Children’s Multivitamin/Mineral Supplements: Label Claims and Measured Content Compared to Recommended Dietary Allowances and Tolerable Upper Intake Levels

Abstract

Abstract Objectives US children ages 4 and older use multivitamin/mineral supplements (MVMs) formulated to meet the Daily Values for adults. To better evaluate the potential for nutrient adequacy and excess, it is helpful to determine actual ingredient content instead of amounts declared on labels. We tested children's MVMs and compared the products’ labeled and measured contents with Recommended Dietary Allowances (RDA) and Upper Tolerable Intake Levels (UL) established for children ages 4 to 8 years. Methods Children's MVMs were defined as dietary supplements (DSs) containing three or more vitamins with or without minerals and other bioactive components labeled for individuals ages 4 and older. Nationally representative children's MVMs were identified based on relative market share estimates (RMSE) derived from frequency of use and respondents’ weights in infant/pediatric MVM subsets of 2003–2006 National Health and Nutrition Examination Surveys, and store surveys. The 21 top and 43 lower market share DSs selected for this study represented ∼72% of the total RMSE. The DSs were purchased in 2008 from multiple market channels in regions of AL, CA, MI, MO, NY, and OK identified using a multistage probability-proportional-to-size approach. Vitamin and mineral content was measured by commercial labs in 3 to 6 lots of 47 chewable tablets, 11 gummies, 4 liquids, 1 gumball, and 1 powder DS. Results For 13 of 16 nutrients (copper, iodine, iron, zinc, folic acid, niacin, riboflavin, thiamin, vitamins A, B-12, B-6, D and E), most MVMs were labeled at or above the RDA but below UL levels. For calcium, magnesium and phosphorus, all the studied DSs were labeled below the RDAs. The DSs that contained zinc, niacin and retinol labeled above their ULs had overall mean RMSEs comparable to the DSs labeled within the RDA-UL ranges. Overages resulted in levels exceeding the UL for folic acid in 24 out of 29 DSs labeled at the UL and for retinol in 10 out 40 DSs labeled below the UL, including one of the three most highly consumed MVMs. Conclusions The prevalence of children's MVMs on the US market with labeled levels at or above the RDA, or at UL, combined with analytically verified overages, suggests risks of excess in intakes for zinc, niacin, retinol and folic acid, especially when MVM use is combined with diets containing many highly fortified foods. Funding Sources NIH ODS and USDA ARS.