A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada

Although supplement use is prevalent in North America, there is little information on how supplements affect the prevalence of nutrient adequacy or risk of intakes greater than the tolerable upper intake level (UL). The objectives of this study were to compare the prevalence of nutrient adequacy and percent of intakes greater than the UL from diet alone between supplement users and nonusers and determine the contribution of supplements to nutrient intakes. Dietary intakes (24-h recall) and supplement use (previous 30 d) from respondents ≥1 y in the Canadian Community Health Survey 2.2 (n = 34,381) were used to estimate the prevalence of nutrient adequacy and intakes greater than the UL. Software for Intake Distribution Evaluation was used to estimate usual intakes. The prevalence of nutrient adequacy from diet alone was not significantly higher among supplement users than nonusers for any nutrient. Based on diet alone, children 1-13 y had a low prevalence of nutrient adequacy (<30%) except for vitamin D and calcium. Among respondents ≥14 y, inadequacies of vitamins A and D, calcium, and magnesium were >30%. For other nutrients, there was a low prevalence of nutrient adequacy. There were no nutrient intakes greater than the UL from diet alone, except zinc in children. When supplements were included, ≥10% of users in some age/sex groups had intakes of vitamins A and C, niacin, folic acid, iron, zinc, and magnesium greater than the UL, reaching >80% for vitamin A and niacin in children. In conclusion, from diet alone, the prevalence of nutrient adequacy was low for most nutrients except for calcium, magnesium, and vitamins A and D. For most nutrients, supplement users were not at greater risk of inadequacy than nonusers; supplement use sometimes led to intakes greater than the UL.     

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.     

Lactating women restricting milk are low on select nutrients

OBJECTIVE: Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not. METHODS: A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intake < or = 250 ml/day and non-restrictors (NRS) (>250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk. Statistical Analyses: Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR). RESULTS: Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakes 相似文献   

Vitamin and Mineral Supplements: Barriers and Challenges for Older Adults

ABSTRACT

Older adults are particularly vulnerable to deficiencies of calcium, vitamin D, and vitamin B₁₂. Despite the availability of fortified foods in the United States, intakes of these nutrients among the elderly remain inadequate. Dietary supplements may be a convenient way to improve nutritional status within this population group. This article provides practical and evidence-based recommendations regarding the use of single vitamin/mineral and multivitamin/mineral (MVM) supplements in older adults and provides details on calcium and vitamin D, B₁₂, E, and K. Some single-nutrient supplements have shown benefits for preventing or reducing risks for chronic diseases. Although MVM supplements have not been shown to prevent several major chronic diseases, they do substantially increase vitamin and mineral intakes and blood concentrations, thus improving overall micronutrient status. Older adults who use MVM and/or vitamin/mineral supplements to foster better nutritional and health status should read labels carefully and consult their health care provider to ensure appropriate dietary supplement use.     

Calcium and Vitamin D Disparities Are Related to Gender,Age, Race,Household Income Level,and Weight Classification but Not Vegetarian Status in the United States: Analysis of the NHANES 2001–2008 Data Set

Objective: Adequate calcium and vitamin D intakes are critical during all life cycle stages. This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be targeted toward populations who are truly in need.

Methods: The National Cancer Institute method was used to estimate usual intakes of calcium and vitamin D by source and compared usual intakes to the established Dietary Reference Intakes for U.S. residents aged ≥4 years using National Health and Nutrition Examination Survey 2001–2002, 2003–2004, 2005–2006, and 2007–2008 data sets.

Results: These results showed for the first time that low-income, overweight, and/or obese minority populations may be at greater risk of calcium and vitamin D insufficiency. Children aged 4–8 years were more likely to obtain recommended dairy intakes compared with older children and adults of all ages. Food intakes of calcium decreased with age in adults. Adults who used supplemental calcium showed a lower prevalence of insufficiency. Calcium and vitamin D intakes from food and dietary supplements were not related to vegetarian status. Excessive intakes of calcium and vitamin D above the tolerable upper intake level were low among all studied populations and “overnutrification” was not widely present across these analyses.

Conclusions: Age- and gender-specific supplementation and modest use of fortification with calcium and vitamin D may be warranted for targeting certain subpopulations, particularly older adults, teenagers, minorities, and those who are low income and overweight and/or obese.

Practical Application: This study aimed to characterize usual intakes of calcium and vitamin D from food and dietary supplements in specific subpopulations of Americans so that fortification/enrichment and supplementation efforts may be better targeted. Low-income, overweight, and/or obese minority populations may be at a greater risk of calcium and vitamin D insufficiency.     

Perinatal Vitamin D and Calcium Status of Northern Canadian Mothers and Their Newborn Infants

Objective: This study was undertaken to examine the vitamin D and calcium status of mothers and their newborns.

Methods: The intakes of vitamin D and calcium were determined prenatally in 121 women including 33 Caucasians, 51 Inuits, and 37 Native Indians, living in the Inuvik zone of the Northwest Territories. Plasma concentrations of 25-(OH)-D and calcium were also measured in mothers as well as in their offspring at delivery.

Results: The daily mean vitamin D intake of native mothers, including Inuits and Indians, with (8.1±5.5 μg) and without supplements (3.4±2.5 μg) was significantly lower than that of non-native mothers (13.2±5.9 μg and 5.8±4.3 μg, respectively). According to the predicted prevalence of low vitamin D intake, there existed a higher risk of vitamin D deficiency without supplementation in both native (88.6% vs 48.4%) and non-native (63.5% vs. 15.1%) mothers. The trend for calcium intakes with and without supplementation was similar to vitamin D intake. At the point of delivery, the plasma levels of 25-(OH)-D were lower in native mothers (50.1±19.3 nmol/L) and their offspring (34.2±13.1 nmol/L) than their counterparts (59.8±29.4 nmol/L and 41.4±23.5 nmol/L, respectively). Its plasma levels in newborn infants averaged only 67% of their mothers. None of these infants showed clinical evidence of vitamin D deficiency. In fact, their plasma calcium levels were significantly higher than their mothers.

Conclusions: Plasma 25-(OH)-D concentrations of 60 to 70% of maternal levels may represent a “normal” range for newborn infants. However, a supplementation in native northern Canadian mothers during pregnancy and in their neonates during infancy may have a role to play in the prevention of vitamin D deficiency.     

Patterns of vitamin/mineral supplement usage by adolescents attending athletic high schools in Korea

An excessive use of vitamin/mineral supplements is considered by many to be a common health problem. We surveyed 1,355 adolescent boys and girls attending athletic high schools in Korea for their usage patterns of vitamin/mineral supplements. The usage rate of the vitamin/mineral supplements was 35.8%. The most favored supplements were vitamin C, multivitamins, and calcium. The reasons most cited for taking supplements were "to recover from fatigue," and "to maintain health." Vitamin and mineral intakes occurred over a wide range; mean intake values were typically higher than the Korean RDA. Vitamins B1, B12 and C were consumed in very high amounts at 29.7, 17.9 and 11.1 times the Korean RDA, respectively. When the intakes of nutrients from supplements and diet were combined, it was observed that the intakes of niacin, folic acid, vitamin C, and iron exceeded levels that have been proposed as upper safe limits. The above data underscore the need to provide sound nutritional education to athletic adolescents and their coaches with respect to the use of vitamin/mineral supplements and the links between adequate diet, good health, and physical performance.     

Dietary vitamin D intake is not associated with 25-hydroxyvitamin D3 or parathyroid hormone in elderly subjects,whereas the calcium-to-phosphate ratio affects parathyroid hormone

This cross-sectional study investigates whether serum 25-hydroxyvitamin D₃ [25(OH)D₃] and intact parathyroid hormone (iPTH) are affected by vitamin D, calcium, or phosphate intake in 140 independently living elderly subjects from Germany (99 women and 41 men; age, 66-96 years). We hypothesized that habitual dietary intakes of vitamin D, calcium, and phosphate are not associated with 25(OH)D₃ or iPTH and that body mass index confounds these associations. Serum 25(OH)D₃ and iPTH were measured by an electrochemiluminescence immunoassay. Dietary intake was determined using a 3-day estimated dietary record. The median dietary intake levels of vitamin D, calcium, and phosphate were 3 μg/d, 999 mg/d, and 1250 mg/d, respectively. Multiple regression analyses confirmed that dietary vitamin D and calcium did not affect 25(OH)D₃ or iPTH; however, supplemental intakes of vitamin D and calcium were associated with 25(OH)D₃ after adjustment for age, sex, body composition, sun exposure, physical activity, and smoking. In addition, phosphate intake and the calcium-to-phosphate ratio were associated with iPTH after multiple adjustments. In a subgroup analysis, calcium and vitamin D supplements, as well as phosphate intake, were associated with 25(OH)D₃ and/or iPTH in normal-weight subjects only. Our results indicate that habitual dietary vitamin D and calcium intakes have no independent effects on 25(OH)D₃ or iPTH in elderly subjects without vitamin D deficiency, whereas phosphate intake and the calcium-to-phosphate ratio affect iPTH. However, vitamin D and calcium supplements may increase 25(OH)D₃ and decrease iPTH, even during the summer, but the impact of supplements may depend on body mass index.     

Calcium intake during pregnancy among white and African-American pregnant women in the United States

OBJECTIVE: To characterize the calcium intake in a racially mixed cohort of pregnant women, including the contribution of supplementation and antacids. METHODS: A cohort of women was interviewed twice during their pregnancies. The interviews included a food frequency questionnaire and questions on calcium supplementation and antacid intake. Pregnant women seeking prenatal care at a Pittsburgh hospital in the first trimester were enrolled. 454 women were enrolled and did not miscarry; 385 completed two interviews and were of white or African-American race. RESULTS: Mean and median intakes of calcium were 1671 mg/day and 1482 mg/day. 36% of the women were under the former RDA level (1200 mg/day) for calcium, while 26% were under the current AI (1000 mg/day). Six percent were taking in less than 600 mg/day, and 15% over 2500 mg/day, the tolerable upper limit. Young women were particularly likely to have low intakes (12% of those less than 21 years of age had less than 600 mg/day). Black women were slightly overrepresented among those with low intake (8% vs. 5% of whites), but, overall, their intake was quite similar to whites. Milk and cheese provided more calcium than other food items. Many women took antacids, especially during the second half of pregnancy, and these were a major source of calcium for some members of the cohort. CONCLUSIONS: Although mean and median calcium intake in the cohort were above the AI, many women had calcium intakes that were too high or low. Dairy products provided the most calcium for most pregnant women, and antacids were an important source for many.     

Dairy Calcium is Related to Changes in Body Composition during a Two-Year Exercise Intervention in Young Women

Objective: Relationships between micronutrients and dairy product intake and changes in body weight and composition over two years were investigated.

Design: Two year prospective non-concurrent analysis of the effect of calcium intake on changes in body composition during a two year exercise intervention.

Subjects: 54 normal weight young women, 18 to 31 years of age.

Measures of Outcome: Mean intakes of nutrients of interest were determined from three-day diet records completed at baseline and every six months for two years. The change in total body weight and body composition (assessed by dual x-ray absorptiometry) from baseline to two years was also determined.

Results: Total calcium/kilocalories and vitamin A together predicted (negatively and positively, respectively) changes in body weight (R² = 0.19) and body fat (R² = 0.27). Further, there was an interaction of calcium and energy intake in predicting changes in body weight, such that, only at lower energy intakes, calcium intake (not adjusted for energy) predicted changes in body weight.

Conclusions: Regardless of exercise group assignment, calcium adjusted for energy intake had a negative relationship and vitamin A intake a positive relationship with two year changes in total body weight and body fat in young women aged 18 to 31 years. Thus, subjects with high calcium intake, corrected by total energy intake, and lower vitamin A intake gained less weight and body fat over two years in this randomized exercise intervention trial.     

Nutritional intake of women and men on the NCEP Step I and Step II diets.

Restriction of dietary fat and cholesterol are recommended for treating hyperlipidemia, but may alter vitamin or mineral intakes. We evaluated changes in nutrients of individuals taught the National Cholesterol Education Program (NCEP) Step II diet.

Subjects participated in a randomized controlled trial of the cholesterol-lowering effect of the NCEP Step II diet. Eligibility criteria included elevated fasting plasma LDL-cholesterol, no lipid-altering medications, and diet not already fat-modified. Subjects attended eight weekly dietitian-led classes. Four-day food records collected 6 months post-intervention were compared to baseline records.

Of 409 subjects with complete data, 123 met Step I and 166 met Step II diet criteria. Intakes of micronutrients associated with fruits and vegetables (beta-carotene and vitamin A, vitamin C, folic acid, magnesium, and potassium) increased on both diets. Patterns of decreased mean intake and/or fewer subjects consuming 2/3 Recommended Dietary Allowance were seen for calcium, vitamin E, and zinc.

NCEP Step I and II diets generally match or exceed unmodified diet for vitamin and mineral content. Premenopausal women do not appear to be at increased risk of low iron intake. Vitamin E intake decreases, although the significance is unknown in the context of lower fat intake and increased intake of other antioxidants. Diet counseling and materials should encourage sources of calcium for women, and zinc for both women and men.     

Do vitamin and mineral supplements improve the dietary intake of elderly Canadians?

The prevalence of nutritional supplementation and the relationship of the adequacy of the diet to the use of nutritional supplements was investigated in a group of 82 healthy, free-living elderly Canadians. Dietary data included a seven-day food record and the reported daily intake of vitamin or mineral supplements. 43% of the men and 62% of the women reported using vitamin and/or mineral supplements during the preceding year. Current use (at the time of interview) was reported in 35% of the study subjects. Supplement users did not differ from non-users in terms of dietary intake from diet alone for any of the nutrients compared. Few subjects corrected inadequate intakes by the use of nutrient supplements; in fact, most supplements were consumed by those not at risk of deficiency for the particular vitamin or mineral. Reliance upon vitamin and/or mineral supplementation for adequate nutrient intake without a dietary evaluation is not recommended.     

Vitamin B6 status of breast-fed infants in relation to pyridoxine HCl supplementation of mothers

The vitamin B6 nutritue of breast-fed infants was evaluated by vitamin B6 intake, plasma pyridoxal 5'-phosphate (PLP) concentration, and growth patterns during the infants' first 6 mo of age. Vitamin B6 intakes of 47 healthy, term infants were significantly correlated with four levels of maternal vitamin B6 supplements: 2.5, 4.0, 7.5, or 10.0 mg pyridoxine (PN) HCl/d and met the B6 Adequate Intake (AI, 1998) of 0.1 mg/d for infants 0 to 6 mo. Only infants whose mothers received 10.0 mg PN x HCl/d exceeded or met the Recommended Dietary Allowances (RDA, 1989) of 0.3 mg vitamin B6/d from 4 to 6 mo of age. Plasma PLP concentrations of infants, measured at 1, 4, and 6 mo of age paralleled their mother's vitamin B6 intake. Most infants showed normal growth. The findings indicated that a maternal PN x HCl supplement of 2.5 mg/d provided an adequate amount of vitamin B6 in breast milk (0.15 mg/d) for the vitamin B6 status parameters and the growth of breast-fed infants.     

Mineral intakes of elderly adult supplement and non-supplement users in the third national health and nutrition examination survey

Calcium, iron and zinc are important in many of the body's functions. We report dietary and combined (diet + supplements) intakes for these minerals for elderly supplement and non-supplement users in the United States and the prevalence of inadequate intakes. We calculated usual dietary intakes for adults 60 y and older from third National Health and Nutrition Examination Survey, 1988-94; mineral intakes from supplements and calcium-containing antacids were added to usual dietary intakes. We evaluated iron and zinc intakes using the dietary reference intakes, recommended dietary allowances and estimated average requirements for elderly adults, as well as calcium intakes using the Adequate Intake and the Healthy People 2010 objective. The highest prevalences of inadequate dietary intakes was for calcium (males, 70-75%; females, 87%) and zinc (males, 35-41%; females, 36-45%). Dietary supplements improved intakes, but nearly two-thirds of elderly adults had combined intakes below the calcium objective. Non-Hispanic blacks usually had lower intakes than non-Hispanic whites and higher prevalences of intakes below the standards. Supplement users had significantly higher mean dietary intakes than non-supplement users for all three minerals for total females and non-Hispanic white females (P < 0.05 for each mineral). Many elderly adults had inadequate dietary zinc intakes, and calcium intakes fell below the Healthy People 2010 objective; dietary supplements improved intakes. Even with supplements most older adults still had intakes below the calcium objective, partly because the supplements they took usually contained low doses of calcium. Total female and non-Hispanic white female supplement users were the only groups that had higher dietary intakes than non-supplement users for all three minerals.     

北京市成年人膳食及营养补充剂中维生素和矿物质的摄入状况

目的研究膳食营养补充剂对北京市居民维生素和矿物质摄入水平及营养素摄入的影响。方法采用多阶段整群抽样法,抽取北京市6区县1440户家庭,调查18岁及以上成年人3992人。结果男性由膳食提供的维生素和矿物质的平均摄入量均高于女性,但是女性烟酸、维生素C的总摄入量高于男性。使用者的维生素和矿物质的摄入量均高于非使用者,在使用者中,补充剂中硫胺素的贡献率男性为60%,女性为70%,核黄素的贡献率为男性47%,女性45%,钙的贡献率为男性42%,女性为45%。使用者中维生素和矿物质达到或超过参考值的比例明显高于非使用者,特别是维生素C和钙,高出20～30个百分点。结论使用营养补充剂提高了维生素和矿物质的摄入水平,使人群达到参考摄入量的比例增加。今后营养调查中应增加营养补充剂调查,以提高营养素评价的准确度。     

Evaluation of antioxidant vitamins intake by students of Warsaw University of Life Science

The aim of this study was the assessment of antioxidant vitamins intake among students of the Faculty of Human Nutrition and Consumer Sciences of Warsaw University of Life Science. The investigation was done among 145 students at the age 21-28 in the 2008 year. Data about food intake were collected using a 3-day dietary records method. On this basis intake of vitamin A, beta-carotene, vitamin E and C was calculated The results shows that the quantity of antioxidant vitamins was adequate for vitamin C (64 mg/d, 102% EAR), but for vitamin A and E was higher then recommended value (698 microg retinol equivalent/d, 135% EAR and 11,5 mg tocopherol equivalent/d, 138% of AI). About 12-15% students used supplements, providing additional 574 microg vitamin A, 116 mg vitamin C and 4 mg vitamin E. It covered together with food intakes 260%, 298% EAR value and 199% of AI value, in case of vitamin E. In smokers, for which recommendations of intake antioxidant vitamins are slightly different, it was found too low their intake.     

Dairy foods are an important source of calcium and vitamin D among Canadian-born and Asian-born Chinese in Edmonton,Alberta

Low intakes of calcium and vitamin D increase the risk for osteoporosis, bone fracture, and other health problems. This study aimed to examine the calcium and vitamin D intakes of Canadian-born Chinese (CBC) and Asian-born Chinese (ABC) in Edmonton, Canada, and to identify usual food sources of these nutrients. We hypothesized that CBC would have higher intakes of calcium and vitamin D than ABC and that the food sources of these nutrients would differ by region of birth (Canada vs Asia). Two in-person multipass 24-hour dietary recalls were administered for 1 weekday and weekend day for 81 healthy ethnically Chinese aged 18 to 58 years. The risks for calcium and vitamin D inadequacy were calculated as were the contributions of specific foods to calcium and vitamin D intakes. Calcium intake was 781 ± 337 mg/d for CBC and 809 ± 369 mg/d for ABC (P = .737). Vitamin D intake was 3.8 ± 3.4 μg/d for CBC and 5.0 ± 3.9 μg/d for ABC (P = .158). Respective risks for calcium and vitamin D inadequacy were 36% and 98% for men and 78% and 100% for women. Dairy contributed most to the calcium (43%) and vitamin D (52%) intake of participants. For ABC, soybean products contributed to 8.1% of calcium, whereas fatty fish contributed to 16.7% of vitamin D. For CBC, red meats contributed to 11.1% of vitamin D. Dietary intakes of calcium and vitamin D need to be increased in Chinese Canadians through the promotion of dairy and culturally relevant sources of these nutrients.     

Effects of High Fruit-Vegetable and/or Low-Fat Intervention on Plasma Micronutrient Levels

Objectives: Higher plasma micronutrient levels have been associated with decreased cancer risks. The objective of this study was to determine the relative effects of reduced fat and/or increased fruit-vegetable (FV) intakes on plasma micronutrient levels.

Methods: Healthy, premenopausal women with a family history of breast cancer (n = 122) were randomized across four diet arms for one year in a 2 × 2 factorial design study: control, low-fat, high fruit-vegetable and combination low-fat/high FV diets. Levels of plasma micronutrients were measured in plasma at 0, 3, 6 and 12 months.

Results: The high FV intervention, regardless of fat intake, significantly increased α-carotene, β-carotene and vitamin C levels in plasma. Only the combination high FV, low-fat intervention significantly increased plasma β-cryptoxanthin and zeaxanthin levels over time. Although α-tocopherol was not affected, a potential concern is that the low-fat intervention resulted in significantly decreased both γ-tocopherol dietary intakes and plasma levels, regardless of whether or not FV intakes were concomitantly increased.

Conclusions: Unlike α-tocopherol, γ-tocopherol plasma levels were decreased by a low fat diet, perhaps because γ-tocopherol is not generally added to foods nor widely used in vitamin E supplements. The decreased dietary intakes and plasma levels of γ-tocopherol with a low-fat diet may have implications for health risks since the biological functions of the different tocopherol isomers have been reported to be distinct.     

The use of dietary supplements among older persons in Southern Germany — Results from the KORA-age study

Objectives

Current population-based surveys in Europe on the prevalence of dietary supplement (DS) use in older individuals are scarce. The aim of the present study was to investigate patterns, prevalence and determinants of non-herbal DS use in aged subjects. Furthermore, the intake amounts of vitamins and minerals from supplements were assessed.

Design

Cross-sectional.

Setting

Data on supplement use were available from an age- and sex-stratified random sample of the German population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age study.

Participants

1,079 persons who were born in or before the year 1943.

Measurements

Use of dietary supplements and medications during the last seven days was recorded in a face-to-face interview in 2009. Participants were asked to bring all packages of ingested preparations to the study center. Not only vitamin/mineral supplements, but also non-vitamin non-mineral non-herbal supplements and drugs containing vitamins and minerals were coded as DS.

Results

The age-standardized prevalence of DS intake was 54.3% in women and 33.8% in men, respectively. The most commonly supplemented mineral and vitamin, respectively, was magnesium (31.9%) and vitamin D (21.5%) in women and magnesium (18.0%) and vitamin E (12.0%) in men. The highest intakes, compared to the German Dietary Reference Intakes, were reported for biotin, vitamin B₆ and B₁. Excessive intakes (equal or above the European Tolerable Upper Intake Levels (UL)) were observed especially for magnesium and vitamin E. 20.2% of the women and 32.5% of the men who took magnesium supplements regularly exceeded the UL for magnesium. In case of vitamin E this was true for 8.0% of the women and 13.6% of the men. Determinants of DS use were sex, education, smoking, physical activity, neurological diseases, and stroke.

Conclusion

A high proportion of the general population aged 65 years and older in Southern Germany uses DS, especially supplements containing vitamins/minerals. The supplementation of vitamin D can be regarded as favorable in this age group, whereas the excessive intakes of vitamin E might be a cause of concern.     

Dietary calcium and vitamin D intake in an adult Middle Eastern population: food sources and relation to lifestyle and PTH

Little is known about calcium and vitamin D intakes in Middle Eastern countries, where the prevalence of hypovitaminosis D is high. This study identifies major sources of calcium and vitamin D in the Lebanese diet, examines lifestyle factors that may influence intake of these nutrients and investigates the relationship between nutritional or lifestyle factors and parathyroid hormone (PTH). Three hundred sixteen young healthy volunteers aged 30 to 50 (men, non-veiled and veiled women) were recruited from different rural and urban Lebanese community centers. Food frequency questionnaire was used to evaluate the consumption of vitamin D and calcium-rich foods. We also measured serum PTH levels. Mean daily calcium and vitamin D intake were respectively 683.8 +/- 281.2 mg and 100.6 +/- 71.0 IU. Daily vitamin D sources were divided as follows: 30.4 +/- 46.4 IU from milk and dairy products, 28.2 +/- 26.3 IU from meat and poultry, 25.8 +/- 25 IU from fish, 8.5 +/- 8.6 IU from eggs, and 7.8 +/- 14.3 IU from sweets (respectively 30.2%, 28%, 25.6%, 8.4% and 7.7% of the total vitamin D intake). Mean daily calcium from animal and vegetable sources were respectively 376.3 +/- 233.6 mg and 307.9 +/- 118.5 mg. Animal/total calcium intake ratio was 52% and was only statistically significantly higher in urban people compared to rural ones. Multivariate analysis showed that male sex and urban residence were independent predictors of both vitamin D and calcium intakes (p < 0.01 and p < 0.01 respectively). In addition, veiling was an independent predictor of low vitamin D intake (p < 0.05) and a high body mass index (BMI) was an independent predictor of low calcium intake (p < 0.05). Finally, PTH was inversely correlated with vitamin D intake and the animal/total calcium intake ratio (r = -0.18 and r = -0.22, p < 0.01), while no significant results were achieved for the vegetable calcium. In a multivariate model, urban living, female gender, low vitamin D and calcium intakes, low animal/total calcium intake ratio, and high BMI, are independent predictors of hyperparathyroidism. The deficient nutritional status of vitamin D and calcium in Lebanon justify the implementation of dietary public health measures. People at most risk for secondary hyperparathyroidism should be advised to increase their dietary calcium (mostly animal calcium) and vitamin D, to take supplements, or to increase their sun exposure.