The effects of oral vitamin supplementation on cardiovascular risk factors.
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Vitamin deficiency is a result of gradual depletion of body stores secondary to poor dietary habits or to disease. Marginal or preclinical vitamin deficiency results in nonspecific symptoms such as malaise, irritability or somnolence, loss of appetite and weight, and impairment of psychologic and physical performance socially or at work. These signs precede clinical signs of disease. The elderly are particularly vulnerable to vitamin deficiency because of the high incidence of illness and disability in the later years of life and because of other common problems, such as low income, poor appetite, and social isolation.
Poor oral health is not a result of normal aging, but rather reflects systemic disease, use of medications, inadequate nutrition, or lack of preventive dental care. The primary care physician usually sees elderly patients much more often than does the dentist and thus has an important role in maintenance of good oral health status. He or she thus should be familiar with normal orofacial anatomy and should routinely include a complete oral examination in the general physical examination. A patient with poor oral health should be referred to a dentist for necessary treatment and preventive care.
Foods rich in vitamins, especially those containing beta carotene and vitamin C, lower the risk of cancer in humans. Whether vitamins alone are responsible for this reduced risk is not known. They may work synergistically with increased dietary fiber and decreased fat intake. Vitamin supplementation at doses higher than the recommended daily allowance is, at present, an unknown factor in preventing cancer and may cause toxic effects in some instances. Consuming megadoses doses of any vitamin or mineral as a cancer preventive should be discouraged. Physicians need to take a more aggressive stance against alternative health care providers who recommend questionable dietary or nutritional regimens. Because of the proliferation of food quacks in recent years and the danger they represent to the general public, physicians need to make preventive health care an important part of their responsibility. This includes educating patients on proper nutrition.
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In order to examine the nutritional status of the population of Linxian (in Henan, China) known to be at high risk for esophageal cancer (EC), we analyzed blood samples and conducted 3-day dietary surveys on 3 groups of normal adults, age 40-50, from Henan province. Two groups were from Linxian, where the EC mortality rate is about 138/100,000 (Group C, consisting of volunteers with a family history of EC, and Group NC, consisting of those who did not have a family history of EC). The third group, Group F, was from Fanxian, where the EC mortality rate is about 24/100,000. The average plasma retinol level was found to be about 0.27 micrograms/ml in all 3 groups; about 13%-20% of the individuals had a level less than 0.2 micrograms/ml. The average plasma carotene level of all 3 groups appeared to be adequate, ranging from 0.5-1.0 micrograms/ml. About 23% of the subjects in both Groups C and NC had low (less than 2 micrograms/ml) plasma ascorbate levels; in Group F, 16% had low ascorbate levels. Less than 12% of the individuals in each of the 3 groups had erythrocyte glutathione reductase activation coefficients less than 1.2, indicating a widely occurring riboflavin deficiency. Consumption of alcoholic beverages was not found to be a contributing factor to EC. The results of the present study reveal a deficiency of vitamins in the study populations, but do not indicate that the average nutritional status of the volunteers in Group C was worse than that of Groups NC and F with regard to vitamin A, ascorbate, and riboflavin.
The nutritional status of individuals from areas of South Africa that are known for having a high incidence of esophageal cancer was investigated. Our results show that individuals living in high-risk areas differ significantly from those in low-risk areas with respect to vitamins A, E, and B12 in addition to folate. These results suggest that deficiencies in these nutrients may play a significant role in the etiology of esophageal cancer.
The relationships between nutrition and immune defence in man are poorly understood. The clinical situations of nutritional origin involving immune deficiency: protein energy malnutrition (marasmus and kwashiorkor), nutritional disorders in developed countries, anorexia, obesity, mineral salt and vitamin deficiencies, hypercholesterolemia and alcoholism are reviewed.
This report describes various clinical and micro-nutrient abnormalities that existed in a 47-year-old woman who underwent a jejunoileal bypass operation. She exhibited extensive electrolyte, mineral, amino acid, and vitamin deficiencies. Amino acid absorption tests indicated an inability to absorb essential amino acids, especially the branched-chain and aromatic varieties. Vitamin absorption tests indicated an inability to notably absorb folic acid, niacin, vitamins B6, A, and E; the fat-soluble beta-carotene (provitamin A) was not absorbed from the diet. A liver biopsy revealed that 80% of the tissue was filled with fatty cysts. The ensuing liver disease compounded with biochemical abnormalities due to the bypass, contributed to the patient's death.
Folate, thiamin, nicotinate, biotin, riboflavin, pantothenate, vitamins A, B6, B12, C, E, and beta-carotene were determined in: (a) eight patients before and after one plasma exchange; (b) in one patient after five consecutive treatments; (c) in three patients before and 2-8 weeks after plasmapheresis. Vitamin B12, beta-carotene, vitamin B6, and vitamins A, C, E were depressed after acute or chronic plasmapheresis. Concentrations of folate, thiamin, nicotinate, biotin, riboflavin, and pantothenate were essentially unchanged after one plasma exchange.
A considerable body of evidence suggests that oxidant stress results in inflammation and tissue damage in the respiratory system, and later in immune damage, and that individuals with lowered cellular reducing capacity are at increased risk to develop asthma. Reducing capacity in the erythrocyte is generated through the pentose phosphate pathway and this pathway also generates a major portion of the reducing capacity in all cells of the body. Therefore, dietary, environmental, and genetic factors which diminish cellular reducing capacity will increase tissue vulnerability to oxidant stress and are likely to increase asthma risk. Dietary selenium deficiency lowers red cell glutathione peroxidase activity and is associated with an increased risk for asthma, and low dietary intakes of vitamins C and E also appear to increase asthma risk. High body iron stores increase free radical production and may also elevate asthma risk. Environmental lead exposure depresses the activities of a several enzyme systems that influence cellular reducing capacity (glucose-6-phosphate dehydrogenase, NAD synthetase, glutathione peroxidase, superoxide dismutase, catalase) and consequently may increase asthma risk. Genetically-determined low activity of glucose-6-phosphate dehydrogenase lowers cellular reducing capacity and may also heighten asthma risk. Simple dietary and environmental interventions may significantly reduce oxidant stress and prevent or minimize the development of asthmatic symptoms and should prove to be a cost effective approach to asthma management in addition to current pharmacological strategies.