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Do they prevent chronic diseases? “He that takes medicine and neglects to diet himself wastes the time of the physician..” Vital to life; necessary for body functions Cannot be made by the body; must be consumed in foods WSV more sensitive to heat, lost in cooking water, evaporate into the air Most WSV excess leaves body in urine, while FSV stored (more likely to be toxic) British sailors died in high numbers of scurvy Naval surgeon suspected that some compound in food was missing and caused scurvy Ordered that limes be sent on long voyages, thus preventing scurvy (deficiency of vitamin C) Acts as an antioxidant to protect cell membrane, important structures and compounds Free radical damage is linked to heart disease and cancer Involved in making proteins that enable..... B vitamins act as “coenzymes” in the many chemical reactions that take place in the body Acts as an antioxidant Helps to form some hormones, nerve transmitters Common cold? Cover compounds in foods that we want to reduce (cholesterol, saturated fat, sodium/salt) Percentages based on a 2000 kcal diet May contain added essential nutrients (vitamins) or phytochemicals Those receiving vitamin E, beta-carotene supplement had higher risk of lung cancer, heart disease, and all-cause mortality Those receiving beta-carotene and vitamin A had higher lung cancer and heart disease rates Select a product that does not provide more than 100% of the RDA/DRI in one dose Select a product that only contains the essential vitamins and minerals Don’t take it on a daily basis (try every other day) The Lewin Group, Inc.., was commissioned by Wyeth Consumer Healthcare to develop estimates of the economic impact of the use of daily multivitamins by older adults within a health insurance context (e.g., Medicare or some other payer). In recent years, an important priority of the Federal Government and other large health care payers and providers has been health promotion and disease prevention for the elderly. This study provides estimates of the costs and potential savings that could result from older adults’ use of a daily multivitamin. Clinical investigators and other researchers are adding to the body of evidence pertaining to the relationship between multivitamins and health outcomes. The five-year estimated cost offset associated with avoidable hospital and skilled nursing facility admissions and home health visits associated with exacerbated infection is approximately $886 million. Our assumptions are based upon an evolving literature that is not definitive on the magnitude of the health effects of multivitamins in the populations of interest. The evidence strongly indicates that daily use of multivitamins by the elderly is nearly risk-free and is potentially associated with significant health improvements. Based on the available evidence regarding risks and benefits, we concur with other researchers that use of daily multivitamins by the elderly has the potential for conferring substantial benefits to any public health initiative. Parameters in our cost estimation model are set conservatively in order to reflect the promising though not conclusive scientific findings regarding multivitamin supplementation. Folate ... Due to lack of suitable data, ULs could not be established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, or carotenoids.http://www.iom.edu/Object.File/Master/7/296/0.pdf. For preformed vitamin A in foods or supplements and for provitamin A carotenoids in supplements, 1 RE = 1 RAE. Teratological effects, liver toxicity Note: From preformed Vitamin A only. Individuals with high alcohol intake, pre-existing liver disease, hyperlipidemia or severe protein malnutrition may be distinctly susceptible to the adverse effects of excess preformed vitamin A intake. -carotene supplements are advised only to serve as a provitamin A source for individuals at risk of vitamin A deficiency. Due to lack of suitable data, ULs could not be established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, or carotenoids. fortified soy-based meat substitutes Fortified cereals, meat, fish, poultry Adverse effects of excessive consumption No adverse effects associated with Vitamin B6 from food have been reported. Because data on the adverse effects of Vitamin B6 are limited, caution may be warranted. No adverse effects have been associated with the consumption of the amounts of vitamin B12 normally found in foods or supplements. Because data on the adverse effects of vitamin B12 are limited, caution may be warranted. percent of older people may malabsorb food-bound vitamin B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12. Due to lack of suitable data, ULs could not be established for vitamin K, thiamin, riboflavin, vitamin ... In this chapter, we’ll talk about why the types of foods your calories come from matter.http://www.health.gov/dietaryguidelines/dga2005/healthieryou/pdf/chapter6.pdf. Calories plus nutrients equals food…well, there is more to it than that. But the impor-tant thing to know is when you eat and drink, you take in nutrients and calories. Now that you have a goal for how many calories you need to achieve or maintain a healthy weight (you wrote it in “My Personal Profile”), it is time to learn what types and amounts of foods to eat that will be healthy, satisfying, and meet your calorie goal. You may be eating enough food, but not eating the right foods that give your body the nutrients you need to be healthy. What you eat is just as important as how much you eat. A healthy eating plan is one that: • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and equivalent milk products. Specifically, many fruits and vegetables are packed with nutrients but have very few calories. For example, vitamins and minerals are nutrients, as are fats, protein, and carbohydrates. Foods contain vitamins and minerals that are often found in supple-ments, but food also contains hundreds of beneficial naturally occurring substances that may protect against chronic health problems. Therefore, if you have a choice between an orange or a vitamin C supplement, it is better to eat the orange. Some specific groups of people have higher requirements for certain nutrients and may benefit from use of vitamin and mineral supplements. Children and adolescents: calcium, potassium, fiber, magnesium, and vitamin E Specific population groups: vitamin B12, iron, folic acid, and vitamins E and D For example, women ... Premix Options and Priorities The views expressed in this paper are the views of the authors and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Directors, or the governments they represent.http://www.adb.org/Documents/Events/2001/Workshop-Flour-Cooking-Oil/flour-break-premix-options.pdf. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequences of their use. Fortificant choice depends upon: Identification and Prevalence of Vitamins – Vitamin A – Vitamins B1, B2, B3, B6, B12 – Vitamin D – NOTE: Vitamin C should not be used as it reacts with cereal proteins and is destroyed Properties of Iron Compounds Vitamin A Vitamin levels are lost during processing Vitamin Standards for processed foods must reflect processing losses Premixes should contain overages of minerals and vitamins The goal of the VitaGrant is to promote the use of folic acid in women of reproductive age in Florida to reduce the risk of certain birth defects of the brain and spine, called neural tube defects (NTDs) and to increase awareness of other pre/interconceptional health issues.http://www.doh.state.fl.us/family/mch/vg/docs/protocol.pdf. A key component of the Florida VitaGrant is distributing multivitamins containing the recommended daily allowance of folic acid (400 micrograms). At least 450,000 bottles of multivitamins will be distributed free to non-pregnant women of childbearing age across the state through a number of distribution sites. Vitamin distribution will begin in January 2005 and will continue for three years or until all of the vitamins have been distributed. Distribution Sites: Any provider/entity that comes in contact with the target population is eligible to participate in the project. Distribution sites will receive a shipment of vitamins and materials every three months. Any woman who meets all of the following criteria is eligible to receive the free vitamins with accompanying materials: Non-pregnant Childbearing age (distribution sites participating in the evaluation must obtain parental consent for participants under the age of 18, unless the individual is an emancipated minor, is married or is receiving the vitamins through a family planning clinic) Client or non-client (a woman does not have to be a client or patient of the provider in order to receive the vitamins) Any staff who encounters a woman meeting the above criteria may distribute the vitamins. How the Vitamins and Materials are to be Distributed: Staff should complete the following steps ... Form 60b - Vitamins, Minerals & Carotenoids Dietary Vitamin A (RAE) Vitamin A as retinol activity equivalents (RAE) Variable # 4 Sas Name: F60VITA Sas Label: Type: Dietary Vitamin A (RAE) Continuous Structure: One row per participant Usage Notes: none Categories: Study: Administration Usage Notes: none Categories: Study: Administration Population: E+P participants Usage Notes: May want to consider excluding participants with a status of 1 or Thus, when reporting total vitamin A (food + supplements) RAE is the preferred unit of measure.http://www.nhlbi.nih.gov/resources/deca/whiep/doc/datadoc/epbase/f60b_ep_base_pub.pdf. RAE Vitamin A = mcg retinol + (mcg beta-carotene equivalents/12) 1 RAE (retinol activity equivalent): = 1 mcg all trans retinol = 2 mcg supplemental all trans beta-carotene = 12 mcg of dietary all trans beta-carotene = 24 mcg of other pro-vitamin A cartenoids (alpha-carotene and beta-cryptoxanthin) Note that beta-carotene equivalents = mcg beta-carotene + Form 60b - Vitamins, Minerals & Carotenoids Dietary Vitamin A (IU) Total Vitamin A in International Units Dietary Vitamin A (IU) Dietary Vitamin A (mcg RE) Total vitamin A in retinol equivalents (RE) Variable # 6 Sas Name: F60VITARE Sas Label: Type: Dietary Vitamin A (mcg RE) Continuous Structure: One row per participant Population: E+P participants Usage Notes: Historically, International Units were the first measure to combine retinol (preformed vitamin A) and vitamin A from carotenoids into a single measure. Categories: IU vitamin A = (mcg retinol/0.3) + (mcg beta-carotene equivalents/0.6) Computed Variables Diet: FFQ Usage Notes: Retinol equivalents (RE) overestimate the amount of vitamin A activity from carotenoids. Categories: RE ... For example, people either take vitamins or they do not.http://www.core.org.cn/NR/rdonlyres/Economics/14-74Spring-2004/35A6087D-8E41-48F3-9792-623EF6B6D389/0/emp_method.pdf. (i.e. Nutrition for individual i =1 if they take vitamins, =0 other wise). In this imaginary world, there were no vitamins before 1990. Then, after 1990, vitamins were made available in cities. Then, we can re-phrase the question: how much more income does a person earn on average when he/she take vitamins? The estimated b tells us the additional income earned when a person take vitamins on average. Another way of answering our question is to simply separate the data into two groups: those that take vitamins and those that do not. In this experiment, non-vitamin takers are the control group and vitamin takers are the treatment group. The point is to exploit the before and after variation in vitamin taking, and the fact that only part of the population took vitamins after 1990. The difference between vitamin takers and non-takers is $150 more after the introduction of vitamins. But to isolate the effect of taking vitamins versus other things that might have happened over time which could affect income (e.g. economic growth, increase in education, etc.) we take the difference-in-difference between vitamin takers and a control group (non-vitamin takers). In Stata, we have to create a new variable for the interaction term: gen postvit=post*vitamin /*generates interaction term called postvit*/ reg income postvit post vitamin /*estimates indirect and main effects*/ It is the effect of taking vitamins for vitamin takers. Endogeneity generally arises when individuals in the data make a choice (e.g. the decision to take vitamins when vitamins where introduced), and the ... Medicaid Nursing Home/Child (Foster) Care Drug Carve-out List The list below represents drugs that are carved-out of the Medicaid nursing home/child (foster) care rates, as of July 1, 2007.http://www.health.state.ny.us/health_care/medicaid/program/docs/carveout.pdf. Claims for drugs on this list may be billed directly to Medicaid by an enrolled pharmacy. Medicaid is the payor of last resort. Medicare Part D or other insurance should be billed first. The list will be periodically updated to add only the generic equivalents of drugs currently on the list or new antiretrovirals used in the treatment of HIV/AIDS. Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 Grams of protein – Premix. Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 Grams of protein – Premix. Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 Grams of protein – Premix. Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 Grams of protein – Premix. Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes) homemix, per day. Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal Parenteral nutrition solution; compounded amino acid and carbohydrates with ... Filters medications from the body Clears and destroys bacteria in the blood Bile and bilirubin (break down products of red blood cells) Forms ammonia from amino acid metabolism Made of amino acids 8 essential amino acids for complete protein Animal protein is a complete protein Plant proteins need to be combined to make a complete protein Incorporated into muscle, blood, bone for building Role in oncotic pressure (fluid balance) Needs are based on lean or dry body mass.http://www.hepb.org/pdf/Obayashi_Nutrition_06.pdf. Protein is vital for growth, building and repairing the body. too little can cause problems if liver function is poor (liver is not making amino acids) Cancer There's no good evidence that eating a little protein or a lot of it influences cancer risk Although substances in soy could conceivably protect against endometrial, ovarian, colorectal, prostate, and other cancers, there is no good evidence for this. Department of Clinical Nutrition Glucose is the end-product of digestion of carbohydrates. The liver stores, releases, and manufactures glucose. Advanced liver disease interferes with this normal function, causing poorly controlled glucose fluctuations. Glucose is primary fuel source for muscles and brain Source of fiber and water soluable vitamins and minerals Found in starches, fruits, dairy, sugars Provides 4 calories/gram Long-lasting, concentrated source of energy Form insulating layer which prevents loss of heat Protects organs and are part of the cell structure Provides essential fatty acids Carries fat soluable vitamins vitamin E in a diet rich in omega-3 fatty acids may help to delay autoimmune diseases such as rheumatoid arthritis. Generic ... File Not Foundhttp://www.citizen.org/documents/Vitamins_%2528PDF%2529.pdf We all know generally what nutrition is.http://www.fns.usda.gov/tn/Resources/blocks3.pdf. It is the process by which our bodies take in and use food. In recent decades, medical researchers have found that good nutrition can also help reduce the risks of coronary heart diseases and certain types of cancer. While we can sometimes get by with less than an optimum diet, to thrive we need a healthy diet. To include the greatest amount of nutrients and meet the recommendations of the Dietary Guidelines for Americans, choose a variety of foods for each meal throughout the week. A food may be a good source of some vitamins and minerals, but still lack other important ones. By regularly serving a variety of foods, you will help children learn healthy food habits. You will also help make sure the children will not become bored with the foods you offer them. Carbohydrates come from many sources and are made up of two different types: simple carbohydrates and complex carbohydrates. Vitamins are organic substances needed by the body in very small amounts. These vitamins are found in colorful fruits and vegetables and in foods containing fats and oils, such as dairy products. Include foods that are high in vitamin A and vitamin C. Plan to include vegetables and fruits frequently in snacks. Sugars and many foods that contain them in large amounts supply calories, but they may be limited in vitamins and minerals. Look for a higher value for nutrients most people need to increase in their diets, such as carbohydrates, vitamins, and minerals. Most consumers need to worry about getting too much of certain nutrients (fat, for example) rather than too few vitamins or minerals, as in the ... Found naturally in the body, it provides energy for high-intensity, very short duration events like sprinting.http://www.extension.umn.edu/family/W00029.pdf. It has been studied for short-term use only. Some athletes benefit from its use but only for certain Whey Protein: A natural part of milk, it has been promoted as easy to digest and absorb with a superior amino acid profile. Manufacturers claim it Big business, big dollars, potential risks, and little to no benefits sum up the supplement industry. Food outlets all across the country have supplements for sale. Athletes are frequently drawn by the lure of picture-perfect bodies and the promise of enhanced performance or recovery by using a certain product. The following section lists some common supplements targeted towards athletes and provides a brief statement on each. Products There is no evidence yet that creatine increases muscle mass. So far it seems relatively safe for use with minimal to no side effects if taken as directed. Vitamins - Minerals: Essential for good health and available everywhere. It is possible to ingest toxic levels of some vitamins and minerals over time. There is no justification for taking lots of extra vitamin supplements. Bottled waters advertise added vitamins, amino acids, and make bold statements about boosting energy when in fact they contain no calories. There are several herbs that may be useful for headache patients.http://www.headachedrugs.com/pdf/herbs.pdf. Quality control is a continuing problem with herbs. Because of the differences in species soil, weather conditions, and adulterants placed into the herbs, different preparations (with the same milligram strength) may have widely varying strength and purities. For instance, a recent study of 10 different preparations of St. John's Wort and feverfew revealed extreme differences among the different farms in strength of the active ingredient in each capsule. 2 VITAMINS AND MINERALS Several vitamins and minerals have been found to be useful for the prevention of headache. The most successful mineral or vitamin in studies has been magnesium. Others that may help include vitamin B2 (riboflavin), vitamin B6 (pyridoxine), calcium, and certain long-chain fatty acids that are contained in compounds such as fish oil or flaxseed oil. VITAMIN B2 (RIBOFLAVIN) Large doses of this B vitamin (400 mg per day) have been utilized to prevent migraine headache. We do not usually utilize this treatment for more than 6 months, as long-term toxic side effects of large doses of vitamin B2 have not been established. However, in general, the B vitamins are safe. Vitamin B6 has been utilized as a preventive for migraine, particularly menstrual migraine. Vitamin Be is very safe in these doses. There have been no scientific studies on most of the other B vitamins other than B2 and B6 in regard to headache. However, it is known that the B vitamins, particularly folate and B12, can help prevent heart disease and possibly stroke. esearch from around the world shows women using multivitamins containing folic acid near the time they become pregnant have less chance of having babies with neural tube defects.http://www.cbdmp.org/pdf/vitaminsntdswhobene.pdf. Although most studies report multivitamins reduce risk by 50% to 70%, until now, no one has looked at whether they benefit some groups of women more than others. Over 1000 California women were interviewed in this study by the California Birth Defects Monitoring Program. As in previous reports, those taking multivitamins around conception were less likely to have babies with neural tube defects. However, results were not the same in all groups of women. MULTIVITAMINS LOWER RISK OVERALL Vitamins did not completely eliminate risk, however–in this study, 60% of women who had affected babies took multivitamins in the first trimester. Women using vitamins had a 35% lower risk than non-users. On the average, vitamin users had a 40% lower risk. Folate is a B-vitamin found in spinach and leafy green vegetables, dried beans, liver, and citrus fruits. In vitamin supplements and fortified foods such as breakfast cereal, it is usually found in the form “folic acid.” The risk reduction was similar whether multi-vitamin use began before conception, in the first trimester, or later in pregnancy. To test this, we asked women in the study if they thought vitamins caused birth defects, prevented them, or had no effect. about vitamin/mineral supplement composition and frequency of use. Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects.
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