Recommendations For Supplementation Research Articles

Evidence‐Based Recommendations for Dietary Supplementation During Pregnancy: Is It Time for a Product Recall?

ABSTRACTBackgroundMicronutrient deficiencies in pregnant women are linked to serious health issues, including conception difficulties, spontaneous abortions, preterm births, low birth weight, birth defects and long‐term metabolic disorders. Despite the recognized importance of dietary supplementation during pregnancy, rigorous research and supplementation monitoring remain limited.ObjectiveThis study aimed to review the evidence on the impact of dietary supplementation on maternal and infant outcomes and to provide evidence‐based recommendations for dietary supplementation during pregnancy.MethodsA systematic search, analysis, and synthesis of randomized controlled trials (RCTs) were conducted between October and January 2022. Databases searched included PubMed, CINAHL with Full Text, Google Scholar and CrossRef. The study adhered to PRISMA guidelines and applied inclusion and exclusion criteria to identify relevant studies. A total of 51 RCTs were included and assessed for quality, categorizing articles as moderate or high quality.ResultsOf the 51 RCTs analyzed, 47 (92.16%) were of moderate quality, and 4 (7.84%) were of high quality. Findings revealed that recommended dietary supplementation doses for pregnant women are often set well below safety thresholds. Evidence supporting the efficacy of certain vitamins and minerals in pregnancy remains inconclusive. The study highlighted a dose–response conundrum, with an emphasis on identifying effective and safe doses.ConclusionMicronutrient deficiencies in pregnant women pose significant risks to maternal and infant health. Current dietary supplementation recommendations require enhancement and alignment with the latest and most robust evidence. This study provides a comprehensive overview of state‐of‐the‐art evidence and underscores the importance of bridging gaps in supplementation guidelines to optimize maternal and infant health outcomes.

Preconceptional and Periconceptional Folic Acid Supplementation in the Visegrad Group Countries for the Prevention of Neural Tube Defects.

Neural tube defects (NTDs) are malformations of the central nervous system that represent the second most common cause of congenital morbidity and mortality, following cardiovascular abnormalities. Maternal nutrition, particularly folic acid, a B vitamin, is crucial in the etiology of NTDs. FA plays a key role in DNA methylation, synthesis, and repair, acting as a cofactor in one-carbon transfer reactions essential for neural tube development. Randomized trials have shown that FA supplementation during preconceptional and periconceptional periods reduces the incidence of NTDs by nearly 80%. Consequently, it is recommended that all women of reproductive age take 400 µg of FA daily. Many countries have introduced FA fortification of staple foods to prevent NTDs, addressing the high rate of unplanned pregnancies. These policies have increased FA intake and decreased NTD incidence. Although the precise mechanisms by which FA protects against NTDs remain unclear, compelling evidence supports its efficacy in preventing most NTDs, leading to national recommendations for FA supplementation in women. This review focuses on preconceptional and periconceptional FA supplementation in the female population of the Visegrad Group countries (Slovakia, Czech Republic, Poland, and Hungary). Our findings emphasize the need for a comprehensive approach to NTDs, including FA supplementation programs, tailored counseling, and effective national-level policies.

A Systematic Review of Isotopically Measured Iron Absorption in Infants and Children Under 2 Years.

Iron is an essential element for critical biological functions, with iron deficiency negatively affecting growth and brain development and iron excess associated with adverse effects. The goal of this review is to provide a comprehensive assessment of up-to-date evidence on iron absorption measured isotopically in children, preterm infants, and full-term infants, up to 24 months of age. Search databases included Pubmed, Cochrane, Web of Science, and Scopus from a date range of 1 January 1953 to 22 July 2024. The included articles were experimental studies with iron absorption outcomes measured by isotopic techniques. The risk of bias was assessed using the Cochrane Risk of Bias Tool. A total of 1594 records were identified from databases, and 37 studies were included in the quality review with a total of 1531 participants. Article results were grouped by study commonality: absorption and red blood cell incorporation, type of milk feedings, additives to improve absorption, how and when to supplement with iron, and iron forms and complimentary foods. The results from this review support the current recommendations of oral iron supplementation. Iron from breast milk has high bioavailability, and unmodified cow's milk reduces iron absorption. Supplemental iron is required at 4-6 months for healthy, full-term infants and sooner for preterm infants. Ascorbic acid increases iron absorption in full-term infants and children. Lactoferrin and prebiotics are promising candidates for enhancing iron absorption, but they require further investigation. Research evidence of iron absorption mechanisms and modulating factors in preterm infants is limited and should be a research priority.

Nutrition, hydration and supplementation considerations for mountaineers in high-altitude conditions: a narrative review.

Staying and climbing in high mountains (>2,500 m) involves changes in diet due to poor access to fresh food, lack of appetite, food poisoning, environmental conditions and physiological changes. The purpose of this review is to summarize the current knowledge on the principles of nutrition, hydration and supplementation in high-altitude conditions and to propose practical recommendations/solutions based on scientific literature data. Databases such as Pubmed, Scopus, ScienceDirect and Google Scholar were searched to find studies published from 2000 to 2023 considering articles that were randomized, double-blind, placebo-controlled trials, narrative review articles, systematic reviews and meta-analyses. The manuscript provides recommendations for energy supply, dietary macronutrients and micronutrients, hydration, as well as supplementation recommendations and practical tips for mountaineers. In view of the difficulties of being in high mountains and practicing alpine climbing, as described in the review, it is important to increase athletes' awareness of nutrition and supplementation in order to improve well-being, physical performance and increase the chance of achieving a mountain goal, and to provide the appropriate dietary care necessary to educate mountaineers and personalize recommendations to the needs of the individual.

Adolescent boys and protein: a first cut at developing environmentally sustainable foodbased dietary guidelines

Male adolescence (10–19 years), is a critical life-stage for adequate nutrition due to the rapid growth and development that occurs during this period. Additionally, this population sub-group may begin to engage in muscle-building exercises due to socially established body image ideals(1), which fuel their desire to increase protein consumption. Currently, Irish diets are not sustainable, and exceed all planetary boundaries apart from freshwater use(2). Thus, there is a need to incorporate sustainability into Ireland’s food-based dietary guidelines (FBDG). The aim of this study was to develop FBDG for adolescent males to meet their nutritional needs more sustainably, whilst exploring protein intakes.Commonly consumed foods (≥10% of consumers) and patterns of consumption were identified from secondary analysis of the National Children’s Food Survey II and the National Teens’ Food Survey II(3). Using the Henry equation(4), energy requirements were calculated, informed by actual height and weight data. Following the food consumption patterns and using foods commonly eaten, four-day omnivore meal patterns (including one lacto-ovo-vegetarian day) were developed within energy requirements for males at nine age-points (9y, 10y, 11y, 12y, 13y, 14y, 15y, 16y, 17–18y), covering five UK90 growth percentiles (5th, 25th, 50th, 75th, 95th), and four physical activity levels (PAL) (1.4, 1.6, 1.8, 2.0). To improve environmental sustainability, diet modelling reduced current FBDG recommendations on meat and dairy for adolescent males. The nutritional composition of modelled meal patterns was assessed using Nutritics software. Nutritional intakes provided by diet modelling were compared with macronutrient and 13 key micronutrient intake goals. The protein digestibility-corrected amino acid score (PDCAAS) was used to record the proportion of highquality protein foods contributing to protein intake.A total of 180 four-day meal patterns were developed in the diet modelling process, which included vitamin D supplementation. Regardless of variations in energy requirements due to body size and PAL, modelled diets met all macronutrient and micronutrient goals (exceeding target intake levels for calcium, Dietary Folate Equivalents, and vitamin C). Inadequate modelled vitamin D provided from foods only (median 4.8µg/day; range 9–11 years 1.7-6.5µg/day; range 12–18 years 1.814.0µg/day) were resolved by existing 10–15µg supplement recommendations(5). Protein intakes (g/kg body weight) were 316% above recommendations, despite the reduction of red meat and dairy in modelled meal patterns. Examination of foods in modelled meal patterns showed that 49– 76% of protein food sources were high-quality (PDCAAS ≥60), and 48–76% of calcium food sources were bioavailable dairy products.In conclusion, FBDG for male adolescents in Ireland have been developed considering environmental sustainability, whilst keeping nutritional requirements at the forefront. This study shows lower dairy and red meat intakes than currently recommended, combined with extra lactoovo-vegetarian days, provide adolescent males with nutritionally adequate, high protein (quality and quantity) diets.

Assessing Dietary Supplements, Nutritional Deficiencies, and the Potential of Personalized Nutrition

The COVID-19 pandemic has heightened public awareness of health, leading to a surge in the consumption of dietary supplements, particularly vitamins and minerals. These micronutrients are vital for numerous physiological processes and overall health maintenance. However, the rapid expansion of the health product market has also resulted in the proliferation of substandard items and the risk of misuse or overconsumption. This study analyzes the ingredients in various health products and assesses the nutritional deficiencies prevalent in local populations. It emphasizes the importance of balanced nutrition while cautioning against the excessive intake of certain supplements. The research also explores the potential of personalized nutrition, driven by advances in genomics and biotechnology, to provide tailored supplement recommendations. Additionally, the study highlights the need for stricter regulations and improved quality control in the health product industry to ensure consumer safety and confidence. By offering insights into the nutritional needs of individuals, this study aims to guide informed and responsible supplement use.

Clinical guidelines for the management of mammographic density: a systematic review of breast screening guidelines worldwide.

High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts. A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument). Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended. Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.

Folate and cobalamin status, indicators, modulators, interactions, and reference ranges from early pregnancy until birth: the Reus–Tarragona birth cohort study

BackgroundFolate and cobalamin status, although essential for pregnancy, are not routinely monitored in prenatal care. ObjectivesTo investigate folate and cobalamin status and determinants throughout pregnancy, in the absence of mandatory folic acid (FA) fortification. MethodsIn a cohort study of 831 mothers recruited at <12 gestational weeks (GW), plasma folate, total homocysteine (tHcy), cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), red blood cell folate (RBCF), and the combined cobalamin status indicator (cB12) were determined at ≤12, 15, 24–27, 34 GW, labor and in the cord. Single nucleotide polymorphisms affecting folate and cobalamin status were determined. FA, cobalamin, micronutrient supplement use, and dietary folate and cobalamin intake (food frequency questionnaire) were recorded. Folate and cobalamin status predictors were assessed by multiple linear regression analysis. ResultsOnly 36.1% of the participants took FA preconceptionally and 47.4% and 7.3% had suboptimal RBCF (<906 nmol/L) and plasma cobalamin status (≤221 pmol/L), respectively, at ≤12 GW. RBCF determinants included planned pregnancy, FA supplementation, plasma cobalamin, and methylenetetrahydrofolate (MTHFR) 677C>T genotype. Cobalamin supplementation was positively associated with plasma cobalamin and early holoTC. Smoking and BMI were inversely associated with plasma cobalamin and early holoTC, but none were associated with MMA. Only participants with the MTHFR 677TT genotype, exceeding FA supplement recommendations, improved their folate status (interaction term: B (95% CI):0.15 (0.01, 0.29), P = 0.032). Smoking was inversely associated with plasma cobalamin status in participants with the methionine synthase reductase (MTRR) 524CC genotype only (interaction term:0.07 (0.01, 0.04), P = 0.014). Mothers with low early pregnancy cobalamin status and also those with bigger newborns, had lower cobalamin status at labor. ConclusionsSuboptimal early pregnancy folate or cobalamin status affected 47.4% and 7.3% of the participants, respectively. The MTHFR 677TT genotype predicted folate status throughout pregnancy. Smoking and BMI were negatively associated with cobalamin status throughout pregnancy.Clinical Trial Registry number and website where it was obtained: NCT01778205. www.clinicaltrials.gov

Expert Perspectives on Prescription Practices and Management Strategies for Neuropathy and Vitamin B12 Deficiency in Indian Settings

Objective: To gather expert opinion regarding prescription practices and management strategies for neuropathy and vitamin B12 deficiency with a special focus on methylcobalamin among clinicians in Indian settings. Methodology: This cross-sectional study utilized a 24-item, multiple-response questionnaire to gather expert opinion from specialists in managing neuropathy and vitamin B12 deficiency. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to managing neuropathy and vitamin B12 deficiency in patients in routine settings. Results: The survey included 81 experts, with more than half (62.96%) of clinicians identifying diabetes as a significant confounding factor for neuropathy in patients. As indicated by 46% and 44% of the clinicians, an appropriate diet for nutrition and maintaining glycemic levels helps to overcome the progression of neuropathy. A significant proportion of experts (60.49%) reported that 26% to 50% of patients with neuropathy have vitamin B12 deficiency. Additionally, 73% of clinicians noted that diabetes mellitus is a common co-morbid condition with vitamin B12 deficiency. In patients with neuropathy complications, 74% of clinicians preferred benfotiamine alongside vitamin B12. As stated by 44% of clinicians, besides those patients with neuropathy, elderly patients are also recommended with methylcobalamin 1500 mcg. About 43% of clinicians suggested a 12-week duration for prescribing a combination of benfotiamine and methylcobalamin for patients with neuropathy. Additionally, more than half (54.32%) of clinicians favored prescribing a combination of methylcobalamin 1500 mcg, pregabalin 75 mg, and nortriptyline 10 mg tablets to patients with chronic neuropathic pain. Conclusion: The survey highlights diabetes as a significant factor in neuropathy management, emphasizing the importance of nutrition and glycemic control. A high prevalence of vitamin B12 deficiency is noted among diabetic patients with neuropathy, leading to recommendations for benfotiamine and methylcobalamin supplementation. Additionally, the use of combination therapy for chronic neuropathic pain demonstrates a comprehensive approach to improving patient outcomes.

ROLE OF INDIVIDUAL MICROELEMENTS AND VITAMINS IN HASHIMOTO'S DISEASE

Introduction and objective. Hashimoto's disease is a chronic autoimmune thyroiditis. The chronic process of this disease leads to hypothyroidism. Various micronutrients and vitamins play an important role in the course of the disease and may have a significant impact on the development and treatment of Hashimoto's disease. The aim of this study is to review the literature to fully assess the impact of micronutrients on symptoms, prognosis and dynamics of change in the context of Hashimoto's disease. Articles were searched by entering keywords in PubMed databases. Scientific articles covering the period from 2016 to 2024 represent 76% of the items included in the literature. Studies from specialized research centers including meta-analyses, double-blinded randomized trials, large cross-sectional studies were considered. Studies from inexperienced centers with methodological flaws were discarded. Abbreviated description of the state of knowledge. Current treatment of clinically overt hypothyroidism is based on the use of levothyroxine. The dose of substitution treatment is determined individually for the patient depending on the symptoms observed, TSH values and age. Currently, there are no recommendations for supplementation of microelements for the disease, which is due to the need to expand research and determine which micronutrients are worth taking to increase the quality of life of patients. Conclusion. The number of cases of Hashimoto's disease is steadily increasing worldwide. Increasing attention is being paid to elements of the patient's diet and environment, in addition to the substitution treatment itself. The modification of a broadly defined lifestyle and the influence of environmental factors may in the near future find a place in the standard therapeutic management of patients with chronic autoimmune thyroiditis.

28 Integrating homeostasis in practical mineral supplementation recommendations

Abstract A long-established objective in ruminant nutrition is an accurate supply of the 4 main trace metal nutrients Zn, Cu, Mn, and Fe, respecting bioavailability, nutritional interactions, and nutrient tolerance. Although, current dietary supplementation practices, justified by the multiple uncertainties of trace metal supply, results in dietary levels that widely exceed nutritional guidelines. Additionally, reference feeding recommendations are defined assuming fixed and highly conservative uptake coefficients, an approach that disregards the opportunity, and limitations, of absorptive regulation, the main homeostatic mechanism of these nutrients. Mitigating deficiency risks by generous supplementation can result in a generally overlooked risk, exceeding tolerable trace metal availability. Complete nutrient balance studies have recently described the overwhelming homeostatic downregulation of trace metals at dietary levels that are not uncommon in practice. This finding calls for a novel approach to define supplementation that resolves this conundrum of trace metal adequacy. This approach integrated 3 elements: a stochastic analysis of native dietary supply; a stochastic analysis of net nutrient requirements; and the identification of the upper and lower boundaries of homeostatic regulation for these 4 nutrients in the bovine species. This last, aims to resolve the main limitation of current dietary guidelines, using the potential maximum uptake rates in homeostatic upregulation, and the minimum uptake rates achievable by downregulation, instead of assuming fixed uptake rates. As result, this approach delivers dietary supply ranges of adequate supply, instead of a minimum dietary level to meet dietary adequacy. The probability distribution of nutrient supply was determined by dry-matter intake variability, diversity in dietary composition, and variability of nutrient occurrence in feedstuffs. The probability distribution of net nutrient requirements was defined by the variability of the components of a classic factorial requirement approach applied to different animal conditions. A maximum apparent absorption efficiency was determined to define lower supply boundaries using published datasets. Upper boundaries were defined as the dietary supply level beyond which apparent absorption empirically has shown to exceed net requirements. As expected, this risk-based approach resulted in much lower supplementation recommendations than current reference models. However, it supports the value of preventive supplementation of Zn and Cu to growing and lactating animals, and Cu to non-lactating non-growing cows. This assessment also indicates merit in Mn supplementation to growing bovines. Furthermore, it confirms that under all circumstances native dietary Fe meets nutritional needs, but it also illustrates a tolerance risk to native Fe supply under multiple productive scenarios. Most interestingly, this analysis illustrates the risk of exceeding trace metal tolerance boundaries with common levels of supplementation under common conditions. This approach offers a novel perspective to trace metal supplementation, pointing at an opportunity to improve nutritional adequacy by reconsidering supplementation practices.

Breast Density Status Changes: Frequency, Sequence, and Practice Implications.

Changes in a patient's reported breast density status (dense vs nondense) trigger modifications in their cancer risk profile and supplemental screening recommendations. This study tracked the frequency and longitudinal sequence of breast density status changes among patients who received serial mammograms. This IRB-approved, HIPAA-compliant retrospective cohort study tracked breast density changes among patients who received at least 2 mammograms over an 8-year study period. BI-RADS density assessment categories A through D, visually determined at the time of screening, were abstracted from electronic medical records and dichotomized into either nondense (categories A or B) or dense (categories C or D) status. A sequence analysis of longitudinal changes in density status was performed using Microsoft SQL. A total of 58 895 patients underwent 231 997 screening mammograms. Most patients maintained the same BI-RADS density category A through D (87.35% [51 444/58 895]) and density status (93.35% [54 978/58 859]) throughout the study period. Among patients whose density status changed, the majority (97% [3800/3917]) had either scattered or heterogeneously dense tissue, and over half (57% [2235/3917]) alternated between dense and nondense status multiple times. Our results suggest that many cases of density status change may be attributable to intra- and interradiologist variability rather than to true underlying changes in density. These results lend support to consideration of automated density assessment because breast density status changes can significantly impact cancer risk assessment and supplemental screening recommendations.

Maternal Docosahexaenoic Acid Supplementation Alters Maternal and Fetal Docosahexaenoic Acid Status and Placenta Phospholipids in Pregnancies Complicated by High Body Mass Index.

An optimal fetal supply of docosahexaenoic acid (DHA) is critical for normal brain development. The relationship between maternal DHA intake and DHA delivery to the fetus is complex and is dependent on placental handling of DHA. Little data exist on placental DHA levels in pregnancies supplemented with the recommended dose of 200 mg/d. Our objective was to determine how prenatal DHA at the recommended 200 mg/d impacts maternal, placental, and fetal DHA status in both normal-weight and high-BMI women compared to women taking no supplements. Maternal blood, placenta, and cord blood were collected from 30 healthy pregnant women (BMI 18.9-43.26 kg/m2) giving birth at term. Red blood cells (RBCs) and villous tissue were isolated, and lipids were extracted to determine DHA content by LC-MS/MS. Data were analyzed by supplement group (0 vs. 200 mg/d) and maternal BMI (normal weight or high BMI) using two-way ANOVA. We measured maternal choline levels in maternal and cord plasma samples. Supplementation with 200 mg/d DHA significantly increased (p < 0.05) maternal and cord RBC DHA content only in pregnancies complicated by high BMI. We did not find any impact of choline levels on maternal or cord RBC phospholipids. There were no significant differences in total placental DHA content by supplementation or maternal BMI (p > 0.05). Placental levels of phosphatidylinositol (PI) and phosphatidic acid containing DHA species were higher (p < 0.05) in high-BMI women without DHA supplementation compared to both normal-BMI and high-BMI women taking DHA supplements. Maternal DHA supplementation at recommended doses cord increased RBC DHA content only in pregnancies complicated by higher BMI. Surprisingly, we found that obesity was related to an increase in placental PI and phosphatidic acid species, which was ameliorated by DHA supplementation. Phosphatidic acid activates placental mTOR, which regulates amino acid transport and may explain previous findings of the impact of DHA on placental function. Current recommendations for DHA supplementation may not be achieving the goal of improving fetal DHA levels in normal-weight women.

Effectiveness of nutritional supplements (vitamins, minerals, omega-3, and probiotics) in preventing and treating COVID-19 and viral respiratory infections

BackgroundViral respiratory infections (VRIs) continue to be among the most common illnesses and are known to be one of the main reasons of medical consultations worldwide.COVID-19 remains a major public concern and a threat to global health. The current focus lies on the pivotal role of the human host's immunologic response in combating viral threats.This critical review aims to examine the current evidence on the potential benefit of nutritional supplements in the prevention and treatment of COVID-19 and viral respiratory infections (VRIs). MethodsThe study was performed in the Google-Scholar and PubMed databases with a main emphasis on publications between January 2000 and September 2023. Consequently, a total of 202 articles were included in this literature review, distributed as follows: 62 meta-analyses and systematic reviews, 20 randomized clinical trials, 11 clinical trials, 28 observational cohorts and 81 others. Of these, 44 % were published between 2020 and 2023. ResultsThe research indicates that Vitamin C may have a mitigating effect on VRIs, whereas a deficiency in Vitamin D might heighten susceptibility to COVID-19. Understanding the roles of Vitamins A, B, and E is hampered by limited data availability. Zinc supplementation and probiotics emerge as potential preventive measures for both COVID-19 and VRIs, with selenium and magnesium demonstrating promising results in treating VRIs. The recommendation for omega-3 fatty acid supplementation for COVID-19 treatment awaits further evidence. ConclusionCurrently, there is insufficient clinical evidence to definitively establish the efficacy of vitamin, mineral, probiotic and/or omega-3 supplementation for combating COVID-19 and VRIs.

Is vitamin D associated with disease activity in patients with axial or peripheral spondyloarthritis? A real-life study.

Vitamin D plays important role in inflammatory rheumatic diseases, which in turn rose an interest for investigating association of its deficiency with disease activity. In this research we aimed to evaluate this matter in the context of spondyloarthritis (SpA), together with treatment modalities and bone density in people diagnosed with axial or peripheral SpA in real-life setting. In our study we enrolled 99 patients with diagnosis of SpA treated at the tertiary level rheumatology department. Serum 25(OH)D levels, treatment modality (NSAIR or DMARDs), disease activity, tobacco smoking habits, mineral density of bone, supplementation and seasonal variations were assessed. We used standardized questionnaires such as ASDAS-CRP, BASFI and joint count, among many others, to evaluate some of the mentioned parameters. Sixty-five percent of patients had vitamin D deficiency. We found marginaly higher activity of disease in subjects with low vitamin D. In cases of peripheral SpA, there was a significant association of higher number of swollen joints and lower vitamin D levels. Additionally, the significant correlation was seen between normal serum vitamin D and supplementation. In our real-life study of patients with SpA we found a significant percentage of vitamin D deficit, with a tendency of slightly higher disease activity in those patients.In order to clarify the impact of the vitamin on disease activity in SpA and the supplementation recommendations for patients with these conditions, the conduction of further studies is required.

Mini-Review on Vitamin D in Pediatric Population and its Role in Respiratory and Atopic Disorders.

In recent years, our comprehension of the function of vitamin D has significantly evolved. The ubiquitous presence of the vitamin D receptor (Vitamin D Receptor- VDR) in the body has led to its redefinition from a steroidal hormone primarily involved in skeletal functions to a hormone with pleiotropic effects, exerting its influence on the circulatory, nervous, and immune systems. This has prompted investigations into its potential use in preventing and treating chronic metabolic disorders, cardiovascular diseases, infections, and allergic and autoimmune diseases. This comprehensive review explores the various aspects of vitamin D, including its sources, synthesis, functions, and its impact on different physiological systems. It delves into the epidemiology of vitamin D deficiency, highlighting its occurrence among various age demographics and geographic regions. The impact of vitamin D on the immune system is also explored, elucidating its immunomodulatory and anti-inflammatory properties, particularly in the context of respiratory infections. The review discusses emerging evidence concerning the potential advantages of vitamin D in respiratory diseases, pediatric asthma and atopic dermatitis. It also addresses vitamin D supplementation recommendations for various pediatric populations, including term and preterm infants. The growing concern regarding the global health impacts of insufficient vitamin D levels necessitates further research to bridge gaps in knowledge, particularly in enhancing screening, prevention, and approaches to address vitamin D deficiency from birth onwards. In summary, this comprehensive overview underscores the vital role of vitamin D, highlighting the significance of understanding its multifaceted functions and the need for tailored supplementation strategies, especially in vulnerable populations.

A Comprehensive Review of the Health Benefits of Calcium and its Bioavailability from Different Leafy Vegetables

Calcium (Ca) is a beneficial mineral for maintaining different physiological activities and is involved in preventing several diseases in human beings. Regular dietary Ca intake is therefore essential. However, the quantity required varies with different age groups. Various leafy vegetables act as a good source of Ca but some natural or physiological factors like phytate and vitamin D may influence Ca absorption from the Gastrointestinal Tract (GIT) thereby affecting the bioavailability of Ca. Methods like boiling and fermentation can be used to increase the bioavailability of Ca. Understanding Ca bioavailability from leafy vegetables can therefore be helpful for a proper recommendation of dietary Ca supplementation.

Methodological quality of research on perioperative immunomodulatory supplementation in oncological gastrointestinal tract surgery: a meta-research protocol

IntroductionOne of the topics that show differences of opinion in the scientific field of nutrition is the recommendation by clinical practice guidelines (CPGs) of an immunomodulatory diet with arginine, nucleotides...

Web scraping of user-simulated online nutrition information for people with multiple sclerosis

BackgroundPeople diagnosed with multiple sclerosis (MS) often seek to modify their diet guided by online advice, however this advice may not align with national dietary guidelines. The aim of this study was to simulate an online search for dietary advice conducted by a person with MS and evaluate the content. It was hypothesised that a variety of eating patterns are promoted for MS online and these dietary approaches can be contradictory. MethodsAn online search was simulated using Google Trends-informed search terms and Google and Bing search engines. URLs were extracted using R. Nutrition data were extracted including recommendations for diets, foods, supplements, and health professional consultation. Statistical analyses were conducted using R. Results73 URLs from 49 websites were extracted, with only 14 results common to both search engines. Dietary recommendations included overall eating patterns (58 webpages, 79%), individual foods (55 webpages, 75%), and supplements (33 webpages, 45%). The most promoted eating pattern for MS was a balanced diet (33 recommendations, 48%), more likely by nonprofit organisations and health information websites (14 and 17 recommendations, 100% and 89%); lifestyle program websites were more likely to recommend restrictive diets (19 recommendations, 100%) (p<0.001). 52% pages advised consulting a health professional, most often a doctor or dietitian. ConclusionA balanced diet is the most recommended eating pattern for MS online, though advice promoting restrictive diets persists.

Maternal non-compliance with recommended folic acid supplement use alters global DNA methylation in cord blood of newborns: A cohort study

Background & aimsPrenatal folate exposure may alter epigenetic marks in the offspring. We aimed to evaluate associations between prenatal exposure to folic acid (FA) in preconception and in utero with cord blood DNA methylation in long interspersed nuclear element 1 (LINE-1) and Alu short interspersed nuclear elements (SINEs) as markers of global DNA methylation levels. MethodsData come from 325 mother-child pairs participating in the Nutrition in Early Life and Asthma (NELA) birth cohort (2015-2018). Pregnant women were asked about supplement use, including brand name and dose, one month before pregnancy (preconception) and through the trimesters of pregnancy. Maternal dietary folate intake was assessed using a validated food frequency questionnaire with additional questions for FA supplement use. Folate serum levels were measured in mothers at 24 weeks of gestation and in cord blood of newborns. DNA methylation was quantitatively assessed by bisulfite pyrosequencing on 5 LINE-1 and 3 Alu different elements. Associations were estimated using multivariable linear regression models. ResultsA reduction in methylation levels of LINE-1 in newborns was associated with the use of FA supplements below the recommended doses (<400 ug/day) during preconception (-0.50; 95% CI: -0.91, -0.09; P=0.016), and from preconception up to 12 weeks of gestation (-0.48; 95% CI: -0.88, -0.08; P=0.018). Maternal use of FA supplements above the tolerable upper intake level of 1000 ug/day from preconception until 12 weeks of gestation was also related to lower methylation in LINE-1 at birth (-0.77; 95% CI: -1.52, -0.02; P=0.044). Neither FA supplement use after 12 weeks of gestation nor maternal total folate intake (diet plus supplements) were associated with global DNA methylation levels at birth. ConclusionsMaternal non-compliance with the use of FA supplement recommendations from preconception up to 12 weeks of gestation reduces offspring global DNA methylation levels at birth.