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#Grand Rounds

Are Dietary Supplements Associated with Decreased Mortality?

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BACKGROUND AND PURPOSE:

  • Although the majority of the US population use dietary supplements, data remains limited as to benefits vs risks
  • Chen et al. (Annals of Internal Medicine, 2019) evaluated dietary supplements, nutrient intake and mortality.

METHODS:

  • Prospective cohort study
  • Data sets
    • NHANES (National Health and Nutrition Examination Survey)
    • National Death Index mortality data
  • Participants
    • U.S. adults ≥20 years
  • Measurements
    • Dietary supplement use in the past 30 days (in-house interview with follow up questions for specifics)
    • Nutrient intake from food and supplements (24-hour diet recalls conducted by trained interviewers)
  • Definitions
    • Inadequate nutrient intake: Levels of total nutrient intake (foods plus supplements) below the Estimated Average Requirement or Adequate Intake level specified in the Dietary Reference Intakes
    • Excess nutrient intake: Levels above the Tolerable Upper Intake Level
  • Primary outcomes
    • Mortality (all causes)
    • Cardiovascular disease (CVD)
    • Cancer
  • Data also collected on demographics, lifestyle factors and comorbid conditions to adjust for confounding

RESULTS:

  • 30,899 U.S. adults were included
    • Median follow up: 6.1 years
  • Ever using dietary supplements did not impact mortality
  • Reduced all-cause or CVD mortality was associated with adequate intake of
    • Vitamin A | Vitamin K | Magnesium | Zinc | Copper
    • Associations restricted to nutrient intake from food
  • Increased risk of cancer death was associated with excess intake of calcium
    • Multivariable-adjusted rate difference: 1.7 (95% CI, −0.1 to 3.5) deaths per 1000 person-years
    • Related to calcium intake from supplements rather than food
      • Comparing ≥1000 mg/day vs no use
      • Multivariable-adjusted rate difference: 1.5 (95% CI, −0.1 to 3.1) deaths per 1000 person-years

CONCLUSION:

  • Use of dietary supplements are not associated with decreased mortality when adjusted for education and lifestyle factors
  • Adequate diet from food is associated with reduced mortality
  • Excess supplement may be associated with increased mortality
  • Authors recognize limitations, including
    • Observational studies cannot account and related confounding
    • Self-reporting recall bias

Learn More – Primary Sources:

Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study

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Related ObG Topics:

Do Vitamin D and Calcium Supplements Decrease Cancer Risk?
Do Vitamin Supplements Inhibit Macular Degeneration?
Results from the VITAL Trial: Does Vitamin D Reduce Cardiovascular and Cancer Risk in the General Population?

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