The association of the Affordable Care Act with nutrient consumption in adults in the United States

The Patient Protection and Affordable Care Act, more commonly known as the ACA, was legislation passed in the United States in 2010 to expand access to health insurance coverage for millions of Americans with a key emphasis on preventive care. Nutrition plays a critical role in overall wellness, disease prevention and resilience to chronic illness but prior to the ACA many Americans did not have adequate health insurance coverage to ensure proper nutrition. With passage of the ACA, more individuals received access to nutritional counseling through their primary care physicians as well as prescription vitamins and supplements free of charge. The objective of this study was to evaluate the impact of a national health insurance reform on nutrient intake among general population, including more vulnerable low-income individuals and patients with chronic conditions. Using data from the National Health and Nutrition Examination Survey (NHANES), we identified 8,443 adults aged 21 years and older who participated in the survey before (2011-2012) and after the ACA (2015-2016) implementation and conducted a subgroup analysis of 952 respondents who identified as Medicaid beneficiaries and 719 patients with a history of cancer. Using pre-post study design and bivariate and multivariable logistic analyses, we compared nutrient intake from food and supplementation before and after the ACA and identified risk factors for inadequate intake. Our results suggest that intake of micronutrients found in nutrient-dense foods, mainly fruit and vegetables, has not changed significantly after the ACA. However, overall use of nutritional supplements increased after the ACA (p = 0.05), particularly magnesium (OR = 1.02), potassium (OR = 0.76), vitamin D (both D2, and D3, OR = 1.34), vitamin K (OR = 1.15) and zinc (OR = 0.83), for the general population as well as those in our subgroup analysis Cancer Survivors and Medicaid Recipients. Given the association of increased use of nutritional supplements and expansion of insurance access, particularly in our subgroup analysis, more research is necessary to understand the effect of increasing access to nutritional supplements on the overall intake of micro- and macronutrients to meet daily nutritional recommended allowances.

Higher intake of certain nutrients among older adults is associated with better cognitive function: an analysis of NHANES 2011-2014

BACKGROUND

An increasing number of adults are over the age of 65, and there is concern about the increasing prevalence of age-associated cognitive decline and poor mental health status in older adults in the United States. Several nutrients are known to have important biological roles in brain health and neurological function, but many individuals fall short of recommended intake levels. The objective of this study was to examine the association between nutrient intake and cognitive function. We also explored whether nutrient intake was associated with depression.

METHODS

This cross-sectional study was based on data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 and included participants ≥ 60 years of age who had reliable day 1 dietary recall data and either valid cognitive function data (n = 2713) or valid depression score data (n = 2943). The sample was stratified by gender, and cognitive functioning test (CFT) composite z-scores were analyzed by quartiles. Depression status was assessed using the Patient Health Questionnaire (PHQ-9).

RESULTS

Higher intake and adequacy of a number of different nutrients from food were associated with higher cognitive function in both males and females. Nutrients that showed the most consistent associations with cognitive function across intake and adequacy analyses for food in both males and females were vitamin A, vitamin E, thiamin, riboflavin, vitamin B6, folate, magnesium, potassium, zinc, vitamin K, and lutein and zeaxanthin (p < 0.05 for all). These associations were positive with increasing intake and adequacy being associated with higher CFT composite z-scores. Analysis of nutrient intake and depression yielded results that differed by gender. In females, the nutrients that showed consistent inverse associations with depression scores across both intake and adequacy analyses for food were vitamin A, vitamin C, magnesium, vitamin K, potassium, and dietary fiber (p < 0.05 for all). In males, no significant associations between nutrient intake from food and depression scores were observed.

CONCLUSIONS

Our findings suggest that older adults with sufficient intakes of certain essential nutrients have higher cognitive function. Future studies are needed to confirm whether a well-balanced diet and/or dietary supplements which emphasize these nutrients are effective for prevention of age-related declines in cognitive function and mood.

Perspective: Council for Responsible Nutrition Science in Session. Optimizing Health with Nutrition-Opportunities, Gaps, and the Future

Achieving optimal health is an aspirational goal for the population, yet the definition of health remains unclear. The role of nutrition in health has evolved beyond correcting malnutrition and specific deficiencies and has begun to focus more on achieving and maintaining 'optimal' health through nutrition. As such, the Council for Responsible Nutrition held its October 2022 Science in Session conference to advance this concept. Here, we summarize and discuss the findings of their Optimizing Health through Nutrition - Opportunities and Challenges workshop, including several gaps that need to be addressed to advance progress in the field. Defining and evaluating various indices of optimal health will require overcoming these key gaps. For example, there is a strong need to develop better biomarkers of nutrient status, including more accurate markers of food intake, as well as biomarkers of optimal health that account for maintaining resilience-the ability to recover from or respond to stressors without loss to physical and cognitive performance. In addition, there is a need to identify factors that drive individualized responses to nutrition, including genotype, metabotypes, and the gut microbiome, and to realize the opportunity of precision nutrition for optimal health. This review outlines hallmarks of resilience, provides current examples of nutritional factors to optimize cognitive and performance resilience, and gives an overview of various genetic, metabolic, and microbiome determinants of individualized responses.

A Randomized, Double-Blind, Crossover Study to Investigate the Pharmacokinetics of Extended-Release Melatonin Compared to Immediate-Release Melatonin in Healthy Adults

Exogenous melatonin can be helpful for treatment of some sleep disorders. However, immediate-release formulations are rapidly absorbed and cleared from the body making it difficult to provide coverage for an entire sleep period. Extended-release melatonin formulations can better mimic the naturally occurring melatonin profile and increase efficacy, but few studies have reported on their pharmacokinetics. To assess the pharmacokinetics of extended-release melatonin, we conducted a randomized, double-blind, crossover study of extended-release melatonin (4 mg) compared to immediate-release melatonin (4 mg) in 18 healthy adults, ages 18-65 years. Participants received immediate-release or extended-release melatonin in clinic after an 8 h fast, and blood samples were taken over a 10-h period. After a 7-day washout period, the same procedures were repeated with the melatonin form not previously received. Extended-release melatonin had a longer time to peak concentration (1.56 vs 0.6 h) and elimination half-life (1.63 vs 0.95 h) compared with immediate-release melatonin. Maximum concentration was lower for extended-release melatonin compared with immediate-release melatonin (7581 pg/mL vs 13120 pg/mL). Extended-release melatonin raised melatonin levels in as little as 15 min and sustained elevated melatonin levels (>300 pg/mL) for 6 h before falling below 50 pg/mL by 9 h. No clinically relevant adverse events were observed, and safety parameters remained within normal ranges for both formulations. The pharmacokinetic profile of this extended-release melatonin formulation suggests that it could be used for future efficacy studies of melatonin and sleep outcomes. This trial is registered at ClinicalTrials.gov, NCT04067791.

Socioeconomic Inequalities Impact the Ability of Pregnant Women and Women of Childbearing Age to Consume Nutrients Needed for Neurodevelopment: An Analysis of NHANES 2007-2018

Adequate consumption of nutrients that support infant neurodevelopment is critical among pregnant women and women of childbearing age. Understanding the potential effects of socioeconomic inequalities on nutrient gaps in these life stages is thus important for informing strategies to mitigate negative health consequences. Usual intake (foods and dietary supplements) of neurodevelopment-related nutrients was determined from 24 h recalls among women of childbearing age and pregnant women (20−44 years) using data from 2007−2018 NHANES. Usual intake was compared across household food security, poverty-to-income ratio (PIR), and household participation in federal food and nutrition assistance programs. Intake of EPA + DHA was universally low with >95% of all women (pregnant and non-pregnant) below the DGA recommendation from foods alone. Women in households that participated in the Supplemental Nutrition Assistance Program had a significantly lower intake of multiple nutrients relative to those who did not participate. For example, 50% had intakes below the estimated average requirement (EAR) for vitamin A (versus 32%), 42% were below the EAR for calcium (versus 33%) and 65% were below the EAR for magnesium (versus 42%). Similar gradients were observed by PIR and household food security, and among pregnant women whereby gaps were more evident in those experiencing socioeconomic inequalities. The use of dietary supplements attenuated shortfalls for most nutrients. These findings highlight a critical need to support the nutritional requirements for women of childbearing age and pregnant women.

Nutrients Known to Support Cognitive Function Are Consumed Less by Many Older Adults: An Analysis of NHANES 2011–2014

Objectives

An increasing number of adults are over the age of 65 and there is increasing prevalence of age-associated concerns with cognitive decline in older adults in the United States. Several nutrients are known to have important biological roles in brain health and neurological function, but many individuals fall short of recommended intake levels. The objective of this study was to examine the association between nutrient intake and cognitive function. We also explored whether nutrient intake was associated with depression.

Methods

This cross-sectional study was based on data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 and included participants ≥60 years of age who had reliable dietary recall data and either valid cognitive function data (n = 2713) or valid depression score data (n = 2943). The sample was stratified by sex, and cognitive functioning test (CFT) composite z-scores were analyzed by quartiles.

Results

Higher intake of a number of different nutrients was associated with higher cognitive function in both males and females. Nutrients that showed consistent associations with cognitive function across intake analyses for both food and food plus supplements in males and females included folate, choline, magnesium, potassium, vitamin K, and lutein and zeaxanthin. These associations were positive with increasing intake associated with higher CFT composite z-scores. Analysis of nutrient intake and depression yielded results that differed by sex, with more nutrients inversely associated with depression in females than males. In females, nutrients that had consistent inverse associations with depression across intake analyses for both food and food plus supplements included EPA, DHA, magnesium, vitamin K, potassium, dietary fiber, and lutein and zeaxanthin.

Conclusions

Our findings suggest that many older adults consume less nutrients known to benefit and support cognitive function and mood.

Funding Sources

This research was funded by Pharmavite LLC.

Cost-Effectiveness of Nutrient Supplementation in Cancer Survivors

Cancer patients are at risk for malnutrition; the aim of this study was to provide a cost-effectiveness analysis of dietary supplementation in cancer survivors. We estimated prevalence of supplementation, hospitalization rates, quality of life (QOL), cost of care and mortality among cancer survivors. We built a decision analytic model to simulate life-long costs of health care and supplementation and QOL among cancer survivors with and without supplementation. Cost of supplements was derived from national pharmacy databases including single- and multivitamin formularies. One-way and probabilistic sensitivity analysis were performed to evaluate the robustness of the incremental cost-effectiveness ratio (ICER) to changes in supplementation costs and duration. The study cohort represented the national cancer survivor population (average age 61 years, 85% white, 52% male, and 94% insured). Hospitalization rates for supplement users and non-users were 12% and 21%, respectively. The cost of hospitalization was $4030. Supplementation was associated with an additional 0.48 QALYs (10.26 vs. 9.78) at the incremental cost of $2094 ($236,933 vs. $234,839) over the remaining lifetime of survivors (on average 13 years). Adequate nutrition provides a cost-effective strategy to achieving potentially optimum health. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes per cancer type.

Beyond Nutrient Deficiency-Opportunities to Improve Nutritional Status and Promote Health Modernizing DRIs and Supplementation Recommendations

The US Dietary Guidelines for Americans (DGA) provide dietary recommendations to meet nutrient needs, promote health, and prevent disease. Despite 40 years of DGA, the prevalence of under-consumed nutrients continues in the US and globally, although dietary supplement use can help to fill shortfalls. Nutrient recommendations are based on Dietary Reference Intakes (DRIs) to meet the nutrient requirements for nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group and many need to be updated using current evidence. There is an opportunity to modernize vitamin and mineral intake recommendations based on biomarker or surrogate endpoint levels needed to 'prevent deficiency' with DRIs based on ranges of biomarker or surrogate endpoints levels that support normal cell/organ/tissue function in healthy individuals, and to establish DRIs for bioactive compounds. We recommend vitamin K and Mg DRIs be updated and DRIs be established for lutein and eicosapentaenoic and docosahexaenoic acid (EPA + DHA). With increasing interest in personalized (or precision) nutrition, we propose greater research investment in validating biomarkers and metabolic health measures and the development and use of inexpensive diagnostic devices. Data generated from such approaches will help elucidate optimal nutrient status, provide objective evaluations of an individual's nutritional status, and serve to provide personalized nutrition guidance.

Flow behavior of concentrated tricalcium phosphate suspensions in oil through injection for softgel encapsulation

Softgel encapsulation is an important manufacturing process used to produce convenient oral dosage forms of pharmaceuticals and dietary supplements. An important step in this process involves the injection of a fill material into a gelatin lined mold, and poor flow of the fill material during the injection may lead to undesired defects. We investigated the effect of fill composition on the injection behavior of an oil-based tricalcium phosphate (TCP) suspension containing lecithin by rheological measurements, capillary breakup extensional rheometry (CaBER), and high-speed flow visualization experiments. Shear rheology for TCP suspensions in soybean oil at concentrations of 27.8 wt% and 55.6 wt% showed shear thinning behaviors both with and without the addition of lecithin. Adding up to 0.5 wt% lecithin led to decreases in shear viscosity, while additions up to 1 wt% caused a slight increase. Results from CaBER and breakoff studies indicated that the length at which flow breakoff occurs was closely related to the Ohnesorge number, a dimensionless parameter representing the relative importance of viscous to surface-tension forces during breakoff, with higher values correlated to longer breakoff lengths. An optimal lecithin concentration exists for minimized TCP suspension viscosity which shortens flow breakoff times and improves softgel capsule seaming quality.

Long-chain omega-3 fatty acid serum concentrations across life stages in the USA: an analysis of NHANES 2011-2012

OBJECTIVE

To determine reference ranges of circulating long-chain (LC) omega-3 fatty acids: eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in a nationally representative population of Americans. To provide context, serum concentrations of LC omega-3 were compared with concentrations associated with consuming the recommended amount of EPA and DHA by the Dietary Guidelines for Americans (DGA) and the Omega-3 Index (EPA+DHA).

DESIGN

Cross-sectional population-based study.

SETTING

The National Health and Nutrition Examination Survey 2011-2012 cycle.

PARTICIPANTS

Participants with fatty acids measured in serum: 945 children, age 3-19 years, and 1316 adults, age 20 and older.

MAIN MEASURE

Serum EPA, DPA, DHA and sum of LC omega-3 fatty acids expressed as per cent of total fatty acids.

RESULTS

Among children, mean (SE) serum concentrations of EPA, DHA and omega-3s were 0.28% (0.01), 1.07% (0.02) and 1.75% (0.03). Among adults, mean (SE) of EPA, DHA and omega-3s were 0.61% (0.02), 1.38% (0.05) and 2.43% (0.08), all of which were significantly higher than corresponding serum fatty acid concentrations in children (p<0.001). Despite recommendations for higher intake, pregnant and/or breastfeeding women had mean (SE) EPA, DHA and LC omega-3 concentrations of 0.34% (0.07), 1.52% (0.08) and 2.18% (0.15), which were comparable to women of childbearing age; p=0.17, p=0.10 and p=0.73. Over 95% of children and 68% of adults had LC omega-3 concentrations below those associated with the DGA recommendation. Approximately 89% of adults had an Omega-3 Index in the high cardiovascular risk category.

CONCLUSIONS

Contemporary reference ranges for circulating LC omega-3s are critical for setting public health recommendations. Our findings show the need for continued emphasis on regular consumption of LC omega-3s among Americans, particularly considering the importance of LC omega-3s in cardiovascular health, brain health and development throughout life.

Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age

BACKGROUND

Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations.

OBJECTIVES

The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers.

METHODS

Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories.

RESULTS

Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category.

CONCLUSIONS

Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.

Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities

Poverty may be a barrier to acquiring adequate nutrient levels for the prevention of osteoporosis. Age and nutritional intake are major factors that contribute to osteoporosis prevalence. This study examined the relationship between markers of poverty with calcium / vitamin D intake and osteoporosis. A cross-sectional analysis of the United States population was performed using National Health and Nutrition Examination Survey (NHANES) data from 2007–2010 and 2013–2014 for older US adults (n = 3,901 participants, 50 years old and older). Odds of inadequate calcium / vitamin D intake and dietary supplement use and risk of probable osteoporosis were calculated in order to determine the relative difference and possible associations between household income, the Family Monthly Poverty Level Index, food security, and participation in the Supplemental Nutrition Assistance Program (SNAP). A sub-analysis of ethnic disparities and biological sex was also performed. In general, women age 50 and older consistently have inadequate calcium intake, regardless of economic level including poverty. While inadequate calcium intake has a larger prevalence among women, markers of poverty increased the risk of inadequate calcium intake in all men and risk of osteoporosis among some subgroups, with the exception of SNAP program participation. Over one fourth of Non-Hispanic black men in the US are below the poverty line. Approximately half of this population has inadequate calcium (58.9%) and vitamin D (46.7%) intake. Typically, osteoporosis risk is relatively low for Non-Hispanic Black males, however considering poverty status, risk is significantly increased (Relative Risk Ratio [RR]: 2.057 ± 0.012) for those with low income suggesting that calcium and vitamin D supplementation may be of benefit for this population.

Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES

A well-functioning immune system is essential for human health and well-being. Micronutrients such as vitamins A, C, D, E, and zinc have several functions throughout the immune system, yet inadequate nutrient intakes are pervasive in the US population. A large body of research shows that nutrient inadequacies can impair immune function and weaken the immune response. Here, we present a new analysis of micronutrient usual intake estimates based on nationally representative data in 26,282 adults (>19 years) from the 2005-2016 National Health and Nutrition Examination Surveys (NHANES). Overall, the prevalence of inadequacy (% of population below estimated average requirement [EAR]) in four out of five key immune nutrients is substantial. Specifically, 45% of the U.S. population had a prevalence of inadequacy for vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc. Dietary supplements can help address nutrient inadequacy for these immune-support nutrients, demonstrated by a lower prevalence of individuals below the EAR. Given the long-term presence and widening of nutrient gaps in the U.S.-specifically in critical nutrients that support immune health-public health measures should adopt guidelines to ensure an adequate intake of these micronutrients. Future research is needed to better understand the interactions and complexities of multiple nutrient shortfalls on immune health and assess and identify optimal levels of intake in at-risk populations.

Providing Infants with the Best Start in Life: Identification of Nutrient Gaps in Women of Childbearing Age in the United States

Objectives

Folate, iron, iodine, DHA, choline, zinc, vitamin A, D, B6 and B12 are key nutrients for supporting the baby's neurodevelopment from conception, throughout pregnancy and for the first two years of life. The objective of this study is to determine total estimated usual nutrient intakes and to identify nutrient gaps by comparing the intakes to corresponding Estimated Average Requirement (EAR) or Adequate Intake (AI), as well as the Tolerable Upper Intake Level (UL) in women of childbearing age (15–44 years).

Methods

Usual intake of nutrients from food and food + supplements were estimated using the National Cancer Institute method from 2 valid 24-hr dietary recalls among 4134 women aged 15–44 years (further grouped into 15–30 and 31–44 years) in NHANES 2011–16, a cross-sectional nationally representative health examination survey.

Results

The mean age of the sample population was 29.2 ± 0.3 years, with a majority non-Hispanic white (54.9%) and high income (55%, PIR &gt; 1.85). The percentage of women that had usual intake from food less than the EAR was as follows (percentage for 15–30 year old followed by percentage for 31–44 year old): vitamin D (&gt;97%, &gt; 97%), vitamin E (92% ± 1.0%, 88% ± 1.4%), magnesium (62% ± 1.9%, 44% ± 1.8%), vitamin A (50% ± 2.3%, 44% ± 2.2%), calcium (49% ± 1.6%, 44% ± 1.9%), vitamin C (47% ± 2.2%, 46% ± 2.2%). The percentage of women that had total usual intake below the AI was approximately (percentage for 15–30 year old followed by percentage for 31–44 year old): choline (96%, 94%), dietary fiber (96%, 92%), potassium (66%, 68%), vitamin K (43%, 43%).

Conclusions

A significant percentage of the women of childbearing age are not meeting the dietary recommendations for vitamin A, D, E, K, C, magnesium, calcium, choline, potassium and dietary fiber. The influence of which can be substantial; when infants are not given the best start in life, our society is directly impacted.

Funding Sources

This study was funded by Pharmavite LLC.

Absorption of Folic Acid from Different Delivery Forms: A Randomized, Crossover Study

Objectives

Folate, or folic acid, is a water-soluble B vitamin that plays a role in single carbon transfer reactions, which are involved in the synthesis and metabolism of nucleotides and amino acids. It has been established that adequate folic acid intake helps decrease the prevalence of neural tube defects during conception and early pregnancy. The objective of this study was to assess the bioavailability of folic acid from Prenatal Multi Gummies and Folic Acid tablets in women of childbearing age.

Methods

Eleven healthy, adult, premenopausal women of childbearing age (18–44 years) were recruited for a single-blind, randomized, crossover study. Each participant was randomly assigned to receive a single dose (2 gummies or 2 tablets) of Prenatal Multi Gummies or Folic Acid tablets (containing ∼800 µg folic acid) and then crossed over to receive the other study product after a wash-out period of ∼7 days. The study product was consumed along with a low folic acid breakfast meal. Blood samples were collected for the analysis of serum folate at t = −0.5, 1, 2, 4, 6 and 8 hours where t = 0 is the time of study product consumption.

Results

The mean serum folate total area under the curve (AUC0–8 hours) was 239.67 ± 24.50 h × ng/mL for the Prenatal Multi Gummies and 255.23 ± 30.17 h × ng/mL for the Folic Acid tablets. For both study products, the dose-adjusted net incremental AUC was significantly greater than 0 h × ng/mL (P ≤ 0.001). The maximum serum folate concentration (Cmax) was 47.69 ± 5.65 ng/mL for the Prenatal Multi Gummies and 52.45 ± 5.86 ng/mL for the Folic Acid tablets, and the median time to maximum serum concentration (Tmax) was 1.00 h for each product (interquartile limits for both included 1.00 to 1.08 hours).

Conclusions

In conclusion, folic acid contained in the Prenatal Multi Gummies and Folic Acid tablets was absorbed from both the Prenatal Multi Gummies and the Folic Acid tablets.

Funding Sources

This study was funded by Pharmavite LLC.

0545 Bi-Layer Melatonin Tablet Provides Immediate and Extended Absorption to Address Primary Sleep Issues

Introduction

Melatonin is a naturally-occurring hormone that functions in the regulation of the sleep-wake cycle. Exogenous melatonin has demonstrated utility for the induction and maintenance of sleep. Modulation of tablet dissolution rates can be achieved by strategically using binding agents in two layers to rapidly raise melatonin levels and sustain elevated levels over time to better emulate normal nocturnal melatonin secretion.

Methods

A randomized, double-blind, controlled cross-over study was conducted in healthy adults (n=18) to investigate the pharmacokinetics of a 4.5 mg melatonin bi-layer tablet with either prolonged-release (PR) or immediate-release (IR) characteristics. Blood samples were collected at 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 6, 8 and 10 h post-ingestion and melatonin concentrations were quantified.

Results

The PR formulation had a lower maximum concentration (Cmax, p&lt;0.002), but a longer time to reach maximum concentration (Tmax, p&lt;0.001). Absorption rate constant (Ka) and terminal disposition rate constant (λ) were both lower in PR melatonin than the IR formulation (p&lt;0.001), indicating slower absorption and elimination rates. These measures were consistent with significantly greater absorption (ta1/2, p&lt;0.002) and elimination half-lives (t1/2, p&lt;0.001) in the IR formulation compared to the PR formulation. Additionally, plasma melatonin concentrations reached pre-ingestion values by 8 h post-administration of the PR formulation, indicating that individuals sleeping for a recommended 7-9 hours will wake with normal melatonin levels, when taken an hour before bedtime.

Conclusion

Prolonged-release bi-layer melatonin tablet safely and effectively extends the absorption of exogenous melatonin compared to an immediate-release formulation.

Support

Pharmavite, LLC

Dietary Intakes of EPA and DHA Omega-3 Fatty Acids among US Childbearing-Age and Pregnant Women: An Analysis of NHANES 2001-2014

BACKGROUND

The 2015–2020 Dietary Guidelines for Americans (DGA) recommend that the general population should consume about 8 ounces (oz.) per week of a variety of seafood, providing approximately 250 mg per day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and that pregnant and lactating women should consume 8–12 oz. per week of seafood.

METHODS

We determined the usual intakes, percentage not meeting recommendations, and trends in EPA and DHA intakes among childbearing-age and pregnant women (15–44 years of age) using the NHANES cycles 2001–2002 through 2013–2014.

RESULTS

For the childbearing-age women, the mean usual intake of seafood was 0.44 ± 0.02 oz. equivalent per day and 100% of the population was below the DGA recommendation. Mean usual intakes of EPA, DHA, and combined EPA and DHA from foods and dietary supplements combined were 26.8 ± 1.4, 62.2 ± 1.9, and 88.1 ± 3.0 mg per day, respectively. Over 95% of the sample did not meet the daily intakes of 250 mg EPA and DHA. Similar results were observed for pregnant women. After controlling for covariates, there were slight but significant increases in EPA and DHA intakes from foods and dietary supplements over the 14-year span among childbearing-age (p = 0.005) and pregnant women (p = 0.002).

CONCLUSIONS

It was estimated that a majority of U.S. childbearing-age and pregnant women consumed significantly lower amounts of seafood than what the DGA recommends, which subsequently leads to low intakes of EPA and DHA; in addition, dietary supplement use has not eliminated the nutrient shortfall.

Potential Impact of Nutrition on Immune System Recovery from Heavy Exertion: A Metabolomics Perspective

This review describes effective and ineffective immunonutrition support strategies for the athlete, with a focus on the benefits of carbohydrates and polyphenols as determined from metabolomics-based procedures. Athletes experience regular cycles of physiological stress accompanied by transient inflammation, oxidative stress, and immune perturbations, and there are increasing data indicating that these are sensitive to nutritional influences. The most effective nutritional countermeasures, especially when considered from a metabolomics perspective, include acute and chronic increases in dietary carbohydrate and polyphenols. Carbohydrate supplementation reduces post-exercise stress hormone levels, inflammation, and fatty acid mobilization and oxidation. Ingestion of fruits high in carbohydrates, polyphenols, and metabolites effectively supports performance, with added benefits including enhancement of oxidative and anti-viral capacity through fruit metabolites, and increased plasma levels of gut-derived phenolics. Metabolomics and lipidomics data indicate that intensive and prolonged exercise is associated with extensive lipid mobilization and oxidation, including many components of the linoleic acid conversion pathway and related oxidized derivatives called oxylipins. Many of the oxylipins are elevated with increased adiposity, and although low in resting athletes, rise to high levels during recovery. Future targeted lipidomics-based studies will help discover whether n-3-polyunsaturated fatty acid (n-3-PUFA) supplementation enhances inflammation resolution in athletes post-exercise.

Probiotics in the management of children with allergy and other disorders of intestinal inflammation

Soon after birth, the human gastrointestinal tract quickly becomes colonised by a variety of bacterial species. Throughout life the gastrointestinal tract continues to serve as host to a complex society of nonpathological bacteria. Microorganisms, such as probiotics, have the potential to modulate mucosal immune response and reduce gastrointestinal inflammation caused by a variety of infectious and allergic events. The most widely studied genera of probiotics are lactobacilli and bifidobacteria. Lactobacillus rhamnosis strain ATC53103 (LGG) can replenish gut flora during infectious diarrhoeal episodes. This beneficial effect is carried over to traveller's diarrhoea and children experiencing antibiotic-associated diarrhoea. Furthermore, LGG can reduce the risk of respiratory tract infections in children attending daycares and hospitals. With allergic disease on the rise, probiotics have the potential to positively impact atopic dermatitis, asthma, and allergic rhinitis. LGG has been shown to decrease the severity and delay the onset of atopic dermatitis. Additionally, LGG is beneficial in the treatment of allergic colitis and necrotising entercolitis. Some strains of probiotics appear to be useful in the treatment and/or prevention of allergic disease, however, caution must be used when generalising the effectiveness of a specific strain of organism to other organisms and other disease states.

The impact of early nutrition on incidence of allergic manifestations and common respiratory illnesses in children

OBJECTIVE

To investigate the incidence of allergic and respiratory diseases through age 3 years in children fed docosahexaenoic acid (DHA)- and arachidonic acid (ARA)-supplemented formula during infancy.

STUDY DESIGN

Children who completed randomized, double-blind studies of DHA/ARA-supplemented (0.32%-0.36%/0.64%-0.72% of total fatty acids, respectively) versus nonsupplemented (control) formulas, fed during the first year of life, were eligible. Blinded study nurses reviewed medical charts for upper respiratory infection (URI), wheezing, asthma, bronchiolitis, bronchitis, allergic rhinitis, allergic conjunctivitis, otitis media, sinusitis, atopic dermatitis (AD), and urticaria.

RESULTS

From the 2 original cohorts, 89/179 children participated; 38/89 were fed DHA/ARA formula. The DHA/ARA group had significantly lower odds for developing URI (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.08-0.58), wheezing/asthma (OR, 0.32; 95% CI, 0.11-0.97), wheezing/asthma/AD (OR, 0.25; 95% CI, 0.09-0.67), or any allergy (OR, 0.28; 95% CI, 0.10-0.72). The control group had significantly shorter time to first diagnosis of URI (P = .006), wheezing/asthma (P = .03), or any allergy (P = .006).

CONCLUSIONS

DHA/ARA supplementation was associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age.

Tolerance of a standard intact protein formula versus a partially hydrolyzed formula in healthy, term infants

BACKGROUND

Parents who perceive common infant behaviors as formula intolerance-related often switch formulas without consulting a health professional. Up to one-half of formula-fed infants experience a formula change during the first six months of life.

METHODS

The objective of this study was to assess discontinuance due to study physician-assessed formula intolerance in healthy, term infants. Infants (335) were randomized to receive either a standard intact cow milk protein formula (INTACT) or a partially hydrolyzed cow milk protein formula (PH) in a 60 day non-inferiority trial. Discontinuance due to study physician-assessed formula intolerance was the primary outcome. Secondary outcomes included number of infants who discontinued for any reason, including parent-assessed.

RESULTS

Formula intolerance between groups (INTACT, 12.3% vs. PH, 13.7%) was similar for infants who completed the study or discontinued due to study physician-assessed formula intolerance. Overall study discontinuance based on parent- vs. study physician-assessed intolerance for all infants (14.4 vs.11.1%) was significantly different (P = 0.001).

CONCLUSION

This study demonstrated no difference in infant tolerance of intact vs. partially hydrolyzed cow milk protein formulas for healthy, term infants over a 60-day feeding trial, suggesting nonstandard partially hydrolyzed formulas are not necessary as a first-choice for healthy infants. Parents frequently perceived infant behavior as formula intolerance, paralleling previous reports of unnecessary formula changes.

TRIAL REGISTRATION

clinicaltrials.gov: NCT00666120.

Clinical response to 2 commonly used switch formulas occurs within 1 day

Very fussy or extremely fussy infants were randomized to receive: soy-based formula (Soy: n = 82) or a partially hydrolyzed cow's milk protein (CMP), low-lactose formula (PHF: n = 77) in a multicenter, double-blind, randomized, parallel, prospective 28-day feeding trial. Body weight and infant formula tolerance were reported. Adverse events were recorded throughout the study. A significant reduction in mean scores of fussiness, gas, spit-up, and crying compared with baseline measures was observed in infants who received either Soy or PHF within 1 day of formula intake; improvement in symptoms was sustained by study end. Stool consistency remained constant through day 28 in the PHF group, whereas stools in the Soy group became more firm by day 2 and did not return to prestudy consistency. PHF, with a protein profile patterned more closely on human breast milk, improved symptoms of formula intolerance as well as soy-based formula.

Roles of long-chain polyunsaturated fatty acids in the term infant: developmental benefits

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are two long-chain polyunsaturated fatty acids (LCPUFAs) found naturally in human milk. DHA and ARA have been receiving increased attention from health care professionals and the public. Research suggests that DHA intake and status have a significant impact on visual and cognitive development in breastfed infants. For formula-fed infants, studies have shown mixed results from DHA or DHA plus ARA supplementation. There are several important differences among LCPUFA studies with term infants that may contribute to the differing results, including levels of LCPUFA added to the formula, variations in test methods, ages of infants evaluated, and sources of LCPUFA. Nevertheless, several expert groups recommend that infant formulas be supplemented with DHA and ARA. Recommendations for term infants for DHA and ARA range from 0.2 percent to 0.4 percent and from 0.35 percent to 0.7 percent of the fatty acids, respectively.

Term infants fed formula supplemented with selected blends of prebiotics grow normally and have soft stools similar to those reported for breast-fed infants

OBJECTIVES

The present study was designed to evaluate the effect of 2 different combinations of prebiotic ingredients, polydextrose (PDX), galactooligosaccharides (GOS), and lactulose (LOS), at 2 different intake levels on the overall growth and tolerance in healthy term infants up to 120 days of age.

PATIENTS AND METHODS

Healthy, formula-fed, term infants (n = 226) were randomly assigned to 1 of 3 study formula groups: control group (n = 76), PG4 group (control formula supplemented with 4 g/L of a prebiotic blend, n = 74), or PGL8 group (control formula supplemented with 8 g/L of a prebiotic blend, n = 76). Anthropometric measurements were taken at 14, 30, 60, 90, and 120 days of age, and 24-hour dietary recall and 24-hour tolerance recall were recorded at 30, 60, 90, and 120 days of age. Adverse events were recorded throughout the study.

RESULTS

There were no statistically significant differences among the 3 formula groups for weight growth rate or length growth rate at any time point. Significant differences in stool consistency were detected among the 3 formula groups at 30, 60, and 90 days of age (P < 0.001, P = 0.025, P = 0.004, respectively), with the supplemented formula groups having looser stools than the control group. The PGL8 group had significantly higher stool frequency compared with the control and PG4 groups at 30 days of age (P = 0.021 and P = 0.017, respectively), but all of the groups were similar at 60, 90, and 120 days of age. A statistical difference was detected among the formula groups in 3 categories of adverse events: diarrhea (control vs PG4, 4% vs 18%, P = 0.008), eczema (PG4 vs control, 18% vs 7%, P = 0.046; PG4 vs PGL8, 18% vs 4%, P = 0.008), and irritability (control vs PGL8, 4% vs 16%, P = 0.027).

CONCLUSIONS

Infants fed formula supplemented with a prebiotic mixture achieved normal growth and stool characteristics more similar to those of breast-fed infants in comparison with infants fed an unsupplemented formula. A pediatrician needs to consider the risk of possible intolerance against the benefits of prebiotics.

Infants fed docosahexaenoic acid- and arachidonic acid-supplemented formula have decreased incidence of bronchiolitis/bronchitis the first year of life

To assess the effect of docosahexaenoic acid and arachidonic acid supplementation in infant formula on the incidence of respiratory illnesses, pediatricians assigned infants to receive docosahexaenoic acid/arachidonic acid-supplemented formula or control formula. Anthropometrics, medical history, and illnesses were reported. Among 1342 infants, there was a higher incidence of bronchiolitis in control versus docosahexaenoic acid/arachidonic acid-supplemented groups at 5, 7, and 9 months (P < .01). Weight, length, and head circumference were similar for both groups. Infants fed formula supplemented with 0.32% docosahexaenoic acid and 0.64% arachidonic acid experienced a lower incidence of bronchiolitis compared with infants fed formula supplemented with no docosahexaenoic acid/arachidonic acid or lower levels of docosahexaenoic acid/arachidonic acid in the first year of life.

fatty acids alter the lipid composition and size of apoB-100-containing lipoproteins secreted by HepG2 cells

This study was conducted to determine the secretion rate and composition of lipoproteins secreted by HepG2 cells as influenced by the type of fatty acid present in the incubation medium. Cells were preincubated for 24 h with palmitic, oleic, elaidic, linoleic or conjugated linoleic acid (CLA), and the lipoproteins secreted during a subsequent incubation period of 24 h were collected for analysis. The secretion rate of apolipoprotein B-100 (apoB) was significantly greater in HepG2 cells preincubated with elaidic acid compared with those preincubated with palmitic or oleic acid; apoB secretion was greater in cells preincubated with CLA compared with those preincubated with linoleic acid. The lipid composition of secreted lipoproteins was also influenced by fatty acid treatment, resulting in significantly smaller lipoprotein particles secreted by cells preincubated with elaidic acid and CLA compared with those secreted by cells treated with oleic acid and linoleic acid, respectively. Our results are relevant to human metabolism for the following reasons: (1) the size of plasma low-density lipoproteins (LDLs) is determined, at least in part, by the composition of apoB-containing lipoproteins secreted by the liver; (2) small plasma LDL particles are associated with an increased risk of coronary heart disease; and (3) specific dietary fatty acids can affect the composition and size of plasma LDLs, thereby imparting a relative atherogenicity to plasma LDLs independent of LDL cholesterol concentration. The present study therefore suggests that elaidic acid and CLA promote the hepatic secretion of small apoB-containing lipoproteins, which could lead to an increased production of small plasma LDL particles.

Vitamin B-6 intakes and plasma B-6 vitamer concentrations of men and women, 19-50 years of age

The vitamin B-6 intakes and plasma B-6 vitamer levels of healthy nonsupplemented men and women, 19-24 and 25-50 years, were compared. The subjects did not take nutrient supplements or medications or use tobacco products. Subjects were grouped as follows: eight, 19-24 y men; nine, 25-50 y men; 11, 19-24 y women; and 13, 25-50 y women. The estimated vitamin B-6 intakes, obtained via 24-h recalls followed by 2-d food records, of the two groups of men were significantly higher (P < 0.05) than those of the two groups of women. Thirty-five percent of the women reported consuming less than the Estimated Average Requirement for vitamin B-6. The four gender: age groups had similar B-6 vitamer concentrations of plasma pyridoxal-5'-phosphate, 4-pyridoxic acid, pyridoxine, pyridoxamine, and pyridoxamine-5'-phosphate. Males 25-50 y had significantly higher (P < 0.05) plasma pyridoxal concentrations than the two groups of females. All subjects had pyridoxal-5'-phosphate concentrations indicative of vitamin B-6 adequacy. Generally the plasma B-6 vitamer concentrations of these men and women, 19-24 and 25-50 years of age, all having adequate vitamin B-6 status, were similar.