Background: Dietary supplements, such as herbals/complementary nutritionals and micronutrients (vitamins/minerals), are commonly used in the U.S., yet national data on adverse effects are limited. Methods: We used a nationally representative stratified probability sample of 63 emergency departments (2004–2013) to describe U.S. emergency department visits for dietary supplement adverse events. Results: Based on 3,667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611–27,398) emergency department visits, resulting in 2,154 (CI, 1,342–2,967) hospitalizations, were attributed to adverse events from supplements annually. Emergency department visits for supplement adverse events commonly involved young adults aged 20–34 years (28.0%; CI, 25.1%−30.8%) and unsupervised children (21.2%; CI, 18.4%−24.0%). Excluding unsupervised child ingestions, 65.9% (CI, 63.2%−68.5%) of emergency department visits for single-supplement adverse events involved herbals/complementary nutritionals; 31.8% (CI, 29.2%−34.3%) involved micronutrients. Herbal/complementary nutritional products for weight loss (25.5%; CI, 23.1%−27.9%) and increased energy (10.0%; CI, 8.0%−11.9%) were commonly implicated. These weight loss or energy products caused 71.8% (CI, 67.6%−76.1%) of supplement adverse events involving palpitations, chest pain, and/or tachycardia, and 58.0% (CI, 52.2%−63.7%) involved persons aged 20–34 years. Among adults aged ≥65 years, choking or pill-induced dysphagia/globus caused 37.6% (CI, 29.1%−46.2%) of all emergency department visits for supplement adverse events; micronutrients were implicated in 83.1% (CI, 73.3%−92.9%) of these visits. Conclusions: Over 20,000 emergency departments visits in the US annually are attributed to dietary supplement adverse events; these commonly involve cardiovascular manifestations from weight loss or energy products in younger adults, micronutrient ingestions by unsupervised children, and swallowing problems, usually from micronutrients, in older adults.

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Objective. Liver disease is a potential complication from using dietary supplements. This study investigated an outbreak of non-viral liver disease associated with the use of OxyELITE Pro™, a dietary supplement used for weight loss and/or muscle building. Methods. Illness details were ascertained from MedWatch reports submitted to the U.S. Food and Drug Administration (FDA) describing consumers who ingested OxyELITE Pro alone or in combination with other dietary supplements. FDA's Forensic Chemistry Center analyzed samples of OxyELITE Pro. Results. From February 2012 to February 2014, FDA received 114 reports of adverse events of all kinds involving consumers who ingested OxyELITE Pro. The onset of illness for the first report was December 2010 and for the last report was January 2014. Thirty-three states, two foreign nations, and Puerto Rico submitted reports. Fifty-five of the reports (48%) described liver disease in the absence of viral infection, gallbladder disease, autoimmune disease, or other known causes of liver damage. A total of 33 (60%) of these patients were hospitalized, and three underwent liver transplantation. In early 2013, OxyELITE Pro products entered the market with a formulation distinct from products sold previously. The new formulation replaced 1,3-dimethylamylamine with aegeline. However, the manufacturer failed to submit to FDA a required “new dietary ingredient” notice for the use of aegeline in OxyELITE Pro products. Laboratory analysis identified no drugs, poisons, pharmaceuticals, toxic metals, usnic acid, N-Nitroso-fenfluramine, pyrrolizidine alkaloids, aristocholic acid, or phenethylamines in the products. Conclusions. Vigilant surveillance is required for adverse events linked to the use of dietary supplements.

Background We investigated associations between tobacco exposure, history of schistosomiasis and bladder cancer risk in Egypt. Methods We analyzed data from a case-control study (1,886 newly diagnosed and histologically confirmed cases and 2,716 age-, gender-, and residence-matched, population-based controls). Using logistic regression we estimated the covariate-adjusted odds ratios (OR) and 95% confidence interval (CI) of the associations. Results Among men, cigarette smoking was associated with an increased risk of urothelial carcinoma (UC) (OR = 1.8, 95% CI = 1.4, 2.2), but not squamous cell carcinoma (SCC); smoking both waterpipes and cigarettes was associated with an even greater risk for UC (OR = 2.9, 95% CI = 2.1, 3.9) and a statistically significant risk for SCC (OR = 1.8, 95% CI = 1.2, 2.6). Among non-smoking men and women, to environmental tobacco smoke exposure was associated with an increased risk of UC. History of schistosomiasis was associated with increased risk of both UC (OR = 1.9, 95% CI = 1.2, 2.9) and SCC (OR = 1.9, 95% CI = 1.2, 3.0) in women and to a lesser extent (OR = 1.4, 95% CI = 1.2, 1.7 and OR = 1.4, 95% CI = 1.1, 1.7, for UC and SCC respectively) in men. Conclusions The results suggest that schistosomiasis and tobacco smoking increase the risk of both SCC and UC. Impact This study provides new evidence for associations between bladder cancer subtypes and schistosomiasis, and suggests that smoking both cigarettes and waterpipes increases the risk for SCC and UC in Egyptian men.