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Yergaliyev KA, Aveling EL, Lee RM, Austin SB. Lessons for Local Policy Initiatives to Address Dietary Supplement Use Among Adolescents: A Qualitative Study of Stakeholders' Perceptions. J Adolesc Health 2020; 67:550-556. [PMID: 32387096 DOI: 10.1016/j.jadohealth.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/10/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Weight-loss and muscle-building dietary supplements can have adverse health consequences for youth. At a time, when the Food and Drug Administration is considering increasing oversight of dietary supplements, this study aimed to explore community stakeholders' perceptions about the use of and access to such supplements among adolescents and to identify challenges and opportunities to engage stakeholders with policy initiatives to curtail youth access to supplements at the local level. METHOD We conducted 32 key informant semistructured interviews in four municipalities in Massachusetts with purposefully selected participants representing three categories of community stakeholders who could contribute to policy agenda setting at the local level: policy professionals, youth service providers, and young adults aged 18-25 years who used weight-loss or muscle-building supplements as minors. Interviews were audio-recorded, transcribed, deidentified, and analyzed using thematic analysis approach, facilitated by Dedoose software. RESULTS Community stakeholders reported wide availability and easy access to dietary supplements. Most participants were unaware of health risks. Many stakeholders did not perceive the use of these products as an issue impacting youth in their communities. The challenges identified in engaging stakeholders were competing concerns on the policy agenda, limited capacity of stakeholders, and uncertainty about who is accountable for the problem. CONCLUSION This study indicates the need for complementary, multipronged approaches at the municipal level to address the problem of weak regulation and easy access to potentially dangerous weight-loss and muscle-building supplements for youth.
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Affiliation(s)
- Kuanysh A Yergaliyev
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; SDU Business School, Suleyman Demirel University, Almaty, Kazakhstan.
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rebekka M Lee
- Department of Social and Behavior Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Social and Behavior Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Shi C, Wang P, Airen S, Brown C, Liu Z, Townsend JH, Wang J, Jiang H. Nutritional and medical food therapies for diabetic retinopathy. EYE AND VISION (LONDON, ENGLAND) 2020; 7:33. [PMID: 32582807 PMCID: PMC7310218 DOI: 10.1186/s40662-020-00199-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
Diabetic retinopathy (DR) is a form of microangiopathy. Reducing oxidative stress in the mitochondria and cell membranes decreases ischemic injury and end-organ damage to the retina. New approaches are needed, which reduce the risk and improve the outcomes of DR while complementing current therapeutic approaches. Homocysteine (Hcy) elevation and oxidative stress are potential therapeutic targets in DR. Common genetic polymorphisms such as those of methylenetetrahydrofolate reductase (MTHFR), increase Hcy and DR risk and severity. Patients with DR have high incidences of deficiencies of crucial vitamins, minerals, and related compounds, which also lead to elevation of Hcy and oxidative stress. Addressing the effects of the MTHFR polymorphism and addressing comorbid deficiencies and insufficiencies reduce the impact and severity of the disease. This approach provides safe and simple strategies that support conventional care and improve outcomes. Suboptimal vitamin co-factor availability also impairs the release of neurotrophic and neuroprotective growth factors. Collectively, this accounts for variability in presentation and response of DR to conventional therapy. Fortunately, there are straightforward recommendations for addressing these issues and supporting traditional treatment plans. We have reviewed the literature for nutritional interventions that support conventional therapies to reduce disease risk and severity. Optimal combinations of vitamins B1, B2, B6, L-methylfolate, methylcobalamin (B12), C, D, natural vitamin E complex, lutein, zeaxanthin, alpha-lipoic acid, and n-acetylcysteine are identified for protecting the retina and choroid. Certain medical foods have been successfully used as therapy for retinopathy. Recommendations based on this review and our clinical experience are developed for clinicians to use to support conventional therapy for DR. DR from both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have similar retinal findings and responses to nutritional therapies.
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Affiliation(s)
- Ce Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Peng Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shriya Airen
- College of Arts and Sciences, University of Miami, Miami, FL USA
| | - Craig Brown
- Department of Ophthalmology, College of Medicine, the University of Arkansas for Medical Sciences, Fayetteville, AR USA
| | - Zhiping Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Justin H. Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL USA
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Temova Rakuša Ž, Kristl A, Roškar R. Quantification of reduced and oxidized coenzyme Q10 in supplements and medicines by HPLC-UV. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:2580-2589. [PMID: 32930284 DOI: 10.1039/d0ay00683a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coenzyme Q10 (CoQ10) supplements are widely used because of their antioxidant and anti-inflammatory effects, especially in the management of cardiovascular diseases. The latest pharmaceutical approach to increase CoQ10 bioavailability and efficiency is the formulation of its reduced form. Regardless of the growing number and usage of CoQ10 preparations, their analytics and quality control is inadequate, neglecting interconversion between the two CoQ10 forms. Therefore, this study proposes a HPLC-UV method for the simultaneous quantification of both reduced and oxidized coenzyme Q10, as well as total CoQ10, as a sum of its individual forms. The suitability of the developed method was confirmed by two additional approaches for total CoQ10 determination - its total reduction and oxidation, differing from the proposed procedure only in the final stage of sample preparation. The results for total CoQ10 content were consistent between the three procedures and also with the official USP method for total CoQ10 determination. The proposed method was applied to 13 dietary supplements and medicines in the form of soft- and hard-shell capsules, revealing the co-existence of both CoQ10 forms in 85% of the tested preparations. CoQ10 forms that were undeclared accounted for up to 75% of the CoQ10 content, which is overlooked by current official methods that evaluate only the total CoQ10 content. This validated HPLC-UV method for the unequivocal quantification of reduced and oxidized CoQ10 is therefore appropriate for the routine analysis of CoQ10 preparations in quality control laboratories, as well as for stability studies, and is suggested to be adopted as an official method.
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Affiliation(s)
- Žane Temova Rakuša
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia.
| | - Albin Kristl
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia.
| | - Robert Roškar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia.
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Ganson KT, Murray SB, Nagata JM. A call for public policy and research to reduce use of appearance and performance enhancing drugs and substances among adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:13-14. [PMID: 31676196 DOI: 10.1016/s2352-4642(19)30345-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kyle T Ganson
- School of Social Work, Simmons University, Boston, MA 02115, USA.
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 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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Abstract
CONTEXT With the increasing use of unregulated dietary supplements, athletes are at continued risk from adverse medical events and inadvertent doping. EVIDENCE ACQUISITION A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2017 was performed using search terms, including dietary supplement, contamination, doping in athletes, inadvertent doping, and prohibited substances. The references of pertinent articles were reviewed for other relevant sources. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Poor manufacturing processes and intentional contamination with many banned substances continue to occur in dietary supplements sold in the United States. Certain sectors, such as weight loss and muscle-building supplements, pose a greater threat because they are more likely to be contaminated. CONCLUSION Athletes will continue to be at risk for adverse events and failed doping tests due to contaminated dietary supplements until legislation changes how they are regulated. In the interim, there are several steps that can be taken to mitigate this risk, including improved education of medical staff and athletes and use of third party-certified products.
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Cohen PA, Venhuis BJ, Brandt SD. Advancing supplement science: challenges and solutions. Drug Test Anal 2016; 8:e1–3. [DOI: 10.1002/dta.1953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | - Bastiaan J. Venhuis
- National Institute for Public Health and the Environment (RIVM) A. van Leeuwenhoeklaan 9 3721 MA Bilthoven the Netherlands
| | - Simon D. Brandt
- School of Pharmacy and Biomolecular SciencesLiverpool John Moores University Byrom Street Liverpool L3 3AF UK
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