Nonvitamin, Nonmineral Supplement Research Articles

Prevalence and trends in dietary supplement use among US adults with diabetes: the National Health and Nutrition Examination Surveys, 1999–2014

ObjectiveTo evaluate overall prevalence and trends of use of any supplements, multivitamins/multiminerals (MVMM), individual vitamins, minerals, and non-vitamin, non-mineral (NVNM) supplements among adults with diabetes in the USA.Research design and...

Use of biologically based complementary medicines in patients with neuroendocrine tumors

Background: Biologically based complementary medicines (BB-CMs) are popular in patients with cancer. However, there are only limited data for BB-CMs in patients with neuroendocrine tumors (NET). We aimed to identify the prevalence and type of BB-CM use and the association to the nutritional risk score (NRS-2002) in NET patients.Methods: We performed a cross-sectional questionnaire study in NET outpatients at the Department of Hepatology and Gastroenterology at Aarhus University Hospital. The nutritional risk was determined by the NRS-2002.Results: We included 186 patients (51% women, median age 66 years). Sixty-six percent were regular BB-CM users. Forty-two percent used at least two supplements. The most popular BB-CMs were vitamin and mineral supplements (47%), calcium and vitamin D (34%). One-third used non-vitamin non-mineral supplements such as fish oil, herbs, Ginger, Q-10, garlic and probiotics. The use of BB-CMs was associated with female gender (48% vs. 37%, p < .05). Intake was significantly more frequent among patients with an NRS score ≥ 3, (60% vs. 76%) and in patients with change in performance status (58% vs. 76%), (p < .05, all). Patients reporting dietary changes used BB-CMs more frequently than patients without dietary changes (61% vs. 77%) (p < .05).Conclusions: In our study, 66% percent of NET patients use BB-CM and 42% used two or more supplements. Vitamins with and without herbal ingredients, minerals, calcium, vitamin D, and fish oil were the most popular supplements. The use of BB-CMs was associated with an NRS score ≥ 3, change in dietary intake, female gender, and change in ECOG performance status.

Use of non-vitamin, non-mineral (NVNM) supplements by hospitalized internal medicine patients and doctor–patient communication

ObjectiveTo study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients. MethodsA convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel. Results280 patients were interviewed (54% female), 15.4% reporting NVNM supplement use. This practice was more prevalent among female patients (p=0.045), more educated (p<0.001) and patients with more impaired quality-of-life, measured by the SF-12 tool (p<0.020). The most common factor influencing NVNM supplement use was a physician's recommendation. Most (74%) patients using NVNM supplements reported having disclosed this practice to community-based physicians, with only 23.7% disclosing to hospital staff. Six patients reported using supplements at the exclusion of conventional medication, with potentially serious implications. ConclusionWhile the majority of patients using NVNM supplements are sharing this information with their primary-care physicians, there is little disclosure of this practice to hospital staff. This may be due to a perceived negative attitude of medical professionals to complementary medicine, and a lack of awareness by hospital staff regarding such practices. Practice implicationsHospital-based medical professionals need to be aware of the use of NVNM supplements and the resulting implications by their internal medicine patients.

Prevalence and Correlates of Dietary Supplement Use in Individuals With Diabetes Mellitus at an Academic Diabetes Care Clinic

This study sought to describe the prevalence of supplement use by those with diabetes mellitus receiving care at an academic outpatient diabetes care center and to identify any association of supplement use with glycemic control. This study is based on a retrospective audit of provider-verified and patient-self-reported medication and supplement use by adults with diabetes at the University of Washington Diabetes Care Center during four 2-week periods from fall 2006 through summer 2007 (1 period per season). Verified medication and supplement histories for 459 adults demonstrated a per-person average use of 7 ± 4.1 prescription medicines and 0.4 ± 0.9 over-the-counter medicines daily, with 55% using some form of vitamin, mineral, or nonvitamin-nonmineral supplement on a daily basis. The rate of nonvitamin-nonmineral use was nearly twice that for type 2 diabetes mellitus as for type 1 diabetes mellitus (39.3% vs 20.3%), and A1c was lower in those using any supplement compared to those not using supplements. Vitamin use was associated with reduced A1c; however, this relationship did not hold at A1c < 7.0%. The findings highlight the prevalence of supplement use in diabetes mellitus and association of supplement use with improved glycemic control. Findings are limited by the retrospective design.

Total mortality risk in relation to use of less-common dietary supplements

Dietary supplement use is common in older US adults; however, data on health risks and benefits are lacking for a number of supplements. We evaluated whether 10-y average intakes of 13 vitamin and mineral supplements and glucosamine, chondroitin, saw palmetto, Ginko biloba, garlic, fish-oil, and fiber supplements were associated with total mortality. We conducted a prospective cohort study of Washington State residents aged 50-76 y during 2000-2002. Participants (n = 77,719) were followed for mortality for an average of 5 y. A total of 3577 deaths occurred during 387,801 person-years of follow-up. None of the vitamin or mineral 10-y average intakes were associated with total mortality. Among the nonvitamin-nonmineral supplements, only glucosamine and chondroitin were associated with total mortality. The hazard ratio (HR) when persons with a high intake of supplements (> or =4 d/wk for > or =3 y) were compared with nonusers was 0.83 (95% CI: 0.72, 0.97; P for trend = 0.009) for glucosamine and 0.83 (95% CI: 0.69, 1.00; P for trend = 0.011) for chondroitin. There was also a suggestion of a decreased risk of total mortality associated with a high intake of fish-oil supplements (HR: 0.83; 95% CI: 0.70, 1.00), but the test for trend was not statistically significant. For most of the supplements we examined, there was no association with total mortality. Use of glucosamine and use of chondroitin were each associated with decreased total mortality.

Nonvitamin, Nonmineral Dietary Supplementation in HIV‐Positive People

Many consumers with chronic diseases attempt to take control of their health by using dietary supplements. The objective of this study was to describe current nonvitamin, nonmineral (NVNM) supplement use of HIV-infected persons in the Nutrition for Healthy Living (NFHL) cohort, the financial burden that buying these supplements might pose to this population, and to review current literature on potential interactions between NVNM supplements. At baseline visit, participants were educated by a registered dietitian on keeping a complete 3-day food record (including all supplements) for 2 weekdays and 1 weekend day. Seventy-two subjects reported consumption of NVNM supplements, and their food records were reviewed in detail. Each of the 72 subjects in this study used a mean of 6 NVNM supplements, which may have been in the form of a pill, powder, bar, or liquid. The 6 most common were glutamine (51%), N-acetyl-cysteine (36%), fish oil (33%), alpha-lipoic acid (32%), acetyl-l-carnitine (28%), and coenzyme Q10 (28%). Participants were also taking an average of 4 vitamin/mineral supplements; the 6 most common were multivitamin/multimineral (83%), vitamin E (51%), vitamin C (47%), vitamin B complex (43%), calcium (29%), and selenium (28%). With a total of 107 different types of NVNM supplements, our estimated cost examples indicated a weekly supplement regimen cost of between $25 and $40 dollars. According to literature review, taking an NVNM supplement may involve some risk because many components have not been studied and these products are not tightly regulated.

Supplements and Age-Related Eye Conditions: The Beaver Dam Eye Study

To investigate the association of use of vitamin, mineral, and nonvitamin nonmineral supplements with common age-related eye diseases. Population-based prospective study with incidence data. Subjects were participants in the Beaver Dam Eye Study who contributed data in 1988 to 1990 (n = 4926), 1993 to 1995 (n = 3722), 1998 to 2000 (n = 2962), and 2003 to 2005 (n = 2375). Use of all medications and supplements were collected from study participants at each of 4 examinations. Intraocular pressure (IOP) measurement and fundus and lens photography were done at each visit. Visual field data are available only from baseline. Photographs of the lenses, retina, and discs were graded using standard protocols by trained graders. Incidence of age-related cataracts, macular degeneration (AMD), and high IOP for one set of analyses and incidence of supplement use for the second set of analyses. There was little evidence of any significant associations between supplement use and incident ocular outcomes except for a small protective effect for cortical cataracts by vitamins A and D, zinc, and multivitamins and increased odds of late AMD. Late AMD was associated with incident use of vitamins A, C, and E and zinc. Age-related macular degeneration seems to precede use of vitamins A, C, and E and zinc. This may reflect advice by family, friends, and health care providers about the benefits of Age-Related Eye Disease Study-like supplements.

A Longitudinal Study of Nonvitamin, Nonmineral Supplement Use: Prevalence, Associations, and Survival in an Aging Population

We sought to describe population and survival characteristics in nonvitamin, nonmineral (NVNM) supplement users in a population-based cohort study. People from 43 to 86 years of age living in Beaver Dam, Wisconsin, participated in a baseline examination from 1988 to 1990 (n = 4,926) and three follow-up examinations at 5-year intervals (n = 3,722, 2,962, 2,375 at each successive examination). Medication and supplement use, medical and lifestyle factors were collected during the examination and survival was monitored through 2002. NVNM supplement use increased from 5% at baseline, to 6% at the second, to 21% at the third to 30% at the fourth examination. In general, younger age, vitamin or mineral use, and taking more medications was directly related to NVNM supplement use, while current smoking and history of other systemic diseases (e.g., cardiovascular disease, cancer) was inversely related to NVNM supplement use. After adjusting for age, sex, and other medical and lifestyle factors, users of NVNM supplements had lower mortality (hazard ratio, 0.74; 95% confidence interval, 0.57-0.95, p = 0.02) than nonusers. NVNM supplement users had a healthier lifestyle and fewer co-morbid medical conditions and were more likely to survive after adjusting for these factors than non-users.

The Use of Herbal and Other Non-vitamin, Non-mineral Supplements among Pre- and Post-menopausal Women in Ontario

Herbal or other non-vitamin, non-mineral (NVNM) supplements are used by many Canadians, and are of public health significance given potential health effects. The majority of supplement users are women, yet there are limited data on their pattern of use. Ontario women were surveyed about their use of NVNM supplements, including those for women's health, and characteristics associated with use were examined. 3,423 randomly selected Ontario households were telephoned to identify eligible women (25-65 years). Of the 1,741 identified, 800 agreed to participate and were mailed a self-administered questionnaire querying NVNM supplement use and health-related characteristics. Prevalence of use, duration, and reasons for use were calculated; distributions of respondent characteristics were tabulated and associations with supplement use were assessed. 478 women (27%) completed questionnaires; 64% reported ever, and 34% reported current use of NVNM supplements. Echinacea was the most frequently used, followed by evening primrose, garlic, and camomile; supplements were used for less than one year. Alleviation of symptoms and prevention of illness were two primary reasons for taking NVNM supplements. 49% reported ever, and 37% reported current use of supplements for women's health, and for reasons similar to other NVNM supplements. High body mass index (> or =30.0 kg/m2) was associated with more supplement use, and visiting a physiotherapist in the past year was associated with less. Findings suggest a high level of NVNM supplement use among Ontario women, possibly associated with certain health-related characteristics. This has important public health implications considering possible benefits and/or interactions with conventional medications.

Prevalence of nonvitamin, nonmineral supplement usage among students in a Turkish university

BackgroundThere have been multiple studies carried out in many countries with regard to the use of nonvitamin, nonmineral (NVNM) supplements. These studies have shown that the use of NVNM supplements is on the increase throughout the world, particularly in western countries. The aim of this study was to assess the extent of NVNM supplement use among Turkish university students.MethodsThe survey was conducted between September and December 2004 at Osmangazi University, a public university located in the west of Turkey. Responses were analysed, using the chi-square (x2) test, t test and percent (%) ratios, according to gender and consumers. Differences were considered significant for p ≤ 0.05.ResultsOf 2253 students attending the university, 1871 participated in the survey (909 men and 962 women). Overall, the prevalence of NVNM supplement use was 16.5% (16.6% in men and 16.3% in women, p < 0.05).The three most commonly given reasons for use were 'improvement of energy and vitality (78.6%)', 'promotion of weight loss (71.1%)', followed by 'enhancement of athletic performance (64.3%)'. Twenty-six of the 308 reported NVNM users (26/308, 8.4%) reported having experienced an adverse reaction. Television (76.3%), magazines/newspapers (41.5%) and internet websites (37.3%) were the most frequently used sources for obtaining information about NVNM supplements. The three most frequently used NVNM supplements were echinacea, ginseng, and gingko biloba (38.6%, 36.4%, and 32.8%, respectively). Nutritional scores were higher in NVNM supplement users than in non-users (66.510.8 vs. 62.712.7) (p < 0.001). Users and nonusers of NVNM supplements differed significantly according to sex, age, Body Mass Index (BMI) values, types of school, mother and fathers' education levels, family income, most permanent place of residence up to the time of survey, smoking status, and participating in sports.ConclusionThe results indicate that the prevalence of NVNM supplement use is relatively modest among Turkish university students and more information is needed on why people use particular NVNM supplements.

Use of dietary supplements by female seniors in a large Northern California health plan

BackgroundWomen aged ≥ 65 years are high utilizers of prescription and over-the-counter medications, and many of these women are also taking dietary supplements. Dietary supplement use by older women is a concern because of possible side effects and drug-supplement interactions. The primary aim of this study was to provide a comprehensive picture of dietary supplement use among older women in a large health plan in Northern California, USA, to raise awareness among health care providers and pharmacists about the need for implementing structural and educational interventions to minimize adverse consequences of self-directed supplement use. A secondary aim was to raise awareness about how the focus on use of herbals and megavitamins that has occurred in most surveys of complementary and alternative therapy use results in a significant underestimate of the proportion of older women who are using all types of dietary supplements for the same purposes.MethodsWe used data about use of different vitamin/mineral (VM) supplements and nonvitamin, nonmineral (NVNM) supplements, including herbals, from a 1999 general health survey mailed to a random sample of adult members of a large Northern California health plan to estimate prevalence of and characteristics associated with supplement use among women aged 65–84 (n = 3,109).ResultsBased on weighted data, 84% had in the past 12 months used >1 dietary supplement, 82% a VM, 59% a supplement other than just multivitamin or calcium, 32% an NVNM, and 25% an herbal. Compared to white, nonHispanic women, African-Americans and Latinas were significantly less likely to use VM and NVNM supplements and Asian/Pacific Islanders were less likely to use NVNM supplements. Higher education was strongly associated with use of an NVNM supplement. Prevalence did not differ by number of prescription medications taken. Among white, nonHispanic women, multiple logistic regression models showed that college education, good health, belief that health practices have at least a moderate effect on health, and having arthritis or depression significantly increased likelihood of NVNM use, while having diabetes decreased likelihood.ConclusionsAn extremely high proportion of older women are using dietary supplements other than multivitamins and calcium, many in combination with multiple prescription medications. Increased resources should be devoted to helping clinicians, pharmacists, supplement vendors, and consumers become more aware of the safety, effectiveness, and potential side effects of dietary supplements.

Nonvitamin, nonmineral supplement use over a 12-month period by adult members of a large health maintenance organization

Objective National survey data show an increase in the prevalence of nonvitamin, nonmineral (NVNM) supplement use among adults over the past 10 years. Concern over this trend is based in part on reports of potential drug-supplement interactions. The type and prevalence of supplement use by demographic and behavior characteristics were examined among members of a large group model health plan, including those with selected health conditions. Design Data on the use of herbal medicines and dietary supplements among survey respondents were analyzed. Questions employed a checklist for six specific NVNM supplements with optional write-ins. Subjects/setting A stratified random sample of 15,985 adult members of a large group model health maintenance organization in northern California, who were respondents to a 1999 general health survey. Statistical analyses performed Analyses were conducted with poststratification weighted data to reflect the actual age, gender, and geographic distribution of the adult membership from which the sample was drawn. Results An estimated 32.7% of adult health plan members used at least one NVNM supplement. The most frequently used herbs were Echinacea (14.7%) and Gingko biloba (10.9%). Use of all NVNM supplements was highest among females, 45 to 64 years of age, whites, college graduates, and among those with selected health conditions. Applications Dietetics professionals need to uniformly screen clients for dietary supplement use and provide accurate information and appropriate referrals to users.

Use of Nonvitamin, Nonmineral Dietary Supplements Among College Students

The authors assessed the use of nonvitamin, nonmineral (NVNM) dietary supplements in a college population. They found that the use of NVNM dietary supplements among college students might be higher than that of other population groups and that the types of NVNM products they use differ from those used by an older population. Of the 272 students who completed the questionnaire, 48.5% reported they took an NVNM supplement during the past 12 months. The most frequently used NVNM products were echinacea, ginseng, and St John's wort. Of the 27 students who took NVNM products to promote weight loss. 81.5% had body mass index (BMI) values in the acceptable range. Eleven of the 19 participants who reported an adverse reaction to an NVNM supplement continued to take the products despite negative effects. Users and nonusers of NVNM supplements did not differ significantly by age, ethnicity, gender, perceived dietary adequacy, or by exercise patterns.

Nonvitamin, Nonmineral Dietary Supplements: Issues and Findings from NHANES III

The Commission on Dietary Supplement Labels encourages nutrition professionals to become knowledgeable about all dietary supplements. The Dietary Supplement Health and Education Act of 1995 (DSHEA) expanded the definition of dietary supplements beyond essential nutrients while distinguishing them from drugs or food additives. In order to give practical advice to consumers and policymakers, dietetics professionals need to understand the implications resulting from this less-restrictive regulatory environment for supplements. Dietetics professionals must also become familiar with claims made by manufacturers, retailers, and others regarding popular nonvitamin, nonmineral (NVNM) supplements, as well as usage prevalence and trends. However, NVNM supplements currently are classified inconsistently, and information on the prevalence of use is limited. Sales data suggest that total intake is increasing, and garlic and ginseng are consistently among the most popular supplements. Reported use of NVNM supplements in the third National Health and Nutrition Examination Survey was highest for garlic and lecithin. The data suggest associations of NVNM supplement use with age and more healthful lifestyles; however, there is also a reported link with higher alcohol consumption and obesity. Associations with education, income, region, and urbanization are not evident from the sales data. Standardized survey procedures regarding question phraseology, referent time period, and supplement categorization—along with use of representative samples—will improve our ability to assess supplement use, prevalence, and trends. J Am Diet Assoc. 2000; 100: 447-454.

Keeping up with the Increasing Popularity of Nonvitamin, Nonmineral Supplements

During the past 5 years, we have observed an expansion of the use of and advertising for a variety of nonvitamin, nonmineral (NVNM) supplements. Use of NVNM supplements increased substantially with the passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA) (1), which gave manufacturers greater freedom to market more products as dietary supplements and to provide information about their purported benefits in package labeling and advertising. Although the US Food and Drug Administration (FDA) regulates additives and drugs, premarket review of dietary supplements is minimal (2).