Vitamins & Minerals

Vitamins and minerals are micronutrients that are required by human body in small quantities but play an important role in normal functioning of human physiology. These micronutrients are mainly supplied by daily diet. However due to lack of dietary diversity and poor diet consumption the recommended intake levels may not be achieved. Consequently, the prevalence of vitamin and mineral deficiency have become public health concern in many countries. Micronutrient supplementation is an important strategy to help meet daily recommended allowance. Vitamins and Minerals journal encompasses these contemporary issues publishing most recent updates. The current issue deals with vitamin C analogues, folic acid fortification effects, iodine fortification and clinical micronutrient deficiency. Vitamin C, a ubiquitous nutrient, cannot be synthesized by human body and therefore must be obtained externally. Human immune system performance is at maximum when vitamin C level is normal in plasma. Based on non-randomized open study with 6 subjects having below normal vitamin C level, Raghavan [1] have demonstrated that Metadichol® by virtue of its ability to bind with vitamin D receptor, functions as a surrogate for vitamin C when administered orally at a dose of 5 mg per day over a period of 90 days normalizing thyroid stimulating hormone (TSH), blood pressure (BP), fasting glucose, triglycerides, bone mass, sodium level and insulin level. Folic acid deficiency in early pregnancy lead to improper closure of embryonic neural tube leading to anencephaly and spinal bifida. About 400 micrograms of folic acid per day supplementation in women capable of becoming pregnant, is required to prevent such neural tube defects (NTD). Mitsuguchi et al. [2] have shown that administering fermented milk fortified with 200 micrograms of folic acid for four weeks elevated the serum folate levels by 1.5 in Japanese female university students upto cutoff value for prevention of NTDs regardless of methylenetetrahydrofolate reductase (MTHFR) C677T genetic polymorphism. Iodine is a component in thyroid hormones. Adequate levels of iodine with intake of 200 to 250 micrograms per day in pregnant and lactating women is required for neural development and function. In year 2009, World Health organization has declared Australia as mild to moderately iodine deficient country. In this context, Wegrecki et al. [3], have studied the prevalence of iodine deficiency among pregnant women in Australia and observed that pregnant women are at high risk of mild iodine deficiency before fortification. Even after mandatory fortification, the level still remained below the recommended level. Therefore, public health education in addition to supplementation programs were deemed necessary for iodine adequacy in all pregnant women. Patients following esophagectomy are subject to mal-absorption and micronutrient deficiencies. Boshier et al. [4] have studied the prevalence of specific micronutrients in 44 patients after a median of 26 months following eosophagectom. The deficiency in one or more micronutrients was as high as 64% and specifically vitamin D, vitamin B12, ferritin, and zinc were less by 21, 32, 16 and 25%, respectively. Therefore, regular screening and prophylactic supplementation has been proposed.

We recently reported that Metadichol® brings about a three to four-fold increase in Vitamin C levels in patients without the use of Vitamin C supplementation. In this study of 6 patients who experienced a 5-12 fold increase in plasma Vitamin C levels higher than 80-100 u mol/L level which is the highest reported to date by oral supplementation at high doses of Vitamin C. Metadichol improved in these patients TSH levels, normalized High Blood pressure, fasting glucose levels, reduced eosinophil count, high triglycerides, body fat reduction and increased bone mass, normalized sodium levels, reducing high insulin levels, increased creatinine output in urine and also reducing of Red Cell Distribution width %. Metadichol thus serves as a surrogate for Vitamin C at doses of 5 mg per day as opposed to mega doses that are currently used.

Objective: We studied effects of fermented milk fortified with 200 μg of folic acid (FF milk) on serum folate levels in Japanese women university students.

Methods: Adopting FF milk as intervention factor, a randomized controlled trial stratified by MTHFR genetic polymorphism C677T was conducted in 143 university women students. Experimental group subjects were requested to consume FF milk for 4 weeks; control group subjects to consume usual meals. Dietary surveys were conducted using an FFQ, and serum folate concentrations were analyzed utilizing chemiluminescence immunoassay. Using oral mucous membranes, MTHFR genotypes were determined employing PCR-RFLP. Paired ttest, one-way ANOVA, Pearson correlation coefficient, Chi-square test, or Fisher’s exact probability test was adequately applied.

Results: MTHFR genotype frequencies were CC type 36 (25%), CT type 75 (52.4%) and TT type 32 (22.4%) as a whole. The subjects were randomly stratified into 73 experimental group (CC type 16, CT type 41, TT type 16) and, 70 control group (CC type 20, CT type 34, TT type 16). Average of folate consumption was 246 μg/day. Average serum folate level was 9.8 ng/mL with statistically significant difference by MTHFR genotype (CC type>CT type>TT type).

Serum folate concentrations in the experimental group increased by 1.5 on average after intervention. At baseline, there were 19 subjects having serum folate levels lower than the reference value of NTDs (7 ng/mL): CC type 1/36, CT type 10/75 and TT type 8/32 with statistical difference by MTHFR genotype. In the experimental group those subjects decreased from 10 to 2 (CT type 1 and TT type 1) after intervention.

Conclusions: Serum folate levels increased in the experimental group subjects after intervention, suggesting consumption of the FF milk sufficiently elevated serum folate concentrations for prevention of NTDs, irrespectively of MTHFR genotypes.

Adequate iodine nutrition is necessary during pregnancy and breastfeeding for proper neurodevelopment in offspring. Iodine deficiency is common in developed nations and persists despite various public health interventions. This review examines the effect of mandatory iodine fortification of food on iodine status in pregnant women in Australia. Although iodine status has improved, additional supplementation is still required to achieve adequate iodine levels in pregnant and breastfeeding women.

Objectives: For those patients who achieve long-term survival following esophagectomy, altered digestion and malabsorption may lead to a range of adverse gastrointestinal sequelae, including micronutrient deficiencies. The aim of the current study was to determine the prevalence of specific micronutrient deficiencies in patients following esophagectomy.

Methods: Levels of vitamin A, vitamin E, vitamin D, vitamin B1, vitamin B12, folate, ferritin, zinc and calcium were measured in a single non-fasting blood sample in patients who has undergone esophagectomy. Findings were compared to both patients who had undergone gastrectomy and an age matched Western control population.

Results: Forty-Four patients (33 male, 65.5 ± 10.2 yrs) a median of 26 months (IQR 12-46) following either two or three stage esophagectomy were recruited. Deficiency in one or more micronutrients was observed in 64% of patients who underwent esophagectomy. Micronutrients most commonly deficient following esophagectomy were vitamin D (21%), vitamin B12 (32%), ferritin (16%) and zinc (25%). Compared to patients who underwent gastrectomy, levels of vitamin B12 and red cell folate were significantly lower, and levels of vitamin E were significantly higher in the blood of patients following esophagetomy. Compared to a Western control population the mean levels of vitamins A, E, D and B12, ferritin and zinc were lower in patients following esophagectomy.

Conclusion: Micronutrient deficiency is common after esophagectomy affecting two thirds of all patients. Regular screening of vitamin D, vitamin B12, ferritin and Zinc levels should be considered as well as prophylactic supplementation in this patient group to prevent deficiency.