Changes in Vitamin A and C Levels In Black Mine-Workers

An investigation of the vitamin A and C status of Black mine-workers was carried out at the request of the Anglo American Corporation of South Africa Ltd. It was found that, although there was no evidence of widespread vitamin A deficiency, there was sufficient evidence of subclinical deficiency to warrant further investigation. In spite of apparently adequate vitamin C intakes, a relatively high incidence of subclinical vitamin C deficiency was found. It is strongly recommended that further studies be undertaken to establish what are the minimum levels of vitamin A and C required daily to reduce effectively the incidence of subclinical deficiency

Effect of enrichment of maize meal with nicotinic acid and riboflavin upon the Vitamin and protein nutritional status of young school-going and pre-school children

A series of experiments was undertaken to investigate the feasibility of enriching maize meal with nicotinic acid and riboflavin. First the necessary level of enrichment was established and then the efficacy of such enrichment of maize was tested in the field on children and young adults. This report deals with the results of an experiment designed to establish whether such an enrichment scheme would have any detrimental effects on· young growing children with marginal protein calorie malnutrition. As in the previous experiments, a marked improvement in the nicotinic acid and riboflavin status was found in the experimental group. These biochemical findings were in conformity with the improvement in clinical status found. Moreover, such enrichment did not have any noticeable adverse effects. The hypothesis that vitamin enrichment could cause growth stimulation, and thus aggravate an existing marginal protein deficiency state, could not in any way be substantiated. The enrichment of maize meal with riboflavin and nicotinic acid during milling has been shown conclusively to be highly effective in improving the vitamin nutritional status while at the same time not harming the protein nutritional status of young children. Since the previous experiments proved it to be economically and technologically feasible, it is now strongly recommended that such an enrichment scheme be introduced on a national basis with the least possible delay.S. Afr. Med. J., 48, 1641 (1974)

Nutritional status of young school-going and pre-school children

A series of experiments was undertaken to investigate the feasibility of enriching maize meal with nicotinic acid and riboflavin. First the necessary level of enrichment was established and then the efficacy of such enrichment of maize was tested in the field on children and young adults. This report deals with the results of an experiment designed to establish whether such an enrichment scheme would have any detrimental effects on young growing children with marginal protein calorie malnutrition. As in the previous experiments, a marked improvement in the nicotinic acid and riboflavin status was found in the experimental group. These biochemical findings were in conformity with the improvement in clinical status found. Moreover, such enrichment did not have any noticeable adverse effects. The hypothesis that vitamin enrichment could cause growth stimulation, and thus aggravate an existing marginal protein deficiency state, could not in any way be substantiated. The enrichment of maize meal with riboflavin and nicotinic acid during milling has been shown conclusively to be highly effective in improving the vitamin nutritional status while at the same time not harming the protein nutritional status of young children. Since tho:! previous experiments proved it to be economically and technologically feasible, it is now strongly r::commended that such an enrichment scheme be introduced on a national basis with the least possible delay.S. Afr. Med. J., 48, 1641 (1974

Relationship between body mass index, cardiovascular biomarkers and incident heart failure

BACKGROUND: There are limited data examining whether body-mass index (BMI) influences the association between cardiovascular biomarkers and incident heart failure (HF). METHODS AND RESULTS: Thirteen biomarkers representing key HF domains were measured: N-terminal-pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-A-type natriuretic peptide (MR-proANP), cardiac troponin-T (cTnT), C-reactive protein, procalcitonin, galectin-3, C-terminal pro-endothelin-1 (CT-pro-ET-1), mid-regional pro-adrenomedullin, plasminogen activator inhibitor-1, copeptin, renin, aldosterone and cystatin-C. Associations of biomarkers with BMI were examined using linear regression models, and with incident HF using Cox regression models. We selected biomarkers significantly associated with incident HF, and evaluated whether BMI modified these associations. RESULTS: Among 8202 individuals, 41% were overweight (BMI 25-30kg/m2 ), and 16% were obese (BMI≥30kg/m2 ). Mean age of the cohort was 49 years (range 28-75), and 50% were women. All biomarkers except renin were associated with BMI: inverse associations were observed with NT-proBNP, MR-proANP, CT-pro-ET-1 and aldosterone whereas positive associations were observed with the remaining biomarkers (Pall ≤0.001). During 11.3±3.1 years follow-up, 357 HF events were recorded. Only NT-proBNP, MR-proANP and cTnT remained associated with incident HF (P0.1). Combined NT-proBNP and cTnT measurements modestly improved performance metrics of the clinical HF model in overweight (ΔC-statistic=0.024; LHRχ2 =38; P<0.001) and in obese (ΔC-statistic=0.020; LHRχ2 =32; P<0.001) individuals. CONCLUSIONS: Plasma concentrations of several cardiovascular biomarkers are influenced by obesity. Only NT-proBNP, MR-proANP and cTnT were associated with incident HF, and BMI did not modify these associations. A combination of NT-proBNP and cTnT improves HF risk prediction in overweight and in obese individuals. This article is protected by copyright. All rights reserved

Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis

Purpose: Conformal sphincter preservation operation (CSPO) is a sphincter preservation operation for very low rectal cancers. Compared to intersphincteric resection (ISR), CSPO retains more dentate line and distal rectal wall, and also avoids damaging the nerves in the intersphincteric space. This study aimed to compare the postoperative anal function and quality of life between the CSPO and ISR. Method: Patients with low rectal cancer undergoing CSPO (n = 117) and ISR (n = 66) were included from Changhai and Huashan Hospital, respectively, between 2011 and 2020. A visual analog scale (range 0–10) was utilized to evaluate satisfaction with anal function and quality of life. The anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score. Quality of life was evaluated with the EORTC QLQ-C30 and QLQ-CR38. Results: The CSPO group had more male patients (65.8% vs. 50%, p = 0.042), more preoperative chemoradiotherapy (33.3% vs. 10.6%, p < 0.001), lower tumor position (3.45 ± 1.13 vs. 4.24 ± 0.86 cm, p < 0.001), and more postoperative chemotherapy (65% vs. 13.6%, p < 0.001) compared to the ISR group. In addition, CSPO patients had shorter postoperative stay (6.63 ± 2.53 vs. 7.85 ± 4.73 days, p = 0.003) and comparable stoma reversal rates within 1 year after surgery (92.16% vs. 96.97%, p = 0.318). Multivariable analysis showed that CSPO significantly contributed to higher satisfaction with anal function (beta = 1.752, 95% CI 0.776–2.728) and with quality of life (beta = 1.219, 95% CI 0.374–2.064), but not to Wexner, LARS score, or EORTC QLQ-C30 and QLQ-CR38. Conclusion: CSPO improved the satisfaction with anal function and quality of life but utilized more preoperative chemoradiotherapy. CSPO may be an alternative choice for patients with very low rectal cancers in better physical health and with higher requirements for anal function and quality of life

Plasma Thallium Concentration, Kidney Function, Nephrotoxicity and Graft Failure in Kidney Transplant Recipients

The nephrotoxic effects of heavy metals have gained increasing scientific attention in the past years. Recent studies suggest that heavy metals, including cadmium, lead, and arsenic, are detrimental to kidney transplant recipients (KTR) even at circulating concentrations within the normal range, posing an increased risk for graft failure. Thallium is another highly toxic heavy metal, yet the potential consequences of the circulating thallium concentrations in KTR are unclear. We measured plasma thallium concentrations in 672 stable KTR enrolled in the prospective TransplantLines Food and Nutrition Biobank and Cohort Study using inductively coupled plasma mass spectrometry. In cross-sectional analyses, plasma thallium concentrations were positively associated with kidney function measures and hemoglobin. We observed no associations of thallium concentration with proteinuria or markers of tubular damage. In prospective analyses, we observed no association of plasma thallium with graft failure and mortality during a median follow-up of 5.4 [interquartile range: 4.8 to 6.1] years. In conclusion, in contrast with other heavy metals such as lead, cadmium, and arsenic, there is no evidence of tubular damage or thallium nephrotoxicity for the range of circulating thallium concentrations observed in this study. This is further evidenced by the absence of associations of plasma thallium with graft failure and mortality in KTR

Utility of iron biomarkers in differentiating menopausal status: Findings from CoLaus and PREVEND.

AIM To examine the association of iron biomarkers with menopausal status and assess whether these biomarkers can help differentiate menopausal status beyond age. METHODS In this cross-sectional study we included 1679 women from the CoLaus and 2133 from the PREVEND cohorts, with CoLaus used as primary cohort and PREVEND for replication. Ferritin, transferrin, iron, and transferrin saturation (TSAT) were used to assess iron status. Hepcidin and soluble transferrin receptor were assessed only in PREVEND. Menopausal status was self-reported and defined as menopausal or non-menopausal. Logistic regressions were used to explore the association of these iron biomarkers with menopause status. Sensitivity, specificity, area under the receiver operating characteristic curves (AUC), positive and negative predictive values as well as cut-off points for the iron biomarkers were calculated. The model with the highest AUC was defined as the best. RESULTS In the CoLaus and PREVEND cohorts, respectively, 513 (30.6 %) and 988 (46.3 %) women were postmenopausal. Ferritin (OR, 2.20; 95 % CI 1.72-2.90), transferrin (OR, 0.03; 95 % CI 0.01-0.10), and TSAT (OR, 1.28; 95 % CI 1.06-1.54) were significantly associated with menopausal status in CoLaus, with the findings replicated in PREVEND. AUC of age alone was 0.971. The best model resulted from combining age, ferritin, and transferrin, with an AUC of 0.976, and sensitivity and specificity of 87.1 % and 96.5 %, respectively. Adding transferrin and ferritin to a model with age improved menopause classification by up to 7.5 %. In PREVEND, a model with age and hepcidin outperformed a model with age, ferritin, and transferrin. CONCLUSION Iron biomarkers were consistently associated with menopausal status in both cohorts, and modestly improved a model with age alone for differentiating menopause status. Our findings on hepcidin need replication

Nonalcoholic fatty liver disease, circulating ketone bodies and all-cause mortality in a general population-based cohort

Background Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent, paralleling the obesity epidemic. Ketone bodies are produced in the liver, but it is currently uncertain whether circulating ketone bodies are increased in the context of NAFLD. We investigated the association between NAFLD and circulating ketone bodies and determined the extent to which NAFLD and circulating ketone bodies are associated with all-cause mortality. Methods Plasma ketone bodies were measured by nuclear magnetic resonance spectroscopy in participants of the general population-based PREVEND study. A fatty liver index (FLI) >= 60 was regarded as a proxy of NAFLD. Associations of an elevated FLI and ketone bodies with all-cause mortality were investigated using Cox regression analyses. Results The study included 6,297 participants aged 54 +/- 12 years, of whom 1,970 (31%) had elevated FLI. Participants with elevated FLI had higher total ketone bodies (194 [153-259] vs 170 [133-243] mu mol/L; P < .001) than participants without elevated FLI. During 7.9 [7.8-8.9] years of follow-up, 387 (6%) participants died. An elevated FLI was independently associated with an increased risk of mortality (HR: 1.34 [1.06-1.70]; P = .02). Higher total ketone bodies were also associated with an increased mortality risk (HR per doubling: 1.29 [1.12-1.49]; P < .001). Mediation analysis suggested that the association of elevated FLI with all-cause mortality was in part mediated by ketone bodies (proportion mediated: 10%, P < .001). Conclusion Circulating ketone bodies were increased in participants with suspected NAFLD. Both suspected NAFLD and higher circulating ketone bodies are associated with an increased risk of all-cause mortality

Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients

There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 +/- 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 +/- 20 mu mol/L. At a median follow-up of 7.0 (IQR, 6.2-7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34-0.74; p <0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83-1.62; p = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR

Plasma Lead Concentration and Risk of Late Kidney Allograft Failure:Findings From the TransplantLines Biobank and Cohort Studies

Rationale &amp; Objective: Heavy metals are known to induce kidney damage, and recent studies have linked minor exposures to cadmium and arsenic with increased risk of kidney allograft failure, yet the potential association of lead with late graft failure in kidney transplant recipients (KTRs) remains unknown. Study Design: Prospective cohort study in The Netherlands. Setting &amp; Participants: We studied outpatient KTRs (n = 670) with a functioning graft for ≥1 year recruited at a university setting (2008-2011) and followed for a median of 4.9 (interquartile range, 3.4-5.5) years. Additionally, patients with chronic kidney disease (n = 46) enrolled in the ongoing TransplantLines Cohort and Biobank Study (2016-2017, ClinicalTrials.gov identifier NCT03272841) were studied at admission for transplant and at 3, 6, 12, and 24 months after transplant. Exposure: Plasma lead concentration was log2-transformed to estimate the association with outcomes per doubling of plasma lead concentration and also considered categorically as tertiles of lead distribution. Outcome: Kidney graft failure (restart of dialysis or repeat transplant) with the competing event of death with a functioning graft. Analytical Approach: Multivariable-adjusted cause-specific hazards models in which follow-up of KTRs who died with a functioning graft was censored. Results: Median baseline plasma lead concentration was 0.31 (interquartile range, 0.22-0.45) μg/L among all KTRs. During follow-up, 78 (12%) KTRs experienced graft failure. Higher plasma lead concentration was associated with increased risk of graft failure (hazard ratio, 1.59 [95% CI, 1.14-2.21] per doubling; P = 0.006) independent of age, sex, transplant characteristics, estimated glomerular filtration rate, proteinuria, smoking status, alcohol intake, and plasma concentrations of cadmium and arsenic. These findings remained materially unchanged after additional adjustment for dietary intake and were consistent with those of analyses examining lead categorically. In serial measurements, plasma lead concentration was significantly higher at admission for transplant than at 3 months after transplant (P = 0.001), after which it remained stable over 2 years of follow-up (P = 0.2). Limitations: Observational study design. Conclusions: Pretransplant plasma lead concentrations, which decrease after transplant, are associated with increased risk of late kidney allograft failure. These findings warrant further studies to evaluate whether preventive or therapeutic interventions to decrease plasma lead concentration may represent novel risk-management strategies to decrease the rate of kidney allograft failure.</p