Nutrition as a military capability to deliver human advantage: more people, more ready, more of the time

Soldiers must achieve high-level mission-preparedness to endure extended periods of physical and cognitive activity, with unpredictable recovery, in all environments. Nutrition provides the foundation for health and performance. Militaries have not maximised the strategic and financial value that considering nutrition as a military capability could deliver. A whole system approach to military nutrition, based on the prepare-perform-recover human capability cycle phases, is presented. Trainee nutrition requirements, through to very-high-readiness forces undertaking arduous roles at reach, must be specifically addressed. Promoting military performance diets in the prepare phase, through practitioner-supported nutrition education and food provision, will ensure mission readiness and mitigate ill health. Delivering nutrition in field settings in the perform phase-through smaller/lighter, nutritionally optimised rations and smart packaging technologies-will improve utility and minimise waste. Strategic dietary supplement use can provide a mission performance-enhancing adjunct to a food-first philosophy. Impact value chain analysis of military nutrition capability investments could support cost-benefit measurement.

Nutraceuticals and dietary supplements: balancing out the pros and cons

While the market is full of different dietary supplements, in most countries, legislation is clear and strict towards these products, with severe limitations on their health claims. Overall, the claims cannot go beyond the consumption of a said supplement will contribute to a healthy diet. Thus, the supplement industry has been reacting and changing their approach to consumers. One change is the considerable growth of the nutraceutical market, which provides naturally produced products, with low processing and close to no claims on the label. The marketing of this industry shifts from claiming several benefits on the label (dietary supplements) to relying on the knowledge of consumers towards the benefits of minimally processed foods filled with natural products (nutraceuticals). This review focuses on the difference between these two products, their consumption patterns, forms of presentation, explaining what makes them different, their changes through time, and their most notable ingredients, basically balancing out their pros and cons.

Multi-elemental composition of botanical preparations and probabilistic evaluation of toxic metals and metalloids intake upon dietary exposure

The aim of this study was to evaluate the inorganic elemental composition (49 elements) of 29 botanical preparations obtained from fruits, leaves, peels, seeds, roots, fungi, and spirulina by using inductively coupled-mass spectrometry and a mercury analyzer. Simultaneously, the risk associated with the chronic dietary exposure to 12 toxic metals and metalloids among the European population was evaluated by using a probabilistic approach based on Monte Carlo simulations. The analysis revealed worrying intake levels of Al, As, and Ni, primarily stemming from the consumption of spirulina-, peel-, and leaf-based botanicals by younger age groups. The intake of As from all analyzed botanicals posed a significant risk for infants, yielding margins of exposure (MOEs) below 1, while those deriving from peel-based botanicals raised concerns across all age groups (MOEs = 0.04-2.3). The consumption of peel-based botanicals contributed substantially (13-130%) also to the tolerable daily intake of Ni for infants, toddlers, and children, while that of spirulina-based botanicals raised concerns related to Al intake also among adults, contributing to 11-176% of the tolerable weekly intake of this element. The findings achieved underscore the importance of implementing a monitoring framework to address chemical contamination of botanicals, thus ensuring their safety for regular consumers.

Assessing β-Sitosterol Levels in Dietary Supplements for Benign Prostatic Hyperplasia: Implications for Therapeutic Efficacy

Introduction Benign prostatic hyperplasia (BPH) is a prevalent condition among aging men that affects their life quality due to urinary symptoms. Current pharmacologic treatments, often lead to sexual dysfunction, so dietary supplements (DS) containing plant-based compounds such as β-sitosterol (SIT) are preferred. DS are highly accessible and widely used, but poorly regulated, so often patients are victims of fraud. The use of DS to treat BPH symptoms is questionable, and this may be due not to the efficacity of the active compound but to the quality of commonly available DS. Aim This study aimed to assess the concentration of SIT in DS available on the market and evaluate whether the concentration of the active compound at the recommended dosage is sufficient to elicit beneficial effects in BPH. Method An HPLC-UV method based on direct saponification and acid hydrolysis was developed for the quantification of free and conjugated SIT in DS. The concentration of SIT in various DS was determined and compared with the one declared on the label. Results The chromatographic analysis confirmed the presence of SIT in all the DS but also showed a considerable variability of SIT content among DS, with only one product meeting the necessary concentration to bring potential benefits in BPH. Conclusion The study highlights inconsistencies in SIT content among DS and the importance of DS containing a standardized extract of SIT. Quality control measures are imperative to ensure that consumers receive effective and safe SIT-based DS to manage BPH symptoms. Further research is needed to establish standardized dosages and to evaluate their long-term efficacy and safety.

Individual Beliefs and Experiences With Brain Health Dietary Supplements in the United States

BACKGROUND

Although the use of brain health dietary supplements (brain DS) has increased, there is limited research on safety and risk of these products. Brain DS may be beneficial for improving memory, concentration, and focus but may also carry risks.

OBJECTIVES

To assess brain DS users' utilization experiences and identify factors associated with likelihood of brain DS use among nonusers.

DESIGN

An internet-based cross-sectional survey study was conducted using a sample of middle-aged US adults. Respondents' sociodemographic characteristics and health beliefs regarding brain DS were collected. Brain DS users' utilization experiences such as negative side effects and spending were also collected.

PARTICIPANTS AND SETTING

Purposive sampling was utilized for users and nonusers sample recruitment.

MAIN OUTCOME MEASURES

Brain DS users' utilization experience and future likelihood of brain DS use among nonusers.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics on brain DS users' utilization experiences were reported. Ordinal logistic regression with sociodemographic and belief characteristics as predictors was employed to identify factors associated with the likelihood of brain DS among nonusers.

RESULTS

Five hundred twenty-five respondents (mean age = 43.8 ± 9.2 years) completed the survey. Among 260 users, primary reasons for use were enhancing memory (n = 136) and helping concentration and focus (n = 108). During the past year, 40% spent $50 to $200 (range = $0 to >$1,000) and 37% reported experiencing negative side effects. Among 265 nonusers, being female (odds ratio 2.04, 95% CI 1.21 to 3.45), perceived susceptibility to brain problems (odds ratio 1.90, 95% CI 1.28 to 2.83), recommendation from others (odds ratio 1.55, 95% CI 1.03 to 2.35) and perceived benefits of brain DS (odds ratio 2.82, 95% CI 1.60 to 4.96) were significantly associated with increased likelihood of future brain DS use.

CONCLUSIONS

Individual spending on brain DS varies and about 40% of users reported experiencing negative side effects. As individuals primarily rely on healthcare providers for recommendations, health care providers should be prepared to engage in discussions about brain DS with patients.

Monitoring of Essential and Toxic Elements in Multivitamin/Mineral Effervescent Tablet Supplements and Safety Assessment

Multivitamin/mineral (MVM) supplements are the most commonly utilized dietary supplements by many populations. However, there is a severe concern about their adverse effects due to elemental impurities. In the present study, it was aimed to determine the levels of 11 elemental impurities (Cd, Pb, As, Hg, Co, V, Ni, Se, Mo, Cu, and Cr) by inductively coupled plasma-mass spectrometry (ICP-MS) and evaluate the human health risk associated with the consumption of 33 MVM effervescent tablet supplements available in Turkey. The precision of the method in terms of relative standard deviation (RSD) was less than 4.6%. The accuracy of the method was tested with recovery experiments, and the results ranged between 86 and 107%. The impurity levels for Cd, Pb, As, Co, V, Ni, Se, Mo, Cu, and Cr were found between 0.011-0.050, 0.025-0.098, 0.018-0.056, 0.010-0.626, 0.027-0.290, 0.026-1.65, 1.92-21.83, 0.034-34.09, 0.140-183.9, and 0.033-13.10 µg/g, respectively, and Hg was not detected in any sample. The calculated concentrations for elemental impurities complied with EMA and USP guidelines, except one supplement for Se (21.83 µg/g) with a permitted limit of 15 µg/g. The hazard quotient (HQ) and hazard index (HI) levels were below 1 for all samples within the ranges of 3.4 × 10-1-1.4 × 10-6 for HQ and 7.8 × 10-1-1.4 × 10-6 for HI indicating that there is no risk for consumption. The carcinogenic risk (CR) of As was between 1.7 × 10-6 and 5.9 × 10-6, below the threshold value of 1 × 10-4. The results showed that there is no risk to human health.

Pattern of dietary supplement use and its psychosocial predictors among females visiting fitness centers in Saudi Arabia: Findings from a cross-sectional study

Background

Establishing a balanced diet is necessary for obtaining the required daily micronutrients and macronutrients. However, the importance of using dietary supplements to complement one's diet is a significant aspect to consider. While studies have reported the prevalence and patterns of dietary supplements in Saudi Arabia, most focused on university students, women in their reproductive life-particularly during pregnancy-or male athletes. Hence, the objective of this study is to estimate the prevalence and patterns of dietary supplement usage, along with the associated sociodemographic and psychiatric predictors among women attending fitness centers in Saudi Arabia.

Methods

A cross-sectional design was utilized using a structured questionnaire to collect data on dietary intakes such as consumption, nutrition supplements, type of nutrition supplements, and reason for consuming dietary supplements. Data collection occurred in female fitness centers, with participants accessing the questionnaires through QR codes linked to online Google forms. The dietary usage was assessed using a structured questionnaire developed by the study authors, and depressive and anxiety symptoms were assessed using the PHQ-9 and the GAD-7 scales, respectively. SPSS 23.0 was utilized to analyze the data, and a multivariable logistic regression analysis was performed to determine the association between sociodemographic and psychiatric predictors and patterns of dietary supplement usage. The results were presented by reporting an unadjusted and adjusted odds ratio (AOR) with 95 % Confidence Intervals (CIs).

Results

The total number of participants in this study was 453 women. Half of the 453 women (46.1 %) consumed dietary supplements, and (84.0 %) reported taking proteins, caffeine, creatinine, mineral salts, fish oil, and/or amino acids or a combination of these dietary supplements. A considerable number of women (41.0 %) reported that a doctor, dietitian, or trainer motivated them to take the dietary supplement, and (38.0 %) of women self-prescribed dietary supplements. More than half (51 %) of the women consumed dietary supplements to compensate for nutrient deficiency, and 48 % used them to improve their health. Women who did not work to earn were 53 % less likely to consume dietary supplements (AOR = 0.47; [95 % CI: 0.30-0.72]) than women who reported working to earn either in the private or government sector. Depressed women were (42 %) less likely to consume dietary supplements than non-depressed women (AOR = 0.58; [95 % CI: 0.33-0.99]) after adjusting for sociodemographic variables and other medical conditions.

Conclusion

It has been evident that a large proportion of women enrolled in the fitness center report consuming dietary supplements, mostly to compensate for energy and to improve overall health. The findings highlight that non-working and depressed women were less likely to use dietary supplements than their counterparts. By understanding these patterns, the community can tailor health interventions and policies to ensure equitable access to proper dietary support, especially for those facing challenges like depression and unemployment. Future research on a larger sample of women outside fitness centers is encouraged to explore further dietary supplement consumption and patterns among diverse population groups, and to ultimately develop health guidelines for the appropriate use of supplements.

Phytochemical analysis and biological evaluation of Ferulago setifolia K. Koch

BACKGROUND

Ferulago setifolia K. Koch (Apiaceae) has been the subject of this study, aiming to comprehensively determine its phenolic fingerprint and evaluate its various biological activities. The liquid chromatography-tandem mass spectrometry analysis of the 70% methanol extract of F. setifolia (FS) revealed the presence of 23 phytochemicals, among which chlorogenic acid, quinic acid, kaempferol-3-O-glucoside, and quercetin-3-O-glucoside were identified as the major phenolics in the extract.

RESULTS

The biological screening included examinations of antioxidant, antibacterial, antiproliferative, and cytotoxic activities. The FS extract displayed moderate 2,2-diphenyl-1-picrylhydrazyl radical scavenging and ferric-reducing capacity, indicating moderate antioxidant activity. Furthermore, FS exhibited significant antiproliferative effects on cancer cells while showing low cytotoxicity on normal cells. The antibacterial activity findings revealed that FS demonstrated potent activity against Pseudomonas aeruginosa, Bacillus cereus, Staphylococcus aureus, and Escherichia coli.

CONCLUSION

The findings of this study suggest that the methanolic extract of FS holds promise as a potential source of biologically active compounds. It can be utilized for the development of pharmaceutical formulations, thanks to its significant antiproliferative and antibacterial activities. Additionally, FS can serve as a valuable source of chlorogenic acid for industrial applications. © 2023 Society of Chemical Industry.

Effects of Supplementing Zinc Magnesium Aspartate on Sleep Quality and Submaximal Weightlifting Performance, following Two Consecutive Nights of Partial Sleep Deprivation

Purpose: We examined whether supplementation of zinc magnesium aspartate (ZMA), while partially sleep deprived, was beneficial to sleep quality and subsequent morning (07:00 h) submaximal weightlifting. Methods: Using a double-blinded, randomized counterbalanced design, sixteen trained males were recruited and completed six sessions: (i) one repetition max (1 RM) for bench press and back squat; (ii) two familiarisation sessions; (iii) three conditions with 4 h sleep and either: ZMA, placebo (PLA), or NoPill control (NoPill). Submaximal exercise session consisted of three repetitions at 40, 60 and 80% of 1 RM for bench press and back squat. Average power (AP), average velocity (AV), peak velocity (PV), displacement (D) and time-to-peak velocity (tPV) were recorded using MuscleLab linear encoders. Data were analysed using a general linear model with repeated measures and linear correlation. Results: No significant main effect for condition was found for performance values or subjective ratings of fatigue. Main effect for "load" on the bar was found, where AP and tPV values increased with load (p < 0.05). No significant relationship between dose of zinc or magnesium ingested and change in performance for 80% 1 RM power-outputs was found. Conclusion: Supplementation of ZMA for two nights of partial sleep deprivation had no effect on sleep or subsequent morning performance.

Rapid Detection of Adulteration in Boswellia Extracts with Citric Acid by UPLC-HRMS and 1H NMR

Boswellia serrata ole-gum-resin extracts (BSEs) are commonly used as food supplements, especially in osteoarthritis management. The quality standard is established by determining 11-keto-β-boswellic acid (KBA) and acetyl-11-keto-boswellic acid (AKBA) content using high-performance liquid chromatography (HPLC) or assessing the total boswellic acid (TBA) content by titrimetry. The limited geographical distribution of Boswellia species and increasing industrial demand could increase the risk of adulteration in Boswellia-containing products. In this study, 14 BSEs from commercial sources, used in food supplements, were analyzed in comparison with a USP Reference Standard extract. The KBA and AKBA content was determined by HPLC, whereas the TBA content was determined by titration. Targeted UHPLC-high-resolution mass spectrometry (HRMS) was applied to identify the carboxylic acid content in the samples. The 1H NMR spectra of extracts were also analyzed. Only two products met the criteria for KBA and AKBA content. Although, the TBA content complied with the expected amount, 10 extracts contained citric acid levels of 6-11% even though citric acid is not a cha-racteristic component of BSEs. Our results suggest undeclared addition of citric acid to comply with declared contents of TBA when using titration methods. Incorporation of citric acid to industrial samples - in order to alter the outcomes of the titration analysis - was demonstrated for the first time.

Type and Frequency in Use of Nutraceutical and Micronutrient Supplementation for the Management of Polycystic Ovary Syndrome: A Systematic Scoping Review

Lifestyle strategies are considered first-line treatment for the management of polycystic ovary syndrome (PCOS). However, complementary therapies, including nutrient supplementation, have been identified as a potential adjunct therapy. Therefore, we systematically mapped the available literature to identify the type and frequency of the use of nutraceutical and micronutrient supplementation for the management of PCOS features. A systematic search of the literature was conducted using CINAHL, Cochrane reviews, Medline, PsycINFO, Scopus and LILACS. All types of study designs were included if they reported on the use of nutraceuticals and/or micronutrient supplementation on features of PCOS in women aged ≥18 years. A total of 344 articles were included. Forty-one supplements were identified, with the most frequently investigated being inositols (n = 86), vitamin D (n = 53), N-acetylcysteine (n = 27) and omega-3 fatty acids (n = 25). Reproductive outcomes were the most commonly reported (n = 285; 83%), followed by metabolic (n = 229; 67%), anthropometric (n = 197; 57%) and psychological (n = 8; 2%). Our results identified that nutraceutical and micronutrient supplementation require further investigation of psychological outcomes in women with PCOS. Moreover, adequately powered primary studies are warranted to investigate therapeutic doses needed for clinical benefits.

An analysis of nutrient facts labels of pediatric multi-vitamin and mineral supplements: Is there a risk of overexposure?

BACKGROUND

Voluntary and mandatory fortification of pediatric foods, along with widespread consumption of dietary supplements have resulted in an increased proportion of children with excessive micronutrient intake.

AIM

This study aimed to analyze the proportion of pediatric dietary supplements that exceed the Recommended Dietary Allowance (RDA) and Tolerable Upper Limit for the individual micronutrients. We further identified the proportion of supplements with large amounts of micronutrients that were marketed through child-friendly and parent-geared promotional language and graphics on the packaging.

METHODS

The nutrient facts label on pediatric supplement packages sold by three large retail pharmacy chains was analyzed for micronutrient content. Labels were examined for the presence of trademarked or generic cartoon characters and parent-geared health promotional statements.

RESULTS

More than a third and almost a fifth of the samples contained vitamin A and niacin respectively in amounts equivalent to or above the established tolerable upper limit for one- to three-year-old children. A major proportion of these supplements had child-friendly and parent-targeted promotional language on the package.

CONCLUSION

The potential for pediatric supplements as a source for excessive micronutrient consumption underscores the need for parents and health care professionals to use nutrition labels as a valuable tool to prevent micronutrient toxicity.

Herbal and Natural Treatments for the Management of the Glaucoma: An Update

Glaucoma causes the degeneration of the retinal ganglion cells (RGCs) and their axons, inducing a tissue reshaping that affects both the retina and the optic nerve head. Glaucoma care especially focuses on reducing intraocular pressure, a significant risk factor for progressive damage to the optic nerve. The use of natural treatments, such as herbs, vitamins, and minerals, is becoming increasingly popular today. While plants are a rich source of novel biologically active compounds, only a small percentage of them have been phytochemically examined and evaluated for their medicinal potential. It is necessary for eye care professionals to inform their glaucoma patients about the therapy, protection, and efficacy of commonly used herbal medicines, considering the widespread use of herbal medicines. The purpose of this review is to examine evidence related to the most widely used herbal medicines for the management and treatment of glaucoma, to better understand the potential benefits of these natural compounds as supplementary therapy.

Risk-taking in consumers' online purchases of health supplements and natural products: a grounded theory approach

BACKGROUND

Health supplements and natural products are widely used by the general public to support physical function and prevent disease. Additionally, with the advent of e-commerce, these products have become easily accessible to the general public. Although several theoretical models have been used to explain the use of health supplements and natural products, empirical evidence on how consumers make decisions to purchase online health supplements and natural products remains limited.

METHODS

In this study, a grounded theory approach was used to develop a substantive theoretical model with the aim of investigating the decision-making process of consumers when purchasing health supplements and natural products online. Malaysian adult consumers who had purchased these products via the Internet were either purposively or theoretically sampled. A total of 18 virtual in-depth interviews (IDIs) were conducted to elicit participants' experiences and priorities in relation to this activity. All the IDIs were audio-recorded and transcribed verbatim. The data were analysed using open coding, focus coding and theoretical coding. The analytical interpretations and theoretical concepts were recorded in research memos.

RESULTS

Consumers' decisions to purchase a health supplement or natural product over the Internet are based on a series of assessments regarding the perceived benefits and risks of this activity, which may be related to the product or the process. In the online marketplace, consumers attempt to choose products, online sellers, sales platforms and/or purchase mechanisms with lower perceived risk, which ultimately enhances their confidence in five elements related to the purchase: (1) product effectiveness, (2) product safety, (3) purchase convenience, (4) fair purchase and (5) online security. Consumers take an acceptable level of risk to purchase these products online, and this acceptable level is unique to each individual and is based on their perception of having control over the potential consequences if the worst-case scenario occurs.

CONCLUSIONS

In this study, a substantive theoretical model is developed to demonstrate how consumers decide to purchase online health supplements and natural products by accepting an acceptable level of risk associated with the product or process. The emerging model is potentially transferable to other populations in similar contexts.

Coffee Silverskin Phytocompounds as a Novel Anti-Aging Functional Food: A Pharmacoinformatic Approach Combined with In Vitro Study

Coffee became a beverage that was in demand in the world and consequently produced millions of tons of coffee byproducts namely coffee silverskin (CS). Unutilized CS will be waste and cause environmental pollution such as greenhouse gas emissions, landfill waste, and groundwater contamination. This is a research concern at this time, although many studies have been conducted to find newer applications of CS, exploration of its benefits in the health sector is still limited. Therefore, exploring the benefits of CS to prevent or delay aging will be very interesting to develop in functional food industry technology. Therefore, this study aims to report profiling metabolites or phytochemicals, biological activities in terms of antioxidant activity, and potential anti-aging of CS via molecular docking simulation and in vitro modulation of the mTOR/AMPK/SIRT1 pathway. Something new has been obtained from this work, the profile of phytocompounds, and biological activities both in molecular docking simulation and in vitro studies. Some of the compounds observed in Robusta CS extract (rCSE) such as Epicatechin, Kaempferol, and Quercitrin, and Arabica CS extract (aCSE) such as (+)-Catechin dan Naringin have promising potential as inhibitors of iNOS, mTOR, and HIF-1α via molecular docking simulation. Interestingly, the in vitro biological activity assay of antioxidant and anti-aging activity, rCSE showed the same promising potential as the results of a molecular docking simulation. More interestingly, AMPK/SIRT1/mTOR expressions are well modulated by rCSE compared to aCSE significantly (p < 0.05). This makes the rCSE have promising biological activity as a candidate for functional food development and/or treatment agent in combating free radicals that cause the aging process. In vivo studies and human trials are certainly needed to see the further efficacy of the rCSE in the future.

Who persistently consumes dietary supplements? A multifaceted analysis using South Korea's nationally representative health and nutrition examination survey data

Objective

This study aimed to identify multifaceted factors affecting intake of dietary supplements among Koreans.

Methods

Korean National Health and Nutrition Examination Survey (KNHANES) data from 2018 to 2020 were obtained, pertaining to functional food intake, health related behaviors and morbidities. A total of 12,031 participants representing the Korean adult population were identified into two groups: 1 year more consumer group (N = 4,345) vs. non-consumer group (N = 7,686). A logistic regression analysis was performed to analyze the predictors of dietary supplement consumptions.

Results

Sociodemographic variables were associated with dietary supplement use. Participants who were female (odds ratio [OR] = 1.85; 95% CI, 1.59-2.15), older (OR = 1.06; 95% CI, 1.04-1.08), married (OR = 6.39; 95% CI, 3.44-11.85), highly educated, and high income earners consumed significantly more dietary supplements. Non-smoking (OR = 1.27; 95% CI, 1.06-1.53) and performing aerobic exercise (OR = 1.28; 95% CI, 1.13-1.46) predict dietary supplement consumption. Self-rated health status and health-related quality of life increased the likelihood of dietary supplement intake by 1.86 (OR = 1.86; 95% CI, 1.04-3.32) and 7.77 times (OR = 7.77; 95% CI, 1.66-33.40), respectively. The number of chronic diseases, cancer, or stroke was not significantly associated with intake. Those with obesity tended to less consume dietary supplements (OR = 0.85; 95% CI, 0.74-0.97). Hypertension (OR = 3.14; 95% CI, 1.36-7.21), osteoporosis (OR = 1.47; 95% CI, 1.11-1.95), and asthma (OR = 0.44; 95% CI, 0.27-0.73) were significantly associated with the intake.

Conclusion

Considering that healthy behaviors and subjective health led to the consumption of dietary supplements, whereas current disease or catastrophic experience did not, the intake of dietary supplements should be included in health promotion in Korea.

Determinants of supplementation among Canadian university students: a theory of planned behavior perspective

OBJECTIVE

The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB).

METHODS

A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants' attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions.

RESULTS

Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention.

CONCLUSIONS

This study confirms the utility of the TPB in predicting university students' supplementation habits.

A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects

Over the last 20 years, the use of dietary supplements (DS) has continued to grow in many countries. Due to the public health crisis brought on by the COVID-19 pandemic and amidst fears regarding COVID-19 vaccines and their low supply in many regions of the world, there has been a marked interest in the use of DS as alternative means of protecting against and treating this emerging disease, as well as boosting the immune system and minimizing the risk of inflammation. Despite a lack of evidence to suggest their efficacy, a surge in the sales of DS has been reported in many parts of the world. Questions have also been raised about the health effects associated with DS due to their increased use during the health crisis. Numerous scientific studies have demonstrated their beneficial properties as well as some adverse and even toxic effects. In addition, given the current global interest in this issue, a review is needed to establish the status of dietary supplements before and during the health crisis. The aim of this review is to summarize the current evidence on the impact of dietary supplements on the incidence of the COVID-19 pandemic, as well as their regulation and associated market trends. First, we provide an overview of DS, including a comprehensive review of the legislative and regulatory aspects of DS in the USA, China, the EU, and Algeria. Second, we describe the prevalence of the most commonly consumed DS and their efficacy as a prophylactic modality in the era of COVID-19. Additionally, we examine the structure and size of the DS market in the countries that predominantly produce and import them, its global market trend, and the impact of the COVID-19 pandemic on market growth. Finally, in this review, we also discuss the profile of DS users.

Authentication of milk thistle commercial products using UHPLC-QTOF-ESI + MS metabolomics and DNA metabarcoding

BACKGROUND

Milk thistle is one of the most popular hepatoprotectants, and is often sold in combination with other ingredients. Botanical supplements are known to be vulnerable to contamination and adulteration, and emerging technologies show promise to improve their quality control.

METHODS

Untargeted and semi-targeted metabolomics based on UHPLC-QTOF-ESI⁺MS techniques, UV spectrometry, and DNA metabarcoding using Illumina MiSeq were used to authenticate eighteen milk thistle botanical formulations (teas, capsules, tablets, emulsion).

RESULTS

Untargeted metabolomics separated 217 molecules and by multivariate analysis the discrimination between the different preparations was established. The semi-targeted metabolomics focused on 63 phytochemicals, mainly silymarin flavonolignans and flavonoids, that may be considered as putative biomarkers of authenticity. All formulations contained molecules from silymarin complexes at different levels. The quantitative evaluation of silybins was done using in parallel UV spectrometry and UHPLC-QTOF-ESI⁺MS and their correlations were compared. DNA metabarcoding detected milk thistle in eleven out of sixteen retained preparations, whereas two others had incomplete evidence of milk thistle despite metabolomics validating specific metabolites, e.g., silymarin complex, identified and quantified in all samples. Meanwhile, the DNA metabarcoding provided insights into the total species composition allowing the interpretation of the results in a broad context.

CONCLUSION

Our study emphasizes that combining spectroscopic, chromatographic, and genetic techniques bring complementary information to guarantee the quality of the botanical formulations.

Complications and treatment errors in root coverage procedures

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them.

Dietary Arginine and Citrulline Supplements for Cardiovascular Health and Athletic Performance: A Narrative Review

The global market for nutritional supplements (NS) is growing rapidly, and the use of L-arginine (Arg), L-citrulline (Cit), and citrulline malate (CitMal) supplements has been shown to enhance cardiovascular health and athletic performance. Over the past decade, Arg, Cit, and CitMal supplements have received considerable attention from researchers in the field of exercise nutrition, who have investigated their potential effects on hemodynamic function, endothelial function, aerobic and anaerobic capacity, strength, power, and endurance. Previous studies were reviewed to determine the potential impact of Arg, Cit, and CitMal supplements on cardiovascular health and exercise performance. By synthesizing the existing literature, the study aimed to provide insight into the possible uses and limitations of these supplements for these purposes. The results showed that both recreational and trained athletes did not see improved physical performance or increased nitric oxide (NO) synthesis with 0.075 g or 6 g doses of Arg supplement per body weight. However, 2.4 to 6 g of Cit per day for 7 to 16 days of various NSs had a positive impact, increasing NO synthesis, enhancing athletic performance indicators, and reducing feelings of exertion. The effects of an 8 g acute dose of CitMal supplement were inconsistent, and more research is needed to determine its impact on muscle endurance performance. Based on the positive effects reported in previous studies, further testing is warranted in various populations that may benefit from nutritional supplements, including aerobic and anaerobic athletes, resistance-trained individuals, elderly people, and clinical populations, to determine the impact of different doses, timing of ingestion, and long-term and acute effects of Arg, Cit, and CitMal supplements on cardiovascular health and athletic performance.

Goodform: A cluster randomised controlled trial of a school-based program to prevent body dissatisfaction and muscle building supplement use among adolescent boys

Although body dissatisfaction is common among adolescent boys, few intervention programs specifically developed for boys have been shown to be effective for reducing body dissatisfaction. Our study aim was to evaluate Goodform, a 4-session, teacher delivered intervention program specifically developed for boys to reduce body dissatisfaction and muscle building supplement use. The Goodform program was based on cognitive dissonance, social learning theory, and a social norms approach, and drew from two existing body image intervention programs that have shown promise among males: The Body Project- More than Muscles, and the Athletes Training and Learning to Avoid Steroids Program (ATLAS). A sample of 488 boys in grades 9 and 10 (M_age = 14.81, SD_age = 0.51) at nine secondary schools in Australia were randomly assigned to Goodform (n = 244) or control (n = 244) at the school level. Self-reported body image, supplement use, anabolic androgenic steroid (AAS) use, and attitudes around using AAS and muscle building supplements were measured at baseline, post-intervention, and eight-week follow-up. Analyses with multi-level, mixed-effect regression models revealed no changes over time attributable to the intervention. Our results have implications for researchers in the body image and eating disorder prevention fields. Lessons learned in this study can inform future school-based efforts for reducing muscle building supplement use.

On-Site Multisample Determination of Chlorogenic Acid in Green Coffee by Chemiluminiscent Imaging

The potential of antioxidants in preventing several diseases has attracted great attention in recent years. Indeed, these products are part of a multi-billion industry. However, there is a lack of scientific information about safety, quality, doses, and changes over time. In the present work, a simple multisample methodology based on chemiluminiscent imaging to determine chlorogenic acid (CHLA) in green coffee samples has been proposed. The multi-chemiluminiscent response was obtained after a luminol-persulfate reaction at pH 10.8 in a multiplate followed by image capture with a charge-coupled device (CCD) camera as a readout system. The chemiluminiscent image was used as an analytical response by measuring the luminescent intensity at 0 °C with the CCD camera. Under the optimal conditions, the detection limit was 20 µM and precision was also adequate with RSD < 12%. The accuracy of the proposed system was evaluated by studying the matrix effect, using a standard addition method. Recoveries of chlorogenic acid ranged from 93-94%. The use of the CCD camera demonstrated advantages such as analysis by image inspection, portability, and easy-handling which is of particular relevance in the application for quality control in industries. Furthermore, multisample analysis was allowed by one single image saving time, energy, and cost. The proposed methodology is a promising sustainable analytical tool for quality control to ensure green coffee safety through dosage control and proper labelling preventing potential frauds.

Dietary Supplements with Proline-A Comprehensive Assessment of Their Quality

Dietary supplements are food products commonly used worldwide to obtain nutritional and physiological effects. They can contain a wide variety of active substances and can be administered for health and disease. Their use can be beneficial if justified, and their quality is adequate. Unfortunately, data on the quality of supplements is scarce. As part of this work, we assess the quality of seven dietary supplements containing proline. The preparations were produced in the EU and the USA. The quality assessment consisted of the detection of potential impurities, the determination of the content of the main ingredient, and the release of proline. The technique used to analyse impurities and proline (Pro) content was liquid chromatography coupled with tandem mass spectrometry. We detected five contaminants. The main ingredient content was in the range of 73-121% in capsules and 103-156% in tablets. Five of the seven analysed dietary supplements released below 80% Pro (for each tablet/capsule at pH 1.2). One of the supplements may be inactive because a very low release of Pro was reported. The results, we hope, will increase consumer awareness of the quality of these preparations and result in a change in the regulations governing the marketing of these preparations, at least by making release testing mandatory.

Investigating the Regulatory Process, Safety, Efficacy and Product Transparency for Nutraceuticals in the USA, Europe and Australia

Increased numbers of patients with chronic conditions use nutraceuticals or food-based therapeutics. However, to date, there is no global consensus on the regulatory processes for nutraceuticals. With the increased use, issues of quality and safety have also arisen. This review summarises the current regulations held for nutraceuticals in the USA, European and Australian jurisdictions using regulatory authority sites and databases. The efficacy and safety concerns, product development, gaps in regulation and challenges in ensuring product authenticity are also summarised. The data highlight the complexity that the globalisation of nutraceuticals brings with respect to challenges in regulation and associated claims regarding efficacy and safety. The development of an effective system with integrity is needed to increase vertical collaboration between consumers, healthcare practitioners, and government agencies and the development of international risk assessment criteria and botanical compendia. This will help in greater transparency and improved trust in the process and products. Emerging technologies could play a role in improving systems engineering by information sharing and leveraging the strengths of different countries. In conclusion, nutraceuticals have been poorly regulated leading to spurious claims based on little or no real evidence. This makes it difficult to separate meaningful results from poor data. More stringent regulation and an effective system of integrity are required to ensure efficacy and safety and enable the adequate monitoring and increase consumer and healthcare professionals' confidence.

Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers

BACKGROUND

Supplements are commonly used by individuals with indications for lipid-lowering therapy, but evidence of their effectiveness to lower low-density lipoprotein cholesterol (LDL-C) is lacking, particularly when compared with statins.

OBJECTIVES

The trial objective was to compare the efficacy of a low-dose statin with placebo and 6 common supplements in impacting lipid and inflammatory biomarkers.

METHODS

This was a single-center, prospective, randomized, single-blind clinical trial among adults with no history of atherosclerotic cardiovascular disease (ASCVD), an LDL-C of 70 to 189 mg/dL, and an increased 10-year risk of ASCVD. Participants were randomized to rosuvastatin 5 mg daily, placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice. The primary endpoint was the percent change in LDL-C from baseline for rosuvastatin 5 mg daily compared with placebo and each supplement after 28 days. The primary endpoint was evaluated in a hierarchical fashion with rosuvastatin first compared with placebo, then each supplement in a prespecified order using analysis of covariance.

RESULTS

A total of 190 participants completed the study. The percent LDL-C reduction with rosuvastatin was greater than all supplements and placebo (P < 0.001). The difference in LDL-C reduction with rosuvastatin compared with placebo was -35.2% (95% CI: -41.3% to -29.1%; P < 0.001). None of the dietary supplements demonstrated a significant decrease in LDL-C compared with placebo. Adverse event rates were similar across study groups.

CONCLUSIONS

Among individuals with increased 10-year risk for ASCVD, rosuvastatin 5 mg daily lowered LDL-C significantly more than placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. (Supplements, Placebo, or Rosuvastatin Study [SPORT]; NCT04846231).

Probiotic supplements and stress-related occupational health outcomes: A scoping review

BACKGROUND

Prolonged and constant stress from work often leads to numerous adverse health effects. In recent years, interest in probiotics, living microorganisms that can benefit their host when consumed in adequate amounts, to aid health and well-being has increased. This scoping review is to systematically evaluate the current state of science on the effects of probiotic supplements on health, stress, and stress-related symptoms among working adults in occupational settings.

METHODS

We performed a systematic scoping review following the Arksey and O'Malley Framework. Studies that examined the effects of probiotics on workers' health and stress-related indicators/outcomes in occupational settings were included. A comprehensive search was performed from November 2021 to January 2022 using MEDLINE/PubMed, Cochrane Library, CINAHL, PsychInfo, Scopus, and Embase.

RESULTS

A total of 14 papers met the inclusion and exclusion criteria. Probiotics consisted primarily of Lactobacillus and/or Bifidobacterium strains in various forms and doses. Three out of eight studies reported statistical differences in inflammatory markers or stress hormone levels between probiotic and placebo groups. Three of six reported reduced respiratory tract infection incidents in the probiotic groups and three out of four studies reported no differences in anxiety and depression between groups. Lastly, three studies found that absenteeism and presentism were lower in probiotic groups compared with placebo groups.

CONCLUSION

The potential benefits of probiotics exist; however, the measurements of outcomes, the types of probiotics used, and the characteristics of the intervention varied across studies. Further research is needed focusing on probiotics' direct and indirect mechanisms of action on the stress response and the standardization of strains and dosing.

Dietary Supplement Use and Associated Factors Among Adults Working in Urban Settings in Tanzania: A Cross-Sectional Study

Dietary supplements are products consumed to provide nutrients or other substances that the user may not consume in sufficient amounts through normal diets. Despite their increased global popularity, there is still scant information regarding the use of dietary supplements and associated factors among adult populations in Tanzania. This study aimed to assess the extent of dietary supplement use and factors associated with use among adults working in urban settings. This was a cross-sectional study involving 419 adults working in public and private institutions within the Ilala District of Dar es Salaam who were selected using stratified and simple random sampling techniques. The study's data was collected using quantitative methods through a self-administered questionnaire. Data analysis was done through descriptive statistics for frequencies, means, standard deviations, and proportions; cross-tabulations with chi-square tests for comparing observed differences in supplement use; and multivariable logistic regression for identifying factors associated with supplement use. A P-value of <.05 was considered statistically significant in the analysis. The prevalence of dietary supplement use among working adults was 46.5%, where 36.9% reported regular and 63.1% occasional supplement use, respectively. Seven types of dietary supplements were identified to be consumed, of which 45.1% of the respondents consumed more than one type of dietary supplement. Multivitamins (64.1%) were the most frequently reported type of supplement consumed, followed by Mineral (34.9%) and Herbal/Botanical (26.7%) supplements. The most commonly reported reason for dietary supplement use among working adults was to improve overall health (67.1%). A third of the users (35.9%) admitted to self-prescribing dietary supplements without seeking professional medical advice. The use of dietary supplements was significantly associated with being female (AOR = 2.243, 95% CI 1.415-3.555, P = .001) and knowledgeable of supplements (AOR = 6.756, 95% CI 4.092-11.154, P < .001). Overall, the use of dietary supplements is popular among adults working within urban settings, but its use is exacerbated by perceived knowledge and self-prescription instead of health professional advice. Therefore, there is a need for further studies to explain better the underlying drivers for perceived knowledge on decision-making. There is also a strong need for extensive health education to prevent inappropriate or excessive use of supplements which might lead to potential adverse events.

Effect of magnesium supplementation in improving hyperandrogenism, hirsutism, and sleep quality in women with polycystic ovary syndrome: A randomized, placebo-controlled clinical trial

Background and Aims

Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders in women, which causes numerous symptoms in women. The relationship of many micronutrients with this syndrome has been investigated. This study was conducted to examine the effects of magnesium supplementation on hyperandrogenism, hirsutism, and sleep quality in women with PCOS.

Methods

In this parallel randomized clinical trial, 64 women with PCOS were randomly assigned to the magnesium group (n = 32) or placebo group (n = 32) for 10 weeks. Patients in the magnesium group received one 250 mg magnesium oxide tablet, per day. Hyperandrogenism, hirsutism, and sleep quality were measured at the beginning and end of the study. This randomized clinical trial was registered at https://www.IRCT.ir (IRCT20130903014551N8).

Results

Magnesium supplementation had no significant effect on hyperandrogenism (p = 0.51 for dehydroepiandrosterone sulfates, p = 0.27 for testosterone), hirsutism (p = 0.23), and sleep quality (p = 0.85) compared with placebo.

Conclusions

The present study showed that a single dose of magnesium supplementation elicited no beneficial effects on the mentioned symptoms in polycystic women. It is possible that the positive effects of magnesium observed in the former studies were due to the synergistic effects of other vitamins or minerals. More studies are needed in this area.

Dietary Supplements among Children Ages 0-3 Years in Poland-Are They Necessary?

(1) Background: One of the ways to prevent nutritional deficiencies may be supplementation. Experts have observed the increased use of dietary supplements, not only in adults but also in children. Considering controversies among dietary supplements and possible errors in children's feeding, the goal of our research was to evaluate use and reasons behind supplementation in terms of children's diet analysis. (2) Methods: Our research involved 507 legal guardians of the youngest children (up to 3 years of age) and was conducted via a questionnaire. (3) Results: 79% of all children received dietary supplements. The analysis of children's diets showed a need to implement omega-3 acids and vitamin D supplementation, which was very low in children. On the other hand, vitamin C, vitamin B, vitamin A, and copper levels were extremely high. (4) Conclusions: Popularity of dietary supplements in Polish children aged 0-3 years old is an omnipresent issue. Although the reasoning behind administering nutritional supplements to children seems justified, considering the supply of vitamin D and omega-3 fatty acids, it seems justified to increase parents' knowledge in this regard in terms of the use and means to choose the best supplement possible, as dietary supplementation should always be tailored to individual needs.

Medicinal plants effective in the treatment of glaucoma from the perspective of traditional Persian medicine

Traditional Persian medicine (TPM) is one of the richest medical schools in the world, which has nurtured valuable books. From Ibn Sina's law to Heravi's successful medicinal facts, all emphasize the treatment of various diseases, especially eye diseases based on herbal medicines, as well as their prevention. In this study, by reviewing the authoritative books of Traditional Persian Medicine, we are looking for medicinal plants so that they can be used in the treatment of glaucoma or glaucoma. the purpose of this study is not to express the complete cure of glaucoma, but this article seeks to classify plants that from the perspective of Traditional Persian Medicine can be used as complementary medicine alongside conventional medical treatments. Methods and Materials: This is a summative qualitative content analysis that focused on Traditional Persian Medicine (TPM) texts from 2th to 13th AH centuries. Literature was searched during centuries 4th to 13th AH, and after described of glaucoma, extracting and classifying plants. Results: The scholars of TPM have opinions in the field of recognizing, describing and treating eye diseases and defining practical words. In almost all books of general Persian PM, the diagnosis and treatment of eye diseases have been discussed. Glaucoma in Traditional Persian Medicine is called “black water”. Conclusion: Unlike other medical schools in the world, in addition to treating diseases, Persian medicine has a strong recommendation to prevent the occurrence of disease and also to strengthen the body's visual powers by using 6 principles of maintaining health along with herbal medicines"

Valorization of mushroom by-products: a review

With the rapid growth of the global economy and the global population, the production of solid waste has increased remarkably. Mushrooms are gaining popularity among researchers for their ability to turn waste into nutrients. However, a large number of by-products are produced during the industrial processing of mushrooms. Traditional waste management, focusing on the utilization and disposal of mushroom by-products, has attracted the attention of researchers. Meanwhile, the circular economy has become a multidisciplinary research field, and the valorization of mushroom by-products is a very important part of circular economy research. Various mushroom by-products of mushroom are reviewed in this paper. By-products are used in food as raw materials or functional components, in livestock and poultry feed after grinding/fermentation, and as electrochemical materials and papermaking materials. The by-products can also be used to produce ethanol and other biological sources of energy, as absorbing substances in sewage treatment, and as fertilizer in soil amendment. Mushroom processing by-products can be applied in various fields. To improve production efficiency, new extraction technology (including supercritical fluid technology and microwave extraction technology) can be adopted to increase the bioactive substance content in the by-products. Choosing appropriate processing temperature, time, and other processing conditions can also enhance product quality. Finally, more research is needed on the cost-effective utilization of the by-products and the feasibility of industrialization. © 2022 Society of Chemical Industry.

Label compliance for ingredient verification: regulations, approaches, and trends for testing botanical products marketed for "immune health" in the United States

During the COVID-19 pandemic, the botanical product market saw a consumer interest increase in immune health supplements. While data are currently insufficient to support public health guidance for using foods and dietary supplements to prevent or treat COVID-19 and other immune disorders, consumer surveys indicate that immune support is the second-most cited reason for supplement use in the United States. Meanwhile, consumers showed increased attention to dietary supplement ingredient labels, especially concerning authenticity and ingredient claims. Top-selling botanical ingredients such as elderberry, turmeric, and functional mushrooms have been increasingly marketed toward consumers to promote immune health, but these popular products succumb to adulteration with inaccurate labeling due to the intentional or unintentional addition of lower grade ingredients, non-target plants, and synthetic compounds, partially due to pandemic-related supply chain issues. This review highlights the regulatory requirements and recommendations for analytical approaches, including chromatography, spectroscopy, and DNA approaches for ingredient claim verification. Demonstrating elderberry, turmeric, and functional mushrooms as examples, this review aims to provide industrial professionals and scientists an overview of current United States regulations, testing approaches, and trends for label compliance verification to ensure the safety of botanical products marketed for "immune health."

Exploration of facilitators and barriers to the regulatory frameworks of dietary and herbal supplements: a scoping review

Background

Over the last decade, the use of dietary and herbal supplements (DHSs) has expanded greatly across national healthcare settings for the prevention, management and/or treatment of a variety of health issues. Although regulatory policies for DHSs across different countries have been aimed towards evaluating safety and efficacy, performing quality controls, monitoring the manufacturing practices, and encouraging further research, significant safety issues have emerged from inappropriate regulatory classification, lack of suitable quality controls, and inadequate testing and labeling of these products. Therefore, the purpose of this scoping review was to identify facilitators and barriers to DHS regulation across different countries.

Methods

A scoping review was conducted and informed by the five-stage methodological framework proposed by Arksey and O’Malley and further enhanced by Levac et al. MEDLINE, EMBASE, AMED, and PsycINFO databases were systematically searched for eligible articles from database inception to September 29, 2020. Studies analyzing DHS regulatory frameworks were eligible for review. Relevant data from eligible articles were extracted and categorized into themes to provide a descriptive overview of the literature.

Results

Searches generated 4314 results, 1800 of which were duplicates, followed by 2472 that were excluded after screening the titles and abstracts of these articles. Of the remaining 42 full-texts, 15 eligible articles were included in this review. Themes identified include: (1) increased financial and human resources encouraging knowledge expansion as a facilitator to DHS regulation; (2) variances in DHS classification and regulatory requirements across countries as a barrier to DHS regulation, and (3) collaboration between various stakeholders (experts, policymakers, representatives of regulatory bodies, product companies and research institutions) facilitating DHS regulation.

Conclusion

The present scoping review identified facilitators and barriers to DHS regulation across different countries. We highlight that safety assessments of DHSs continue to be inadequate, and emerging technologies could potentially play a significant role in establishing common reference standards of herbal materials and products between regulatory agencies. Regulatory harmonization, increased scientific research, and collaboration could improve regulations globally through appropriate categorization and safe application of DHSs.

Dietary Supplements Use among Serbian Undergraduate Students of Different Academic Fields

The rising popularity of dietary supplements as a part of self-care practice increases interest in monitoring their usage in the general and specific population groups. This study investigated the prevalence and patterns of dietary supplement use among Belgrade University undergraduate students and its variations across different academic study fields. Of the 914 online survey students, 55.7% used dietary supplements during the past year. Female gender, eating behavior, and academic field were significant predictors of dietary supplement use. For all students, the most commonly used dietary supplements were vitamins and minerals, alone or in combination. Magnesium, vitamin C, and B vitamins were the most frequently supplemented micronutrients. The reasons for using, place of purchase, and source of information regarding dietary supplements significantly varied among students of different fields of study. Adverse effects related to dietary supplement use, including gastrointestinal symptoms, skin flushing, dizziness, and heart palpitation, were reported in 4.5% of students. Insufficient knowledge about these products was self-reported by 16.5% of users, more common among non-medical students. Thus, public health interventions are needed to improve students' knowledge regarding rational and safe dietary supplement use.

The Effects of Consuming Amino Acids L-Arginine, L-Citrulline (and Their Combination) as a Beverage or Powder, on Athletic and Physical Performance: A Systematic Review

Consumption of amino acids L-arginine (L-Arg) and L-citrulline (L-Cit) are purported to increase nitric oxide (NO) production and improve physical performance. Clinical trials have shown relatively more favorable outcomes than not after supplementing with L-Cit and combined L-Arg and L-Cit. However, in most studies, other active ingredients such as malate were included in the supplement. Therefore, the aim of this study was to determine the efficacy of consuming standalone L-Arg, L-Cit, and their combination (in the form of powder or beverage) on blood NO level and physical performance markers. A systematic review was undertaken following PRISMA 2020 guidelines (PROSPERO: CRD42021287530). Four electronic databases (PubMed, Ebscohost, Science Direct, and Google scholar) were used. An acute dose of 0.075 g/kg of L-Arg or 6 g L-Arg had no significant increase in NO biomarkers and physical performance markers (p > 0.05). Consumption of 2.4 to 6 g/day of L-Cit over 7 to 16 days significantly increased NO level and physical performance markers (p < 0.05). Combined L-Arg and L-Cit supplementation significantly increased circulating NO, improved performance, and reduced feelings of exertion (p < 0.05). Standalone L-Cit and combined L-Arg with L-Cit consumed over several days effectively increases circulating NO and improves physical performance and feelings of exertion in recreationally active and well-trained athletes.

Effects of Oral Multi-Vitamin Multi-Mineral Supplement Formulations on Laboratory Outcomes and Quality of Life: A Quasi-Experimental Study

Background

Multi-vitamin multi-mineral (MVMM) products often come in several single-substance capsules from different manufacturers. However, attempts to mix several vitamins and minerals into one MVMM product have been complicated and often involve legal concerns. This study aimed to comparatively investigate the changes in laboratory parameters and the quality of life (QOL) among individuals who received different MVMM formulations.

Methods

This three-arm non-randomized controlled trial was conducted at VitalLife Scientific Wellness Center (VSWC), Bangkok, Thailand. A total of 72 healthy adult individuals with total serum 25-(OH)D level of 20–29 ng/ml were invited to choose from the three available options, namely, (1) Hydro-Cell-Key (HCK®, Hepart AG, Switzerland) contains vitamin D3 2,000 IU, vitamin C 1,000 mg, vitamin E 166 mg, vitamin A 1 mg, coenzyme Q10 30 mg, natural carotenoids 8 mg, and citrus flavonoids 200 mg in granule formulation; (2) VTL-7 (VWSC) contains similar vitamins and minerals but in capsule formulation; and (3) placebo capsule (no supplement). The 36-Item Short-Form Health Survey (SF-36) was used to measure QOL at baseline, month 3 and 6. A generalized estimating equation (GEE) was used to compare the repeated-measure outcomes across the three groups. This study was registered at the Thai Clinical Trial Registration (TCTR20190205002) and approved by the Bumrungrad International Institutional Review Board (BI-IRB No.258-10-18PhFub).

Results

Both VTL-7 and HCK saw a significantly higher increase in vitamin D than placebo at months 3 and 6, i.e., VTL-7 from 25.15 ± 2.13 to 35.53 ± 6.11 (p &lt; 0.001) and 33.38 ± 6.89 (p &lt; 0.001); HCK from 24.25 ± 3.08 to 28.43 ± 5.93 (p = 0.005) and 27.40 ± 5.24 (p = 0.012); and placebo from 24.00 ± 2.73 to 23.05 ± 4.39 (p = 0.273) and 22.30 ± 6.23 (p = 0.200), respectively. Similarly, β-carotenoids of VTL-7 vs. HCK groups significantly increased from 0.88 ± 0.68 vs. 0.94 ± 0.55 at baseline to 3.03 ± 1.79 (p &lt; 0.001) vs. 1.09 ± 0.61 (p = 0.125) and 3.26 ± 1.74 (p &lt; 0.001) vs. 1.15 ± 0.66 (p = 0.064), respectively. These findings were corroborated through the GEE analysis. Other micronutrients at months 3 and 6 did not increase significantly from baseline in any group. The overall QOL among the three groups in terms of physical (p = 0.560) and mental (p = 0.750) health increased but was not statistically significant.

Conclusion

The supplements of MVMM in capsule formulation increased the serum levels of some micronutrients to a higher extent than that of granule formulation. Participant adherence remains a potential confounder and should be further explored.

Clinical Trial Registration

identifier: TCTR20190205002.

A Nutraceutical Product Based on a Mixture of Algae and Extra Virgin Olive Oils and Olive Leaf Extract Attenuates Sepsis-Induced Cardiovascular and Muscle Alterations in Rats

Nutraceuticals are products of natural origin widely used for the treatment and/or prevention of some chronic diseases that are highly prevalent in Western countries, such as obesity or type II diabetes, among others. However, its possible use in the prevention of acute diseases that can put life at risk has been poorly studied. Sepsis is an acute condition that causes cardiovascular and skeletal muscle damage due to a systemic inflammatory state. The aim of this work was to evaluate the possible beneficial effect of a new nutraceutical based on a mixture of algae oil (AO) and extra virgin olive oil (EVOO) supplemented with an olive leaf extract (OLE) in the prevention of cardiovascular alterations and skeletal muscle disorders induced by sepsis in rats. For this purpose, male Wistar rats were treated with the nutraceutical or with water p.o. for 3 weeks and after the treatment they were injected with 1mg/kg LPS twice (12 and 4 h before sacrifice). Pretreatment with the nutraceutical prevented the LPS-induced decrease in cardiac contractility before and after the hearts were subjected to ischemia-reperfusion. At the vascular level, supplementation with the nutraceutical did not prevent hypotension in septic animals, but it attenuated endothelial dysfunction and the increased response of aortic rings to the vasoconstrictors norepinephrine and angiotensin-II induced by LPS. The beneficial effects on cardiovascular function were associated with an increased expression of the antioxidant enzymes SOD-1 and GSR in cardiac tissue and SOD-1 and Alox-5 in arterial tissue. In skeletal muscle, nutraceutical pretreatment prevented LPS-induced muscle proteolysis and autophagy and significantly increased protein synthesis as demonstrated by decreased expression of MURF-1, atrogin-1, LC3b and increased MCH-I and MCH -IIa in gastrocnemius muscle. These effects were associated with a decrease in the expression of TNFα, HDAC4 and myogenin. In conclusion, treatment with a new nutraceutical based on a mixture of AO and EVOO supplemented with OLE is useful to prevent cardiovascular and muscular changes induced by sepsis in rats. Thus, supplementation with this nutraceutical may constitute an interesting strategy to reduce the severity and mortality risk in septic patients.

The Use of Medications and Dietary Supplements by Masters Athletes - a Review

PURPOSE OF REVIEW

Masters athletes (MA) are generally considered healthier than their sedentary peers. However, the prevalence of chronic conditions in any population increases with age. Treatments involve pharmacological and non-pharmacological interventions. A substantial proportion of the general population also use dietary supplements (DS). This raises questions about the potential for drug-nutrient interactions which may lead to adverse effects. We sought to determine the potential for drug-nutrient interactions MA may be exposed to by examining the prevalence of chronic conditions treated with medications and their DS use.

RECENT FINDINGS

Common conditions in MA include hypertension, hyperlipidemia, asthma, osteoarthritis, depression and anxiety. Treatments may involve prescribed medications. Few recent studies were identified on DS use; however, indications are for around 60% prevalence of supplement usage. The higher prevalence of DS use by MA may result in drug-nutrient interactions that impact the effectiveness and safety of prescribed medications for chronic conditions.

Relationship between socioeconomic, demographic, health and social characteristics and ability to access reliable information on herbal and food supplements: analysis of Thai Health Literacy Survey 2019

Background

The consumption of herbal and food supplements attributing to health expenditures in Thailand has been increasing over the years. However, information on herbal and food supplement products can make it difficult for some people with limited health literacy to use. Evidence from previous studies outside Thailand shows that SES disadvantaged groups are more likely to have limited health literacy compared with their counterparts with advantaged SES. The present study adds to this body of knowledge through an exploration of health literacy competencies related to herbal and food supplement consumption to determine what competency would be most problematic among Thai people. The study also investigated the influences of demographic and socio-economic factors on the most problematic health literacy competency on herbal and food supplements.

Methods

The THL-S used a stratified three-stage-sampling to draw a sample of Thais aged 15 years and above. Participants were interviewed with a questionnaire of 34 items measuring health literacy and 8 items measuring behavioural practices. Responses to questions on accessing, understanding, communicating, and making decisions related to herbal and food supplement consumption were analysed. A logistic regression model was used to explore the association between having difficulties in accessing information and participant’s socio-economic factors.

Results

Levels of difficulties the participants experienced varied among their health literacy competencies. Accessing reliable information was found to be the most problematic health literacy competency faced by respondents (48%), followed by asking healthcare providers about herbal products and food supplements (41%). Significant differences in the ability to access reliable information on herbal and food supplements were found to be based on differences in: education, income levels, occupation, insurance scheme coverage, age, sex, reading ability, writing ability, chronic diseases, wearing eyeglasses or lenses, hearing impairment, and having a community leading role.

Conclusions

Accessing reliable information on herbal and food supplements has been found to be the most difficult health literacy competency among respondents to the survey, particularly vulnerable consumers in the society such as people with hearing impairment or having limited overall literacy competencies. Therefore, health literacy programs might be developed to build health literacy competencies and empower vulnerable consumers for reasonable use of herbal and food supplements.

Zinc availability from zinc-enriched yeast studied with an in vitro digestion/Caco-2 cell culture model

BACKGROUND

Organic zinc sources for the treatment of zinc deficiency or as a supplement to a specific diet are increasingly needed. Zinc-enriched yeast (ZnYeast) biomass is a promising nutritional supplement for this essential micronutrient. However, these products are not yet authorized in the European Union and a clear position from the European Food Safety Authority on the use of ZnYeast as a zinc supplement is pending, demanding more data on its bioavailability.

OBJECTIVE

The study aimed to produce a ZnYeast based on a Saccharomyces genus (S. pastorianus Rh), characterize its zinc enrichment quota, cellular distribution of zinc, and evaluate its zinc bioavailability after human digestion by comparing it to commonly used inorganic and organic zinc supplements (ZnO, ZnSO4, zinc gluconate, and zinc aspartate).

METHOD AND MAIN FINDINGS

The zinc-enriched S. pastorianus Rh contained 5.9 ± 1.0 mg zinc/g yeast, which was predominantly localized on the cell surface according to its characterization on the microscale with scanning electron microscopy (SEM) with energy-dispersive X-ray (EDX). Combined experiments with a human in vitro digestion model and the in vitro intestinal cell model Caco-2 showed that intestinal zinc bioavailability of digested yeast biomass was comparable to the other zinc supplements, apart from ZnO, which was somewhat less bioavailable. Moreover, zinc released from digested ZnYeast was available for biological processes within the enterocytes, leading to mRNA upregulation of metallothionein, a biomarker of intestinal zinc status, and significantly elevated the cellular labile zinc pool.

CONCLUSIONS

Our findings demonstrated that ZnYeast represents a suitable nutritional source for organically bound zinc and highlighted optimization strategies for future production of dietary ZnYeast.

Dietary Supplements as Source of Unintentional Doping

Background

The substances used in sport could be divided into two major groups: those banned by the World Anti-Doping Agency and those which are not. The prohibited list is extremely detailed and includes a wide variety of both medicinal and nonmedicinal substances. Professional athletes are exposed to intense physical overload every day. They follow a relevant food regime and take specific dietary supplements, which is essential for the better recovery between trainings and competitions. However, the use of “nonprohibited” dietary supplements (DS) is not always completely safe. One of the risks associated with the use of dietary supplements is the risk of unintended doping—originating from contaminated products. The presence of undeclared compounds in the composition of DS is a serious concern. The aim of this study is to evaluate the risk of unintentional doping.

Materials and Methods

Literature search was done through PubMed, Science Direct, Google Scholar, and Web of Science. Studies investigating the presence of undeclared compounds, in dietary supplements, banned by WADA met the inclusion criteria. The last search was conducted in June 2021. The present review is based on a total of 50 studies, which investigated the presence of undeclared compounds in DS.

Results

The total number of analyzed DS is 3132, 875 of which were found to contain undeclared substances. Most frequently found undeclared substances are sibutramine and anabolic-androgenic steroids.

Conclusion

More than 28% of the analyzed dietary supplements pose a potential risk of unintentional doping. Athletes and their teams need to be aware of the issues associated with the use of DS. They should take great care before inclusion of DS in the supplementation regime.

Nutritional and Exercise Interventions in Cancer-Related Cachexia: An Extensive Narrative Review

One of the common traits found in cancer patients is malnutrition and cachexia, which affects between 25% to 60% of the patients, depending on the type of cancer, diagnosis, and treatment. Given the lack of current effective pharmacological solutions for low muscle mass and sarcopenia, holistic interventions are essential to patient care, as well as exercise and nutrition. Thus, the present narrative review aimed to analyze the nutritional, pharmacological, ergonutritional, and physical exercise strategies in cancer-related cachexia. The integration of multidisciplinary interventions could help to improve the final intervention in patients, improving their prognosis, quality of life, and life expectancy. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Cancer-related cachexia is a complex multifactorial phenomenon in which systemic inflammation plays a key role in the development and maintenance of the symptomatology. Pharmacological interventions seem to produce a positive effect on inflammatory state and cachexia. Nutritional interventions are focused on a high-energy diet with high-density foods and the supplementation with antioxidants, while physical activity is focused on strength-based training. The implementation of multidisciplinary non-pharmacological interventions in cancer-related cachexia could be an important tool to improve traditional treatments and improve patients' quality of life.

Application of Liquid Chromatography Coupled to Mass Spectrometry in Quality Assessment of Dietary Supplements—A Case Study of Tryptophan Supplements: Release Assay, Targeted and Untargeted Studies

Dietary supplements are widely consumed in the EU and the USA. Based on their similarity to pharmaceuticals, consumers mistakenly believe that dietary supplements have also been approved for safety and efficacy. However, in the absence of mandatory testing, data on supplement quality is scarce. Thus, we applied liquid chromatography coupled with tandem mass spectrometry to analyse the quality of dietary supplements containing tryptophan (Trp). We examined 22 supplements in tablets or capsules, produced in the USA, Great Britain, Germany, France, Czech Republic, and Poland. Trp release, crucial for bioavailability and efficiency, was assessed. Additionally, we performed a qualitative analysis of the main ingredient and screened for contaminants. Among the contaminants, we detected Trp’s metabolites, condensation products of Trp and carbonyl compounds, Trp degradation products, degradation products of kynurenine, and other contaminants such as glucosamine and melatonin. The main ingredient content was in the range of 55–100% in capsules and 69–87% in tablets. Surprisingly, almost no Trp release was noted from some supplements. Our study confirms the need to advance research on supplements. We believe that the high-quality analysis of supplements based on reliable analytical techniques will be an important contribution to the discussion on the regulatory framework of these products.

Prevalence of and Factors Associated With Nutritional Supplement Use Among Older Chinese Adults: A Nationwide Cross-Sectional Study in China

Objective

This study identified the prevalence of nutritional supplement (NS) use among older Chinese adults and explored the factors associated with NS use in this population.

Methods

We used data from 11,089 Chinese men and women aged ≥ 65 years from the 2018 Chinese Longitudinal Healthy Longevity Survey. The chi-square test was used to examine the differences in demographics, health status and lifestyles at different levels. Multivariate logistic regression was used to assess the association between NS use and demographic and lifestyle characteristics.

Results

Twelve percent of Chinese adults aged 65 years and above used NS. In terms of the type of supplement used, the most commonly used was calcium (8.49%), followed by protein (2.73%) and multivitamins (2.40%). In terms of demographic characteristics, women, older people, urban residents with other marital status, higher educational level, better living conditions and better lifestyle habits showed a greater use of some kinds of NS to varying degrees. Factors associated with the use of any NS included female gender [OR = 1.71, 95% confidence intervals (95% CI): 1.09-1.44], age 85-94 (OR = 1.30, 95% CI: 1.08-1.58), urban household registration (hukou) (OR = 1.25, 95% CI:1.46-2.00), higher education (primary school and middle school: OR = 1.32, 95% CI:1.14-1.52; high school and above: OR = 1.56, 95% CI:1.25-1.94), average and poor living standard (average: OR = 0.64, 95% CI:0.56-0.73; poor: OR = 0.42, 95% CI:0.32-0.55), poor health status (OR = 1.36, 95% CI:1.13-1.63), former smoking (OR = 1.33, 95% CI:1.11-1.60), and having exercise habits (former exercise: OR = 2.24, 95% CI:1.83-2.74; current exercise: OR = 2.28, 95% CI:2.00-2.61). Women reported taking 2-3 kinds of NSs, and more than 50% of NS users reported taking supplements often.

Conclusion

This study provides information on the current prevalence of NS use among older Chinese adults, and it clarifies the association of NS use with demographic, lifestyle and other factors. Providing scientifically based health guidance on NS use for older people is crucial to promoting their health.

Physically inactive adults are the main users of sports dietary supplements in the capital of Brazil

Purpose

This cross-sectional study aimed to provide estimates of dietary supplements (DS) use and to examine the relationship between sports dietary supplements (SDS) use and sociodemographic and lifestyle characteristic, body mass index and total daily physical activity (PA) in the adult population of Brasília, Brazil.

Methods

DS use was collected from 506 adults via a Food Frequency Questionnaire. DS were divided into multivitamin-minerals, electrolyte drinks, energy, protein, partial meal replacements, creatine, caffeine, and others. Electrolyte drinks, energy, and protein supplements were considered as SDS. PA was estimated from a 24-h PA recall, and total MET (metabolic equivalents)/day and MET-h/day were calculated. Participants were categorized as physically inactive or active according to MET-h/day.

Results

DS were used by 68% of adults; multivitamin-minerals (38%) and protein supplements (29%) were the most commonly used products. SDS use was associated with the highest socioeconomic level, younger age, and male gender, but not with PA. Also, most SDS users were physically inactive.

Conclusion

These findings indicate that SDS may be used unnecessarily by adults in Brasília. Specific recommendations and control procedures for the use of SDS are warranted.