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Tao J, Rupar CA, Miller MR, Ratko S, Prasad C. Use of complementary and alternative medicine in patients with inborn errors of metabolism: A single-center study. JIMD Rep 2019; 51:105-112. [PMID: 32071845 PMCID: PMC7012736 DOI: 10.1002/jmd2.12089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives There is a paucity of information on the use of complementary and alternative medicine (CAM) in patients with inborn errors of metabolism (IEM). This study's objective was to evaluate the self-reported use and perceived effectiveness of CAM in adults and children with IEM. Methods Patients aged 0-70 years and caregivers seen at the London Health Sciences Centre Metabolic Clinic (London, Ontario, Canada) between July 2017 and August 2017 were recruited to complete a questionnaire regarding CAM use to help their IEM diagnosis and perceived effectiveness of these therapies. Survey responses were analyzed using descriptive statistics; age, sex, and education level associations among CAM users were tested using the Pearson χ 2 test. Results Of 50 potential participants, 44 (88%) completed the questionnaire, including 21 adults (6 by caregivers) and 23 children (22 by caregivers). The most common IEM category was Aminoacidopathies and Small Molecule Disorders (50%). Twenty-seven (61%) participants reported CAM use to help their IEM diagnosis. The most common CAM therapies used were chiropractic manipulation, omega-3 fatty acids, probiotics, and aromatherapy/essential oils. Most CAM users and caregivers (74%) perceived their CAM therapies as effective overall. Among CAM users, 40% had not discussed CAM use with a health care professional (HCP). CAM use was similar when comparing age, sex and education level. Conclusions CAM is commonly used among patients with IEM. The safety and efficacy of CAM therapies for IEM should be further investigated. HCPs and patients should openly discuss CAM use in order to evaluate safety.
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Affiliation(s)
- Jessica Tao
- Faculty of Science Western University London Ontario Canada
| | - C Anthony Rupar
- Department of Pathology & Laboratory Medicine and Biochemistry Western University London Ontario Canada.,Department of Paediatrics Western University London Ontario Canada.,Children's Health Research Institute, Western University London Ontario Canada
| | - Michael R Miller
- Department of Paediatrics Western University London Ontario Canada.,Children's Health Research Institute, Western University London Ontario Canada
| | - Suzanne Ratko
- Children's Hospital, London Health Sciences Centre London Ontario Canada
| | - Chitra Prasad
- Department of Paediatrics Western University London Ontario Canada.,Children's Health Research Institute, Western University London Ontario Canada
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153
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Shi J, Hu H, Harnett J, Zheng X, Liang Z, Wang YT, Ung COL. An evaluation of randomized controlled trials on nutraceuticals containing traditional Chinese medicines for diabetes management: a systematic review. Chin Med 2019; 14:54. [PMID: 31798675 PMCID: PMC6884840 DOI: 10.1186/s13020-019-0276-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutraceuticals containing traditional Chinese medicine (TCM) are promoted for use in the management of diabetes. The evidence to support such use is largely unknown. This study aimed to summarise and evaluate the literature reporting the results of randomized controlled trials (RCTs) investigating the effects of nutraceuticals in people living with diabetes. METHODS Literature from four electronic databases (PubMed, Scopus, CINAHL and Web of Science) was searched following PRISMA guidelines to yield RCT publications on nutraceutical for diabetes management published since 2009. The quality of reporting was assessed using the CONSORT 2010 checklist statement. Risk-of-bias for each study was assessed using the Cochrane risk of bias tool. RESULTS Out of 1978 records identified in the initial search, 24 randomized, double/triple-blinded, controlled trials that investigated the effect of nutraceuticals covering 17 different TCM herbs for diabetes management were selected. Participants included people who were diabetic (n = 16), pre-diabetic (n = 3) or predisposed to diabetes (n = 5). Sample sizes ranged between 23 and 117 for 2 arms, or 99-165 for 3 arms. Comparisons were made against placebo (n = 22), conventional medicine (n = 1), or regular diet (n = 1) for a duration between 4 and 24 weeks. All but one study tested the effect on fasting blood glucose levels (n = 23) or glycated haemoglobin levels (n = 18), and/or postprandial 2-h blood glucose levels (n = 4) as the primary outcomes. Nineteen studies reported some statistically significant reductions in the respective measures while 5 studies showed no effect on primary or secondary outcomes. None of the included studies met all the criteria for the CONSORT guidelines. Incomplete reporting about randomization and blinding, and a lack of ancillary analyses to explore other influential factors and potential harms associated with the use were repeatedly noted. Based on the Cochrane risk-of-bias tool, 19 studies were deemed to have a high risk of bias mainly attributed to sponsor bias. CONCLUSIONS There is some evidence to suggest positive clinical outcomes in response to the administration of a range of nutraceuticals containing TCM in the management of diabetes. However, these results must be interpreted with caution due to the overall low quality of the trials.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Joanna Harnett
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Xiaoting Zheng
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Zuanji Liang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Yi-Tao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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154
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Subaiea GM, Altebainawi AF, Alshammari TM. Energy drinks and population health: consumption pattern and adverse effects among Saudi population. BMC Public Health 2019; 19:1539. [PMID: 31752795 PMCID: PMC6869250 DOI: 10.1186/s12889-019-7731-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caffeine containing energy drinks (EDs) are heavily consumed, particularly among young adults. The number of reports of caffeine intoxication from caffeinated EDs and problems related to caffeine dependence and withdrawal is increasing. The objective was to assess the knowledge and perceived beneficial effects of EDs consumers, to assess consumption patterns and determine the adverse effects experienced by different EDs consumer groups residing in Saudi Arabia. METHODS An observational cross-sectional study with data from a randomly selected Saudi population was conducted during the period of January 15th, 2015, to April 15th, 2015, using a pre-tested 43-item questionnaire. The data were obtained and collected using interview questionnaires. Sociodemographic characteristics and data on EDs consumption patterns, the level of awareness among study subjects, and the purported benefits and reported adverse effects of EDs were collected. Frequency, percentage, and arithmetic means were calculated using Chi-square and ANOVA tests, and data with p < 0.05 were considered significant. RESULTS Of the 816 individuals invited to participate in the study, 783 participants responded and completed interviews, response rate was 96%. Consumers attributed the popularity of EDs to massive advertising media (46.7%) and their stimulating and invigorating effects (37.5%). EDs are consumed by subjects for their effects on fatigue reduction (64.6%), increased alertness and focus (75.8%), and assistance during long driving trips (75.7%). Study subjects reported suffering from adverse effects, including mainly diuresis (53.7%), palpitations (50.7%), insomnia (50.7%). Importantly, an inverse association was identified between knowledge of EDs and consumption rate, and a proportional association was identified between experienced adverse effects and consumption frequency. Lower knowledge scores were identified in daily consumers than in 1-3 times monthly consumers; higher adverse events were experienced by daily consumers than by 1-3 times monthly consumers. The majority of consumers (84.6%) recommended that authorities should regulate EDs consumption. CONCLUSIONS Excessive EDs consumption is associated with an increased risk of experiencing several adverse events, which is commensurate with published studies. Increasing knowledge about EDs and their possible risks could decrease their consumption by the general public.
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Affiliation(s)
- Gehad M. Subaiea
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Ali F. Altebainawi
- Medication Safety Research Chair, King Saud University, Riyadh, Kingdom of Saudi Arabia
- College of Pharmacy, University of Hail, Hail, Kingdom of Saudi Arabia
- Clinical Pharmacy Department, Pharmaceutical Care Services, King Khalid Hospital, Ministry of Health, Hail, Kingdom of Saudi Arabia
| | - Thamir M. Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, P.O.Box 6166, Zip code 81442 Hail City, Kingdom of Saudi Arabia
- Saudi Food and Drug Authority, Riyadh, Kingdom of Saudi Arabia
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Punzalan C, Budnitz DS, Chirtel SJ, Geller AI, Jones OE, Mozersky RP, Wolpert B. Swallowing Problems and Dietary Supplements: Data From U.S. Food and Drug Administration Adverse Event Reports, 2006-2015. Ann Intern Med 2019; 171:771-773. [PMID: 31426091 PMCID: PMC7031005 DOI: 10.7326/m19-0947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Cecile Punzalan
- U.S. Food and Drug Administration, College Park, Maryland (C.P., S.J.C., O.E.J., R.P.M., B.W.)
| | - Daniel S Budnitz
- Centers for Disease Control and Prevention, Atlanta, Georgia (D.S.B., A.I.G.)
| | - Stuart J Chirtel
- U.S. Food and Drug Administration, College Park, Maryland (C.P., S.J.C., O.E.J., R.P.M., B.W.)
| | - Andrew I Geller
- Centers for Disease Control and Prevention, Atlanta, Georgia (D.S.B., A.I.G.)
| | - Olivia E Jones
- U.S. Food and Drug Administration, College Park, Maryland (C.P., S.J.C., O.E.J., R.P.M., B.W.)
| | - Robert P Mozersky
- U.S. Food and Drug Administration, College Park, Maryland (C.P., S.J.C., O.E.J., R.P.M., B.W.)
| | - Beverly Wolpert
- U.S. Food and Drug Administration, College Park, Maryland (C.P., S.J.C., O.E.J., R.P.M., B.W.)
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Hamilton N, Alamri Y, Allan C, Doogue M. Ginkgo biloba-related hyponatraemia: a reminder that herbal supplements are not benign. Intern Med J 2019; 49:1458-1460. [PMID: 31713332 DOI: 10.1111/imj.14625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Niall Hamilton
- Department of Infectious Diseases, Auckland District Health Board, Auckland, New Zealand
| | - Yassar Alamri
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Caroline Allan
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Matthew Doogue
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
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157
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Elliott C. Assessing Vitamins, Minerals and Supplements Marketed to Children in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224326. [PMID: 31698815 PMCID: PMC6888471 DOI: 10.3390/ijerph16224326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/03/2022]
Abstract
Given the growth of supplements specifically designed for children in Canada, this study examines the nutrient levels of these products, and evaluates them in light of the US Health and Medical Division (HMD)—formerly the Institute of Medicine—and Health Canada’s recommendations. Content analysis was used to document the nutrient levels of child-targeted vitamins, minerals and fish oils/omega-3s (n = 80) in Calgary, Alberta, Canada. Products were assessed according to HMD and Health Canada dosage recommendations for children, and the percentage of Estimate Average Requirements (EAR), Adequate Intakes (AI), and Tolerable Upper Intakes Level (UL) calculated. Median EAR/AI/UL percentages and quartiles were calculated for each nutrient, and estimates for the adequate intake recommendations plotted with box plots. Sixty five percent of the products assessed were multivitamins; the median dose was higher than AI recommendations for vitamins A, B6, B12, and C, as well as thiamin, riboflavin, pantothenic acid, and biotin. Substantial variation in vitamin, mineral, or fish oil dosage was found between similar supplements—with nutrients such as vitamin B12 ranging from 83% to 5557% of AI. Such findings matter because the very existence of these products suggests that children should be taking them, yet more research is needed on their potential (adverse) effects over both the short and long term. The substantial variation in dosages between products also raises questions about the (perhaps unnecessary) fortification of our children, as well as the expectations that parents know—or are even aware of—appropriate nutrient levels for their kids.
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Affiliation(s)
- Charlene Elliott
- Department of Communication, Media, and Film, University of Calgary, Calgary, AB T2N 1N4, Canada
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158
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Parker ML, Stefan C, Reich HN, Kulasingam V. What Is Really in This Weight Loss Supplement? J Appl Lab Med 2019; 4:270-273. [PMID: 31639674 DOI: 10.1373/jalm.2018.027169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Michelle L Parker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Canada
| | - Heather N Reich
- Division of Nephrology, Toronto Glomerulonephritis Registry, University Health Network, Toronto, Canada
| | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; .,Department of Clinical Biochemistry, University Health Network, Toronto, Canada
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159
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Or F, Kim Y, Simms J, Austin SB. Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults. J Adolesc Health 2019; 65:455-461. [PMID: 31176525 DOI: 10.1016/j.jadohealth.2019.03.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of the study was to evaluate the relationship between supplement categories and adverse events in children, adolescents, and young adults. METHODS This is a retrospective observational study using adverse event reports between January 2004 and April 2015 in the U.S. Food and Drug Administration Adverse Event Reporting System on food and dietary supplements database. We quantified the relative risks for severe medical events of dietary supplements sold for various functions relative to vitamins among individuals aged between 0 and 25 years. Severe medical events include death, disability, life-threatening events, hospitalization, emergency room visit, and/or required intervention to prevent permanent disability. RESULTS There were 977 single-supplement-related adverse event reports affecting individuals aged between 0 and 25 years over 11 years (50.6% female; age: mean = 16.5 years, standard deviation = 7.5 years). Supplements sold for muscle building (risk ratio [RR] = 2.7; 95% confidence interval [CI] = 1.9-4.0), energy (RR = 2.6; 95% CI = 1.9-3.6), and weight loss (RR = 2.6; 95% CI = 1.9-3.4) were associated with almost three times the risk for severe medical events compared with vitamins. CONCLUSIONS Consumption of dietary supplements sold for weight loss, muscle building, and energy involved increased risks for severe medical events compared with vitamins. Proactive enforcement of regulations is needed to reduce access and consumption among children, adolescents, and young adults.
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Affiliation(s)
- Flora Or
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Juliana Simms
- Harvard University Information Technology, Cambridge, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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160
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Nathan JP, Kudadjie-Gyamfi E, Halberstam L, Wright JT. Consumers' Information-Seeking Behaviors on Dietary Supplements. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:171-176. [PMID: 31514581 DOI: 10.1177/0272684x19874967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Consumers are advised to seek information about dietary supplements (DS) before using them; little is known concerning whether this recommendation is heeded. Objective The objectives of this pilot study were to investigate whether users of DS seek information about these products before using them and particularly whether such information is sought from health-care professionals (HCPs). Methods Surveys administered face-to-face to adult consumers at three venues in New York City. Results Between November 2017 and October 2018, 199 consumers were surveyed. Of the 139 (70%) DS users, 104 (75%) used at least one DS that was not prescribed/recommended by an HCP. Of those, 88 (85%) reported seeking information about DS before using them and two (2%) noted that for some they do and for some they do not. The source of information most frequently used was the Internet (76; 84%). Pharmacists, dietitians/nutritionists, and medical doctors were reported to be a source of information by seven (8%), six (7%), and five (6%) of the respondents, respectively. DS were most commonly purchased at a pharmacy (76; 54%). Of the 199 participants, 111 (56%) perceived DS to be “very safe” or “safe,” while 20 (10%) reported that DS were “unsafe” or “very unsafe”; 60 (30%) participants were “neutral.” Conclusion Although most DS users sought information prior to using them, the majority did so by using the Internet and only a few consulted with an HCP. HCPs should be proactive in educating consumers about the importance of consulting with them prior to using these products.
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Affiliation(s)
- Joseph P Nathan
- International Drug Information Center, CVS Health, Queens, NY, USA
| | | | | | - Josephine T Wright
- Accreditation Council for Education in Nutrition and Dietetics, Academy of Nutrition and Dietetics, Chicago, IL, USA
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161
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European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks. J Interv Card Electrophysiol 2019; 56:99-115. [PMID: 31482331 DOI: 10.1007/s10840-019-00610-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.
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162
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Crighton E, Weisenseel J, Bunce M, Musgrave IF, Trengove R, Maker G. Exploring the Application of the DSA-TOF, a Direct, High-resolution Time-of-Flight Mass Spectrometry Technique for the Screening of Potential Adulterated and Contaminated Herbal Medicines. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2019; 30:1713-1719. [PMID: 31209791 DOI: 10.1007/s13361-019-02256-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
Global consumption of complementary and alternative medicines, including herbal medicines, has increased substantially, and recent reports of adulteration demonstrate the need for high throughput and extensive pharmacovigilance to ensure product safety and quality. Three different standard reference materials and five previously analyzed herbal medicines have been used as a proof of concept for the application of adulteration/contamination screening using a Direct Sample Analysis (DSA) ion source with TOF MS on the Perkin Elmer AxION 2 TOF. This technique offers the advantages of minimum sample preparation, rapid analysis, and mass accuracies of 5 ppm. The DSA TOF analysis correlates well with the previous analysis on the initial sample set (which found undeclared herbal ingredients), with the added advantage of detecting previously untargeted compounds, including species-specific flavonoids and alkaloids. The rapid analysis using the DSA-TOF facilitates screening for hundreds of compounds in minutes with minimal sample preparation, generating a comprehensive profile for each sample. Graphical Abstract.
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Affiliation(s)
- Elly Crighton
- Separation Science and Metabolomics Laboratory, Murdoch University, South St, Murdoch, WA, 6150, Australia
- Medical, Molecular and Forensic Sciences, Murdoch University, South St, Murdoch, WA, 6150, Australia
| | - Jason Weisenseel
- PerkinElmer Environmental Health, 710 Bridgeport Ave., Shelton, CT, 06484, USA
| | - Michael Bunce
- Trace and Environmental DNA (TrEnD) Laboratory, School of Molecular and Life Sciences, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Ian F Musgrave
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Robert Trengove
- Separation Science and Metabolomics Laboratory, Murdoch University, South St, Murdoch, WA, 6150, Australia
| | - Garth Maker
- Separation Science and Metabolomics Laboratory, Murdoch University, South St, Murdoch, WA, 6150, Australia.
- Medical, Molecular and Forensic Sciences, Murdoch University, South St, Murdoch, WA, 6150, Australia.
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163
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Vasilakes J, Fan Y, Rizvi R, Bompelli A, Bodenreider O, Zhang R. Normalizing Dietary Supplement Product Names Using the RxNorm Model. Stud Health Technol Inform 2019; 264:408-412. [PMID: 31437955 PMCID: PMC6792000 DOI: 10.3233/shti190253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of dietary supplements (DSs) is increasing in the U.S. As such, it is crucial for consumers, clinicians, and researchers to be able to find information about DS products. However, labeling regulations allow great variability in DS product names, which makes searching for this information difficult. Following the RxNorm drug name normalization model, we developed a rule-based natural language processing system to normalize DS product names using pattern templates. We evaluated the system on product names extracted from the Dietary Supplement Label Database. Our system generated 136 unique templates and obtained a coverage of 72%, a 32% increase over the existing RxNorm model. Manual review showed that our system achieved a normalization accuracy of 0.86. We found that the normalization of DS product names is feasible, but more work is required to improve the generalizability of the system.
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Affiliation(s)
- Jake Vasilakes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, USA
| | - Yadan Fan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Rubina Rizvi
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, USA
| | - Anusha Bompelli
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Olivier Bodenreider
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutions of Health, USA
| | - Rui Zhang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, USA
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Suspected adverse reactions associated with herbal products used for weight loss: spontaneous reports from the Italian Phytovigilance System. Eur J Clin Pharmacol 2019; 75:1599-1615. [PMID: 31428816 DOI: 10.1007/s00228-019-02746-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Overweight and obesity represent worldwide a rising health problem. In this context, dietary supplements and herbal preparations are often used as self-medication for weight loss. The aim of this study was to describe the safety profile of dietary supplements for weight control by analyzing spontaneous reports of suspected adverse reactions (ARs) received by the Italian Phytovigilance System, from July 2010 to October 2017. METHODS The suspected ARs were collected using an ad hoc reporting form, registered in a database at the National Institute of Health and evaluated by a multidisciplinary group of experts. The causality assessment was performed using the WHO-UMC system or the CIOMS/RUCAM score. In case of serious adverse reactions, a feedback is provided to the reporter by e-mail. RESULTS Sixty-six spontaneous reports were collected. ARs involved cardiovascular system (26%), liver (14%), central nervous system (12%), skin (9%), gastrointestinal system (17%), thyroid (8%), kidney (4%), and other organs/systems (10%). In 64% of cases, the reaction was serious. Dechallenge was positive in 46 cases; three cases of positive rechallenge were reported. After the causality assessment, the association between the product intake and the adverse reaction was judged as possible in the majority of the cases (n = 43; 65%). CONCLUSIONS The data collected confirmed the existence of safety concerns on herbal dietary supplements used for body weight control, mainly related to quality of products and their use as self-medication. In this scenario, spontaneous reports represent the only tools available to monitor safety of these products.
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165
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Hebestreit A, Bogl LH. Dietary Behavior and Physical Activity in Children and Adolescents. Nutrients 2019; 11:E1849. [PMID: 31404953 PMCID: PMC6723607 DOI: 10.3390/nu11081849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
In recent years, diet- and lifestyle-related disorders have become a major health threat in Europe and worldwide [...].
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Affiliation(s)
- Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, D-28359 Bremen, Germany
| | - Leonie H Bogl
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1. Floor, A-1090 Vienna, Austria.
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Guzman JR, Paterniti DA, Liu Y, Tarn DM. Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine. ACTA ACUST UNITED AC 2019; 5. [PMID: 32051918 PMCID: PMC7015169 DOI: 10.23937/2469-5793/1510109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients’ disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. Methods: Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. Results: We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients’ convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). Conclusions: When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.
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Affiliation(s)
- Jennifer R Guzman
- Department of Anthropology, State University of New York at Geneseo, USA
| | - Debora A Paterniti
- Department of Sociology, Sonoma State University, USA.,Departments of Internal Medicine and Sociology, University of California - Davis, USA
| | | | - Derjung M Tarn
- Department of Family Medicine, University of California - Los Angeles, USA
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167
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Sassone J, Muster M, Barrack MT. Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes. J Strength Cond Res 2019; 33:443-450. [PMID: 30531412 DOI: 10.1519/jsc.0000000000002979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.
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Affiliation(s)
- John Sassone
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | - Mark Muster
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
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168
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Fontana RJ. Severe Acute Hepatitis Attributed to the Herbal and Dietary Supplement OxyELITE Pro. Clin Liver Dis (Hoboken) 2019; 14:45-48. [PMID: 31508218 PMCID: PMC6726377 DOI: 10.1002/cld.809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/15/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Robert J. Fontana
- Division of Gastroenterology, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMI
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169
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Lombardi N, Crescioli G, Bettiol A, Menniti-Ippolito F, Maggini V, Gallo E, Mugelli A, Vannacci A, Firenzuoli F. Safety of complementary and alternative medicine in children: A 16-years retrospective analysis of the Italian Phytovigilance system database. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 61:152856. [PMID: 31035051 DOI: 10.1016/j.phymed.2019.152856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dietary supplements and homeopathic medicines are largely used in children as complementary and alternative medicine (CAM) to treat different health conditions. Safety of CAM is unknown when they are marketed. This study analysed suspected CAM-related adverse reaction (AR) in pediatric population. METHODS The Italian Phytovigilance system was searched for reports of suspected AR related to CAM use in children (0-18 years) from 2002 to 2018. AR reports were evaluated and information about patient's demographic characteristics, suspected CAM, conventional medications, and ARs were collected. In particular, we evaluated whether patient's and CAM characteristics, and concomitant drugs could be potential predictors of ARs seriousness. RESULTS We evaluated 206 pediatric CAM-related AR reports, of which 69 were serious. Patients were mostly treated with only one CAM (n = 193), and 39% of AR reports were related to products containing 2-5 components. Most reported ARs were related to dietary supplements (57.18%), and skin and subcutaneous tissue disorders (40.29%) were the most involved System Organ Class. CAM-related AR reported as serious were higher in subjects exposed to homeopathic medicines (ROR 3.13 [1.88-5.22]), to CAM in presence of concomitant medications (ROR 1.77 [1.01-3.10]), to CAM containing 2-4 components (ROR 2.18 [1.13-4.22]), and to more than three concomitant CAM (ROR 7.81 [1.97-32.69]). CONCLUSION We provide new insights on factors that might increase the risk of serious AR associated with CAM use in children: products containing more than two components and simultaneously administered with conventional medications can represent a potential risk in children.
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Affiliation(s)
- Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | | | - Valentina Maggini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Eugenia Gallo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
| | - Fabio Firenzuoli
- Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
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170
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Kurani S, Hickson LJ, Thorsteinsdottir B, Barreto EF, Haag JD, Shah ND, McCoy RG. Supplement Use by US Adults With CKD: A Population-Based Study. Am J Kidney Dis 2019; 74:862-865. [PMID: 31327533 DOI: 10.1053/j.ajkd.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Shaheen Kurani
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | - LaTonya J Hickson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bjorg Thorsteinsdottir
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Erin F Barreto
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | - Nilay D Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rozalina G McCoy
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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171
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Abdulla NM, Aziz F, Blair I, Grivna M, Adam B, Loney T. Prevalence of, and factors associated with health supplement use in Dubai, United Arab Emirates: a population-based cross-sectional study. Altern Ther Health Med 2019; 19:172. [PMID: 31299957 PMCID: PMC6624985 DOI: 10.1186/s12906-019-2593-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/04/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Health supplement (HS) products that are available in the Emirate of Dubai (United Arab Emirates; UAE) contain chemicals that may adversely affect human health. This study aimed to investigate the prevalence of, and factors associated with HS consumption, knowledge, related adverse events, and reporting practices of adverse events amongst the general population in Dubai, UAE. METHODS A cross-sectional household telephone survey using a computer-assisted questionnaire was conducted amongst a random representative sample (n = 1203) of the Dubai population that assessed HS use and knowledge. Dependent variables were supplement use and reports of adverse events while independent variables included socio-demographic factors, knowledge, attitudes, and practice. Logistic regression analysis was performed to identify factors independently associated with HS use. RESULTS Among the 1203 participants in this study, 455 (37.8%) reported ever using HS. Amongst ever-users, reasons for use were to improve health (66.1%), for bodybuilding (9.9%), disease prevention (6.8%), and weight management (5.3%). The majority of users purchased their HS from pharmacies (88.4%) or were prescribed HS (46.6%). Vitamins were the most commonly used HS (87.9%) followed by minerals (10.5%) and sports nutrition products (10.5%). Only 2.9% of users experienced an adverse event associated with HS use which all resolved when the HS was discontinued. Only three of those affected reported the incident. Multivariate logistic regression analysis revealed that HS use was independently associated with female gender (adjusted odds ratio [AOR]; 3.26, 95% confidence interval [CI]: 2.26-4.70), higher income (AOR 2.41, 95% CI: 1.20-4.83), being a past-smoker (AOR 2.39, 95% CI: 1.27-4.48), having an allergy (AOR 1.75, 95% CI: 1.14-2.66), more frequent doctor visits (AOR 1.86, 95% CI: 1.02-3.39), taking prescribed medications (AOR 1.47, 95% CI: 1.04-2.06), and knowledge about HS (AOR 3.91, 95% CI: 2.26-6.76). CONCLUSIONS Our study provides the first population-based estimates of HS use and HS-related adverse events in the Gulf region. Adverse events associated with HS are infrequent and this may be due to the well-developed regulatory framework in Dubai and the high level of knowledge amongst consumers who mainly consume vitamins and minerals on the advice of pharmacists or healthcare professionals.
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172
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Wahab MSA, Sakthong P, Winit-Watjana W. Development and validation of novel scales to determine pharmacist's care for herbal and dietary supplement users. Res Social Adm Pharm 2019; 16:475-487. [PMID: 31255476 DOI: 10.1016/j.sapharm.2019.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The factors associated with the provision of pharmacist's care (PCare) for herbal and dietary supplement (HDS) users are multidimensional. These factors should be investigated to assess the needs for community pharmacists (CPs) to provide the service. However, at present, there are no validated and reliable theory-based instruments to measure the factors. OBJECTIVES The study aims to develop and validate scales (direct and indirect) based on a modified Theory of Planned Behavior (TPB) to measure factors associated with the provision of PCare for HDS users by Thai CPs. METHOD Item generation for the scales was based on the theoretical constructs of the modified TPB framework, literature review, and authors' previous qualitative study. Draft items were then subjected to content validity and face validity. Psychometric testing was carried out among CPs in Bangkok, Thailand. Refinement of the scales utilized factor analysis and validity was assessed using factor analysis and Rasch analysis. Internal consistency reliability and construct reliability were used to assess the scales' reliability. RESULTS Initially, the direct and indirect scales contained 15 and 28 items, respectively and were reduced to 12 and 16 items, after experts' review. Factor analysis further reduced the number of items of the indirect scale to 13. For both scales, confirmatory factor analysis showed model-data fit. Each construct of the direct scale was significant predictors of intention. Moreover, each construct of the direct scale correlated positively and significantly with the respective construct of the indirect scale, signifying concurrent validity. No misfit item was identified in the Rasch analysis and the majority of items were invariant across gender. Internal consistency reliability and construct reliability of the scales were acceptable. CONCLUSION This study presents the development and validation of theoretically-grounded scales to measure the factors associated with the provision of PCare for HDS users by Thai CPs.
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Affiliation(s)
- Mohd Shahezwan Abd Wahab
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Patumwan, Bangkok, 10330, Thailand; Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, 42300, Malaysia
| | - Phantipa Sakthong
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Patumwan, Bangkok, 10330, Thailand.
| | - Win Winit-Watjana
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
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173
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Prevalence and Predictors of Dietary and Nutritional Supplement Use in the Australian Army: A Cross-Sectional Survey. Nutrients 2019; 11:nu11071462. [PMID: 31252600 PMCID: PMC6682915 DOI: 10.3390/nu11071462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022] Open
Abstract
Dietary supplements (DSs) and nutritional supplements (NSs) can enhance performance, recovery or training adaptations, however, some substances, dosages, and usage protocols are unsafe. Knowledge of the type and extent of use within populations enables strategies to be formulated to promote safe and effective use (where needed) and to avoid adverse side effects. The purpose of this study was to understand DS and NS use by active-duty Australian soldiers. Surveys were distributed by e-mail and hard copy to eligible participants (n = 23,195). Respondents (males n = 1833; females n = 296) comprised 9.3% of the total population. Use of ≥1 DSs/week was reported by 76.4% of males and 86.8% of females, and use of ≥1 NSs/week was reported by 21.7% of males and 20.9% of females. The most commonly used supplements were protein or amino acids (55.6%), multivitamins and minerals (38.2%), other DSs (37.8%), individual vitamins and minerals (33.0%), and combination products (32.8%). Logistic regression revealed the number of DSs respondents used simultaneously was significantly different between males and females, age groups, BMI ranges, and body weight actions. Engagement in special operations was a significant predictor of the use of any DS, individual vitamin and minerals and multivitamin and minerals. Approximately 16% of regular DS users reported experiencing one or more side effects, with the most common being palpitations (10.6%), tingling or numbness in the face, fingers, arms, or legs (5.5%), tremors or shaking (2.9%), flushing (2.3%), headache (2.0%), abdominal pain (1.6%), anxiety (1.4%), and dizziness or confusion (0.9%). The results revealed more prevalent use of several categories of DSs and NSs among some subgroups. Ongoing surveillance of DS and NS use is important for tracking trends in use over time and gauging the effectiveness of any strategies employed to enhance the quality of supplement use.
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174
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Senekal M, Meltzer S, Horne A, Abrey NCG, Papenfus L, van der Merwe S, Temple NJ. Dietary supplement use in younger and older men exercising at gyms in Cape Town. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1628609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marjanne Senekal
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Shelly Meltzer
- Shelly Meltzer & Associates, Sports Science Institute of SA, Cape Town, South Africa
| | - Anri Horne
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Nicole CG Abrey
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Lauren Papenfus
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
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175
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Jatau AI, Shitu Z, Khalid GM, Yunusa I, Awaisu A. Understanding adverse drug-related emergency department visits: development of a conceptual model through a systematic review. Ther Adv Drug Saf 2019; 10:2042098619852552. [PMID: 31258886 PMCID: PMC6591658 DOI: 10.1177/2042098619852552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background The burden of adverse drug event (ADE)-related emergency department (ED) visits is increasing despite several preventive measures. The objective of this paper was to develop and validate a conceptual model for a better understanding of ADE-related ED visits and to guide the design and implementation of effective interventions. Methods The development of the model involved a systematic review of the literature using PubMed and Embase databases. Studies reporting the risk factors associated with ADE-related ED visits were included. The methodological qualities of the included studies were assessed using the Mixed Methods Appraisal Tool (MMAT). The model was mapped and validated using face and content validity by an expert panel. Deficiencies and targeted interventions were identified, and steps for the design and implementation were recommended. Results The literature search generated 1361 articles, of which 38 were included in the review; 41 risk factors associated with ADE-related ED visits were identified. All factors were mapped, and the model was validated through face and content validity. The model consisted of six concepts related to sociodemographic factors, clinical factors, ADE-related to ED visits, ADE while in the ED, outcomes, and consequences. Interventions could be targeted at the factors identified in each concept to prevent ADE-related ED burden. Conclusion A conceptual model to guide the successful design and implementation of strategies to prevent ADE-related ED visits and the occurrence of ADE at ED was developed. Clinicians should take these factors into consideration to prevent untoward events, especially when treating high-risk patients.
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Affiliation(s)
| | - Zayyanu Shitu
- Faculty of Health Science, Univeristi Sultan Zainal Abidin, Terengganu, Malaysia
| | - Garba Mohammed Khalid
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Ismaeel Yunusa
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, USA
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
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176
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Kobayashi E, Sato Y, Umegaki K, Chiba T. [Analysis of Safety Alerts Associated with Dietary Supplements from Japan and Overseas]. Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi) 2019; 59:93-98. [PMID: 29695678 DOI: 10.3358/shokueishi.59.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of dietary supplement use has increased in Japan, and consumers can purchase supplements from foreign countries through the internet. Therefore, it is important to consider both domestic and overseas safety alerts to prevent adverse events associated with dietary supplement use. We have been collecting global safety alerts associated with dietary supplements and providing this information to the public via the "Information system on safety and effectiveness for health foods (HFNet)" website. In this study, we analyzed the characteristics of safety alerts from 2010 to 2016 in HFNet (total: 2,124 alerts). The most common reason for alerts was illegal adulteration with pharmaceutical substances (85%), and sexual enhancement or weight loss products accounted for 68% of all alerts. Most alerts were based on market surveillance reports or recall information. However, 181 adverse event reports were identified, and most of them were related to weight loss or disease treatment in patients. In Japan, a majority of the adverse events was caused by products intended for weight loss or purchased online, and young female users were commonly involved. These findings should be helpful for prevention of adverse events associated with dietary supplement use.
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Affiliation(s)
- Etsuko Kobayashi
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Yoko Sato
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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177
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Vida RG, Fittler A, Somogyi-Végh A, Poór M. Dietary quercetin supplements: Assessment of online product informations and quantitation of quercetin in the products by high-performance liquid chromatography. Phytother Res 2019; 33:1912-1920. [PMID: 31155780 DOI: 10.1002/ptr.6382] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/31/2019] [Accepted: 04/15/2019] [Indexed: 12/18/2022]
Abstract
Administration of the increasingly popular dietary supplements containing quercetin may interfere with drug therapy. We intended to evaluate the online availability and quercetin content of the high-dose mono-component quercetin products and to review the potential use of quercetin products and their interactions with drugs. We monitored the online access to quercetin-containing dietary supplements, collected the relevant information from the websites, procured selected products from the vendors, and subjected them to substance analysis. The quercetin content was quantified by an HPLC-UV method. Twenty-five websites offered mono-component quercetin products, and nine products were procured. The quercetin content of eight products differed only ±10% from the nominal dose, whereas one product contained almost 30% more quercetin. Misleading indications such as antitumor and cardiovascular effects were often found on the sellers' websites. Quercetin-containing dietary supplements are available online with misleading indications. The recommended daily doses are often high (occasionally over 1,000 mg), which may induce clinically relevant interactions with medications. Because high-quercetin content of dietary supplements was confirmed, health care professionals should be aware of the unregulated internet market of dietary supplements and should consider the interactions of these substances with drugs.
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Affiliation(s)
- Róbert György Vida
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - András Fittler
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Anna Somogyi-Végh
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Miklós Poór
- Department of Pharmacology, University of Pécs, Faculty of Pharmacy, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
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178
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Iqbal U, Anwar H, Siddiqui HU, Mehmood A. Acute Pancreatitis Secondary to Use of Appetite Suppressant: Garcinia cambogia. Cureus 2019; 11:e4676. [PMID: 31328067 PMCID: PMC6634349 DOI: 10.7759/cureus.4676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Due to the global epidemic of obesity, weight loss and appetite suppressant herbal products are quite popular. As these medications are not United States Food and Drug Administration-approved and are regulated as dietary supplements, little evidence exists regarding their safety. This case discusses an 82-year-old man with the past medical history of obesity who presented to the emergency department with abdominal pain in the epigastric region. His serum lipase was elevated, and an abdominal computed tomography revealed acute pancreatitis (AP). He reported two episodes of AP in the past. He denied any alcohol use and reported no recent changes in his medications. He reported taking Garcinia cambogia (GC) recently as an appetite suppressant. Due to prior cholecystectomy, no alcohol abuse, no recent changes in medications and recent use of GC, a likely etiology of AP was thought to be secondary to the use of GC. He was treated with bowel rest and intravenous fluid hydration with significant improvement in his symptoms. He was advised to avoid GC in the future. Clinicians should be vigilant in evaluating their patients with AP and should get a meticulous history regarding their use of over-the-counter medications and herbal products.
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Affiliation(s)
- Umair Iqbal
- Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, USA
| | - Hafsa Anwar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Hafiz Umair Siddiqui
- Surgery, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Asif Mehmood
- Internal Medicine, Geisinger Medical Center, Danville, USA
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179
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Vasilakes JA, Rizvi RF, Zhang J, Adam TJ, Zhang R. Detecting Signals of Dietary Supplement Adverse Events from the CFSAN Adverse Event Reporting System (CAERS). AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:258-266. [PMID: 31258978 PMCID: PMC6568094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dietary supplement adverse events are potentially severe, yet knowledge regarding the safety of dietary supplements is limited. The CFSAN Adverse Event Reporting System (CAERS) contains records of adverse events attributed to supplements and is potentially useful for dietary supplement pharmacovigilance. This study investigates the feasibility of mining CAERS for dietary supplement adverse events as well as for monitoring the safety of dietary supplement products. Using three online resources, we mapped products in CAERS to their listed ingredients. We then ran four standard signal detection algorithms over the ingredient-adverse event and product-adverse event pairs extracted from CAERS and ranked the detected associations. Comparing 130 signals detected by all four algorithms with a dietary supplement resource, we found evidence for 73 (56%) associations. In addition, some detected product-adverse event signals were consistent with product safety information. We have made a database of the detected adverse events publicly available at https://github.com/zhang-informatics/DDSAE.
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Affiliation(s)
- Jake A Vasilakes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Rubina F Rizvi
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Jianqiu Zhang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Terrence J Adam
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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180
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Sánchez-Oliver AJ, Grimaldi-Puyana M, Domínguez R. Evaluation and Behavior of Spanish Bodybuilders: Doping and Sports Supplements. Biomolecules 2019; 9:biom9040122. [PMID: 30925786 PMCID: PMC6523090 DOI: 10.3390/biom9040122] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023] Open
Abstract
The use of doping agents has these days become a public health problem, as it also affects young and non-competitive amateurs in different sports. To prepare for competition, bodybuilders perform aggressive dietary protocols, so, bodybuilders frequently consume nutritional supplements (NS) and banned substances in large dosages. Thus, the aim of this study is to analyze the prevalence of banned substances consumption and NS intake in competitive level bodybuilders. A total of 48 bodybuilders (44 males and 4 females) completed a validated online questionnaire on NS consumption. The quantitative data was presented as a mean (M) ± standard deviation (SD), as well as having minimum and maximum values. The categorical variables were expressed using frequencies and percentages. 83.3% of the participants declared that they had consumed or would consume banned substances, the most consumed being anabolic steroids (72.9%). One hundred percent of those sampled use NS. Whey protein (96%), branched-chain amino acids (BCAA) (94%), creatine (85%) and vitamin complexes (83%) were the most consumed, however, there is a low consumption of certain NS which could also increase athletic performance.
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Affiliation(s)
| | - Moisés Grimaldi-Puyana
- Department of Physical Education and Sports, Faculty of Educational Sciences, University of Seville, 41013 Seville, Spain.
| | - Raúl Domínguez
- Faculty of Health Sciences of Universidad Isabel I, Universidad Isabel I, 09004 Burgos, Spain.
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181
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Farrington R, Musgrave IF, Byard RW. Evidence for the efficacy and safety of herbal weight loss preparations. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:87-92. [PMID: 30738773 DOI: 10.1016/j.joim.2019.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/14/2018] [Indexed: 12/19/2022]
Abstract
Rising rates of obesity across the globe have been associated with an increase in the use of herbal preparations for weight control. However, the mechanisms of action for these substances are often not known, as is the potential for interaction with other herbal preparations or prescription pharmaceutical drugs. To investigate the reported efficacy and safety of herbal weight loss preparations, we conducted a review of the literature focusing on herbs that are most commonly used in weight loss preparations, specifically, Garcinia cambogia, Camellia sinensis, Hoodia gordonii, Citrus aurantium and Coleus forskohlii. There was no clear evidence that the above herbal preparations would cause sustained long-term weight loss in humans in the long term. Serious illness and even death have occasionally resulted from the use of herbal weight loss preparations. Few clinical trials have been undertaken to evaluate the efficacy and/or safety of herbal weight loss preparations. In addition, potential issues of herb-herb and herb-drug interactions are often not considered. Regulation of these products is much less rigorous than for prescription medications, despite documented cases of associated hepatotoxicity.
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Affiliation(s)
- Rachael Farrington
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Ian F Musgrave
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia; Forensic Science SA, Adelaide, South Australia 5000, Australia
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182
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Shade MY, Witry M, Robinson K, Kupzyk K. Analysis of oral dietary supplement use in rural older adults. J Clin Nurs 2019; 28:1600-1606. [PMID: 30589152 DOI: 10.1111/jocn.14763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES To describe and explore characteristics associated with oral dietary supplement use and identify potential interactions with prescription medications in a sample of rural community-dwelling older adults. BACKGROUND Older adults use polypharmacy to help manage chronic diseases. Due to healthcare access disparities, rural older adults may consider dietary supplement use as an alternative approach to maintain health and manage disease. Oral dietary supplement use is expected to increase among ageing adults; placing them at risk for potential interactions and adverse events. DESIGN A secondary analysis was conducted on oral dietary supplement, medication and health characteristic data collected on N = 138 participants. The original study was adherent to STROBE guidelines. RESULTS Researchers found that 83% of the rural older adults used oral dietary supplements in addition to their prescribed medications. Participants took additional single-dose vitamins along with their multivitamin; 57% took vitamin D, 52% took calcium, 15% took vitamin C and 13% took additional potassium and vitamin E. Participants also used oral dietary supplements with medications that had a potential for interaction. CONCLUSIONS Compared with national samples of older adults, a high percentage of rural older adults used oral dietary supplements in addition to their prescribed medications. In the rural setting, older adults are at risk for potential drug-oral dietary supplement interactions. RELEVANCE TO CLINICAL PRACTICE Nurses can conduct vigilant medication reconciliation that includes documenting characteristics of oral dietary supplement use. Nurses can assist with providing appropriate dietary supplements education that promotes patient knowledge and prevent inappropriate use; particularly when caring for older adults from rural settings.
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Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing-Omaha, Omaha, Nebraska.,University of Iowa College of Nursing, Iowa City, Iowa
| | - Matthew Witry
- University of Iowa College of Pharmacy, Iowa City, Iowa
| | | | - Kevin Kupzyk
- University of Nebraska Medical Center College of Nursing-Omaha, Omaha, Nebraska
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183
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Nishijima C, Sato Y, Chiba T, Umegaki K. Nationwide Online Survey to Complement the Current Voluntary Reporting System for Adverse Events Associated with Dietary Supplements: Application to the Case of Skin Manifestations. J Nutr Sci Vitaminol (Tokyo) 2019; 64:277-283. [PMID: 30175791 DOI: 10.3177/jnsv.64.277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current adverse event reporting system for dietary supplements lacks the ability to collect and analyze ongoing case reports in sufficient numbers to detect health issues. We conducted an online survey to collect data on skin manifestations due to supplement use in consumers and to identify the suspected products and ingredients. An online survey was conducted among 63,737 dietary supplement users in 2016. Those who self-reported experiences of skin anthema or itching caused by supplement use and recognized a causal relationship as almost certain (0.8%) were invited to provide further details of symptoms and products. Most of the users experienced mild symptoms with "itching and/or rash of body part." After the onset of skin manifestations, 69.3% ceased supplement use, while 26.6% continued supplement use, including those who reduced the amount or frequency of use. Respondents who visited the hospital in response to symptoms accounted for 26.0%, while 53.3% did not seek treatment. The products used were identified in 155 of 300 eligible respondents. Although those products were composed of multiple ingredients, the accumulated data suggested that cutaneous symptoms were related to the following constituents: "Peptides or animal by-products" (31.0%), "Herbal/Botanical" (23.2%) and "Fats and lipid" (13.5%). Conducting an online survey to elicit information directly from consumers identified components of supplements that are involved in skin manifestations that could lead to serious damage, and may fill a void in the current adverse event reporting system.
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Affiliation(s)
- Chiharu Nishijima
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Laboratory of Medical Chemistry, Graduate School of Nutrition Sciences, Kagawa Nutrition University
| | - Yoko Sato
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Department of Food Safety and Management, Showa Women's University
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184
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Affiliation(s)
- Michael Incze
- Department of Medicine, University of California, San Francisco.,Editorial Fellow
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185
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Alnaim L, Almazrou S, Alsunbul M, Alhaji A, Alenazi A, Alboami S. Pharmacist’s knowledge and attitudes towards complementary and alternative medicine in Saudi Arabia: A cross-sectional study. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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186
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Investigation and Comparison of Nutritional Supplement Use, Knowledge, and Attitudes in Medical and Non-Medical Students in China. Nutrients 2018; 10:nu10111810. [PMID: 30463386 PMCID: PMC6267366 DOI: 10.3390/nu10111810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
The objective of this study is to investigate and compare the prevalence, knowledge, and attitudes of Chinese university students with respect to nutritional supplements. We conducted a cross-sectional study in several universities around China from January to December 2017, and enrolled a total of 8752 students. Of these, 4252 were medical students and 4500 were non-medical students. The use of nutritional supplements was reported by 58.9% in universities students, with a higher rate for medical students as compared to non-medical students. It was found 24.2% of participants had taken supplements in the past year. Medical students had a higher level of knowledge on nutritional supplements than non-medical students (p < 0.001). The most commonly used nutritional supplements were vitamin C, calcium, and vitamin B. Gender (p < 0.001), household income (p < 0.001), and health status (p < 0.001) were related to the nutritional supplement use after adjustment for related factors. In conclusion, in China, nutritional supplement use was found to be more common in medical students than those studying other disciplines, and was associated with sex, income, and health status. The attitude towards nutritional supplements by medical students was positive. Students’ knowledge levels about nutritional supplements need to be improved
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187
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Abstract
The exploits of elite athletes delight, frustrate, and confound us as they strive to reach their physiological, psychological, and biomechanical limits. We dissect nutritional approaches to optimal performance, showcasing the contribution of modern sports science to gold medals and world titles. Despite an enduring belief in a single, superior “athletic diet,” diversity in sports nutrition practices among successful athletes arises from the specificity of the metabolic demands of different sports and the periodization of training and competition goals. Pragmatic implementation of nutrition strategies in real-world scenarios and the prioritization of important strategies when nutrition themes are in conflict add to this variation. Lastly, differences in athlete practices both promote and reflect areas of controversy and disagreement among sports nutrition experts.
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188
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Mister S. A tax on weight loss products based on fiction, not facts. Prev Med 2018; 116:223-224. [PMID: 30297143 DOI: 10.1016/j.ypmed.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
The recent article by Austin et al., "Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects," is disappointing for its lack of objectivity and its misrepresentation. While the conclusion is not surprising, the misinformation woven into the narrative is. Ultimately, their tax solution drives up cost; fails to distinguish between those willing to pay higher prices and those who are not; and may have relatively little influence on overall purchasing behavior.
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Affiliation(s)
- Steve Mister
- Council for Responsible Nutrition, 1828 L St., NW, Suite 810, Washington, DC 20036, United States of America.
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189
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Authors reply. Prev Med 2018; 116:225. [PMID: 30179631 DOI: 10.1016/j.ypmed.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022]
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190
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Kullen C, Prvan T, O’Connor H. Dietary Supplement Use in Australian Army Personnel. Mil Med 2018; 184:e290-e297. [DOI: 10.1093/milmed/usy266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/26/2018] [Accepted: 09/19/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Charina Kullen
- Australian Regular Army, Randwick Barracks, Sydney, NSW, Australia
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Tania Prvan
- Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
| | - Helen O’Connor
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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191
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Affiliation(s)
- Pieter A Cohen
- Department of Medicine, Cambridge Health Alliance, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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192
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Tucker J, Fischer T, Upjohn L, Mazzera D, Kumar M. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. JAMA Netw Open 2018; 1:e183337. [PMID: 30646238 PMCID: PMC6324457 DOI: 10.1001/jamanetworkopen.2018.3337] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Over half of adults in the United States report consuming dietary supplements. The US Food and Drug Administration (FDA) has warned of numerous dietary supplements containing undeclared, unapproved pharmaceutical ingredients. These FDA warnings have not been comprehensively analyzed for recent years. OBJECTIVE To summarize trends across adulterated (containing unapproved ingredients) dietary supplements associated with a warning released by the FDA from 2007 through 2016. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study, data were extracted from the FDA's Center for Drug Evaluation and Research, Tainted Products Marketed as Dietary Supplements_CDER database from 2007 through 2016. Data from each warning were recorded unless multiple warnings were issued for the same product within a 6-month period. Date, product name, company, hidden ingredient(s), product category, source of sample, and warning document type were recorded for each included warning. Data analysis was conducted from February 2017 to June 2017. RESULTS From 2007 through 2016, 776 adulterated dietary supplements were identified by the FDA and 146 different dietary supplement companies were implicated. Most of these products were marketed for sexual enhancement (353 [45.5%]), weight loss (317 [40.9%]), or muscle building (92 [11.9%]), with 157 adulterated products (20.2%) containing more than 1 unapproved ingredient. The most common adulterants were sildenafil for sexual enhancement supplements (166 of 353 [47.0%]), sibutramine for weight loss supplements (269 of 317 [84.9%]), and synthetic steroids or steroid-like ingredients for muscle building supplements (82 of 92 [89.1%]). There were 28 products named in 2 or 3 warnings more than 6 months apart. Of these products, 19 (67.9%) were reported to contain new unapproved ingredients in the second or third warning, consistent with the assumption that the FDA found the product to be adulterated more than once. In recent years (2014-2016), 117 of 303 adulterated samples (38.6%) were identified through online sampling and 104 of 303 (34.3%) were identified through the examination of international mail shipments. CONCLUSIONS AND RELEVANCE Active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.
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Affiliation(s)
- Jenna Tucker
- Food and Drug Branch, California Department of Public
Health, Sacramento
- California Epidemiologic Investigation Service (Cal
EIS) Fellowship Program, Sacramento
| | - Tessa Fischer
- Food and Drug Branch, California Department of Public
Health, Sacramento
- California Epidemiologic Investigation Service (Cal
EIS) Fellowship Program, Sacramento
| | - Laurence Upjohn
- Food and Drug Branch, California Department of Public
Health, Sacramento
| | - David Mazzera
- Food and Drug Branch, California Department of Public
Health, Sacramento
| | - Madhur Kumar
- Food and Drug Branch, California Department of Public
Health, Sacramento
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193
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Martin C. A role for plant science in underpinning the objective of global nutritional security? ANNALS OF BOTANY 2018; 122:541-553. [PMID: 29982346 PMCID: PMC6153469 DOI: 10.1093/aob/mcy118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/08/2018] [Indexed: 05/29/2023]
Abstract
Background The challenges of achieving global food security have become more demanding as scientists have realized that not only calorie content but also food composition and colonic microbial content impact our health and well-being, dramatically. The ways that the nutrients we consume affect our health are highly complex due to the diversity of what we eat, the varying digestibility of what we eat, the changing composition and functioning of each individual's gut microbiota, the differences in absorption and bioavailability of the nutrients we eat, the differences in responses between individuals to what they eat and the multi-fold mechanisms of action that nutrients have on our health. Perspective and Conclusions It has been accepted for more than 50 years that diets rich in plants, particularly fruit and vegetables, protect health, and yet such diets have declined, with lower fruit and vegetable content and much more cheap, sugary, oily, processed foods, over the same period. These dietary shifts have had a marked impact on the incidence of chronic diseases: obesity, metabolic diseases, type 2 diabetes and cardiovascular diseases. Greater support for research into the ways that plant-based foods impact health will be essential for changing dietary patterns to protect health and to achieve global nutritional security.
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Affiliation(s)
- Cathie Martin
- Department of Metabolic Biology, John Innes Centre, Norwich Research Park, Norwich, UK
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194
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Cohen PA, Travis JC, Keizers PHJ, Boyer FE, Venhuis BJ. The stimulant higenamine in weight loss and sports supplements. Clin Toxicol (Phila) 2018; 57:125-130. [DOI: 10.1080/15563650.2018.1497171] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Pieter A. Cohen
- Department of Internal Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Peter H. J. Keizers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Bastiaan J. Venhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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195
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Austin SB, Liu SH, Tefft N. Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects. Prev Med 2018; 114:39-46. [PMID: 29842920 DOI: 10.1016/j.ypmed.2018.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023]
Abstract
Abuse of widely available, over-the-counter (OTC) drugs and supplements such as diet pills, laxatives, and diuretics by adolescents for weight control is well-documented, yet manufacturers and retailers can sell them to minors without restriction. The aim of our study was to estimate the effect of added taxation of OTC drugs and dietary supplements sold for weight loss on household purchases of these products. With data from 60,538 U.S. households in the 2012 waves of the Nielsen/IRi National Consumer Panel (NCP) and the Nielsen/IRi Retail Scanner (NRS) datasets, we conducted analyses in 2017 to tally annual quantities and expenditures on OTC drugs or dietary supplements making weight-loss, cleanse/detox, or diuretic claims. We estimated the percent reduction in household purchases due to a simulated 20% added tax on each category. Among the 14,151 households reporting at least one purchase in the three claims categories, a 20% higher average price of weight-loss products was associated with a 5.2% lower purchases of those products. Among households with children ages 12 to 17 years old present, purchases were 17.5% lower, and among households with a daughter present, purchases were 10.3% lower. Taxation may be an effective public health strategy to reduce purchasing of potentially dangerous OTC drugs and supplements sold for weight loss, especially for households that include children ages 12-17 years old or a daughter.
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Affiliation(s)
- S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA.
| | - Selena Hua Liu
- Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA; Department of Nutrition, Simmons College, Boston, MA, USA
| | - Nathan Tefft
- Department of Economics, Bates College, Lewiston, ME, USA
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196
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Qato DM, Alexander GC, Guadamuz JS, Lindau ST. Prevalence of Dietary Supplement Use in US Children and Adolescents, 2003-2014. JAMA Pediatr 2018; 172:780-782. [PMID: 29913013 PMCID: PMC6142922 DOI: 10.1001/jamapediatrics.2018.1008] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses NHANES data to estimate the prevalence of dietary supplement use, including both nutritional products and alternative medicines, among US children and adolescents between 2003 and 2014.
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Affiliation(s)
- Dima M. Qato
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago,Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jenny S. Guadamuz
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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197
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Fan Y, Zhang R. Using natural language processing methods to classify use status of dietary supplements in clinical notes. BMC Med Inform Decis Mak 2018; 18:51. [PMID: 30066648 PMCID: PMC6069512 DOI: 10.1186/s12911-018-0626-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Despite widespread use, the safety of dietary supplements is open to doubt due to the fact that they can interact with prescribed medications, leading to dangerous clinical outcomes. Electronic health records (EHRs) provide a potential way for active pharmacovigilance on dietary supplements since a fair amount of dietary supplement information, especially those on use status, can be found in clinical notes. Extracting such information is extremely significant for subsequent supplement safety research. Methods In this study, we collected 2500 sentences for 25 commonly used dietary supplements and annotated into four classes: Continuing (C), Discontinued (D), Started (S) and Unclassified (U). Both rule-based and machine learning-based classifiers were developed on the same training set and evaluated using the hold-out test set. The performances of the two classifiers were also compared. Results The rule-based classifier achieved F-measure of 0.90, 0.85, 0.90, and 0.86 in C, D, S, and U status, respectively. The optimal machine learning-based classifier (Maximum Entropy) achieved F-measure of 0.90, 0.92, 0.91 and 0.88 in C, D, S, and U status, respectively. The comparison result shows that the machine learning-based classifier has a better performance, which is more efficient and scalable especially when the sample size doubles. Conclusions Machine learning-based classifier outperforms rule-based classifier in categorization of the use status of dietary supplements in clinical notes. Future work includes applying deep learning methods and developing a hybrid system to approach use status classification task.
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Affiliation(s)
- Yadan Fan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA. .,Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
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198
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Dreher M, Ehlert T, Simon P, Neuberger EWI. Boost Me: Prevalence and Reasons for the Use of Stimulant Containing Pre Workout Supplements Among Fitness Studio Visitors in Mainz (Germany). Front Psychol 2018; 9:1134. [PMID: 30065677 PMCID: PMC6056667 DOI: 10.3389/fpsyg.2018.01134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 06/13/2018] [Indexed: 12/24/2022] Open
Abstract
The rapidly increasing interest in fitness related sports over the past few years has been accompanied by a booming industry of nutritional supplements. Many of these substances have unproven benefits and are even potentially harmful to the user. The aim of this study was to determine the prevalence and reasons for nutritional supplement (NS) use among fitness studio visitors in Mainz (Germany), emphasizing new multi-ingredient based supplements such as pre workout boosters (PWBs). Some of the PWBs contain stimulants such as DMAA, N,α-DEPEA, DMAE and DMBA with so far unknown risks, harms and benefits. Four-Hundred and Ninety Two participants in 13 fitness studios completed a questionnaire on the use of nutritional supplements. Descriptive statistics and chi-square tests were used to examine differences in supplement use regarding training- and intake-reasons. About 57.0% of the participants reported the use of NS during the last 4 weeks. The all-time prevalence of creatine use was 28.7%, whereas 12.2% of the participants stated creatine use during the past 4 weeks. The all-time prevalence of PWB intake was 25.8%, whereas the last month prevalence was 11.8%. Among the group of PWB users, 20.5% stated to search specifically for substances such as DMAA, N,α-DEPEA, DMAE or DMBA. Logistic regression analysis showed positive relations between creatine use and the predictor variables gender, strength training and bodybuilding, as well as the stated exercisers' training reasons to increase physical- and sports-performance, and quality of life. PWB consumption was related to the variables gender, training frequency, and the reason for sports performance enhancement. Specific ingredient focus was related to the predictor variables competition participation and increase of mental performance. The results of the study show a high prevalence of PWB consumption among fitness studios visitors, which is comparable with creatine use. The predicting variables for consumption seem to be slightly different between the supplements, especially if the users are searching for stimulating agents. The current findings help to create preliminary consumption patterns and can help to identify potential endangered fitness studio visitors for prevention and risk communication, especially for PWBs.
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Affiliation(s)
- Matthias Dreher
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tobias Ehlert
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elmo W I Neuberger
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University Mainz, Mainz, Germany
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199
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Singh H, Kennedy RD, Lagasse LP, Czaplicki LM, Cohen JE. E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents. Nicotine Tob Res 2018; 20:1010-1014. [PMID: 28525609 PMCID: PMC6037115 DOI: 10.1093/ntr/ntx112] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/13/2022]
Abstract
Objective There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss. Methods Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control. Results Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user. Conclusions Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain. Implications This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.
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Affiliation(s)
- Harkirat Singh
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa P Lagasse
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren M Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Mittakanti HR, Elliott CS. Priapism caused by "Rhino 7 Platinum 3000" an over-the-counter male enhancement supplement. Int J Impot Res 2018; 30:190-191. [PMID: 29915255 DOI: 10.1038/s41443-018-0033-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/23/2018] [Accepted: 04/08/2018] [Indexed: 11/09/2022]
Abstract
Male enhancement and erectile dysfunction supplements are typically non-Food and Drug Administration (FDA) approved and readily available for purchase by anyone. Longstanding priapism is a significant potential side effect. A 25-year-old man presented with a 48-h priapism after taking Rhino 7 Platinum 3000. He required bilateral corpo-glanular shunting to alleviate his priapism. On initial 2-week follow-up, he had significant fibrosis of the corporal bodies bilaterally and had been unable to achieve an erection. There are few studies performed and few case reports regarding the roles of various supplements in causing priapism. We are unaware of any studies regarding Rhino 7 Platinum 3000. Interestingly, since our initial contact with the FDA Safety Reporting Portal, multiple investigations of Rhino products have demonstrated that sildenafil is a non-labeled ingredient. Given the lack of FDA oversight of many other supplements similar to this one, patients must be wary that the ingredients listed may not be comprehensive and that serious side effects can occur.
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Affiliation(s)
- Harsha R Mittakanti
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA. .,Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, USA.
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