Leucocyte-vitamin-C content and clinical signs in the elderly

Estimating ascorbic acid requirements for cigarette smokers

This analysis of a large, population based, cross-sectional survey demonstrates that the association of smoking with decreased serum ascorbic acid (AA) levels is independent of the reduced AA intake found in smokers. Smokers have a threefold higher incidence of low serum AA levels (< or = 11 mumol/L) which could place them at increased risk for the clinical manifestations of AA deficiency. Smokers not taking vitamin supplements who consumed less than 15 servings weekly of fruits and vegetables were especially prone to have serum AA levels less than 11 mumol/L. An AA intake of > or = 200 mg was necessary to provide smokers with equivalent protection from hypovitaminosis AA as had nonsmokers whose AA intake exceeded the recommended dietary allowance (RDA [60 mg]). This level of dietary AA intake is considerably higher than the newly increased RDA for smokers of 100 mg. Although the simplest and most direct method to increase the low serum vitamin C levels found in many smokers would be to stop smoking, markedly increasing dietary AA consumption is appropriate when this is unsuccessful. However, if dietary modification fails to sufficiently increase AA intake, then vitamin supplementation may be necessary to significantly reduce the high prevalence of hypovitaminosis AA present in smokers.

Dietary intake and clinical, anthropometric and biochemical indices of malnutrition in elderly demented patients and non-demented subjects

Anthropometric and biochemical indices of nutritional status and weighed dietary intake have been studied in hospitalized patients with senile dementia, demented patients living in the community and age-matched control subjects who were not cognitively impaired. Demented patients were lighter than control subjects, and had a lower body mass index, skinfold thickness, mid-arm circumference and arm muscle bulk. The hospitalized patients were more seriously affected than those living in the community, and body weight was significantly negatively correlated with duration of hospitalization. Over a 6-month period the hospitalized patients showed a further weight loss, while those living in the community did not. Both groups of demented patients had higher intakes of energy, protein, vitamins and minerals than the control subjects. The diet of the hospitalized patients was slightly, but not significantly, superior to that of the patients living in the community. Biochemical evidence of specific vitamin inadequacy was equally prevalent in all three groups of subjects, and there were no significant correlations between the degree of cognitive impairment or behavioural disorder and any of the indices of nutritional state. Clinical signs suggestive of malnutrition were not correlated with either biochemical evidence of deficiency or cognitive impairment and behavioural disturbance.

The influence of smoking on vitamin C status in adults

To further define the relation between smoking and vitamin C status, the dietary and serum vitamin C levels of 11,592 respondents in the second National Health and Nutrition Examination Survey (NHANES II) were analyzed. Smokers of 20 cigarettes daily had the lowest vitamin C dietary intake (79 mg, 95% CI:73, 84) and serum levels (0.82 mg/dl, 95% CI: 0.77, 0.86; 46.6 mumol/L, 95% CI: 43.7, 48.8), while smokers of 1-19 cigarettes daily had decreased vitamin C intake (97 mg; 95% CI: 90, 104 mg) and serum levels (0.97 mg/dl, 95% CI: 0.92, 1.03; 55.1 mumol/L, 95% CI: 52.2, 58.5) compared to respondents who had never smoked (109 mg, 95% CI: 105, 113 and 1.15 mg/dl, 95% CI: 1.11, 1.18; 65.3 mumol/L, 95% CI: 63.0, 67.0, respectively). This inverse association between both intake and serum levels of vitamin C and smoking was independent of age, sex, body weight, race, and alcoholic beverage consumption. Following further adjustment for dietary vitamin C intake, the negative correlation between cigarette smoking and serum vitamin C levels persisted. The risk of severe hypovitaminosis C (serum levels less than or equal to 0.2 mg/dl; 11.4 mumol/L) was increased in smokers, particularly when not accompanied by vitamin supplementation (odds ratio 3.0, 95% CI: 2.5, 3.6). These data suggest that even though smoking adversely affects preferences for vitamin C rich foods, the inverse association between smoking and serum vitamin C levels occurs independently of dietary intake.

Appropriateness of vitamin and mineral prescription orders for residents of health related facilities

A study was made of the medical charts of 433 elderly patients admitted to four Health Related Facilities in upper New York State, to determine whether the respective prescription orders for vitamins and minerals were appropriate to the given diagnoses and, if not, identify the variables correlated with inappropriateness. For 11.1 percent of the patients, vitamins or minerals were prescribed when there was no specific diagnostic indication, or they were not prescribed when the medical diagnosis indicated that they should have been. Women and medicaid patients were more likely than men and self-paying patients to be treated inappropriately with respect to vitamins and minerals, but the differences were not satistically significant.

The effect of vitamin supplementation upon antipyrine metabolism in the elderly

1 Antipyrine plasma half-life and clearance rates were studied in 19 elderly patients shortly after admission to a geriatric ward and again 2 weeks after a course of dietary supplementation with Vitamins A, B complex, C and D. 2 Antipyrine half-life fell and clearance increased in the nine who had sub-clinical evidence of ascorbic acid deficiency. No correlation was found with other indices of nutritional status. 3 Vitamin supplementation in elderly people with no demonstrable deficiencies did not alter the metabolism of antipyrine.

A note on the effect of food restriction on tissue ascorbic acid in guinea-pigs

1. Male, adult guinea-pigs received a scorbutogenic diet and a daily supplement of 1-0 mg ascorbic acid/100 g body-weight. 2. Restriction of food intake for a period of 17 d resulted in a 25% loss in body-weight and a significant reduction in the retention of ascorbic acid by the spleen, liver and adrenal glands.

Ascorbic acid supplementation in the treatment of pressure-sores

In a prospective double-blind controlled trial the effect of large doses of ascorbic acid on the healing of pressure-sores has been assessed. 20 surgical patients were studied, the pressure areas being assessed by serial photography and ulcer tracings. The mean ascorbic-acid levels in treated and non-treated groups one month after the start of treatment were 65.6 and 25.8 mug per 10-8 white blood-cells. In the group treated with ascorbic acid there was a mean reduction in pressure-sore area of 84% after one month compared with 42.7% in the placebo group. These findings are statistically significant (P less than 0.005) and suggest that ascorbic acid may accelerate the healing of pressure-sores.

Ascorbic acid deficiency in malignant diseases: a clinical and biochemical study

In a study of the vitamin C status of 50 patients with malignant disease, 46 had leucocyte levels less than the lower limit of the normal range (18-50,μg/10(8) W.B.C.) and of these 30 had very low levels (< 12.5 μg/10(8) W.B.C.). Physical signs compatible with subclinical scurvy were frequently recorded and there was a significant decrease in capillary fragility in those with the lowest levels. Most patients had an inadequate dietary intake of ascorbic acid-containing foods and this was felt to be the major factor in producing the vitamin depletion.

Relationship between leucocyte and plasma ascorbic acid concentrations

Leucocyte and plasma ascorbic acid values were measured in healthy students, adult factory employees, and old people not receiving supplementary vitamin C and in healthy old people receiving 500 mg of vitamin C daily. Significant positive correlations between leucocyte and plasma ascorbic acid were found in all the groups. The regression lines differed significantly between one another within the sexes, but the pooled lines for each sex did not differ significantly in the unsupplemented groups. The relationship between plasma and leucocyte ascorbic acid values in the supplemented group differed significantly from that in the pooled unsupplemented groups.There was a limited range of variation in leucocyte ascorbic acid values compared with the range in plasma values in the supplemented group, whereas there was a wider range of variation in the leucocyte values in the unsupplemented groups. Leucocytes can therefore achieve a saturation level of ascorbic acid. Measurement of leucocyte ascorbic acid concentrations alone does not provide a reliable guide for the estimation of tissue status of ascorbic acid in normal individuals. Leucocyte concentrations provide a measure of the availability of ascorbic acid for storage, and plasma levels give an indication of its metabolic turnover rate. When these values are related the regression lines provide information about the storage and metabolism of ascorbic acid in normal individuals.

Vitamin C supplementation in the elderly: a 17-month trial in an old persons' home

Seventeen months' supplementation of the diet with vitamin C in elderly residents in an old persons' home failed to show any changes in sublingual lesions, which on histological examination proved to be aneurysmal dilatations of the venules. Nine months' supplementation of 40 to 80 mg. daily of vitamin C was necessary before the white-cell vitamin levels reached that found in younger people. There was a marked individual variation in response.

Hypovitaminosis C and splenic rupture

Two cases of splenic rupture in patients with hypovitaminosis C are reported. In Case 1 the deficiency was dietary in origin; this patient also had pernicious anaemia with an associated thrombocytopenia. These 2 abnormalities are considered significant in predisposing to splenic rupture on minimal trauma. In Case 2, in which the vitamin C deficiency was due to dietary deficiency and to malabsorption following partial gastrectomy, the low leucocyte ascorbic acid was the only abnormality detected, and the splenic rupture was spontaneous. A splenectomy was carried out and at operation there was noted to be persistent oozing of blood from muscle and subcutaneous tissue, and post-operatively, from the wound.

It is suggested that in cases of spontaneous rupture of the spleen, as in any case of unexplained haemorrhage, the diagnosis of scurvy should be considered.

Trial of ascorbic acid in purpura and sublingual haemorrhages

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