Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden?

All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis, may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels is not undertaken for most vitamins except folate, B12, and 25-hydroxyvitamin D because assays may not be available or may be costly to perform and do not always correlate with body stores. The last systematic review through 2016 was performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update, so this article summarizes the more recent evidence. We review the use of vitamins supplementation in the CKD population. To date there have been no randomized trials to support the benefits of any vitamin supplementation for kidney, cardiovascular, or patient-centered outcomes. The decision to supplement water-soluble vitamins should be individualized, taking account the patient's dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status, and dialysis loss. Nutritional vitamin D deficiency should be corrected, but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage, and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. Although more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.

Long-term prevalence of vitamin deficiencies after bariatric surgery: a meta-analysis.

BACKGROUND: Bariatric surgery can lead to short-mid-term vitamin deficiencies, but the long-term vitamin deficiencies is unclear. This study aimed to conduct a meta-analysis regarding the long-term prevalence (≥ 5 years) of vitamin deficiencies after bariatric surgery. METHODS: We searched the EMBASE, PubMed, and CENTRAL databases for clinical studies until June 2023. Meta-analysis, sensitivity, subgroup, and meta-regression analyses were performed. RESULTS: This meta-analysis included 54 articles with follow-up duration ranging from 5 to 17 years. The most prevalent vitamin deficiencies after surgery were vitamin D (35.8%), followed by vitamin E (16.5%), vitamin A (13.4%), vitamin K (9.6%), and vitamin B12 (8.5%). Subgroup analyses showed that the prevalence of vitamin A and folate deficiencies increased with the follow-up time. Roux-en-Y gastric bypass had a higher rate of vitamin B12 deficiency than sleeve gastrectomy and biliopancreatic diversion with duodenal switch (BPD-DS). Studies conducted in Europe had higher vitamin A deficiency (25.8%) than in America (0.8%); Asian studies had more vitamin B12 but less vitamin D deficiency than European and American studies. Meta-regression analysis displayed that publication year, study design, preoperative age, BMI, and quality assessment score were not associated with vitamin A, B12, D, and folate deficiencies rate. CONCLUSION: A high prevalence of vitamin deficiencies was found after bariatric surgery in the long-term follow-up, especially vitamin D, E, A, K, and B12. The variation in study regions, surgical procedures, and follow-up time are associated with different postoperative vitamin deficiencies; it is necessary to develop more targeted vitamin supplement programs.

A systematic review on the impact of nutrition and possible supplementation on the deficiency of vitamin complexes, iron, omega-3-fatty acids, and lycopene in relation to increased morbidity in women after menopause.

A balanced and healthy diet during the menopausal transition and after menopause is crucial for women to reduce the risk for morbidities and chronic diseases due to deficiency of essential nutrients. PURPOSE: The objective of this study was to conduct a systematic review of studies that analyzed the impact of vitamin and nutrient deficiencies in postmenopausal women in relation to increased morbidities and chronic conditions. METHODS: Observational studies were searched in the databases PubMed, UpToDate, and Google Scholar. RESULTS: We searched 122 studies, of which 90 were included in our analysis. The meta-analysis of the data could not be performed because of the heterogeneity of the statistical methods in the included studies. In our study, we focused on the aspects of vitamin B6, vitamin B12, vitamin D, iron, omega-3-fatty acids, and lycopene, belonging to the family of carotenoids. Postmenopausal women with deficiencies of these nutrients are more vulnerable to comorbidities such as cardiovascular and cerebrovascular events, metabolic diseases, osteoporosis, obesity, cancer and neurodegenerative diseases such as Parkinson's disease, Alzheimer's disease, depression, cognitive decline, dementia, and stroke. We concluded that women after menopause tend to have a greater probability of suffering from deficiencies in various vitamins and nutrients, and consequently have an increased risk of developing morbidities and chronic diseases. CONCLUSION: In conclusion, maintaining optimum serum levels of nutrients and vitamins, either through a balanced and healthy diet consuming fresh fruits, vegetables, and fats or by taking appropriate supplementation, is essential in maintaining optimal health-related quality of life and reducing the risk for women during the menopausal transition and after menopause. Nevertheless, more recent studies need to be assessed to formulate adequate recommendations to achieve positive clinical outcomes.

Nutritional peripheral neuropathies.

Nutritional peripheral neuropathies are a global problem, heavily influenced by geopolitical, cultural and socioeconomic factors. Peripheral neuropathy occurs most frequently secondary to B-vitamin deficiencies, which is suspected to increase in years to come due to the popularity of vegan and vegetarian diets and increased use of bariatric surgery.This review will focus on the common B-vitamins for which a causal link to peripheral neuropathy is more established (vitamins B1, B2, B6, B9 and B12). We will review the historical human and animal data on which much of the clinical descriptions of vitamin deficiencies are based and summarise current available tools for accurately diagnosing a nutritional deficiency. We will also review recently described genetic diseases due to pathogenic variants in genes involved in B-vitamin metabolism that have helped to inform the phenotypes and potential causality of certain B-vitamins in peripheral neuropathy (B2 and B9).Endemic outbreaks of peripheral neuropathy over the last two centuries have been linked to food shortages and nutritional deficiency. These include outbreaks in Jamaican sugar plantation workers in the nineteenth century (Strachan's syndrome), World War two prisoners of war, Cuban endemic neuropathy and also Tanzanian endemic optic neuropathy, which remains a significant public health burden today. An improved understanding of lack of which vitamins cause peripheral neuropathy and how to identify specific deficiencies may lead to prevention of significant and irreversible disability in vulnerable populations.

The Associations of Dietary Vitamin K Intake and Circulating Vitamin 25(OH)D with Serum Lipoprotein Levels: The Vitamin Deficiency Matters.

A synergistic interplay between vitamins K and D appears to exist. We aimed to investigate for the first time whether the associations of dietary vitamin K intake and circulating 25(OH)D with serum lipoprotein levels are influenced by the existence of deficiency of either or both vitamins K and D. Sixty individuals [24 males, 36(18-79) years old] were examined. Vitamin deficiency of K1 and D were defined as vitamin K1 intake/body weight (BW)<1.00 µg/kg/day and circulating 25(OH)D<20 ng/ml, respectively. In individuals with vitamin K1 deficiency, the vitamin K1 intake/BW correlated positively with high density lipoprotein-cholesterol (HDL-C) (r=0.509, p=0.008) and negatively with serum triglycerides (TG) (r=-0.638, p=0.001), whereas circulating 25(OH)D correlated negatively with TG (r=-0.609, p=0.001). In individuals with vitamin D deficiency, the vitamin K1 intake/BW correlated positively with HDL-C (r=0.533, p=0.001) and negatively with TG (r=-0.421, p=0.009), while circulating 25(OH)D correlated negatively with TG (r=-0.458, p=0.004). The above-mentioned associations of vitamin K1 intake/BW and circulating 25(OH)D with serum lipoproteins were not detected in individuals without vitamin K1 deficiency or the ones without vitamin D deficiency. The vitamin K2 intake/BW correlated negatively with low density lipoprotein-cholesterol (LDL-C) (r=-0.404, p=0.001). In conclusion, the associations of vitamin K1 intake with TG and HDL-C and of circulating 25(OH)D with TG were more pronounced in individuals with deficiency of either or both vitamins K1 and D. Increased dietary vitamin K2 intake was associated with decreased LDL-C.

Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic pancreatitis patients.

PURPOSE: Chronic pancreatitis (CP) leads to diabetes and pancreatic exocrine insufficiency (PEI). PEI may lead to maldigestion and malnutrition, which may cause fat-soluble vitamin deficiency, sarcopenia and abnormal bone density. We aim to study the prevalence of osteoporosis, sarcopenia and vitamin deficiency among CP patients. METHODS: Long-term (4-5 years) follow-up was implemented on CP patients. We recorded CP duration, BMI, smoking, alcohol consumption and medication. We determined the serum values for A, D and E vitamins, albumin, creatinine, haemoglobin, calcium and magnesium. Bone density measurement was taken from the proximal femur and lumbar spine. CT/MRI scans were used to measure for psoas muscle area. RESULTS: A total of 33 patients (median age 62 [39-81] years, 61% male) were included. None of these patients had earlier diagnosis of osteopathy, and none of them had known vitamin deficiency or were sarcopenic. Nineteen patients (57%) had pancreatic exocrine insufficiency and of these seven patients (37%) had no pancreatic enzyme replacement therapy (PERT) and one (5%) had inadequate enzyme therapy. During the study, osteoporosis was diagnosed in 20% and possible sarcopenia in 48% of patients. PEI and inadequate PERT was associated with low E vitamin levels (75% vs. 0%, p = 0.012), higher risk of osteoporosis (43% vs. 5.6%, p = 0.013) and sarcopenia (80% vs. 36%, p = 0.044). CONCLUSION: This study demonstrates that chronic pancreatitis is associated with osteoporosis, sarcopenia and vitamin deficiency. If untreated, pancreatic exocrine insufficiency is associated with increased risk of these outcomes. This highlights the importance of identifying and treating PEI in CP patients.

Blood-brain barrier dysfunction and folate and vitamin B12 levels in first-episode schizophrenia-spectrum psychosis: a retrospective chart review.

Vitamin deficiency syndromes and blood-brain barrier (BBB) dysfunction are frequent phenomena in psychiatric conditions. We analysed the largest available first-episode schizophrenia-spectrum psychosis (FEP) cohort to date regarding routine cerebrospinal fluid (CSF) and blood parameters to investigate the association between vitamin deficiencies (vitamin B12 and folate) and BBB impairments in FEP. We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with an ICD-10 diagnosis of a first-episode F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture, blood-based vitamin status diagnostics and neuroimaging within the clinical routine. 222 FEP patients were included in our analyses. We report an increased CSF/serum albumin quotient (Qalb) as a sign of BBB dysfunction in 17.1% (38/222) of patients. White matter lesions (WML) were present in 29.3% of patients (62/212). 17.6% of patients (39/222) showed either decreased vitamin B12 levels or decreased folate levels. No statistically significant association was found between vitamin deficiencies and altered Qalb. This retrospective analysis contributes to the discussion on the impact of vitamin deficiency syndromes in FEP. Although decreased vitamin B12 or folate levels were found in approximately 17% of our cohort, we found no evidence for significant associations between BBB dysfunction and vitamin deficiencies. To strengthen the evidence regarding the clinical implications of vitamin deficiencies in FEP, prospective studies with standardized measurements of vitamin levels together with follow-up measurements and assessment of symptom severity in addition to CSF diagnostics are needed.

Systemic Biomarkers and Liver Morphology in Rats during Chronic Low-Dose Toxicant Administration against the Background of Vitamin Deficiency.

Liver morphology, intensity of apoptosis, and activity of xenobiotic metabolism enzymes were studied in a chronic model experiment in rats receiving a mixture of 6 pesticides against the background of life-long diets with adequate and insufficient supply of water-soluble vitamins. The dose of each pesticide in the mixture did not exceed the acceptable daily intake (1 ADI). It was found that chronic exposure to low doses of anthropogenic toxicants in combination with permanent vitamin deficiency provokes a number of liver changes, such as increased apoptosis activity, cytochrome P450 system depletion, steatosis, and inflammatory infiltration, which is a potential health risk factor.

Correlations of Inflammatory Cytokines in the Intestinal Mucosa, Serum Inflammation, Oxidative Stresses and Immune Changes with Vitamin Deficiency in Ulcerative Colitis Patients.

Ulcerative colitis (UC) is a chronic inflammatory disease. Studies in China and foreign countries have shown that vitamins have anti-inflammation and immunoregulation functions in patients with UC, but the specific mechanism is not yet clear. In this study, the levels of inflammatory cytokines in the intestinal mucosa, serum inflammatory indexes, oxidative stress indexes and immune-related indexes were detected, and their correlations with vitamin deficiency and clinical significance were discussed. Enzyme-linked immunosorbent assay (ELISA) was adopted to detect the serum level of 25-hydroxyvitamin D3, immunohistochemistry was applied to examine the expression of inflammatory cytokines in the intestinal mucosa, serum inflammatory indexes, oxidative stress indexes and immune-related indexes were measured, and their correlations were analyzed. Inflammatory and oxidative stress indexes in the UC group were notably higher than in the control group. The Vitamin deficiency group had more inflammatory cytokines than the normal vitamin group. Oxidative stress indexes such as superoxide dismutase (SOD) and malondialdehyde (MDA) in the vitamin deficiency group were significantly different from those in the normal vitamin group, but no difference was found in myeloperoxidase (MPO). Immune-related indexes, complement 3 (C3) and interferon-gamma (IFN-γ), in the normal vitamin group were higher than those in the vitamin deficiency group. Besides, interleukin-4 (IL-4) (r=-0.37, p=0.04) and IL-1ß (r=-0.31, p=0.04) had significant correlations with vitamins. Vitamins in patients with UC have significant correlations with inflammatory responses in vivo, which can be used to predict inflammatory responses in vivo and have strong clinical significance. Vitamins are also related to oxidative stresses to some extent but have little effect on immune-related indexes.

Vitamin requirements during stem cell transplantation: a systematic review.

Patients undergoing stem cell transplantation (SCT) are at high risk of malnutrition during the acute post-transplantation period. This systematic review aimed to collate and analyse the evidence for vitamin requirements post-SCT. A systematic search of five databases was conducted to include studies published until March 2021. The review utilised the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework. Inclusion criteria consisted of adults undergoing SCT who received vitamin supplementation or had their vitamin levels monitored up to 100 days post-SCT. Studies with paediatric patients or those that looked at vitamin derivates such as folinic acid were excluded. Main outcomes included vitamin deficiency and relevant clinical outcomes. Eleven studies (n = 11) were eligible for inclusion with five rated as neutral quality and six as positive quality. Five studies focused on allogenic SCT, two on autologous SCT and the remaining included a mix of both. Eight studies monitored vitamins levels post-SCT, and seven studies provided vitamin supplementation. Three studies (one provided supplementation) found a high prevalence of vitamin D deficiency (23-60%) prior to SCT. Findings indicate an unclear association between vitamin deficiency and post-SCT complications including acute graft-versus-host-disease, oral mucositis, and mortality. The GRADE certainty of evidence across these outcomes was low or very low. It is unclear if supplementation is needed during SCT, though assessing vitamin D levels prior to transplant should be considered. Further large observational studies or randomised control trials are required to establish vitamin requirements and guide supplementation protocols during SCT.

[Vitamin deficiencies in the adult outpatient setting]. / Carences vitaminiques chez l'adulte en médecine ambulatoire.

Since their discovery more than a century ago to this day, vitamins went from misunderstood molecules with mysterious properties to fundamental components with undoubted clinical implications. Despite the scientific progresses in the understanding of their physiopathological role, vitamins raise to this day multiple interrogations in clinical practice. This article aims at answering questions that are frequently encountered in the outpatient setting regarding vitamin deficiencies: who to screen ? At what moment ? By which test ? How to interpret the results ? How to supplement ? By answering these questions, we hope to provide the general practitioners with a pragmatic tool to guide them in the management of issues related to vitamins.

Depuis leur découverte il y a plus d'un siècle à aujourd'hui, les vitamines sont passées de molécules méconnues et aux propriétés mystérieuses à des composants primordiaux et aux implications cliniques certaines. Malgré les progrès scientifiques dans la compréhension de leur rôle physiopathologique, les vitamines suscitent encore de nombreuses interrogations en pratique clinique. Cet article s'efforce de répondre aux questions fréquem ment rencontrées en médecine ambulatoire portant sur les carences vitaminiques: qui dépister ? À quel moment ? Par quel test ? Comment interpréter les résultats ? Comment supplémenter ? En répondant à ces questions, nous espérons fournir au médecin de premier recours un outil pragmatique pour l'orienter dans la prise en charge des problématiques vitaminiques.

[Regulatory role and anticarcinogenic properties of certain vitamins' active derivatives and vitamin-like substances].

Vitamins are low-molecular compounds consisting of an essential part of the human diet. After entering the human organism vitamins or their precursors can undergo chemical modification, changing their biological properties and regulatory activity. For many decades, vitamins were considered mainly as precursors of enzyme cofactors, and hypovitaminosis was interpreted as a deficiency of a particular metabolite resulting from enzyme's insufficient activity. However, with the development of molecular biology techniques and breakthrough in understanding of gene expression regulation and cell signaling mechanisms, as well as in molecular mechanisms of diseases associated with impaired functions, it became clear that there are significantly more active forms of vitamins, and their functions in the human body are more diverse than it had been suggested previously. The purpose of this review was to consider vitamins' and vitamins' derivatives regulatory and anti-tumor role and their potential for clinical application as main or adjuvant drugs for malignant neoplasms treatment. Material and methods. The present review is based on the results of literature analysis conducted in the Scopus, PubMed, Science Direct databases for the keywords «vitamin A AND cancer¼, «retinoids AND cancer¼, «vitamin D AND cancer¼, «vitamins AND cancer¼, «vitamins AND cancer¼. The search depth was 6 years (2016-2021). Results. Active forms of hydrophilic and lipophilic vitamins are key participants in the processes of chromatin remodeling, genome stability maintaining, covalent modification of proteins, including signaling and regulatory ones, and also act as chemical messengers themselves. Therefore, vitamin deficiency is associated with autoimmune and chronic diseases such as cancer, atherosclerosis, diabetes mellitus, etc. This review considers the regulatory role of active forms of vitamins, their derivatives and vitamin-like substances as well as their involvement in the process of carcinogenesis. Conclusions. Modern studies confirm the high therapeutic potential of vitamins: the use of pharmacological doses of vitamins or their derivatives may help to prevent or fight non-communicable diseases, including cancer.

Fat-soluble Vitamin Deficiency is Common in Children With Chronic Pancreatitis Undergoing Total Pancreatectomy With Islet Autotransplantation.

ABSTRACT: The prevalence of fat-soluble vitamin (FSV) deficiency in children undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis (CP) is unknown. We quantified FSV deficiency in 100 children (age ≤18) undergoing TPIAT. FSV levels (vitamins A, E, D) and clinical history were abstracted from medical records. Vitamin A was low in 4% before and 7% at 1 year after TPIAT, vitamin E in 17% and 18%, and vitamin D in 22% and 24%, respectively, regardless of pancreatic enzyme or vitamin supplement dosing. Longer duration of CP was associated with pre-TPIAT vitamin D insufficiency (P = 0.0002). This remained significant in a multivariate regression model (adjusted P = 0.01). On multivariate analysis, there were no significant predictors of low FSV levels post-TPIAT. FSV deficiencies are common among children undergoing TPIAT and patients who have had longer disease duration may be at increased risk. All children should be monitored for FSV deficiency after TPIAT.

Impact of vitamin deficiency on microbiota composition and immunomodulation: relevance to autistic spectrum disorders.

OBJECTIVES: Inappropriate vitamin supply is a public health problem and is related to abnormalities in brain development, immune response and, more recently, in changes of gut microbial composition. It is known that low levels of vitamin in early life are linked to increased susceptibility to neurodevelopmental disorders, such as Autism Spectrum Disorders (ASD). Unfortunately, the possible peripheral influences of vitamin deficiency that leads to alterations in the gut microbiota-immune-brain axis, one important modulator of the ASD pathology, remain unclear. This narrative review discusses how the impact of vitamin deficiency results in changes in the immune regulation and in the gut microbiota composition, trying to understand how these changes may contribute for the development and severity of ASD. METHODS: The papers were selected using Pubmed and other databases. This review discusses the following topics: (1) vitamin deficiency in alterations of central nervous system in autism, (2) the impact of low levels of vitamins in immunomodulation and how it can favor imbalance in gut microbiota composition and gastrointestinal (GI) disturbances, (3) gut microbiota imbalance/inflammation associated with the ASD pathophysiology, and (4) possible evidences of the role of vitamin deficiency in dysfunctional gut microbiota-immune-brain axis in ASD. RESULTS: Studies indicate that hypovitaminosis A, B12, D, and K have been co-related with the ASD neuropathology. Furthermore, it was shown that low levels of these vitamins favor the Th1/Th17 environment in the gut, as well as the growth of enteropathogens linked to GI disorders. DISCUSSION: GI disorders and alterations in the gut microbiota-immune-brain axis seems to be linked with ASD severity. Although unclear, hypovitaminosis appears to regulate peripherally the ASD pathophysiology by modulating the gut microbiota-immune-brain axis, however, more research is still necessary to confirm this hypothesis.

The association of deficiencies of water-soluble vitamin intake with health-related quality of life and prognosis in patients with heart failure.

PURPOSE: The purpose of this study was to determine whether deficiencies of water-soluble vitamin intake predicted health-related quality of life (HRQOL) and the composite end point of all-cause mortality or cardiac- or heart failure (HF)-related hospitalization in HF patients. Patients with HF may be at risk for inadequate consumption of water-soluble vitamins due to poor appetite and dietary sodium restriction. Because water-soluble vitamins are important in metabolic processes, inadequate dietary intake of these vitamins may negatively affect health outcomes. METHODS: We consecutively recruited patients with HF from outpatient clinics affiliated with academic medical centers. Patients were referred by providers to investigators who verified their eligibility. Patients with HF completed a four-day food diary to determine dietary deficiencies of water-soluble vitamins and the Minnesota Living with HF questionnaire to assess HRQOL at baseline. Patients were followed to determine an event. RESULTS: A total of 216 patients were included. Patients with a higher number of dietary deficiencies of water-soluble vitamins had poorer HRQOL (unstandardized coefficient = 4.92, 95% confidence interval 2.20-7.27). Cox regression showed that for each additional deficiency of a water-soluble vitamin intake, there was a 30% increase in risk for an event (95% confidence interval 1.03-1.75), controlling for demographic and clinical variables. CONCLUSION: Inadequate dietary consumption of water-soluble vitamins was associated with poor HRQOL and prognosis and in HF. Our findings highlight that clinicians should understand the importance of encouraging patients to consume water-soluble vitamin-rich foods, which may result in enhancing outcomes in HF.

Clinically-diagnosed vitamin deficiencies and disorders in the entire United States military population, 1997-2015.

BACKGROUND: This study examined incidence rates, temporal trends, and demographic factors associated with vitamin deficiencies/disorders in all United States military personnel from 1997 to 2015 (mean N = 1,382,266/year). METHODS: Employing an ecological study design, the Defense Medical Epidemiological Database and specific International Classification of Diseases codes were used to determine incidence rates for clinically-diagnosed vitamin deficiencies/disorders. Associations with demographic factors were examined. RESULTS: The overall incidence rate of vitamin deficiencies/disorders was 92.7 cases/100,000 person-years (p-yr). Highest rates were for vitamin D (53.7 cases/100,000 p-yr), other B-complex vitamins (20.2 cases, 100,000 p-yr), vitamin B12 anemia (7.6 cases/100,000 p-yr), deficiencies of "other vitamins" (5.9 cases/100,000 p-yr), and vitamin A (2.5 cases/100,000 p-yr). Thiamin, riboflavin, niacin, pyridoxine, folate, vitamin C, and vitamin K deficiencies and hypervitaminoses A and D had < 1 case/100,000 p-yr. Rates for vitamin D, other B-complex, "other vitamin", and thiamin deficiencies increased over time, while vitamin A and C deficiencies decreased. Women had higher incidence rates for all examined deficiencies/ disorders except niacin and vitamin C. Incidence rates rose with age in 8 of 15 deficiency/disorder categories and blacks had higher incidence rates in 9 of 15 deficiency/disorder categories. CONCLUSIONS: The overall rate of clinically-diagnosed vitamin deficiencies and disorders was low but higher in women and minority subgroups. As for most illnesses, the diagnosed incidence of such disorders may be an underestimate of the actual incidence. These findings can guide clinical decision making with regard to testing for nutritional deficiencies and delivering public health information to at risk populations. CLINICAL TRIAL REGISTRATION: (No. ISRCTN58987177 ). Registration date 9 October 2019.

Prolonging healthy aging: Longevity vitamins and proteins.

It is proposed that proteins/enzymes be classified into two classes according to their essentiality for immediate survival/reproduction and their function in long-term health: that is, survival proteins versus longevity proteins. As proposed by the triage theory, a modest deficiency of one of the nutrients/cofactors triggers a built-in rationing mechanism that favors the proteins needed for immediate survival and reproduction (survival proteins) while sacrificing those needed to protect against future damage (longevity proteins). Impairment of the function of longevity proteins results in an insidious acceleration of the risk of diseases associated with aging. I also propose that nutrients required for the function of longevity proteins constitute a class of vitamins that are here named "longevity vitamins." I suggest that many such nutrients play a dual role for both survival and longevity. The evidence for classifying taurine as a conditional vitamin, and the following 10 compounds as putative longevity vitamins, is reviewed: the fungal antioxidant ergothioneine; the bacterial metabolites pyrroloquinoline quinone (PQQ) and queuine; and the plant antioxidant carotenoids lutein, zeaxanthin, lycopene, α- and ß-carotene, ß-cryptoxanthin, and the marine carotenoid astaxanthin. Because nutrient deficiencies are highly prevalent in the United States (and elsewhere), appropriate supplementation and/or an improved diet could reduce much of the consequent risk of chronic disease and premature aging.

Impact of malnutrition and vitamin deficiency in geriatric patients undergoing orthopedic surgery.

Background and purpose - There is growing evidence that hypoproteinemia is an important risk factor for adverse events after surgery. Less is known about the impact of vitamin deficiency on postoperative outcome. Therefore we evaluated the prevalence and impact of malnutrition and vitamin deficiency in geriatric patients undergoing elective orthopedic surgery.Patients and methods - In a retrospective analysis of 599 geriatric patients who had undergone elective orthopedic surgery in 2018 and 2019, hypoproteinemia, and deficiency of vitamin D, vitamin B12, and folate were assessed. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between malnourished patients and patients with normal parameters. Multivariable logistic regression models were used to assess the relationship between malnutrition and postoperative adverse events, controlling for confounding factors such as age, sex, diabetes mellitus, and frailty.Results - Patients with malnutrition showed a higher rate of reoperation (13% vs. 5.5%; p = 0.01) and exhibited more wound-healing disorders (7.4% vs. 1.3%, p = 0.001) as well as Clavien-Dindo IV° complications (7.4% vs. 2.4%; p = 0.03). Deficiency of vitamin D led to a higher rate of falls (8.4% vs. 2.9%, p = 0.006). Deficiency of vitamin B12 and folate did not affect postoperative adverse events. Although correlated to frailty (p = 0.004), multivariable regression analysis identified malnutrition as independent risk factor for reoperation (OR 2.6, 95% CI 1.1-6.2) and wound healing disorders (OR 7.1, CI 1.9-26).Interpretation - Malnutrition is common among geriatric patients undergoing elective orthopedic surgery and represents an independent risk factor for postoperative adverse events.

[Vitamin D status in women with rheumatoid arthritis: frequency of hypovitaminosis, associations with disease activity, body composition and comorbidity].

AIM: To evaluate the status of vitamin D in women with rheumatoid arthritis (RA) and establish its associations with comorbidity, disease activity, and body composition components. MATERIALS AND METHODS: 86 women with RA (average age 58.18.5 years) were enrolled in the study. We analyzed the relationship of vitamin D levels with clinical and laboratory parameters and with the results of two-energy x-ray absorptiometry. MannWhitney or KruskalWallis, 2 and Spearman tests were performed using Statistica for Windows 10.0 (StatSoft Inc., USA). RESULTS: Vitamin D level was 22.4 [17.8; 27.3] ng/ml: deficiency was detected in 33%, and insufficiency in 46% of women with RA. Only 41% of patients with low vitamin D levels received supplements of cholecalciferol, while only 9% in a sufficient dose. 25(OH)D level was significantly lower in RA patients with sarcopenia, obesity, high activity according to DAS28 and in those who did not receive vitamin D supplements. There werent differences in 25(OH)D levels among subgroups of patient according to age, fertility, BMD status, comorbidity index, RA duration, ESR and CRP levels, medical therapy performed. CONCLUSION: 79% of patients with RA had low levels of vitamin D, while less than half of them received additional cholecalciferol supplements. Low vitamin D levels in RA patients were associated with high disease activity, sarcopenia, and obesity.

[Efficiency of vitamin D deficit correction depending on rats' supply with B vitamins].

Despite the presence of combined deficiency of vitamins D and group B among the population of Russia, the intake of cholecalciferol is often recommended without correcting the supply with B group vitamins, which are involved in ensuring the biological functions of vitamin D. The aim of the study was to compare the effectiveness of vitamin D deficit correction by replenishing its content in the diet to an adequate level without eliminating the deficit of B vitamins and by restoring vitamin D level in combination with B vitamins. Material and methods. The experiment was carried out on male Wistar rats (n=33) with an initial body weight of 69.5±0.8 g. Combined deficit of vitamins D and B group in rats (n=24) was caused by a 5-fold decrease in their content in the vitamin mixture of a semi-synthetic diet for 23 days. Over the next 7 days, in order to correct vitamin deficiency, 12 rats (group «-B+D¼) were fed a diet, replenished up to 100% for vitamin D with continued deficiency of B group vitamins, and 12 rats (group «+B+D¼) were fed a diet replenished for all missing vitamins. Animals of the control group (n=9) received a full semi-synthetic diet during the entire experiment. The concentration of vitamins A and E in blood plasma and lyophilized liver and whole brain was determined by HPLC, vitamins B1 and B2 in the liver, brain and urine, riboflavin in plasma and 4-pyridoxic acid in urine - by fluorimetric methods, 25(OH)D in blood plasma was determined by ELISA. The content of calcium, magnesium, iron, manganese, zinc and copper in freeze-dried liver and brain was determined by atomic absorption method, biochemical parameters of blood and urine were determined using a biochemical analyzer. Results. The only vitamin D addition to the feed with a persisting deficiency of B vitamins did not restore the concentration of 25(OH)D and osteocalcin to the level in control animals sufficiently provided with all vitamins. In animals of the "-B+D" group, 25(OH)D plasma level was reduced by 17.3% (p<0.10), osteocalcin - by 11.7% (p<0.05), the activity of aspartate aminotransferase was 1.5 fold less, alanine aminotransferase - 2.3 fold (p<0.05), lactate dehydrogenase - by 14.9% (p<0.10), while the concentration of iron exceeded 2.7 times, glucose - by 15.0%, calcium - by 8.0%, creatinine - by 8.7% (p<0.05), urea - by 32.1%, direct bilirubin - by 24.2% (p<0.10 ) compared with corresponding indicator in rats of the control group. The level of cholesterol and HDL cholesterol was 14.7% and 15.9% higher (p<0.10) than in animals of the «+B+D¼ group. Conclusions. Deficiency of B vitamins inhibits the restoration of adequate supply with vitamin D. In the presence of a lack of B vitamins in rats, vitamin D deficit and its consequences cannot be completely eliminated. Adequate supply with vitamins D and B group are synergistic factors in maintaining the level of glucose, cholesterol in blood plasma and other diagnostically significant parameters.