Vitamin Deficiency In Patients Research Articles

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

Low vitamin K status in adults with cystic fibrosis is associated with reduced body mass index, insulin secretion, and increased pseudomonal colonization.

Patients with cystic fibrosis(CF) are at high risk of fat-soluble vitamin deficiencies, even with supplementation. The contribution of a suboptimal vitamin K status to respiratory and endocrine pathophysiology in CF has been inadequately characterized. This is a cross-sectional study in adult CF patients(≥18 years old) from the Montreal Cystic Fibrosis Cohort. Vitamin K1(VK1) was measured with high-performance liquid chromatography, using fasted serum samples collected during an oral glucose tolerance test(OGTT: 2h with plasma glucose and insulin every 30min)(n=168). Patients were categorized according to VK1 status(suboptimal defined as<0.30nmol/L). Suboptimal VK1 levels were observed in 66% of patients. Patients with a suboptimal VK1 status have a higher risk of colonization with Pseudomonas aeruginosa(p=0.001), have lower body mass index(BMI)(p=0.003), and were more likely to have exocrine pancreatic insufficiency(p=0.002). Using an established threshold for VK1, we did show significantly reduced OGTT-derived measures of insulin secretion in patients with a VK1 status below 0.30nmol/L(first- and second-phase area under the curve (AUC)INS/GLU(p=0.002 and p=0.006), AUCINS(p=0.012) and AUCINS/GLU(p=0.004)). Subclinical vitamin K deficiency is more common than other fat-soluble vitamin deficiencies in patients with CF. We demonstrate an association between a suboptimal VK1 status and measures of insulin secretion. We highlight the potential associations of mild vitamin K deficiency with pseudomonal colonization and lower BMI, although these need to be validated in prospective studies.

Scrutinizing the causal relationship between schizophrenia and vitamin supplementation: a Mendelian randomization study

Abstract Objective: Observational studies have reported malnutrition and vitamin deficiency in patients with schizophrenia (SZ), which can lead to serious metabolic syndromes and decrease anti-psychiatric drug outcomes. Whereas, vitamin intake along with psychiatric medication can enhance the medication outcomes. However, it is still unknown if SZ induces vitamin deficiency. Herein, we conduct the Mendelian randomization analysis to explore the causal relationship between schizophrenia and vitamins supplementation. Methods: We retrieved the genome-wide summary statistical data for schizophrenia from recent SZ GWAS data (43,175 cases and 65,166 controls) and vitamins supplementation GWAS data from Neale's GWAS datasets (more than 337,000 samples from the European population) and performed a two-sample Mendelian randomization analysis to determine the causal association of SZ with vitamin supplementation, in addition, we conduct the sensitivity analysis to obtain reliable results and remove confounding bias. Results: SZ have causal relationships with vitamins A, B, C, D, and E (SZ/vitamin A: β = 0.002, se = 0.001, 95% confidence interval (CI): 0.001 to 0.004, P = 1.41E−05, heterogeneity P = 0.4486; SZ/vitamin B: β = 0.004, se = 0.001, 95% CI: 0.002–0.005, P = 7.0E−05, heterogeneity P = 0.2217; SZ/vitamin C: β = 0.004, se = 0.001, 95% CI: 0.002–0.007, P = 0.001, heterogeneity P = 0.1349; SZ/vitamin D: β = 0.003, se = 0.001, 95% CI: 0.002–0.005, P = 0.001, heterogeneity P = 0.433; SZ/vitamin E: β = 0.003, se = 0.001, 95% CI: 0.002–0.005, P = 5.0E−05, heterogeneity P = 0.1382). Conclusion: Our findings suggest that vitamin levels and supplementation should be carefully controlled in patients with SZ, which in turn may enhance the therapeutic effects of antipsychotic drug treatments.

P435 High rate of vitamin deficiencies in patients after total proctocolectomy and pouch surgery- results from a prospective cohort

Abstract Background Patients with ulcerative colitis (UC) undergoing total proctocolectomy with ileal pouch anal anastomosis (pouch surgery) may be prone to develop nutritional deficiencies. Here we aimed to evaluate the rates of vitamin deficiencies and their risk factors in these patients. Methods Patients after pouch surgery were consecutively enrolled in a tertiary referral center. Pouch behavior determined clinically (normal pouch; recurrent acute pouchitis; chronic pouchitis; Crohn’s like disease of the pouch), disease activity, inflammatory markers and serum vitamin D, B12 and folic acid levels were repeatedly assessed. Body mass index (BMI) and the use of dietary supplements were recorded at each visit. Results A total of, 136 patients (mean age-, 47.5±16 years, mean BMI-, 24.9±5 Kg/m2, female gender, 58%) underwent, 721 study visits. Average visits/patients:, 5 (range, 1–15); between-visit interval:, 5±4 months. Normal pouch:, 41%, recurrent acute pouchitis, 24%, chronic pouchitis/ Crohn’s like disease of the pouch:, 35%. Vitamin D deficiency (&amp;lt;25 nmol/L) and insufficiency (25–75 nmol/L) were detected in, 6.5% and, 82% of patients, respectively. Vitamin B12 deficiency (&amp;lt;221 pmol/L) was detected in, 29%, and folic acid deficiency (&amp;lt;7 nmol/L) in, 9.5% of patients. After controlling for disease activity and inflammatory markers, vitamin D deficiency was positively associated with pouch age (i.e interval from the ileostomy closure, OR=, 1.47, 95%CI, 1.1–1.9, p=, 0.007). Vitamin B12 deficiency was positively associated with BMI (OR=1.07, 95%CI, 1.001–1.14, p=0.045), and folic acid deficiency was inversely associated with patient’s age (OR=, 0.95, 95%CI, 0.9–0.99, p=0.017). Of patients with vitamin D, B12 and folic acid insufficiencies or deficiencies, only, 60/121 (49.6%), 17/40 (42%), and, 4/13 (30%), respectively, reported the use of appropriate dietary supplements throughout the long-term follow-up. Conclusion In a longitudinal follow up of patients with UC after pouch surgery, we detected significant vitamin D, B12 and folic acid deficiencies and identified specific risk factors. Insufficient active correction with dietary supplements was noticed. Screening and improved correction of nutritional deficiencies should be a part of the routine pro-active multidisciplinary care of patients after pouch surgery.

Prevalence of malnutrition and vitamin deficiencies in patients undergoing surgery for ovarian cancer

The National Comprehensive Cancer Network (NCCN) recommends evaluation of nutritional status in newly diagnosed ovarian cancer patients. There are a paucity of studies evaluating compliance with the NCCN guidelines. The objective of this study is to identify the prevalence of preoperative malnutrition and vitamin deficiencies in patients undergoing surgery for ovarian cancer.

Vitamin status of patients with certain chronic non-communicable diseases

Background. Inadequate supply with vitamins is a risk factor for the development of many nutritionally-related diseases and their progression. Data on the actual vitamin status of patients are necessary to develop measures for its improvement. Aim. To characterize the supply of persons with non-communicable diseases with vitamins A, E, C, B2 and -carotene by determining their level in the blood of patients. Material and methods. The blood serum level of vitamins C, A, E, B2 and -carotene in 138 patients (41 men and 97 women) 2280 years old with cardiovascular diseases, obesity, gastrointestinal diseases, type 2 diabetes mellitus (T2DM), osteoarthrosis has been determined. Results. Vitamin C concentration corresponded to adequate status in approximately 2/3 of the examined patients; among patients with T2DM, such sufficiency occurred 1.61.9 fold less often than in other groups. The frequency of reduced levels of vitamins C, A and E was statistically significantly more frequent in patients with gastrointestinal diseases. The -/-tocopherol ratio in the serum of patients in all groups was close to 1:50, while in patients with gastrointestinal diseases reached 1:60.7. The proportion of patients sufficiently supplied with all studied vitamins ranged from 15.8 to 70.0%. Patients with osteoarthrosis were best of all provided with all vitamins: multiple (3 or more vitamins) vitamin deficiency was not found. In other groups of patients, multiple vitamin deficiency occurred in 5.327.6% of the examined (an average of 16.4%). Among patients with gastrointestinal diseases there was not a single person sufficiently provided with all the studied vitamins. Multiple vitamin deficiency in patients with gastrointestinal diseases was detected more often (p 0.01) compared with patients with T2DM and osteoarthrosis. Given the high prevalence of vitamin D deficiency, it is possible to extrapolate that a significant proportion of patients with a combined deficiency of 2 vitamins (6.931.6% in the samples examined) will move into the category of persons with a simultaneous deficiency of 3 vitamins. Conclusion. The purposeful development of supplements containing effective doses of vitamins for various nosologies is necessary.

The Etiological Role of Thyroid Dysfunction and Vitamin Deficiency in Patients with Telogen Effluvium

Aim: Telogen effluvium (TE) is one of the most common forms of non-scarring alopecia. This study aims to examine the proportion of vitamin B12 deficiency, vitamin D deficiency, iron deficiency, and thyroid dysfunction in patients with TE. Materials and Methods: This retrospective observational study reviewed the records of 151 patients with TE who were admitted to our hospital from January 2016 to December 2019. The etiology of the patients' history information, medications, and laboratory findings were conducted. Ferritin, vitamin B12, vitamin D, TSH, sT4, sT3, thyroid autoantibodies (anti-TPO, anti-thyroglobulin, TSH receptor blocker antibody) of the patients were recorded. Results: The median age of 151 patients was 29 (18 – 67). 22% of patients had vitamin B12 deficiency, 34% had a folic acid deficiency, 93.5% had vitamin D deficiency, and 68.5% had iron deficiency and 22.5% were anemic. While 117 (77.5%) of the women were premenopausal, 34 (22.5%) were postmenopausal. There were 23 (15.2%) patients with thyroid dysfunction, 2 had subclinical hyperthyroidism, 2 had hypothyroidism, and 19 had subclinical hypothyroidism. Discussion and Conclusion: Study findings were obtained in our study that vitamin D and vitamin B12 deficiency, iron deficiency, and thyroid dysfunction may be associated with TE.

Efficient Prediction of Vitamin B Deficiencies via Machine-Learning Using Routine Blood Test Results in Patients With Intense Psychiatric Episode.

BackgroundVitamin B deficiency is common worldwide and may lead to psychiatric symptoms; however, vitamin B deficiency epidemiology in patients with intense psychiatric episode has rarely been examined. Moreover, vitamin deficiency testing is costly and time-consuming, which has hampered effectively ruling out vitamin deficiency-induced intense psychiatric symptoms. In this study, we aimed to clarify the epidemiology of these deficiencies and efficiently predict them using machine-learning models from patient characteristics and routine blood test results that can be obtained within one hour.MethodsWe reviewed 497 consecutive patients, who are deemed to be at imminent risk of seriously harming themselves or others, over a period of 2 years in a single psychiatric tertiary-care center. Machine-learning models (k-nearest neighbors, logistic regression, support vector machine, and random forest) were trained to predict each deficiency from age, sex, and 29 routine blood test results gathered in the period from September 2015 to December 2016. The models were validated using a dataset collected from January 2017 through August 2017.ResultsWe found that 112 (22.5%), 80 (16.1%), and 72 (14.5%) patients had vitamin B1, vitamin B12, and folate (vitamin B9) deficiency, respectively. Further, the machine-learning models were well generalized to predict deficiency in the future unseen data, especially using random forest; areas under the receiver operating characteristic curves for the validation dataset (i.e., the dataset not used for training the models) were 0.716, 0.599, and 0.796, respectively. The Gini importance of these vitamins provided further evidence of a relationship between these vitamins and the complete blood count, while also indicating a hitherto rarely considered, potential association between these vitamins and alkaline phosphatase (ALP) or thyroid stimulating hormone (TSH).DiscussionThis study demonstrates that machine-learning can efficiently predict some vitamin deficiencies in patients with active psychiatric symptoms, based on the largest cohort to date with intense psychiatric episode. The prediction method may expedite risk stratification and clinical decision-making regarding whether replacement therapy should be prescribed. Further research includes validating its external generalizability in other clinical situations and clarify whether interventions based on this method could improve patient care and cost-effectiveness.

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients' micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia's largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C (P < .01), albumin (P = .03), and hemoglobin (P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients.

Supply of vitamins for patients with type 2 diabetes and obesity in the autumn

Aim. To assess the availability of patients with type 2 diabetes mellitus (DM-2) and obesity with vitamins C, A, E, D, B2, B6, niacin and betacarotene.Material and methods. We assess vitamin status of 40 patients with DM-2 (14 men and 26 women) aged 42-80 years was 60,2±1,3 (Me=60,5) with concomitant obesity and a body mass index from 31,2 to 57,4 kg 42,1±1,1 (Me=42,0), receiving oral hypoglycemic therapy. The disease duration ranged from six months to 32 years — 7,4±1,0 (Me=6,0), the level of glycohemoglobin — from 5,20% to 7,70% — 6,27±0,11 (Me=6,05). The provision of C, A, E, D, B2 vitamins and beta-carotene was assessed by their serum concentration, B6 and niacin vitamins — by excretion of their metabolites with urine.Results. Against the background of a good supply of patients with A, E, C and PP vitamins, a reduced serum concentration of 25-OH vitamin D was detected in the majority (83%) of the patients, beta carotene — in 55%, insufficient provision with vitamins B6 and B2 — 15-18%. A reduced serum concentration of 1-2 vitamins was detected in 65% of the patients. A combined deficiency of 3-4 vitamins had 25% of patients.Conclusion. The presence of vitamin deficiencies in patients with DM-2, which are a risk factor for its occurrence and the development of complications, indicates the need to optimize vitamin status. The negative association between the level of basal glycemia in venous blood and glucosuria and the concentration of γ-tocopherol may indicate certain benefits of using dietary oils with a high level of vitamer.

Nutritional assessment and vitamin deficiencies in patients with NETs

Nutritional assessment and vitamin deficiencies in patients with NETs

Vitamin Deficiencies in Patients with Myopathies and Other Neuromuscular Conditions (P2.115)

Vitamin Deficiencies in Patients with Myopathies and Other Neuromuscular Conditions (P2.115)

169 Improved lung function and hepatosteatosis after oral choline substitution in CF patients

intestinal malabsorption of both fat-soluble vitamins and nutrients. In this cross-sectional study, we tried to evaluate the nutritional status and determine the prevelance of fat-soluble vitamin deficiency in patients with cystic fibrosis (CF) in Turkey. Methods: We retrospectively analysed the data of fat-soluble vitamin levels, microbiological status, lung function tests and nutritional status of patients with CF who attend to Hacettepe University Department of Pediatric Pulmonology and Gastroenterology within three months. Results: We evaluated 130 patients; the mean age of the patients was 11.9±6.7 years and the mean duration of following time was 8.7 years. According to WHO BMI Z score, 10.7% of patients had malnutrition. The mean FEV1 was 75±26% and the mean FVC was 75±22%. Staphyloccus aureus was the most common microorganism isolated from sputum culture. Pancreatic insufficiency was detected in 99% of patients. Vitamin A and D deficiencies were the most common findings with 26% and 32% respectively in our cohort. In addition to multivitamin complex, 20% of patients were receiving extra vitamin A and 22.3% of patients were receiving extra vitamin E supplement. Conclusion: Fat-soluble vitamin testing and assessment of nutritional status are essential to identify deficiency in pancreatic-insufficient children who may be noncompliant to supplementation or require a higher supplement dose and nutritional support.

168 Evaluation of nutritional status and fat-soluble vitamin deficiency in patients with cystic fibrosis

168 Evaluation of nutritional status and fat-soluble vitamin deficiency in patients with cystic fibrosis

Postoperative vitamin deficiencies in patients undergoing laparoscopic roux‐en‐y gastric bypass

BACKGROUNDNutritional abnormalities are common in severely obese patients and can be worsened following laparoscopic Roux‐en‐Y Gastric Bypass (LRYGB). This study aimed to determine the relationship between postoperative vitamin B12, folate and iron deficiency to LRYGB outcomes.METHODS630 patients underwent LRYGB by three surgeons at a single academic institution. Patient records were reviewed for vitamin levels, weight loss, and cardiac risk factors postoperatively.RESULTSOverall patient demographics were: mean age 44.4 years, mean BMI 46.3, and 89% female. At 3, 6 and 12 months postoperative, 0.2, 1.2 and 1.6% had Vitamin B12 deficiency; 0.3, 0.7 and 0% had folate deficiency; and 11.3, 4.5, and 7.3% had iron deficiency, respectively. Men had higher rates than women of vitamin deficiencies at all time points (p&lt;0.001). Patients who had a known deficiency at 3 months had significantly higher weights preoperative (278lbs vs 311lbs, p&lt;0.001), at 3 months (227lbs vs 254lbs, p=0.01) and at 12 months (185lbs vs 208lbs, p=0.01).CONCLUSIONSMale patients and patients with higher preoperative weight should be monitored closely for nutritional deficiencies following LRYGB.Grant Funding Source: NIH Clinical and Translational Science Award

VITAMIN deficiencies in patients with diabetic retinopathy.

Vitamin Deficiencies in Patients with Diabetic Retinopathy Get access Nutrition Reviews, Volume 13, Issue 3, March 1955, Pages 74–76, https://doi.org/10.1111/j.1753-4887.1955.tb03411.x Published: 01 March 1955

Vitamin deficiencies in acutely intoxicated patients in the ED

Objective Physicians often administer intravenous multivitamins to intoxicated patients in the emergency department (ED); however, this practice is not supported by evidence from any prior study. We determined the prevalences of vitamin deficiencies in patients presenting to our ED with alcohol intoxication. Methods This study was a prospective, cross-section, observational study of a convenience sample of ED patients presenting with acute alcohol intoxication. Patients were tested for B 12, folate, and thiamine levels as add-ons to their blood samples. Results Seventy-seven patients were included in the final analysis. The mean age was 46 years, and 19% were female; the mean blood alcohol level was 280 mg/dL. Of 75 patients, no one (0%) had low B 12 or folate levels (95% confidence interval, 0-0.05); 6 (15%) of 39 patients had low thiamine levels (95% confidence interval, 0.06-0.31). Of these 6 patients, none exhibited clinical signs of thiamine deficiency. Conclusions In our ED, patients with acute ethanol intoxication do not have B 12 or folate deficiencies. A significant minority (15%) of patients have thiamine deficiency; its clinical significance is unclear. Widespread administration of multivitamins is unwarranted by these findings, but thiamine may be considered.

Zinc and antioxidant vitamin deficiency in patients with severe sickle cell anemia

BACKGROUNDPatients with severe sickle cell anemia (SCA) have a higher potential for oxidative damage due to chronic redox imbalance in red blood cells that often leads to hemolysis, endothelial injury and recurrent vaso-occlusive episodes. This study evaluated the plasma levels of vitamins A, C and E as indicators of antioxidant status. In addition, serum levels of zinc and copper were also estimated.PATIENTS AND METHODSTwenty-five adult patients with severe sickle cell anemia (12 males and 13 females aged 29.72±12.94 years) and 25 matched controls were studied. Plasma levels of vitamins A, C and E were measured by HPLC technique. Serum zinc and copper levels were measured by atomic absorption spectrometry.RESULTSThere was a significant decrease in plasma levels of vitamins A, C and E and in serum levels of zinc in patients with SCA as compared with controls (P<0.0001). Serum copper levels were signficantly elevated compared with controls (P<0.0001).CONCLUSIONThese findings emphasize the significant deficiencies of the antioxidant vitamins A, C and E and the trace element zinc along with the significant elevation of serum copper in patients with severe sickle cell disease. Further studies are needed to find out whether supplementation of antioxidant vitamins and zinc may ameliorate some sickle cell disease complications.

Fat-soluble vitamin levels in patients with primary biliary cirrhosis

OBJECTIVE: To determine the occurrence of fat-soluble vitamin deficiencies and to identify clinical factors that may predict vitamin deficiency in patients with primary biliary cirrhosis (PBC). METHODS: Review of our data from a randomized, placebo-controlled trial that evaluated the efficacy of UDCA in 180 patients with PBC. We use the first available measurements of vitamin levels in each study participant. Vitamin levels for A, D, and E were measured in serum. The prothrombin time (PT) was used as a surrogate marker for vitamin K. RESULTS: The proportion of patients with fat-soluble vitamin deficiencies in the treatment and placebo groups was similar and the data sets were combined. The proportion with vitamin A, D, E or K deficiency was 33.5%, 13.2%, 1.9%, and 7.8%, respectively. In multivariate analysis, the Mayo risk score, advanced histological stage, and total cholesterol were independently associated with vitamin A deficiency whereas serum albumin levels was independently associated with vitamin D deficiency. No factors were associated with vitamin E or K deficiency in multivariate analysis owing to the few vitamin E and K deficient patients. Factors predictive of vitamin K deficiency by univariate analysis included Mayo risk score, advanced histological stage, HDL, total bilirubin, AST, and albumin. The cut-off value of the Mayo risk score with the highest sensitivity and specificity for vitamin A deficiency was 5.0. CONCLUSION: Other than deficiency of vitamin A, deficiency of fat-soluble vitamins occurs uncommonly in patients with PBC. A Mayo risk score ≥ 5 helps in selecting patients with PBC for surveillance for vitamin A deficiency.

Fat-soluble vitamin levels in patients with primary biliary cirrhosis.

To determine the occurrence of fat-soluble vitamin deficiencies and to identify clinical factors that may predict vitamin deficiency in patients with primary biliary cirrhosis (PBC). Review of our data from a randomized, placebo-controlled trial that evaluated the efficacy of UDCA in 180 patients with PBC. We use the first available measurements of vitamin levels in each study participant. Vitamin levels for A, D, and E were measured in serum. The prothrombin time (PT) was used as a surrogate marker for vitamin K. The proportion of patients with fat-soluble vitamin deficiencies in the treatment and placebo groups was similar and the data sets were combined. The proportion with vitamin A, D, E or K deficiency was 33.5%, 13.2%, 1.9%, and 7.8%, respectively. In multivariate analysis, the Mayo risk score, advanced histological stage, and total cholesterol were independently associated with vitamin A deficiency whereas serum albumin levels was independently associated with vitamin D deficiency. No factors were associated with vitamin E or K deficiency in multivariate analysis owing to the few vitamin E and K deficient patients. Factors predictive of vitamin K deficiency by univariate analysis included Mayo risk score, advanced histological stage, HDL, total bilirubin, AST, and albumin. The cut-off value of the Mayo risk score with the highest sensitivity and specificity for vitamin A deficiency was 5.0. Other than deficiency of vitamin A, deficiency of fat-soluble vitamins occurs uncommonly in patients with PBC. A Mayo risk score > or = 5 helps in selecting patients with PBC for surveillance for vitamin A deficiency.