Las vitaminas en nutrición geriátrica / Vitamins in geriatric nutrition

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¿Qué es una alimentación sana? / What is a healthy diet?

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Carotenoids, retinol and tocopherols in patients with insulin-dependent diabetes mellitus and their immediate relatives.

1. Patients with insulin-dependent diabetes mellitus are classified among the groups at risk for low vitamin status, and recent studies suggest that some degree of supplementation with antioxidants may be beneficial in helping to prevent certain long-term complications of diabetes mellitus. Our objective was to compare the status of the fat-soluble vitamins and antioxidant-related compounds in patients with well-defined insulin-dependent diabetes mellitus with that of their first-degree relatives, controlling seasonal and analytical variability as factors influencing the interpretation of the data. 2. Fifty-four patients with insulin-dependent diabetes mellitus, 214 non-diabetic, first-degree relatives (controls) and 236 unrelated controls were analysed for retinol, tocopherols (alpha and gamma) and main carotenoids in serum (beta-carotene, alpha-carotene, beta-cryptoxanthin, lutein, zeaxanthin and lycopene) by means of a validated HPLC method. 3. Insulin-dependent diabetes mellitus was associated with lower retinol levels and higher levels of beta-carotene, alpha-carotene and beta-cryptoxanthin than sex-matched, first-degree relatives. alpha-Tocopherol, the alpha-tocopherol/cholesterol ratio, gamma-tocopherol, lutein, zeaxanthin and lycopene showed no differences. Retinol and beta-carotene were the variables most closely associated with diabetes. 4. Patients with insulin-dependent diabetes mellitus showed lower serum retinol status together with higher concentrations of provitamin-A carotenoids. Serum fat-soluble antioxidant levels were greater than or equal to those in controls. According to the serum status observed, individuals with diabetes do not require supplementation with alpha-tocopherol or carotenoids, although the need for retinol supplementation in patients with marginal serum levels should be evaluated.

[Serum status of carotenoids in control subjects and its relation to the diet]. / Status sérico de carotenoides en sujetos control y su relación con la dieta.

Carotenoids are a group of fat soluble pigments which are present in the human being, both in blood, as in tissues, and which are obtained through the diet, mainly from fruits and vegetables. The interest of these compounds is due not only to the provitamin A activity of some of them, but also due to a whole series of biological activities such as: antioxidant or prooxidant, photo-protective, modulator of the immune response, anti-carcinogen, etc. The best analytical method available for the analysis of carotenoids is high performance liquid chromatography (HPLC), which is used in our study both for serum as for foods, and it is controlled throughout periodic quality controls. In this article we present the preliminary results of the levels of the major serum carotenoids (b-carotene, a-carotene, b-cryptoxanthin, lutein, zeaxanthin, and lycopene) in control subjects from five European countries, as well as indicating the major dietary contributors to the carotenoids intake in the Spanish population. The percentage of each carotenoid to the total of the carotenoids analyzed, varies according to the origin of the studied population. Ireland and the UK show a very similar carotenoids profile. France presents the highest levels of lutein and b-carotene, which are present simultaneously in green vegetables. Spain shows the lowest levels of b-carotene, along with the highest levels of b-cryptoxanthin, which in our country is supplied mainly by oranges and tangerines. The most abundant carotenoid in all countries was lycopene. The average daily intake of these carotenoids (from fresh fruits and vegetables) in our population, is 3.5 mg/day. Through the relationships between the dietary carotenoid contents and serum the identification of "biomarkers" have been proposed, which might be correlated with several pathological situations, and thus contribute to the prevention of certain diseases.

Variability in the intercomparison of food carotenoid content data: a user's point of view.

The availability of reliable information on food composition is essential both for the evaluation of diet and for nutritional research to relate diet to health or disease. In this article, we compare the total and individual carotenoid contents and the retinol equivalents in fruits and vegetables reported in several food composition tables and HPLC studies. The impact of the variability in carotenoid intake was evaluated on the basis of Spanish National Consumption Statistics and on the values for a standard diet. We identify, from a user's point of view, errors concerning identification of the items and the terms used to refer to the compounds. Food composition tables overestimate (by 2 to 48%) the retinol equivalent intake, whereas they underestimate (by 30 to 50%) the total carotenoid intake according to HPLC data. We study the effect of these main sources of error, their impact on dietary assessment and on the classification of relevant contributors, and the possible consequences with respect to proper diet in terms of nutritional assessment and epidemiological studies. Given the different dietary habits among populations and the fact that certain items may be over- or underestimated in databases, the use of a single database may be misleading as to the rate of carotenoid consumption and the "true" nutrient intake in a given population, thus weakening the reliability of the study and resulting in erroneous conclusions.

Reference values for retinol, tocopherol, and main carotenoids in serum of control and insulin-dependent diabetic Spanish subjects.

To establish reference ranges for use in clinical and epidemiological studies, we determined concentrations of retinol, alpha-tocopherol, beta-carotene, alpha-carotene, beta-cryptoxanthin, lutein, zeaxanthin, and lycopene in 450 Spanish control subjects and 123 Spanish patients with insulin-dependent diabetes mellitus (IDDM). Results were grouped according to sex, and samples were collected throughout the year. Concentrations of retinol were significantly lower and beta-carotene and alpha-carotene were higher in women than in men, both in controls and IDDM subjects, whereas beta-cryptoxanthin concentrations were higher only in control women. Conditional logistic regression analysis showed that retinol, beta-carotene, and lycopene were the variables associated with diabetes. In comparison with other populations, our controls showed, in general, ordinary concentrations of retinol, comparatively low beta-carotene and high beta-cryptoxanthin concentrations, and a relatively high alpha-tocopherol/ cholesterol ratio.

Major fruit and vegetable contributors to the main serum carotenoids in the Spanish diet.

OBJECTIVE: To identify the main sources of serum carotenoids (lutein, zeaxanthin, lycopene, beta-cryptoxanthin, alpha-carotene and beta-carotene) among the fruits and vegetables in the Spanish diet, to be used in the design of food questionnaires and to provide useful information for epidemiological and comparative studies. DESIGN: A Family Budget Survey from the National Institute of Statistics (1990-1991); an open questionnaire dealing with foods consumed over a one-week period; physical amounts consumed annually and during three-month periods. Calculation of the percentage contribution of each food on the basis of a standard portion as well as the carotenoid concentrations previously reported by our laboratory. SETTING: Nationwide (urban and rural). SUBJECTS: Twenty-one thousand, one hundred and fifty-five (21 155) randomly selected, private households throughout Spain (72279 subjects). RESULTS: Nine vegetables (potato, tomato, green bean, green and/or red pepper, carrot, artichoke, spinach, lettuce and beet) and five fruits (orange, tangerine, banana, peach and watermelon) account for more than 96% of the intake of the major six carotenoids in serum, both on a yearly and on a seasonal basis. Fruit and vegetables provide between 3.0mg (in autumn) and 4.3mg (in summer) of these carotenoids per day. CONCLUSIONS: In our population, a small number of fruits and vegetables can provide significant information on carotenoid intake (both annually and seasonally) to be used in the design of questionnaires for epidemiological studies, minimizing misclassification and errors. The marked seasonality of some products causes wide differences in the supply of, above all, beta-cryptoxanthin and lycopene.

Evaluation of retinol, alpha-tocopherol, and carotenoids in serum of men with cancer of the larynx before and after commercial enteral formula feeding.

BACKGROUND: Both epidemiologic and in vitro studies have indicated the inverse correlation between intake and/or blood concentrations of different carotenoids, retinol, and tocoferol with different chronic and degenerative disturbances (cancer, cardiovascular diseases, cataracts, aging). The purpose of this study was to determine the fat-soluble vitamin and carotenoid levels in men with recently diagnosed cancer of the larynx (n = 51) who had undergone total or partial laryngectomy and compare them with those of an age- and sex-matched control group (n = 51). In addition, the effects of commercial enteral formula feeding were assessed in a subgroup of these patients (n = 35). METHODS: A validated high-performance liquid chromatography method was used to determine the concentrations of six carotenoids (lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, and beta-carotene), retinol, and alpha-tocopherol in serum. Commercial, rather than blender prepared, enteral formulas were supplied to the patients as the only food source for an average period of 12 days. The statistical analysis was based on nonparametric methods (Mann-Whitney and Wilcoxon). RESULTS: The levels of all compounds analyzed were significantly lower in men with laryngeal cancer than in the control group. Retinol and tocopherol increased significantly after enteral formula feeding, although they continued to be significantly lower than those of the controls. The carotenoid levels decreased after enteral nutrition. CONCLUSIONS: The retinol and carotenoid concentrations should be monitored on a routine basis in these patients because of their relationship to this type of cancer. Moreover, it would be of interest to assess the effects of the addition of carotenoids to enteral formulas because they may offer protection from oxidative damage and potentiate the immune system.

[The importance of parenteral nutrition via the peripheral route in patients with inflammatory bowel diseases (IBD)]. / Importancia de la nutrición parenteral por vía periférica en pacientes con enfermedades inflamatoria intestinal (EEI).

The objective of the present study is to evaluate the effects of peripheral parenteral nutrition (PNN) in a homogeneous group of patients who had not had surgery, and to determine whether the deterioration of the nutritional state can be avoided while keeping the advantages of the administration of a peripheral route. We have included 7 patients (4 male and 3 female) with an acute episode of inflammatory bowel disease (IBD). Each received 1780 kcal/day (1500 non-protein kcal 66% as fats, and 33% as glucose), with a kcal/g of N ratio of 160 by means of the preparation technique of "all in one". The anthropometric parameters: initial and final weight (58.5 +/- 12 vs. 57.3 +/- 11); triceps skin fold (14.1 +/- 4 vs. 14.1 +/- 4), and mean circumference of the arm (25.1 +/- 3 vs. 25.0 +/- 3), did not give any significant differences during the treatment period. In the biochemical data there were no significant differences either, except for the final level of serum albumin (3.44 +/- 0.28), which was significantly higher than the initial value (3.11 +/- 0.38) (p < 0.05). The mean duration of the treatment was 12 days (range 6-18). There was no case of phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hyperglycemia in toxic oil syndrome]. / Hiperglucemia en el síndrome del aceite tóxico.

OBJECTIVE: To know the prevalence of hyperglycemia in patients with Spanish toxic oil syndrome (TOS). To analyze clinical, biochemical, and pathological associated factors. To compare them with a control group. DESIGN: Case and controls study. SETTING: Primary Health Care. XI Sanitary district in Madrid. PATIENTS AND OTHER PARTICIPANTS: 734 cases with toxic oil syndrome. 1474 control subjects. MEASUREMENTS AND MAIN RESULTS: Prevalence of impaired glucose tolerance was 2.95% in TOS and 0.07% in control subjects (p < 0.001; OR, 7.55; IC, 291-19.57). Diabetes No insulin treated was 7.78% in TOS and 3.26% in controls (p < 0.001; OR 250; IC 1.62-3.87). Diabetes insulin treated was 1.99% in TOS and 0.47% in controls (p < 0.01; OR, 4.98; IC, 1.80-13.78). Prevalence of diabetes mellitus in TOS was 9.77 and 3.67% (p < 0.001; OR, 2.85; IC, 1.90-4.25) in controls. The pancreatic lesions found in the necropsies were vasculitis type TOS (4 cases) and endothelial vascular lesions (1 case). CONCLUSIONS: The prevalence of hyperglycemia in TOS reached 13%, where as in the control subjects, it was 3.8% (p < 0.001). The pancreatic lesions detected in deceased TOS patients did not coincide with those commonly described in diabetes mellitus.

Seasonal and sex-related variations in six serum carotenoids, retinol, and alpha-tocopherol.

We report the results of a study on the influence of season and sex on serum concentrations of six carotenoids, retinol, and alpha-tocopherol, as determined by reversed-phase HPLC. The subjects were 111 healthy individuals (54 females, 57 males); 18 additional subjects (10 females, 8 males) were assessed for within-subject longitudinal seasonal variations. Men presented significantly higher retinol concentrations (P = 0.002) and lower concentrations of provitamin A carotenoids--alpha carotene (P = 0.006), beta-carotene (P < 0.001), and beta-cryptoxanthin (P < 0.001)--than women. There were no significant differences between the sexes with respect to nonprovitamin A carotenoids (lutein, zeaxanthin, and lycopene) or alpha-tocopherol. Significant seasonal increments (P < 0.05) in serum concentrations of alpha-carotene and beta-carotene (in summer) and of beta-cryptoxanthin (in winter) were detected in both sexes; in males, lutein was higher in summer whereas in females it rose in spring. No sex-related or seasonal variations were observed in alpha-tocopherol, zeaxanthin, or lycopene. Serum concentrations of provitamin A carotenoids vary according to the individual's sex and season of the year.

[2,070 simultaneous determinations of blood glucose, glucosylated hemoglobin and fructosamine as index of metabolic control in 519 diabetic patients]. / Estudio de 2.070 determinaciones simultáneas de glucemia, hemoglobina glucosilada y fructosamina como índice de control metabólico en 519 pacientes diabéticos.

Two thousand and seventy simultaneous determinations of glucose, glucosylated hemoglobin (HbA1) and plasma fructosamine have been performed in 519 diabetic patients in order to obtain a follow up index and metabolic profile. This retrospective study points out the difficulty of achieving a good metabolic control in diabetic patients. Although the determination of plasma glucosylated proteins (HbA1 and fructosamine) has meant a great improvement in diabetic control, the study of the correlation of the above mentioned.