Microcirculation, vitamin E and omega 3 fatty acids: an overview

Improvement of accommodation with anti-oxidant supplementation in visual display terminal users

OBJECTIVE

To determine the antioxidant supplementation effect on accommodation among VDT users.

DESIGN

A double blind randomized placebo controlled study. Registered under ClinicalTrials.gov Identifier No. NCT00877201.

PARTICIPANTS AND CONTROLS

Fourty right eyes of 40 healthy VDT users (30 females, 10 males, mean age: 43.8±2.8 years, range: 40-49 years). 20 subjects (15 females, 5 males; mean age: 44.0±2.7 years, range: 40-49 years).

METHODS

Subjects were required to take an antioxidant supplement, 20 age and sex matched subjects (15 females, 5 males; mean age: 43.6±3.1 years, range: 40-49 years) were required to take placebo medication for 4 weeks.

RESULTS

The mean of the change in accommodation power was significantly higher in the group receiving antioxidant supplements (0.20±0.50 Diopter(D)) compared to the placebo group (-0.12±0.48(D)) (p<0.05).

CONCLUSIONS

Antioxidant supplementation was observed to improve accommodation in Japanese Visual Display Terminal (VDT) Users.

Effects of pharmaconutrients on cellular dysfunction and the microcirculation in critical illness

PURPOSE OF REVIEW

A growing body of data has revealed that specific nutrient deficiencies contribute to microvascular and cellular dysfunction following critical illness. Further, targeted administration of these 'pharmaconutrients' may reverse or improve this dysfunction and improve clinical outcome.

RECENT FINDINGS

Specific nutrient therapy with glutamine protects cellular metabolism and vascular function via induction of heat shock proteins, which are key proteins found to be deficient following acute illness. Arginine becomes rapidly deficient following trauma and surgery. This leads to significant immunosuppression, which when treated by arginine administration significantly reduces postoperative infection. Omega-3 fatty acids attenuate the inflammatory response and provide for resolution of ongoing inflammatory injury via production of resolvins/protectins. Antioxidants (vitamin C and selenium) and trace elements (zinc) become rapidly depleted in critical illness and replacement appears vital to ensure optimal cellular and microvascular function. Data on targeted metabolic (mitochondrial) therapies (i.e. co-enzyme Q10) show promise to improve myocardial function following cardiac surgery.

SUMMARY

These specific nutrients have newly discovered vital mechanistic roles in the optimization of cellular and microcirculatory function in critical illness and injury. A growing body of literature is demonstrating that correction of key nutrient deficiencies via therapeutic administration of these pharmaconutrients can improve clinical outcome in critically ill patients.

Immune-modulating enteral formulations: optimum components, appropriate patients, and controversial use of arginine in sepsis

Nutrients have traditionally been viewed as a means to provide basic calories to sustain homeostasis. However, critically ill, surgical, and trauma patients are in a constant dynamic state between systemic inflammatory response (SIRS) and compensatory anti-inflammatory response (CARS). Results from ongoing research strongly support the use of specific nutrients to modulate the immune and/or metabolic response. These agents can now be considered therapeutic tools in the management of complex hypermetabolic diseases. The principle of using nutrients as a therapeutic strategy rather than just as "nutritional support" requires a shift in the current dogma. The most common nutrients found in currently available enteral immune-modulating formulas are omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid), antioxidants, nucleotides, glutamine, and arginine. Multiple individual reports and at least five meta-analyses using combinations of immune-modulating nutrients have reported almost uniform beneficial results. However, certain conflicting hypotheses continue to revolve around the use of arginine in septic patients.

The efficacy of vitamin E against oxidative damage and autoantibody production in systemic lupus erythematosus: a preliminary study

The hypothesis that reactive oxygen species (ROS) modification of DNA is involved in the development of autoantibodies in systemic lupus erythematosus (SLE) is supported by the enhanced reactivity of anti-DNA antibodies to ROS-denatured DNA. We studied the efficacy of vitamin E against both oxidative DNA damage and autoantibody production in SLE. Urinary 8-hydroxydeoxyguanosine (8-OHdG), an indicator of oxidative DNA damage, and the anti-double-stranded DNA (anti-ds DNA) antibody, a predictor of disease activity, were assayed twice, first during the season with the most intense sunlight and then later in the year. Twelve women among 36 outpatients received vitamin E (150 to 300 mg/day) together with prednisolone (PSL). No significant age or daily dose of PSL differences were evident between patient groups. Urinary 8-OHdG in the PSL with vitamin E group (15.0 +/- 10.2 ng/mg during the period of intense sunlight and 11.7 +/- 8.7 ng/mg during the remainder of the year) did not differ significantly from that in the PSL without vitamin E group (20.0 +/- 23.2 and 11.0 +/- 5.9 ng/mg, at these respective times), but the anti-ds DNA antibody titer in the PSL with vitamin E group (17.9 +/- 20.3 IU/l during the period of intense sunlight and 16.3 +/- 19.4 IU/l during the remainder of the year) was significantly lower than that in the PSL without vitamin E group for both sunlight-defined periods (66.3 +/- 76.8 and 55.8 +/- 59.0 IU/l, at these respective times; P < 0.05). The present study suggests that vitamin E can suppress autoantibody production via a mechanism independent of antioxidant activity.