Use of an arginine‐enriched oral nutrition supplement in the healing of pressure ulcers in patients with spinal cord injuries: An observational study

Aim: Pressure ulcers are a serious secondary consequence of spinal cord injuries. The objective of the present study was to determine whether an arginine‐containing nutritional supplement can reduce the healing time of pressure ulcers in people with spinal cord injuries compared with those not consuming the supplement until full wound healing. Methods: Thirty‐four spinal cord injured patients with a grade 2, 3 or 4 pressure ulcer were prescribed two 237 mL tetrapaks/day of a supplement containing additional protein, arginine, zinc and vitamin C. Pressure ulcer healing was assessed with the Pressure Ulcer Scale for Healing tool. Results: Twenty patients consumed the nutritional supplement until full pressure ulcer healing had occurred, while 14 patients ceased consuming the supplement before full healing occurred because of intolerance, compliance or taste issues. A 2.5‐fold greater rate of healing was observed in patients consuming the supplement until full healing compared with those who ceased taking the supplement (8.5 ± 1.1 weeks vs 20.9 ± 7.0 weeks respectively; P= 0.04). There were no significant differences in age, nutritional status, gender or reason for admission between groups. Comparison of healing rates in the group consuming the supplement to full wound healing against expected rates derived from the medical literature showed a significantly shorter time‐to‐healing (grade 3 pressure ulcer: 6.5 ± 0.8 weeks vs 18.2 weeks; grade 4: 11.4 ± 2.0 weeks vs 22.1 weeks; P < 0.001). Conclusion: The present small‐scale study demonstrated the potential for specialised wound healing nutritional supplements to shorten the time to pressure ulcer healing in spinal cord injured patients.     

Zinc and acute tropical ulcers in Gambian children and adolescents

28 Gambian children and adolescents with acute tropical leg ulcers entered a double blind trial of oral zinc supplements as an adjunct to standard treatment. Analysis of the area healing of the ulcers resulted in a mathematical expression which showed that for each subject re-epithelialization reduced the ulcer radius at a constant healing rate (k). k was derived from the equation At = pi X (r - k X t)2, where At = residual ulcer area at time "t", r = initial ulcer radius and t = time from start of treatment. In the zinc treated group k was 0.55 +/- 0.39 mm/day, and 0.51 +/- 0.25 mm/day in the placebo group. The initial low plasma zinc of 6.5 +/- 1.9 mumol/L in the ulcerated subjects was not significantly lower than that of 7.5 +/- 3.6 mumol/L in the nonulcerated controls. Oral zinc supplements significantly elevated plasma zinc concentrations by 5.8 +/- 4.8 mumol/L compared to the placebo group's change of 0.4 +/- 2.0 mumol/L (p less than 0.001). Plasma alkaline phosphatase activities and fatty acid profiles did not change with zinc supplementation. Thus unequivocal clinical and biochemical evidence of zinc deficiency in these ulcerated subjects was not established, despite changes in plasma zinc. This study does not indicate any role for zinc supplementation in the management of acute tropical ulcers.     

Nutrient intake from habitual oral diet in patients with severe short bowel syndrome living in the southeastern United States

OBJECTIVES: Little data are published on the habitual home oral diet of patients with short bowel syndrome (SBS). METHODS: We assessed nutrient intake from oral food and beverages in 19 stable patients with severe SBS who live in the southeastern United States. Intestinal absorption of energy, fat, nitrogen (N), and carbohydrate (CHO) was determined in a metabolic ward. RESULTS: We studied 12 women and 7 men, age 48 +/- 3 y of age (mean +/- SE) receiving parenteral nutrition for 31 +/- 8 mo following massive small bowel resection (118 +/- 25 cm residual small bowel). The patients demonstrated severe malabsorption of energy (59 +/- 3% of oral intake), fat (41 +/- 5%), N (42 +/- 5%) and CHO (76 +/- 3%). Oral energy intake was 2656 +/- 242 kcal/d (39 +/- 3 kcal/kg/d) and oral protein intake was 1.4 +/- 0.1 g/kg/d. Food/beverage intake constituted 49 +/- 4% of total (enteral plus parenteral) daily fluid intake, 66 +/- 4% of total daily kcal and 58 +/- 5% of total daily N intake. Oral fat intake averaged 92 +/- 11 g/day ( approximately 35% of total oral energy). Oral fluid intake averaged 2712 +/- 240 ml/d, primarily from water, soft drinks, sweet tea and coffee. Simple sugars comprised 42 +/- 3% of oral CHO intake. Usual dietary intake of multiple micronutrients were below the Recommended Dietary Allowances (RDA) in a large percentage of patients: vitamin A (47%), vitamin D (79%), vitamin E (79%), vitamin K (63%), thiamine (42%), vitamin B6 (68%), vitamin B12 (11%), vitamin C (58%), folate (37%), iron (37%), calcium (63%), magnesium (79%) and zinc (68%). Only seven patients (37%) were taking oral multivitamin-mineral supplements and only six subjects (32%) were taking oral iron and calcium supplements, respectively. CONCLUSION: In these SBS patients, an oral diet provided a significant proportion of daily nutrient intake. The types of foods and fluids consumed are likely to worsen malabsorption and thus increase PN requirements. Oral intake of essential micronutrients was very low in a significant proportion of these individuals.     

Efficacy of a disease-specific nutritional support for pressure ulcer healing: A systematic review and meta-analysis

Objectives

The aim of this systematic review was to summarize the evidence on the efficacy of high-calorie, high-protein nutritional formula enriched with arginine, zinc, and antioxidants (disease-specific support) in patients with pressure ulcers (PUs).

Methods

Randomized controlled trials in English published from January 1997 until October 2015 were searched for in electronic databases (EMBASE, Medline, PubMed, and CINAHL). Studies comparing a disease-specific nutritional support (oral supplements or tube feeding) to a control nutritional intervention enabling the satisfaction of energy requirements regardless of the use of high-calorie formula or placebo or no support for at least 4 weeks were considered eligible. Study outcomes were the percentage of change in PU area, complete healing and reduction in the PU area ≥40% at 8 weeks, and the percentage of change in area at 4 weeks.

Results

A total of 3 studies could be included in the metaanalysis. Compared with control interventions, formulas enriched with arginine, zinc and antioxidants resulted in significantly higher reduction in ulcer area (-15.7% [95%CI, -29.9, -1.5]; P=0.030; I2=58.6%) and a higher proportion of participants having a 40% or greater reduction in PU size (OR=1.72 [95%CI, 1.04, 2.84]; P=0.033; I2=0.0%) at 8 weeks. A nearly significant difference in complete healing at 8 weeks (OR=1.72 [95%CI, 0.86, 3.45]; P=0.127; I2=0.0%) and the percentage of change in the area at 4 weeks (-7.1% [95%CI, -17.4, 3.3]; P=0.180; I2=0.0%) was also observed.

Conclusions

This systematic review shows that the use of formulas enriched with arginine, zinc and antioxidants as oral supplements and tube feeds for at least 8 weeks are associated with improved PU healing compared with standard formulas.

     

Zinc intakes and plasma concentrations in men with osteoporosis: the Rancho Bernardo Study

BACKGROUND: Low zinc intakes and reduced blood zinc concentrations have been reported to be associated with osteoporosis in women. OBJECTIVE: The objective was to examine the independent association between dietary zinc and plasma zinc and the association of each with bone mineral density (BMD) and 4-y bone loss in community-dwelling older men. DESIGN: Of the original Rancho Bernardo Study subjects, 396 men (age: 45-92 y) completed BMD measurements at baseline in 1988-1992 and 4 y later. Osteoporosis was defined as a BMD > or = 2.5 SDs below the mean for young women (a T-score < or = -2.5). At baseline, dietary intake data were collected by using a standard food-frequency questionnaire, and plasma zinc concentrations were measured by using inductively coupled plasma spectroscopy. RESULTS: The mean dietary zinc intake was 11.2 mg, and the mean plasma zinc concentration was 12.7 micromol/L. Plasma zinc was correlated with total zinc intake (diet plus supplements). Dietary zinc intake and plasma zinc concentrations were lower in men with osteoporosis at the hip and spine than in men without osteoporosis at those locations. BMDs for the hip, spine, and distal wrist were significantly lower in men in the lowest plasma zinc quartile (<11.3 micromol/L) than in men with higher plasma zinc concentrations. The association between plasma zinc and BMD was cross-sectional, longitudinal, and independent of age or body mass index. However, plasma zinc did not predict bone loss during the 4-y interval. CONCLUSION: Dietary zinc intake and plasma zinc each have a positive association with BMD in men.     

Validation of a food frequency questionnaire for use in a Scottish population: correlation of antioxidant vitamin intakes with biochemical measures

Background: The food frequency questionnaire (FFQ) has become established as the primary method for assessing dietary intake in epidemiological studies of diet and disease; attention must now be given to developing and evaluating FFQs that extend the range of populations studied. Aim: To assess the validity of antioxidant vitamin intake estimates derived from a self-administered food frequency questionnaire which was developed for use in Scottish populations. Method: Intake estimates of vitamins A, C, E and β-carotene were compared with corresponding biochemical measurements in 273 Scottish men and women aged 39–45 years. Results: The mean ratios of energy intake to calculated basal metabolic rate were 1.40 for men and 1.46 for women suggesting that the intake values derived from the FFQ were not biased towards under-reporting. Significant positive correlation coefficients ranging from 0.14 (for vitamin A) to 0.42 (for vitamin C) were observed between total intake (including diet and supplements) and plasma values. Adjustment for other known determinants of diet and plasma values (i.e. energy intake, body mass index, gender, smoking and plasma lipid levels) improved the correlations for vitamin E and β-carotene. Excluding supplement users generally reduced the correlations suggesting that failure to include supplemental sources may result in misclassification of antioxidant vitamin intake. The food frequency questionnaire assigned 68–89% of subjects correctly into the upper or lower plus adjacent tertiles of plasma vitamin concentration. Conclusions: These results demonstrate that the food frequency questionnaire is a valid measure of antioxidant vitamin intake.     

Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA.

STUDY OBJECTIVE: To examine the relationship between dietary vitamin C and hip bone mineral density (BMD) in postmenopausal women. DESIGN: This was a cross sectional study using retrospective diet and vitamin supplement data. SETTING: The Seattle area of Washington State. PARTICIPANTS: Screenees for a clinical trial of a drug to prevent osteoporotic fractures; 1892 women aged 55-80 years who had hip bone densitometry and osteoporosis risk factor information. MAIN RESULTS: Mean energy adjusted dietary intake of vitamin C was 113 mg/day; including supplement use, mean intake was 407 mg/day. There were no differences in BMD according to diet-only vitamin C intake or combined dietary and supplemental vitamin C intake. Longer duration of vitamin C supplement use was associated with higher BMD in women who had not used oestrogen replacement therapy (trend p = 0.02) and among women aged 55-64 years (trend p = 0.01). Women aged 55-64 years who used vitamin C supplements for > or = 10 years had a higher BMD than non-users aged 55-64 years (multivariate adjusted mean BMD 0.699 (0.017) g/cm2 versus 0.655 (0.007) g/cm2, p = 0.02). Benefits were not evident in older age groups or in women who had used oestrogen in the past. Frequent intake of foods rich in vitamin C was not associated with BMD. CONCLUSION: There was no evidence that vitamin C from the diet was associated with BMD, although long term use of vitamin C supplements was associated with a higher BMD in the early postmenopausal years and among never users of oestrogen.     

Nutritional status of U.S. elite female heptathletes during training

This study describes the body composition, dietary nutrient intake, dietary practices, and biochemical indices of iron status of elite female American heptathletes during training. Four-day diet records and dietary practice questionnaires were obtained from 19 female heptathletes (26 +/- 3 years) during the training season. Anthropometric measurements and fasting blood samples were obtained at the lowest phase of the training cycle. These athletes had a low body fat (13.8 +/- 2.7%) and high fat-free mass to height ratios (33.0 +/- 2.0 kg/m). Average nutrient intakes were > 67% of the reference intakes for all nutrients except vitamin E. Most dietary nutrient densities were higher than NHANES III nutrient densities for women 20-29 years old. More than 50% of the athletes took vitamin supplements and monitored their hydration status. Fifteen of the 17 athletes reported a normal menstrual cycle. Markers of biochemical iron status were all within the normal range. On average, these athletes were lean with high levels of fat free mass, adequate nutrient intakes, and normal biochemical indices of iron status. However, individual data reveals considerable variability within this group.     

Zinc supplementation during pregnancy: zinc concentration of serum and hair from low-income women of Mexican descent

The effect of zinc supplementation on concentrations of zinc in hair and serum of 213 pregnant Hispanic women attending a clinic in Los Angeles was assessed using a random, double-blind experiment. Both the treatment (T) and control (C) groups received similar vitamin and mineral supplements except that 20 mg zinc was added to the supplements for the treatment group. Nutrient intakes were calculated from 24-h recalls. The initial mean dietary zinc intake of both groups was about 50% of the Recommended Dietary Allowance (9 +/- 5 mg). Initially there were no significant differences between the two groups in mean zinc levels in serum (66 +/- 11 micrograms/dl, C, and 65 +/- 12 micrograms/dl, T) or in hair (184 +/- 41 micrograms/g, C, and 175 +/- 38 micrograms/g, T). Zinc supplementation did not alter mean zinc levels in serum or hair but significantly (p less than 0.05) reduced the number of low serum zinc values (less than or equal to 53.3 micrograms/dl) toward the end of pregnancy. Although serum zinc levels do decline in pregnancy, our results suggest that severely depressed levels (less than or equal to 50 to 55 micrograms/dl) indicate inadequate zinc status.     

Plasma changes in micronutrients following a multivitamin and mineral supplement in healthy adults

OBJECTIVE: To estimate the micronutrient (riboflavin, folate, vitamin C, vitamin B(12), iron, zinc and copper) bioavailability in healthy adults from a multi-micronutrient dietary supplement to assess the possible influence on it by the tablet disintegration properties and by the relative intestinal permeability of subject. METHODS: The bioavailability of seven micronutrients from a single brand of multi-micronutrient dietary supplement was measured on two separate occasions in the presence of a standardized test meal in 15 healthy adult subjects. Each subject visited the Metabolic Research Unit on four separate randomized occasions for an absorption test. One test measured the intestinal permeability. The other three tests measured the postprandial changes in plasma or serum concentrations after consuming a test meal alone (control:placebo effect), or the test meal with either whole or crushed and powdered dietary supplements. 15 healthy Caucasian adult volunteers, aged 42 +/- 14 years. RESULTS: The 12 hour-post-dose AUC for riboflavin, folate and vitamin C (whole and crushed tablet), and that for vitamin B(12) (only for the crushed tablet treatment) and iron (only for the whole tablet treatment) were all significantly (p < 0.001) higher than after a test meal alone. In contrast there was no significant increase in the AUC after supplement intake for zinc and copper. Neither the form of the supplement for all micronutrients tested nor intestinal permeability of the subject for riboflavin, folate, vitamin C, iron, zinc and copper influenced the postdose nutrient AUC. In contrast, for vitamin B(12) the intestinal permeability of the subject influenced significantly the nutrient AUC (p = 0.003). CONCLUSION: Tablet disintegration characteristics of this dietary supplement did not limit absorption of these seven micronutrients. The intestinal permeability of subject was only positively correlated with the B(12) bioavailability. Results are suggestive of using multi-micronutrients dietary supplements as a vehicle to decrease the prevalence of multiple micronutrient deficiencies overall for vitamins in healthy adults.     

Interaction among heme iron, zinc, and supplemental vitamin C intake on the risk of lung cancer: Iowa Women's Health Study

Redox-active iron present at physiological levels in the pulmonary epithelial lining fluid may lead to damage of lung tissue under some circumstances. For example, factors that increase potential for oxidative stress, such as higher intake of heme iron or higher intake of vitamin C in the presence of high intake of iron, might increase the risk of lung cancer, whereas higher intake of the antioxidant zinc might decrease that risk. During 16 yr of follow-up, 34,708 postmenopausal women, aged 55-69 yr at baseline who completed a food-frequency questionnaire for the Iowa Women's Health Study, were followed for 700 incident lung cancers. When subjects were stratified by intake of vitamin C supplements, among women who took vitamin C supplements of >500 mg/day, after adjusting for age, total energy intake, cigarette smoking, alcohol consumption, and dietary zinc or dietary heme iron intake, relative risks across categories of dietary heme iron intake were 1.0, 0.85, 0.93, 1.32, 1.70, and 3.77 (P for trend = 0.05; P for interaction = 0.08), whereas corresponding figures for dietary zinc intake were 1.0, 1.15, 0.71, 0.84, 0.61, and 0.11 (P for trend = 0.12; P for interaction = 0.04). The strength of the associations of heme iron and zinc intake with lung cancer appeared to be stronger with increasing levels of vitamin C supplement intake. Our results suggest that high dietary heme iron intake may increase the risk of lung cancer, whereas high dietary zinc may decrease the risk of lung cancer among postmenopausal women who consume high-dose vitamin C supplements. This finding may be of particular importance to smokers, for whom vitamin C supplementation is a common recommendation.     

Calcium and vitamin D3 supplements in calcium and vitamin D3 sufficient early postmenopausal healthy women

OBJECTIVE: To study the calcium homeostasis in healthy, calcium and vitamin D replete early postmenopausal women during oral supplementation with calcium and vitamin D3. DESIGN: A prospective, placebo-controlled, randomised, double-single-blind, 3-week study. SETTING: Outpatient clinic at Copenhagen University Hospital, Denmark. SUBJECTS: In all, 17 started, one was excluded. Totally, 16 healthy women, 45-61 y of age (mean 57.3 y) who were at least 4 y after menopause (mean 6.7 y) completed. INTERVENTIONS: All underwent three consecutive 7-day study periods. Each began with 4 days of normal diet followed by 3 days treatment of either C: one tablet of 1.250 mg calcium carbonate (ie 500 mg Ca2+ per tablet) twice daily (breakfast and dinner), or CD3: as in C but plus 400 IU vitamin D3 b.i.d., or P (only) placebo tablets b.i.d. RESULTS: At baseline plasma 25-hydroxycholecalciferol was normal (66+/-22 nmol/l) and the calcium intake without supplements 850 mg/day. In group C, the 24-h urinary calcium increased by 35% (6.9+/-2.0 mmol), vs the placebo group P (5.1+/-1.6 mmol) (P < 0.05). Addition of 800 IU vitamin D3 daily (CD3) did not increase calcium excretion further (6.6+/-2.1 mmol) but decreased plasma 1,25-(OH)2-vitamin D3 by 21% (P < 0.05). CONCLUSIONS: In this carefully controlled study calcium plus vitamin D3 supplements only had minor influences of uncertain significance on the calcium balance in healthy, calcium and vitamin D sufficient early postmenopausal women.     

Plasma urea-cycle-related amino acids,ammonium levels,and urinary orotic acid excretion in short-bowel patients managed with an oral diet

BACKGROUND AND AIMS: The small intestine contains several enzymes involved in arginine synthesis and converts glutamine to citrulline, the major compound for endogenous arginine synthesis. This study was conducted to assess the plasma status of urea-cycle intermediates and orotic urinary excretion in short-bowel patients. METHODS:Thirteen stable short-bowel syndrome patients (7 men; 60.2+/-15.2 years) were studied. Patients were divided into moderately resected (Group A; n=6) and severely resected (Group B; n=7) according to their remnant bowel length (Group A: 61-150 cm; Group B: < or =60 cm). All subjects were consuming an oral diet plus dietetic supplements. Plasma urea-cycle amino acids, ammonium and urinary orotic acid were determined. RESULTS: Plasma glutamine levels were significantly higher in both patient groups than in the control group (P<0.001). Regarding citrulline, Group B levels were significantly lower vs. controls (P<0.001). Comparisons between patient groups showed higher arginine in Group A (P<0.05) and non-statistically lower citrulline in Group B. Blood ammonium and orotic urinary excretion were normal. CONCLUSIONS: Although plasma citrulline and glutamine alterations were found, patients showed no hyperammonemia or orotic aciduria, which suggests a certain degree of adaptation in arginine and related amino acid metabolism, when an adequate dietary supply of arginine is provided.     

Effect of chronic administration of excess dietary vitamin A and zinc on lipid metabolism in rats

The effects of chronic feeding of excess dietary vitamin A and zinc on serum cholesterol, liver cholesterol and total liver lipids were studied in rats. Sixty-four Sprague-Dawley female rats were randomly allocated to 4 groups: basal diet: 4848 micrograms of vitamin A and 61 mg of Zn/kg of diet; high Zn (33-fold excess of the requirement) + basal vitamin A; basal Zn + high vitamin A (154-fold excess of the requirement) and high Zn + high vitamin A. After 120 days serum cholesterol, liver cholesterol, total liver lipids, and vitamin A and zinc in the liver and kidney were measured. The mean serum cholesterol (+/- SE) for the 4 groups were: 121 (+/- 12.6), 159 (+/- 6), 133 (+/- 7.6) and 186 (+/- 7.6) mg/dl, respectively. Liver cholesterol and total lipids for the 4 groups were determined as 1.8 (+/- 0.05), 2.2 (+/- 0.09), 4.9 (+/- 0.12) and 4.6 (+/- 0.24) mg/g of tissue and 26.3 (+/- 0.7), 26.0 (+/- 1.1), 38.9 (+/- 0.9) and 40.3 (+/- 1.4) mg/g of tissue, respectively. Liver and kidney vitamin A levels were significantly higher in group C than in group D, suggesting increased vitamin A metabolism in the high dietary zinc + high vitamin A groups. In high dietary zinc groups, a significant elevation of serum cholesterol was observed regardless of the vitamin A levels. Total liver lipids and liver cholesterol were significantly higher in rats fed high vitamin A irrespectively of the zinc levels in the diet.     

A two-year dietary survey of middle-aged women: repeated dietary records as a measure of usual intake

A two-year survey of the dietary consumption and supplement use patterns of adult women was conducted at the University of Wisconsin-Madison. Participants were asked to record their diet on two randomly selected days per month over a two-year period. Each subject filled out an average of 19 records a year, for an overall 71% return rate. Because of the sampling design, it was possible to estimate each woman's "usual" or average daily dietary and total intake (diet plus supplements) of 15 nutrients. Many women were consuming usual amounts of energy, calcium, iron, magnesium, vitamin B-6, and, especially, zinc and total folate that were 30% to 50% below recommended levels. It was also found that the women generally took vitamin/mineral supplements for nutrients already adequately supplied in the diet. Low nutrient intakes may have been due, in part, to underreporting of food intakes.     

Food choices of vegetarians and nonvegetarians during pregnancy and lactation

Data on food choices and nutrient intake were obtained from 60 lactating women, including 29 vegetarians. The most common changes in consumption patterns during pregnancy were increased intake of high-protein foods, especially milk products, and decreased intake of coffee, tea, and alcohol. The changes were partially based on food cravings and/or aversions. In addition to high-protein foods, some of the women craved fruits and sweets. Items most commonly eliciting aversive reactions were vegetables, strong-smelling and strong-tasting combination dishes, and greasy foods. Aversions to coffee, tea, and alcohol were almost as frequent as those to greasy foods. Nutrient intake during lactation was measured using 24-hour recalls and 2-day diet records that also considered dietary supplements. A total of 332 intake records were evaluated relative to the RDAs for lactating women. Mean energy intake was 2,200 kcal (88% of the recommendation), and mean protein intake was 86 gm (134% of the RDA). Mean nutrient intakes from diet alone ranged from 89% of the RDA for iron to 154% for vitamin A; mean intakes from diet plus supplements ranged from 133% of the RDA for calcium to 581% of the RDA for thiamin. Dietary supplementation provided a substantial part of the intake of some nutrients; for most women, however, the RDAs were met by diet alone.     

Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women

BACKGROUND: Limited evidence suggests that a higher ratio of protein to carbohydrate during weight loss has metabolic advantages. OBJECTIVE: The objective was to evaluate the effects of a diet with a high ratio of protein to carbohydrate during weight loss on body composition, cardiovascular disease risk, nutritional status, and markers of bone turnover and renal function in overweight women. DESIGN: The subjects were randomly assigned to 1 of 2 isocaloric 5600-kJ dietary interventions for 12 wk according to a parallel design: a high-protein (HP) or a high-carbohydrate (HC) diet. RESULTS: One hundred women with a mean (+/-SD) body mass index (in kg/m(2)) of 32 +/- 6 and age of 49 +/- 9 y completed the study. Weight loss was 7.3 +/- 0.3 kg with both diets. Subjects with high serum triacylglycerol (>1.5 mmol/L) lost more fat mass with the HP than with the HC diet (x +/- SEM: 6.4 +/- 0.7 and 3.4 +/- 0.7 kg, respectively; P = 0.035) and had a greater decrease in triacylglycerol concentrations with the HP (-0.59 +/- 0.19 mmol/L) than with the HC (-0.03 +/- 0.04 mmol/L) diet (P = 0.023 for diet x triacylglycerol interaction). Triacylglycerol concentrations decreased more with the HP (0.30 +/- 0.10 mmol/L) than with the HC (0.10 +/- 0.06 mmol/L) diet (P = 0.007). Fasting LDL-cholesterol, HDL-cholesterol, glucose, insulin, free fatty acid, and C-reactive protein concentrations decreased with weight loss. Serum vitamin B-12 increased 9% with the HP diet and decreased 13% with the HC diet (P < 0.0001 between diets). Folate and vitamin B-6 increased with both diets; homocysteine did not change significantly. Bone turnover markers increased 8-12% and calcium excretion decreased by 0.8 mmol/d (P < 0.01). Creatinine clearance decreased from 82 +/- 3.3 to 75 +/- 3.0 mL/min (P = 0.002). CONCLUSION: An energy-restricted, high-protein, low-fat diet provides nutritional and metabolic benefits that are equal to and sometimes greater than those observed with a high-carbohydrate diet.     

Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients

ObjectiveWe investigated the potential of a high-protein, arginine- and micronutrient-enriched oral nutritional supplement (ONS) to improve healing of pressure ulcers in non-malnourished patients who would usually not be considered for extra nutritional support.MethodsForty-three non-malnourished subjects with stage III or IV pressure ulcers were included in a multicountry, randomized, controlled, double-blind, parallel group trial. They were offered 200 mL of the specific ONS or a non-caloric control product three times per day, in addition to their regular diet and standard wound care, for a maximum of 8 wk. Results were compared with repeated-measures mixed models (RMMM), analysis of variance, or Fisher's exact tests for categorical parameters.ResultsSupplementation with the specific ONS accelerated pressure ulcer healing, indicated by a significantly different decrease in ulcer size compared with the control, over the period of 8 wk (P ≤ 0.016, RMMM). The decrease in severity score (Pressure Ulcer Scale for Healing) in the supplemented group differed significantly (P ≤ 0.033, RMMM) from the control. Moreover, significantly fewer dressings were required per week in the ONS group compared with the control (P ≤ 0.045, RMMM) and less time was spent per week on changing the dressings (P ≤ 0.022, RMMM). At the end of the study, blood vitamin C levels had significantly increased in the ONS group compared with the control (P = 0.015, analysis of variance).ConclusionSpecific nutritional supplementation accelerated healing of pressure ulcers and decreased wound care intensity in non-malnourished patients, which is likely to decrease overall costs of pressure ulcer treatment.     

Selenium and zinc status are suboptimal in a sample of older New Zealand women in a community-based study

The importance of selenium and zinc in the immune functioning of the aged is widely recognized. Seniors in New Zealand are at particularly high risk of low selenium status because of the low selenium soil environment. The zinc status of the New Zealand elderly has never been assessed. In this cross-sectional study, the biochemical selenium, zinc and lipid levels, physical functional capacity and dietary intakes of 103 randomly selected free-living New Zealand women (mean age +/- SD, 75 +/- 3 y) were assessed. Among nonusers of selenium supplements (n = 80), 80% [95% confidence interval (CI): 70; 88%] had plasma selenium levels (0.85 +/- 0.23 micromol/L) below 1.00 micromol/L [ approximately 10% below mean plasma selenium necessary for full expression of glutathione peroxidase (GPx) activity in New Zealand subjects]. Plasma selenium was strongly correlated with GPx: r = 0.56; P < 0.0001. For nonusers of zinc supplements (n = 88), serum zinc concentrations were 12.4 +/- 1.4 micromol/L, with 12% (95% CI: 6; 21%) having levels below the cut-off value (10.7 micromol/L). Estimated mean daily selenium and zinc intakes were 34 +/- 10 microg and 8.7 +/- 2.0 mg, respectively. Subjects in the highest tertile of a functional capacity index had higher biochemical zinc and selenium values than those in the lowest tertile (P < 0.05). The correlation between plasma selenium and GPx indicates that selenium intake in these women is still insufficient for full expression of GPx activity. Lower serum zinc levels also appear to be prevalent. Because a suboptimal trace element status may be more common among those with a poor physical functioning, promotion of the consumption of nutrient dense foods or supplements to improve selenium and zinc status of elderly women in New Zealand may be beneficial.     

Dietary supplement use in the Prostate Cancer Prevention Trial: implications for prevention trials

Nutrients included in commonly used dietary supplements, such as vitamins C and E, may affect cancer risk. To better understand how supplement use may affect the interpretation of cancer prevention trials, we examined dietary supplement use among participants in the Prostate Cancer Prevention Trial, a double-blind, placebo-controlled trial of the drug finasteride (Proscar) for the primary prevention of prostate cancer. Of 15,387 men who completed food frequency questionnaires and dietary supplement questionnaires, 44.3% used a multivitamin, 35% used single supplements of vitamin C or E, and 10-15% used antioxidant mixtures or single supplements of vitamins A and D, zinc, or beta-carotene at least three times per week. The strongest correlates of supplement use were higher education and lower body mass index (p < 0.001), and whites and Asians were more likely to use multivitamins and single supplements of vitamins C and E than were blacks and Hispanics. Supplement users obtained 87% of their total daily vitamin E intake, 61-64% of vitamins A, C, and D, and about half of beta-carotene, folate, and zinc from supplements. Because supplements, especially antioxidants, may confer independent cancer-preventive effects, analytic models of study findings should include exposure measurement of dietary supplements with appropriate tests for interaction. Our results can be generalized to similar chemoprevention trials.