Sports nutrition supplements and adverse events – a meta-epidemiological study of case reports specifically addressing causality assessment

• Published in: European journal of clinical pharmacology Vol. 78; no. 1; pp. 1 - 9
• Main Authors: Zeijlon, Rickard, Hantelius, Victor, Wallerstedt, Susanna M., Holmqvist, Lina
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2022; Springer Nature B.V
• Subjects: Adolescent; Adult; Adverse; Adverse events; Biomedical and Life Sciences; Biomedicine; Case reports; Causality; Causality assessment; Clinical reasoning; death; Dietary supplement; Dietary supplements; Dietary Supplements - adverse effects; drug-reactions; Epidemiologic Studies; Epidemiology; event; Farmakologi och toxikologi; Female; hemorrhagic stroke; hepatotoxicity; Humans; Male; Middle Aged; Nutrition; Pharmacology & Pharmacy; Pharmacology and Toxicology; Pharmacology/Toxicology; probability; Review; Sports Nutritional Sciences; Young Adult; Clinical reasoning; Adverse event; Dietary supplement; Causality assessment
• ISSN: 0031-6970; 1432-1041; 1432-1041
• DOI: 10.1007/s00228-021-03223-9

Purpose This meta-epidemiological study aimed to systematically review case reports regarding sports nutrition supplements and adverse events (AEs), specifically addressing the issue of causality assessments. Methods Through a systematic literature search we identified all published case reports of AEs associated with sports nutrition supplements between 1 January 2008 and 1 March 2019. Data regarding AEs, suspected supplements, relevant causality assessment factors and the reporting of clinical reasoning and/or systematic causality assessment methods were extracted. Results In all, 72 publications were included, reporting 134 supplements and 37 different AEs in 97 patients (85% males; median age: 30 years [range: 14–60]). Information regarding previous health and regular prescription drugs was not presented in 30% (29/97) and 46% (45/97) of cases, respectively. In 23% (22/97) of the cases, no alternative cause was mentioned. Clinical reasoning was identified in 63% (61/97), and in 13% (8/61) of these, a systematic causality assessment method was applied. In cases with clinical reasoning, a theoretic rationale (92% vs 78%, P = 0.05), a description of previous cases (90% vs 72%, P = 0.021) and body fluid analysis (18% vs 3%, P = 0.027) were reported to a greater extent. Among cases with clinical reasoning, the application of a systematic causality assessment method captured additional important aspects: use of medication (100% vs 55%, P = 0.015), alcohol use (88% vs 43%, P = 0.020) and illicit drug use (88% vs 40%, P = 0.011). Conclusions In published case reports where sports nutrition supplements were suspected to have caused AEs, essential factors for causality assessment were left out in a non-negligible proportion. Clinical reasoning was identified in most cases whereas a systematic causality assessment method was applied in a minority. Factors of importance for causality assessment were reported to a greater extent in cases including clinical reasoning, and the application of a systematic causality assessment method captured additional aspects of importance.