Lec 7: Natural Health Products and Clinical Nutrition Flashcards
What are nutraceuticals
Can be considered a food, drug, or
natural health product (NHP) under the Canadian regulatory system
*We will be defining a nutraceutical as “a nutrient compound that has health benefits in addition to the basic nutritional value contained in foods”
-These health benefits typically refer to a major physiological endpoint like skeletal muscle mass or cholesterol levels
What are natural health products
Natural health products include:
* Probiotics
* Herbal remedies
* Vitamins and minerals
* Homeopathic medicines
* Traditional medicines such as traditional Chinese medicines
* Other products like amino acids and essential fatty acids
*NHPs must be safe to use as over-the-counter products and do not need a prescription to be sold
Regulations in Canada – what does it take to get a nutraceutical product on store shelves?
-Health Canada is the Canadian governing body responsible for drug and health product approval prior to a product becoming available for consumer use in Canada
-NHP license applications including evidence supporting the safety and efficacy of the NHP according to its
recommended conditions of use must be submitted to Health Canada
Health Claims
Health claims are statements that indicate the intended beneficial effect of a product when used in accordance with its recommended conditions of use
-NHP licensing is based on at least one health claim to support at least one of the medicinal ingredients in the product
-Health claims can be related to functional (e.g. strength), therapeutic (e.g. pain), or preventative outcomes
-Health Canada uses a risk-based assessment approach where the standard of evidence required to support the safety and efficacy of the product is proportionate to the risk to health
Requirements for the legal sale of NHPs in Canada (3)
- Natural product number (NPN) – shows Health Canada has reviewed and approved the product for sale
- NHP compliant label – shows NPN, ingredients, directions for use, and warnings
- Licensed importer of record – if NHP manufactured outside of Canada must be a licensed importer of record with Health Canada. NHPs
manufactured in Canada need to be manufactured, packaged, and labelled in a licensed facility
Reading product monographs and labels (7 things)
- Brand name (trade name, product name in English, French and perhaps other languages *bilingual)
- Health claim authorized by Health Canada
- Potency
- Quantity per dosage unit
- Natural product number (NPN) that indicated Health Canada has assessed product for safety, claim, quality and authorized it for sale
- Net amount, dosage form
- Medicinal and non-medicinal ingredients
Key considerations when evaluating the efficacy of a nutraceutical or natural health product (6 factors)
- Minimal effective dose
- Population (sex/age)
- Interactions with medications
- Formulation/active ingredients (if it has high protein but very little BCAA, but increased sugar?)
- Scenario/environment
- Immediate vs. Chronic effects (potency over time- may stop working after few years)
Β-hydroxy-Β-methylbutyrate (HMB)
-HMB is a product of leucine breakdown but only ~5% of leucine is converted into HMB
-Proposed mechanism of action is
enhancement of muscle protein synthesis
-HMB may also help reduce muscle damage and promote muscle recovery following exercise while also attenuating muscle disuse atrophy.
HMB and vitamin D supplementation
HMB with vitamin D supplementation may improve muscle function in older adults deficient in vitamin D
-supplement can increase functional index without exercise
Hypercaloric HMB and vitamin D ONS (oral nutrition supplements) in older adults: SHIELD study
May improve clinical outcomes in older adults
-not sure if it’s HMB causing increased survival with increased kcal supplement (causative) but found HMB with vitamin D improved survival in older adults
-maybe survivial due to increased macronutrients
Reactive oxygen species (ROS)
Everyone’s favourite villain- not always bad (small amounts help with cell signalling) but can cause cellular damage if overproduced (can damage proteins and cellular membranes)
Highly reactive molecule that contains oxygen, high amounts can cause oxidative stress and disease. Antioxidants counter these molecules
Antioxidants
Substances that inhibit or reduce oxidative damage caused by reactive oxygen species/ROS
Polyphenols
Type of antioxidant
-Naturally occurring compounds found in plants (more than 8,000 identified)
-Fruits like grapes, pears, cherries, apples, and berries are rich in polyphenols
-Polyphenols are antioxidants that may protect cells from oxidative damage and limit risk of various diseases
Flavonoid intake and all-cause mortality in older women
-5 year follow-up period for 1063
women >75 years old randomly
selected from the Calcium Intake Fracture Outcome Age Related Extension Study
-USDA and Phenol-Explorer food composition databases used to
estimate flavonoid intake based on completed food-frequency questionnaires
-Low intake group was the referent group meaning all comparisons are versus the low intake group
-Some differences in intake estimates between PE and USDA databases but relationships similar and remained after adjustment for mortality risk factors
*Participants with higher total flavonoid consumption associated with reduced risk of all-cause mortality
*Higher total flavonoid intake associated with reduced risk of CVD and cancer mortality compared with low intake group
Malnutrition in clinical populations and settings
is an important public health concern
-Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients
-Malnourished surgical patients experience poor postoperative outcomes including increased hospital length of stay and readmission
-Malnutrition is often a precursor to sarcopenia
Pre-operative nutritional supplementation to improve postoperative outcomes
-Pre-operative nutritional supplementation and other nutritional considerations can decrease infection risk, hospital length of stay, and other negative postoperative outcomes
-Prehabilitation can be defined as supplementation of macronutrient containing or immune-enhancing nutrition in the preoperative period
Perioperative period:
preoperative period-> intra-operative period (having operation) -> postoperative period (bed at home or hospital)
Trauma and critical care considerations
-Patients may require serial procedures or surgeries that interrupt or alter nutrient delivery and requirements
-After a traumatic injury tissue damage triggers an acute response characterized by protein catabolism, insulin resistance, and increased energy expenditure (20-50% higher in trauma patients compared to those undergoing elective surgery)
*multiple surgeries= impaired nutrition and delivery, may have to be given by IV
Oral nutritional supplements (ONS)
-ONS are sterile liquids, semi-solids, or powders that contain additional protein, energy, and micronutrients and potentially other specialized nutrients to improve nutritional status
-Can be used acutely or chronically
-Can be used in many different scenarios including preparation of undernourished patients, dysphagia
(difficulty swallowing), and disease related malnutrition
Enteral vs. parenteral nutrition
Enteral:
-Delivery of a nutritionally complete feed via a tube into the stomach, duodenum, or jejunum
-Suitable for people who have inadequate oral intake but a functional GI tract
Parenteral:
-Delivery of a nutritionally complete feed intravenously via a central or peripheral venous catheter
-Bypasses the GI tract and portal/liver venous system
*depends on scenario
EFFORT Study: Early nutritional support on Frailty, Functional Outcomes and Recovery
-Nutritionally at-risk patients with anticipated LOS >4 days; individualized nutritional support initiated no later than 48 h after admission (N=1015) *doses based on requirements, not standard care
-Nutritionally at-risk patients with anticipated LOS >4 days; hospital food with no dietary consultation
(N=1013) *standard care
*Early use of individualized nutritional support in medical inpatients at nutritional risk lowers risk of mortality and functional decline within 30 days
LOS=length of stay
Enhanced Recovery After Surgery (ERAS) knowledge translation
-The ERAS society aims to develop
peri-operative care and to improve patient recovery
-ERAS society guidelines can be
found for many surgical procedures and include guidance on nutrition, wound healing, and other topics to improve recovery
-Enhanced Recovery Canada is an
associated site with the ERAS Society – there is also an ERAS Alberta site
