Impact of daily vitamin D3 supplementation on the risk of vitamin D deficiency with the interaction of rs2282679 in vitamin D binding protein gene (GC) among overweight and obese children and adolescents: A one-year randomized controlled trial.

Background: The rs2282679 polymorphism in the vitamin D binding protein (DBP) gene may influence the response to vitamin D supplementation. Therefore, we examine the effect of 1-year vitamin D supplementation on vitamin D deficiency (VDD) with the interaction of rs2282679 polymorphism in overweight and obese children and adolescents. Materials and methods: The participants (n = 300) were part of a randomized controlled trial who received a daily supplement of either 1,000 or 2,000 IU or four supplements of 1,000 IU weekly (equal to 600 IU daily) of vitamin D3 for 12 months. Genotyping was performed using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). Results: The mean of 25(OH)D values at baseline for participants with the TT, TG, and GG genotypes were 15.4, 14.4, and 10.8 ng/mL, respectively, and were not different between the three genotype groups (P = 0.062). A significant reduction in VDD was observed after vitamin D supplementation with dosages of 1,000 or 2,000 IU compared to 600 IU. No significant association of genotypes with risk of VDD was observed in each intervention group after vitamin D supplementation, except, that individuals with TG genotype showed a higher risk of VDD compared to those with TT genotype in the 2,000 IU group after 6 months of supplementation [odds ratio (95% CI): 6.94; 1.30-37.02]. We observed no interaction between time duration, three genotypes, and dosages with serum 25(OH)D, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels. Conclusion: Response to vitamin D supplementation by three doses of 600, 1,000, and 2,000 IU could not be affected by rs2282679 polymorphism during 12 months in overweight and obese children and adolescents.

Case Report: Management of a Patient With Chylomicronemia Syndrome During Pregnancy With Medical Nutrition Therapy.

Background: Hypertriglyceridemia (HTG) during pregnancy may be accompanied by acute pancreatitis, hyperviscosity syndrome, and preeclampsia. HTG during pregnancy should be managed by a multidisciplinary team; however, no clinical guidelines exist for severe gestational HTG. Case Presentation: We herein present a case of a 36-year-old in the first pregnancy (G1P0Ab0), with a history of severe HTG-induced necrotizing pancreatitis 9 years earlier. There was no family history of HTG. During these years, she did not follow any appropriate diet or medical therapy for HTG. She became pregnant in May 2019, without preconception counseling. Eruptive and tuberoeruptive xanthomas appeared in the 27th week of pregnancy. Serum triglycerides (TGs) and fasting blood sugar (FBS) were 6,620 and 124 mg/dL, respectively, indicating HTG and gestational diabetes (GDM). After admission for the management of severe HTG, she was put on parenteral nutrition with dextrose water 5% and infusion insulin therapy without receiving any enteral carbohydrate for 2 days. Following that, a very low-fat diet and omega-3 fatty acids (1,200 mg/day) were started. After 4 weeks, TG levels reached 1,000 mg/dL, and her self-monitoring blood glucose levels showed appropriate blood glucose for pregnancy. She underwent a successful elective cesarean section in the 39th of pregnancy. Conclusion: This case report demonstrates that HTG during pregnancy could be managed by medical nutrition therapy (MNT).

Daily vitamin D3 in overweight and obese children and adolescents: a randomized controlled trial.

PURPOSE: To assess the efficacy of different doses of vitamin D3 on serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone(iPTH), calcium, phosphorus, and alkaline phosphatase concentrations in overweight and obese school-children. METHODS: A total of 378 children and adolescents, 6-13 years of age, with age- and sex-specific body mass index(BMI) Z-score ≥ 1(according to the World Health Organization criteria) were allocated to receive 600, 1000, and 2000 IU vitamin D3/days. 25(OH)D, iPTH, calcium, phosphorus, and alkaline phosphatase concentrations were measured at baseline, 6, and 12 months. In this intention-to-treat analysis, we fitted a linear mixed effect model involving a random effect of participants within treatment groups and fixed effects of dose, time, and their interactions. RESULTS: Mean(SD) of age and BMI Z-score were 9.3 (1.7) years and 2.55 (0.73), respectively. The median (IQR) for 25(OH)D was 11.5 (8.9), 11.7 (10.5), 12.2 (10.2) ng/mL (28.75, 29.25, and 30.50 nmol/L) at baseline and 23.1 (8.0), 25.6 (8.3), 28.6 (10.4) ng/mL (57.75, 64.00, and 71.50 nmol/L) at the end of 12 months in 600, 1000, and 2000 IU, respectively (p values for dose, time, and the interaction being < 0.0001, < 0.0001,and 0.082, respectively). Prevalence of vitamin D deficiency (< 20 ng/mL) was 80.2, 77.5, and 75.5% in 600, 1000, and 2000 IU groups at baseline, respectively, which decreased to 34, 18.4, and 7.5%, respectively, at 12 months. Patterns of iPTH, calcium, phosphorus, and alkaline phosphatase response over time did not differ significantly among groups (p values = 0.452, 0.670, 0.377, 0.895, respectively). CONCLUSIONS: Increases in 25(OH)D concentration were found with supplementation of 1000 and 2000 IU, compared with 600 IU/days, whereas there was no evidence of iPTH suppression or change in serum calcium, phosphorus, and alkaline phosphatase among children with excess weight.

Safety Aspects of a Randomized Clinical Trial of Maternal and Infant Vitamin D Supplementation by Feeding Type Through 7 Months Postpartum.

Background: The safety of higher dose vitamin D (vitD) supplementation in women who change from exclusive or full breastfeeding to combination feeding or who continue supplementation after cessation of breastfeeding is unknown. Objective: Compare vitD supplementation safety of 6,400 to 400 IU/day and 2,400 IU/day using specific laboratory parameters in postpartum women and their infants through 7 months postpartum by feeding type. Design: In this randomized controlled trial, mothers (exclusively breastfeeding or formula-feeding) were randomized at 4-6 weeks' postpartum to 400, 2,400, or 6,400 IU vitD3 (cholecalciferol)/day for 6 months. Breastfeeding infants in 400 IU group received oral 400 IU vitD3/day; infants in 2,400 and 6,400 IU groups received placebo. Maternal safety parameters (serum vitD, 25-hydroxy-vitamin D [25(OH)D; calcidiol], calcium, phosphorus, intact PTH; urinary calcium/creatinine ratios; and feeding type/changes) were measured monthly; infant parameters were measured at months 1, 4, and 7. Sufficiency was defined as 25(OH)D >50 nmol/L. Feeding type was defined as exclusive/full, combination, or formula-feeding. Data were analyzed using SAS 9.4. Results: Four hundred nineteen mother-infant pairs were randomized into the three treatment groups and followed: 346 breastfeeding and 73 formula-feeding pairs. A dose of 6400 IU/day safely and significantly increased maternal vitD and 25(OH)D from baseline in all mothers regardless of feeding type (p < 0.0001) and was superior to the 400 and 2,400 IU groups in achieving vitD sufficiency with no other differences in safety parameters by treatment or feeding type. Infants in the 2,400 IU group were more likely vitD-deficient than the other groups; otherwise, there were no infant safety parameter differences. Conclusions: While 6,400 IU/day was more effective than 400 or 2,400 IU/day in achieving maternal vitD sufficiency in all feeding groups, the groups did not differ on other safety parameters. Similarly, infant safety parameters did not differ by treatment group or feeding status. Clinical Trial Registration: FDA IND Number: 66,346; ClinicalTrials.gov Number: NCT00412074.

Effect of vitamin D supplementation on serum 25-hydroxyvitamin D concentration in children and adolescents: a systematic review and meta-analysis protocol.

INTRODUCTION: The importance of vitamin D for bone health as well as its role in non-skeletal functions has long been documented. However, review investigations on the effect of vitamin D supplementation on serum 25-hydroxyvitamin D (25(OH)D) levels in children and adolescents are scarce. The aims of the current study were to assess the impact of various doses of vitamin D supplementation on serum 25(OH)D concentrations in children and adolescents, and to identify relevant determinants of variations in the effect of vitamin D supplementation. METHODS: PubMed, Scopus, ISI Web of Science and Cochrane Central Register of Controlled Trials databases up to 27 September 2017 will systematically be searched for randomised controlled trials of vitamin D supplementation. We considered articles with the following control groups as eligible: placebo control, control group without any supplementation or a comparative arm investigation. Two reviewers will assess articles for eligibility according to prespecified selection criteria, after which data extraction and quality appraisal will be conducted by two independent reviewers. The quality assessment will be assessed using the Jadad scale. Meta-analyses will be conducted where appropriate. We will express continuous measures (ie, serum 25(OH)D concentration) as mean differences with 95% CIs. Heterogeneity of the data will be investigated via visual inspection of the forest plots and using χ2 test on N-1 df, with a significance level of α=0.1. We will also assess individual study and subgroup characteristics and perform a sensitivity analysis. Publication bias will be assessed using funnel plot and statistical analysis of Egger's test. ETHICS AND DISSEMINATION: Ethics approval is not required because the work will be carried out on published documents. The authors will publish findings from this review through peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER: CRD42017067179.

The Association of Potato Intake With Risk for Incident Type 2 Diabetes in Adults.

OBJECTIVES: Previous studies indicate that the risk for diabetes associated with high consumption of potato differs in various populations. We aimed to investigate the associations between total, boiled and fried potato intake and the risk for incident diabetes in Tehranian adults. METHODS: This cohort study was conducted in 1,981 adults, aged 19 to 70 years, who participated in the Tehran Lipid and Glucose Study and were followed up for 6 years. Usual dietary potato intakes were assessed using a valid and reliable food-frequency questionnaire. Anthropometric, biochemical and blood pressure data were determined, and diabetes was defined according to the criteria of the American Diabetes Association. RESULTS: The mean (± SD) age and potato intake of participants was 38.9±13.4 years and 30.2±30.7 g/day, respectively. The risk for incident diabetes in participants was 6.7% after 6 years of follow up. After adjusting for age, sex, body mass index, physical activity, smoking, family history of diabetes, hypertension, serum triglyceride levels, high-density lipoprotein cholesterol levels, energy intakes and consumption of saturated fat, fruit, whole grains, vegetables, nuts and legumes, the risk for incident diabetes was lower in subjects with higher intakes of total potato (OR=0.46; 95% CI 0.25 to 0.84) and boiled potato (OR=0.47; 95% CI 0.26 to 0.85) in comparison with those who had the lowest intakes (p for trend <0.05). However, there was no significant association between fried potato intake and risk for diabetes (OR=0.50; 95% CI 0.25 to 1.07; p for trend >0.05). CONCLUSIONS: Our findings indicate that, in Tehranian adults, a moderate intake of dietary total and boiled, but not fried, potatoes may be associated with a lower risk for incident diabetes.

Low carbohydrate diet is associated with reduced risk of metabolic syndrome in Tehranian adults.

This cohort study was conducted to examine the association of low carbohydrate diet (LCD) score with risk of incident metabolic syndrome (MetS) and its components after 3.6 years of follow-up in 2044 healthy adults within framework of the Tehran Lipid and Glucose Study. The LCD was calculated according to intakes of carbohydrate, monounsaturated fatty acids, refined grains, vegetable protein, fiber, n3/n6 polyunsaturated fatty acids ratio and glycemic load (GL), using a food frequency questionnaire at baseline. In the final model, after adjustment for age, gender, smoking status, physical activity and energy intake, there was significant association between LCD score and fasting plasma glucose (ß: -0.002, 95%CI: -0.005, -0.001), triglycerides (TGs) (ß: -0.002, 95%CI: -0.004, -0.001), BP (ß: -0.001, 95%CI: -0.002, 0.000), WC-BMI (ß: -0.003, 95%CI: -0.005, -0.001) and MetS risk Z-scores (ß: -0.015, 95%CI: -0.021, -0.002). In conclusion, LCD may be associated with a decreased risk of MetS and its components in adults.

Associations of dietary macronutrients with glomerular filtration rate and kidney dysfunction: Tehran lipid and glucose study.

BACKGROUND: Although dietary components may play a role in the development of chronic kidney disease (CKD), data on this topic are scarce. The objective of this study was to investigate the association between macronutrient intakes and CKD in a large non-diabetic adult population-based study. METHODS: This cross-sectional study recruited 5,316 participants aged ≥27 years without diabetes within the framework of the Tehran lipid and glucose study. Dietary intake was collected using a validated food-frequency questionnaire. Macronutrients intake including total-, animal-, and plant-protein, carbohydrate, simple sugar, fructose, total fat, saturated fatty acids, poly- and monounsaturated-fatty acids (PUFA and MUFA), and n-3 and n-6 fatty acids was categorized into quartiles. Anthropometrics, blood pressure, serum creatinine, and fasting plasma glucose and lipids were measured. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation. CKD was defined as eGFR <60 ml/min/1.73 m(2). RESULT: Mean age of participants was 45.0 ± 12.2 years. Mean eGFR was 71.9 ± 11.1 ml/min/1.73 m(2), and 13% had CKD. After adjustment for serum triglycerides and cholesterol, body mass index, and hypertension, the risk of CKD decreased in the highest quartile compared to lowest quartile of plant protein (OR, 95% CI) (0.70, 0.51-0.97), PUFA (0.73, 0.55-0.99), and n-6 fatty acids (0.75, 0.57-0.97). However, the risk of CKD increased in the highest quartile of animal protein (1.37, 1.05-1.79) compared to the lowest. CONCLUSION: Plant protein, PUFA, and n-6 fatty acids are associated with a lower risk of CKD, independently of hypertension and diabetic mellitus, while animal protein may be a risk factor for CKD in adults.

Effect of pomegranate seed oil on serum TNF-α level in dyslipidemic patients.

Pomegranate punicic acid and pomegranate fruit extracts have the potential effects in inhibiting tumour necrosis factor-α (TNF-α) and inflammatory diseases. The aim of this study was to evaluate the effect of pomegranate seed oil (PSO) consumption on serum TNF-α level in dyslipidemic patients. Fifty-one subjects with serum total cholesterol concentration >200 mg/dl and serum triglyceride concentrations >150 mg/dl were randomly assigned into the PSO (n = 25) and placebo (n = 26) groups. Subjects were given 400 mg PSO or placebo capsules twice daily for 4 weeks. Six patients were excluded because of complications or lack of compliance. Serum TNF-α level was measured at baseline and after 4 weeks. Mean (SD) serum concentration of TNF-α decreased from 14.73 ± 5.25 to 13.28 ± 3.79 pg/ml in the PSO group (P = NS). Corresponding values in the placebo group were 12.46 ± 1.67 versus 13.14 ± 1.67 pg/ml (P = NS). In conclusion, administration of PSO in dyslipidemic patients does not affect the serum TNF-α.

Effect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trial.

In vitro and in vivo studies have shown that punicic acid, a type of conjugated fatty acid and the main constituent of pomegranate seed oil (PSO), has anti-atherogenic effects. The present study aimed at determining the effect of PSO treatment on serum lipid profiles. This double-blind placebo-controlled randomised clinical trial included fifty-one hyperlipidaemic subjects, diagnosed according to National Cholesterol Education Program definition, and randomly assigned to the PSO and the control groups. The PSO and placebo groups received 400 mg PSO and placebo twice daily, respectively and were followed up for 4 weeks. Serum concentrations of lipids and lipoproteins were measured before and 4 weeks after intervention. Mean concentration of TAG and the TAG:HDL cholesterol (HDL-C) ratio were significantly decreased after 4 weeks in the PSO group as compared with baseline values (2.75 (sd 1.40) v. 3.45 (sd 1.56) mmol/l, P = 0.009 and 5.7 (sd 4.6) v. 7.5 (sd 5.0), P = 0.031, respectively). The treatment effect was statistically significant in the PSO group as compared with controls in diminution of cholesterol:HDL-C ratio (5.4 (sd 1.5) v. 5.9 (sd 1.4), P < 0.05) adjusted for baseline values. We found a mean difference for PSO v. placebo in HDL-C concentration (0.13 v. - 0.02 mmol/l) and cholesterol:HDL-C ratio ( - 0.42 v. 0.01, P < 0.05). Serum cholesterol, LDL cholesterol and glucose concentrations and body composition variables remained unchanged. It is concluded that administration of PSO for 4 weeks in hyperlipidaemic subjects had favourable effects on lipid profiles including TAG and TAG:HDL-C ratio.