The use of dietary supplements occurs in the majority of American adults >20 years old and has been reported to be on the rise by the National Health and Nutrition Examination Survey. People are not only taking more dietary supplements, but taking them without the advice of a health care provider. With the lack of education time and focus on this topic, physicians need to know some evidence regarding the most common supplements used, how to understand dietary supplement labels, and where to find reputable information about dietary supplements. Vitamin D, Omega-3, and Glucosamine/ Chondroitin are reviewed here. Also, a description of the various components of a dietary supplement label is explained. Finally, a brief description of independent companies (Consumerlabs.com®, US Pharmacopedial Convention, Natural Medicine Comprehensive Database, and Natural Standard) as well as the federally run Office of Dietary Supplements are presented.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: To evaluate the safety and tolerability of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids (Warmi®, Lima Perú;) in otherwise healthy adult women. Methods: This was a phase-I, randomized parallel three arms, double-blinded, and a placebo-controlled clinical trial. A total of 55 participants aged 18-40 were randomly assigned to one of three groups to receive for three months: (1) an oral herbal supplement of 1650 mg/day; (2) an oral herbal supplement of 3300 mg/day; or (3) an oral placebo 3300 mg/day. The primary endpoints were oral safety and tolerability of the supplement. The secondary endpoint was its effect on vital functions, anthropometrics, and laboratory tests. We used an exploratory approach by covariance analysis (ANCOVA) adjusted for the variables’ baseline value for the secondary outcomes. Results: All women completed three months of follow-up, reporting no side effects. Our exploratory analysis revealed that treatment with the herbal supplement of 1650 mg/day was associated with increased glucose and uric acid levels. In comparison, the herbal supplement 3300 mg/day was associated with reduced breathing rate, increased basal temperature, and systolic blood pressure, both compared to the placebo group. However, despite significant differences, none of these was clinically significant. Conclusion: The oral herbal supplement had a favorable safety and tolerability profile in studied women. There is a need to study its potential as an option to treat menopausal symptoms. / Revisión por pares

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Obesity is a major risk factor for many health problems, including cardiovascular disease and diabetes. It is anticipated that the prevalence of obesity in the United States will grow as time passes. The objective of this study is to compare the health of obese women who engage in regular exercise to that of nonobese women. This literature review is drawn from eight library-based research articles at East Tennessee State University (ETSU). The search engine covers topics such as obesity, postmenopausal women, physical activity, nutrition, health, fitness, and lifestyle. Taking nutritional supplements and increased physical exercise minimizes the likelihood of health decline, according to the study's primary findings. Nurses should consider implementing education on regular physical exercise, well-balanced diet, and involvement in activities with those seeking the same goal. Among the limitations include a small sample size, a restricted variety of persons, self-reporting of physical activity, and more.

Introduction: Acute ketone monoester (KE) supplementation affects exercise responses but there are equivocal data regarding the effects on exercise efficiency. We examined the effect of ketone monoester ingestion on exercise efficiency during cycling and probed further the influence of supplement dose and exercise intensity. This study was registered prior to data collection at ClinicalTrials.org (NCT05665855). Methods: Twenty-eight trained adults were recruited [16 males, 12 females; peak oxygen uptake (V̇O2peak): 59±11 ml·kg-1·min-1]. Participants completed three experimental trials in a randomized, crossover, and double-blinded manner, each separated by ~1 week. Participants ingested either a 0.3 (KE-LO) or 0.6 g/kg (KE-HI) body mass dose of KE or a flavour-matched placebo (PLAC) ~30 min prior to exercise. The incremental cycling protocol involved a 3-minute warm-up, three 5-minute stages at 75%, 100%, and 125% of individual ventilatory threshold, and a ramp increase to volitional exhaustion. Expired gases and heart rate were measured continually during exercise. Results: Venous blood [ß-hydroxybutyrate], the major circulating ketone body, was higher in both KE conditions compared to PLAC and also different between conditions (3.0±1.1 and 2.3±0.6 vs 0.2±0.1 mM; all p<0.05). There were no differences in submaximal exercise V̇O2, exercise economy, gross efficiency, or delta efficiency between conditions (all p>0.05). Submaximal exercise heart rate and ventilation were higher in both KE conditions compared to PLAC (141±11 and 141±12 vs 137±12 beats/min; 63±14 and 62±13 vs 60±13 L/min, respectively; all p<0.05). Peak power output at V̇O2peak was lower in KE-HI compared to both KE-LO and PLAC (329±60 vs 339±62 and 341±61 W; both p<0.05). Conclusion: KE supplementation did not alter exercise efficiency during submaximal cycling. KE ingestion increased cardiorespiratory stress during submaximal exercise and the higher dose reduced peak aerobic power output. Future studies should investigate the mechanisms by which KE ingestion alters exercise responses. / Thesis / Master of Science (MSc) / Endurance exercise performance is determined by many variables including the efficiency of the individual. This can be measured during cycling by calculating the ratio of oxygen uptake relative to power output. Ketone supplements have been suggested to alter exercise efficiency. We investigated this issue by having trained adults complete an incremental cycling protocol on three occasions. Before exercise the participants ingested either a small or large dose of a ketone supplement or a taste-matched placebo drink. Exercise efficiency was not different between the conditions but ventilation rate and heart rate were higher during the ketone supplemented trials compared to the placebo. The power output that the participants could achieve at maximal exercise was reduced in the high dose ketone condition. Our study does not support the use of ketone supplements as a strategy to enhance endurance exercise performance. Future studies should investigate the mechanisms by which ketones affect exercise responses.

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Background: Calciferol (vitamin D) is an essential nutrient that can be synthesized in the skin upon exposure to ultraviolet-B (UVB) light, or obtained through dietary and supplement sources. Traditionally known for its role in bone metabolism, vitamin D is currently described as a pleiotropic hormone with genomic and non-genomic roles in most body tissues. Clinical practice guidelines related to vitamin D are inconsistent and controversial. The purpose of this dissertation was to describe current patterns of vitamin D-related clinical care in a variety of settings, and to evaluate the impact of vitamin D supplements on the health and performance of collegiate athletes, a group with high prevalence of low vitamin D (LVD). Methods: This dissertation consists of five studies: 1) a scoping review of the health services literature related to clinical management of vitamin D; 2) a retrospective analysis of clinical care following non-indicated vitamin D testing using electronic health record (EHR) data from a regional health system; 3) a survey study to assess vitamin D-related practices among National Collegiate Athletic Association (NCAA) Division I programs; 4) an open clinical trial to evaluate the efficacy of a specific vitamin D supplement protocol in treating collegiate basketball athletes with LVD; and 5) a randomized, double-blind clinical trial to determine health and performance effects of vitamin D supplements in collegiate swimmers participating in fall season training. Results: Substantial inconsistency in vitamin D-related care was observed throughout the first three studies. Exponential increases in vitamin D testing and treatment, and associated costs, were identified in the U.S. and several other countries. A high proportion of this care was considered non-indicated (i.e., counter to professional guidelines). A lower rate of non-indicated vitamin D-related services was conducted within the health system we studied, but a cascade of low value services followed non-indicated vitamin D testing. Vitamin D testing was regularly performed by more than 65% of NCAA programs. In basketball athletes, 10 weeks of daily vitamin D3 supplements (5000 or 10,000 IU based on initial vitamin D status) improved serum 25-hydroxyvitamin D [25(OH)D], the common biomarker of vitamin D status. In swimmers, a vitamin D supplement protocol (5,000 IU vitamin D3 daily for 12 weeks) was efficacious in attenuating a seasonal decline in 25(OH)D compared with placebo. Swimmers taking vitamin D supplements also showed greater improvements in strength, power, and fat free mass. In both athlete studies, taking vitamin D supplements was associated with higher free testosterone concentration. Conclusions: The provision of evidence-based care related to vitamin D is complicated by contradictory clinical practice guidelines, resulting in inconsistent and sometimes, non-indicated care. Focused research on specific populations at high-risk for LVD can inform best practices. Our results suggest that taking vitamin D supplements is an efficacious strategy for athletes to improve 25(OH)D, especially when UVB exposure is low, and to enhance strength and power in collegiate swimmers. / Ph.D. / Vitamin D is known as the “sunshine vitamin” since it can be synthesized by the human body when exposed to specific wavelengths of ultraviolet-B (UVB) light. Some foods and dietary supplements also contain vitamin D. A relationship between vitamin D and bone health is well-established, but emerging research has also associated vitamin D status with a number of different diseases and health problems, including cancer, cardiovascular disease, autoimmune conditions, and depression. Unfortunately, this research is currently inconclusive, and healthcare providers’ professional guidelines related to vitamin D are highly variable. Thus, providing evidence-based care related to vitamin D is complicated. This dissertation consists of a series of three research studies that describe healthcare providers’ vitamin D-related care considering the uncertain landscape, and two research studies that explore the role of vitamin D in collegiate athletes. We chose athletes since a high proportion of them have deficient or insufficient vitamin D status, and because some research has shown that this low vitamin D status affects athletic performance. Results of these studies showed that vitamin D-related health services such as blood testing have increased dramatically over the past 15 years, as have costs associated with these services. Opportunities to improve consistency and quality of care were observed in multiple settings. In the athlete studies, a high rate of vitamin D deficiency and insufficiency was observed among basketball athletes, and we identified vitamin D supplement treatment protocol effective in improving vitamin D status. In addition, swimmers who took vitamin D supplements performed better on strength and conditioning tests than those who took placebo supplements. A favorable relationship between testosterone concentrations and vitamin D status was shown in both basketball athletes and swimmers. Continuing to conduct research focused on specific populations can help healthcare providers develop consistent, high quality, evidence-based care related to vitamin D.

Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.