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Species differences in calcium and phosphorus metabolism can be expressed via dietary and faecal calcium/phosphorus ratios. The aim of the present meta-analysis was to use faecal Ca/P ratios as an indicator of phosphorus digestibility in growing pigs as a simple diagnostic tool. This tool can be useful in cases of suspected phosphorus deficiency but adequate dietary calcium and phosphorus contents.Studies (n = 34) with phytase-supplemented (PHYT; n = 110) and non-supplemented control (CON; n = 106) diets were analysed for dietary intake, faecal excretion and apparent digestibility of calcium and phosphorus. A modified Lucas-test was used for both minerals plotting intake against faecal excretion (mg/kg body weightFor calcium, there was no significant difference between PHYT and CON (p = 0.29) while in accordance with literature, the relative faecal phosphorus excretion was significantly lower in PHYT than CON (p0.01). Faecal calcium/phosphorus ratios were calculated and grouped according to the animals' body weight and apparent phosphorus digestibility (body weight ≤ 30 kg: apparent phosphorus digestibility ≤ 60 % and60 %; body weight30 kg: apparent phosphorus digestibility ≤ 40 % and40 %).Data distribution as displayed in a box plot shows that - given a dietary Ca/P ratio of1.2 - faecal Ca/P ratios of1.5 in pigs with a body weight of ≤ 30 kg and of1.2 in pigs with a body weight of30 kg indicate a high apparent digestibility of phosphorus of60 % and40 %, respectively.When faecal samples reveal a Ca/P ratio above the indicated thresholds, a low phosphorus digestibility is unlikely. No conclusion regarding the apparent phosphorus digestibility can be drawn from faecal Ca/P ratios below this threshold.Speziesunterschiede im Kalzium- und Phosphorstoffwechsel lassen sich quantitativ über die Berechnung der Kalzium/Phosphor-Quotienten in Futter und Kot darstellen. In der vorliegenden Meta-Analyse wurde überprüft, ob auf diese Weise eine Aussage zur Phosphorverdaulichkeit bei wachsenden Schweinen getroffen werden kann, um einen möglichst einfachen Prüfparameter zu definieren. Dies ist in Fällen sinnvoll, in denen trotz adäquater Kalzium- und Phosphorgehalte des Futters der Verdacht auf einen Phosphormangel besteht.Es wurden 34 Studien mit phytasesupplementierten Rationen (PHYT; Datensätze n = 110) und entsprechenden Kontrollrationen (CON; Datensätze n = 106) anhand der Parameter Kalzium- und Phosphoraufnahme, fäkale Kalzium- und Phosphorausscheidung und der jeweiligen scheinbaren Verdaulichkeit ausgewertet. Für beide Mineralien kam ein modifizierter Lucas-Test zur Anwendung, indem eine Regressionsberechnung von fäkaler Ausscheidung gegen Aufnahme (beides in mg/kg KMDer Lucas-Test zeigte keinen signifikanten Unterschied der fäkalen Kalziumausscheidung zwischen PHYT und CON (p = 0,29), während der in der Literatur vielfach beschriebene positive Effekt der Phytase auf die Phosphorverdaulichkeit sehr deutlich wurde (p0,01). Die fäkalen Kalzium/Phosphor-Quotienten aller Datensätze wurden berechnet und gruppiert, und zwar nach der Körpermasse (KM) der Tiere sowie der scheinbaren Phosphorverdaulichkeit (KM ≤ 30 kg: scheinbare Phosphorverdaulichkeit ≤ 60 % und60 %; KM30 kg: scheinbare Phosphorverdaulichkeit ≤ 40 % und40 %).Aus der Datenverteilung im Box Plot kann – unter der Voraussetzung eines Kalzium/Phosphor-Verhältnisses im Futter von ≥ 1,2 – bei einem fäkalen Kalzium/Phosphor-Quotienten von1,5 (für Schweine ≤ 30 kg KM) bzw.1,2 (für Schweine30 kg KM) auf eine hohe scheinbare Phosphorverdaulichkeit von über 60 % bzw. 40 % geschlossen werden.Werden in Kotproben Kalzium/Phosphor-Quotienten über diesen Schwellenwerten erreicht, ist eine schlechte Phosphorverdaulichkeit somit unwahrscheinlich. Bei fäkalen Kalzium/Phosphor-Quotienten unterhalb dieser „Grenzwerte“ ist keine Einschätzung der Phosphorverdaulichkeit möglich.

This case report presents investigations of muscle problems in three male water buffaloes (1-2 years) kept extensively (loose housing, pasture). The bulls were presented because of listlessness and increased lying periods. They displayed difficulties to stand up, a stilted gait, and tremor in the legs. The determination of the selenium concentration by the measurement of glutathione peroxidase activity in whole blood samples (EDTA) demonstrated selenium deficiency in all three buffaloes. This confirmed the tentative diagnosis of nutritive myodystrophy due to selenium deficiency. Following a single injection of 1500 mg all-rac-alpha-tocopherol acetate and 11 mg sodium selenite, the bulls recovered clinically. The whole blood samples taken subsequently from seven adult water buffaloes on the farm showed selenium deficiency in all animals. Consequently, slow-release multi-trace element boluses were administered once orally - as far as possible - to all adult animals of the herd. After 1 year, a good to very good selenium supply was observed in all these buffaloes, except for one cow, in which bolus application had failed.

Iron deficiency (ID) occurs in up to 50% of patients with heart failure (HF). Even without presence of anaemia ID contributes to more severe symptoms, increased hospitalization and mortality. A number of randomized controlled trials demonstrated the clinical benefit of replenishment of iron stores with improvement of symptoms and fewer hospitalizations. Assessment of iron status should therefore become routine assessment in newly diagnosed and in symptomatic patients with HF. ID can be identified with simple and straightforward diagnostic steps. Assessment of Ferritin (indicating iron stores) and transferrin saturation (TSAT, indication capability to mobilise internal iron stores) are sufficient to detect ID. In this review a plain diagnostic algorithm for ID is suggested. Confounding factors for diagnosis and adequate treatment of ID in HF are discussed. A regular workup for iron deficiency parameters may benefit patients with heart failure by providing symptomatic improvements and fewer hospitalizations.

Evaluation of differences in the selenium supply of cattle across Europe.A total of 35,722 serum samples from cattle throughout Europe (unknown clinical status), which had been sent by veterinarians to the IDEXX Vet Med Lab Ludwigsburg, Germany between January 1st, 2006, and June 30th, 2013, were analyzed routinely for the selenium concentration using ICP-analysis.The collective data of the selenium concentration in cattle serum display seasonal variations, with a lower concentration during summer when compared to the winter. In recent years, the selenium supply has decreased. The farm size, husbandry conditions, economic situation, soil selenium concentration and the countries' specific feeding together play a key role in the selenium supply of the herd. Hungary and the Scandinavian countries Sweden and Denmark show the best selenium supply in Europe. A very poor situation exists in France and Luxembourg (50% of the cattle samples are undersupplied).An optimal selenium supply for cattle is very important; a trace element deficiency can cause negative health effects and impair herd performance. The selenium concentration varies considerably, depending upon feeding and husbandry conditions. Therefore, a serum selenium analysis in cattle is essential and should be performed annually.

The increasing prevalence of morbid obesity in Germany is associated with an increasing number of metabolic surgical interventions. Short-term surgical and long-term metabolic complications such as nutrient deficiencies can be considered the main risks of metabolic surgery and its restrictive and malabsorbant surgical procedures. The aim of this compact short overview based on a selective literature search and our own clinical experience is to characterise the long-term metabolic complications, which are specific for the various bariatric procedures, and to refine the published guidelines for supplementation. Restrictive bariatric procedures can be associated with well-known surgical problems such as pouch dilatation or band migration, e.g., after gastric banding. After sleeve gastrectomy, emerging reflux disease can become a substantial problem. The most frequent deficiencies after restrictive procedures are related to B-vitamins whereas iron, folate, vitamin B1 and B12 and vitamin D deficiencies are associated with the malabsorptive procedure such as biliopancreatic diversion, duodenal switch and Roux-en-Y gastric bypass. Due to possible metabolic and surgical complications after bariatric surgery, patients need to undergo life-long medical follow-up investigations. The currently available guidelines of German Society of Treatment of Obesity (CAADIP) of DGAV for supplementation should be known and followed, in particular, by the physicians who i) are exceptionally involved in medical care of obese people and ii) do it in full awareness of the obligatory postoperative clinical observation.

In recent years the number of bariatric surgery has markedly increased in industrial nations. Surgery provides a more rapid decrease of body weight than conservative approach. However a long term conservative follow up therapy is mandatory to stabilize reduced weight. Due to increasing knowledge from long term follow up of surgically treated obese patients there is a growing body of evidence that frequently there is necessity of reoperations and of substitution both of trace elementsand of minerals or vitamins due to their hampered enteral resorption. Additionally therapy of surgery induced endocrine alterations not seldom is necessary.These insights are of outstanding importance because meanwhile an enlargement of the indications for bariatric surgery as a therapeutic option for metabolic disorders is being discussed. This review refers to the recent internationally published papers concerning consequences of bariatric surgery.

Worldwide the obesity epidemic is becoming one of the leading causes of mortality and morbidity. The rates of bariatric surgery procedures are sharply increasing. Today it is the only treatment option for a substantial and durable long-term weight loss. However, bariatric surgery is not a guarantee of successful weight loss and maintenance. For all patients undergoing bariatric surgery, education and clinical management to prevent and detect nutritional deficiencies are recommended. Particularly for patients undergoing malabsorptive procedures, the management of potential nutritional deficiencies is important. Strategies should be employed to compensate for food intolerance aiming at risk reduction for nutritional deficiencies. All patients should receive care from a multidisciplinary team and be considered for comprehensive perioperative program for nutrition and lifestyle management.

Iron deficiency (ID) without anaemia frequently remains undiagnosed when symptoms are attributed to ID with anaemia. Serum ferritin is the primary diagnostic parameter, whereas10 microg/l represent depleted iron stores, 10-30 microg/l can confirm ID without anaemia and 30-50 microg/l might indicate functional ID. In case of increased CRP or ALT, normal/elevated ferritin should be interpreted with caution. Intravenous iron is indicated if oral iron is not effective or tolerated. At ferritin10 microg/l, a cumulative dose of 1000 mg iron and at ferritin 10-30 microg/l, a cumulative dose of 500 mg is advised. At ferritin 30-50 microg/l a first dose of 200 mg might be considered. Ferritin shall be reassessed not sooner than 2 weeks after the last oral or 8-12 weeks after the last iv iron administration.

Short bowel syndrome (SBS) is defined in adults as a malabsorption disorder as a result of shortening the bowel to200 cm. The severity of symptoms is less dependent on the amount of residual intestine than on the anatomical position of the resected bowel, the type of operative reconstruction, and the type and quality of nutritional, medical, and surgical treatment. Numerous complications and deficiency symptoms are associated with SBS. The extent of deficient nutrition should be determined. The need to create accesses for enteral and parenteral delivery, to supply supplementation as needed, perform pharmacological therapy, and in individual cases surgical treatment all necessitate a broad knowledge of nutritional medicine. The goals of therapy are correction and prevention of malnourishment, restoration of a normal nutritional status, and the normal thriving of children. Complications should be avoided, particularly those problems associated with parenteral nutrition. The frequency of diarrhea should be reduced. Overall, the aim is to achieve an optimized quality of life.

As shown in the first part of this article, consuming high amounts of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. However, the relevance of animal foods consumed within a vegetarian diet is less well-known.We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE-research was performed for all animal food groups relevant with a vegetarian diet (key words: "eggs", "milk", "dietary pattern" "vegetarian diet", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis", "vitamin D", "vitamin B(12)", "iron", "iodine"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence.Based on the evidence criteria of the WHO/FAO, colorectal cancer risk reduction by a high intake of milk and milk products is assessed as probable, while a higher risk of prostate and ovarial carcinomas is also probable. The evidence of a risk-increasing effect of eggs relating to cardiovascular disease, colorectal cancer and breast cancer is assessed as probable. As the data of prospective cohort studies suggest, a prudent diet pattern characterized high in fruits, vegetables, whole grains and nuts is associated with a lower risk of coronary heart disease and diabetes mellitus type 2. In contrast, there is no overall association between prudent diet pattern and risk of breast cancer or colorectal cancer. The critical key nutrients for vegetarians are vitamin D and B12, iodine and iron.For the first time evidence based dietary recommendations were provided for persons on a vegetarian diet in the D-A-CH-region.