HOME > EDICIONES > Año 2003, Volumen 53 - Número 3
Trabajos de Investigación
Interactions Among Indicators of B1, B2, B6 and Vitamin C Status in University Students.
Avila AV, Liuzzi JP, Cioccia AM and Hevia P Escuela de Nutrición y Dietética, Universidad Central de Venezuela, Caracas. Venezuela. Universidad Simón Bolívar, Caracas Venezuela.
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SUMMARY Interactions Among Indicators of B1, B2, B6 and Vitamin C Status in University Students. In 209 young university students (109 males and 80 females) with body mass index within the normal range, the activation coefficient of the erythrocyte transketolase (ETKAC) glutathione reductase (EGRAC) and aspartate amino transferase (EASTAC) as well as the circulating levels of vitamin C were determined. Using the usual cutoff points for ETKAC and serum vitamin C and higher than usual cutoff points for EASTAC and EGRAC 99, 95, 92, and 87% of the study subjects exhibited activation coefficients which were compatible with an acceptable status for vitamin B2, B6, C and B1 respectively. A correlation analysis showed a high correlation (r = 0.81) between erythrocyte indicators of B1 and B2 status a lower correlation between indicators of the status of these vitamins and B6 and no correlation between the indicators of B1, B2 and B6 status and serum vitamin C. This study indicated that in this largely nutritionally adequate population, the activation coefficient of the erythrocyte enzymes used here as markers of the nutritional status of B1, B2 and B6 were related between themselves and varied in the same direction. These changes, however, were not associated with circulating levels of vitamin C.
Key words: B1, B2, B6, vitamin C, ETKAC, EASTAC, EGRAC, interactions.
RESUMEN Relaciones entre indicadores del estado nutricional de las vitaminas B1, B2, B6, y C en una población de estudiantes universitarios Los niveles séricos de vitamin C y los coeficientes de activación de las enzimas eritrocitarias: transcetolasa (ETKAC), glutation reductasa (EGRAC), y aspartato amino transferasa (EASTAC) se midieron en una muestra de 209 estudiantes universitarios (109 hombres y 80 mujeres) que presentaban índices de masa corporal dentro de los niveles normales. Usando los puntos de corte habituales para la vitamina C y ETKAC así como puntos de corte mayores que lo habitual para EASTAC y EGRAC 99, 95, 92 y 87% de los estudiantes mostraron valores dentro de la normalidad para las vitaminas B2, B6, C y B1 respectivamente. Un estudio de correlación, mostró una alta correlación entre los indicadores eritrocitartios de las vitaminas B1 y B2 (r = 0.81), una correlación intermedia entre los indicadores de estas vitaminas y el de la vitamina B6 y ninguno de estos indicadores correlacionó con los niveles séricos de la vitamina C. En general, este estudio muestra que en esta población de individuos esencialmente normales, los indicadores eritrocitarios del estado nutricional de las vitaminas B1, B2 y B6 mostraron una correlacion entre ellos y cambiaron en la misma dirección. En contraste, el estado nutricional de estas vitaminas del complejo B no se correlacionaron con los niveles séricos de la vitamina C.
Palabras claves: B1, B2, B6, Vitamina C, ETKAC, EASTAC, EGRAC, interacciones.
INTRODUCTION
During the last decades a new concept has evolved concerning with micronutrient
requirements. Currently it is accepted that the optimal intake of vitamins and
minerals should include not only the amount necessary for preventing the
clinical signs of deficiency but also to promote health benefits (1), primarily
associated with the prevention of chronic diseases such as cancer,
cardiovascular diseases (2), cataracts (3), joint inflammation and
arthritis (4). This new role of the micronutrients emphasizes the utility of
maintaining, throughout the whole life cycle, an optimal nutritional status for
the prevention of these diseases whose symptoms are seen at maturity and old
age.
The majority of the benefits offered by the micronutrients
"beyond deficiency" is thought to be related to the function of
vitamins and minerals as well as other compounds present mainly in fruits and
vegetables as potential antioxidants (5). Among the essential vitamins, vitamin
C, vitamin E and the carotenes with pro vitamin A activity are considered to be
antioxidants (6). Additionally, niacin, riboflavin and thiamin are involved in
antioxidant sparing and vitamin C regeneration. This is so because one way of
achieving this regeneration is through the oxidation of glutathione which in
turn can be reduced in the FAD dependent-glutathione reductase system (7). The
NADPH required by this system is generated mainly in the pentose phosphate shunt
which includes thiamin dependent-transketolases (8). Therefore, these B vitamins
may also contribute in maintaining antioxidant capacity in mammalian organisms
as it has been already showed by others in the case of niacin (9).
In this study, indicators of the nutritional status of
vitamin C, thiamin, riboflavin and pyridoxine were determined in a sample of
university students. The purpose of this, was on the one hand to identify
potential deficiencies of these vitamins in the students and on the other hand
to look for possible interactions among the indicators of the four water soluble
vitamins studied here.
The indicators of the status of B1, B2 and B6
used in this study were the activation coefficient of erythrocyte tranketolase
(ETKAC), glutathione reductase (EGRAC), and aspartate amino transferase
(EASTAC). The serum levels of vitamin C was used as an indicator of vitamin C
status.
SUBJECTS AND METHODS
The studied population included 209 young university students randomly
selected from the different undergraduate programs offered by the Universidad
Simón Bolívar in Caracas city. The students gave their written consent of
participation before entering the study.
After measuring weight and height (Stadiometer Holtain-Limit.
UK. Scale Detecto. Spain), a 12 h fast blood sample was drawn into evacuated
tubes containing EDTA. Within 1h of collection, samples were centrifuged at
3000xg for 8-10 min at 4° C, plasma and buffy coat were removed and the
remaining red cells frozen and stored at - 20° C until analyzed. The
erythrocyte activities of the enzymes aspartate amino transferase (AST, EC
2.6.1.2), transketolase (ETK, EC 2.2.1.1) and glutathione reductase (EGR,
EC1.6.4.2) as well as their coefficient of activation with pyridoxal-5-phosphate
(PLP), thiamin pyrophosphate (TPP) and riboflavin (FAD) were determined as
indicators of the nutritional status of B6, B1 and B2
respectively. The conditions for determining these enzymes were those reported
by Bayoumi and Rosalki (10). Since the activity of these enzymes is expressed in
terms of the hemoglobin content of samples of red cell hemolizates, hemoglobin
was determined by the cyanmethemoglobin method (11). In the same subjects, serum
ascorbic acid was determined using 2,4-dinitrophenylhydrazine (12).
The population data are presented as means and standard
deviation. Cases found to differ from the guidelines used to determine
nutritional status for the studied vitamins were expressed as a percent of the
total population. Differences between males and females were established using
the Student´s t-test at 5%. Correlation and regression analysis were used to
determine relationships between variables. The BMDP Statistical Software was
used in all cases (13).
RESULTS
Table 1 data shows that the university students studied here, independent of
their sex, were slightly older than twenty years. Within the group, there were
more males than females and the males were heavier, taller and had a higher body
mass index than the female subjects.
TABLE 1
Study subjects grouped by sex
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Population
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Males
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Females
|
|
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Age (y)
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20.5 ± 2.4 1
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20.8 ± 2.47
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20.2 ± 2.2
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Weight (Kg)
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61.6 ± 12.9
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69.8 ± 12.9 *
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53.33 ± 7.54
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Height (cm)
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168.3 ± 9.5
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175.5 ± 6.7 *
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161.0 ± 5.5
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BMI 2
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21.7 ± 3.8
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22.7 ± 3.6
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20.6 ± 4.3
|
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n 3
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209
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129
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80
|
|
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1. Means ± SD. 2. Body mass index. 3 Number
of subjects. * Different from the females p<0.05.
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The data in Table 2 show the mean activation coefficients
found in single samples of erythrocytes obtained from the 129 young males and
from the 80 young females under study. As shown in the Table, the three enzymes
measured were stimulated by the in vitro addition of their coenzymes.
Also, this activation was slightly but significantly higher in the females.
Since the higher the activation coefficient of these enzymes by their coenzymes
the greater the degree of vitamin deficiency (14), the data in Table 2 suggest
that the male group featured a slightly better status of the vitamins B6,
B2 and B1 than the female group. Table 2 also shows that
the females had higher circulating levels of vitamin C.
TABLE 2
Activation Coefficient1 (AC) of the erythrocyte Aspartate Amino
Transferase (EASTAC),
Glutathione Reductase (EGRAC)and Transketolase (ETKAC)
enzymes and serum vitamin C levels in the study subjects
|
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Population
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Males
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Females
|
|
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EASTAC
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1.75 ± 0.16 2
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1.74 ± 0.17
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1.78 ± 0.16*
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EGRAC
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1.21 ± 0.07
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1.20 ± 0.06
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1.23 ± 0.08*
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ETKAC
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1.11 ± 0.04
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1.10 ± 0.03
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1.13 ± 0.04*
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Vitamin C
(m
moles/L)
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38.04 ± 11.92
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36.34 ± 10.79
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42.02 ± 12.49*
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n 3
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209
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129
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80
|
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| 1.
Enzyme activity with additional coenzyme/Enzyme activity without
additional coenzyme. 2. Means ± SD. 3. Number of subjects. * Different
from the males p<0.05. EASTAC, EGRAC and ETK were used as indices of
B6, B2 and B1 status respectively.
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Table 3 information indicates the number of male and female
subjects whose indices fell within the acceptable, marginal and deficient range
for each of the four water soluble vitamins studied here. Since this study
included more males, Table 3 also shows the percentage of males and females
found in the same categories for B6, B2, B1 and
Vitamin C. The results showed that using the cutoff points indicated in the
table, the majority of the subjects independent of their sex were in the
acceptable range for all these vitamins. In addition, the results showed that
there were no males with a marginal or deficient index of B2 status,
only 2.3% of them showed a marginal index for B6 status and slightly
more than 7 and 8% had low indices for B1 and vitamin C status
respectively. In the case of the females, only a very low fraction of the
population showed indices of a marginal B2 status but the fraction of the
population with marginal indices for B1 and B6 was approximately three times
higher than that found in the male population. In contrast with the lower B
vitamin status found in the females, low circulating levels of vitamin C were
equally frequent in males and females.
TABLE 3
Subjects with activation coefficients1 (AC) for erythrocyte Aspartate
Amino Transferase (EASTAC), Glutathione Reductase (EGRAC)
and Transketolase (ETKAC) enzymes and serum vitamin C levels
in the acceptable, marginal and deficient range
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Population
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Males
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Females
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Subjects
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%
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Subjects
|
%
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Subjects
|
%
|
|
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EASTAC
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|
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Acceptable
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199
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95.22
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126
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97.7
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74
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92.50
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Marginal
(>2.0)2
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10
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4.78
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4
|
2.33
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6
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7.50
|
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Deficient
|
0
|
0
|
0
|
0
|
0
|
0
|
|
EGRAC
|
|
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Acceptable
|
207
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99.04
|
129
|
100
|
78
|
97.50
|
|
Marginal
(>1.4)3
|
2
|
0.96
|
0
|
0
|
2
|
2.50
|
|
Deficient
|
0
|
0
|
0
|
0
|
0
|
0
|
|
ETKAC
|
|
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Acceptable
|
181
|
86.60
|
119
|
92.25
|
62
|
77.50
|
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Marginal
(>1.15)4
|
26
|
12.44
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10
|
7.75
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16
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20.00
|
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Deficient
(>1.24)4
|
2
|
0.96
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0
|
0
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2
|
2.50
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Vitamin C
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|
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Acceptable
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192
|
91.87
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118
|
91.47
|
74
|
92.50
|
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Marginal
(<23)5
|
15
|
7.18
|
9
|
6.98
|
6
|
7.50
|
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Deficient
(<11)5
|
2
|
0.96
|
2
|
1.55
|
0
|
0
|
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n 6
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209
|
100
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129
|
100
|
80
|
100
|
|
| 1.Activation
coeficient = Enzyme activity with additional coenzyme/ Enzyme activity
without additional coenzyme. 2. Value indicating inadequate status
according to Sauberlich et al. (18). 3.Value indicating inadequate
status according to Bates et al (19) and Boisvert et al (20). 4. Value
indicating inadequate status according to Gibson (14) and Sauberlich
(15). 5. (m moles/L) Value indicating inadequate status according to
Jacobs et al (27). 6. Number of subjects.
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Table 4 summarizes the correlation coefficients found between
the activation coefficient of erythrocyte aspartate amino transferase,
transketolase and glutathione reductase used here as indicators of B6,
B1 and B2 status respectively and also between these
activation coefficients and the serum levels of vitamin C. The data show that in
this sample of young, largely nutritionally adequate students, those having
indices of a low B1 or B2 status, had also a tendency to show indices
of a low B6 status. However, none of these B vitamin indices,
correlated with serum vitamin C. In addition, Table 4 shows a very high
correlation between the indexes of B1 and B2 status both
in the males and the females.
TABLE 4
PEARSON CORRELATION COEFFICIENTS BETWEEN ERYTHROCYTE FUNCTIONAL
INDICATORS OF B1, B2, B6 1STATUS AND
SERUM VITAMIN C IN THE STUDY SUBJECTS
|
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Nutrient
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Population
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Males
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Females
|
|
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B1
vs B2
|
0.81*
|
0.75*
|
0.85*
|
|
B1
vs B6
|
0.43*
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0.36*
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0.49*
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B2
vs B6
|
0.29*
|
0.15
|
0.45*
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B1
vs Vit C
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0.11
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-0.04
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0.15
|
|
B2 vs
Vit C
|
-0.07
|
-0.15
|
-0.03
|
|
B6
vs Vit C
|
0.04
|
-0.07
|
0.06
|
|
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1. For B1 ETKAC, for B2
EGRAC and for B6 EASTAC. * P< 0.001
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In accordance with the data on Table 4, Figure 1 shows the
linear regression line calculated from the activation coefficient of the
transketolase and glutathione reductase, measured in the erythrocyte samples, of
all the subjects included in this study. The figure indicates that subjects
showing a low ETKAC also had a low EGRAC. Conversely, subjects having a high
ETKAC also had a high EGRAC.
FIGURE 1
Relationship between the activation coefficient of the erythrocyte glutathione
reductase (EGRAC) and transketolase (ETKAC) in 209 young university students

DISCUSSION
The studied population included a group of young university students without
any obvious sign of nutritional deficiencies. The group was quite homogeneous in
terms of age, had more males and their calculated body mass index were in the
normal range (14).
In the study group, the activation coefficient of the
erythrocyte aspartate amino transferase , glutathione reductase and
transketolase were determined. These coefficients are considered functional
assays for the status of B6, B2 and B1
respectively (14) and they have been used in the screening for deficiencies of
these vitamins both in normal populations (14-15) and also in detecting and
correcting B vitamin deficiencies occurring spontaneously in different parts of
the world (16-17).
Cutoff points for the interpretation of the activation
coefficients of these erythrocyte enzymes have recently been reviewed (14,15)
and, the literature shows a good agreement in the case of the transketolase but
not for the aspartate amino transferase or glutathione reductase. Accordingly,
different investigators (18-21) have used different values to represent
acceptable, marginal or deficient status of B6 and B2 in
the populations they have studied. In this study, the values used for the
transketolase assay are those reported by Sauberlich (15) and Gibson (14).
However, the values used for the activation of aspartate amino transferase and
glutathione reductase were considerably higher and similar to those recommended
by Sauberlich (18) and Bates et al (19) as well as Boisvert et al (20)
respectively. Using these cutoff points the mean values for the activation
coefficient of the enzymes studied here fell well within the acceptable range
both in the males and in the female students.
The decision to use higher activation coefficients for these
two enzymes was made since there were no obvious signs of nutritional
deficiencies in any of the subjects. In other populations with no signs of
deficiency, activation coefficients higher than those established as the upper
limit of normality (14-15) have also been used for the three enzymes measured in
this study (18-26). These discrepancies limit the value of using these enzymes
in predicting vitamin status.
As described by Sauberlich (15), the guidelines for
interpreting vitamin C status, from serum vitamin C levels has also been a
matter of debate with acceptable levels ranging from 11-34 mm mol/L. In this
study we used 23 mm mol/L based on the work of Jacob et al (27). Using this
value, it appears that on the average, the study subjects had an appropriate
status for this water soluble vitamin. The higher circulating levels of vitamin
C found here for the females has also been reported by others (27,28).
This interpretation of the data suggested that in general,
the population as a whole as well as the males and females studied here had
acceptable indices for B1, B2, B6 and vitamin
C. However, there were a few subjects with marginal or deficient indices for
some of these vitamins. In general, the fraction of the subjects within the
acceptable range was much higher than that within a marginal or deficient range
and, among those in the latter group, there were more females than males. After
comparing the percentage of the subjects showing low B vitamin indices in this
study with those found in non-supplemented healthy subjects in other studies
(21), it appears that the incidence of marginal indices for the three B vitamins
in this population, fell well within a reasonable range. The incidence of low
serum vitamin C levels, found in this study, is similar to previous studies
reported by us in an older population (28).
The results of the correlation analysis performed here on
EASTAC, EGRAC and ETKAC showed a direct relationship between the activation
coefficient for the three enzymes. The strongest of these relationships was seen
between EGRAC and ETKAC. The relationship between ETKAC and EASTAC was
intermediate and the lowest was seen between EGRAC and EATAC.
A certain degree of agreement between indicators of
nutritional status for various nutrients, like those seen in this study for B1
and B6 or B2 and B6 erythrocyte dependent
enzymes, may be expected. This agreement may result from coincidences of the
same nutrients in the foods consumed or due to biochemical relationships between
them. However, a relationship as high as that seen here for the
erythrocyte B1 and B2 dependent enzymes was unexpected.
Thus, riboflavin and thiamin are not present in the same foods (29-30) and
neither riboflavin nor thiamin are required in the synthesis or interconversions
of the active thiamin coenzymes (29) or the flavin nucleotides (30).
Nevertheless, since in the erythrocyte the utilization of glucose in the pentose
phosphate shunt as well as the capacity of reducing glutathione are critical in
maintaining integrity and function (31), it is possible that in this cell the
enzymes of these two systems, namely the B1 dependent transketolases
and the B2 dependent glutathione reductase, may be related.
In contrast to the strong relationship between the indicators
of B1 and B2 status just described, these results showed
that there was no relationship between the level of vitamin C measured in the
serum and the activation coefficient of any of the B vitamin dependent enzymes
measured in the erythrocytes of the same individuals. It is possible that a more
complete assessment of the status of B1, B2 and vitamin C,
together with a larger variability in the nutritional status of these vitamins
in the subjects, may be needed to show a relationship between these two B
vitamins and vitamin C.
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Recibido: 21/07/2002 Aceptado: 28/02/2003
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ALAN-VE ISSN 0004-0622 - Depósito Legal: pp 199602DF83
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