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1.
J Orthop Surg Res ; 19(1): 460, 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39095815

RESUMO

PURPOSE: Both vitamin C and D deficiencies are extremely common in clinical practice, especially in elderly population. Unfortunately, the role of vitamin C deficiency in osteoporosis related consequences is often neglected. The aim of the present study is to analyse if combined vitamin C and D deficiency would have an association with bone mineral density (BMD) and osteoporotic vertebral fracture (OVF). METHODS: Ninety-nine post-menopausal female patients admitted in the department of spine surgery of third affiliated hospital of Sun Yat-sen University were enrolled in the study. The participants were divided into four groups; vitamin D deficiency alone (comparator group), vitamin C deficiency alone and combined vitamin C and D deficiency as experimental group. The levels of vitamin C, vitamin D, calcium, phosphorous, BMD and condition of OVF were analysed. RESULTS: There were statistically significant differences between the groups in terms of vitamin C and D levels. In terms of lumbar BMD, significant differences were observed between vitamin D deficiency alone and combined vitamin C and D deficiency. Only the combined vitamin C and D deficiency had a significant negative association with lumbar BMD and T-score. Similarly, combined vitamin C and D deficiency had a significant positive association with lumbar osteoporosis. None of the groups had any significant association with OVF. Combined vitamin C and D deficiency was found to be significantly associated with lower lumbar BMD and osteoporosis. CONCLUSION: Combined vitamin C and D deficiency results in lower bone mineral density and higher risk of osteoporosis. We believe that existence of deficiencies of both vitamins could have a synergistic effect. Therefore, we recommend that vitamin C and D should be routinely measured in clinical practice.


Assuntos
Deficiência de Ácido Ascórbico , Densidade Óssea , Fraturas da Coluna Vertebral , Deficiência de Vitamina D , Humanos , Feminino , Deficiência de Vitamina D/complicações , Fraturas da Coluna Vertebral/etiologia , Idoso , Deficiência de Ácido Ascórbico/complicações , Pessoa de Meia-Idade , Fraturas por Osteoporose/etiologia , Vértebras Lombares/diagnóstico por imagem , Ácido Ascórbico/administração & dosagem , Idoso de 80 Anos ou mais
2.
Int J Mol Sci ; 25(14)2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-39062764

RESUMO

The role of food constituents as pharmacological agents is an important consideration in health and obesity. Vitamin C acts as a small molecule antioxidant but is also a co-factor for numerous transition metal-dependent enzymes involved in healthy weight and energy metabolism. Vitamin C cannot be manufactured by humans and is mainly obtained from the dietary intake of fresh fruit and vegetables. There is great variability between different nutritional guidelines in the recommended daily allowance of vitamin C. Vitamin C deficiency results from an inadequate intake of vitamin C-containing foods and also increased utilization by oxidative and carbonyl stress. Risk factors for vitamin C deficiency include cigarette smoking, malnutrition, obesity, type 2 diabetes mellitus, age, race, sex, social isolation, major surgery, and Western-type diets. Despite the common belief that vitamin C deficiency is rare in affluent countries, surveys of large populations and specific patient groups suggest otherwise. Patients with obesity typically consume highly processed, energy-dense foods which contain inadequate micronutrients. As obesity increases, larger amounts of oral vitamin C are required to achieve adequate plasma and tissue concentrations, as compared to persons with a healthy weight. This is important in the control of oxidative stress and the maintenance of homeostasis and organ function. In this narrative review, the dosage, absorption, distribution, excretion, and catabolism of vitamin C are reviewed, together with the latest findings on vitamin C pharmacology in patients with obesity.


Assuntos
Ácido Ascórbico , Obesidade , Humanos , Obesidade/metabolismo , Obesidade/tratamento farmacológico , Ácido Ascórbico/metabolismo , Ácido Ascórbico/uso terapêutico , Ácido Ascórbico/farmacologia , Animais , Deficiência de Ácido Ascórbico/metabolismo , Antioxidantes/farmacologia , Antioxidantes/metabolismo , Antioxidantes/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos
3.
Neurobiol Dis ; 199: 106602, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39004234

RESUMO

Clinical studies have reported that increased epileptiform and subclinical epileptiform activity can be detected in many patients with an Alzheimer's disease (AD) diagnosis using electroencephalogram (EEG) and this may correlate with poorer cognition. Ascorbate may have a specific role as a neuromodulator in AD as it is released concomitantly with glutamate reuptake following excitatory neurotransmission. Insufficiency may therefore result in an exacerbated excitatory/inhibitory imbalance in neuronal signaling. Using a mouse model of AD that requires dietary ascorbate (Gulo-/-APPswe/PSEN1dE9), EEG was recorded at baseline and during 4 weeks of ascorbate depletion in young (5-month-old) and aged (20-month-old) animals. Data were scored for changes in quantity of spike trains, individual spikes, sleep-wake rhythms, sleep fragmentation, and brainwave power bands during light periods each week. We found an early increase in neuronal spike discharges with age and following ascorbate depletion in AD model mice and not controls, which did not correlate with brain amyloid load. Our data also show more sleep fragmentation with age and with ascorbate depletion. Additionally, changes in brain wave activity were observed within different vigilance states in both young and aged mice, where Gulo-/-APPswe/PSEN1dE9 mice had shifts towards higher frequency bands (alpha, beta, and gamma) and ascorbate depletion resulted in shifts towards lower frequency bands (delta and theta). Microarray data supported ascorbate insufficiency altering glutamatergic transmission through the decreased expression of glutamate related genes, however no changes in protein expression of glutamate reuptake transporters were observed. These data suggest that maintaining optimal brain ascorbate levels may support normal brain electrical activity and sleep patterns, particularly in AD patient populations where disruptions are observed.


Assuntos
Doença de Alzheimer , Deficiência de Ácido Ascórbico , Ácido Ascórbico , Modelos Animais de Doenças , Eletroencefalografia , Ácido Glutâmico , Camundongos Transgênicos , Animais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/genética , Ácido Ascórbico/metabolismo , Ácido Glutâmico/metabolismo , Camundongos , Deficiência de Ácido Ascórbico/metabolismo , Deficiência de Ácido Ascórbico/fisiopatologia , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Transdução de Sinais/fisiologia , Masculino , Fenótipo
4.
BMJ Case Rep ; 17(6)2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926124

RESUMO

A major complication with extracorporeal membrane oxygenation (ECMO) is bleeding which can occur in up to 40% of cases and can be life-threatening. Minor bleeding may be overlooked and under-reported. While some of the underlying mechanisms such as platelet injury and anticoagulation therapy have been identified, several other factors are still under-researched. Here, we describe a unique case of a subtle mucosal membrane bleeding that is found to be associated with vitamin C deficiency while on treatment with ECMO. Investigating vitamin C levels may be useful in understanding causes of bleeding in some patients on ECMO therapy, particularly if there are risk factors for malnutrition.


Assuntos
Deficiência de Ácido Ascórbico , Oxigenação por Membrana Extracorpórea , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Deficiência de Ácido Ascórbico/complicações , Masculino , Hemorragia/etiologia , Hemorragia/terapia , Ácido Ascórbico/uso terapêutico , Feminino , Pessoa de Meia-Idade , Mucosa
5.
Eur J Nutr ; 63(6): 2357-2366, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38811416

RESUMO

PURPOSE: Vitamin C deficiency is associated with excess mortality in kidney transplant recipients (KTR). We aim to evaluate plasma vitamin C status at different post-transplantation moments and assess the main characteristics associated with vitamin C deficiency in KTR. METHODS: Plasma vitamin C was assessed in 598 KTR at 3-, 6-, 12-, 24-, and 60-months post-transplantation, 374 late KTR with a functioning graft ≥ 1 year, and 395 potential donors. Vitamin C deficiency was defined as plasma vitamin C ≤ 28 µmol/L. Diet was assessed by a 177-item food frequency questionnaire. Data on vitamin C-containing supplements use were extracted from patient records and verified with the patients. RESULTS: Vitamin C deficiency ranged from 46% (6-months post-transplantation) to 30% (≥ 1 year post-transplantation). At all time points, KTR had lower plasma vitamin C than potential donors (30-41 µmol/L vs 58 µmol/L). In cross-sectional analyses of the 953 KTR at their first visit ≥ 12 months after transplantation (55 ± 14 years, 62% male, eGFR 55 ± 19 mL/min/1.73 m2), the characteristics with the strongest association with vitamin C deficiency were diabetes and smoking (OR 2.67 [95% CI 1.84-3.87] and OR 1.84 [95% CI 1.16-2.91], respectively). Dietary vitamin C intake and vitamin C supplementation were associated with lower odds (OR per 100 mg/day 0.38, 95% CI 0.24-0.61 and OR 0.21, 95% CI 0.09-0.44, respectively). CONCLUSION: Vitamin C deficiency is frequent among KTR regardless of the time after transplantation, especially among those with diabetes and active smokers. The prevalence of vitamin C deficiency was lower among KTR with higher vitamin C intake, both dietary and supplemented. Further research is warranted to assess whether correcting this modifiable risk factor could improve survival in KTR.


Assuntos
Deficiência de Ácido Ascórbico , Ácido Ascórbico , Transplante de Rim , Humanos , Transplante de Rim/métodos , Transplante de Rim/efeitos adversos , Masculino , Deficiência de Ácido Ascórbico/epidemiologia , Estudos Transversais , Feminino , Pessoa de Meia-Idade , Estudos de Coortes , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/sangue , Adulto , Fatores de Risco , Bancos de Espécimes Biológicos/estatística & dados numéricos , Suplementos Nutricionais , Idoso , Prevalência
6.
Am Surg ; 90(8): 2132-2134, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38567434

RESUMO

Outcomes after adjustable gastric banding (AGB) were unsatisfactory and many devices need to be removed for dysphagia. Vitamin C and thiamin deficiency are rare conditions in industrialized countries. Patients undergoing AGB removal (90% for dysphagia) from 2021 to 2023 (laparoscopic 15 and robotic 5) were tested for vitamin C and thiamin levels. Twenty patients (8 m/12 f median aged 56 (range 33.6-79.4) were included. BMI at AGB removal was 39.7 (range 24.4-50.1) kg/m2. Only 20% of patients had normal thiamin levels, 30% had low levels, 20% were deficient, and 30% were critically low. Only 25% of patients had normal vitamin C levels, 40% had low levels, 25% were deficient, and 10% were critically low. One third of patients had HbA1c levels between 5.8 and 6.4 and 22% had levels >6.5; 60% of patients had hyperlipidemia. Adjustable gastric banding patients develop concerning rates of vitamin C and thiamin deficiency, and routine testing for levels is recommended.


Assuntos
Gastroplastia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Deficiência de Tiamina , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/sangue , Gastroplastia/métodos , Gastroplastia/efeitos adversos , Idoso , Remoção de Dispositivo , Deficiência de Ácido Ascórbico , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ácido Ascórbico/sangue
7.
BMC Pulm Med ; 24(1): 140, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38504249

RESUMO

BACKGROUND: In the early literature, unintentional vitamin C deficiency in humans was associated with heart failure. Experimental vitamin C deficiency in guinea pigs caused enlargement of the heart. The purpose of this study was to collect and analyze case reports on vitamin C and pulmonary hypertension. METHODS: We searched Pubmed and Scopus for case studies in which vitamin C deficiency was considered to be the cause of pulmonary hypertension. We selected reports in which pulmonary hypertension was diagnosed by echocardiography or catheterization, for any age, sex, or dosage of vitamin C. We extracted quantitative data for our analysis. We used the mean pulmonary artery pressure (mPAP) as the outcome of primary interest. RESULTS: We identified 32 case reports, 21 of which were published in the last 5 years. Dyspnea was reported in 69%, edema in 53% and fatigue in 28% of the patients. Vitamin C plasma levels, measured in 27 cases, were undetectable in 24 and very low in 3 cases. Diet was poor in 30 cases and 17 cases had neuropsychiatric disorders. Right ventricular enlargement was reported in 24 cases. During periods of vitamin C deficiency, the median mPAP was 48 mmHg (range 29-77 mmHg; N = 28). After the start of vitamin C administration, the median mPAP was 20 mmHg (range 12-33 mmHg; N = 18). For the latter 18 cases, mPAP was 2.4-fold (median) higher during vitamin C deficiency. Pulmonary vascular resistance (PVR) during vitamin C deficiency was reported for 9 cases, ranging from 4.1 to 41 Wood units. PVR was 9-fold (median; N = 5) higher during vitamin C deficiency than during vitamin C administration. In 8 cases, there was direct evidence that the cases were pulmonary artery hypertension (PAH). Probably the majority of the remaining cases were also PAH. CONCLUSIONS: The cases analyzed in our study indicate that pulmonary hypertension can be one explanation for the reported heart failure of scurvy patients in the early literature. It would seem sensible to measure plasma vitamin C levels of patients with PH and examine the effects of vitamin C administration.


Assuntos
Deficiência de Ácido Ascórbico , Ácido Ascórbico , Hipertensão Pulmonar , Deficiência de Ácido Ascórbico/complicações , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Humanos
8.
J Nutr Biochem ; 128: 109608, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38458474

RESUMO

Vitamin C (VitC) is maintained at high concentrations in the brain and is an essential micronutrient for brain function. VitC deficiency leads to neuropsychiatric scurvy, which is characterized by depression and cognitive impairment. However, the molecular mechanism by which mild VitC deficiency impairs brain function is currently unknown. In the present study, we conducted RNA sequencing analysis and found that a short-term VitC deficiency altered the brain transcriptome in ODS rats, which cannot synthesize VitC. Bioinformatic analysis indicated that VitC deficiency affected the expression of genes controlled by the glucocorticoid receptor in the brain. We confirmed an increased secretion of glucocorticoids from the adrenal gland during VitC deficiency. We found that non-neuronal cells, including microglia, which are resident immune cells in the brain, changed their transcriptional patterns in response to VitC deficiency. Immunohistochemical analysis revealed that the quiescent ramified microglia transform into the activated amoeboid microglia during three weeks of VitC deficiency. The morphological activation of microglia was accompanied by increased expression of proinflammatory cytokines such as interleukin-6 in the hippocampus. Furthermore, VitC deficiency decreased the number of newly born neurons in the dentate gyrus of the hippocampus, suggesting that VitC was required for adult neurogenesis that plays a crucial role in learning and memory. Our findings may provide insights into the molecular mechanisms underlying the maintenance of normal brain function by adequate levels of VitC.


Assuntos
Deficiência de Ácido Ascórbico , Encéfalo , Glucocorticoides , Microglia , Neurogênese , Transcriptoma , Animais , Microglia/metabolismo , Ratos , Encéfalo/metabolismo , Masculino , Glucocorticoides/metabolismo , Deficiência de Ácido Ascórbico/metabolismo , Receptores de Glucocorticoides/metabolismo , Receptores de Glucocorticoides/genética , Hipocampo/metabolismo , Ácido Ascórbico/metabolismo , Ácido Ascórbico/farmacologia
9.
Int J Paleopathol ; 45: 18-29, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38520801

RESUMO

OBJECTIVE: This study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. MATERIALS: 86 non-adult individuals were assessed from three early medieval sites. METHODS: Morphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20-40x magnification. RESULTS: A significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. CONCLUSIONS: In this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. SIGNIFICANCE: This study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. LIMITATIONS: Poor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. SUGGESTIONS FOR FURTHER RESEARCH: Future applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.


Assuntos
Deficiência de Ácido Ascórbico , Escorbuto , Humanos , Áustria , História Medieval , Feminino , Lactente , Masculino , Criança , Adolescente , Deficiência de Ácido Ascórbico/história , Deficiência de Ácido Ascórbico/patologia , Pré-Escolar , Escorbuto/história , Escorbuto/patologia , Adulto , Prevalência , Adulto Jovem , Paleopatologia , Recém-Nascido
10.
BMJ Case Rep ; 17(2)2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38417944

RESUMO

Scurvy is caused by vitamin C deficiency and is often thought of as an ancient malady. However, it still afflicts present-day patients with insufficient nutrition, excessive alcohol consumption and disorders of absorption. Scurvy is traditionally characterised by ecchymosis, petechiae, haemorrhages, poor wound healing, myalgias and arthralgias, but it can also present with non-specific symptoms, including mood changes, fatigue, malaise and dyspnoea. Although scurvy can present with signs of excess bleeding, it does not involve blood clotting. We present a case of concurrent scurvy and pulmonary embolism in which clinical presentation and laboratory findings mimicked a coagulation disorder, resulting in delayed diagnosis and excessive resource expenditure. This case underscores the importance of obtaining an early dietary and substance use history in patients with unexplained haematological symptoms. These crucial components of history-taking can significantly reduce invasive and costly tests, resulting in quicker diagnosis and enhanced patient outcomes.


Assuntos
Deficiência de Ácido Ascórbico , Púrpura , Escorbuto , Humanos , Escorbuto/diagnóstico , Escorbuto/etiologia , Deficiência de Ácido Ascórbico/complicações , Deficiência de Ácido Ascórbico/diagnóstico , Dieta , Hemorragia/complicações , Ácido Ascórbico/uso terapêutico
11.
Hosp Pediatr ; 14(2): e98-e103, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38234212

RESUMO

OBJECTIVES: Vitamin C deficiency in children commonly presents with musculoskeletal symptoms such as gait disturbance, refusal to bear weight, and bone or joint pain. We aimed to identify features that could facilitate early diagnosis of scurvy and estimate the cost of care for patients with musculoskeletal symptoms related to scurvy. METHODS: We conducted a retrospective chart review of patients at a single site with diagnostic codes for vitamin C deficiency, ascorbic acid deficiency, or scurvy. Medical records were reviewed to identify characteristics including presenting symptoms, medical history, and diagnostic workup. The Pediatric Health Information System was used to estimate diagnostic and hospitalization costs for each patient. RESULTS: We identified 47 patients with a diagnosis of scurvy, 49% of whom had a neurodevelopmental disorder. Sixteen of the 47 had musculoskeletal symptoms and were the focus of the cost analysis. Three of the 16 had moderate or severe malnutrition, and 3 had overweight or obesity. Six patients presented to an emergency department for care, 11 were managed inpatient, and 3 required critical care. Diagnostic workups included MRI, computed tomography, echocardiogram, endoscopy, lumbar puncture, and/or EEG. Across all patients evaluated, the cost of emergency department utilization, imaging studies, diagnostic procedures, and hospitalization totaled $470 144 (median $14 137 per patient). CONCLUSIONS: Children across the BMI spectrum, particularly those with neurodevelopmental disorders, can develop vitamin C deficiency. Increased awareness of scurvy and its signs and symptoms, particularly musculoskeletal manifestations, may reduce severe disease, limit adverse effects related to unnecessary tests/treatments, and facilitate high-value care.


Assuntos
Deficiência de Ácido Ascórbico , Escorbuto , Humanos , Criança , Escorbuto/complicações , Escorbuto/diagnóstico , Ácido Ascórbico , Estudos Retrospectivos , Imageamento por Ressonância Magnética
12.
ANZ J Surg ; 94(1-2): 229-233, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38291316

RESUMO

BACKGROUND: Spondylodiscitis can be a disabling and life-threatening infection. Ascorbic Acid is crucial for neutrophil function and collagen formation. Its association and clinical relevance in spondylodiscitis has not been previously examined. AIMS: To determine the prevalence, characteristics, and clinical outcomes of spondylodiscitis patients with Ascorbic Acid deficiency. METHODS: Sixty-eight consecutive patients admitted with spondylodiscitis, between December 2021 and August 2023 were included. Clinical characteristics, Ascorbic Acid levels and clinical outcomes were evaluated. RESULTS: Thirty-seven patients had Ascorbic Acid levels taken during admission. The median initial Ascorbic Acid level was 15 µmol/L with an IQR 6.5-27 µmol/L. Depletion defined as <28 µmol/L was present in 78% of patients. Deficiency defined as ≤11 µmol/L was present in and 46% of patients. Patients with depletion were more likely to require Intensive Care Admission (absolute risk increase = 24.1%; 2.6%-45.7%). Fifteen patients had repeat serum levels taken during admission with median increase of 17 µmol/L and an IQR 0-26 µmol/L. Patients that received supplementation had a significantly greater increase in Ascorbic Acid levels compared with those that did not receive supplementation (P = 0.002). CONCLUSION: Ascorbic acid deficiency is highly prevalent amongst spondylodiscitis patients. Depletion was associated with worse outcomes. Replacement significantly increased serum levels in comparison to standard hospital diet. The clinical significance of replacement remains to be evaluated.


Assuntos
Deficiência de Ácido Ascórbico , Discite , Humanos , Discite/epidemiologia , Deficiência de Ácido Ascórbico/complicações , Deficiência de Ácido Ascórbico/epidemiologia , Ácido Ascórbico/uso terapêutico , Hospitalização , Prevalência
13.
Pediatr Nephrol ; 39(4): 1135-1142, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37889280

RESUMO

BACKGROUND: Vitamin C is a potent scavenger of reactive oxygen species, which induce neutrophil extracellular trap (NET) formation. NETs are a major source of autoantigens and are involved in systemic lupus erythematosus (SLE) pathogenesis. We determined vitamin C status and evaluated NET formation and inflammatory cytokines in children with lupus nephritis. METHODS: Serum vitamin C was measured in 46 patients (82.6% females, mean age 14.5 ± 0.3 years). Vitamin C levels < 0.3 mg/dL indicated vitamin C deficiency. Patients were divided into two groups according to serum vitamin C levels: normal and low (< 0.3 mg/dL). We compared NET formation and levels of SLE-related cytokines, including interleukin (IL)-8, IL-10, and tumor necrosis factor-α (TNF-α), between groups. NET formation was determined through measurement of serum citrullinated histone 3 levels and mRNA expression of peptidyl arginine deiminase-4 and assessment of the percentage of neutrophils with NETs by immunofluorescence. RESULTS: Nine patients (19.6%) had vitamin C deficiency. Kidney pathology assessment at disease onset revealed that histological activity index and number of kidney biopsies containing crescentic glomeruli were higher in vitamin C-deficient patients, but chronicity index was not. NET formation and serum IL-8 were more prominent in vitamin C-deficient patients. Serum IL-8 levels were 12.9 ± 5.2 pg/mL in low vitamin C group and 5.2 ± 0.9 pg/mL in normal vitamin C group (p = 0.03). Serum IL-10 and TNF-α were similar between groups. CONCLUSIONS: Our study demonstrated correlation among vitamin C deficiency, increased NET formation, and IL-8 upregulation in children with lupus nephritis. A prospective study is required to evaluate cause‒effect relationships of vitamin C status, NET formation and IL-8 expression.


Assuntos
Deficiência de Ácido Ascórbico , Armadilhas Extracelulares , Interleucina-8 , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Adolescente , Criança , Feminino , Humanos , Masculino , Ácido Ascórbico , Deficiência de Ácido Ascórbico/complicações , Citocinas/metabolismo , Armadilhas Extracelulares/metabolismo , Interleucina-10/metabolismo , Interleucina-8/metabolismo , Lúpus Eritematoso Sistêmico/metabolismo , Lúpus Eritematoso Sistêmico/patologia , Fator de Necrose Tumoral alfa/metabolismo
14.
Nutr Clin Pract ; 39(1): 235-245, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37294371

RESUMO

Hypovitaminosis C is prevalent in critically ill patients. Continuous renal replacement therapy (CRRT) clears vitamin C, increasing the risk for vitamin C deficiency. However, recommendations for vitamin C supplementation in critically ill patients receiving CRRT vary widely, from 250 mg/day to 12 g/day. This case report describes a patient who developed a severe vitamin C deficiency after prolonged CRRT despite receiving ascorbic acid (450 mg/day) supplementation in her parenteral nutrition. This report summarizes recent research investigating vitamin C status in critically ill patients receiving CRRT, discusses the patient case, and provides recommendations for clinical practice. In critically ill patients receiving CRRT, the authors of this manuscript suggest providing at least 1000 mg/day of ascorbic acid to prevent vitamin C deficiency. Baseline vitamin C levels should be checked in patients who are malnourished and/or have other risk factors for vitamin C deficiency, and vitamin C levels should be monitored thereafter every 1-2 weeks.


Assuntos
Injúria Renal Aguda , Deficiência de Ácido Ascórbico , Terapia de Substituição Renal Contínua , Feminino , Humanos , Estado Terminal/terapia , Deficiência de Ácido Ascórbico/complicações , Ácido Ascórbico/uso terapêutico , Terapia de Substituição Renal , Injúria Renal Aguda/terapia
15.
Sci Rep ; 13(1): 21396, 2023 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-38049537

RESUMO

The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730-580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.


Assuntos
Deficiência de Ácido Ascórbico , Escorbuto , Humanos , Escorbuto/diagnóstico , Escorbuto/patologia , Ácido Ascórbico , Europa (Continente) , Dieta , Arqueologia
16.
JBJS Case Connect ; 13(4)2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37889997

RESUMO

CASE: We present a 17-month-old girl with postencephalitic sequelae only on high-calorie cereal milk through a nasogastric tube. She presented with a 3-week history of swelling and decreased lower limb movements. Synovial fluid analysis ruled out septic arthritis. Plain radiograph and magnetic resonance imaging (MRI) were suggestive of scurvy. She was diagnosed to have pseudoparalysis secondary to scurvy. She was started on vitamin C supplements, after which she showed good clinical improvement. CONCLUSION: This case report is to re-emphasize the need for awareness of the possibility of scurvy in children with poor nutritional status due to feeding difficulties.


Assuntos
Deficiência de Ácido Ascórbico , Escorbuto , Feminino , Humanos , Pré-Escolar , Lactente , Escorbuto/complicações , Ácido Ascórbico/uso terapêutico , Deficiência de Ácido Ascórbico/complicações , Imageamento por Ressonância Magnética , Radiografia
17.
Clin Nutr ESPEN ; 57: 106-116, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37739644

RESUMO

OBJECTIVE: Vitamin C deficiency is common in patients with chronic intestinal failure. Risk factors are poorly understood and guidelines for monitoring largely based on expert opinion. The aim of this study was to describe patterns of vitamin C deficiency in patients on long-term home parenteral support (HPS). DESIGN: A retrospective review of a prospectively collated database for 236 HPS patients cared for in Glasgow, from 1998 to 2023, was interrogated for subjects with paired CRP and vitamin C measurements. Following analysis of the impact of CRP on vitamin C levels, further review of associated clinical, micronutrient and dietetic details in those with a paired CRP <5 mg L-1 were used to identify risk factors for hypoascorbataemia. RESULTS: 1527 recorded episodes with paired CRP and vitamin C measurements were analysed. Period prevalence of hypoascorbataemia was between 29.3 and 52.5%, depending on choice of the lower reference range for vitamin C as either 15 µmol L-1 or 26.1 µmol L-1. The influence of CRP appeared most significant early during HPS with other factors, including extensive mucosal disease, precedent surgery or presence of a colostomy identified as more significant on multivariate analysis for those on long-term HPS (OR 1.3261-1.5609, 1.0752-1.1008, and 0.6260-0.6663 for threshold vitamin C of 26.1 or 15 µmol L-1 respectively). CONCLUSION: Vitamin C may present differently in long term HPS patients in comparison to those in the acute phase of illness. An evidence based approach to guideline development should be promoted to reduce morbidity.


Assuntos
Deficiência de Ácido Ascórbico , Dietética , Humanos , Ácido Ascórbico , Vitaminas , Deficiência de Ácido Ascórbico/epidemiologia , Bases de Dados Factuais
18.
Pediatr Cardiol ; 44(7): 1487-1494, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37498330

RESUMO

Vitamin C levels are known rapidly decrease in adult critical illness. Vitamin C scavenges free radicals, provides critical protection of the endothelial barrier, and improves endothelial responsiveness to catecholamines. Children with congenital heart disease and undergoing cardiac surgery might be at increased risk for low circulating vitamin C levels. A prospective single-center observational study investigated perioperative changes in vitamin C levels in critically ill Children who underwent congenital heart surgery using CPB. Vitamin C serum levels were collected preoperatively and postoperatively (upon admission to the ICU, 24 and 72 h). Linear mixed-effect model was used to estimate mean circulating concentration of vitamin C and to estimate changes in concentration over time. Primary outcome was change in circulating levels of vitamin C before and after CPB. Secondary outcomes were hospital length of stay (LOS), acute kidney injury (AKI), and illness severity. Forty-one patients with a median age of 4.5 [interquartile range (IQR) 2.6-65.6] months at the time of surgery were consented and enrolled. Median CPB duration was 130 [90-175] minutes, and hospital LOS was 9.1 [5.2-19] days. Mean vitamin C levels (µmol/L) before CPB, at PICU admission, 24 h, and 72 h were 82.0 (95% CI 73.4-90.7), 53.4 (95% CI 44.6,62.0), 55.1 (95% CI 46.3,63.8), and 59.2 (95% CI 50.3,68.1), respectively. Upon postoperative admission to the PICU, vitamin C levels decreased by 28.7 (95% CI 20.6-36.8; p < 0.001) µmol/L, whereas levels at 24 and 72 h recovered and did not differ substantially from concentrations reported upon PICU admission (p > 0.15). Changes in vitamin C concentration were not associated with CPB time, STAT mortality category, age, or PIM3. Three patients had post-CPB hypovitaminosis C or vitamin C deficiency. Reduction in vitamin C levels was not associated with hospital LOS (p = 0.673). A 25 µmol/L decrease in vitamin C levels upon PICU admission was associated with developing AKI (aOR = 3.65; 95% CI 1.01-18.0, p = 0.049). Pediatric patients undergoing cardiac surgery with CPB showed decreased vitamin C levels during the immediate postoperative period. Effects of hypovitaminosis C and vitamin C deficiency in this population remain unclear.


Assuntos
Injúria Renal Aguda , Deficiência de Ácido Ascórbico , Criança , Humanos , Lactente , Pré-Escolar , Ponte Cardiopulmonar/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Deficiência de Ácido Ascórbico/complicações , Ácido Ascórbico , Injúria Renal Aguda/etiologia
19.
J Bone Miner Res ; 38(10): 1509-1520, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37493605

RESUMO

Vitamin C (VitC) is essential for bone health, and low VitC serum levels increase the risk for skeletal fractures. If and how VitC affects bone mineralization is unclear. Using micro-computed tomography (µCT), histologic staining, as well as quantitative backscattered electron imaging (qBEI), we assessed the effects of VitC on femoral structure and microarchitecture, bone formation, and bone mineralization density distribution (BMDD) in the VitC incompetent Gulo-/- mouse model and wild-type mice. In particular, VitC-supplemented, 20-week-old mice were compared with age-matched counterparts where dietary VitC intake was excluded from week 15. VitC depletion in Gulo-/- mice severely reduced cortical thickness of the diaphyseal shaft and bone volume around the growth plate (eg, bone volume of the primary spongiosa -43%, p < 0.001). Loss of VitC also diminished the amount of newly formed bone tissue as visualized by histology and calcein labeling of the active mineralization front. BMDD analysis revealed a shift to higher calcium concentrations upon VitC supplementation, including higher average (~10% increase in female VitC deficient mice, p < 0.001) and peak calcium concentrations in the epiphyseal and metaphyseal spongiosa. These findings suggest higher bone tissue age. Importantly, loss of VitC had significantly more pronounced effects in female mice, indicating a higher sensitivity of their skeleton to VitC deficiency. Our results reveal that VitC plays a key role in bone formation rate, which directly affects mineralization. We propose that low VitC levels may contribute to the higher prevalence of bone-degenerative diseases in females and suggest leveraging this vitamin against these conditions. © 2023 American Society for Bone and Mineral Research (ASBMR).


Assuntos
Deficiência de Ácido Ascórbico , Mustelidae , Masculino , Camundongos , Animais , Feminino , Cálcio/farmacologia , Microtomografia por Raio-X , Osso e Ossos/diagnóstico por imagem , Densidade Óssea , Calcificação Fisiológica , Ácido Ascórbico/farmacologia
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