Effect of Combination Folic Acid, Vitamin B6 , and Vitamin B12 Supplementation on Fracture Risk in Women: A Randomized, Controlled Trial.

Epidemiologic studies have demonstrated an association of elevated plasma homocysteine levels with greater bone resorption and fracture risk. Vitamins B12 , B6 , and folic acid are cofactors in homocysteine metabolism, and supplementation with B vitamins is effective in lowering homocysteine levels in humans. However, randomized trials of supplemental B vitamins for reduction of fracture risk have been limited. Therefore, we performed an ancillary study to the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS), a large randomized trial of women with preexisting cardiovascular disease or three or more coronary risk factors, to test whether a daily B vitamin intervention including folic acid (2.5 mg/day), vitamin B6 (50 mg/day), and vitamin B12 (1 mg/day) reduces nonspine fracture risk over 7.3 years of treatment and follow-up. Among 4810 women, we confirmed 349 nonspine fracture cases by centralized review of medical records. In a substudy of 300 women (150 in treatment group and 150 controls) with paired plasma samples at randomization and follow-up (7.3 years later), we measured two bone turnover markers, including C-terminal cross-linking telopeptide of type I collagen (CTX) and intact type I procollagen N-propeptide (P1NP). In Cox proportional hazards models based on intention-to-treat, we found no significant effects of B vitamin supplementation on nonspine fracture risk (relative hazard = 1.08; 95% confidence interval, 0.88 to 1.34). In a nested case-cohort analysis, there were no significant effects of B vitamins on fracture risk among women with elevated plasma homocysteine levels, or low levels of vitamins B12 or B6 , or folate at baseline. Furthermore, treatment with B vitamins had no effect on change in markers of bone turnover. We found no evidence that daily supplementation with B vitamins reduces fracture risk or rates of bone metabolism in middle-aged and older women at high risk of cardiovascular disease. © 2017 American Society for Bone and Mineral Research

Food-Aid Quality Correlates Positively With Diet Quality of Food Pantry Users in the Leket Israel Food Bank Collaborative

Introduction: In many affluent countries, including Israel, networks of food banks and pantries have increasing responsibility to alleviate endemic poverty and food insecurity. While they may relieve acute hunger, their long-term influence on health and well-being is poorly understood.Methods: An exploratory cross-sectional telephone survey assessed both adequacy and quality of food aid provided via food pantries in the Leket Israel food bank network, in relation to recipients' dietary needs and health. The quality of food baskets and recipient diets were given a Healthy Portions Score (HPS) to measure compliance with Government guidelines for a “Basic Healthy Food Basket,” and a Nutrient Density Score (NDS) to capture how well the food achieved the recommended dietary allowance (RDA) for vital macro and micronutrients. A total of 105 pantry users were surveyed from 16 pantries around the country.Results: The basket HPS correlated positively and highly significantly with dietary quality (individual NDS) after adjusting for gender, marital status and country of birth (standardized β = 0.22, p = 0.03). Nearly half (46%) reported food insecurity with hunger. Two thirds were overweight or obese, and anemia, cardiovascular and metabolic disease were prevalent. The average food basket provides 30% of energy, 55% of protein, 50% of fiber, but only 33% or less of the household requirement for most minerals and vitamins. Only 60% of participants met their estimated energy requirements, and the intake of many essential micronutrients was well below the RDA. Fruits and vegetable portions contributed by Leket Israel correlated positively with the dietary quality (individual NDS) after adjustment for the same covariates (Standardized β = 0.20, p = 0.04).Discussion: A structured telephone survey proved a feasible method to study the impact of food-aid quality on the nutrition and health of food pantry users in an affluent country. Food baskets with fruits, vegetables and higher quality nutrition were correlated with healthier diets among the recipients. Data correlating food-aid quality and recipient diet and health is essential to effective policy making

Translational models for vascular cognitive impairment: a review including larger species.

BACKGROUND: Disease models are useful for prospective studies of pathology, identification of molecular and cellular mechanisms, pre-clinical testing of interventions, and validation of clinical biomarkers. Here, we review animal models relevant to vascular cognitive impairment (VCI). A synopsis of each model was initially presented by expert practitioners. Synopses were refined by the authors, and subsequently by the scientific committee of a recent conference (International Conference on Vascular Dementia 2015). Only peer-reviewed sources were cited. METHODS: We included models that mimic VCI-related brain lesions (white matter hypoperfusion injury, focal ischaemia, cerebral amyloid angiopathy) or reproduce VCI risk factors (old age, hypertension, hyperhomocysteinemia, high-salt/high-fat diet) or reproduce genetic causes of VCI (CADASIL-causing Notch3 mutations). CONCLUSIONS: We concluded that (1) translational models may reflect a VCI-relevant pathological process, while not fully replicating a human disease spectrum; (2) rodent models of VCI are limited by paucity of white matter; and (3) further translational models, and improved cognitive testing instruments, are required

Progress and challenges in eliminating iodine deficiency in Ethiopia: a systematic review

BACKGROUND: Iodine deficiency disorders (IDD) and their attendant effects on human development, perinatal mortality and intellectual dysfunction are a major nutrition and public health problem worldwide, with Ethiopia counted among the top iodine-deficient countries. Despite the passing of new legislation in 2011 under the National Nutrition Programme and subsequent increase in the availability of iodized salt, the eradication of IDD in Ethiopia remains a significant challenge. This paper critically reviews the recent published data on iodine-status in Ethiopia as a basis for formulating future research and policy initiatives. METHODS: We performed a structural search for IDD studies in Ethiopia for all population groups published after the year 2000. RESULTS: Twenty four studies reported national and regional data giving a national total goiter rate above 35.8 % in women, with rates close to 60 % in four regional states, and an estimated prevalence of IDD ranging from 0.4 to 66.3 % depending on region. The prevalence of goiter in children was 35 %, but was as high as 71 % in the South Nations Nationalities and Peoples Region. The problem persists despite the widespread availability of iodized salt. CONCLUSIONS: Eradicating IDD in Ethiopia will require concerted efforts including the close evaluation of intervention programs through regular, nation-wide monitoring of IDD and salt-iodization coverage. Salt iodization became mandatory in Ethiopia in 2011 and despite significant progress, the current level of eradicating IDD could be improved. Prospective and controlled intervention studies to evaluate biomarkers of thyroid function and cognitive outcomes will help to monitor and improve eradication efforts. Ascertaining and improving health and development in the most vulnerable populations of women and children is a priority that may be advanced through a greater investment in outreach and education

Editorial Nutrition and Dementia

Dementia is a progressive decline in the ability to remember, learn, understand, and communicate. Alzheimer's disease (AD) represents the most common form of dementia in the elderly, affecting about 28 million individuals worldwide. Current treatments for AD and other dementias are sorely limited, falling short of preventing or significantly slowing disease progression. Worldwide, the number of people afflicted by AD is expected to exceed 100 million by 2050, as a result of the increased life-span expectancy in both developed and developing countries Despite this, evidence for the cognitive benefit of nutritional and lifestyle interventions in age-associated cognitive impairment and dementia remains equivocal, and a clear elucidation of mechanisms remains elusive. Although some good evidence is available for the beneficial effect of nutritional interventions on neurocognitive outcomes This special issue presents timely review articles and research papers covering several aspects of nutrition in dementia providing a forum for the critical evaluation and delineation of new approaches and opportunities for nutritional and lifestyle interventions. Three papers in this issue address the role of obesity in dementia. R. Businaro et al. reviewed the molecular mechanisms linking obesity to AD risk, focusing on the correlation between the onset and progression of the disease and the stress-induced changes in lifestyle, leading to overnutrition and reduced physical activity, ending with metabolic syndrome and obesity. Particularly, the authors reviewed the factors leading to alterations of energy metabolism in favour of visceral fat accumulation and the subsequent promotion of insulin resistance and chronic inflammation, both critical factors for AD initiation and progression. They also discussed strategies to reduce abdominal fat deposits and their beneficial role on cognitive decline in a comprehensive and updated review article. It 2 Current Gerontology and Geriatrics Research is clear from this review that hyperinsulinemia is one of the most frequent endocrine features in overweight people leading to insulin desensitization and represents a risk factor for cognitive decline. This point was discussed also by L. Moll and M. Schubert that reviewed the literature dealing with the role of insulin and insulin-like growth factor-1 in the pathogenesis of obesity-associated dementia, with focus on the possible contribution of forkhead-box transcription factors (FoxO). FoxO are mediators of insulin and insulinlike growth factor-1 involved in several processes including neuronal proliferation, differentiation, stress response, and β-amyloid detoxification. In this original review article, the authors discuss the few studies performed so far in animal models to investigate the possible contribution of FoxO-mediated transcription to AD pathology. Studies in C. elegans are in conflict with those performed in mice that suggest that FoxO-mediated transcription does not protect against but rather increase amyloid pathology. However, the small number of published papers limits our understanding of the role of this pathway in dementia, and additional research is required to fully address this interesting topic. It is also noteworthy that FoxO-mediated transcription is not the only mediator of the insulin and insulin-like growth factor-1 cascade, and that several factors might therefore be involved in the pathogenesis of dementia. As an example, insulin resistance and inflammation, observed in people with an excess of visceral adiposity, are also believed to contribute to metabolic deterioration of skeletal muscle, manifesting clinically as sarcopenia. M. E. Levine and E. M. Crimmins investigated the influence of insulin resistance and inflammation on the association between body composition and cognitive performance in older adults. The study included 1127 adults from the US National Health and Nutrition Examination Survey (NHANES 1999(NHANES -2002 and showed that body composition does not predict cognitive functioning in adults aged 60-69 years, but, for adults aged 70 years and over, sarcopenia and obesity, either independently or concurrently, were associated with worse cognitive functioning (WAIS III, Digit Symbol substitution performance) relative to nonsarcopenic nonobese older adults. Cognitive functioning was lowest among the sarcopenic obese group, and sarcopenic obese people also showed the highest levels of inflammation. Moreover, insulin resistance accounted for a significant proportion of the relationship between cognitive performance and obesity, with or without sarcopenia. This is a novel, interesting, and important study on the association between sarcopenic obesity, insulin resistance, and cognitive functioning strengthened by the large sample size and suggesting that individuals who are sarcopenic obese have a lower cognitive ability than other subjects, and that this association might be partially explained by insulin resistance and inflammation. Aging seems also to be an important factor to be considered in order to see a significant effect. The study has, however, several limitations that the authors have acknowledged, including the lack of longitudinal data to evaluate whether insulin resistance precedes frailty and cognitive decline, the use of a single measure of cognitive functioning to study cognitive performance, and the fact that insulin resistance and inflammation were measured only one point in time. However, it provides preliminary interesting data for the design of longitudinal studies to better address this issue. Collectively, these three papers provide new insight into the role that obesity, metabolic syndrome and sarcopenia might play in dementia, by focusing on possible biological mechanisms or by providing novel and interesting preliminary data on humans. G. L. Bowman et al. analysed 36 subjects with mildto-moderate AD investigating the correlation between dyslipidemia and blood-brain barrier (BBB) impairment. The CSF-to-serum ratio of albumin (CSF Albumin Index) ≥9 was considered as BBB impairment. The study revealed that dyslipidemia was frequent in AD subjects with BBB impairment. Furthermore, patients with BBB dysfunction showed significantly higher mean plasma triglyceride and lower HDL cholesterol levels with respect to those without BBB dysfunction. Overall, plasma triglycerides explained 22% of the variance in BBB integrity and remained significant after correcting for age, gender, APOE-ε4 genotype, blood pressure, and statin use. This research paper adds to the growing literature on BBB dysfunction in AD by suggesting that dyslipidemia may have a detrimental role in maintaining BBB integrity in mild-to-moderate AD

Effect of Combination Folic Acid, Vitamin B6 , and Vitamin B12 Supplementation on Fracture Risk in Women: A Randomized, Controlled Trial.

Epidemiologic studies have demonstrated an association of elevated plasma homocysteine levels with greater bone resorption and fracture risk. Vitamins B12 , B6 , and folic acid are cofactors in homocysteine metabolism, and supplementation with B vitamins is effective in lowering homocysteine levels in humans. However, randomized trials of supplemental B vitamins for reduction of fracture risk have been limited. Therefore, we performed an ancillary study to the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS), a large randomized trial of women with preexisting cardiovascular disease or three or more coronary risk factors, to test whether a daily B vitamin intervention including folic acid (2.5 mg/day), vitamin B6 (50 mg/day), and vitamin B12 (1 mg/day) reduces nonspine fracture risk over 7.3 years of treatment and follow-up. Among 4810 women, we confirmed 349 nonspine fracture cases by centralized review of medical records. In a substudy of 300 women (150 in treatment group and 150 controls) with paired plasma samples at randomization and follow-up (7.3 years later), we measured two bone turnover markers, including C-terminal cross-linking telopeptide of type I collagen (CTX) and intact type I procollagen N-propeptide (P1NP). In Cox proportional hazards models based on intention-to-treat, we found no significant effects of B vitamin supplementation on nonspine fracture risk (relative hazard = 1.08; 95% confidence interval, 0.88 to 1.34). In a nested case-cohort analysis, there were no significant effects of B vitamins on fracture risk among women with elevated plasma homocysteine levels, or low levels of vitamins B12 or B6 , or folate at baseline. Furthermore, treatment with B vitamins had no effect on change in markers of bone turnover. We found no evidence that daily supplementation with B vitamins reduces fracture risk or rates of bone metabolism in middle-aged and older women at high risk of cardiovascular disease. © 2017 American Society for Bone and Mineral Research