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Liu L, Tao H, Xu J, Liu L, Nahata MC. Quantity, Duration, Adherence, and Reasons for Dietary Supplement Use among Adults: Results from NHANES 2011-2018. Nutrients 2024; 16:1830. [PMID: 38931186 PMCID: PMC11206876 DOI: 10.3390/nu16121830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/30/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
Dietary supplement use is common among US adults. We aimed to investigate the quantity, duration, adherence, and reasons for supplement use in individuals who take supplements. Data from 2011 to 2018 from the National Health and Nutrition Examination Survey (NHANES) dataset were analyzed. Four cycles of data were combined to estimate these outcomes. Results are presented as overall group and by subgroups. All analyses were weighted to be nationally representative. The Taylor Series Linearization approach was used to generate variance estimates. A total of 12,529 participants were included. Over 70% of these individuals reported taking more than one unit of dietary supplements daily. Notably, approximately 40% had been taking supplements for more than five years and about 67% were highly adherent to at least one supplement. However, only 26.9% of these supplements were taken following a doctor's recommendation. The primary reasons for dietary supplements intake included improving overall health (37.2%), maintaining health (34.7%), bone health (21.4%), and diet supplementation (20.3%). Our findings indicate that most participants proactively used multiple dietary supplements focused on self-managed health and prevention, with substantial dedication to long-term use and high adherence. Healthcare professionals should play a more active role in guiding such behaviors to optimize the health outcomes of dietary supplement users across the United States.
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Affiliation(s)
- Ligang Liu
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA;
| | - Heqing Tao
- Department of Gastroenterology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510182, China;
| | - Jinyu Xu
- IT Research & Innovation, Nationwide Children’s Hospital, Columbus, OH 43210, USA;
| | - Lijun Liu
- Drake Institute for Teaching and Learning, The Ohio State University, Columbus, OH 43210, USA;
| | - Milap C. Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA;
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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2
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Wauthier L, Cabo J, Eucher C, Rosseels C, Elsen M, Favresse J. Biotin interference in immunoassays: water under the bridge? Clin Chem Lab Med 2023; 61:e196-e199. [PMID: 37036736 DOI: 10.1515/cclm-2023-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Loris Wauthier
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Julien Cabo
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Christine Eucher
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Catherine Rosseels
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Marc Elsen
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for LIfes Sciences, University of Namur, Namur, Belgium
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3
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Brady S, Bates K, Oddy S, Jeon YL, Pichayayothin T, Tetteh R, Voong K, Harrington DJ. Prevalence of elevated serum concentrations of biotin in patients from South East England, Korea, Singapore and Thailand and risk of immunoassay interference. J Clin Pathol 2023; 76:637-641. [PMID: 37156614 DOI: 10.1136/jcp-2022-208733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
Biotin interference in immunoassays using biotin-streptavidin binding technology is well recognised by clinical laboratories, though the prevalence of elevated biotin in patient populations is largely unknown. We determined serum biotin concentrations in 4385 patient samples received sequentially by 6 laboratories for routine immunoassay analysis in England, and Korea, Singapore and Thailand (3 countries within the Asia Pacific region, APAC). Samples were initially analysed using a research use-only immunoassay, with those identified as having potentially elevated biotin concentrations referred for definitive analysis by LC-MS/MS. The prevalence of elevated serum biotin was 0.4% and 0.6% for England and APAC, respectively (range 10.0-129.0 µg/L). Our data adds to a report from a different region of England and is the first for APAC. Laboratories and clinicians benefit from an awareness of the prevalence of elevated serum biotin, which coupled with an understanding of the threshold at which interference occurs, reduces clinical impact of analytical error.
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Affiliation(s)
- Sally Brady
- Department of Clinical Biochemistry, HCA Laboratories, London, UK
| | - Katharine Bates
- Department of Blood Sciences, King's College Hospital, SYNLAB UK & Ireland, London, UK
| | - Susan Oddy
- Department of Blood Sciences, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Ruby Tetteh
- Department of Blood Sciences, Addenbrooke's Hospital, Cambridge, UK
| | - Kieran Voong
- Nutristasis Unit, St. Thomas' Hospital, SYNLAB UK & Ireland, London, UK
| | - Dominic J Harrington
- Nutristasis Unit, St. Thomas' Hospital, SYNLAB UK & Ireland, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Sandoval KE. Changes in Reported Dietary Supplement Use in Cognitively Normal National Alzheimer's Coordinating Center Participants Aged 55 and Older From 2015 to 2019. J Nutr 2023; 153:1771-1782. [PMID: 37044210 PMCID: PMC10447883 DOI: 10.1016/j.tjnut.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Although reported dietary supplement use is common in older adults, evaluations of dietary supplement use over the past 10 y are lacking. OBJECTIVE This analysis determined changes in reported dietary supplement use in cognitively normal older adults (aged ≥ 55 y) using the National Alzheimer's Coordinating Center data from 2015 to 2019 using a serial cross-sectional study design. METHODS The first available visit for cognitively normal participants aged ≥ 55 y from 2015 to 2019 with a complete medication form was used, resulting in 9357 participants. Associations between visit year categories and reported use of dietary supplement categories/individual supplements were tested using categorical statistics. To determine whether the probabilities of reported supplement use changed in 2019 compared with those of 2015, z-scores and two-sided P values were used. Weighted analyses were used to confirm analytical findings. RESULTS When comparing 2015 and 2019, the reported use of any dietary supplement decreased from 77.7% in 2015 to 71.0% in 2019 (P < 0.0001); any vitamin from 72.5% to 65.5% (P < 0.0001); any mineral from 39.2% to 30.4% (P < 0.0001); "other" nonvitamin/nonmineral supplements from 34.4% to 26.9% (P < 0.0001), calcium from 31.2% to 21.7% (P < 0.0001), multivitamins from 48.4% to 38.4% (P < 0.0001), potassium from 5.6% to 3.5% (P = 0.001), vitamin C from 13.0% to 9.2% (P = 0.0002), chondroitin from 6.0% to 4.1% (P = 0.006), glucosamine from 11.1% to 6.5% (P < 0.0001), and all omega fatty acids from 25.2% to 17.0% (P < 0.0001). Reported use increased for vitamin B7/biotin from 3.1% in 2015 to 5.8% in 2019 (P = 0.0003), melatonin from 3.1% to 5.8% (P = 0.0002), and turmeric from 1.2% to 4.7% (P < 0.0001). CONCLUSION Although the reported use of many major dietary supplement categories and individual supplements significantly decreased in older adults from 2015 to 2019, biotin, turmeric, and melatonin significantly increased. Because biotin may interfere with some laboratory tests, this may have important public health implications.
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Affiliation(s)
- Karin E Sandoval
- Pharmaceutical Sciences Southern Illinois University Edwardsville, 200 University Park Drive, Building 220, Edwardsville IL 62025.
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5
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Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med 2023; 12:jcm12030893. [PMID: 36769541 PMCID: PMC9917549 DOI: 10.3390/jcm12030893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The hair cycle is composed of four primary phases: anagen, catagen, telogen, and exogen. Anagen is a highly mitotic phase characterized by the production of a hair shaft from the hair follicle, whereas catagen and telogen describe regression and the resting phase of the follicle, respectively, ultimately resulting in hair shedding. While 9% of hair follicles reside in telogen at any time, a variety of factors promote anagen to telogen transition, including inflammation, hormones, stress, nutritional deficiency, poor sleep quality, and cellular division inhibiting medication. Conversely, increased blood flow, direct stimulation of the hair follicle, and growth factors promote telogen to anagen transition and subsequent hair growth. This review seeks to comprehensively describe the hair cycle, anagen and telogen balance, factors that promote anagen to telogen transition and vice versa, and the clinical utility of a variety of lab testing and evaluations. Ultimately, a variety of factors impact the hair cycle, necessitating a holistic approach to hair loss.
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Scheib N, Bauersachs D, Pogorelov D, Heinrich CM, Hefeng FQ, Bindslev-Jensen C, Skevaki C, Ollert M. Biotin interference can cause false-negative specific IgE results in patients with anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2459-2462.e2. [PMID: 35654368 DOI: 10.1016/j.jaip.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/26/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Nils Scheib
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Daniel Bauersachs
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - Dimitrii Pogorelov
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Charlotte Mara Heinrich
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - Feng Q Hefeng
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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7
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Wauthier L, Plebani M, Favresse J. Interferences in immunoassays: review and practical algorithm. Clin Chem Lab Med 2022; 60:808-820. [PMID: 35304841 DOI: 10.1515/cclm-2021-1288] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Immunoassays are currently the methods of choice for the measurement of a large panel of complex and heterogenous molecules owing to full automation, short turnaround time, high specificity and sensitivity. Despite remarkable performances, immunoassays are prone to several types of interferences that may lead to harmful consequences for the patient (e.g., prescription of an inadequate treatment, delayed diagnosis, unnecessary invasive investigations). A systematic search is only performed for some interferences because of its impracticality in clinical laboratories as it would notably impact budget, turnaround time, and human resources. Therefore, a case-by-case approach is generally preferred when facing an aberrant result. Hereby, we review the current knowledge on immunoassay interferences and present an algorithm for interference workup in clinical laboratories, from suspecting their presence to using the appropriate tests to identify them. We propose an approach to rationalize the attitude of laboratory specialists when faced with a potential interference and emphasize the importance of their collaboration with clinicians and manufacturers to ensure future improvements.
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Affiliation(s)
- Loris Wauthier
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for LIfes Sciences, University of Namur, Namur, Belgium
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8
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Nelson HA, La'ulu SL, Lu J, Doyle K. Mitigation of Biotin Interference in Manual and Automated Immunoassays by Preconjugating Biotinylated Antibodies to the Streptavidin Surface as an Alternative to Biotin Depletion. J Appl Lab Med 2022; 7:762-775. [PMID: 35018420 DOI: 10.1093/jalm/jfab169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Streptavidin-to-biotin binding is one of the strongest noncovalent interactions in nature and incorporated into many immunoassays. Biotin-streptavidin coupling assays are susceptible to interference from free biotin in patient specimens, which may falsely decrease or increase results. To prevent biotin interference, we evaluated a method to preconjugate biotinylated antibodies to the assay's streptavidin solid surface before adding patient specimen and compared this technique to a biotin depletion protocol. METHODS Biotin interference in 3 manual ELISAs and 2 automated immunoassays was established. Mitigation of biotin interference by preincubation was evaluated in each assay by adding biotinylated antibody to the streptavidin-coated surface before adding biotin- or PBS-spiked serum. Lastly, the preincubation method was compared to a biotin-depletion protocol to compare the effectiveness of mitigating biotin interference. RESULTS In the presence of 400 µg/L biotin, analyte detection was reduced to 10% to 15% of total in the ELISA assays and to 15.2% in the automated sandwich (thyroglobulin) immunoassay. In the automated competitive (free thyroxine) immunoassay, biotin caused an increased detection of 551.6%. Preconjugation of the biotinylated capture antibody to the streptavidin surface in the ELISA assays resulted in 84% to 99% activity recovery, compared to 84% to 97% by a biotin depletion protocol. Similarly, automated sandwich and competitive immunoassays obtained 97.1% and 116.5% recovery by preconjugation, compared to 95.6% and 100.3% by the depletion method, respectively. CONCLUSION This study demonstrates how assay redesign to include preconjugation of biotinylated capture antibody to streptavidin is an effective alternative to biotin-depletion methods to mitigate biotin interference.
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Affiliation(s)
- Heather A Nelson
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Sonia L La'ulu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Jun Lu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Kelly Doyle
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
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9
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Knudsen CS, Adelborg K, Søndergaard E, Parkner T. Biotin interference in routine IDS-iSYS immunoassays for aldosterone, renin, insulin-like growth factor 1, growth hormone and bone alkaline phosphatase. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 82:6-11. [PMID: 34859720 DOI: 10.1080/00365513.2021.2003854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Biotin is increasingly used as dietary supplement. As many immunoassays rely on a binding between biotin and streptavidin, intake of biotin may interfere with laboratory tests, leading to spurious test results. We examined the extent to which levels of aldosterone, renin, insulin-like growth factor 1 (IGF-1), growth hormone (GH) and bone alkaline phosphatase (BAP) were affected by biotin. In an experimental study performed at Aarhus University Hospital, Denmark, patient samples (plasma or serum) were pooled and spiked with biotin in increasing concentrations (0, 20, 50, 100 and 500 ng/mL). All biomarkers were analyzed using Immunodiagnostic Systems (IDS-iSYS) Multi-Discipline Automated System assays. The average bias (%) was calculated, as the difference in concentrations between the sample without biotin (reference) and the samples with increasing concentrations of biotin. Both aldosterone and renin assays showed substantial biotin interference in a dose-dependent manner, with biases up to +3484% for aldosterone and -98% for renin in the highest concentrations of biotin (100-500 ng/mL). IGF-1, GH and BAP results were generally less affected by added biotin and significant bias (>10%) was observed only when the biotin concentration was 100 ng/mL (IGF-1 and GH) or 500 ng/mL (BAP). In conclusion, biotin interfered with the IDS-iSYS immunoassays, particularly for aldosterone and renin. The assays for GH, IGF-1 and BAP were less sensitive and only with high concentrations of biotin.
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Affiliation(s)
| | - Kasper Adelborg
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Søndergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Rodrigo J, Bullock H, Mumma BE, Kasapic D, Tran N. The prevalence of elevated biotin in patient cohorts presenting for routine endocrinology, sepsis, and infectious disease testing. Clin Biochem 2021; 99:118-121. [PMID: 34736902 DOI: 10.1016/j.clinbiochem.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022]
Abstract
Elevated blood biotin levels may interfere with some biotin-streptavidin immunoassays, used in clinical laboratories to aid diagnosis. The objective of this study was to determine the prevalence of elevated blood biotin levels in three at risk patient cohorts, where misclassification of disease status would have a high clinical impact. This retrospective, single-center study screened residual, de-identified plasma samples (N = 700) from adult patients undergoing routine thyroid stimulating hormone (TSH) (n = 500), procalcitonin (PCT) (n = 100), or human immunodeficiency virus (HIV) (n = 100) testing using the Elecsys® BRAHMS PCT (Roche Diagnostics), Access TSH (3rd IS) (Beckman Coulter Inc), and ARCHITECT HIV Ag/Ab Combo (Abbott Laboratories) immunoassays, respectively, for elevated levels of biotin (quantified by gas chromatography-time of flight mass spectrometry). Patients taking biotin supplements were included and dosages recorded from medical records. In the overall study cohort, blood biotin levels ranged 0.1-21.3 ng/mL; 44.3% (310/700) of samples were < 1 ng/mL, 54.7% (383/700) were 1-<10 ng/mL, and 1% (7/700) were ≥ 10 ng/mL. The sub-cohorts had similar ranges of biotin levels: 0.5-21.3 ng/mL (TSH), 0.1-12.1 ng/mL (PCT), and 0.3-7.3 ng/mL (HIV). In the 44 patients (6.3% of overall study cohort) who were documented as taking biotin supplements (range of doses, 2.5-10 mg/day), blood biotin levels ranged 0.9-21.3 ng/mL; 2.3% (1/44) of samples were < 1 ng/mL, 86.4% (38/44) were 1-<10 ng/mL, and 11.4% (5/44) were ≥ 10 ng/mL. Most patients who reported taking biotin supplements had blood biotin levels ≥ 1 ng/mL and the highest blood biotin level detected was 21.3 ng/mL.
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Affiliation(s)
- John Rodrigo
- Department of Pathology and Laboratory Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817, United States
| | - Hannah Bullock
- Department of Pathology and Laboratory Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817, United States
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA 95817, United States
| | - Dusanka Kasapic
- Roche Diagnostics International Ltd, Centralised and Point of Care Solutions, Forrenstrasse 2, 6343 Rotkreuz, Switzerland
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817, United States.
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Sobolevsky T, Ahrens B. Biotin as a masking agent in chorionic gonadotropin assays utilizing biotinylated antibodies. Drug Test Anal 2021; 13:1929-1935. [PMID: 34378342 DOI: 10.1002/dta.3141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
Biotin interference in streptavidin/biotin-based immunoassays has been recently recognized as a confounding factor in clinical settings. Depending on the nature of the assay, the presence of excess biotin in patient samples can cause falsely high or low results. One of the platforms known to be affected, Roche Cobas, is widely used in anti-doping laboratories to test for intact chorionic gonadotropin (hCG) in urine. While biotin levels in blood have been well studied, less is known about urinary biotin due to its limited clinical significance. Having analyzed over 4000 urine samples, we have established a reference range for urinary biotin with a median concentration of approximately 12 ng/mL. However, a significant number of samples contain much higher amounts, with a maximum approaching 10 μg/mL, suggesting biotin supplementation. Consequently, the tolerance of hCG STAT assay towards biotin was investigated over a wide concentration range. The apparent hCG concentration was found to decrease almost linearly as biotin increased from 100 to 1000 ng/mL, with only 10% of the expected value reported by the assay as biotin reached 1000 ng/mL. Further increase of biotin resulted in a progressive, albeit more moderate, decline in measured hCG concentration. To avoid a false negative result in the context of anti-doping analysis, it is highly recommended to monitor biotin in urine and perform diafiltration before hCG measurement in samples with elevated biotin to remove the interference.
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Affiliation(s)
- Tim Sobolevsky
- UCLA Olympic Analytical Laboratory, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Brian Ahrens
- UCLA Olympic Analytical Laboratory, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, Los Angeles, California, USA
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Prevalence of Detectable Biotin in Five US Emergency Department Patient Cohorts. Clin Biochem 2021; 93:26-32. [PMID: 33771568 DOI: 10.1016/j.clinbiochem.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of this study was to estimate the prevalence of biotin supplementation in United States emergency department patients using a multi-site, geographically distributed sampling model. METHODS Biotin was measured using an Abbott ARCHITECT Biotin research use only assay in 7118 emergency department patient serum or plasma samples from five US medical centers. Samples with biotin ≥10 ng/mL underwent additional LC-MS/MS confirmatory testing for biotin and its primary metabolites. The overall and site-specific prevalence of detectable biotin was determined using the screening assay while biotin speciation (i.e., prevalence of detectable metabolites) was determined using LC-MS/MS. RESULTS Of 7118 samples screened, 291 (4.1%) had biotin ≥10 ng/mL and were considered positive. Across five medical centers, the fraction of positive samples ranged from 2.0% to 5.4%. The maximum biotin concentration observed was 355 ng/mL. Of the 285 positive screens that underwent additional LC-MS/MS testing, 89 (31%) showed detectable biotin, bisnorbiotin, and/or biotin sulfoxide. Biotin, bisnorbiotin, and biotinsulfoxide were detected in 82/89 (92.1%), 61/89 (68.5%), and 18/89 (20.2%) samples, respectively; biotin was detected in the absence of either metabolite in 18/89 (20.2%) samples. CONCLUSIONS Using a screening assay, 4.1% of emergency department patient samples were found to be potentially susceptible to interference from biotin. Confirmatory testing showed detectable biotin and/or biotin metabolites in 31% of positive screens (1.3% overall). The prevalence of biotin ≥10 ng/mL varied 2-3-fold across US emergency department patient cohorts. Biotin metabolites were observed in 80% of samples confirmed to have detectable biotin species by LC-MS/MS, suggesting that rigorous assessments of assay susceptibility to biotin interference, often performed using in vitro studies, should consider the potential role of biotin metabolites present in vivo.
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