Associations of 24 h urinary excretions of alpha- and gamma-carboxyethyl hydroxychroman with plasma alpha- and gamma-tocopherol and dietary vitamin E intake in older adults:the Lifelines-MINUTHE Study

Background Urinary metabolites of vitamin E, i.e., alpha- and gamma-carboxyethyl hydroxychroman (alpha- and gamma-CEHC), have gained increasing attention and have been proposed as novel biomarkers of vitamin E intake and status. However, there are insufficient data on the relationship of plasma alpha-tocopherol and gamma-tocopherol and dietary vitamin E intake with 24 h urinary excretions of alpha- and gamma-CEHC. Objectives We aimed to (1) investigate the associations of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC with plasma alpha- and gamma-tocopherol, respectively; (2) investigate the associations of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC with dietary vitamin E intake, and we hypothesize that 24 h urinary excretions of alpha- and gamma-CEHC will better correlate with vitamin E intake than urinary alpha- and gamma-CEHC/creatinine ratios. Design 24 h Urine and plasma samples were collected from 1519 participants (60-75 years, male: 50%) included in the Lifelines-MINUTHE Study for the assessments of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC, and plasma alpha- and gamma-tocopherol. Among those participants, dietary vitamin E intake data from 387 participants were available from an externally validated Flower-Food Frequency Questionnaire (FFQ). The associations of plasma alpha- and gamma-tocopherol, dietary vitamin E intake, with urinary alpha- and gamma-CEHC were assessed using multivariate linear regressions. Results 24 h Urinary excretion of alpha-CEHC (median (IQR): 0.9 (0.3-2.4) mu mol) was less than that of gamma-CEHC (median (IQR): 1.5 (0.5-3.5) mu mol). After adjustment for covariates, we found that 24 h urinary alpha-CEHC excretion and urinary alpha-CEHC/creatinine ratio were both positively associated with plasma alpha-tocopherol (std.beta: 0.06, p = 0.02; std.beta: 0.06, p = 0.01, respectively). Furthermore, the sum of 24 h urinary alpha- and gamma-CEHC excretions was positively associated with dietary vitamin E intake (std.beta: 0.08; p = 0.03), whereas there was no relation between urinary alpha- and gamma-CEHC/creatinine ratios and vitamin E intake. No association was observed neither between plasma alpha- and gamma-tocopherol and dietary vitamin E intake, nor between urinary gamma-CEHC and plasma gamma-tocopherol. Conclusion Our study confirmed our hypothesis that 24 h urinary alpha- and gamma-CEHC excretions would be a better marker for dietary vitamin E intake than urinary alpha- and gamma-CEHC/creatinine ratios. Considering that both 24 h urinary alpha- and gamma-CEHC excretions and alpha- and gamma-CEHC/creatinine ratios were also associated with plasma alpha-tocopherol status, we suggest that 24 h urinary alpha- and gamma-CEHC excretions could be used to assess overall vitamin E status

Methylmalonic acid, vitamin B12, renal function, and risk of all-cause mortality in the general population:results from the prospective Lifelines-MINUTHE study

Background: Methylmalonic acid (MMA) is best known for its use as a functional marker of vitamin B12 deficiency. However, MMA concentrations not only depend on adequate vitamin B12 status, but also relate to renal function and endogenous production of propionic acid. Hence, we aimed to investigate to what extent variation in MMA levels is explained by vitamin B12 and eGFR and whether MMA levels are associated with mortality if vitamin B12 and eGFR are taken into account. Methods: A total of 1533 individuals (aged 60–75 years, 50% male) were included from the Lifelines Cohort and Biobank Study. Individuals were included between 2006 and 2013, and the total follow-up time was 8.5 years. Results: Median [IQR] age of the study population was 65 [62–69] years, 50% was male. At baseline, median MMA concentration was 170 [138–216] nmol/L, vitamin B12 290 [224–362] pmol/L, and eGFR 84 [74–91] mL/min/1.73 m2. Log 2 vitamin B12, log 2 eGFR, age, and sex were significantly associated with log 2 MMA in multivariable linear regression analyses (model R 2 = 0.22). After a total follow-up time of 8.5 years, 72 individuals had died. Log 2 MMA levels were significantly associated with mortality (hazard ratio [HR] 1.67 [95% CI 1.25–2.22], P < 0.001). Moreover, we found a significant interaction between MMA and eGFR with respect to mortality (P interaction < 0.001). Conclusions: Only 22% of variation in MMA levels was explained by vitamin B12, eGFR, age, and sex, indicating that a large part of variation in MMA levels is attributable to other factors (e.g., catabolism, dietary components, or gut microbial production). Higher MMA levels are associated with an increased risk for mortality, independent of vitamin B12, eGFR, and sex. This association was more pronounced in individuals with impaired renal function

Hidden Hunger: Solutions for America’s Aging Populations

The global population, including the United States, is experiencing a demographic shift with the proportion of older adults (aged ≥ 65 years) growing faster than any other age group. This demographic group is at higher risk for developing nutrition-related chronic conditions such as heart disease and diabetes as well as infections such as influenza and pneumonia. As a result, an emphasis on nutrition is instrumental for disease risk reduction. Unfortunately, inadequate nutrient status or deficiency, often termed hidden hunger, disproportionately affects older adults because of systematic healthcare, environmental, and biological challenges. This report summarizes the unique nutrition challenges facing the aging population and identifies strategies, interventions, and policies to address hidden hunger among the older adults, discussed at the scientific symposium “Hidden Hunger: Solutions for America’s Aging Population”, on March 23, 2018