Vitamin D insufficiency and disease risk in the elderly

Vitamin D insufficiency, milder than deficiency, is common, and a risk of various diseases. Since vitamin D exert diverse actions, both skeletal and non-skeletal, its insufficiency is a risk of various diseases including osteoporosis, sarcopenia, cardiovascular disease, cancer, and even mortality. Regarding the association of vitamin D status and disease risk, a marked discrepancy exists between the results from the observational studies and intervention studies, mostly yielding the positive and negative results in the former and latter, respectively. Such inconsistency probably arises from methodological problems, of which the baseline vitamin D status would be the most important. Vitamin D intervention would be effective in the deficient/insufficient subjects, but not in sufficient subjects. Since the elderly subjects, especially the institutionalized people, are mostly vitamin D deficient/insufficient, they are likely to benefit from improvement of vitamin D status. Vitamin insufficiency is a risk of various diseases, and correcting the vitamin status alone would reduce the risk of many diseases, and favorable to avoid the undesirable consequences of polypharmacy in the elderly. Additionally, disease prevention by nutritional improvement is cheap and free from side effects, and suited for the primary prevention of diseases.

The Association between Atherosclerotic Disease Risk Factors and Serum 25-Hydroxyvitamin D Concentration in Japanese Subjects

Recent studies have described that vitamin D deficiency/insufficiency is associated with hypertension, insulin resistance, and dyslipidemia, which are major components of metabolic syndrome causing atherosclerosis. Therefore, we investigated the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentration and atherosclerotic disease risk factors in healthy Japanese adults. In the present cross-sectional study, 1,177 subjects (348 males and 829 females) aged 20-72 y living in Japan (34.7-35.0ºN) were evaluated for vitamin D status by measuring serum 25(OH)D concentration. Atherosclerotic disease risk factors were defined as the presence of two or more of the following three risk factors: high blood pressure, dyslipidemia, and hyperglycemia. The percentages of vitamin D deficient and insufficient subjects were 33% and 46% in males and 59% and 32% in females, respectively. Subjects with atherosclerotic disease risk factors were significantly older and had higher BMI than those without it in both sexes. Male subjects with atherosclerotic disease risk factors had significantly lower physical activity and serum 25(OH)D concentration than those without it. In a logistic regression analysis adjusted for confounding factors, serum 25(OH)D concentration showed a significant inverse association with risk factors of atherosclerotic disease in males (OR=0.951, 95%CI: 0.906-0.998), but not in females. A covariance structure analysis also suggested that serum 25(OH)D level has a direct association with risk factors of atherosclerotic disease. In conclusion, we have demonstrated that low serum 25(OH)D level is a significant factor for increased atherosclerotic disease risk factors in males.

Usefulness of Vitamin D Deficiency Questionnaire for Japanese (VDDQ-J) for Screening of Vitamin D Deficiency and Low Muscle Mass in Relatively Healthy Japanese Anti-Aging Health Checkup Examinees

The Vitamin D Deficiency Questionnaire for Japanese (VDDQ-J) has been developed as an alternative indicator of the vitamin D nutritional status when serum 25(OH)D measurement is unavailable. In the present study, we compared the usefulness of the VDDQ-J with that of serum 25(OH)D concentration and examined the relationship among vitamin D, DXA-based body composition, and muscle strength in 163 anti-aging health check examinees. The median age, 25(OH)D concentration and VDDQ-J score were 62.0 y, 20.1 ng/mL and 22.0 points, respectively. In total, 47.9% of the subjects had serum 25(OH)D concentrations of <20 ng/mL. The VDDQ-J score was significantly negatively correlated with the serum 25(OH)D concentration, and the positive predictive value for vitamin D deficiency was 86.3%. The prevalence of sarcopenia was 6.1%. Low 25(OH)D levels and high VDDQ-J scores were significantly associated with low muscle mass in both univariate analysis and multiple linear regression analysis. The serum 25(OH)D level showed a significant negative correlation with body fat mass. The VDDQ-J score was selected as a significant determinant of low skeletal muscle mass index (<7.0 kg/m2 for men and <5.4 kg/m2 for women) by a multiple logistic regression analysis. In conclusion, the present study showed that a low vitamin D nutritional status as indicated by both low 25(OH)D levels, and high VDDQ-J scores was associated with low muscle mass and the VDDQ-J is considered useful not only for the detection of vitamin D deficiency but also in the screening of individuals with low muscle mass and a high risk of sarcopenia.

Vitamin D Status in Japanese Young Women in 2016-2017 and 2020: Seasonal Variation and the Effect of Lifestyle Including Changes Caused by the COVID-19 Pandemic

Avoidance of sunlight and self-restraint due to the COVID-19 pandemic may contribute to reduced vitamin D status. This study provides comparable data on vitamin D status in Japanese young women and assesses the effect of lifestyle, including changes caused by the COVID-19 pandemic, on vitamin D status. In study 1, 39 young healthy Japanese women aged 21-25 y were recruited from May 2016-June 2017. Serum 25-hydroxyvitamin D (25OHD) concentration and diet and lifestyle information were obtained from participants each month (n=124). In study 2, using the same parameters as study 1, young women aged 21-23 y (n=10) were recruited in September 2020. In the results of study 1, we found the frequencies of vitamin D deficiency (25OHD<20 ng/mL) in spring, summer, fall, and winter were 90.5%, 62.5%, 81.5%, and 91.3%, respectively. The substantial difference of serum 25OHD concentration was obtained in spring (Δ3.6 ng/mL) and summer (Δ5.1 ng/mL) depending on the frequency of sunscreen use (0-2 d/wk, 3-7 d/wk). In study 2, serum 25OHD concentration in September 2020 was extremely lower than in September 2016 (13.2 ng/mL vs. 21.7 ng/mL). The number of days spent outside in 2020 decreased drastically compared with 2019. In conclusion, vitamin D deficiency was highly common in Japanese women in their early 20s, and frequent sunscreen use contributed to low vitamin D status. Moreover, because the decrease in days outside due to the COVID-19 pandemic obviously resulted in a decline in vitamin D status, both appropriate sunbathing and increased dietary vitamin D intake are recommended to young women.

Vitamin K intake and health, consideration from the epidemiological studies

The most fundamental function of vitamin K is to activate the blood coagulation factors in the liver. Despite the recent recognition of its extra-hepatic actions, the current Dietary Reference Intakes for vitamin K is based on the amount necessary for maintaining the normal blood coagulation in many countries. To define the Dietary Reference Intake for vitamin K, appropriate biomarkers well-reflecting the vitamin K status are essential. Unfortunately, however, no markers are currently available with properties enabling us to properly define the vitamin K status; i.g., no interference by other factors and the presence of widely approved cut-off values. Thus, Adequate Intake is determined, which is an index based on the representative dietary intake data from healthy individuals. Recently, epidemiological studies have been reported regarding the relationship between vitamin K and noncommunicable diseases including osteoporotic fracture. Furthermore, studies focusing on the relationship between vitamin K intake and metabolic syndrome, physical function, depression, cognition, and all-cause mortality have become available, although limited in number. This review summarizes the recent findings in favor of the novel functions of vitamin K. More epidemiological studies are needed to define the appropriate vitamin K intake value based on the prevention of various disorders.

Vitamin D in the Dietary Reference Intakes for Japanese (DRIs) 2020

Dietary Reference Intakes for Japanese (DRIs) are revised every five years. In DRIs 2020, major revision has been made on vitamin D (VD). In DRIs, five indices are defined for nutrients; estimated average requirement (EAR), recommended dietary allowance (RDA) and adequate intake (AI) for the prevention of deficiency/insufficiency, tolerable upper intake level (UL) for avoiding excess intake, and tentative dietary goal for preventing life-style related diseases (DG) for the primary prevention of life-style related diseases. For VD, AI has been determined. VD deficiency causes rickets and osteomalacia. VD insufficiency, milder than deficiency, is a risk for various diseases including osteoporotic fracture. Previously, the basis of AI for VD was the prevention of rickets and osteomalacia, but was changed to the median intake of healthy subjects in DRIs 2005. Recent studies have shown, however, that VD deficiency/insufficiency is quite prevalent, and the above basis is considered inadequate. Then in DRIs 2020, AI was defined as the amount necessary for fracture prevention (15 μg/d) minus that possibly produced in Sapporo during winter in the skin by ultraviolet (5 μg/d). UL and AI for infants were revised in DRIs 2015. For the future DRIs, more clinical and epidemiological studies are urgently needed.

Vitamin D deficiency as the risk of respiratory tract infections in the institutionalized elderly: A prospective 1-year cohort study

BACKGROUND & AIMS

Respiratory tract infections (RTIs) are one of the major causes of morbidity and mortality in the elderly. Since vitamin D is known to play important roles in immunity, and its deficiency has been reported to be prevalent in the elderly, we have studied the relationship between serum 25-hydroxyvitamin D [25(OH)D] level, which is the most reliable marker for vitamin D status, and the incidence of RTIs in the institutionalized elderly by a prospective observational study.

METHODS

From 208 Japanese subjects aged 60 and older fulfilling the inclusion criteria, 148 subjects remained after propensity score matching. Data were obtained from the medical records including their age, gender, histories of co-morbidities and medications, the incidence of acute RTIs including pneumonia. Measurement of serum 25(OH)D level and assessment of nutrients intake including vitamin D were done at baseline. Cox's proportional hazard analysis was performed to assess the significant predictors for RTIs during the follow-up period.

RESULTS

The median observation duration was 354.2 days, and the incidence of RTIs was 75.8 person-years. Subjects with RTIs had significantly lower serum 25(OH)D concentration, and a higher prevalence of vitamin D deficiency (25(OH)D < 10 ng/mL). Cox's proportional hazard analysis revealed that vitamin D deficiency was a significant predictor for RTIs.

CONCLUSIONS

Our results suggested that vitamin D deficiency was a significant predictor for an increased incidence of RTIs in institutionalized elderly, and the necessity of vitamin D supplementation for the prevention of RTIs was considered.

The Relationship between Serum Vitamin E Level and Risk Factors for Arteriosclerosis in Japanese Postmenopausal Women

Since vitamin E is one of the most potent antioxidant and anti-inflammatory agents, vitamin E can play a role against arteriosclerosis through various actions. Then, we have studied the relationship between serum vitamin E status and risk factors for arteriosclerosis in Japanese postmenopausal women. One hundred and seven subjects (70.0±7.7 y) were evaluated for vitamin E status by measuring serum α- and γ-tocopherol (αT and γT) levels. The number of arteriosclerosis risk factors was defined by the existence of high blood pressure, hyperglycemia, and dyslipidemia. Median serum αT and γT concentrations were 24.32 and 2.79 μmol/L, respectively. In none of the subjects, serum αT level was below the cutoff value (<12 μmol/L) for vitamin E deficiency which causes fragile erythrocyte and hemolysis. While no significant differences were found in serum levels of αT and γT between the groups categorized by the number of arteriosclerosis risks, serum levels of αT adjusted by serum total cholesterol (TC) and triglyceride (TG) decreased with an increasing number of arteriosclerotic risk factors (p=0.074). Serum αT level adjusted by serum TC and TG was also a negative significant predictor for the number of arteriosclerosis risk factors controlled by covariates associated with arteriosclerosis. The present study described that serum vitamin E level was positively associated with a lower number of arteriosclerotic risks, and its role for preventing noncommunicable diseases was suggested.

Insufficiency of B vitamins with its possible clinical implications

Vitamin deficiency causes classical deficiency diseases such as beriberi and rickets. Vitamin insufficiency, which is milder than deficiency, is a risk for various chronic diseases, but its significance has not been recognized in Japan. Vitamin D insufficiency is quite common in Japan, and a serious risk for osteoporotic fracture through its unbeneficial effect on bone and muscle. Insufficiency of B vitamins has been little studied. However, hyperhomocysteinemia caused by the insufficiency of vitamin B12 or folate is a risk for cardiovascular disease, osteoporotic fracture, and cognitive impairment. Additionally, we have recently reported that vitamin B1 insufficiency is a risk for heart failure in the elderly. The effect of improvement of nutritional status including vitamins is less marked compared to drug treatment, but it costs far less, and is suited for the primary prevention of diseases. Randomized controlled trial is considered the study with the most robust evidence in the evaluation of drug treatment, but more emphasis should be put on the well-designed cohort studies in evaluating the role of nutrients. Vitamin insufficiency is quite prevalent, and vitamin requirement is much higher for its prevention than for the prevention of deficiency.

Gastric and Jejunal Enteral Feeding Differently Affect Vitamin B12 Status in Subjects with Severe Motor and Intellectual Disabilities

The absorption of vitamin B₁₂ is a complex process involving gastric acid and intrinsic factor as the indispensable components. In this study, we have investigated the effects of the administration site in enteral feeding on vitamin B₁₂ status in subjects with severe motor and intellectual disabilities (SMID). This is a cross-sectional study conducted from January to June 2016. Blood concentrations of vitamin B₁₂, folate, vitamin B₆, and homocysteine (Hcy) were measured in a total of 82 subjects (38 men, 44 women). Also, nutrients intake was assessed. Subjects with enteral feeding (EF) had significantly higher intakes of vitamin B₁₂, folate, and vitamin B₆ than those with oral ingestion (OI). Serum folate and vitamin B₆ concentrations in subjects with EF were significantly higher than those with OI. Among the EF subjects, serum vitamin B₁₂ concentration was significantly higher in those fed with gastric tube than those fed with jejunal tube in spite of similar vitamin B₁₂ intakes. No significant difference was observed between the two groups regarding the circulating concentrations of folate, vitamin B₆, or Hcy. Although each administration route has its own benefit, gastric tube is advantageous in the absorption of vitamin B₁₂.

A simple questionnaire for the prediction of vitamin D deficiency in Japanese adults (Vitaimn D Deficiency questionnaire for Japanese: VDDQ-J)

Vitamin D deficiency (VDD) is associated with an increased risk of various diseases. Serum 25-hydroxyvitamin D [25(OH)D] concentration is the best marker for vitamin D status and its concentration < 20 ng/mL indicates VDD. However, its measurement is not easily applicable for the evaluation of vitamin D status in the general population because of its cost. Therefore, we aimed to develop a simple questionnaire for easily identifying the risk of VDD. From the total sample (649 healthy subjects aged 19-70 years), 434 and 215 subjects were randomly assigned to the derivation and the validation cohort, respectively. Prediction model for VDD was developed by backward logistic regression analysis. The regression β coefficients of the significant predictors were transformed into integral numbers and used for the individual score. These individual scores were summed to calculate the total risk score (VDD questionnaire for Japanese score: VDDQ-J score). VDD was present in 54.1% of the total subjects. The model for the prediction of VDD consisted of 7 predictors. Areas under the curve were 0.78 and 0.75 in the data set of internal validation and of the external validation, respectively. The cutoff value was determined to be 31 points (range 0-54) with the sensitivity/specificity and positive predictive value/negative predictive value of 61%/79%, and 81%/57%, respectively. Our VDDQ-J score is easy to answer by the wide range of subjects, and well predicts VDD. This risk score would be useful to identify subjects at risk for VDD both in clinical and epidemiological settings.

Possible involvement of thiamine insufficiency in heart failure in the institutionalized elderly

Heart failure is a major manifestation of thiamine deficiency; beriberi. Even thiamine insufficiency, milder than deficiency, may be associated with increased heart failure risk. In this cross-sectional study, the relationship between thiamine insufficiency and heart failure was investigated in the Japanese institutionalized elderly from April to November 2017. Fifty-five subjects in four care facilities were evaluated for their whole blood thiamine and plasma brain natriuretic peptide concentrations. Mean whole blood thiamine concentration was 88.7 ± 22.3 nmol/L in men and 92.0 ± 16.5 nmol/L in women, and significantly and negatively correlated with plasma brain natriuretic peptide concentrations (r = −0.378, p = 0.007). In the multiple regression analysis adjusted by age, sex, body mass index, and eGFR, whole blood thiamine concentration was a significant negative contributor (standardized coefficient β = −0.488, p = 0.001) to plasma brain natriuretic peptide. In the logistic regression analysis adjusted by the same variables, whole blood thiamine concentration significantly contributed to plasma brain natriuretic peptide concentration higher than over 40 pg/ml (OR: 0.898, 95%CI: 0.838–0.962). Whole blood thiamine concentration in subjects with diuretics was significantly lower than those without it (p = 0.023). Thiamine insufficiency was related to increased plasma brain natriuretic peptide concentration and may increase the risk of heart failure.

Associations between serum 25-hydroxyvitamin D3 level and skeletal muscle mass and lower limb muscle strength in Japanese middle-aged subjects

Objectives

One of the important risk factors of falling is decreased muscle mass and muscle strength. Recently, there has been an increasing concern on the role of vitamin D in muscle strength and physical activity. Aim of our study is to examine the relationships between vitamin D status and muscle mass and muscle strength in middle-aged healthy adults.

Methods

Subjects were 40 healthy volunteers aged 42.0 ± 10.6 years old. Evaluation was made for serum vitamin D₃ metabolites including 25-hydroxyvitamin D₃ [25(OH)D₃] and 24,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃] concentrations, lower limb muscle strength, and dietary intake by food frequency questionnaire. Body composition was measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal mass index (ASMI) was calculated as skeletal muscle mass/squared height.

Results

70% of the subjects had vitamin D insufficiency/deficiency (serum total 25(OH)D < 20 ng/mL), and female subjects had significantly lower serum total 25(OH)D level compared with males. Vitamin D insufficiency/deficiency group had significantly higher body fat, lower SMI and muscle strength, probably reflecting higher percentage of female subjects. Serum vitamin D₃ metabolites levels were significantly correlated with whole and site-specific ASMI, and lower limb muscle strength, except for the correlation between serum 24,25(OH)₂D₃ concentration and lower limb muscle strength. In addition, serum 25(OH)D₃ level was a positive significant predictor for both ASMI and lower limb muscle strength, while serum 24,25(OH)₂D₃ level was not their significant predictor.

Conclusions

Serum 25(OH)D₃ level was significantly correlated with both skeletal muscle mass and lower limb muscle strength.

Effect of oxygen vacancy segregation in Au or Pt/oxide hetero-interfaces on electronic structures

We investigated the effects of oxygen vacancy segregation on electronic structures in the vicinity of hetero-interfaces between noble metals (Au and Pt) and yttria stabilized zirconia by performing first-principles calculations and Bader analysis.

Contribution of hypoalbuminemia and decreased renal function to the increased mortality after newly diagnosed vertebral fracture in Japanese subjects

BACKGROUND AND OBJECTIVES

Reports on the mortality and its contributing factors after vertebral fracture (VFx) has been scarce, and limited to prevalent VFx. In this paper, we have studied the factors influencing mortality after freshly diagnosed VFx.

METHODS AND STUDY DESIGN

759 subjects aged 78.8±8.5 years old with back or lumbar pain, and diagnosed as fresh VFx by MRI were studied for their age, gender, number of prevalent fracture (s), survival or the date of death, circulating concentrations of Hb, albumin, C reactive protein, and estimated glomerular filtration rate (eGFR). Cox's proportional hazard analysis was performed to assess the significant predictors for mortality. The cut-off concentrations of the variables for mortality were analyzed using the receiver operator characteristic (ROC) curve.

RESULTS

The median observation duration was 3.8 years, and 3-year survival rate was 78.8%. Cox's proportional hazard analysis has shown that serum albumin concentration (hazard ratio (HR) =0.355) and eGFR (HR=0.993) were significant predictors for mortality. The cut-off concentrations were 3.6 g/dL and 60 mL/min/1.73m2, respectively. Kaplan-Meier curves revealed that survival rates were significantly decreased in patients with both serum albumin concentration and eGFR below these cut-off concentrations.

CONCLUSIONS

The present study has revealed that malnutrition and impaired renal function were significant predictors for mortality after VFx.

[The role of gastro-intestinal tract in the calcium absorption]

Calcium is associated with various functions of clinical importance. Its unique distribution;low intracellular and high extracellular concentration, is crucial for the neuro-muscular function. Calcium is also indispensable for the vascular contraction and blood coagulation. Thus, circulating calcium concentration must be strictly maintained within a narrow range, for which parathyroid hormone(PTH), vitamin D, and calcitonin contribute. Food-derived protein-bound calcium must be first released in the acidic condition. Thus, gastric acid is essential for the effective calcium absorption. Intestinal calcium absorption occurs via both active transport and passive transport. For the former, such molecules as transient receptor potential vanilloid type 6(TRPV6), calbindin 9k, and Ca²⁺-ATPase contribute. In the adult, calcium absorption rate is approximately 30% under the ordinary condition. Lower calcium intake is associated with increased calcium absorption and decreased urinary excretion. In the Dietary Reference Intakes for Japanese, calcium requirement is determined based on factorial method. Recommended Dietary Allowance(RDA)for calcium ranges from 600-800 mg/day for adult. However, the average calcium intake is far lower than Estimated Average Requirement(EAR). Thus, an effort to increase the calcium intake, rather than considering the detailed calcium absorption rate, is most essential in Japan.

[Bone and Nutrition. The association of vitamin K intake and bone health]

The association of vitamin K with bone mineral density has been reported in some previous cohort studies and intervention studies. In cohort studies, higher vitamin K1 intake was associated with lower fracture incidence. Some intervention studies have described that vitamin K1 and vitamin K2 (menaquinone-4 : MK-4) supplementation were modestly efficacious in preventing fracture, but not in preserving bone mass. Although dietary reference intake (adequate intake : AI) for vitamin K was increased from previous value, current AI was determined as the dose sufficient to maintain normal blood coagulation with little mentioning to bone. Vitamin K intake greater than the current AI would be required for the bone health.

The association between vitamin E intake and hypertension: results from the re-analysis of the National Health and Nutrition Survey

Recently, there has been an increasing concern about noncommunicable diseases (NCDs), in which oxidative damage plays a role. In this paper, we have re-analyzed the data from the National Health and Nutrition Survey (NHNS) 2007 to study the relationship between an NCD (e.g. hypertension) and the dietary intake of vitamin E, a potent anti-oxidative vitamin. The inclusion criteria were those aged 40 and over, excluding pregnant or lactating women, and data from 1,405 males and 2,102 females were analyzed. The mean ages were 63.5 and 62.4, respectively. Nutrients intake was evaluated from a semi-weighted, 1-d household dietary record. When the subjects were categorized into tertiles based on their vitamin E intake, higher vitamin E intake was associated with a lower percentage of subjects with hypertension (p for trend=0.01). Subjects with higher vitamin E intake had higher energy intake-adjusted intake of other nutrients which have been considered to be related to hypertension such as potassium, magnesium, and vitamin C. Logistic regression analysis was done with the low tertile of vitamin E intake as the reference. The medium and high tertiles of vitamin E intake were associated with a significantly lower odds ratio for hypertension, 0.73 (95% CI; 0.62-0.87) for the former and 0.81 (95% CI; 0.69-0.96) for the latter. Additional analyses, one adjusted for the indices associated with hypertension and one excluding the subjects with vitamin E supplementation, have yielded the similar results. In summary, re-analysis of data from NHNS has revealed that higher vitamin E intake was significantly associated with lower prevalence of hypertension.

Detective value of historical height loss and current height/knee height ratio for prevalent vertebral fracture in Japanese postmenopausal women

Vertebral fracture (VFx) is associated with various co-morbidities and increased mortality. In this paper, we have studied the detective value of height loss for VFx using two indices; historical height loss (HHL) which is the difference between the maximal height, and the current height (CH), and CH/knee height (KH) ratio. One-hundred and fifty-one postmenopausal women visiting the outpatient clinic of orthopaedics were studied for their CH, self-reported maximal height, KH, and radiographically diagnosed VFx number(s). VFx was present in 41.1 % of the subjects. Multiple regression analyses revealed that the number of prevalent fractures was a significant predictor of HHL and CH/KH ratio. Receiver operator characteristic curve analysis has shown that for HHL, the area under the curve (AUC) with their 95 %CI in the parentheses was 0.84 (0.77, 0.90), 0.88 (0.83, 0.94), and 0.91 (0.86, 0.96) for ≥ 1, ≥ 2, and ≥ 3 fractures, respectively. For the presence of ≥ 1 VFx, the cut-off value was 4.0 cm (specificity 79 %; sensitivity 79 %). Regarding the CH/KH ratio, AUC was 0.73 (0.65, 0.82), 0.85 (0.78, 0.93), and 0.91 (0.86, 0.96) for ≥ 1, ≥ 2, and ≥ 3 fractures, respectively. For the presence of ≥ 1 VFx, the cut-off value was 3.3 (specificity 47 %; sensitivity 91 %). Both cut-off values for HHL and CH/KH ratio had high negative predictivity across the wide range of theoretical VFx prevalence. Thus, HHL and CH/KH were both good detectors of VFx. Our data would be the basis to determine the cut-off value for the screening or case finding of subjects with VFx.

Patients' perception on the nutritional therapy for diabetic nephropathy

Low protein diet (LPD) plays an important role in preventing the progression of diabetic nephropathy. However, it is a great burden to the patients. In this paper, we have studied the quality of life (QOL) in such patients.

The study subjects were 59 patients (male 38, female 21) with type 2 diabetes. The patients were classified into tertiles based on their protein intake (g/kg BW). Scores from the diet-related QOL questionnaire were summarized by principal component analysis into four components; mental health, less burden, satisfaction and merit, and less social restriction.

Higher protein intake was associated with less burden and less social restriction. In multiple regression analysis, the significant predictors for the “less burden” component were higher protein intake/BW and estimated glomerular filtration rate (eGFR).

In summary, registered dietitians and clinicians must keep in mind that LPD is a serious burden to the patients and efforts must be made to minimize their burden in order to avoid discontinuation.

Impact of lithium-ion ordering on surface electronic states of Li(x)CoO2

Li(x)CoO(2) exhibits intriguing electronic properties due to a strong electron correlation and complex interplay between Co and Li ions. However, fundamental understanding of the nanoscale distribution of Li ions and its effect on the electronic properties remains unclear. We use scanning tunneling microscopy and density functional theory to elucidate the degree of Li(x)CoO(2) surface electronic state modification that can be achieved by Li ordering. The surface Li ions are highly mobile and preferentially form a (1 × 1) hexagonal lattice, whereas the surface CoO(2) layer shows metallic and insulating phases, indicating the coexistence of ordered and disordered Li ions in the subsurface layer. These results provide evidence of novel electronic properties produced by spatially inhomogeneous Li-ordering patterns.

[SF-36 and EQ-5D in the evaluation of QOL in the osteoporotic patients as the generic questionnaires]

Health-related quality of life (HRQOL) , abbreviated as QOL, can be evaluated by various questionnaires, which are classified as generic and disease-targeted ones. Generic questionnaires are further subdivided into profile-type and preference-based ones. SF-36 and EQ-5D are the best known examples for the former and the latter, respectively. In SF-36 and its shortened one SF-8, the subjects' QOL is expressed by several profiles or subscales. Their advantages include well-conducted validation and availability of national norms. In EQ-5D, a single value representing the subjects' QOL status (utility) is obtained through 5 questions. These generic questionnaires are applicable to patients with various diseases or even to healthy citizens. In contrast, disease-targeted questionnaires lack such features, but can include items that are specifically related to the disease but devoid of general applicability. Thus, generic and disease-targeted questionnaires have their own pros and cons. Selection of the questionnaires depends on the object of the study.

Multi-Component Structure of Roland-Morris Disability Questionnaire (RDQ), a Lumbago-Specific QOL (Quality of Life) Measure

Lumbago is one of the most prevalent symptoms in patients with osteoporotic vertebral fracture. Roland-Morris Disability Questionnaire (RDQ) is a quality of life (QOL) questionnaire targeted for evaluating lumbago. Although total score is the usual way of analysis, we have tried to make more use of it by subscale analysis. Forty-four osteoporotic patients were evaluated for their QOL using RDQ and SF-8; a widely accepted generic (non disease-specific) QOL questionnaire. Subscales and summary scores of SF-8 were significantly lower than Japanese norm. Patients with fracture had significantly lower scores including RDQ. Multiple regression analysis has shown that total score of RDQ was significantly contributed by bodily pain as well as other subscales of SF-8. Principal component analysis has revealed that RDQ consists of two components representing general, and mental or social aspect of lumbago. Defining the component structure and determining the procedure to obtain the subscales would make the most use of RDQ, and contribute to the better evaluation of patients with lumbago.

High prevalence of hypovitaminosis D and K in patients with hip fracture

Although hip fracture is considered to be associated with hypovitaminosis D and K, few reports have previously studied both of them. We have studied the vitamin D- and K-status as well as the general nutritional status in ninety-nine patients with hip fracture. Mean serum concentration of 25hydroxy-vitamin D (25OH-D) in female fractured patients was only approximately 9 ng/mL, suggesting severe vitamin D deficiency. There was no significant difference between the two groups in serum concentration of intact parathyroid hormone in both genders and serum 25OH-D levels in the male subjects. Plasma concentrations of phylloquinone (vitamin K1; PK) and menaquinone-7 (MK-7) were significantly lower in the fractured group than in the control group in both genders. Logistic regression analysis indicated that circulating concentrations of albumin, PK and 25OH-D were the significant and independent determinants of fracture risk, with their higher concentrations associated with decreased fracture risk. Finally, principal component analysis (PCA) was performed to summarize the clinical parameters into smaller numbers of independent components. Three components were obtained, each representing the overall nutritional status, the vitamin D status, and the vitamin K status. In conclusion, our study has shown that patients with hip fracture have vitamin D and K deficiency independent of general malnutrition.

Bone is more susceptible to vitamin K deficiency than liver in the institutionalized elderly

In Japan, γ-carboxylation of blood coagulation factors is the basis for determining adequate intake (AI) for vitamin K in Dietary Reference Intakes (DRIs) issued in 2010. Recently, vitamin K is also known to be essential for preventing fracture. In this study, relative susceptibility of liver and bone to vitamin K deficiency was studied. Thirty-seven elderly institutionalized subjects were evaluated for vitamin K status by measuring serum PIVKA (protein induced by vitamin K absence) -II and ucOC (undercarboxylated osteocalcin) levels, as sensitive markers for hepatic and skeletal vitamin K deficiency, respectively. Serum PIVKA-II and ucOC levels, with their cut-off values in the parentheses, were 20.2±8.9 mAUmL (28 mAU/mL) and 4.7±3.0 ng/mL (4.5 ng/mL), respectively. Median vitamin K intake was approximately 200 μg/day, which is more than 3 times higher than the current Japanese AI. Vitamin K intake was significantly correlated with serum PIVKA-II and ucOC/OC levels, but not with serum ucOC level. Although serum ucOC level is generally a good indicator for vitamin K status, multiple regression analysis revealed that elevated bone turnover marker significantly contributed to serum ucOC level. All subjects had vitamin K intake exceeding AI for vitamin K. Nevertheless, serum PIVKA-II and ucOC concentrations exceeded the cut-off value in 14% and 43% of subjects, respectively. The present findings suggest that vitamin K intake greater than the current AI is required for the skeletal health in the institutionalized elderly.

Deterioration of glomerular endothelial surface layer induced by oxidative stress is implicated in altered permeability of macromolecules in Zucker fatty rats

AIMS/HYPOTHESIS

The glomerular endothelial layer is coated by the endothelial surface layer (ESL), which is suggested to play a role in regulation of the permselectivity of macromolecules. Production of heparanase, a degrading enzyme of the ESL, is induced by reactive oxygen species (ROS). We hypothesised that oxidative stress could cause deterioration of the glomerular ESL by induction of heparanase, resulting in increased glomerular permeability.

METHODS

Male Zucker fatty (ZF) rats with albuminuria and Zucker lean (ZL) rats were used in this study. Some of the ZF rats were treated with the angiotensin II receptor blocker, irbesartan. We determined the amount of ESL by wheat germ agglutinin staining and heparan sulphate proteoglycan production by western blot analysis. Glomerular hyperfiltration of macromolecules was visualised using in vivo microscopy. We used 2',7'-dichlorofluorescein diacetate-derived chemiluminescence staining to assess ROS production, and heparanase production and expression were determined by western blot analysis and quantitative real-time polymerase chain reaction respectively.

RESULTS

By 18 weeks of age, ZF rats had developed albuminuria. The glomerular endothelial cell glycocalyx was significantly decreased in ZF compared with ZL rats. Glomerular filtration and the permeability of macromolecules were increased in ZF, but not in ZL rats. Glomerular ROS and heparanase production were significantly increased in ZF compared with ZL rats. These changes in ZF rats were reversed by irbesartan treatment.

CONCLUSIONS/INTERPRETATION

Increased oxidative stress induces glomerular ESL deterioration in part through increased heparanase levels, resulting in exacerbation of glomerular permselectivity and development of albuminuria.

[Nutrition and bone health. Dietary sodium intake and bone health]

Dietary sodium (Na) intake has been known to influence urinary calcium (Ca) excretion. High Na intake has been reported to increase urinary Ca excretion and bone resorption markers, and to be associated with bone loss. In these studies, however, the effect of high Na intake is small, and also affected by other nutrients intakes such as Ca or potassium intakes. Therefore, the association of Na intake and bone health could not be studied alone, but should be studied with full consideration of its interaction with other nutrients.

Compressive force induces osteoclast differentiation via prostaglandin E(2) production in MC3T3-E1 cells

In orthodontic tooth movement, prostaglandin E(2) (PGE(2)) released from osteoblasts can alter the normal process of bone remodeling. We previously showed that compressive force (CF) controls bone formation by stimulating the production of PGE(2) and Ep2 and/or Ep4 receptors in osteoblasts. The present study was undertaken to examine the effect of CF on the production of PGE(2), cyclooxygenase-2 (COX-2), macrophage colony-stimulating factor (M-CSF), receptor activator of NF-kappaB ligand (RANKL), and osteoprotegerin (OPG) using osteoblastic MC3T3-E1 cells and to examine the indirect effect of CF on osteoclast differentiation using RAW264.7 cells as osteoclast precursors. MC3T3-E1 cells were cultured with or without continuous CF (1.0 or 3.0 g/cm(2)) for 24 hr, and PGE(2) production was determined using ELISA. The expression of COX-2, M-CSF, RANKL, and OPG genes and proteins was determined using real-time PCR and ELISA, respectively. Osteoclast differentiation was estimated using tartrate-resistant acid phosphatase (TRAP) staining of RAW 264.7 cells cultured for 10 days with conditioned medium from CF-treated MC3T3-E1 cells and soluble RANKL. As CF increased, PGE(2) production and the expression of COX-2, M-CSF, and RANKL increased, whereas OPG expression decreased. The number of TRAP-positive cells increased as CF increased. Celecoxib, a specific inhibitor of COX-2, blocked the stimulatory effect of CF on TRAP staining and the production of PGE(2), M-CSF, RANKL, and OPG. These results suggest that CF induces osteoclast differentiation by increasing M-CSF production and decreasing OPG production via PGE(2) in osteoblasts.

[Nutrition and bone health. Protein intake and bone ; pros and cons]

The association of protein intake and bone health is still controversial. The negative effects have been reported such as the association between high protein intake and increasing urinary calcium excretion. In contrast, high protein intake has beneficial effect on bone mineral density (BMD) and bone mineral content (BMC) . Recent meta-analyses or systematic reviews indicate that protein intake dose not promote net loss of whole body calcium, and hence have a small positive effect on BMD and BMC. However, the effect of high protein intake on hip fracture prevention is not supported by previous cohort studies. Therefore, long-term cohort studies are required to clarify the association between protein intake and fracture.

Hypovitaminosis D and K are highly prevalent and independent of overall malnutrition in the institutionalized elderly

There have been methodological problems for studying hypovitaminosis D and K in the elderly. First, studies were done either by evaluating food intake or measuring their circulating levels, but rarely by both in Japan. In this paper, vitamin D and K intakes and their circulating levels were simultaneously determined. Second issue is whether hypovitaminosis D and K are independent of general malnutrition, prevalent in the elderly. We tried to statistically discriminate them by principal component analysis (PCA). Fifty institutionalized elderly were evaluated for their circulating 25 hydroxy-vitamin D (25OH-D), intact parathyroid hormone (PTH), phylloquinone (PK), menaquinone-7 (MK-7) levels, and their food intake. Although average vitamin D intake (7.0 microg/day) exceeded the Japanese Adequate Intake (AI) of 5.0 microg/day, average serum 25OH-D concentration was in the hypovitaminosis D range (11.1 ng/mL). Median vitamin K intake was 168 microg/day, approximately 2.5 times as high as AI for vitamin K. Nevertheless, plasma PK and MK-7 concentrations were far lower than those of healthy Japanese elderly over 70 years old. PCA yielded four components; each representing overall nutritional, vitamin K2, vitamin D, and vitamin K1 status, respectively. Since these components are independent of each other, vitamin D- and K-deficiency in these subjects could not be explained by overall malnutrition alone. In summary, institutionalized elderly had a high prevalence of hypovitaminosis D and K, and the simultaneous determination of their circulating level and dietary intake is mandatory in such studies. PCA would yield fruitful results for eliminating the interference by confounders in a cross-sectional study.

[Fat soluble vitamins for maintaining bone health]

Vitamin D and K are nutrients necessary for bone health. Vitamin D insufficiency, which is milder than vitamin D deficiency to cause rickets and osteomalacia, is associated with increased fracture risk. Serum 25 (OH) D concentration, a good marker for vitamin D status, must be higher than the traditional held consensus of 20 ng/mL for bone health. Daily dose of 800 IU or higher is considered to be necessary for fracture prevention. Recently, much attention has been paid on extra-hepatic actions of vitamin K including bone. Elevated serum concentration of undercarboxylated osteocalcin, a sensitive marker for vitamin K inadequacy in the bone, is a risk factor for fracture independent of bone mineral density.

[Foods rich in fat-soluble vitamins and bone health]

Intervention studies and meta-analyses have shown that vitamin D(3) at 700-800 IU/day decreases the fracture incidence. Higher phylloquinone (vitamin K(1)) intake or "natto" intake was associated with lower fracture incidence. In contrast, current intake of vitamin D and K in Japanese is likely to be unsatisfactory for preventing fracture. The intake of fish, abundant in vitamin D(3) is encouraged. Regarding vitamin K, "natto" intake is strongly recommended, since it contains extraordinary amount of menaquinone-7. Phylloquinone in green vegetables would be efficiently absorbed when cooked with oil. Thus Japanese traditional foods seem to be appropriate for bone health.

High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease

SUMMARY

Vitamin K and D deficiency and decreased bone mineral density (BMD) were highly prevalent in patients with inflammatory bowel disease (IBD), especially Crohn's disease (CD). Dietary intakes of these vitamins, however, were above the Japanese adequate intakes in IBD patients, suggesting that malabsorption is the basis for hypovitaminosis K and D and decreased BMD.

INTRODUCTION

We have studied the possible involvement of vitamin K and D deficiency in the pathogenesis of decreased BMD in IBD.

METHODS

Seventy patients with IBD were evaluated for their BMD; plasma levels of vitamin K; phylloquinone (PK), menaquinone-7 (MK-7), and 25OH-D; serum PTH, protein induced by vitamin K absence (PIVKA-II), and undercarboxylated osteocalcin (ucOC) levels; and their food intake.

RESULTS

Compared with ulcerative colitis (UC) patients, CD patients had significantly lower plasma vitamin K and 25OH-D concentrations; significantly higher serum levels of PTH, PIVKA-II, and ucOC; and significantly lower BMD scores at almost all measurement sites. More IBD patients were vitamin K deficient in bone than in liver. Multiple regression analyses revealed that low plasma concentrations of vitamin K and 25OH-D were independent risk factors for low BMD and that they were associated with the patients' fat intake, but not with their intake of these vitamins.

CONCLUSION

IBD patients have high prevalence of decreased BMD and vitamin K and D deficiency probably caused by malabsorption of these vitamins.

Effect of vitamin D supplementation in the institutionalized elderly

An intervention study with vitamin D supplementation was conducted in order to study the amount of vitamin D required in the elderly. Sixty-four institutionalized elderly were randomly assigned to two groups: group (A) to take a beverage containing 200 mg calcium daily, and group (B) to take a beverage containing 200 mg calcium and 5 microg vitamin D daily for 30 days. Prior to the study, the subjects' average vitamin D intake was 7.3 microg/day, which is approximately 150% of the current adequate intake (AI), however their mean plasma 25 OH-D level at baseline was only 12 ng/mL, strongly indicating hypovitaminosis D. During the study, average plasma 25 OH-D concentration significantly increased to 14.7 ng/mL in group (B), but not in group (A). However, group (B) was still in the hypovitaminosis range. Thus, daily intake exceeding the current AI of 5 microg is required for the institutionalized elderly.

[Early results of new style aortosaphenous vein graft connector in coronary artery bypass grafting]

We retrospectively studied early clinical results of PAS-Port (PP) system. Fifty patients who underwent coronary artery bypass surgery with saphenous vein graft (SVG) from April 2004 to May 2005 were enrolled in this study. PP was tried for 36 SVGs in 32 patients. In 2 patients, SVG 4.0 mm in diameter could not be loaded into the device. In other 2 patients, anastomosis with PP was failed and followed by hand-sewing under aortic clamp or with Heartstring. Anastomosis with PP was successfully completed for 34 SVGs in 30 patients (group P) and conventional hand-sewing was performed for 23 SVGs in 20 patients (group C). The target vessels for SVG were similar between the 2 groups. No complication occurred in the use of PP. Postoperative angiography before discharge was performed for 31 SVGs in 27 patients (90.0%) in group P and 20 SVGs in 17 patients (85.0%) in group C. The patency rate of SVG was 96.8% in group P and 100% in group C. In conclusion, early results of PP were satisfactory compared with those of conventional hand-sewing. Severely sclerotic aorta and oversized SVG should be excluded because of possibility for incomplete deployment of the inner flange in PP.

Anti-inflammatory sesquiterpenes fromCurcuma zedoaria

From the methanolic extract of the rhizome of Curcuma zedoaria, we isolated anti-inflammatory sesquiterpene furanodiene (1) and furanodienone (2) along with new sesquiterpene compound 3 and known eight sesquiterpenes, zederone (4), curzerenone (5), curzeone (6), germacrone (7), 13-hydroxygermacrone (8), dehydrocurdione (9), curcumenone (10), and zedoaronediol (11). Their structures were elucidated on the basis of spectroscopic data. The anti-inflammatory effect of isolated components on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced inflammation of mouse ears were examined. Compounds 1 and 2 suppressed the TPA-induced inflammation of mouse ears by 75% and 53%, respectively, at a dose of 1.0 micromol. Their activities are comparable to that of indomethacin, the normally used anti-inflammatory agent.

Near-infrared analysis of protein secondary structure in aqueous solutions and freeze-dried solids

Near-infrared spectroscopy (NIR) of various proteins (bovine serum albumin, lysozyme, ovalbumin, gamma-globulin, beta-lactoglobulin, myoglobin, cytochrome-c) was investigated as a possible analytical method of the protein secondary structure in various physical states. The spectra of proteins in aqueous solutions (transmission mode, solvent-compensated) and those in freeze-dried solids (nondestructive diffuse reflection mode) showed several bands at similar frequencies in the combination (4000-5000 cm(-1)) and first overtone (5600-6600 cm(-1)) spectral regions. The normalized second-derivative near-infrared spectra of proteins in aqueous solutions suggested that some bands indicated alpha-helix (4090, 4365-4370, 4615, and 5755 cm(-1)) and beta-sheet (4060, 4405, 4525-4540, 4865, and 5915-5925 cm(-1)) structures. The proteins mostly maintained spectra characteristic of their native structure after freeze-drying, although some reductions in alpha-helical structure and increase in unordered or beta-sheet structures were observed. The near-infrared analysis also showed beta-sheet formation of heat-treated BSA in aqueous solutions and in subsequently freeze-dried solids. The present results thus indicated that the nondestructive near-infrared analysis can be used for the investigation of dehydration-induced changes in protein secondary structures.

Effect of counterions on the physical properties of l-arginine in frozen solutions and freeze-dried solids

The objective of this study was to elucidate the physical properties of L-arginine and various counterion combinations in frozen aqueous solutions and in freeze-dried solids. L-Arginine remains amorphous in the highly concentrated non-ice phase in frozen solutions with a Tg (glass transition temperature of maximally freeze-concentrated solutes) of -41.4 degrees C. Some acids and salts (e.g., H3PO4, H2SO4, HNO3, and NaH2PO4) raised the Tg , whereas others (e.g., HCl, CH3COOH, HCOOH, Na2HPO4, and NaCl) had little effect or lowered the L-arginine Tg . Co-lyophilization with phosphoric acid also raised the glass transition temperature (Tg) of amorphous freeze-dried L-arginine solids. Arginine-H3PO4 combinations exhibited properties that led to either the stabilization or destabilization of a model protein (lactate dehydrogenase: LDH) during freeze-drying, depending on their concentration ratios. Fourier-transform infrared (FT-IR) and diffusion reflectance near-infrared (NIR) spectra indicated the presence of interactions between the amino and/or guanidyl groups of L-arginine and phosphate ions in the amorphous freeze-dried cakes. It was postulated that the interaction between L-arginine and the multivalent counterions, as well as an increase in hydrogen bonding network, reduced the mobility of molecules in the frozen solutions and freeze-dried solids.

General rule for displacive phase transitions in perovskite compounds revisited by first principles calculations

A recent high pressure experiment on LaAlO3 has revealed that the compound is an exception for the "general rule" of displacive phase transition associated with zone-boundary phonons. In the present study, the experimental result is successfully confirmed by first principles calculations. The pressure dependence of phonon frequencies as well as the phase transition pressure is quantitatively well reproduced. We found that the behavior is not peculiar to LaAlO3 but rather ubiquitous. RAlO3 (R = La, Nd, Sm, and Gd) and LaGaO3 can be classified in the same group.

[Right atrial lipoma with calcification in ascending aorta; report of a case]

A 67-year-old male was diagnosed to have a right atrial tumor by echocardiography incidentally. Computed tomography (CT) indicated a mass which showed very low radiodensity and magnetic resonance imaging (MRI) [T1-weighted] showed the high signal intensity of tumor. We could predict the mass as lipoma. Tumor removal was performed under cardio-pulmonary bypass and under ventricular fibrillation because of the calcification in ascending aorta. Microscopically the tumor was consisted of mature adipose tissue. The postoperative course was uneventful. Cardiac lipomas are rare tumors. CT and MRI are better investigations for preoperative diagnosis. After surgical excision the prognosis is excellent.

Contemplation of age-adjusted standard values of lipid profiles in Japan

In order to establish the age-adjusted standard values of lipids in both sexes in Japan, we examined the plasma levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride levels in 1262 healthy Japanese subjects (male 616, female 646). LDL-cholesterol levels in women increased significantly in relation to menopause as it rises from 112 mg/dL in 40 year olds to 131.2 mg/dL in 50 year olds. Menopause seems to affect the triglyceride levels as well. These age- and sex-dependent changes should be considered in evaluation of patients' lipid profiles.

Sphingosine 1-phosphate may be a major component of plasma lipoproteins responsible for the cytoprotective actions in human umbilical vein endothelial cells

Sphingosine 1-phosphate (S1P), a novel lipid mediator, is concentrated in the fraction of lipoproteins that include high density lipoprotein (HDL) and low density lipoprotein (LDL) in human plasma. Here, we show that oxidation of LDL resulted in a marked reduction in the S1P level in association with a marked accumulation of lysophosphatidylcholine (LPC). We therefore investigated the role of the lipoprotein-associated lipids especially S1P in the lipoprotein-induced cytoprotective or cytotoxic actions in human umbilical vein endothelial cells. The viability of the cells gradually decreased in the absence of serum or growth factors in the culture medium. The addition of oxidized LDL (ox-LDL) accelerated the decrease in the cell viability. LPC and 7-ketocholesterol mimicked ox-LDL actions. On the other hand, HDL and LDL almost completely reversed the serum deprivation- or ox-LDL-induced cytotoxicity. Exogenous S1P mimicked cytoprotective actions. Moreover, the S1P-rich fraction and chromatographically purified S1P from HDL exerted cytoprotective actions, but the rest of the fractions did not. The cytoprotective actions of HDL and S1P were associated with extracellular signal-regulated kinase (ERK) activation and were almost completely inhibited by pertussis toxin and PD98059, an ERK kinase inhibitor. The HDL-induced action was specifically desensitized in the S1P-pretreated cells. Taken together, these results indicate that the lipoprotein-associated S1P and the lipid receptor-mediated signal pathways may be responsible for the lipoprotein-induced cytoprotective actions. Furthermore, the decrease in the S1P content, in addition to the accumulation of cytotoxic substances such as LPC, may be important for the acquisition of the cytotoxic property to ox-LDL.

Correlation of circulating interleukin-10 with thyroid hormone in acute myocardial infarction

In patients with acute myocardial infarction (AMI), euthyroid sick syndrome (ESS) has been reported to be linked to increase in interleukin (IL)-6 and activation of its receptors. Recent reports have shown that IL-10, an anti-inflammatory cytokine, also plays a key role in the pathogenesis of AMI. Therefore we investigated the relationship between thyroid state and IL-10 in patients with AMI. We measured thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), IL-10, and IL-6 in plasma from 20 patients with AMI and 20 healthy controls. All 20 AMI patients showed significantly lower concentrations of FT3 than in controls accompanied by normal or subnormal levels of TSH, characterized ESS. Concentrations of IL- 10 and IL-6 were higher in patients than in controls. Both IL-10 and IL-6 significantly (p<0.05, respectively) correlated with thyroid hormone in patients with AMI. Time course of IL-10, IL-6, and FT3 seemed to be tightly linking. In conclusion, IL-10 and IL-6 appears to affect thyroid hormone homeostasis in patients with AMI.