In the Journals

Dietary supplements lead to 23,000 ED visits annually

Researchers estimated that 23,000 ED visits in the United States were attributable to adverse events associated with dietary supplements, according to data published in the New England Journal of Medicine.

An analysis of nationally representative surveillance data indicated that these visits commonly involved young adults who had taken weight loss or energy products and were experiencing cardiac symptoms.

"Although supplements cannot be marketed for the treatment or prevention of disease, they are often taken to address symptoms or illnesses, as well as to maintain or improve overall health," Andrew I. Geller, MD, Division of Healthcare Quality Promotion, CDC, and colleagues wrote. "The estimated number of supplement products increased from 4,000 in 1994 to more than 55,000 in 2012 (the most recent year for which data are publicly available), and approximately half of all adults in the United States report having used at least one dietary supplement in the past month."

Geller and colleagues used data from 63 hospitals that were participating in the National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance (NEISS-CADES) program, which was conducted by the CDC, FDA and the Consumer Product Safety Commission. The data consisted of 10 years of measurement, from January 2004 through December 2013.

The analysis included orally administered complementary or herbal nutritional supplements, such as botanicals, amino acids and microbial additives, and micronutrients. Products seen as foods or drinks such as energy drinks and herbal tea beverages, were excluded.

The researchers defined adverse events as allergic reactions, excess doses, adverse reactions, unsupervised ingestion by children or other events such as choking.

Results showed an estimated 23,005 ED visits (95% CI, 18,611-27,398) annually for adverse events related to dietary supplements, based on 3,667 identified cases. The researchers also estimated that 2,154 of the visits (95% CI, 1,342-2,967) would result in hospitalizations each year.

Geller and colleagues also reported that 58.3% (95% CI, 56.4-60.1) of the visits involved female patients. The most common age groups involved were 20 to 34 years old (28%; 95% CI, 25.1-30.8) and 4 years or younger (21.6%; 95% CI, 18.9-24.3).

When excluding unsupervised ingestion by children, data shows 65.9% (95% CI, 63.2-68.5) of ED visits involved a single herbal or complementary nutritional product, compared to 31.8% (95% CI, 29.2-34.3) of visits involving a single micronutrient product.

Energy products and weight-loss products were involved in 71.8% (95% CI, 67.6-76.1) of ED visits for adverse events related to palpitations, tachycardia or chest pain. Patients aged 20 to 34 years accounted for most cardiac-related visits (58%; 95% CI, 52.5-63.7).

Additionally, ED visits for supplement-induced swallowing issues were common in patients aged older than 65 years (37.6%; 95% CI, 29.1-46.2), but not in patients aged 6 to 64 years (9.4%, 95% CI, 7.3-11.4).

"We estimate that more than 23,000 emergency department visits annually in the United States from 2004 through 2013 were for adverse events associated with dietary supplements," Geller and colleagues concluded. "Such visits commonly involved cardiovascular adverse events from weight-loss or energy herbal products among young adults, unsupervised ingestion of micronutrients by children, and swallowing problems associated with micronutrients among older adults. These findings can help target interventions to reduce the risk of adverse events associated with the use of dietary supplements." by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.

Researchers estimated that 23,000 ED visits in the United States were attributable to adverse events associated with dietary supplements, according to data published in the New England Journal of Medicine.

An analysis of nationally representative surveillance data indicated that these visits commonly involved young adults who had taken weight loss or energy products and were experiencing cardiac symptoms.

"Although supplements cannot be marketed for the treatment or prevention of disease, they are often taken to address symptoms or illnesses, as well as to maintain or improve overall health," Andrew I. Geller, MD, Division of Healthcare Quality Promotion, CDC, and colleagues wrote. "The estimated number of supplement products increased from 4,000 in 1994 to more than 55,000 in 2012 (the most recent year for which data are publicly available), and approximately half of all adults in the United States report having used at least one dietary supplement in the past month."

Geller and colleagues used data from 63 hospitals that were participating in the National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance (NEISS-CADES) program, which was conducted by the CDC, FDA and the Consumer Product Safety Commission. The data consisted of 10 years of measurement, from January 2004 through December 2013.

The analysis included orally administered complementary or herbal nutritional supplements, such as botanicals, amino acids and microbial additives, and micronutrients. Products seen as foods or drinks such as energy drinks and herbal tea beverages, were excluded.

The researchers defined adverse events as allergic reactions, excess doses, adverse reactions, unsupervised ingestion by children or other events such as choking.

Results showed an estimated 23,005 ED visits (95% CI, 18,611-27,398) annually for adverse events related to dietary supplements, based on 3,667 identified cases. The researchers also estimated that 2,154 of the visits (95% CI, 1,342-2,967) would result in hospitalizations each year.

Geller and colleagues also reported that 58.3% (95% CI, 56.4-60.1) of the visits involved female patients. The most common age groups involved were 20 to 34 years old (28%; 95% CI, 25.1-30.8) and 4 years or younger (21.6%; 95% CI, 18.9-24.3).

When excluding unsupervised ingestion by children, data shows 65.9% (95% CI, 63.2-68.5) of ED visits involved a single herbal or complementary nutritional product, compared to 31.8% (95% CI, 29.2-34.3) of visits involving a single micronutrient product.

Energy products and weight-loss products were involved in 71.8% (95% CI, 67.6-76.1) of ED visits for adverse events related to palpitations, tachycardia or chest pain. Patients aged 20 to 34 years accounted for most cardiac-related visits (58%; 95% CI, 52.5-63.7).

Additionally, ED visits for supplement-induced swallowing issues were common in patients aged older than 65 years (37.6%; 95% CI, 29.1-46.2), but not in patients aged 6 to 64 years (9.4%, 95% CI, 7.3-11.4).

"We estimate that more than 23,000 emergency department visits annually in the United States from 2004 through 2013 were for adverse events associated with dietary supplements," Geller and colleagues concluded. "Such visits commonly involved cardiovascular adverse events from weight-loss or energy herbal products among young adults, unsupervised ingestion of micronutrients by children, and swallowing problems associated with micronutrients among older adults. These findings can help target interventions to reduce the risk of adverse events associated with the use of dietary supplements." by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.