US supplement usage

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TITLE:

Dietary Supplement Use by US Adults: Data from the National Health

and Nutrition Examination Survey, 1999-2000

SOURCE:

American Journal of Epidemiology 160 no4 339-49 Ag 15 2004

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Kathy Radimer(FN1)

Bernadette Bindewald(FN1)

Jeffery Hughes(FN1)

Bethene Ervin(FN1)

Christine Swanson(FN2)

Mary Frances Picciano(FN2)

 

ABSTRACT

Data from the 1999-2000 National Health and Nutrition Examination

Survey, a nationally representative, crosssectional survey of US

health and nutrition, were analyzed to assess prevalence of dietary

supplement use overall and in relation to lifestyle and demographic

characteristics. Fifty-two percent of adults reported taking a

dietary supplement in the past month; 35% took a multivitamin/

multimineral. Vitamin C, vitamin E, B-complex vitamins, calcium, and

calcium-containing antacids were taken by more than 5% of adults. In

bivariate analyses, female gender; older age, more education, non-

Hispanic White'race/ethnicity, any' physical activity, normal/

underweight, more frequent wine or distilled spirit consumption,

former smoking, and excellent/very good self-reported health were

associated with greater use of any supplement and of multivitamin/

multiminerals; in multivariable comparisons, the latter three

characteristics' were not associated with supplement use. Most

supplements were taken daily and for at least 2 years. Forty-seven

percent of adult supplement users took just one supplement; 55% of

women and 63% of adults aged [greater or equal]60 years took more

than one. These findings suggest that, to minimize possible spurious

associations, epidemiologic studies of diet, demography, or lifestyle

and health take dietary supplement use into account because of 1)

supplements' large contribution to nutrient intake and 2)

differential use of supplements by demographic and lifestyle

characteristics.

adult; antacids; dietary supplements; health surveys; minerals;

nutrition surveys; vitamins

Abbreviations: Cl, confidence interval; NHANES, National Health

and Nutrition Examination Survey; OR, odds ratio; UL, Upper Intake

Levels.

 

 

The Dietary Supplement Health and Education Act of 1994 (FN1)

assured consumer access to a wide range of dietary supplements.

Dietary supplements of all varieties are now marketed in the United

States, including single-ingredient products and various combinations

of vitamins, minerals, botanicals, and other constituents. Media

attention to supplements, including advertisements, informational

articles, and studies reporting associations with health conditions,

is considerable. Marketing data show a dramatic increase in

supplement sales since 1997, which totaled approximately $18.8

billion in 2003 (FN2):

 

 

Consequently, current detailed data on the prevalence of

supplement use and characteristics of users are needed to inform the

design, analysis, and interpretation of epidemiologic 'studies of

diet' or lifestyle and health: A high prevalence of vitamin and

mineral siipplement use would call for assessment of supplement use

in any study that requires nutrient intake data, since, supplements

often contain 100 percent or more of the daily value of one or more

nutrients. Differences in demographic and behavioral characteristics

between supplement users and nonusers would demonstrate the

importance of including supplement assessment in both the planning

and analysis of any epidemiologic study of diet or lifestyle

characteristics and health,'to minimize findings derived from

confounding with supplement intake rather than from the

characteristic itself. Caveats regarding the generalizability of

findings from groups with nonrepresentative lifestyles or

demographics would also be indicated. At present, the only published,

nationally representative data on dietary supplement use collected

since the Dietary Supplement Health and Education Act was passed in

1994 are those from the Continuing Survey of Food Intake by

Individuals 1994-1996, which show higher use by women versus men and

the highest use by women aged 50-59 years but do not present data by

other demographic or lifestyle characteristics (FN3).

 

 

The National Health and Nutrition Examination Survey (NHANES) is

a nationally representative survey that comprises medical

examinations and tests as well as detailed questions about

participants' health, lifestyle, and diet, including dietary

supplement use. This paper presents NHANES 1999-2000 data on the

prevalence and details of use of any dietary supplement, and of

specific vitamin and mineral supplements for the US population aged

20 years or older, and on associations of use with select demographic

and lifestyle characteristics.