Sociodemographic and health behaviour factors among dietary supplement and natural remedy users

Phytotherapy and Drugs: Can Their Interactions Increase Side Effects in Cancer Patients?

BACKGROUND

The use of herbs to treat illnesses was common in all historical eras. Our aim was to describe the phytotherapeutic substances that cancer patients use most commonly, and to determine whether their use can increase side effects.

METHODS

This was a retrospective and descriptive study conducted among older adults actively undergoing chemotherapy, admitted at the Oncology DH Unit (COES) of the Molinette Hospital AOU Città della Salute e della Scienza in Turin (Italy). Data collection was conducted through the distribution of self-compiled and closed-ended questionnaires during chemotherapy treatment.

RESULTS

A total of 281 patients were enrolled. Evaluating retching and sage consumption was statistically significant in multivariate analysis. The only risk factor for dysgeusia was chamomile consumption. Ginger, pomegranate, and vinegar use were retained as mucositis predictors.

CONCLUSIONS

Phytotherapeutic use needs more attention in order to decrease the risks of side effects, toxicity, and ineffective treatment. The conscious administration of these substances should be promoted for safe use and to provide the reported benefits.

Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study

OBJECTIVE

Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population.

RESEARCH DESIGN AND METHODS

This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation.

RESULTS

A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m² , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03).

CONCLUSIONS

In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.

Food and nutrient intake in dietary supplement users: a nationwide school-based study in Japan

Dietary supplements can be used to compensate for an inadequate diet. However, some studies indicate that supplement users consume healthier diets than non-users, although such data are lacking in Japanese children. The aim of the present study was to investigate the food and nutrient intake of dietary supplement users among school-aged children in Japan. A nationwide school dietary survey was conducted at fourteen elementary schools and thirteen junior high schools in twelve prefectures in Japan. Three-day non-consecutive semi-weighed dietary records were obtained on two weekdays and one weekend day. Analysis of covariance was performed to investigate differences in food and nutrient intake from meals consumed at school and outside of school between dietary supplement users and non-users, adjusted for socio-demographic and health-related characteristics. Of the 910 children included in this analysis, 80 (8⋅8 %) reported supplement use. Based on 3-d dietary records, dietary supplement users consumed higher mean amounts of oils and lower amounts of fruits and vegetables than non-users. In school lunches, users consumed significantly higher amounts of oils and lower amounts of protein than non-users. In meals consumed outside of school, dietary supplement users consumed significantly higher amounts of confectioneries and lower amounts of fruits and vegetables, folate, vitamin C and dietary fibre than non-users. Collectively, our findings indicate that dietary supplement users consumed less healthy diets than non-users. Additional studies are warranted to confirm these results and identify factors contributing to poorer dietary habits in supplement users.

Prevalence and Determinants of Sex-Specific Dietary Supplement Use in a Greek Cohort

We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history and clinical measurements was assessed using logistic regression models, separately for women and men. The overall prevalence of dietary supplement use was 31.4%, and it was higher in women (37.3%) compared to men (22.4%; p-value = 4.2-08). Based on multivariable logistic regression models, dietary supplement use in women was associated with age (positively until middle-age and slightly negatively afterwards), the presence of a chronic health condition (OR = 1.71; 95% CI, 1.18-2.46), lost/removed teeth (OR = 0.52; 95% CI, 0.35-0.78) and diastolic blood pressure (OR per 5 mmHg increase =0.84; 95% CI, 0.73-0.96); body mass index and worse general health status were borderline inversely associated. In men, dietary supplement use was positively associated with being employed (OR = 2.53; 95% CI, 1.21-5.29). A considerable proportion of our sample used dietary supplements, and the associated factors differed between women and men.

Do Dietary Supplements Improve Perceived Health Well-Being? Evidence from Korea

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.

Vitamin C and the Lens: New Insights into Delaying the Onset of Cataract

Cataracts or clouding of the lens is the leading cause of blindness in the world. Age and diabetes are major risk factors, and with an increasing aging and diabetic population, the burden of cataracts will grow. Cataract surgery is an effective way to restore vision; however, alternatives to cataract surgery are required to reduce the looming cataract epidemic. Since it is well established that oxidative damage plays a major role in the etiology of cataracts, antioxidants have been promoted as therapies to delay and/or prevent cataracts. However, many antioxidant interventions including vitamin C have produced mixed results as anti-cataract therapies. Progress has been made towards our understanding of lens physiology and the mechanisms involved in the delivery and uptake of antioxidants to the lens which may guide future studies aimed at addressing some of the inconsistencies seen in previous animal and human studies. Of interest is the potential for vitamin C based supplements in delaying the onset of cataracts post vitrectomy which occurs in up to 80% of patients within two years. These targeted approaches are required to reduce the burden of cataract on hospitals and improve the quality of life of our aging and diabetic population.

The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study

Background

The mass media have been condemned for encouraging young people to take dietary supplements (DS). Media literacy, which includes authors and audiences (AA), messages and meanings (MM), and representation and reality (RR) domains, is a new approach to teaching young adults to make better informed health decisions. However, it is not clear which domains are the most important for media literacy education.

Objective

The purpose of this study is to investigate the associations among individual factors, media literacy, and DS use.

Methods

The survey instrument included demographic items, the DS Media Literacy Scale (DSMLS), and DS use items (users or nonusers, types of DS, current use of DS, and intention to use DS in the future). The DSMLS is an 11-item instrument designed to assess college students’ AA, MM, and RR media literacy in relation to DS. A total of 467 Taiwanese college students participated in the study. Descriptive statistical analysis, logistic regression analysis, and multiple regression analysis were conducted.

Results

A total of 338/467 (72.4%) participants reported using DS, and 176/467 (37.7%) consumed 3 or more supplements. Moreover, the MM media literacy domain was associated with having been a DS user (odds ratio 0.63, P=.002), current DS use (β=–.10, P=.02), and intention to use DS in the future (β=–.12, P=.011). Finally, perceived importance of health was positively related to current DS use (β=.18, P=.001) and intention to use DS in the future (β=.18, P=.001).

Conclusions

This study showed that the majority of Taiwanese college students were DS users and used multiple types of supplements. Moreover, students with lower MM media literacy were more likely to be DS users, to take DS more frequently, and to have higher intentions for future frequent DS use. Finally, those who placed extreme importance on health were more likely to take DS frequently and have higher intentions for future frequent DS use.

Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review

AIM

To identify predictive factors of CAM use in the general population in Europe.

METHODS

We performed a systematic review to summarize and analyse the published data on factors predictive of CAM use by the general population in Europe. The Cumulative Index to Nursing and Allied Health Literature, Google Scholar, PsycInfo, PubMed and the Web of Science databases were systematically searched up to August 2, 2018. We selected observational studies (case-control, cohort and cross-sectional) of adults conducted in Europe. Risk of bias was determined using the ROBINS-I tool recommended by the Cochrane Group.

RESULTS

Over six thousand articles were identified of which 49 met our inclusion criteria. Twenty three studies investigated the consultation of CAM practitioners, five looked at the use of CAM products, one concerned CAM practices and twenty studied combinations of these. Female gender and self-reported chronic disease are predictive factors of CAM practitioner use. In contrast, marital status is not a predictive factor for consulting a CAM practitioner. Female gender is also a predictive factor of CAM product use. For all other factors investigated, no clear conclusions could be drawn.

CONCLUSION

We found no clear specificity of the use of CAM practitioners versus conventional health practitioners. Other directions of public health research should be explored, rather than assuming that there is specificity.

Predictors of alternative medicine use by multiple sclerosis patients

Objective: To determine the frequency of alternative medicine use among multiple sclerosis (MS) patients, and the factors which predict such use. Methods: We examined 20778 MS patients enrolled in the North A merican Research C onsortium on Multiple Sclerosis (NARC O MS) Patient Registry, residing in the USA. We used demographic and clinical data to create multivariate logistic regression models for i) lifetime use of any alternative medicine, ii) lifetime use of any alternative provider (A P), and iii) lifetime use of each of the three most common A P. Results: 20387 patients provided data regarding alternative medicine use. Lifetime use of any alternative medicine was 54% and current use was 30%. C hiropractors (51%), massage therapists (34%), and nutritionists (24%) were the most commonly used A P. In all five models, use of alternative medicine was most strongly predicted by use of a conventional provider, and more modestly by disease factors indicating more severe or prolonged disease. Predictive power of the models was poor (c-index =0.62-0.68), despite good fits for the data. Conclusions: Demographic factors play only a minimal role in predicting the use of alternative medicine in this MS population while disease factors play a slightly stronger role. There must be other factors involved that may include accessibility, social acceptability and cultural factors. G iven the frequency of alternative medicine use by this patient population, further characterization of these factors is important.

Dietary supplements and disease prevention - a global overview

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.

Alternative Therapy Use Among the Young-Old (Ages 65 to 74): An Evaluation of the MIDUS Database

By the year 2020, 20% of the U.S. population will be age 65 years or older. From a health care perspective, there is growing concern about the aging population. Little is known about the elderly and their use of alternative therapies. This study included data from the National Survey of Midlife Development in the United States (MIDUS). Three-hundred and thirty-five participants between the ages of 65 and 74 completed the interview and mailback questionnaire. One-hundred and forty-five individuals (43.3%) reported using alternative medicine therapies during the past year. The most common types of alternative medicine utilized were as follows: spiritual practices, exercise/movement therapies, special diets, chiropractic, and meditation. Income, education, and sex of respondent were found to be predictors of alternative therapy use among this age group. Results from this study could provide conventional practitioners greater awareness of the health beliefs and practices of their young-old patients.

Vitamin-Mineral Supplement Use Patterns in Elderly Koreans: Data from the 2007-2008 Korean National Health and Nutrition Examination Survey

Background

Vitamin-mineral supplements are the most popular dietary supplements in Korea. However, few studies have assessed the relationship between vitamin-mineral supplementation and associated factors among the Korean elderly. The purpose of this study was to assess the use of vitamin-mineral supplements among elderly in Korea as well as its association with sociodemographic factors, health-related behaviors, medical conditions, and nutrient intake.

Methods

This study was based on data from the Korean National Health and Nutrition Examination Survey, conducted by the Korean Ministry of Health and Welfare from 2008 to 2009. Data from 3,294 elderly men and women (65 years of age and older) were analyzed. Multivariable-weighted logistic regression model analysis was used to evaluate the association between vitamin-mineral supplement use and sociodemographic factors, health-related habits, and medical conditions.

Results

Vitamin-mineral supplementation was reported by 16.3% of the participants. The most common reason for using dietary supplements was recommendations from friends and acquaintances. Highly educated person, female participants had a greater likelihood of taking vitamin-mineral supplements. In addition, analysis of nutrient intake from food sources alone revealed a lower proportion of vitamin-mineral supplement users with nutrient intakes below the estimated average requirements for vitamin A, vitamin C, thiamine, riboflavin, niacin, calcium, iron, and phosphorus, compared to nonusers. However, vitamin-mineral supplementation was not associated with health-related behaviors or medical conditions.

Conclusion

Highly educated person, elderly Korean women had a greater likelihood of using vitamin-mineral supplements. In addition, nutrient intakes from food sources alone were significantly higher among vitamin-mineral supplement users. Finally, vitamin-mineral supplementation may be an indicator of healthier diet in elderly Koreans.

Modulation of Aromatase by Phytoestrogens

The aromatase enzyme catalyzes the conversion of androgens to estrogens in many human tissues. Estrogens are known to stimulate cellular proliferation associated with certain cancers and protect against adverse symptoms during the peri- and postmenopausal intervals. Phytoestrogens are a group of plant derived naturally occurring compounds that have chemical structures similar to estrogen. Since phytoestrogens are known to be constituents of animal/human food sources, these compounds have received increased research attention. Phytoestrogens may contribute to decreased cancer risk by the inhibition of aromatase enzyme activity and CYP19 gene expression in human tissues. This review covers (a) the aromatase enzyme (historical descriptions on function, activity, and gene characteristics), (b) phytoestrogens in their classifications and applications to human health, and (c) a chronological coverage of aromatase activity modulated by phytoestrogens from the early 1980s to 2015. In general, phytoestrogens act as aromatase inhibitors by (a) decreasing aromatase gene expression, (b) inhibiting the aromatase enzyme itself, or (c) in some cases acting at both levels of regulation. The findings presented herein are consistent with estrogen's impact on health and phytoestrogen's potential as anticancer treatments, but well-controlled, large-scale studies are warranted to determine the effectiveness of phytoestrogens on breast cancer and age-related diseases.

The Use of Complementary and Alternative Medicine in Hospitalized Patients with Type 2 Diabetes Mellitus in Israel

INTRODUCTION

The use of complementary and alternative medicine (CAM) has been on the rise in recent years in the general population, as well as among patients with chronic diseases such as diabetes mellitus. The aim of this study was to add information regarding the use of CAM in patients with type 2 diabetes mellitus (DM2) in Israel and explore possible interactions between CAM and prescription medication (PM).

METHODS

This is a cross-sectional study based on questionnaires. The study included type 2 diabetic patients who were hospitalized in an internal medicine department at Assaf Harofeh Medical Center, Zerifin, Israel, between December 2013 and December 2014. Possible interactions between CAM and PM were evaluated by a clinical pharmacist and a clinical pharmacologist.

RESULTS

Out of 111 diabetic patients, 23.4% used CAM. There was no significant difference between the consumers and nonconsumers in terms of age, education, income, smoking, or alcohol habits. Only 11 of the 26 CAM consumers informed their physician regarding the use. We found possible drug-herb interactions in 19 of the 26 CAM consumers. A major interaction was found between omega-3 and antiaggregants and was encountered in 7 (26.9%) of the CAM consumers. Other minor and major interactions were found with vitamin E, ginkgo-biloba, co-enzyme Q10, green tea, fenugreek seeds, pyridoxine, and dandelion.

CONCLUSIONS

Since CAM consumption is on the rise, it is desirable to improve our knowledge concerning their potential effects and adverse effects, especially in conjunction with PM. Given the complexity of pharmaceutics in patients with chronic diseases, among them patients with DM, the use of supplementary medicine cannot be ignored.

Herbal and dietary supplement use in Bangkok: a survey

BACKGROUND

People living in Asian countries including Thailand are likely to use herbal and dietary supplements (HDS). However, there is limited evidence of their usage in Thailand. The objectives of this study were to determine (1) the prevalence of HDS usage amongst a general population in Bangkok; (2) patterns of HDS use; (3) reasons why Bangkok residents use HDS.

METHODS

This cross-sectional survey recruited 400 Thai people aged 15 years or over at busy bus stops in Bangkok, Thailand, using convenience sampling. Data were collected via an interview regarding demographics, HDS usage and reasons of using HDS. Descriptive statistics, such as frequencies and percentages, were used to analyse the prevalence and the patterns of HDS use.

RESULTS

The prevalence of HDS usage in the previous 6 months was 52%. The majority of people who took herbs used them to treat illnesses (58%), whereas the majority of people who took dietary supplements used them to promote well-being (65%). Respondents reported using HDS due to their efficacy (28%), wanting to try them (26%) and safety concerns with conventional medicines (15%).

CONCLUSIONS

Health care providers should be aware of HDS use amongst Thai residents in Bangkok. Policy makers should educate people about appropriate HDS use.

Concomitant use of dietary supplements and medicines in patients due to miscommunication with physicians in Japan

We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines.

Influence of diet supplementation with green tea extract on drug-metabolizing enzymes in a mouse model of monosodium glutamate-induced obesity

PURPOSE

Consumption of dietary supplements with green tea extract (GTE) is popular for weight management, but it may be accompanied by various side effects, including interactions with drugs. The aim of the present in vivo study was to evaluate the effect of defined GTE (Polyphenon 60) in three dosage schemes on insulin, leptin and drug-metabolizing enzymes in obese mice.

METHODS

Experimental obesity was induced by repeated s.c. application of monosodium glutamate to newborn mice. Green tea extract was administered in three dosage schemes in chow diet. The plasmatic levels of insulin and leptin were assayed using enzyme-linked immunosorbent assay. Enzyme activities and mRNA expressions of drug-metabolizing enzymes (totally 13) were analyzed in liver and small intestine using spectrophotometric and HPLC assays and RT-PCR, respectively.

RESULTS

GTE-treatment decreased insulin and leptin levels. Eleven enzymes were significantly affected by GTE-treatment. Long-term administration of 0.01% GTE caused increase in the activity and mRNA level of cytochrome P450 3A4 (CYP3A4) ortholog in the liver as well as in the small intestine. Interestingly, short-term overdose by GTE (0.1%) had more pronounced effects on enzyme activities and mRNA expressions than long-term overdose.

CONCLUSIONS

GTE-mediated induction of CYP3A4 ortholog, the main drug-metabolizing enzyme, could result in decreased efficacy of simultaneously or subsequently administered drug in obese individuals.

Inappropriate usage of dietary supplements in patients by miscommunication with physicians in Japan

Recently, people have used dietary supplements not only for nutritional supplementation, but also for treatment of their diseases. However, use of dietary supplements to treat diseases, especially with medications, may cause health problems in patients. In this study, we investigated use of dietary supplements in patients in Japan. This survey was conducted from January to December 2012, and was completed by 2732 people, including 599 admitted patients, 1154 ambulatory patients, and 979 healthy subjects who attended a seminar about dietary supplements. At the time of the questionnaire, 20.4% of admitted patients, 39.1% of ambulatory patients, and 30.7% of healthy subjects were using dietary supplements, which including vitamin/mineral supplements, herbal extracts, its ingredients, or food for specified health uses. The primary purpose for use in all groups was health maintenance, whereas 3.7% of healthy subjects, 10.0% of ambulatory patients, and 13.2% of admitted patients used dietary supplements to treat diseases. In addition, 17.7% of admitted patients and 36.8% of ambulatory patients were using dietary supplements concomitantly with their medications. However, among both admitted patients and ambulatory patients, almost 70% did not mention dietary supplement use to their physicians. Overall, 3.3% of all subjects realized adverse effects associated with dietary supplements. Communication between patients and physicians is important to avoid health problems associated with the use of dietary supplements.

Folic acid supplementation and IVF pregnancy outcome in women with unexplained infertility

Folic acid supplements are commonly used by infertile women which leads to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to IVF pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P < 0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P < 0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility. Folate is one of the B vitamins which has been suggested to be related to infertility. Folic acid is an artificial form of folate which is commonly used in dietary supplements. Folic acid supplementation has been shown to increase folate concentrations and decrease concentrations of the amino acid homocysteine in the blood. Folic acid supplementation is commonly used by infertile women, but the effect on pregnancy outcome in women with a diagnosis of unexplained infertility has not been thoroughly investigated. In the present study, folic acid supplement use and folate status (concentrations of folate and homocysteine) in women with unexplained infertility were evaluated in relation to pregnancy outcome. In addition, the use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile control women. Our results showed that women with unexplained infertility used considerably more folic acid supplements and had higher total folic acid intake from supplements compared with fertile control women. Women with unexplained infertility had better blood folate and homocysteine concentrations than fertile women, but folic acid supplementation or folate status were not related to pregnancy outcome following the infertility treatment. In conclusion, high folic acid intake or good folate status did not increase the possibility of a birth of a healthy baby after infertility treatment in women with unexplained infertility.

Secular trends in the use of vitamins, minerals and fish-oil products in two cohorts of community-dwelling older people in Helsinki--population-based surveys in 1999 and 2009

OBJECTIVES

To examine and compare the prevalence of use of vitamins, minerals, and fish-oil products (VMFO) in Finnish community-dwelling older people at two time points over a decade, and to explore the associated factors with the VMFO use.

METHODS

A postal survey was sent to people aged 75, 80, 85, 90, and 95 years living in Helsinki, Finland in 1999 (N=3219) and in 2009 (N=2247). The response rates were 78% (n=2511) and 73% (n=1637), respectively. The surveys included items on demographic and health related factors, used medication and self-reported supplemental use of vitamins or minerals, and natural products.

RESULTS

The proportion of respondents using at least one VMFO was 49.8% in 1999 and 66.8% in 2009 (p<0.001). The proportion using vitamin D (RR 4.58, 95% CI 3.89 to 5.40; p<0.001), calcium (RR 2.47, 95% CI 2.18 to 2.80; p<0.001), magnesium (RR 1.47, 95% CI 1.17 to 1.85; p<0.001), and fish-oil/omega3 products (RR 3.66, 95% CI 2.41 to 5.55; <0.001) was higher in 2009 than in 1999, even when adjusted for age, gender, living conditions, education and comorbidities, whereas that of other vitamins and fish-liver-oil products was lower. At both time points the use of VMFO was associated with female gender and higher number of used medications. In 1999, higher education was associated with VMFO-use while age and comorbidities was not. In 2009 higher age and comorbidities was associated with VMFO-use.

CONCLUSIONS

The use of VMFO is common among community-dwelling older people and it has significantly increased over ten years. The increase was mainly due to the use of vitamin D and calcium. The consumption of other vitamin supplements has decreased. Education was no longer associated with use of VFMO in 2009 where as age and comorbidities were.

Dietary supplement use and health-related behaviors in a Mediterranean population

OBJECTIVE

To determine predictors and health-related motivation for supplement use.

DESIGN

Population-based, cross-sectional survey. Food intake was determined by a validated food frequency questionnaire that included questions on dietary supplement consumption. Physical activity, smoking status, educational level, self-perceived mental and physical health, and medical information and drug treatment of diabetes, hypertension, and hypercholesterolemia were recorded. Weight and height were measured.

SETTING

Girona, Spain.

PARTICIPANTS

Six thousand three hundred fifty-two men and women aged 35-80 years.

ANALYSIS

Multiple logistic regression analysis to evaluate the association between dietary supplement use and the other variables.

RESULTS

Dietary supplements were consumed by 9.3% of the participants. Positive predictors of supplement use were female sex (odds ratio = 2.44, 95% confidence interval 1.96-3.04), higher educational level (P < .001), and a high adherence to the Mediterranean diet pattern (P < .001) and to the nutrient adequacy score (P = .004). A higher body mass index (P < .001) and the awareness of hypertension (odds ratio = 0.69, 95% confidence interval 0.56-0.87) were negatively associated with supplement use.

CONCLUSIONS AND IMPLICATIONS

The relatively small number of dietary supplement users did not show a clustering of healthy lifestyle habits. Self-perception of mental and physical health and awareness of a cardiometabolic disorder were not motivators for supplement use.

Understanding support for complementary and alternative medicine in general populations: Use and perceived efficacy

Proponents of complementary and alternative medicine argue that these treatments can be used with great effect in addition to, and sometimes instead of, conventional medicine, a position which has drawn sustained opposition from those who advocate an evidence-based approach to the evaluation of treatment efficacy. Using recent survey data from the United Kingdom, this article seeks to establish a clearer understanding of the nature of the public’s relationship with complementary and alternative medicine within the general population by focusing on beliefs about the perceived effectiveness of homeopathy, in addition to its reported use. Using recent data from the United Kingdom, we initially demonstrate that reported use and perceived effectiveness are far from coterminous and argue that for a proper understanding of the motivations underpinning public support of complementary and alternative medicine, consideration of both reported use and perceived effectiveness is necessary. We go on to demonstrate that although the profile of homeopathy users differs from those who support this form of medicine, neither outcome is dependent upon peoples’ levels of knowledge about science. Instead, the results suggest a far greater explanatory role for need and concerns about conventional medicine.

Use of food supplements and determinants of usage in a sample Italian adult population

OBJECTIVE

The aims were to collect data on consumption of different food supplements in a sample of the adult Italian population and to characterize users by demographic, physical and health-related characteristics, lifestyle and behaviour.

DESIGN

Cross-sectional survey.

SETTING

The study was conducted in 2008 in ten towns of Italy (two towns from each of the five macro-areas: Northwest, Northeast, Centre, South and Islands).

SUBJECTS

Adults (n 10 000) aged ≥18 years were randomly selected and asked to fill in a self-administered questionnaire regarding their use of food supplements and the above variables. The effect of these variables on food supplement use was evaluated by univariate and multivariate logistic regression.

RESULTS

Of the 1723 individuals who returned the questionnaire, 49% were users of food supplements. A large proportion (54%) of users used more than one category of food supplement: vitamin and/or mineral supplements were the most used (61%), followed by supplements with botanicals and botanical extracts (28%). The results obtained by logistic regression showed that gender, town size, education level, sports practice, regular use of wholemeal cereal-based foods and presence of a low stress level were determinants for the use of food supplements in the examined population. However, these determinants were not shared by all categories of supplements.

CONCLUSIONS

The results of this preliminary study highlight that associations between demographic, dietary and lifestyle factors and use of different categories of food supplements differ according to products, and cannot be accounted for simply by dichotomizing individuals as users or non-users.

Community pharmacists' attitudes relating to patients' use of health products in Japan

BACKGROUND

There is little information about Japanese pharmacists' perceived facilitators and barriers to communication with patients about orally taken health products, including herbs and dietary supplements.

OBJECTIVE

To explore Japanese pharmacists' attitudes relating to patients' use of health products.

METHOD

Qualitative study involving focus group interviews with pharmacists was conducted. Data were analyzed using the constant comparative method.

SETTING

Focus group interviews with community pharmacists were conducted in Japan. Main outcome measure Pharmacists' views and experiences about patients' health product use and their perceived facilitators and barriers to communication.

RESULTS

Sixteen pharmacists participated and were asked to describe their views and experiences about patients' health product use. Some were uncomfortable inquiring about and being asked about patients' health product use, due to lack of scientific evidence for their efficacy and safety, lack of knowledge to advise patients properly, and fear that they could not answer patients' questions. Other pharmacists had similar views or experiences, but those who were proactive in communicating with patients were motivated by certain predisposing factors, such as their professional responsibility for ensuring patients' health and safety.

CONCLUSION

This study showed that differences in opinion about their roles might create differences in pharmacists' attitudes toward patients' health product use. This highlights the importance of reconsidering pharmacists' roles in community settings. Further studies and debate are needed in order to clarify the pharmacists' roles and to ensure the design of educational objectives that would enable pharmacists to support their patients in using health products and prescription drugs safely.

Nutrient intake and risk of open-angle glaucoma: the Rotterdam Study

Open-angle glaucoma (OAG) is the commonest cause of irreversible blindness worldwide. Apart from an increased intraocular pressure (IOP), oxidative stress and an impaired ocular blood flow are supposed to contribute to OAG. The aim of this study was to determine whether the dietary intake of nutrients that either have anti-oxidative properties (carotenoids, vitamins, and flavonoids) or influence the blood flow (omega fatty acids and magnesium) is associated with incident OAG. We investigated this in a prospective population-based cohort, the Rotterdam Study. A total of 3502 participants aged 55 years and older for whom dietary data at baseline and ophthalmic data at baseline and follow-up were available and who did not have OAG at baseline were included. The ophthalmic examinations comprised measurements of the IOP and perimetry; dietary intake of nutrients was assessed by validated questionnaires and adjusted for energy intake. Cox proportional hazard regression analysis was applied to calculate hazard ratios of associations between the baseline intake of nutrients and incident OAG, adjusted for age, gender, IOP, IOP-lowering treatment, and body mass index. During an average follow-up of 9.7 years, 91 participants (2.6%) developed OAG. The hazard ratio for retinol equivalents (highest versus lowest tertile) was 0.45 (95% confidence interval 0.23–0.90), for vitamin B1 0.50 (0.25–0.98), and for magnesium 2.25 (1.16–4.38). The effects were stronger after the exclusion of participants taking supplements. Hence, a low intake of retinol equivalents and vitamin B1 (in line with hypothesis) and a high intake of magnesium (less unambiguous to interpret) appear to be associated with an increased risk of OAG.

Intake of micronutrients among Danish adult users and non-users of dietary supplements

Objectives

To evaluate the intake of micronutrients from the diet and from supplements in users and non-users of dietary supplements, respectively, in a representative sample of the Danish adult population. A specific objective was to identify the determinants of supplement use.

Design

A cross-sectional representative national study of the intake of vitamins and minerals from the diet and from dietary supplements.

Method

The Danish National Survey of Dietary Habits and Physical Activity, 2000–2004. Participants (n=4,479; 53% females) aged 18–75 years gave information about the use of dietary supplements in a personal interview. The quantification of the micronutrient contribution from supplements was estimated from a generic supplement constructed from data on household purchases. Nutrient intakes from the diet were obtained from a self-administered 7-day pre-coded dietary record. Median intakes of total nutrients from the diets of users and non-users of supplements were analysed using the Wilcoxon rank-sum test.

Results

Sixty percent of females and 51% of males were users of supplements. With the exception of vitamin D, the intake of micronutrients from the diet was adequate at the group level for all age and gender groups. Among females in the age group 18–49 years, the micronutrient intake from the diet was significantly higher compared with the non-users of dietary supplements. The use of dietary supplements increased with age and with ‘intention to eat healthy.’

Conclusion

Intake of micronutrients from the diet alone was considered adequate for both users and non-users of dietary supplements. Younger females who were supplement users had a more micronutrient-dense diet compared to non-users.

Dietary calcium and magnesium intake and mortality: a prospective study of men

The authors examined the association of dietary calcium and magnesium intake with all-cause, cardiovascular disease (CVD), and cancer mortality among 23,366 Swedish men, aged 45-79 years, who did not use dietary supplements. Cox proportional hazards regression models were used to estimate the multivariate hazard ratios and 95% confidence intervals of mortality. From baseline 1998 through December 2007, 2,358 deaths from all causes were recorded in the Swedish population registry; through December 2006, 819 CVD and 738 cancer deaths were recorded in the Swedish cause-of-death registry. Dietary calcium was associated with a statistically significant lower rate of all-cause mortality (hazard ratio (HR) = 0.75, 95% confidence interval (CI): 0.63, 0.88; P(trend) < 0.001) and a nonsignificantly lower rate of CVD (HR = 0.77, 95% CI: 0.58, 1.01; P(trend) = 0.064) but not cancer mortality (HR = 0.87, 95% CI: 0.65, 1.17; P(trend) = 0.362) when the highest intake tertile (mean = 1,953 mg/day; standard deviation (SD), 334) was compared with the lowest (990 mg/day; SD, 187). Dietary magnesium intake (means of tertiles ranged from 387 mg/day (SD, 31) to 523 mg/day (SD, 38) was not associated with all-cause, CVD, or cancer mortality. This population-based, prospective study of men with relatively high intakes of dietary calcium and magnesium showed that intake of calcium above that recommended daily may reduce all-cause mortality.

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.

Dietary supplementation by older adults in southern China: a hospital outpatient clinic study

BACKGROUND

There has been little knowledge about dietary supplementation by the Chinese elderly. The aim of this cross-sectional study was to investigate the usage of dietary supplements by older adults in southern China.

METHODS

A total of 600 community-dwelling older adults were recruited from the outpatient clinics of three major hospitals in Foshan city between July 2007 and July 2008. Face-to-face interviews of participants were conducted to obtain information on demographics, lifestyle and dietary supplements use. Frequency and duration of usage were recorded for six categories of dietary supplements.

RESULTS

Among the 446 consented participants (241 men and 205 women) who were over 55 years of age, 19.1% consumed one or more types of dietary supplements. The prevalence of usage was significantly higher (p = 0.008) for females (24.4%) than for males (14.5%). Dietary supplements were more likely to be consumed by non-smokers (p = 0.021) and those with hyperlipidemia (p = 0.003). The most popular supplement among users was calcium (53%). The majority (71%) of the users consumed supplements on a regular basis at one or more times per day, with an average duration of 2.95 (SD 4.80) years.

CONCLUSION

The overall prevalence of dietary supplementation in this older Chinese population was considerably lower than those in other Asia-Pacific countries.

Trends in the use of complementary and alternative medicine in Pakistan: a population-based survey

OBJECTIVES

The objective of this study was to evaluate the extent of use of complementary and alternative systems of medicine by different segments of society and to identify the diseases in which they have been found to be effective.

METHODS

This was a questionnaire-based descriptive study carried out from April 2002 to March 2004, in selected urban and rural areas of four provinces of Pakistan representing general strata of population from various socioeconomic conditions.

RESULTS

The overall trend in Pakistan shows that 51.7% (CI 54.3-49.1) chose complementary and alternative medicine (CAM) while 48.3% (CI 50.71-48.89) chose biomedicine. Of those who chose CAM, 20% (CI 21-19) also used biomedicine as well; 16% (CI 16.8-15.2) homeopathy, 12.4% (CI 13.02-11.78) unani medicine, 2.1% (CI 2.20-1.99) mind-body medicine (faith healing), 0.9% biologically based practices (home remedies, diet and nutrition) 0.05% energy medicine (Reiki), 0.05% Traditional Chinese Medicine, and 0.02% aromatherapy.

CONCLUSIONS

About half of the studied population used CAM. The population estimates of use of CAM are within the range reported elsewhere. It reflects an increasing popularity of CAM in Pakistan as well. Combined use of biomedicine with CAM was common and often patients did not reveal the use of CAM to the biomedicine practitioners.

Reasons given by homebound older adults living in a large midwestern city for taking or not taking vitamin and mineral supplements

The prevalence of vitamin and mineral supplement usage in a group of homebound older adults in a large Midwestern city and their motivation for supplement use or nonuse were evaluated. Sixty-one selected homebound individuals 60 years and older from three assistance programs for older adults participated in the study. Forty-seven percent reported taking vitamin or mineral supplements, and of these 93% were taking a multivitamin supplement. Most participants received their information regarding supplements from a health care professional, generally a physician. For those not taking supplements, the most common reason given was the absence of a prescription/recommendation. For those taking supplements, the most common reason given was that supplements were prescribed/recommended.

Sociodemographic, health and lifestyle characteristics reported by discrete groups of adult dietary supplement users in Alberta, Canada: findings from The Tomorrow Project

Objective

To determine the extent to which differences in sociodemographic, dietary and lifestyle characteristics exist between users of different types of dietary supplements and supplement non-users.

Design

We analysed cross-sectional data obtained from self-administered questionnaires completed at baseline by participants in The Tomorrow Project; a prospective cohort study in Alberta, Canada. Participants who used at least one type of dietary supplement at least weekly in the year prior to questionnaire completion were defined as supplement users, while the remainder were classified as non-users. Seven discrete user categories were created: multivitamins (+/− minerals) only, specific nutritional supplements only, herbal/other supplements only, and all possible combinations. Differences in sociodemographic, dietary and lifestyle characteristics between different groups of supplement users and non-users were analysed using Rao–Scottχ2tests and multinomial logistic regression.

Subjects and setting

Subjects were 5067 men and 7439 women, aged 35–69 years, recruited by random digit dialling throughout Alberta.

Results

Supplement use was extensive in this study population (69·8 %). Users of herbal/other supplements only, and women who used multivitamins only, tended to report dietary and lifestyle characteristics that were not significantly different from non-users. In contrast, those who reported using a combination of multivitamins, specific nutritional and herbal/other supplements were more likely than non-users to report behaviours and characteristics consistent with current health guidelines.

Conclusions

Dichotomizing participants as supplement users or non-users is likely to mask further differences in sociodemographic, dietary and lifestyle characteristics among users of different types of supplements. This may have implications for analysis and interpretation of observational studies.

Herbal medicines: prevalence and predictors of use among Malaysian adults

OBJECTIVE

The aim of this study was to examine the prevalence and identify factors, which predict the use of herbal medicines among Malaysian adults.

METHODS

Using a cross-sectional design, data were collected via face-to-face interview using structured questionnaire from convenience sample of adults from four towns in Malaysia. Multivariate logistic regression analysis was used to identify the significant predictors of herbal medicines use.

RESULTS

From a total of 1601 respondents, 542 (33.9%) reported use of herbal medicines in the previous 12 months. Multivariate logistic regression analysis revealed the following variables to be predictive of herbal medicines use: female gender [odds ratio (OR) 1.80, confidence interval (CI) 1.40-2.31], being married [OR 1.97, CI 1.44-2.71], having health problems [OR 2.31, CI 1.74-3.07] and having high-income levels [OR 4.21, CI 1.72-10.30]. The odds of someone using herbal medicines also increases though slightly if someone has favorable opinions about herbal medicines on the aspects examined. On the other hand, being Chinese [OR 0.74, CI 0.57-0.96] and Indians [OR 0.17, CI 0.11-0.27] were associated with decreased odds of using herbal medicines compared to Malays.

CONCLUSION

The prevalence of herbal medicines use is high. Respondents' personal attributes and opinions influence their likelihood of using herbal medicines. These findings are important because knowledge of the predictors of herbal medicines use may help health care providers to identify patients at increased risk who would be candidates for receiving guidance on safe use of herbal medicines.

Dietary supplement use and mortality in a cohort of Swedish men

The use of dietary supplements has increased substantially in most industrialized countries. The aim of this study was to prospectively examine the association between use of dietary supplements and all-cause mortality, cancer mortality and CVD mortality in men. We used the population-based prospective cohort of 38 994 men from central Sweden, 45–79 years of age, with no cancer or CVD at baseline and who completed a self-administered FFQ including questions on dietary supplement use and life-style factors in 1997. During average 7.7 years of follow-up, 3403 deaths were ascertained; among them, 771 due to cancer and 930 due to CVD (during 5.9 years of follow-up). In multivariate adjusted models including all men there was no association observed between use of any dietary supplement or of multivitamins, vitamin C, vitamin E or fish oil specifically and all-cause mortality, cancer or CVD mortality. Among current smokers, regular use of any supplement was associated with statistically significant increased risk of cancer mortality: relative risk (RR) 1·46 (95 % CI 1·06, 1·99). Among men reporting an inadequate diet at baseline (assessed by Recommended Food Score), there was a statistically significant inverse association between use of any dietary supplement and CVD mortality (RR 0·72; 95 % CI 0·57, 0·91), no associations were observed among men with adequate diets. In conclusion, we cannot exclude that the use of dietary supplements is harmful for smokers. On the other hand, among men with an insufficient diet, the use of supplements might be beneficial in reducing CVD mortality.

Dietary patterns associated with vitamin/mineral supplement use and smoking among women of the E3N-EPIC cohort

BACKGROUND/OBJECTIVES

An understanding of the relationships between dietary habits and supplement use or smoking is useful for aetiological studies and surveillance purposes. The objective of this study is to describe dietary patterns associated with vitamin/mineral supplement use and smoking habits in French women.

METHODS

Scores for dietary patterns were obtained by factor analysis in 64,252 women from the French E3N-EPIC cohort. The association with supplement and tobacco use was investigated by logistic regression analysis.

RESULTS

We identified three dietary patterns: 'processed meat/starchy foods' (fast foods, processed meat, rice/pasta/semolina and cakes and few vegetables); 'fruit/vegetables' (fruits, vegetables, seafood, vegetable oils and yoghurt); and 'alcohol/meat products' (alcohol, meat and meat products, and coffee, and few fruits and soup). Supplement use was positively associated with the fruit/vegetables pattern (multivariate OR for quartile 4 versus 1 (OR(4))=1.55, 95% confidence interval: 1.47-1.63), and inversely associated with the processed meat/starchy foods (OR(4)=0.84; 0.80-0.89) and alcohol/meat products (OR(4)=0.69; 0.66-0.73) patterns (P trend for all associations <0.0001). As compared with never smoking, current smoking was inversely associated with the fruit/vegetables pattern (OR(4)=0.85; 0.78-0.92), while former smoking was positively associated with the fruit/vegetables pattern (OR(4)=1.32; 1.25-1.40); both current and former smoking were inversely associated with the processed meat/starchy foods pattern (OR(4)=0.57; 0.53-0.62 and 0.64; 0.60-0.67, respectively); whereas current and former smoking were both strongly positively associated with the alcohol/meat products pattern (OR(4)=5.78; 5.26-6.36 and 2.03; 1.91-2.15, respectively); P trend for all associations was <0.001.

CONCLUSIONS

Supplement use and smoking are strongly associated with dietary patterns.

Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes

OBJECTIVE

To measure nutrient intake adequacy of vitamin/mineral supplement users and nonusers aged 51 years and older, determine the efficacy of supplement practices in compensating for dietary deficits, and identify predictors of supplement use.

DESIGN

Analyses of two 24-hour recalls, demographic variables, and attitude questions collected during the Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey in 1994 to 1996. Data were weighted to be representative of older Americans.

SUBJECTS

Four thousand three hundred eighty-four adults aged 51 years and older (1,777 daily supplement users, 428 infrequent users, and 2,179 nonusers) residing in households in the United States.

STATISTICAL ANALYSES

Usual nutrient intake distributions were estimated using the Iowa State University method. The Estimated Average Requirement (EAR) cutpoint method was applied to determine the proportion of older adults not meeting requirements before and after accounting for nutrient intake from supplements. Student t tests were used to assess differences between users and nonusers. Logistic regression was used to determine sociodemographic and attitudinal predictors of supplement use.

RESULTS

For one or more of the sex-age groups studied, a significantly smaller proportion of supplement users than nonusers had intakes from food alone below the EAR for vitamins A, B-6, and C; folate; zinc; and magnesium. Even so, less than 50% of both users and nonusers met the EAR for folate, vitamin E, and magnesium from food sources alone. Overall, supplements improved the nutrient intake of older adults. After accounting for the contribution of supplements, 80% or more of users met the EAR for vitamins A, B-6, B-12, C, and E; folate; iron; and zinc, but not magnesium. However, some supplement users, particularly men, exceeded Tolerable Upper Intake Levels for iron and zinc and a small percentage of women exceeded the Tolerable Upper Intake Level for vitamin A. Significant sociodemographic factors related to supplement use for older men were age group, metropolitan area, and educational status. Race, region, smoking status, and vegetarian status were significant factors for women. Attitude about the importance of following a healthful diet was a consistent predictor of supplement use for both men and women.

CONCLUSIONS

A large proportion of older adults do not consume sufficient amounts of many nutrients from foods alone. Supplements compensate to some extent, but only an estimated half of this population uses them daily. These widespread inadequacies should be considered when developing recommendations for supplement use for clients in this age group. Modifying dietary attitudes may result in a higher rate of supplement use in this at-risk population.

The profiles of adults who consult alternative health practitioners and/or general practitioners

OBJECTIVE

To compare the profiles of people visiting only a general practitioner (GP), those visiting only a practitioner of complementary and alternative medicine (CAM), and those visiting both (GP&CAM).

DESIGN

A comparative total population health survey in central Norway (HUNT 2).

SUBJECTS

A total of 54,448 persons 20 years of age and over who answered questions about their use of health services during the previous 12 months.

VARIABLES

Sociodemographic characteristics, self-perceived health, subjective health complaints, and a variety of common diseases.

RESULTS

Some 34,854 (64.0%) of those who answered the health service use question had visited only a GP, 837 (1.5%) only a CAM practitioner, and 4563 (8.4%) both during the last 12 months. The likelihood of being a CAM-only user as compared to a GP-only user was significantly increased (p < 0.005) if the participant was male; aged between 30 and 69; and without cardiovascular disease. The likelihood of being a GP&CAM user compared with a GP-only user was significantly increased (p < 0.005) for those who were female; aged between 30-59; had a higher education level; were non-smokers; had lower perceived global health; had a limiting chronic complaint; had experienced a health complaint during the last 12 months; had musculoskeletal disease; had a psychiatric complaint; and had hay fever.

CONCLUSION

There were few CAM-only users and they differ from GP-only users by being male, aged 30-69, and without cardiovascular disease. Users of both GP&CAM were less healthy with more complaints and poorer self-reported health than GP- and CAM-only users.

What non-prescription treatments do UK women with breast cancer use?

Understanding the self-prescribing behaviours of patients as well as their attitudes towards prescribed medication regimens is essential if healthcare professionals are to support treatment adherence and avoid unwanted pharmacological interactions and compromises in treatment efficacy. Evidence shows that women with breast cancer are particularly likely to use complementary and alternative therapies. This paper describes the reported treatment profile of a sample of 208 women with breast cancer in the UK. The information was gathered as part of a study exploring the preferences for injection or tablets in the administration of breast cancer treatment. Almost two-thirds of the sample were currently taking prescribed breast cancer treatment, mostly a single hormone therapy. Prescribed medications for co-morbid diseases were also common, and 53% of the women were self-medicating mainly with supplements, principally vitamins, various oils and minerals. In line with other studies, higher levels of education, socio-economic status and internal locus of control were associated with non-prescription use as well as a body mass index <30.

Age and gender effect on the use of herbal medicine products and food supplements among the elderly

OBJECTIVE

To describe the users of herbal medicine products and food supplements with regard to age and gender specifically among persons aged > or = 60 years.

DESIGN

A descriptive study with baseline data from a longitudinal study of the elderly, stratified into different age cohorts (60-69, 70-79, 80-89, and > or = 90 years).

SETTING

Blekinge county, situated in south-eastern Sweden.

SUBJECTS

In total 1380 persons aged 60-96 years (median age 78 years).

MAIN OUTCOME MEASURES

Current use of herbal medicine products and the use of food supplements.

RESULTS

Of the participants, 264/1380 (19.1%) used at least one herbal medicine product, 184/1380 (13.3%) used at least one food supplement and 382/1380 (27.7%) used herbal medicine products and/or food supplements. In all regression models, women had a higher probability of using herbal medicine and/or food supplements in comparison with men. Focusing on the use of herbal medicine products alone and the combination of using herbal medicine and/or food supplements, decreased use was seen with increasing age. However, 27.9% were still users of herbal medicine products and/or food supplements in the age group 80-89 years. In comparison, 14% were users in the age group > or = 90 years. Age did not have an impact on the probability of taking food supplements.

CONCLUSION

General practitioners need to consider the high use of herbal medicine products and food supplements among the elderly when making decisions on treatment.

Validity of a self-administered food frequency questionnaire (FFQ) and its generalizability to the estimation of dietary folate intake in Japan

BACKGROUND

In an epidemiological study, it is essential to test the validity of the food frequency questionnaire (FFQ) for its ability to estimate dietary intake. The objectives of our study were to 1) validate a FFQ for estimating folate intake, and to identify the foods that contribute to inter-individual variation of folate intake in the Japanese population.

METHODS

Validity of the FFQ was evaluated using 28-day weighed dietary records (DRs) as gold standard in the two groups independently. In the group for which the FFQ was developed, validity was evaluated by Spearman's correlation coefficients (CCs), and linear regression analysis was used to identify foods with large inter-individual variation. The cumulative mean intake of these foods was compared with total intake estimated by the DR. The external validity of the FFQ and intake from foods on the same list were evaluated in the other group to verify generalizability. Subjects were a subsample from the Japan Public Health Center-based prospective Study who volunteered to participate in the FFQ validation study.

RESULTS

CCs for the internal validity of the FFQ were 0.49 for men and 0.29 and women, while CCs for external validity were 0.33 for men and 0.42 for women. CCs for cumulative folate intake from 33 foods selected by regression analysis were also applicable to an external population.

CONCLUSION

Our FFQ was valid for and generalizable to the estimation of folate intake. Foods identified as predictors of inter-individual variation in folate intake were also generalizable in Japanese populations. The FFQ with 138 foods was valid for the estimation of folate intake, while that with 33 foods might be useful for estimating inter-individual variation and ranking of individual folate intake.

Use of natural medicines in the Danish population: a national cross-sectional survey

BACKGROUND

The use of natural medicines is widespread and increasing. In addition, natural medicine use is based primarily on individual's decisions without counseling from health professionals. Unlike with conventional medicines, it is not possible to evaluate sales statistics and prescription records to determine how much natural medicine is being used and by whom. Self-reporting is the only method available for investigating use of these products.

OBJECTIVE

To investigate the use of natural medicines with respect to sociodemographic factors, health status, and conventional drug therapy in a general national population.

METHODS

Data were derived from the Danish Health and Morbidity Survey 2000. A representative sample of the Danish population (N = 16 690) was interviewed face-to-face. The association between use of natural medicines within the past 14 days and age, education, health status, and conventional medicine use was analyzed by logistic regression. All analyses were performed separately for each gender.

RESULTS

Fourteen percent of the sample population had taken natural medicines within the past 14 days. Use was most prevalent among women and increased with age, but decreased again in the oldest age group (> or = 80 y). Respondents with poor health were the greatest consumers of natural medicines. Use was not associated with educational level and conventional drug therapy. Among conventional medicine users, 14% and 22% of men and women, respectively, used natural medicines.

CONCLUSIONS

This study demonstrated that natural medicine use is common and widespread health behavior in all strata of the population and should not be regarded as an alternative to conventional medicine. Clinicians should ask patients about natural medicine use to avoid interactions with conventional drugs.