Estado nutricional de vitamina E e fatores de risco cardiovascular em adultos e idosos: estudo Brazuca Natal / Nutritional status of vitamin E and cardiovascular risk factors in adults and elderly people: Brazuca Natal study

Introdução: As doenças cardiovasculares (DCV) são a principal causa de morbimortalidade no mundo. Diante disso, são estudadas estratégias de prevenção e tratamento de eventos cardiovasculares. Dentre elas, a vitamina E destaca-se por suas propriedades antioxidantes e anti-inflamatórias, apoiado por descobertas de que maior ingestão dietética de vitamina E e maiores concentrações de α-tocoferol (α-TOH) sérico estão associados com menor risco de eventos cardiovasculares. Com isso, dados sobre o estado nutricional de vitamina E da população e a sua relação com os fatores de risco cardiovascular são estratégias importantes para subsidiar programas e políticas públicas voltadas a prevenção e tratamento das DCV. Objetivo: Avaliar o estado nutricional de vitamina E e a relação com fatores de risco cardiovascular em adultos e idosos do Estudo Brazuca Natal. Métodos: Trata-se de um estudo de diferentes métodos. 1) A revisão narrativa que investigou na literatura estudos populacionais sobre a relação da vitamina E e as DCV, buscando compreender se a deficiência de vitamina E (DVE) também deve ser considerada um problema de saúde pública. 2) Estudo transversal que se decompõe, a partir das variáveis dependentes, em dois artigos científicos. O primeiro artigo desse estudo buscou avaliar a prevalência de DVE e os fatores de risco cardiovascular que estão associados ao status do α-TOH sérico em adultos e idosos do estudo Brazuca Natal. Análise de regressão linear múltipla foi realizada entre o αTOH sérico (variável dependente) e fatores de risco cardiovascular. O segundo artigo do estudo transversal objetivou avaliar o consumo de vitamina E, e identificar as principais fontes alimentares consumidas do micronutriente pela população avaliada. Para tanto, foram analisadas as condições socioeconômicas e demográficas (sexo, idade, cor/raça, escolaridade, renda per capita e distrito sanitário de moradia) e o consumo alimentar de vitamina E (variável dependente). Resultados: Na revisão narrativa foi observado que a DVE pode ser um problema de saúde pública, por ocorrer uma variação de 0,6% a 55,5% de DVE em todo o mundo, com percentuais mais elevados na Ásia e na Europa, onde se destacam as elevadas taxas de mortalidade por DCV. Estudos populacionais sugerem efeitos protetores da vitamina E nas DCV, porém, estudos de intervenção com suplementação de α-TOH não confirmaram a sua ação cardioprotetora. No artigo 2 do estudo transversal foi observado que 24,8% dos adultos e idosos de Natal apresentavam DVE e 89% apresentaram baixas concentrações de αTOH circulante (abaixo de 30 µmol/L). Verificamos que as pessoas do sexo feminino tinham maiores valores médios de α-TOH sérico. Além disso, o índice de adiposidade visceral elevado e maiores valores do escore de risco global foram associados a maiores concentrações de α-TOH sérico. O artigo 3 demonstrou que 95,7% dos indivíduos apresentavam baixa ingestão de vitamina E, considerando a Estimated Average Requirement (EAR) de 12 mg/dia, com menores valores de ingestão em indivíduos acima de 40 anos, mulheres, naqueles com renda per capita menor que um salário-mínimo e com menor escolaridade. O óleo de soja, polpa de açaí e carne vermelha forneceram o maior teor de vitamina E ingerida. Conclusão: A partir da revisão narrativa, foi demonstrado que a DVE pode ser um problema de saúde pública. O estudo transversal observou uma elevada prevalência de DVE na população estudada, em que o sexo, o índice de adiposidade visceral e o escore de risco global estão associados ao α-TOH sérico. Além disso, foi observado um baixo consumo de vitamina E, principalmente, em indivíduos mais velhos, mulheres e com baixa condição socioeconômica. A maior parte da vitamina E consumida era proveniente do óleo de soja, polpa de açaí e carne vermelha, destacando-se também a vitamina E proveniente de alimentos ultraprocessados, principalmente, na população de menor renda (AU).

Introduction: Cardiovascular diseases (CVD) are the principal cause of morbidity and mortality in the world. Therefore, experts have studied strategies for preventing and treating cardiovascular events. One of this knowledge is vitamin E stands out for its antioxidant and anti-inflammatory properties, supported by findings that higher dietary intake of vitamin E and higher concentrations of serum α-tocopherol (α-TOH) are associated with a lower risk of cardiovascular events. Therefore, data on the nutritional status of vitamin E in the population and its relationship with cardiovascular risk factors are relevant strategies to support programs and public policies aimed at preventing and treating CVD. Objective: To evaluate the nutritional status of vitamin E and its association with cardiovascular risk factors in adults and older adults in the Brazuca Natal Study. Methods: This is a study of different methodological strategies. 1) The narrative review aimed to verify if surveys could demonstrate an association between serum vitamin E and the occurrence of CVD. Moreover, we would like to understand whether vitamin E deficiency (VED) should also be considered a public health problem. 2) Cross-sectional study, divided into two scientific articles. The first article of this study sought to evaluate the prevalence of VED and cardiovascular risk factors that are associated with serum α-TOH status in adults and elderly people from the Brazuca Natal study. We performed a multiple linear regression analysis between serum α-TOH (dependent variable) and cardiovascular risk factors. The second article aimed to evaluate vitamin E intake, and we would like to identify the principal food sources of this micronutrient intake. To this end, we analyzed socioeconomic and demographic conditions (sex, age, color/race, education, per capita income, and health district of residence), and vitamin E intake (dependent variable). Results: In the narrative review, we observed that VED could be a public health problem. The prevalence of VED varies from 0.6% to 55.5% in the world, with higher percentages in Asia and Europe, where the high mortality rates from CVD stand out. Population studies suggest the protective effects of vitamin E on CVD. However, intervention studies with α-TOH supplementation have not confirmed its cardioprotective action. In article 2 of the crosssectional study, we observed that 24.8% of adults and older adults in Natal had VED, and 89% had low concentrations of circulating α-TOH (below 30 µmol/L). Furthermore, high visceral adiposity index and higher global risk score values were associated with higher serum α-TOH concentrations. Article 3 demonstrated that 95.7% of individuals had a low intake of vitamin E, considering the Estimated Average Requirement (EAR) of 12 mg/day, with lower intake values in individuals over 40 years of age, women, those who have a per capita income of less than the minimum wage and with less education. Soybean oil, açaí pulp, and red meat provided the highest content of ingested vitamin E. Conclusion: From the narrative review, it was demonstrated that VED can be a public health problem. The cross-sectional study observed a high prevalence of VED in the studied population, in which sex, visceral adiposity index and global risk score are associated with serum α-TOH. Furthermore, a low consumption of vitamin E was observed, mainly in older individuals, women and those with low socioeconomic status. Most of the vitamin E consumed came from soybean oil, açaí pulp and red meat, with vitamin E also coming from ultra-processed foods, especially in the lowerincome population (AU).

Treatment with ascorbic acid and alpha-tocopherol modulates oxidative-stress markers in the spinal cord of rats with neuropathic pain

Vitamin E (vit. E) and vitamin C (vit. C) are antioxidants that inhibit nociception. The effect of these vitamins on oxidative-stress markers in the spinal cord of rats with chronic constriction injury (CCI) of the sciatic nerve is unknown. This study investigated the effect of intraperitoneal administration of vit. E (15 mg·kg-1·day-1) and vit. C (30 mg·kg-1·day-1), given alone or in combination, on spinal cord oxidative-stress markers in CCI rats. Adult male Wistar rats weighing 200-250 g were divided equally into the following groups: Naive (rats did not undergo surgical manipulation); Sham (rats in which all surgical procedures involved in CCI were used except the ligature), and CCI (rats in which four ligatures were tied loosely around the right common sciatic nerve), which received injections of vitamins or vehicle (saline containing 1% Tween 80) for 3 or 10 days (n=6/each group). The vitamins prevented the reduction in total thiol content and the increase in superoxide-anion generation that were found in vehicle-treated CCI rats. While nitric-oxide metabolites increased in vehicle-treated CCI rats 3 days after surgery, these metabolites did not show significant changes in vitamin-treated CCI rats. In all rats, total antioxidant capacity and hydrogen-peroxide levels did not change significantly. Lipid hydroperoxides increased 25% only in vehicle-treated CCI rats. These changes may contribute to vit. C- and vit. E-induced antinociception, because scavenging reactive oxygen species seems to help normalize the spinal cord oxidative status altered by pain.

Grape extract and α-Tocopherol effect in cardiovascular disease model of Apo E -/- Mice / Efeito do extrato de uva e α-Tocoferol em camundongos Apo E -/-, modelo de doença cardiovascular

PURPOSE: To verify the effect of consumption of grape extract isolated or combined with α-tocopherol supplementation on atherosclerosis model with Apo E -/- mice. METHODS: After six weeks of atherogenic diet, Apo E -/- mice were divided into the following groups: Control, Grape, Tocopherol and Grape plus Tocopherol. The treatment progressed for 11 weeks when animals were submitted to euthanasia. RESULTS: All the treatments presented hypocholesterolemic effect with reduction of serum and liver cholesterol levels. This effect was parallel to an increase in the fecal excretion of cholesterol. There was also a higher fecal excretion of saturated fatty acids in groups receiving grape extract or α-tocopherol. All the groups treated presented a tendency to show higher levels of vitamin E. The fatty acid profile showed a tendency for monounsaturated fatty acid preservation after grape extract and α-tocopherol consumption. Morphological analysis revealed a lower degree of evolution of the atherosclerotic plaque of the animals that were fed α-tocopherol combined with grape extract, even when no difference was found in the size of the largest lesion. CONCLUSION: A synergistic effect between the polyphenols and α-tocopherol was observed, resulting in diminished evolution of atherosclerosis and a greater beneficial effect on atherosclerosis than the isolated consumption of antioxidants.

OBJETIVO: Verificar o efeito do consumo de extrato de uva isolada ou combinada com a suplementação de α-tocoferol em modelo de aterosclerose, utilizando camundongos Apo E -/-. MÉTODOS: Os camundongos Apo E -/- foram tratados com dieta aterogênica por seis semanas e foram divididos em quatro grupos: Controle, Uva, Tocoferol e Uva e Tocoferol. Após 11 semanas de tratamento os animais foram submetidos à eutanasia. RESULTADOS: Todos os tratamentos apresentaram efeito hipocolesterolêmico, com redução de colesterol plasmático e hepático. Este efeito foi acompanhado de um aumento na excreção fecal de colesterol. Houve também uma maior excreção fecal de ácidos graxos saturados nos grupos que receberam extrato de uva ou de α-tocoferol. Todos os grupos apresentaram uma tendência a apresentar níveis mais elevados de vitamina E. O perfil de ácidos graxos mostrou uma tendência para a preservação de ácidos graxos monoinsaturados, após consumo de extrato de uva e α-tocoferol. A análise morfológica revelou um menor grau de evolução da placa aterosclerótica dos animais que foram alimentados com α-tocoferol combinado com extrato de uva, mesmo quando não houve diferença no tamanho da lesão. CONCLUSÃO: Foi observado um efeito sinergístico entre os polifenóis e α-tocoferol, resultando na redução na evolução da aterosclerose e um maior de efeito benéfico na aterosclerose do que o consumo isolado de antioxidantes sobre a aterosclerose do que o consumo isolado de antioxidantes.

Inhibitory action of antioxidants (ascorbic acid or α-tocopherol) on seizures and brain damage induced by pilocarpine in rats / Ação inibitória de antioxidantes (ácido ascórbico e α-tocoferol) nas convulsões e dano cerebral em ratos induzidos pela pilocarpina

Temporal lobe epilepsy is the most common form of epilepsy in humans. Oxidative stress is a mechanism of cell death induced by seizures. Antioxidant compounds have neuroprotective effects due to their ability to inhibit free radical production. The objectives of this work were to comparatively study the inhibitory action of antioxidants (ascorbic acid or α-tocopherol) on behavioral changes and brain damage induced by high doses of pilocarpine, aiming to further clarify the mechanism of action of these antioxidant compounds. In order to determinate neuroprotective effects, we studied the effects of ascorbic acid (250 or 500 mg/kg, i.p.) and α-tocopherol (200 or 400 mg/kg, i.p.) on the behavior and brain lesions observed after seizures induced by pilocarpine (400 mg/kg, i.p., P400 model) in rats. Ascorbic acid or α-tocopherol injections prior to pilocarpine suppressed behavioral seizure episodes. These findings suggested that free radicals can be produced during brain damage induced by seizures. In the P400 model, ascorbic acid and α-tocopherol significantly decreased cerebral damage percentage. Antioxidant compounds can exert neuroprotective effects associated with inhibition of free radical production. These results highlighted the promising therapeutic potential of ascorbic acid and α-tocopherol in treatments for neurodegenerative diseases.

A epilepsia de lobo temporal é a mais comum forma de epilepsia em humanos. O estresse oxidativo é um dos mecanismos de morte celular induzida pelas crises convulsivas. Os compostos antioxidantes apresentam efeitos neuroprotetores devido à sua capacidade de inibir a produção de radicais livres. Os objetivos do presente trabalho foram estudar de forma comparativa a ação inibitória de antioxidantes (ácido ascórbico e α-tocoferol) sobre as alterações comportamentais e histopatológicas no hipocampo de ratos após convulsões induzidas pela pilocarpina. A fim de determinar os efeitos neuroprotetores destas drogas, o presente trabalho estudou os efeitos do ácido ascórbico (250 ou 500 mg/kg, i.p.) e do α-tocoferol (200 ou 400 mg/kg, i.p.) sobre o comportamento e as lesões cerebrais observados após convulsões induzidas pela pilocarpina (400 mg/kg, i.p., P400), em ratos. As injeções de ácido ascórbico ou α-tocoferol antes da administração de pilocarpina reduzem o número de animais que convulsionam. Estes achados sugerem que os radicais livres podem induzir o desenvolvimento de lesão cerebral durante as crises epilépticas. No modelo P400, o ácido ascórbico e o α-tocoferol, diminuem significativamente os danos cerebrais. Os compostos antioxidantes podem exercer efeitos neuroprotetores, e esses resultados podem estar associados à inibição da produção de radicais livres. Estes resultados sugerem um promissor potencial terapêutico tanto para o ácido ascórbico quanto para o α-tocoferol no tratamento de doenças neurodegenerativas.

Effects of radiation and alpha-tocopherol on saliva flow rate, amylase activity, total protein and electrolyte levels in oral cavity cancer.

OBJECTIVE: The objective of the present study was to evaluate early and late effects of radiation and a-tocopherol on the secretion rate of saliva and on selected saliva salivary parameters in oral cavity cancer patients. PATIENTS & METHODS: Eighty-nine histologically confirmed oral cavity cancer patients (OCC) were enrolled in the study. Resting whole saliva was collected before, during and at the end of the radiation therapy (RT) and simultaneous supplementation with alpha - tocopherol to the radiation treated patients (RT + AT). RESULTS: Salivary flow rate, pH, amylase activity, total protein, sodium and potassium were analyzed. Increased pH, potassium and decreased flow rate, amylase activity, protein content and sodium were observed in 6 weeks of radiation treated patients when compared to OCC patients. A significant improvement of those parameters was observed on alpha - tocopherol supplementation in RT + AT patients. CONCLUSION: Supplementation with alpha - tocopherol improves the salivary flow rate thereby, maintains salivary parameters.

Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection.

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.