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Crawford C, Avula B, Lindsey AT, Katragunta K, Khan IA, Deuster PA. Label Accuracy of Weight Loss Dietary Supplements Marketed Online With Military Discounts. JAMA Netw Open 2024; 7:e249131. [PMID: 38691359 PMCID: PMC11063798 DOI: 10.1001/jamanetworkopen.2024.9131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
Importance Dietary supplements for weight loss, among the most popular supplement products on the market, are promoted not only for losing weight and shedding fat, but also for added benefits of energy and performance, all packed into 1 capsule with multiple combinations of ingredients. Fraudulent marketing of weight loss supplements, some with exaggerated claims, some that are potentially dangerous, and some that contain illegal ingredients, is ever present, especially through online sources, where multiple manufacturers target service members by offering military discounts. Objectives To examine whether select dietary supplements marketed online for weight loss from companies advertising military discounts are accurately labeled according to the Supplement Facts listed ingredients, whether they contain any ingredients prohibited for use in the military, and to qualitatively describe the products' label claims. Design, Setting, and Participants In this case series, 30 dietary supplement products marketed for weight loss were selected and purchased in June 2023 from 12 online companies advertising military discounts. Data were analyzed from July to August 2023. Main Outcomes and Measures Liquid chromatography-mass spectrometry was used to verify whether products were accurately labeled according to the Supplement Facts listed ingredients and whether they contained any substances on the DoD Prohibited Dietary Supplement Ingredients List. A separate analysis was conducted to describe product label claims by using the Operation Supplement Safety (OPSS) Risk Assessment Scorecard. Results Of the 30 products tested, analysis showed that 25 had inaccurate labels. Of these, 24 had ingredients listed on the label that were not detected (misbranded); 7 had hidden components not present on the label, some of which would be considered adulterated; and 10 had substances on the DoD Prohibited Dietary Supplement Ingredients List either on or hidden from the label. All products were rated as risky when applying the OPSS Scorecard. Conclusions and Relevance In this case series study, the majority of products had inaccurate labels. Some were misbranded, others would be considered adulterated with ingredients not allowed in dietary supplements, and some contained ingredients prohibited for use in the military.
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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, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Andrea T. Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Kumar Katragunta
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Ikhlas A. Khan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - 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, Maryland
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Raffoul A, Beccia AL, Jackson DA, Sarda V, Hart JE, Chavarro JE, Austin SB. Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States. Soc Sci Med 2023; 335:116232. [PMID: 37708694 PMCID: PMC10567056 DOI: 10.1016/j.socscimed.2023.116232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m2 and 30-34.9 kg/m2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic.
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Affiliation(s)
- Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Destiny A Jackson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Okoya FT, Santoso M, Raffoul A, Atallah MA, Bryn Austin S. Weak regulations threaten the safety of consumers from harmful weight-loss supplements globally: results from a pilot global policy scan. Public Health Nutr 2023; 26:1917-1924. [PMID: 37132256 PMCID: PMC10478046 DOI: 10.1017/s1368980023000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To pilot a global policy scan assessing how governments worldwide regulate weight-loss supplements (WLS). DESIGN Experts on WLS policies from thirty countries that varied by World Bank income classification, with five from each of the six WHO regions, completed an online survey on WLS regulation in their country. The survey covered six domains: legal frameworks; pre-market requirements; claims, labelling, and advertisements; product availability; adverse events reporting; and monitoring and enforcement. Percentages were calculated for presence or absence of a type of regulation. SETTING Experts were recruited through websites of regulatory bodies and professional LinkedIn networks and scientific article searches on Google Scholar. PARTICIPANTS Thirty experts, one from each country (i.e. researchers, regulators, other experts in food and drug regulation). RESULTS WLS regulations varied widely across countries, and a number of gaps were identified. One country (Nigeria) has a minimum legal age to purchase WLS. Thirteen countries reported independently evaluating the safety of a new WLS product sample. Two countries have limitations on where WLS can be sold. In eleven countries, reports on adverse events related to WLS are publicly available. In eighteen countries, safety of new WLS is to be established through scientific criteria. Penalties for WLS non-compliance with pre-market regulations exist in twelve countries and labelling requirements in sixteen countries. CONCLUSIONS Results of this pilot study document wide variability in national WLS regulations globally, exposing many gaps in important components of consumer protection regulatory frameworks for WLS, which likely put consumer health at risk.
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Affiliation(s)
- Funmbi T Okoya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Monique Santoso
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA02115, USA
| | - Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Maya Azar Atallah
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, England
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Hewlings SJ. Eating Disorders and Dietary Supplements: A Review of the Science. Nutrients 2023; 15:2076. [PMID: 37432190 DOI: 10.3390/nu15092076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
Disordered eating is a serious health concern globally. The etiology is complex and multidimensional and differs somewhat for each specific eating disorder. Several risk factors have been identified which include psychological, genetic, biochemical, environmental, and sociocultural factors. Poor body image, low self-esteem, teasing, family dynamics, and exposure to media images have also been identified as risk factors. While it is enticing to consider a single behavioral risk factor, doing so fails to consider the documented environmental, social, psychological, biological, and cultural factors that contribute to the development of an eating disorder in a multidimensional and complex integration that is undoubtedly unique to everyone. Focusing only on any one factor without taking the complex etiology into account is remiss. For example, it has been suggested that the use of dietary supplements may lead to eating disorders, despite a lack of evidence to support this conjecture. Therefore, the purpose of this review is to examine the evidence-based risk factors for eating disorders and discuss why connecting dietary supplements to eating disorder etiology is not supported by the scientific literature and may interfere with treatment. Established, effective prevention and treatment approaches for eating disorders should be the focus of public health initiatives in this domain.
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Affiliation(s)
- Susan J Hewlings
- Nutrasource Pharmaceutical and Nutraceutical Services, Inc., Guelph, ON N1G 0B4, Canada
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Ganson KT, Hallward L, Cunningham ML, Murray SB, Nagata JM. Use of Legal Appearance- and Performance-Enhancing Drugs and Substances: Findings from the Canadian Study of Adolescent Health Behaviors. Subst Use Misuse 2023; 58:289-297. [PMID: 36576273 DOI: 10.1080/10826084.2022.2161318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold "over-the-counter," however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study. METHODS Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use. RESULTS Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers. CONCLUSIONS This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Laura Hallward
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,School of Kinesiology, Western University, London, Canada
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Targeting skeletal muscle mitochondrial health in obesity. Clin Sci (Lond) 2022; 136:1081-1110. [PMID: 35892309 PMCID: PMC9334731 DOI: 10.1042/cs20210506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 11/21/2022]
Abstract
Metabolic demands of skeletal muscle are substantial and are characterized normally as highly flexible and with a large dynamic range. Skeletal muscle composition (e.g., fiber type and mitochondrial content) and metabolism (e.g., capacity to switch between fatty acid and glucose substrates) are altered in obesity, with some changes proceeding and some following the development of the disease. Nonetheless, there are marked interindividual differences in skeletal muscle composition and metabolism in obesity, some of which have been associated with obesity risk and weight loss capacity. In this review, we discuss related molecular mechanisms and how current and novel treatment strategies may enhance weight loss capacity, particularly in diet-resistant obesity.
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10,12-conjugated linoleic acid supplementation improves HDL composition and function in mice. J Lipid Res 2022; 63:100241. [PMID: 35714730 PMCID: PMC9283942 DOI: 10.1016/j.jlr.2022.100241] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022] Open
Abstract
Obesity is associated with inflammation, insulin resistance, and type 2 diabetes, which are major risk factors for CVD. One dietary component of ruminant animal foods, 10,12-conjugated linoleic acid (10,12 CLA), has been shown to promote weight loss in humans. Previous work has shown that 10,12 CLA is atheroprotective in mice by a mechanism that may be distinct from its weight loss effects, but this exact mechanism is unclear. To investigate this, we evaluated HDL composition and function in obese LDL receptor (Ldlr−/−) mice that were losing weight because of 10,12 CLA supplementation or caloric restriction (CR; weight-matched control group) and in an obese control group consuming a high-fat high-sucrose diet. We show that 10,12 CLA-HDL exerted a stronger anti-inflammatory effect than CR- or high-fat high-sucrose-HDL in cultured adipocytes. Furthermore, the 10,12 CLA-HDL particle (HDL-P) concentration was higher, attributed to more medium- and large-sized HDL-Ps. Passive cholesterol efflux capacity of 10,12 CLA-HDL was elevated, as was expression of HDL receptor scavenger receptor class B type 1 in the aortic arch. Murine macrophages treated with 10,12 CLA in vitro exhibited increased expression of cholesterol transporters Abca1 and Abcg1, suggesting increased cholesterol efflux potential of these cells. Finally, proteomics analysis revealed elevated Apoa1 content in 10,12 CLA-HDL-Ps, consistent with a higher particle concentration, and particles were also enriched with alpha-1-antitrypsin, an emerging anti-inflammatory and antiatherosclerotic HDL-associated protein. We conclude that 10,12 CLA may therefore exert its atheroprotective effects by increasing HDL-P concentration, HDL anti-inflammatory potential, and promoting beneficial effects on cholesterol efflux.
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Leão TK, Ribeiro DL, Machado ART, Costa TR, Sampaio SV, Antunes LMG. Synephrine and caffeine combination promotes cytotoxicity, DNA damage and transcriptional modulation of apoptosis-related genes in human HepG2 cells. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2021; 868-869:503375. [PMID: 34454690 DOI: 10.1016/j.mrgentox.2021.503375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 11/19/2022]
Abstract
The abusive consumption of thermogenic supplements occurs worldwide and deserves special attention due to their use to stimulate weight loss and prevent obesity. Thermogenic formulations usually contain Synephrine (SN) and Caffeine (CAF), stimulating compounds extracted from natural sources, but no genetic toxicology studies have predicted this hazardous combination potential. This study examined the toxicogenomic responses induced by SN and CAF, either alone or in combination, in the human hepatic cell line HepG2 in vitro. SN (0.03-30 μM) and CAF (0.6-600 μM) alone did neither decrease cell viability nor induce DNA damage, as assessed using the MTT and comet assays, respectively. SN (3 μM) and CAF (30-600 μM) were combined at concentrations similar to those found in commercial dietary supplements. SN/CAF at 3:90 and 3:600 μM ratios significantly decreased cell viability and increased DNA damage levels in HepG2 cells. CAF (600 μM) and the SN/CAF association at 3:60, 3:90, and 3:600 μM ratios promoted cell death by apoptosis, as demonstrated by flow cytometry. Similar results were observed in gene expression (RT-qPCR): SN/CAF up-regulated the expression of apoptosis- (BCL-2 and CASP9) and DNA repair-related (XPC) genes. SN/CAF at 3:90 μM also downregulated the expression of cell cycle control (CDKN1A) genes. In conclusion, the SN/CAF combination reduces cell viability by inducing apoptosis, damages DNA, and modulates the transcriptional expression of apoptosis-, cell cycle-, and DNA repair-related genes in human hepatic (HepG2) cells in vitro. These effects can be worrisome to consumers of thermogenic supplements.
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Affiliation(s)
- Tainá Keiller Leão
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n°, CEP: 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Diego Luís Ribeiro
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Avenida dos Bandeirantes, 3900, CEP: 14040-901, Ribeirão Preto, São Paulo, Brazil
| | - Ana Rita Thomazela Machado
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n°, CEP: 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Tássia Rafaela Costa
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n°, CEP: 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Suely Vilela Sampaio
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n°, CEP: 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Lusânia Maria Greggi Antunes
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n°, CEP: 14040-903, Ribeirão Preto, São Paulo, Brazil.
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Ng JY, Ahmed S, Zhang CJ. Dietary and herbal supplements for weight loss: assessing the quality of patient information online. Nutr J 2021; 20:72. [PMID: 34315485 PMCID: PMC8317391 DOI: 10.1186/s12937-021-00729-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Given the high prevalence of dietary and herbal supplement (DHS) use in tandem with the growing ease of internet access, patients commonly search online for consumer health information about these products. One common reason for DHSs use includes weight loss. Healthcare providers need to be aware of the quality of online information about DHSs for weight loss so they can adequately counsel their patients and provide them with guidance surrounding the identification of high-quality information resources. This study aimed to assess the quality of online DHSs consumer health information for weight loss that a “typical” patient might access online. Methods Six search terms were used to generate the first 20 websites on the Google search engine in four countries: Australia, Canada, the United Kingdom, and the United States (n = 480 websites). After applying exclusion criteria, eligible websites were quality assessed using the DISCERN instrument. This tool is comprised of 16 questions, each evaluated on a 5-point scale. The averages and standard deviations for each DISCERN instrument item, in addition to overall summed scores between 15 and 75 were calculated. Results Across 87 eligible websites, the mean summed score was 44.80 (SD = 11.53), while the mean overall DISCERN score of each website was 2.72 (SD = 0.99). In general, websites detailed and achieved their specified aims and described treatment benefits. However, most websites failed to describe the impact of treatment on overall quality of life and the impact of a no treatment option. The highest-scoring websites were largely government or health portal websites, while the lowest-scoring websites were largely commercial in nature. Conclusion High variability in DISCERN instrument scores was found across all websites assessed. Healthcare providers should be aware of the fact that their patients may be accessing misinformation online surrounding the use of DHSs for weight loss. Therefore, it is important for healthcare providers to ensure that they are providing their patients with guidance on how to identify high-quality resources online, in order that safe, effective, and evidence-based decisions are made surrounding the use of DHSs for weight loss. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00729-x.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Saad Ahmed
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Catherine Jiayi Zhang
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Hua SV, Granger B, Bauer K, Roberto CA. A content analysis of marketing on the packages of dietary supplements for weight loss and muscle building. Prev Med Rep 2021; 23:101504. [PMID: 34367889 PMCID: PMC8326432 DOI: 10.1016/j.pmedr.2021.101504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Weight loss dietary supplement packages have a high prevalence of marketing claims. Such claims are potentially misleading and lack scientific evidence. Products with the FDA disclaimers and warnings displayed more claims on average. FDA disclaimers and warnings are never displayed on the front of the package.
Most dietary supplements for weight loss and muscle growth lack scientific evidence in support of product claims and contain ingredients that can be harmful to health. Many people, however, still use these products. This paper aims to address a gap in the knowledge of the number and types of marketing claims appearing on dietary supplements for weight loss and muscle building and how they relate to the presence of an FDA disclaimer. We identified all products (n = 110) found in the weight loss and muscle building section of three stores (a pharmacy, supermarket, and superstore) in the Boston, MA area during 2013. We performed a content analysis to assess the presence of marketing claims displayed on product packaging, including claims about weight loss, safety, quality, and scientific evidence. Warnings and the FDA disclaimer were also coded. We found that, on average, products displayed 6.5 claims. Among weight loss- and muscle building- related claims, claims about reducing weight, BMI, or body fat were most common (60.9%), followed by protein claims (40.0%). Nearly half of the products made claims that scientific research supported product use. Products with the FDA disclaimer (53.6%) or a warning for vulnerable populations (56.4%) had a higher average number of claims compared to products without the disclaimer or warning (p < 0.001). Dietary supplements for weight loss and muscle building displayed many marketing claims promising weight loss despite a lack of scientific evidence that such products can be used safely and effectively. Greater FDA regulation of these marketing claims are needed.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
| | - Brigitte Granger
- Supporti, LLC, 665 Huntington Ave., Building 2, Room 320, 300 Lenora Street #667, Seattle, WA 98121, United States
| | - Kelly Bauer
- Division of Hematology and Oncology, Department of Medicine, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, 550 16 Street, Mission Hall, San Francisco, CA 94158, United States
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr., Blockley Hall, Philadelphia, PA 19104, United States
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Han JH, Jang KW, Myung CS. Garcinia cambogia attenuates adipogenesis by affecting CEBPB and SQSTM1/p62-mediated selective autophagic degradation of KLF3 through RPS6KA1 and STAT3 suppression. Autophagy 2021; 18:518-539. [PMID: 34101546 DOI: 10.1080/15548627.2021.1936356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The overexpansion of adipose tissues leads to obesity and eventually results in metabolic disorders. Garcinia cambogia (G. cambogia) has been used as an antiobesity supplement. However, the molecular mechanisms underlying the effects of G. cambogia on cellular processes have yet to be fully understood. Here, we discovered that G. cambogia attenuated the expression of CEBPB (CCAAT/enhancer binding protein (C/EBP), beta), an important adipogenic factor, suppressing its transcription in differentiated cells. In addition, G. cambogia inhibited macroautophagic/autophagic flux by decreasing autophagy-related gene expression and autophagosome formation. Notably, G. cambogia markedly elevated the expression of KLF3 (Kruppel-like factor 3 (basic)), a negative regulator of adipogenesis, by reducing SQSTM1/p62-mediated selective autophagic degradation. Furthermore, increased KLF3 induced by G. cambogia interacted with CTBP2 (C-terminal binding protein 2) to form a transcriptional repressor complex and inhibited Cebpa and Pparg transcription. Importantly, we found that RPS6KA1 and STAT3 were involved in the G. cambogia-mediated regulation of CEBPB and autophagic flux. In an obese animal model, G. cambogia reduced high-fat diet (HFD)-induced obesity by suppressing epididymal and inguinal subcutaneous white adipose tissue mass and adipocyte size, which were attributed to the regulation of targets that had been consistently identified in vitro. These findings provide new insight into the mechanism of G. cambogia-mediated regulation of adipogenesis and suggest molecular links to therapeutic targets for the treatment of obesity.
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Affiliation(s)
- Joo-Hui Han
- Department of Pharmacology, College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Keun-Woo Jang
- Department of Pharmacology, College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Chang-Seon Myung
- Department of Pharmacology, College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
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Use of Complementary Alternative Medicine and the Associated Factors among Patients with Depression. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6626394. [PMID: 33854557 PMCID: PMC8019377 DOI: 10.1155/2021/6626394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 02/03/2023]
Abstract
Complementary Alternative Medicine (CAM) has been widely used in the world, but limited data are available on the use of CAM in depression. This study aimed to evaluate the use of CAM and its associated factors in depression. This cross-sectional study was conducted on 300 depressed patients referred to the Yasuj Neurology and Psychiatric Clinic, southern Iran, between 2019 and 2020. A valid semistructured international questionnaire was used; amongst the participants, 230 (77%) were female. The mean age of the patients was 41.47 ± 12.2 years and the mean duration of the disease was 4.49 ± 4.88 years. The prevalence of CAM use was 37.6% among the patients. The results showed a significant difference between the CAM users and nonusers regarding the disease duration (p=0.045) and body mass index (p=0.007). Moreover, the results of logistic regression analysis revealed a significant relationship between CAM use and female gender, disease duration, overweight, obesity, and self-employment (p=0.039, p=0.028, p=0.029, p=0.048, and p=0.044, resp.). The most frequently used type of CAM was herbal medicine (97.35%) followed by pray therapy (23.89%). Additionally, the most widely used herbs were borage (77%), chamomile (46.9%), and lavender (21.2%). Furthermore, 62.8% of the patients reported that their main reason for using CAM was its effectiveness. The majority of the patients (77%) had not consulted their physicians prior to utilization of CAM therapies. Herbal medicine was the most common form of CAM in depression, with a high satisfaction level. Thus, it is necessary to increase physicians' awareness in different fields of CAM.
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Kim D, Ji I, Ng’ombe JN, Han K, Vitale J. Do Dietary Supplements Improve Perceived Health Well-Being? Evidence from Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031306. [PMID: 33535620 PMCID: PMC7908388 DOI: 10.3390/ijerph18031306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
This study analyzes the self-reported intake of dietary supplements (DS) and their effects on perceived health well-being from a survey with 1210 adult respondents in Korea. To account for selectivity bias from observable confounders, we use a propensity score matching (PSM) model. Our findings show that demographics, health concerns, family history of disease, frequency of hospital visits, and regular exercise are positively associated with intake of DS among consumers. Results from PSM show that the intake of DS leads to significant improvements in perceived health well-being among DS takers relative to DS non-takers regardless of gender, urban residence, having self-reported diseases or not. The paper concludes with implications for policies that promote intake of DS in Korea.
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Affiliation(s)
- Donghoon Kim
- Department of Food Industrial Management, Dongguk University, 30 Pildong-ro 1-gil Jung-gu, Seoul 04620, Korea;
| | - Inbae Ji
- Department of Food Industrial Management, Dongguk University, 30 Pildong-ro 1-gil Jung-gu, Seoul 04620, Korea;
- Correspondence:
| | - John N. Ng’ombe
- Department of Agricultural Economics and Extension, University of Zambia, Lusaka 10101, Zambia;
| | - Kwideok Han
- Department of Institutional Research and Analytics, Oklahoma State University, 203 PIO Building, Stillwater, OK 74078, USA;
| | - Jeffrey Vitale
- Department of Agricultural Economics, Oklahoma State University, 418 Ag Hall, Stillwater, OK 74078, USA;
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Maunder A, Bessell E, Lauche R, Adams J, Sainsbury A, Fuller NR. Effectiveness of herbal medicines for weight loss: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2020; 22:891-903. [PMID: 31984610 DOI: 10.1111/dom.13973] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 01/09/2023]
Abstract
AIM To update the available evidence on the efficacy and safety of complementary medicines to assist in weight loss by conducting a systematic review and meta-analysis of herbal medicines for weight loss. METHODS Four electronic databases (Medline, Embase, CINAHL and Web of Science) were searched from inception until August 2018. A total of 54 randomized placebo-controlled trials of healthy overweight or obese adults were identified. Meta-analyses were conducted for herbal medicines with ≥4 studies available. Weight differences of ≥2.5 kg were considered clinically significant. RESULTS As a single agent, only Phaseolus vulgaris resulted in a statistically significant weight loss compared to placebo, although this was not considered clinically significant. No effect was seen for Camellia sinensis or Garcinia cambogia. Statistically, but not clinically, significant differences were observed for combination preparations containing C. sinensis, P. vulgaris or Ephedra sinica. Of the herbal medicines trialled in ≤3 randomized controlled trials, statistically and clinically significant weight loss compared to placebo was reported for Irvingia gabonensis, Cissus quadrangularis, and Sphaeranthus indicus combined with Garcinia mangostana, among others, but these findings should be interpreted cautiously because of the small number of studies, generally poor methodological quality, and poor reporting of the herbal medicine interventions. Most herbal medicines appeared safe for consumption over the short duration of the studies (commonly ≤12 weeks). Some warrant further investigation to determine effect size, dosage and long-term safety. CONCLUSION There is currently insufficient evidence to recommend any of the herbal medicines for weight loss included in the present review.
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Affiliation(s)
- Alison Maunder
- University of Sydney, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Central Clinical School, Charles Perkins Centre, New South Wales, Australia
| | - Erica Bessell
- University of Sydney, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Central Clinical School, Charles Perkins Centre, New South Wales, Australia
| | - Romy Lauche
- University of Technology Sydney, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), NSW, Australia
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Germany
| | - Jon Adams
- University of Technology Sydney, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), NSW, Australia
| | - Amanda Sainsbury
- University of Sydney, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Central Clinical School, Charles Perkins Centre, New South Wales, Australia
| | - Nicholas R Fuller
- University of Sydney, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Central Clinical School, Charles Perkins Centre, New South Wales, Australia
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Zheng E, Sandhu N, Navarro V. Drug-induced Liver Injury Secondary to Herbal and Dietary Supplements. Clin Liver Dis 2020; 24:141-155. [PMID: 31753247 DOI: 10.1016/j.cld.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of herbal and dietary supplements (HDS) is increasing in the United States and worldwide. Its significant association with liver injury has become a concern, particularly because rates of hepatotoxicity caused by HDS are increasing. There are variety of HDS available, ranging from multi-ingredient substances, to anabolic steroids for bodybuilding purposes, to individual ingredients for purposes of supplementing a diet. This article reviews the impact of liver injury cause by HDS and explores the hepatotoxic potential of such products and their individual ingredients.
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Affiliation(s)
- Elizabeth Zheng
- Columbia University Medical Center, 622 West 168th Street, PH-14-406, New York, NY 10032, USA
| | - Naemat Sandhu
- Einstein Medical Center, 5401 Old York Road, Klein Building Suite 505, Philadelphia, PA 19141, USA
| | - Victor Navarro
- Einstein Medical Center, 5401 Old York Road, Klein Building Suite 505, Philadelphia, PA 19141, USA.
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16
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Lee J, Chung M, Fu Z, Choi J, Lee HJ. The Effects of Irvingia gabonensis Seed Extract Supplementation on Anthropometric and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2019; 39:388-396. [DOI: 10.1080/07315724.2019.1691956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jounghee Lee
- Department of Food and Nutrition, Kunsan National University, Gunsan-si, South Korea
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Zhuxuan Fu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jihee Choi
- Department of Food and Nutrition, Gachon University, Seongnam-si, South Korea
| | - Hae-Jeung Lee
- Department of Food and Nutrition, Gachon University, Seongnam-si, South Korea
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Levinson JA, Sarda V, Sonneville K, Calzo JP, Ambwani S, Austin SB. Diet Pill and Laxative Use for Weight Control and Subsequent Incident Eating Disorder in US Young Women: 2001-2016. Am J Public Health 2019; 110:109-111. [PMID: 31751147 DOI: 10.2105/ajph.2019.305390] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate the prospective association of diet pill and laxative use for weight control with subsequent first eating disorder diagnosis in young women.Methods. We used longitudinal data from 10 058 US women spanning 2001 through 2016. We used multivariable logistic regression models, adjusting for age, race/ethnicity, and overweight status to estimate the association between weight-control behaviors and subsequent eating disorder diagnosis.Results. Among those who had not previously received an eating disorder diagnosis, women who reported diet pill (adjusted odds ratio [AOR] = 5.6; 95% confidence interval [CI] = 3.0, 10.5) or laxative (AOR = 6.0; 95% CI = 4.2, 8.7) use for weight control had higher odds of receiving a subsequent first eating disorder diagnosis within 1 to 3 years than those who did not report using these products.Conclusions. Use of diet pills or laxatives for weight loss can be dangerous and may be a warning sign that warrants counseling and evaluation for the presence of or risk of developing an eating disorder.Public Health Implications. Policymakers and public health professionals should develop and evaluate policy initiatives to reduce or prohibit access to diet pills and laxatives abused for weight control.
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Affiliation(s)
- Jordan A Levinson
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
| | - Vishnudas Sarda
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
| | - Kendrin Sonneville
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
| | - Jerel P Calzo
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
| | - Suman Ambwani
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
| | - S Bryn Austin
- Jordan A. Levinson, Vishnudas Sarda, and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Kendrin Sonneville is with the Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor. Jerel P. Calzo is with the Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA. Suman Ambwani is with the Department of Psychology, Dickinson College, Carlisle, PA
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Lubowiecki-Vikuk A, Król-Zielińska M, Kantanista A. Consumption of dietary supplements to support weight reduction in adults according to sociodemographic background, body mass index, waist-hip ratio, body fat and physical activity. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:31. [PMID: 31690346 PMCID: PMC6833227 DOI: 10.1186/s41043-019-0191-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study was to analyse the use of dietary supplements to support weight reduction (DSSWR) in adults according to sociodemographic background, body mass index (BMI), waist-hip ratio (WHR), body fat percentage (%BF) and level of physical activity (PA). METHOD Participants (n = 1130) were recruited from a region of Poland with a high rate of adult overweight and obesity. Based on anthropometric data, BMI and WHR were calculated. %BF was assessed using a bioimpedance method. To examine the association between DSSWR use and sociodemographic factors, BMI, WHR, %BF and PA multiple logistic regression were conducted. RESULTS The rate of DSSWR use in the group studied was high (69.5%). A higher proportion of women, individuals aged 18-35 years, those who had completed higher education, those who did not report financial status as "poor", with a BMI < 18.5, normal %BF and individuals with a high level of PA used DSSWR. In complete case analysis (n = 1108), primarily financial status reported as "good" (OR = 2.18, 95% CI: 1.69, 2.81) or "hard to say" (OR = 2.41, 95% CI: 1.86, 3.12) (vs. "poor") and female sex (OR = 2.59, 95% CI: 2.17, 3.08) were associated with DSSWR intake. CONCLUSION It seems that primarily financial status and sex, but also age, education, and level of PA, have significance in DSSWR use in adults and may be considered when developing appropriate strategies for body weight management and health promotion.
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Affiliation(s)
- Adrian Lubowiecki-Vikuk
- Department of Consumer Behaviour Research, Collegium of Management and Finance, Warsaw School of Economics, Al. Niepodległości 162, 02-554 Warsaw, Poland
| | - Magdalena Król-Zielińska
- Department of Physical Education and Lifelong Sports, Poznan University of Physical Education, Królowej Jadwigi 27/39, 61-871 Poznań, Poland
| | - Adam Kantanista
- Department of Physical Education and Lifelong Sports, Poznan University of Physical Education, Królowej Jadwigi 27/39, 61-871 Poznań, Poland
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Or F, Kim Y, Simms J, Austin SB. Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults. J Adolesc Health 2019; 65:455-461. [PMID: 31176525 DOI: 10.1016/j.jadohealth.2019.03.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of the study was to evaluate the relationship between supplement categories and adverse events in children, adolescents, and young adults. METHODS This is a retrospective observational study using adverse event reports between January 2004 and April 2015 in the U.S. Food and Drug Administration Adverse Event Reporting System on food and dietary supplements database. We quantified the relative risks for severe medical events of dietary supplements sold for various functions relative to vitamins among individuals aged between 0 and 25 years. Severe medical events include death, disability, life-threatening events, hospitalization, emergency room visit, and/or required intervention to prevent permanent disability. RESULTS There were 977 single-supplement-related adverse event reports affecting individuals aged between 0 and 25 years over 11 years (50.6% female; age: mean = 16.5 years, standard deviation = 7.5 years). Supplements sold for muscle building (risk ratio [RR] = 2.7; 95% confidence interval [CI] = 1.9-4.0), energy (RR = 2.6; 95% CI = 1.9-3.6), and weight loss (RR = 2.6; 95% CI = 1.9-3.4) were associated with almost three times the risk for severe medical events compared with vitamins. CONCLUSIONS Consumption of dietary supplements sold for weight loss, muscle building, and energy involved increased risks for severe medical events compared with vitamins. Proactive enforcement of regulations is needed to reduce access and consumption among children, adolescents, and young adults.
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Affiliation(s)
- Flora Or
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Juliana Simms
- Harvard University Information Technology, Cambridge, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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20
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Galnares-Olalde JA, Vázquez-Mézquita AJ, Gómez-Garza G, Reyes-Vázquez D, Higuera-Ortiz V, Alegría-Loyola MA, Mendez-Dominguez A. Cytotoxic Lesions of the Corpus Callosum Caused by Thermogenic Dietary Supplements. AJNR Am J Neuroradiol 2019; 40:1304-1308. [PMID: 31272963 DOI: 10.3174/ajnr.a6116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Consumption of over-the-counter dietary supplements to reduce body weight is common among the population. Thermogenics are herbal combinations that claim to produce a fat-burning process through an increase in the cellular metabolic rate and greater cellular energy consumption, having a high risk for patients developing toxic leukoencephalopathy. We present a series of 6 patients with acute neurologic symptoms and MR imaging showing restricted diffusion and decreased apparent diffusion coefficient values (mean value, 400 mm2/s × 10-6) in the entire corpus callosum compatible with a cytotoxic lesion of the corpus callosum. Although patients responded favorably to the product discontinuation with rapid recovery of neurologic symptoms, there was a more prolonged resolution on imaging alterations. Because of the widespread availability and unregulated nature of thermogenic dietary supplements, physicians must be aware of the clinical and radiologic characteristics of these potential complications of their use.
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Affiliation(s)
| | | | | | | | | | - M A Alegría-Loyola
- Neurology Service (M.A.A.-L., A.M.-D.), The American British Cowdray Medical Center, Mexico City, Mexico
| | - A Mendez-Dominguez
- Neurology Service (M.A.A.-L., A.M.-D.), The American British Cowdray Medical Center, Mexico City, Mexico
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Nutritionist and obesity: brief overview on efficacy, safety, and drug interactions of the main weight-loss dietary supplements. INTERNATIONAL JOURNAL OF OBESITY SUPPLEMENTS 2019; 9:32-49. [PMID: 31391923 DOI: 10.1038/s41367-019-0007-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Over the past 20 years the use of dietary supplements as adjuvant therapy for weight loss gained growing favor among consumers and dietician-nutritionists, with the subsequent astounding increase in health costs. Despite the reassuring label of natural remedy for losing weight, dietary supplements contain a wide variety of ingredients on which available information is rather scanty and scientifically incomplete. Currently, there is little evidence that weight-loss supplements offer effective aids to reduce weight and meet criteria for recommended use. Robust, randomized, placebo-controlled studies to provide clear-cut scientific evidence of their efficacy and potential side effects in clinical practice are still lacking. Understanding the evidence for the efficacy, safety, and quality of these supplements among nutritionists and physicians is critical to counsel patients appropriately, especially considering the risk of serious adverse effects and interference with concomitant therapies. Detailed information on the efficacy and safety of the most commonly used weight-loss dietary supplements has been recently published by the National Institutes of Health (NIH). However, in this report the thorny issue that may result from drug interactions with weight-loss dietary supplements has been not sufficiently addressed. The aim of this review was to provide a synthetic, evidence-based report on efficacy and safety of the most commonly used ingredients in dietary supplements marketed for weight loss, particularly focusing on their possible drug interactions.
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Bortolin RC, Vargas AR, de Miranda Ramos V, Gasparotto J, Chaves PR, Schnorr CE, da Boit Martinello K, Silveira AK, Gomes HM, Rabelo TK, Grunwald MS, Ligabue-Braun R, Gelain DP, Moreira JCF. Guarana supplementation attenuated obesity, insulin resistance, and adipokines dysregulation induced by a standardized human Western diet via brown adipose tissue activation. Phytother Res 2019; 33:1394-1403. [PMID: 30868680 DOI: 10.1002/ptr.6330] [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] [Received: 08/28/2018] [Revised: 12/17/2018] [Accepted: 02/09/2019] [Indexed: 01/17/2023]
Abstract
Obesity is a metabolic disorder associated with adverse health consequences that has increased worldwide at an epidemic rate. This has encouraged many people to utilize nonprescription herbal supplements for weight loss without knowledge of their safety or efficacy. However, mounting evidence has shown that some herbal supplements used for weight loss are associated with adverse effects. Guarana seed powder is a popular nonprescription dietary herb supplement marketed for weight loss, but no study has demonstrated its efficacy or safety when administered alone. Wistar rats were fed four different diets (low-fat diet and Western diet with or without guarana supplementation) for 18 weeks. Metabolic parameters, gut microbiota changes, and toxicity were then characterized. Guarana seed powder supplementation prevented weight gain, insulin resistance, and adipokine dysregulation induced by Western diet compared with the control diet. Guarana induced brown adipose tissue expansion, mitochondrial biogenesis, uncoupling protein-1 overexpression, AMPK activation, and minor changes in gut microbiota. Molecular docking suggested a direct activation of AMPK by four guarana compounds tested here. We propose that brown adipose tissue activation is one of the action mechanisms involved in guarana supplementation-induced weight loss and that direct AMPK activation may underlie this mechanism. In summary, guarana is an attractive potential therapeutic agent to treat obesity.
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Affiliation(s)
- Rafael Calixto Bortolin
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Civil y Ambiental, Universidad de la Costa, Barranquilla, Colombia
| | - Amanda Rodrigues Vargas
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vitor de Miranda Ramos
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Juciano Gasparotto
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Paloma Rodrigues Chaves
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | - Alexandre Kleber Silveira
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Henrique Mautone Gomes
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Thallita Kelly Rabelo
- Departamento de Educação em Saúde, Campus Universitário Professor Antônio Garcia Filho, Universidade Federal de Sergipe (UFS), Lagarto, Brazil
| | - Marcelo Sartori Grunwald
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Ligabue-Braun
- Programa de Pós-graduação em Biologia Celular e Molecular, Centro de Biotecnologia (CBiot), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Daniel Pens Gelain
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - José Cláudio Fonseca Moreira
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Conjugated Linoleic Acid Effects on Cancer, Obesity, and Atherosclerosis: A Review of Pre-Clinical and Human Trials with Current Perspectives. Nutrients 2019; 11:nu11020370. [PMID: 30754681 PMCID: PMC6413010 DOI: 10.3390/nu11020370] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/03/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Obesity and its comorbidities, including type 2 diabetes and cardiovascular disease, are straining our healthcare system, necessitating the development of novel strategies for weight loss. Lifestyle modifications, such as exercise and caloric restriction, have proven effective against obesity in the short term, yet obesity persists because of the high predilection for weight regain. Therefore, alternative approaches to achieve long term sustainable weight loss are urgently needed. Conjugated linoleic acid (CLA), a fatty acid found naturally in ruminant animal food products, has been identified as a potential anti-obesogenic agent, with substantial efficacy in mice, and modest efficacy in obese human populations. Originally described as an anti-carcinogenic fatty acid, in addition to its anti-obesogenic effects, CLA has now been shown to possess anti-atherosclerotic properties. This review summarizes the pre-clinical and human studies conducted using CLA to date, which collectively suggest that CLA has efficacy against cancer, obesity, and atherosclerosis. In addition, the potential mechanisms for the many integrative physiological effects of CLA supplementation will be discussed in detail, including an introduction to the gut microbiota as a potential mediator of CLA effects on obesity and atherosclerosis.
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Mister S. A tax on weight loss products based on fiction, not facts. Prev Med 2018; 116:223-224. [PMID: 30297143 DOI: 10.1016/j.ypmed.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
The recent article by Austin et al., "Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects," is disappointing for its lack of objectivity and its misrepresentation. While the conclusion is not surprising, the misinformation woven into the narrative is. Ultimately, their tax solution drives up cost; fails to distinguish between those willing to pay higher prices and those who are not; and may have relatively little influence on overall purchasing behavior.
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Affiliation(s)
- Steve Mister
- Council for Responsible Nutrition, 1828 L St., NW, Suite 810, Washington, DC 20036, United States of America.
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Haber SL, Awwad O, Phillips A, Park AE, Pham TM. Garcinia cambogia for weight loss. Am J Health Syst Pharm 2018; 75:17-22. [PMID: 29317394 DOI: 10.2146/ajhp160915] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Stacy L Haber
- Midwestern University College of Pharmacy-GlendaleGlendale, AZ
| | - Omar Awwad
- Department of PharmacyBlessing Health SystemQuincy, IL
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Kumar MM. Severe iodine deficiency from dietary restriction and subsequent iodine excess from seaweed snack overuse in an adolescent with disordered eating. Int J Eat Disord 2018; 52:95-95. [PMID: 30189113 DOI: 10.1002/eat.22940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022]
Abstract
Individuals with disordered eating commonly exclude salt and animal products from their diets, which may predispose them to iodine deficiency even without significant weight loss. Overconsumption of dietary supplements and "natural" foods are also commonly observed among eating disorder patients. This report describes an adolescent female with disordered eating presenting with growth and pubertal delay, found to have severe iodine deficiency (urine iodine of 18 mcg/L) and abnormal thyroid function resulting from strict avoidance of salt and animal products despite adequate caloric intake. To avoid having to start eating animal products, she began consuming excessive quantities of seaweed supplements to increase her iodine intake resulting in excessive iodine levels (urine iodine of >1,500 mcg/L) and worsening of thyroid function. When her parents began supervising her nutritional intake, her abnormal iodine levels, abnormal thyroid function tests, and hypogonadotropic hypogonadism all resolved. This is the first report of both iodine deficiency and iodine excess developing from disordered eating behavior.
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Affiliation(s)
- Maya Michelle Kumar
- Department of Pediatrics, University of California San Diego, San Diego, California
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Hazzard VM, Borton KA, Bauer KW, Sonneville KR. Cross-sectional associations between gender-linked personality traits and use of weight-loss and muscle-building products among U.S. young adults. Eat Disord 2018; 26:418-429. [PMID: 29240529 PMCID: PMC8238011 DOI: 10.1080/10640266.2017.1415582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the cross-sectional associations between gender-linked personality traits and use of products for weight loss and muscle building using data from young adults participating in Wave III of the National Longitudinal Study of Adolescent to Adult Health who completed the short-form Bem Sex-Role Inventory (n = 3,343). Among men, a higher score on the masculinity scale was associated with greater odds of diet pill use, legal performance-enhancing substance (PES) use, and illicit PES use, while a higher score on the femininity scale was associated with lower odds of illicit PES use. These findings can inform interventions for men with weight/shape concerns.
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Affiliation(s)
- Vivienne M Hazzard
- a Department of Nutritional Sciences , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Kelley A Borton
- a Department of Nutritional Sciences , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Katherine W Bauer
- a Department of Nutritional Sciences , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Kendrin R Sonneville
- a Department of Nutritional Sciences , University of Michigan School of Public Health , Ann Arbor , MI , USA
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Austin SB, Liu SH, Tefft N. Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects. Prev Med 2018; 114:39-46. [PMID: 29842920 DOI: 10.1016/j.ypmed.2018.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023]
Abstract
Abuse of widely available, over-the-counter (OTC) drugs and supplements such as diet pills, laxatives, and diuretics by adolescents for weight control is well-documented, yet manufacturers and retailers can sell them to minors without restriction. The aim of our study was to estimate the effect of added taxation of OTC drugs and dietary supplements sold for weight loss on household purchases of these products. With data from 60,538 U.S. households in the 2012 waves of the Nielsen/IRi National Consumer Panel (NCP) and the Nielsen/IRi Retail Scanner (NRS) datasets, we conducted analyses in 2017 to tally annual quantities and expenditures on OTC drugs or dietary supplements making weight-loss, cleanse/detox, or diuretic claims. We estimated the percent reduction in household purchases due to a simulated 20% added tax on each category. Among the 14,151 households reporting at least one purchase in the three claims categories, a 20% higher average price of weight-loss products was associated with a 5.2% lower purchases of those products. Among households with children ages 12 to 17 years old present, purchases were 17.5% lower, and among households with a daughter present, purchases were 10.3% lower. Taxation may be an effective public health strategy to reduce purchasing of potentially dangerous OTC drugs and supplements sold for weight loss, especially for households that include children ages 12-17 years old or a daughter.
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Affiliation(s)
- S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA.
| | - Selena Hua Liu
- Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA; Department of Nutrition, Simmons College, Boston, MA, USA
| | - Nathan Tefft
- Department of Economics, Bates College, Lewiston, ME, USA
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Rogers J, Urbina SL, Taylor LW, Wilborn CD, Purpura M, Jäger R, Juturu V. Capsaicinoids supplementation decreases percent body fat and fat mass: adjustment using covariates in a post hoc analysis. BMC OBESITY 2018; 5:22. [PMID: 30123516 PMCID: PMC6088424 DOI: 10.1186/s40608-018-0197-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/09/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Capsaicinoids (CAPs) found in chili peppers and pepper extracts, are responsible for enhanced metabolism. The objective of the study was to evaluate the effects of CAPs on body fat and fat mass while considering interactions with body habitus, diet and metabolic propensity. METHODS Seventy-five (N = 75) volunteer (male and female, age: 18 and 56 years) healthy subjects were recruited. This is a parallel group, randomized, double-blind, placebo controlled exploratory study. Subjects were randomly assigned to receive either placebo, 2 mg CAPs or 4 mg CAPs dosing for 12 weeks. After initial screening, subjects were evaluated with respect to fat mass and percent body fat at baseline and immediately following a 12-week treatment period. The current study evaluates two measures of fat loss while considering six baseline variables related to fat loss. Baseline measurements of importance in this paper are those used to evaluate body habitus, diet, and metabolic propensity. Lean mass and fat mass (body habitus); protein intake, fat intake and carbohydrate intake; and total serum cholesterol level (metabolic propensity) were assessed. Body fat and fat mass were respectively re-expressed as percent change in body fat and change in fat mass by application of formula outcome = (12-week value - baseline value) / baseline value) × 100. Thus, percent change in body fat and change in fat mass served as dependent variables in the evaluation of CAPs. Inferential statistical tests were derived from the model to compare low dose CAPs to placebo and high dose CAPs to placebo. RESULTS Percent change in body fat after 12 weeks of treatment was 5.91 percentage units lower in CAPs 4 mg subjects than placebo subjects after adjustment for covariates (p = 0.0402). Percent change in fat mass after 12 weeks of treatment was 6.68 percentage units lower in Caps 4 mg subjects than placebo subjects after adjustment for covariates (p = 0.0487). CONCLUSION These results suggest potential benefits of Capsaicinoids (CAPs) on body fat and fat mass in post hoc analysis. Further studies are required to explore pharmacological, physiological, and metabolic benefits of both chronic and acute Capsaicinoids consumption. TRIAL REGISTRATION ISRCTN10458693 'retrospectively registered'.
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Affiliation(s)
- James Rogers
- Summit Analytical, LLC, 8354 Northfield Blvd., Building G, Suite 3700, Denver, CO 80238 USA
| | - Stacie L. Urbina
- Human Performance Laboratory, University of Mary Hardin-Baylor, Belton, TX 76513 USA
| | - Lem W. Taylor
- Human Performance Laboratory, University of Mary Hardin-Baylor, Belton, TX 76513 USA
| | - Colin D. Wilborn
- Human Performance Laboratory, University of Mary Hardin-Baylor, Belton, TX 76513 USA
| | - Martin Purpura
- Increnovo LLC, 2138 E Lafayette Pl, Milwaukee, WI 53202 USA
| | - Ralf Jäger
- Increnovo LLC, 2138 E Lafayette Pl, Milwaukee, WI 53202 USA
| | - Vijaya Juturu
- OmniActive Health Technologies Inc., 67 East Park Place, Suite 500, Morristown, NJ 07950 USA
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Abstract
PURPOSE OF REVIEW Obesity in the United States has been on a constant rise since the Center for Disease Control and Prevention (CDC) began tracking it over 50 years ago. Despite focused attention on this epidemic, pharmacological treatments aimed at obesity are lacking. Here, we briefly give perspective on the central and peripheral mechanisms underlying feeding behaviors and describe the existing pharmacological treatments for obesity. With this lens, I suggest future targets for the treatment of obesity. RECENT FINDINGS Given the development of genetic and molecular tools, understanding of how energy expenditure is modulated is becoming more nuanced. There is growing evidence for a link between obesity and addiction, which should be utilized in the development of new pharmacological treatments. SUMMARY More focus is needed on identifying targets for anti-obesity pharmacology. In doing so, research should include intensive investigation of the brain's reward circuitry.
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Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, Kushner RF, Daniels SR, Wadden TA, Tsai AG, Hu FB, Jakicic JM, Ryan DH, Wolfe BM, Inge TH. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev 2018; 39:79-132. [PMID: 29518206 PMCID: PMC5888222 DOI: 10.1210/er.2017-00253] [Citation(s) in RCA: 429] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who suffer from the disease. Obesity is associated with and contributes to a shortened life span, type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others. Weight loss reduces all of these diseases in a dose-related manner-the more weight lost, the better the outcome. The phenotype of "medically healthy obesity" appears to be a transient state that progresses over time to an unhealthy phenotype, especially in children and adolescents. Weight loss is best achieved by reducing energy intake and increasing energy expenditure. Programs that are effective for weight loss include peer-reviewed and approved lifestyle modification programs, diets, commercial weight-loss programs, exercise programs, medications, and surgery. Over-the-counter herbal preparations that some patients use to treat obesity have limited, if any, data documenting their efficacy or safety, and there are few regulatory requirements. Weight regain is expected in all patients, especially when treatment is discontinued. When making treatment decisions, clinicians should consider body fat distribution and individual health risks in addition to body mass index.
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Affiliation(s)
- George A Bray
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - William E Heisel
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | | | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Michael Long
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Stephen R Daniels
- Department of Pediatrics, University of Colorado Children Hospital, Denver, Colorado
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adam G Tsai
- Kaiser Permanente Colorado, Denver, Colorado
| | - Frank B Hu
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Donna H Ryan
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon
| | - Thomas H Inge
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
- Children’s Hospital Colorado, Aurora, Colorado
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Correa M, SanMiguel N, López-Cruz L, Carratalá-Ros C, Olivares-García R, Salamone JD. Caffeine Modulates Food Intake Depending on the Context That Gives Access to Food: Comparison With Dopamine Depletion. Front Psychiatry 2018; 9:411. [PMID: 30237771 PMCID: PMC6135917 DOI: 10.3389/fpsyt.2018.00411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022] Open
Abstract
Caffeine is a methylxanthine consumed in different contexts to potentiate alertness and reduce fatigue. However, caffeine can induce anxiety at high doses. Caffeine is also a minor psychostimulant that seems to act as an appetite suppressant, but there are also reports indicating that it could stimulate appetite. Dopamine also is involved in food motivation and in behavioral activation. In the present series of experiments, we evaluated the effects of acute administration of caffeine on food consumption under different access conditions. CD1 male adult mice had access to highly palatable food (50% sucrose) in a restricted but habitual context, under continuous or intermittent access as well as under anxiogenic, or effortful conditions. Caffeine (2.5-20.0 mg/kg) increased intake at the highest dose under familiar continuous and intermittent access. However, this high dose reduced food intake in the dark-light paradigm. In contrast, a dopamine-depleting agent, tetrabenazine (TBZ; 1.0-8.0 mg/kg) did not affect food intake in any of those experimental conditions. In the T-maze-barrier task that evaluates seeking and taking of food under effortful conditions, caffeine (10.0 mg/kg) decreased latency to reach the food, but did not affect selection of the high-food density arm that required more effort, or the total amount of food consumed. In contrast, TBZ (4.0 mg/kg) reduced selection of the high food density arm with the barrier, thus affecting amount of food consumed. Interestingly, a small dose of caffeine (5.0 mg/kg) was able to reverse the anergia-inducing effects produced by TBZ in the T-maze. These results suggest that caffeine can potentiate or suppress food consumption depending on the context. Moreover, caffeine did not change appetite, and did not impair orientation toward food under effortful conditions, but it rather helped to achieve the goal by improving speed and by reversing performance to normal levels when fatigue was induced by dopamine depletion.
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Affiliation(s)
- Mercè Correa
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, Castelló, Spain.,Behavioral Neuroscience Division, University of Connecticut, Storrs, CT, United States
| | - Noemí SanMiguel
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, Castelló, Spain
| | - Laura López-Cruz
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, Castelló, Spain
| | - Carla Carratalá-Ros
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, Castelló, Spain
| | | | - John D Salamone
- Behavioral Neuroscience Division, University of Connecticut, Storrs, CT, United States
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Leveraging corporate social responsibility to improve consumer safety of dietary supplements sold for weight loss and muscle building. Transl Behav Med 2017; 7:92-97. [PMID: 27573294 DOI: 10.1007/s13142-016-0434-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The potential dangers associated with dietary supplements sold for weight loss and muscle building are well documented and increasingly garnering the attention of the media, public, and government leaders. Public health professionals have an opportunity to improve population health in the context of dietary supplement use by translating scientific evidence into action. In this commentary, we discuss the potential to motivate corporate social responsibility (CSR) among manufacturers and retailers of dietary supplements sold for weight loss and muscle building. We examine levers available to public health professionals for generating voluntary corporate self-regulation by reviewing examples from successful CSR initiatives in other domains of public health and offering recommendations highlighting effective advocacy strategies. We encourage public health professionals to use one or multiple advocacy strategies to improve consumer protections for dietary supplements sold for weight loss and muscle building.
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Hoang TT, Agopian A, Mitchell LE. Maternal Use of Weight Loss Products and the Risk of Neural Tube Defects in Offspring: A Systematic Literature Review. Birth Defects Res 2017; 110:48-55. [DOI: 10.1002/bdr2.1116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Thanh T. Hoang
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
| | - A.J. Agopian
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
| | - Laura E. Mitchell
- UTHealth School of Public Health, Department of Epidemiology; Human Genetics, and Environmental Sciences; Houston Texas
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Wang S, Goodspeed L, Turk KE, Houston B, den Hartigh LJ. Rosiglitazone Improves Insulin Resistance Mediated by 10,12 Conjugated Linoleic Acid in a Male Mouse Model of Metabolic Syndrome. Endocrinology 2017; 158. [PMID: 28651330 PMCID: PMC5659669 DOI: 10.1210/en.2017-00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Trans-10, cis-12 conjugated linoleic acid (10,12 CLA) is a dietary fatty acid that promotes weight loss and disproportionate fat loss. Obese mice fed a high-fat, high-sucrose (HFHS) diet containing 10,12 CLA are resistant to weight gain and contain markedly reduced subcutaneous fat and adiponectin, with a concurrent lack of improvement in insulin sensitivity despite significant weight loss. Taken together, 10,12 CLA promotes a phenotype resembling peroxisome proliferator-activated receptor (PPAR)γ antagonism. Because thiazolidinediones such as rosiglitazone (Rosi) are used clinically to improve insulin sensitivity by activating PPARγ, with particular efficacy in subcutaneous white adipose tissue, we hypothesized that Rosi would improve glucose metabolism in mice losing weight with 10,12 CLA. Obese low-density lipoprotein receptor-deficient mice were fed a HFHS control diet, or supplemented with 1% 10,12 CLA with or without Rosi (10 mg/kg) for 8 weeks. Body composition, glucose and insulin tolerance tests, tissue gene expression, and plasma lipid analyses were performed. Mice consuming 10,12 CLA with Rosi lost weight and body fat compared with control groups, but with a healthier redistribution of body fat toward more subcutaneous adipose tissue than with 10,12 CLA alone. Further, Rosi improved 10,12 CLA-mediated insulin resistance parameters and increased plasma and subcutaneous adipose tissue adiponectin levels without adverse effects on plasma or hepatic lipids. We conclude that cotreatment of mice with 10,12 CLA and Rosi promotes fat loss with a healthier fat distribution that leads to improved insulin sensitivity, suggesting that the combination treatment strategy of 10,12 CLA with Rosi could have therapeutic potential for obesity treatment.
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Affiliation(s)
- Shari Wang
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98109
| | - Leela Goodspeed
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98109
| | - Katherine E. Turk
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98109
| | - Barbara Houston
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98109
| | - Laura J. den Hartigh
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98109
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Kumar NB, Patel R, Pow-Sang J, Spiess PE, Salup R, Williams CR, Schell MJ. Long-term supplementation of decaffeinated green tea extract does not modify body weight or abdominal obesity in a randomized trial of men at high risk for prostate cancer. Oncotarget 2017; 8:99093-99103. [PMID: 29228755 PMCID: PMC5716795 DOI: 10.18632/oncotarget.18858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/03/2017] [Indexed: 01/28/2023] Open
Abstract
Background Evidence continues to demonstrate the role of obesity in prostate carcinogenesis and prognosis, underscoring the need to identify and continue to evaluate the effective interventions to reduce obesity in populations at high risk. The aim of the study was to determine the effect of daily consumption of decaffeinated green tea catechins (GTC) formulation (Polyphenon E® (PolyE)) for 1 year on biomarkers of obesity in men who are at high risk for prostate cancer. Materials and Methods A randomized, double-blinded trial was conducted targeting 97 men diagnosed with HGPIN or ASAP. Subjects were randomized to receive GTC (PolyE) (n = 49) or placebo (n = 48) for 1 year. Anthropometric data were collected at baseline, 6 and 12 months and data analyzed to observe change in weight, body mass index (indicator of obesity) and waist: hip ratio (indicator of abdominal obesity). Results Decaffeinated GTC containing 400 mgs of the bioactive catechin, EGCG administered for 1 year to men diagnosed with ASAP and HGPIN appears to be bioavailable, well tolerated but not effective in reducing biomarkers of obesity including body weight, body mass index and waist: hip ratio. Conclusions The results of our trial demonstrates that men who are obese and at high risk for prostate cancer should resort to effective weight management strategies to reduce obesity and not resort to ineffective measures such as taking supplements of green tea to reduce biomarkers of obesity. Changes in body mass index and abdominal obesity seen in other studies were potentially due to caffeine and not GTC.
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Affiliation(s)
- Nagi B Kumar
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/CANCONT, Tampa, FL 33612, USA
| | - Roshni Patel
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/CANCONT, Tampa, FL 33612, USA
| | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center and Research Institute, Inc., WCB-GU PROG, Tampa, FL 33612, USA
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center and Research Institute, Inc., WCB-GU PROG, Tampa, FL 33612, USA
| | - Raoul Salup
- James A Haley Veterans Hospital, Tampa, FL 33612, USA
| | - Christopher R Williams
- Urologic Oncology, Research, and Robotic Surgery, University of Florida and Shands Medical Center, Jacksonville, FL 32209, USA
| | - Michael J Schell
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/BIOSTAT, Tampa, FL 33612, USA
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Household expenditures on dietary supplements sold for weight loss, muscle building, and sexual function: Disproportionate burden by gender and income. Prev Med Rep 2017; 6:236-241. [PMID: 28377850 PMCID: PMC5377432 DOI: 10.1016/j.pmedr.2017.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Dietary supplements sold for weight loss (WL), muscle building (MB), and sexual function (SF) are not medically recommended. They have been shown to be ineffective in many cases and pose serious health risks to consumers due to adulteration with banned substances, prescription pharmaceuticals, and other dangerous chemicals. Yet no prior research has investigated how these products may disproportionately burden individuals and families by gender and socioeconomic position across households. We investigated household (HH) cost burden of dietary supplements sold for WL, MB, and SF in a cross-sectional study using data from 60,538 U.S. households (HH) in 2012 Nielsen/IRi National Consumer Panel, calculating annual HH expenditures on WL, MB, and SF supplements and expenditures as proportions of total annual HH income. We examined sociodemographic patterns in HH expenditures using Wald tests of mean differences across subgroups. Among HH with any expenditures on WL, MB, or SF supplements, annual HH first and ninth expenditure deciles were, respectively: WL $5.99, $145.36; MB $6.99, $141.93; and SF $4.98, $88.52. Conditional on any purchases of the products, female-male-headed HH spent more on WL supplements and male-headed HH spend more on MB and SF supplements compared to other HH types (p-values < 0.01). High-income ($30,000 < annual income < $100,000), compared to low-income (annual income < $30,000) HH, spent more on all three supplements types (p-values < 0.01); however, proportional to income, low-income HH spent 2–4 times more than high-income HH on WL and MB supplements (p-values < 0.01). Dietary supplements sold for WL, MB, and SF disproportionately burden HH by income and gender. Female-male-headed households spend more than others on weight-loss supplements. Male-headed households spend more than others on muscle-building and sexual-function supplements. Low-income households bear the heaviest financial burden in terms of proportion of household income spent.
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Xing S, Sharp LK, Touchette DR. Weight loss drugs and lifestyle modification: Perceptions among a diverse adult sample. PATIENT EDUCATION AND COUNSELING 2017; 100:592-597. [PMID: 27847132 DOI: 10.1016/j.pec.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/26/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Explore how adults from diverse racial and socioeconomic backgrounds perceive the use of weight loss drugs (prescription, over-the counter, herbals and supplements) and lifestyle modification. METHODS Individual, face-to-face, semi-structured interviews were conducted with persons presenting to an academic hospital-affiliated outpatient pharmacy serving ethnic minorities and low income individuals. RESULTS Fifty persons were interviewed, including 21 African Americans, 11 Hispanics and 17 low-income individuals (annual income <$20,000), of whom 33 self-reported as overweight or obese. Ever-users (14/50) and nonusers (36/50) of weight loss drugs expressed a belief in the importance of diet and exercise, but were not necessarily doing so themselves. Fear of side effects and skepticism towards efficacy of drugs deterred use. Some expressed concern over herbal product safety; others perceived herbals as natural and safe. Drugs were often viewed as a short-cut and not a long-term weight management solution. CONCLUSION A range of concerns related to the safety and efficacy of weight loss drugs were expressed by this lower income, ethnically diverse population of underweight to obese adults. PRACTICE IMPLICATIONS There is need and opportunity for healthcare providers to provide weight loss advice and accurate information regarding the safety and efficacy of various types of weight loss approaches.
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Affiliation(s)
- S Xing
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
| | - L K Sharp
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
| | - D R Touchette
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
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Metabolically distinct weight loss by 10,12 CLA and caloric restriction highlight the importance of subcutaneous white adipose tissue for glucose homeostasis in mice. PLoS One 2017; 12:e0172912. [PMID: 28245284 PMCID: PMC5330530 DOI: 10.1371/journal.pone.0172912] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Widely used as a weight loss supplement, trans-10,cis-12 conjugated linoleic acid (10,12 CLA) promotes fat loss in obese mice and humans, but has also been associated with insulin resistance. OBJECTIVE We therefore sought to directly compare weight loss by 10,12 CLA versus caloric restriction (CR, 15-25%), an acceptable healthy method of weight loss, to determine how 10,12 CLA-mediated weight loss fails to improve glucose metabolism. METHODS Obese mice with characteristics of human metabolic syndrome were either supplemented with 10,12 CLA or subjected to CR to promote weight loss. Metabolic endpoints such as energy expenditure, glucose and insulin tolerance testing, and trunk fat distribution were measured. RESULTS By design, 10,12 CLA and CR caused equivalent weight loss, with greater fat loss by 10,12 CLA accompanied by increased energy expenditure, reduced respiratory quotient, increased fat oxidation, accumulation of alternatively activated macrophages, and browning of subcutaneous white adipose tissue (WAT). Moreover, 10,12 CLA-supplemented mice better defended their body temperature against a cold challenge. However, 10,12 CLA concurrently induced the detrimental loss of subcutaneous WAT without reducing visceral WAT, promoted reduced plasma and WAT adipokine levels, worsened hepatic steatosis, and failed to improve glucose metabolism. Obese mice undergoing CR were protected from subcutaneous-specific fat loss, had improved hepatic steatosis, and subsequently showed the expected improvements in WAT adipokines, glucose metabolism and WAT inflammation. CONCLUSIONS These results suggest that 10,12 CLA mediates the preferential loss of subcutaneous fat that likely contributes to hepatic steatosis and maintained insulin resistance, despite significant weight loss and WAT browning in mice. Collectively, we have shown that weight loss due to 10,12 CLA supplementation or CR results in dramatically different metabolic phenotypes, with the latter promoting a healthier form of weight loss.
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Denham BE. Psychosocial Correlates of Dietary Supplement Use: Results from the National Survey of Midlife Development in the United States. Ecol Food Nutr 2017; 56:171-186. [PMID: 28121160 DOI: 10.1080/03670244.2016.1277711] [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: 12/14/2022]
Abstract
Drawing on data gathered in the National Survey of Midlife Development in the United States, this study examined internal and external locus of control, self-esteem, neuroticism, perceived health status, uniqueness, and somatic amplification as correlates of dietary supplement use. With sex, race, and age measures also included in the study, bivariate analyses showed greater supplement use among women and older respondents as well as those scoring higher on internal locus of control, self-esteem, perceived health status, and somatic amplification. Regression analyses identified sex and internal locus of control as the strongest predictors. Interactions between age and external locus of control also emerged.
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Affiliation(s)
- Bryan E Denham
- a Department of Communication , Clemson University , Clemson , South Carolina , USA
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The Dangerous Mix of Adolescents and Dietary Supplements for Weight Loss and Muscle Building: Legal Strategies for State Action. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:496-503. [PMID: 25248073 DOI: 10.1097/phh.0000000000000142] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Adolescents use dietary supplements marketed for weight loss or muscle building, but these are not recommended by physicians. These products are often ineffective, adulterated, mislabeled, or have unclear dosing recommendations, and consumers have suffered injury and death as a consequence. When Congress passed the Dietary Supplement Health and Education Act, it stripped the Food and Drug Administration of its premarket authority, rendering regulatory controls too weak to adequately protect consumers. State government intervention is thus warranted. This article reviews studies reporting on Americans' use of dietary supplements marketed for weight loss or muscle building, notes the particular dangers these products pose to the youth, and suggests that states can build on their historical enactment of regulatory controls for products with potential health consequences to protect the public and especially young people from unsafe and mislabeled dietary supplements.
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Abstract
Obesity is a common disorder with complex causes. The epidemic has spurred significant advances in the understanding of nutritional approaches to treating obesity. Although the primary challenge is to introduce a dietary intake that creates an energy deficit, clinicians should also consider targeted risk factor modification with manipulation of the nutrient profile of the weight-reducing diet. These strategies produce significant weight loss and improvements in cardiometabolic risk factors. Future research is needed to better understand how to personalize nutrient prescriptions further to promote optimal risk modification and maintenance of long-term energy balance in the weight-reduced state.
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Affiliation(s)
- Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
| | - Gary Miller
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Scott Kahan
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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44
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Corey R, Werner KT, Singer A, Moss A, Smith M, Noelting J, Rakela J. Acute liver failure associated with Garcinia cambogia use. Ann Hepatol 2016; 15:123-6. [PMID: 26626648 DOI: 10.5604/16652681.1184287] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Millions of Americans regularly use herbal supplements, but many are unaware of the potential hidden dangers. Numerous supplements have been associated with hepatotoxicity and, indeed dietary/herbal supplements represent an increasingly common source of acute liver injury. We report a case of acute liver failure requiring liver transplantation associated with the use of Garcinia cambogia, a supplement widely promoted for weight loss. When patients present with acute hepatitis or liver failure from an unknown etiology, a careful history of supplement use should be performed.
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Affiliation(s)
- Rebecca Corey
- Transplantation Center, Mayo Clinic, Phoenix, AZ, USA
| | | | - Andrew Singer
- Division of Transplantation Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Adyr Moss
- Division of Transplantation Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Maxwell Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Jessica Noelting
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Jorge Rakela
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
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Chatham-Stephens K, Taylor E, Chang A, Peterson A, Daniel J, Martin C, Deuster P, Noe R, Kieszak S, Schier J, Klontz K, Lewis L. Hepatotoxicity associated with weight loss or sports dietary supplements, including OxyELITE Pro™ - United States, 2013. Drug Test Anal 2016; 9:68-74. [PMID: 27367536 DOI: 10.1002/dta.2036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/25/2016] [Accepted: 06/26/2016] [Indexed: 12/14/2022]
Abstract
In September 2013, the Hawaii Department of Health (HDOH) was notified of seven adults who developed acute hepatitis after taking OxyELITE Pro™, a weight loss and sports dietary supplement. CDC assisted HDOH with their investigation, then conducted case-finding outside of Hawaii with FDA and the Department of Defense (DoD). We defined cases as acute hepatitis of unknown etiology that occurred from April 1, 2013, through December 5, 2013, following exposure to a weight loss or muscle-building dietary supplement, such as OxyELITE Pro™. We conducted case-finding through multiple sources, including data from poison centers (National Poison Data System [NPDS]) and FDA MedWatch. We identified 40 case-patients in 23 states and two military bases with acute hepatitis of unknown etiology and exposure to a weight loss or muscle building dietary supplement. Of 35 case-patients who reported their race, 15 (42.9%) reported white and 9 (25.7%) reported Asian. Commonly reported symptoms included jaundice, fatigue, and dark urine. Twenty-five (62.5%) case-patients reported taking OxyELITE Pro™. Of these 25 patients, 17 of 22 (77.3%) with available data were hospitalized and 1 received a liver transplant. NPDS and FDA MedWatch each captured seven (17.5%) case-patients. Improving the ability to search surveillance systems like NPDS and FDA MedWatch for individual and grouped dietary supplements, as well as coordinating case-finding with DoD, may benefit ongoing surveillance efforts and future outbreak responses involving adverse health effects from dietary supplements. This investigation highlights opportunities and challenges in using multiple sources to identify cases of suspected supplement associated adverse events. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Kevin Chatham-Stephens
- EIS officer, 1600 Clifton Road NE MS C-09, Atlanta, GA.,Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Ethel Taylor
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Arthur Chang
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Amy Peterson
- Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center
| | - Johnni Daniel
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Colleen Martin
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Patricia Deuster
- Department of Military and Emergency Medicine, Uniformed Services University
| | - Rebecca Noe
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Stephanie Kieszak
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Josh Schier
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Karl Klontz
- Office of Analytics and Outreach, Center for Food Safety and Applied Nutrition, Food and Drug Administration
| | - Lauren Lewis
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention
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Garcia-Alvarez A, Mila-Villarroel R, Ribas-Barba L, Egan B, Badea M, Maggi FM, Salmenhaara M, Restani P, Serra-Majem L. Usage of Plant Food Supplements (PFS) for weight control in six European countries: results from the PlantLIBRA PFS Consumer Survey 2011-2012. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:254. [PMID: 27465483 PMCID: PMC4964311 DOI: 10.1186/s12906-016-1227-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 07/19/2016] [Indexed: 01/27/2023]
Abstract
Background Obesity is increasing worldwide and weight-control strategies, including the consumption of plant food supplements (PFS), are proliferating. This article identifies the herbal ingredients in PFS consumed for weight control and by overweight/obese dieters in six European countries, and explores the relationship between their consumption and their self-reported BMI. Methods Data used were a subset from the PlantLIBRA PFS Consumer Survey 2011-2012, a retrospective survey of 2359 PFS consumers. The survey used a bespoke frequency-of-PFS-usage questionnaire. Analyses were performed in two consumer subsamples of 1) respondents taking the products for “body weight reasons”, and 2) “dieters for overweight/obesity”, to identify the herbal ingredients consumed for these reasons. The relationship between the 5 most consumed herbal ingredients and self-reported BMI in groups 1 and 2 is explored by comparing BMI proportions of consumers vs. non-consumers (using Chi-squared test). Results 252 PFS (8.8 %) were consumed for “body weight reasons” (by 240 PFS consumers); 112 PFS consumers (4.8 %) were “dieting for overweight/obesity”. Spain is the country where consuming herbal ingredients for body weight control and dieting were most popular. Artichoke was the most consumed herbal ingredient. Considering only the 5 top products consumed by those who responded “body weight”, when using the total survey sample, a greater proportion of BMI ≥ 25 was observed among consumers of PFS containing artichoke and green tea as compared to non-consumers (58.4 % vs. 49.1 % and 63.2 % vs. 49.7 % respectively). Considering only the 5 top products consumed by “dieters” and using only the “dieters” sample, a lower proportion of BMI ≥ 25 was observed among pineapple-containing PFS consumers (38.5 % vs. 81.5 %); however, when using the entire survey sample, a greater proportion of BMI ≥ 25 was observed among artichoke-containing PFS consumers (58.4 % vs. 49.1 %). Conclusions A comparison of results among the scarce publications evaluating the use of weight-loss supplements at the population level is limited. Nevertheless every hint is important in finding out which are the self-treatment strategies used by overweight/obese individuals in European countries. Although limited by a small sample size, our study represents a first attempt at analysing such data in six EU countries. Our findings should encourage the conduction of further studies on this topic, long-term and large sample-sized studies, ideally conducted in the general population.
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Eichner S, Maguire M, Shea LA, Fete MG. Banned and discouraged-use ingredients found in weight loss supplements. J Am Pharm Assoc (2003) 2016; 56:538-43. [PMID: 27475836 DOI: 10.1016/j.japh.2016.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/17/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify banned and discouraged-use ingredients, such as ephedra, 1,3-dimethylamylamine, and beta-methyl-phenylethylamine, in readily available weight loss dietary supplements within a 10-mile radius of Regis University. METHODS A list of banned and discouraged-use ingredients was compiled with the use of the Food and Drug Administration (FDA) dietary supplement website which provides information on supplement ingredients that are no longer legal or are advised against owing to adverse event reporting. Investigators visited all retail outlet stores within a 10-mile radius of Regis University in Denver, Colorado. Retail chains were not duplicated and only one of each chain was evaluated. RESULTS A total of 51 weight loss supplement products from retail stores were found with banned or discouraged-use substances listed on their labels. At least one banned ingredient was found to be listed on the product labels in 17 of the 51 studied supplements (33%). At least one discouraged-use ingredient was found in 46 of the 51 products (90%). Retail outlet stores dedicated to supplements and sports nutrition alone were found to have the greatest number of weight loss supplements that included banned and discouraged-use ingredients. CONCLUSION The FDA has taken action to remove some weight loss supplements from the market that contain banned ingredients. Unfortunately, based on the findings of this study, it is evident that products containing these ingredients remain on the market today.
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Bahmani M, Eftekhari Z, Saki K, Fazeli-Moghadam E, Jelodari M, Rafieian-Kopaei M. Obesity Phytotherapy. J Evid Based Complementary Altern Med 2016; 21:228-234. [DOI: 10.1177/2156587215599105] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Obesity is an important disorders due to which 25 million deaths occur annually worldwide. Synthetic drugs for weight loss have low efficacy and high side effects. Apart from synthetic drugs in modern medicine, various other methods including the use of herbal medications are used to induce weight loss. Cambodia hoodia, green tea, Citrus aurantium, white beans, fenugreek, caffeine, ephedrine, capsaicin, yohimbine, chitosan, fitostreols, and guar gum have been studied in clinical trials and their effects have been confirmed. It seems necessary to study more to determine the effectiveness and safety of medicinal plants and herbal extracts as well as pharmaceutically active ingredients that may have the property of weight loss. In this article, we aimed to review recent knowledge about medicinal plants that are recommended for weight loss.
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Affiliation(s)
- Mahmoud Bahmani
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Kourosh Saki
- Lorestan University of Medical Sciences, Khorramabad, Iran
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Johnston DI, Chang A, Viray M, Chatham-Stephens K, He H, Taylor E, Wong LL, Schier J, Martin C, Fabricant D, Salter M, Lewis L, Park SY. Hepatotoxicity associated with the dietary supplement OxyELITE Pro™ - Hawaii, 2013. Drug Test Anal 2016; 8:319-27. [PMID: 26538199 PMCID: PMC4833726 DOI: 10.1002/dta.1894] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 12/16/2022]
Abstract
Dietary supplements are increasingly marketed to and consumed by the American public for a variety of purported health benefits. On 9 September 2013, the Hawaii Department of Health (HDOH) was notified of a cluster of acute hepatitis and fulminant hepatic failure among individuals with exposure to the dietary supplement OxyELITE Pro™ (OEP). HDOH conducted an outbreak investigation in collaboration with federal partners. Physicians were asked to report cases, defined as individuals with acute onset hepatitis of unknown etiology on or after 1 April 2013, a history of weight-loss/muscle-building dietary supplement use during the 60 days before illness onset, and residence in Hawaii during the period of exposure. Reported cases' medical records were reviewed, questionnaires were administered, and a product investigation, including chemical analyses and traceback, was conducted. Of 76 reports, 44 (58%) met case definition; of these, 36 (82%) reported OEP exposure during the two months before illness. No other common supplements or exposures were observed. Within the OEP-exposed subset, two patients required liver transplantation, and a third patient died. Excessive product dosing was not reported. No unique lot numbers were identified; there were multiple mainland distribution points, and lot numbers common to cases in Hawaii were also identified in continental states. Product analysis found consumed products were consistent with labeled ingredients; the mechanism of hepatotoxicity was not identified. We report one of the largest statewide outbreaks of dietary supplement-associated hepatotoxicity. The implicated product was OEP. The increasing popularity of dietary supplements raises the potential for additional clusters of dietary supplement-related adverse events. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- David I. Johnston
- Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, HI, USA
| | - Arthur Chang
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa Viray
- Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, HI, USA
| | - Kevin Chatham-Stephens
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hua He
- Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, HI, USA
| | - Ethel Taylor
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joshua Schier
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Colleen Martin
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Monique Salter
- Office of Foods and Veterinary Medicine/Coordinated Outbreak Response and Evaluation Network, U.S. Food & Drug Administration
| | - Lauren Lewis
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Y. Park
- Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, HI, USA
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50
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Taing MW, Tan ETX, Williams GM, Clavarino AM, McGuire TM. Herbal and nutrient complementary medicines for weight loss: community pharmacists' practices, attitudes, recommendations, information and education needs. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 24:160-9. [PMID: 26671003 DOI: 10.1111/ijpp.12232] [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: 04/08/2015] [Accepted: 09/23/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate pharmacists' herbal/nutrient weight loss complementary medicine (WLCM) practices in the context of other pharmacist weight management support practices (provision of lifestyle advice, orlistat and meal replacement treatments); and gain insight into their attitudes, recommendations, information and education needs. METHODS Pharmacists from a randomly selected sample of 214 community pharmacies from different socioeconomic areas in the Greater Brisbane region, Australia, were invited to complete a survey to explore their weight management practices, with a specific focus on herbal/nutrient WLCM practices. Data collected from the sample group represented pharmacist practices within the metropolitan Greater Brisbane region. KEY FINDINGS This survey achieved a 51% response rate. During weight management consultations, a high proportion of customers (37%) sought advice from community pharmacists relating to WLCMs relative to other weight management practices; however, only a small proportion (10%) of pharmacists recommended them. Most were also found to be using resources that may not be evidence-based or do not provide sufficient WLCMs' information. CONCLUSION Study results highlight the need for pharmacy professional bodies to develop evidence-based continuing education programmes to assist consumers with popular and widely available WLCMs products.
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Affiliation(s)
- Meng-Wong Taing
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Eunice Tze Xin Tan
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Gail M Williams
- School of Population Health, The University of Queensland, Brisbane, Qld, Australia
| | | | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.,Mater Pharmacy Services, Mater Health Services, Brisbane, Qld, Australia.,Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia
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