Trends in exposure to drugs and prohibited substances among sports: A nationwide analysis of 2008-2022 inquiry records

To prevent athletes from unintentional doping, the anti-doping authorities in Taiwan have launched several sports-prohibited substances inquiry services since 2008. This study aimed to enhance the prevention of sports-prohibited substance misuse by analyzing data collected from major nationwide service systems, enabling the identification of trends in athletes' exposure to drugs and prohibited substances. The study collected over 30,000 data points from three major national anti-doping inquiry systems, spanning from 2008 to 2022. The information of the users consulted products, prohibited substances, and sports disciplines in the data were calculated and categorized. The usage of inquiry systems has shown an increasing trend from 2008 to 2022. Athletes comprised the majority of users (> 40%), significantly outnumbering other user groups (all below 20%). Among the inquiries, Western medicine accounted for the highest percentage (up to 79.6%), and it also contained the majority of the prohibited substances. Interestingly, traditional Chinese medicines had a higher chance (35.9%) of containing prohibited substances, as indicated by the mobile application. The prohibited substances mainly belonged to class S6 stimulants and S9 glucocorticoids. Among the daily medicinal products and nutritional supplements encountered by sports personnel, approximately 30% of them were found to contain prohibited substances. Future educational efforts should focus on raising awareness about traditional Chinese medicines and drugs for the common cold, ADHD, and pain relief, as well as their regulation, to prevent the misuse of prohibited substances.

No additive effect of creatine, caffeine, and sodium bicarbonate on intense exercise performance in endurance-trained individuals

BACKGROUND

Athletes commonly use creatine, caffeine, and sodium bicarbonate for performance enhancement. While their isolated effects are well-described, less is known about their potential additive effects.

METHODS

Following a baseline trial, we randomized 12 endurance-trained males (age: 25 ± 5 years, VO2max: 56.7 ± 4.6 mL kg-1 min-1; mean ± SD) and 11 females (age: 25 ± 3 years, VO2max: 50.2 ± 3.4 mL kg-1 min-1) to 5 days of creatine monohydrate (0.3 g kg-1 per day) or placebo loading, followed by a daily maintenance dose (0.04 g kg-1) throughout the study. After the loading period, subjects completed four trials in randomized order where they ingested caffeine (3 mg kg-1), sodium bicarbonate (0.3 g kg-1), placebo, or both caffeine and sodium bicarbonate before a maximal voluntary contraction (MVC), 15-s sprint, and 6-min time trial.

RESULTS

Compared to placebo, mean power output during 15-s sprint was higher following loading with creatine than placebo (+34 W, 95% CI: 10 to 58, p = 0.008), but with no additional effect of caffeine (+10 W, 95% CI: -7 to 24, p = 0.156) or sodium bicarbonate (+5 W, 95% CI: -4 to 13, p = 0.397). Mean power output during 6-min time trial was higher with caffeine (+12 W, 95% CI: 5 to 18, p = 0.001) and caffeine + sodium bicarbonate (+8 W, 95% CI: 0 to 15, p = 0.038), whereas sodium bicarbonate (-1 W, 95% CI: -7 to 6, p = 0.851) and creatine (-6 W, 95% CI: -15 to 4, p = 0.250) had no effects.

CONCLUSION

While creatine and caffeine can enhance sprint- and time trial performance, respectively, these effects do not seem additive. Therefore, supplementing with either creatine or caffeine appears sufficient to enhance sprint or short intense exercise performance.

Development of non-destructive methods for the assessment of authenticity of sports whey protein supplements

In the category of sports supplements, whey protein powder is one of the popular supplements for muscle building applications. Therefore, verification of the sport supplements as authentic products has become a universal concern. This work aimed to propose vibrational spectroscopy including near infrared (NIR) and infrared (IR) as rapid and non-destructive testing tools for the detection and quantification of maltodextrin, milk powder and milk whey powder in whey protein supplements. Initially, principal component analysis was applied to data for pattern recognition and the results displayed a fine pattern of discrimination. Partial least square discrimination analysis (PLS-DA) and K-nearest neighbours (KNN) were exploited as supervised method modelling classification. This process was done in order to respond to two vital questions whether the sample is adulterated or not and what is the kind of adulteration. PLS-DA showed better classification results rather than KNN according to the figure of merits of the model. Partial least square regression (PLSR) was employed on pre-treated spectra to quantify the amount of adulteration in sport whey supplements. Eventually, it seems vibrational spectroscopy could be implemented as a simple, and low-cost analysis method for the detection and quantification of mentioned adulterants in whey protein supplements.

Novel methods for the remote investigation of emerging substances: Application to kratom

The botanical product commonly called "kratom" is still relatively novel to the United States. Like other natural products marketed as supplements, kratom is highly variable, both in terms of the alkaloids naturally occurring in kratom leaves and in terms of processing and formulation. Kratom products sold in the United States are not well-characterized, nor are daily use patterns among regular users. Surveys and case reports have comprised most of the literature on kratom use among humans. To advance our understanding of real-world kratom use, we developed a protocol for the remote study of regular kratom-using adults in the United States. Our study had three aspects implemented in one pool of participants nationwide: an in-depth online survey, 15 days of ecological momentary assessment (EMA) via smartphone app, and the collection and assay of the kratom products used by participants during EMA. Here, we describe these methods, which can be used to investigate myriad drugs or supplements. Recruiting, screening, and data collection occurred between July 20, 2022 and October 18, 2022. During this time, we demonstrated that these methods, while challenging from a logistical and staffing standpoint, are feasible and can produce high-quality data. The study achieved high rates of enrollment, compliance, and completion. Substances that are emerging or novel, but still largely legal, can be productively studied via nationwide EMA combined with assays of shipped product samples from participants. We discuss challenges and lessons learned so other investigators can adapt these methods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dietary intake with supplementation of vitamin D, vitamin B6, and magnesium on depressive symptoms: a public health perspective

Objective

This study aims to understand the impact of dietary intake through supplementation of vitamins D, B6, and magnesium on elevated depressive symptoms, a mental health illness that is a leading contributor to global disability and a public health concern.

Methods

Multiple datasets from the National Health and Nutrition Examination Survey 2017-March 2020 investigated the associations between vitamin D, B6, and magnesium on depression screening scores. A cross-sectional sample of adults over 20 was extracted (n = 9,232). Chi-square tests and logistic regression analyses were used to investigate the associations.

Results

Individuals with low amounts of vitamin D (p = 0.0481) were more likely to report elevated depressive symptoms relative to those with low amounts of vitamin B6 (p = 0.0225). These results remained significant among those with high magnesium (p = 0.0133) proportionate to high vitamin B6 (p = 0.0225). In the age-adjusted model, a lower intake of vitamin D, vitamin B6, and magnesium showed a relationship with elevated depressive symptoms (Vitamin D: OR = 0.611, 95% CI 0.382-0.980 Vitamin B6: OR = 0.503, 95% CI 0.291-0.867 Magnesium: OR = 0.458, 95% CI 0.277-0.759). The fully adjusted regression model (gender, race/ethnicity, and household food security) showed that a lower intake of vitamin B6 and magnesium correlated with elevated depressive symptoms (Vitamin B6: OR = 0.439, 95% CI 0.260-0.738 Magnesium: OR = 0.465, 95% CI 0.303-0.714).

Conclusion

Preventive measures could be addressed by identifying the risks of vitamin deficiencies. Further epidemiological research is needed for the individual effects of vitamin supplementation and depression screening scores. Future prospective cohort studies exploring these associations, focusing on daily dietary intake, are needed to validate the direction of causation further and understand the underlying mechanisms.

Lactobacillus as probiotics: opportunities and challenges for potential benefits in female reproductive health

The growing interest of the scientific community in the study of probiotics has gathered valuable data about its beneficial effects for multiple clinical conditions. This data also provides evidence for the functions and properties of probiotics and how they contribute to health benefits by influencing normal microbiota. Lactobacillus is an important genus which has long been utilized in the food industry and is also found as normal oral, intestinal and vaginal microbiota. Lactobacillus has shown multiple health benefits but its relative importance as a probiotic is majorly explored for gastrointestinal health. Healthy vaginal microbiota typically harbors Lactobacillus spp. providing several health benefits for female reproductive health, but there is more data required in order to compare the relative benefits with probiotic Lactobacillus added through either natural food sources or with standard probiotics supplements. The present article discusses the current status of knowledge about vaginal Lactobacillus as a probiotic and also compares the potential of probiotics from natural sources and through supplements along with recent approaches in this area.

Dietary Interventions and Supplementation in Patients With an Ileal Pouch-Anal Anastomosis: A Systematic Review

The restorative proctocolectomy with ileal pouch–anal anastomosis is the preferred surgery for patients with medically refractory ulcerative colitis. Although the ileal pouch–anal anastomosis provides gastrointestinal continuity and is an excellent alternative to a permanent end ileostomy, it is not without its complications including acute pouchitis, which occurs in up to 80% of patients. Diet may have a significant impact on pouch function and the development of pouchitis by virtue of its impact on motility and the microbiome. Multiple studies have evaluated the ability of different diets and supplements to improve pouch function and manage pouchitis, yet results are conflicting; thus, evidence-based dietary recommendations are lacking. Patients with an ileoanal pouch routinely ask about dietary interventions to maintain pouch health, and it is crucial that concrete evidence-based recommendations are identified to provide guidance. The goal of this systematic review is to summarize the available data on dietary patterns in patients with an ileoanal pouch, dietary interventions in this cohort, and the impact of supplements on pouch function and pouchitis.

The effect of curcumin supplementation on functional strength outcomes and markers of exercise-induced muscle damage: A systematic review and meta-analysis

Background: Curcumin is a polyphenol derived from the Curcuma longa L (turmeric) plant and has gained attention through its perceived anti-inflammatory characteristics. The potential interaction with exercise-induced muscle damage (EIMD) and delayed onset muscle soreness (DOMS) has led to investigation of curcumin as a post-exercise strategy that may have the potential to lessen acute reductions in functional strength (FS) following physical activity. Aim: The purpose of this review is to assess the evidence examining curcumin in relation to four outcome measures: FS, EIMD, DOMS and inflammation. Methods: A Medline, SPORTDiscus and CINAHL database search was undertaken with no publication date limit. Sixteen papers met the inclusion criteria and were included in this review. Three meta-analyses were completed for EIMD, DOMS and inflammation, respectively, with FS being excluded due to limited research. Results: Effect sizes were as follows: EIMD (0.15, -0.12, -0.04, -0.2 and -0.61 corresponding to 0, 24, 48, 72 and 96 h post-exercise, respectively), DOMS (-0.64, -0.33, 0.06, -0.53 and -1.16 corresponding to 0, 24, 48, 72 and 96 h post-exercise, respectively) and inflammation (-0.10, 0.26, 0.15 and 0.26 corresponding to 0, 24, 48 and 72 h post-exercise, respectively). A 96 h post-exercise inflammation meta-analysis was not conducted due to limited data. Conclusion: No effect sizes were statistically significant for EIMD (p = 0.644, 0.739, 0.893, 0.601 and 0.134), DOMS (p = 0.054, 0.092, 0.908, 0.119 and 0.074) and inflammation (p = 0.729, 0.603, 0.611 and 0.396). Further research is needed to thoroughly examine whether an effect exists.

Evaluating Common Ingredients Contained in Dietary Acne Supplements: An Evidence-Based Review

Objective

Acne vulgaris is a common skin condition treated with various medications targeting different aspects of its pathogenesis. Though increasing in popularity, the United States Food and Drug Administration (FDA) does not evaluate the safety or efficacy of dietary supplements marketed for the treatment of acne, calling into question the veracity of their labels. This review aimed to assess the safety and effectiveness of ingredients in popular acne supplements.

Methods

A comprehensive review was conducted on 13 popular supplements marketed for acne, found through a Google search. Their ingredients, prices, ratings, and existing literature on efficacy and safety were analyzed. A literature review was performed regarding the most common ingredients contained in these supplements.

Results

The most common ingredients in acne supplements were probiotics, diindolylmethane (DIM), vitamin A, vitamin B complex, and zinc. Despite the increasing popularity of dietary supplements, including those for skin health and acne, the absence of FDA regulation and evidence-based data raises concerns about their safety and efficacy. The safety of acne supplement ingredients raises significant worries, with reported cases of thrombotic events and adverse effects, even during pregnancy. The lack of standardized labeling and clear dosing information further complicates the understanding and potential risks of these supplements. Additionally, there is a potential for interactions with other medications, yet this information is often not provided on the product labels.

Limitations

A Google search was used to identify popular acne supplements. Search engine algorithms determine the ranking and presentation of results based on various factors, such as popularity, keywords, as well as user preferences and location, thus posing a potential sampling bias.

Conclusion

It is crucial to exercise caution and prioritize evidence-based information when counseling patients regarding the use of acne supplements.

Vitamin D concentrations were often insufficient among native Norwegian adolescents and children with a non-Western immigrant background

AIM

The aim of this study was to review papers that assessed the vitamin D intake of children living in Norway, as research has suggested that it has remained below the recommended daily allowance of 10 μg/day.

METHODS

This mini review examined the vitamin D status of Norwegian children aged 0-18 years by systematically searching the PubMed, Google Scholar and Scopus databases from 1 January 2009 to 1 July 2020.

RESULTS

The review comprised six studies published in English between 2009 and 2020 on native-born and non-Western immigrant children. Most studies defined satisfactory vitamin D status as a plasma 25-hydroxyvitamin D (25(OH)D) concentration of 50 nmol/L, with 25-50 nmol/L being classified as insufficient and below 25 nmol/L being classified as deficient. A study of healthy children found that 21% had insufficient levels and a further 1% were deficient, but this second finding was only among adolescents. Other studies showed that 47% of Norwegian children with a non-Western immigrant background were deficient, and so were 19% of overweight children, mainly adolescents.

CONCLUSION

Vitamin D concentrations were often insufficient among children living in Norway, particularly adolescents and those with a non-Western immigrant background. Higher recommended supplements may be needed.

Curcumin-Based Fixed Dose Combination Products for Cholesterol Management: A Narrative Review

Curcumin, a polyphenol compound that belongs to a class of molecules known as curcuminoids, may interact with various biological macromolecules in the body, including proteins, nucleic acids, and lipids. Curcumin-based fixed-dose combination (FDC) products enhance curcumin stability and bioavailability for better clinical use in cholesterol management. Preclinical studies on curcumin and cholesterol are mostly positive. Obstacles are the variable composition of the many different curcumin-based FDC products, the lack of standards, and the limitation of the randomized controlled trials (RCTs) conducted for specific products. Once these downfalls have been addressed, curcumin-based FDC products have great potential for cholesterol management. They can supplement the uptake of statins, reducing their dosage for the same controlling effects or even replacing them.

Adherence to Iron and Folic Acid Supplementation Among Pregnant Women From Northern Ghana

Iron and folic Acid (IFA) supplementation is an effective intervention for reducing the incidence of anaemia during pregnancy. The WHO recommends at least 6 months intake of IFA to pregnant women. However, in Ghana some women experience challenges with adhering to IFA supplementation. The main objective of the study was to assess the level of adherence to iron and folic acid supplementation and its associated factors among pregnant women in a peri-urban municipality in Northern Ghana. A cross-sectional study was conducted from March to December 2021 among 400 pregnant women who attended ANC in Sagnarigu municipality in Ghana and were selected through a 3-stage random sampling technique. A structured questionnaire was used to collect data. The data were analysed using descriptive statistics, univariate and binary logistic regression statistical tools. Self-reported level of adherence to iron and folic acid supplementation was 84.5%. Knowledge of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) was associated with adherence. Three other factors: time of first antenatal visit (AOR = 0.32: 0.153, 0.649) having history of anaemia [AOR = 2.67: 1.373, 5.201] having side effects of IFA [AOR = 3.70, CI: (1.756, 7.793)], and having knowledge of management of side effects of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) were found to be significantly associated with adherence. Adherence to iron and folic supplementation among the pregnant women was generally frequent. Strategies to increase iron and folic acid supplementation adherence among pregnant women could focus on encouraging pregnant women to have early ANC visits and educating them on how to manage side effects.

A historical, evidence-based, and narrative review on commonly used dietary supplements in lipid-lowering

Dietary supplements augment the nutritional value of everyday food intake and originate from the historical practices of ancient Egyptian (Ebers papyrus), Chinese (Pen Ts'ao by Shen Nung), Indian (Ayurveda), Greek (Hippocrates), and Arabic herbalists. In modern-day medicine, the use of dietary supplements continues to increase in popularity with greater than 50% of the US population reporting taking supplements. To further compound this trend, many patients believe that dietary supplements are equally or more effective than evidence-based therapies for lipoprotein and lipid-lowering. Supplements such as red yeast rice, omega-3 fatty acids, garlic, cinnamon, plant sterols, and turmeric are marketed to and believed by consumers to promote "cholesterol health." However, these supplements are not subjected to the same manufacturing scrutiny by the Food and Drug Administration as pharmaceutical drugs and as such, the exact contents and level of ingredients in each of these may vary. Furthermore, supplements do not have to demonstrate efficacy or safety before being marketed. The holistic approach to lowering atherosclerotic cardiovascular disease risk makes dietary supplements an attractive option to many patients; however, their use should not come at the expense of established therapies with proven benefits. In this narrative review, we provide a historical and evidence-based approach to the use of some dietary supplements in lipoprotein and lipid-lowering and provide a framework for managing patient expectations.

Nutrition knowledge, weight loss practices, and supplement use in senior competition climbers

Introduction

Sport climbing has gained increased scientific attention, including studies investigating the dietary habits and nutritional requirements of climbers; however, significant gaps in the literature remain. An assessment of nutritional knowledge, weight loss for competition, and supplement use has not been previously reported in senior competition climbing athletes.

Methods

Fifty climbers (26 male, 24 female; BMI 21.6 ± 1.9; 23.7 ± 5.2 years) participated in the study. Participants answered a 72-item questionnaire, comprised of demographic data and three main sections to assess general and sports nutrition knowledge, weight loss strategies, and supplement use.

Results

The mean nutrition knowledge score was 'average', with considerable individual variation (53.5 ± 11.1 %). There were no significant sex differences in the general (GNK) or sport (SNK) nutrition knowledge scores, or effect of age. Significantly higher knowledge was demonstrated by national vs. international athletes for the GNK scores (11.09 ± 1.58 vs. 9.58 ± 1.75; p = 0.028). Participants scored well in questions concerning protein, carbohydrates, alcohol, and supplements, and conversely, performed poorly in hydration and micronutrient related questions. Less than one-fifth of respondents had access to a dietitian. Forty-six percent of males and 38% of female climbers reported intentional weight loss for competition on at least one occasion. Of those, ~76% reported utilizing concerning practices, including methods that conform with disordered eating and/or eating disorders, dehydration, vomiting, and misuse of laxatives. Approximately 65% of athletes reported using at least one nutritional supplement in the previous 6 months, with 44% reporting multiple supplement use. There was no significant difference in supplement use between sexes or competition level.

Discussion

Due to the established importance of nutritional intake on athlete health and performance, educational support should be employed to improve knowledge in climbers and address shortcomings. Moreover, intentional weight loss for climbing competition is common, with most athletes achieving ~3-8% body weight loss over ≥2 weeks. It is crucial that professionals working with competitive climbers are vigilant in identifying athletes at risk of concerning weight management and establish referral pathways to the appropriate specialist services. High quality intervention trials to assess the efficacy of ergogenic aids in climbing remains inadequate.

Effects of Melatonin, GM-CSF, IGF-1, and LIF in Culture Media on Embryonic Development: Potential Benefits of Individualization

The implantation of good-quality embryos to the receptive endometrium is essential for successful live birth through in vitro fertilization (IVF). The higher the quality of embryos, the higher the live birth rate per cycle, and so efforts have been made to obtain as many high-quality embryos as possible after fertilization. In addition to an effective controlled ovarian stimulation process to obtain high-quality embryos, the composition of the embryo culture medium in direct contact with embryos in vitro is also important. During embryonic development, under the control of female sex hormones, the fallopian tubes and endometrium create a microenvironment that supplies the nutrients and substances necessary for embryos at each stage. During this process, the development of the embryo is finely regulated by signaling molecules, such as growth factors and cytokines secreted from the epithelial cells of the fallopian tube and uterine endometrium. The development of embryo culture media has continued since the first successful human birth through IVF in 1978. However, there are still limitations to mimicking a microenvironment similar to the reproductive organs of women suitable for embryo development in vitro. Efforts have been made to overcome the harsh in vitro culture environment and obtain high-quality embryos by adding various supplements, such as antioxidants and growth factors, to the embryo culture medium. Recently, there has been an increase in the number of studies on the effect of supplementation in different clinical situations such as old age, recurrent implantation failure (RIF), and unexplained infertility; in addition, anticipation of the potential benefits from individuation is rising. This article reviews the effects of representative supplements in culture media on embryo development.

Evaluating ChatGPT's efficacy in assessing the safety of non-prescription medications and supplements in patients with kidney disease

Background

This study investigated the efficacy of ChatGPT-3.5 and ChatGPT-4 in assessing drug safety for patients with kidney diseases, comparing their performance to Micromedex, a well-established drug information source. Despite the perception of non-prescription medications and supplements as safe, risks exist, especially for those with kidney issues. The study's goal was to evaluate ChatGPT's versions for their potential in clinical decision-making regarding kidney disease patients.

Method

The research involved analyzing 124 common non-prescription medications and supplements using ChatGPT-3.5 and ChatGPT-4 with queries about their safety for people with kidney disease. The AI responses were categorized as "generally safe," "potentially harmful," or "unknown toxicity." Simultaneously, these medications and supplements were assessed in Micromedex using similar categories, allowing for a comparison of the concordance between the two resources.

Results

Micromedex identified 85 (68.5%) medications as generally safe, 35 (28.2%) as potentially harmful, and 4 (3.2%) of unknown toxicity. ChatGPT-3.5 identified 89 (71.8%) as generally safe, 11 (8.9%) as potentially harmful, and 24 (19.3%) of unknown toxicity. GPT-4 identified 82 (66.1%) as generally safe, 29 (23.4%) as potentially harmful, and 13 (10.5%) of unknown toxicity. The overall agreement between Micromedex and ChatGPT-3.5 was 64.5% and ChatGPT-4 demonstrated a higher agreement at 81.4%. Notably, ChatGPT-3.5's suboptimal performance was primarily influenced by a lower concordance rate among supplements, standing at 60.3%. This discrepancy could be attributed to the limited data on supplements within ChatGPT-3.5, with supplements constituting 80% of medications identified as unknown.

Conclusion

ChatGPT's capabilities in evaluating the safety of non-prescription drugs and supplements for kidney disease patients are modest compared to established drug information resources. Neither ChatGPT-3.5 nor ChatGPT-4 can be currently recommended as reliable drug information sources for this demographic. The results highlight the need for further improvements in the model's accuracy and reliability in the medical domain.

Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population

BACKGROUND

Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated.

OBJECTIVE

We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital.

METHODS

The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback.

RESULTS

Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact.

CONCLUSION

VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.

Non-oestrogen-based and complementary therapies for menopause

Women are living a significant portion of their adult lives in the post-reproductive phase, and many seek help for debilitating menopausal symptoms. Every individual's experience of menopausal transition is unique. Adopting a holistic approach to managing the menopause using a combination of lifestyle, hormonal, and non-hormonal interventions is key to maximise the quality of life of affected women. However, many opt to use non hormonal options or have contraindications to using hormonal therapy. Studies have shown that several pharmacological non-hormonal medications such as SSRIs, SSRI/SNRIs, Gabapentin, and Pregabalin are effective for managing vasomotor symptoms as well as other menopausal symptoms. Their main side effects are dry mouth, nausea, constipation, reduced libido, and loss of appetite. Clonidine is the only non-hormonal drug which is licenced for control of vasomotor symptoms in the UK, but has several side effects including dizziness and sleep disturbance. Cognitive Behavioural Therapy is recommended as a treatment for anxiety, sleep problems and vasomotor symptoms related to menopausal transition. Evidence for clinical efficacy and safety of herbal remedies and alternative therapies remains weak. Studies with neurokinin receptor 3 antagonists on women with hot flushes have shown improvement in vasomotor symptoms and results of large-scale studies are awaited.

Therapeutic Applications of Plant and Nutraceutical-Based Compounds for the Management of Type 2 Diabetes Mellitus: A Narrative Review

Diabetes mellitus is a condition caused by a deficiency in insulin production or sensitivity that is defined by persistent hyperglycemia as well as disturbances in glucose, lipid, and protein metabolism. Uncurbed diabetes or incessant hyperglycemic condition can lead to severe complications, including renal damage, visual impairment, cardiovascular disease, neuropathy, etc., which promotes diabetes-associated morbidity and mortality rates. The therapeutic management of diabetes includes conventional medications and nutraceuticals as complementary therapies. Nutraceuticals are bioactive compounds derived from food sources that have health-promoting properties and are instrumental in the management and treatment of various maladies. Nutraceuticals are clinically exploited to tackle DM pathogenesis, and the clinical evidence suggests that nutraceuticals can modulate biochemical parameters related to diabetes pathogenesis and comorbidities. Hypoglycemic medicines are designed to mitigate DM in traditional medicinal practice. This review intends to emphasize and comment on the various therapeutic strategies available to manage this chronic condition, conventional drugs, and the potential role of nutraceuticals in managing the complexity of the disease and reducing the risk of complications. In contrast to conventional antihyperglycemic drugs, nutraceutical supplements offer a higher efficacy and lesser adverse effects. To substantiate the efficacy and safety of various functional foods in conjunction with conventional hypoglycemic medicines, additional data from clinical studies are required.

Dietary Interventions in Parkinson's Disease

Several dietary patterns and nutritional supplements have been linked to the development, progression, and symptomatic treatment of Parkinson's disease (PD). Most of the evidence, at this point, is preliminary and based largely on observational studies. Interventional studies are scarce, so the evidence on effectiveness remains inconclusive. Dietary interventions could, analogous to exercise, potentially have a beneficial effect on disease symptoms as well as on the progression of the disease and should therefore be researched in high quality studies. Further work is also needed to study whether dietary interventions, when applied to an at-risk population, have any potential to postpone the onset of manifest PD. In this paper, we summarize all ongoing clinical trials on dietary interventions in PD. We found 10 ongoing studies, all aimed at a different intervention. These studies are mostly exploratory in nature or represent phase I or phase II trials focusing on safety, biological responses, and symptomatic effects. Taken together, we conclude that research on dietary interventions in persons with PD is still in its early days. The results of the various ongoing trials are expected to generate new hypotheses and will help to shape the agenda for future research on this important topic.

Moderators of Caffeine's Effects on Jumping Performance in Females: A Systematic Review and Meta-Analysis

We aimed to perform a systematic review and meta-analysis of caffeine's effects on vertical jumping performance in females, with subgroup analyses for potential moderators, including phase of the menstrual cycle, testing time of day, caffeine dose, and test type. Fifteen studies were included in the review (n = 197). Their data were pooled in a random-effects meta-analysis of effect sizes (Hedges' g). In the main meta-analysis, we found an ergogenic effect of caffeine on jumping performance (g: 0.28). An ergogenic effect of caffeine on jumping performance was found when the testing was carried out in the luteal phase (g: 0.24), follicular phase (g: 0.52), luteal or follicular phase (g: 0.31), and when the phase was not specified (g: 0.21). The test for subgroup differences indicated that the ergogenic effects of caffeine were significantly greater in the follicular phase compared to all other conditions. An ergogenic effect of caffeine on jumping performance was found when the testing was carried out in the morning (g: 0.38), evening (g: 0.19), mixed morning or evening (g: 0.38), and when time was not specified (g: 0.32), with no subgroup differences. An ergogenic effect of caffeine on jumping performance was found when the dose was ≤3 mg/kg (g: 0.21), or >3 mg/kg (g: 0.37), with no subgroup differences. An ergogenic effect of caffeine on jumping performance was found in the countermovement jump test (g: 0.26) and squat jump test (g: 0.35), with no subgroup differences. In summary, caffeine ingestion is ergogenic for vertical jumping performance in females, and it seems that the magnitude of these effects is the largest in the follicular phase of the menstrual cycle.

Effect of Ginseng Intake on Muscle Damage Induced by Exercise in Healthy Adults

One of the most popular herbal supplements in the world is ginseng. Several studies have evaluated the capacity of ginseng as a protective element in the physiological response to exercise. The result produced by the exercise causes an increase in cellular biomarkers of damage in the skeletal muscle, mainly in the pro-inflammatory types. The different types of ginseng are composed of ginsenosides, which are active ingredients that act on the central nervous system and have antioxidant and anti-inflammatory properties, as well as effects on cortisol modulation. The use of ginseng as a nutritional supplement can help muscle regeneration and renewal. The objective of this review is to enrich the knowledge regarding the consumption of ginseng for a specific situation, such as exercise, which would cause an improvement in the tolerance to chronic load stimuli in sport, thus helping the subjects to recover between training sessions. Due to these benefits, it could also be an ideal food supplement for regenerative processes in muscle injuries in which inflammatory markers increase significantly. This review aims to summarise that biological factors can be attenuated after exercise due to the consumption of ginseng in healthy subjects, accelerating and improving muscle regeneration and, therefore, improving the ability to adapt to the stimuli generated by said exercise.

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

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

Creatine supplementation and endurance performance: surges and sprints to win the race

Creatine supplementation is an effective ergogenic aid to augment resistance training and improve intense, short duration, intermittent performance. The effects on endurance performance are less known. The purpose of this brief narrative review is to discuss the potential mechanisms of how creatine can affect endurance performance, defined as large muscle mass activities that are cyclical in nature and are >~3 min in duration, and to highlight specific nuances within the literature. Mechanistically, creatine supplementation elevates skeletal muscle phosphocreatine (PCr) stores facilitating a greater capacity to rapidly resynthesize ATP and buffer hydrogen ion accumulation. When co-ingested with carbohydrates, creatine enhances glycogen resynthesis and content, an important fuel to support high-intensity aerobic exercise. In addition, creatine lowers inflammation and oxidative stress and has the potential to increase mitochondrial biogenesis. In contrast, creatine supplementation increases body mass, which may offset the potential positive effects, particularly in weight-bearing activities. Overall, creatine supplementation increases time to exhaustion during high-intensity endurance activities, likely due to increasing anaerobic work capacity. In terms of time trial performances, results are mixed; however, creatine supplementation appears to be more effective at improving performances that require multiple surges in intensity and/or during end spurts, which are often key race-defining moments. Given creatines ability to enhance anaerobic work capacity and performance through repeated surges in intensity, creatine supplementation may be beneficial for sports, such as cross-country skiing, mountain biking, cycling, triathlon, and for short-duration events where end-spurts are critical for performance, such as rowing, kayaking, and track cycling.

Zinc improves sexual performance and erectile function by preventing penile oxidative injury and upregulating circulating testosterone in lead-exposed rats

AIM

The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function.

METHODS

Twenty male Wistar rats were randomly assigned into four groups; the control, zinc-treated, lead-exposed, lead + zinc-treated groups. Administrations were per os daily for 28 days.

RESULTS

Zinc co-administration significantly improved absolute and relative penile weights and the latencies and frequencies of mount, intromission, and ejaculation in lead-exposed rats. Also, zinc ameliorated lead-induced reductions in motivation to mate and penile reflex/erection. These findings were accompanied by attenuation of lead-induced suppression of circulating nitric oxide (NO), penile cyclic guanosine monophosphate (cGMP), dopamine, serum luteinizing hormone, follicle-stimulating hormone, and testosterone. In addition, zinc alleviated lead-induced upregulation of penile activities of acetylcholinesterase and xanthine oxidase (XO), and uric acid (UA) and malondialdehyde (MDA) levels. Furthermore, zinc ameliorated the lead-induced decline in penile nuclear factor erythroid 2-related factor 2 (Nrf2) and reduced glutathione (GSH) levels, and catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) activities.

CONCLUSION

This study revealed that co-administration of zinc improves lead-induced sexual and erectile dysfunction by suppressing XO/UA-driven oxidative stress and upregulating testosterone via Nrf2-mediated signaling.

Understanding the Impact of Vitamin B Supplements on a Saudi Population

Introduction B vitamins help generate energy within cells. A significant portion of populations in developed countries suffer a deficiency in one or more B vitamins. This study assesses the use of vitamin B supplements and their effects. Methodology This cross-sectional study was conducted using public participants in Saudi Arabia. Participants from all over Saudi Arabia were recruited through self-conducted surveys to study the effects of using vitamin B supplements on appetite, BMI, energy, and sleep, and to identify any side effects in participants. Inclusion criteria included age (18 years or older) and use of vitamin B supplements. Children, pregnant women, adults who had never used vitamin B, and those not willing to participate in the study were excluded. Results In total, 1,521 adults were recruited. Most of the participants were young Saudi Females. While taking vitamin B supplements, a minority of participants complained of mild gastrointestinal upset, but a significant proportion experienced no side effects. In this study, a significant proportion of participants experienced an increase in appetite, which was associated with a significant increase in BMI after taking vitamin B supplements. This study also explored increases in energy, which were significant and associated with significant increases in sleeping time. Male participants in the present study noticed a significant increase in erectile dysfunction (ED). Conclusions This study found significant effects of vitamin B supplements on BMI, appetite, energy, and sleep, as well as an increase in ED in male participants. More studies are needed to further explore these findings.

A Cross-Sectional Study on the Awareness and Practice of the Use of Supplemental Vitamin C, Arginine, and Zinc in Managing Wounds Among Healthcare Workers in Saudi Arabia

Introduction The intricate connection between nutrition and compromised wound healing exposes patients to heightened risks of pressure ulcers, infections, and delayed recovery from wounds or traumatic injuries. In-depth scientific investigations have shed light on the potential of specialized nutritional supplements, combined with regular wound care, to significantly boost the management of pressure ulcers and the wound healing process. The study focuses on supplemental Vitamin C, Arginine, and Zinc due to their established roles in wound healing, aiming to assess the awareness and practice of healthcare workers in Saudi Arabia regarding these essential nutrients for effective wound management. This cross-sectional study aimed to assess awareness and practice among healthcare workers in Saudi Arabia regarding the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds. Methods This study adopts a cross-sectional research design to explore the dynamics to assess the awareness and practice among healthcare workers about the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds in Saudi Arabia. The research methodology encompasses developing and validating a questionnaire, data collection, and subsequent analysis. Thorough statistical analyses, encompassing descriptive statistics, validated assessment scales, and inferential statistics, were conducted using SPSS and Microsoft Excel to explore intricacy prevalence and severity relationships with various factors, maintaining a statistical power of 80% at a cutoff value of 0.05. Result In a cross-sectional survey of 510 healthcare professionals, the socio-demographic analysis revealed a predominant hospital workplace (61.56%), with pharmacists representing 10.19%, and comprehensive tabulation of response rates and p-values, while the knowledge and awareness assessment demonstrated varied understanding and perceptions of wound care supplements, including frequent encounters with pressure ulcers or wounds (36.5%), diverse awareness levels for Vitamin C, Arginine, and Zinc, with the collaboration and communication dynamics among healthcare workers, detailed in tabulated response rates and p-values. Conclusion The findings reveal a diverse understanding landscape, with varying levels of awareness, perceived effectiveness, and confidence in applying these supplements.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Physiological Requirements of and Nutritional Recommendations for Equestrian Riders

Equestrian sport is under-researched within the sport science literature, creating a possible knowledge vacuum for athletes and support personnel wishing to train and perform in an evidence-based manner. This review aims to synthesise available evidence from equitation, sport, and veterinary sciences to describe the pertinent rider physiology of equestrian disciplines. Estimates of energy expenditure and the contribution of underpinning energy systems to equestrian performance are used to provide nutrition and hydration recommendations for competition and training in equestrian disciplines. Relative energy deficiency and disordered eating are also considered. The practical challenges of the equestrian environment, including competitive, personal, and professional factors, injury and concussion, and female participation, are discussed to better highlight novelty within equestrian disciplines compared to more commonly studied sports. The evidence and recommendations are supported by example scenarios, and future research directions are outlined.

Nutritional Approach in Selected Inherited Metabolic Cardiac Disorders-A Concise Summary of Available Scientific Evidence

Inborn errors of metabolism (IMDs) are a group of inherited diseases that manifest themselves through a myriad of signs and symptoms, including structural or functional cardiovascular damage. The therapy of these diseases is currently based on enzyme-replacement therapy, chaperone therapy or the administration of supplements and the establishment of personalized dietary plans. Starting from the major signs identified by the pediatric cardiologist that can indicate the presence of such a metabolic disease-cardiomyopathies, conduction disorders or valvular dysplasias-we tried to paint the portrait of dietary interventions that can improve the course of patients with mitochondrial diseases or lysosomal abnormalities. The choice of the two categories of inborn errors of metabolism is not accidental and reflects the experience and concern of the authors regarding the management of patients with such diagnoses. A ketogenic diet offers promising results in selected cases, although, to date, studies have failed to bring enough evidence to support generalized recommendations. Other diets have been successfully utilized in patients with IMDs, but their specific effect on the cardiac phenotype and function is not yet fully understood. Significant prospective studies are necessary in order to understand and establish which diet best suits every patient depending on the inherited metabolic disorder. The most suitable imagistic monitoring method for the impact of different diets on the cardiovascular system is still under debate, with no protocols yet available. Echocardiography is readily available in most hospital settings and brings important information regarding the impact of diets on the left ventricular parameters. Cardiac MRI (magnetic resonance imaging) could better characterize the cardiac tissue and bring forth both functional and structural information.

Effects of Collagen and Exercise on Tendon Properties and Pain: A Critically Appraised Topic

CLINICAL SCENARIO

Achilles tendon ruptures are prevalent and devastating injuries that require the need for extensive rehabilitation. The methods for preventing these injuries vary between different exercise methods and nutritional supplementation. Although proven effective for decreasing pain and increasing tendon properties, the influence of these 2 methods in combination has not yet been evaluated.

CLINICAL QUESTION

Does exercise combined with collagen supplementation improve Achilles tendon structural and mechanical properties and diminish subsequent patient-reported pain compared with exercise alone in adults?

SUMMARY OF KEY FINDINGS

Exercise training, including eccentric training protocols and concentric resistance training protocols, combined with collagen supplementation influence Achilles tendon properties and subsequent patient-reported pain compared with exercise alone.

CLINICAL BOTTOM LINE

Evidence supports that collagen along with exercise training has a significant influence on pain mitigation, augmented cross-sectional area, and tendon thickness, but may have little to no influence on tendon stiffness and microvascularity compared with exercise alone. Further research is needed to determine the effects of combined methods on various populations.

STRENGTH OF RECOMMENDATION

Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A.

Nutritional intake of riboflavin (vitamin B2) and migraine: a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2001-2004

OBJECTIVES

Clinical studies demonstrate that supplemental riboflavin is an efficacious and low risk prophylactic treatment for migraine. However, background riboflavin intake of adults with migraine from nutritional sources has not been evaluated. This study aimed to evaluate riboflavin consumption of adults with migraine in the United States, and further investigate the relationship between nutritional riboflavin consumption and the prevalence of migraine among adults.

METHODS

This cross-sectional secondary analysis included 3439 participants ages 20-50 years old in the National Health and Nutrition Examination Survey from 2001 to 2004. Presence of migraine in the past three months was self-reported. Riboflavin intake was determined from one 24-hour recall interview. Odds ratios and 95% confidence intervals were calculated for riboflavin intake quartiles using an adjusted logistic regression model. Statistical significance was determined using an adjusted Wald test.

RESULTS

Results showed that mean dietary consumption of riboflavin fulfilled the Recommended Dietary Allowance for migraine and control groups. Dietary riboflavin intake was associated with the odds of migraine (pWald = 0.002), but no association was found for supplemental or total riboflavin consumption (pWald = 0.479 and 0.136). When stratified by gender, there was no association of dietary riboflavin with migraine in males (pWald = 0.423), but an association was observed in females (pWald = 0.014).

DISCUSSION

The RDA value for riboflavin was not relevant for assessing odds of migraine; however, differing odds of migraine were detected across dietary riboflavin consumption groups at levels above the RDA. Future riboflavin supplementation trials for migraine prophylaxis should consider measuring background dietary intake.

Vitamin D and Cardiovascular Diseases: An Update

Vitamin D is a vital nutrient that plays a significant part in several physiological processes within the human body, including calcium metabolism, bone health, immune function, and cell growth and differentiation. It is obtained mainly through exposure to sunlight but can be acquired from certain foods and supplements as well. Vitamin D deficiency (VDD) could be the risk factor for cardiovascular diseases (CVDs), such as heart disease and stroke. In blood vitamin D low levels have been linked with an enhanced risk of developing CVDs. However, it is unclear whether vitamin D levels are the leading cause or consequence of these conditions. While some studies highlight that taking vitamin D supplements could decrease the risk of CVD; however, more research is required to better understand the association between vitamin D and cardiovascular health. In this review, we aimed to summarize the currently available evidence supporting the association between vitamin D and CVDs and anesthesia considerations.

How does Canada's new vitamin D fortification policy affect the high prevalence of inadequate intake of the vitamin?

TAKE-HOME MESSAGE

The 2023 vitamin D fortification policy may significantly reduce inadequacies in non-supplement consumers; however, the policy is far from eliminating population-level vitamin D inadequacies and supplementation should still be encouraged.

'Oxidative stress'-A new target in the management of diabetes mellitus

Diabetes mellitus (DM) is a chronic condition that poses a mammoth challenge for the healthcare system in developing as well as developed nations. Diabetes mellitus is associated with damage to the vasculature which leads to microvascular and macrovascular complications. Oxidative stress is a consequence of glucotoxicity and lipotoxicity, which are associated with diabetes. Glucotoxicity and lipotoxicity play a part in the pathogenesis of β-cell dysfunction. The hyperglycemic state in DM leads to oxidative stress which further hampers insulin secretion. In diabetes, the biological antioxidants also get depleted along with a reduction in glutathione (GSH), an increase in the oxidized glutathione (GSSG)/GSH ratio, and a depletion of non-enzymatic antioxidants. This results in the formation of a viscous circle of hyperglycemia leading to increased oxidative stress that further hampers insulin secretion which in turn results in hyperglycemia. Antioxidants are efficacious in reducing diabetic complications. The antioxidants produced biologically fall short, hence external supplements are required. In this review, the authors have discussed the relationship between oxidative stress in DM and the advantages of antioxidant supplements in controlling blood glucose levels and also in deaccelerating the complications related to DM.

Awareness of Nutrition and Supplements Among Pregnant and Preconception Women: A Real-World Study in Vietnam

Background

Few studies have addressed relationships between health literacy (HL) and nutritional awareness in preconception/pregnancy populations, especially within Asia. We explored the rationale for nutrition-related education and/or HL interventions to improve nutritional intake among preconception/pregnant women.

Methods

A cross-sectional questionnaire-based real-world study was conducted among 100 preconception and 200 pregnant women in Vietnam in January/February 2022. The questionnaire included a validated screening tool for HL (Newest Vital Sign [NVS]), and questions on preconception/pregnancy-related nutritional knowledge and behavior, prenatal supplementation, sources of nutritional advice.

Results

Most respondents (62%) had limited HL and only 5% had adequate HL. Respondents with limited HL (NVS 0-1) showed less awareness of benefits of healthy eating before/during pregnancy, such as reduction in risk of birth defects. Most (94%) considered prenatal supplements beneficial, yet 64% were not convinced of supplement safety. The limited HL group reported the lowest use of supplements, including multivitamins, iron, and folic acid/folate.

Conclusion

The prevalence of limited HL and the low awareness of preconception/pregnancy-related nutrition suggest an urgent need to invest in nutrition-specific education and improving HL in maternal populations. This will help support adequate maternal nutrition and appropriate micronutrient supplementation before conception and throughout the "first 1000 days" of life.

Lower Intakes of Key Nutrients Are Associated with More School and Workplace Absenteeism in US Children and Adults: A Cross-Sectional Study of NHANES 2003-2008

The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003-2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.

Prevalence of anemia and iron deficiency and its association with body mass index in elite Japanese high school long-distance runners

OBJECTIVES

Anemia is a common condition in long-distance runners (LDRs). Recently, not only iron deficiency (ID) but also energy deficiency has been considered as a risk factor for anemia in athletes but no evidence has yet been established. The aim of this study was to investigate the prevalence of anemia and ID and the influence of body mass index (BMI) on anemia in high-school LDRs.

METHODS

The participants were 406 male and 235 female elite Japanese LDRs who competed in the All-Japan High-School Ekiden Championship 2019. They submitted their anthropometric data and results of a blood test within five days after the competition. The prevalence of anemia and ID and the influence of BMI on anemia were assessed retrospectively.

RESULTS

Mean hemoglobin concentrations (Hb) were 14.8 ± 0.9 g/dl in males and 13.2 ± 0.9 g/dl in females. The prevalence of anemia (Hb < 14 g/dl in males and < 12 g/dl in females) was significantly higher in males (16.3%) than females (6.4%), but males also showed higher prevalence of non-iron deficiency anemia (NIDA) than females (11.6% and 3.0%, respectively). No significant gender difference was found in the prevalence of iron deficiency anemia (IDA) (4.7% in males and 3.4% in females). ID (serum ferritin level < 25 ng/ml) was significantly more prevalent in females (37.4%) than males (18.5%). A binary logistic regression analysis revealed that low BMI was a contributor to anemia in females (odds ratios: 0.577 (95% CI: 0.369-0.901), p = 0.012).

CONCLUSION

In Japanese high-school LDRs, one in six males was anemic, but most males did not have ID. Conversely, one-third of females were diagnosed with ID. Lower BMI was identified as a risk for anemia in females, suggesting that leanness may also lead to anemia in females.

Functional Role of Taurine in Aging and Cardiovascular Health: An Updated Overview

Taurine, a naturally occurring sulfur-containing amino acid, has attracted significant attention in recent years due to its potential health benefits. Found in various foods and often used in energy drinks and supplements, taurine has been studied extensively to understand its impact on human physiology. Determining its exact functional roles represents a complex and multifaceted topic. We provide an overview of the scientific literature and present an analysis of the effects of taurine on various aspects of human health, focusing on aging and cardiovascular pathophysiology, but also including athletic performance, metabolic regulation, and neurological function. Additionally, our report summarizes the current recommendations for taurine intake and addresses potential safety concerns. Evidence from both human and animal studies indicates that taurine may have beneficial cardiovascular effects, including blood pressure regulation, improved cardiac fitness, and enhanced vascular health. Its mechanisms of action and antioxidant properties make it also an intriguing candidate for potential anti-aging strategies.

Recent advances in medicinal compounds related to corneal crosslinking

Corneal crosslinking (CXL) is the recognized technique to strengthen corneal collagen fibers through photodynamic reaction, aiming to halt progressive and irregular changes in corneal shape. CXL has greatly changed the treatment for keratoconus (KCN) since it was introduced in the late 1990's. Numerous improvements of CXL have been made during its developing course of more than 20 years. CXL involves quite a lot of materials, including crosslinking agents, enhancers, and supplements. A general summary of existing common crosslinking agents, enhancers, and supplements helps give a more comprehensive picture of CXL. Either innovative use of existing materials or research and development of new materials will further improve the safety, effectiveness, stability, and general applicability of CXL, and finally benefit the patients.

Nutritional Considerations for Elite Golf: A Narrative Review

Golf is predominantly a skill-based sport where technical aspects are regarded as a priority area for improving performance. At present, most of the existing literature has focused on improving a player's physicality, endurance and technical attributes in an effort to enhance performance. While important, the role of nutrition in elite golf has received little attention to date. The energy demands of the sport can vary depending on the level of the individual (recreational-professional), with distances of up to 20 km being covered and the time spent on the course ranging approximately 4-8 h each day. Like other sports, a focus on pre-game, during and post-game nutrition, including hydration, is integral to ensuring that individuals are adequately fuelled, hydrated and optimally recovered. For the elite athletes who travel extensively to international tournaments, it is important to understand the additional impact of travel on the body and consider the role nutrition can play in preventing illness and ensuring minimal disruption to golf performance. Lastly, the role of dietary supplements to enhance the performance of golfers is also important to consider. This review aims to consolidate the findings of the existing research focusing on nutrition strategies for golf performance and identify areas for potential future research.

In Vitro Assessment of Gold Nanoparticles on Telomerase Activity and Telomere Length in Human Fibroblasts

Telomerase activity coincides with lengthening of the ends of chromosomes known as telomeres. Telomere length is used as a marker for cellular aging. Telomeres shorten over time as cells divide, and certain bioactive compounds such as gold nanoparticles (AuNPs) may slow the shortening of telomeres by increasing telomerase activity. The objective of the present study is to assess the effect of AuNPs on telomerase activity and telomere length in human fibroblasts. Telomerase activity was measured using enzyme-linked immunosorbent assay (ELISA) in primary human lung fibroblasts (IMR90) and using quantitative PCR-based telomeric repeat amplification protocol (Q-TRAP) in primary human dermal fibroblasts, neonatal (HDFn). Telomere length was determined by Telomere Analysis Technology (TAT®)assay in HDFn. In IMR90, all AuNP treatments showed significant increases in telomerase activity when compared to earlier passages. HDFn treated with AuNPs at 0 ppm, 0.05 ppm, 0.5 ppm, or 5 ppm did not show significant differences in telomerase activity compared to the control group. Significant differences in telomere length in HDFn were observed at 2 weeks of 0.05 and 0.5 ppm AuNPs under oxidative culture conditions as compared to the control group. The study showed preliminary evidence that AuNPs may increase telomerase activity and decelerate the shortening of telomeres in human fibroblasts, suggesting its potential anti-aging effects, which warrants further investigation.

A Nutritional Supplement as Adjuvant of Gabapentinoids for Adults with Neuropathic Pain following Spinal Cord Injury and Stroke: Preliminary Results

Gabapentinoids are first choice drugs for central neuropathic pain (CNP) despite limited evidence of efficacy and side effects affecting therapy outcomes. Nutraceuticals could improve their efficacy and tolerability. Our aim is to investigate the effect of NACVAN®, in addition to gabapentinoids, on pain symptomatology in CNP patients. The effect of 6 weeks of treatment of NACVAN® was preliminary observed among 29 adult inpatients with spinal cord injury (SCI) or stroke-related CNP recruited to the experimental group. Pain intensity, neuropathic pain, and quality-of-life were measured at baseline (T0) and after 3 (T1) and 6 weeks (T2). Change in each outcome over time was assessed through a repeated measures analysis of variance or Wilcoxon matched-pairs test. Preliminary results show a significant reduction in pain intensity (T0 → T1, p = 0.021; T0 → T2, p = 0.011; T1 → T2, p = 0.46), neuropathic symptoms (T0 → T1, p = 0.024; T0 → T2, p = 0.003), and evoked pain (T0 → T2, p = 0.048). There were no significant reductions in other neuropathic pain dimensions and in quality-of-life components. No side-effects were detected. NACVAN® could have a beneficial adjuvant effect when used as an add-on to gabapentinoids in patients suffering from CNP due to SCI or stroke, with no adverse effect. Future analysis on a larger sample, compared with a placebo condition, could confirm these preliminary results.

Use of Cells, Supplements, and Peptides as Therapeutic Strategies for Modulating Inflammation after Spinal Cord Injury: An Update

Spinal cord injury is a traumatic lesion that causes a catastrophic condition in patients, resulting in neuronal deficit and loss of motor and sensory function. That loss is caused by secondary injury events following mechanical damage, which results in cell death. One of the most important events is inflammation, which activates molecules like proinflammatory cytokines (IL-1β, IFN-γ, and TNF-α) that provoke a toxic environment, inhibiting axonal growth and exacerbating CNS damage. As there is no effective treatment, one of the developed therapies is neuroprotection of the tissue to preserve healthy tissue. Among the strategies that have been developed are the use of cell therapy, the use of peptides, and molecules or supplements that have been shown to favor an anti-inflammatory environment that helps to preserve tissue and cells at the site of injury, thus favoring axonal growth and improved locomotor function. In this review, we will explain some of these strategies used in different animal models of spinal cord injury, their activity as modulators of the immune system, and the benefits they have shown.

Cyclodextrins for the Delivery of Bioactive Compounds from Natural Sources: Medicinal, Food and Cosmetics Applications

Cyclodextrins have gained significant and established attention as versatile carriers for the delivery of bioactive compounds derived from natural sources in various applications, including medicine, food and cosmetics. Their toroidal structure and hydrophobic cavity render them ideal candidates for encapsulating and solubilizing hydrophobic and poorly soluble compounds. Most medicinal, food and cosmetic ingredients share the challenges of hydrophobicity and degradation that can be effectively addressed by various cyclodextrin types. Though not new or novel-their first applications appeared in the market in the 1970s-their versatility has inspired numerous developments, either on the academic or industrial level. This review article provides an overview of the ever-growing applications of cyclodextrins in the delivery of bioactive compounds from natural sources and their potential application benefits.

Perspective: Call for Re-evaluation of the Tolerable Upper Intake Level for Magnesium Supplementation in Adults

In 1997, the US Institute of Medicine (IOM) dietary reference intakes (DRI) Committee established a magnesium (Mg) tolerable upper intake level (UL) for adults of 350 mg/d from supplemental intake alone. Diarrhea was the limiting factor. The safety of oral Mg dietary supplements exceeding the UL is currently in debate. Increasing the UL may result in more Mg supplementation, decreasing the prevalence of undernutrition for this nutrient and thus providing additional protection against numerous chronic diseases. This perspective aims to show that more recent and comprehensive evidence-based data on the occurrence of diarrhea indicate that the Mg UL for adults should be re-evaluated. To update the literature base to re-evaluate setting the Mg UL, a PubMed search was conducted to identify intervention studies published between 1997 and 2022 that used single-ingredient Mg products reporting a priori diarrhea adverse events among adults. The Food and Drug Administration Center for Food Safety and Adverse Event Reporting System (CAERS) was also searched for adverse events caused by Mg supplementation. The PubMed search identified 10 studies, including 5 meta-analyses and 5 randomized controlled trials, that met the search criteria. Seven studies (Mg intakes of 128-1200 mg/d) found no significant differences in diarrhea occurrence between the intervention and control groups. One meta-analysis found only minor differences in gastrointestinal disturbances between groups given placebo versus 520 mg Mg/d, but withdrawals were not significantly different between groups. Another meta-analysis found that 3 of 13 studies (120-973 mg/d) reported diarrhea that led to study withdrawal, but the treatment arm was not specified in 2 studies. The CAERS search, when limited to single-ingredient suspect Mg products, found only 40 attributable cases of gastrointestinal adverse events. Only one-third of these 40 cases noted a complaint of diarrhea. These updated data indicate that doses above the current UL for Mg supplements can be consumed without adverse events.

Improvement of vitamin D status through consumption of either fortified food products or supplement pills increased hemoglobin concentration in adult subjects: Analysis of pooled data from two randomized clinical trials

Background: It is documented that vitamin D may have a role in erythropoiesis as its deficiency is accompanied by an increased risk of anemia. Aim: This study aimed to examine whether improvement of vitamin D status through daily consumption of either fortified foods or supplements could impinge on certain hematologic parameters in adults. Methods: We pooled data from our two separate clinical trials and made five experimental groups. As part of their usual diet, one group consumed 500 mL/day of yogurt drink fortified with 1000 IU of vitamin D (D-yogurt, n = 27) whereas one group consumed 500 mL/day of the plain yogurt drink (P-yogurt, n = 27). In addition three other groups consumed either 50 g/day bread fortified with 1000 IU of vitamin D (D-bread) or supplement containing 1000 IU vitamin D (D-supplement, n = 27) or placebo (placebo, n = 27). Biochemical measurements were performed before and after the intervention. Results: In all three vitamin D-supplemented groups, serum 25(OH)D concentration increased after the intervention period, which was interestingly accompanied by a significant increment of hemoglobin (D-yogurt, p < 0.001, D-bread, p = 0.003, D-supplement, p < 0.001). Analyses indicated that among participants in vitamin D-intervention groups, being in D-yogurt group was more favourable predictor of improvement in hemoglobin concentrations compared with the placebo (p < 0.001), D-bread (p = 0.045) and P-yogurt (p = 0.001). Conclusion: Improvement of vitamin D status via regular intake of either vitamin D-fortified food products or supplements can result in a significant increment of hemoglobin in adult subjects. This finding has very important clinical as well as public health implications.

Collagen Hydrolysates: A Source of Bioactive Peptides Derived from Food Sources for the Treatment of Osteoarthritis

Osteoarthritis (OA) is the most common joint disorder, with a social and financial burden that is expected to increase in the coming years. Currently, there are no effective medications to treat it. Due to limited treatment options, patients often resort to supplements, such as collagen hydrolysates (CHs). CHs are products with low molecular weight (MW) peptides, often between 3 and 6 kDa, and are a result of industrialized processed collagen. Collagen extraction is often a by-product of the meat industry, with the main source for collagen-based products being bovine, although it can also be obtained from porcine and piscine sources. CHs have demonstrated positive results in clinical trials related to joint health, such as decreased joint pain, increased mobility, and structural joint improvements. The bioactivity of CHs is primarily attributed to their bioactive peptide (BAP) content. However, there are significant knowledge gaps regarding the digestion, bioavailability, and bioactivity of CH-derived BAPs, and how different CH products compare in that regard. The present review discusses CHs and their BAP content as potential treatments for OA.