The use of multivitamin preparations in children and teenagers is fully justified by the level of polyhypovitaminosis in population, confirmed by numerous studies of Institute of Nutrition, which attract the attention of modern medical community. The most frequently discussed questions are which vitamins to use, for how long, in what doses, with other microelements or separately. Another concern is can their use cause the state of hypervitaminosis or any adverse reactions in patients. One of the factors that increase the risk of hypovitaminosis in the manifestation of allergic diseases in children is the rapid growth of the organism in this age and the lack of vitamins that occurs with it. In addition, patients with allergic diseases receive hypoallergenic diets, which in turn contribute to deficit of vitamins. An additional factor is the lack of vitamins in foods, or their loss because of improper cooking. Chemical interactions between vitamins and minerals also should not be forgotten. That is why ingredients for multivitamin-mineral compositions are prepared in a way to limit contact between them, but full elimination of such interactions is impossible. Multivitamin pills, often "leak", i.e., there are reactions between ingredients. As a result, the actual amount of vitamins or microelements may be smaller than the stated amount. One of the most striking examples of such reactions is, well described in the chemistry, redox reaction between iron in bivalent form and vitamins A and E and beta-carotene (provitamin A). Reactions are more active with inorganic salts of iron (eg, sulfate) than with organic salts (eg, fumarate). A well-known example of reactions between vitamins is reaction of ascorbic acid and B vitamins: B1, B2, B6, B12 .
Often the components interact at the level of the body, when one component can affect the effects of another in a beneficial or adverse way. The most important interaction is direct competition between the metals. It is well known that iron, calcium, magnesium and zinc compete with each other, during absorption. In addition, calcium and iron inhibit the adsorption of manganese, and zinc inhibits copper. In general, almost all substances assimilated in the intestine, are absorbed through a process of active transport rather than simple diffusion. These minerals have the same or similar system of active transport during absorption in the intestine. Moreover, some of them compete for transfer proteins during transport in the blood and tissues .
Another type of negative interactions can be illustrated by the example of vitamin C (ascorbic acid), which can cause copper deficiency, especially in case of excessive consumption of vitamin C.
There are many mutually beneficial interactions between vitamins and micronutrients. Everyone knows that calcium is required for the synthesis of vitamin D. Vitamin B6 and magnesium are also synergistic because they mutually reinforce absorption and effects of each other. Synergy also exists between vitamins with antioxidant action: A, E and C. In addition, vitamin E acts synergistically with selenium, a mineral with antioxidant action.
Vitamins A and C contribute (albeit to a lesser extent) to better assimilation of iron, and vitamin C additionally contributes to absorption of chromium. Thus, there are multiple effects of components interactions and there could be one effect (negative in this case) at the chemical level and the opposite at the level of the organism .
The interaction of components can be divided into direct and indirect, particularly at physiological level. Competition between the minerals for the adsorption and assimilation exemplifies direct interaction. Most of the positive effects of vitamins and microelements on each other and the phenomenon of synergism are due to an indirect functional relationship between vitamins and micronutrients in the metabolic pathways in the body, rather than their direct interaction with each other when taken together. For example, the effect of vitamin D3 begins to appear only after 24-48 hours after its intake .
Increase in the number of components in the multivitamin / mineral compositions increases the chance for and the number of interactions between the ingredients. This leads to the fact that for many components the negative effects of their interactions are carried out on many different levels. In case of therapeutic intake of vitamins and micronutrients, ie, in case of manifestation of clinical signs of disease, this requires medical intervention and it is a common norm to use them as single drugs or combinations of desirable (such as calcium and vitamin D) components. The desirability of separation of certain components for prophylactic multivitamin / mineral compositions, to minimize the negative effects of each other, is still not achieved .
Thus, there are important aspects that should be considered before using multivitamin preparations. Vitamin-mineral complexes which containphysiological norms of vitamins and minerals, are not always effective. One reason for this is the antagonism of some vitamins and microelements.
A randomized, placebo-controlled study of the efficacy and tolerability of the vitamin-mineral complex ALFAVIT School was conducted in Research Center of Children 's Health (Director: Academician, Professor Baranov AA). ALFAVIT School is manufactured by ZAO AKVION and contains full range of essential vitamins and minerals (Table 1).
Tablet № 1 (Cherry flavor)
Tablet № 2 (Orange flavor)
Tablet № 3 (Banana flavor)
С – 30 mg (50 %)
В1 – 0,7 mg (75 %)
А (1 000 МЕ) – 0,3 mg (45 %)
Folic acid– 50 mkg (25 %)
Iron – 10 mg (100 %)
Copper – 0,7 mg (45 %)
С – 30 mg (50 %)
Nicotinamide (РР) – 9 mg (75 %)
Е – 6 mg (85 %)
В2 – 0,8 mg (80 %)
В6 – 0,7 mg (55 %)
А – (1 000 МЕ) – 0,3 mg (45 %)
Magnesium – 30 mg (15 %)
Zinc – 5 mg (63 %)
Iodine – 50 mkg (70 %)
Selenium – 20 mkg (100 %)
Calcium pantothenate – 2 mg (50 %)
Folic acid – 50 mkg (25 %)
В12 – 1,5 mkg (75 %)
D3 (25 МЕ) – 0,6 mkg (6 %)
Calcium – 100 mg (10 %)
% – percentage from the physiological requirements for children older than 7 years (according to the conclusion Institute of Nutrition)
Materials and methods:
The study included 60 children aged 7 to 14 years with the following diagnosis: atopic mild or moderate bronchial asthma, in remission and / or pollen disease in remission.
20 patients (group 2a), received adequate basic treatment and vitamin-mineral complex ALFAVIT School for one month, with 1 tablet of every color per day with each meal ( pink pill - morning, orange - during the day, white - in the evening, with interval between pills is 4-6 hours).
20 patients (group 2B), received adequate basic therapy, and 1 month of vitamin-mineral complex ALFAVIT School, with 3 tablets taken simultaneously with breakfast.
20 patients (group 2c), received adequate basic therapy, and placebo for 1 month in the same way as the patients in group 2a. The results of this study were compared with blood levels of vitamins in healthy children of similar age and sex (Group 1) received during regular check-ups or blood analysis for determination of antibody titers to various infections in case of dispute (to confirm feasibility of vaccination). Before observation and after 1 month from the beginning of the study, the levels of six most important vitamins (A, E, C, B1, B2, B6) were determined in blood serum. Physical examination of all patients was conducted in the beginning of the trial, 15 days after its start and after 1 month from the beginning of the study:
Determination of serum levels of vitamins A, E, C, B1, B2 and B6 was performed by high performance liquid chromatography on a Gilson liquid chromatograph with the following components:
A 100 mcl microsyringe ("Hamilton" type) was used to inject the samples.
Results analysis had shown that initially all patients with allergic diseases had deficit of certain vitamins.
Concentrations of vitamins in the blood serum of children with allergic diseases and their healthy counterparts are shown in Figure 1.
Fig. 1 a. The concentration of vitamin A in the blood serum of children and teenagers with allergic diseases compared with healthy peers.
Fig. 1 b. Concentrations of vitamins B1, B2 and B6 in the blood serum of children and teenagers with allergic diseases compared with healthy peers.
Fig. 1 c. The concentrations of vitamins C and E in the blood serum of children and teenagers with allergic diseases compared with healthy peers
After the end of therapy with vitamin-mineral complex ALFAVIT School vitamin concentrations in the blood serum of patients were reditermined, identifying their significant increase in group 2a, whereas the patients belonging to groups 2b and 2c did not experience significant changes in vitamin content (Fig. 2).
Fig. 2 a. The dynamics of vitamin A in blood serum in children with allergic diseases (*p <0,05).
Fig. 2 b. Dynamics of vitamins B1, B2 and B6 in the blood serum of children with allergic diseases (*p <0,05).
Fig. 2 c. Dynamics of vitamins C and E in blood serum of children with allergic diseases (*p <0,05).
It should be noted that all patients pointed to a pleasant taste of this preparation and took it with pleasure. The drug did not cause exacerbation of underlying disease. In addition, the use of vitamin-mineral complex ALFAVIT School together with other pharmacological agents prevented the adverse effects that could be caused by the interaction of vitamin components with other drugs. Administration of vitamin-mineral complex ALFAVIT School did not cause any undesirable (adverse) reactions.
Despite the fact that, prior to taking the drug all studied participants experienced deficits of certain vitamins as compared with healthy children (Fig. 1 a, b, c) there were no clinical signs of hypovitaminosis before and after administration of vitamin-mineral complex ALFAVIT School.
The study suggests that, for the most optimal and adequate vitamins and minerals necessary to consider the interaction of micronutrients among themselves, but also take into account their age and the daily requirement. Thus, ALFAVIT School is a balanced vitamin-mineral complex with adequate dosage of individual components. It is a modern high non-allergic product with a pleasant taste, which can be recommended to healthy children from 7 to 14 years of age, and children with allergic diseases of mild and moderate severity in the period of remission, for prevention course with duration 2 to 4 weeks, several times a year.