Inappropriate Usage of Dietary Supplements in Patients by Miscommunication with Physicians in Japan

Recently, people have used dietary supplements not only for nutritional supplementation, but also for treatment of their diseases. However, use of dietary supplements to treat diseases, especially with medications, may cause health problems in patients. In this study, we investigated use of dietary supplements in patients in Japan. This survey was conducted from January to December 2012, and was completed by 2732 people, including 599 admitted patients, 1154 ambulatory patients, and 979 healthy subjects who attended a seminar about dietary supplements. At the time of the questionnaire, 20.4% of admitted patients, 39.1% of ambulatory patients, and 30.7% of healthy subjects were using dietary supplements, which including vitamin/mineral supplements, herbal extracts, its ingredients, or food for specified health uses. The primary purpose for use in all groups was health maintenance, whereas 3.7% of healthy subjects, 10.0% of ambulatory patients, and 13.2% of admitted patients used dietary supplements to treat diseases. In addition, 17.7% of admitted patients and 36.8% of ambulatory patients were using dietary supplements concomitantly with their medications. However, among both admitted patients and ambulatory patients, almost 70% did not mention dietary supplement use to their physicians. Overall, 3.3% of all subjects realized adverse effects associated with dietary supplements. Communication between patients and physicians is important to avoid health problems associated with the use of dietary supplements.     

Concomitant Use of Dietary Supplements and Medicines in Patients due to Miscommunication with Physicians in Japan

We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines.     

Consumer perceptions of trans fats in 2009 show awareness of negative effects but limited concern regarding use in snack foods

The purpose of this study was to determine consumers' perceptions of industrially produced trans fats. A cross-sectional study was conducted in Regina at 3 different grocery store chains located in 3 different regions. A 21-item survey was administered in English by 3 research assistants at the grocery stores over a 5-day period. Of 498 potential respondents who were approached, 211 completed the survey, for a 42% response rate. The majority of respondents were female and over 61 years of age. When respondents were asked if they looked for information on food packages while grocery shopping, none of the respondents indicated that they looked for trans fat on the food label. Ninety-six percent of respondents identified that trans fat is found in processed foods, whereas 42% of respondents incorrectly identified trans fat as being found in nonhydrogenated margarines. More female respondents self-reported that they had made dietary changes to decrease trans fat intake as compared with male respondents (p < 0.05). Those participants who made dietary changes to decrease trans fat intake had higher mean knowledge scores than did those who did not make changes (p < 0.043). Sixty-three percent of respondents indicated that they would not make dietary changes to their snack food selections even if their selections contained trans fat. Consumers know a little about trans fats and consider them to be a concern. However, consumers are reluctant to make dietary changes to limit these fats in their snack food selections.     

Nutritional supplement utilization in an urban family practice center

A survey of 128 patients in an urban family health center examined their use of nutritional supplements and found that 31 percent currently used supplements, primarily multivitamins and other vitamins. The patients' desire to increase their energy and to ensure good nutrition were the major reasons for their taking supplements, along with prevention of illness, desire for strength, and dealing with stress. Patients reported that they were influenced by their physicians' advice and were willing to change their supplement use upon physician recommendation. The resident physicians who cared for these patients were also surveyed, and they estimated that an average of 23 percent of their patients used nutritional supplements. Residents did not consider discussion of nutritional supplements to be of high priority, nor did they usually discuss them with their patients. Discussion about the use of nutritional supplements can contribute to the role family physicians play in nutrition education.     

Consumer Acceptance and Market Potential of Iodine-Biofortified Fruit and Vegetables in Germany

Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that iodine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers’ markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in supermarkets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs.     

Funktionelle Lebensmittel und Nahrungsergänzungsmittel Wissenschaftliche Gesichtspunkte

In the past years many different kinds of new foods have appeared on the German market. Two groups of them, functional foods and dietary supplements, are of special interest, as they are generally offered in order to improve health, performance or wellbeing. The initiatives which pushed forward functional foods as a group started in Japan, where special “health products” are developed and approved by the government as foods for special health use (FOSHU's). For these foods also special claims are allowed. In the USA, legislation was changed to enable the food industry to inform consumers in more detail about the possible health benefit of a certain food. Also so-called “health claims” were allowed, in which consumers learn about the suitability of special foods helping to reduce the risk of several diseases. Tentatively, functional foods can be regarded as a concept to design foods in order to provide an additional, scientifically proven benefit beyond that of meeting basic nutritional needs. In contrast dietary supplements are not ordinary foods, but pills or capsules. They offer substances or ingredients in concentrated form, and they are advertised to supplement an increased need of the human body for these substances. However, the great diversity of substances and the variance of concentrations and dosages, which can be found in dietary supplements suggest that there is no clear health promoting concept behind this particular kind of foods. One of the main problems with these new foods is the lack of transparency, i.e. the absence of an obligatory definition. By this, a straightforward discussion about advantages and disadvantages of these novelties is prohibited and the development of prudent products may be hindered. Moreover questions of effectiveness and safety of functional foods and dietary supplements have to be answered in a very specific way.     

Dietary intake and use of dietary supplements in relation to demographic variables among pregnant Finnish women

Proper nutrition during pregnancy may be important for maternal health and fetal growth and development. In Finland, targeted recommendations are given to guide pregnant women in their food choice and dietary supplement use so that they may obtain adequate nutritional status and meet the increased need for nutrients. The aims of the present study were to examine food choices, nutrient intake and dietary supplement use of pregnant Finnish women in association with demographic variables. One thousand and seventy-five families were invited to a birth cohort study during 1998-9. Mothers of 797 newborns completed a validated 181-item food-frequency questionnaire from which the food and nutrient intakes were calculated. The information about supplement use was collected concerning the whole pregnancy. The results of the present study suggest that healthy food choices are rather common among pregnant Finnish women and the choices are positively correlated with age and education. Nutrient supplements were used by 85 % of the women. Supplements were favoured by the older and well-educated women and by those who had normal weight before pregnancy. Of the women in the present study, 31 % received vitamin A-containing supplements, although it is not recommended during pregnancy. Taking food and supplementation into account, the intake of vitamin D did not meet the dietary recommendation and folic acid intake was below recommendation in 44 % of the women. Therefore there seemed to be unnecessary nutrient supplementation and at the same time lack of relevant supplementation among these pregnant women.     

Barriers to supplemental calcium use among women in suburban family practice: a report from the Cleveland Clinic Ambulatory Research Network (CleAR-eN)

BACKGROUND: The majority of adult women in the United States fail to meet daily calcium intake recommendations. This study was undertaken to (1) identify predictors of calcium supplement use versus non-use, (2) understand barriers to calcium supplementation, and (3) determine the potential impact of physician recommendation on calcium supplement use. METHODS: Surveys were self-administered by 185 women, ages 20 to 64, presenting consecutively for care at 6 suburban community-based family medicine practices within the Cleveland Clinic Ambulatory Research Network (CleAR-eN). We compared demographic characteristics, health beliefs, and health behaviors of those women who reported never using calcium supplements with those who presently took calcium supplements. Women who never took calcium were also queried about reasons for non-use and whether physician recommendation would influence their adoption of calcium supplementation. RESULTS: Multivitamin use, self-perceived risk of osteoporosis, and age were independent predictors of calcium supplement use. Leading barriers for never-users were lack of knowledge about the need/importance of increasing calcium intake, lack of motivation to start supplements, and the belief that their dietary calcium intake alone was sufficient. Ninety-six percent of never-users reported that they would consider taking a calcium supplement if recommended by their physician. CONCLUSIONS: Many patient-identified barriers to calcium supplementation seem amenable to focused and brief office-based interventions that could increase the number of women meeting calcium intake guidelines.     

The Perception of Vitamins and Their Prevalence in Fortified Food and Supplements in Japan

Most vitamins are primarily ingested from foods. However, it has been reported that intakes of some vitamins do not meet the nutrition reference values even in high-income countries. In this case, vitamin-fortified foods and/or vitamin supplements are helpful to fix insufficient/deficient status. However, it is not clear whether consumers are aware of their nutritional status or whether they use these products efficiently. To address this issue, we conducted an online cross-sectional questionnaire survey among 14,741 Japanese adults (over 20 years old, 7489 males and 7252 females) concerning the perceptions and prevalence of vitamin-fortified food and/or vitamin supplements. Differences in distribution among groups were compared using the chi-squared test. According to dietary habits, 33.2% of the participants consumed a well-balanced diet every day, but 25.5% could not because of time (41.6%) or money (36.9%) constraints. The perception of each vitamin varied: the highest was for vitamin C (93.2%) and the lowest was for biotin (41.9%). In addition, only a portion of the participants believed that they took sufficient amounts of each vitamin; the highest was vitamin C (22.3%) and the lowest was biotin (5.2%). Despite this situation, most did not use vitamin-fortified food and/or vitamin supplements due to economic reasons. Among vitamin-fortified food and/or vitamin supplement users, the purposes for the usage of these products were varied, such as maintaining health (80.5%), supplementation of nutrients (47.8%), beauty-related purposes (27.5%), and to prevent infectious disease (23.2%). To remedy nutritional status in individuals, it is important to improve not only consumer awareness but also the environment, which can lead consumers to use acceptable vitamin products without any burden.     

Health food users in two Texas cities. Nutritional and socioeconomic implications.

Health food buyers--both casual purchasers and confirmed customers of health food stores--were surveyed in Dallas and Houston. In both groups, users were generally in the middle class economically and in the active productive age brackets. Users in lower income groups spent larger proportions of their food budget in health food stores. The majority of confirmed users did so in the belief that such foods would provide health benefits, as health food proponents claim. Sixty-six per cent of the general public reported using vitamin and mineral supplements, compared with 93% of the confirmed health food users; the latter usually bought their supplements in health food stores, where megavitamins are likely to be promoted. Users among the general public, on the other hand, purchased supplements in drug stores and supermarkets as a rule.     

Use of vitamins,minerals, and other dietary supplements by 17- and 18-year-old students in Korea

Various types of dietary supplements (DS) are popularly taken by young individuals. We surveyed 1,190 Korean senior high school third grade students for their DS use, motivational factors for this use, and potential dietary consequences of vitamin/mineral supplement (VMS) use. The use prevalence of DS-including VMS, tonic medicines, manufactured health food supplements, cordial food supplements, and drink rehabilitators-was 54%. VMS were taken most frequently, followed by tonic medicines and manufactured health food supplements. VMS use was highest in individuals who had a significant concern for their overall health and in those from families with a high socioeconomic level and with parental use of DS. Total daily study time of DS users was only slightly longer than that of nonusers. The VMS most frequently used were vitamin C and multivitamins. More than 46% of other DS users, and 58% of VMS users, had increased their intake of supplements during third grade relative to the previous year. VMS users had a more positive view of the potential health benefit of VMS than did nonusers. Vitamin and mineral intakes from VMS occurred over a wide range, with mean intakes typically exceeding the Korean and Canadian-U.S. Recommended Dietary Allowances. For a significant number of individuals, intakes of vitamin A, niacin, folic acid, vitamin C, calcium, iron, and zinc exceeded the Tolerable Upper Intake Levels. Given the widespread use of DS by older teenagers, the contribution of these supplements to their overall health and well-being is a subject that clearly merits additional study.     

Achieving a public health recommendation for preventing neural tube defects with folic acid.

OBJECTIVES: This study examined 3 approaches to achieving the public health recommendation that all women of child-bearing age ingest 0.40 mg of folic acid per day to reduce the occurrence of neural tube defects (NTDs). METHODS: A total of 1136 mothers of infants with major malformations from the Boston and Philadelphia areas, whose pregnancies began from 1993 to 1995, were interviewed within 6 months of delivery about vitamin supplementation, dietary intakes, and other factors. RESULTS: Seventy-one percent of the 1136 women in the study did not take folic acid--containing supplements daily before conception, but the proportion decreased over the years of the study. Women not taking supplements consumed an average of 0.25 mg of naturally occurring folates daily. On the basis of dietary intakes reported by women not taking folic acid supplements, a simulation of cereal grain fortification with folic acid at the level required by the US Food and Drug Administration showed that an average of only 0.13 mg of folic acid would be ingested daily. CONCLUSIONS: With consumption of folic acid only through dietary intake, sizeable portions of the childbearing population would receive less than the level of folic acid recommended for preventing NTDs. Even with food fortification, women of childbearing age should be advised to take folic acid--containing supplements on a daily basis.     

Protecting consumers in the wake of the U.S. Dietary Supplement Health and Education Act

The Dietary Supplement Health and Education Act of 1994 has given allied health professionals the responsibility of assisting consumers with the use of dietary supplements. Problematic dietary supplements have been marketed and consumed, often for many years, before interventions by the Food and Drug Administration, and the clinical evaluation of these products takes pharmacologic and toxicologic skills that may be beyond the basic competency skills of some allied health professionals. Allied health professionals are in a position to make a stand regarding dietary supplements and their clinical application, but to do so they may need to complement their pharmacologic and toxicologic skills accordingly.     

Cholesterol treatment practices of primary care physicians.

The active involvement of primary care physicians is necessary in the diagnosis and treatment of elevated blood cholesterol. Empirical evidence suggests that primary care physicians generally initiate dietary and pharmacological treatment at threshold values higher than is currently recommended. To determine current treatment thresholds and establish factors that distinguish physicians who are more likely to initiate therapy at lower cholesterol values, 119 primary care physicians in four northern California communities were surveyed. Data collection included their demographic factors, treatment of hypothetical patients, self-efficacy regarding counseling patients about cholesterol reduction and personal health behaviors, outcome expectations, and cholesterol knowledge and attitudes. Results indicated that 59 percent of respondents would not start dietary treatment on a middle-aged female patient with a cholesterol of 215 milligrams per deciliter (mg per dl). Only 44 percent of respondents indicated that they would initiate pharmacological therapy for a middle-aged man with a cholesterol of 276 mg per dl. Logistic regression models were used to determine characteristics that influenced dietary and pharmacological treatment practices. Younger physicians, those who had had their own cholesterol checked, and those who personally ate a low-fat diet, were more likely to recommend diet therapy to patients with modest elevations of cholesterol. Willingness to use lipid lowering medications at more marked elevations was associated only with increased self-efficacy regarding use of drugs to lower cholesterol. These results indicate that physicians' personal health behaviors and self-efficacy should be addressed in interventions to modify cholesterol-related practice behavior.     

Characteristics that enhance adherence to high-carbohydrate/high-fiber diets by persons with diabetes

This study sought to characterize 40 clients with diabetes, 19 of whom adhered to a high-carbohydrate/fiber diet and 21 of whom did not, in accordance with the adherence pattern. There would seem to be distinct differences in the characteristics of adherers and non-adherers. Dietary adherence was found to be independent for sex, age, occupation, marital status, ethnicity, and education. However, comparison of the groups' health and dietary perceptions showed that non-adherers, as opposed to adherers, were not concerned about reaching their ideal body weight; needed to be motivated to exercise by family or friends; did not perceive diabetes as a threat to their health; were not satisfied with their knowledge about diabetes; were not content with their nutrient status but believed they were consuming adequate amounts of carbohydrate; and believed that they did not need to change their intake of fruit, vegetables, and bread--liking/disliking of these foods being the most important barrier to dietary change. Such patients, identified in screening for potential dietary non-adherence, may benefit from the use of educational strategies different from those used with patients who are more oriented toward health.     

The consumer cost of calcium from food and supplements

Nutritional authorities encourage consumers to include calcium-rich foods in their daily diets. However, consumer purchases are driven not only by health considerations and dietary preferences, but also by cost. This study assessed the cost of calcium from a wide variety of food sources, as well as supplements, based on retail prices in Seattle, San Francisco, Raleigh, NewYork City, and Washington, D.C., while controlling for seasonal variation. Costs were adjusted based on calcium absorption fractions. Calcium carbonate supplements emerged as the least expensive source of calcium, at roughly one-third the cost of the least expensive food source of calcium. The least expensive food sources of calcium were Total cereal, skim milk, and calcium-fortified orange juice from frozen concentrate. This information is useful for dietitians, health professionals, and consumers in meeting calcium requirements on a budget.