Multivitamin-mineral Supplement Research Articles

Improved cognitive performance and mental fatigue following a multi-vitamin and mineral supplement with added guaraná ( Paullinia cupana)

Guaraná ( Paullinia cupana) extracts are most commonly used in Western markets as putatively psychoactive food and drink additives. This double-blind, randomised, placebo-controlled, parallel groups study assessed the acute effects of either a vitamin/mineral/guaraná supplement or placebo drink in 129 healthy young adults (18–24 years). Participants completed a 10 min version of the Cognitive Demand Battery (comprising: Serial 3s and Serial 7s subtraction tasks, a Rapid Visual Information Processing (RVIP) task, ‘mental fatigue’ scale). Thirty minutes following their drink participants made six consecutive completions of the battery (i.e. 60 min). The vitamin/mineral/guaraná combination resulted in improved task performance, in comparison to placebo, in terms of both increased speed and accuracy of performing the RVIP task throughout the post-dose assessment. The increase in mental fatigue associated with extended task performance was also attenuated by the supplement. This research supports previous findings demonstrating guaraná's cognition enhancing properties and provides evidence that its addition to a multi-vitamin–mineral supplement can improve cognitive performance and reduce the mental fatigue associated with sustained mental effort.

Progress in developing analytical and label-based dietary supplement databases at the NIH Office of Dietary Supplements

Although an estimated 50% of adults in the United States consume dietary supplements, analytically substantiated data on their bioactive constituents are sparse. Several programs funded by the Office of Dietary Supplements (ODS) at the National Institutes of Health enhance dietary supplement database development and help to better describe the quantitative and qualitative contributions of dietary supplements to total dietary intakes. ODS, in collaboration with the United States Department of Agriculture, is developing a Dietary Supplement Ingredient Database (DSID) verified by chemical analysis. The products chosen initially for analytical verification are adult multivitamin-mineral supplements (MVMs). These products are widely used, analytical methods are available for determining key constituents, and a certified reference material is in development. Also MVMs have no standard scientific, regulatory, or marketplace definitions and have widely varying compositions, characteristics, and bioavailability. Furthermore, the extent to which actual amounts of vitamins and minerals in a product deviate from label values is not known. Ultimately, DSID will prove useful to professionals in permitting more accurate estimation of the contribution of dietary supplements to total dietary intakes of nutrients and better evaluation of the role of dietary supplements in promoting health and well-being. ODS is also collaborating with the National Center for Health Statistics to enhance the National Health and Nutrition Examination Survey dietary supplement label database. The newest ODS effort explores the feasibility and practicality of developing a database of all dietary supplement labels marketed in the US. This article describes these and supporting projects.

Dietary supplement ingredient database (DSID): Preliminary USDA studies on the composition of adult multivitamin/mineral supplements

The Nutrient Data Laboratory of the United States Department of Agriculture (USDA) is collaborating with the Office of Dietary Supplements (ODS), the National Center for Health Statistics (NCHS), and other government agencies to design and populate a dietary supplement ingredient database (DSID). This analytically based, publicly available database will provide reliable estimates of vitamin and mineral content of dietary supplement (DS) products. The DSID will initially be populated with multivitamin/mineral (MVM) products because they are the most commonly consumed supplements. Challenges associated with the analysis of MVMs were identified and investigated. A pilot study addressing the identification of appropriate analytical methods, sample preparation protocols, and experienced laboratories for the analysis of 12 vitamins and 11 minerals in adult MVM supplement products was completed. Preliminary studies support the development of additional analytical studies with results that can be applied to the DSID. Total intakes from foods and supplements are needed to evaluate the associations between dietary components and health. The DSID will provide better estimates of actual nutrient intake from supplements than databases that rely on label values alone.

Measuring vitamins and minerals in dietary supplements for nutrition studies in the USA

This article illustrates the importance of having analytical data on the vitamin and mineral contents of dietary supplements in nutrition studies, and describes efforts to develop an analytically validated dietary supplement ingredient database (DSID) by a consortium of federal agencies in the USA. Preliminary studies of multivitamin mineral supplements marketed in the USA that were analyzed as candidates for the DSID are summarized. Challenges are summarized, possible future directions are outlined, and some related programs at the Office of Dietary Supplements, National Institutes of Health are described. The DSID should be helpful to researchers in assessing relationships between intakes of vitamins and minerals and health outcomes.

Multivitamin-Mineral Supplementation Prevents Lipid Peroxidation during “The Marathon des Sables”

Objective: We investigated the effect of a moderate mutivitamin and mineral supplementation containing mainly vitamin C (150.0 mg.day−1), vitamin E (24.0 mg.day−1) and β-carotene (4.8 mg.day−1) prior to and during an extreme running competition -the Marathon des Sables (MDS)- that consisted of six long races in the desert.Methods: Seventeen athletes participated in our double blind, placebo-controlled study. Blood samples were collected prior to the supplementation i.e. three weeks before the competition (D-21), two days prior to the MDS (D-2), after the third race (D3) and at the end of the competition (D7). Erythrocyte antioxidant enzyme activity (glutathione peroxidase (GPx), superoxide dismutase (SOD)), erythrocyte glutathione level (GSH), plasma non-enzymatic antioxidant status (uric acid, vitamin C, α-tocopherol, retinol, β-carotene), markers of plasma lipid peroxidation (thiobarbituric reactive substances (TBARS)), reactive carbonyl derivatives (RCD) and membrane damage (creatine kinase and lactate dehydrogenase activities) were measured.Results: In both groups, GSH levels, uric acid levels and membrane damage significantly increased during the competition while SOD activity significantly decreased. In Supplemented group, plasma α-tocopherol, β-carotene and retinol levels significantly increased after three weeks of supplementing. In contrast to Placebo group, α-tocopherol, vitamin C and retinol levels were significantly affected by the competition in Supplemented group. Moreover, no increase in TBARS was observed in Supplemented group during the competition, whereas TBARS significantly increased at D3 in the placebo group.Conclusion: The moderate multivitamin-mineral supplementation prevented the transient increase in TBARS levels during this extreme competition.

Comparison of acute absorption of commercially available chromium supplements

Chromium (Cr) supplements are available as picolinate, nicotinate or chloride (the latter primarily in multivitamin–mineral supplements). The picolinate form has been reported to be the best absorbed and most efficacious, but some reports question which form has superior absorption. The present study examined acute Cr absorption, based on 24 h urinary Cr values, for picolinate, two types of nicotinate, and chloride in young adult, non-overweight females. College-aged women were given 200 μg of Cr as each of the four supplement types in random order accompanied by a small standardized meal, separated by at least a week washout. Cr picolinate produced significantly higher 24 h urinary Cr than either of two nicotinate supplements or Cr chloride given in a multivitamin–mineral supplement. This difference was seen for absolute values of the urinary Cr and for percent increases. In conclusion, based on an indirect measure of acute absorption, Cr picolinate was superior to three other Cr complexes commonly sold as supplements.

Challenges and opportunities in the translation of the science of vitamins

Some 100 y after the description and naming of the first vitamin, this conference on the state-of-the-science has shown that remarkable and exciting advances have been made in our understanding of the biology, chemistry, and metabolism of vitamins, explaining their essentiality in the diet. A great deal more needs to be done in the translation of this knowledge into an understanding of the benefit of vitamin supplements to disease prevention and to health and well-being. Not only are advances in fundamental science and biology necessary, but more attention must be paid to genomics, epigenetics, behavioral science, and new techniques for evidence analysis of studies. Information relating individual vitamins or small combinations of vitamins to disease prevention is stronger than that for multivitamins, formulations that cry out for greater standardization. This large task of translating emerging science to better policy in the field of vitamin and multivitamin-mineral supplement use should occupy our attention intensively in the years to come. Issues needing more attention include the content and labeling of such products and the effects of the products on nutrient adequacy as well as in chronic degenerative disease prevention. In this quest, the development of more and better surrogate markers will be critical. Dose-response assessments of safety are badly needed for updating Tolerable Upper Intake Levels. At its best, all of these disparate types of research will require a robust interaction between the public and private sectors in a regulatory framework that supports and rewards investment in good science.

Nutritional supplements and infection in the elderly: why do the findings conflict?

BackgroundMost of the randomized placebo-controlled trials that have examined the clinical effects of multivitamin-mineral supplements on infection in the elderly have shown no significant effect. The exceptions are three such trials, all using a supplement with the same composition, and all claiming dramatic benefits: a frequently cited study published in 1992, which reported a 50% reduction in the number of days of infection (NDI), and two 2002 replication studies. Questions have been raised about the 1992 report; a second report in 2001 based on the same trial, but describing effects of the supplement on cognitive functions, has been retracted by Nutrition. The primary purpose of the present paper is to evaluate the claims about the effects of supplements on NDI in the two replication reports.MethodsExamination of internal consistency (outcomes of statistical tests versus reported data); comparison of variability of NDI across individuals in these two reports with variability in other trials; estimation of the probability of achieving the reported close agreement with the original finding.ResultsThe standard deviations of NDI and levels of statistical significance reported are profoundly inconsistent. The reported standard deviations of NDI are consistently below what other studies have found. The reported percent reductions in NDI agree too closely with the original study.ConclusionThe claims of reduced NDI in the two replication reports should be questioned, which also adds to concerns about the 1992 study. It follows that there is currently no trustworthy evidence from randomized placebo-controlled clinical trials that favors the use of vitamin-mineral supplements to reduce infection in the elderly.

Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage.

Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life.

The use of slurry sampling for the determination of manganese and copper in various samples by electrothermal atomic absorption spectrometry

Manganese and copper in multivitamin–mineral supplements and standard reference materials were determined by slurry sampling electrothermal atomic absorption spectrometry. Slurries were prepared in an aqueous solution containing Triton X-100. The effects of different parameters such as ratio of solid to liquid phase volume, total slurry volume and addition of Triton X-100 as a dispersant on the analytical results were investigated. The graphite furnace programs were optimized for slurry sampling depending on the analytes and their concentrations in the samples. The linear calibration method with aqueous standard solutions was used for the quantification. At optimum experimental conditions, R.S.D. values were below 5%. The analytes were determined in the limits of 95% confidence level with respect to certified values in coal and soil standard reference materials and to those found by wet-digestion in multivitamin–mineral supplements. Detection limits (3 δ) for Mn and Cu were 0.10 μg L −1 and 1.82 μg L −1 for 10 μL coal standard reference material slurry, respectively.

Effect of Prenatal Multiple Micronutrient Supplements on Maternal Weight and Skinfold Changes: A Randomized Double-Blind Clinical Trial in Mexico

Recent trials of prenatal multivitamin-mineral supplements have yielded mixed findings for outcomes such as birth size, but the benefits of prenatal multivitamin-mineral supplements for maternal outcomes are unknown. The main objective of this study was to examine the effect of prenatal multiple micronutrient supplements (MM) compared to iron only (FE) supplements on changes in maternal weight and body composition during pregnancy and the early postpartum period. A randomized double-blind clinical trial was conducted in semi-rural Mexico. Women received either MM or FE supplements, 6 days per week from early pregnancy to delivery. Anthropometric measurements were obtained at recruitment, 26 and 37 weeks pregnancy, and 1 month postpartum. Women in both groups were similar at recruitment except that body-mass index (BMI) was greater in the FE group. Mean weight gain during pregnancy was significantly greater (-0.6 kg) in the MM group (n = 283) compared to the FE group (n = 287), but not after adjusting for maternal BMI at recruitment. Overweight women in the MM group gained 0.53 kg between recruitment and 1 month postpartum, whereas those in the FE group lost 0.63 kg; there were no differences between experimental groups among non-overweight women (p =.06 for interaction). Compared to iron supplements, MM supplements did not increase weight gain during pregnancy after adjusting for baseline differences in BMI but may lead to greater postpartum weight retention among overweight women.

Effect of Daily Cod Liver Oil and a Multivitamin-Mineral Supplement with Selenium on Upper Respiratory Tract Pediatric Visits by Young, Inner-City, Latino Children: Randomized Pediatric Sites

We studied the effect of daily supplementation with lemon-flavored cod liver oil and a children's multivitamin-mineral supplement containing selenium on the number of pediatric visits by young, inner-city, Latino children from late autumn of 2002 through early spring of 2003. Two private pediatric offices with similar demographics, located 1.1 miles apart in upper Manhattan, New York City, were randomized to a supplementation site and a medical records control site. Ninety-four children (47 at each site), 6 months to 5 years of age, were enrolled. The mean age of the supplementation group was 2.03 years (SD, +/- 1.04 years); that of the control group was 2.08 years (SD, +/- 1.10 years). Children > or = 1 year of age in the supplementation group received 1 teaspoon of lemon-flavored cod liver oil per day and one half-tablet of a children's multivitamin-mineral; the starting dose was halved for children < 1 year of age. The supplements were given from enrollment through May 1, 2003. The primary outcome measure was the number of upper respiratory tract pediatric visits during the follow-up/supplementation period. The supplementation group had a statistically significant decrease in the mean number of upper respiratory tract visits over time (p = .042; r = 0.893; y = 0.602 - 0.002x); the medical records control group had no change in this parameter (p = .999; r = 0.0006; y = 0.259 + 1.43 x 10(-6)x). The supplements were well tolerated; per parental report, 70% of children completed the 5- to 6-month course of cod liver oil. Use of these nutritional supplements was acceptable to the inner-city Latino families and their young children, and was associated with a decrease in upper respiratory tract pediatric visits over time; this approach therefore deserves further research and attention.

Multivitamin-mineral supplementation is not as efficacious as is iron supplementation in improving hemoglobin concentrations in nonpregnant anemic women living in Mexico

Iron supplements improve hemoglobin status and reduce anemia due to iron deficiency. It is not known whether multiple micronutrient (MM) supplements are as efficacious as are iron supplements alone in improving hemoglobin concentrations. We conducted a randomized, double-blind community trial in Mexico to compare the efficacy of MM supplements containing iron with that of iron alone in improving hemoglobin concentrations in nonpregnant women. Nonpregnant women (n = 158) were recruited from a semirural community in Mexico and were randomly assigned to receive iron alone (60 mg; Fe group) or MM supplements (vitamins A, B complex, C, D, E, and K and iron, zinc, and magnesium; MM group) 6 d/wk in their home for 12 wk. Hemoglobin concentrations were measured in capillary blood samples at baseline and follow-up. The treatment groups (MM: n = 75; Fe: n = 77) did not differ significantly at recruitment in age, schooling, literacy, or socioeconomic status. There were no significant differences between groups in compliance (median: 97.5%), baseline hemoglobin concentrations, or prevalence of anemia (20%). Losses to follow-up (4%) and mean (+/-SD) changes in hemoglobin (MM group: 6.7 +/- 10.6 g/L; Fe group: 7.1 +/- 13.6 g/L) were not significantly different between groups. However, the change in hemoglobin in anemic subjects was greater in the Fe group than in the MM group (P < 0.05 for interaction), and there was no significant difference in nonanemic subjects. MM supplements may not be as efficacious as is iron alone in improving the hemoglobin status of anemic women.

Supplements and Tuning Up Metabolism

Americans’ intake of the 40 essential micronutrients (vitamins, minerals, and other biochemicals that humans require) is commonly thought to be adequate. Classic deficiency diseases, such as scurvy, beriberi, pernicious anemia, and rickets, are rare. The evidence suggests, however, that much chronic metabolic damage occurs at levels between the level that causes acute micronutrient deficiency disease and the recommended dietary allowances (RDAs). 5 In addition, the prevention of more subtle metabolic damage may not be addressed by current RDAs. When one input in the metabolic network is inadequate, repercussions are felt on a large number of systems and can lead to degenerative disease. This may, for example, result in an increase in DNA damage (and cancer), neuron decay (and cognitive dysfunction) or mitochondrial decay (and accelerated aging and degenerative diseases). The optimum amount of folic acid or zinc that truly is ‘‘required” is the amount that minimizes DNA damage and maximizes a healthy life span, which is higher than the amount needed to prevent acute deficiency disease. The requirements of the elderly for vitamins and metabolites are likely to differ from those of the young, but this issue has not been examined seriously. An optimal intake of micronutrients and metabolites also varies with genetic constitution. A tune-up of micronutrient metabolism should give a marked increase in health at little cost. It is a distortion of priorities for much of the world’s population to have an inadequate intake of a vitamin or mineral, at great cost to health, when a year’s supply of a daily multivitaminmineral pill as insurance against deficiencies costs less than a few packs of cigarettes. The poor, in general, eat the worst diets and have the most to gain from multivitamin-mineral supplementation and improvement in diet.

Nutrition and low birth weight: from research to practice

Low birth weight (LBW) remains a significant public health problem in many developing countries, and poor nutrition both before and during pregnancy is recognized as an important cause. Emerging evidence on the role of intergenerational effects in determining maternal preconceptual nutritional status indicates the need for continued investment in strategies that improve women's nutrition and health throughout the life cycle, especially during the early years. Controlled trials have shown that improving food intakes during pregnancy effectively reduces LBW, but programs have been less successful because these interventions are expensive and difficult to manage. Multivitamin-mineral supplements have been viewed as a simpler solution, but 2 of 3 controlled trials conducted to date failed to show that multivitamin-mineral supplements are more effective than are iron-folate supplements, which are already the standard of care during pregnancy. Emerging evidence indicating the benefits of iron supplements in improving birth weight illustrate the need for increased efforts to reduce iron deficiency by improving coverage of antenatal programs and promoting fortification. Other causes of LBW include environmental factors, such as smoking; indoor air pollution; and infections, such as malaria. However, little is known about the interactions between nutrition and infection. Underlying social factors, such as poverty and women's status, are also important, especially in South Asia, where more than one-half of the world's LBW infants are born. In summary, strategies that combine nutrition-based interventions, such as improving food intakes and micronutrient status, especially iron status, with approaches that improve women's status and reproductive health are needed to reduce LBW.

Use of Dietary Supplements by Elite Figure Skaters

The present study examined the prevalence of dietary supplement use among elite figure skaters, gender differences in supplement use, and differences in nutrient intake of supplement users versus non-users. Male (n = 46) and female (n = 59) figure skaters completed a supplement survey and 3-day food records. Descriptive analysis, chi-square test, and independent t tests were used to analyze the data. Sixty-five percent of male (n = 30) and 76% of female (n = 45) figure skaters reported use of supplements. Forty-seven percent of males and 55% of females reported daily use of supplements. Multivitamin-mineral supplements were the most popular dietary supplements consumed by figure skaters. Significant gender differences were observed in the use of multivitamin-mineral supplements (61% males vs. 83% females, p < .05). Echinacea and ginseng were popular herbal supplements used by these skaters. The 3 main reasons given by male figure skaters for taking supplements were: to provide more energy (41%), to prevent illness or disease (34%), and to enhance performance (21%). Among female figure skaters, the 3 main reasons given were: to prevent illness or disease (61%), to provide more energy (39%), and to make up for an inadequate diet (28%). Significant differences (p < .05) were observed in protein, total fat, saturated fat, polyunsaturated fat intakes, and % energy from carbohydrate and total fat of male supplement users versus non-users, with supplement users having higher intakes except for percent energy from carbohydrate. Sodium was the only nutrient significantly different (p < .05) among female supplement users versus non-users, with supplement users having lower intakes. Given the popularity of dietary supplements, it is important to understand the factors influencing athletes' use of supplements, their knowledge and attitudes regarding supplements, dosage of supplements used, and the effectiveness of these dietary supplements in meeting the goals of the athletes.

Family Influences: Mothers' and Daughters' Use of Multivitamin Mineral Supplements.

Girls' multivitamin mineral (MVM) use was evaluated among a white middle-class sample (n = 192 mother-daughter pairs). Daughters' MVM use was predicted by mothers' use by mothers' beliefs attitudes practices regarding her own eating child feeding practices. Mothers who gave daughters supplements reported greater monitoring of daughters' intake were more likely to pressure daughters to eat. MVM user diets did not differ from nonusers with the exception that nonusers consumed more fats sweets. Patterns of intake revealed food group servings below recommended levels for both groups whereas vitamin mineral intakes exceeded the RDA. This pattern reflects girls' high levels of consumption of fortified foods.

Lemon-Flavored Cod Liver Oil and a Multivitamin-Mineral Supplement for the Secondary Prevention of Otitis Media in Young Children: Pilot Research

We measured blood levels of fatty acids, vitamin A, and trace metals in children undergoing ambulatory surgery for placement of tympanostomy tubes and a comparison group having other ambulatory surgical procedures. We then performed a small, outpatient, secondary prevention study using nutritional supplements chosen on the basis of those blood levels. The study subjects had lower levels of red blood cell eicosapentaenoic acid (EPA) than did adult controls. Consistent with previous reports, the levels of vitamin A were < or = 40 microg/dL for 69% of our subjects, and the plasma selenium levels for children were lower than published values for adults. We then studied one otitis media (OM) season; 8 children (0.8 to 4.4 years of age) received 1 teaspoon of lemon-flavored cod liver oil (containing both EPA and vitamin A) and 1 half-tablet of a selenium-containing children's chewable multivitamin-mineral tablet per day. During this OM season, study subjects received antibiotics for OM for 12.3% +/- 13.4% (SD; p < .05) fewer days during supplementation than before supplementation. Larger, controlled trials are warranted to assess the utility of cod liver oil (of acceptable purity and taste) and a children's multivitamin-mineral preparation containing selenium, both for the prevention of OM and for the acceptance of delayed prescription of antibiotics for this disorder.

Vitamin and mineral supplement use among children attending elementary schools in Korea: a survey of eating habits and dietary consequences

We surveyed the mothers of 2,904 Korean elementary schoolchildren (1st–6th grade) for their children’s vitamin/mineral supplement use, and dietary consequences of this use. Thirty two percent of subjects provided their schoolchildren with vitamin/mineral supplements. Supplement use was higher in schoolchildren in lower grades, in higher socioeconomic groups, and in larger cities, than their counterparts. Multivitamin-mineral supplements were provided most frequently. Dietary habits were poorer in schoolchildren who did use supplements than in those who did not. Supplements were given ‘to ensure that they are healthy and strong’ and ‘to ensure their optimal nutrition’. Intakes of vitamin A, niacin, folic acid, vitamin C, Fe, and Zn from diet and supplements often exceeded upper safe levels (ULs). Therefore, there may be a link between eating habits and vitamin/mineral supplement use among schoolchildren. Total intake of some nutrients was in excess of ULs. The health consequences of supplement use by this group merit additional study.

Maternal influences on 5- to 7-year-old girls' intake of multivitamin-mineral supplements.

To examine diet quality of girls who do or do not take multivitamin-mineral (MVM) supplements and to evaluate predictors of girls' MVM use, including maternal eating behaviors, MVM use, beliefs, attitudes, and perceptions about child feeding, eating, and health. Participants were 192 mother and daughter pairs. Daughters were categorized as MVM supplement users or nonusers based on whether girls were consistently given MVM supplements at 5 and 7 years. Girls' and mothers' nutrient and food group intakes, maternal child-feeding practices, and maternal eating behavior were compared between the groups. Mothers who used MVM supplements were more likely to give MVM supplements to daughters. Excluding nutrients from MVM supplements, MVM users and nonusers did not differ in vitamin and mineral intake, either for girls or mothers, and patterns of food group intake were similar for users and nonusers. Mothers of MVM users reported the following: higher levels of pressuring their daughters to eat healthier diets, more monitoring of daughters' food intake, more success in dieting for weight control, more positive evaluations of their success in eating healthy diets, and lower body mass indexes than mothers who did not give MVMs to daughters. Daughters' MVM supplement use was predicted by mothers' beliefs, attitudes, perceptions, and practices regarding mothers' own eating and child feeding practices, rather than by daughters' diet quality. For both MVM users and nonusers, daughters' food group servings were below recommendations, whereas vitamin and mineral intakes exceeded recommendations, a pattern indicative of girls' relatively high intakes of fortified foods. Mothers should be encouraged to foster healthier patterns of food intake in daughters, rather than providing MVM supplements.