bluuebunny/crossref_metadata_2025 huggingface dataset:
Neue Antikoagulantien - die direkten Thrombininhibitoren
Authors: Brand  , Graf
Published: February 2013

Die direkten Thrombininhibitoren hemmen nicht nur das freie sondern auch das Fibrin-gebundene Thrombin. Zu den parenteralen direkten Thrombininhibitoren gehören die rekombinanten Hirudine Lepirudin und Desirudin, das synthetische Hirudin Bivalirudin sowie das kleine synthetische Molekül Argatroban. Alle diese Substanzen interagieren nicht mit Heparin/PF4-Antikörpern und sowohl Argatroban als auch Bivalirudin werden deshalb aktuell zur Behandlung der Heparin-induzierten Thrombozytopenie verwendet. Der orale direkte Thrombininhibitor Dabigatranetexilat ist bereits in vielen Ländern zur Behandlung des nicht-valvulären Vorhofflimmerns zugelassen. Dabigatranetexilat kann dank des stabilen, voraussehbaren Effekts ohne Dosisanpassung und ohne Monitoring appliziert werden. Die Substanz zeigt relativ wenige Interaktionen mit anderen Medikamenten. Starke Inhibitoren von P-Glykoprotein können den Dabigatranspiegel allerdings gefährlich anheben. Dabigatranetexilat wird durch Esterasen zum Hauptwirkstoff Dabigatran verstoffwechselt, welcher praktisch ausschließlich renal eliminiert wird. Um die Sicherheit und Effizienz zu prüfen, wurde Dabigatranetexilat einem ausführlichen Studienprogramm unterzogen. Sowohl für die Prävention von venösen Thromboembolien nach Gelenksersatz, der Schlaganfallprophylaxe bei Vorhofflimmern und die Behandlung akuter venöser Thromboembolien war die Substanz den bisherigen Standardtherapien in fast allen Studien mindestens ebenbürtig. Im klinischen Alltag konkurriert Dabigatranetexilat vor allem mit den neuen direkten Faktor Xa-Inhibitoren. Da keine direkten Vergleichsstudien vorliegen kann bezüglich Überlegenheit der einen oder anderen Substanzklasse bislang keine abschließende Aussage getroffen werden.
Der Fall eines Patienten mit Fieber unklarer Genese - eine bekannte Ursache mit atypischer Präsentation
Authors: Jauch  , Kesten  , Daikeler  , Holbro
Published: February 2013

Fieber unklarer Genese (FUO) ist eine häufige Ausschlussdiagnose in der Medizin. Dabei ist Fieber das Leitsymptom einer zugrundeliegenden Krankheit. Wir beschreiben hier den Fall eines 60-jährigen Patienten mit FUO, bei dem zunächst trotz langer und intensiver Abklärungen die definitive Diagnose nicht gestellt werden konnte. Erst im Verlauf zeigten sich die typischen Symptome - die Diagnose konnte gestellt und der Patient somit entsprechend behandelt werden.
Von Caipirinhas und zwei Schweinskoteletts - Variationen zum "White Hat Syndrome" des Abschieds
Authors: Stalder  , Beer H.
Published: February 2013

Anhand von drei Fällen wird die Rolle des Geruchssinnes und seiner Assoziation mit lebensgeschichtlich bedeutenden Erinnerungen resp. Entscheiden demonstriert. Die Rolle bestimmter Essensgerüche gerade bei schwer und terminal Kranken wird diskutiert. Eine "white hat round" eines sensibilisierten Spitalkochs für spezielle Indikationen wird vorgeschlagen.
Diagnostik bei Leitsymptom Schwindel
Authors: Hüfner Katharina , Strupp Michael
Published: February 2013

Schwindel ist keine Krankheitseinheit, sondern ein Symptom wie z. B. Kopfschmerz. Er umfasst multisensorische und sensomotorische Störungen unterschiedlicher Pathogenese und Ätiologie. Schwindel gehört zu den häufigsten Leitsymptomen. Die Lebenszeitprävalenz liegt bei etwa 30 %. Schlüssel zur diagnostischen Einordnung und damit spezifischen Therapie sind Anamnese und körperliche Untersuchung. Dabei ist es wichtig, periphere von zentralen Schwindelsyndromen zu unterscheiden, weil dies unmittelbare diagnostische und therapeutische Implikationen hat. In diesem Übersichtsartikel sollen die Grundzüge der Anamneseerhebung und der Untersuchung der vestibulären und okulomotorischen Systeme von Patienten mit dem Leitsymptom Schwindel dargestellt werden.
Schwindel – aus Hals-Nasen-Ohrenärztlicher Sicht
Authors: Welge-Lüssen Antje , Bodmer Daniel
Published: February 2013

Schwindel und Gleichgewichtsstörungen, beides häufige Symptome, können oft anhand einer exakten Anamnese unterschieden werden. Diese ist auch richtungsweisend, um systematischen von unsystematischem Schwindel zu unterscheiden. Peripher vestibuläre Funktionenstörungen äußern sich typischerweise durch systematischen Drehschwindel, der je nach Ursache unterschiedlich lang persistiert und in der Regel von typischen Augenbewegungen, den Nystagmen, begleitet wird. Der Nystagmus ist beim Vorliegen von peripher vestibulären Funktionsstörungen richtungsbestimmt und meistens horizontal oder rotatorisch, wohingegend ein rein vertikaler Nystagmus an eine zentral vestibuläre Störung denken lassen muss, ebenso wie begleitende Kopfschmerzen oder zusätzliche Hirnnervenläsionen. Beim Vorhandensein von letzteren ist eine neurologische Untersuchung und gegebenfalls eine Bildgebung indiziert, um eine zentrale Pathologie auszuschließen. Typische peripher vestibuläre Funktionsstörungen wie der benigne, paroxysmale Lagerungsschwindel, die Neuronitis vestibularis und der Morbus Menière werden besprochen; ihre Diagnose und Therapie, ebenso ihre Therapie und die Diagnosestellung.
Schwindel aus psychosomatischer Sicht
Authors: Langewitz Wolf , Schmid Dagmar
Published: February 2013

Die psychosomatische Perspektive kommt meist ins Spiel, wenn Schwindel ohne nachweisbares organisches oder funktionelles Korrelat auftritt. Diagnostisch lassen sich die so definierten Beschwerden unter die somatoformen Störungen einordnen (ICD-10 F45). Ätiologisch hilft diese Einordnung nicht weiter, da die Erklärungskonzepte somatoformer Störungen uneinheitlich sind. Diese ätiologische Unsicherheit widerspiegelt sich im Fehlen eindeutig belegter wirksamer Therapieoptionen, die medikamentöse Behandlung mit SSRI und Benzodiazepinen sowie kognitiv behaviorale Psychotherapie umfassen. Im zweiten Teil des Artikels wird an Hand von Fallbeispielen versucht, über das Konzept einer Unterscheidung leiblicher von körperlichen Phänomenen Schwindel in seinen Auswirkungen auf das leibliche Befinden von Patienten zu verstehen und daraus therapeutische Interventionen abzuleiten. Betont wird die Abhängigkeit der Inzidenz von Schwindel als ängstigendes Symptom vom Zeitgeist einer Epoche, der darüber entscheidet, welche Wahrnehmungen Krankheitswert erhalten. Schwindel als leibliche Regung kann Orientierungslosigkeit bedeuten, oder abgeleitet sein aus Zuständen des sich Verlierens in die Weite der Schläfrigkeit; beides wird an Fallbeispielen erläutert.
Synkope auf der Notfallstation
Authors: Rosin Christiane , Bingisser Roland
Published: February 2013

Die Synkope ist ein häufiges medizinisches Problem, wobei das strukturierte Vorgehen bei Anamnese, Untersuchung und Zusatzuntersuchungen hilft, die zugrundeliegende Ätiologie zu diagnostizieren. Bei Patienten mit gesicherter Diagnose einer Synkope, bei denen jedoch nach ersten Untersuchungen und klinischer Ersteinschätzung die Ätiologie unklar bleibt, helfen Risikostratifizierungsscores, Hochrisikopatienten zu identifizieren und einer stationären Abklärung zuzuführen.
Körperwahrnehmungstherapie bei Adipositas
Authors: Wiesmann-Fiscalini Silvia
Published: February 2013

Achtsame Körperwahrnehmung hat sich in der klinischen Praxis als effektives Therapiemodul in der Behandlung von Adipositas und problematischen Ess­verhaltensmustern  erwiesen. Die Schulung wertfreier Aufmerksamkeit bezüglich sensorischen Empfindungen, Gefühlen und Gedanken eröffnet innere Flexibilität und Handlungsspielraum im Umgang mit (Ess-)Verhaltensmustern.
Psychische Folgeprobleme der Adipositas
Authors: Müller Roland
Published: February 2013

Die Annahme, das Menschen mit Übergewicht einen hohen Leidensdruck unter Figur, Gewicht und Essverhalten aufweisen, ist verständlich. Eine pauschale Generalisierung dieser Annahme auf alle Übergewichtigen ist jedoch falsch. In diesem Artikel soll einerseits auf die aktuelle Forschungslage bezüglich Ursachen und Prädiktoren für einen erhöhten psychischen Leidensdruck unter Adipositas eingegangen werden, zum anderen sollen aber auch konkrete spezifische Be­lastungsfaktoren im Alltag Übergewichtiger diskutiert werden.
Ernährungsberatung bei Adipositas
Authors: Meyer Nathalie , Haslebacher Yvonne , Teuscher-Sick Patricia , Fischer Beatrice
Published: February 2013

Informationen über Gewichtsreduktion und gesunde Ernährung sind heutzu­tage für alle zugänglich. Die teilweise sehr unterschiedlichen und oft einschränkenden Empfehlungen führen aber bei Betroffenen mehrheitlich zu Verwirrung und selten zu einer Veränderung der Ernährungsgewohnheiten. Das Prinzip einer langfristigen und gesunden Gewichtsabnahme basiert auf ­einer negativen Energiebilanz. Anzustreben ist daher eine gesunde, ausgewogene und leicht hypokalorische Ernährung, aber keine restriktive Diät mit rigiden Vorgaben und Verboten. Eine Umstellung des Essverhaltens geschieht schrittweise und sollte sich nach den Gewohnheiten und Möglichkeiten der Patienten richten. Die Grundvoraussetzung zur Therapie von Adipositas und der dazugehörenden Verhaltensänderung liegt in der Motivation der Betroffenen. Der Zeitpunkt für den Start einer Behandlung von Übergewicht und Adipositas muss stimmen. Neben Gewichtszielen sollten auch weitere Ziele aus den Bereichen Wohlbefinden, Gesundheit und Bewegung verfolgt werden, und der Fokus auf eine Veränderung des Essverhaltens gelegt werden. Die Ernährungsberatung sollte vorzugsweise im Rahmen eines interdisziplinären Behandlungskonzepts stattfinden.
Nachsorge nach bariatrischen Operationen
Authors: Borbély Yves , Kröll Dino , Egermann Ulrich , Nett Philipp C.
Published: February 2013

Mit der stetigen Zunahme an bariatrisch operierten Patienten wird die langfristige Nachsorge dieser Patientengruppe zu einer Herausforderung. Bariatrische Patienten bedürfen einer regelmäßigen und lebenslangen Nachkontrolle, damit die erzielten Erfolge nachhaltig positiv beeinflusst zu werden. Deswegen soll die Nachbetreuung von bariatrisch operierten Patienten in der ersten Phase von einem multidisziplinären Team übernommen werden, was bei stabiler Situation und unter Berücksichtigung einiger grundsätzlichen Überlegungen in der Betreuung der postbariatrischen Patienten auch durch niedergelassene Ärzte ­außerhalb eines Kompetenzzentrums durchgeführt werden können.
Aflatoxin B1 albumin adducts in plasma and aflatoxin M1 in urine are associated with plasma concentrations of vitamins A and E
Authors: Obuseh Francis A. , Jolly Pauline E. , Jiang Yi , Shuaib Faisal M.B. , Waterbor John , Ellis William O. , Piyathilake Chandrika J. , Desmond Renee A. , Afriyie-Gyawu Evans , Phillips Timothy D.
Published: February 2013

Background: Although aflatoxin exposure has been associated with micronutrient deficiency in animals, there are few investigations on the effects of aflatoxin exposure on micronutrient metabolism in humans. Objective: To examine the relationship between aflatoxin B1 (AFB1) albumin adducts (AF-ALB) in plasma and the aflatoxin M1 (AFM1) metabolite in urine and plasma concentrations of retinol (vitamin A) and alpha-tocopherol (vitamin E) in Ghanaians. Methods: A cross-sectional study of 147 adult participants was conducted. Blood and urine samples were tested for aflatoxin and vitamins A and E levels. Results: Multivariable analysis showed that participants with high AF-ALB (>= 0.80 pmol/mg albumin) had increased odds of having vitamin A deficiency compared to those with lower AF-ALB [Odds Ratio (OR) = 2.61; CI = 1.03 - 6.58; p = 0.04]. Participants with high AF-ALB also showed increased odds of having vitamin E deficiency but this was not statistically significant (OR = 2.4; CI = 0.96 - 6.05; p = 0.06). Conversely, those with higher AFM1 values had a statistically nonsignificant reduced odds of having vitamin A deficiency (OR = 0.31; CI = 0.09 - 1.02; p = 0.05) and a statistically significant reduced odds of having vitamin E deficiency (OR = 0.31; CI = 0.10 - 0.97; p = 0.04). Participants with high AF-ALB or high AFM1 (>= 437.95 pg/dL creatinine) were almost 6 times more likely to be hepatitis B virus surface antigen (HBsAg)-positive (OR = 5.88; CI = 1.71 - 20.14; p = 0.005) and (OR = 5.84; CI = 1.15 - 29.54; p = 0.03) respectively. Conclusions: These data indicate that aflatoxin may modify plasma micronutrient status. Thus, preventing aflatoxin exposure may reduce vitamin A and E deficiencies.
Vitamin Profile of Some Standardized Nigerian Composite Dishes
Authors: Onabanjo  , Aderibigbe  , Akinyemi  , Adetogun
Published: February 2013

The purpose of the study was to determine the vitamin content of twenty standardized dishes commonly consumed in Nigeria. Representative samples of twenty Nigerian dishes were analyzed for fat-soluble (vitamins A, D, E, and K) and water-soluble (vitamin C and B- complexes) vitamins. The foods analyzed included those based on cereals, starchy tubers and roots, legumes, and vegetables. The analysis was carried out using spectrophotometry. The results revealed the following concentrations (mg/100 g): vitamin C , undetectable to 2.692 mg/100 g; thiamine, 0.011 - 1.094 mg/100 g; riboflavin, 0.011 - 0.816 mg/100 g; pyridoxine, undetectable to 0.412 mg/100 g; niacin, 0.070 - 0.967 mg/100 g; pantothenic acid, 0.060 - 1.193 mg/100 g; biotin, undetectable to 2.092 mg/100 g; B12, 0.045 - 2.424 µg/100 g; folate, 7.822 - 101.764 µg/100 g; total vitamin A, undetectable to 121.444 µg RE/100 g; vitamin D, undetectable to 2.445 IU/100 g; vitamin E, undetectable to 2.627 IU/100 g; and vitamin K, 0.266 - 13.091 µg/100 g. The results suggest that these dishes are good sources of fat-soluble and water-soluble vitamins and will provide baseline data that will be valuable in complementing available food composition data, and in estimating dietary intake of vitamins in Nigeria.
Inverse Correlation Between Plasma Beta-Carotene and Interleukin-6 in Patients with Advanced Coronary Artery Disease
Authors: Muzáková Vladimíra , Kandár Roman , Meloun Milan , Skalický Jirí , Královec Karel , Záková Pavla , Vojtísek Petr
Published: February 2013

The interrelationships between plasma beta-carotene, alpha-tocopherol, and the level of systemic inflammation and oxidative stress were investigated in patients with advanced coronary artery disease (CAD). Plasma beta-carotene, alpha-tocopherol, malondialdehyde, free radicals, interleukin-6, high sensitive C-reactive protein levels, and other risk factors of CAD were determined in a group of patients with advanced CAD [significant stenosis according to coronarographic examination (n = 91) and a control group of examined patients with coronary arteries with no stenosis (n = 49)]. Between-group differences in continuous variables were analyzed with the Hotelling T2-test (software NCSS2000), analyses of correlation matrix with the software STATISTICA. Advanced CAD coincided with significantly lower plasma concentrations of high-density lipoprotein (HDL)-cholesterol and beta-carotene as well as with elevated levels of all inflammatory markers, but only with mild increase of oxidative stress. Beta-carotene significantly inversely correlated with interleukin-6. This inverse correlation could suggest potential protective effect of beta-carotene on atherosclerosis due to the inhibition of inflammatory processes.
Reliability of a Self-Administered Postal Questionnaire on the Use of Food Supplements in an Italian Adult Population
Authors: Giammarioli Stefania , Boniglia Concetta , Carratù Brunella , Ciarrocchi Marco , Chiarotti Flavia , Sanzini Elisabetta
Published: February 2013

The objective of this study was to evaluate the reliability of a self-administered postal questionnaire on the use of food supplements. The study was carried out in subjects representative of an Italian adult population. Eight thousand eight hundred twenty-three subjects received the questionnaire; 1723 subjects completed it of which 102 twice (baseline and 1-month re-administration). The latter 204 questionnaires were used to test reliability using Cohens kappa statistic (k) and the intra-class correlation coefficient (ICC) for categorical and quantitative variables, respectively. Subjects characteristics such as sociodemographic and physical data, lifestyles, dietary habits, and most health characteristics showed very good agreement (ICC or k 1.00 - 0.55) between questionnaires, with the exception of answers about the consumption of some medicines (k 0.37 - 0.40). The reliability concerning the use of food supplements was satisfactory on the whole (k 0.69) and fairly satisfactory for different categories of food supplements (k 0.83 - 0.41). With regard to additional information about users of food supplements, the reliability of responses was fairly satisfactory on the whole (k 0.93 - 0.41), with some exceptions. The concordance/correlation coefficient values generally showed that the questionnaire is fairly reliable over the entire sample for collecting information on the use of food supplements.
Paradoxical effect of severe dietary restriction on Long-Evans rat life span
Authors: Abalan François , Mayo Willy , Simon Hervé , Le Moal Michel
Published: February 2013

It has been firmly established that the longevity of 20- to 60 %-calorie-restricted rodents, with malnutrition (essential nutrients deficiency) being avoided, is increased when compared to ad libitum fed rodents. However, the effects on life span of severe dietary restriction (i. e. malnutrition), with limited weight loss, remained unknown. The purpose of this 4-year study was to investigate the effects on longevity of a severe form of dietary restriction, with limited and controlled weight loss. To this end, a group of male Long-Evans rats severely dietary restricted (SDR group), with a weight loss throughout the experiment <= 25 % of their weight before the onset of the experiment at 9 weeks of age, was compared to a control group of rats 30- to 40 %-calorie-restricted (C group). Our results show that a severe dietary restriction, excessive weight loss being prevented, paradoxically increased rat longevity by nearly 50 %. The life span increase observed in our SDR rats is in accordance with some other studies investigating the effects on longevity of partial essential nutrients deficiencies (tryptophan, methionine, and fat, for example).
White Beans Provide More Bioavailable Iron than Red Beans: Studies in Poultry (Gallus gallus) and an in vitro Digestion/Caco-2 Model
Authors: Tako Elad , Glahn Raymond P.
Published: February 2013

Iron-biofortification of crops is a strategy that alleviates iron deficiency. The common bean (Phaseolus vulgaris L.) is an attractive candidate for biofortification. However, beans are high in polyphenols that may inhibit iron absorption. In vitro studies have shown that iron bioavailability from white beans is higher than that from colored beans. In this study, our objective was to determine if white beans contain more bioavailable iron than red beans and to determine if the in vitro observations of bean-iron bioavailability would be evident in an in vivo feeding trial. We compared iron bioavailability between diets containing either white (Matterhorn) or red (Merlot) beans, which differ in polyphenol content. One-week-old chicks (Gallus gallus) were divided into four groups: 1. WB: 40 % white-bean diet; 2. RB :40 % red-bean diet; 3. WB + Fe: 40 % white-bean diet; 4. RB + Fe: 40 % red-bean diet (51, 47, 179, and 175 ppm iron, respectively). Diets 1 and 2 had no supplemental iron; whereas 125 µg/g iron was added to diets 3 and 4. For 8 weeks, hemoglobin, feed consumption, and body weights were measured. Divalent metal transporter 1 (iron-uptake-transporter), duodenal-cytochrome-B (iron reductase), and ferroportin (iron-exporter) expressions were higher (p < 0.05), villus-surface-area (tissue iron-deficiency adaptation) was greater in the RB group vs. other groups. Cecal microflora was similar between treatments. Hemoglobin, body-hemoglobin iron, and body weights were lower in the RB group vs. other groups (p < 0.05). In vitro analysis showed lower ferritin formation (less bioavailable iron) in cells exposed to the RB diet. We conclude that the in vivo results support the in vitro observations; i. e., white beans contain more bioavailable iron than red beans.
Gastrointestinal Factors Influencing Zinc Absorption and Homeostasis
Authors: Cousins Robert J.
Published: February 2013

Diet-derived luminal factors have a major influence on zinc available for uptake across the apical membrane of enterocytes. Malabsorption and possibly intestinal microbiota limit this zinc availability. The transporter ZIP4 is expressed along the entire gastrointestinal tract and acts as a major processor of dietary zinc for loading into enterocytes from the apical membrane. Zip4 and other Zip family genes expressed in the gastrointestinal tract are up-regulated in periods of dietary zinc restriction. This provides for powerful homeostatic control. The transporter ZIP14 is up-regulated along the entire gastrointestinal tract by proinflammatory conditions. Intracellular transporters such as ZnT7, influence the transcellular movement of zinc across the enterocyte. Metallothionein, an intracellular metal buffer, and the transporter ZnT1 at the basolateral membrane, regulate the amount of zinc released to the portal circulation for systemic distribution. Pancreatic release of zinc by acinar cells is through the secretory process and apical membrane and involves transporters ZnT2 and ZnT1, respectively. Expression of both transporters is zinc-responsive. Enterocytes and acinar cells constitutively express Zip5 at the basolateral membrane, where it may serve as a monitor of zinc status.
Estimating the Bioavailability Factors Needed for Setting Dietary Reference Values
Authors: Fairweather-Tait Susan J. , Collings Rachel
Published: February 2013

Estimated average requirements for micronutrients are central to deriving Dietary Reference Values. These are used for nutrition policies and programs, and also for regulatory and labeling purposes, and are traditionally devised to cover the needs of virtually all individuals in any population group. In order to estimate the average requirement, an appropriate endpoint (biomarker) is selected which describes the relationship between dietary intake and health. However, for some micronutrients, such as zinc, there are no good biomarkers, and for others, such as iron, the intake-status relationship is confounded by variations in absorption. Average requirements for these nutrients are derived using a factorial approach in which physiological needs for tissue growth and maintenance and endogenous losses are estimated, and the total converted to a dietary requirement by taking into account the overall absorption from the diet; i. e. multiplying the requirement by a bioavailability factor. The latter can be determined using algorithms, or estimates from absorption studies, some of which are described in this short review paper.
Algorithms for Iron and Zinc Bioavailability: Are they Accurate?
Authors: Hunt Janet R.
Published: February 2013

Several bioavailability algorithms have been proposed for iron and zinc, confirming the need for these tools while emphasizing the challenge of deriving algorithms with accepted accuracy. This manuscript briefly reviews current evidence on the accuracy of proposed algorithms. Iron absorption is strongly influenced by both body iron status and dietary availability, and most evidence suggests that these do not interact. There is considerable evidence of a logarithmic relationship between percent iron absorption and serum ferritin that allows a simple and accurate computation of how human iron status affects absorption (in the absence of inflammation). Computing the effect of dietary variation on nonheme iron absorption has been challenging because of multiple influential dietary factors and incomplete knowledge of their chemical characteristics, food composition, interactions, and dose-response relationships. At present there is no fully validated algorithm for dietary iron bioavailability. Predicting zinc absorption is less complex. Fractional zinc absorption is substantially influenced by the amount of zinc consumed, and this factor, together with ingested phytic acid, account for a considerable degree of the variance. A multivariate saturation model based on these two variables has been derived using data from multiple studies and independently validated with a single large data set.
Does Obesity Increase Risk for Iron Deficiency? A Review of the Literature and the Potential Mechanisms
Authors: Cepeda-Lopez Ana C. , Aeberli Isabelle , Zimmermann Michael B.
Published: February 2013

Increasing obesity is a major global health concern while at the same time iron-deficiency anemia remains common worldwide. Although these two conditions represent opposite ends of the spectrum of over- and under-nutrition, they appear to be linked: overweight individuals are at higher risk of iron deficiency than normal-weight individuals. Potential explanations for this association include dilutional hypoferremia, poor dietary iron intake, increased iron requirements, and/or impaired iron absorption in obese individuals. Recent evidence suggests obesity-related inflammation may play a central role through its regulation of hepcidin. Hepcidin levels are higher in obese individuals and are linked to subclinical inflammation; this may reduce iron absorption and blunt the effects of iron fortification. Thus, low iron status in overweight individuals may result from a combination of nutritional (reduced absorption) and functional (increased sequestration) iron deficiency. In this review, we focus on subclinical inflammation in obesity, and its effect on hepcidin levels, as the most plausible explanation for the link between iron deficiency and obesity.
Calcium and Iron Absorption - Mechanisms and Public Health Relevance
Authors: Lönnerdal Bo
Published: February 2013

Studies on human subjects have shown that calcium (Ca) can inhibit iron (Fe) absorption, regardless of whether it is given as Ca salts or in dairy products. This has caused concern as increased Ca intake commonly is recommended for children and women, the same populations that are at risk of Fe deficiency. However, a thorough review of studies on humans in which Ca intake was substantially increased for long periods shows no changes in hematological measures or indicators of iron status. Thus, the inhibitory effect may be of short duration and there also may be compensatory mechanisms. The interaction between Ca and Fe may be a lumenal event, affecting Fe uptake through DMT1 (divalent metal transporter 1) at the apical membrane. However, it is also possible that inhibition occurs during Fe transfer into circulation, suggesting roles for the serosal exporter ferroportin (FPN) and hephaestin. We explored these possibilities in human intestinal Caco-2 cells cultured in monolayers. Iron transport (59Fe) and expression of DMT1, FPN, and hephaestin were assessed after 1.5 and 4 hours with 0 or 100 µM CaCl2. Although Ca did not affect Fe uptake or DMT1 expression at 1.5 hours, FPN abundance at the basolateral membrane decreased, resulting in increased cellular Fe retention and decreased Fe efflux. After 4 hours, DMT1 and FPN expression increased and there was increased FPN at the membrane, suggesting a rebound effect. Thus, the effect of Ca on Fe absorption may be of short duration and adaptation may occur with time. This may explain why studies on long-term Ca supplementation of different groups fail to show any adverse effects on Fe status.
Does Zinc Absorption Reflect Zinc Status?
Authors: King Janet C.
Published: February 2013

Unlike iron, zinc absorption is influenced by dietary zinc intake, not zinc status. As dietary zinc increases, the total amount of absorbed zinc increases while the percent absorbed declines. The gastrointestinal tract maintains whole-body zinc homeostasis by adjusting endogenous zinc losses to the amount absorbed. At intakes below about 9 mg/day, zinc absorption occurs primarily by a saturable (carrier) process involving ZIP4, ZnT1, and other transporters. There is no evidence that past zinc intakes, or status, influences zinc absorption. Instead, current zinc intake is the chief determinant of zinc absorption. Supplemental zinc taken with water in the post-absorptive state initially is absorbed more efficiently than food zinc, but absorption efficiency declines within 24 hours presumably due to down-regulation of the zinc transporters. More research is needed to understand the effect of physiological state on zinc absorption.
The Use of Caco-2 Cells to Estimate Fe Absorption in Humans - a Critical Appraisal
Authors: Sandberg Ann-Sofie
Published: February 2013

The Caco-2 cell model is widely used to assess the bioaccessibility/availability of iron from foods and diets. Analysis of iron uptake in this human epithelial cell line is usually preceded by a two-step digestion to simulate the conditions in the stomach and small intestine. Moreover, culturing the cells on inserts permits the measurement of iron transport. The cellular iron uptake is determined by direct measurements using radioisotopes, or indirectly by measurement of ferritin, the intracellular storage form of iron. There is a good correlation between Caco-2 cell uptake and human iron bioavailability for a number of dietary factors known to affect iron absorption. However, recent data suggest that in some cases there is no correlation. Possible reasons for such discrepancies, the benefits, and limitations of the Caco-2 cell model are discussed. In conclusion, in vitro experiments with Caco-2 cells are important tools for ranking foods with respect to bioavailability, for mechanistic studies of iron absorption, and for studies of dietary factors influencing absorption. The results need to be confirmed in humans.
Polymorphisms Affecting Trace Element Bioavailability
Authors: Mathers John C. , Méplan Catherine , Hesketh John E.
Published: February 2013

This review outlines the nature of inter-individual variation in trace element bioavailability, focusing on genetic and epigenetic determinants. We note that pathogenic mutations responsible for dangerously high (or low) status for the micronutrient are unlikely to make large contributions to variability in bioavailability among the general population. Prospective genotyping (for variants in genes encoding selenoproteins) of participants in human studies illustrate one approach to understanding the complex interactions between genotype and trace element supply, which determine the functional bioavailability of selenium. Rapid advances in technological and bioinformatics tools; e. g., as used in Genome-Wide Association Studies, are opening new avenues for research on the genetic determinants of inter-individual variation in trace element bioavailability. This may include copy number variants in addition to the more widely studied polymorphisms. Future research on trace element bioavailability should encompass studies of epigenetic variants, including the role of non-coding (micro) RNA.
Genetic Variation: Impact on Folate (and Choline) Bioefficacy
Authors: West Allyson A. , Caudill Marie A.
Published: February 2013

Folate and choline are water-soluble micronutrients that serve as methyl donors in the conversion of homocysteine to methionine. Inadequacy of these nutrients can disturb one-carbon metabolism as evidenced by alterations in circulating folate and/or plasma homocysteine. Among common genetic variants that reside in genes regulating folate absorptive and metabolic processes, homozygosity for the MTHFR 677C > T variant has consistently been shown to have robust effects on status markers. This paper will review the impact of genetic variants in folate-metabolizing genes on folate and choline bioefficacy. Nutrient-gene and gene-gene interactions will be considered along with the need to account for these genetic variants when updating dietary folate and choline recommendations.
Bioavailability of Vitamin B12
Authors: Allen Lindsay Helen
Published: February 2013

Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied to diagnose vitamin B12 malabsorption, including Schillings test, which is now used rarely, but these do not quantify percent bioavailability. Most of the information on B12 bioavailability from foods was collected 40 to 50 years ago, using radioactive isotopes of cobalt to label the corrinoid ring. The data are sparse, and the level of radioactivity required for in vivo labeling of animal tissues can be prohibitive. A newer method under development uses a low dose of radioactivity as 14C-labeled B12, with measurement of the isotope excreted in urine and feces by accelerator mass spectrometry. This test has revealed that the unabsorbed vitamin is degraded in the intestine. The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods. This has important implications for the assessment and interpretation of bioavailability values, setting dietary requirements, and interpreting relationships between intake and status of the vitamin.
Provitamin A Carotenoid Bioavailability:What Really Matters?
Authors: Tanumihardjo Sherry A. , Palacios Natalia , Pixley Kevin V.
Published: February 2013

Micronutrient malnutrition, or hidden hunger, afflicts a large part of the worlds population, with vitamin A deficiency among the most prevalent public health problems. Provitamin A carotenoids in plant foods are a source of vitamin A for humans; however, several factors, including species of carotenoids, host status, and effectors of absorption can negatively, positively, or in yet undetermined ways affect the bioavailability of these compounds. Staple foods biofortified with provitamin A carotenoids have shown more efficient bioconversion to retinol than generally observed for vegetables (e. g., 3 - 6 versus 10 - 80 beta-carotene to 1 µg retinol). Staple foods such as maize, rice, and cassava, are generally more accessible than meat or vegetable sources of retinol or provitamin A carotenoids to poor consumers, who are most likely to suffer micronutrient malnutrition. Interdisciplinary teamwork, including plant breeders, nutritionists, government and local agencies, seed companies, and communities, is needed to avail biofortified crops to needy populations. Key steps include developing, validating the nutritional effects of, providing nutrition education concerning, and promoting the use of biofortified crops. Provitamin A carotenoid biofortification of sweet potato, maize, cassava, and rice are at different stages along this continuum. Close linkages between agriculture, nutrition, and health, are essential in the quest to eradicate hunger among the poor.
Decreases in Bone Mineral Content by Dietary All-Trans Retinoic Acid Precede Decreases in Bone Mineral Density in a Weanling Rat Model of Cigarette Smoke - Induced Lung Injuries
Authors: Xue Yuan , Haub Mark D. , Smith Brendon W. , Baybutt Richard C.
Published: February 2013

Research has indicated that excessive vitamin A can have deleterious impacts on bone. Retinoic acid (RA), the most active metabolite of vitamin A, has been tested in clinical trials for treatment of lung cancer and emphysema. These trials are not measuring Bone Mineral Content (BMC) or Bone Mineral Density (BMD). In this study, we used an animal model to determine potential deleterious effects of all-trans RA on bone mass when used as a means to protect against or treat cigarette smoke-induced lung injuries, and also to evaluate BMC as a potential early indicator of osteoporosis risk. Twenty-four male weanling rats were fed either a control diet or a RA-supplemented diet. Half of each group was exposed to 40 cigarettes per day, 5 days per week, for 4 weeks. BMC and BMD were measured at weeks 2 and 4. RA supplementation in all groups significantly decreased (p < 0.05) only BMC at week 2 and both BMC and BMD (both p < 0.05) at week 4. The same results were observed when BMC was expressed relative to body weight. These data suggest that caution should be used when RA is used to treat smoke-related lung injuries.
Dietary Patterns and Smoking in Northern Irish Men: a Population at High Risk of Coronary Heart Disease
Authors: ODoherty Mark G. , Skidmore Paula M.L. , Young Ian S. , McKinley Michelle C. , Cardwell Chris , Yarnell John W.G. , Gey Fred K. , Evans Alun , Woodside Jayne V.
Published: February 2013

This study evaluated dietary habits of Northern Irish men who are at high risk of cardiovascular disease, stratified as never-, ex-, moderate-, or heavy-smokers. Participants were male volunteers (30 - 49 years) from a single workforce in Belfast (n = 765). Dietary information was collected using a validated food frequency questionnaire. For a priori diet scores, never- and ex-smokers had a significantly higher fruit and vegetable score, Mediterranean diet score, and alternative Mediterranean diet score than moderate or heavy-smokers (all p < 0.05). For a posteriori patterns, scores for the healthy, sweet tooth, and traditional dietary patterns, derived from principal component analysis, differed significantly by smoking status, being lower among smokers for the healthy and sweet tooth patterns, and higher in ex-smokers for the traditional pattern (all p < 0.05). When the a posteriori patterns were included in models predicting likelihood of being in a particular smoking category with the a priori patterns, the results for the fruit and vegetable score lost significance (p = 0.13). Both a priori and a posteriori dietary patterns identified smokers, particularly heavy smokers, as exhibiting fewer healthy dietary habits than never- or ex-smokers, but a posteriori dietary patterns appeared to be more strongly associated with smoking status.
Anti-Diabetic Activity of a Mineraloid Isolate, in vitro and in Genetically Diabetic Mice
Authors: Deneau Joel , Ahmed Taufeeq , Blotsky Roger , Bojanowski Krzysztof
Published: February 2013

Type II diabetes is a metabolic disease mediated through multiple molecular pathways. Here, we report anti-diabetic effect of a standardized isolate from a fossil material - a mineraloid leonardite - in in vitro tests and in genetically diabetic mice. The mineraloid isolate stimulated mitochondrial metabolism in human fibroblasts and this stimulation correlated with enhanced expression of genes coding for mitochondrial proteins such as ATP synthases and ribosomal protein precursors, as measured by DNA microarrays. In the diabetic animal model, consumption of the Totala isolate resulted in decreased weight gain, blood glucose, and glycated hemoglobin. To our best knowledge, this is the first description ever of a fossil material having anti-diabetic activity in pre-clinical models.
Striae Gravidarum, Vitamin C and Other Related Factors
Authors: Findik Rahime Bedir , Hascelik Nurcihan Karakurt , Akin Kadir Okhan , Unluer Ayse Nurcan , Karakaya Jale
Published: February 2013

Background: Striae gravidarum, a clinical condition commonly seen in pregnant women, produces serious cosmetic problems and may lead to psychological problems. Aim: The present study investigated whether there was any relation between the presence of striae in primigravid pregnant women and blood vitamin C levels, and factors thought to contribute to the formation of striae such as family history, weight gained during pregnancy, smoking status, abdominal and thigh circumference, and age. Methods: Overall, 69 primigravid women attending routine antenatal follow-up and, using prophylactic iron and vitamin preparations, underwent investigation. All were pregnant 36 or more weeks. Scoring was based on striae examination and whether striae were present. The relation between the presence of striae, vitamin C blood levels, and other factors was investigated. Results and Conclusions: Multiple logistic regression analysis showed a significant relation between the presence of striae and blood vitamin C levels (p = 0.046) and between the presence of striae and family history (p = 0.023). No significant relation was found between the presence of striae and age, weight gained during pregnancy, abdominal and thigh circumference, or smoking status. It was concluded that further, more comprehensive studies on the issue are required.
Chemical Composition of Aspongopus nepalensis Westwood 1837 (Hemiptera; Pentatomidae), a Common Food Insect of Tribal People in Arunachal Pradesh (India)
Authors: Chakravorty Jharna , Ghosh Sampat , Meyer-Rochow
Published: February 2013

We identified nutritionally relevant fatty acids and macro- and micronutrient content in Aspongopus nepalensis Westwood 1837 (Hemiptera), an insect used as food by the ethnic people of Arunachal Pradesh (North East India). Regarding macronutrients, crude lipids made up 38.35 %, fibre 33.47 %, protein 10.6 %, moisture 41.9 %, and ash 2.1 %. Lipid amounts were higher than those of most other insects. A. nepalensis was rich in Na: 1.02 %, K: 0.35 %, Ca: 0.12 %, Mg: 0.16 % and moreover, contained considerable amounts of Fe, Cu, Zn, and Mn. With regard to vitamins, A was most abundant (34.38 µg/100 g); C, D, E, and those of the B-complex were present, but less abundant, and monounsaturated fatty acid (MUFA) content was high (56.1 % of the total fat). Oleic and palmitic acids (46.41 % and 32.32 % of total fat) were the two major fatty acids in this insects oil. The latter also contained moderate amounts of stearic, palmitoleic, linoleic, myristic, eicosenoic, and linolenic acids.
Considerations for the Safe and Effective Use of Iron Interventions in Areas of Malaria Burden - Executive Summary
Authors: Raiten Daniel J. , Namasté Sorrel , Brabin Bernard
Published: February 2013

In 2006, the World Health Organization and the United Nations Childrens Fund released a joint statement advising that, in regions where the prevalence of malaria and other infectious diseases is high, iron and folic acid supplementation should be limited to those who are identified as iron-deficient. Although precipitated, in large part, by a recent report of adverse events associated with iron supplementation in children, questions about the risk/benefit of iron deficiency and mechanisms underlying potential adverse effects of iron in the context of infection are long-standing. Moreover, the implementation of this revised policy is compromised in most settings by the lack of consensus on the best methods to screen for iron deficiency. In response to these concerns a comprehensive review was conducted by a Technical Working Group (TWG), constituted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the U.S. National Institutes of Health, in partnership with the Bill and Melinda Gates Foundation. The review included an evaluation of the putative mechanisms associated with adverse effects of iron in the context of malaria; applicability of available biomarkers for assessing iron status in the context of infections; and evaluation of evidence with regard to the safety and effectiveness of available interventions to prevent iron deficiency, particularly in areas of endemic malaria. The aim of this paper is to summarize the technical details of the larger TWG review conclusion that the occurrence and mechanism(s) of adverse effects associated with providing iron supplements (i. e., pills/liquid) under conditions of malaria and high infection exposure remain a concern, especially in settings where care and treatment are not readily available or accessible. Iron deficiency remains a problem that demands appropriate clinical care. When target groups have already been identified as being iron-deficient, iron supplementation is the intervention of choice for the treatment of anemia and other manifestations of iron deficiency. Of available intervention options to prevent iron deficiency, supplements are probably least desirable, particularly for infants and children. This paper also provides a synopsis of the TWG responses to the recently published Cochrane Review on the safety of iron supplementation for children in the context of malaria, and a research agenda outlined by the TWG that can best address outstanding questions.
Bioactive Proteins and Peptides in Foods
Authors: Walther Barbara , Sieber Robert
Published: February 2013

Increasing amounts of data demonstrate a bioactive role of proteins and peptides above and beyond their nutritional impact. The focus of the investigations has mainly been on vitamin- and mineral-binding proteins, on antimicrobial, immunosuppressing/-modulatory proteins, and on proteins with enzyme inhibitory activity as well as on hormones and growth factors from different food proteins; most research has been performed on milk proteins. Because of their molecular size, intact absorption of proteins in the human gastrointestinal tract is limited. Therefore, most of the proteins with biological functions show physiological activity in the gastrointestinal tract by enhancing nutrient absorption, inhibiting enzymes, and modulating the immune system to defend against pathogens. Peptides are released during fermentation or digestion from food proteins by proteolytic enzymes; such peptides have been found mainly in milk. Some of these released peptides exert biological activities such as opiate-like, antihypertensive, mineral-binding, antioxidative, antimicrobial, immuno-, and cytomodulating activity. Intact absorption of these smaller peptides is more likely than that of the larger proteins. Consequently, other organs than the gastrointestinal tract are possible targets for their biological functions. Bioactive proteins as well as bioactive peptides are part of a balanced diet. It is possible to accumulate bioactive peptides in food, for example by using specific microorganisms in fermented dairy products. Although bioactive peptides have been the subject of several studies in vitro and in vivo, their health potential is still under investigation. Up to now, the Commission of European Communities has not (yet) authorized any health claims for bioactive proteins and peptides from food.
Allergic Reactions to Food Proteins
Authors: Ballmer-Weber Barbara K.
Published: February 2013

Four to eight percent of the population are estimated to be food-allergic. Most food allergies in adolescents and adults are acquired on the basis of cross-reaction to pollen allergens. Theses allergens are ubiquitous in the plant kingdom. Therefore pollen-allergic patients might acquire a multitude of different plant food allergies, and even react to novel foods to which they have never previously been exposed. A curative therapy for food allergy does not yet exist. Food-allergic patients have to rely on strict avoidance diets, The widespread use of industrially processed foods poses a general problem for food-allergic patients. Although the most frequent allergens must be declared openly in the list of ingredients, involuntary contamination with allergy-provoking compounds can occur. The precautionary labelling may contain is sometimes applied even if the chance of contamination is very low; on the other hand, foods not declared to contain possible traces of allergenic components may actually contain relevant amounts of allergenic proteins. Switzerland is the only country in Europe with legal regulations on contamination by allergenic food; however, the allowance of 1 g/kg is too high to protect a relevant proportion of food-allergic individuals.