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Vitamins As Markers of Nutrition: What Vitamers Do We Measure?

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Vitamins As Markers of Nutrition: What Vitamers Do We Measure? Int J Anal Bio-Sci Vol. 9, No 1 (2021) 〈Review Article〉 Vitamins as markers of nutrition: What vitamers do we measure? Sachiko Kiuchi1, Hiroshi Ihara2*, Yoshikazu Nishiguchi3, Noriko Ishihara2, Nobue Ito2, Takeyoshi Murano2, Hiromitsu Yokota4 and Naotaka Hashizume5 Summary Nutritional assessment of vitamins is performed not only using a dietary questionnaire but by also determining the deficiency or the abundance of certain vitamins in blood or urine speci- mens. Every vitamin has several vitamers (defined as compounds with a molecular structure similar to that of a particular vitamin, which is comparable to “isomers” in chemical analysis). Therefore, there is a need for knowledge of the vitamers that we measure as markers of nutrition. Herein, we summarize the findings published to date on the vitamers of four vitamins (vitamin A, vitamin D, vitamin B1, and vitamin C), as the Japanese tend to be deficient in their daily intake of these four vitamins. The physiological functions, blood concentrations, and half-lives of the vita- mers were considered in this review. Key words: ‌Nutritional assessment, Retinol, 25-Hydroxyvitamin D, Thiamine pyrophosphate, Ascorbic acid from dietary tryptophan, and menaquinone-7 1. Introduction (vitamin K) is synthesized by enteric bacteria and is absorbed through the portal vein1. Moreover, some Vitamins are essential nutrients required for a amount of cholecalciferol (vitamin D) is synthesized healthy life in humans. Our body cannot synthesize from 7-dehydrocholesterol present in the skin that most of the vitamins except for niacin, menaqui- was exposed to ultraviolet B radiation in sunlight at none-7, and cholecalciferol. Niacin is synthesized body temperature. Unfortunately, the production of 1Department of Health and Medical Sciences, Faculty 4Keio University Hospital, Office of Clinical of Risk and Crisis Management, Chiba Institute of Laboratory Technology, 35 Shinanomachi, Shinjuku, Science, 15-8 Choshi, Chiba 288-0025, Japan Tokyo 160-8582, Japan 2Medical Technology Course, Faculty of Science, Toho 5KSO Corporation, 1-9-7 Shibaura, Minato, Tokyo University, 2-2-1 Miyama, Funabashi, Chiba 274-8510, 105-0023, Japan Japan *Corresponding author: Hiroshi Ihara, Medical 3Laboratory of Molecular Cell Biology, Department of Technology Course, Faculty of Science, Toho Clinical Pharmacy, Faculty of Pharmaceutical Sciences, University, 2-2-1 Funabashi, Chiba 274-8510, Japan Graduate School of Pharmaceutical Science, Josai E-mail: [email protected] International University, 1 Gumyo, Togane, Chiba 283-8555, Japan Received for publication: December 14, 2020 Accepted for publication: February 3, 2021 ― 1 ― Int J Anal Bio-Sci Vol. 9, No 1 (2021) such vitamins does not meet our daily requirement. major vitamers present at high concentrations in Therefore, there is a need for vitamin intake through body fluids. diet or dietary supplements. The recent National Health and Nutrition Vitamin A Survey in Japan (NHNS-J), conducted in 2018, In humans, vitamin A is present in plant foods revealed that median (and/or average) intake levels and consumed in the form of β-carotene, which is of vitamin A, vitamin D, vitamin B1, and vitamin C converted to retinal. Vitamin A is also consumed as were apparently lower than the defined reference retinyl esters (mostly as retinyl palmitate) from intake level for each vitamin2. However, because animal foods. Although vitamin A has three major dietary intake assessment does not consider the vitamers, namely, retinal, retinol, and retinoic acid, magnitude of vitamin absorption in the small intes- “retinol” is the vitamer exclusively measured for tine, it is somewhat less accurate than the selected nutritional assessment1,5. Retinal is bound to opsins analysis of vitamins in body fluids such as blood and in visual function, and retinoic acid binds to the urine. nuclear receptor for the regulation of genomic The Dietary Reference Intakes (DRIs) for the expression. Fundamentally, retinal (11-cis form) is United States and Canada3-6, and Japan7 has defined formed from retinol in the retinal pigment epithelium the nutrient intake levels for four fat-soluble vita- of the ocular tissue8, and thus, serum retinal concen- mins (vitamin A, vitamin D, vitamin E, and vitamin tration (mouse data) is 4% (32.2 nmol/L) that of 9 K) and nine water-soluble vitamins (vitamin B1, retinol (810 nmol/L) . The half-life of retinoic acid vitamin B2, vitamin B6, niacin, pantothenic acid, is 0.8 hr, and its serum concentration (23.2 nmol/L) folate, vitamin B12, biotin, and vitamin C). All of is lower than that of retinol (1.05–2.80 μmol/L) in these vitamins have several vitamers1 (i.e., humans10,11. Retinol, the transporting form of vitamin compounds with a molecular structure similar to a A, has no physiological function; however, it particular vitamin, which are comparable to behaves as the vitamin A reservoir in the plasma “isomers” in chemical analysis), among which (Table 1). Previously, we revealed that plasma levels selected vitamers are used as a marker for nutritional of retinol remain constant until the retinol stored in assessment. Therefore, there is a need for knowledge the liver (as retinyl esters) becomes exhausted12. of the vitamers that we measure as markers of nutri- Retinol present in circulating plasma binds to the tion. In this short review, we present an overview of retinol-binding protein 4 (RBP4) and becomes the most recent evidence, including our observations complexed with transthyretin as an equimolar on vitamers of the aforementioned four vitamins binding of each of the three compounds. measured in body fluids such as blood and urine that Accordingly, serum retinol levels can be nearly esti- can be used as a marker for assessing nutritional mated from serum RBP4 concentrations. Holo-RBP4 status. bound to transthyretin exclusively exists in circu- lating plasma but not in tissues and has a half-life of 1 2. Fat-soluble vitamins 11–16 hr in humans . Among fat-soluble vitamins, vitamin A, vitamin Vitamin D K, and vitamin D bind to the nuclear receptor. Vitamin D has two major vitamers: ergocalcif- β-Carotene (precursor of vitamin A) and vitamin E erol (vitamin D2) and cholecalciferol (vitamin D3). act as an antioxidant, while vitamin K acts as a Vitamin D is hydrophobic; therefore, all vitamin D coenzyme apart from being a ligand that binds to the vitamers present in the plasma become bound to nuclear receptor1. Although vitamin A and vitamin vitamin D-binding protein (DBP). Ergocalciferol is D and their metabolites have several kinds of struc- synthesized by the photolysis of plant sterols, and tural and geometrical isomers8, we describe only cholecalciferol is synthesized through the photolysis ― 2 ― Int J Anal Bio-Sci Vol. 9, No 1 (2021) Table 1 Selected markers of nutrition in major vitamers of 7-dehydrocholesterol in the skin. Ergocalciferol Vitamin B1 8 and cholecalciferol are converted to 25-hydroxyvi- Vitamin B1 has four vitamers : thiamine, thia- tamin D2 (25-OH-D2) and D3 (25-OH-D3) by mine monophosphate (TMP), thiamine hydroxylation, respectively, in the liver, which does pyrophosphate (TPP), and thiamine triphosphate 1 not retain 25-OH-D2 and 25-OH-D3 . They are trans- (TTP). Plant foods are rich in thiamine, while animal ported to the kidney and further hydroxylated to the foods are rich in TPP and TTP1,3. Thiamine phos- active form of vitamin D, i.e., 1,25-(OH)2-D2 and phate esters are absorbed in the jejunum of the small 1,25-(OH)2-D3. Both 1,25-(OH)2-D2 and 1,25- intestine after hydrolysis to thiamine by intestine (OH)2-D3 bind to the nuclear receptors of vitamin D alkaline phosphatase. Body cells including erythro- distributed mainly in bone osteoblasts and epithelial cytes contain all four forms of B1 vitamers; however, cells of the kidney and intestine. 25-OH-D3 has a thiamine and TMP are predominantly present in the longer half-life in circulating plasma (2–3 wk) than plasma16. TPP and TTP have physiological func- 13 1,25-(OH)2-D3 (4–6 hr) ; therefore, “25-OH-D3” tions; TPP acts as a coenzyme for various enzymes reflects the body’s store of vitamin D and is consid- involved in the carbohydrate and amino acid metab- ered as a marker of nutritional status6 (Table 1). The olism. The physiological functions of TTP are not serum concentration11 is 16–65 pg/mL for 1,25- exactly known, but it is considered to have an effect (OH)2-D3 and 14–60 ng/mL for 25-OH-D3. In our on neurotransmission. Therefore, “TPP” is consid- 14 study , because the concentration of 25-OH-D2 is ered as a marker of vitamin B1 nutriture (Table 1). less than 1.0 ng/mL, it is unsuitable for consideration TMP is reported to be a more sensitive marker of as a nutritional marker. Tissues (e.g., beef kidney) deficiency than TPP according to the catabolic contains low amounts of 25-OH-D3, i.e., 0.9–23.3 pathway wherein TMP is formed exclusively from ng/g as compared with that in plasma, although the TPP17. Unfortunately, we have not encountered such highest concentrations are found in the kidney and a case thus far. Herein, the whole-blood concentra- the lowest in muscle meat (0.2–4.1 ng/g)15. tion is 2–18 nmol/L for thiamine, 4–60 nmol/L for TMP, 63–229 nmol/L for TPP, and 0–4 nmol/L for 18,19 3. Water-soluble vitamins TTP , while the serum concentration is 1–15 nmol/L for thiamine, 1–16 nmol/L for TMP, 0–3 Water-soluble vitamins function as enzyme nmol/L for TPP, and 0.0 nmol/L for TTP. The elimi- cofactors. Among water-soluble vitamins, vitamin C nation half-life of TPP (664 min by intravenous acts as a coenzyme for several enzymes, and addi- administration) is longer than that for thiamine (96 tionally acts an antioxidant.
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