Very few studies to date have assessed nutritional biomarkers in pregnant vegan women, and very few nutrients have been assessed. The present prospective, two-centre pilot study compared pregnant vegans (n = 32) and omnivores (n = 13) in Germany (2019–2021). Fourteen circulating biomarkers were measured at gestational weeks 9–16 (t1) and 35–38 (t2). After adjustment for covariates, no statistically significant differences were found between groups at either time point for mean circulating levels of vitamin B12 markers (holotranscobalamin, methylmalonic acid), vitamin B2, folate, vitamin D (25-hydroxyvitamin D), iron markers (haemoglobin, ferritin), or gamma-linolenic acid. In contrast, vegans displayed significantly lower levels of eicosapentaenoic acid (-52%), docosahexaenoic acid (-43%), dihomo-gamma-linolenic acid (DGLA; −31%), and arachidonic acid (-23%) at t1. At t2, vegans had higher alpha-linolenic acid (+62%) and linoleic acid (+29%) and lower DGLA (-22%) levels. These findings suggest acceptable vitamin B12, vitamin D, vitamin B2, and iron status in supplementing pregnant vegans, similar to omnivores, but notable differences in certain fatty acids, possibly reflecting intake and the near-absence of long-chain omega-3 and omega-6 fatty acids in common food plants. Sample size was small, and the results require replication in adequately powered studies.

The aim of the MultiVeg study, a double-blind, randomised controlled trial (RCT), was to investigate the nutritional status of healthy vegans following 4 months of multinutrient supplementation. A double-blind, RCT was conducted with 72 vegan adults (19–57 years) in Germany. Data on anthropometric parameters, dietary nutrient intake, and nutritional status were collected. The nutritional status of the participants was assessed at baseline and after 4 months. The results were compared between groups using ANCOVA. The results for vitamins and choline are presented here. After adjustment for baseline values, age, sex, and multiple testing, no significant between-group differences in biomarker concentration changes from baseline to 4 months were observed for vitamin A, retinol-binding protein, transthyretin, beta-carotene, methylmalonic acid, homocysteine, choline, total osteocalcin, carboxylated and undercarboxylated osteocalcin, and folate. In contrast, significant between-group differences in changes were observed for flavin adenine dinucleotide (FAD), serum vitamin B12, holotranscobalamin, and the combined vitamin B12 status indicator (cB12) after adjustment. A multinutrient supplement containing 82 µg of vitamin B12 per day significantly positively affected vitamin B12 blood biomarkers in healthy vegans. This study was registered in the German Clinical Trials Register (DRKS00028151).

Background and objectives: There is a lack of data on the environmental impact of children’s and adolescents’ food consumption as most studies only consider adult dietary intake and, in addition, use hypothetical diets or focus on specific food products. Hence, our aim was to assess two indicators of environmental impact of the total diet among omnivorous (OM), vegetarian (VG), and vegan (VN) children and adolescents from Germany. Methods: Greenhouse gas emissions (GHGE) and land use (LU) were calculated using 3-day weighed dietary records from 820 participants (1–18 years old) of the cross-sectional VeChi Diet Study (n = 430, 1–3 years of age, conducted 2016–2018), the VeChi Youth Study (n = 390, 6–18 years, 2017–2019), and the life cycle-analyses food-item (SHARP-Indicators) database. Group differences of indicators were analysed using analysis of covariance. Results: On average, food consumption of OM, VG, and VN diets caused GHGE of 2.6, 1.6, and 1.0 kg CO2eq/kg food and LU of 3.1, 2.0, and 1.6 m2·year/kg food, respectively. The median total daily GHGE and LU amounts differed significantly between diet groups (p < 0.001). Standardisation to energy intake per 1000 kcal (GHGE: (OM) 2.2, (VG) 1.3, (VN) 0.9 kg CO2eq/1000 kcal; LU: (OM) 2.5, (VG) 1.6, (VN) 1.3 m2·year/1000 kcal) confirmed these results. Discussion and conclusions: To the best of our knowledge, this is the first evaluation to show that even in children and adolescents, the GHGE and LU caused by an OM diet is considerably higher than the GHGE and LU on a VG or VN diet. In this way, plant-based diets performed better in terms of environmental sustainability.

Introduction: The German market for dietary supplements and fortified foods is of considerable size, and many target-group-specific products, e.g., for vegans and vegetarians, are available. Growing sales volumes in recent years reflect the large demand for these products. However, the broad variety and easy availability may lead to unfavorable use of these products. Methods: The VeChi Youth Study (2017–2019) was a cross-sectional study among vegan (VN), vegetarian (VG), and omnivorous (OM) participants aged 6 to 18 years (n = 401). Dietary data were collected from 3-day weighed dietary records (n = 390). The present analysis investigates nutrient intake from dietary supplements and unfortified/fortified foods. Results: VN had the highest dietary supplement use and the highest intake of fortified foods (both significantly different from OM; p < 0.0001 and p = 0.0342, respectively). Among VN and VG, vitamins B12 and D were the most frequently supplemented nutrients, while among OM, this was vitamin C. The mean nutrient intake from dietary supplements (excluding vitamins B12 and D) and fortified foods contributed up to 49% and 11% of the German reference values, respectively. Except for iron, VN had the highest mean intake of all nutrients from dietary supplements. Including unfortified and fortified foods as well as supplements, the mean intake in all three diet groups reached the reference values for vitamin B12, vitamin C, iron, and zinc but not for calcium and iodine. Discussion: Dietary supplements, and to a smaller extent fortified foods, increased the nutrient intake of the participants of the VeChi Youth Study. In order to achieve recommended intakes, the intake of dietary supplements and fortified foods was either unnecessary (e.g., vitamin C), not sufficiently effective (e.g., calcium and iodine), or effective (e.g., vitamin B12). Conclusions: Specific intake of dietary supplements is useful to improve the intake of critical nutrients in VN and VG diets, especially for vitamins B12 and D. In Germany, fortified foods appear to contribute only to a small extent to the intake of critical nutrients in VN and VG children and adolescents.

Introduction The Consensus Guidelines of the TDM-AGNP working group contains a comprehensive list of therapeutic reference ranges, often derived from clinical trials with strict predefined inclusion criteria [1]. The goal of this study is to analyze whether these ranges are reflected in routine patient care using samples from a medical laboratory.

Myasthenia gravis (MG) is the most common autoimmune disease affecting the neuromuscular junction by specific autoantibodies. The etiology of MG and its heterogeneity in clinical courses are poorly understood, although it was recently shown that gut microbial dysbiosis plays a critical role. Since levels of Calprotectin (CLP) seem to correlate with level of dysbiosis, we hypothesize that CLP may serve as potential disease activity biomarker in MG. Sera from 251 patients with MG and 90 controls were analyzed in an explorative, cross-sectional design. Prospectively, we tested CLP levels in MG patients up to 3 years. Association of CLP levels with socio-demographics, disease activity (quantitative myasthenia gravis (QMG) score, myasthenia gravis-specific Activities of Daily Living scale (MG-ADL)), antibody (Abs) status, history of myasthenic crisis, treatment regime, and history of thymectomy were investigated using univariate analysis. Mean baseline serum levels of CLP were significantly higher in MG patients compared to controls (4.3 μg/ml vs. 2.1 μg/ml; p < 0.0001). Higher levels of CLP were associated with a higher clinical disease severity measured by MGFA classification and QMG score. Nevertheless, the only weak correlation of CLP with clinical outcome parameters needs confirmation in future studies. Currently, there are no validated blood biomarkers for MG. The significantly elevated CLP and mild correlation with parameters of disease activity suggests that CLP holds promise as a biomarker for measurement of individual disease severity.

There is a lack of data on associations between modern vegetarian and vegan diets and health among children and adolescents. The aim of the Vechi Youth Study was to cross-sectionally examine anthropometry, dietary intakes and nutritional status in a sample of 149 vegetarian, 115 vegan and 137 omnivore children and adolescents (6–18 years old, mean age: 12.7 ± 3.9 years). Group differences of dietary intake (calculated from three-day dietary records), nutrient biomarker and blood lipid concentrations were assessed using an analysis of covariance, adjusted for sex, age and other covariates. The total energy intake did not differ significantly between groups, but intake of carbohydrates was higher among vegetarians and vegans than among omnivores (p = 0.0002, respectively). The median protein intake exceeded 0.9 g/kg body weight/day in all diet groups and was lowest among vegetarians (p < 0.02). There was no significant difference of haemoglobin, vitamin B2, 25-OH vitamin D3, HDL-C and triglycerides blood concentrations between diet groups. Vegan participants had higher folate concentrations than vegetarian participants (p = 0.0053). Ferritin concentration was significantly higher in omnivores than in vegetarians (p = 0.0134) and vegans (p = 0.0404). Vegetarians had lower concentrations of holotranscobalamin (p = 0.0042) and higher concentrations of methylmalonic acid (p = 0.0253) than omnivores. Vegans had the lowest non-HDL-C and LDL-C concentrations in comparison to vegetarians (p = 0.0053 and p = 0.0041) and omnivores (p = 0.0010 and p = 0.0010). A high prevalence (>30%) of 25-OH vitamin D3 and vitamin B2 concentrations below reference values were found irrespective of the diet group. In conclusion, the Vechi Youth Study did not indicate specific nutritional risks among vegetarian and vegan children and adolescents compared to omnivores.

Background: The oral application of vitamin B-12 may prevent its deficiency if the vitamin is absorbed via the mucosal barrier. Objectives: We studied the effect of the use of a vitamin B-12– fortified toothpaste on vitamin-status markers in vegans and assessed the efficiency of markers in the identification of vitamin-augmentation

Background: The oral application of vitamin B-12 may prevent its deficiency if the vitamin is absorbed via the mucosal barrier.Objectives: We studied the effect of the use of a vitamin B-12-fortified toothpaste on vitamin-status markers in vegans and assessed the efficiency of markers in the identification of vitamin-augmentation status.Design: In this 12-wk, double-blinded, randomized, placebo-controlled study, 76 vegans received either a placebo (n = 34) or vitamin B-12 (n = 42) toothpaste. Sixty-six subjects (n = 30 in the placebo arm; n = 36 in the vitamin B-12 arm) completed the intervention. Serum and plasma concentrations of vitamin B-12, holotranscobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA) were measured before and after the intervention.Results: Both postintervention concentrations of vitamin B-12 and holotranscobalamin and their changes over 12 wk were higher in the vitamin B-12 group (mean ± SD change: 81 ± 135 pmol/L for vitamin B-12 and 26 ± 34 pmol/L for holotranscobalamin) than in the placebo group (-27 ± 64 and -5 ± 17 pmol/L, respectively) after adjustment for baseline concentrations. Postintervention concentrations of MMA and their changes differed significantly between groups (MMA changes: -0.169 ± 0.340 compared with -0.036 ± 0.544 μmol/L in vitamin B-12 and placebo groups, respectively; P < 0.001). After adjustment for baseline tHcy, postintervention concentrations of tHcy tended to be lower (P = 0.051), and the changes in tHcy (-0.7 ± 4.4 compared with 2.0 ± 5.6 μmol/L, respectively) were greater in the vitamin B-12 group than in the placebo group. Changes in vitamin B-12 markers were more prominent in vegans who reported that they had not taken vitamin B-12 supplements.Conclusion: Vitamin B-12 that is applied to the oral cavity via toothpaste enters the circulation and corrects the vitamin B-12 markers in the blood of vegans who are at higher risk of vitamin B-12 deficiency. This trial was registered at clinicaltrials.gov as NCT02679833.

We retrospectively analyzed outcomes of a CD34(+)-selected stem cell boost (SCB) without prior conditioning in 32 patients (male/22; median age of 54 years; range, 20 to 69) with poor graft function, defined as neutrophils ≤1.5 x 10(9)/L, and/or platelets ≤30 x 10(9)/L, and/or hemoglobin ≤8.5 g/dL). The median interval between stem cell transplantation and SCB was 5 months (range, 2 to 228). The median number of CD34(+) and CD3(+) cells were 3.4 x 10(6)/kg (.96 to 8.30) and 9 x 10(3)/kg body weight (range, 2 to 70), respectively. Hematological improvement was observed in 81% of patients and noted after a median of 30 days (range, 14 to 120) after SCB. The recipients of related grafts responded faster than recipients of unrelated grafts (20 versus 30 days, P = .04). The cumulative incidence of acute (grade II to IV) and chronic graft-versus-host disease (GVHD) after SCB was 17% and 26%, respectively. Patients with acute GVHD received a higher median CD3(+) cell dose. The 2-year probability of overall survival was 45%. We suggest that SCB represents an effective approach to improve poor graft function post transplantation, but optimal timing of SCB administration, anti-infective, and GVHD prophylaxis needs further evaluation.

Hydroxyethyl starch (HES) is an important industrial additive in the paper, textile, food, and cosmetic industries and has been shown to be an effective cryoprotectant for red blood cells; however, little is known about its thermodynamic solution properties. In many applications, in particular those in biology, HES is used in an aqueous solution with sodium chloride (NaCl). The osmotic virial solution thermodynamics approach accurately captures the dependence of osmolality on molality for many types of solutes in aqueous systems, including electrolytes, sugars, alcohols, proteins, and starches. Elliott et al. proposed mixing rules for the osmotic virial equation to be used for osmolality of multisolute aqueous solutions [Elliott, J. A. W.; et al. J. Phys. Chem. B 2007, 111, 1775-1785] and recently applied this approach to the fitting of one set of aqueous HES-NaCl solution data reported by Jochem and Körber [Cryobiology 1987, 24, 513-536], indicating that the HES osmotic virial coefficients are dependent on HES-to-NaCl mass ratios. The current study reports new aqueous HES-NaCl vapor pressure osmometry data which are analyzed using the osmotic virial equation. HES modifications were measured after dialysis (membrane cut off: 10,000 g/mol) and freeze-drying using vapor pressure osmometry at different mass ratios of HES to NaCl for HES up to 50% and NaCl up to 25% with three different HES modifications (weight average molecular weights [g/mol]/degree of substitution: 40,000/0.5; 200,000/0.5; 450,000/0.7). Equations were then fit to the data to provide a model for HES osmotic virial coefficient dependence on mass ratio of HES to NaCl. The osmolality data of the three HES modifications were accurately described over a broad range of HES-to-NaCl mass ratios using only four parameters, illustrating the power of the osmotic virial approach in analyzing complex data sets. As expected, the second osmotic virial coefficients increase with molecular weight of the HES and increase with HES-to-NaCl mass ratio.

Die transfusionsassoziierte akute Lungeninsuffizienz (TRALI) hat sich nach Einführung der Bezeichnung „TRALI“ durch Popovsky et al. vor annähernd 3 Jahrzehnten zur häufigsten Ursache der transfusionsbedingten Morbidität und Mortalität entwickelt. Vor Implementierung von Maßnahmen zur Risikominimierung, wie der Spenderselektion, war die TRALI überwiegend für transfusionsassoziierte Todesfälle verantwortlich. Plasmareiche Präparate, wie gefrorenes Frischplasma und Thrombozytenkonzentrate, sind als führende Auslöser beschrieben worden. Definitionsgemäß bedeutet die TRALI eine Verschlechterung der Lungenfunktion mit Hypoxämie und Entwicklung von radiologisch gesicherten, nichtkardiogenen, bilateralen Lungeninfiltraten innerhalb von 6 h nach stattgefundener Transfusion. Die Diagnose ist schwierig, und differenzialdiagnostisch müssen Herzinsuffizienz und andere transfusionsbedingte Lungenschäden, wie z. B. „transfusion-associated circulatory overload“ (TACO), unterschieden werden. Eine kausale Therapie ist bisher nicht möglich, daher beschränken sich therapeutische Maßnahmen auf Sauerstoffinsufflation und ggf. mechanische Ventilation. Über die genaue Pathogenese herrscht bisher noch Uneinigkeit. Die in der Literatur favorisierte Hypothese geht von einem „Two-event“-Modell aus, bei der als „first event“ die Sensibilisierung von neutrophilen Granulozyten durch bestimmte Umstände, wie Sepsis oder Trauma, stattfindet. Im Rahmen des „second event“ kommt es durch transfundierte Antikörper (immunogene TRALI) und biologisch aktive Mediatoren (nichtimmunogene TRALI) zur Aktivierung der sensibilisierten neutrophilen Granulozyten mit anschließender Freisetzung von u. a. Proteasen sowie Radikalen, gefolgt von der Entwicklung einer kapillären Leckage und eines Lungenödems. Bis zur Einführung der Spenderselektion, bei der weibliche Spender mit zurückliegenden Schwangerschaften und mit Antikörpern gegen das humane Neutrophilenantigen (HNA) und/oder das humane Leukozytenantigen (HLA) ausgeschlossen werden, schien der Second event durch Transfusion antileukozytärer Antikörper dieser Spendergruppe v. a. immunogener Art zu sein. So konnte die 2009 in Deutschland eingeführte Spenderselektion das Auftreten von tödlichen TRALI-Fällen in den nachfolgenden Jahren vollständig verhindern.