Hypercarotenaemia or hypercarotenoidaemia
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Background: Serum carotenoids consist of a variety of different compounds. Xanthoderma may result from an increased concentration of any of the carotenoids. Method and results: High-performance liquid chromatography of serum carotenoids shows that a normal chromatogram contains mainly β-carotene, lutein and lycopene. Serum α- and β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin were found to be increased in the investigation of hypercarotenaemia. Conclusion: Patients presenting with possible xanthoderma should have a dietary history taken and serum sent for carotenoid analysis.Keywords:
Carotene
Food composition data
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Xanthophylls are dietary lipophilic compounds. Among them, lutein and zeaxanthin are the major carotenoids found in the human lens and retina, and referred as macular pigment within the retina. Lutein and zeaxanthin cannot be synthesized endogenously. They may therefore be considered as essential and must be provided by adequate dietary intakes. Lutein and zeaxanthin are present in various food items, mainly in plants and fruits such as green vegetables or yellow-orange fruits, as well as in a few animal sources, such as egg yolk. Epidemiological studies consistently suggest that dietary lutein and zeaxanthin are protective factors against the development of Age-Related Maculopathies and Age-related Macular Degeneration. Intervention trials consisting in supplementing the diet with lutein and zeaxanthin demonstrate the bioavailability of those carotenoids in plasma and, in some of them, their efficacy in increasing the density of the macular pigment. An overview will be presented on the mechanisms of xanthophyll bioavailability in blood and retina.
Yolk
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The retina is unique in the human body in containing three xanthophyll carotenoids; 3R,3'R-zeaxanthin, meso-zeaxanthin (MZ) and lutein. Humans consume 1 to 3 mg lutein per d and the lutein:zeaxanthin ratio in the diet is about 5:1.Xanthophyll pigments occur widely in vegetables and fruits but MZ is found in only a few foods such as the shrimp carapace and fish skin. In spite of the amounts of the different xanthophylls in the diet, zeaxanthin and MZ occur in approximately equal amounts in the eye, and their combined concentration can exceed that of lutein. In the present review the bioavailablity of zeaxanthin and lutein is assessed using the plasma xanthophyll response to dietary intervention. A number of studies have used single and mixed sources of the pure xanthophylls to achieve steady-state plasma responses. Mostly these have been with lutein and zeaxanthin but two using MZ are also described. Responses following the intervention with the pure xanthophylls are compared with those following food intervention. Vegetables are the richest source of dietary lutein and several vegetable-feeding studies are discussed. Intervention studies with eggs, which are a good source of zeaxanthin, suggest that the xanthophyll carotenoids in egg yolk may be more bioavailable than those in other foods and are described separately. MZ has been a component of a xanthophyll supplement added to chicken feed in Mexico in the last 10 years. Egg consumption in Mexico is approximately one egg/person per d and the potential contribution of this food source of MZ to Mexican dietary intakes is described. Very limited information from human feeding studies of MZ-containing supplements suggests that MZ is less well absorbed than zeaxanthin. However, MZ is unusual in the diet and not reported in the plasma. Thus plasma responses may not reflect true absorption if it takes MZ longer to equilibrate with body tissues than the other xanthophylls and competition with zeaxanthin may lower the relative concentrations of MZ in plasma. Lastly, the effects of long-term feeding with both pure and food sources of the xanthophyll pigments on macular pigment optical density is compared and the importance of previous dietary intake on the effects of intervention is discussed.
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Epidemiological studies demonstrate that a high dietary intake of carotenoids may offer protection against age-related macular degeneration, cancer and cardiovascular and neurodegenerative diseases. Humans cannot synthesize carotenoids and depend on their dietary intake. Major carotenoids that have been found in human plasma can be divided into two groups, carotenes (nonpolar molecules, such as β-carotene, α-carotene or lycopene) and xanthophylls (polar carotenoids that include an oxygen atom in their structure, such as lutein, zeaxanthin and β-cryptoxanthin). Only two dietary carotenoids, namely lutein and zeaxanthin (macular xanthophylls), are selectively accumulated in the human retina. A third carotenoid, meso-zeaxanthin, is formed directly in the human retina from lutein. Additionally, xanthophylls account for about 70% of total carotenoids in all brain regions. Some specific properties of these polar carotenoids must explain why they, among other available carotenoids, were selected during evolution to protect the retina and brain. It is also likely that the selective uptake and deposition of macular xanthophylls in the retina and brain are enhanced by specific xanthophyll-binding proteins. We hypothesize that the high membrane solubility and preferential transmembrane orientation of macular xanthophylls distinguish them from other dietary carotenoids, enhance their chemical and physical stability in retina and brain membranes and maximize their protective action in these organs. Most importantly, xanthophylls are selectively concentrated in the most vulnerable regions of lipid bilayer membranes enriched in polyunsaturated lipids. This localization is ideal if macular xanthophylls are to act as lipid-soluble antioxidants, which is the most accepted mechanism through which lutein and zeaxanthin protect neural tissue against degenerative diseases.
Carotene
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Macular xanthophylls, which are absorbed from the human diet, accumulate in high concentrations in the human retina, where they efficiently protect against oxidative stress that may lead to retinal damage. In addition, macular xanthophylls are uniquely spatially distributed in the retina. The zeaxanthin concentration (including the lutein metabolite meso-zeaxanthin) is ~9-fold greater than lutein concentration in the central fovea. These numbers do not correlate at all with the dietary intake of xanthophylls, for which there is a dietary zeaxanthin-to-lutein molar ratio of 1:12 to 1:5. The unique spatial distributions of macular xanthophylls-lutein, zeaxanthin, and meso-zeaxanthin-in the retina, which developed during evolution, maximize the protection of the retina provided by these xanthophylls. We will correlate the differences in the spatial distributions of macular xanthophylls with their different antioxidant activities in the retina. Can the major protective function of macular xanthophylls in the retina, namely antioxidant actions, explain their evolutionarily determined, unique spatial distributions? In this review, we will address this question.
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Abstract Lutein, zeaxanthin, and meso-zeaxanthin are three xanthophyll carotenoid pigments that selectively concentrate in the center of the retina. Humans cannot synthesize lutein and zeaxanthin, so these compounds must be obtained from the diet or supplements, with meso-zeaxanthin being converted from lutein in the macula. Xanthophylls are major components of macular pigments that protect the retina through the provision of oxidant defense and filtering of blue light. The accumulation of these three xanthophylls in the central macula can be quantified with non-invasive methods, such as macular pigment optical density (MPOD). MPOD serves as a useful tool for assessing risk for, and progression of, age-related macular degeneration, the third leading cause of blindness worldwide. Dietary surveys suggest that the dietary intakes of lutein and zeaxanthin are decreasing. In addition to low dietary intake, pregnancy and lactation may compromise the lutein and zeaxanthin status of both the mother and infant. Lutein is found in modest amounts in some orange- and yellow-colored vegetables, yellow corn products, and in egg yolks, but rich sources of zeaxanthin are not commonly consumed. Goji berries contain the highest known levels of zeaxanthin of any food, and regular intake of these bright red berries may help protect against the development of age-related macular degeneration through an increase in MPOD. The purpose of this review is to summarize the protective function of macular xanthophylls in the eye, speculate on the compounds’ role in maternal and infant health, suggest the establishment of recommended dietary values for lutein and zeaxanthin, and introduce goji berries as a rich food source of zeaxanthin.
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The carotenoid xanthophylls, lutein and zeaxanthin, accumulate in the eye lens and macular region of the retina. Lutein and zeaxanthin concentrations in the macula are greater than those found in plasma and other tissues. A relationship between macular pigment optical density, a marker of lutein and zeaxanthin concentration in the macula, and lens optical density, an antecedent of cataractous changes, has been suggested. The xanthophylls may act to protect the eye from ultraviolet phototoxicity via quenching reactive oxygen species and/or other mechanisms. Some observational studies have shown that generous intakes of lutein and zeaxanthin, particularly from certain xanthophyll-rich foods like spinach, broccoli and eggs, are associated with a significant reduction in the risk for cataract (up to 20%) and for age-related macular degeneration (up to 40%). While the pathophysiology of cataract and age-related macular degeneration is complex and contains both environmental and genetic components, research studies suggest dietary factors including antioxidant vitamins and xanthophylls may contribute to a reduction in the risk of these degenerative eye diseases. Further research is necessary to confirm these observations.
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