Causes and consequences of hypochlorhydria in the elderly.
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Achlorhydria↗
Biomedical subjects
R M Russell
Publications and source records attributed to R M Russell.
Effect of aging on in vivo and in vitro ethanol metabolism and its toxicity in F344 rats.
To investigate the effect of aging on ethanol metabolism, 24 male and female F344 rats aged 2 and 12 mo that were fed a laboratory diet received ethanol (1.2 and 2.5 g/kg body wt) intraperitoneally. In male rats, in vivo ethanol elimination significantly decreased according to age both at high (436 +/- 38 vs. 294 +/- 27 mg/kg.h; p less than 0.01) and low (365 +/- 19 vs. 261 +/- 8 mg/kg.h; p less than 0.01) blood ethanol concentrations. Age did not influence the specific activity of hepatic or gastric alcohol dehydrogenase, whereas the activity was significantly decreased with age in the liver (p less than 0.05) and in the stomach (p less than 0.001) when related to body weight. In addition, the activity of the hepatic microsomal ethanol oxidizing system decreased significantly according to age (8.7 +/- 0.5 vs. 6.00 +/- 0.3 nmol/min.mg micr. protein; p less than 0.001). To study the response of ethanol-metabolizing enzymes to chronic ethanol ingestion, 2- and 19-mo-old male F344 rats were pair-fed nutritionally adequate liquid diets containing 36% of total calories either as ethanol or isocaloric carbohydrate for 3 wk. In this experiment specific alcohol dehydrogenase activity was not significantly affected by age, whereas the hepatic microsomal function estimated by the determination of cytochrome P450, microsomal ethanol oxidizing system, and aniline hydroxylation as well as hepatic mitochondrial low Km-acetaldehyde dehydrogenase activity was found to be markedly depressed with age (p less than 0.01). Chronic ethanol consumption increased microsomal enzyme activities in older rats to levels comparable to those observed in young animals prior to ethanol administration. Chronic ethanol feeding also resulted in an increased hepatic fat accumulation, which was significantly enhanced in older rats. In contrast to male rats, in vivo ethanol metabolism was practically identical for 2- and 12-mo-old female rats. These data demonstrate an enhanced toxicity of alcohol in older compared to younger male but not female rats associated with a delay in alcohol elimination both at high and low ethanol blood concentrations and a decrease in ethanol- and acetaldehyde-metabolizing enzyme activities.
Aging↗
Effect of age on tests of intestinal and hepatic function in healthy humans.
We studied intestinal function and hepatic microsomal phase I monooxygenase function in healthy, free-living subjects, aged 19-91 yr. In subjects (n = 114) given a diet including 100 g/day of fat, fecal fat in a 72-h collection did not increase with advancing age. D-Xylose excretion (n = 54) following a 25-g oral load significantly declined with increasing age, but a concomitant decline in creatinine clearance suggested a decrease in renal function rather than an absorptive defect. Furthermore, there was no evidence for an age-associated increase in bile salt deconjugation by intestinal bacteria as shown by the glycocholate breath test (n = 60). Finally, there was no evidence for a decrease in hepatic microsomal function with advancing age as measured by the aminopyrine breath test (n = 60). We conclude that digestive/absorptive and hepatic microsomal phase I monooxygenase function are well preserved in healthy humans throughout life.
Adult↗
Role of triglyceride-rich lipoproteins from the liver and intestine in the etiology of postprandial peaks in plasma triglyceride concentration.
Plasma triglyceride concentration in human subjects peaks once, twice or three times in the twelve-hour period following the ingestion of a fat-rich meal. Triglyceride-rich lipoproteins (TRL) containing apolipoprotein (apo)B-48 (of intestinal origin), and TRL containing apoB-100 (predominantly of hepatic origin) both contribute to postprandial changes in plasma triglyceride concentration. To test the hypothesis that earlier peaks in postprandial triglyceridemia are due predominantly to the secretion of TRL from the intestine, while later peaks are due to the secretion of TRL from the liver, TRL apoB-48, TRL apoB-100 and retinyl ester (a marker of intestinal lipoproteins) were measured in plasma samples from subjects fed a fat-rich meal (1 g fat/kg body wt). Data from seven subjects (four fed 40 retinol equivalents vitamin A/kg body wt, three fed 20 retinol equivalents vitamin A/kg body wt, with the fat meal), showed that postprandial peaks in plasma triglyceride were always associated with increases in plasma retinyl ester concentration. In four subjects, who were selected because they had two clearly defined postprandial triglyceride peaks, the plasma concentration of TRL triglyceride, apoB-48, apoE and apoC increased in conjunction with both the earlier (three hour) and later (nine hour) peaks in plasma triglyceride. Increase in TRL apoB-100 was associated with both peaks in two of the four subjects. Our data suggest that 1) TRL from the liver and intestine contribute to both earlier and later peaks in postprandial triglyceridemia; and 2) the rate of appearance of TRL from the intestine is not constant after dietary fat absorption.
Adult↗
Effects of a vitamin-A-free diet on tissue vitamin A concentration and dark adaptation of aging rats.
Changes in serum, hepatic, and ocular vitamin A levels were followed in 9-month-old Long Evans rats fed either a vitamin-A-free or vitamin-A-sufficient diet for up to 18 months. After 18 months, hepatic total vitamin A fell exponentially from 2542 +/- 433 to 48 +/- 12 micrograms/g wet weight, but these stores maintained normal serum retinol and ocular total vitamin A concentrations in vitamin-A-deprived rats. However, retinal dark-adaptation time, a functional indicator of photoreceptor integrity, was prolonged in elderly vitamin-A-deprived rats as compared to vitamin-A-sufficient controls (p less than 0.05). Aging appeared to be the most important factor that depressed the rate of dark adaptation, with vitamin A status having a secondary effect. The proportion of total ocular retinaldehyde decreased (p less than 0.05) and the concentration of retinyl ester increased (p less than 0.05) in the eyes of 27-month-old vitamin-A-deprived rats compared to age-matched vitamin-A-sufficient animals. Possible mechanisms of visual dysfunction include abnormal retinal rhodopsin recycling caused by a dependence on newly absorbed dietary vitamin A (e.g., chylomicron). Alternatively, in the vitamin-A-deprived rat, decreased hepatic oxidation of pentobarbital (used for electroretinographic anesthesia) could prolong retinal anesthetic exposure and either directly depress neural transmission or indirectly alter transmission by affecting rhodopsin recycling.
Aging↗
Rabbits fed on beta-carotene have higher serum levels of all-trans retinoic acid than those receiving no beta-carotene.
The aim of the present work was to determine the effect of giving increasing doses of supplements of beta-carotene on serum retinoic acid levels in rabbits. Four groups of 7-week-old female rabbits were fed for 9 weeks on a pelleted diet containing 1.72 mg vitamin A as retinyl acetate/kg and including control gelatin beadlets devoid of beta-carotene or 1, 2 or 4 mg beta-carotene/kg body-weight per d. Serum was collected at 3, 6 and 9 weeks after the beginning of the experiment and the concentration of all-trans retinoic acid was determined by a gradient reverse-phase high-performance liquid chromatography system following a double-phase extraction. The average concentration of retinoic acid in serum of the combined control and 1 mg beta-carotene/kg groups was 3.80, 3.06 and 2.40 nM at 3, 6 and 9 weeks respectively. The concentrations of retinoic acid in serum of the combined 2 and 4 mg beta-carotene/kg groups were 4.80 nM (P less than 0.05), 3.76 nM (not significant) and 4.90 nM (P less than 0.005) at 3, 6 and 9 weeks respectively. A SAS (SAS Institute Inc., 1985) general linear model repeated-measures analysis of variance revealed that the effects of treatment (P less than 0.01), time (P less than 0.05) and treatment x time interaction (P less than 0.05) were statistically significant. It is concluded that giving beta-carotene is associated with higher concentrations of all-trans retinoic acid in the serum of rabbits than in those receiving no beta-carotene.
Animals↗
Relationship of vitamin A and vitamin E intake to fasting plasma retinol, retinol-binding protein, retinyl esters, carotene, alpha-tocopherol, and cholesterol among elderly people and young adults: increased plasma retinyl esters among vitamin A-supplement users.
We studied the relationships of supplemental and total vitamin A and supplemental vitamin E intake with fasting plasma biochemical indicators of vitamin A and vitamin E nutritional status among 562 healthy elderly people (aged 60-98 y) and 194 healthy young adult (aged 19-59 y) volunteers. All subjects were nonsmokers. For the young adults, plasma retinol was significantly greater in males than in females (p less than 0.01); retinol was not related to supplemental vitamin A intake for either group. Fasting plasma retinyl esters demonstrated a significant increase with vitamin A supplement use. For supplemental vitamin A intakes of 5001-10,000 IU/d, a 2.5-fold increase over nonusers in fasting plasma retinyl esters was observed for elderly people (p less than 0.05) and a 1.5-fold increase for young adults (p greater than 0.20). For elderly people, greater fasting plasma retinyl esters were associated with long-term vitamin A supplement use (greater than 5 y) and biochemical evidence of liver damage. Elderly people who take vitamin A supplements may be at increased risk for vitamin A overload.
Aged↗
Moderate alcohol intake and nutritional status in nonalcoholic elderly subjects.
Three hundred and seventy-three female and 213 male nonalcoholic subjects, aged 60-100 y, who had participated in a nutritional status survey of elderly people in the Boston area were grouped according to usual alcohol intake: 0-4, 5-14, or 15+ g/d. The age- and sex-adjusted mean intake of calories, fat, protein, carbohydrate, and 10 micronutrients and the mean levels of 14 nutrient and 22 nonnutrient biochemical indices were compared for the three categories of alcohol intake. The mean micronutrient intakes were also adjusted for total caloric intake and the mean nutrient biochemical concentrations were also adjusted for the corresponding nutrient intakes. The results suggest that caloric intake and blood concentrations of retinol, iron, ferritin, HDL cholesterol, AST, and ALT increased with increasing alcohol intake whereas folate and phosphorus intakes and blood measures of riboflavin, copper, zinc, urea nitrogen, and creatinine decreased with increasing alcohol intake.
Age Factors↗
Dietary beta-carotene absorption and metabolism in ferrets and rats.
The ability of the ferret (Mustela putorius furo) to absorb dietary beta-carotene was studied to determine its appropriateness as a laboratory animal model for studies on beta-carotene metabolism. At baseline, the mean serum beta-carotene level in ferrets was 0.6 micrograms/dl and no beta-carotene was present in liver or adipose tissue. After the ferrets were fed 4 or 20 mg of beta-carotene/kg body wt daily for 2 wk, serum levels were 15.3 and 41.5 micrograms/dl, liver values were 0.9 and 4.1 micrograms/g and adipose tissue values were 0.1 and 0.2 microgram/g of beta-carotene, respectively. Thus, like humans, ferrets are able to absorb dietary beta-carotene intact. Further, these animals can store quantifiable amounts of dietary beta-carotene in their liver and, to a lesser extent, in adipose tissue. In contrast, serum beta-carotene levels in rats fed the two levels of beta-carotene were very low (0.5 to 0.6 microgram/dl) and no beta-carotene was found in liver or adipose tissue. Thus, the ferret is a more appropriate animal model for studying the intestinal absorption of beta-carotene and its storage and metabolism in body tissues.
Adipose Tissue↗
Postoperative hypotension associated with enalapril.
We describe the case of a patient treated for hypertension with the angiotensin converting enzyme inhibitor enalapril, who developed hypotension after recovery from anaesthesia.
Anesthesia↗
Longitudinal relationships between nutrition and oral health.
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Deficiency Diseases↗
Hypochlorhydria: a factor in nutrition.
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Achlorhydria↗
The effects of chronic vitamin A excess on bone remodeling in aged rats.
This study was conducted to assess the effects of long-term ingestion of moderate excesses of vitamin A on trabecular bone remodeling in the fifth lumbar vertebral body of aged rats. Eighteen-month-old rats were fed diets with vitamin A content equal to the daily requirement (DR), 2-fold, and 5-fold the DR along with calcium content of either the DR or 0.3-fold the DR, for 14 months each. As expected, serum concentrations of 1,25-dihydroxyvitamin D were higher in the reduced than in the normal calcium intake groups (65.1 +/- 2.4 SEM vs 47.8 +/- 2.1 pg/ml, P less than 0.001). Calcium balance was more positive at the higher than the lower calcium intake (5.7 vs 0.9 mg, P less than 0.001) but was unaffected by vitamin A intake. Histomorphometric analysis of the fifth lumbar vertebral body revealed that the 2-fold but not the 5-fold excess in vitamin A intake resulted in a 15% increase in percentage of trabecular bone (P less than 0.02). The low calcium diet depressed bone growth (total bone tissue) but did not affect percentage of trabecular bone. Several effects of the vitamin A excess and low calcium diet were noted along the trabecular surface including increased mineral apposition rate and resorption surfaces and decreased formation surfaces. The net effect of vitamin A on trabecular bone of the rat varies as intake begins to exceed the DR. At a 2-fold excess, a modest favorable effect on percentage of trabecular bone was observed.
Aging↗
Dark adaptation in hyperprolactinemic women.
In a study to test the hypothesis that hyperprolactinemia is caused by subclinical zinc deficiency, dark-adaptation curves of seven women with primary hyperprolactinemia and seven normal women were measured to assess tissue zinc status. Although plasma zinc levels, final dark-adapted thresholds, and the time courses of rod dark-adaptation did not differ significantly between patients and normal subjects, the median cone plateau of the hyperprolactinemic patients was significantly higher (0.66 log units) than that of normal subjects. It appears unlikely that derangements of vitamin A metabolism, for which zinc is a cofactor, explains this unanticipated and subtle abnormality in dark adaptation of the hyperprolactinemic women.
Adult↗
Fat-soluble vitamin nutriture in primary biliary cirrhosis.
We measured serum levels of vitamins A, E, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D, as well as levels of abnormal (des-gamma-carboxy) prothrombin, in 52 patients with primary biliary cirrhosis. Decreased serum levels of retinol (vitamin A) and 25-hydroxyvitamin D and elevated levels of abnormal prothrombin were common in these patients and correlated with the histologic stage of the disease and with the clinical severity of disease as judged by elevated serum bilirubin levels and decreased serum albumin levels. The increased levels of abnormal prothrombin were due primarily to vitamin K deficiency but also, in part, to the severity of the liver disease itself. Vitamin E deficiency was rare. Only 1 patient had clinical manifestations of fat-soluble vitamin deficiency, night blindness, and gastrointestinal bleeding related to a marked prolongation of the prothrombin time. Deficiencies of fat-soluble vitamins are most likely to be present in jaundiced patients with long-standing, severe cholestasis. We suggest that fat-soluble vitamin status be determined in all patients with primary biliary cirrhosis by appropriate blood tests and that vitamin supplements be given only to those patients who require them.
Biomarkers↗
Nutrient supplement use by healthy elderly.
As part of a nutritional status survey of 691 non-institutionalized men and women aged 60 years and older, supplement use was reported by 45% of the males and 55% of the females. Supplement use was more prevalent in females than males at each age decade. Vitamins C and E were the most commonly used supplements. Mean dietary nutrient intakes were calculated from a 3-day food diary. The percentage of dietary intakes falling below 2/3 1980 Recommended Dietary Allowance (RDA) was comparable for users and non-users of supplements. Use of supplements markedly decreased the proportion of subjects with inadequate nutrient intake (using a 2/3 RDA criterion), particularly for vitamins B6, B12, and D, folic acid, and calcium. However, for both males and females, potentially excessive intake levels (10 times the RDA) of thiamin, vitamin A, and vitamin E supplementation were observed.
Aged↗
Dietary intakes and biochemical indicators of nutritional status in an elderly, institutionalized population.
A dietary and biochemical assessment of the nutritional status of 260 elderly men and women, 60-101 y (average 80.5 y), was conducted in 15 long-term-care facilities in the Boston area. Subjects were free of clinically apparent terminal or wasting illness. Nutrient intakes were comparable to those in a simultaneously studied free-living population as were most biochemical markers of nutrient status. Although no specific nutrient deficiencies were identified, blood levels of vitamin A and retinol-binding protein in males and of zinc in both sexes were lower in this institutionalized group than in the free-living subjects. Hematologic indices, albumin, prealbumin, and transferrin levels were also lower than in noninstitutionalized elderly populations. These differences may reflect the greater prevalence of chronic diseases and medication use in a long-term-care population. However, there is no evidence that institutionalization in itself leads to impairment of nutritional status.
Aged↗
Vitamin C status and nutrient interactions in a healthy elderly population.
Vitamin C status and interactions with other nutrients were studied in 677 healthy, noninstitutionalized elderly people aged 60-98 y. Although 6% of the males and 3% of the females showed marginal vitamin C status (plasma ascorbic acid 11 to less than 23 mumol/L), only one person had a plasma ascorbic acid (AA) level less than 11 mumol/L. At all levels of total vitamin C intake, mean plasma AA levels were higher in females than males. Vitamin C supplement use was associated with generally higher blood levels of vitamins B-6, B-12, and E and folate in both sexes and with higher levels of retinol in females. However, after both age and the total dietary intake of the specific nutrient being examined were controlled for, plasma AA levels were significantly correlated only with plasma levels of vitamin E and folate in females.
Aged↗