Obesity, vitamin D deficiency and old age a serious combination with respect to coronavirus disease-2019 severity and outcome

PURPOSE OF REVIEW

Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D.

RECENT FINDINGS

The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely.

SUMMARY

There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.

Climate Change Enhanced Carotenoid Pro-Vitamin A Levels of Selected Plantain Cultivars

Diet diversification and the exploitation of traditional, micronutrient-rich germplasm of staple crops are generally regarded as sustainable and low-cost approaches to increase the micronutrient intake of resource-poor people. Sun's UV index was collected daily throughout the year. The study assessed the seasonality of provitamin A carotenoids in three plantain cultivars in response to climatic condition. Fruits were harvested at three maturities and freeze-dried before analysis. The results showed that there were high levels of the sun's UV-B radiations throughout the year with the highest occurring from November to May when the area experienced clear skies with minimal cloud cover. These high levels of the sun's UV-B index occurred between 9.00 h GMT and 17.00 h GMT. The study also showed that α-carotene content increased with maturity in "Apantu" during the rainy seasons ranging from 95 to 172 μg/100 g of dry pulp. Similar trends were observed during the dry season with a range of 28 to 489 μg/100 g. The α-carotene contents were very high in the periods of high sun's UV-B radiations compared to the periods of low sun's UV-B radiations. The α-carotene levels in the giant French plantains showed similar trends. Intermediate French "Oniaba" and False Horn "Apantu" plantain cultivar showed the highest content of β-carotene during the dry season. The high provitamin A carotenoid levels in the cultivars coincided with the high levels of the sun's UV index.

Validation of the CIMI-Ethiopia Program and Seasonal Variation in Maternal Nutrient Intake in Enset (False Banana) Growing Areas of Southern Ethiopia

BACKGROUND

Tools for the rapid and accurate analysis of nutrient intakes from diets of individuals in Southern Ethiopia are lacking. The Calculator of Inadequate Micronutrient Intake program for Ethiopia (CIMI-Ethiopia) has been developed to overcome this problem. CIMI-Ethiopia also computes protein and energy intakes from the diet. The objectives of the current study were to validate CIMI-Ethiopia for the dietary pattern of Southern Ethiopia, and assess the nutrient intakes in postharvest dry and lean wet seasons.

METHODS

24-h dietary recall (24HR) data was collected from 578 women of a reproductive age in postharvest dry and lean wet seasons in 2017. For analysis, 24HR data was entered into NutriSurvey (NS), which was the reference nutrition software, and then into CIMI-Ethiopia. For validation, the mean and standard deviation (SD) of the difference between CIMI-Ethiopia and NS were computed. The percentage of participants with an inadequate intake was calculated. The correlation between CIMI-Ethiopia and NS results was determined. The nutrient intakes in postharvest dry and lean seasons were compared.

RESULTS

Among the nutrients, pantothenic acid, vitamin B1, and protein showed a very high accuracy in CIMI-Ethiopia calculation (|difference (D)| < 5.0% of the NS result). Nutrients with a good accuracy (|D| = 5%-15%) were iron, zinc, magnesium, vitamin B12, vitamin B6, and energy. The accuracy for calcium, niacin, and vitamin A was moderate (|D| = 15%-30%). The intakes calculated by CIMI-Ethiopia and NS of iron, zinc, magnesium, calcium, B-complex vitamins, vitamin A, protein, and energy were highly correlated (r = 0.85-0.97, p < 0.001). NS analysis identified a significant reduction in the mean intake of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season; however, calcium and vitamin A intake increased.

CONCLUSIONS

It has been found that CIMI-Ethiopia is a valid tool for estimating nutrient intakes at an individual level in Southern Ethiopia. The study demonstrated a decline in intakes of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season. This result provides some hint for fortification and supplementation programs that aim to combat maternal malnutrition in rural Southern Ethiopia.

Dietary Diversity and Anthropometric Status of Mother-Child Pairs from Enset (False Banana) Staple Areas: A Panel Evidence from Southern Ethiopia

BACKGROUND

A sizable cross-sectional studies demonstrated a low dietary diversity in Southern Ethiopia. However, its seasonal trend has not been well studied in areas where nutrient-poor enset (false banana (Ensete ventricosum)) foods are major staple. Moreover, there is scarcity of information on seasonal nature of anthropometric status of mother-child pairs (MCP) from the same areas in Southern Ethiopia. Therefore, the present study aimed to investigate the dietary diversity and anthropometric status of MCP in postharvest dry and lean wet seasons and identify factors associated with anthropometric status.

METHODS

The dietary intake and anthropometric data were collected from 578 households (578 mothers and 578 children) January-June 2017. The study compared data of the two seasons using McNemar's test for dichotomous, Wilcoxon signed-rank test for non-normally distributed, and paired samples t-test for normally distributed continuous data. Logistic regression was conducted to identify risk factors for malnutrition. In addition, Spearman's Rho test was used to determine correlations between maternal and child variables.

RESULTS

Over 94% of the mothers did not fulfil the minimum diet diversity score in both seasons. The meal frequency and pulses/legumes intake significantly declined in lean wet season; however, dark green leaves consumption increased. Meat, poultry, and fish consumption dropped to almost zero in the lean wet season. The dietary diversity and anthropometric status of the MCP were correlated. Weight-for-age (WAZ) and weight-for-height (WHZ) of children significantly declined in the lean wet season. In the same way, maternal mid upper arm circumference (MUAC), body weight, and body mass index (BMI) dropped (p < 0.001) in this season. Being pregnant and a lactating mother, poverty, and the ability to make decisions independently predicted maternal undernutrition (low MUAC). On the other hand, maternal undernutrition and education were associated with child underweight.

CONCLUSIONS

The results demonstrated that the dietary diversity of MCP is low in both postharvest dry and lean wet seasons. This suggests the need for continuous nutrition intervention to improve the dietary diversity. In addition, the anthropometric status of MCP declines in lean wet season. This may provide some clue for policy targeting on improving nutritional status of mothers and children in rural Southern Ethiopia.

Vitamin D2 as Adjunctive Therapy of Tuberculosis (OR15-04-19)

Objectives

Despite the availability of effective antimicrobials, tuberculosis (TB) remains as a public health threat globally. There is a need for simple and inexpensive strategies to improve the treatment outcomes.The objective of our study was to deal with the potential use of vitamin D2 derived from sun-exposed oyster mushroom as adjunctive therapy to standard anti-TB treatment

Methods

Randomized controlled trial was conducted on 64 pulmonary TB patients (32 assigned to intervention and 32 assigned to control) in North Shewa, Ethiopia. Intervention group was provided with a sandwich prepared from sun-exposed oyster mushroom containing 146 µg (5840 IU) vitamin D2 continuously from Monday to Friday during the first 16 weeks of anti-TB treatment. Blood and sputum specimens were taken at the beginning and end of the study. The primary outcomes were changes in vitamin D status, clinical improvements (assessed by TB score and Karnofsky performance status scale) and immunologic responses. Sputum smear and culture conversion were evaluated as secondary outcomes. P < 0.05 was considered as statistically significant.

Results

Vitamin D2 intervention brought significant difference of 8.1 ± 6.2 ng/mL (95% CI: 5.9 to 10.3 ng/mL) in the serum 25(OH)D level and corrected vitamin D deficiency in more than 35% of TB patients. After intervention, 96.9% vs 21.5% of TB patients found in TB score SC-I and had mean ± SD of Karnofsky performance status scale of 80.3 ± 6.9% vs 64.7 ± 5.7% in the intervention group vs control group, respectively. IFN-g and cathelicidin LL-37 levels were showed significant improvement solely in the intervention group. the changes in the IL-4 and IL-10 levels were insignificant and sputum smear culture conversion was not achieved in both groups.

Conclusions

Vitamin D2 derived from sun-exposed oyster mushroom was effective in improving vitamin D status, clinical outcomes and immune responses. And hence, it could serve as potential, safe, easily available and cost-effective adjunctive therapy for TB.

Funding Sources

None.

Animal-based food taboos during pregnancy and the postpartum period of Southeast Asian women - A review of literature

This paper gives an overview of the various taboos on animal products and the reasons behind such practices among women in the member countries of the Association of Southeast Asian Nations (ASEAN), while they are pregnant, during their postpartum period, and while breastfeeding. Three data search engines, Google® Scholar, PubMed and Scopus, were used one after the other, to generate the papers for this review. The online searches using the term food taboo, its synonyms, and truncations, in combination with the terms pregnancy, postpartum, and breastfeeding, and with the country name, were conducted from January to February 2017. In total, 28 papers were pooled and included in this review. The taboos and the justification for avoidance were collated and grouped per their occurrence, and according to the country where they are practiced. Nine papers provided information on the food taboos during pregnancy, 16 on postpartum food taboos, and six on breastfeeding. The food taboos included various river or seafood, meat from terrestrial animals, and derived products like fish paste, blood and internal organs. Healthcare providers should be aware of the food taboos being adhered to in the region to provide the right information and guidance to the women practicing them. There is a need to educate the public in general, and women, in particular, about the risk of malnutrition when food taboos are followed, and to support their nutritional requirements during pregnancy and the postpartum period by promoting dietary diversification. More research could be conducted to fill in the gap in information with regards to the food taboos and their impact in some of the ASEAN members. Culture-sensitive health interventions based on timely research work can contribute to the attainment of the sustainable development goal of reducing the maternal and under-five mortality ratios in Southeast Asia.

Vitamin A Supplementation by Endotracheal Application of a Nano-encapsulated Preparation Is Feasible in Ventilated Preterm Lambs

BACKGROUND

Vitamin A (VA) is crucial for lung growth and development. In premature infants, inadequate VA levels are associated with an increased risk of bronchopulmonary dysplasia (BPD). Intramuscular VA supplementation has been shown to decrease the incidence of BPD, but is not widely used in the clinical setting due to concerns about feasibility and pain. We studied VA kinetics, distribution, and the induction of early genetic expression of retinoid homeostatic genes in the lung after endotracheal and intravenous application in a preterm lamb model.

METHODS

Lambs were delivered prematurely after 85% of gestation, intubated, and ventilated for 3 hours. The animals were randomized to receive no VA ("control"), a bolus of VA intravenously ("i.v."), or VA endotracheally directly after administration of surfactant ("e.t.").

RESULTS

Animals treated with VA endotracheally directly after administration of surfactant showed significant increases of VA in serum and lung compared to controls. Animals treated with a bolus of VA intravenously showed significant increases of VA in serum, lung, and liver; however, peak serum concentrations and mRNA levels of homeostatic genes raised concerns about toxicity in this group.

CONCLUSIONS

Endotracheal VA supplementation in preterm lambs is feasible and might offer advantages in comparison to i.v. Further studies are warranted to explore biological effects in the context of BPD.

Nutrition meets the microbiome: micronutrients and the microbiota

There is increasing evidence that food is an important factor that influences and shapes the composition and configuration of the gut microbiota. Most studies have focused on macronutrients (fat, carbohydrate, protein) in particular and their effects on the gut microbiota. Although the microbiota can synthesize different water-soluble vitamins, the effects of vitamins synthesized within the microbiota on systemic vitamin status are unclear. Few studies exist on the shuttling of vitamins between the microbiota and intestine and the impact of luminal vitamins on the microbiota. Studying the interactions between vitamins and the microbiota may help to understand the effects of vitamins on the barrier function and immune system of the intestinal tract. Furthermore, understanding the impact of malnutrition, particularly low micronutrient supply, on microbiota development, composition, and metabolism may help in implementing new strategies to overcome the deleterious effects of malnutrition on child development. This article reviews data on the synthesis of different micronutrients and their effects on the human microbiota, and further discusses the consequences of malnutrition on microbiota composition.

Multivitamin/mineral supplements: Rationale and safety

Multivitamin/mineral supplements (MVMs) are widely used in many populations. MVMs, together with iron and folic acid, are recommended for pregnant women to improve birth outcome and to reduce low-birthweight and rates of miscarriage. However, MVM use is common in the general population as well. The aim of the present review was to evaluate the safety of long-term use of these supplements. To examine the safety of MVM use, we performed a literature search for randomized controlled studies involving supplementation with a combination of at least nine vitamins and three minerals at a maximum concentration of 100% of the Recommended Dietary Allowance. We found nine studies evaluating the use and efficacy of MVMs in pregnant women and healthy adults and six studies in the elderly where adverse effects were explicitly addressed. Only minor adverse events (e.g., unspecific gastrointestinal symptoms) were reported in all studies. In particular, there were no significant differences between treatment and placebo groups. MVM use within the range of the Dietary Reference Intake will not result in excess intake, even when including the effect of food and fortified food, and does not increase mortality. Taken together, these findings indicate that MVMs can be safe for long-term use (>10 y).

Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity

A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.

There's life in the old dog yet: vitamin C as a therapeutic option in endothelial dysfunction

The use of vitamin C against different diseases has been controversially and emotionally discussed since Linus Pauling published his cancer studies. In vitro and animal studies showed promising results and explained the impact of vitamin C, particularly in cases with endothelial dysfunction. Indeed, studies (reviewed in this issue of Critical Care by Oudemans-van Straaten and colleagues) using high-dose vitamin C and the parenteral route of application seem to be more successful than oral vitamin C delivery.

Micronutrients supplementation and nutritional status in cognitively impaired elderly persons: a two-month open label pilot study

BACKGROUND

Malnutrition is a widespread problem in elderly people and is associated with cognitive decline. However, interventional studies have produced ambiguous results. For this reason, we wanted to determine the effect of micronutrient supplementation on blood and tissue levels and on general nutritional status in persons with mild or moderate cognitive impairment.

METHODS

We performed a 2-month, open-label trial, administering a daily micronutrient supplement to 42 memory clinic patients with mild cognitive deficits. Blood levels of antioxidants, zinc, and B vitamins were determined before and after supplementation. In addition, we assessed metabolic markers for B vitamins and intracellular (buccal mucosa cell [BMC]) antioxidant levels. Nutritional status was assessed by using the Mini Nutritional Assessment (MNA).

RESULTS

Blood levels of B vitamins, folic acid, lutein, β-carotene, α-carotene, and α-tocopherol increased significantly. Decreases in homocysteine levels and the thiamine pyrophosphate effect and an increase in holotranscobalamin were observed. We found no increase in intracellular antioxidant levels of BMC. The MNA score in subjects at risk for malnutrition increased significantly, mainly owing to better perception of nutritional and overall health status.

CONCLUSIONS

Micronutrient supplementation improved serum micronutrient status, with improved metabolic markers for B vitamins but not for intracellular antioxidant status, and was associated with improved self-perception of general health status. Our data underline the necessity of determining micronutrient status and support the use of additional assessments for general health and quality of life in nutritional supplementation trials.

Massive and long-lasting decrease in vitamin C plasma levels as a consequence of extracorporeal circulation

OBJECTIVE

The use of cardiopulmonary bypass (CPB) is suggested to induce oxidative stress, reflected by an imbalance between prooxidant and antioxidant substances. The majority of studies published have either focused on only one aspect (prooxidant or antioxidant side) or covered only a short observation period. Therefore, the aim of this study was to investigate the long-term effects of CPB on the balance of prooxidative markers and antioxidant substances in one single group of patients, being able to estimate the degree of oxidative stress.

METHODS

Blood samples were taken from 29 patients undergoing cardiovascular surgery beginning the day before surgery through postoperative day 6 (discharge). Plasma concentrations of vitamins C (total ascorbic acid) and E and malondialdehyde were measured by high-performance liquid chromatography. Plasma levels of ascorbyl free radical were determined using electron paramagnetic resonance spectroscopy.

RESULTS

The study showed a significant decrease in vitamin C plasma levels during CPB without any recovery of vitamin C up to the time of discharge. Furthermore, CPB induced a significant increase in malondialdehyde plasma concentrations immediately after unclamping, accompanied by a significant increase in the ascorbyl free radical to total ascorbic acid ratio. The latter stayed elevated until the end of observation.

CONCLUSIONS

Our findings indicate that the oxidative stress event after CPB can be divided into two phases: Immediately after reperfusion, a massive oxidative stress occurs, reflected by the increase in malondialdehyde. During convalescence, there must be an ongoing situation of oxidative stress, especially in the water-soluble compartment, leading to the consumption of vitamin C. Because the main antioxidant substance, vitamin C, did not increase again over the entire observation period, supplementation should be given consideration.

Health benefits of nut consumption with special reference to body weight control

Nuts are an integral part of the Mediterranean food patterns, and their incorporation into the regular diets of human beings is believed to provide many health benefits. The recent recognition of nuts as "heart-healthy" foods by the U.S. Food and Drug Administration has given a major boost to the positive image of nuts. Nut consumption has been associated with several health benefits, such as antioxidant, hypocholesterolemic, cardioprotective, anticancer, anti-inflammatory, and antidiabetic benefits, among other functional properties. However, although nuts possess these many health benefits, their consumption has been hampered by a lack of adequate information regarding those benefits. In addition, because nuts are energy-dense foods with high-fat content, there is a misconception among consumers that increased consumption may lead to unwanted gain in body weight with the risk of developing overweight/obesity. Nonetheless, available epidemiologic studies and short-term controlled feeding trials have supported the theory that the inclusion of nuts in the typical diet does not induce weight gain, despite an expected increase in total caloric intake. To address the misperception about nuts and body weight gain, the present review focuses mainly on the relation between nut consumption and body weight gain, in the context of the many health benefits of nuts.

Protection by flavanol-rich foods against vascular dysfunction and oxidative damage: 27th Hohenheim Consensus Conference

Criteria for assessing the purported protection by flavanol-rich foods against vascular dysfunction and oxidative damage to biomolecules was the subject of the 27th Hohenheim Consensus Conference held on July 11, 2011. State-of-the-art evidence was put into perspective, focusing on several questions that were followed by a consensus answer. Among the topics addressed were the major sources of flavanols in the human diet, the bioavailability of flavanols, biomarkers for "health benefit," and the biological function of flavanols. Consensus was reached on these topics. No conclusion was reached on the design of randomized, controlled trials for substantiation of health claims for flavanol-rich foods as to the necessity of a study arm with an isolated pharmacologically active compound, e.g., (-)-epicatechin.

Supplementary feeding with locally-produced Ready-to-Use Food (RUF) for mildly wasted children on Nias Island, Indonesia: comparison of daily and weekly program outcomes

Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) >=-2 to <-1.5 SD aged >=6 to <60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ >=-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was higher than in weekly programs (72.9%; n=48) by a similar length of stay of about 6 weeks. Weight gain of the children in daily programs was higher (3.1±3.6 g/kg body weight/day) than in weekly programs (2.0±2.1 g/kg body weight/day), and they achieved significantly higher WHZ at discharge. However, the majority of caretakers preferred weekly programs due to lower time constraints. Locally produced RUF in the form of biscuits for treatment of mild wasting among children demonstrated promising results both in daily and weekly community-based intervention programs.

Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia

To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (>=-1.5 to <-1.0 WHZ) children aged >=6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p<0.001 and 3.0±8.0; p<0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%; n=13), and NNE (20.0%; n=10) groups (p<0.001). Shortest length of stay until recovery was observed among children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE (86.2 days) respectively (p<0.001). Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children.

Bioactive compounds extracted from Indian wild legume seeds: antioxidant and type II diabetes-related enzyme inhibition properties

Seven different wild legume seeds (Acacia leucophloea, Bauhinia variegata, Canavalia gladiata, Entada scandens, Mucuna pruriens, Sesbania bispinosa and Tamarindus indica) from various parts of India were analyzed for total free phenolics, l-Dopa (l-3,4 dihydroxyphenylalanine), phytic acid and their antioxidant capacity (ferric-reducing antioxidant power [FRAP] and 2,2-diphenyl-1-picrylhydrazyl [DPPH] assay) and type II diabetes-related enzyme inhibition activitiy (α-amylase). S. bispinosa had the highest content in both total free phenolics and l-Dopa, and relatively low phytic acid when compared with other seeds. Phytic acid content, being highest in E. scandens, M. pruriens and T. indica, was highly predictive for FRAP (r = 0.47, p < 0.05) and DPPH (r = 0.66, p < 0.001) assays. The phenolic extract from T. indica and l-Dopa extract from E. scandens showed significantly higher FRAP values among others. All seed extracts demonstrated a remarkable reducing power (7-145 mM FeSO4 per mg extract), DPPH radical scavenging activity (16-95%) and α-amylase enzyme inhibition activity (28-40%).

Micronutrients in pregnancy: current knowledge and unresolved questions

Micronutrient status is increasingly recognized to play an important role in the health and well-being of pregnant women and in the development and long-term health of the offspring. On 26th - 28th February 2009, The Child Health Foundation invited leading experts in this area to a scientific workshop at Obergurgl, Austria to review and critically discuss current knowledge, to identify issues that may need to be addressed in future recommendations, and to highlight priorities and opportunities for future research. This report summarizes updated key conclusions of the workshop with regards to micronutrients' intake and physiological role related to mother, placenta and fetus, as well as relevance for adverse pregnancy and long-term outcomes.

Beta-carotene is an important vitamin A source for humans

Experts in the field of carotenoids met at the Hohenheim consensus conference in July 2009 to elucidate the current status of β-carotene research and to summarize the current knowledge with respect to the chemical properties, physiological function, and intake of β-carotene. The experts discussed 17 questions and reached an agreement formulated in a consensus answer in each case. These consensus answers are based on published valid data, which were carefully reviewed by the individual experts and are justified here by background statements. Ascertaining the impact of β-carotene on the total dietary intake of vitamin A is complicated, because the efficiency of conversion of β-carotene to retinol is not a single ratio and different conversion factors have been used in various surveys and following governmental recommendations within different countries. However, a role of β-carotene in fulfilling the recommended intake for vitamin A is apparent from a variety of studies. Thus, besides elucidating the various functions, distribution, and uptake of β-carotene, the consensus conference placed special emphasis on the provitamin A function of β-carotene and the role of β-carotene in the realization of the required/recommended total vitamin A intake in both developed and developing countries. There was consensus that β-carotene is a safe source of vitamin A and that the provitamin A function of β-carotene contributes to vitamin A intake.

Reexamination of a meta-analysis of the effect of antioxidant supplementation on mortality and health in randomized trials

A recent meta-analysis of selected randomized clinical trials (RCTs), in which population groups of differing ages and health status were supplemented with various doses of β-carotene, vitamin A, and/or vitamin E, found that these interventions increased all-cause mortality. However, this meta-analysis did not consider the rationale of the constituent RCTs for antioxidant supplementation, none of which included mortality as a primary outcome. As the rationale for these trials was to test the hypothesis of a potential benefit of antioxidant supplementation, an alternative approach to a systematic evaluation of these RCTs would be to evaluate this outcome relative to the putative risk of greater total mortality. Thus, we examined these data based on the primary outcome of the 66 RCTs included in the meta-analysis via a decision analysis to identify whether the results provided a positive (i.e., benefit), null or negative (i.e., harm) outcome. Our evaluation indicated that of these RCTs, 24 had a positive outcome, 39 had a null outcome, and 3 had a negative outcome. We further categorized these interventions as primary (risk reduction in healthy populations) or secondary (slowing pathogenesis or preventing recurrent events and/or cause-specific mortality) prevention or therapeutic (treatment to improve quality of life, limit complications, and/or provide rehabilitation) studies, and determined positive outcomes in 8 of 20 primary prevention studies, 10 of 34 secondary prevention studies, and 6 out of 16 therapeutic studies. Seven of the eight RCTs with a positive outcome in primary prevention included participants in a population where malnutrition is frequently described. These results suggest that analyses of potential risks from antioxidant supplementation should be placed in the context of a benefit/risk ratio.

More than the sum of its parts? Nutrition in Alzheimer's disease

The aim of this article is to emphasize the importance of malnutrition and micronutrient deficiencies in Alzheimer's disease and discuss recent supplementation trials. Alzheimer's disease (AD) is a devastating neurodegenerative disease with increasing socio-economic impact. It leads to cognitive decline over the years, finally resulting in brain atrophy and gradually destroying a person's ability to learn, reason, make judgments, and communicate. Most of the cases are sporadic and risk factors evolve. There is evidence that malnutrition, oxidative stress, and homocysteine-related vitamins play a role in the pathogenesis of AD. A plethora of epidemiologic studies have explored the associations between nutrients and AD. In addition, more and more data from recent trials are evolving to analyze the impact of micronutrient supplementation in AD and incipient AD concerning B vitamin status and antioxidants. Available data do not support definitive conclusions regarding specific recommendations on micronutrient supplementation for the prevention or treatment of AD; however, more data from prospective trials are needed. Approaches with multiple nutritional components might be promising.

Qualitative and quantitative analysis of retinol, retinyl esters, tocopherols and selected carotenoids out of various internal organs form different species by HPLC

We report the validation of a reversed-phase gradient HPLC method allowing simultaneous quantification of retinol, retinyl esters, tocopherols and selected carotenoids in lung, liver and plasma of mouse, rat and guinea pig (gp) using a diode array detector. A significant species difference was observed regarding the distribution of retinol and retinyl esters. The levels of total retinol in lung, liver and plasma were in the following order: mouse >> rat > gp; rat >mouse > gp; and gp >> rat > mouse, respectively. Furthermore, comparison studies revealed similarities between the vitamin A profiles of human and gp lung samples.

Water, electrolytes, vitamins and trace elements - Guidelines on Parenteral Nutrition, Chapter 7

A close cooperation between medical teams is necessary when calculating the fluid intake of parenterally fed patients. Fluids supplied parenterally, orally and enterally, other infusions, and additional fluid losses (e.g. diarrhea) must be considered. Targeted diagnostic monitoring (volume status) is required in patients with disturbed water or electrolyte balance. Fluid requirements of adults with normal hydration status is approximately 30-40 ml/kg body weight/d, but fluid needs usually increase during fever. Serum electrolyte concentrations should be determined prior to PN, and patients with normal fluid and electrolyte balance should receive intakes follwing standard recommendations with PN. Additional requirements should usually be administered via separate infusion pumps. Concentrated potassium (1 mval/ml) or 20% NaCl solutions should be infused via a central venous catheter. Electrolyte intake should be adjusted according to the results of regular laboratory analyses. Individual determination of electrolyte intake is required when electrolyte balance is initially altered (e.g. due to chronic diarrhea, recurring vomiting, renal insufficiency etc.). Vitamins and trace elements should be generally substituted in PN, unless there are contraindications. The supplementation of vitamins and trace elements is obligatory after a PN of >1 week. A standard dosage of vitamins and trace elements based on current dietary reference intakes for oral feeding is generally recommended unless certain clinical situations require other intakes.

Vitamin E requirements in parenteral nutrition

Patients with parenteral nutrition depend on an adequate supply of micronutrients, in particular, antioxidant vitamins and cofactors such as selenium. In cases of oxidative stress (eg, chronic inflammation, sepsis, lung distress syndrome, and organ failure), there is a higher need for antioxidants. One of the most important antioxidant vitamins is vitamin E. For very low birth weight infants the plasma level is an indicator for adequate supply and for safety. Safe and effective blood levels are between 23 and 46 micromol/L, maintained with a dose of 2.8 IU/kg body weight (1-2 mg/day). For safety reasons a plasma level of 80 micromol/L should not be exceeded. For adults, 10 IU/day (9.1 mg/day) are recommended. Whether this dose is sufficient to ensure body stores and sufficient antioxidant activity is controversial. If parenteral lipid emulsions are supplied there is an additional need for vitamin E to protect the lipids (polyunsaturated fatty acids) from lipid peroxidation and to deliver additional vitamin E. Dietary guidelines for healthy adults recommend an intake of polyunsaturated fatty acids equal to 10% of total energy and an intake of alpha-tocopherol greater than 0.4 mg/g of polyunsaturated fatty acids. Randomized clinical trials are performed using special formulations of vitamin E solutions because vitamin E is available only in lipid emulsions to protect lipids, but not in an isolated solution for parenteral supply.

Parenteral ascorbic acid in haemodialysis patients

PURPOSE OF REVIEW

Parenteral ascorbic acid has been frequently used to overcome problems of vitamin C deficiency in haemodialysis patients. The benefits of vitamin C supplementation in clinical studies have been controversial and did not consider toxicological aspects. The review summarizes recent findings of the effects of parenteral ascorbic acid and discusses toxicological effects.

RECENT FINDINGS

Vitamin C deficiency in haemodialysis patients, which has been frequently described, cannot be improved with oral supplementation due to limited absorption of high dosages. To avoid consequences of vitamin C deficiency, parenteral vitamin C solutions should be administered because this intervention is the only way to guarantee a sufficient supply to the cells. A beneficial consequence of parenteral vitamin C on the recombinant human erythropoietin resistance is an additional therapeutic effect, which contributes to the prevention of iron deficiency anaemia in haemodialysis patients. Thus, large amount of supplemental vitamin C are required for extended periods of time (up to 500 mg 3 times a week). To avoid hyperoxaluria, plasma oxalate levels should be monitored on a regular basis, for example, once a week.

SUMMARY

Parenteral administration of ascorbic acid may be an approach that can overcome problems of vitamin C deficiency in haemodialysis patients - in particular problems of iron overload, erythropoetin resistance, and chronic inflammation.

Inhibition of heme oxygenase-1 increases responsiveness of melanoma cells to ALA-based photodynamic therapy

Based on the observation that 5-aminolevulinic acid (ALA) induces the expression of heme oxygenase-1 (HO-1) in cultured melanoma cells, the role of HO-1 on the effectiveness of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) was examined. Transcriptional activation of the HO-1 gene is considered to be an adaptive response to oxidative and cellular stress and confers a protective capacity against cell and tissue injury, which could affect the responsiveness to ALA-PDT. A time-dependent accumulation (0-16 h) of protoporphyrin IX (PPIX) within melanoma cells was seen after incubation with ALA (0.5 mM ALA). Over the same time interval, a significant increase (up to 25-fold) in HO-1 protein expression was observed. Thus, the production and degradation of PPIX (via heme by HO-1) were simultaneously enhanced, leading to a reduced intracellular concentration of the photodynamically active substance PPIX. Diminishing HO-1 activity by the HO-1 inhibitor tin protoporphyrin IX (SnPPIX) significantly enhanced the formation of PPIX up to 1.8 fold. A further strong increase in HO-1 protein expression (up to 128-fold) was seen after ALA-PDT treatment. Induction of HO-1 is an essential step in the 'rescue response' of tumor cells. The pharmacological inhibition of HO-1 activity by SnPPIX leads to a considerable increase in the sensitivity of tumor cells to ALA-PDT treatment. At low radiation doses (0.42 J/cm(2)), the percentages of death cells increased significantly from 7.3+/-1.3% to 43.7+/-6.4%. This effect could be further intensified by cellular depletion of HO-1 mRNA by siRNA. The combination of pharmacological inactivation of HO-1 with gene silencing led to an increase in the death rate of up to 54.1+/-8.6%. The results presented indicate that HO-1 can play a protective role against ALA-PDT mediated cytotoxicity so that a specific inhibition of HO-1 activity and/or expression might be used to increase the efficacy of ALA-based photodynamic therapy.

Polyphenols and inflammation: basic interactions

PURPOSE OF REVIEW

For more than 20 years polyphenols, food-derived bioactive compounds in fruits and vegetables, are claimed to help prevent cancer, degenerative diseases and chronic and acute inflammation. Modern methods in cell and molecular biology allow us to understand the interactions of different polyphenols with basic mechanisms of inflammatory response. This review summarizes recent papers dealing with the effect of polyphenols on modulators of the inflammatory cascade.

RECENT FINDINGS

The majority of papers deal with the effects of different antioxidants on the redox sensitive transcription factor nuclear factor kappaB, inducible nitric oxide synthase expression and cyclooxygenase inhibition. Understanding the regulatory steps and the multiple potential actions of polyphenols within the inflammatory cascade may help to define special polyphenols to be used for prevention and intervention in clinical conditions of inflammation. The relation between formation of advanced glycation end products as a consequence of high glucose and the activation of defence mechanisms through polyphenols opens new fields in the prevention and treatment of oxidative stress and hyperglycemia.

SUMMARY

Polyphenols are promising compounds that may help to control oxidative stress and consequently inflammatory response. To date, however, clinical studies are missing and should be carried out with specific polyphenols.

Impact of therapeutically induced reactive oxygen species and radical scavenging by alpha-tocopherol on tumor cell adhesion

Many tumor treatment modalities such as ionizing radiation or some chemotherapy induce reactive oxygen species (ROS) resulting in therapeutic cell damage. The aim of this study was to analyze whether such ROS induction may affect the mechanical stability of solid tumor tissue by degradation of the extracellular matrix proteins or by a loss of cell adhesion molecules. Additionally, the protective impact of alpha-tocopherol treatment on these processes was studied. Experimental DS-sarcomas in rats were treated with a combination of localized 44 degrees C hyperthermia, inspiratory hyperoxia and xanthine oxidase in order to induce pronounced oxidative stress. A second group of animals were pretreated with alpha-tocopherol. The in vivo expression of E- and N-cadherin, alpha-catenin, integrins alphav, beta3 and beta5 as well as the expression of the integrin dimer alphavbeta3 were assessed by flow cytometry. The activity of the matrix metalloproteinases MMP-2 and -9 and the activity of the urokinase-type plasminogen activator (uPA) were determined by zymography. The expression of E-cadherin, the alphav-, beta3-integrin and the alphavbeta3-integrin dimer was significantly reduced by ROS induction, an effect which was at least partially reversible by alpha-tocopherol. N-cadherin, alpha-catenin and the beta5-integrin expression was not affected by ROS. In addition, MMP-2, MMP-9 and uPA activities were markedly reduced immediately after hyperthermia. Whereas 24 h later the effects on MMP-2 and -9 were no longer evident, for uPA the impact of oxidative stress became even more pronounced at this time. These results show that several processes responsible for the structural stability of the tumor tissue are affected by therapeutic ROS generation. Changes in some of the markers assessed suggested a decrease in tissue stability upon ROS induction, whereas others indicated changes which could lead to a more stable tumor cell cluster. Depending on the individual tumor entity ROS may therefore influence the mechanical stability of solid tumors and by this affect metastatic behavior.

Comparison of the relative bioavailability of different coenzyme Q10 formulations with a novel solubilizate (Solu Q10)

The relative bioavailability of coenzyme Q10 (CoQ10) is markedly influenced by its delivery systems. The aim of this study was to compare four standard CoQ10 supplements available on the market with a novel solubilizate formulation of CoQ10 (Solu Q10). Pharmacokinetic parameters were assessed in 54 healthy volunteers after single and multiple intakes of 60 mg CoQ10 over a time period of 14 days. Solubilizates showed earlier flooding compared with oily dispersions and crystalline CoQ10, resulting in significantly elevated area under the curve between 0 and 4 h (P<0.01 solubilizates versus crystalline). The difference in the pharmacokinetic parameters of maximum plasma concentration, time to reach the peak plasma concentration and area under the curve between 0 and 12 h was not statistically significant between formulations. Long-term supplementation resulted in significantly higher plasma levels (P<0.01) for all formulations, with Solu Q10 performing best. Intracellular CoQ10 levels measured in buccal mucosa cells were increased (P<0.05) in response to supplementation when starting within the physiological range. In summary, solubilizates were clearly superior to oily dispersions and crystalline CoQ10 in their overall bioavailability, with the best absorption characteristics seen for the novel Solu Q10 solubilizate.

No evidence for prooxidative effects of homocysteine in vascular endothelial cells

Many epidemiological studies predict a role for homocysteine (HCys) in cardiovascular disease occurrence, progression, and risk factors. In vitro studies demonstrated that HCys is an atherogenic determinant that promotes oxidant stress, inflammation, endothelial dysfunction and cell proliferation. This study originally attempted to examine the mechanism by which exposure of endothelial cells to HCys (0-250 microM) initiates inflammatory reaction and oxidative stress, by (i) investigating whether physiological and pathophysiological concentrations of HCys exhibit a prooxidative activity in vitro, (ii) examining the interaction of monocyte adhesion (Mono Mac 6) to monolayers of human microvascular endothelial cells (HMEC-1) exposed to different HCys concentrations, and (iii) examining if adherent monocytes increase reactive oxygen species either in endothelial cells or in monocytes themselves. However, our results demonstrate that HCys had neither prooxidative nor cytotoxic effects on endothelial cells. Only a moderate time- and concentration-dependent increase in monocyte adhesion up to 28.3 +/- 5.5% was achieved relative to control after 4 h of HCys stimulation. This effect was accompanied by an increased VCAM and ICAM-1 mRNA expression. This "proinflammatory" effect appeared also when HMEC-1 cells were incubated with cysteine or glutathione at the concentration range 0-250 microM, demonstrating a non-specific rather than a specific HCys effect. In addition, adherent monocytes did not increase ROS formation neither in endothelial cells nor in monocytes themselves, indicating no direct or indirect cytotoxic or prooxidative effects of HCys.

β-Carotene and α-tocopherol concentration and antioxidant status in buccal mucosal cells and plasma after oral supplementation

The uptake of α-tocopherol and β-carotene and their antioxidative effect in plasma and buccal mucosal cells after oral application in twelve subjects is demonstrated in our study. The effect on the antioxidative status was evaluated using a modified thiobarbituric acid-reactive substance (TBARS) method. As expected, the supplement of 134·2 mg α-tocopherol/d and 25 mg β-carotene/d for 7 d resulted in a significant increase of α-tocopherol and β-carotene concentration in plasma (P<0·05). In buccal mucosal cells, the concentration of β-carotene increased after supplementation (P<0·05), whereas the concentration of α-tocopherol remained constant. A decrease in TBARS (P<0·05) was found in buccal mucosal cells but not in plasma. In conclusion, an uptake of the supplemented antioxidants was detected in plasma and in buccal mucosal cells. There was significant change in β-carotene concentration and oxidative stress as measured using a modified TBARS test in buccal mucosal cells, but not in the plasma.

Antioxidanzien – hilfreich oder schädlich?

Angereicherte und daher oft mit einer besonderen Funktionalität beworbene Lebensmittel werden in zunehmendem Maße angeboten. Dabei erfolgt besonders eine Anreicherung mit Antioxidanzien (Vitamine C, E und Provitamin A). Da die gewählten Dosierungen unterhalb der Empfehlungen liegen und bei verzehrsüblichen Mengen diese auch nur unwesentlich überschritten werden, besteht vom einzelnen Lebensmittel her kein Risiko für den Verbraucher. Auch bei Verzehr mehrerer angereicherter Lebensmittel führt eine Kumulation nicht zu bedenklichen Werten. Allerdings sollten angereicherte Lebensmittel nicht als Ersatz für eine ungesunde Ernährung genommen werden. Hierin liegt viel eher ein Risiko, da meist nur sehr wenige Antioxidanzien im Lebensmittel angereichert sind. In wie weit der Verbraucher einen Nutzen von angereicherten Lebensmitteln hat ist im Falle der Antioxidanzien nicht gesichert.

Solubility, uptake and biocompatibility of lutein and zeaxanthin delivered to cultured human retinal pigment epithelial cells in tween40 micelles

Carotenoids lutein and zeaxanthin are proposed to protect ocular tissues from free-radical damage that can cause cataract and age-related macular degeneration (AMD). They accumulate selectively in the lens and macular region of the retina. Changes in the retinal pigment epithelium are characteristic in AMD. Efficient uptake is essential to study the intracellular effects of carotenoids in cell cultures. For in vitro experiments carotenoids are often dissolved in organic solvents like tetrahydrofuran (THF), dimethylsulfoxide (DMSO) and n-hexane, but difficulties have been associated with these application methods. Recently, O'Sullivan et al. (SM O'Sullivan et al., Br J Nutr 91 (2004) 757) developed a method whereby carotenoids could be delivered to cultured cells without the cytotoxic side effects often observed when organic solvents are used. We modified this method and investigated the effects of different carotenoid-formulations (ethanol/Tween40, methanol/tween40 and acetone/Tween40) on the uptake of lutein and zeaxanthin by differentiated ARPE-19 cells, cell viability and the expression of the "stress" gene HO-1, which is easily induced by a range of stimuli including chemical and physical agents. Micelle formulations prepared with ethanol/Tween40 resulted in the lowest LDH release, the highest carotenoid uptake and the lowest stress response (changes in HO-1 mRNA expression).

Conversion of beta-carotene to retinal pigment

Vitamin A and its active metabolite retinoic acid (RA)(1) play a major role in development, differentiation, and support of various tissues and organs of numerous species. To assure the supply of target tissues with vitamin A, long-lasting stores are built in the liver from which retinol can be transported by a specific protein to the peripheral tissues to be metabolized to either RA or reesterified to form intracellular stores. Vitamin A cannot be synthesized de novo by animals and thus has to be taken up from animal food sources or as provitamin A carotenoids, the latter being converted by central cleavage of the molecule to retinal in the intestine. The recent demonstration that the responsible beta-carotene cleaving enzyme beta,beta-carotene 15,15'-monooxygenase (Bcmo1) is also present in other tissues led to numerous investigations on the molecular structure and function of this enzyme in several species, including the fruit fly, chicken, mouse, and also human. Also a second enzyme, beta,beta-carotene-9',10'-monooxygenase (Bcmo2), which cleaves beta-carotene eccentrically to apo-carotenals has been described. Retinal pigment epithelial cells were shown to contain Bcmo1 and to be able to cleave beta-carotene into retinal in vitro, offering a new pathway for vitamin A production in another tissue than the intestine, possibly explaining the more mild vitamin A deficiency symptoms of two human siblings lacking the retinol-binding protein for the transport of hepatic vitamin A to the target tissues. In addition, alternative ways to combat vitamin A deficiency of specific targets by the supplementation with beta-carotene or even molecular therapies seem to be the future.

Consensus meeting on "Relevance of parenteral vitamin C in acute endothelial dependent pathophysiological conditions (EDPC)"

The 22 supersetnd Hohenheim Consensus Workshop took place in at the University of Stuttgart-Hohenheim. The subject of this conference was vitamin C and its role in the treatment of endothelial dysfunction. Scientists, who had published and reviewed scientific and regulatory papers on that topic were invited, among them basic researchers, toxicologists, clinicians and nutritionists. The participants were presented with eleven questions, which were discussed and answered at the workshop, with the aim of summarising the current state of knowledge. The explicatory text accompanying the short answers was produced and agreed on after the conference and was backed up by corresponding references. The therapeutic relevance of administration of the physiological antioxidant vitamin C in high parenteral doses in Endothelial Dependent Pathophysiological Conditions (EDPC) was discussed. Endothelial dysfunction is defined as including disturbed endothelial dependant relaxation of resistance vessels, breakdown of the microvascular endothelial barrier and/or loss of anti-adhesive function. It occurs in severe burn injury, intoxications, acute hyperglycemia, sepsis, trauma, and ischemic-reperfusion tissue injury and is induced by oxidative stress. Reduced plasma ascorbate levels are a hallmark of oxidative stress and occur in severe burns, sepsis, severe trauma, intoxication, chemotherapy/radiotherapy and organ transplantation. Vitamin C directly enhances the activity of nitric oxide synthase, the acyl CoA oxidase system and inhibits the actions of proinflammatory lipids. There is experimental evidence that parenteral high-dose vitamin C restores endothelial function in sepsis. In vitro, supraphysiological concentrations (> 1mM) of ascorbate restore nitric oxide bioavailability and endothelial function. Only parenterally, can enough vitamin C be administered to combat oxidative stress. There is no evidence that parenteral vitamin C exerts prooxidant effects in humans. Theoretical concerns in relation to competitive interactions between vitamin C and glucose cellular uptake are probably only relevant for oxidised vitamin C (dehydroascorbate).