Supplement Users Research Articles

Determination of the Relationship between Attitude towards Food Supplements and Physical Health Perception

In this age when the importance of human and public health is increasing, inactivity, which is seen as one of the most important problems, and the increase in obesity rates threaten public health. Therefore, the importance of physical activity and nutrition is increasing and new researches are being conducted in this field. The aim of this study is to analyse the relationship between physical health perception and attitude towards the usage of food supplements. Relational survey method was used in this study designed to determine this relationship between variables. 287 academic staff (85= female, 202= male) participated in the study. The physical health statements of the PROMIS global health scale and the scale adapted to the use of food supplements after a literature review were used. As a result, significant relationships were determined between attitude towards the use of food supplements and physical health perception. It was determined that academicians generally considered themselves healthy and were open-minded about the use of food supplements (F=8.150 p=0.000), physical health perception differed according to their field of study (F=4.912; p=0.002), and those who exercised regularly had a higher physical health perception (F=8,339; p>0.05). The study revealed important results in terms of guiding individual, public health and government policies. It is recommended for new researchers to examine the concepts related to rest, sleep behaviours and nutritional knowledge.

The Prevalence of Stimulant and Nutritional Supplement Usage Among Students at Abu Dhabi Universities in Gyms

University students in Abu Dhabi used stimulants and nutritional supplements at gyms. The study pinpointed variations based on the variables (years of practice, education level, age, and gender) and other. 512 male and female students from various colleges made randomly up the sample. The questionnaire was used to obtain the results. Findings revealed that (46 %) took tablets at a rate of (30.9%), (9.8%) take injections at a rate of (6.3%). Statistically, (8.2%) used supplements for more than five years, (91.2%) of students realized the difference between nutritional supplements and stimulants. The first-year attained the greatest rate in age variable. However, the gender variable was (63.1%) for males and (36.9%) for females in (19-25 Years) age group. The years of physical activity variable showed the most in the use of nutritional supplements and stimulants. All in all, this is to provide supervision for gyms and nutrition centers, get doctor’s approval for such materials, and conduct educational courses and workshops for trainers and gym supervisors to limit stimulants and supplements use.

Prevalence, attitudes, and practices of dietary supplements among middle-aged and older adults in Asir region, Saudi Arabia: A cross-sectional study.

The objectives of this study were to 1) identify the prevalence of dietary supplements (DS) among middle-aged and older adults; 2) determine attitudes toward DS and patterns of DS usage among middle-aged and older adults; and 3) assess the association of sociodemographic, clinical, and lifestyle factors with DS attitudes and DS usage. A cross-sectional online survey was undertaken among middle-aged and older adults. Data were collected by an online self-administered pretested questionnaire used as a study tool and distributed to respondents via social media applications. The DS usage prevalence among 501 respondents was 50.7%, and 53.5% of participants reported a positive attitude toward DS. The positive attitudes and higher usage of dietary supplements were statistically significant in higher proportions among older adults compared to middle-aged individuals. Significantly lower proportion of middle aged (54.9%) reported taking DS daily compared to 59.9% of older adults. A significant difference in the type of DS among the two groups was found for Omega-3 (p<0.001), minerals (p = 0.004), proteins (p = 0.002), fibers (p = 0.002), phytonutrients (p = 0.007), and probiotics (p = 0.015), with a higher proportion of middle-aged respondents reporting their use compared to older adults. Dietary supplement usage is a prevalent phenomenon among older adults and the middle-aged population. However, some undesirable practices regarding their use still exist in the community. Thus, there is a need of focussed health education to enhance attitudes and improve practices regarding the use of DS.

Dietary supplements, nutraceuticals and functional foods use after myocardial infarction depend on the age, sex, BMI and professional activity - a pilot study.

To assess dietary supplements, functional foods and nutraceuticals use among the patients after myocardial infarction (MI). The authors prospectively enrolled 100 consecutive patients hospitalized due to MI and remaining under coordinated outpatient care after MI in the authors' cardiology department. The authors showed that patients within median (interquartile range) 12.30 (10.18-14.57) months after MI use dietary supplements, nutraceuticals and functional foods in their everyday diet. Vitamins (53% patients), especially vitamin D (35%), were the most frequently used dietary supplements. In contrary to common usage of dietary supplements (59%), smaller proportion of patients use functional foods (21%) and nutraceuticals (5%), especially phytosterols. The authors found that the use of over-the-counter (OTC) drugs and dietary supplements is associated with age (participants <60 years old vs. participants ≥60 years old: OTC drugs: N = 8 [20.0%] vs. N = 32 [53.3%], p < 0.001; herbals: N = 3 [7.5%] vs. N = 16 [26.7%], p = 0.019), sex of the patients following MI (females vs. males: vitamins: N = 17 [70.8%] vs. N = 36 [47,4%], p = 0.045; vitamin D: N = 13 [54.2%] vs. N = 22 [28.9%], p = 0.024; omega-3 fatty acids: N = 3 [12.5%] vs. N = 1 [1.3%], p = 0.042; herbals: N = 8 [33.3%] vs. N = 11[14.5%], p = 0.040), as well as the BMI of the participants (BMI < 24.9 vs. BMI ≥ 25.0: multivitamin/ multimineral dietary supplements: N = 3 [15.0%] vs. N = 31 [42.5%], p = 0.035; vitamin B6: N = 1 [5.0%] vs. N = 21 [28.8%], p = 0.035). In the study group all participants with the age above retirement age have already withdrawn from professional activity and they more often used OTC drugs (N = 14 [25.9%] before retirement age vs. N = 26 [56.5%] above retirement age, p = 0.002). The patients following MI use supplements, functional foods and nutraceuticals. Their use depends on sex, age, BMI and professional activity. The authors believe that their potential beneficial effects require further evaluation in clinical longitudinal studies. Int J Occup Med Environ Health. 2023;36(6):732-43.

Evaluation of Knowledge and Attitude of People Referred to Pharmacies in Rasht, Iran, Regarding Nutritional Supplements

Background Today, the consumption of nutritional supplements is increasing dramatically in the world. Objective This study aims to survey the knowledge and attitudes of people in Rasht, Iran, towards nutritional supplements and determine their consumption rate. Methods This descriptive-analytical study with a cross-sectional design was conducted over 6 months on 1220 people referred to pharmacies in Rasht city. They completed a self-report questionnaire surveying demographic data, knowledge, and attitude towards nutritional supplements. Results The majority of people had poor knowledge (mean score: 5.14±2.36 out of 9). The knowledge scores were significantly different in terms of educational level, occupation, use/non-use of supplements, number of used supplements, and the reason for taking drug supplements, such that people with a master’s degree or higher, healthcare providers, and supplement users had higher scores. The attitude score was 16.14±4.64 (out of 40), and 76.33% had a negative attitude towards nutritional supplements. The knowledge score had a significant negative relationship with the attitude score. Conclusion Given the poor knowledge of people in Rasht city and their negative attitude towards nutritional supplements, it is recommended to develop public education programs to improve their knowledge of nutritional supplements.

Association between dietary vitamin intake and mortality in US adults with diabetes: A prospective cohort study.

To explore the association of dietary vitamin intake from food and/or supplement with mortality in US adults with diabetes. This prospective cohort study was conducted on 5418 US adults with diabetes from the National Health and Nutrition Examination Survey 1999-2018. Vitamin intake from food and supplements was estimated via dietary recall. Sufficient intake from food or food+supplement was defined as≥estimated average requirement (EAR) and≤tolerable upper intake level (UL), insufficient intake, <EAR; and excess intake, >UL. Medium supplementary intake was classified as>median level and ≤75th percentile; low intake,≤median level; and high intake, >75th percentile, as reported by supplement users. A total of 1601 deaths occurred among the participants over a median follow-up of 11.0years. Cox regression analysis of the single-vitamin model demonstrated that sufficient vitamin A and folate intake from food and food+supplement and medium vitamin A and folate intake from supplement; sufficient riboflavin, niacin, and vitamin B6 intake from food and food+supplement; and sufficient thiamin and vitamin E intake from food+supplement were significantly associated with reduced all-cause mortality (all p<0.05). In the multivitamin model, sufficient vitamin A and folate intake from food and food+supplement, medium vitamin A and folate intake from the supplement, and sufficient niacin intake from food and food+supplement were inversely associated with mortality (all p<0.05). Vitamin A and folate intake from food or supplement and niacin intake from food were significantly associated with reduced mortality in US adults with diabetes.

Association between potential supplement–drug interactions and liver diseases in patients with cancer: A large prospective cohort study

The concurrent use of herbal and dietary supplements and conventional drugs can lead to interactions in patients with cancer, of which hepatotoxicity is one of the most concerning sequelae. This study examined the potential supplement-drug interactions involving the hepatic system, and their associations with documented liver diseases, among patients with cancer in a large population-based cohort in the UK Biobank. Participants diagnosed with cancer and had completed supplement-use assessment after diagnosis were included. Potentially interacting supplement-drug combinations that involved CYP enzymes or increased the risk of hepatotoxicity were identified from four tertiary databases. Liver diseases were identified using ICD-codes K70-77. Log-binomial regression was used to investigate the associations between potentially-interacting supplement-drug combinations and liver diseases documented (1) at any time, and (2) confined to only after the time of supplement-use assessment, adjusting for age, sex and pre-existing comorbidities. This analysis included 30,239 participants (mean age=60.0 years; 61.9% female). Over half (n=17,698, 58.5%) reported the use of supplements after cancer diagnoses. Among supplements users, 36.9% (n=6537/17,698) were on supplement-drug combinations with interacting potential involving the hepatic system. Patients taking supplements and drugs who had hepatic comorbidities were more likely to take potentially interacting pairs (adjusted risk ratio=1.14, 95% CI=1.06-1.23, p<0.001). However, no significant association was observed between the use of these combinations and subsequent liver diseases (all p>0.05). Approximately one-third of the participants who had cancer and were supplement users had a risk of potential supplement-drug interactions that contribute to adverse liver effect. Healthcare professionals should communicate with patients with cancer, especially those with pre-existing liver diseases, about supplement use and proactively assess the clinical significance of potential interactions.

Assessment of Awareness and Knowledge about Osteoporosis in Relation to Health Prevention among Patients Treated in Osteoporosis Clinics.

The increasing incidence of osteoporosis indicates that the disease is a serious public health problem, with about 200 million people being affected worldwide. The aims of this research are to assess the awareness and knowledge about osteoporosis in relation to risk factors, health condition, supplementation used, socio-demographic factors and other variables among osteoporosis patients. The study was conducted in 2016-2018 in osteoporosis clinics in Poland. The study involved 312 patients with a diagnosis of osteoporosis. In the diagnostic survey method, the authors' own questionnaire was used. The results indicate that the more frequent the symptoms associated with the disease, the lower the general self-assessment of the health condition of the respondents (rho = -0.682, p < 0.001). In addition, almost half of the respondents stated that their knowledge of osteoporosis is negligible. Moreover, the use of dietary supplements significantly differentiated respondents in terms of health self-assessed (p < 0.001), and it is noteworthy that users of dietary supplements assessed their health significantly better. We also saw a statistically significant relationship between the self-assessment of knowledge about osteoporosis and the use of dietary supplements (p < 0.001). Accordingly, significantly more respondents rating their knowledge as good or very good used dietary supplements. The conducted study demonstrates the need to educate patients and implement educational programs at central and provincial levels to improve patient knowledge concerning the disease. Supporting adaptation to chronic diseases and appropriate therapeutic management may contribute to improved osteoporosis treatment and enhanced patient quality of life.

Do Dietary Supplements Affect Inflammation, Oxidative Stress, and Antioxidant Status in Adults with Hypothyroidism or Hashimoto's Disease?-A Systematic Review of Controlled Trials.

This systematic review aims to summarise the results of controlled trials on dietary supplements (DS) usage and inflammation, oxidative stress, antioxidant status, and thyroid parameter improvement in hypothyroidism (HT)/Hashimoto's thyroiditis (AIT) patients. The study protocol was registered with PROSPERO (no. CRD42022365149). A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of nineteen randomised controlled trials and three non-randomised studies for the review; three studies examined the effect of supplementation with vitamin D, twelve studies-with selenium, and seven studies-with other DS. Based on very limited evidence, the lack of influence of vitamin D supplementation on inflammatory parameters was found, while no studies have examined oxidative stress and antioxidant status parameters, and only one provided results for a single thyroid parameter after an intervention. Some evidence was found proving that selenium supplementation may decrease inflammation and improve thyroid parameters, but reaching a conclusion about its influence on oxidative stress and antioxidant status is not possible because of the insufficient number of studies. Additionally, due to examining other DS (e.g., multicomponent, Nigella sativa, and genistein) only in single studies, conclusions cannot be drawn. Further long-term, high-quality randomised controlled trials are necessary to better understand the influence of DS on inflammation, oxidative stress, and antioxidant status, as well as their potential to improve thyroid gland function in HT/AIT patients.

Supplementation of creatine and its role in brain function

Introduction and aim. In recent years growing awareness of the society regarding healthy lifestyle leads to increased interest in regular physical activity and usage of dietary supplements. Creatine supplementation is often used among athletes to improve muscle mass, performance and recovery. The aim of this paper is to present the effects of creatine supplementation as well as its function in the body, forms and ways of intake, and potential benefits of its use. &#x0D; Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following keywords: creatine, creatine supplementation, sports nutrition, brain function &#x0D; Analysis of literature. Creatine is one of the most popular supplements recommended for athletes. It catalyzes transfer of phosphate groups into high energy compounds contributing in energy transportation and cellular energy buffering for cells and tissues with high energy demands. Its supplementation improves exercise performance, increases muscle mass and enhances recovery after training. In addition, there are indications that creatine shows promise in reducing symptoms associated with concussion, mild traumatic brain injury, and depression. &#x0D; Conclusion. Creatine supplementation is used in sport mainly to improve exercise performance and muscle gain, however, it also plays an important role in brain function. In future it may be used in reducing symptoms associated with concussion, mild traumatic brain injury and depression.

Gastrointestinal Symptoms In American Football Athletes Are Higher In Protein Supplement Users Than In Non-users

Gastrointestinal Symptoms In American Football Athletes Are Higher In Protein Supplement Users Than In Non-users

Withania somnifera (L.) Ashwagandha: A Review on Ethnopharmacology, Phytochemistry, Biomedicinal and Traditional uses

Traditional medicine is a set of knowledge, abilities, and procedures based on assumptions, beliefs, and experiences of traditional societies in order to preserve their health. In many undeveloped countries, many rural or indigenous people place a great importance on traditional herbal medicines. The World Health Organization estimates that 60% of rural Indians use. The usage of herbal supplements increased from 2.5% to 12% over the previous five years. India's transition from traditional to modern medicine has been made easier by the examination of novel drugs, especially those made using components derived from plants. Tannins, alkaloids, sugars, terpenoids, steroids, flavonoids, and phenols are a few of the chemical elements included in therapeutic plants that have a specific physiological impact on the human body. Natural therapeutic properties are just one benefit of medicinal plants; they also offer natural disease prevention. In this comprehensive review study research, we are making an effort to summarize, collect the number of plants, and identify their ethnopharmacological characteristics.

COMPARATIVE EVALUATION OF NUTRITIONAL STATUS AND LIFESTYLE OF DOCTORS AND NURSES WORKING IN A LOCAL PUBLIC HOSPITAL

This study aimed to compare doctors' and nurses' nutritional status and lifestyle working in a local hospital. The prospective study was conducted in DHQ Hospital Muzaffargarh. The study was conducted on 60 participants (30 doctors, 30 nurses).To conduct this study, a questionnaire was prepared and distributed. There were questions on weight, height, waist circumference, hip circumference, and BMI in addition to the standard demographic information (age, gender, parental status, income, and education). Questions on eating habits, supplement usage, digestive health, exercise, stress, and other aspects of lifestyle and diet, as well as their current nutritional status, were included in the survey. 2.0 doctors were underweight because their BMI was less than 18.5. Sixteen doctors and 22 nurses were healthy because their BMI was 18.5 - 14.97.8; doctors and 5 nurses were overweight because their BMI was 25.5 - 29.59. Four doctors and 3 nurses were obese because their BMI was 30.77 - 38.41. All variables showed no statistically significant variation in both groups except for waist circumference (p-value=0.053) and height (p-value=0.05). The pattern of exercise between both groups was not significantly different. There is no difference in the nutritional status and lifestyle of doctors and nurses.

Knowledge, Attitudes and Practices on Dietary Supplements among Allied Health Sciences Undergraduates of Sri Lanka

According to research conducted in foreign coun-tries among undergraduates, there is a huge con-sumption of dietary supplements without proper consultation, and many have encountered adverse effects. However, there have been no satisfactory research studies done on dietary supplement usage among Allied Health Sciences undergraduates in Sri Lanka. The objective of the study was to de-scribe knowledge, attitudes, and practices of die-tary supplement usage among Allied Health Sci-ences undergraduates in Sri Lanka. In this descrip-tive cross-sectional study, a sample taken from a population of 2000 undergraduates of five Allied Health Sciences faculties in Sri Lanka were as-sessed using a structured, self-administered ques-tionnaire during the period from March 2021 to June 2022. Stratified random sampling was used to select participants from each department using population proportion and finalized by using sim-ple random sampling with 354 respondents as the sample size. According to the results obtained, the overall prevalence of dietary supplement usage was 63.8%. Of the individuals who used dietary supplements, 97.3% were female and 2.7% were male. The most common reason for using dietary supplements (91.2%) was to compensate for the lack of nutrients in the diet. Multivitamins and min-erals were the most frequently reported supple-ments (86.7%), followed by fish oil (84.5%), beauty ingredients added supplements (77.4%), weight loss supplements (75.2%), and pro-tein/amino acids (70.4%). Among undergraduates, there was widespread use of internet-driven, self-prescribed dietary supplements intake (95.1%). A significant number of undergraduates took dietary advice from their family members (79.2%). Only 67.3% asked for medical advice from physicians, pharmacists, and dietitians. In conclusion, preva-lence of dietary supplement consumption among participants is high (63.8%) but most of were not confident enough to recommend supplements to others (75.7%). Furthermore, side effects among consumers were minimum (4.9%) and most of them obtained the desired benefit. This study can be used to provide background knowledge for fu-ture researchers.

Thyroid function and urinary concentrations of iodine, selenium, and arsenic in vegans, lacto-ovo vegetarians and pescatarians

PurposePopulations following a plant-based diet may be at particular risk of thyroid dysfunction due to low iodine and selenium intakes. The main purpose was to assess thyroid function and urinary concentration of iodine, selenium, and arsenic, in subjects following a vegan, lacto-ovo vegetarian, or pescatarian diet.MethodsIn Norway, a country without mandatory dietary iodine fortification, 205 adults, following vegan (n = 115), lacto-ovo vegetarian (n = 55) and pescatarian diet (n = 35) were included. Thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and serum anti-TPO (S-anti-TPO) were measured in a venous blood sample and concentrations of iodine (UIC), creatinine (UCC), selenium, and arsenic were measured from single spot urine samples.ResultsSubclinical hypothyroidism (TSH > 4.0 mU/L) was observed in 3% of subjects. The overall median (p25, p75) Tg was 17 (9, 30) µg/L and vegans had higher Tg compared to pescatarians. Vegans not consuming iodine-containing supplements (n = 43) had higher Tg, than supplement users (n = 72), 27 (11, 44) vs. 16 (8, 25) µg/L and higher fT4, 16 (15, 17) vs. 15 (14, 17) pmol/L, respectively. The overall median UIC was 57 (28, 130) µg/L, all dietary groups had median UIC below WHO thresholds. Median urinary selenium and arsenic concentration was 13 (6, 22) and 3 (2, 8) µg/L, respectively.ConclusionThe prevalence of subclinical hypothyroidism was low and fT4 and fT3 were within the normal range for all dietary groups. Vegans had significantly increased Tg compared to pescatarians.

Motivational Drivers behind the Consumption of Dietary Supplements by Leisure-Time Athletes.

The prevalence of dietary supplement use has been growing continuously worldwide. Nevertheless, limited research evidence is available on dietary supplement usage related to the segment of leisure-time athletes with the determinants of motivational drivers, sport types, and demographic characteristics. This research, which was conducted in Hungary among leisure-time athletes, aims to learn about the demographic and sports characteristics of consumers who identified themselves as active dietary supplement consumers in the survey. The motivational drivers for consuming dietary supplements and their differences, as well as the frequency of dietary supplement consumption in each sports category, are examined. The findings of the study provide valuable insights into the key motivational drivers, among which health preservation, improvement in physical well-being, and cartilage protection are predominant. The results show that there are significant differences between segments taking part in different leisure-time sport activities and age groups when it comes to dietary supplement usage. Three different segments were identified based on the motivational drivers examined. As a limitation, to note is that due to the sample size, the study can be considered as prospective. In practical terms, the results of the study can be used to support marketing projects that aim to reach leisure-time sport athletes.

Supplement use in relation to dietary intake in pregnancy: an analysis of the Swedish GraviD cohort.

We aimed to study supplement use in relation to dietary intake among pregnant women in Sweden, and adherence to the Nordic Nutrition Recommendations among supplement and non-supplement users. Pregnant women were recruited at registration to antenatal care in 2013–2014. In third trimester, supplement use was collected using a questionnaire, and dietary intake was collected using a FFQ. The majority (64 %) of the 1044 women reported use of one or more supplements. Among all, 0–23 % reported dietary intakes above recommended intake (RI) of vitamin D, folate, Fe and Se. Median dietary intakes of thiamine (1·4 v. 1·3 mg P = 0·013), phosphorus (1482 v. 1440 mg P = 0·007), folate (327 v. 316 µg P = 0·02), Fe (12 v. 11·5 mg P = 0·009), Mg (361 v. 346 mg P < 0·001) and Zn (10·7 v. 10·4 mg P = 0·01) were higher among supplement users compared with non-users. Larger proportions of supplement users than non-users adhered to RI of dietary intakes of thiamine (42 % v. 35 % P = 0·04) and Mg (75 % v. 69 % P = 0·05). Among non-users, a minority had dietary intakes above RI for vitamin D (6 %), folate (10 %) and Fe (21 %). The majority (75–100 %) of supplement users had total intakes above RI for most nutrients. In conclusion, supplement use contributed substantially to reaching RI for vitamin D, folate and Fe. Supplement users had a higher dietary intake of several nutrients than non-users. This highlights that non-supplement users are at risk of inadequate nutrient intakes during pregnancy, suggesting a need for heightened awareness of nutritional adequacy for pregnant women.

Perspectives and practices of nutritionists on dietary supplements for elite soccer teams: a cross-sectional survey study.

Dietary supplements are part of the nutritional strategies frequently applied in sports performance support. With growing research on this subject and high demand from athletes, nutritionists need to keep up to date with the latest evidence and utility of dietary supplements, particularly in real-world contexts. As information about the use of dietary supplements among elite soccer players is still scarce, this work aimed to know how nutritionists working with elite soccer teams perceive and use these substances in their daily practice. A questionnaire previously used to describe nutritionists' beliefs and attitudes regarding the use of dietary supplements in a clinical context was adapted for this study. The online questionnaire was addressed to nutritionists working with elite soccer teams from six European Leagues and Brazil, between November 2022 and February 2023. Overall, the participants considered themselves well-trained (76.9%), knowledgeable (95.4%), and interested in dietary supplements (95.4%). The majority (70.8%) of the participants agreed or strongly agreed to recommend dietary supplements to soccer players. Personal usage of dietary supplements was associated with recommending supplements (p < 0.001), but no relationships were found with years of experience and academic level. Nutritionists working with elite soccer players consider the use of dietary supplements for performance-enhancement purposes and not only to compensate for nutritional deficits, which might contribute to their higher interest, training and perceived knowledge about this topic. Participants recognize players' interest in dietary supplements, and are mindful of the safety and efficacy of these products. The present study suggests that nutritionists working with elite soccer teams are among the highest prescribers of dietary supplements, although personal usage is lower than that of nutritionists working in a clinical context.

Association between dietary supplement use and mortality among US adults with diabetes: a longitudinal cohort study

BackgroundDespite the popularity of dietary supplements, their effectiveness and safety in patients with diabetes remain controversial. Furthermore, evidence from clinical trials may not be generalizable to real-world settings. This study examined the association between dietary supplement use and mortality outcomes among patients with diabetes based on a nationally representative sample of US adults.MethodsThis study analyzed data from National Health and Nutrition Examination Survey (NHANES) 1999–2018. Supplement users referred to adults with diabetes who reported the use of any dietary supplements in the last 30 days, and with a cumulative duration of ≥ 90 days. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between supplement use and all-cause mortality, and mortality from cardiovascular diseases (CVD), diabetes, and cancer. Subgroup analysis of different supplement classes (vitamins, minerals, botanicals, amino acids, fatty acids, probiotics and glucosamine) were also conducted.ResultsWe included 8,122 adults with diabetes (mean age: 59.4 years; 48.7% female), of whom 3,997 (54.0%) reported using supplements regularly. Vitamins (87.3%), minerals (75.3%) and botanicals (51.8%) were the most popular supplements. At a median follow-up of 6.9 years, 2447 all-cause deaths had occurred. Overall supplement use was not associated with risk of all-cause mortality among patients with diabetes (HR = 0.97, 95% CI: 0.87 to 1.08, P = 0.56). Subgroup analyses suggested that amino acid use was associated with a lower all-cause mortality (HR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), while the use of fatty acids (HR = 0.62, 95% CI: 0.42 to 0.92, P = 0.018) and glucosamine (HR = 0.69, 95% CI: 0.51 to 0.95, P = 0.022) supplements were significantly associated with lower CVD mortality.ConclusionsOur results derived from real-world data suggested that overall supplement use was not associated with any mortality benefit in patients with diabetes. However, there is preliminary evidence that suggests a protective effect of amino acid use on all-cause mortality, and a benefit of fatty acids and glucosamine supplement use on CVD mortality. Future large-scale longitudinal studies are needed to investigate the association between dietary supplement use and other intermediate diabetes-related outcomes, such as glucose control and reducing diabetes-related complications.

The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study

SummaryProton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08–2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults.PurposeProton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults.MethodsParticipants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism.ResultsA total of 4139 participants met the inclusion criteria, of whom 37.8% (n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08–2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities.DiscussionThe results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.