The science of micronutrients in clinical practice – Report on the ESPEN symposium
ESPEN ENDORSED RECOMMENDATION| VOL 43, # 1, P268-283, Jan 2024 https://doi.org/10.1016/j.clnu.2023.12.006
Background & aims
The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium.
Methods
Current evidence was discussed, the first day being devoted to clarifying the biology underlying the guidelines, especially regarding the definition of deficiency, the impact of inflammation, and the roles in antioxidant defences and immunity. The second day focused on clinical situations with high prevalence of MN depletion and deficiency.
Results
The importance of the determination of MN status in patients at risk and diagnosis of deficiencies is still insufficiently perceived, considering the essential role of MNs in immune and antioxidant defences. Epidemiological data show that deficiencies of several MNs (iron, iodine, vitamin D) are a global problem that affects human health and well-being including immune responses such as to vaccination. Clinical conditions frequently associated with MN deficiencies were discussed including cancer, obesity with impact of bariatric surgery, diseases of the gastrointestinal tract, critical illness, and aging. In all these conditions, MN deficiency is associated with worsening of outcomes. The recurrent problem of shortage of MN products, but also lack of individual MN-products is a worldwide problem.
Conclusion
Despite important progress in epidemiology and clinical nutrition, numerous gaps in practice persist. MN depletion and deficiency are frequently insufficiently searched for in clinical conditions, leading to inadequate treatment. The symposium concluded that more research and continued education are required to improve patient outcome.
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Note: Most farmers and vets know this, but very few doctors
Pigs, for example
- 2,000 IU of Vitamin D per kg of food – best growth, bone strength, etc. (pig trial) – Dec 2022
- High dose vitamin D (20,000 IU per kg of feed) safe for pigs – Aug 2015
- Healthy pigs get at least 2 X more vitamin D than the govt recommends
- National requirement of vitamin D for pigs increased by 4X, (4X more than for humans) - Jan 2014