1
|
Siglin J, Restrepo D. A Break in the Case: an Exercise in Clinical Reasoning. J Gen Intern Med 2024; 39:1515-1518. [PMID: 38499722 PMCID: PMC11169111 DOI: 10.1007/s11606-023-08572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 03/20/2024]
Affiliation(s)
- Jonathan Siglin
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Gray 730, Boston, MA, 02114, USA.
| | - Daniel Restrepo
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Gray 730, Boston, MA, 02114, USA
| |
Collapse
|
2
|
Appiah D, Ingabire-Gasana E, Appiah L, Yang J. The Relation of Serum Vitamin C Concentrations with Alzheimer's Disease Mortality in a National Cohort of Community-Dwelling Elderly Adults. Nutrients 2024; 16:1672. [PMID: 38892605 PMCID: PMC11174700 DOI: 10.3390/nu16111672] [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: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The relation of vitamin C with Alzheimer's disease (AD) is equivocal. The aim of this study was to assess the relation of serum vitamin C levels with AD-related mortality, and to evaluate the threshold beyond which the potential benefits of higher serum concentrations of vitamin C for AD mortality ceases. The cohort consisted of 4504 adults aged ≥60 years enrolled in the National Health and Nutrition Examination Survey who had serum measures of vitamin C and no cognitive impairment at baseline (1988-1994) and were followed-up for mortality until 2019. Vitamin C was assayed from fasting blood samples using isocratic high-performance liquid chromatography. At baseline, the mean age of participants was 70 years, with 42.7% being men. At the end of follow-up (median: 15 years), the AD mortality rate was 2.4 per 1000 person-years. In the Cox regression models, compared to participants in the lowest tertile of serum vitamin C (<0.56 mg/dL), those in the highest tertile (>0.98 mg/dL) had a lower risk of AD mortality (hazard ratio: 0.44, 95% confidence intervals: 0.25-0.77) after adjusting for sociodemographic factors, behavior/lifestyle factors, prevalent health conditions, and dietary vitamin C intake. In dose-response analysis using restricted cubic splines, vitamin C concentrations beyond 2.3 mg/dL were associated with the elevated risk of AD-related mortality. The findings from this national sample of community-dwelling elderly adults suggest that higher levels of serum vitamin C are associated with slower AD disease progression, although levels beyond the normal reference values were associated with a higher risk of AD mortality.
Collapse
Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | | | - Linda Appiah
- College of Education, Texas Tech University, Lubbock, TX 79409, USA
| | - Jeanne Yang
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| |
Collapse
|
3
|
Fletcher BD, Haszard JJ, Vissers MCM, Conner TS. Smartphone survey data reveal the timecourse of changes in mood outcomes following vitamin C or kiwifruit intervention in adults with low vitamin C. Br J Nutr 2024; 131:1384-1396. [PMID: 38073290 PMCID: PMC10950451 DOI: 10.1017/s0007114523002787] [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: 06/18/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
Vitamin C-rich foods can improve mood; however, the timecourse of these benefits is unknown. This study utilised intensive longitudinal smartphone surveys from a three-armed placebo-controlled trial to determine mood-related changes following supplementation with vitamin C (250 mg tablet/d), kiwifruit (2 SunGold™ kiwifruit/d) or a placebo (1 tablet/d). Secondary data were analysed from the KiwiC for Vitality trial (Trial ID: ACTRN12617001031358). Adults (n 155, 63 % female, aged 18-35 years) with low plasma vitamin C (<40 μmol/l) completed a 14-d lead-in, 28-d intervention and 14-d washout. Participants self-reported vitality (SF-36), mood (POMS total mood disturbance), flourishing (flourishing scale), sleep quality, sleep quantity and physical activity every second day using smartphone surveys. Plasma vitamin C, measured fortnightly, reached saturation after 2 weeks of vitamin C or kiwifruit supplementation. Kiwifruit supplementation improved vitality and mood within 4 days, peaking around 14-16 days, and improved flourishing from day 14. Vitamin C marginally improved mood until day 12. Incremental AUC analyses revealed significant overall effects of kiwifruit consumption on vitality and mood compared with placebo, which were stronger than effects for vitamin C tablets, but attenuated when adjusting for covariates. Sensitivity analyses of participants with low baseline vitamin C status revealed improved mood (vitamin C and kiwifruit) and flourishing (kiwifruit only). This is the first study to use intensive smartphone surveys to model the day-to-day timecourse of mood-related states following vitamin C intervention and highlights the value of using smartphone surveys to reveal the temporal changes in mood-related outcomes following nutrient supplementation.
Collapse
Affiliation(s)
- Benjamin D. Fletcher
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Margreet C. M. Vissers
- Centre for Free Radical Research, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Tamlin S. Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
| |
Collapse
|
4
|
Radulescu D, Mihai FD, Trasca MET, Caluianu EI, Calafeteanu CDM, Radulescu PM, Mercut R, Ciupeanu-Calugaru ED, Marinescu GA, Siloşi CA, Nistor CCE, Danoiu S. Oxidative Stress in Military Missions-Impact and Management Strategies: A Narrative Analysis. Life (Basel) 2024; 14:567. [PMID: 38792589 PMCID: PMC11121804 DOI: 10.3390/life14050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
This narrative review comprehensively examines the impact of oxidative stress on military personnel, highlighting the crucial role of physical exercise and tailored diets, particularly the ketogenic diet, in minimizing this stress. Through a meticulous analysis of the recent literature, the study emphasizes how regular physical exercise not only enhances cardiovascular, cognitive, and musculoskeletal health but is also essential in neutralizing the effects of oxidative stress, thereby improving endurance and performance during long-term missions. Furthermore, the implementation of the ketogenic diet provides an efficient and consistent energy source through ketone bodies, tailored to the specific energy requirements of military activities, and significantly contributes to the reduction in reactive oxygen species production, thus protecting against cellular deterioration under extreme stress. The study also underlines the importance of integrating advanced technologies, such as wearable devices and smart sensors that allow for the precise and real-time monitoring of oxidative stress and physiological responses, thus facilitating the customization of training and nutritional regimes. Observations from this review emphasize significant variability among individuals in responses to oxidative stress, highlighting the need for a personalized approach in formulating intervention strategies. It is crucial to develop and implement well-monitored, personalized supplementation protocols to ensure that each member of the military personnel receives a regimen tailored to their specific needs, thereby maximizing the effectiveness of measures to combat oxidative stress. This analysis makes a valuable contribution to the specialized literature, proposing a detailed framework for addressing oxidative stress in the armed forces and opening new directions for future research with the aim of optimizing clinical practices and improving the health and performance of military personnel under stress and specific challenges of the military field.
Collapse
Affiliation(s)
- Dumitru Radulescu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania; (D.R.); (E.-I.C.); (P.-M.R.); (G.-A.M.)
| | - Florina-Diana Mihai
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania;
| | - Major Emil-Tiberius Trasca
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania; (D.R.); (E.-I.C.); (P.-M.R.); (G.-A.M.)
| | - Elena-Irina Caluianu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania; (D.R.); (E.-I.C.); (P.-M.R.); (G.-A.M.)
| | - Captain Dan Marian Calafeteanu
- Department of Ortopedics, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania;
| | - Patricia-Mihaela Radulescu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania; (D.R.); (E.-I.C.); (P.-M.R.); (G.-A.M.)
| | - Razvan Mercut
- Department of Plastic and Reconstructive Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Georgiana-Andreea Marinescu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania; (D.R.); (E.-I.C.); (P.-M.R.); (G.-A.M.)
| | - Cristian-Adrian Siloşi
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania;
| | | | - Suzana Danoiu
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| |
Collapse
|
5
|
Gaieski DF. Scurvy: A Rare Disease or a Rare Diagnosis? J Emerg Trauma Shock 2024; 17:53-57. [PMID: 39070860 PMCID: PMC11279507 DOI: 10.4103/jets.jets_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 07/30/2024] Open
Abstract
Introduction Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness's sake. Methods We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described. Results There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED. Conclusion The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.
Collapse
Affiliation(s)
- David F. Gaieski
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
6
|
Golder JE, Bauer JD, Barker LA, Lemoh CN, Gibson SJ, Davidson ZE. Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review. Nutr Rev 2024:nuad157. [PMID: 38219216 DOI: 10.1093/nutrit/nuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).
Collapse
Affiliation(s)
- Janet E Golder
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Nutrition and Dietetics Department, Allied Health, Monash Health, Melbourne, Victoria, Australia
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa A Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher N Lemoh
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne, Victoria, Australia
| | - Simone J Gibson
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Chiscano-Camón L, Ruiz-Rodriguez JC, Plata-Menchaca EP, Martin L, Bajaña I, Martin-Rodríguez C, Palmada C, Ferrer-Costa R, Camos S, Villena-Ortiz Y, Ribas V, Ruiz-Sanmartin A, Pérez-Carrasco M, Ferrer R. Vitamin C deficiency in critically ill COVID-19 patients admitted to intensive care unit. Front Med (Lausanne) 2023; 10:1301001. [PMID: 38188336 PMCID: PMC10769492 DOI: 10.3389/fmed.2023.1301001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives To determine vitamin C plasma kinetics, through the measurement of vitamin C plasma concentrations, in critically ill Coronavirus infectious disease 2019 (COVID-19) patients, identifying eventually the onset of vitamin C deficiency. Design Prospective, observational, single-center study. Setting Intensive Care Unit (ICU), Vall d'Hebron University Hospital, Barcelona. Study period from November 12th, 2020, to February 24th, 2021. Patients Patients who had a severe hypoxemic acute respiratory failure due to COVID-19 were included. Interventions Plasma vitamin C concentrations were measured on days 1, 5, and 10 of ICU admission. There were no vitamin C enteral nor parenteral supplementation. The supportive treatment was performed following the standard of care or acute respiratory distress syndrome (ARDS) patients. Measurement Plasma vitamin C concentrations were analyzed using an ultra-performance liquid chromatography (UPLC) system with a photodiode array detector (wavelength set to 245 nm). We categorized plasmatic levels of vitamin C as follows: undetectable: < 1,5 mg/L, deficiency: <2 mg/L. Low plasma concentrations: 2-5 mg/L; (normal plasma concentration: > 5 mg/L). Main results Forty-three patients were included (65% men; mean age 62 ± 10 years). The median Sequential Organ Failure Assessment (SOFA) score was 3 (1-4), and the Acute Physiology and Chronic Health disease Classification System (APACHE II) score was 13 (10-22). Five patients had shock. Bacterial coinfection was documented in 7 patients (16%). Initially all patients required high-flow oxygen therapy, and 23 (53%) further needed invasive mechanical ventilation during 21 (± 10) days. The worst PaO2/FIO2 registered was 93 (± 29). ICU and hospital survival were 77 and 74%, respectively. Low or undetectable levels remained constant throughout the study period in the vast majority of patients. Conclusion This observational study showed vitamin C plasma levels were undetectable on ICU admission in 86% of patients with acute respiratory failure due to COVID-19 pneumonia requiring respiratory support. This finding remained consistent throughout the study period.
Collapse
Affiliation(s)
- Luis Chiscano-Camón
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona, Bellatera, Spain
| | - Juan Carlos Ruiz-Rodriguez
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona, Bellatera, Spain
| | - Erika P. Plata-Menchaca
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Martin
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ivan Bajaña
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Martin-Rodríguez
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Palmada
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Roser Ferrer-Costa
- Clinical Biochemistry Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Silvia Camos
- Clinical Biochemistry Laboratory, ICS-IAS Girona Clinical Laboratory, Doctor Josep Trueta University Hospital, Girona, Spain
| | - Yolanda Villena-Ortiz
- Clinical Biochemistry Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicent Ribas
- Fundació Eurecat Centre Tecnològic de Catalunya, Catalonia, Spain
| | - Adolf Ruiz-Sanmartin
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marcos Pérez-Carrasco
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Biochemistry Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
8
|
Hashizume H, Ishikawa Y, Ajima S. Modern scurvy revisited: Japanese cases of a "forgotten" disease. J Dermatol 2023; 50:e388-e389. [PMID: 37485719 DOI: 10.1111/1346-8138.16891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Hideo Hashizume
- Department of Dermatology, Iwata City Hospital, Iwata, Japan
| | - Yuto Ishikawa
- Department of Dermatology, Iwata City Hospital, Iwata, Japan
| | - Sayaka Ajima
- Department of Dermatology, Iwata City Hospital, Iwata, Japan
| |
Collapse
|
9
|
Gandhi M, Elfeky O, Ertugrul H, Chela HK, Daglilar E. Scurvy: Rediscovering a Forgotten Disease. Diseases 2023; 11:78. [PMID: 37366866 DOI: 10.3390/diseases11020078] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a nutritional deficiency caused by low vitamin C levels that has been described since ancient times. It leads to a varied presentation, affecting multiple organ systems due to its role in the biochemical reactions of connective tissue synthesis. Common manifestations include gingival bleeding, arthralgias, skin discoloration, impaired wound healing, perifollicular hemorrhage, and ecchymoses. Although there has been a dramatic reduction in the prevalence of scurvy in modern times owing to vitamin C supplementation and intake, sporadic cases still occur. In developed countries, it is mainly diagnosed in the elderly and malnourished individuals and is associated with alcoholism, low socio-economic status, and poor dietary habits. Scurvy has been an unusual cause of gastrointestinal (GI) bleeding among other GI manifestations. It can be adequately treated and prevented via vitamin C supplementation.
Collapse
Affiliation(s)
- Mustafa Gandhi
- Department of Internal Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Omar Elfeky
- Department of Medicine, University of Florida, Leesburg, FL 32611, USA
| | - Hamza Ertugrul
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| |
Collapse
|
10
|
Semenetz ZJ, Al-Jaberi L, Brescia AC, Saul D, Holton RS. An Atypical Case of Scurvy in an Adolescent With Sacroiliitis. Clin Pediatr (Phila) 2022; 61:826-829. [PMID: 35746876 DOI: 10.1177/00099228221106426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zachary J Semenetz
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - David Saul
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
11
|
Carroll M, Yoon J, Elliot P. Scurvy: Rare Orthopaedic Complications Associated with Multinutritional Deficiencies. Eur J Case Rep Intern Med 2022; 9:003359. [PMID: 36506738 PMCID: PMC9728213 DOI: 10.12890/2022_003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Suboptimal nutrition can lead to deficiencies in micronutrients such as ascorbic acid (vitamin C), which can present with catastrophic neurological sequelae. Deficiencies of vitamin C, vitamin B3 (niacin) and zinc levels contribute to reduced bone density. Vitamin C associated vertebral fractures, although rare in adults, are still treatable if diagnosed early with a thorough clinical and nutritional history, and early supplementation. Radiological clues suggestive of scurvy-induced vertebral fractures can be diagnosed on plain X-ray and MRI spine imaging. LEARNING POINTS Although nutritional deficits like scurvy, pellagra and zinc deficiency are rare, early recognition and prompt treatment can prevent critical neurological sequelae.Clinical history including nutritional intake and associated patient symptoms are vital to diagnose scurvy-related vertebral fractures, which are treatable.It is important to note that scurvy can also present in an adult population.
Collapse
|
12
|
Kwon D, Lee W, Kim SH, Jung YS. Comparison of Hepatic Metabolite Profiles between Infant and Adult Male Mice Using 1H-NMR-Based Untargeted Metabolomics. Metabolites 2022; 12:metabo12100910. [PMID: 36295812 PMCID: PMC9611911 DOI: 10.3390/metabo12100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
Although age-related characteristics of hepatic metabolism are reported, those in infants are not fully understood. In the present study, we performed untargeted metabolomic profiling of the livers of infant (3-week-old) and adult (9-week-old) male ICR mice using 1H-NMR spectroscopy and compared 35 abundant hepatic metabolite concentrations between the two groups. The liver/body weight ratio did not differ between the two groups; however, serum glucose, blood urea nitrogen, total cholesterol, and triglyceride concentrations were lower in infants than in adults. Hepatic carbohydrate metabolites (glucose, maltose, and mannose) were higher, whereas amino acids (glutamine, leucine, methionine, phenylalanine, tyrosine, and valine) were lower in infant mice than in adult mice. The concentrations of ascorbate, betaine, sarcosine, and ethanolamine were higher, whereas those of taurine, inosine, and O-phosphocholine were lower in infant mice than in adult mice. The differences in liver metabolites between the two groups could be due to differences in their developmental stages and dietary sources (breast milk for infants and laboratory chow for adults). The above results provide insights into the hepatic metabolism in infants; however, the exact implications of the findings require further investigation.
Collapse
Affiliation(s)
- Doyoung Kwon
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Korea
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju 690-756, Korea
| | - Wonho Lee
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Korea
| | - Sou Hyun Kim
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Korea
- Correspondence: (S.H.K.); (Y.-S.J.); Tel.: +82-51-5102816 (Y.-S.J.)
| | - Young-Suk Jung
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Korea
- Correspondence: (S.H.K.); (Y.-S.J.); Tel.: +82-51-5102816 (Y.-S.J.)
| |
Collapse
|
13
|
Jo H, Lee D, Go C, Jang Y, Chu N, Bae S, Kang D, Im JP, Kim Y, Kang JS. Preventive Effect of Vitamin C on Dextran Sulfate Sodium (DSS)-Induced Colitis via the Regulation of IL-22 and IL-6 Production in Gulo(−/−) Mice. Int J Mol Sci 2022; 23:ijms231810612. [PMID: 36142515 PMCID: PMC9505994 DOI: 10.3390/ijms231810612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/24/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Reactive oxygen species (ROS), which are exceptionally high in IBD lesions, are known to cause abnormal immune responses to inflammatory reactions in inflammatory bowel diseases (IBD) through damage to the intestinal mucosal linings. Moreover, they are theorized to be an agent of IBD development. Vitamin C is widely known to be an effective antioxidant for its ability to regulate inflammatory responses through its ROS scavenging effect. Therefore, we examined vitamin C’s influence on the development and progression of IBD in Gulo(−/−) mice, which cannot synthesize vitamin C like humans due to a defect in the expression of L-gulono-γ–lactone oxidase, an essential enzyme for vitamin C production. First, we found extensive oxidative stress and an inflammation increase in the colon of vitamin C-insufficient Gulo(−/−) mice. We also found decreased IL-22 production and NKp46(+) cell recruitment and the impaired activation of the p38MAPK pathway. Additionally, comparing vitamin C-insufficient Gulo(−/−) mice to vitamin C-sufficient Gulo(−/−) mice and wild-type mice, the insufficient group faced a decrease in mucin-1 expression, accompanied by an increase in IL-6 production, followed by the activation of the STAT3 and Akt pathways. The results suggest that vitamin C insufficiency induces severe colitis, meaning vitamin C could also take on a preventative role by regulating the production of cytokines and the induction of inflammation.
Collapse
Affiliation(s)
- Hyejung Jo
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dahae Lee
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Cheolhyeon Go
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yoojin Jang
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Naghyung Chu
- Department of Biology, College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA
| | - Suhyun Bae
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dongmin Kang
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA 02215, USA
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yejin Kim
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
- Medical Research Center, Institute of Allergy and Clinical Immunology, Seoul National University, Seoul 03080, Korea
- Correspondence: (Y.K.); (J.S.K.)
| | - Jae Seung Kang
- Laboratory of Vitamin C and Antioxidant Immunology, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul 03080, Korea
- Medical Research Center, Institute of Allergy and Clinical Immunology, Seoul National University, Seoul 03080, Korea
- Artificial Intelligence Institute, Seoul National University, Seoul 08826, Korea
- Correspondence: (Y.K.); (J.S.K.)
| |
Collapse
|
14
|
Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol 2022; 8:4. [PMID: 35818085 PMCID: PMC9275129 DOI: 10.1186/s40748-022-00139-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/13/2022] [Indexed: 01/21/2023] Open
Abstract
The blood levels of most vitamins decrease during pregnancy if un-supplemented, including vitamins A, C, D, K, B1, B3, B5, B6, folate, biotin, and B12. Sub-optimal intake of vitamins from preconception through pregnancy increases the risk of many pregnancy complications and infant health problems. In the U.S., dietary intake of vitamins is often below recommended intakes, especially for vitamin D, choline and DHA. Many studies suggest that insufficient vitamin intake is associated with a wide range of pregnancy complications (anemia, Cesarean section, depression, gestational diabetes, hypertension, infertility, preeclampsia, and premature rupture of membranes) and infant health problems (asthma/wheeze, autism, low birth weight, congenital heart defects, intellectual development, intrauterine growth restriction, miscarriage, neural tube defects, orofacial defects, and preterm birth). The primary goal of this paper is to review the research literature and propose evidence-based recommendations for the optimal level of prenatal supplementation for each vitamin for most women in the United States. A secondary goal was to compare these new recommendations with the levels of vitamins in over 180 commercial prenatal supplements. The analysis found that prenatal supplements vary widely in content, often contained only a subset of essential vitamins, and the levels were often below our recommendations. This suggests that increasing prenatal vitamin supplementation to the levels recommended here may reduce the incidence of many pregnancy complications and infant health problems which currently occur.
Collapse
|
15
|
Abstract
OBJECTIVES To evaluate the presence of vitamin C deficiency in critically ill children admitted to the PICU. DESIGN Single-center prospective observational cohort study. SETTING A 28-bed PICU and a pediatric outpatient sedation room of a tertiary-care teaching hospital. PATIENTS Two pediatric patient groups 0-21 years old were studied: a PICU group and a group receiving deep sedation for elective outpatient procedures (noncritical care group). INTERVENTIONS Vitamin C level was drawn for the PICU group within 24 hours of admission. Vitamin C level was drawn prior to start of deep sedation for the noncritical group. MEASUREMENT AND MAIN RESULTS Vitamin C deficiency was present in 11/60 (18%) in the PICU group and 0/21 (0%) of the noncritical group (p < 0.05). CONCLUSIONS Vitamin C deficiency was prevalent in our patients admitted to PICU.
Collapse
|
16
|
Holton KF. Micronutrients May Be a Unique Weapon Against the Neurotoxic Triad of Excitotoxicity, Oxidative Stress and Neuroinflammation: A Perspective. Front Neurosci 2021; 15:726457. [PMID: 34630015 PMCID: PMC8492967 DOI: 10.3389/fnins.2021.726457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 12/21/2022] Open
Abstract
Excitotoxicity has been implicated in many neurological disorders and is a leading cause of oxidative stress and neuroinflammation in the nervous system. Most of the research to date has focused on each of these conditions individually; however, excitotoxicity, oxidative stress, and neuroinflammation have the ability to influence one another in a self-sustaining manner, thus functioning as a "neurotoxic triad." This perspective article re-introduces the concept of the neurotoxic triad and reviews how specific dietary micronutrients have been shown to protect against not only oxidative stress, but also excitotoxicity and neuroinflammation. Future dietary interventions for neurological disorders could focus on the effects on all three aspects of the neurotoxic triad.
Collapse
Affiliation(s)
- Kathleen F Holton
- Nutritional Neuroscience Lab, Department of Health Studies, Center for Neuroscience and Behavior, American University, Washington, DC, United States
| |
Collapse
|
17
|
Affiliation(s)
- Cayla Pichan
- From the University of Michigan Medical School (C.P.), the Department of Internal Medicine, University of Michigan Medical School (A.C., S.S., N.H.), the Veterans Affairs Ann Arbor Healthcare System Medicine Service (A.C., S.S., N.H.), and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Department of Medicine, University of California San Francisco, and the San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D.)
| | - Gurpreet Dhaliwal
- From the University of Michigan Medical School (C.P.), the Department of Internal Medicine, University of Michigan Medical School (A.C., S.S., N.H.), the Veterans Affairs Ann Arbor Healthcare System Medicine Service (A.C., S.S., N.H.), and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Department of Medicine, University of California San Francisco, and the San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D.)
| | - Alice Cusick
- From the University of Michigan Medical School (C.P.), the Department of Internal Medicine, University of Michigan Medical School (A.C., S.S., N.H.), the Veterans Affairs Ann Arbor Healthcare System Medicine Service (A.C., S.S., N.H.), and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Department of Medicine, University of California San Francisco, and the San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D.)
| | - Sanjay Saint
- From the University of Michigan Medical School (C.P.), the Department of Internal Medicine, University of Michigan Medical School (A.C., S.S., N.H.), the Veterans Affairs Ann Arbor Healthcare System Medicine Service (A.C., S.S., N.H.), and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Department of Medicine, University of California San Francisco, and the San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D.)
| | - Nathan Houchens
- From the University of Michigan Medical School (C.P.), the Department of Internal Medicine, University of Michigan Medical School (A.C., S.S., N.H.), the Veterans Affairs Ann Arbor Healthcare System Medicine Service (A.C., S.S., N.H.), and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Department of Medicine, University of California San Francisco, and the San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D.)
| |
Collapse
|
18
|
Shi L, Rath M, Niedzwiecki A. Dietary Vitamin C and Age-Induced Lipid and Hormonal Metabolic Changes in a Humanized Mouse Model Not Synthesizing Vitamin C and Producing Lipoprotein(a) [Gulo (-/-); Lp(a)+]. J Nutr Metab 2021; 2021:5591697. [PMID: 34221500 PMCID: PMC8221897 DOI: 10.1155/2021/5591697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 01/12/2023] Open
Abstract
The lack of ability to produce vitamin C innately and the ability to synthesize human lipoprotein(a) (Lp(a)) are two unique metabolic features present in humans, compared with most other animal species. The Gulo (-/-) and Lp(a)+ mouse model displays these two features and is therefore suitable for the study of metabolic aspects relevant to human metabolism. It is a well-known fact that vitamin C is essential in collagen synthesis, and in maintaining extracellular matrix integrity, as well as being a powerful antioxidant and cofactor in many metabolic pathways, which makes it a critically important micronutrient for health and healthy aging. In this study, we investigated the effects of a long-term intake of high and low doses of vitamin C on age-related metabolic lipid and hormonal changes in young (eight to nine months), mid-aged (one year), and old (two years) Gulo (-/-) and Lp(a)+ mice. We observed that chronic vitamin C deficiency resulted in a less healthy metabolic lipid profile, impaired serum insulin-like growth factor (IGF-1), and sex-hormones secretion, all of which can accelerate the development of various pathological conditions in the aging process. The most susceptible to the negative impact of vitamin C deficiency were the young (eight to nine months) and old (two years) mice. Our study conducted in this humanized mouse model indicates that sustained adequate vitamin C intake is essential in maintaining a healthier metabolic profile, important in preventing age-related pathologies throughout the aging process.
Collapse
Affiliation(s)
- Lei Shi
- Dr. Rath Research Institute, 5941 Optical Ct, San Jose, California 95138, USA
| | - Matthias Rath
- Dr. Rath Research Institute, 5941 Optical Ct, San Jose, California 95138, USA
| | | |
Collapse
|
19
|
Rodd BG, Tas AA, Taylor KDA. Dysphagia, texture modification, the elderly and micronutrient deficiency: a review. Crit Rev Food Sci Nutr 2021; 62:7354-7369. [PMID: 33905267 DOI: 10.1080/10408398.2021.1913571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dysphagia is an underlying symptom of many health issues affecting a person's ability to swallow. Being unable to swallow correctly may limit food intake and subsequently micronutrient status. The elderly may be the most at risk group of suffering dysphagia as well as most likely to be deficient in micronutrients. The use of texture-modified meals is a common approach to increasing dysphagia sufferer's food intake. The modification of food may affect the micronutrient content and currently there is a limited number of studies focusing on micronutrient content of texture-modified meals. This review considers the prevalence of dysphagia within the elderly UK community whilst assessing selected micronutrients. Vitamin B12, C, D, folate, zinc and iron, which are suggested to be most likely deficient in the general elderly UK population, were reviewed. Each micronutrient is considered in terms of prevalence of deficiency, metabolic function, food source and processing stability to provide an overview with respect to elderly dysphagia sufferers.
Collapse
Affiliation(s)
- B G Rodd
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - A A Tas
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - K D A Taylor
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| |
Collapse
|
20
|
Hujoel PP, Kato T, Hujoel IA, Hujoel MLA. Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials. Nutr Rev 2021; 79:964-975. [PMID: 33517432 DOI: 10.1093/nutrit/nuaa115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. OBJECTIVES (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. DATA SOURCES Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. RESULTS In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 μmol/L (standardized mean difference [SMD], -0.83; 95%CI, -1.16 to -0.49; P < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48 μmol/L or unknown (respective standardized mean differences: -0.23, 95%CI, -0.45 to -0.01, P < 0.05; and -0.56; 95%CI: -1.19 to 0.06, P < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11-28 μmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22-1.77; and 1.64; 95%CI: 1.32-2.03; P < 0.001 for both). CONCLUSION Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.
Collapse
Affiliation(s)
- Philippe P Hujoel
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Tomotaka Kato
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Isabel A Hujoel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaux L A Hujoel
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Patterson T, Isales CM, Fulzele S. Low level of Vitamin C and dysregulation of Vitamin C transporter might be involved in the severity of COVID-19 Infection. Aging Dis 2021; 12:14-26. [PMID: 33532123 PMCID: PMC7801272 DOI: 10.14336/ad.2020.0918] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 01/02/2023] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been spreading around the world at an exponential pace, leading to millions of individuals developing the associated disease called COVID-19. Due to the novel nature and the lack of immunity within humans, there has been a collective global effort to find effective treatments against the virus. This has led the scientific community to repurpose Food and Drug Administration (FDA) approved drugs with known safety profiles. Of the many possible drugs, vitamin C has been on the shortlist of possible interventions due to its beneficial role as an immune booster and inherent antioxidant properties. Within this manuscript, a detailed discussion regarding the intracellular function and inherent properties of vitamin C is conducted. It also provides a comprehensive review of published research pertaining to the differences in expression of the vitamin C transporter under several pathophysiologic conditions. Finally, we review recently published research investigating the efficacy of vitamin C administration in treating viral infection and life-threatening conditions. Overall, this manuscript aims to present existing information regarding the extent to which vitamin C can be an effective treatment for COVID-19 and possible explanations as to why it may work in some individuals but not in others.
Collapse
Affiliation(s)
- Taylor Patterson
- Department of Medicine, Augusta University, Augusta, GA 30912, USA.
| | - Carlos M Isales
- Center for Healthy Aging, Augusta University, Augusta, GA 30912, USA
- Department of Cell biology and anatomy, Augusta University, Augusta, GA 30912, USA
| | - Sadanand Fulzele
- Department of Medicine, Augusta University, Augusta, GA 30912, USA.
- Center for Healthy Aging, Augusta University, Augusta, GA 30912, USA
- Department of Cell biology and anatomy, Augusta University, Augusta, GA 30912, USA
| |
Collapse
|
22
|
Xing Y, Zhao B, Yin L, Guo M, Shi H, Zhu Z, Zhang L, He J, Ling Y, Gao M, Lu H, Mao E, Zhang L. Vitamin C supplementation is necessary for patients with coronavirus disease: An ultra-high-performance liquid chromatography-tandem mass spectrometry finding. J Pharm Biomed Anal 2021; 196:113927. [PMID: 33549875 PMCID: PMC7839397 DOI: 10.1016/j.jpba.2021.113927] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
To administer vitamin C (VC) with precision to patients with the coronavirus disease (COVID-19), we developed an ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to assess plasma VC concentrations. 31 patients with COVID-19 and 51 healthy volunteers were enrolled. VC stability was evaluated in blood, plasma, and precipitant-containing stabilizers. A proportion of 7.7 % of VC was degraded in blood at room temperature (RT) (approximately 20–25 °C) at 1.5 h post administration with respect to the proportion degraded at 0.5 h, but without statistical difference. VC was stable in plasma for 0.75 h at RT, 2 h at 4 °C, 5 days at −40 °C, and 4 h in precipitant-containing stabilizer (2 % oxalic acid) at RT. The mean plasma concentration of VC in patients with COVID-19 was 2.00 mg/L (0.5–4.90) (n = 8), which was almost 5-fold lower than that in healthy volunteers (9.23 mg/L (3.09. 35.30)) (n = 51). After high-dose VC treatment, the mean VC concentration increased to 13.46 mg/L (3.93. 34.70) (n = 36), higher than that in healthy volunteers, and was within the normal range (6–20 mg/L). In summary, we developed a simple UPLC-MS/MS method to quantify VC in plasma, and determined the duration for which the sample remained stable. VC levels in patients with COVID-19 were considerably low, and supplementation at 100 mg/kg/day is considered highly essential.
Collapse
Affiliation(s)
- Yaru Xing
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Bing Zhao
- Ruijin Hospital, Jiaotong University, Shanghai 200025, China
| | - Lin Yin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Mingquan Guo
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Huichun Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhaoqin Zhu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Juan He
- Ruijin Hospital, Jiaotong University, Shanghai 200025, China
| | - Yun Ling
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Menglu Gao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
| | - Enqiang Mao
- Ruijin Hospital, Jiaotong University, Shanghai 200025, China.
| | - Lijun Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
| |
Collapse
|
23
|
Benton D, Young HA. Role of fruit juice in achieving the 5-a-day recommendation for fruit and vegetable intake. Nutr Rev 2021; 77:829-843. [PMID: 31504822 PMCID: PMC6786897 DOI: 10.1093/nutrit/nuz031] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Although there is strong evidence that consumption of fruit and vegetables is associated with a reduced rate of all-cause mortality, only a minority of the population consumes 5 servings a day, and campaigns to increase intake have had limited success. This review examines whether encouraging the consumption of fruit juice might offer a step toward the 5-a-day target. Reasons given for not consuming whole fruit involve practicalities, inconvenience, and the effort required. Psychologically, what is important is not only basic information about health, but how individuals interpret their ability to implement that information. It has been argued that fruit juice avoids the problems that commonly prevent fruit consumption and thus provides a practical means of increasing intake and benefitting health through an approach with which the population can readily engage. Those arguing against consuming fruit juice emphasize that it is a source of sugar lacking fiber, yet juice provides nutrients such as vitamin C, carotenoids, and polyphenols that offer health-related benefits. Actively encouraging the daily consumption of fruit juice in public health policy could help populations achieve the 5-a-day recommendation for fruit and vegetable intake.
Collapse
Affiliation(s)
- David Benton
- Department of Psychology, Swansea University, Wales, United Kingdom
| | - Hayley A Young
- Department of Psychology, Swansea University, Wales, United Kingdom
| |
Collapse
|
24
|
Vitamin C and Cardiovascular Disease: An Update. Antioxidants (Basel) 2020; 9:antiox9121227. [PMID: 33287462 PMCID: PMC7761826 DOI: 10.3390/antiox9121227] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
The potential beneficial effects of the antioxidant properties of vitamin C have been investigated in a number of pathological conditions. In this review, we assess both clinical and preclinical studies evaluating the role of vitamin C in cardiac and vascular disorders, including coronary heart disease, heart failure, hypertension, and cerebrovascular diseases. Pitfalls and controversies in investigations on vitamin C and cardiovascular disorders are also discussed.
Collapse
|
25
|
Guellich A, Tella E, Mahé E. [Scurvy presenting with low-extremity necrotic and purpuric ulcers: Two cases]. Rev Med Interne 2020; 42:214-217. [PMID: 33203540 DOI: 10.1016/j.revmed.2020.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scurvy is a clinical syndrome resulting from ascorbic acid deficiency. Although presently rare in the developed world, it continues to occur within certain susceptible populations, particularly the elderly and those with dietary habits with low vitamin C intake. CASES Two men aged 87 and 69 were referred with multifactorial, progressive ulceration of the lower limbs, without scarring, in a context of arterial disease and other associated comorbidities. In both cases, the level of vitamin C was undetectable. An improvement in the necrotic component and in the purpura was promptly observed after vitamin C supplementation. CONCLUSIONS Diagnosis of scurvy can be challenging. This report highlights the importance of maintaining a high index of suspicion for scurvy in atypical necrotic ulcerations of lower extremities with poor response to standard therapy especially in populations at high risk of vitamin C deficiency. Early diagnosis can improve patient prognosis.
Collapse
Affiliation(s)
- A Guellich
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France.
| |
Collapse
|
26
|
The Effects of Surgery on Plasma/Serum Vitamin C Concentrations: A Systematic Review and Meta-Analysis. Br J Nutr 2020; 127:233-247. [DOI: 10.1017/s0007114520004353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Vitamin C (ascorbic acid) is a water soluble vitamin with an array of biological functions. A number of proposed factors contribute to the vitamin’s plasma bioavailability and ability to exert optimal functionality. The aim of this review was to systematically assess plasma vitamin C levels post-surgery compared with pre-surgery/ the magnitude and timeframe of potential changes in concentration. We searched the PUBMED, SCOPUS, SciSearch and the Cochrane Library databases between 1970 to April 2020 for relevant research papers. Prospective studies, control groups and true placebo groups derived from controlled trials that reported means and standard deviations of plasma vitamin C concentrations pre and post operatively were included into the meta-analysis. Data were grouped into short-term (≤7 days) and long term (> 7 days) post-operative follow-up. 23 of 31 studies involving 642 patients included in the systematic review were suitable for meta-analysis. Pooled data from the meta-analysis revealed a mean depletion of plasma vitamin C concentration of -17.99 µmol/L (39% depletion) (CI = -22.81, -13.17) (trial arms = 25, n = 565, p < 0.001) during the first post-operative week and -18.80 µmol/L (21% depletion) (-25.04, -12.56) (trial arms = 6, n = 166, p < 0.001) 2-3 months post-operatively. Subgroup analyses revealed that these depletions occurred following different types of surgery, however, high heterogeneity was observed amongst trials assessing concentration change during the first post-operative week. Overall, our results warrant larger, long term investigations of changes in post-operative plasma vitamin C concentrations and their potential effects on clinical symptomology.
Collapse
|
27
|
Cerullo G, Negro M, Parimbelli M, Pecoraro M, Perna S, Liguori G, Rondanelli M, Cena H, D’Antona G. The Long History of Vitamin C: From Prevention of the Common Cold to Potential Aid in the Treatment of COVID-19. Front Immunol 2020; 11:574029. [PMID: 33193359 PMCID: PMC7655735 DOI: 10.3389/fimmu.2020.574029] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
From Pauling's theories to the present, considerable understanding has been acquired of both the physiological role of vitamin C and of the impact of vitamin C supplementation on the health. Although it is well known that a balanced diet which satisfies the daily intake of vitamin C positively affects the immune system and reduces susceptibility to infections, available data do not support the theory that oral vitamin C supplements boost immunity. No current clinical recommendations support the possibility of significantly decreasing the risk of respiratory infections by using high-dose supplements of vitamin C in a well-nourished general population. Only in restricted subgroups (e.g., athletes or the military) and in subjects with a low plasma vitamin C concentration a supplementation may be justified. Furthermore, in categories at high risk of infection (i.e., the obese, diabetics, the elderly, etc.), a vitamin C supplementation can modulate inflammation, with potential positive effects on immune response to infections. The impact of an extra oral intake of vitamin C on the duration of a cold and the prevention or treatment of pneumonia is still questioned, while, based on critical illness studies, vitamin C infusion has recently been hypothesized as a treatment for COVID-19 hospitalized patients. In this review, we focused on the effects of vitamin C on immune function, summarizing the most relevant studies from the prevention and treatment of common respiratory diseases to the use of vitamin C in critical illness conditions, with the aim of clarifying its potential application during an acute SARS-CoV2 infection.
Collapse
Affiliation(s)
- Giuseppe Cerullo
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Massimo Negro
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)—Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Mauro Parimbelli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)—Sport Medicine Centre, University of Pavia, Voghera, Italy
| | | | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir, Bahrain
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Hellas Cena
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
| | - Giuseppe D’Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)—Sport Medicine Centre, University of Pavia, Voghera, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
28
|
Lewis LN, Hayhoe RPG, Mulligan AA, Luben RN, Khaw KT, Welch AA. Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass. J Nutr 2020; 150:2789-2798. [PMID: 32851397 PMCID: PMC7549302 DOI: 10.1093/jn/nxaa221] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Age-related loss of skeletal muscle mass contributes to poor outcomes including sarcopenia, physical disability, frailty, type 2 diabetes, and mortality. Vitamin C has physiological relevance to skeletal muscle and may protect it during aging, but few studies have investigated its importance in older populations. OBJECTIVES We aimed to investigate cross-sectional associations of dietary and plasma vitamin C with proxy measures of skeletal muscle mass in a large cohort of middle- and older-aged individuals. METHODS We analyzed data from >13,000 men and women in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, aged 42-82 y. Fat-free mass (FFM), as a proxy for skeletal muscle mass, was estimated using bioelectrical impedance analysis and expressed as a percentage of total mass (FFM%) or standardized by BMI (FFMBMI). Dietary vitamin C intakes were calculated from 7-d food diary data, and plasma vitamin C was measured in peripheral blood. Multivariable regression models, including relevant lifestyle, dietary, and biological covariates, were used to determine associations between FFM measures and quintiles of dietary vitamin C or insufficient compared with sufficient plasma vitamin C (<50 μmol/L and ≥50 μmol/L). RESULTS Positive trends were found across quintiles of dietary vitamin C and FFM measures for both sexes, with interquintile differences in FFM% and FFMBMI of 1.0% and 2.3% for men and 1.9% and 2.9% for women, respectively (all P < 0.001). Similarly, FFM% and FFMBMI measures were higher in participants with sufficient than with insufficient plasma vitamin C: by 1.6% and 2.0% in men, and 3.4% and 3.9% in women, respectively (all P < 0.001). Associations were also evident in analyses stratified into <65-y and ≥65-y age groups. CONCLUSIONS Our findings of positive associations, of both dietary and circulating vitamin C with measures of skeletal muscle mass in middle- and older-aged men and women, suggest that dietary vitamin C intake may be useful for reducing age-related muscle loss.
Collapse
Affiliation(s)
- Lucy N Lewis
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Richard P G Hayhoe
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Angela A Mulligan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Ailsa A Welch
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
29
|
Coelho JM, Cansanção K, Perez RDM, Leite NC, Padilha P, Ramalho A, Peres W. Association between serum and dietary antioxidant micronutrients and advanced liver fibrosis in non-alcoholic fatty liver disease: an observational study. PeerJ 2020; 8:e9838. [PMID: 32995080 PMCID: PMC7502233 DOI: 10.7717/peerj.9838] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite clinical trials with antioxidant supplementation, few studies have been conducted to evaluate the nutritional status of antioxidant vitamins and minerals, and none have reported on the status of these serum antioxidants associated with the dietary intake of antioxidants by non-alcoholic fatty liver disease (NAFLD) patients. OBJECTIVE To evaluate association between serum and dietetics antioxidants with liver fibrosis in patients with NAFLD. METHODS Across-section analysis with out with 72 patients diagnosed with NAFLD. Hepatic fibrosis was measured by FibroScan®, and liver stiffness ≥7.9 kPa was considered to indicate advanced fibrosis. Retinol, alpha-tocopherol, ascorbic acid, beta-carotene, serum zinc, and selenium were evaluated, as was the dietary intake of these micronutrients in the previous 24 h (using 24-h dietary recall). The Mann-Whitney test was used to compare the fibrosis groups and, a linear regression analysis was performed to determine associated risk factors between age, sex, BMI, hepatic fibrosis, and serum antioxidants. RESULTS A high proportion of inadequate serum retinol (20.8%), vitamin C (27%), and selenium (73.6%) was observed in the patients with NAFLD, in addition to a significant inadequacy of vitamin A (98.3%) and vitamin E (100%) intake. Patients with advanced liver fibrosis had reduced levels of serum retinol (P = 0.002), with liver fibrosis being the independent risk factor associated with serum retinol lower. CONCLUSION Hepatic fibrosis was associated with a reduction in serum retinol and was reduced in advanced fibrosis. NAFLD patients showed an important serum deficiency and insufficient dietary intake of the evaluated micronutrients.
Collapse
Affiliation(s)
- Juliana Moraes Coelho
- The Capriglione Luiz State Institute of Diabetes and Endocrinology, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Katia Cansanção
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata de Mello Perez
- Universidade Federal do Rio de Janeiro and D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Nathalie Carvalho Leite
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Andrea Ramalho
- Department of Social and Applied Nutrition and Center for Research on Micronutrients (NPqM), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wilza Peres
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
30
|
|
31
|
Travica N, Ried K, Hudson I, Sali A, Scholey A, Pipingas A. The Contribution of Plasma and Brain Vitamin C on Age and Gender-Related Cognitive Differences: A Mini-Review of the Literature. Front Integr Neurosci 2020; 14:47. [PMID: 32973470 PMCID: PMC7471743 DOI: 10.3389/fnint.2020.00047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Abstract
There is increasing evidence that sex differences in the brain may contribute to gender-related behavioral differences, including cognitive function. Literature has revealed gender dimorphisms in cognitive function between males and females. Additionally, several risk factors associated with cognitive decline depend on chronological age. It is well recognized that the process of aging is associated with a decline in cognitive ability and brain function. Various explanations may account for these gender-related cognitive differences and age-associated cognitive changes. Recent investigations have highlighted the importance of vitamin C in maintaining brain health and its association with cognitive function in both cognitively intact and impaired cohorts. The present review explores previous literature that has evaluated differences in plasma/brain vitamin C between genders and during aging. It then assesses whether these age and gender-related differences may affect the relationship between plasma/brain vitamin C and cognition. The purpose of this review was to examine the evidence for a link between plasma/brain vitamin C and cognition and the impact of gender and age on this relationship. Epidemiological studies have frequently shown higher vitamin C plasma concentrations in women. Similarly, aging has been systematically associated with reductions in plasma vitamin C levels. A range of animal studies has demonstrated potential gender and age-related differences in vitamin C brain distribution and utilization. The reviewed literature suggests that gender differences in plasma and brain vitamin C may potentially contribute to differences in gender-associated cognitive ability, particularly while females are pre-menopausal. Additionally, we can propose that age-associated differences in plasma and brain vitamin C may be potentially linked to age-associated cognitive differences, with older cohorts appearing more vulnerable to experience declines in plasma vitamin C concentrations alongside compromised vitamin C brain regulation. This review encourages future investigations to take into account both gender and age when assessing the link between plasma vitamin C concentrations and cognitive function. Further large scale investigations are required to assess whether differences in cognitive function between genders and age groups may be causally attributed to plasma vitamin C status and brain distribution and utilization.
Collapse
Affiliation(s)
- Nikolaj Travica
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
- The National Institute of Integrative Medicine, Melbourne, VIC, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, VIC, Australia
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
- Torrens University, Melbourne, VIC, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
- School of Science, College of Science, Engineering and Health, Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, VIC, Australia
- School of Mathematical and Physical Science, University of Newcastle, Callaghan, NSW, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, VIC, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| |
Collapse
|
32
|
Rowe S, Carr AC. Global Vitamin C Status and Prevalence of Deficiency: A Cause for Concern? Nutrients 2020; 12:E2008. [PMID: 32640674 PMCID: PMC7400810 DOI: 10.3390/nu12072008] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Vitamin C is an essential nutrient that must be obtained through the diet in adequate amounts to prevent hypovitaminosis C, deficiency and its consequences-including the potentially fatal deficiency disease scurvy. Global vitamin C status and prevalence of deficiency has not previously been reported, despite vitamin C's pleiotropic roles in both non-communicable and communicable disease. This review highlights the global literature on vitamin C status and the prevalence of hypovitaminosis C and deficiency. Related dietary intake is reported if assessed in the studies. Overall, the review illustrates the shortage of high quality epidemiological studies of vitamin C status in many countries, particularly low- and middle-income countries. The available evidence indicates that vitamin C hypovitaminosis and deficiency is common in low- and middle-income countries and not uncommon in high income settings. Further epidemiological studies are required to confirm these findings, to fully assess the extent of global vitamin C insufficiency, and to understand associations with a range of disease processes. Our findings suggest a need for interventions to prevent deficiency in a range of at risk groups and regions of the world.
Collapse
Affiliation(s)
- Sam Rowe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L35QA, UK;
| | - Anitra C. Carr
- Nutrition in Medicine Research Group, Department of Pathology & Biomedical Science, University of Otago, Christchurch 8011, New Zealand
| |
Collapse
|
33
|
Carr AC, Rowe S. Factors Affecting Vitamin C Status and Prevalence of Deficiency: A Global Health Perspective. Nutrients 2020; 12:E1963. [PMID: 32630245 PMCID: PMC7400679 DOI: 10.3390/nu12071963] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022] Open
Abstract
A recent review of global vitamin C status has indicated a high prevalence of deficiency, particularly in low- and middle-income countries, as well as in specific subgroups within high-income countries. Here, we provide a narrative review of potential factors influencing vitamin C status globally. The in vivo status of vitamin C is primarily affected by dietary intake and supplement use, with those who supplement having a higher mean status and a lower prevalence of deficiency. Dietary intake can be influenced by cultural aspects such as traditional cooking practices and staple foods, with many staple foods, such as grains, contributing negligible vitamin C to the diet. Environmental factors can also affect vitamin C intake and status; these include geographic region, season, and climate, as well as pollution, the latter partly due to enhanced oxidative stress. Demographic factors such as sex, age, and race are known to affect vitamin C status, as do socioeconomic factors such as deprivation, education and social class, and institutionalization. Various health aspects can affect vitamin C status; these include body weight, pregnancy and lactation, genetic variants, smoking, and disease states, including severe infections as well as various noncommunicable diseases such as cardiovascular disease and cancer. Some of these factors have changed over time; therefore, we also explore if vitamin C status has shown temporal changes. Overall, there are numerous factors that can affect vitamin C status to different extents in various regions of the world. Many of these factors are not taken into consideration during the setting of global dietary intake recommendations for vitamin C.
Collapse
Affiliation(s)
- Anitra C. Carr
- Nutrition in Medicine Research Group, Department of Pathology & Biomedical Science, University of Otago, Christchurch 8011, New Zealand
| | - Sam Rowe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L35QA, UK;
| |
Collapse
|
34
|
Evans LW, Stratton MS, Ferguson BS. Dietary natural products as epigenetic modifiers in aging-associated inflammation and disease. Nat Prod Rep 2020; 37:653-676. [PMID: 31993614 PMCID: PMC7577396 DOI: 10.1039/c9np00057g] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Covering: up to 2020Chronic, low-grade inflammation is linked to aging and has been termed "inflammaging". Inflammaging is considered a key contributor to the development of metabolic dysfunction and a broad spectrum of diseases or disorders including declines in brain and heart function. Genome-wide association studies (GWAS) coupled with epigenome-wide association studies (EWAS) have shown the importance of diet in the development of chronic and age-related diseases. Moreover, dietary interventions e.g. caloric restriction can attenuate inflammation to delay and/or prevent these diseases. Common themes in these studies entail the use of phytochemicals (plant-derived compounds) or the production of short chain fatty acids (SCFAs) as epigenetic modifiers of DNA and histone proteins. Epigenetic modifications are dynamically regulated and as such, serve as potential therapeutic targets for the treatment or prevention of age-related disease. In this review, we will focus on the role for natural products that include phytochemicals and short chain fatty acids (SCFAs) as regulators of these epigenetic adaptations. Specifically, we discuss regulators of methylation, acetylation and acylation, in the protection from chronic inflammation driven metabolic dysfunction and deterioration of neurocognitive and cardiac function.
Collapse
Affiliation(s)
- Levi W Evans
- Department of Nutrition, University of Nevada, Reno, NV 89557, USA.
| | | | | |
Collapse
|
35
|
de Lima FD, Battaglini CL, Chaves SN, Ugliara L, Sarandy J, Lima RM, Bottaro M. Effect of strength training and antioxidant supplementation on perceived and performance fatigability in breast cancer survivors: a randomized, double-blinded, placebo-controlled study. Appl Physiol Nutr Metab 2020; 45:1165-1173. [PMID: 32348688 DOI: 10.1139/apnm-2020-0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This randomized, double-blinded, placebo-controlled study aimed to investigate the effect of strength training (ST) combined with vitamin C and E supplementation on perceived and performance fatigability in breast cancer survivors (BCS). Twenty-five BCS were randomly assigned to 1 of 2 groups: vitamins (VIT; n = 12; 51.0 ± 9.0 years) or placebo (PLA; n = 13; 48.2 ± 8.3 years). Both groups performed a 10-week ST protocol, twice a week. The VIT group was supplemented with vitamins C (500 mg/day) and E (180 mg/day) and the PLA group with polydextrose (1 g/day), once a day after breakfast. At the beginning and at the end of the training period, perceived fatigability was assessed using Multidimensional Fatigue Inventory (MFI)-20 (general fatigue and physical fatigue). Performance fatigability was assessed during 30 maximal isokinetic knee extensions at 120°/s. General fatigue decreased similarly in the VIT (p = 0.004) and PLA (p = 0.011) groups. Physical fatigue decreased similarly in the VIT (p = 0.011) and PLA (p = 0.001) groups. Performance fatigability also decreased similarly in the VIT (p = 0.026) and PLA (p < 0.001) groups. There was no difference between groups at any moment (p > 0.05). In summary, antioxidant supplementation does not add any positive synergistic effect to ST in terms of improving perceived or performance fatigability in BCS. This clinical trial is registered in the Brazilian Clinical Trials Registry, number RBR-843pth (UTN no.: U1111-1222-6511). Novelty ST with maximal repetitions reduces perceived and performance fatigability of BCS. Vitamins C and E supplementation does not add any positive synergistic effect to ST in terms of reducing fatigability in BCS.
Collapse
Affiliation(s)
- Filipe Dinato de Lima
- College of Health Sciences, University of Brasília, Brasília, DF 70910-900, Brazil.,College of Health and Education Sciences, University Center of Brasília, Brasília, DF 70790-075, Brazil
| | - Cláudio L Battaglini
- Department of Exercise and Sport Science and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA
| | - Sandro Nobre Chaves
- College of Physical Education, University of Brasília, Brasília, DF 70910-900, Brazil
| | - Lucas Ugliara
- College of Physical Education, University of Brasília, Brasília, DF 70910-900, Brazil
| | - Jonathan Sarandy
- College of Physical Education, University of Brasília, Brasília, DF 70910-900, Brazil
| | - Ricardo Moreno Lima
- College of Physical Education, University of Brasília, Brasília, DF 70910-900, Brazil
| | - Martim Bottaro
- College of Physical Education, University of Brasília, Brasília, DF 70910-900, Brazil
| |
Collapse
|
36
|
Travica N, Ried K, Hudson I, Sali A, Scholey A, Pipingas A. Gender Differences in Plasma Vitamin C Concentrations and Cognitive Function: A Pilot Cross-Sectional Study in Healthy Adults. Curr Dev Nutr 2020; 4:nzaa038. [PMID: 32337476 PMCID: PMC7170048 DOI: 10.1093/cdn/nzaa038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A number of investigations have highlighted the importance of vitamin C in maintaining brain health. Biologically, vitamin C has exhibited roles in neuromodulation, neurodevelopment, vascular support, and neuroprotection. Vitamin C's contribution to cognitive function in both cognitively intact and impaired cohorts has previously been assessed, with little focus on gender variability. OBJECTIVE The present study explored the interaction between gender and plasma vitamin C on cognitive performance, and the effect of different amounts of plasma vitamin C (adequate/inadequate) on various cognitive tasks by gender. METHODS This retrospective analysis was conducted in healthy adults (n = 80, female = 52, male = 28, 24-96 y) with a range of blood plasma vitamin C concentrations. Cognitive assessments included the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) and 2 pen-and-paper tests, the Symbol Digits Modalities Test (SDMT) and the Hopkins Verbal Learning Test-Revised (HVLT-R). Food-frequency questionnaires were used to elucidate dietary consumption. RESULTS After adjusting for a number of potential covariates such as age, number of prescribed medications and dose of vitamin C supplementation, results indicated a significant interaction (P < 0.001) between plasma vitamin C and gender on cognitive function, on both the computerized and pen-and-paper assessments. A novel finding was that the performance of males with inadequate plasma vitamin C was poorer on tasks involving components of memory (short/delayed), inhibition, and visual perception, whereas females presenting with inadequate vitamin C were more compromised on tasks involving psychomotor performance/motor speed. Additionally, females with adequate vitamin C concentrations exhibited higher performance than males on tasks involving recall, recognition, attention, and focus. CONCLUSIONS Further larger-scale investigations are required to establish a cause-and-effect relation and to elucidate whether differences in cognitive function between genders may be attributed to plasma vitamin C status.This trial was registered at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369440&isReview=true as ACTRN12615001140549.
Collapse
Affiliation(s)
- Nikolaj Travica
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
- The National Institute of Integrative Medicine, Melbourne, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, Australia
- Discipline of General Practice, University of Adelaide, South Australia, Australia
- Torrens University, Melbourne, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
- School of Science, College of Science, Engineering, and Health, Mathematical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
- School of Mathematical and Physical Science, University of Newcastle, Newcastle, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
37
|
Carr AC, Lykkesfeldt J. Discrepancies in global vitamin C recommendations: a review of RDA criteria and underlying health perspectives. Crit Rev Food Sci Nutr 2020; 61:742-755. [PMID: 32223303 DOI: 10.1080/10408398.2020.1744513] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The concept of a 'recommended dietary allowance' (RDA) and similar terms describing the daily intake of essential nutrients recommended for healthy individuals is widely used by various health authorities around the world. For vitamin C, however, there remain significant discrepancies in the criteria used to establish dietary recommendations and consequently, global recommendations for daily vitamin C intake vary by more than five fold. While it appears that the scientific data underlying the recommendations are more or less the same, the interpretation differs considerably. Moreover, although a number of the assumptions used in e.g. the body pool estimates of the 1960s and 1970s have later been proven wrong and give rise to significant underestimations, these data are still used as the main support of several recommendations. Aspects that modify vitamin C requirements, such as gender, age, pregnancy, lactation, and smoking, have been taken into consideration by many but not all regulatory authorities, and are thus subject of debate. In contrast, body weight, a significant predictor of vitamin C status and requirement, has not been taken into consideration with respect to vitamin C recommendations, even in the face of the looming global obesity pandemic. The present review examines the discrepancies in vitamin C dietary recommendations of international authorities and critically discusses representative examples of criteria and the underlying health perspectives used to derive current recommended intakes of vitamin C. New biological signatures of vitamin C nutriture are also explored with regard to their potential use for future updates of dietary recommendations.
Collapse
Affiliation(s)
- Anitra C Carr
- Nutrition in Medicine Research Group, University of Otago, Christchurch, New Zealand
| | - Jens Lykkesfeldt
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
Hirschfeld J, Higham J, Blair F, Richards A, Chapple ILC. Systemic disease or periodontal disease? Distinguishing causes of gingival inflammation: a guide for dental practitioners. Part 2: cancer related, infective, and other causes of gingival pathology. Br Dent J 2020; 227:1029-1034. [PMID: 31873257 DOI: 10.1038/s41415-019-1053-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Periodontitis and gingivitis are highly prevalent inflammatory diseases of the oral cavity, and typically are characterised by the presence of dental plaque. However, other causes of oral inflammation exist, which can resemble plaque-induced gingivitis and periodontitis, and may thus first be seen by a dental practitioner. This paper aims to provide dentists with an understanding of the manifestations of systemic diseases to the periodontium and highlights anamnestic and clinical clues important for distinguishing between plaque-induced and non plaque-induced lesions. In the first part of this series immune-mediated and hereditary conditions as causes of gingival lesions were discussed; this second part highlights cancer-related gingival lesions as well as those caused by specific pathogens, medication or malnutrition. A clear clinical, epidemiological and visual overview of the different conditions is provided. Early diagnosis of non plaque-related causes of gingival lesions can be vital for affected patients. Therefore, dental practitioners should be aware of the various manifestations of systemic diseases to the periodontium.
Collapse
Affiliation(s)
- Josefine Hirschfeld
- Department of Periodontology, Birmingham Dental School and Hospital, 5 Mill Pool Way, B5 7EG, Birmingham, UK.
| | - Jon Higham
- Department of Oral Medicine, Birmingham Dental School and Hospital, 5 Mill Pool Way, B5 7EG, Birmingham, UK
| | - Fiona Blair
- Department of Periodontology, Birmingham Dental School and Hospital, 5 Mill Pool Way, B5 7EG, Birmingham, UK
| | - Andrea Richards
- Department of Oral Medicine, Birmingham Dental School and Hospital, 5 Mill Pool Way, B5 7EG, Birmingham, UK
| | - Iain L C Chapple
- Department of Periodontology, Birmingham Dental School and Hospital, 5 Mill Pool Way, B5 7EG, Birmingham, UK
| |
Collapse
|
39
|
Sharma Y, Miller M, Shahi R, Doyle A, Horwood C, Hakendorf P, Thompson C. Vitamin C deficiency in Australian hospitalised patients: an observational study. Intern Med J 2019; 49:189-196. [PMID: 29968401 DOI: 10.1111/imj.14030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/02/2018] [Accepted: 06/27/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vitamin C has anti-oxidant properties and acts as a cofactor for several enzymes. Hypovitaminosis C has been associated with bleeding, endothelial dysfunction and death. The prevalence of hypovitaminosis C is unknown in Australian hospitalised patients, and its clinical relevance is uncertain. AIMS To determine the prevalence, characteristics and clinical outcomes of hospitalised patients with hypovitaminosis C. METHODS This observational study included general-medical inpatients in a tertiary-level hospital in Australia. High-performance liquid chromatography (HPLC) was used to determine plasma vitamin C levels. As per Johnston's criteria, vitamin C levels of ≥28 μmol/L were classified as normal and <28 μmol/L as low. Clinical outcomes determined included length of hospital stay (LOS), nosocomial complications, intensive care unit admission and in-hospital mortality. RESULTS A total of 200 patients participated in this study, and vitamin C levels were available for 149 patients, of whom 35 (23.5%) had normal vitamin C levels, and 114 (76.5%) had hypovitaminosis C. Patients with hypovitaminosis C were older and had higher C-reactive protein (CRP) levels. Median LOS was 2 days longer in patients with hypovitaminosis C (6 days (interquartile range (IQR) 4, 8) vs 4 days (IQR 3, 6), P = 0.02), and they had fourfold higher odds of staying in hospital for >5 days than those with normal vitamin C levels. Other clinical outcomes were similar between the two groups. CONCLUSIONS Hypovitaminosis C is common in hospitalised patients and is associated with prolonged LOS. Further research is needed to ascertain the benefits of vitamin C supplementation in vitamin C-depleted patients.
Collapse
Affiliation(s)
- Yogesh Sharma
- Department of General Medicine, Flinders Medical Centre, Flinders Drive, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Flinders Drive, South Australia, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, Flinders University, South Australia, Australia
| | - Rashmi Shahi
- Department of Nutrition and Dietetics, Flinders University, South Australia, Australia
| | - Adrienne Doyle
- Department of Nutrition and Dietetics, Flinders University, South Australia, Australia
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, South Australia, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, South Australia, Australia
| | - Campbell Thompson
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
40
|
Kozeniecki M, Ludke R, Kerner J, Patterson B. Micronutrients in Liver Disease: Roles, Risk Factors for Deficiency, and Recommendations for Supplementation. Nutr Clin Pract 2019; 35:50-62. [PMID: 31840874 DOI: 10.1002/ncp.10451] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Micronutrients are essential components of the diet and are required to maintain fundamental bodily functions. Liver disease has a profound effect on nutrient intake, metabolism of nutrients, and nutrition status, often resulting in some degree of malnutrition, including micronutrient deficiency. Vitamin and mineral deficiencies can impair metabolic processes at the cellular and biochemical level even before clinical and physical alterations are seen. It is essential that micronutrient status is evaluated as part of a comprehensive nutrition assessment for all patients with chronic or advanced liver disease. Early intervention to correct suspected or confirmed deficiencies may minimize symptoms and improve clinical outcomes and quality of life. In this narrative review, different types of liver disease and associated micronutrient abnormalities are outlined, and methods of micronutrient assessment and supplementation are discussed.
Collapse
Affiliation(s)
- Michelle Kozeniecki
- Department of Nutrition Services, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Rachel Ludke
- Department of Nutrition Services, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Jennifer Kerner
- Transplant Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brittney Patterson
- Clinical Nutrition Department, Stanford Health Care, Stanford, California, USA
| |
Collapse
|
41
|
Puddy AC, Hughes JL, Joffe AL, Khanna PC, Thornburg CD, Mubarak SJ. Scurvy Findings in a Child with Jacobsen Syndrome: A Case Report. JBJS Case Connect 2019; 9:e0352. [PMID: 31584905 DOI: 10.2106/jbjs.cc.18.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the first reported case of scurvy developing secondary to behavioral traits of Jacobsen syndrome. The diagnosis of scurvy was significantly delayed because bleeding symptoms were initially attributed to baseline thrombocytopenia and platelet dysfunction associated with Jacobsen syndrome and patient's medication. Following vitamin C supplementation, signs and symptoms of the patient's disease quickly resolved. CONCLUSIONS We aim to reinforce the need to consider nutritional deficiencies in patients with complex medical histories and behavioral issues, especially when presenting with new complaints.
Collapse
Affiliation(s)
- Alan C Puddy
- United States Air Force Medical Corps, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Jessica L Hughes
- Department of Orthopedic Surgery, Baylor Scott and White, Temple, Texas
| | - Avrum L Joffe
- North Jersey Pediatric Orthopedics, Ridgewood, New Jersey
| | - Paritosh C Khanna
- Division of Radiology, Rady Children's Hospital-San Diego, San Diego, California
| | - Courtney D Thornburg
- Division of Hematology-Oncology, Rady Children's Hospital-San Diego, San Diego, California
| | - Scott J Mubarak
- Division of Orthopedic Surgery, Rady Children's Hospital-San Diego, San Diego, California
| |
Collapse
|
42
|
Myers KO, Ibrahimou B, Yusuf KK, Mauck DE, Salihu HM. The effect of maternal vitamin C intake on fetal telomere length. J Matern Fetal Neonatal Med 2019; 34:1143-1148. [PMID: 31170852 DOI: 10.1080/14767058.2019.1628940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A telomere is a nucleoprotein structure that is located at the end of a chromosome. Reduced telomere length manifests as physical ailments such as the increased risk of age-related illnesses. These age-related illnesses include heart disease and failure. Telomere length has been studied extensively in adults; however, limited information exists regarding maternal dietary influences on fetal telomere length. OBJECTIVES The objective of this study is to investigate the relationship between maternal vitamin C intake and fetal telomere length. METHODS Data for this analysis were collected as part of a prospective cohort study that recruited pregnant women upon admission into labor and delivery. Umbilical cord serum was collected for 96 maternal-fetal dyads, and DNA analysis was performed using a quantitative polymerase chain reaction. The telomere to single copy gene ratio method was used to determine telomere length, and maternal vitamin C intake was measured using the Dietary History Questionnaire (DHQ). Statistical analysis was conducted using generalized linear modeling-based analyses. RESULTS The linear model indicates that maternal vitamin C intake (OR = 1.0032, 95%CI: 1.0014-1.0052, p ≤ .05) was positively associated with fetal telomere length. BMI (OR = 1.1096, 95%CI: 1.0619-1.1660, p ≤ .05) had a significant positive association with fetal telomere length while sodium intake was negatively associated with this outcome (OR = 0.9997, 95%CI: 0.9995-0.9998, p ≤ .05). Black ethnicity had a significant negative association with fetal telomere length (OR = 0.0186, 95%CI: 0.0031-0.0824, p ≤ .05). CONCLUSIONS Our study shows a positive association between maternal vitamin C intake and fetal telomere length. These findings may provide a method of understanding and preventing adult-onset disease and mortality through intrauterine reprograming.
Collapse
Affiliation(s)
- Kristopher O Myers
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Korede K Yusuf
- Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL, USA
| | - Daniel E Mauck
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Hamisu M Salihu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
43
|
McCall SJ, Clark AB, Luben RN, Wareham NJ, Khaw KT, Myint PK. Plasma Vitamin C Levels: Risk Factors for Deficiency and Association with Self-Reported Functional Health in the European Prospective Investigation into Cancer-Norfolk. Nutrients 2019; 11:E1552. [PMID: 31324013 PMCID: PMC6682997 DOI: 10.3390/nu11071552] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the demographic and lifestyles factors associated with vitamin C deficiency and to examine the association between plasma vitamin C level and self-reported physical functional health. METHODS A population-based cross-sectional study using the European Prospective Investigation into Cancer-Norfolk study. Plasma vitamin C level < 11 µmol/L indicated vitamin C deficiency. Unconditional logistic regression models assessed the association between vitamin C deficiency and potential risk factors. Associations between quartiles of vitamin C and self-reported functional health measured by the 36-item short-form questionnaire (SF-36) were assessed. RESULTS After adjustment, vitamin C deficiency was associated with older age, being male, lower physical activity, smoking, more socially deprived area (Townsend index) and a lower educational attainment. Compared to the highest, those in the lowest quartile of vitamin C were more likely to score in the lowest decile of physical function (adjusted odds ratio (aOR): 1.43 (95%CI: 1.21-1.70)), bodily pain (aOR: 1.29 (95% CI: 1.07-1.56)), general health (aOR: 1.4 (95%CI: 1.18-1.66)), and vitality (aOR: 1.23 (95%CI: 1.04-1.45)) SF-36 scores. CONCLUSIONS Simple public health interventions should be aimed at populations with risk factors for vitamin C deficiency. Poor self-reported functional health was associated with lower plasma vitamin C levels, which may reflect symptoms of latent scurvy.
Collapse
Affiliation(s)
- Stephen J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
- Ageing Clinical & Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
| |
Collapse
|
44
|
Uddin MA, Robson C, Dotel R. Disease of the past re-emerging in modern Australian society. BMJ Case Rep 2019; 12:12/4/e228448. [PMID: 31005867 DOI: 10.1136/bcr-2018-228448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 28-year-old man with fever, atraumatic lower limb pain and rash was noted to have multiple areas of ecchymosis involving both lower limbs. He was anaemic and also had a grossly swollen left leg. Differential diagnoses of compartment syndrome, vascular tear, platelet and clotting factor disorders, vasculitis and myositis were ruled out. Scurvy was only considered after failing to reach a diagnosis. A dietary history revealed consumption of a restricted diet with no fresh fruits or vegetables. Diagnosis was supported by an undetectable vitamin C level in blood and a rapid improvement of symptoms on oral vitamin C replacement. Prevalence of vitamin C deficiency in developed countries is also discussed.
Collapse
Affiliation(s)
- Mohammed Arif Uddin
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia.,Medical Workforce Unit, BMDH, Western Sydney Local Health District, Penrith, New South Wales, Australia
| | - Christopher Robson
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
| |
Collapse
|
45
|
Travica N, Ried K, Sali A, Hudson I, Scholey A, Pipingas A. Plasma Vitamin C Concentrations and Cognitive Function: A Cross-Sectional Study. Front Aging Neurosci 2019; 11:72. [PMID: 31001107 PMCID: PMC6454201 DOI: 10.3389/fnagi.2019.00072] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/13/2019] [Indexed: 12/14/2022] Open
Abstract
Vitamin-C is a water soluble molecule that humans have lost the ability to produce. Vitamin-C plays a role in CNS functions such as neuronal differentiation, maturation, myelin formation and modulation of the catecholaminergic systems. A recent systematic review by our team indicated the need for further research into the relationship between plasma vitamin C and cognition in cognitively intact participants using plasma vitamin C concentrations instead of estimates derived from food-frequency-questionnaires (FFQ), and more sensitive cognitive assessments suitable for cognitive abilities vulnerable to aging. It was hypothesized that higher plasma vitamin C concentrations would be linked with higher cognitive performance. This cross-sectional trial was conducted on healthy adults (n = 80, Female = 52, Male = 28, 24-96 years) with a range of plasma Vitamin C concentrations. Cognitive assessments included The Swinburne-University-Computerized-Cognitive-Assessment-Battery (SUCCAB) and two pen and paper tests, the Symbol-Digits-Modalities-Test (SDMT) and Hopkins-Verbal-Learning-Test-Revised (HVLT-R). The pen and paper assessments were conducted to establish whether their scores would correlate with the computerized tasks. Plasma-Vitamin C concentrations were measured using two biochemical analyses. Participants were grouped into those with plasma vitamin-C concentrations of adequate level (≥28 μmol/L) and deficient level (<28 μmol/L). The SUCCAB identified a significantly higher performance ratio (accuracy/reaction-time) in the group with adequate vitamin-C levels vs. deficient vitamin-C on the choice reaction time (M = 188 ± 4 vs. 167 ± 9, p = 0.039), immediate recognition memory (M = 81 ± 3 vs. 68 ± 6, p = 0.03), congruent Stroop (M = 134 ± 3 vs. 116 ± 7, p = 0.024), and delayed recognition tasks (M = 72 ± 2 vs. 62 ± 4, p = 0.049), after adjusting for age (p < 0.05). Significantly higher scores in immediate recall on the HVLT-R (M = 10.64 ± 0.16 vs. 9.17 ± 0.37, p = 0.001), delayed recall (M = 9.74 ± 0.22 vs. 7.64 ± 0.51, p < 0.001), total recall (M = 27.93 ± 0.48 vs. 24.19 ± 1.11, p = 0.003) were shown in participants with adequate plasma Vitamin-C concentrations, after adjusting for vitamin-C supplementation dose (p < 0.05). Similarly, higher SDMT scores were observed in participants with adequate plasma Vitamin-C concentrations (M = 49.73 ± 10.34 vs. 41.38 ± 5.06, p = 0.039), after adjusting for age (p < 0.05). In conclusion there was a significant association between vitamin-C plasma concentrations and performance on tasks involving attention, focus, working memory, decision speed, delayed and total recall, and recognition. Plasma vitamin C concentrations obtained through vitamin C supplementation did not affect cognitive performance differently to adequate concentrations obtained through dietary intake. Clinicaltrials.gov Unique Identifier: ACTRN 12615001140549, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369440.
Collapse
Affiliation(s)
- Nikolaj Travica
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
- National Institute of Integrative Medicine, Hawthorn, VIC, Australia
| | - Karin Ried
- National Institute of Integrative Medicine, Hawthorn, VIC, Australia
- Discipline of General Practice, The University of Adelaide, Adelaide, SA, Australia
- Health and Sports Institute, Bond University, Gold Coast, QLD, Australia
| | - Avni Sali
- National Institute of Integrative Medicine, Hawthorn, VIC, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
- School of Science, College of Science, Engineering and Health, Department of Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, VIC, Australia
- School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| |
Collapse
|
46
|
Day W, Gyurjyan-Bunch A, Van Voorhees A. Severe scurvy in an adult male without clear risk factors for nutritional deficiency. JAAD Case Rep 2019; 5:309-311. [PMID: 30989097 PMCID: PMC6446126 DOI: 10.1016/j.jdcr.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
47
|
Fenech M, Amaya I, Valpuesta V, Botella MA. Vitamin C Content in Fruits: Biosynthesis and Regulation. FRONTIERS IN PLANT SCIENCE 2019; 9:2006. [PMID: 30733729 PMCID: PMC6353827 DOI: 10.3389/fpls.2018.02006] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/31/2018] [Indexed: 05/19/2023]
Abstract
Throughout evolution, a number of animals including humans have lost the ability to synthesize ascorbic acid (ascorbate, vitamin C), an essential molecule in the physiology of animals and plants. In addition to its main role as an antioxidant and cofactor in redox reactions, recent reports have shown an important role of ascorbate in the activation of epigenetic mechanisms controlling cell differentiation, dysregulation of which can lead to the development of certain types of cancer. Although fruits and vegetables constitute the main source of ascorbate in the human diet, rising its content has not been a major breeding goal, despite the large inter- and intraspecific variation in ascorbate content in fruit crops. Nowadays, there is an increasing interest to boost ascorbate content, not only to improve fruit quality but also to generate crops with elevated stress tolerance. Several attempts to increase ascorbate in fruits have achieved fairly good results but, in some cases, detrimental effects in fruit development also occur, likely due to the interaction between the biosynthesis of ascorbate and components of the cell wall. Plants synthesize ascorbate de novo mainly through the Smirnoff-Wheeler pathway, the dominant pathway in photosynthetic tissues. Two intermediates of the Smirnoff-Wheeler pathway, GDP-D-mannose and GDP-L-galactose, are also precursors of the non-cellulosic components of the plant cell wall. Therefore, a better understanding of ascorbate biosynthesis and regulation is essential for generation of improved fruits without developmental side effects. This is likely to involve a yet unknown tight regulation enabling plant growth and development, without impairing the cell redox state modulated by ascorbate pool. In certain fruits and developmental conditions, an alternative pathway from D-galacturonate might be also relevant. We here review the regulation of ascorbate synthesis, its close connection with the cell wall, as well as different strategies to increase its content in plants, with a special focus on fruits.
Collapse
Affiliation(s)
- Mario Fenech
- Departamento de Biología Molecular y Bioquímica, Instituto de Hortofruticultura Subtropical y Mediterránea (IHSM), Consejo Superior de Investigaciones Científicas, Universidad de Málaga, Málaga, Spain
| | - Iraida Amaya
- Instituto Andaluz de Investigación y Formación Agraria y Pesquera, Area de Genómica y Biotecnología, Centro de Málaga, Spain
| | - Victoriano Valpuesta
- Departamento de Biología Molecular y Bioquímica, Instituto de Hortofruticultura Subtropical y Mediterránea (IHSM), Consejo Superior de Investigaciones Científicas, Universidad de Málaga, Málaga, Spain
| | - Miguel A. Botella
- Departamento de Biología Molecular y Bioquímica, Instituto de Hortofruticultura Subtropical y Mediterránea (IHSM), Consejo Superior de Investigaciones Científicas, Universidad de Málaga, Málaga, Spain
| |
Collapse
|
48
|
Armstrong E, Jamieson R, Porter J. Food cooking methods contribute to the reduced vitamin C content of foods prepared in hospitals and care facilities: a systematic review. Int J Food Sci Technol 2018. [DOI: 10.1111/ijfs.13979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Emma Armstrong
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
| | - Rachel Jamieson
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
| | - Judi Porter
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
- Department of Nutrition; Dietetics & Food, Monash University; Ferntree Gully road Notting Hill Vic. 3168 Australia
| |
Collapse
|
49
|
Margaritelis NV, Paschalis V, Theodorou AA, Kyparos A, Nikolaidis MG. Antioxidants in Personalized Nutrition and Exercise. Adv Nutr 2018; 9:813-823. [PMID: 30256898 PMCID: PMC6247356 DOI: 10.1093/advances/nmy052] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The present review highlights the idea that antioxidant supplementation can be optimized when tailored to the precise antioxidant status of each individual. A novel methodologic approach involving personalized nutrition, the mechanisms by which antioxidant status regulates human metabolism and performance, and similarities between antioxidants and other nutritional supplements are described. The usefulness of higher-level phenotypes for data-driven personalized treatments is also explained. We conclude that personally tailored antioxidant interventions based on specific antioxidant inadequacies or deficiencies could result in improved exercise performance accompanied by consistent alterations in redox profile.
Collapse
Affiliation(s)
- Nikos V Margaritelis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece,Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece,Address correspondence to NVM (e-mail: )
| | - Vassilis Paschalis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios A Theodorou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Antonios Kyparos
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Michalis G Nikolaidis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| |
Collapse
|
50
|
Bennett SE, Schmitt WP, Stanford FC, Baron JM. Case 22-2018: A 64-Year-Old Man with Progressive Leg Weakness, Recurrent Falls, and Anemia. N Engl J Med 2018; 379:282-289. [PMID: 30021092 PMCID: PMC6060279 DOI: 10.1056/nejmcpc1802826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Susan E Bennett
- From the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Massachusetts General Hospital, and the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Harvard Medical School - both in Boston
| | - William P Schmitt
- From the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Massachusetts General Hospital, and the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Harvard Medical School - both in Boston
| | - Fatima C Stanford
- From the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Massachusetts General Hospital, and the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Harvard Medical School - both in Boston
| | - Jason M Baron
- From the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Massachusetts General Hospital, and the Departments of Medicine (S.E.B., W.P.S., F.C.S.), Pediatrics (F.C.S.), and Pathology (J.M.B.), Harvard Medical School - both in Boston
| |
Collapse
|