A Nutraceutical Formula Is Effective in Raising the Circulating Vitamin and Mineral Levels in Healthy Subjects: A Randomized Trial

Hatice Zeynep Nenseth, Aparna Sahu, Fahri Saatcioglu, Steven Osguthorpe, Hatice Zeynep Nenseth, Aparna Sahu, Fahri Saatcioglu, Steven Osguthorpe

Abstract

Low levels of nutrient intake are common in industrialized countries. This has negative implications on health and is associated with chronic diseases. Supplementation of vitamins, minerals, and key nutrients to optimal levels may, therefore, be beneficial for individual health and for the health economy. Although the use of supplements has become very common, due to a lack of monitoring, there is very limited data on the efficacy of supplementation with different formulas. In this study, we present the results of a randomized controlled study on the efficacy of a novel formulated nutraceutical, N247, in 250 healthy volunteers aged 26-75 years and a placebo control group (n = 35). The broad-spectrum formulation of N247 includes essential vitamins, minerals, and trace elements that are adequately balanced in regard to synergies and related metabolic functions. Moreover, tolerance, safety, and nutrient availability is an important aspect of daily, long-term use of N247. After 3 months of regular N247 use, levels of vitamins and minerals in serum were significantly increased in the N247 group compared with the control group and a placebo group, with excellent compliance rates. Coupled with additional natural ingredients that aim to increase the potency of the nutrients, N247 may represent a novel and beneficial supplement for individuals with nutritional deficiencies. Clinical Trial Registration:https://ichgcp.net/clinical-trials-registry/NCT04054505" title="See in ClinicalTrials.gov">NCT04054505.

Keywords: clinical trial; minerals; nutraceuticals; supplementation; vitamins.

Conflict of interest statement

SO is employed by the company Optimal Health Research. SO is married to Dianne Osguthorpe, the owner of ReaLifeResources, Inc, which is the owner of N247, the subject matter of this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Nenseth, Sahu, Saatcioglu and Osguthorpe.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
Graphical representation of N247 effects on serum vitamin A, C, D, and E levels. Serum concentrations of vitamin A (A), vitamin C (B), vitamin D (C), and vitamin E (D) in control and N247 receiving group of women and men subjects during the study. Values are mean ± SEM.
Figure 3
Figure 3
Serum concentrations of vitamin A, C, D, and E. Values are mean ± SD. % values are given in parentheses.
Figure 4
Figure 4
Graphical representation of N247 effects on serum vitamin B1, B2, B6, and B12 levels. Serum concentrations of vitamin B1 (A), vitamin B2 (B), vitamin B6 (C), and vitamin B12 (D) in control and N247 receiving group of women and men subjects during the study. Values are mean ± SEM.
Figure 5
Figure 5
Serum concentrations of vitamin B1, B2, B6, and B12. Values are mean ± SD% values are given in parentheses.
Figure 6
Figure 6
Graphical representation of N247 effects on serum calcium, iron, IGF-1, and FT-3 levels. Serum concentrations of calcium (A), iron (B), IGF-1 (C), and FT-3 (D) in control and N247 receiving group of women and men subjects during the study of 3 months. Values are mean ± SEM.
Figure 7
Figure 7
Serum concentrations of calcium, iron, IGF-1, and FT-3. Values are mean ± SD% values are given in parentheses.

References

    1. Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients. (2017) 9:849. 10.3390/nu9080849
    1. Dickinson A, Boyon N, Shao A. Physicians nurses use recommend dietary supplements: report of a survey. Nutr J. (2009) 8:29. 10.1186/1475-2891-8-29
    1. Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, et al. . Dietary supplement use in the United States, 2003-2006. J Nutr. (2011) 141:261–6. 10.3945/jn.110.133025
    1. Kennedy ET, Luo H, Houser RF. Dietary supplement use pattern of U.S. adult population in the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Ecol Food Nutr. (2013) 52:76–84. 10.1080/03670244.2012.706000
    1. Austin KG, Price LL, McGraw SM, Lieberman HR. Predictors of dietary supplement use by U.S. coast guard personnel. PLoS ONE. (2015) 10:e0133006. 10.1371/journal.pone.0133006
    1. Burnett AJ, Livingstone KM, Woods JL, McNaughton SA. Dietary supplement use among Australian adults: findings from the 2011-2012 national nutrition and physical activity survey. Nutrients. (2017) 9:1248. 10.3390/nu9111248
    1. Rock CL. Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr. (2007) 85:277S–9S. 10.1093/ajcn/85.1.277S
    1. Gardiner P, Woods C, Kemper KJ. Dietary supplement use among health care professionals enrolled in an online curriculum on herbs and dietary supplements. BMC Complement Altern Med. (2006) 6:21. 10.1186/1472-6882-6-21
    1. Couris RR, Dwyer JT. Nutrition and pharmacy: a prescription for health? Nutr Today. (1995) 30:75–8. 10.1097/00017285-199503000-00010
    1. Hall LM, Kimlin MG, Aronov PA, Hammock BD, Slusser JR, Woodhouse LR, et al. . Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations. J Nutr. (2010) 140:542–50. 10.3945/jn.109.115253
    1. Hayes DP. Adverse effects of nutritional inadequacy and excess: a hormetic model. Am J Clin Nutr. (2008) 88:578S–81S. 10.1093/ajcn/88.2.578S
    1. Diethelm K, Huybrechts I, Moreno L, De Henauw S, Manios Y, Beghin L, et al. . Nutrient intake of European adolescents: results of the HELENA (healthy lifestyle in Europe by nutrition in adolescence) study. Public Health Nutr. (2014) 17:486–97. 10.1017/S1368980013000463
    1. Troesch B, Hoeft B, McBurney M, Eggersdorfer M, Weber P. Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries. Br J Nutr. (2012) 108:692–8. 10.1017/S0007114512001808
    1. Akseer N, Kandru G, Keats EC, Bhutta ZA. COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. (2020) 112:251–6. 10.1093/ajcn/nqaa171
    1. Carducci B, Keats EC, Ruel M, Haddad L, Osendarp SJM, Bhutta ZA. Food systems, diets and nutrition in the wake of COVID-19. Nat Food. (2021) 2:68–70. 10.1038/s43016-021-00233-9
    1. Park B, Kim J. Oral contraceptive use, micronutrient deficiency, and obesity among premenopausal females in Korea: the necessity of dietary supplements and food intake improvement. PLoS ONE. (2016) 11:e0158177. 10.1371/journal.pone.0158177
    1. Office of the Federal Register NARA . Food Labeling: Subpart D—Specific Requirements for Nutrient Content Claims—Nutrient Content Claims for “Good Source,” “High,” “More,” and “High Potency.” Washington, DC: US Government Printing Office; (2018).
    1. Dwyer J. Dietary requirements of adults. In: Caballero B, editor. Encyclopedia of Food Sciences and Nutrition. 2nd edn. Oxford: Academic Press; (2003). p. 1863–8. 10.1016/B0-12-227055-X/00350-3
    1. Medicine IO. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press; (2006).
    1. Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. (2009) 56:1143–60. 10.1016/j.pcl.2009.06.007
    1. U.S. Department of Agriculture . USDA Nutrient Data Laboratory, Composition of Foods Raw, Processed, Prepared,USDA Nutrient Database for Standard Reference, Release 22, Beltsville, MD: U.S. Department of Agriculture; (2009).
    1. Kiely M, Flynn A, Harrington KE, Robson PJ, O'Connor N, Hannon EM, et al. . The efficacy and safety of nutritional supplement use in a representative sample of adults in the North/South ireland food consumption survey. Public Health Nutr. (2001) 4:1089–97. 10.1079/PHN2001190
    1. National Institutes of Health State-of-the-Science P . National Institutes of health state-of-the-science conference statement: multivitamin/mineral supplements chronic disease prevention. Am J Clin Nutr. (2007) 85:257S–64S. 10.1093/ajcn/85.1.257S
    1. Milani A, Basirnejad M, Shahbazi S, Bolhassani A. Carotenoids: biochemistry, pharmacology and treatment. Br J Pharmacol. (2017) 174:1290–324. 10.1111/bph.13625
    1. Chopra RK, Bhagavan HN. Relative bioavailabilities of natural and synthetic vitamin E formulations containing mixed tocopherols in human subjects. Int J Vitam Nutr Res. (1999) 69:92–5. 10.1024/0300-9831.69.2.92
    1. Samsam Shariat SZ, Mostafavi SA, Khakpour F. Antioxidant effects of vitamins C e on the low-density lipoprotein oxidation mediated by myeloperoxidase. Iran Biomed J. (2013) 17:22–8. 10.6091/ibj.1092.2012
    1. Krukoski DW, Comar SR, Claro LM, Leonart MS, do Nascimento AJ. Effect of vitamin C. deferoxamine, quercetin and rutin against tert-butyl hydroperoxide oxidative damage in human erythrocytes. Hematology. (2009) 14:168–72. 10.1179/102453309X402296
    1. Traber MG, Vitamin E.regulatory mechanisms. Annu Rev Nutr. (2007) 27:347–62. 10.1146/annurev.nutr.27.061406.093819
    1. Trachtman H. Vitamin E prevents glucose-induced lipid peroxidation and increased collagen production in cultured rat mesangial cells. Microvasc Res. (1994) 47:232–9. 10.1006/mvre.1994.1068
    1. Ohta Y, Imai Y, Kaida S, Kamiya Y, Kawanishi M, Hirata I. Vitamin E protects against stress-induced gastric mucosal lesions in rats more effectively than vitamin C. Biofactors. (2010) 36:60–9. 10.1002/biof.73
    1. Hewison M, Adams JS. Vitamin D insufficiency and skeletal development in utero. J Bone Miner Res. (2010) 25:11–3. 10.1002/jbmr.2
    1. Aranow C. Vitamin D and the immune system. J Investig Med. (2011) 59:881–6. 10.2310/JIM.0b013e31821b8755
    1. Gopinath B, Wang JJ, Flood VM, Burlutsky G, Wong TY, Mitchell P. The associations between blood levels of homocysteine, folate, vitamin B12, and retinal vascular caliber. Am J Ophthalmol. (2009) 148:902–9. 10.1016/j.ajo.2009.07.018
    1. Calderon-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. (2020) 26:5–13. 10.1111/cns.13207
    1. Powers HJ. Riboflavin (vitamin B-2) and health. Am J Clin Nutr. (2003) 77:1352–60. 10.1093/ajcn/77.6.1352
    1. Ashoori M, Saedisomeolia A. Riboflavin (vitamin B(2)) and oxidative stress: a review. Br J Nutr. (2014) 111:1985–91. 10.1017/S0007114514000178
    1. Farris PK. Chapter 5 - topical skin care the cosmetic patient. In: Azizzadeh B, Murphy MR, Johnson CM, Massry GG, Fitzgerald R, editors. Master Techniques in Facial Rejuvenation. 2nd edn. Elsevier (2018). p. 68–72.e2. 10.1016/B978-0-323-35876-7.00005-4
    1. Gasperi V, Sibilano M, Savini I, Catani MV. Niacin in the central nervous system: an update of biological aspects and clinical applications. Int J Mol Sci. (2019) 20:974. 10.3390/ijms20040974
    1. Parra M, Stahl S, Hellmann H. Vitamin B(6) and its role in cell metabolism and physiology. Cells. (2018) 7:84. 10.3390/cells7070084
    1. Chang N, Kim E, Kim KN, Kim H, Kim SY, Jeong BS. Folate nutrition is related to neuropsychological functions in the elderly. Nutr Res Pract. (2009) 3:43–8. 10.4162/nrp.2009.3.1.43
    1. Hsu CC, Cheng CH, Hsu CL, Lee WJ, Huang SC, Huang YC. Role of vitamin B6 status on antioxidant defenses, glutathione, and related enzyme activities in mice with homocysteine-induced oxidative stress. Food Nutr Res. (2015) 59:25702. 10.3402/fnr.v59.25702
    1. Bailey LB, Stover PJ, McNulty H, Fenech MF, Gregory JF, Mills JL, et al. . Biomarkers of nutrition for development-folate review. J Nutr. (2015) 145:1636S–80S. 10.3945/jn.114.206599
    1. Scalabrino G. Vitamin-regulated cytokines and growth factors in the CNS and elsewhere. J Neurochem. (2009) 111:1309–26. 10.1111/j.1471-4159.2009.06417.x
    1. Nohr D, Biesalski HK. Vitamin B12, Reference Module in Food Science. Stuttgart: Elsevier; (2016). 10.1016/B978-0-08-100596-5.01075-1
    1. Rivera-Calimlim L, Hartley D, Osterhout D. Effects of ethanol and pantothenic acid on brain acetylcholine synthesis. Br J Pharmacol. (1988) 95:77–82. 10.1111/j.1476-5381.1988.tb16550.x
    1. Depeint F, Bruce WR, Shangari N, Mehta R, O'Brien PJ. Mitochondrial function and toxicity: role of the B vitamin family on mitochondrial energy metabolism. Chem Biol Interact. (2006) 163:94–112. 10.1016/j.cbi.2006.04.014
    1. Jeney V, Balla J, Yachie A, Varga Z, Vercellotti GM, Eaton JW, et al. . Pro-oxidant and cytotoxic effects of circulating heme. Blood. (2002) 100:879–87. 10.1182/blood.V100.3.879
    1. Beto JA. The role of calcium in human aging. Clin Nutr Res. (2015) 4:1–8. 10.7762/cnr.2015.4.1.1
    1. Wang Y, Hou Y, Dong J, Xu H, Gong J, Chen J. Developmental iodine deficiency and hypothyroidism reduce phosphorylation of calcium/calmodulin-dependent kinase II in the rat entorhinal cortex. Biol Trace Elem Res. (2010) 137:353–63. 10.1007/s12011-009-8591-7
    1. Grober U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. (2015) 7:8199–226. 10.3390/nu7095388
    1. Kambe T, Tsuji T, Hashimoto A, Itsumura N. The physiological, biochemical, and molecular roles of zinc transporters in zinc homeostasis and metabolism. Physiol Rev. (2015) 95:749–84. 10.1152/physrev.00035.2014
    1. Dardenne M. Zinc and immune function. Eur J Clin Nutr. (2002) 3 (56 Suppl):S20–3. 10.1038/sj.ejcn.1601479
    1. Rayman MP. Selenium and human health. Lancet. (2012) 379:1256–68. 10.1016/S0140-6736(11)61452-9
    1. Kohrle J, Gartner R. Selenium and thyroid. Best Pract Res Clin Endocrinol Metab. (2009) 23:815–27. 10.1016/j.beem.2009.08.002
    1. Vincente AR, Manganaris GA, Ortiz CM, Sozzi GO, Crisosto CH. Chapter 5 - nutritional quality of fruits vegetables. In: Florkowski WJ, Shewfelt RL, editors Postharvest Handling. 3rd edn. San Diego, CA: Academic Press; (2014). p. 69–122. 10.1016/B978-0-12-408137-6.00005-3
    1. Preuss HG, Echard B, Perricone NV, Bagchi D, Yasmin T, Stohs SJ. Comparing metabolic effects of six different commercial trivalent chromium compounds. J Inorg Biochem. (2008) 102:1986–90. 10.1016/j.jinorgbio.2008.07.012
    1. Grech BJ. Mechanistic insights into the treatment of iron-deficiency anemia and arthritis in humans with dietary molybdenum. Eur J Clin Nutr. (2021) 10.1038/s41430-020-00845-7
    1. Seifter JL. 119–potassium disorders. In: Goldman L, Schafer AI, editors. Goldman's Cecil Medicine. 24th edn. Philadelphia, PA: Saunders WB; (2012). p. 734–41. 10.1016/B978-1-4377-1604-7.00119-6
    1. Peterson JA, Crowther CM, Andrus MB, Kenealey JD. Resveratrol derivatives increase cytosolic calcium by inhibiting plasma membrane ATPase and inducing calcium release from the endoplasmic reticulum in prostate cancer cells. Biochem Biophys Rep. (2019) 19:100667. 10.1016/j.bbrep.2019.100667
    1. Baci D, Bruno A, Bassani B, Tramacere M, Mortara L, Albini A, et al. . Acetyl-l-carnitine is an anti-angiogenic agent targeting the VEGFR2 and CXCR4 pathways. Cancer Lett. (2018) 429:100–16. 10.1016/j.canlet.2018.04.018
    1. Lee SA, Bedford MR. Inositol - an effective growth promotor? Worlds Poultry Sci J. (2016) 72:743–60. 10.1017/S0043933916000660
    1. Dai Z, Chung SK, Miao D, Lau KS, Chan AW, Kung AW. Sodium/myo-inositol cotransporter 1 and myo-inositol are essential for osteogenesis and bone formation. J Bone Miner Res. (2011) 26:582–90. 10.1002/jbmr.240
    1. Macri MA, D'Alessandro N, Di Giulio C, Di Iorio P, Di Luzio S, Giuliani P, et al. . Regional changes in the metabolite profile after long-term hypoxia-ischemia in brains of young and aged rats: a quantitative proton MRS study. Neurobiol Aging. (2006) 27:98–104. 10.1016/j.neurobiolaging.2005.01.007
    1. Fenech M. Vitamins associated with brain aging, mild cognitive impairment, and alzheimer disease: biomarkers, epidemiological and experimental evidence, plausible mechanisms, knowledge gaps. Adv Nutr. (2017) 8:958–70. 10.3945/an.117.015610
    1. Mendelson SD. 10–Nutritional supplements and metabolic syndrome. In: Mendelson SD, editor. Metabolic Syndrome and Psychiatric Illness. San Diego, CA: Academic Press; (2008). p. 141–86. 10.1016/B978-012374240-7.50012-7
    1. Barhwal K, Hota SK, Jain V, Prasad D, Singh SB, Ilavazhagan G. Acetyl-l-carnitine (ALCAR) prevents hypobaric hypoxia-induced spatial memory impairment through extracellular related kinase-mediated nuclear factor erythroid 2-related factor 2 phosphorylation. Neuroscience. (2009) 161:501–14. 10.1016/j.neuroscience.2009.02.086
    1. Traina G. The neurobiology of acetyl-L-carnitine. Front Biosci. (2016) 21:1314–29. 10.2741/4459
    1. Curi R, Lagranha CJ, Doi SQ, Sellitti DF, Procopio J, Pithon-Curi TC, et al. . Molecular mechanisms of glutamine action. J Cell Physiol. (2005) 204:392–401. 10.1002/jcp.20339
    1. Struzynska L, Sulkowski G. Relationships between glutamine, glutamate, and GABA in nerve endings under Pb-toxicity conditions. J Inorg Biochem. (2004) 98:951–8. 10.1016/j.jinorgbio.2004.02.010
    1. Spignoli G, Magnani M, Giovannini MG, Pepeu G. Effect of pyroglutamic acid stereoisomers on ECS and scopolamine-induced memory disruption and brain acetylcholine levels in the rat. Pharmacol Res Commun. (1987) 19:901–12. 10.1016/0031-6989(87)90040-3
    1. Attipoe S, Zeno SA, Lee C, Crawford C, Khorsan R, Walter AR, et al. . Tyrosine for mitigating stress and enhancing performance in healthy adult humans, a rapid evidence assessment of the literature. Mil Med. (2015) 180:754–65. 10.7205/MILMED-D-14-00594
    1. Linssen AM, Riedel WJ, Sambeth A. Effects of tyrosine/phenylalanine depletion on electrophysiological correlates of memory in healthy volunteers. J Psychopharmacol. (2011) 25:230–8. 10.1177/0269881109348160
    1. Tammenmaa-Aho I, Asher R, Soares-Weiser K, Bergman H. Cholinergic medication for antipsychotic-induced tardive dyskinesia. Cochrane Database Syst Rev. (2018) 3:CD000207. 10.1002/14651858.CD000207.pub2
    1. Ferris SH, Sathananthan G, Gershon S, Clark C. Senile dementia: treatment with deanol. J Am Geriatr Soc. (1977) 25:241–4. 10.1111/j.1532-5415.1977.tb00407.x
    1. Grossman R. The role of dimethylaminoethanol in cosmetic dermatology. Am J Clin Dermatol. (2005) 6:39–47. 10.2165/00128071-200506010-00005
    1. Tandon N, Yadav SS. Safety and clinical effectiveness of withania somnifera (Linn.) dunal root in human ailments. J Ethnopharmacol. (2020) 255:112768. 10.1016/j.jep.2020.112768
    1. Kuboyama T, Tohda C, Komatsu K. Neuritic regeneration and synaptic reconstruction induced by withanolide A. Br J Pharmacol. (2005) 144:961–71. 10.1038/sj.bjp.0706122
    1. Farooqui AA, Farooqui T, Madan A, Ong JH, Ong WY. ayurvedic medicine for the treatment of dementia: mechanistic aspects. Evid Based Complement Alternat Med. (2018) 2018:2481076. 10.1155/2018/2481076
    1. Coultrap SJ, Bickford PC, Browning MD. Blueberry-enriched diet ameliorates age-related declines in NMDA receptor-dependent LTP. Age. (2008) 30:263–72. 10.1007/s11357-008-9067-y
    1. Smith JV, Luo Y. Studies on molecular mechanisms of Ginkgo biloba extract. Appl Microbiol Biotechnol. (2004) 64:465–72. 10.1007/s00253-003-1527-9
    1. Ramassamy C, Longpre F, Christen Y. Ginkgo biloba extract (EGb 761) in Alzheimer's disease: is there any evidence? Curr Alzheimer Res. (2007) 4:253–62. 10.2174/156720507781077304
    1. Bahrke MS, Morgan WR. Evaluation of the ergogenic properties of ginseng: an update. Sports Med. (2000) 29:113–33. 10.2165/00007256-200029020-00004
    1. Huang L, Zhao H, Huang B, Zheng C, Peng W, Qin L. Acanthopanax senticosus: review of botany, chemistry and pharmacology. Pharmazie. (2011) 66:83–97. 10.1002/chin.201125219
    1. Zhang W, Huang Y, Li Y, Tan L, Nao J, Hu H, et al. . Efficacy and safety of vinpocetine as part of treatment for acute cerebral infarction: a randomized, open-label, controlled, multicenter CAVIN (chinese assessment for vinpocetine in neurology) trial. Clin Drug Investig. (2016) 36:697–704. 10.1007/s40261-016-0415-x
    1. French JM, King MD, McDougal OM. Quantitative determination of vinpocetine in dietary supplements. Nat Prod Commun. (2016) 11:607–9. 10.1177/1934578X1601100512
    1. Zeisel SH. A brief history of choline. Ann Nutr Metab. (2012) 61:254–8. 10.1159/000343120
    1. Jager R, Purpura M, Kingsley M. Phospholipids and sports performance. J Int Soc Sports Nutr. (2007) 4:5. 10.1186/1550-2783-4-5
    1. Barbagallo Sangiorgi G, Barbagallo M, Giordano M, Meli M, Panzarasa R. alpha-Glycerophosphocholine in the mental recovery of cerebral ischemic attacks. An Italian multicenter clinical trial. Ann N Y Acad Sci. (1994) 717:253–69. 10.1111/j.1749-6632.1994.tb12095.x
    1. Bellar D, LeBlanc NR, Campbell B. The effect of 6 days of alpha glycerylphosphorylcholine on isometric strength. J Int Soc Sports Nutr. (2015) 12:42. 10.1186/s12970-015-0103-x
    1. Komori T. The effects of phosphatidylserine and omega-3 fatty acid-containing supplement on late life depression. Ment Illn. (2015) 7:5647. 10.4081/mi.2015.5647
    1. Shoben AB, Kestenbaum B, Levin G, Hoofnagle AN, Psaty BM, Siscovick DS, et al. . Seasonal variation in 25-hydroxyvitamin D concentrations in the cardiovascular health study. Am J Epidemiol. (2011) 174:1363–72. 10.1093/aje/kwr258
    1. Liu BA, Gordon M, Labranche JM, Murray TM, Vieth R, Shear NH. Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc. (1997) 45:598–603. 10.1111/j.1532-5415.1997.tb03094.x
    1. Gannage-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. (2000) 15:1856–62. 10.1359/jbmr.2000.15.9.1856
    1. Heaney RP. Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr. (2008) 88:541S–4S. 10.1093/ajcn/88.2.541S
    1. Macdonald HM. Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int. (2013) 92:163–76. 10.1007/s00223-012-9634-1
    1. Dwyer JT, Coates PM, Smith MJ. Dietary supplements: regulatory challenges and research resources. Nutrients. (2018) 10:41. 10.3390/nu10010041
    1. Chang AY, Skirbekk VF, Tyrovolas S, Kassebaum NJ, Dieleman JL. Measuring population ageing: an analysis of the global burden of disease study 2017. Lancet Public Health. (2019) 4:e159–67. 10.1016/S2468-2667(19)30019-2
    1. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B, et al. . CDC grand rounds: a public health approach to detect and control hypertension. MMWR Morb Mortal Wkly Rep. (2016) 65:1261–4. 10.15585/mmwr.mm6545a3
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. . American Heart Association Statistics, and S. Stroke Statistics, Heart disease and stroke statistics−2015 update: a report from the American heart association. Circulation. (2015) 131:e29–322. 10.1161/CIR.0000000000000157
    1. Palar K, Sturm R. Potential societal savings from reduced sodium consumption in the U.S. adult population. Am J Health Promot. (2009) 24:49–57. 10.4278/ajhp.080826-QUAN-164
    1. Leenders NHJ, Vervloet MG. Magnesium: a magic bullet for cardiovascular disease in chronic kidney disease? Nutrients. (2019) 11:455. 10.3390/nu11020455
    1. Alehagen U, Alexander J, Aaseth J. Supplementation with selenium and coenzyme Q10 reduces cardiovascular mortality in elderly with low selenium status. A secondary analysis of a randomised clinical trial. PLoS ONE. (2016) 11:e0157541. 10.1371/journal.pone.0157541
    1. Alehagen U, Aaseth J, Alexander J, Johansson P. Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: a validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly. PLoS ONE. (2018) 13:e0193120. 10.1371/journal.pone.0193120

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