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Concept: Vitamin

454

Nutrient timing is a popular nutritional strategy involves the consumption of combinations of nutrients–primarily protein and carbohydrate–in and around an exercise session. Some have claimed that this approach can produce dramatic improvements in body composition. It has even been postulated that the timing of nutritional consumption may be more important than the absolute daily intake of nutrients. The post-exercise period is widely considered the most critical part of nutrient timing. Theoretically, consuming the proper ratio of nutrients during this time not only initiates the rebuilding of damaged muscle tissue and restoration of energy reserves, but it does so in a supercompensated fashion that enhances both body composition and exercise performance. Several researchers have made reference to an anabolic “window of opportunity” whereby a limited time exists after training to optimize training-related muscular adaptations. However, the importance - and even the existence - of a post-exercise ‘window’ can vary according to a number of factors. Not only is nutrient timing research open to question in terms of applicability, but recent evidence has directly challenged the classical view of the relevance of post-exercise nutritional intake with respect to anabolism. Therefore, the purpose of this paper will be twofold: 1) to review the existing literature on the effects of nutrient timing with respect to post-exercise muscular adaptations, and; 2) to draw relevant conclusions that allow practical, evidence-based nutritional recommendations to be made for maximizing the anabolic response to exercise.

Concepts: Metabolism, Nutrition, Muscle, Nutrient, Vitamin, Ontology, Muscular system, Existence

290

BACKGROUND: Avocados contain monounsaturated fatty acids (MUFA) dietary fiber, essential nutrients and phytochemicals. However, no epidemiologic data exist on their effects on diet quality, weight management and other metabolic disease risk factors. The objective of this research was to investigate the relationships between avocado consumption and overall diet quality, energy and nutrient intakes, physiological indicators of health, and risk of metabolic syndrome. METHODS: Avocado consumption and nutrition data were based on 24-hour dietary recalls collected by trained NHANES interviewers using the USDA Automated Multiple Pass Method (AMPM). Physiological data were collected from physical examinations conducted in NHANES Mobile Examination Centers. Diet quality was calculated using the USDA’s Healthy Eating Index-2005. Subjects included 17,567 US adults >19 years of age (49% female), including 347 avocado consumers (50% female), examined in NHANES 2001–2008. Least square means, standard errors, and ANOVA were determined using appropriate sample weights, with adjustments for age, gender, ethnicity, and other covariates depending on dependent variable of interest. RESULTS: Avocado consumers had significantly higher intakes of vegetables (p < 0.05); fruit, diet quality, total fat, monounsaturated and polyunsaturated fats, dietary fiber, vitamins E, K, magnesium, and potassium (p < 0.0001); vitamin K (p = 0.0013); and lower intakes of added sugars (p < 0.0001). No significant differences were seen in calorie or sodium intakes. Body weight, BMI, and waist circumference were significantly lower (p < 0.01), and HDL-C was higher (p < 0.01) in avocado consumers. The odds ratio for metabolic syndrome was 50% (95th CI: 0.32-0.72) lower in avocado consumers vs. non-consumers. CONCLUSIONS: Avocado consumption is associated with improved overall diet quality, nutrient intake, and reduced risk of metabolic syndrome. Dietitians should be aware of the beneficial associations between avocado intake, diet and health when making dietary recommendations.

Concepts: Epidemiology, Nutrition, Obesity, Fat, Vitamin, Unsaturated fat, Avocado, Monounsaturated fat

209

Vegetables are important sources of dietary fiber, vitamins and minerals in the diets of children. The United States Department of Agriculture (USDA) National School Lunch Program has new requirements for weekly servings of vegetable subgroups as well as beans and peas. This study estimated the cost impact of meeting the USDA requirements using 2008 national prices for 98 vegetables, fresh, frozen, and canned. Food costs were calculated per 100 grams, per 100 calories, and per edible cup. Rank 6 score, a nutrient density measure was based on six nutrients: dietary fiber; potassium; magnesium; and vitamins A, C, and K. Individual nutrient costs were measured as the monetary cost of 10% daily value of each nutrient per cup equivalent. ANOVAs with post hoc tests showed that beans and starchy vegetables, including white potatoes, were cheaper per 100 calories than were dark-green and deep-yellow vegetables. Fresh, frozen, and canned vegetables had similar nutrient profiles and provided comparable nutritional value. However, less than half (n = 46) of the 98 vegetables listed by the USDA were were consumed >5 times by children and adolescents in the 2003-4 National Health and Nutrition Examination Survey database. For the more frequently consumed vegetables, potatoes and beans were the lowest-cost sources of potassium and fiber. These new metrics of affordable nutrition can help food service and health professionals identify those vegetable subgroups in the school lunch that provide the best nutritional value per penny.

Concepts: Nutrition, Nutrient, Vitamin, Essential nutrient, Vegetable, Dietary fiber, Potato, National School Lunch Act

190

BACKGROUND: Vitamin K2 contributes to bone and cardiovascular health. Therefore, two vitamin K2 homologues, menaquinone-4 (MK-4) and menaquinone-7 (MK-7), have been used as nutrients by the food industry and as nutritional supplements to support bone and cardiovascular health. However, little is known about the bioavailability of nutritional MK-4. To investigate MK-4 and MK-7 bioavailability, nutritional doses were administered to healthy Japanese women. FINDINGS: Single dose administration of MK-4 (420 mug; 945 nmol) or MK-7 (420 mug; 647 nmol) was given in the morning together with standardized breakfast. MK-7 was well absorbed and reached maximal serum level at 6 h after intake and was detected up to 48 h after intake. MK-4 was not detectable in the serum of all subjects at any time point. Consecutive administration of MK-4 (60 mug; 135 nmol) or MK-7 (60 mug; 92 nmol) for 7 days demonstrated that MK-4 supplementation did not increase serum MK-4 levels. However, consecutive administration of MK-7 increased serum MK-7 levels significantly in all subjects. CONCLUSIONS: We conclude that MK-4 present in food does not contribute to the vitamin K status as measured by serum vitamin K levels. MK-7, however significantly increases serum MK-7 levels and therefore may be of particular importance for extrahepatic tissues.

Concepts: Health, Nutrition, Nutrient, Vitamin, Essential nutrient, Dietary supplement, Food, Dietary mineral

185

Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features especially with accompanying extrapyramidal symptoms lacking a clear etiology may be rare manifestation of vitamin B12 and/or folate deficiency in children and adolescents and be potentially amenable to treatment.

Concepts: Vitamin, Ataxia, Helicobacter pylori, Folic acid, Megaloblastic anemia, Vitamin B12, B vitamins, Vitamin B12 deficiency

169

OBJECTIVE: To identify reasons why eligible families are not accessing free ‘Healthy Start’ vitamin supplementation (providing vitamins A, C and D) in England. DESIGN: Qualitative study using in-depth interviews. SETTING: 13 primary care trusts in England. PARTICIPANTS: Purposive sample of 15 Healthy Start coordinators, 50 frontline health and children’s professionals and 107 parents. RESULTS: Vitamin take-up was low across all research sites, reported as below 10% of eligible beneficiaries for free vitamins. Reasons identified by both parents and professionals included (1) poor accessibility of vitamins, (2) low promotion of the scheme by health professionals, (3) a lack of awareness among eligible families, and (4) low motivation among mothers to take vitamins for themselves during pregnancy or for children under 4 years old. CONCLUSIONS: Low uptake rates can be explained by poor accessibility of vitamins and lack of awareness and motivation to take vitamin supplements among eligible families. Universal provision (at least for pregnant women) and better training for health professionals are identified as potential solutions worthy of further research and evaluation.

Concepts: Family, Pregnancy, Nutrition, Vitamin, Dietary supplement, Educational psychology, Folic acid, Mother

169

Considering that hyperhomocysteinemia is an independent risk factor for cardiovascular disease, the purpose of this study was to determine the kinetics of serum homocysteine (tHcy) and the vitamins involved in its metabolism (folates, B(12), and B(6)) in response to acute exercise at different intensities. Eight sedentary males (18-27 yr) took part in the study. Subjects were required to complete two isocaloric (400 kcal) acute exercise trials on separate occasions at 40% (low intensity, LI) and 80% VO(2peak) (high intensity, HI). Blood samples were drawn at different points before (pre4 and pre0 h), during (exer10, exer20, exer30, exer45, and exer60 min), and after exercise (post0, post3, and post19 h). Dietary, genetic, and lifestyle factors were controlled. Maximum tHcy occurred during exercise, both at LI (8.6 (8.0-10.1) µmol/L, 9.3% increase from pre0) and HI (9.4 (8.2-10.6) µmol/L, 25.7% increase from pre0), coinciding with an accumulated energy expenditure independent of the exercise intensity. From this point onwards tHcy declined until the cessation of exercise and continued descending. At post19, tHcy was not different from pre-exercise values. No values of hyperhomocysteinemia were observed at any sampling point and intensity. In conclusion, acute exercise in sedentary individuals, even at HI, shows no negative effect on tHcy when at least 400 kcal are spent during exercise and the nutritional status for folate, B(12), and B(6) is adequate, since no hyperhomocysteinemia has been observed and basal concentrations were recovered in less than 24 h. This could be relevant for further informing healthy exercise recommendations.

Concepts: Nutrition, Obesity, Cardiovascular disease, Vitamin, Folic acid, Negative feedback, Homocysteine, Homocystinuria

167

BACKGROUND: Strenuous physical activity can alter the status of folic acid, a vitamin directly associated with homocysteine (Hcy); alterations in this nutrient are a risk factor for cardiovascular disease. Handball players are a population at risk for nutrient deficiency because of poor dietary habits. OBJECTIVE: The aims of this study were to evaluate nutritional status for macronutrients and folic acid in members of a high-performance handball team, and determine the effect of a nutritional intervention with folic acid supplementation and education. DESIGN: A total of 14 high-performance handball players were monitored by recording training time, training intensity (according to three levels of residual heart rate (RHR): <60%, 60%--80% and >80%), and subjective perceived exertion (RPE) during a 4-month training period. Nutritional, laboratory and physical activity variables were recorded at baseline (Week 0), after 2 months of dietary supplementation with 200 mug folic acid (50% of the recommended daily allowance) (Week 8) and after 2 months without supplementation (Week 16). We compared training load and analyzed changes in plasma concentrations of Hcy before and after the intervention. RESULTS: Bivariate analysis showed a significant negative correlation (P < 0.01) between Hcy and folic acid concentrations (r = -0.84) at Week 8, reflecting a significant change in Hcy concentration (P < 0.05) as a result of hyperhomocysteinemia following the accumulation of high training loads. At Week 16 we observed a significant negative correlation (P < 0.01) between Hcy concentration and training time with an RHR <60%, indicating that aerobic exercise avoided abrupt changes in Hcy and may thus reduce the risk of cardiovascular accidents in high-performance athletes. CONCLUSION: Integral monitoring and education are needed for practitioners of handball sports to record their folic acid status, a factor that directly affects Hcy metabolism. Folic acid supplementation may protect athletes against alterations that can lead to cardiovascular events related to exertion during competition.

Concepts: Protein, Nutrition, Cardiovascular disease, Physical exercise, Vitamin, Essential nutrient, Folic acid, Homocysteine

148

Vitamin A supplementation (VAS) programs targeted at children aged 6-59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. At the same time, the coverage of VA interventions can also be measured. We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.

Concepts: Immune system, Measurement, Vitamin, Vitamin C, Implementation, Intervention, Vitamin A, Internet Explorer

125

BACKGROUND: Consumption of 100% orange juice (OJ) has been positively associated with nutrient adequacy and diet quality, with no increased risk of overweight/obesity in children; however, no one has examined these factors in adults. The purpose of this study was to examine the association of 100% OJ consumption with nutrient adequacy, diet quality, and risk factors for metabolic syndrome (MetS) in a nationally representative sample of adults. METHODS: Data from adults 19+ years of age (n = 8,861) participating in the National Health and Nutrition Examination Survey 2003-2006 were used. The National Cancer Institute method was used to estimate the usual intake (UI) of 100% OJ consumption, selected nutrients, and food groups. Percentages of the population below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was measured by the Healthy Eating Index-2005 (HEI-2005). Covariate adjusted logistic regression was used to determine if consumers had a lower odds ratio of being overweight or obese or having risk factors of MetS or MetS. RESULTS: Usual per capita intake of 100% OJ was 50.3 ml/d. Among consumers (n = 2,310; 23.8%), UI was 210.0 ml/d. Compared to non-consumers, consumers had a higher (p < 0.05) percentage (% +/- SE) of the population meeting the EAR for vitamin A (39.7 +/- 2.5 vs 54.0 +/- 1.2), vitamin C (0.0 +/- 0.0 vs 59.0 +/- 1.4), folate (5.8 +/- 0.7 vs 15.1 +/- 0.9), and magnesium (51.6 +/- 1.6 vs 63.7 +/- 1.2). Consumers were also more likely to be above the AI for potassium (4.1 +/- 0.8 vs 1.8 +/- 0.2). HEI-2005 was significantly (p < 0.05) higher in consumers (55.0 +/- 0.4 vs 49.7 +/- 0.3). Consumers also had higher intakes of total fruit, fruit juice, whole fruit, and whole grain. Consumers had a lower (p < 0.05) mean body mass index (27.6 +/- 0.2 vs 28.5 +/- 0.1), total cholesterol levels (197.6 +/- 1.2 vs 200.8 +/- 0.75 mg/dL), and low density lipoprotein-cholesterol levels (112.5 +/- 1.4 vs 116.7 +/- 0.93 mg/dL). Finally, compared to non-consumers of 100% OJ, consumers were 21% less likely to be obese and male consumers were 36% less likely to have MetS. CONCLUSION: The results suggest that moderate consumption of 100% OJ should be encouraged to help individuals meet the USDA daily recommendation for fruit intake and as a component of a healthy diet.

Concepts: Cholesterol, Health, Nutrition, Obesity, Nutrient, Vitamin, Essential nutrient, Healthy diet