Trials and tribulations of recruiting 2,000 older women onto a clinical trial investigating falls and fractures : vital D study

Background Randomised, placebo-controlled trials are needed to provide evidence demonstrating safe, effective interventions that reduce falls and fractures in the elderly. The quality of a clinical trial is dependent on successful recruitment of the target participant group. This paper documents the successes and failures of recruiting over 2,000 women aged at least 70 years and at higher risk of falls or fractures onto a placebo-controlled trial of six years duration. The characteristics of study participants at baseline are also described for this study.

Methods The Vital D Study recruited older women identified at high risk of fracture through the use of an eligibility algorithm, adapted from identified risk factors for hip fracture. Participants were randomised to orally receive either 500,000 IU vitamin D3 (cholecalciferol) or placebo every autumn for five consecutive years. A variety of recruitment strategies were employed to attract potential participants.

Results Of the 2,317 participants randomised onto the study, 74% (n = 1716/2317) were consented onto the study in the last five months of recruiting. This was largely due to the success of a targeted mail-out. Prior to this only 541 women were consented in the 18 months of recruiting. A total of 70% of all participants were recruited as a result of targeted mail-out. The response rate from the letters increased from 2 to 7% following revision of the material by a public relations company. Participant demographic or risk factor profile did not differ between those recruited by targeted mail-outs compared with other methods.

Conclusion The most successful recruitment strategy was the targeted mail-out and the response rate was no higher in the local region where the study had extensive exposure through other recruiting strategies. The strategies that were labour-intensive and did not result in successful recruitment include the activities directed towards the GP medical centres. Comprehensive recruitment programs employ overlapping strategies simultaneously with ongoing assessment of recruitment rates. In our experience, and others direct mail-outs work best although rights to privacy must be respected.

The prevalence of vitamin B12 deficiency in a random sample from the Australian population

 Objective: Vitamin B12 deficiency is common in older adults, and may increase the risk of cognitive impairment. The distribution of vitamin B12 insufficiency in younger age groups is less studied. This study aims to assess the prevalence of vitamin B12 deficiency (<156ρmol/L) and subclinical low-normal levels (156-250ρmol/L) in a large, random sample of the Australian population across the adult life span.
Methods: We examined serum vitamin B12 levels in a random sample of 1,085 men and 1,125 women aged 20-97 years between 1994 and 2006; in the Barwon Statistical Division, a regional area in south eastern Australia that is representative of the socioeconomic status of the Australian population.
Results: The age-standardised prevalence of vitamin B12 deficiency in this cohort of men and women was 3.6%. Subclinical low-normal vitamin B12 levels (156-250ρmol/L) were found in 26%. Serum vitamin B12 levels declined with age among men (p-value <0.001) and were lower in men than women (p-value <0.001). Vitamin B12 levels were higher among supplement users (8.0% of the cohort).
Conclusions: Vitamin B12 levels decline with age, and have been associated with neurodegenerative diseases and cognitive decline. Early intervention by diet education or supplement use to address this age-associated decline in vitamin levels may be an effective strategy to prevent decline in a significant segment of the population. Such intervention may need to start in mid-life (from 50-years of age) before the onset age-related decline in vitamin B12 levels.

Effects of omega-3 PUFA on the vitamin E and glutathione antioxidant defense system in individuals at ultra-high risk of psychosis

BACKGROUND: Oxidative stress and impaired antioxidant defenses are reported in schizophrenia and are associated with disturbed neurodevelopment, brain structural alterations, glutamatergic imbalance, increased negative symptoms, and cognitive impairment. There is evidence that oxidative stress predates the onset of acute psychotic illness. Here, we investigate the effects of omega-3 PUFA on the vitamin E and glutathione antioxidant defense system (AODS). METHOD: In 64 help-seeking UHR-individuals (13-25 years of age), vitamin E levels and glutathione were investigated before and after 12 weeks of treatment with either 1.2g/d omega-3 (PUFA-E) or saturated fatty acids (SFA-E), with each condition also containing 30.4mg/d alpha-tocopherol to ensure absorption without additional oxidative risk. RESULTS: In multivariate tests, the effects on the AODS (alpha-tocopherol, total glutathione) were not significantly different (p=0.13, p=0.11, respectively) between treatment conditions. According to univariate findings, only PUFA-E caused a significant alpha-tocopherol increase, while PUFA-E and SFA-E caused a significant gamma- and delta-tocopherol decrease. Total glutathione (GSHt) was decreased by PUFA-E supplementation. CONCLUSION: Effects of the PUFA-E condition on the vitamin E and glutathione AODS could be mechanisms underlying its clinical effectiveness. In terms of the vitamin E protection system, PUFA-E seems to directly support the antioxidative defense at membrane level. The effect of PUFA-E on GSHt is not yet fully understood, but could reflect antioxidative effects, resulting in decreased demand for glutathione. It is still necessary to further clarify which type of PUFA/antioxidant combination, and in which dose, is effective at each stage of psychotic illness.

Vitamin C and E supplementation prevents some of the cellular adaptations to endurance-training in humans

BACKGROUND: It is clear that reactive oxygen species (ROS) produced during skeletal muscle contraction have a regulatory role in skeletal muscle adaptation to endurance exercise. However, there is much controversy in the literature regarding whether attenuation of ROS by antioxidant supplementation can prevent these cellular adaptations. Therefore, the aim of this study was to determine whether vitamin C and E supplementation attenuates performance and cellular adaptations following acute endurance exercise and endurance training. METHODS: A double-blinded, placebo-controlled randomized control trial was conducted in eleven healthy young males. Participants were matched for peak oxygen consumption (VO2peak) and randomly allocated to placebo or antioxidant (vitamin C (2×500mg/day) and E (400IU/day)) groups. Following a four-week supplement loading period, participants completed acute exercise (10×4min cycling at 90% VO2peak, 2min active recovery). Vastus lateralis muscle samples were collected pre-, immediately-post- and 3h-post-exercise. Participants then completed four weeks of training (3 days/week) using the aforementioned exercise protocol while continuing supplementation. Following exercise training, participants again completed an acute exercise bout with muscle biopsies. RESULTS: Acute exercise tended to increase skeletal muscle oxidative stress as measured by oxidized glutathione (GSSG) (P=0.058) and F2-isoprostanes (P=0.056), with no significant effect of supplementation. Acute exercise significantly increased mRNA levels of peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α), mitochondrial transcription factor A (TFAM) and PGC related coactivator (PRC), with no effect of supplementation. Following endurance training, supplementation did not prevent significantly increased VO2peak, skeletal muscle levels of citrate synthase activity or mRNA or protein abundance of cytochrome oxidase subunit 4 (COX IV) (P<0.05). However, following training, vitamin C and E supplementation significantly attenuated increased skeletal muscle superoxide dismutase (SOD) activity and protein abundance of SOD2 and TFAM. CONCLUSION: Following acute exercise, supplementation with vitamin C and E did not attenuate skeletal muscle oxidative stress or increased gene expression of mitochondrial biogenesis markers. However, supplementation attenuated some (SOD, TFAM) of the increased skeletal muscle adaptations following training in healthy young men.

Quality of polyunsaturated fatty acids in Nile tilapias (Oreochromis niloticus) fed with vitamin E supplementation

Freshwater fish are an important source of protein, but they also contain other highly nutritive components such as fats. Polyunsaturated fatty acids (PUFAs) are essential for normal growth, development and reproduction of vertebrates. The antioxidant role of vitamin E in cell membranes prevents fatty acid and cholesterol oxidation, thereby promoting PUFA and subcellular particle stabilization. The effects of vitamin E supplementation on the quality of Nile tilapia (Oreochromis niloticus) carcass were investigated. The experiments were carried out in an experimental laboratory over 106 d. After sex reversal, 400 early juvenile O. niloticus were tested in a completely randomized experiment with 5 treatments (4 repetitions each), consisting of vitamin E monophosphate supplementation at 0, 50, 100, 150 or 200 mg/kg of a base diet. Treatment diets contained equal amounts of protein and energy. Tilapias supplemented with vitamin E contained arachidonic acid (20:4 omega-6; AA) which participates in inflammatory response. Nile tilapia carcasses that received vitamin E at 100 and 150 mg/kg diet had improved carcass quality by increasing the PUFA:SFA ratio and had the highest levels of polyunsaturated fatty acids from the omega-3 (linolenic acid; 18:3 omega-3) and omega-6 (linoleic acid; 18:2 omega-6) series. (C) 2012 Elsevier Ltd. All rights reserved.

Desempenho, Temperatura Corporal e Qualidade dos Ovos de Poedeiras Alimentadas com Vitaminas D e C em Três Temperaturas Ambiente

O experimento foi conduzido em câmara climática para determinar os efeitos das vitaminas D3 e C sobre o desempenho, temperatura corporal e qualidade dos ovos de poedeiras em três temperaturas: termoneutra (24,8º a 27,0º C), estresse calórico cíclico (26,2º C por 16h e 32,1º C por 8h) e estresse calórico constante (30,0º a 32,0º C). Foram utilizadas 144 galinhas brancas com 31 semanas num delineamento inteiramente ao acaso em arranjo fatorial 3x3x3: vitamina D3 (2500, 3000 e 3500 UI/kg), vitamina C (0, 200 e 400 ppm) e temperatura ambiente (termoneutra, estresse calórico cíclico e constante). As características avaliadas foram: consumo de ração (CR), produção de ovos (PO), peso dos ovos (PE), massa de ovos (MO), conversão alimentar (CA), porcentagens de albúmem (AL) e de gema (GE), unidade Haugh (UH), índice de gema (IG), porcentagem de casca (PC), espessura de casca (EC), gravidade específica dos ovos (GO), temperaturas dorsal (TD) e retal (TR). A vitamina D3 interferiu nas características PC, EC, GO e TD; a vitamina C no IG, PC e GO. A temperatura ambiente não afetou somente a UH. Concluiu-se que níveis mais altos de vitamina D3 e níveis de 200 ou 400 ppm de vitamina C na dieta podem melhorar a qualidade da casca e que o estresse calórico prejudicou as principais características avaliadas.

Vitamin C partially attenuates male reproductive deficits in hyperglycemic rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Oxidative stress markers and apoptosis in the prostate of diabetic rats and the influence of vitamin C treatment

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Activity of pectinmethylesterase, pectin content and vitamin C in acerola fruit at various stages of fruit development

In order to know which stage of fruit development is better for acerola industrialization, we studied the PME specific activity, pectin content and vitamin C at various stages of development. The acerola fruits were classified according to colour and weight in five stages: immature green (2.62-3.21 g), green (4.04-4.83 g), mature green/yellow (5.03-5.88 g), pale-red (6.16-6.77 g) and ripe mature (6.92-8.37 g). The results showed that the highest content of pectin and vitamin C occurred at the immature green stage, 4.51 +/- 0.1% yield, 2424 mg/100 g of pulp and decreased as fruit ripened, 2.99 +/- 0.03% yield, 957 +/- 0.0 mg/100 g of pulp, respectively. However, at the same stages, the values of PME specific activity were lowest, 0.61 +/- 0.01 and 0.55 +/- 0.0 units g(-1)/g of pulp, respectively. The highest value of PME activity was 2.08 +/- 0.01 units g(-1)/g of pulp in the green stage. (C) 2001 Elsevier B.V. Ltd. All rights reserved.

Interaction between vitamin K nutriture and bacterial overgrowth in hypochlorhydria induced by omeprazole

Subjects taking a hydrogen pump blocking agent (omeprazole) develop bacterial overgrowth of the small intestine. We tested the hypothesis that this bacterial overgrowth produces menaquinones, which would meet the Vitamin requirement in situations of vitamin K deficiency. In a crossover-type design, 13 healthy Volunteers eating a phylloquinone-restricted diet for 35 d were randomly assigned to take omeprazole during the first period of study or starting on day 15 until the end of the study. Coagulation times, serum osteocalcin [total osteocalcin and undercarboxylated osteocalcin (ucOC)], plasma phylloquinone, urinary gamma-carboxyglutamic acid, and plasma undercarboxylated prothrombin (PIVKA-II) were measured. Plasma phylloquinone concentrations declined 82% with dietary phylloquinone restriction (P < 0.05) and were not significantly different in the period when the diet was combined with omeprazole treatment (P > 0.05), the mean value for PIVKA-II during the phylloquinone-restricted diet significantly increased 5.7-fold from baseline (P < 0.05); however, the combination of omeprazole treatment and the phylloquinone-restricted diet significantly reduced PIVKA-II values by 21% (P < 0.05) compared with the diet period alone. There were no alterations in total or percentage ucOC concentrations during the phylloquinone-restricted diet or during the period of diet plus omeprazole treatment. Our data support the hypothesis that bacterial overgrowth results in the synthesis and absorption of menaquinones. These menaquinones contribute to vitamin K nutriture during dietary phylloquinone restriction, but not enough to restore normal vitamin K status.

Physiological responses of Nile tilapia, Oreochromis niloticus, fed vitamin C- and lipid-supplemented diets and submitted to low-temperature stress

Water temperature alterations can determine harmful physiological modifications in fish, which should be prepared to cope with this, and nutrition strategies seem to be essential. This study evaluated the effects of different levels of vitamin C and lipids on physiological responses of Nile tilapia, Oreochromis niloticus, submitted to temperature stress. There were two phases: Phase I - preparing fish to store vitamin C and lipid at appropriate temperature, and Phase II - evaluating the contributions these reserves make to fish physiology under low-temperature stress. The experiment used a 3 x 2 factorial design with three vitamin C levels (300, 600, and 1200 mg/kg diet) and two lipid levels (8.0 and 12.0%), plus absence of nutrient test and a diet of 6.0% lipids and 125.0 mg/kg vitamin C. In Phase I, 192 fish were kept at 26.0 +/- 1.0 C for 112 d, and in Phase II, 48 fish were kept at 18.0 +/- 0.5 C for 32 d and at 15.0 +/- 0.5 C for 11 d. Fish fed C0L0 diet showed lower erythrocytes values in both phases; higher vitamin C supplement determined higher red blood cell (RBC) number and higher hematocrit (Htc) (Phase II); Htc was significantly lower in Phase II; after temperature stress, fish fed C0L0 diet had higher mean corpuscular volume, lower hemoglobin corpuscular concentration, and significantly lower vitamin C concentration in the liver; and higher supplementation determined a higher concentration in the liver (Phases I and II). Higher plasmatic cortisol concentration was seen in fish fed C0L0 diet. In conclusion, our results show that the absence of vitamin C in diets impairs RBC formation and does not enable fish to cope with stress; excess vitamin C is efficient in mitigating stress and 600 mg/kg diet is economic and physiologically sufficient to prepare fish for coping with low-temperature stress. Lipid supplementation does not determine alterations in stress biochemical parameters.