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Because of an increase in the number of elderly and the problems of nutrition associated with them, it is of interest to study the nutritional status of elderly persons in Alexandria City. The purpose of this study was to assess the nutritional status of elderly population and to compare between the nutritional status of those institutionalized and those living free. The study was conducted on 240 elderly persons (120 institutionalized and 120 free living) selected randomly from institutions and from different sites. The basic data, weight, height, body mass index (BMI) of each were recorded. Dietary intake study was done by using 24 hours recall for 3 consecutive days and food frequency were used to obtain the best estimate of food intake. Energy and nutrient intakes were obtained and compared with the recommended dietary allowance (RDAs). The main findings of the study revealed that the mean age of the institutionalized elderly was greater than those living free. Percent of obesity among females was 71.7% among free living and 45% among institutionalized. Under-nutrition was present in 11.7% and 8.3% of institutionalized males and females respectively. Food habits showed that institutionalized subjects consume more amounts of many food items than free-living. Total daily energy intake was found to be below the recommendation for all subjects, with higher intake among institutionalized than free living. Nutrient intakes among institutionalized and free living elderly were inadequate except thiamin, riboflavin, vitamin C and iron. The nutrients least adequately supplied in the diets of elderly are vitamin A and calcium along with energy deficits. In conclusion both institutionalized and free living are at risk for developing nutrient deficiencies. Deficient energy, calcium and vitamin A are common problems among most subjects. The composition of the diet among free living subjects seem to be also poor in some micronutrients. We recommended a nutrition intervention program and nutrition education to improve nutritional status of elderly people.
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PMID:Nutritional status of institutionalized and free-living elderly in Alexandria. 1721 83

Age-related macular degeneration (AMD) is one of the most important causes of blindness among the elderly. Although the disease presents a serious social problem, its pathogenesis is still unclear. AMD involves the posterior pole of the retina, the place responsible for acute vision. Retinal factors (intensive oxygen metabolism, continual exposure to light, a high concentration of polyunsaturated fatty acids, the presence of photosensitizers) increase the production of reactive oxygen species. Oxidative stress is aggravated by the presence of lipofuscin. The pigment accumulates with age, especially in the eyes of those with AMD. The most important risk factors for AMD, beside genetic predisposition, are factors leading to oxidative stress in the retina, e.g. age above 65 years, cigarettes smoking, obesity, exposition to blue light, and bright irises. Macular pigment is a natural barrier protecting the central retina against oxidative damage. It is formed by two dihydroxycarotenoids, lutein and zeaxanthin. The prereceptoral location of the macular pigment permits it to act as an optical filter that absorbs short-wavelength visible light. Carotenoids also demonstrate antioxidant activity. Eyes with a predisposition to develop AMD or which already have developed the disease have considerably less macular pigment and a greater risk of oxidative damage compared with healthy eyes. Investigations have shown that diet poor in antioxidant micronutrients (vitamin C, E, carotenoids, zinc) and low plasma levels of antioxidants may favor the development of the age-related macular degeneration. The findings demonstrated that micronutrient supplementation enhances antioxidant defense and might prevent or retard AMD or modify the course of the disease.
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PMID:[The potential role of oxidative stress in the pathogenesis of the age-related macular degeneration (AMD)]. 1724 15

It has been reported that apelin functions as an adipokine, which has been associated to obesity and insulin resistance. The objective of this study was to analyze the apelin mRNA expression in white adipose tissue (WAT) from high-fat (Cafeteria) fed rats, in order to examine potential relationships with obesity markers and other related risk factors. Animals fed on the high-fat diet during 56 days increased their body weight, total body fat and WAT depots weights when compared to controls. Apelin subcutaneous mRNA expression was higher in the Cafeteria than in the Control fed group and this increase was partially reversed by dietary vitamin C supplementation. Statistically significant associations between subcutaneous apelin gene expression and almost all the studied variables were identified, being of special interest the correlations found with serum leptin (r=0.517), liver malondialdehyde (MDA) levels (r=0.477), and leptin, IRS-3 and IL-1ra retroperitoneal mRNA expression (r=0.701; r=0.692 and r=0.561, respectively). These associations evidence a possible role for apelin in the excessive weight gain induced by high-fat feeding and increased adiposity, insulin-resistance, liver oxidative stress and inflammation.
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PMID:Adiposity dependent apelin gene expression: relationships with oxidative and inflammation markers. 1759 60

We have previously shown that urinary sugars excretion in 24 h urine collections can serve as an independent biomarker of sugars consumption. In the European Prospective Investigation of Cancer (EPIC) Norfolk study of nutrition and cancer, this biomarker in spot urines has been assessed in a cross-sectional comparison of 404 obese individuals aged 45 to 75 years with a body mass index (BMI) of >30 kg/m(2) and 471 normal weight individuals aged 45 to 75 years with a BMI of <25 kg/m(2). In individuals of normal weight, sucrose, protein, and vitamin C intake were positively and highly significantly related to biomarkers in spot urine or plasma (P < 0.001), but there were no significant associations between biomarkers and food intake reports in the obese. Odds ratios for a BMI of >30 were significantly elevated for urinary sucrose [trend per milligram per liter quintile, 1.13; 95% confidence interval (95% CI), 1.02-1.25; P = 0.016], and the odds ratio for urinary sucrose/fructose ratio was highly significant (trend per quintile, 1.264; 95% CI, 1.142-1.401; P < 0.001). No associations for sugars intake and obesity were found using a food frequency questionnaire, and dietary vitamin C was apparently associated with increased risk (P < 0.001) despite an inverse association for plasma vitamin C. Nutritional biomarkers of consumption can complement existing methods for assessing cancer risk from diet in epidemiologic studies.
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PMID:Epidemiologic assessment of sugars consumption using biomarkers: comparisons of obese and nonobese individuals in the European prospective investigation of cancer Norfolk. 1768 41

C-reactive protein (CRP) is one of the acute-phase proteins in inflammation and CRP serum concentrations are therefore of interest. Data for high-sensitivity CRP (hs-CRP) with a low detection limit of approximately 0.04 mg/L have become available over the past decade and research has shown a link between high concentrations of hs-CRP and obesity as well as smoking. Expanded adipose tissue is in fact known to secrete proinflammatory cytokines which enhance hepatic synthesis of CRP. Moderate alcohol consumption and high physical activity have been associated with low levels of hs-CRP, but the evidence in these cases is not conclusive. It has been suggested that hs-CRP is an independent marker of the risk of cardiovascular disease, but the predictive capacity remains controversial. However, many prospective studies have observed increased risk of type 2 diabetes mellitus associated with high concentrations of hs-CRP, independent of obesity and other cardiovascular risk factors. On the other hand, no measurable increase in the risk associated with high levels of hs-CRP was observed with multivariate adjustment in several studies. A number of authors have reported that high concentrations of hs-CRP are associated with increased risks of colorectal and other cancers, but the findings again are inconsistent. Diet and hs-CRP are also of increasing research interest. High intakes of carotenoids and vitamin C, but not of vitamin E, seem to decrease the level of circulating hs-CRP. In addition, high consumption of vegetables and fruit are associated with lower levels of circulating hs-CRP, perhaps by exerting anti-inflammatory effects. Both mechanistic and epidemiologic studies regarding dietary factors and low-grade inflammation are necessary to add to our knowledge of dietary influence on chronic disease development.
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PMID:Impact of C-reactive protein on disease risk and its relation to dietary factors. 1769 26

Ample intakes of fruit and vegetables have been linked epidemiologically with reduced risk for coronary disease, stroke, hypertension, obesity, many types of cancer, chronic pulmonary disease, osteoporosis, and various ocular disorders. The favorable impact of diets rich in fruit and vegetables on coronary risk has been confirmed in meta-analyses, and is thought to be largely attributable to the folk acid and potassium supplied by these foods. Although high intakes of vitamin C appear to confer some cardiovascular protection, the amounts supplied by typical diets may be too low to be of much benefit in this regard. High flavonoid intakes emerge as protective in some epidemiological studies, albeit the dose-response pattern observed is often L-shaped - seemingly more consistent with low intakes being harmful, than with high intakes being protective. Nonetheless, flavonoids have shown anti-atherogenic activity in rodent models, and both clinical and rodent supplementation studies with foods and food extracts rich in flavonoids demonstrate improvements in endothelium-dependent vasodilation traceable to increased endothelial nitric oxide synthesis. However, flavonoids do not appear to increase the expression of endothelial NO synthase, nor do they modify endothelial superoxide production. A likely explanation is that, even in nanomolar concentrations achievable in vivo, flavonoids can act as efficient scavengers of peroxynitrite-derived radicals, thereby protecting the cofactor tetrahydrobiopterin, crucial for NO synthase activity. Studies with cultured endothelial cells should be useful for evaluating this possibility. It would also be appropriate to assess the effects of flavonoids on prostacylin synthetase activity, on endothelial catabolism of asymmetric dimethylarginine, and on signaling mechanisms that activate NO synthase. Since peroxynitrite can induce mutagenic damage to DNA, it is conceivable that scavenging of peroxynitrite-derived radicals contributes to the reduction in mutagenesis associated with high intakes of fruits and vegetables. Carotenoids also have the potential to prevent peroxynitrite-mediated damage, although, as contrasted with flavonoids, there is comparatively little evidence that these compounds are anti-atherogenic or beneficial for endothelial function; a recent meta-analysis of epidemiological studies suggests that high lutein intakes may modestly reduce coronary risk.
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PMID:Scavenging of peroxynitrite-derived radicals by flavonoids may support endothelial NO synthase activity, contributing to the vascular protection associated with high fruit and vegetable intakes. 1782

This review describes the basic physiological requirements, expert opinions and medico-biological recommendations for the optimal nutritional regime of pregnant women. In the first trimester of pregnancy the nutritional intake should be supplemented by about +68 kcal/24 h (the normal intake is 2000 kcal/24 h for non-pregnant women in the respective age group). In the second trimester the supplementation should be by +266 kcal/24 h, while in the III trimester--by up to +496 kcal/24 h. The requirements of folic acid and vitamin B6 during pregnancy are increased by 50%. The need for vitamin A is augmented up to 60%, while for vitamin C, niacin, vitamin B2 and B12--up to 30%. However, the requirements of iron and iodine are increased at most--100%. The weight gain in pregnant women should normally be in the range of 10-12.5 kg. During the I and II trimester it should be not substantial, while in the III trimester it should be about 350-400 g/per week. The risks associated with obesity and uncontrolled weight gain during pregnancy are discussed. Consulting physicians are provided with expert opinions about the individualization of the nutritional intake according to the specific metabolic changes during pregnancy and with definitions of an adequate in energy supply and nutritional balance diet.
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PMID:[Modern medico-biological nutritional requirements for pregnant women]. 1797 68

Oxidative stress has been associated with mechanisms of EH (essential hypertension). The aim of the present study was to test the hypothesis that the antioxidant properties of vitamins C and E are associated with a decrease in BP (blood pressure) in patients with EH. A randomized double-blind placebo-controlled clinical trial was conducted in 110 men with grade 1 EH (35-60 years of age without obesity, dyslipidaemia and diabetes mellitus, non-smokers, not undergoing vigorous physical exercise, without the use of any medication and/or high consumption of fruit and vegetables). Participants were randomly assigned to receive either vitamins C+E [vitamin C (1 g/day) plus vitamin E (400 international units/day)] or placebo for 8 weeks. Measurements included 24 h ambulatory BP and blood analysis of oxidative-stress-related parameters in erythrocytes (GSH/GSSH ratio, antioxidant enzymes and malondialdehyde) and plasma [FRAP (ferric reducing ability of plasma)], and levels of 8-isoprostane, vitamins C and E were measured at baseline and after treatment. Following administration of vitamins C+E, patients with EH had significantly lower systolic BP, diastolic BP and mean arterial BP and higher erythrocyte and serum antioxidant capacity compared with either placebo-treated patients with EH or the patients with EH at baseline prior to treatment. BP correlated positively with plasma 8-isoprostane levels and negatively with plasma FRAP levels in the vitamins C+E- and placebo-treated groups. In conclusion, the present study supports the view that oxidative stress is involved in the pathogenesis of EH, and that enhancement of antioxidant status by supplementation with vitamins C and E in patients with EH is associated with lower BP. This suggests intervention with antioxidants as an adjunct therapy for hypertension.
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PMID:Decrease in oxidative stress through supplementation of vitamins C and E is associated with a reduction in blood pressure in patients with essential hypertension. 1799 38

Morbid obesity is a health problem that has been shown to be refractory to diet, exercise, and medical treatment. Surgeries designed to promote weight loss, termed bariatric surgery and typically involving a gastric bypass procedure, have recently been implemented to treat obesity with high success rates. However, long-term sequelae can result in micronutrient deficiencies. This review will focus on iron deficiency and its association with obesity and bariatric surgery. Iron deficiency develops after gastric bypass for several reasons including intolerance for red meat, diminished gastric acid secretion, and exclusion of the duodenum from the alimentary tract. Menstruating women, pregnant women, and adolescents may be particularly predisposed toward developing iron deficiency and microcytic anemias after bypass surgery. Preoperative assessment of patients should include a complete hematological work-up, including measurement of iron stores. Postoperatively, oral iron prophylaxis and vitamin C in addition to a multivitamin should be prescribed for bypass patients, especially for vulnerable populations. Once iron deficiency has developed, it may prove refractory to oral treatment, and require parenteral iron, blood transfusions, or surgical interventions. Bariatric surgery patients require lifelong follow-up of hematological and iron parameters since iron deficiency and anemia may develop years after surgery.
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PMID:Obesity, bariatric surgery, and iron deficiency: true, true, true and related. 1806 40

Hypoferremia is more prevalent in obese than nonobese adults, but the reason for this phenomenon is unknown. To elucidate the role dietary factors play in obesity-related hypoferremia, the intake of heme and nonheme iron and the intake of other dietary factors known to affect iron absorption were compared cross-sectionally from April 2002 to December 2003 in a convenience sample of 207 obese and 177 nonobese adults. Subjects completed 7-day food records, underwent phlebotomy for serum iron measurement, and had body composition assessed by dual-energy x-ray absorptiometry, during a 21-month period. Data were analyzed by analysis of covariance and multiple linear regression. Serum iron (mean+/-standard deviation) was significantly lower in obese than nonobese individuals (72.0+/-61.7 vs 85.3+/-58.1 microg/dL [12.888+/-11.0443 vs 15.2687+/-10.3999 micromol/L]; P<0.001). The obese cohort reported consuming more animal protein (63.6+/-34.5 vs 55.7+/-32.5 g/day; P<0.001) and more heme iron (3.6+/-2.8 vs 2.7+/-2.6 mg/day; P<0.001). Groups did not differ, however, in total daily iron consumption, including supplements. Obese subjects reported consuming less vitamin C (77.2+/-94.9 vs 91.8+/-89.5 mg/day; P=0.01), which may increase absorption of nonheme iron, and less calcium (766.2+/-665.0 vs 849.0+/-627.2 mg/day; P=0.038), which may decrease nonheme iron absorption, than nonobese subjects. Groups did not significantly differ in intake of other dietary factors that can impact absorption of iron, including phytic acid, oxalic acid, eggs, coffee, tea, zinc, vegetable protein, or copper. After accounting for demographic covariates and dietary factors expected to affect iron absorption, fat mass (P=0.007) remained a statistically significant negative predictor of serum iron. This cross-sectional, exploratory study suggests that obesity-related hypoferremia is not associated with differences in reported intake of heme and nonheme iron or intake of dietary factors that can affect iron absorption.
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PMID:Obesity-related hypoferremia is not explained by differences in reported intake of heme and nonheme iron or intake of dietary factors that can affect iron absorption. 1924 54


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