Factors influencing the absorption of vitamin D in GIT: an overview

Relationship between the double burden of malnutrition and mental health in overweight and obese adult women

The co-existence of overweight or obesity with concurrent deficiency of one or more nutrients is referred to as double burden of malnutrition (DBM), and numerous mental health impairments have been associated with a variety of nutrient deficiencies. Although DBM is relevant for several health outcomes, the ubiquitous involvement of vitamin D across multiple systems and tissues suggests D insufficiency as a viable target for nutritional modification. The present study aimed to evaluate the contribution of DBM and mental health among adult women. Study participants included 300 women, aged 18–59 years, who presented to one of the 25 health centres in Tehran. Participants with a body mass index (BMI) of greater than 25 kg/m² and a plasma concentration of 25-hydroxy vitamin D [25(OH)D] of >20 ng/ml were considered to have DBM. The 147-item food frequency questionnaire was used to estimate their dietary intake. Mental health status was assessed using the depression, anxiety and stress scales-21 (DASS-21). The mean ± standard deviation age, weight and BMI of the participants were 36⋅49 ± 8⋅38, 80⋅89 ± 12⋅45 kg and 31⋅04 ± 4⋅31 kg/m², respectively. DBM was significantly associated with stress, after adjusting for potential confounders, including age, energy and marital status in model 1 (OR = 1⋅28, 95 % confidence interval (CI) 1⋅00, 1⋅65, P < 0⋅04) v. the crude model (OR = 1⋅22; 95 % CI 0⋅96, 1⋅55, P = 0⋅09). No significant association was seen among DBM and DASS-21 outcomes. In this cross-sectional study, stress and DBM were significantly associated. While vitamin D insufficiency was associated with mental health and obesity in opposing directions. Elucidation of whether vitamin D supplementation can improve mental health impairments requires further evaluation.

Vitamin D Deficiency Presenting as Proximal Myopathy: An Overlooked Diagnosis - A Case Series and Review of the Literature

The prevalence of vitamin D deficiency is ubiquitous. Severe disease can present very dramatically and can be misleading to the treating physician, resulting in mismanagement. A high index of suspicion in vulnerable patients should help circumvent this problem, including a thorough history and physical examination to lead the clinician in the right direction. Insidious onset and progressive proximal pelvic girdle myopathy, in the absence of other neurological findings, in the appropriate patient should prompt the physician to test for serum 25 hydroxyvitamin D levels. The literature on endocrine myopathy does not highlight this condition as much as it does the thyroid, parathyroid, and adrenal aetiologies. Testing for vitamin D deficiency is simple, and treatment is available all over the world. The following article presents three patients, in different scenarios, with the condition. In all three patients, incapacitating pelvic girdle weakness resolved and quality of life improved dramatically with timely intervention. Most importantly, the correct approach prevented misdiagnosis and mismanagement.

Vitamin D deficiency and tumor aggressiveness in gastroenteropancreatic neuroendocrine tumors

PURPOSE

Data regarding vitamin D status in patients affected by gastroenteropancreatic (GEP) neuroendocrine tumor (NET) are limited and often showing contrasting results. The aim of the study was to evaluate the incidence of vitamin D deficiency (<20 ng/mL) in GEP-NET patients and compare the 25-hydroxyvitamin D (25(OH)D) levels with clinicopathological parameters and clinical outcome.

METHODS

A retrospective cross-sectional study including 75 low grade (G1-G2) GEP-NETs and 123 healthy controls matched for age, sex, and body mass index, was performed.

RESULTS

GEP-NET patients had significantly lower 25(OH)D levels compared to controls (17.9 ± 7.8 vs 24.2 ± 7.7 ng/mL, p < 0.0001). Ileal NETs were associated to lower 25(OH)D levels compared to other primary tumor sites (p = 0.049) and small bowel resection posed a significant increased risk of severe vitamin D deficiency (OR = 2.81, 95% CI = 1.25-3.37, p = 0.018). No correlation with somatostatin analogs treatment was found. 25(OH)D levels were significantly lower in G2 compared to G1 GEP-NETs (15.6 ± 7.8 vs 19.9 ± 7.4 ng/mL, p = 0.016) and in patients with progressive disease (12.6 ± 5.7 ng/mL) compared to those with stable disease (mean 21.5 ± 8.2 ng/mL, p = 0.001) or tumor free after surgery (19.6 ± 7.3 ng/mL, p = 0.002). Patients with vitamin D deficiency and insufficiency had shorter progression-free survival compared to those with sufficiency (p = 0.014), whereas no correlation was found with disease-specific survival.

CONCLUSIONS

Vitamin D deficiency is highly prevalent among GEP-NETs and could be associated with high tumor grade and disease progression. Therefore, the monitoring of 25(OH)D levels is relevant in these patients and vitamin D supplementation should be considered in the management of GEP-NET patients with vitamin D deficiency or insufficiency.

Tipping the Balance: Vitamin D Inadequacy in Children Impacts the Major Gut Bacterial Phyla

Vitamin D inadequacy appears to be on the rise globally, and it has been linked to an increased risk of osteoporosis, as well as metabolic, cardiovascular, and autoimmune diseases. Vitamin D concentrations are partially determined by genetic factors. Specific single nucleotide polymorphisms (SNPs) in genes involved in vitamin D transport, metabolism, or binding have been found to be associated with its serum concentration, and these SNPs differ among ethnicities. Vitamin D has also been suggested to be a regulator of the gut microbiota and vitamin D deficiency as the possible cause of gut microbial dysbiosis and inflammation. This pilot study aims to fill the gap in our understanding of the prevalence, cause, and implications of vitamin D inadequacy in a pediatric population residing in Qatar. Blood and fecal samples were collected from healthy subjects aged 4–14 years. Blood was used to measure serum metabolite of vitamin D, 25-hydroxycholecalciferol 25(OH)D. To evaluate the composition of the gut microbiota, fecal samples were subjected to 16S rRNA gene sequencing. High levels of vitamin D deficiency/insufficiency were observed in our cohort with 97% of the subjects falling into the inadequate category (with serum 25(OH)D < 75 nmol/L). The CT genotype in rs12512631, an SNP in the GC gene, was associated with low serum levels of vitamin D (ANOVA, p = 0.0356) and was abundant in deficient compared to non-deficient subjects. Overall gut microbial community structure was significantly different between the deficient (D) and non-deficient (ND) groups (Bray Curtis dissimilarity p = 0.049), with deficient subjects also displaying reduced gut microbial diversity. Significant differences were observed among the two major gut phyla, Firmicutes (F) and Bacteroidetes (B), where deficient subjects displayed a higher B/F ratio (p = 0.0097) compared to ND. Vitamin D deficient children also demonstrated gut enterotypes dominated by the genus Prevotella as opposed to Bacteroides. Our findings suggest that pediatric vitamin D inadequacy significantly impacts the gut microbiota. We also highlight the importance of considering host genetics and baseline gut microbiome composition in interpreting the clinical outcomes related to vitamin D deficiency as well as designing better personalized strategies for therapeutic interventions.

The Role of Macronutrients, Micronutrients and Flavonoid Polyphenols in the Prevention and Treatment of Osteoporosis

Osteoporosis is considered an age-related disorder of the skeletal system, characterized primarily by decreased bone mineral density (BMD), microstructural quality and an elevated risk of fragility fractures. This silent disease is increasingly becoming a global epidemic due to an aging population and longer life expectancy. It is known that nutrition and physical activity play an important role in skeletal health, both in achieving the highest BMD and in maintaining bone health. In this review, the role of macronutrients (proteins, lipids, carbohydrates), micronutrients (minerals—calcium, phosphorus, magnesium, as well as vitamins—D, C, K) and flavonoid polyphenols (quercetin, rutin, luteolin, kaempferol, naringin) which appear to be essential for the prevention and treatment of osteoporosis, are characterized. Moreover, the importance of various naturally available nutrients, whether in the diet or in food supplements, is emphasized. In addition to pharmacotherapy, the basis of osteoporosis prevention is a healthy diet rich mainly in fruits, vegetables, seafood and fish oil supplements, specific dairy products, containing a sufficient amount of all aforementioned nutritional substances along with regular physical activity. The effect of diet alone in this context may depend on an individual’s genotype, gene-diet interactions or the composition and function of the gut microbiota.

Dietary vitamin D intake and colorectal cancer risk: a longitudinal approach within the PREDIMED study

PURPOSE

We evaluated whether the intake of dietary vitamin D is associated with the incidence of both colorectal cancer (CRC) and colon cancer in the framework of the PREDIMED cohort of older adults at high cardiovascular risk.

METHODS

We analyzed data from 7216 men and women (55-80 years) without CRC at baseline from the PREvención con DIeta MEDiterránea study. Baseline consumption of vitamin D was assessed using a validated 137-item food frequency questionnaire. Cox proportional hazards ratios (HRs) of CRC and colon cancer incidence were estimated for quartiles and per 1-SD of baseline vitamin D intake.

RESULTS

During a median follow-up of 6 years, we documented 97 incident CRC cases after the exclusion of subjects with no baseline dietary data and/or outliers of energy intake. A non-significant HRs and 95% confidence intervals (CIs) of CRC for the comparison of extreme quartiles (4th vs 1st) of vitamin D intake were observed [0.55 (0.30-1.00), P for trend = 0.072], whereas it was significant for colon cancer incidence alone [0.44 (0.22-0.90), P for trend = 0.032]. However, this association became significant in CRC and colon cancer incidence, after excluding 391 subjects consuming baseline vitamin D and/or calcium medication or prescribed supplements [0.52 (0.28-0.96) and 0.41 (0.12-0.85), respectively].

CONCLUSION

A higher dietary intake of vitamin D was significantly associated with a reduced CRC risk in individuals at high cardiovascular risk.

Mucormycosis in COVID-19 pandemic: Risk factors and linkages

Mucormycosis is a serious and potentially fatal fungal infection caused by a type of rare but opportunistic fungal pathogen called mucormycetes. Recently, mucormycosis, also known as black fungus, made severe chaos in India during the second wave (between April and June 2021) of the tragical COVID-19 epidemic by its sudden and devastating surge with up to 50% mortality rate. While the exact cause of its sharp rise suddenly and specifically during the second wave still remains debatable, it has been noted that the people who are diabetic and have recovered from COVID-19 infection are more predisposed to mucormycosis. Nevertheless, the precise reason and mechanism(s) underlying the surge of this deadly infection needs to be investigated to comprehend its pathogenesis and pathological elements and discover rationale preventative/ therapeutic solutions. It is speculated that the indiscriminate use of steroids, antibiotics and zinc as a self-medication practice that increased during the COVID-19 epidemic may have promoted the dysbiosis of gut microbiota thereby inducing immune-suppression and making the risk group highly susceptible to this mycotic disease. In these contexts, this timely article attempts to contemplate and discuss some of the possible factors and potential mechanisms that can help to understand and explain the conundrum of sudden, steep and deadly upsurge of mucormycosis infections during the second wave of COVID-19 epidemic.

Co-administration of vitamin D3 and Lacticaseibacillus paracasei DG increase 25-hydroxyvitamin D serum levels in mice

Purpose

Subclinical vitamin D (vitD) deficiency enhances the predisposition to a myriad of acute and chronic pathologies in many people worldwide. Due to the scarcity of vitD-rich foods, the consumption of supplements or fortified foods can be required to maintain healthy serum levels of 25-hydroxyvitamin D [25(OH)D], and the major circulating form of vitD that is commonly measured in serum to determine the vitD status. Since the vitD absorption seems to resemble that of lipids, improved emulsification in the gut could favor vitD permeation through the enterocyte membrane. Contextually, we hypothesized that a microorganism with cholecalciferol (vitD3)-solubilization properties may potentially result in enhanced serum vitD levels.

Methods and results

Six probiotic strains were screened for their ability to create a stable suspension of vitD3 in water: Lacticaseibacillus paracasei DG, L. paracasei LPC-S01, L. paracasei Shirota, L. rhamnosus GG, Limosilactobacillus reuteri DSM 17938, and Lactobacillus acidophilus LA5. The DG strain displayed the strongest vitD3 solubilization ability and, consequently, were used in an in vivo trial where a commercial preparation of vitD3 in refined olive oil was administered by gavage to CD-1 mice with or without the concurrent administration of L. paracasei DG. ELISA measurements showed that the DG strain significantly increased the serum levels of 25(OH) D when administered once a day for 1 week in association with the vitD3 supplement.

Conclusion

This preliminary pre-clinical study suggests that the combined administration of L. paracasei DG with an oil-based cholecalciferol supplement could contribute to the maintenance of the adequate 25(OH) D serum levels in people at risk of vitD deficiency.

Sources of vitamin D for humans

Both vitamin D insufficiency and deficiency are now well-documented worldwide in relation to human health, and this has raised interest in vitamin D research. The aim of this article is therefore to review the literature on sources of vitamin D. It can be endogenously synthesised under ultraviolet B radiation in the skin, or ingested through dietary supplements and dietary sources, which include food of animal and plant origin, as well as fortified foods. Vitamin D is mainly found in two forms, D₃ (cholecalciferol) and D₂ (ergocalciferol). In addition to the D₃ and D₂ forms of vitamin D, 25-hydroxy vitamin D also contributes significantly to dietary vitamin D intake. It is found in many animal-derived products. Fortified food can contain D₃ or D₂ forms or vitamin D metabolite 25-hydroxy vitamin D. Not many foods are a rich source (> 4 μg/100 g) of vitamin D (D represents D₃ and/or D₂), e.g., many but not all fish (5-25 μg/100 g), mushrooms (21.1-58.7 μg/100 g), Reindeer lichen (87 μg/100 g) and fish liver oils (250 μg/100 g). Other dietary sources are cheese, beef liver and eggs (1.3-2.9 μg/100 g), dark chocolate (4 μg/100 g), as well as fortified foods (milk, yoghurt, fat spreads, orange juice, breakfast grains, plant-based beverages). Since an adequate intake of vitamin D (15 μg/day set by the European Food Safety Authority) is hard to achieve through diet alone, dietary supplements of vitamin D are usually recommended. This review summarizes current knowledge about different sources of vitamin D for humans.

1α,25-(OH)2 vitamin D3 prevents insulin resistance and regulates coordinated exocytosis and insulin secretion

Vitamin D₃ is associated with improvements in insulin resistance and glycemia. In this study, we investigated the short-term effect of 1α,25(OH)₂ Vitamin D₃ (1,25-D₃) and cholecalciferol (vitamin D₃) on the glycemia and insulin sensitivity of control and dexamethasone-induced insulin-resistance rats. ⁴⁵Ca²⁺ influx responses to 1,25-D₃ and its role in insulin secretion were investigated in isolated pancreatic islets from control rats. In vivo, 5 d treatment with 1,25-D₃ (i.p.) prevented insulin resistance in dexamethasone-treated rats. Treatment with 1,25-D₃ improved the activities of hepatic enzymes, serum lipids and calcium concentrations in insulin-resistant rats. 25-D₃ (o.g.) does not affect insulin resistance. In pancreatic islets, 1,25-D₃ increased insulin secretion and stimulated rapid response ⁴⁵Ca²⁺ influx. The stimulatory effect of 1,25-D₃ on ⁴⁵Ca²⁺ influx was decreased by diazoxide, apamine, thapsigargin, dantrolene, 2-APB, nifedipine, TEA, PKA, PKC, and cytoskeleton inhibitor, while it was increased by glibenclamide and N-ethylmaleimide. The stimulatory effect of 1,25-D₃ on ⁴⁵Ca²⁺ influx involves the activation of L-type VDCC, K⁺-ATP, K⁺-Ca^2+, and Kv channels, which augment cytosolic calcium. These ionic changes mobilize calcium from stores and downstream activation of PKC, PKA tethering vesicle traffic and fusion at the plasma membrane for insulin secretion. This is the first study highlighting the unprecedented role of 1,25-D₃ (short-term effect) in the regulation of glucose homeostasis and on prevention of insulin resistance. Furthermore, this study shows the intracellular β-cell signal transduction of 1,25-D₃ through the modulation of pivotal ionic channels and proteins exhibiting a coordinated exocytosis of vesicles for insulin secretion.

Vitamin D Incorporation in Foods: Formulation Strategies, Stability, and Bioaccessibility as Affected by the Food Matrix

Inadequate intake of vitamin D is a global health issue related to severe diseases, mainly involving subjects with dark skin pigmentation, patients affected by malnutrition, malabsorption syndromes, or obesity, and elderly people. Some foods fortified with vitamin D have been tested in vivo, but fortification strategies with a global outreach are still lacking. This review is focused on food fortification with vitamin D, with the aim to collect information on (a) formulation strategies; (b) stability during processing and storage; and (c) in vitro bioaccessibility. Approaches to add vitamin D to various foods were analyzed, including the use of free vitamin D, vitamin D loaded in simple and double nanoemulsions, liposomes, casein micelles, and protein nanocapsules. Numerous studies were reviewed to elucidate the impact of food technologies on vitamin D’s stability, and mechanisms that lead to degradation were identified—namely, acid-catalyzed isomerization, radical-induced oxidation, and photo-oxidation. There is, however, a lack of kinetic data that allow for the prediction of vitamin D’s stability under industrial processing conditions. The roles that lipids, proteins, fibers, and antioxidants play in vitamin bioaccessibility have been clarified in various studies, while future needs include the design of specific food matrices that simultaneously achieve a balance between the long-term stability, bioaccessibility and, ultimately, in vivo functionality of vitamin D.

Nutritional Supplementation of Naturally Occurring Vitamin D to Improve Hemorrhagic Stroke Outcomes

Vitamin D deficiency, if left untreated, is associated with bone disorders, cardiovascular damage, and an increased risk of ischemic stroke. While there are various nutritional options for the natural intake of vitamin D, we hope to elucidate the potential mechanisms dietary vitamin D may play in hemorrhagic stroke pathology. This scoping review outlines findings from studies relevant to the biochemical activity of vitamin D, the impact of vitamin D deficiency on hemorrhagic stroke outcomes, and the potential benefit of nutritional vitamin D on hemorrhagic stroke outcomes. Here, we analyze the relevant factors that can lead to vitamin D deficiency, and subsequently, a higher risk of hemorrhagic stroke incidence with worsened subsequent outcomes. The neuroprotective mechanisms through which vitamin D works to attenuate hemorrhagic stroke onset and post-stroke outcomes have not yet been thoroughly examined. However, researchers have proposed several potential protective mechanisms, including reduction of blood brain barrier disturbance by inhibiting the production of reactive oxygen species, mitigation of inflammation through a reduction of levels of proinflammatory cytokines, and prevention of cerebral vasospasm and delayed cerebral ischemia following subarachnoid hemorrhage and intracerebral hemorrhage. While more research is needed and there are limitations to vitamin D supplementation, vitamin D as a whole may play a significant role in the dynamics of hemorrhagic stroke. Further research should focus on expanding our understanding of the neuroprotective capacity and mechanisms of vitamin D, as well as how vitamin D supplementation could serve as an effective course of treatment of hemorrhagic strokes.

The future is bright: Biofortification of common foods can improve vitamin D status

Vitamin D deficiency is a global concern, linked to suboptimal musculoskeletal health and immune function, with status inadequacies owing to variations in UV dependent cutaneous synthesis and limited natural dietary sources. Endogenous biofortification, alongside traditional fortification and supplement usage is urgently needed to address this deficit. Evidence reviewed in the current article clearly demonstrates that feed modification and UV radiation, either independently or used in combination, effectively increases vitamin D content of primary produce or ingredients, albeit in the limited range of food vehicles tested to date (beef/pork/chicken/eggs/fish/bread/mushrooms). Fewer human trials have confirmed that consumption of these biofortified foods can increase circulating 25-hydroxyvitamin D [25(OH)D] concentrations (n = 10), which is of particular importance to avoid vitamin D status declining to nadir during wintertime. Meat is an unexplored yet plausible food vehicle for vitamin D biofortification, owing, at least in part, to its ubiquitous consumption pattern. Consumption of PUFA-enriched meat in human trials demonstrates efficacy (n = 4), lighting the way for exploration of vitamin D-biofortified meats to enhance consumer vitamin D status. Response to vitamin D-biofortified foods varies by food matrix, with vitamin D₃-enriched animal-based foods observing the greatest effect in maintaining or elevating 25(OH)D concentrations. Generally, the efficacy of biofortification appears to vary dependent upon vitamer selected for animal feed supplementation (vitamin D₂ or D₃, or 25(OH)D), baseline participant status and the bioaccessibility from the food matrix. Further research in the form of robust human clinical trials are required to explore the contribution of biofortified foods to vitamin D status.

The Safety of a Vegan Diet During Pregnancy

There is an increasing number of people who go vegetarian. Some young parents also switch to this diet. The safety of vegetarian diets, especially vegan diets, is very important, especially during pregnancy. Unfortunately, reference publications do not provide coherent data on the safety of vegetarian diets during pregnancy. On the one hand, the vegan diet has advantages because it reduces the risk of heart disease and gestational diabetes. On the other hand, vegetarians/vegans should be aware of potential deficiencies of some nutrients (iron, zinc, vitamin B12, vitamin D, omega-3 fatty acids, calcium, iodine) and the clinical consequences for the fetus. For example, iron deficiency may affect cognitive abilities, behavior, intelligence and increase the risk of preterm birth and low birth weight of infants. Plant food contains non-haem iron with variable absorption. Therefore, the vegan diet should include nutrients increasing the bioavailability of iron, e.g. ascorbic acid, carotene and retinol. Due to the fact that animal food is the main source of vitamin B12, vegans are at a very high risk of vitamin B12 deficiency, which will affect the infant’s weight at birth. Low level of vitamin D, which is prevalent in animal food, is the most common deficiency among vegans and lacto-ovo vegetarians. This vitamin prevents gestational diabetes, reduces insulin resistance and guarantees normal function of the musculoskeletal system. Zinc deficiency during pregnancy may lead to preterm birth, neural tube defects or even miscarriage. In view of the clinical consequences of potential deficiencies of nutrients, the vegetarian/vegan diet should be well balanced.

Immunomodulatory Effects of Vitamin D Supplementation in a Deficient Population

In addition to its canonical functions, vitamin D has been proposed to be an important mediator of the immune system. Despite ample sunshine, vitamin D deficiency is prevalent (>80%) in the Middle East, resulting in a high rate of supplementation. However, the underlying molecular mechanisms of the specific regimen prescribed and the potential factors affecting an individual's response to vitamin D supplementation are not well characterized. Our objective is to describe the changes in the blood transcriptome and explore the potential mechanisms associated with vitamin D3 supplementation in one hundred vitamin D-deficient women who were given a weekly oral dose (50,000 IU) of vitamin D3 for three months. A high-throughput targeted PCR, composed of 264 genes representing the important blood transcriptomic fingerprints of health and disease states, was performed on pre and post-supplementation blood samples to profile the molecular response to vitamin D3. We identified 54 differentially expressed genes that were strongly modulated by vitamin D3 supplementation. Network analyses showed significant changes in the immune-related pathways such as TLR4/CD14 and IFN receptors, and catabolic processes related to NF-kB, which were subsequently confirmed by gene ontology enrichment analyses. We proposed a model for vitamin D3 response based on the expression changes of molecules involved in the receptor-mediated intra-cellular signaling pathways and the ensuing predicted effects on cytokine production. Overall, vitamin D3 has a strong effect on the immune system, G-coupled protein receptor signaling, and the ubiquitin system. We highlighted the major molecular changes and biological processes induced by vitamin D3, which will help to further investigate the effectiveness of vitamin D3 supplementation among individuals in the Middle East as well as other regions.

Effect of low-fat dairy products fortified with 1500IU nano encapsulated vitamin D3 on cardiometabolic indicators in adults with abdominal obesity: a total blinded randomized controlled trial

BACKGROUND & AIMS

Vitamin D deficiency is widespread worldwide. In this study, we aimed to evaluate the effect of a nano encapsulated form of vitamin D used for fortifying low-fat dairy products (milk and yogurt) on anthropometric indices, glycemic status, and lipid profile in subjects with abdominal obesity.

METHODS

In a totally (quadruple) blinded, randomized, and parallel-controlled trial, 306 individuals with abdominal obesity were randomly allocated to one of four groups: fortified low-fat yogurt (FY, 1500 IU nano encapsulated vitamin D₃ per 150 g/d), non-fortified low-fat yogurt (nFY), fortified low-fat milk (FM, 1500 IU nano encapsulated vitamin D₃ per 200 g/d), non-fortified low-fat milk (nFM), for 10 weeks (nFM and nFY, were considered as the control groups). Anthropometric and biochemical parameters were measured at baseline and after a ten-week trial in Mashhad, Iran.

RESULTS

After the ten-week intervention, we found a significant increase in serum concentration of 25(OH)D in both the FM and FY groups compared to the respective control groups (19.10 ± 5.69 ng/mL and 20.88 ± 5.76 ng/mL respectively, p < .001). We observed a significant reduction in weight to hip ratio (p = .04) and a significant improvement in triglyceride (p < .001) and HDL-C (p = .01) only in FM group compared to nFM group. Also, we found a significant reduction in fasting serum insulin (p < .001), and a significant improvement of HOMA-IR (p < .001) and QUICKI (p < .001) in both intervention groups compared to their placebos.

CONCLUSIONS

An intake of fortified dairy products containing nano-encapsulated vitamin D₃ was associated with an improvement in some measures of anthropometric indices, glucose homeostasis, and lipid profiles, particularly in individuals receiving fortified milk. Hence, along with other benefits, fortification of dairy products with vitamin D may be an effective approach to improve some cardiometabolic indicators, such as insulin resistance.

TRIAL REGISTRATION NUMBER

IRCT20101130005280N27.

Protective effect of nano vitamin D against fatty degeneration in submandibular and sublingual salivary glands: A histological and ultrastructural study

BACKGROUND

Poor nutritional habits and a low level of physical activity are associated with obesity, leading to increased caloric and fat intakes. A high-fat diet can significantly impact oral health through the accumulation of lipids in the salivary glands, which ultimately affect salivary gland function. Recently, an increasing number of supplement nano-formulations, such as nano vitamin D, have become available. However, only few studies have explored the effects of nano vitamin D on the maintenance of oral health.

OBJECTIVE

This study aimed to compare the histological effects of nano vitamin D to those of regular vitamin D on fatty degeneration in submandibular and sublingual salivary glands using a rat model.

METHODS

Twenty-four adult male albino Sprague-Dawley rats were divided into the following groups: untreated group, high-fat diet group, high-fat diet and regular vitamin D group, and high-fat diet and nano vitamin group.Thereafter, samples of the submandibular and sublingual salivary glands were dissected for histological and electron microscopic studies. Morphometric digital image analysis was used to quantitatively measure the changes in the size and number of acini and secretory granules.

RESULTS

Regular vitamin D had a partial protective effect. However, vitamin D could fully restore cellular structures to their normal state, thereby protecting against fatty degeneration of the salivary tissue and immune cell infiltration, particularly in the submandibular serous tissue. Nano vitamin D was more efficacious than regular vitamin D at restoring the number and size of submandibular serous secretory granules.

CONCLUSION

Employing nano vitamin D as a supplement to high-fat diets could protect against high-fat diet-induced salivary gland damage in rats.

Effects of vitamin D3 on glucose metabolism in patients with severe osteoarthritis: A randomized double-blind trial comparing daily 2000 with 800 IU vitamin D3

AIM

To investigate the effect of daily 800 versus 2000 IU of vitamin D3 supplementation over 24 months on glycaemic control in older adults after unilateral knee replacement.

MATERIALS AND METHODS

The Zurich Multiple Endpoint Vitamin D Trial in Knee OA Patients was a randomized, double-blind trial conducted from 2008 to 2014 in Zurich, Switzerland. Participants were randomly allocated to 800 or 2000 IU vitamin D3 daily for 24 months. This study investigates the predefined secondary endpoints of fasting blood glucose (FBG) and homeostatic model assessment for insulin resistance (HOMA-IR) using linear mixed models adjusted for age, sex, baseline vitamin D deficiency and body mass index.

RESULTS

A total of 251 participants (age 70.2 ± 6.5 years; 55.4% women; 39% impaired glucose tolerance, mean 25-hydroxyvitamin D 27.48 ± 12.48 ng/mL, mean FBG 5.49 ± 0.71 mmol/L) were included in this analysis. There was no significant difference in FBG between the group receiving 800 versus 2000 IU after 2 years with a least square mean (95% CI) of 5.32 (5.19; 5.44) versus 5.39 (5.27; 5.51) mmol/L (p_treat = .130) and no difference in HOMA-IR (0.44 [0.37; 0.52] vs. 0.49 [0.41; 0.58]; p_treat = .162), respectively. However, FBG decreased significantly over time independent of vitamin D3 dose (800 IU: 5.54 [5.42; 5.66] to 5.32 [5.19; 5.44], p_time < .001; 2000 IU: 5.5 [5.38; 5.62] to 5.39 [5.27; 5.51] mmol/L, p_time = .019).

CONCLUSIONS

There was no clinically meaningful difference between 800 and 2000 IU of vitamin D3 over 2 years in FBG or HOMA-IR in community-dwelling older adults. Glycaemic outcomes improved in both groups.

Vitamin D and Allergy Susceptibility during Gestation and Early Life

Worldwide, the prevalence of allergies in young children, but also vitamin D deficiency during pregnancy and in newborns is rising. Vitamin D modulates the development and activity of the immune system and a low vitamin D status during pregnancy and in early life might be associated with an increased risk to develop an allergy during early childhood. This review studies the effects of vitamin D during gestation and early life, on allergy susceptibility in infants. The bioactive form of vitamin D, 1,25(OH)2D, inhibits maturation and results in immature dendritic cells that cause a decreased differentiation of naive T cells into effector T cells. Nevertheless, the development of regulatory T cells and the production of interleukin-10 was increased. Consequently, a more tolerogenic immune response developed against antigens. Secondly, binding of 1,25(OH)2D to epithelial cells induces the expression of tight junction proteins resulting in enhanced epithelial barrier function. Thirdly, 1,25(OH)2D increased the expression of anti-microbial peptides by epithelial cells that also promoted the defense mechanism against pathogens, by preventing an invasive penetration of pathogens. Immune intervention by vitamin D supplementation can mitigate the disease burden from asthma and allergy. In conclusion, our review indicates that a sufficient vitamin D status during gestation and early life can lower the susceptibility to develop an allergy in infants although there remains a need for more causal evidence.

Fate of β-Carotene within Loaded Delivery Systems in Food: State of Knowledge

Nanotechnology has opened new opportunities for delivering bioactive agents. Their physiochemical characteristics, i.e., small size, high surface area, unique composition, biocompatibility and biodegradability, make these nanomaterials an attractive tool for β-carotene delivery. Delivering β-carotene through nanoparticles does not only improve its bioavailability/bioaccumulation in target tissues, but also lessens its sensitivity against environmental factors during processing. Regardless of these benefits, nanocarriers have some limitations, such as variations in sensory quality, modification of the food matrix, increasing costs, as well as limited consumer acceptance and regulatory challenges. This research area has rapidly evolved, with a plethora of innovative nanoengineered materials now being in use, including micelles, nano/microemulsions, liposomes, niosomes, solidlipid nanoparticles, nanostructured lipids and nanostructured carriers. These nanodelivery systems make conventional delivery systems appear archaic and promise better solubilization, protection during processing, improved shelf-life, higher bioavailability as well as controlled and targeted release. This review provides information on the state of knowledge on β-carotene nanodelivery systems adopted for developing functional foods, depicting their classifications, compositions, preparation methods, challenges, release and absorption of β-carotene in the gastrointestinal tract (GIT) and possible risks and future prospects.

Ultrasonic microencapsulation of oil-soluble vitamins by hen egg white and green tea for fortification of food

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Highly stable vitamin loaded microcapsules are synthesised by ultrasound.

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Egg white proteins provide robust shells to protect vitamins from degradation.

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External green tea/iron coating imparts UV filtering property to microcapsules.

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Microcapsules maintain structural integrity during food fortification.

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In-vitro digestion model shows the effective release of the encapsulated vitamin.

We report the microencapsulation of oil soluble vitamins (A, D and E) using a one pot ultrasonic process and raw egg white proteins as a shell material. Green tea catechin/iron complex coating method was further developed to impart UV filtering property to the microcapsules in order to protect the encapsulated nutrients from photodegradation. The microcapsules showed antibacterial properties and long shelf-life. The encapsulated vitamins were protected from degradation upon heating, UV irradiation, simulated storage/transit and cooking processes. The in-vitro digestion study showed that functional vitamin D can be potentially released in the gastrointestinal tract improving vitamin D availability by more than 2-fold compared to the free vitamin. The vitamin D microcapsules were highly stable and maintained their microstructures once incorporated into staple food products. The low-cost egg white shell encapsulated vitamins can improve the nutritional value of staple food products to combat maternal and child malnutrition.

Immunosecurity: immunomodulants enhance immune responses in chickens

The global population has increased with swift urbanization in developing countries, and it is likely to result in a high demand for animal-derived protein-rich foods. Animal farming has been constantly affected by various stressful conditions, which can be categorized into physical, environmental, nutritional, and biological factors. Such conditions could be exacerbated by banning on the use of antibiotics as a growth promoter together with a pandemic situation including, but not limited to, African swine fever, avian influenza, and foot-and-mouth disease. To alleviate these pervasive tension, various immunomodulants have been suggested as alternatives for antibiotics. Various studies have investigated how stressors (i.e., imbalanced nutrition, dysbiosis, and disease) could negatively affect nutritional physiology in chickens. Importantly, the immune system is critical for host protective activity against pathogens, but at the same time excessive immune responses negatively affect its productivity. Yet, comprehensive review articles addressing the impact of such stress factors on the immune system of chickens are scarce. In this review, we categorize these stressors and their effects on the immune system of chickens and attempt to provide immunomodulants which can be a solution to the aforementioned problems facing the chicken industry.

Fruits and Vegetables in the Management of Underlying Conditions for COVID-19 High-Risk Groups

SARS-CoV-2 or COVID-19 is a novel coronavirus, which is the cause of the current pandemic with 107,411,561 infections and 2,351,195 death worldwide so far. There are multiple symptoms that are linked with the infection of COVID-19 such as coughing, shortness of breath, congestion together with fatigue, fever, loss of taste or smell, headaches, diarrhea, vomiting, and loss of appetite. The lack of or early stage of development of a cure for COVID-19 illness, there is need for insuring the best possible position of health to be able to fight the virus naturally through a robust immune system to limit severe complication. In this article, we have discussed the role of fruits and vegetables consumption to boost the immune system and major emphasis has been given to high risk group. We have taken into consideration a number of underlying conditions such as people with cardiovascular diseases, obesity, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, hemoglobin disorder such as sickle cell disease, weakened immune system due to organ transplant. Furthermore, factors to improve the immune system, risks associated with quarantine and lifestyle and food handling during COVID-19 has been discussed.

Nutritional and health factors affecting the bioavailability of calcium: a narrative review

Calcium is responsible for the effectiveness of various processes, and its supply in the diet is necessary for the normal function of the human body. Apart from being an important component of the skeleton, calcium also helps maintain the structure of cell organelles and regulates intracellular and extracellular fluid homeostasis. This review presents the nutritional and health factors that affect the bioavailability of calcium. Physiological conditions and factors such as pregnancy, infancy, menopause, old age, hormones, growth factors associated with calcium metabolism, diseases limiting its absorption, and intestinal microbiota are distinguished among endogenous factors. Although the calcium supply in the body is genetically conditioned and specific to each person, its qualitative and quantitative composition can be modified by external factors. The exogenous factors include dietary modifications with particular nutrients and pharmacological treatment. Adequate calcium levels increase bone protection and prevent osteoporosis, a disease involving low mineral bone mass.

Joint position statement on management of patient with osteoporosis during COVID-19 contingency from the AMMOM, CONAMEGER, FELAEN, FEMECOG, FEMECOT, and ICAAFYD

Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. This joint position statement of Latin American Medical Societies provides an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis.

BACKGROUND

Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. Characterized by high contagiousness, significative morbidity, and mortality in a segment of those infected, it has overwhelmed health services and forced to redirect resources to the emergency while impacting the attention of acute non-COVID-19 and many chronic conditions.

OBJECTIVE

The objective of this study is to provide an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis.

METHODS

A task force, of bone specialists with a wide range of disciplines in the field of osteoporosis and fragility fracture, was convened with the representation of several professional associations, namely, the Mexican Association of Bone and Mineral Metabolism (AMMOM), the National College of Geriatric Medicine (CONAMEGER), the Latin American Federation of Endocrinology (FELAEN), the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG), the Mexican Federation of Colleges of Orthopedics and Traumatology (FEMECOT), and the Institute of Applied Sciences for Physical Activity and Sports of the University of Guadalajara (ICAAFYD). Clinical evidence was collated, and an evidence report was rapidly generated and disseminated. After finding the gaps in the available evidence, a consensus opinion of experts was made. The resulting draft was reviewed and modified accordingly, in 4 rounds, by the participants.

RESULTS

The task force approved the initial guidance statements, with moderate and high consensus. These were combined, resulting in the final guidance statements on the (1) evaluation of fracture risk; (2) stratification of risk priorities; (3) indications of bone density scans and lab tests; (4) initiation and continuation of pharmacologic therapy; (5) interruptions of therapy; (6) treatment of patients with incident fracture; (7) physical therapy and fall prevention; and (8) nutritional interventions.

CONCLUSION

These guidance statements are provided to promote optimal care to patients at risk for osteoporosis and fracture, during the current COVID-19 pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document" and future updates are anticipated.

The potential role of vitamin D supplementation as a gut microbiota modifier in healthy individuals

Vitamin D deficiency affects approximately 80% of individuals in some countries and has been linked with gut dysbiosis and inflammation. While the benefits of vitamin D supplementation on the gut microbiota have been studied in patients with chronic diseases, its effects on the microbiota of otherwise healthy individuals is unclear. Moreover, whether effects on the microbiota can explain some of the marked inter-individual variation in responsiveness to vitamin D supplementation is unknown. Here, we administered vitamin D to 80 otherwise healthy vitamin D-deficient women, measuring serum 25(OH) D levels in blood and characterizing their gut microbiota pre- and post- supplementation using 16S rRNA gene sequencing. Vitamin D supplementation significantly increased gut microbial diversity. Specifically, the Bacteroidetes to Firmicutes ratio increased, along with the abundance of the health-promoting probiotic taxa Akkermansia and Bifidobacterium. Significant variations in the two-dominant genera, Bacteroides and Prevotella, indicated a variation in enterotypes following supplementation. Comparing supplementation responders and non-responders we found more pronounced changes in abundance of major phyla in responders, and a significant decrease in Bacteroides acidifaciens in non-responders. Altogether, our study highlights the positive impact of vitamin D supplementation on the gut microbiota and the potential for the microbial gut signature to affect vitamin D response.

Trans-Resveratrol Oral Bioavailability in Humans Using LipiSperse™ Dispersion Technology

Resveratrol is a naturally produced compound that has been well researched for its potential health benefits. The primary hindrance towards resveratrol’s therapeutic efficacy is its traditionally poor oral bioavailability. LipiSperse^® is a novel delivery system designed to increase the dispersion of lipophilic ingredients, like resveratrol, in aqueous environments. This single-dose, double-blind, randomized study compared the pharmacokinetics of a commercially available resveratrol with (Veri-Sperse^®) and without (Veri-te) the LipiSperse^® delivery complex. Healthy adults randomly received a single dose of either 150 Veri-te, 75 Veri-Sperse^®, or 150 mg Veri-Sperse^®. Venous blood samples were taken prior to dosing in a fasted state and at 0.5, 1, 2, 3, 4, 5, 6, 8 and 24 h post supplementation. Plasma trans-resveratrol conjugates were measured by liquid-chromatography tandem mass spectrometry (LC-MS/MS). The area under the curve (AUC) (0–24 h), maximum concentration (C_max), and time of maximum concentration (T_max) of plasma conjugates were calculated. The 150 mg dose of Veri-Sperse^® had a 2-fold increase in absorption (AUC) and a 3-fold increase in C_max of trans-resveratrol conjugates compared to 150 mg Veri-te. There was no statistical difference between 75 Veri-Sperse and 150 mg Veri-te for AUC or C_max of resveratrol conjugates. These findings provide support for the use of LipiSperse^® to improve absorption of resveratrol.

The impact of vitamin D supplementation as an adjuvant therapy on clinical outcomes in patients with severe atopic dermatitis: A randomized controlled trial

Vitamin D supplementation with standard treatment yielded positive clinical outcomes in mild and moderate atopic dermatitis; however, the potential benefit of vitamin D in severe cases remains unclear. This study aimed to evaluate the impact of vitamin D supplementation on response to standard treatment in pediatrics with severe atopic dermatitis. The patients were randomized to receive either vitamin D 3 1600 IU/day or placebo, plus baseline therapy of topical 1% hydrocortisone cream twice daily for 12 weeks. The primary endpoints were the change in mean Eczema Area and Severity Index (EASI) score at the end of the study and the mean percent change in EASI score from baseline to week 12. Eighty-six subjects completed the study. The treated group achieved a significant higher level of 25 hydroxy vitamin D (P < .001) compared to control group at week 12. The mean EASI score was significantly lower in the treatment group compared to placebo group (P = .035). The percent change in EASI score from baseline differed significantly between the supplementation (56.44 ± 29.33) and placebo (42.09 ± 19.22) groups after intervention (P = .039). Vitamin D supplementation could be an effective adjuvant treatment that improves the clinical outcomes in severe atopic dermatitis.

Factors affecting the fate of β-carotene in the human gastrointestinal tract: A narrative review

Carotenoids and their metabolites play crucial roles in human health such as in immunity, cell differentiation, embryonic development, maintenance of plasma membrane integrity, and gastrointestinal functions, in addition to counteracting night blindness and other eye-related diseases. However, carotenoid bioavailability is highly variable and often low. The bioavailability of β-carotene, among the most frequently consumed carotenoid from the diet, is determined by food matrix related factors such as carotenoid dose, its location in food the matrix, the physical state in food, the presence of other food compounds in the matrix such as dietary fiber, dietary lipids, other micronutrients present such as minerals, and food processing, influencing also the size of food particles, and the presence of absorption inhibitors (fat replacers and anti-obesity drugs) or enhancers (nano-/micro-formulations). However, also host-related factors such as physiochemical interactions by gastrointestinal secretions (enzyme and salts) and other host-related factors such as surgery, age, disease, obesity, and genetic variations have shown to play a role. This review contributes to the knowledge regarding factors affecting the bioavailability of β-carotene (food and host-relegated), as well as highlights in vitro models employed to evaluate β-carotene bioavailability aspects.

Nutraceutical nanodelivery; an insight into the bioaccessibility/bioavailability of different bioactive compounds loaded within nanocarriers

Nanofoods is a current concept that is based on the application of nanotechnologies in the preparation of safe foods, with superior nutritional and sensory characteristics, and capable of providing multiple health benefits. In line with the principles of this concept, food scientists have focused on developing new types of nano biosystems that can contribute to increasing the bioavailability of bioactive compounds used in food fortification. Numerous research teams have investigated the main factors limiting oral bioavailability including: bioaccessibility, absorption and transformation of bioactive compounds and bioactive-loaded nanocarriers. The physicochemical processes involved in the factors limiting oral bioavailability have been extensively studied, such asthe release, solubility and interaction of bioactive compounds and nanocarriers during food digestion, transport mechanisms of bioactive compounds and nanoparticles through intestinal epithelial cells as well as the chemical and biochemical transformations in phase I and phase II reactions. In this comprehensive review, the physicochemical processes involved in the bioaccessibility/bioavailability of different encapsulated bioactive compounds, that play an important role in human health, will be explained including polyphenols, phytosterols, carotenoids, vitamins and minerals. In particular, the mechanisms involved in the cellular uptake of bioactive-loaded nanocarriers including transcellular transport (diffusion, endocytosis, pinocytosis, transcytosis, phagocytosis), paracellular transport (through the "tight junctions" between epithelial cells), and the active transport of bioactive compounds under the action of membrane transporters are highlighted.

Vitamin D microencapsulation and fortification: Trends and technologies

Today, as per the latest medical reports available, majority of the population throughout globe is facing vitamin D (Vit D) deficiency. Even in sub-tropical countries like India and many others Vit D deficiency is highly prevalent despite the exuberant available sunshine (a major source of Vit D) throughtout the year. The reason could be attributed to an array of factors including socioeconomical, cultural and religious. Further, other than the sunlight, there are very limited sources of Vit D to fulfil the recommended dietary allowance of Vit D (RDA: 400-800 IU per day). A large proportion of Vit D is lost during food processing and storage due to environmental stress conditions such as temperature, pH, salt, oxygen and light. Vita D, an important micronutrient, is essentially required for the prevention of disorders such as neurodegenerative diseases, cardiovascular diseases, cancer etc. in addition to its traditional role in bone metabolism. Therefore, in order to meet the daily requirements of Vit D for human body, WHO has recognized fortification as the most efficient and safest method to address malnutrition. But there are innumerable chellenges involved during food fortification using Vit D as fortificants such as homogeneity into the food matrix, physico-chemical/photochemical degradation, loss during processing and storage, interactions with other components of food matrix resulting into change in taste, texture and appearance thus affecting acceptability, palatability and marketability. Fortification of Vit D into food products especially the ones which have an aqueous portion, is not simple for food technologist. Recent advances in nanotechnology offer various microencapsulation techniques such as liposome, solid-lipid particles, nanostructured lipid carriers, emulsion, spray drying etc. which have been used to design efficient nanomaterials with desired functionality and have great potential for fortification of fortificants like Vit D. The present review is an undate on Vit D, in light of its fortification level, RDA, factors affecting its bioavailability and various microencapsulation techniques adopted to develop Vit D-nanomaterials and their fate in food fortification.

A Critical Appraisal of Strategies to Optimize Vitamin D Status in Germany, a Population with a Western Diet

During the last decade, our scientific knowledge of the pleiotropic biological effects of vitamin D metabolites and their relevance to human health has expanded widely. Beyond the well-known key role of vitamin D in calcium homeostasis and bone health, it has been shown that vitamin D deficiency is associated with a broad variety of independent diseases, including several types of cancer, and with increased overall mortality. Moreover, recent findings have demonstrated biological effects of the vitamin D endocrine system that are not mediated via activation of the classical nuclear vitamin D receptor (VDR) by binding with high affinity to its corresponding ligand, the biologically active vitamin D metabolite 1,25-dihydroxyvitamin D (1,25(OH)₂D). In contrast, many of these new biological effects of vitamin D compounds, including regulation of the circadian clock and many metabolic functions, are mediated by other vitamin D metabolites, including 20-hydroxyvitamin D and 20,23-dihydroxyvitamin D, and involve their binding to the aryl hydrocarbon receptor (AhR) and retinoid-orphan receptor (ROR). In most populations, including the German population, UVB-induced cutaneous vitamin D production is the main source for fulfilling the human body’s requirements of vitamin D. However, this causes a dilemma because solar or artificial UVR exposure is associated with skin cancer risk. In addition to UVB-induced vitamin D production in skin, in humans, there are two other possible sources of vitamin D: from diet and supplements. However, only a few natural foods contain substantial amounts of vitamin D, and in most populations, the dietary source of vitamin D cannot fulfill the body´s requirements. Because an increasing body of evidence has convincingly demonstrated that vitamin D deficiency is very common worldwide, it is the aim of this paper to (i) give an update of the vitamin D status in a population with a western diet, namely, the German population, and to (ii) develop strategies to optimize the vitamin D supply that consider both the advantages as well as the disadvantages/risks of different approaches, including increasing vitamin D status by dietary intake, by supplements, or by UVB-induced cutaneous synthesis of vitamin D.

GutSelf: Interindividual Variability in the Processing of Dietary Compounds by the Human Gastrointestinal Tract

Nutritional research is currently entering the field of personalized nutrition, to a large extent driven by major technological breakthroughs in analytical sciences and biocomputing. An efficient launching of the personalized approach depends on the ability of researchers to comprehensively monitor and characterize interindividual variability in the activity of the human gastrointestinal tract. This information is currently not available in such a form. This review therefore aims at identifying and discussing published data, providing evidence on interindividual variability in the processing of the major nutrients, i.e., protein, fat, carbohydrates, vitamins, and minerals, along the gastrointestinal tract, including oral processing, intestinal digestion, and absorption. Although interindividual variability is not a primary endpoint of most studies identified, a significant number of publications provides a wealth of information on this topic for each category of nutrients. This knowledge remains fragmented, however, and understanding the clinical relevance of most of the interindividual responses to food ingestion described in this review remains unclear. In that regard, this review has identified a gap and sets the base for future research addressing the issue of the interindividual variability in the response of the human organism to the ingestion of foods.

A phase inversion based nanoemulsion fabrication process to encapsulate vitamin D3 for food applications

A phase inversion based nanoemulsion fabrication process was developed to encapsulate vitamin D₃ by blending caprylic-/capric triglyceride (CCTG), Leciva S70, Kolliphor® HS 15, vitamin D₃ and aqueous phase (sodium chloride solution). In order to find out nanoparticle formation zone (NFZ), a ternary diagram was plotted with 41 possible combinations of three components CCTG, Kolliphor® HS 15 and aqueous phase. Out of forty one, only twelve combinations resulted in formation of stable nanoemulsion where the composition varied between 10%-40% (v/v), 10%-25% (v/v) and 35%-80% (v/v) for Kolliphor, CCTG and water respectively. Further, these 12 nanoemulsions were investigated for their particle size, zeta potential, emulsion stability, encapsulation efficiency and release kinetics (simulated digestion) of vitamin D. The nanoemulsion (NE-20) fabricated with 30% (v/v) Kolliphor, 20% (v/v) CCTG and 50% (v/v) aqueous phase was found to be the most suitable with respected to zeta potential, emulsion stability and encapsulation efficiency and also demonstrated high bioavailability of vitamin D as compared to other combinations and hence was selected for further physiochemical studies. The selected nanoemulsion was also investigated for particle size and zeta potential and stability of vitamin D₃ retention under different environmental stress conditions (i) temperature and humidity: (a) accelerated condition: 45 ± 2 °C and RH 75 ± 5%, (b) ambient condition: 25 ± 3 °C and RH 65 ± 5% and (c) refrigerated condition: 6 ± 2 °C and RH 55 ± 5% (ii) pH (3-7) under refrigerated condition and (iii) ionic strength: NaCl concentration (0 mM, 250 mM, 500 mM and 750 mM) under crefrigerated condition. Fourier transform infrared spectroscopy and High Perfomance Liquid Chromatograpy technique were used to study physico-chemical stability of encapsulated vitamin D₃ in the developed nanoemulsion. The sensory evaluation also indicated the acceptability of the selected nanoemulsion the purpose of fortification for beverages.

Bioequivalence Studies of Vitamin D Gummies and Tablets in Healthy Adults: Results of a Cross-Over Study

The objective of this investigation was to compare bioavailability between single oral dose Vitamin D₃ (vitD₃) gummies vs. tablets in healthy adults. An initial crossover, randomized clinical trial involving healthy adults (n = 9) was conducted followed by a larger, confirmatory study (n = 31). Healthy participants aged 18–45 years with body mass index (BMI) 18–30 without anemia or vitD deficiency were randomized to receive 20,000 international units (IU) vitD₃ as single dose gummies or tablets with serial samples obtained to measure plasma vitD₃ at baseline, 3, 6, 10, 24, and 48 h followed by a 2-week washout period. The same participants then crossed over to receive 20,000 IU vitD₃ in the form not previously given, with sampling at the same time points. Deidentified blood samples were analyzed for vitD₃ concentration by liquid chromatography (LC)-mass spectroscopy. In Study 1, results suggested bioavailability was greater with gummies compared with tablets, (effect size 1.08 at 24 h). In Study 2, the area under the concentration curve (AUC) was higher with gummies than tablets (gummy mean (95% CI): 1474 ng·/mL (1393–1555); tablet mean (95% CI): 774 ng·h/mL (693–855), p < 0.0001). Average peak blood concentration (C_max) values were significantly higher with gummies (gummy: 47.3 ng/mL; tablet: 23.4 ng/mL; p < 0.0001). VitD₃ gummies had greater bioavailability than tablets with higher vitD concentrations over time, which may have implications for achieving vitD sufficiency.