Use of complementary and alternative medicine in vitiligo: a cross-sectional survey.

Vitiligo is characterized by skin depigmentation, which can lead to profound psychological effects and decreased quality of life, especially for those with skin of color. Individuals with vitiligo may utilize complementary and alternative medicine (CAM) due to limited treatment options with varying efficacy.An anonymous, multiple-choice, cross-sectional questionnaire was distributed to participants with vitiligo in the United States through online forums. Data on disease characteristics, use of prescription medications, use of topical therapies, supplements, and diets, and perceptions of CAM were collected.In total, 625 respondents completed the survey. Overall, 32.5% of participants (203/625) have tried CAM. Commonly reported CAM include supplements of vitamin D (57.7%, 116/203), vitamin B12 (46.3%, 93/203), vitamin C (27.4%, 55/203), topical Nigella sativa oil (26.4%, 53/203), oral omega-3 fatty acids (24.9%, 50/203), folic acid (22.9%, 46/203), and vitamin E (22.9%, 46/203). Frequently cited reasons for CAM use include desire to try "new" (40.4%, 82/203) or "more natural" (26.6%, 54/203) therapies, "frustration with conventional medicine" (24.6%, 50/203), and fear of "adverse side effects of conventional medicine" (23.6%, 48/203). Non-White participants were more likely than their White counterparts to report CAM use and have more positive perceptions of CAM therapies. Less than half (43.3%, 88/203) of CAM users reported that they disclosed their use of CAM with their physician.Dermatologists should be mindful of CAM and ask patients about their use. Further investigation of the role of CAM as adjuvant therapy for vitiligo is warranted to better advise patients.

Prevalence and characteristics of multivitamin-multimineral (MVMM) use among Saudi populations in Riyadh, Saudi Arabia: A cross-sectional study.

ABSTRACT: Use of multivitamin multimineral (MVMM) preparations is prevalent and growing worldwide, contributing to major health expenditure. Minimal literature on prevalence and characteristics of MVMM use is available from Saudi Arabia.The study was conducted to determine the prevalence and characteristics of MVMM use among Saudi population in Riyadh, Saudi Arabia.A cross-sectional study was conducted at 6 shopping malls located in the different regions of Riyadh city for 6 months from February 01, 2019, to July 31, 2019. A well-structured English questionnaire was developed, translated into Arabic language, and validated by the experts. A pertinent inclusion and exclusion criteria were established. After having informed consent to be included in the study, the printed copies of the questionnaire were distributed among the participants using a convenient sampling technique. The data were collected and analyzed using SPSS version 24. Descriptive statistics were presented as numbers, percentages, means, and standard deviations. A P value of ≤.05 and 95% confidence intervals were used to report the statistical significance.Out of 1200 surveys distributed, 1105 were returned by the participants (response rate 92%). Prevalence of MVMM supplements use turned out to be 47%. The study revealed statistically significant association between MVMM use and gender, marital status, education, regular exercise, smoking, following special diet, and eating fruits and vegetables (P ≤ .05). Majority of the participants used MVMM on daily basis (57.9%), and hospital prescriptions (57.9%) were the most common reason of MVMM use. Majority of the participants used MVMM for diet supplements (32.2%), health promotion (29.4%), and treatment of disease (16%).The MVMM use is prevalent in Saudi population, warranting sound regulatory policies for their judicial use and increase awareness about the benefits and side effects of dietary supplements.

Disparities in Oral Nutritional Supplement Usage and Dispensing Patterns across Primary Care in Ireland: ONSPres Project.

When treating malnutrition, oral nutritional supplements (ONSs) are advised when optimising the diet is insufficient; however, ONS usage and user characteristics have not been previously analysed. A retrospective secondary analysis was performed on dispensed pharmacy claim data for 14,282 anonymised adult patients in primary care in Ireland in 2018. Patient sex, age, residential status, ONS volume (units) and ONS cost (EUR) were analysed. The categories of 'Moderate' (<75th centile), 'High' (75th-89th centile) and 'Very High' ONS users (≥90th centile) were created. The analyses among groups utilised t-tests, Mann-Whitney U tests and chi-squared tests. This cohort was 58.2% female, median age was 76 years, with 18.7% in residential care. The most frequently dispensed ONS type was very-high-energy sip feeds (45% of cohort). Younger males were dispensed more ONSs than females (<65 years: median units, 136 vs. 90; p < 0.01). Patients living independently were dispensed half the volume of those in residential care (112 vs. 240 units; p < 0.01). 'Moderate' ONS users were dispensed a yearly median of 84 ONS units (median cost, EUR 153), 'High' users were dispensed 420 units (EUR 806) and 'Very High' users 892 yearly units (EUR 2402; p < 0.01). Further analyses should focus on elucidating the reasons for high ONS usage in residential care patients and younger males.

COVID-19: A Review on the Role of Trace Elements Present in Saudi Arabian Traditional Dietary Supplements.

The novel coronavirus infection is also called COVID-19 (coronavirus disease 2019). The infection has affected millions of people worldwide and caused morbidity as well mortality in patients with pre-existing chronic conditions such as metabolic, respiratory and cardiovascular disorders. The severity of the disease is mostly seen in people with low immunity and chronic sufferers of respiratory, cardiovascular and metabolic disorders. To date, there is no specific treatment available for COVID-19. Precaution and prevention are the most recommended options followed for controlling the spread of infection. Trace elements such as zinc, calcium, iron and magnesium play an important role in boosting the immunity of the host system. These components assist in the development and functioning of lymphocytes, cytokines, free radicals, inflammatory mediators and endothelial functioning. This review summarizes the common dietary supplements that are regularly consumed in Saudi Arabia and are known to contain these vital trace elements. Data available in Google Scholar, NCBI, PUBMED, EMBASE and Web of Science about COVID-19, micronutrients, trace elements and nutritional supplements of Saudi Arabia was collected. By highlighting the traditionally used dietary components containing the essential elements, this review could provide useful knowledge crucial for building immunity in the population.

Interactions in cancer treatment considering cancer therapy, concomitant medications, food, herbal medicine and other supplements.

PURPOSE: The aim of our study was to analyse the frequency and severity of different types of potential interactions in oncological outpatients' therapy. Therefore, medications, food and substances in terms of complementary and alternative medicine (CAM) like dietary supplements, herbs and other processed ingredients were considered. METHODS: We obtained data from questionnaires and from analysing the patient records of 115 cancer outpatients treated at a German university hospital. Drug-drug interactions were identified using a drug interaction checking software. Potential CAM-drug interactions and food-drug interactions were identified based on literature research. RESULTS: 92.2% of all patients were at risk of one or more interaction of any kind and 61.7% of at least one major drug-drug interaction. On average, physicians prescribed 10.4 drugs to each patient and 6.9 interactions were found, 2.5 of which were classified as major. The most prevalent types of drug-drug interactions were a combination of QT prolonging drugs (32.3%) and drugs with a potential for myelotoxicity (13.4%) or hepatotoxicity (10.1%). In 37.2% of all patients using CAM supplements the likelihood of interactions with medications was rated as likely. Food-drug interactions were likely in 28.7% of all patients. CONCLUSION: The high amount of interactions could not be found in literature so far. We recommend running interaction checks when prescribing any new drug and capturing CAM supplements in medication lists too. If not advised explicitly in another way drugs should be taken separately from meals and by using nonmineralized water to minimize the risk for food-drug interactions.

Do Perceptions of Cognitive Changes Matter in Self-Management Behaviors Among Persons With Mild Cognitive Impairment?

BACKGROUND AND OBJECTIVES: This secondary analysis examined (a) the association between illness perceptions (perceived understanding and cause of mild cognitive impairment [MCI]) and self-management behaviors for cognitive health, and (b) whether sociodemographic and clinical factors moderate such relationships among persons with MCI. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study of 85 participants using baseline data from the Return of Amyloid Imaging Scan Results Study. The coherence and causality subscales of the Revised Illness Perceptions Questionnaires were used. Self-management behaviors (dietary changes, physical activity, mental activities, dietary supplements) were assessed using the Risk Evaluation and Education for ALzheimer's disease health behavior measure. Sociodemographic and clinical information was extracted from patients' medical records. We performed hierarchical linear regression and binary logistic regression. RESULTS: We found no main effects for illness perceptions and self-management of cognitive health. Interaction effects were detected, including (a) coherence and age on the total number of self-management behaviors (b = 0.01, p = .04) and on physical activity (p = .04, odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.00-1.03), (b) causality and age on dietary supplements (p = .03, OR = 1.31, 95% CI = 1.02-1.67), and (c) causality and education on mental activities (p = .02, OR = 0.44, 95% CI = 0.22-0.88). DISCUSSION AND IMPLICATIONS: Findings suggest that age and education moderate the relationship between illness perceptions and self-management behaviors. Health care professionals should consider subjective perceptions about MCI in light of sociodemographic and clinical factors when discussing cognitive health self-management.

Resultados de una encuesta dirigida a dietistas-nutricionistas sobre la gestión de los equipos de nutrición clínica durante la pandemia de COVID-19 en centros hospitalarios de Cataluña / Results of a survey aimed at dietitians-nutritionists on the management of clinical nutrition teams during the COVID-19 pandemic in hospitals in Catalonia

Introducción: la pandemia por COVID-19 ha tenido implicaciones directas en los equipos de nutrición (EN) clínica a nivel tanto organizativo como asistencial. Desde marzo de 2020 se dispone de recomendaciones de expertos sobre la intervención nutricional en pacientes con COVID-19. Objetivos: describir la intervención nutricional que se ha llevado a cabo en los pacientes con COVID-19, estimar la presencia de dietistas-nutricionistas (DN) clínicos en los hospitales de Cataluña y conocer la organización de los EN. Métodos: estudio transversal realizado a través de una encuesta online dirigida a los DN clínicos de los hospitales de Cataluña (marzo 2021). Resultados: se han analizado las encuestas de 36 EN, formados por 104 DN. El 44,44 % de los EN han tenido que dejar de hacer o reducir alguna de sus actividades habituales durante la pandemia. Cuando se ha empleado el cribado nutricional, este se ha realizado de forma precoz (24-48 h) en el 56,25 % de los casos y la herramienta más común ha sido el NRS-2002 (66,67 %). El 41,67 % de los EN han instaurado una dieta hospitalaria específica, siendo esta generalmente hiperproteica (89,66 %). El 41,67 % de los EN han pautado la suplementación nutricional oral de forma sistemática, priorizando las fórmulas hiperproteicas (97,14 %) e hipercalóricas (74,29 %). Se estima que la figura del DN clínico está presente en aproximadamente el 61,54 % de los hospitales de agudos públicos de Cataluña. Conclusiones: los resultados reflejan la capacidad de adaptación de los EN, reorganizando y redistribuyendo sus tareas habituales e instaurando medidas poco habituales para asegurar el soporte nutricional. (AU)

Introduction: the COVID-19 pandemic has had direct implications for clinical nutrition teams (NT), both at an organizational and healthcare level. Since March 2020, expert recommendations on nutritional intervention for patients with COVID-19 have been available. Objectives: to describe the nutritional intervention that has been carried out in patients with COVID-19, to estimate the presence of clinical dietitians-nutritionists (DN) in hospitals in Catalonia, and to know the organization of NTs. Methods: a cross-sectional study through an online survey directed to clinical DNs at hospitals in Catalonia (March 2021) was made. Results: the surveys of 36 NTs, made up of 104 DNs, have been analysed. A total of 44.44 % of NTs had to interrupt or reduce some of their usual activities during the pandemic. When nutritional screening was used, it was carried out early (24-48 h) in 56.25 % of cases, and the most common tool was the NRS-2002 (66.67 %). In 41.67 % of NTs a specific hospital diet was established, this being generally hyperproteic (89.66 %). Oral nutritional supplementation was systematically prescribed by 41.67 % of NTs, prioritizing hyperproteic (97.14 %) and hypercaloric (74.29 %) formulas. It is estimated that clinical DNs are present in approximately 61.54 % of public acute hospitals in Catalonia. Conclusions: the results reflect the adaptive capacity of NTs, reorganizing and redistributing their usual tasks and establishing infrequent measures to ensure nutritional support. (AU)

Post-Diagnosis use of Antioxidant Vitamin Supplements and Breast Cancer Prognosis: A Systematic Review and Meta-Analysis.

Antioxidant vitamin supplements (AVSs) are widely used among breast cancer survivors. Whether post-diagnosis use of AVSs would impair cancer survival is unclear. To assess the association between breast cancer survival and post-diagnosis AVSs use. We performed a literature search using PubMed, Cochrane Library, and Embase from their inception to October 1, 2020. Studies that investigated the association between breast cancer survival and post-diagnosis AVS use included. The AVSs included 1 or more of the following: vitamin A, C, or E. The meta-analysis included 8 studies with 17,062 patients. There was no significant difference between AVS use or not after diagnosis (HR 0.92, 95% CI 0•82-1•03) or during chemotherapy (HR 1.15, 95% CI 0.78-1.68) in overall survival (OS). Whenever during chemotherapy or after diagnosis, AVS users had a worse prognosis in the later studies. There was no significant inverse association between post-diagnosis vitamin A or E supplements use and OS. Vitamin C intake after breast cancer diagnosis was significantly associated with better OS (HR 0.84, 95% CI 0.76-0.93). Our findings suggest that post-diagnosis AVSs use would not worsen breast cancer survival, while vitamin C use after diagnosis might benefit OS. The discrepancy of survivals associated with post-diagnosis AVS use between earlier and later studies may cast doubt on the recommendation on guidelines. RCTs with large sample sizes are needed.

Consumption of Food Supplements during the Three COVID-19 Waves in Poland-Focus on Zinc and Vitamin D.

Food supplements (FS) are a concentrated source of vitamins, minerals, or other ingredients with nutritional or other physiological effects. Due to their easy availability, widespread advertising, and sometimes low price, increased consumption of this group of preparations has been observed. Therefore, the aim of the study was to assess the knowledge and intake of FS during the COVID-19 pandemic in Poland, with particular reference to FS containing zinc and vitamin D. It was noted that both of the above ingredients were used significantly more often by people with higher education (59.0%), with a medical background or related working in the medical field (54.5%), and/or exercising at home (60.1%). Preparations containing vitamin D were used by 22.8% of the respondents in the first wave, 37.6% in the second wave, and 32.9% in the third wave. To sum up, we showed the highest consumption of vitamin and mineral supplements, and preparations containing zinc and vitamin D were taken significantly more often by people with higher medical and related education. This indicates a high awareness of health aspects and the need for preventive measures in these groups.

[Results of a survey aimed at dietitians-nutritionists on the management of clinical nutrition teams during the COVID-19 pandemic in hospitals in Catalonia]. / Resultados de una encuesta dirigida a dietistas-nutricionistas sobre la gestión de los equipos de nutrición clínica durante la pandemia de COVID-19 en centros hospitalarios de Cataluña.

INTRODUCTION: Introduction: the COVID-19 pandemic has had direct implications for clinical nutrition teams (NT), both at an organizational and healthcare level. Since March 2020, expert recommendations on nutritional intervention for patients with COVID-19 have been available. Objectives: to describe the nutritional intervention that has been carried out in patients with COVID-19, to estimate the presence of clinical dietitians-nutritionists (DN) in hospitals in Catalonia, and to know the organization of NTs. Methods: a cross-sectional study through an online survey directed to clinical DNs at hospitals in Catalonia (March 2021) was made. Results: the surveys of 36 NTs, made up of 104 DNs, have been analysed. A total of 44.44 % of NTs had to interrupt or reduce some of their usual activities during the pandemic. When nutritional screening was used, it was carried out early (24-48 h) in 56.25 % of cases, and the most common tool was the NRS-2002 (66.67 %). In 41.67 % of NTs a specific hospital diet was established, this being generally hyperproteic (89.66 %). Oral nutritional supplementation was systematically prescribed by 41.67 % of NTs, prioritizing hyperproteic (97.14 %) and hypercaloric (74.29 %) formulas. It is estimated that clinical DNs are present in approximately 61.54 % of public acute hospitals in Catalonia. Conclusions: the results reflect the adaptive capacity of NTs, reorganizing and redistributing their usual tasks and establishing infrequent measures to ensure nutritional support.

INTRODUCCIÓN: Introducción: la pandemia por COVID-19 ha tenido implicaciones directas en los equipos de nutrición (EN) clínica a nivel tanto organizativo como asistencial. Desde marzo de 2020 se dispone de recomendaciones de expertos sobre la intervención nutricional en pacientes con COVID-19. Objetivos: describir la intervención nutricional que se ha llevado a cabo en los pacientes con COVID-19, estimar la presencia de dietistas-nutricionistas (DN) clínicos en los hospitales de Cataluña y conocer la organización de los EN. Métodos: estudio transversal realizado a través de una encuesta online dirigida a los DN clínicos de los hospitales de Cataluña (marzo 2021). Resultados: se han analizado las encuestas de 36 EN, formados por 104 DN. El 44,44 % de los EN han tenido que dejar de hacer o reducir alguna de sus actividades habituales durante la pandemia. Cuando se ha empleado el cribado nutricional, este se ha realizado de forma precoz (24-48 h) en el 56,25 % de los casos y la herramienta más común ha sido el NRS-2002 (66,67 %). El 41,67 % de los EN han instaurado una dieta hospitalaria específica, siendo esta generalmente hiperproteica (89,66 %). El 41,67 % de los EN han pautado la suplementación nutricional oral de forma sistemática, priorizando las fórmulas hiperproteicas (97,14 %) e hipercalóricas (74,29 %). Se estima que la figura del DN clínico está presente en aproximadamente el 61,54 % de los hospitales de agudos públicos de Cataluña. Conclusiones: los resultados reflejan la capacidad de adaptación de los EN, reorganizando y redistribuyendo sus tareas habituales e instaurando medidas poco habituales para asegurar el soporte nutricional.

Efectos de la ingesta de lácteos enriquecidos de forma natural con selenio y omega-3 en una muestra de mujeres posmenopáusicas con síndrome metabólico: un ensayo clínico aleatorizado, triple ciego y controlado con placebo / Effects of the intake of dairy products naturally enriched with selenium and omega-3 polyunsaturated fatty acids in a sample of postmenopausal women with metabolic syndrome: a randomized, triple-blind, placebo-controlled clinical trial

Introducción: el síndrome metabólico de las mujeres posmenopáusicas puede mejorar con una alimentación saludable. Objetivos: evaluar si una intervención alimentaria con productos lácteos enriquecidos en selenio y ácidos grasos poliinsaturados omega-3 aumenta los niveles de selenio y mejora los factores de riesgo cardiovascular en las mujeres posmenopáusicas con síndrome metabólico. Material y métodos: ensayo clínico aleatorizado, triple ciego y controlado, realizado en atención primaria. Captación: abril 2018, 46 mujeres posmenopáusicas con síndrome metabólico consumidoras habituales de lácteos. Aleatorización: 23 en el grupo de control y 23 en el grupo experimental. Intervención: consumo durante 3 meses de lácteos enriquecidos naturalmente con selenio y ácidos grasos poliinsaturados omega-3 (leche, yogur y queso fresco). Controles: consumo de lácteos convencionales. Variable principal: selenio en plasma; secundarias: criterios del síndrome metabólico. Número de registro 2018/256, Comité de Ética Galicia. Resultados: finalizaron 23 mujeres en el grupo de control y 21 en el grupo de intervención. Aumentó el selenio en el grupo de intervención (7,2 µg/L, IC del 95 %: 3,7/10,8) frente al grupo de control (-4,5 µg/L, IC del 95 %: -8/-1) (p < 0,001) y disminuyó el colesterol unido a lipoproteínas de muy baja densidad (-2,3 mg/dl, IC del 95 %: -5,6/1) respecto al grupo de control (1,9 mg/dl, IC del 95 %: -0,7/4,5) (p = 0,043). Las mujeres del grupo experimental mejoraron respecto a su medición basal en perímetro de cintura (p = 0,010), índice de masa corporal (p = 0,047) y colesterol unido a lipoproteínas de alta densidad (p < 0,001). Conclusiones: una intervención con lácteos enriquecidos naturalmente con selenio y omega-3 en mujeres posmenopáusicas con síndrome metabólico puede mejorar los niveles de selenio en plasma y de colesterol unido a lipoproteínas de muy baja densidad. (AU)

Introduction: metabolic syndrome in postmenopausal women can improve with a healthy diet. Objectives: to evaluate whether a dietary intervention with dairy products naturally enriched with selenium and omega-3 polyunsaturated fatty acids increases selenium plasma levels and improves cardiovascular risk factors in postmenopausal women with metabolic syndrome. Material and methods: a randomized, triple-blind, controlled clinical trial carried out in GP surgeries. Recruitment: April 2018, 46 postmenopausal women with metabolic syndrome who were frequent dairy consumers. Randomization: 23 in control group and 23 in experimental group. Intervention: consumption of dairy products naturally enriched with selenium and omega-3 polyunsaturated fatty acids (milk, yogurt, fresh cheese) for three months. Controls took conventional dairy. Primary endpoint: plasma selenium levels; secondary endpoints: metabolic syndrome criteria. Registration number 2018/256, Galicia Ethics Committee. Results: in all, 23 women in the control group and 21 in the intervention group completed the trial. Selenium increased in the intervention group (7.2 µg/L, 95 % CI, 3.7/10.8) compared to the control group (-4.5 µg/L, 95 % CI, -8/-1) (p < 0.001) and very low-density lipoprotein cholesterol decreased (-2.3 mg/dL, 95 % CI, -5.6/1) compared to the control group (1.9 mg/dL, 95 % CI, -0.7/4.5) (p = 0.043). Waist circumference (p = 0.010), body mass index (p = 0.047) and high-density lipoprotein cholesterol (p < 0.001) in the experimental group improved in comparison to baseline measurements. Conclusions: an intervention with dairy products naturally enriched with selenium and omega-3 in a sample of postmenopausal women with metabolic syndrome can improve plasma selenium levels and very low-density lipoprotein cholesterol. (AU)

Influencia de los carotenoides sobre los marcadores de riesgo cardiometabólico en mujeres peri y posmenopáusicas / Influence of dietary carotenoids on biomarkers of cardiometabolic risk in peri- and post-menopausal women

Introducción: durante la menopausia hay una mayor tendencia a la obesidad y el depósito de grasa visceral, aumentando el riesgo cardiometabólico. Objetivos: evaluar mediante un estudio de intervención el efecto del consumo de carotenoides sobre los biomarcadores relacionados con el riesgo cardiometabólico en mujeres peri y posmenopáusicas. Métodos: se seleccionaron 12 mujeres peri y posmenopáusicas, sin antecedentes de enfermedad cardiovascular pero con algún factor de riesgo cardiometabólico. Durante 4 semanas se suplementó su dieta con zumo de naranja-zanahoria, zumo de tomate y espinacas cocidas, proporcionando una ingesta de 415 mg de carotenoides totales a la semana (carotenos, criptoxantina, licopeno y luteína + zeaxantina). En el momento inicial (TI) y en el final (TF) se midieron los parámetros antropométricos y se analizaron los parámetros bioquímicos, los carotenoides plasmáticos y los biomarcadores de estrés oxidativo, de inflamación y de función endotelial. Resultados: en el TF se observaron cambios significativos, disminuyendo el colesterol unido a LDL y el índice aterogénico, y aumentando el colesterol-HDL. Los carotenoides plasmáticos se incrementaron significativamente (p < 0,05) de 0,56 µg/ml en el TI hasta 1,22 µg/ml en el TF. Paralelamente se observaron cambios significativos (p < 0,05) en los biomarcadores de estrés oxidativo e inflamación, disminuyendo la proteína C-reactiva y el malonaldehído, y aumentando la adiponectina. Por el contrario, los biomarcadores de daño endotelial (sVCAM y sICAM) y la capacidad antioxidante (ORAC) no mostraron cambios tras la intervención. Conclusiones: el consumo de carotenoides aumenta los niveles plasmáticos de carotenoides y disminuye la dislipemia aterogénica, y mejora los biomarcadores de inflamación y el estrés oxidativo, lo que está relacionado con una disminución del riesgo cardiometabólico. (AU)

Background: peri- and post-menopausal women exhibit a high tendency towards obesity and visceral fat deposition, which increases cardiometabolic risk. Objective: to evaluate through a prospective nutritional study the effect of carotenoid consumption on cardiometabolic risk biomarkers in peri- and post-menopausal women. Material and methods: twelve peri- and post-menopausal women without previous symptoms of cardiovascular disease, but with some cardiometabolic risk factor, were recruited. Their diet was supplemented during 4 weeks with orange-carrot juice, tomato juice, and boiled spinach, providing 415 mg of total carotenoids/week (carotenes, cryptoxanthin, lycopene, and lutein + zeaxanthin). At the beginning (TI) and at the end (TF) of the intervention period blood samples were drawn to measure biochemical parameters, oxidative stress, inflammation and endothelial function biomarkers, and plasma carotenoid levels. Results: at TF a significant decrease (p < 0.05) in LDL-cholesterol and atherogenic index, and an increase in HDL-cholesterol were observed. Plasma carotenoids increased significantly (p < 0.05) from 0.56 µg/mL at TI to 1.22 µg/mL at TF. Concurrently, a shift in oxidative stress and inflammation biomarkers was detected, with a decrease in plasma C-reactive protein and malonaldehyde levels, and an increase in adiponectin. However, endothelial dysfunction biomarkers (sVCAM and sICAM) and total antioxidant capacity remained unchanged. Conclusions: dietary supplementation with carotenoids leads to an increase in plasma carotenoids, a decrease in atherogenic dyslipidemia, and an improvement in oxidative stress and inflammation biomarkers, which indicates a reduction in cardiometabolic risk. (AU)

Cuantificación, adecuación de la ingesta y fuentes alimentarias de nutrientes relacionados con el ciclo metionina-metilación (colina, betaína, folatos, vitamina B6 y vitamina B12) en mujeres embarazadas en España / Quantification, dietary intake adequacy, and food sources of nutrients involved in the methionine-methylation cycle (choline, betaine, folate, vitamin B6 and vitamin B12) in pregnant women in Spain

Objetivo: cuantificar las ingestas dietéticas de los micronutrientes implicados en el ciclo metilación-metionina (colina, betaína, folatos, vitaminas B6 y B12) en una muestra representativa de mujeres gestantes residentes en España; determinar la adecuación a las recomendaciones, y analizar sus principales fuentes alimentarias. Material y métodos: la determinación de la ingesta media se realizó a partir de los datos de consumo de los alimentos recogidos en la “Encuesta Nacional de Alimentación en población adulta, mayores y embarazadas” (ENALIA-2) (n = 133). Para el cálculo del aporte de folatos y de vitaminas B6 y B12 se emplearon los datos de composición nutricional recogidos en las “Tablas de Composición de Alimentos en España”, mientras que para la colina y la betaína, nutrientes no incluidos en las bases de datos de composición de alimentos en Europa, se empleó la “Base de Datos Nacional de Nutrientes para Referencia Estándar del Departamento de Agricultura de los Estados Unidos” (USDA). La adecuación de la ingesta se estimó de acuerdo con las recomendaciones de las principales guías españolas, europeas y estadounidenses. (AU)

Objective: a quantification of dietary intakes of the micronutrients involved in the methylation-methionine cycle (choline, betaine, folate, vitamins B6 and B12) in a representative sample of pregnant women in Spain; assessment of intake adequacy to available official recommendations; and analysis of their main food sources. Material and methods: the median intake of each micronutrient was established using food consumption data reported in the National Dietary Survey of adults, the elderly, and pregnant women (ENALIA-2) (n = 133). For folate, vitamin B6 and vitamin B12 intake, nutritional composition data from the Spanish Food Composition Tables were used, whereas for choline and betaine, which are not included in European food composition databases, the National Nutrient Database for Standard Reference of the United States Department of Agriculture (USDA) was considered. Intake adequacy was estimated in accordance with the recommendations of the main Spanish, European, and US guidelines. (AU)

Functional Cupcake for Preventing Vitamin A Deficiency and Correlated Anemia and Oxidative Stress.

<b>Background and Objective:</b> Vitamin A Deficiency (VAD) is a critical public health problem that affects the health of kids worldwide and may induce anemia and oxidative stress. The current study aimed to pre-clinically assess the effect of a cupcake, prepared to be served for primary school children, on vitamin A deficiency and related anemia and oxidative stress in rats. <b>Materials and Methods:</b> Flour of flash orange sweet potatoes, as a rich source of pro-vitamin A, was used to prepare the cupcake. The chemical composition, amino acids and sensory evaluation of the cupcake were done. The biological evaluation was carried out using 18 weaning rats in three groups (control group, vitamin A-deficient group and vitamin A-deficient group fed on a diet fortified with 20% of the prepared cupcake for two months). <b>Results:</b> The results indicated the high value of vitamin A in the prepared cupcake. Excellent sensory characteristics were noticed. Feeding on the VDA diet fortified with the prepared cupcake suppressed the reduction in Retinol-Binding Protein (RBP), hemoglobin and iron. Total Iron Binding Capacity (TIBC) increased in the VAD group. Also, feeding on the prepared cupcake suppressed the reduction in Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPx) and the elevation of Malondialdehyde (MDA). <b>Conclusion:</b> It can be suggested that the prepared cupcake is promising in preventing of vitamin A deficiency and related anemia and oxidative stress. Thus, the prepared cupcake may be efficient for children to prevent vitamin A deficiency.

Dietary Supplement Use among Primary Health Care Attendants in Abha City, Southwestern Saudi Arabia.

Dietary supplements are commercially available manufactured products used as an addition to the normal diet and involve vitamins, minerals, herbs (botanicals), amino acids, and various other products. With the use of a cross-sectional survey, the present paper intended to analyze dietary supplement usage and its health and sociodemographic determinants among attendants of primary health care centers in Abha City, southwestern Saudi Arabia. The sample was selected randomly using the two-stage cluster sampling technique. The study included 438 participants (115 males and 323 females). Their ages ranged from 18 to 59 years, with an average of 36.2 ± 11.7 years. The study showed that 330 people used dietary supplementation, giving a prevalence of 75.3% (95% CI: 71.1-79.2%). The most commonly used supplements were multivitamins (215, 65.2%), specific vitamins (60, 18.2%), and mineral pills (38, 11.5%). Advice from health care workers was the most frequent reason for using dietary supplements (49.4%). The majority (71.2%) reported feeling a better quality of life after using dietary supplements. The most frequent disadvantages of using dietary supplements were constipation and headache (30%) and the most frequent advantage was increasing appetite (59.8%). The people who most frequently recommended the use of supplements were health care workers (190, 57.6%), followed by friends or family members (62, 18.8%), and people on social media (43, 13%). Females had a significantly higher probability of using dietary supplements than males did (Cor = 2.0, 95% CI = 1.21-3.27), and those with a chronic disease had a considerably higher likelihood of using dietary supplements (cOR = 3.48, 95% CI = 2.04-6.06). Age, educational level, and marital status were not significantly related with dietary supplement usage. In conclusion, health care workers should focus on females and persons with chronic diseases in their practice. They should provide them with evidence-based advice regarding the use of dietary supplements. Continued medical education training programs tailored to the needs of health care staff addressing this issue should be provided. New guidelines should be developed to help health professionals to provide their patients with comprehensive care at the primary health care level.

Factors Influencing the Compliance of Pregnant Women with Iron and Folic Acid Supplementation in the Philippines: 2017 Philippine Demographic and Health Survey Analysis.

Anemia in pregnancy, which is a public health concern for most developing countries, is predominantly caused by iron deficiency. At least, 180 days of iron and folic acid (IFA) supplementation is recommended for pregnant women to mitigate anemia and its adverse effects. This study aimed to examine compliance with the recommendation of IFA supplementation and its underlying factors using the 2017 Philippine National Demographic and Health Survey data. The variables assessed included age, highest level of education, occupation, wealth index, ethnicity, religion, residence, number of pregnancies, time of first antenatal care (ANC) visit and number of ANC visits. Compliance with the recommendation of at least 180 days of IFA supplementation was the outcome variable. The study assessed 7983 women aged 15-49 years with a history of pregnancy. Of these participants, 25.8% complied with the IFA supplementation recommendation. Multiple logistic regression analysis showed that pregnant women of Islamic faith and non-Indigenous Muslim ethnicity were less likely to comply with the IFA supplementation recommendation. Being aged between 25 and 34 years, having better education and higher wealth status, rural residency, initiating ANC visits during the first trimester of pregnancy and having at least four ANC visits positively influenced compliance with IFA supplementation. The effect of residence on IFA adherence differed across the wealth classes. Strategies targeted at specific groups, such as religious minorities, poor urban residents, the less educated and young women, should be strengthened to encourage early and regular antenatal care visits for improving compliance.

Impact of vitamin C supplementation on placental DNA methylation changes related to maternal smoking: association with gene expression and respiratory outcomes.

BACKGROUND: Maternal smoking during pregnancy (MSDP) affects development of multiple organ systems including the placenta, lung, brain, and vasculature. In particular, children exposed to MSDP show lifelong deficits in pulmonary function and increased risk of asthma and wheeze. Our laboratory has previously shown that vitamin C supplementation during pregnancy prevents some of the adverse effects of MSDP on offspring respiratory outcomes. Epigenetic modifications, including DNA methylation (DNAm), are a likely link between in utero exposures and adverse health outcomes, and MSDP has previously been associated with DNAm changes in blood, placenta, and buccal epithelium. Analysis of placental DNAm may reveal critical targets of MSDP and vitamin C relevant to respiratory health outcomes. RESULTS: DNAm was measured in placentas obtained from 72 smokers enrolled in the VCSIP RCT: NCT03203603 (37 supplemented with vitamin C, 35 with placebo) and 24 never-smokers for reference. Methylation at one CpG, cg20790161, reached Bonferroni significance and was hypomethylated in vitamin C supplemented smokers versus placebo. Analysis of spatially related CpGs identified 93 candidate differentially methylated regions (DMRs) between treatment groups, including loci known to be associated with lung function, oxidative stress, fetal development and growth, and angiogenesis. Overlap of nominally significant differentially methylated CpGs (DMCs) in never-smokers versus placebo with nominally significant DMCs in vitamin C versus placebo identified 9059 candidate "restored CpGs" for association with placental transcript expression and respiratory outcomes. Methylation at 274 restored candidate CpG sites was associated with expression of 259 genes (FDR < 0.05). We further identified candidate CpGs associated with infant lung function (34 CpGs) and composite wheeze (1 CpG) at 12 months of age (FDR < 0.05). Increased methylation in the DIP2C, APOH/PRKCA, and additional candidate gene regions was associated with improved lung function and decreased wheeze in offspring of vitamin C-treated smokers. CONCLUSIONS: Vitamin C supplementation to pregnant smokers ameliorates changes associated with maternal smoking in placental DNA methylation and gene expression in pathways potentially linked to improved placental function and offspring respiratory health. Further work is necessary to validate candidate loci and elucidate the causal pathway between placental methylation changes and outcomes of offspring exposed to MSDP. Clinical trial registration ClinicalTrials.gov, NCT01723696. Registered November 6, 2012. https://clinicaltrials.gov/ct2/show/record/NCT01723696 .

Prevalence, factors associated with use, and adverse effects of sport-related nutritional supplements (sport drinks, sport bars, sport gels): the US military dietary supplement use study.

BACKGROUND: Sport-related nutritional supplements (SRNSs) include sport drinks, sport bars, and sport gels. Previous studies indicate that 25-35 % of athletes and 25-50 % of military personnel report using these supplements. This study examined prevalence, factors associated with use, and adverse effects (AEs) of SRNSs among United States military service members (SMs). METHODS: A stratified random sample of 200,000 SMs was obtained from military workforce records, and asked to complete a survey on demographics, SRNS use, and AEs experienced. About 18 % (n = 26,681) of contacted SMs (n = 146,365) completed the survey between December 2018 and August 2019. RESULTS: Overall, 45 % of SMs used ≥ 1 SRNS at least once per week in the past 6 months. Prevalence of use (± standard error) for sport drinks, bars, and gels were 32 ± 0.3, 27 ± 0.3, and 3 ± 0.1 %, respectively. Use of 1, 2, or 3 SRNSs was 28.9 ± 0.5, 13.6 ± 0.6, and 2.2 ± 0.6 %, respectively. Multivariable logistic regression indicated greater use of any SRNS was independently associated with male gender, younger age, single marital status, more weekly aerobic or resistance training, tobacco use, higher alcohol intake, officer status, combat arms occupations, and service in the Marine Corps or Navy (compared to the Air Force). Overall, the proportion of users reporting ≥ 1 AE was 2.0 ± 0.1 %, with 1.3 ± 0.1 % for sport drinks, 1.6 ± 0.2 % for sport bars, and 2.8 ± 0.6 % for sport gels. CONCLUSIONS: This large study of a stratified random sample of SMs found that nearly half of SMs consumed SRNSs weekly, and self-reported AEs were comparatively low. The AE incidence for SRNSs was much lower than typically found for dietary supplements, possibly because of more rigorous regulatory oversight for SRNSs.

Supplement Intake in Recreational Vegan, Vegetarian, and Omnivorous Endurance Runners-Results from the NURMI Study (Step 2).

Nutrient deficiency is a common cause of underperformance in endurance athletes, and supplement intake is frequently considered compensatory for vegan and vegetarian athletes specifically. This study aimed to investigate the patterns of supplement intake among vegan, vegetarian, and omnivorous distance (>10 km) runners and its association with age, sex, and race distance. From a total of 317 runners who participated in an online survey, 220 distance runners (mean age: 38.5 years; mean BMI: 21.75 kg/m2) were selected for the final sample after data clearance and assigned to 100 omnivores, 40 vegetarians, or 80 vegans. Sociodemographic information, racing experience, and patterns of supplement intake, including type, frequency, dosage, etc., were collected using a questionnaire. Macronutrient intake was assessed using a food frequency questionnaire. ANOVA and logistic regression were used for data analysis. The prevalence of supplement intake was 51% for total runners and 72% among vegan runners. Age, sex, and race distance had no significant effect on the type of supplement intake (p > 0.05). Compared to omnivores and vegetarians, vegan runners reported consuming more vitamin (but not carbohydrate/protein or mineral) supplements (p < 0.05). Vitamin B12, magnesium, and multivitamin had the most prevalent use amongst micronutrient supplements. This study points to a central role for supplementary nutritional strategies in different groups of distance runners. The present findings may help future investigations by design to identify specific requirements of endurance runners when adhering to specific kinds of diet particularly plant-based diets.

Community-Based Survey Exploring Use of the Dietary Supplement Creatine by Adult Non-Athletes.

Creatine is classified as a "sports supplement", but it also has health benefits. The purpose of this study was to assess use of creatine as a dietary supplement in adult non-athletes. Three hundred ninety-nine adults (19-89 years) completed an online survey. Among the respondents, 77% (n = 307) were regularly active, including participation in weightlifting (34%), running (34%), and cycling (21%). Twenty-eight percent (n = 111) reported use of creatine with an average dose of 6.4 ± 4.5 g. Daily creatine use was reported by 45%, and 38% reported using creatine 2-6 times weekly. Primary sources of information about creatine were trainers/coaches (29%), friends/family (32%), and internet (28%). Forty percent (n = 44) of creatine users were female. When compared by age, 46% of young, 32% of midlife, and 6% of old respondents reported creatine use with no differences in dose or frequency. Young and midlife respondents reported primarily trainers/coaches, friends/family, and internet as sources of information about creatine, but old respondents limited their sources to friends/family and fitness magazines. Although creatine is widely used by adult non-athletes who regularly exercise, dietitians and other healthcare providers are not the primary source of information. Fitness trainers can appropriately provide guidance and education regarding safe and effective use of creatine.