Drug-induced acute liver injury mimicking autoimmune hepatitis after intake of dietary supplements containing glucosamine and chondroitin sulfate

INTRODUCTION Herbal and dietary supplements are widely used as measures to improve and preserve health and well-being. Among the bestselling preparations are dietary supplement containing glucosamine and chondroitine sulfate taken to improve symptoms of osteoarthritis. METHODS AND RESULTS We here present a case of a male patient with biopsy-proven acute and severe autoimmune hepatitis subsequent to intake of a preparation containing glucosamine and chondroitine sulfate. Response to steroids was favorable and resulted in complete remission of the patient. Diagnostic work-up of the case revealed no other possible cause of liver injury, and causality assessment using the Roussel Uclaf Causality Assessment Method (RUCAM) resulted in a possible causal relationship between intake of glucosamine and chondroitine sulfate and the adverse hepatic reaction. CONCLUSION The present case recalls that products containing glucosamine and chondroitine sulfate can occasionally cause acute liver injury mimicking autoimmune hepatitis, and reminds of the potential dangers of compounds with poor efficacy and ill-defined safety records.

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements

Objective-To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements. Design-Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas. Procedures-A telephone survey was administered to dog and cat owners. Results-Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least I dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculoskeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used. Conclusions and Clinical Relevance-Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people.

Dietary supplements based on borututu: wich is the most suitable choice for bioactive purposes?

Borututu ( Cochlospermum angolensis Welw.) is a widespread tree in Angola used since antiquity by traditional healers for the prevention and treatment of hepatic diseases and for the prophylaxis of malaria [1]. This plant is mostly consumed as infusions but is also available as dietary supplements, such as piiis, capsules, and syrups, among others. In the present study, the aim was to evaluate the proximate composition and energetic contribution of borututu as weii as its composition in hydrophilic (sugars and organic acids) and lipophilic (fatty acids and tocopherols) compounds, given the fact that this plant is directly introduced in some dietary supplements. Furthermore, the bioactivity (antioxidant, hepatoprotective and antimicrobial activities) of three different formulations of borututu (infusion, pills, and syrup) was assessed and compared, and since plant beneficial properties are often ascribed to phenolic compounds [2], the phenolic profile of the formulations was also analysed. Carbohydrates (88 g/100 g) and fat (2.5 g/100 g) were the major and tl1e minor components of the studied borututu dry barks, respectively, with an energetic contribution of 384 kcal/100 g. Fructose was the most abundant sugar (1.3 g/100 g), foilowed by sucrose, trehalose and glucose (1.1, 0.98 and 0.79 g/100 g, respectively). Oxalic (0.70 g/100 g), malic (0.63 g/100 g) and citric (0.57 g/100 g) acids were present in higher amounts but shikimic and fumaric acids were also detected. Among the fatty acids found in borututu, a prevalence of saturated fatty acids (SF A; 48.2%) was observed, whereas polyunsaturated (PUFA) and monounsaturated (MUFA) fatty acids were detected in relative percentages of 30.9% and 20.8%, respectively. P-tocopherol was the most abundant of the four isoforms found in the sample, foiiowed by o-, a- and y-tocopherol, present in concentrations of 597,43, 3.7 and 2.0 g/100 g, respectively. Borututu infusion revealed the highest antioxidant activity, with EC50 values ranging from 20 to 600 J.lg/mL and was the only formulation inhibiting the growth of an HepG2 ceii line, with a Gl5o value of 146 J.lg/mL. This formulation.also revealed the best antimicrobial capacity and proved to be able to inhibit the growth of Escherichia coli, E. coli ESBL, Staphylococcus aureus and Pseudomonas aeruginosa, with MIC values of 50, 6.2, 1.6 and 25 mg!mL, respectively. Pills revealed activity against some of the studied bacterial strains and the syrup did not reveal antimicrobial activity at the studied concentration. Eilagic acids, methyl ellagic acids, eucaglobulinlglobulusin B and (epi)gaiiocatechin-0-gallate were the compounds present in all the different formulations. The highest concentration of phenolic compounds was found in the infusion extract. Protocatechuic acid was the most abundant phenolic compound in the infusions, the only preparation where it was detected, whereas ( epi)gaiiocatechin- 0-gallate was the main phenolic in the pills and eucaglobulinlglobulusin in the syrup. In a general way, borututu proved to be a good source of phytochemicals such as phenolic compounds, with the infusions revealing the best bioactive properties.

Phenolic profile and antimicrobial activity of dietary supplements based on Cochlospermum angolensis Welw.

Cochlospermum angolensis Welw. (borututu) is a widespread tree in Angola that belongs to the Cochlospermaceae family. Its bark infusion is used in the traditional medicine of Angola for the treatment of jaundice, hepatic diseases and for the prophylaxis of malaria [1]. In the present work, three formulations based on this plant (infusion, pills, and syrup) were characterized by HPLC-DAD-ESI/MS regarding phenolic composition, and evaluated by their in vitro antimicrobial activity against isolates of multiresistant bacteria (Escherichia coli, Escherichia coli spectrum extended producer of β-lactamases (ESBL), Proteus mirabilis, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa). The infusion and pills revealed the highest variety of phenolic compounds, with eleven compounds identified. Protocatechuic acid was only present in infusions, being the most abundant compound, while (epi)gallocatechin-O-gallate and eucaglobulin/globulusin were the main molecules identified in pills and syrup, respectively. Methyl ellagic acids, eucaglobulin/globulusin B (Fig. 1) and (epi)gallocatechin-O-gallate were found in all the formulations. The infusion revealed antimicrobial activity against all the studied bacteria with the exception of P. mirabilis whereas the pills revealed activity in E. coli ESBL and MRSA. No significant antimicrobial activity was detected in the syrup, in agreement with its low concentrations of phenolic compounds. None of the tested formulations inhibited P. mirabilis. Considering the obtained results, C. angolensis infusion can be considered a good source of phenolic compounds as well as a good antimicrobial agent.

Développement de méthodes de dépistage des médicaments de contrefaçon et des produits adultérés par LC-MS/MS

Ce projet de maitrise implique le développement et l’optimisation de deux méthodes utilisant la chromatographie liquide à haute performance couplée à la spectrométrie de masse en tandem (HPLC-MS/MS). L'objectif du premier projet était de séparer le plus rapidement possible, simultanément, 71 médicaments traitant la dysfonction érectile (ED) et 11 ingrédients naturels parfois retrouvés avec ces médicaments dans les échantillons suspectés d’être adultérés ou contrefaits. L'objectif du deuxième projet était de développer une méthode de dépistage permettant l'analyse rapide simultanée de 24 cannabinoïdes synthétiques et naturels pour une grande variété d'échantillons tels que les mélanges à base de plantes, des bâtons d'encens, de sérums et de cannabis. Dans les deux projets, la séparation a été réalisée en moins de 10 min et cela en utilisant une colonne C18 à noyau solide 100 x 2,1 mm avec des particules de 2,6 µm de diamètre couplée à un système MS avec trappe ionique orbitale fonctionnant en électronébulisation positive. En raison du nombre élevé de composés dans les deux méthodes et de l’émergence de nouveaux analogues sur le marché qui pourraient être présents dans les échantillons futurs, une méthode de dépistage LC-MS/MS ciblée/non-ciblée a été développée. Pour les deux projets, les limites de détection étaient sous les ng/mL et la variation de la précision et de l’exactitude étaient inférieures de 10,5%. Le taux de recouvrement à partir des échantillons réels variait entre 92 à 111%. L’innovation des méthodes LC-MS/MS développées au cours des projets est que le spectre de masse obtenu en mode balayage lors de l'acquisition, fournit une masse exacte pour tous les composés détectés et permet l'identification des composés initialement non-ciblés, comme des nouveaux analogues. Cette innovation amène une dimension supplémentaire aux méthodes traditionnellement utilisées, en permettant une analyse à haute résolution sur la masse de composés non-ciblés.

Influence of dietary protein level on the broiler chicken's response to methionine and betaine supplements

Two experiments were conducted to compare broiler chicken responses to methionine and betaine supplements when fed diets with low protein and relatively high metabolizable energy levels (17%, 3.3 kcal/g) or moderate protein and lower metabolizable energy levels (24%, 3.0 kcal/g), resulting in different levels of carcass fat. In Experiment 1, the basal diets were formulated with corn, soybean meal, poultry by-product meal, and poultry oil. In Experiment 2, glucose monohydrate was also added, so that identical amino acid profiles could be maintained in the 17 and 24% protein diets. On average, feeding the 17 vs. 24% protein diet decreased 21-d body weight gain by 20%, increased feed conversion ratio (FCR) by 13%, and increased abdominal fat pad weight by 104%. Methionine and betaine supplements improved the performance of chicks fed the 24% protein diet in both experiments, as indicated by body weight gain and FCR. Only supplementary methionine increased performance of chicks fed 17% protein diets, and then only in Experiment 2. Neither methionine nor betaine decreased abdominal fat pad size in either experiment. Methionine supplementation decreased relative liver size and increased breast muscle protein. Both methionine and betaine increased sample feather weight, but when expressed as a percentage of body weight, no significant differences were detected. It is concluded that increasing carcass fat by manipulating percentage dietary protein level or amino acid balance does not influence betaine's activity as a lipotropic agent.

Dietary Supplement Usage And Motivation In Brazilian Road Runners.

The consumption of dietary supplements is highest among athletes and it can represent potential a health risk for consumers. The aim of this study was to determine the prevalence of consumption of dietary supplements by road runners. We interviewed 817 volunteers from four road races in the Brazilian running calendar. The sample consisted of 671 male and 146 female runners with a mean age of 37.9 ± 12.4 years. Of the sample, 28.33% reported having used some type of dietary supplement. The main motivation for this consumption is to increase in stamina and improve performance. The probability of consuming dietary supplements increased 4.67 times when the runners were guided by coaches. The consumption of supplements was strongly correlated (r = 0.97) with weekly running distance, and also highly correlated (r = 0.86) with the number of years the sport had been practiced. The longer the runner had practiced the sport, the higher the training volume and the greater the intake of supplements. The five most frequently cited reasons for consumption were: energy enhancement (29.5%), performance improvement (17.1%), increased level of endurance (10.3%), nutrient replacement (11.1%), and avoidance of fatigue (10.3%). About 30% of the consumers declared more than one reason for taking dietary supplements. The most consumed supplements were: carbohydrates (52.17%), vitamins (28.70%), and proteins (13.48%). Supplement consumption by road runners in Brazil appeared to be guided by the energy boosting properties of the supplement, the influence of coaches, and the experience of the user. The amount of supplement intake seemed to be lower among road runners than for athletes of other sports. We recommend that coaches and nutritionists emphasise that a balanced diet can meet the needs of physically active people.

Development of a dietary supplement database

Data describing the composition of dietary supplements are not readily available to the public health community. As a result, intake from dietary supplements is generally not considered in most dietary surveys and, hence, little is known about the significance of supplement intake in relation to total diet or disease risk. To enable a more comprehensive analysis of dietary data, a database of the composition of various dietary supplements has been compiled. Active ingredients of all dietary supplements sold in Australia are included in the Australian Register of Therapeutic Goods (ARTG), maintained by the Therapeutic Goods Administration. Products included in the database were restricted to those vitamin, mineral and other supplements identified in dietary data collected from studies conducted in southeast Queensland and New South Wales (850 supplements). Conversion factors from ingredients compounds to active elements were compiled from standard sources. No account has been made for bioavailability, consistent with current practice for food composition databases. The database can be queried by ARTG identification number, brand, product title, or a variety of other fields. Expected future developments include development of standard formulations for use when supplements are incompletely specified, and expansion of products included for more widespread use.

Factors associated with dietary supplement use by people who exercise at gyms

OBJECTIVE To assess the factors associated with the use of dietary supplements by people who exercise at gyms.METHODS A cross-sectional study with a sample defined by convenience, considering the number of gyms registered in the Conselho Regional de Educação Física (Regional Council of Physical Education) of Sao Luis, MA, Northeastern Brazil, from July 2011 to July 2012. The final sample comprised 723 individuals who exercise at gyms. The dependent variable was supplement use, and the explanatory variables were length of time and motivation of the physical exercises, duration, goal and self-perception of training, weekly frequency of gym attendance, sex, age, educational attainment, self-perception of body weight, smoking and self-perception of diet. The association between variables was analysed by hierarchical Poisson regression based on a theoretical model.RESULTS Supplement use was reported by 64.7% of the participants. Most of the sample was male (52.6%). The most frequent age group was 20 to 39 years (74.4%). Most participants (46.1%) had been exercising for over a year. The following variables were associated with supplement use: self-perceiving body weight as below ideal (p < 0.001), smoking (p < 0.001), exercising for 7 to 12 months (p = 0.028) or more than one year (p < 0.001), spending more than two hours at the gym (p = 0.051), and perceiving training as moderate (p = 0.024) or intense (p = 0.001).CONCLUSIONS The use of supplements lacks proper professional guidance, being motivated by individuals unsatisfied with their low body weight and who perceive their workout as intense, which raises the need for monitoring this population.

Osmolality of Elemental and Semi-Elemental Formulas Supplemented with Nonprotein Energy Supplements

Elemental and semi-elemental formulas are used to feed infants with short bowel syndrome, who may not be able to tolerate feeds of more than 310 mOsm kg(-1). The present study aimed to measure the osmolality of elemental and semi-elemental formulas at different concentrations, with and without the addition of nonprotein energy supplements.

Risques rénaux des compléments alimentaires: une cause ignorée [Renal risks of dietary complements: a forgotten cause].

The use of dietary complements like vitamins, minerals, trace elements, proteins, aminoacids and plant-derived agents is prevalent in the general population, in order to promote health and treat diseases. Dietary complements are considered as safe natural products and are easily available without prescription. However, these can lead to severe renal toxicity, especially in cases of unknown pre-existing chronic kidney disease (CKD). In particular, Chinese herbs including aristolochic acid, high doses of vitamine C, creatine and protein complements may lead to acute and chronic renal failure, sometimes irreversible. Dietary complement toxicity should be suspected in any case of unexplained renal impairement. In the case of pre-existing CKD, the use of potentially nephrotoxic dietary complements should be screened for.

Dietary n-6- or n-3-rich vegetable fats and antioxidants: effects on fatty acid composition and stability of rabbit plasma, liver and meat

We supplemented diets with a-tocopheryl acetate (100 mg/kg) and replaced beef tallow (BT) in feeds with increasing doses of n-6- or n-3-rich vegetable fat sources (linseed and sunflower oil), and studied the effects on the fatty acid (FA) composition, the a-tocopherol (aT) content and the oxidative stability of rabbit plasma and liver. These effects were compared with those observed in a previous study in rabbit meat. As in meat, the content of saturated, monounsaturated and trans FA in plasma and liver mainly reflected feed FA profile, except stearic acid in liver, which increased as feeds contained higher doses of vegetable fat, which could be related to an inhibition of the activity of the stearoyl-CoA-desaturase. As linseed oil increased in feeds, the n-6/n-3 FA ratio was decreased in plasma and liver as a result of the incorporation of FA from diets and also, due to the different performance and selectivity of desaturase enzymes. However, an increase in the dose of vegetable fat in feeds led to a significant reduction in the aT content of plasma and liver, which was greater when the fat source was linseed oil. Increasing the dose of vegetable fat in feeds also led to an increase in the susceptibility to oxidation (lipid hydroperoxide (LHP) value) of rabbit plasma, liver and meat and on the thiobarbituric acid (TBA) values of meat. Although the dietary supplementation with a-tocopheryl acetate increased the aT content in plasma and liver, it did not modify significantly their TBA or LHP values. In meat however, both TBA and LHP values were reduced by the dietary supplementation with a-tocopheryl acetate. The plasma aT content reflected the aT content in tissues, and correlated negatively with tissue oxidability. From the studied diets, those containing 1.5% linseed oil plus 1.5% BT and 100 mg of a-tocopheryl acetate/kg most improved the FA composition and the oxidative stability of rabbit tissues.

Prevalence and characteristics of vitamin or dietary supplement users in Lausanne, Switzerland: the CoLaus study.

BACKGROUND AND OBJECTIVES: Vitamin+mineral supplement (VMS) and dietary supplement (DS) use is widespread in the general population, but the motivations for such use are poorly known. The prevalence and characteristics of VMS and DS users in Lausanne, Switzerland, were thus assessed. METHOD: Cross-sectional study was performed including 3249 women and 2937 men (CoLaus study). VMS were defined as single or multivitamin-multimineral preparations. DS included omega-3 or omega-6 fatty acids, herbal teas, plant or animal extracts and bacterial (Lactobacillus) preparations. Calcium and iron supplements were assessed separately. RESULTS: Twenty-six percent of the subjects reported using VMS or DS. VMS were the most frequently consumed item (16.8%), followed by DS (10%), calcium (6.6%) and iron (1.8%). Women reported a higher consumption than men. In women, VMS, DS and calcium use increased and iron use decreased with age, whereas in men only VMS and calcium intake increased with age. Multivariate analysis showed female gender, being born in Switzerland, increased age, higher education and increased physical activity to be positively related with VMS and DS. On bivariate analysis, VMS and DS users presented more frequently with arthritis, anxiety, depression and osteoporosis, but on multivariate analysis only positive relationships between DS use and anxiety/depression (odds ratio (OR)=1.40; 95% confidence interval (CI): [1.16-1.70]) and calcium and osteoporosis (OR=10.6; 95% CI [7.77-14.4]) were found. CONCLUSION: VMS and DS use is common in the population of Lausanne and associated with a better health profile. Calcium supplements are taken to prevent osteoporosis, whereas the rationale for taking other VMS and DS is unclear.