Improving vitamin D status in bariatric surgery subjects with monthly high-dose ergocalciferol.

Background: Vitamin D insufficiency is common before and after bariatric surgery. Optimal supplementation to treat vitamin D insufficiency is not clearly defined. Objective: Determine if serum 25 (OH) D levels improve by the consumption of an additional monthly ergocalciferol supplement by subjects after bariatric surgery. Study design: Thirty-two subjects were randomly divided to receive an additional 100,000 IUs of ergocalciferol monthly after bariatric surgery (n=10) or standard level vitamin D supplement after bariatric surgery (n=22). Serum 25 (OH) D, calcium, and hemoglobin A1c levels were measured preoperatively and one year after bariatric surgery. Results: Mean changes in BMI at 1-year post-operation was -18.12±6.46 kg/m2 in the control group versus -18.84±4.7 kg/m2; p=0.638 in the vitamin D group. One year after bariatric surgery, the mean changes from baseline in vitamin D levels were 2.69±9.4 and 12.4±17.0 ng/mL in control and intervention groups, respectively. The treated group showed a marginally higher mean increase in Vitamin D than the control group, p=0.059. Other mean changes at 1-year post-surgery that were not significantly different include calcium -0.264±0.45 and -0.21±0.509 mg/dl in control and intervention groups, respectively and HbA1c -1.0±1.21 and -0.95±0.071% in control and intervention groups, respectively. Conclusion: This study showed 100,000 IUs ergocalciferol once a month is a safe and effective treatment for vitamin D insufficiency in most patients having bariatric surgery.

In Vitro Cytotoxicity of Trastuzumab (Tz) and Se-Trastuzumab (Se-Tz) against the Her/2 Breast Cancer Cell Lines JIMT-1 and BT-474.

Her/2+ breast cancer accounts for ~25% mortality in women and overexpression of Her/2 leads to cell growth and tumor progression. Trastuzumab (Tz) with Taxane is the preferred treatment for Her/2+ patients. However, Tz responsive patients often develop resistance to Tz treatment. Herein, redox selenides (RSe-) were covalently linked to Tz using a selenium (Se)-modified Bolton-Hunter Reagent forming Seleno-Trastuzumab (Se-Tz; ~25 µgSe/mg). Se-Tz was compared to Tz and sodium selenite to assess the viability of JIMT-1 and BT-474 cells. Comparative cell viability was examined by microscopy and assessed by fluorometric/enzymatic assays. Se-Tz and selenite redox cycle producing superoxide (O2•-) are more cytotoxic to Tz resistant JIMT-1 and Tz sensitive BT-474 cells than Tz. The results of conjugating redox selenides to Tz suggest a wider application of this technology to other antibodies and targeting molecules.

Investigating the Potential of Conjugated Selenium Redox Folic Acid as a Treatment for Triple Negative Breast Cancer.

Previous studies have demonstrated that redox selenium compounds arrest cancer cell viability in vitro through their pro-oxidative activity by generating superoxide (O2•-). Currently, there are no efficacious treatment options for women with Triple Negative Breast Cancer (TNBC). However, the association between the over-expression of the Folate Receptor Alpha (FRA) in TNBC and other cancer cells, has led to the possibility that TNBCs might be treated by targeting the FRA with redox selenium covalent Folic Acid conjugates. The present study reports the synthesis of the redox active vitamer, Selenofolate, generating superoxide. Superoxide (O2•-) catalytic generation by Selenofolate was assessed by an in vitro chemiluminescence (CL) assay and by a Dihydroethidium (DHE) in vivo assay. Cytotoxicity of Selenofolate was assessed against the TNBC cell line MDA-MB-468 and an immortalized, mammary epithelial cell line, HME50-5E. Cytotoxicity of Selenofolate was compared to Folic Acid and sodium selenite, in a time and dose dependent manner. Selenofolate and selenite treatments resulted in greater inhibition of MDA-MB-468 cell proliferation than HME50-5E as evaluated by Trypan Blue exclusion, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) metabolic assay and Annexin V apoptosis assays. Folate receptor alpha (FRA) protein expression was assessed by Western blotting, with the experimental results showing that redox active Selenofolate and selenite, but not Folic Acid, was cytotoxic to MDA-MB-468 cells in vitro, suggesting a possible clinical option for treating TNBC and other cancers over-expressing FRA.

Cytotoxicity of Selenium Immunoconjugates against Triple Negative Breast Cancer Cells.

Within the subtypes of breast cancer, those identified as triple negative for expression of estrogen receptor α (ESR1), progesterone receptor (PR) and human epidermal growth factor 2 (HER2), account for 10⁻20% of breast cancers, yet result in 30% of global breast cancer-associated deaths. Thus, it is critical to develop more targeted and efficacious therapies that also demonstrate less side effects. Selenium, an essential dietary supplement, is incorporated as selenocysteine (Sec) in vivo into human selenoproteins, some of which exist as anti-oxidant enzymes and are of importance to human health. Studies have also shown that selenium compounds hinder cancer cell growth and induce apoptosis in cancer cell culture models. The focus of this study was to investigate whether selenium-antibody conjugates could be effective against triple negative breast cancer cell lines using clinically relevant, antibody therapies targeted for high expressing breast cancers and whether selenium cytotoxicity was attenuated in normal breast epithelial cells. To that end, the humanized monoclonal IgG1 antibodies, Bevacizumab and Trastuzumab were conjugated with redox selenium to form Selenobevacizumab and Selenotrastuzumab and tested against the triple negative breast cancer (TNBC) cell lines MDA-MB-468 and MDA-MB-231 as well as a normal, immortalized, human mammary epithelial cell line, HME50-5E. VEGF and HER2 protein expression were assessed by Western. Although expression levels of HER2 were low or absent in all test cells, our results showed that Selenobevacizumab and Selenotrastuzumab produced superoxide (O2•-) anions in the presence of glutathione (GSH) and this was confirmed by a dihydroethidium (DHE) assay. Interestingly, superoxide was not elevated within HME50-5E cells assessed by DHE. The cytotoxicity of selenite and the selenium immunoconjugates towards triple negative cells compared to HME-50E cells was performed in a time and dose-dependent manner as measured by Trypan Blue exclusion, MTT assay and Annexin V assays. Selenobevacizumab and Selenotrastuzumab were shown to arrest the cancer cell growth but not the HME50-5E cells. These results suggest that selenium-induced toxicity may be effective in treating TNBC cells by exploiting different immunotherapeutic approaches potentially reducing the debilitating side effects associated with current TNBC anticancer drugs. Thus, clinically relevant, targeting antibody therapies may be repurposed for TNBC treatment by attachment of redox selenium.

25 hydroxy vitamin D is higher when a renal multivitamin is given with cholecalciferol at hemodialysis.

BACKGROUND AND OBJECTIVES: Seventy six hemodialysis (HD) patients were used in a prospective randomized and clinical trial to determine if a multivitamin with vitamin D (cholecalciferol 12,000 IU/week) given during dialysis would improve the vitamin D status of hemodialysis subjects. METHODS AND STUDY DESIGN: Subjects were randomly assigned to two groups: 37 subjects were in the renal multivitamin without vitamin D (MV) group and 39 subjects were in a multivitamin route with vitamin D (MVD) group (12,000 IU of cholecalciferol per week). All subjects were given 2 multivitamin tablets at their 3 HD sessions each week for 20 weeks. Serum 25(OH)D, calcium (Ca), and phosphorus (P) levels were evaluated. RESULTS: At baseline, mean serum 25(OH)D were below adequate (<30 ng/mL) in the MV group (23.5±12.2 ng/mL) and in the MVD group (20.8±10.3 ng/mL). A significant increase was seen in serum 25(OH)D levels (37.7±11.4 ng/mL; p<0.001) in the MVD group after vitamin D supplementation with no rise in the MV group value (21.7±11.4 ng/mL; p=0.06). Prior to supplementation, 17.9% of patients in the MVD group had adequate serum 25(OH)D level and post supplementation 76.9% in the MVD group had adequate serum 25(OH)D. In the MV group, 18.9% subjects had adequate serum 25(OH)D levels at baseline with 18.9% having 25(OH)D >30 ng/mL at the end of the study. There were no significant differences in group values for serum Ca and P. CONCLUSION: The majority of HD subjects given a multivitamin with cholecalciferol at dialysis had improvement in their vitamin D status.

In-hospital Breastfeeding and Intention to Return to Work Influence Mothers' Breastfeeding Intentions.

BACKGROUND: Research continues to demonstrate that formula feeding is associated with numerous long-term negative outcomes for a mother and her infant. However, many women cease breastfeeding sooner than intended and recommended. Breastfeeding has been found to be related to demographics, maternal mood, and returning to work outside the home. OBJECTIVES: This study aimed to shed light on the woman's perception of the effect of working on intended breastfeeding duration. This study used intentions to return to work and in-hospital breastfeeding to predict breastfeeding intentions. METHODS: Women (N = 160) were surveyed during the first 48 hours postdelivery of healthy, full-term infants. Survey instruments included demographics (socioeconomic status, maternal age, education, and marital status), depression, fetal attachment, current exclusive breastfeeding status, as well as breastfeeding and return-to-work intentions for the next year. A path analysis was used to explore relationships and predictors of breastfeeding intentions. RESULTS: The model had a good fit and breastfeeding intentions were predicted by exclusive breastfeeding in the hospital (ß = 0.21, P < .01) and negatively predicted by return to work (ß = -0.18, P < .05). CONCLUSION: Exclusive breastfeeding in the hospital within the first 48 hours postpartum and intention to return to work influence how long a mother intends to breastfeed. Attention to these areas can be provided immediately postpartum to support exclusive breastfeeding and provide informational support on continuing to breastfeed/express milk upon return to work if the mother intends to return to work.

Pilot Study: Survey Tools for Assessing Parenting Styles and Family Contributors to the Development of Obesity in Arab Children Ages 6 to 12 Years.

OBJECTIVE: Our pilot study was conducted to test the reliability of the Caregiver's Feeding Styles Questionnaire (CFSQ) and the Family Nutrition and Physical Activity Assessment (FNPA) in a sample of Arab mothers. DESIGN: Twenty-five Arab mothers completed the CFSQ, FNPA, and the Participant Background Survey for the first administration. After 1-2 weeks, participants completed the CFSQ and the FNPA for the second administration. The two administrations of the surveys allowed for test/retest reliability of the CFSQ and the FNPA and to measure the internal consistency of the two surveys. RESULTS: Pearson's correlation between the first and second administrations or the 19-item scale (demandingness) and the 7-item scale (responsiveness) of the CFSQ were .95 and .86, respectively. As for the FNPA, Pearson's correlation was .80. The estimated reliabilities (Cronbach's alpha) of the CFSQ increased from .86 for the first administration to .93 for the second administration. However, the estimated reliabilities of the FNPA slightly increased from .58 for first administration to .59 for the second administration. CONCLUSION: In our pilot study of Arab mothers, the CFSQ and FNPA were shown to be promising in terms of reliability and content validity.

Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS).

BACKGROUND: Polycystic Ovary Syndrome (PCOS) affects approximately 15% of reproductive-age women and increases risk of insulin resistance, type 2 diabetes mellitus, cardiovascular disease, cancer and infertility. Hyperinsulinemia is believed to contribute to or worsen all of these conditions, and increases androgens in women with PCOS. Carbohydrates are the main stimulators of insulin release, but research shows that dairy products and starches elicit greater postprandial insulin secretion than non-starchy vegetables and fruits. The purpose of this study was to determine whether an 8-week low-starch/low-dairy diet results in weight loss, increased insulin sensitivity, and reduced testosterone in women with PCOS. METHODS: Prospective 8-week dietary intervention using an ad libitum low starch/low dairy diet in 24 overweight and obese women (BMI ≥ 25 kg/m2 and ≤ 45 kg/m2) with PCOS. Diagnosis of PCOS was based on the Rotterdam criteria. Weight, BMI, Waist Circumference (WC), Waist-to-Height Ratio (WHtR), fasting and 2-hour glucose and insulin, homeostasis model assessment of Insulin Resistance (HOMA-IR), HbA1c, total and free testosterone, and Ferriman-Gallwey scores were measured before and after the 8-week intervention. RESULTS: There was a reduction in weight (-8.61 ± 2.34 kg, p<0.001), BMI (-3.25 ± 0.88 kg/m2, p<0.001), WC (-8.4 ± 3.1 cm, p<0.001), WHtR (-0.05 ± 0.02 inches, p<0.001), fasting insulin (-17.0 ± 13.6 µg/mL, p<0.001) and 2-hour insulin (-82.8 ± 177.7 µg/mL, p=0.03), and HOMA-IR (-1.9 ± 1.2, p<0.001) after diet intervention. Total testosterone (-10.0 ± 17.0 ng/dL, p=0.008), free testosterone (-1.8 pg/dL, p=0.043) and Ferriman-Gallwey scores (-2.1 ± 2.7 points (p=0.001) were also reduced from pre- to post-intervention. CONCLUSION: An 8-week low-starch/low-dairy diet resulted in weight loss, improved insulin sensitivity and reduced testosterone in women with PCOS.

Redox-active selenium compounds--from toxicity and cell death to cancer treatment.

Selenium is generally known as an antioxidant due to its presence in selenoproteins as selenocysteine, but it is also toxic. The toxic effects of selenium are, however, strictly concentration and chemical species dependent. One class of selenium compounds is a potent inhibitor of cell growth with remarkable tumor specificity. These redox active compounds are pro-oxidative and highly cytotoxic to tumor cells and are promising candidates to be used in chemotherapy against cancer. Herein we elaborate upon the major forms of dietary selenium compounds, their metabolic pathways, and their antioxidant and pro-oxidant potentials with emphasis on cytotoxic mechanisms. Relative cytotoxicity of inorganic selenite and organic selenocystine compounds to different cancer cells are presented as evidence to our perspective. Furthermore, new novel classes of selenium compounds specifically designed to target tumor cells are presented and the potential of selenium in modern oncology is extensively discussed.

Zumba® dance improves health in overweight/obese or type 2 diabetic women.

OBJECTIVE: To evaluate the feasibility and health improvements from a Zumba® intervention in overweight/obese women. METHODS: Twenty-eight (14 type 2 diabetic and 14 non-diabetic) over-weight/obese women (BMI: 37.3±1.5 kg/m(2)) 50.8±1.8 y of age, completed a 16-week intervention attending Zumba® dance classes 3 days/week, 60 minutes/class. We measured aerobic fitness, body weight, body fat %, and motivation to exercise before and after the study. RESULTS: Intrinsic motivation to exercise (p < .05) and aerobic fitness (1.01 ± 0.40 mL/kg/min, p < .05) improved, and the participants lost body weight (-1.05 ± 0.55kg, p < .05) and body fat% (-1.2 ± 0.6%, p < .01). CONCLUSION: The Zumba® intervention improved health and physical fitness in women.

Effect of a low-starch/low-dairy diet on fat oxidation in overweight and obese women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) affects between 4%-18% of reproductive-aged women and is associated with increased risk of obesity and obesity-related disease. PCOS is associated with hyperinsulinemia, which is known to impair fat oxidation. Research shows that carbohydrates from dairy and starch-based foods cause greater postprandial insulin secretion than carbohydrates from nonstarchy vegetables and fruits. The purpose of this study was to determine whether an ad libitum 8-week low-starch/low-dairy diet would improve fasting and postprandial fat oxidation after a high saturated fat liquid meal (HSFLM) in overweight and obese women with PCOS. Prospective 8-week dietary intervention using a low-starch/low-dairy diet in 10 women (body mass index ≥25 kg/m(2) and ≤45 kg/m(2)) with PCOS. Indirect calorimetry was used at fasting and for 5 h following consumption of the HSFLM to determine respiratory exchange ratio (RER), macronutrient oxidation, and energy expenditure (EE) at week 0 and week 8. Participants had a reduction in body weight (-8.1 ± 1.8 kg, p < 0.05) and fasting insulin (-19.5 ± 8.9 µg/mL, p < 0.05) after dietary intervention; however, these were not significantly correlated with improved fat oxidation. There was a reduction in fasting RER, and fasting and postprandial carbohydrate oxidation, and an increase in fasting and postprandial fat oxidation after adjusting for body weight. There was also significant difference in incremental area under the curve from pre- to post-diet for fat (0.06 ± 0.00 g/kg per 5 h; p < 0.001) and carbohydrate oxidation (-0.29 ± 0.06 g/kg per 5 h; p < 0.001), but not for RER or EE. In conclusion, an 8-week low-starch/low-dairy diet increased fat oxidation in overweight and obese women with PCOS.

Associations between tissue visfatin/nicotinamide, phosphoribosyltransferase (Nampt), retinol binding protein-4, and vaspin concentrations and insulin resistance in morbidly obese subjects.

Visfatin/Nampt, vaspin, and retinol binding protein-4 (RBP-4) play an important role in insulin resistance. The objectives of this study were to measure visfatin/Nampt, vaspin, and RBP-4 concentrations in blood, liver, muscle, subcutaneous, omental, and mesenteric adipose tissues in morbidly obese subjects and investigate their relationship to insulin resistance. Blood and tissue samples were collected from 38 morbidly obese subjects during Roux-en-Y surgery. Insulin resistance biomarkers were measured using standard kits. Visfatin/Nampt, vaspin, and RBP-4 gene expression levels in tissues were measured using real-time PCR. Their protein concentrations in blood and tissues were measured using ELISA kits. Diabetic subjects had significantly higher homeostasis model of assessment-insulin resistance and age and lower blood HDL-cholesterol concentrations than nondiabetic and prediabetic subjects. Diabetic and prediabetic subjects had significantly higher blood concentrations of visfatin/Nampt and vaspin than nondiabetic subjects. Liver RBP-4 concentrations were positively associated with blood glucose concentrations. Blood insulin resistance biomarker levels were positively associated with visfatin/Nampt concentrations in omental adipose tissue and liver, and vaspin concentrations in mesenteric adipose tissue. In conclusion, the correlations of visfatin/Nampt, vaspin, and RBP-4 with insulin resistance are tissue dependent.

Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance.

Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance, and other metabolic disorders. Obesity is considered a chronic low-grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted toward higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase and serine kinases inhibitor κB kinase and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt), and nuclear factor kappa B. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.

Vitamin B-6 vitamer levels in plasma and related symptoms in hemodialysis subjects taking low- and high-dose renal multivitamin supplements.

INTRODUCTION: The purpose of this study was to evaluate the B-6 vitamers in plasma and related symptoms in hemodialysis subjects taking high- or low-dose vitamins. METHODS: A total of 24 hemodialysis (HD) subjects were divided into two groups. Twelve subjects received a high-dose vitamin supplement [50 mg pyridoxine hydrochloride (PN-HCl) /tablet] and 12 received a low-dose vitamin supplements containing (10 mg PN-HCl/tablet) for 6+ months. Plasma B-6 vitamers were analyzed using HPLC. Other data were obtained from subjects' medical records. Subjects were assessed for vitamin B-6 related symptoms. Cluster analysis was used to form symptom groups. Student t-tests and analysis of variance were used to determine differences (p < 0.05) in group means. RESULTS: The mean ± SD plasma B-6 vitamer and 4-pyridoxic acid concentrations (nmol/L) were as follows in the 10-mg and 50-mg PN-HCl groups, respectively: pyridoxal- 5'-phosphate (PLP) 10 ± 3 and 16 ± 8 (p = 0.04); pyridoxal (PL) 50 ± 96 and 68 ± 06; pyridoxine (PN) 26 ± 50 and 191 ± 107; and 4-pyridoxic acid (4-PA) 43 ± 64 and 99 ± 361. The cluster group with a significantly higher (p = 0.04) plasma 4-PA concentration of 167 ± 697 nmol/L reported more tingling hands, tachycardia, and diarrhea. CONCLUSION: Plasma PLP levels and symptoms related to B-6 in HD subjects are impacted by dose of PN-HCl.

Assessment of the effect of acculturation on dietary and physical activity behaviors of Arab mothers in Lubbock, Texas.

OBJECTIVES: Our study was conducted to collect exploratory data on Arab mothers in the United States regarding their dietary and physical activity behaviors and to assess the relationship of acculturation to these behaviors. DESIGN: Focus groups and interviews were conducted to collect data on dietary and physical activity behaviors of Arab mothers in Lubbock, Texas. The Social Cognitive Theory guided the development of questions related to the role of acculturation on the dietary and physical activity behaviors. The Male Arab-American Acculturation Scale was used to measure acculturation. RESULTS: A bicultural dietary pattern of Arab mothers emerged. Negative behaviors included skipping meals, increased intake of high-fat fast foods and meat consumption, and lack of traditional physical activity. Some reported reasons for the negative behaviors included children's preferences, lack of access to traditional foods, preference for convenience, the low cost of some foods, and lack of time. Positive changes for some Arab mothers included healthier cooking techniques, reading nutritional labels, and making new healthy food choices due to increased awareness of healthy foods, availability and affordability of many healthy choices in the United States, and Arab mothers' attempts to enrich their families' meals with vegetables in order to keep the Arabic dietary pattern. CONCLUSION: Positive dietary and physical activity changes should be supported. Nutrition interventions are needed that address the major barriers to diet and physical activity changes reported by these Arab mothers.

Determination of total cholesterol in meat and poultry by gas chromatography: single-laboratory validation.

The primary objective of this study was to determine the intralaboratory performance of a cholesterol determination method that combines direct saponification of a 1 g meat or poultry sample and GC quantification of liberated cholesterol without derivatization. Cholesterol was detected at 11.96 min using a GC-flame ionization detector (FID) system. With a 0.005 mg/mL 5alpha-cholestane internal standard and 0.008 to 0.020 mg/mL cholesterol standard series, the FID response was linearly correlated to standard concentrations with a coefficient of determination of 0.995 and a response factor of 0.66. The LOD and LOQ were 1.24 and 4.00 mg/100 g, respectively. Cholesterol could be analyzed within 6 days of preparation with high precision (CV of 0.92 to 2.69%) and accuracy (recovery of 93.24 to 100.56%). This simplified procedure allows for decreased errors and increased productivity, and the method proved to be reliable and able to withstand practical variation in procedural application. The method has been applied routinely with excellent precision to update data on the cholesterol content of beef, pork, and chicken in the U.S. Department of Agriculture National Nutrient Database for Standard Reference.

Low-level groundwater arsenic exposure impacts cognition: a project FRONTIER study.

Arsenic is a ubiquitous environmental toxin with known neurological consequences. Few studies, however, have investigated groundwater arsenic concentrations and cognition among adults and elders. In the study described in this article, the authors examined the potential link between cognitive functioning and low concentrations of arsenic in drinking water. Arsenic concentrations were estimated by the Geographic Information System approach (GIS-arsenic) for 299 rural-dwelling adults and elders. Cognition was assessed with Folstein Mini-Mental State Examination (MMSE). Those in the relatively high GIS-arsenic exposure (> 10.0 microg/L) group had significantly lower MMSE scores than those in the low GIS-arsenic exposure (< or = 10.0 microg/L) group (p < .03). The number of years of education was significantly lower in those in the high GIS-arsenic group(s) than in those in the low GIS-arsenic group (p < .05). These results suggest that poorer cognitive functioning and lower education levels were associated with higher (though still low-level) GIS-arsenic levels in this rural adult cohort.

Micronutrient deficiencies after bariatric surgery.

It has been estimated that approximately 220,000 people with morbid obesity underwent bariatric surgery in 2008. Modification of the gastrointestinal tract affects absorption and health care professionals counseling bariatric patients need to be aware of possible micronutrient deficiencies and their symptoms. A systematic review of several databases and bariatric surgery center websites on the Internet was conducted from January 1980 to July 2009 to identify literature related to micronutrient deficiencies occurring after bariatric surgery. Keywords used individually or in combination were bariatric surgery, obesity, vitamin/mineral deficiencies, altered gastrointestinal function, nutrient absorption, nutrient supplementation, and metabolic complications, and were variously combined in the search list. Based on this review, all patients scheduled for bariatric surgery should receive daily multivitamin and multitrace mineral supplements. The literature suggests that bariatric surgery patients are at risk for deficiency of the following nutrients after surgery: vitamins B(12), B(1), C, folate, A, D, and K, along with the trace minerals iron, selenium, zinc, and copper. Over-the-counter multivitamin and mineral supplements do not provide adequate amounts of certain nutrients such as vitamin B(12), iron, or fat-soluble vitamins and patients will require additional doses of prophylactic supplementation life-long to maintain optimal micronutrient status. In addition, preconception care for adequate prenatal supplementation is critical for pregnant women who have undergone bariatric surgery, as iron, vitamin A, vitamin B(12), vitamin K, and folate deficiencies are associated with maternal and fetal complications, including severe anemia, congenital abnormalities, low birth weight, and failure to thrive. All bariatric surgery patients would be best served by receiving regular monitoring of serum nutrient levels starting at 3 mo after surgery and periodically thereafter.

Transformation for health: a framework for conceptualizing health behaviors in vulnerable populations.

Shedding light on the factors and circumstances that operate to bring about marginalization of groups can facilitate appropriate responses to the issue of health disparities among vulnerable groups in society. This is showing to be a seemingly intractable problem; however, it may well be that the approaches currently used to respond to the issues are not appropriate because we overlook the "realties" that really matter: those emanating from the people being visited by these circumstances themselves. Under normal conditions, human behavior can only be controlled by the individual. Facilitating an environment in which an individual can comprehend his or her internal and external realities is the first step toward transformative behavior.

Serum levels of folate and cobalamin are lower in depressed than in nondepressed hemodialysis subjects.

OBJECTIVE: The purpose of this study was to evaluate if there was a significant difference in serum and RBC folate or serum cobalamin levels in depressed and nondepressed subjects on hemodialysis (HD). DESIGN: A cross-sectional design was used in this study. Each subject's serum folate and cobalamin, and red blood cell (RBC) folate were measured. The Beck Depression Index II (BDI-II) was used to assess for depression. Subjects with scores of 10 or greater were considered depressed. Other laboratory, anthropometric, and demographic data were obtained from the subjects' medical records. To assess for significant differences (P < 0.05) in the laboratory values of the outcome variables between depressed and nondepressed subjects, t tests were performed on the groups' mean values. SETTING: The study was conducted with patients in two dialysis centers in Texas. PATIENTS OR OTHER PARTICIPANTS: Seventy-three individuals undergoing HD for at least six months who met study inclusion criteria were solicited to participate in the study after the study was approved by the respective institutional review board. INTERVENTION: Depression and mental status of each subject were assessed using the BDI-II and the Folstein Mini-Mental State Exam, respectively. MAIN OUTCOME MEASURE: Serum folate, cobalamin, total homocysteine, and RBC folate were measured and mean values were evaluated for significant differences in the depressed and nondepressed groups. RESULTS: Of the subjects in this study, 43.8% had BDI-II scores > 10 indicating depression. The nondepressed subjects had significantly higher mean serum folate (281 +/- 649 vs. 52 +/- 137 ng/mL), serum cobalamin (1162 +/- 1014 vs. 757 +/- 463 pg/mL), and RBC folate (1433 +/- 1757 vs. 810 +/- 654 ng/mL) levels than did depressed subjects. In the nondepressed group, 39% of subjects were taking a supplement containing 35-42 mg folacin and 7 mg cobalamin per week while only 9.1% of depressed subjects were taking a vitamin containing these levels of B vitamins. The group means were not significantly different for age, months on HD, body mass index, erythropoietin/kg body weight, total homocysteine, hemoglobin, albumin, or ferritin. CONCLUSION: As with the general population, lower serum folate, RBC folate, and serum cobalamin levels were found in depressed as compared to nondepressed subjects on HD. Plasma levels of these vitamins may be one of many factors related to depression, but larger studies with stronger designs are needed to confirm the results of this study.