Arterial stiffness is associated with cardiovascular risk, morbidity, and mortality. The present paper reviews the main vitamins related to arterial stiffness and enabling destiffening, their mechanisms of action, providing a brief description of the latest studies in the area, and their implications for primary cardiovascular prevention, clinical practice, and therapy. Despite inconsistent evidence for destiffening induced by vitamin supplementation in several randomized clinical trials, positive results were obtained in specific populations. The main mechanisms are related to antiatherogenic effects, improvement of endothelial function (vitamins A, C, D, and E) and metabolic profile (vitamins A, B12, C, D, and K), inhibition of the renin-angiotensin-aldosterone system (vitamin D), anti-inflammatory (vitamins A, D, E, and K) and antioxidant effects (vitamins A, C, and E), decrease of homocysteine level (vitamin B12), and reversing calcification of arteries (vitamin K). Vitamins A, B12, C, D, E, and K status is important in evaluating cardiovascular risk, and vitamin supplementation may be an effective, individualized, and inexpensive destiffening therapy.

/pdf/crosstalk-between-vitamins-a-b12-d-k-c-and-e-status-and-522ji26dy6.pdf

Crosstalk between Vitamins A, B12, D, K, C, and E Status and Arterial Stiffness

The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.

Osteoporosis in East Asia: Current issues in assessment and management.

Ruminant production has been an essential part of human activities worldwide since ancient times. The expected increase in world population and per capita income, with an increase in the amount and...

https://tandfonline.com/doi/pdf/10.1080/1828051X.2016.1260500

Sustainable ruminant production to help feed the planet

Introduction. Fractures are quite common, especially among the elderly. However, they can increase in prevalence in younger ages too if the bone health is not good. This may happen as a result of bad nutrition. Methods. A customized, retrospective review of available literature was performed using the following keywords: bone health, nutrition, and fractures. Results. Insufficient intake of certain vitamins, particularly A and D, and other nutrients, such as calcium, may affect bone health or even the time and degree of bone healing in case of fracture. The importance of different nutrients, both dietary and found in food supplements, is discussed concerning bone health and fracture healing. Conclusion. A healthy diet with adequate amounts of both macro- and micronutrients is essential, for both decreasing fracture risk and enhancing the healing process after fracture.

/pdf/nutritional-aspects-of-bone-health-and-fracture-healing-2dnfx3kf21.pdf

Nutritional Aspects of Bone Health and Fracture Healing

The effects of vitamin K2 on apoptosis in a variety of cancer cells have been well established in previous studies. However, the apoptotic effect of vitamin K2 on bladder cancer cells has not been evaluated. The aim of this study is to examine the apoptotic activity of Vitamin K2 in bladder cancer cells and investigate the underlying mechanism. In this study, Vitamin K2 induced apoptosis in bladder cancer cells through mitochondria pathway including loss of mitochondria membrane potential, cytochrome C release and caspase-3 cascade. Furthermore, the phosphorylation of c-Jun N-terminal kinase (JNK) and p38 MAPK was detected in Vitamin K2-treated cells and both SP600125 (an inhibitor of JNK) and SB203580 (an inhibitor of p38 MAPK) completely abolished the Vitamin K2-induced apoptosis and loss of mitochondria membrane potential. Moreover, the generation of reactive oxygen species (ROS) was detected in bladder cancer cells, upon treatment of vitamin K2 and the anti-oxidant N-acetyl cysteine (NAC) almost blocked the Vitamin K2-triggered apoptosis, loss of mitochondria membrane potential and activation of JNK and p38 MAPK. Taken together, these findings revealed that Vitamin K2 induces apoptosis in bladder cancer cells via ROS-mediated JNK/p38 MAPK and Mitochondrial pathways.

/pdf/vitamin-k2-induces-mitochondria-related-apoptosis-in-human-375v7btdm2.pdf

Vitamin K2 Induces Mitochondria-Related Apoptosis in Human Bladder Cancer Cells via ROS and JNK/p38 MAPK Signal Pathways.

The focus of this paper is to explore better strategies for optimising bone strength and reducing risk of fracture, while at the same time decreasing risk of cardiovascular disease. The majority of Americans do not consume the current recommended dietary allowance for calcium, and the lifetime risk of osteoporosis is about 50%. However, traditional mononutrient calcium supplements may not be ideal. We comprehensively and systematically reviewed the scientific literature in order to determine the optimal dietary strategies and nutritional supplements for long-term skeletal health and cardiovascular health. To summarise, the following steps may be helpful for building strong bones while maintaining soft and supple arteries: (1) calcium is best obtained from dietary sources rather than supplements; (2) ensure that adequate animal protein intake is coupled with calcium intake of 1000 mg/day; (3) maintain vitamin D levels in the normal range; (4) increase intake of fruits and vegetables to alkalinise the system and promote bone health; (5) concomitantly increase potassium consumption while reducing sodium intake; (6) consider increasing the intake of foods rich in vitamins K1 and K2; (7) consider including bones in the diet; they are a rich source of calcium-hydroxyapatite and many other nutrients needed for building bone.

https://openheart.bmj.com/content/openhrt/3/1/e000325.full.pdf

Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa.

Introduction. Global coverage of Kangaroo mother care (KMC) remains low and health system intervention strategies that may improve coverage are not known. Methods. We conducted a systematic review of studies evaluating the effect of health system intervention strategies for KMC implementation compared to no or different interventions, on KMC coverage in preterm or LBW infants. KMC coverage achieved by various studies was summarized. All included studies were classified as those that achieved increased KMC coverage (defined as [≥]25% increase from baseline, with final coverage [≥]50%) or low KMC coverage (defined as <25% increase from baseline or final coverage <50%). Studies that achieved increased KMC coverage were further classified based on the mean duration of skin-to-skin contact (SSC; hours per day) achieved. Health system interventions in different categories were summarized by WHO health system building blocks to understand factors linked to increased KMC coverage. Findings. We identified 16 studies evaluating 15 health system intervention packages for KMC implementation that applied interventions in one or more health system building blocks that reported KMC coverage. All three studies that applied interventions across 5-6 building blocks (100%), two of the four studies that applied interventions across 3-4 building blocks (50%), and three of the nine studies that applied interventions across 1-2 building blocks (33%), achieved increased KMC coverage. Studies that did not achieve increased coverage had interventions primarily targeting health workforce and service delivery and were weak on leadership and governance, financing, and health information systems. All three studies that achieved increased KMC coverage with mean SSC [≥]8h/d (100%), three of the five studies that achieved increased KMC coverage with mean SSC <8h/d (60%), and three of the eight studies with low KMC coverage (38%) had high-intensity interventions in at least one health system building blocks. High-level leadership engagement, KMC supportive policies, staff licensing, and facility standards regulations, strengthened numbers and capacity of nursing staff, government funding and expanded health insurance, wards with conducive environment, and recording KMC-specific indicators in clinical registers were key factors among studies that achieved increased KMC coverage. Conclusion. High-intensity interventions across multiple health system building blocks should be used for equitable scale-up of KMC.

/pdf/health-system-intervention-packages-on-improving-coverage-of-37svvptz.pdf

Health system intervention packages on improving coverage of kangaroo mother care for preterm or LBW infants: a mixed-methods systematic review

Rural older adults are at risk of readmissions and medication-related problems after hospital discharge.This study aimed to compare 30-day hospital readmissions between participants and nonparticipants and describe medication therapy problems (MTPs) and barriers to care, self-management, and social needs among participants.The Michigan Region VII Area Agency on Aging (AAA) Community Care Transition Initiative (CCTI) for rural older adults after hospitalization.Eligible AAA CCTI participants were identified by an AAA community health worker (CHW) trained as a pharmacy technician. Eligibility criteria were Medicare insurance; diagnoses at risk of readmission; length of stay, acuity of admission, comorbidities, and emergency department visits score more than 4; and discharge to home from January 2018 to December 2019. The AAA CCTI included a CHW home visit, telehealth pharmacist comprehensive medication review (CMR), and follow-up for up to 1 year.A retrospective cohort study examined the primary outcomes of 30-day hospital readmissions and MTPs, categorized by the Pharmacy Quality Alliance MTP Framework. Primary care provider (PCP) visit completion, barriers to self-management, health, and social needs were collected. Descriptive statistics, Mann-Whitney U, and chi-square analyses were used.Of 825 eligible discharges, 477 (57.8%) enrolled in the AAA CCTI; differences in 30-day readmissions between participants and nonparticipants were not statistically significant (11.5% vs. 16.1%, P = 0.07). More than one-third of participants (34.6%) completed their PCP visit within 7 days. MTPs were identified in 76.1% of the pharmacist visits (mean MTP 2.1 [SD 1.4]). Adherence (38.2%) and safety-related (32.0%) MTPs were common. Physical health and financial issues were barriers to self-management.AAA CCTI participants did not have lower hospital readmission rates. The AAA CCTI identified and addressed barriers to self-management and MTPs in participants after the care transition home. Community-based, patient-centered strategies to improve medication use and meet rural adults' health and social needs after care transitions are warranted. 

Nathaniel Bergman

Papers

Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa.

Health system intervention packages on improving coverage of kangaroo mother care for preterm or LBW infants: a mixed-methods systematic review

Impact of an Area Agency on Aging Pharmacist-led Community Care Transition Initiative.