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1.
BMC Infect Dis ; 20(1): 867, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213392

RESUMO

BACKGROUND: Micronutrients are minerals and vitamins and they are essential for normal physiological activities. The objectives of the study were to describe the progress and determinants of micronutrient levels and to assess the effects of micronutrients in the treatment outcome of kalazar. METHODS: A prospective cohort study design was used. The data were collected using patient interviews, measuring anthropometric indicators, and collecting laboratory samples. The blood samples were collected at five different periods during the leishmaniasis treatments: before starting anti-leishmaniasis treatments, in the first week, in the second week, in the third week, and in the 4th week of anti-leishmaniasis treatments. Descriptive statistics were used to describe the profile of patients and to compare the treatment success rate. The generalized estimating equation was used to identify the determinants of serum micronutrients. RESULTS: The mean age of the patients were 32.88 years [SD (standard deviation) ±15.95]. Male constitute 62.3% of the patients and problematic alcohol use was present in 11.5% of the patients. The serum zinc level of visceral leishmaniasis patients was affected by alcohol (B - 2.7 [95% CI: - 4.01 - -1.5]), DDS (B 9.75 [95% CI: 7.71-11.79]), family size (B -1.63 [95% CI: - 2.68 - -0.58]), HIV (B -2.95 [95% CI: - 4.97 - -0.92]), and sex (B - 1.28 [95% CI: - 2.5 - -0.07]). The serum iron level of visceral leishmaniasis patients was affected by alcohol (B 7.6 [95% CI: 5.86-9.35]), family size (B -5.14 [95% CI: - 7.01 - -3.28]), malaria (B -12.69 [95% CI: - 14.53 - -10.87]), Hookworm (- 4.48 [- 6.82 - -2.14]), chronic diseases (B -7.44 [95% CI: - 9.75 - -5.13]), and HIV (B -5.51 [95% CI: - 8.23 - -2.78]). The serum selenium level of visceral leishmaniasis patient was affected by HIV (B -18.1 [95% CI: - 20.63 - -15.58]) and family size (B -11.36 [95% CI: - 13.02 - -9.7]). The iodine level of visceral leishmaniasis patient was affected by HIV (B -38.02 [95% CI: - 41.98 - -34.06]), DDS (B 25 .84 [95% CI: 22.57-29.1]), smoking (B -12.34 [95% CI: - 15.98 - -8.7]), chronic illness (B -5.14 [95% CI: - 7.82 - -2.46]), and regular physical exercise (B 5.82 [95% CI: 0.39-11.26]). The serum vitamin D level of visceral leishmaniasis patient was affected by HIV (B -9.43 [95% CI: - 10.92 - -7.94]), DDS (B 16.24 [95% CI: 14.89-17.58]), malaria (B -0.61 [95% CI: - 3.37 - -3.37]), and family size (B -1.15 [95% CI: - 2.03 - -0.28]). The serum vitamin A level of visceral leishmaniasis patient was affected by residence (B 0.81 [95% CI: 0.08-1.54]), BMI (B 1.52 [95% CI: 0.42-2.6]), DDS (B 1.62 [95% CI: 0.36-2.88]), family size (B -5.03 [95% CI: - 5.83 - -4.22]), HIV (B -2.89 [95% CI: - 4.44 - -1.34]),MUAC (B 0.86 [95% CI: 0.52-1.21]), and age (B 0.09 [95% CI: 0.07-0.12]). CONCLUSION: The micronutrient levels of visceral leishmaniasis patients were significantly lower. The anti-leishmaniasis treatment did not increase the serum micronutrient level of the patients.


Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Visceral/tratamento farmacológico , Micronutrientes/sangue , Adulto , Consumo de Bebidas Alcoólicas , Feminino , Infecções por HIV/complicações , Infecções por HIV/patologia , Humanos , Entrevistas como Assunto , Leishmaniose Visceral/complicações , Leishmaniose Visceral/patologia , Malária/complicações , Malária/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Selênio/sangue , Zinco/sangue
2.
Am J Clin Nutr ; 112(3): 669-682, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649760

RESUMO

BACKGROUND: Maternal supplementation during lactation could increase milk B-vitamin concentrations, but little is known about the kinetics of milk vitamin responses. OBJECTIVES: We compared acute effects of maternal lipid-based nutrient supplement (LNS) consumption (n = 22 nutrients, 175%-212% of the RDA intake for the nutrients examined), as a single dose or at spaced intervals during 8 h, on milk concentrations and infant intake from milk of B-vitamins. METHODS: This randomized crossover trial in Quetzaltenango, Guatemala included 26 mother-infant dyads 4-6 mo postpartum who were randomly assigned to receive 3 treatments in a random order: bolus 30-g dose of LNS (Bolus); 3 × 10-g doses of LNS (Divided); and no LNS (Control), with control meals. Mothers attended three 8-h visits during which infant milk consumption was measured and milk samples were collected at every feed. Infant intake was assessed as $\mathop \sum \nolimits_{i\ = \ 1}^n ( {{\rm{milk\ volum}}{{\rm{e}}_{{\rm{feed\ }}n}} \times \ {\rm{nutrient\ concentratio}}{{\rm{n}}_{{\rm{feed}}\ n}}} )$ over 8 h. RESULTS: Maternal supplementation with the Bolus or Divided dose increased least-squares mean (95% CI) milk and infant intakes of riboflavin [milk: Bolus: 154.4 (138.2, 172.5) µg · min-1 · mL-1; Control: 84.5 (75.8, 94.3) µg · min-1 · mL-1; infant: Bolus: 64.5 (56.1, 74.3) µg; Control: 34.5 (30.0, 39.6) µg], thiamin [milk: Bolus: 10.9 (10.1, 11.7) µg · min-1 · mL-1; Control: 7.7 (7.2, 8.3) µg · min-1 · mL-1; infant: Bolus: 5.1 (4.4, 6.0) µg; Control: 3.4 (2.9, 4.0) µg], and pyridoxal [milk: Bolus: 90.5 (82.8, 98.9) µg · min-1 · mL-1; Control: 60.8 (55.8, 66.3) µg · min-1 · mL-1; infant: Bolus: 39.4 (33.5, 46.4) µg; Control: 25.0 (21.4, 29.2) µg] (all P < 0.001). Only the Bolus dose increased cobalamin in milk [Bolus: 0.054 (0.047, 0.061) µg · min-1 · mL-1; Control: 0.041 (0.035, 0.048) µg · min-1 · mL-1, P = 0.039] and infant cobalamin intake [Bolus: 0.023 (0.020, 0.027) µg; Control: 0.015 (0.013, 0.018) µg, P = 0.001] compared with Control. Niacin was unaffected. CONCLUSIONS: Maternal supplementation with LNS as a Bolus or Divided dose was similarly effective at increasing milk riboflavin, thiamin, and pyridoxal and infant intakes, whereas only the Bolus dose increased cobalamin. Niacin was unaffected in 8 h. This trial was registered at clinicaltrials.gov as NCT02464111.


Assuntos
Aleitamento Materno , Lactação , Micronutrientes/administração & dosagem , Micronutrientes/sangue , Vitaminas/administração & dosagem , Vitaminas/sangue , Adulto , Área Sob a Curva , Estudos Cross-Over , Suplementos Nutricionais , Feminino , Guatemala , Humanos , Lactente , Micronutrientes/química , Leite Humano/química , Niacina/administração & dosagem , Niacina/sangue , Niacina/farmacocinética , Piridoxal/administração & dosagem , Piridoxal/sangue , Piridoxal/farmacocinética , Riboflavina/administração & dosagem , Riboflavina/sangue , Riboflavina/farmacocinética , Tiamina/administração & dosagem , Tiamina/sangue , Tiamina/farmacocinética , Vitamina B 12/administração & dosagem , Vitamina B 12/sangue , Vitamina B 12/farmacocinética , Vitaminas/farmacocinética , Adulto Jovem
3.
JAMA Netw Open ; 3(6): e205123, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32515795

RESUMO

Importance: Few studies have described the longitudinal trajectories of serum levels of micronutrients whose deficiencies are associated with serious sequelae following bariatric procedures, such as anemia, osteoporotic fractures, and neuropathies. Furthermore, previous studies comparing laparoscopic sleeve gastrectomy (LSG) vs Roux-en-Y gastric bypass (LRYGB) or one-anastomosis gastric bypass (OAGB) procedures may have been limited by selection and confounding biases. Objective: To appraise the spectrum and temporal course of micronutrient deficiencies associated with bone metabolism and erythropoiesis after LSG vs OAGB or LRYGB procedures, using the propensity score as a balancing score. Design, Setting, and Participants: This prospective, longitudinal comparative effectiveness study was conducted at a high-volume bariatric unit in Singapore from September 1, 2008, to November 30, 2017, with a cutoff date for analysis of September 2018. Patients who underwent adjustable gastric banding, biliopancreatic diversion procedures, and intragastric balloon procedures were excluded. All other patients who underwent bariatric procedures were included. Data were analyzed from September 23 to 30, 2018. Main Outcomes and Measures: Serial assessment of 13 biochemical parameters at 12 time points for up to 5 years after bariatric procedure. Inverse probability-of-treatment weights were used to obtain estimates of the mean associations of variables assessed with the bariatric surgical interventions. Longitudinal trajectories were analyzed using mixed-effects generalized linear models to apportion the temporal variation of serum micronutrients into fixed-effects and random-effects components. Results: A total of 688 patients were included in this study, of whom 499 underwent LSG (mean [SD] age, 41.5 [11.3] years; 318 [63.7%] women) and 189 underwent OAGB or LRYGB (mean [SD] age, 48.6 [9.4] years; 112 [59.3%] women). There were no differences during follow-up among patients who underwent LSG vs those who underwent OAGB or LRYGB in intact parathyroid hormone levels (mean difference, 7.05 [95% CI, -28.67 to 42.77] pg/mL; P = .70), serum 25-hydroxyvitamin D levels (mean difference, -0.72 [95% CI, -1.56 to 0.12] ng/mL; P = .09), or phosphate levels (mean difference, 0.006 [95% CI, -0.052 to 0.064] mg/dL; P = .83). Hemoglobin levels were a mean 0.63 (95% CI, 0.41 to 0.85) g/dL higher among patients who underwent LSG compared with those who underwent OAGB or LRYGB (P < .001), despite no differences in iron concentration levels (mean difference, 1.50 [95% CI, -1.39 to 4.39] µg/dL; P = .31), total iron-binding capacity (mean difference, 4.36 [95% CI, -5.25 to 13.98] µg/dL; P = .37), or ferritin levels (mean difference, 3.0 [95% CI, -13.0 to 18.9] ng/mL; P = .71). Compared with patients who underwent LSG procedures, patients who underwent OAGB or LRYGB had higher folate levels (mean difference, 2.376 [95% CI, 1.716 to 3.036] ng/mL; P < .001) but lower serum magnesium levels (mean difference, -0.25 [95% CI, -0.35 to -0.16] mg/dL; P < .001) and zinc levels (mean difference, -7.58 [95% CI, -9.92 to -5.24] µg/dL; P < .001). Conclusions and Relevance: These findings suggest that LSG vs OAGB or LRYGB procedures have differential associations with various micronutrient and metabolic parameters. These differences should be recognized in guidelines for postbariatric nutritional surveillance and prevention.


Assuntos
Gastrectomia , Derivação Gástrica , Micronutrientes/sangue , Adulto , Anemia/etiologia , Osso e Ossos/metabolismo , Pesquisa Comparativa da Efetividade , Eritropoese , Feminino , Ferritinas/sangue , Ácido Fólico/sangue , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Hemoglobinas/metabolismo , Humanos , Ferro/sangue , Estudos Longitudinais , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Pontuação de Propensão , Estudos Prospectivos , Albumina Sérica/metabolismo , Fatores Sexuais , Vitamina D/análogos & derivados , Vitamina D/sangue , Zinco/sangue
4.
Am J Clin Nutr ; 112(1): 168-179, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32133498

RESUMO

BACKGROUND: We recently presented associations between serum-based biomarkers of carotenoid and tocopherol intake and chronic disease risk in a Women's Health Initiative (WHI) Measurement Precision subcohort (n = 5488). Questions remain as to whether self-reported dietary data can usefully augment such biomarkers or can be calibrated using biomarkers for reliable disease association estimation in larger WHI cohorts. OBJECTIVES: The aims were to examine the potential of FFQ data to explain intake variation in a WHI Feeding Study and to compare association parameter estimates and their precision from studies based on biomarker-calibrated FFQ intake in larger WHI cohorts, with those previously presented. METHODS: Serum-based intake measures were augmented by using FFQ data in a WHI Feeding Study (n = 153). Corresponding calibration equations were generated, both in a companion Nutritional Biomarker Study (n = 436) and in the previously mentioned subcohort (n = 5488), by regressing these intake measures on dietary data and participant characteristics, for α- and ß-carotene, lutein plus zeaxanthin, and α-tocopherol. The supplemental value of FFQ data was considered by examining the fraction of feeding study intake variation explained by these regression models. Calibrated intake and disease association analyses were evaluated by comparisons with previously reported subcohort results. RESULTS: The inclusion of FFQ data led to some increases in feeding study intake variation explained (total R2 of ∼50%). Calibrated intake estimates explained 25-75% of serum-based intake variation, whether developed using either of the 2 cohort subsamples. Related disease associations for micronutrients were precisely estimated in larger WHI cohorts (n = 76,691) but were often closer to the null compared with previously reported associations. CONCLUSIONS: FFQ data may usefully augment blood concentrations in estimating the intake of carotenoids and tocopherols. Calibrated intake estimates using FFQ, dietary supplement, and participant characteristics only may require further justification to ensure reliable estimation of related disease associations.


Assuntos
Micronutrientes/sangue , Idoso , Biomarcadores/sangue , Carotenoides/sangue , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Micronutrientes/metabolismo , Pessoa de Meia-Idade , Estado Nutricional , Saúde da Mulher , alfa-Tocoferol/sangue , beta Caroteno/sangue
5.
Nutrients ; 12(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32069820

RESUMO

We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian women planning to become pregnant. A cross-sectional analysis was completed of 95 women aged 18-35 years, living in the Upper Manya Krobo District in the Eastern Region of Ghana. Questionnaires were administered to collect sociodemographic and food security data; weight and height were measured. Blood was drawn from an antecubital vein; one drop was used to assess hemoglobin via Hemocue. Zinc and copper were analyzed using flame atomic spectrophotometry while iron biomarkers, retinol and 25-hydroxyvitamin D were analyzed using ELISA, ultra-performance liquid chromatography and liquid chromatography-tandem mass spectrometry, respectively. Logistic regression models were used to determine the relationship between food insecurity (FIS) and micronutrient deficiencies. FIS was reported among 23% of the households, while micronutrient deficiencies ranged from 7-28% irrespective of FIS status. Retinol concentrations were negatively associated with FIS (p = 0.043) after controlling for covariates, although levels were within the normal range in both groups. No statistically significant associations between FIS and micronutrient deficiencies were found. Among those with FIS, 59% were deficient in at least one nutrient with 18% deficient in two nutrients. Unmarried women were at higher risk of FIS (p = 0.017) than married women. FIS was associated with retinol concentrations but not other micronutrient biomarkers in Ghanaian women expecting to become pregnant in the next 6 months.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Micronutrientes/sangue , Estado Nutricional , Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , Biomarcadores/sangue , Cobre/sangue , Estudos Transversais , Feminino , Gana , Hemoglobinas/análise , Humanos , Ferro/sangue , Modelos Logísticos , Gravidez , Vitamina A/sangue , Adulto Jovem , Zinco/sangue
6.
Sci Rep ; 10(1): 1505, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001725

RESUMO

Malnutrition is common in patients with acute kidney injury (AKI) and the risk of mortality is high, especially if renal replacement therapy is needed. Between April 2013 through April 2014, we recruited critically ill adult patients (≥18 years) with severe AKI in two University hospitals in London, UK, and measured serial plasma concentrations of vitamin B1, B6, B12, C and D, folate, selenium, zinc, copper, iron, carnitine and 22 amino acids for six consecutive days. In patients receiving continuous renal replacement therapy (CRRT), the concentrations of the same nutrients in the effluent were also determined. CRRT patients (n = 31) had lower plasma concentrations of citrulline, glutamic acid and carnitine at 24 hrs after enrolment and significantly lower plasma glutamic acid concentrations (74.4 versus 98.2 µmol/L) at day 6 compared to non-CRRT patients (n = 24). All amino acids, trace elements, vitamin C and folate were detectable in effluent fluid. In >30% of CRRT and non-CRRT patients, the plasma nutrient concentrations of zinc, iron, selenium, vitamin D3, vitamin C, trytophan, taurine, histidine and hydroxyproline were below the reference range throughout the 6-day period. In conclusion, altered micronutrient status is common in patients with severe AKI regardless of treatment with CRRT.


Assuntos
Lesão Renal Aguda/metabolismo , Micronutrientes/análise , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/fisiopatologia , Adulto , Idoso , Terapia de Substituição Renal Contínua/métodos , Estado Terminal/mortalidade , Feminino , Humanos , Masculino , Metais Pesados/análise , Metais Pesados/sangue , Micronutrientes/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Terapia de Substituição Renal/métodos , Vitaminas/análise , Vitaminas/sangue
7.
J Acad Nutr Diet ; 120(5): 874-884, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31892499

RESUMO

BACKGROUND: Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies. OBJECTIVE: The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup. DESIGN: A cross-sectional study of data collected at the time of the preoperative evaluation. PARTICIPANTS/SETTING: Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected. STATISTICAL ANALYSES: Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ2 test. RESULTS: Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively). CONCLUSIONS: The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.


Assuntos
Cirurgia Bariátrica , Deficiências Nutricionais/epidemiologia , Obesidade Mórbida/sangue , Adulto , Árabes/estatística & dados numéricos , Índice de Massa Corporal , Estudos Transversais , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/cirurgia , Feminino , Ácido Fólico/sangue , Humanos , Ferro/sangue , Ferro/deficiência , Israel/epidemiologia , Masculino , Micronutrientes/sangue , Micronutrientes/deficiência , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Período Pré-Operatório , Prevalência , Fatores de Risco , Fatores Sexuais , Vitamina B 12/sangue , Vitamina D/sangue
8.
J Trop Pediatr ; 66(4): 395-402, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31747014

RESUMO

BACKGROUND: Micronutrients and antioxidants may ameliorate oxidative stress. This study aimed to determine the serum Zinc (Zn), Selenium (Se) and Total Antioxidant Contents (TAC) of Nigerian children with asthma and relate these to disease severity and symptoms control. METHODS: Children aged 2-15 years with asthma and age and sex matched controls were consecutively recruited. The children's serum Zn, Se and TAC were assayed and compared. RESULTS: Eighty children each with asthma and controls participated in the study. Serum Zn (71.0 ± 30.3 µg/dl vs. 84.2 ± 31.7 µg/dl; p = 0.008), Se (67.3 ± 29.8 µg/l vs. 80.0 ± 31.7 µg/l; p = 0.033) and TAC [median (interquartile range) 5.2 (3.8-6.8) ng/dl vs. 6.2 (4.3-8.0) ng/dl; p = 0.019] were lower in children with asthma. Serum Se (65.7 ± 29.1 µg/l vs. 92.4 ± 28.6 µg/l; p = 0.001) was lower in those with moderate/severe than mild disease, but no association with symptoms control (p > 0.05). CONCLUSION: Micronutrient supplementation may be beneficial in Nigerian children with asthma as they have relatively lower antioxidant micronutrients than nonasthmatics.


Assuntos
Antioxidantes/análise , Asma/sangue , Micronutrientes/sangue , Selênio/sangue , Zinco/sangue , Adolescente , Asma/diagnóstico , Asma/epidemiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Estado Nutricional , Estresse Oxidativo , Índice de Gravidade de Doença
10.
Curr Diabetes Rev ; 16(7): 674-689, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31686640

RESUMO

This article presents a scoping review and synthesis of research findings investigating the toxic cellular accumulation of dysregulated inorganic phosphate-phosphate toxicity-as a pathophysiological determinant of diabetes and diabetic complications. Phosphorus, an essential micronutrient, is closely linked to the cellular metabolism of glucose for energy production, and serum inorganic phosphate is often transported into cells along with glucose during insulin therapy. Mitochondrial dysfunction and apoptosis, endoplasmic reticulum stress, neuronal degeneration, and pancreatic cancer are associated with dysregulated levels of phosphate in diabetes. Ectopic calcification involving deposition of calcium-phosphate crystals is prevalent throughout diabetic complications, including vascular calcification, nephropathy, retinopathy, and bone disorders. A low-glycemic, low-phosphate dietary intervention is proposed for further investigations in the treatment and prevention of diabetes and related diabetic pathologies.


Assuntos
Complicações do Diabetes/metabolismo , Diabetes Mellitus/terapia , Fosfatos/metabolismo , Fenômenos Fisiológicos Celulares , Células/metabolismo , Complicações do Diabetes/etiologia , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/sangue , Diabetes Mellitus/dietoterapia , Diabetes Mellitus/prevenção & controle , Glucose/metabolismo , Humanos , Micronutrientes/efeitos adversos , Micronutrientes/sangue , Micronutrientes/metabolismo , Micronutrientes/toxicidade , Fosfatos/efeitos adversos , Fosfatos/sangue , Fosfatos/toxicidade
11.
Adv Wound Care (New Rochelle) ; 9(1): 9-15, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31871826

RESUMO

Objective: To explore the prevalence of micronutrient deficiencies in patients with diabetic foot ulcers and correlate this with foot disease severity and other clinical factors. Approach: Prospective cohort study of diabetic patients with foot ulcers seen in multidisciplinary foot clinics across Adelaide or admitted to the Vascular Surgery Unit at the Royal Adelaide Hospital between February 2017 and September 2018. A total of 131 patients were included in the study. Plasma serum levels of vitamins A, C, D, and E, copper, zinc, and ferritin were measured. Demographic and clinical data, including BMI, smoking status, duration of diabetes, HbA1c, and WIfI score, were obtained. Results: The most prevalent nutritional deficiency found was vitamin D affecting 55.7% of patients. Suboptimal levels of vitamin C affected 73% of patients, comprising marginal levels in 22.2% and deficient levels in 50.8%. Zinc deficiency, vitamin A deficiency, and low ferritin levels were present in 26.9%, 10.9%, and 5.9% of patients, respectively. There was no correlation between BMI, grip strength, duration of diabetes, HbA1c, or smoking status with micronutrient deficiency. Increased severity of diabetic foot disease was associated with lower vitamin C levels (p = 0.02). Innovation: This study has demonstrated that the deficiency of micronutrients, especially vitamin D, vitamin C, zinc, and vitamin A, is common in diabetic patients with foot ulcers. Conclusions: The prevalence of micronutrient deficiency is high in a diabetic population with foot ulcers/wounds. Special concerns regarding the high prevalence of vitamin C and zinc deficiency, given their roles in wound healing. Although further research needs to be performed to determine the clinical implications of our findings, micronutrient deficiency should be considered in diabetic patients with foot wounds.


Assuntos
Complicações do Diabetes/epidemiologia , Úlcera do Pé/complicações , Micronutrientes/sangue , Estado Nutricional/fisiologia , Idoso , Deficiência de Ácido Ascórbico/epidemiologia , Austrália/epidemiologia , Índice de Massa Corporal , Cobre/deficiência , Feminino , Ferritinas/deficiência , Úlcera do Pé/metabolismo , Hospitalização , Humanos , Masculino , Micronutrientes/deficiência , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina E/epidemiologia , Cicatrização/fisiologia , Zinco/deficiência
12.
J Acad Nutr Diet ; 120(4): 624-640, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31248791

RESUMO

Malnutrition is common in patients with Crohn's disease and negatively influences immunity and quality of life. The optimal tools for nutrition assessment in patients with Crohn's disease are not clearly defined and lead to variations in practice. With this review, we aimed to appraise the existing evidence for nutrition assessment of patients with Crohn's disease compared with healthy controls and provide a comprehensive guide with relevant measures applicable to clinical practice. A literature search using Medline, Embase, and Scopus from inception to October 1, 2018, was conducted. Forty-one articles that assessed body composition, muscle strength, micronutrient status and/or dietary intake in adults with Crohn's disease compared with an age- and sex-matched healthy individuals were included. There were heterogeneous findings on nutritional status in patients with Crohn's disease compared with healthy controls. Only one article reported a clinically significant difference for body mass index; however, significant deficits in fat mass, fat-free mass, and muscle strength were observed in patients with Crohn's disease compared with healthy controls, with more pronounced differences with increasing disease activity and length of diagnosis. Most research reported significantly lower serum micronutrients in patients with Crohn's disease compared with healthy controls. Half of studies measuring micronutrient intake reported lower intakes in patients with Crohn's disease compared with healthy controls. Fruit and vegetable intake was also lower in patients with Crohn's disease. Difficulties characterizing the type and prevalence of malnutrition exist due to the heterogeneous nature of Crohn's disease and warrants continued investigation. As a result of this review, we advocate that a nutrition assessment should include more parameters than weight and body mass index.


Assuntos
Antropometria/métodos , Doença de Crohn/fisiopatologia , Dieta Saudável/estatística & dados numéricos , Avaliação Nutricional , Adulto , Biomarcadores/análise , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Estudos de Casos e Controles , Inquéritos sobre Dietas , Feminino , Humanos , Masculino , Micronutrientes/sangue , Estado Nutricional
13.
PLoS One ; 14(12): e0226609, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877169

RESUMO

Minerals, such as zinc, copper, and iron are reported to play roles in chronic infectious diseases; however, their role in paracoccidioidomycosis (PCM) remains unknown. This study aimed to examine the micronutrient dynamics and their correlation with serum proteins and thyroid hormones in patients with PCM. In 14 patients with PCM and 10 healthy subjects, we evaluated the body mass index (BMI) along with serum levels of hemoglobin, iron, ferritin, zinc, copper, magnesium, albumin, globulin, thyroid stimulating hormone (TSH), thyroxine (free T4), and triiodothyronine (T3). Evaluations were conducted at the first appointment, before treatment, and at the end of the first, second, fourth, and sixth month of PCM treatment. The control group was only evaluated once. We observed that before treatment, patients with PCM, had higher levels of copper and lower level of iron than those of the control group. After one month of treatment, the iron levels increased, whereas the levels of copper after six months of treatment. Reduction in inflammatory activity, indicated by the normalization of C-reactive protein, ferritin, albumin, and globulin levels, was observed during treatment. However, no correlation was observed between the serum levels of minerals and inflammatory activity or thyroid function in this study. In conclusion, our results showed higher serum copper levels in control group compared to those in pretreatment patients; the clinical importance of this observation should be investigated in further studies. After treatment, serum copper levels showed a tendency to decrease. In addition, serum iron levels were decreased at the stage of active disease, and were increased after treatment. Thus, serum iron levels can be used as a better biomarker for treatment control.


Assuntos
Proteínas Sanguíneas/análise , Micronutrientes/sangue , Paracoccidioidomicose/sangue , Hormônios Tireóideos/sangue , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/diagnóstico
14.
Sci Rep ; 9(1): 19070, 2019 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-31836749

RESUMO

This study aimed to compare the trajectory of serum 25(OH)D, micronutrient levels, and anthropometric measurements between exclusively breastfed and mixed-fed children. This is a prospective cohort study. Anthropometric measurements of the children were obtained during scheduled clinical visits. Tests for 25(OHD), ferritin, zinc and complete blood count were performed yearly until 3 years of age. Clinical records and questionnaires on dietary habits were obtained. The results showed that despite official recommendations on vitamin D/iron supplements for breastfed children, less than 10% of our exclusively breastfed children received regular supplements. Thus, after 1 year, the odds for having iron deficiency anemia and vitamin D insufficiency were 9 [95% CI, 4-19] and 6 [95% CI, 2-16], respectively. Longitudinal follow-up showed the prevalence of iron deficiency to decrease from 34% at 1 year to 2% at age 3 years. However, the prevalence of vitamin D insufficiency remained persistently high throughout the first three years of life (60% at 1 to 44% at 3 years). Very few children had zinc deficiency. Anthropometric measurements showed exclusively breastfed children to have lower mean z-scores for body weight and height when compared to mixed-fed children after 12 months. In conclusion, children who were exclusively breastfed for longer than 4 months without proper supplement were more likely to have transient iron deficiency anemia and persistent vitamin D insufficiency. Their growth became relatively slower after infancy. Whether this was associated with underlying inadequate serum vitamin D and iron level remains an important issue to be explored.


Assuntos
Aleitamento Materno , Desenvolvimento Infantil , Micronutrientes/sangue , Vitamina D/sangue , Contagem de Células Sanguíneas , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Lactente , Ferro/deficiência , Masculino , Zinco/sangue
15.
Nutrients ; 11(11)2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31703461

RESUMO

: High visceral fat area (VFA) is a stronger predictor of cardiovascular disease and overall mortality than body mass index or waist circumference. VFA may be decreased by proper dietary habits. Although previous epidemiologic studies demonstrated an association between nutritional components or foodstuffs and VFA, only the associations of a few nutrients, such as dietary fiber and calcium, are reported. We performed a comprehensive 2-year longitudinal study in more than 624 healthy people and analyzed 33 micronutrients to investigate nutrients that contribute to changes in visceral fat. Our analyses revealed that "macronutrients" and "micronutrients" were "mutual confounders". Therefore, when evaluating the association between VFA and micronutrients, associations were adjusted by macronutrients. The ingestion of 7 nutrients: soluble dietary fiber, manganese, potassium, magnesium, vitamin K, folic acid, and pantothenic acid, which are abundant components in vegetable diets, was significantly inversely correlated with a change in VFA. Additionally, a change in the ingestion of one nutrient, monounsaturated fat, was significantly positively correlated with a change in VFA. These associations were independent of body mass index and waist circumference. Thus, a predominantly vegetable diet may decrease VFA. In addition, adjusting the intake of macronutrients might help to clarify the association of micronutrients with VFA.


Assuntos
Dieta/estatística & dados numéricos , Gordura Intra-Abdominal/fisiologia , Micronutrientes/sangue , Obesidade Abdominal , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Obesidade Abdominal/sangue , Obesidade Abdominal/epidemiologia , Verduras , Circunferência da Cintura/fisiologia
16.
Nutrients ; 11(11)2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31731609

RESUMO

The present study aimed to investigate the changes in dietary patterns of adult Saudis with prediabetes who underwent a six-month lifestyle modification program. A total of 160 Saudis with prediabetes (baseline fasting glucose 5.6-6.9 mmol/L), aged 20-60 years, were enrolled in one of the two arms: A one-time general advice about lifestyle modification (GA group) at orientation or a well-structured and monitored nutrition and lifestyle counseling for six months (guidance group). Fasting blood samples and a dietary recall for daily intakes of macro/micronutrients using a validated computerized food database "ESHA-the Food Processor Nutrition Analysis program" were collected pre- and post-intervention. Compliance to reference daily intake (RDI) was also calculated at both time points. At baseline, overall, severe deficiencies in the majority of micronutrient intakes were observed. Post intervention, clinically significant improvements in the glycemic indices (fasting glucose and insulin resistance) were seen over time in the guidance group. Also, significant improvements in dietary habits and physical activity levels were more apparent in the guidance group than the GA group, particularly in the daily intakes of total carbohydrate (46.9% compliance post vs. 20.3% at baseline); dietary fiber (21.9% vs. 3.1%); and some micronutrients like vitamin B6 (21.3% vs. 6.7%), vitamin B12 (45.3% vs. 28%), vitamin C (21.9% vs. 7.8%), riboflavin (40% vs. 10.7%), niacin (41.3% vs. 14.7%), magnesium (18.8% vs. 4.7%), iron (54.7% vs. 34.4%), and copper (37.3% vs. 13.3%). The study highlights the effects of a six-month lifestyle modification program in improving dietary micronutrient intakes of Saudis with prediabetes. Since micronutrient intake was observed to be low, fortification of these micronutrients in the Saudi diet is recommended.


Assuntos
Dieta/métodos , Estilo de Vida , Micronutrientes/sangue , Minerais/sangue , Estado Pré-Diabético/terapia , Adulto , Árabes , Glicemia/análise , Aconselhamento/métodos , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Arábia Saudita , Resultado do Tratamento , Adulto Jovem
17.
PLoS One ; 14(10): e0223000, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600243

RESUMO

BACKGROUND: Vitamin B-12 deficiency is often considered synonymous with pernicious anemia, a rare condition in which severe malabsorption of the vitamin requires high-dose parenteral treatment. In developing countries such as India, inadequate dietary intake of B-12 due to socio-cultural factors leads to widely prevalent asymptomatic low B-12 status. In this scenario, lower doses of oral B-12 may be effective, safer and more affordable. OBJECTIVE: To examine the effects of oral B-12 treatment at physiological doses on hematological and biochemical indices and peripheral nerve function in B-12 deficient rural Indian adolescent women. METHODS: Thirty-nine women with B-12 deficiency who were excluded from a community based B-12 supplementation trial (Pune Rural Intervention in Young Adolescents (PRIYA)) received oral B-12 2µg/day, either alone (n = 19) or with multiple micronutrients (UNIMAPP formula + 20gm milk powder, n = 20) for 11 months. Hematological indices, nutrients (B-12, folate), metabolites (homocysteine) and peripheral nerve function (SUDOSCAN, Impetomedical, Paris and sensory nerve conduction velocity (NCV) of median and sural nerves) were assessed at baseline and after 11 months of B-12 treatment. RESULTS: Results were similar in the two treatment allocation groups, which were therefore combined. At baseline, all women had B-12 concentration <100pmol/L, 79% were anemic and 33% had macrocytosis, but none had neuropathy. After 11 months of treatment, B-12 levels increased, while folate did not change. The prevalence of anemia fell to 59% and mean corpuscular volume (MCV) and plasma homocysteine concentrations decreased. Sudomotor nerve function in the feet improved by an average of 14.7%, and sensory conduction velocity in median and sural nerves increased by 16.2% and 29.4% respectively. CONCLUSION: We document clinically beneficial effects of supplementation with a physiological dose of oral B-12 in asymptomatic rural Indian adolescent women with very low B-12 status. These findings support a public health approach to tackle the widely prevalent low B-12 status in young Indians.


Assuntos
Suplementos Nutricionais , Nervos Periféricos/efeitos dos fármacos , Deficiência de Vitamina B 12/tratamento farmacológico , Vitamina B 12/administração & dosagem , Administração Oral , Adolescente , Feminino , Ácido Fólico/sangue , Humanos , Índia/epidemiologia , Micronutrientes/sangue , Micronutrientes/deficiência , Estado Nutricional , Nervos Periféricos/fisiologia , População Rural , Vitamina B 12/sangue , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/epidemiologia , Deficiência de Vitamina B 12/patologia , Complexo Vitamínico B/administração & dosagem
18.
Eur J Clin Nutr ; 73(12): 1618-1621, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31570757

RESUMO

The application of the isometric log-ratio (ilr) transformation to dietary data leads to the definition of nutrient balances that represent new variables which can be included in regression models as covariates. However, their effects on the response variable are not easy to quantify. We then propose borrowing the concept of elasticity from econometrics as an appealing means of improving the interpretability of the ilr-related coefficients. Using data from an Italian population-based study, a multiple linear regression model of the serum total-/HDL-cholesterol ratio on nutrient balances was fitted and the estimated coefficients were used to derive elasticities. The elasticities measure the relative changes in the cholesterol ratio in response to the relative changes in specific nutrient ratios, while keeping unchanged the proportional relationships between the other dietary elements. In a comprehensive overview of the diet, this alternative approach to dietary data analysis allows isocaloric analysis and may provide interesting new insights.


Assuntos
Colesterol/sangue , Micronutrientes/sangue , Modelos Estatísticos , Nutrientes/sangue , Adulto , Idoso , Colesterol/metabolismo , Dieta , Feminino , Humanos , Itália , Masculino , Micronutrientes/metabolismo , Pessoa de Meia-Idade , Nutrientes/metabolismo , Estado Nutricional/fisiologia
19.
Am J Clin Nutr ; 110(4): 1015-1025, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31565748

RESUMO

BACKGROUND: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. OBJECTIVE: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. METHODS: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network. RESULTS: A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations. CONCLUSIONS: EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.


Assuntos
Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Inflamação/patologia , Intestinos/fisiologia , Micronutrientes/sangue , Nutrientes/metabolismo , Teorema de Bayes , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Coortes , Fezes/química , Humanos , Lactente , Inflamação/metabolismo , Enteropatias , Intestinos/efeitos dos fármacos , Estado Nutricional , Permeabilidade
20.
Am J Clin Nutr ; 110(6): 1456-1464, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504095

RESUMO

BACKGROUND: To accurately assess micronutrient status, it is necessary to characterize the effects of inflammation and the acute-phase response on nutrient biomarkers. OBJECTIVE: Within a norovirus human challenge study, we aimed to model the inflammatory response of C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) by infection status, model kinetics of micronutrient biomarkers by inflammation status, and evaluate associations between inflammation and micronutrient biomarkers from 0 to 35 d post-norovirus exposure. METHODS: Fifty-two healthy adults were enrolled into challenge studies in a hospital setting and followed longitudinally; all were exposed to norovirus, half were infected. Post hoc analysis of inflammatory and nutritional biomarkers was performed. Subjects were stratified by inflammation resulting from norovirus exposure. Smoothed regression models analyzed the kinetics of CRP and AGP by infection status, and nutritional biomarkers by inflammation. Linear mixed-effects models were used to analyze the independent relations between CRP, AGP, and biomarkers for iron, vitamin A, vitamin D, vitamin B-12, and folate from 0 to 35 d post-norovirus exposure. RESULTS: Norovirus-infected subjects had median (IQR) peak concentrations for CRP [16.0 (7.9-29.5) mg/L] and AGP [0.9 (0.8-1.2) g/L] on day 3 and day 4 postexposure, respectively. Nutritional biomarkers that differed (P < 0.05) from baseline within the inflamed group were ferritin (elevated day 3), hepcidin (elevated days 2, 3), serum iron (depressed days 2-4), transferrin saturation (depressed days 2-4), and retinol (depressed days 3, 4, and 7). Nutritional biomarker concentrations did not differ over time within the uninflamed group. In mixed models, CRP was associated with ferritin (positive) and serum iron and retinol (negative, P < 0.05). CONCLUSION: Using an experimental infectious challenge model in healthy adults, norovirus infection elicited a time-limited inflammatory response associated with altered serum concentrations of certain iron and vitamin A biomarkers, confirming the need to consider adjustments of these biomarkers to account for inflammation when assessing nutritional status. These trials were registered at clinicaltrials.gov as NCT00313404 and NCT00674336.


Assuntos
Biomarcadores/sangue , Infecções por Caliciviridae/sangue , Micronutrientes/sangue , Adulto , Proteína C-Reativa/análise , Proteína C-Reativa/imunologia , Infecções por Caliciviridae/imunologia , Infecções por Caliciviridae/virologia , Feminino , Ferritinas/sangue , Ácido Fólico/sangue , Humanos , Ferro/sangue , Estudos Longitudinais , Masculino , Norovirus/fisiologia , Vitamina A/sangue , Vitamina D/sangue
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