New guidelines recommend increasing vitamin D intake

Inadequate exposure to sunlight predisposes to vitamin D deficiency. This may lead may result in impaired bone mineralization which may lead to a disease known as rickets in children and osteomalacia in adults. It may even contribute to osteoporosis.

Vitamin D deficiency may also result from inadequate intake, reduced absorption, impaired or abnormal metabolism or resistance to the effects of vitamin D.

Deficiency of vitamin D is preventable with adequate nutritional intake with nutritional and dietary supplements or by exposure to sunlight. Unfortunately, both dietary intake of vitamin D (other than with supplements) and exposure to sunlight continue decline. Research shows that this especially noticeable with exclusively breastfed infants and infants with darker skin pigmentation in the United States and other Western countries.

Based on recent research The American Academy of Pediatrics (141 Northwest Point Blvd, Elk Grove Village, IL 60007, phone 847 434 4000, http://aap.org) is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," recommends all children receive 400 IU a day of vitamin D, beginning in the first few days of life. The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.

The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.

Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.

"We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits," said Frank Greer, MD, FAAP, chair of The American Academy of Pediatrics (AAP) Committee on Nutrition and co-author of the report. “Supplementation is important because most children will not get enough vitamin D through diet alone.”

"Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother’s milk, it is important that breastfed infants receive supplements of vitamin D,” said Carol Wagner, MD, FAAP, member of the AAP Section on Breastfeeding Executive Committee and co-author of the report. “Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.”

The new recommendations include:

• Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life
• All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day
• Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount
• Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D
• Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.

For a copy of the report, visit the website of the AAP at http://www.aap.org/new/VitaminDreport.pdf

For more information about Vitamin D, click here.

Large clinical trial fails to show beneficial effects of statins in patients with Chronic Heart Failure.

Statin should not be considered for patients with heart failure (HF) of non-ischemic etiology, because lipid (cholesterol) lowering drugs do not translate into any clinically meaningful benefit for patients with heart failure (HF).

This is one of the unexpected outcomes from a large scale Italian study (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Heart Failure or GISSI-HF study) involving 6,975 patients with New York Heart Association (NYHA) class II-IV HF of any cause and with any left ventricular ejection fraction who were randomized to receive daily supplementation of omega-3 fatty acids 1 g (805-882 mg eicosapentaenoic acid and docosahexaenoic acid in the average ratio 1:1.2) or placebo. In addition, 4,574 patients of the same group were also randomized to receive Crestor, (rosuvastatin calcium, 10 mg daily, Astra Zeneca) or placebo.

Trial design
The GISSI-HF trial was designed to investigate the effects of omega-3 fatty acids and statin therapy on mortality and morbidity in patients with chronic heart failure (HF).

Trial results
The results of this trial were presented by dr Luigi Tavazzi of the Fondazione Policlinico San Matteo, Pavia in Italy during the European Society of Cardiology (ESC) Congress 2008 in Munich, Germany and simultaneously published in The Lancet (1, 2)

Based on the results of the GISSI-HF study, the investigators concluded that the prescription of Crestor, which is indicated to reduce elevated total cholesterol, LDL-C, ApoB, non-HDL-C and triglyceride levels and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia, or any statin to patients with heart failure (HF) of non-ischemic etiology should not be considered. The primary reason for their conclusion is that the use of the lipid (cholesterol-) lowering drugs does not translate into any clinically meaningful benefit for patients with heart failure (HF). The data showed that 29% of people taking Crestor died from any cause against 28% of those given a placebo.

In other words, patients given Crestor proved just as likely to die early or be admitted to hospital with cardiovascular problems as those on standard therapy alone. Therefore, the investigators concluded that physicians can confidently stop statins in patients already taking them if convinced of the drug's futility or if they are concerned over multiple drug use. On the other hand doctors may be reassured that they can safely use statins in this population.

This is the second clinical trial for heart failure in which Crestor failed, suggesting that statins don't improve survival in patients with the chronic heart condition.

CORONA-study
The conclusions this study confirm the results of another medical study, the CORONA- trial (Controlled Rosuvastatin Multinational Trial in HF), published in 2007 in the New England Journal of Medicine, which researched the effect of Crestor in older patients (averaging 73 years of age) with moderate to severe systolic heart failure of ischemic origin who had already received extensive treatment with other drugs for cardiovascular disease (4).

Although Crestor reduced LDL-C (low density-lipoprotein) and C-reactive protein (CRP), it had no significant effect on cardiovascular outcomes as measured by the primary endpoint composite of cardiovascular death, nonfatal myocardial infarct or stroke. The investigators in this study failed to find any benefit from statin treatment in this patient population and concluded that ‘statins as a class may not be efficacious in patients with ischemic left ventricular systolic dysfunction who are already receiving evidence-based therapy for heart failure (HF)’.

The CORONA-trial, presented and published in November 2007, included only patients with coronary heart disease, whereas just 40% of patients in GISSI-HF had ischemic HF. After considering the results of both trials, the investigators conclude that the cholesterol-lowering effects of statins do not reduce ischemic events in patients with heart failure and that the apparent pleiotropic effects of statins does not influence HF development (5).

The outcome of the CORONA-trial showed that treatment with Crestor had no significant effect on cardiovascular outcomes. However, it did significantly reduce the number of hospitalizations from cardiovascular causes and from heart failure (HR).

Commenting on the results of both trials, dr Gregg Fonarow of the of the Ahmanson-UCLA (University of California) Cardiomyopathy Center in Los Angeles, USA said that ‘these two well-conducted clinical trials establish that, although statin therapy lowers concentrations of LDL-C, is well tolerated and seems reasonably safe, it does not produce meaningful improvements in survival in patients with chronic heart failure.’(3)

Sources

1. GISSI-HF investigators. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomized, double-blind, placebo-controlled trial. Lancet 2008; DOI: 10.1016/S0140-6736(08)61241-6. Available online at: http://www.thelancet.com.
2. GISSI-HF investigators. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomized, double-blind, placebo-controlled trial. Lancet 2008; DOI: 10.1016/S0140-6736(08)61241-6. Available online at: http://www.thelancet.com.
3. Fonarow GC. Statins and n-3 fatty acid supplementation in heart failure. Lancet 2008; DOI: 10.1016/S0140-6736(08)61239-8. Available online at: http://www.thelancet.com.
4. Kjekhus J, Apetrei E, Barrios V, et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007; DOI: 10.1056.nejmoa0706201. Available online at: http://www.nejm.org
5. Hjalmarson Å Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)-Results of an outcomes trial in patients with ischemic heart disease and heart failure. American Heart Association 2007 Scientific Sessions; November 5, 2007; Orlando, FL, Late-breaking clinical trials 2.

Increased Dietary Choline May Reduce Breast Cancer Risk

Finally some positive news about possible breast cancer reduction and the use of vitamins. A study conducted by a team of doctors including Dr Xinran Xu and Dr Marilie Gammon of the Department of Community and Preventive Medicine at the Mount Sinai School of Medicine, in New York, confirmed that greater intake of the B vitamin choline is associated with a reduction in the risk of breast cancer.

The study was funded by the National Institutes of Health (NIH) and published in the June 2008 edition of The FASEB Journal, the offical publication of the Federation of American Societies for Experimental Biology (Xu X, Gammon MD, Zeisel SH, Lee YL, et al , Choline metabolism and risk of breast cancer in a population-based study. FASEB J 2008 Jun;22(6):2045-52. Epub 2008 Jan 29).

"Choline metabolism may play an important role in breast cancer etiology..."

Choline is an essential nutrient required for methyl group metabolism, but its role in carcinogenesis and tumor progression is not well understood. The Scientists compared dietary intake data from 1,508 women with breast cancer with 1,556 women whoid not have the disease. They focused on choline and two other, related, nutrients, methionine and betaine, involved in methylation, which plays a role in cancer development [odds ratio (OR): 0.76; 95% confidence interval (CI): 0.58-1.00].

Women whose intake of choline was in the highest one-fifth of participants (>455mg/day) had a 24% lower risk of breast cancer than women whose intake was in the lowest fifth (<196mg/day). Despite choline’s importance for maintaining normal cellular function, only 10% of Americans are estimated to meet the Institute of Medicine’s adequate choline intake level of 425mg/day for women and 550 mg/day for men and breastfeeding women. This concerns the team as they believe that their 'findings suggest that choline metabolism may play an important role in breast cancer etiology'.

Food-, dietary supplements and vitamins: Know what you take!

It’s a question that needs to be asked. If you are serious about your health and are taking food supplements, vitamins weight loss products and nutraceuticals do you know what you take? Do you know how these product impact your health? Are all these products good for your health? These seems simple, and easy questions, but the answer is very important. In this blog I'll try to explain.

Knowing what you take to improve your health requires having access to trustworthy information. As distributors of food- and dietary supplements we tell our customers that they can trust the products we sell. We feel very comfortable in educating our clients about our products. We feel that it’s our responsibility to give them access to information so that they can research and indeed feel confident that what we tell them is in fact true.

"It's our responsibility to give ...information... and feel confident that what we tell them is in fact true!"

Unfortunately, not every vitamin and dietary supplements is good for your health. But how do you know? There are various resources available. Some of these resources are available online, for other resources and information a trip to your local library may be required. But whatever the case, we feel that every consumer needs to make sure that he/she knows about the product they are taking.

One resource I really like is from The International Bibliographic Information on Dietary Supplements. This information is generated by various agencies from the US government. But there are also many European and national resources worth reading.

Naturally, as a senior consultant of the European division of Vitaelin Nutraceuticals, I'll make sure that information that impacts any of the products we distribute is immediately released to the public. That's, what I feel, is my duty: be honest and fair in health education and information. But, at the same time we encourage our clients to continue researching all the products they take.

A great Database
As mentioned, we like the resources from The International Bibliographic Information on Dietary Supplements (IBIDS). The database prepared by this organization is very complete. It provides access to bibliographic citations and abstracts from published, international, and scientific literature on dietary supplements. IBIDS is collaboration between two US government agencies: the Office of Dietary Supplements of the National Institutes of Health, and the Food and Nutrition Information Center (FNIC) of the United States Department of Agriculture's (USDA) National Agricultural Library (NAL).

What is the IBIDS Database?
The International Bibliographic Information on Dietary Supplements database is an easy to search free of charge internet resource. It is a collaboration between two government agencies: the Office of Dietary Supplements, National Institutes of Health (NIH) and The Food and Nutrition Information Center (FNIC), The National Agricultural Library (NAL), Agricultural Research Service (ARS), United States Department of Agriculture (USDA)

The database is a "work in progress" with new search terms, abstracts and citations added quarterly and modifications made to the search approach to respond to suggestions from users

Content
As of September 2007 there are over 760,000 citations on the topic of dietary supplements from four major database sources: biomedical-related articles from MEDLINE, botanical and agricultural science from AGRICOLA, worldwide agricultural literature through AGRIS, and coverage of international applied life sciences literature from CAB Abstracts and CAB Global Health.

Scope
The database generally lists the use and function of vitamin, mineral, phytochemical, botanical, and herbal supplements in human nutrition.It also lists the role of nutrient supplementation in metabolism in normal nutrition and disease states. Furthermore, animal studies that relate to the function of dietary supplements in human nutrition, chemical composition, biochemical roles, and antioxidant activity of botanical and nutrient supplements and fortification of foods with supplemental nutrients and health-related effects are reported.

The database also lists:

• Nutrient composition of herbal and botanical products;
• Surveys on dietary supplement use by various populations;
• The growth and production of herbal and botanical products used as dietary supplements;
• Abstracts where permission has been granted from the publisher;
• Citations from 1986 to the present
• Citations in foreign languages, if the abstract is in English;
• Citations have been selected from multiple databases to ensure that the database is comprehensive and internationally representative;
• Full, peer-reviewed and consumer journal databases;
• Keywords to help you find your topic of interest
• In the future -- citations from additional database sources.

In addition to having records on substances used as dietary supplements, IBIDS also includes records on substances such as niacin and glucosamine used in situations where they may be considered drugs. Such records are included in order to provide information on mechanism of action, possible adverse effects, and other information of potential interest to IBIDS users.

What does the IBIDS database not contain?

• Full journal articles - these may be obtained through your local public or university library or online through journal websites or document delivery services
• All herbal and botanical supplement ingredients - the American Herbal Products Association estimates that there are over 2000 herbal ingredients available in supplement products in the United States. The IBIDS database began with literature on the top 50 botanicals identified by the European Union and now contains literature on over 250 botanicals. These include the best sellers in the U.S. market.
• Complementary and alternative medicine approaches such as homeopathy, chiropractic, massage, and acupuncture. For more information on these topics, contact the National Center for Complementary and Alternative Medicine.
  

Conclusion
The IBIDS database is just one of the resources we like. There are more resources dealing with information about supplements related to health and healthcare. In the weeks ahead I’ll discuss other resources as well.

If you have any questions or comments, you can contact me directly by sending us an email. For more information visit our website at Vitaelin Nutraceuticals.