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Crawford C, Avula B, Lindsey AT, Katragunta K, Khan IA, Deuster PA. Label Accuracy of Weight Loss Dietary Supplements Marketed Online With Military Discounts. JAMA Netw Open 2024; 7:e249131. [PMID: 38691359 PMCID: PMC11063798 DOI: 10.1001/jamanetworkopen.2024.9131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
Importance Dietary supplements for weight loss, among the most popular supplement products on the market, are promoted not only for losing weight and shedding fat, but also for added benefits of energy and performance, all packed into 1 capsule with multiple combinations of ingredients. Fraudulent marketing of weight loss supplements, some with exaggerated claims, some that are potentially dangerous, and some that contain illegal ingredients, is ever present, especially through online sources, where multiple manufacturers target service members by offering military discounts. Objectives To examine whether select dietary supplements marketed online for weight loss from companies advertising military discounts are accurately labeled according to the Supplement Facts listed ingredients, whether they contain any ingredients prohibited for use in the military, and to qualitatively describe the products' label claims. Design, Setting, and Participants In this case series, 30 dietary supplement products marketed for weight loss were selected and purchased in June 2023 from 12 online companies advertising military discounts. Data were analyzed from July to August 2023. Main Outcomes and Measures Liquid chromatography-mass spectrometry was used to verify whether products were accurately labeled according to the Supplement Facts listed ingredients and whether they contained any substances on the DoD Prohibited Dietary Supplement Ingredients List. A separate analysis was conducted to describe product label claims by using the Operation Supplement Safety (OPSS) Risk Assessment Scorecard. Results Of the 30 products tested, analysis showed that 25 had inaccurate labels. Of these, 24 had ingredients listed on the label that were not detected (misbranded); 7 had hidden components not present on the label, some of which would be considered adulterated; and 10 had substances on the DoD Prohibited Dietary Supplement Ingredients List either on or hidden from the label. All products were rated as risky when applying the OPSS Scorecard. Conclusions and Relevance In this case series study, the majority of products had inaccurate labels. Some were misbranded, others would be considered adulterated with ingredients not allowed in dietary supplements, and some contained ingredients prohibited for use in the military.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Andrea T. Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Kumar Katragunta
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Ikhlas A. Khan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
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Pravst I, Lavriša Ž, Hristov H, Hribar M, Krušič S, Žmitek K, Kušar A, Zdešar Kotnik K, Golja P, Čibej Andlovec A, Pograjc L. Assessment of the Use of Food Supplements by Military Personnel: Study Protocol and Results. Nutrients 2023; 15:nu15081902. [PMID: 37111120 PMCID: PMC10145590 DOI: 10.3390/nu15081902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Due to their specific mode of operation, military personnel are challenged physically as well as mentally. In most countries, the use of food supplements by military personnel is not regulated, and a high prevalence of supplementation is expected. However, data on this are scarce or very limited, without insights into the importance of supplementation for the intake of bioactive substances. Our goal was, therefore, to develop a study protocol to enable an assessment of the prevalence of using food supplements and an estimate of the contribution of supplementation practices to the dietary intake of specific nutrients and other compounds. The protocol was tested in a study of Slovene Armed Forces (SAF) personnel. Data were collected using an anonymous questionnaire in a sample of 470 participants from different military units-about half from the barracks located across the country, and the other half returning from military operations abroad. To provide meaningful results, we recorded the use of food supplements and functional foods available in single-sized portions (i.e., energy drinks, protein bars, etc.). Altogether, 68% of the participants reported supplementation, most commonly with vitamin, mineral, and protein supplements. Military rank, participation status in military operations, and physical activity were the main determinants of the specific supplements used. Surprisingly, a lower prevalence of overall and protein supplementation was observed in subjects returning from military operations abroad (62 vs. 74%) than in personnel stationed in barracks across Slovenia; however, the frequency of the use of energy drinks and caffeine supplements was higher in this population (25 vs. 11%). The study design allowed for estimations of the daily intake of supplemented bioactive compounds. We describe the challenges and approaches used in the study to support similar studies in the future and within other populations.
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Affiliation(s)
- Igor Pravst
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
- VIST-Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Živa Lavriša
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
| | - Hristo Hristov
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
| | - Maša Hribar
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
| | - Sanja Krušič
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
| | - Katja Žmitek
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
- VIST-Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
| | - Anita Kušar
- Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia
| | - Katja Zdešar Kotnik
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Petra Golja
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Anja Čibej Andlovec
- Ministry of Defence of the Republic of Slovenia, Vojkova Cesta 55, SI-1000 Ljubljana, Slovenia
| | - Larisa Pograjc
- Ministry of Defence of the Republic of Slovenia, Vojkova Cesta 55, SI-1000 Ljubljana, Slovenia
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Crawford C, Walter AR, Avula B, Lindsey AT, Hunter AM, Ikhlas AK, Deuster PA. Relative safety and quality of various dietary supplement products U.S. Service Members ask about. Clin Toxicol (Phila) 2022; 60:737-744. [PMID: 35156875 DOI: 10.1080/15563650.2022.2036751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT The purpose of this project was to determine types of dietary supplement products U.S. Service Members frequently ask about and identify risks associated with select products that consumers should be aware of when considering their use. METHODS Forty-one dietary supplement products frequently asked about through the Operation Supplement Safety's (OPSS.org) Ask-the-Expert portal were selected. Product analysis was performed to verify whether select products were accurately labeled and to identify any risky ingredients contained in these products. Operation Supplement Safety Risk Assessment Scorecard criteria were additionally used as a screening tool to assess a product's relative safety potential. RESULTS Among the select dietary supplements, 12 (29.3%) were marketed as pre-workout products; 14 (34.1%) for weight loss; four (9.8%) for male enhancement/testosterone boosters; and 11 (26.8%) as body building supplements. Eleven (26.8%) products had accurate labels; only eight of these had accurate labels plus no risky ingredients listed on the labels. Twenty-six (63.4%) products were misbranded; 10 (24.4%) were adulterated, and six (14.6%) were both misbranded and adulterated. Risky ingredients appeared on 23 (56%) of all product labels. Eight of these 23 products also had additional risky ingredients not listed on the labels but detected through analysis. According to the Scorecard based on label claims, 35 (85.4%) received a rating of "no-go/risky". CONCLUSIONS U.S. Service Members and the public at large should be aware that dietary supplements may contain risky ingredients and know how to identify ingredients on the label to evaluate potential risk.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Abraham R Walter
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Andrea T Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Aimee M Hunter
- Department of Laboratory Animal Resources, Uniformed Services University, Bethesda, MD, USA
| | - A Khan Ikhlas
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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Meiselman HL, Kuesten C, Bi J. The Use of Demographics and Psychographics to Study Product Effects with Nutrient Supplements: Exploratory Multi-Country Data. Foods 2021; 10:1918. [PMID: 34441695 PMCID: PMC8391947 DOI: 10.3390/foods10081918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Demographics and psychographics are used to study the influence of different consumers on product effects in food development and testing. Demographics have a longer history and are routinely used in most research; psychographics are more recent, raising the question of whether they add to research on food products. The research presented here represents extensive exploratory data that demonstrate that both demographic measures and psychographic measures add to our understanding of consumer's liking ratings for nutrient supplements. The results are discussed in the context of broader research on a range of food products. In addition, the research reported here was conducted in four different countries, demonstrating many country effects. Finally, tests were conducted with users of the products, lapsed users of the product, and users of other nutrient supplements (non-users), and this led to many differences in product testing. These results further suggest that age and gender are not the only demographic variables to be studied, along with psychographic variables. The psychographic variables should be selected for a particular product category under investigation, as effects of specific psychographic measures vary for product categories. Specific variables do not fit all products for both demographics and psychographics.
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Affiliation(s)
| | - Carla Kuesten
- Amway, Consumer Product Research, Ada, MI 49355, USA;
| | - Jian Bi
- Sensometrics Research and Service, Richmond, VA 23236, USA;
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Kegel JL, Kazman JB, Scott JM, Deuster PA. Health Behaviors and Psychosocial Attributes of US Soldiers. J Acad Nutr Diet 2020; 120:1469-1483. [DOI: 10.1016/j.jand.2020.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 02/02/2023]
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Lieberman HR. Why Are Certain Caffeine-Containing Products Associated With Serious Adverse Effects? Mayo Clin Proc 2020; 95:1562-1564. [PMID: 32753126 DOI: 10.1016/j.mayocp.2020.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
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Agans RT, Giles GE, Goodson MS, Karl JP, Leyh S, Mumy KL, Racicot K, Soares JW. Evaluation of Probiotics for Warfighter Health and Performance. Front Nutr 2020; 7:70. [PMID: 32582752 PMCID: PMC7296105 DOI: 10.3389/fnut.2020.00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
The probiotic industry continues to grow in both usage and the diversity of products available. Scientific evidence supports clinical use of some probiotic strains for certain gastrointestinal indications. Although much less is known about the impact of probiotics in healthy populations, there is increasing consumer and scientific interest in using probiotics to promote physical and psychological health and performance. Military men and women are a unique healthy population that must maintain physical and psychological health in order to ensure mission success. In this narrative review, we examine the evidence regarding probiotics and candidate probiotics for physical and/or cognitive benefits in healthy adults within the context of potential applications for military personnel. The reviewed evidence suggests potential for certain strains to induce biophysiological changes that may offer physical and/or cognitive health and performance benefits in military populations. However, many knowledge gaps exist, effects on health and performance are generally not widespread among the strains examined, and beneficial findings are generally limited to single studies with small sample sizes. Multiple studies with the same strains and using similar endpoints are needed before definitive recommendations for use can be made. We conclude that, at present, there is not compelling scientific evidence to support the use of any particular probiotic(s) to promote physical or psychological performance in healthy military personnel. However, plausibility for physical and psychological health and performance benefits remains, and additional research is warranted. In particular, research in military cohorts would aid in assessing the value of probiotics for supporting physical and psychological health and performance under the unique demands required of these populations.
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Affiliation(s)
- Richard T Agans
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.,Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Grace E Giles
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Michael S Goodson
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States
| | - J Philip Karl
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Samantha Leyh
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States.,Oak Ridge Institute for Science and Education, Wright Patterson Air Force Base, Oak Ridge, TN, United States
| | - Karen L Mumy
- Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Kenneth Racicot
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Jason W Soares
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
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