Feeding Dairy Goats Dehydrated Orange Pulp Improves Cheese Antioxidant Content

Agroindustrial by-products constitute an alternative source of feed livestock, and their use contributes to the sustainability of livestock systems and the circular bioeconomy. The effects of replacing cereal (0%, 40%, and 80%) with dehydrated orange pulp (DOP) in the diet of goats on the antioxidant and fatty acid (FA) contents of cheeses were evaluated. For a more suitable understanding of the role of coagulant enzymes in establishing the properties of the cheese, the effect of milk-clotting with animal and vegetable rennet was also analysed. The rennet did not substantially affect the FA or the antioxidant compounds, and the use of DOP did not affect the FA contents. However, the α-tocopherol levels, total phenolic compounds (TPC), and total antioxidant capacity (TAC) in cheeses increased as the percentage of DOP replacing cereals increased. Moreover, the high correlation obtained between the TAC and the TPC (r = 0.73) and α-tocopherol (r = 0.62) contents indicated the important role played by these compounds in improving the antioxidant capacity of the cheese. In conclusion, DOP is a suitable alternative to cereals in the diet of goats and improves the antioxidant status of the cheese produced.

Fat-soluble Vitamins and Lung Cancer: Where We Are?

Fat-soluble vitamins (vitamins A, D, E, and K) are vital substances for maintaining normal physiological functions in the body. In recent years, scholars have explored the relationship between fat-soluble vitamins and the wasting disease - lung cancer. In this paper, we review recent studies on fat-soluble vitamins and lung cancer to clarify the relevance and molecular mechanisms of various vitamins in lung cancer, and whether the levels of fat-soluble vitamins in the body and vitamin supplementation affect the development of lung cancer. Our review could facilitate the discovery of biomarkers, potential therapeutic targets in lung cancer, and anti-tumor adjuvant drugs, in addition to highlighting other new ideas in the prevention and treatment of lung cancer.

Effects of Hemp Seed on the Production, Fatty Acid Profile, and Antioxidant Capacity of Milk from Goats Fed Hay or a Mixed Shrubs-Grass Rangeland

The research objective was to evaluate the effect of dietary incorporation of hemp seeds in goats fed with hay or mixed shrubs-grass rangeland on the production, FA profile and health-related lipid indices, antioxidant content and total antioxidant capacity of milk, with the purpose to increase the content of beneficial ingredients in milk and to improve its functional activity. Forty indigenous Carpathian goats were allocated into two groups according to the type of basic forage in their diet: hay (H) or mixed shrubs-grass rangeland (SG); each of them was further divided into two subgroups according to the presence of Hs in the concentrate mixture (250 g/kg) or not. Milk production was determined, and milk samples were collected and analyzed for fat, protein, lactose, and cholesterol content, as well as FA profile, lipophilic antioxidant content (α-tocopherol and retinol), and milk TAC. SG goats gave less milk (p < 0.01) but with higher milk fat (p < 0.001) and lower cholesterol content (p < 0.01) than H goats, while milk protein and lactose contents were not affected. Supplementing the diet with Hs caused a significant increase in milk production (p < 0.05) and milk fat content (p < 0.001) and a decrease in cholesterol content (p < 0.05). Grazing compared to indoor feeding but also supplementing the diet with Hs had the effect of decreasing the proportion of SFAs and increasing the concentrations of polyunsaturated FA (PUFA) in goat milk fat (p < 0.01). Fats in the milk of SG goats compared to H, but also in those supplemented with Hs, showed significantly higher proportions of vaccenic acid (VA), rumenic acid (CLA c-9,t-11) and omega-3 FA (α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosapentaenoic acid (DPA)) which are considered healthy for consumers. The feeding system based on SG and the diet supplementation with Hs ensured the best nutritional and functional quality of milk, confirmed by the FA profile, antioxidant content, and by the value of health-related lipid indices (n-6/n-3 FA ratio and hypo-/hypercholesterolemia, atherogenic index (AI), thrombogenic index (TI), and health promotion index (HPI)). The results of our work will be useful for the development of optimal nutritional strategies that improve the FA profile and the antioxidants content in goat milk, with beneficial effects on human health.

A new method based on dispersive liquid-liquid microextraction for fat-soluble vitamin determination in serum by LC-MS/MS

A green and inexpensive pretreatment known as dispersive liquid-liquid microextraction (DLLME) was developed in this assay coupled with the LC-MS/MS method for routine analysis of fat soluble vitamins (FSVs). The technique was performed with methanol as the dispersive solvent and dichloromethane as the extraction solvent. The extraction phase containing FSVs was evaporated to dryness and reconstituted in a mixture of acetonitrile and water. The influence variables concerning the DLLME procedure were optimized. After that, the method was investigated for its applicability in LC-MS/MS analysis. As a result, the parameters were settled for the optimal conditions during the DLLME process. A cheap and lipid-free substance was found as an alternative to serum to eliminate the matrix effect while preparing the calibrators. The method validation indicated that it was suitable for determining FSVs in serum. Moreover, this method was applied successfully to determine serum samples, which was consistent with the literature. In summary, the DLLME method developed in this report was reliable and more cost-effective than the traditional LC-MS/MS method, and could be applied in the future.

A Randomized Double-Blind Placebo-Controlled Clinical Study to Evaluate the Effect on the Weight of a Medical Device with Polyglucosamine L112 in a Group of Overweight and Obese Subjects

BACKGROUND

Overweight and obesity have reached epidemic proportions and safe treatments are needed to heal these diseases.

OBJECTIVE

The objective of this study is to examine the activity of a medical device based on polyglucosamine polymers (PG) on body weight (BW) reduction, insulin resistance, and the serum levels of fat-soluble vitamins and glucosamine.

METHODS

A double-blind placebo-controlled interventional study comparing PG and a placebo (PL) was conducted. One hundred and fifty overweight or obese cases were treated, divided into two groups for a period of 90 days at the dosage of 3 g/day.

RESULTS

One hundred and nineteen cases (58 with PG and 61 with PL, respectively) concluded the treatment. PG was more effective than the PL on the reduction of BW and insulin resistance. No modification of fat-soluble vitamins (Vit A, E, D3, K1) and glucosamine levels was shown. Total cholesterol levels were significantly more reduced in the PG group compared to the PL group as it was for subjects with a BW decrease of >5%.

CONCLUSIONS

PG acts as a safe medical device, is not absorbed, and binds lipids in the upper gastrointestinal tract, reducing their availability, with a significant activity on the reduction of BW, insulin resistance, and cholesterol levels without the modification of fat-soluble vitamins.

Severe cholestasis-associated coagulopathy diagnosed by routine screening: a case report

Recent case reports suggest an association between severe intrahepatic cholestasis of pregnancy and fat-soluble vitamin deficiencies, including vitamin K deficiency. Screening for coagulopathy and fat-soluble vitamin deficiency has been proposed as a possible strategy to identify pregnancies at additional risk of adverse outcomes and allow for earlier risk-reducing iatrogenic preterm delivery. This report highlights a case of routine screening that resulted in the detection of subclinical coagulopathy that allowed for earlier intervention and delivery of a healthy neonate at 34 weeks of gestation. Further prospective studies are needed to determine the clinical use of routine screening in detecting coagulopathy and fat-soluble vitamin deficiency in cases of severe cholestasis.

Serum fat-soluble vitamin levels may be related to sudden sensorineural hearing loss

BACKGROUND

Few related studies reported yet the association between vitamins and the onset of sudden sensorineural hearing loss (SSNHL).

OBJECTIVE

To explore the relationship between the serum levels of fat-soluble vitamins A, D, and E and the risk of SSNHL.

METHODS

This retrospective analysis included 310 SSNHL patients and 154 people without risk of hearing loss. The demographic information of all participants like age, gender, body mass index, occupation, cigarette smoking or drinking status, etc. were recorded. The serum levels of vitamins A, D, and E were determined using the electrochemical method.

RESULTS

The results indicated that serum vitamin D levels in SSNHL patients were significantly lower. Vitamin D deficiency was only observed in SSNHL group. Similarly, serum vitamin A levels in female SSNHL patients were significantly lower than the control group. Meanwhile, serum vitamin E levels in male SSNHL patients were significantly lower than the control group.

CONCLUSION AND SIGNIFICANCE

Our results revealed that the serum levels of fat-soluble vitamins A, D, and E in SSNHL patients were lower than those in the control group with normal hearing, indicating that the decrease of serum fat-soluble vitamins may be related to SSNHL pathogenesis.

Association of fat-soluble vitamins (A, D, and E) status with humoral immune response to COVID-19 inactivated vaccination

Background

Fat-soluble vitamins (A, D, and E) are essential for the proper functioning of the immune system and are of central importance for infection risk in humans. Vitamins A, D, and E have been reported to be associated with the immune response following vaccination; however, their effects on the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination remain unknown.

Methods

We measured the neutralizing antibody titers against wild type and omicron within 98 days after the third homologous boosting shot of inactivated SARS-CoV-2 vaccine (BBIBP-CorV or CoronaVac) in 141 healthy adults in a prospective, open-label study. High-performance liquid chromatography-tandem mass spectroscopy was used to determine the concentrations of plasma vitamins A, D, and E.

Results

We found that the anti-wide-type virus and anti-omicron variant antibody levels significantly increased compared with baseline antibody levels (P < 0.001) after the third vaccination. 25(OH)D₃ was significantly negatively associated with the baseline anti-wide-type virus antibody concentrations [beta (95% CI) = -0.331 (-0.659 ~ -0.003)] after adjusting for covariates. A potentially similar association was also observed on day 98 after the third vaccination [beta (95% CI) = -0.317 (-0.641 ~ 0.007)]. After adjusting for covariates, we also found that 25(OH)D₃ was significantly negatively associated with the seropositivity of the anti-omicron variant antibody at day 98 after the third vaccination [OR (95% CI) = 0.940 (0.883 ~ 0.996)]. The association between plasma 25(OH)D₃ with anti-wild-type virus antibody levels and seropositivity of anti-omicron variant antibodies were persistent in subgroup analyses. We observed no association between retinol/α-tocopherol and anti-wide-type virus antibody levels or anti-omicron variant antibody seropositive in our study.

Conclusion

The third inactivated SARS-CoV-2 vaccination significantly improved the ability of anti-SARS-CoV-2 infection in the human body. Higher vitamin D concentrations could significantly decrease the anti-wide-type virus-neutralizing antibody titers and anti-omicron variant antibody seropositive rate after the inactivated SARS-CoV-2 vaccination in people with adequate levels of vitamin D, better immune status, and stronger immune response; further studies comprising large cohorts of patients with different nutritional status are warranted to verify our results.

Nutrition in children with exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency (EPI) is a condition defined as pancreatic loss of exocrine function, including decreased digestive enzymes and bicarbonate secretion, which leads to maldigestion and malabsorption of nutrients. It is a common complication in many pancreatic disorders. If left undiagnosed, EPI can cause poor digestion of food, chronic diarrhea, severe malnutrition and related complications. Nutritional status and fat-soluble vitamins should be carefully assessed and monitored in patients with EPI. Early diagnosis of EPI is clinically important for appropriate nutritional support and initiating pancreatic enzyme replacement therapy (PERT) which could significantly improve patient outcomes. The evaluation of nutritional status and related unique management in children with EPI will be discussed in this review.

The relationship between nutrition, gut dysbiosis, and pediatric sickle cell pain outcomes: A pilot study

BACKGROUND

Nutritional deficiencies are prevalent in sickle cell disease (SCD) and may be associated with worse pain outcomes. Gut dysbiosis has been reported in patients with SCD and may contribute to both nutritional deficiencies and pain.

OBJECTIVES

We tested the association of nutrition, fat-soluble vitamin (FSV) deficiency, and gut microbiome composition on clinical outcomes in SCD. Second, we measured the association between diet and exocrine pancreatic function on FSV levels.

METHODS

Using case control design, we enrolled children with SCD (n = 24) and matched healthy controls (HC; n = 17, age, sex, race/ethnicity). Descriptive statistics summarized demographic and clinical data. Wilcoxson-rank tests compared FSV levels between cohorts. Regression modeling tested the association between FSV levels and SCD status. Welch's t-test with Satterthwaite adjustment evaluated associations between microbiota profiles, SCD status, and pain outcomes.

RESULTS

Vitamin A and D levels were significantly decreased in participants with HbSS as compared to HC (vitamin A, p = < .0001, vitamin D, p = .014) independent of nutritional status. FSV correlated with dietary intake in SCD and HC cohorts. Gut microbial diversity was reduced in hemoglobin SS (HbSS) compared to hemoglobin SC (HbSC) and HC, p = .037 and .059, respectively. The phyla Erysipelotrichaceae and Betaproteobacteria were higher in SCD children reporting the highest quality-of-life (QoL) scores (p = .008 and .049, respectively), while Clostridia were higher in those with lower QoL scores (p = .03).

CONCLUSION

FSV deficiencies and gut dysbiosis are prevalent in children with SCA. Gut microbial composition is significantly different in children with SCD with low QoL scores.

Lipid Characteristics of the Muscle and Perirenal Fat in Young Tudanca Bulls Fed on Different Levels of Grass Silage

Beef derived from grass-fed cattle is a specific quality criterion. The effect of grass silage intake on quality characteristics, i.e., fatty acids, fat-soluble vitamins, and lipid-derived volatile composition of intramuscular and perirenal fat from fattening bull weaners were studied. Visible (VIS) and near-infrared (NIR) spectra were also obtained from perirenal fat. Perirenal fat analysis was performed for feeding differentiation purposes. A total of 22 Tudanca breed 11-month-aged bulls were finished on three different diets: grass silage and a commercial concentrate ad libitum (GS-AC), grass silage ad libitum and the commercial concentrate restricted to half of the intake of the GS-AC group (GS-LC), and barley straw and concentrate ad libitum (Str-AC). Feeding had a significant effect (p < 0.05) on γ-linolenic acid and the ratio n-6/n-3 fatty acids. Furthermore, β-carotene content was greater in beef from silage groups than in the Str-AC group. Feeding also affected the perirenal fat composition. Beef from silage-fed bulls and straw-fed bulls could be differentiated by fatty acid percentages, especially 18:0, t-18:1, and c9-18:1, β-carotene content, b* colour value, and carotenoid colour index. However, the VIS or NIR spectra data showed poor differentiating performance, and the volatile composition did not have appreciable differentiation power.

[Rapid determination of 10 fat-soluble vitamins in health foods by ultra performance convergence chromatography]

Fat-soluble vitamins are important efficacy indicators in health foods because they are essential for human physiological functions. The existing method for the simultaneous determination of fat-soluble vitamins has various problems, such as limited determination components, complex sample, pretreatment process, and high requirements for personnel operating ability. Therefore, establishing a fast, simple, and accurate method that can detect various common fat-soluble vitamins at the same time is necessary. In this study, a method for the simultaneous determination of 10 commonly used fat-soluble vitamins such as vitamin A acetate (VA acetate), vitamin A palmitate (VA palmitate), vitamin E acetate (VE acetate), vitamin K1 (VK1), α-tocopherol, β-tocopherol, γ-tocopherol, δ-tocopherol, vitamin D2(VD2) and vitamin D3 (VD3) in health foods was established by ultra performance convergence chromatography (UPC2). First, the contents of about 1.0 g of capsule samples were accurately weighed. A grinder was used to grind tablet samples into powder. The powder mixture was then precisely weighed at 2.0 g. Both substances were placed in 50 mL brown stopper tubes. The test tube was then filled with 20 mL 75% dimethylsulfoxide (DMSO) aqueous solution for demulsification. The tubes were then sonicated before being extracted with n-hexane. The centrifuged supernatant was added to vials for detection. Viridis HSS C18 SB column (100 mm×3.0 mm, 1.8 μm) was applied and CO2 was used as the mobile phase A. After comparing the influence of acetonitrile, methanol, and their mixture on chromatographic peak separation, acetonitrile-methanol (85∶15, v/v) was used as the mobile phase B. The injection volume was 1 μL. Using simulator software, the optimal chromatographic conditions were obtained after a set of three-factor orthogonal experiments of flow rate, gradient slope, and column temperature. The flow rate and column temperature were both set at 1.9 mL/min and 30 ℃. Furthermore, the maximum absorption wavelength of these 10 fat-soluble vitamins was selected for detection. Ten vitamins were baseline separated after 7 min of gradient elution. The limits of detection (LODs) and quantification (LOQs) of capsule samples were 0.4-60 μg/g and 2-150 μg/g, respectively, whereas the results for tablet samples were 0.2-30 μg/g and 0.8-75 μg/g. The linear ranges of the 10 fat-soluble vitamins were 0.1-100 μg/mL. The recoveries of spiked samples ranged from 96.5% to 113.9%, with RSD values less than 4%. Precision, stability, and repeatability RSD values were all less than 2%. By comparison, the determination results of this method were basically consistent with the existing national food safety standards. This method is simple, rapid, sensitive, and accurate, and it can meet the detection requirements of the 10 fat-soluble vitamins in health foods. Simultaneously, this method lays the foundation for the rapid and simultaneous detection of fat-soluble vitamins in existing health foods.

Fish Microbiome Modulation and Convenient Storage of Aquafeeds When Supplemented with Vitamin K1

Vitamin K (VK) is a fat-soluble vitamin necessary for fish metabolism and health. VK stability as dietary component during aquafeed storage and its potential effect on intestinal microbiome in fish have not yet been completely elucidated. The convenient storage conditions of aquafeeds when supplemented with phylloquinone (VK1), as well as its potential effects on the gut microbiota of Senegalese sole (Solea senegalensis) juveniles, have been explored. Experimental feeds were formulated to contain 0, 250 and 1250 mg kg^-1 of VK1 and were stored at different temperatures (4, -20 or -80 °C). VK stability was superior at -20 °C for short-term (7 days) storage, while storing at -80 °C was best suited for long-term storage (up to 3 months). A comparison of bacterial communities from Senegalese sole fed diets containing 0 or 1250 mg kg^-1 of VK1 showed that VK1 supplementation decreased the abundance of the Vibrio, Pseudoalteromonas, and Rhodobacterace families. All these microorganisms were previously associated with poor health status in aquatic organisms. These results contribute not only to a greater understanding of the physiological effects of vitamin K, particularly through fish intestinal microbiome, but also establish practical guidelines in the industry for proper aquafeed storage when supplemented with VK1.

Effects of Non-Polar Dietary and Endogenous Lipids on Gut Microbiota Alterations: The Role of Lipidomics

Advances in sequencing technologies over the past 15 years have led to a substantially greater appreciation of the importance of the gut microbiome to the health of the host. Recent outcomes indicate that aspects of nutrition, especially lipids (exogenous or endogenous), can influence the gut microbiota composition and consequently, play an important role in the metabolic health of the host. Thus, there is an increasing interest in applying holistic analytical approaches, such as lipidomics, metabolomics, (meta)transcriptomics, (meta)genomics, and (meta)proteomics, to thoroughly study the gut microbiota and any possible interplay with nutritional or endogenous components. This review firstly summarizes the general background regarding the interactions between important non-polar dietary (i.e., sterols, fat-soluble vitamins, and carotenoids) or amphoteric endogenous (i.e., eicosanoids, endocannabinoids-eCBs, and specialized pro-resolving mediators-SPMs) lipids and gut microbiota. In the second stage, through the evaluation of a vast number of dietary clinical interventions, a comprehensive effort is made to highlight the role of the above lipid categories on gut microbiota and vice versa. In addition, the present status of lipidomics in current clinical interventions as well as their strengths and limitations are also presented. Indisputably, dietary lipids and most phytochemicals, such as sterols and carotenoids, can play an important role on the development of medical foods or nutraceuticals, as they exert prebiotic-like effects. On the other hand, endogenous lipids can be considered either prognostic indicators of symbiosis or dysbiosis or even play a role as specialized mediators through dietary interventions, which seem to be regulated by gut microbiota.

Vitamins A, D, E status as related to supplementation and lung disease markers in young children with cystic fibrosis

BACKGROUND

The variable response to fat-soluble vitamin supplementation in young children with cystic fibrosis (CF), and factors contributing to this variability, remain under-investigated.

OBJECTIVE

To determine if recommended supplement doses normalize serum vitamins A (retinol), D (25-hydroxy-vitamin D, 25OHD), and E (α-tocopherol), and identify factors predictive of achieving sufficiency, in children with CF in the first 3 years of life.

DESIGN

We studied 144 infants born during 2012-2017 and diagnosed with CF through newborn screening. Serum retinol, 25OHD, α-tocopherol and plasma cytokines interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were measured in early infancy and yearly thereafter. Vitamin supplement intakes and respiratory microbiology were assessed every 1-2 months in infancy and quarterly thereafter.

RESULTS

The prevalence of vitamin D insufficiency (<30 ng/ml) at all ages combined was significantly higher (22%) compared to vitamin A (<200 ng/ml, 3%) and vitamin E (<5 µg/ml, 5%). All children were vitamin A sufficient by age 2 years. Vitamin E insufficiency was rare. Only 42% were early responders of vitamin D and 17% remain insufficient despite high supplement intakes. IL-6 was positively correlated, while IL-8, IL-10, and TNF-α were negatively correlated, with retinol and 25OHD. Multiple regression analysis revealed that supplement dose, season, α-tocopherol, pancreatic insufficiency, respiratory infections and IL-10 were significant predictors of 25OHD.

CONCLUSION

Diagnosis through newborn screening coupled with supplementation normalized serum retinol and α-tocopherol in almost all infants with CF by age 3 years. However, response to vitamin D supplements in young children with CF occurred later and variably despite early and sustained supplementation.

The Quality of Five Natural, Historical Italian Cheeses Produced in Different Months: Gross Composition, Fat-Soluble Vitamins, Fatty Acids, Total Phenols, Antioxidant Capacity, and Health Index

Simple Summary

For the purposes of raising awareness of five historical cheeses of Southern Italy that are less known by consumers, and of restoring dignity to the breeders and producers of these cheeses, we studied their quality in terms of chemical composition, monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), conjugated linoleic acid (CLA), PUFA-ω6, PUFA-ω3, α-tocopherol, retinol, cholesterol, polyphenol content (TPC), total antioxidant capacity (FRAP and TEAC), and health index (GHIC). Two stretched-curd bovine cheeses, Caciocavallo Palermitano (CP) and Casizolu del Montiferru (CdM), two ovine cheeses, Vastedda della Valle del Belìce (VVB) and Pecorino Siciliano (PS), and one caprine cheese, Caprino Nicastrese (CN), were evaluated. These cheeses are produced in different months, with raw milk from animals reared in an extensive feeding system. In April, the CP cheese showed high values for CLA, TPC, and GHIC, while the CN cheese exhibited high PUFA, PUFA-ω6, PUFA-ω3, TEAC, and GHIC. In May, the CdM cheese exhibited high content of fat, saturated fatty acids, PUFA-ω3, α-tocopherol, TEAC, and GHIC, while the PS cheese showed high values of protein, CLA, PUFA, PUFA-ω3, α-tocopherol, and GHIC. These measured parameters characterize and distinguish each cheese due to links with numerous factors: species, breed, feeding system, pasture biodiversity, climate, production technology, traditional tools, and ripening type. It is highlighted that, in general, the highest nutritional quality, linked to the highest presence of healthy compounds, originates from the pasture of cheese production in the spring.

Abstract

Five natural historic cheeses of Southern Italy were investigated—Caciocavallo Palermitano (CP), Casizolu del Montiferru (CdM), Vastedda della Valle del Belìce (VVB), Pecorino Siciliano (PS), and Caprino Nicastrese (CN)—which are produced with raw milk and with traditional techniques and tools, from autochthonous breeds reared under an extensive system. The effects of the month of production on gross composition, MUFA, PUFA, PUFA-ω6, PUFA-ω3, α-tocopherol, retinol, cholesterol, TPC, TEAC, and GHIC were evaluated. In CP, CLA, TPC, and GHIC were higher in April than in February. CdM showed higher values in terms of fat, saturated fatty acids, PUFA-ω3, α-tocopherol, TEAC, and GHIC in May than in February and September, while low values in terms of protein, moisture, and CLA were found. In VVB, MUFA, PUFA-ω6, and α-tocopherol increased in June compared with April; conversely, protein, FRAP, and TEAC were higher in April. In PS, protein, CLA, PUFA, PUFA-ω3, α-tocopherol, and GHIC increased in May compared with January; on the contrary, moisture, NaCl, and TEAC showed high values in January. CN showed higher values in terms of PUFA, PUFA-ω6, PUFA-ω3, TPC, TEAC, and GHIC in April and June compared with January. It is shown that each cheese is unique and closely linked to the production area. Cheeses produced in the spring months showed a high nutritional quality due to the greatest presence of healthy compounds originating from an extensive feeding system.

Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis

BACKGROUND

Infants with cholestasis are at risk of fat-soluble vitamin deficiency. The present study amied to review practice relating to the assessment, deficiency and supplementation of fat-soluble vitamins in infants with cholestasis.

METHODS

The medical records of all newly diagnosed infants with cholestasis (conjugated bilirubin >17 mmol L^-1 />20% total bilirubin) at King's College Hospital between 2017 and 2019 were reviewed. Data extracted included bilirubin, serum vitamin concentrations (A, D, E), international normalised ratio and evidence of supplementation at initial assessment, as well as at 3 and 6 months. Rates of vitamin assessment, deficiency and supplementation were compared using chi-squared or Fisher's exact test.

RESULTS

In total, 136 infants (87 male) with idiopathic neonatal cholestasis (n = 62), biliary atresia (n = 40) and other aetiology (n = 34) were included. Assessment of serum vitamins (A, D, E) was low (33.3%-52.2%) and deficiency was initially high for vitamin D (60.6%) and vitamin E (70.9%). Supplementation prevalence at initial assessment was high (A, E, K), but dropped significantly at 3 and 6 months for vitamin E (p = 0.003) and vitamin K (p = 0.001), whereas vitamin D supplementation was consistently low throughout (25%-33.3%). Infants with biliary atresia were more likely to have vitamins assessed (3 months), be deficient initially (D, E) and supplemented (E, K) throughout. Supplementation continued in up to 80% of infants despite cholestasis resolving.

CONCLUSIONS

Supplementation was generally high and continued in many despite cholestasis resolving. Deficiency of vitamin D and vitamin E was high at initial assessment, although lower at follow-up. Actual prevalence of deficiency of all vitamins is unknown because monitoring was not consistently performed.

Effects of pH and Temperature on Water under Pressurized Conditions in the Extraction of Nutraceuticals from Chaga (Inonotus obliquus) Mushroom

Currently, there is increased interest in finding appropriate food-grade green extraction systems capable of extracting these bioactive compounds from dietary mushrooms for applications in various food, pharmacological, or nutraceutical formulations. Herein, we evaluated a modified Swiss water process (SWP) method using alkaline and acidic pH at low and high temperature under pressurized conditions as a suitable green food grade solvent to obtained extracts enriched with myco-nutrients (dietary phenolics, total antioxidants (TAA), vitamins, and minerals) from Chaga. Ultra-high performance liquid chromatography coupled to high resolution accurate mass tandem mass spectrometry (UHPLC-HRAMS-MS/MS) was used to assess the phenolic compounds and vitamin levels in the extracts, while inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the mineral contents. Over 20 phenolic compounds were quantitatively evaluated in the extracts and the highest total phenolic content (TPC) and total antioxidant activity (TAA) was observed at pH 11.5 at 100 °C. The most abundant phenolic compounds present in Chaga extracts included phenolic acids such as protocatechuic acid 4-glucoside (0.7–1.08 µg/mL), syringic acid (0.62–1.18 µg/mL), and myricetin (0.68–1.3 µg/mL). Vitamins are being reported for the first time in Chaga. Not only, a strong correlation was found for TPC with TAA (r-0.8, <0.0001), but also, with individual phenolics (i.e., Salicylic acid), lipophilic antioxidant activity (LAA), and total antioxidant minerals (TAM). pH 2.5 at 100 °C treatment shows superior effects in extracting the B vitamins whereas pH 2.5 at 60 and 100 °C treatments were outstanding for extraction of total fat-soluble vitamins. Vitamin E content was the highest for the fat-soluble vitamins in the Chaga extract under acidic pH (2.5) and high temp. (100 °C) and ranges between 50 to 175 µg/100 g Chaga. Antioxidant minerals ranged from 85.94 µg/g (pH7 at 100 °C) to 113.86 µg/g DW (pH2.5 at 100 °C). High temperature 100 °C and a pH of 2.5 or 9.5. The treatment of pH 11.5 at 100 °C was the most useful for recovering phenolics and antioxidants from Chaga including several phenolic compounds reported for the first time in Chaga. SWP is being proposed herein for the first time as a novel, green food-grade solvent system for the extraction of myco-nutrients from Chaga and have potential applications as a suitable approach to extract nutrients from other matrices. Chaga extracts enriched with bioactive myconutrients and antioxidants may be suitable for further use or applications in the food and nutraceutical industries.

Supplementing the Diet of Dairy Goats with Dried Orange Pulp throughout Lactation: II Effect on Milk Fatty Acids Profile, Phenolic Compounds, Fat-Soluble Vitamins and Antioxidant Capacity

Simple Summary

Spain is a major global producer of both goats and oranges. The orange juice industry produces high levels of organic waste that could be used as alternative feedstock for ruminants, enhancing dairy farm sustainability by lowering feed costs and reducing the environmental impact. An example of such organic waste is dried orange pulp (DOP), which has been proven beneficial as a 40% or 80% replacement for cereal in the diet of goats at an early lactation stage; therefore, it is pertinent to study these by-products over a longer period, such as the complete lactation cycle of 180 days. This study evaluated the Payoya dairy breed and the resultant milk’s antioxidant composition and fatty acid (FA) content in terms of saturated, monounsaturated, and polyunsaturated FAs (SFA, MUFA, and PUFA, respectively). The levels of vitamin E, total phenolic compounds, and antioxidant capacity in milk increased as the percentage of DOP replacing cereals increased. Moreover, the inclusion of DOP improved the nutritional value of the milk for human health (according to the thrombogenicity index, MUFA/SFA, and PUFA/SFA ratios), especially at the end of lactation, leading to the conclusion that DOP might be an appropriate alternative to cereals in the diets of goats.

Abstract

Although dried orange pulp (DOP) as a short-term dietary supplementation has been proven an effective substitute for cereals in goat diets–without impairing milk quality–there have been no studies considering its use over the full lactation period. This study evaluated replacing cereal with DOP in goat diets for the full 180-day lactation period on milk’s fatty acid (FA) and antioxidant composition. Payoya goats were assigned to three diet groups: a control group consuming a commercial concentrate with alfalfa hay as forage; a DOP40 or DOP80 group, wherein 40% or 80% of the cereal in the concentrate was replaced by DOP. The α-tocopherol and phenolic compounds levels and the antioxidant capacity in the milk increased as the DOP percentage increased. Including DOP might improve the FA indices of milk in the context of human health, especially when included at the end of lactation because it contributes to reducing the thrombogenicity index and increasing both the monounsaturated/saturated FA and polyunsaturated/saturated FA indices and the amounts of indispensables α-C18:3 n-3 and C18:2 n-6 cis. Ultimately, DOP presents a plausible alternative to cereals in the diet of goats throughout lactation to improve the nutritional milk quality, especially the healthy antioxidant capacity.

Short Communication: Quantification of the Effect of Mycotoxin Binders on the Bioavailability of Fat-Soluble Vitamins In Vitro

The aim of this study was to determine the capacity of six mycotoxin binders (MTBs) to adsorb vitamins A, D and E in an in vitro system that simulates gastric and intestinal digestion. Experiment 1 evaluated the recovery rate of vitamins A, D and E in the incubation conditions. In Experiment 2, the main factors were the MTB (bentonite, clinoptilolite, sepiolite, montmorillonite, active carbon and yeast cell walls), vitamins (A, D and E) and incubation type (vitamins incubated separately or together). The recovery was high for vitamin D (83%) and E (93%), but low for vitamin A (23%), for which no further analyses were conducted. When incubated separately, vitamin D was only adsorbed by yeast cell wall (20.2%). Vitamin E adsorption was highest with bentonite (54.5%) and montmorillonite (46.3%) and lowest with sepiolite (16.6%) and active carbon (18.5%). When incubated together, vitamin D was not adsorbed by any MTB. Vitamin E adsorption was highest in bentonite (61.8%) and montmorillonite (50.7%) and lowest in sepiolite (15.4%). Results indicate that the bioavailability of vitamin E, but not that of vitamin D, may be reduced in the presence of MTBs.

Fat-Soluble Vitamins and the Current Global Pandemic of COVID-19: Evidence-Based Efficacy from Literature Review

The outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later named COVID-19 by the World Health Organization (WHO), was initiated at Wuhan, Hubei, China, and there was a rapid spread of novel SARS-CoV-2 and the disease COVID-19 in late 2019. The entire world is now experiencing the challenge of COVID-19 infection. However, still very few evidence-based treatment options are available for the prevention and treatment of COVID-19 disease. The present review aims to summarize the publicly available information to give a comprehensive yet balanced scientific overview of all the fat-soluble vitamins concerning their role in SARS-CoV-2 virus infection. The roles of different fat-soluble vitamins and micronutrients in combating SARS-CoV-2 infection have been recently explored in several studies. There are various hypotheses to suggest their use to minimize the severity of COVID-19 infection. These vitamins are pivotal in the maintenance and modulation of innate and cell-mediated, and antibody-mediated immune responses. The data reported in recent literature demonstrate that deficiency in one or more of these vitamins compromises the patients’ immune response and makes them more vulnerable to viral infections and perhaps worse disease prognosis. Vitamins A, D, E, and K boost the body’s defense mechanism against COVID-19 infection and specifically prevent its complications such as cytokine storm and other inflammatory processes, leading to increased morbidity and mortality overemphasis. However, more detailed randomized double-blind clinical pieces of evidence are required to define the use of these supplements in preventing or reducing the severity of the COVID-19 infection.

Vitamin retention during the canning of swordfish (Xiphias gladius) with different filling media

Swordfish (Xiphias gladius) is an economically and nutritionally important fish. The aims of this study were to determine the effects of the various steps of the canning process and of different filling media (olive oil, corn oil, sunflower oil, and high oleic sunflower oil) on the fat- and water-soluble vitamin contents of swordfish. An HPLC-based method was used for this purpose. The canning process led to loss of some vitamins, particularly of vitamin D₃ . Loss of this vitamin mainly occurred during storage and although important (89.34% to 91.36%), canned swordfish can be considered a good source of vitamin D₃ , providing between 50% and 64% of the RDI. The frying process also caused significant loss of vitamin B₉ (73.7%). However, the vitamin E content increased due to contributions from the frying and filling oils. The canned swordfish packed in olive oil had lower vitamin A (107.35 µg/100 g) and E (1.58 mg/100 g) contents than the fish packed in sunflower oil (193.28 µg/100 g and 2.28 mg/100 g, respectively). The swordfish packed in sunflower oil also had the highest B₂ (0.036 mg/100 g) content. The swordfish packed in corn oil had the lowest vitamin A (80.17 µg/100 g) and B₂ (0.012 mg/100 g) contents, while the samples packed in high oleic sunflower oil had the lowest contents of vitamins B₉ (0.14 µg/100 g) and B₁₂ (2.37 mg/100 g). PRACTICAL APPLICATION: Swordfish (Xiphias gladius) is consumed worldwide and is economically very important in the seafood industry. The canning process caused losses of some vitamins, particularly of vitamins D₃ and B₉ ; however, the vitamin E content increased due to the frying and filling oils. The study findings may contribute to increasing knowledge about how processing, storage and the filling medium influence the composition of canned fish.

Comparative Study for the Determination of Fat-Soluble Vitamins in Rice Cereal Baby Foods Using HPLC-DAD and UHPLC-APCI-MS/MS

Two liquid chromatographic systems, one coupled to atmospheric pressure chemical ionization and tandem mass spectrometric methods (UHPLC-APCI-MS/MS) and the other a high-performance liquid chromatographic coupled to diode array detector (HPLC-DAD) were used to develop and validate methods for the simultaneous determination of fat-soluble vitamins A, D3 and E in rice cereal baby foods. The chromatographic separation was performed on C18 columns with a mixture of methanol-acetonitrile as mobile phase for all methods. The extraction of fat-soluble vitamins included enzymatic hydrolysis with α-amylase, saponification, extraction with petroleum ether or n-hexane and purification with silica cartridge (only for vitamin D3). Quantification of vitamin D3 and E through UHPLC-APCI-MS/MS was performed by the use of internal standards (IS) D3-d3 and E-d6, respectively, while IS was not used for vitamin A. The methods were optimized and validated in terms of linearity, precision, trueness, limits of detection and quantification. The recoveries were in the range of 85.0-107% for retinol, 92.0-105% for α-tocopherol and 95.2-106% for cholecalciferol and the %RSD (Relative Standard Deviation) values ranged from 6.4% to 15%. The evaluation of the methods was also conducted through the estimation of uncertainties, the application in commercial samples and the participation in a proficiency test.

Hidden Hunger of Vitamin E among Healthy College Students: A Cross- Sectional Study

BACKGROUND

College students may have a risk of fat-soluble vitamin deficiencies due to unhealthy dietary habits, especially for vitamin A and E. They are important members of the human antioxidant network; deficiencies of these vitamins may increase the risk of many critical diseases.

OBJECTIVE

The current study was undertaken to determine the status of vitamin A and E in college students.

METHODS

Healthy college students were recruited, and fasting blood samples of them were collected and used for determining serum levels of retinol and α-tocopherol by the HPLC method.

RESULTS

We found that there was no vitamin A deficiency in college students. However, vitamin E deficiency existed in 34.5% of college students, especially in males. All the students had no vitamin E adequacy. In addition, our findings showed that BMI was inversely associated with serum α-- tocopherol, but not serum retinol.

CONCLUSION

These results suggest that vitamin E deficiency in college students should be given more attention, and it is necessary to consider using vitamin E supplements.

Vitamin A and D Absorption in Adults with Metabolic Syndrome versus Healthy Controls: A Pilot Study Utilizing Targeted and Untargeted LC-MS Lipidomics

SCOPE

Persons with metabolic syndrome (MetS) absorb less vitamin E than healthy controls. It is hypothesized that absorption of fat-soluble vitamins (FSV) A and D2 would also decrease with MetS status and that trends would be reflected in lipidomic responses between groups.

METHODS AND RESULTS

Following soymilk consumption (501 IU vitamin A, 119 IU vitamin D2 ), the triglyceride-rich lipoprotein fractions (TRL) from MetS and healthy subjects (n = 10 age- and gender-matched subjects/group) are assessed using LC-MS/MS. Absorption is calculated using area under the time-concentration curves (AUC) from samples collected at 0, 3, and 6 h post-ingestion. MetS subjects have ≈6.4-fold higher median vitamin A AUC (retinyl palmitate) versus healthy controls (P = 0.07). Vitamin D2 AUC is unaffected by MetS status (P = 0.48). Untargeted LC-MS lipidomics reveals six phospholipids and one cholesterol ester with concentrations correlating (r = 0.53-0.68; P < 0.001) with vitamin A concentration.

CONCLUSIONS

The vitamin A-phospholipid association suggests increased hydrolysis by PLB, PLRP2, and/or PLA2 IB may be involved in the trend in higher vitamin A bioavailability in MetS subjects. Previously observed differences in circulating levels of these vitamins are likely not due to absorption. Alternate strategies should be investigated to improve FSV status in MetS.

Effect of Fat-Soluble Vitamins A, D, E and K on Vitamin Status and Metabolic Profile in Patients with Fat Malabsorption with and without Urolithiasis

Patients with intestinal fat malabsorption and urolithiasis are particularly at risk of acquiring fat-soluble vitamin deficiencies. The aim of the study was to evaluate the vitamin status and metabolic profile before and after the supplementation of fat-soluble vitamins A, D, E and K (ADEK) in 51 patients with fat malabsorption due to different intestinal diseases both with and without urolithiasis. Anthropometric, clinical, blood and 24-h urinary parameters and dietary intake were assessed at baseline and after ADEK supplementation for two weeks. At baseline, serum aspartate aminotransferase (AST) activity was higher in stone formers (SF; n = 10) than in non-stone formers (NSF; n = 41) but decreased significantly in SF patients after supplementation. Plasma vitamin D and E concentrations increased significantly and to a similar extent in both groups during intervention. While plasma vitamin D concentrations did not differ between the groups, vitamin E concentrations were significantly lower in the SF group than the NSF group before and after ADEK supplementation. Although vitamin D concentration increased significantly in both groups, urinary calcium excretion was not affected by ADEK supplementation. The decline in plasma AST activity in patients with urolithiasis might be attributed to the supplementation of ADEK. Patients with fat malabsorption may benefit from the supplementation of fat-soluble vitamins ADEK.

The Effect of Selected Factors on the Content of Fat-Soluble Vitamins and Macro-Elements in Raw Milk from Holstein-Friesian and Simmental Cows and Acid Curd Cheese (Tvarog)

Simple Summary

Depending on the region, specific methods of cheese production are used. Acid coagulation is applied in the production of the traditional acid curd cheese highly valued in Poland, called ‘tvarog’. It is important to maintain the traditional nature of production that guarantees cheese with a high nutritional value and health-promoting properties. By conducting an analysis of tvarog, taking into account the quality of the raw milk and the type of starter cultures used, we found that the content of fat-soluble vitamins (A, D₃, and E) mainly depended on the quality of the raw milk from which it was produced. A higher content of fat-soluble vitamins was found in milk obtained from Simmental cows kept in a traditional system in the spring/summer season and in the tvarog produced from it. Vitamin retention rates from raw milk to cheese were above 90%. In contrast, we noticed that the mineral composition of the cheese was not linked to the quality of the milk used. More Ca and Mg were lost with the whey, as indicated by the very low retention rates of these minerals from milk to tvarog (below 20%).

Abstract

The study was conducted to determine the content and retention of selected fat-soluble vitamins and minerals in curd cheese–tvarog made by a traditional method, taking into account the effect of the quality of the raw milk and the type of starter cultures used. The raw milk used to make the tvarog was obtained in various conditions, i.e., with and without the use of pasture forage (in a traditional and an intensive system), in two production seasons (spring/summer and autumn/winter), from two breeds raised in Poland (the Black-and-White variety of Polish Holstein-Friesian and Simmental). Two variants of starter cultures were used to make tvarog: Freeze-dried DVS starters (Flora Danica) and pure cultures of mesophilic lactic acid bacteria. The acidity and content of protein, fat, selected fat-soluble vitamins (A, D₃, and E), and selected macro-elements (Ca and Mg) were determined in samples of bulk milk and cheese. Retention rates of individual nutrients from the milk to the cheese were calculated. A higher content of fat-soluble vitamins was found in milk obtained from Simmental cows kept in a traditional system in the spring/summer season, as well as in the tvarog produced from it. Vitamin retention rates from the raw material to the tvarog were above 90%. The mineral composition of the cheese was not associated with the quality of the milk used. Very low retention rates from milk to cheese were obtained for Ca and Mg (below 20%). Higher retention rates were obtained in the spring/summer season when culture variant 1 was used. However, the starter culture was not found to significantly influence the concentration or retention of vitamins in the experimental cheese.

Protective effect of pristine C60 fullerene nanoparticle in combination with curcumin against hyperglycemia-induced kidney damage in diabetes caused by streptozotocin

The present study aims to examine the protective effects of C60 fullerene (C60), Curcumin (CUR; Curcuma longa), C60 + CUR combination against oxidative stress, apoptosis, and changes in cellular level in kidney tissue of diabetic rats. Treatment practices were administered separately to groups for 8 weeks following the approval of diabetes induction. It was observed that the treatment groups had increased antioxidant potential, decreased oxidative stress levels, decreased cholesterol, alpha tocopherol, retinol levels along with improved important changes in fatty acid metabolism compared with the diabetic group. C60, CUR, and C60 + CUR were also determined to act in the direction of reducing kidney damage by activating apoptotic pathways. It can be concluded based on these findings that C60, CUR, and especially C60 + CUR combination has beneficial properties in maintaining kidney tissue and function by effectively preventing oxidative stress, apoptotic changes, and changes at the cellular level in kidney tissue under hyperglycemia conditions. PRACTICAL APPLICATIONS: C60 and CUR have various biological activities which can be indicated as antioxidant, anti-inflammatory, anticancer, neuroprotective, and hepatoprotective. It has been reported that C60 and CUR protect the cells against oxidative injury brought about by reactive oxygen species (ROS). Data acquired from the present study puts forth that C60 and C60 + CUR may be promising agents to prevent damage induced by hyperglycemic conditions in kidney tissue.

Impact of storage conditions and premix type on fat-soluble vitamin stability

Feed ingredients and additives could be a potential medium for foreign animal disease entry into the United States. The feed industry has taken active steps to reduce the risk of pathogen entry through ingredients. Medium chain fatty acid (MCFA) and heat pulse treatment could be an opportunity to prevent pathogen contamination. The objective of experiment 1 was to determine the impact of 0, 30, 60, or 90 d storage time on fat-soluble vitamin stability when vitamin premix (VP) and vitamin trace mineral premix (VTM) were blended with 1% inclusion of MCFA (1:1:1 blend of C6:C8:C10) or mineral oil (MO) with different environmental conditions. Samples stored at room temperature (RT) (~22 °C) or in an environmentally controlled chamber set at 40 °C and 75% humidity, high-temperature high humidity (HTHH). The sample bags were pulled out at days 0, 30, 60 and 90 for RT condition and HTHH condition. The objective of experiment 2 was to determine the effect of heat pulse treatment and MCFA addition on fat-soluble vitamin stability with two premix types. A sample from each treatment was heated at 60 °C and 20% humidity. For experiment 1, the following effects were significant for vitamin A: premix type × storage condition (P = 0.031) and storage time × storage condition (P = 0.002) interactions; for vitamin D3: main effect of storage condition (P < 0.001) and storage time (P = 0.002); and for vitamin E: storage time × storage condition interaction (P < 0.001). For experiment 2, oil type did not affect the stability of fat-soluble vitamins (P > 0.732) except for vitamin A (P = 0.030). There were no differences for fat-soluble vitamin stability between VP and VTM (P > 0.074) except for vitamin E (P = 0.016). Therefore, the fat-soluble vitamins were stable when mixed with both vitamin and VTM and stored at 22 °C with 28.4% relative humidity (RH). When premixes were stored at 39.5 °C with 78.8%RH, the vitamin A and D₃ were stable up to 30 d while the vitamin E was stable up to 60 d. In addition, MCFA did not influence fat-soluble vitamin degradation during storage up to 90 d and in the heat pulse process. The vitamin stability was decreased by 5% to 10% after the premixes was heated at 60 °C for approximately nine and a half hours. If both chemical treatment (MCFA) and heat pulse treatment have similar efficiency at neutralizing or reducing the target pathogen, the process of chemical treatment could become a more practical practice.

Associations between Circulating Lipids and Fat-Soluble Vitamins and Carotenoids in Healthy Overweight and Obese Men

Inconsistent associations between lipids and circulating markers of fat-soluble vitamin and carotenoid status have been reported. The aim of this hypothesis-generating study was to examine the contribution of the LC-MS-based lipidome, characterized by lipid class, carbon count, and the number of unsaturated bonds, to the interindividual variability in circulating concentrations of retinol, carotenoids, 25-hydroxyvitamin D3, α-tocopherol, γ-tocopherol, and phylloquinone in 35 overweight and obese, but healthy men. A sparse partial least-squares method was used to accomplish this aim. Highly abundant phospholipids and triglycerides (TGs) contributed to the interindividual variability in phylloquinone, α-tocopherol, and γ-tocopherol. Interindividual variability in lycopene concentrations was driven by concentrations of low-abundant TG. 25-Hydroxyvitamin D3, retinol, and the other carotenoids were not influenced by lipids. Except for lycopene, evaluation of lipids beyond class does not appear to further explain the interindividual variability in circulating concentrations of fat-soluble vitamins and carotenoids.

Using dried orange pulp in the diet of dairy goats: effects on milk yield and composition and blood parameters of dams and growth performance and carcass quality of kids

Although dried orange pulp (DOP) may conveniently replace cereals in ruminant diets, few studies have considered similar diet substitution for goats. We hypothesised that DOP could replace cereal-based concentrate in goat diets without detrimental effects on growth performance and carcass quality of suckling kids and milk performance and blood biochemical parameters of dams in early lactation. We also hypothesised that DOP substitution may increase the levels of antioxidants, such as phenolic compounds and vitamin E, in milk and improve its total antioxidant capacity (TAC). Therefore, 44 primiparous Payoya dairy goats were allocated to three experimental groups, each fed a different diet: control (CD, n = 14) based on a commercial concentrate with alfalfa hay as forage; and DOP40 (n = 16) in which 40% and DOP80 (n = 14) in which 80% of the cereal in the concentrate were replaced by DOP. The experiment lasted from the final month of pregnancy to 55 days postpartum. The DOP diets did not affect suckling kids' carcass quality, but at 28 days, led to improvement in live weight (LW) and average daily gain (ADG) from birth, although no differences were found between DOP40 and DOP80 (for CD, DOP40 and DOP80, LW at 28 days was 8.00, 8.58 and 8.34 kg and ADG was 184, 199 and 195 g/day, respectively). Diet had no significant effect on milk yield (average daily milk yield and total yield at 55 days were 1.66 l/day and 90.6 l, respectively) and commercial and fatty acid composition. Nevertheless, α-tocopherol, total phenolic compound (TPC) and TAC concentration in milk increased with substitution of cereals by DOP (for CD, DOP40 and DOP80, concentration of α-tocopherol was 21.7, 32.8 and 42.3 μg/100 g, TPCs was 63.5, 84.1 and 102 mg gallic acid equivalents/l, and TAC was 6.63, 11.1 and 12.8 μmol Trolox equivalents/ml, respectively). Every plasma biochemistry parameter considered was within reference values for healthy goats; therefore, no pathological effect was detected for these variables due to dietary treatment. However, DOP diets caused a reduction in plasmatic creatine kinase and aspartate aminotransferase, implying reduced oxidative damage to muscles. In conclusion, DOP may be an interesting alternative to cereals in early lactation goat diets for increasing farmers' income and the healthy antioxidant capacity of milk.

Retinol, Retinoic Acid, and Retinol-Binding Protein 4 are Differentially Associated with Cardiovascular Disease, Type 2 Diabetes, and Obesity: An Overview of Human Studies

Vitamin A is a fat-soluble essential nutrient obtained from plant- and animal-based sources that has roles in growth, vision, and metabolism. Vitamin A circulates mainly as retinol bound to retinol-binding protein 4 (RBP4), and is delivered to tissues and converted to retinoic acid, which is a ligand for several nuclear receptors. In recent years, aspects of vitamin A metabolism have been under scrutiny with regards to the development of metabolic and lifestyle diseases including cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and overweight and obesity in humans. Studies have mainly focused on RBP4 in this context, whereas the major circulating form, retinol, and the major bioactive form, retinoic acid, have been overlooked in this regard until recently. As one of the main roles of RBP4 is to deliver retinol to tissues for biological action, the associations of retinol and retinoic acid with these diseases must also be considered. In this review, we summarize and discuss recent and available evidence from human studies with focus on retinol, retinoic acid, and RBP4 and provide an overview of these crucial components of vitamin A metabolism in CVD, T2DM, and obesity. In summary, retinol was found to be both inversely and positively associated with CVD whereas the associations with T2DM and obesity were less clear. Although only a few studies have been published on retinoic acid, it was inversely associated with CVD. In contrast, serum RBP4 was mostly found to be positively associated with CVD, T2DM, and obesity. At present, it is difficult to ascertain why the reported associations differ depending on the compound under study, but there is a clear imbalance in the literature in disfavor of retinol and retinoic acid, which needs to be considered in future human studies.

Simultaneous LC/MS Analysis of Carotenoids and Fat-Soluble Vitamins in Costa Rican Avocados (Persea americana Mill.)

Avocado (a fruit that represents a billion-dollar industry) has become a relevant crop in global trade. The benefits of eating avocados have also been thoroughly described as they contain important nutrients needed to ensure biological functions. For example, avocados contain considerable amounts of vitamins and other phytonutrients, such as carotenoids (e.g., β-carotene), which are fat-soluble. Hence, there is a need to assess accurately these types of compounds. Herein we describe a method that chromatographically separates commercial standard solutions containing both fat-soluble vitamins (vitamin A acetate and palmitate, Vitamin D₂ and D₃, vitamin K₁, α-, δ-, and γ-vitamin E isomers) and carotenoids (β-cryptoxanthin, zeaxanthin, lutein, β-carotene, and lycopene) effectively (i.e., analytical recoveries ranging from 80.43% to 117.02%, for vitamins, and from 43.80% to 108.63%). We optimized saponification conditions and settled at 80 °C using 1 mmol KOH L⁻¹ ethanol during 1 h. We used a non-aqueous gradient that included methanol and methyl tert-butyl ether (starting at an 80:20 ratio) and a C₃₀ chromatographic column to achieve analyte separation (in less than 40 min) and applied this method to avocado, a fruit that characteristically contains both types of compounds. We obtained a method with good linearity at the mid to low range of the mg L⁻¹ (determination coefficients 0.9006–0.9964). To determine both types of compounds in avocado, we developed and validated for the simultaneous analysis of carotenoids and fat-soluble vitamins based on liquid chromatography and single quadrupole mass detection (LC/MS). From actual avocado samples, we found relevant concentrations for cholecalciferol (ranging from 103.5 to 119.5), δ-tocopherol (ranging from 6.16 to 42.48), and lutein (ranging from 6.41 to 15.13 mg/100 g dry weight basis). Simmonds cultivar demonstrated the higher values for all analytes (ranging from 0.03 (zeaxanthin) to 119.5 (cholecalciferol) mg/100 g dry weight basis).

Pancreatic Function in Chronic Pancreatitis: A Cohort Study Comparing 3 Methods of Detecting Fat Malabsorption and the Impact of Short-term Pancreatic Enzyme Replacement Therapy

OBJECTIVES

Reliable pancreatic function tests in patients with chronic pancreatitis (CP) are needed. This cohort study identified malabsorption in people with CP compared with healthy people and then investigated short-term pancreatic enzyme replacement therapy (PERT) and fat malabsorption, nutritional status, and quality of life (QOL).

METHODS

Subjects with CP were evaluated before and after PERT and compared with the healthy cohort using coefficient of fat absorption (CFA), stool bomb calorimetry, and the malabsorption blood test (MBT). Anthropometrics, micronutrients, and QOL data were collected. Group means at baseline and after PERT were analyzed.

RESULTS

The 24 subjects with CP had greater stool energy loss (5668 cal/g [standard deviation {SD}, 753] vs 5152 cal/g [SD, 418], P < 0.01), reduced triglyceride absorption (MBT, 8.3 mg·h/dL [SD, 4.3] vs 17.7 mg·h/dL [SD, 10.3], P < 0.001), lower fat intake, and poorer QOL. Differences in CFA were not significant (90.9% [SD, 12.8] vs 95.4% [SD, 9.3]). After PERT, triglyceride absorption (Δ = 1.7 [SD, 3], P < 0.05) and QOL increased.

CONCLUSIONS

The MBT detected changes in triglyceride absorption in the absence of CFA changes. The MBT may be helpful in guiding PERT initiation in patients with CP before significant morbidity.

Extraction of Carotenoids and Fat-Soluble Vitamins from Tetradesmus Obliquus Microalgae: An Optimized Approach by Using Supercritical CO2

In recent years, great attention has been focused on rapid, selective, and environmentally friendly extraction methods to recover pigments and antioxidants from microalgae. Among these, supercritical fluid extraction (SFE) represents one of the most important alternatives to traditional extraction methods carried out with the use of organic solvents. In this study, the influence of parameters such as pressure, temperature, and the addition of a polar co-solvent in the SFE yields of carotenoids and fat-soluble vitamins from T. obliquus biomass were evaluated. The highest extraction of alpha-tocopherol, gamma-tocopherol, and retinol was achieved at a pressure of 30 MPa and a temperature of 40 °C. It was observed that overall, the extraction yield increased considerably when a preliminary step of sample pre-treatment, based on a matrix solid phase dispersion, was applied using diatomaceous earth as a dispersing agent. The use of ethanol as a co-solvent, under certain conditions of pressure and temperature, resulted in selectively increasing the yields of only some compounds. In particular, a remarkable selectivity was observed if the extraction was carried out in the presence of ethanol at 10 MPa and 40 °C: under these conditions, it was possible to isolate menaquinone-7, a homologous of vitamin K2, which, otherwise, cannot not recovered by using traditional extraction procedures.

Supercritical Fluid Chromatography with Photodiode Array Detection in the Determination of Fat-Soluble Vitamins in Hemp Seed Oil and Waste Fish Oil

In the presented study for the first time a new, optimized, fast SFC (supercritical fluid chromatography) method was applied to separate in one run fat-soluble vitamins from waste fish oil, including cis-and trans-retinyl palmitate, cis- and trans-retinyl acetate, retinol, α-tocopherol, β-tocopherol, γ‑tocopherol, δ-tocopherol, ergocalciferol (D₂), cholecalciferol (D₃), cis- and trans-phylloquinone (K₁) and menaquinone-4 (K₂-MK4). Vitamins were baseline separated on an Acquity UPC² (ultra performance convergence chromatography) HSS C18 SB (highly strength chemically modified silica) column within 13 min. The influence of the stationary phase, such as Torus 1-AA (1-aminoanthracene), Torus Diol (high density diol), Torus DEA (diethylamine), BEH (silica with no bonding), BEH-2EP (2-ethylpirydine), CSH Fluoro-Phenyl (silica with fluoro-phenyl groups), column temperature, flow rate and back pressure on the separation of the compounds was described. The application of the modified saponification procedure allowed us to increase concentration in the sample prepared for the analysis of γ‑tocopherol from less than 1% (wt %) to 14% for the first time. In addition, α‑tocopherol, γ‑tocopherol, δ‑tocopherol and retinol were identified in waste fish oil. Vitamin purification and analysis in waste fish oil are reported for the first time here. Due to the short time and effectiveness of the proposed method, it can be easily applied in industrial processes.

Analysis of retinol, α-tocopherol, 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 in plasma of patients with cardiovascular disease by HPLC-MS/MS method

Fat-soluble vitamins play a pivotal role in the progression of atherosclerosis and the development of cardiovascular disease. Therefore, plasma monitoring of their concentrations may be useful in the diagnosis of these disorders as well as in the process of treatment. The study aimed to develop and validate an HPLC-MS/MS method for determination of retinol, α-tocopherol, 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 in plasma of patients with cardiovascular disease. The analytes were separated on an HPLC Kinetex F5 column via gradient elution with water and methanol, both containing 0.1% (v/v) formic acid. Detection of the analytes was performed on a triple-quadrupole MS with multiple reaction monitoring via electrospray ionization. The analytes were isolated from plasma samples with liquid-liquid extraction using hexane. Linearity of the analyte calibration curves was confirmed in the ranges 0.02-2 μg/mL for retinol, 0.5-20 μg/mL for α-tocopherol, 5-100 ng/mL for 25-hydroxyvitamin D2 and 2-100 ng/mL for 25-hydroxyvitamin D3. Intra- and inter-assay precision and accuracy of the method were satisfactory. Short- and long-term stabilities of the analytes were determined. The HPLC-MS/MS method was applied for the determination of the above fat-soluble vitamin concentrations in patient plasma as potential markers of the cardiovascular disease progression.

Do Current Fortification and Supplementation Programs Assure Adequate Intake of Fat-Soluble Vitamins in Belgian Infants, Toddlers, Pregnant Women, and Lactating Women?

Abstracts: Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants (n = 455), toddlers (n = 265), pregnant women (n = 161), and lactating women (n = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.

Association between vitamin deficiency and metabolic disorders related to obesity

Inappropriate food behavior contributes to obesity and leads to vitamin deficiency. This review discusses the nutritional status of water- and fat-soluble vitamins in obese subjects. We verified that most vitamins are deficient in obese individuals, especially the fat-soluble vitamins, folic acid, vitamin B₁₂ and vitamin C. However, some vitamins have been less evaluated in cases of obesity. The adipose tissue is considered a metabolic and endocrine organ, which in excess leads to changes in body homeostasis, as well as vitamin deficiency which can aggravate the pathological state. Therefore, the evaluation of vitamin status is of fundamental importance in obese individuals.

Flotation/ultrasound-assisted microextraction followed by HPLC for determination of fat-soluble vitamins in multivitamin pharmaceutical preparations

Dissolved carbon dioxide flotation-emulsification microextraction technique coupled with high-performance liquid chromatography was developed for separation and determination of fat-soluble vitamins (A, D₃ , E, and K₃ ) in multivitamin pharmaceutical preparations. Dissolved carbon dioxide flotation was used to break up the emulsion of extraction solvent in water and to collect the extraction solvent on the surface of aqueous sample in narrowed capillary part of extraction cell. Carbon dioxide bubbles were generated in situ through the addition of 300 μL of concentrated hydrochloric acid into the alkaline sample solution at pH = 11.5 (1% w/v sodium carbonate), which was sonicated to intensify the carbon dioxide bubble generation. Several factors affecting the extraction process were optimized. Under the optimal conditions, the limits of detection were 0.11, 0.47, 0.20 and 0.35 μg/L for A, E, D₃ , and K₃ vitamins in water samples, respectively. The inter-day and intra-day precision of the proposed method were evaluated in terms of the relative standard deviation and were <10.5%.

A mechanism based approach to management of children with end-stage liver disease

Due to parallel advances in surgical and acute care disciplines, liver transplantation (LT) has revolutionized the outlook for children with end-stage liver disease (ESLD). Contrary to advances in technical aspects of LT and the peri-operative care, pre-transplant management of ESLD remains quite a formidable challenge. Areas covered: This review provides mechanisms based management strategies to address common complications of ESLD including malnutrition, amended metabolic pathways, gastrointestinal dysfunction, and development of ascites. Clinically relevant discussion of each paradigm is followed by an account of high impact therapeutic interventions which can be used as guides for formulating management plans. A tabulated summary of the suggested interventions is also provided. Indeed, execution of a dynamic plan tailored to the evolution of pathophysiologic derangements can further enhance outcomes of pediatric LT. Expert commentary: LT has evolved as a dependable therapeutic option for a variety of fatal pediatric liver diseases. However, relative organ shortage remains a formidable challenge. Similarly, consumer expectations continue to grow for sustained improvement of graft and patient survival after LT. In this environment, the level of sophistication applied to the management ESLD before LT stands out as a major opportunity with lasting impact on the future of pediatric LT.

Vitamin E Bioavailability: Mechanisms of Intestinal Absorption in the Spotlight

Vitamin E is an essential fat-soluble micronutrient whose effects on human health can be attributed to both antioxidant and non-antioxidant properties. A growing number of studies aim to promote vitamin E bioavailability in foods. It is thus of major interest to gain deeper insight into the mechanisms of vitamin E absorption, which remain only partly understood. It was long assumed that vitamin E was absorbed by passive diffusion, but recent data has shown that this process is actually far more complex than previously thought. This review describes the fate of vitamin E in the human gastrointestinal lumen during digestion and focuses on the proteins involved in the intestinal membrane and cellular transport of vitamin E across the enterocyte. Special attention is also given to the factors modulating both vitamin E micellarization and absorption. Although these latest results significantly improve our understanding of vitamin E intestinal absorption, further studies are still needed to decipher the molecular mechanisms driving this multifaceted process.

Fat-soluble micronutrients and metabolic syndrome

PURPOSE OF REVIEW

Metabolic syndrome (MetS) is associated with increased risk of obesity, type 2 diabetes mellitus and cardiovascular diseases. MetS prevalence has been associated with diet inadequacy. Conversely, the cumulative incidence of MetS has been inversely associated with a Mediterranean-style diet that includes many different health-beneficial nutrients. Adherence to a Mediterranean-style diet could reduce or at least stabilize metabolic risk factors.

RECENT FINDINGS

Low serum level of fat-soluble micronutrients, such as carotenoids, vitamin (vit) A, D and E, has been linked to MetS. Fat-soluble micronutrients could contribute to prevent MetS thanks to their antioxidant and anti-inflammatory properties (vit E, carotenoids) or to their central role as hormone regulators (vit D) and/or lipid metabolism and glucose homeostasis sensors (vit D and E).

SUMMARY

This review summarizes recent epidemiological studies linking fat-soluble micronutrients to MetS and highlights new evidence on their mechanisms of actions.

Vitamin A status and its determinants in patients with cystic fibrosis

BACKGROUND

Routine administration of vitamin A, recommended in CF patients, can help to prevent its deficiency. However, high vitamin A supplementation may lead to its excessive level and possible toxicity. Therefore, the aim of the present study was to assess the status of vitamin A and the determinants of its body resources in CF patients.

METHODS

In 196 CF patients aged from 4 months to 47 years, the following parameters  were analysed: nutritional status (standardized body weight and height, serum albumin concentration) and clinical expression of disease (lung function - spirometry; biochemical markers of liver function - ALT, AST, GGT; respiratory tract colonization by Pseudomonas aeruginosa; diabetes; cirrhosis, non-cirrhotic liver disease; exocrine pancreatic function - fecal elastase-1 concentration; blood clotting -  INR  and  vitamin  A supplementation).

RESULTS

Median vitamin A concentration in the study group was 383.0 ng/ml (1st-3rd quartile: 316.5-457.0). Vitamin A deficiency was found in 32 (16.3%) subjects studied. Vitamin A concentrations above the reference range were observed only in 3 (1.5%) CF patients. CF patients with vitamin A deficiency were significantly older and had lower values of FEV1 compared to CF subjects with normal vitamin A status. Moreover, vitamin A deficiency occurred more frequently in CF patients with diabetes, Pseudomonas aeruginosa colo- nization, worse lung function and in those without vitamin A supplementation. However, in multiple linear regression analyses, none of the independent variables was documented to be important for predicting vita- min A status.

CONCLUSIONS

Vitamin A body resources in CF patients are mostly normal. Moreover, there are no good de- terminants of vitamin A status in these patients. Further studies targeted at exploring potential toxicity and deficiencies of vitamin A in CF patients are needed.

Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements

A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. Data of the 2014 Belgian food consumption survey (n = 3200) were used to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements. This study revealed inadequate intakes for vitamin A, from all sources, in the entire Belgian population and possible inadequacies for vitamin D. The prevalence of inadequate intake of vitamin A was lowest in children aged 3-6 (6-7%) and highest in adolescents (girls, 26%; boys, 34-37%). Except for women aged 60-64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 μg/day. The risk for inadequate intake of vitamins K and E was low (median > AI). Belgian fortification and supplementation practices are currently inadequate to eradicate suboptimal intakes of vitamins A and D, but increase median vitamin E intake close to the adequate intake. For vitamin A, a small proportion (1-4%) of young children were at risk of exceeding the upper intake level (UL), while for vitamin D, inclusion of supplements slightly increased the risk for excessive intakes (% > UL) in adult women and young children. The results may guide health authorities when developing population health interventions and regulations to ensure adequate intake of fat-soluble vitamins in Belgium.

Comparing monolithic and fused core HPLC columns for fast chromatographic analysis of fat-soluble vitamins

HPLC stationary phases of monolithic and fused core type can be used to achieve fast chromatographic separation as an alternative to UPLC. In this study, monolithic and fused core stationary phases are compared for fast separation of four fat-soluble vitamins. Three new methods on the first and second generation monolithic silica RP-18e columns and a fused core pentafluoro-phenyl propyl column were developed. Application of three fused core columns offered comparable separations of retinyl palmitate, DL-α-tocopheryl acetate, cholecalciferol and menadione in terms of elution speed and separation efficiency. Separation was achieved in approx. 5 min with good resolution (Rs > 5) and precision (RSD ≤ 0.6 %). Monolithic columns showed, however, a higher number of theoretical plates, better precision and lower column backpressure than the fused core column. The three developed methods were successfully applied to separate and quantitate fat-soluble vitamins in commercial products.

Development of an Advanced HPLC-MS/MS Method for the Determination of Carotenoids and Fat-Soluble Vitamins in Human Plasma

The concentration of carotenoids and fat-soluble vitamins in human plasma may play a significant role in numerous chronic diseases such as age-related macular degeneration and some types of cancer. Although these compounds are of utmost interest for human health, methods for their simultaneous determination are scarce. A new high pressure liquid chromatography (HPLC)-tandem mass spectrometry (MS/MS) method for the quantification of selected carotenoids and fat-soluble vitamins in human plasma was developed, validated, and then applied in a pilot dietary intervention study with healthy volunteers. In 50 min, 16 analytes were separated with an excellent resolution and suitable MS signal intensity. The proposed HPLC-MS/MS method led to improvements in the limits of detection (LOD) and quantification (LOQ) for all analyzed compounds compared to the most often used HPLC-DAD methods, in some cases being more than 100-fold lower. LOD values were between 0.001 and 0.422 µg/mL and LOQ values ranged from 0.003 to 1.406 µg/mL, according to the analyte. The accuracy, precision, and stability met with the acceptance criteria of the AOAC (Association of Official Analytical Chemists) International. According to these results, the described HPLC-MS/MS method is adequately sensitive, repeatable and suitable for the large-scale analysis of compounds in biological fluids.

Development of an Advanced HPLC-MS/MS Method for the Determination of Carotenoids and Fat-Soluble Vitamins in Human Plasma

The concentration of carotenoids and fat-soluble vitamins in human plasma may play a significant role in numerous chronic diseases such as age-related macular degeneration and some types of cancer. Although these compounds are of utmost interest for human health, methods for their simultaneous determination are scarce. A new high pressure liquid chromatography (HPLC)-tandem mass spectrometry (MS/MS) method for the quantification of selected carotenoids and fat-soluble vitamins in human plasma was developed, validated, and then applied in a pilot dietary intervention study with healthy volunteers. In 50 min, 16 analytes were separated with an excellent resolution and suitable MS signal intensity. The proposed HPLC-MS/MS method led to improvements in the limits of detection (LOD) and quantification (LOQ) for all analyzed compounds compared to the most often used HPLC-DAD methods, in some cases being more than 100-fold lower. LOD values were between 0.001 and 0.422 µg/mL and LOQ values ranged from 0.003 to 1.406 µg/mL, according to the analyte. The accuracy, precision, and stability met with the acceptance criteria of the AOAC (Association of Official Analytical Chemists) International. According to these results, the described HPLC-MS/MS method is adequately sensitive, repeatable and suitable for the large-scale analysis of compounds in biological fluids.

Oral Supplementation with a Special Additive of Retinyl Palmitate and Alpha Tocopherol Reduces Growth Retardation in Young Pancreatic Duct Ligated Pigs Used as a Model for Children Suffering from Exocrine Pancreatic Insufficiency

Pancreatic exocrine insufficiency (PEI) is a disease of diverse aetiology-e.g., majority of patients suffering from cystic fibrosis (CF) show PEI congenitally. Malnutrition and malabsorption of nutrients impair growth and nutritional status. As reduced fat digestion leads to a deficiency of fat-soluble vitamins the supplementation is standard, but absorption is a critical point in PEI-patients. The pancreatic duct ligated (PL) pig is an established model for PEI in humans and has been proven to be a suitable model to compare different vitamin additives for supplementation. In a former study, PEI caused distinct growth retardation in young piglets, but did not affect growth in older ones. Our study hypothesised that this age-dependent effect is caused by exhausted body reserves of fat-soluble vitamins and, therefore, extra supply reduces growth retardation. PEI was induced by PL at the age of seven (PL-7) or 16 weeks (PL-16). Controls (C) underwent a sham surgery. Some PL-7 pigs (PL-7 + Vit) were fed a special vitamin additive. PEI reduced the mean final body weight (kg) at 26 weeks of age significantly with lower effect in PL-16-pigs (C:117; PL-7:49.5; PL-7 + Vit:77.1; PL-16:96.4). Extra vitamin supply resulted in an increased growth and normalised serum concentration of alpha-tocopherol, underlining the importance of special supplementation in PEI-patients.