Daily Vitamin Research Articles

Characterization of the effects of vitamin D synthesis and sunburn in the population due to solar radiation exposure using PROBIT methodology

The main objective of this work is to present a set of equations that relates exposure time to solar radiation, the ultraviolet index (UVI), and its effects, both positive (vitamin D synthesis) and negative (sunburns), including the influence of repeated doses and the incorporation of protective factors. To do so, expressions are proposed for both effects and a time range is specified where repeated doses can be applied. Moreover, we propose expressions (PROBIT equations) that relate the percentage of a population that would reach the recommended daily amount of vitamin D and the repeated dosage to which the population is exposed for skin types I to IV. For all the cases studied, protective factors, such as the use of clothes or sunscreens, were taken into account. Additionally, comparisons were made based on skin types between the generation of daily vitamin D and the onset of sunburn, being able to establish a percentage of those who would suffer from first-degree sunburns when this population reached the recommended daily amount of vitamin D. Thus, it can be noted that when a large percentage of a population wants to obtain the recommended daily allowance of vitamin D of 2000 IU or more, and by exposing a small portion of skin to solar radiation, a considerable percentage of that population would suffer from first-degree sunburn as vitamin D generation is related to the area of exposed skin. Therefore, by increasing the area of skin that is exposed to solar radiation, vitamin D needs can be safely met even with higher daily amounts.

A comprehensive integration of factors affecting vitamin B12 concentration in milk of Holstein cows: genetic variability, milk productivity, animal characteristics, and feeding management

Daily vitamin B12 (VB12) requirements of humans can naturally be fulfilled by animal product consumption, especially products from ruminants because of bacteria dwelling in their rumen. Indeed, only bacteria can synthesize this vitamin. Milk is hence an excellent source of VB12. This cross-sectional study was undertaken to unravel factors, such as genetic variation, diet and cow characteristics, and milk production, explaining the large variation in milk B12 concentration among cows by using an integrative approach. Milk samples from 2 consecutive milkings were collected from 3,533 Canadian Holstein cows (1,239 first, 932 s, and 1,362 third and more lactations) located in 99 herds with various feeding management. For genetic variation analysis purpose, pedigrees were traced back for 3 complete generations for each sire and dam. A total of 10,021 identities were used in the subsequent genetic analyses. Milk VB12 averaged 4.2 ng/mL with a range between 0.7 and 9.0 ng/mL. Dietary fiber (NDF from forage, dietary NDF, ADF, and lignin) increased and dietary components related to energy (non-fiber carbohydrate, starch, net energy of lactation, and percentage of concentrate) decreased VB12 in milk. Milk VB12 varied with days in milk, with a similar pattern as milk fat and protein concentration lactation curves. Milk VB12 increased as age at calving increased. When disregarding the herd variance, heritability value was 0.37, meaning that milk VB12 can be modified by genetic selection. The final model including factors related to the diet, animal characteristics and milk productivity, and genetic variation explained 79% (pseudo-R2) of the milk VB12 variation. When excluding the random effect of the cow, i.e., excluding the animal and genetic relationships, the pseudo-R2 dropped to 43%, reinforcing the importance of genetic variation in explaining milk VB12 variation. To our knowledge, the present study is the most comprehensive evaluation of factors affecting milk VB12 variation including the greatest number of cows from various lactation stages.

The Relationship Between Vitamin D Intake and Serum 25-hydroxyvitamin D in Young Children: A Meta-Regression to Inform WHO/FAO Vitamin D Intake Recommendations

BackgroundThis work was commissioned by the World Health Organization and Food and Agriculture Organization to inform their update on the vitamin D requirements for children aged <4 y. ObjectivesThe objective of this work was to undertake multilevel and multivariable dose-response modeling of serum 25-hydroxyvitamin D (25OHD) to total vitamin D intake in children aged <4 y with the goal of deriving updated vitamin D requirements for young children. MethodsSystematically identified randomized controlled trials among healthy children from 2 wk up to 3.9 y of age provided with daily vitamin D supplements or vitamin D-fortified foods were included. Linear and nonlinear random effects multilevel meta-regression models with and without covariates were fitted and compared. Interindividual variability was included by simulating the individual serum 25OHD responses. The percentage of individuals reaching set minimal and maximal serum 25OHD thresholds was calculated and used to derive vitamin D requirements. ResultsA total of 31 trials with 186 data points from North America, Europe, Asia, and Australasia/Oceania, with latitudes ranging from 61°N to 38°S, and with participants of likely mostly light or medium skin pigmentation, were included. In 29 studies the children received vitamin D supplements and in 2 studies the children received vitamin D-fortified milk with or without supplements. The dose-response relationship between vitamin D intake and serum 25OHD was best fitted with the unadjusted quadratic model. Adding additional covariates, such as age, did not significantly improve the model. At a vitamin D intake of 10 μg/d, 97.3% of the individuals were predicted to achieve a minimal serum 25OHD threshold of 28 nmol/L. At a vitamin D intake of 35 μg/d, 1.4% of the individuals predicted to reach a maximal serum 25OHD threshold of 200 nmol/L. ConclusionsIn conclusion, this paper details the methodological steps taken to derive vitamin D requirements in children aged <4 y, including the addition of an interindividual variability component.

Longitudinal change of energy expenditure, body composition and dietary habits in Progressive Supranuclear Palsy patients.

Alterations in metabolic status, body composition, and food intake are present in all neurodegenerative diseases. Aim of this study was to detect the progression of these changes in Progressive Supranuclear Palsy (PSP). We conducted a longitudinal study of 15 patients with PSP. The assessments were performed at baseline (T0) and after 7(IQR = 5) months of follow-up (T1). We collected anthropometric measures including body weight, height, body mass index and waist circumference, metabolic parameters through indirect calorimeters, body composition using bioimpedance analysis, and dietary habits with a validated questionnaire. PSP-rating scale (PSP-rs) was used to evaluate disease severity and dysphagia. The majority of patients (66.66%) presented PSP-Richardson Syndrome and 33.33% the other variant syndromes of the disease. At T1 there was a decrease in intake of total daily calories (p < 0.001), proteins (p < 0.001), fibers (p = 0.001), calcium (p = 0.008), iron (p < 0.001), zinc (0.034), vitamin E (p = 0.006) and folates (p = 0.038) compared to T0. No other changes were found. As for T1 data, no significant differences were shown according to disease phenotypes or the presence of clinically significant dysphagia for solids. Within a mid-term follow up, PSP patients presented reduced caloric and proteins intake regardless the presence of dysphagia. The PSP-rs is likely not adequate to assess dysphagia, which should be investigated by specific clinical scales or instrumental examinations. With the goal of maintaining adequate nutritional status, the administration of protein and vitamin supplements should be considered even in the absence of dysphagia evidenced by the rating scales.

Effects of Vitamin D Supplementation on Central Hemodynamic Parameters and Autonomic Nervous System in Obese or Overweight Individuals.

Previous studies have been inconsistent in demonstrating beneficial cardiovascular effects of vitamin D supplementation. To evaluate the effects of vitamin D3 supplementation on central hemodynamic parameters and autonomic activity in obese/overweight individuals with low vitamin D levels (<30ng/dl). Adults 40-65 years old with body mass index ≥25<40 kg/m2 were enrolled in this prospective, randomized, double-blind clinical trial (NCT05689632). Central hemodynamics was assessed using the oscillometric method (Mobil-O-Graph®), and heart rate variability using a Polar heart rate monitor (Kubios® software). Patients (n=53) received a placebo in the control group (CO, n=25) or vitamin D3 (VD, n=28) 7000 IU/day, and were evaluated before (W0) and after 8 weeks (W8) with a significance level of 0.05. The groups were homogeneous regarding age (51±6 vs 52±6 years, p=0.509) and vitamin D levels (22.8±4.9 vs 21.7±4.5ng/ml, p=0.590). At W8, the VD group had significantly higher levels of vitamin D (22.5 vs 35.6ng/ml, p<0.001). Only the VD group showed a significant reduction in systolic blood pressure (SBP; 123±15 vs 119±14mmHg, p=0.019) and alkaline phosphatase (213±55 vs 202±55mg/dl, p=0.012). The CO group showed an increase in augmentation pressure (AP: 9 vs 12 mmHg, p=0.028) and augmentation index (AIx: 26 vs 35%, p=0.020), which was not observed in the VD group (AP: 8 vs 8 mmHg, AIx: 26 vs 25%, p>0.05). VD group showed an increase in the parasympathetic nervous system index (PNSi) (-0.64±0.94 vs -0.16±1.10, p=0.028) and the R-R interval (866±138 vs 924±161 ms, p= 0.026). In this sample, eight weeks of daily vitamin D supplementation resulted in an improvement in blood pressure levels and autonomic balance.

Adherence to Vitamin D Supplementation Recommendations for Breastfed Infants and Young Children: An Analysis of Canadian Community Health Survey Data Cycles From 2015 to 2018

BackgroundIn Canada, nutrition policy, as outlined in the Nutrition for Healthy Term Infants recommendations, includes a daily vitamin D supplement of 10 μg (400 IU) for breastfed infants and young children to support adequate vitamin D status. ObjectivesThis study aimed to report on adherence to vitamin D supplementation recommendations for breastfed infants (≤12 months); and for children breastfed >12 mo. MethodsCanadian Community Health Survey (paired-cycles 2015/2016 and 2017/2018) maternal experiences data for infants born 2012–2018 who received any breastmilk formed the sample (n = 7079). Whether the infant was given a vitamin D supplement (yes/no) and the frequency (daily/almost every day, 1–2/wk, or <1/wk) were surveyed. Weighted data (95% CI) were summarized according to breastfeeding history (exclusive to 6 mo and continuing; partial to 6 mo and continuing; and stopped ≤6 mo). Correlates of supplement adherence were explored using logistic regression. ResultsOverall, 87.1% (95% CI: 85.9%, 88.3%) of participants reported giving their infant (≤12 mo) a vitamin D supplement, and of these, 83.3% (95% CI: 81.9%, 84.7%) did so daily/almost every day, 12.4% (95% CI: 11.1%, 13.7%) did so 1–2/wk, and 4.3% (95% CI: 3.6%, 5.0%) did so <1/wk. Lower adjusted odds of adherence were observed among participants reporting: stopped breastfeeding ≤6 mo, lower education or income, recent immigration, and overweight prepregnancy body mass index; higher odds of adherence were observed in the western provinces. Regarding mothers of children >12 mo and breastfed (n = 2312), 58.0% (95% CI: 54.9%, 61.1%) gave a vitamin D supplement daily/almost every day. ConclusionsAdherence to providing a vitamin D supplement to breastfed infants is high in Canada. Nonetheless, we estimate that ∼27% of mothers are nonadherent to daily/almost every day administration of a vitamin D supplement and that adherence declines in children breastfed >12 mo. Further promotion to support uptake of the current guidance may be necessary, particularly for parents of recent immigration or lower socioeconomic status.

Knowledge of vitamin D and practices of vitamin D supplementation in a Scottish adult population: A cross-sectional study.

Background: Vitamin D supplementation practices (dose and frequency) are relatively unknown in the Scottish population, with no recent up-to-date data available. Reassessing current knowledge, practices, and awareness of vitamin D supplementation following a national health campaign in 2020 by Food Standards Scotland on vitamin D is warranted. Aim: This article aims to present the knowledge and awareness of vitamin D, and current vitamin D supplementation practices in adults living in Scotland. Methods: A cross-sectional study was performed between June and July 2022 using an online survey adapted from previous work on assessing knowledge of vitamin D in adults. Participants aged 18+, living in Scotland for ≥6 months were eligible to participate. Scores for knowledge were calculated as a percentage. Univariate associations between demographic and supplement use were established by χ2-test and logistic regression performed to predict factors associated with daily vitamin D intake. Results: Four hundred and three participants (72.7% female), mean age 36.4 (±14.2 years), completed the study. Awareness of vitamin D was very high (99.5%) but the mean overall knowledge score was poor (31.4 ± 15.3%), with those with a university degree more likely to have knowledge scores at/above the mean compared with those with lower levels of education, χ2(1, N = 393) 10.7, p = 0.001, odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.7-2.7). Finally, 64.3% took vitamin D supplements, of which 37.5% took them daily during winter months, with only 7.4% taking the recommended daily dose. Conclusion: The current study highlights the need to improve both knowledge of vitamin D and practices of vitamin D supplementation during the autumn and winter months in Scotland.

How to Suppress Mineral Loss and Stimulate Anabolism in Postmenopausal Bones with Appropriate Timing of Exercise and Nutrients.

Background. Bone Health and Osteoporosis Foundation (BHOF) reports that as of 2023, approximately 10 million of older Americans have osteoporosis and another 44 million have low bone density. Osteoporosis is a serious handicap for the elderly and, in particular, for estrogen-deficient postmenopausal women, as it increases the risk of debilitating bone weakness and fractures. The BHOF recommendations for prevention of osteopenia, osteoporosis and bone fractures are to perform weight-bearing and muscle-strengthening exercises and to take recommended amounts of daily calcium and vitamin D. Methods. The purpose of this review is to describe and discuss recent evidence-based research on how to effectively utilize timing of exercise and calorie intake for stimulation of postmenopausal bone anabolism, and to provide this new information in the form of specific and actionable recommendations. Results. The five evidence-based recommendations are as follows: 1. Select an appropriate circadian time of day for exercise; 2. Increase walking speed to raise the movement momentum; 3. Eat a weight-maintenance meal one or two hours before the exercise bout; 4. Sustain the duration of walking activity (impulse) for 40 to 45 min; and 5. Repeat effective exercise stimulus 7 to 8 h after the first one to double the anabolic effect. Osteogenesis can also be increased with subthreshold mechanical loading, where needed, under several special circumstances. Conclusions. This review should provide pragmatic actionable pointers on how to utilize the idiosyncratic bone responsiveness to timing of movement and meals to prevent osteoporosis and encourage research toward a better understanding of how bone detects adequacy of a mechanical stimulus and determines duration of necessary rest to recover its sensitivity to mechanical stimulation and nutrients.

Feasibility of Introducing a Prehabilitation Program into the Care of Gynecological Oncology Patients-A Single Institution Experience.

Prehabilitation is an upcoming strategy to optimize patient's functional capacity, nutritional status, and psychosocial well-being in order to reduce surgical complications and enhance recovery. This study aims to assess the feasibility of implementing a multimodal prehabilitation program into the standard care of gynecological oncology patients at an academic hospital in terms of recruitment, adherence, and safety, which were assessed by the number of patients eligible, recruitment rate, participation rate, and adherence to individual modalities. Data were derived from the F4S PREHAB trial, a single-center stepped-wedge trial implementing a multimodal prehabilitation program among various surgical specialties. All patients undergoing elective surgery as part of treatment for ovarian, uterine, and vulvar cancer at the Radboudumc, an academic hospital in The Netherlands, between May 2022 and September 2023 were considered eligible for the F4S PREHAB trial and, consequently, were included in this cohort study. The multimodal prehabilitation program comprised a physical exercise intervention, nutritional intervention, psychological intervention, and an intoxication cessation program. A total of 152 patients were eligible and approached for participation of which 111 consented to participate, resulting in a recruitment rate of 73%. Participants attended an average of six exercise sessions and adhered to 85% of possible training sessions. Respectively, 93% and 98% of participants adhered to the prescribed daily protein and vitamin suppletion. Ten participants were referred to a psychologist and completed consultations. Out of nine active smokers, two managed to quit smoking. A total of 59% adhered to alcohol cessation advice. No adverse events were reported. This study demonstrates that introducing a multimodal prehabilitation program into the standard care of gynecological oncology patients is feasible in terms of recruitment and adherence, with no serious adverse events.

Effect of eight-week controlled dietary modification trial on nutritional biomarkers in young Indian athletes

Objective: Present study was intended to examine the effects of dietary modification on nutritional biomarkers in young Indian male athletes. Methods: Eighty-eight footballers and hockey players were randomly segregated into ad-libitum group (ALG) and nutrition counselling group (NCG). Eight weeks of dietary modification trial was implemented on NCG, resulting in 9.5, 2.6, and 2.1 g/kgbw/day of carbohydrate, protein, and fat respectively. Rate of changes in daily nutrient intake and nutrition biomarkers were captured. Results: NCG revealed significant increases in total serum protein (5.6%, p&lt;0.001), haemoglobin (3.9%, p&lt;0.001) and vitamin E (2.9%, p&lt;0.001). They also exhibited rises in serum vitamin C (6%, p=0.004), folate (4.5%, p=0.004), ferritin (4.8%, p=0.003), calcium (4.2%, p=0.009), serum vitamins B12 (3.9%, p=0.012) and D (12.3%, p&lt;0.001). Haemoglobin levels were positively correlated with daily protein (p&lt;0.01), iron (p&lt;0.05), vitamins B12 and vitamin C (p&lt;0.05 both) intakes. Serum calcium positively correlated with daily calcium (p&lt;0.01), phosphorus and protein (p&lt;0.05 both) intakes. Serum zinc was positively correlated with daily protein, calcium, vitamin B9 and vitamin D intake, while serum ferritin and vitamin B12 were positively correlated with protein and iron intake. Post-intervention, NCG reported optimal blood levels of calcium, zinc, protein, Hb, ferritin, vitamins B12, C and E, whereas the folate and vitamin D values were suboptimal. On the other hand, the ALG revealed marginal levels of zinc and total protein as well as noticeably low levels of calcium, folate, and vitamin D. Conclusion: Enhanced blood levels of nutritional biomarkers noted after eight-weeks of controlled dietary modification was supported by positive correlations observed with the daily nutrient intakes.

SARS-CoV-2 Infection and Multiple Sclerosis: Proactive Approach in a Vulnerable Patient Group through Daily Vitamin D Supplementation?

SARS-CoV-2 Infection and Multiple Sclerosis: Proactive Approach in a Vulnerable Patient Group through Daily Vitamin D Supplementation?

Prospective cohort study of vitamin D deficiency in pregnancy: Prevalence and limited effectiveness of 1000 IU vitamin D supplementation.

Vitamin D deficiency is highly prevalent worldwide among pregnant women. Although vitamin D supplementation is effective in improving vitamin D status, the safety and optimal dosing of vitamin D supplementation during pregnancy remain less well understood. This study aimed to investigate the prevalence of vitamin D deficiency among pregnant women and evaluate the effectiveness of vitamin D supplementation in improving vitamin D status during pregnancy. This prospective cohort study assessed the impact of a 16-week daily vitamin D supplementation 1000 IU regimen on vitamin D status among pregnant women. A total of 365 pregnant women were recruited, and their baseline total circulating 25-hydroxy vitamin D concentrations were measured. Of these, 249 participants completed the study, which involved oral daily supplementation with 1000 IU of vitamin D and a repeat of total circulating 25-hydroxy vitamin D concentrations after 16 weeks. The study found that 57.7% of the participants had vitamin D deficiency, consistent with the rates reported in other studies. However, vitamin D supplementation at a dose of 1000 IU had a small effect size and was not clinically significant. However, 67% of participants with vitamin D deficiency remained deficient; among participants initially with vitamin D insufficiency, 30% became deficient. Moreover, 26.5% of individuals with sufficient vitamin D status at 12 weeks showed insufficient levels by 28 weeks. Vitamin D deficiency is widespread among pregnant women, and vitamin D supplementation at a daily dose of 1000 IU may not adequately address this problem. Although the study has limitations, its results align with previous research and may apply to other populations with a high prevalence of vitamin D deficiency during pregnancy. Further research is necessary to determine the most effective approach for addressing prenatal vitamin D deficiency.

Impact of Vitamin D Deficiency on Youth: Current Scenario

Background: A detailed study on vitamin D status in India has revealed a significant frequency of vitamin D insufficiency among people. People's hectic schedules cause various deficits in their bodies since they are not exposed to enough sunshine, which results in inadequate vitamin D intake over time, diminished sunshine exposure, the kidney's failure to convert 25(OH)D to its active form, or insufficient vitamin D absorption through the digestive system. Objective: The study aimed to explore the role of vitamin D in young adults and explain some of the vital roles of vitamin D in human bodies, as well as display the prevalence of vitamin D in India along with its pathophysiology, metabolism, and several mechanisms of action. Methods: We have searched several research and review articles in English on Medline, Scopus, Pubmed, NCBI data, Science Direct, and the Cochrane Library of systematic review databases from 2000 to 2022. Results: According to a comprehensive study, our bodies require vitamin D for bone formation and maintenance. It is also important for controlling a variety of other cellular functions in the body. Conclusion: The importance of vitamin D and the repercussions of its insufficiency must be made known to the general population and healthcare practitioners. On average, our Indian cuisine falls short of a normal adult's daily vitamin D need. This emphasises the importance of vitamin D fortification in diverse foods through governmental initiatives. This silent pandemic has to be tackled with strong public health measures.

Association between Dietary Potassium Intake and Nonalcoholic Fatty Liver Disease and Advanced Hepatic Fibrosis in U.S. Adults.

The correlation between potassium and nonalcoholic fatty liver disease (NAFLD) is currently still poorly understood. We conducted this study to explore the correlation between dietary potassium intake and NAFLD, as well as advanced hepatic fibrosis (AHF). The study also sought to identify any potential interactions. The data employed in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) program, encompassing a period from 2007 to 2018. Employing the multiple logistic regression analysis, we evaluated the association of dietary potassium intake with NAFLD and AHF. Subsequently, stratification analysis, based on demographic variables, was constructed so as to assess the stability of the results. In addition, potential interaction effects were assessed by interaction tests. A total of 9443 participants were included in the analysis. The mean age of the participants was 50.4 years, and their daily mean dietary potassium and vitamin C intake was 2556.49 mg and 82.93 mg, respectively. Following comprehensive statistical analyses, the findings indicated a negative correlation between dietary potassium intake and both NAFLD and AHF. Participants in Q4 group with dietary potassium intake exhibited a 31% and 42% reduction in the odds of developing NAFLD and AHF, respectively, in comparison to Q1 group. An interaction effect of dietary vitamin C intake was observed in the association between dietary potassium intake and NAFLD. The results imply that high dietary vitamin C intake augment the inverse relationship between dietary potassium intake and NAFLD. Dietary potassium intake was found to have an inverse association with the odds of both NAFLD and AHF. The association between dietary potassium intake and NAFLD was amplified by the presence of vitamin C in the diet.

Liprotide-encapsulated vitamin D3 modulates circulated PTH levels and improved bone microstructure

Background: vitamin D (25(OH)D) is a fat-soluble vitamin that is unstable in the gastrointestinal environment and has low bioavailability. A protein-lipid complex (liprotide) can be used as a shell to increase vitamin D stability and bioavailability. Liprotide can also serve as a delivery system for transporting vitamin D to its intended site. Little attention has been paid to utilizing liprotide as a delivery system for vitamin D and evaluating its functional activity.Objective: to investigate the effect of liprotide-encapsulated vitamin D3 on PTH levels and bone microstructure in vitamin D and calcium (VD-Ca) deficient rats.Materials and Methods: an overall of 24 Wistar rats had been divided into four groups, a normal control group (K), a VD-Ca group without treatment (K-), a VD-Ca group with 180 IU/200 gBW/day free vitamin D3 (FVD3), and a VD-Ca group with 180 IU/200 gBW/day liprotide-encapsulated vitamin D3 (LVD3). Before and after 28 days of vitamin D intervention, blood samples were taken and analysed for serum PTH levels. The microstructure of the bone was analyzed using the Scanning Electron Microscope (SEM).Results: the VD-Ca rats supplemented with vitamin D3 (FVD3 and LVD3) had a significant decrease in serum PTH levels (p&lt;0.001) and improved bone microstructure (p&lt;0.05) compared to the (K-) group. The reduction of PTH in the LVD3 group was higher compared to the FVD3 group. The bone microstructure between the FVD3 and LVD3 groups is significantly different, as seen in the Ct.Wi parameter, with the LVD3 group having a higher Ct.Wi than the FVD3 group.Conclusion: liprotide-encapsulated vitamin D3 improves the serum PTH level and bone microstructure in a rat model of vitamin D and calcium deficiency.

Vitamin C - a scoping review for Nordic Nutrition Recommendations 2023.

Vitamin C has multiple metabolic functions in the body, but the available information on the exact relationship between these functions and the intake necessary to maintain them is very limited. However, most attempts to objectively measure adequacy of vitamin C status, including, for example, replacement of metabolic turnover, chronic disease prevention, urinary excretion, and saturation of immune cells and body compartment, currently point toward 50 µmol/L as a reasonable target plasma concentration. As a strong correlation between body weight and vitamin C status exists, recommended intakes (RIs) for other age groups may be extrapolated from the adult RI based on weight. However, as body weights above 70 kg are becoming increasingly common - also in the Nordic region - an RI of 140 mg/day for individuals weighing 100 kg or more should be considered to compensate for the larger volume of distribution. Finally, smoking continues to be a common contributor to poor vitamin C status; therefore, it is proposed that people who smoke increase their daily vitamin C intake by 40 mg/day to compensate for the increased metabolic turnover induced by smoking.

Effect of Daily Vitamin D Supplementation on Risk of Upper Respiratory Infection in Older Adults: A Randomized Controlled Trial.

Among individuals with vitamin D deficiency, daily vitamin D supplementation appears to lower risk of acute respiratory infection. However, recent trials, in different populations and using different regimens, have yielded null results. We investigated the effect of daily vitamin D supplementation (vs placebo) on risk of upper respiratory infection (URI) in older adults. The VITamin D and OmegA-3 TriaL (VITAL) is a randomized, double-blind, placebo-controlled trial of supplemental vitamin D and/or omega-3 fatty acids in generally healthy men (age ≥50 years) and women (age ≥55 years). This prespecified analysis focuses on vitamin D3 (2000 IU/day) versus placebo in the 15 804 (61%) participants with baseline serum total 25-hydroxyvitamin D level. The primary outcome was self-report of a recent URI at 1-year follow-up. Participants had a mean age of 68 years and 51% were women; 76% were non-Hispanic White, 16% Black, and 8% other race/ethnicity. The mean 25-hydroxyvitamin D level at baseline was 31 (standard deviation, 10) ng/mL, with <12 ng/mL in 2.4%. The overall effect of vitamin D supplementation on recent URI was nonsignificant (odds ratio [OR], 0.96 [95% confidence interval {CI}, .86-1.06]). In the prespecified subgroup of primary interest (<12 ng/mL and denied taking concurrent vitamin D), which had only 255 participants, vitamin D supplementation was nonsignificant (OR, 0.60 [95% CI, .28-1.30]). Statistical power to assess effect modification in other subgroups was limited. In older adults not selected for vitamin D deficiency, supplemental vitamin D did not lower URI risk overall. Whether effects differ in subgroups requires further study. Clinical Trials Registration. NCT01169259.

Assessment of the dietary intake among patients with Alzheimer’s disease in Kazakhstan

AbstractBackgroundDietary intake alterations have been studied in relation to Alzheimer’s disease and have shown that a diet that is rich in fruits, vegetables, whole grains, and low‐fat dairy products may be associated with a reduced risk of cognitive decline, including Alzheimer’s disease (AD). Traditionally, the Kazakh diet is high in protein, fats, and carbohydrates, and low in fruits and vegetables. With the increasing urbanization and globalization, the diet of Kazakhs is starting to change, and more people are starting to adopt a more Westernized diet which is higher in processed foods and sugar. However, little is known about dietary patterns in AD patients from the Central Asia region. Thus, the aim of the study was to identify dietary intake among local Alzheimer’s patientsMethodWe included 106 patients with AD dementia and 100 controls and retrospectively assessed the average intake over a given time period of foods and dishes in a defined food list using the Food Frequency Questionnaire (FFQ). The FETA tool was used to analyze nutrient and food group data from the questionnaireResultOur results demonstrate that AD patients’ diets are characterized by lower fruit, vegetable, and fish consumption compared to the controls. Patients with AD dementia did significantly differ from controls in total daily energy intake (1696 (IQR 1152;2168) vs 2019 (IQR 1424;2515) kcal/day, p &gt; 0.05), in protein, total carbohydrate, and fats. The daily Vitamin C, D, E, and iodine intake was lower than recommended amounts in both groups.ConclusionAD patients in Kazakhstan have a diet with low income of fruits and vegetables which leads to certain nutrients and vitamin deficiencies. It is advised that patients follow a balanced diet that is rich in fruits, vegetables, whole grains, and lean protein sources.

Spontaneous Laryngeal Hematoma: A Rare Presentation of Supratherapeutic INR

Introduction: Warfarin is one of the most routinely used drugs for anticoagulation. However, it poses a significant bleeding risk. Incidence of major bleeding events ranges from 0.4-7.2% per year, and that of minor bleeding events can be as high as 15.4% per year. Here we present a rare case of laryngeal hematoma due to supratherapeutic INR. Case description: A 48-year-old male with past medical history of hypertension, Insulin dependent diabetes mellitus, and multiple episodes of deep venous thromboses on chronic anticoagulation with warfarin presented to the emergency department complaining of left sided neck pain and hoarseness of voice that started and progressively worsened since the past 24 hours. He denies any fever, chills, cough, shortness of breath, or dental pain. He was found to be hemodynamically stable with no oxygen requirement. He spoke with a hoarse voice, but no stridor was noted. Tenderness of the left anterior triangle of the neck below the jawline and mild trismus was noted. Laboratory work-up showed stable hemoglobin of 12.2 and a supratherapeutic INR of 9.9. CT of soft tissue neck showed retropharyngeal fluid collection extending from skull base to C7 with mild to moderate supraglottic airway narrowing. Flexible nasopharyngeal endoscopy showed significant collection of secretions with omega shaped epiglottis and retropharyngeal swelling, raising concerns for a hematoma. INR reversal with 2 units of fresh frozen plasma was initiated and patient was transferred to medical intensive care unit. He underwent daily endoscopies for three days; on day 3 significant improvement of the hematoma size was noted. Daily oral Vitamin K for 3 days ensured INR reversal from 9.9 to 1.7. After transferring to floors, the patient was gradually re-started on his anticoagulation and discharged home safely. Discussion: This case exemplified one of the rare but life-threatening complications of supratherapeutic INR. Bleeding into the larynx is a very rare life-threatening complication of chronic anticoagulation with warfarin. Similar case was reported by Cody A. Koch et al in 2010. In 2017 another case was reported which resulted in death from asphyxia before patient was taken to the hospital. A patient with similar presentation and demographics with the index case was reported also in 2019. As per literature, this case will be one of the very few reported cases of Spontaneous laryngeal hematoma due to supratherapeutic INR. Several factors could potentially affect the INR level of patients on chronic warfarin therapy and can cause acute elevation of INR which can lead to several complications including epiglottal hematoma as seen in this case. The index patient has significant history of chronic diarrhea along with OTC Tylenol ingestion for chronic patient both of which can cause INR increase. Thus, high index of suspicion is important especially for patients with comorbidities due to the fragile interaction of warfarin with several common medications and clinical conditions. Epiglottal hematoma can expand and potentially compromise the airway if immediate reversal of supratherapeutic INR is not commenced. Regardless of presentation, every patient who exhibits warfarin-associated upper airway hemorrhage should receive treatment that includes stopping anticoagulation, correcting the coagulopathy quickly, closely monitoring the patient's airway in an intensive setting, and having a low threshold for tracheostomy. Given the predicted difficulty with direct and fiberoptic laryngoscopy, the delayed time course for hematoma clearance, and the potential trauma resulting in further bleeding in an anticoagulated patient, securing the airway via intubation is frequently not desirable. Such cases of non-traumatic hemorrhage may be managed medically or surgically. Spontaneous hemorrhage is usually managed conservatively. Regarding the ideal course of treatment, there is, however, no agreement. Conclusion: There is need for a high index of suspicion for atypical presentations of supratherapeutic INR (including bleeding into the airway) in patients on prolonged anticoagulation with warfarin. The need for immediate reversal and routine INR monitoring in these patients is also emphasized in this clinical vignette.

Supplementation of vitamin D reduces energy intake and prevents body fatness accumulation in obese woman

Link of Video Abstract: https://youtu.be/bqtP9eagX1E Introduction: Obese people are at higher risk of comorbidities, including metabolic syndrome, autoimmune, tumor progression and other inflammation diseases because of low-grade chronic inflammation. Vitamin D is closely related to transcriptional activity in adipose tissue, which regulates adipogenesis, inflammatory pathways, and adipose cell metabolism. This research aims to know the effect of Vitamin D supplementation on energy intake and body fat accumulation. Methods: 40 obese women between the ages of 26 and 45 were randomly assigned to the Intervention and Control groups, which received daily supplements of 5000 IU of vitamin D and a placebo, respectively. Data were gathered before the intervention and after 12 weeks of it. We measured the energy intake, BMI, waist circumference (WC), and conicity index. The participants were told to keep their daily calorie consumption at or below 1500 kcal. Results: After 12 weeks of supplementation, 25(OH) Vitamin D levels increased significantly (p=0.001), and energy intake decreased (p=0.014) significantly in the intervention group, but no change in the control group (p&gt;0,05). Body fatness indices (BMI and WC) increased (p=0.005 and p=0.003) significantly in the control group; however, these parameters did not change in the intervention group (p&gt;0.05). Conclusion: Daily Vitamin D 5000 IU for 12 weeks decreases energy intake and prevents body fat accumulation in obese women.