Antioxidant vitamin status of obese patients in terms of the risk of comorbidities

BACKGROUND: Synchronously optimized concentrations of vitamins C, E, A, carotenoids and their ratios in blood plasma help to prevent or slow down the development of many alimentary-dependent diseases and their complications. AIMS: to characterize the vitamin status of obese patients from the standpoint of the risk of progression of existing and development of associated diseases. MATERIALS AND METHODS: An observational single-site cross-sectional study of the sufficiency with antioxidant vitamins in 81 patients (21 men, 60 women) aged 20–75 years with body mass index 40,7±1,2 kg/m2, enrolled for treatment from April to June in Federal Research Centre of Nutrition, Biotechnology had been conducted. The concentration of α- and γ-tocopherols, retinol, ascorbic acid, β-carotene was determined in blood serum and their ratios with lipid profile were calculated. RESULTS: Indicators of vitamin status were determined in 35 patients with obesity, 27 patients with obesity and cardiovascular diseases (CVD), 19 patients with obesity and type 2 diabetes mellitus (T2DM). The concentration of ascorbic acid in more than 50% of patients did not reach the optimal level (50 µmol/l). Compared to patients of other groups, patients with T2DM were better supplied with vitamin E, but worse with other vitamins. They have a non-optimal ratio of concentrations of vitamin C and E more often compared with patients of other groups (p≤0.050). Among them, the combined suboptimal level of vitamin C and β-carotene (<0.4 µmol/l) was detected 1.6–1.8 fold more often. The lack of antioxidants in patients with T2DM according to simultaneously reduced vitamin C/vitamin E ratio (<1.5) and β-carotene level was detected 3.3-fold more often, synchronously lowered vitamin C/vitamin E ratio and vitamin C level – 2.4-fold. γ-tocopherol level in serum of patients with T2DM tended to increase compared with that in patients with obesity (p=0.063) and CVD (p=0.081), γ-tocopherol/triacylglycerides ratio was 1.5-fold higher (respectively р=0.009 и р=0.076). Only in 2 patients with obesity and 2 patients with CVD all serum indicators corresponded to the optimal level of all vitamins. In terms of α-tocopherol/cholesterol (<5 µmol/mol), an increased risk of myocardial infarction was detected in 10.5–42.9% of the examined patients. Glucose level was positively associated with serum levels of α- and γ-tocopherols, as well as cholesterol-adjusted individual tocopherols; while glycemia was inversely associated with triacylglycerides-standardized individual tocopherols, as well as β-carotene and vitamin C/vitamin E ratio. CONCLUSIONS: In most patients, a non-optimal serum vitamin content was found according to one or several parameters. In order to vitamin C/vitamin E ratio, patients with T2DM need to increase vitamin C intake. Increasing serum β-carotene and achieving an optimal C/E ratio will help to prevent an increase in glycemia

Национальная программа по оптимизации обеспеченности витаминами и минеральными веществами детей России. Краткий обзор документа

Providing the body with micronutrients — vitamins and minerals — is an indispensable component of human health and is essential in the  early stages of ontogenesis. However, studies conducted abroad and  in our country show that due to the fact that the content of  micronutrients in the daily ration can vary significantly, it is  impossible to provide the necessary consumption them with food.  This is confirmed by data on the high incidence of insufficient  provision with vitamins and minerals of all strata of the population.  In February 2017 at the congress of the Union of Pediatricians of  Russia, the consensus paper «The National Program for Optimization of Provision with Vitamins and Minerals of Children in Russia» was  presented. It sums up the results of the work of expert group  including pediatricians, nutritionists, clinical pharmacologists,  biochemists, vitaminologists, neonatologists, gastroenterologists, allergologists-immunologists, psychoneurologists, and others from several cities of Russia. The first chapter of the document highlights  general issues including a definition of concepts, current  epidemiological data on provision, and methodological approaches.  The second chapter presents the evidence base for the use of  vitamins and minerals in different areas of pediatrics. The purpose of this publication is to acquaint a wide range of the pediatric  community with the main provisions of the document.Обеспеченность организма микронутриентами — витаминами и минеральными веществами — является обязательной составляющей здоровья человека и критически важна на ранних  этапах онтогенеза. Однако, как показывают исследования, проведенные за рубежом и в  нашей стране, вследствие того что содержание микронутриентов в суточном рационе может  значительно колебаться, обеспечить необходимое их потребление с пищей не удается. Это  подтверждают данные о высокой частоте недостаточной обеспеченности витаминами и  минеральными веществами всех слоев населения. В феврале 2017 года на съезде Союза  педиатров России был представлен согласительный документ «Национальная программа по  оптимизации обеспеченности витаминами и минеральными веществами детей России»,  ставший итогом работы группы экспертов, в которую вошли представители разных специальностей — педиатры, диетологи, клинические фармакологи, биохимики,  витаминологи, неонатологи, гастроэнтерологи, аллергологи-иммунологи, психоневрологи и  другие специалисты из нескольких городов России. В первой главе документа освещаются общие вопросы, включая определение понятий, современные эпидемиологические данные  по обеспеченности, методологические подходы. Во второй главе представлена  доказательная база применения витаминов и минеральных веществ в различных областях  педиатрии. Целью настоящей публикации является ознакомление с основными положениями документа широких кругов педиатрического сообщества.Конфликт интересов.В.М. Коденцова выступала с лекциями для компаний Пфайзер, КРКА, АО «ПРОГРЕСС».Л.С. Намазова-Баранова — получение исследовате льских грантов от фармацевтических  компаний Пьер Фабр, Genzyme Europe B. V., ООО «Астра зенека Фармасьютикалз»,  Gilead/PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», Teva Branded Pharmaceutical products R&D, Inc/ООО «ППД Девелопмент (Смоленск)», «Сталлержен С. А.»/«Квинтайлс ГезмбХ» (Австрия).С.Г. Макарова является научным консультантом компании «Нутриция».Источник финансирования.Статья опубликована при поддержке компании Pfizer

Эффективность применения витаминных комплексов в виде мармеладных пастилок у здоровых детей и детей с аллергическими заболеваниями дошкольного и школьного возраста

Background. Vitamins and minerals are significant components of the diet of a person of any age. Nowadays, when there is a focus on the ‘Western’ type of food, it is impossible to get the necessary amount of all vitamins and minerals with a normal diet, which explains the high prevalence of hypovitaminosis in children. It is known that children with allergic diseases have a lower provision of vitamins as compared to apparently healthy children, which is the rationale for the relevance of this study.Our aim was to evaluate the efficacy and tolerability of vitamin complexes in children, including children with allergic reactions.Patients and Methods. The work was performed at the Federal State Autonomous Institution ‘NMRC for Children’s Health’ of the Ministry of Healthcare of Russia from February to August 2017. We examined 90 apparently healthy children without severe somatic pathology at the age of 4–14 years, including 17 children with a history of allergic reactions. The children were divided into 2 groups. Group 1 received marmalade pastilles with vitamins C (16–27% of the recommended dietary allowance, RDA), E (29–40% of the RDA), A (24–34% of the RDA), B5 (40–80% of the RDA) , B9 (18–35% of the RDA), and D3 (4–9% of the RDA). Group 2 received marmalade pastilles with vitamins C (57–80% of the RDA), E (50–86% of the RDA), A (40–80% of the RDA), B5 (143–167% of the RDA), B3 (44 –73% of the RDA), D3 (10% of the RDA), B6 (82–117% of the RDA), and B12 (83–167% of the RDA). The tolerance of the vitamin complex was evaluated by the questionnaire method. The provision of vitamins C and B6 was evaluated in 39 children by an hourly urinary excretion of vitamins at the beginning of the study before taking the vitamin complex and 1 month after the start of intake.Results. The studied vitamin complexes showed good clinical tolerance in all children, including those with a history of allergic reactions to vitamin-mineral complexes. Evaluation of the efficacy of the vitamin complex in the 2nd group showed an improved provision, especially in children who had a deep deficiency of vitamins C (10%) and B6 (22%). At the same time, the excretion of vitamin B6 metabolite increased by 42.2%.Conclusion. The study showed the effective absorption of the studied vitamins and the good tolerability of the used vitamin complexes, including children with a history of allergic reactions to vitamin-mineral complexes.Обоснование. Витамины и минеральные вещества — значимые составляющие рациона человека любого возраста. В современном мире, ориентированном на «западный» тип питания, невозможно получить необходимое количество всех витаминов и минеральных веществ с обычным рационом, что объясняет высокую распространенность гиповитаминозов у детей. Известно, что дети с аллергическими заболеваниями имеют более низкую обеспеченность витаминами по сравнению с практически здоровыми детьми, чем и обоснована актуальность данного исследования.Цель исследования — оценить эффективность и переносимость витаминных комплексов у детей, в том числе детей с аллергическими реакциями.Методы. Работа выполнена в ФГАУ «НМИЦ здоровья детей» Минздрава России с февраля по август 2017 г. Обследовано 90 практически здоровых детей без тяжелой соматической патологии в возрасте 4–14 лет, в том числе 17 детей с аллергическими реакциями в анамнезе. Дети были разделены на 2 группы. Группа 1 получала мармеладные пастилки с витаминами С (16–27% от рекомендуемой нормы потребления, РНП), Е (29–40% от РНП), А (24–34% от РНП), B5 (40–80% от РНП), B9 (18–35% от РНП) и D3 (4–9% от РНП). Группа 2 получала мармеладные пастилки с витаминами С (57–80% от РНП), Е (50–86% от РНП), А (40–80% от РНП), B5 (143–167% от РНП), B3 (44–73% от РНП), D3 (10% от РНП), В6 (82–117% от РНП) и В12 (83–167% от РНП). Оценку переносимости витаминного комплекса осуществляли опросно-анкетным методом. Обеспеченность витаминами С и В6 оценивали у 39 детей по часовой экскреции витаминов с мочой в начале исследования перед началом приема витаминного комплекса и через 1 мес.Результаты. Исследуемые витаминные комплексы показали хорошую клиническую переносимость у всех детей, включая лиц с аллергическими реакциями на витаминно-минеральные комплексы в анамнезе. Оценка эффективности применения витаминного комплекса во 2-й группе показала улучшение обеспеченности, особенно у детей, имевших глубокий дефицит витаминов С (10%) и В6 (22%). При этом экскреция метаболита витамина В6 повысилась на 42,2%.Заключение. Проведенное исследование показало эффективное усвоение исследованных витаминов и хорошую переносимость применявшихся витаминных комплексов, в том числе у детей с аллергическими реакциями на витаминно-минеральные комплексы в анамнезе

Enriched Milk Drinks for Vitamin Deficiency Correction in Toddlers and Preschoolers

After switching to general diet, children aged over 1 year lack vitamins D, B12, C, as well as folates, calcium, iodine, iron, zinc, and docosahexaenoic acid. High prevalence of multi-micronutrient deficiency among toddlers and preschoolers constitutes grounds for administration of food products rich in micronutrients, including beverages made on different bases (juices, cow's milk, etc.). Baby food products for young children as well as micronutrient-enriched milk drinks have advantages over other dietary dishes because the vitamins and minerals contained in them correspond to the child's age requirement. The article discusses disagreements in the name of milk drinks for children over 1 year. The article also considers conformity of the quality of such drinks with the regulatory framework in force in the Russian Federation. The analysis of scientific literature on the effectiveness of inclusion of micronutrientenriched beverages in the diet of toddlers and preschoolers was carried out. Children whose diet includes only cow's milk with excessive intake of protein and saturated fats have a risk of developing deficiency of alpha-linolenic and docosahexaenoic acids, iron, vitamins C and D. Inclusion of milk drinks in the general diet guarantees adequate consumption of micronutrients, provides the body with vitamins and microelements, reduces disease incidence, improves cognitive functions of children

The National Program for Optimization of Provision with Vitamins and Minerals of Children in Russia. Summary Review of the Document

Providing the body with micronutrients — vitamins and minerals — is an indispensable component of human health and is essential in the  early stages of ontogenesis. However, studies conducted abroad and  in our country show that due to the fact that the content of  micronutrients in the daily ration can vary significantly, it is  impossible to provide the necessary consumption them with food.  This is confirmed by data on the high incidence of insufficient  provision with vitamins and minerals of all strata of the population.  In February 2017 at the congress of the Union of Pediatricians of  Russia, the consensus paper «The National Program for Optimization of Provision with Vitamins and Minerals of Children in Russia» was  presented. It sums up the results of the work of expert group  including pediatricians, nutritionists, clinical pharmacologists,  biochemists, vitaminologists, neonatologists, gastroenterologists, allergologists-immunologists, psychoneurologists, and others from several cities of Russia. The first chapter of the document highlights  general issues including a definition of concepts, current  epidemiological data on provision, and methodological approaches.  The second chapter presents the evidence base for the use of  vitamins and minerals in different areas of pediatrics. The purpose of this publication is to acquaint a wide range of the pediatric  community with the main provisions of the document

Evaluation of the Efficacy and Tolerability of Vitamin Complexes in Marmalade Pastilles in Healthy Children and Children With Allergic Diseases of Pre-School and School Age

Background. Vitamins and minerals are significant components of the diet of a person of any age. Nowadays, when there is a focus on the ‘Western’ type of food, it is impossible to get the necessary amount of all vitamins and minerals with a normal diet, which explains the high prevalence of hypovitaminosis in children. It is known that children with allergic diseases have a lower provision of vitamins as compared to apparently healthy children, which is the rationale for the relevance of this study.Our aim was to evaluate the efficacy and tolerability of vitamin complexes in children, including children with allergic reactions.Patients and Methods. The work was performed at the Federal State Autonomous Institution ‘NMRC for Children’s Health’ of the Ministry of Healthcare of Russia from February to August 2017. We examined 90 apparently healthy children without severe somatic pathology at the age of 4–14 years, including 17 children with a history of allergic reactions. The children were divided into 2 groups. Group 1 received marmalade pastilles with vitamins C (16–27% of the recommended dietary allowance, RDA), E (29–40% of the RDA), A (24–34% of the RDA), B5 (40–80% of the RDA) , B9 (18–35% of the RDA), and D3 (4–9% of the RDA). Group 2 received marmalade pastilles with vitamins C (57–80% of the RDA), E (50–86% of the RDA), A (40–80% of the RDA), B5 (143–167% of the RDA), B3 (44 –73% of the RDA), D3 (10% of the RDA), B6 (82–117% of the RDA), and B12 (83–167% of the RDA). The tolerance of the vitamin complex was evaluated by the questionnaire method. The provision of vitamins C and B6 was evaluated in 39 children by an hourly urinary excretion of vitamins at the beginning of the study before taking the vitamin complex and 1 month after the start of intake.Results. The studied vitamin complexes showed good clinical tolerance in all children, including those with a history of allergic reactions to vitamin-mineral complexes. Evaluation of the efficacy of the vitamin complex in the 2nd group showed an improved provision, especially in children who had a deep deficiency of vitamins C (10%) and B6 (22%). At the same time, the excretion of vitamin B6 metabolite increased by 42.2%.Conclusion. The study showed the effective absorption of the studied vitamins and the good tolerability of the used vitamin complexes, including children with a history of allergic reactions to vitamin-mineral complexes

URINARY EXCRETION OF WATER-SOLUBLE VITAMINS (C, B1, B2, AND B6) IN HEALTHY CHILDREN OF PRESCHOOL AND SCHOOL AGE: A CROSS-SECTIONAL STUDY

Background. Children of preschool and school age are at risk of developing vitamin deficiency. Screening of the vitamin provision of children remains an urgent problem of pediatrics. Objective. Our aim was to determine the prevalence of low excretion of watersoluble vitamins among healthy preschool and school-age children.Methods. The study was conducted in March-April 2017. We determined the urinary excretion (fasting morning portion collected during 30–120 min after night-time urination) of metabolites of vitamins C, B1, B2, and B6 in healthy children. Riboflavin (vitamin B2 metabolite) was determined spectrophotometrically by titration with a riboflavin-binding apoprotein; 4-pyridoxyl acid (vitamin B6 metabolite) and thiamine (vitamin B1 metabolite) — by fluorescent method, ascorbic acid (vitamin C metabolite) — by visual titration with Tillman’s reagent. The excretion considered to be low (equivalent to vitamin deficiency) when thiamine excretion was < 7, 10, 11, and 12 μg/h and riboflavin < 6, 9, 10, and 13 μg/h in children aged 3–5, 6–8, 9–11, and above 12 years, respectively; 4-pyridoxylic acid — < 40, 60, and 70 μg/h in children aged 3–5, 6–8, and ≥ 9 years, ascorbic acid — < 0.2 and 0.4 mg/h in children aged 3–11 and ≥ 12 years, respectively.Results. Metabolites were excreted in 39 children (20 girls), 14 of them aged 4–6 years and 25 children aged 7–14 years. A low level of ascorbic acid excretion was found in 13 (33%) children, of thiamine — in 24 (62%), of riboflavin — in 16 (41%), of 4-pyridoxyl acid — in 26 (67%). Low excretion of at least one vitamin metabolite was detected in 30 (77%) children, of 3 or more metabolites simultaneously — in 15 (39%).Conclusion. A low level of urinary excretion of metabolites of at least one water-soluble vitamin (C, B1, B2, and B≥) occurs in most preschool and schoolage children