Optimization of daily folate, vitamin B12 and vitamin B6 supplements in paediatric patients with sickle cell disease

We determined optimal folate, vitamin B12 and vitamin B6 dosages in 21 sickle cell disease (SCD) patients (11 HbSS, 10 HbSC; mean 7 years, range 7-16), using plasma homocysteine (Hcy) as functional marker. They received daily 400 g (0-3 weeks), 700 g (3-6) and 1000 g (6-70) folate; 1 (0-21), 3 (21-45 and 5 RDA (45-70) vitamin B12; and 1 RDA vitamin B6 (0-70). Blood was taken at baseline (P0) and after 3 (PI), 6 (P2), 9 (P3), 21 (P4), 33 (P5), 45 (P6), 57 (P7) and 70 (P8) weeks for measurement of erythrocyte (RBC), serum folate, plasma vitamin B12, whole blood vitamin B6 and plasma Hcy. Vitamin B6 increased from P0 to P1 and P1 to P2; vitamin B12 from P4 to P8; serum folate from P0 to P1 and P1 to P2; RBC folate from P0 to P1, P1 to P2 and P2 to P3. Hcy decreased from P1 to P2 and P4 to P6. Most pronounced Hcy decreases occurred from P0 to P1 (43 percent of patients), P1 to P2 (14 percent) and P4 to P5 (24 percent). Haematological indices did not change. Patients with HbSS had higher RBC folate at P1, P2 and P8. The entire group exhibited inverse relations between RBC folate and haemoglobin on P1, P2, P3, P6, P7 and P8. We conclude that RBC folate is less valuable for folate status assessment in SCD patients. The optimal daily supplement is 700 g folate (3.5-7 RDA vitamin B12 (4.2-6.0 g) and 1 RDA vitamin B6 (1.4-2.0 mg). This combination causes Hcy levels that do not decrease further upon higher dosages and may reduce by simple and relatively inexpensive means their inherently high risk of endothelial damage.(Au)

Folic acid status of paediatric patients with sickle cell disease

We investigated whether paediatric patients with sickle cell disease (9ñ4 years; 27 HbSS; 19 HbSC) have different folic acid status compared with age-, sex-and race-matched HbAA controls (n=20), and whether their folic acid status can be improved by folic acid supplementation. The patients were supplemented with vitamins B6 and B12 during one week and with folic acid during the next week. Circulating folic acid, homocysteine, vitamin B6 and vitamin B12 levels were measured at baseline (patients and controls), after 1 and 2 weeks (patients). The patients had similar folic acid, vitamin B6 and vitamin B12, but higher homocysteine levels, compared with HbAA controls (12.7ñ4.5 vs 10.9ñ3.5 mmol/l;p=0.04). Vitamin B6 and B12 supplementation did not change their homocysteine levels, but folic acid supplementation caused a 52 percent reduction (to 5.7ñ1.6). We conclude that patients with sickle cell disease have adequate vitamin B6 and B12 status, but suboptimal folic acid status. They may benefit from folic acid supplementation to reduce their high risk for endothelial damage.(AU)

The dietary fatty acids of patients with coronary artery disease and control in Curacao: implications for primary and secondary prevention

Patients with coronary artery diseases are advised to augment their dietary linoleic acid intakes at the expense of saturated fatty acids. We investigated whether the dietary linoleic acid intake of 57 patients with coronary artery disease (47 males, 10 females; ages 61 ñ 10 years) in Curacao is higher as compared with 77 controls (51 males, 26 females; ages 56 ñ 7 years). For this, we measured plasma cholesterol ester fatty acids, which reflect the dietary fatty acid composition of the preceeding weeks. Patients with coronary artery disease and controls had minor differences in cholesterol ester fatty acids. Their cholesterol ester linoleic acid content suggests that the dietary polyunsaturated/saturated fatty acid ratio is far below 1. Comparison with data reported for the the Netherlands, Greenland and Crete showed that the dietary fatty acid composition in Curacao is typically Western with a high intake of saturated fatty acids, a low intake of monounsaturated fatty acids and the consumption of linoleic acid as the predominant polyunsaturated fatty acid. Intake of long chain polyunsaturated fatty acids from fatty fish is low. Reduction of dietary saturated fatty acids, augmentation of fish consumption, and an increase of the O-linolenic/linoleic acid ratio are likely to be of benefit to both primary and secondary prevention from coronary artery disease in Curaco.(AU)

The dietary fatty acids of patients with coronary artery disease and control in Curacao: implications for primary and secondary prevention

Patients with coronary artery diseases are advised to augment their dietary linoleic acid intakes at the expense of saturated fatty acids. We investigated whether the dietary linoleic acid intake of 57 patients with coronary artery disease (47 males, 10 females; ages 61 ñ 10 years) in Curacao is higher as compared with 77 controls (51 males, 26 females; ages 56 ñ 7 years). For this, we measured plasma cholesterol ester fatty acids, which reflect the dietary fatty acid composition of the preceeding weeks. Patients with coronary artery disease and controls had minor differences in cholesterol ester fatty acids. Their cholesterol ester linoleic acid content suggests that the dietary polyunsaturated/saturated fatty acid ratio is far below 1. Comparison with data reported for the the Netherlands, Greenland and Crete showed that the dietary fatty acid composition in Curacao is typically Western with a high intake of saturated fatty acids, a low intake of monounsaturated fatty acids and the consumption of linoleic acid as the predominant polyunsaturated fatty acid. Intake of long chain polyunsaturated fatty acids from fatty fish is low. Reduction of dietary saturated fatty acids, augmentation of fish consumption, and an increase of the Ó-linolenic/linoleic acid ratio are likely to be of benefit to both primary and secondary prevention from coronary artery disease in Curaco.

Vitamin D supplementation of post-menopausal women in Curacao, and pre- and post-menopausal women in the Netherlands - abstract

Pre- and post-menopausal white women living in The Netherlands in late winter/early spring and black and white post-menopausal women living in Curacao were supplemented with either 400,800 and 2x400 IU vitamin D (3)/day or placebo for 4, 5, or 9 weeks. Baseline plasma 25-hydroxyvitamin D [25(OH)D] of Dutch women was lower than that of Curacao women. Post-menopausal Dutch women had higher parathyroid hormone (PTH) than pre-menopausal Dutch and post-menopausal Curacao women. There were no differences in 1,25-dihydroxyvitamin D [1,25(OH)2D]. Vitamin D supplementation increased 25(OH)D levels in all groups, PTH and 1,25(OH)2D in post-menopausal Curacao women, and PTH in pre-menopausal Dutch women. Serum and urinary calcium and phosphate did not change. There were no response differences between 400 and 800 IU daily doses, or 800 and 2x400 IU doses. Oral vitamin D supplementation raises late winter/early spring plasma 25(OH)D of women living at high latitudes to baseline levels encountered in the tropics (AU)

Vitamin E, lipid fractions, and fatty acid composition of colostrum, transitional milk, and mature milk: an international comparative study

Triglycerides, cholesterol, fatty acid composition, and tocopherols were determined in colustrum, transitional milk, and mature milk in St. Lucia. With progress of lactation, triglycerides and percentage medium-chain fatty acids increased whereas tocopherols, cholesterol and percentage long-chain polyunsaturated fatty acids decreased. These changes reflect augmented de novo synthesis of fatty acids (8:0, 10:0, 12:0, and 14:0) in the mammary gland and a tendency of increasing fat-globule size as milk matures. Transitional and mature milks, but particularly colustrum, contained higher concentrations of components considered to be derived from the fat-globule membrane (cholesterol, tocopherols, percentage long-chain polyunsaturated fatty acids) compared with those reported for Western countries. Percentage medium-chain fatty acids in mature milk was two to three times higher than in developed countries. Differences from data from studies in Western countries are discussed in relation to analytical methods and possible consequences for lipid digestion, lipid absorption, growth, and brain development.(AU)

Human milk in mothers in Belize, Curacao, Dominica, St. Lucia and Suriname, the fatty acid composition and the relevance of medium chain fatty acids containing triglycerides - abstract

Fatty acid composition of mature milk from Belize, Curacao, Dominica and Suriname and of colostrum, transitional and mature milk from women in St. Lucia was analyzed by capillary gas chromatography. Remarkable differences and striking similarities were found in fatty acid compositions. The levels of 6:0-12:0, the medium chain fatty acids (MCFA), and 14:0 were high (12:0-16:9 and 9.6-15.0 gm percent respectively) in all 5 countries as compared to reports from European countries. Palmitic acid (16:) levels (20.2-23.6 gm percent were similar to reported levels from other societies. The levels of 22.+c, W3 (docosahexaenoic acid or DHA) were extremely high in Dominica (average 1.15 gm percent) and relatively high (0.25-0.56 gm percent) in other Caribbean countries as compared to reported levels of 0.05-0.23 gm percent in studies from the USA. When a mother is in energy equilibrium or positive energy balance, the fatty acid composition of her breast milk is related to that of her diet, whereas in negative energy balance, it resembles that of her adipose tissue. High levels of DHA in breast milk may be explained by consumption of fish rich in DHA. A high carbohydrate intake leads to a high MCFA content of breast milk, such as seen in all 5 Caribbean countries but especially in Dominica. The levels of MCFAs and 14:0 in breast milk from St. Lucia increased substantially from colostrum to mature milk at the expense of the longer chain fatty acids (AU)

Fatty acid composition of breast milk fat from women in Curacao - abstract

The new-born infant exclusively breastfed receives approximately 52 percent of his energy from fats, 40 percent from carbohydrates and approximately 8 percent from proteins. Dietary fat in young infants not only serves as the most important source of energy but also contains nutrients essential for normal growth and development of the nervous system. In the very young infant, intestinal absorption of fats is, among other factors, dependent on the fatty acid composition of the fat consumed. The nature of the fat consumed by the mother will have an important influence on the fatty acid composition of human milk fat. Samples were obtained from 47 mothers of low to middle social class, who had lived in Curacao for at least 10 years, and given birth to a normal term infant. Milk was collected at least 14 days after birth by manual expression, and deep frozen until analysed by gas chromatography. The relative concentration of the saturated fatty acids (g/100g total fatty acids) were C6:0, 0.1; C8:0, 0.7; C10.0, 3.2; C12:0, 11.7; C14:0, 9.8; C16:0, 16.8; C18:0, 4.8: and for the unsaturated fatty acids C14:1, 0.2; C16:1, 2.5; C18:1, 26.7; C18:2, 18.3; C18.3, 1.7; C20:2, 0.5; C20:3, 0.6; C20:4, 1.4; C22:5, 0.3 and C22:6, 0.6. This pattern is more similar to that found in Tanzanian women, than to that found in women in Great Britain (AU)