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Introduction. The correlation between potassium and nonalcoholic fatty liver disease (NAFLD) is currently still poorly understood. We conducted this study to explore the correlation between dietary potassium intake and NAFLD, as well as advanced hepatic fibrosis (AHF). The study also sought to identify any potential interactions. Methods. The data employed in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) program, encompassing a period from 2007 to 2018. Employing the multiple logistic regression analysis, we evaluated the association of dietary potassium intake with NAFLD and AHF. Subsequently, stratification analysis, based on demographic variables, was constructed so as to assess the stability of the results. In addition, potential interaction effects were assessed by interaction tests. Results. A total of 9443 participants were included in the analysis. The mean age of the participants was 50.4 years, and their daily mean dietary potassium and vitamin C intake was 2556.49 mg and 82.93 mg, respectively. Following comprehensive statistical analyses, the findings indicated a negative correlation between dietary potassium intake and both NAFLD and AHF. Participants in Q4 group with dietary potassium intake exhibited a 31% and 42% reduction in the odds of developing NAFLD and AHF, respectively, in comparison to Q1 group. An interaction effect of dietary vitamin C intake was observed in the association between dietary potassium intake and NAFLD. The results imply that high dietary vitamin C intake augment the inverse relationship between dietary potassium intake and NAFLD. Conclusion. Dietary potassium intake was found to have an inverse association with the odds of both NAFLD and AHF. The association between dietary potassium intake and NAFLD was amplified by the presence of vitamin C in the diet. [ABSTRACT FROM AUTHOR]

Introduction: Although the association between nonalcoholic fatty liver disease (NAFLD) and vitamin C has been well studied, the effects of dietary potassium intake on this relationship are still unclear. Thus, this study aimed to determine the effects of dietary potassium intake on the association between vitamin C and NAFLD. Methods: We performed a cross-sectional learn about with 9443 contributors the usage of 2007–2018 NHANES data. Multiple logistic regression evaluation has been utilized to check out the affiliation of dietary vitamin C intake with NAFLD and advanced hepatic fibrosis (AHF). Subsequently, we plotted a smoothed match curve to visualize the association. Especially, the analysis of AHF was conducted among the NAFLD population. In addition, stratified evaluation used to be developed primarily based on demographic variables to verify the steadiness of the results. Effect amendment by way of dietary potassium intake used to be assessed via interplay checks between vitamin C and NAFLD in the multivariable linear regression. Results: In this cross-sectional study, we found that vitamin C was negatively related to NAFLD and AHF. The relationship between vitamin C and NAFLD was different in the low, middle and high potassium intake groups. Furthermore, potassium intake significantly modified the negative relationship between vitamin C and NAFLD in most of the models. Conclusion: Our research showed that potassium and vitamin C have an interactive effect in reducing NAFLD, which may have great importance for clinical medication. [ABSTRACT FROM AUTHOR]

Background: Klotho is widely recognized as a protein that combats aging and possesses antioxidative characteristics, which have been implicated in the pathophysiology of numerous diseases. There is emerging evidence suggesting that the consumption of dietary nutrients, particularly those rich in antioxidants, could be associated with serum Klotho concentrations. Dietary vitamin C is one of the critical nutrients that possesses antioxidant properties. Nonetheless, the association between dietary vitamin C consumption and serum Klotho concentrations remains unclear. Objective: Aiming to evaluate the relationship between serum Klotho concentrations and dietary vitamin C consumption among Americans aged 40 to 79, we conducted a population-based study. Methods: From the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2016, a grand total of 11,282 individuals who met the criteria were selected as eligible participants for the study. Serum Klotho concentrations were measured using an ELISA kit that is commercially available. Trained interviewers evaluated the consumption of dietary vitamin C in the diet through a 24-hour dietary recall technique. A generalized linear model was used to evaluate the correlation between the consumption of dietary vitamin C in the diet and serum Klotho concentrations. Further examination was conducted using restricted cubic spline (RCS) analysis to explore the non-linear correlation between dietary vitamin C consumption in the diet and serum Klotho concentrations. Results: After accounting for possible confounding factors, serum Klotho concentrations rose by 1.17% (95% confidence interval (CI): 0.37%, 1.99%) with every standard deviation (SD) rise in dietary vitamin C consumption. With the first quintile of dietary vitamin C consumption as a reference, the percentage change of serum Klotho concentrations in the fifth quintile of dietary vitamin C consumption was 3.66% higher (95% CI: 1.05%, 6.32%). In older, normal-weight, and male participants, the subgroup analysis revealed a stronger correlation between dietary vitamin C consumption and serum Klotho concentrations. Analysis of RCS showed a linear positive association between dietary vitamin C consumption and the levels of serum Klotho concentrations. Conclusion: The findings of this research indicate a strong and positive correlation between dietary vitamin C consumption and serum Klotho concentrations among the general adult population in the United States. Further studies are needed to validate the present findings and to explore specific mechanisms. [ABSTRACT FROM AUTHOR]

Hyperuricemia and its complications are severe risks to human health. Dietary intervention is considered an essential part of the management of hyperuricemia. Studies have reported that the intake of antioxidants has a positive effect on hyperuricemia. Here, we collected data from 8761 participants of the National Health and Nutrition Examination Survey for this analysis. Daily intakes of vitamins A, C, and E; manganese; selenium; and zinc were calculated as the composite dietary antioxidant index (CDAI). The participants were divided into four groups (Q1, Q2, Q3, and Q4) according to the CDAI. Univariate analysis was used to assess the association of covariates with hyperuricemia. The association between the CDAI and hyperuricemia was evaluated using multinomial logistic regression, and its stability was determined by stratified analysis. Our results revealed that the CDAI has a significant negative association with hyperuricemia (Q2: 0.81 (0.69, 0.95); Q3: 0.75 (0.62, 0.90); Q4: 0.65 (0.51, 0.82); P < 0.01). The results of stratified analysis emphasize that this association between CDAI and hyperuricemia is stable. In conclusion, this study suggested a negative association between the CDAI and hyperuricemia. [ABSTRACT FROM AUTHOR]

Objectives: Oxidative stress level takes part in the development of cognitive decline. However, the association between total antioxidant capacity (TAC) from diet and cognitive function is controversial. The aim of this study was to investigate the relationship between TAC and the cognitive function of older adults in the U.S. Design: A cross-sectional study. Setting: National Health and Nutrition Examination Surveys database. Participants: 2712 older adults aged over 60 years. Measurements: TAC was calculated from 8 antioxidative vitamins based on the reference values for vitamin C equivalent antioxidant capacity obtained from individuals' 24 h dietary recall. Four memory-related assessments were employed [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)]. Results: Among the 2712 participants, the median age was 68 years, and 50.4% were women. Participants in the group with higher TAC levels had relatively higher IRT, AFT and DSST scores (P=0.025, P=0.008, P<0.001, respectively). In adjusted weighted linear regression, log-transformed TAC was positively associated with AFT (β=1.10, 95%CI: 0.51, 1.70) and DSST (β=2.81, 95%CI: 1.16, 4.45). Compared with the first quartile, the participants in the second (Q2 vs. Q1, OR=0.66, 95%CI: 0.43,1.02) and fourth quartile (Q4 vs. Q1, OR=0.47, 95%CI:0.28, 0.78) of log-transformed TAC showed a decreased risk of impaired cognitive function (ICF) after adjusting for confounders. The dose-response analysis indicated a gradual descent in the risk of ICF as TAC increases. Diabetes mellitus (DM) mediated part of the effect of TAC on ICF. The relationship between TAC and ICF was more pronounced in subjects with DM (Q4 vs Q1, OR=0.36, 95%CI:0.17, 0.74). Conclusion: Our findings support that higher dietary antioxidant potential was related to a decreased risk of cognitive dysfunction, particularly in the subjects with DM who may have oxidative injury. DM was one of the factors mediating the effect of TAC on ICF. [ABSTRACT FROM AUTHOR]

The percentage of US adults following low-carbohydrate diets (LCD) doubled in the last decade. Some researchers observed this trend with concern and highlighted the potential for nutritional deficiencies and impaired overall diet quality with LCD. The present study investigated nutrient intake in a nationally representative sample of 307 US adults following an LCD. Using cross-sectional data from the National Health and Nutrition Examination Surveys, we compared nutrient intake profiles in said individuals with the daily nutritional goals specified in the current 2020–2025 Dietary Guidelines for Americans (DGA). Results were then compared with the general population consuming a standard American diet. Almost 57 % of low-carbohydrate dieters were female, and the mean age was 48·67 (1·35) years. Individuals consuming LCD exceeded the recommendations for saturated fat, total lipid and sodium intake (both sexes). An insufficient intake was observed for fibre, Mg, potassium and several other vitamins (vitamins A, E, D in both sexes as well as vitamin C in men and folate in women). Neither men nor women met the recommendations for fibre intake. A comparable picture was found for the general population. The potentially insufficient intake of several essential nutrients in LCD warrants consideration and a careful assessment with regard to the current DGA. [ABSTRACT FROM AUTHOR]

Background The benefit of a Mediterranean-style diet in reducing frailty is not well established in older Americans. Objectives We sought to determine associations of a Mediterranean-style dietary pattern and related antioxidants with frailty onset and worsening of the Fried phenotype in adults. Methods This prospective study included 2384 nonfrail adults from the Framingham Offspring Study with a Mediterranean-style dietary pattern score (MSDPS) and data on antioxidant intakes (vitamin C, E, and total carotenoids) estimated from an FFQ at the index examination (1998–2001) and 1 prior examination (if available), as well as a frailty assessment at the index examination and at least 1 follow-up. Frailty onset was defined as ≥3 of 5 Fried frailty phenotype criteria at follow-up and the worsening of the Fried frailty phenotype was defined as an increased number of frailty criteria over follow-up (yes or no). Logistic regression with generalized estimating equations estimated ORs and 95% CIs, adjusting for confounders. Analyses were stratified by age (<60 and ≥60 years) for significant interactions. Results The mean ± SD age was 60 ± 9 years (range, 33–86 years) and 55% were female. In adjusted models, a 1-unit higher MSDPS reduced the odds of frailty by 3% (OR, 0.97; 95% CI: 0.96–0.99). Each 10-mg higher total carotenoid and vitamin E intake reduced the odds of frailty by 16% (OR, 0.84; 95% CI: 0.73–0.98) and 1% (OR, 0.99; 95% CI: 0.98–1.00), respectively. No association with vitamin C (P = 0.36) was observed. The associations among participants aged <60 years of age were stronger for each 1-unit higher MSDPS (OR, 0.93; 95% CI: 0.89–0.96) and total carotenoid intake (OR, 0.59; 95% CI: 0.41–0.82) than those observed in older individuals [ORs, 0.98 (95% CI: 0.97–1.00) and 0.92 (95% CI: 0.79–1.08), respectively]. Conclusions Our findings suggest that adherence to a Mediterranean-style diet and higher total carotenoid intake are associated with frailty prevention over time, particularly in adults <60 years. [ABSTRACT FROM AUTHOR]

Objective: To identify the most cost-effective options/contributors of under-consumed food groups and nutrients in the USA.Design: Twenty-four-hour dietary recall data were used for the dietary sources of under-consumed food groups and nutrients. Costs were estimated using USDA National Food Price Database 2001-2004 after adjustments for inflation using Consumer Price Index.Setting: National Health and Nutrition Examination Survey, 2013-2016.Participants: A total of 10 112 adults aged 19+ years.Results: Top five cost-effective options for food groups were apple and citrus juice, bananas, apples, and melons for fruit; baked/boiled white potatoes, mixtures of mashed potatoes, lettuce, carrots and string beans for vegetables; oatmeal, popcorn, rice, yeast breads and pasta/noodles/cooked grains for whole grain; and reduced-fat, low-fat milk, flavoured milk and cheese for dairy. Top five cost-effective sources of under-consumed nutrients were rice, tortillas, pasta/noodles/cooked grains, rolls and buns, and peanut butter-jelly sandwiches for Mg; grits/cooked cereals, low- and high-sugar ready-to-eat (RTE) cereal, rolls and buns, and rice for Fe; low- and high-sugar RTE cereals, rice, protein and nutritional powders, and rolls and buns for Zn; carrots, margarine, other red and orange vegetables, liver and organ meats, butter and animal fats for vitamin A; and citrus juice, other fruit juice, vegetable juice, mustard and other condiments, and apple juice for vitamin C.Conclusions: Apple/citrus juice, white potatoes/carrots, oatmeal, RTE cereals and milk were the most cost-effective food sources of multiple under-consumed food groups and nutrients and can help promote healthy eating habits at minimal cost. [ABSTRACT FROM AUTHOR]

Background: This study examined incidence rates, temporal trends, and demographic factors associated with vitamin deficiencies/disorders in all United States military personnel from 1997 to 2015 (mean N = 1,382,266/year).Methods: Employing an ecological study design, the Defense Medical Epidemiological Database and specific International Classification of Diseases codes were used to determine incidence rates for clinically-diagnosed vitamin deficiencies/disorders. Associations with demographic factors were examined.Results: The overall incidence rate of vitamin deficiencies/disorders was 92.7 cases/100,000 person-years (p-yr). Highest rates were for vitamin D (53.7 cases/100,000 p-yr), other B-complex vitamins (20.2 cases, 100,000 p-yr), vitamin B12 anemia (7.6 cases/100,000 p-yr), deficiencies of "other vitamins" (5.9 cases/100,000 p-yr), and vitamin A (2.5 cases/100,000 p-yr). Thiamin, riboflavin, niacin, pyridoxine, folate, vitamin C, and vitamin K deficiencies and hypervitaminoses A and D had < 1 case/100,000 p-yr. Rates for vitamin D, other B-complex, "other vitamin", and thiamin deficiencies increased over time, while vitamin A and C deficiencies decreased. Women had higher incidence rates for all examined deficiencies/ disorders except niacin and vitamin C. Incidence rates rose with age in 8 of 15 deficiency/disorder categories and blacks had higher incidence rates in 9 of 15 deficiency/disorder categories.Conclusions: The overall rate of clinically-diagnosed vitamin deficiencies and disorders was low but higher in women and minority subgroups. As for most illnesses, the diagnosed incidence of such disorders may be an underestimate of the actual incidence. These findings can guide clinical decision making with regard to testing for nutritional deficiencies and delivering public health information to at risk populations.Clinical Trial Registration: (No. ISRCTN58987177 ). Registration date 9 October 2019. [ABSTRACT FROM AUTHOR]

CVD is the most common chronic condition and the highest cause of mortality in the USA. The aim of the present work was to investigate diet and sedentary behaviour in relation to mortality in US CVD survivors. The National Health and Nutrition Examination Surveys conducted between 1999 and 2014 linked to the US mortality registry updated to 2015 were investigated. Multivariate adjusted Cox regression was used to derive mortality hazards in relation to sedentary behaviour and nutrient intake. A multiplicative and additive interaction analysis was conducted to evaluate how sedentariness and diet influence mortality in US CVD survivors. A sample of 2473 participants followed for a median period of 5·6 years resulted in 761 deaths, and 199 deaths were due to CVD. A monotone increasing relationship between time spent in sedentary activities and mortality risk was observed for all-cause and CVD mortality (hazard ratio (HR) = 1·20, 95 % CI 1·09, 1·31 and HR = 1·19, 95 % CI 1·00, 1·67, respectively). Inverse mortality risks in the range of 22–34 % were observed when comparing the highest with the lowest tertile of dietary fibre, vitamin A, carotene, riboflavin and vitamin C. Sedentariness below 360 min/d and dietary fibre and vitamin intake above the median interact on an additive scale influencing positively all-cause and CVD mortality risk. Reduced sedentariness in combination with a varied diet rich in dietary fibre and vitamins appears to be a useful strategy to reduce all-cause and CVD mortality in US CVD survivors. [ABSTRACT FROM AUTHOR]

To analyze the antioxidant activity of Resveratrol and Ascorbic Acid against hydrogen peroxide (an oxidant) mediated cell injury of human trabecular meshwork cells. Study Design: Experimental study. Setting: Molecular Biology Laboratory at Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro. Period: Six months. (21- 09-2016 to 20-03-2017). Materials and Methods: Human Trabecular Meshwork cells were purchased from ScienCell Research Laboratories, USA. TM cell metabolism, TM cell viability and Reactive oxygen species were detected by standard methods in co- and pre- treated TM cells. Results: A significant reduction in TM cell metabolism was observed approximating 61% at 1.0 mM H2O2 compared to Ascorbate - 99% and Resveratrol 99% (p=0.0001). Resveratrol was more effective than Ascorbate even at 4.0 mM H2O2, the TM cell activity was noted 76%. Compared to H2O2- treated TM cells, resveratrol improved mitochondrial function upto 4.0 mM H2O2 (76%). Compared to co-treatment, the pretreatment shows similar results except at 4.0 mM H2O2. At 4.0 mM H2O2 the pre-treat TM cell metabolic activity was found as 11%, 31% and 47% compared to co-treat as 9%, 31% and 76% in controls, ascorbate and resveratrol groups respectively (p<0.05). Resveratrol shows significant decrease in viability was seen in controls compared to Ascorbate and Resveratrol groups. Cell viability showed statistically significant differences at 2.0 and 4.0 mM H2O2 compared to controls (P=0.0001). For reactive oxygen species (ROS), cells were incubated and with Ascorbate and Resveratrol for 24 hours and TM cells were treated with 0.0mM, 0.5 mM, 1.0 mM, 2.0mM and 4.0mM H2O2. Significant decrease in ROS was noted by Resveratrol compared to Ascorbate. Conclusions: Resveratrol and Ascorbate may prove useful in preventing and delaying the glaucoma, and timely institution of these anti - oxidants may help maintain trabecular meshwork functions and prevent visual loss. [ABSTRACT FROM AUTHOR]

'HoneySweet', a transgenic plum (Prunus domestica) resistant to plum pox virus through RNAi, was deregulated in the U.S. in 2011. The compositional study of 'HoneySweet' fruit was expanded to include locations outside of the US as well as utilizing a wide variety of comparators and different collection years to see the variability possible. The results revealed that plums have a wide variation in composition and that variation among locations was greater than variation among cultivars. This was also the case for different years at one location. The results supported the supposition that the transgene and insertion event had no significant effect on the composition of 'HoneySweet' fruit even under virus pressure, and that it fell in the normal range of composition of commercially grown plums. It also suggested that the effect of environment is as great as that of genetics on the fruit composition of plums. [ABSTRACT FROM AUTHOR]

Background: Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect., Objective: We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is because of high intakes of dietary vitamin C and carotenoids., Methods: We used data from 7572 participants in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (8 United States medical centers, 2010‒2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We estimated the indirect effect of ≥2.5 cups/1000 kcal of fruits and vegetables through vitamin C and carotenoid on the risk of preeclampsia. We estimated these effects using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders, including other dietary components, health behaviors, and psychological, neighborhood, and sociodemographic factors., Results: Participants who consumed ≥2.5 cups of fruits and vegetables per 1000 kcal were less likely than those who consumed <2.5 cups/1000 kcal to develop preeclampsia (6.4% compared with 8.6%). After confounder adjustment, we observed that higher fruit and vegetable density was associated with 2 fewer cases of preeclampsia (risk difference: -2.0; 95% CI: -3.9, -0.1)/100 pregnancies compared with lower density diets. High dietary vitamin C and carotenoid intake was not associated with preeclampsia. The protective effect of high fruit and vegetable density on the risk of preeclampsia and late-onset preeclampsia was not mediated through dietary vitamin C and carotenoids., Conclusions: Evaluating other nutrients and bioactives in fruits and vegetables and their synergy is worthwhile, along with characterizing the effect of individual fruits or vegetables on preeclampsia risk., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Whether or not to mandate nutrition labels on alcoholic beverages is a topic of debate. We examined the effect of nutrition labels on (1) plans for drinking and (2) alcohol expectancies. Study 1, n=80 underage college drinkers responded to an image of a beer with or without a nutrition label. Study 2, n=98 community drinkers responded to either: an accurate label, none, enhanced vitamin C label, extreme low-calorie label. Study 3, n=191 community drinkers compared different labels across five beverages/foods. Results showed null effects for labels; however, 86.1% to 87.0% preferred having information. Though participants reported not believing labels would affect drinking, they largely preferred unrealistically low-calorie alcohol. This may apply toward decisional balance. Nutrition-related approaches offer fruitful directions. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the relationship between serum vitamin C levels and human papillomavirus (HPV) infection is limited. Therefore, this study aimed to investigate whether serum vitamin C levels are independently associated with HPV infection., Methods: Data for this cross-sectional study were obtained from the National Health and Nutrition Examination Survey 2003-2006. A total of 2174 women, 18-59 years of age, were enrolled in this study. The associations between serum vitamin C levels (continuous and categorical forms) and cervicovaginal HPV infection were estimated using weighted logistic regression., Results: The adjusted binary logistic regression showed that serum vitamin C was not associated with the risk of HPV infection after adjusting for age, race, poverty income ratio, alcohol consumption, smoking, body mass index, education, and health condition (odds ratio [OR] 0.998, 95% confidence interval [CI] 0.994-1.001). Serum vitamin C levels were converted from a continuous variable to a categorical variable for the analysis. Compared with the vitamin C deficiency and hypovitaminosis groups, there was a negative correlation between vitamin C and HPV infection when vitamin C was adequate (OR 0.7, 95% CI: 0.52-0.94); however, when the serum vitamin C level was inadequate and saturated, this negative correlation was weaker or nonexistent (OR 0.76, 95% CI 0.56-1.03 and OR 0.76, 95% CI 0.55-1.04, respectively). A nonlinear relationship was detected between vitamin C level and HPV infection. Furthermore, we performed subgroup analysis of different models and found that serum vitamin C concentration was negatively associated with HPV infection in women ≥ 25 years of age; however, in women < 25 years of age, serum vitamin C levels were not associated with HPV infection., Conclusion: The results from this United States nationally representative sample supported the hypothesis that there was a U-shaped relationship between serum vitamin C levels and HPV infection. Future studies are warranted to assess the association between vitamin C and HPV persistence and clarify the underlying mechanisms of these associations., (© 2022. The Author(s).)

Skin cancer is the most common cancer in the United States and among Caucasians worldwide, with more people diagnosed each year than all other cancers combined. Basal cell cancer is the most common form with an estimated 4.3 million cases diagnosed annually, and treatment costs estimated at $4.8 billion. The objective of this study was to compare efficacy of a topical solution consisting of 30% ascorbic acid in 95% dimethylsulfoxide with topical imiquimod in the treatment of basal cell carcinoma. Twenty-five patients with 29 biopsy confirmed basal cell carcinomas were randomly assigned to receive either the topically applied ascorbic acid treatment twice daily for 8 weeks or topical imiquimod, a standard and well characterized topical treatment. After 8 weeks, post-treatment biopsy of lesions showed complete resolution of 13/15 (86.7%) in the ascorbic acid group, while 8/14 (57.1%) lesions in the IMQ group were resolved (p < 0.05 Chi Square). Topical ascorbic acid was superior at 8 weeks, and non-inferior at 12 weeks to topical imiquimod in the treatment of low risk nodular and superficial lesions. In addition, ascorbic acid was associated with fewer adverse effects than imiquimod. 70% of patients in the imiquinod group showed residual hypopigmentation at 30mo follow up versus 0% in the ascorbate group. [Display omitted] • Basal cell cancer is the most common cancer diagnosis in the world. • 30% topical ascorbate acid solution is compared to 5% imiquimod at 8 wks for BCC. • Lesion resolution rates of 86% ascorbate vs 57% imiquimod confirmed by punch biopsy. • Skin hypopigmentation rates at 30 mo follow up: 70% imiquimod vs. 0% ascorbate. • Topical ascorbate is superior to imiquimod for nodular or superficial BCC at 8 wks. [ABSTRACT FROM AUTHOR]

Background: The protective effects of antioxidant vitamins on hearing loss are well established in animal studies but in few human studies. Recent animal studies suggest that magnesium intake along with antioxidants may act in synergy to prevent hearing loss. Objective: We examined associations between intake of antioxidant vitamins (daily b-carotene and vitamins C and E) and magnesium and hearing thresholds and explored their joint effects in US adults. Design: We analyzed cross-sectional data from 2592 participants aged 20-69 y from NHANES 2001-2004. Hearing thresholds as pure tone averages (PTAs) at speech (0.5, 1, 2, and 4 kHz) and high frequencies (3, 4, and 6 kHz) were computed. Results: When examined individually, modeled as quartiles, and after adjustment for potential confounders, higher intakes of b-carotene, vitamin C, and magnesium were associated with lower (better) PTAs at both speech and high frequencies. High intakes of β-carotene or vitamin C combined with high magnesium compared with low intakes of both nutrients were significantly associated with lower (better) PTAs at high frequencies (214.82%; 95% CI: 220.50% to 28.74% for b-carotene + magnesium and 210.72%; 95% CI: 216.57% to 24.45% for vitamin C + magnesium). The estimated joint effects were borderline significantly larger than the sums of the individual effects [high β-carotene/low magnesium (24.98%) and low β-carotene/high magnesium (20.80%), P-interaction = 0.08; high vitamin C/low magnesium (21.33%) and low vitamin C/high magnesium (2.13%), P-interaction = 0.09]. Conclusion: Dietary intakes of antioxidants and magnesium are associated with lower risks of hearing loss [ABSTRACT FROM AUTHOR]

The authors examined long-term antioxidant intake in relation to cognitive decline among older women. Beginning in 1980, Nurses’ Health Study (NHS) participants completed dietary assessments every 4 years; in 1995–2001, 16,010 participants aged ≥70 years completed initial cognitive assessments, which were repeated 3 times at 2-year intervals. Long-term antioxidant intake was averaged from 1980 through the time of initial cognitive interviews. Multivariable-adjusted linear regression was used to estimate mean differences in rates of cognitive decline across categories of vitamin E, vitamin C, and carotenoid intake; statistical tests were 2-sided. No associations were evident for vitamin E or total carotenoid intake and cognitive decline (e.g., after multivariable adjustment, P-trend = 0.44 and P-trend = 0.51, respectively, for a global composite score averaging all 6 cognitive tests), although higher lycopene intake and lower vitamin C intake were related to slower cognitive decline. In alternative analyses of overall cognitive status at older ages (averaging all 4 cognitive assessments), results for vitamins E and C were generally null, but higher carotenoid intake was related to better cognition. Overall, long-term vitamin E and C intakes were not consistently related to cognition, although greater consumption of carotenoids may have cognitive benefits in older adults. [ABSTRACT FROM PUBLISHER]

Background: Children from ethnic minority and low-income families in the United States have higher rates of poor health and higher mortality rates. Diet, an acknowledged correlate of health, may mediate the known race-ethnic and socioeconomic differentials in the health of US children. Objective: The objective was to examine the independent association of race-ethnicity, family income, and education with nutritional and lipid biomarkers in US children. Design: We used data from the NHANES 2003-2006 to examine serum concentrations of vitamins A, D, E, C, B-6, and B-12; serum concentrations of folate, carotenoids, and lipids; and dietary intakes of corresponding nutrients for 2-19-y-old children (n - ~2700- 7500). Multiple covariate-adjusted regression methods were used to examine the independent and joint associations of race-ethnicity, family income, and education with biomarker status. Results: Non-Hispanic blacks had lower mean serum concentrations of vitamins A, B-6, and E and α-carotene than did non- Hispanic whites. Both non-Hispanic blacks and Mexican Americans had higher mean serum vitamin C, β-cryptoxanthin, and lutein + zeaxanthin but lower folate and vitamin D concentrations compared with non-Hispanic whites. In comparison with non-Hispanic whites, non-Hispanic blacks were less likely to have low serum HDL cholesterol or high triglycerides. Family income and education predicted few biomarker or dietary outcomes, and the observed associations were weak. Moreover, modification of race-ethnic differentials by income or education (or vice versa) was noted for very few biomarkers. Conclusion: Race-ethnicity, but not family income or education, was a strong independent predictor of serum nutrient concentrations and dietary micronutrient intakes in US children and adolescents. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the association of antioxidant intakes from diet and supplements with elevated blood C-reactive protein (CRP) and homocysteine (Hcy) concentrations.DesignA cross-sectional study. The main exposures were vitamins C and E, carotene, flavonoid and Se intakes from diet and supplements. Elevated blood CRP and Hcy concentrations were the outcome measures.SettingThe US population and its subgroups.SubjectsWe included 8335 US adults aged ≥19 years from the National Health and Nutrition Examination Survey 1999–2002.ResultsIn this US population, the mean serum CRP concentration was 4·14 (95 % CI 3·91, 4·37) mg/l. Intakes of vitamins C and E and carotene were inversely associated with the probability of having serum CRP concentrations >3 mg/l in multivariate logistic regression models. Flavonoid and Se intakes were not associated with the odds of elevated serum CRP concentrations. The mean plasma Hcy concentration was 8·61 (95 % CI 8·48, 8·74) μmol/l. Intakes of vitamins C, E, carotenes and Se were inversely associated with the odds of plasma Hcy concentrations >13 μmol/l after adjusting for covariates. Flavonoid intake was not associated with the chance of elevated plasma Hcy concentrations.ConclusionsThese results suggest that high antioxidant intake is associated with lower blood concentrations of CRP and Hcy. These inverse associations may be among the potential mechanisms for the beneficial effect of antioxidant intake on CVD risk mediators in observational studies. [ABSTRACT FROM PUBLISHER]

Given the importance of dietary antioxidants in reducing the risks of chronic diseases, the present study aimed to estimate the intake of total antioxidant capacity (TAC) from diet and dietary supplements of US adults. We utilised the US Department of Agriculture flavonoid and proanthocyanidin databases, dietary supplement data and food consumption data of 4391 US adults aged 19+ years in the National Health and Nutrition Examination Survey 2001–2. In order to convert the intake data of individual antioxidant compounds to TAC values, the vitamin C equivalent (VCE) of forty-three antioxidant nutrients measured previously was also applied. Daily TAC averaged 503·3 mg VCE/d (approximately 75 % from diet and 25 % from supplements). The energy-adjusted daily TAC level from diet and supplements was higher in women (except for carotenoids), older adults, Caucasian (except for carotenoids), non-alcohol consumers (for vitamin E and proanthocyanidins), subjects with higher income (except for carotenoids) and higher exercise levels than their counterparts (P < 0·05). TAC was positively associated with daily consumption of fruits and fruit juices, vegetables and vegetable products, beverages, wines and teas (P < 0·001). Teas, dietary supplements, and fruits and fruit juices were the major sources of dietary TAC of the US population (28, 25 and 17 %, respectively), while the contribution of vegetables and vegetable products to TAC was minimal ( < 2 %). The present study indicates that antioxidant intake from various diet and supplements contributes to TAC status. TAC levels are different in sociodemographic subgroups of the US population. The relationship between TAC intake and risks of chronic disease warrants further investigation. [ABSTRACT FROM PUBLISHER]

The article reports on the nutritional and health benefits of blueberries according to scientists in the U.S. Blueberries, according to studies, are low in calories and rich in vitamin C. Clinical trials are being conducted in order to determine whether responses to blueberry compounds observed in animals also occur in people. The cholesterol lowering effects of blueberries are being studied in laboratory animals by Agricultural Research Service (ARS) chemist Wallace H. Yokoyama.

The article presents a study on the quality of weight-reducing diet on micronutrients in the U.S. It highlights the consumption of the nutrients in obese women and collection of dietary data. An overview of analysis on vitamins C, E and B-12 as well as folic acid which indicated decreased energy intake is also provided.

The article presents a study on the effects of antioxidant supplementation particularly vitamin C and E supplementation to endurance athletes in the U.S. It says that vitamin supplementation for physical exercise is associated with reactive oxygen and nitrogen species (RONS) production, which may cause cell damage. Even so, RONS are said to act as important signals for redox state and transcription factors, which may promote training adaptation. Meanwhile, it cites the use of double-blinded placebo-controlled design for the allocation of supplements to participants and a normal distribution for data analysis. Results showed that the ingestion of vitamin C and E to individuals does not alter endurance training adaptation.

Background: Non-Hodgkin lymphoma (NHL) is the fifth most common cancer in the U.S. and few causes have been identified. Genetic association studies may help identify environmental risk factors and enhance our understanding of disease mechanisms. Methodology/Principal Findings: 768 coding and haplotype tagging SNPs in 146 genes were examined using Illumina GoldenGate technology in a large population-based case-control study of NHL in the San Francisco Bay Area (1,292 cases 1,375 controls are included here). Statistical analyses were restricted to HIV- participants of white non-Hispanic origin. Genes involved in steroidogenesis, immune function, cell signaling, sunlight exposure, xenobiotic metabolism/oxidative stress, energy balance, and uptake and metabolism of cholesterol, folate and vitamin C were investigated. Sixteen SNPs in eight pathways and nine haplotypes were associated with NHL after correction for multiple testing at the adjusted q<0.10 level. Eight SNPs were tested in an independent case-control study of lymphoma in Germany (494 NHL cases and 494 matched controls). Novel associations with common variants in estrogen receptor 1 (ESR1) and in the vitamin C receptor and matrix metalloproteinase gene families were observed. Four ESR1 SNPs were associated with follicular lymphoma (FL) in the U.S. study, with rs3020314 remaining associated with reduced risk of FL after multiple testing adjustments [odds ratio (OR) = 0.42, 95% confidence interval (CI) = 0.23-0.77) and replication in the German study (OR = 0.24, 95% CI = 0.06-0.94). Several SNPs and haplotypes in the matrix metalloproteinase-3 (MMP3) and MMP9 genes and in the vitamin C receptor genes, solute carrier family 23 member 1 (SLC23A1) and SLC23A2, showed associations with NHL risk. Conclusions/Significance: Our findings suggest a role for estrogen, vitamin C and matrix metalloproteinases in the pathogenesis of NHL that will require further validation. [ABSTRACT FROM AUTHOR]

A short period of combined deficiency of vitamins E and C causes profound central nervous system (CNS) dysfunction in guinea pigs. For this report, CNS histopathology was studied to define the nature and extent of injury caused by this double deficiency. Weanling guinea pigs were fed a vitamin E-deficient or -replete diet for 14 d. Then vitamin C was withdrawn from the diet of some guinea pigs. Four diet groups were thus formed: replete, vitamin E deficient, vitamin C deficient, and both vitamin E and C deficient. From 5 to 11 d after institution of the doubly deficient diet, 9 of 12 guinea pigs developed paralysis, and 2 more were found dead. The remaining guinea pig in the doubly deficient group and all animals in the other 3 groups survived without clinical impairment until the experiment was terminated at 13-15 d. Brains and spinal cords were serially sectioned and stained for examination. Only the combined deficiency produced damage in the CNS. The damage consisted mainly of nerve cell death, axonal degeneration, vascular injury, and associated glial cell responses. The spinal cord and the ventral pons in the brainstem were most severely affected, often exhibiting asymmetric cystic lesions. Several features of the lesions suggest that the primary damage was to blood vessels. These results indicate that the paralysis and death caused by combined deficiency of vitamins E and C in guinea pigs is caused by severe damage in the brainstem and spinal cord. [ABSTRACT FROM AUTHOR]

Although oxidative stress has been proposed as a mechanism of lead and cadmium toxicity mostly based on in vitro experiments or animal studies, it is uncertain whether this mechanism is relevant in the pathogenesis of lead- or cadmium-related diseases in the general population with low environmental exposure to lead and cadmium. We examined associations of blood lead and urinary cadmium levels with oxidative stress markers of serum γ-glutamyltransferase (GGT), vitamin C, carotenoids, and vitamin E among 10,098 adult participants in the third U.S. National Health and Nutrition Examination Survey. After adjusting for race, sex, and age (plus serum total cholesterol in the case of serum carotenoids and vitamin E), blood lead and urinary cadmium levels both showed graded associations, positive with serum GGT and inverse with serum vitamin C, carotenoids, and vitamin E (p for trend < 0.01, respectively). These associations were consistently observed among most subgroups: non-Hispanic white, non-Hispanic black, men, women, all age groups, nondrinkers, drinkers, nonsmokers, ex-smokers, current smokers, and body mass index (< 25, 25–29.9, and ≥ 30). The strong association of blood lead and urinary cadmium levels with oxidative stress markers in this population suggests that oxidative stress should be considered in the pathogenesis of lead- and cadmium-related diseases even among people with low environmental exposure to lead and cadmium. [ABSTRACT FROM AUTHOR]

Within- and between-person variation in nutrient intake has been characterized in different adult populations, but little is known of country, age, or sex differences among children. The objectives of this study were as follows: 1) to describe the mean intake, within- and between-individual CV and variance ratios of nutrient intake among children ages 9-18 y old in Russia and the United States in 1996; 2) to compare the age and sex-related differences in nutrient intake variance within and between countries; and 3) to hypothesize about the feasibility of using within-individual variance estimates from one nationally representative sample to adjust the usual intake distributions in another nationally representative sample. Mean intakes of all nutrients except magnesium were significantly higher among U.S. children (P < 0.001); within-person variation was higher among the U.S. children, possibly indicating greater access to a wide array of foods. Strong differentials existed in variance components by sex in both countries, although not in the same direction, and differed by age in U.S. girls. Ratios of within- to between-person variance in 8 of 11 nutrients were lower among Russian (range: 0.9-1.6) than U.S. children (range: 1.4-1.7), suggesting that day-to-day bias may not affect Russian dietary recalls as strongly as in the United States. Researchers are encouraged to use these estimates to conduct sensitivity analyses of usual intake distributions in their own data when multiple days of data collection are not feasible. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States. Methods. We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C. Results. Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%-17% and 13%-23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks. Conclusions. Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency. (Am J Public Health. 2004;94:870-875). [ABSTRACT FROM AUTHOR]

Dietary intake, especially of antioxidant vitamins A, C, E, and the carotenoids, has been linked with the presence and severity of asthma. From the Third National Health and Nutrition Examination Survey (NHANES III), conducted in the United States between 1988 and 1994, the authors selected 4,093 children (aged 6–17 years) for whom relevant medical, socioeconomic, and anthropometric data were complete. The children were 50.6% female, and 9.7% reported a diagnosis of asthma. Bivariate analyses showed that asthma diagnosis was associated with lower levels of serum vitamin C, α-carotene, β-carotene, and β-cryptoxanthin. However, antioxidant levels may be surrogate markers for socioeconomic variables such as race, poverty, tobacco exposure, or general nutritional status. In logistic models that included age, body mass index, socioeconomic variables, antioxidant levels, parental asthma, and household smoking, the only antioxidants significantly associated with asthma were vitamin C (odds ratio = 0.72 per mg/dl, 95% confidence interval = 0.55, 0.95) and α-carotene (odds ratio = 0.95 per µg/dl, 95% confidence interval = 0.90, 0.99). The odds ratio for asthma in the highest quintile of serum vitamin C relative to the lowest was 0.65 (p < 0.05), whereas it was 0.74 for α-carotene (p = 0.066). The authors concluded that low vitamin C and α-carotene intakes are associated with asthma risk in children. [ABSTRACT FROM AUTHOR]

Ascorbic acid is an essential nutrient involved in collagen formation, and its deficiency is associated with abnormal bone development. To examine the relation of ascorbic acid to bone mineral density and the prevalence of self-reported fractures, the authors analyzed data collected from 13,080 adults enrolled in the Third National Health and Nutrition Examination Survey (NHANES III) during 1988-1994. Because they identified three-way interactions among smoking, history of estrogen use, and dietary and serum ascorbic acid in postmenopausal women, they analyzed these relations stratified by smoking and estrogen use. Dietary ascorbic acid intake was independently associated with bone mineral density among premenopausal women (p = 0.002). Among men, serum ascorbic acid was associated in a nonlinear fashion with bone mineral density (p < 0.05), and dietary ascorbic acid intake was associated in a nonlinear fashion with self-reported fracture (p = 0.05). Among postmenopausal women without a history of smoking or estrogen use, serum ascorbic acid was unexpectedly associated with lower bone mineral density (p = 0.01). However, among postmenopausal women with a history of smoking and estrogen use, a standard deviation increase in serum ascorbic acid was associated with a 49% decrease in fracture prevalence (p = 0.001). Dietary and serum ascorbic acid measures were associated inconsistently with bone mineral density and self-reported fracture among adult participants in NHANES III. [ABSTRACT FROM AUTHOR]

The authors evaluated the association between use of individual supplements of vitamins A, C, and E only and multivitamins and fatal non-Hodgkin's lymphoma in a large prospective mortality study of US men and women. During 14 years of follow-up (1982–1996), 1,571 non-Hodgkin's lymphoma deaths among 508,351 men and 1,398 non-Hodgkin's lymphoma deaths among 676,306 women were documented. Long-term regular use of individual supplements of vitamins A, C, and E only and multivitamins was unrelated to fatal non-Hodgkin's lymphoma among either men or women. The multivariate relative risks for men who used supplements for 10 or more years were 1.03 (95% confidence interval (CI): 0.54, 2.00) for vitamin A supplements, 1.04 (95% CI: 0.78, 1.39) for vitamin C supplements, 1.06 (95% CI: 0.74, 1.51) for vitamin E supplements, and 1.14 (95% CI: 0.92, 1.40) for multivitamins. The multivariate relative risks for women who used supplements for 10 or more years were 1.40 (95% CI: 0.77, 2.54) for vitamin A supplements, 1.19 (95% CI: 0.89, 1.60) for vitamin C supplements, 1.27 (95% CI: 0.87, 1.84) for vitamin E supplements, and 1.21 (95% CI: 0.98, 1.50) for multivitamins. All associations became weaker when vitamin supplements were mutually adjusted. These findings do not support an important relation between long-term regular use of individual supplements of vitamins A, C, and E only and multivitamins and fatal non-Hodgkin's lymphoma. [ABSTRACT FROM PUBLISHER]

Investigates the link between serum ascorbate concentration and mortality among adults in the United States, and whether the association was modified by cigarette smoking status or sex. Method used to estimate relative risk of death; Percent risk of dying from any cause by men in the lowest versus highest serum ascorbate level; Absence of link between serum ascorbate quartile and mortality in women.

Although undisputed for its anti-inflammatory and immune system boosting properties, vitamin C remains an inconsistently investigated nutrient in the United States. However, subclinical inadequacies may partly explain increased inflammation and decreased immune function within the population. This secondary analysis cross-sectional study used the 2003-2006 NHANES surveys to identify more clearly the association between plasma vitamin C and clinical biomarkers of acute and chronic inflammation C-reactive protein (CRP) and red cell distribution width (RDW). From plasma vitamin C levels separated into five defined categories (deficiency, hypovitaminosis, inadequate, adequate, and saturating), ANOVA tests identified significant differences in means in all insufficient vitamin C categories (deficiency, hypovitaminosis, and inadequate) and both CRP and RDW in 7607 study participants. There were also statistically significant differences in means between sufficient plasma vitamin C levels (adequate and saturating categories) and CRP. Significant differences were not identified between adequate and saturating plasma vitamin C levels and RDW. Although inadequate levels of vitamin C may not exhibit overt signs or symptoms of deficiency, differences in mean levels identified between inflammatory biomarkers suggest a closer examination of those considered at risk for inflammatory-driven diseases. Likewise, the subclinical levels of inflammation presented in this study provide evidence to support ranges for further clinical inflammation surveillance.

Objectives. This study examined the correlates of clinical gallbladder disease among US adults and whether serum ascorbic acid levels are associated with a decreased prevalence of gallbladder disease. Methods. Cross-sectional analyses of data from the Second National Health and Nutrition Examination Survey were conducted. Results. A total of 384 women (8%) and 107 men (3%) reported a history of gallstone disease, and 347 women (7%) and 81 men (2%) reported a history of cholecystectomy. An inverted U-shaped relation was found between serum ascorbic acid level and clinical gallbladder disease among women but not among men. Conclusions. Ascorbic acid, which affects the catabolism of cholesterol to bile acids and, in turn, the development of gallbladder disease in experimental animals, may reduce the risk of clinical gallbladder disease in humans. [ABSTRACT FROM AUTHOR]

Agreement among three indicators of vitamin C status-serum ascorbate level, a 24-hour recall, and the frequency of fruit and vegetable consumption-was examined using data from the Second National Health and Nutrition Examination Survey conducted between 1976 and 1980. Agreement between pairs of these indicators was good when assessed at the group level but inconsistent at the individual level. These indicators, when classified as continuous measures, had moderately good agreement (r = 0.45–0.54), whereas agreement was poor when classified as quartiles (kappa = 0.17–0.23). Agreement between clinically based categories of serum ascorbate and total intake levels was poorer than expected (kappa = 0.25) as was agreement between low or deficient levels hof both of these indicators (kappa = 0.3). Disagreement between low or deficient serum and intake levels was greater in participants who were younger, African American compared with white and other races, less educated, current smokers, onsupplement users, and examined in the winter compared with in the summer or fall. These findings suggest that the indicators cannot be used interchangeably to assess vitamin C status because they distinguish between different aspects of status, intake level versus serum level, an indicator of available pool. Moreover, depending upon how these indicators are used in statistical analyses, they may classify individuals differently. [ABSTRACT FROM AUTHOR]

The article presents a study on the lognormal model for ascorbic acid requirements in man. The article implies that there is uncertainty in the accuracy of the minimum daily adult requirement of Vitamin C set down by the Food and Drug Administration and this initiated the study. The article draws concepts and grounds coming from other studies on optimum human health, common cold prevention, and log-normal distribution to see if the natural logarithm is normally distributed. The article concludes with an assumption on the proper dosages of Vitamin C intake and its threshold effect on the common cold and an assumption on the ordinary diet with food containing 100 milligrams of Vitamin C per day.

Parkinson's disease (PD) is a neurodegenerative disorder caused by the depletion of dopaminergic neurons in the basal ganglia, the movement center of the brain. Approximately 60,000 people are diagnosed with PD in the United States each year. Although the direct cause of PD can vary, accumulation of oxidative stress-induced neuronal damage due to increased production of reactive oxygen species (ROS) or impaired intracellular antioxidant defenses invariably occurs at the cellular levels. Pharmaceuticals such as dopaminergic prodrugs and agonists can alleviate some of the symptoms of PD. Currently, however, there is no treatment to halt the progression of PD pathology. Due to the nature of PD, a long and progressive neurodegenerative process, strategies to prevent or delay PD pathology may be well suited to lifestyle changes like dietary modification with antioxidant-rich foods to improve intracellular redox homeostasis. In this review, we discuss cellular and genetic factors that increase oxidative stress in PD. We also discuss neuroprotective roles of dietary antioxidants including vitamin C, vitamin E, carotenoids, selenium, and polyphenols along with their potential mechanisms to alleviate PD pathology. [ABSTRACT FROM AUTHOR]

Low intakes of fruits and vegetables have resulted in suboptimal intakes of several micronutrients, including vitamin C. This cross-sectional study used data from 84,902 children/adults (≥1 y) who completed a 24-h dietary recall as part of the United States National Health and Nutrition Examination Survey (1999-2018). Mean vitamin C intakes from foods/beverages were calculated as were trends in major food/beverage sources of vitamin C. Percentages below the Estimated Average Requirement (EAR) were estimated. Overall, mean vitamin C consumption declined by 23% (97-75 mg/d; p -value for trend < 0.001). 100% fruit juice was the leading source of vitamin C (25.6% of total or 21.7mg/d), but this declined by 48% (25-13 mg/d; p -value for trend < 0.001). Whole fruit increased among children/adolescents (+75.8%;10-17 mg/d; p -value for trend < 0.001), but not adults, while the vegetable contribution was generally unchanged. The proportion of the population below the EAR increased by 23.8% on a relative scale or 9 percentage points on an absolute scale (38.3-47.4%). Declines in vitamin C intake is driven largely by decreases in fruit juice coupled with modest increases in whole fruit. Due to associations between vitamin C intake and numerous health outcomes these trends warrant careful monitoring moving forward.

Background: Use of complementary and alternative medicine (CAM), including vitamins, minerals, herbals, and other dietary supplements, is widespread in the United States (ranging from 24% in Hispanics to 50% in American Indians). Pharmacists are an accessible source for healthcare information, but little is known about their use of CAM products and to whom they would recommend these products. Methods: A cross-sectional survey was sent via email to pharmacists licensed in one state in the United States in 2015. The survey included items about their use of 10 vitamins and minerals, and 21 herbal or other dietary supplements, as well as reasons for use, conditions used to treat, if they would recommend the product to patients, family, or friends, their perception of CAM safety and effectiveness, and four demographic questions. Descriptive statistics were used to summarize the data, and a chi-square test was used to determine differences between pharmacists' use of vitamins/minerals and herbals/other dietary supplements. The a priori alpha level was 0.05. Results: A total of 639 pharmacists completed the survey. Female pharmacists used vitamins/minerals (p = 0.031) and herbals/others (p = 0.039) more than male pharmacists. Older pharmacists used herbals/others more than younger pharmacists (p < 0.001). Fifty-nine percent thought the dietary supplements in the survey were safe while 32% reported they were effective. Seventy-eight percent of respondents reported use of any vitamin or mineral product versus 42% who reported use of any herbal or other dietary supplement. Commonly used products included: multivitamins (91%), vitamin C (71%), fish oil (65%), probiotics (53%), and fiber (53%). The most commonly reported reason for use was general health and wellness (17–90%). Pharmacists most commonly recommend fiber/psyllium (94%) and calcium (90%) to patients, family, and friends. Conclusions: Pharmacists in this survey selectively used vitamins, minerals, herbals and other dietary supplements, and recommended some of the more commonly used products to patients, family and friends. This is valuable information given that pharmacists are frontline healthcare professionals who may be asked to provide advice about these products. [ABSTRACT FROM AUTHOR]

Background: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed., Methods: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll patients with sepsis causing respiratory or circulatory compromise or both. Patients will be randomly assigned (1:1) to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 h or matching placebos until a total of 16 administrations have been completed or intensive care unit discharge occurs (whichever is first). Patients randomly assigned to the comparator group are permitted to receive open-label stress-dose steroids at the discretion of the treating clinical team. The primary outcome is consecutive days free of ventilator and vasopressor support (VVFDs) in the 30 days following randomization. The key secondary outcome is mortality at 30 days. Sample size will be determined adaptively by using interim analyses with pre-stated stopping rules to allow the early recognition of a large mortality benefit if one exists and to refocus on the more sensitive outcome of VVFDs if an early large mortality benefit is not observed., Discussion: VICTAS is a large, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial that will test the efficacy of vitamin C, thiamine, and hydrocortisone as a combined therapy in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. Because the components of this therapy are inexpensive and readily available and have very favorable risk profiles, demonstrated efficacy would have immediate implications for the management of sepsis worldwide., Trial Registration: ClinicalTrials.gov Identifier: NCT03509350 . First registered on April 26, 2018, and last verified on December 20, 2018. Protocol version: 1.4, January 9, 2019.