Supplementation In People Research Articles

QOL-30. DIETARY CONSIDERATIONS FOR PEOPLE WITH NF1: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract BACKGROUND Neurofibromatosis type 1 (NF1) is a neurocutaneous genetic condition. Limited pre-clinical and clinical data suggests that certain metabolic disturbances, body composition differences and nutritional deficiencies may be more prevalent in people with NF1. Data on the role of dietary patterns in people with NF1 and their effects in NF1-related manifestations is scarce. METHODS A systematic literature review was conducted; the MeSH database of PubMed was utilized to identify controlled vocabulary and key words associated with NF1, diet, and nutrition. These terms were combined using boolean operators to query PubMed, Embase, PLOS One, and Cochrane. The inclusion criteria consisted of articles in English, full text available, human studies, published between 2000-2024. The results were screened and key details were extracted. RESULTS 394 published articles were identified, out of which 15 met the inclusion criteria. 379 papers were excluded due to duplication or not meeting all inclusion criteria. Manuscripts included case reports, case series, retrospective and prospective studies, including a phase 2a clinical trial that only included six participants. Topics included vitamin D and bone metabolism, nutritional supplements, glucose metabolism, and nutritional intake. CONCLUSIONS Data regarding the effects of diet or nutritional supplements in people with NF1 is limited. Available studies suggest that a diet composed of therapeutic elements, including but not limited to, medium-chain fatty acids, calcium, and vitamin D, aids in bone growth and density, and muscle lipolysis. A single clinical trial suggests that L-carnitine supplementation is safe and feasible and might result in improved functional muscle performance in children with NF1. These conclusions might only be applicable to a small population of people with NF1 and did not result in conclusive significant clinical benefit. Further research is needed to better comprehend the role that nutrition plays in patients’ quality of life.

Anti-hyperlipidemic effects of 500 mg spilanthol (SA3X) supplementation in people with dyslipidemia- a randomized, parallel-group placebo-controlled trial.

Dyslipidemia is a critical risk factor for cardiovascular disease. This study investigated the impact of 500 mg of spilanthol (SA3X) supplementation on lipid profiles in men with dyslipidemia using a randomized, parallel-group, placebo-controlled design. A total of 279 male participants were randomly allocated to one of four groups: SA3X without exercise, placebo without exercise, SA3X with exercise, and placebo with exercise. After a one-month control period, participants received SA3X capsules or placebo for three months. The exercise groups undertook standardized weight-lifting exercises four times weekly. Lipid profiles, biochemical parameters, and anthropometric measurements were monitored throughout and after the intervention. Both SA3X groups exhibited significant reductions in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) compared to the placebo groups. By day 90, the SA3X-no-exercise group showed a 16.78 % decrease in TC, while the SA3X-plus-exercise group demonstrated a 52.87 % decrease compared to placebo. Significant reductions in TG and LDL-C were noted at days 60 and 90 (p=0.01 and p=0.03, respectively). The SA3X-plus-exercise group also exhibited decreased random blood sugar levels at days 60 and 90 compared to placebo-plus-exercise. Moreover, decreases in C-reactive protein, creatine kinase, and serum creatinine levels were observed. SA3X supplementation, particularly when combined with exercise, effectively improved lipid profiles and various health markers in men with dyslipidemia. Adverse events, primarily taste disturbance, were mild. These findings suggest SA3X may be a promising adjunctive therapy for managing dyslipidemia, emphasizing its potential cardiovascular health benefits and supporting further investigation. CTRI/2021/05/033694; May 2021.

Sex- and age-specific associations of serum essential elements with diabetes among the Chinese adults: a community-based cross-sectional study

BackgroundAlthough several studies have found the relationship between essential elements and diabetes, the studies about the association of essential elements with diabetes diagnosed according to an oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) in a sex- and age-specific manner were limited. To investigate the linear and nonlinear relationship of five essential elements including iron (Fe), copper (Cu), Zinc (Zn), magnesium (Mg), and calcium (Ca) with diabetes, fasting plasma glucose (FPG), 2-h postprandial plasma glucose (PPG), and HbA1c and to evaluate the sex- and age-specific heterogeneities in these relationships.MethodsA total of 8392 community-dwelling adults were recruited to complete a questionnaire and undergo checkups of anthropometric parameters and serum levels of five metals (Fe, Cu, Zn, Mg, and Ca). The multivariable logistic and linear regression, the restricted cubic spline (RCS) analysis, and subgroup analysis were applied to find the associations between the essential elements and the prevalence of diabetes as well as FPG, PPG, and HbA1c.ResultsIn the multivariable logistic regression and multivariable linear regression, serum Cu was positively associated with FPG, PPG, and HbA1c while serum Mg was significantly inversely correlated with FPG, PPG, HbA1c, and diabetes (all P < 0.001). In the RCS analysis, the non-linear relationship of Cu and diabetes (P < 0.001) was found. In the subgroup analysis, stronger positive associations of Cu with diabetes (P for interaction = 0.027) and PPG (P for interaction = 0.002) were found in younger women.ConclusionsThese findings may lead to more appropriate approaches to essential elements supplementation in people with diabetes of different ages and sexes. However, more prospective cohort and experimental studies are needed to probe the possible mechanism of sex- and age-specific associations between serum essential elements and diabetes.

VITAMIN D AND ASTHMA MANAGEMENT. DOES LOW SERUM LEVELS OF VITAMIN D INFLUENCE ASTHMA CONTROL AND EXACERBATION? – SYSTEMATIC REVIEW

Asthma is a disease characterized by chronic inflammation of the respiratory tract. It is defined by the occurrence of symptoms such as wheezing, shortness of breath, chest tightness, and cough. Restriction of airflow is caused by the contraction of smooth muscles and swelling of the bronchial mucosa, formation of mucus plugs and remodeling of the bronchial wall. Vitamin D (cholecalciferol) is a steroid hormone that must be supplied to the body. It may be provided with food (ergocalciferol) or synthesized in the skin by solar radiation. Vitamin D produced in the skin has no biological activity, it undergoes hydroxylation in the liver and kidneys to active form – 1,25-dihydroxycholecalciferol. Aims: The aim of this review is to assess the impact of vitamin D supplementation on asthma management and exacerbation occurrence and severity. Methods: We conducted this literature review by selecting articles, meta-analyses and reviews from recent clinical trials from Pubmed. Results: Studies have shown the strong immunomodulatory impact of vitamin D and that there are beneficial effects of vitamin D supplementation in individuals with asthma whose vitamin D levels are insufficient. Conclusions: Children and adults have provided significant evidence demonstrating the beneficial effects of vitamin D supplementation in people with asthma, whose vitamin D levels are insufficient. The role of vitamin D status in patients with asthma with adequate vitamin D levels is still a matter of debate. Medical doctors need to monitor the level of vitamin D in their patients and, if necessary, supplement its deficiencies.

A Randomized, Placebo-controlled Study to Assess the Efficacy and Safety of Herbal Extract and Micronutrient Blend Supplementation in People with Prediabetes

Background and Objective: Prediabetes is a precursor stage to type 2 diabetes mellitus (T2DM), characterized by elevated blood glucose levels. This study aimed to evaluate the efficacy and safety of herbal extract and micronutrient blend supplementation in managing prediabetes. Materials and Methods: This multicentric, randomized, placebo-controlled study involved 319 subjects with prediabetes (159 in the test group and 160 in the placebo group). Considering the dropouts, a total of 303 patients were analyzed. The test group received herbal extract and a micronutrient blend, while the placebo group received a placebo for 90 days along with lifestyle modifications. Anthropometric parameters, glycemic markers (glycated hemoglobin [HbA1c], fasting and postprandial plasma glucose, and homeostatic model assessment for insulin resistance [HOMA-IR]), lipid profile, perceived stress, and health-related quality of life (HRQoL) were assessed. Results: Compared to the placebo group, the test group exhibited significant improvements in anthropometric parameters (weight, body mass index, and body fat percentage), lipid profile, glycemic control (reduced HbA1c by 6.9%, fasting plasma glucose by 15.4%, postprandial plasma glucose by 8.9%, and HOMA-IR by 19.7%), perceived stress reduction, and enhanced HRQoL (P &lt; 0.001). The intervention was well-tolerated, with no clinically significant changes in lipid profiles, hematological parameters, or vital signs. Conclusion: Herbal extract and micronutrient blend supplementation effectively improved glycemic control, anthropometric parameters, and overall well-being in people with prediabetes, potentially reducing the risk of progression to T2DM.

The immune cell transcriptome is modulated by vitamin D3 supplementation in people with a first demyelinating event participating in a randomized placebo-controlled trial

Vitamin D deficiency is a risk factor for developing multiple sclerosis. The PrevANZ trial was conducted to determine if vitamin D3 supplementation can prevent recurrent disease activity in people with a first demyelinating event. As a sub-study of this trial, we investigated the effect of supplementation on peripheral immune cell gene expression. Participants were randomized to 1000, 5000 or 10,000 international units daily of vitamin D3 or placebo. Peripheral blood was collected at baseline and 12 weeks and sent for ribonucleic acid sequencing. Datasets from 55 participants were included. Gene expression was modulated by high dose supplementation. Antigen presentation and viral response pathways were upregulated. Oxidative phosphorylation and immune signaling pathways, including tumor necrosis factor-alpha and interleukin-17 signaling, were downregulated. Overall, vitamin D3 supplementation for 12 weeks modulated the peripheral immune cell transcriptome with induction of anti-inflammatory gene expression profiles. Our results support a dose-dependent effect of vitamin D3 supplementation on immune gene expression.

The relationship between magnesium deficiency and anxiety, the therapeutic effects of magnesium supplementation – literature review

Introduction and purpose: The main aim of our study is to summarise existing knowledge and draw conclusions about the impact of magnesium deficiency on the occurrence of anxiety. Methodology: The literature available in the National Library of Medicine database at https://pubmed.ncbi.nlm.nih.gov and Google Scholar was reviewed. Articles were searched by using keywords: magnesium, deficiency, supplementation, anxiety disorders. Forty-seven research papers and meta-analyses were analysed. Description of the state of knowledge: Magnesium is an extremely important mineral in the human body involved in many physiological processes. A deficiency of this element affects the whole body and can cause mental disorders - including anxiety disorders. There are many theories showing a link between magnesium and anxiety disorders in both humans and animals. Magnesium has been shown to influence the function of neurotransmitters affecting the experience of anxiety. Supplementation in people with hypomagnesaemia has been proven to improve their health and well-being. However, it should be noted that supplements on the market vary in the bioavailability of the mineral, and the frequency of intake and dosage also affect the bioavailability of magnesium. Conclusions: It is important to ensure adequate levels of magnesium in the diet, given its impact on the proper functioning of the human body (including the nervous system) and the fact that most people consume insufficient amounts of this macronutrient. Evidence of a link between magnesium levels and anxiety has led to increased interest in the potential efficacy of magnesium supplementation to alleviate anxiety symptoms.

Improving the quality of life through vitamin D supplementation in people with multiple sclerosis: Pathobiological, immunologically based, A narrative review of the literature

An inadequate vitamin D nutritional status is associated with autoimmune diseases, heart disease, deadly types of cancer, neurological disorders and undesirable consequences in pregnancy, amongother things. In a nationally representative sample of adults in Australia on vitamin D (VitD) congestion in the general population, 20% of participants were verified to be Vit D deficient and 43% to have insufficient VitD levels [1]. It is therefore to be welcomed that in 2020 a guideline on VitD supplementation for medical use was created, taking into consideration the opinions of various global institutions [2]. For more than 15 years there have been reports that vitamin D (VitD) has an immunomodulatory function in multiple sclerosis (MS) [3] and that there is an association between low circulating serum levels of 25-hydroxyvitamin D [s25(OH)D] and an increase in inflammatory activity and impact on quality of life in persons with multiple sclerosis (PwMS) [4] [5]. Nevertheless, up to the present the "neurological community" has not been able to agree to start a daily add-on therapy using an easy to carry out, inexpensive and low-side effect vitamin D supplementation (VitD suppl. from the beginning of the diagnosed MS disease or the chronically isolated syndrome (CIS). In the last decade, there has been an accumulation of evidence of immunological and pathophysiological mechanisms that VitD positively influences the course of the disease and should become an eminent factor in therapy ([6]. For 13 years, neurologists in Sweden have been informing PwMS about the benefits of VitD-suppl. and given a recommendation for add-on therapy [7].

EFFECTS OF NUTRITIONAL FORMULA SUPPLEMENTATION IN PEOPLE WITH ELEVATED LIVER ENZYMES

The controlled randomized intervention study to evaluate the effects of nutritional formula supplementation in people having elevated liver enzymes was implemented in Ninh Binh province from March to September 2023. 120 participated subjects were randomly divided into 2 groups, each group had 60 subjects: the intervention group supplemented with 45 g of formula twice daily and the control group with regular diet. Results showed that indicators of liver enzymes, nutrition, and health in the intervention group were better than the control group with statistical significance: average aspartate aminotransferase (AST) level decreased by 45.32 UI/L (-4.29 ± 8.36 vs. 1.03 ± 0.45); average alanine aminotransferase (ALT) level decreased by 53.96 UI/L (-56.98 ± 6.53 vs. -3.02 ± 1.35) (p&lt;0.001); Reducing amount of food decreased by 20% (p&lt;0.01); Loss of appetite decreased by 16.7% (p&lt;0.05); Constipation reduced by 15% (p&lt;0.05); Diarrhoea decreased by 11.7% (p&lt;0.05); No-deep sleep decreased by 40% (p&lt;0.05); Fitful sleep decreased by 18.4% (p&lt;0.05); Some indicators tended to be better but not statistically significant (p&gt;0.05): Difficulty sleeping decreased by 10.0%; Itching decreased by 13.4%; Urticaria decreased by 6.6%; Respiratory infections decreased by 1.6%; Fatigue decreased by 10%; Anxiety and emotional changes decreased by 8.4%; and average weight increased by 0.1 kg with p&gt;0.05. Product acceptability of users was 100% of which there were 73.3% very satisfied; 21.7% satisfied; and 5.0% accepted./.

The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art.

In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The main forms of vitamin D, Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are converted into the active form (1,25-dihydroxyvitamin D) thanks to two hydroxylations in the liver, kidney, pancreas, and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased, and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity, and cardiovascular disease. It is interesting to note that several long-term studies also revealed an inverse correlation between vitamin D levels and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects. While some studies demonstrated improvements in insulin sensitivity, glucose, and lipid metabolism, others revealed no significant effect on glycemic homeostasis and inflammation. This review aims to provide insight into the molecular basis of the relationship between vitamin D, insulin resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.

Effect of single-dose oral vitamin D (200,000 IU) for the treatment of painful diabetic neuropathy

Abstract Objective: To assess the effect of a single-dose, oral vitamin D supplementation (soft gel capsule of 200,000 IU) in subjects with painful diabetic neuropathy (PDN) in Pakistan. Design: Randomized control trial. Materials and Methods: This randomized control trial was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Pakistan from November 2021 to August 2022. Subjects with diabetes without any signs of vitamin D deficiency were included. Baseline details were obtained by a predesigned questionnaire. Douleur neuropathy 4 (DN4) score was used for diagnosing PDN. Biochemical tests include serum 25-hydroxyvitamin D (OH)D and HbA1c for screening at baseline and at 3 months follow-up were analyzed. Subjects were categorized into two: a control group and an intervention group. The intervention group was given a single soft gel vitamin D capsule (200,000 IU) after screening by expert paramedical staff. Based on baseline serum vitamin D levels, the intervention group was further categorized into insufficient vs. deficient groups, and the control group was categorized into insufficient vs. sufficient. Results: Of 159 participants, 19.5% vs. 44.7% subjects were with insufficient vs. deficient vitamin D levels in the intervention group, and 10.7% vs. 25.1% were with insufficient vs. sufficient vitamin D levels in the control group, respectively. Though the findings are insignificant, DN4 score at follow-up in intervention groups and control groups was reduced compared to the baseline DN4 score. Furthermore, we observed a reduction in post-HbA1c levels in both the intervention groups (insufficient vs. deficient) and the control-sufficient group. Conclusion: Treatment with vitamin D supplementation in people with PDN helps to improve vitamin D levels, DN4 score, and HbA1c levels, though dose-response is yet to be compared.

Vitamin D supplementation in people with chronic kidney disease

Vitamin D supplements have long been advocated for people with chronic kidney disease based on data from observational studies among the general population and people with chronic kidney disease. These data consistently suggested that higher circulating concentrations of 25-hydroxyvitamin D are associated with improved fracture, cardiovascular, cancer, and mortality outcomes. In the past few years, large clinical trials have been conducted to assess the effects of vitamin D supplements on a range of clinically relevant outcomes. Most of these studies were performed in the general population, but they also enrolled people with chronic kidney disease. Virtually all of these trials were negative and contradicted the observational data. In this review, the key observational data and clinical trials are summarized, and potential explanations for the discrepancies between these studies are discussed.

Therapeutic Potential of Vitamin D in Management of Asthma: A Literature Review.

Asthma, a prevalent chronic respiratory illness, affects a substantial number of individuals worldwide, with an estimated occurrence of 358 million cases. Evidence for the benefits of vitamin D in treating asthma is ambiguous and contradictory. The goal of this review article is to emphasize the value of vitamin D supplementation for people with asthma. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on vitamin D supplementation in asthma patients. We selected a comprehensive range of academic writing examples published in English, encompassing various types of texts. The study included a total of 37 papers, of which 18 were randomized controlled trials (RCTs) and five were meta-analyses. The use of a corticosteroid, with or without the inclusion of an adrenergic receptor agonist, improves the disease's symptoms, but it is unable to halt the long-term decline in lung function. Over the past 20 years, vitamin D has developed into a potent immunomodulator, influencing both immunological and structural cells, most notably airway smooth muscle cells. Among adults withlow 25-hydroxyvitamin D levels, the administration of vitamin D supplements was found to have positive effects in a reduction in the likelihood of asthma exacerbations requiring systemic corticosteroids. The provision of vitamin D supplements during pregnancy significantly reduces the risk of asthma in babies. Both children and adults with inadequate vitamin D levels who have been given vitamin D supplements have shown evident preventive effects against asthma. Therefore, we conclude there should bea lower threshold for prescribing vitamin D to patients with asthma who are vitamin D deficient.

A Protocol for Systematic Review and Meta-analysis of Dietary Calcium and Fracture

Despite the fact that there are few and inconsistent randomized controlled studies investigating calcium obtained from food, calcium and vitamin D are frequently utilized as calcium supplements in people's daily lives, so the effectiveness of food-derived calcium and calcium or a combination of the two is in question. Through a review and qualitative research, this paper explores the connection between dietary calcium and fracture incidence. The link between dietary calcium, vitamin D, or combination dietary calcium and vitamin D supplements and fracture incidence in the elderly over 65 years of age was examined. Calcium intake was based on food sources.A comprehensive search of the PubMed database was conducted. Use the keywords dietary calcium, vitamin D, and fracture to search for relevant randomized controlled trials in English studies. Search the Cochrane Library and EMBASE databases to add additional randomized clinical trials. Data were extracted from papers independently by two reviewers and entered into data tables. By using Cochran's Q statistic and the I-2 statistic, it was possible to determine whether the rate estimates were heterogeneous. Hip fracture was the primary outcome and total fracture was the secondary outcome.

The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials.

The effect of calcium supplementation on bone mineral accretion in people under 35 years old is inconclusive. To comprehensively summarize the evidence for the effect of calcium supplementation on bone mineral accretion in young populations (≤35 years). This is a systematic review and meta-analysis. The Pubmed, Embase, ProQuest, CENTRAL, WHO Global Index Medicus, Clinical Trials.gov, WHO ICTRP, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases were systematically searched from database inception to April 25, 2021. Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old. This systematic review and meta-analysis identified 43 studies involving 7,382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (standardized mean difference [SMD] 0.627, 95% confidence interval [CI] 0.338-0.915; SMD 0.364, 95% CI 0.134-0.595; respectively) and total body (SMD 0.330, 95% CI 0.163-0.496; SMD 0.149, 95% CI 0.006-0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008-0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peripeak bone mass (PBM) population (20-35 years) than the pre-PBM population (<20 years). Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation significantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis. This work was supported by Wenzhou Medical University grant [89219029].

Hypoxia-inducible factor stabilisers for the anaemia of chronic kidney disease.

Anaemia occurs in chronic kidney disease (CKD) and is more prevalent with lower levels of kidney function. Anaemia in CKD is associated with death related to cardiovascular (CV) disease and infection. Established treatments include erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions. Oral hypoxia-inducible factors (HIF) stabilisers are now available to manage anaemia in people with CKD. We aimed to assess the benefits and potential harms of HIF stabilisers for the management of anaemia in people with CKD. We searched the Cochrane Kidney and Transplant Register of Studies up to 22 November 2021 through contact with the Information Specialist using search terms relevant to our review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. Randomised and quasi-randomised studies evaluating hypoxia-inducible factors stabilisers compared to placebo, standard care, ESAs or iron supplementation in people with CKD were included. Five authors independently extracted data and assessed the risk of bias. Treatment estimates were summarised using random effects pair-wise meta-analysis and expressed as a relative risk (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI). Evidence certainty was assessed using GRADE. We included 51 studies randomising 30,994 adults. These studies compared HIF stabilisers to either placebo or an ESA. Compared to placebo, HIF stabiliser therapy had uncertain effects on CV death (10 studies, 1114 participants): RR 3.68, 95% CI 0.19 to 70.21; very low certainty evidence), and nonfatal myocardial infarction (MI) (3 studies, 822 participants): RR 1.29, 95% CI 0.31 to 5.36; I² = 0%; very low certainty evidence), probably decreases the proportion of patients requiring blood transfusion (8 studies, 4329 participants): RR 0.51, 95% CI 0.44 to 0.60; I² = 0%; moderate certainty evidence), and increases the proportion of patients reaching the target haemoglobin (Hb) (10 studies, 5102 participants): RR 8.36, 95% CI 6.42 to 10.89; I² = 37%; moderate certainty evidence). Compared to ESAs, HIF stabiliser therapy may make little or no difference to CV death (17 studies, 10,340 participants): RR 1.05, 95% CI 0.88 to 1.26; I² = 0%; low certainty evidence), nonfatal MI (7 studies, 7765 participants): RR 0.91, 95% CI 0.76 to 1.10; I² = 0%; low certainty evidence), and nonfatal stroke (5 studies, 7285 participants): RR 1.06, 95% CI 0.71 to 1.56; I² = 8%; low certainty evidence), and had uncertain effects on fatigue (2 studies, 3471 participants): RR 0.80, 95% CI 0.56 to 1.16; I² = 0%; very low certainty evidence). HIF stabiliser therapy probably decreased the proportion of patients requiring blood transfusion (11 studies, 10,786 participants): RR 0.87, 95% CI 0.76 to 1.00; I² = 25%; moderate certainty evidence), but may make little or no difference on the proportion of patients reaching the target Hb (14 studies, 4601 participants): RR 1.00, 95% CI 0.93 to 1.07; I² = 70%; low certainty evidence), compared to ESA. The effect of HIF stabilisers on hospitalisation for heart failure, peripheral arterial events, loss of unassisted dialysis vascular access patency, access intervention, cancer, infection, pulmonary hypertension and diabetic nephropathy was uncertain. None of the included studies reported life participation. Adverse events were rarely and inconsistently reported. HIF stabiliser management of anaemia had uncertain effects on CV death, fatigue, death (any cause), CV outcomes, and kidney failure compared to placebo or ESAs. Compared to placebo or ESAs, HIF stabiliser management of anaemia probably decreased the proportion of patients requiring blood transfusions, and probably increased the proportion of patients reaching the target Hb when compared to placebo.

A Systematic Review on the Role of Vitamin C in Tissue Healing.

Vitamin C is an essential nutrient for humans and animals which are unable to synthesise it themselves. Vitamin C is important for tissue regeneration due to the role it plays in collagen formation, and its antioxidant properties. We reviewed the literature to evaluate potential associations between vitamin C supplementation and healing of an acute or chronic condition. Embase, Medline, PubMed, and the Cochrane Library were searched for studies published prior to April 2022. Studies were eligible if they reported at least one association between vitamin C supplementation and healing outcomes. Eighteen studies met the inclusion criteria and were included in this review. Overall, vitamin C supplementation improved healing outcomes in certain pathologies, predominantly pressure ulcers. However, many of the studies had small sample sizes, combined nutritional treatments, and did not test baseline vitamin C. Future studies should be of larger scale, exclusively using vitamin C to determine its role in tissue healing in other wounds. We recommend consideration of vitamin C supplementation for people with pressure ulcers.

Dietary Supplements in People with Metastatic Cancer Who Are Experiencing Malnutrition, Cachexia, Sarcopenia, and Frailty: A Scoping Review.

Cancer-associated malnutrition, or cachexia, stemming from cancer or its treatments, is particularly prevalent in metastatic cancers, and is often interrelated with sarcopenia and frailty. Evidence suggests that dietary supplements play a role in managing these conditions. As metastatic cancer cells are associated with notable genomic and phenotypic alterations, response to dietary supplements may differ between metastatic and non-metastatic cancers. However, research in this area is lacking. This scoping review aims to identify the dietary supplements that have been studied in patients with metastatic cancers and malnutrition-related conditions, along with their proposed effects, mechanisms, outcome measures, and tools used. A systematic search was conducted across databases, including MEDLINE, EMBASE, CINAHL, and clinical trial registries. Of the initial 6535 records screened, a total of 48 studies were included, covering a range of dietary supplements—vitamins, minerals, antioxidants, proteins, amino acids, fatty acids, fiber, and others. While the types of dietary supplements included varied across cancer types, omega-3 and carnitine were investigated most often. Proposed relevant attributes of dietary supplements included their antioxidant, anti-inflammatory, anti-cancer, and immunomodulatory properties. Overall, there was a paucity of interventional studies, and more randomized controlled trials are warranted.

Fall prevention in older people: past, present and future.

Over the past 50years we have transitioned from accepting falls as an inevitable consequence of ageing to something that can and should be prevented. Numerous studies have elucidated the contributors to falls and how to assess a person's risk of falling. There are many effective approaches to preventing falls in older people including those with cognitive and physical impairments. Exercise is the most tried and tested approach with good evidence that moderate to high intensity balance training is an effective fall prevention strategy. Other successful single modality interventions include enhanced podiatry, home safety interventions, expedited cataract extraction, cardiac pacing for people with carotid sinus hypersensitivity and vitamin D supplementation in people living in care homes. Multiple interventions (everyone receives the same intervention package) and multifactorial interventions (interventions tailored to identified risk factors) are effective particularly in high-risk populations. In more recent years we have seen the emergence of new technologies such as devices and software programs that can offer low-cost interventions which may be more sustainable than our traditional time- and resource-limited approach to prevention. There is still more to be done and a translational focus is needed to ensure that effective interventions are scaled up and delivered to more people while at the same time maximising adherence and maintaining the fidelity of the interventions.

The Future of L-Arginine Dietary Supplementation Research - The Impact on NOS Dependent and Independent Systems

Introduction: The consumption of L-arginine is of particular concern, due to the importance of dietary supplements in people’s daily life, continually increasing. Also, the counter position is the impact of adulterants, contaminants and undeclared constituents in L-arginine products, and consequently to health/wellness. Aim: To contextualize and provide new perspectives for L-arginine dietary supplement research, that would have an impact on the consumers, and patients, health/wellness. Method: The approach was to do a literature search in multiple online electronic academic open-source scientific databases. These covered, PubMed, Scopus, Google Scholar, Elsevier, Taylor &amp; Francis, Sabinet, ScienceDirect, ClinicalTrials.gov, and The Cochrane Collaboration. The search terms covered&nbsp; L-arginine, and the specific research related interest. Outcome: The role of L-arginine in inhibition and control of disease is essentially via the dependent or independent NO metabolic pathways. In L-arginine deficiency, the selective delivery is exogenously taking the amino acid. That there is an impact of dietary arginine containing supplements consumption (or in combination) on human performance (exercise), including effects on cognitive flexibility, and/or mental ability. That L-arginine supplementation is indicated for stress reduction, anxiety, and adaptogenic capabilities in the healthy. However, L-arginine is not lacking, in side effects, including drug-interactions when taken in combination. Gastrointestinal disturbances being the most common adverse effects. Conclusion: Of prominence is the potential benefit, pure L-arginine holds for the consumer. It is recommended that further scientific research scrutiny is warranted. This will provide awareness for an improved specific national regulatory framework, globally, but also set the tone for future research studies.