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Qin L, Liu Q, Zhang T, Tang X, Mo X, Liang Y, Wang X, Cao J, Huang C, Lu Y, Zhang Z, Qin J, Cai J. Association Between Combined Polymetallic Exposure and Osteoporosis. Biol Trace Elem Res 2024; 202:3945-3958. [PMID: 38109003 DOI: 10.1007/s12011-023-04002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
Combined polymetallic exposure may be an influential factor in osteoporosis. This study aimed to explore the association between polymetallic combined exposure and osteoporosis. A total of 2115 participants were included. Plasma concentrations of 22 metals were determined by inductively coupled plasma mass spectrometry. Osteoporosis was defined as a T ≤ - 2.5. The least absolute shrinkage and selection operator (LASSO) regression, binary logistics regression, and Bayesian kernel machine regression (BKMR) model were used to explore the association between plasma metals and osteoporosis. LASSO regression showed that 10 metals were associated with osteoporosis in the total population (magnesium, calcium, manganese, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum) and women (magnesium, calcium, molybdenum, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum), and four metals associated with men (magnesium, cobalt, aluminum, iron). Logistics regression showed that in total population, magnesium (ORQ3 = 0.653, 95% CI = 0.446-0.954) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.569, 95% CI = 1.095-2.248, ORQ4 = 1.616, 95% CI = 1.109-2.354) and cadmium (ORQ4 = 1.989, 95% CI = 1.379-2.870) were positively correlated; in women, magnesium (ORQ3 = 0.579, 95% CI = 0.379-0.883) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.563, 95% CI = 1.051-2.326, ORQ4 = 1.543, 95% CI = 1.024-2.326) and cadmium (ORQ3 = 1.482, 95% CI = 1.003-2.191, ORQ4 = 1.740, 95% CI = 1.167-2.596) were positively correlated. BKMR model showed that combined polymetallic exposure had an overall positive effect on osteoporosis, magnesium was negatively associated with osteoporosis, and cadmium, selenium, and aluminum were positively associated with osteoporosis. Metal mixtures in plasma were associated with osteoporosis risk. Magnesium may reduce the risk of osteoporosis, while cadmium, selenium, and aluminum may increase the risk of osteoporosis. Future studies needed to explore correlations and mechanisms.
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Affiliation(s)
- Lidong Qin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Qiumei Liu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Tiantian Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Xu Tang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Xiaoting Mo
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Yujian Liang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Xuexiu Wang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Jiejing Cao
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Chuwu Huang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Yufu Lu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
| | - Zhiyong Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University, Guilin, China
| | - Jian Qin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China.
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, China.
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, Nanning, China.
- Key Laboratory of Longevity and Aging-Related Diseases of Chinese Ministry of Education, Guangxi Medical University, Nanning, China.
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Shuangyong Road 22, Nanning, 530021, Guangxi, China.
- Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Huan Cheng North 2Nd Road 109, Guilin, 541004, Guangxi, China.
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Romanowska H, Bartoszewicz K, Danko M, Wielopolska J, Popińska K, Żydak J, Sibilska M, Borkowska A, Szlagatys-Sidorkiewicz A, Książyk J. Unexpected Serum and Urine Aluminum Concentrations in Pediatric Patients on Home Parenteral Nutrition. Nutrients 2023; 15:3597. [PMID: 37630787 PMCID: PMC10458977 DOI: 10.3390/nu15163597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
The intravenous supply of aluminum (Al) present in parenteral nutrition solutions poses a high risk of the absorption of this element, which can result in metabolic bone disease, anemia, and neurological complications. The aim of this study is to determine the impact of long-term parenteral nutrition (PN) in children on serum Al concentration and its urinary excretion compared to healthy children. We evaluated serum Al concentrations and its urinary excretion in patients enrolled in the Polish home parenteral nutrition (HPN) program between 2004 and 2022. The study group included 83 patients and the control group consisted of 121 healthy children. In children whose PN was started in the neonatal period, we found higher serum Al concentrations and higher urinary Al excretion than in other subjects whose PN was started later. Only 12% of the children on chronic parenteral nutrition had serum Al concentrations of less than 5 μg/L. Healthy children in the control group had higher serum Al concentrations than those in the parenteral nutrition group, which may indicate the influence of one's environment and diet on Al serum levels.
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Affiliation(s)
- Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Klaudia Bartoszewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Mikołaj Danko
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Wielopolska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Katarzyna Popińska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Żydak
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Marta Sibilska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Anna Borkowska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
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3
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Jiang H, Guo J, Li J, Li C, Du W, Canavese F, Baker C, Ying H, Hua J. Artificial Neural Network Modeling to Predict Neonatal Metabolic Bone Disease in the Prenatal and Postnatal Periods. JAMA Netw Open 2023; 6:e2251849. [PMID: 36689226 PMCID: PMC9871802 DOI: 10.1001/jamanetworkopen.2022.51849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Early recognition of metabolic bone disease (MBD) in infants is necessary but difficult; an appropriate tool to screen infants at risk of developing MBD is needed. Objectives To develop a predictive model for neonates at risk for MBD in the prenatal and postnatal periods and detect the pivotal exposed factors in each period. Design, Setting, and Participants A diagnostic study was conducted from January 1, 2012, to December 31, 2021, in Shanghai, China. A total of 10 801 pregnant women (singleton pregnancy, followed up until 1 month after parturition) and their infants (n = 10 801) were included. An artificial neural network (ANN) framework was used to build 5 predictive models with different exposures from prenatal to postnatal periods. The receiver operating characteristic curve was used to evaluate the model performance. The importance of each feature was examined and ranked. Results Of the 10 801 Chinese women who participated in the study (mean [SD] age, 29.7 [3.9] years), 7104 (65.8%) were local residents, 1001 (9.3%) had uterine scarring, and 138 (1.3%) gave birth to an infant with MBD. Among the 5 ANN models, model 1 (significant prenatal and postnatal factors) showed the highest AUC of 0.981 (95% CI, 0.970-0.992), followed by model 5 (postnatal factors; AUC, 0.977; 95% CI, 0.966-0.988), model 4 (all prenatal factors; AUC, 0.850; 95% CI, 0.785-0.915), model 3 (gestational complications or comorbidities and medication use; AUC, 0.808; 95% CI, 0.726-0.891), and model 2 (maternal nutritional conditions; AUC, 0.647; 95% CI, 0.571-0.723). Birth weight, maternal age at pregnancy, and neonatal disorders (anemia, respiratory distress syndrome, and septicemia) were the most important model 1 characteristics for predicting infants at risk of MBD; among these characteristics, extremely low birth weight (importance, 50.5%) was the most powerful factor. The use of magnesium sulfate during pregnancy (model 4: importance, 21.2%) was the most significant predictor of MBD risk in the prenatal period. Conclusions and Relevance In this diagnostic study, ANN appeared to be a simple and efficient tool for identifying neonates at risk for MBD. Combining prenatal and postnatal factors or using postnatal exposures alone provided the most precise prediction. Extremely low birth weight was the most significant predictive factor, whereas magnesium sulfate use during pregnancy could be an important bellwether for MBD before delivery.
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Affiliation(s)
- Honglin Jiang
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jialin Guo
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunlin Li
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
- Faculty of Medicine, Jeanne de Flandre Hospital, Rue Eugène Avinée, Lille, France
| | - Charlie Baker
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Hao Ying
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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4
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Başaran B. Assessment of Aluminum via Baby Foods Consumption in Turkey: Estimated Early-Life Dietary Exposure and Target Hazard Quotient. Biol Trace Elem Res 2022; 200:3892-3901. [PMID: 34661845 DOI: 10.1007/s12011-021-02961-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
This study focuses on infant formulas and baby biscuits, which have an important place in the nutrition of the most vulnerable individuals, namely babies. In this sense, the aluminum levels of 64 different baby foods, retrospectively consumed by 348 babies for dietary recall 24 h, were determined by ICP-MS. Then, the exposure resulting from the consumption of these foods was calculated via a deterministic model, and a risk assessment was made. Aluminum levels of infant formulas and baby biscuits that are of higher values compared to other studies were found in the range of 718-6987 and 1803-15,479 μg/kg, respectively. Aluminum exposure was calculated as 8.02, 7.28, 4.03, and 4.08 μg/kg bw/day in babies aged 0-6, 7-12, 13-24, and 25-36 months, respectively. There is no statistically significant difference between different age groups according to the total aluminum exposure levels. The toxicological contribution of aluminum exposure is quite limited (< 6.0% of PTWI). THQ values were calculated as 10-20 for babies aged 0-36 months. Therefore, THQ values indicate a potential health problem.
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Affiliation(s)
- Burhan Başaran
- Department of Travel, Tourism and Recreation Services, Ardeşen Vocational School, Recep Tayyip Erdogan University, Rize, 53100, Turkey.
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5
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Alasfar RH, Isaifan RJ. Aluminum environmental pollution: the silent killer. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:44587-44597. [PMID: 34196863 PMCID: PMC8364537 DOI: 10.1007/s11356-021-14700-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/31/2021] [Indexed: 04/16/2023]
Abstract
The concern about aluminum (Al) toxicity has been proven in various cases. Some cases are associated with the fact that Al is a neurotoxic substance that has been found in high levels in the brain tissues of Alzheimer's disease (AD), epilepsy, and autism patients. Other cases are related to infants, especially premature infants and ones with renal failure, who are at the risk of developing the central nervous system (CNS) and bone toxicity. This risk is a result of infants' exposure to Al from milk formulas, intravenous-feeding solutions, and possibly from aluminum-containing vaccinations. Furthermore, most antiperspirants contain aluminum compounds that raise human exposure to toxic Al. This review paper is intended to discuss in detail the above concerns associated with aluminum, and hence urges the need for more studies exploring the effects of overexposure to Al and recommending mitigation actions.
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Affiliation(s)
- Reema H Alasfar
- Division of Sustainable Development (DSD), College of Science and Engineering (CSE), Hamad Bin Khalifa University (HBKU)/Qatar Foundation (QF), P.O. Box 5825, Doha, Qatar
| | - Rima J Isaifan
- Division of Sustainable Development (DSD), College of Science and Engineering (CSE), Hamad Bin Khalifa University (HBKU)/Qatar Foundation (QF), P.O. Box 5825, Doha, Qatar.
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Abstract
Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and small-volume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.
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Affiliation(s)
- Mark R Corkins
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
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7
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Taylor MH, Choi D, Fitzpatrick SM, Gunn KN. Characterisation of aluminium release by the enFlow® fluid‐warming system in crystalloids and blood products. Anaesthesia 2019; 74:1374-1380. [DOI: 10.1111/anae.14697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2019] [Indexed: 11/27/2022]
Affiliation(s)
- M. H. Taylor
- Department of Anaesthesia Middlemore Hospital Counties Manukau Health AucklandNew Zealand
| | - D. Choi
- Department of Anaesthesia Middlemore Hospital Counties Manukau Health AucklandNew Zealand
| | | | - K. N. Gunn
- Department of Anaesthesia and Peri‐operative Medicine Auckland District Health Board Auckland New Zealand
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Perl T, Kunze‐Szikszay N, Bräuer A, Quintel M, Röhrig AL, Kerpen K, Telgheder U. Aluminium release by coated and uncoated fluid‐warming devices. Anaesthesia 2019; 74:708-713. [DOI: 10.1111/anae.14601] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- T. Perl
- Department of General, Visceral and Pediatric Surgery University Medical Center Goettingen Germany
| | - N. Kunze‐Szikszay
- Department of Anesthesiology University Medical Center Goettingen Germany
| | - A. Bräuer
- Department of Anesthesiology University Medical Center Goettingen Germany
| | - M. Quintel
- Department of Anesthesiology University Medical Center Goettingen Germany
| | - A. L. Röhrig
- Faculty of Chemistry Departments of Instrumental Analytical Chemistry University Duisburg‐Essen Duisburg Germany
| | - K. Kerpen
- Faculty of Chemistry Departments of Instrumental Analytical Chemistry University Duisburg‐Essen Duisburg Germany
| | - U. Telgheder
- Faculty of Chemistry Departments of Instrumental Analytical Chemistry University Duisburg‐Essen Duisburg Germany
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9
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Hartman C, Shamir R, Simchowitz V, Lohner S, Cai W, Decsi T, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, Darmaun D, Decsi T, Domellöf M, Embleton N, Fewtrell M, Fidler Mis N, Franz A, Goulet O, Hartman C, Hill S, Hojsak I, Iacobelli S, Jochum F, Joosten K, Kolaček S, Koletzko B, Ksiazyk J, Lapillonne A, Lohner S, Mesotten D, Mihályi K, Mihatsch WA, Mimouni F, Mølgaard C, Moltu SJ, Nomayo A, Picaud JC, Prell C, Puntis J, Riskin A, Saenz De Pipaon M, Senterre T, Shamir R, Simchowitz V, Szitanyi P, Tabbers MM, Van Den Akker CH, Van Goudoever JB, Van Kempen A, Verbruggen S, Wu J, Yan W. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications. Clin Nutr 2018; 37:2418-2429. [DOI: 10.1016/j.clnu.2018.06.956] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/30/2022]
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10
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Cheng D, Tang J, Wang X, Zhang X, Wang S. Effect of aluminum (Al) speciation on erythrocytic antioxidant defense process: Correlations between lipid membrane peroxidation and morphological characteristics. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2018; 157:201-206. [PMID: 29625393 DOI: 10.1016/j.ecoenv.2018.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 06/08/2023]
Abstract
Al contamination becomes a growing problem in human society. Accumulation of Al in blood could destroy the structure and disorder function of erythrocyte, and finally cause blood diseases. In the present study, AlCl3 and Al(malt)3 are respectively used in the erythrocyte system, in order to investigate the comparative toxic effect on erythrocyte fragility, the influence on cellular biochemical components and lipid peroxidation level. We find that the osmotic fragility, the number of Heinz bodies, the content of MDA and advanced oxidation protein product of the AlCl3 treated erythrocytes were higher than the Al(malt)3 treated erythrocytes at the same concentrations of Al(Ⅲ). The morphological and membrane protein changes of the AlCl3 treated group show superior to the Al(malt)3 treated group. In summary, we conclude that the comparative effect on the erythrocyte between organic aluminum and inorganic aluminum is significantly different, and the prime comparative difference between the toxic effects of both the compounds is oxidative stress. Further research should focus on in vivo experiments to confirm the differential toxicity and to elucidate the molecular mechanisms underlying Al-induced erythrocyte toxicity in order to prevent hematological disorders.
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Affiliation(s)
- Dai Cheng
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China; State Key Laboratory of Food Nutrition and Safety, College of Food Engineering and Biotechnology, Tianjin University of Science and Technology, Tianjin, China
| | - Jinlei Tang
- State Key Laboratory of Food Nutrition and Safety, College of Food Engineering and Biotechnology, Tianjin University of Science and Technology, Tianjin, China
| | - Xuerui Wang
- State Key Laboratory of Food Nutrition and Safety, College of Food Engineering and Biotechnology, Tianjin University of Science and Technology, Tianjin, China
| | - Xinyu Zhang
- State Key Laboratory of Food Nutrition and Safety, College of Food Engineering and Biotechnology, Tianjin University of Science and Technology, Tianjin, China
| | - Shuo Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
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11
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Bone impairment caused by AlCl3 is associated with activation of the JNK apoptotic pathway mediated by oxidative stress. Food Chem Toxicol 2018; 116:307-314. [DOI: 10.1016/j.fct.2018.04.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 01/30/2023]
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12
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Huston RK, Christensen JM, Alsharhani SM, Mohamed SM, Heisel CF. Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions without Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology. Nutrients 2018; 10:E208. [PMID: 29443921 PMCID: PMC5852784 DOI: 10.3390/nu10020208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022] Open
Abstract
There are no compatibility studies for neonatal parenteral nutrition solutions without cysteine containing calcium chloride or calcium gluconate using light obscuration as recommended by the United States Pharmacopeia (USP). The purpose of this study was to do compatibility testing for solutions containing calcium chloride and calcium gluconate without cysteine. Solutions of TrophAmine and Premasol (2.5% amino acids), containing calcium chloride or calcium gluconate were compounded without cysteine. Solutions were analyzed for particle counts using light obscuration. Maximum concentrations tested were 15 mmol/L of calcium and 12.5 mmol/L of phosphate. If the average particle count of three replicates exceeded USP guidelines, the solution was determined to be incompatible. This study found that 12.5 and 10 mmol/L of calcium and phosphate, respectively, are compatible in neonatal parenteral nutrition solutions compounded with 2.5% amino acids of either TrophAmine or Premasol. There did not appear to be significant differences in compatibility for solutions containing TrophAmine or Premasol when solutions were compounded with either CaCl₂ or CaGlu-Pl. This study presents data in order to evaluate options for adding calcium and phosphate to neonatal parenteral nutrition solutions during shortages of calcium and cysteine.
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Affiliation(s)
- Robert K Huston
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR 97227, USA.
| | - J Mark Christensen
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Sultan M Alsharhani
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Sumeia M Mohamed
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Carl F Heisel
- Neonatal Pharmacy, Randall Children's Hospital at Legacy Emanuel, Portland, OR 97227, USA.
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13
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Fortenberry M, Hernandez L, Morton J. Evaluating Differences in Aluminum Exposure through Parenteral Nutrition in Neonatal Morbidities. Nutrients 2017; 9:nu9111249. [PMID: 29144406 PMCID: PMC5707721 DOI: 10.3390/nu9111249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
Aluminum is a common contaminant in many components of parenteral nutrition, especially calcium and phosphate additives. Although long-term effects have been described in the literature, short-term effects are not well-known. Currently, the Food and Drug Administration recommends maintaining aluminum at <5 mcg/kg/day. This was a single center, retrospective case-control study of 102 neonatal intensive care unit patients. Patients were included if they had a diagnosis of necrotizing enterocolitis, rickets/osteopenia, or seizures and received at least 14 days of parenteral nutrition. Patients were matched 1:1 with control patients by gestational age and birth weight. Mean total aluminum exposure for the 14 days of parenteral nutrition was calculated using manufacturer label information. Differences in mean aluminum exposure between cases and controls, as well as subgroup analysis in those with renal impairment or cholestasis, was conducted. Aluminum exposure in patients meeting inclusion criteria closely mirrored the aluminum exposure of control patients. The difference in aluminum exposure was not found to be statistically significant, except in patients with cholestasis. Although the study found no difference in aluminum exposure in short-term complications with neonates, long-term complications are well established and may warrant the need to monitor and limit neonatal aluminum exposure.
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Affiliation(s)
- Megan Fortenberry
- University of North Carolina Health Care, Chapel Hill, NC 27514, USA.
| | - Lela Hernandez
- Wesley Children's Hospital, 550 N Hillside, Wichita, KS 67214, USA.
| | - Jacob Morton
- Saint Vincent Hospital, 123 Summer St, Worcester, MA 01608, USA.
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Ukarapong S, Venkatarayappa SKB, Navarrete C, Berkovitz G. Risk factors of metabolic bone disease of prematurity. Early Hum Dev 2017; 112:29-34. [PMID: 28683339 DOI: 10.1016/j.earlhumdev.2017.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the factors that increase risk of metabolic bone disease of prematurity (MBD). STUDY DESIGN A retrospective case-control study of infants born between January 2013-April 2014 with gestation age <30weeks and birth weight <1000g. MBD was defined as serum alkaline phosphatase above 500U/L and characteristic radiographic changes. Information was obtained on the presence of specific comorbidities. RESULTS Of 76 infants evaluated, 40 met criteria for MBD. Median gestational age was 25weeks in both groups (p=0.512). Median birth weight of infants with MBD was significantly lower than that of controls (560 vs. 765g, p<0.01). Longer period of parenteral nutrition and dexamethasone use was observed in MBD group. Cholestasis was associated with the highest likelihood of MBD (OR 16.6, 95% CI 4.8-56.9). Seizures (OR 5.2, 95% CI 1.3-20.5) and the prolonged use of diuretics (OR 2.6, 95% CI 1.0-7.0) also significantly increased the likelihood of MBD. Only cholestasis remained significant (OR 9.6, 95% CI 2.1-45.3) after multiple regression analysis. CONCLUSION Cholestasis is a significant risk factor for the development of MBD. Our future studies will be directed towards determining the causal relationship between cholestasis and MBD.
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Affiliation(s)
- Supamit Ukarapong
- Pediatric Endocrinology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | | | - Cristina Navarrete
- Neonatology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Gary Berkovitz
- Pediatric Endocrinology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Li G, Zhao X, Wu S, Hua H, Wang Q, Zhang Z. Dietary exposure to aluminium in the popular Chinese fried bread youtiao. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2017; 34:972-979. [PMID: 28332421 DOI: 10.1080/19440049.2017.1306757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Youtiao is a typical, traditional and widely consumed fried food in China. Fermentation of youtiao involves the use of aluminium potassium sulphate (alum). There are health concerns related to the levels of aluminium in food; therefore, we aimed to determine the aluminium concentrations of youtiao from various locations, and to estimate the dietary exposure by different age groups in southern and northern China. The aluminium content of youtiao samples varied considerably (range = 4.46-852.69 mg kg-1). Both the mean and median aluminium contents of youtiao exceeded 100 mg kg-1, which is the China National Standard (GB) 2760-2014 National Food Safety for Standards for food additives. However, the median and 97.5th percentile of weekly dietary exposure to aluminium from youtiao, estimated using Monte Carlo simulation, did not exceed the provisional tolerable weekly intake (PTWI) set by the joint FAO/WHO Expert Committee on Food Additives (JECFA) for children, adolescents, adults and seniors. The weekly dietary exposure to aluminium would exceed the PTWI if children, adolescents, adults and seniors consumed 134.47, 260.98, 327.10 or 320.41 g of youtiao per week, respectively.
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Affiliation(s)
- Ge Li
- a Department of Food Science and Technology , School of Agriculture and Biology, Shanghai Jiao Tong University , Shanghai , China.,b Bor S. Luh Food Safety Research Center , Shanghai Jiao Tong University , Shanghai , China
| | - Xue Zhao
- a Department of Food Science and Technology , School of Agriculture and Biology, Shanghai Jiao Tong University , Shanghai , China.,b Bor S. Luh Food Safety Research Center , Shanghai Jiao Tong University , Shanghai , China
| | - Shimin Wu
- a Department of Food Science and Technology , School of Agriculture and Biology, Shanghai Jiao Tong University , Shanghai , China.,b Bor S. Luh Food Safety Research Center , Shanghai Jiao Tong University , Shanghai , China.,c Key Laboratory of Urban Agriculture (South) , Ministry of Agriculture , Shanghai , China
| | - Hongying Hua
- a Department of Food Science and Technology , School of Agriculture and Biology, Shanghai Jiao Tong University , Shanghai , China.,b Bor S. Luh Food Safety Research Center , Shanghai Jiao Tong University , Shanghai , China
| | - Qiang Wang
- d Laboratory of Quality & Safety Assessment for Agro-products (Hangzhou) , Ministry of Agriculture , Hangzhou , China.,e Institute of Quality and Standard for Agro-products , Zhejiang Academy of Agricultural Sciences , Hangzhou , China
| | - Zhiheng Zhang
- d Laboratory of Quality & Safety Assessment for Agro-products (Hangzhou) , Ministry of Agriculture , Hangzhou , China.,e Institute of Quality and Standard for Agro-products , Zhejiang Academy of Agricultural Sciences , Hangzhou , China
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Aluminum and Phthalates in Calcium Gluconate: Contribution From Glass and Plastic Packaging. J Pediatr Gastroenterol Nutr 2017; 64:109-114. [PMID: 27111341 DOI: 10.1097/mpg.0000000000001243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass-packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container-packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity. METHODS Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic-packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers. RESULTS The initial aluminum concentration was approximately 5000 μg/L in the 2 glass-packaged products and approximately 20 μg/L in the plastic-packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates. CONCLUSIONS Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass-packaged product.
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Huston RK, Kaempf JW, Wang M, Wang L, Grunkemeier GL, Cohen HS. Calcium chloride in neonatal parenteral nutrition: A 15 year experience. J Neonatal Perinatal Med 2017; 10:33-38. [PMID: 28304321 DOI: 10.3233/npm-1646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to determine if outcomes at our neonatal intensive care units (NICUs) since we began using calcium chloride (CaCl2) as our preferred calcium additive in order to reduce aluminum (Al) exposure are within expected outcome ranges for NICUs in the U.S. where calcium gluconate in glass vials (CaGlu-Gl) has been the preferred additive. STUDY DESIGN A retrospective study of very low birth weight infants born between January 1, 2000 and December 31, 2014. Outcomes in two intensive care units (NICUs) using CaCl2 were compared to all U.S. NICUs in the Vermont Oxford Network. Primary outcomes were chronic lung disease (CLD), percent requiring supplemental oxygen at 28 days, and mortality excluding early deaths (MEED). The incidence of IV infiltrates of all admissions to the study NICUs in 2013-2014 was compared to the literature. RESULTS The incidence of CLD and those requiring oxygen at 28 days were 24.0% vs 28.6% and 46.2% vs 51.8% for the study NICUs compared to all U.S. NICUs, respectively (both p < 0.0001). The MEED was 8.7% vs 10.3% (p < 0.002). All major morbidities were lower at the study NICUs. The incidence of infiltrates was lower than that in the literature. CONCLUSION The use of CaCl2 was not associated with any detectable adverse effects. Calcium chloride appears to be a safe alternative to the use of CaGlu-Gl based upon studies of clinical outcomes.
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Affiliation(s)
- R K Huston
- Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA
| | - J W Kaempf
- Women's and Children's Program, Providence St. Vincent Medical Center, Portland, OR, USA
| | - M Wang
- Medical Data Research Center, Providence Health and Services, Portland, OR, USA
| | - L Wang
- Medical Data Research Center, Providence Health and Services, Portland, OR, USA
| | - G L Grunkemeier
- Medical Data Research Center, Providence Health and Services, Portland, OR, USA
| | - H S Cohen
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, USA
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Huston RK, Heisel CF, Vermillion BR, Christensen JM, Minc L. Aluminum Content of Neonatal Parenteral Nutrition Solutions. Nutr Clin Pract 2016; 32:266-270. [PMID: 27679526 DOI: 10.1177/0884533616668789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Calcium chloride (CaCl2) has been the only calcium additive available in the United States that has a low aluminum (Al) content. Calcium gluconate in glass vials (CaGluc-Gl) has a high Al content while calcium gluconate in plastic vials (CaGluc-Pl) has a low Al content. The purpose of this study was to measure Al concentrations in neonatal parenteral nutrition (PN) solutions prepared using various calcium additives. METHODS Samples of solutions compounded with CaCl2 or CaGluc-Gl and sodium phosphate (NaPhos) as well as CaGluc-Pl and sodium glycerophosphate (NaGP) with and without cysteine were analyzed for Al content. Samples of the cysteine and calcium gluconate additives were also sent for analysis. RESULTS Solutions containing CaCl2 and CaGlu-Pl had mean Al concentrations of 1.2-2.3 mcg/dL, while those with CaGlu-Gl had mean concentrations of 14.6-15.1 mcg/dL. Solutions made with NaGP were low in Al content. The measured Al content of 2 lots of the cysteine additive were 168 ± 23 mcg/L and 126 ± 5 mcg/L. The Al concentration equalled 2730 ± 20 mcg/L for the CaGlu-Gl additive and 310 ± 80 mcg/L for the CaGlu-Pl additive. CONCLUSION The study indicates that solutions containing CaCl2 or CaGluc-Pl and NaPhos or NaGP are low in Al content. Using these options for calcium and phosphate additives can limit aluminum intake from neonatal PN to levels within the Food and Drug Administration guideline of ≤5 mcg/kg/d.
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Affiliation(s)
- Robert K Huston
- 1 Northwest Newborn Specialists, PC, and Pediatrix Medical Group, Portland, Oregon, USA
| | - Carl F Heisel
- 2 Neonatal Pharmacy, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - Benjamin R Vermillion
- 2 Neonatal Pharmacy, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - J Mark Christensen
- 3 Department of Pharmaceutical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Leah Minc
- 4 Radiation Center, Oregon State University, Corvallis, Oregon, USA
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Anderson C, MacKay M. Physical Compatibility of Calcium Chloride and Sodium Glycerophosphate in Pediatric Parenteral Nutrition Solutions. JPEN J Parenter Enteral Nutr 2016; 40:1166-1169. [DOI: 10.1177/0148607115592673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/01/2015] [Indexed: 01/15/2023]
Affiliation(s)
| | - Mark MacKay
- Primary Children’s Hospital, Salt Lake City, Utah
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20
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Mohseni HK, Cowan D, Chettle DR, Milić AP, Priest N, Matysiak W, Atanackovic J, Byun SH, Prestwich WV. A Pilot Study Measuring Aluminum in Bone in Alzheimer’s Disease and control Subjects Using in vivo Neutron Activation Analysis. J Alzheimers Dis 2016; 53:933-42. [DOI: 10.3233/jad-160194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hedieh K. Mohseni
- Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada
| | - David Cowan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David R. Chettle
- Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Nicholas Priest
- Canadian Nuclear Laboratories, Chalk River Laboratories, ON, Canada
| | - Witold Matysiak
- University of Florida Proton Therapy Institute, Jacksonville, FL, USA
| | | | - Soo Hyun Byun
- Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada
| | - William V. Prestwich
- Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada
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Mohseni HK, Chettle DR. A History of In Vivo Neutron Activation Analysis in Measurement of Aluminum in Human Subjects. J Alzheimers Dis 2016; 50:913-26. [DOI: 10.3233/jad-150595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Guo J, Peng S, Tian M, Wang L, Chen B, Wu M, He G. Dietary exposure to aluminium from wheat flour and puffed products of residents in Shanghai, China. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2015; 32:2018-26. [PMID: 26414493 DOI: 10.1080/19440049.2015.1099078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A dietary survey of 3431 residents was conducted by a 24-h dietary recall method in Shanghai, China, quarterly from September 2013 to September 2014. A total of 400 food samples were tested for aluminium concentration, including wheat flour and puffed products from 2011 to 2013. Probabilistic analysis was used to estimate the dietary exposure to aluminium from wheat and puffed products. The means of dietary aluminium exposure for children (2-6 years old), juveniles (7-17 years old), adults (18-65 years old) and seniors (over 65 years old) were 1.88, 0.94, 0.44 and 0.42 mg kg(-1) body weight (bw) week(-1) respectively, with a population average of 0.51 mg kg(-1) bw week(-1). The proportions of those who had aluminium exposure from wheat and puffed products lower than the provisional tolerable weekly intake (PTWI) were 77%, 90%, 97%, and 97% respectively from children to seniors. We estimated that the proportions of people at risk would decrease by 13%, 6%, 2% and 2% respectively under the new China National Standards - GB 2760-2014 National Food Safety for Standards for using food additives. The results indicated that aluminium from wheat flour and puffed products is unlikely to cause adverse health effects in the general population in Shanghai; however, children were at a higher risk of excess aluminium exposure. Significant improvements in reducing the dietary exposure to aluminium are expected in the population, especially for children after the implementation of GB 2760-2014.
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Affiliation(s)
- Junfei Guo
- a Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety , Fudan University , Shanghai , China
| | - Shaojie Peng
- b General Enforcement Team of Shanghai Food and Drug Administration , Shanghai , China
| | - Mingsheng Tian
- b General Enforcement Team of Shanghai Food and Drug Administration , Shanghai , China
| | - Liwei Wang
- b General Enforcement Team of Shanghai Food and Drug Administration , Shanghai , China
| | - Bo Chen
- a Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety , Fudan University , Shanghai , China
| | - Min Wu
- a Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety , Fudan University , Shanghai , China
| | - Gengsheng He
- a Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety , Fudan University , Shanghai , China
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Huston RK, Christensen JM, Alshahrani SM, Mohamed SM, Clark SM, Nason JA, Wu YX. Calcium Chloride in Neonatal Parenteral Nutrition Solutions with and without Added Cysteine: Compatibility Studies Using Laser and Micro-Flow Imaging Methodology. PLoS One 2015; 10:e0136894. [PMID: 26317344 PMCID: PMC4552580 DOI: 10.1371/journal.pone.0136894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies of compatibility of calcium chloride (CaCl2) and phosphates have not included particle counts in the range specified by the United States Pharmacopeia. Micro-flow imaging techniques have been shown to be comparable to light obscuration when determining particle count and size in pharmaceutical solutions. OBJECTIVE The purpose of this study was to do compatibility testing for parenteral nutrition (PN) solutions containing CaCl2 using dynamic light scattering and micro-flow imaging techniques. METHODS Solutions containing TrophAmine (Braun Medical Inc, Irvine, CA), CaCl2, and sodium phosphate (NaPhos) were compounded with and without cysteine. All solutions contained standard additives to neonatal PN solutions including dextrose, trace metals, and electrolytes. Control solutions contained no calcium or phosphate. Solutions were analyzed for particle size and particle count. Means of Z-average particle size and particle counts of controls were determined. Study solutions were compared to controls and United States Pharmacopeia (USP) Chapter 788 guidelines. The maximum amount of Phos that was compatible in solutions that contained at least 10 mmol/L of Ca in 2.5% amino acids (AA) was determined. Compatibility of these solutions was verified by performing analyses of 5 repeats of these solutions. Microscopic analyses of the repeats were also performed. RESULTS Amounts of CaCl2 and NaPhos that were compatible in solutions containing 1.5%, 2%, 2.5%, and 3% AA were determined. The maximum amount of NaPhos that could be added to TrophAmine solutions of > = 2.5% AA containing at least 10 mmol/L of CaCl2 was 7.5 mmol/L. Adding 50 mg/dL of cysteine increased the amount of NaPhos that could be added to solutions containing 10 mmol/L of CaCl2 to 10 mmol/L. CONCLUSION Calcium chloride can be added to neonatal PN solutions containing NaPhos in concentrations that can potentially provide an intravenous intake of adequate amounts of calcium and phosphorus.
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Affiliation(s)
- Robert K. Huston
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, United States of America
- * E-mail:
| | - J. Mark Christensen
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America
| | - Sultan M. Alshahrani
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America
| | - Sumeia M. Mohamed
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America
| | - Sara M. Clark
- Neonatal Pharmacy, Providence St. Vincent Medical Center, Portland, OR, United States of America
| | - Jeffrey A. Nason
- School of Chemical, Biological, & Environmental Engineering, Oregon State University, Corvallis, OR, United States of America
| | - Ying Xing Wu
- Medical Data Research Center, Providence Health and Services, Portland, OR, United States of America
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Embleton ND, Morgan C, King C. Balancing the risks and benefits of parenteral nutrition for preterm infants: can we define the optimal composition? Arch Dis Child Fetal Neonatal Ed 2015; 100:F72-5. [PMID: 24925929 DOI: 10.1136/archdischild-2013-304061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nutrient intakes in preterm infants are frequently inadequate and are associated with worse neuro-developmental outcome. Preterm infants take time to establish enteral intakes, and parenteral nutrition (PN) is now an integral component of care. Despite this, the evidence base for PN intakes is extremely limited. There remains uncertainty over safe initial and maximum amounts of macronutrients, and the optimal amino acid and lipid composition. Studies have tended to focus on short-term growth measures and there are few studies with long-term follow-up. There may be a tradeoff between improving cognitive outcomes while minimising metabolic harm that means determining the optimal regimen will require long-term follow-up. Given the importance of appropriate nutrition for long-term metabolic and cognitive health, and the associated healthcare costs, optimising the composition of PN deserves to be seen as a research priority in neonatal medicine.
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Affiliation(s)
- Nicholas D Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Colin Morgan
- Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK
| | - Caroline King
- Neonatal Units, Imperial College Healthcare NHS Trust, London, UK
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Seneff S, Swanson N, Li C. Aluminum and Glyphosate Can Synergistically Induce Pineal Gland Pathology: Connection to Gut Dysbiosis and Neurological Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/as.2015.61005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW In 1986, the US Food and Drug Administration issued an aluminum mandate in hopes of minimizing patient exposure to aluminum contaminates contained in parenteral nutrition additives. The purpose of this article is to revisit the status of aluminum contamination as it relates to parenteral nutrition and to survey the recent literature to determine if any new findings have emerged. A special emphasis will be placed on the complications associated with aluminum toxicity. RECENT FINDINGS In addition to metabolic bone disease, patients with aluminum toxicity are also prone to other complications such as neurodevelopmental delays and cholestasis. Other potentially serious consequences, including osteoporosis, growth failure, and dementia, can arise years after the initial exposure to aluminum, showing that preventing toxicity is imperative. SUMMARY Unlike the rapid response to eliminating aluminum toxicity in the dialysis patient population, similar successes have not been realized in patients receiving parenteral nutrition solutions. Product formulation changes have been slow to emerge from manufacturers. It remains the responsibility of healthcare practitioners to recognize the patient populations at risk for toxicity and act accordingly. Monitoring aluminum status and purchasing products known to possess the least amount of aluminum are two such approaches.
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Affiliation(s)
- Kathleen M Gura
- aDepartment of Pharmacy, Boston Children's Hospital bMCPHS University, Boston, Massachusetts, USA
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Yokel RA, Harris WR, Spilling CD, Abramov VP, Lone JM, Kuhn RJ. A Filtration System That Greatly Reduces Aluminum in Calcium Gluconate Injection, USP Used to Prepare Parenteral Nutrition Solutions. J Pediatr Pharmacol Ther 2014; 19:189-95. [PMID: 25309149 DOI: 10.5863/1551-6776-19.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study objective was to reduce aluminum (Al) in Calcium Gluconate Injection, US Pharmacopeia (USP) used in the preparation of parenteral nutrition (PN) solutions. METHODS A flow-through filter containing an immobilized chelator that complexes Al from Calcium Gluconate Injection, USP as it flows through the filter was designed, refined by design modifications, and extensively tested. When a small-volume parenteral vial containing 100 mL of Calcium Gluconate Injection, USP is connected on the inlet side of the filter, and the outlet side is connected to an evacuated receiving vial, the filtered solution is drawn into the receiving vial. This constitutes a complete system to remove Al from Calcium Gluconate Injection, USP. RESULTS The extent of Al removal is flow rate dependent. At a flow rate of 1 mL/min approximately 85% of the Al was removed from calcium gluconate solution. PN solutions have been reported to deliver 15 to 23 mcg/kg/day Al to neonates. Given that Calcium Gluconate Injection, USP provides 85% of the Al in neonatal PN solutions, removal of 85% of the Al from this source was calculated to reduce Al delivered to most neonates to <5 mcg/kg/day. CONCLUSIONS A point-of-use, self-contained, single-use, disposable, Al-complexing filter has been created. It was calculated to reduce Al delivered in PN solutions by 72%, resulting in daily Al delivery below the level that results in Al accumulation associated with central nervous system and bone toxicity to all but the smallest (<1 kg) infants.
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Affiliation(s)
- Robert A Yokel
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky ; ALKYMOS Inc, Lexington, Kentucky
| | - Wesley R Harris
- ALKYMOS Inc, Lexington, Kentucky ; Department of Chemistry and Biochemistry, University of Missouri, St Louis, Missouri
| | - Christopher D Spilling
- ALKYMOS Inc, Lexington, Kentucky ; Department of Chemistry and Biochemistry, University of Missouri, St Louis, Missouri
| | | | | | - Robert J Kuhn
- ALKYMOS Inc, Lexington, Kentucky ; Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Shaw CA, Li D, Tomljenovic L. Are there negative CNS impacts of aluminum adjuvants used in vaccines and immunotherapy? Immunotherapy 2014; 6:1055-71. [DOI: 10.2217/imt.14.81] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In spite of a common view that aluminum (Al) salts are inert and therefore harmless as vaccine adjuvants or in immunotherapy, the reality is quite different. In the following article we briefly review the literature on Al neurotoxicity and the use of Al salts as vaccine adjuvants and consider not only direct toxic actions on the nervous system, but also the potential impact for triggering autoimmunity. Autoimmune and inflammatory responses affecting the CNS appear to underlie some forms of neurological disease, including developmental disorders. Al has been demonstrated to impact the CNS at every level, including by changing gene expression. These outcomes should raise concerns about the increasing use of Al salts as vaccine adjuvants and for the application as more general immune stimulants.
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Affiliation(s)
- Christopher A Shaw
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
| | - Dan Li
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
| | - Lucija Tomljenovic
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
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Willhite CC, Karyakina NA, Yokel RA, Yenugadhati N, Wisniewski TM, Arnold IMF, Momoli F, Krewski D. Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts. Crit Rev Toxicol 2014; 44 Suppl 4:1-80. [PMID: 25233067 PMCID: PMC4997813 DOI: 10.3109/10408444.2014.934439] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007) . Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of "total Al"assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al(+3) to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)(+2) and Al(H2O)6 (+3)] that after complexation with O2(•-), generate Al superoxides [Al(O2(•))](H2O5)](+2). Semireduced AlO2(•) radicals deplete mitochondrial Fe and promote generation of H2O2, O2 (•-) and OH(•). Thus, it is the Al(+3)-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer's disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances.
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Affiliation(s)
- Calvin C. Willhite
- Risk Sciences International, Ottawa, ON, Canada
- McLaughlin Centre for Population Health Risk Assessment, Ottawa, ON, Canada
| | | | - Robert A. Yokel
- Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | | | - Thomas M. Wisniewski
- Departments of Neurology, Psychiatry and Pathology, New York University School of Medicine, New York City, New York, USA
| | - Ian M. F. Arnold
- Occupational Health Program, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Daniel Krewski
- Risk Sciences International, Ottawa, ON, Canada
- McLaughlin Centre for Population Health Risk Assessment, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Huston RK, Christensen JM, Karnpracha C, Rosa JE, Clark SM, Migaki EA, Wu Y. Calcium chloride in neonatal parenteral nutrition: compatibility studies using laser methodology. PLoS One 2014; 9:e106825. [PMID: 25192060 PMCID: PMC4156409 DOI: 10.1371/journal.pone.0106825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/07/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction We have previously reported results of precipitation studies for neonatal parenteral nutrition solutions containing calcium chloride and sodium phosphate using visual methods to determine compatibility. The purpose of this study was to do further testing of compatibility for solutions containing calcium chloride using more sensitive methods. Methods Solutions of Trophamine (Braun Medical Inc, Irvine, CA) and Premasol (Baxter Pharmaceuticals, Deerfield, IL) were compounded with calcium chloride and potassium phosphate. Controls contained no calcium or phosphate. After incubation at 37° for 24 hours solutions without visual precipitation were analyzed to determine mean particle size using dynamic light scattering from a laser light source. Results Particle sizes were similar for control solutions and those without visual precipitation and a mean particle size <1000 nm. Compatible solutions were defined as those with added calcium and phosphate with no visual evidence of precipitation and mean particle size <1000 nm. In solutions containing 2.5–3% amino acids and 10 mmol/L of calcium chloride the maximum amount of potassium phosphate that was compatible was 7.5 mmol/L. Conclusion Maximum amounts of phosphate that could be added to parenteral nutrition solutions containing Trophamine and calcium chloride were about 7.5–10 mmol/L less for a given concentration of calcium based upon laser methodology compared to visual techniques to determine compatibility. There were minor differences in compatibility when adding calcium chloride and potassium phosphate to Premasol versus Trophamine.
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Affiliation(s)
- Robert K. Huston
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, United States of America
- * E-mail:
| | - J. Mark Christensen
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America
| | - Chanida Karnpracha
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America
| | - Jill E. Rosa
- Pharmacy Department, Denver Veterans Affairs Medical Center, Denver CO, United States of America
| | - Sara M. Clark
- Neonatal Pharmacy, Providence St. Vincent Medical Center, Portland, OR, United States of America
| | - Evelyn A. Migaki
- Neonatal Pharmacy, Providence St. Vincent Medical Center, Portland, OR, United States of America
| | - YingXing Wu
- Medical Data Research Center, Providence Health and Services, Portland, OR, United States of America
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Bone Mineral Density in Children From Anthropological and Clinical Sciences: A Review. ANTHROPOLOGICAL REVIEW 2014. [DOI: 10.2478/anre-2014-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Bone mineral density (BMD) is a frequent topic of discussion in the clinical literature in relation to the bone health of both adults and children. However, in archaeological and/ or anthropological studies the role of BMD is often cited as a possible factor in the poor skeletal preservation which can lead to an under-representation of juvenile skeletal remains. During skeletal development and growth throughout childhood and adolescence changes take place in both the size and shape of bones and these changes also result in the increasing of mineral content. BMD can be affected by many factors, which include, age, genetics, sexual maturation, amount of physical activity and dietary calcium. This paper aims to review the clinical and anthropological literature on BMD and discuss the numerous methods of measurement and how the availability of certain methods such as Dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) can influence the study of bone density in archaeological skeletal collections and also the future potential for forensic anthropological studies.
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Abstract
A recent review of macronutrients in parenteral nutrition (PN) in the NICU population summarized the carbohydrate, protein, and fat nutrients in PN.1 The purpose of this article is to review the other nutrients in PN that are important for growth and homeostasis including minerals or electrolytes, vitamins, and trace elements. Although the macronutrients contribute more dramatically to adequate nutrition and growth, the other components in PN have significant impact on use of macronutrients as well as targeted organ and cellular function.
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Fanni D, Ambu R, Gerosa C, Nemolato S, Iacovidou N, Van Eyken P, Fanos V, Zaffanello M, Faa G. Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods. World J Pediatr 2014; 10:101-7. [PMID: 24801228 DOI: 10.1007/s12519-014-0477-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the last years, human newborns have been overexposed to biologically reactive aluminum, with possible relevant consequences on their future health and on their susceptibility to a variety of diseases. Children, newborns and particularly preterm neonates are at an increased risk of aluminum toxicity because of their relative immaturity. DATA SOURCES Based on recent original publications and classical data of the literatures, we reviewed the aluminum content in mother's food during the intrauterine life as well as in breast milk and infant formula during lactation. We also determined the possible role of aluminum in parenteral nutrition solutions, in adjuvants of vaccines and in pharmaceutical products. A special focus is placed on the relationship between aluminum overexposure and the insurgence of bone diseases. RESULTS Practical points of management and prevention are suggested. Aluminum sources that infants may receive during the first 6 months of life are presented. In the context of prevention of possible adverse effects of aluminum overload in fetal tissues during development, simple suggestions to pregnant women are described. Finally, practical points of management and prevention are suggested. CONCLUSIONS Pediatricians and neonatologists must be more concerned about aluminum content in all products our newborns are exposed to, starting from monitoring aluminum concentrations in milk- and soy-based formulas in which, on the basis of recent studies, there is still too much aluminum.
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Affiliation(s)
- Daniela Fanni
- Department of Pathology, University Hospital San Giovanni di Dio, AOU Cagliari and University of Cagliari, Cagliari, Italy
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XXXIV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 27–30 May 2014, Brussels, Belgium. Clin Toxicol (Phila) 2014. [DOI: 10.3109/15563650.2014.906213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Courtney-Martin G, Kosar C, Campbell A, Avitzur Y, Wales PW, Steinberg K, Harrison D, Chambers K. Plasma Aluminum Concentrations in Pediatric Patients Receiving Long-Term Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2014; 39:578-85. [PMID: 24743391 DOI: 10.1177/0148607114531046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients receiving long-term parenteral nutrition (PN) are at increased risk of aluminium (Al) toxicity because of bypass of the gastrointestinal tract during PN infusion. Complications of Al toxicity include metabolic bone disease (MBD), Al-associated encephalopathy in adults, and impaired neurological development in preterm infants. Unlike the United States, there are no regulations regarding Al content of large- and small-volume parenterals in Canada. We, therefore, aimed to present our data on plasma Al concentration and Al intake from our cohort of pediatric patients receiving long-term PN. METHODS Plasma Al concentration was retrospectively gathered from the patient charts of all 27 patients with intestinal failure (IF) receiving long-term PN at The Hospital for Sick Children, Toronto, Canada, and compared with age- and sex-matched controls recruited for comparison. In addition, Al concentration was measured in PN samples collected from 10 randomly selected patients with IF and used to determine their Al intake. RESULTS The plasma Al concentration of patients with IF receiving long-term PN was significantly higher than that of control participants (1195 ± 710 vs 142 ± 63 nmol/L; P < .0001). In the subgroup of 10 patients for whom Al intake from their PN solution was determined, mean ± SD Al intake from PN was 15.4 ± 15 µg/kg, 3 times the Food and Drug Administration upper recommended intake level, and Al intake was significantly related to plasma Al concentration (P = .02, r (2) = 0.52). CONCLUSION Pediatric patients receiving long-term PN for IF in Canada are at risk for Al toxicity.
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Affiliation(s)
- Glenda Courtney-Martin
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Christina Kosar
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Alison Campbell
- Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Yaron Avitzur
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Paul W Wales
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Surgery, University of Toronto, Toronto, Canada
| | - Karen Steinberg
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Debra Harrison
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Kathryn Chambers
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
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Zhu Y, Sun H, Fu Y, Wang J, Song M, Li M, Li Y, Miao L. Effects of sub-chronic aluminum chloride on spermatogenesis and testicular enzymatic activity in male rats. Life Sci 2014; 102:36-40. [DOI: 10.1016/j.lfs.2014.02.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/17/2013] [Accepted: 02/20/2014] [Indexed: 01/20/2023]
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Abstract
Evaluation of suspected endocrine pathology in newborn infants requires knowledge of the dynamic changes that characterize normal hormonal function in the neonatal period. This article reviews normal endocrine physiology as it pertains to common clinical scenarios encountered in neonatal surgical patients. Topics covered include thyroid and adrenal function as well as glucose and calcium metabolism.
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Affiliation(s)
- Ari J Wassner
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Biren P Modi
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
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Viswanathan S, Khasawneh W, McNelis K, Dykstra C, Amstadt R, Super DM, Groh-Wargo S, Kumar D. Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr 2013; 38:982-90. [PMID: 23963689 DOI: 10.1177/0148607113499590] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Metabolic bone disease (MBD) is an important prematurity-related morbidity, but remains inadequately investigated in extremely low birth weight (ELBW) infants, the group most at risk. The objective was to describe the incidence and associated risk factors of MBD in ELBW infants. METHODS Retrospective analysis of all ELBW infants admitted between January 2005 and December 2010 who survived > 8 weeks. MBD was defined as the presence of osteopenia or rickets in radiographs. RESULTS Of the 230 infants included in the study, 71 (30.9%) developed radiological evidence of MBD (cases) of which 24/71 (33.8%) developed spontaneous fractures. MBD and fractures were noted at mean postnatal ages of 58.2 ± 28 and 100.0 ± 61 days, respectively. Compared with controls, cases were smaller at birth (664.6 ± 146 g vs 798.1 ± 129 g), more premature (25.0 ± 1.8 vs 26.4 ± 1.9 weeks), more frequently associated with mechanical ventilation, chronic lung disease, parenteral nutrition days, cholestasis, furosemide, postnatal steroids, and antibiotics use (all P < .01). Cases had lower average weekly intake of calcium, phosphorous, vitamin D, protein, and calories during the first 8 weeks of life compared with controls. Cases with MBD, compared with controls, had higher mortality (14.1 vs 4.4%) and longer hospital stay (140.2 ± 51 vs 101.0 ± 42 days; P < .01). CONCLUSIONS MBD remains an important morbidity in ELBW infants despite advances in neonatal nutrition. Further research is needed to optimize the management of chronic lung disease and early nutrition in ELBW infants.
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Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Wasim Khasawneh
- Division of Neonatology, Department of Pediatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Kera McNelis
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Carly Dykstra
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Randi Amstadt
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Dennis M Super
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sharon Groh-Wargo
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Deepak Kumar
- Division of Critical Care, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Pichler J, Chomtho S, Fewtrell M, Macdonald S, Hill SM. Growth and bone health in pediatric intestinal failure patients receiving long-term parenteral nutrition. Am J Clin Nutr 2013; 97:1260-9. [PMID: 23576042 DOI: 10.3945/ajcn.112.057935] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Children with chronic intestinal failure (IF) treated with long-term parenteral nutrition (PN) may present with low bone mineral density (BMD). The cause may reflect small body size or suboptimal bone mineralization. OBJECTIVE We assessed growth and bone health in children with severe IF. DESIGN Height, weight, and fracture history were recorded. The lumbar spine bone mass was measured in 45 consecutive patients (24 male subjects) aged 5-17 y receiving PN for a median of 5 y. BMD and bone mineral apparent density (BMAD) [ie, adjusted-for-height SD scores (SDSs)] were calculated. RESULTS Diagnoses were short bowel syndrome in 12 patients (27%), intestinal enteropathy in 20 patients (44%), and motility disorder in 13 patients (29%). Mean (±SD) weight, height, and body mass index SDSs were -0.8 ± 1.3, -1.80 ± 1.5, and 0.4 ± 1.3, respectively. The height SDS was less than -2 in 23 children (50%). Patients with enteropathy or intestinal mucosal inflammation (associated with dysmotility or short bowel) were significantly shorter than patients without enteropathy (P = 0.007). The BMD SDS was -1.7 ± 1.6, and the BMAD SDS was -1.4 ± 1.5, independent of primary diagnosis or mucosal inflammation. Nineteen patients (42%) had low BMD (SDS less than -2.0), and 14 patients (31%) had low BMAD. In 25 patients studied at 1-2-y intervals, the BMD SDS fell significantly with time, whereas BMAD declined less, which suggested that a poor bone mineral accretion reflected poor growth. A total of 11 of 37 patients (24%) had nonpathologic fractures (P = 0.3 compared with the general population). CONCLUSIONS Approximately 50% of children were short, and one-third of children had low BMD and BMAD. Children with enteropathy or intestinal mucosal inflammation are at greatest risk of growth failure. Close nutritional monitoring and bespoke PN should maximize the potential for growth and bone mass.
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Affiliation(s)
- Judith Pichler
- Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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Nehra D, Carlson SJ, Fallon EM, Kalish B, Potemkin AK, Gura KM, Simpser E, Compher C, Puder M. A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease. JPEN J Parenter Enteral Nutr 2013; 37:570-98. [PMID: 23685349 DOI: 10.1177/0148607113487216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Premature infants are at increased risk for metabolic bone disease, with resulting delayed bone growth, osteopenia, and rickets. METHOD A systematic review of the best available evidence to answer a series of questions regarding neonatal patients at risk of metabolic bone disease receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. QUESTIONS (1) What maternal risk factors predispose the neonate to metabolic bone disease? (2) What is the optimal type of feeding to promote neonatal bone health? (3) When and how should vitamin D supplements be administered? (4) Does parenteral nutrition (PN) predispose a neonate to metabolic bone disease, and if so, are there PN formulation recommendations to minimize this risk?
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Affiliation(s)
- Deepika Nehra
- Department of Surgery and The Vascular Biology Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
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Wood CL, Wood AM, Harker C, Embleton ND. Bone mineral density and osteoporosis after preterm birth: the role of early life factors and nutrition. Int J Endocrinol 2013; 2013:902513. [PMID: 23662104 PMCID: PMC3639624 DOI: 10.1155/2013/902513] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/24/2013] [Indexed: 01/22/2023] Open
Abstract
The effects of preterm birth and perinatal events on bone health in later life remain largely unknown. Bone mineral density (BMD) and osteoporosis risk may be programmed by early life factors. We summarise the existing literature relating to the effects of prematurity on adult BMD and the Developmental Origins of Health and Disease hypothesis and programming of bone growth. Metabolic bone disease of prematurity and the influence of epigenetics on bone metabolism are discussed and current evidence regarding the effects of breastfeeding and aluminium exposure on bone metabolism is summarised. This review highlights the need for further research into modifiable early life factors and their effect on long-term bone health after preterm birth.
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Affiliation(s)
- Claire L. Wood
- Child Health, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Alexander M. Wood
- Orthopaedic Department, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - Caroline Harker
- Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4HH, UK
| | - Nicholas D. Embleton
- Child Health, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Institute of Health and Society, Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4HH, UK
- *Nicholas D. Embleton:
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Li X, Han Y, Guan Y, Zhang L, Bai C, Li Y. Aluminum induces osteoblast apoptosis through the oxidative stress-mediated JNK signaling pathway. Biol Trace Elem Res 2012; 150:502-8. [PMID: 23065425 DOI: 10.1007/s12011-012-9523-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/04/2012] [Indexed: 11/25/2022]
Abstract
Aluminum (Al) is considered to be a potentially toxic metal. Al exposure inhibits bone formation. Few studies have investigated the mechanism of inhibitory effects of Al on bone formation. Thus, in this study, osteoblasts were cultured and exposed to different concentrations of Al to investigate the mechanism behind the inhibitory effects of Al on bone formation. Al-treated osteoblasts showed signs of oxidative stress and a high apoptosis rate. The levels of osteoblasts activity markers (bone gamma-carboxyglutamic acid protein and bone alkaline phosphatase) were significantly lower in the Al-treated groups than in the control group. The c-Jun N-terminal kinase (JNK), a major signaling pathway in regulating cell apoptosis, was activated. The phosphorylation state of JNK was significantly increased. The mRNA and protein expression of c-Jun were both significantly upregulated. The pro-apoptotic genes (caspase 3, caspase 9, bax, and factor-related apoptosis ligand) were significantly increased. However, Bcl-2, an anti-apoptotic gene, was significantly decreased. In conclusion, the results of this study indicate that Al induces osteoblast apoptosis by activating the oxidative stress-mediated JNK pathway, which causes cell injuries and reduces the number and function of osteoblasts, thereby inhibiting bone formation.
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Affiliation(s)
- Xinwei Li
- College of Animal Science and Veterinary Medicine, Jilin University, 5333 Xi'an Road, Changchun, Jilin, 130062, China
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Poole RL, Pieroni KP, Gaskari S, Dixon T, Kerner JA. Aluminum exposure in neonatal patients using the least contaminated parenteral nutrition solution products. Nutrients 2012; 4:1566-74. [PMID: 23201834 PMCID: PMC3509507 DOI: 10.3390/nu4111566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/16/2012] [Accepted: 10/23/2012] [Indexed: 11/23/2022] Open
Abstract
Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN solution products prior to being compounded in the clinical setting [1]. The investigation assessed quantitative Al content of all available products used in the formulation of PN solutions. The objective of this study was to assess the Al exposure in neonatal patients using the least contaminated PN solutions and determine if it is possible to meet the FDA “safe limit” of less than 5 μg/kg/day of Al. The measured concentrations from our previous study were analyzed and the least contaminated products were identified. These concentrations were entered into our PN software and the least possible Al exposure was determined. A significant decrease (41%–44%) in the Al exposure in neonatal patients can be achieved using the least contaminated products, but the FDA “safe limit” of less than 5 μg/kg/day of Al was not met. However, minimizing the Al exposure may decrease the likelihood of developing Al toxicity from PN.
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Affiliation(s)
- Robert L. Poole
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - Kevin P. Pieroni
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304, USA; (K.P.P.); (J.A.K.)
| | - Shabnam Gaskari
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - Tessa Dixon
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - John A. Kerner
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304, USA; (K.P.P.); (J.A.K.)
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Poole RL, Pieroni KP, Gaskari S, Dixon TK, Park K, Kerner JA. Aluminum in pediatric parenteral nutrition products: measured versus labeled content. J Pediatr Pharmacol Ther 2012; 16:92-7. [PMID: 22477831 DOI: 10.5863/1551-6776-16.2.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination). METHODS All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration. RESULTS Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products. CONCLUSIONS The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients.
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Huston RK, Migaki EA. Issues Concerning the Safety of Calcium Chloride in Neonatal Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2012. [DOI: 10.1177/0148607112456297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Identification of Fracture Risk and Strategies for Bone Health in the Neonatal Intensive Care Unit. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e318262d434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Migaki EA, Melhart BJ, Dewar CJ, Huston RK. Calcium Chloride and Sodium Phosphate in Neonatal Parenteral Nutrition Containing TrophAmine. JPEN J Parenter Enteral Nutr 2012; 36:470-5. [DOI: 10.1177/0148607111420154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Robert K. Huston
- The Children’s Hospital at Legacy Emanuel Medical Center, Portland, Oregon
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Wier HA, Kuhn RJ. Aluminum Toxicity in Neonatal Parenteral Nutrition: What Can We Do? Ann Pharmacother 2012; 46:137-40. [DOI: 10.1345/aph.1q399] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aluminum toxicity has been described in patients of all ages who are receiving a variety of therapies, including dialysis, phosphate-binding medications, and parenteral nutrition (PN). Neonates are at an increased risk of aluminum toxicity because of anatomic, physiologic, and nutrition-related factors not present in other populations. In 2004, the Food and Drug Administration recommended restricting daily aluminum administration to 5 μg/kg/day and now requires that additives used to compound PN have the maximum aluminum content at expiration listed on the product label. Although the pharmacist can work to decrease aluminum toxicity in this population, it remains difficult to reach this threshold.
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Affiliation(s)
- Heather Ann Wier
- Heather Ann Wier PharmD, Pediatric and Neonatal Clinical Pharmacy Specialist, Centennial Medical Center, Nashville, TN
| | - Robert J Kuhn
- Robert J Kuhn PharmD, Professor, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY
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Fewtrell MS. Does early nutrition program later bone health in preterm infants? Am J Clin Nutr 2011; 94:1870S-1873S. [PMID: 21543543 DOI: 10.3945/ajcn.110.000844] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Preterm infants are at risk of metabolic bone disease (MBD) because of an inadequate mineral intake. Although infants with MBD are frequently asymptomatic during the neonatal period, we previously reported that MBD predicted reduced linear growth in infancy and midchildhood. Nevertheless, some studies suggest that preterm infants undergo catch-up growth in bone mineralization during infancy. To examine the hypothesis that early nutrition programs affect later bone health and peak bone mass, we studied 20-y-old subjects who were born preterm and who were randomly assigned to a diet during the neonatal period; the diets used varied markedly in nutrient and mineral content, and phosphate supplements were not provided. Despite large variations in early nutrient and mineral intakes (and the occurrence of MBD) during the neonatal period, the randomly assigned diets did not influence peak bone mass or turnover. However, the proportion of (unsupplemented) human milk in the neonatal diet was significantly positively associated with later whole-body bone size and mineral content. Compared with population reference data, preterm subjects were significantly shorter and had lower lumbar spine bone mineral density; the deficits were greatest in those born small for gestational age (ie, a birth weight <1250 g). The lack of effect of the randomly assigned diets on peak bone mass suggests that the observed deficits in height and lumbar spine bone mass may not be related to suboptimal early nutrient or mineral intake. The higher whole-body bone mass associated with human milk intake, despite its very low nutrient content, may instead reflect nonnutritive factors in breast milk. These findings are relevant to discussions on the mineral requirements of preterm infants.
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Affiliation(s)
- Mary S Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom.
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