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De zin en onzin van voedingssupplementen
- 1. De zin en onzin van voedingssupplementen Bart Wilms Promotor: Gijs van Pottelbergh
- 4. Apothekers- en huisartsenenquête - Contact via email of nieuwsbrief - 33 respondenten - 15 huisartsen en 18 apothekers
- 5. Resultaten 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Ja Nee Actief aanraden Apothekers Huisartsen 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Akkoord Niet akkoord Veilig Vit D omega 3 multivitamine
- 6. Resultaten: Bewezen werking 0% 10% 20% 30% 40% 50% 60% 70% a. Volledig akkoord b. Eerder akkoord c. Eerder niet akkoord d. Volledig niet akkoord Omega-3 0% 10% 20% 30% 40% 50% 60% a. Volledig akkoord b. Eerder akkoord c. Eerder niet akkoord d. Volledig niet akkoord vit D 0% 10% 20% 30% 40% 50% 60% a. Volledig akkoord b. Eerder akkoord c. Eerder niet akkoord d. Volledig niet akkoord Multivitamines
- 7. Resultaten: grootte effect 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% a. <0.1% b. 0.1- 1% c. 1- 10% d. >10% vitamine D 0% 10% 20% 30% 40% 50% 60% a. <0.1% b. 0.1- 1% c. 1-10% d. >10% Omega 3 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% a. <0.1% b. 0.1- 1% c. 1- 10% d. >10% Multivitamine
- 8. Conclusie - Steekproef is niet representatief - Trend: - Apothekers: Werking bewezen, effectiever - Huisarts: skeptischer
- 12. Vitamine D • Vit. D + ca: - 0,7% fracturen -0,2% heup, -0,1% indeukingsfractuur, +0,4% MI, +0,3% CVA • Ca alleen: +0,9% fracturen • Lage vitamine D, >65, vrouwen: -0,4% heupfactuur • Vitamine D alleen: -9,5% valrisico • Heel hoge vitamine D: +0,31% fracturen, +3,2% vallen
- 13. Omega 3 vetzuren - visolie • Geen significante resultaten • Trend naar minder mortaliteit, vermindering van hartziekten • Risico prostaatkanker +2,4%, geen invloed op mortaliteit • Hoger bloedingsrisico, zeker in combinatie met antiaggregantia.
- 14. Multivitamines • Kleine effecten in studies; voor of tegen • Maculadegeneratieprogressie • Betacaroteen, vitamine E bij rokers: +1% longkankerincidentie, -mortaliteit
- 15. Primaire preventie • Statine: JUPITER-trial • Normale LDL, Hoge CRP: rosuvastatine • 0,2-0,6% absoluut risicoreductie/j • NNT= 25/2j: 1 CV vermeden
- 16. Jupiter-trial
- 18. Primaire preventie: Aspirine • Primaire preventie bij 1000 mensen vs placebo o Man: - 6 minder MI, + 2,8 CVA o Vrouw: -2 CVA o Laag risico: -6 MI +4 grote bloedingen o Hoog risico: -31MI +22 grote bloedingen • Interactie met vitamine E en visolie • Secundair: o - 37 MI o - 26 CVA o + 25 grote bloedingen o - 13 doden (randsignificant)
- 19. Primaire Preventie • Franco et al, Primary prevention of cardiovascular disease: Cost-effectiveness comparison2007, International Journal of Technology Assessment in Health Care
- 21. Acute pijn Placebo: 18% na 4-6u
- 22. Conclusie • Geen evidentie op dit moment voor het gebruik van voedingingssupplementen • Mattheüs-effect • Niet ongevaarlijk • Casus-selectie blijft belangrijk • Geneeskunde is secundaire preventie • RTC of grote dataset in plaats van epidemiologische studies
- 23. Conclusie
Editor's Notes
- www.multivitaminguide.org
- Foodinaction.com Bron: LISTEN, marktonderzoek bij een representatief panel van 1.000 Belgen boven 15 jaar, 2010
- Chocolate Consumption, Cognitive Function, and Nobel Laureates — NEJM. (n.d.). Retrieved June 05, 2015, from http://www.nejm.org/doi/full/10.1056/NEJMon1211064
- Xkcd.com
- 1. Seeman, E. (2010). Evidence that calcium supplements reduce fracture risk is lacking. Clinical Journal of American Society of Nephrology, 2010 (5), S3–S11. 2. Jackson, R. D., et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354 (7), 669–683. 3. Tang, B. M., et al. (2007). Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: A metaanalysis. Lancet, 370 , 657–666. 4. Freychuss, B., et al. (2007). Calcium and vitamin D for prevention of osteoporotic fractures. Lancet, 2007 (370), 2098–2099. 5. Reid, I. R., & Bolland, M. J. (2008). Effect of calcium supplementation on hip fractures. Osteoporosis International, 2008 (19), 1119–1123. 6. Bolland, M. J., et al. (2011). Calcium supplements with or without vitamin D and risk of cardiovascular events: Reanalysis of the women’s health initiative. British Medical Journal, 342 , d2040. 7. Bolland, M. J., et al. (2008). Vascular events in healthy older women receiving calcium supplementation. British Medical Journal, 336 , 262–266. 8. Xiao, Q., et al. (2013). Dietary and supplemental calcium intake and cardiovascular disease mortality the national institutes of health – AARP Diet and Health Study. Journal of American Medical Association Internal Medicine, 173 (8), 639–646. 9. Bischoff-Ferrari, H. A., et al. (2012). A pooled analysis of vitamin d dose requirements for fracture prevention. New England Journal of Medicine, 367 , 40–49. 10. Chung, M., et al. (2011). Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. preventive services task force. Annals of Internal Medicine, 155 (12), 827–838. 11. Bolland, M. J., et al. (2014). Effect of vitamin D supplementation on bone mineral density. Lancet, 2014 (383), 146–155. 12. Bischoff-Ferrari, H. A., et al. (2009). Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomized controlled trials. British Medical Journal, 339 , b3692. 13. Durup, D., et al. (2012). A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: The CopD study. Journal of Clinical Endocrinolgy and Metabolism, 97 (8), 2644–2652. 14. Sanders, K. M., et al. (2010). Annual high-dose oral vitamin D and falls and fractures in older women: A randomized controlled trial. Journal of American Medical Association, 303 (18), 1815–1822.
- 8, Kwak, S., et al. (2012). Effi cacy of omega-3 fatty acid supplements in the secondary prevention of cardiovascular disease. Archives of Internal Medicine, 175 (9), 686–694. 9. Risk and Prevention Study Collaborative Group. (2013). N-3 fatty acids in patients with multiple cardiovascular risk factors. New England Journal of Medicine, 368 , 1800–1808. 10. Rizos, E., et al. (2012). Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: A systematic review and meta-analysis. Journal of American Medical Association, 308 (10), 1024–1033. 11. Brasky, T. M., et al. (2013). Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. Journal of the National Cancer Institute, 105 (15), 1132–1141.
- Figure 1. Cumulative Incidence of Cardiovascular Events According to Study Group. Panel A shows the cumulative incidence of the primary end point (nonfatal myocardial infarction, nonfatal stroke, arterial revascularization, hospitalization for unstable angina, or confirmed death from cardiovascular causes). The hazard ratio for rosuvastatin, as compared with placebo, was 0.56 (95% confidence interval [CI], 0.46 to 0.69; P<0.00001). Panel B shows the cumulative incidence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes, for which the hazard ratio in the rosuvastatin group was 0.53 (95% CI, 0.40 to 0.69; P<0.00001). Panel C shows the cumulative incidence of arterial revascularization or hospitalization for unstable angina, for which the hazard ratio in the rosuvastatin group was 0.53 (95% CI, 0.40 to 0.70; P<0.00001). Panel D shows the cumulative incidence of death from any cause, for which the hazard ratio in the rosuvastatin group was 0.80 (95% CI, 0.67 to 0.97; P=0.02). In each panel, the inset shows the same data on an enlarged y axis and on a condensed x axis. Ridker, P. M., Danielson, E., Fonseca, F. A. H., Genest, J., Gotto, A. M., Kastelein, J. J. P., … Glynn, R. J. (2008). Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. New England Journal of Medicine, 359(21), 2195–2207. doi:10.1056/NEJMoa0807646
- Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800). Apple ipv statine : avoid more than a thousand excess cases of myopathy and more than 12 000 excess diabetes diagnoses Prescribing either apples or statins to everybody over 30 years old is estimated to reduce the annual number of vascular deaths by 8800 (6500 to 11 100) or 9600 (7200 to 12 900) respectively, 3% more than prescribing to everybody over 50 years. The number of adverse events is predicted to double to 2400 cases of myopathy, 400 of rhabdomyolysis, and 24 400 excess diabetes diagnoses. The cost of statins would be £360m, and that of apples £480m. If compliance with apple prescriptions was 90%, the number of vascular deaths averted would increase to 11 000 (8100 to 13 900); this is 29% more than with 70% compliance, costing £339m in apples. Finally, if the apple prescription has no effect on any aspect of the average diet except amount of fruit consumed, annual vascular deaths would reduce by 7100 (5000 to 9400), 20% fewer than if dietary compensation occurs; costs would remain the same. http://www.futureoffood.ox.ac.uk/project/modelling-relationship-between-food-system-and-health-development-and-environment/web-based-prime-model
- Aspirin is recommended for secondary prevention. Studies show a 37/1,000 reduction of heart attack vs. placebo, and a 26/1,000 reduction in stroke. • For primary prevention in low-risk patients, studies show a 6/1,000 reduction in heart attack vs. placebo. In high-risk patients, there is a 31/1,000 reduction in heart attack • There are differences between men and women. Aspirin is more helpful to prevent heart attacks in men and strokes in women. For primary prevention, men have 6/1,000 fewer heart attacks compared to placebo, but 2.8/1,000 more strokes. Women have no change in heart attacks, and 2/1,000 fewer strokes. 13 Aspirin for Prevention of Heart Disease and Stroke 107 • The rate of serious bleeding with aspirin in secondary prevention and in primary prevention of high-risk patients is 25/1,000 higher than placebo. For low-risk primary prevention, the excess major bleeds are 4/1,000 people. There were many more minor side effects with aspirin over placebo as well • There is no consensus about the dose and timing of aspirin. • Several supplements interact with aspirin, including Vitamin E and Fish Oil. • Other anti-platelet agents such as Clopidogrel TM seem to confer no additional risk reduction compared to aspirin.
- Franco, O. H., der Kinderen, A. J., De Laet, C., Peeters, A., & Bonneux, L. (2007). Primary prevention of cardiovascular disease: cost-effectiveness comparison. International Journal of Technology Assessment in Health Care, 23(1), 71–9. doi:10.1017/S0266462307051598
- Franco, O. H., der Kinderen, A. J., De Laet, C., Peeters, A., & Bonneux, L. (2007). Primary prevention of cardiovascular disease: cost-effectiveness comparison. International Journal of Technology Assessment in Health Care, 23(1), 71–9. doi:10.1017/S0266462307051598
- Oxford league table of analgesics in acute pain Dementie studies: 30% significante verbetering bij placebogroep, dat verdwijnt na een paar maanden. Macpherson, H., Rowsell, R., Cox, K. H. M., Scholey, A., & Pipingas, A. (2015). Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial. Age (Dordrecht, Netherlands), 37(3), 9782. doi:10.1007/s11357-015-9782-0 Vergeljking: caffeine-studies ivm mortaliteit, cv-eindpunten.
- Het effect van een gezond dieet blijkt wel significant te correleren met all-cause mortaliteit (OR 0.76) en cardiovasculaire ziekte (0.81) (17) hoge consumptie van (3e en 4e kwartiel vs andere) van melk (RR 0.61, 95% CI 0.44–0.86), en groenten en fruit (0.66, 0.46–0.94), en gematigde consumptie van yoghurt (0.50, 95% CI 0.31–0.80), en andere kazen (0.63, 0.40–0.98), and brood (0.58, 0.37–0.89) op 15 jaar tijd. (18) Dit zorgt er ook voor dat de epidemiologische studies van supplementen wordt bemoeilijkt omdat het consistent de mensen die de gezondste levensstijl, qua dieet, lichaamsbeweging zijn die voedingssupplementen nemen(19) alsook blanke mensen, met een hogere sociaaleconomische klasse die a priori een lagere sterftekans hebben (20)
- Rifkin, E., & Lazris, A. (2015). Interpreting Health Benefits and Risks. Cham: Springer International Publishing. doi:10.1007/978-3-319-11544-3