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Current Diabetes Reports

, Volume 2, Issue 5, pp 448–456 | Cite as

Antioxidant vitamins and their influence in diabetes mellitus

  • Bibi Hasanain
  • Arshag D. Mooradian
Article

Abstract

Diabetes mellitus is a chronic disease associated with serious complications. A number of studies have suggested that enhanced oxidation is the underlying abnormality responsible for some of the complications of diabetes. It is not known whether the ingestion of antioxidant vitamins could retard or perhaps reverse the oxidative damage. The information regarding the benefit of antioxidant vitamin supplementation is conflicting; some trials have demonstrated adverse effects of excessive consumption of vitamin supplements. In this article, we review the available literature on the association of cardiovascular events and ingestion of vitamins with antioxidant properties. Given the lack of data to substantiate the benefit and safety of ingestion of antioxidant vitamins in excess of the recommended dietary allowance, physicians should avoid the recommendation of vitamin supplementation to their patients.

Keywords

Carotenoid Carotene Beta Carotene Antioxidant Vitamin Oxidative Load 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Mooradian AD, Failla M, Hoogwerf B, et al.: Selected vitamins and minerals in diabetes. Diabetes Care 1994, 17:4645–4679.Google Scholar
  2. 2.
    Mooradian AD: Micronutrients in diabetes mellitus. In drugs, diet and disease. Mechanistic Approaches to Diabetes 1995, 2:183–200.Google Scholar
  3. 3.
    Franz, MJ, Bantle JP, Beebe CA, et al.: Technical review: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25:148–198.PubMedCrossRefGoogle Scholar
  4. 4.
    Mooradian AD, Thurman JE: Glucotoxicity: potential mechanisms. Clin Geriatr Med 1999, 15:255–263.PubMedGoogle Scholar
  5. 5.
    Baynes JW, Thorpe SR: Role of oxidative stress in diabetic complications: a new perspective on an old paradigm. Diabetes 1999, 48:1–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Rosen P, Nawroth PP, King G, et al.: The role of oxidative stress in the onset and progression of diabetes and its complications: a summary of a Congress Series sponsored by NESCOMCBN, the American Diabetes Association and the German Diabetes Society. Diabetes Metab Res Rev 2001, 17:189–212.PubMedCrossRefGoogle Scholar
  7. 7.
    Mooradian AD: Tissue specificity of premature aging in diabetes mellitus: the role of cellular replicative capacity. J Am Geriatr Soc 1988, 36:831–839.PubMedGoogle Scholar
  8. 8.
    Thurman J, Mooradian AD: Vitamin supplementation therapy in the elderly. Drugs Aging 1997, 11:433–449.PubMedCrossRefGoogle Scholar
  9. 9.
    Mooradian AD, Dickerson F, Smith TL: Lipid order and composition of synaptic membranes in experimental diabetes mellitus. Neurochem Res 1990, 15:981–985.PubMedCrossRefGoogle Scholar
  10. 10.
    Mooradian AD, Smith TL: The effect of experimentally induced diabetes mellitus on the lipid order and composition of rat cerebral microvessels. Neurosci Lett 1992, 145:145–148.PubMedCrossRefGoogle Scholar
  11. 11.
    Mooradian AD, Pinnas JL, Lung CC, et al.: Diabetes related changes in the protein composition of rat cerebral micro-vessels. Neurochem Res 1994, 19:123–128.PubMedCrossRefGoogle Scholar
  12. 12.
    Shah G, Pinnas JL, Lung CC, et al.: Tissue-specific distribution of malondialdehyde modified proteins in diabetes mellitus. Life Sci 1994, 55:1343–1349.PubMedCrossRefGoogle Scholar
  13. 13.
    Habib MP, Dickerson F, Mooradian AD: Effect of diabetes, insulin and glucose load on lipid peroxidation in the rat. Metabolism 1994, 43:1442–1445.PubMedCrossRefGoogle Scholar
  14. 14.
    Wehmeir KR, Mooradian AD: Autooxidative and antioxidative potential of simple carbohydrate. Free Radic Biol Med 1994, 17:83–86.CrossRefGoogle Scholar
  15. 15.
    Mooradian AD, Habib MP, Dickerson F: Age-related changes in the effect of simple carbohydrates, casein hydrolysate and a lipid test meal on ethane exhalation rate. J Appl Physiol 1994, 76:1119–1122.PubMedGoogle Scholar
  16. 16.
    Mohanty P, Hamouda W, Garg R, et al.: Glucose challenge stimulates reactive oxygen species (ROS) generation by leukocytes. J Clin Endocrinol Metab 2000, 85:2970–2973.PubMedCrossRefGoogle Scholar
  17. 17.
    Ceriello A: Hyperglycaemia: the bridge between nonenzymatic glycation and oxidative stress in the pathogenesis of diabetic complications. Diabetes Nutr Metab Clin Exp 1999, 12:42–46.Google Scholar
  18. 18.
    Mooradian AD: Glycosylation enhances malondialdehyde binding to proteins. Free Radic Biol Med 1996, 21:699–701.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim J, Chehade J, Pinnas JL, Mooradian AD: Effect of select antioxidants on malondialdehyde-modification of proteins. Nutrition 2000, 16:1079–1081.PubMedCrossRefGoogle Scholar
  20. 20.
    Mooradian AD: The effect of ascorbate and dehydroascorbate on tissue uptake of glucose. Diabetes 1987, 36:1001–1004.PubMedCrossRefGoogle Scholar
  21. 21.
    Mooradian AD: The antioxidative potential of cerebral microvessels in experimental diabetes mellitus. Brain Res 1995, 71:164–169.CrossRefGoogle Scholar
  22. 22.
    Mooradian AD: Increased serum conjugated dienes in elderly diabetic patients. J Am Geriatr Soc 1991, 39:571–574.PubMedGoogle Scholar
  23. 23.
    Sharma A, Kharb S, Chugh SN, et al.: Evaluation of oxidative stress before and after control of glycemia and after vitamin E supplementation in diabetic patients. Metab Clin Exp 2000, 49:160–162.PubMedGoogle Scholar
  24. 24.
    Schleicher ED, Wagner E, Nerlich AG: Increased accumulation of the glycoxidation product N (epsilon)-(carboxymethyl) lysine in human tissues in diabetes and aging. J Clin Invest 1997, 99:457–468.PubMedCrossRefGoogle Scholar
  25. 25.
    Mol MJ, de Rijke YB, Demacker PN, Stalenhoef AF: Plasma levels of lipid and cholesterol oxidation products and cytokines in diabetes mellitus and cigarette smoking: effects of vitamin E treatment. Atherosclerosis 1997, 129:169–176.PubMedCrossRefGoogle Scholar
  26. 26.
    Dandona P, Thusu K, Cook S, et al.: Oxidative damage to DNA in diabetes mellitus. Lancet 1996, 347:444–445.PubMedCrossRefGoogle Scholar
  27. 27.
    Patrono C, FitzGerald GA: Isoprostanes: potential markers of oxidant stress in atherothrombotic disease. Arterioscler Thromb Vasc Biol 1997, 17:2309–2315.PubMedGoogle Scholar
  28. 28.
    Weber P, Bendich A, Schalch W: Vitamin C and human health: a review of recent data relevant to human requirements. Int J Vitam Nutr Res 1996, 66:19–30.PubMedGoogle Scholar
  29. 29.
    McLaren CJ, Bett JH, Nye JA, Halliday JW: Congestive cardiomyopathy and haemochromatosis-rapid progression possibly accelerated by excessive ingestion of ascorbic acid. Aust N Z J Med 1982, 12:187–188.Google Scholar
  30. 30.
    Weber P, Bendich A, Machlin LJ: Vitamin E and human health: rationale for determining recommended intake levels. Nutrition 1997, 13:450–460.PubMedCrossRefGoogle Scholar
  31. 31.
    Berson EL, Rosner B, Sandberg MA, et al.: Vitamin A supplementation for retinitis pigmentosa. Arch Ophthalmol 1993, 111:1456–1459.PubMedGoogle Scholar
  32. 32.
    Cantorna MT, Nashold FE, Hayes CE: Vitamin A downregulation of IFN-gamma synthesis in cloned mouse Th1 lymphocytes depends on the CD28 costimulatory pathway. J Immunol 1996, 156:2674–2679.PubMedGoogle Scholar
  33. 33.
    Melhus H, Michaelsson K, Kindmard A, et al.: Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Ann Intern Med 1998, 129:770–778.PubMedGoogle Scholar
  34. 34.
    Rothman KJ, Moore LL, Singer MR, et al.: Teratogenicity of high vitamin A intake. N Engl J Med 1995, 333:1369–1373.PubMedCrossRefGoogle Scholar
  35. 35.
    Dwyer JH, Bairey Merz CN, Shircore A, et al.: Progression of early atherosclerosis and intake of vitamin C and vitamin E from supplements and food. The Los Angeles Atherosclerosis Study [abstract]. Circulation 2001, 103:1365D.Google Scholar
  36. 36.
    D'Odorico A, Martines D, Kiechl S, et al.: High plasma levels of alpha- and beta-carotene are associated with a lower risk of atherosclerosis: results from the Bruneck study. Atherosclerosis 2000, 153:231–239. An observational study of 392 randomly selected men and women aged 45 to 65 years followed up for 5 years. Plasma levels of carotenoids (α and ß carotene, lutein, lycopene, zeaxanthin, ß cryptoxathin), vitamins A and E were determined, and atherosclerosis of carotid and femoral arteries was assessed by ultrasonography. Plasma levels of α and ß carotene were inversely associated with the prevalence of atherosclerosis of carotid and femoral arteries.PubMedCrossRefGoogle Scholar
  37. 37.
    Ford ES, Will JC, Bowman BA, Narayan KMV: Diabetes mellitus and serum carotenoids: findings from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 1999, 149:168–176. A cross-sectional study of 1010 control subjects, 277 persons with impaired glucose tolerance, and 230 diabetics aged 40 to 74 years living in the United States. Plasma level of carotenoids, ß carotene, and to lesser degree cryptoxanthin and lycopene, were inversely correlated with the degree of glucose tolerance. All the carotenoids were inversely related to fasting insulin concentration.PubMedGoogle Scholar
  38. 38.
    Klipstein-Grobusch K, Geleijnse JM, den Breeijen JH, et al.: Dietary antioxidants and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr 1999, 69:261–266. An observational trial with a 4-year follow-up of 4802 participants aged 55 to 95 years. Food frequency questionnaire was used for assessment of dietary antioxidant intake. High ß carotene intake but not vitamin C or E was associated with decreased incidence of myocardial infarction.PubMedGoogle Scholar
  39. 39.
    Will JC, Ford ES, Bowman BA: Serum vitamin C concentrations and diabetes: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. Vitamin C in diabetes. NHANES III. Am J Clin Nutr 1999, 70:49–52. A cross-sectional study of 237 patients with diabetes and 1803 nondiabetic subjects aged 40 to 74 years living in the United States. After adjustment for dietary intake of vitamin C and other covariables, mean concentration of serum vitamin C did not differ according to diabetes status.PubMedGoogle Scholar
  40. 40.
    Mayer-Davis EJ, Bell RA, Reboussin BA, et al.: Antioxidant nutrient intake and diabetic retinopathy: the San Luis Valley Diabetes Study. Ophthalmology 1998, 105:2264–2270.PubMedCrossRefGoogle Scholar
  41. 41.
    Coudray C, Roussel AM, Mainard F, et al.: Lipid peroxidation level and antioxidant micronutrient status in a pre-aging population: correlation with chronic disease prevalence in a French epidemiological study (Nantes, France). J Am Coll Nutr 1997, 16:584–597.PubMedGoogle Scholar
  42. 42.
    Mayer-Davis EJ, Monaco JH, Marshall JA, et al.: Vitamin C intake and cardiovascular disease risk factors in persons with non-insulin-dependent diabetes mellitus. From the Insulin Resistance Atherosclerosis Study and the San Luis Valley Diabetes Study. Prev Med 1997, 26:277–278.PubMedCrossRefGoogle Scholar
  43. 43.
    Sanchez-Lugo L, Mayer-Davis EJ, Howard G, et al.: Insulin sensitivity and intake of vitamins E and C in African, Hispanic, and non-Hispanic white men and women: The Insulin Resistance and Atherosclerosis Study (IRAS). Am J Clin Nutr 1997, 66:1224–1231.PubMedGoogle Scholar
  44. 44.
    Jacques PF, Taylor A, Hankinson SE, et al.: Long-term vitam in C supplement use and prevalence of early age related lens opacities. Am J Clin Nutr 1997, 66:911–916.PubMedGoogle Scholar
  45. 45.
    Kushi LH, Folsom AR, Prineas RJ, et al.: Dietary antioxidant vitamins and death from coronary in post-menopausal women. N Eng J Med 1996, 334:1156–1162.CrossRefGoogle Scholar
  46. 46.
    Losonczy KG, Harris TB, Havlik RS: Vitamin E and vitamin C supplement use and risk of all cause and coronary heart disease mortality in older persons: the Established Population for Epidemiologic Studies of the Elderly. Am J Clin Nutr 1996, 64:190–196.PubMedGoogle Scholar
  47. 47.
    Gaziano JM, Manson JE, Branch LG, et al.: A prospective study of consumption of carotenoids in fruits and vegetables and decreased cardiovascular mortality in the elderly. Ann Epidemiol 1995, 5:255–260.PubMedCrossRefGoogle Scholar
  48. 48.
    Salonen JT, Nyyssonen K, Tuomainen TP, et al.: Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. BMJ 1995, 311:1124–1127.PubMedGoogle Scholar
  49. 49.
    Knekt P, Reunanen A, Jarvinen R, et al.: Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 1994, 139:1180–1189.PubMedGoogle Scholar
  50. 50.
    Rimm EB, Stampfer MJ, Ascherio A, et al.: Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993, 328:1450–1456.PubMedCrossRefGoogle Scholar
  51. 51.
    Shoff SM, Mares-Perlman JA, Cruickshanks KJ, et al.: Glycosylated hemoglobin concentrations and vitamin E, vitamin C, and beta carotene intake in diabetic and nondiabetic older adults. Am J Clin Nutr 1993, 58:412–416.PubMedGoogle Scholar
  52. 52.
    Stampfer MJ, Hennekens CH, Manson JE, et al.: Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993, 328:1444–1449.PubMedCrossRefGoogle Scholar
  53. 53.
    Enstrom JE, Kanim LE, Klein MA: Vitamin C intake and mortality among a sample of the United States population. Epidemiology 1992, 3:194–202.PubMedCrossRefGoogle Scholar
  54. 54.
    Gey KF, Puska P: Plasma vitamins E and A inversely correlated to mortality from ischemic heart disease in cross-cultural epidemiology. Ann N Y Acad Sci 1989, 570:268–282.PubMedCrossRefGoogle Scholar
  55. 55.
    de Gaetano G: Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomized trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet 2001, 357:89–95. A controlled, centrally randomized, open-label clinical trial of 4495 people with 3.6 years of follow-up. Patients were divided either to take low-dose aspirin or vitamin E 300 mg/d and each arm was compared with placebo. Vitamin E supplementation conferred no cardiovascular protection.PubMedCrossRefGoogle Scholar
  56. 56.
    Yusuf S, Dagenais G, Pogue J, et al.: Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:154–160. A double-blinded randomized trial with a two-by-two factorial design of 2545 women and 6996 men 55 years or older at high risk of cardiovascular events, randomly assigned to receive either 400 IU of vitamin E or placebo daily for a mean of 4.5 years. There was no benefit of cardiovascular outcome observed with vitamin E supplementation.PubMedCrossRefGoogle Scholar
  57. 57.
    Salonen JT, Nyyssonen K, Salonen R, et al.: Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis. J Intern Med 2000, 248:377–386.PubMedCrossRefGoogle Scholar
  58. 58.
    Lee IM, Cook NR, Manson JE, et al.: Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women's Health Study. J Natl Cancer Inst 1999, 91:2102–2106. A randomized, double-blind, placebo-controlled trial of 39, 876 women aged 45 years or older. A total of 19,939 were in the ß carotene (50 mg on alternate days) arm, 19,937 received placebo, and the rest were divided to receive aspirin or vitamin E. There was no harm or benefit demonstrated in the subjects receiving the ß carotene.PubMedCrossRefGoogle Scholar
  59. 59.
    Dietary supplements with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevention Trial. GISSI-Prevenzione Investigators [no authors listed]. Lancet 1999, 354:447–455.A randomized placebo-controlled trial of 11,324 subjects with a 3.5 year follow-up. Patients were randomly assigned to receive either n-3 polyunsaturated fatty acid (n-3 PUFA) 1 g daily, vitamin E 300 mg daily, both or none. Vitamin E conferred no significant benefit. Dietary supplement with n-3 PUFA led to a clinically significant benefit.Google Scholar
  60. 60.
    Hennekens CH, Buring JE, Manson JE, et al.: Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996, 334:1145–1149.PubMedCrossRefGoogle Scholar
  61. 61.
    Omenn GS, Goodman GE, Thornquist MD, et al.: Risk factors for lung cancer and for intervention effects in CARET: the Beta Carotene and Retinol Efficacy Trial. J Natl Cancer Inst 1996, 88:1550–1559.PubMedCrossRefGoogle Scholar
  62. 62.
    Stephens NG, Parsons A, Schofield PM, et al.: Randomized, controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study. Lancet 1996, 347:781–786.PubMedCrossRefGoogle Scholar
  63. 63.
    The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group [no authors listed]. N Engl J Med 1994, 330:1029–1035.Google Scholar
  64. 64.
    Blot WJ, Li JY, Taylor PR, et al.: Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/ mineral combinations: cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 1993, 85:1483–1492.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2002

Authors and Affiliations

  • Bibi Hasanain
    • 1
  • Arshag D. Mooradian
    • 1
  1. 1.Division of Endocrinology, Diabetes and Metabolism, Department of Internal MedicineSaint Louis University School of MedicineSaint LouisUSA

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