Vitamin D supplementation is associated with higher serum 25OHD in Asian and White infants living in Vancouver, Canada

To prevent rickets, the Health Canada and the American Academy of Pediatrics recommend that breastfed infants receive a daily vitamin D supplement of 10 μg d(-1) . Compliance with this recommendation is variable and its effect on infant vitamin D status is unclear. We measured serum 25-hydroxyvitamin D (25OHD) in Asian immigrant (n=28) and White (n=37) mothers and their infants aged 2-4 months living in Vancouver (49°N). Mothers completed health and demographic questionnaires. All subjects were term infants who were primarily breastfed. Analysis of variance, χ(2) , multiple regression and logistic regression analysis were performed as appropriate. Mean 25OHD of the infants was 31 (95% confidence interval 28-34) ng mL(-1) . Only two infants had a 25OHD concentration indicative of deficiency, <10 ng mL(-1) . Of the infants, 14% (n=9) and 49% (n=32) were vitamin D insufficient based on two commonly used cut-offs of 20 and 30 ng mL(-1) , respectively. Fifty-eight (89%) infants had been given a vitamin D supplement. Mean 25OHD was 9.4 ng mL(-1) higher in infants consuming ≥10 μg d(-1) of vitamin D from supplements vs. those consuming less (P=0.003). Mother's 25OHD, season, skin colour or ethnicity (Asian vs. White) did not influence infant 25OHD. The infants in our study, most of whom received vitamin D supplements, were generally protected against low 25OHD. The study was limited by sample size and the nature of the cross-sectional study design.

The effects of 8 weeks of heavy resistance training and branched-chain amino acid supplementation on body composition and muscle performance

PURPOSE

This study determined the effects of 8 weeks of heavy resistance training combined with branched-chain amino acid (BCAA) supplementation on body composition and muscle performance.

METHODS

Resistance training was performed by 19 non-resistance-trained males (three sets of 8-10 repetitions) four times/week, for 8 weeks, while also ingesting 9 g/day of BCAA or 9 g/day of placebo (PLAC) on the exercise days only (one-half of total dose 30 min before and after exercise). Data were analyzed with separate 2 × 2 analysis of variance (ANOVA) (p < 0.05).

RESULTS

For total body mass, neither group significantly increased with training (p = 0.593) and also, there were no significant changes in total body water (p = 0.517). In addition, no training- or supplement-induced (p = 0.783) changes occurred with fat mass or fat-free mass (p = 0.907). Upper-body (p = 0.047) and lower-body strength (p = 0.044) and upper- (p = 0.001) and lower-body muscle endurance (p = 0.013) increased with training; however, these increases were not different between the groups (p > 0.05).

CONCLUSION

When combined with heavy resistance training for 8 weeks, supplementation with 9 g/day of BCAA 30 min before and after exercise had no preferential effects on body composition and muscle performance.

Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in Australian women: pre- and post-iodine fortification

A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007–2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%–62%). A low intake of fish and seafood resulted in this food group contributing only 3%–8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.

Vitamin-C as anti-Helicobacter pylori agent: More prophylactic than curative- Critical review

Potential of nonantibiotic therapies for treatment of Helicobacter pylori-related acid peptic disease remains underexplored. Several clinical studies have shown that higher prevalence of H. pylori infection is associated with low Vitamin C (Vit C) level in serum and gastric juice. However, there is no consensus regarding the usefulness of Vit C supplementation in the management of H. pylori infection. Surveying the existing literature we conclude that high concentration of Vit C in gastric juice might inactivate H. pylori urease, the key enzyme for the pathogen's survival and colonization into acidic stomach. Once infection established, urease is not very important for its survival. The role of Vit-C as anti-H. pylori agent in peptic ulcer diseases appears to be preventive rather than curative. Rather than supplementing high dose of Vit C along with conventional triple therapy, it is preferable to complete the conventional therapy and thereafter start Vit C supplementation for extended period which would prevent reinfection in susceptible individuals, provided the patients are not achlorhydric. Further studies are required to prove the role of Vit C in susceptible population.

The problems of vitamin d insufficiency in older people

This report reviews evidence on disorders related to inadequate vitamin D repletion in older people. Vitamin D is as essential for bone health in adults as in children, preventing osteomalacia and muscle weakness and protecting against falls and low-impact fractures. Vitamin D is provided by skin synthesis by UVB-irradiation from summer sunshine and to a small extent by absorption from food. However, these processes become less efficient with age. Loss of mobility or residential care restricts solar exposure. Reduced appetite and financial problems often add to these problems. Thus, hypovitaminosis D is common world-wide, but is more common and more severe in older people. Non-classical effects of vitamin D, depending on serum circulating 25-hydroxyvitamin D concentrations, are present in most non-bony tissues; disorders associated with hypovitaminosis D include increased risks of sepsis [bacterial, mycobacterial and viral], cardiovascular and metabolic disorders [e.g. hyperlipidemia, type 2 diabetes mellitus, acute vascular events, dementia, stroke and heart failure]. Many cancer risks are associated with vitamin D inadequacy, though causality is accepted only for colo-rectal cancer. Maintenance of repletion in healthy older people requires intakes of ≥800IU/day [20μg], as advised by the Institute of Medicine [IOM], but achieving such intakes usually requires supplementation. Excessive intakes are dangerous, especially in undiagnosed primary hyperparathyroidism or sarcoidosis, but the IOM finds doses <4000 IU/day are safe. Many experts suggest that ≥1000-2000 IU [25-50μg] of vitamin D daily is necessary for older people, especially when independence is lost, or hypovitaminosis D could add to the clinical problem[s]. Much higher doses than these are needed for treatment of established deficiency or insufficiency.

Effects of Six Weeks of β-alanine Administration on VO(2) max, Time to Exhaustion and Lactate Concentrations in Physical Education Students

OBJECTIVES

Supplementation with β-alanine has been proposed to improve performance in some exercises such as cycling and running. Also, it has been demonstrated that great deals of proton ions are produced in the skeletal muscles during exercise that result in acidosis, whereas β-alanine may reduce this effect. Therefore, the aim of this study is to assess the effects of alanine supplementation on VO(2) max, time to exhaustion and lactate concentrations in physical education male students.

METHODS

Thirty-nine male physical education students volunteered for this study. Participants were supplemented orally for 6 week with either β-alanine (5*400 mg/d) or placebo (5*400 mg dextrose/d), randomly. VO(2) max and time to exhaustion (TTE) with a continuous graded exercise test (GXT) on an electronically braked cycle ergometer; and serum lactate and glucose concentrations were measured before and after supplementation.

RESULTS

Supplementation with β-alanine showed a significant increase in VO(2) max (P<0.05) and a significant decrease in TTE and lactate concentrations (P<0.05). A significant elevation in lactate concentrations and a non significant increase in TTE were observed in placebo group. Plasma glucose concentrations did not change significantly in two groups after intervention.

CONCLUSION

It can be concluded that β-alanine supplementation can reduce lactate concentrations during exercise and thus can improve exercise performance in endurance athletes.

Effect of zinc supplementation on pregnancy and infant outcomes: a systematic review

Poor maternal zinc status has been associated with foetal loss, congenital malformations, intra-uterine growth retardation, reduced birth weight, prolonged labour and preterm or post-term deliveries. A meta-analysis completed in 2007 showed that maternal zinc supplementation resulted in a small but significant reduction in preterm birth. The purposes of this analysis are to update that previous review and expand the scope of assessment to include maternal, infant and child health outcomes. Electronic searches were carried out to identify peer-reviewed, randomised controlled trials where daily zinc supplementation was given for at least one trimester of pregnancy. The co-authors applied the study selection criteria, assessed trial quality and abstracted data. A total of 20 independent intervention trials involving more than 11,000 births were identified. The 20 trials took place across five continents between 1977 and 2008. Most studies assessed the zinc effect against a background of other micronutrient supplements, but five were placebo-controlled trials of zinc alone. The provided dose of supplemental zinc ranged from 5 to 50 mg/day. Only the risk of preterm birth reached statistical significance (summary relative risk 0.86 [95% confidence interval 0.75, 0.99]). There was no evidence that supplemental zinc affected any parameter of foetal growth (risk of low birth weight, birth weight, length at birth or head circumference at birth). Six of the 20 trials were graded as high quality. The evidence that maternal zinc supplementation lowers the risk of preterm birth was graded low; evidence for a positive effect on other foetal outcomes was graded as very low. The effect of zinc supplementation on preterm birth, if causal, might reflect a reduction in maternal infection, a primary cause of prematurity. While further study would be needed to explore this possibility in detail, the overall public health benefit of zinc supplementation in pregnancy appears limited.

Changes in the vitamin D endocrine system and bone turnover after oral vitamin D3 supplementation in healthy adults: results of a randomised trial

BACKGROUND

There is uncertainty as to which intake of vitamin D is needed to suppress PTH and maintain normal bone metabolism throughout winter at northern latitudes. We aimed to investigate whether four weeks' daily supplementation with 10 μg vitamin D3 from fish oil produced a greater change in serum vitamin D metabolites, parathyroid hormone, and bone turnover in healthy adults compared with solid multivitamin tablets. Furthermore, it was studied whether age, gender, ethnic background, body mass index, or serum concentrations at baseline predicted the magnitude of change in these parameters.

METHODS

Healthy adults aged 19-48 years living in Oslo, Norway (59°N) were randomised to receive a daily dose of 10 μg vitamin D3 given as fish oil capsules or multivitamin tablets during four weeks in late winter. Serum samples from baseline and after 28 days were analysed for 25-hydroxyvitamin D (s-25(OH)D), 1,25-dihydroxyvitamin D (s-1,25(OH)2D), intact parathyroid hormone (s-iPTH), and osteoclast-specific tartrate-resistant acid phosphatase 5b (s-TRACP). Fifty-five eligible participants completed the intervention (74% of those randomised).

RESULTS

S-25(OH)D increased by mean 34.1 (SD 13.1) nmol/l, p < 0.001; s-iPTH decreased by mean 1.2 (SD 2.5) pmol/l, p = 0.001; s-1,25(OH)2D increased by mean 13 (SD 48) pmol/l, p = 0.057; and s-TRACP increased by mean 0.38 (SD 0.33) U/l, p < 0.001. For all these parameters, there was no difference between fish oil and multivitamin formulation. Baseline concentrations were the only independent predictors of changes in biochemical parameters.

CONCLUSIONS

Four weeks of daily supplementation with 10 μg vitamin D3 decreased mean s-iPTH and increased s-TRACP concentration, and this did not differ by mode of administration. Our results suggest an increased bone resorption following vitamin D supplementation in young individuals, despite a decrease in parathyroid hormone levels.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01482689.

Applicability of the use of waste from different banana cultivars for the cultivation of the oyster mushroom

The objective of this research was to evaluate the oyster mushroom Pleurotus ostreatus- (Jacq.: Fr.) Kumm. cultivation in substrates based on different combinations of wastes (leaf, pseudo-stem and pseudo-stem + leaf) and banana cultivars - Musa spp. (Thap Maeo, Prata AnãPelipita and Caipira) during 49 days. Organic matter loss in the substrate by action of the fungus was also evaluated during that period. It was verified that the pseudo-stem waste provided the best averages of biological efficiency among all cultivars tested and best rates were obtained by Thap Maeo (61.5%). The highest organic matter loss (OML) was obtained from pseudo-stem + leaf wastes (Prata Anã 78.6%; Thap Maeo - 67.6%; Pelipita - 64.8%; Caipira - 60.6%). Therefore, the use of those wastes showed itself viable for P. ostreatus cultivation due to its availability and low cost, besides decreasing discards to environment.

Pomegranate juice and punicalagin attenuate oxidative stress and apoptosis in human placenta and in human placental trophoblasts

The human placenta is key to pregnancy outcome, and the elevated oxidative stress present in many complicated pregnancies contributes to placental dysfunction and suboptimal pregnancy outcomes. We tested the hypothesis that pomegranate juice, which is rich in polyphenolic antioxidants, limits placental trophoblast injury in vivo and in vitro. Pregnant women with singleton pregnancies were randomized at 35∼38 wk gestation to 8 oz/day of pomegranate juice or apple juice (placebo) until the time of delivery. Placental tissues from 12 patients (4 in the pomegranate group and 8 in the control group) were collected for analysis of oxidative stress. The preliminary in vivo results were extended to oxidative stress and cell death assays in vitro. Placental explants and cultured primary human trophoblasts were exposed to pomegranate juice or glucose (control) under defined oxygen tensions and chemical stimuli. We found decreased oxidative stress in term human placentas from women who labored after prenatal ingestion of pomegranate juice compared with apple juice as control. Moreover, pomegranate juice reduced in vitro oxidative stress, apoptosis, and global cell death in term villous explants and primary trophoblast cultures exposed to hypoxia, the hypoxia mimetic cobalt chloride, and the kinase inhibitor staurosporine. Punicalagin, but not ellagic acid, both prominent polyphenols in pomegranate juice, reduced oxidative stress and stimulus-induced apoptosis in cultured syncytiotrophoblasts. We conclude that pomegranate juice reduces placental oxidative stress in vivo and in vitro while limiting stimulus-induced death of human trophoblasts in culture. The polyphenol punicalagin mimics this protective effect. We speculate that antenatal intake of pomegranate may limit placental injury and thereby may confer protection to the exposed fetus.

The potential role of the antioxidant and detoxification properties of glutathione in autism spectrum disorders: a systematic review and meta-analysis

BACKGROUND

Glutathione has a wide range of functions; it is an endogenous anti-oxidant and plays a key role in the maintenance of intracellular redox balance and detoxification of xenobiotics. Several studies have indicated that children with autism spectrum disorders may have altered glutathione metabolism which could play a key role in the condition.

METHODS

A systematic literature review and meta-analysis was conducted of studies examining metabolites, interventions and/or genes of the glutathione metabolism pathways i.e. the γ-glutamyl cycle and trans-sulphuration pathway in autism spectrum disorders.

RESULTS

Thirty nine studies were included in the review comprising an in vitro study, thirty two metabolite and/or co-factor studies, six intervention studies and six studies with genetic data as well as eight studies examining enzyme activity.

CONCLUSIONS

The review found evidence for the involvement of the γ-glutamyl cycle and trans-sulphuration pathway in autistic disorder is sufficiently consistent, particularly with respect to the glutathione redox ratio, to warrant further investigation to determine the significance in relation to clinical outcomes. Large, well designed intervention studies that link metabolites, cofactors and genes of the γ-glutamyl cycle and trans-sulphuration pathway with objective behavioural outcomes in children with autism spectrum disorders are required. Future risk factor analysis should include consideration of multiple nutritional status and metabolite biomarkers of pathways linked with the γ-glutamyl cycle and the interaction of genotype in relation to these factors.

Zinc status and its association with the health of adolescents: a review of studies in India

BACKGROUND

Zinc is important in adolescence because of its role in growth and sexual maturation. Adolescents from developing countries such as India may be at high risk of zinc deficiency because of unwholesome food habits and poor bioavailability of zinc from plant-based diets.

OBJECTIVE

(1) to study zinc status and its association with profile of other micronutrients, (2) to construct a simple tool in the form of Adolescent Micronutrient Quality Index (AMQI) to assess quality of diets of the girls and (3) to examine the effect of zinc supplement on health of adolescent girls.

METHODS

Girls (10-16 years) from two secondary schools of Pune, Maharashtra state, in Western India were enrolled in a cross-sectional study (n = 630). Data were collected on dietary intake, cognitive performance, taste acuity, haemoglobin, erythrocyte zinc and plasma levels of zinc, vitamin C, β-carotene and retinol. AMQI was developed using age-sex-specific Indian dietary guidelines and healthy foods and habits described in the recent US dietary guidelines. Zinc-rich recipes were developed considering habitual diets of the girls and vegetarian sources of zinc. An intervention trial (n = 180) was conducted to assess the effect of zinc-rich dietary supplements and ayurvedic zinc (Jasad) supplementation.

RESULTS

Prevalence of micronutrient deficiencies was high in these girls. Poor cognitive performance was seen in half of the girls, and salt taste perception was affected in 45%. AMQI was correlated with nutrient intakes and blood micronutrient levels (p < 0.01), indicating the potential of AMQI to measure micronutrient quality of diets of adolescent girls. Results of the intervention trial indicated that supplementation of zinc-rich recipes vis-a-vis ayurvedic Jasad zinc has the potential to improve plasma zinc status, cognitive performance and taste acuity in adolescent girls.

CONCLUSIONS

Review of the studies on Indian adolescent girls demonstrates the necessity of adopting zinc and micronutrient-rich diets for positive health building in adolescents.

The effect of carrot juice, β-carotene supplementation on lymphocyte DNA damage, erythrocyte antioxidant enzymes and plasma lipid profiles in Korean smoker

High consumption of fruits and vegetables has been suggested to provide some protection to smokers who are exposed to an increased risk of numerous cancers and other degenerative diseases. Carrot is the most important source of dietary β-carotene. Therefore, the objective of this study was to investigate whether carrot juice supplementation to smokers can protect against lymphocyte DNA damage and to compare the effect of supplementation of capsules containing purified β-carotene or a placebo (simple lactose). The study was conducted in a randomized and placebo-controlled design. After a depletion period of 14 days, 48 smokers were supplemented with either carrot juice (n = 18), purified β-carotene (n = 16) or placebo (n = 14). Each group was supplemented for 8 weeks with approximately 20.49 mg of β-carotene/day and 1.2 mg of vitamin C/day, as carrot juice (300 ml/day) or purified β-carotene (20.49 mg of β-carotene, 1 capsule/day). Lymphocyte DNA damage was determined using the COMET assay under alkaline conditions and damage was quantified by measuring tail moment (TM), tail length (TL), and% DNA in the tail. Lymphocyte DNA damage was significantly decreased in the carrot juice group in all three measurements. The group that received purified β-carotene also showed a significant decrease in lymphocyte DNA damage in all three measurements. However, no significant changes in DNA damage was observed for the placebo group except TM (P = 0.016). Erythrocyte antioxidant enzyme was not significantly changed after supplementation. Similarly plasma lipid profiles were not different after carrot juice, β-carotene and placebo supplementation. These results suggest that while the placebo group failed to show any protective effect, carrot juice containing beta-carotene or purified β-carotene itself had great antioxidative potential in preventing damage to lymphocyte DNA in smokers.

A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease

BACKGROUND

Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance.

OBJECTIVES

To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD.

METHODS

A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals.

RESULTS

The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019).

CONCLUSION

Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.

A multi-nutrient supplement reduced markers of inflammation and improved physical performance in active individuals of middle to older age: a randomized, double-blind, placebo-controlled study

BACKGROUND

While exercise acts to combat inflammation and aging, the ability to exercise may itself be compromised by inflammation and inflammation's impact on muscle recovery and joint inflammation. A number of nutritional supplements have been shown to reduce inflammation and improve recovery. The purpose of the current investigation was to examine the effect of a multi-nutrient supplement containing branched chain amino acids, taurine, anti-inflammatory plant extracts, and B vitamins on inflammatory status, endothelial function, physical function, and mood in middle-aged individuals.

METHODS

Thirty-one healthy and active men (N = 16, mean age 56 ± 6.0 yrs) and women (N = 15, mean age = 52 ± 7.5 yrs) participated in this investigation. Subjects completed one 28 day cycle of placebo supplementation and one 28 day cycle of multi-nutrient supplementation (separated by a one week washout period) in a balanced, randomized, double-blind, cross-over design. Subjects completed weekly perceptual logs (PROMIS-57, KOOS) and pre- and post- testing around the supplementation period. Testing consisted of brachial artery flow mediated dilation (FMD), blood measures, and physical performance on vertical jump, handgrip strength, and balance (dispersion from center of pressure). Significance for the investigation was p ≤ 0.05.

RESULTS

IL-6 significantly decreased in both men (from 1.2 ± 0.2 to 0.7 ± 0.4 pg·mL(-1)) and women (from 1.16 ± 0.04 to 0.7 ± 0.4 pg·mL(-1)). Perceived energy also improved for both men (placebo: 1.8 ± 0.7; supplement: 3.7 ± 0.8 AUC) and women (placebo: 1.2 ± 0.7; supplement: 2.8 ± 0.8 AUC). Alpha-1-antichymotrypsin (from 108.9 ± 38.6 to 55.5 ± 22.2 ug·mL(-1)), Creatine Kinase (from 96 ± 34 to 67 ± 23 IU·L(-1)), general pain, and joint pain decreased in men only, while anxiety and balance (from 0.52 ± 0.13 to 0.45 ± 0.12 cm) improved in women only. Men showed increased performance in vertical jump power (from 2642 ± 244 to 3134 ± 282 W) and grip strength (from 42.1 ± 5.9 to 48.5 ± 4.9 kg).

CONCLUSIONS

A multi-nutrient supplement is effective in improving inflammatory status in both men and women, markers of pain, joint pain, strength, and power in men only, and both anxiety and balance (a risk factor for hip fracture) in women. Therefore, a multi-nutrient supplement may help middle-aged individuals to prolong physical function and maintain a healthy, active lifestyle.

Effects of vitamin E supplementation on some pregnancy health indices: a randomized clinical trial

Objective:

Available evidence about the role of supplementary vitamin E in normal pregnancy is inadequate. This study assessed the potential benefit of vitamin E supplementation on some pregnancy health indices.

Methods:

A 1:2 weighted simple randomization technique was used to allocate 104 eligible pregnant women to receive vitamin E and 168 women (control) not to receive the drug. Treated women received capsules containing 400 IU vitamin E from week 14 of gestation to the end of the pregnancy.

Results:

Background variables including maternal age were found to be similarly distributed between the study groups. The rate of maternal and perinatal outcomes including Apgar score and birth weight did not differ significantly between groups. Preeclampsia occurred in 1% of treated women vs 1.78% of control women.

Conclusion:

Giving supplemental vitamin E from the second trimester of pregnancy did not appear to affect the risk of pregnancy outcomes and occurrence of preeclampsia.

Creatine Plus Carbohydrate Supplementation on Resistance Training Adaptations

The purpose of this study was to evaluate the effects of combined creatine and fenugreek extract supplementation on strength and body composition. Forty- seven resistance trained men were matched according to body weight to ingest either 70 g of a dextrose placebo (PL), 5 g creatine/70 g of dextrose (CRD) or 3.5 g creatine/900 mg fenugreek extract (CRF) and participate in a 4-d/wk periodized resistance-training program for 8-weeks. At 0, 4, and 8-weeks, subjects were tested on body composition, muscular strength and endurance, and anaerobic capacity. Statistical analyses utilized a separate 3X3 (condition [PL vs. CRD vs. CRF] x time [T1 vs. T2 vs. T3]) ANOVAs with repeated measures for all criterion variables (p ≤ 0.05). No group x time interaction effects or main effects (p > 0.05) were observed for any measures of body composition. CRF group showed significant increases in lean mass at T2 (p = 0.001) and T3 (p = 0.001). Bench press 1RM increased in PL group (p = 0.050) from T1-T3 and in CRD from T1-T2 (p = 0. 001) while remaining significant at T3 (p < 0.001). CRF group showed a significant increase in bench press 1RM from T1-T2 (p < 0.001), and also increased from T2-T3 (p = 0.032). Leg press 1RM significantly increased at all time points for PL, CRD, and CRF groups (p < 0.05). No additional between or within group changes were observed for any performance variables and serum clinical safety profiles (p > 0.05). In conclusion, creatine plus fenugreek extract supplementation had a significant impact on upper body strength and body composition as effectively as the combination of 5g of creatine with 70g of dextrose. Thus, the use of fenugreek with creatine supplementation may be an effective means for enhancing creatine uptake while eliminating the need for excessive amounts of simple carbohydrates. Key pointsFenugreek plus creatine supplementation may be a new means of increasing creatine uptake.Creatine plus fenugreek seems to be just as effective as the classic creatine plus carbohydrate ingestion in terms of stimulating training adaptations.This is the first study to our knowledge that has combined fenugreek with creatine supplementation in conjunction with a resistance training program.

Optimal use of vitamin D when treating osteoporosis

Inadequate serum 25-hydroxyvitamin D (25[OH]D) concentrations are associated with muscle weakness, decreased physical performance, and increased propensity in falls and fractures. This paper discusses several aspects with regard to vitamin D status and supplementation when treating patients with osteoporosis in relation to risks and prevention of falls and fractures. Based on evidence from literature, adequate supplementation with at least 700 IU of vitamin D, preferably cholecalciferol, is required for improving physical function and prevention of falls and fractures. Additional calcium supplementation may be considered when dietary calcium intake is below 700 mg/day. For optimal bone mineral density response in patients treated with antiresorptive or anabolic therapy, adequate vitamin D and calcium supplementation is also necessary. Monitoring of 25(OH)D levels during follow-up and adjustment of vitamin D supplementation should be considered to reach and maintain adequate serum 25(OH)D levels of at least 50 nmol/L, preferably greater than 75 nmol/L in all patients.

Cognitive awareness of carbohydrate intake does not alter exercise-induced lymphocyte apoptosis

OBJECTIVE

The purpose of this investigation was to determine whether cognitive awareness of carbohydrate beverage consumption affects exercise-induced lymphocyte apoptosis, independent of actual carbohydrate intake.

INTRODUCTION

Carbohydrate supplementation during aerobic exercise generally protects against the immunosuppressive effects of exercise. It is not currently known whether carbohydrate consumption or simply the knowledge of carbohydrate consumption also has that effect.

METHODS

Endurance trained male and female (N = 10) athletes were randomly assigned to one of two groups based on either a correct or incorrect cognitive awareness of carbohydrate intake. In the incorrect group, the subjects were informed that they were receiving the carbohydrate beverage but actually received the placebo beverage. Participants completed a 60-min ride on a cycle ergometer at 80% VO₂peak under carbohydrate and placebo supplemented conditions. Venous blood samples were collected at rest and immediately after exercise and were used to determine the plasma glucose concentration, lymphocyte count, and extent of lymphocyte apoptosis. Cognitive awareness, either correct or incorrect, did not have an effect on any of the measured variables.

RESULTS

Carbohydrate supplementation during exercise did not have an effect on lymphocyte count or apoptotic index. Independent of drink type, exercise resulted in significant lymphocytosis and lymphocyte apoptosis (apoptotic index at rest = 6.3 ± 3% and apoptotic index following exercise = 11.6 ± 3%, P < 0.01).

CONCLUSION

Neither carbohydrate nor placebo supplementation altered the typical lymphocyte apoptotic response following exercise. While carbohydrate supplementation generally has an immune-boosting effect during exercise, it appears that this influence does not extend to the mechanisms that govern exercise-induced lymphocyte cell death.

Folate status of reproductive age women and neural tube defect risk: the effect of long-term folic acid supplementation at doses of 140 µg and 400 µg per day

Primary prevention of most folate-responsive neural tube defects (NTDs) may not require 400 μg folic acid/day but may be achieved by attaining a high maternal folate status. Using RBC folate ≥906 nmol/L as a marker for NTD risk reduction, the study aimed to determine the change in blood folate concentrations in reproductive age women in response to long-term folic acid supplementation at 400 µg/day and 140 µg/day (dose designed to mimic the average daily folic acid intake received from New Zealand's proposed mandatory bread fortification program). Participants were randomly assigned to a daily folic acid supplement of 140 µg (n = 49), 400 µg (n = 48) or placebo (n = 47) for 40 weeks. RBC folate concentrations were measured at baseline, and after 6, 12, 29 and 40 weeks. At 40 weeks, the overall prevalence of having a RBC folate <906 nmol/L decreased to 18% and 35% in the 400 µg and 140 µg groups, respectively, while remaining relatively unchanged at 58% in the placebo group. After 40 weeks, there was no evidence of a difference in RBC folate between the two treatment groups (P = 0.340), nor was there evidence of a difference in the odds of a RBC folate <906 nmol/L (P = 0.078). In conclusion, the average daily intake of folic acid received from the proposed fortification program would increase RBC folate concentrations in reproductive age women to levels associated with a low risk of NTDs.

Reexamination of a meta-analysis of the effect of antioxidant supplementation on mortality and health in randomized trials

A recent meta-analysis of selected randomized clinical trials (RCTs), in which population groups of differing ages and health status were supplemented with various doses of β-carotene, vitamin A, and/or vitamin E, found that these interventions increased all-cause mortality. However, this meta-analysis did not consider the rationale of the constituent RCTs for antioxidant supplementation, none of which included mortality as a primary outcome. As the rationale for these trials was to test the hypothesis of a potential benefit of antioxidant supplementation, an alternative approach to a systematic evaluation of these RCTs would be to evaluate this outcome relative to the putative risk of greater total mortality. Thus, we examined these data based on the primary outcome of the 66 RCTs included in the meta-analysis via a decision analysis to identify whether the results provided a positive (i.e., benefit), null or negative (i.e., harm) outcome. Our evaluation indicated that of these RCTs, 24 had a positive outcome, 39 had a null outcome, and 3 had a negative outcome. We further categorized these interventions as primary (risk reduction in healthy populations) or secondary (slowing pathogenesis or preventing recurrent events and/or cause-specific mortality) prevention or therapeutic (treatment to improve quality of life, limit complications, and/or provide rehabilitation) studies, and determined positive outcomes in 8 of 20 primary prevention studies, 10 of 34 secondary prevention studies, and 6 out of 16 therapeutic studies. Seven of the eight RCTs with a positive outcome in primary prevention included participants in a population where malnutrition is frequently described. These results suggest that analyses of potential risks from antioxidant supplementation should be placed in the context of a benefit/risk ratio.

Low vitamin D status: definition, prevalence, consequences, and correction

Vitamin D is obtained from cutaneous production when 7-dehydrocholesterol is converted to vitamin D(3) (cholecalciferol) by ultraviolet B radiation or by oral intake of vitamin D(2) (ergocalciferol) and D(3). An individual's vitamin D status is best evaluated by measuring the circulating 25-hydroxyvitamin D (25(OH)D) concentration. Although controversy surrounds the definition of low vitamin D status, there is increasing agreement that the optimal circulating 25(OH)D level should be approximately 30 to 32 ng/mL or above. Using this definition, it has been estimated that approximately three-quarters of all adults in the United States have low levels. Low vitamin D status classically has skeletal consequences such as osteomalacia/rickets. More recently, associations between low vitamin D status and increased risk for various nonskeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determined. To achieve optimal vitamin D status, daily intakes of at least 1000 IU or more of vitamin D are required. The risk of toxicity with "high" amounts of vitamin D intake is low. Substantial between-individual variability exists in response to the same administered vitamin D dose. When to monitor 25(OH)D levels has received little attention. Supplementation with vitamin D(3) may be preferable to vitamin D(2).

Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males

RATIONALE

A significant proportion of the general population report supplementing their diet with one or more vitamins or minerals, with common reasons for doing so being to combat stress and fatigue and to improve mental functioning. Few studies have assessed the relationship between supplementation with vitamins/minerals and psychological functioning in healthy cohorts of non-elderly adults.

OBJECTIVES

The present randomised, placebo-controlled, double-blind, parallel groups trial assessed the cognitive and mood effects of a high-dose B-complex vitamin and mineral supplement (Berocca(R)) in 215 males aged 30 to 55 years, who were in full-time employment.

METHODS

Participants attended the laboratory prior to and on the last day of a 33-day treatment period where they completed the Profile of Mood States (POMS), Perceived Stress Scale (PSS) and General Health Questionnaire (GHQ-12). Cognitive performance and task-related modulation of mood/fatigue were assessed with the 60 min cognitive demand battery. On the final day, participants also completed the Stroop task for 40 min whilst engaged in inclined treadmill walking and subsequent executive function was assessed.

RESULTS

Vitamin/mineral supplementation led to significant improvements in ratings on the PSS, GHQ-12 and the 'vigour' subscale of the POMS. The vitamin/mineral group also performed better on the Serial 3s subtractions task and rated themselves as less 'mentally tired' both pre- and post-completion of the cognitive demand battery.

CONCLUSIONS

Healthy members of the general population may benefit from augmented levels of vitamins/minerals via direct dietary supplementation. Specifically, supplementation led to improved ratings of stress, mental health and vigour and improved cognitive performance during intense mental processing.

Acceptability and effectiveness of chickpea sesame-based ready-to-use therapeutic food in malnourished HIV-positive adults

OBJECTIVE

A prospective descriptive study to assess acceptability and effectiveness of a locally made ready-to-use therapeutic food (RUTF) in HIV-infected chronically sick adults (CSA) with mid-upper-arm circumference (MUAC) <210 mm or pitting edema.

METHODS

Sixty-three wasted AIDS adults were prescribed 500 g representing ~2600 kcal/day of locally made RUTF for three months and routine cotrimoxazole. Weight, height, MUAC, Karnofsky score and morbidity were measured at admission and at monthly intervals. The amount of RUTF intake and acceptability were assessed monthly.

RESULTS

Ninety-five percent (60/63) of the CSA that were invited to join the study agreed to participate. Mean daily intake in these 60 patients was 300 g/person/day (~1590 Kcal and 40 g of protein). Overall, 73.3% (44/60) gained weight, BMI, and MUAC. The median weight, MUAC and BMI gains after three months were 3.0 kg, 25.4 mm, and 1.1 kg/m(2), respectively. The intervention improved the physical activity performance of participants and 78.3% (47/60) regained sufficient strength to walk to the nearest health facility. Mortality at three months was 18.3% (11/60).

CONCLUSION

Locally made RUTF was acceptable to patients and was associated with a rapid weight gain and physical activity performance. The intervention is likely to be more cost effective than nutritional support using usual food-aid commodities.

Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D?

OBJECTIVE

Single-center studies suggest [corrected] that hypovitaminosis D is widespread. Our objective was to determine the serum levels of 25-hydroxyvitamin D (25[OH]D) in a nationally representative sample of U.S. [corrected] children ages 1-11 [corrected] years.

METHODS

Data were obtained from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). [corrected] Serum 25(OH)D levels was [corrected] determined by radioimmunoassay and categorized as <25 nmol/L, [corrected] <50 nmol/L, [corrected] and <75 nmol/L. National estimates were obtained by using assigned patient visit weights and reported with 95% confidence intervals (95% CI). [corrected]

RESULTS

During [corrected] 2001-2006, the mean serum 25(OH)D level for U.S. children ages 1 to 11 years was 68 nmol/L (95% CI, [corrected] 66-70). Children ages 6-11 [corrected] years had lower mean levels of 25(OH)D (66 nmol/L 95% CI, [corrected] 64-68) compared to [corrected] children ages 1-5 [corrected] years (70 nmol/L 95% [corrected] CI, 68-73). [corrected] Overall, the prevalence of <25 nmol/L [corrected] was 1% (95% CI, 0.7-1.4), <50 nmol/L was 18% (95% CI, [corrected] 16-21), and <75 nmol/L was 69% (95% CI, [corrected] 65-73). The prevalence of [corrected] 25(OH)D [corrected] <75 nmol/L was higher among ages [corrected] 6-11 [corrected] years (73%) compared to ages [corrected] 1-5 [corrected] years (63%); females [corrected] (71%) compared to males [corrected] (67%); and non-Hispanic black (92%) and Hispanic (80%) [corrected] compared to [corrected] non-Hispanic whites [corrected] (59%).

CONCLUSIONS

Based on [corrected] a nationally representative sample of U.S. children aged 1-11 [corrected] years, millions of children may have suboptimal levels of 25(OH)D, especially non-Hispanic black and Hispanic children. More data in children are needed not only to understand better the health implications of specific serum levels of 25(OH)D but also to determine the appropriate vitamin D supplement requirements for children.

Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings

Access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of ART programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of ART as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, we review the current evidence supporting macronutrient supplementation for HIV-infected adults, we report on clinical trials in resource-adequate and resource-constrained settings, and we highlight priority areas for future research.

Haematological effects of multimicronutrient supplementation in non-pregnant Gambian women

BACKGROUND/OBJECTIVES

The use of multimicronutrient (MMN) supplementation to reduce the burden of anaemia in non-pregnant women of reproductive age has been little studied, particularly in Africa. The objective of the study was to evaluate haematological outcomes in non-pregnant, rural Gambian women of reproductive age, receiving daily MMN supplements for 1 year.

SUBJECTS/METHODS

The study in 293 women aged from 17 to 45 years old was nested within a double-blind, randomized placebo-controlled trial of periconceptional MMN supplementation [ISRCTN 13687662], using the United Nations International Multiple Micronutrient Preparation (UNIMMAP), received daily for 1 year or until conception. Red cell parameters and free erythrocyte protoporphyrin concentration were measured at baseline and after 12 months in those women who did not conceive.

RESULTS

Anaemic women (haemoglobin concentration <12 g per 100 ml) were more likely to be older and in economic deficit at baseline. Mean change in haemoglobin concentration was +0.6+/-1.4 g per 100 ml in the intervention arm and -0.2+/-1.2 g per 100 ml in the placebo arm (P<0.001). After supplementation with MMN, the relative risk of anaemia (<12 g per 100 ml) was 0.59 (0.46, 0.76) compared with placebo. Anaemic subjects at baseline showed an increase in mean haemoglobin from 10.6 g per 100 ml to 11.8 g/l (P<0.001) after MMN supplementation.

CONCLUSIONS

MMN supplementation should be considered as a strategy for improving the micronutrient and haematological status of non-pregnant women of reproductive age.

Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial

CONTEXT

Ready-to-use therapeutic foods (RUTFs) are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated.

OBJECTIVE

To evaluate the effect of a 3-month distribution of RUTF on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger.

DESIGN, SETTING, AND PARTICIPANTS

A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. All children in the study villages aged 6 to 60 months were eligible for recruitment.

INTERVENTION

Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF (92 g [500 kcal/d]) from August to October 2006. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007.

MAIN OUTCOME MEASURES

Changes in weight-for-height z score (WHZ) according to the World Health Organization Child Growth Standards and incidence of wasting (WHZ <-2) over 8 months of follow-up.

RESULTS

The number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively. The WHZ difference between the intervention and nonintervention groups was -0.10 z (95% confidence interval [CI], -0.23 to 0.03) at baseline and 0.12 z (95% CI, 0.02 to 0.21) after 8 months of follow-up. The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z (95% CI, 0.13 to 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 events/841 child-years) and 0.03 events per child-year (29 events/943 child-years) in the intervention villages, compared with 0.26 events per child-year (233 events/895 child-years) and 0.07 events per child-year (71 events/1029 child-years) in the nonintervention villages. The intervention thus resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.007 deaths per child-year (7 deaths/986 child-years) in the intervention villages and 0.016 deaths per child-year (18 deaths/1099 child-years) in the nonintervention villages (adjusted hazard ratio, 0.51; 95% CI, 0.25 to 1.05).

CONCLUSION

Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00682708.

Timing Carbohydrate Beverage Intake During Prolonged Moderate Intensity Exercise Does Not Affect Cycling Performance

Carbohydrate beverages consumed during long-term exercise have been shown to attenuate fatigue and improve performance; however, the optimal timing of ingestion is unclear. Therefore, the purpose of this study was to determine if timing the carbohydrate ingestion (continual loading (CL), front-loading (FL), and end-loading (EL)) during prolonged exercise influenced exercise performance in competitive cyclists. Ten well-trained cyclists completed three separate exercise bouts on a bicycle ergometer, each lasting 2 hours at an intensity of ~67% VO₂ max, followed by a 15-minute "all out" time trial. In the CL trial, a carbohydrate beverage was ingested throughout the trial. In the FL trial, participants ingested a carbohydrate beverage during the first hour and a placebo beverage during the second hour. In the EL trial, a carbohydrate beverage was ingested during the second hour and a placebo during the first hour. The amount of carbohydrate consumed (75 g) was the same among conditions. The order of conditions was single-blinded, counterbalanced, and determined randomly. Performance was measured by the work output during the 15-minute performance ride. There were no differences in work output among the three conditions during the final time trial. In the first hour of exercise, peak venous blood glucose was highest in the FL condition. In the second hour, peak venous blood glucose was highest in the EL condition. Following the time trial, venous blood glucose levels were similar among CL, FL, and EL. Overall, the timing of carbohydrate beverage consumption during prolonged moderate intensity cycling did not alter cycling performance.

[Nutritional recommendations, supplementation, and physical activity program following Roux-en-Y gastric bypass for morbid obesity]

Die Zahl der notwendigen Magenbypass-Operationen (RYGB) steigt aufgrund der Adipositasepidemie jÄhrlich an. Dabei wird ein Erfolg dieser Behandlung nur garantiert, wenn im Nachsorgeprogramm eine entsprechende Bewegungstherapie, eine verfahrensadaptierte ErnÄhrungsumstellung und eine ausreichende Supplementation greifen. In AbhÄngigkeit von muskuloskelettalen Vorerkrankungen sollte eine Bewegungstherapie circa 4 Wochen postoperativ beginnen und aus einem abwechselnd kardiovaskulÄren und bindegewebsrestitutiven Training bestehen. Die erforderliche ErnÄhrungsumstellung fokussiert aufeine klein portionierte, kalorienreduzierte und eiweiΒ- bzw. vitaminangereicherte ErnÄhrung. Das tÄgliche RichtmaΒ sollte zwischen 800 und 1200 kcal liegen. Trotzdem kÖnnen nach RYGB nutritive MangelzustÄnde fÜr Proteine in 1–3%, fÜr Eisen in 45–52%, Vitamin B₁₂ in 33–37%,FolsÄurein circa 35%,Calciumin10–12% und fÜr Vitamine in 10–45% der FÄlle registriert werden. Aus diesem Grund ist eine regelmÄΒige Laboranalytik im Follow-up notwendig, und es muss eine entsprechende Supplementation von Mineralien, Vitaminen und Spurenelementen durchgefÜhrt werden. Nutritional Recommendations, Supplementation, and Physical Activity ProgramFollowing Roux-en-Y Gastric Bypass for Morbid Obesity The number of gastric bypass operations (RYGB) needed worldwide is increasing annually due to the obesity epidemic. Yet the success of this treatment is only guaranteed if an appropriate exercise therapy, a corresponding change of diet, and an adequate supplementation take hold in the aftercare program. Subject to pre-existing musculoskeletal diseases, exercise therapy should start about 4 weeks after the operation and comprise alternating cardiovascular and connective tissue-restitution training. The required change of diet focuses on small portions of calorie-reduced as well as protein- and vitaminenriched food. The standard daily intake should be between 800 and 1,200 kcal. However, after RYGB, nutritive deficiencies have been registered for proteins in 1-3%, for iron in 45-52%, vitamin B₁₂ in 33-37%, folic acid in about 35%, calcium in 10− 12%, and vitamins in 10-45% of the patients. For this reason, laboratory analysis at regular intervals is necessary in the follow- up and an appropriate supplementation of minerals, vitamins, and trace elements must be implemented.

A critical review of Vitamin D and Cancer: A report of the IARC Working Group

The International Agency for Research on Cancer (IARC) released a report, Vitamin D and Cancer, on November 25, 2008. The report focused on the current state of knowledge and level of evidence of a causal association between vitamin D status and cancer risk. Although presenting and evaluating evidence for the beneficial role of UVB and vitamin D in reducing the risk of cancer, it discounted or omitted important evidence in support of the efficacy of vitamin D. The report largely dismissed or ignored ecological studies on the grounds that confounding factors might have affected the findings. The report accepted a preventive role of vitamin D in colorectal cancer but not for breast cancer.The only randomized controlled trial (RCT) on cancer incidence that used a sufficiently high dose of vitamin D (1,100 IU/day) and calcium (1,400-1,500 mg/day) found a 77% reduction in the risk of all-cancer incidence in postmenopausal women who received both, of which approximately 35% reduction in risk was attributed to vitamin D alone. Unfairly, the report dismissed these findings on the basis of a flawed critique.The report called for RCTs of vitamin D supplementation to settle the issue. Although RCTs theoretically would be beneficial, development of sound and effective public health policies does not necessarily depend on them, and the field of vitamin D, calcium and chronic disease has reached the point where RCTs may not be ethical.The IARC report should therefore not form the basis for public health policy decisions.

Effect of calcium supplementation on blood lead levels in pregnancy: a randomized placebo-controlled trial

BACKGROUND

Prenatal lead exposure is associated with deficits in fetal growth and neurodevelopment. Calcium supplementation may attenuate fetal exposure by inhibiting mobilization of maternal bone lead and/or intestinal absorption of ingested lead.

OBJECTIVE

Our goal was to evaluate the effect of 1,200 mg dietary calcium supplementation on maternal blood lead levels during pregnancy.

METHODS

In a double-blind, randomized, placebo-controlled trial conducted from 2001 through 2003 in Mexico City, we randomly assigned 670 women in their first trimester of pregnancy to ingest calcium (n = 334) or placebo (n = 336). We followed subjects through pregnancy and evaluated the effect of supplementation on maternal blood lead, using an intent-to-treat analysis by a mixed-effects regression model with random intercept, in 557 participants (83%) who completed follow-up. We then conducted as-treated analyses using similar models stratified by treatment compliance.

RESULTS

Adjusting for baseline lead level, age, trimester of pregnancy, and dietary energy and calcium intake, calcium was associated with an average 11% reduction (0.4 microg/dL) in blood lead level relative to placebo (p = 0.004). This reduction was more evident in the second trimester (-14%, p < 0.001) than in the third (-8%, p = 0.107) and was strongest in women who were most compliant (those who consumed > or = 75% calcium pills; -24%, p < 0.001), had baseline blood lead > 5 microg/dL (-17%, p < 0.01), or reported use of lead-glazed ceramics and high bone lead (-31%, p < 0.01).

CONCLUSION

Calcium supplementation was associated with modest reductions in blood lead when administered during pregnancy and may constitute an important secondary prevention effort to reduce circulating maternal lead and, consequently, fetal exposure.

Does testosterone supplementation improve health and function in elderly men?

BACKGROUND

Low serum testosterone levels are associated with age-related changes in physical and cognitive function. Replacement therapy could, therefore, help alleviate symptoms of aging.

OBJECTIVE

To determine whether 6 months’ supplementation with testosterone improved signs of aging in a population of elderly men with low-normal testosterone levels.

DESIGN AND INTERVENTION

This was a double-blind, randomized, placebo-controlled trial of testosterone supplementation conducted at a single center in the Netherlands between January 2004 and April 2005. Participants were recruited by direct mailing. Inclusion criteria included age 60–80 years and a serum testosterone level below the 50^th percentile of the study population-based testosterone distribution (cutoff 13.7 nmol/l). Exclusion criteria included myocardial infarction, heart failure, malignancy, serious liver or renal disease, epilepsy, diabetes mellitus, elevated prostate-specific antigen, use of corticosteroids, and use of testosterone esters within the previous 60 days. Eligible participants were randomly allocated to receive either 80 mg oral testosterone undecenoate or placebo twice daily for 6 months. Functional ability was measured with the timed ‘get up and go’ test, the Stanford Health Assessment Questionnaire, an isometric handgrip strength test, and a maximal voluntary isometric leg strength test. Cognitive parameters assessed included verbal episodic memory, cognitive and perceptual speed, attention and mental flexibility, extrapersonal spatial perception, and visuospatial performance. BMD and total body composition were measured by dual-energy X-ray absorptiometry. Quality of life was assessed with the Short-Form 36 Health Survey (SF-36) and the Questions on Life Satisfaction Modules questionnaires.

OUTCOME MEASURES

The main outcome measures were functional mobility, cognitive function, BMD, anthropometry, body composition, biochemical measures, quality of life, and safety parameters.

RESULTS

The study enrolled 113 men in the testosterone group (mean age 67.1 years; mean serum testosterone level 11.0 nmol/l) and 110 men in the placebo group (mean age 67.4 years; mean serum testosterone level 10.4 nmol/l). Treatment adherence was >90% for both groups. When compared with the placebo group, treatment with testosterone was associated with increased lean body mass, decreased body fat mass and decreased body fat percentage (P <0.001 for all comparisons); however, no significant changes in parameters of functional ability were observed in either group. Total cholesterol and HDL cholesterol decreased in the testosterone group, whereas insulin and glucose concentrations and measures of insulin resistance increased in the placebo group. Cognitive function improved in both groups but BMD and quality of life were unchanged. The mean number of adverse events per participant was 0.87 in the testosterone group and 0.90 in the placebo group.

CONCLUSION

The results of this study suggest that eugonadal or slightly hypogonadal men might not benefit substantially from short-term, low-dose testosterone supplementation.

The Serum Levels of Trace Metals in Nigerian Males with Different PSA Values

Prostate cancer (PCa), the primary disease of men over 50 years of age is on the increase worldwide. Most PCa grows slowly from overt clinical disease to the stage that lead to death. The gradual course of PCA development provides opportunity for intervention. Supplement of diet taken by PCa patients may be an effective intervention because certain micronutrients had been implicated in cancer prevention. The present study is designed to determine the levels of trace metals in 80 Nigeria males having different concentrations of serum prostate surface antigen (PSA) using atomic absorption spectrophotometer. The serum levels of PSA were measured with Beckman Coulter Access Immunoassay automated machine. Subjects with PSA values 5-10ng/ml had significantly high serum levels of Zn, Fe, Cd and Mn but significantly low level of Se compared with the controls (PSA 0-4ng/ml). Subjects with PSA >10ng/ml had significantly low levels of Mn, Mg and Se compared with the controls. Subjects with PSA values 5-10ng/ml had significantly reduced level of Se compared with subjects with PSA >10ng/ml. Only Se was low in all subjects with PSA >4ng/ml, therefore there is a possibility that Se intake may reduce the risk and progression of PCA.

Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers

OBJECTIVE

Mounting evidence indicates that low levels of n-3 polyunsaturated fatty acids (PUFAs) play a role in the pathophysiology of a large number of psychiatric disorders. In light of the suboptimal n-3 PUFAs intake due to poor dietary habits among substance abusers and the strong associations between aggression, anxiety and substance use disorders we examined if insurance of adequate intakes of n-3 PUFAs with supplementation would decrease their anger and anxiety scores.

METHOD

Substance abusers (n=22) were assigned to either 3 g of n-3 PUFAs, mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or soybean oil in identically looking capsules. The trial was double-blind, randomized and lasted 3 months. Anger and anxiety scales were administered at baseline and once a month thereafter. Blood samples were collected at baseline and at the end of the trial.

RESULTS

Patients' dietary intakes of n-3 PUFAs fell below recommended levels. Assignment to n-3 PUFA treatment was accompanied by significant decreases in anger and anxiety scores compared to placebo assignment. These changes were associated with increases in plasma levels of both EPA and DHA but an increase in EPA was more robustly correlated with low end-of-trial anxiety scores and an increase in DHA was more robustly correlated with low end-of-trial anger scores.

CONCLUSION

These pilot data indicate that ensuring adequate n-3 PUFA intake via supplementation benefits substance abusers by reducing their anger and anxiety levels. The strong correlations between an increase in plasma EPA and lower anxiety scores and between an increase in plasma DHA and lower anger scores suggests a need for the further exploration of the differential responses to these two n-3 PUFAs in different psychiatric conditions.

Long-chain n-3 polyunsaturated fatty acids decrease feelings of anger in substance abusers

It has been suggested that low levels of n-3 polyunsaturated fatty acids (PUFAs) play a role in the pathophysiology of some psychiatric disorders. In light of the existence of strong associations between high-frequency and high-severity aggressive behaviors and substance use disorders and of our observation that substance abusers have poor dietary habits, the possibility that the administration of supplements of n-3 PUFAs would decrease their anger levels was explored. A lifelong history of aggressive behaviors and problems with the law was obtained in 24 patients. Thirteen patients received on a daily basis capsules containing 3 g of n-3 PUFAs (EPA+DHA). Eleven patients received placebo capsules. The trial was double-blind, randomized, and lasted 3 months. An anger scale was administered at baseline and every month thereafter. Six PUFA group patients and eight placebo group patients were followed for an additional 3 months after treatment discontinuation. Four patients in each group had a history of assaultive behavior. The baseline fish and n-3 PUFA intakes of these eight patients were significantly lower than those of the non-aggressive patients. When given for 3 months, n-3 PUFAs were superior to placebo in diminishing anger scores. Scores remained decreased for 3 months following treatment discontinuation. These data provide further support for emerging evidence indicating that supplementation with long-chain n-3 PUFAs could be beneficial in the treatment of some individuals with aggressive tendencies.

Serum concentrations of trace elements in patients with Crohn's disease receiving enteral nutrition

We investigated the trace element status in Crohn's disease (CD) patients receiving enteral nutrition, and evaluated the effects of trace element-rich supplementation. Thirty-one patients with CD were enrolled in this study. All patients were placed on an enteral nutrition regimen with Elental(R) (Ajinomoto pharmaceutical. Ltd., Tokyo, Japan). Serum selenium, zinc and copper concentrations were determined by atomic absorption spectroscopy. Serum selenoprotein P levels were determined by an ELISA system. Average serum levels of albumin, selenium, zinc and copper were 4.1 +/- 0.4 g/dl, 11.2 +/- 2.8 microg/dl, 71.0 +/- 14.8 microg/dl, and 112.0 +/- 25.6 microg/dl, respectively. In 9 patients of 31 CD patients, serum albumin levels were lower than the lower limit of the normal range. Serum selenium, zinc and copper levels were lower than lower limits in 12 patients, 9 patients and 1 patient, respectively. Serum selenium levels significantly correlated with both serum selenoprotein P levels and glutathione peroxidase activity. Supplementation of selenium (100 microg/day) and zinc (10 mg/day) for 2 months significantly improved the trace element status in CD patients. In conclusion, serum selenium and zinc levels are lower in many CD patients on long-term enteral nutrition. In these patients, supplementation of selenium and zinc was effective in improving the trace element status.

Hypolipidemic potential of Panicum miliare on selected cardiovascular subjects

Hypolipidemic effect of Samai (.i.e. Panicum miliare) on selected fifty cardiovascular patients were studied for a period of sixty days (25 control; 25 supplemented with Samai). Lipid profiles were analyzed before and after supplementation period for both control and experimental group. It was heartwarming to note that all the lipid values with the exception of HDL - cholesterol had reduced after supplementation with Samai and the reductions were statistically significant at 1 per cent level. There was a mild increase in the HDL cholesterol level, which was desirable.

Iron supplementation in early childhood: health benefits and risks

The prevalence of iron deficiency among infants and young children living in developing countries is high. Because of its chemical properties--namely, its oxidative potential--iron functions in several biological systems that are crucial to human health. Iron, which is not easily eliminated from the body, can also cause harm through oxidative stress, interference with the absorption or metabolism of other nutrients, and suppression of critical enzymatic activities. We reviewed 26 randomized controlled trials of preventive, oral iron supplementation in young children (aged 0-59 mo) living in developing countries to ascertain the associated health benefits and risks. The outcomes investigated were anemia, development, growth, morbidity, and mortality. Initial hemoglobin concentrations and iron status were considered as effect modifiers, although few studies included such subgroup analyses. Among iron-deficient or anemic children, hemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron-replete children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. In a malaria-endemic population of Zanzibar, significant increases in serious adverse events were associated with iron supplementation, whereas, in Nepal, no effects on mortality in young children were found. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programs may need to be targeted through identification of iron-deficient children.

The prolonged intake of L-arginine-L-aspartate reduces blood lactate accumulation and oxygen consumption during submaximal exercise

L-arginine-L-aspartate is widely used by athletes for its potentially ergogenic properties. However, only little information on its real efficacy is available from controlled studies. Therefore, we evaluated the effects of prolonged supplementation with L-arginine-L-aspartate on metabolic and cardiorespiratory responses to submaximal exercise in healthy athletes by a double blind placebo-controlled trial. Sixteen healthy male volunteers (22 ± 3 years) performed incremental cycle spiroergometry up to 150 watts before and after intake of L-arginine-L-aspartate (3 grams per day) or placebo for a period of 3 weeks. After intake of L-arginine-L-aspartate, blood lactate at 150 watts dropped from 2.8 ± 0.8 to 2.0 ± 0.9 mmol·l(-1) (p < 0.001) and total oxygen consumption during the 3-min period at 150 watts from 6.32 ± 0.51 to 5.95 ± 0.40 l (p = 0.04) compared to placebo (2.7 ± 1.1 to 2.7 ± 1.4 mmol·l(-1); p = 0.9 and 6.07 ± 0.51 to 5.91 ± 0.50 l; p = 0.3). Additionally, L-arginine-L-aspartate supplementation effected an increased fat utilisation at 50 watts. L-arginine and L-aspartate seem to have induced synergistic metabolic effects. L-arginine might have reduced lactic acid production by the inhibition of glycolysis and L-aspartate may have favoured fatty acid oxidation. Besides, the results indicate improved work efficiency after L-arginine-L-aspartate intake. The resulting increases of submaximal work capacity and exercise tolerance may have important implications for athletes as well as patients. Key PointsAmino acids are among the most common nutritional supplements taken by athletes. They are involved in numerous metabolic pathways that affect exercise metabolism.Three weeks of L-arginine-L-aspartate supplementation resulted in lower blood lactate concentrations and oxygen consumption, diminished glucose and enhanced fat oxidation, and reduced heart rate and ventilation during submaximal cycle exercise.This implies increased submaximal work capacity and exercise tolerance, which may have important implications for both athletes as well as patients.

The vitamin E distribution in serum, liver, adipose and muscle tissues in the pig during depletion and repletion

This study was designed to examine the storage capacity for vitamin E in liver, adipose tissue and skeletal muscle of growing pigs during a period of supplementation and of depletion. Therefore, biopsy specimens of these tissues and samples of serum were frequently taken from 7 pigs throughout the experimental period. After a 7-week period on a diet highly supplemented with vitamin E (405 mg/kg), a significant increase (p less than 0.001) in the concentration of this vitamin was observed in all tissues sampled. The highest level (102.9 +/- 26.2 mg/kg) was observed in the liver. After 2 days of depletion the concentration of vitamin E in the liver had fallen by 80%, whereas the concentration in the fat and muscle remained unchanged during 1 week of depletion. The serum vitamin E value rose significantly (p less than 0.001) after 1 week on the supplemented diet and then remained at about 7 mg/l throughout the supplementation period and decreased (p less than 0.001) after 2 days on a nonsupplemented diet. Generally, the serum vitamin E levels among growing pigs are between 2 and 3 mg/l. The results show that the serum and liver values were correlated when the serum level was within this range. Moreover, it is clearly demonstrated that the concentrations of vitamin E in serum and liver reflect the immediate nutritional status of the animal, whereas the vitamin concentrations in adipose and skeletal muscle tissue reflect its long-term nutritional history.