Vitamin concentrations 5 years after gastric bypass.

BACKGROUND/OBJECTIVES: Few studies have investigated the effects of bariatric surgery on vitamin status in the long term. We examined changes in vitamin status up to 5 years after Roux-en-Y gastric bypass surgery. SUBJECTS/METHODS: Using a retrospectively maintained database of patients undergoing weight loss surgery, we identified all patients operated with Roux-en-Y gastric bypass at our tertiary care hospital during July 2004-May 2008. Data on vitamin concentrations and patient-reported intake of dietary supplements were collected up to July 2012. Linear mixed models were used to estimate changes in vitamin concentrations during follow-up, adjusting for age and sex. All patients were recommended daily oral multivitamin, calcium/vitamin D and iron supplements and 3-monthly intramuscular B-12 after surgery. RESULTS: Out of the 443 patients operated with gastric bypass, we included 441 (99.5%) patients with one or more measurements of vitamin concentrations (75.1% women; mean age 41.5 years, mean body mass index 46.1 kg/m(2) at baseline). At 5 years after surgery, the patients' estimated mean vitamin concentrations were either significantly higher (vitamin B-6, folic acid, vitamin B-12, vitamin C and vitamin A) or not significantly different (thiamine, 25-hydroxyvitamin D and lipid-adjusted vitamin E) compared with before surgery. Use of multivitamin, calcium/vitamin D and vitamin B-12 supplements was reported by 1-9% of patients before surgery, 79-84% of patients at 1 year and 52-83% of patients 5 years after surgery. CONCLUSIONS: In patients who underwent gastric bypass surgery, estimated vitamin concentrations were either significantly increased or unchanged up to 5 years after surgery.

A randomized placebo-controlled trial of an omega-3 fatty acid and vitamins E+C in schizophrenia.

Membrane lipid metabolism and redox regulation may be disturbed in schizophrenia. We examined the clinical effect of adding an omega-3 fatty acid and/or vitamins E+C to antipsychotics. It was hypothesized that lower baseline levels of polyunsaturated fatty acids (PUFAs) would predict more benefit from the add-on treatment. The trial had a multicenter, randomized, double-blind, placebo-controlled 2 × 2 factorial design. Patients aged 18-39 years with schizophrenia or related psychoses were consecutively included at admission to psychiatric departments in Norway. They received active or placebo ethyl-eicosapentaenoate (EPA) 2 g day⁻¹ and active or placebo vitamin E 364 mg day⁻¹+vitamin C 1000 mg day⁻¹ (vitamins) for 16 weeks. The main outcome measures were Positive and Negative Syndrome Scale (PANSS) total and subscales scores, analyzed by linear mixed models. Ninety-nine patients were included. At baseline, erythrocyte PUFA were measured in 97 subjects. Given separately, EPA and vitamins increased drop-out rates, whereas when combined they did not differ from placebo. In low PUFA patients, EPA alone impaired the course of total PANSS (Cohen's d=0.29; P=0.03) and psychotic symptoms (d=0.40; P=0.003), especially persecutory delusions (d=0.48; P=0.0004). Vitamins alone impaired the course of psychotic symptoms (d= 0.37; P=0.005), especially persecutory delusions (d=0.47; P=0.0005). Adding vitamins to EPA neutralized the detrimental effect on psychosis (interaction d=0.31; P=0.02). In high PUFA patients, there were no significant effects of trial drugs on PANSS scales. In conclusion, given separately during an acute episode, EPA and vitamins E+C induce psychotic symptoms in patients with low levels of PUFA. Combined, these agents seem safe.

Clinical and biochemical validation of two endophenotypes of schizophrenia defined by levels of polyunsaturated fatty acids in red blood cells.

BACKGROUND: Polyunsaturated fatty acids (PUFAs) are bimodally distributed in acute schizophrenia, suggesting two endophenotypes. We intended to characterize these endophenotypes clinically. Our a priori hypothesis was that low PUFA patients have more negative symptoms. PATIENTS AND METHODS: Patients (aged 18-39) with schizophrenia, schizoaffective or schizophreniform disorders were recruited at hospital admission during an acute episode. The baseline Positive and Negative Syndrome Scale, vital signs and biochemical variables were measured in 97 patients with available RBC PUFA levels. Adjustment for multiple testing was not performed. RESULTS: The median Negative Subscale score was higher (p=0.04) in the low PUFA (25 points, n=30) than in the high PUFA group (19 points, n=67). Among 95 patients with measurements of serum triglycerides, hypertriglyceridaemia was more prevalent (p=0.009) among low PUFA patients (66%) than high PUFA patients (36%). PUFA modified the effect of antipsychotics on triglycerides (p=0.046). Serum glucose and mean corpuscular haemoglobin were higher (p=0.03, 0.001, respectively) in low PUFA than in high PUFA patients. Low PUFA men were heavier (p=0.04) than high PUFA men. CONCLUSIONS: During an acute episode of schizophrenia, patients with low RBC PUFA have more negative symptoms and more metabolic and haematological abnormalities than those with high PUFA. This indicates that PUFA levels define two clinically distinct endophenotypes of the disorder.

High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway.

Poor dietary habits among drug addicts represent health hazards. However, very few studies have focused on dietary intake as an independent health risk factor in relation to this group. The objective of the present study was to examine the dietary habits of drug addicts living on the fringes of an affluent society. The study focused on food access, food preferences, intake of energy and nutrients, and related nutrient blood concentrations. The respondent group consisted of 123 male and seventy-two female drug addicts, who participated in a cross-sectional study that included a 24 h dietary recall, blood samples, anthropometrical measurements and a semi-structured interview concerning food access and preferences. Daily energy intake varied from 0 to 37 MJ. Food received from charitable sources and friends/family had a higher nutrient density than food bought by the respondents. Added sugar accounted for 30 % of the energy intake, which was mirrored in biomarkers. Sugar and sugar-sweetened food items were preferred by 61 % of the respondents. Of the respondents, 32 % had a TAG concentration above the reference values, while 35 % had a cholesterol concentration beneath the reference values. An elevated serum Cu concentration indicated inflammation among the respondents. Further research on problems related to the diets of drug addicts should focus on dietary habits and aim to uncover connections that may reinforce inebriation and addiction.

Living as a drug addict in Oslo, Norway--a study focusing on nutrition and health.

OBJECTIVES: To investigate nutritional status and related living conditions among drug addicts in Oslo. DESIGN: A cross-sectional study of nutritional status evaluated by anthropometric and biochemical measurements; a structured interview concerning education, living conditions, income source, drug history and sex practice; and biochemical testing of sexually transmitted infections. SETTING: The present study was conducted between November 2001 and April 2003 in locations where the drug addicts reside in Oslo. SUBJECTS: A total of 123 male and seventy-two female addicts using drugs by injections regularly. RESULTS: We found that 20 % of the women were moderately underweight (BMI in kg/m2) (16.5 < BMI < 18.5), 7 % were severely underweight (BMI < or = 16.5) and 3 % of the men were moderately underweight (16.5 < BMI < 18.5). BMI was positively correlated with days institutionalised and number of eating events per day. Respondents sleeping rough had significantly reduced BMI compared to those in hostels and shelters. The concentrations of Hb, serum ferritin and albumin supported a higher prevalence of malnutrition among the women. Hepatitis C was found in 85 %, active hepatitis B in 6 % and less than 2 % were HIV positive. Also, 84 % received public financial support, 38 % of the women had prostitution as a significant income source, while burglary was most prevalent among the men; 20 % were pushing drugs. CONCLUSION: Malnutrition among the drug addicts varied from 5 % to 30 %, independent of drug history, education and income. Moderate and severe underweight was most prevalent among the women. Being previously institutionalised and having increased number of eating events increased BMI. Sleeping rough correlated with reduced body weight. Hepatitis C infection was common; hepatitis B and HIV were rare.

[Vaccine therapy of prostate cancer]. / Vakzinetherapie des Prostatakarzinoms.

Vaccine therapy of prostate cancer has been increasingly studied in trials over the past few years. The different vaccine techniques are quite variable and are predominantly used in patients with advanced hormone-refractory prostate cancer. In this review, vaccine techniques using tumor cells, dendritic cells or poxvirus are analyzed. For theses approaches phase-III trials are being planned, have been initiated or are already completed. Many trials demonstrate the efficacy with regard to endpoints such as stimulation of the immune system and/or biochemical response and/or clinical response. Recently, one vaccine approach using autologous dendritic cells demonstrated a statistically significant prolongation of overall survival compared to placebo in patients with hormone-refractory prostate cancer. Side effects of vaccination are generally mild. At present, there are trials are being planned or are already ongoing that combine vaccine with other treatment strategies or enroll patients with earlier disease stages.

Reduced concentrations of several vitamins in normal weight patients with late-onset dementia of the Alzheimer type without vascular disease.

BACKGROUND: There is an uncertainty to what an extent initiation of late onset dementia of the Alzheimer type (DAT) is related to nutritional factors. OBJECTIVE: To find any differences in nutrient concentrations between women (75-85 y), well-nourished with moderate DAT, and a control group, all without vascular disease. DESIGN: A case control study assessing clinical, anthropometrical, biochemical and micronutrient characteristics of 20 DAT patients and 18 free-living healthy women. RESULTS: Significant differences (* = p < 0.05) were found for the following nutrients, given in sequence (Mean (SD)) for controls and DAT patients, respectively: Thiamine (nmol/L): 11.7 (6.9), 7.1(3.7)*; Blood thiamine diphosphate (nmol/L): 86.0 (12.5), 65.8 (27.5)*; Pyridoxal-5-phosphate 90.2 (14), 24.8 (3.3)*; Cobalamin (nmol/L) 435(263), 350 (264)*; Homocysteine (mmol/L) 14.7 (1.3), 18.5 (1.6)*; Ascorbic acid (mmol/L) 77.7 (28), 46.2 (25)*; alpha-tocopherol (mmol/L) 38.2 (9.2), 27.1 (11.5)*; Serum and blood thiamine mono-phosphate and ascorbic acid in cerebrospinal fluid were significantly different as well. Age, BMI, MMSE, MADRS, 'Vascular Score ' and a set of other biochemical parameters were similar between the groups. Using logistic regression analysis, models for predicting the presence of DAT all contained pyridoxal-5-phosphate, and CSF-protein, in combination with either one of variables, age, ascorbic acid, retinol, alpha-tocopherol, homocysteine, thiamin-diphosphate, CSF-thiamin. All the models give complete separation between DAT and controls. CONCLUSIONS: The presence of reduced concentrations of several vitamins in the DAT patients compared to the controls might indicate that these nutrients may contribute to the development of DAT.

Zinc deficiency is of limited clinical importance in the elderly (>69 y) of Oslo.

BACKGROUND: Zinc is an important trace element, and deficiency can cause disease and impairment of several physiological functions. OBJECTIVE: To examine s-zinc concentration in a large elderly population (347 subjects), and correlate it to standard biochemical markers, nutritional core indicators, and anamnestic data. DESIGN: A randomized population survey, studying two groups of elderly; one living at home and the other recently admitted to hospital. RESULTS: Serum zinc concentration was (Mean SD) in the home group (11.6 1.8 micromoles /L), and in the hospital group (11,5 2.5 micromoles /L). S-zinc was below 8 micromol/L in the hospital group in 22 of 250 patients and in 4 out of 97 of the home group. There was no significant difference in prevalence of zinc deficiency in hospital versus the home living group. Low s-zinc was significantly correlated to diarrhea, but to no other marker used in this study. CONCLUSION: Zinc deficiency is most probably of limited clinical importance in the elderly of Oslo, and there is no biochemical or nutritional marker that in addition to s-zinc can aid in the diagnosis.

Reduced serum concentrations of riboflavine and ascorbic acid, and blood thiamine pyrophosphate and pyridoxal-5-phosphate in geriatric patients with and without pressure sores.

BACKGROUND: Patients with pressure sores have as part of their treatment been reefed with energy and proteins with varying result. It has been uncertain, however, to what an extent these patients also were depleted of micronutrients which might be critical for ulcer healing. OBJECTIVE: To study the nutritional intake and nutritional status of a number of micronutrients in geriatric pressure sore patients and in matched controls. DESIGN: The nutritional intake and nutritional status as anthropometric measures, serum conc. of albumin, zinc, and of vitamins (ascorbic acid, riboflavin, calcidiol), were measured. Thiamin pyrophosphate and pyridoxal-5-phosphate were determined in whole blood from 11 geriatric in-patients with pressure sores and 11 matched controls. RESULTS: The serum conc. of ascorbic acid was significantly (p< 0.05) more reduced in pressure sore patients (mean+/-S.D.) 4.2+/-3.4 (ug/ml) than in control patients 7.4+/-5.4 (ug/ml) which still was lower than in a reference group (10.9+/-1.9) (ug/ml). In all the geriatric patients compared to the reference group, the conc. of serum-riboflavin was reduced to about 15 %, thiamine-pyrophosphate and pyridoxine-5-phosphate in whole blood and serum calcidiol to about 50 %, without any differences between the pressure sore patients and the matched controls. CONCLUSION: Refeeding of pressure sore patients who often are catabolic and have increased needs for protein and energy, should include micronutrients not only to cover recommended dietary allowances, but sufficient to reach normal nutritional status for the individual micronutrient.

Reduced appetite. A predictor for undernutrition in aged people.

BACKGROUND: Malnutrition is a common condition among aged, hospitalised patients, which may be due to lack of appetite in the same group. It is uncertain, however, the relationship between a reduced appetite and the nutritional status. OBJECTIVE: Assess the prevalence of reduced appetite, and to study the relationship between a reduced appetite and the nutritional status. DESIGN: A randomised population survey among elderly: one group recruited from patients recently admitted for acute disease or exacerbation of disease, and one group recruited from their homes. RESULTS: Reduced appetite was present in 43% in the hospital group, compared to 15% in the home living group. Seventy-one % of those with reduced appetite were undernourished, while 44% with normal appetite were undernourished. The sensitivity for malnutrition was 0.55, while the positive predictive value was 0.71. CONCLUSION: Reduced appetite is common among aged people in hospital, and is a predictor for undernutrition.

[Tongue atrophy--a marker of malnutrition]. / Tungeatrofi--en markør for underernaering.

BACKGROUND: Atrophic glossitis is considered to be a marker for nutritional deficiency. Study of the tongue is part of the clinical examination. The importance of atrophic tongue has been unclear. As part of a bigger nutritional investigation in the elderly, we wanted to study the occurrence of atrophic tongue and relate this finding to other nutritional measures. MATERIAL: The presence of atrophic tongue was studied in 311 hospitalized, and in 106 randomly selected elderly at home. RESULTS: Atrophic tongue was present in 100 of 311 hospitalized patients, and only in ten out of the 106 persons living in their own homes. Compared to those without, patients with atrophic tongue had significantly lower weight, body-mass index, triceps skinfold, arm muscle circumference and increased Katz index values for independence in daily activities. Patients with atrophic tongue had significantly reduced concentrations of serum cholesterol, ascorbic acid and calcidiol. Tongue atrophy had a sensitivity for serious malnutrition 0.30, for serious and moderate malnutrition together 0.70. The specificity for malnutrition was 0.76. INTERPRETATION: We conclude that atrophic tongue is common in elderly people and a marker for malnutrition and reduced muscle function.

Reduced thiamine phosphate, but not thiamine diphosphate, in erythrocytes in elderly patients with congestive heart failure treated with furosemide.

OBJECTIVES: To measure the concentrations of thiamine and thiamine esters by high-pressure liquid chromatography (HPLC) in elderly patients treated with furosemide for heart failure and in a control group. DESIGN: A cross-sectional study of blood thiamine and thiamine ester concentrations. SUBJECTS: Forty-one patients admitted to hospital for heart failure and 34 elderly living at home. No vitamin supplementation was allowed. RESULTS: Compared with the healthy controls, furosemide-treated patients had significantly reduced whole blood thiamine phosphate (TP; 4.4 +/- 2.2 vs. 7.6 +/- 2.0 nmol L-1) and thiamine diphosphate (TPP; 76 +/- 21.5 vs. 91 +/- 19.8 nmol L-1) (mean +/- SD). When the thiamine concentrations were related to the haemoglobin concentrations, which were reduced in the heart failure patients, the levels of TP (nmol g-1 Hb) were 0.38 +/- 0.26 vs. 0.54 +/- 0.17 (P < 0.0001), and of TPP were 6.35 +/- 1.76 vs. 6.37 +/- 1.29 (P = 0.95). There were no differences in T and TP concentrations in plasma between the two groups. CONCLUSIONS: The elderly patients with heart failure treated with furosemide have not reduced the storage form of thiamine, TPP, but only TP. This change is most likely not an expression of a thiamine deficiency, but rather of an altered metabolism of thiamine, which is not understood at present.

The association between atrophic glossitis and protein-calorie malnutrition in old age.

AIM: To examine the relationship between atrophic glossitis (absence of papillae in more than 50% of the tongue) and nutritional status. DESIGN: A randomized population survey. SETTING: The medical department of Aker University Hospital, and people living at home. PARTICIPANTS: 310 old people recently admitted to hospital and 106 randomly selected elderly people at home. MEASURES: The presence of atrophic glossitis and nutritional indices. RESULTS: Atrophic glossitis occurred in 13.2% of men and 5.6% of women at home and in 26.6% of men and 37% of women in hospital. The atrophic glossitis was related to reduced weight, body mass index, triceps skinfold thickness, arm-muscle circumference, muscular strength, activities of daily living and serum concentrations of cholesterol, ascorbic acid, cholecalcidiol and B12, but not to levels of zinc or folate. In a multiple logistic regression model, atrophic glossitis was related only to cholesterol (P = 0.032), muscular strength (P = 0.018) and activities of daily living (P = 0.03). CONCLUSION: Atrophic glossitis is common in elderly people and is a marker for malnutrition and reduced muscle function.

[Leg cramps in pregnancy--how common are they?]. / Leggkramper i svangerskapet--hvor hyppig forekommer det?

Leg cramps in pregnancy, defined as painful spasms of the calf, were investigated among women giving birth at the maternity ward at Baerum Hospital from 1 October to 20 October 1997. A questionnaire distributed to 120 women three days after parturition revealed that 45% had suffered from leg cramps during pregnancy. Among 54% of them the cramps appeared after the 25th week of pregnancy. 76% of the women had experienced the symptoms twice per week or less often; 81% of them suffered from painful cramps only during night-time. We conclude that leg cramps are still a common symptom in pregnancy and may compromize sleep and hence the ability to work.

[Prolonged half-life of digitoxin in the elderly]. / Forlenget halveringstid for digitoksin hos de eldste.

Digitoxin is frequently used in Norway in the treatment of cardiac failure. Digitalis glycosides may give rise to a number of side effects difficult to separate from disease in the elderly. Six patients aged 77-93 years, treated with digitoxin 0.05 mg/day, were hospitalized due to digitalis intoxication. Mean digitoxin half-life was 25.2 days. This is significantly more than reported in other studies on younger patients. The symptoms of digitoxin intoxication disappeared on discontinuation of medication. The slow elimination of digitoxin may be related to reduced serum albumin concentration. When digitoxin is used in the treatment of heart failure in the very elderly patients, one should be aware of the possibility of digitoxin intoxication, even at a low dose.

[Severe hypophosphatemia--an overlooked condition?]. / Alvorlig hypofosfatemi--en oversett tilstand?

Severe hypophosphataemia is a well known metabolic disturbance, potentially serious. Clinicians are not always aware of this condition, which most likely is missed sometimes. We present a case in which severe hypophosphataemia was an important part of the clinical picture. An alcoholic was hospitalized because of epigastric pain, nausea and poor health. Seven days after admission he still was very weak and somnolent. He did not eat, and developed urinary retention due to paresis of the bladder. An extremely low level of s-phosphate, 0.12 mmol/l, was discovered the seventh day. The next two days he was substituted with 60 mmol phosphate i.v. At the same time his general condition improved dramatically. We believe that severe hypophosphataemia was an important cause of the persistently poor clinical condition of our patient. Finally, we present the causes of hypophosphataemia, stressing that serum phosphate does not always reflect total body phosphate. We discuss the possible manifestations of hypophosphataemia, and we give practical advice on treatment.

Low serum calcidiol concentration in older adults with reduced muscular function.

OBJECTIVE: To examine the association between muscular function and the serum concentrations of 25-hydroxyvitamin D (calcidiol) and 1,25-dihydroxyvitamin D (calcitriol). DESIGN: A randomized population survey. Baseline measurements of serum calcidiol and calcitriol concentrations and assessment of muscular function (hand grip strength, ability to climb stairs, outdoor activity, and fall occurrence). SETTING: The Medical department, Aker University Hospital, Oslo, and subjects' homes. PARTICIPANTS: Two hundred forty-six recently hospitalized older patients and 103 randomly selected older people living at home. MEASUREMENTS: Serum concentration of calcidiol and calcitriol in relation to muscle function. MAIN RESULTS: Reduced muscle function was associated with low calcidiol levels. In both the hospital group and the home group, calcidiol concentrations correlated positively to arm muscle strength (r = .22, P < .001; r = .37, P < .001), ability to climb stairs (r = -.16, P < .05; r = -.42, P = < .001), physical activity (r = -.27, P < .001; r = -.31, P < .001), and the absence of fall occurrences (r = -.27, P < .001; r = -.31, P = .004). Calcitriol showed an association with physical activity in the hospital group (r = -.19, P < .05), and with fall last month in the home group (r = -.22, P < .05). CONCLUSIONS: Older people with reduced muscle function often had reduced levels of calcidiol serum concentration. Low levels of calcidiol were not associated with signs of general undernutrition, such as low body mass, or with reduced arm-muscle circumference or triceps skinfold thickness. This finding may suggest a physiological role for calcidiol in muscle function. Reduced muscle strength increased disability in our older subjects, which may be improved by vitamin D supplementation in vitamin D-deficient subjects.

[Vitamin D deficiency among hospitalized and home-bound elderly]. / Vitamin D-mangel hos eldre sykehusinnlagte og hjemmeboende i Oslo.

Vitamin D status, measured as serum calcidiol concentration, was studied in a group of 273 recently hospitalised patients at Aker University Hospital and compared to a group of 98 persons living in their own homes, all living in Oslo and all above 70 years of age. We found lower serum calcidiol concentrations in the hospital group than among people living in their own homes, in men as well as in women (mean +/- SD, 40.4 nmol/l +/- 23.2 vs 59.6 nmol/l +/- 28.9 in men and 37.5 nmol/l +/- 22.6 vs 48.5 +/- 20.3 in women). 34% of the men and 49% of the women in the hospital group had vitamin D deficiency (se. calcidiol < 20 nmol/l). There was no seasonal variation in the hospitalised group; the group living at home did show seasonal variations, with highest levels in late autumn (62.2 nmol/l) and lowest levels in February (42.7 nmol/l). The low levels of calcidiol concentration may contribute to the high prevalence of hip-fracture among elderly in Oslo.