Assessing the nutritional quality of lipid components in commercial meal replacement shakes using an in vitro digestion model

This study aimed to investigate the nutritional value of five commercial meal-replacement shakes, and mainly focused on the lipid digestion fates and fat-soluble vitamin bioavailability. Four out of five samples exhibited a low lipolysis level (37.33-61.42%), aligning with the intended objectives of these products. Although the remaining sample rich in diacylglycerol (DAG) had a higher lipolysis level (80.83%), the inherent low-calorie nature of DAG might compensate for this drawback. The release level of individual fatty acid was largely determined by the glycerolipid composition. Moreover, the strong positive correlation between lipid hydrolyzed products amounts and the fat-soluble vitamin bioavailability was observed. Surprisingly, one out of five samples can provide enough vitamin A and vitamin E for consumers as a total replacement of one or two regular meals. Consequently, the meal-replacement shakes hold the potential to emerge as healthy products for this fast-paced era if the composition and structure were carefully designed and calculated.

Liquid chromatography-tandem mass spectrometry in fat-soluble vitamin deficiency

Fat-soluble vitamins, including vitamins A, D, E, and K, are essential for maintaining normal body function and metabolism. Fat-soluble vitamin deficiency may lead to bone diseases, anemia, bleeding, xerophthalmia, etc. Early detection and timely interventions are significant for preventing vitamin deficiency-related diseases. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is developing into a potent instrument for the precise detection of fat-soluble vitamins due to its high sensitivity, high specificity, and high resolution.

Seasonal variations of vitamin A, D and E levels in serum of female camels (Camelus dromedarius) and their calves raised in five geographic regions of Saudi Arabia

The aim of this study was to investigate the serum level of fat-soluble vitamins A, D and E in clinically healthy lactating female camel (Camelus dromedarius) and suckling calf > one-year-old during winter and summer seasons in five main regions of Saudi Arabia. 60 sera samples were collected and tested for vitamins A, D and E levels and the results were statistically analyzed. The statistical mean value of vitamin A was within the reported range but for D and E, there were minor variations. The effect of season was insignificant (p > 0.05) for vitamins A and E in the combined results of the dam and newborn together. This seasonal effect was highly significant in dam serum (p < 0.05). Region effect was significant for vitamin A in the northern area (p < 0.05) and for vitamin E in the southern region (p < 0.05). Correlations analysis revealed significant results in the season vs vitamin A and E p < 0.05. Mean values of vitamins A, D and E in dam and newborn did not observe significant variations however, in the season and regions there were significant variations which can be attributed to the climate difference, availability of balanced rations and camel management in each location of the five main regions of Saudi Arabia. There is a great need for further studies and the consequent development of supplementation programs and camel feed manufacturers awareness of such results is highly recommended.

Simultaneous analysis of water-soluble and fat-soluble vitamins through RP-HPLC/DAD in food supplements and brewer's yeast

The current study is focused on investigation and quantitation of seven commercially available on the Bulgarian market food supplements, containing multivitamin mixtures of water-soluble and fat-soluble vitamins. In addition, a second fermentation brewer's yeast is also analyzed. The analytical procedures are performed on a RP-HPLC/DAD using Purospher STAR C18 (Merck Millipore, Germany) 5 μm, 25 × 0.46 cm column, conditioned at 25 °C in a column oven. Dionex UltiMate 3000 high performance liquid chromatograph was carried out in diode array detector, set up at 270 nm for water-soluble vitamins, except for vitamin B₅, where 210 nm was applied as analytical wavelength. The fat-soluble vitamins were detected at 325 nm and 265 nm for vitamin A and vitamin E, respectively. Two general methods were developed where Method 1 was based on gradient elution and Method 2 was based on isocratic elution. Both methods identified stated by the manufacturer labeled amounts. The developed methods are applicable for routine analysis of vitamin contents both in multivitamin preparations and in brewer's yeast from secondary fermentation.

Fat-soluble vitamins: updated review of their role and orchestration in human nutrition throughout life cycle with sex differences

Age and Gender are vital determinants for the micronutrient demands of normal indviduals. Among these micronutrients are vitamins that are required in small amounts for optimum metabolism, homeostasis, and a healthy lifestyle, acting as coenzymes in several biochemical reactions. The majority of previous studies have examined such issues that relates to a specific vitamin or life stage, with the majority merely reporting the effect of either excess or deficiency. Vitamins are classified into water-soluble and fat-soluble components. The fat-soluble vitamins include vitamins (A, D, E, and K). Fat-soluble vitamins were found to have an indisputable role in an array of physiological processes such as immune regulation, vision, bone and mental health. Nonetheless, the fat-soluble vitamins are now considered a prophylactic measurement for a multitude of diseases such as autism, rickets disease, gestational diabetes, and asthma. Herein, in this review, a deep insight into the orchestration of the four different fat-soluble vitamins requirements is presented for the first time across the human life cycle beginning from fertility, pregnancy, adulthood, and senility with an extensive assessment ofthe interactions among them and their underlying mechanistic actions. The influence of sex for each vitamin is also presented at each life stage to highlight the different daily requirements and effects.

Outcomes and Perioperative Nutritional Management in a Porcine Model of Short Bowel Syndrome

INTRODUCTION

Short bowel syndrome (SBS) results from significant intestinal loss and is characterized by insufficient absorption of nutrients and fluids. Preclinical large animal SBS models typically require parenteral nutrition (PN) support and may not be appropriate for studying interventions to improve intestinal absorption or adaptation. Here, we describe the development of a porcine SBS model that does not require PN support.

METHODS

Eight male Yorkshire piglets underwent either a 75% or 90% jejunoileal resection (n = 5) or no resection (n = 3). Continuous enteral nutrition (EN) was provided via a gastrostomy tube. The final SBS model consisted of a 75% resection and nutrition provided via combination EN (60%) and per oral pig chow (40%). Body weight and concentration of fat-soluble vitamins were assessed on postoperative days (POD) 7, 14, and 21. For assessing fat malabsorption, the coefficient of fat absorption (CFA) was calculated following a 72-h stool collection.

RESULTS

Resected animals had decreased weight gain compared to unresected controls (POD21 + 8.3% versus +28.8%, P = 0.048). Vitamin D concentration was significantly lower in resected animals compared to controls on POD 7, POD 14, and POD 21. Serum vitamin E concentration was also lower on POD 21. Resected animals developed fat malabsorption with lower CFA (76.5% versus 95.3%, P = 0.014).

CONCLUSIONS

We describe the development of a porcine SBS model that does not require PN support. Piglets in this model gain less weight, demonstrate fat malabsorption, and develop fat-soluble vitamin deficiencies. This model will benefit investigations of intestinal absorption or adaptation while potentially decreasing costs and confounding complications related to PN administration.

Development and Validation of a Liquid Chromatography Mass Spectrometry Method for Simultaneous Measurement of 25(OH)D3, epi-25(OH)D3, 25(OH)D2, Vitamin A, α-Tocopherol, and γ-Tocopherol

OBJECTIVES

Fat-soluble vitamins are measured to identify deficiencies that may lead to rickets, osteomalacia, night blindness, and reversible motor and sensory neuropathies. We present a rapid liquid chromatography-mass spectrometry (LC-MS/MS) method that simultaneously measures 25-hydroxyvitamin D3 (25[OH]D3), epi-25(OH)D3, 25(OH)D2, vitamin A, α-tocopherol, and γ-tocopherol.

METHODS

We mixed 100 µL serum with internal standard and extracted it by using supported liquid extraction plates. Reconstituted specimens were analyzed by LC-MS/MS with a 10-minute gradient.

RESULTS

The method was linear, covering physiological levels with r2 > 0.99, and the total precision was less than 15% at all quality control levels. The lower limit of the measuring intervals for 25(OH)D3, epi-25(OH)D3, 25(OH)D2, vitamin A, α-tocopherol, and γ-tocopherol were 4 ng/mL, 4 ng/mL, 4 ng/mL, 1 µg/dL, 0.2 µg/mL, and 0.2 µg/mL, respectively, with coefficient of variation of 20% or less. Recoveries were between 92% and 111% for National Institute of Standards and Technology reference materials and 81% and 122% for spike-recovery studies. Comparison studies for vitamin D total, vitamin A, and α-tocopherol demonstrated slopes between 1.04 and 1.11 and r2 between 0.94 and 0.96. Minimal matrix effect was observed for all analytes.

CONCLUSIONS

We developed and validated a rapid LC-MS/MS method for the simultaneous measurement of 25(OH)D3, epi-25(OH)D3, 25(OH)D2, vitamin A, α-tocopherol, and γ-tocopherol.

Effect of different levels of organic zinc supplementation on pork quality

This study investigated the effect of two supplementation levels of zinc glycinate (ZnGly) on performance, carcass characteristics, and meat quality of growing-finishing pigs. Thirty pigs (bodyweight: 61 ± 4.0 kg) were assigned to three treatments and fed ad libitum for 56 days a diet supplemented with 0 (control), 45 (Zn45), or 100 mg/kg (Zn100) of ZnGly. The highest ZnGly supplementation lowered the average daily gain (P = 0.031); while, cold carcass weight did not differ between treatments. Both ZnGly levels reduced carcass chill loss (P < 0.001). Micromineral content, color stability, and fatty acid profile of meat were not altered by ZnGly. Superoxide dismutase activity was lowered by Zn45 compared to control (P = 0.007); while, catalase activity was enhanced by Zn100 (P = 0.003). Although ZnGly supplementation did not influence lipid oxidation in raw meat and in meat homogenates incubated with pro-oxidant catalysts, Zn45 limited lipid oxidation in cooked meat (P = 0.037). Our results demonstrated that supplementing pigs with 45 mg/kg of ZnGly could improve the oxidative stability of pork subjected to strong pro-oxidant conditions, but this effect needs to be further elucidated.

Optimization and application of high-throughput supported liquid extraction for simultaneous determination of carotenoids and fat-soluble vitamins in serum

The demand for analysis of carotenoids (CAR) and fat-soluble vitamins (FSV) is continuously expanding, but currently used sample preparation methods either require complicated extraction procedure or large sample volume, let alone the reliability of the results. This study aimed to develop a fast, high-efficient, and high-throughput method based on supported liquid extraction (SLE) for the simultaneous extraction of FSV and CAR from human serum before using high-performance liquid chromatography-diode array detector (HPLC-DAD) analysis. The optimization of SLE parameters was achieved through response surface methodology (RSM) based on the Box-Behnken design (BBD) and included serum-water-extraction solvent ratio and eluent volume. Under optimal conditions, the proposed method gives acceptable limits of detection (LOD) (0.005-0.3 μg/mL), good recovery (89.6-110.9%) as well as relative standard deviation (RSD) of less than 10.1% by consuming lower serum sample (100 μL) and less sample preparation time (2 min per sample). Compared with liquid-phase extraction (LLE), the SLE delivers rapid extraction with higher recovery, better reproducibility, and lower matrix effect for CAR and FSV analysis. The method has been successfully applied to quantify CAR and FSV levels in serum of healthy individuals and age-related macular degeneration (AMD) patients, demonstrating the feasibility of the proposed method for epidemiology and routine applications.

Fat-Soluble Vitamins

The fat-soluble vitamins are vitamins A, D, E, and K. Each vitamin has unique characteristics and contributes to the overall health of an individual. These vitamins have complex absorption, metabolism, and distribution elements that provide protection to the cells in the body as well as many organs. Fat-soluble vitamins, once ingested and processed, are stored in the body for use. Most fat-soluble vitamins are obtained from fruits, vegetables, nuts, and animals.

Nanoparticle-based polyacrylonitrile monolithic column for highly efficient micro solid-phase extraction of carotenoids and vitamins in human serum

In this work, a biocompatible monolithic column based micro-solid-phase extraction (µ-SPE) method was developed for biological fluid analysis. A novel nanoparticle-based polyacrylonitrile monolithic column (C30 NP-PMC) was fabricated by incorporating triacontyl (C30) modified silica nanoparticles (NPs) into the polyacrylonitrile monolithic matrix through thermally induced phase separation. With efficient mass transfer and sorption capacity, C30 NP-PMC exhibited outstanding performance for the extraction of carotenoids and fat-soluble vitamins (FSVs) from human serum samples, superior to commercial C18 cartridges as well as liquid-liquid extraction (LLE) method. Under optimal conditions, the proposed µ-SPE method coupled with high-performance liquid chromatography-diode array detection (HPLC-DAD) achieved satisfactory limits of detection (LODs) (1.5-75.0 ng/mL) and good recoveries (85.0-106.5 %) with relative standard deviations (RSDs) of less than 12.1% by consuming lower sorbent (35.0 mg) and organic solvent (0.8 mL). Successful application of the developed method demonstrated the great potential of such monolithic sorbents for efficient isolation and preconcentration of trace analytes from blood samples.

Metabolic and functional interplay between gut microbiota and fat-soluble vitamins

Gut microbiota is a complex ecosystem seen as an extension of human genome. It represents a major metabolic interface of interaction with food components and xenobiotics in the gastrointestinal (GI) environment. In this context, the advent of modern bacterial genome sequencing technology has enabled the identification of dietary nutrients as key determinants of gut microbial ecosystem able to modulate the host-microbiome symbiotic relationship and its effects on human health. This article provides a literature review on functional and molecular interactions between a specific group of lipids and essential nutrients, e.g., fat-soluble vitamins (FSVs), and the gut microbiota. A two-way relationship appears to emerge from the available literature with important effects on human metabolism, nutrition, GI physiology and immune function. First, FSV directly or indirectly modify the microbial composition involving for example immune system-mediated and/or metabolic mechanisms of bacterial growth or inhibition. Second, the gut microbiota influences at different levels the synthesis, metabolism and transport of FSV including their bioactive metabolites that are either introduced with the diet or released in the gut via entero-hepatic circulation. A better understanding of these interactions, and of their impact on intestinal and metabolic homeostasis, will be pivotal to design new and more efficient strategies of disease prevention and therapy, and personalized nutrition.

Follicular fat-soluble vitamins as markers of oocyte competency

The main aim of this prospective study was to investigate the effect of the concentration of fat-soluble vitamins A, D, E and K in individual follicles on oocyte quality and developmental competence. The analysis was performed on 313 follicular fluid (FF) samples from 50 patients undergoing ovarian stimulation with intracytoplasmic sperm injection. We demonstrated that the mean concentration of individual vitamins in FF correlated with their level in serum (p < 0.0001). The levels of vitamin D in FF were higher than in serum, while the opposite was observed for other analyzed vitamins. We did not observe a correlation between FF vitamin D concentration with fertilization success. However, we observed its association with embryo development status on day 3. Moreover, we showed a statistically significant negative correlation between the mean day 5 embryo score and the concentration of vitamin D in serum (rS = -0.68 p = 0.01) and follicular fluid (rS = -0.71 p = 0.01). Our study showed that FF concentration of vitamin A and E was helpful in the prediction of fertilization success of each individual oocyte. Moreover, vitamin A and E concentrations in FF were associated with status of embryo development on the third day of culture. Vitamin A was also associated with the embryo quality on day 2 and the embryo development status on day 5 after fertilization. In conclusion, a combination of FF vitamin analysis and routine morphological assessment could allow for a more accurate and sensitive method of determining embryonic developmental competence and enable the selection of a better embryo to transfer and perhaps translating into an increased chance of pregnancy.Abbreviations: in vitro fertilization: IVF; anti-Mullerian hormone: AMH; follicular fluid: FF; intracytoplasmic sperm injection: ICSI; top quality: TQ; vitamin D binding globulin level: VDBP; assisted reproductive technology: ART.

Identification of cadmium-produced lipid hydroperoxides, transcriptomic changes in antioxidant enzymes, xenobiotic transporters, and pro-inflammatory markers in human breast cancer cells (MCF7) and protection with fat-soluble vitamins

Cadmium (Cd) is a toxic metal that is regarded as a metallohormone with estrogen-like properties. The present study aimed at identification of lipid hydroperoxides produced in human breast cancer (MCF7) exposed to cadmium (Cd) at environmentally relevant levels. Cd induced cytotoxicity and oxidative stress and produced a series of 26 lipid hydroperoxide species including 14 phosphatidylcholine hydroperoxides (PC-OOH), 9 triacylglycerol hydroperoxides (TG-OOH), and 3 cholesteryl ester hydroperoxides (CE-OOH). Among these hydroperoxides, PC34:2-OOH, PC34:3-OOH, TG60:14-OOH, TG48:5-OOH, TG60:15-OOH, and CE20:4-OOH were produced in a dose-dependent manner, suggesting these as possible biomarkers for Cd exposure in MCF7 cells. In addition, Cd led to significant decreases in the gene expressions of antioxidants, detoxification enzymes, and xenobiotic transporters. In a protection trial, co-exposure of MCF7 cells to fat-soluble vitamins including vitamin A, D, and E reduced Cd-induced cytotoxicity, lipid peroxidation, oxidative stress, and inflammatory responses. Fat-soluble vitamins upregulated antioxidant and detoxification enzymes, and xenobiotic transporters. Therefore, dietary supplementation of such micronutrients is recommended for people at risk for exposure to Cd.

Nutritional markers in patients with diabetes and pancreatic exocrine failure

AIMS

Altered pancreatic exocrine function can be observed in patients with type 1 or type 2 diabetes. In the present study, we evaluated the potential nutritional consequences of this dysfunction.

METHODS

Serum concentrations of nutritional markers, including albumin, cholesterol, triacylglycerol, vitamins A, D, and E, were assessed in a cohort of 468 patients (137 with type 1 diabetes and 331 with type 2 diabetes), after exclusion of the patients with a CRP > 10 mg/l. These patients were compared with 47 patients with diseases of the exocrine pancreas and diabetes (type 3c diabetes or pancreatogenic diabetes). Fecal elastase-1 and chymotrypsin concentrations were measured and patients with type 1 and type 2 diabetes were divided into three groups according to whether zero (group NN), one (group LN), or both (group LL) concentrations were decreased.

RESULTS

Several markers differed significantly between the groups of patients, including BMI, albumin, phosphorus, and fat-soluble vitamins. Patients with pancreatogenic diabetes had markedly more profound alterations than patients with type 1 or type 2 diabetes and altered exocrine function. However, patients with type 1 or type 2 diabetes and decreased concentrations of both elastase-1 and chymotrypsin had lower albumin, phosphorus, and vitamin A than patients with normal pancreatic exocrine function.

CONCLUSIONS

Modest nutritional alterations were found in patients with type 1 or type 2 diabetes and altered exocrine function. Patients with type 1 or type 2 diabetes and altered exocrine function may thus deserve to be screened for nutritional deficiencies.

Vitamin E status and its determinants in patients with cystic fibrosis

PURPOSE

The risk of vitamin E deficiency is of primary concern in cystic fibrosis patients. However, early diagnosis and routine vitamin E supplementation can lead to its normal or even high levels. In the present study, we assessed vitamin E status in a large group of cystic fibrosis patients. Moreover, we also aimed to establish determinants of its body resources in cystic fibrosis patients.

MATERIAL AND METHODS

The study group comprised 211 cystic fibrosis patients aged from 1 month to 48 years. In all of them serum α-tocopherol concentration was analyzed using high-performance liquid chromatography.

RESULTS

Median vitamin E concentration was 9.9 μg/ml (1st-3rd quartile: 7.5-13.5). Vitamin E deficiency was found in 17 (8.0%) and high levels were documented in 24 (11.4%) participants. Patients with and without vitamin E deficiency did not differ significantly with respect to age, standardized body weight and height, FEV1, albumin concentration and vitamin E supplementation dose. However, vitamin E deficiency appeared more frequently in participants without vitamin E supplementation. Moreover, in multiple linear regression analysis pancreatic insufficiency, severe CFTR gene mutation and vitamin E dose, were potentially defined as determinants of vitamin E concentration.

CONCLUSIONS

Vitamin E deficiency in cystic fibrosis patients is rather rare nowadays. Excessive vitamin E levels seem to be more frequent. Vitamin E status wasn't documented to be strictly related to clinical determinants. Beyond vitamin E supplementation, exocrine pancreatic function and CFTR gene mutations may have had an impact on the vitamin E body resources in cystic fibrosis patients.

Fat soluble vitamin levels in children with newly diagnosed celiac disease, a case control study

Background

In children diagnosed with celiac disease, fat soluble vitamin levels were aimed to be evaluated and it was intended to determine whether fat soluble vitamin levels were needed to be assessed routinely in these patients during diagnosis.

Methods

Between May 2015–May 2016, diagnosis symptoms of celiac patients (CD) in newly diagnosed pediatric group were questioned, fat soluble vitamin levels simultaneous with intestinal biopsies were evaluated. Vitamin levels were compared with those of healthy control group.

Results

A total of 52 patients involving 27 female (51.9%), 25 male (48.1%); and a total of 50 healthy control group including 25 female (50%), 25 male (50%) were evaluated. The average age of patients was 9 ± 4.3 years, and their average weight was determined as 16.2 ± 6.3 kg. Growth retardation was the most frequent symptom in our patients (61.5%). Abdominal pain (51.9%) and diarrhea (11.5%) are among the other most commonly seen symptoms. In the histological examination of patients, Marsh 3B n = 23 (45.1%) was mostly established. Vitamin A and vitamin D levels of patients were determined significantly lower compared to those of control group. Vitamin A and vitamin D deficiencies were identified significantly higher compared to those of healthy control group. Vitamin D insufficiency was observed in 48 patients (92.3%) and vitamin D deficiency was determined in 32 (61.5%) out of 48. Vitamin A deficiency was established in 17 (32.7%) patients. Vitamin E and vitamin K1 deficiency were determined in no patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. Other vitamin levels were identified at normal levels in the healthy group.

Conclusions

In newly diagnosed children with CD, a significant lowness was established in vitamin D and A. The evaluation of vitamin A and D levels will be helpful in the course of diagnosis in these patients.

Fat-soluble vitamin intake from the consumption of food, fortified food and supplements: design and methods of the Belgian VITADEK study

Background

The adequacy of micronutrient intake is a public health concern, as both insufficient and excessive intake levels may result in adverse health effects. Data on dietary intake are needed to evaluate potential problems regarding inadequate intake at population level and to formulate effective public health and food safety recommendations. Assessing the intake of micronutrients in population subgroups such as infants, toddlers, pregnant and lactating women is challenging and requires specific approaches. This paper describes the Belgian VITADEK study, developed to assess fat-soluble vitamin intake from the consumption of food, fortified foods and supplements in four vulnerable groups namely infants, toddlers, pregnant and lactating women.

Methods

Subjects were selected according to a multi-stage stratified sampling design with a selection of clusters proportionate to the population size. Recruitment occurred in collaboration with Belgian child health consultation centres and obstetric clinics. Participants were asked to complete a self-administered online food frequency questionnaire (FFQ) or to answer the questionnaire by phone if online participation was not possible.

The questionnaire was tailored to the specific diet of the different target populations. In order to capture vitamin intake from the consumption of foods, fortified foods and supplements, a market study was conducted to take an inventory of the fortified foods and supplements available on the Belgian market. The food list of the FFQ was based on both this inventory and the top 90% food groups that contribute to fat-soluble vitamin intake. Since fortification differs at brand level, food groups and subgroups were split up to the level of the brand of foods. Brand pictures were used as mnemonics to facilitate the recall of the consumed food items and portion pictures were used to facilitate the reproduction of the consumed portion sizes. Finally a composition table was compiled allowing for the computation of vitamin intake from all sources providing as such more accurate estimates of fat-soluble vitamin intake.

Discussion

The results will allow assessing inadequate micronutrient intake by comparison of vitamin intake with dietary reference values. The data will further allow describing the most contributing food groups as well as the contribution of fortified foods and supplements to total vitamin intake. The data will enable evaluating whether infants, toddlers, pregnant and/or lactating women are reached by the actual Belgian fortification and supplementation programmes. Finally the retrieved data will reveal the potential for voluntary fortification and the need for future fortification and supplementation programmes.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-017-0199-3) contains supplementary material, which is available to authorized users.

Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis

BACKGROUND AND AIMS

Chronic pancreatitis (CP) patients are at risk for fat-soluble vitamins (A, D, E, K) deficiency, but available studies are small and heterogeneous. We conducted a systematic review and meta-analysis to determine the prevalence of fat-soluble vitamins deficiency in CP patients.

METHODS

Medline was searched up to January 2016 for case series and case-control studies reporting prevalence of fat-soluble vitamin deficiency in CP patients. The prevalent deficiency rate was pooled for included studies, and deficiency rate between CP and controls, with relative odds ratio (OR) and 95% confidence interval (CI) calculated for case-control studies.

RESULTS

Twelve studies including 548 patients included. With a random-effect model, the pooled prevalence rate of vitamin A, D and E deficiency were 16.8% (95%CI 6.9-35.7), 57.6% (95%CI 43.9-70.4) and 29.2% (95%CI 8.6-64.5) respectively, with considerable heterogeneity (I² = 75%, 87.1% and 92%). Only one study evaluated vitamin K deficiency. The pooled OR for vitamin D deficiency in CP cases compared with controls was 1.17 (95% CI 0.77-1.78). Sensitivity analyses showed lower prevalence of vitamin A and E, and higher prevalence of vitamin D deficiency in high-quality studies. The rate of pancreatic exocrine insufficiency did not seem affect the deficiency rates, while the use of different cut-offs influences results and heterogeneity for vitamin E, but not A.

CONCLUSIONS

Fat-soluble vitamins deficiency is frequent in CP patients, with considerable heterogeneity. There is, however, no apparent increased risk of vitamin D deficiency in CP compared to controls. Larger, high-quality studies are necessary to better estimate the prevalence of fat-soluble vitamins deficiency, including vitamin K.

Plasma fat-soluble vitamin and carotenoid concentrations after plant sterol and plant stanol consumption: a meta-analysis of randomized controlled trials

Purpose

Plant sterols and stanols interfere with intestinal cholesterol absorption, and it has been questioned whether absorption and plasma concentrations of fat-soluble vitamins and carotenoids are also affected. We conducted a meta-analysis to assess the effects of plant sterol and stanol consumption on plasma fat-soluble vitamin and carotenoid concentrations.

Methods

Forty-one randomized controlled trials involving 3306 subjects were included. Weighted absolute and relative changes of non-standardized and total cholesterol (TC)-standardized values (expressed as summary estimates and 95 % CIs) were calculated for three fat-soluble vitamins (α- and γ-tocopherol, retinol and vitamin D) and six carotenoids (β-carotene, α-carotene, lycopene, lutein, zeaxanthin and β-cryptoxanthin) using a random effects model. Heterogeneity was assessed using predefined subject and treatment characteristics.

Results

Average plant sterol or stanol intake was 2.5 g/d. Relative non-standardized and TC-standardized concentrations of β-carotene decreased by, respectively, −16.3 % (95 % CI −18.3; −14.3) and −10.1 % (−12.3; −8.0), α-carotene by −14.4 % (−17.5; 11.3) and −7.8 % (−11.3; −4.3), and lycopene by −12.3 % (−14.6; −10.1) and −6.3 % (−8.6; −4.0). Lutein concentrations decreased by −7.4 % (−10.1; −4.8), while TC-standardized concentrations were not changed. For zeaxanthin, these values were −12.9 % (−18.9; −6.8) and −7.7 % (−13.8; −1.7) and for β-cryptoxanthin −10.6 % (−14.3; −6.9) and −4.8 % (−8.7; −0.9). Non-standardized α-tocopherol concentrations decreased by −7.1 % (−8.0; −6.2) and γ-tocopherol by −6.9 % (−9.8; −3.9), while TC-standardized tocopherol concentrations were not changed. Non-standardized retinol and vitamin D concentrations were not affected. Results were not affected by baseline concentrations, dose, duration and type of plant sterols/stanols, except for significant effects of duration (≤4 vs. >4 weeks) on TC-standardized lutein concentrations (1.0 vs. −5.6 %) and type of plant sterol/stanol on TC-standardized β-carotene concentrations (−8.9 vs. −14.2 %).

Conclusions

Plant sterol and stanol intake lowers TC-standardized hydrocarbon carotenoid concentrations, differently affects TC-standardized oxygenated carotenoid concentrations, but does not affect TC-standardized tocopherol concentrations or absolute retinol and vitamin D concentrations. Observed concentrations remained within normal ranges.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-016-1289-7) contains supplementary material, which is available to authorized users.

Nutrition and Growth in Cystic Fibrosis

Close attention to nutrition and growth is essential in caring for children with cystic fibrosis (CF). Growth and nutritional status should be monitored as part of routine CF care. Children with CF should achieve growth and nutritional status comparable with that of well-nourished children without CF. Children with CF are at risk for nutritional deficiencies. Optimal nutritional and growth status may be difficult to attain in this population given risk of insufficient caloric intake and likelihood of increased caloric expenditure. Various methods to attain optimal nutritional status may be used, including oral supplementation, behavioral treatment, pharmacotherapy, and enteral nutrition.

A simultaneous quantitative method for vitamins A, D and E in human serum using liquid chromatography-tandem mass spectrometry

Non-classical roles of fat-soluble vitamins (FSVs) in many pathologies including cancer have been identified. There is also evidence of hormonal interactions between two of these vitamins, A and D. As a result of this enhanced clinical association with disease, translational clinical research and laboratory requests for FSV measurement has significantly increased. However there are still gaps in the analytical methods available for the measurement of these vitamins. This study aimed to develop a method for simultaneous quantification of 25-hydroxyvitamin-D2 (25-OHD2), 25-hydroxyvitamin-D3 (25-OHD3) and its 3-epimer (epi-25-OHD3), retinol and α-tocopherol in human serum using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The procedure was developed and validated across two LC-MS/MS platforms, using commercial calibrators referenced to certified reference materials, controls, and deuterated internal standards. The samples were prepared by liquid-liquid extraction prior to injection and LC separation (using a Pursuit-PFP column) on two Agilent MS/MS systems (6410 and 6490) in electrospray ionisation positive mode with multiple reaction monitoring. Identification and quantification of 25-OHD3 from its 3-epimer as well as 25-OHD2, retinol and α-tocopherol were achieved. The dynamic ranges were 4-160 nmol/L for 25-OHD2 and epi-25-OHD3, 4-200 nmol/L for 25-OHD3, 0.1-4.0μmol/L for retinol and 4-70μmol/L for α-tocopherol with correlation (r(2)) of 0.997-0.998. Based on participation in an external quality assurance program, the overall performance of the simultaneous methods were: imprecision (CV%) and inaccuracy (average bias) 3.0% and 3.2 nmol/L, respectively, for 25-OHD3; 5.0% and 0.04μmol/L, respectively, for retinol; and 4.7% and 0.2μmol/L, respectively, for α-tocopherol. In summary, two simple LC-MS/MS methods were successfully developed and validated for the simultaneous quantification of the three vitamin D metabolites (25-OHD2, 25-OHD3 and 3-epimer of 25-OHD3), vitamin A (retinol) and vitamin E (α-tocopherol) in serum.

Total biliary diversion as a treatment option for patients with progressive familial intrahepatic cholestasis and Alagille syndrome

BACKGROUND

Progressive familial intrahepatic cholestasis (PFIC) with low gamma-glutamyl transpeptidase (GGT) and Alagille syndrome are associated with persistent cholestasis and severe pruritus. Various types of biliary diversion have been used to reduce this pruritus and prevent liver dysfunction. We report our experience concerning the efficacy and safety of total biliary diversion (TBD) as an additional treatment option.

METHODS

TBD was performed in four PFIC patients and one patient with Alagille syndrome, and was accomplished by anastomosing a jejunal segment to the choledochal duct terminating as an end stoma, or by disconnecting the choledochal duct after previous cholecystojejunocutaneostomy.

RESULTS

TBD resulted in a marked improvement of symptoms and biochemical parameters in all PFIC patients. Despite relief of pruritus, cholestasis persisted in the Alagille patient. During 5-15years of follow-up, no clinical signs of fat malabsorption such as diarrhea or weight loss were encountered. However, to maintain adequate levels of fat-soluble vitamins, especially of vitamin K, substantial supplementation was necessary.

CONCLUSIONS

Total biliary diversion can be a useful surgical treatment option for patients with low-GGT PFIC and possibly also Alagille syndrome, when partial biliary diversion is insufficient. It can be performed without inducing clinical signs of fat malabsorption although individualized supplementation of fat-soluble vitamins with careful monitoring is warranted.