Longitudinal patterns of vitamin and mineral supplement use in young white children

OBJECTIVES: The objective of this article is to report longitudinal patterns of nutrient supplementation in children, to quantify nutrient intakes from supplements and diet, and to examine relationships between supplement use and sociodemographic factors. DESIGN AND SUBJECTS: Subjects were followed prospectively from birth to 24 months with periodic questionnaires on vitamin/mineral supplement use. Food diaries were completed to report food and beverage intake. Estimates of daily intakes of vitamins and minerals were calculated. Fisher's Exact tests and t tests were used to assess the association of sociodemographic variables with supplement use. RESULTS: A substantial proportion of young children used supplements. The prevalence of supplement use increased with age. By the end of 24 months, 31.7% used some supplement. Young supplement users consume supplements regularly, ranging from 40% to 60% of days reported. The majority of young children in this cohort could obtain adequate vitamins and minerals from diet alone for the first 24 months of life. Intakes of some nutrients from diet alone, such as vitamin E and folate, were not sufficient for a large proportion of young children. However, intake above the dietary reference intake was observed for a few nutrients, in particular for vitamin A. CONCLUSIONS: Use of nutrient supplements is a common behavior during the first 2 years of life. This study shows that most young children obtain adequate nutrients from diet alone. Health professionals should provide recommendations for nutrient supplementation of generally healthy children based on an assessment of their dietary practices.     

Efficacy and safety of regular vitamin and mineral supplement use in France: results from the ECCA study

This study investigated the prevalence of inadequate micronutrient intake and the proportion of subjects who exceed Tolerable Upper Intake Levels a) with food only, and b) with food + supplements, in a population of French regular supplement users (n = 259). Assessment tools were seven-day records for supplements, three-day records for food intake, and a questionnaire about supplement use. Most subjects were recruited in retail outlets that sold supplements. They were recent users of vitamin/mineral supplements, aged over 15 years, and normo-energy reporters. The prevalence (%) of inadequate intake decreased with the inclusion of mean annual supplements, from 68.0 to 54.8 for magnesium, 55.9 to 40.7 for vitamin C, 53.4 to 43.9 for folic acid, 37.5 to 27.5 for iron, and 40.1 to 29.7 for pantothenic acid. Few subjects exceeded upper intake levels when mean annual intake of supplements was considered. When supplement consumption was considered during the studied week only, the proportion of subjects who were in excess of the upper intake levels was higher (maximum: 9.6% for magnesium). Supplement use brought a nutritional benefit for some targeted nutrients. It was not associated with excessive intake in this study, but could become hazardous if the annual frequency of use were to increase.     

Characteristics of vitamin and mineral supplement products in the United States

A 1986 nationwide survey of 11,775 adults 18 y or older and 1877 children 2-6 y old identified approximately 3400 different (unique) vitamin and mineral supplement products being taken. The most commonly included nutrient listed on the product labels was vitamin C, which was present in 50% of the unique products examined. Calcium and iron were the most commonly included minerals and were present in 25% of the unique products examined. Prenatal and children's chewable products came in a relatively narrow potency range and generally contained nutrients in amounts approximating or less than the US recommended daily allowances. These products also contained significant minimum amounts of nutrients. Potencies of products not targeted for use by these special groups, particularly those products that were self-prescribed, varied widely and ranged from insignificant to extremely large amounts of nutrients. Units used to declare product potency or to prescribe the dosage varied.     

Herbal and vitamin/mineral supplement use by retirement community residents: preliminary findings

A survey questionnaire assessed supplement use by free-living residents of a retirement community. Of the 318 respondents (mean age 82.2 years), 20% of women and 20% of men reported using herbal supplements, with 62% of these using them at least once per week. Most herbal supplements users (97%) also used vitamin/mineral supplements. Sixty-eight percent of herbal supplement users felt very much/somewhat informed about taking the supplements. Forty-four percent, however, were not sure whether there was testing before marketing; 33% were not sure about side effects. Half (52%) relied "very much/somewhat" on doctors/nurses as information sources; 40% relied on dietitians.     

A report of vitamin and mineral supplement use among university athletes in a division I institution

The influences of gender, ethnicity, and sport of varsity athletes on their vitamin/mineral supplementation habits were examined. Subjects included 145 females and 266 males from 22 varsity teams; 80% were Caucasian; 12% African American; and 8% Combined-Other. Over half of the subjects took supplements. Males were more likely than females to give "too expensive" as a reason for not taking supplements, and "improve athletic performance" and "build muscle" as reasons for taking supplements. The most common supplement was multivitamins plus minerals. Females were more likely to take calcium and iron, and males vitamins B12 and A. African Americans were the most likely to take vitamin A. Males were more likely to get supplement information from nutritionists/dietitians and self, and females from family members or friends and physicians or pharmacists. Football players were more likely to get supplement information from nutritionists/dietitians, and males in other sports from coaches/trainers. There were some differences in vitamin/mineral supplement habits of the athletes by gender, ethnicity, and sport.     

Relationships between vitamin and mineral supplement use, dietary intake, and dietary adequacy among adolescents

OBJECTIVE: To examine patterns of supplement use among US adolescents and the relationship between supplement use and dietary intake and adequacy. DESIGN: Adolescents self-reported 2 days of food intake using the 24-hour recall method and supplement use during a personal interview conducted as part of the 1994 Continuing Survey of Food Intakes of Individuals (CSFII). SUBJECTS: A national sample of 423 adolescents included in the 1994 CSFII survey. STATISTICAL ANALYSIS: chi 2 analysis was used to determine which demographic factors were significantly related to patterns of supplement use. Weighted percentages of adolescents by category of supplement use for selected vitamins and minerals (calcium; iron; zinc; folic acid; and vitamins A, B-6, C, and E) are presented. Relationships between dietary intake of macronutrients and vitamins and minerals among adolescents and supplement use were determined using a least-squares model of general linear regression. RESULTS: Approximately one-third of adolescents reported using supplements, with 15.6% of youth using them on a daily basis. The majority of supplement users reported taking multivitamins (N = 95; 65.5%) whereas only one-third of supplement users reported taking individual vitamins or minerals. Supplement use was found to vary by gender, household size, and US region of residence. Adolescents who reported using supplements had higher mean dietary intakes of most micronutrients and lower intakes of total and saturated fat than those who did not use supplements. More than one-third of adolescents had dietary intakes of vitamins A and E, calcium, and zinc that were < 75% of the US Recommended Dietary Allowance. APPLICATIONS/CONCLUSIONS: The majority of US adolescents do not use vitamin or mineral supplements. Interestingly, adolescents who do use supplements, even on an infrequent basis, consume diets that are more nutrient-dense than those who do not use supplements. Dietary intakes of several micronutrients were inadequate among all adolescents in this study, regardless of supplement use status. There is a need to develop and implement programs aimed at improving the dietary intakes of US adolescents.     

Prospective cohort study of antioxidant vitamin supplement use and the risk of age-related maculopathy

In a prospective cohort study, the authors examined whether self-selection for antioxidant vitamin supplement use affects the incidence of age-related maculopathy. The study population consisted of 21,120 US male physician participants in the Physicians' Health Study I who did not have a diagnosis of age-related maculopathy at baseline (1982). During an average of 12.5 person-years of follow-up, a total of 279 incident cases of age-related maculopathy with vision loss to 20/30 or worse were confirmed by medical record review. In multivariate analysis, as compared with nonusers of supplements, persons who used vitamin E supplements had a possible but nonsignificant 13% reduced risk of age-related maculopathy (relative risk = 0.87, 95 percent confidence interval (CI) 0.53-1.43), while users of multivitamins had a possible but nonsignificant 10% reduced risk (relative risk = 0.90, 95% CI 0.68-1.19). Users of vitamin C supplements had a relative risk of 1.03 (95% CI 0.71-1.50). These observational data suggest that among persons who self-select for supplemental use of antioxidant vitamin C or E or multivitamins, large reductions in the risk of age-related maculopathy are unlikely. Randomized trial data are accumulating to enable reliable detection of the existence of more plausible small-to-moderate benefits of these agents alone and in combination on age-related maculopathy.     

Vitamin and mineral supplement use among US medical students: A longitudinal study

OBJECTIVE: To provide data on medical students' multivitamin and calcium supplement use during medical school. DESIGN: Medical students were anonymously surveyed at three time points: freshman orientation, orientation to wards, and during senior year. SUBJECTS: Medical students (n = 2,316) at 16 US medical schools (response rate = 80.3%). OUTCOME MEASURES: Prevalence and correlates of multivitamin and calcium supplement use throughout medical school. STATISTICAL ANALYSES: Chi2 tests with associated P values, and logistic regression with associated odds ratios and confidence intervals. RESULTS: Half of medical students surveyed used multivitamins, and 19% used calcium supplements, at least once per week as freshmen. Consumption of calcium, but not multivitamin, supplements increased during subsequent years (P = 0.0001) and both supplements were more commonly used by women (P < 0.0003). Of 970 students tracked across all three time points, 14% of women, compared with only 2% of men (P < 0.0001), took calcium at all three time points. Using multivariate models, we found that medical students were more likely to use multivitamins if they exercised regularly, had children, were underweight, or were women who were not heavy users of alcohol (P < 0.0001 to P < 0.05). Similarly, students who were women, underweight, exercised regularly, or had a personal or family history of osteoporosis were more likely to consume supplemental calcium (P < 0.0001 to P = 0.04). CONCLUSIONS: Medical students of all types used supplements at moderate rates, and women used supplements more commonly and consistently than did men. Medical students, especially nonunderweight and nonexercising students, may be particularly important targets for messages regarding appropriate and adequate vitamin/mineral use.     

Vitamin/mineral supplement use by geriatric outpatients in the United Kingdom

Many elderly people in the United States take vitamin/mineral supplements, but little is known about supplement use by the elderly in the United Kingdom. Among 203 patients referred to a geriatric outpatient clinic in Britain, 28% used supplements during the last year. Most supplement users consumed them daily and had used them for over a year. Multivitamins were the most frequent type of supplement taken, followed by Iron, B Vitamins, Vitamin C, and Vitamin E. The primary reasons for supplement use were for more energy, treating illness, and feeling stronger.     

Vitamin and mineral supplement use and mortality in a US cohort.

OBJECTIVES. Vitamin and mineral supplementation is a common practice in the United States, yet little is known about the long-term health effects of regular supplement use. METHODS. To examine the relationship between reported use of supplements and mortality, we analyzed data from US adults 25 to 74 years of age who were examined in the First National Health and Nutrition Examination Survey (1971 to 1975), with vital status determined through 1987. RESULTS. At baseline, 22.5% of the cohort reported using supplements regularly and 10.0% reported irregular use. The risk of mortality for regular supplement users was similar to that for nonusers. No consistent mortality benefits or risks of supplement use were found across a number of population subgroups. The risk for those who reported supplement use at both the baseline and a follow-up interview approximately 10 years later was similar to the risk for those who reported not using supplements at either interview. CONCLUSIONS. We found no evidence of increased longevity among vitamin and mineral supplement users in the United States. Considering the wide use of supplements in the general population, the cost-effectiveness and the safety of supplement use need to be better defined.     

Vitamin/mineral supplement use among general practice patients in the United Kingdom

Many patients take vitamin/mineral supplements, sometimes in doses which may cause toxicity. A survey of 186 patients in one general practice showed that 44% consumed supplements; almost half of these took them daily, and over half had taken them for longer than a year. Younger patients were more likely to take vitamins than older ones. Multivitamins were the most frequently used supplement, followed by iron and vitamin C. Major reasons patients cited for supplement use were to ensure good nutrition, to prevent illness, and for tiredness/fatigue. Patients were most influenced in their decision to take vitamins by family and friends rather than by doctors. General practitioners may find it valuable to include questions about vitamin/mineral supplement use in the medical history.     

Chronic disease risk factors in vitamin/mineral supplement users and nonusers in a farm population

Dietary, anthropometric, and chronic disease risk factors (CDRF) in vitamin/mineral supplement users (U) and non-users (NU) were measured in a farm population consisting of 162 subjects (46% females and 54% males; 20-79 years of age, mean age: 52 years). Subjects were white, except for two black males. Supplements were used by 62 subjects (38%); 47% of females and 31% of males used supplements; 43% of subjects over 50 years of age and 32% of subjects age 50 or under used supplements. Both dietary intake and energy expenditure were measured using 4-day records. Indices of adiposity included body weight, BMI, and estimated body fat. Total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C), serum ferritin, hemoglobin, hematocrit, zinc, copper, and vitamin C were based on 12-hr fasting blood samples. Dietary intake (excluding supplements) for vitamin/mineral U was greater than NU for vitamin C (p = 0.006), thiamin (p = 0.01), riboflavin (p = 0.03), niacin (p = 0.02), folic acid (p = 0.001), vitamin B6 (p = 0.01), and magnesium (p = 0.019). Vitamin C levels were significantly higher and the sum of four skinfolds was significantly lower among U than NU. In this population, 24% of males and 18% of females had TC levels over 240 mg%; 8% of both males and females had blood pressures (BP) greater than 140/90 mm Hg, while 49% of males and 46% of females had BP between 120/80 and 140/90; and 71% of males were more than 25% fat, and 56% of females were more than 35% fat. Despite the high prevalence of CDRF, there were no significant differences between supplement U and NU.     

Trends in prevalence and magnitude of vitamin and mineral supplement usage and correlation with health status.

The 1980 Food and Drug Administration Vitamin and Mineral Supplement Use Survey and the 1986 National Health Interview Survey used similar questions and procedures to estimate and identify trends in the prevalence and magnitude of supplement usage in the United States. A comparison of the two surveys reveals that prevalence of supplement use among adults decreased slightly, from 42% in 1980 to 38% in 1986. The magnitude of supplement use has also decreased; users reported taking a mean of 2.15 supplements in 1980 compared with a mean of 1.77 in 1986. The prevalence of supplement users identified as light users increased from 42% in 1980 to 57% in 1986. Supplement usage was more likely and more intense among individuals who had one or more health problems and among individuals who perceived their health as very good or excellent. The findings indicate that supplement usage remains a widespread behavior linked to popular conceptions of good health and well-being but one that is susceptible to change.     

Examination of vitamin intakes among US adults by dietary supplement use

BackgroundMore than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data.ObjectiveThe purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003-2006 (n=8,860).ResultsAmong male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level.ConclusionsSupplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.