Multiple Dietary Supplements Research Articles

Longitudinal changes in adverse effects reporting in multiple dietary supplement classifications: The US military dietary supplement use study

Over 70% of United States military service members (SMs) regularly use dietary supplements (DSs) and about 18% have reported adverse effects (AEs) associated with use. This investigation examined longitudinal changes in AEs reporting among DS users. On two separate occasions 1.3 ± 0.2 years apart (mean ± standard deviation), 5778 SMs completed identical questionnaires on DS use and associated AEs. Among SMs reporting DS use ≥1 time/week, ≥1 AE was reported by 19% and 15% in the baseline and follow-up phases, respectively. The risk of reporting DS use at follow-up was similar among those reporting and not reporting AEs at baseline for most DS categories including prohormones, proteins/amino acids, individual vitamins and minerals, multivitamin/multiminerals, herbals, fish oils, joint health products, and other DSs. An exception was combination products where those reporting AEs at baseline had an increased risk of use at follow-up (risk ratio = 1.13, 95% confidence interval = 1.06–1.09). Those reporting AEs at baseline and continuing DS use in the follow-up were more likely to report AEs at follow-up compared to those not reporting baseline AEs. In conclusion, AEs reported at baseline did not deter many participants from using DSs in the follow-up period, and many SMs reporting AEs at baseline continued reporting them at follow-up.

Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport.

The prevalence of dietary supplement use among athletes continues to rise with 60-80% of athletes often reporting current or previous use of dietary supplements. While select dietary ingredients have been shown to improve acute performance and enhance training adaptations over time, it is important to still consider the risk vs. reward for athletes before opting to consume a dietary supplement. Previous work has indicated that certain dietary supplements may pose risks for inadvertent doping, may be susceptible to mislabelling, could be banned by certain governing bodies of sport, or pose health risks for certain populations. The purpose of the current narrative review is to summarize the prevalence of adulteration in dietary sport supplement products, outline the risks of inadvertent doping for athletes, and highlight best practices regarding safe supplementation strategies. Analytical studies have found anywhere from 14 to 50% of samples analyzed from dietary supplement products have tested positive for anabolic agents or other prohibited substances. It is important for the consumer to adhere to safe supplementation strategies, which include following serving size recommendations, cross-referencing ingredient profiles with the list of prohibited substances, choosing quality products that have been verified by a third-party certification program, and being cognizant of consuming multiple dietary supplement products with overlapping ingredient profiles. Once these practices have been considered, it is reasonable for an athlete to utilize dietary supplements as a strategy to optimize performance and health, with a low risk of failing a drug test (adverse analytical finding) and experiencing adverse events.

The association of serum vitamin D concentrations in paediatric migraine

IntroductionMigraine is a neurologic condition characterized by hypersensitivity to auditory, olfactory, visual, and cutaneous stimuli; vomiting and nausea; and severe headache. It is the most frequent headache syndrome in children and can be categorized in chronic and/or episodic. Multiple dietary supplements have been inaugurated for the management of migraine, the most prevalent of which is vitamin D. BackgroundIn recent years, vitamin D deficiency has been a global public health problem, with 30–80% of the worldwide population having vitamin D deficiency. The significant role of vitamin D in neurological disorders is underlined by its key role in the brain function of the central nervous system (CNS). Current approaches in paediatric neurology include nonsteroidal anti-inflammatory drugs (NSAID) for the treatment of paediatric migraine, among others. Vitamin D is one of the dietary factors that has been linked to migraine, however, this association has mostly been examined in the adult population. ObjectiveThe aim of this study is to investigate the association between serum vitamin D and paediatric migraine by conducting a review of existing literature. The main question is described with the PICO format (population, intervention, control, and outcomes), while the assessment of the present research is under the PRISMA guidelines for systematic reviews. Results/ConclusionA systematic review of the literature reveals a remarkable association between vitamin D and migraine presentation in the paediatric population, affecting the frequency and duration of the episodes. That being the case, vitamin D supplementation could potentially improve the quality of life of paediatric patients suffering from migraine headaches.

Associations between clinically diagnosed medical conditions and dietary supplement use: the US military dietary supplement use study.

This study examined associations between multiple dietary supplement (DS) categories and medical conditions diagnosed by health professionals. Cross-sectional. Volunteers completed an online questionnaire on DS use and demographic/lifestyle factors. Medical diagnoses were obtained from a comprehensive military electronic medical surveillance system and grouped into twenty-four clinically diagnosed medical conditions (CDMC). A stratified random sample of US service members (SM) from all military services (n 26 680). After adjustment for demographic/lifestyle factors (logistic regression), higher risk was found for 92 % (22/24) of CDMC among individual vitamins/minerals users, 58 % (14/24) of CDMC among herbal users, 50 % (12/24) of CDMC among any DS users and 46 % (11/24) of CDMC among multivitamins/multiminerals (MVM) users. Among protein/amino acid (AA) users, risk was lower in 25 % (6/24) of CDMC. For combination products, risk was higher in 13 % (3/24) of CDMC and lower in 8 % (2/24). The greater the number of CDMC, the higher the prevalence of DS use in most DS categories except proteins/AA where prevalence decreased. Users in many DS categories had a greater number of CDMC, but protein/AA users had fewer CDMC; results for combination products were mixed. These data indicate those with certain CDMC were also users in some DS categories, especially individual vitamins/minerals, herbals and MVM. Data are consistent with the perception that use of DS enhances health, especially in those with CDMC. Protein/AA and combination product users were more likely to be younger, more physically active men, factors that likely reduced CDMC.

A beneficial cardiometabolic health profile associated with dietary supplement use: A cross-sectional study.

As a follow-up to an earlier study demonstrating healthier cardiometabolic profiles among long-term multiple dietary supplement (LTMDS) users, we examined if cardiometabolic health benefits associated with LTMDS use persisted with aging. The study is based on LTMDS users from North America and 2007-2010 NHANES participants who were used for comparison to the LTMDS users. NHANES subjects were classified as non-dietary supplement (NS) users, single supplement/single purpose supplement (SS) users, multivitamin/mineral supplement (MVMS) users, and multiple dietary supplement (MDS) users. Supplement groups were compared for total, HDL and LDL cholesterol; triglycerides; glucose; insulin; CRP and HbA1c≥6.5%, adjusting for age, sex, income, education, BMI, history of CVD, and medications for hypercholesterolemia and diabetes. Geometric mean (95% confidence interval) LDL cholesterol was significantly lower (P<0.05) for all supplement groups (SS: 110 (104-117) mg/dL; MVMS: 113 (107-119) mg/dL; MDS: 115 (111-118) mg/dL; LTMDS: 112 (105, 119) mg/dL) compared with the NS users (122 (118-126) mg/dL). Compared with the NS group, MDS users had significantly (P<0.05) lower mean total cholesterol (198 (194-201) vs 201 (197, 206) mg/dL), MDS and LTMDS users higher mean HDL cholesterol (54.2 (53.3-55.1) and 60.0 (57.4, 62.7) mg/dL vs 52.0 (50.8-53.3) mg/dL), LTMDS users lower fasting glucose (100 (98-103) vs 105 (103-106) mg/dL), SS and MDS users lower insulin (8.4 (7.4-9.6) and 9.1 (8.3-9.9) vs 10.2 (9.4-11.1) μIU/mL), and MDS users lower CRP (%≥1.5mg/L, 50.8 (47.9-53.6) vs 57.0 (52.4-61.6) %). These findings add to the evidence that use of dietary supplements may provide cardiometabolic health benefits.

Comparison of Cardiometabolic Biomarkers in Two Groups of US Adults Using Multiple Dietary Supplements: A Cross-Sectional Study (P18-116-19)

ObjectivesThe aim of the present study is to compare cardiometabolic biomarker levels (MARKERS) from a cohort using multiple (2+) dietary supplements (MDS) manufactured by Shaklee Corporation for 3–5 yr (SHAKLEE) to those from the age-matched MDS users from NHANES 2007–10 (NHANES). MethodsEach subject from SHAKLEE [n = 58; mean age: 48 yr (22–79 yr)], using MDS manufactured by Shaklee Corp for 3–5 yr, voluntarily signed the IRB approved informed consent form before the study participation. Body mass index (BMI), systolic and diastolic blood pressures (SBP and DSP) were measured, and approximately 30 mL of 12-h fasting blood sample was collected. Pregnant women and people with a history of cancer were excluded. MARKERS from SHAKLEE were compared to those from NHANES [n = 1952; mean age: 51 yr (22–79 yr)]. MARKERS included total cholesterol (TC), HDL-c, TC/HDL-c ratio, LDL-c, triglycerides (TG), high sensitivity C-Reactive Protein (CRP), glucose, hemoglobin A1c (HbA1c), and Insulin levels in the blood as well as BMI, SBP, and DBP. Statistical analyses were performed using independent samples t-tests, and P < 0.05 was considered significantly different between groups. ResultsSHAKLEE had significantly lower TC (189 vs. 201 mg/dL), TC/HDL-c ratio (3.1 vs. 4.0), LDL-c (103 vs. 118 mg/dL), TG (81 vs. 131 mg/dL), glucose (93 vs. 107 mg/dL), HbA1c (5.1 vs. 5.7%), insulin (8.3 vs. 13.4 mIU/L), BMI (26.7 vs. 29.0), and SBP (110 vs. 122 mmHg), and higher HDL-c (69 vs. 55 mg/dL) but had higher DBP (76 vs. 71 mmHg) than NHANES. There was no significant difference in CRP although CRP was slightly lower in SHAKLEE than NHANES (2.9 vs. 3.8 mg/L). ConclusionsThe present study showed that 3–5 yr MDS users from the Shaklee cohort had healthier pattern in cardiometabolic biomarkers than the age-matched MDS users from NHANES 2007–2010. Funding SourcesShaklee Corporation, 4747 Willow Road, Pleasanton, CA 94,588, USA.

Telomere Length of Multiple Dietary Supplement Users - A Cross-sectional Study in Comparison with Age-matched Controls

Telomeres are DNA-protein complexes that cap chromosomal ends to promote chromosomal stability. Telomere length has been associated with diet and nutrition and inversely associated with mortality, life stress, and diseases. The objective of the current study was to explore the effect of long-term intake of multiple dietary supplements on telomere length in adults compared with age-matched controls. Salivary telomere lengths were determined from a group of heavy supplement users (HSU group; n=81; 20 males and 61 females age 30-79), the majority of whom took > 12 different supplements daily at least 4 days per week for at least 5 years, compared to a population of relatively healthy, non-smoking, age-matched subjects in the San Francisco Bay Area (control group; n=323; 146 males and 177 females) who took ≤ 3 different supplements daily. Telomere lengths were measured by quantitative PCR to determine the telomere-to-single copy gene (T/S) ratio and were compared between groups that were age-matched by decade from 30 to 79. There was an age effect (p≤0.05) and a significant difference between groups (p≤0.001). The HSU group had significantly longer telomere length in the 50s, 60s, and 70s age groups (p ≤0.01, 0.001, 0.01 respectively). Routine clinical blood chemistry biomarkers (glucose, lipid profiles, liver enzymes, renal function and CRP) in both groups were all within the normal ranges. The results of this cross-sectional study suggest that heavy dietary supplementation may attenuate telomere shortening compared to an age-matched control group. Longitudinal studies are needed to further explore the potential association between nutritional supplementation, healthy aging and the reduced rate of telomere shortening.

Comparison of a Medication Inventory and a Dietary Supplement Interview in Assessing Dietary Supplement Use in the Hispanic Community Health Study/Study of Latinos.

Although dietary supplement use is common, its assessment is challenging, especially among ethnic minority populations such as Hispanics/Latinos. Using the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (n = 16,415), this report compares two strategies for capturing dietary supplement use over a 30-day period: a medication-based inventory and a nutrition-based dietary supplement interview. Age-standardized prevalence was calculated across multiple dietary supplement definitions, adjusted with survey/nonresponse weights. The prevalence of dietary supplement use was substantially higher as measured in the dietary supplement interview, compared to the medication inventory: for total dietary supplements (39% vs 26%, respectively), for nonvitamin, nonmineral supplements (24% vs 12%), and for botanicals (9.2% vs 4.5%). Concordance between the two assessments was fair to moderate (Cohen’s kappa: 0.31–0.52). Among women, inclusion of botanical teas increased the prevalence of botanical supplement use from 7% to 15%. Supplement assessment that includes queries about botanical teas yields more information about patient supplement use.

Identification and quantification of 1,3-dimethylbutylamine (DMBA) from Camellia sinensis tea leaves and dietary supplements

1,3-dimethylbutylamine (DMBA), is a CNS stimulant, which has recently been identified in multiple dietary supplements and sometimes labeled as a natural constituent of Pouchung tea. DMBA is an homologue of 1,3-dimethylamylamine (DMAA) which the US Food and Drug Administration has attempted to remove from all dietary supplements after DMAA consumption was linked to strokes, heart disease, and sudden death. To address questions concerning the natural origin of DMBA, three independent analytical methods were developed for analyzing authentic tea samples and dietary supplements. A high performance thin layer chromatography (HPTLC) method was developed for the fast screening and chemical fingerprint analysis. Chiral Gas Chromatography–Mass Spectrometry (GC–MS) was used to determine the enantiopurity and a validated Ultra-High Performance Liquid Chromatography-Quadrupole Time of Flight Mass Spectrometry (UHPLC-QToF-MS) method was developed for the quantification of DMBA. Using these techniques the presence of DMBA was confirmed using a reference standard and was not detected in any of 25 authentic or commercial samples of Camellia sinensis tea leaves (green tea, black tea, Oolong tea, and Pouchung tea). Of 13 dietary supplements tested, 11 contained DMBA in racemic form and ranged from 0.1 to 214mg per daily dose.

An amphetamine isomer whose efficacy and safety in humans has never been studied, β-methylphenylethylamine (BMPEA), is found in multiple dietary supplements.

The amphetamine isomer β-methylphenylethylamine (BMPEA) was first synthesized in the early 1930s, but its efficacy and safety in humans has not been studied. Recently, the United States Food and Drug Administration (FDA) detected BMPEA in dietary supplements labelled as containing Acacia rigidula. Over a year after the FDA reported its findings, we analyzed Acacia rigidula dietary supplements to determine if BMPEA had been removed. Supplements were analyzed using liquid chromatography-quadrupole time-of-flight mass spectrometry. Diluted methanolic extract from each supplement was run three times and each data set obtained was analyzed using Agilent MassHunter Qualitative Analysis. The presence of BMPEA was confirmed by accurate mass, retention time and mass spectra match against a reference standard. Quantification of BMPEA was determined using an eight-point calibration curve of spiked standard to a matrix blank. Twenty-one brands of Acacia rigidula supplements were analyzed. More than half (11/21; 52.4%) of the Acacia rigidula supplement brands contained BMPEA. The stimulant was present at quantities such that consumers following recommended maximum daily servings would consume a maximum of 93.7 mg of BMPEA per day. Consumers of Acacia rigidula supplements may be exposed to pharmacological dosages of an amphetamine isomer that lacks evidence of safety in humans. The FDA should immediately warn consumers about BMPEA and take aggressive enforcement action to eliminate BMPEA in dietary supplements. Copyright © 2015 John Wiley & Sons, Ltd.

Methyl-Sulfonyl-Methane (MSM)-Induced Acute Angle Closure

To report the first case of presumed bilateral acute angle closure (AAC) secondary to ingestion of the dietary supplement, methyl-sulfonyl-methane (MSM). A 35-year-old woman presented with bilateral AAC 1 week after starting multiple dietary supplements, one of which contained MSM. Ultrasound biomicroscopy demonstrated bilateral anterior rotation of the iris-lens diaphragm, ciliary body edema, and choroidal effusion. Four days after discontinuation of the supplements, her angle closure and uveal effusion resolved, and her best-corrected vision recovered to 20/20 bilaterally. Sulfa-based drugs have been reported to cause AAC, choroidal effusion, and ciliary body edema. In our patient, the coincidence of bilateral AAC with choroidal and ciliary body effusion that began 1 week after starting dietary supplements was suspicious for drug-induced AAC. The dietary supplement Basic Detox Nutrients contains MSM, the only constituent in the patient's medication list with a sulfonyl moiety. Given the similarities in chemical structure and clinical presentation, we postulate that MSM induces AAC in a manner similar to mechanisms previously described for other sulfa-based drugs. As MSM continues to be used and studied for its anti-inflammatory and antioxidative properties, investigators and marketers will need to be cognizant of its potential to cause AAC and provide proper warning to consumers.

A synthetic stimulant never tested in humans, 1,3‐dimethylbutylamine (DMBA), is identified in multiple dietary supplements

A synthetic stimulant never tested in humans, 1,3‐dimethylbutylamine (DMBA), is identified in multiple dietary supplements

A synthetic stimulant never tested in humans, 1,3-dimethylbutylamine (DMBA), is identified in multiple dietary supplements.

A synthetic stimulant never before studied in humans, 1,3-dimethylbutylamine (DMBA), was suspected of being present in dietary supplements. DMBA is an analogue of the pharmaceutical stimulant, 1,3-dimethylamylamine (DMAA), which was recently banned by the US Food and Drug Administration. We obtained all dietary supplements sold by US distributors that listed an ingredient on the label, such as AMP Citrate, that might be a marketing name for DMBA. Supplements were analyzed for the presence and quantity of DMBA. Fourteen supplements met our inclusion criteria and were analyzed by two separate laboratories using ultra high performance liquid chromatography (UHPLC) - mass spectrometry and a reference standard. The identity of DMBA was confirmed in 12 supplements in the range of 13 to 120 mg DMBA per serving. Following recommendations on the supplement label for maximum daily intake, customers would consume from 26 to 320 mg of DMBA per day. Supplements containing DMBA were marketed to improve athletic performance, increase weight loss and enhance brain function. DMBA has never before been detected in supplements. The stimulant has never been studied in humans; its efficacy and safety are entirely unknown. Regulatory agencies should act expeditiously to warn consumers and remove DMBA from all dietary supplements.

Effect of Multiple Dietary Supplement Containing Lutein, Astaxanthin, Cyanidin-3-glucoside, and DHA on Accommodative Ability

ObjectiveThe study aimed to verify that ingestion of multiple dietary supplement containing lutein, astaxanthin, cyanidin-3-glucoside and docosahexaenoic acid (DHA) would improve accommodative ability of aged and older subjects who were aware of eye strain on a daily basis.MethodsA randomized double-blind placebo-controlled parallel group comparison study was conducted for 48 participants aged 45 to 64 years who complained of eye strain. The subjects took multiple dietary supplement containing 10 mg of lutein, 20 mg of bilberry extract and 26.5 mg of black soybean hull extract (a total of 2.3 mg of cyanidin-3-glucoside in both extracts), 4 mg of astaxanthin, and 50 mg of DHA (test supplement) or placebo for four consecutive weeks. Near-point accommodation (NPA) and subjective symptoms were evaluated both before and after four weeks’ intake.ResultsThe variation of the NPA of both eyes from baseline to 4 weeks’ post-intake in the test supplement group was significantly higher than in the placebo group (1.321±0.394 diopter (D) in the test supplement group and 0.108±0.336 D in the placebo group, p=0.023). The multiple dietary supplement group showed improvement in the NPA. Regarding subjective symptoms, significant improvement of “stiff shoulders or neck” and “blurred vision” was also found in the test supplement group compared to the placebo group (p<0.05). There were no safety concerns in this study.ConclusionThis study shows that multiple dietary supplement containing lutein, astaxanthin, cyanidin-3-glucoside, and DHA has effect to improve accommodative ability and subjective symptoms related to eye fatigue.

Multiple dietary supplements do not affect metabolic and cardiovascular health

Dietary supplements are widely used for health purposes. However, little is known about the metabolic and cardiovascular effects of combinations of popular over-the-counter supplements, each of which has been shown to have anti-oxidant, anti-inflammatory and pro-longevity properties in cell culture or animal studies. This study was a 6-month randomized, single-blind controlled trial, in which 56 non-obese (BMI 21.0-29.9 kg/m(2)) men and women, aged 38 to 55 yr, were assigned to a dietary supplement (SUP) group or control (CON) group, with a 6-month follow-up. The SUP group took 10 dietary supplements each day (100 mg of resveratrol, a complex of 800 mg each of green, black, and white tea extract, 250 mg of pomegranate extract, 650 mg of quercetin, 500 mg of acetyl-l-carnitine, 600 mg of lipoic acid, 900 mg of curcumin, 1 g of sesamin, 1.7 g of cinnamon bark extract, and 1.0 g fish oil). Both the SUP and CON groups took a daily multivitamin/mineral supplement. The main outcome measures were arterial stiffness, endothelial function, biomarkers of inflammation and oxidative stress, and cardiometabolic risk factors. Twenty-four weeks of daily supplementation with 10 dietary supplements did not affect arterial stiffness or endothelial function in nonobese individuals. These compounds also did not alter body fat measured by DEXA, blood pressure, plasma lipids, glucose, insulin, IGF-1, and markers of inflammation and oxidative stress. In summary, supplementation with a combination of popular dietary supplements has no cardiovascular or metabolic effects in non-obese relatively healthy individuals.

Patterns and Perceptions of Supplement Use by U.S. Marines Deployed to Afghanistan

Dietary supplements are implicated in an increasing number of minor and serious adverse events, including death. A series of adverse events in deployed Marines using multiple supplements prompted medical officers to investigate the prevalence of supplement use among Marines stationed on Camp Leatherneck, Afghanistan. The investigators developed a survey to identify the types of supplements used, patterns of supplement use, reasons for taking supplements, perceived benefits from using supplements, and self-reported adverse effects. Marines were invited to complete an anonymous 17-question survey while visiting recreational and athletic facilities. A total of 329 active duty Marines completed the survey. The prevalence of supplement use was 72% for males and 42% for females (p = 0.009). Of the 12% of Marines reporting side effects, 79% were taking multiple supplements and 89% were using stimulants. Deployment was significantly associated with new supplement use (p < 0.001). Of users, 81% noted an improvement in physical performance. The majority of deployed Marines use multiple dietary supplements and perceive a high benefit. Given the high prevalence of supplement use and recent deaths associated with supplement use, recommendations are needed to guide the use of certain supplements by U.S. Marines in the deployed environment.

The influence of dietary supplements advertising on the Lublin university students

Introduction. The media has a powerful influence on the audience; its power of manipulation often directs our actions and shapes our knowledge. The characteristic feature of the press that distinguishes it from other sources of information is the opportunity to go back to the previously read content. This makes it more reliable than other messages. Currently, numerous advertisements that encourage the use of multiple dietary supplements are placed in media. Aim. The purpose of this study was to investigate whether and how the advertising of dietary supplements placed in popular magazines for women affects the young recipient. Material and methods. The research method used was a diagnostic survey and the research technique – a questionnaire survey. The survey comprised 12 questions about the reception and the impact of advertising of dietary supplements on the respondents as well as 4 questions on demographics. Results. The respondents noticed that in the press the majority of advertisements concern dietary supplements supporting weight loss (20%), or strengthening hair or nail (19%). Sixty five per cent of the respondents used supplements, including 52% of respondents taking 1 dietary supplement, and 48% using two or 3 preparations. Under the influence of advertising in the press, 12% of respondents started to use supplementation. Sixty seven per cent of respondents buy this kind of preparations for health problems, rather than refer to the doctor for expert advice. Seventy six per cent of consultees believe that dietary supplements are completely safe to use. Conclusions. Respondents willingly use dietary supplements. One of the reasons for their reaching for supplementation is the effect of advertisements appearing in the press. Respondents have great confidence in the safety of dietary supplements; often use them without consulting a doctor or a pharmacist.

Perceptions and Beliefs About the Role of Physical Activity and Nutrition on Brain Health in Older Adults

To examine older adults' perceptions of the link between physical activity (PA) and nutrition to the maintenance of cognitive health. Forty-two focus groups (FGs) were conducted with 396 ethnically diverse (White, African American, American Indian, Chinese, Vietnamese, and Hispanic) community-dwelling older adults. FGs were audio recorded, transcribed verbatim, and coded using a constant comparison method. Responses pertaining to PA and nutrition were analyzed. Participants noted a positive link between both PA and dietary practices and brain health, although some participants voiced skepticism regarding diet. Walking was most frequently cited as a recommended PA, but participants did not know the recommended frequency, duration, and intensity. Limiting portion sizes; preparing foods in healthier ways; eating more fish, fruits, vegetables, low-fat foods, and chicken; and eating less red meat and chicken with the skin were associated with brain health. Multiple dietary supplements were also discussed. More racial/ethnic differences were noted for PA than for diet. Interventions and media campaigns may benefit from explicitly linking PA and dietary habits with brain health and helping older adults understand that cardiovascular risk factors are also dementia risk factors. Emphasizing the total diet (vs. specific nutrients) and providing clear messages regarding the frequency, duration, and intensity of recommended PA would also be useful.

Trends in Dietary Supplement Use in a Cohort of Postmenopausal Women From Iowa

Although it is widely known that use of dietary supplements is common in the United States, little is known about use patterns among older Americans. The authors examined trends in dietary supplement use and its contribution to total nutrient intake in the Iowa Women's Health Study cohort in 1986 (baseline) and 2004 (follow-up). The proportion of women who reported using dietary supplements increased substantially between baseline (66%) and follow-up (85%). Moreover, a substantial proportion of women reported using multiple dietary supplements, with 27% using 4 or more products in 2004. Dietary supplements contributed substantially to total intake of many nutrients at baseline, and their contribution became relatively greater at follow-up for most nutrients examined. For most nutrients, no decline in intake was observed, as might have been expected in an aging cohort. Rather, intake of many nutrients increased, primarily because of the rising use of dietary supplements. Use of dietary supplements by older individuals is of particular importance because of the potential benefits of maintaining nutrient intake levels despite potentially declining food intake. However, possible risks from obtaining a large proportion of purified nutrients from dietary supplements rather than deriving them from foods should be studied.

The Use of Multiple Dietary Supplements

Dietary supplements are widely used in the belief that they confer additional benefit to health and longevity. Most people take one or two supplements but some take far more. What evidence is there to support use of multiple supplements and how should we advise patients who are using them? This case report gives a framework to address this issue with patients.