Estimation of vitamin K intake in Koreans and determination of the primary vitamin K-containing food sources based on the fifth Korean National Health and Nutrition Examination Survey (2010-2011)

Changes in Plant-based Dietary Quality and Subsequent Risk of Cognitive Impairment among Older Chinese Adults: A National Community-based Cohort Study

BACKGROUND

It is unclear how changes in plant-based dietary quality are linked to subsequent risk of cognitive impairment. This study aims to evaluate this relationship using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

A total of 6662 participants free of cognitive impairment in 2008 were included and followed up to 2018. Plant-based dietary quality was assessed by three indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Changes in plant-based diet quality from 2008 to 2011 were classified into quintiles. We assessed incident cognitive impairment (from 2011 to 2018) by using the Mini-Mental State Examination (MMSE). Cox proportional-hazards models were performed.

RESULTS

We recorded 1571 incident cases of cognitive impairment during a median of 10 years of follow-up. Compared with participants whose plant-based diet had no change or was relatively stable over three years, the full-adjusted hazard ratios (HRs) with 95% confidence intervals (CI) for cognitive impairment were 0.77 (0.64, 0.93), 0.72 (0.60, 0.86), and 1.50 (1.27, 1.77) among participants with a large increase in PDI, hPDI, and uPDI, respectively. The HRs with 95% CI were 1.22 (1.02, 1.44), 1.30 (1.11, 1.54), and 0.80 (0.67, 0.96) among participants with a large decrease in PDI, hPDI, and uPDI, respectively. Every 10-point increase in PDI and hPDI was associated with 26% and 30% lower risk of cognitive impairment, while every 10-point increase in uPDI was associated with 36% higher risk.

CONCLUSIONS

Older adults with increased adherence to an overall plant-based diet and a healthful plant-based diet over three years have a lower risk of cognitive impairment, while those with increased adherence to an unhealthy plant-based diet had a higher risk of cognitive impairment.

Phytonutrients and Metabolism Changes in Topped Radish Root and Its Detached Leaves during 1 °C Cold Postharvest Storage

Glucosinolates, lipid-soluble vitamins E and K contents, primary metabolites and plant hormones were analyzed from topped radish root and detached leaf during storage at 1 °C. The topped root was analyzed at 0, 5, 15, 30, and 90 days after storage while the detached leaf was analyzed at 0, 5, 15, 30, and 45 days in an airtight storage atmosphere environment. The results showed that aliphatic glucosinolates were gradually decreased in leaf but not in root. There was a highly significant correlation between tryptophan and 4-methoxyindoleglucobrassicin in both tissues (r = 0.922, n = 10). There was no significant difference in vitamins E and K in leaf and root during storage. Plant hormones partially explained the significantly changed metabolites by tissue and time, which were identified during cold storage. Phenylalanine, lysine, tryptophan, and myo-inositol were the most important biomarkers that explained the difference in leaf and root tissue during cold storage. The most different metabolism between leaf and root tissue was starch and sucrose metabolism. Therefore, different postharvest technology or regimes should be applied to these tissues.

Maintenance dose of warfarin beyond time in therapeutic range for preventing vascular events

BACKGROUND

The quality of anticoagulation is closely associated with efficacy and safety in warfarin users. Although genetic polymorphisms have been related to warfarin dosages and vascular events(VE), genetic evaluations have not been recommended for all warfarin users. The aim is to evaluate the significance of the maintenance dose of warfarin (MDW) on VE, considering the time in therapeutic range (TTR).

METHODS

This retrospective study analyzed the data of patients who received warfarin for any reasons. A total of 11,835 patients with warfarin were divided into quartiles by MDW. We assessed TTR using the Rosendaal method and VE.

RESULTS

VE occurred in 9.1% of the warfarin users. The mean TTR level was 34.0 ± 25.7%, and the MDW was 3.38 ± 1.06 mg per day. Patients with VE were more likely to have a lower MDW and lower TTR levels. In moderate- or well-controlled TTR status, a lower MDW was significantly related to under-controlled anticoagulation and associated with higher risks of VE. Lower MDW had a higher risk of stroke or arterial/venous thromboembolism (Q1: OR, 1.57; 95% CI 1.25 to 1.96; Q2: OR, 1.40; 95% CI 1.12 to 1.75; Q3: OR, 1.35; 95% CI 1.08 to 1.68).

CONCLUSIONS

We suggest that patients with very low MDW might be at risk when using warfarin. Therefore, we propose that patients with a very low MDW might be alternatively considered for novel oral anticoagulants rather than warfarin.

Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-vitamin K antagonist oral anticoagulants into practice in Korea

Background

This study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015.

Methods

Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Data were collected at 11 time points during the first 3 years of follow-up. The primary outcome event was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group (modified TTR ≥47.0% vs <47.0%).

Results

Of 1,350 patients enrolled in this study, 95% were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77% and 40% at discharge and 3 years, respectively). The cumulative event rates of the primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started with VKA-only therapy but discontinued VKAs during follow-up without restarting (70.2%); this was followed by those starting with antiplatelet-only therapy and stopping it without restart (66.7%). Among VKA users, the 3-year cumulative primary outcome rates were higher in the poorly-controlled INR group than the well-controlled INR group (24.5% vs 15.7%; p = 0.015).

Conclusion

Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use. The incidence of the composite outcome also varied by patterns of antithrombotic use.

Dietary reference values for vitamin K

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) derives dietary reference values (DRVs) for vitamin K. In this Opinion, the Panel considers vitamin K to comprise both phylloquinone and menaquinones. The Panel considers that none of the biomarkers of vitamin K intake or status is suitable by itself to derive DRVs for vitamin K. Several health outcomes possibly associated with vitamin K intake were also considered but data could not be used to establish DRVs. The Panel considers that average requirements and population reference intakes for vitamin K cannot be derived for adults, infants and children, and therefore sets adequate intakes (AIs). The Panel considers that available evidence on occurrence, absorption, function and content in the body or organs of menaquinones is insufficient, and, therefore, sets AIs for phylloquinone only. Having assessed additional evidence available since 1993 in particular related to biomarkers, intake data and the factorial approach, which all are associated with considerable uncertainties, the Panel maintains the reference value proposed by the Scientific Committee for Food (SCF) in 1993. An AI of 1 μg phylloquinone/kg body weight per day is set for all age and sex population groups. Considering the respective reference body weights, AIs for phylloquinone are set at 70 μg/day for all adults including pregnant and lactating women, at 10 μg/day for infants aged 7-11 months, and between 12 μg/day for children aged 1-3 years and 65 μg/day for children aged 15-17 years.

Association of Dietary Patterns With Global and Domain-Specific Cognitive Decline in Chinese Elderly

BACKGROUND

Significant differences exist between eastern and western diets, and the way in which Chinese dietary intake relates to specific cognitive domains remains unclear. We aimed to assess the association between dietary patterns (DPs) and cognitive decline in Chinese elderly.

SETTING

Participants were recruited from the elderly health checkup program of a teaching hospital in Taipei, Taiwan.

PARTICIPANTS

A total of 475 elders (age ≥65) were included in this prospective cohort study.

MEASUREMENTS

The outcome comprised the decline of global and domain-specific cognition between baseline (2011-2013) and follow-up (2013-2015). Dietary data from the previous year were collected via a food frequency questionnaire at baseline, and a factor analysis was performed to identify DPs. Multivariable linear regression and logistic regression models were used to assess associations between Chinese DPs and cognitive decline over 2 years adjusting for selected covariates.

RESULTS

Three DPs (vegetable, meat, and traditional) were identified. Moderate- or high-score "vegetable" DP significantly protected against decline of logical memory (recall I: β = 0.16-0.18, odds ratio (OR) = 0.42-0.48; recall II: β = 0.17-0.21); while high-score DP increased executive function decline (β = -0.22). A high-score "meat" DP was related to decline of verbal fluency-total score (β = -0.19); while moderate- or high-score "meat" DP protected against attention decline (β = 0.20-0.22). High-score "traditional" DP protected against decline of logical memory-recall I (β = 0.18). No significant association was observed for global cognition.

CONCLUSION

These findings suggest that three DPs identified in Chinese elderly were associated with different cognitive domains. Further research is needed to explore the efficacy of dietary interventions in reducing cognitive decline in older adults.

Quality of Anticoagulation with Warfarin in Korean Patients with Atrial Fibrillation and Prior Stroke: A Multicenter Retrospective Observational Study

Background and Purpose

The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF).

Methods

This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range.

Results

The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA₂DS₂-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9–50.3%), and the TTR quartiles were <34.5, 34.5–49.1, 49.1–64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0.

Conclusions

In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.

Dietary intake of vitamin K in relation to bone mineral density in Korea adults: The Korea National Health and Nutrition Examination Survey (2010-2011)

Low vitamin K nutritional status has been associated with increased risk of fracture, however inconsistent results exist to support the role of vitamin K on bone mineral density depending on ethnic difference and gender. Our objective was to determine vitamin K intake in Korean adults, examine correlation between vitamin K intake and bone mineral density. This study analyzed raw data from the fifth Korea National Health and Nutrition Examination Survey for adults (2,785 men, 4,307 women) aged over 19 years. Cross-sectional analyses showed only positive association between vitamin K intake and femur bone mineral density in men after adjusting bone-related factors. However, women in high tertiles of vitamin K intake had a significantly higher bone mineral density both in femur and lumber as compared to women in lowest tertiles (p<0.05). The risk for osteoporosis was decreased as vitamin K intake increased in women, but this effect was not persisted after adjusting factors. The findings of this study indicate that low dietary vitamin K intake was associated with low bone mineral density in subjects. From these results we may suggest an increase in dietary vitamin K intakes for maintaining bone mineral density. (2010-02CON-21-C, 2011-02CON-06-C).

Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy

This study aimed to explore the correlation between usual vitamin K intake and response to anticoagulant therapy among patients under warfarin therapy. We conducted a retrospective survey of patients (n = 50) on continuous warfarin therapy. Clinical information and laboratory parameters were sourced from medical records. Anticoagulant effect was evaluated by using the percent time in therapeutic range (TTR) and the coefficient of variation (CV) of International normalized ratio (INR). Dietary vitamin K intake was assessed using a semi-quantitative food frequency questionnaire that has been developed for the purpose of assessing dietary intake of vitamin K. A total of 50 patients aged between 21 and 87 years were included in the study. The mean vitamin K intake was 262.8 ± 165.2 µg/day. Study subjects were divided into tertiles according to their usual vitamin K intake. The proportion of men was significantly higher in second and third tertile than first tertile (p = 0.028). The mean percent TTR was 38.4 ± 28.4% and CV of INR was 31.8 ± 11.8%. Long-term warfarin therapy group (≥ 3 years) had a higher percentage of TTR as compared to the control group (< 3 years) (p = 0.046). No statistically significant correlation was found between usual vitamin K intake and percent TTR (p > 0.05). In conclusion, no significant association was observed between usual vitamin K intake and anticoagulant effects. Further studies are required to consider inter-individual variability of vitamin K intake. Development of assessment tools to measure inter-individual variability of vitamin K intake might be helpful.

Analysis of mandipropamid residual levels through systematic method optimization against the matrix complexity of sesame leaves using HPLC/UVD

An analytical method was developed to detect mandipropamid residues in sesame leaves using high-performance liquid chromatography-ultraviolet detection. Samples were extracted with acetonitrile and were prepurified using a solid-phase extraction (SPE) cartridge with an additional dispersive-SPE (d-SPE) sorbent application. The method was validated using an external calibration curve prepared using pure solvent. The linearity was excellent with determination coefficient = 1. The limits of detection and quantification were 0.003 and 0.01 mg/kg, respectively. Recoveries at three spiking levels - 0.1, 0.5, and 1.0 mg/kg - were in the range 80.3-90.7% with relative standard deviations <2%. This method was applied to field-treated samples collected from two different areas, Gwangju and Muan, in the Republic of Korea and the half-lives were similar, 5.10 and 5.41 days, respectively. The pre-harvest residue limit was also predicted for both sites. The proposed method is sensitive and able to quantify trace amounts of mandipropamid in leafy vegetables. The combination of SPE and d-SPE effectively removed the matrix components in sesame leaves. Copyright © 2015 John Wiley & Sons, Ltd.