Friday, October 5, 2012

Caffeine effective as an analgesic adjuvant

Caffeine effective as an analgesic adjuvant
September 17, 2012
PEARLS 362, July 2012, written by Brian R McAvoy

Clinical question: How effective is caffeine as an analgesic adjuvant for acute pain in adults?

Bottom line: Adding caffeine (at a dose equivalent to a mug of coffee, ie, about 100mg) to a standard dose of common analgesics, such as paracetamol or ibuprofen, increased the number of people with acute pain who experience a good level of pain relief (at least 50% of the maximum) by 5 to 10% (NNT* 15). The most common conditions studied were postoperative dental pain, postpartum pain, menstrual period pain and headache. One serious adverse event was reported with caffeine but was considered unrelated to any study medication. *NNT = number needed to treat to benefit 1 individual.

Caveat: Most comparisons individually demonstrated numerical superiority with caffeine but not statistical superiority.

Context: Caffeine is commonly used as a component in analgesics available from pharmacies without a prescription in the belief that it enhances analgesic efficacy.

Cochrane Systematic Review: Derry CJ et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Reviews, 2012, Issue 3. Article No. CD009281. DOI: 10.1002/14651858.CD009281.pub2. This review contains 19 studies involving 7238 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

Tuesday, October 2, 2012

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners

J Acad Nutr Diet. 2012 May;112(5):739-58. Epub 2012 Apr 25.
Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners.
Fitch C, Keim KS; Academy of Nutrition and Dietetics.
Source
West Virginia University, Morgantown, WV, USA.
Erratum in
J Acad Nutr Diet. 2012 Aug;112(8):1279.
Abstract
It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.
Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Use of nutritive and nonnutritive sweeteners

J Am Diet Assoc. 2004 Feb;104(2):255-75.
Position of the American Dietetic Association: use of nutritive and nonnutritive sweeteners.
American Dietetic Association.
Erratum in
J Am Diet Assoc. 2004 Jun;104(6):1013.

Sweeteners elicit pleasurable sensations with (nutritive) or without (nonnutritive) energy. Nutritive sweeteners (eg, sucrose, fructose) are generally recognized as safe (GRAS) by the Food and Drug Administration (FDA), yet concern exists about increasing sweetener intakes relative to optimal nutrition and health. Dietary quality suffers at intakes above 25% of total energy (the Institutes of Medicine's suggested maximal intake level). In the United States, estimated intakes of nutritive sweeteners fall below this, although one in four children (ages 9 to 18 years) can surpass this level. Polyols (sugar alcohols), GRAS-affirmed or petitions filed for GRAS, add sweetness with reduced energy and functional properties to foods/beverages and promote dental health. Five nonnutritive sweeteners with intense sweetening power have FDA approval (acesulfame-K, aspartame, neotame, saccharin, sucralose) and estimated intakes below the Acceptable Daily Intake (level that a person can safely consume everyday over a lifetime without risk). By increasing palatability of nutrient-dense foods/beverages, sweeteners can promote diet healthfulness. Scientific evidence supports neither that intakes of nutritive sweeteners by themselves increase the risk of obesity nor that nutritive or nonnutritive sweeteners cause behavioral disorders. However, nutritive sweeteners increase risk of dental caries. High fructose intakes may cause hypertriglyceridemia and gastrointestinal symptoms in susceptible individuals. Thus, it is the position of The American Dietetic Association that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed in a diet that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary References Intakes, as well as individual health goals. Dietetics professionals should provide consumers with science-based information about sweeteners and support research on the use of sweeteners to promote eating enjoyment, optimal nutrition, and health.