Abstract:
Vitamin C is an essential enzyme cofactor and antioxidant with pleiotropic roles in human physiology. Circulating vitamin C concentrations are lower in people with diabetes mellitus, suggesting a higher dietary requirement for the vitamin. We interrogated the NHANES 2017-2018 and EPIC-Norfolk datasets to compare vitamin C requirements between those with and without diabetes mellitus using dose-concentration relationships fitted with sigmoidal (four-parameter logistic) curves. The NHANES cohort (n = 2828 non-supplementing adults) comprised 488 (17%) participants with diabetes (self-reported or HbA1c ≥ 6.5%). The participants with diabetes had a lower vitamin C status (median [IQR]) than those without (38 [17, 52] µmol/L vs. 44 [25, 61] µmol/L, p < 0.0001), despite comparable dietary intakes between the two groups (51 [26, 93] mg/d vs. 53 [24, 104] mg/d, p = 0.5). Dose-concentration relationships indicated that the group without diabetes reached adequate vitamin C concentrations (50 µmol/L) with an intake of 81 (72, 93) mg/d, whilst those with diabetes required an intake of 166 (126, NA) mg/d. In the EPIC-Norfolk cohort, comprising 20692 non-supplementing adults, 475 (2.3%) had self-reported diabetes at baseline. The EPIC cohort had a lower BMI than the NHANES cohort (26 [24, 28] kg/m2 vs. 29 [25, 34] kg/m2, p < 0.0001). Correspondingly, the EPIC participants without diabetes required a lower vitamin C intake of 64 (63, 65) mg/d while those with diabetes required 129 (104, NA) mg/d to reach adequate circulating vitamin C status. C-reactive protein concentrations were strongly correlated with body weight and BMI and provided a surrogate biomarker for vitamin C requirements. In conclusion, people with diabetes had 1.4 to 1.6 fold higher requirements for vitamin C than those without diabetes. This corresponds to additional daily vitamin C intake requirements of ~30-40 mg for people with diabetes, equating to a total daily intake of at least 125 mg/d.
摘要:
维生素C是人体生理学中必需的酶辅因子和抗氧化剂,具有多效性作用。糖尿病患者的循环维生素C浓度较低,表明饮食对维生素的需求更高。我们查询了NHANES2017-2018和EPIC-Norfolk数据集,使用符合S形(四参数逻辑)曲线的剂量-浓度关系,比较有糖尿病和无糖尿病患者的维生素C需求。NHANES队列(n=2828名非补充成人)包括488名(17%)糖尿病患者(自我报告或HbA1c≥6.5%)。糖尿病患者的维生素C状态(中位数[IQR])低于无糖尿病患者(38[17,52]µmol/Lvs.44[25,61]µmol/L,p<0.0001),尽管两组之间的饮食摄入量相当(51[26,93]mg/dvs.53[24,104]mg/d,p=0.5)。剂量-浓度关系表明,无糖尿病组达到足够的维生素C浓度(50µmol/L),摄入量为81(72,93)mg/d,而糖尿病患者需要摄入166(126,NA)毫克/天。在EPIC-诺福克队列中,包括20692名不补充的成年人,475(2.3%)在基线时自我报告糖尿病。EPIC队列的BMI低于NHANES队列(26[24,28]kg/m2与29[25,34]kg/m2,p<0.0001)。相应地,没有糖尿病的EPIC参与者需要较低的维生素C摄入量64(63,65)mg/d,而糖尿病患者需要129(104,NA)mg/d才能达到足够的循环维生素C状态.C反应蛋白浓度与体重和BMI密切相关,并提供了维生素C需求的替代生物标志物。总之,糖尿病患者对维生素C的需求比非糖尿病患者高1.4~1.6倍.这相当于糖尿病患者每天额外摄入约30-40毫克的维生素C,相当于每日总摄入量至少为125毫克/天。