1
|
Zapata-Linares J, Gervasini G. Contaminants in Dietary Supplements: Toxicity, Doping Risk, and Current Regulation. Int J Sport Nutr Exerc Metab 2024; 34:232-241. [PMID: 38653450 DOI: 10.1123/ijsnem.2023-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
Athletes, both amateur and professional, often resort to the consumption of nutritional supplements without professional supervision and without being aware of the risks they may entail. We conducted an exhaustive literature search to determine the most common substances found as contaminants in dietary supplements. For each substance, we analyzed its mechanism of action, clinical indication, health risk, and putative use as doping agent. In addition, we evaluated the current regulation of these supplements. Contamination of nutritional supplements (accidental or intentional), especially with steroids and stimulants, is a hazardous situation. The prolonged consumption of these products without being aware of their composition can cause serious health risks and, in the case of professional athletes, a possible sanction for doping.
Collapse
Affiliation(s)
- Jesús Zapata-Linares
- Faculty of Medicine and Health Sciences, Division of Pharmacology, Department of Medical and Surgical Therapeutics, School of Medicine and Health Sciences, University of Extremadura, Badajoz, Spain
| | - Guillermo Gervasini
- Faculty of Medicine and Health Sciences, Division of Pharmacology, Department of Medical and Surgical Therapeutics, School of Medicine and Health Sciences, University of Extremadura, Badajoz, Spain
- Instituto Universitario de Biomarcadores de Patologías Moleculares, University of Extremadura, Badajoz, Spain
| |
Collapse
|
2
|
Knapik JJ, Trone DW, Steelman RA, Lieberman HR. Longitudinal changes in adverse effects reporting in multiple dietary supplement classifications: The US military dietary supplement use study. Food Chem Toxicol 2024; 188:114635. [PMID: 38582347 DOI: 10.1016/j.fct.2024.114635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
Over 70% of United States military service members (SMs) regularly use dietary supplements (DSs) and about 18% have reported adverse effects (AEs) associated with use. This investigation examined longitudinal changes in AEs reporting among DS users. On two separate occasions 1.3 ± 0.2 years apart (mean ± standard deviation), 5778 SMs completed identical questionnaires on DS use and associated AEs. Among SMs reporting DS use ≥1 time/week, ≥1 AE was reported by 19% and 15% in the baseline and follow-up phases, respectively. The risk of reporting DS use at follow-up was similar among those reporting and not reporting AEs at baseline for most DS categories including prohormones, proteins/amino acids, individual vitamins and minerals, multivitamin/multiminerals, herbals, fish oils, joint health products, and other DSs. An exception was combination products where those reporting AEs at baseline had an increased risk of use at follow-up (risk ratio = 1.13, 95% confidence interval = 1.06-1.09). Those reporting AEs at baseline and continuing DS use in the follow-up were more likely to report AEs at follow-up compared to those not reporting baseline AEs. In conclusion, AEs reported at baseline did not deter many participants from using DSs in the follow-up period, and many SMs reporting AEs at baseline continued reporting them at follow-up.
Collapse
Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - Daniel W Trone
- Naval Health Research Center, Building 329, Ryne Rd, San Diego, CA, 92152, USA
| | - Ryan A Steelman
- Defense Centers for Public Health-Aberdeen, 8300 Ricketts Point Rd, Building E-2850, Aberdeen Proving Ground, MD, 21010, USA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Goldin D, Salani D. Let's Get to the Root of Ashwagandha: What Health Care Professionals Need to Know. J Psychosoc Nurs Ment Health Serv 2024; 62:33-40. [PMID: 37751577 DOI: 10.3928/02793695-20230919-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
The prevalence of stress- and anxiety-related disorders is increasing along with widespread demand for anxiolytics. Due to drug supply shortages and access restrictions, nonprescription remedies have gained popularity. In addition, the marketing of herbals and botanicals as low-cost and all-natural products with fewer access restrictions has increased their use. The current article explores the evidence to provide an overview of the current understanding of Ashwagandha (Withania somnifera), an anxiolytic and apoptogenic herb with therapeutic and health-promoting potentials to help the body reduce stress and maintain a homeostatic state. Due to poor quality controls and diversity of Ashwagandha products, clinical trials on Ashwagandha's effectiveness in anxiety-related conditions reveal conflicting results, although many show favorable findings. Furthermore, health care professionals, such as nurses, advanced practice nurses, physicians, physician assistants, and pharmacists, need to be aware of variability in Ashwagandha products, quality controls, reported evidence regarding use, safety profile, and clinical implications in stress reduction. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 33-40.].
Collapse
|
5
|
Prajapati P, Holmes E, Yang Y. Individual Beliefs and Experiences With Brain Health Dietary Supplements in the United States. J Acad Nutr Diet 2024:S2212-2672(24)00143-6. [PMID: 38527569 DOI: 10.1016/j.jand.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Although the use of brain health dietary supplements (brain DS) has increased, there is limited research on safety and risk of these products. Brain DS may be beneficial for improving memory, concentration, and focus but may also carry risks. OBJECTIVES To assess brain DS users' utilization experiences and identify factors associated with likelihood of brain DS use among nonusers. DESIGN An internet-based cross-sectional survey study was conducted using a sample of middle-aged US adults. Respondents' sociodemographic characteristics and health beliefs regarding brain DS were collected. Brain DS users' utilization experiences such as negative side effects and spending were also collected. PARTICIPANTS AND SETTING Purposive sampling was utilized for users and nonusers sample recruitment. MAIN OUTCOME MEASURES Brain DS users' utilization experience and future likelihood of brain DS use among nonusers. STATISTICAL ANALYSES PERFORMED Descriptive statistics on brain DS users' utilization experiences were reported. Ordinal logistic regression with sociodemographic and belief characteristics as predictors was employed to identify factors associated with the likelihood of brain DS among nonusers. RESULTS Five hundred twenty-five respondents (mean age = 43.8 ± 9.2 years) completed the survey. Among 260 users, primary reasons for use were enhancing memory (n = 136) and helping concentration and focus (n = 108). During the past year, 40% spent $50 to $200 (range = $0 to >$1,000) and 37% reported experiencing negative side effects. Among 265 nonusers, being female (odds ratio 2.04, 95% CI 1.21 to 3.45), perceived susceptibility to brain problems (odds ratio 1.90, 95% CI 1.28 to 2.83), recommendation from others (odds ratio 1.55, 95% CI 1.03 to 2.35) and perceived benefits of brain DS (odds ratio 2.82, 95% CI 1.60 to 4.96) were significantly associated with increased likelihood of future brain DS use. CONCLUSIONS Individual spending on brain DS varies and about 40% of users reported experiencing negative side effects. As individuals primarily rely on healthcare providers for recommendations, health care providers should be prepared to engage in discussions about brain DS with patients.
Collapse
Affiliation(s)
- Prachi Prajapati
- Department of Pharmacy Administration, University of Mississippi, University, Mississippi
| | - Erin Holmes
- Department of Pharmacy Administration, University of Mississippi, University, Mississippi; Research Institute of Pharmaceutical Sciences, University of Mississippi, University, Mississippi
| | - Yi Yang
- Department of Pharmacy Administration, University of Mississippi, University, Mississippi; Research Institute of Pharmaceutical Sciences, University of Mississippi, University, Mississippi.
| |
Collapse
|
6
|
Carty J, Navarro VJ. Dietary Supplement-Induced Hepatotoxicity: A Clinical Perspective. J Diet Suppl 2024:1-20. [PMID: 38528750 DOI: 10.1080/19390211.2024.2327546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The consumption of dietary supplements (DS) has resulted in a significant and escalating number of cases involving liver injury. It is crucial for clinicians and consumers to be well informed about the adverse effects of such products, leading to their discontinuation and timely reporting of any harmful cases. This article delves into the clinical perspective of DS-related hepatotoxicity, highlighting key concepts such as a systematic diagnostic approach. The discussion extends to notable examples of both currently popular and potential future dietary supplements, such as garcinia cambogia, turmeric, and ashwagandha, accompanied by an overview of recent findings. Causality assessment tools play a crucial role in establishing a connection between these products and instances of liver injury, with consideration of the advantages and disadvantages associated with their use. Fostering a comprehensive understanding of regulatory standards, coupled with a solid foundation of knowledge of DS, will prove instrumental in preventing DS-related hepatotoxicity. Achieving this goal requires collaborative efforts from both consumers and clinicians.
Collapse
Affiliation(s)
- Jordan Carty
- Department of Medicine, Jefferson Einstein Medical Center, Philadelphia, PA, USA
| | - Victor J Navarro
- Department of Medicine, Jefferson Einstein Medical Center, Philadelphia, PA, USA
| |
Collapse
|
7
|
Carrão Dantas EK, Ferreira CLS, da Cunha Goldstein A, da Silva Fernandes A, Anastacio Ferraz ER, Felzenszwalb I, Araújo-Lima CF. Marketable 1,3-dimethylamylamine and caffeine-based thermogenic supplements: Regulatory genotoxicity assessment through in vitro and in silico approaches. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2024; 87:245-265. [PMID: 38115604 DOI: 10.1080/15287394.2023.2294925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
The consumption of dietary supplements to enhance physical performance has increased significantly in the last century, especially thermogenic pre-workout supplements. Nevertheless, this industry has faced criticism for inadequate safety measures surveillance in regulatory issues regarding their products. The aims of our study were to investigate two pre-workout supplements with respect to (1) mutagenicity utilizing Salmonella/microsome assay; (2) genotoxicity employing cytokinesis-block micronucleus (CBMN) assay protocols; and (3) hepatocytoxicity using WST cell proliferation, activities of lactate dehydrogenase (LDH) and alkaline phosphatase using human liver carcinoma (HepG2) and mouse fibroblast (F C3H) cells. Oxidative stress was determined through glutathione (GSH) measurement and in silico for predictions of pharmacokinetics and toxicity for the most abundant isolated substances present in these supplements. Both supplements induced mutagenicity in all examined bacterial strains, especially in the presence of exogenous metabolism. Further, tested supplements significantly elevated the formation of micronuclei (MN) as well as other cellular phenomena. Concentration- and time-dependent curves were observed for hepatotoxicity in both studied cell lines. In addition, both supplements decreased levels of intracellular and extracellular GSH. In silico predictions showed that the isolated individual compounds failed to induce the observed outcomes. Our findings provide contributions to the molecular mechanisms underlying two pre-workout supplement-induced toxicity and the need for surveillance.
Collapse
Affiliation(s)
- Eduardo Kennedy Carrão Dantas
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Caroline Lopes Simões Ferreira
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Alana da Cunha Goldstein
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Andreia da Silva Fernandes
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Israel Felzenszwalb
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Carlos Fernando Araújo-Lima
- Laboratory of Environmental Mutagenicity, Department of Biophysics and Biometry, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Genetics and Molecular Biology, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Kloner RA, Burnett AL, Miner M, Blaha MJ, Ganz P, Goldstein I, Kim NN, Kohler T, Lue T, McVary KT, Mulhall JP, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip ID, Rosen RC. Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health. J Sex Med 2024; 21:90-116. [PMID: 38148297 DOI: 10.1093/jsxmed/qdad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND In 1999, 1 year after the approval of the first oral phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED), the first Princeton Consensus Conference was held to address the clinical management of men with ED who also had cardiovascular disease. These issues were readdressed in the second and third conferences. In the 13 years since the last Princeton Consensus Conference, the experience with PDE5 inhibitors is more robust, and recent new data have emerged regarding not only safety and drug-drug interactions, but also a potential cardioprotective effect of these drugs. AIM In March 2023, an interdisciplinary group of scientists and practitioners met for the fourth Princeton Consensus Guidelines at the Huntington Medical Research Institutes in Pasadena, California, to readdress the cardiovascular workup of men presenting with ED as well as the approach to treatment of ED in men with known cardiovascular disease. METHOD A series of lectures from experts in the field followed by Delphi-type discussions were developed to reach consensus. OUTCOMES Consensus was reached regarding a number of issues related to erectile dysfunction and the interaction with cardiovascular health and phosphodiesterase-5 inhibitors. RESULTS An algorithm based on recent recommendations of the American College of Cardiology and American Heart Association, including the use of computed tomography coronary artery calcium scoring, was integrated into the evaluation of men presenting with ED. Additionally, the issue of nitrate use was further considered in an algorithm regarding the treatment of ED patients with coronary artery disease. Other topics included the psychological effect of ED and the benefits of treating it; the mechanism of action of the PDE5 inhibitors; drug-drug interactions; optimizing use of a PDE5 inhibitors; rare adverse events; potential cardiovascular benefits observed in recent retrospective studies; adulteration of dietary supplements with PDE5 inhibitors; the pros and cons of over-the-counter PDE5 inhibitors; non-PDE5 inhibitor therapy for ED including restorative therapies such as stem cells, platelet-rich plasma, and shock therapy; other non-PDE5 inhibitor therapies, including injection therapy and penile prostheses; the issue of safety and effectiveness of PDE5 inhibitors in women; and recommendations for future studies in the field of sexual dysfunction and PDE5 inhibitor use were discussed. CLINICAL IMPLICATIONS Algorithms and tables were developed to help guide the clinician in dealing with the interaction of ED and cardiovascular risk and disease. STRENGTHS AND LIMITATIONS Strengths include the expertise of the participants and consensus recommendations. Limitations included that participants were from the United States only for this particular meeting. CONCLUSION The issue of the intersection between cardiovascular health and sexual health remains an important topic with new studies suggesting the cardiovascular safety of PDE5 inhibitors.
Collapse
Affiliation(s)
- Robert A Kloner
- Department of Cardiovascular Research Pasadena, Huntington Medical Research Institutes, CA 91105, United States
- Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, United States
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University, Baltimore, MD, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, United States
| | - Michael J Blaha
- Cardiology and Epidemiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Peter Ganz
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Irwin Goldstein
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | - Noel N Kim
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | | | - Tom Lue
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Kevin T McVary
- Center for Male Health, Stritch School of Medicine at Loyola University Medical Center, Maywood, IL, United States
| | - John P Mulhall
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sharon J Parish
- Weill Cornell Medicine, New York, NY, United States
- Department of Medicine and Psychiatry White Plains, Westchester Behavioral Health Center, NewYork-Presbyterian Hospital, NY, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology NY, NYU Langone Grossman School of Medicine, NY, United States
| | - Richard Sadovsky
- Department of Family and Community Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Ira D Sharlip
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Raymond C Rosen
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
9
|
García-Durán J, González-Jurado JA, Sánchez-Oliver AJ. Analysis of Sports Supplement Consumption in 1688 Federated Road Cyclists. Nutrients 2023; 16:123. [PMID: 38201954 PMCID: PMC10780486 DOI: 10.3390/nu16010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
The widespread use of sports supplements (SS) to enhance athletic performance extends to cyclists, although little research has been conducted on this subject within this sport. This descriptive and cross-sectional study involved 1688 federated road cyclists, aiming to analyse the pattern of SS consumption concerning the degree of scientific evidence and different categories. This study categorised SS based on the groups and subgroups established by the Australian Sport Institute (AIS, 2023) based on the level of evidence. Our results showed that 62.5% of the sample cyclists used SS, with an average of 12.2 ± 8.6 supplements consumed per participant. Health status (78.2%), pharmacies (62.5%), and medical doctors (45.7%) were the main reasons, purchase sites, and sources of information for SS consumption, respectively. The most prevalent SS consumed were Sports Gels (94%), Sports Bars (89.3%), and Sports Drinks (73.8%). Notably, 80% of the top ten most consumed SS belonged to the group with the highest level of evidence according to the AIS, with an average of 6.9 ± 3.2 supplements per participant. However, 23.3% of the total SS consumers used prohibited substances. In conclusion, while the prevalence of SS consumption among road cyclists is considerable and the primary sources for purchasing SS and obtaining advice are reliable, there is a notable prevalence of prohibited substance use within the sample.
Collapse
Affiliation(s)
- Jesús García-Durán
- Facultad de Ciencias del Deporte, Universidad Pablo de Olavide de Sevilla, 41013 Sevilla, Spain
| | | | | |
Collapse
|
10
|
Thakral N, Konjeti VR, Salama FW. Drug induced autoimmune hepatitis: An unfortunate case of herbal toxicity from Skullcap supplement: A case report. World J Hepatol 2023; 15:1333-1337. [PMID: 38223420 PMCID: PMC10784811 DOI: 10.4254/wjh.v15.i12.1333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/14/2023] [Accepted: 11/24/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The surge in traditional herbal dietary supplement (HDS) popularity has led to increased drug-induced liver injuries (DILI). Despite lacking evidence of efficacy and being prohibited from making medical claims, their acceptance has risen over sevenfold in the last two decades, with roughly 25% of United States (US) adults using these supplements monthly. An estimated 23000 emergency room visits annually in the US are linked to HDS side effects. NIH-funded research suggests HDS contribute to 7-20% of DILI cases, with similar trends in Europe-Spain reporting 2% and Iceland up to 16%. Patients with acute liver failure from HDS undergo liver transplantation more frequently than those from prescription medicines. Here we describe a case of drug-induced autoimmune hepatitis due to Skullcap supplements, this association appears to be the first documented instance in literature. CASE SUMMARY A middle-aged Caucasian woman, previously healthy, presented with sudden jaundice. Four months earlier, her liver enzymes were normal. She mentioned recent use of Skullcap mushroom supplements. Tests for chronic liver disease were negative. The first liver biopsy indicated severe resolving drug-induced liver injury. Despite treatment, she was readmitted due to worsening jaundice. Follow-up tests raised concerns about autoimmune hepatitis. A subsequent biopsy confirmed this diagnosis. The patient responded as expected to stopping the medication with improvement in liver enzymes. CONCLUSION This scenario highlights an uncommon instance of DILI caused by Skullcap supplements. It's crucial for hepatologists to recognize this connection due to the increasing prevalence of herbal supplements.
Collapse
Affiliation(s)
- Nimish Thakral
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY 40536, United States.
| | - Venkata Rajesh Konjeti
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY 40536, United States
| | - Fady William Salama
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY 40536, United States
| |
Collapse
|
11
|
Papatesta EM, Kanellou A, Peppa E, Trichopoulou A. Is Dietary (Food) Supplement Intake Reported in European National Nutrition Surveys? Nutrients 2023; 15:5090. [PMID: 38140349 PMCID: PMC10871081 DOI: 10.3390/nu15245090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Dietary (food) supplements (DSs) have seen a sharp increase in use and popularity in recent years. Information on DS consumption is vital for national nutrition monitoring. The objective of this study was to investigate whether DS intake was reported in the National Nutrition Surveys (NNSs) in all European countries. NNSs reporting DS use were retrieved via literature review (i.e., PubMed, Google Scholar, Scopus), scientific and organizational publications (EFSA), or open-published government and other official reports. Included were the European NNSs referring to adults, published in English, French, or German, post-2000. Out of the 53 European countries, 30 recorded DS intake. Among them, related findings on the percentage of DS intake were published in 21 cases, 5 of them written in the local language. DS use varied by nation, with Finland and Denmark having the greatest (over 50%) and Italy having the lowest percentage (5%). In terms of comprehensive reported data on DS consumption in Europe and the investigation of the contribution of DSs to total nutrient intake, there is a need for improvement. Common DS categories should be defined upon agreement among the involved scientific parties to allow for comparable data and estimations between surveys.
Collapse
Affiliation(s)
- Eleni Maria Papatesta
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
| | - Anastasia Kanellou
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
- Department of Food Science and Technology, University of West Attica (UniWA), 28 Agiou Spyridonos Str., 12243 Egaleo-Athens, Greece
| | - Eleni Peppa
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
| | - Antonia Trichopoulou
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
| |
Collapse
|
12
|
Backhouse SH. A Behaviourally Informed Approach to Reducing the Risk of Inadvertent Anti-doping Rule Violations from Supplement Use. Sports Med 2023; 53:67-84. [PMID: 37801267 PMCID: PMC10721667 DOI: 10.1007/s40279-023-01933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023]
Abstract
For many reasons, athletes' use of supplements is highly prevalent across sports and competitive levels, despite the risk of these products containing a substance on the World Anti-Doping Agency Prohibited List. Contravening anti-doping rules through supplement use could have serious consequences for competitive athletes (e.g., ineligibility from major competitions, loss of medals and funding) due to the principle of strict liability. Indiscriminate supplement use also poses a risk to athlete health. To reduce the possibility of ingesting a supplement containing prohibited substances, independent quality assurance and certification programs have been established (e.g., Informed Sport). However, these programs do not completely eliminate risk, leading to some anti-doping organisations promoting a 'just say no' to supplements stance. Yet, this approach can be problematic as a small number of supplements may be necessary for athletes to consume, in certain situations. Recognising that athletes will continue to use these heavily marketed products, this narrative review describes a theoretically underpinned and systematic approach to preventing inadvertent doping by considering the barriers to and enablers of athlete adherence to risk minimisation supplement use guidelines (RMSUG). By outlining a conceptual shift towards a behaviourally informed approach, this review serves to stimulate the development of multifaceted interventions to prevent inadvertent doping through supplement use. Recognising that risk-minimised supplement use involves a myriad of behaviours, the problem of inadvertent doping through supplement use is framed, and research appraised, through the lens of the Behaviour Change Wheel.
Collapse
|
13
|
Guerrero-Pérez F, Peiró I, Villabona C. Syndrome of inappropriate antidiuresis and Ginkgo biloba: An overlooked relationship. Med Clin (Barc) 2023; 161:457. [PMID: 37567826 DOI: 10.1016/j.medcli.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Fernando Guerrero-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Inmaculada Peiró
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Nutrición Clínica, Instituto Catalán de Oncología, L'Hospitalet de Llobregat, Barcelona, España
| | - Carles Villabona
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
14
|
Xiao Y, Zhang J, Chi C, Ma Y, Song A. Criticality and clinical department prediction of ED patients using machine learning based on heterogeneous medical data. Comput Biol Med 2023; 165:107390. [PMID: 37659113 DOI: 10.1016/j.compbiomed.2023.107390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PROBLEM Emergency triage faces multiple challenges, including limited medical resources and inadequate manual triage nurses, which cause incorrect triage, overcrowding in the emergency department (ED), and long patient waiting time. OBJECTIVE This paper aims to propose and validate an accurate and efficient artificial intelligence-based method for effectively ED triage and alleviating the pressure on medical resources. METHODS We propose two novel machine learning models, TransNet and TextRNN, for predicting patient severity levels and clinical departments using heterogeneous medical data in ED triage. Our models employ a parallel structure for feature extraction and incorporate an attention mechanism to extract essential information from the fused features, enabling accurate predictions. The models analyze the triage data (2020-2022) from the ED of Beijing University People's Hospital, incorporating variables (demographics, triage vital signs, and chief complaints) to identify patient severity levels and clinical departments. We performed data cleaning, categorization, and encoding first. Then, we divided the available data into a training set (56%), a validation set (24%), and a test set (20%) by random sampling. Finally, our models underwent 5-fold cross-validation and were compared with other state-of-the-art models. RESULTS We comprehensively evaluated the proposed models against various Recurrent Neural Networks (RNN), Convolutional Neural Networks (CNN), Traditional Machine Learning (TML), and Transformer-based (TF) models, achieving excellent performance in predicting triage outcomes. Specifically, TextRNN achieved a prediction success rate of 86.23% [85.86-86.70] for severity levels and 94.30% [94.00-94.46] for clinical departments among 161,198 ED visits. Moreover, TransNet demonstrated higher sensitivities of 84.08% and 90.05% for severity levels and clinical departments, respectively, with specificities of 76.48% and 95.16%. The accuracy of our model is 0.87%, 0.18%, 4.29%, and 1.96%, higher than that of the above four family models on average. Furthermore, our method significantly reduced under-triage by 12.06% and over-triage by 17.92% compared to manual triage. CONCLUSIONS Experimental results demonstrated that the proposed models fuse heterogeneous medical data in the triage process, successfully predicting patients' triage outcomes. Our models can improve triage efficiency, reduce the under/over-triage rate, and provide physicians with valuable decision-making support.
Collapse
Affiliation(s)
- Yi Xiao
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Jun Zhang
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China.
| | - Cheng Chi
- Department of Emergency, Peking University People's Hospital, Beijing, 100044, China
| | - Yuqing Ma
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Aiguo Song
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
Jagim AR, Harty PS, Erickson JL, Tinsley GM, Garner D, Galpin AJ. Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front Sports Act Living 2023; 5:1239121. [PMID: 37841887 PMCID: PMC10570429 DOI: 10.3389/fspor.2023.1239121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
The prevalence of dietary supplement use among athletes continues to rise with 60-80% of athletes often reporting current or previous use of dietary supplements. While select dietary ingredients have been shown to improve acute performance and enhance training adaptations over time, it is important to still consider the risk vs. reward for athletes before opting to consume a dietary supplement. Previous work has indicated that certain dietary supplements may pose risks for inadvertent doping, may be susceptible to mislabelling, could be banned by certain governing bodies of sport, or pose health risks for certain populations. The purpose of the current narrative review is to summarize the prevalence of adulteration in dietary sport supplement products, outline the risks of inadvertent doping for athletes, and highlight best practices regarding safe supplementation strategies. Analytical studies have found anywhere from 14 to 50% of samples analyzed from dietary supplement products have tested positive for anabolic agents or other prohibited substances. It is important for the consumer to adhere to safe supplementation strategies, which include following serving size recommendations, cross-referencing ingredient profiles with the list of prohibited substances, choosing quality products that have been verified by a third-party certification program, and being cognizant of consuming multiple dietary supplement products with overlapping ingredient profiles. Once these practices have been considered, it is reasonable for an athlete to utilize dietary supplements as a strategy to optimize performance and health, with a low risk of failing a drug test (adverse analytical finding) and experiencing adverse events.
Collapse
Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Patrick S. Harty
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO, United States
| | - Jacob L. Erickson
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Grant M. Tinsley
- Energy Balance & Body Composition Laboratory, Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, United States
| | - Dan Garner
- BioMolecular Athlete, LLC., Wilmington, DE, United States
| | - Andrew J. Galpin
- BioMolecular Athlete, LLC., Wilmington, DE, United States
- Department of Kinesiology, Center for Sport Performance, California State University, Fullerton, CA, United States
| |
Collapse
|
17
|
Kotnik KZ, Seljak BK, Gregorič M, Jurak G, Golja P. Questionable advisability of vitamin and mineral dietary supplement use in adolescents. BMC Nutr 2023; 9:110. [PMID: 37770942 PMCID: PMC10537492 DOI: 10.1186/s40795-023-00768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Present study aimed to assess potential health risk in Slovenian adolescents due to inadequate diet and/or dietary supplement (DS) use. METHODS Data on DS use, micronutrient intake (24-h recall), eating habits (FFQ), body height and mass were collected within ACDSi (Analysis of Children's Development in Slovenia) cross-sectional study conducted in 2014. Adolescents enrolled in first year of 15 secondary schools (average (SD) age: 15.4 (0.7) years, N = 342) were included in the sample. RESULTS Adolescents' use of DS (especially multivitamins ingested as a popular drink (60%), magnesium (16%), and vitamin C (10%)) significantly contributed to their absolute intake of vitamins/minerals, resulting in higher percentage of DS users meeting reference values proposed by the nutrition societies of Germany, Austria, and Switzerland (D-A-CH recommendation). Simultaneously, DS users did not exceed the upper tolerable level proposed by the European Food Safety Authority for daily intake. With diet alone, adolescents consumed less than recommended amounts of the following vitamins/minerals: the intake was lowest for fat-soluble vitamins A, D, and E; water-soluble vitamins folate, biotin, and pantothenic acid; and minerals fluoride, iodine, chromium, and molybdenum. Suboptimal intake was due to the fact that around ¾ of adolescents consumed less than 54% of the recommended amounts (according to Optimized Mixed Diet (OMD) recommendations) for fruits, vegetables, milk/dairy products, fish, and cereals/cereal products. In contrast, the diet contributed to the consumption of 200-300% of D-A-CH minimum value for sodium. Furthermore, almost ¾ of adolescents exceeded the recommended amount for meat/meat products (320% of OMD) and sweet/salty snacks (453% of OMD). CONCLUSIONS Although DS use improved micronutrient intake in adolescents (especially vitamin C and magnesium), activities on public-health interventions should be focus to improve their diets, especially to achieve increased intakes of fruits, vegetables, cereals/cereal products and milk/dairy products, and to reduce consumption of sweet/salty snacks and meat products.
Collapse
Affiliation(s)
- Katja Zdešar Kotnik
- Biotechnical Faculty, Department of Biology, University of Ljubljana, Vecna pot 111, Ljubljana, SI-1000 Slovenia
| | | | - Matej Gregorič
- National Institute of Public Health, Ljubljana, Slovenia
| | - Gregor Jurak
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Golja
- Biotechnical Faculty, Department of Biology, University of Ljubljana, Vecna pot 111, Ljubljana, SI-1000 Slovenia
| |
Collapse
|
18
|
Pfender EJ, Wanzer C, Bleakley A. A Content Analysis of Social Media influencers' "What I Eat in a day" Vlogs on YouTube. HEALTH COMMUNICATION 2023:1-12. [PMID: 37743622 DOI: 10.1080/10410236.2023.2260966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Food diaries on social media, known as "what I eat in a day" (WIEIAD) content, are increasingly popular across a variety of platforms, and can potentially affect audiences' attitudes and behaviors regarding diet. WIEIAD content is frequently posted by social media influencers (SMI), who have powerful and persuasive effects on their audiences. Using expectancy-value and social norms as theoretical frameworks, this study examines characteristics of SMIs and the way they talk about diet. A mixed-methods content analysis of YouTube vlogs (n = 83) posted from October 2015 to October 2016, and October 2021 to October 2022 was conducted on SMIs who post WIEIAD vlogs. Results suggested that influencers may want to embrace body positivity, but their WIEIAD day content contains weight normative messaging. Furthermore, influencers send messages about what health should look like and assign social identities to specific diets. Aside from sponsorship, influencers use other persuasive strategies to grow large followers, such as listing positive expectancies of their diets. Future research should examine the effects of WIEIAD content on diet-related attitudes and behaviors.
Collapse
Affiliation(s)
| | | | - Amy Bleakley
- Department of Communication, University of Delaware
| |
Collapse
|
19
|
Amidžić M, Banović Fuentes J, Banović J, Torović L. Notifications and Health Consequences of Unauthorized Pharmaceuticals in Food Supplements. PHARMACY 2023; 11:154. [PMID: 37888499 PMCID: PMC10609884 DOI: 10.3390/pharmacy11050154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Health concerns associated with the consumption of food supplements rise in parallel with the rise in the popularity and market availability of these products. In pursuit of data related to the unauthorized presence of pharmaceuticals in food supplements, the Rapid Alert System for Food and Feed (RASFF) database was searched for the 2011-2022 period. The most "popular" pharmaceuticals for the adulteration of food supplements were phosphodiesterase-5 inhibitors (235 records); anorexics and laxatives (76), including sibutramine and its active metabolite N-didesmethyl sibutramine, phenolphthalein and 2,4-dinitrophenol; stimulants, among which 1,3-dimethylamine (97), and synephrine (53) were the most numerous; nootropic drugs (24); anabolics and prohormones (16); and cannabinoid cannabidiol (14) (pending authorization as a novel food ingredient). Over 65% of notifications of interest were classified as serious risks, and over 80% of these were alert or border rejection notifications, mainly generated as a result of official control on the market. The alarming number of RASFF notifications should be considered a public health issue, demanding clear and targeted recommendation for action for the legislature and authorities. A harmonized nutrivigilance system should be considered as a tool to detect and scrutinize the adverse health effects of food supplements, along with measures to improve their safety, quality, and testing.
Collapse
Affiliation(s)
- Maja Amidžić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
| | - Jelena Banović Fuentes
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
| | - Jovica Banović
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Ljilja Torović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Halpern B, Mancini MC, van de Sande-Lee S, Miranda PAC. "Anti-obesity medications" or "medications to treat obesity" instead of "weight loss drugs" - why language matters - an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e230174. [PMID: 37585688 PMCID: PMC10665066 DOI: 10.20945/2359-4292-2023-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term "weight loss drugs" to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as "medications to treat obesity" or "anti-obesity medications" conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.
Collapse
Affiliation(s)
- Bruno Halpern
- Associação Brasileira para o Estudo da Obesidade e Síndrome MetabólicaSão PauloSPBrasilAssociação Brasileira para o Estudo da Obesidade e Síndrome Metabólica, São Paulo, SP, Brasil
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Hospital 9 de JulhoCentro de ObesidadeSão PauloSPBrasilCentro de Obesidade, Hospital 9 de Julho, São Paulo, SP, Brasil
| | - Marcio C. Mancini
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São PauloDepartamento de Endocrinologia e MetabolismoGrupo de Obesidade e Síndrome MetabólicaSão PauloSPBrasilGrupo de Obesidade e Síndrome Metabólica, Departamento de Endocrinologia e Metabolismo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Simone van de Sande-Lee
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Universidade Federal de Santa CatarinaDepartamento de Clínica MédicaFlorianópolisSCBrasilDepartamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Paulo Augusto Carvalho Miranda
- Sociedade Brasileira de Endocrinologia e MetabologiaSão PauloSPBrasilSociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Santa Casa de Belo HorizonteBelo HorizonteMGBrasilSanta Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| |
Collapse
|
22
|
El Khoury D, Tabakos M, Dwyer JJM, Mountjoy M. Determinants of supplementation among Canadian university students: a theory of planned behavior perspective. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1957-1965. [PMID: 34398710 DOI: 10.1080/07448481.2021.1951276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/14/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB). METHODS A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants' attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions. RESULTS Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention. CONCLUSIONS This study confirms the utility of the TPB in predicting university students' supplementation habits.
Collapse
Affiliation(s)
- Dalia El Khoury
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Madelyn Tabakos
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - John J M Dwyer
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Margo Mountjoy
- Health and Performance Center, John T. Powell Building, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
23
|
Fravel MA, Ernst ME, Gilmartin-Thomas J, Woods RL, Orchard SG, Owen AJ. Dietary supplement and complementary and alternative medicine use among older adults in Australia and the United States. J Am Geriatr Soc 2023; 71:2219-2228. [PMID: 36852896 PMCID: PMC10460828 DOI: 10.1111/jgs.18305] [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: 08/12/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Dietary supplement and complementary and alternative medication (CAM) use can contribute to drug interactions, polypharmacy, nonadherence with prescription medications, and healthcare expenses, whereas evidence supporting benefits of using these products is sparse. There is a lack of current published literature describing the patterns or predictors of their use in community-dwelling older adults. MATERIALS AND METHODS We performed a cross-sectional analysis of community-dwelling adults from Australia and the US, aged 70 years and older (65 years for US minorities), enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study. At study enrollment, eligible participants were required to be without concurrent 5-year life-limiting illness and free of documented evidence of cardiovascular disease, dementia, or significant physical disability. During the final study visit, a questionnaire was administered to collect information about supplement/CAM use. Data from 15,729 participants who completed this questionnaire between January 2017 and January 2018 were analyzed. Descriptive statistics were used to report the prevalence and types of products used. Factors associated with use were determined using multivariate regression. RESULTS Mean age of respondents was 79.6 years; 56.4% were female, 88.8% were from Australia, 56.5% reported 12 years of education or less, and 98.7% were living at home. Two-thirds (66.2%) of participants reported use of one or more supplement/CAM in the previous month. Products most commonly used included vitamin D (33.8% of participants), fish oil (22.7%), calcium (20.6%), glucosamine (14.8%), and multivitamin (12.9%). Female sex, US residency, higher education, polypharmacy (prescription medications), and frailty (in women) were significantly associated with higher use of supplements/CAMs. CONCLUSIONS Dietary supplement and CAM use is common among community-dwelling older adults in the United States and Australia. Given the high prevalence of use, collaboration between healthcare providers and older adult patients is important to insure safe and optimal use of these products.
Collapse
Affiliation(s)
- Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Julia Gilmartin-Thomas
- College of Health and Biomedicine & Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J. Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | |
Collapse
|
24
|
Heymsfield SB. Dietary Supplements for Weight Loss. Gastroenterol Clin North Am 2023; 52:457-467. [PMID: 37197886 DOI: 10.1016/j.gtc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The Federal Drug Administration has approved, following rigorous testing, 6 pharmacologic agents and one drug in device form for the management of overweight and obesity. Myriad products that purport to act on physiological mechanisms leading to weight loss also pervade the market with minimal regulatory oversight. Systematic reviews and meta-analyses of these products and their ingredients fail to establish any as meaningfully effective at the clinical level. Moreover, safety concerns prevail with adulteration, hypersensitivity reactions, and recognized adverse reactions. Lifestyle, pharmacologic, and bariatric surgical treatments are increasingly available, effective, and safe management tools for practitioners who should council patients, many of whom are susceptible to misinformation, on the lack effective and safe dietary supplements for weight loss.
Collapse
Affiliation(s)
- Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| |
Collapse
|
25
|
Sandoval KE. Changes in Reported Dietary Supplement Use in Cognitively Normal National Alzheimer's Coordinating Center Participants Aged 55 and Older From 2015 to 2019. J Nutr 2023; 153:1771-1782. [PMID: 37044210 PMCID: PMC10447883 DOI: 10.1016/j.tjnut.2023.04.004] [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: 11/29/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Although reported dietary supplement use is common in older adults, evaluations of dietary supplement use over the past 10 y are lacking. OBJECTIVE This analysis determined changes in reported dietary supplement use in cognitively normal older adults (aged ≥ 55 y) using the National Alzheimer's Coordinating Center data from 2015 to 2019 using a serial cross-sectional study design. METHODS The first available visit for cognitively normal participants aged ≥ 55 y from 2015 to 2019 with a complete medication form was used, resulting in 9357 participants. Associations between visit year categories and reported use of dietary supplement categories/individual supplements were tested using categorical statistics. To determine whether the probabilities of reported supplement use changed in 2019 compared with those of 2015, z-scores and two-sided P values were used. Weighted analyses were used to confirm analytical findings. RESULTS When comparing 2015 and 2019, the reported use of any dietary supplement decreased from 77.7% in 2015 to 71.0% in 2019 (P < 0.0001); any vitamin from 72.5% to 65.5% (P < 0.0001); any mineral from 39.2% to 30.4% (P < 0.0001); "other" nonvitamin/nonmineral supplements from 34.4% to 26.9% (P < 0.0001), calcium from 31.2% to 21.7% (P < 0.0001), multivitamins from 48.4% to 38.4% (P < 0.0001), potassium from 5.6% to 3.5% (P = 0.001), vitamin C from 13.0% to 9.2% (P = 0.0002), chondroitin from 6.0% to 4.1% (P = 0.006), glucosamine from 11.1% to 6.5% (P < 0.0001), and all omega fatty acids from 25.2% to 17.0% (P < 0.0001). Reported use increased for vitamin B7/biotin from 3.1% in 2015 to 5.8% in 2019 (P = 0.0003), melatonin from 3.1% to 5.8% (P = 0.0002), and turmeric from 1.2% to 4.7% (P < 0.0001). CONCLUSION Although the reported use of many major dietary supplement categories and individual supplements significantly decreased in older adults from 2015 to 2019, biotin, turmeric, and melatonin significantly increased. Because biotin may interfere with some laboratory tests, this may have important public health implications.
Collapse
Affiliation(s)
- Karin E Sandoval
- Pharmaceutical Sciences Southern Illinois University Edwardsville, 200 University Park Drive, Building 220, Edwardsville IL 62025.
| |
Collapse
|
26
|
Conway K, Ferstl C, Kumar M. Dietary supplement adulteration - knowledge, attitudes, and practices of California health care professionals: A cross-sectional survey study. PATIENT EDUCATION AND COUNSELING 2023; 114:107824. [PMID: 37290282 DOI: 10.1016/j.pec.2023.107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess knowledge, attitudes, and practices surrounding dietary supplements (DS) among California health care professionals (HCPs) and assess factors contributing to the frequency with which HCPs discuss DS with patients. METHODS In this cross-sectional study, an online questionnaire was distributed to HCPs in California from December 2021-April 2022 via professional membership email listservs. RESULTS Among 514 HCPs, overall knowledge of DS did not vary significantly by professional group, and 90% had received little to no DS education. Pharmacists (OR = 0.328, p = 0.0001) and those with less reported DS education (OR = 0.58, p = 0.0045; OR = 0.075, p = 0.0097) had a decreased likelihood of initiating conversations about DS more frequently. Females (OR = 2.5, p < 0.0001) and those with a higher knowledge score (OR = 1.2, p = 0.0297) had an increased likelihood of initiating conversations about DS more frequently. CONCLUSIONS HCPs acknowledge the clinical significance of DS adulteration and would benefit from additional informational resources to reduce the adverse effects associated with adulterated supplements. PRACTICE IMPLICATIONS HCPs initiate more conversations about DS use when they are more informed and will gain from staying up to date on DS-related information to encourage more patient communication.
Collapse
Affiliation(s)
- Kimberly Conway
- California Department of Public Health, Sacramento, USA; California Epidemiologic Investigation Service (Cal-EIS) Fellowship, Sacramento, USA.
| | - Carrie Ferstl
- California Department of Public Health, Sacramento, USA.
| | - Madhur Kumar
- California Department of Public Health, Sacramento, USA.
| |
Collapse
|
27
|
Redd D, Workman TE, Shao Y, Cheng Y, Tekle S, Garvin JH, Brandt CA, Zeng-Treitler Q. Patient Dietary Supplements Use: Do Results from Natural Language Processing of Clinical Notes Agree with Survey Data? Med Sci (Basel) 2023; 11:37. [PMID: 37367736 DOI: 10.3390/medsci11020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/28/2023] Open
Abstract
There is widespread use of dietary supplements, some prescribed but many taken without a physician's guidance. There are many potential interactions between supplements and both over-the-counter and prescription medications in ways that are unknown to patients. Structured medical records do not adequately document supplement use; however, unstructured clinical notes often contain extra information on supplements. We studied a group of 377 patients from three healthcare facilities and developed a natural language processing (NLP) tool to detect supplement use. Using surveys of these patients, we investigated the correlation between self-reported supplement use and NLP extractions from the clinical notes. Our model achieved an F1 score of 0.914 for detecting all supplements. Individual supplement detection had a variable correlation with survey responses, ranging from an F1 of 0.83 for calcium to an F1 of 0.39 for folic acid. Our study demonstrated good NLP performance while also finding that self-reported supplement use is not always consistent with the documented use in clinical records.
Collapse
Affiliation(s)
- Douglas Redd
- Center for Data Science and Outcome Research, Washington DC VA Medical Center, Washington, DC 20422, USA
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
| | - Terri Elizabeth Workman
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
| | - Yijun Shao
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
| | - Yan Cheng
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
| | - Senait Tekle
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
| | - Jennifer H Garvin
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Biomedical Informatics, University of Utah School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Qing Zeng-Treitler
- Center for Data Science and Outcome Research, Washington DC VA Medical Center, Washington, DC 20422, USA
- Department of Clinical Research and Leadership, George Washington University, Washington, DC 20037, USA
| |
Collapse
|
28
|
Keyßer G, Michalsen A, Reuß-Borst M, Frohne I, Gläß M, Pfeil A, Schultz O, Seifert O, Sander O. [Recommendations of the committee on complementary medicine and nutrition in ayurvedic medicine, homeopathy, nutrition and Mediterranean diet]. Z Rheumatol 2023:10.1007/s00393-023-01356-z. [PMID: 37212842 PMCID: PMC10382356 DOI: 10.1007/s00393-023-01356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/23/2023]
Abstract
Methods of complementary and alternative medicine (CAM) are appealing for many patients with rheumatic diseases. The scientific data are currently characterized by a large number of publications that stand in contrast to a remarkable shortage of valid clinical studies. The applications of CAM procedures are situated in an area of conflict between efforts for an evidence-based medicine and high-quality therapeutic concepts on the one hand and ill-founded or even dubious offers on the other hand. In 2021 the German Society of Rheumatology (DGRh) launched a committee for CAM and nutrition, which aims to collect and to evaluate the current evidence for CAM applications and nutritional medical interventions in rheumatology, in order to elaborate recommendations for the clinical practice. The current article presents recommendations for nutritional interventions in the rheumatological routine for four areas: nutrition, Mediterranean diet, ayurvedic medicine and homeopathy.
Collapse
Affiliation(s)
- Gernot Keyßer
- Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Andreas Michalsen
- Immanuel Krankenhaus Berlin, Königstr. 63, 14109, Berlin-Wannsee, Deutschland
| | - Monika Reuß-Borst
- Facharztpraxis für Innere Medizin, Frankenstr. 36, 97708, Bad Bocklet, Deutschland
| | - Inna Frohne
- Privatpraxis für Rheumatologie, Frankenstr. 238, 45134, Essen, Deutschland
| | - Mandy Gläß
- Helios Fachklinik Vogelsang-Gommern, Sophie-von-Boetticher-Str. 1, 39245, Vogelsang-Gommern, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Olaf Schultz
- Rheumazentrum, ACURA Kliniken Baden-Baden, Rotenbachtalstr. 5, 76530, Baden-Baden, Deutschland
| | - Olga Seifert
- Klinik und Poliklinik für Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland
| | - Oliver Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| |
Collapse
|
29
|
Yasgar A, Bougie D, Eastman RT, Huang R, Itkin M, Kouznetsova J, Lynch C, McKnight C, Miller M, Ngan DK, Peryea T, Shah P, Shinn P, Xia M, Xu X, Zakharov AV, Simeonov A. Quantitative Bioactivity Signatures of Dietary Supplements and Natural Products. ACS Pharmacol Transl Sci 2023; 6:683-701. [PMID: 37200814 PMCID: PMC10186358 DOI: 10.1021/acsptsci.2c00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 05/20/2023]
Abstract
Dietary supplements and natural products are often marketed as safe and effective alternatives to conventional drugs, but their safety and efficacy are not well regulated. To address the lack of scientific data in these areas, we assembled a collection of Dietary Supplements and Natural Products (DSNP), as well as Traditional Chinese Medicinal (TCM) plant extracts. These collections were then profiled in a series of in vitro high-throughput screening assays, including a liver cytochrome p450 enzyme panel, CAR/PXR signaling pathways, and P-glycoprotein (P-gp) transporter assay activities. This pipeline facilitated the interrogation of natural product-drug interaction (NaPDI) through prominent metabolizing pathways. In addition, we compared the activity profiles of the DSNP/TCM substances with those of an approved drug collection (the NCATS Pharmaceutical Collection or NPC). Many of the approved drugs have well-annotated mechanisms of action (MOAs), while the MOAs for most of the DSNP and TCM samples remain unknown. Based on the premise that compounds with similar activity profiles tend to share similar targets or MOA, we clustered the library activity profiles to identify overlap with the NPC to predict the MOAs of the DSNP/TCM substances. Our results suggest that many of these substances may have significant bioactivity and potential toxicity, and they provide a starting point for further research on their clinical relevance.
Collapse
Affiliation(s)
- Adam Yasgar
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Danielle Bougie
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Richard T Eastman
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Ruili Huang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Misha Itkin
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Jennifer Kouznetsova
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Caitlin Lynch
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Crystal McKnight
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Mitch Miller
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Deborah K Ngan
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Tyler Peryea
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Pranav Shah
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Paul Shinn
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Menghang Xia
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Xin Xu
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Alexey V Zakharov
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Anton Simeonov
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| |
Collapse
|
30
|
Engel E, Friedt CT, Reinert JP. An Evaluation of Tertiary Drug Resources' Consistency Regarding Drug-Drug Interactions Between Tricyclic Antidepressants and Herbal Supplements. J Pharm Technol 2023; 39:62-67. [PMID: 37051281 PMCID: PMC10084409 DOI: 10.1177/87551225231154405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Background: Tertiary drug information resources are utilized frequently by health care providers. While pharmacists are uniquely trained and prepared to interpret the information available on these resources, including the results of drug-drug interaction evaluations, discrepancies between such resources pose a major concern for clinicians with regard to patient safety and medication regimen efficacy. It was postulated that drug-drug interaction evaluations between prescription medications and over-the-counter herbal supplements would be particularly problematic. Objective: The objective of this project was to distinguish the discrepancies between tertiary drug information resources in the setting of drug-drug interactions between tricyclic antidepressants (TCAs) and herbal supplements. Methods: The following medications and herbal supplements were evaluated on Lexicomp, Micromedex, and Medscape: amitriptyline, nortriptyline, doxepin, imipramine, desipramine, amoxapine, St. John's Wort, valerian root, ginkgo biloba, and ginseng. Results: While all of the tertiary drug information resources identified a significant reaction between each TCA and St. John's Wort due to the risk of serotonin syndrome, several other discrepancies were noted, with regard to both the severity of the interaction indicated and whether or not an interaction was identified. Conclusion: It is imperative that clinicians be aware of potential discrepancies between tertiary drug information resources, including the potential for variation in both the clinical interpretation of its severity and the recognition of an interaction.
Collapse
Affiliation(s)
- Elizabeth Engel
- College of Pharmacy and Pharmaceutical
Sciences, The University of Toledo, Toledo, OH, USA
| | - Carter T. Friedt
- College of Pharmacy and Pharmaceutical
Sciences, The University of Toledo, Toledo, OH, USA
| | - Justin P. Reinert
- College of Pharmacy and Pharmaceutical
Sciences, The University of Toledo, Toledo, OH, USA
| |
Collapse
|
31
|
Lauritzen F, Gjelstad A. Trends in dietary supplement use among athletes selected for doping controls. Front Nutr 2023; 10:1143187. [PMID: 37006918 PMCID: PMC10050343 DOI: 10.3389/fnut.2023.1143187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundDietary supplements (DS) may be beneficial for athletes in certain situations, whereas incorrect or excessive use may impair performance, pose a risk to the athlete's health and cause positive doping tests by containing prohibited substances. To provide athletes with relevant and tailored information on safe supplement use, a better knowledge about DS trends over time and between sport disciplines are needed.MethodsThis study examines the use of DS among athletes who have participated in doping controls by extracting information derived from 10,418 doping control forms (DCF) collected by Anti-Doping Norway from 2015 to 2019.ResultsOverall, 51% of the DCFs contained information about at least one DS. National level athletes (NLA) more often reported using DS than recreational athletes (RA) (53 vs. 47%, p < 0.001). Athletes in strength and power (71%), VO2max endurance (56%) and muscular endurance sports (55%) had the highest proportion of DCFs with information about DS. Medical supplements were the most used supplement category for both genders and across all sports. Dietary supplements with a high risk of containing doping substances were most common among male, RA in strength and power sports. There were small and non-significant year-to-year variations in the prevalence of athletes using DS, while the number of products used concomitantly peaked in 2017 before declining in 2019 (2.30 vs. 2.08, p < 0.01). The use of medical supplements and ergogenic substances increased slightly for both NLA and RA from 2015 to 2019, while the use of all other supplement categories declined.ConclusionHalf of the 10,418 DCFs contained information about DS, with variations within the athlete population. DS with high risk of containing prohibited substances were mostly seen in sport disciplines requiring a high degree of specialization in strength/power, including powerlifting and weightlifting, as well as in some team sports, such as cheerleading and american football.
Collapse
Affiliation(s)
- Fredrik Lauritzen
- Science and Medicine, Anti-Doping Norway, Oslo, Norway
- *Correspondence: Fredrik Lauritzen
| | - Astrid Gjelstad
- Science and Medicine, Anti-Doping Norway, Oslo, Norway
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
32
|
Austin SB, Beccia AL, Raffoul A, Jackson DA, Sarda V, Hart JE, Chavarro JE, Rich-Edwards J. Financial precarity, food insecurity, and psychological distress prospectively linked with use of potentially dangerous dietary supplements during the pandemic in the US. Front Public Health 2023; 11:1120942. [PMID: 36935695 PMCID: PMC10018192 DOI: 10.3389/fpubh.2023.1120942] [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: 12/12/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Supplements sold with claims to promote weight loss, cleansing/detoxing, increased energy, or boosted immunity can be dangerous, and consumers experiencing extreme stressors may be especially vulnerable to deceptive claims. The purpose of our study was to investigate associations of financial strain and psychological distress during the COVID-19 pandemic with use of supplements sold for weight loss, cleanse/detox, energy, or immunity. Methods We used repeated-measures data gathered over five survey waves from April/May 2020-April 2021 from the COVID-19 Substudy (N = 54,951), within three prospective US national cohorts (Nurses' Health Study 2, Nurses' Health Study 3, and Growing Up Today Study), to investigate longitudinal associations between financial strain and psychological distress and risk of use of potentially dangerous types of supplements. Surveys assessed use of supplements prior to and during the first year of the pandemic, as well as financial precarity, food insecurity, depressive and anxiety symptoms, perceived stress, and daily hassles. We fit sociodemographic-adjusted modified Poisson GEE models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between baseline or lagged time-varying predictors and prevalent or incident (i.e., new-onset) use of each supplement type. Results At baseline in April/May 2020, soon after pandemic onset, current use of supplement types was: weight loss 2.7%; cleanse/detox 3.2%; energy 4.4%; immune 22.6%. By the end of the study period, cumulative incidence was: weight loss 3.5%; cleanse/detox 3.7%; energy 4.5%; immune 21.3%. In prevalent-use analyses, financial precarity, food insecurity, and psychological distress were associated with up to 2.4 times the risk of use of these types of supplements across the study period. Similarly, in incident-use analyses, financial precarity and psychological distress were associated with up to 2.1 times the risk of initiating use; whereas, high food insecurity was associated with nearly 1.8 times higher risk of onset of weight-loss supplements use but was not associated with onset of use of other types of supplements. Discussion We found consistent evidence that during the first year of the pandemic, participants experiencing elevated financial strain and psychological distress were at heightened risk of initiating use of potentially dangerous types of supplements. Our findings raise concerns about deceptive claims about the safety and product effectiveness by manufacturers of these supplements to profit from vulnerable consumers during the pandemic.
Collapse
Affiliation(s)
- S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Ariel L. Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Destiny A. Jackson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jaime E. Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jorge E. Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
33
|
Loria A, Marianetti I, Cook CA, Melucci AD, Ghaffar A, Juviler P, Temple LK, Jones CMC, Fleming FJ. Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021. Am J Emerg Med 2023; 69:76-82. [PMID: 37060632 DOI: 10.1016/j.ajem.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Presentations to the emergency department for rectal foreign bodies are common, but there is little epidemiologic information on this condition. This limits the ability to provide evidence-based education to trainees regarding the populations affected, the types and frequency of foreign bodies, and factors associated with hospitalization. To address this, we analyzed national estimates of emergency department presentations for rectal foreign bodies from 2012 to 2021 in the US. METHODS We queried the National Electronic Injury Surveillance System for any injury to the 'pubic region' or 'lower trunk' with an accompanying diagnosis of foreign body, puncture, or laceration. Two authors manually reviewed all clinical narratives to identify cases of rectal foreign bodies. National estimates were determined using weighting and strata variables, incidence rates calculated using census data, trends assessed by linear regression, and factors associated with hospitalization identified by multivariable logistic regression. RESULTS From 885 cases, there were an estimated 38,948 (95% CI, 32,040-45,856) emergency department visits for rectal foreign bodies among individuals ≥15 years from 2012 to 2021. The average age was 43, 77.8% were male, 55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization. The annual incidence of presentations for rectal foreign bodies increased from 1.2 in 2012 to 1.9 per 100,000 persons in 2021 (R2 = 0.84, p < 0.01). Males have a bimodal age distribution peaking in the fifth decade, while females have a right-skewed age distribution peaking in the second decade. Female sex (odds ratio [OR] 0.4; 95% confidence interval [CI], 0.2-0.6) and, compared to sexual devices, balls/marbles (OR 0.2; 95% CI, 0.05-0.6) or drugs/paraphernalia (OR 0.1; 95% CI, 0.05-0.4) are associated with a reduced odds of hospitalization. CONCLUSIONS Presentations to the emergency department for rectal foreign bodies increased for males and females from 2012 to 2021 in the United States. These epidemiologic estimates for a complex form of anorectal trauma provide preclinical information for emergency medicine, surgery, and radiology trainees.
Collapse
Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ila Marianetti
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Caitlin A Cook
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Aqsa Ghaffar
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Juviler
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
34
|
Herrera-Añazco P, Mougenot B, Benites-Meza JK, Barturén-Alvarado LC, Zumarán-Nuñez CJ, Boyd-Gamarra MA, Runzer-Colmenares FM, Benites-Zapata VA. Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults. Can Geriatr J 2023; 26:187-199. [PMID: 36865404 PMCID: PMC9953501 DOI: 10.5770/cgj.26.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). Conclusions This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.
Collapse
Affiliation(s)
- Percy Herrera-Añazco
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Trujillo, Peru,Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico
| | - Benoit Mougenot
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru,Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jerry K. Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru,Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Luz C. Barturén-Alvarado
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Carlos J. Zumarán-Nuñez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Maria A. Boyd-Gamarra
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Fernando M. Runzer-Colmenares
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, CHANGE Research Working Group, Lima, Peru
| | - Vicente A. Benites-Zapata
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| |
Collapse
|
35
|
Morio KA, Sternowski RH, Brogden KA. Induction of Endogenous Antimicrobial Peptides to Prevent or Treat Oral Infection and Inflammation. Antibiotics (Basel) 2023; 12:antibiotics12020361. [PMID: 36830272 PMCID: PMC9952314 DOI: 10.3390/antibiotics12020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Antibiotics are often used to treat oral infections. Unfortunately, excessive antibiotic use can adversely alter oral microbiomes and promote the development of antibiotic-resistant microorganisms, which can be difficult to treat. An alternate approach could be to induce the local transcription and expression of endogenous oral antimicrobial peptides (AMPs). To assess the feasibility and benefits of this approach, we conducted literature searches to identify (i) the AMPs expressed in the oral cavity; (ii) the methods used to induce endogenous AMP expression; and (iii) the roles that expressed AMPs may have in regulating oral inflammation, immunity, healing, and pain. Search results identified human neutrophil peptides (HNP), human beta defensins (HBD), and cathelicidin AMP (CAMP) gene product LL-37 as prominent AMPs expressed by oral cells and tissues. HNP, HBD, and LL-37 expression can be induced by micronutrients (trace elements, elements, and vitamins), nutrients, macronutrients (mono-, di-, and polysaccharides, amino acids, pyropeptides, proteins, and fatty acids), proinflammatory agonists, thyroid hormones, and exposure to ultraviolet (UV) irradiation, red light, or near infrared radiation (NIR). Localized AMP expression can help reduce infection, inflammation, and pain and help oral tissues heal. The use of a specific inducer depends upon the overall objective. Inducing the expression of AMPs through beneficial foods would be suitable for long-term health protection. Additionally, the specialized metabolites or concentrated extracts that are utilized as dosage forms would maintain the oral and intestinal microbiome composition and control oral and intestinal infections. Inducing AMP expression using irradiation methodologies would be applicable to a specific oral treatment area in addition to controlling local infections while regulating inflammatory and healing processes.
Collapse
Affiliation(s)
| | | | - Kim A. Brogden
- College of Dentistry, The University of Iowa, Iowa City, IA 52242, USA
- Correspondence:
| |
Collapse
|
36
|
Beninger P. Drug-Drug Interactions: How to Manage the Risk-A Stakeholder Approach. Clin Ther 2023; 45:106-116. [PMID: 36754731 DOI: 10.1016/j.clinthera.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
Drug-drug interactions (DDIs) are well-recognized, chronic, multidimensional issues that have defied efforts to make substantial reductions in the burden of effects on patients and the health care system. This Commentary offers a stakeholder approach to characterizing the problem and identifying potential ways to address the risks posed by DDIs. Stakeholders may comprise 2 groups: a triad consisting of the patient, the prescriber, and the pharmacist and a pentad of institutional stakeholders consisting of institutions of education and training for prescribers and pharmacists, drug development sector companies, regulatory agencies, payer institutions, and publishing companies of journals on healthcare topics. Suggested strategic opportunities to mitigate the risk of harm from DDIs include the following: (1) identify critical leadership to set the agenda, manage the process, and mark progress; (2) enhance self-advocacy skills, particularly for patients; (3) create more opportunities for patients to learn, understand, and participate in the process; (4) establish and enhance partnerships between and among stakeholders; (5) seek broader use of regulatory machinery; (6) institutionalize principles of conservative prescribing and deprescribing in medical education and professional training; (7) establish, highlight, and promote DDI in HEDIS quality metrics, key performance indicators, and balanced scorecards; (8) encourage publishers to engage the issue more deeply by developing dedicated specialty journals for physicians, pharmacists, and cross-professional audiences and encourage journal editors to dedicate sections in pharmacy and clinical journals; and (9) involve the political process to include markers for DDI mitigation and to set performance goals in US Food and Drug Administration-directed legislation.
Collapse
Affiliation(s)
- Paul Beninger
- Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.
| |
Collapse
|
37
|
Laffin LJ, Bruemmer D, Garcia M, Brennan DM, McErlean E, Jacoby DS, Michos ED, Ridker PM, Wang TY, Watson KE, Hutchinson HG, Nissen SE. Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers. J Am Coll Cardiol 2023; 81:1-12. [PMID: 36351465 DOI: 10.1016/j.jacc.2022.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Supplements are commonly used by individuals with indications for lipid-lowering therapy, but evidence of their effectiveness to lower low-density lipoprotein cholesterol (LDL-C) is lacking, particularly when compared with statins. OBJECTIVES The trial objective was to compare the efficacy of a low-dose statin with placebo and 6 common supplements in impacting lipid and inflammatory biomarkers. METHODS This was a single-center, prospective, randomized, single-blind clinical trial among adults with no history of atherosclerotic cardiovascular disease (ASCVD), an LDL-C of 70 to 189 mg/dL, and an increased 10-year risk of ASCVD. Participants were randomized to rosuvastatin 5 mg daily, placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice. The primary endpoint was the percent change in LDL-C from baseline for rosuvastatin 5 mg daily compared with placebo and each supplement after 28 days. The primary endpoint was evaluated in a hierarchical fashion with rosuvastatin first compared with placebo, then each supplement in a prespecified order using analysis of covariance. RESULTS A total of 190 participants completed the study. The percent LDL-C reduction with rosuvastatin was greater than all supplements and placebo (P < 0.001). The difference in LDL-C reduction with rosuvastatin compared with placebo was -35.2% (95% CI: -41.3% to -29.1%; P < 0.001). None of the dietary supplements demonstrated a significant decrease in LDL-C compared with placebo. Adverse event rates were similar across study groups. CONCLUSIONS Among individuals with increased 10-year risk for ASCVD, rosuvastatin 5 mg daily lowered LDL-C significantly more than placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. (Supplements, Placebo, or Rosuvastatin Study [SPORT]; NCT04846231).
Collapse
Affiliation(s)
| | | | - Michelle Garcia
- C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Ellen McErlean
- C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | - Paul M Ridker
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Karol E Watson
- University of California-Los Angeles, Los Angeles, California, USA
| | | | - Steven E Nissen
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Osman A, Chittiboyina AG, Avula B, Ali Z, Adams SJ, Khan IA. Quality Consistency of Herbal Products: Chemical Evaluation. PROGRESS IN THE CHEMISTRY OF ORGANIC NATURAL PRODUCTS 2023; 122:163-219. [PMID: 37392312 DOI: 10.1007/978-3-031-26768-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
The widespread utility of herbal products has been rising considerably worldwide, including both developed and developing countries, leading to the rapid growth of their availability in the United States and globally. This substantial increase in consumption of herbal products has witnessed the emergence of adverse effects upon oral administration of certain of these products, and thus has raised safety concerns. The adverse effects caused by the consumption of certain botanical medicines occur primarily as a result of the poor quality of plant raw materials or the finished products, which inherently may affect safety and/or efficacy. The poor quality of some herbal products can be attributed to a lack of proper quality assurance and quality control. A high demand for herbal products that surpasses production, combined with a desire for maximizing profits, along with a lack of rigorous quality control within some manufacturing facilities have led to the emergence of quality inconsistencies. The underlying causes for this involve the misidentification of plant species, or their substitution, adulteration, or contamination with harmful ingredients. Analytical assessments have revealed there to be frequent and significant compositional variations between marketed herbal products. The inconsistency of the quality of herbal products can be ascribed essentially to the inconsistency of the botanical raw material quality used to manufacture the products. Thus, the quality assurance and the quality control of the botanical raw materials is may contribute significantly to improving the quality and consistency of the quality of the end products. The current chapter focuses on the chemical evaluation of quality and consistency of herbal products, including botanical dietary supplements. Different techniques, instruments, applications, and methods used in identifying, quantifying, and generating chemical fingerprints and chemical profiles of the ingredients of the herbal products will be described. The strengths and weaknesses of the various techniques available will be addressed. Limitations of the other approaches including morphological or microscopic analysis and DNA-based analysis will be presented.
Collapse
Affiliation(s)
- Ahmed Osman
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA.
| | - Amar G Chittiboyina
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA
| | - Bharathi Avula
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA
| | - Zulfiqar Ali
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA
| | - Sebastian J Adams
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA
| | - Ikhlas A Khan
- School of Pharmacy, National Center for Natural Products Research, The University of Mississippi, University, MS, 38677, USA
| |
Collapse
|
40
|
Kaci H, Bodnárová S, Fliszár-Nyúl E, Lemli B, Pelantová H, Valentová K, Bakos É, Özvegy-Laczka C, Poór M. Interaction of luteolin, naringenin, and their sulfate and glucuronide conjugates with human serum albumin, cytochrome P450 (CYP2C9, CYP2C19, and CYP3A4) enzymes and organic anion transporting polypeptide (OATP1B1 and OATP2B1) transporters. Biomed Pharmacother 2023; 157:114078. [PMID: 36481402 DOI: 10.1016/j.biopha.2022.114078] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Luteolin and naringenin are flavonoids found in various foods/beverages and present in certain dietary supplements. After a high intake of these flavonoids, their sulfate and glucuronide conjugates reach micromolar concentrations in the bloodstream. Some pharmacokinetic interactions of luteolin and naringenin have been investigated in previous studies; however, only limited data are available in regard to their metabolites. In this study, we aimed to investigate the interactions of the sulfate and glucuronic acid conjugates of luteolin and naringenin with human serum albumin, cytochrome P450 (CYP2C9, 2C19, and 3A4) enzymes, and organic anion transporting polypeptide (OATP1B1 and OATP2B1) transporters. Our main findings are as follows: (1) Sulfate conjugates formed more stable complexes with albumin than the parent flavonoids. (2) Luteolin and naringenin conjugates showed no or only weak inhibitory action on the CYP enzymes examined. (3) Certain conjugates of luteolin and naringenin are potent inhibitors of OATP1B1 and/or OATP2B1 enzymes. (4) Conjugated metabolites of luteolin and naringenin may play an important role in the pharmacokinetic interactions of these flavonoids.
Collapse
Affiliation(s)
- Hana Kaci
- Drug Resistance Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok krt. 2., H-1117 Budapest, Hungary; Doctoral School of Biology, Institute of Biology, Eötvös Loránd University, Pázmány P. stny. 1/C, H-1117 Budapest, Hungary
| | - Slávka Bodnárová
- Department of Pharmacology, Faculty of Pharmacy, University of Pécs, Rókus u. 2, H-7624 Pécs, Hungary
| | - Eszter Fliszár-Nyúl
- Department of Pharmacology, Faculty of Pharmacy, University of Pécs, Rókus u. 2, H-7624 Pécs, Hungary; Food Biotechnology Research Group, János Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | - Beáta Lemli
- Department of Pharmacology, Faculty of Pharmacy, University of Pécs, Rókus u. 2, H-7624 Pécs, Hungary; Green Chemistry Research Group, János Szentágothai Research Center, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | - Helena Pelantová
- Institute of Microbiology of the Czech Academy of Sciences, Vídeňská 1083, CZ-142 20 Prague, Czech Republic
| | - Kateřina Valentová
- Institute of Microbiology of the Czech Academy of Sciences, Vídeňská 1083, CZ-142 20 Prague, Czech Republic
| | - Éva Bakos
- Drug Resistance Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok krt. 2., H-1117 Budapest, Hungary
| | - Csilla Özvegy-Laczka
- Drug Resistance Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok krt. 2., H-1117 Budapest, Hungary
| | - Miklós Poór
- Department of Pharmacology, Faculty of Pharmacy, University of Pécs, Rókus u. 2, H-7624 Pécs, Hungary; Food Biotechnology Research Group, János Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary.
| |
Collapse
|
41
|
Intake of Food Supplements, Caffeine, Green Tea and Protein Products among Young Danish Men Training in Commercial Gyms for Increasing Muscle Mass. Foods 2022; 11:foods11244003. [PMID: 36553745 PMCID: PMC9777690 DOI: 10.3390/foods11244003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Sixty-three men (15-35 years of age) regularly training in Danish gyms and supplement users were interviewed about the use of supplemental protein and food supplements, intake of caffeine- and (-)-epigallocathechin-3-gallate (EGCG)-containing supplements and beverages and any experienced adverse effects. Protein powder (60%), fish oil (54%) and multivitamin/mineral supplements (41%) were the most popular products. The daily supplementary protein intake (mean 0.42 g/kg body weight, users only) in adult men contributed substantially to their protein intake and exceeded the recommended allowance (0.83 g/kg body weight) for six adult participants (14%). Thirty-eight percent of the adult men exceeded the daily caffeine intake presumed to be safe (400 mg) with coffee as the main contributor. Thirty percent drank green tea and among this percentage, two participants had an extreme daily intake (1.5 and 2 -L). EGCG intake could not be estimated from the food supplements due to the lack of label information. Eighteen participants (29%) reported having experienced adverse effects but seventeen did not consult a physician or report the adverse effect to the Danish food authority. The most common adverse effects were insomnia, shaking, headache and palpitations, itching of the skin and stinging. Pre-workout products accounted for 53% of the adverse effects. Three adverse effects came after intake of two brands of supplements known to have contained substances such as 1,3-dimethylamine or derivatives of phenylethylamines previously having caused serious adverse effects.
Collapse
|
42
|
Safety Considerations for Natural Products Commonly Used By Patients with Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3131-3138. [PMID: 36174919 DOI: 10.1016/j.jaip.2022.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
Natural products are a category of Complementary and Alternative Medicine that includes medicinal plants, vitamins, and dietary supplements. These products are often utilized by patients with allergies in conjunction with, or as an alternative to, their conventional medical therapies. Despite the wide use of these modalities, many clinicians often have limited knowledge and training in their use. It is important for health care providers to know the safety and risks of these products that their patients may use. This Clinical Commentary reviews the side effects and adverse reactions of several natural products commonly used by patients with allergies and gives an overview of the U.S. Food and Drug Administration requirements for manufacturing, advertising and distribution.
Collapse
|
43
|
Ośko J, Szewczyk A, Berk P, Prokopowicz M, Grembecka M. Assessment of the Mineral Composition and the Selected Physicochemical Parameters of Dietary Supplements Containing Green Tea Extracts. Foods 2022; 11:foods11223580. [PMID: 36429172 PMCID: PMC9689700 DOI: 10.3390/foods11223580] [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: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Our aim was to assess the mineral composition as well as the physicochemical quality of green tea-based dietary supplements (capsules and tablets) with respect to average weight, size and shape, friability, breaking force and disintegration time. Products were analysed by flame atomic absorption spectrometry for Ca, K, Mg, Na, Cr, Cu, Fe, Zn, Mn, Pb and Cd. Approximately 60% of the analysed supplements met the requirements of European and Polish regulations. The dietary supplements passed weight variation tests, but not all products had compliant capsule sizes. One product in tablet form failed the friability test, and eleven dietary supplements in tablet form failed the disintegration test. The supplements were characterised by a varied elemental composition, with the highest values found for Ca, Fe, Zn and Mn. The recommended daily allowance realisation for Fe and Zn in two dietary supplements (capsule form) exceeded 100%. As a result of the estimation of the monthly intake of toxic metals, it was concluded that the tested products do not pose a risk to consumer health. Significant relationships (p < 0.001) were found for K, Mg, Na, Cu, Fe, Mn and Zn. The application of factor and cluster analyses allowed the verification of the similarity of green tea extracts contained in dietary supplements to the natural raw material, green tea leaves, used as a reference material.
Collapse
Affiliation(s)
- Justyna Ośko
- Department of Bromatology, Faculty of Pharmacy, Medical University of Gdańsk, Gen. J. Hallera Avenue 107, 80-416 Gdańsk, Poland
| | - Adrian Szewczyk
- Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Gen. J. Hallera Avenue 107, 80-416 Gdańsk, Poland
| | - Paulina Berk
- Student Scientific Circle at the Department of Bromatology, Faculty of Pharmacy, Medical University of Gdańsk, Gen. J. Hallera Avenue 107, 80-416 Gdańsk, Poland
| | - Magdalena Prokopowicz
- Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Gen. J. Hallera Avenue 107, 80-416 Gdańsk, Poland
| | - Małgorzata Grembecka
- Department of Bromatology, Faculty of Pharmacy, Medical University of Gdańsk, Gen. J. Hallera Avenue 107, 80-416 Gdańsk, Poland
- Correspondence:
| |
Collapse
|
44
|
DiConti-Gibbs A, Chen KY, Coffey CE. Polypharmacy in the Hospitalized Older Adult. Clin Geriatr Med 2022; 38:667-684. [DOI: 10.1016/j.cger.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
45
|
Differences in the Perception of Dietary Supplements between Dietary Supplement/Medicine Users and Non-Users. Nutrients 2022; 14:nu14194114. [PMID: 36235766 PMCID: PMC9572052 DOI: 10.3390/nu14194114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
Some patients use dietary supplements and medicines concomitantly, with an inappropriate perception of their safety and efficacy. To clarify the perception between dietary supplement and medicine users and non-users, we conducted an internet survey. In this survey, 38.9% of participants used dietary supplements, 32.6% used prescription medicines, and 14.7% used dietary supplements and prescription medicines concomitantly. Then, we conducted a further survey on four groups, dietary supplement and prescription medicine users, dietary supplement only users, prescription medicine only users, and non-users (500 each). Dietary supplement users had favorable outcomes in terms of both the safety and efficacy of dietary supplements compared to dietary supplement non-users. This perception of dietary supplements was independent from medicine use. The awareness of the Health Food Network consumer navigation site, which provides information about dietary supplements for consumers, was the highest among dietary supplement and prescription medicine users, but it was still low (2.2%). In conclusion, consumers who use dietary supplement and prescription medicine concomitantly have favorable outcomes for their safety and efficacy and a low awareness of their interaction. There is a need to provide information, especially regarding the risk of interaction, that takes into account the consumer's situation.
Collapse
|
46
|
Kim NS, Choi HS, Lim NY, Lee JH, Kim H, Baek SY. Intercomparison study of fragmentation pathways and fragment ion structures for screening of illegal drugs and their novel analogues used to adulterate dietary supplements using liquid chromatography/quadrupole time-of-flight mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9353. [PMID: 35830417 DOI: 10.1002/rcm.9353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/22/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
RATIONALE As public interest in health and immunity has increased in recent years, so has the demand for dietary supplements. However, supplements adulterated with illegal drugs and their novel analogues are being sold even as the pharmacological efficacies of these drugs are being advertised. Since the use of these illegal compounds can have serious side effects, they pose a risk to public health. Hence, in this study, we propose a strategy for proactively testing drugs and novel analogues that may be added to dietary supplements illegally. METHODS The optimal conditions for liquid chromatography/quadrupole time-of-flight mass spectrometry were explored to determine the fragmentation patterns for 60 compounds. The optimal conditions were established by comparing the areas and heights of the precursor ion peaks at a fragmentor voltage of 125 or 175 V. Furthermore, the optimized spectra were acquired using collision energies of 1 to 50 eV. The energy value was selected based on the condition that the mass error of the precursor ions is 10 ppm or lower. RESULTS The fragmentation pathway of each product ion and its chemical structure were predicted and determined. In addition, the obtained structural information was used to screen 18 seized samples. Based on the precursor ions and the corresponding fragmentation patterns, the unknown compounds present in the samples were identified as desulfonylchlorosildenafil and propoxyphenylthiohydroxy homosildenafil. CONCLUSIONS We obtained mass spectrometry-based information for various compounds by predicting the fragmentation pathways and chemical structures of their fragment ions. Subsequently, based on the obtained structural information, we tested several seized samples and were able to detect two novel analogues in four of the samples. Therefore, the proposed approach is suitable for quickly and accurately identifying the unknown compounds detected in real-world samples.
Collapse
Affiliation(s)
- Nam Sook Kim
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Hwan Seong Choi
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Na Young Lim
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Ji Hyun Lee
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Hyungil Kim
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sun Young Baek
- Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| |
Collapse
|
47
|
Kang MG, Lee JY, Woo SI, Kim KS, Jung JW, Lim TH, Yoon HJ, Kim CW, Yoon HR, Park HK, Kim SH. Adverse drug events leading to emergency department visits: A multicenter observational study in Korea. PLoS One 2022; 17:e0272743. [PMID: 36121802 PMCID: PMC9484687 DOI: 10.1371/journal.pone.0272743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Adverse drug events are significant causes of emergency department visits. Systematic evaluation of adverse drug events leading to emergency department visits by age is lacking. This multicenter retrospective observational study evaluated the prevalence and features of adverse drug event-related emergency department visits across ages. We reviewed emergency department medical records obtained from three university hospitals between July 2014 and December 2014. The proportion of adverse drug events among total emergency department visits was calculated. The cause, severity, preventability, and causative drug(s) of each adverse drug event were analyzed and compared between age groups (children/adolescents [<18 years], adults [18–64 years], and the elderly [≥65 years]). Of 59,428 emergency department visits, 2,104 (3.5%) were adverse drug event-related. Adverse drug event-related emergency department visits were more likely to be female and older. Multivariate logistic regression analysis revealed that compared to non- adverse drug event-related cases, adverse drug event-related emergency department visitors were more likely to be female (60.6% vs. 53.6%, p<0.001, OR 1.285, 95% CI 1.025–1.603) and older (50.8 ± 24.6 years vs. 37.7 ± 24.4 years, p<0.001, OR 1.892, 95% CI: 1.397–2.297). Comorbidities such as diabetes, chronic kidney disease, chronic liver disease, and malignancies were also significantly associated with adverse drug event-related emergency department visits. Side effects were the most common type of adverse drug events across age groups, although main types differed substantially depending on age. Serious adverse drug events, hospitalizations, and adverse drug event-related deaths occurred more frequently in the elderly than in adults or children/adolescents. The proportion of adverse drug event-related emergency department visits that were preventable was 15.3%. Causative drugs of adverse drug events varied considerably depending on age group. Adverse drug event features differ substantially according to age group. The findings suggest that an age-specific approach should be adopted in the preventive strategies to reduce adverse drug events.
Collapse
Affiliation(s)
- Min-Gyu Kang
- Department of Internal Medicine, Subdivision of Allergy, Chungbuk National University Hospital, Cheongju, Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Subdivision of Allergy, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Sook Kim
- Department of Pharmacy, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- * E-mail: (SHK); (JWJ)
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye-Ran Yoon
- College of Pharmacy, Duksung Women’s University, Seoul, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (SHK); (JWJ)
| |
Collapse
|
48
|
Chaisiwamongkhol K, Phonchai A, Pon-In S, Bunchuay T, Limbut W. A microplate spectrophotometric method for analysis of indole-3-carbinol in dietary supplements using p-dimethylaminocinnamaldehyde (DMACA) as a chromogenic reagent. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:3366-3374. [PMID: 36039897 DOI: 10.1039/d2ay01129h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This work presents the development of a microplate spectrophotometric method for determination of indole-3-carbinol in dietary supplements. The colorimetric procedure is based on the reaction of indole-3-carbinol with the p-dimethylaminocinnamaldehyde (DMACA) reagent under acidic conditions. The absorbance of the colored product measured at 675 nm was used to determine the target analyte. To achieve optimal spectrophotometric performance, the DMACA reagent concentration, the hydrochloric acid concentration, and the reaction time were optimized. The developed technique performed well under the optimal conditions, with a linear calibration range of 30 to 300 mg L-1 and a high correlation coefficient (r2 = 0.9954). The limit of detection and limit of quantification were 7.8 mg L-1 and 26.2 mg L-1, respectively. This approach demonstrated good repeatability (intra- and inter-day precision) with a % RSD lower than 9.4%, good accuracy with acceptable relative recoveries in the range of 98 to 106%, and high sample throughput (24 detection per min). This simple, rapid, and multi-sample analysis approach for routine analysis of indole-3-carbinol has the potential to be used for the quality control of dietary supplements.
Collapse
Affiliation(s)
- Korbua Chaisiwamongkhol
- School of Science, Mae Fah Luang University, Chiang Rai 57100, Thailand.
- Center of Chemical Innovation for Sustainability (CIS), Mae Fah Luang University, Chiang Rai 57100, Thailand
| | - Apichai Phonchai
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Forensic Science Innovation and Service Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Sunisa Pon-In
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Thanthapatra Bunchuay
- Department of Chemistry, Center of Excellence for Innovation in Chemistry (PERCH-CIC), Faculty of Science, Mahidol University, 272 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Warakorn Limbut
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Forensic Science Innovation and Service Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| |
Collapse
|
49
|
Vidović B, Đuričić B, Odalović M, Milošević Georgiev A, Tadić I. Dietary Supplements Use among Serbian Undergraduate Students of Different Academic Fields. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11036. [PMID: 36078751 PMCID: PMC9518540 DOI: 10.3390/ijerph191711036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
The rising popularity of dietary supplements as a part of self-care practice increases interest in monitoring their usage in the general and specific population groups. This study investigated the prevalence and patterns of dietary supplement use among Belgrade University undergraduate students and its variations across different academic study fields. Of the 914 online survey students, 55.7% used dietary supplements during the past year. Female gender, eating behavior, and academic field were significant predictors of dietary supplement use. For all students, the most commonly used dietary supplements were vitamins and minerals, alone or in combination. Magnesium, vitamin C, and B vitamins were the most frequently supplemented micronutrients. The reasons for using, place of purchase, and source of information regarding dietary supplements significantly varied among students of different fields of study. Adverse effects related to dietary supplement use, including gastrointestinal symptoms, skin flushing, dizziness, and heart palpitation, were reported in 4.5% of students. Insufficient knowledge about these products was self-reported by 16.5% of users, more common among non-medical students. Thus, public health interventions are needed to improve students' knowledge regarding rational and safe dietary supplement use.
Collapse
Affiliation(s)
- Bojana Vidović
- Department of Bromatology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Bojana Đuričić
- Department of Bromatology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Marina Odalović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Andrijana Milošević Georgiev
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Ivana Tadić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| |
Collapse
|
50
|
Wahab MSA, Jalani MM, Goh KW, Ming LC, Faller EM. Why Did I Consult My Pharmacist about Herbal and Dietary Supplements? An Online Survey Amid the COVID-19 Pandemic in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710994. [PMID: 36078707 PMCID: PMC9517816 DOI: 10.3390/ijerph191710994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 05/08/2023]
Abstract
Herbal and dietary supplements (HDSs) are frequently obtained from community pharmacies, but community pharmacists (CPs) have been underutilized for information regarding them. This study aimed to determine the prevalence of, factors behind, and reasons for consultation with CPs among HDS consumers in Malaysia. A cross-sectional study using an online survey was conducted among conveniently sampled individuals in Malaysia. Reasons for consultation or non-consultation with CPs about HDSs were sought from the respondents. A logistic regression analysis was conducted to determine the predictors of consultation with CPs. Overall, 40.3% (239/593) of participants consulted CPs about the HDSs that they purchased. The participants were predominantly unmarried (362/588, 61.6%) and belonged to the 18-29 age group (332/593, 56%). The multivariate analysis showed that a suburban residential setting was the only significant predictor for consultation with CPs (adjusted odds ratio = 0.390, 95% CI = 0.260-0.583). Respondents who consulted CPs generally agreed that the CPs were the right people to consult on HDSs (mean = 4.37, SD = 0.73). However, their discussion with CPs regarding HDSs mostly revolved around the benefits and directions for use, but little on the potential risks. Meanwhile, most respondents who did not consult CPs agreed that they had never thought of consulting CPs about their HDS use (mean = 3.45, SD = 1.02). The majority of them referred to the Internet (61.3%, 217/354) and social media (59.9%, 212/354) for information about HDSs. The findings from this study show that more efforts are warranted in encouraging consumers to consult CPs about their HDS use and to enhance their awareness of the roles of CPs in ensuring the safe use of HDSs.
Collapse
Affiliation(s)
- Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
- Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart Manufacturing Research Institute, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
- Correspondence: (M.S.A.W.); (L.C.M.)
| | - Muhammad Mustaqim Jalani
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
- Correspondence: (M.S.A.W.); (L.C.M.)
| | | |
Collapse
|