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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.
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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
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2
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Crawford C, Avula B, Lindsey AT, Katragunta K, Khan IA, Deuster PA. Label Accuracy of Weight Loss Dietary Supplements Marketed Online With Military Discounts. JAMA Netw Open 2024; 7:e249131. [PMID: 38691359 PMCID: PMC11063798 DOI: 10.1001/jamanetworkopen.2024.9131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
Importance Dietary supplements for weight loss, among the most popular supplement products on the market, are promoted not only for losing weight and shedding fat, but also for added benefits of energy and performance, all packed into 1 capsule with multiple combinations of ingredients. Fraudulent marketing of weight loss supplements, some with exaggerated claims, some that are potentially dangerous, and some that contain illegal ingredients, is ever present, especially through online sources, where multiple manufacturers target service members by offering military discounts. Objectives To examine whether select dietary supplements marketed online for weight loss from companies advertising military discounts are accurately labeled according to the Supplement Facts listed ingredients, whether they contain any ingredients prohibited for use in the military, and to qualitatively describe the products' label claims. Design, Setting, and Participants In this case series, 30 dietary supplement products marketed for weight loss were selected and purchased in June 2023 from 12 online companies advertising military discounts. Data were analyzed from July to August 2023. Main Outcomes and Measures Liquid chromatography-mass spectrometry was used to verify whether products were accurately labeled according to the Supplement Facts listed ingredients and whether they contained any substances on the DoD Prohibited Dietary Supplement Ingredients List. A separate analysis was conducted to describe product label claims by using the Operation Supplement Safety (OPSS) Risk Assessment Scorecard. Results Of the 30 products tested, analysis showed that 25 had inaccurate labels. Of these, 24 had ingredients listed on the label that were not detected (misbranded); 7 had hidden components not present on the label, some of which would be considered adulterated; and 10 had substances on the DoD Prohibited Dietary Supplement Ingredients List either on or hidden from the label. All products were rated as risky when applying the OPSS Scorecard. Conclusions and Relevance In this case series study, the majority of products had inaccurate labels. Some were misbranded, others would be considered adulterated with ingredients not allowed in dietary supplements, and some contained ingredients prohibited for use in the military.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Andrea T. Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Kumar Katragunta
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Ikhlas A. Khan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
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3
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Mason N, Sweet LM, Wills Z, Schall S. Vitamin D Abuse in Pursuit of "Gains" Resulting in Acute Kidney Injury. Mil Med 2024; 189:e417-e419. [PMID: 37402617 DOI: 10.1093/milmed/usad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/24/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
Vitamin toxicity represents an increasingly frequent clinical diagnosis and can be difficult to initially recognize given the plethora of over-the-counter supplements available. The young, active, and heavily male population of the military is especially susceptible to such supplementation pitfalls. Here we present the case of acute renal failure with hypercalcemia that was found to be secondary to unrecognized high-dose over-the-counter vitamin supplementation and subsequent vitamin D hypervitaminosis initiated by the patient in the hope of boosting testosterone production. This clinical scenario demonstrates the dangers of easily accessible, often seemingly benign supplements and the need for greater education and awareness of supplementation use.
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Affiliation(s)
- Nicholas Mason
- Arizona College of Medicine, Midwestern University, Ocotillo Hall, Glendale, AZ 85308, USA
| | - Lauren M Sweet
- Department of Internal Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - Zachary Wills
- Department of Internal Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - Sarah Schall
- Department of Internal Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
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4
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Knapik JJ, Trone DW, Steelman RA, Farina EK, Lieberman HR. Prevalence and adverse effects of sport-related nutritional supplements (sport drinks, bars, and gels) in the military before and during the COVID-19 pandemic: the US Military Dietary Supplement Use Study. J Int Soc Sports Nutr 2023; 20:2277246. [PMID: 37947831 PMCID: PMC10653656 DOI: 10.1080/15502783.2023.2277246] [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: 08/14/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Sport-related nutritional supplements (SRNS) include sport drinks, sport bars, and sport gels. This investigation examined temporal patterns in SRNS use and adverse effects (AEs) reported by a single cohort of United States active-duty service members (SMs) surveyed before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A stratified random sample (n = 22,858) of SMs (Air Force, Army, Navy, and Marine Corps) who completed a questionnaire on their SRNS use and AE experiences and were still on active duty were asked to complete the identical questionnaire on a second occasion. Twenty-five percent of successfully contacted SMs completed both questionnaires (n = 5,778) and were included in this investigation. The average ± standard deviation time between questionnaires was 1.3 ± 0.2 years. RESULTS Prevalence of reported SRNS use ≥1 time/week in the baseline (BL) and follow-up (FU) phases were as follows: any SRNS: BL = 46%, FU = 41%; sport drinks: BL = 31%, FU = 28%; sport bars: BL = 30%, FU = 24%; sport gels: BL = 4%, FU = 4%. Reported weekly aerobic and resistance training durations were reduced in the FU period (8% and 26%, respectively). The proportion of SMs reporting SRNS use in both study phases was as follows: any SRNS = 62%, sport drinks = 54%, sport bars = 50%, sport gels = 35%. Prevalence of reported AEs in the BL and FU phases were as follows: any SRNS: BL = 1.9%, FU = 1.9%; sport drinks: BL = 1.0%, FU = 1.3%; sport bars: BL = 1.7%, FU = 1.4%; sport gels: BL = 3.3%, FU = 2.5%. The proportion of SMs reporting AEs in both phases was as follows: any SRNS = 14%, sport drinks = 11%, sport bars = 17%, sport gels = 0%. CONCLUSIONS Overall SRNS use prevalence decreased slightly in the FU period, possibly because of reduced physical training related to military restrictions imposed during the emergence of COVID-19 between surveys. A large proportion of SMs reported changing their use patterns in the FU with some discontinuing use and others initiating use. The AE incidence was similarly low in the BL and FU phases, and few SMs reported AEs in both phases suggesting AEs were transitory. AE reporting for SRNSs was much lower than previously found for dietary supplements, possibly because of greater government regulatory control over SRNSs.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, Military Nutrition Division, Natick, MA, USA
| | - Daniel W Trone
- Military Population Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Ryan A Steelman
- Clinical Public Health & Epidemiology, Defense Centers for Public Health - Aberdeen, Aberdeen Proving Ground, MD, USA
| | - Emily K Farina
- US Army Research Institute of Environmental Medicine, Military Nutrition Division, Natick, MA, USA
| | - Harris R Lieberman
- US Army Research Institute of Environmental Medicine, Military Nutrition Division, Natick, MA, USA
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Knapik JJ, Farina EK, Steelman RA, Trone DW, Lieberman HR. The Medical Burden of Obesity and Overweight in the US Military: Association of BMI with Clinically Diagnosed Medical Conditions in United States Military Service Members. J Nutr 2023; 153:2951-2967. [PMID: 37619919 DOI: 10.1016/j.tjnut.2023.08.023] [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: 04/18/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND A high BMI is associated with various medical conditions, notably type 2 diabetes, cardiovascular disease, and mental health disorders. In the US military, BMI increased linearly between 1975 and 2015. OBJECTIVE This cross-sectional study investigated the associations between BMI and a comprehensive range of clinically diagnosed medical conditions (CDMCs) in US military service members (SMs). METHODS A stratified random sample of SMs (n=26,177) completed an online questionnaire reporting their height, weight, and demographic/lifestyle characteristics. Medical conditions for 6 mo before questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 39 CDMCs covering both broad (largely systemic) and specific medical conditions. BMI was calculated as weight/height2 (kg/m2). The prevalence of CDMCs was compared among normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2) SMs. RESULTS After multivariable adjustment for demographic/lifestyle characteristics, higher BMI was associated with higher odds of a diagnosed medical condition in 30 of 39 CDMCs, with all 30 displaying dose-response relationships. The 5 major CDMCs with the largest odds ratios comparing obese to normal weight were endocrine/nutritional/metabolic diseases (OR=2.67, 95%CI=2.24-3.15), nervous system diseases (odds ratio [OR]=2.59, 95%CI=2.32-2.90), circulatory system diseases (OR=2.56, 95%CI=2.15-3.06), musculoskeletal system diseases (OR=1.92, 95%CI=1.76-2.09), and mental/behavioral disorders (OR=1.69, 95%CI=1.51-1.90). Compared with normal weight SMs, overweight or obese SMs had a higher number of CDMCs (1.8±1.9 vs. 2.0±2.0 and 2.5±2.3, mean ± standard deviation, respectively, P<0.01). CONCLUSIONS In a young, physically active population, higher BMI was associated with a host of medical conditions, even after adjustment for demographic/lifestyle characteristics. The US Department of Defense should improve nutrition education and modify other factors that contribute to overweight and obesity. This study demonstrates that the medical burden of obesity is substantial in overweight and obese SMs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States.
| | - Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
| | - Ryan A Steelman
- Clinical Public Health and Epidemiology, Defense Centers for Public Health-Aberdeen, MD, United States
| | - Daniel W Trone
- Deployment Health, Naval Health Research Center, CA, United States
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
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Djaoudene O, Romano A, Bradai YD, Zebiri F, Ouchene A, Yousfi Y, Amrane-Abider M, Sahraoui-Remini Y, Madani K. A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects. Nutrients 2023; 15:3320. [PMID: 37571258 PMCID: PMC10421343 DOI: 10.3390/nu15153320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Over the last 20 years, the use of dietary supplements (DS) has continued to grow in many countries. Due to the public health crisis brought on by the COVID-19 pandemic and amidst fears regarding COVID-19 vaccines and their low supply in many regions of the world, there has been a marked interest in the use of DS as alternative means of protecting against and treating this emerging disease, as well as boosting the immune system and minimizing the risk of inflammation. Despite a lack of evidence to suggest their efficacy, a surge in the sales of DS has been reported in many parts of the world. Questions have also been raised about the health effects associated with DS due to their increased use during the health crisis. Numerous scientific studies have demonstrated their beneficial properties as well as some adverse and even toxic effects. In addition, given the current global interest in this issue, a review is needed to establish the status of dietary supplements before and during the health crisis. The aim of this review is to summarize the current evidence on the impact of dietary supplements on the incidence of the COVID-19 pandemic, as well as their regulation and associated market trends. First, we provide an overview of DS, including a comprehensive review of the legislative and regulatory aspects of DS in the USA, China, the EU, and Algeria. Second, we describe the prevalence of the most commonly consumed DS and their efficacy as a prophylactic modality in the era of COVID-19. Additionally, we examine the structure and size of the DS market in the countries that predominantly produce and import them, its global market trend, and the impact of the COVID-19 pandemic on market growth. Finally, in this review, we also discuss the profile of DS users.
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Affiliation(s)
- Ouarda Djaoudene
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Anabela Romano
- MED—Mediterranean Institute for Agriculture, Environment and Development, CHANGE—Global Change and Sustainability Institute, Faculdade de Ciências e Tecnologia, Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Yasmine Djedjiga Bradai
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Feriel Zebiri
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Amina Ouchene
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Yasmine Yousfi
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Meriem Amrane-Abider
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Yasmine Sahraoui-Remini
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
| | - Khodir Madani
- Centre de Recherche en Technologies Agroalimentaires, Route de Targa Ouzemmour, Campus Universitaire, Bejaia 06000, Algeria; (Y.D.B.); (F.Z.); (A.O.); (Y.Y.); (M.A.-A.); (Y.S.-R.); (K.M.)
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7
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Knapik JJ, Trone DW, Steelman RA, Farina EK, Lieberman HR. Associations between clinically diagnosed medical conditions and dietary supplement use: the US military dietary supplement use study. Public Health Nutr 2023; 26:1238-1253. [PMID: 36775272 PMCID: PMC10346078 DOI: 10.1017/s1368980023000095] [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: 04/11/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 02/14/2023]
Abstract
OBJECTIVE This study examined associations between multiple dietary supplement (DS) categories and medical conditions diagnosed by health professionals. DESIGN Cross-sectional. SETTING Volunteers completed an online questionnaire on DS use and demographic/lifestyle factors. Medical diagnoses were obtained from a comprehensive military electronic medical surveillance system and grouped into twenty-four clinically diagnosed medical conditions (CDMC). PARTICIPANTS A stratified random sample of US service members (SM) from all military services (n 26 680). RESULTS After adjustment for demographic/lifestyle factors (logistic regression), higher risk was found for 92 % (22/24) of CDMC among individual vitamins/minerals users, 58 % (14/24) of CDMC among herbal users, 50 % (12/24) of CDMC among any DS users and 46 % (11/24) of CDMC among multivitamins/multiminerals (MVM) users. Among protein/amino acid (AA) users, risk was lower in 25 % (6/24) of CDMC. For combination products, risk was higher in 13 % (3/24) of CDMC and lower in 8 % (2/24). The greater the number of CDMC, the higher the prevalence of DS use in most DS categories except proteins/AA where prevalence decreased. CONCLUSIONS Users in many DS categories had a greater number of CDMC, but protein/AA users had fewer CDMC; results for combination products were mixed. These data indicate those with certain CDMC were also users in some DS categories, especially individual vitamins/minerals, herbals and MVM. Data are consistent with the perception that use of DS enhances health, especially in those with CDMC. Protein/AA and combination product users were more likely to be younger, more physically active men, factors that likely reduced CDMC.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, USARIEM, 10 General Greene Ave, Natick, MA01760, USA
| | - Daniel W Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | | | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, USARIEM, 10 General Greene Ave, Natick, MA01760, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, USARIEM, 10 General Greene Ave, Natick, MA01760, USA
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8
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Scott JM, Deuster PA. Role of nutrition in human performance in military populations. BMJ Mil Health 2023:e002311. [PMID: 36792226 DOI: 10.1136/military-2022-002311] [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: 11/08/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
The role of nutrition and performance is well established. Service members' physical and cognitive performance, sleep and mood are impacted by nutritional choices. Although many eating patterns have emerged, consensus among experts recommend a dietary pattern focused on predominantly whole plant-based foods. Adequate intakes of fruits, vegetables, whole grains, beans, legumes, nuts and seeds should be prioritised. Implementation of strategic and intentional fuelling strategies around times of activity maintain adequate energy stores, enhance recovery and protect against training injuries. Carbohydrates are prioritised before, during and after activity or a mission, although the type and amount will vary based on duration and intensity of activity. Protein is generally the focus after activity or a mission and may be included before activity depending on individual tolerance. There are no specific recommendations for fat consumption before, during and after exercise that will improve performance. That said, Service members generally tolerate low-fat meals/snacks prior to exercise, limit fat intake during exercise, may include fat as part of the post exercise meal/snack, and generally consume most fat during the maintenance and growth phase. Careful consideration and planning for food and fluid requirements should be made when Service members are exposed to heat, cold and/or altitude. Operational rations are formulated to meet the nutritional needs of all Service members across a variety of diverse climates, environments and altitudes. Service members may use dietary supplements to improve their performance and need to be aware of available resources to help them make informed decisions.
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Affiliation(s)
- Jonathan M Scott
- Consortium for Health and Military Performance, Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - P A Deuster
- Consortium for Health and Military Performance, Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
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9
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Knapik JJ, Caldwell JA, Steelman RA, Trone DW, Farina EK, Lieberman HR. Short sleep duration is associated with a wide variety of medical conditions among United States military service members. Sleep Med 2023; 101:283-295. [PMID: 36470164 DOI: 10.1016/j.sleep.2022.11.015] [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] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This cross-sectional study investigated self-reported sleep duration and its association with a comprehensive range of clinically-diagnosed medical condition categories (CDMCs), as well as the relationship between short sleep duration (≤6 h) and demographic/lifestyle factors, among United States military service members (SMs). METHODS A stratified random sample of SMs (n = 20,819) completed an online questionnaire on usual daily hours of sleep and demographic/lifestyle characteristics. CDMCs for a six-month period prior to questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 33 CDMCs covering both broad and specific medical conditions. Prevalence of CDMCs was compared among three sleep duration categories (≤4, 5-6 and ≥7 h). RESULTS SMs reported a mean ± standard deviation of 6.3 ± 1.4 h of sleep per day. After adjustment for demographic/lifestyle characteristics, shorter sleep duration was associated with higher odds of a medical condition in 25 of 33 CDMCs, with most (n = 20) demonstrating a dose-response relationship. The five CDMCs with the largest differences between ≤4 vs ≥ 7 h sleep were: diseases of the nervous system (odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 2.4-3.4), mental/behavioral diseases (OR = 2.7, 95%CI = 2.3-3.2), diseases of the musculoskeletal system (OR = 1.9, 95%CI = 1.6-2.1), diseases of the circulatory system (OR = 1.7, 95%CI = 1.3-2.2), and diseases of the digestive system (OR = 1.6, 95%CI = 1.2-2.0). Six hours of sleep or less was independently associated with older age, less formal education, race, Hispanic ethnicity, higher body mass index, smoking, and military service branch. CONCLUSIONS In this young, physically active population, reporting shorter sleep duration was associated with a higher risk of multiple CDMCs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - John A Caldwell
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA; Laulima Government Solutions, 5301 Buckystown Pike, STE 460, Frederick, MD, 21704, USA
| | - Ryan A Steelman
- U.S. Army Public Health Center, 8252 Blackhawk Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Daniel W Trone
- Naval Health Research Center, Building 329, Ryne Rd, San Diego, CA, 92152, USA
| | - Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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10
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Tareq MA, Emi UH, Banna MHA, Rezyona H, Seidu AA, Abid MT, Tetteh JK, Sultana MS, Kundu S, Hasanuzzaman M, Mondal S, Mandal M, Khan MSI. Prevalence and factors associated with dietary supplement use among Bangladeshi public university students: A cross-sectional study. PLoS One 2022; 17:e0276343. [PMID: 36251676 PMCID: PMC9576072 DOI: 10.1371/journal.pone.0276343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The usage of dietary supplement (DS) such as vitamins, minerals, and fish oil has expanded, but there is limited data on their use by sub-populations such as university students. The study was aimed to investigate the prevalence of DS use among Bangladeshi university students and its associated factors. METHODS A cross-sectional survey of 390 students was conducted from two public universities from Barishal Division in Bangladesh using a structured questionnaire with 72 questions divided into five sections: sociodemographic, knowledge, opinions, and attitudes, types of DS, reasons and sources for using DS, and adverse reactions after taking DS. Descriptive statistics and logistic regression were utilized to estimate the results. RESULTS Among all the students, 15.6% students were using DS where only 7.7% of them used DS according to physicians' recommendation. Additionally, students used DS for general health and well-being, weight gaining and as a source of energy for physical and sporting activities, etc. The use of DS was significantly associated with female sex (AOR = 5.44, 95% CI: 2.18-13.52), ≥25 years age (AOR = 0.08, 95% CI: 0.01-0.67), underweight (AOR = 5.86, 95% CI: 1.95-17.62), having major illness (AOR = 6.99, 95% CI: 1.98-24.70) and good knowledge of DS (AOR = 2.64, 95% CI: 1.23-5.64). CONCLUSION This study provides new findings on DS use and its correlates in Bangladeshi students which may be used by the policymakers to improve DS usage among students. Adaptation of an appropriate program is recommended to educate students on proper and safer ways of using DS.
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Affiliation(s)
- Md. Abu Tareq
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Umme Habiba Emi
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md. Hasan Al Banna
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
- * E-mail:
| | - Humayra Rezyona
- Department of Food and Nutrition, College of Home Economics, Azimpur, Dhaka, Bangladesh
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Mohammad Tazrian Abid
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, University Post Office, Cape Coast, Ghana
| | - Mst. Sadia Sultana
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Satyajit Kundu
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
- School of Public Health, Southeast University, Nanjing, China
| | - Md. Hasanuzzaman
- Department of Environmental Sanitation, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Shuvajit Mondal
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Moumita Mandal
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md. Shafiqul Islam Khan
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Lee JKW, Tan B, Ogden HB, Chapman S, Sawka MN. Exertional heat stroke: nutritional considerations. Exp Physiol 2022; 107:1122-1135. [PMID: 35521757 PMCID: PMC9790308 DOI: 10.1113/ep090149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the topic of this review? The potential role of nutrition in exertional heat stroke. What advances does it highlight? Certain nutritional and dietary strategies used by athletes and workers may exert a protective effect the pathophysiological processes of exertional heat stroke, whereas others may be detrimental. While current evidence suggests that some of these practices may be leveraged as a potential countermeasure to exertional heat stroke, further research on injury-related outcomes in humans is required. ABSTRACT Exertional heat stroke (EHS) is a life-threatening illness and an enduring problem among athletes, military servicemen and -women, and occupational labourers who regularly perform strenuous activity, often under hot and humid conditions or when wearing personal protective equipment. Risk factors for EHS and mitigation strategies have generally focused on the environment, health status, clothing, heat acclimatization and aerobic conditioning, but the potential role of nutrition is largely underexplored. Various nutritional and dietary strategies have shown beneficial effects on exercise performance and health and are widely used by athletes and other physically active populations. There is also evidence that some of these practices may dampen the pathophysiological features of EHS, suggesting possible protection or abatement of injury severity. Promising candidates include carbohydrate ingestion, appropriate fluid intake and glutamine supplementation. Conversely, some nutritional factors and low energy availability may facilitate the development of EHS, and individuals should be cognizant of these. Therefore, the aims of this review are to present an overview of EHS along with its mechanisms and pathophysiology, discuss how selected nutritional considerations may influence EHS risk focusing on their impact on the key pathophysiological processes of EHS, and provide recommendations for future research. With climate change expected to increase EHS risk and incidence in the coming years, further investigation on how diet and nutrition may be optimized to protect against EHS would be highly beneficial.
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Affiliation(s)
- Jason K. W. Lee
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Heat Resilience and Performance Centre, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Physiology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,N.1 Institute for HealthNational University of SingaporeSingapore,Global Asia InstituteNational University of SingaporeSingapore,Institute for Digital MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore,Singapore Institute for Clinical SciencesAgency for Science, Technology and Research (A*STAR)Singapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Beverly Tan
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Henry B. Ogden
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Department of Sport, Health and WellbeingPlymouth Marjon UniversityPlymouthUK
| | - Shaun Chapman
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Cambridge Centre for Sport and Exercise SciencesSchool of Psychology and Sport ScienceAnglia Ruskin UniversityCambridgeUK
| | - Michael N. Sawka
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGAUSA
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12
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Knapik JJ, Trone DW, Steelman RA, Farina EK, Lieberman HR. Prescription medication use of United States military service members by therapeutic classification. Front Pharmacol 2022; 13:972031. [PMID: 36238571 PMCID: PMC9552294 DOI: 10.3389/fphar.2022.972031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: This cross-sectional study investigated the prevalence of, and factors associated with, filled prescription medications (FPMs) among United States (US) service members (SMs). Methods: A stratified random sample of active duty SMs from the Air Force, Army, Marine Corps, and Navy was obtained from military workforce records. Participants (n = 26,680) completed a questionnaire on demographics, physical characteristics, and lifestyle factors and approved access to their FPM for the previous 6 months. FPMs were obtained from the military Pharmacy Data Transaction Service that included all prescription medications dispensed at military medical treatment facilities, abroad, at retail pharmacies in the US, and/or through mail-order programs. Results: About two-thirds (65%) of SMs had ≥1 FPM in the 6 months surveillance period. Central nervous system (CNS) agents had the highest prevalence (41%), followed by anti-infective agents (20%), eye/ear/nose/throat preparations (20%), gastrointestinal drugs (18%), autonomic drugs (17%), skin and mucous membrane agents (13%), antihistamine drugs (12%), respiratory tract agents (12%) and cardiovascular drugs (9%). Among CNS agents, overall prevalence of dispensed non-steroidal anti-inflammatory drug (NSAIDs) was 30%. The odds of any FPM was independently associated with female gender, older age, higher body mass index, former tobacco use (smoking and smokeless tobacco), lower alcohol consumption, and was highest among Army, lowest among Marine Corps personnel. Conclusion: In this sample of SMs, dispensing of prescription medication was high, especially NSAIDs, but dispensing of cardiovascular drugs was much lower compared to the general US population, likely because of the younger age and higher level of physical activity of SMs.
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Affiliation(s)
- Joseph J. Knapik
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
- *Correspondence: Joseph J. Knapik,
| | | | - Ryan A. Steelman
- United States Army Public Health Center, Aberdeen Proving Ground, MD, United States
| | - Emily K. Farina
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Harris R. Lieberman
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
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13
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Knapik JJ, Steelman RA, Trone DW, Farina EK, Lieberman HR. Prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among active duty United States military personnel. Nutr J 2022; 21:22. [PMID: 35421992 PMCID: PMC9008906 DOI: 10.1186/s12937-022-00774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although representative data on caffeine intake in Americans are available, these data do not include US service members (SMs). The few previous investigations in military personnel largely involve convenience samples. This cross-sectional study examined prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among United States active duty military service members (SMs).
Methods
A stratified random sample of SMs were asked to complete an on-line questionnaire on their personal characteristics and consumption of caffeinated products (exclusive of dietary supplements). Eighteen percent (n = 26,680) of successfully contacted SMs (n = 146,365) completed the questionnaire.
Results
Overall, 87% reported consuming caffeinated products ≥1 time/week. Mean ± standard error per-capita consumption (all participants) was 218 ± 2 and 167 ± 3 mg/day for men and women, respectively. Caffeine consumers ingested 243 ± 2 mg/day (251 ± 2 mg/day men, 195 ± 3 mg/day women). On a body-weight basis, men and women consumed respectively similar caffeine amounts (2.93 vs 2.85 mg/day/kg; p = 0.12). Among individual caffeinated products, coffee had the highest use (68%), followed by sodas (42%), teas (29%), energy drinks (29%) and gums/candy/medications (4%). In multivariable logistic regression, characteristics independently associated with caffeine use (≥1 time/week) included female gender, older age, white race/ethnicity, higher body mass index, tobacco use or former use, greater alcohol intake, and higher enlisted or officer rank.
Conclusion
Compared to National Health and Nutrition Examination Survey data, daily caffeine consumption (mg/day) by SMs was higher, perhaps reflecting higher mental and physical occupational demands on SMs.
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Knowledge, Attitudes, and Use of Protein Supplements among Saudi Adults: Gender Differences. Healthcare (Basel) 2022; 10:healthcare10020394. [PMID: 35207007 PMCID: PMC8872357 DOI: 10.3390/healthcare10020394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022] Open
Abstract
Saudi Arabia has witnessed recent reforms and positive socio-political changes that have led to increased opportunities for women to participate in fitness centers. This study investigated protein supplement consumption among Saudi females compared with that among males and examined the knowledge and attitudes of the participants toward protein supplement use. A cross-sectional study was conducted in Riyadh using a previously validated, self-administered online survey. The questionnaire included items related to the prevalence, knowledge, attitudes, and practice of protein supplementation. The participants were 354 adults (58.2% were females). The results showed that over 47% of the participants attended fitness centers with more male (80.3%) than female (41%) attendees. Nearly 50% of the participants consumed protein supplements, with males (68.7%) using significantly (p < 0.001) more protein supplements than females (35.6%). The powdered form was most commonly consumed. The percentage of gym attendees (67.8%) who used protein supplements was higher than that among non-gym attendees (32.2%). Gaining muscles (56.1%) followed by compensating for protein deficiency (28.6%) were the reasons for taking protein supplements, with a significant gender difference (p < 0.001). Coaches provided the most information on protein supplements. The participants appeared to be knowledgeable about protein supplements. Although over 68% of protein supplement users suffered from various symptoms, only 20% of the participants thought that there was no risk in taking protein supplements, with significant gender differences. It was concluded that Saudi male participants are twice more likely to attend the gym and consume protein supplements compared with females. Of both genders, those attending the gym consumed more protein supplements than non-gym attendees.
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15
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Crawford C, Walter AR, Avula B, Lindsey AT, Hunter AM, Ikhlas AK, Deuster PA. Relative safety and quality of various dietary supplement products U.S. Service Members ask about. Clin Toxicol (Phila) 2022; 60:737-744. [PMID: 35156875 DOI: 10.1080/15563650.2022.2036751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT The purpose of this project was to determine types of dietary supplement products U.S. Service Members frequently ask about and identify risks associated with select products that consumers should be aware of when considering their use. METHODS Forty-one dietary supplement products frequently asked about through the Operation Supplement Safety's (OPSS.org) Ask-the-Expert portal were selected. Product analysis was performed to verify whether select products were accurately labeled and to identify any risky ingredients contained in these products. Operation Supplement Safety Risk Assessment Scorecard criteria were additionally used as a screening tool to assess a product's relative safety potential. RESULTS Among the select dietary supplements, 12 (29.3%) were marketed as pre-workout products; 14 (34.1%) for weight loss; four (9.8%) for male enhancement/testosterone boosters; and 11 (26.8%) as body building supplements. Eleven (26.8%) products had accurate labels; only eight of these had accurate labels plus no risky ingredients listed on the labels. Twenty-six (63.4%) products were misbranded; 10 (24.4%) were adulterated, and six (14.6%) were both misbranded and adulterated. Risky ingredients appeared on 23 (56%) of all product labels. Eight of these 23 products also had additional risky ingredients not listed on the labels but detected through analysis. According to the Scorecard based on label claims, 35 (85.4%) received a rating of "no-go/risky". CONCLUSIONS U.S. Service Members and the public at large should be aware that dietary supplements may contain risky ingredients and know how to identify ingredients on the label to evaluate potential risk.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Abraham R Walter
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - 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, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Aimee M Hunter
- Department of Laboratory Animal Resources, Uniformed Services University, Bethesda, MD, USA
| | - A Khan Ikhlas
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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16
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Knapik JJ, Trone DW, Steelman RA, Farina EK, Lieberman HR. Adverse effects associated with use of specific dietary supplements: The US Military Dietary Supplement Use Study. Food Chem Toxicol 2022; 161:112840. [PMID: 35093428 DOI: 10.1016/j.fct.2022.112840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
Dietary supplements (DSs) are used by 50% of Americans and 70% of United States military service members (SMs); some have adverse effects (AEs). This cross-sectional investigation examined AEs associated with specific DSs. A stratified random sample of SMs from the Air Force, Army, Marine Corps, and Navy was obtained. Volunteers completed a questionnaire reporting AEs for 96 generic and 62 specific DSs. The highest prevalence (≥1 AE) in specific DS categories was 35% prohormones, 33% weight loss supplements, 26% pre/post workout supplements, 14% herbal products, 12% multivitamin/multiminerals, 11% protein/amino acids, 9% muscle building supplements, 7% other DSs, 6% joint health products, and 5% individual vitamins/minerals. Specific DSs of concern (with proportion reporting AEs) included: Libido Max® (35%), Hydroxycut Hardcore® (33%), OxyElite® (33%), Roxylean® (31%), Growth Factor 9® (30%), Super HD® (29%), Hydroxycut Advanced® (29%), Lipo 6® (28%), The Ripper® (27%), Test Booster® (27%), Xenadrine Xtreme Thermogenic® (27%), C4 Extreme® (26%), and C4 Origional® (25%). Products marketed for weight loss, use before/after workout, and prohormones had the highest AE prevalence. DSs can contain substances with independent/additive AEs and/or interact with other ingredients or prescribed medications. Methods described here could provide a continuous surveillance system detecting dangerous DSs entering the market.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US 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
- Army Public Health Center, 8252 Blackhawk Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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Calvo MS. Expanding Our Understanding of Dietary Supplement Use to Include Both Civilian and Institutionalized Consumers: The US Military Dietary Supplement Use Study. J Nutr 2021; 151:3267-3268. [PMID: 34587232 DOI: 10.1093/jn/nxab319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mona S Calvo
- Division of Nephrology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; Retired, US FDA, Silver Spring, MD, USA
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18
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Ordway S, Sadowski B, Driggers KE, Kwok R. Severe Drug-Induced Liver Injury in the Military: A Retrospective Review. Mil Med 2021; 188:e991-e996. [PMID: 34697623 DOI: 10.1093/milmed/usab445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality. Establishing a diagnosis is challenging due to the broad differential diagnosis of liver injury. We retrospectively reviewed patients with severe idiosyncratic DILI at Walter Reed National Military Medical Center in order to define the scope and patterns of injury in the military population. METHODS Using the military health database, we identified a total of 110 patients who had an International Classification of Disease (ICD)-10 code for toxic liver injury in the electronic medical record at Walter Reed National Military Medical Center between 2016 and 2019. Each patient record was reviewed, and all pertinent data for included patients were recorded into a database for analysis. RESULTS Twenty-seven out of 110 patients with a diagnostic code for toxic liver injury met inclusion criteria for severe idiosyncratic DILI. Nine cases were caused by supplements, including 5 active duty service members using synthetic anabolic steroids or preworkout supplements. The majority of patients were men and one-third were serving on active duty. The ranges of liver enzyme elevation and patterns of liver injury widely varied. CONCLUSION Military service members are at particularly high risk for DILI given the frequent use of over-the-counter and other unregulated strength- and performance-enhancing supplements. These injuries not only have significant medical consequences but can profoundly impact military readiness and mission capability. Diagnosis of DILI among active duty service members requires a strong index of suspicion, and inquiry regarding all ingestions is crucial. Educating physicians, providers, and policy makers on the risks of supplement-induced liver injury among service members is crucial. These data will facilitate additional studies exploring susceptibility to severe idiosyncratic DILI among the military population.
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Affiliation(s)
- Sarah Ordway
- Department of Internal Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Brett Sadowski
- Department of Internal Medicine, Division of Gastroenterology/Hepatology, Portsmouth Naval Medical Center, Portsmouth, VA 23708, USA
| | - Kathryn E Driggers
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Ryan Kwok
- Department of Family Medicine, Division of Gastroenterology/Hepatology, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
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19
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Knapik JJ, Trone DW, Steelman RA, Farina EK, Lieberman HR. Prevalence, factors associated with use, and adverse effects of sport-related nutritional supplements (sport drinks, sport bars, sport gels): the US military dietary supplement use study. J Int Soc Sports Nutr 2021; 18:59. [PMID: 34433482 PMCID: PMC8390290 DOI: 10.1186/s12970-021-00457-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background Sport-related nutritional supplements (SRNSs) include sport drinks, sport bars, and sport gels. Previous studies indicate that 25–35 % of athletes and 25–50 % of military personnel report using these supplements. This study examined prevalence, factors associated with use, and adverse effects (AEs) of SRNSs among United States military service members (SMs). Methods A stratified random sample of 200,000 SMs was obtained from military workforce records, and asked to complete a survey on demographics, SRNS use, and AEs experienced. About 18 % (n = 26,681) of contacted SMs (n = 146,365) completed the survey between December 2018 and August 2019. Results Overall, 45 % of SMs used ≥ 1 SRNS at least once per week in the past 6 months. Prevalence of use (± standard error) for sport drinks, bars, and gels were 32 ± 0.3, 27 ± 0.3, and 3 ± 0.1 %, respectively. Use of 1, 2, or 3 SRNSs was 28.9 ± 0.5, 13.6 ± 0.6, and 2.2 ± 0.6 %, respectively. Multivariable logistic regression indicated greater use of any SRNS was independently associated with male gender, younger age, single marital status, more weekly aerobic or resistance training, tobacco use, higher alcohol intake, officer status, combat arms occupations, and service in the Marine Corps or Navy (compared to the Air Force). Overall, the proportion of users reporting ≥ 1 AE was 2.0 ± 0.1 %, with 1.3 ± 0.1 % for sport drinks, 1.6 ± 0.2 % for sport bars, and 2.8 ± 0.6 % for sport gels. Conclusions This large study of a stratified random sample of SMs found that nearly half of SMs consumed SRNSs weekly, and self-reported AEs were comparatively low. The AE incidence for SRNSs was much lower than typically found for dietary supplements, possibly because of more rigorous regulatory oversight for SRNSs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA. .,Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | | | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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