transcript
- Slide 1
- By: Susan Albert
- Slide 2
- Vitamin K Fat soluble vitamin Stands between life and death
Coenzyme Family of compounds Phylloquinone (K1) Menaquiones (K2)
Menadione (K3) (Insel P., Turner, E., Ross, D., 2007)
- Slide 3
- Functions of Vitamin K Blood clotting Factor II, Factor VIII,
Factor IX Inactive clotting factor X Vitamin K (adds carbon dioxide
to glutamic acid) Calcium Factor Xa Prothrombin Thrombin (Gropper
et al., 2009)
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- Bone Formation Inactive osteocalcin (substrate) Vitamin K
Calcium Mechanism of action: carboxylation Active osteocalcin
(product) (Insel et al., 2007)
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- Recommendations Deficiencies are extremely rare No tolerable
upper intake level Adequate Intake (AI) Men: 120 micrograms/day
Women: about 90 micrograms/day Children: 30-55 micrograms/day
(Insel et al., 2007)
- Slide 6
- Sources of Vitamin K Other sources: vegetable oils (soybean,
cottonseed, canola, and olive), animal products (egg yolks, butter,
various cheeses, liver), soybean products (tofu)
SourceGramsServingmcg Kale85~ cup694 Spinach85~ 3 cups410 Turnip
greens85~3 cups213 Broccoli85~ cup120 Romaine lettuce85~ 1 cups87
Beef liver853 oz3.3 (Insel et al., 2007)
- Slide 7
- Cancer Breast Colorectal Lung Liver (hepatocellular carcinoma)
Pancreatic Prostate Factors that increase risk: tobacco, diet,
exposure to carcinogens in environment/workplace (Insel et al.,
2007)
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- Mechanism of Action Vitamin K-dependent carboxylation reactions
Potential Anticancer agent (Ohlsson et al., 2004) Specific link to
cancer is still unclear Number proposed Focus on oxidative capacity
of K3 Cell line research K exerts inhibitory effects (Alternative
Medicine Review, 2009)
- Slide 9
- Quick Review Sources of vitamin K? Functions? What are the
three types?
- Slide 10
- What is the relationship between vitamin K and cancer?
- Slide 11
- Nimptsch, K., Rohrmann, S., Kaaks, R., & Linseisen, J.
(2010). American Journal of Clinical Nutrition, 91(5),
1348-1358.
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- Overview Study Design Prospective cohort study 24,340
participants 11, 438 men & 12,902 women Enrollment until 2008
Objective Location of study
- Slide 13
- Method and Statistics Method Baseline Follow-up and outcome
assessment Descriptive Mean Standard deviation Median Range
Inferential Cox proportional hazards regression model with hazard
ratios 95% confidence interval
- Slide 14
- Results Q1Q2Q3Q4P value K1
Cases/non-cases129/5956104/5982111/5975115/5969 HR*10.880.890.93
95% CI(0.68,1.14)(0.69,1.16)(0.71,1.22)0.70 K2
Cases/non-cases156/5928114/597290/599698/5986 HR*10.770.640.72 95%
CI(0.60, 0.99)(0.49, 0.85)(0.53, 0.98)0.03 Cancer Mortality Note:
adapted from Nimptsch et al., 2010 * Age and sex stratified
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- Results Q1Q2Q3Q4P value K1 HR*11.061.301.190.54 K2
HR*10.620.430.380.002 Lung Cancer Incidence Note: adapted from
Nimptsch et al., 2010 * Age and sex stratified
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- Results Q1Q2Q3Q4P Value K1 HR*10.891.00 0.84 K2
HR*10.790.670.650.03 Prostate Cancer Incidence Note: adapted from
Nimptsch et al., 2010 * Age and sex stratified
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- Other cancers Cancer typeP value for trend (K1) P value for
trend (K2) Colorectal0.500.57 Premenopausal breast cancer 0.580.70
Postmenopausal breast cancer 0.510.57 Cancer Incidence Note:
adapted from Nimptsch et al., 2010
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- Strengths and Weaknesses Strengths Hypothesis Large sample size
Statistics Planning and organization Validity Weaknesses
Validity
- Slide 19
- Conclusion No relationship between K1 and K2 Colorectal cancer
incidence Pre & post menopausal breast cancer incidence No
relationship between vitamin k1 Prostate cancer incidence Lung
cancer incidence Cancer mortality Relationship between vitamin K2
Prostate cancer incidence Lung cancer incidence Cancer
mortality
- Slide 20
- What is the relationship between vitamin K and cancer?
- Slide 21
- Sarin, S.K., Kumar, M., Hissar, S., Pandey, C., & Sharma,
B.C. (2006). Journal of Gastroenterology & Hematology, 21(9),
1478-1482.
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- Overview Study Design: randomized controlled clinical trial
Total participants: 42 Placebo group (n=19) High dose of vitamin K3
(n=23) Objective Location of study
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- Method & Statistics Method Baseline characteristics
Criteria to be included (4) Treatment Descriptive statistics Median
Range Mean Standard deviation Inferential statistics Student t-test
Chi squared test Kaplan-Meier survival curves
- Slide 24
- Baseline Characteristics CharacteristicsVitamin K( n=23)Placebo
(n=19)P-Value Age (years) Mean +/- SD50.7 +/- 11.951.7 +/- 8.40.859
Median4854 Range27-7241-69 Sex n (%) Male 18 (78.3) 15(78.9) 1.000
Female 5(21.7) 4(21.1) Etiology n (%) Hepatitis B 17(73.9) 15(78.9)
0.895 Hepatitis C 4 (17.4) 3(15.8) Other 2 (8.7) 1 (5.3) Note:
adapted from Sarin et al., 2006
- Slide 25
- Results Groupn (%)Survival (months) median (range) 1-year
survival n (%) High dose K3 Complete response1 (4.3)371/1 (100)
Partial response3 (13)14 (11-28)2/3 (66.7) Objective response4
(17.4)21 (11-37)3/4 (75) Non-responsive19 (82.6)5 (1-16)4/19 (21.1)
Stable disease4 (17.4)12.5 (3-16)3/4 (75) Progressive disease15
(65.2)3.5(1-13)1/14 (6.7) Placebo19 (100)5(1.5-21)3/19(15.8) Note:
adapted from Sarin et al., 2006 Survival of patients with advanced
heptacellular carcinoma treated with high dose K3 or placebo
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- Causes of death in patients with advanced hepatocellular
carcinoma treated with high dose K3 or placebo TreatmentCancer
related n (%) Hepatic failure n (%) Hemorrhage n (%) High dose K313
(56.5)6 (26.1)4 (17.4) Placebo14 (73.7)4 (21.1)1 (5.3) Note:
adapted from Sarin et al., 2006
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- Kaplan-Meier survival curves
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- Strengths and Weaknesses Strengths Purpose Evidence of planning
and organization Statistics clearly stated Population Weaknesses
First trial for those with advanced liver cancer Demographics
Population Small sample size
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- Conclusion More research is needed High doses do not affect
overall survival Vitamin K3 does not cure cancer 1 patient achieved
complete response 13% partial response 17.4% objective response All
patients died
- Slide 30
- Final Conclusions The relationship between vitamin K and
cancer
- Slide 31
- Vitamins A and D but not E and K decreased the cell number in
human pancreatic cell lines B. Ohlsson, E. Albrechtsson & J.
Axelson
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- Overview Study design Experimental Seven pancreatic cancer cell
lines Objective Location
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- Method and Statistics Method Descriptive statistics Mean
Standard deviation Inferential Statistics Kruskal-Wallis test
Mann-Whitney U test
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- Results
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- Strengths and Weaknesses Strengths Purpose Evidence of planning
and organization Statistics clearly stated Weaknesses Weaknesses
Controlled environment Statistics Future research
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- Verdict Vitamin K1 No relationship Vitamin K2 Lung cancer
incidence Prostate cancer incidence Overall cancer mortality
Vitamin K3 More research needed
- Slide 37
- Future Direction American Cancer Society Vitamin K1 and K2
(Nimptsch et al., 2010) Biomarkers More studies in humans Vitamin
K3 (Sarin et al., 2006). Larger studies Different dosages
- Slide 38
- Any questions?