Allowing for variations in multivitamin supplement composition improves nutrient intake estimates for epidemiologic studies

Collecting detailed data on dietary supplement use is time-consuming for study participants and investigators, and this is particularly difficult for multivitamin use because of the many different formulations available. Therefore, many studies simply ask about the frequency of multivitamin use and assign default nutrient composition values to obtain nutrient intakes. Multivitamin supplements are important contributors to total nutrient intakes, but it is not known how default values affect the accuracy of intake estimation. In this study, nutrient intakes were calculated from multivitamins consumed by 26,735 multivitamin users who provided detailed information like product name(s) and frequency of use on a mailed questionnaire. We then recalculated the intakes, using 2 different assumptions about the composition of the multivitamin supplements: 1) a single default composition for all products; and 2) four default compositions, 1 for each subtype of multivitamin, i.e., one-a-day with minerals, one-a-day without minerals, B-complex or stress multivitamins, and antioxidant combinations. A total of 1246 different brands of multivitamins were reported and nutrient composition varied widely. Spearman correlation coefficient analyses, using the 4 default nutrient profiles compared with actual nutrient intakes, were >0.5 (P < 0.001) for 12 of 15 nutrients examined. However, correlations using the single default were lower, with only 5 correlations >0.5. Our findings suggest that a questionnaire designed to assess the composition profiles for 4 types of multivitamin products substantially improves the accuracy of nutrient-intake estimates over one that uses a single default nutrient profile for all multivitamin products.     

补充维生素矿物质的安全性和重要性

多种维生素矿物质对满足人体营养需求、维持人体健康起重要作用。2002年全国营养调查结果表明，我国城乡居民仍然存在营养不良问题，维生素矿物质摄人不足及不均衡现象普遍存在，以维生素A的缺乏状况较为普遍。每日摄入维生素矿物质补充剂有效防治慢性疾病，不仅安全，而且必需。     

Adherence to the Food Guide Pyramid recommendations among Japanese Americans,Native Hawaiians,and whites: results from the Multiethnic Cohort Study

The Food Guide Pyramid is designed to help Americans make healthful food choices. Whereas national data have been collected to examine adherence to the pyramid recommendations in whites, African-Americans, and Latinos, there are virtually no data available for Japanese Americans or Native Hawaiians. Here we present data on intakes of the Food Guide Pyramid food groups (as servings per day) as well as of the components of the pyramid tip (discretionary fat, added sugar, and alcohol) in these ethnic groups and examine adherence to each of the food group recommendations. Degree of adherence to the fruit group recommendation was similar among the ethnic groups and energy-intake categories, but adherence to the other recommendations was greatest for those consuming more than 2,800 kilocalories per day. However, subjects in this energy-intake group also consumed more than three times as much discretionary fat, added sugar, and alcohol.     

Dietary Intake Mediates Ethnic Differences in Gut Microbial Composition

Background: The human gut microbiome (GM) has been observed to vary by race/ethnicity. Objective: Assess whether racial/ethnic GM variation is mediated by differences in diet. Design: Stool samples collected from 2013 to 2016 from 5267 healthy Multiethnic Cohort participants (age 59–98) were analyzed using 16S rRNA gene sequencing to estimate the relative abundance of 152 bacterial genera. For 63 prevalent genera (>50% in each ethnic group), we analyzed the mediation of GM differences among African Americans, Japanese Americans, Latinos, Native Hawaiians, and Whites by overall diet quality (Healthy Eating Index score (HEI-2015)) and intake amounts of 14 component foods/nutrients assessed from 2003 to 2008. For each significant mediation (p < 1.3 × 10⁻⁵), we determined the percent of the total ethnicity effect on genus abundance mediated by the dietary factor. Results: Ethnic differences in the abundance of 12 genera were significantly mediated by one or more of eight dietary factors, most frequently by overall diet quality and intakes of vegetables and red meat. Lower vegetable intake mediated differences in Lachnospira (36% in African Americans, 39% in Latinos) and Ruminococcus-1 (−35% in African Americans, −43% in Latinos) compared to Native Hawaiians who consumed the highest amount. Higher red meat intake mediated differences in Lachnospira (−41%) and Ruminococcus-1 (36%) in Native Hawaiians over African Americans, who consumed the least. Dairy and alcohol intakes appeared to mediate and counterbalance the difference in Bifidobacterium between Whites and Japanese Americans. Conclusions: Overall diet quality and component food intakes may contribute to ethnic differences in GM composition and to GM-related racial/ethnic health disparities.     

Food Supplement Use Differs from the Recommendations in Pregnant Women: A Multinational Survey

The aim was to investigate, among pregnant women, (1) the use of food supplements and (2) the awareness of food supplement recommendations and beliefs about food supplement use in four European countries: Finland, Italy, Poland, and the United Kingdom. The participants (n = 1804) completed an online questionnaire with predefined statements. Daily intakes of vitamins and minerals were calculated using uploaded pictures or weblinks of the supplement packages. Country differences were assessed. Most participants (91%) used at least one food supplement during pregnancy. A prenatal multivitamin was the most commonly used supplement type (84% of the users), and 75% of the participants thought consumption of multivitamin is recommended. Of the participants, 81% knew that folic acid is recommended during pregnancy while 58% knew the recommendation for vitamin D. In 19% of the supplement users, the daily safe upper intake limit of at least one nutrient was exceeded. Nevertheless, most participants agreed that they knew which supplements (91%) and doses of supplements (87%) needed to be used during pregnancy. To conclude, the majority of the participants used food supplements, but lower proportions knew and adhered to the recommended intakes. Between-country differences were observed in the use and knowledge of and beliefs regarding supplements. The results suggest a need for assessment and monitoring of supplement use in antenatal care to ensure appropriate use.     

Multivitamin-multimineral supplements: who uses them?

Dietary supplement use is increasingly common in the United States. Multivitamin formulations with or without minerals are typically the most common type of dietary supplement reported in surveys and studies that collect data relating to dietary supplement use. In the National Health and Nutrition Examination Survey (NHANES) 1999-2000, 52% of adults reported taking a dietary supplement in the past month, and 35% reported regular use of a multivitamin-multimineral (MVMM) product. NHANES III data indicate an overall prevalence of dietary supplement usage of 40%, with prevalence rates of 35% in NHANES II and 23% in NHANES I. Women (versus men), older age groups, non-Hispanic whites (versus non-Hispanic blacks or Mexican Americans), and those with a higher education level, lower body mass index, higher physical activity level, and more frequent consumption of wine had a greater likelihood of reporting use of MVMM supplements in NHANES 1999-2000. Data from children suggest a similar prevalence rate, but lower prevalence rates of usage were reported in studies of adolescents. Individuals who use dietary supplements (including MVMM formulations) generally report higher dietary nutrient intakes and healthier diets in studies in which dietary data were also collected. Among adults with a history of breast or prostate cancer, usage rates for dietary supplements in general and MVMMs are considerably higher (eg, 56-57% for MVMMs), and these subgroups are more likely to also report use of single vitamin and mineral supplements. Thus, MVMM use contributes a considerable proportion of nutrient intakes in the United States and may contribute to risk of excessive intakes.     

Observations on the nutrient intakes of eating-dependent nursing home residents: underutilization of micronutrient supplements.

To estimate the intakes of essential nutrients by eating-dependent nursing home residents (EDR).

This study was done in a 190 bed VA nursing home. Thirty-four EDR were selected for the study. Clinical data base which included age, sex, primary diagnosis, body mass index, albumin, hematocrit, activities of daily living status, decubitus ulcer medications and use of multivitamin/trace mineral supplement were recorded from the medical records. Caloric and essential nutrient intakes were determined over a 3-day period by a registered dietitian.

Seventy percent (24/34) residents in the study group were underweight (body mass index < 23 kg/m2), 26% were hypoalbuminemic (serum level < 3.5 g/dl), 50% were anemic (hematocrit < 37%); and 38% had pressure ulcers. In 88% EDR, the dietary intakes of three or more essential nutrients were below 50% of the RDA. Most frequent and severely deficient were zinc, copper, and vitamin B6. Despite the inadequate essential micronutrient intakes in the majority of EDR, only 35% received a multivitamin supplement and only 3% received a trace mineral supplement. A survey of 30 other VA nursing homes indicated generally similar findings to those in the Milwaukee facility with regard to the high frequency for eating-dependence, and the low frequency for administration of multivitamin and trace mineral supplements.

Despite eating supervision and assistance, the majority of EDR have inadequate intakes of numerous essential macro- and micronutrients. The deficient micronutrient intakes could be normalized by administration of a multivitamin/trace mineral supplement daily. Nevertheless, only a minority of EDR in VA nursing homes currently receive such a supplement.     

Nutrient intakes of whites, blacks, and Mexican Americans in southeast Texas

Ethnic groups in the United States exhibit different patterns of cardiovascular disease and cancer morbidity and mortality. This has, in part, been attributed to differences in dietary intake. However, there is limited comparative information available regarding the dietary patterns of whites, blacks, and Hispanics residing in the same geographic area. Selected nutrient intakes were obtained by an interviewer-administered 24-hr dietary recall from 231 white, 102 black, and 98 Mexican-American persons residing in the same communities in Southeast Texas. Mean caloric intakes were highest for whites, followed by Mexican Americans and blacks. Mexican Americans had carbohydrate intakes that were significantly higher, but total fat intakes that were significantly lower, than those of whites. Blacks of both sexes had the highest cholesterol intakes and black males had the highest saturated fat intakes. Neither was significantly higher than that of whites or Mexican Americans. Overall, the mean vitamin A and C values were highest for blacks and lowest for whites, although the differences were not statistically significant. Mean calcium and phosphorus intakes were significantly higher for whites compared with those for blacks and Mexican Americans. Blacks had significantly lower mean fiber values than whites or Mexican Americans. International ethnic differences in disease distribution have long been used to provide clues to etiologic factors. National ethnic differences in disease distribution related to dietary intake can further elucidate these causative and/or preventive factors. However, to do so will require additional attention to dietary methodology of the type presented here.     

Supplement use: is there any nutritional benefit?

OBJECTIVE: To examine the role of dietary supplements in improving total nutrient intakes in adults. DESIGN: Dietitian-administered 24-hour recalls (of intake including supplements) were conducted in 1997 and 1998. Supplement users were categorized into groups based on the types of supplements used and nutrient intake was examined. SUBJECTS: Using a multistage, stratified random sampling, 1,530 Canadian adults aged 19 to 65 years were surveyed. STATISTICAL ANALYSES PERFORMED: Intakes from diet, supplements, and diet plus supplements were examined by age/gender stratification. RESULTS: Supplement users had dietary intakes, from food alone, similar to nonusers with mean intakes in some age/sex groups below the Recommended Daily Allowance (RDA)/Adequate Intake (AI) for iron, calcium, and folate. Multivitamin users had mean intakes (from diet plus supplement) of folate above the RDA and iron intakes also increased to RDA levels among women aged 19 to 50 years. Calcium supplement users had lower calcium and vitamin D intakes than nonusers from diet alone in some age/sex groups. Calcium tablets increased mean calcium intakes to AI levels among all age/sex groups. Many supplement users exceeded the new Upper Limits of safe intake; 47% in the case of niacin. APPLICATIONS: Supplements are commonly used and can help some persons adhere to Dietary Reference Intake recommendations concerning intake of folate, calcium, vitamin D. and iron. We found multivitamin users to have higher total intakes of folic acid, iron, calcium, and vitamin D. Also, targeted use of calcium supplements effectively enhanced intakes. However, concurrent vitamin D supplementation is important and awareness of product composition with respect to Upper Limits is essential.     

Multivitamin-multimineral supplements' effect on total nutrient intake

Use of multivitamin-multimineral supplements is widespread and can contribute substantially to total nutrient intakes. In the Hawaii-Los Angeles Multiethnic Cohort (MEC), 48% of men and 56% of women without chronic diseases reported use of multivitamin supplements at least weekly over the past year. We calculated the prevalence of nutrient adequacy for 17 nutrients based on responses to a self-administered quantitative food-frequency questionnaire administered to MEC participants at baseline in 1993-1996. Although the prevalence of nutrient adequacy from food only was higher for multivitamin supplement users (n = 21,056) than for nonusers (n = 69,715), differences averaged only 2 percentage points. For multivitamin users, the prevalence of adequacy improved by an average of 8 percentage points for both men and women when intake from supplements was included. Users were also more likely to have potentially excessive intakes, particularly for iron, zinc, vitamin A, and niacin. The 26,735 MEC participants in Hawaii who answered an open-ended question about multivitamin use in 1999-2001 reported using 1246 different products. The nutrient profile of these products varied widely, and the composition of products at the 90th percentile was 10-fold greater than the composition at the median for some nutrients. We conclude that analyses of nutrient adequacy and excess for supplement users should be extended to national samples and that composition data on actual supplements used are preferable to assuming a default nutrient profile for multivitamin supplements. Multivitamin products could be better formulated to reduce the prevalence of inadequacy and also to reduce the risk of excessive intakes.     

Racial/ethnic differences in endometrial cancer risk: the multiethnic cohort study

Few studies have examined differences in endometrial cancer risk among ethnic groups in the United States. The authors assessed the extent to which known risk factors for endometrial cancer explain the racial/ethnic differences in risk among 46,933 postmenopausal African-American, Native-Hawaiian, Japanese-American, Latina, and White women recruited to the prospective Multiethnic Cohort Study in 1993-1996. During a 7.3-year follow up period, 321 incident endometrial cancer cases were identified among these women. Data on known/suspected risk factors were obtained from baseline questionnaires, and comparisons of endometrial cancer incidence across racial/ethnic groups were estimated using log-linear proportional hazard models. Later age at menopause, unopposed estrogen therapy use, and obesity were associated with increased risk, while increasing parity and increasing duration of oral contraceptive use were associated with decreased risk. The relative risks for endometrial cancer (vs. Whites) were 0.76 (95% confidence interval (CI): 0.53, 1.08) for African Americans, 0.92 (95% CI: 0.58, 1.46) for Native Hawaiians, 0.61 (95% CI: 0.46, 0.83) for Japanese Americans, and 0.63 (95% CI: 0.46, 0.87) for Latinas. After adjustment for the risk factors, the relative risks were 0.68 (95% CI: 0.47, 0.98) for African Americans, 0.91 (95% CI: 0.56, 1.46) for Native Hawaiians, 0.74 (95% CI: 0.54, 1.01) for Japanese Americans, and 0.65 (95% CI: 0.47, 0.92) for Latinas. Results from this study show that the interethnic differences in endometrial cancer risk do not appear to be explained by differences in the distribution of known risk factors among women of different races/ethnicities.     

Patterns of nutrient intake among dietary supplement users: attitudinal and behavioral correlates

A national telephone interview survey of an age-stratified random sample of 2,991 adults, aged 16 and over, provided detailed information from 1,142 vitamin and mineral supplement users about their nutrient intake patterns from dietary supplements. Dietary supplement users were divided into four groups (Light, Moderate, Heavy, and Very Heavy) on the basis of the type and amount of nutrient intake from supplements. The Light, Moderate, Heavy, and Very Heavy nutrient intake groups accounted for 42%, 16%, 28%, and 14%, respectively, of the total users. Young supplement users (aged 16 to 25) tended to be in the Light user group. Older adults (aged 41 to 64) and residents of the western United States tended to be in the Heavy and Very Heavy user groups. Users in the Light and Moderate nutrient intake groups generally used only one broad-spectrum vitamin and mineral product. Users in the Heavy and Very Heavy groups were typically taking two or more specialized vitamin and mineral products at a time as part of a personalized supplement regimen. Heavy and Very Heavy nutrient intakes were associated with more frequent visits to health food stores, greater nutrition activity, and less physician involvement. Light and Moderate nutrient intakes were more likely to be associated with a defensive interest in avoiding nutritional deficiencies. The implications of generally different motivations for dietary supplement use are discussed in the context of public information strategies.     

Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey

OBJECTIVE: To examine the adequacy of dietary intake of calcium; folate; and vitamins C, D, E, B-6, and B-12 in premenopausal US women of differing ethnicity. DESIGN: Analyses of single and duplicate 24-hour recalls were conducted to determine dietary intake during the Third National Health and Nutrition Examination Survey. SUBJECTS: Three thousand five hundred eighty-five randomly selected women aged 20 to 50 years from across the United States who were not pregnant or lactating were examined between 1988 and 1994. STATISTICAL ANALYSES: Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement cut-point method was used to determine the proportion of women with inadequate intake for each nutrient in each ethnic group. RESULTS: More than 75% of women irrespective of ethnic group had usual intakes of calcium lower than the new Adequate Intake. More than 90% of the women had inadequate intakes of folate and vitamin E from food sources alone. More than half of smokers had inadequate intakes of vitamin C. Intakes of vitamins B-6 and B-12 were low in less than 10% of these women. APPLICATIONS/CONCLUSIONS: This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods.     

Multivitamin/mineral supplementation improves plasma B-vitamin status and homocysteine concentration in healthy older adults consuming a folate-fortified diet

Elevated homocysteine has been identified as an independent risk factor for cardiovascular and cerebrovascular disease. Although multivitamin use has been associated with low plasma homocysteine concentrations in several observational studies, no clinical trials have been conducted using multivitamin/mineral supplements to lower homocysteine. We determined whether a multivitamin/mineral supplement formulated at about 100% Daily Value will further lower homocysteine concentration and improve B-vitamin status in healthy older adults already consuming a diet fortified with folic acid. In this randomized, double-blind, placebo-controlled trial, 80 free-living men and women aged 50-87 y with total plasma homocysteine concentrations of > or =8 micromol/L received either a multivitamin/mineral supplement or placebo for 56 d while consuming their usual diet. After the 8-wk treatment, subjects taking the supplement had significantly higher B-vitamin status and lower homocysteine concentration than controls (P: < 0.01). Plasma folate, pyridoxal phosphate (PLP) and vitamin B-12 concentrations were increased 41.6, 36.5 and 13.8%, respectively, in the supplemented group, whereas no changes were observed in the placebo group. The mean homocysteine concentration decreased 9.6% in the supplemented group (P: < 0.001) and was unaffected in the placebo group. There were no significant changes in dietary intake during the intervention. Multivitamin/mineral supplementation can improve B-vitamin status and reduce plasma homocysteine concentration in older adults already consuming a folate-fortified diet.     

Do adolescent vitamin-mineral supplement users have better nutrient intakes than nonusers? Observations from the CATCH tracking study.

OBJECTIVE: Describe whether users of vitamin-mineral supplements differed from nonusers in micronutrient intakes or in nutrition awareness. DESIGN: Cross-sectional, observational study. SUBJECTS: One thousand five hundred thirty-two students now in grade 8, who participated in the Third Child and Adolescent Trial for Cardiovascular Health tracking study and who also provided a single 24-hour dietary recall. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of covariance was used to ascertain if supplement users had higher vitamin and mineral intakes from food sources, and to examine if supplement users had better nutrition awareness than nonusers. RESULTS: The 24-hour recall showed that 17.6% of the students reported using vitamin-mineral supplements. Users reported a mean of 1.4 supplements, of which 47% were multivitamin or multimineral preparations, 37% were single nutrients, and 16% were combinations. White persons and residents of Minnesota and California were more likely to be supplement users. Users had higher micronutrient intakes from food sources for 16 of the 20 nutrients studied after adjusting for gender, race/ethnicity, site, treatment condition, and within-school variability. Users had higher scores on a health behavior survey for food choice and slightly but not significantly higher nutrition knowledge scores. CONCLUSIONS: Vitamin-mineral supplement use is prevalent among eighth-grade students. Users have higher nutrient intakes from foods, higher total intakes for several micronutrients, higher nutrition awareness, and differ in their demographic characteristics from nonusers.     

Dietary Intake Among Native Hawaiian,Filipino, and White Children and Caregivers in Hawai‘i

Little is published about dietary intake of children of ethnic populations found in Hawai‘i, due to an absence of national statistics collected on Hawai‘i''s population. This information is needed to focus planning of food, agriculture and health programs aimed to prevent obesity and related chronic disease and to improve health. Dietary patterns of 156 Native Hawaiian (n=110), Filipino (n=28) and White (n=18) children and their caregivers were compared using socio-demographic, annual “food season,” and 24 hour dietary recall data from a baseline survey of four lower income communities selected for an intervention program in rural Hawai‘i. Ethnic differences were found in the Healthy Eating Index (HEI) dairy component, and in calcium and vitamin C nutrient intakes among caregivers only (adjusting for food season). Whites always had higher intakes of these foods and nutrients than Filipinos or Native Hawaiians. Vitamin C intake remained significantly different among ethnic groups after further adjusting for dairy food group intake. Dietary patterns showed low intake of fruits and vegetables, fiber and dairy foods among these understudied populations.     

Ethnic differences in breast cancer survival: status and determinants

Ethnic differences in breast cancer survival have been a long-standing concern. The objective of this article is to present relevant studies for all major US racial/ethnic groups including African-Americans, Latinos, Native Americans, Japanese-Americans and Native Hawaiians, and to discuss underlying causes of disparity. In comparison to Caucasian women, African-American women continue to experience the poorest breast cancer-specific survival of all ethnic groups in the USA. The prognosis for Latinos, Native Hawaiians and Native Americans is intermediate, better than for African-Americans but not as good as for Caucasians, whereas Japanese-American women tend to have better outcomes. The following possible contributors to the observed differences are discussed in detail: unfavorable distribution of stage at diagnosis due to low screening rates, limited access to care and treatment, tumor type, comorbidities, socioeconomic status, obesity and physical activity.     

Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai'i

Health literacy is understudied in Asian Americans/Pacific Islanders (AA/PI). We used a population-based sample in Hawai'i to consider if low health literacy is associated with poor health outcomes in Japanese, Filipino, Native Hawaiians, and other AA/PI groups compared with Whites. In data weighted and adjusted for population undercounts and complex survey design, low health literacy varied significantly by group, from 23.9% among Filipinos, 20.6% in Other AA/PI, 16.0% in Japanese, 15.9% in Native Hawaiians, and 13.2% in Whites (χ(2) (4) = 52.22; p < .001). In multivariate models, low health literacy was significantly associated with (a) poor self-reported health in Japanese, Filipinos, Other AA/PI, and Whites; (b) diabetes in Hawaiians and Japanese; and (c) depression for Hawaiians. Low health literacy did not significantly predict overweight/obesity in any ethnic grouping in multivariate models. The design and relevance of health literacy interventions, as well as the pathways that link health literacy to health status, may vary by race/ethnicity, culture, and health outcomes.     

Development of a supplement composition database for the SURE study

The Supplement Reporting (SURE) study is one of the first to systematically examine the accuracy of collection of dietary supplement use data for population-based studies of diet. In 2005–2007, the SURE study collected data from 444 participants in Hawaii and Los Angeles. Several methods of collecting data were compared, including an inventory of supplements, a recall, a daily diary, and a one-page supplement frequency questionnaire. Considerable effort was put into developing an extensive supplement composition database. To quantify intakes, we extended the existing supplement composition table (SCT) used at the Cancer Research Center of Hawaii. The original SCT contained default codes for multivitamin/multimineral products to be used when insufficient detail was available to assign an existing code. However, the default concept needed to be expanded for the SURE study to include additional multivitamin/multimineral default codes, as well as single nutrients and other components. Approximately 1800 new codes were created, including 211 new default codes. Roughly 130 nutrients and 870 other components were included in the SCT at the conclusion of the study. To accurately quantify intakes from supplements, it is crucial to maintain a comprehensive supplement composition database. Future improvements to our SCT include incorporation of analytic values from the US Department of Agriculture to replace composition data taken from supplement labels.     

Traditional and nontraditional supplement use by collegiate female varsity athletes

This study examined the traditional (single and multivitamin/mineral supplements) and nontraditional supplement (herbals, botanicals, and other biologic and nutrient supplements) use by female athletes. Frequency, reasons for use, and sources of supplement information were assessed with a self-report questionnaire. Participants were 162 collegiate female varsity athletes. More than half of all athletes used some type of supplement at least once a month (65.4%). Thirty-six percent (n = 58) of the sample used a multivitamin and mineral with iron. Twelve percent (n = 19) reported amino acid/protein supplement use and 17% (n = 29) used an herbal/botanical supplement. The most frequently cited reason for supplement use was "good health" (60.1%). A major source of information on supplements reported was family (53%). With the general rise in supplement use, nutrition education on the use of traditional and non-traditional supplements is warranted.