Detrimental effects of 6 months exposure to very low doses of a mixture of six pesticides associated with chronic vitamin deficiency on rats

This study aimed to evaluate the long-term low-dose effects of exposure to a mixture of 6 pesticide active substances (diquat, imazamox, imazethapyr, tepraloxydin, bentazone, acifluorfen) and to elucidate if chronic vitamin deficiency can influence their toxicity. Two hundred Wistar rats were divided in 4 groups: a vitamin-sufficiency control group, a vitamin-deficiency control group, a vitamin sufficiency test group and a vitamin-deficiency test group. The test groups were treated with the aforementioned pesticides at doses 100 times lower than the corresponding NOAEL. After 6 months, ten rats from each group were sacrificed and a complete evaluation of blood and urine biochemistry, biomarkers of oxidative stress, xenobiotic detoxification enzymes and lysosomal enzymes and organ histopathology was performed. The pesticides mixture and vitamin deficiency determined an increase in alkaline phosphatase levels and urinary calcium levels, abnormal serum lipid profile, and a decrease of total blood proteins levels, red blood cells, haematocrit and haemoglobin. The combination of the two stressors up-regulated CYP1A1, CYP1A2, CYP2B1 and GST levels. This study provides a new proof for the need to move forward from single chemical testing to a more complex approach to account for the multitude of stressors that can challenge the setting of real safety levels.

Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60–75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.

Multiple vitamin deficiencies additively increase the risk of incident fractures in Japanese postmenopausal women

The associations of multiple vitamin deficiencies on incident fractures were uncertain, the relationships between serum vitamin markers and incident bone fractures were investigated in Japanese postmenopausal women. The number of deficiencies was additively associated with incident fracture after adjustment for possible confounding factors including the treatment of osteoporosis.

INTRODUCTION

To evaluate the associations of multiple vitamin deficiencies on incident fractures, the relationships between serum vitamin markers and incident bone fractures were investigated in Japanese postmenopausal women.

METHODS

This analysis used a subset of the ongoing cohort maintained by a primary care institution. Inclusion criteria of the present study were postmenopausal women aged ≥ 50 years, without vitamin supplementation and secondary osteoporosis. Baseline serum concentrations of 25-hydroxyvitamin D (25(OH)D), undercarboxylated osteocalcin (ucOC), and homocysteine (Hcy) were measured to assess vitamin D, vitamin K, and vitamin B, respectively. Since 25(OH) D positively relates to vitamin D, ucOC and Hcy negatively relate to vitamin K and vitamin B nutrients, respectively, the subjects with lower (25(OH)D) or higher (ucOC or Hcy) values than each median value was defined as subjects with the corresponding vitamin deficiency. Subjects were divided into four groups according to the number of deficiency: no deficiency, single deficiency, double deficiencies, and triple deficiencies. Relationships between the vitamin deficiencies and incident fractures were evaluated by Cox regression analysis.

RESULTS

A total of 889 subjects were included in this analysis; their mean and SD age was 68.3 ± 9.5 years, and the follow-up period was 6.3 ± 5.1 years. The numbers of subjects in the four groups were 139 (15.6%), 304 (34.2%), 316 (35.5%), and 130 (14.6%) for the groups with no, single, double, and triple deficiencies, respectively. Incident fractures were observed in 264 subjects (29.7%) during the observation period. The number of deficiencies was significantly associated with incident fracture (hazard ratio 1.25, 95% confidence interval 1.04-1.50, P = 0.018) after adjustment for possible confounding factors including the treatment of osteoporosis.

CONCLUSION

Accumulation of vitamin deficiencies was related to incident fractures.

Serum and synovial fluid vitamin D metabolites and rheumatoid arthritis

Vitamin D-deficiency has been linked to inflammatory diseases including rheumatoid arthritis (RA). Studies to date have focused on the impact of serum 25-hydroxyvitamin D3 (25(OH)D3), an inactive form of vitamin D, on RA disease activity and progression. However, anti-inflammatory actions of vitamin D are likely to be mediated at sites of RA disease, namely the inflamed joint, and may involve other vitamin D metabolites notably the active form of vitamin D, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). In the current study serum and synovial fluid samples from n = 20 patients with persistent RA and n = 7 patients with reactive arthritis (ReA) were analysed for multiple vitamin D metabolites. Serum data for RA and ReA patients were compared to healthy controls (HC). There was no significant difference between RA or ReA patients relative to HC for 25(OH)D3, 24,25(OH)2D3, 1,25(OH)2D3 or 25(OH)D2. However, 3-epi-25(OH)D3 was significantly lower in RA and ReA patients compared to HC (p < 0.05). All vitamin D metabolites, apart from 25(OH)D2, were lower in SF compared to serum, and SF 1,25(OH)2D3 was unquantifiable in 13/20 RA and 4/7 ReA samples. SF 25(OH)D3, 3-epi-25(OH)D3 and DBP correlated inversely with swollen joint score, and serum 25(OH)D2 and SF DBP correlated directly with C-reactive protein levels. These data indicate that serum 25(OH)D3 provides only limited insight into the role of vitamin D in RA. Alternative serum metabolites such as 3-epi-25(OH)2D3, and SF metabolites, notably lack of SF 1,25(OH)2D3, may be more closely linked to RA disease severity and progress.

Vitamin and trace element deficiencies in the pediatric dialysis patient

Pediatric dialysis patients are at risk of nutritional illness secondary to deficiencies in water-soluble vitamins and trace elements. Unlike 25-OH vitamin D, most other vitamins and trace elements are not routinely monitored in the blood and, consequently, the detection of any deficiency may not occur until significant complications develop. Causes of vitamin and trace element deficiency in patients on maintenance dialysis patient are multifactorial, ranging from diminished nutritional intake to altered metabolism as well as dialysate-driven losses of water-soluble vitamins and select trace elements. In this review we summarize the nutritional sources of key water-soluble vitamins and trace elements with a focus on the biological roles and clinical manifestations of their respective deficiency to augment awareness of potential nutritional illness in pediatric patients receiving maintenance dialysis. The limited pediatric data on the topic of clearance of water-soluble vitamins and trace elements by individual dialysis modality are reviewed, including a brief discussion on clearance of water-soluble vitamins and trace elements with continuous renal replacement therapy.

Maintenance of Multivitamin Supplements After Sleeve Gastrectomy

INTRODUCTION

After all bariatric procedures, multivitamin supplements are uniformly prescribed to minimize eventual deficiencies. These supplements are usually maintained long time, even during the whole life after malabsorptive techniques, while these are maintained at least during 1 year after restrictive procedures. Given that sleeve gastrectomy does not alter intestinal absorption, the supplements are possibly unnecessary, once the patient can take an adequate diet.

PATIENTS AND METHODS

A prospective randomized study of patients undergoing a laparoscopic sleeve gastrectomy was performed. Patients were randomized into two groups: those patients receiving the multivitamin supplement (Multicentrum, Pfizer, 1 tablet/day) during 3 months (group 1) and those receiving the supplement during 12 months (group 2). Laboratory data were recorded: vitamins (D, B12 and folic acid) and oligoelements (calcium, iron, phosphorus, magnesium and zinc) at 3, 6 and 12 months after surgery.

RESULTS

Eighty patients were included, 40 in each group. At 3 months, 7.5 % of the patients presented iron deficiency and 2.5 % ferritin one, similarly in both groups, that was corrected with specific extra iron supplements. At 6 months, one patient (2.5 %) in group 1 presented iron deficiency and one in group 2 vitamin D deficiency (NS). At 12 months, only one patient in group 2 presented vitamin D deficiency, treated with specific supplements.

CONCLUSION

The maintenance of multivitamin supplements more than 3 months postoperatively seems to be of no benefit. It is preferable monitoring laboratory values and adding specific supplements when necessary. CLINICALTRIALS.

GOV IDENTIFIER

NCT02620137.

Circulating Vitamin K Is Inversely Associated with Incident Cardiovascular Disease Risk among Those Treated for Hypertension in the Health, Aging, and Body Composition Study (Health ABC)

Background: A role for vitamin K in coronary artery calcification (CAC), a subclinical manifestation of cardiovascular disease (CVD), has been proposed because vitamin K-dependent proteins, including the calcification inhibitor matrix Gla protein (MGP), are present in vascular tissue. Observational studies found that low circulating phylloquinone (vitamin K-1) was associated with increased CAC progression, especially in persons treated for hypertension. It is unknown whether hypertension treatment modifies this putative role of vitamin K in clinical CVD risk.Objective: We determined the association between vitamin K status and incident clinical CVD in older adults in the Health ABC (Health, Aging, and Body Composition Study) and whether the association differed by hypertension treatment status.Methods: Plasma phylloquinone was measured in 1061 participants free of CVD (70-79 y of age, 58% women, 39% black). Plasma uncarboxylated MGP [(dp)ucMGP] was measured in a subset of 635 participants. Multivariate Cox models estimated the HR for incident CVD over 12.1 follow-up years. Effect modification by hypertension was tested with the use of interaction terms.Results: Neither low plasma phylloquinone (<0.2 nmol/L) nor elevated (dp)ucMGP (≥574 pmol/L) was significantly associated with incident CVD [respective HRs (95% CIs): 1.27 (0.75, 2.13) and 1.02 (0.72, 1.45)]. In participants treated for hypertension (n = 489; 135 events), low plasma phylloquinone was associated with higher CVD risk overall (HR: 2.94; 95% CI: 1.41, 6.13). In those with untreated hypertension (n = 153; 48 events) and without hypertension (n = 418; 92 events), low plasma phylloquinone was not associated with incident CVD. The association between high (dp)ucMGP did not differ by hypertension treatment status (P-interaction = 0.72).Conclusions: Vitamin K status was not significantly associated with CVD risk overall, but low plasma phylloquinone was associated with a higher CVD risk in older adults treated for hypertension. Additional evidence from larger clinical studies is needed to clarify the importance of vitamin K to CVD in persons treated for hypertension, a segment of the population at high risk of clinical CVD events.

Risk of Malnutrition, Trace Metal, and Vitamin Deficiency Post Roux-en-Y Gastric Bypass--a Prospective Study of 20 Patients with BMI < 35 kg/m²

BACKGROUND

Due to its reliable effects on type 2 diabetes mellitus (T2DM) remission, Roux-en-Y gastric bypass (RYGB) has recently been investigated as a treatment option for nonseverely obese patients with T2DM (body mass index (BMI) <35 kg/m(2)). The purpose of this study was to investigate whether RGYB induces malnutrition of macro- and micronutrients within 24 months in these patients.

METHODS

A prospective cohort of 20 patients with longstanding, insulin-dependent T2DM and a BMI of 25-35 kg/m(2) were treated with RYGB. The patients were supplemented with over-the-counter, multivitamin, and micronutrient supplements. Serum concentrations of albumin, vitamins, and trace elements, hemoglobin, and bone density were measured preoperatively and over a 24-month period (DRKS00004605).

RESULTS

RYGB did not result in underweight or protein malnutrition. No new onset of deficiencies of water- or fat-soluble vitamins developed over the study period. However, serum selenium, zinc, and ferritin decreased significantly (selenium, 1.17 ± 0.13 to 0.89 ± 0.11 μmol/l, p = 0.018; zinc, 13.9 ± 0.5 to 10.8 ± 0.5 μmol/l, p = 0.012; ferritin, 171.7 ± 26.9 to 31.8 ± 11.2 μg/l, p = 0.018). Hemoglobin remained stable. Vitamin D (13.7 ± 1.8 to 19.1 ± 1.1 ng/ml, p = 0.017) and osteocalcin (15.3 ± 1.7 to 25.4 ± 2.7 ng/ml, p = 0.025) rose significantly, whereas the parathyroid hormone remained stable. Despite increased bone formation, bone density decreased (T score hip, 0.15 ± 0.25 to -0.71 ± 0.34, p = 0.005) resulting in a significant increase in osteopenia rates (18 to 50 %, p = 0.046).

CONCLUSIONS

This is the first prospective cohort to investigate malnutrition after RYGB in nonseverely obese patients. These patients are at risk of developing iron, selenium, and zinc deficiencies within 24 months, as well as osteopenia despite an increase in bone formation.

Anemia and Micronutrient Status of Women of Childbearing Age and Children 6-59 Months in the Democratic Republic of the Congo

Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low (<5%); RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC), children 6–23 months (23% in SK; 20% in KC), and children 24–59 months (25% in SK; 27% in KC). The rate of biochemical zinc deficiency among Congolese women and children requires attention.

[The analysis of domestic and international policy of food fortification with vitamins]

Fortification of food products of mass consumption with vitamins is a modern, most cost-effective, efficient and physiological way to improve the vitamin status of the population. Free or voluntary enrichment on the initiative of producers is used in the industrialized countries at low risk for inadequate population intake of micronutrients. Enrichment of products of mass consumption is almost always mandatory, legislative consolidated, while target enrichment of foods intended for different groups can be both mandatory and voluntary The criteria for the effectiveness of mandatory food fortification are an increase of certain vitamin consumption, reduce of the relative number of people with inadequate intake of certain micronutrients, improvement of micronutrient sufficiency (blood level), enhancement of biomarkers of some alimentar diseases, reduction of the frequency of congenital defects (neural tube defect). Assessment of risk/benefit ratio indicates safety of mandatory fortification of flour with B vitamins. In Russia, the regulatory framework for food fortification (enrichment levels, forms of vitamins) has been yet laborated. But initiative enrichment, held in Russia, does not give the desired result. An urgent need for legislative mandatory fortification of products consumed by the majority of the population (bread, milk) with B vitamins (the lack of which is the most frequently detected in the population of Russia) arose in a lack of knowledge of the population about the benefits of fortified foods and lack of preference in the selection of such products.

Micronutrient deficiencies in inflammatory bowel disease

PURPOSE OF REVIEW

Malnutrition, protein-energy, and micronutrient deficiencies are common among patients with inflammatory bowel disease (IBD). The deficiencies are a manifestation of the complicated disease and a cause of morbidity. The present review summarizes recent advances and evidence-based knowledge regarding micronutrients in relation to patients with IBD.

RECENT FINDINGS

Micronutrient deficiencies occur in more than half of patients with IBD. Most common are deficiencies of iron, B12, vitamin D, vitamin K, folic acid, selenium, zinc, vitamin B6, and vitamin B1. Deficiencies are more common in Crohn's disease than in ulcerative colitis, and more in active disease than at times of remission. Micronutrient deficiency is associated with prolonged and complicated course of disease. Iron deficiency is the most common cause for anemia. Definite diagnosis of B12 deficiency cannot be established by serum levels alone. Vitamin D and vitamin K deficiencies are thought to be associated with heightened inflammatory state. The relationship of these deficiencies with bone disease is controversial. The present review focuses on the significance, epidemiology, treatment options, and recommendations regarding micronutrient deficiencies in IBD.

SUMMARY

Micronutrient deficiencies are common and have clinical significance. High suspicion for micronutrient deficiencies is advocated so that treatable causes of morbidity are treated appropriately and late and irreversible sequlae are prevented.

[Vitamin-mineral supplements in nutrition of adults]

The diet of population consisting of natural products is quite adequate and even excessive of energy consumption, but is not able to meet fully the need of organism in a number of micronutrients. Due to lack of sun exposure and long presence indoors endogenous synthesis of vitamin D in the skin by ultraviolet radiation does not provide the body’s need for this vitamin. Intake of vitaminmineral supplements (VMS) is appropriate because combined deficiency of vitamins and minerals takes place in population. Prophylactic doses (equal to physiological needs) provide a diet completeness and reduce the risk of vitamin deficiency and its consequences. The high incidence of combined deficiency of vitamins among population and the existence of vitamin interactions are the basis for the application of the multivitamins. The simultaneous intake of vitamins is more physiological, their combination is more effective than a separate or isolated destination of each of them. Efficacy of the VMS has been shown in the treatment and prevention of some diseases. The main requirements for the VMS are full list of vitamins and minerals, the lack of which is detected most frequently, in doses covering the needs of organism. For the health of the pregnant woman and her unborn child preference should be given for complexes, containing DHA and/or probiotics along with vitamins. The principles of the selection of the composition and vitamin doses in the VMS for using patients suffering from various pathologies should be based on data on the patient’s sufficiency with vitamins, the understanding of the role of vitamin deficiency in the pathogenesis of the disease, as well as on the composition of the diet and its modifications.

[Influence of combined vitamin deficiency on unconditioned reflexes and learning in growing rats]

The aim of this study was to investigate the effect of combined deficiency of all vitamins on the manifestation of unconditioned reflex and learning (in response to an electric current) in growing Wistar rats with initial body weight 53.4 ± 1.2 g (45.5-62.0 g). 20 of 46 tested male rats (latent period of transition from the illuminated chamber to the dark compartment did not exceed 60 s) were included in the experiment. Rats were randomly divided into 2 groups (control and experimental) for the duration of the latent period and body mass. Within 23 days the rats of the control group received a complete semisynthetic diet. Combined vitamin deficiency in tested rats was caused by 5-fold diet decrease of the amount of vitamin mixture without vitamin E. On the 12th day the second phase of testing was performed, during which the rat received electrocutaneous irritation on paws (current 0.4 mA, 8 seconds) after transition to the dark compartment of the chamber. Preservation of the conducted reflex was performed 24 h and 9 days after training. On the 23rd day pre-anesthetized with ether rats were taken out from the experiment by decapitation. The content of vitamin A (retinol and retinol palmitate) and E (tocopherols) in plasma and liver and in the sunflower oil was analyzed by HPLC, the level of vitamins B1 and B2 in liver and casein by fluorimetric method, blood serum malondialdehyde content--by spectrophotometric method. Reducing of vitamin mixture amount of the diet lead to significant reduction in liver vitamin A, E, B1, and B2 level and in blood plasma vitamin A and E concentration by the end of the experiment, but had no effect on blood plasma MDA concentration. On the 12th day of vitamin deficiency in rats manifestation of unconditioned reflex (photophobia) has been deteriorated, as evidenced by the significant 3,2-fold increase of latent period of transition to the dark compartment compared with animals fed a complete diet (47.8 ± 15.8 vs 14.8 ± 3.6 sec), but their ability to learn hadn't been effected. Based on the data that vitamin deficiency, especially of vitamin-antioxidants, causes oxidative stress, and that increase of corticosterone level in hippocampus during aging significantly inhibits the function of the brain, we can assume that increasing of corticosterone level may be one of the cause of the detected cognitive impairment, as isolated vitamin A deficiency in rats increases tissue corticosterone levels.

[Effect of wheat bran fiber on vitamin status of weaning rats with alimentary polyhypovitaminosis]

Effect of wheat bran on the vitamin status of rats adequately provided with vitamins or insufficiently supplied with vitamins has been investigated. 32 male Wistar weaning rats (initial body mass--49-67g) were randomly divided into 4 groups and fed with complete semi-synthetic diet, containing 100 or 20% of vitamin mixture with or without addition of wheat bran (5% of diet mass) for 35 days. The animals of the control group received 100% of vitamin mixture without adding of wheat bran; 2 group--received those diet with wheat bran; 3 deficient group--20% of vitamin mixture with full exclusion of vitamins E, B1 and B2; 4 group--20% of vitamin mixture and wheat bran. The inclusion of wheat bran in full semi-synthetic diet has been accompanied by significant decrease of alpha-tocopherol liver content on 17% (p = 0.006), significant increase of vitamin B1 liver level on the 16% (p = 0.027) and blood plasma vitamin D elevation on 19% (p = 0.017), as well as a tendency (p = 0.059) to increase the liver level of vitamin B2. Indicators of vitamin A status as well as plasma vitamin E concentration, liver and blood plasma MDA levels were not changed in this group rats. The 5-fold reduction of the vitamin mixture quota and the exclusion of vitamins E, B1 and B2 resulted in a significant (p < 0.05) 1.6-1.8 fold decreased in animal body weight and liver mass and the manifestation of the deep external signs of vitamin deficiency. Young animals were more sensitive than adult animals to a lack of vitamins in the diet. Vitamin A (retinol palmitate) liver content in rats from this group was 25.1-fold reduced, vitamin E (alpha-tocopherol)--2.1-fold, vitamins B1 and B2--by 57 and 38% compared with animals received a complete control diet (p < 0.05). Blood plasma concentration of vitamins A, E, D was 19-34% decreased. Adding of bran in vitamin deficit diet led to increased consumption of vitamin B--on 40%, vitamins B2 and E--21%, both due to their natural content in the bran, and as a result of increased eatability of the feed by 16% relative to deficient group due to improved taste of the diet. Enrichment of vitamin scarce diet with wheat bran led to an increase in body weight by 56%, the efficiency of the diet by 67%. This circumstance didn't allow to reveal the effect of dietary fiber on the vitamin status of rats with polyhypovitaminosis. The significant (p < 0.05) increase of retinol plasma level by 34% and liver and blood plasma tocopherol content by 17% and 22% and reduction of MDA blood plasma level by 24% took place in animals from this group compared to a group of rats receiving vitamin deficit diet without any effect on liver MDA level, liver vitamin A, B1 and B2 content and heart coenzyme Q10 level. The results obtained suggest that wheat bran inclusion in the diet of rats adequately supplied with vitamins may lead to a deficiency of vitamin E.

[Correction of the combined vitamin deficiency in growing rats fed fiber enriched diets with different doses of vitamins]

The effect of 5% dietary wheat bran (WB) on the correction of combined vitamin deficiency by two doses of vitamins (physiological and enhanced) has been analyzed using a rat model (8 groups, n = 8/group). Vitamin deficiency in male weanling Wistar rats (58.1 ± 0.5 g) was induced by 5-fold reduction of vitamin mixture amount in the feed and complete vitamin E, B1 and B2 exclusion from the mixture for 30 days, then deficit was corrected within 5 days. Rats from control group were fed a complete semisynthetic diet containing microcrystalline cellulose 2%. Vitamin deficient diet for 35 days resulted in reduced (p < 0.05) levels of vitamin A in the liver by 25 fold, vitamin E and B1--2.0-2.3 fold, vitamin B2--by 40%, 25(OH)D blood plasma concentration--by 21% compared with the control. Feed consumption of the animals treated with vitamin deficient diet and WB was higher by 43% than in rats with vitamin deficit. Their rate of weight occupied the intermediate position between the rates of weight in deficit and in control animals, and they could not serve a full control to evaluate the WB impact on vitamin sufficiency. After filling the vitamin diet content to an adequate level vitamin E liver content was fully restored. To restore vitamins B1 and B2 liver level higher doses of vitamins (120-160% of adequate content) were required, and to restore the reduced levels of vitamin A in rat liver even 2-fold increased dose of vitamin A was insufficient. The diet enrichment with WB had no effect on vitamin B1 and B2 liver content, regardless of the amount of vitamins in the diet. Adding fiber to the diet of animals adequately provided with vitamins resulted in significantly 1,3-fold increase of 25(OH)D blood plasma concentration and a slight but significant decrease of α-tocopherol liver level by 16% as compared to rats not receiving WB. The enrichment of rat diet with dietary fibers worsened restoration of the reduced vitamin E status not only by filling vitamin content in the diet to an adequate level, but also by using 2-fold enhanced dose of vitamin. Within 5 days deficiency of vitamins A, B1, B2 was not eliminated with increasing vitamin diet content to an adequate level. Higher doses of vitamins are needed for the complete correction of vitamin status. The addition of vitamins to an adequate level was sufficient to normalize the elevated liver levels of MDA in rats with combined vitamin deficiency that may be associated with vitamin E status improvement. The diet enrichment with fiber did not affect on the intensity of lipid peroxidation in rat liver regardless of their provision with vitamins.

Biochemistry of blood plasma and some parameters of antioxidant status in rats with polyhypovitaminosis of varying severity

In rats with profound vitamin deficiency, blood plasma level of triglycerides significantly decreased by 1.6 times, potassium ions by 5%, uric acid by 23%, ALT and AST by 1.4 times, while the levels of glucose increased by 32%, iron by 31%, urea by 58%, and alkaline phosphatase by 19%. Plasma level of phosphorus tended to decrease and ionized calcium concentration tended to increase. Severe deficiency of all vitamins is accompanied by pronounced accumulation of MDA in the plasma and liver together with simultaneous increase in the level of coenzyme Q10 by 4.6 times and decrease in vitamin C content by 21.4% in the rat liver compared to the control. It was found that severe combined deficiency of vitamins for 4 weeks produced considerable multidirectional alterations in diagnostically important metabolic parameters in rat plasma.

[Micronutrient deficiencies in osteoporosis]

Osteoporosis is a disease characterized by a progressive reduction of bone mass and a simultaneous deterioration of skeletal microarchitecture leading to a loss of bone strength, resulting in bone fracture as consequence of even very low traumas. Osteoporosis has only recently been accorded growing clinical and pathological importance for its impact on health. This disease, thanks to considerable increases in life expectancy, is becoming more visible and is now treated either as a serious public health issue of socio-economic importance, and as a multifactorial disease. In fact, both in women and men, osteoporosis is often associated with e hypogonadism as well as with individual traits such as genetic constitution, cytokines, sex and race, which represent non-modifiable endogenous risk factors. In addition, modifiable exogenous risk factors related to lifestyle (e.g. smoking, alcohol consumption, diet) can lead to an acceleration in the genesis of osteoporosis. This article is intended to contribute to the knowledge of exogenous risk factors in osteoporosis, with special consideration to the role of micronutrient deficiencies.

[Correction of polyhypovitaminosis in rats, having standard and enriched with polyunsaturated fatty acids family omega-3 diets with different doses of vitamins]

The efficiency of the correction of combined alimentary vitamin deficit in male Wistar rats (body weight 90-121 g) fed standard diet or enriched with omega-3 polyunsaturated fatty acids diet (by replacing sunflower oil (4.5% of the diet) with linseed oil) with different doses (physiological and enhanced) of vitamins has been investigated. The control group of animals (n = 12) received a complete semisynthetic diet during all experimental period (42 d). The animals of the test groups (each of 20 rats) received vitamin-deficient diet containing sunflower or linseed oil and 20% per cent of vitamin mixture amount in control diet from which vitamin E had been excluded. After 28 days of such feeding each of test groups was divided into two subgroups (6-8 rats in each), and the next 14 days the animals of subgroups received the diet with different degree of vitamin compensation (50 or 180% percent of vitamin content in the diet of the control group). The addition of both low and high vitamin dose in deficient diet based on standard fat component did not compensate the reduced liver vitamin A content, which amounted to 47.4% of the level in the liver of the control group. The lack of vitamin E in animals was eliminated only after adding of the enhanced dose of vitamin E to the ration. Recovering of decreased plasma and liver B2 level, plasma 25(OH)D and liver vitamin B1 content have been occurred after addition of the low dose of these vitamins to rat diet. Increasing of omega-3 PUFA diet level improved vitamins A and D sufficiency to some extent, but was accompanied by the significant reduction of rat liver alfa-tocopherol content both under combined vitamin deficiency (by 14%) and increased vitamins consumption (by 43%). PUFA enrichment of the diet of rats with vitamin deficiency had no impact on vitamin B1 and B2 liver level. The use of high doses of vitamins for a long time to eliminate a combined deficiency of vitamins has been proved.

[Enrichment effect of vitamin-deficient diet of rats by polyunsaturated fatty acids omega-3 on vitamin biomarkers and antioxidant status]

Using the model of combined vitamin deficiency based on 5-fold reduction of the amount of vitamin mixture in semi-synthetic diet and on vitamin E exclusion from the mixture, the influence of omega-3 polyunsaturated fatty acids (PUFA) on vitamin and antioxidant status has been investigated. The enrichment of rat diet with PUFA was achieved by replacing of sunflower oil (4.5% of the diet) on linseed oil. This substitute led to omega-3 PUFA elevation from 0.03 to 2.4 g per 100 g of food and PUFA and saturated fatty acids diet ratio increased from 1.3 to 1.9. The diet treatment with PUFA did not affect blood plasma retinol concentration and total vitamin A (retinol palmitate and retinol) rat liver content, while liver retinol significantly 1,5-fold elevated. Despite of preliminary equation of tocopherols content in vegetable oils (up to 60 IU per 100 g by adding dl-alpha-tocopherol to linseed oil) the consuming of linen oil deteriorated animal vitamin E supply. The liver alpha-tocopherol content significantly decreased by 14%, its blood plasma concentration insignificantly decreased by 26%, while the amount of beta - and gamma-tocopherol significantly increased in 5,4-fold. At the same deprivation of vitamin D in the diet of rats treated with linseed oil 25(OH)D blood plasma concentration was 1,3-fold higher compared with the animals treated with sunflower oil, but the difference did not reach significance reliable. In this case, this index had significant differences from that of the receiving adequate diet rats in control group, having 2-fold higher concentration of vitamin D transport form in blood plasma. PUFA enrichment of the combined vitamin-deficit diet did not affect liver level of vitamin C, vitamin B1 and vitamin B2. Contrary to the assumptions, the enrichment with PUFA of vitamin-deficient diet did not lead to a further increase of liver MDA level and a decrease of liver ascorbic acid content, which is typical for animals in combined vitamin deficiency. The deterioration of vitamin E status at enriched with PUFA vitamin-deficient diet requires the additional intake of this vitamin for maintaining of vitamin E sufficiency.

[Hematological indices of rats having complete and vitamin-deficient diets enriched with dietary fibers]

The hematological indices in 48 rats Wistar male with initial body weight 58.1+/- 0.5g has been studied. The rats were divided into 6 group and fed the complete semi-synthetic diet, containing 100% or 20% of vitamin mixture (Vit) with or without addition of dietary fiber (DF) in the form of wheat bran (5% of diet mass) during 4 weeks. The animals of the 1 group received 100% of vitamin mixture (100% Vit); of the 2 group--100% Vit+DF; 3 group--20% of vitamin mixture (20% Vit); 4 group--20% of vitamin mixture and DF (20% Vit+DF). The next 5 days rats from vitamin-deficient groups were fed with diets supplemented with 80% of Vit: (5 group--20% Vit+ 80% Vit; 6 group--20% Vit+DF+80% Vit). The animals fed vitamin-deficient diet lag significantly in growth from animals fed a complete diet. The growth curve of rats fed a diet with DF took an intermediate position. The studies were carried out at the Hematology analyzer "Coulter AC TTM 5 diff OV" (Beckman Coulter, USA) under the program, developed for the study of rat blood. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin content (MCHC) were significantly decreased in rats with combined vitamin deficiency (20% Vit) in the diet compared with those of control group rats, while the compensatory increase in the number of red blood cells (RBC) and leukocytopenia took place. The enrichment of vitamin-deficient diet with DF (20% Vit+DF) prevented MCV and RBC changes, but MCHC left reduced in comparison with the indicator of the rats in control group. Indicators characterizing the state of platelets had no statistically significant differences between the groups. Compensation of vitamin deficiency in the diet of rats from group 5 (20% Vit+80% Vit) led only to the normalization of MCV. After vitamin restore in the diet of group 6 (20% Vit+DF+80% Vit) all investigated parameters were indistinguishable from the parameters of the control group. This indicates a positive effect of wheat bran DF consumption on the studied hematological indices.

Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia

OBJECTIVE

Cholestasis predisposes to fat-soluble vitamin (FSV) deficiencies. A liquid multiple FSV preparation made with tocopheryl polyethylene glycol-1000 succinate (TPGS) is frequently used in infants with biliary atresia (BA) because of ease of administration and presumed efficacy. In this prospective multicenter study, we assessed the prevalence of FSV deficiency in infants with BA who received this FSV/TPGS preparation.

METHODS

Infants received FSV/TPGS coadministered with additional vitamin K as routine clinical care in a randomized double-blinded, placebo-controlled trial of corticosteroid therapy after hepatoportoenterostomy (HPE) for BA (identifier NCT 00294684). Levels of FSV, retinol binding protein, total serum lipids, and total bilirubin (TB) were measured 1, 3, and 6 months after HPE.

RESULTS

Ninety-two infants with BA were enrolled in this study. Biochemical evidence of FSV insufficiency was common at all time points for vitamin A (29%-36% of patients), vitamin D (21%-37%), vitamin K (10%-22%), and vitamin E (16%-18%). Vitamin levels were inversely correlated with serum TB levels. Biochemical FSV insufficiency was much more common (15%-100% for the different vitamins) in infants whose TB was ≥2 mg/dL. At 3 and 6 months post HPE, only 3 of 24 and 0 of 23 infants, respectively, with TB >2 mg/dL were sufficient in all FSV.

CONCLUSIONS

Biochemical FSV insufficiency is commonly observed in infants with BA and persistent cholestasis despite administration of a TPGS containing liquid multiple FSV preparation. Individual vitamin supplementation and careful monitoring are warranted in infants with BA, especially those with TB >2 mg/dL.

Vitamin status in elderly people in relation to the use of nutritional supplements

OBJECTIVE

This study aimed to evaluate the status of several vitamins and to investigate the effect of regular individual supplementation on their status in this population.

DESIGN

An observational study.

SETTING

State of Burgenland, Austria.

PARTICIPANTS

A total of 102 non-institutionalized subjects (49% supplementing regularly, 51% without supplementation) aged between 70-90 years were recruited.

MEASUREMENTS

Plasma levels of vitamins A, D, E, K and C were determined by HPLC. The functional parameters of vitamins B1, B2 and B6, i.e. the activities of the erythrocyte enzymes transketolase, glutathione reductase and glutamic oxaloacetic transaminase, were analyzed photometrically; plasma folate and vitamin B12 were determined by RIA.

RESULTS

The status of vitamins A, E and C was generally satisfactory. Eighty-eight percent and 42% of participants were deficient in vitamins D and K, respectively, as were 29% for B6; up to 10% of participants were deficient in vitamins B1, B2, B12 and folate. A considerable percentage of participants was, however, at risk for vitamin deficiencies (vitamins B1, B6, B12, folate: 20-30%, vitamin B2: 60%). Except for vitamins A and K, regular intake of supplements had a significant positive influence on vitamin levels.

CONCLUSION

These results indicate that use of supplements significantly improved the status of several vitamins in elderly people. Due to age-related problems concerning the intake and digestion of nutrients, a moderate, regular supplementation might be a useful option for older people who are otherwise unable to satisfy their micronutrient requirements.

[The experimental model of alimentary polyhypovitaminosis of different degree in rats]

A model of the alimentary polyhypovitaminosis varying degrees basing on partitive simultaneous reduction of all vitamins in rats diet has been proposed. The model has a principal difference from other experimental models, based on complete exclusion of 1 or 2 vitamins from animal diet. The proposed model allows you to get as close to the actually observed combined deficiency of several vitamins among the population. 5-fold decrease of vitamin mixture resulted in the fact that animals received 20-23% of vitamins D, A, B2, 33% of vitamin B1 and 57% of vitamin E from the content of these vitamins in the diet of animals from control group because of some nature vitamins contained in such diet basic components as casein (vitamins D, A, B1, B2) and sunflower oil (vitamin E). After one month treatment a deep deficiency of all vitamins has developed in rats from this group. Liver level of vitamin A decreased 8,5-fold, vitamins E and B1 - approximately 2-fold, vitamins C and B2 by 22%. Urinary excretion of vitamin B1 and B2 declined 2 and 5,3 fold. Blood plasma concentration of vitamin A decreased 1,9 fold, and E - 1,4 fold, B2 - by 30%. Activities of blood plasma vitamin B6-dependent enzymes reduced 1,4-fold. 2-fold decrease in the amount of vitamin mixture ensured intake about 50-59% of vitamins D, A, B2, and B1 and about 71% of vitamin E of those contained in the diet of animals from control group. Vitamin status indexes of these animals occupied an intermediate position. They have developed a moderate deficit of these essential micronutrients. The proposed model may be useful for metabolic disorders identification, the study of vitamins and minerals assimilation, investigations of the influence of biologically active components of food on these processes, as well as the development of personalized approaches to the correction of vitamin insufficient accuracy.

[Food fortified with vitamins: the history and perspectives]

The recommended daily intakes of vitamins in different countries have been compared. The data on consumption of vitamins and vitamin status are submitted. It is noted that since 2008 the values of recommended daily intakes of vitamin-antioxidants C and E and folate in Russia as in other countries has been significantly increased. The recommended vitamin D consumption in Russia has been increased 2-3-fold as in most European countries and USA, while vitamin A recommended intake, on the contrary, has been reduced by 10%. Monitoring of vitamin status of various groups of adult population (by vitamin serum blood level evaluation) during the period since 2003 to 2011 has shown that that since 2003 deficiency of B group vitamins takes place in 10-47% of surveyed, vitamin D insufficiency was detected in 20.7% of adults. Thus the deficiency of these micronutrients has been determined much more often than the deficit of vitamins E and C (2.8-11%). The key causes of vitamin deficiency among the population in current conditions have been discussed. The main ways of increasing of diet vitamin value by means of fortified foods usage or/and vitamin and mineral complexes intake have been considered. The effective and safe levels of food enrichment have been examined. Harmonized with the EU documents and Codex Alimentarius acting sanitary rules and regulations which govern the enrichment of food products of mass consumption with vitamins and minerals have been commented upon. The history of food enrichment (fortification) with vitamins and salt iodization in our country and abroad has been described. Basing on the experience of several countries in which the mandatory enrichment of regularly consumed food products (flour, breakfast cereals) had compensated inadequate intake of vitamin D, group B, iodine and iron to a large extent, the conclusion on the feasibility and health benefits of fortified foods intake has been done.

Time-course changes in bone turnover markers and fat-soluble vitamins after obesity surgery

BACKGROUND

The available evidence indicates a progressive increase in the incidence and severity of the deficiency of certain vitamins and related clinical conditions (i.e., metabolic bone disease). Because of the potential role of fat-soluble vitamins and carotenoids in bone metabolism, our aim was to assess the time-course changes of fat-soluble vitamins and serum markers of bone metabolism in candidates for obesity surgery and following two bariatric procedures.

METHODS

Sixty-five candidates for bariatric surgery and 150 serum samples after obesity surgery (i.e., Roux-en-Y gastric bypass, n = 85; biliopancreatic diversion, n = 65) were consecutively analyzed over a period of more than 2 years. Retinol, α- and γ-tocopherol, 25-OH-vitamin D3, β-cryptoxanthin, and β-carotene were analyzed by high-performance liquid chromatography. Calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), osteocalcin, beta-crosslaps, and N-terminal peptide of procollagen I (P1NP) were determined using commercial kits.

RESULTS

Retinol, β-cryptoxanthin, β-carotene, and α- and γ-tocopherol levels were significantly lower in post-surgery samples while osteocalcin, b-crosslaps, and P1NP were significantly increased. Along the time and regardless of the surgical procedure, P1NP, b-crosslaps, and osteocalcin increased during the first 12-24 months but declined afterward. 25-OH-vitamin D increased during the first 12 months and tended to decrease afterward while iPTH remained constant or decreased but increased after 1 year in both groups. Vitamin A remained constant but α- and γ-tocopherol, β-cryptoxanthin, and β-carotene decreased in both groups.

CONCLUSIONS

In addition to the nutritional assessment, regular monitoring of bone markers seems necessary in these patients and the early introduction of preventive strategies (i.e., the use of antiresorptive agents) should be evaluated.

[Characteristics of nutrition and vitamin supply in girls with metabolic syndrome]

Assessment of actual nutrition in girls with metabolic syndrome revealed excess dietary energy value due to the higher intake of fat and carbohydrates (mono- and disaccharides in particular) and the low intake of vitamin E. The vitamin status of the majority of girls with metabolic syndrome showed varying blood and urinary vitamin E, C, and B, deficiencies.

[The alteration of vitamin status of adult population of the Russisn Federation in 1987-2009 (to the 40th anniversary of the Laboratory of Vitamins and Minerals of Institute of Nutrition at Russian Academy of Medical Sciences)]

Monitoring of vitamin status of various groups of adult population (by vitamin serum blood level evaluation) during the period since 1987 on 2009 has shown that an authentic improvement of sufficiency with vitamin C takes place. At the present time the deficiency of B group vitamins has been determined much more often than the deficit of vitamins C, A and E. The revealed deficiencies don't depend on a place of residing and a professional accessory and, as a rule, affect not any one vitamin, but have a character of combined insufficiency of B group vitamins and some other vitamins.

[Impact of environmental pollution with variable valence metals on the pediatric population's provision with vitamins in an agroindustrial region]

The urinary and serum levels of vitamins B1, B2, B3, A, E, and C were analyzed in 300 children aged 2 to 7 years, who lived in the Orenburg Regions areas having a varying oxidative load. The most severe deficiency of vitamins was observed in the children residing in the regional area characterized by the highest oxidative load.

Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop

OBJECTIVE

Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostic tests for this condition in clinical practice.

PARTICIPANTS

Interested professional societies selected a representative for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed. The conclusions were then circulated to the participating professional societies.

EVIDENCE

Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting.

CONSENSUS PROCESS

Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies.

CONCLUSIONS

We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second- and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) DNA sequence testing can be useful in familial hyperparathyroidism or hypercalcemia; 4) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 5) serum 25-hydroxyvitamin D levels should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; and 6) the estimated glomerular filtration rate should be used to determine the level of kidney function in PHPT: an estimated glomerular filtration rate of less than 60 ml/min.1.73 m2 should be a benchmark for decisions about surgery in established asymptomatic PHPT.

[Functional reserves of humans in North condition and its providing of fat-soluble vitamins]

It was been examined 810 healthy peoples inhabited in Russian European North. It was been shown that more than 35% of examined person from different group have lowered serum level of retinol and alpha-tocopherol. Described that alpha-tocopherol deficits occur more often and proposed that it cased as a result of free radical oxidation typical for North inhabitances.

Serum concentrations of antioxidant vitamins and carotenoids are low in individuals with a history of attempted suicide

PRIMARY OBJECTIVE

Low consumption of fruits and vegetable has been reported in individuals with psychiatric disorders. We tested the hypothesis that antioxidant vitamins and carotenoids rich in fruits and vegetable may be consequently low among attempters.

DESIGN AND METHODS

As a part of the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994, serum vitamins and carotenoids were measured in 6680 adults aged 17-39 years, who also completed a mental disorder diagnostic interview. Serum levels below gender-specific 1st quartile of the population were defined as low, otherwise as normal.

RESULTS

Compared with non-attempters, prevalence ratios (PRs) of low alpha-carotene, beta-cryptoxanthin in attempters were 1.45 (95% CI = 1.06-1.98) and 2.12 (1.47-3.08), respectively, the mean differences (nonattempter-attempter) of vitamin C, lutein/zeaxanthin and lycopene were 6.071 mmol/1 (SE = 1.948, p < 0.005), 0.041 micromol/l (0.015, p < 0.005) and 0.045 micromol/l (0.015, p < 0.005) respectively. Total carotenoid was significantly lower (PR = 2.34 (1.56-3.49) and mean difference = 0.142 (0.058) micromol/l). These differences were reduced by adjustment for fruit/vegetables consumption, vitamin supplementation and serum cotinine, but remain significant for beta-cryptoxanthin, lycopene and total carotenoids.

CONCLUSION

A history of attempted suicide is associated with low levels of antioxidant vitamins and carotenoids. Clinical importance of low antioxidants in attempters and interventional opportunity warrant further examination.

Epidemiological survey of vitamin deficiencies in older Thai adults: implications for national policy planning

OBJECTIVE

To examine the prevalence and risk factors of vitamin deficiencies among older Thai adults.

METHODS

The cross-sectional study was conducted in four rural communities, one from each of the four main regions of Thailand. In total, 2336 subjects aged 60 years and over were recruited. Anthropometric variables, demographic data, blood glucose and lipid profile, albumin, globulin and blood levels of vitamin A, beta-carotene, folic acid, vitamin B12, vitamin C, vitamin E and vitamin B1 were all measured.

RESULTS

The prevalence of vitamin deficiencies was 0.6% for vitamin B12, 6.1% for vitamin A, 9.9% for vitamin C, 30.1% for vitamin B1, 38.8% for erythrocyte folate, 55.5% for vitamin E and 83.0% for beta-carotene. Male gender was a common risk factor for at least three vitamin deficiencies, i.e. beta-carotene, folate and vitamin E. Being a manual worker was a common risk factor of beta-carotene and vitamin B1 deficiency. Poor income was found as a risk factor only in erythrocyte folate deficiency while increasing age was a significant factor only in vitamin C deficiency.

CONCLUSION

The prevalence of vitamin deficiencies among older Thai people was quite different from that found in Western countries, reflecting different socio-economic backgrounds. Vitamin deficiency was not only from poor food intake but also from the dietary habit of monotonous food consumption in older people. Some common associated factors of atherosclerosis were also significantly related to folate and vitamin E deficiencies.

Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly

OBJECTIVES

To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population.

DESIGN AND SETTING

Population-based study of 209 community-dwelling subjects, mean age 76 years.

INTERVENTIONS

Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo.

MAIN OUTCOME MEASURES

Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex.

RESULTS

Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%).

CONCLUSIONS

The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented.

Clinical application of a semimechanistic-physiologic population PK/PD model for neutropenia following pemetrexed therapy

PURPOSE

The objective of these analyses was to examine the effect of variations in the explanatory factors of neutropenic response, identified by semimechanistic-physiologic population pharmacokinetic/pharmacodynamic (PK/PD) modeling, on clinically important features of the absolute neutrophil count (ANC)-time profile (e.g, the nadir of the ANC [NANC], its timing [T (Nadir)], and the timecourse of recovery [T (Rec)]).

METHODS

Correlation analyses were used to evaluate the relationship of NANC, T (Nadir), and T (Rec) as a function of overall systemic exposure (AUC) and each of the covariates contained in the population PK/PD model. Simulations using the final PK/PD model were used to generate complete ANC-time profiles. Frequency counts of NANCs from the simulated profiles were used to quantitatively explore differences in the incidence and severity of neutropenia associated with a variety of scenarios (500 mg/m2 versus 600 mg/m2, normal vitamin deficiency markers versus elevated vitamin deficiency markers, and body surface area-based versus renal function-based dosing) and to evaluate the effect of individual explanatory factors with respect to neutropenic response.

RESULTS

Information obtained from correlation analysis and simulations was helpful in quantitatively exploring the impact of dose, exposure, and/or patient characteristics on neutropenic response. The information gained from these simulations provided supportive evidence for the decision to routinely include vitamin supplementation during pemetrexed treatment as a means of managing the risk of severe neutropenia secondary to pemetrexed administration. These techniques also provided information regarding the specific T (Nadir) and T( Rec) for inclusion in product labeling and suggested that a 14-day treatment cycle might be feasible for pemetrexed.

CONCLUSION

For population PK/PD models, to provide useful information for the practicing clinician or the clinical development team, it is not sufficient to look only at influences of covariates on model parameters. Rather, the modeling results need to be carefully investigated in terms of clinically relevant measures.

[Blood levels of vitamins in neonatal infants before and after correction of vitamin deficiency in their mothers]

The paper presents the data of a study of the vitamin status in the neonatal infants before and after correction of vitamin deficiency in their apparently healthy mothers.

[Vitamin metabolism and status in patients with gastrointestinal diseases]

Principle differences in vitamin C, B2, B6, A, E and carotenoids sufficiency of healthy suffering from gastrointestinal diseases (gastric and duodenal ulcer, chronic gastritis, dyskinesia bile tracts) ulc adults and children has not been determined by means of the statistic analysis including such parameters as median, mode, insufficiency frequency, curves of vitamin blood plasma concentration distribution. Polyhypovitaminosis frequency among patients is a result of low vitamin content in reduced diets but not reflect vitamin metabolism alteration.

Homocysteine and Cardiovascular Disease: Interactions Between Nutrition, Genetics and Lifestyle

Homocysteine is a sulfur-containing amino acid that arises during methionine metabolism. Although its concentration in plasma is only about 10 micromolar, even moderate hyperhomocysteinemia is associated with increased incidence of cardiovascular disease and Alzheimer's disease. Elevations in plasma homocysteine are commonly found as a result of vitamin deficiencies, polymorphisms of enzymes of methionine metabolism, and renal disease. Pyridoxal, folic acid, riboflavin, and Vitamin B12 are all required for methionine metabolism, and deficiences of each of these vitamins result in elevated plasma homocysteine. A polymorphism of methylenetetrahydrofolate reductase (C677T), which is quite common in most populations with a homozygosity rate of 10-15%, is associated with moderate hyperhomocysteinemia, especially in the context of marginal folate intake. Plasma homocysteine is inversely related to plasma creatinine in patients with renal disease. This is due to an impairment in homocysteine removal in renal disease. The role of these factors, and of modifiable life style factors, in affecting methionone metabolism and in determining plasma homocysteine levels is discussed. Key words: methionine, liver metabolism, folic acid, vitamin B12, polymorphisms, neural tube defects, end-stage renal disease, coffee consumption

[Role of vitamins in metabolic correction of alcohol intoxication]

The status of some vitamins during chronic alcohol intoxication was considered. The efficacy and expediency of vitamin therapy in comprehensive treatment of alcoholism has been proved.

Analysis of hippocampal atrophy in alcoholic patients by a Kohonen feature map

We investigated the correlation of hippocampal volume with homocysteine, folate, vitamin B12 and B6 in alcoholic patients and healthy controls applying a Kohonen feature map (KFM) and conventional statistics. Representation of subjects on the KFM suggested an inverse correlation of hippocampal volume with blood levels of homocysteine and correlation with folate and vitamin B6. In conventional statistical analyses (t-test) reduced folate and increased homocysteine was found in alcoholics compared to healthy controls (p < 0.01). In female alcoholics vitamin B6 was reduced significantly (p = 0.03). Multiple linear regression analyses showed a significant correlation between average hippocampal volume and homocysteine (p < 0.001). KFM proved to be a sensitive tool for visualisation of statistical correlations in data sets even if no further statistical information is available.

Down syndrome and epilepsy: a nutritional connection?

Non-Asian individuals with Down syndrome are much more likely to develop epileptic seizure disorders than individuals without Down syndrome. Examination of nutrient and metabolite levels in patients with these two seemingly disparate disorders reveals numerous similarities. Compared to individuals without these disorders, individuals with Down syndrome and individuals with seizures may have lower levels of vitamin A, vitamin B1, folate, vitamin B12, vitamin C, magnesium, manganese, selenium, zinc, carnitine, carnosine, choline, and possibly serine. Excesses of copper, cysteine, phenylalanine, and superoxide dismutase are also sometimes encountered in both disorders. In addition to common nutritional lower levels and excesses, disorders of metabolism involving vitamin B6, vitamin D, calcium, and tryptophan may play a common role. This paper hypothesizes that nutritional factors may account for the high joint occurrence of these conditions. Further examination of these data may provide insights into nutritional, metabolic and pharmacological treatments for both conditions.

Anti-oxidant vitamins and steroid responsive nephrotic syndrome in Indian children

OBJECTIVE

In recent years, it has been proposed that nephrotic syndrome is a consequence of an imbalance between oxidant and anti-oxidant activity. In the present study, the levels of micronutrient anti-oxidant vitamins (vitamin E, vitamin C, carotene and riboflavin) in Indian children with steroid responsive nephrotic syndrome were investigated. Their levels were measured during the acute proteinuric phase of the disease, as well as during clinical recovery (remission), in order to understand the possible role of nutritionally modifiable anti-oxidants in the aetiopathogenesis of the disease.

METHODS

The study was a hospital based, prospective cohort study. Serum and erythrocyte vitamin E, leucocyte vitamin C, serum carotene, erythrocyte riboflavin activity and serum malonyldialdehyde (MDA) levels were measured in 30 consecutive cases of children with nephrotic syndrome (International Study of Kidney Diseases in Children (ISKDC) criteria) during the proteinuric phase of the disease and at 4 weeks after remission was induced by steroid therapy. The same biochemical parameters were measured in healthy siblings (controls) of the 30 patients.

RESULTS

Mean vitamin E (serum and erythrocyte), vitamin C and carotene were significantly lower during the proteinuric phase of the disease, and there was decreased erythrocyte riboflavin activity. There was significant elevation in the serum level of MDA during this phase. In addition, all these parameters tended to improve during remission, although complete normalization did not occur.

CONCLUSION

These vitamins were active in performing their anti-oxidant function, as indicated by significant depression in their levels during the acute (proteinuric) phase, followed by partial recovery during remission. It may be concluded that steroid responsive nephrotic syndrome in children is associated with oxidative stress.

Effects of orlistat on fat-soluble vitamins in obese adolescents

STUDY OBJECTIVES

To determine whether orlistat causes fat-soluble vitamin deficiencies in African-American and Caucasian adolescents.

DESIGN

Prospective, open-label pilot study.

SETTING

Warren Grant Magnuson Clinical Center of the National Institutes of Health.

PATIENTS

Seventeen adolescents with body mass indexes above the 95th percentile for age, race, and gender who also had at least one obesity-related comorbid condition.

INTERVENTION

Subjects received orlistat 120 mg 3 times/day and a daily multivitamin supplement containing vitamin A 5000 IU, vitamin D 400 IU, vitamin E 300 IU, and vitamin K 25 microg.

MEASUREMENTS AND MAIN RESULTS

During 3-6 months of orlistat treatment, acute absorption of retinol (vitamin A) was not significantly altered, but absorption of alpha-tocopherol (vitamin E) was significantly reduced compared with baseline levels (p<0.001). Serum levels of vitamins A and E did not change significantly; however, there was a nonsignificant decrease in vitamin K. Mean vitamin D levels were significantly reduced compared with baseline (p<0.02) after 1 month of orlistat, despite multivitamin supplementation.

CONCLUSION

It may be prudent to monitor vitamin D concentrations in adolescents who take orlistat, even when a multivitamin is prescribed.

Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: vitamin deficiencies

In the past, recommended vitamin or micronutrient intakes have often been based on levels that were adequate to prevent clinical deficiencies from developing. Once these levels were reached, clinicians and nutrition scientists generally attributed little value to higher vitamin intake from supplements or food sources. Evidence has continued to mount showing that the intake and serum concentration of certain vitamins above those necessary to prevent clinical deficiencies, might importantly influence health status. This paper discusses the association of anti-oxidant vitamins and cardiovascular disease, and the association of low intake or serum concentrations of folate, vitamin B6 and vitamin B12, and elevated serum homocysteine, resulting in an increase in vascular disease risk.

Vitamin profile of 563 gravidas during trimesters of pregnancy

OBJECTIVE

Gestation imposes metabolic stress on the mother which heightens as pregnancy progresses. The need for quantifying circulating vitamins is important for identifying pitfalls in metabolic imbalance and nutritional status. For this reason we wanted to analyze blood vitamin concentrations of B12, thiamin, biotin, pantothenate, B6, niacin, riboflavin, folate, vitamins A, C, E and total carotenes to determine if imbalances occur during the trimesters of pregnancy.

METHODS

We randomly selected 563 gravidas who volunteered for this study from the obstetrical clinic of New Jersey Medical School; 132 were in 1st trimester, 198 were in 2nd trimester, and 233 were in 3rd trimester. All were healthy, taking a good diet and supplemented with vitamins. Blood, from an antecubital vein, was analyzed for thiamin, biotin, B12, B6, pantothenate, riboflavin, nicotinate, folates, vitamins A, E, C and total carotenes. Gravidas were classified as being normovitaminemic, hypervitaminemic or hypovitaminemic compared with blood vitamins seen in healthy non-pregnant, non-vitamin supplemented women.

RESULT

Hypervitaminemic levels of folate, biotin, pantothenate and riboflavin were found during any trimester of pregnancy due to vitamin supplementation. Despite the vitamin supplementation, a high percent of vitamin A, B6, niacin. thiamin and B 12 hypovitaminemia was noted during pregnancy trimesters. An especially high percentage of niacin deficiency was seen during the 1st trimester; it worsened in later trimesters; B12 deficits increased during the late trimesters. Combination deficits of niacin, thiamin, vitamins A, B6, B12 were noted in each of the trimesters.

CONCLUSIONS

Despite vitamin supplementation, a vitamin profile of pregnancy indicates that vitamin deficits exist during the trimesters. Also, combination hypovitaminemias of deficient vitamins were noted; this indicates that a vitamin deficit during pregnancy does not occur in isolation.

Scanning electron microscopy of rat erythrocytes during chronic alcoholic intoxication combined with protein and vitamin deficit

Electron microscopy revealed morphological changes in erythrocytes from rats with chronic alcoholic intoxication kept on protein- and vitamin B-deficient rations. All animals had anisopoikilocytosis (up to 50%). Most pronounced changes in erythrocyte population attesting to accelerated erythrocyte aging (stomato- and microcytosis, discocyte swelling, and spontaneous hemolysis) were found in alcohol-fed rats kept on deficient ration.

A new HPLC micromethod to measure total plasma homocysteine in newborn

Total plasma homocysteine (tHcy) in children may be an useful biochemical marker for genetic risk of premature cardiovascular disease. We reported a rapid, isocratic HPLC method able to process very small amount of newborn plasma samples. A blood sample from heel capillary circulation was collected, using a heparinized capillary glass tube. Plasma sample from 1 to 10 microl was derivatized with ammonium-7-fluorobenzo-2-oxa-1,3-diazole-4-sulphonate after reduction with tri-n-butylphosphine and analyzed on Discovery C18 column, with a solution of acetonitrile-dihydrogenphosphate 0.1 M (8:92 v/v pH*2.1). This assay ensures a good recovery (95%), precision (CV 4.5%) and linearity (y=2.41x + 0.31, r=1). Due to its simplicity and reliability, our method is suitable for routine analysis of tHcy and other aminothiols (Cys, Cys-Gly, GSH) assessed for clinical and research purposes. With this HPLC method we have assayed tHcy levels in 1400 apparently healthy newborn babies (tHcy mean value=4.9+/-2.7 microM). In conclusion, this accurate and linear HPLC method allows measurement of tHcy in newborn during the routinary capillary blood collection in the fourth living day without any other invasive procedure.