Plasma Micronutrient Concentrations Research Articles

Four-week administration of an energy and protein dense oral nutritional supplement on plasma micronutrient concentrations in malnourished older adults living in nursing homes

Four-week administration of an energy and protein dense oral nutritional supplement on plasma micronutrient concentrations in malnourished older adults living in nursing homes

A methodology for examining the association between plasma volume and micronutrient biomarker mass and concentration in healthy eumenorrheic women.

BackgroundAccurate estimation and interpretation of nutritional biomarker concentrations are important in nutritional research, clinical care, and public health surveillance. Plasma volume (PV) may affect the interpretation of plasma biomarkers but is rarely measured. We aimed to examine the association between plasma volume (PV) and micronutrient biomarker concentrations and mass as part of pilot work to develop methods.MethodsNine healthy women with regular menstrual cycles provided fasting blood samples to measure micronutrient biomarkers. Indocyanine green was injected, and five timed blood draws were taken from 2 to 5 min to measure PV. Visits were scheduled around menstrual cycle day 2. Retinol, 25-hydroxyvitamin D, riboflavin, alpha-tocopherol, zinc, copper, magnesium, manganese, cobalt, iron, and ferritin concentrations were measured in serum. Total circulating micronutrient biomarker mass was calculated from PV and concentration.ResultsThe mean PV was 2067 ± 470 mL. PV correlated positively with concentration of iron (r = 0.87, P = 0.005); other correlations were weaker with p > 0.05. PV and total mass of retinol (r = 0.90), 25(OH)D (r = 0.75), zinc (r = 0.88), copper (r = 0.83), magnesium (r = 0.93), manganese (r = 0.72), and iron (r = 0.92) were strongly correlated (all p < 0.05). PV was positively correlated with circulating micronutrient mass for most biomarkers, implying that concentrations are maintained at different volumes of plasma. Larger studies are needed to further examine these relationships.ConclusionThough there appear to be some association between micronutrient biomarker mass and plasma volume, we are unable to draw a firm conclusion about any relationship from these results because of the small sample size. We consider these findings as a preliminary analysis to establish methods for future studies.

Dynamics of plasma micronutrient concentrations and their correlation with serum proteins and thyroid hormones in patients with paracoccidioidomycosis.

Minerals, such as zinc, copper, and iron are reported to play roles in chronic infectious diseases; however, their role in paracoccidioidomycosis (PCM) remains unknown. This study aimed to examine the micronutrient dynamics and their correlation with serum proteins and thyroid hormones in patients with PCM. In 14 patients with PCM and 10 healthy subjects, we evaluated the body mass index (BMI) along with serum levels of hemoglobin, iron, ferritin, zinc, copper, magnesium, albumin, globulin, thyroid stimulating hormone (TSH), thyroxine (free T4), and triiodothyronine (T3). Evaluations were conducted at the first appointment, before treatment, and at the end of the first, second, fourth, and sixth month of PCM treatment. The control group was only evaluated once. We observed that before treatment, patients with PCM, had higher levels of copper and lower level of iron than those of the control group. After one month of treatment, the iron levels increased, whereas the levels of copper after six months of treatment. Reduction in inflammatory activity, indicated by the normalization of C-reactive protein, ferritin, albumin, and globulin levels, was observed during treatment. However, no correlation was observed between the serum levels of minerals and inflammatory activity or thyroid function in this study. In conclusion, our results showed higher serum copper levels in control group compared to those in pretreatment patients; the clinical importance of this observation should be investigated in further studies. After treatment, serum copper levels showed a tendency to decrease. In addition, serum iron levels were decreased at the stage of active disease, and were increased after treatment. Thus, serum iron levels can be used as a better biomarker for treatment control.

Plasma Volume, Hydration and Nutritional Biomarker Concentrations Across the Menstrual Cycle (P24-052-19)

ObjectivesTo examine changes in plasma volume, hydration, and micronutrient concentrations across the menstrual cycle among healthy women of reproductive age. MethodsHealthy women aged 18 to 44 years were studied longitudinally across a single menstrual cycle (n = 35). Women made three visits (v1, v2, and v3) to the study center around cycle days 2, 12 and 21 (adjusted for individual cycle length) representing early follicular, late follicular and midluteal phases, respectively. At each visit, blood samples were collected before and after injection of indocyanine green (ICG). ICG in plasma was measured with a spectrophotometer within 2 hours of blood draw, to estimate plasma volume. Urine specific gravity (USG) was measured with a hand-held refractometer; urine and plasma osmolality were measured using freezing point depression osmometry. Serum ferritin was measured by ELISA; serum concentrations for 5 minerals were measured by inductively coupled plasma mass spectrometry. A mixed-effects model was used to examine changes in plasma volume and biomarker concentrations across the menstrual cycle; plasma volume and biomarker associations were tested with Spearman’s correlation. ResultsParticipants had a mean (SD) BMI of 21.6 (1.9) kg/m2. Plasma volume showed a non-significant decrease of 122 mL from v1 to v2 (P = 0.165; Table 1) and remained stable from v2 to v3 (P = 0.900). However, plasma osmolality decreased throughout the cycle from v1 to v3 (P < 0.001). Urine osmolality fell slightly from v1 to v2 (P = 0.214) followed by a significant rise from v2 to v3 (P = 0.026) but USG was constant across the cycle. From v1 to v3, serum magnesium concentration declined by 4.5% (P = 0.001); zinc had a similar decline that did not reach statistical significance (P = 0.057). Mean copper, calcium, manganese, ferritin, and hemoglobin concentrations did not change across the cycle (all P > 0.05). Adjusting for markers of inflammation (α1-acid glycoprotein and C-reactive protein) and plasma volume did not affect biomarker concentration changes. Plasma volume was not correlated with nutritional biomarkers at any timepoint (all P > 0.05, Table 2). ConclusionsConcentrations of micronutrients were not related to plasma volume. Some hydration and micronutrient biomarkers changed across the menstrual cycle, which could have implications for the timing of measurements in women of reproductive age. Funding SourcesThe Pennsylvania State University. Supporting Tables, Images and/or Graphs▪▪

Relationship between nutritional status and the systemic inflammatory response: micronutrients.

Micronutrients such as trace elements and vitamins are important as enzyme cofactors in the metabolism of all cells in the body and therefore key to determining nutritional status. The present systematic review examined the evidence of the impact of the systemic inflammatory response on plasma micronutrient status in acute (surgical) and chronic tissue injury. A literature review using targeted subject headings was carried out. Plasma C-reactive protein was used to classify minor (80 mg/l) inflammation. The literature search produced 2344 publications and plasma vitamin D, zinc and carotenoids were most commonly studied and plasma vitamins K, B2 and B6 were least studied. In acute injury thirteen studies (all prospective) and in chronic injury twenty-four studies (largely retrospective) were included in the review. There was consistent evidence that most common measured micronutrients in the plasma (zinc, selenium, vitamins A, D, E, K, B2, B6, B12, C, lutein, lycopene, α- and β-carotene) were significantly lowered from minor to moderate to major inflammation. The results of the present systematic review indicate that most plasma micronutrients fall as part of the systemic inflammatory response irrespective of acute or chronic injury. Therefore, in the presence of a systemic inflammation, plasma micronutrient concentrations should be interpreted with caution. There are a number of methods applied to adjust plasma micronutrient concentrations to avoid misdiagnosis of deficiency. Alternatively, intracellular measurements appear to obviate the need for such plasma adjustment to assess micronutrient status.

Normal Plasma Volume Expansion and Micronutrient Status in Pregnancy

Plasma volume expansion is widely known as an important physiologic change in pregnancy, yet normal expansion in healthy pregnancies has not been well described. This expansion influences plasma micronutrient concentrations and may impact interpretation of biomarkers. Our objective was to review studies that measured plasma volume longitudinally across gestation to describe normal plasma volume expansion; secondarily, we examined the impact of plasma volume expansion on micronutrient biomarkers. We systematically searched PubMed for original articles that directly measured plasma volume in pregnant women at more than one time across gestation. We also searched reference lists from these publications for additional papers. We found 15 studies published from 1963 to 2006 that directly measured plasma volume in pregnancy more than one time. We excluded 3 studies because the measurements were not longitudinal and one study because it used an unconventional measurement technique (iron dextran) and some values appeared extreme. Of the 11 longitudinal studies included, 8 studies were conducted in the UK and one each was conducted in India, Chile, and Nigeria. All studies used the Evans blue dye (T‐1824) indicator dilution method to measure the plasma volume. The total number of women in all studies was 524; study size ranged from 11 to 95. Plasma volume was measured 3 to 7 times in women across the studies. Two studies measured plasma volume before conception and 5 studies measured postpartum values (6–8 weeks after birth) as a proxy for pre‐conception. Plasma volume increases varied across the studies. Plasma volume increased by 8% between preconception and 12 weeks, 18% by 16 weeks, 27% by 20 weeks and 36% by 25 weeks gestation. The maximum mean plasma volume increase was 52% (1267 ± 38 ml) at 33–34 weeks gestation. This peak mean expansion ranged from 48% to 59% (1218 to 1323 ml) across studies, while reports of expansion for individual women ranged from 25% to 80%. Plasma volume slightly declined from late third trimester to term. Only one plasma volume study measured micronutrient status. In that study, plasma zinc concentrations declined across gestation to 30 weeks but intravascular zinc mass (the product of zinc concentration and plasma volume) increased across pregnancy. Plasma copper concentration increased up to gestational week 35 but intravascular copper mass was not reported. Few studies have measured plasma volume longitudinally in pregnancy. Studies of healthy pregnancies similarly show plasma volume increases progressively to approximately 52% above the non‐pregnant state in the third trimester with a slight decline to term. Plasma zinc concentration changes in pregnancy did not reflect actual changes in zinc status. Future studies in pregnancy should measure plasma volume to have a valid estimation of micronutrient status and to understand underlying physiologic changes that may be related to adverse outcomes.Support or Funding InformationNIH BIRCWH 12HD055882 (Dr. Gernand)

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women1–3

Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings.Objective: We examined associations of highly active antiretroviral therapy (HAART) and lipid-based nutrient supplements (LNS) with concentrations of selected micronutrients in HIV-infected Malawian women at 24 wk postpartum.Methods: Plasma micronutrient concentrations were measured in a subsample (n = 690) of Breastfeeding, Antiretrovirals, and Nutrition (BAN) study participants who were randomly assigned at delivery to receive HAART, LNS, HAART+LNS, or no HAART/no LNS (control). HAART consisted of protease inhibitor–based triple therapy. LNS (140 g/d) met energy and micronutrient requirements of lactation. Multivariable linear regression tested the association of HAART and LNS, plus their interaction, with micronutrient concentrations, controlling for season, baseline viral load, and baseline CD4 count.Results: We found significant HAART by LNS interactions for folate (P = 0.051), vitamin B-12 (P < 0.001), and transferrin receptors (TfRs) (P = 0.085). HAART was associated with lower folate (with LNS: −27%, P < 0.001; without LNS: −12%, P = 0.040) and higher TfR concentrations (with LNS: +14%, P = 0.004; without LNS: +28%, P < 0.001), indicating iron deficiency. LNS increased folate (with HAART: +17%, P = 0.037; without HAART: +39%, P < 0.001) and decreased TfR concentrations (with HAART only: −12%, P = 0.023). HAART was associated with lower vitamin B-12 concentrations only when LNS was present (−18%, P = 0.001), whereas LNS increased vitamin B-12 only when no HAART was present (+27%, P < 0.001). HAART, but not LNS, was associated with higher retinol-binding protein (RBP; +10%, P = 0.007). We detected no association of HAART or LNS with selenium, ferritin, or hemoglobin.Conclusion: The association of HAART with lower folate, iron deficiency, and higher RBP plus the attenuation of LNS effects on folate and vitamin B-12 when combined with HAART has implications for the health of lactating HIV-infected women taking HAART in prevention of mother-to-child transmission programs. This trial was registered at clinicaltrials.gov as NCT00164736.

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Association between maternal micronutrient status, oxidative stress, and common genetic variants in antioxidant enzymes at 15 weeks׳ gestation in nulliparous women who subsequently develop preeclampsia

Preeclampsia is a pregnancy-specific condition affecting 2–7% of women and a leading cause of perinatal and maternal morbidity and mortality. Deficiencies of specific micronutrient antioxidant activities associated with copper, selenium, zinc, and manganese have previously been linked to preeclampsia at the time of disease. Our aims were to investigate whether maternal plasma micronutrient concentrations and related antioxidant enzyme activities are altered before preeclampsia onset and to examine the dependence on genetic variations in these antioxidant enzymes. Predisease plasma samples (15±1 weeks׳ gestation) were obtained from women enrolled in the international Screening for Pregnancy Endpoints (SCOPE) study who subsequently developed preeclampsia (n=244) and from age- and BMI-matched normotensive controls (n=472). Micronutrient concentrations were measured by inductively coupled plasma mass spectrometry; associated antioxidant enzyme activities, selenoprotein-P, ceruloplasmin concentration and activity, antioxidant capacity, and markers of oxidative stress were measured by colorimetric assays. Sixty-four tag–single-nucleotide polymorphisms (SNPs) within genes encoding the antioxidant enzymes and selenoprotein-P were genotyped using allele-specific competitive PCR. Plasma copper and ceruloplasmin concentrations were modestly but significantly elevated in women who subsequently developed preeclampsia (both P<0.001) compared to controls (median (IQR), copper, 1957.4 (1787, 2177.5) vs 1850.0 (1663.5, 2051.5) µg/L; ceruloplasmin, 2.5 (1.4, 3.2) vs 2.2 (1.2, 3.0) µg/ml). There were no differences in other micronutrients or enzymes between groups. No relationship was observed between genotype for SNPs and antioxidant enzyme activity. This analysis of a prospective cohort study reports maternal micronutrient concentrations in combination with associated antioxidant enzymes and SNPs in their encoding genes in women at 15 weeks׳ gestation that subsequently developed preeclampsia. The modest elevation in copper may contribute to oxidative stress, later in pregnancy, in those women that go on to develop preeclampsia. The lack of evidence to support the hypothesis that functional SNPs influence antioxidant enzyme activity in pregnant women argues against a role for these genes in the etiology of preeclampsia.

Micronutrient Status in Children With IBD

In the January 2013 issue of JPGN, Alkhouri et al (1) assessed the micronutrient status in children with inflammatory bowel disease (IBD). They concluded that plasma vitamin B12 and folate “deficiencies” are rare at IBD diagnosis and question whether routine monitoring is warranted. Likewise they found that vitamin A and zinc “deficiencies” were common in their cohort and recommend that these should be routinely screened for so that nutritional repletion can commence. Because plasma concentrations of several micronutrients including vitamin A and zinc are known to be significantly influenced by the systemic inflammatory response (SIR) (2–5), these are unlikely to reflect true body stores in children with active IBD. Suboptimal plasma micronutrient concentrations are likely to result from redistribution and sequestration of micronutrients by tissues in the presence of a SIR (3). We have shown this for many micronutrients, and recently for vitamin D, in acute and chronic illness including in children with Crohn disease (2–7). Additionally, because vitamin B12 stores in the liver can last for >2 years, it is unlikely that a previously well child would develop vitamin B12 deficiency early on in IBD. Long-term monitoring is, therefore, essential. The authors’ interpretation of the findings is likely to mislead, resulting in unnecessary nutritional interventions with minimal clinical benefit. We propose that in conditions likely to be associated with SIR, assessment of micronutrient status in plasma should be interpreted in conjunction with measurements of C-reactive protein. Measurements in other cellular matrices (eg, erythrocytes) are likely to be a more reliable marker of body nutrient stores in acute and chronic illness

PP027. Alterations in maternal antioxidant micronutrient concentrations in women prior to developing pre-eclampsia

Changes in plasma antioxidant trace elements during pregnancy are closely related to mortality and morbidity in the newborn. Deficiencies of specific micronutrient antioxidant activities, associated with copper, selenium, zinc and manganese have previously been associated with pre-eclampsia (PE) at term. The purpose of the present study was to investigate these maternal plasma micronutrient concentrations with associated enzyme activities, specifically the copper-related caeruloplasmin, in a subcohort of the international SCreening fOr Pregnancy Endpoints (SCOPE) study, in early pregnancy, prior to disease onset. Pre-disease plasma samples (14-16+6 weeks') collected from women who subsequently developed PE (n=245) and age- and BMI-matched uncomplicated normotensive controls (NC; n=471) were used following written informed consent. Micronutrient concentrations were measured by inductively-coupled mass spectrometry and caeruloplasmin activity by colorimetric activity assay. Plasma copper concentrations at 15 weeks' gestation were significantly elevated in women who subsequently developed PE; no differences were seen for all other micronutrients (Table). No differences were seen in caeruloplasmin activity between the two groups. However, a positive association between copper concentration and caeruloplasmin activity was observed (r=0.305; R2=0.093; P<0.0001). Copper has a dual function in pregnancy, while it may be beneficial as a cofactor for numerous antioxidant enzymes, it also a redox-active transition metal, which catalyses the formation of free radicals and increased levels may contribute to oxidative stress status in PE. These data indicate that although women with PE show significantly higher copper, the caeruloplasmin activity is not significantly higher. It seems that during PE, the activity does not increase proportionally with the levels of copper and may indicate a dysfunction of the antioxidant enzyme. Work is underway to characterise copper-dependent antioxidant superoxide dismutase activity and markers of oxidative stress in these women. British Heart Foundation (Charity No. 225971).

Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements

Plasma concentrations of several trace elements and vitamins decrease because of the systemic inflammatory response. Thus, low values do not necessarily indicate deficiency. The magnitude of this effect on plasma micronutrient concentrations was investigated to provide guidance on the interpretation of routine clinical results. Between 2001 and 2011, the results (2217 blood samples from 1303 patients) of routine micronutrient screens (plasma zinc, copper, selenium, and vitamins A, B-6, C, and E) and all vitamin D results (4327 blood samples from 3677 patients) were extracted from the laboratory database. C-reactive protein concentrations were measured as a marker of the severity of inflammation and categorized into 6 groups; for each group, plasma micronutrient concentrations and percentage changes were calculated. Except for copper and vitamin E, all plasma micronutrient concentrations decreased with increasing severities of the acute inflammatory response. For selenium and vitamins B-6 and C, this occurred with only slightly increased C-reactive protein concentrations of 5 to 10 mg/L. For each micronutrient, the change in plasma concentrations varied markedly from patient to patient. The magnitude of the effect was greatest for selenium and vitamins A, B-6, C, and D, for which the median plasma concentrations decreased by >40%. The clinical interpretation of plasma micronutrients can be made only with knowledge of the degree of inflammatory response. A reliable clinical interpretation can be made only if the C-reactive protein is <20 mg/L (plasma zinc), <10 mg/L (plasma selenium and vitamins A and D), or <5 mg/L (vitamins B-6 and C).

Associations between plasma micronutrient concentrations and inflammatory cytokine levels among Mexican women with a high prevalence of obesity

Associations between plasma micronutrient concentrations and inflammatory cytokine levels among Mexican women with a high prevalence of obesity

Metabolic syndrome in the elderly living in marginal peri-urban communities in Quito, Ecuador.

The proportion of the Latin American population aged >60 years is expected to double during the next few decades. Metabolic syndrome (MetS) is associated with high morbidity and mortality worldwide. However, little is known about MetS in Latin America in general, and in Ecuador in particular. The present study aimed to examine the prevalence of MetS and its association with blood micronutrient, homocysteine (Hcy) and C-reactive protein (CRP) concentrations in the elderly living in a low-income urban area. We performed a cross-sectional study. MetS, using the International Diabetes Federation definition, dietary intake and plasma micronutrient, CRP and Hcy concentrations were assessed. A total of 352 elderly (≥65 years) Ecuadorians. Quito, Ecuador. MetS was prevalent (40%)--considerably more so among women (81%) than men (19%; χ² = 32·6, P < 0·0001). Further, 53 % of those without MetS exhibited two or more of its components. Micronutrient deficiencies were prevalent, including those of vitamin C, zinc, vitamin B₁₂ and folate. Vitamin C and E concentrations were inversely (OR = 0·78, 95% CI 0·71, 0·86; OR = 0·16, 95% CI 0·03, 0·81, respectively) and CRP (OR = 1·79, 95 % CI 1·04, 3·06) was positively associated with MetS. The coexistence of MetS with micronutrient deficiencies suggests that elderly Ecuadorians suffer from the double burden of diseases that are increasingly being observed in less developed countries. More research is needed to determine the causal factors, but results presented suggest that these older adults would benefit from interventions to reduce the risk factors for MetS, in particular higher consumption of micronutrient-rich foods.

Plasma carotenoids, retinol, and tocopherols and postmenopausal breast cancer risk in the Multiethnic Cohort Study: a nested case-control study

IntroductionAssessments by the handful of prospective studies of the association of serum antioxidants and breast cancer risk have yielded inconsistent results. This multiethnic nested case-control study sought to examine the association of plasma carotenoids, retinol, and tocopherols with postmenopausal breast cancer risk.MethodsFrom the biospecimen subcohort of the Multiethnic Cohort Study, 286 incident postmenopausal breast cancer cases were matched to 535 controls on age, sex, ethnicity, study location (Hawaii or California), smoking status, date/time of collection and hours of fasting. We measured prediagnostic circulating levels of individual carotenoids, retinol, and tocopherols. Conditional logistic regression was used to compute odds ratios and 95% confidence intervals.ResultsWomen with breast cancer tended to have lower levels of plasma carotenoids and tocopherols than matched controls, but the differences were not large or statistically significant and the trends were not monotonic. No association was seen with retinol. A sensitivity analysis excluding cases diagnosed within 1 year after blood draw did not alter the findings.ConclusionsThe lack of significant associations in this multiethnic population is consistent with previously observed results from less racially-diverse cohorts and serves as further evidence against a causal link between plasma micronutrient concentrations and postmenopausal breast cancer risk.

Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia

Background: Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children.Objective: We assessed the effect of micronutrients, long-chain n−3 fatty acids, or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children.Design: Two 2-by-2 factorial randomized controlled double-blind trials were performed home-based in Adelaide, South Australia, and at 6 primary schools in Jakarta, Indonesia. A total of 396 children (aged 6-10 y) in Australia and 384 children in Indonesia were randomly allocated to receive a drink with a micronutrient mix (iron, zinc, folate, and vitamins A, B-6, B-12, and C), with docosahexanoic acid (DHA,88 mg/d) and eicosapentaenoic acid (EPA, 22 mg/d), or with both or placebo 6 d/wk for 12 mo. Biochemical indicators were determined at baseline and 12 mo. Cognitive performance was measured at baseline, 6 mo, and 12 mo.Results: The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children. DHA+EPA treatment increased plasma DHA and total plasma n−3 fatty acids in both countries. The micronutrient treatment resulted in significant increases in scores on tests representing verbal learning and memory in Australia (estimated effect size: 0.23; 95% CI: 0.01, 0.46). A similar effect was observed among Indonesian girls (estimated effect size: 0.32; 95% CI: −0.01, 0.64). No effects were found on tests measuring general intelligence or attention. No effects of DHA+EPA on the factors of cognitive tests were observed.Conclusion: In well-nourished school-aged children, fortification with multiple micronutrients can result in improvements in verbal learning and memory.

Relation between prenatal lipid-soluble micronutrient status, environmental pollutant exposure, and birth outcomes

Background:Adverse postnatal health effects have been associated with compromised fetal growth, which makes it essential to understand its determinants. Significant effects of environmental pollutants on birth outcomes have been observed in our study population, and nutritional status may be an additional factor influencing fetal development and effects of environmental toxins.Objective:The objective of the study was to examine the relations between birth outcomes and lipid-soluble plasma micronutrient concentrations and to explore interactions between micronutrients and environmental pollutant exposure in newborns in Krakow, Poland.Design:In this prospective cohort study, retinol, α-tocopherol, and carotenoids were measured in maternal and cord blood samples obtained at delivery (251 maternal-newborn pairs), and birth weight, birth length, head circumference (HC), and gestational age were evaluated. Linear regression analysis was used to estimate the effects of micronutrients while covariates were controlled for. Interaction terms assessed whether the effects of polycyclic aromatic hydrocarbons (PAHs), common environmental pollutants, varied by nutrient status.Results:Infants whose mothers had low plasma α-tocopherol concentrations (below the median) weighed 92.9 g less and had 0.41-cm smaller HCs than did infants whose mothers had high α-tocopherol concentrations. Infants with low plasma retinol (below the median) weighed 125.9 g less and had 0.31-cm smaller HCs. There was no evidence of an interaction between PAHs and micronutrients, although power was limited.Conclusion:Maternal α-tocopherol and cord retinol concentrations were significantly and positively associated with BW and HC. These micronutrients may have direct effects or may be markers for other underlying determinants of these pregnancy outcomes.

Update on clinical micronutrient supplementation studies in the critically ill

During the past 2 years a number of studies, meta-analyses and reviews have shown that micronutrient supplementation may be beneficial in critical illness. Selenium is emerging as a particularly important micronutrient. This paper reviews the evidence from trials in the critically ill, putting mechanisms, methods and shortcomings into perspective. There is growing evidence that antioxidant supplements, particularly high-dose selenium, may reduce mortality, infectious complications, and improve wound healing. Deleterious effects may result from prolonged high doses, whereas short-term high dose supplements are probably safe in most critically ill populations. Plasma micronutrient concentrations are low during critical illness, as a result of losses, low intakes and dilution, and redistribution from plasma to tissues. An assessment of status is difficult. Micronutrient supplements appear beneficial in conditions such as major burns, trauma and sepsis and stroke, and are most likely to benefit patients with previous or actual depletion. The intravenous route seems more efficient than the enteral. Although chronic high intakes may be harmful, short-term interventions appear to be free of deleterious effects. Further research is required to determine the optimal micronutrient combinations and the doses required according to the timing of intervention and severity of disease.

Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi.

BackgroundWasting and micronutrient malnutrition have not been well characterized in adults with pulmonary tuberculosis. We hypothesized that micronutrient malnutrition is associated with wasting and higher plasma human immunodeficiency virus (HIV) load in adults with pulmonary tuberculosis.MethodsIn a cross-sectional study involving 579 HIV-positive and 222 HIV-negative adults with pulmonary tuberculosis in Zomba, Malawi, anthropometry, plasma HIV load and plasma micronutrient concentrations (retinol, α-tocopherol, carotenoids, zinc, and selenium) were measured. The risk of micronutrient deficiencies was examined at different severity levels of wasting.ResultsBody mass index (BMI), plasma retinol, carotenoid and selenium concentrations significantly decreased by increasing tertile of plasma HIV load. There were no significant differences in plasma micronutrient concentrations between HIV-negative individuals and HIV-positive individuals who were in the lowest tertile of plasma HIV load. Plasma vitamin A concentrations <0.70 μmol/L occurred in 61%, and zinc and selenium deficiency occurred in 85% and 87% respectively. Wasting, defined as BMI<18.5 was present in 59% of study participants and was independently associated with a higher risk of low carotenoids, and vitamin A and selenium deficiency. Severe wasting, defined as BMI<16.0 showed the strongest associations with deficiencies in vitamin A, selenium and plasma carotenoids.ConclusionsThese data demonstrate that wasting and higher HIV load in pulmonary tuberculosis are associated with micronutrient malnutrition.

Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia

Chemotherapy leads to an increase in reactive oxygen species, which stresses the antioxidant defense system. Children with acute lymphoblastic leukemia rarely are overtly malnourished, which makes this population ideal for an investigation of the relations between dietary antioxidant consumption, plasma antioxidant concentrations, and chemotherapy-induced toxicity. This study was conducted to investigate the effect of therapy on antioxidant intakes in children with acute lymphoblastic leukemia, the relation between dietary antioxidant intakes and plasma antioxidant concentrations, and the relation between the incidence of side effects due to treatment and antioxidant intake. We conducted a 6-mo observational study of 103 children with acute lymphoblastic leukemia. Plasma micronutrient concentrations, dietary intakes, and incidence of side effects of chemotherapy were ascertained at diagnosis and after 3 and 6 mo of therapy. Throughout the 6-mo study period, subjects ingested vitamin E, total carotenoid, beta-carotene, and vitamin A in amounts that were 66%, 30%, 59%, and 29%, respectively, of the US recommended dietary allowance or of the amounts specified in the third National Health and Nutrition Examination Survey. Greater vitamin C intakes at 6 mo were associated with fewer therapy delays, less toxicity, and fewer days spent in the hospital. Greater vitamin E intakes at 3 mo were associated with a lower incidence of infection. Greater beta-carotene intakes at 6 mo were associated with a decreased risk of toxicity. A large percentage of children undergoing treatment for acute lymphoblastic leukemia have inadequate intakes of antioxidants and vitamin A. Lower intakes of antioxidants are associated with increases in the adverse side effects of chemotherapy.