A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and 'At-Risk' Individuals.

A systematic review and meta-analysis was undertaken to examine and quantify the effects of B vitamin supplementation on mood in both healthy and 'at-risk' populations. A systematic search identified all available randomised controlled trials (RCTs) of daily supplementation with ≥3 B group vitamins with an intervention period of at least four weeks. Random effects models for a standardized mean difference were used to test for overall effect. Heterogeneity was tested using the I2 statistic. Eighteen articles (16 trials, 2015 participants) were included, of which 12 were eligible for meta-analysis. Eleven of the 18 articles reported a positive effect for B vitamins over a placebo for overall mood or a facet of mood. Of the eight studies in 'at-risk' cohorts, five found a significant benefit to mood. Regarding individual facets of mood, B vitamin supplementation benefited stress (n = 958, SMD = 0.23, 95% CI = 0.02, 0.45, p = 0.03). A benefit to depressive symptoms did not reach significance (n = 568, SMD = 0.15, 95% CI = -0.01, 0.32, p = 0.07), and there was no effect on anxiety (n = 562, SMD = 0.03, 95% CI = -0.13, 0.20, p = 0.71). The review provides evidence for the benefit of B vitamin supplementation in healthy and at-risk populations for stress, but not for depressive symptoms or anxiety. B vitamin supplementation may particularly benefit populations who are at risk due to (1) poor nutrient status or (2) poor mood status.

B vitamins for stroke prevention.

Supplementation with B vitamins (vitamin B9(folic acid), vitamin B12 and vitamin B6) lowers blood total homocysteine (tHcy) concentrations by about 25% and reduces the relative risk of stroke overall by about 10% (risk ratio (RR) 0.90, 95% CI 0.82 to 0.99) compared with placebo. Homocysteine-lowering interventions have no significant effect on myocardial infarction, death from any cause or adverse outcomes. Factors that appear to modify the effect of B vitamins on stroke risk include low folic acid status, high tHcy, high cyanocobalamin dose in patients with impaired renal function and concurrent antiplatelet therapy. In regions with increasing levels or established policies of population folate supplementation, evidence from observational genetic epidemiological studies and randomised controlled clinical trials is concordant in suggesting an absence of benefit from lowering of homocysteine with folic acid for prevention of stroke. Clinical trials indicate that in countries which mandate folic acid fortification of food, folic acid supplementation has no significant effect on reducing stroke risk (RR 1.05, 95% CI 0.90 to 1.23). However, in countries without mandatory folic acid food fortification, folic acid supplementation reduces the risk of stroke by about 15% (RR 0.85, 95% CI 0.77 to 0.94). Folic acid alone or in combination with minimal cyanocobalamin (≤0.05 mg/day) is associated with an even greater reduction in risk of future stroke by 25% (RR 0.75, 95% CI 0.66 to 0.86), whereas the combination of folic acid and a higher dose of cyanocobalamin (≥0.4 mg/day) is not associated with a reduced risk of future stroke (RR 0.95, 95% CI 0.86 to 1.05). The lack of benefit of folic acid plus higher doses of cyanocobalamin (≥0.4 mg/day) was observed in trials which all included participants with chronic kidney disease. Because metabolic B12 deficiency is very common and usually not diagnosed, future randomised trials of homocysteine-lowering interventions for stroke prevention should probably test a combination of folic acid and methylcobalamin or hydroxocobalamin instead of cyanocobalamin, and perhaps vitamin B6.

Urinary excretion of 3-hydroxyisovaleryl carnitine is an early and sensitive indicator of marginal biotin deficiency in humans.

Mounting evidence indicates that marginal biotin deficiency is not rare, contrary to previous assumptions. Accordingly, robust indicators of biotin status would be useful. In a study of 10 healthy adults, we recently provided evidence that abnormally increased plasma concentration of 3-hydroxyisovaleryl carnitine (3HIA-carnitine) is a sensitive indicator of marginal biotin deficiency. We sought to determine whether urinary excretion of 3HIA-carnitine (expressed as the ratio to urinary creatinine) significantly increases in marginal biotin deficiency. Marginal, asymptomatic biotin deficiency was induced experimentally in the same 10 healthy adults (8 women) by feeding undenatured egg white with meals for 28 d. Biotin status was repleted by a mixed general diet plus biotin supplementation. Urinary excretion of 3HIA-carnitine was determined by liquid chromatography-tandem MS on d 0, 14, and 28 (depletion) and on d 35 and 50 (repletion). Mean urinary 3HIA-carnitine concentration increased with depletion (P < 0.0001; d 0 vs. 28) and decreased with repletion (P = 0.0002; d 28 vs. 50). Urinary 3HIA-carnitine excretion was greater than the upper limit of normal in 9 of 10 participants by d 14 and decreased to within normal limits by d 50 in all participants. This study provides evidence that urinary excretion of 3HIA-carnitine is an early and sensitive indicator of marginal biotin deficiency. The ease of collection of untimed urine samples and application of a new analytical method with simplified sample preparation suggest that urinary 3HIA-carnitine is likely to be a useful indicator for large population studies.

Nutritional deficiencies during normal growth.

Nutritional deficiencies have always been a major consideration in pediatrics. Although the classic forms of many of the well-documented nutritional deficiencies are memorized during training as a physician, nutritional deficiencies that can occur in otherwise asymptomatic normally growing children are often overlooked. The two most common deficiencies seen in children who are growing normally are iron and vitamin D deficiencies. These deficiencies are surprisingly common and can have a significant impact on the overall health of a child. This article reviews these nutritional deficiencies and other less commonly seen deficiencies in children who are otherwise growing normally.

[To 20-years anniversary of Chernobyl catastrophe: an attempt to study the vitamin, calcium, iron and selenium status of children and adult population in Slavutich and to correct elicited deficiencies].

The article concisely illustrates the vitamin and mineral state of population of town of Slavutich, including personal of Chernobyl Nuclear Power Station, children of pre-school age and pregnancy women, studied in 1992. Vitamins and minerals deficiency in the main of C and B vitamins and selenium was revealed in all the studied groups. Appropriate measures were developed and introduced to eliminate the detected dusturbances; but however some unsolved problems remained. Taking into account the forthcoming 20th anniversary of Chernobyl disarter, the authors of the come back to considering the obtained data in hope to atlract attention of medical scientific and public to the remained unsolved problems of micronutrient deficiency.

Low essential fatty acid and B-vitamin status in a subgroup of patients with schizophrenia and its response to dietary supplementation.

We assessed essential fatty acid (EFA) and B-vitamin status, together with their determinants, in 61 patients with schizophrenia and established whether those with poor status responded biochemically to the appropriate dietary supplements. As a group, the patients had high erythrocyte saturated fatty acids (FAs), monounsaturated FA and low polyunsaturated FA of the omega3 and omega6 series. Patients reporting not to take vitamin supplements had low vitamin B12 and high homocysteine. Homocysteine variance proved best explained by folate in both the total group and male patients, and by vitamins B12 and B6 in females. Alcohol consumption and duration of illness are risk factors for low polyunsaturated FA status (< P2.5 of reference range), while male gender and absence of fish consumption predict hyperhomocysteinemia (> P97.5 of reference range). Two patients exhibited biochemical EFA deficiency and seven showed biochemical signs of omega3/docosahexaenoic acid (DHA) marginality. Four patients exhibited moderate hyperhomocysteinemia with plasma values ranging from 57.5 to 74.8 micromol/L. None of the five patients with either moderate hyperhomocysteinemia, biochemical EFA deficiency, or both, was predicted by their clinicians to have poor diets. That diet was nevertheless at the basis of these abnormalities became confirmed after supplementing 4 of them with B vitamins and with soybean and fish oils. We conclude that a subgroup of patients with schizophrenia has biochemical EFA deficiency, omega3/DHA marginality, moderate hyperhomocysteinemia, or combinations. Correction seems indicated in view of the possible relation of poor EFA and B-vitamin status with some of their psychiatric symptoms, but notably to reduce their high risk of cardiovascular disease.

Vitamins, minerals and supplements: part two.

Vitamins and minerals are organic food substances found only in plants and animals and are essential to the normal functioning of the body. Although only required in small amounts, as previously discussed in the past decade there has been an increased use of vitamin, mineral, herbal and nutritional supplements in the general population. While deficiencies in such nutrients can be harmful to health, conflicting claims have been made about the health benefits of such supplementation. In the second of an occasional series on vitamins, minerals, and supplements, JUNE THOMPSON gives an overview of the role that water-soluble vitamins play in the health of the individual, including their functions, and the potential impact of any deficiency of these.

[Vitamin sufficiency of young basketball players]. / Obespechennost' vitaminami podrostkov-basketbolistov.

The investigation of vitamin sufficiency of young basket-ball players 14-16 years old (17 girls and 14 boys) has been carried out 59-77 per cent of the children had the deficiency of B group vitamins, 24-54 per cent--vitamin E insufficiency, most of them (82-100 per cent)--deficit of carotenoids while they were sufficiently vitamins C and A supplied. The girls were supplied with vitamins better than boys. There was no one adequately supplied with all vitamins among boys while 12 per cent of girls had adequately sufficiency. The girls had deficit of 1-2 vitamins more often whereas the combined insufficiency of 3-4 vitamins took place in 1.8-2.3 fold more frequently among boys. Daily intake of multivitamin containing 10 vitamins in daily recommended doses, lipoic acid, methionin and 9 minerals by boys lead to their blood plasma vitamin C, E, B-2 and beta-carotene level increase. Vitamin C insufficiency disappeared. Deficit of beta-carotene and vitamin B-6 became 1.5 fold rarely, vitamin B-2--2 fold, vitamin E--6 fold. Thus daily intake of recommended doses of vitamins eliminates biochemical signs of vitamin deficiency.

Pelagra: el penúltimo caso / Pellagra: the next to the last case

Varón de 50 años, gastrectomizado y alcohólico, que consultó por unas lesiones cutáneas de distribución simétrica en áreas fotoexpuestas y alteraciones neurológicas leves. El tratamiento con suplementos vitamínicos y proteicos originó una rápida resolución de las lesiones cutáneas. La pelagra debe ser considerada ante un paciente desnutrido con fotodermatosis (AU)

[Characteristics of actual nutrition and health of children in regions of the Russian Federation]. / Kharakteristika fakticheskogo pitaniia i zdorov'ia detei v regionakh Rossiiskoi Federatsii.

In the article the problems of actual nutrition and state of Russian children health are considered. The carried out examinations of the vitaminous status have shown presence of a deficit of vitamins E, B1, B6, PP, and also calcium, phosphorus, iron lactate, zinc in daily ration of children. The inadequate organization of C-vitaminization of boiled food in children establishments, low supplying of learning schools by a hot food, insufficient use of products from suer milk, fish, juices, meat products, butter, vegetables, fruit, eggs in a nutrition of children is marked. In same of regions of Russia the inadequate nutrition organization of early age children is marked. The positive experience of areas (St.-Petersburg, Ul'yanovsk, Rostov, Smolensk, Kirov, Kurgan, Samara region, Republic Buryatiya) on organization of children and juveniles nutrition, development of the regional programs on a children's food industry evolution, on providing of early age children by food stuffs, on improvement of a schoolboys nutrition, on improvement a nutrition of children in children's preschool establishments is analyzed. The positive experience of nutrition organization of children on an example of the Ryazan and Arkhangel'sk regions surveyed. The actual information about a vitaminization, quality and safety of children's nutrition, ready dishes in the organized collectives on data of 1999 are given.

Skin signs of nutritional disorders.

Children, especially infants, require adequate calories and nutrients to meet the high demands of normal growth and development; protein, essential fatty acids, vitamins and minerals are all important in achieving this goal. Malnutrition results from deficiency in one or more of these basic nutrients. It may be caused by (1) insufficient dietary intake, (2) malabsorption, (3) poor utilization of nutrients, and (4) increased catabolism. A range of clinical and metabolic changes occurs as a result of profound and generalized abnormalities at a cellular level. Mucocutaneous changes constitute one of the variable and multisystemic clinical manifestations of malnutrition. Although some signs are characteristic of a specific nutrient deficiency, an overlap of skin manifestations is observed in multiple deficiency states. The periorificial glazed erythema and hair loss of zinc deficiency also may be seen in patients with essential fatty acid deficiency, biotinidase deficiency, and even kwashiorkor. Mucous membrane changes associated with deficiency of many water-soluble vitamins may likewise be difficult to distinguish.

[Vitamins and trace elements in the elderly (author's transl)]. / Zur Problematik der Zufuhr von Vitaminen und Spurenelementen an alte Menschen.

A review of published research data on the requirement, intake, and signs of deficiency of vitamins and trace elements in old age is presented. It particularly deals with the problem of a general indication for vitamins and trace element supplements - the mean components of geriatric preparations. Special emphasis is laid on the question if these substances exhibit a specific effect on the alterations of physical and psychic capacity typically accompanying the growing old. It could be shown that in several groups of the elderly diminished vitamin levels are common and/or vitamin and trace element intake does not reach daily recommended allowances. But it still remains unclear if these findings have to be considered as disease symptoms.

Evaluation of methods of coenzyme activation of erythrocyte enzymes for detection of deficiency of vitamins B1, B2, and B6.

We describe optimized, ultraviolet spectrophotometric procedures for determination of erythrocyte transketolase, glutathione reductase, and aspartate aminotransferase activity, and their activation by their respective coenzymes--thiamine pyrophosphate, flavin-adenine dinucleotide, and pyridoxal-5-phosphate--as tests for vitamin B1, B2, and B6 deficiency. With these procedures we have investigated healthy subjects on normal and vitamin-supplemented diets, and a series of (mainly) alcoholic hospital in-patients. The enzyme procedures described have good precision and can be readily carried out in the routine laboratory. Abnormal transketolase activation correlated well with clinical evidence of vitamin B1 deficiency.