Routine Vitamin Supplementation Research Articles

Intracranial hemorrhage due to late hemorrhagic disease in two siblings

Deficiency of vitamin K predisposes to early, classic or late hemorrhagic disease of the newborn (HDN); late HDN may be associated with serious and life-threatening intracranial hemorrhage. Late HDN is characterized by intracranial bleeding in infants aged 1 week to 6 months due to severe vitamin K deficiency, occurring particularly in exclusively breastfed infants. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. In this study, we report on two siblings with intracranial bleeding who were fully breastfed without a routine supplementation of vitamin K. Vitamin K should be given to all newborns as a single, intramuscular dose of 1 mg.

Folic acid-based multivitamin therapy to prevent stroke: the jury is still out.

There is a large body of observational and laboratory evidence suggesting but not proving that increasing plasma concentrations of total homocysteine (tHcy) is a causal risk factor for atherothromboembolic ischemic stroke and other vascular events.1–9 Recent publication of the results of the landmark Vitamins in Stroke Prevention (VISP) Trial is the first evidence from a large randomized controlled trial (RCT) of the effect of lowering tHcy via folic acid–based multiple B vitamin supplementation on the incidence of “hard” clinical events, such as recurrent stroke, in patients with recent ischemic stroke.10,11 In contrast to what was expected from the epidemiological evidence, the VISP Trial did not identify a significant treatment effect of lowering tHcy by vitamin therapy on recurrent stroke, coronary events, or death, despite confirming a consistent and graded association between baseline tHcy and vascular risk (particularly the probability of stroke over time).11 Recruiting primarily from North America, VISP enrolled 3680 recent (3 to 120 days) survivors of nondisabling, noncardiogenic, ischemic stroke with baseline tHcy above the 25th percentile of the North American stroke population into a double-blind, randomized comparison of high versus low doses of a combination of 12 different vitamins, including folic acid, vitamin B12, vitamin B6, and riboflavin, which are cofactors for enzymes responsible for metabolizing homocysteine.11 After 2 years of follow-up, there was no significant difference in the cumulative incidence of the primary outcome event of recurrent cerebral infarction: 8.4% of 1814 patients who were allocated to high-dose multivitamins [including 2.5 mg of folic acid, 0.4 mg of vitamin B12, and 25 mg of vitamin B6] versus 8.1% of 1835 patients allocated to low-dose multivitamins [including 0.02 mg of folic acid, 0.006 mg of vitamin B12, 0.2 mg of vitamin B6 …

Routine vitamin supplements for pregnancy

Midwives have a role in promoting healthy eating during pregnancy, particularly as pregnant women are faced with constant media messages about a healthy diet. However, health education information about nutrition may be misinterpreted or not fully understood. Many women choose to use routine vitamin supplementation in pregnancy to ensure an adequate nutritional intake. A variety of products are available as over-the-counter preparations. This article gives midwives the opportunity to familiarise themselves with some of the commonly available products, and to consider the advice and information for pregnant women in relation to their diet and vitamin supplements.

Routine vitamin supplementation to prevent cardiovascular disease: a summary of the evidence for the U.S. preventive services task force

This systematic review evaluates the evidence that routine vitamin supplementation reduces the risk for cancer and cardiovascular disease.

Routine vitamin supplementation to prevent cardiovascular disease: a summary of the evidence for the U.S. Preventive Services Task Force.

Antioxidant vitamins are thought to play a role in atherosclerosis. Supplementation of these nutrients has been explored as a means of reducing cardiovascular morbidity and mortality. To assess the evidence of the effectiveness of vitamin supplementation, specifically vitamins A, C, and E; beta-carotene; folic acid; antioxidant combinations; and multivitamin supplements, in preventing cardiovascular disease. Cochrane Controlled Trials Registry and MEDLINE (1966 to September 2001), reference lists, and experts. The researchers selected English-language reports of randomized trials and cohort studies that assessed vitamin supplementation in western populations and reported incidence of or death from cardiovascular events. They also included reports of good- or fair-quality clinical trials of primary and secondary prevention and good- or fair-quality prospective cohort studies. Studies that examined only dietary nutrients or did not provide separate estimates for supplements were not included. Two reviewers abstracted descriptive information and data on cardiovascular outcomes and mortality from included studies. The researchers assessed study quality using predetermined criteria. Evidence tables were constructed to summarize data from included studies. The researchers summarized the strength, level, and quality of the overall evidence for the effectiveness of each of the vitamin supplements in preventing or treating cardiovascular disease. Some good-quality cohort studies have reported an association between the use of vitamin supplements and lower risk for cardiovascular disease. Randomized, controlled trials of specific supplements, however, have failed to demonstrate a consistent or significant effect of any single vitamin or combination of vitamins on incidence of or death from cardiovascular disease. Understanding the sources of these differences will permit researchers to better analyze the cohort study data and to better design long-term clinical trials.

Assessment of vitamin K deficiency in CF—how much sophistication is useful?

Background: Due to maldigestion of dietary lipids, fat soluble vitamins are prone to malabsorption in cystic fibrosis (CF) patients with pancreatic insufficiency (PICF). Routine supplementation of vitamin K 1 in PICF is presently subject of discussion. Methods: Serum vitamin K, prothrombin time, PIVKA-II (‘liver marker’, by two different ELISAs), hydroxyapatite binding capacity (HBC, ‘bone marker’) and ApoE genotypes were measured in 32 PICF patients (age: 7 months to 25 years) with (PICFK) or without (PICFN) oral vitamin K 1 supplementation, all receiving lipase supplementation, and in 18 healthy controls (C). Results: PIVKA-II was positive only in 4/7 PICFN. HBC medians of all groups were 57–60%. HBC values of PIVKA-II positive patients were below HBC median of their group. There was no correlation between HBC and PIVKA-II. There was no correlation between prothrombin time and other measurements. HBC medians with regard to ApoE were ApoE2/3 (62.9%)>ApoE3/3 (57.6%)>ApoE3/4+ApoE4/4=(56.65%). Conclusions: Vitamin K deficiency of liver or bone may occur independently. Prothrombin time is an insensitive marker. Individuals with ApoE4 allels might be more susceptible to osteopenia. As high expenditures are necessary to detect patients at risk, routine vitamin K supplementation for all PICF patients appears appropriate.

A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit.

Wernicke-Korsakoff syndrome and peripheral neuropathy are very uncommon in bariatric surgical practice. The literature indicates that these complications tend to strike patients receiving unbalanced diets or undergoing rapid weight-loss. In a retrospective analysis of the initial experience of a bariatric team in the city of Belem, Pará, in northern Brazil, 5 cases were diagnosed in the first year, 4 of them following gastric bypass and the last one after therapy with an intragastric balloon. All episodes followed periods of severe vomiting, which certainly interfered with intake of food as well as of routine vitamin supplements, resulting in severe polyneuropathy and other neurologic manifestions, mostly damaging motility of lower limbs. Therapy consisted of pharmacologic doses of vitamin B1 along with restoration of adequate diet and multivitamin prescriptions. Physical therapy was employed to prevent atrophy and accelerate normalization of muscle strength. All patients responded to this program after variable intervals without significant sequelae. Thiamine-related neurologic derangements were a cause for much concern and prolonged morbidity in this series, but responded to vitamin B1 replenishment. A high degree of clinical suspicion in bariatric patients and urgent therapeutic intervention whenever postoperative vomiting persists for several days, especially during the first 2-3 months after operation, are the safest approach to these uncommon episodes. It is speculated whether peculiarities in the regional diet of this area in Brazil could have influenced the high incidence of the neurologic aberrations.

Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial

Background: Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies. Objectives: To determine the effect on patient throughput of a policy of routine vitamin supplementation, and of early routine sipfeed supplementation in ‘thin’ patients (5–10% weight loss or body mass index 18–22). Design: Factorial randomized placebo controlled trial of oral multivitamins from the first day of admission, and, after nutritional screening, of a nutritionally complete sipfeed from the second day in ‘thin’ patients. Setting: Acute medical, surgical and orthopaedic hospital services of a London teaching hospital.Participants: 1561 patients admitted as emergencies were included in the vitamin study of which 549 were included in the sipfeed study. Main Outcome Measure: Length of hospital stay (LOS).Results: Offering multivitamins to acute admissions resulted in a mean change (reduction) in LOS of −0.4 days 95% CI (−2–1.2days). The results suggest greater reductions for those discharged after 10 days: mean change=−2.3 days 95% CI (−5.7 to 1.2). Sipfeed supplementation was associated with an increased mean length of stay 2.8 days 95% CI (−0.8–6.3). 18% of acute admissions were classified undernourished on the basis of BMI, MUAC or percent weight loss combined.Conclusions: No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded. Vitamin supplementation may have slight but economically important benefit.

Late hemorrhagic disease of the newborn.

Late hemorrhagic disease of the newborn (HDN) may occur without an underlying disorder or as a secondary manifestation of an underlying disorder. It may be seen in fully breast-fed infants without a routine supplementation of vitamin K. In contrast, idiopathic late HDN is defined as HDN without the presence of any risk factor, such as gastroenteritis or use of antibiotics. Severe hemorrhagic symptoms frequently occur. Between March 1987 and May 1997, we evaluated 15 infants with idiopathic late HDN, who were diagnosed by detailed history, physical examination and laboratory findings. The age (mean +/- SD) at onset of symptoms was 62.4 +/- 33.9 days. All children were breast-fed infants and were born at term from healthy mothers. The delivery histories were uneventful. There was no history of vitamin K administration at birth. Signs and symptoms of the patients were convulsions (47%), feeding intolerance and poor sucking (47%), irritability (33%) and pallor (20%). In physical examination; there was bulging or full fontanel in 10 patients (67%), diminished or absent neonatal reflexes in nine patients (60%) and ecchymosis in three patients (20%). Before administration of vitamin K, prothrombin time (PT) was 76.1 +/- 43.0 s and partial thromboplastin time (PTT) was 123.4 +/- 68.8 s. Six to 12 h after administration of vitamin K, PT was 15.6 +/- 1.8 s and PTT was 33.4 +/- 1.0 s. Neurologic, gastrointestinal and skin hemorrhagic findings were found in 11 (73%), three (20%) and three patients (20%), respectively. There were both neurologic and skin bleeding symptoms in two patients. The mortality in the present study was 33%. Late HDN results in severe hemorrhage, especially hemorrhage in the central nervous system. Administration of vitamin K (1 mg, i.m.) at the birth can reduce these severe complications.

Clinical surveillance of gynecologic cancer patients

A survey of gynecologic oncologists was used to determine the optimum follow-up plan for asymptomatic, disease-free patients previously treated for a gynecologic malignancy. Ninety-four (91%) of 103 questionnaires were completed and returned. The majority of respondents recommended a clinic visit for these patients every 3 months for the first year after the completion of therapy, every 3 or 4 months for the second year, every 6 months for the following 3 years, and then annually after this initial 5-year period. Breast, abdominal, lymph node, and pelvic examinations, as well as a pap smear and stool guaiac, were done at each of these clinic visits. A yearly chest X ray was performed by the majority of the survey respondents for the first 3 years following initial treatment. Determinations of serum CA-125 and ovarian germ cell tumor markers were done at each follow-up appointment during the first 5 years after therapy if they were previously elevated. The patients' smoking habits were discussed with them by the majority of respondents. Mammograms were performed periodically before age 50 and then yearly after age 50 by most respondents. Serum cholesterol determinations were accomplished every 5 years or more frequently if indicated. Calcium supplementation was recommended for postmenopausal patients. The majority of respondents did not recommend routine vitamin supplementation or surveillance sigmoidoscopy.

DARK-ADAPTATION TESTING FOR DIAGNOSIS OF SUBCLINICAL VITAMIN-A DEFICIENCY AND EVALUATION OF THERAPY

Thirteen patients with chronic small-intestinal disease without overt evidence of nutritional deficit were found to have abnormal dark-adaptation tests. Ten patients were receiving 3500 to 10,000 units of vitamin A daily in oral multivitamin preparations. Dark adaptation did not change in five patients after a week of oral vitamin-A therapy (25,000 units per day). Normal dark adaptation was restored in two of four patients after a single dose of parenteral vitamin A (50,000 units) and in five of seven patients after 30 days of oral therapy (50,000 units per day). The high frequency of subclinical vitamin-A deficiency found in this group suggests that occult nutritional deficiency may be more prevalent in patients with intestinal disease than is commonly appreciated. Routine vitamin supplementation cannot be relied upon to prevent the functional deficit demonstrated in this study.

Effects of routine vitamin supplementation in the aged.

Abstract: A study was made in a nursing home of the effects of multivitamin therapy on appetite and weight (during periods varying from sixty to one hundred and ten days) in 59 patients (18 males and 41 females), of whom 55 were over 65 years of age. None of them manifested symptoms of vitamin deficiency.Approximately half of the patients responded with an increase in weight, and approximately half with an increase in appetite. An increase in appetite was more common in cases of appetite deficiency. When there was an improvement in appetite (and help for feeding was available), a gain in weight usually occurred. When there was no increase in appetite, there was little gain in weight unless the appetite was good before vitamin administration. Attention to feeding procedures apparently was a factor in producing some of the weight gain.There is no reliable method for predicting the outcome of multivitamin therapy when the indications for such treatment are not specific deficiency states.