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[Hepatobiliary and pancreatic disorders as risk factors for fat-soluble vitamin deficiencies].

The aim of this article is to describe the fat-soluble vitamin status in patients with hepatobiliary and pancreatic diseases, and the contribution of these vitamin deficiency or excess to hepatic injury. A considerable number of patients with advanced liver disease and cholestasis might actually be fat-soluble vitamin deficient, although clinical signs of deficiency are uncommonly seen in patients with vitamin A and E deficiency. Increased bone resorption may be the predominant cause of hepatic osteodystrophy. On the other hand, the possible causes of vitamin K deficiency seen in patients with hepatobiliary disease are the decrease of vitamin K absorption from intestine, the disturbance of vitamin K cycle and the decrease of pool area for vitamin K storage. The intake of vitamin A may be associated with the risk of liver cirrhosis in lifetime teetotalers, although the retinyl palmitate reduces hepatic fibrosis in rats.

Avitaminosis↗

[Recent advances in geriatric vitaminology].

The recent report concludes that elderly people have satisfying the recommended daily allowance in nutritional consumption except for calcium. However, those who are institutionalized, of low income, alcoholic and living alone are at high risk of vitamin deficiency. The high incidence in vitamin deficiency is shown when vitamin levels were measured with biological activity. Physiological range of vitamin seems to be enough to normalize this deficiency and nutritional supplementation would be useful. Those who are with the lack of calcium consumption or of time spent under the sunshine are at higher risk of having fracture. This is because of secondary hyperparathyroidism triggered by the decreased concentrations in serum calcium and 25-hydroxy-vitamin D3 level, and it is suspected to be the cause of osteoporosis among the elderly. To prevent the progression of osteoporosis in the elderly, serum PTH level needs to be kept in the normal range, and 100 IU/day, the recommended daily allowance of vitamin D in Japan, is far too small.

Aged↗

[Vitamin and dermatology].

Vitamin A, B1, B2, B6, B12, biotin, nicotinic acid, panthotenic acid, vitamin C, E and K have been used for various skin disorders. The use is mostly based on the similarity of the skin manifestations seen in their deficiencies, except for the rare cases of clear deficiency like pellagra. Recent introduction of vitamin A and D analogues for psoriasis and keratinization disorders resulted in significant progress in clinical dermatology. Application of vitamin C, E and beta-carotene++ for UV-induced skin damages are being studied, and the vitamins will be more important in dermatology in the future.

Avitaminosis↗

[A case of various neurological deficits caused by multi-vitamin deficiency associated with malabsorption syndrome after pancreatomy and small bowel resection].

A 34-year-old woman presented with walking difficulty and pain in the legs 3 years after several abdominal operations for pancreatic cancer and intestinal obstruction thereafter. Corneal erosion, loss of deep sensation in the legs, polyneuropathy, myopathy, and memory disturbance were recognized. Deficiency of multiple vitamins (A, B1, B6, D, E, K) was found. The diagnoses were vitamin A-deficient corneal erosion, vitamin K-deficient bleeding abnormality (asymptomatic), and the neurological deficits caused by vitamin E, B1, B6 and D deficiency. Although the vitamin supplement started 2 years after the onset of the neurological disease, both clinical and electrophysiological recovery was seen. She was unable to walk on admission, but became able to walk after vitamin E supplement. To our knowledge, this is the first report showing multi-vitamin deficiency causing extensive neurological, ophthalmological, and hematological deficits. Recognition of this condition would prevent the progression of potentially irreversible neurological disorders in patients with malabsorption syndrome after extensive abdominal surgery.

Adult↗

Vitamins: common supplements and therapy.

Vitamin supplements and therapies have recently gained popularity because of current scientific studies supporting their benefits. Although many consumers are taking vitamins and other supplements, they may not be aware of the numerous benefits and hazards associated with many of these over-the-counter substances. Clinicians should be familiar with common vitamin products so that they may prescribe and monitor their use. This article provides an overview of fat- and water-soluble vitamins, and addresses functions, deficiency effects, recommended dietary allowances, therapy uses, toxicity concerns, and food sources.

Adolescent↗

[Seasonal variations of vitamin sufficiency in pregnant women (Mzensk City)].

The investigation of sufficiency of vitamin C, A, E, B2, B6, carotenoids and iron dietary intake has been carried out in 61 pregnant women in spring and early autumn 1998. There were no women adequately supplied with all vitamins irrespective of season and residence. Most of them (70-80 per cent) had combined deficiency of 3-5 vitamins in spring. About 50 per cent of women had combined insufficiency of vitamins and iron. Intake of vitamins improved in autumn especially due to vitamins C, A, E and carotenoids. The frequency of 3-5 vitamins deficit decreased while occurrence of combined deficiency of vitamin B6 and carotenoids still often took place. Thus, normalization of vitamin status of pregnant women is necessary all year round.

Adult↗

[The eye and nutrition].

PURPOSE: To examine the effect of vitamins and trace elements on ocular tissue. MATERIALS AND METHODS: Rats or mice were fed diets deficient in the trace elements Zn, Cu, Mn, Se, Mg, and Cr or in vitamins A, B12, C, and E. In some rats Al and vitamin A were injected in excessive amounts. We studied the conjunctiva, cornea, retina, and optic nerve with a light microscope, transmission and scanning electron microscopes, an energy dispersive X-ray analyser, and an ion microscope. Histochemical, cytochemical, and immunohistochemical techniques were applied to the pathological specimens. RESULTS: Deficiencies of Zn, Cu, Mn, and vitamins A, C and E caused a loss of goblet cells in the conjunctiva and a prominent decrease of microvilli and microplicae in the conjunctiva and cornea. The elements in the goblet cells were changed in these conditions. In addition, epithelial cells showed poor fibrous development and abnormal distribution of chromatin in the nucleus. Zn, Cu, Mn, and vitamins A and E deficiencies caused photoreceptor cells to degenerate and disappear. Se deficiency reduced the horizontal and amacrine cells. Vitamin B12 deficiency reduced nerve fibers in the nerve fiber layer of the retina. Mg deficiency induced multifocal necrosis in the retinal pigment epithelium and apoptotic nuclear changes in the photoreceptor cells. Cr deficiency showed abnormal phagocytosis of the photoreceptor outer segment discs in the retinal pigment epithelium. Vitamin B12 was found to be related to the circadian rhythm in the retina. Deficiencies of Zn, Cu, Mn, and vitamins A, B12, and E induced degeneration and disappearance of myelin lamellae in the myelinated optic nerve fibers. In hypervitaminosis A, lipid droplets appeared in the retinal pigment epithelium and alcohol dehydrogenase disappeared in the retinal pigment epithelium and photoreceptor outer segments. Excessive Al was toxic to the retina, which showed disappearance of photoreceptor cells. Al deposits were seen in dendrites and neurons in the outer plexiform layer. Zn seemed to be necessary for corneal epithelial cell wound healing. DISCUSSION: Trace elements usually are contained in enzymes, which have many metabolic functions. They are related to synthesis and breakdown of many substances. Some trace elements such as Zn, Cu, Mn, and Se and vitamins including vitamins A, C, and E prevent peroxidation of lipids. Some vitamins have an affinity for specific tissues such as epithelial cells, nerve fibers, and neuronal cells and are needed for cell differentiation, development, and maintenance. CONCLUSION: Cu, Zn, Mn, Se, Mg, and Cr and vitamins A, B12, C, and E are necessary for maintenance of cellular structure and metabolism.

Animals↗

Nutrients and HIV: part two--vitamins A and E, zinc, B-vitamins, and magnesium.

There is compelling evidence that micronutrient deficiencies can profoundly affect immunity; micronutrient deficiencies are widely seen in HIV, even in asymptomatic patients. Direct relationships have been found between deficiencies of specific nutrients, such as vitamins A and B12, and a decline in CD4 counts. Deficiencies appear to influence vertical transmission (vitamin A) and may affect progression to AIDS (vitamin A, B12, zinc). Correction of deficiencies has been shown to affect symptoms and disease manifestation (AIDS dementia complex and B12; diarrhea, weight loss, and zinc), and certain micronutrients have demonstrated a direct anti-viral effect in vitro (vitamin E and zinc). The previous article in this series focused on selenium and beta carotene deficiencies in HIV/AIDS. This literature review elucidates how deficiencies of the micronutrients zinc, magnesium, vitamins A, E, and specific B vitamins relate to HIV symptomology and progression, and clearly illustrates the need for nutritional supplementation in HIV disease.

Avitaminosis↗

[Nutritional deficiency and Alzheimer's disease: how to identify and prevent].

Weight loss is a very common problem for patients with Alzheimer's Disease (AD), whether they live at home or in long-term care facilities. At any rate it depends on an imbalance between energy expenditure and intake. Though in the initial phases of the illness, the weight loss might be caused by socio-environmental and psychological factors and reduced autonomy, in the following stages it depends on Adversive Feeding Behaviours (AFBs). The AFBs invariably lead to protein, fat and sugar deficits as well as a vitamin deficit which presents a positive correlation with the cognitive performance level and negatively affects the course of the disease. Thus it is important to identify AFBs (Blandford Scale) as soon as possible, especially when they can be treated. Furthermore it is very important to recognise weight loss immediately and identify a possible malnutrition state, using investigative methods which allow for follow-up monitoring (Mini Nutritional Assessment). Pharmacological therapy of cognitive deficit and AFBs together with possible contemporary conditions (depression) and intervention on the nutrition, will be useful to avoid a deficiency state and the consequent negative repercussion on the disease.

Aged↗

Nutrient intake among two-year-old children on cows' milk-restricted diets.

UNLABELLED: Approximately 2-3% of young children develop allergy or intolerance to cows' milk. The only available treatment is elimination of milk from the diet. However, as milk is an important source of nutrients in childhood, a milk-free diet may not adequately meet the child's nutritional needs. A dietary survey was conducted to assess the nutrient intake of children on cows' milk-restricted diets. A population-based sample of families with young children (31-37 mo) with adverse reaction to cows' milk and/or eggs was contacted, of which 75% agreed to complete a dietary intake assessment. Dietary intake was assessed using a 4-d weighed recording. The nutrient intake in a group of children on cows' milk protein-free (n = 16) and cows' milk reduced (n = 8) diets were compared to a group of cows' milk consumers (n = 10). There were significant differences in nutrient intake of children on milk-free diets and children consuming milk. Children on milk-free diets had significantly lower intake of energy, fat, protein, calcium, riboflavin and niacin. Use of milk substitutes improved the nutritional content of the cows' milk-free diets; however, the recommendations for riboflavin and calcium were still not met. CONCLUSION: The results reveal a risk for malnutrition in children on cows' milk-free diets, unless precautions are taken to replace the valuable nutrients from milk in the diet. Parents of children on milk-free diets need advice about food choices in order to reduce the risk of low intake of energy, fat and protein. Supplements with calcium, vitamin D and riboflavin are indicated.

Animals↗

Drugs-nutrient interactions: a potential problem during adolescence.

The concept of drug-nutrient interactions is not new, but it has only recently gained currency in medicine. Although the elderly are normally considered to be at particular risk, other groups may also be at risk: infants, adolescents, pregnant women, alcohol and tobacco users, etc. In infants and adolescents there are several factors that may influence the possible interactions: firstly, nutrient needs are usually higher, mainly micronutrients; systems for detoxification of anutrients are not complete; the tendency to restricted diets (especially girls) that are unable to cover the actual recommended intakes for a number of micronutrients (i.e. vitamins); and the dangerous increase in alcohol consumption either in males or females. Administration of drugs in population with adequate vitamin intake is usually not a problem, but administration of drugs in those with borderline intake of vitamins or in patients with low nutritional status can result in symptomatic vitamin deficiency states. The groups at risk of poor vitamin status are smokers (a high proportion of adolescents are active smokers); dieters (skipping meals and dieting to lose weight frequently compromise micronutrient intake, and it should be considered that it is extremely difficult to meet all the requirements at intakes of less than 1,200 calories per day), oral contraceptive users, and pregnant and lactating women, excessive alcohol users, etc. The chapter also focuses on the case of folate: rapidly dividing tissues during the adolescent growth spurt increase requirements for folate. Because of this increased need, folate status appears to be of concern during the age of this rapid growth. A variety of drugs are known to interfere with vitamin utilization by blocking or altering transformation of the vitamin to its metabolically active form. Serum folate levels are known to be low in a high percentage of patients with rheumatoid arthritis, suggesting that aspirin alters the transport of folate by competition for binding sites on serum proteins. Methotrexate, a drug commonly used at low doses for the treatment of psoriasis, rheumatoid arthritis and certain liver disorders, limits the availability of methyl groups derived from one-carbon metabolism by inhibiting competitively a key enzyme in the intracellular folate metabolism. In humans, the antiepileptic drug valproic acid (VPA) is associated with two major adverse effects: teratogenicity and folate deficiency. The mechanisms by which VPA exerts the teratogenic or antifolate effect remain unclear, but an alteration in the methionine cycle is the strongest hypothesis proposed.

Adolescent↗