(N Engl J Med ) 年輕人應留意營養補充品 (Weight-loss / energy products)

營養補充品惹禍 美每年2萬人掛急診 2015-10-18 09:07:10 聯合報 編譯李京倫／報導 還相信營養補充品「有病治病，沒病養身」嗎？美國政府主持的一項大規模研究顯示，美國平均每年有二萬三千人次因為服用營養補充品而掛急診，其中許多案例是二、三十歲的成人在服用號稱能減重或增加活力的補充品後，出現心血管問題。 這是第一份呈現「營養補充品導致的嚴重傷害與住院行為」的研究。營養補充品產業成長迅速，年產值達三百二十億美元（約台幣一兆元）。批評營養補充品產業的人說，這份研究證實，美國對補充品管制太鬆，讓許多消費者陷入險境。補充品產業則說，美國有半數人口都在吃補充品，這份研究呈現的只是其中極少數受到重大傷害的人。研究由美國食品藥物管理局與疾病管制中心主持，報告發表在十四日號的「新英格蘭醫學期刊」上。研究人員追蹤二○○四到二○一三年全美各地多家醫院的急診紀錄，分析涉及營養補充品的案例。研究提到的傷害包括嚴重的過敏反應、心臟問題、惡心、嘔吐等，這些症狀與多種補充品有關，包括草藥丸、氨基酸、維他命與礦物質。研究顯示，每年掛急診的人次中，約有百分之十、也就是二千一百五十人次嚴重到必須住院。研究人員發現，因為吃補充品而掛急診的主要是年輕人，因為吃處方藥而掛急診的多半是年長者。研究第一作者、美國疾管中心醫療品質促進部門官員蓋勒說：「這對比真讓人驚訝。」研究顯示，掛急診的人次之中，百分之廿八的年紀介於廿到卅四歲之間，其中又有半數是因服用號稱能減重或增強活力的補充品，常見症狀有胸痛、心悸與心律不整等等。研究人員說，這種補充品往往含有多種草本植物與萃取物，通常在網路、雜誌或電視上做廣告。目前不清楚這些因為吃補充品而掛急診的人之中，有多少人死亡，因為這份研究並不追查死亡紀錄。減肥與增加活力的補充品曾涉及嚴重問題，例如曾在二○一三年造成九十七人生病，至少一人死亡，三人接受肝臟移植。醫學專家指出，這類補充品有可能危害很大，因為對人體效力強，而且經常摻了有毒化學物。這份研究顯示，心血管疾病跟減重、增強活力補充品的關聯，比跟處方興奮劑如安非他命、Adderall的關聯更強。處方興奮劑依法須標註「服用後可能引發心臟方面的副作用」警語，補充品卻無須標註。未參與研究的哈佛大學醫學院助理教授柯漢說：「這真的很讓人沮喪，從這份研究可以看出，管理制度失靈，沒法保護消費者不受重大傷害。」美國疾管中心官員蓋勒建議，吃營養補充品應注意下列事項：．吃減肥或增強活力補充品的年輕人應留意，這類補充品之中，有些會影響心臟功能，不能吃太多。如果你的心臟有問題，請在服用前請教醫師。．年紀較長者請在吞服補充品時，注意咀嚼或吞嚥問題，不要一次吞好幾顆，不要吞下太大顆的藥丸，服用時記得配上大量的水。如果你很難吞下補充品藥丸，請告訴醫師，看看能否換成別種藥丸，或將它切成兩半。

Emergency Department Visits for Adverse Events Related to Dietary Supplements

N Engl J Med 2015; 373:1531-1540 BACKGROUND Dietary supplements, such as herbal or complementary nutritional products and micronutrients (vitamins and minerals), are commonly used in the United States, yet national data on adverse effects are limited. METHODS We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements. RESULTS On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement–related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits. CONCLUSIONS An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.)