
| | - M Hewison
- Institute of Metabolism and Systems Research University of Birmingham Birmingham UK
| | - K N Manolopoulos
- Institute of Metabolism and Systems Research University of Birmingham Birmingham UK
| | - K S Jones
- NIHR BRC Nutritional Biomarker Laboratory University of Cambridge Cambridge UK
| | - A Koulman
- NIHR BRC Nutritional Biomarker Laboratory University of Cambridge Cambridge UK
| | - D Thompson
- Department for Health University of Bath Bath UK
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21
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Braithwaite VS, Crozier SR, D'Angelo S, Prentice A, Cooper C, Harvey NC, Jones KS. The Effect of Vitamin D Supplementation on Hepcidin, Iron Status, and Inflammation in Pregnant Women in the United Kingdom. Nutrients 2019; 11:E190. [PMID: 30669280 PMCID: PMC6356300 DOI: 10.3390/nu11010190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 01/02/2019] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/29/2022] Open
Abstract
Iron and vitamin D deficiencies are common during pregnancy. Our aim was to identify whether antenatal vitamin D₃ supplementation affects iron status (via hepcidin suppression) and/or inflammation. Using a subset of the UK multicenter Maternal Vitamin D Osteoporosis Study (MAVIDOS)-a double-blinded, randomized, placebo-controlled trial (ISRCTN82927713; EudraCT2007-001716-23)-we performed a secondary laboratory analysis. Women with blood samples from early and late pregnancy (vitamin D₃ (1000 IU/day from ~14 weeks gestation n = 93; placebo n = 102) who gave birth in the springtime (March⁻May) were selected as we anticipated seeing the greatest treatment group difference in change in 25-hydroxyvitamin D (25OHD) concentration. Outcomes were hepcidin, ferritin, C-reactive protein, and α1-acid glycoprotein concentration in late pregnancy (25OHD concentration was measured previously). By late pregnancy, 25OHD concentration increased by 17 nmol/L in the vitamin D₃ group and decreased by 11 nmol/L in the placebo group; hepcidin, ferritin, and inflammatory markers decreased but no treatment group differences were seen. In late pregnancy, positive relationships between 25OHD and hepcidin and 25OHD and ferritin in the placebo group were observed but not in the treatment group (group × 25OHD interaction, p < 0.02). Vitamin D₃ supplementation had no effect on hepcidin, ferritin, or inflammatory status suggesting no adjunctive value of vitamin D₃ in reducing rates of antenatal iron deficiency.
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Affiliation(s)
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Ann Prentice
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford OX1 2JD, UK.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge CB2 0AH, UK.
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22
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Hennig BJ, Unger SA, Dondeh BL, Hassan J, Hawkesworth S, Jarjou L, Jones KS, Moore SE, Nabwera HM, Ngum M, Prentice A, Sonko B, Prentice AM, Fulford AJ. Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)-a platform for integrated research and health care provision in rural Gambia. Int J Epidemiol 2018; 46:e13. [PMID: 26559544 PMCID: PMC5837564 DOI: 10.1093/ije/dyv206] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Branwen J Hennig
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan A Unger
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,University of Edinburgh, Department of Child Life and Health, Edinburgh, UK
| | - Bai Lamin Dondeh
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Jahid Hassan
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Sophie Hawkesworth
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Landing Jarjou
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Sophie E Moore
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Helen M Nabwera
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Mohammed Ngum
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Ann Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Bakary Sonko
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Andrew M Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony J Fulford
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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23
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Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci 2018; 1430:44-79. [PMID: 30225965 DOI: 10.1111/nyas.13968] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/15/2022]
Abstract
Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.
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Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - John Aloia
- NYU Winthrop Hospital, Mineola, New York
| | - Gilles Bergeron
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | - Megan W Bourassa
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | | | - Mona S Calvo
- Retired, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, University College Cork, Cork, Ireland
| | | | | | | | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Adrian R Martineau
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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24
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Schwartz JB, Gallagher JC, Jorde R, Berg V, Walsh J, Eastell R, Evans AL, Bowles S, Naylor KE, Jones KS, Schoenmakers I, Holick M, Orwoll E, Nielson C, Kaufmann M, Jones G, Bouillon R, Lai J, Verotta D, Bikle D. Determination of Free 25(OH)D Concentrations and Their Relationships to Total 25(OH)D in Multiple Clinical Populations. J Clin Endocrinol Metab 2018; 103:3278-3288. [PMID: 29955795 PMCID: PMC6126881 DOI: 10.1210/jc.2018-00295] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT The optimal measure of vitamin D status is unknown. OBJECTIVE To directly measure circulating free 25-hydroxyvitamin D [25(OH)D] concentrations and relationships to total 25(OH)D in a clinically diverse sample of humans. DESIGN Cross-sectional analysis. SETTING Seven academic sites. PATIENTS A total of 1661 adults: healthy (n = 279), prediabetic (n = 479), outpatients (n = 714), cirrhotic (n = 90), pregnant (n = 20), nursing home resident (n = 79). INTERVENTIONS Merge research data on circulating free 25(OH)D (directly-measured immunoassay), total 25(OH)D (liquid chromatography/tandem mass spectrometry), D-binding protein [DBP; by radial (polyclonal) immunodiffusion assay], albumin, creatinine, intact parathyroid hormone, and DBP haplotype. MAIN OUTCOME MEASURES Distribution of free 25(OH)D (ANOVA with Bonferroni correction for post hoc comparisons) and relationships between free and total 25(OH)D (mixed-effects modeling incorporating clinical condition, DBP haplotype with sex, race, estimated glomerular filtration rate (eGFR), body mass index (BMI), and other covariates). RESULTS Free 25(OH)D was 4.7 ± 1.8 pg/mL (mean ± SD) in healthy persons and 4.3 ± 1.9 pg/mL in outpatients, with levels of 0.5 to 8.1 pg/mL and 0.9 to 8.1 pg/mL encompassing 95% of healthy persons and outpatients, respectively. Free 25(OH)D was higher in patients with cirrhosis (7.1 ± 3.0 pg/mL; P < 0.0033) and nursing home residents (7.9 ± 2.1 pg/mL; P < 0.0033) than in other groups and differed between whites and blacks (P < 0.0033) and between DBP haplotypes (P < 0.0001). Mixed-effects modeling of relationships between free and total 25(OH)D identified clinical conditions (patients with cirrhosis > nursing home residents > patients with prediabetes > outpatients > pregnant women) and BMI (lesser effect) as covariates affecting relationships but not eGFR, sex, race, or DBP haplotype. CONCLUSIONS Total 25(OH)D, health condition, race, and DBP haplotype affected free 25(OH)D, but only health conditions and BMI affected relationships between total and free 25(OH)D. Clinical importance of free 25(OH)D needs to be established in studies assessing outcomes.
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Affiliation(s)
- Janice B Schwartz
- Department of Medicine, University of California, San Francisco, California
- Correspondence and Reprint Requests: Janice B. Schwartz, MD, Department of Medicine, University of California, San Francisco, Box 1265, 3333 California Street, San Francisco, California 94143-1265. E-mail:
| | | | - Rolf Jorde
- Tromso Endocrine Research Group, UiT the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vivian Berg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Jennifer Walsh
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom
| | - Richard Eastell
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom
| | - Amy L Evans
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Bowles
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom
| | - Kim E Naylor
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Inez Schoenmakers
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Department of Medicine, Norwich Medical School, Faculty of Medicine and Health Sciences, Norwich, United Kingdom
- University of East Anglia, Norwich, United Kingdom
| | - Michael Holick
- Boston University School of Medicine, Boston, Massachusetts
| | - Eric Orwoll
- Oregon Health and Science University, Portland, Oregon
| | | | | | | | | | - Jennifer Lai
- Department of Medicine, University of California, San Francisco, California
| | - Davide Verotta
- Departments of Bioengineering and Therapeutic Sciences and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Daniel Bikle
- Department of Medicine, University of California, San Francisco, California
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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25
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Jones KS, Redmond J, Fulford AJ, Jarjou L, Zhou B, Prentice A, Schoenmakers I. Diurnal rhythms of vitamin D binding protein and total and free vitamin D metabolites. J Steroid Biochem Mol Biol 2017; 172:130-135. [PMID: 28732681 PMCID: PMC5571031 DOI: 10.1016/j.jsbmb.2017.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/02/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022]
Abstract
Vitamin D binding protein (DBP) concentration is known to influence the availability and bioactivity of vitamin D metabolites but its diurnal rhythm (DR), its inter-relationships with the DRs of vitamin D metabolites and its influence on free vitamin D metabolite concentrations are not well described. The DRs of plasma total 25(OH)D, total 1,25(OH)2D, DBP, albumin and calculated free 25(OH)D and free 1,25(OH)2D were measured in men and women aged 60-75 years and resident in the UK (n 30), Gambia (n 31) and China (n 30) with differences in lifestyle, dietary intake and vitamin D status. Blood samples were collected every 4h for 24h and DRs statistically analysed with Fourier regression. Gambians had significantly higher plasma concentrations of vitamin D metabolites and lower albumin concentration compared to the British and Chinese. Significant DRs were observed for all analytes and calculated free vitamin D metabolites (P<0.01). The pattern of DRs was similar between countries. The magnitude of the DRs of free 1,25(OH)2D was attenuated compared to that of total 1,25(OH)2D whereas it was not different between total and free 25(OH)D. Relationships between the DRs were generally weak. There was no phase shift between 1,25(OH)2D and DBP with the strongest cross correlation at 0h time lag (r=0.15, P=<0.001). In comparison, 25(OH)D correlated less well with DBP (1h time lag, r=0.07, P=0.12). These data demonstrate a relationship between the DRs of 1,25(OH)2D and DBP, possibly to maintain free 1,25(OH)2D concentrations. In contrast, the DRs of total and free 25(OH)D appeared to be less influenced by DBP, suggesting that DBP has comparatively less effect on 25(OH)D concentration and 25(OH)D availability. This work highlights the importance of standardisation in timing of sample collection particularly for the assessment of plasma protein concentrations.
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Affiliation(s)
- Kerry S Jones
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom.
| | - Jean Redmond
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom
| | - Anthony J Fulford
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | | | - Bo Zhou
- Department of Public Health, Shenyang Medical College, Shenyang 110034, PR China
| | - Ann Prentice
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom; MRC Keneba, MRC Unit, Gambia
| | - Inez Schoenmakers
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom
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26
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Schoenmakers I, Jones KS. Letter to the Editor: The Effect of Genetic Factors on the Response to Vitamin D Supplementation May Be Mediated by Vitamin D-Binding Protein Concentrations. J Clin Endocrinol Metab 2017; 102:2562-2563. [PMID: 28899076 PMCID: PMC5505207 DOI: 10.1210/jc.2017-00666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/21/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Inez Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, United Kingdom
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Brewer WM, Xin Y, Hatem C, Diercks D, Truong VQ, Jones KS. Lateral Ge Diffusion During Oxidation of Si/SiGe Fins. Nano Lett 2017; 17:2159-2164. [PMID: 28249115 DOI: 10.1021/acs.nanolett.6b04407] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This Letter reports on the unusual diffusion behavior of Ge during oxidation of a multilayer Si/SiGe fin. It is observed that oxidation surprisingly results in the formation of vertically stacked Si nanowires encapsulated in defect free epitaxial strained SixGe1-x. High angle annular dark field scanning transmission electron microscopy (HAADF-STEM) shows that extremely enhanced diffusion of Ge occurs along the vertical Si/SiO2 oxidizing interface and is responsible for the encapsulation process. Further oxidation fully encapsulates the Si layers in defect free single crystal SixGe1-x (x up to 0.53), which results in Si nanowires with up to -2% strain. Atom probe tomography reconstructions demonstrate that the resultant nanowires run the length of the fin. We found that the oxidation temperature plays a significant role in the formation of the Si nanowires. In the process range of 800-900 °C, pure strained and rounded Si nanowires down to 2 nm in diameter can be fabricated. At lower temperatures, the Ge diffusion along the oxidizing Si/SiO2 interface is slow, and rounding of the nanowire does not occur, while at higher temperatures, the diffusivity of Ge into Si is sufficient to result in dilution of the pure Si nanowire with Ge. The use of highly selective etchants to remove the SiGe could provide a new pathway for the creation of highly controlled vertically stacked nanowires for gate all around transistors.
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Affiliation(s)
- William M Brewer
- Department of Materials Science and Engineering, University of Florida , Gainesville, Florida 32611, United States
| | - Yan Xin
- National High Magnetic Field Laboratory, Florida State University , Tallahassee, Florida 32310, United States
| | - C Hatem
- Applied Materials, Gloucester, Massachusetts 01930, United States
| | - D Diercks
- Department of Metallurgical and Materials Engineering, Colorado School of Mines , Golden, Colorado 80401, United States
| | - V Q Truong
- Department of Materials Science and Engineering, University of Florida , Gainesville, Florida 32611, United States
| | - K S Jones
- Department of Materials Science and Engineering, University of Florida , Gainesville, Florida 32611, United States
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Assar S, Schoenmakers I, Koulman A, Prentice A, Jones KS. UPLC-MS/MS Determination of Deuterated 25-Hydroxyvitamin D (d 3-25OHD 3) and Other Vitamin D Metabolites for the Measurement of 25OHD Half-Life. Methods Mol Biol 2017; 1546:257-265. [PMID: 27896775 DOI: 10.1007/978-1-4939-6730-8_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Plasma 25-hydroxyvitamin D (25OHD) half-life (25OHDt 1/2) is a dynamic marker of vitamin D metabolism that can be used to assess vitamin D expenditure and help inform vitamin D requirements. Our group recently established an approach to determine the 25OHDt 1/2 as an alternative biomarker of 25OHD expenditure in humans. The approach uses a small oral dose of stable isotope labeled 25OHD3 [3-2H-25OHD3 (6,19,19-d3)] (d3-25OHD3) (tracer), which is distinguishable from endogenous 25OHD by liquid chromatography tandem-mass spectrometry (LC-MS/MS). We report here the method, which relies on protein precipitation, purification with solid phase extraction, derivatization with 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD), and determination of the compounds by isotope-dilution UPLC-MS/MS. The method proved to be rapid and sensitive (LOQ 0.2 nmol/L) for the quantification of this tracer as well as the other vitamin D metabolites: 25OHD3, 25OHD2, and 24,25(OH)2D3 in human plasma.
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Affiliation(s)
- Shima Assar
- MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK.
| | - Inez Schoenmakers
- MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - Albert Koulman
- MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - Ann Prentice
- MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
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Schoenmakers I, Pettifor JM, Peña-Rosas JP, Lamberg-Allardt C, Shaw N, Jones KS, Lips P, Glorieux FH, Bouillon R. Prevention and consequences of vitamin D deficiency in pregnant and lactating women and children: A symposium to prioritise vitamin D on the global agenda. J Steroid Biochem Mol Biol 2016; 164:156-160. [PMID: 26569647 DOI: 10.1016/j.jsbmb.2015.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 01/18/2023]
Abstract
The Department of Nutrition for Health and Development of the World Health Organization (WHO) in collaboration with the Executive Committee of the 18th Vitamin D Workshop (VDW), organised a joint symposium on the prevention and consequences of vitamin D deficiency in pregnant women and children, convening experts on vitamin D, clinicians and policy-makers. The overall aim was to identify priority areas for research and to discuss the need for global options for policy, with a focus on the prevention of rickets in infants and children and vitamin D deficiency in pregnant women. The scope and purpose were: (i) to present the WHO research strategy for health, addressing vitamin D-related public health problems and the process for the development of evidence-informed guidelines in general and how vitamin D interventions in diverse populations could be prioritised; (ii) to provide an overview of vitamin D status in children and pregnant and lactating women across the world; (iii) to review the health risks associated with vitamin D deficiency in children and in pregnant women and their offspring; (iv) to understand the aetiology of vitamin D deficiency in pregnant women and children; (v) to identify and interpret biomarkers to assess vitamin D status and to consider possible clinical and biochemical screening tools for determining the prevalence of nutritional rickets in at risk groups or communities; and (vi) to provide an overview of policies and recommendations on vitamin D across the world. The format of the symposium was a composite of comprehensive scientific presentations and a panel debate with international experts on WHO guidelines, nutritional rickets, nutritional policy and consequences of vitamin D deficiency during pregnancy. This paper summarizes the content and outcomes of the panel debate.
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Affiliation(s)
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juan-Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organisation, Geneva, Switzerland
| | | | - Nick Shaw
- Birmingham Children's Hospital, University of Birmingham, UK
| | - Kerry S Jones
- Medical Research Council (MRC) Human Nutrition Research, UK
| | - Paul Lips
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, KU, Leuven, Belgium
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Schoenmakers I, Gousias P, Jones KS, Prentice A. Prediction of winter vitamin D status and requirements in the UK population based on 25(OH) vitamin D half-life and dietary intake data. J Steroid Biochem Mol Biol 2016; 164:218-222. [PMID: 26970588 DOI: 10.1016/j.jsbmb.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/08/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
On a population basis, there is a gradual decline in vitamin D status (plasma 25(OH)D) throughout winter. We developed a mathematical model to predict the population winter plasma 25(OH)D concentration longitudinally, using age-specific values for 25(OH)D expenditure (25(OH)D3t1/2), cross-sectional plasma 25(OH)D concentration and vitamin D intake (VDI) data from older (70+ years; n=492) and younger adults (18-69 years; n=448) participating in the UK National Diet and Nutrition Survey. From this model, the population VDI required to maintain the mean plasma 25(OH)D at a set concentration can be derived. As expected, both predicted and measured population 25(OH)D (mean (95%CI)) progressively declined from September to March (from 51 (40-61) to 38 (36-41)nmol/L (predicted) vs 38 (27-48)nmol/L (measured) in older people and from 59 (54-65) to 34 (31-37)nmol/L (predicted) vs 37 (31-44)nmol/L (measured) in younger people). The predicted and measured mean values closely matched. The predicted VDIs required to maintain mean winter plasma 25(OH)D at 50nmol/L at the population level were 10 (0-20) to 11 (9-14) and 11 (6-16) to 13(11-16)μg/d for older and younger adults, respectively dependent on the month. In conclusion, a prediction model accounting for 25(OH)D3t1/2, VDI and scaling factor for the 25(OH)D response to VDI, closely predicts measured population winter values. Refinements of this model may include specific scaling factors accounting for the 25(OH)D response at different VDIs and as influenced by body composition and specific values for 25(OH)D3 t1/2 dependent on host factors such as kidney function. This model may help to reduce the need for longitudinal measurements.
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Affiliation(s)
- Inez Schoenmakers
- Medical Research Council (MRC), Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL Cambridge, UK.
| | - Petros Gousias
- Medical Research Council (MRC), Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL Cambridge, UK
| | - Kerry S Jones
- Medical Research Council (MRC), Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL Cambridge, UK
| | - Ann Prentice
- Medical Research Council (MRC), Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL Cambridge, UK
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Walsh JS, Evans AL, Bowles S, Naylor KE, Jones KS, Schoenmakers I, Jacques RM, Eastell R. Free 25-hydroxyvitamin D is low in obesity, but there are no adverse associations with bone health. Am J Clin Nutr 2016; 103:1465-71. [PMID: 27169839 DOI: 10.3945/ajcn.115.120139] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The mechanism and clinical significance of low circulating 25-hydroxyvitamin D [25(OH)D] in obese people are unknown. Low total 25(OH)D may be due to low vitamin D-binding proteins (DBPs) or faster metabolic clearance. However, obese people have a higher bone mineral density (BMD), which suggests that low 25(OH)D may not be associated with adverse consequences for bone. OBJECTIVE We sought to determine whether 1) vitamin D metabolism and 2) its association with bone health differ by body weight. DESIGN We conducted a cross-sectional observational study of 223 normal-weight, overweight, and obese men and women aged 25-75 y in South Yorkshire, United Kingdom, in the fall and spring. A subgroup of 106 subjects was also assessed in the winter. We used novel techniques, including an immunoassay for free 25(OH)D, a stable isotope for the 25(OH)D3 half-life, and high-resolution quantitative tomography, to make a detailed assessment of vitamin D physiology and bone health. RESULTS Serum total 25(OH)D was lower in obese and overweight subjects than in normal-weight subjects in the fall and spring (geometric means: 45.0 and 40.8 compared with 58.6 nmol/L, respectively; P < 0.001) but not in the winter. Serum 25(OH)D was inversely correlated with body mass index (BMI) in the fall and spring and in the winter. Free 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)2D] were lower in obese subjects. DBP, the DBP genotype, and the 25(OH)D3 half-life did not differ between BMI groups. Bone turnover was lower, and bone density was higher, in obese people. CONCLUSIONS Total and free 25(OH)D and 1,25(OH)2D are lower at higher BMI, which cannot be explained by lower DBP or the shorter half-life of 25(OH)D3 We speculate that low 25(OH)D in obesity is due to a greater pool of distribution. Lower 25(OH)D may not reflect at-risk skeletal health in obese people, and BMI should be considered when interpreting serum 25(OH)D as a marker of vitamin D status.
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Affiliation(s)
| | | | | | | | - Kerry S Jones
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | - Inez Schoenmakers
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | - Richard M Jacques
- School of Health and Related Research, University of Sheffield, United Kingdom; and
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Jones KS, Assar S, Prentice A, Schoenmakers I. Vitamin D expenditure is not altered in pregnancy and lactation despite changes in vitamin D metabolite concentrations. Sci Rep 2016; 6:26795. [PMID: 27222109 PMCID: PMC4879580 DOI: 10.1038/srep26795] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022] Open
Abstract
Pregnancy and lactation are associated with changes in vitamin D and calcium metabolism but the impact of these changes on vitamin D expenditure is unknown. We measured plasma 25(OH)D3 half-life with a stable-isotope tracer and investigated relationships with vitamin D metabolites in pregnant, lactating and ‘non-pregnant, non-lactating’ (NPNL) women. Vitamin D metabolites, vitamin D binding protein (DBP), PTH and 25(OH)D3 half-life were measured in third-trimester pregnant women (n22) and repeated during lactation 12 weeks post-partum (n14) and twice in NPNL women (n23 and n10, respectively) in rural Gambia where calcium intakes are low with little seasonality in UVB-exposure. 25(OH)D3 half-life was not significantly different between groups (mean(SD): 20.6(6.8), 22.6(7.7), 18.0(4.7) and 17.7(9.5) days in pregnant, lactating and NPNL women, respectively). Plasma 25(OH)D3, 1,25(OH)2D, and DBP were higher in pregnancy, and calculated free-25(OH)D3 and PTH were lower (P < 0.05). In lactation, 25(OH)D3 and 24,25(OH)2D3 were lower compared to pregnant (P < 0.001, P = 0.02) and NPNL women (P = 0.04, P = 0.07). Significant associations were observed between half-life and 25(OH)D3 (+ve) in pregnancy, and in all groups between 25(OH)D3 and free-25(OH)D3 (+ve) and PTH and 25(OH)D3 (−ve) (P < 0.0001). These data suggest that adaptive changes in pregnancy and lactation occur that prevent pronounced changes in vitamin D expenditure.
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Affiliation(s)
- Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.,MRC Keneba, MRC Unit, Banjul, The Gambia
| | - Shima Assar
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK
| | - Ann Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.,MRC Keneba, MRC Unit, Banjul, The Gambia
| | - Inez Schoenmakers
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK
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Nielson CM, Jones KS, Chun RF, Jacobs JM, Wang Y, Hewison M, Adams JS, Swanson CM, Lee CG, Vanderschueren D, Pauwels S, Prentice A, Smith RD, Shi T, Gao Y, Schepmoes AA, Zmuda JM, Lapidus J, Cauley JA, Bouillon R, Schoenmakers I, Orwoll ES. Free 25-Hydroxyvitamin D: Impact of Vitamin D Binding Protein Assays on Racial-Genotypic Associations. J Clin Endocrinol Metab 2016; 101:2226-34. [PMID: 27007693 PMCID: PMC4870848 DOI: 10.1210/jc.2016-1104] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Total 25-hydroxyvitamin D (25OHD) is a marker of vitamin D status and is lower in African Americans than in whites. Whether this difference holds for free 25OHOD (f25OHD) is unclear, considering reported genetic-racial differences in vitamin D binding protein (DBP) used to calculate f25OHD. OBJECTIVES Our objective was to assess racial-geographic differences in f25OHD and to understand inconsistencies in racial associations with DBP and calculated f25OHD. DESIGN This study used a cross-sectional design. SETTING The general community in the United States, United Kingdom, and The Gambia were included in this study. PARTICIPANTS Men in Osteoporotic Fractures in Men and Medical Research Council studies (N = 1057) were included. EXPOSURES Total 25OHD concentration, race, and DBP (GC) genotype exposures were included. OUTCOME MEASURES Directly measured f25OHD, DBP assessed by proteomics, monoclonal and polyclonal immunoassays, and calculated f25OHD were the outcome measures. RESULTS Total 25OHD correlated strongly with directly measured f25OHD (Spearman r = 0.84). Measured by monoclonal assay, mean DBP in African-ancestry subjects was approximately 50% lower than in whites, whereas DBP measured by polyclonal DBP antibodies or proteomic methods was not lower in African-ancestry. Calculated f25OHD (using polyclonal DBP assays) correlated strongly with directly measured f25OHD (r = 0.80-0.83). Free 25OHD, measured or calculated from polyclonal DBP assays, reflected total 25OHD concentration irrespective of race and was lower in African Americans than in US whites. CONCLUSIONS Previously reported racial differences in DBP concentration are likely from monoclonal assay bias, as there was no racial difference in DBP concentration by other methods. This confirms the poor vitamin D status of many African-Americans and the utility of total 25OHD in assessing vitamin D in the general population.
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Nielson CM, Jones KS, Bouillon R, Chun RF, Jacobs J, Wang Y, Hewison M, Adams JS, Swanson CM, Lee CG, Vanderschueren D, Pauwels S, Prentice A, Smith RD, Shi T, Gao Y, Zmuda JM, Lapidus J, Cauley JA, Schoenmakers I, Orwoll ES. Role of Assay Type in Determining Free 25-Hydroxyvitamin D Levels in Diverse Populations. N Engl J Med 2016; 374:1695-6. [PMID: 27007809 PMCID: PMC4870041 DOI: 10.1056/nejmc1513502] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Kerry S Jones
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | | | - Rene F Chun
- University of California, Los Angeles, Los Angeles, CA
| | - Jon Jacobs
- Pacific Northwest National Laboratory, Richland, WA
| | - Ying Wang
- Oregon Health and Science University, Portland, OR
| | | | - John S Adams
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | - Ann Prentice
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | | | - Tujin Shi
- Pacific Northwest National Laboratory, Richland, WA
| | - Yuqian Gao
- Pacific Northwest National Laboratory, Richland, WA
| | | | - Jodi Lapidus
- Oregon Health and Science University, Portland, OR
| | | | - Inez Schoenmakers
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
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Connor B, Sun Y, von Hieber D, Tang SK, Jones KS, Maucksch C. AAV1/2-mediated BDNF gene therapy in a transgenic rat model of Huntington's disease. Gene Ther 2015; 23:283-95. [PMID: 26704721 DOI: 10.1038/gt.2015.113] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Abstract
Reduced expression and disrupted corticostriatal transportation of brain-derived neurotrophic factor (BDNF) is proposed to contribute to the selective vulnerability of medium spiny striatal projection neurons (MSNs) in Huntington's disease (HD). We have previously demonstrated that BDNF overexpression in the quinolinic acid lesioned rat striatum attenuates motor impairment and reduces the extent of MSN cell loss. To further investigate the potential therapeutic properties of BDNF for HD, the current study examines the effect of bilateral AAV1/2-mediated BDNF expression in the striatum of a transgenic rat model of HD. Transfer of the BDNF gene to striatal neurons using an AAV1/2 serotype vector enhanced BDNF protein levels in the striatum. Bilateral BDNF expression attenuated the impairment of both motor and cognitive function when compared with AAV1/2-vehicle- or YFP-treated transgenic HD rats. Interestingly, a gender effect was apparent with female transgenic HD rats exhibiting less functional impairment than males. Quantification of NeuN and DARRP32 immunoreactivity and striatal volume revealed limited disease phenotype between wild type and transgenic HD animals. However, AAV1/2-BDNF-treated transgenic HD rats showed evidence of greater striatal volume and increased NeuN+ cell numbers compared with wild-type vehicle- and AAV1/2-vehicle- or YFP-treated transgenic HD rats. We propose BDNF holds considerable therapeutic potential for alleviating behavioral dysfunction and neuronal degeneration in HD, with further work required to examine the role of BDNF-TrkB signaling and the preservation of axonal and synaptic function.
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Affiliation(s)
- B Connor
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Y Sun
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - D von Hieber
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S K Tang
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - K S Jones
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C Maucksch
- Department of Pharmacology and Clinical Pharmacology, Centre for Brain Research, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Braithwaite VS, Jones KS, Schoenmakers I, Silver M, Prentice A, Hennig BJ. Vitamin D binding protein genotype is associated with plasma 25OHD concentration in West African children. Bone 2015; 74:166-70. [PMID: 25652210 PMCID: PMC4366041 DOI: 10.1016/j.bone.2014.12.068] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023]
Abstract
Vitamin D is well known for its role in promoting skeletal health. Vitamin D status is determined conventionally by circulating 25-dihydroxyvitamin D (25OHD) concentration. There is evidence indicating that circulating 25OHD concentration is affected by variation in Gc, the gene encoding the vitamin D binding protein (DBP). The composite genotype of two single nucleotide polymorphisms (rs7041 and rs4588) results in different DBP isotypes (Gc1f, Gc1s and Gc2). The protein configurational differences among DBP isotypes affect DBP substrate binding affinity. The aims of this study were to determine 1) Gc variant frequencies in a population from an isolated rural region of The Gambia, West Africa (n=3129) with year-round opportunity for cutaneous vitamin D synthesis and 2) the effects of Gc variants on 25OHD concentration (n=237) in a genetically representative sub-group of children (mean (SD) age: 11.9 (4.8) years). The distribution of Gc variants was Gc1f: 0.86, Gc1s: 0.11 and Gc2: 0.03. The mean (SD) concentration of 25OHD was 59.6 (12.9) nmol/L and was significantly higher in those homozygous for Gc1f compared to other Gc variants (60.7 (13.1) vs. 56.6 (12.1) nmol/L, P=0.03). Plasma 25OHD and 1,25(OH)2D concentration was significantly associated with parathyroid hormone in Gc1f-1f but not in the other Gc variants combined. This study demonstrates that different Gc variants are associated with different 25OHD concentrations in a rural Gambian population. Gc1f-1f, thought to have the highest affinity for 25OHD, had the highest 25OHD concentration compared with lower affinity Gc variants. The considerable difference in Gc1f frequency observed in Gambians compared with other non-West African populations and associated differences in plasma 25OHD concentration, may have implications for the way in which vitamin D status should be interpreted across different ancestral groups.
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Affiliation(s)
- V S Braithwaite
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
| | - K S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - I Schoenmakers
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - M Silver
- MRC International Nutrition Group at London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT UK and MRC Unit, The Gambia
| | - A Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK; MRC Keneba, Keneba, The Gambia
| | - B J Hennig
- MRC International Nutrition Group at London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT UK and MRC Unit, The Gambia
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Jones KS, Assar S, Vanderschueren D, Bouillon R, Prentice A, Schoenmakers I. Predictors of 25(OH)D half-life and plasma 25(OH)D concentration in The Gambia and the UK. Osteoporos Int 2015; 26:1137-46. [PMID: 25278297 PMCID: PMC4331602 DOI: 10.1007/s00198-014-2905-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Predictors of 25(OH)D3 half-life were factors associated with vitamin D metabolism, but were different between people in The Gambia and the UK. Country was the strongest predictor of plasma 25(OH)D concentration, probably as a marker of UVB exposure. 25(OH)D3 half-life may be applied as a tool to investigate vitamin D expenditure. INTRODUCTION The aim of this study was to investigate predictors of 25(OH)D3 half-life and plasma 25(OH)D concentration. METHODS Plasma half-life of an oral tracer dose of deuterated-25(OH)D3 was measured in healthy men aged 24-39 years, resident in The Gambia, West Africa (n = 18) and in the UK during the winter (n = 18), countries that differ in calcium intake and vitamin D status. Plasma and urinary markers of vitamin D, calcium, phosphate and bone metabolism, nutrient intakes and anthropometry were measured. RESULTS Normally distributed data are presented as mean (SD) and non-normal data as geometric mean (95% CI). Gambian compared to UK men had higher plasma concentrations of 25(OH)D (69 (13) vs. 29 (11) nmol/L; P < 0.0001); 1,25(OH)2D (181 (165, 197) vs. 120 (109, 132) pmol/L; P < 0.01); and parathyroid hormone (PTH) (50 (42, 60) vs. 33 (27, 39); P < 0.0001). There was no difference in 25(OH)D3 half-life (14.7 (3.5) days vs. 15.6 (2.5) days) between countries (P = 0.2). In multivariate analyses, 25(OH)D, 1,25(OH)2D, vitamin D binding protein and albumin-adjusted calcium (Caalb) explained 79% of variance in 25(OH)D3 half-life in Gambians, but no significant predictors were found in UK participants. For the countries combined, Caalb, PTH and plasma phosphate explained 39 % of half-life variability. 1,25(OH)2D, weight, PTH and country explained 81% of variability in 25(OH)D concentration; however, country alone explained 74%. CONCLUSION Factors known to affect 25(OH)D metabolism predict 25(OH)D3 half-life, but these differed between countries. Country predicted 25(OH)D, probably as a proxy measure for UVB exposure and vitamin D supply. This study supports the use of 25(OH)D half-life to investigate vitamin D metabolism.
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Affiliation(s)
- K S Jones
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge, CB1 9NL, UK,
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Jones KS, Assar S, Harnpanich D, Bouillon R, Lambrechts D, Prentice A, Schoenmakers I. 25(OH)D2 half-life is shorter than 25(OH)D3 half-life and is influenced by DBP concentration and genotype. J Clin Endocrinol Metab 2014; 99:3373-81. [PMID: 24885631 PMCID: PMC4207933 DOI: 10.1210/jc.2014-1714] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT There is uncertainty over the equivalence of vitamins D2 and D3 to maintain plasma 25-hydroxyvitamin D (25(OH)D). OBJECTIVE The objective of the study was to compare the plasma half-lives of 25(OH)D2 and 25(OH)D3 in two distinct populations with different dietary calcium intake and 25(OH)D status. PARTICIPANTS Healthy men (aged 24 and 39 y), resident in The Gambia (n = 18) or the United Kingdom (n = 18) participated in the study. INTERVENTIONS The intervention included an oral tracer dose of deuterated-25(OH)D2 and deuterated-25(OH)D3 (both 40 nmol). Blood samples were collected over 33 days. MAIN OUTCOME MEASURES 25(OH)D2 and 25(OH)D3 plasma half-lives, concentrations of 25(OH)D, and vitamin D binding protein (DBP) and DBP genotypes were measured. RESULTS 25(OH)D2 half-life [mean (SD)] [13.9 (2.6) d] was shorter than 25(OH)D3 half-life [15.1 (3.1) d; P = .001] for countries combined, and in Gambians [12.8 (2.3) d vs 14.7 (3.5) d; P < .001], but not in the United Kingdom [15.1 (2.4) d vs 15.6 (2.5) d; P = .3]. 25(OH)D concentration was 69 (13) and 29 (11) nmol/L (P < .0001), and the DBP concentration was 259 (33) and 269 (23) mg/L (P = .4) in The Gambia and United Kingdom, respectively. Half-lives were positively associated with plasma DBP concentration for countries combined [25(OH)D2 half-life: regression coefficient (SE) 0.03 (0.01) d per 1 mg/L DBP, P = .03; 25(OH)D3 half-life: 0.04 (0.02) d, P = .02] and in Gambians [25(OH)D2 half-life: 0.04 (0.01) d; P = .02; 25(OH)D3 half-life: 0.06 (0.02) d, P = .01] but not in UK participants. The DBP concentration × country interactions were not significant. DBP Gc1f/1f homozygotes had shorter 25(OH)D2 half-lives compared with other combined genotypes (P = .007) after correction for country. CONCLUSIONS 25(OH)D2 half-life was shorter than 25(OH)D3 half-life, and half-lives were affected by DBP concentration and genotype. The stable isotope 25(OH)D half-life measurements provide a novel tool to investigate vitamin D metabolism and vitamin D expenditure and aid in the assessment of vitamin D requirements.
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Affiliation(s)
- K S Jones
- Medical Research Council Human Nutrition Research (K.S.J., S.A., D.H., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; Medical Research Council Keneba (K.S.J., A.P.), The Gambia; Clinic and Laboratory of Experimental Medicine and Endocrinology (R.B.) and Laboratory for Translational Genetics (D.L.), Katholieke Universiteit, B-3000 Leuven, Belgium; and Vesalius Research Center (D.L.), VIB, Katholieke Universiteit, B-3000, Leuven, Belgium
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Braithwaite V, Jones KS, Assar S, Schoenmakers I, Prentice A. Predictors of intact and C-terminal fibroblast growth factor 23 in Gambian children. Endocr Connect 2013; 3:1-10. [PMID: 24258305 PMCID: PMC3869962 DOI: 10.1530/ec-13-0070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/20/2013] [Indexed: 12/16/2022]
Abstract
Elevated C-terminal fibroblast growth factor 23 (C-FGF23) concentrations have been reported in Gambian children with and without putative Ca-deficiency rickets. The aims of this study were to investigate whether i) elevated C-FGF23 concentrations in Gambian children persist long term; ii) they are associated with higher intact FGF23 concentrations (I-FGF23), poor iron status and shorter 25-hydroxyvitamin D half-life (25OHD-t1/2); and iii) the persistence and predictors of elevated FGF23 concentrations differ between children with and without a history of rickets. Children (8-16 years, n=64) with a history of rickets and a C-FGF23 concentration >125 RU/ml (bone deformity (BD), n=20) and local community children with a previously measured elevated C-FGF23 concentration (LC+, n=20) or a previously measured C-FGF23 concentration within the normal range (LC-, n=24) participated. BD children had no remaining signs of bone deformities. C-FGF23 concentration had normalised in BD children, but remained elevated in LC+ children. All the children had I-FGF23 concentration within the normal range, but I-FGF23 concentration was higher and iron status poorer in LC+ children. 1,25-dihydroxyvitamin D was the strongest negative predictor of I-FGF23 concentration (R(2)=18%; P=0.0006) and soluble transferrin receptor was the strongest positive predictor of C-FGF23 concentration (R(2)=33%; P≤0.0001). C-FGF23 and I-FGF23 concentrations were poorly correlated with each other (R(2)=5.3%; P=0.07). 25OHD-t1/2 was shorter in BD children than in LC- children (mean (s.d.): 24.5 (6.1) and 31.5 (11.5) days respectively; P=0.05). This study demonstrated that elevated C-FGF23 concentrations normalised over time in Gambian children with a history of rickets but not in local children, suggesting a different aetiology; that children with resolved rickets had a shorter 25OHD-t1/2, suggesting a long-standing increased expenditure of 25OHD, and that iron deficiency is a predictor of elevated C-FGF23 concentrations in both groups of Gambian children.
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Affiliation(s)
- Vickie Braithwaite
- Medical Research Council (MRC) Human Nutrition ResearchElsie Widdowson LaboratoriesFulbourn Road, Cambridge, CB1 9NLUK
| | - Kerry S Jones
- Medical Research Council (MRC) Human Nutrition ResearchElsie Widdowson LaboratoriesFulbourn Road, Cambridge, CB1 9NLUK
- MRC Keneba, KenebaWest KiangThe Gambia
| | - Shima Assar
- Medical Research Council (MRC) Human Nutrition ResearchElsie Widdowson LaboratoriesFulbourn Road, Cambridge, CB1 9NLUK
| | - Inez Schoenmakers
- Medical Research Council (MRC) Human Nutrition ResearchElsie Widdowson LaboratoriesFulbourn Road, Cambridge, CB1 9NLUK
| | - Ann Prentice
- Medical Research Council (MRC) Human Nutrition ResearchElsie Widdowson LaboratoriesFulbourn Road, Cambridge, CB1 9NLUK
- MRC Keneba, KenebaWest KiangThe Gambia
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Abstract
Few studies have investigated the absorption of phylloquinone (vitamin K1). We recruited twelve healthy, non-obese adults. On each study day, fasted subjects took a capsule containing 20 microg of 13C-labelled phylloquinone with one of three meals, defined as convenience, cosmopolitan and animal-oriented, in a three-way crossover design. The meals were formulated from the characteristics of clusters identified in dietary pattern analysis of data from the National Diet and Nutrition Survey conducted in 2000-1. Plasma phylloquinone concentration and isotopic enrichment were measured over 8 h. Significantly more phylloquinone tracer was absorbed when consumed with the cosmopolitan and animal-oriented meals than with the convenience meal (P = 0.001 and 0.035, respectively). Estimates of the relative availability of phylloquinone from the meals were: convenience meal = 1.00; cosmopolitan meal = 0.31; animal-oriented meal = 0.23. Combining the tracer data with availability estimates for phylloquinone from the meals provides overall relative bioavailability values of convenience = 1.00, cosmopolitan = 0.46 and animal-oriented = 0.29. Stable isotopes provide a useful tool to investigate further the bioavailability of low doses of phylloquinone. Different meals can affect the absorption of free phylloquinone. The meal-based study design used in the present work provides an approach that reflects more closely the way foods are eaten in a free-living population.
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Affiliation(s)
- Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Rudawski NG, Jones KS, Gwilliam R. Kinetics and morphological instabilities of stressed solid-solid phase transformations. Phys Rev Lett 2008; 100:165501. [PMID: 18518213 DOI: 10.1103/physrevlett.100.165501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 05/26/2023]
Abstract
An atomistic model of the growth kinetics of stressed solid-solid phase transformations is presented. Solid phase epitaxial growth of (001) Si was used for comparison of new and prior models with experiments. The results indicate that the migration of crystal island ledges in the growth interface may involve coordinated atomic motion. The model accounts for morphological instabilities during stressed solid-solid phase transformations.
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Affiliation(s)
- N G Rudawski
- Department of Materials Science and Engineering, University of Florida, Gainesville, Florida 32611-6400, USA.
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Jones KS, Bluck LJC, Wang LY, Coward WA. A stable isotope method for the simultaneous measurement of vitamin K1 (phylloquinone) kinetics and absorption. Eur J Clin Nutr 2007; 62:1273-81. [PMID: 17671443 DOI: 10.1038/sj.ejcn.1602859] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To measure uptake and disposal kinetics and absolute absorption of vitamin K(1) using two stable isotope-labelled forms of vitamin K(1). SUBJECTS Ten subjects (nine women and one man) aged between 22 and 31 years, with a mean (+/-standard deviation) body mass index of 22.5+/-2.4 kg/m(2). Subjects took capsules containing 3 microg of methyl-(13)C vitamin K(1), three times a day for six days to reach a steady state for plasma vitamin K(1) isotopic enrichment. On day seven, subjects were given an intravenous dose of Konakion MM to measure disposal kinetics and at the same time, a capsule containing 4 microg of ring-D(4) vitamin K(1) to measure absorption. Plasma vitamin K(1) concentration was measured by high-performance liquid chromatography and isotopic composition by gas chromatography mass spectrometry. RESULTS The disposal kinetics of the intravenous dose of vitamin K(1) were resolved into two exponentials with half-times of 0.22 (+/-0.14) and 2.66 (+/-1.69) h. Absorption of oral, deuterated vitamin K(1) was 13 (+/-9)%. CONCLUSIONS Two-compartmental kinetic parameters observed in this study are similar to those obtained previously using radioactive tracers, but there may be additional slow-turnover body pools acting as stores of vitamin K(1). The kinetic parameters determined from the intravenous dose allowed determination of the absolute absorption of vitamin K(1) from a bolus oral dose.
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Affiliation(s)
- K S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
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Bourbeau PP, Riley JA, Shoemaker BC, Jones KS. Use of CultureSwab Plus swabs with Amies gel agar for testing of naris specimens with the GeneOhm MRSA assay. J Clin Microbiol 2007; 45:2281-3. [PMID: 17494713 PMCID: PMC1933012 DOI: 10.1128/jcm.01600-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The GeneOhm MRSA assay detects nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the use of seeded swabs with liquid Stuart's medium and that of seeded swabs with Amies gel for the assay. Overall, the swabs with liquid Stuart's medium detected significantly greater numbers of MRSA than the swabs with Amies gel (P = 0.0003).
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Affiliation(s)
- P P Bourbeau
- Geisinger Medical Center, Danville, PA 17822-0131, USA.
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Abstract
Factors affecting absorption of physiological doses of vitamin C in man have not been widely studied, partly because few suitable tools exist to distinguish recently absorbed vitamin C from endogenous vitamin. Stable isotope-labelled vitamin C provides such a tool. Fifteen healthy non-smoking subjects aged 26–59 years were studied. Each received 30 mg L-[1-13C]ascorbic acid orally on two occasions, 3–4 weeks apart. The ascorbate was given alone or with Fe (100 mg as ferrous fumarate) or with red grape juice, which is rich in polyphenols. Blood was collected at frequent intervals for 1 h, and then each hour for a further 3 h. Total concentration of vitamin C was measured fluorometrically and its13C-isotope enrichment was measured by GC–MS after conversion to volatile trimethylsilyl esters. Peak plasma enrichment occurred within 25–50 min. No kinetic variables were significantly altered by the iron fumarate supplement. Grape juice attenuated vitamin C absorption, reaching significance at the 20 min time point. There were weak correlations between isotope enrichment and body weight or endogenous ascorbate concentration. The increment in total plasma ascorbate was smaller if calculated from isotope enrichment than from vitamin C concentration increase. The dilution pool was much larger than the plasma ascorbate pool. Further studies are needed to resolve these paradoxes. Stable isotope-labelled ascorbate is potentially useful for measurement of vitamin C absorption by human subjects.
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Abstract
Previous studies of vitamin C absorption in man using stable isotope probes have given results which cannot easily be reconciled with those obtained using non-isotope measurement. In order to investigate some of the apparent paradoxes we have conducted a study using two consecutive doses of vitamin C, one labelled and one unlabelled, given 90 min apart. Compatibility of the experimental results with two feasible models was investigated. In Model 1, ingested vitamin C enters a pre-existing pool before absorption, which occurs only when a threshold is exceeded; in Model 2, ingested vitamin C is exchanged with a pre-existing flux before absorption. The key difference between these two models lies in the predicted profile of labelled material in plasma. Model 1 predicts that the second unlabelled dose will produce a secondary release of labelled vitamin C which will not be observed on the basis of Model 2. In all subjects Model 1 failed to predict the observed plasma concentration profiles for labelled and unlabelled vitamin C, but Model 2 fitted the experimental observations. We speculate on possible physiological explanations for this behaviour, but from the limited information available cannot unequivocally confirm the model structure by identifying the source of the supposed flux.
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Affiliation(s)
- Leslie J C Bluck
- MRC Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, UK.
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Jones KS, Bluck LJC, Coward WA. Analysis of isotope ratios in vitamin K1 (phylloquinone) from human plasma by gas chromatography/mass spectrometry. Rapid Commun Mass Spectrom 2006; 20:1894-8. [PMID: 16715474 DOI: 10.1002/rcm.2538] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Vitamin K(1) is a fat-soluble vitamin required for the gamma-carboxylation of vitamin K-dependent proteins. Recent work has suggested an important role for vitamin K(1) in bone health beyond its more established function in the control and regulation of blood coagulation. However, current UK recommended intakes do not reflect this recent evidence. The use of stable isotopes provides a powerful tool to investigate vitamin K kinetics, turnover and absorption in man, although published methods have reported difficulties in the extraction and analysis of isotope ratios of vitamin K in human plasma. In this paper, we report a new methodology for the extraction and measurement of isotope ratios in vitamin K(1). Sample clean-up is achieved with liquid-liquid extraction, enzyme hydrolysis with lipase and cholesterol esterase, and solid-phase extraction. Isotopic analysis of the pentafluoropropionyl derivative of vitamin K(1) is performed by gas chromatography/mass spectrometry (GC/MS). The limit of quantitation is equivalent to at least 0.3 nmol/L and the method is demonstrated to be linear over a range of enrichments. This method provides a robust alternative to previous work requiring the use of semi-preparative high-performance liquid chromatography (HPLC).
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Affiliation(s)
- Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Bluck LJC, Jones KS, Bates CJ. (2)H- and (13)C-labelled tracers compared for kinetic studies of ascorbic acid metabolism in man: a factor analytical approach. Rapid Commun Mass Spectrom 2002; 16:879-883. [PMID: 11948820 DOI: 10.1002/rcm.653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A recent report that a (13)C stable isotope method can be used to measure the kinetics of ascorbic acid uptake and distribution in man has raised some interesting questions with regard to the physiological interpretation of the data obtained, in particular the sizes of the ascorbate distribution spaces. In order to prove that this result is not a function of the label used we have compared the behaviour of two different tracers to see if they are likely to give comparable results for the kinetic parameters. Volunteers received an oral dose of ascorbic acid, half of which was labelled with (2)H, and half of which was labelled with (13)C. Blood samples were taken over the course of the next 48 h, and ascorbic acid mass spectra measured by gas chromatography/mass spectrometry (GC/MS). Principal component analysis was used to investigate the number of factors required to explain the total variations observed in the ratios of the molecular isotopomer cluster over the time course of the experiment. Theoretical cracking patterns were then used as test vectors in target transformation and as the basis for subsequent combination to determine tracer/tracee ratios. Two factors were found sufficient to account for the observed cracking pattern variations within experimental error. These were identified as (1) the spectrum of unlabelled (endogenous) ascorbic acid, and (2) a linear combination of the spectra of the two labelled species used. The absence of a third factor in the decomposition indicates that there is no difference in the behaviour of the (13)C- and (2)H-labelled tracers. Target testing allowed the tracer/tracee ratios to be determined using calculated cracking patterns, and produced equivalent results to conventional methods. Our experience in this work indicates that factor analysis has a useful place in many kinetic studies of this kind, either with one or many labelled species.
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Affiliation(s)
- Leslie J C Bluck
- Medical Research Council Human Nutrition Research, Peterhouse Park, Fulbourn Road, Cambridge CB1 9NL, UK.
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Bluck LJC, Jones KS, Thomas J, Liggins J, Harding M, Bingham SA, Coward WA. Quantitative analysis using gas chromatography/combustion/isotope ratio mass spectrometry and standard addition of intrinsically labelled standards (SAIL)--application to isoflavones in foods. Rapid Commun Mass Spectrom 2002; 16:2249-54. [PMID: 12478567 DOI: 10.1002/rcm.850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We have investigated a novel application of gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) for the quantitative analysis of the isoflavones in food matrices. Previous methods have been hampered by the lack of analytical standards to introduce early enough in the extraction procedure to allow compensations for losses at all stages of the procedure. In this work we have produced standard materials that can be added at the initial extraction, by intrinsically labelling soya plants by growing them in an atmosphere enriched in the stable isotope of carbon in CO(2). On analysis these plants were shown to contain phytoestrogens at a high (up to 20%) level of enrichment. The dried plant material has been used to estimate the isoflavone concentrations of a set of spiked flours. For daidzein the methodology was shown to produce results comparable to those achieved by GC/MS techniques. The method was less successful for genistein, possibly due to the greater fragility of this compound under the conditions required for the analysis.
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Affiliation(s)
- Leslie J C Bluck
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Byrd JW, Jones KS. Hip arthroscopy in athletes. Clin Sports Med 2001; 20:749-61. [PMID: 11675884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The limited data (n = 42) and diverse pathology within this study make statistical analysis difficult, although the observations are still meaningful. Diagnostic arthroscopy has defined elusive causes of disabling hip pain in an athletic population including occult labral and chondral damage and rupture of the ligamentum teres. Operative arthroscopy has been effective in reducing the symptoms associated with many of these forms of pathology. For more evident causes of hip pain, such as loose bodies or impinging osteophytes, arthroscopy offers an excellent alternative to traditional open techniques. This study has defined that many intraarticular disorders initially may go unrecognized. The benefit of earlier diagnosis seems intuitive and may minimize extraneous investigative studies, but there are a few caveats. First, various forms of extraarticular pathology (e.g., muscle strains) far outnumber intraarticular injuries and thus the temptation for an extensive intraarticular work up for every hip injury should be avoided. Second, as mentioned, does earlier diagnosis always mean early intervention? There is much that we may not fully understand regarding the natural history of many of these intraarticular disorders that we are only now learning to diagnose.
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Affiliation(s)
- J W Byrd
- Nashville Sports Medicine & Orthopaedic Center, Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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