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Objective: To identify the lifetime prevalence and correlates of appearance- and performance-enhancing drugs and substances (APEDS) use among a national sample of US college and university students. Participants: Student participants from the 2020–2021 Healthy Minds Study (N = 7,401; ages 18–30 years). Methods: Lifetime prevalence of five forms of APEDS was estimated. Modified Poisson regression analyses were conducted to determine the sociodemographic correlates of protein and creatine supplement use. Results: Lifetime protein (23.8%) and creatine (7.7%) supplement use were most common among the sample. Older age within young adulthood, male sex, perceiving oneself to be normal weight or somewhat overweight, any athletics participation, and 2–3 or ≥ 5 h/week of exercise were associated with greater likelihood of lifetime protein and creatine supplement use. Conclusions: Awareness and prevention efforts on the potential harms of APEDS use are needed on campuses, particularly among males and those who participate in athletics and high-frequency exercise. [ABSTRACT FROM AUTHOR]

The use of nutritional supplements can lead to doping risk and no data exist on high school athletes' use of certified third-party tested supplements. A cross-sectional cohort design was developed using an anonymous survey. Descriptive data for supplement use, use of third-party tested supplements, and knowledge in high school athletes were reported. A total of 225 high school athletes, ranging from 14-19 years of age, from a private high school in the western US, were included in the analysis of the results. A total of 94% (n=211) of athletes reported nutritional supplement use within the past year with an average of six (interquartile range: 3-9) individual supplements, ranging from 0-20 supplements per person. Most frequently reported were sports drinks (72%), vitamins (65%), sports bars (60%), protein powder (58%), caffeine (37%, as part of normal beverages, or 13% as a supplement), followed by creatine (23%). A total of 24% claimed to know for sure that all their supplements were third-party tested. In addition, the recognition of third-party testing organization icons was low (46% in supplement users vs. 14% in nonusers). Athletes also scored low in reporting how to find (22%) and how to order (25%) third-party tested supplements. In conclusion, almost all athletes in this study reported the use of multiple nutritional supplements annually. Only one-fourth of the athletes reported consistently using third-party tested supplements. Knowledge of where and how tested supplements could be purchased was limited in this high school athlete population. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease, affecting approximately 6.5 million older adults in the United States. Development of AD treatment has primarily centered on developing pharmaceuticals that target amyloid-β (Aβ) plaques in the brain, a hallmark pathological biomarker that precedes symptomatic AD. Though recent clinical trials of novel drugs that target Aβ have demonstrated promising preliminary data, these pharmaceuticals have a poor history of developing into AD treatments, leading to hypotheses that other therapeutic targets may be more suitable for AD prevention and treatment. Impaired brain energy metabolism is another pathological hallmark that precedes the onset of AD that may provide a target for intervention. The brain creatine (Cr) system plays a crucial role in maintaining bioenergetic flux and is disrupted in AD. Recent studies using AD mouse models have shown that supplementing with Cr improves brain bioenergetics, as well as AD biomarkers and cognition. Despite these promising findings, no human trials have investigated the potential benefits of Cr supplementation in AD. This narrative review discusses the link between Cr and AD and the potential for Cr supplementation as a treatment for AD. [ABSTRACT FROM AUTHOR]

Simple Summary: Diffuse intrinsic pontine gliomas in children are rare, highly malignant infiltrating tumors in a location precluding surgical resection. The absence of non-invasive correlates of response and disease progression in these tumors invites the exploration of imaging biomarkers. Magnetic resonance spectroscopy is an advanced imaging technique for measuring cell metabolites. This study evaluated whether measurements of in vivo cell metabolites using magnetic resonance spectroscopy may serve as biomarkers of response to therapy, including progression. Single-voxel magnetic resonance spectra were serially acquired in two cohorts of patients with these tumors treated with radiation therapy with or without concurrent chemotherapy and prior to progression: 14 participants were enrolled in a clinical trial of adjuvant glioma-associated antigen peptide vaccines and 32 patients were enrolled who did not receive adjuvant vaccine therapy. In the vaccine cohort, an elevated myo-inositol/choline ratio after 2–3 doses was associated with longer survival. Scans performed up to 6 months before death showed a terminal decline in the myo-inositol/choline ratio. Higher myo-inositol/choline ratios following radiation therapy, consistent with less proliferate tumors and decreased cell turnover, were associated with longer survival, suggesting that this ratio can serve as a biomarker of prognosis following radiation therapy. Purpose: Diffuse intrinsic pontine gliomas (DIPG) are highly aggressive tumors with no currently available curative therapy. This study evaluated whether measurements of in vivo cell metabolites using magnetic resonance spectroscopy (MRS) may serve as biomarkers of response to therapy, including progression. Methods: Single-voxel MR spectra were serially acquired in two cohorts of patients with DIPG treated with radiation therapy (RT) with or without concurrent chemotherapy and prior to progression: 14 participants were enrolled in a clinical trial of adjuvant glioma-associated antigen peptide vaccines and 32 patients were enrolled who did not receive adjuvant vaccine therapy. Spearman correlations measured overall survival associations with absolute metabolite concentrations of myo-inositol (mI), creatine (Cr), and n-acetyl-aspartate (NAA) and their ratios relative to choline (Cho) during three specified time periods following completion of RT. Linear mixed-effects regression models evaluated the longitudinal associations between metabolite ratios and time from death (terminal decline). Results: Overall survival was not associated with metabolite ratios obtained shortly after RT (1.9–3.8 months post-diagnosis) in either cohort. In the vaccine cohort, an elevated mI/Cho ratio after 2–3 doses (3.9–5.2 months post-diagnosis) was associated with longer survival (rho = 0.92, 95% CI 0.67–0.98). Scans performed up to 6 months before death showed a terminal decline in the mI/Cho ratio, with an average of 0.37 ratio/month in vaccine patients (95% CI 0.11–0.63) and 0.26 (0.04–0.48) in the non-vaccine cohort. Conclusion: Higher mI/Cho ratios following RT, consistent with less proliferate tumors and decreased cell turnover, were associated with longer survival, suggesting that this ratio can serve as a biomarker of prognosis following RT. This finding was seen in both cohorts, although the association with OS was detected earlier in the vaccine cohort. Increased mI/Cho (possibly reflecting immune-effector cell influx into the tumor as a mechanism of tumor response) requires further study. [ABSTRACT FROM AUTHOR]

Objectives: Recent clinical trials suggested a potential benefit of dietary creatine on cognitive function for aging individuals. However, the association between creatine consumption from food and cognitive function in the older adults remained undetermined at the populational level. The present study quantified the amount of creatine consumed through a regular diet among U.S. adults aged 60 years and over, and evaluated the link between dietary creatine and cognitive function using data from the 2001–2002 National Health and Nutrition Examination Survey (NHANES). Methods: NHANES 2001–2002 round included a total of 1340 older adults (51.8% women; age 71.4 ± 7.8 years) who provided valid dietary information and cognitive testing measures. Dietary intake information was obtained from the NHANES Dietary Data component through a 24-h in-person dietary recall interview. Cognitive function was assessed using the WAIS III Digit Symbol Substitution Test (DSS) conducted during the household interview. Results: A bivariate model revealed a significant positive correlation between DSS scores and creatine intake across the whole sample (τb = 0.043; P = 0.02). The partial models demonstrated a significant correlation between creatine consumption and DSS score when adjusted for sociodemographic variables (r = 0.062; P = 0.039), and nutritional variables (r = 0.055; P = 0.049). The participants who consumed more than 0.95 g of creatine per day (3rd and 4th quartiles of creatine intake) were found to have higher scores on the cognitive functioning test as compared to their peers with lower creatine intake (1st and 2nd quartiles) (P < 0.05). Conclusion: Our findings suggest that creatine from food might be protective against reduced cognitive performance in the older population. Further research is highly warranted to investigate the role of dietary creatine amount in cognitive function in the older adults. [ABSTRACT FROM AUTHOR]

We examined dietary intake of creatine in U.S. men and women aged 65 years and over, and evaluated the association between creatine intake and risk of self‐reported medical conditions, and physical functioning/disability variables using data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). The NHANES 2017–2018 target population included the noninstitutionalized civilian resident population of the United States aged 65 years and over. Detailed dietary intake data from NHANES elderly were obtained by dietary interview component through a 24‐h dietary recall interview, with estimated individual values for total grams of creatine consumed per day for each respondent. A threshold for dietary intake of creatine used to calculate risk between creatine intake and medical conditions was set at 1.00 g/day. The sample population included 1500 participants aged 65 years and older, of which 1221 individuals (627 men and 594 women) provided detailed dietary data via a dietary interview. Creatine intake across all participants was 0.76 ± 0.79 g/day (95% CI from 0.72 to 0.81). As much as 70% of U.S. elderly consume <1.00 g of creatine per day, with about 1 in 5 individuals (19.8%) consume no creatine at all. Elderly with the suboptimal intake of creatine were found to have 2.62 times higher risk of angina pectoris (adjusted OR = 2.62, 95% CI from 1.14 to 6.01, p =.023) and 2.59 times higher risk of liver conditions (adjusted OR = 2.59, 95% CI from 1.23 to 5.48, p =.013), compared with older counterparts who consume ≥1.00 g of creatine per day after controlling for demographic and nutritional variables. The considerable shortage of dietary creatine is associated with an increased risk of heart and liver conditions, which calls for public measures that foster diets rich in creatine‐containing foods, and additional research to investigate the role of creatine in age‐related diseases. [ABSTRACT FROM AUTHOR]

Glomerular filtration rate (GFR) is a key index of renal function. The classic method for assessing GFR is the clearance of inulin. Several current methods using isotopic (125I-iothalamate, 51Cr-EDTA, or 99Tc-DTPA) or nonisotopic (iohexol or iothalamate) markers are available. Clinically, GFR is estimated (eGFR) from serum creatinine or cystatin C levels. Estimated GFR based on creatinine and/or cystatin are less accurate than measured GFR. The creatinine-based equations calculate higher eGFR values (suggesting better kidney function) for black individuals. This upward adjustment for all black individuals is embedded in eGFR calculations on the belief of higher serum creatinine concentrations among black individuals than among white individuals. Thus "race-corrected" eGFR has become a widely accepted and scientifically valid procedure. However, race is not a genetic or biological category. Rather, race is a social construction defined by region-specific cultural and historical ideas. Furthermore, there is no accepted scientific method for classifying people as black or white individuals. Studies typically rely on self-identification of race. However, any person in the United States with any known black ancestry is considered to be a black individual. This is known as the "one-drop rule," meaning that a single drop of "black blood" makes anyone a black individual. It does not matter if an individual has 50%, 25%, 5%, or 0.5% African ancestry. The limited accuracy and reliability of this approach would not be allowed for any other scientific variable. Admixture and migration have produced such broad variations that race categories should not be used as experimental variables. [ABSTRACT FROM AUTHOR]

Introduction: Recent population-based studies reported an inadequate dietary intake of creatine, a conditionally essential nutrient that plays an important role in human metabolism. Methods: We analyzed here the nutritional profiles of US adults with low creatine consumption, using data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES). Results: Among 4,004 NHANES adult participants that reported detailed dietary intake information, 2,611 (65.2%) were calculated to have dietary creatine intake below recommended levels of 1.00 g/day. The average daily creatine intake in this subpopulation was 0.52 ± 0.26 g (95% confidence interval, from 0.51 to 0.53). This was accompanied by a significantly lower dietary intake of meat-based protein, as compared to participants whose dietary creatine intake was equal to or above recommended levels (20.1 ± 10.2 g/day vs. 67.1 ± 30.4 g/day; p < 0.001). Conclusion: The large-scale rate of suboptimal dietary creatine intake found in this cross-sectional study warrants additional research, and calls for immediate public health measures fostering creatine-rich foods in human nutrition. [ABSTRACT FROM AUTHOR]

The history and trends in use of dietary supplements as documented in the National Health and Nutrition Examination Survey are summarized. The safety and efficacy of selected supplements are discussed. The current regulation of dietary supplements is not robust because legislation governing enforcement is weaker than it is for drugs. [ABSTRACT FROM AUTHOR]

In the article, the authors present their study on the amount of creatinine consumed by American children on a regular diet based on data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES).

ε-Polylysine is a novel food preservative approved by the U.S. Food and Drug Administration (FDA), yet the mechanism of its effect on animal-derived foods remains unclear. Assessment of the effect of preservatives on goat meat products is necessary. Herein, metabolite accumulation and protein expression of ε-polylysine (0.025%, w/w) spiked with goat meat were investigated by nontarget metabolomics and proteomics combined with ultrahigh performance liquid chromatography quadrupole-Orbitrap high-resolution-mass spectrometry (UHPLC-Q-Orbitrap HRMS) in a simulated in vitro digestion model. The amino side chain of ε-polylysine increased the activity of glycine aminotransferase due to its nucleophilic nature, inducing a significant upregulation of l-arginine (0.43-0.72 mg kg -1 ) and creatine (3.98-6.89 mg kg -1 ), with an improvement in muscle quality of goat meat. Downregulation of enzyme phenylalanine hydroxylase expression led to upregulation of l-phenylalanine (2.26-3.25 mg kg -1 ) and l-tyrosine (0.98-1.29 mg kg -1 ). Collectively, this study first revealed the biochemical mechanism of ε-polylysine in goat meat products, which makes available new prospects for more accurate use of ε-polylysine in animal-derived foods.

Background: The sale and utilization of dietary and fitness supplements in America, with industry revenue totaling 140.3 billion in 2020 alone, has proven significant. Unfortunately, these supplements are not held to high standards of manufacturing or marketing, leading to ethical, financial, and physiological repercussions for consumers. Aim: The aim of this study is to discuss specific examples of a prevalent issue within the supplementation industry; we suggest the implementation of regulatory processes in the sale and marketing of such products. Methods: Studies from 2007 to 2021 which illustrate positive or negative effects of specific supplements based on gross revenue or a high level of publicity were analyzed. Results: Within this paper, we outline potential regulations which could assist in mitigating the negative impact that a lack of oversight has precipitated. These regulations include an initial approval request which reviews supplement ingredients, effects, risks, and therapeutic index. Conclusion: If the proposed regulations are introduced, the data collected via supplement applications may be utilized in classifying the supplement by its risk before it is marketed to the general population with supervision by pharmacists when indicated, ultimately reducing the adverse effects of inappropriate supplementation.

Elevated circulating total homocysteine (tHcy) concentrations are related to increased risk for cardiovascular disease. Folic acid fortification resulted in a significant decrease in circulating tHcy in the United States. In the post-folic acid fortification period, associations between plasma tHcy and demographic, health, and lifestyle factors and B vitamin status were investigated. Data from the 3 recent NHANES cycles (1999-2004) were used to study the associations among plasma tHcy and sex, race/ethnicity, age, BMI, blood pressure (BPI, serum creatinine, serum cotinine, vitamin/mineral supplement use, and folate and cobalamin status in 16,254 persons 18329 men, 7925 women). Multivariate-adjusted plasma tHcy was ~9.7% higher in men than in women IP < 0.00011, ~53% higher in non-Hispanic whites than in non-Hispanic blacks (P < 0.0001), ~64.5% higher in individuals aged ≥60 y than in individuals aged <20 y (P < 0.0001), and ~5% higher in supplement nonusers than in supplement users IP < 0.0001). Persons in the 4th quartile for serum creatinine, serum cotinine, systolic BP, and serum methylmalonic acid (MMA) had ~36.1, ~13.4, ~5.6, ard ~16.2%, respectively, higher tHcy than those in the 1st quartile (P < 0.0001). Plasma tHcy was inversely associated with serum folate (P < 0.0001), RBC folate )P< 0.00011, and serum cobalamin (P< 0.0001). In the post-folic acid fortification period, sex, race/ethnicity, age, systolic BP, supplement use, RBC folate, and serum creatinine, cotinine, folate and cobalamin are significant determinants of plasma tHcy. Serum MMA was strongly associated with plasma tHcy. [ABSTRACT FROM AUTHOR]

Purpose: 3'-[F-18]Fluoro-3'-deoxythymidine (FLT) is an analog of thymidine that is being developed for imaging cellular proliferation. The goal of this study was to prove that the dose of FLT used for positron emission tomography imaging produces no significant toxicity.Procedures: Twelve patients with gliomas with either recurrence or suspected radionecrosis were imaged with FLT. Before and at several time points after imaging, subjects underwent general physical and neurological examinations with review of systems and tests of hematologic, hepatic, renal, and several other metabolic parameters. Vital signs and electrocardiograms were monitored during and after the imaging session.Results: There were no significant adverse effects from FLT injected at a dose of 0.07 mCi/kg (maximum of 5 mCi) at specific activities of 1.25 Ci/micromol or higher. The FLT mass administered for imaging was 0.0001% to 0.0009% of the least toxic cumulative dose administered in clinical trials of FLT as an antiretroviral agent.Conclusions: FLT is a safe radiotracer for quantifying proliferation in the human cancer setting. [ABSTRACT FROM AUTHOR]

Presents the text of oral presentations on shoulder rehabilitation among athletes at the 2004 National Athletic Trainer's Association Annual Meeting & Clinical Symposia on June 17, 2004 in Baltimore, Maryland. "The Effects of Exercise Sequence on Muscular Activity in Selected Rotator Cuff Muscles"; "Influence of Ten Days of Creatine Loading on Hydration Status"; "Power Output and Pain Perception of Three Common Rehabilitation Exercises for the Supraspinatus Muscle."

Linkage of creatinine clearance to chromosome 10 in Utah pedigrees replicates a locus for end-stage renal disease in humans and renal failure in the fawn-hooded rat. Background. Renal failure is an important health concern for persons with hypertension and diabetes. In the fawn-hooded rat, a renal failure locus, Rf-1 , has been identified on rat chromosome 1. A study of African American sibpairs with end-stage renal disease (ESRD) replicated this finding on the orthologous region in humans, chromosome 10, with a maximum logarithm of odds (LOD) score of 3.4. An important question is whether this region can be detected in healthy subjects prior to onset of ESRD by examining creatinine clearance as an indicator of early renal damage. Methods. We analyzed 49 Utah Caucasian pedigrees and performed quantitative nonparametric linkage analysis using 21 markers spanning chromosome 10. Pedigree members (mean age of 40 ± 17) were examined up to three different times over 10 years, with creatinine clearance measured at each exam. For examination 1, three overnight, timed, 12-hour urine samples were obtained and averaged. One 12-hour sample was obtained for examinations 2 and 3. Results. Heritabilities of creatinine clearance were 0.33 (N = 1360), 0.36 (N = 1196), and 0.53 (N = 718) for the three examinations, respectively. The nonparametric LOD score for examination 1 was 1.4 at marker D10S677 (∼117 cM). The LOD score at examination 2, an average of 21 /2 years later, was 1.8 at marker D10S1239 (∼123 cM) and 1.9 at marker D10S1425 (∼137 cM). The LOD score at examination 3, an average of 10 years from baseline, was 2.1 at marker D10S2470 (∼113 cM). Thus, there is consistent evidence of linkage to this region from three different examinations spanning a period of 10 years. Conclusions. These linkage results confirm the ESRD linkage and the rat renal failure linkage to this region even though the LOD score is somewhat... [ABSTRACT FROM AUTHOR]

Conclusions. Despite current recommendations against use in adolescents less than 18 years old, creatine is being used by middle and high school athletes at all grade levels. The prevalence in grades 11 and 12 approaches levels reported among collegiate athletes. Until the safety of creatine can be established in adolescents, the use of this product should be discouraged. creatine, nutritional supplements, ergogenic aids, adolescent sports medicine, preparticipation examination. [ABSTRACT FROM AUTHOR]

Focuses on the importance of creatine excretion analysis in determining the sexual maturity of children in California. Comparison between the creatine excretion of males and females; Accounts on the level of creatine found in the urine of adult females; Factors affecting the occurrence of creatine excretion.

Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Introduction: We described here the annual variations in mean dietary creatine intake from 1999 to 2018 in U.S. children and adults using National Health and Nutrition Examination Survey (NHANES) database., Methods: Dietary intake information from ten consecutive rounds of NHANES (from 1999 to 2000 to 2017-2018) was extracted for a total of 89,161 respondents aged 0-85 years. Individual values for total grams of creatine consumed per day were computed using the average amount of creatine (3.88 g/kg) across all creatine-containing food sources., Results: The average daily intake of creatine across the entire sample was 0.70 ± 0.78 g (95% confidence interval [CI], from 0.69 to 0.71) and 13.1 ± 16.5 mg/kg body weight (95% CI, from 13.0 to 13.2). A significant negative trend for dietary creatine intake was found in infants (r = - 0.019; P = 0.042), and children and adolescents (r = - 0.024; P < 0.001)., Conclusions: Our findings suggest a variation in dietary creatine intake in the U.S. population during the past 20 years, with young persons tend to consume fewer grams of creatine per day from 1999 onwards. Long-running studies are highly warranted to assess possible health consequences of variable creatine intake in human nutrition.

• Slc6a8−/y mice have increased striatal, hippocampal 5-hydroxyindoleacetic acid and hippocampal tryptophan hydroxylase and monoamine oxidase. • Slc6a8−/y mice and female mice heterozygous for Slc6a8 (Slc6a8+/−) mice are resilient to learned helplessness induction. • Minor alterations in anxiety-like and native-depression-like measures were discovered in Slc6a8−/y and Slc6a8 +/− mice. • The results of this study suggest that creatine plays a role in serotonin metabolism, which may manifest as changes in induced depressive-like behaviors. Approximately 20% of adults in the U.S. will experience an affective disorder during their life. While it is well established that serotonin (5-HT) is a crucial factor in mood, impaired cellular bioenergetics are also implicated. Creatine (Cr), through the Cr/Phospho-Cr (PCr) shuttle, maintains high ATP concentrations in the neuron. This system may be implicated in the etiology of affective disorders, as reduced Cr, PCr, and ATP are often seen in the brains of affected patients. To address this issue, Cr transporter (Crt) deficient male mice (Slc6a8−/y) and female mice heterozygous for Crt expression (Slc6a8+/-) were used to evaluate how a Cr deficient system would alter affective-like behaviors. Slc6a8−/y and Slc6a8+/- mice had faster escape latencies in learned helplessness, indicating a potential resilience to behavioral despair. Slc6a8−/y had decrease latency to immobility in the tail-suspension test and Slc6a8+/- had increased open entries in elevated zero maze, but all other variables matched those of wildtype mice, however. Slc6a8−/y mice have increased 5-hydroxyindoleacetic acid content in the hippocampus and striatum and increased monoamine oxidase protein and tryptophan hydroxylase-2 protein content in the hippocampus, while 5-HT levels are unchanged. This indicates an alteration to the 5-HTergic system in Cr deficient mice. Our results indicate that Cr plays a complex role in affective disorders and 5-HT, warranting further investigation. [ABSTRACT FROM AUTHOR]

A possible role of dietary creatine for ensuring proper growth and development remains unknown. The main aim of this cross-sectional study was to quantify the amount of creatine consumed through regular diet among U.S. children and adolescents aged 2 to 19 years and investigate the relationship between creatine intake and growth indicators, using data from the 2001-2002 National Health and Nutrition Examination Survey (NHANES). We included data for NHANES 2001-2002 respondents (4291 participants, 2133 boys and 2158 girls) aged 2 to 19 years at the time of screening, who provided valid dietary information and examination measures (standing height and weight). Individual values for total grams of creatine consumed per day for each participant were computed using the average amount of creatine (3.88 g/kg) across all sources of meat-based foods. All participants were categorized for height-for-age and BMI-for-age categories. The average daily intake of creatine across the whole sample was 1.07 ± 1.07 g (95% CI, from 1.04 to 1.10). Height, weight, and BMI were significantly different across creatine quartiles ( p < 0.001), with all measures significantly higher in the 4th quartile of creatine intake (≥1.5 g/day) than those in other quartiles ( p < 0.05). The participants from the 3rd quartile of creatine intake (0.84-1.49 g/day) were significantly different from others with respect to having lower rates of normal stature and higher rates of tall stature ( p < 0.05). Each additional 0.1 g of creatine consumed per day increases height by 0.60 cm (simple model) or 0.30 cm (adjusted model). The daily intake of creatine from a regular diet in taller children and adolescents was higher than in shorter peers aged 2-19 years. Future research has to monitor temporal changes in growth and dietary creatine and validate our findings in interventional studies across pediatric populations.

Creatine riboside (CR) is a novel metabolite of cancer metabolism. It is a urinary diagnostic biomarker of lung and liver cancer risk and prognosis. The level of CR is highly positive correlated in tumor and urine indicating that it is derived from human lung and liver cancers. A precise and sensitive ultra-pressure liquid chromatography-tandem mass spectrometry (UPLC-ESI-MS/MS) method was developed and validated for simultaneous quantification of the noninvasive biomarker CR, along with creatinine riboside (CNR), and their precursors creatine and creatinine, utilizing the labeled internal standard creatine riboside- 13 C, 15 N 2 (CR- 13 C, 15 N 2 ). Chromatography was carried out on a hydrophilic interaction chromatography column under a gradient mobile phase condition. MRM transitions were monitored for CR (264.1 > 132.1, m/z), CNR (246.1 > 113.9, m/z), creatine (132.0 > 72.0, m/z), creatinine (114.0 > 85.8, m/z) and CR- 13 C, 15 N 2 (267.1 > 134.9, m/z) with a 11.0 min run time in the positive mode ionization. The calibration plot of the method was linear over the concentration range of 4.50-10,000 nM. Method validation was performed according to regulatory guidelines established for sensitivity, selectivity, calibration curve, stability at different storage conditions, reinjection reproducibility, ruggedness with acceptable accuracy, and precision. This assay was applied for the quantification of CR along with CNR, creatine and creatinine in a subset of urine and serum samples from the National Cancer Institute - Maryland (NCI-MD) cohort population controls and lung cancer cases. It can be standardized and used in multiple laboratories for cancer diagnosis and determining the efficacy of cancer therapy and monitoring cancer recurrence., Competing Interests: Declaration of Competing Interest The authors disclose no potential conflict of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The authors of this article defend their study on urinary creatinine, in which they thoroughly documented the predictors in one study population. The large volume of data available in the Third National Health and Nutrition Examination Survey in the U.S., was ideal for examining and documenting these predictors. They further commend that their study provides the most concrete data in the literature demonstrating creatinine variation in diverse populations and the factors contributing to this variation.

Focuses on the association of ephedrine and creatine use among football players with heatstroke deaths in the U.S. Amphetamine like effects of Implications of shifting body water into muscle caused by creatine; Suggestions for preventing heatstroke.

The article reports that the NIH National Institute of Neurological Disorders and Stroke(NINDS) will launch a double-blind, placebo-controlled, phase III clinical trial to test the efficacy of creatine in slowing the progression of Parkinson's disease(PD). The study will enroll 1,720 people making the study one of the largest PD clinical trials.

The article reports that the U.S. Patent and Trademark Office has awarded U.S. Patent No. 7,186,754 to Avicena Group for creatine, entitled “Use of creatine or creatine compounds for skin preservation.” The patent covers claims focusing on methods and compositions for treating uneven skin pigmentation using a topical application of creatine and carnitine. It improves skin care with claims directed to methods for treating skin damage due to sun radiation, stress or fatigue by using creatine.

The article presents news briefs about medicine and health agencies in the U.S. The U.S. Food and Drug Administration has proposed stricter rules regarding conflicts of interest in its advisory committees. The National Institute of Neurological Disorders and Stroke is examining whether creatine, a nutritional supplement, could be used to slow the progression of Parkinson disease. The Centers for Medicare & Medicaid Services will now allow infants born to immigrant parents in the U.S. to automatically receive coverage under Medicaid.

The article reports on an announcement by the U.S. National Institute of Neurological Disorders and Stroke (NINDS) of NIH in Bethesda, Maryland, regarding the recruitment of participants to conduct a clinical trial to test the efficacy of the nutritional supplement, Creatine, against Parkinson's disease. Earlier trials which began in the year 2000 focused on the futility of a drug to combat the disease, and found that of the four compounds only Creatine passed the test. NINDS will begin recruiting for the phase III of the trial, to test whether a purified medicinal version can slow the progress of the disease. According to Debra Babcock, scientific director of the creatine trial; at NINDS, the trial will recruit 1720 participants and is expected to last 7 years.

Reports on the concerns regarding the use of performance enhancing dietary supplements by athletes in the United States, with reference to US baseball players, Mark McGwire and Sammy Sosa, who used the energy boosting protein, creatine. Reason creatine and similar substances do not require regulation by the US Food and Drug Administration; Details on other supplements taken by McGwire; How such supplements may be obtained; Information on androstenedione.

Adolescents may regard the use of performance-enhancing substances as an easy means to gain self-esteem through improved body appearance and athletic performance. The use of performance-enhancing substances by adolescents is particularly troubling because safety data are largely lacking. This poses a dilemma for the pediatrician who needs correct information, including the potential efficacy and negative health effects of such substances, to identify the patients in need of counseling and to find the best way to help adolescent patients make informed decisions to promote healthy behaviors. This article is intended to assist pediatricians by providing a summary of the current state of knowledge regarding the prevalence of use of performance-enhancing substances by United States adolescents.

Ongoing research in several areas of pediatric nutrition has new practical applications for community-based pediatricians. For example, a fresh understanding of risk factors for rickets persuades pediatricians to recognize and treat this disease, which was thought to be nearly extinct in the modern industrialized world. Similarly, an expanded awareness of the antibacterial components of breast milk encourages a more complete dialogue between pediatricians and new mothers about the potential benefits of breast-feeding. For those infants with feeding intolerance, new data help to refine the indications for hypoallergenic formulas, which are increasingly recommended for children with a variety of symptoms. The past year also has seen breakthroughs in our understanding of supplemental nutrition for children. Vitamin A may provide direct benefits for the most vulnerable of children, namely premature infants at high risk for lung disease. At the other end of the pediatric spectrum, adolescent athletes seeking to enhance their performance are consuming poorly studied sports supplements that may not be beneficial and may even be toxic. Finally, a greater appreciation for the epidemic of obesity that is sweeping the United States and other countries suggests that children at high risk may represent a far more diverse population than had been recognized previously.