November 15, 2016
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Multivitamin/multimineral use declines, overall supplement use stable since 1999

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From 1999 to 2012, the use of multivitamins and multiminerals declined, but overall dietary supplement use remained stable according to a report in the JAMA.

“This stabilization appears to be the balance of several opposing trends, with a major contributing downward factor being the decrease in use of [multivitamins and multiminerals],” Elizabeth D. Kantor, PhD, MPH, department of epidemiology and biostatistics, Memorial Sloan Kettering Cancer Center, and colleagues wrote. “This trend may reflect increased scrutiny of [multivitamins and multiminerals], following several studies showing no benefit.”

Kantor and colleagues wrote the economic downturn of the late 2000s also could have impacted use, as could statements and recommendations indicating no evidence, or not enough, to show supplements or multivitamins/multiminerals (MVMM) can prevent or limit chronic disease. 

Researchers used data from the seven National Health and Nutrition Examination Surveys conducted from 1999 to 2012. The study included 37,958 adults, with an overall response rate of 74%.

Researchers wrote overall supplement use remained at 52%; however, the use fluctuated by subgroup. MVMM decreased from 37% in 1999-2000 to 31% in 2011-2012.

Findings on specific supplements include:

  • decreases in the use of vitamins C and E, selenium, para-aminobenzoic acid, echinacea, garlic, gingko biloba and ginseng;
  • stable use of vitamin D; also, amino acids, fiber, glucosamine and chondroitin did not significantly change;
  • increases in the use of lycopene-containing supplements, fish oil, alphalinolenic acid, coenzyme Q10, cranberry, epigallocatechin gallate, methylsulfonylmethane, probiotics and omega-3, omega-6 and omega-9 fatty acids increased; and

Researchers also found that use of MVMM significantly decreased among those with higher education levels and non-Hispanic white adults and trends in any supplement use fluctuated by age.

“The reasons for these patterns are unclear,” Kantor and colleagues wrote. “It is possible that the difference in trends in MVMM use by age group may reflect a cohort effect, but a longer timeframe would be needed to address this question. It is also possible that differences in trends by population subgroup reflect that research translates into behavior change more quickly in certain population subgroups, although differences across subgroups also likely reflect underlying health status and socioeconomic differences.”

Clinicians should use Kantor and colleagues’ study as the basis for bringing up supplements with their patients, Pieter A. Cohen, MD, department of internal medicine, Somerville Hospital Primary Care, Somerville Mass., wrote in an accompanying editorial.

“Physicians should include supplements when they review medications with all patients and also consider supplements when symptoms raise the possibility of a supplement-related adverse effect. It is now known that many supplements contain pharmaceutically active botanicals, which can have important clinical effects,” he wrote.  – by Janel Miller

Disclosure: Cohen reports receiving funds to buy research supplies from Consumers Union and at the time of his editorial submission, he reports he was a defendant in a civil suit brought by a supplement manufacturer involving beta-methylphenethylamine. All other researchers report no relevant financial disclosures.