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Estimating Vitamin C Status in Critically Ill Patients with a Novel Point-of-Care Oxidation-Reduction Potential Measurement.
Rozemeijer, S, Spoelstra-de Man, AME, Coenen, S, Smit, B, Elbers, PWG, de Grooth, HJ, Girbes, ARJ, Oudemans-van Straaten, HM
Nutrients. 2019;11(5)
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This cohort study examines Vitamin C status as a functional measure in critically ill ICU patients with those of healthy volunteers. Vitamin C deficiency is common in critically ill patients and so establishing vitC status in everyday clinical practise may help quickly identify patients who might benefit from vitamin C supplementation. Common practise is to measure plasma concentrations using timely and expensive high-pressure liquid chromatography. A new point-of-care device enables clinicians to measure the static oxidation-reduction potential (sORP), reflecting oxidative stress, and antioxidant capacity (AOC) as functional indicators of vitC status. This cohort study measured sORP and AOC in 211 samples taken from 103 subjects in stored plasma samples taken from two 2015 studies; an observational vitamin C status study and a randomized pharmacokinetics study. Normal plasma vitC concentrations were defined as 23 to 100 µmol/L whilst deficiency is defined as <11 µmol/L. The results showed that VitC concentrations were negatively associated with sORP (R2 = 0.816) and positively associated with AOC (R2 = 0.842) indicating oxidative stress and vitamin C deficiency. This novel device may help facilitate speedy measurement of vitC status to identify critically ill patients who could benefit from vitC therapy.
Abstract
Vitamin C deficiency is common in critically ill patients. Vitamin C, the most important antioxidant, is likely consumed during oxidative stress and deficiency is associated with organ dysfunction and mortality. Assessment of vitamin C status may be important to identify patients who might benefit from vitamin C administration. Up to now, vitamin C concentrations are not available in daily clinical practice. Recently, a point-of-care device has been developed that measures the static oxidation-reduction potential (sORP), reflecting oxidative stress, and antioxidant capacity (AOC). The aim of this study was to determine whether plasma vitamin C concentrations were associated with plasma sORP and AOC. Plasma vitamin C concentration, sORP and AOC were measured in three groups: healthy volunteers, critically ill patients, and critically ill patients receiving 2- or 10-g vitamin C infusion. Its association was analyzed using regression models and by assessment of concordance. We measured 211 samples obtained from 103 subjects. Vitamin C concentrations were negatively associated with sORP (R2 = 0.816) and positively associated with AOC (R2 = 0.842). A high concordance of 94-100% was found between vitamin C concentration and sORP/AOC. Thus, plasma vitamin C concentrations are strongly associated with plasma sORP and AOC, as measured with a novel point-of-care device. Therefore, measuring sORP and AOC at the bedside has the potential to identify and monitor patients with oxidative stress and vitamin C deficiency.
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Melatonin Supplementation Lowers Oxidative Stress and Regulates Adipokines in Obese Patients on a Calorie-Restricted Diet.
Szewczyk-Golec, K, Rajewski, P, Gackowski, M, Mila-Kierzenkowska, C, Wesołowski, R, Sutkowy, P, Pawłowska, M, Woźniak, A
Oxidative medicine and cellular longevity. 2017;2017:8494107
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Obesity is one of the major global health problems. Melatonin is a hormone which regulates wakefulness, functions as an antioxidant and plays a role in the immune system. Previous research suggests that melatonin deficiency is associated with obesity. The aim of this study was to estimate the effect of melatonin on oxidative stress and levels of cell signalling proteins released by fat cells (adipokines) in obese patients on a calorie-restricted diet. Thirty obese patients were supplemented with a daily dose of 10 mg of melatonin or placebo for 30 days with a calorie-restricted diet. Blood levels of melatonin, adipokines and markers of oxidative stress were measured at baseline and after supplementation. Significant body weight reduction (7%) was observed only in the melatonin group. After melatonin supplementation, the adiponectin and omentin-1 levels and glutathione peroxidase activities statistically increased, whereas the malondialdehyde concentrations were reduced. In the placebo group, a significant rise in 4-hydroxynonenal and a drop in the melatonin concentrations were found. The results show evidence of increased oxidative stress accompanying calorie restriction. The authors concluded that melatonin supplementation facilitated body weight reduction, improved the antioxidant defence, and regulated adipokine secretion. The findings suggest that melatonin should be considered in the management of obesity.
Abstract
Obesity is one of the major global health problems. Melatonin deficiency has been demonstrated to correlate with obesity. The aim of the study was to estimate the effect of melatonin on oxidative stress and adipokine levels in obese patients on a calorie-restricted diet. Thirty obese patients were supplemented with a daily dose of 10 mg of melatonin (n = 15) or placebo (n = 15) for 30 days with a calorie-restricted diet. Serum levels of melatonin, 4-hydroxynonenal (HNE), adiponectin, omentin-1, leptin, and resistin, as well as erythrocytic malondialdehyde (MDA) concentration and Zn/Cu-superoxide dismutase, catalase, and glutathione peroxidase (GPx) activities, were measured at baseline and after supplementation. Significant body weight reduction was observed only in the melatonin group. After melatonin supplementation, the adiponectin and omentin-1 levels and GPx activities statistically increased, whereas the MDA concentrations were reduced. In the placebo group, a significant rise in the HNE and a drop in the melatonin concentrations were found. The results show evidence of increased oxidative stress accompanying calorie restriction. Melatonin supplementation facilitated body weight reduction, improved the antioxidant defense, and regulated adipokine secretion. The findings strongly suggest that melatonin should be considered in obesity management. This trial is registered with CTRI/2017/07/009093.
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The Effect of a 12-Week Health Training Program on Selected Anthropometric and Biochemical Variables in Middle-Aged Women.
Pilch, W, Tota, Ł, Sadowska-Krępa, E, Piotrowska, A, Kępińska, M, Pałka, T, Maszczyk, A
BioMed research international. 2017;2017:9569513
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Regular physical activity is an important factor for health. This study evaluated physiological and biochemical changes induced by a 12 week regular exercise programme in healthy middle-aged women. 15 healthy women aged 42-47 participated in this programme which consisted of three 45 minutes high and low impact aerobics classes for 12 weeks. Body composition and biochemical markers were determined at baseline and after 12 weeks. The investigators observed a significant increase in lean body mass, and a decrease in total weight and fat mass. Biochemical markers showed decreased inflammation, increased antioxidant status and an improvement in lipid profiles (these had been within normal range at baseline). The authors also determined vitamin D status of the participants. Vitamin D levels were within normal range at baseline and did not change during the duration of the study. Higher vitamin D levels were correlated with better antioxidant status. The authors conclude that regular aerobic exercise had beneficial effects on body composition, antioxidant status, inflammatory markers and lipid profiles. The main limitation of this study was a lack of control group.
Abstract
Regular moderate physical activity positively affects health, fitness, and body composition; it regulates the pro- and anti-inflammatory cytokines levels. Vitamin D plays an important regulatory role; its adequate levels correlate with low values of inflammation markers and an increase in muscle strength and fitness in exercising people. The study's aim was to evaluate changes in somatic variables, oxidative stress, and inflammation markers, as well as blood calcidiol concentration in middle-aged healthy women after 12 weeks of aerobics classes-endurance exercises, including choreographic sequences, aiming to improve fitness and motor coordination. The training led to a significant reduction of body mass and fat tissue; it induced an increase in lean body mass. After the 12-week training program, plasma antioxidant status increased (0.65 ± 0.21, p < 0.01) and the concentration of lipid peroxidation products decreased (0.07 ± 0.02, p < 0.001). A significant increase in plasma antioxidant status associated with training could have reduced the level of proinflammatory interleukin as indicated by a positive correlation between these variables (rs = 0.64, p < 0.05). The study proved that a 12-week health training program in physically inactive middle-aged women might provide improvements in their anthropometric parameters and selected biochemical indicators.
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Antioxidant intervention in rheumatoid arthritis: results of an open pilot study.
van Vugt, RM, Rijken, PJ, Rietveld, AG, van Vugt, AC, Dijkmans, BA
Clinical rheumatology. 2008;27(6):771-5
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While the aetiology of rheumatoid arthritis (RA) is largely unknown, oxidative stress triggered by immune activation is well described. Oxidative stress is thought to play a causal role in the inflammation of RA. Hence, this study attempts to add to the evidence of using antioxidants as therapeutic agents, alongside drug treatment. The study was a small, open study involving eight female participants with steady disease state and drug regimes. The intervention was a an antioxidant enriched margarine (mixture of a-tocopherol, lycopene, palm oil carotenoids (mainly α-carotene) and lutein) plus vitamin C supplement, consumed daily over ten weeks. After the intervention blood samples did not show a significant change in laboratory markers of inflammation. However, the number of painful joints decreased, as shown by a significant decrease in disease activity score (DAS). The author suggested alternative markers for measuring antioxidant status and oxidative damage. Whilst these results indicate promise for using a mixture of antioxidants to help relieve symptoms of RA, this was a small, open pilot study. Double blinded, placebo controlled human trials are required to establish effect and causality.
Abstract
There is evidence that reactive oxygen species play a causal role in auto-immune diseases, such as rheumatoid arthritis (RA). Despite the supporting evidence for a beneficial effect of antioxidants on clinical characteristics of RA, the right balance for optimal effectiveness of antioxidants is largely unknown. To determine the potential beneficial effects of an antioxidant intervention on clinical parameters for RA, an open pilot study was designed. Eight non-smoking female patients with rheumatoid factor + RA and a Disease Activity Score (DAS 28) higher than 2.5 were enrolled in the study. Patients had to be receiving stable non-steroidal anti-inflammatory drug treatment and/or 'second line' medication for at least 3 months. The pilot group consumed 20 g of antioxidant-enriched spread daily during a period of 10 weeks. The intervention was stopped after 10 weeks and was followed by a 'wash-out' period of 4 weeks. At t = 0, t = 10 weeks and t = 14 weeks, patients' condition was assessed by means of DAS. In addition, standard laboratory analyses were performed, and blood-samples for antioxidants were taken. The antioxidant-enriched spread was well tolerated. All laboratory measures of inflammatory activity and oxidative modification were generally unchanged. However, the number of swollen and painful joints were significantly decreased and general health significantly increased, as reflected by a significantly improved (1.6) DAS at t = 10 weeks. The antioxidant effect was considered beneficial as, compared to the scores at t = 0, the DAS significantly reduced at t = 10 weeks. Increase of the DAS (0.7) after the "wash-out period" at t = 14 confirmed a causal relation between changes in clinical condition and antioxidants. This open pilot study aimed to assess the clinical relevance of an antioxidant intervention as a first step in assessing potential beneficial effects of antioxidants on rheumatoid arthritis. These conclusions need to be validated in a larger controlled study population.
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Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants.
Zino, S, Skeaff, M, Williams, S, Mann, J
BMJ (Clinical research ed.). 1997;314(7097):1787-91
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Previous studies have suggested that people with high intake of fruit and vegetables or plasma antioxidant levels have a reduced risk of cancer and cardiovascular disease. There is limited data concerning the extent to which increased intake of fruit and vegetables, opposed to antioxidant supplementation, correlate with antioxidant plasma concentration levels. he aim of this trial was to examine whether advice to increase fruit and vegetable consumption affect the plasma concentrations of antioxidants, total and low-density lipoprotein (LDL). Eighty-seven subjects with normal lipid profiles who ate three of fewer servings of fruit and vegetables a day were included and the intervention group was asked to consume eight servings of fruit and vegetables a day for eight weeks. he findings of this study showed that plasma concentrations of vitamin C, alpha-carotene and beta-carotene, factors associated with reduced cancer risk, increased in parallel with increased fruit and vegetable intake in the intervention group. More specific dietary advice may be required to modify the levels of lipoprotein and vitamin E.
Abstract
OBJECTIVES To determine the extent to which plasma antioxidant concentrations in people with habitual low intake of fruit and vegetables respond to increased intakes of these foods. To examine whether advice to increase fruit and vegetables will result in reduction of concentrations of total and low density lipoprotein cholesterol. DESIGN Randomised controlled trial in which intervention and control groups were followed up for eight weeks. The intervention group was asked to consume eight servings of fruit and vegetables a day. SETTING Dunedin, New Zealand. SUBJECTS Eighty seven subjects with normal lipid concentrations who ate three or fewer servings of fruit and vegetables daily. MAIN OUTCOME MEASURES Plasma concentrations of vitamin C, retinol, alpha and beta carotene, alpha tocopherol, lipids, and lipoproteins. Dietary intake assessed with diet records over four days. RESULTS The mean plasma vitamin C, alpha carotene, and beta carotene concentrations increased in parallel with increased dietary intake of fruit and vegetables in the intervention group. Concentrations of retinol, alpha tocopherol, lipids, and lipoproteins remained unchanged despite some increase in dietary vitamin E and a small reduction in saturated fat intake. CONCLUSIONS Following a recommendation to increase fruit and vegetable consumption produces change in plasma concentrations of vitamin C, alpha carotene, and beta carotene likely to reduce incidence of cancer. More specific dietary advice to modify fat intake may be necessary to reduce the risk of cardiovascular disease mediated by lipoprotein and vitamin E.