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Starek M, Gumułka P, Dąbrowska M. Quality Control of the Dietary Supplements Containing Selected Fat-Soluble Vitamins D and K. Nutrients 2023; 15:nu15071650. [PMID: 37049490 PMCID: PMC10096846 DOI: 10.3390/nu15071650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Nowadays, the most important aspect related to the use of dietary supplements seems to be their quality. There are many reports indicating their insufficient quality primarily related to a much lower content of ingredients or even their absence. Currently, there is an increasing interest in supplementing the diet with various kinds of supplements, including those containing combinations of vitamins and minerals, among which preparations with vitamin D are very popular. This is probably due to the reduced production of this vitamin, depending on the amount of time spent in the sun and the use of UV-filters. Very often, preparations with cholecalciferol also contain vitamin K2, which is associated with their synergistic effect. Therefore, the question arises about the effectiveness of supplementation, which may be correlated with the quality of commonly available dietary supplements. In the presented work, it was undertaken to develop optimal conditions for the qualitative and quantitative determination of vitamins D2, D3 and K2 in dietary supplements available in various forms, using thin-layer chromatography with densitometric detection. As a result, the methodology for analyzing the content of three vitamins from various matrices was developed, optimized and validated in accordance with ICH requirements. The obtained results allow us to conclude that it is reliable and meets the requirements for analytical procedures used in the analysis of medicinal products. Based on the results obtained for examined dietary supplements, it can be stated that the amount of vitamin D3 in analyzed products is basically similar to that declared by the manufacturer, in contrast to vitamin K2, the content of which is diverse. The developed methodology seems to be a good, low-cost and quick way to control the quality of dietary supplements so that they can supplement the human diet and be a wholesome product.
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Affiliation(s)
- Małgorzata Starek
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St, 30-688 Kraków, Poland
| | - Paweł Gumułka
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St, 30-688 Kraków, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, 16 Łazarza St, 31-530 Kraków, Poland
| | - Monika Dąbrowska
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St, 30-688 Kraków, Poland
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2
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Dietary supplement use and recommendations for discontinuation in an integrative oncology clinic. Support Care Cancer 2023; 31:40. [DOI: 10.1007/s00520-022-07504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
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Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation. Pharmaceuticals (Basel) 2022; 15:ph15111388. [DOI: 10.3390/ph15111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Hand-Foot syndrome (HFS) and diarrhoea are dose-limiting Adverse Drug Reactions (ADRs) of capecitabine-based chemotherapy. Four polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) gene, encoding the DPD enzyme responsible for the metabolism of fluoropyrimidines, such as capecitabine, are strongly associated with severe ADRs, and their screening should be performed before starting treatment. Moreover, capecitabine-related toxicity may worsen due to drug-drug and drug-supplement interactions. Here we investigated factors responsible for severe HFS and diarrhoea presented by two patients, non-carriers of the recommended DPYD single nucleotide polymorphisms (SNPs) but carriers of other genetic variants suggested to increase the risk of capecitabine-related ADRs. Through careful therapy recognition, we demonstrated that, unbeknownst to the oncologists, the patients were taking folic acid during the treatment with capecitabine at a dosage higher than 2000 mg/m2, which is the maximum tolerated dose when folate is administered. To resolve the ADRs, the therapy had to be drastically changed. In one case, dose reduction of capecitabine and discontinuation of lipid-lowering agents were carried out. In the other case, discontinuation of capecitabine and folic acid and capecitabine re-administration were performed after a month. Genetic and environmental factors should be considered good predictors of severe capecitabine-related toxicity. Medication reconciliation should be encouraged to avoid the harmful consequences of inappropriate treatments.
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Sibbritt D, Peng W, Wardle J, Stewart C, Komesaroff P, Adams J. The Regulation of the Complementary Health Sector: General Public's Knowledge of Complementary Medicine-Related Quality Assurance and Consumer Protection. Int J Health Policy Manag 2022; 11:1482-1488. [PMID: 34273921 PMCID: PMC9808326 DOI: 10.34172/ijhpm.2021.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Complementary medicine (CM) use is a ubiquitous aspect of an increasingly consumer-driven model of healthcare delivery and plays an increasingly prominent role in the Australian health sector. Yet there is limited empirical research investigating the quality and integrity of protections for consumers in Australia. The aim of this study is to help address this gap in knowledge by exploring how members of the public engage with protection mechanisms related to CM use. METHODS This study utilised a cross-sectional online survey to recruit a sample of 1132 Australian adults aged 18 and over. Purposive convenience sampling was used to recruit participants from an existing database of Australian adults who had expressed interest in participating in research. RESULTS The majority of the participants (64.0%) had visited a CM practitioner in their lifetime. However, a minority of participants (36.9%) indicated they would feel confident in knowing where to complain if something went wrong with the treatment they received from a CM practitioner. Most participants (74.7%) had used a CM product in their lifetime. Specifically, 32.3% had 'ever' used an herbal product and 69.9% had 'ever' used a nutritional supplement. However, a minority of participants (32.7%) indicated they would feel confident knowing where to complain if something went wrong with a herbal or nutritional supplement they used. Most participants indicated a lack of knowledge about how CM practitioners and CM products are regulated in Australia. CONCLUSION The findings of this study clearly highlight a concerning lack of knowledge by CM patients and consumers regarding the regulation of CM in Australia. From a policy perspective, it is necessary to seek proactive approaches that target complaint-related knowledge of the CM patients and consumers through education and advocacy efforts.
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Affiliation(s)
- David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Wenbo Peng
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Wardle
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Cameron Stewart
- Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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5
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Hassen G, Belete G, Carrera KG, Iriowen RO, Araya H, Alemu T, Solomon N, Bam DS, Nicola SM, Araya ME, Debele T, Zouetr M, Jain N. Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective. Cureus 2022; 14:e26893. [PMID: 35978741 PMCID: PMC9375827 DOI: 10.7759/cureus.26893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
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Sesso HD, Rist PM, Aragaki AK, Rautiainen S, Johnson LG, Friedenberg G, Copeland T, Clar A, Mora S, Moorthy MV, Sarkissian A, Wactawski-Wende J, Tinker LF, Carrick WR, Anderson GL, Manson JE. Multivitamins in the prevention of cancer and cardiovascular disease: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. Am J Clin Nutr 2022; 115:1501-1510. [PMID: 35294969 PMCID: PMC9170475 DOI: 10.1093/ajcn/nqac056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although older adults commonly take multivitamin-multimineral (MVM) supplements to promote health, evidence on the use of daily MVMs on invasive cancer is limited. OBJECTIVES The study objective was to determine if a daily MVM decreases total invasive cancer among older adults. METHODS We performed a randomized, double-blind, placebo-controlled, 2-by-2 factorial trial of a daily MVM and cocoa extract for prevention of cancer and cardiovascular disease (CVD) among 21,442 US adults (12,666 women aged ≥65 y and 8776 men aged ≥60 y) free of major CVD and recently diagnosed cancer. The intervention phase was from June 2015 through December 2020. This article reports on the MVM intervention. Participants were randomly assigned to daily MVM or placebo. The primary outcome was total invasive cancer, excluding nonmelanoma skin cancer. Secondary outcomes included major site-specific cancers, total CVD, all-cause mortality, and total cancer risk among those with a baseline history of cancer. RESULTS During a median follow-up of 3.6 y, invasive cancer occurred in 518 participants in the MVM group and 535 participants in the placebo group (HR: 0.97; 95% CI: 0.86, 1.09; P = 0.57). We observed no significant effect of a daily MVM on breast cancer (HR: 1.06; 95% CI: 0.79, 1.42) or colorectal cancer (HR: 1.30; 95% CI: 0.80, 2.12). We observed a protective effect of a daily MVM on lung cancer (HR: 0.62; 95% CI: 0.42, 0.92). The composite CVD outcome occurred in 429 participants in the MVM group and 437 participants in the placebo group (HR: 0.98; 95% CI: 0.86, 1.12). MVM use did not significantly affect all-cause mortality (HR: 0.93; 95% CI: 0.81, 1.08). There were no safety concerns. CONCLUSIONS A daily MVM supplement, compared with placebo, did not significantly reduce the incidence of total cancer among older men and women. Future studies are needed to determine the effects of MVMs on other aging-related outcomes among older adults. This trial is registered at www.clinicaltrials.gov as NCT02422745.
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Affiliation(s)
- Howard D Sesso
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pamela M Rist
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Susanne Rautiainen
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lisa G Johnson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Clar
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Vinayaga Moorthy
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ara Sarkissian
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - William R Carrick
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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7
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Rist PM, Sesso HD, Johnson LG, Aragaki AK, Wang L, Rautiainen S, Hazra A, Tobias DK, LeBoff MS, Schroeter H, Friedenberg G, Copeland T, Clar A, Tinker LF, Hunt RP, Bassuk SS, Sarkissian A, Smith DC, Pereira E, Carrick WR, Wion ES, Schoenberg J, Anderson GL, Manson JE. Design and baseline characteristics of participants in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS). Contemp Clin Trials 2022; 116:106728. [PMID: 35288332 PMCID: PMC9133193 DOI: 10.1016/j.cct.2022.106728] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
Background Cocoa extract and multivitamins have been proposed to reduce the risk of cardiovascular disease (CVD) and cancer, respectively. However, few randomized clinical trials have tested their long-term effects on these outcomes. Methods The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of a cocoa extract supplement and a multivitamin supplement to reduce the risk of CVD and cancer. Here we describe the pragmatic, hybrid design of the trial and baseline characteristics of the trial participants. Results The nationwide study population includes 21,442 U.S. women aged ≥65 years and men aged ≥60 years without baseline myocardial infarction (MI), stroke, or a recent (within the past 2 years) cancer diagnosis. Participants were randomized in a 2 × 2 factorial design to one of four groups: (1) cocoa extract (containing 500 mg/d flavanols, including 80 mg (-)-epicatechin) and a multivitamin (Centrum Silver©); (2) cocoa extract and multivitamin placebo; (3) multivitamin and cocoa extract placebo; or (4) both placebos. Randomization successfully distributed baseline demographic, clinical, behavioral, and dietary characteristics across treatment groups. Baseline biospecimens were collected from 6867 participants, with at least one follow-up biospecimen from 2142 participants. The primary outcome for the cocoa extract intervention is total CVD (a composite of MI, stroke, cardiovascular mortality, coronary revascularization, unstable angina requiring hospitalization, carotid artery surgery, and peripheral artery surgery); the primary outcome for the multivitamin intervention is total invasive cancer. Conclusion COSMOS will provide important information on the health effects of cocoa extract and multivitamin supplementation in older U.S. adults. Clinical Trials Registration: clinicaltrials.gov #NCT02422745.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Howard D Sesso
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Lisa G Johnson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lu Wang
- Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Aditi Hazra
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Deirdre K Tobias
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Meryl S LeBoff
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Georgina Friedenberg
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Clar
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca P Hunt
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shari S Bassuk
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ara Sarkissian
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas C Smith
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eduardo Pereira
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William R Carrick
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Emily S Wion
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer Schoenberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Okuhara T, Yokota R, Shirabe R, Iye R, Okada H, Kiuchi T, Chiba T, Akamatsu R. Japanese newspaper advertisements for dietary supplements before and after COVID-19: a content analysis. BMJ Open 2021; 11:e050898. [PMID: 34815281 PMCID: PMC8611233 DOI: 10.1136/bmjopen-2021-050898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread. DESIGN Content analysis. PARTICIPANTS We analysed advertisements for dietary supplements in two major Japanese newspapers in February-July 2019 and February-July 2020. Our analysis covered 2167 advertisements. RESULTS The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as 'defence' and 'prevent' were used to promote the preventive effect. CONCLUSIONS False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rie Yokota
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ritsuko Shirabe
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Reina Iye
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan
| | - Rie Akamatsu
- Natural Science Division, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
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9
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Batsis JA, Apolzan JW, Bagley PJ, Blunt HB, Divan V, Gill S, Golden A, Gundamraj S, Heymsfield S, Kahan S, Kopatsis K, Port A, Parks EP, Reilly CA, Rubino D, Saunders KH, Shean R, Tabaza L, Stanley A, Tchang BG, Gundumraj S, Kidambi S. A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss. Obesity (Silver Spring) 2021; 29:1102-1113. [PMID: 34159755 PMCID: PMC8231729 DOI: 10.1002/oby.23110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Dietary supplements and alternative therapies are commercialized as a panacea for obesity/weight gain as a result of the minimal regulatory requirements in demonstrating efficacy. These products may indirectly undermine the value of guideline-driven obesity treatments. Included in this study is a systematic review of the literature of purported dietary supplements and alternative therapies for weight loss. METHODS A systematic review was conducted to evaluate the efficacy of dietary supplements and alternative therapies for weight loss in participants aged ≥18 years. Searches of Medline (PubMed), Cochrane Library, Web of Science, CINAHL, and Embase (Ovid) were conducted. Risk of bias and results were summarized qualitatively. RESULTS Of the 20,504 citations retrieved in the database search, 1,743 full-text articles were reviewed, 315 of which were randomized controlled trials evaluating the efficacy of 14 purported dietary supplements, therapies, or a combination thereof. Risk of bias and sufficiency of data varied widely. Few studies (n = 52 [16.5%]) were classified as low risk and sufficient to support efficacy. Of these, only 16 (31%) noted significant pre/post intergroup differences in weight (range: 0.3-4.93 kg). CONCLUSIONS Dietary supplements and alternative therapies for weight loss have a limited high-quality evidence base of efficacy. Practitioners and patients should be aware of the scientific evidence of claims before recommending use.
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Affiliation(s)
- John A. Batsis
- Division of Geriatric Medicine, School of Medicine, and the Department of Nutrition, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John W. Apolzan
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | | | | | | | - Sonia Gill
- University of California, Davis School of Medicine, Sacramento, California
| | | | | | - Steven Heymsfield
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | - Scott Kahan
- Director, National Center for Weight and Wellness, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Ava Port
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
| | - Elizabeth Prout Parks
- The Children’s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, The Healthy Weight Program, Perelman Medical Center, University of Pennsylvania
| | - Clifford A. Reilly
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington VT
| | - Domenica Rubino
- Washington Center for Weight Management and Research, Arlington, VA
| | - Katherine H. Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY
| | - Ryan Shean
- Dartmouth College, Hanover, New Hampshire
| | - Luai Tabaza
- Albert Einstein Medical Center, Philadelphia, PA
| | - Abishek Stanley
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | - Beverly G. Tchang
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY
| | - Shivani Gundumraj
- AT Still University School of Osteopathic Medicine in Arizona, Mesa, AZ
| | - Srividya Kidambi
- Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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10
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A Content Analysis of Video Advertisements for Dietary Supplements in Japan. Healthcare (Basel) 2021; 9:healthcare9060742. [PMID: 34204421 PMCID: PMC8235716 DOI: 10.3390/healthcare9060742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were “Exemption” (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and “Health Concerns” (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was “Lifestyle” (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). “Lifestyle” advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice.
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11
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Zamil DH, Burns EK, Perez-Sanchez A, Parke MA, Katta R. Risk of Birth Defects From Vitamin A "Acne Supplements" Sold Online. Dermatol Pract Concept 2021; 11:e2021075. [PMID: 34123566 DOI: 10.5826/dpc.1103a75] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background Dietary supplements are popular among US consumers and claim to address a variety of conditions, including acne. Acne supplements containing vitamin A are of particular interest, due to the potentially teratogenic effects of vitamin A doses over 10,000 IU. Objective This study examined dosage, pregnancy risks, and labeling of vitamin A-containing acne supplements available online. Methods An Internet search of acne supplements sold online was conducted between March and May 2020. Supplement labels and websites were analyzed for vitamin A content and pregnancy warnings, and then divided into categories based on dosage and teratogenic risk. Results A total of 49 acne supplements was found, and of these 26 (53%) contain vitamin A. Three supplements are likely teratogenic, 4 contain vitamin A doses exceeding the daily level of intake that meets the nutritional needs of most people, and 15 have an unknown teratogenic risk. Among the 6 supplements with over 10,000 IU vitamin A, 2 have no pregnancy warning at all, including the supplement with the highest vitamin A dose found in this study. Conclusions Dietary supplements are not subject to the same stringent regulations as drugs, and as such, consumers may be unaware of pregnancy risks. Furthermore, FDA requirements on labeling of vitamin A supplements may lead to consumer confusion regarding dosage. As such, we encourage stricter labeling requirements for vitamin A-containing supplements, including pregnancy warnings for high-dose supplements and clearer dosage labeling.
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Affiliation(s)
| | | | - Ariadna Perez-Sanchez
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Rajani Katta
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
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12
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ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol 2021; 116:878-898. [PMID: 33929376 DOI: 10.14309/ajg.0000000000001259] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) are the most common classes of agents to cause DILI in the Western world. DILI is a diagnosis of exclusion, and thus, careful assessment for other etiologies of liver disease should be undertaken before establishing a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are important determinants of mortality in patients presenting with suspected DILI. DILI carries a mortality rate up to 10% when hepatocellular jaundice is present. Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. The role of systemic corticosteroids is controversial, but they may be administered when a liver injury event cannot be distinguished between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.
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13
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Burcă V, Csorba LM, Munteanu FD, Rusu S. The Romanian consumers’ perception regarding the safety of dietary supplements. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Correia RB, Wood IB, Bollen J, Rocha LM. Mining Social Media Data for Biomedical Signals and Health-Related Behavior. Annu Rev Biomed Data Sci 2020; 3:433-458. [PMID: 32550337 PMCID: PMC7299233 DOI: 10.1146/annurev-biodatasci-030320-040844] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Social media data have been increasingly used to study biomedical and health-related phenomena. From cohort-level discussions of a condition to population-level analyses of sentiment, social media have provided scientists with unprecedented amounts of data to study human behavior associated with a variety of health conditions and medical treatments. Here we review recent work in mining social media for biomedical, epidemiological, and social phenomena information relevant to the multilevel complexity of human health. We pay particular attention to topics where social media data analysis has shown the most progress, including pharmacovigilance and sentiment analysis, especially for mental health. We also discuss a variety of innovative uses of social media data for health-related applications as well as important limitations of social media data access and use.
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Affiliation(s)
- Rion Brattig Correia
- Instituto Gulbenkian de Cincia, 2780-156 Oeiras, Portugal
- Center for Social and Biomedical Complexity, Luddy School of Informatics, Computing & Engineering, Indiana University, Bloomington, Indiana 47408, USA
- CAPES Foundation, Ministry of Education of Brazil, 70040 Braslia DF, Brazil
| | - Ian B Wood
- Center for Social and Biomedical Complexity, Luddy School of Informatics, Computing & Engineering, Indiana University, Bloomington, Indiana 47408, USA
| | - Johan Bollen
- Center for Social and Biomedical Complexity, Luddy School of Informatics, Computing & Engineering, Indiana University, Bloomington, Indiana 47408, USA
| | - Luis M Rocha
- Instituto Gulbenkian de Cincia, 2780-156 Oeiras, Portugal
- Center for Social and Biomedical Complexity, Luddy School of Informatics, Computing & Engineering, Indiana University, Bloomington, Indiana 47408, USA
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15
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Crawford C, Boyd C, Avula B, Wang YH, Khan IA, Deuster PA. A Public Health Issue: Dietary Supplements Promoted for Brain Health and Cognitive Performance. J Altern Complement Med 2020; 26:265-272. [PMID: 32119795 PMCID: PMC7153641 DOI: 10.1089/acm.2019.0447] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Dietary supplements targeting brain health have quickly emerged in the marketplace as cognitive performance becomes an important public health issue. While manufacturers are required to report the exact ingredients and formulations listed on the Supplement Facts labels of products, many reports have indicated such labels are not always truthful, and the content of some products is inconsistent with the ingredients listed on the Supplement Facts label. Objectives: To identify dietary supplement products and ingredients marketed for brain health and cognitive performance and perform analyses of select products to verify whether purported claims are truthful and product labels accurate. Design: A scoping review was performed to identify products and ingredients. Products were selected for content analysis, investigated for scientific-sounding claims made, and assessed using an educational tool for potential red flags when reading Supplement Facts labels. Results: Twelve products were selected from the 650 products being marketed for brain health and queried about by Service Members. Eight (67%) had at least one ingredient listed on the Supplement Facts label not detected through analysis. Compounds not reported on the label were detected in 10 (83%) products. Scientific-sounding claims made are not supported by science and red flags are presented. Conclusions: There are dietary supplements targeting brain health being marketed to consumers that should be considered adulterated and misbranded. Advertisements and product labels may be deceiving and could put the public at risk. Education is required so that the public can recognize red flags while the U.S. Food and Drug Administration works to “modernize” the current regulations for dietary supplements.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Courtney Boyd
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS
| | - Yan-Hong Wang
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS
| | - Ikhlas A Khan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS.,Division of Pharmacognosy, Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
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Abstract
Pinterest, a widely used social media platform, has shaped how people seek and share health information. Cannabidiol (CBD), a non-psychoactive component of cannabis is marketed as a treatment for many conditions and sales rose to more than 820 million in 2017. Yet CBD is mostly unregulated, legality is murky, and many of the health claims are not scientifically proven. Purpose: This content analysis examined how CBD products were portrayed on Pinterest. Methods: In 2018, using the search terms cannabidiol and CBD, researchers sampled every fifth pin to collect 226 relevant pins. A codebook was developed, pilot tested, and used to code pins. Results: The majority (91.6%) of pins positively portrayed CBD with many claiming a physical or mental benefit including anxiety, depression, pain, and inflammation relief. Most pins did not (98.2%) address potential side effects or recommend dosage. In this sample, user engagement was high with 85.2% of pins being saved and links to commercial sites selling CBD products, personal blogs, and social media accounts. Conclusions: Social media has become a powerful source of health information. This study revealed widespread acceptance of the use of CBD products with minimal information from reliable public health sources represented.
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Affiliation(s)
- Julie Williams Merten
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
| | - Benjamin T Gordon
- Department of Health and Human Performance, Exercise Physiology University of Florida, Gainesville, Florida, USA
| | - Jessica L King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Calista Pappas
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
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17
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Guzman JR, Paterniti DA, Liu Y, Tarn DM. Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine. ACTA ACUST UNITED AC 2019; 5. [PMID: 32051918 PMCID: PMC7015169 DOI: 10.23937/2469-5793/1510109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients’ disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. Methods: Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. Results: We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients’ convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). Conclusions: When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.
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Affiliation(s)
- Jennifer R Guzman
- Department of Anthropology, State University of New York at Geneseo, USA
| | - Debora A Paterniti
- Department of Sociology, Sonoma State University, USA.,Departments of Internal Medicine and Sociology, University of California - Davis, USA
| | | | - Derjung M Tarn
- Department of Family Medicine, University of California - Los Angeles, USA
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18
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Eichner AK, Coyles J, Fedoruk M, Maxey TD, Lenaghan RA, Novitzky J, Lindsey AT, Deuster PA. Essential Features of Third-Party Certification Programs for Dietary Supplements: A Consensus Statement. Curr Sports Med Rep 2019; 18:178-182. [PMID: 31082891 DOI: 10.1249/jsr.0000000000000595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The presence of performance-enhancing drugs in dietary supplements poses serious anti-doping and health risks to athletes and military service members. A positive drug test, suboptimal health, or adverse event can ruin a career in either setting. These populations need to be certain in advance that a product is of high quality and free from performance-enhancing drugs and other banned substances. However, no regulatory authority conducts or mandates a quality review before dietary supplements are sold. Under the Food Drug and Cosmetic Act, the Food and Drug Administration does not have a role in the premarket safety review of dietary supplements. Due to the increasing demand for high-quality, properly labeled dietary supplements, multiple companies have stepped into this void by offering testing and quality review programs for dietary supplements. Each of these third-party programs has its own quality assurance program with varying testing components. It is difficult for consumers in the sport and military settings to assess whether a particular certification program reduces the risks enough so that they can use a product with confidence. This article puts forward the consensus of the authors on current best practices for third-party certification programs for dietary supplements consumed by athletes and military service members. Also discussed are important ways that third-party programs can develop in the future to improve access to safe, high-quality dietary supplements for these populations.
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Affiliation(s)
| | | | | | - Timothy D Maxey
- Major League Baseball/Major League Baseball Players Association, New York, NY
| | | | - Jeff Novitzky
- Vice President of Athlete Health and Performance UFC, Las Vegas, NV
| | - Andrea T Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
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19
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Teoh SL, Ngorsuraches S, Lai NM, Bangpan M, Chaiyakunapruk N. Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review. Int J Food Sci Nutr 2019; 70:491-512. [PMID: 30634867 DOI: 10.1080/09637486.2018.1538326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.
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Affiliation(s)
- Siew Li Teoh
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia
| | - Surachat Ngorsuraches
- b Department of Health Outcomes Research and Policy, Harrison School of Pharmacy , Auburn University , Auburn , AL , USA
| | - Nai Ming Lai
- c School of Medicine , Taylor's University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | - Mukdarut Bangpan
- e Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Department of Social Science, UCL Institute of Education , University College London , London , UK
| | - Nathorn Chaiyakunapruk
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia.,f Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.,g School of Pharmacy , University of Wisconsin , Madison , WI , USA
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20
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Hsu KY, Kwan Ho Chui K, Conboy L. Prescription patterns and characteristics of users of Chinese herbal products in the US: Analysis of a teaching center prescription database. JOURNAL OF ETHNOPHARMACOLOGY 2018; 227:150-154. [PMID: 29933013 DOI: 10.1016/j.jep.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE We know little about US use of Chinese herbal products (CHP). AIM OF THE STUDY To understand CHP users' sociodemographic characteristics, CHP indications for use, and prescribing patterns in an acupuncture teaching center in the United States. MATERIALS AND METHODS Retrospective chart review and descriptive statistics. RESULTS CHP users were mostly female and white with at least a college education. The most common main complaint for CHP treatment was genitourinary system. Most of the CHP users were given thirteen different herbs per prescription, and the mean number of herbs per CHP prescription was twelve. The most common dosing frequency was twice a day (BID) and the most common duration of prescription was seven days. Dang Gui / Angelicae sinensis (Oliv.) Diels was the most frequently prescribed Chinese herb. CONCLUSION We identified CHP users' sociodemographic characteristics and CHP prescription patterns in a teaching center in the United States. Future studies will focus on safety and the adverse effect of CHP.
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Affiliation(s)
- Kai-Yin Hsu
- Research Department, New England School of Acupuncture at MCPHS University, 19 Norwich Street, Worcester, MA 01608, United States.
| | - Kenneth Kwan Ho Chui
- Dept. of Public Health and Community Medicine, Tufts School of Medicine, Tufts University, Boston, MA, United States.
| | - Lisa Conboy
- New England School of Acupuncture at MCPHS University, Worcester, MA, United States; Beth Israel Deaconess Medical Center, Harvard Medical School, United States.
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21
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Gong W, Liu A, Yao Y, Ma Y, Ding C, Song C, Yuan F, Zhang Y, Feng G, Chen Z, Ding G. Nutrient Supplement Use among the Chinese Population: A Cross-Sectional Study of the 2010⁻2012 China Nutrition and Health Surveillance. Nutrients 2018; 10:E1733. [PMID: 30424493 PMCID: PMC6266204 DOI: 10.3390/nu10111733] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Abstract
Nutrient supplements play a key role in managing malnutrition/chronic diseases and are commonly used in the world, but few studies described the prevalence of nutrient supplement use at the national level in China. To our knowledge, this study provides the first detailed investigation of nutrient supplement use in a nationally representative sample of the Chinese population. This study aimed to describe the prevalence of the nutrient supplement use among the Chinese population aged 6 years or older in 2010⁻2012. A stratified multistage cluster sampling method was conducted to recruit participants from 150 surveillance sites. The demographic characteristics and information about nutrient supplement use were collected through an interview-administrative questionnaire. A total of 74,501 children and adults (excluding the pregnant women) were included in the study (mean age, 35.7 years; male, 47.0%, female, 53.5%). Only 0.71% of the participants reported using nutrient supplements in the previous month. Participants aged 6⁻11 years and 60 years and above, female, living in large urban, with higher education level and higher family incomes were more likely to use nutrient supplements than their counterparts (p < 0.05). The prevalence of nutrient supplement use increased with age in Chinese adults. The highest usage among the nutrient supplements was multi-vitamins and minerals with 0.37%. More females used single vitamin, multi-mineral, multi-vitamins and minerals than males (p < 0.05). The nutrient supplement use proportion was highest amongst the participants with a health problem, and the participants who had no idea about their health conditions were the least likely to use the nutrient supplements (p < 0.05). The prevalence of nutrient supplement use was low among the Chinese population in 2010⁻2012. Further research is required to understand the social cognition, usage reasons, dosage and consumption motivation of NS, and the relationships with health effects, to ensure that the nutrient supplements can be appropriately promoted in China.
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Affiliation(s)
- Weiyan Gong
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Ailing Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Yecheng Yao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Yanning Ma
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Caicui Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Chao Song
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Fan Yuan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Yan Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Ganyu Feng
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Zheng Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 10000, China.
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22
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Paine MF, Shen DD, McCune JS. Recommended Approaches for Pharmacokinetic Natural Product-Drug Interaction Research: a NaPDI Center Commentary. Drug Metab Dispos 2018; 46:1041-1045. [PMID: 29735755 DOI: 10.1124/dmd.117.079962] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
Abstract
Sales of botanical dietary supplements and other purported medicinal natural products (NPs) have escalated over the past ∼25 years, increasing the potential for NPs to precipitate clinically significant pharmacokinetic interactions with U.S. Food and Drug Administration-approved medications [NP-drug interactions (NPDIs)]. However, published NPDI studies to date often lack consistency in design, implementation, and documentation, which present difficulties in assessing the clinical significance of the results. Common hurdles include large variability in the admixture composition of phytoconstituents between and within batches of a given NP, limited knowledge on the pharmacokinetics of precipitant NP constituents, and use of animal and/or in vitro models which, in some cases, are not mechanistically appropriate for extrapolation to humans. The National Center for Complementary and Integrative Health created a Center of Excellence for Natural Product-Drug Interaction Research (NaPDI Center) to address these unmet research needs. The NaPDI Center has two overarching goals: 1) develop Recommended Approaches to guide researchers in the proper conduct of NPDI studies, which will evolve over time concurrent with emerging technologies and new research data, and 2) apply the Recommended Approaches in evaluating four model NPs as precipitants of NPDIs with clinically relevant object drugs. The major objectives of this commentary are to 1) explain the rationale for creating the NaPDI Center; 2) describe the decision trees developed by the NaPDI Center to enhance the planning, rigor, and consistency of NPDI studies; and 3) provide a framework for communicating results to the multidisciplinary scientists interested in the NaPDI Center's interaction projects.
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Affiliation(s)
- Mary F Paine
- Center of Excellence for Natural Product-Drug Interaction (NaPDI) Research, Spokane, Washington (M.F.P., D.D.S., J.S.M.); Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington (D.D.S., J.S.M.)
| | - Danny D Shen
- Center of Excellence for Natural Product-Drug Interaction (NaPDI) Research, Spokane, Washington (M.F.P., D.D.S., J.S.M.); Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington (D.D.S., J.S.M.)
| | - Jeannine S McCune
- Center of Excellence for Natural Product-Drug Interaction (NaPDI) Research, Spokane, Washington (M.F.P., D.D.S., J.S.M.); Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington (D.D.S., J.S.M.)
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23
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Eloge J, Napier TC, Dantz B. OPQRST(U): Integrating substance use disorders or "Use" into the medical history. Subst Abus 2018; 39:505-508. [PMID: 29693496 DOI: 10.1080/08897077.2018.1469104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Substance use disorders (SUDs) are pervasive in the United States, with 20.1 million cases in 2016, of which only 19% receive treatment. SUDs permeate all medical specialties and should be considered in the differential diagnosis of every chief complaint. Acknowledging the salience of SUDs provides a unique opportunity for early identification and intervention. Thus, SUDs should be reflected prominently in the history of the present illness rather than in the social history. To this effect, we propose the inclusion of Use (U) in the history of present illness and incorporating "U" into the pedagogical mnemonic of OPQRST that is commonly used in medical training. Obtaining this history will help determine if and which abused substances may be contributing to the chief complaint. We also suggest the incorporation of an additional acronym, SORTED, to account for the various domains of Use, including Street (illicit drugs), OTCs (over-the-counter medications), Rx (prescriptions, including nonmedicinal use of pharmaceutical drugs), Tobacco (including e-cigarettes), EtOH (alcohol), and Dietary (caffeine, vitamins, and herbal supplements) agents. We discuss how utilizing OPQRSTU will help reshape the way medical students think about SUDs and will facilitate detection and diagnosis of all domains of SUDs.
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Affiliation(s)
- Joshua Eloge
- a Rush Medical College , Chicago , Illinois , USA
| | - T Celeste Napier
- b Center for Compulsive Behavior and Addiction , Rush University Medical Center , Chicago , Illinois , USA
| | - Bezalel Dantz
- c Department of Psychiatry , Rush University Medical Center , Chicago , Illinois , USA
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24
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Wang JB, Zhu Y, Bai ZF, Wang FS, Li XH, Xiao XH. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury. Chin J Integr Med 2018. [PMID: 29542018 DOI: 10.1007/s11655-018-3000-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Herb-induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM), and is now a growing segment of drug-induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM, it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM), the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points-suspected diagnosis, clinical diagnosis, and confirmed diagnosis-could be reached according to the length of the evidence chain acquired in the structured diagnostic workflow. Either identifying the species of CM or HM or excluding adulterations and toxin contaminants was strongly recommended to improve the level of evidence for a clinical diagnosis of HILI. In addition, the authors report that the improper use of CM, which violates the general law of CM theory, is one of the most important factors that contributes to HILI and should be avoided. By contrast, based on syndrome differentiation, some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore, 9 recommendations are put forward in this guideline.
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Affiliation(s)
- Jia-Bo Wang
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Yun Zhu
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Zhao-Fang Bai
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Fu-Sheng Wang
- Research Center for Biological Therapy, 302 Military Hospital of China, Beijing, 100039, China
| | - Xiu-Hui Li
- Integrative Medical Center, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China.
| | - Xiao-He Xiao
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China.
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25
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Grimstein M, Huang SM. A regulatory science viewpoint on botanical-drug interactions. J Food Drug Anal 2018; 26:S12-S25. [PMID: 29703380 PMCID: PMC9326881 DOI: 10.1016/j.jfda.2018.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022] Open
Abstract
There is a continued predisposition of concurrent use of drugs and botanical products. Consumers often self-administer botanical products without informing their health care providers. The perceived safety of botanical products with lack of knowledge of the interaction potential poses a challenge for providers and both efficacy and safety concerns for patients. Botanical–drug combinations can produce untoward effects when botanical constituents modulate drug metabolizing enzymes and/or transporters impacting the systemic or tissue exposure of concomitant drugs. Examples of pertinent scientific literature evaluating the interaction potential of commonly used botanicals in the US are discussed. Current methodologies that can be applied to advance our efforts in predicting drug interaction liability is presented. This review also highlights the regulatory science viewpoint on botanical–drug interactions and labeling implications.
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Affiliation(s)
- Manuela Grimstein
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Abstract
The idea that the degree of infringement public health interventions have on individual rights should be proportional to the degree of expected benefits has emerged as an influential principle in public health ethics and policy. While proportionality makes sense in theory, it may be difficult to implement in practice, due to the inherent conflict between individual rights and the common good underlying the principle. To apply the proportionality principle to a decision of policy, one must still find a reasonable way of balancing these competing values in light of the available options and empirical evidence. In this article, I consider how the proportionality principle applies to the regulation of dietary supplements and examine some critiques of the current oversight system. I argue that it may be difficult maintain proportional oversight because the risks of dietary supplements vary considerably. Strengthening the regulations may therefore promote an appropriate level of regulation in some cases but lead to overregulation in others.
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Affiliation(s)
- David B Resnik
- National Institute of Environmental Health Sciences, National Institutes of Health, 111 Alexander Drive, Box 12233, Mail Drop E1-06, Research Triangle Park, NC, 27709, USA
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Levy I, Attias S, Ben-Arye E, Schiff E. Use and safety of dietary and herbal supplements among hospitalized patients: What have we learned and what can be learned?—A narrative review. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rashrash M, Schommer JC, Brown LM. Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States. J Patient Exp 2017; 4:108-113. [PMID: 28959715 PMCID: PMC5593261 DOI: 10.1177/2374373517706612] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use. DESIGN The data for herbal products use were collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis. RESULTS Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy." All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems. CONCLUSIONS More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.
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Affiliation(s)
- Mohamed Rashrash
- Chapman University School of Pharmacy, Rinker Health Science Campus, Irvine, CA, USA
| | - Jon C Schommer
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Lawrence M Brown
- Chapman University School of Pharmacy, Rinker Health Science Campus, Irvine, CA, USA
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Exploring beliefs about dietary supplement use: focus group discussions with Dutch adults. Public Health Nutr 2017; 20:2694-2705. [PMID: 28768564 DOI: 10.1017/s1368980017001707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Although dietary supplement use is increasing in Europe and the USA, little research involving adults' beliefs regarding dietary supplements has been conducted. Therefore, the present study aimed to explore and compare users' and non-users' beliefs towards dietary supplements. DESIGN Thirteen focus group discussions were conducted of which seven groups were dietary supplement users and six groups were non-users. Based on the socio-cognitive factors of the Integrated Change Model, a semi-structured topic guide was set up. The discussions were audio-recorded and subjected to qualitative content analysis, applying the framework approach. SETTING Data were collected in Maastricht, the Netherlands, in 2014 and 2015. SUBJECTS In total fifty-six individuals participated in the study, of whom twenty-eight were dietary supplement users and twenty-eight non-users. The average age of participants was 42·9 years. RESULTS Dietary supplement users' attitude beliefs were mainly related to mental and physical health enhancement, illness prevention and curative health benefits. Users were critical of the nutritional knowledge of health professionals and of the quality of food products. Non-users were convinced that the human body does not need any support and that regular food is enough to cover one's nutritional needs. Users and non-users held comparable beliefs regarding the definition and risks of dietary supplements, and perceived social influences. CONCLUSIONS In their decision about dietary supplement use, both groups were guided by their own convictions to a great extent. Both groups would benefit from improved understanding of the health effects of dietary supplements to improve informed decision making.
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Elemental composition of dietary supplements most consumed in Belo Horizonte, Brazil, analysed by k 0-INAA. J Radioanal Nucl Chem 2017. [DOI: 10.1007/s10967-017-5222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pajor EM, Eggers SM, Curfs KCJ, Oenema A, de Vries H. Why do Dutch people use dietary supplements? Exploring the role of socio-cognitive and psychosocial determinants. Appetite 2017; 114:161-168. [PMID: 28359781 DOI: 10.1016/j.appet.2017.03.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/22/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the Netherlands, the prevalence of dietary supplement use has doubled (from 17 to 40 per cent) since the 1980s. Yet, limited data is available on which socio-cognitive factors are associated with dietary supplement use. Therefore, the purpose of the study is to explain dietary supplement use with determinants deriving from the Integrated Change Model (ICM) and from formative research. METHOD/DESIGN Socio-cognitive and psychosocial factors were measured among users and non-users of dietary supplements in a longitudinal survey study, with measurements at baseline (N = 1448) and at one-month follow-up (N = 1161). Negative binomial regression analysis was applied to de data. RESULTS Intention emerged as the main predictor of dietary supplement use (OR = 1.99). Further predictors of dietary supplement use with smaller effect-sizes were: health regulatory focus (promotion, OR = 1.46), social modelling (OR = 1.44), attitude (pros, OR = 1.37), attitude (cons, OR = 0.87), health locus of control (OR = 0.77), and risk perception (chance of getting ill, OR = 1.22). CONCLUSIONS Individuals tend to use dietary supplements if they are promotion oriented, notice dietary supplement users in their social environment, estimate their chances of getting ill higher, and have positive attitudes towards dietary supplements. In contrast, non-users believe that external factors affect their health, and hold negative attitudes towards dietary supplements. PRACTICAL IMPLICATIONS Mapping out individuals' socio-cognitive profile may contribute to the development of online health communication. Based on socio-cognitive and demographical factors, personalised advice can be given about dietary supplement use.
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Affiliation(s)
- E M Pajor
- Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - S M Eggers
- Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - K C J Curfs
- Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - A Oenema
- Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - H de Vries
- Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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Romero K, Goparaju B, Russo K, Westover MB, Bianchi MT. Alternative remedies for insomnia: a proposed method for personalized therapeutic trials. Nat Sci Sleep 2017; 9:97-108. [PMID: 28360539 PMCID: PMC5364017 DOI: 10.2147/nss.s128095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Insomnia is a common symptom, with chronic insomnia being diagnosed in 5-10% of adults. Although many insomnia patients use prescription therapy for insomnia, the health benefits remain uncertain and adverse risks remain a concern. While similar effectiveness and risk concerns exist for herbal remedies, many individuals turn to such alternatives to prescriptions for insomnia. Like prescription hypnotics, herbal remedies that have undergone clinical testing often show subjective sleep improvements that exceed objective measures, which may relate to interindividual heterogeneity and/or placebo effects. Response heterogeneity can undermine traditional randomized trial approaches, which in some fields has prompted a shift toward stratified trials based on genotype or phenotype, or the so-called n-of-1 method of testing placebo versus active drug in within-person alternating blocks. We reviewed six independent compendiums of herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge the gap between the unfeasible expectation of formal evidence in this space and the reality of common self-medication by those with insomnia, we propose a method for guided self-testing that overcomes certain operational barriers related to inter- and intraindividual sources of phenotypic variability. Patient-chosen outcomes drive a general statistical model that allows personalized self-assessment that can augment the open-label nature of routine practice. The potential advantages of this method include flexibility to implement for other (nonherbal) insomnia interventions.
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Affiliation(s)
- Kate Romero
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Balaji Goparaju
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Kathryn Russo
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Kesselheim AS, Connolly J, Rogers J, Avorn J. Mandatory disclaimers on dietary supplements do not reliably communicate the intended issues. Health Aff (Millwood) 2016; 34:438-46. [PMID: 25732494 DOI: 10.1377/hlthaff.2014.0515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Some efforts by the government to regulate the promotional statements of pharmaceutical manufacturers have recently been found unconstitutional under the First Amendment, which has been interpreted to protect commercial as well as personal speech. As an alternative means of protecting patients from unreliable marketing claims, courts have proposed that the Food and Drug Administration could add disclaimers to promotional messages that discuss off-label, or unapproved, uses. We conducted a systematic review of studies of the disclaimers currently required for dietary supplements, to assess how well disclaimers inform consumers' health choices. A few small studies reported a modest impact of disclaimers on consumers' attitudes about dietary supplements, but larger and more rigorous studies generally revealed that many consumers were unaware of a disclaimer or reported that it did not affect their perceptions of a product. The available evidence indicates that replacing government restrictions on pharmaceutical marketing with potentially ineffective disclaimers will be an inadequate way of informing patients about the efficacy and safety of drugs, and it risks returning the United States to a previous era when inappropriate marketing claims about prescription drugs proliferated and contributed to the inappropriate use of those products.
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Affiliation(s)
- Aaron S Kesselheim
- Aaron S. Kesselheim is an associate professor of medicine at Harvard Medical School, in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, in Boston, Massachusetts
| | - John Connolly
- John Connolly is a research assistant in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital
| | - James Rogers
- James Rogers is a research assistant in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital
| | - Jerry Avorn
- Jerry Avorn is a professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital
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Curtis P, Gaylord S. Safety Issues in the Interaction of Conventional, Complementary, and Alternative Health Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1533210105275144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews issues of safety in health care, applied particularly to the interface between conventional medicine and complementary and alternative medicine. These issues include errors in treatment and medical management, adverse effects of pharmaceuticals, and defining risk for patients. For complementary and alternative medicine, especially dietary supplements, problems of quality control, licensing, regulation, and misrepresentation are discussed. An important issue is the interface between conventional and complementary therapies, in terms of drug/herb interactions, laboratory diagnosis, and lack of communication between clinicians about patients. Improvements in safety and quality will come from a commitment to better education and understanding between both types of care.
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Affiliation(s)
- Peter Curtis
- Department of Family Medicine, CB# 7595, University of North Carolina School of Medicine, Chapel Hill, NC 27599
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, School of Medicine, UNC, Chapel Hill
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Prevalence, perceptions and factors influencing the use of traditional and complementary medicine (T&CM) in Zimbabwe’s adult population: The case of Bindura District. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Patel NM, Derkits RM. Possible Increase in Liver Enzymes Secondary to Atorvastatin and Black Cohosh Administration. J Pharm Pract 2016. [DOI: 10.1177/0897190007303051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Since the publication of the Women's Health Initiative (WHI) trials, there has been a decline in the use of hormonal replacement therapy (HRT). The risks outweighed the benefits in the WHI trials, and therefore women are seeking alternative treatments including herbal remedies to HRT for mitigation of postmenopausal conditions. The authors report a case of drug-herb interaction between black cohosh (Cimicifuga racemosa ) and atorvastatin leading to elevation in liver enzymes. Case summary: A 53-year-old woman with a past medical history significant for atypical chest pain, family history of coronary artery disease, and menopause discontinued oral HRT and started black cohosh for treatment of her menopausal symptoms. The patient also reported taking atorvastatin, aspirin, glucosamine/chondroitin, and vaginal estradiol (Vagifem® ). Routine lab results revealed an acute elevation of her liver enzymes. At this time, additional blood tests were performed to rule out other plausible causes of acute elevation in liver enzymes, which did not reveal other etiologies. It was recommended that she discontinue the black cohosh immediately due to a potential drug-herb interaction. Following the patient's discontinuation of black cohosh, her liver enzymes decreased within 1 week and completely returned to normal within 1 month. Discussion: Several case reports have associated black cohosh with hepatotoxicity. It was reported that a commercially available formulation of black cohosh may potently inhibit human cytochrome (CYP) 3A4. Inhibition of CYP3A4 by black cohosh could possibly elevate levels of atorvastatin, causing an elevation of liver enzymes. To the authors' knowledge, they report the first case report of drug-herb interaction with use of the black cohosh and atorvastatin. Conclusion: The use of black cohosh concomitantly with atorvastatin may potentially lead to a drug-herb interaction resulting in an elevation of liver enzymes. According to the Naranjo probability scale, there was a possible drug-induced adverse event. Black cohosh should not be routinely recommended for treatment of menopausal symptoms. However, if a patient chooses to use black cohosh against medical advice, particular attention should be given to the potential CYP3A4 drug interactions.
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Affiliation(s)
- Nima M. Patel
- Temple University School of Pharmacy, Philadelphia, PA,
| | - Ramona M. Derkits
- Rutgers Pharmaceutical Industry Fellowship, Pfizer Consumer Healthcare, Morris Plains, NJ
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Benefit beliefs about protein supplements: A comparative study of users and non-users. Appetite 2016; 103:229-235. [PMID: 27103061 DOI: 10.1016/j.appet.2016.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 11/21/2022]
Abstract
The consumption of protein supplements among leisure time exercisers is growing. The present study aims to identify factors that motivate protein supplement consumption by comparing users' and non-users' underlying benefit beliefs about protein supplement. The study is based on an online survey of 813 Swiss adults (376 users of protein supplements and 437 non-users). Participants answered questions related to their benefit beliefs regarding protein supplement, their protein supplements consumption frequency, their activity level (GPAQ), and their reasons for taking protein supplement. In women, the most commonly cited reasons were to increase muscles (57.3%) and to regulate their weight (48.6%); and in men to increase muscles (83.7%) and to promote regeneration (53.7%). Furthermore, a principal component analysis revealed four benefit belief factors: (a) restore nutrients/avoid weakness; (b) fitness promotion; (c) health/well-being; (d) muscle modulation/competitive performance. The analysis showed that both users and non-users predominantly perceive protein supplements consumption as a strategy to modulate muscle mass, while beliefs in a health and well-being promoting effect was more prevalent among users (M = 3.2, SD = 1.3) than non-users (M = 2.7, SD = 1.3) (p < 0.001). Moreover, health and wellbeing-related beliefs were associated with an increased likelihood of a higher protein supplements intake frequency (OR = 1.5, 95% CI: 1.1-1.9), while physical activity level was not associated with protein supplements intake frequency. In addition, a negative correlation between physical activity level and beliefs in a fitness-promoting effect of protein supplements (r = -0.14, p < 0.001) was observed, indicating that for a subgroup, protein supplements might license lower activity levels. Despite a lack of scientific evidence, consumers of varying activity levels consume protein supplements and believe in its' various positive features. Users should be better informed to prevent misguided health beliefs.
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Kapoor A, Sharfstein JM. Breaking the gridlock: Regulation of dietary supplements in the United States. Drug Test Anal 2015; 8:424-30. [PMID: 27072846 DOI: 10.1002/dta.1892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/16/2015] [Accepted: 09/07/2015] [Indexed: 12/29/2022]
Abstract
Despite increasing use of dietary supplements by millions of consumers, regulation of these products has not kept pace with changes and risks in the market. A major reason for this policy gridlock is the inability of different parties to come to an agreement on a path forward. The purpose of this paper is to set out a new framework for regulation in which consumers, industry, and regulators can all find common ground. This framework is based on a conceptual shift from 'benefit versus risk', the model for prescription drugs, to 'access with safety'. Steps should include registration of all dietary supplements to permit easier enforcement against rogue products, a stronger disclaimer explaining the limited role of FDA in evaluating structure/function product claims, the establishment of standard laboratory techniques for characterization of products, and more clear authority for the agency when safety concerns arise. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Akshay Kapoor
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Joshua M Sharfstein
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Stournaras E, Tziomalos K. Herbal medicine-related hepatotoxicity. World J Hepatol 2015; 7:2189-2193. [PMID: 26380043 PMCID: PMC4561772 DOI: 10.4254/wjh.v7.i19.2189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/22/2015] [Accepted: 08/21/2015] [Indexed: 02/06/2023] Open
Abstract
Herbal medicine products represent a common therapeutic approach in the East and are gaining increasing popularity in Western countries. They are unjustifiably considered to be side-effect free; on the contrary, severe toxicity, including catastrophic hepatic injury has been reported in association with their use. Vigilance is required from both physicians and the general public. Physicians should always suspect herbal medicines when evaluating a patient with unexplained liver injury. Regulation standards for herbal products need to be reconsidered, so that the efficacy and safety of these products have been clearly demonstrated before they enter the markets.
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Ward J, Humphries K, Coats J, Whitfield P. Attributes of Non-Hispanic Blacks That Use Chiropractic Health Care: A Survey of Patients in Texas and Louisiana. J Chiropr Med 2015; 14:15-23. [PMID: 26693213 DOI: 10.1016/j.jcm.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to describe non-Hispanic blacks that use chiropractic health care to better understand this underserved demographic. METHODS E-mail and telephone calls were used to recruit doctors of chiropractic (DCs) in Texas and Louisiana to distribute anonymous surveys to their non-Hispanic black patients. Twenty doctors volunteered to participate. Each was sent 10 surveys and self-addressed envelopes to distribute. All doctors were given at least 3 months to distribute surveys to as many non-Hispanic black patients that they had. The survey contained 20 questions designed to develop a profile of non-Hispanic black patients that used chiropractic care. Descriptive statistics were used to summarize demographic and other patient attributes. RESULTS Two-hundred surveys were distributed and 44 were completed, yielding a response rate of 22%. Non-Hispanic black patients were more likely to be female (54.5%), be older than 50 years (56.8%), be a college graduate (59.1%), be employed (61.9%), report not receiving public assistance in the past 5 years (81.4%), report a household income of $20 000 to $60 000 a year (48.8%), and born in the United States (83.7%). Participants reported that there was a DC within 30 minutes of their address (81.4%), their DC always explained things to them in an easy-to-understand manner (81.8%), their DC always showed respect for what they had to say (88.6%), and their DC always cared about them as a person (86.4%). CONCLUSIONS In the sample surveyed, non-Hispanic black patients tended to be female, be older, be college educated, be employed, and have a positive viewpoint on their interactions with their DC.
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Affiliation(s)
- John Ward
- Associate Professor/Research Fellow, Department of Physiology and Chemistry, Texas Chiropractic College, Pasadena, TX
| | | | - Jesse Coats
- Professor, Department of Clinical Specialties, Texas Chiropractic College, Pasadena, TX
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He TT, Ung COL, Hu H, Wang YT. Good manufacturing practice (GMP) regulation of herbal medicine in comparative research: China GMP, cGMP, WHO-GMP, PIC/S and EU-GMP. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2014.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health 2015; 105:478-85. [PMID: 25602879 DOI: 10.2105/ajph.2014.302348] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Millions of people in the United States consume dietary supplements hoping to maintain or improve their health; however, extensive research has failed to demonstrate the efficacy of numerous supplements in disease prevention. In addition, concerns about the safety of routine and high-dose supplementation have been raised. The Food and Drug Administration regulates dietary supplement quality, safety, and labeling, and the Federal Trade Commission monitors advertisements and marketing; still, vast enforcement challenges remain, and optimal governmental oversight has not been achieved. If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.
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Affiliation(s)
- Ranjani R Starr
- Ranjani R. Starr, MPH, is with the Office of Public Health Studies, Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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Hardy ML, Duvall K. Multivitamin/multimineral supplements for cancer prevention: implications for primary care practice. Postgrad Med 2015; 127:107-16. [PMID: 25584933 DOI: 10.1080/00325481.2015.993284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a popular belief that multivitamin and mineral (MVM) supplements can help prevent cancer and other chronic diseases. Studies evaluating the effects of MVM supplements on cancer risk have largely been observational, with considerable methodologic limitations, and with conflicting results. We review evidence from the few available randomized, controlled trials that assessed the effects of supplements containing individual vitamins, a combination of a few select vitamins, or complete MVM supplements, with a focus on the recent Physicians' Health Study II (PHS II). PHS II is a landmark trial that followed generally healthy middle-aged and older men (mean age 64 years) who were randomized to daily MVM supplementation for a mean duration of 11 years. Men taking MVMs experienced a statistically significant 8% reduction in incidence of total cancer (hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.86-0.998; p = 0.04). Men with a history of cancer derived an even greater benefit: cancer incidence was 27% lower with MVM supplementation versus placebo in this subgroup (HR: 0.73; 95% CI: 0.56-0.96; p = 0.02). Positive results of PHS II contrast with randomized studies of individual vitamins or small combinations of vitamins, which have largely shown a neutral effect, and in some cases, an adverse effect, on cancer risk. The results of PHS II may have a considerable public health impact, potentially translating to prevention of approximately 68 000 cancers per year if all men were to use similar supplements, and to an even greater benefit with regard to secondary prevention of cancer.
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Affiliation(s)
- Mary L Hardy
- Stiles Integrative Oncology Program, University of California at Los Angeles , Los Angeles, CA
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Review of the regulations for clinical research in herbal medicines in USA. Chin J Integr Med 2014; 20:883-93. [PMID: 25428336 DOI: 10.1007/s11655-014-2024-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Indexed: 01/17/2023]
Abstract
In 2012, USA Food and Drug Administration (FDA) approved 39 new drugs, however, there are only two botanical drugs (one topical and one oral) approved by FDA since the publication of the FDA's industry guidelines for the botanical drug product in June 2004. The approval shows the Western guideline can be used for herbal medicines, authors investigate current regulation on herbal medicine clinical research, identify challenges conducting clinical trials, and seek to produce some guidance for potential investigators and sponsors considering a clinical trial in this area. Key words were formulated for searching on Medline and FDA website to locate relevant regulations for clinical research in herbal medicines to understand current environment for herbal medicine usage and examine the barriers affecting herbal medicine in clinical trials. Authors critically explore case study of the 1st FDA approved botanical drugs, Veregen (sinecatechins), green tea leaves extract, a topical cream for perianal and genital condyloma. In consideration of current regulation environment in USA, based on the findings and analysis through the literature review and Veregen case study, authors produce and propose a Checklist for New Drug Application of Herbal Medicines for potential investigators and sponsors considering in a herbal medicine clinical trial.
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Basedow M, Runciman WB, March L, Esterman A. Australians with osteoarthritis; the use of and beliefs about complementary and alternative medicines. Complement Ther Clin Pract 2014; 20:237-42. [DOI: 10.1016/j.ctcp.2014.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Tarn DM, Guzmán JR, Good JS, Wenger NS, Coulter ID, Paterniti DA. Provider and patient expectations for dietary supplement discussions. J Gen Intern Med 2014; 29:1242-9. [PMID: 24875792 PMCID: PMC4139527 DOI: 10.1007/s11606-014-2899-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/24/2014] [Accepted: 05/09/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dietary supplement use in the United States is common. Patients can procure supplements without a prescription, and often do not disclose supplement use to their healthcare providers. Providers and patients may be uncertain about what would be appropriate or helpful in discussions of supplements during routine office visits. OBJECTIVE To explore provider and patient expectations for discussions of dietary supplements. DESIGN Semi-structured interviews were conducted with a purposeful sample of healthcare providers from three specialties and their patients who reported taking supplements. PARTICIPANTS Thirty-five outpatient providers (14 primary care, six integrative medicine, and 15 complementary and alternative medicine (CAM) providers) and 107 of their patients. APPROACH Qualitative analysis of transcripts using grounded theory and iterative review. RESULTS Both providers and patients raised twelve common topics about dietary supplements that they felt were important to discuss during office visits, such as: supplements taken; supplement risks (interactions, safety/harm, side effects/adverse events); treatment benefits; efficacy; alternative treatments; and patient expectations/preferences for treatment. Some topics were mentioned more frequently by providers than patients, such as how to take, reason for taking, and evidence for use. Providers raised several topics that were mentioned infrequently by patients. Supplement costs and regulations were not brought up by any patients, even though consideration of these topics could influence patient decisions to take supplements. Complementary healthcare providers brought up topics not mentioned by primary care providers, such as the importance of supplement brands and supplement mega-dosing. CONCLUSIONS Patients and providers have concordant views about the need to discuss patient supplement use and ensure patient safety. Patients may undervalue, be unaware of, or discount information about cost or regulations that could affect their decision-making about supplement use. Future studies could examine the value, acceptability, and influence of a more comprehensive approach to discussions to help patients appropriately evaluate supplements.
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Affiliation(s)
- Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, CA, USA,
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Wardle J(JL, Adams J. Indirect and non-health risks associated with complementary and alternative medicine use: An integrative review. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.01.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol 2014; 109:950-66; quiz 967. [PMID: 24935270 DOI: 10.1038/ajg.2014.131] [Citation(s) in RCA: 479] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/10/2014] [Indexed: 02/07/2023]
Abstract
Idiosyncratic drug-induced liver injury (DILI) is a rare adverse drug reaction and it can lead to jaundice, liver failure, or even death. Antimicrobials and herbal and dietary supplements are among the most common therapeutic classes to cause DILI in the Western world. DILI is a diagnosis of exclusion and thus careful history taking and thorough work-up for competing etiologies are essential for its timely diagnosis. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis and management of DILI with special emphasis on DILI due to herbal and dietary supplements and DILI occurring in individuals with underlying liver disease.
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Affiliation(s)
- Naga P Chalasani
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul H Hayashi
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - William M Lee
- University of Texas at Southwestern Medical Center, Dallas, Texas, USA
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Herbs and liver injury: a clinical perspective. Clin Gastroenterol Hepatol 2014; 12:1069-76. [PMID: 23924877 DOI: 10.1016/j.cgh.2013.07.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 02/07/2023]
Abstract
Despite a perception that herbal and dietary supplements are safe, devastating liver injury has been reported to result from their use. The difficulty in characterizing liver injury attributable to herbal and dietary supplements stems from the permissive regulatory environment, the complexity of marketed products, and underreporting by the patients who use them. Despite these limitations, researchers, clinicians, and regulators have increasing awareness of the need for study in this area.
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