Vitamin

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Vitamin

  • vitamin a deficiency
  • vitamin a level
  • vitamin a status
  • vitamin a supplementation
  • vitamin b1
  • vitamin b12
  • vitamin b12 concentration
  • vitamin b12 deficiency
  • vitamin b12 level
  • vitamin b2
  • vitamin b6
  • vitamin c
  • vitamin c concentration
  • vitamin c content
  • vitamin c deficiency
  • vitamin c intake
  • vitamin c level
  • vitamin c supplementation
  • vitamin c.
  • vitamin concentration
  • vitamin content
  • vitamin d
  • vitamin d analog
  • vitamin d analogue
  • vitamin d binding protein
  • vitamin d deficiency
  • vitamin d deficiency rickets
  • vitamin d insufficiency
  • vitamin d intake
  • vitamin d level
  • vitamin d metabolism
  • vitamin d metabolite
  • vitamin d receptor
  • vitamin d receptor gene polymorphism
  • vitamin d receptor polymorphism
  • vitamin d status
  • vitamin d supplement
  • vitamin d supplementation
  • vitamin d synthesis
  • vitamin d therapy
  • vitamin d-resistant rickets
  • vitamin d.
  • vitamin d2
  • vitamin d3
  • vitamin d3 analogue
  • vitamin d3 ointment
  • vitamin deficiency
  • vitamin e
  • vitamin e concentration
  • vitamin e deficiency
  • vitamin e group
  • vitamin e intake
  • vitamin e level
  • vitamin e supplement
  • vitamin e supplementation
  • vitamin e therapy
  • vitamin e treatment
  • vitamin e.
  • vitamin intake
  • vitamin k
  • vitamin k absence
  • vitamin k administration
  • vitamin k antagonist
  • vitamin k deficiency
  • vitamin k1
  • vitamin k2
  • vitamin level
  • vitamin loss
  • vitamin supplement
  • vitamin supplementation
  • vitamin use

  • Selected Abstracts


    Retention of Folate, Carotenoids, and Other Quality Characteristics in Commercially Packaged Fresh Spinach

    JOURNAL OF FOOD SCIENCE, Issue 9 2004
    S. Pandrangi
    ABSTRACT: The effect of storage temperature (4 °C, 10 °C, and 20 °C) on retention of folate, carotenoids, and other quality characteristics in commercially packaged fresh spinach were determined. Based on visual color and appearance, spinach was unacceptable after 8 d, 6 d, and 4 d at 4 °C, 10 °C, and 20 °C, respectively. Color differences (AE), chlorophyll degradation, fresh weight loss, and microbial populations increased at all storage temperatures and occurred more rapidly at higher temperatures. Peroxidase activity increased but was not significantly (P > 0.05) affected by storage temperature. Lipoxygenase activity was unaffected by storage time or temperature. Substantial losses of nutrients occurred at each storage temperature. Only 53% of folate in packaged spinach was retained after 8 d, 6 d, and 4 d at 4 °C, 10 °C, and 20 °C, respectively. Carotenoid losses increased with temperature with only 54%, 61%, and 44%, respectively, of initial detected levels remaining. Vitamin and quality changes were unaffected by presence or absence of packaging. [source]


    Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosa

    JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2004
    S Ingen-Housz-Oro
    ABSTRACT Background, In recessive dystrophic epidermolysis bullosa (RDEB), a good nutritional balance is necessary to obtain healing of the chronic wounds. However, involvement of the oral mucosa and oesophagus stenosis may be responsible for severe nutritional deficiencies. Objective, In order to propose an adapted nutritional management, we studied the vitamin and trace metal status of 14 RDEB patients. Methods, Height and weight were measured. Plasma levels of albumin, iron, ferritin, calcium, parathyroid hormone (PTH), folates, vitamins C, D, B12, A, E, B1, B6, PP and B2, zinc, selenium, carnitine and copper were measured. Results, Most patients had a significant growth retardation. We found iron, vitamin D, C, B6, PP, zinc and selenium deficiencies in 36,70% of the patients, without clinical expression, except in one case. Vitamin B1, 12, B2, A/RBP, E/lipids and carnitine were normal. The three patients with gastrostomy feeding had better growth but still a protein deficiency and sometimes vitamin C, B6, PP, zinc and carnitine deficiencies. Conclusion, Vitamin and trace metal deficiencies are frequent in RDEB, even in patients receiving gastrostomy feeding, and often go unrecognized. Regular nutritional evaluation is necessary. Dietary advice and supplements should be given. Enteral feeding by gastrostomy should be discussed in early childhood. [source]


    Nahrungsergänzungsmittel bei Übergewicht und Adipositas: Produkte mit hohem Beratungsbedarf

    PHARMAZIE IN UNSERER ZEIT (PHARMUZ), Issue 6 2006
    Ralf Goebel Dr.
    Wer sich abwechslungsreich und vollwertig ernährt und regelmäßig körperlich betätigt, benötigt weder NEM, Stärkungsmittel, Vitamin- und Mineralstoffpräparate noch Schlankheitsmittel. Der größte Teil der angebotenen Schlankheits- und Wundermittel gegen Übergewicht ist im besten Fall wirkungslos, kann aber im schlimmsten Fall gesundheitsschädliche Risiken für den Verbraucher haben. Eine langfristig erfolgreiche Gewichtsabnahme und -stabilisierung kann nur durch eine Veränderung der Ernährungs- und Lebensgewohnheiten erreicht werden. Kein Schlankheitsprodukt, das sich als NEM auf dem Markt befindet, hat den eindeutigen wissenschaftlichen Nachweis erbracht, dass es bei alleiniger Einnahme zu einer längerfristigen Gewichtsreduktion und -stabilisierung führen kann. Allenfalls sinnvoll kann eine Vorsättigung bei Übergewichtigen und Personen mit extremen Hungergefühlen sein. Diesen Effekt erreichen die meisten ballaststoffhaltigen Quellungsmittel. Derartige Produkte sind allerdings nur dann effektiv und sinnvoll, wenn sie eine Ernährungsumstellung und Bewegungstherapie begleiten. Dass sich die steigende Nachfrage nach NEM und Schlankheitsmitteln bremsen lässt, damit rechnen Gesundheitsexperten und Marktanalysten gegenwärtig nicht. Im Gegenteil, die Vermarktung durch das Internet und den Versandhandel wird eher noch weiter zunehmen. Um die aus Sicht des Verbraucher- und Gesundheitsschutzes unbefriedigende Situation zu verbessern, sind europaweite einheitliche gesetzliche Bestimmungen und Standards erforderlich. Um die Verbraucher besser in die Lage zu versetzen, kritisch und eigenverantwortlich mit der kaum zu überschauenden Produktpalette umzugehen, sind mehr Transparenz in der Kennzeichnung, die Erstellung einer ständig aktualisierten Positivliste und gezieltere kundenorientiertere Informationen erforderlich. Zwischen den Überwachungsbehörden müssen länderübergreifende Kooperationen, insbesondere ein beschleunigter Daten- und Informationsaustausch und ausreichende personelle Kapazitäten für eine stärkere Kontrolle dieser Produkte abgesichert werden. Die öffentlichen Apotheken sind für den Verbraucher wichtige Ansprechpartner für herstellerunabhängige Informationen zu Gesundheitsprodukten. Um sich ihren Marktanteil und das Vertrauen ihrer Kunden durch kompetente Aufklärung und Beratung bei diesen Produkten auch in der Zukunft zu sichern, sind verstärkte qualifizierende Fortbildungen aller Mitarbeiter erforderlich. [source]


    Scavenging Free Radicals To Preserve Enhancement and Extend Relaxation Times in NMR using Dynamic Nuclear Polarization,

    ANGEWANDTE CHEMIE, Issue 35 2010
    Pascal Miéville
    Länger leben dank Vitamin,C: N -Oxid-Radikale, die weithin zur dynamischen Kernpolarisation eingesetzt werden, können beim Auflösen durch Abfangreagentien wie Natriumascorbat (Vitamin,C) reduziert werden, wodurch Polarisierungsverluste während des Transfers vermieden und transversale wie longitudinale Relaxationszeiten in NMR-spektroskopischen Experimenten verlängert werden (siehe Bild). [source]


    Loop Diuretic Therapy, Thiamine Balance, and Heart Failure

    CONGESTIVE HEART FAILURE, Issue 4 2007
    Domenic A. Sica MD
    Thiamine, or vitamin B1, is a water-soluble B complex vitamin that was first discovered in 1910 in the process of exploring how rice bran cured patients of beriberi. Thiamine is not synthesized in humans, therefore its availability for necessary cellular processes hinges on its continual ingestion. The amount of thiamine one needs to ingest to maintain balance is disease state-dependent or medication-dependent. Severe chronic thiamine deficiency can have significant neurologic and cardiac effects, the latter is reflected in a particular type of heart failure called wet beriberi. This form of heart failure clearly benefits from thiamine supplementation. It is unclear, however, whether thiamine supplementation offers any benefit in other forms of heart failure. Despite this, it is not unreasonable for heart failure patients to routinely ingest a thiamine-containing multivitamin; patients using diuretics have an increased urinary excretion of thiamine and thus are at a higher risk for developing thiamine deficiency. The role of thiamine in heart failure, however, remains arguable. [source]


    Ascorbic acid oral treatment modifies lipolytic response and behavioural activity but not glucocorticoid metabolism in cafeteria diet-fed rats

    ACTA PHYSIOLOGICA, Issue 4 2009
    D. F. Garcia-Diaz
    Abstract Aim:, To analyse the effects of vitamin C (VC), a potent dietary antioxidant, oral supplementation on body weight gain, behavioural activity, lipolytic response and glucocorticoid metabolism in the early stages of diet-induced overweight in rats. Methods:, Food intake, locomotive activity and faecal corticosterone were assessed during the 14 day trial period. After 2 weeks, the animals were sacrificed and the body composition, biochemical markers and lipolytic response from isolated adipocytes from retroperitoneal white adipose tissue were examined. Results:, The intake of a high-fat diet by rats induced a significant increase in body weight, adiposity and insulin resistance markers as well as a decrease in faecal corticosterone levels compared with standard diet-fed rats. Interestingly, the animals fed on the cafeteria diet showed a significant increase in the isoproterenol-induced lipolytic response in isolated adipocytes. Furthermore, this cafeteria-fed group showed a reduced locomotive behaviour than the control rats. On the other hand, oral VC supplementation in animals receiving the high-fat diet restored the cafeteria diet effect in some of the analysed variables such as final body weight and plasma insulin to control group levels. Remarkably, increases in locomotive behaviour and a significant decrease in the lipolytic response induced by isoproterenol on isolated adipocytes from animals treated with VC were observed. Conclusion:, This work demonstrates that an oral ascorbic acid supplementation has direct effects on behavioural activity and on adipocyte lipolysis in early obesity stages in rats, which could indicate a protective short-term role of this vitamin against adiposity induced by chronic high-fat diet consumption. [source]


    Retinoic acid induces CDK inhibitors and growth arrest specific (Gas) genes in neural crest cells

    DEVELOPMENT GROWTH & DIFFERENTIATION, Issue 3 2005
    Linping Wang
    Retinoic acid (RA), the active metabolite of vitamin A, regulates cellular growth and differentiation during embryonic development. In excess, this vitamin is also highly teratogenic to animals and humans. The neural crest is particularly sensitive to RA, and high levels adversely affect migration, proliferation and cell death. We investigated potential gene targets of RA associated with neural crest proliferation by determining RA-mediated changes in gene expression over time, using microarrays. Statistical analysis of the top ranked RA-regulated genes identified modest changes in multiple genes previously associated with cell cycle control and proliferation including the cyclin-dependent kinase inhibitors Cdkn1a (p21), Cdkn2b (p15INK4b), and Gas3/PMP22. The expression of p21 and p15INK4b contribute to decreased proliferation by blocking cell cycle progression at G1-S. This checkpoint is pivotal to decisions regulating proliferation, apoptosis, or differentiation. We have also confirmed the overexpression of Gas3/PMP22 in RA-treated neural crests, which is associated with cytoskeletal changes and increased apoptosis. Our results suggest that increases in multiple components of diverse regulatory pathways have an overall cumulative effect on cellular decisions. This heterogeneity contributes to the pleiotropic effects of RA, specifically those affecting proliferation and cell death. [source]


    Different apoptotic responses of human and bovine pericytes to fluctuating glucose levels and protective role of thiamine

    DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2009
    Elena Beltramo
    Abstract Background Vascular cells in diabetes are subjected to daily fluctuations from high to low glucose. We aimed at investigating whether pulsed exposure to different glucose concentrations influences apoptosis in human retinal pericytes (HRP) versus bovine retinal pericytes (BRP), with consequences on the onset of diabetic retinopathy, and the possible protective role of thiamine. Methods BRP and HRP (wild-type and immortalized) were grown in physiological/high glucose for 7 days, and then returned to physiological glucose for another 24, 48 or 72 h. Cells were also kept intermittently at 48-h intervals in high/normal glucose for 8 days, with/without thiamine/benfotiamine. Apoptosis was determined through ELISA, TUNEL, Bcl-2, Bax and p53 expression/concentration. Results Continuous exposure to high glucose increased apoptosis in BRP, but not HRP. BRP apoptosis normalized within 24 h of physiological glucose re-entry, while HRP apoptosis increased within 24,48 h of re-entry. Intermittent exposure to high glucose increased apoptosis in HRP and BRP. Bcl-2/Bax results were consistent with DNA fragmentation, while p53 was unchanged. Thiamine and benfotiamine countered intermittent high glucose-induced apoptosis. Conclusions Human pericytes are less prone to apoptosis induced by persistently high glucose than bovine cells. However, while BRP recover after returning to physiological levels, HRP are more vulnerable to both downwardly fluctuating glucose levels and intermittent exposure. These findings reinforce the hypotheses that (1) glycaemic fluctuations play a role in the development of diabetic retinopathy and (2) species-specific models are needed. Thiamine and benfotiamine prevent human pericyte apoptosis, indicating this vitamin as an inexpensive approach to the prevention and/or treatment of diabetic complications. Copyright © 2009 John Wiley & Sons, Ltd. [source]


    The MTHFR C677T polymorphism confers a high risk for stroke in both homozygous and heterozygous T allele carriers with Type 2 diabetes

    DIABETIC MEDICINE, Issue 5 2006
    M. P. Hermans
    Abstract Objective Individuals with Type 2 diabetes are at increased risk of stroke. Plasma homocysteine (tHcy) is an independent risk factor for cardiovascular (CV) disease. The methylene,tetrahydrofolate reductase (MTHFR) gene polymorphism (thermolabile variant C677T) is associated with CV risk, partly as a result of increased Hcy, especially in homozygous subjects. Aim To relate the occurrence of the MTHFR polymorphism with stroke prevalence by examining allelic frequency and genotype distribution in 165 subjects with Type 2 diabetes studied for the presence of thermolabile C677T MTHFR mutation. Results Mean age was 67.7 years, and tHcy 18.2 µmol/l. T allele frequency was 38.5%. MTHFR genotypes were: normal (CC) 40%; heterozygous (CT) 43%; homozygous (TT) 17%. Serum levels of folic acid and B12 vitamin were within normal limits. Stroke prevalence was 14%. Sixty-four per cent of stroke-free subjects had the normal C allele vs. 46% in stroke subjects. The frequencies of genotypes (CC-CT-TT) were (%): 44-41-15 in stroke-free vs. 17-57-26 in stroke patients. Coronary (CAD) and peripheral artery disease (PAD) were common in all groups, with no differences according to genotypes. Stroke prevalence was markedly higher in genotypes CT and TT (18 and 21%) compared with CC (6%). Mean tHcy levels were higher in TT subjects. Conclusion The allelic frequency of C677T MTHFR mutation in Type 2 diabetes subjects with stroke is markedly different from that of subjects without stroke. Genotypic characteristics suggest that C677T MTHFR mutation confers a higher risk for stroke to both homozygous and heterozygous T allele carriers that cannot be ascribed solely to raised tHcy and/or lower folate status in CT subjects, nor to phenotypic expression of conventional risk factors for stroke. The impact of the MTHFR polymorphism on stroke may result from T allele-linked deleterious effects, or C allele-linked protection. Confirmatory studies are warranted, as this cohort was not randomly selected, and a type 1 error cannot be ruled out. [source]


    Folate, colorectal carcinogenesis, and DNA methylation: Lessons from animal studies

    ENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 1 2004
    Young-In Kim
    Abstract Folate, a water-soluble B vitamin and cofactor in one-carbon transfer, is an important nutritional factor that may modulate the development of colorectal cancer (CRC). Epidemiologic and clinical studies indicate that dietary folate intake and blood folate levels are inversely associated with CRC risk. Collectively, these studies suggest an , 40% reduction in the risk of CRC in individuals with the highest dietary folate intake compared with those with the lowest intake. Animal studies using chemical and genetically predisposed rodent models have provided considerable support for a causal relationship between folate depletion and colorectal carcinogenesis as well as a dose-dependent protective effect of folate supplementation. However, animal studies also have shown that the dose and timing of folate intervention are critical in providing safe and effective chemoprevention; exceptionally high supplemental folate levels and folate intervention after microscopic neoplastic foci are established in the colorectal mucosa promote, rather than suppress, colorectal carcinogenesis. These animal studies, in conjunction with clinical observations, suggest that folate possesses dual modulatory effects on carcinogenesis depending on the timing and dose of folate intervention. Folate deficiency has an inhibitory effect, whereas folate supplementation has a promoting effect on the progression of established neoplasms. In contrast, folate deficiency in normal epithelial tissues appears to predispose them to neoplastic transformation, and modest levels of folate supplementation suppress the development of tumors in normal tissues. Notwithstanding the limitations associated with animal models, these studies suggest that the optimal timing and dose of folate intervention must be established for safe and effective chemoprevention in humans. Folate is an important factor in DNA synthesis, stability, and integrity, the repair aberrations of which have been implicated in colorectal carcinogenesis. Folate may also modulate DNA methylation, which is an important epigenetic determinant in gene expression (an inverse relationship), in the maintenance of DNA integrity and stability, in chromosomal modifications, and in the development of mutations. A mechanistic understanding of how folate status modulates colorectal carcinogenesis further strengthens the case for a causal relationship and provides insight into a possible chemopreventive role of folate. Environ. Mol. Mutagen. 44:10,25, 2004. © 2004 Wiley-Liss, Inc. [source]


    Malathion-induced oxidative stress in human erythrocytes and the protective effect of vitamins C and E in vitro

    ENVIRONMENTAL TOXICOLOGY, Issue 3 2009
    Dilek Durak
    Abstract Malathion is an organophosphate (OP) pesticide that has been shown to induce oxidative stress in erythrocytes through the generation of free radicals and alteration of the cellular antioxidant defense system. We examined the effect of several different doses of malathion (25, 75, 200 ,M), or malathion in combination with vitamin C (VC; 10 ,M) or vitamin E (VE; 30 ,M), on the levels of malondialdehyde (MDA), and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities in human erythrocytes in vitro. Erythrocytes were incubated under various treatment conditions (malathion alone, vitamins alone, or malathion plus vitamin) at 37°C for 60 min, and the levels of MDA, and SOD, CAT and GPx activities, were determined. Treatment with malathion alone increased the levels of MDA and decreased SOD, CAT, and GPx activities in erythrocytes (P < 0.05). There were no statistical differences among VC-treated, VE-treated, or VC + VE-treated erythrocyes, as compared with nontreated control cells. Treatment of cells with malathion + VC, malathion + VE, or a combination of all three agents prevented malathion-induced changes in antioxidant enzyme activity and lipid peroxidation. However, this effect was seen only at low concentrations of malathion (25 and 75 ,M), and the combination of VC + VE had a more protective effect than VC or VE alone. These results indicated that the presence of vitamins at concentrations that are similar to the levels found in plasma have no effect on malathion-induced toxicity in erythrocytes at a concentration of malathion (200 ,M) that is typically used in pesticides. © 2008 Wiley Periodicals, Inc. Environ Toxicol, 2009. [source]


    A Modified Atkins Diet Is Effective for the Treatment of Intractable Pediatric Epilepsy

    EPILEPSIA, Issue 2 2006
    Eric H. Kossoff
    Summary:,Purpose: The Atkins diet may induce ketosis as does the ketogenic diet, without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Our objective was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy. Methods: Twenty children were treated prospectively in a hospital-based ambulatory clinic from September 2003 to May 2005. Children aged 3,18 years, with at least three seizures per week, who had been treated with at least two anticonvulsants, were enrolled and received the diet over a 6-month period. Carbohydrates were initially limited to 10 g/day, and fats were encouraged. Parents measured urinary ketones semiweekly and recorded seizures daily. All children received vitamin and calcium supplementation. Results: In all children, at least moderate urinary ketosis developed within 4 days (mean, 1.9). Sixteen (80%) completed the 6-month study; 14 chose to remain on the diet afterward. At 6 months, 13 (65%) had >50% improvement, and seven (35%) had >90% improvement (four were seizure free). Mean seizure frequency after 6 months was 40 per week (p = 0.005). Over a 6-month period, mean serum blood urea nitrogen increased from 12 to 17 mg/dl (p = 0.01); creatinine was unchanged. Cholesterol increased from 192 to 221 mg/dl, (p = 0.06). Weight did not change significantly (34.0,33.7 kg); only six children lost weight. A stable body mass index over time correlated with >90% improvement (p = 0.004). Conclusions: A modified Atkins diet is an effective and well-tolerated therapy for intractable pediatric epilepsy. [source]


    Oral vitamin E supplementation on oxidative stress, vitamin and antioxidant status in intensely exercised horses

    EQUINE VETERINARY JOURNAL, Issue S36 2006
    C. A. WILLIAMS
    Summary Reasons for performing study: Vitamin E is the most commonly supplemented antioxidant in horses; however, previous research is not conclusive as to the recommended level for exercising horses. Objective: To evaluate the effects of 3 levels of vitamin E supplementation on oxidative stress and vitamin/antioxidant status in intensely exercised horses to determine the optimal level of vitamin E supplementation. Methods: Twelve unfit Standardbreds were divided into 3 groups, supplemented orally with 0 (CON), 5000 (MOD), or 10,000 (HI) iu/day of DL-,-tocopheryl acetate. The 3 times 3 Latin square design consisted of three 4 week supplementation periods with 4 week wash out periods between. After each period, horses underwent a treadmill interval exercise test. Blood samples were collected and heart rate (HR) measured before, during and after exercise. Data were analysed using ANOVA with repeated measures in SAS. Results: The CON group had lower HR throughout the test compared to the MOD and HI groups (P<0.05). There was an increase in plasma retinol (RET), ,-carotene (BC), red blood cell total glutathione and glutathione peroxidase with exercise (P<0.05), but all groups returned to baseline after 24 h. Plasma ,-tocopherol (TOC) increased from baseline with exercise (P<0.0001) in all groups; treatment differences were observed at 24 h (P<0.05). The HI and CON groups had lower BC compared to the MOD group (P = 0.05). Conclusions: Horses supplemented with vitamin E, at nearly 10-times the 1989 NRC recommended level, did not experience lower oxidative stress compared to control horses. Additionally, lower plasma BC levels observed in the HI group, which may indicate that vitamin E has an inhibitory effect on BC metabolism. Potential relevance: Supplementation above control levels is not more beneficial to oxidative stress and antioxidant status in intensely exercising horses; indeed, levels 10 times in excess may be detrimental to BC and should be avoided. [source]


    Iron status in Danish men 1984,94: a cohort comparison of changes in iron stores and the prevalence of iron deficiency and iron overload

    EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2002
    Nils Milman
    Abstract:,Background and objectives : From 1954 to 1987, flour in Denmark was fortified with 30 mg carbonyl iron per kg. This mandatory fortification was abolished in 1987. The aim of this study was to compare iron status in Danish men before and after abolition of iron fortification. Methods : Iron status (serum ferritin, haemoglobin), was assessed in population surveys in Copenhagen County during 1983,84 comprising 1324 Caucasian men (1024 non-blood-donors, 300 blood donors) and in 1993,94 comprising 1288 Caucasian men (1103 non-blood-donors, 185 donors), equally distributed in age cohorts of 40, 50, 60 and 70 yr. Results : In the 1984 survey median serum ferritin values in the four age cohorts in non-blood-donors were 136, 141, 133 and 111 µg/L, and in the 1994 survey 177, 173, 186 and 148 µg L ,1 , respectively. The difference was significant in all age groups ( P <0.001). There was no significant difference between the two surveys concerning the prevalence of small iron stores (ferritin 16,32 µg L ,1 ), depleted iron stores (ferritin <16 µg L ,1 ) or iron-deficiency anaemia (ferritin <13 µg L ,1 and Hb <5th percentile for iron-replete men). However, from 1984 to 1994, the prevalence of iron overload (ferritin >300 µg L ,1 ) increased from 11.3% to 18.9% ( P <0.0001). During the study period there was an increase in body mass index ( P <0.0001), alcohol consumption ( P <0.03) and use of non-steroid anti-inflammatory drugs (NSAID) ( P <0.0001), and a decrease in the use of vitamin,mineral supplements ( P <0.04) and in the prevalence of tobacco smoking ( P <0.0001). In contrast, median ferritin in blood donors showed a significant fall from 1984 to 1994 (103 vs. 74 µg L ,1 , P <0.02). Conclusion : Abolition of iron fortification reduced the iron content of the Danish diet by an average of 0.24 mg MJ ,1 , and the median dietary iron intake in men from 17 to 12 mg d ,1 . From 1984 to 1994, body iron stores and the prevalence of iron overload in Danish men increased significantly, despite the abolition of food iron fortification. The reason appears to be changes in dietary habits, with a lower consumption of dairy products and eggs, which inhibit iron absorption, and a higher consumption of alcohol, meat, and poultry, containing haem iron and enhancing iron absorption. The high prevalence of iron overload in men may constitute a health risk. [source]


    Dendritic cells derived from TBP-2-deficient mice are defective in inducing T cell responses

    EUROPEAN JOURNAL OF IMMUNOLOGY, Issue 5 2008
    Aoi Son
    Abstract Thioredoxin-binding protein-2 (TBP-2), also known as vitamin,D3-up-regulated protein,1 (VDUP1), was identified as an endogenous molecule interacting with thioredoxin (TRX). Here, we show that dendritic cells (DC) derived from TBP-2-deficient mice are defective in the function of T cell activation. To compare TBP-2,/, DC function with wild-type (WT) DC, we stimulated DC with lipopolysaccharide (LPS). Although TBP-2,/, DC and WT DC expressed comparable levels of MHC class,II and costimulatory molecules such as CD40, CD80 and CD86, the IL-12p40, IL-12p70 and IL-6 productions of TBP-2,/, DC were attenuated. In a mixed leukocyte reaction (MLR), the concentrations of IL-2, IFN-,, IL-4 and IL-10 in the culture supernatant of MLR with TBP-2,/, DC were significantly lower than those in the cultures with WT DC. In MLR also, as with LPS stimulation, IL-12p40 and IL-12p70 production from TBP-2,/, DC was less than that from WT DC. Proliferation of T cells cultured with TBP-2,/, DC was poorer than that with WT DC. Invivo delayed-type hypersensitivity responses in TBP-2,/, mice immunized with ovalbumin were significantly reduced compared to WT mice. These results indicate that TBP-2 plays a crucial role in DC to induce T cell responses. [source]


    Thermostability of genetically modified sunflower oils differing in fatty acid and tocopherol compositions

    EUROPEAN JOURNAL OF LIPID SCIENCE AND TECHNOLOGY, Issue 8 2008
    Susana Marmesat
    Abstract The objective of the study was to investigate the performance at frying temperature of a new sunflower oil with high content of oleic and palmitic acid (HOHPSO) and containing ,-tocopherol as the most abundant natural antioxidant. HOHPSO either containing ,- or ,-tocopherol (HOHPSO-, and HOHPSO-,, respectively) were obtained from genetically modified sunflower seeds and refined under identical conditions. The oil stability against oxidation, as measured by Rancimat at 120,°C, was much higher for the oil containing ,-tocopherol, suggesting the higher effectiveness of ,-tocopherol as compared to ,-tocopherol to delay oxidation. Experiments at high temperature (180,°C) simulating the conditions applied in the frying process clearly demonstrated that, for the same periods of heating, the oil degradation and the loss of natural tocopherol were significantly lower for the oil containing ,-tocopherol. Comparison of different genetically modified sunflower oils with different fatty acid compositions confirmed that oil degradation depended on the fatty acid composition, being higher at a higher degree of unsaturation. However, the loss of tocopherol for a similar level of oil degradation was higher as the degree of unsaturation decreased. Overall, the results showed that HOHPSO-, had a very high stability at frying temperatures and that mixtures of HOHPSO-, and HOHPSO-, would be an excellent alternative to fulfill the frying performance required by the processors and the vitamin,E content claimed by the consumers. [source]


    Tocotrienols and cancer: Beyond antioxidant activity

    EUROPEAN JOURNAL OF LIPID SCIENCE AND TECHNOLOGY, Issue 4 2007
    Kalanithi Nesaretnam
    Abstract The edible oil industry has emerged as an important provider of raw material for the extraction of vitamin,E. Vegetable oils, especially the seed oils, are rich sources of tocopherols. However, in palm oil, vitamin,E occurs as a complex mixture of tocopherols and tocotrienols. Various tocotrienol isomers of vitamin,E in palm oil have been reported to possess interesting biological and physiological properties not generally evident with tocopherol-rich vitamin,E preparations. They include potential blood cholesterol-lowering and cardioprotective effects, more efficient antioxidant activity in biological systems, and possible anti-cancer and neuroprotective effects. With the emergence of palm oil as the largest edible oil in world markets, technology is now available to extract tocotrienol-rich palm vitamin,E. Initiatives in Malaysia to manufacture biodiesel will further generate large amounts of micronutrients, especially tocotrienols, to be available to the nutraceutical and functional food industry. [source]


    Ubiquinone biosynthesis in microorganisms

    FEMS MICROBIOLOGY LETTERS, Issue 2 2001
    R Meganathan
    Abstract The quinoid nucleus of the benzoquinone, ubiquinone (coenzyme Q; Q), is derived from the shikimate pathway in bacteria and eukaryotic microorganisms. Ubiquinone is not considered a vitamin since mammals synthesize it from the essential amino acid tyrosine. Escherichia coli and other Gram-negative bacteria derive the 4-hydroxybenzoate required for the biosynthesis of Q directly from chorismate. The yeast, Saccharomyces cerevisiae, can either form 4-hydroxybenzoate from chorismate or tyrosine. However, unlike mammals, S. cerevisiae synthesizes tyrosine in vivo by the shikimate pathway. While the reactions of the pathway leading from 4-hydroxybenzoate to Q are the same in both organisms the order in which they occur differs. The 4-hydroxybenzoate undergoes a prenylation, a decarboxylation and three hydroxylations alternating with three methylation reactions, resulting in the formation of Q. The methyl groups for the methylation reactions are derived from S -adenosylmethionine. While the prenyl side chain is formed by the 2- C -methyl- d -erythritol 4-phosphate (non-mevalonate) pathway in E. coli, it is formed by the mevalonate pathway in the yeast. [source]


    Knowledge and practices of dementia patients across Sussex in relation to vitamin and herbal extract use

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2010
    R. Khan
    No abstract is available for this article. [source]


    Diagnostic clues to megaloblastic anaemia without macrocytosis

    INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2007
    C. W. J. CHAN
    Summary Masking of the macrocytic expression of megaloblastic anaemia (MA) by coexisting thalassaemia, iron deficiency and chronic illness has been widely reported. We described the haematological and clinical features of 20 Chinese patients with MA presenting with mean corpuscular volume (MCV) ,99 fl, and analysed the steps leading to the final diagnosis of MA with concomitant thalassaemia trait (n = 11), thalassaemia trait and iron deficiency (n = 3), iron deficiency (n = 4) and chronic illness (n = 2). We also compared the haematological characteristics of this group of patients with a group of normocytic anaemic patients without vitamin B12/folate deficiency, and identified certain laboratory information useful for differentiating the two groups. Statistically significant parameters included the mean values of haemoglobin, MCV, red cell distribution width (RDW), reticulocyte index, platelet count and serum bilirubin. All provided clues to maturation disorders within the marrow. A decision flowchart for the diagnosis of MA without macrocytosis was proposed. In the studied population, by using the parameters of haemoglobin <10 g/dl, MCV 80,99 fl, RDW , 16% and reticulocyte index , 2% as indicators, there was a 58% chance that a patient had MA without macrocytosis if he/she had all the four indicators, and a 2.2% chance of having it if he/she did not have these indicators. We emphasized the importance of including peripheral blood smear examination in the diagnostic procedures for such patients, as well as the importance of paying attention to patients' medical history, racial background and previous MCV value. [source]


    Growth inhibition of Listeria monocytogenes by a nonbacteriocinogenic Carnobacterium piscicola

    JOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2005
    L. Nilsson
    Abstract Aims:, This study elucidates the mechanisms by which a nonbacteriocinogenic Carnobacterium piscicola inhibits growth of Listeria monocytogenes. Methods and Results:,Listeria monocytogenes was exposed to live cultures of a bacteriocin-negative variant of C. piscicola A9b in co-culture, in a diffusion chamber system, and to a cell-free supernatant. Suppression of maximum cell density (0,3·5 log units) of L. monocytogenes was proportional to initial levels of C. pisciola (103,107 CFU ml,1). Cell-to-cell contact was not required to cause inhibition. The cell-free C. piscicola supernatant caused a decrease in L. monocytogenes maximum cell density, which was abolished by glucose addition but not by amino acid, vitamin or mineral addition. The fermentate also gave rise to a longer lag phase and a reduction in growth rate. These effects were independent of glucose and may have been caused by acetate production by C. piscicola. 2D gel-electrophoretic patterns of L. monocytogenes exposed to C. piscicola or to L. monocytogenes fermentate did not differ. Treatment with C. piscicola fermentate resulted in down-regulation (twofold) of genes involved in purine- or pyrimidine metabolism, and up-regulation (twofold) of genes from the regulon for vitamin B12 biosynthesis and propanediol and ethanolamine utilization. Conclusions:, A nonbacteriocinogenic C. piscicola reduced growth of L. monocytogenes partly by glucose depletion. Significance and Impact of the Study:, Understanding the mechanism of microbial interaction enhances prediction of growth in mixed communities as well as use of bioprotective principles for food preservation. [source]


    Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis Study

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2005
    Katherine L Tucker
    Abstract Vitamin B12 is important to DNA synthesis and may affect bone formation. We examined the association between this vitamin and BMD in 2576 adults. Men with plasma B12 < 148 pM had significantly lower BMD at the hip, and women at the spine, relative to those with higher B12, and trends were similar for both at all sites. Low vitamin B12 may be a risk factor for low BMD. Introduction: Vitamin B12 is important to DNA synthesis and may affect bone formation. It has been linked to osteoblastic activity in clinical studies and cell culture. Materials and Methods: We examined the relationship between plasma vitamin B12 status and BMD in 2576 adult participants in the Framingham Offspring Osteoporosis Study (1996,2001). BMD was measured by DXA at the hip and spine. Plasma vitamin B12 was measured by radioassay. Mean BMD measures were estimated for four categories of vitamin B12 concentration, based on commonly used cut-offs, using analysis of covariance, adjusted for age, BMI, physical activity score for the elderly (PASE), alcohol use, smoking status, total calcium and vitamin D intake, season of bone measurement, and for women, menopause status and current estrogen use. Further adjustment for protein intake and total homocysteine concentration was also performed. Results: Both men and women with vitamin B12 concentrations <148 pM had lower average BMD than those with vitamin B12 above this cut-off. These differences were significant (p < 0.05) for men at most hip sites and for women at the spine. Significance remained after further adjustment for protein intake and plasma homocysteine. Conclusions: Vitamin B12 deficiency may be an important modifiable risk factor for osteoporosis. [source]


    Comparative study of total protein, and total and lipid-associated serum sialic acid levels in patients with type 2 diabetes mellitus

    JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 4 2003
    Suat Ekin
    Abstract The aim of the present study was to investigate the serum total protein (TP), total sialic acid (TSA), lipid-associated sialic acid (LSA), LSA/TP, and LSA/TP values in type 2 diabetes mellitus (DM) patients. Two study groups (healthy controls and type 2 DM subjects) were examined. For the type 2 DM group, 120 patients (60 females and 60 males) who had been diagnosed and treated for type 2 DM in the Yuzuncu Yil University Hospital, Van, Turkey, were selected consecutively. Forty healthy individuals (20 females and 20 males) were selected from hospital staff and other outpatient clinics to serve as the control group. They were matched for age, sex, body mass index, and smoking status. None of the participants had taken vitamin or mineral supplements for at least 2 weeks before sampling. To determine serum glucose, TP, TSA, and LSA levels, blood samples were drawn after all of the subjects fasted overnight. It was found that diabetics had higher TSA, LSA, TSA/TP, and LSA/TP levels than controls. However, the TP levels were not significantly different between the groups. Our results showed that TSA, LSA, TSA/TP, and LSA/TP have interactive connections with DM. These parameters can be used as a diagnostic index for patients with DM. J. Clin. Lab. Anal. 17:124,126, 2003. © 2003 Wiley-Liss, Inc. [source]


    SIMULATION OF THIN-FILM DEODORIZERS IN PALM OIL REFINING

    JOURNAL OF FOOD PROCESS ENGINEERING, Issue 2010
    ROBERTA CERIANI
    ABSTRACT As the need for healthier fats and oils (natural vitamin and trans fat contents) and interest in biofuels are growing, many changes in the world's vegetable oil market are driving the oil industry to developing new technologies and recycling traditional ones. Computational simulation is widely used in the chemical and petrochemical industries as a tool for optimization and design of (new) processes, but that is not the case for the edible oil industry. Thin-film deodorizers are novel equipment developed for steam deacidification of vegetable oils, and no work on the simulation of this type of equipment could be found in the open literature. This paper tries to fill this gap by presenting results from the study of the effect of processing variables, such as temperature, pressure and percentage of stripping steam, in the final quality of product (deacidified palm oil) in terms of final oil acidity, the tocopherol content and neutral oil loss. The simulation results have been evaluated by using the response surface methodology. The model generated by the statistical analysis for tocopherol retention has been validated by matching its results with industrial data published in the open literature. PRACTICAL APPLICATIONS This work is a continuation of our previous works (Ceriani and Meirelles 2004a, 2006; Ceriani et al. 2008), dealing with the simulation of continuous deodorization and/or steam deacidification for a variety of vegetable oils using stage-wised columns, and analyzing both the countercurrent and the cross-flow patterns. In this work, we have studied thin-film deodorizers, which are novel equipment developed for steam deacidification of vegetable oils. Here, we highlight issues related to final oil product quality and the corresponding process variables. [source]


    EXPERIMENTAL VACUUM SPRAY DRYING OF PROBIOTIC FOODS INCLUDED WITH LACTIC ACID BACTERIA

    JOURNAL OF FOOD PROCESSING AND PRESERVATION, Issue 6 2009
    YUTAKA KITAMURA
    ABSTRACT This research aims to develop a vacuum spray dryer (VSD) that performs spray drying in a vacuumed drying tower at a lower temperature than the conventional spray drying. The VSD operational drying temperatures for the probiotic foods containing lactic acid bacteria were determined by the relationships between the temperature and the vapor pressure, and were correlated by Clapeyron's equation. The drying of the fermented milk starter at 35C drying tower was experimentally possible; however, powder from the lactic fermenting beverage was not obtained even at 50C, which resulted from the lower glass transition temperature of the material. Compared with ATP concentration of the fermented milk starter before and after the VSD drying, the lower the drying temperature, the higher the microbial activity is retained. The ATP ratio as 30% of the raw materials shows the high feasibility of VSD for dairy processing. PRACTICAL APPLICATIONS During the spray drying of liquid or slurry food, the heat-sensitive functional ingredients such as vitamin, enzyme or bacteria are usually degraded or lost because of the contact with hot air between 120 and 180C. Markets need food powder that involves a lot of functional materials and a long shelf life for the expansion of healthy food. The experimental vacuum spray dryer (VSD) showed a potential to dry probiotic foods involving lactic acid bacteria without their inactivation. Although the lactic acid bacteria contained in the powder at 35C,VSD was 30% of the raw material, it is more economical than using the liquid type fermented milk starter. With some mechanical or operational modifications for the high moisture content and low recovery ratio of the powder, VSD is applicable for dairy processing factories. [source]


    Dietary intakes and nutrient status of vegetarian preschool children from a British national survey

    JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2000
    C.W. Thane
    Background Dietary intakes and nutrient status were compared in meat-eaters and non-meat-eaters from the National Diet and Nutrition Survey of children aged 1.5,4.5 years. Methods Children (n = 1351) were categorized as ,omnivores' or ,vegetarians', according to whether they consumed meat or meat products during a 4-day dietary record. Blood samples were also obtained for analysis of haematological and biochemical nutrient status. Results Three per cent of children were ,vegetarian'. They consumed higher proportions of milk and milk products, although this was significant only in older children (P = 0.007), owing to high consumption by the high proportion of Asian children. In vegetarians, energy intakes tended to be lower in both age groups. Percentage energy from protein and fat were lower, while that from carbohydrate was higher compared with omnivores. Cholesterol intakes were lower, significantly so for younger children (P < 0.001). Intakes of micronutrients were either higher (vitamins C and E, potassium) or lower (niacin and sodium) in younger vegetarians compared with omnivores. Energy-adjusted intakes of iron and zinc did not differ significantly from those of omnivores, although both intakes were low in many children (6,20% < LRNI), particularly in the younger group. Haematological and biochemical nutrient status indices showed few differences. Serum ferritin was lower in vegetarians, significantly so in younger children (P = 0.002). Antioxidant vitamin (A, C and E) status tended to be higher in vegetarians, while vitamin B12 intakes and status were more than adequate. Apart from poorer vitamin D intake and status in older Asian vegetarians, very few ethnic differences were observed. Conclusions Nutrient intakes and status were generally adequate in preschool children who did not eat meat. Although serum ferritin levels were inferior (particularly in vegetarians under 3 years old), the lower intakes of fat, cholesterol and sodium, and higher antioxidant vitamin intakes and status indices were potentially beneficial. Given a balanced diet, adequate nutrient intakes and status can be maintained without consuming meat. [source]


    Nicotinic acid: the broad-spectrum lipid drug.

    JOURNAL OF INTERNAL MEDICINE, Issue 2 2005
    A 50th anniversary review
    Abstract. Nicotinic acid has, like the Roman God Janus, two faces. One is the vitamin. The other is the broad-spectrum lipid drug. The Canadian pathologist Rudolf Altschul discovered 50 years ago that nicotinic acid in gram doses lowered plasma levels of cholesterol. From the point of view of treatment of the dyslipidaemias that are risk factors for clinical atherosclerosis nicotinic acid is a miracle drug. It lowers the levels of all atherogenic lipoproteins , VLDL and LDL with subclasses as well as Lp(a) , and in addition it raises more than any other drug the levels of the protective HDL lipoproteins. Trials have shown that treatment with nicotinic acid reduces progression of atherosclerosis, and clinical events and mortality from coronary heart disease. The new combination treatment with statin-lowering LDL and nicotinic acid-raising HDL is reviewed. A basic effect of nicotinic acid is the inhibition of fat-mobilizing lipolysis in adipose tissue leading to a lowering of plasma free fatty acids, which has many metabolic implications which are reviewed. The very recent discovery of a nicotinic acid receptor and the finding that the drug stimulates the expression of the ABCA 1 membrane cholesterol transporter have paved the way for exciting and promising new 50 years in the history of nicotinic acid. [source]


    Poster Sessions CP10: Blood,Brain Barrier

    JOURNAL OF NEUROCHEMISTRY, Issue 2002
    M. A. García
    Kinetic analysis of vitamin C uptake has demonstrated that specialized cells take up ascorbic acid (AA), the reduced form of vitamin C, through sodium-AA cotransporters. Recently, two different isoforms of sodium-vitamin C cotransporters (SVCT 1, 2) that mediate high affinity Na+ -dependent l -ascorbic acid have been cloned. SVCT2 was detected mainly in choroid plexus cells and neurons, however, there are no evidences of SVCT2 expression in glial cells. High concentrations of vitamin C has been demonstrated in brain hypothalamic area. The hypothalamic glial cells, known as alpha and beta tanycytes, are specialized ependymal cells that bridge the cerebrospinal fluid and the portal blood of the median eminence. Our hypothesis postulates that tanycytes take up reduced vitamin C from the portal blood and cerebrospinal fluid generating an high concentration of this vitamin in brain hypothalamic area. In situ immunohistochemical analyses demonstrated that SVCT2 transporter is selectively expressed in apical region of tanycytes. A newly developed primary culture of mouse hypothalamic tanycytes was used to confirm the expression and function of SVCT2 isoform in these cells. Reduced vitamin C uptake was temperature and sodium dependent. Kinetic analysis showed an apparent Km of 20 ,m and a Vmax of 45 pmol/min per million cells for the transport of ascorbic acid. The expression of SVCT2 was confirmed by immunoblots and RT,PCR. Tanycytes may perform a neuroprotective role concentrating the vitamin C in the hypothalamic area. Acknowledgements:, Supported by Grands FONDECYT 1010843 and DIUC-GIA 201.034.006-1.4 from Concepción University. [source]


    Polymeric systems for amorphous ,9 -tetrahydrocannabinol produced by a hot-melt method.

    JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 11 2006
    Part II: Effect of oxidation mechanisms, chemical interactions on stability
    Abstract The objectives of the present research investigations were to (i) elucidate the mechanism for the oxidative degradation of ,9 -tetrahydrocannabinol (THC) in polymer matrix systems prepared by a hot-melt fabrication procedure, and (ii) study the potential for controlling these mechanisms to reduce the degradation of THC in solid dosage formulations. Various factors considered and applied included drug-excipient compatibility, use of antioxidants, cross-linking in polymeric matrices, microenvironment pH, and moisture effect. Instability of THC in polyethylene oxide (PEO)-vitamin E succinate (VES) patches was determined to be due to chemical interaction between the drug and the vitamin as well as with the atmospheric oxygen. Of the different classes and mechanisms of antioxidants studied, quenching of oxygen by reducing agents, namely, ascorbic acid was the most effective in stabilizing THC in PEO-VES matrices. Only 5.8% of the drug degraded in the ascorbic acid-containing patch as compared to the control (31.6%) after 2 months of storage at 40°C. This coupled with the cross-linking extent and adjustment of the pH microenvironment, which seemed to have an impact on the THC degradation, might be effectively utilized towards stabilization of the drug in these polymeric matrices and other pharmaceutical dosage forms. These studies are relevant to the development of a stable transmucosal matrix system for the therapeutic delivery of amorphous THC. © 2006 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 95:2473,2485, 2006 [source]


    Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosa

    JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2004
    S Ingen-Housz-Oro
    ABSTRACT Background, In recessive dystrophic epidermolysis bullosa (RDEB), a good nutritional balance is necessary to obtain healing of the chronic wounds. However, involvement of the oral mucosa and oesophagus stenosis may be responsible for severe nutritional deficiencies. Objective, In order to propose an adapted nutritional management, we studied the vitamin and trace metal status of 14 RDEB patients. Methods, Height and weight were measured. Plasma levels of albumin, iron, ferritin, calcium, parathyroid hormone (PTH), folates, vitamins C, D, B12, A, E, B1, B6, PP and B2, zinc, selenium, carnitine and copper were measured. Results, Most patients had a significant growth retardation. We found iron, vitamin D, C, B6, PP, zinc and selenium deficiencies in 36,70% of the patients, without clinical expression, except in one case. Vitamin B1, 12, B2, A/RBP, E/lipids and carnitine were normal. The three patients with gastrostomy feeding had better growth but still a protein deficiency and sometimes vitamin C, B6, PP, zinc and carnitine deficiencies. Conclusion, Vitamin and trace metal deficiencies are frequent in RDEB, even in patients receiving gastrostomy feeding, and often go unrecognized. Regular nutritional evaluation is necessary. Dietary advice and supplements should be given. Enteral feeding by gastrostomy should be discussed in early childhood. [source]