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Providing perspectives on recent research into vitamins and nutritionals

Archive for 'August 2015'


    Drug-Nutrient Interactions: Do We Want to Rely upon Nutrition or Drugs?

    Anthea Webb, WFP Indonesia Country Director, is quoted in the United Nations Global Nutrition Agenda (UNGNA v1.), “As we come to grips with the double burden of under- and over nutrition, empowering people to choose a healthy, balanced diet becomes even more urgent. The UN Global Nutrition Agenda will be judged by how it helps ease that burden.”  

    As someone trained in nutrition, I accept the premise that nutritional status affects disease risk. I especially believe in the 6th core principle underlying the UN’s interagency work on nutrition – Good nutrition is necessary for functioning education systems, social protection, and efforts to eradicate poverty and reduce inequality. As our CEO of DSM, Feike Sijbesma, has said, “You cannot be successful, nor call yourself successful, in a society that fails.” 

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    Age-Related Macular Degeneration Risk is Influenced by Vitamin D Status

    Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness as people age. Two large RCTs (AREDS and AREDS2) have demonstrated that increased consumption of antioxidant nutrients (vitamins C, E, zinc, copper, beta-carotene, lutein, zeaxanthin) can significantly decrease the progression of AMD by ~27%.

    The CARED study measured pigment density (MPOD) of lutein and zeaxanthin in the macula of the retina of 1,803 individuals. 

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    The Trick is Getting Nutrients, like the Book “George”, to as Many People as Possible

    To be frank, I am still perturbed by quotes in The Washington Post surrounding the secondary analysis of the AREDS2 randomized controlled trial (RCT) which was so aptly summarized by Dr Eric Ciappio yesterday.

    While it is entirely correct to say “We don’t know whether these supplements might be beneficial at an earlier age”, the AREDS2 study design and results do not support the statement “A much better bet for all-around brain and heart health is eating foods naturally high in omega-3 fatty acids, such as salmon, flaxseed, and walnuts.” Show me the evidence from RCTs to justify this statement. It doesn’t exist. There aren’t any placebo-controlled RCTs with salmon, flaxseed, or walnuts.

    Why recommend eating more fish? Are fish a more sustainable protein source? Or is it because of an inherent property, such as n-3 fatty acids? What about the risk of mercury contamination?

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    Square Pegs & Round Holes: Complications Of Interpreting Secondary Analyses of Nutrition RCTs

    In nutrition we depend on large clinical trials to answer important questions about the efficacy of nutrients. These studies are often designed to answer a single question – does vitamin D reduce fracture incidence? Do antioxidants prevent the progression of eye disease? When we try to answer questions other than what a study was designed to answer, it feels like we’re trying to put a square peg into a round hole. Sure, we can get it to fit, but does that mean it’s the right fit?  

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    How Does Food Insecurity Affect Nutrient Intakes?

    Pulitzer Prize winner Frank McCourt writes about the extreme food insecurity that he experienced growing up in the United States and Ireland in the 1930s and 1940s:

    "...everything was precious. I remember a loaf of bread that was precious because it was so little. My mother would bring home what they called a Vienna loaf. I remember one particular loaf of bread when we were so hungry. I can still taste it. So poverty does make things precious. It turns everything into jewelry."

    Food insecurity changes food choices and how we think about food. This can affect micronutrient intakes, as shown in a recent study of food security in South Korea.

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    Nutritional Harmony: Keeping PUFA and Vitamin E in Balance

    As I sat down to eat lunch today with my colleagues, they had a question for me: what is healthier to eat for breakfast, a fried egg or a bowl of cereal? Humans love dichotomies almost as much as talking about why their own dietary choices are the best, and my first reaction was to tell them that what I eat for breakfast, a bowl of natural muesli, is the superior choice. But with a second’s deliberation, my answer was that it depends. Good nutrition is not about what single food we eat at one moment in the day. Just as our total diet should be balanced, so should particular nutrients that work in tandem, like vitamin E and PUFA.

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    Fixing A Broken Vitamin D Status...That's Actually Broken

    In writing for TalkingNutrition, I routinely post blogs that say “if only this researcher did XYZ, they might have seen an effect!” (where XYZ is normally recruiting subjects with low nutrient status at baseline). It brings me great joy when I get to see a similar study to the one I just wrote the “if only!” blog about that actually did what I had wished for and then sees a positive effect. And it’s particularly exciting for me when both examples happen in the same week.

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    Study Questions Vitamin E Status of Americans

    Vitamin E (α-tocopherol) is an essential lipophilic antioxidant that plays a key role in protecting lipoproteins and membranes (cellular and intracellular) from free radical damage. Vitamin E has been identified as a ‘shortfall nutrient’ because >90% of Americans are not consuming recommended amounts of vitamin E.

    Based on serum α-tocopherol concentrations measured by federal agency laboratories in a nationally representative sampling of Americans (NHANES 2003-2006),

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    Multinational Nutrition Challenges in Toddlerhood

    Nutrition needs change throughout the lifespan, and the toddler years represent a time of great transition. Infants used to liquids and soft foods gradually take in more and “normal” foods, and by the time they reach the preschool years they have a diet that closely resembles that of their parents, albeit with more snacks. Toddlers have a high nutrient and energy demand: they need to support a fast growth rate, and their increasing levels of activity. We need to monitor the nutrient intakes and status of toddlers individually and in populations to make sure that they are meeting their nutrient needs. Does living in a different country affect nutrient intakes? Is there a difference between developing and developed countries?

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    Omega-3 Fatty Acids Linked with Joint Health and Rheumatoid Arthritis

    Every 1% increase in plasma phospholipid eicosapentaenoic acid (EPA) concentration (% of total fatty acids) is associated with a 12% increase in the probability of remission in rheumatoid arthritis, according to a new Br J Nutrition study.

    The patients had been diagnosed with rheumatoid arthritis within the past 12 months. They were randomized to receive 3.2g EPA + 2.3 g docosahexaenoic acid (DHA) daily (high-dose) or 0.21 g EPA + 0.19g DHA daily (low-dose) and results are presented after 1 year. 

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    Fixing A Broken Vitamin D Status

    The saying goes “if it ain’t broke, don’t fix it”. In other words, don’t expect something that’s already in good shape to get better when you try to tinker with it. Common sense tells us that tightening a screw that’s already tightened won’t help matters, yet we routinely fail to follow this same logic in nutrition intervention trials. Why do we continue to measure the impact of giving vitamins to people who are already replete and then expect to see results?

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    Can PUFA Intakes Affect Body Composition in Young Children?

    Adequate intakes of fat are important in the diets of infants and young children. The World Health Organisation gives advice regarding the role of fat in the diet: fats provide around half of the energy in the diets of infants aged up to 6 months, and should thereafter decline to providing around one quarter to one third of energy in adolescents. Some research has shown that PUFA intake is associated with reduced risk of the metabolic syndrome and may affect body composition by reducing waist circumference and body fat percentage in adults. Is there also a link in children?

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    Worried about Heart Health? Understanding the Roles of Nutrition and Drugs

    According to JAMA, a new class of lipid-lowering agents, PCSK-9 inhibitors, are being developed to treat patients with hyperlipidemia. These expensive specialty medications will be targeted to the 73 million adults (32%) in the US with elevated cardiovascular risk (elevated LDL-C). The authors fear these drugs will not be adopted because the American Heart Association (AHA) and American College of Cardiology (ACC) abandoned specific LDL-C target guidelines in 2013

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    Measuring Folate Status can Trump Genetics

    As a proponent of nutrition status assessments, a common reaction is that personalized insights into our genetics will be the most meaningful information. True but genetic assessments have to be interpreted to be meaningful. For micronutrients, deficiency states are already known. The cutoffs have been established. See the CDC Second Nutrition Report: A Comprehensive Biochemical Assessment of Nutrition Status.

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    Iodine Inadequacy may be Complicating Pregnancy Outcomes

    Iodine deficiency in pregnancy is a leading cause of preventable mental retardation worldwide. It is estimated that 18 million infants are mentally impaired due to iodine deficiency. Two new papers examine iodine deficiency among pregnant women in Europe and the cost/benefit ratio of iodine supplementation.

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    Pregnant? Did you know Maternal Omega-3 Status may Affect a Child’s Development?

    Pregnancy is one of the most important developmental periods of life. During pregnancy, mothers transfer nutrients from their circulation to the baby by way of the placenta. The capacity to provide essential nutrients (vitamins, minerals, long-chain polyunsaturated fatty acids (LCPUFA)) depends upon their availability in maternal circulation and body stores. When nutritional status is assessed during pregnancy, the information can be used to determine its effect on the child’s development.

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    Don’t Worry - Just Focus on Consuming Recommended Amounts of EPA+DHA

    If you read any articles suggesting that more omega-3 fatty acids are deposited into the body from krill oil than fish oil, check the citation. A new study by Ghasemifard and colleagues compared the bioavailability and metabolic fate of n-3 fatty acids from krill oil and fish oil in a rat study. There were no diet-related differences in body weight, tissue weights, or whole-body lipid content between the dietary treatments. As the authors note, oil-related differences in apparent n-3 fatty acid digestibility were small, less than 1%.

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    Think About It: Children & Adolescents NEED Omega-3 Fatty Acids

    Adolescent depression has been associated with low DHA and EPA concentrations in red blood cells (RBC). Because brains are still developing during adolescence and DHA is an important component of cell membranes, research in animal models finds that maintaining sufficient DHA concentrations throughout adolescence increases resiliency to emotional stressors.

    Ooi and colleagues hypothesized that omega-3 fatty acid supplementation would increase RBC fatty acid concentrations and improve behavioral measures in children and adolescents diagnosed with Autism Spectrum Disorder. 

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    Are Your Brain and Muscles Getting Enough Vitamin D?

    While experts may wonder how much vitamin D is enough, new research finds increased risk of developing Alzheimer’s diseases and dementia if vitamin D status is low. In a meta-analysis with 10 studies published between 2010-2015, Sheng and Ji report 21% and 63% increased risk of developing Alzheimer’s disease and dementia, respectively, in subjects with serum 25(OH)D concentrations < 50nmol/L (vs >50 nmol/L). 

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