RESUMEN
The published literature supports the high prevalence of supplement use in children and adolescents in the United States. Pediatricians today are faced with questions from parents and patients about the benefits, safety, efficacy, and correct dose of vitamins and minerals. In this article, we review 7 vitamins with the most clinical relevance as judged by abundance in food, risks and symptoms of deficiency, and potential for toxicity. Specifically, we focus on possible clinical scenarios that can be indicative of nutritional deficiency. We synthesize and summarize guidelines from nutrition experts, various medical societies, the World Health Organization, and the American Academy of Pediatrics.
Asunto(s)
Avitaminosis , Vitaminas/efectos adversos , Adolescente , Avitaminosis/diagnóstico , Avitaminosis/etiología , Avitaminosis/terapia , Lactancia Materna , Niño , Dieta/efectos adversos , Dieta/métodos , Suplementos Dietéticos , Humanos , Lactante , Pediatría , Relaciones Profesional-Familia , Ingesta Diaria Recomendada , Medición de Riesgo , Factores de Riesgo , Vitaminas/uso terapéuticoRESUMEN
BACKGROUND: The usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common. METHODS: This cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B12, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies. RESULTS: CRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP. CONCLUSIONS: Infections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.
Asunto(s)
Avitaminosis/epidemiología , Proteína C-Reactiva/metabolismo , Enfermedades Transmisibles/epidemiología , Adolescente , Adulto , Avitaminosis/etiología , Enfermedades Transmisibles/etiología , Estudios Transversales , Femenino , Humanos , Indígenas Centroamericanos/estadística & datos numéricos , Lactancia , Panamá/epidemiología , Embarazo , Adulto JovenRESUMEN
OBJECTIVES: Byler disease, originally described in Amish kindred, results from mutations in ATPase Class I Type 8b Member 1 (ATP8b1). Specific clinical reports of Amish Byler disease were last published 40 years ago. These investigations were directed at the present detailed clinical understanding of the early course of hepatic manifestations of Byler disease. METHODS: This study analyzed routine clinical practice and outcomes of children with Byler disease (defined by homozygous c.923G>T mutation in ATP8b1), who initially presented to Children's Hospital of Pittsburgh of UPMC between January 2007 and October 2014. Data were analyzed to the earlier of 24 months of age or partial external biliary diversion. RESULTS: Six children presented between 1 and 135 days of life: 2 presented with newborn direct hyperbilirubinemia, 2 had complications of coagulopathy, 1 had failure to thrive and rickets, and 1 sibling was identified by newborn genetic testing. Intensive fat-soluble vitamin supplementation was required to prevent insufficiencies in vitamins D, E, and K. Hyperbilirubinemia was variable both over time and between children. Serum bile acid levels were elevated, whereas γ-glutamyltranspeptidase levels were low normal. Scratching behavior (pruritus) was intractable in 4 of 6 children with onset between 6 and 12 months of age. Features of portal hypertension were not observed. Partial external biliary diversion was used during the second year of life in 4 children. CONCLUSIONS: Detailed analysis of Byler disease revealed varied disease presentation and course. Nutritional issues and pruritus dominated the clinical picture in the first 2 years of life.
Asunto(s)
Adenosina Trifosfatasas/genética , Conductos Biliares/patología , Colestasis Intrahepática/patología , Hígado/patología , Mutación , Avitaminosis/etiología , Ácidos y Sales Biliares/sangre , Conductos Biliares/cirugía , Colestasis Intrahepática/epidemiología , Colestasis Intrahepática/terapia , Insuficiencia de Crecimiento/epidemiología , Insuficiencia de Crecimiento/etiología , Pruebas Genéticas , Hospitales , Humanos , Hiperbilirrubinemia/epidemiología , Hiperbilirrubinemia/etiología , Incidencia , Lactante , Recién Nacido , Pennsylvania/epidemiología , Prevalencia , Prurito/etiología , Raquitismo/epidemiología , Raquitismo/etiología , gamma-Glutamiltransferasa/sangreRESUMEN
Bariatric surgery is an effective treatment to reduce obesity by means of procedures aimed at restricting food intake and /or malabsorption. All procedures cause anatomic and functional changes that alter digestive physiology and reduce macro and micronutrients bioavailability. In the long run, surgical, metabolic and nutritional complications might occur. Anemia, vitamins and minerals deficiency are more frequent with malabsorption techniques, but they may also occur with restrictive techniques. Vitamin deficiency can cause neurological, hematologic and bone disorders, some of them with severe clinical manifestation. After bariatric surgery it is recommended to prescribe specific nutritional supplements and control patients periodically for prevention, early diagnosis and treatment of any complications.
La cirugía bariátrica es un efectivo tratamiento para reducir la obesidad mediante técnicas que sólo restringen la ingesta de alimentos y otras que además disminuyen la absorción intestinal. Todos los procedimientos causan cambios anatómicos y funcionales que alteran la fisiología digestiva y disminuyen la biodisponibilidad de macro y micronutrientes. En el largo plazo, pueden ocurrir complicaciones quirúrgicas, metabólicas y nutricionales, entre las que destacan anemia, deficiencia de vitaminas y minerales que son más frecuentes con las técnicas de mala absorción, pero también pueden ocurrir con técnicas restrictivas. La deficiencia de vitaminas produce alteraciones neurológicas, hematológicas y óseas que en algunos casos pueden ser severas. Después de la cirugía bariátrica se recomienda la administración de suplementos nutricionales específicos y controlar periódicamente a los pacientes para prevención, diagnóstico y tratamiento precoz de eventuales complicaciones.
Asunto(s)
Humanos , Cirugía Bariátrica/efectos adversos , Obesidad/cirugía , Avitaminosis/etiología , Avitaminosis/terapia , Hierro/uso terapéutico , Hipoglucemia/etiología , Hipoglucemia/tratamiento farmacológico , Complicaciones Posoperatorias , /uso terapéutico , Vitamina D/uso terapéuticoRESUMEN
Restricted food intake after bariatric surgery can be an important factor both in the long-term control of body weight and in the onset of nutritional deficiencies. The objective of this study was to assess the adequacy of food intake in women two or more years after bariatric surgery according to the excess weight lost. A group of 141 women who underwent banded Roux-en-Y gastric bypass (RYGB) was divided according to the percentage of excess weight they lost (%EWL)<50; 50â¤75; = 75. The habitual energy and nutrient intakes were determined by a 24-hour recall over two days and the probability of adequate intake was based on the Dietary Reference Intake. The mean total estimated energy requirement (EER) as well as energy, macronutrient and cholesterol intakes did not differ among the groups. Only the %EWL<50 group had an intake equal to their EER, but they presented a higher number of inadequacies, such as low levels of magnesium, folic acid and vitamins C and E. Calcium and dietary fiber intakes were extremely low in all three groups. In conclusion, weight loss after surgery is associated with food habits that favor energy intake over micronutrient intake.
Asunto(s)
Dieta , Ingestión de Energía , Derivación Gástrica , Desnutrición/epidemiología , Necesidades Nutricionales , Obesidad/cirugía , Pérdida de Peso , Adulto , Avitaminosis/etiología , Colesterol en la Dieta/administración & dosificación , Registros de Dieta , Metabolismo Energético , Conducta Alimentaria , Femenino , Humanos , Incidencia , Deficiencia de Magnesio/etiología , Desnutrición/etiología , Persona de Mediana Edad , Política Nutricional , Complicaciones PosoperatoriasRESUMEN
Is well known that obesity has increased significantly in recent times and therefore many dietary supplements, synthetic or natural, have been proposed in order to prevent and/or to treat obesity or overweight. Chitosan, a polysaccharide with ability to act as a carrier and to absorb fat, has been used for this purpose. However, interactions with other molecules present in the body may also occur and, therefore, the purpose of this study was to evaluate interactions of chitosan with vitamin B12. Spectroscopic properties of vitamin B12 (acid aqueous solution) were monitored in the absence and the presence of chitosan in order to evaluate possible interactions between the two. Results showed that the rigid micro-environment generated by chitosan solution modifies the photophysical properties of vitamin B12. Thus, chitosan is able to eliminate vitamin B12 and, based on this information, some care must be taken during prolonged treatment with chitosan.
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Fármacos Antiobesidad/efectos adversos , Avitaminosis/etiología , Quitosano/efectos adversos , Suplementos Dietéticos/efectos adversos , Obesidad/metabolismo , Procesos Fotoquímicos , Vitamina B 12/metabolismo , Fármacos Antiobesidad/química , Fármacos Antiobesidad/uso terapéutico , Avitaminosis/metabolismo , Avitaminosis/prevención & control , Quitosano/química , Quitosano/uso terapéutico , Obesidad/tratamiento farmacológico , Vitamina B 12/químicaRESUMEN
OBJECTIVE: The objective of this study was to determine whether constant daily vitamin supplementation would be sufficient to prevent possible vitamin deficiencies in obese patients undergoing bariatric surgery. METHODS: The study was conducted on 58 men and women (mean age 41 ± 10 y) who underwent Roux-en-Y gastric bypass RYGB and were assessed preoperatively and at 3, 6, and 12 mo after surgery. During the postoperative period, the patients received a multivitamin-mineral supplement on a daily basis. RESULTS: Serum ß-carotene and vitamin C were lower starting from the third postoperative month and continued to be low after 12 mo, and vitamin A was decreased by the sixth month and increased by 12 mo. Vitamin B12 levels were stable up to 6 mo but were decreased by 12 mo. Folic acid levels increased from the third month and remained higher throughout follow-up. One year after surgery there were 19% and 21% increases in the number of patients with vitamin A and vitamin C deficiency, respectively, and a 4% decreased of patients with folic acid deficiency. CONCLUSION: Weight loss and improvement in patients' general condition followed surgery, but serum levels of some vitamins were decreased despite the use of a vitamin-mineral supplement. These patients need continuous follow-up and individualized prescription of supplementation after the surgical procedure to prevent and treat vitamin deficiencies.
Asunto(s)
Avitaminosis/prevención & control , Suplementos Dietéticos , Derivación Gástrica , Obesidad/cirugía , Complicaciones Posoperatorias/prevención & control , Vitaminas/uso terapéutico , Adulto , Avitaminosis/epidemiología , Avitaminosis/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad/sangre , Complicaciones Posoperatorias/epidemiología , Prevalencia , Vitaminas/sangre , Vitaminas/farmacologíaRESUMEN
Obesity is a serious health problem and its prevalence has increased over the years. Studies have assessed the polysaccharide chitosan as anti-obesity supplement due to its ability to absorb fats. However, this property may cause the interaction of chitosan with essential substances for the proper functioning of the body, such as vitamins. In this context, the purpose of the present study was to evaluate interactions of the chitosan with vitamin B2. These interactions were evaluated in the absence and the presence of acid aqueous solution of chitosan using fluorescence and ultraviolet-visible absorption measurements of vitamin B2. Results showed that the rigid microenvironment generated by chitosan solution modifies the photophysics properties of vitamin B2. Thus, chitosan is able to eliminate vitamin B2 and the present study aims to warn of excessive loss of vitamins or other nutrients by the body during prolonged treatment with chitosan.
Asunto(s)
Avitaminosis/etiología , Quitosano/farmacología , Suplementos Dietéticos/efectos adversos , Hipolipemiantes/farmacología , Obesidad/tratamiento farmacológico , Riboflavina/metabolismo , Absorción , Quitosano/uso terapéutico , Interacciones Farmacológicas , Fluorescencia , Humanos , Hipolipemiantes/uso terapéuticoRESUMEN
BACKGROUND: Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. METHODS: This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. RESULTS: It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. CONCLUSION: This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.
Asunto(s)
Avitaminosis/prevención & control , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Vitaminas/uso terapéutico , Adulto , Avitaminosis/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Periodo PosoperatorioRESUMEN
A obesidade é uma condição crônica que tem se tornado prevalente ao redor do mundo. Os tratamentos clínicos incluem dieta, exercícios, alteração comportamental e uso de medicações. A cirurgia deve ser reservada para os pacientes obesos mórbidos que não respondem às terapias não invasivas para perda de peso. Durante as últimas décadas, a cirurgia bariátrica se expandiu rapidamente e cada vez mais mulheres jovens estão procurando esta forma de tratamento, o que pode causar um aumento no número de gestações após a perda de peso. A gravidez após a cirurgia bariátrica nos traz uma série de questionamentos e preocupações a respeito da gestante e de seu feto. A suplementação nutricional e a monitorização intensiva antes, durante e após a gravidez podem ajudar a evitar complicações relacionadas à nutrição e melhorar a saúde materno-fetal, e os obstetras devem estar preparados para lidar com esse tipo de paciente, que será cada vez mais freqüente na prática diária em um futuro próximo.
Asunto(s)
Femenino , Embarazo , Humanos , Atención Prenatal/métodos , Avitaminosis/etiología , Monitoreo Fisiológico/métodos , Obesidad Mórbida/cirugía , Resultado del Embarazo , Embarazo de Alto RiesgoRESUMEN
PURPOSE OF REVIEW: The number of adolescent and adult patients submitting to bariatric surgery is increasing rapidly around the world. This review describes the literature published in the last few years concerning nutritional deficiencies after bariatric surgery as well as their etiology, incidence, treatment and prevention. RECENT FINDINGS: Although bariatric surgery was first introduced in the 1950s, safe and successful surgical management has progressed over the last two decades and longer post-surgical follow-up data are now available. Most of the patients undergoing malabsorptive procedures will develop some nutritional deficiency, justifying mineral and multivitamin supplementation to all postoperatively. Nutrient deficiency is proportional to the length of absorptive area and to the percentage of weight loss. Low levels of iron, vitamin B12, vitamin D and calcium are predominant after Roux-en-Y gastric bypass. Protein and fat-soluble vitamin deficiencies are mainly detected after biliopancreatic diversion. Thiamine deficiency is common in patients with frequent vomiting. As the incidence of these deficiencies progresses with time, the patients should be monitored frequently and regularly to prevent malnutrition. SUMMARY: Nutritional deficiencies can be prevented if a multidisciplinary team regularly assists the patient. Malnutrition is generally reverted with nutrient supplementation, once it is promptly diagnosed. Especial attention should be given to adolescents, mainly girls at reproductive age who have a substantial risk of developing iron deficiency. Future studies are necessary to detect nutrient abnormalities after new procedures and to evaluate the safety of bariatric surgery in younger obese patients.
Asunto(s)
Avitaminosis/etiología , Trastornos Nutricionales/etiología , Obesidad Mórbida/cirugía , Estómago/cirugía , Anastomosis en-Y de Roux/efectos adversos , Anemia Ferropénica/etiología , Anemia Ferropénica/prevención & control , Avitaminosis/epidemiología , Desviación Biliopancreática/efectos adversos , Suplementos Dietéticos , Derivación Gástrica/efectos adversos , Humanos , Absorción Intestinal , Minerales/administración & dosificación , Minerales/metabolismo , Trastornos Nutricionales/tratamiento farmacológico , Trastornos Nutricionales/prevención & control , Complicaciones Posoperatorias , Vitaminas/administración & dosificaciónRESUMEN
Liver disease, alcohol and malnutrition are combinations usually associated with micronutrient impairment. Chronic liver disease courses with lower storage and activation of vitamin-coenzymes related to their malabsorption. Alcohol worsens the picture by reducing food intake, ncreasing micronutrients utilization and decreasing their absorption secondary to either intestinal or pancreatic injuries. Other concurrent causes would be drug treatments, urinary losses, protein deficiency and oxidative stress. As consequences the clinical signs are anemia, liver steatosis, oxidative stress and immunosuppression
Asunto(s)
Humanos , Alcoholismo/metabolismo , Anemia/etiología , Avitaminosis/etiología , Hepatopatías Alcohólicas/metabolismo , Micronutrientes/metabolismo , Estrés Oxidativo , Alcoholismo/complicaciones , Enfermedad Crónica , Hepatopatías Alcohólicas/complicacionesRESUMEN
Liver disease, alcohol and malnutrition are combinations usually associated with micronutrient impairment. Chronic liver disease courses with lower storage and activation of vitamin-coenzymes related to their malabsorption. Alcohol worsens the picture by reducing food intake, increasing micronutrients utilization and decreasing their absorption secondary to either intestinal or pancreatic injuries. Other concurrent causes would be drug treatments, urinary losses, protein deficiency and oxidative stress. As consequences the clinical signs are anemia, liver steatosis, oxidative stress and immunosuppression.
Asunto(s)
Anemia/etiología , Avitaminosis/etiología , Hepatopatías Alcohólicas/metabolismo , Micronutrientes/metabolismo , Estrés Oxidativo , Alcoholismo/complicaciones , Alcoholismo/metabolismo , Enfermedad Crónica , Humanos , Hepatopatías Alcohólicas/complicacionesRESUMEN
La desnutrición es uno de los azotes que más afectan a la infancia en la América Latina. Las dos causas más importantes son la pobreza y la ignorancia. Los doctores R. Aguilar y E. Ajtemberg hicieron estudios sobre subalimentación en 10,000 niños pobres en el "Consultorio Infantil Dolores Sanz", habiendo obtenido los resultados alarmantes expresados en la gráficas. En ellas se ve que las curvas de peso y talla son inferiores a las normales; en algunas ocasiones se encontraron casos de "enanismo de subalimentación". En 969 niños, se comprobaron las desnutriciones de segundo y tercer grado. En 939, se presentaron cuadros de carencia vitamínica y en 88 de ellos se presentó el síndrome edematoso hipoproteinémico-avitaminósico. La pelagra fue la más frecuentemente encontrada, con otras asociaciones. No se encontraron casos clínicos de avitaminosis C. La geofagía se encontró con frecuencia entre estos mismos niños. El Hospital Infantil ha adoptado la denominación de desnutrición de primer grado, en los casos de pérdida inferior al 25 por ciento del peso normal; de segundo grado cuando pasa del 25 por ciento y no llega al 40 por ciento y de tercer grado cuando pasa del 40 por ciento, según la clasificación iniciada por el doctor Federico Gómez
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Avitaminosis/etiología , Desnutrición Proteico-Calórica/clasificación , Desnutrición Proteico-Calórica/epidemiología , Desnutrición Proteico-Calórica/etiología , Trastornos Nutricionales/clasificación , Trastornos Nutricionales/dietoterapia , Trastornos Nutricionales/etiología , Enanismo Nutricional , Pelagra/etiología , México/epidemiología , PobrezaRESUMEN
This thesis is an account of investigations in which a special diet was fed to rats and the resulting effects on protein metabolism studied. The special diet closely resembled a type of diet consumed by poorer Jamaicans; similar diets are implicated in the protein malnutrition common in tropical areas. Rats fed this special diet were compared with others consuming adequate amounts of all the known essential nutrients. It was shown that the special diet was deficient in protein of good nutritional quality, and also in certain vitamins and minerals. The protein deficiency was chiefly responsible for the growth failure observed. The diet induced an increased susceptibility to Hypoglycin A, a toxic principle derived from the fruit of Blighia sapida. It appeared likely that this was a result of depressed gluconeogenesis. Liver and kidney, but not heart, were found to be depleted of protein. In liver, protein of varying sulphur content appeared equally affected. Serum albumin and globulin were both reduced, with no change in ratio. Respiration rates of tissue slices remained normal. The protein depletion in liver was accompanied by a parallel decrease in succinic dehydrogenase enzyme. Methionine containing radioactive sulphur was used to observe the rates of protein synthesis in tissue of animals fed the special diet. Experiments "in vitro" with liver slices gave inconclusive results, but experiments "in vivo" showed that synthesis of liver, serum and kidney protein was depressed, while that of heart protein was normal. Radioactive measurements on urine and on the non-protein fraction of serum supported the conclusion that protein synthesis was depressed in rats fed the special diet. It appeared that the major effect of the special diet was to decrease the rate of protein synthesis in the animals, the result being most apparent in tissues normally containing appreciable stores of labile protein (AU)