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Bailey RL, Jun S, Cowan AE, Eicher-Miller HA, Gahche JJ, Dwyer JT, Hartman TJ, Mitchell DC, Seguin-Fowler RA, Carroll RJ, Tooze JA. Major Gaps in Understanding Dietary Supplement Use in Health and Disease. Annu Rev Nutr 2023; 43:179-197. [PMID: 37196365 PMCID: PMC11078263 DOI: 10.1146/annurev-nutr-011923-020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Precise dietary assessment is critical for accurate exposure classification in nutritional research, typically aimed at understanding how diet relates to health. Dietary supplement (DS) use is widespread and represents a considerable source of nutrients. However, few studies have compared the best methods to measure DSs. Our literature review on the relative validity and reproducibility of DS instruments in the United States [e.g., product inventories, questionnaires, and 24-h dietary recalls (24HR)] identified five studies that examined validity (n = 5) and/or reproducibility (n = 4). No gold standard reference method exists for validating DS use; thus, each study's investigators chose the reference instrument used to measure validity. Self-administered questionnaires agreed well with 24HR and inventory methods when comparing the prevalence of commonly used DSs. The inventory method captured nutrient amounts more accurately than the other methods. Reproducibility (over 3 months to 2.4 years) of prevalence of use estimates on the questionnaires was acceptable for common DSs. Given the limited body of research on measurement error in DS assessment, only tentative conclusions on these DS instruments can be drawn at present. Further research is critical to advancing knowledge in DS assessment for research and monitoring purposes.
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Affiliation(s)
- Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Alexandra E Cowan
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | | | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Diane C Mitchell
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, Texas, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Youness RA, Dawoud A, ElTahtawy O, Farag MA. Fat-soluble vitamins: updated review of their role and orchestration in human nutrition throughout life cycle with sex differences. Nutr Metab (Lond) 2022; 19:60. [PMID: 36064551 PMCID: PMC9446875 DOI: 10.1186/s12986-022-00696-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Age and Gender are vital determinants for the micronutrient demands of normal indviduals. Among these micronutrients are vitamins that are required in small amounts for optimum metabolism, homeostasis, and a healthy lifestyle, acting as coenzymes in several biochemical reactions. The majority of previous studies have examined such issues that relates to a specific vitamin or life stage, with the majority merely reporting the effect of either excess or deficiency. Vitamins are classified into water-soluble and fat-soluble components. The fat-soluble vitamins include vitamins (A, D, E, and K). Fat-soluble vitamins were found to have an indisputable role in an array of physiological processes such as immune regulation, vision, bone and mental health. Nonetheless, the fat-soluble vitamins are now considered a prophylactic measurement for a multitude of diseases such as autism, rickets disease, gestational diabetes, and asthma. Herein, in this review, a deep insight into the orchestration of the four different fat-soluble vitamins requirements is presented for the first time across the human life cycle beginning from fertility, pregnancy, adulthood, and senility with an extensive assessment ofthe interactions among them and their underlying mechanistic actions. The influence of sex for each vitamin is also presented at each life stage to highlight the different daily requirements and effects.
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Affiliation(s)
- Rana A Youness
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt. .,Biology and Biochemistry Department, School of Life and Medical Sciences, University of Hertfordshire Hosted By Global Academic Foundation, Cairo, Egypt.
| | - Alyaa Dawoud
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt.,Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Omar ElTahtawy
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Mohamed A Farag
- Pharmacognosy Department, College of Pharmacy, Cairo University, Kasr El Aini St, Cairo, 11562, Egypt.
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Zhang Y, Song M, Mucci LA, Giovannucci EL. Regular, Long-Duration Multivitamin Use and Risk of Overall and Aggressive Prostate Cancer in the Health Professionals Follow-Up Study. J Urol 2022; 208:633-640. [PMID: 35522215 PMCID: PMC9378679 DOI: 10.1097/ju.0000000000002735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Multivitamin supplement is commonly used among older adults in the United States. Evidence on multivitamin use and prostate cancer risk is limited, and some suggested potential risk for clinically important subtypes of cancer. MATERIALS AND METHODS A total of 48,137 men from the Health Professionals Follow-up Study were followed from 1986 to 2017. Multivitamin use and frequency were self-reported at baseline and updated biennially. Clinical features of prostate cancer included advanced, lethal and high-grade outcomes. Cox proportional hazards models were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) of multivitamin use and incidence of prostate cancer. RESULTS The median followup for men without prostate cancer diagnosis or death was 30.7 years. We documented 7,108 incident prostate cancer cases including 564 advanced and 1,065 lethal. Overall, we observed a null association between multivitamin use and risk of prostate cancer. Compared to never-users, men who used multivitamin 10 or more tablets per week had similar risk of advanced (HR: 1.14, 95% CI: 0.77-1.70, Ptrend=0.46) or lethal (HR: 1.07, 95% CI: 0.80-1.44, Ptrend=0.59) prostate cancer, and multivitamin use of 15 years or more was not associated with risk of advanced (HR: 1.10, 95% CI: 0.80-1.50, Ptrend=0.46) or lethal (HR: 1.04, 95% CI: 0.83-1.31, Ptrend=0.13) prostate cancer. CONCLUSIONS Regular or long-duration multivitamin use among older, generally well-nourished men was not associated with either increased or lower risk of overall or aggressive prostate cancer.
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Affiliation(s)
- Yiwen Zhang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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4
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Alwalan SI, Alrasheed AA, Aldossari KK, Al-Zahrani JM, Alshahrani AM, Batais MA, Almigbal TH. Prevalence and characteristics of multivitamin-multimineral (MVMM) use among Saudi populations in Riyadh, Saudi Arabia: A cross-sectional study. Medicine (Baltimore) 2022; 101:e28638. [PMID: 35089203 PMCID: PMC8797584 DOI: 10.1097/md.0000000000028638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Use of multivitamin multimineral (MVMM) preparations is prevalent and growing worldwide, contributing to major health expenditure. Minimal literature on prevalence and characteristics of MVMM use is available from Saudi Arabia.The study was conducted to determine the prevalence and characteristics of MVMM use among Saudi population in Riyadh, Saudi Arabia.A cross-sectional study was conducted at 6 shopping malls located in the different regions of Riyadh city for 6 months from February 01, 2019, to July 31, 2019. A well-structured English questionnaire was developed, translated into Arabic language, and validated by the experts. A pertinent inclusion and exclusion criteria were established. After having informed consent to be included in the study, the printed copies of the questionnaire were distributed among the participants using a convenient sampling technique. The data were collected and analyzed using SPSS version 24. Descriptive statistics were presented as numbers, percentages, means, and standard deviations. A P value of ≤.05 and 95% confidence intervals were used to report the statistical significance.Out of 1200 surveys distributed, 1105 were returned by the participants (response rate 92%). Prevalence of MVMM supplements use turned out to be 47%. The study revealed statistically significant association between MVMM use and gender, marital status, education, regular exercise, smoking, following special diet, and eating fruits and vegetables (P ≤ .05). Majority of the participants used MVMM on daily basis (57.9%), and hospital prescriptions (57.9%) were the most common reason of MVMM use. Majority of the participants used MVMM for diet supplements (32.2%), health promotion (29.4%), and treatment of disease (16%).The MVMM use is prevalent in Saudi population, warranting sound regulatory policies for their judicial use and increase awareness about the benefits and side effects of dietary supplements.
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Affiliation(s)
- Saleh I. Alwalan
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Alrasheed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled K. Aldossari
- Family and Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Jamaan M. Al-Zahrani
- Family and Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Mohammed A. Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Turky H. Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Vision College of Medicine, Vision Colleges, Riyadh, Saudi Arabi
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5
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Vitamin B1, eye and brain. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210929019b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the
normal function of the nervous system, visual system and heart and is part
of important enzymes in the body. Thiamine enables the normal use of
glucose, other carbohydrates and proteins, and enables the supply of energy
to the organism. The main sources of thiamine are exogenous and small
amounts are synthesized by microorganisms of the human intestinal
microbiome. Vitamin B1 cannot accumulate in the body, so signs of
deficiency are quickly manifested. Hypovitaminosis B1 is seen in chronic
ethyl abuse, persistent vomiting (as in some pregnant women) or after
bariatric surgical procedures, but in a mild form it is present in the
general population. Normal daily needs for vitamin B1 depend on calorie
intake, and 0.4 mg should be ingested for every 1000 kcal.
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6
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Padhani ZA, Moazzam Z, Ashraf A, Bilal H, Salam RA, Das JK, Bhutta ZA. Vitamin C supplementation for prevention and treatment of pneumonia. Cochrane Database Syst Rev 2021; 11:CD013134. [PMID: 34791642 PMCID: PMC8599445 DOI: 10.1002/14651858.cd013134.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND According to the Global Burden of Disease Study 2015, lower respiratory tract infection is the leading cause of infectious disease death, and the fifth most common cause of death overall. Vitamin C has a role in modulating resistance to infectious agents, therefore vitamin C supplementation may be important in preventing and treating pneumonia. OBJECTIVES To assess the impact of vitamin C supplementation to prevent and treat pneumonia in children and adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed, CINAHL, LILACS, Web of Science, and two trials registers to 4 March 2020. We also checked references to identify additional studies. We did not apply any publication status or language filters. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs (studies using allocation methods that are not random, e.g. date of birth, medical record number) assessing the role of vitamin C supplementation in the prevention and treatment of pneumonia in children and adults compared to control or placebo. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included five studies in the review and identified two ongoing studies. The five included studies involved a total of 2655 participants; two studies were RCTs and three were quasi-RCTs. The included studies were conducted in one high-income country (USA) and three lower-middle-income countries (Bangladesh and Pakistan). Three studies were conducted in hospital inpatient settings, one in school, and one in a military training centre. Three studies included children under five years of age, one study included school-aged children, and one study included adult participants. Two studies assessed the effect of vitamin C supplementation for pneumonia prevention; and three studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment. For pneumonia prevention, the included studies provided supplementation in doses of 1 g daily for 14 weeks, 2 g daily for 8 weeks, and 2 g daily for 14 weeks. For pneumonia treatment, the included studies provided vitamin C supplementation in doses of 125 mg daily and 200 mg daily until the symptoms resolved or discharge, as an adjunct to the pneumonia treatment. Overall, the included studies were judged to be at either high or unclear risk of bias for random sequence generation, allocation concealment, and blinding; and the evidence certainty was very low. Two studies assessed the effect of vitamin C supplementation for pneumonia prevention; we judged the certainty of the evidence as very low. We are uncertain about the effect of vitamin C supplementation on pneumonia incidence and adverse events (urticaria). None of the included studies reported other primary outcomes (pneumonia prevalence and mortality) or any of the secondary outcomes. Three studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment; we judged the certainty of the evidence as very low. We are uncertain of the effect of vitamin C supplementation on duration of illness and hospitalisation. None of the included studies reported other primary or secondary outcomes. AUTHORS' CONCLUSIONS Due to the small number of included studies and very low certainty of the existing evidence, we are uncertain of the effect of vitamin C supplementation for the prevention and treatment of pneumonia. Further good-quality studies are required to assess the role of vitamin C supplementation in the prevention and treatment of pneumonia.
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Affiliation(s)
- Zahra Ali Padhani
- Department of Women's and Children's Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Hasana Bilal
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Vincenti A, Bertuzzo L, Limitone A, D’Antona G, Cena H. Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population. Nutrients 2021; 13:1913. [PMID: 34199569 PMCID: PMC8226782 DOI: 10.3390/nu13061913] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin B12 (also known as cobalamin) is an essential water-soluble vitamin that plays a pivotal role for several physiologic functions during one's lifespan. Only certain microorganisms are able to synthetize B12, thus humans obtain cobalamin exclusively from their diet, specifically from animal-derived foods. Specific sub-group populations are at risk of vitamin B12 subclinical deficiency due to different factors including poor intake of animal source foods and age-dependent decrease in the capacity of intestinal B12 uptake. Consumption of animal products produces some negative health issues and negatively impacts sustainability while a plant-based diet increases the risk of B12 deficiency. Taking a cue from the aforementioned considerations, this narrative review aims to summarize facts about B12 deficiency and the burden of inadequate dietary intake in elderly population, as well as to discuss sustainable approaches to vitamin B12 deficiency in aging population.
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Affiliation(s)
- Alessandra Vincenti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Laura Bertuzzo
- Glaxosmithkline (GSK) Consumer Healthcare, via Zambeletti s.n.c., 20021 Baranzate, Italy; (L.B.); (A.L.)
| | - Antonio Limitone
- Glaxosmithkline (GSK) Consumer Healthcare, via Zambeletti s.n.c., 20021 Baranzate, Italy; (L.B.); (A.L.)
| | - Giuseppe D’Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)—Sport Medicine Centre, University of Pavia, 27058 Voghera, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Alonso Street EM, Grutzmacher S, Branscum A, Smit E. Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009-2014 National Health and Nutrition Examination Survey. J Diet Suppl 2021; 19:689-703. [PMID: 34033728 DOI: 10.1080/19390211.2021.1924336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28-1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13-1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were "personal choice or influenced by advertisements or word of mouth," "improve health," and "specific health conditions" (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.
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Affiliation(s)
- Ellen M Alonso Street
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Stephanie Grutzmacher
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Adam Branscum
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Ellen Smit
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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10
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Clayton P, Hill M, Bogoda N, Subah S, Venkatesh R. Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci 2021; 22:5305. [PMID: 34069940 PMCID: PMC8157570 DOI: 10.3390/ijms22105305] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 01/23/2023] Open
Abstract
All nations which have undergone a nutrition transition have experienced increased frequency and falling latency of chronic degenerative diseases, which are largely driven by chronic inflammatory stress. Dietary supplementation is a valid strategy to reduce the risk and severity of such disorders. Palmitoylethanolamide (PEA) is an endocannabinoid-like lipid mediator with extensively documented anti-inflammatory, analgesic, antimicrobial, immunomodulatory and neuroprotective effects. It is well tolerated and devoid of side effects in animals and humans. PEA's actions on multiple molecular targets while modulating multiple inflammatory mediators provide therapeutic benefits in many applications, including immunity, brain health, allergy, pain modulation, joint health, sleep and recovery. PEA's poor oral bioavailability, a major obstacle in early research, has been overcome by advanced delivery systems now licensed as food supplements. This review summarizes the functionality of PEA, supporting its use as an important dietary supplement for lifestyle management.
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Affiliation(s)
- Paul Clayton
- Institute of Food, Brain and Behaviour, Beaver House, 23-28 Hythe Bridge Street, Oxford OX1 2EP, UK
| | - Mariko Hill
- Gencor Pacific Limited, Discovery Bay, Lantau Island, New Territories, Hong Kong, China; (M.H.); (N.B.); (S.S.)
| | - Nathasha Bogoda
- Gencor Pacific Limited, Discovery Bay, Lantau Island, New Territories, Hong Kong, China; (M.H.); (N.B.); (S.S.)
| | - Silma Subah
- Gencor Pacific Limited, Discovery Bay, Lantau Island, New Territories, Hong Kong, China; (M.H.); (N.B.); (S.S.)
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11
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Devarshi PP, Legette LL, Grant RW, Mitmesser SH. Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age. Am J Clin Nutr 2021; 113:1042-1052. [PMID: 33567452 PMCID: PMC8023996 DOI: 10.1093/ajcn/nqaa392] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/24/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations. OBJECTIVES The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers. METHODS Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories. RESULTS Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category. CONCLUSIONS Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.
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Affiliation(s)
| | | | - Ryan W Grant
- Science and Technology, Pharmavite, West Hills, CA, USA
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12
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Goh WJ, Tan SX, Pastorin G, Ho PCL, Hu J, Lim SH. 3D printing of four-in-one oral polypill with multiple release profiles for personalized delivery of caffeine and vitamin B analogues. Int J Pharm 2021; 598:120360. [PMID: 33548364 DOI: 10.1016/j.ijpharm.2021.120360] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
Personalized supplementation has found recent momentum with an estimated global market size of USD 1.6 billion in 2019 and an expected CAGR of 8.5% between 2020 and 2028. Alongside this rising trend, a simple, accurate, inexpensive and flexible method to produce personalized dosage forms of a wide variety of supplements would be beneficial to both the industry players and individual consumers. Here, we present a 3D printing method to fabricate a four-in-one oral polypill with multiple release profiles for personalized delivery of caffeine and vitamin B analogues. The 3D printable formulations were fabricated and optimized from existing FDA GRAS excipients based on their viscosity, shear thinning properties, recovery of paste and mechanical strength. In the polypill, vitamin B analogues and caffeine were used as the model dietary ingredients. We performed a standard 2 stage USP in vitro dissolution test of the polypill, and demonstrated that vitamin B1, B3 and B6 could be immediately released within 30 min, while caffeine could be slowly released over a period of 4 h. This demonstrated the ability dietary supplement containing different ingredients with varying release profiles, all within a single polypill. Throughout the formulation and 3D printing process, there were no detectable changes to the dietary ingredients nor any interactions with the excipients. This method serves as an intriguing complement to traditional manufacturing of oral tablets, especially when flexibility in design, dose, volume and release profiles of each dietary ingredient is required, as exemplified in personalized supplementation.
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Affiliation(s)
- Wei Jiang Goh
- NUS Graduate School for Integrative Sciences and Engineering, University Hall, Tan Chin Tuan Wing Level 04, #04-02, 21 Lower Kent Ridge Road, Singapore 119077, Singapore; Craft Health Pte Ltd., 21 Bukit Batok Crescent, #10-75, WCEGA Tower, Singapore 658065, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore 117543, Singapore
| | - Si Xuan Tan
- Craft Health Pte Ltd., 21 Bukit Batok Crescent, #10-75, WCEGA Tower, Singapore 658065, Singapore
| | - Giorgia Pastorin
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore 117543, Singapore
| | - Paul Chi Lui Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore 117543, Singapore
| | - Jun Hu
- Institute of Chemical and Engineering Sciences, Agency for Science, Technology and Research, 1 Pesek Road, Jurong Island, Singapore 627833, Singapore
| | - Seng Han Lim
- Craft Health Pte Ltd., 21 Bukit Batok Crescent, #10-75, WCEGA Tower, Singapore 658065, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore 117543, Singapore.
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13
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The Joint Effects of Diet and Dietary Supplements in Relation to Obesity and Cardiovascular Disease over a 10-Year Follow-Up: A Longitudinal Study of 69,990 Participants in Australia. Nutrients 2021; 13:nu13030944. [PMID: 33804132 PMCID: PMC8001791 DOI: 10.3390/nu13030944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
It is unknown whether a healthy diet or unhealthy diet combined with specific supplements may jointly contribute to incidence of obesity and cardiovascular disease (CVD). We included 69,990 participants from the 45 and Up Study who completed both baseline (2006–2009) and follow-up (2012–2015) surveys. We found that compared to participants with a long-term healthy diet and no supplement consumption, those with a long-term healthy diet combined with multivitamins and minerals (MVM) or fish oil consumption were associated with a lower incidence of CVD (p < 0.001); whilst those with an unhealthy diet and no MVM or fish oil consumption were associated with a higher risk of obesity (p < 0.05). Compared to participants with a long-term healthy diet and no calcium consumption, the combination of a long-term healthy diet and calcium consumption was linked to a lower risk of CVD (IRR = 0.87, 95% CI: 0.78; 0.96). In conclusion, a long-term healthy diet combined with MVM or fish oil was associated with a lower incidence of CVD. Participants who maintained a healthy diet and used calcium supplements were associated with a lower incidence of obesity. However, these associations were not found among those with an unhealthy diet, despite taking similar supplements.
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14
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Michael AM, Mohamed AA, Abdelaziz YA, Fahmy NM. A Comparative Study Between Conventional ICP-OES and the Innovative PLS Model-Assisted ICP-OES for the Assay of Trace Elements. J AOAC Int 2021; 104:84-90. [PMID: 33035314 DOI: 10.1093/jaoacint/qsaa090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inductively coupled plasma is widely used for elemental analysis with the advantage of being eco-friendly since the discharge is free of contaminants. OBJECTIVE A rapid, novel method was developed for the quantitation of trace elements using inductively coupled plasma with optical emission spectrometry.This method has the advantage of simultaneous calibration compared to the conventional method. METHOD The assay was carried out for iron, copper, zinc, and molybdenum using the linear regression model partial least-squares. RESULTS The method was optimized and validated as per the International Conference on Harmonization guidelines, showing highly accurate and precise results. The linearity range was 0.25-4 ppm for all trace elements under investigation. The method was applied for the assay of the cited elements in non-chelated and amino acid chelated multi-mineral preparations in the Egyptian market with acceptable mean percent recovery. CONCLUSIONS In comparison with the official method by flame emission, statistical analysis showed no significant difference with Student's t-test and F-values. HIGHLIGHTS Inductively coupled plasma is superior as all of the elements can be measured simultaneously. The method was found to have a high degree of specificity and can be easily applied in routine elemental analysis in laboratories.
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Affiliation(s)
- Adel M Michael
- Ahram Canadian University, Faculty of Pharmacy, Giza, Egypt
| | - Ahmed A Mohamed
- Nerhadou International for Pharmaceuticals and Nutraceuticals, Giza, Egypt
| | - Yousef A Abdelaziz
- Nerhadou International for Pharmaceuticals and Nutraceuticals, Giza, Egypt
| | - Nesma M Fahmy
- Ahram Canadian University, Faculty of Pharmacy, Giza, Egypt
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15
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Mullin GE, Limketkai BN, Parian AM. Fish Oil for Inflammatory Bowel Disease: Panacea or Placebo? Gastroenterol Clin North Am 2021; 50:169-182. [PMID: 33518163 DOI: 10.1016/j.gtc.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Dietary supplements have increasingly gained popularity over the years not only to replete micronutrient deficiencies but for their use in treatment of disease. The popularity of dietary supplements for inflammatory bowel diseases (IBD) arises from their perceived ease of use, potential disease-modifying benefits, and perceived safety. Overall, randomized controlled trials have not consistently shown a benefit of fish oil for the maintenance of remission with Crohn's disease. The inconsistency of these findings highlights the need for more studies that are powered to clarify the context in which omega-3 fatty acids might have a role in the treatment algorithm of IBD.
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Affiliation(s)
- Gerard E Mullin
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Berkeley N Limketkai
- Division of Digestive Diseases, UCLA School of Medicine, 100 UCLA Medical Center Plaza, Suite 345, Los Angeles, CA 90095, USA
| | - Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21205, USA
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16
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Circulatory and Urinary B-Vitamin Responses to Multivitamin Supplement Ingestion Differ between Older and Younger Adults. Nutrients 2020; 12:nu12113529. [PMID: 33212933 PMCID: PMC7698360 DOI: 10.3390/nu12113529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
Multivitamin and mineral (MVM) supplements are frequently used amongst older populations to improve adequacy of micronutrients, including B-vitamins, but evidence for improved health outcomes are limited and deficiencies remain prevalent. Although this may indicate poor efficacy of supplements, this could also suggest the possibility for altered B-vitamin bioavailability and metabolism in older people. This open-label, single-arm acute parallel study, conducted at the Liggins Institute Clinical Research Unit in Auckland, compared circulatory and urinary B-vitamer responses to MVM supplementation in older (70.1 ± 2.7 y, n = 10 male, n = 10 female) compared to younger (24.2 ± 2.8 y, n = 10 male, n = 10 female) participants for 4 h after the ingestion of a single dose of a commercial MVM supplement and standardized breakfast. Older adults had a lower area under the curve (AUC) of postprandial plasma pyridoxine (p = 0.02) and pyridoxal-5′phosphate (p = 0.03) forms of vitamin B6 but greater 4-pyridoxic acid AUC (p = 0.009). Urinary pyridoxine and pyridoxal excretion were higher in younger females than in older females (time × age × sex interaction, p < 0.05). Older adults had a greater AUC increase in plasma thiamine (p = 0.01), riboflavin (p = 0.009), and pantothenic acid (p = 0.027). In older adults, there was decreased plasma responsiveness of the ingested (pyridoxine) and active (pyridoxal-5′phosphate) forms of vitamin B6, which indicated a previously undescribed alteration in either absorption or subsequent metabolic interconversion. While these findings cannot determine whether acute B6 responsiveness is adequate, this difference may have potential implications for B6 function in older adults. Although this may imply higher B vitamin substrate requirements for older people, further work is required to understand the implications of postprandial differences in availability.
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17
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Padhani ZA, Moazzam Z, Ashraf A, Bilal H, Salam RA, Das JK, Bhutta ZA. Vitamin C supplementation for prevention and treatment of pneumonia. Cochrane Database Syst Rev 2020; 4:CD013134. [PMID: 32337708 PMCID: PMC7192369 DOI: 10.1002/14651858.cd013134.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND According to the Global Burden of Disease Study 2015, lower respiratory tract infection is the leading cause of infectious disease death, and the fifth most common cause of death overall. Vitamin C has a role in modulating resistance to infectious agents, therefore vitamin C supplementation may be important in preventing and treating pneumonia. OBJECTIVES To assess the impact of vitamin C supplementation to prevent and treat pneumonia in children and adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed, CINAHL, LILACS, Web of Science, and two trials registers to 4 March 2020. We also checked references to identify additional studies. We did not apply any publication status or language filters. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs (studies using allocation methods that are not random, e.g. date of birth, medical record number) assessing the role of vitamin C supplementation in the prevention and treatment of pneumonia in children and adults compared to control or placebo. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven studies in the review and identified two ongoing studies. The seven included studies involved a total of 2774 participants; five studies were RCTs and two were quasi-RCTs. The included studies were conducted in high-income countries (UK, USA and Chile) and lower-middle-income countries (Bangladesh and Pakistan). Four studies were conducted in hospital inpatient settings, two in schools, and one in a military training centre. Three studies included children under five years of age, two school-aged children, one adult participants, and one older participants aged 60 to 90 years. Two studies assessed the effect of vitamin C supplementation for pneumonia prevention; four studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment; and one study assessed the role of vitamin C for both prevention and treatment of pneumonia. For pneumonia prevention, the included studies provided supplementation in doses of 500 mg daily for 14 weeks, 2 g daily for 8 weeks, and 2 g daily for 12 weeks. For pneumonia treatment, the included studies provided vitamin C supplementation in doses of 125 mg daily (until discharge), 200 mg for 4 weeks, and 200 mg until discharge, as an adjunct to the pneumonia treatment. We assessed the included studies as at overall either high or unclear risk of bias for random sequence generation, allocation concealment, and blinding. We judged the quality of the evidence as very low. Three studies assessed the effect of vitamin C supplementation for pneumonia prevention; we judged the quality of the evidence as very low. We are uncertain about the effect of vitamin C supplementation on pneumonia incidence (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.06 to 3.61; 2 studies, 736 participants; I² = 75%; very low-quality evidence) and adverse events (urticaria) (RR 3.11, 95% CI 0.13 to 76.03; 1 study, 674 participants; very low-quality evidence). No included studies reported our other primary outcomes (pneumonia prevalence and mortality) or any of our secondary outcomes. Five studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment; we judged the quality of the evidence as very low. One study reported a decrease in the duration of illness in the vitamin C supplementation group (3.4 days ± 2.54) compared to the control group (4.5 days ± 2.35), and one study reported a decrease in number of days required for improvement in oxygen saturation (1.03 days ± 0.16 versus 1.14 days ± 1.0) and respiratory rate (3.61 days ± 1.50 versus 4.04 days ± 1.62) in the vitamin C supplementation group compared to the control group. We are uncertain of the effect of vitamin C supplementation on mortality due to pneumonia (RR 0.21, 95% CI 0.03 to 1.66; 1 study, 57 participants; very low-quality evidence). One study reported that the mean duration of hospital stay was 6.75 days amongst children in the vitamin C supplementation group and 7.75 days in the control group; another study reported a lower mean duration of hospital stay in the vitamin C supplementation group compared to the control group (109.55 hours ± 27.89 versus 130.64 hours ± 41.76). AUTHORS' CONCLUSIONS Due to the small number of included studies and very low quality of the existing evidence, we are uncertain of the effect of vitamin C supplementation for the prevention and treatment of pneumonia. Further good-quality studies are required to assess the role of vitamin C supplementation in the prevention and treatment of pneumonia.
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Affiliation(s)
- Zahra Ali Padhani
- Department of Women's and Children's Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Hasana Bilal
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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18
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Cowan AE, Jun S, Tooze JA, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Moshfegh AJ, Rhodes DG, Bhadra A, Bailey RL. Comparison of 4 Methods to Assess the Prevalence of Use and Estimates of Nutrient Intakes from Dietary Supplements among US Adults. J Nutr 2020; 150:884-893. [PMID: 31851315 PMCID: PMC7138661 DOI: 10.1093/jn/nxz306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs). METHODS The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011-2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR. RESULTS Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR. CONCLUSIONS A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults.This trial was registered at clinicaltrials.gov as NCT03400436.
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Affiliation(s)
- Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kevin W Dodd
- NIH National Cancer Institute, Bethesda, MD, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Alanna J Moshfegh
- Beltsville Agricultural Research Center, Agricultural Research Service, USDA, Beltsville, MD, USA
| | - Donna G Rhodes
- Beltsville Agricultural Research Center, Agricultural Research Service, USDA, Beltsville, MD, USA
| | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA,Address correspondence to RLB (e-mail: )
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19
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Lubout CMA, Goorden SMI, van den Hurk K, Jaeger B, Jager NGL, van Koningsbruggen S, Chegary M, van Karnebeek CDM. Successful Treatment of Hereditary Folate Malabsorption With Intramuscular Folinic Acid. Pediatr Neurol 2020; 102:62-66. [PMID: 31371121 DOI: 10.1016/j.pediatrneurol.2019.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hereditary folate malabsorption is a multisystem disease owing to biallelic variants in the gene encoding the proton-coupled folate transporter. Hereditary folate malabsorption is treated with folinic acid, aimed to restore blood and cerebrospinal fluid folate levels. Little is known as to whether oral or intramuscular supplementation of folinic acid is most effective. METHODS Here we describe a one-year-old boy with hereditary folate malabsorption presenting with the typical features including failure to thrive, aphthous stomatitis, macrocytic anemia along with severe developmental impairment and epilepsy, as well as a magnetic resonance imaging of the brain showing bilateral occipital, cortical calcifications characteristic of hereditary folate malabsorption. We compared the effect of treatment with oral folinic acid versus intramuscular folinic acid supplementation by measuring plasma and cerebrospinal fluid folate levels. RESULTS Compared with oral administration, intramuscular treatment resulted in higher folate levels in blood and, most importantly, normalization of folate levels in cerebrospinal fluid. Clinically, nearly all systemic and neurological symptoms resolved. CONCLUSION Normal cerebrospinal fluid folate levels can be achieved in individuals with hereditary folate malabsorption with intramuscular (but not with oral) administration of folinic acid.
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Affiliation(s)
- Charlotte M A Lubout
- Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam Gastro-Enterology & Metabolism Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Susanna M I Goorden
- Department of Clinical Chemistry, Laboratory of Genetic Metabolic Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Karin van den Hurk
- Department of Clinical Chemistry, OLVG Lab BV, Amsterdam, The Netherlands
| | - Bregje Jaeger
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nynke G L Jager
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Malika Chegary
- Department of Pediatrics, OLVG, Amsterdam, The Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam Gastro-Enterology & Metabolism Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
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20
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Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers. Nutrients 2019; 11:nu11123046. [PMID: 31847176 PMCID: PMC6950482 DOI: 10.3390/nu11123046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022] Open
Abstract
Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg/m2. A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg/m2. Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7–70.7) vs. 60.1 (58.4–61.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6–13.1)), magnesium (OR = 2.9 (1.8–4.7)), potassium (OR = 4.7 (1.4–16.5)), vitamin A (OR = 2.8 (1.7–4.8)), vitamin B6 (OR = 2.9 (1.6–5.2)), and vitamin C (OR = 5.0 (2.8–8.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7–50.8) vs. 46.7% (44.8–48.7); p = 0.0001) and protein (18.2% (18.0–18.5) vs. 15.9% (15.1–16.6); p = 0.0001) and lower calories from fat (32.3% (31.9–32.8) vs. 37.4% (35.8–38.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.
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Radhakrishnan A, Kuppusamy G, Ponnusankar S, Shanmukhan NK. Pharmacogenomic phase transition from personalized medicine to patient-centric customized delivery. THE PHARMACOGENOMICS JOURNAL 2019; 20:1-18. [PMID: 31819163 DOI: 10.1038/s41397-019-0135-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
Personalized medicine has been a booming area in clinical research for the past decade, in which the detailed information about the patient genotype and clinical conditions were collected and considered to optimize the therapy to prevent adverse reactions. However, the utility of commercially available personalized medicine has not yet been maximized due to the lack of a structured protocol for implementation. In this narrative review, we explain the role of pharmacogenetics in personalized medicine, next-generation personalized medicine, i.e., patient-centric personalized medicine, in which the patient's comfort is considered along with pharmacogenomics to be a primary factor. We extensively discuss the classifications, strategies, tools, and drug delivery systems that can support the implementation of patient-centric personalized medicine from an industrial perspective.
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Affiliation(s)
- Arun Radhakrishnan
- Department of Pharmaceutics, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India.
| | - Gowthamarajan Kuppusamy
- Department of Pharmaceutics, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India.
| | - Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India
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22
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Wallace TC, Frankenfeld CL, Frei B, Shah AV, Yu CR, van Klinken BJW, Adeleke M. Multivitamin/Multimineral Supplement Use is Associated with Increased Micronutrient Intakes and Biomarkers and Decreased Prevalence of Inadequacies and Deficiencies in Middle-Aged and Older Adults in the United States. J Nutr Gerontol Geriatr 2019; 38:307-328. [PMID: 31502930 DOI: 10.1080/21551197.2019.1656135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Micronutrient inadequacies are common in older adults and using a multivitamin/multimineral supplement (MVM) may improve their nutritional status. National Health and Nutrition Examination Survey data were analyzed to determine micronutrient intakes based on diet and MVM use in adults aged ≥51 years. Deficiencies were evaluated using nutrient biomarkers. The National Cancer Institute Method was used to estimate usual intakes of 18 micronutrients stratified by age and frequency of MVM use. Compared with food alone, MVM use was associated with higher nutrient intake and lower prevalence of inadequacies of almost all micronutrients examined and improved nutrient biomarker status of folate, iodine, selenium, and vitamins B6, B12, and D. Regular MVM use (≥16 days/month) decreased the odds of clinical deficiency (defined by biomarker status) of vitamins B6 and D but increased the proportion exceeding the tolerable upper intake level of folic acid. Vitamin B6 deficiency in MVM non-users was common and increased with age.
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Affiliation(s)
- Taylor C Wallace
- Department of Nutrition and Food Studies, George Mason University , Fairfax , VA , USA.,Think Healthy Group, Inc. , Washington , DC , USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University , Fairfax , VA , USA
| | - Balz Frei
- Department of Biochemistry and Biophysics, Linus Pauling Institute, Oregon State University , Corvallis , OR , USA
| | - Alpa V Shah
- Pfizer Consumer Healthcare , Madison , NJ , USA
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23
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Harnett JE, McIntyre E, Steel A, Foley H, Sibbritt D, Adams J. Use of complementary medicine products: a nationally representative cross-sectional survey of 2019 Australian adults. BMJ Open 2019; 9:e024198. [PMID: 31315853 PMCID: PMC6661602 DOI: 10.1136/bmjopen-2018-024198] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/12/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To provide a contemporary description of complementary medicine (CM) product use in Australia. DESIGN Cross-sectional survey. SETTING Online. PARTICIPANTS A nationally representative sample (n=2019) of the Australian adult population. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes measures included the use and type of CM products used, and source of recommendation. Secondary measures included disclosure of CM product use to health practitioners, concomitant use of pharmaceuticals and predictors of use. RESULTS Prevalence of CM product use was 50.3%, with the most frequently used being vitamin and mineral supplements (VMSs; 47.8%) and homoeopathic medicines the least used (6.8%). A majority of respondents using CM products were also using pharmaceutical products, and small but significant associations were found between the use of CM products and pharmaceuticals (p<0.05). Small statistically significant associations were found between use of vitamin products and disclosure of use to general practitioners (GPs; Cramer's V=0.13, p=0.004) and hospital doctors (Cramer's V=0.11, p=0.04), and between use of herbal medicines and disclosure to both GPs (Cramer's V=0.11, p=0.02) and hospital doctors (Cramer's V=0.12, p=0.03). Women, those with higher education and those with no private health insurance were more likely to use CM products (p<0.05), while those without chronic conditions were less likely to use CM products (p<0.05) (χ2(29)=174.70, p<0.001). CONCLUSIONS The number of Australians using CM products has remained relatively stable and substantial for nearly two decades. The majority of CM use relates to VMSs. Given the number of Australians using both CM products and pharmaceutical medicines, it is important to evaluate the potential clinical implications of such practices to ensure safe, effective and coordinated health policy and patient care.
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Affiliation(s)
- Joanna E Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erica McIntyre
- Faculty of Health, University of Technology Sydney, Sydney, UK
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hope Foley
- Endeavour College of Natural Health - Sydney, Sydney, New South Wales, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
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24
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Bailey RL, Pac SG, Fulgoni VL, Reidy KC, Catalano PM. Estimation of Total Usual Dietary Intakes of Pregnant Women in the United States. JAMA Netw Open 2019; 2:e195967. [PMID: 31225890 PMCID: PMC6593963 DOI: 10.1001/jamanetworkopen.2019.5967] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Nutrition during pregnancy is a critical dimension not only for women's health but also for the lifelong health of the offspring. Very limited national data exist on the usual dietary intakes of pregnant women. OBJECTIVE To estimate total usual nutrient intakes (from foods and dietary supplements) and the population prevalence of meeting or exceeding the National Academies of Sciences, Engineering, and Medicine Dietary Reference Intake recommendations among pregnant US women. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis was performed of a nationally representative sample of 1003 pregnant US women aged 20 to 40 years from the 2001-2014 National Health and Nutrition Examination Survey. EXPOSURE Usual dietary intakes assessed by two 24-hour dietary recalls (including dietary supplements) adjusted for within-person variation using the National Cancer Institute method. MAIN OUTCOMES AND MEASURES The proportion of women at risk of inadequate dietary intake as determined by the Estimated Average Requirement, the proportion of women assumed to have adequate dietary intake as determined by the Adequate Intake, and the proportion of women at risk of excess dietary intake as determined by the Tolerable Upper Intake Level. Demographic differences between pregnant and nonpregnant women were compared with t tests. RESULTS As representative of the US population, this sample of 1003 pregnant women had a mean (SE) age of 28.0 (0.3) years, was predominantly non-Hispanic white (mean [SE], 54.5% [3.1%]), and was at above 185% of the income to poverty ratio (mean [SE], 56.8% [3.0%]). Most pregnant women used a dietary supplement (mean [SE], 69.8% [2.3%]). A total of 10% or more of pregnant women had a total usual intake that is less than the Estimated Average Requirement for magnesium (mean [SE], 47.5% [2.8%]), vitamin D (mean [SE], 46.4% [2.7%]), vitamin E (mean [SE], 43.3% [2.7%]), iron (mean [SE], 36.2% [2.8%]), vitamin A (mean [SE], 15.5% [2.1%]), folate (mean [SE], 16.4% [1.6%]), calcium (mean [SE], 12.9% [2.4%]), vitamin C (mean [SE], 11.5% [1.9%]), vitamin B6 (mean [SE], 11.5% [1.5%]), and zinc (mean [SE], 10.9% [1.9%]). Some pregnant women exceeded the Adequate Intake for potassium (mean [SE], 41.7% [2.9%]), choline (mean [SE], 7.9% [3.2%]), and vitamin K (mean [SE], 47.9% [4.3%]). Most women exceeded the Tolerable Upper Intake Level for sodium (mean [SE], 95.0% [2.2%]), and some women exceeded the Tolerable Upper Intake Level of folic acid (mean [SE], 33.4% [2.8%]), iron (mean [SE], 27.9% [2.8%]), calcium (mean [SE], 3.0% [0.8%]), and zinc (mean [SE], 7.1% [1.6%]). For iron, the prevalence of an at-risk intake from foods alone was lower among women who used supplements (mean [SE], 80.3% [4.3%]) than those who did not use supplements (mean [SE], 95.3% [7.3%]); however, supplement use increased the risk of excessive iron and folic acid intakes given the amounts that are being consumed from supplemental products. CONCLUSIONS AND RELEVANCE This study suggests that a significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements. Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet but not exceed dietary recommendations is warranted.
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Affiliation(s)
- Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | | | | | | | - Patrick M. Catalano
- Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University Medical Center, Boston, Massachusetts
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25
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Bailey RL, Dodd KW, Gahche JJ, Dwyer JT, Cowan AE, Jun S, Eicher-Miller HA, Guenther PM, Bhadra A, Thomas PR, Potischman N, Carroll RJ, Tooze JA. Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring. J Nutr 2019; 149:181-197. [PMID: 30753685 PMCID: PMC6374152 DOI: 10.1093/jn/nxy264] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022] Open
Abstract
The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN,Address correspondence to RLB (e-mail: )
| | - Kevin W Dodd
- National Institutes of Health, National Cancer Institute, Rockville, MD
| | - Jaime J Gahche
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD
| | - Johanna T Dwyer
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD
| | - Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Paul R Thomas
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD
| | - Nancy Potischman
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD
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26
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Kok DE, Steegenga WT, Smid EJ, Zoetendal EG, Ulrich CM, Kampman E. Bacterial folate biosynthesis and colorectal cancer risk: more than just a gut feeling. Crit Rev Food Sci Nutr 2018; 60:244-256. [DOI: 10.1080/10408398.2018.1522499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dieuwertje E. Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Wilma T. Steegenga
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Eddy J. Smid
- Laboratory of Food Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Erwin G. Zoetendal
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Cornelia M. Ulrich
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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27
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Bailey RL. Current regulatory guidelines and resources to support research of dietary supplements in the United States. Crit Rev Food Sci Nutr 2018; 60:298-309. [PMID: 30421981 PMCID: PMC6513729 DOI: 10.1080/10408398.2018.1524364] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/31/2022]
Abstract
The U.S. Dietary Supplement Health and Education Act (DSHEA) established the regulatory framework for dietary supplements as foods through the Food and Drug Administration (FDA). DSHEA outlined the legal definition, labeling requirements, and process for adverse event reporting for dietary supplements. FDA also issued formal guidance on current Good Manufacturing Practice to ensure that processes for preparation, packaging, labeling, and storage of supplements and ingredients are documented and meet specifications to ensure purity, composition, and strength. However, efficacy of dietary supplements is not required under U.S. law. Despite regulations to improve the marketplace, many challenges remain; as a result, the quality and safety of products available can be highly variable, especially for botanical and herbal products. The ability of regulators to successfully carry out their mission is hampered by the sheer number of products and manufacturing facilities and a lack of analytical methods for all ingredients and products in the marketplace, this is especially difficult for herbal and botanical dietary supplements. Safety issues continue to exist such as adulteration and contamination, especially with specific product types (i.e. body building, sexual enhancement). Thus, a need remains for continued efforts and improved techniques to assess the quality of dietary supplements, especially with regard to purity, bioavailability, and safety. This review will highlight the existing American regulatory framework for dietary supplements and will describe the remaining regulatory barriers to ensuring that safe and high-quality dietary supplements are offered in the marketplace.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, , West Lafayette, Indiana 47907, USA
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28
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Abstract
It is proposed that proteins/enzymes be classified into two classes according to their essentiality for immediate survival/reproduction and their function in long-term health: that is, survival proteins versus longevity proteins. As proposed by the triage theory, a modest deficiency of one of the nutrients/cofactors triggers a built-in rationing mechanism that favors the proteins needed for immediate survival and reproduction (survival proteins) while sacrificing those needed to protect against future damage (longevity proteins). Impairment of the function of longevity proteins results in an insidious acceleration of the risk of diseases associated with aging. I also propose that nutrients required for the function of longevity proteins constitute a class of vitamins that are here named "longevity vitamins." I suggest that many such nutrients play a dual role for both survival and longevity. The evidence for classifying taurine as a conditional vitamin, and the following 10 compounds as putative longevity vitamins, is reviewed: the fungal antioxidant ergothioneine; the bacterial metabolites pyrroloquinoline quinone (PQQ) and queuine; and the plant antioxidant carotenoids lutein, zeaxanthin, lycopene, α- and β-carotene, β-cryptoxanthin, and the marine carotenoid astaxanthin. Because nutrient deficiencies are highly prevalent in the United States (and elsewhere), appropriate supplementation and/or an improved diet could reduce much of the consequent risk of chronic disease and premature aging.
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Affiliation(s)
- Bruce N Ames
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute (CHORI), Oakland, CA 94609-1809
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29
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Das JK, Bilal H, Salam RA, Bhutta ZA. Vitamin C supplementation for prevention and treatment of pneumonia. Hippokratia 2018. [DOI: 10.1002/14651858.cd013134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jai K Das
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan
| | - Hasana Bilal
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan
| | - Rehana A Salam
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan
| | - Zulfiqar A Bhutta
- The Hospital for Sick Children; Centre for Global Child Health; Toronto ON Canada M5G A04
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30
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Cowan AE, Jun S, Gahche JJ, Tooze JA, Dwyer JT, Eicher-Miller HA, Bhadra A, Guenther PM, Potischman N, Dodd KW, Bailey RL. Dietary Supplement Use Differs by Socioeconomic and Health-Related Characteristics among U.S. Adults, NHANES 2011⁻2014. Nutrients 2018; 10:E1114. [PMID: 30126136 PMCID: PMC6116059 DOI: 10.3390/nu10081114] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to estimate the prevalence of use and types of dietary supplements (DS) used by U.S. adults (≥19 years) by sociodemographic characteristics: family income-to-poverty ratio (PIR), food security status, and Supplemental Nutrition Assistance Program (SNAP) participation using NHANES 2011⁻2014 data (n = 11,024). DS use was ascertained via a home inventory and a retrospective 30-day questionnaire. Demographic and socioeconomic differences related to DS use were evaluated using a univariate t statistic. Half of U.S. adults (52%) took at least one DS during a 30-day period; multivitamin-mineral (MVM) products were the most commonly used (31%). DS and MVM use was significantly higher among those with a household income of ≥ 350% of the poverty level, those who were food secure, and SNAP income-ineligible nonparticipants across all sex, age, and race/ethnic groups. Among women, prevalence of use significantly differed between SNAP participants (39%) and SNAP income-eligible nonparticipants (54%). Older adults (71+ years) remained the highest consumers of DS, specifically among the highest income group (82%), while younger adults (19⁻30 years), predominantly in the lowest income group (28%), were the lowest consumers. Among U.S. adults, DS use and the types of products consumed varied with income, food security, and SNAP participation.
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Affiliation(s)
- Alexandra E Cowan
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN 47907, USA.
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN 47907, USA.
| | - Jaime J Gahche
- National Institutes of Health, Office of Dietary Supplements, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA.
| | - Janet A Tooze
- School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA.
| | - Johanna T Dwyer
- National Institutes of Health, Office of Dietary Supplements, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA.
| | - Heather A Eicher-Miller
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN 47907, USA.
| | - Anindya Bhadra
- Department of Statistics, Purdue University, 250 N. University St., West Lafayette, IN 47907, USA.
| | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, 250 South 850 East, Salt Lake City, UT 84112, USA.
| | - Nancy Potischman
- National Institutes of Health, Office of Dietary Supplements, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA.
| | - Kevin W Dodd
- National Institutes of Health, National Cancer Institute, Medical Center Drive, Rockville, MD 20850, USA.
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN 47907, USA.
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31
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Luna RCP, Dos Santos Nunes MK, Monteiro MGCA, da Silva CSO, do Nascimento RAF, Lima RPA, Pimenta FCF, de Oliveira NFP, Persuhn DC, de Almeida ATC, da Silva Diniz A, Pissetti CW, Vianna RPT, de Lima Ferreira FEL, Rodrigues Gonçalves MDC, de Carvalho Costa MJ. α-Tocopherol influences glycaemic control and miR-9-3 DNA methylation in overweight and obese women under an energy-restricted diet: a randomized, double-blind, exploratory, controlled clinical trial. Nutr Metab (Lond) 2018; 15:49. [PMID: 30008789 PMCID: PMC6042339 DOI: 10.1186/s12986-018-0286-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Background Excess weight is a strong risk factor for the development of dysglycaemia. It has been suggested that changes in the metabolism microRNAs, small non-coding RNAs that regulate gene expression, could precede late glycaemic changes. Vitamin E in turn may exert important functions in methylation and gene expression processes. This study aimed to determine the effect of α-tocopherol on glycaemic variables and miR-9-1 and miR-9-3 promoter DNA methylation in overweight women. Methods A randomized, double-blind, exploratory, placebo-controlled study was conducted in overweight and obese adult women (n = 44) who ingested synthetic vitamin E (all-rac-α-tocopherol), natural source vitamin E (RRR-rac-α-tocopherol) or placebo capsules and were followed up for a period of 8 weeks. Supplemented groups also received dietary guidance for an energy-restricted diet. An additional group that received no supplementation and did not follow an energy-restricted diet was also followed up. The intervention effect was evaluated by DNA methylation levels (quantitative real-time PCR assay) and anthropometric and biochemical variables (fasting plasma glucose, haemoglobin A1C, insulin, and vitamin E). Results Increased methylation levels of the miR-9-3 promoter region (P < 0.001) and reduced haemoglobin A1C (P < 0.05) were observed in the natural source vitamin E group after intervention. Increased fasting plasma glucose was observed in the synthetic vitamin E group, despite the significant reduction of anthropometric variables compared to the other groups. Conclusions α-Tocopherol from natural sources increased methylation levels of the miR-9-3 promoter region and reduced haemoglobin A1C in overweight women following an energy-restricted diet. These results provide novel information about the influence of vitamin E on DNA methylation. Trial registration ClinicalTrials.gov, NCT02922491. Registered 4 October, 2016. Electronic supplementary material The online version of this article (10.1186/s12986-018-0286-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rafaella Cristhine Pordeus Luna
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil.,10Postgraduate in Nutrition Sciences, Health Sciences Center, Health and Nutrition Studies Interdisciplinary Center (NIESN), Federal University of Paraíba (Universidade Federal da Paraíba), Castelo Branco, João Pessoa, Paraíba 58051-900 Brazil
| | - Mayara Karla Dos Santos Nunes
- 2Postgraduate Program in Cellular and Molecular Biology, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58059-900 Brazil
| | - Mussara Gomes Cavalcante Alves Monteiro
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Cássia Surama Oliveira da Silva
- 3Health and Nutrition Studies Interdisciplinary Center, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Rayner Anderson Ferreira do Nascimento
- 2Postgraduate Program in Cellular and Molecular Biology, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58059-900 Brazil
| | - Raquel Patrícia Ataíde Lima
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Flávia Cristina Fernandes Pimenta
- 4Department of Internal Medicine, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Naila Francis Paulo de Oliveira
- 5Departament of Molecular Biology, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, 58059-900 Paraíba Brasil
| | - Darlene Camati Persuhn
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil.,2Postgraduate Program in Cellular and Molecular Biology, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58059-900 Brazil.,5Departament of Molecular Biology, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, 58059-900 Paraíba Brasil
| | - Aléssio Tony Cavalcanti de Almeida
- 6Department of Economics, Postgraduate Program in Applied Economics and Economics of the Public Sector, Center for Applied Social Sciences, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58059-900 Brazil
| | - Alcides da Silva Diniz
- 7Department of Nutrition, Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco 50670901 Brazil
| | - Cristina Wide Pissetti
- 8Department of Obstetrics and Gynecology, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Rodrigo Pinheiro Toledo Vianna
- 9Department of Nutrition, Graduate Program in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Flavia Emília Leite de Lima Ferreira
- 9Department of Nutrition, Graduate Program in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Maria da Conceição Rodrigues Gonçalves
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil.,9Department of Nutrition, Graduate Program in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
| | - Maria José de Carvalho Costa
- 1Postgraduate in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil.,9Department of Nutrition, Graduate Program in Nutrition Sciences, Health Sciences Center, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba 58051-900 Brazil
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Littlejohn P, Cop I, Brown E, Afroze R, Davison KM. Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e115. [PMID: 29891470 PMCID: PMC6018240 DOI: 10.2196/resprot.9846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/24/2018] [Accepted: 02/24/2018] [Indexed: 01/03/2023] Open
Abstract
Background Although nutrition interventions are a widely accepted resource for the prevention of long-term health conditions, current approaches have not adequately reduced chronic disease morbidity. Nutrigenomics has great potential; however, it is complicated to implement. There is a need for products based on nutrition-related gene test results that are easily understood, accessible, and used. Objective The primary objective of this study was to compare a nonpractitioner-assisted direct-to-consumer self-driven approach to nutrigenomics versus an integrated and personalized practitioner-led method. Methods This 4-month study used a mixed-methods design that included (1) a phase 1 randomized controlled trial that examined the effectiveness of a multifaceted, nutrition-based gene test (components assessed included major nutrients, food tolerances, food taste and preferences, and micronutrients) in changing health behaviors, followed by (2) a qualitative investigation that explored participants’ experiences. The study recruited 55 healthy males and females (aged 35-55 years) randomized as a 2:1 ratio where 36 received the intervention (gene test results plus integrated and personalized nutrition report) and 19 were assigned to the control group (gene test results report emailed). The primary outcomes of interest measures included changes in diet (nutrients, healthy eating index), changes in measures on General Self-efficacy and Health-Related Quality of Life scales, and anthropometrics (body mass index, waist-to-hip ratio) measured at baseline, post intervention (3 and 6 weeks), and the final visit (week 9 post intervention). Results Of the 478 individuals who expressed interest, 180 were invited (37.7%, 180/478) and completed the eligibility screening questionnaire; 73 of the 180 invited individuals (40.5%) were deemed eligible. Of the 73 individuals who were deemed to be eligible, 58 completed the baseline health questionnaire and food records (79%). Of these 58 individuals, 3 were excluded either because they did not complete all required data collection forms or were later found to be ineligible. The final sample (n=55) was mostly female (75%), married (85%), and those who had completed postsecondary education (62%). Conclusions This study will leverage quantitative and qualitative findings, which will guide the development of nutrigenomics-based products in electronic formats that are user-friendly for consumers and health professionals. Although the quantitative data have not been analyzed yet, the overwhelming interest in the study and the extremely high retention rate show that there is a great degree of interest in this field. Given this interest and the fact that nutrigenomics is an evolving science, a need for continued research exists to further the understanding of the role of genetic variation and its role and applications in nutrition practice. Trial Registration Clinicaltrials.gov NCT03310814; http://clinicaltrials.gov/ct2/show/NCT03310814 (Archived by WebCite at http://www.webcitation.org/6yGnU5deB) Registered Report Identifier RR1-10.2196/9846
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Affiliation(s)
- Paula Littlejohn
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Health Science, Department of Biology, Kwantlen Polytechnic University, Surrey, BC, Canada
| | - Irene Cop
- Health Science, Department of Biology, Kwantlen Polytechnic University, Surrey, BC, Canada
| | - Erin Brown
- Health Science, Department of Biology, Kwantlen Polytechnic University, Surrey, BC, Canada.,Fraser Health Authority, Surrey, BC, Canada.,Vancouver Coastal Health, Vancouver, BC, Canada
| | - Rimi Afroze
- Health Science, Department of Biology, Kwantlen Polytechnic University, Surrey, BC, Canada
| | - Karen M Davison
- Health Science, Department of Biology, Kwantlen Polytechnic University, Surrey, BC, Canada.,Department of Psychology, University of Hawai`i at Mānoa, Honolulu, HI, United States
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Clegg ME, Williams EA. Optimizing nutrition in older people. Maturitas 2018; 112:34-38. [PMID: 29704915 DOI: 10.1016/j.maturitas.2018.04.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
Abstract
Older adults are at increased risk of malnutrition, for a variety of physiological and psychological reasons. This has implications for health, quality of life, independence and economic circumstances. Improvements in nutrition are known to bring tangible benefits to older people and many age-related diseases and conditions can be prevented, modulated or ameliorated by good nutrition. However, practical and realistic approaches are required to optimize diet and food intake in older adults. One area where improvements can be made relates to appetite. Encouraging older adults to prepare meals can increase appetite and food intake, and providing opportunities for older adults to eat a wide variety of foods, in company, is a simple strategy to increase food intake. The protein requirement of older adults is subject to controversy and although considered the most satiating macronutrient, it appears that protein does not elicit as great a satiating effect in older adults as it does in younger individuals. This indicates that there is potential to increase protein intake without impacting on overall energy intake. Other areas where simple practical improvements can be made include both packaging of foods that are easy to prepare and the education of older adults on the safe storage and preparation of food. Research into improving the diets and nutritional status of older adults has indicated that many of the strategies can be easily and cost-effectively undertaken.
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Affiliation(s)
- Miriam E Clegg
- Oxford Brookes Centre for Nutrition and Health, Department of Sport, Health Sciences and Social Work, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP, UK.
| | - Elizabeth A Williams
- Department of Oncology & Metabolism, Human Nutrition Unit, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
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