The effect of chloride-containing potassium supplements on chloride titrator estimates of dietary sodium intake.

To examine the effect of chloride-containing potassium supplements on chloride titrator estimates of dietary sodium intake, we gave normal subjects diet containing 10, 100, or 200 mEq/d sodium in random order either as such, or supplemented with one of two potassium supplements. One regimen consisted of potassium 45 mEq/d with 12 mEq/d chloride and 33 mEq/d of citrate and gluconate; the other contained 48 mEq/d potassium and 48mEq/d chloride. Increased potassium intake with either supplemented regimen resulted in increased 24-hour potassium excretion, which was manifested in only the diurnal collections. Increased chloride intake resulted in increased urinary chloride excretion both during the day and at night. At all chloride intakes, urinary sodium and chloride excretion were highly correlated. The 48 mEq/d chloride intake generated a relationship with the same slope but with a different intercept from the other two regimens. The highest chloride intake resulted in a greater chloride titrator reading; however, the relationship was sufficiently predictable that adjustments in interpretation could be easily made. We conclude that if daily potassium chloride intake is known, chloride titrators continue to be reliable tools for estimating dietary sodium intake.     

血液透析患者膳食状况的评价

目的利用理想膳食模式评分法评价维持性血液透析患者的膳食质量。方法选取2012年10月—2013年2月在无锡市某三甲医院血液透析中心透析的79例患者,进行膳食情况及个人基本情况调查,采用理想膳食模式（desirable diet-ary pattern,DDP）评分及评价方法评价维持性血液透析人群的膳食质量。结果79例维持性血透患者的DDP分值为79．8分,动物性食物和食用油的摄入量超过了最大允许值（动物性食物58。s50,食用油10vs10）。从食物类别的分类看,谷类、蔬菜类及水果类的DDP得分均低于理想得分（谷类28vs40,蔬菜水果类5vs10）。按透析年数、透析频次、体重控制情况、知晓饮食情况及饮食控制程度不同比较,食用油摄入量差异均有统计学意义（P〈0．05）,余均无统计学意义。结论经理想膳食模式评分法评价,维持性血液透析患者膳食质量存在结构不均衡及总能量摄入不足的问题。     

The effect of chloride-containing potassium supplements on chloride titrator estimates of dietary sodium intake

To examine the effect of chloride-containing potassium supplements on chloride titrator estimates of dietary sodium intake, we gave normal subjects diet containing 10, 100, or 200 mEq/d sodium in random order either as such, or supplemented with one of two potassium supplements. One regimen consisted of potassium 45 mEq/d with 12 mEq/d chloride and 33 mEq/d of citrate and gluconate; the other contained 48 mEq/d potassium and 48mEq/d chloride. Increased potassium intake with either supplemented regimen resulted in increased 24-hour potassium excretion, which was manifested in only the diurnal collections. Increased chloride intake resulted in increased urinary chloride excretion both during the day and at night. At all chloride intakes, urinary sodium and chloride excretion were highly correlated. The 48 mEq/d chloride intake generated a relationship with the same slope but with a different intercept from the other two regimens. The highest chloride intake resulted in a greater chloride titrator reading; however, the relationship was sufficiently predictable that adjustments in interpretation could be easily made. We conclude that if daily potassium chloride intake is known, chloride titrators continue to be reliable tools for estimating dietary sodium intake.     

The liberating effect of weight loss supplements on dietary control: A field experiment

ObjectivesTaking weight-loss supplements may create illusion of protection against weight gain and thereby loosen subsequent dietary self-control. The current study examined whether taking weight-loss supplement would increase food intake and further tested whether positive attitudes toward supplements would increase susceptibility to overeating.MethodsParticipants were randomly assigned to take either a known placebo or a purported weight loss supplement (actually, the same placebo). After supplement provision, participants' actual food consumption at a reward buffet lunch was recorded.ResultsCompared with controls, participants receiving a purported weight loss supplement ate more food at the reward buffet. Perceived progress toward the goal of weight reduction mediated the connection between use of weight loss supplements and subsequent food consumption. Participants with more positive attitudes toward weight loss supplements were more susceptible to the liberating effect of taking weight loss supplements on food intake.ConclusionUsing weight loss supplements may produce unintended consequences on dietary self-regulation. The public should pay more attention to the notion of psychological liberation when using weight loss supplements.     

A dietary survey in Indian hemodialysis patients

Malnutrition is a common problem in maintenance hemodialysis (MHD) patients, and compromised intake is an important cause. There is no information available about the nutrient intakes of MHD patients in India. The nutrient intakes of 106 MHD patients were studied cross-sectionally and on follow-up. A 24-hour recall was used on 4 consecutive days. After 2 months on dialysis, the mean energy intake was 29±6.6 kcal/kg ideal body weight (IBW) and the mean protein intake was .93±.39 g/kg IBW (high biological value [HBV] protein 49%±8.5%). Dietary deficiency of both protein and calories was present in 64.9%. Intake was better on nondialysis days compared with dialysis days, and in women and older patients. On follow-up there was no significant increase in food intake up to 6 months. After that, the total calorie intake increased significantly with a disproportionate drop in high biological value protein consumed and appeared to be derived predominantly from carbohydrate food (mean kcal/kg, 37±6.9; mean protein g/kg, 0.96±0.19; ratio of HBV protein to total protein consumed, .42±.09). In summary this study showed suboptimal energy and protein intake in an MHD population. Intakes were further compromised on dialysis days, and with increasing time spent on dialysis, the quality of nutrient intake became poorer.     

Effectiveness of dietary supplements in patients with osteoarthritis: the doubt persists

Earlier studies with glucosamines in patients with osteoarthritis have shown conflicting results. A placebo-controlled randomised trial was now carried out in 1583 patients with osteoarthritis. The primary endpoint was a 20% reduction in knee pain between baseline and week 24 according to the 'Western Ontario and McMaster Universities arthritis index'(WOMAC)-score. No statistically significant difference was found between the groups using placebo (60% response), glucosamine (64%), chondroitin sulphate (65%) or combination therapy (67%). The results of this trial do not support the hypothesis that glucosamines have a positive effect on symptoms in patients with osteoarthritis of the knee. However, (a) the chance of a statistically significant difference decreases with increasing magnitude of the placebo response, (b) there was a statistically significant reduction in the patients with moderate to severe pain, (c) when the pain was assessed with the more sensitive 'Outcome measures in rheumatology clinical trials'(OMERACT)-'Osteoarthritis Research Society International'(OARSI)-score, there was a better response in the group given combined treatment, (d) the data on radiological progression and the effects on cartilage markers must still come in, and (e) the efficacy may have been higher ifa different dietary supplement had been used. These questions on the design and the robustness of the study indicate that further studies are necessary.     

Update on dietary supplements for depression

When does an alternative therapy become mainstream? When enough studies show it's safe and effective. For mild to moderate depression, a handful of supplements seem headed in that direction.     

The effect of fish oil supplements on blood pressure.

We conducted a double-blind, placebo-controlled crossover study to determine the effects of fish oil supplementation on blood pressure in middle-aged men. Subjects were randomly assigned to consume either 20 g of fish oil or safflower oil for 12 weeks and then consume the other oil for an additional 12 weeks after a 4-week washout period. We found no significant changes from the pretreatment value in systolic or diastolic blood pressure with the use of fish oil supplements. In addition, there were no significant differences in the posttreatment blood pressures comparing the fish and safflower oil phases of the study.     

The usage of dietary supplements among the elderly individuals in Taiwan

This study describes dietary supplement consumption practices among the Taiwanese population over the age of 65. Data for the analyses were derived from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) which was carried out from 1999-2000. Data from a total of 1937 participants (970 men and 967 women) were collected in the study to delineate patterns of supplement usage. The results indicated that the percentage of women taking supplements was 34.9%, which was higher than 30.1% for men. About 50% of male and female supplement takers took only one type of supplement. The numbers of people taking supplements decreased as the total number of supplement types chosen increased. The top five types of supplements consumed from highest to lowest were: multivitamins and minerals, calcium, vitamin E, vitamin C and fish oil. The elderly residing in the first stratum in the northern areas of Taiwan had the highest rate of taking supplements compared to other locations. In contrast, the elderly residing in mountain areas, eastern areas, and the third stratum in the central areas of Taiwan had a significantly lower rate of supplement ingestion. In addition, elderly people with the following characteristics had a significantly higher rate of taking supplements: higher education, higher monthly income, sufficient disposable income, higher scores in nutrition knowledge, daily ingestion of vitamin or mineral supplements, awareness of nutritional knowledge, regular ingestion of health-enhancing medicines, a lacto-ovo vegetarian diet, good understanding of their own health status, and frequent exercisers.     

Lead content in 70 brands of dietary calcium supplements.

OBJECTIVES. Elevated lead levels in calcium supplements may pose a health risk, particularly to children with milk intolerance who rely on these products to meet their calcium requirement. Earlier reports chiefly focused on the lead content in supplements derived from bonemeal and dolomite. This study undertook to determine the lead levels in the major forms of calcium supplements currently available. METHODS. The lead content was measured in 70 brands of calcium supplements grouped in the following five categories: dolomite, bonemeal, refined and natural source calcium carbonate, and calcium chelates. RESULTS. The lead levels measured in the supplements ranged from 0.03 microgram/g to 8.83 micrograms/g. Daily lead ingestion rates revealed that about 25% of the products exceeded the US Food and Drug Administration's "provisional" total tolerable daily intake of lead for children aged 6 years and under. Less than 20% of the supplements had "normalized" lead levels comparable to or lower than that reported for cow's milk. CONCLUSIONS. Children are the most sensitive to the low-level effects of lead. If calcium supplements are to provide an alternate source of calcium to some of these individuals, they should also deliver concomitant lead dosages no greater than those obtained from milk products themselves.     

Ensuring the safety of botanical dietary supplements

Botanical dietary supplements with a history of safe human use may not require the same level of toxicity testing as synthetic pharmaceutical drugs. Most of the documented examples of acute toxicity caused by botanical dietary supplements have been caused by the substitution of toxic plants for the desired species, probably through misidentification or production errors, or by contamination with pharmaceutical agents, either as a result of poor manufacturing practices or adulteration. Although more difficult to document, chronic toxicities attributed to botanical dietary supplements may be caused by contamination by heavy metals, pesticides, or microbes or by inherent properties of constituents of the botanicals themselves. Like drug-drug interactions, botanical-drug interactions can also be a source of toxicity. Most of these toxicity problems may be prevented by implementing good agricultural practices and good manufacturing practices and applying existing toxicity testing similar to those used in drug development or new toxicity assays under development based on proteomics, genomics, or metabolomics.     

Lipid-lowering effect of polyunsaturated fatty acids in hemodialysis patients.

In this randomized and placebo-controlled trial, safety and lipid-lowering effect of fish and corn oils rich in polyunsaturated fatty acids compared with sesame oil that is mainly saturated were studied in 60 hemodialysis cases allocated to 4 different treatment groups. Each group (n = 15) received either fish oil (1.5 g), corn oil (4.5 g), sesame oil (4.5 g), or placebo, daily. Serum triglyceride, cholesterol, low density lipoprotein cholesterol (LDL-c), and high density lipoprotein cholesterol (HDL-c) were measured before and after 2 months of therapy. Serum HDL-c increased, but LDL-c decreased significantly after fish and corn oil therapy. In addition, serum triglyceride decreased significantly after supplementary fish oil. The ratios of LDL-c to HDL-c, total cholesterol to HDL-c, and triglyceride to HDL-c decreased significantly after fish and corn oil therapy. Sesame oil had no significant effect on the lipid profile of hemodialysis patients. Our results suggest that short-term low-dose supplementary polyunsaturated fatty acids are safe and beneficial for the lipid abnormalities of hemodialysis patients.     

The effect of altitude change on anemia treatment response in hemodialysis patients

Hemodialysis patients who live at high altitude use less exogenous erythropoietin but achieve higher hematocrit levels than those living at a lower altitude. The authors hypothesized that the effect of altitude would be strongest in hemodialysis patients with poor anemia treatment response. To explore this hypothesis, they studied anemia-related outcomes in US hemodialysis patients who move to higher altitudes. Using Medicare and US Geological Survey data, in 1992-2004 they identified instances in which a patient moved from a dialysis center at an altitude of <2,000 feet (600 m) to one at a higher elevation. Of these moves, 5,274 were ≥3,000 feet (900 m; the altitude group) and 25,345 were 250-500 feet (75-150 m; the control group). Among patients with poor treatment response at baseline, large increases in hematocrit and decreases in erythropoietin dosing were observed in the altitude relative to the control group. At 6 months, hematocrit had increased more in the altitude group (5.1%, 95% confidence interval (CI): 4.1, 6.2 vs. 3.7%, 95% CI: 3.5, 3.9), and erythropoietin dosing decreased more (4,600 units/week, 95% CI: 500, 8,700 vs. 1,700 units/week, 95% CI: 1,000, 2,400). No effect of altitude was observed in patients with better treatment response at baseline. These results support the hypothesis that altitude-induced hypoxia reduces erythropoietin requirements in hemodialysis patients with treatment-refractory anemia.