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A Change-Point Regression Approach for Efficacy Evaluation of Dietary Supplements

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      In clinical trials for dietary supplements and functional foods, the study population tends to be a mixture of healthy subjects and those who are not so healthy but are not definitely diseased (called “borderline subjects”). For such heterogeneous populations, the t-test and ANCOVA method often fail to provide the desired treatment efficacy. We propose an alternative approach for the efficacy evaluation of dietary supplements and functional foods based on a change-point linear regression model. The model does not require the assumption of a constant treatment effect and provides clinically interpretable results. By employing the AIC-based profile likelihood method, inferences can be made easily using standard statistical software. The proposed method was applied to the Garcinia study data, and the merit of the method was demonstrated by comparing it with traditional methods.

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      Most cited references 18

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      Estimation of nutrient requirements using broken-line regression analysis.

      We evaluated and compared various broken-line regression models and SAS (SAS Inst. Inc., Cary, NC) procedures for estimating nutrient requirements from nutrient dose response data. We used the SAS (Version 9) procedures NLIN and NLMixed and the response data of Parr et al. (2003), who evaluated the isoleucine requirement of growing swine. The SAS NLIN was used to fit 2 different broken-line regression models: a simple 2 straight-line, one-breakpoint model and a quadratic broken-line model in which the response below the single breakpoint was quadratic; there was a plateau above the breakpoint. The latter was fit using 2 different approaches in NLIN. We also used SAS NLMixed to fit 3 different broken-line models: the 2 straight-line, one-breakpoint model that included a random component for the plateau; the quadratic broken-line model that included a random component for the plateau; and the quadratic broken-line model that included random components for both the plateau and the slope of the curve below the requirement. The best fit (greater adjusted R2; least log likelihood) was achieved using SAS NLMixed and the quadratic model with a random component for asymptote included in the model. Model descriptions, SAS code, and output are presented and discussed. Additionally, we provide other examples of possible models and discuss approaches to handling difficult-to-fit data.
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        Estimation of nutrient requirements from growth data.

        Two least squares methods of estimating nutrient requirements from growth data were compared. One method involved fitting a broken line by the method of least squares. The requirement was taken as the abscissa of the breakpoint in the curve. The other method involved fitting an appropriate exponential function to the growth data and estimating the requirement as the abscissa of the point on the fitted curve whose ordinate was 95% of the upper asymptote. For the nine sets of data studied, the broken line provided adequate fits for only six. The nonlinear models provided adequate fits for all the data studied. When both the broken line and the chosen nonlinear model provided adequate fits, the estimated requirements were nearly the same. However, the consistently good fits obtained with the nonlinear models suggest that this approach may generally be more useful.
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          Chemistry and biochemistry of (-)-hydroxycitric acid from Garcinia.

          (-)-Hydroxycitric acid [(-)-HCA] is the principal acid of fruit rinds of Garcinia cambogia, Garcinia indica, and Garcinia atroviridis. (-)-HCA was shown to be a potent inhibitor of ATP citrate lyase (EC, which catalyzes the extramitochondrial cleavage of citrate to oxaloacetate and acetyl-CoA: citrate + ATP + CoA --> acetyl-CoA + ADP + P(i) + oxaloacetate. The inhibition of this reaction limits the availability of acetyl-CoA units required for fatty acid synthesis and lipogenesis during a lipogenic diet, that is, a diet high in carbohydrates. Extensive animal studies indicated that (-)-HCA suppresses the fatty acid synthesis, lipogenesis, food intake, and induced weight loss. In vitro studies revealed the inhibitions of fatty acid synthesis and lipogenesis from various precursors. However, a few clinical studies have shown controversial findings. This review explores the literature on a number of topics: the source of (-)-HCA; the discovery of (-)-HCA; the isolation, stereochemistry, properties, methods of estimation, and derivatives of (-)-HCA; and its biochemistry, which includes inhibition of the citrate cleavage enzyme, effects on fatty acid synthesis and lipogenesis, effects on ketogenesis, other biological effects, possible modes of action on the reduction of food intake, promotion of glycogenesis, gluconeogenesis, and lipid oxidation, (-)-HCA as weight-controlling agent, and some possible concerns about (-)-HCA, which provides a coherent presentation of scattered literature on (-)-HCA and its plausible mechanism of action and is provocative of further research.

            Author and article information

            [1 ]FANCL Research Institute, Evaluation Technology Group, 12-13 Kamishinano, Totsuka-ku, Yokohama, Kanagawa 244-0806, Japan
            [2 ]Biostatistics Center, Kurume University, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
            [3 ]Graduate School of Medical Sciences, Kyushu University Department of Innovative Applied Oncology, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
            Author notes
            *To whom correspondence should be addressed. Tel: +81-45-820-3519 Fax: +81-45-820-3509 E-mail: kohayamizu@
            J Clin Biochem Nutr
            Journal of Clinical Biochemistry and Nutrition
            the Society for Free Radical Research Japan (Kyoto, Japan )
            May 2009
            25 April 2009
            : 44
            : 3
            : 285-290
            Copyright © 2009 JCBN

            This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Original Article


            clinical trial, change-point, dietary supplements, aic


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