Dietary Supplement Ingredient Database (DSID) and the Application of Analytically Based Estimates of Ingredient Amount to Intake Calculations.

OBJECTIVE: We describe the purpose of the Dietary Supplement Ingredient Database (DSID), the statistical methodology underlying online calculators of analytically verified supplement content estimates, and the application and significance of DSID label adjustments in nutritional epidemiology. BACKGROUND AND HISTORY: During dietary supplement (DS) manufacturing, many ingredients are added at higher than declared label amounts, but overages are not standardized among manufacturers. As a result, researchers may underestimate nutrient intakes from DSs. The DSID provides statistical tools on the basis of the results of chemical analysis to convert label claims into analytically predicted ingredient amounts. These adjustments to labels are linked to DS products reported in NHANES. RATIONALE: Tables summarizing the numbers of NHANES DS products with ingredient overages and below label content show the importance of DSID adjustments to labels for accurate intake calculations. RECENT DEVELOPMENTS: We show the differences between analytically based estimates and labeled content for vitamin D, calcium, iodine, caffeine, and omega-3 (n-3) fatty acids and their potential impact on the accuracy of intake assessments in large surveys. Analytical overages >20% of label levels are predicted for several nutrients in 50-99% of multivitamin-mineral products (MVMs) reported in NHANES: for iodine and selenium in adult MVMs, for iodine and vitamins D and E in children's MVMs, and for iodine, chromium, and potassium in nonprescription prenatal MVMs. Predicted overages of 10-20% for calcium can be applied to most MVMs and overages >10% for folic acid in the vast majority of adult and children's MVMs. FUTURE DIRECTIONS: DSID studies are currently evaluating ingredient levels in prescription prenatal MVMs and levels of constituents in botanical DSs. CONCLUSIONS: We estimate that the majority of MVM products reported in NHANES have significant overages for several ingredients. It is important to account for nonlabeled additional nutrient exposure from DSs to better evaluate nutritional status in the United States.

Opportunities to significantly reduce expenditure associated with cancer drugs.

AIM: To identify cancer drugs amenable to strategies for reducing expenditure and avoiding drug wastage. METHODS: Information was sourced from product information in 20 countries on parenteral cytotoxic agents, and cancer and noncancer monoclonal antibodies. Data were collected on vial sizes, overage, stability and presentation forms. RESULTS: Vial size availability varied significantly between countries, with often only single vial sizes for numerous medications. Overage was poorly reported. Stability data were inconsistent and variable between countries, with most drugs only having a 24 h expiry. Three cancer-indicated monoclonal antibodies, thought suitable for prefilled syringe administration, were only available as vials. CONCLUSION: Many expensive cancer drugs are suitable for global cost-reduction strategies. Collaboration is vital to affecting change and reducing expenditure.

Failing to progress or progressing to fail? Age-for-grade heterogeneity and grade repetition in primary schools in Karonga district, northern Malawi.

Timely progression through school is an important measure for school performance, completion and the onset of other life transitions for adolescents. This study examines the risk factors for grade repetition and establishes the extent to which age-for-grade heterogeneity contributes to subsequent grade repetition at early and later stages of school. Using data from a demographic surveillance site in Karonga district, northern Malawi, a cohort of 8174 respondents (ages 5-24 years) in primary school was followed in 2010 and subsequent grade repetition observed in 2011. Grade repetition was more common among those at early (grades 1-3) and later (grades 7-8) stages of school, with little variation by sex. Being under-age or over-age in school has different implications on schooling outcomes, depending on the stage of schooling. After adjusting for other risk factors, boys and girls who were under-age at early stages were at least twice as likely to repeat a grade as those at the official age-for-grade (girls: adjusted OR 2.06 p < 0.01; boys: adjusted OR 2.37 p < 0.01); while those over-age at early stages were about 30% less likely to repeat (girls: adjusted OR 0.65 p < 0.01; boys: adjusted OR 0.72 p < 0.01). Being under/over-age at later grades (4-8) was not associated with subsequent repetition but being over-age was associated with dropout. Other risk factors identified that were associated with repetition included both family-level factors (living away from their mother, having young children in the household, lower paternal education) and school-level factors (higher student-teacher ratio, proportion of female teachers and schools without access to water). Reducing direct and indirect costs of schooling for households; and improving school quality and resources at early stages of school may enable timely progression at early stages for greater retention at later stages.

Overage labor, value perceptions, and happiness in urban older adults' lives: Empirical evidence from China.

Background: Over the past four decades, China has seen a rapid increase in the level of urbanization, along with an increasing number of older adults. How to promote active aging in the midst of rapid urbanization has become a new challenge for the Chinese government and all sectors of society. This study attempts to verify the relationship between overage labor and happiness in life, and further explore the possible mediating role of multidimensional value perceptions. Method: Based on 5010 valid samples from the 2011, 2013, 2015, and 2018 China Health and Aging Tracking Survey datasets (CHARLS), the study explored and tested the differences in happiness in life between older adults with overage labor and retired older adults. In addition, this study further examined the mediating role of multidimensional value perceptions using a mediation model. Results: (1) Urban older adults with overage labor had significantly higher levels of happiness in life compared to urban retired older adults. (2) The higher level of life happiness of urban older adults with overage labor depends on their perceptions of different values; (3) Specifically, the realization of value perceptions in personal, family and social dimensions through labor contributes to the life happiness of urban older adults with overage labor. Conclusion: There is a significant difference between urban old adults with overage labor and urban retired old adults in terms of happiness in life. At the same time, the study confirmed that all three aspects of value perceptions, such as personal, family and social, are the mediating mechanisms between overage labor and urban old adults in terms of happiness in life.

Overage labor, intergenerational financial support, and depression among older rural residents: evidence from China.

Background: Depression is a major factor affecting the happiness of older rural residents. With the increasing aging of the Chinese population, overage labor is becoming more prevalent in rural areas of China. This study aimed to assess whether, and if so, how, overage labor affects depression status in older rural residents. Methods: Using data from the China Health and Retirement Longitudinal Study, this study explored the association between overage labor and depression among older rural residents by using ordinary least squares and moderated mediation models. Results: The results show that overage labor significantly reduced levels of depression in older rural residents. This result remained robust after using propensity score matching and double machine learning. Furthermore, the improvement of older rural residents' depression via overage labor is mainly achieved through work income, but this mediating effect is negatively moderated by intergenerational financial support. This implies that in traditional Chinese rural society, intergenerational financial support from children plays an important role in reducing depression among older rural residents. Conclusion: Our findings have potential policy implications for China and other developing countries in terms of addressing issues related to aging and depression in older adults.

Exposures and Health Risks Associated with Elements in Diets from a Gold Mining Area.

There has been a concern of metal contamination from the mining areas which could expose the population to toxic metal through consumption of food products in the regions. Therefore, the study was conducted to analyze 18 elements using X-ray fluorescence analyzer and to assess for metal exposure through dietary intakes. Dietary recall survey instrument was used to collect consumption, demographic, and anthropometric data from 308 consumers in life-stage groups: toddlers, adolescents, and adults. Cassava, maize, rice, tomato, and yam indigenous diet samples (66) from the gold mining regions of Ghana were obtained by purposively sampling from street vendors. Principal component analysis was used to apportion pollution source. Health risks due to dietary elements were quantified using US EPA probabilistic protocols for cancer and non-cancer disease endpoints. Deficiency and overage risks of essential elements were tested against reference nutrient intakes. The element-diet-location mode of principal component analysis separated cassava and maize diets as significant vehicles for both essential and toxic elements apportioned to mining pollution source. The chronic daily intake trend revealed a preponderance for arsenic (maize: toddlers 0.009, adolescents 0.025 adults 0.010 mg/kg-d) and lead (maize: toddlers 0.009, adolescents 0.026, adults 0.010 mg/kg-d) exposure through maize diets compared to cassava diets. The hazard quotient showed (HQ > 1) life-stage risk differentiation for barium, although there were cumulative and pervasive health risks for all age groups based on the hazard index (Ag, Ba, Cd, Co, Hg, Mn, Mo, Sb, Sn, Sr, U, V, W, and Zr). The likely cancer risk (mode) for all life-stage groups (3 × 10-6-1 × 10-2) were also high in that they exceeded the 1 × 10-6 safety threshold. The modal margin of exposure (MoE < 1) alerted high public health concern due to lead-induced toxicities among all life-stage groups through all diet vehicles. Regarding nutritional adequacy, there were possible overage risks associated with selenium, including deficiency risks for calcium, potassium, and zinc for all life-stage groups. Toddlers and adolescents were susceptible to iron deficiency risks through cassava diets and iron overage risks through maize diets.

Storage conditions and packaging greatly affects the stability of fortified wheat flour: Influence on vitamin A, iron, zinc, and oxidation.

Micronutrient deficiencies result in irreversible physical and cognitive consequences. Fortification of flour is widely applied to address micronutrient deficiencies, but vitamin losses can occur during the storage of fortified products. This work aimed at assessing the combined influence of different factors on vitamin A retention and the oxidative status of wheat flours: storage duration (up to 6months), temperature during storage, relative humidity within storage facilities, type of packaging (oxygen-permeable or not), and premix composition (with or without ferrous sulphate). Vitamin A degradation was high and occurred rapidly: more than 45% was lost within 3months in the mildest conditions, whereas over 85% was lost within 3months in the most severe conditions. Vitamin A retention was related to the extent of oxidation reactions that occurred in flours during storage, and the factors that mostly affected vitamin A retention were the storage duration, the type of packaging and the temperature.

Analytical ingredient content and variability of adult multivitamin/mineral products: national estimates for the Dietary Supplement Ingredient Database.

BACKGROUND: Multivitamin/mineral products (MVMs) are the dietary supplements most commonly used by US adults. During manufacturing, some ingredients are added in amounts exceeding the label claims to compensate for expected losses during the shelf life. Establishing the health benefits and harms of MVMs requires accurate estimates of nutrient intake from MVMs based on measures of actual rather than labeled ingredient amounts. OBJECTIVES: Our goals were to determine relations between analytically measured and labeled ingredient content and to compare adult MVM composition with Recommended Dietary Allowances (RDAs) and Tolerable Upper Intake Levels. DESIGN: Adult MVMs were purchased while following a national sampling plan and chemically analyzed for vitamin and mineral content with certified reference materials in qualified laboratories. For each ingredient, predicted mean percentage differences between analytically obtained and labeled amounts were calculated with the use of regression equations. RESULTS: For 12 of 18 nutrients, most products had labeled amounts at or above RDAs. The mean measured content of all ingredients (except thiamin) exceeded labeled amounts (overages). Predicted mean percentage differences exceeded labeled amounts by 1.5-13% for copper, manganese, magnesium, niacin, phosphorus, potassium, folic acid, riboflavin, and vitamins B-12, C, and E, and by ∼25% for selenium and iodine, regardless of labeled amount. In contrast, thiamin, vitamin B-6, calcium, iron, and zinc had linear or quadratic relations between the labeled and percentage differences, with ranges from -6.5% to 8.6%, -3.5% to 21%, 7.1% to 29.3%, -0.5% to 16.4%, and -1.9% to 8.1%, respectively. Analytically adjusted ingredient amounts are linked to adult MVMs reported in the NHANES 2003-2008 via the Dietary Supplement Ingredient Database (http://dsid.usda.nih.gov) to facilitate more accurate intake quantification. CONCLUSIONS: Vitamin and mineral overages were measured in adult MVMs, most of which already meet RDAs. Therefore, nutrient overexposures from supplements combined with typical food intake may have unintended health consequences, although this would require further examination.

Influence of light exposure and oxidative status on the stability of vitamins A and D3 during the storage of fortified soybean oil.

Food fortification is implemented to address vitamins A and D deficiencies in numerous countries. The stability of vitamins A and D3 was assessed during a two-month period reproducing the usual oil storage conditions before sale to consumers. Soybean oils with different oxidative status and vitamin E contents were stored in the dark, semi-dark, or exposed to natural light. Lipid peroxidation took place after 3 weeks of storage in dark conditions. After 2 months, the vitamin A and D3 losses reached 60-68% and 61-68%, respectively, for oils exposed to natural light, and 32-39% and 24-44% in semi-dark conditions. The determining factors of vitamin A and D3 losses were (in decreasing order) the storage time, the exposure to light and the oxidative status of the oil, whereas vitamin E content had a protective role. Improving these parameters is thus essential to make vitamins A and D fortification in oils more efficient.