Effects of dietary vitamins supplementation level on the production performance and intestinal microbiota of aged laying hens.

The objective of this study was to investigate the effects of higher vitamins supplementation level on the performance, immunity, and intestinal microbiota of old laying hens. Twelve birds were randomly chosen from 312 healthy, 65-wk-old Hy-Line Brown layers for sampling after a 7-wk acclimation period. The remaining 300 hens were randomly allocated to 1 of 4 dietary treatments for a 13-wk feeding trial: basal diet (CON), basal diet with 2-fold supplementation level of lipid-soluble vitamins (LV), 2-fold supplementation level of water-soluble vitamins (WV), or 2-fold supplementation level of both lipid-soluble and water-soluble vitamins (BV), respectively. Compared with 72-wk-old laying hens, the 85-wk-old laying hens showed declined egg quality, which implied by inferior eggshell strength and yolk color (P < 0.05). However, after 13 wks feeding trial, the birds in WV group had higher yellowness of yolk color, and LV group had increased laying rate (P < 0.05) compared with CON. Meanwhile, WV and/or BV groups showed improved GSH/GSSG levels in liver and increased secretory immunoglobulin A concentrations in jejunum compared with CON (P < 0.05). In addition, higher dietary vitamin supplementation levels significantly altered the composition of intestinal microbiota, as evidenced by increased abundance of ileal Lactobacillus, whereas reduced richness of ileal Romboutsia, Turicibacter, and cecal Faecalibacterium (P < 0.05) in WV group and increased cecal Megasphaera and Phascolarctobacterium (P < 0.05) in LV group compared with CON group. In conclusion, higher vitamin supplementation levels in the diet could improve laying performance and egg quality of aged hens, which was closely correlated with the increased abundance of beneficial microbiota in the intestine.

Micronutrient intake in children with cystic fibrosis in Sydney, Australia.

BACKGROUND: Children with CF have been reported to consume significantly more energy-dense, nutrient-poor foods than controls where there are now concerns of inadequate micronutrient intake. There are no current or comprehensive dietary studies assessing micronutrient intake in CF children. OBJECTIVES: To evaluate micronutrient intake in children with CF compared to recommended dietary intakes (RDIs). METHODS: Dietary intake of 13 micronutrients was measured in CF children aged 2-18 years and age- and sex-matched controls using a validated food frequency questionnaire (The Australian Child and Adolescent Eating Survey). RESULTS: CF children (n = 82) consumed significantly more energy than controls (n = 82) [3142(2531-3822) kcal vs 2216(1660-2941) kcal; p < .001]. Absolute intake in CF children was significantly higher in all micronutrients except vitamin C and folate, however energy-adjusted intake was significantly lower for all micronutrients except vitamin A, sodium, calcium and phosphorous. Energy-adjusted intake in primary school CF children was significantly less than controls in 8/13 micronutrients. Overall, median intakes exceeded the RDIs for all micronutrients however CF children fell short of the RDIs for folate (26.8%), iron (15.9%) and calcium (9.8%). In pre-school, 50% of CF children and 91.7% of controls did not meet the iron RDI. High school CF and control children failed to meet RDIs for 7/13 and 9/13 micronutrients respectively. CONCLUSION: Increased intake of most micronutrients in CF children was largely attributed to higher energy consumption. However, micronutrient density of the diet declined with increasing age, where high school children failed to meet RDIs for most key micronutrients.

Do specialized bariatric multivitamins lower deficiencies after RYGB?

BACKGROUND: One of the side effects of bariatric surgery is the risk of vitamin and mineral deficiencies. Vitamin B12, vitamin D, folate, and iron deficiencies are especially common among Roux-en-Y gastric bypass patients. OBJECTIVE: To examine the effectiveness of a specialized multivitamin supplement for Roux-en-Y gastric bypass patients on deficiencies the first 3 years postoperatively, retrospectively in a large, prospectively collected cohort. SETTING: Large specialized bariatric hospital. RESULTS: One thousand one hundred sixty patients were included, 883 users and 258 who were nonusers of the specialized multivitamin. Patient characteristics and total weight were comparable. Higher serum concentrations of ferritin (124.7 ± 96.2 µg/L versus 106.0 ± 83.0 µg/L, P = .016), vitamin B12 (347.3 ± 145.1 pmol/L versus 276.8 ± 131.4 pmol/L, P<.001), folic acid (34.9 ± 9.6 nmol/L versus 25.4 ± 10.7 nmol/L, P<.001), and vitamin D (98.4 ± 28.7 nmol/L versus 90.0 ± 34.5 nmol/L, P = .002) were observed in users compared with nonusers after 1 year. Less new deficiencies were found for ferritin (1% versus 4%, P = .029), vitamin B12 (9% versus 23%, P<.001), and vitamin D (0% versus 4%, P<.001) in users compared with nonusers. Two and 3 years after the surgery these findings remained almost identical. CONCLUSIONS: The use of specialized multivitamin supplements resulted in less deficiencies of vitamin B12, vitamin D, folic acid, and ferritin. The study showed that Roux-en-Y gastric bypass patients benefited from the specialized multivitamin supplements and it should be advised to this patient group.

Bactérias láticas produtoras de folato e riboflavina: Isolamento e avaliação do seu potencial de aplicação na produção de produtos lácteos caprinos com alto teor de vitaminas / Folate and riboflavin producing lactic acid bacteria: isolation and evaluation of their potential application for production of goat dairy products with higher vitamin content

O valor nutricional e as características físico-químicas fazem com que os produtos lácteos caprinos sejam muito apreciados e tenham um alto valor agregado. Muitas bactérias láticas (BAL) possuem a capacidade de produzir compostos com propriedades benéficas à saúde, inclusive vitaminas do grupo B, como a riboflavina (B2) e o folato (B9), que participam de importantes funções metabólicas. O presente estudo objetivou isolar e identificar BAL capazes de produzir folato e riboflavina, utilizando leite de cabra cru e de queijos de cabra como fonte, para em seguida, avaliar a produção destas vitaminas em leite de cabra UHT, para estimar uma possível aplicação na produção de derivados lácteos de cabra com teores mais altos destas vitaminas. Um total de 179 isolados de BAL, sendo 87 provenientes de leite e 92 de queijos, foram obtidas e analisados quanto à produção de folato e de riboflavina extracelular (EC) e intracelular (IC), empregando-se ensaios microbiológicos apropriados. A produção de folato em meio de cultura a 37ºC foi observada em 151 isolados (84,4%) e de riboflavina em 15 isolados (8,4%), sendo que 14 produziram as duas vitaminas concomitantemente. A média da produção folato total (EC + IC) foi 138,8 µg/L, sendo que em 77 isolados (51%) a produção estava acima da média. Houve diferença significativa entre as médias de produção de folato total pelos isolados de leite e de queijo. A média da produção de riboflavina total (EC + IC) foi 363,7 µg/L, sendo que em 9 isolados (60%) a produção foi acima da média. Com base no RAPD-PCR e sequenciamento da porção 16S do rDNA, foram obtidos 19 perfis genéticos diferentes e identificadas 7 espécies, com predominância de Streptococcus thermophilus (7 isolados), Weissella paramensenteroides (6 isolados) e Lactococcus lactis subsp. lactis (4 isolados). Oito isolados produtores de folato acima da média foram selecionados e submetidos à avaliação da produção de folato em leite de cabra UHT a 37°C, sendo 7 positivas, com média da concentração de folato total de 120,55 µg/L, variando de 12,97 a 261,91 µg/L. Os melhores produtores de folato em leite de cabra UHT foram Lc. lactis subsp. lactis FP368 e St. thermophilus FP34v, FP170v e FP268v. A concentração de folato produzido por estes isolados foi acima da média, evidenciando seu interessante potencial de aplicação na produção de novos derivados lácteos caprinos com teores aumentados desta vitamina. Por outro lado, não foi possível detectar a produção de riboflavina em leite de cabra por nenhum dos isolados testados

Due to the high nutritional value and physicochemical characteristics, goat milk and cheeses are highly appreciated. Many strains of lactic acid bacteria (LAB) are able to produce vitamins from the B complex, such as riboflavin (B2) and folate (B9). These vitamins have important metabolic roles. The present study aimed to isolate riboflavin- and folate-producing LAB strains from goat milk and cheeses, and evaluate the potential application of those strains in the production of goat dairy products with higher content of these vitamins. A total of 179 LAB isolates were obtained from milk (87) and cheese (92) samples. The isolates were evaluated for production of extra (EC) and intracellular (IC) riboflavin and folate, applying appropriate microbiological methods. Among these isolates, 151 (84.4%) were able to produce folate, while 15 (8.4%) displayed the ability to produce riboflavin, and 14 produced both vitamins. The average production of total folate (EC + IC) was 138.8 µg/L, and the amount of folates produced by 77 isolates (51%) were above this average. The differences observed for the average production of total folate from milk and cheese isolates were statistically significant. For total riboflavin (EC+ IC), the average rate was 363.7 µg/L. Nine isolates (60%) presented production rates above the average. No significant difference was observed between the average production of total riboflafin from milk or cheese isolates (319.3 µg/L and 379.8 µg/L, respectively). Based on RAPD-PCR and 16S rDNA sequencing, 19 different genetic profiles were obtained and 7 species were identified, with predominance of Streptococcus thermophilus (7 isolates), Weissella paramensenteroides (6 isolates), and Lactococcus lactis subsp. lactis (4 isolates). Eight isolates that produced folate above the average were selected and tested for vitamins production in UHT goat milk at 37°C. Seven isolates produced an average of 120.55 µg/L of folate in the milk and concentration varied from 12.97 to 261,91 µg/L. The best folate producers were Lactococcus lactis subsp. lactis FP368, Streptococcus thermophilus FP34v, Streptococcus thermophilus FP170v and Streptococcus thermophilus FP268v. The amount of folate produced by these isolates surpassed the average, and was above the amounts described in other studies, evidencing their potential application in the production of goat dairy products with higher content of folate. None of the tested isolates was able to produce riboflavin in UHT goat milk

[Vitamins and nutritional supplements in older persons: How to diagnose and when to substitute?]. / Vitamine und Nahrungsergänzung bei älteren Menschen : Welche Diagnostik und Substitution ist sinnvoll?

Despite an excellent food supply in Germany, a large percentage of older persons living at home or institutionalized older persons suffer from or are at risk for malnutrition. The purpose of this article is to highlight the association between nutrient deficiencies and age-related diseases and give rational recommendations for substitution. Both malnutrition and low levels of specific nutrients are associated with cognitive and functional impairment, dementia, and depression in older persons. Most prevalent are deficiencies in vitamin B1, vitamin B12, and vitamin D. Serum levels are often misleading and show false negative results in vitamin B1 and B12 deficiencies; therefore, determination of erythrocyte transketolase activity (ETKA) and the thiamine pyrophosphate (TPP) effect for vitamin B1 and of methylmalonic acid and holotranscobalamine for vitamin B12 is recommended. Prophylactic supplementation with vitamins is not supported by prospective trials; however, positive data from observational studies support a Mediterranean diet combined with intake of vitamins, antioxidants, and unsaturated fatty acids. Older persons should be regularly screened for malnutrition and the threshold for determination of vitamin B1, B12, and vitamin D should be low. Vitamin substitution should be reserved for proven deficits. There is now data regarding cognition from prospective trials on effects of a healthy diet combined with other life-style factors like physical and cognitive activity.

Study of Protein Oxidative Stress, Antioxidant Vitamins and Inflammation in Patients Undergoing either Hemodialysis or Peritoneal Dialysis.

BACKGROUND: The influence of dialysis modality on oxidative stress (OS) and inflammation is not yet clear. Elucidating this influence could provide novel therapy concepts for cardiovascular diseases. AIM: To compare protein OS, antioxidant vitamins and inflammation in patients undergoing either hemodialysis (HD) or peritoneal dialysis (PD). METHODS: A cross-sectional study was performed with 19 PD and 21 HD patients treated for ≥ 6 months. The control group was composed of 17 healthy individuals. Advanced oxidation protein products (AOPP), advanced glycation end products (AGEs), vitamins C, A and E, C-reactive protein and interleukin 6 were measured in plasma samples. RESULTS: OS was higher in the dialysis group when compared with controls, but HD patients showed higher AOPP compared with PD (HD:141.9 ± 75.2 µmol/L; PD: 112.5 ± 69.3 µmol/L, P< 0.01) and AGEs (HD: 32.2 ± 10.6 AU x10³; PD: 26.6 ± 4.9 AUx10³, P< 0.05). There was no difference in inflammation and vitamin levels among dialysis patients. In HD patients, AGEs correlated moderately with serum vitamin C (r = 0.46; P< 0.05). CONCLUSION: The dialysis modality adopted influences protein OS, but it has no effect on antioxidant status or inflammation. Hemodialysis probably exacerbates OS due to the increased bioincompatibility of the dialysis procedure, and this scenario seems to be related to the intravenous supplementation of vitamin C. Peritoneal dialysis allows for a better oxidative balance, which may reduce cardiovascular risk.

Quantification of the level of fat-soluble vitamins in feed based on the novel microemulsion electrokinetic chromatography (MEEKC) method.

BACKGROUND: Simultaneous quantification of liposoluble vitamins is not a new area of interest, since these compounds co-determine the nutritional quality of food and feed, a field widely explored in the human and animal diet. However, the development of appropriate methods is still a matter of concern, especially when the vitamin composition is highly complex, as is the case with feed designated for laboratory animals, representing a higher health and microbiological status. RESULTS: A method combining microemulsion electrokinetic chromatography (MEEKC) with liquid-liquid extraction was developed for the determination of four fat-soluble vitamins in animal feed. A separation medium consisting of 25 mmol L⁻¹ phosphate buffer (pH 2.5), 2-propanol, 1-butanol, sodium dodecyl sulfate and octane allowed the simultaneous determination of vitamins A, D, E and K within a reasonable time of 25 min. The polarity of the separation voltage was reversed in view of the strongly suppressed electro-osmotic flow, and the applied voltage was set at 12 kV. The fat-soluble vitamins were separated in the order of decreasing hydrophobicity. CONCLUSION: It was proved that the proposed MEEKC method was sufficiently specific and sensitive for screening fat-soluble vitamins in animal feed samples after their sterilization.

Hydrosoluble vitamins.

The hydrosoluble vitamins are a group of organic substances that are required by humans in small amounts to prevent disorders of metabolism. Significant progress has been made in our understanding of the biochemical, physiologic and nutritional aspects of the water-soluble vitamins. Deficiency of these particular vitamins, most commonly due to inadequate nutrition, can result in disorders of the nervous system. Many of these disorders have been successfully prevented in developed countries; however, they are still common in developing countries. Of the hydrosoluble vitamins, the nervous system depends the most on vitamins B and C (ascorbic acid) for proper functioning. The B group vitamins include thiamin (vitamin B1), riboflavin (vitamin B2), niacin or niacinamide (vitamin B3), pantothenic acid (vitamin B5), pyridoxine or pyridoxal (vitamin B6) and cobalamin (vitamin B12). Clinical findings depend upon the deficiency of the underlying vitamin; generally, deficiency symptoms are seen from a combination rather than an isolated vitamin deficiency. True hereditary metabolic disorders and serious deficiency-associated diseases are rare and in general limited to particular geographic regions and high-risk groups. Their recognition is truly important as that determines the appropriate therapeutic management. The general availability of vitamins to practically everyone and several national health programs have saved many lives and prevented complications. However, there has been some apprehension for several decades about how harmless generous dosages of these vitamins are. Overt overdosages can cause vitamin toxicity affecting various body systems including the nervous system. Systemically, vitamin toxicity is associated with nonspecific symptoms, such as nausea, vomiting, diarrhea, and skin rash which are common with any acute or chronic vitamin overdose. At a national level, recommended daily allowances for vitamins become policy statements. Nutrition policy has far reaching implications in the food industry, in agriculture, and in food provision programs. Overall, water-soluble vitamins are complex molecular structures and even today, many areas of vitamin biochemistry still need to be explored. Many readers might be of the opinion that the classic forms of nutritional deficiency diseases have faded into the background of interesting history. This has caused their diverse symptoms to be neglected by most modern physicians since vitamin enrichment of many foods automatically erases them from their consideration in differential diagnosis. Vitamin B12 and folic acid deficiencies are discussed in other chapters.

Casimer Funk, nonconformist nomenclature, and networks surrounding the discovery of vitamins.

In the 2 decades between when the existence of vitamins was first postulated and when they were isolated, scientists and research physicians could produce no conclusive evidence for their existence from the laboratory or clinic. By the time the first vitamin was chemically isolated, vitamins were already widely accepted by scientists, clinicians, the public, and government agencies. In the period between when vitamins were postulated and the Nobel Prize was awarded for their discovery, a debate over nomenclature served as a substitute for a priority dispute. The most popular term "vitamine" was introduced by Casimer Funk in 1912 and was changed to "vitamin" by Cecil Drummond in 1920. Initial conditions surrounding the discovery of vitamins, including World War I, necessitated the creation of unusual networks for the dissemination of scientific information about vitamins. In Great Britain, research institutes, government agencies, and individual researchers were instrumental in creating a set of national and international networks for the dissemination of information from research laboratories to hospitals, physicians, pharmaceutical houses, and the public. These networks of dissemination still exert an influence on how scientific information about vitamins is communicated to the public today.

Effect of antioxidants and B-group vitamins on risk of infections in patients with type 2 diabetes mellitus.

Previous studies have revealed that diabetic patients have a decline in immunity and an increased risk of infections, and this may be associated with poor micronutrient status. The aim of this study was to measure the effect of dietary supplements on risk of infection in patients with type 2 diabetes mellitus. One hundred patients with type 2 diabetes mellitus were randomly assigned to receive an oral dose of daily B-group vitamins and antioxidant vitamins (n = 50) or an identical placebo (n = 50) daily for 90 days. Patients had baseline, three and 12 month assessment for nutritional status, fruits and vegetables intake, physical activity and self-reported infections. Supplementation with antioxidants and B-group vitamins significantly increased the plasma concentration of vitamin E and folate and reduced homocysteine in the intervention group (p-values were 0.006, 0.001 and 0.657, respectively). The number of infections reported by the treatment group after three months of supplements was less than that reported by the placebo group, 9 (27%) vs. 15 (36%) (p = 0.623). Corresponding numbers of infections at 12 months were 25 (67.5%) and 27 (56.3%), respectively (p = 0.488). Up to 90% of the diabetic patients were either overweight or obese with a sedentary life style, and their body weight increased further during three months of follow up. The study showed that multivitamin supplements improved vitamin blood concentrations; however, this did not reduce the number of infections in diabetic patients.

Nutrición parenteral: macronutrientes, electrolitos y vitaminas / Parenteral nutrition: macronutrients, electrolytes and vitamins

La indicación de la nutrición parenteral (NP) en niños, está sujeta a enfermedades complejas y/o alteraciones estructurales del tracto gastrointestinal. Su acceso venoso puede ser central o periférico. Existen 2 formas de preparación: la mezcla 2 en 1, que comprende los lípidos por separado y la 3 en 1, donde se encuentran todos los nutrimentos mezclados en la misma bolsa. El agua es el componente esencial e indispensable. La glucosa es la principal fuente de energía. Los aminoácidos cristalinos son la fuente de proteínas. Los lípidos contribuyen como fuente concentrada de energía. Los electrolitos, son agregados separadamente a la solución. El requerimiento de vitaminas parenterales aún no se conoce con exactitud.

The indication for parenteral nutrition (PN) in children, is subject to complex conditions and/or structural abnormalities of the gastrointestinal tract. Its venous Access may be central or peripheral. There are 2 ways to prepare: mix 2 to 1, which includes separate lipids and 3 in 1, where all nutrients are mixed in the same bag. Water is the essential and indispensable. Glucose is the main source of energy. Crystalline amino acids are the source of protein. Lipids contribute as concentrated source of energy. Electrolytes are added separately to the solution. The requirement for parenteral vitamins are not yet understood.

Respuesta inadecuada a los patógenos y otros agresores: ¿Deficiencia de Vitamina A? / Is inadequate response to pathogens and other aggressors due to vitamin A deficiency?

La vitamina A desempeña un papel fundamental en el desarrollo de los tejidos y órganos gracias a su capacidad de promover la diferenciación celular y regular la apoptosis. Específicamente en el sistema inmune, esta vitamina tiene efectos muy importantes sobre componentes específicos tanto de la respuesta inmune innata como de la adaptativa. En la inmunidad innata, el ácido retinoico (AR) participa en la regeneración de las mucosas y epitelios, promueve la diferenciación de células como los neutrófilos y eosinófilos y potencia la fagocitosis. Además, ayuda a la migración de las diferentes células inmunes promoviendo la producción de metaloproteinasas de matriz extracelular. Aunque sus efectos en las células NK son más controversiales, se ha encontrado que el número y la función lítica de estas células disminuyen cuando hay deficiencia de vitamina A (DVA). Por otra parte, el AR influencia el desarrollo de la inmunidad adaptativa alterando el perfil de producción de citoquinas por parte de las células presentadoras de antígeno, lo que influye en la diferenciación de los linfocitos T ayudadores. En general, se ha observado que el AR amplifica la proliferación de las células T y potencia el desarrollo de células plasmáticas a partir de los linfocitos B maduros. Todos estos efectos tienen repercusiones importantes en la adecuada defensa contra las infecciones, especialmente en la infancia en la cual la DVA es un problema importante de salud pública, no solo en Colombia sino también en aproximadamente otros 60 países.

Vitamin A plays a pivotal role in tissue and organ development due to its ability to regulate cellular differentiation and apoptosis. Moreover, this vitamin produces very important effects on specific components of innate and adaptative immune responses. Concerning the innate immune system, retinoic acid (RA) participates in the regeneration of mucosal surfaces and epithelia, also promoting neutrophil and eosinophil differentiation and enhancing phagocytosis. Additionally, vitamin A supports the production of extracellular matrix metalloproteinases enhancing the migration of different immune cells to effector sites. On the other hand, although the effects of vitamina A in the function of NK cells are more controversial, it is known that blood NK cell numbers and function are diminished during vitamin A deficiency (VAD). In adaptive immunity, RA influences the production of cytokines by antigen presenting cells, in turn, affecting the differentiation of naïve T lymphocytes into different T helper cell subpopulations. Overall, it has been established that RA increases T cell proliferation and enhances the development of plasma cell from mature B lymphocytes. Therefore, vitamin A is essential to promote suitable immune responses against pathogens, especially in children who are commonly affected by VAD not only in Colombia, but also in approximately 60 countries worldwide.

Requerimientos y recomendaciones de macro y micronutrientes en el niño con infección por VIH/SIDA / Requirements and recommendations of macro and micronutrients in children with HIS/AIDS

En niños con infección por VIH/SIDA, existen diferentes métodos para estimar las necesidades de proteína y energía. Estos requerimientos pueden ser estimados, sustituyendo la ingesta diaria recomendada (IDR) por proteína, o incrementando la IDR de proteína entre 50%-100%. Los lípidos ayudan a aumentar el aporte energético. La restricción de carbohidratos simples, se hará en el caso de presentar resistencia periférica a la insulina, al igual que cuando se presente hipertrigliceridemia. Es necesario mantener una buena hidratación para asegurar el equilibrio hidroelectrolítico. El objetivo del soporte nutricional especial, tiene que estar encaminado a preservar la masa grasa y mantener los niveles adecuados de nutrimentos y minimizar los síntomas de malabsorción. De preferencia se deberá utilizar la vía oral ó enteral. Aunque muchos estudios reportan la transmisión del VIH a través de la leche materna, la proporción y la epidemiología no está completamente establecida.

In children with HIV/AIDS infection, there are different methods for estimating protein and energy needs. These requirements can be estimated by replacing the recommended daily intake (RDI) for protein, or increasing the RDA of protein between 50%-100%. Lipids help to increase energy intake. The restriction of simple carbohydrates, will be presented in the case of peripheral insulin resistance, like when presented hypertriglyceridemia. Must be maintained to ensure good hydration and electrolyte balance. The purpose of the special nutritional support, must be designed to preserve body fat and maintain proper levels of nutrients and minimize symptoms of malabsorption. Preferably it should use the oral or enteral. Although many studies report HIV transmission through breast milk, the proportion and epidemiology is not fully established.

Safety considerations and potential interactions of vitamins: should vitamins be considered drugs?

OBJECTIVE: To examine adverse effects, adverse events, and potential interactions of vitamins in light of their current prevalence of use, and to discuss whether vitamins should be considered over-the-counter drugs or natural health products/dietary supplements. DATA SOURCES: We performed a MEDLINE/PubMed search, explored 4 online databases (Medline Plus, Drug Digest, Natural Medicine Comprehensive Database, and the database of the University of Maryland), and examined reference lists of included studies published from 1966 through October 2009. STUDY SELECTION AND DATA EXTRACTION: The studies were reviewed, with an emphasis on randomized controlled clinical trials. We included articles with the most clinically important information with regard to adverse events and interactions. DATA SYNTHESIS: Vitamins are used by over one third of the North American population. Vitamins have documented adverse effects and toxicities, and most have documented interactions with drugs. While some vitamins (biotin, pantothenic acid, riboflavin, thiamine, vitamin B(12), vitamin K) have minor and reversible adverse effects, others, such as fat-soluble vitamins (A, E, D), can cause serious adverse events. Two water-soluble vitamins, folic acid and niacin, can also have significant toxicities and adverse events. CONCLUSIONS: Our recommendation is that vitamins A, E, D, folic acid, and niacin should be categorized as over-the-counter medications. Labeling of vitamins, especially those intended for children and other vulnerable groups, should include information on possible toxicities, dosing, recommended upper intake limits, and concurrent use with other products. Vitamin A should be excluded from multivitamin supplements and food fortificants.

Contents of selected B vitamins in NIST SRM 3280 multivitamin/multielement tablets by liquid chromatography isotope dilution mass spectrometry.

There is increased interest in accurately assessing the total dietary intake of vitamins from all sources, including foods and dietary supplements. Consequently, a Dietary Supplement Ingredient Database (DSID), based upon analytical values, is being established by USDA with support of the Office of Dietary Supplements (ODS), NIH. The DSID necessitated the development of a new SRM, 3280--Multivitamin/Multimineral Tablets, by the National Institute of Standards and Technology (NIST), with support from the ODS. As a continuation of a long-term project to develop and validate new methods of determining water-soluble B vitamins in foods and dietary supplements, and as part of a collaborative effort with NIST to characterize SRM 3280, values for the vitamin contents of SRM 3280 have been generated by a liquid chromatographic isotope dilution mass spectrometric (LC/IDMS) method. Isotope-labeled ((13)C and/or (2)H) B vitamins (B1-thiamine, B6-pyridoxine, B3-nicotinamide, and B5-pantothenic acid) were obtained from commercial sources, with the support of the ODS/NIH. Our LC/IDMS method uses a C18 reversed phase column, an Agilent 1100 HPLC system, and a Quattro Micro triple-quad mass spectrometer (MS). B vitamin determination was achieved using a gradient LC profile combined with MS/MS detection in multiple reaction monitoring mode. Stock solutions of the isotope-labeled vitamins were calibrated against USP standard solutions. The SRM tablets, with added amounts of the four isotope-labeled B vitamins, were extracted and the vitamins simultaneously determined in a single LC run, in contrast with the single-component determinations performed via IDMS. Unknown vitamin concentrations were calculated by comparing the ratios of the integrated LC peaks at the different masses of the unlabeled and labeled vitamins.

Plasma antioxidant status, immunoglobulin g oxidation and lipid peroxidation in demented patients: relevance to Alzheimer disease and vascular dementia.

A large body of evidence supports a role of oxidative stress in Alzheimer disease (AD) and in cerebrovascular disease. A vascular component might be critical in the pathophysiology of AD, but there is a substantial lack of data regarding the simultaneous behavior of peripheral antioxidants and biomarkers of oxidative stress in AD and vascular dementia (VaD). Sixty-three AD patients, 23 VaD patients and 55 controls were included in the study. We measured plasma levels of water-soluble (vitamin C and uric acid) and lipophilic (vitamin E, vitamin A, carotenoids including lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha- and beta-carotene) antioxidant micronutrients as well as levels of biomarkers of lipid peroxidation [malondialdehyde (MDA)] and of protein oxidation [immunoglobulin G (IgG) levels of protein carbonyls and dityrosine] in patients and controls. With the exception of beta-carotene, all antioxidants were lower in demented patients as compared to controls. Furthermore, AD patients showed a significantly higher IgG dityrosine content as compared to controls. AD and VaD patients showed similar plasma levels of plasma antioxidants and MDA as well as a similar IgG content of protein carbonyls and dityrosine. We conclude that, independent of its nature-vascular or degenerative-dementia is associated with the depletion of a large spectrum of antioxidant micronutrients and with increased protein oxidative modification. This might be relevant to the pathophysiology of dementing disorders, particularly in light of the recently suggested importance of the vascular component in AD development.

A prospective study of diet and benign breast disease.

Much attention has been paid to the relation between diet and breast cancer risk. Because benign breast disease (BBD), particularly atypical hyperplasia (AH), is a marker of increased breast cancer risk, studies of diet and BBD may provide evidence about the effect of diet at an early stage in the process of breast carcinogenesis. We evaluated the relationship between fat, fiber, antioxidant and caffeine intake and incidence of non-proliferative BBD, proliferative BBD without atypia and AH in the Nurses' Health Study II. We calculated rate ratios (RR) and 95% confidence intervals (95% CI) for each quartile of energy-adjusted intake using the lowest quartile as reference. There was no increase in risk of BBD with increasing fat intake, rather increasing vegetable fat was associated with a significant reduction in the rate of proliferative BBD without atypia. There was no significant association between any type of BBD and micronutrient intake. High caffeine consumption was positively associated (RR = 2.46, 95% CI 1.11-5.49 for the highest quartile), and use of multivitamin supplements inversely associated (RR = 0.57, 95% CI 0.33-0.98) with risk of AH although these analyses were based on small numbers. These data do not support the hypothesis that higher fat consumption increases risk of BBD, with or without atypia, and also provide little evidence for a major role of antioxidants in the development of breast disease. They do, however, raise the possibility that high caffeine intake may increase, and use of vitamin supplements may decrease risk of developing AH.

Persistence of nutritional deficiencies after short-term weight recovery in adolescents with anorexia nervosa.

OBJECTIVES: To study nutritional abnormalities in adolescent anorexia nervosa and to establish whether certain abnormalities persist after short-term refeeding. METHOD: Sixty-one patients (10-19 years old) admitted to a reference unit for eating disorders between 1999 and 2000 with a diagnosis of anorexia nervosa were evaluated at admission and at discharge. A range of biochemical, nutritional, and hormonal parameters were determined. RESULTS: At admission, no protein or lipid deficiencies were found, although many patients presented with hormonal abnormalities and red blood cell folate and zinc deficiencies. Hormonal abnormalities reverted significantly (p <.000) after renutrition. There were decreases in erythrocytes and in levels of hemoglobin (p <.000) and folic acid (p <.05). Red blood cell folate and zinc increased but did not reach normal levels. CONCLUSIONS: In a large proportion of adolescent anorexic patients, supplementation of folic acid and zinc is recommended although protein or hormonal replacement does not seem to be necessary.