Oral Supplementation Of Vitamin Research Articles

Vitamin-Microbiota Crosstalk in Intestinal Inflammation and Carcinogenesis.

Inflammatory bowel disease (IBD) and colitis-associated colorectal cancer (CAC) are common diseases of the digestive system. Vitamin deficiencies and gut microbiota dysbiosis have a close relationship with the risk, development, and progression of IBD and CAC. There is a strong link between vitamins and the gut microbiome. Vitamins are extremely crucial for maintaining a healthy gut microbiota, promoting growth and development, metabolism, and innate immunity. Gut microbiota can not only influence the transport process of vitamins, but also produce vitamins to compensate for insufficient food intake. Emerging evidence suggests that oral vitamin supplementation can reduce inflammation levels and improve disease prognosis. In addition, improving the diet structure and consuming foods rich in vitamins not only help to improve the vitamin deficiency, but also help to reduce the risk of IBD. Fecal microbiota transplantation (FMT) and the application of vitamin-producing probiotics can better assist in the treatment of intestinal diseases. In this review, we discuss the interaction and therapeutic roles of vitamins and gut microbiota in IBD and CAC. We also summarize the methods of treating IBD and CAC by modulating vitamins. This may highlight strategies to target gut-microbiota-dependent alterations in vitamin metabolism in the context of IBD and CAC therapy.

Effect of Supplementation of Vitamin D in Patients with Periodontitis Evaluated before and after Nonsurgical Therapy.

Background Vitamin D has anti-inflammatory properties and the potential to increase the generation of antimicrobial peptides like cathelicidin and defensins that may have a good impact on oral health. Higher vitamin D consumption has also been linked to a reduced risk of periodontal disease progression. Hence, the primary objective of this study was to evaluate and compare the clinical and laboratory parameters of oral supplementation of vitamin D as an adjuvant to scaling and root planing and to assess the bone mineral density via qualitative ultrasound bone density scanner in chronic periodontitis patients. Methodology. This study included 40 patients with periodontitis categorized into 2 groups with twenty patients each, Group I comprising scaling and root planing (SRP) alone and Group II comprising SRP along with vitamin D supplementation. Plaque index, gingival index, probing pocket depth, and clinical attachment loss was measured as clinical parameters. Serum vitamin D levels were assessed before and after SRP at both baseline and 6 weeks. Results The intergroup comparison of clinical parameters (PI, GI, PPD, and CAL) at 6 weeks for both the groups showed statistical significance. Intragroup comparison of clinical parameters from baseline to 6 weeks showed a statistically significant reduction in both groups. The mean bone mineral density level in both the control and test groups demonstrated a mean T score of –1.3 and –1.21, respectively. The mean vitamin D levels were 27.8460 and 28.1020 for the test and control groups, respectively, which was statistically insignificant (p = 0.705) and those at six-week intervals improved to 31.3650 and 28.0240 which were statistically significant (p ≤ 0.001). Conclusion It could be stated that a positive relationship exists between periodontitis and osteopenia which could aggravate periodontal destruction. All periodontitis cases should thus be evaluated for BMD and supplemented with vitamin D3 in an appropriate dosage and time frame to treat both these diseases.

What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta-analysis.

Hip fractures have a huge impact in reducing the quality of life and increasing mortality. This review aims to assess the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in people over 65 years. PRISMA guidelines were followed and RCTs that evaluated the effectiveness of daily oral supplementation of vitamin D3 plus calcium in preventing hip fracture in adults over 65 years were included in the study. The databases such as Cochrane Library, Embase, Medline, PubMed, CINAHL, Web of Science and Scopus were searched from October 2019- January 2020.The Cochrane risk of bias tool was used to check the quality of the included studies. A meta-analysis with fixed effect model using Review Manager (Revman 5.3) was used to analyse the data. The meta-analysis of seven RCTs on vitamin D3 plus calcium supplementation and hip fracture (n= 12,620) identified odds ratio (OR) of 0.75; 95% Confidence interval (CI): 0.64, 0.87; p= .0003. Daily oral supplementation of 800 IU of Vitamin D3 plus 1200 mg of calcium was found more effective (n= 5676 participants; OR=0.69; 95% CI: 0.58, 0.82; p < .0001) than daily oral supplementation of 800 IU of Vitamin D3 plus 1000 mg of calcium (n= 6555,OR=1.08; 95% CI: 0.74, 1.56; p= .70) in reducing hip fracture. A meta-analysis of the seven RCTs to identify the incidence of non-vertebral fracture gave the OR of 0.80; 95% CI: 0.72, 0.89; p< .0001. A meta-analysis of three RCTs on femoral neck bone mineral density (BMD) (n= 483) gave a mean difference of 1.21; 95% CI: -0.79, 3.20; p= .24. Daily oral supplementation 800 IU of vitamin D3 plus 1200 mg of calcium reduces hip fracture and non-vertebral fracture in older people. Administering vitamin D3 and calcium supplements had no effect in increasing the femoral neck BMD. Even though it is evident from the review that optimal daily intake of vitamin D3 plus calcium supplementation help in the prevention of fracture, it is only one essential element in fracture prevention. Also, people who are on dietary supplements should be compliant with same for better result. Efforts to prevent bone loss and osteoporosis should begin from an early age. It includes maintaining a healthy lifestyle, optimal intake of calcium and vitamin D3, proper nutrition, adequate exposure to sunlight, exercise etc. Proper education on healthy lifestyle, avoiding risk factors like smoking, caffeine, alcohol and awareness of bone health should continue throughout life with emphasis during menopause when increased bone loss is expected.

Effect of Pre-partum Supplementation of Vitamin E and Selenium on Post-partum Reproductive and Productive Performance in Dairy Cows

Background: The study was planned to determine the effect of oral supplementation of vitamin E and Selenium on productive and reproductive performance in 40 Jersey cows and consequent effect on the growth of their progeny (calves). Methods: The experimental animals were divided into two homogenous groups (A and B). Animals in group A were given Vitamin E (200 mg) and Selenium (10 mg) daily orally; 250 days onwards prepartum for 21 days. The cows belonging to the group B were not provided these supplements and served as untreated control group. Result: Group A animals took significantly (P less than 0.01) less (2/3) time than those included in Group B for expulsion of the placenta. Additionally, lesser number of cows in Group A than those in Group B suffered from retention of placenta (ROP) indicating improvement of reproductive performance in the group with no significant effect on growth of calves and milk yield in the two groups. Therefore, from the experiment, it was concluded that supplementation of Vitamin E and Selenium to dairy cows during last month of pregnancy decreases time of placenta expulsion with no significant effect on the growth of their progeny (calves). The present study also concludes that higher number of animals may be taken for the experiment for a good dairy managemental programme.

Nano Matrix Soft Confectionary for Oral Supplementation of Vitamin D: Stability and Sensory Analysis.

Vitamin D deficiency distresses nearly 50% of the population globally and multiple studies have highlighted the association of Vitamin D with a number of clinical manifestations, including musculoskeletal, cardiovascular, cerebrovascular, and neurological disorders. In the current study, vitamin D oil-in-water (O/W) nanoemulsions were developed and incorporated in edible gummies to enhance bioavailability, stability, and patient compliance. The spontaneous emulsification method was employed to produce a nano-emulsion using corn oil with tween 20 and lecithin as emulsifiers. Optimization was carried out using pseudo-ternary phase diagrams and the average particle size and polydispersity index (PDI) of the optimized nanoemulsion were found to be 118.6 ± 4.3 nm and 0.11 ± 0.30, respectively. HPLC stability analysis demonstrated that the nano-emulsion prevented the degradation and it retained more than 97% of active vitamin D over 15 days compared to 94.5% in oil solution. Similar results were obtained over further storage analysis. Vitamin D gummies based on emulsion-based gelled matrices were then developed using gelatin as hydrocolloid and varying quantities of corn oil. Texture analysis revealed that gummies formulated with 10% corn oil had the optimum hardness of 3095.6 ± 201.7 g on the first day which remained consistent on day 45 with similar values of 3594.4 ± 210.6 g. Sensory evaluation by 19 judges using the nine-point hedonic scale highlighted that the taste and overall acceptance of formulated gummies did not change significantly (p > 0.05) over 45 days storage. This study suggested that nanoemulsions consistently prevent the environmental degradation of vitamin D, already known to offer protection in GI by providing sustained intestinal release and enhancing overall bioavailability. Soft chewable matrices were easy to chew and swallow, and they provided greater patient compliance.

Bone Health Considerations in Breast Cancer.

The treatment of breast cancer requires the use of multiple modalities to achieve local control of disease and to prevent distant recurrence. Among patients whose tumors are hormone-receptor positive, endocrine therapy for up to 10 years in the adjuvant setting can be an important component of such therapy, but it is not without adverse events. Ovarian suppression or estrogen restriction can have a rapid and clinically significant detrimental effect on bone mineral density, leading to potential osteoporotic fracture. This article reviews the major causes of breast cancer treatment-induced bone loss and pharmacologic and nonpharmacologic management strategies to maintain bone health in this population. PubMed and international clinical practice guidelines were used. A holistic, long-term approach is needed to identify and offer early intervention to patients at high-risk of significant bone density loss. A combination of routine screening, use of oral or intravenous bone-modifying agents, oral supplementation of calcium and vitamin D, and physical activity, including weight-bearing exercise, are required to maintain adequate bone health during treatment for breast cancer. Oncology nurses are well-situated in the primary and survivorship care teams for patients with breast cancer to provide proactive education on the need to assess and actively manage bone health. Nonpharmacologic interventions such as dietary supplementation and physical activity are essential to health promotion and are within the nursing scope of practice to emphasize with this patient population.

Comparison of effect of parenteral and oral supplementation of Selenium and vitamin E on selected antioxidant parameters and udder health of dairy cows.

The aim of this study was to compare the effect of parenteral and oral supplementation of Selenium (Se) and vitamin E (VTE) on selected antioxidant parameters in blood and colostrum as well as their effect on the incidence of mastitis in dairy cows during the final phase of gravidity (6 weeks) and first two weeks after calving. For the practical part of the study 36 dairy cows of Slovak pied breed in the second to fourth lactation-gestation cycle were selected. The animals weredivided into three groups: the control (C) and two experimental groups (D1 and D2). The selected groups were treated as follows: in group D1 products containing Se (Selevit inj.) and vitamin E (Erevit sol. inj.) were administered intramuscularly twice, six and three weeks prior to parturition; in group D2 a vitamin-minerals supplement in the form of sodium selenite (Na2SeO3) and dl-α-tocopherol acetate were supplemented orally for six weeks calving. The blood samples were collected from the vena jugularis in dairy cows approximately 42 days before calving (control sampling), on parturition day, and the 14th day after calving. Higher concentrations of Se and VTE were found in the blood plasma samples of both experimental groups collected on the day of parturition. In addition, the orally supplemented group (D2) showed higher Se and α-tocopherol concentrations in blood plasma on the14th day after calving as well a reduction of occurrence of mastitis by about 25 % compared to the control group. The relationship between inflammatory response and oxidative stress was also confirmed. The concentrations of milk malondialdehyde indicating lipid peroxidation during mastitis were significantly higher in milk samples from infected cows than in milk samples from healthy animals in each monitored group. In order to prevent oxidative stress and moderate inflammatory response in dairy cows it is very important to optimally balance their nutritive needs with an appropriate ratio of Se and VTE supplements. Therefore we still recommend supplementation of the cows' postpartum dietwith 0.5 mg of Se/kg dry matter (DM) and 102 mg of dl-α-tocopherol acetate/kg DM to stabilize their optimal blood levels, stimulate the activity of glutathione peroxidase and reduce the incidence of mastitis.

The Comparative Effects of Different Types of Oral Vitamin Supplements on Arterial Stiffness: A Network Meta-Analysis.

Arterial stiffness, a significant prognostic factor of cardiovascular disease, may be affected by dietary factors. Research on the effects of oral vitamin supplements on arterial stiffness and/or endothelial function has produced controversial results. Therefore, the aim of this network meta-analysis was to comparatively assess the effect of different types of oral vitamin supplements on arterial stiffness in the adult population. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials from their inception to 30 September 2021. A network meta-analysis using a frequentist perspective was conducted to assess the effects of different types of oral vitamin supplements on arterial stiffness, as determined by pulse wave velocity. In total, 22 studies were included, with a total of 1318 participants in the intervention group and 1115 participants in the placebo group. The included studies were listed in an ad hoc table describing direct and indirect comparisons of the different types of vitamins. Our findings showed that, in both pairwise comparison and frequentist network meta-analysis, the different types of oral vitamin supplements did not show statistically significant effects on arterial stiffness. However, when oral vitamin supplementation was longer than 12 weeks, vitamin D3 showed a significant reduction in arterial stiffness, compared with the placebo (ES: −0.15; 95% CI: −0.30, −0.00; −60.0% m/s) and vitamin D2 (ES: −0.25; 95% CI: −0.48, −0.02, −52.0% m/s). In summary, our study confirms that oral vitamin D3 supplementation for more than 12 weeks could be an effective approach to reduce arterial stiffness and could be considered a useful approach to improve vascular health in patients at high risk of cardiovascular disease.

Vitamin D Attenuates Pain and Cartilage Destruction in OA Animals via Enhancing Autophagic Flux and Attenuating Inflammatory Cell Death.

Osteoarthritis (OA) is the most common form of arthritis associated with ageing. Vitamin D has diverse biological effect on bone and cartilage, and observational studies have suggested it potential benefit in OA progression and inflammation process. However, the effect of vitamin D on OA is still contradictory. Here, we investigated the therapeutic potential of vitamin D in OA. Six-week-old male Wistar rats were injected with monosodium iodoacetate (MIA) to induce OA. Pain severity, cartilage destruction, and inflammation were measured in MIA-induced OA rats. Autophagy activity and mitochondrial function were also measured. Vitamin-D (1,25(OH)2D3) and celecoxib were used to treat MIA-induced OA rats and OA chondrocytes. Oral supplementation of vitamin D resulted in significant attenuations in OA pain, inflammation, and cartilage destruction. Interestingly, the expressions of MMP-13, IL-1β, and MCP-1 in synovial tissues were remarkably attenuated by vitamin D treatment, suggesting its potential to attenuate synovitis in OA. Vitamin D treatment in OA chondrocytes resulted in autophagy induction in human OA chondrocytes and increased expression of TFEB, but not LC3B, caspase-1 and -3, in inflamed synovium. Vitamin D and celecoxib showed a synergistic effect on antinociceptive and chondroprotective properties in vivo. Vitamin D showed the chondroprotective and antinociceptive property in OA rats. Autophagy induction by vitamin D treatment may be a promising treatment strategy in OA patients especially presenting vitamin D deficiency. Autophagy promoting strategy may attenuate OA progression through protecting cells from damage and inflammatory cell death.

Effect of Vitamin D Supplementation on Glycemic Control in Prediabetes: A Meta-Analysis.

Clinical research results of vitamin D supplementation in the improvement of prediabetes remain controversial. Accordingly, a literature search was conducted of PubMed, Embase (Ovid), and Web of Science prior to 9 November 2021. Randomized controlled studies reported that the following indicators were included: body mass index (BMI), fasting blood glucose (FBG), 2 h oral glucose tolerance test plasma glucose (2h-PG), hemoglobin A1c (HbA1c), insulin resistance by homeostasis model assessment (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-B), and fasting insulin (FINS). Twenty-nine articles (N = 3792) were included in the present meta-analysis. Intriguingly, vitamin D supplementation resulted in a vast improvement in FBG (standardized mean difference (SMD) = −0.38; 95%CI: −0.59, −0.16), HbA1c (SMD = −0.14; 95%CI: −0.22, −0.06) and FINS (SMD = 0.18; 95%CI: −0.26, −0.09), but not in other outcomes. However, preferred changes were observed in subgroups, as follows: Asia (SMD2h-PG = −0.25, 95%CI: −0.45, −0.04), study duration ≥1 year (SMDHOMA-IR = −0.44, 95%CI: −0.81, −0.06) (SMDHOMA-B = 0.34, 95%CI: 0.01, 0.66), baseline 25(OH)D < 50 nmol/L (SMD2h-PG = −0.23, 95%CI: −0.39, −0.06), and baseline 25(OH)D ≥ 50 nmol/L (SMDHOMA-IR = −0.50, 95%CI: −0.96, −0.03). In conclusion, oral supplementation of vitamin D has shown better effects in improving FBG, HbA1c, and FINS compared with controls among prediabetics; long-term vitamin D supplementation could have additional effects in participants with vitamin D deficiency for 2h-PG, HOMA-IR, and HOMA-B.

Neonatal hepatitis in a term newborn: sequelae to in utero COVID-19 infection

Neonatal hepatitis is a common disease entity seen among newborns. It is known as inflammation of liver parenchyma in newborns, specifically in first month of life. Most common cause of neonatal hepatitis is viral infection which infects liver in utero or in postnatal period. Newborns carrying neonatal hepatitis mostly present with jaundice, failure to gain weight and hepatosplenomegaly. Neonatal hepatitis due to in utero COVID infection is diagnosed by conjugated hyperbilirubinemia, raised SGOT and SGPT levels and raised COVID antibody levels. Treatment includes addition of fat-soluble vitamins, phenobarbitone and supportive care. Here author is reporting a rare case of 11 days old newborn with neonatal hepatitis, who presented with severe jaundice (TSB/DB- 44/22) hepatosplenomegaly and hypoxemia with mild respiratory distress. Maternal history revealed high grade fever with low cell count during 5th month of gestation, though COVID RAT was negative and RT-PCR was not done. Baby was managed in NICU with IV antibiotics, IV fluids, oxygen by prongs, oral fat-soluble vitamin supplementation, adequate calorie intake and phenobarbitone. Baby responded very well to the treatment and discharged in healthy condition after 7 days. Paucity of data documenting in utero COVID-19 infection as cause of neonatal hepatitis led us to report this rare case.

Biomarker Level of Oxidative Stress after Oral Supplementation of Vitamin C in Patients with Type 2 Diabetes Mellitus

Background: Diabetes mellitus is one of the most widespread endocrine disorders and its complications are increasing all over the world. Hyperglycemia causes excess free radicals generation leading to oxidative stress which is responsible for micro vascular and macro vascular complications. Serum malondialdehyde (MDA) level may reflect oxidative stress in type 2 DM. Vitamin C has been suggested to be an important antioxidant for scavenging oxygen-derived free radicals. Objective: To observe the effects of oral supplementation of vitamin C on biomarker level of oxidative stress in patients with type 2 diabetes mellitus. Method: From July 2015 to June 2016, a prospective interventional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka. A total of 33 diagnosed type 2 diabetic patients of both sexes with age ranging from 40 to 55 years were chosen. The study group consisted of 17 type 2 diabetic patients who received vitamin C (1000 mg/day) supplements for 6 weeks. Another 16 age-matched type 2 diabetic patients were used as a control group for comparison, with no vitamin C supplementation. All subjects in both groups were studied twice, once at the beginning of the study (baseline) and once after 6 weeks of study. Result: At the beginning of the study, the mean MDA level was almost identical, and the difference between the control and study groups was not statistically significant (baseline). The mean serum MDA level in diabetic patients was significantly (p&lt;0.001) reduced after six weeks of vitamin C supplementation compared to their baseline value. Again, after 6 weeks, serum MDA level was significantly (p=0.002) lower in vitamin C supplemented patients compared to control group who were not supplemented with vitamin C. Conclusion: Supplementation of vitamin C is found effective in reducing the biomarker level of oxidative stress.

Effects of Oral Vitamin C on Hepcidin Levels and Erythropoietin Requirements in Functional Iron Deficiency Anemia among Hemodialysis Patients

Abstract Background Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia. Patients and Methods This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months. Results Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P &amp;lt; 0.05). A Decrease in EPO requirements and elevation of hemoglobin level were observed in the study group but were not statistically significant as a short term effect of oral vitamin C, in comparison to the control group. A highly significant correlation was observed between serum hepcidin and hs-CRP (R=0.46, P&amp;lt;0.01). Conclusion Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.

METABOLIC AND ORTHOPEDIC ASPECT OF X-LINKED VITAMIN D-RESISTANT HYPOPHOSPHATEMIC RICKETS

INTRODUCTION: - The X-linked vitamin D-resistant hypophosphatemic rickets (VDXLR) is a metabolic disorder. Medication treatment consists of oral phosphate substitution and supplementation of active vitamin D compounds. Our study aimed to review our patients with VDXLR, focusing on those undergoing surgery, mainly lengthening procedures. The main parameters of interest were growth, height, the axis of the lower limbs, pain, and degenerative arthropathy. METHODS: - Twelve patients with VDXLR were followed at our institution. Eight patients underwent surgical correction, and three of them in combination with bone lengthening. The corrections were executed at the end of growth in the patients. Clinical end points were height, leg axis, and pain. RESULTS: - Single bilateral surgical correction was performed in six patients; one patient had three and ve corrections. Bone lengthening was performed in three patients. At the last follow-up, the height of seven operated patients was within normal range. In addition, the leg axis was normalized in six patients with mild genua vara in two. Bone healing was excellent, and no surgical complications. There was no one radiological evidence of degenerative arthropathy. CONCLUSIONS: - In case of bone deformity, surgery can safely be performed, independent of age or bone maturation. All patients were happy with the outcomes of axial corrective surgery and bone lengthening, and in the majority. Only one corrective intervention was needed.

Effect of oral vitamin C on serum hepcidin level, iron status and inflammation among hemodialysis patients with functional iron deficiency anaemia

Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Patients and Methods: This study is an interventional prospective cohort study; 48 prevalent HD patients were enrolled. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group two: 17 patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level &lt;11 g/dL, ferritin level &gt;200 ng/mL and transferrin saturation (TSAT) &gt;20 % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after 3 months. Results: On comparing the two groups, oral vitamin C in group 1 resulted in a statistically significant reduction in hepcidin levels [mean 2506.456 ± 1320.53 pg/mL to 1748.396 ± 1432.28 pg/mL (P = 0.03)], and a significant reduction in hs-CRP level [mean 8603.236 ± 2547.77 ng/mL to 5611.296 ± 2829.27 ng/mL] (P = 0.001) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.

Evidence-Based Nutritional Interventions in Wound Care.

The role of nutritional intervention in wound care has been a topic of controversy. Although the efficacy of macronutrient supplementation has been well described, there is a paucity of evidence and no official recommendation regarding the use of vitamins and minerals to optimize wound healing. This is the first review of vitamin and mineral wound intervention that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence by wound type. In this comprehensive review, the authors outline the nutrients and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize nutrient effectiveness, and propose evidence-based conclusions to improve wound healing outcomes and enhance the consistency of nutritional intervention in wound care. Thirty-six studies with a combined total of 2339 patients investigated the use of oral, topical, or intravenous vitamin and/or mineral supplementation for treatment of the following wound types: burn wounds (n = 3), pressure ulcers (n = 7), diabetic ulcers (n = 4), venous ulcers (n = 7), digital ulcers (n = 1), skin incisions (n = 9), hypertrophic scars (n = 4), and sinonasal wounds (n = 1). Improved outcomes were reported in patients with burn wounds receiving vitamins A, B1, B6, B12, D, and E and zinc, calcium, copper, magnesium, selenium, and zinc; patients with pressure ulcers receiving vitamin C and zinc; patients with diabetic ulcers receiving vitamin A, B9, D, and E; patients with venous ulcers receiving zinc; and patients with hypertrophic scars receiving vitamin E. Based on the high-level data provided in this review, the use of specific nutritional interventions may improve the outcome of certain wound types. Further investigation is warranted to draw definitive conclusions.

Determination and Evaluation of Bioavailability of Vitamins from Different Multivitamin Supplements Using a Pig Model

This study was performed to evaluate the plasma vitamin kinetic behavior following oral vitamin supplement administration in pigs, and to determine the bioavailability of vitamins. A total of 36 pigs (fitted with jugular catheters) with an average body weight of 25 ± 2.24 kg were divided into three treatment groups: (1) placebo, (2) non-microencapsulated multivitamins supplement, or (3) lipid matrix microencapsulated multivitamins supplement. The blood samples were obtained starting pre-meal until 72 h post-meal for plasma vitamin analysis. Pharmacokinetic parameters were modeled with a non-compartmental method. The AUC (Area under the curve) from the time of dosing to the time of the last observation, Cmax (Maximum observed concentration), and MRT (Mean residence time) of α-tocopherol from oral non-microencapsulated supplement were significantly lower than oral microencapsulated supplement (p &lt; 0.01). The average relative bioavailability of vitamin A (VA) and vitamin E (VE) from microencapsulated supplement was greater than that from non-microencapsulated supplement, but relative bioavailability of vitamin K3 (VK3) and water-soluble vitamins from microencapsulated supplement was lower than non-microencapsulated supplement. The AUC and Cmax of menadione, thiamine, and riboflavin from microencapsulated supplement were significantly lower than these parameters from oral non-microencapsulated supplement. Lipid matrix microencapsulation was able to delay absorption and improved the bioavailability of VE, whereas there were limited effects of microencapsulation on vitamin D (VD), VK3, and water-soluble vitamins.

The Unusual Suspect: Hypocalcemia in Preeclampsia After Magnesium Infusion

Background: Magnesium plays a vital role in calcium homeostasis. Magnesium sulfate is used in obstetric populations for the management of preeclampsia and eclampsia. Hypocalcemia secondary to iatrogenic hypermagnesemia is an uncommon complication. We report a case of symptomatic hypocalcemia due to hypermagnesemia. Clinical Case: A 26-year-old female with type 1 diabetes at 33 weeks gestation was admitted for preeclampsia. She had severe hypertension and proteinuria, and the decision to induce labor was made. She was started on a magnesium sulfate drip and remained on the drip for 33 hours. Magnesium levels peaked at 7.5 mg/dL (1.7–2.5 mg/dL). The magnesium drip was suspended after delivery. She complained of mild tingling and numbness in her hands, feet, and perioral area. Shortly after delivery, she had a pre-syncopal event. The laboratory evaluation revealed a calcium of 5.9 mg/dL (8.4–10.4) with an albumin of 2.2 g/dL (3.7–5.5), magnesium of 4.2 mg/dL, phosphorus 2.2 mg/dL (2.3–4.6) and GFR above 60 mL/min/1.73m2 . Spot urine calcium to creatinine ratio was 0.17 mg/dL. The 25-hydroxy vitamin D level was low at 12 ng/mL (20–100). The parathyroid hormone (PTH) level was inappropriately normal at 21.7 pg/mL (12–88). She had no history of hypocalcemia, and calcium level obtained six months before the presentation was normal. She received one calcium gluconate infusion, was then started on a continuous calcium gluconate infusion for symptomatic hypocalcemia. She also received oral supplementation of calcium and vitamin D. The calcium levels normalized within 24 hours as the hypermagnesemia resolved from the discontinuation of the magnesium drip. The subsequent PTH level was 38.8 pg/mL. She was discharged on vitamin D supplements. She had no recurrence of hypocalcemia. Conclusion: Our case highlights the effect of magnesium infusion on the parathyroid gland leading to profound symptomatic hypocalcemia. Magnesium plays an essential role in the secretion of PTH. Transient hypoparathyroidism can occur due to hypomagnesemia and hypermagnesemia (tocolytic therapy). In hypomagnesemia, the parathyroid gland secretes insufficient PTH, and the renal and skeletal response to PTH is reduced. In hypermagnesemia, the magnesium activates the extracellular calcium-sensing receptor, subsequently causing inhibition of the parathyroid gland. Amelioration of hypermagnesemia leads to the normalization of parathyroid function. Health care providers should be aware of this phenomenon, especially in the obstetric population receiving magnesium infusion. The monitoring of calcium levels may be necessary for this patient population. The laboratory testing should include magnesium in the evaluation of hypocalcemia.

A clinical study of vitamin d supplementation in diabetic retinopathy patients with type 2 diabetes mellitus

Aim: To evaluate the effect of supplementation of Vitamin D in delaying the progression of diabetic retinopathy (DR), and its use as a predictor for the severity of Diabetic Retinopathy. Materials and Methods: 100 patients with type 2 diabetes melitus and diabetic retinopathy were included in this retrospective study which was carried out at the vitreoretinal services, department of ophthalmology at DR B.R Ambedkar medical college and hospital over a period of 1 year. Results: Out of 100 patients, 59 were males and 41 were females. At 3 months, no progression noted in moderate, severe and very severe NPDR. However in control group 20% progressed to high risk PDR which is not found in cases. It was statistically significant (p value < 0> Conclusions: From the results of the study we can conclude that oral supplementation of Vitamin D in addition to the recommended treatment with photocoagulation, delays the progression of severe, very severe and early PDR. Our study demonstrated that low levels of vitamin D may be a risk marker of development or progression of diabetic retinopathy. Keywords: Diabetic retinopathy vitamin D, Diabetic millitus.

Prevalence and treatment of vitamin K deficiency in paediatric patients with recessive dystrophic epidermolysis bullosa-severe subtype.

IntroductionPatients with recessive dystrophic epidermolysis bullosa‐severe subtype (RDEB‐S) are at risk of vitamin K deficiency, potentially causing abnormal clotting, excessive bleeding, poor bone metabolism and abnormal vascular calcification. This study quantifies vitamin K deficiency prevalence in this cohort and identifies potential risk‐factors to prevent deficiency.MethodsPatients with RDEB‐S who attended the EB service between 2014 and 2020 were included. Serum vitamin K and PIVKAII were measured as part of the usual nutritional blood screen. Dietetic and medical notes were reviewed to establish: antibiotic use, enteral feed intake and micronutrient supplementation.ResultsA total of 16/25 64% (10/16 female), of children aged 22–180 months, had serum vitamin K and PIVKAII analysed. Six of sixteen (37.5%) patients had vitamin K deficiency requiring supplementation. Two of six (33.3%) normalized serum vitamin K after 12 weeks supplementation with oral menadiol diphosphate. Four of six (66.6%) await retesting following supplementation. Six of six (100%) patients with vitamin K deficiency were not consuming a gastrostomy/sip feed. Nine of ten (90%) patients with sufficient vitamin K levels were consuming either; more than 200 ml prescribed sip feed or more than 400–800 ml gastrostomy feed daily (containing 5.9–11 µg/100 ml vitamin K). Patients who were consuming either more than 200 ml prescribed sip feed or more than 400–800 ml gastrostomy feed daily (containing 5.9–11 µg/100 ml vitamin K) were significantly less likely to suffer from vitamin K deficiency (0.08 odds ratio [(1/7)/(5/3)] with significance level p = 0.0342 [95% CI: 0.0074–0.8275]). Sixteen of sixteen (100%) received antibiotics (range 0–4 courses/year; median, 3; IQR, 3). Patients with the most frequent antibiotics (n = 4) had normal vitamin K and PIVKAII levels if they consumed a minimum of 200 ml prescribed sip feed or 400–800 ml gastrostomy feed daily. Sixteen of sixteen (100%) patients took a multivitamin/mineral supplement; none contained vitamin K.SummaryThe prevalence of vitamin K deficiency is 37.5% in this cohort. Patients whom were not consuming gastrostomy/sip feeds of at least 200 ml daily were at greatest risk of vitamin K deficiency. Patients on a micronutrient supplement remain at risk of vitamin K deficiency, as most contain no vitamin K. Prescribing a vitamin/mineral supplement that contains vitamin K is recommended. Twelve‐week supplementation of oral vitamin K (5 mg/day for 1–10 years and 10 mg/day for 12–17 years) adequately improved stores.