Recent studies have verified that the SARS-CoV-2 infection (from December 2019 has affected 123 million people throughout the world and more than 3 million people in Italy), can have medium-term and long-term effects, collectively referred to as “post-Covid syndrome” or “long-Covid” characterized by chronic fatigue, followed by muscle weakness, dyspnea and headache. Chronic fatigue or chronic tiredness is a persistent symptom both in patients who have experienced a severe infection and in those who have experienced a mild form of infection. Studies conducted on both patients discharged from hospital and patients managed at home showed that there was no association between the severity of the Coronavirus disease (Covid-19) and the subsequent chronic fatigue symptom. The aim of this study was to evaluate the ability of a nutritional supplement based on vitamins, minerals, amino acids and plant extracts (Apportal®) intake, to ameliorate the general health status in particular the chronic fatigue symptom in subjects after SARS-CoV-2 negativity. Participants were advised to take one sachet daily of Apportal® for 28 consecutive days. At the beginning (T0), after 14 days (T1) and after 28 days (T2) of supplementation, general fatigue, mental fatigue and Quality of Life indexes were evaluated through specific questionnaires. The assessment of quality of life and health status were measured through the EuroQoL-5D questionnaire, chronic fatigue using the FACIT-Fatigue questionnaire and mental fatigue using the modified Chalder questionnaire. 201 subjects were enrolled for the study; results showed a significant improvement in all indexes analyzed after 14 and 28 days of supplementation. The main significant improvement was observed after the first 14 days and it was further confirmed at 28 days as well. The RTE (Relative Treatment Effect) trend about quality of life, health status, FACIT-Fatigue and mental fatigue in the three questionnaires was statistically significant (Wald Statistic, p < 0.0001). The data of FACIT-questionnaire showed an improvement of at least 1 unit in 76.62% of subjects after 14 days and in 90.05% of subjects after 28 days. An improvement of 10-unit was found in about one third of subjects after 14 days and in half of the subjects after 28 days. This study shows that Apportal® can reduce chronic fatigue and improve quality of life and health status in subjects after SARS-CoV-2 negativity due to the synergistic effect of its components.

Background/Objectives: The development and implementation of new treatments for knee osteoarthritis in routine practice remains an unmet need. The aim of this study was to assess the efficacy and safety of a Cetylated Fatty Acids (CFA)-based dietary supplement in patients with knee osteoarthritis (OA), a prevalent and difficult-to-treat condition. Subjects/methods: 60 patients (mean age: 66.0 ± 7.7 years, 85% female) with grade 3–4 knee osteoarthritis and a pain intensity of > 4 cm on the visual analog scale (VAS) were enrolled and randomized in a 1:1 ratio to receive either 1.5 g of oral CFA or a placebo for 60 days. The primary outcome was the change in pain intensity (VAS), secondary outcomes included changes in range of motion (ROM), in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the safety profile of the food supplement. Results: After 60 days of CFA assumption, the mean reduction in pain intensity (VAS) was −1.7 cm (95% CI [−2.0, −1.4]), showing a statistically significant difference compared to placebo (−0.6 cm, 95% CI [−1.0, −0.2]; p < 0.005). The mean decrease in the WOMAC total score was also greater in the CFA group (−19.5 vs. −15.8), although the placebo-corrected effect was not statistically significant (−3.7, 95% CI [−8.3, 0.8]; p = 0.108). Observed improvements in flexion (3.8° [95% CI: 2.6, 5.0]) and external rotation (2.9° [95% CI: 2.1, 3.8]) were both statistically significant in favor of CFA ( p ≤ 0.001) compared to placebo. Differences in extension and internal rotation were negligible. The safety profile of the investigational product resulted favorable, considering that only 4 out of 30 patients reported mild adverse events, and none withdrawn from the study due to adverse events. Conclusion: In patients with knee osteoarthritis, incorporating a CFA oral supplement into the treatment regimen provides superior efficacy in pain relief and range of motion improvement compared to placebo, while maintaining a favorable safety profile.

Purpose: This real-world observational study was conducted to evaluate decrease in pain after 30-day administration of a new oral cetylated fatty acids (CFA) food supplement, assess if decreased pain resulted in a lower consumption of oral non-steroidal anti-inflammatory drugs (NSAIDs), and improvement in related gastric side effects. It was the first study of this food supplement in a real-world setting. Patients and Methods: A hundred and twenty Italian primary care physicians recruited 562 patients who were prescribed oral CFA. Patients completed the Brief Pain Inventory (BPI) questionnaire at baseline and after 30 days of dosing. Their CFA intake adherence and use of NSAIDs were recorded. All analyses were done using R statistical software; p-value ≤ 0.005 was considered statistically significant. Results: We analyzed data of 196 males and 366 females aged in an average 49.2 years. After 30 days of CFA intake, we observed a statistically significant reduction (38.84%) in the overall pain score, 44.53% reduction in the interference score in daily activities, relief from pain within the previous 24 hours 47.16 (± 11.44%) at baseline and 62.14 (± 27.93%) after 30 days, and progressive reduction in NSAID intake frequency and total dose over time. More than half of participants (55.2%) reported improvement in gastric side effects typically associated with NSAID use. Conclusion: Data analyses indicated that using the new oral CFA food supplement decreased pain, which helped improve the quality of life, better perform daily activities (interference reduced by 44.5%), and reduce painkiller consumption by 19.7% in terms of both dose and frequency. Half of participants (55.2%) rated NSAID-related hyperchlorhydria and heartburn as improved. Although placebo effect might have contributed, the results suggest that CFA may have a positive effect in patients with sub-acute and chronic musculoskeletal pain and can enhance therapies typically used in this population.

Background: Nutritional deficiencies are common during the first postoperative year after mini gastric bypass (OAGB/MGB). This retrospective study evaluated the adequacy of a Food for Special Medical Purposes formulated for bariatric patients in maintaining mineral and vitamin status after OAGB/MGB. Methods: Patients who underwent laparoscopic OAGB/MGB at the Nutrition Clinic of Koelliker Hospital (Turin, Italy) between January 2023 and March 2024, aged 18–65 years and taking the product at 2 sachets/day for 12 consecutive months within a structured postoperative nutritional program, were retrospectively analyzed. Anthropometric and biochemical parameters were assessed at baseline (T0), 6 months (T6), and 12 months (T12) and compared using nonparametric repeated-measures tests. Results: Twenty-five patients were included (9 males, 36%; 16 females, 64%; mean age 52.8±7.2 years; preoperative BMI 46.4±5.8 kg/m²). At 12 months, mean weight loss was 34% and excess weight loss 74%. Vitamin D deficiency (<30 ng/mL) declined significantly from 79% at baseline to 28% at T6 and 16% at T12 (p<0.001). Vitamin B12 increased significantly within the first 6 months and then stabilized (p=0.0056), with only one residual deficiency at T6. Folate levels did not change significantly (p=0.099), though deficient/borderline values fell from 40% to 4%. Hemoglobin and mean corpuscular volume remained stable. Serum iron improved significantly only at 12 months (p<0.001), while ferritin declined significantly, mainly between T0 and T6 (p=0.046), remaining above the deficiency threshold on average. Conclusions: In this real-world series, the tested product combined with structured nutritional follow-up was associated with maintenance or improvement of most micronutrient parameters during the first year after OAGB/MGB, although ferritin remained a critical parameter requiring continued surveillance.

The purpose of this letter is to comment on the review titled “Iron Deficiency and Oral Treatments: Limitations, Pharmacokinetics, and the Role of Iron Protein Succinylate in Clinical Practice” by García-Erce et al

Was not provided for this article.