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Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements

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... An increasing number of individuals take multivitamin (and multimineral) supplements to maintain good health and to be protected from different diseases including cardiovascular disease, cancer, and decline in cognitive function [1]. However, now that diets are more assorted, supplemented, and fortified, diseases of overt vitamin deficiency are rare, and the most commonly occurring diseases have a multifactorial cause. ...
... However, now that diets are more assorted, supplemented, and fortified, diseases of overt vitamin deficiency are rare, and the most commonly occurring diseases have a multifactorial cause. Hence, it may be unlikely for a supplement to confer a health benefit [1]. This impression is supported by studies and meta-analyses demonstrating that vitamin and mineral supplements do not provide benefits to individuals in the general population [1][2][3]. ...
... Hence, it may be unlikely for a supplement to confer a health benefit [1]. This impression is supported by studies and meta-analyses demonstrating that vitamin and mineral supplements do not provide benefits to individuals in the general population [1][2][3]. Nevertheless, these products, which can be purchased without medical prescription, are very commonly used by the general population [4] and are often recommended in naturopathic medicine [5]. ...
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Multivitamins are commonly used by the general population, often without medical prescription. The purpose of this report is to inform on the daily vitamin D supply provided by multivitamins containing vitamin D that are commercialized online by Amazon in Western and Southern Europe. We surveyed multivitamins aimed at adults using the following marketplaces: amazon.es®, amazon.de®, amazon.it®, and amazon.fr®. We identified 199 vitamin D3-containing multivitamins sold by Amazon marketplaces: 77 from amazon.es®, 73 from amazon.de®, 33 from amazon.it®, and 16 from amazon.fr®. No multivitamin contained vitamin D2. The daily vitamin D3 supply ranged from 16 to 2000 IU: it was less than 400 IU daily in 108 (54%), 400–800 IU daily in 53 (27%), and more than 800 IU daily in the remaining 38 (19%) products. The vitamin D3 supply of products sold by amazon.it® was on average higher (p < 0.05) than that of products sold by amazon.de®, amazon.fr®, and amazon.es®. In conclusion, the vitamin D supply of multivitamins sold by Amazon may be insufficient, marginally sufficient, or adequate for subjects at high risk of hypovitaminosis D such as subjects 65 years or more of age, pregnant (or lactating) women, or patients on drug treatment or with an underlying disease, where a vitamin D supplementation is advocated.
... Use of supplements in the non-institutionalized, general American population stabilized between 1999 and 2012 with just over half of the population reporting some form of supplement use [24], resulting in a $32 billion industry with little evidence of benefit, and a slow regulatory response to harm when demonstrated [25]. Several rigorous trials and systematic reviews have shown that vitamin supplementation among adults without nutritional deficiencies did not reduce all-cause mortality, cardiovascular disease or cancer [26], and has no longterm effect on cognitive performance [27], and that high-dose multivitamins had no effect on cardiovascular disease compared to placebo [28]. Published studies have indicated that there is no substantial health benefit associated with multivitamin use and recommend against routine supplementation without indication of a specific micronutrient/antioxidants deficiency [27]. ...
... Several rigorous trials and systematic reviews have shown that vitamin supplementation among adults without nutritional deficiencies did not reduce all-cause mortality, cardiovascular disease or cancer [26], and has no longterm effect on cognitive performance [27], and that high-dose multivitamins had no effect on cardiovascular disease compared to placebo [28]. Published studies have indicated that there is no substantial health benefit associated with multivitamin use and recommend against routine supplementation without indication of a specific micronutrient/antioxidants deficiency [27]. Evidence-based guidelines for women in pregnancy support the use of folic acid (to reduce the risk of fetal neural tube defect) and vitamin D supplementation for bone health, however there is insufficient evidence to show a clinical benefit for other supplements in well-nourished women [29]. ...
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Background Although micronutrient and antioxidant supplementation are widely used by persons with human immunodeficiency virus (HIV), a therapeutic role beyond recommended daily allowances (RDA) remains unproven. An oral high-dose micronutrient and antioxidant supplement (Treatment) was compared to an RDA supplement (Control) for time to progressive immunodeficiency or initiation of antiretroviral therapy (ART) in people living with HIV (PLWH). Methods This study was a randomized, double-blind, placebo-controlled multicenter clinical trial. PLWH were recruited from Canadian HIV Trials Network sites, and followed quarterly for two years. Eligible participants were asymptomatic, antiretroviral treatment (ART)-naïve, HIV-seropositive adults with a CD4 T lymphocyte count (CD4 count) between 375–750 cells/μL. Participants were randomly allocated 1:1 to receive Treatment or Control supplements. The primary outcome was a composite of time-to-first of confirmed CD4 count below 350 cells/μL, initiation of ART, AIDS-defining illness or death. Primary analysis was by intention-to-treat. Secondary outcomes included CD4 count trajectory from baseline to ART initiation or two years. A Data and Safety Monitoring Board reviewed the study for safety, recruitment and protocol adherence every six months. Results Of 171 enrolled participants: 66 (38.6%) experienced a primary outcome: 27 reached a CD4 count below 350 cells/μL, and 57 started ART. There was no significant difference in time-to-first outcome between groups (Hazard Ratio = 1.05; 95%CI: 0.65, 1.70), or in time to any component outcome. Using intent-to-treat censoring, mean annualized rates of CD4 count decline were -42.703 cells/μL and -79.763 cells/μL for Treatment and Control groups, with no statistical difference in the mean change between groups (-37.06 cells/μL/52 weeks, 95%CI: (-93.59, 19.47); p = 0.1993). Accrual was stopped at 171 of the 212 intended participants after an interim analysis for futility, although participant follow-up was completed. Conclusions In ART-naïve PLWH, high-dose antioxidant, micronutrient supplementation compared to RDA supplementation had no significant effect on disease progression or ART initiation. Clinical trial registration ClinicalTrials.gov Identifier: NCT00798772.
... As reasoned by the American College of Physicians (ACP), "although available evidence does not negate some health benefits in a small sub-group of people, we believe that the case is closed -supplementing the diet of well-nourished adults with (most) MVMs has no clear benefit and might even be harmful." [36] The present massive scientific evidence on the ineffectiveness and potential health hazards of dietary supplements has important clinical and public health implications. [36] The present evidence is strong enough for clinicians to take action and advice against routine diet supplementation in healthy adults with no clear clinical indication. ...
... [36] The present massive scientific evidence on the ineffectiveness and potential health hazards of dietary supplements has important clinical and public health implications. [36] The present evidence is strong enough for clinicians to take action and advice against routine diet supplementation in healthy adults with no clear clinical indication. [33] Whereas, public health policymakers should focus their efforts on developing policies, programs, materials and methods that encourage healthy diets and lifestyles among the general population. ...
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There has been a massive surge in the intake of dietary supplements in recent years, with millions of people taking the “magic pills” worldwide, either with the hope of achieving general well‑being, treat specific disease, or retard the aging process. Supplementing the diet with multivitamins and minerals (MVMs) has revolutionized modern healthcare, with many “experts” claiming such drugs have a critical role to play in the prevention and treatment of many health conditions. Many are of the opinion that since dietary supplements are mere extracts from certain foods and herbs, so unlike drugs, have no significant side effects, are “all natural,” and are therefore “safe” for a non‑medical prescription. The association of the deficiency of some MVMs, such as vitamins C, D, and Zinc, with the increased incidence and progression of COVID‑19, has also strengthened the argument in favor of routine diet supplementation. The objectives of this article are to investigate the health and therapeutic claims attributed to some dietary supplements, their safety concerns, and their possible role in modern healthcare. A review of related online free‑full articles written in the English language published from 2000 to 2021 was done. While the pharmacokinetics and pharmacodynamics of some dietary supplements are clearly understood and established, others are still shrouded in serious confusions and safety concerns, especially for long‑term use. Until more evidence is available, routine intake of dietary supplements should be discouraged, except there are clear medical indications. Rather, all people should ensure they get their required nutrients from whole foods. Keywords: Chronic noncommunicable diseases, COVID‑19, dietary supplements, diet supplementation, micronutrients, multivitamins and minerals.
... B-vitamins are often used in conditions not characterized with a vitamin B deficiency for which evidence for efficacy is lacking (Table II 8 -17 ). Clinical studies and guidelines have consistently reported no clear benefits or possible harm of using B-vitamins or MVM supplements for decreasing morbidity and mortality due to major chronic diseases 18 . For example, the use of B-vitamins like folic acid has been found harmful in those with high baseline homocysteine levels 19 . ...
... There is ample evidence to discourage the use of B-vitamins or MVM supplements in well-nourished adults 18 . However, notwithstanding the above clinical situations, B-vitamins are often prescribed or self-administered by people regularly as nutrition supplements. ...
... an editorial, researchers criticized the roles of vitamins and dietary supplements in improving individuals' health, especially those suffering from any chronic disease. The authors asserted that minerals or vitamins dietary supplements should not be used for supplementing the diet of well-nourished individuals as there is scanty evidence of the benefits derived from their consumption (Guallar et al., 2013). It was also noted that in some cases, these dietary supplements could also be harmful. ...
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Pro-environmental behavior is increasingly becoming a topic of interest for academia and industry. Simultaneously, there is a growing concern about how this behavior impacts environmental sustainability. Values and lifestyle are psychographic variables that help identify a cohort of the ecologically concerned consumer segment. The study aims to determine the impact of pro-environmental behaviour on environmental sustainability with consumer green values acting as a mediator. This study adopted a quantitative research design utilizing convenience sampling to collect data from 168 university students. Structural equation modelling (SEM) by using SmartPLS software was employed for data analysis. The research model underwent a two-stage assessment: the first stage focused on evaluating the measurement model, while the second stage tested the structural model. The result shows a positive and significant impact of Pro-environmental behaviour on environmental sustainability. Further, we tested the impact of PEB on green consumer behaviour the results show a positive and significant impact of PEB on GC). The study highlights the importance of pro-environmental behavior and green consumer values in promoting environmental sustainability. The findings of the study can help marketers create value for consumers who are health-conscious and at the same time want to consume safe and environmentally friendly products.
... Indeed, there appears to be a disparity between nutritional and health needs and dietary supplement use. Most supplement users use them for preventive purposes and are more health-conscious than non-users of supplements [3][4][5], although it has been shown that supplementing the diet of wellnourished adults with mineral or vitamin supplements provides no clear benefit and may even be harmful, so vitamins should not be used for chronic disease prevention in this context [28]. Those who take supplements for treatment purposes may have underlying health indications and may be more likely to benefit from supplementation than those who take supplements for preventive purposes [29]. ...
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Background/Objectives: Vitamin and/or mineral supplements are designed to correct micronutrient deficiencies or maintain adequate intake. However, evidence suggests the indiscriminate use of these products, particularly among populations that already meet their micronutrient requirements through diet. This study aims to estimate the prevalence of vitamin and/or mineral supplement use and assess the dietary intake of micronutrients among users and non-users in the Brazilian adult and elderly populations. Methods: The prevalence of vitamin and/or mineral supplement use was estimated from a sample of 37,364 individuals who participated in the Brazilian National Food Survey, a module of the 2017–2018 Household Budget Survey. The average dietary intake of micronutrients—including calcium, magnesium, phosphorus, iron, copper, zinc, vitamin A, thiamine, riboflavin, niacin, cobalamin, pyridoxine, vitamin D, vitamin E, vitamin C, and folate—was calculated for both users and non-users of these supplements, based on 24 h dietary recalls collected during the survey. Analyses of dietary intake were stratified by sex and age group. Results: The estimated overall prevalence of supplement use was 16.0% (95% CI: 15.4–16.6), with a higher prevalence among women (19.5% [95% CI: 18.7–20.5]) and the elderly (27.9% [95% CI: 26.4–29.4]). Women who used vitamin and/or mineral supplements showed higher average intakes for a greater number of dietary micronutrients compared to non-users. Conclusions: The findings from the analysis of average micronutrient intake from food sources, particularly among women and elderly women who used supplements, support the paradox of the “inverse supplement hypothesis”, which suggests that individuals who use dietary supplements are often those with the least need for them.
... Although fortification may increase the intake of vitamins and minerals, there is little evidence to suggest that adding nutrients (other than folic acid) may improve health [203]. Several experimental plans are available to reduce micronutrient deficiencies, but uncoordinated implementation of multiple interventions may result in excessive intakes [204]. ...
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Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women’s education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources.
... Traditional pharmacotherapy, such as statins, is widely used to manage high cholesterol levels; however, there is increasing interest in the use of dietary supplements (DS) as adjuncts or alternatives to conventional treatments. Despite their growing popularity, the efficacy and mechanisms of action of various DS in lowering cholesterol levels are not uniformly understood, and their use in clinical practice remains controversial [1]. ...
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Emerging evidence suggests that personalized dietary supplement regimens can significantly influence lipid metabolism and cardiovascular risk. The efficacy of AI-guided dietary supplement prescriptions, compared with standard physician-guided prescriptions, remains underexplored. In a randomized, parallel-group pilot study, 70 patients aged 40–75 years with LDL-C levels between 70 and 190 mg/dL were enrolled. Participants were randomized to receive either AI-guided dietary supplement prescriptions or standard physician-guided prescriptions for 90 days. The primary endpoint was the percent change in LDL-C levels. Secondary endpoints included changes in total cholesterol, HDL-C, triglycerides, and hsCRP. Supplement adherence and side effects were monitored. Sixty-seven participants completed the study. The AI-guided group experienced a 25.3% reduction in LDL-C levels (95% CI: −28.7% to −21.9%), significantly greater than the 15.2% reduction in the physician-guided group (95% CI: −18.5% to −11.9%; p < 0.01). Total cholesterol decreased by 15.4% (95% CI: −19.1% to −11.7%) in the AI-guided group compared with 8.1% (95% CI: −11.5% to −4.7%) in the physician-guided group (p < 0.05). Triglycerides were reduced by 22.1% (95% CI: −27.2% to −17.0%) in the AI-guided group versus 12.3% (95% CI: −16.7% to −7.9%) in the physician-guided group (p < 0.01). HDL-C and hsCRP changes were not significantly different between groups. The AI-guided group received a broader variety of supplements, including plant sterols, omega-3 fatty acids, red yeast rice, coenzyme Q10, niacin, and fiber supplements. Side effects were minimal and comparable between groups. AI-guided dietary supplement prescriptions significantly reduce LDL-C and triglycerides more effectively than standard physician-guided prescriptions, highlighting the potential for AI-driven personalization in managing hypercholesterolemia.
... Consequently, worldwide use of nutritional supplements has increased dramatically over the recent decades (52). However, some nutrition studies suggest that the intake of vitamin supplements may be needless and even harmful (53)(54)(55). Thus, this subject remains controversial. ...
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Natural aging encompasses physiological and psychological changes that impact overall health and quality of life. Mitigating these effects requires physical and mental exercise, coupled with proper nutrition. Notably, protein malnutrition emerges as a potential risk factor for senile dementia, with insufficient intake correlating with premature cognitive decline. Adequate protein intake in the elderly positively associates with memory function and lowers cognitive impairment risk. Considering diet as a modifiable risk factor for cognitive decline, extensive research has explored diverse dietary strategies to prevent dementia onset in older adults. However, conclusive results remain limited. This review aims to synthesize recent evidence on effective dietary approaches to enhance cognitive function and prognosis in older individuals. Specifically, the study evaluates complex multicomponent programs, protein-rich diets, and branched-chain amino acid supplementation. By addressing the nexus of nutrition and cognitive health, this review contributes to understanding viable interventions for promoting cognitive well-being in aging populations.
... Some researchers tried to predict vitamin D deficiency on the basis of several demographic characteristics and lifestyle factors. A cross-sectional study of 644 60-to 84-year-old participants in Australia found that use of "time outdoors, physical activity, vitamin D intake and ambient UVR, and inversely correlated with age, BMI, and poor self-reported health status" explained 21% of the variance in 25(OH)D concentration [153]. ...
Chapter
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Vitamin D deficiency, generally defined as 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L, affects nearly half the world's population. Solar ultraviolet B (UVB) exposure is the primary source of vitamin D for most people. Many factors affect 25(OH)D concentrations related to solar UVB exposure, including skin pigmentation, solar zenith angle, atmospheric aerosols and clouds, time spent in the sun, amount of skin surface area exposed, use of sunscreen, age, and body mass index. Cultural and lifestyle differences-such as beauty standards, including high regard for fair skin in darker-skinned populations and avoidance of wrinkling; occupation; religion; urban/rural residence; and fear of developing skin cancer or melanoma-also affect some of those factors. Thus, fortification of food with vitamin D and vitamin D supplementation would have to be employed to compensate for unavoidable or inconvenient lack of solar UVB exposure.
... 26,27 however, these health claims are generally not supported by robust evidence. 28 in addition, it has strongly agree; 2, agree; 3, neutral; 4, disagree; 5, strongly disagree). for each participant, responses to all questions were summed to produce a pS misconception score. ...
Article
Background: Protein supplements (PSs) have gained widespread popularity among non-athlete gym attendees, who often perceive them as essential tools for muscle growth and recovery. However, misinformation surrounding PSs may lead to inappropriate use and negative health consequences. This study aimed to assess whether non-athlete gym attendees using PSs have greater misconceptions than non-users while also examining the prevalence of PS consumption and gender differences. Methods: A cross-sectional study of 387 participants in the Jazan region was conducted. Customers of 10 fitness centers were screened with a questionnaire comprising questions to measure PS misconceptions. Participants were divided into PS users and non-users. Data were analyzed using descriptive statistics and the chi-square test to assess the associations between variables. An independent t-test was used to compare the PS Misconception Index Score between the two groups. Results: A total of 82.4% of non-athlete gym attendees consumed at least one PS. Our findings revealed a significant association between gender and PS utilization (P<0.001), with a higher proportion of females (90.8%) consuming PS than males (77.6%). PS users had a significantly lower PS Misconception Index Score than non-users (26.8 vs. 28.3; P=0.006), indicating that PS users had a higher number of misconceptions. The internet (41.37%) and coaches (gym instructors/trainers) (34.48%) were the most common sources of information about PSs, with muscle gain being the primary reason for consumption (82.75%). Conclusions: PS consumption is highly prevalent among non-athlete gym attendees in the Jazan region, with many individuals having misconceptions about their benefits and potential risks. Targeted educational interventions are needed to promote evidence-based knowledge about PSs for gym attendees, as well as for coaches, given that they were among the primary sources of information on supplements.
... It is one of the most used supplements by adults in the United States (Knapik et al. 2014). Vitamins are mainly important for the primary and secondary prevention of many chronic diseases (Guallar et al. 2013). For example, vitamin C is most popularly consumed to improve the immune system. ...
Chapter
Nutraceuticals are bioactive compounds used to enhance health-supporting effects and to treat and prevent various diseases. They are largely used to control and prevent chronic diseases like diabetes, cardiovascular diseases, respiratory diseases, cancer, and gastrointestinal and neurological disorders. Thus, the nutraceutical market is increasing at a fast rate. Nutraceuticals can be prescribed by a qulified health professional based on a patient’s health issues or can be used without a prescription. While nutraceuticals are good for health in general and have various advantages including antioxidant, anti-inflammatory, anticancer, etc., the significant disadvantages are underreported as available literature expresses concerns over the authentic source of their raw materials, purity of the compound, presence of other active compounds, quality, lack of experimental evidence, false advertising, contamination with heavy metals, and interactions between supplements and drugs. One of the major limitations of nutraceuticals is questionable drug bioavailability, which is the accessibility of the nutrients by the body after digestion, absorption, and transportation. Poor bioavailability may result in little or no effect in lessening the advantage of nutraceuticals. People with underlying diseases requiring multidrug regimens often simultaneously self-prescribe nutraceuticals. Meanwhile, they are unaware of drug–drug interactions that not only diminish the efficacy of nutraceuticals but also lead to potentially toxic side effects. Side effects of nutraceuticals due to misuse or overuse may vary from mild to moderate and severe. Therefore, it is important to understand the bioavailability, toxicity, and side effect profile of nutraceuticals before use. This review focuses on highlighting the advantages and disadvantages of some commonly used nutraceuticals in various conditions related to heart, liver, kidney, gastrointestinal, and pulmonary disorders. We also explore the potential advantages and disadvantages of nutraceuticals in various neurological conditions, and the mechanisms of their action, particularly their role in the blood–brain barrier in transporting these nutraceuticals into the brain to regulate brain homeostasis and thereby other organs.
... Moreover, the study indicates that individuals with health concerns are inclined to take preventive measures, such as regular exercise and dietary supplement consumption, more frequently than those without such concerns (18) . (19) Approximately 54% of American adults use dietary supplements, including multivitamins and minerals (20) . Several studies have consistently identified attitude as one of the primary factors influencing behavior (21) . ...
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Using the Theory of Planned Behavior model developed by Ajzen in 1985, the authors assessed the influence of attitude (ATT) toward vitamins, health awareness (HA), perceived behavioral control (PBC), subjective norms (SN), and knowledge of COVID-19 (KN) on the purchasing intention (PI) of vitamins in Kuwait during the COVID-19 pandemic. A total of 587 adults living in Kuwait completed the online survey, which was available in both Arabic and English. The measured variables included health awareness, attitude, knowledge about COVID-19, purchasing intention, perceived behavioral control, and subjective norms. The findings indicate that HA has a significant impact on ATT. Furthermore, the results revealed that HA significantly influences ATT, ATT has a significant influence on PI, KN has a significant influence on ATT, KN has a significant influence on PI, PBC positively influences PI, SN has a significant influence over PI, and SN positively influences PI.
... Es muy importante la participación del servicio de psiquiatría para control del delirium, depresión, estrés post traumático y el aislamiento que muchos de estos pacientes confrontaron. 94,95El uso de suplementos vitamínicos como prevención primaria en pacientes sin déficit nutricional es controvertido.96 No existe evidencia clara del beneficio que pudiese aportar el uso de estos suplementos en la sobrevida de los pacientes con o sin COVID-19. ...
Article
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A finales del año 2019 se desarrolla la pandemia de COVID-19, una enfermedad infecciosa causada por un virus previamente no identificado, que produjo consecuencias catastróficas a nivel mundial. Los reportes epidemiológicos mostraron que después de adquirir la infección, la mayoría de las personas experimentan enfermedad leve sin complicaciones, sin embargo, algunos de los pacientes, requirieron hospitalización. Durante los años 2020 a 2022, fueron evaluados en nuestra institución cerca de 1800 pacientes. Dentro del arsenal terapéutico, fueron utilizados equipos de ventilación mecánica invasiva y no invasiva y medicamentos que incluyeron: antivirales, oxígeno, sedantes, antibióticos, anticoagulantes, protectores gástricos, analgésicos, hipolipemiantes, antiarrítmicos, diuréticos, hipotensores, antipsicóticos, analgésicos, hemoderivados, colchicina, esteroides, fibrinolÍticos y anticuerpos contra interleukina 6: tocilizumab, suplementos vitamínicos entre otros. De igual manera fueron utilizados, catéteres venosos y arteriales, tubos endotraqueales, sondas nasogástricas y de aspiración, tubos de drenaje, sondas vesicales y colocación en posición prona en aquellos pacientes con hipoxemia severa. La terapéutica no estuvo exenta de complicaciones. Nuestro objetivo es hacer del conocimiento a la comunidad médica de algunos pormenores de estos eventos ocurridos tanto en la sala de hospitalización como en la unidad de cuidados intensivos COVID, no atribuidos a efectos directos perjudiciales del virus, sino, a las consecuencias de los tratamientos aplicados.
... Paradossalmente, questi soggetti, che evidentemente avranno meno necessità di un'integrazione di nutrienti, sono quelli a maggior rischio di superare i livelli di assunzione massimi tollerabili. Questo dato, associato all'osservazione che nei soggetti con un buono stato di nutrizione le evidenze di un reale beneficio di una qualsiasi integrazione di nutrienti sono decisamente scarse, imporrebbe un percorso prescrittivo attento al reale rapporto costo-beneficio [44][45][46]. D'altro canto, c'è da considerare che in altri soggetti l'uso di integratori possa predisporre gli individui ad acquisire/mantenere comportamenti alimentari scorretti: può suggerire di fare affidamento sugli integratori per soddisfare i bisogni nutrizionali piuttosto che di adottare una dieta equilibrata e uno stile di vita sano in grado di assicurare tutti i nutrienti di cui abbiamo bisogno, senza necessità di ricorrere agli integratori alimentari [7]. ...
Article
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The use of dietary supplements is widespread in developed countries, and in Italy we find the largest market, with a forecast of sales of 5 billion euros in 2025. The reasons for using dietary supplements are mainly the search for psycho-physical well-being or the answer to specific health needs. Dietary supplements are products intended to integrate the diet and to provide nutrients that are missing or are not taken in sufficient quantities with food alone. However, the concept of supplementation has been extended to substances for which we have no real need in physiological conditions, and to nutrients prescribed at dosages that are pharmacological, causing confusion among health care professionals and consumers. Three concepts are often forgotten when deciding to use a supplement: 1) the bioavailability of nutrients: the fact that the concentration of a nutrient is high in a food or dietary supplement does not mean that that food is an adequate source of that nutrient for our body; 2) all substances, including nutrients, can become toxic and there is a maximum tolerable intake level for each nutrient; and 3) nutrients can interact with drugs with effects on pharmacokinetics and pharmacodynamics. Under certain conditions, some categories of people may be at risk for nutritional deficiencies such as pregnant women, elderly people with difficult access to food, individuals addicted to alcohol or other substances, individuals who adopt an eating pattern in which entire food groups are avoided (vegetarian or vegan), patients in whom the clinical status prevents the intake/correct use of nutrients, imposes a restrictive diet in some nutrients or generates an increased need. In any case, dietary supplementation must be preceded by the evaluation of nutritional status which defines the real intake of that nutrient through food, its concentration in the body, the possibility or not of increasing the intake through a different modulation of the eating pattern.
... Health care practitioners continue to incorporate dietary changes with beneficial outcomes on some medical disorders, such as headaches [18]. These alternative medicines are often misused by patients beyond their therapeutic purpose [19], thus actually causing side effects, drug reactions, and waste of time and money [20]. The high intakes of alternative medicines in neuropsychiatric patients are largely consistent with the perception that food could be a modulator of mood. ...
Article
Neurotransmitters (NTs) are biologically active chemicals, which mediate the electrochemi-cal transmission between neurons. NTs control numerous organic functions particularly crucial for life, including movement, emotional responses, and the physical ability to feel pleasure and pain. These molecules are synthesized from simple, very common precursors. Many types of NTs have both excitatory and inhibitory effects. Neurotransmitters' imbalance can cause many diseases and disorders , such as Parkinson's disease, depression, insomnia, increased anxiety, memory loss, etc. Natural food sources containing NTs and/or their precursors would be a potential option to help maintain the balance of NTs to prevent brain and psychiatric disorders. The level of NTs could be influenced, therefore, by targeting dietary habits and nutritional regimens. The progressive implementation of nutritional approaches in clinical practice has made it necessary to infer more about some of the nutritional NTs in neuropsychiatry. However, the importance of the intake of nutritional NTs requires further understanding, since there are no prior significant studies about their bioavailability, clinical significance, and effects on nerve cells. Interventional strategies supported by evidence should be encouraged.
... There is a concern about excessive use of micronutrients by healthy people who do not present any nutritional deficiencies 42 and the use of these products for purposes that are not backed by scientific evidence found in clinical studies 43 . The literature describes that most of these products are used for personal reasons rather than on medical advice 24 . ...
Article
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The purpose of the present study was to estimate the prevalence of vitamin and/or mineral use among urban Brazilian populations aged 20 years and over and to identify associated factors. Data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines in Brazil (PNAUM) were analyzed and a population-based cross-sectional study with probability sampling was performed in urban areas of Brazil’s five geographic regions from September 2013 to February 2014. The estimated prevalence of vitamin and/or mineral use was 4.8% (95%CI: 4.3-5.3), higher in women 6.4% (95%CI: 5.7-7.1) and in the elderly population 11.6% (95%CI: 10.5-12.8). Vitamin and/or mineral use was associated with the following factors: women, 60 years of age or older, economic class A/B, chronic disease(s) and self-perceived health held as average and very poor/poor. Multivitamins and multiminerals were the most used ones with 24.5% (95%CI 20.1-29.4), followed by calcium and vitamin D with 23.4% (95%CI 19.7-27.5). Data suggest that elderly women should be the reference public for actions aimed at promoting rational use. Nationwide epidemiological surveys should increase monitoring of these products to support the analysis of trends.
... Existe uma preocupação sobre o uso excessivo de micronutrientes nas pessoas saudáveis sem deficiência nutricional 42 e também para fins que não obtiveram evidências científicas em estudos clínicos 43 . A literatura descreve que a maioria desses produtos é usada por motivação pessoal e não por recomendação médica 24 . ...
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Resumo O objetivo do estudo foi estimar a prevalência do uso de vitaminas e/ou minerais na população brasileira urbana com idade maior ou igual a 20 anos e identificar os fatores associados ao uso. Foram analisados os dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal de base populacional, com amostra probabilística, realizada nas áreas urbanas das cinco regiões geográficas do país entre setembro de 2013 e fevereiro de 2014. A prevalência do uso estimada foi de 4,8% (IC95% 4,3-5,3), maior no sexo feminino, 6,4% (IC95% 5,7-7,1), e na população idosa, 11,6% (IC95% 10,5-12,8). O uso de vitaminas e/ou minerais mostrou-se associado aos fatores: sexo feminino, 60 anos ou mais, classe econômica A/B, apresentar doença(s) crônica(s) e autopercepção de saúde regular e muito ruim/ruim. Os multivitamínicos e multiminerais obtiveram maior frequência de uso, 24,5% (IC95% 20,1-29,4), seguido de cálcio e vitamina D, 23,4% (IC95% 19,7-27,5). Os dados sugerem que mulheres idosas devam ser o público referencial para ações de promoção do uso racional. Recomenda-se que os inquéritos epidemiológicos de abrangência nacional possam ampliar a observação desses produtos para possibilitar a análise de tendências.
... Bread, as a staple food in the human diet, provides essential nutrients, including carbohydrates, vitamins, minerals, and fiber (Bowles & Demiate, 2006). Adequate intake of these nutrients is crucial, especially when individuals consume insufficient quantities (Guallar et al., 2013;Food and Drug Administration, 2014). While the functional and nutritional aspects of bread play a crucial role in its general acceptance, the textural characteristics of bread have a greater influence on consumer preferences (Ficco et al.,2016). ...
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The present investigation aimed to improve the nutritional and healthy values and evaluate the influence of bread fortified with dried potato peels (BPP) on Triton X-100-induced hyperlipidemia in male albino rats. The findings demonstrated that BPP lowered hepatic triglycerides and total cholesterol while increasing high-density lipoprotein (HDL-C). BPP exhibited potential lipid-lowering and hepatoprotective actions that were generated by the reduction of oxidative damage and preservation of the non-enzymatic and enzymatic antioxidant systems compromised by hyperlipidemic condition. Furthermore, BPP considerably enhanced the mRNA expression of AMPKα (AMP-activated protein kinase-alpha), suppressed the expression of fatty acid synthase (FAS) and acetyl-CoA carboxylase alpha (ACCα), and decreased the mRNA expression of the adipogenic transcription factor SREBP-1c (sterol regulatory element-binding protein-1c), which are essential regulators of hepatocyte lipid metabolism. A histopathological assessment of the liver confirmed the results. In conclusion, this investigation revealed a positive impact of bread fortified with BPP therapy in preventing hyperlipidemia.
... It should be mentioned that supplementation practices are very closely related to personal knowledge in the area of nutrition and health [49,65]. Individuals lacking nutrition knowledge can be more easily misled into the (unnecessary) use of food supplements, which can result in undesirable effects on general health and the waste of money [66,67]. Further studies in this area should, therefore, also focus on the identification of knowledge gaps related to dietary supplementation. ...
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Due to their specific mode of operation, military personnel are challenged physically as well as mentally. In most countries, the use of food supplements by military personnel is not regulated, and a high prevalence of supplementation is expected. However, data on this are scarce or very limited, without insights into the importance of supplementation for the intake of bioactive substances. Our goal was, therefore, to develop a study protocol to enable an assessment of the prevalence of using food supplements and an estimate of the contribution of supplementation practices to the dietary intake of specific nutrients and other compounds. The protocol was tested in a study of Slovene Armed Forces (SAF) personnel. Data were collected using an anonymous questionnaire in a sample of 470 participants from different military units—about half from the barracks located across the country, and the other half returning from military operations abroad. To provide meaningful results, we recorded the use of food supplements and functional foods available in single-sized portions (i.e., energy drinks, protein bars, etc.). Altogether, 68% of the participants reported supplementation, most commonly with vitamin, mineral, and protein supplements. Military rank, participation status in military operations, and physical activity were the main determinants of the specific supplements used. Surprisingly, a lower prevalence of overall and protein supplementation was observed in subjects returning from military operations abroad (62 vs. 74%) than in personnel stationed in barracks across Slovenia; however, the frequency of the use of energy drinks and caffeine supplements was higher in this population (25 vs. 11%). The study design allowed for estimations of the daily intake of supplemented bioactive compounds. We describe the challenges and approaches used in the study to support similar studies in the future and within other populations.
... We found stabilization of the trends in using vitamins, acupuncture, acupressure, reflexology, and other alternative therapies across all-year cycles. The stable trend seen in vitamin use may reflect the increased scrutiny of multivitamins and minerals following studies showing no benefit [30] and the stance/recommendations of several professional bodies that concluded that there was insufficient or no evidence to support their use [31,32]. Furthermore, weaker evidence for the use of acupuncture [16], acupressure [22], and reflexology [20] could deter further use, especially in the current explosion in accessible health information. ...
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Complementary and Alternative Medicines/Therapies (CAM) are commonly used by US asthma adults, yet little is known about recent trends in their use. Our aim was to report trends in CAM use among US adults with current asthma. We conducted a serial cross-sectional study using nationally representative data from the BRFSS Asthma Call-Back Survey (ACBS) collected between 2008 and 2019 (sample size per cycle, 8222 to 14,227). The exposure was calendar time, as represented by ACBS cycle, while the main outcomes were use of at least one CAM and eleven alternative therapies. We analyzed CAM use overall and by population subgroups based on age, gender, race/ethnicity, income, and daytime and night-time asthma symptoms. Our findings show that there was an increase in the use of at least one CAM from 41.3% in 2008 to 47.9% in 2019 (p-trend < 0.001) and an upward trend in the use of herbs, aromatherapy, yoga, breathing exercises, homeopathy, and naturopathy (p-trend < 0.05). However, the use of vitamins, acupuncture, acupressure, reflexology, and other CAM therapies remained stable (p-trend > 0.05). These trends varied according to population characteristics (age, sex, race, income) and asthma symptoms. In conclusion, our study suggests that CAM use among US adults with current asthma is either increasing or stable, and further studies are needed to explore the factors influencing these trends.
... (43) This translates into a lucrative industry, with an estimated 40 billion USD for this country alone, (44) even though vitamin supplements have shown no clinical benefits in the general population. (45) A study in 63 emergency departments in the United States found that 2,154 hospitalizations between 2004 and 2013 were due to adverse effects of nutritional supplements. (43) Among older adults, pill-induced asphyxia or dysphagia accounted for 37.6% of all emergency visits for adverse events related to nutritional supplements. ...
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Background: Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods: A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results: In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). Conclusions: This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.
... Misinformation about health and wellness may encourage decisions that strain personal finances People in Canada are estimated to spend close to $200 million annually on homeopathy, and well over $100 million annually on energy healing (e.g., reiki) despite weak or non-existent clinical evidence of efficacy (Cucherat et al., 2000;Ernst & Seip, 2011;Mathie et al., 2014;Rao et al., 2016;Esmail, 2017). There is compelling evidence that routine vitamin supplementation in healthy populations provides no benefit, yet supplement consumption is widespread (Guallar et al., 2013). In Canada, expenditures are estimated at close to $700 million annually (though this has dropped by almost half since 1996) (Esmail, 2017). ...
Technical Report
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Misinformation can cause significant harm to individuals, communities, and societies. Because it’s designed to appeal to our emotions and exploit our cognitive shortcuts, everyone is susceptible to it. We are particularly vulnerable to misinformation in times of crisis when the consequences are most acute. Science and health misinformation damages our community well-being through otherwise preventable illnesses, deaths, and economic losses, and our social well-being through polarization and the erosion of public trust. These harms often fall most heavily on the most vulnerable. The pervasive spread of misinformation and the damage it can cause underscore the need for reasoned, evidence-informed decision-making at both the personal and public level. Strategies and tools exist to help combat these harms, strengthen, and build trust in our institutions, and boost our ability to recognize and reject the misinformation we encounter. Fault Lines details how science and health misinformation can proliferate and its impacts on individuals, communities, and society. It explores what makes us susceptible to misinformation and how we might use these insights to improve societal resilience to it. The report includes a model of the impacts of COVID‑19 misinformation on vaccination rates in Canada, producing quantitative estimates of its impacts on our health and the economy, and situating these within a broader context of societal and economic harms.
... Health care practitioners continue to incorporate dietary changes with beneficial outcomes on some medical disorders, such as headaches [18]. These alternative medicines are often misused by patients beyond their therapeutic purpose [19], thus actually causing side effects, drug reactions, and waste of time and money [20]. The high intakes of alternative medicines in neuropsychiatric patients are largely consistent with the perception that food could be a modulator of mood. ...
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Neurotransmitters (NTs) are biologically active chemicals, which mediate the electrochemical transmission between neurons. NTs control numerous organic functions particularly crucial for life, including movement, emotional responses, and the physical ability to feel pleasure and pain. These molecules are synthesized from simple, very common precursors. Many types of NTs have both excitatory and inhibitory effects. Neurotransmitters’ imbalance can cause many diseases and disorders, such as Parkinson’s disease, depression, insomnia, increased anxiety, memory loss, etc. Natural food sources containing NTs and/or their precursors would be a potential option to help maintain the balance of NTs to prevent brain and psychiatric disorders. The level of NTs could be influenced, therefore, by targeting dietary habits and nutritional regimens. The progressive implementation of nutritional approaches in clinical practice has made it necessary to infer more about some of the nutritional NTs in neuropsychiatry. However, the importance of the intake of nutritional NTs requires further understanding, since there are no prior significant studies about their bioavailability, clinical significance, and effects on nerve cells. Interventional strategies supported by evidence should be encouraged.
... The high rate of DS use among college students is associated with greater levels of physical activity and a lower body mass index (BMI) [7], and the majority of studies find no gender difference in the frequency of usage [8]. The high prevalence of DS usage among students persists despite the paucity of information about the effectiveness of such supplements as well as the short-term and long-term health implications of their use [9]. Because public health guidelines do not cover the use of DS, this raises a worry because its usage could potentially increase the risk of an intake that is higher than the safety limits of a variety of nutrients [10]. ...
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Background: Dietary supplements (DS) are products that are intended to be consumed orally and serve the purpose of supplementing one's diet. Although, these products are very popular, their usage among undergraduate students in Iraq is still obscure. Aim: To evaluate the pattern, type, and reasons for supplement usage among Iraqi undergraduate students and to detect the source of information about dietary supplements. Methods: A sample of 442 students at different colleges in Baghdad were surveyed through a questionnaire composed of 13 questions and divided into four sections: socio-demographic, dietary supplement (DS) knowledge, DS intake, and reasons behind their usage. Descriptive statistics were conducted to determine the frequency and percentages of respondents for each variable. Results: A total of 442 participants were included in the study; 160 (36.2%) were males and 282 (63.8%) were females. Out of the total number of the participants, 329 (74%) were dietary supplement users, 139 (42.25%) were males, and 190 (57.75%) were females. Most of the participants (72%) used vit. D3 supplement, and the mean reason for using DS was to overcome nutritional deficiency. Conclusion: Most of the participants are dietary supplement users, with a higher percentage of females. The main reasons for both genders' resorting to dietary supplement use are to improve their health and improve their immunity.
... As of 2017-2018, multivitamin-mineral (MVM) products, which provide >100% of the recommended daily value for many nutrients, remain the most commonly used DSs in the United States (11,12). The effect of supplementation on chronic disease risk continues to be debated (13,14). However, sufficient nutrient intakes are important for health (15,16), and DSs contribute substantial amounts of essential micronutrients (17)(18)(19). ...
Article
Background Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. Objectives The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007–2018 NHANES using a combined approach. Methods NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P < 0.05). Results DS use increased from 50% in 2007 to 56% in 2018 (P = 0.001); use of MN products increased from 46% to 49% (P = 0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P < 0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P < 0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR ≤130%). In children (1–18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P = 0.03). Conclusions The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.
... In humans, several large meta-analyses of human populations had revealed that antioxidants, folic acid and B vitamins, as well as multivitamin and mineral supplements are ineffective in terms of increasing a healthy lifespan. There is no clear evidence in human studies to support the beneficial effect of these supplements in relation to all-cause mortality, cardiovascular disease, cancer, or cognitive function [58]. In animal studies using mammalian models, many studies have shown that treatment with antioxidant supplements, when aimed at extending lifespan, result in no overt effect or even can have a negative effect [59]. ...
... In humans, several large meta-analyses of human populations had revealed that antioxidants, folic acid and B vitamins, as well as multivitamin and mineral supplements are ineffective in terms of increasing a healthy lifespan. There is no clear evidence in human studies to support the beneficial effect of these supplements in relation to all-cause mortality, cardiovascular disease, cancer, or cognitive function [58]. In animal studies using mammalian models, many studies have shown that treatment with antioxidant supplements, when aimed at extending lifespan, result in no overt effect or even can have a negative effect [59]. ...
Article
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Background The human CISD2 gene is located within a longevity region mapped on chromosome 4q. In mice, Cisd2 levels decrease during natural aging and genetic studies have shown that a high level of Cisd2 prolongs mouse lifespan and healthspan. Here, we evaluate the feasibility of using a Cisd2 activator as an effective way of delaying aging. Methods Hesperetin was identified as a promising Cisd2 activator by herb compound library screening. Hesperetin has no detectable toxicity based on in vitro and in vivo models. Naturally aged mice fed dietary hesperetin were used to investigate the effect of this Cisd2 activator on lifespan prolongation and the amelioration of age-related structural defects and functional decline. Tissue-specific Cisd2 knockout mice were used to study the Cisd2-dependent anti-aging effects of hesperetin. RNA sequencing was used to explore the biological effects of hesperetin on aging. Results Three discoveries are pinpointed. Firstly, hesperetin, a promising Cisd2 activator, when orally administered late in life, enhances Cisd2 expression and prolongs healthspan in old mice. Secondly, hesperetin functions mainly in a Cisd2-dependent manner to ameliorate age-related metabolic decline, body composition changes, glucose dysregulation, and organ senescence. Finally, a youthful transcriptome pattern is regained after hesperetin treatment during old age. Conclusions Our findings indicate that a Cisd2 activator, hesperetin, represents a promising and broadly effective translational approach to slowing down aging and promoting longevity via the activation of Cisd2.
... The high frequency of DS use among students exists despite the scarce evidence on the efficacy and acute and long-term health effects from using such supplements [15]. This is a concern as public health guidelines do not include the use of DS, and use might therefore potentially increase the risk of an intake above the safety limits of various nutrients [16]. ...
Article
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Abstract Background Use of dietary supplements (DS) and muscle enhancing dietary supplements (MEDS) is frequent among students despite the lack of evidence of effects and health risks related to consumption. We need to increase our understanding of students’ motivation, examine potential gender differences, and explore explanatory factors, to address preventive measures related to use. Therefore, this study aimed to explore the frequency of, and the reasons for, DS use among university students, as well as explanatory factors for use of MEDS. Method Male and female students from nine Norwegian universities participated in this cross-sectional study. Participants responded to questions about demographics, DS and MEDS use, internalization of body ideals, physical activity- and exercise level, motives for exercise, and exercise context. Independent t-test, Chi-square test, Pearson’s correlation, and logistic regression were used to investigate between group differences, associations, and explanatory factors for use, respectively. P-values ≤ 0.05 were defined as significant. Results A total of 1001 males (34%) and females, with a mean(sd) age of 24.21(4.76) years, participated. The frequency of DS use was 42% and 40% (p = .414) in males and females, respectively, in which more males than females used DS to improve physical or mental performance (p
... On the other hand, it has been argued that supplementation with micronutrients is useless and a waste of money . A number of researchers from several research institutions subsequently argued that this is not the case, that the claim is wrong and misinforms the public , correspondence 34 . Thus, further research in standardized, better-characterized clinical trials is urgently required to further investigate the possible effects of supplementation on the risk of infection and its management in different types of populations, considering their micronutrient status. ...
Article
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It has since been established that the complex, integrated immune system needs multiple specific micronutrients, including vitamins A, D, C, E, B6, and B12, folate, zinc, iron, copper, and selenium, which play vital, often synergistic roles at every stage of the immune response. Adequate amounts are essential to ensure the proper function of physical barriers and immune cells; however, daily micronutrient intakes necessary to support immune function may be higher than current recommended dietary allowances. Certain populations have inadequate dietary micronutrient intakes, and situations with increased requirements (e.g., infection, stress, and pollution) further decrease stores within the body. Several micronutrients may be deficient, and even marginal deficiency may impair immunity. Although contradictory data exist, available evidence indicates that supplementation with multiple micronutrients with immune-supporting roles may modulate immune function and reduce the risk of infection. Micronutrients with the strongest evidence for immune support are vitamins C and D and zinc. Better design of human clinical studies addressing dosage and combinations of micronutrients in different populations are required to substantiate the benefits of micronutrient supplementation against infection. The best evidence for benefit is in critical illness, and in children in developing countries consuming a deficient diet. More clinical trials are required with good clinical outcomes to optimize intake in prevention and treatment of disease.
... To this end, we exposed participants to misinformation 1 suggesting that high-dose vitamin E can reliably prevent and cure COVID-19. Although vitamins are essential for health, there is ample evidence that vitamin supplementation is contra-indicated in individuals with no pre-existing deficiencies (Guallar, Stranges, Mulrow, Appel, & Miller, 2013), and the present claim that vitamin E will reliably cure COVID-19 is demonstrably false (Shakoor et al., 2021). The misinformation employed a number of deceptive techniques used by real-life disinformants (MacFarlane et al., 2020b). ...
Article
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General Audience Summary Health misinformation proliferates online, especially during a crisis such as the COVID-19 pandemic, when demand for effective treatments is pronounced. Such misinformation has the potential to cause harm; for example, a promoted treatment might be unproven or ineffective but have unintended side effects or prevent uptake of superior interventions (e.g., using a non-prescribed vitamin supplement to prevent viral infection while abstaining from social distancing or mask use). Combating misinformation about medical treatments is therefore a particularly exigent issue. Alas, counteracting misinformation is a non-trivial task, with psychological research demonstrating that even clearly-corrected misinformation can continue to influence reasoning and decision making. The present study targeted misinformation about high-dose vitamin E as a potent remedy for COVID-19 prevention and treatment. It shows that refutations that follow best-practice guidelines from psychological research are more effective than tentative refutations often employed by health authorities or the media, reducing both demand for the product and the propensity to share related misinformation online.
... It is estimated that more than 50% of adults in the UK use at least one dietary supplement daily [21]. Some studies have suggested the role of supplements in preventing or progression of chronic diseases [22,23]; however other studies have not found a positive association between supplementation and chronic diseases [24][25][26]. Also, some health experts are concerned about the interactions of these supplements with the drugs used by people with chronic diseases, especially those with cancer [16]. ...
Article
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Background Dietary supplements (DSs) use have become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Some people use supplements with the thought that they can improve their health, reduce symptoms and prevent disease. The aim of the present study was to define the frequency of DS use and its association with socioeconomic factors among participants with selected main non-communicable chronic diseases (NCDs) (diabetes, cardiovascular disease (CVD), hypertension (HTN), cancers, and obesity in the north of Iran. Methods This large cross-sectional study was conducted as a part of the PERSIAN Guilan cohort study. Supplement use during last year and its type, demographic factors, socioeconomic status, lifestyle habits were asked by face-to-face interview. The history of chronic disease was defined by a trained team. Data were analyzed using SPSS. The chance of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression. Results 10,520 men and women aged 35–70 years in Some’e Sara County (including urban regions and 39 villages) were studied. About 25% of participants consumed DSs. The highest consumption of DS was calcium/vitamin D (11.1%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and general obesity (32.7), respectively. After adjustment for confounders, those with female gender, the highest age ranges (55–65 and > 65 years), high academic education, living in urban regions, and good economic status were more likely to be DSs consumers; however, married and smoker subjects were more likely to consume DS. Participants who had a history of diabetes, HTN, CVD, Obesity, and Central Obesity were more likely to intake DS in comparison with healthy subjects. Conclusion This study showed that a quarter of the participants were DS users. Female sex, older age groups, and higher educated participants, and among chronic disease, patients with HTN, CVD, and diabetes were more likely to be users of any DS.
... However, limited studies are available regarding the proper use, dose, the long term health effect of DS and the recent trends in supplement use [10]. Some studies suggested that the increase intake and the high doses of some dietary constituents could be associated with some adverse effects and health consequences including cancer and cardiovascular disease [11,12,13] Furthermore, DS are not strictly regulated, they are markedly and vastly available in the market, in addition, it is difficult to ascertain the safety and purity of all supplements [14] which may lead to skepticism regarding their use [15]. ...
Article
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Background: The consumption of dietary supplements (DS) has noticeably increased among men and women in Benghazi-Libya. DS are widely available in the market with poor regulations and guidance. However, Data on DS consumption in Libya is insufficient. Objectives: To explore the prevalence of DS use at University of Benghazi medical campus, types of DS used, and reasons for using DS. Material and Methods: This is a cross sectional study in which data were collected from 253 participants from. The study was conducted for one month using an electronic questionnaire. Results: Most of the participants (81%) were females. Around half of the participants (51%) used DS. The main reason for using DS by participants was to improve general health (49%). Multivitamins and green tea were the most commonly used DS among participants (49 % and 45%, respectively). Health care providers and the internet were the main sources of information for consumers (38% and 24%, respectively). Conclusion: There is a noticeable consumption of DS. Regular awareness should be provided by health care providers and the ministry of health. In addition, more studies should be conducted regarding the prevalence of DS use and the patterns of DS consumption among men and women in Libya.
... The US Preventive Services Task Force panel of experts also opposes the use of both beta-carotene and vitamin E in cardiovascular disease prevention [74]. The most radical position on antioxidant supplementation has been taken by the authors of the "Enough is enough: Stop wasting money on vitamin and mineral supplements", who claim that a sufficient number of studies have demonstrated the lack of benefits of vitamin-mineral supplementation to warrant ceasing any further research on their effectiveness [75]. ...
Article
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Dietary supplements are products containing nutrients sold in various medicinal forms, and their widespread use may stem from the conviction that a preparation that looks like a drug must have therapeutic properties. The aim of this scoping review is to present what is known about the effects of using selected dietary supplements in the context of chronic diseases, as well as the risks associated with their use. The literature shows that the taking of vitamin and mineral supplements by healthy people neither lowers their risk of cardiovascular diseases nor prevents the development of malignancies. Many scientific societies recognize that omega-3 fatty acids lower blood triglycerides, but whether taking them prevents heart disease is less clear-cut. Taking weight loss supplements is not an effective method of fighting obesity. Often, some supplements are increasingly sold illegally, which is then also associated with the higher risk that they may be adulterated with banned substances, thus making them even more dangerous and potentially life-threatening. Supplements are necessary in cases of nutrient deficiency; however, even though prescription is not required, their use should be recommended and monitored by a physician.
... In recent years, the dietary supplement (DS) market was flooded with products that advertise impressive health claims, with many of them being unproven. 1 This has led consumers to believe that DS are an essential component of a healthy lifestyle with hypothesized benefits that are likened to physical activity and healthy eating. 2 Overall, 45.6% of Canadians and 52.1% of adults residing in Ontario reported using DS. 3 Similarly, the current literature reveals a supplementation rate of 43.4% among Canadian university non-athlete students. 4 Despite the popular opinion that DS are fundamental for healthy living, DS are not recommended to the general population due to the limited spread of micronutrient deficiencies. ...
Article
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Objective The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB). Methods A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants’ attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions. Results Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention. Conclusions This study confirms the utility of the TPB in predicting university students’ supplementation habits.
... Equally important is the demand for large and well-conducted clinical trials to determine supplement efficacy in diverse clinical settings and for governmental agencies to strengthen supplement regulation. Current unnecessary consumption of supplements generates excessive spending (Guallar et al., 2013) and important adverse effects in the general public including: acute intoxication, insomnia, gastrointestinal symptoms, calculi formation, hematological abnormalities, susceptibility to infection and pro-carcinogenic effects (Rutkowski and Grzegorczyk, 2012). ...
Chapter
Supplements are products used to replenish specific biochemical components of the host that present decreased physiological concentrations or are in great demand. When taken at proper concentrations and intervals, supplements may improve biological functions, such as the immune response in individuals with nutrient and other biochemical deficiencies. However, supplementation used to prevent disease and infection should target populations that present specific deficiencies. In addition, when used in sick individuals, supplementation should solely be employed as coadjuvant therapy. Worryingly, most clinical studies evaluating supplements have limited study-subject populations, narrow follow-up periods or other serious methodological flaws. And although many supplements are of natural origin, we should not conclude that they are harmless, as many reports state that they may cause significant adverse effects, especially when improperly consumed. In this article, we will therefore detail the use and limitations of the immunomodulatory actions of mammal, plant and prokaryotic-derived supplements, as well as of nutritional synthetic supplements such as vitamins and trace minerals.
Chapter
Nesta coletânea de fôlego, os organizadores e autores oferecem uma poderosa ferramenta de trabalho aos pesquisadores e interessados na epidemiologia nutricional brasileira. Ampliando os horizontes tradicionais desse campo de estudo, o livro vai além de avaliação de dietas e da relação entre alimentação e doenças crônicas não transmissíveis. Os 38 capítulos desta segunda edição revista e ampliada contemplam métodos e análises que abrangem antigos e atuais problemas nutricionais brasileiros, com engajamento propositivo na solução de problemas. Simultaneamente, manual técnico da complexa área da avaliação nutricional e rigorosa enciclopédia nutricional brasileira, este compêndio de enfoque amplo e multidisciplinar reúne os principais investigadores na área de nutrição e saúde pública no Brasil e surge como leitura fundamental para os estudos de nutrição e saúde coletiva.
Chapter
The link between nutrition and psychosis has long been an area of interest for scientists and researchers. Recent studies identified that individuals with psychosis may have lower levels of certain nutrients than those without the condition. This led to the suggestion that dietary interventions may be a potential treatment option for those with psychosis. This chapter delivers a wide-ranging summary of the current research on nutrition and psychosis. It overviews the most critical studies in the field, including but not limited to vitamins, minerals, and particular types of diet and their link with psychosis, the function of the gut microbiome, and hunger. While some studies hinted towards a link between certain dietary habits and psychosis, others have not. Additionally, the exact mechanisms by which nutrition may impact the progress of psychosis and its treatment are still not entirely understood. Nonetheless, the potential for nutritional interventions as a complementary approach for those with psychosis is an exciting area of research that warrants further exploration.
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Use of dietary supplements has much increased over recent decades; around half of people in North America regularly use supplements. A wide variety of supplements are sold. In some cases there is firm evidence supporting their efficacy but in most cases there is little or no supporting evidence. Some herbal preparations have toxic effects and should therefore only be used with much caution. Supplements are marketed by a variety of different methods, including health food stores, advertisements in newspapers and on TV, multilevel marketing, bulk mail, spam e-mails, and Internet websites. Marketing of supplements often involves giving unreliable or dishonest information that is not supported by scientific studies. The marketing of supplements in the United States is only weakly regulated.KeywordsDietary supplementsDietary Supplement and Health Education ActHerbal preparationsMarketing of dietary supplementsMultivitamin supplements
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The scientific community and lay press are participating in a heated debate over the usefulness of food bioactives when used as dietary supplements. This debate often ignores hard scientific evidence and the outcomes of proper research in either direction. Some propose that health claims should be awarded based on classic pharmacological parameters of efficacy and safety. Others suggest that a botanical history of their safe use and basic biological evidence in support of their effects should suffice to allow their marketing. The current regulatory impasse does not help solve this conundrum. It is time for scientists, regulators, and legislators to open an epistemological debate on the appropriateness of using classic pharmacological methods for substances that do not share the usual drug profiles and which are, consequently, difficult to study in humans.
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Food supplement, according to the Dietary Supplement Health and Education Act (DSHEA) of 1994 (Public Law 103–417) [1], is a product that is not a pharmaceutical drug, a food additive (spice or preservative), or “conventional food,” and which meets the following criteria:Multivitamins are the most popular food supplements worldwide [2] and represent a significant percentage of health-related expenses in the U.S., reaching more than 1/3 of prescription drug expenses. A multivitamin/mineral supplement is defined in the U.S. as: “A supplement containing 3 or more vitamins and minerals and not herbs, hormones, or drugs, in which, each vitamin and mineral is included at a dose below the tolerable upper level, as determined by the Food and Drug Board, and does not present a risk of adverse health effects” [3]. Multivitamin supplements are commonly provided in combination with dietary minerals and the terms multivitamin and multimineral are often used interchangeably. Even though the term multivitamin/multimineral supplements (MVM) regularly appears in scientific literature, none of these terms has a precise scientific definition [4]. MVMs might even contain more than 10 different vitamins and 7–10 minerals.
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Background: Intravenous edetate disodium-based infusions reduced cardiovascular events in a prior clinical trial. The Trial to Assess Chelation Therapy 2 (TACT2) will replicate the initial study design. Methods: TACT2 is an NIH-sponsored, randomized, 2x2 factorial, double masked, placebo-controlled, multicenter clinical trial testing 40 weekly infusions of a multi-component edetate disodium (disodium ethylenediamine tetra-acetic acid, or Na2EDTA)-based chelation solution and twice daily oral, high-dose multivitamin and mineral supplements in patients with diabetes and a prior myocardial infarction (MI). TACT2 completed enrollment of 1000 subjects in December 2020, and infusions in December 2021. Subjects are followed for 2.5 to 5 years. The primary endpoint is time to first occurrence of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The trial has >;85% power to detect a 30% relative reduction in the primary endpoint. TACT2 also includes a Trace Metals and Biorepository Core Lab, to test whether benefits of treatment, if present, are due to chelation of lead and cadmium from patients. Design features of TACT2 were chosen to replicate selected features of the first TACT, which demonstrated a significant reduction in cardiovascular outcomes in the EDTA chelation arm compared with placebo among patients with a prior MI, with the largest effect in patients with diabetes. Results: Results are expected in 2024. Conclusion: TACT2 may provide definitive evidence of the benefit of edetate disodiumbased chelation on cardiovascular outcomes, as well as the clinical importance of longitudinal changes in toxic metal levels of participants.
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Objective: The increasing use of health foods has led to concerns about the possible health problems it could create. This review aims to clarify the current status and problems in ensuring the safety of health foods in Japan by comparing it with the measures prescribed for dietary supplement (DS) systems in the US. Methods: A literature review provided data on actual status, usage of products, and systems for collecting and evaluating adverse events. Information on the situation in the US was obtained by visiting the concerned department in charge. Results: The majority of severe adverse events suspected to be related to health foods was not attributed to the foods themselves, but to unapproved pharmaceutical ingredients added illegally to them. Minor to moderate cases involved discomforts such as gastrointestinal problems and allergies, which were not reported to the concerned authorities. Not enough action was taken on the reported adverse events owing to the small number of cases and the difficulty in determining the causal relationship of the symptom with the product. The US DS system and the Japanese system are similar in terms of safety measures, except for the mandatory GMP for products, compulsory reporting of severe adverse events to business operators, quick information collection using electronic media, and evaluation of information. Conclusions: Measures should be implemented to collect and evaluate as many cases of minor to moderate adverse events as possible, which have occurred post marketing of the health foods, to prevent recurrence of such events and more severe reactions.
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Recent evidence from laboratory and epidemiologic studies has shed a different light on selenium health effects and its recommended range of environmental exposure, compared with earlier research. Specifically, epidemiologic studies in Western populations have shown adverse effects of selenium exposure at low levels, sometimes below or slightly above selenium intakes needed to maximize selenoprotein expression and activity. In addition, three recent lines of evidence in molecular and biochemical studies suggest some potential drawbacks associated with selenoprotein maximization: 1) the possibility that selenoprotein upregulation is a compensatory response to oxidative challenge, induced by selenium itself or other oxidants; 2) the capacity of selenoproteins to trigger tumor growth in some circumstances; and 3) the deleterious metabolic effects of selenoproteins and particularly of selenoprotein P. The last observation provides a toxicological basis to explain why in humans selenium intake levels as low as 60 μg/day, still in the range of selenium exposure upregulating selenoprotein expression, might start to increase risk of type 2 diabetes. Overall, these new pieces of evidence from the literature call into question the purported benefit of selenoprotein maximization, and indicate the need to reassess selenium dietary reference values. This reassessment should clarify which range of selenoprotein upregulation follows restoration of adequate selenium availability and which range is driven by a compensatory response to selenium toxicity and oxidative stress.
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In this chapter, dietary supplements refer to any substance taken in addition to regular food. This includes vitamins, minerals, amino acids, herbs, enzymes, and various substances extracted from plants and animals. Some of these products are not technically dietary supplements. One person in two in North America is a regular user of dietary supplements. A great many different supplements are sold, but evidence demonstrating their efficacy is often lacking. Some supplements, especially herbal preparations, may be harmful. Supplements are often marketed in unscrupulous ways that involve giving unreliable or dishonest information. The marketing of supplements in the USA is weakly regulated. Suggestions are given on how healthcare professionals can provide solid advice to patients.
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Objectives Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread. Design Content analysis. Participants We analysed advertisements for dietary supplements in two major Japanese newspapers in February–July 2019 and February–July 2020. Our analysis covered 2167 advertisements. Results The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as ‘defence’ and ‘prevent’ were used to promote the preventive effect. Conclusions False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.
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Minerals are critical for maintaining overall health. These tiny chemical compounds are responsible for enzymatic activation, maintaining healthy teeth and bones, regulating energy metabolism, enhancing immunity and aiding muscle and brain function. However, mineral deficiency in the form of inadequate or under nourished intake affects millions of people throughout the world, with well-documented adverse health consequences of malnutrition. Conversely, mineral deficiency may also be a risk factor for insulin resistance (IR) and obesity. This review focuses on another, more “less discussed” form of malnutrition, namely mineral deficiency and its contribution to metabolic disorders. At the cellular level, minerals maintain not only molecular communication but also trigger several key biochemical pathways. Disturbances in these processes due to mineral insufficiency may gradually lead to metabolic disorders such as insulin resistance, pre-diabetes and central obesity which might lead to renal failure, cardiac arrest, hepatic carcinoma and various neurodegenerative diseases. Here we discuss the burden of disease promoted by mineral deficiencies and the medical, social and economic consequences. Mineral deficiency-mediated IR and obesity have a considerable negative impact on individual well-being and physical consideration and economic productivity. We discuss possible molecular mechanisms of mineral deficiency that may lead to IR and obesity and suggest strategies to counter these metabolic disorders. To protect mankind from mineral nutrient deficiencies, the key is to take a variety of foods in reasonable quantities, such as organic and pasture-raised eggs, low fat dairy, and grass-fed and finished meats, insecticide and pesticide-free vegetables and fruits.
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Growing competitiveness in education and workplaces has led to increased interest in cognitive-enhancing substances. Abuse of prescription drugs purported to offer nootropic potential is increasing, and new brands of over-the-counter nootropics are being developed. However, the majority of research into the effectiveness and safety of cognitive-enhancing substances has been performed on adults, and the prefrontal cortex, the brain region in control of higher-order cognitive function, does not finish developing until adulthood, raising concerns that adolescent abuse of cognitive enhancers could result in lasting changes to the brain. In this chapter, we discuss the current trends in cognitive enhancement among adolescents and adults, examine several prescription drugs commonly used or being examined for their potential cognitive-enhancing effects, and discuss the potential risks of each substance. We also discuss the state of over-the-counter nootropics and the lack of reliable research into their efficacy and safety.
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Whether high-dose multivitamins are effective for secondary prevention of atherosclerotic disease is unknown. To assess whether oral multivitamins reduce cardiovascular events and are safe. Double-blind, placebo-controlled, 2 x 2 factorial, multicenter, randomized trial. (ClinicalTrials.gov: NCT00044213) SETTING: 134 U.S. and Canadian academic and clinical sites. 1708 patients aged 50 years or older who had myocardial infarction (MI) at least 6 weeks earlier and had serum creatinine levels of 176.8 mol/L (2.0 mg/dL) or less. Intervention: Patients were randomly assigned to an oral, 28-component, high-dose multivitamin and multimineral mixture or placebo. The primary end point was time to total death, recurrent MI, stroke, coronary revascularization, or hospitalization for angina. The median age was 65 years, and 18% of patients were women. The qualifying MI occurred a median of 4.6 years (interquartile range [IQR], 1.6 to 9.2 years) before enrollment. Median follow-up was 55 months (IQR, 26 to 60 months). Patients received vitamins for a median of 31 months (IQR, 13 to 59 months) in the vitamin group and 35 months (IQR, 13 to 60 months) in the placebo group (P = 0.65). Totals of 645 (76%) and 646 (76%) patients in the vitamin and placebo groups, respectively, completed at least 1 year of oral therapy (P = 0.98), and 400 (47%) and 426 (50%) patients, respectively, completed at least 3 years (P = 0.23). Totals of 394 (46%) and 390 (46%) patients in the vitamin and placebo groups, respectively, discontinued the vitamin regimen (P = 0.67), and 17% of patients withdrew from the study. The primary end point occurred in 230 (27%) patients in the vitamin group and 253 (30%) in the placebo group (hazard ratio, 0.89 [95% CI, 0.75 to 1.07]; P = 0.21). No evidence suggested harm from vitamin therapy in any category of adverse events. There was considerable nonadherence and withdrawal, limiting the ability to draw firm conclusions (particularly about safety). High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate. National Institutes of Health.
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Multivitamin and mineral supplements are the most commonly used dietary supplements in the United States. To synthesize studies on the efficacy and safety of multivitamin/mineral supplement use in primary prevention of cancer and chronic disease in the general population. English-language literature search of the MEDLINE, EMBASE, and Cochrane databases through February 2006 and hand-searching of pertinent journals and articles. Randomized, controlled trials in adults were reviewed to assess efficacy, and randomized, controlled trials and observational studies in adults or children were reviewed to assess safety. Paired reviewers extracted data and independently assessed study quality. 12 articles from 5 randomized, controlled trials that assessed efficacy and 8 articles from 4 randomized, controlled trials and 3 case reports on adverse effects were identified. Study quality was rated fair for the studies on cancer, cardiovascular disease, cataracts, or age-related macular degeneration and poor for the studies on hypertension. In a poorly nourished Chinese population, combined supplementation with beta-carotene, alpha-tocopherol, and selenium reduced the incidence of and mortality rate from gastric cancer and the overall mortality rate from cancer by 13% to 21%. In a French trial, combined supplementation with vitamin C, vitamin E, beta-carotene, selenium, and zinc reduced the rate of cancer by 31% in men but not in women. Multivitamin and mineral supplements had no significant effect on cardiovascular disease or cataracts, except that combined beta-carotene, selenium, alpha-tocopherol, retinol, and zinc supplementation reduced the mortality rate from stroke by 29% in the Linxian study and that a combination of 7 vitamins and minerals stabilized visual acuity loss in a small trial. Combined zinc and antioxidants slowed the progression of advanced age-related macular degeneration in high-risk persons. No consistent adverse effects of multivitamin and mineral supplements were evident. Only randomized, controlled trials were considered for efficacy assessment. Special nutritional needs, such as use of folic acid by pregnant women to prevent birth defects, were not addressed. Findings may not apply to use of commercial multivitamin supplements by the general U.S. population. Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease.
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Despite widespread use of multivitamin supplements, their effect on cognitive health-a critical issue with aging-remains inconclusive. To date, no long-term clinical trials have studied multivitamin use and cognitive decline in older persons. To evaluate whether long-term multivitamin supplementation affects cognitive health in later life. Randomized, double-blind, placebo-controlled trial of a multivitamin from 1997 to 1 June 2011. The cognitive function substudy began in 1998. Up to 4 repeated cognitive assessments by telephone interview were completed over 12 years. (ClinicalTrials.gov: NCT00270647) SETTING: The Physicians' Health Study II. 5947 male physicians aged 65 years or older. Daily multivitamin or placebo. A global composite score averaging 5 tests of global cognition, verbal memory, and category fluency. The secondary end point was a verbal memory score combining 4 tests of verbal memory, which is a strong predictor of Alzheimer disease. No difference was found in mean cognitive change over time between the multivitamin and placebo groups or in the mean level of cognition at any of the 4 assessments. Specifically, for the global composite score, the mean difference in cognitive change over follow-up was -0.01 SU (95% CI, -0.04 to 0.02 SU) when treatment was compared with placebo. Similarly, cognitive performance did not differ between the multivitamin and placebo groups on the secondary outcome, verbal memory (mean difference in cognitive change over follow-up, -0.005 SU [CI, -0.04 to 0.03 SU]). Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin. In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits. National Institutes of Health, BASF, Pfizer, and DSM Nutritional Products.
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Vitamin and mineral supplements are commonly used to prevent chronic diseases. To systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2005 to 29 January 2013, with manual searches of reference lists and gray literature. Two investigators independently selected and reviewed fair- and good-quality trials for benefit and fair- and good-quality trials and observational studies for harms. Dual quality assessments and data abstraction. Two large trials (n = 27 658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.94 [95% CI, 0.89 to 1.00]). The study that included women showed no effect in them. High-quality studies (k = 24; n = 324,653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor β-carotene prevented CVD or cancer, and β-carotene increased lung cancer risk in smokers. The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years. Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD. Agency for Healthcare Research and Quality.
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Earlier identification of cognitive impairment may reduce patient and caregiver morbidity. To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts. English-language studies of fair to good quality, primary care-feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia. Dual quality assessment and abstraction of relevant study details. The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment. Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes. Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear. Agency for Healthcare Research and Quality.
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Are antioxidant supplements associated with higher or lower all-cause mortality? Antioxidant supplements are not associated with lower all-cause mortality. Beta carotene, vitamin E, and higher doses of vitamin A may be associated with higher all-cause mortality.
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Description: New U.S. Preventive Services Task Force (USPSTF) recommendation statement on vitamin D and calcium supplementation to prevent fractures in adults. Methods: The USPSTF commissioned 2 systematic evidence reviews and a meta-analysis on vitamin D supplementation with or without calcium to assess the effects of supplementation on bone health outcomes in community-dwelling adults, the association of vitamin D and calcium levels with bone health outcomes, and the adverse effects of supplementation. Population: These recommendations apply to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures. This recommendation does not apply to the treatment of persons with osteoporosis or vitamin D deficiency. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men. (I statement)The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. (I statement)The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. (D recommendation).
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Experimental models and observational studies suggest that homocysteine-lowering therapy with folic acid (FA) may prevent cardiovascular disease (CVD). However, FA also stimulates cell proliferation and might promote progression of atherosclerosis. Our objectives were to perform a meta-analysis of FA supplementation trials on CVD events and to explore a potential interaction between FA supplementation and baseline homocysteine levels on CVD events. We searched MEDLINE for randomized controlled trials of FA supplementation to prevent CVD events (January 1966 to July 2009) and performed meta-analyses using random effects models. For trials that reported responses to FA supplementation stratified by baseline levels of homocysteine, we pooled within-trial estimates of differences in log-relative risks by baseline homocysteine levels using a random effects model. Overall, FA supplementation did not affect primary cardiovascular clinical end points (relative risk 1.02, 95% confidence interval [CI] 0.93 to 1.13, p = 0.66) or stroke (relative risk 0.95, 95% CI 0.84 to 1.08, p = 0.43). However, in trials that reported analyses stratified by baseline homocysteine, effect of FA supplementation differed by strata of baseline homocysteine (p for interaction = 0.030). Specifically, risks of primary clinical CVD events comparing FA supplementation to control were 1.06 (95% CI 1.00 to 1.13) in strata with mean baseline homocysteine levels >12 mumol/L and 0.94 (95% CI 0.86 to 1.03) in strata with baseline homocysteine levels <12 micromol/L. In conclusion, FA had no effect on CVD or stroke. However, analysis of within-trial results stratified by baseline homocysteine suggests potential harm in those with high homocysteine at baseline. This interaction may have important implications for recommendations of FA supplement use. In the meantime, FA supplementation should not be recommended as a means to prevent or treat CVD or stroke.