Journal of Family Practice
Published in September 2016, a Journal of Family Practice article sponsored by CFEN demonstrated the prevalence of the nutritional gap facing Americans. The article also featured a first glimpse at the CFEN scientific advisors’ analysis of the impact of frequency of supplement use on nutrient intakes and status.
A New Look at Supplementation to Improve Nutrient Intakes
While past NHANES analyses have clearly and consistently shown nutrient shortfalls among Americans, they likely underestimate the impact of vitamin and mineral supplements (VMS) on nutrient intakes because of certain methods they’ve used:
- Some of the analyses estimated nutrient intakes from food only and food plus supplements based on data from both multivitamin/mineral supplement (MVMS) users and non-users combined.
- “MVMS users” were usually broadly defined as those who reported taking a MVMS as infrequently as just once during the last 30 days.
- Most MVMS provide low or no amounts of certain nutrients, such as calcium, magnesium, potassium, and choline.
- Some analyses have broadly defined “supplements” as those containing vitamins, minerals and/or herbal ingredients.
A new analysis was designed to avoid such problems and more closely examine the effects of consumption frequency of VMS, including MVMS and single supplements, on micronutrient intake. NHANES data from 2009 through 2012 (2012 data were the most recent at the time) on nutrient intake from both foods and MVMS in adults 19 years of age and older (n = 10,698) were analyzed by quartiles of MVMS consumption frequency over the previous 30 days:
- None (no supplement of any kind), or
- MVMS use on 1 to 12 days, 13 to 24 days, or 25 or more days.
To ensure adequate sample sizes, the frequencies of single supplement use were categorized as:
- None, <2 days/week (<8.5 days in the previous 30 days), and
- >2 days/week (>8.5 days in the previous 30 days).
MVMS were defined as supplements providing 100% or more of the Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs) for 9 or more of the 21 micronutrients with defined DRI values. Single supplements were defined as supplements providing 100% of the RDA or AI for one or more of the same 21 micronutrients. The analysis focused on micronutrients previously shown to be consumed by many Americans in amounts below the Estimated Average Requirement (EAR) or AI level.
Initial findings show that, for most micronutrients, more frequent MVMS use is clearly and markedly associated with achieving required micronutrient intake (Figure 1). For example, for vitamin D, which the Dietary Guidelines for Americans identify as a nutrient “of public health concern,” intake at or above the EAR was achieved by 98%, 75%, 34%, and 4% of adults who, in the previous 30 days, took a MVMS on 25 or more days, 13 to 24 days, 1 to 12 days, and who took no supplement at all, respectively.
Choline and potassium (not shown in Figure 1) were exceptions, with few adults (less than approximately 10% and 5%, respectively) achieving recommended intake levels regardless of MVMS consumption, likely because those nutrients are found in insignificant amounts in most MVMS products.
Similar results were seen for single supplements (Figure 2). For example, for vitamin C, intake at or above the EAR was achieved by 91%, 61% and 50% of adults who, in the previous 30 days, took a single supplement containing vitamin C on 8.5 or more days per month, less than 8.5 days per month, or who took no supplement at all, respectively. Results for choline and vitamin K were not tabulated because very few individuals reported consuming single supplements with those nutrients.
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