Multiple Micronutrient Plasma Level Changes Are Related to Oxidative Stress Intensity in Critically Ill Children*

Valla, Frédéric V.; Bost, M.; Roche, Sylvain; Pitance, Marion; Cuerq, Charlotte; Ridout, Jenna; Écochard, René; Ginhoux, Tiphanie; Bellon, Amandine; Ford-Chessel, Carole; Portefaix, Aurélie; Javouhey, Étienne; Blond, Emilie

doi:10.1097/pcc.0000000000001626

Cited by 19 publications

(12 citation statements)

References 33 publications

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“…This state, together with an abrupt reduction in the intake of carbohydrates, proteins, and vitamins, and the subsequent decrease of antioxidant mechanisms, could constitute some of the mechanisms underlying the increase in ROS. Moreover, multiple micronutrient deficiency or redistribution has been reported to occur in critically ill children displaying high levels of oxidative stress, in which there is a significant trend toward a decrease in plasma levels of micronutrients in parallel with an increase in the intensity of oxidative stress [25]. Our data of mitochondrial membrane potential, ROS, and oxygen consumption also confirm an undermined mitochondrial function in DRM subjects.…”

Section: Discussionsupporting

confidence: 77%

Role of Endoplasmic Reticulum and Oxidative Stress Parameters in the Pathophysiology of Disease-Related Malnutrition in Leukocytes of an Outpatient Population

et al. 2019

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Cellular pathways such as inflammation or oxidative stress are the cause and triggers of disease-related malnutrition (DRM), but the influence of these markers on endoplasmic reticulum (ER) stress is unknown. The objective of this study was to analyze the relationship between mitochondrial function and ER stress parameters in a DRM population. The study population was composed of 82 outpatient subjects, of whom 45 were diagnosed with DRM and 37 were confirmed to be normonourished according to the American Society for Parenteral and Enteral Nutrition ASPEN criteria. We evaluated anthropometrical and biochemical parameters, pro-inflammatory cytokines in serum. Oxidative and ER stress markers were analyzed in leukocytes. DRM patients showed significant reductions in albumin and transferrin concerning the normonourished group, and also displayed higher levels of hsCRP, IL6, and TNFα, and the soluble adhesion molecules VCAM-1 and ICAM-1. Besides, oxygen consumption and mitochondrial membrane potential were reduced and Radical Oxygen Species ROS production was enhanced in DRM patients. In the case of ER markers, protein and mRNA expression revealed that CHOP, ATF6, and the P-eIF2α signal were enhanced in malnourished patients compared to control subjects. Correlation studies supported a relationship between weight loss and increased inflammation, mitochondrial dysfunction, and compromised function of the ER. Our results demonstrate that ER stress signaling pathways are influenced by inflammation and mitochondrial function in the leukocytes of a DRM population.

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Section: Discussionsupporting

confidence: 77%

Role of Endoplasmic Reticulum and Oxidative Stress Parameters in the Pathophysiology of Disease-Related Malnutrition in Leukocytes of an Outpatient Population

et al. 2019

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“…Unfortunately, there is a paucity of evidence in critically ill children regarding the clinical consequences of insufficient micronutrient provision, low serum levels or true depletion of body stores. Moreover, the redistribution of micronutrients during critical illness and the interaction with oxidative stress preclude reliable identification of true deficiencies [11,26,27]. Only two studies investigated the impact of zinc and selenium supplementation in critically ill children, and unfortunately, the generated data was insufficient to provide recommendations on dose and timing of supplementation [26,28].…”

Section: Discussionmentioning

confidence: 99%

Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription

Eveleens

Witjes

Casaer

et al. 2021

Clinical Nutrition ESPEN

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Background and aims: Following the results of the paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial, the new ESPGHAN/ESPEN/ESPR/ CSPEN and ESPNIC guidelines recommend to consider withholding parenteral macronutrients for 1 week, while providing micronutrients, in critically ill children if enteral nutrition is insufficient. Critically ill children are suspected to be vulnerable to micronutrient deficiencies due to inadequate enteral nutrition, increased body's demands and excessive losses. Hitherto, micronutrient requirements in PICU are estimated based on recommended daily intakes for healthy children and expert opinion. We aimed to provide an overview of the current practice of micronutrient administration and practical considerations in the three participating centres of the PEPaNIC study, and compare these therapies with the recommendations in the new ESPGHAN/ESPEN/ESPR/CSPEN guidelines. Methods: We describe the current composition and preparation of the prescribed parenteral micronutrients (consisting of vitamins, trace elements and electrolytes) in the three centres (Leuven, Rotterdam and Edmonton) that participated in the PEPaNIC RCT, and compare this per micronutrient with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommendations. Results: The three centres use a different micronutrient supplementation protocol during the first week of critical illness in children, with substantial differences regarding the amounts administered. Leuven administers commercial vitamins, trace elements and electrolytes in separate infusions both in 4 h. Rotterdam provides commercial vitamins and trace elements simultaneously via 8-h infusion and electrolytes continuously over 24 h. Lastly, Edmonton administers commercial vitamins and institutionally prepared trace elements solutions in 1 h and electrolytes on demand. Comparison with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines yields in differences between the recommendations and the administered amounts, which are most substantial for vitamins. Conclusion:The practice of intravenous micronutrient administration differs substantially between the three PEPaNIC centres and in comparison with the current guideline recommendations. This deviation is at least partially explained by the inability to provide all recommended amounts with the currently available commercial products and by the lack of strong evidence supporting these recommendations.

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“… 106 , 107 In a study of micronutrient levels in critically ill children, lower beta-carotene levels were associated with higher organ dysfunction and oxidation. 108 …”

Section: Other Vitaminsmentioning

confidence: 99%

“…Several clinical observational studies in critically ill patients have associated lower levels of vitamin E with sepsis, septic shock, and ARDS in both adults and children. 105 – 108 Vitamin E levels have also been inversely correlated with C-reactive protein in critically ill patients. 2 However, vitamin E supplementation has not been shown to consistently elevate vitamin E levels in patients with acute lung injury.…”

Section: Other Vitaminsmentioning

confidence: 99%

Vitamin therapy in sepsis

et al. 2021

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Vitamins are essential micronutrients with key roles in many biological pathways relevant to sepsis. Some of these relevant biological mechanisms include antioxidant and anti-inflammatory effects, protein and hormone synthesis, energy generation, and regulation of gene transcription. Moreover, relative vitamin deficiencies in plasma are common during sepsis and vitamin therapy has been associated with improved outcomes in some adult and pediatric studies. High-dose intravenous vitamin C has been the vitamin therapy most extensively studied in adult patients with sepsis and septic shock. This includes three randomized control trials (RCTs) as monotherapy with a total of 219 patients showing significant reduction in organ dysfunction and lower mortality when compared to placebo, and five RCTs as a combination therapy with thiamine and hydrocortisone with a total of 1134 patients showing no difference in clinical outcomes. Likewise, the evidence for the role of other vitamins in sepsis remains mixed. In this narrative review, we present the preclinical, clinical, and safety evidence of the most studied vitamins in sepsis, including vitamin C, thiamine (i.e., vitamin B 1 ), and vitamin D. We also present the relevant evidence of the other vitamins that have been studied in sepsis and critical illness in both children and adults, including vitamins A, B 2 , B 6 , B 12 , and E. Impact Vitamins are key effectors in many biological processes relevant to sepsis. We present the preclinical, clinical, and safety evidence of the most studied vitamins in pediatric sepsis. Designing response-adaptive platform trials may help fill in knowledge gaps regarding vitamin use for critical illness and association with clinical outcomes.

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Multiple Micronutrient Plasma Level Changes Are Related to Oxidative Stress Intensity in Critically Ill Children*

Cited by 19 publications

References 33 publications

Role of Endoplasmic Reticulum and Oxidative Stress Parameters in the Pathophysiology of Disease-Related Malnutrition in Leukocytes of an Outpatient Population

Role of Endoplasmic Reticulum and Oxidative Stress Parameters in the Pathophysiology of Disease-Related Malnutrition in Leukocytes of an Outpatient Population

Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription

Vitamin therapy in sepsis

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