Many horses display unwanted behaviour prior to receiving concentrate feed or forage. These behaviours have received relatively little scientific attention as a distinct group of equine behaviour problems and risk factors for their performance have not been quantified. The objective of this study was to generate data on the diet of UK leisure horses, the feeding practices employed by their carers, and the prevalence of behaviour problems seen prior to feeding. A convenience sample of leisure horse carers were surveyed via a self-administered internet survey. Each carer provided data for only one horse, and to minimise recall bias was asked to report details of their horse's feeding routine over the week prior to completing the survey. Recruitment was spread over twelve calendar months. The survey was completed by 1,324 respondents, each reporting data for an individual horse in their care. Pre-feeding behaviour problems were common within the sample and were reduced by Principal Components Analysis into three components labelled: aggression; frustration; and stereotypies. While the specific risk factors associated with these problems differed, they fell into four distinct themes: how the horse is fed; the use of nutritional supplements; exercise and stabling; and the performance of oral investigative behaviour. The risk factors for pre-feeding behaviour problems identified in this study raise concerns about the way domestic horses are currently fed and managed. In conjunction with published empirical evidence they indicate that the welfare of domestic horses may be improved by adopting a feeding regime and management system more suited to their physiological and behavioural needs.

Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms ‘nutraceuticals’, ‘dietary supplements’, ‘herbal drug’ and ‘heart failure’ or ‘left verntricular dysfunction’ were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.

Aplastic anaemia (AA) is characterised by pancytopenia resulting from a marked reduction in haemopoietic stem cells (HSC). The regulation of haemopoiesis depends on the interaction between HSC and various cells of the bone marrow (BM) microenvironment, including BM-derived mesenchymal stromal cells (BMSC). The purpose of this study was to analyse the biological effect of nutritional supplement (NS), a dietary supplement consisting of thirty-six compounds: amino acids, nucleotides, vitamins and micronutrients on the BMSC of AA rats. The AA rat model was established by irradiating X-ray (2·5 Gy) and intraperitoneal injections of cyclophosphamide (35 mg/kg; Sigma) and chloramphenicol (35 mg/kg; Sigma). Then AA rats were fed with NS in a dose-dependent manner (2266·95, 1511·3, 1057·91 mg/kg d) by intragastric administration. The effect of NS on the BMSC of AA rats was analysed. As compared with AA rats, NS treatment significantly improved these peripheral blood parameters and stimulated the proliferation of total femoral nucleated cells. NS treatment affected proliferative behaviour of BMSC and suppressed BMSC differentiation to adipocytes. Furthermore, NS treatment of AA rats accelerated osteogenic differentiation of BMSC and enhanced bone mineral density. Co-incubation of HSC with mesenchymal stromal cells and serum from AA rats subjected to high-dose NS markedly improved the yield of CD34+cells. Protein microarray analysis revealed that there were eleven differentially expressed proteins in the NS group compared with the AA rat group. The identified specific NS might be implicated in rehabilitation of BMSC in AA rats, suggesting their potential of nutritional support in AA treatment.

Randomised controlled trials (RCT) testing the effects of antioxidant supplements on endothelial function (EF) have reported conflicting results. We aimed to investigate the effects of supplementation with antioxidant vitamins C and E on EF and to explore factors that may provide explanations for the inconsistent results. We searched four databases (MEDLINE, Embase, Cochrane Library and Scopus) from inception until May 2014 for RCT involving adult participants aged ≥ 18 years who were supplemented with vitamins C and E alone or in combination for more than 2 weeks and reporting changes in EF measured using flow mediated dilation or forearm blood flow. Data were pooled as standardised mean difference (SMD) and analysed using a random-effects model. Significant improvements in EF were observed in trials supplementing with vitamin C alone (500–2000 mg/d) (SMD: 0·25, 95 % CI 0·02, 0·49, P= 0·043) and vitamin E alone (300–1800 IU/d; 1 IU vitamin E = 0·67 mg natural vitamin E) (SMD: 0·48, 95 % CI 0·23, 0·72, P= 0·0001), whereas co-administration of both vitamins was ineffective (vitamin C: 500–2000 mg/d; vitamin E: 400–1200 IU/d) (SMD: 0·12, 95 % CI − 0·18, 0·42, P= 0·428). The effect of vitamin C supplementation on EF increased significantly with age (β 0·023, 95 % CI 0·001, 0·05, P= 0·042). There was a significant negative correlation between baseline plasma vitamin E concentration and the effect of vitamin E supplementation on EF (β − 0·03, 95 % CI − 0·06, − 0·001, P= 0·029). Supplementation with either vitamin C or vitamin E alone improves EF. However, subgroup analysis emphasises the importance of careful characterisation and selection of a population group which may benefit from such supplementation.

Malnutrition is common in older people and is associated with a number of adverse outcomes. We review the evidence for the effectiveness of nutritional supplementation for older people in the community, in institutional care and following discharge from hospital. Studies in these settings are scarce, often include only small numbers of participants and are of variable quality. The interventions used are heterogeneous and difficult to directly compare. Oral nutritional supplements (sip feeds), dietary fortification, educational programmes, exercise, flavour enhancement and meal setting have all been studied. Evidence for use of oral nutritional supplements as sip feeds in undernourished community-dwelling and institutionalized older people and in those discharged from hospital is currently insufficient to recommend routine use. Flavour enhancement and more sociable meal environments may be beneficial. Further, more methodologically robust research is needed to clarify the effect of these interventions.

The use of nutritional supplements in sport is widespread and few serious athletes do not, at some stage in their career, succumb to the temptation to experiment with one or more nutritional supplements. Nutritional ergogenic aids are aimed primarily at enhancing performance (either by affecting energy metabolism or by an effect on the central nervous system), at increasing lean body mass or muscle mass by stimulation of protein synthesis and at reducing body fat content. Although not strictly ergogenic (i.e. capable of enhancing work performance), supplements aimed at increasing resistance to infection and improving general health are seen by athletes as important in reducing the interruptions to training that minor illness and infection can cause. Creatine is perhaps the most widely used supplement in sport at the moment. Supplementation can increase muscle creatine phosphate levels and, although not all published studies show positive results, there is much evidence that performance of short-term high-intensity exercise can be improved by supplementation. Ingestion of large doses of bicarbonate can enhance performance of exercise where metabolic acidosis may be a limiting factor, but there is a significant risk of adverse gastrointestinal side effects. Caffeine can also improve performance, in part by a stimulation of fatty acid mobilization and sparing of the body's limited carbohydrate stores, but also via direct effects on muscle and possibly by central nervous system effects on the perception of effort and fatigue. Carnitine plays an essential role in fatty acid oxidation in muscle but, although supplements are used by athletes, there is no good evidence of a beneficial effect of supplementation. None of these products contravenes the International Olympic Committee regulations on doping in sports, although caffeine is not permitted above a urine concentration of 12 mg/l. Supplementation is particularly prevalent among strength and power athletes, where an increase in muscle mass can benefit performance. Protein supplements have not been shown to be effective except in those rare cases where the dietary protein intake is otherwise inadequate. Individual amino acids, especially ornithine, arginine and glutamine, are also commonly used, but their benefit is not supported by documented evidence. Cr and hydroxymethylbutyrate are also used by strength athletes, but again there are no well-controlled studies to provide evidence of a beneficial effect. Athletes use a wide variety of supplements aimed at improving or maintaining general health and vitamin and mineral supplementation is widespread. There is a theoretical basis, and limited evidence, to support the use of antioxidant vitamins and glutamine during periods of intensive training, but further evidence is required before the use of these supplements can be recommended.

Based upon recent sales numbers, nutritional supplements play a key role in the lifestyle of a substantial proportion of the population. As well as products such as vitamins or minerals, several precursors of anabolic steroids are marketed as nutritional supplements. Another group of commercially available supplements are products for weight loss based upon herbal formulations originating from Ephedra species. Apart from supplements indicating the presence of these active compounds, numerous non-hormonal nutritional supplements were found that were contaminated with non-labelled anabolic steroids. Stimulating agents other than naturally occurring analogues of ephedrine were detected. A major group using dietary supplements are sportsmen, ranging from amateur level to elite athletes. Besides the possible health risks associated with the use of dietary supplements, athletes should take care not to violate the rules of the World Anti-Doping Agency because athletes remain responsible for substances detected in their biofluids, irrespective of their origin. Several analytical methods have been developed to determine the presence of doping agents as contaminants. The present review attempts to address the issues concerning the use of nutritional supplements and the detection of doping agents as contaminants in dietary supplements.

The use of complementary medicines in patients suffering from chronic illnesses such as cancer and depression is widely documented. Current studies suggest that the prevalence of the use of complementary medicines in patients with cancer ranges from 7% to 80%. In patients suffering from severe depression the use of complementary medicines may be >40%. The aim of the present review is to systematically explore the main dimensions that clinicians have to consider when advising patients suffering from these conditions. The Medline and Cochrane databases were searched for evidence relating to the benefits and risks of supplements in the treatment of cancer and depression, including the potential interactions with pharmaco- and radiotherapy. Supplements predominantly used by patients with cancer include vitamins A, C and E, β-carotene and ubiquinone 10. Supplements predominantly used by patients with depression include S-adenosylmethionine, l-tryptophan and 5-hydroxytryptophan and inositol. Supplements potentially used by both groups include n-3 fatty acids, Se and folic acid. Four dimensions are identified and discussed: effectiveness; safety; communication; medico-legal aspects. These dimensions have to be addressed in an illness- and case-specific context. This task can be complex given the emerging clinical evidence, patients' own preferences and expectations and current prescribing guidelines.

The use of vitamins, minerals and other supplements has increased considerably during recent years. In the National Diet and Nutrition Survey of British adults aged 19–64 years 40% of those surveyed were taking supplements. In 2005 sales of dietary supplements in the UK were approximately £325·7×106 in ‘bricks and mortar’ shops (excluding health food shops). The physiological effects of vitamins and minerals in amounts approximating to the UK reference nutrient intake or the EU RDA are well understood in terms of reducing the risk of micronutrient deficiency. However, the effects of vitamins, minerals and other supplements in larger amounts have attracted much attention in recent decades, and these effects, some of which may be pharmacological, are not as well categorised. Some of these effects are beneficial, some are not. Although vitamins and minerals and other supplements are generally safe at higher doses, there are some safety issues that are relevant in the context of the wide availability of supplements without a doctor's prescription. Thus, several authorities throughout the world have established upper limits (UL) for the intake of vitamins and minerals, and the EU is in the process of setting maximum permitted levels (MPL) for vitamins and minerals in food supplements. The present paper discusses the potential benefits and safety issues relating to the use of supplements at doses higher than the RDA. The rationale for the establishment of UL is also discussed, explaining the differences between the values set by different authorities and the expected guidance and legislation from the European Commission on MPL for vitamins and minerals in food supplements.