Cellulose Fiber Diet Pills: A New Cause of Esophageal Obstruction

Jones, Kathleen; Pillsbury, Harold C.

doi:10.1001/archotol.1990.01870090107020

Cited by 5 publications

(1 citation statement)

References 5 publications

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“…Cases of oesophageal and GI obstruction have been reported in the literature following intake of methyl cellulose (Belmont, 1952;Hedayaty and Shuman, 1953;Friedman and Alessi, 1954;FDA, 2015), carboxy methyl cellulose (Leger et al, 1952;Monod-Broca, 1952;Soullard et al, 1952;Derobert and Heully, 1956;FDA, 2015) and cellulose fibre diet pills (Jones and Pillsbury, 1990).…”

Section: Case Reportsmentioning

confidence: 99%

Re‐evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives

Younes¹,

Aggett²,

Aguilar³

et al. 2018

EFS2

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Following a request from the European Commission, the EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS) was asked to deliver a scientific opinion re-evaluating the safety of microcrystalline cellulose (E 460(i)), powdered cellulose (E 460(ii)), methyl cellulose (E 461), ethyl cellulose (E 462), hydroxypropyl cellulose (E 463), hydroxypropyl methyl cellulose (E 464), ethyl methyl cellulose (E 465), sodium carboxy methyl cellulose (E 466), enzymatically hydrolysed carboxy methyl cellulose (E 469) and cross-linked carboxy methyl cellulose (E 468) as food additives. The Joint FAO/WHO Expert Committee on Food Additives (JECFA) and the Scientific Committee on Food (SCF) established an acceptable daily intake (ADI) 'not specified' for unmodified and modified celluloses. Celluloses are not absorbed and are excreted intact in the faeces; in addition, microcrystalline cellulose, powdered and modified celluloses could be fermented by the intestinal flora in animals and humans. Specific toxicity data were not always available for all the celluloses evaluated in the present opinion and for all endpoints. Given their structural, physicochemical and biological similarities, the Panel considered it possible to readacross between all the celluloses. The acute toxicity of celluloses was low and there was no genotoxic concern. Short-term and subchronic dietary toxicity studies performed with E 460(i), E 461, E 462, E 463, E 464, E 466 and E 469 at levels up to 10% did not indicate specific treatment related adverse effects. In chronic toxicity studies performed with E 460(i), E 461, E 463, E 464, E 465 and E 466, the no observed adverse effect level (NOAEL) values reported ranged up to 9,000 mg/kg body weight (bw) per day. No carcinogenic properties were detected for microcrystalline cellulose and modified celluloses. Adverse effects on reproductive performance or developmental effects were not observed with celluloses at doses greater than 1,000 mg/kg bw by gavage (often the highest dose tested). The combined exposure to celluloses (E 460-466, E 468 and E 469) at 95th percentile of the refined (brand-loyal) exposure assessment for the general population was up to 506 mg/kg bw per day. The Panel concluded that there was no need for a numerical ADI and that there would be no safety concern at the reported uses and use levels for the unmodified and modified celluloses (E 460(i); E 460(ii); E 461-466; E 468 and E 469). The Panel considered an indicative total exposure of around 660-900 mg/kg bw per day for microcrystalline, powdered and modified celluloses.

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Section: Case Reportsmentioning

confidence: 99%

Re‐evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives

Younes¹,

Aggett²,

Aguilar³

et al. 2018

EFS2

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Defining obesity in children and adolescents: Clinical approaches

Robinson

1993

Critical Reviews in Food Science and Nutrition

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For clinical utility, obesity should be defined as a condition of excess adipose tissue associated with adverse health outcomes. Based on a number of criteria, body mass index (BMI) (weight/height) is the most appropriate measure for clinical assessment of adiposity in children and adolescents. However, sufficient information regarding associations between adiposity and current or future morbidity is lacking. Available data suggest a definition of obesity based on adiposity alone would perform poorly as a clinical screening test for adverse health outcomes. In addition, labeling and attempted weight control therapy may produce more harm than benefit. Therefore, until better information regarding the risks of adiposity and risks of treatment are available, recommendations for weight control therapy should be focused primarily on those children and adolescents who currently manifest adiposity-related morbidity, those with a BMI above the 95th percentile, or those above the 85th percentile who perceive their adiposity to be a significant psychosocial problem. To produce a clinically useful definition of obesity, longitudinal data should be used to determine the sensitivities, specificities, and predictive values of comparative measures of childhood and adolescent adiposity for predicting current and future morbidity, and to evaluate the utilities of including characteristics such as age, age of adiposity rebound, persistence of increased adiposity, family adiposity, family morbidities, and fat distribution to improve predictive values and minimize misclassification. Weight control research should attempt to identify patient characteristics that predict long-term treatment success, treatment failure, and treatment side effects.

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Esophageal obstruction from a hygroscopic pharmacobezoar containing glucomannan

Vanderbeek¹,

Fasano²,

O’Malley³

et al. 2007

Clinical Toxicology

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Glucomannan is a dietary fiber that is the main polysaccharide obtained from the tubers of the Amorphophallus konjac plant. It has been used as a dietary fiber for more than 1,000 years in eastern cultures, and has gained popularity in many western countries over the last 20 years. This soluble fiber has very substantial water-holding properties, and forms highly viscous solutions when dissolved in water. It also has considerable hygroscopic properties, expanding rapidly to many times the size of the original material. These properties have made glucomannan an ideal diet agent as the material swells in the GI tract after ingestion, producing a feeling of satiety and fullness. It has also been reported to have hypocholesterolemic, hypoglycemic, hypoinsulinemic and anti-constipatory effects. The negative effects reported include flatulence, abdominal pain, gastrointestinal obstruction, and possible modification of the bioavailability of other medications. This report describes a 37-year-old female who developed delayed esophageal obstruction after ingesting an over-the-counter diet aid containing glucomannan. The patient ultimately cleared the obstruction through forceful emesis, just prior to upper gastrointestinal endoscopy. The patient was noted to have an esophageal web during outpatient endoscopy. This case illustrates the potential dangers of glucomannan and other hygroscopic medications in patients with a history of upper gastrointestinal pathology.

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Cellulose Fiber Diet Pills: A New Cause of Esophageal Obstruction

Cited by 5 publications

References 5 publications

Re‐evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives

Re‐evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives

Defining obesity in children and adolescents: Clinical approaches

Esophageal obstruction from a hygroscopic pharmacobezoar containing glucomannan

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