Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden?

All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis, may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels is not undertaken for most vitamins except folate, B12, and 25-hydroxyvitamin D because assays may not be available or may be costly to perform and do not always correlate with body stores. The last systematic review through 2016 was performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update, so this article summarizes the more recent evidence. We review the use of vitamins supplementation in the CKD population. To date there have been no randomized trials to support the benefits of any vitamin supplementation for kidney, cardiovascular, or patient-centered outcomes. The decision to supplement water-soluble vitamins should be individualized, taking account the patient's dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status, and dialysis loss. Nutritional vitamin D deficiency should be corrected, but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage, and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. Although more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.

Alarming levels of inadequate intake of B group vitamins in tribal lactating women from South India

Background

Micronutrients are necessary for proper growth and development of the human body, though required in small amounts. Dietary intake of these micronutrients by lactating women is essential for their own health as well as children's overall growth and development. objective of present study is to assess the adequacy of dietary B-group vitamins intake during lactation and to find out the factors associated with their inadequate intake.

Design and methods

It was a analysis of data from prospective cohort study for 10 months carried out among 340 Scheduled Tribes mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection was done using a 24 h dietary recall questionnaire. A p-value less than 0.05 was considered to be statistically significant.

Results

All the mothers (n = 340) were not having adequate intake of Thiamine, Riboflavin, Niacin, Pyridoxine, Pantothenic acid, Biotin and Folic acid. Methyl cobalamin intake was inadequate in 37.5% mothers (n = 136). The mean intake of Vitamin B12 was 40.98 + 42.8 (SD) µg/day. Age at marriage, location and parity were significantly associated with inadequate intake of Vitamin B12.

Conclusions

The current diet pattern of mothers of vulnerable groups might affect the growth and development of the infant. We strongly recommend for supplementation of B-group vitamins to pregnant and lactating women in India.

[Influence of multiple insufficiency of vitamin D and B group vitamins, calcium and magnesium in the diet of rats on micronutrient sufficiency and plasma biochemical indicators]

The lack of vitamins D, B group, calcium and magnesium is common for the diet of the Russian population. It has been previously demonstrated that that the elimination of B vitamin deficiency is a necessary condition for the implementation of vitamin D biological functions. The aim of the research was to assess the effect of a combined deficiency of vitamins D and B group, calcium and magnesium in the diet of rats on biomarkers of micronutrient sufficiency and plasma biochemical indicators. Material amd methods. Male Wistar rats with an initial body weight of 66±1 g were randomly assigned to one of five groups. The rats of the 1st group (Control) were fed a standard semi-synthetic diet (SD) for 28 days. The combined deficit of vitamins D and B group, calcium and magnesium in rats of four experimental groups was caused by a 5-fold decrease in their content in the vitamin mixture and 2-fold decrease in their content in mineral mixture of the SD for 23 days. Over the next 5 days, the rats of 2nd group (+В+D+Ca+Mg) were fed a diet replenished for all missing vitamins and minerals, the rats of 3rd group (-В+D+Ca+Mg) were fed a diet with continued deficiency of B group vitamins, the rats of the 4th group (+В+D-Ca-Mg) were fed a diet with continued lack of calcium and magnesium, the diet of the 5th group (-B-D-Ca-Mg) was not replenished. Vitamins B1 and B2 in lyophilized liver and brain and urine, riboflavin in plasma and 4-pyridoxic acid in urine were determined by fluorimetric methods, 25(OH)D in plasma was determined by ELISA, the level of vitamins A and E in blood plasma and lyophilized liver, of vitamin E in whole brain - by HPLC. Biochemical parameters of blood plasma were determined using a biochemical analyzer. Results. In rats of the 5th group (-B-D-Ca-Mg), there were 3.4-fold increase (p<0.05) in iron plasma level, 1.7-fold elevation (p<0.10) in alkaline phosphatase activity, and 1.8-fold decrease (p<0.05) in alanine aminotransferase (ALT) activity on the background of the increase in α-tocopherol blood plasma level by 26.7% (p<0.05) and liver content by 2.0 fold (p<0.05) relative to the indicators in animals who hadn't passed the deficiency of micronutrients (Control) and / or from the 2nd group (+B+D+Ca+Mg). The lack of B group vitamins in the diet, which persisted during the correction of vitamin D, calcium and magnesium deficiency in rats of the 3rd group (-B+D+Ca+Mg), inhibited the recovery of diagnostically significant biochemical parameters of blood plasma (namely, an increased level of glucose, iron, triglycerides, cholesterol, α-tocopherol, increased alkaline phosphatase activity and reduced ALT activity) to the level in animals of the control group and/or rats fed the diet replenished for all missing micronutrients (+B+D+Ca+Mg). Conclusion. Combined deficiency of several micronutrients led to changes in biochemical blood parameters. Reduced intake of calcium and magnesium during the correction of the lack of vitamins D and B group in the diet can have a negative impact on vitamin B2 status. Even under normal dietary vitamin E intake the combined deficiency of several other micronutrients affected the metabolism of this vitamin (increased levels of vitamin E in the liver and blood plasma of animals). Chronic combined alimentary deficit of B vitamins, calcium and magnesium, which is characteristic in the diet of the Russian population, reduces vitamin D bioavailability, which justifies the expediency of using vitamin-mineral complexes.

Dietary B group vitamin intake and the bladder cancer risk: a pooled analysis of prospective cohort studies

PURPOSE

Diet may play an essential role in the aetiology of bladder cancer (BC). The B group complex vitamins involve diverse biological functions that could be influential in cancer prevention. The aim of the present study was to investigate the association between various components of the B group vitamin complex and BC risk.

METHODS

Dietary data were pooled from four cohort studies. Food item intake was converted to daily intakes of B group vitamins and pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were obtained using Cox-regression models. Dose-response relationships were examined using a nonparametric test for trend.

RESULTS

In total, 2915 BC cases and 530,012 non-cases were included in the analyses. The present study showed an increased BC risk for moderate intake of vitamin B1 (HRB1: 1.13, 95% CI: 1.00-1.20). In men, moderate intake of the vitamins B1, B2, energy-related vitamins and high intake of vitamin B1 were associated with an increased BC risk (HR (95% CI): 1.13 (1.02-1.26), 1.14 (1.02-1.26), 1.13 (1.02-1.26; 1.13 (1.02-1.26), respectively). In women, high intake of all vitamins and vitamin combinations, except for the entire complex, showed an inverse association (HR (95% CI): 0.80 (0.67-0.97), 0.83 (0.70-1.00); 0.77 (0.63-0.93), 0.73 (0.61-0.88), 0.82 (0.68-0.99), 0.79 (0.66-0.95), 0.80 (0.66-0.96), 0.74 (0.62-0.89), 0.76 (0.63-0.92), respectively). Dose-response analyses showed an increased BC risk for higher intake of vitamin B1 and B12.

CONCLUSION

Our findings highlight the importance of future research on the food sources of B group vitamins in the context of the overall and sex-stratified diet.