Erythrocyte concentrations of B1, B2, B6 but not plasma C and E are reliable indicators of nutrition status in the presence of systemic inflammation

Ghashut, Rawia A.; McMillan, Donald C.; Kinsella, John; Talwar, Dinesh

doi:10.1016/j.clnesp.2016.10.007

Cited by 14 publications

(19 citation statements)

References 27 publications

(26 reference statements)

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“…Erythrocyte transketolase activity (ETKA) is a functional marker of thiamine dependent enzyme activity which was commonly used to measure thiamine status until the late 1990s, however this method of routine measurement of thiamine status fell out of favor due to difficulty with standardization, inter-laboratory variation and the advent of high performance liquid chromatography (HPLC), which enabled direct measurement of TDP mass [39, 40]. Direct measurement of erythrocyte and/or whole blood thiamine concentrations is now more widely available [35] and has the advantage of remaining consistent in the context of the systemic inflammatory response [41, 42]. Nonetheless, it is of note that significant enhancement of basal erythrocyte transketolase activity (ETKA) has been demonstrated in response to co-administration of thiamine and magnesium, as compared to thiamine alone, in a cohort of alcohol dependent patients [16].…”

Section: Discussionmentioning

confidence: 99%

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

et al. 2019

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BackgroundAlcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS.MethodsPatients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded.ResultsThe majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275–675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05).ConclusionThe prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.

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Section: Discussionmentioning

confidence: 99%

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

et al. 2019

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“…Thirdly, intracellular measurements could be carried out. There are now erythrocyte measures of zinc, selenium, vitamins E, B 2 and B 6 that appear to abrogate the acute effect of the systemic inflammatory response seen in plasma micronutrients ( 8 , 16 , 36 , 42 ) . Fourthly, potential correction of plasma micronutrients using CRP or other acute phase proteins and carrier proteins.…”

Section: Discussionmentioning

confidence: 99%

“…Fourthly, potential correction of plasma micronutrients using CRP or other acute phase proteins and carrier proteins. This approach has been examined for zinc ( 23 ) , vitamin A ( 43 , 44 ) , vitamin D ( 12 , 28 ) , vitamin C ( 36 ) and carotenoids ( 39 ) . Recently, the case has been made for the use of IL-6, a pro-inflammatory cytokine, as a correction factor for iron, zinc and selenium ( 45 ) .…”

Section: Discussionmentioning

confidence: 99%

“…There were five independent studies that examined plasma vitamin C concentrations in chronic diseases (20,21,24,29,36) . Vitamin C concentrations were (21) 22 Vitamin A 2·43 (2·10-2·77) (n 11) 1·32 (0·93-2·04) (n 11) Significant decrease about 55 % significantly lower with increasing CRP concentrations from minor to moderate to major inflammation by approximately 75 %.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Relationship between nutritional status and the systemic inflammatory response: micronutrients

2018

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Micronutrients such as trace elements and vitamins are important as enzyme cofactors in the metabolism of all cells in the body and therefore key to determining nutritional status. The present systematic review examined the evidence of the impact of the systemic inflammatory response on plasma micronutrient status in acute (surgical) and chronic tissue injury. A literature review using targeted subject headings was carried out. Plasma C-reactive protein was used to classify minor (80 mg/l) inflammation. The literature search produced 2344 publications and plasma vitamin D, zinc and carotenoids were most commonly studied and plasma vitamins K, B2 and B6 were least studied. In acute injury thirteen studies (all prospective) and in chronic injury twenty-four studies (largely retrospective) were included in the review. There was consistent evidence that most common measured micronutrients in the plasma (zinc, selenium, vitamins A, D, E, K, B2, B6, B12, C, lutein, lycopene, α- and β-carotene) were significantly lowered from minor to moderate to major inflammation. The results of the present systematic review indicate that most plasma micronutrients fall as part of the systemic inflammatory response irrespective of acute or chronic injury. Therefore, in the presence of a systemic inflammation, plasma micronutrient concentrations should be interpreted with caution. There are a number of methods applied to adjust plasma micronutrient concentrations to avoid misdiagnosis of deficiency. Alternatively, intracellular measurements appear to obviate the need for such plasma adjustment to assess micronutrient status.

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“…Taken together, these laboratory data help characterize the presence of APR syndrome, a process mediated by proinflammatory cytokines that could underlie high catabolism and resting energy expenditure observed in inflammation . These patients would have increased body proinflammatory activity with increased consumption of antioxidants, including vitamin C …”

Section: Discussionmentioning

confidence: 90%

Vitamin C Status in Hospitalized Adults According to Subjective Global Assessment Method

Avelino

Maltos

Portari

et al. 2018

J Parenter Enteral Nutr

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Background The subjective global assessment (SGA) is a powerful tool for nutrition status assessment. Our aim was to compare vitamin C serum levels among patients classified as A, B, or C in the SGA. Methods One hundred‐and‐fifty adults in the wards of the University Hospital participated in this study. Besides SGA, all cases were submitted to anthropometry, bioelectrical impedance analysis (BIA), and 24‐hour dietary recall. Laboratory data included blood hemoglobin, serum ferritin, serum albumin, transferrin, C‐reactive protein (CRP), and vitamin C. Acute phase response was defined by serum CRP > 0.5 mg/dL; low serum vitamin C was defined by serum levels < 0.4 mg/dL. Analysis of variance and χ2 tests were used to compare groups; P < 0.05 was considered significant. Results Patients were diagnosed as SGA A (n = 76), B (n = 38), or C (n = 36) and showed different anthropometry and BIA. The same occurred, respectively, with vitamin C (median; range, in mg/day) intake (55.0; 4.7–140.6 vs 34.0; 10.3–244.2 vs 15.8; 2.3–124.0) and high (%) CRP (88.3 vs 65.8 vs 48.7) and low (%) vitamin C serum levels (21.1 vs 34.2 vs 63.9). Conclusion Patients with worst nutrition parameters (SGA C) showed lower ascorbic acid serum levels than those classified as SGA A or B. These results are in accordance with reduced vitamin C intake and the presence of acute phase response.

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Erythrocyte concentrations of B1, B2, B6 but not plasma C and E are reliable indicators of nutrition status in the presence of systemic inflammation

Cited by 14 publications

References 27 publications

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

Relationship between nutritional status and the systemic inflammatory response: micronutrients

Vitamin C Status in Hospitalized Adults According to Subjective Global Assessment Method

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