Chinese expert consensus on metformin in clinical practice: 2023 update / 中华内科杂志

Metformin has robust glucose-lowering effects and multiple benefits beyond hypoglycemic effects. It can also be used in combination with various hypoglycemic drugs and is cost effective. In the absence of the strong indications of glucagon like peptide-1 receptor agonist (GLP-1RA) or sodium glucose cotransporter 2 inhibitor (SGLT2i) for cardiorenal protection, metformin should be used as the first-line pharmacological treatment for newly diagnosed type 2 diabetes and the basic drug for the combined treatment of hypoglycemic drugs. Metformin does not increase the risk of liver and kidney function damage, but patients with renal dysfunction should adjust the dosage of metformin based on estimated glomerular filtration rate (eGFR) levels. Moreover, the correct use of metformin does not increase the risk of lactic acidosis. Because long-term use of metformin is associated with a decrease in vitamin B12 levels, patients with insufficient intake or absorption of vitamin B12 should be regularly monitored and appropriately supplemented with vitamin B12. In view of the new progress made in the basic and clinical research related to metformin, the consensus updating expert group updated the consensus on the basis of the Expert Consensus on the Clinical Application of Metformin (2018 Edition).

Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents.@*METHODS@#We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study.@*RESULTS@#Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44-0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43-0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43-0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.13-1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo.@*CONCLUSIONS@#Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence.@*REGISTRATION@#PROSPERO, No. CRD42022296376.

Changes and clinical significance of erythrocyte lifespan in megaloblastic anemia / 中华内科杂志

Objective: To investigate the lifespan of erythrocytes in megaloblastic anemia (MA) patients. Methods: A prospective cohort study analysis. Clinical data from 42 MA patients who were newly diagnosed at the Department of Hematology, Lanzhou University Second Hospital from January 2021 to August 2021 were analyzed, as were control data from 24 healthy volunteers acquired during the same period. The carbon monoxide breath test was used to measure erythrocyte lifespan, and correlations between erythrocyte lifespan and laboratory test indexes before and after treatment were calculated. Statistical analysis included the t-test and Pearson correlation. Results: The mean erythrocyte lifespan in the 42 newly diagnosed MA patients was (49.05±41.60) d, which was significantly shorter than that in the healthy control group [(104.13±42.62) d; t=5.13,P=0.001]. In a vitamin B12-deficient subset of MA patients the mean erythrocyte lifespan was (30.09±15.14) d, and in a folic acid-deficient subgroup it was (72.00±51.44) d, and the difference between these two MA subsets was significant (t=3.73, P=0.001). The mean erythrocyte lifespan after MA treatment was (101.28±33.02) d, which differed significantly from that before MA treatment (t=4.72, P=0.001). In MA patients erythrocyte lifespan was positively correlated with hemoglobin concentration (r=0.373), and negatively correlated with total bilirubin level (r=-0.425), indirect bilirubin level (r=-0.431), and lactate dehydrogenase level (r=-0.504) (all P<0.05). Conclusions: Erythrocyte lifespan was shortened in MA patients, and there was a significant difference between a vitamin B12-deficient group and a folic acid-deficient group. After treatment the erythrocyte lifespan can return to normal. Erythrocyte lifespan is expected to become an informative index for the diagnosis and treatment of MA.

Associations between vitamin D levels and systemic lupus erythematosus risk:a Mendelian randomized study / 中华预防医学杂志

Objective: To explore the causal effects of the serum Vitamin D levels on the risk of systemic lupus erythematosus (SLE). Methods: A two-sample Mendelian randomization (MR) study was performed to infer the causality. Three Genome-wide association studies (GWAS) for circulating Vitamin D levels, including 25-hydroxyvitamin D [25(OH)D], 25-hydroxyvitamin D3 [25(OH)D3] and C3-epimer of 25-hydroxyvitamin D3 [C3-epi-25(OH)D3] published in 2020, and one GWAS for SLE published in 2015 were utilized to analyze the causal effects of the serum Vitamin D levels on the risk of SLE. MR analyses were conducted using the inverse-variance weighted method (IVW), weighted median, MR-Egger methods, MR-pleiotropy residual sum and outlier (MR-PRESSO) method. Results: 34, 29 and 6 SNPs were respectively selected as instrumental variables to analyze the causal association of total 25 (OH) D level, 25 (OH) D3 level and C3-epi-25 (OH) D3 level with the risk of SLE. The MR results showed that each standard deviation decrease in the level of 25(OH)D3 would result in 14.2% higher risk of SLE (OR, 0.858; 95%CI, 0.753-0.978; P=0.022). The levels of 25(OH)D and C3-epi-25(OH)D3 had null associations with risk of SLE (OR, 0.849; 95%CI, 0.653-1.104; P=0.222; OR, 0.904; 95%CI, 0.695-1.176; P=0.452). Conclusion: This study have identified a causal effect of 25(OH)D3 on increased risk of SLE. These findings highlighted the significance of active monitoring and prevention of SLE in population of low Vitamin D levels.

Association of plasma vitamin B12 level with plasma uric acid level among the elderly over 65 years old in 9 longevity areas of China / 中华预防医学杂志

Objective: To investigate the association of plasma vitamin B12 level with plasma uric acid level among the elderly over 65 in 9 longevity areas of China. Methods: The elderly over 65 years old with complete information on plasma vitamin B12 and plasma uric acid from Healthy Aging and Biomarkers Cohort Study (2017 to 2018) were recruited in this study. Information on socio-demographic characteristics, life styles, diet intake, and health status were collected by questionnaire and physical examination; and fasting venous blood was collected to detect the levels of plasma vitamin B12, uric acid and other indicators. Multiple linear regression models were used to analyze the association of plasma vitamin B12 level per interquartile range increase with plasma uric acid level. The association trend of plasma vitamin B12 level with plasma uric acid level was described by restrictive cubic splines fitting multiple linear regression model. Multiple logistic regression models were used to analyze the association of plasma vitamin B12 level stratified by quartiles with hyperuricemia. Results: A total of 2 471 participants were finally included in the study, the age was (84.88±19.76) years old, of which 1 291 (52.25%) were female. The M (Q1, Q3) level of plasma vitamin B12 was 294 (203, 440) pg/ml and the plasma uric acid level was (341.01±90.46) μmol/L. A total of 422 participants (17.08%) were defined with hyperuricemia. The results of multiple linear regression model showed that there was a positive association of plasma vitamin B12 level with plasma uric acid level after adjustment for covariates (P<0.05). An IQR increase in plasma vitamin B12 (237 pg/ml) was associated with a 6.36 (95%CI: 2.00-10.72) μmol/L increase in the plasma uric acid level. The restrictive cubic splines curve showed a positive linear association of log-transformed plasma vitamin B12 with uric acid level (P<0.001). Conclusion: There is a positive association of plasma vitamin B12 level with plasma uric acid level among the elderly over 65 years old in 9 longevity areas of China.

Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between serum 25(OH)D and anti-Müllerian hormone (AMH) among infertile females and their predictive impacts on in vitro fertilization and embryo transfer pregnancy outcome.@*METHODS@#Totally 756 infertile females treated with assisted reproductive technology were enrolled and divided into three groups according to their vitamin D levels (group A with serum 25(OH)D≤10 μg/L, group B with serum (10-20) μg/L, and group C with serum ≥20 μg/L). The serum AMH levels were detected. The differences among the groups were analyzed, as well as the correlation between vitamin D levels and serum AMH levels in various infertility types (fallopian tube/male factor, polycystic ovary syndrome (PCOS), ovulation disorders excluded PCOS, endometriosis, unexplained infertility, and others). Also, the predictive roles of vitamin D and AMH in pregnancy outcome in all the infertile females were discussed.@*RESULTS@#(1) 87.7% of the enrolled females were insufficient or deficient in vitamin D. (2) The serum AMH levels in the three groups with different vitamin D levels were 1.960 (1.155, 3.655) μg/L, 2.455 (1.370, 4.403) μg/L, 2.360 (1.430, 4.780) μg/L and there was no significant difference in serum AMH levels among the three groups (P>0.05). (3) Serum 25(OH)D and AMH levels presented seasonal variations (P < 0.05). (4) There was no prominent correlation between the serum AMH level and serum 25(OH)D level in females of various infertility types after adjusting potential confounding factors [age, body mass index (BMI), antral follicle count (AFC), vitamin D blood collection season, etc.] by multiple linear regression analysis (P>0.05). (5) After adjusting for confounding factors, such as age, BMI, number of transplanted embryos and AFC, the results of binary Logistics regression model showed that in all the infertile females, the serum AMH level was an independent predictor of biochemical pregnancy outcome (P < 0.05) while the serum 25(OH)D level might not act as a prediction factor alone (P>0.05). In the meanwhile, the serum 25(OH)D level and serum AMH level were synergistic predictors of biochemical or clinical pregnancy outcome (P < 0.05).@*CONCLUSION@#Based on the current diagnostic criteria, most infertile females had vitamin D insufficiency or deficiency, but there was not significant correlation between serum 25(OH)D and ovarian reserve. While vitamin D could not be used as an independent predictor of pregnancy outcome in infertile females, the serum AMH level could predict biochemical pregnancy outcome independently or jointly with vitamin D.

Vitamina D: Apontamentos históricos e sua importância para manutenção da saúde / Vitamin D: Historical notes and its importance for health maintenance / Vitamina D: apuntes históricos y su importancia para el mantenimiento de la salud

Heródoto, do grego Ἡρόδοτος, viveu até onde se conhece entre 485 a 425 a.C., perseverando seu interesse intelectual junto as atividades de historiador e de geógrafo, sendo reconhecido enquanto "pai da história" e, tendo analisado e escrito sobre a invasão da Pérsia ao estado da Grécia.1,2,3 Em seus escritos, Heródoto pode observar que os guerreiros persas possuíam os seus "crânios moles", por conta dos mesmos, segundo suas observações, "utilizarem turbante" e, desta forma, não tendo acesso a exposição aos raios solares.

Diferentes formas de presentación de la anemia megaloblástica en el lactante / Different forms of presentation of megaloblastic anemia in the infant

Introducción: La anemia megalobástica es un trastorno madurativo de los precursores eritroides y mieloides causado por déficit de vitamina B12, ácido fólico, o ambos. Es poco común en la infancia y su prevalencia se desconoce por ser una enfermedad poco frecuente. Objetivo: Describir diferentes formas de presentación de la anemia megaloblástica en el lactante. Presentación de casos: Se presentan dos casos de lactantes, en el caso 1 la madre tuvo una alimentación precaria durante el embarazo y la lactancia, prolongó la lactancia materna exclusiva más de 6 meses. La paciente comenzó a perder las habilidades ganadas en el desarrollo psicomotor y presentó trastornos neurológicos graves, por lo que se consideró que se trataba de una enfermedad progresiva del sistema nervioso central. En el caso 2, en el que se prolongó la lactancia materna exclusiva, apareció trombocitopenia, por lo que se sospechó una enfermedad hematológica maligna. Resultados: En ambos casos después de realizar diversas pruebas para descartar enfermedades neurológicas (caso 1) y enfermedades hematológicas (caso 2) se diagnosticó anemia megaloblástica por déficit de vitamina B12 por disminución en la ingesta y una reserva limítrofe en la madre que lacta. En ambos casos los síntomas desaparecieron con el tratamiento vitamínico sustitutivo. Conclusiones: En el lactante la anemia megaloblástica se puede presentar de diferentes formas clínicas a pesar de tener la misma causa, un déficit en la ingesta y una reserva escasa de la madre durante el embarazo y lactancia(AU)

Introduction: Megaloblastic anemia is a maturing disorder of the erythroid and myeloid precursors caused by deficiency of vitamin B12, folic acid, or both. It is uncommon in childhood and its prevalence is unknown because it is a rare disease. Objective: To describe different forms of presentation of megaloblastic anemia in infants. Presentation of cases: Two cases of infants are presented, in case 1 the mother had a precarious diet during pregnancy and lactation, and prolonged exclusive breastfeeding more than 6 months. The patient began to lose the skills gained in psychomotor development and presented severe neurological disorders, so it was considered that it was a progressive disease of the central nervous system. In case 2, in which exclusive breastfeeding was prolonged, thrombocytopenia appeared, so a malignant hematological disease was suspected. Results: In both cases, after performing various tests to rule out neurological diseases (case 1) and hematological diseases (case 2), megaloblastic anemia was diagnosed due to vitamin B12 deficiency due to a decrease in intake and a borderline reserve in the breastfeeding mother. In both cases the symptoms disappeared with vitamin replacement therapy. Conclusions: In the infant, megaloblastic anemia can occur in different clinical ways despite having the same cause, a deficit in intake and a low reserve of the mother during pregnancy and lactation(AU)

Norma técnica de farmacovigilancia / Pharmacovigilance technical standard

La presente Norma establece las disposiciones para la organización y operación de los procesos técnicos y administrativos relacionados a la farmacovigilancia de productos farmacéuticos, productos naturales, suplementos vitamínicos, vacunas, homeopáticos y donativos de los antes mencionados fabricados, importados, exportados, comercializados, distribuidos y dispensados en el territorio nacional. Es aplicable a todas las personas naturales o jurídicas prestadoras de servicios de salud, así como aquellas que desarrollen procesos relacionados con la fabricación, importación, exportación, comercialización, distribución, prescripción, dispensación y administración en el territorio nacional de productos farmacéuticos, productos naturales, suplementos vitamínicos, vacunas, homeopáticos y donativos de los antes mencionados

This Standard establishes the provisions for the organization and operation of the technical and administrative processes related to the pharmacovigilance of pharmaceutical products, natural products, vitamin supplements, vaccines, homeopathic products and donations of the aforementioned manufactured, imported, exported, marketed, distributed and dispensed in the national territory. It is applicable to all natural or legal persons providing health services, as well as those that develop processes related to the manufacture, import, export, marketing, distribution, prescription, dispensing and administration in the national territory of pharmaceutical products, natural products, vitamin supplements, vaccines, homeopathic and donations of the aforementioned

Variation in phenolic, antioxidant and vitamin amounts among some medicinal plants and investigation by PCA analysis: Lamiaceae family / Variación en las cantidades de fenoles, antioxidantes y vitaminas entre algunas plantas medicinales e investigación poranálisis PCA: familia Lamiaceae

Aromatic and medicinal plants are of great importance to determine the contents of the active compounds of plant origin and to evaluate them depending on variety and climate factors in order to determine the phenolic, antioxidant enzyme activity, vitamin contents in species belonging to the Lamiaceae family. Examination of the characteristics of different species, the highest peroxidase (POD) enzyme activity, ascorbate peroxidase (AxPOD), total antioxidant (TA), malondialdehyte (MDA), caffeic acids (CA), vitamin C contents,and chloric acid (ChA) were obtained in the M. longifoliaspecies. The highest vitamin E and catalase (CAT) were determined in the S. hortensisspecies but the highest total phenolic (TP), superoxide dismutase (SOD) enzyme, hydrogen peroxide (H2O2) and chlorogenic acid (ChgA) were determined in the S. spicigeraspecies. As a result of PCA analysis, it can be said that Mentha longifolia(L.) Hudson and Satureja spicigeraspecies have significant value in terms of biochemical and phenolic content.

Las plantas aromáticas y medicinales son de gran importancia para determinar el contenido de los compuestos activos de origen vegetal y evaluarlos en función de la variedad y factores climáticos con el fin de determinar la actividad enzimática fenólica, antioxidante, contenido vitamínico en especies pertenecientes a la familia Lamiaceae. El examen de las características de diferentes especies, la mayor actividad enzimática de peroxidasa (POD), ascorbato peroxidasa (AxPOD), antioxidante total (TA), malondialdehído (MDA), ácidos cafeicos (CA), contenido de vitamina C y ácido clorhídrico (ChA) se obtuvieron en la especie M. longifolia. La mayor cantidad de vitamina E y catalasa (CAT) se determinó en la especie S. hortensis, pero la mayor cantidad total de enzima fenólica (TP), superóxido dismutasa (SOD), peróxido de hidrógeno (H2O2) y ácido clorogénico (ChgA) se determinó en la especie S. spicigera. Como resultado del análisis de PCA, se puede decir que las especies Mentha longifolia(L.) Hudson y Satureja spicigeratienen un valor significativo en términos de contenido bioquímico y fenólico.

Suplemento alimentar de vitamina C: fiscalização durante o período de adequação à nova legislação / Vitamin C dietary supplement: inspection during adequacy period of new legislation

Os suplementos à base de vitamina C são amplamente consumidos pela população, evidenciando a importância da fiscalização desses produtos. Em julho de 2018, a ANVISA (Agência Nacional de Vigilância Sanitária) publicou as novas regulamentações sobre suplementos alimentares, estabelecendo-se o prazo de 60 meses para as empresas se adequarem a essas normas. O presente trabalho teve como objetivo determinar os teores de vitamina C, comparar os valores analisados com os declarados na informação nutricional e avaliar os dizeres de rotulagem em produtos à base dessa vitamina. Os teores de vitamina C foram determinados por titulação potencio métrica e as análises de rotulagem foram realizadas com base nas legislações da ANVISA em doze amostras de suplementos colhidos pelas Vigilâncias Sanitárias do Estado de São Paulo. Os teores de vitamina C avaliados estavam de acordo com os declarados na informação nutricional do rótulo, com exceção de uma amostra que apresentou teor abaixo do valor declarado. Em relação aos dizeres de rotulagem, sete amostras (58%) apresentaram um ou mais itens em desacordo com a legislação, mostrando a necessidade de monitoramento constante desse tipo de produto. O trabalho representa um estudo preliminar de avaliação dos suplementos no período de adequação às novas regulamentações (AU).

Vitamin C-based supplements are widely consumed by the population, highlighting the importance of monitoring these products. In July 2018, the ANVISA (National Health Surveillance Agency) published new regulations for dietary supplements,setting a 60 months deadline for companies to comply with these standards.The objective of the present work was to evaluate the contents of vitamin C, and compare the analyzed/real values with those reported on the nutrition facts label, and to evaluate the labeling of vitamin supplements. Vitamin C contents were determined by potentiometric titration, and labeling analysis were performed based on ANVISA legislation in twelve samples of supplements collected by the Sanitary Surveillance of the State of São Paulo.The contents of vitamin C were in accordance with those declared in the nutritional information on the label, with the exception of one sample that presented content below the declared value. Regarding the labeling analysis, seven samples (58%) presented one or more items in disagreement with the legislation, showing the need for constant monitoring of this type of product.The work represents a preliminary study to evaluate the supplements in the adequacy period of new regulations (AU).

Alergia a frutos do mar: principais desafios na alimentação e soluções desenvolvidas por alunos do curso de nutrição e gastronomia / Seafood allergy: main challenges in their diet and solutions developed by students of the nutrition and gastronomy course

A alergia alimentar caracteriza-se por uma reação adversa a um determinado alimento, envolvendo um mecanismo imunológico. Uma das alergias mais comuns encontradas atualmente é a alergia a frutos do mar, a qual se baseia em uma hipersensibilidade a animais desse grupo. O objetivo desta pesquisa é identificar os desafios expostos na alimentação de alérgicos a frutos do mar e formular soluções para essa população baseadas em alimentos nutricionalmente substitutos. Sendo realizado em três etapas: investigação inicial, construção de conceitos e planejamento de uma ação com orientações nutricionais. De acordo com as dificuldades encontradas na alimentação dessa parcela populacional, realizaram-se diferentes preparações, com nutrientes como ômega-3, proteínas, vitaminas do complexo B, zinco, ferro, potássio, magnésio, iodo e selênio, os quais também são encontrados nos frutos do mar, a fim de evitar possíveis contaminações cruzadas e garantir seu aporte nutricional em alimentos substitutos. Foi possível concluir que os alérgicos aos frutos do mar não apresentam uma interferência significativa em sua qualidade de vida, tendo um impacto nutricional pequeno, visto que por meio da alimentação existem outras fontes, necessitando somente de alguns cuidados no dia a dia em virtude das consequências de uma possível contaminação.

Food allergy is characterized by an adverse reaction to a given food, involving an immunological mechanism. One of the most common allergies currently found is seafood allergy, which is based on hypersensitivity to animals in this group. The objective of this research is to identify the challenges exposed in the feeding of seafood allergies and formulate solutions for this population based on nutritionally substitute foods. Being carried out in 3 stages, initial investigation, construction of concepts and planning of an action with nutritional guidance. According to the difficulties encountered in feeding this portion of the population, different preparations were carried out, with nutrients such as: ômega-3, proteins, B vitamins, zinc, iron, potassium, magnesium, iodine and selenium. Which are also found in seafood. In order to avoid possible cross-contamination and ensure their nutritional intake in substitute foods. It was possible to conclude that seafood allergies do not present a significant interference in their quality of life, having a small nutritional impact, since through food there are other sources, requiring only some care on a daily basis due to the consequences of possible contamination.

Impact of supplemental vitamins and natural honey for treatment of COVID-19: A review

Abstract The main aim of the paper is to assess whether vitamin C, vitamin D, and natural honey can be administered in the course of the COVID-19 pandemic for promising in line methods with recent evidence. Both systematic literature and clinical trial identification were conducted by searching various databases. A total 58 articles and 29 clinical trials were selected wherein 11 for vitamin C, 16 for vitamin D, and 2 for natural honey were identified for analysis. The high doses of vitamin C (i.e. '200 mg/kg body weight/day, divided into 4 doses') has been found to reduce COVID-19 lung damage, various flu infections. Additionally, the high doses of vitamin C can shorten around 7.8% stay in the intensive care unit. At the same time, vitamin D can effectively protect from lung injury and acute respiratory infections whereas vitamin D deficiency severely affects 75% of the institutionalized people (serum 25(OH) D < 25 nmol/L). Meanwhile, natural honey which contains proteins (0.1-0.4%); ash (0.2%); water (15-17%) has potential antiviral effects and the ability to improve immunity. Therefore, the administration of vitamins and honey is the promising evidence-based approach for reducing fatalities, saving lives, and bringing the COVID-19 pandemic to a rapid end. It is believed that the utilization of vitamin C, vitamin D, and natural honey with the current treatment may be effective in treating COVID-19-caused fatal complications such as pneumonia. Therefore, high-level clinical studies are required on COVID-19 to administrate the effects of vitamins and natural honey

Levels of fat-soluble vitamins A, D, and E and their influencing factors in children with obesity / 中国当代儿科杂志

OBJECTIVES@#To investigate the levels of fat-soluble vitamins A, D, and E in children with obesity and their influencing factors.@*METHODS@#A total of 273 children with obesity who attended the Department of Clinical Nutrition, Xi'an Children's Hospital, from January 2019 to April 2021 were enrolled as the obesity group. A total of 226 children with normal body weight who underwent physical examination during the same period were enrolled as the control group. Anthropometric parameters and body composition were measured for both groups, and the serum concentrations of vitamins A, D, and E were also measured.@*RESULTS@#Compared with the control group, the obesity group had significantly higher serum levels of vitamin A [(1.32±0.21) μmol/L vs (1.16±0.21) μmol/L, P<0.001] and vitamin E [(9.3±1.4) mg/L vs (8.3±1.2) mg/L, P<0.001] and a significant reduction in the level of 25-hydroxyvitamin D [(49±22) nmol/L vs (62±24) nmol/L, P<0.001]. In the obesity group, the prevalence rates of marginal vitamin A deficiency, vitamin D deficiency/insufficiency, and vitamin E insufficiency were 5.5% (15/273), 56.8% (155/273), and 4.0% (11/273), respectively. After adjustment for body mass index Z-score and waist-to-height ratio, serum vitamin A level was positively correlated with age (P<0.001), while vitamins E and 25-hydroxyvitamin D levels were negatively correlated with age in children with obesity (P<0.001). After adjustment for age, the serum levels of vitamin A, vitamin E and 25-hydroxyvitamin D were not correlated with degree of obesity, percentage of body fat, and duration of obesity in children with obesity, while the serum levels of vitamins A and E were positively correlated with waist-to-height ratio (P<0.001).@*CONCLUSIONS@#There are higher serum levels of vitamins A and E in children with obesity, especially in those with abdominal obesity, while serum vitamin D nutritional status is poor and worsens with age. Therefore, vitamin D nutritional status should be taken seriously for children with obesity, and vitamin D supplementation should be performed when necessary.

Analysis of vitamin D status among children under 7 years of age in some regions of China / 中华儿科杂志

Objective: To explore current vitamin D status and influential factors of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China. Methods: According to the "province-city-hospital" sampling technical route, a total of 1 531 healthy children under 7 years of age were sampled from 11 provinces, autonomous regions or municipalities in China by the cluster random sampling method from November 2020 to November 2021. The demographic information, family conditions, behavior and living habits and feeding behaviors were collected using unified questionnaire. Serum 25-hydroxyvitamin D(25(OH)D) levels were measured by liquid chromatography-tandem mass spectrometry. Serum 25(OH)D<30 nmol/L was considered deficient and 30-50 nmol/L was considered insufficient. With 25(OH)D≤50 nmol/L as the dependent variable, multivariate Logistic regression was applied to analyze the association between vitamin D deficiency and insufficiency and potential influential factors. Results: The prevalence of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China was 14.0% (215/1 531), 3.8% (25/664) and 21.9% (190/867) in 0-<3 and 3-<7 of age years, respectively. Compared to children aged 0-<3 years, children aged 3-<7 years had a 2.6-fold increased risk of vitamin D deficiency and insufficiency (OR=3.60, 95%CI 1.93-6.72, P<0.001). Frequent sunlight exposure (OR=0.46, 95%CI 0.29-0.73, P=0.001), vitamin D supplementation (sometimes, OR=0.33, 95%CI 0.21-0.51, P<0.001; daily, OR=0.20, 95%CI 0.11-0.36, P<0.001) and infant formula intake(4-7 times per weeks, OR=0.43, 95%CI 0.28-0.68, P<0.001) were protective factors for vitamin D deficiency and insufficiency. Conclusion: Vitamin D deficiency and insufficiency are common among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China, which is affected by age, sunlight exposure, vitamin D supplementation and infant formula intake.

Relationship between micronutrients supplementation during periconceptional period and serum concentration of vitamin E in the 1st trimester of gestational period / 北京大学学报(医学版)

OBJECTIVE@#To explore the association of maternal periconceptional folic acid or multiple micronutrients supplementation during periconceptional period and the serum vitamin E (Vit.E) concentration in the 1st trimester of gestational period.@*METHODS@#A retrospective cohort study was conducted based on the prenatal health care system and clinical laboratory information system. Totally, 22 171 pregnant women who had their prenatal health care and gave birth in Tongzhou Maternal & Child Health Hospital of Beijing from Jan. 2016 to Dec. 2018 were recruited. The usage patterns of nutritional supplements [folic acid (FA) or multiple micronutrients (MM)] during periconceptional period were independent variables, and serum Vit.E concentration and serum Vit.E concentration≥11.2 mg/L in the 1st trimester of gestational period were outcome variables for generalized linear regression model and Logistic regression model, respectively, to analyze the relationships between the independent and outcome variables.@*RESULTS@#The range of the serum Vit.E concentration in the 1st trimester of gestational period was 5.2-24.0 mg/L, and the median concentration was 10.1 (8.8-11.6) mg/L; the excess rate of the serum Vit.E of those who took MM supplementation was 0.3%, and the rates for the groups of FA only or no nutritional supplements used were both 0.1%. Compared with women without nutritional supplement or the women taking FA, the women who took MM had higher serum Vit.E levels in the 1st trimester of gestational period (both P < 0.05). The women taking FA or MM initiated before the conception showed that the serum Vit.E concentration in the 1st trimester of gestational period was higher than that after the conception (P < 0.05), and the serum Vit.E concentration of women who took regularly was higher than that of irregular taking (P < 0.05); with taking compliance elevated, the serum Vit.E concentration of the two groups of women taking FA or MM increased (P < 0.05). The risk of serum Vit.E concentration≥11.2 mg/L among the women taking MM was higher than that of the women without nutritional supplements or taking FA only [odds ratio (OR)=1.36, 95% confidence interval (95%CI): 1.21-1.53; OR=1.39, 95%CI: 1.31-1.48)]; women who took FA or MM showed a lower risk for serum Vit.E concentration≥11.2 mg/L of taking it after the conception than before, the ORs (95%CI) were 0.86 (95%CI: 0.77-0.96) and 0.88 (95%CI: 0.81-0.95), respectively; the women taking the two supplements regularly had higher risk for serum Vit.E concentration≥11.2 mg/L than irregular taking, the ORs (95%CI) were 1.16 (95%CI: 1.05-1.29) and 1.13 (95%CI: 1.04-1.22) for FA and MM users, respectively; with the compliance increasing, the women taking MM had a higher risk of serum Vit.E levels≥11.2 mg/L in the 1st trimester [OR (95%CI) was 1.10 (1.07-1.14)], but for FA users, the OR (95%CI) was 1.04(1.00-1.08).@*CONCLUSION@#Vit.E nutritional status in women in early gestational period in Beijing was generally good, and the excess rate of serum Vit.E was higher in women who took MM during periconceptional period than those without nutritional supplement or taking FA only, suggesting that women need to consider their own Vit.E nutritional status to choose the type of nutritional supplements during periconceptional period, so as to avoid related health hazards.