Factors affecting the use of dietary supplements by Korean adults: data from the Korean National Health and Nutrition Examination Survey III

A Life-Stage Approach to Precision Nutrition: A Narrative Review

The concept of precision nutrition highlights the customization of nutrition to specific needs, emphasizing that a one-size-fits-all approach is not sufficient for either optimal nutrition or optimal health. Precision nutrition encompasses a range of factors, from broad strata of age and sex categories to personal characteristics such as lifestyle to an individual's unique genotype. This breadth of scope requires us to consider how precision nutrition can be implemented in an inclusive and appropriate way for individuals and groups within real-life populations. In this narrative review, we explore the potential of precision nutrition through a life-stage approach that emphasizes age- and gender-specific nutritional needs as these change across the lifespan. Focusing on adult life stages, we delineated trends in age-related conditions and health needs among Korean adults based on national-level survey data (KNHANES 2019-2021). We also reviewed the intake of nutrients associated with these health needs to better understand how life-stage guided approaches to nutrition and supplementation could support optimal health. Looking beyond preventing deficiency or disease, we discuss how tailored supplementation of essential vitamins, minerals, and certain bioactive substances could promote healthy functioning. Finally, we discuss the complexities and challenges of developing multivitamin/multimineral supplements (MVMS) to support life-stage appropriate nutrition while maximizing adherence. Future prospects include leveraging advancements in intelligent technologies and dietary assessments for tracking nutrient intake and health indicators and using these to optimize MVMS formulations in ways that are sensitive to a person's needs and priorities/preferences at different life stages. By adopting a life-stage guided approach to nutrition, we can better support health and well-being across the lifespan.

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

OBJECTIVE

This study examined associations between multiple dietary supplement (DS) categories and medical conditions diagnosed by health professionals.

DESIGN

Cross-sectional.

SETTING

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).

PARTICIPANTS

A stratified random sample of US service members (SM) from all military services (n 26 680).

RESULTS

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.

CONCLUSIONS

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.

Factors That Influence the Use of Dietary Supplements among the Students of Wroclaw Medical University in Poland during the COVID-19 Pandemic

Background and aim: The use of dietary supplements (DS) and over-the-counter (OTC) drugs is increasing every year. The COVID-19 pandemic might additionally influence the use of such preparations. The study aimed to investigate factors influencing the use of dietary supplements (DS), including stress-relieving supplements, by the students. Methods: In the cross-sectional study, 624 students of the Wroclaw Medical University in Poland, from the second to the last year of studies, completed the anonymous questionnaire, consisting of 22 items, about the use of DS/OTC drugs during the academic year 2020/2021. Obtained data were analyzed using Pearson’s chi-square test, the U-Mann Whitney test, the Kruskal–Wallis test with the post-hoc analysis, and with logistic regression. Results: About 70% of students declared the use of any DS, 33% used DS for stress, anxiety, depression, or sleeping problems, and 59% used other DS. The most important factors influencing the decision to take any kind of DS were Division (p = 0.0001, odds ratio [OR]: 0.35, and confidence interval [CI]: 0.21–0.59), a self-estimated level of stress (p = 0.014, OR: 1.13, CI: 1.03–1.25), and self-estimated level of knowledge about DS (p = 0.0000, OR: 1.31, CI: 1.19–1.36). In the case of students taking DS for stress, anxiety, depression, or sleeping problems, the level of stress and the declared knowledge had the greatest impact on the decision for such a use of DS (p = 0.0001, OD: 1.24, CI: 1.11–1.39 and p = 0.0000, OD: 1.35, CI: 1.22–1.5, respectively). The COVID-19 pandemic did not change the pattern of DS/OTC drug usage in about 33% of students. Those who started taking DS during the pandemic accounted for 19% of all students. Conclusions: The use of DS is common among Wroclaw Medical University students with some differences between subgroups of respondents. Additionally, despite declared good knowledge about DS, most students declare the need to learn more about them.

Analysis of Dietary Supplement Use and Influencing Factors in the Mongolian Population

Objective

Dietary supplements (DS) may improve micronutrient deficiencies, but the unique eating habits and cultural customs of the Chinese Mongolian population affect their choice of DS. Therefore, this study adopted a cross-sectional method to explore the current status of DS use and to assess the influencing factors in the Mongolian population in Inner Mongolia, China.

Methods

We used a multistage random cluster sampling method to select 1,434 Mongolian people aged ≥ 18 years in Hohhot and Xilinhot, Inner Mongolia. Data regarding general patient characteristics and DS use through questionnaire surveys were obtained, and the blood plasma was collected for biochemical index detection. The binary logistic regression and decision tree algorithm were used to predict the factors influencing DS use among the Mongolian population.

Results

Among 1,434 participants that completed the baseline survey, the usage rate of DS was 18.83%, and more women than men used DS (P = 0.017). Higher use of DS was reported among individuals aged ≤ 34 years, but this difference is not statistically significant (P = 0.052). Usage rate was higher among those living in urban areas (P < 0.001), those with higher education (P < 0.001), those engaged in mental work (P < 0.001), and nonsmokers (P = 0.019). The biochemical test results showed that the proportion of people with abnormal total cholesterol levels using DS was lower (P = 0.003), but that of those with abnormal triglyceride levels using DS was higher (P = 0.001), compared with the proportion of those with normal levels in each case. The most commonly used supplement was calcium (58.15%). Education level was the main factor affecting DS intake. The results of the binary logistic regression model and decision tree model both showed that region, educational level, and abnormal triglyceride levels were significant factors influencing DS intake among Mongolians.

Conclusion

Findings from this study indicate that DS intake is uncommon in the Mongolian population. In addition, sex, region, education level, and triglyceride levels may influence DS use.

Prevalence of vitamin-mineral supplement use and associated factors among Canadians: results from the 2015 Canadian Community Health Survey

Vitamin/mineral supplements are used for improving micronutrient intake and preventing deficiencies, particularly for shortfall nutrients. We assessed the prevalence of vitamin/mineral supplement use and associated factors among a representative sample of Canadians aged ≥1 y. We used nationally representative data from the 2015 Canadian Community Health Survey (CCHS)-Nutrition. The prevalence of vitamin/mineral supplement use containing shortfall nutrients (Vitamins: A, C, D, B6, B12 and folate; Minerals: calcium, magnesium, and zinc) was examined in this study. Logistic regression models were performed to determine factors associated with vitamin/mineral supplement use among Canadian children (1-18 years) and adults (>19 years). The overall prevalence of vitamin/mineral supplement use was 38% among men and 53% among women. Males aged 14-18 years had the lowest prevalence (26.5%; 95% CI = 21.9-31.0) and females aged ≥71 years had the highest prevalence (67.8%; 95% CI = 64.1-71.5) of vitamin/mineral supplement use. Female gender, older age, higher education level, higher income, living in urban areas, having chronic conditions, having a normal body mass index (BMI), and being non-smoker were independent positive predictors of vitamin/mineral supplement use among adults. Independent positive predictors of vitamin/mineral supplement use among Canadian children included younger age, having a normal BMI, and being food secure. Novelty bullets • The overall prevalence of vitamin/mineral supplement use among Canadian men and women was 38% and 53%, respectively. • Sociodemographic and lifestyle variables were associated with vitamin/mineral supplement use, especially among Canadian adults.

Qualitative exploration of the factors influencing the use of dietary supplements in Iranian women: introduction to areas of focus for developing interventions

BACKGROUND

Literature shows that the consumption of Dietary Supplements (DS) is more common in Iran. This study aimed to explore the experiences of a sample of Iranian women regarding the factors influencing the use of DS.

METHODS

This qualitative content analysis study was conducted in Qods city, Tehran province, Iran from January to March 2020. Forty-two semi-structured in-depth interviews were performed with women. The participants were asked about their experiences about the determinants of the consumption of DS. After the first round of the interviews was done, we performed content analysis of the data and continued up to data saturation.

RESULTS

Two main themes including personal factors (with 5 subthemes including sociodemographic characteristics, perceived benefits of DS, history of illness, physiological conditions, and lifestyle factors) and socio-economic factors (with 3 subthemes including subjective norms, the price of food and commercial considerations of the sectors involved in the production and sale of DS) emerged as the experiences of the participants as to the intake of DS.

CONCLUSIONS

These variables may suggest areas which need to be focused on for performing more effective interventions to affect appropriate consumption of DS in Iran.

Vitamin C and the Lens: New Insights into Delaying the Onset of Cataract

Cataracts or clouding of the lens is the leading cause of blindness in the world. Age and diabetes are major risk factors, and with an increasing aging and diabetic population, the burden of cataracts will grow. Cataract surgery is an effective way to restore vision; however, alternatives to cataract surgery are required to reduce the looming cataract epidemic. Since it is well established that oxidative damage plays a major role in the etiology of cataracts, antioxidants have been promoted as therapies to delay and/or prevent cataracts. However, many antioxidant interventions including vitamin C have produced mixed results as anti-cataract therapies. Progress has been made towards our understanding of lens physiology and the mechanisms involved in the delivery and uptake of antioxidants to the lens which may guide future studies aimed at addressing some of the inconsistencies seen in previous animal and human studies. Of interest is the potential for vitamin C based supplements in delaying the onset of cataracts post vitrectomy which occurs in up to 80% of patients within two years. These targeted approaches are required to reduce the burden of cataract on hospitals and improve the quality of life of our aging and diabetic population.

Effect of Baseline Nutritional Status on Long-term Multivitamin Use and Cardiovascular Disease Risk: A Secondary Analysis of the Physicians' Health Study II Randomized Clinical Trial

Importance

Long-term multivitamin use had no effect on risk of cardiovascular disease (CVD) in the Physicians' Health Study II. Baseline nutritional status may have modified the lack of effect.

Objective

To investigate effect modification by various baseline dietary factors on CVD risk in the Physicians' Health Study II.

Design, Setting, and Participants

The Physicians' Health Study II was a randomized, double-blind, placebo-controlled trial testing multivitamin use (multivitamin [Centrum Silver] or placebo daily) among US male physicians. The Physicians' Health Study II included 14 641 male physicians 50 years or older, 13 316 of whom (91.0%) completed a baseline 116-item semiquantitative food frequency questionnaire and were included in the analyses. This study examined effect modification by baseline intake of key foods, individual nutrients, dietary patterns (Alternate Healthy Eating Index and Alternate Mediterranean Diet Score), and dietary supplement use. The study began in 1997, with continued treatment and follow-up through June 1, 2011.

Interventions

Multivitamin or placebo daily.

Main Outcomes and Measures

Major cardiovascular events, including nonfatal myocardial infarction, nonfatal stroke, and CVD mortality. Secondary outcomes included myocardial infarction, total stroke, CVD mortality, and total mortality individually.

Results

In total, 13 316 male physicians (mean [SD] age at randomization, 64.0 [9.0] years in those receiving the active multivitamin and 64.0 [9.1] years in those receiving the placebo) were observed for a mean (SD) follow-up of 11.4 (2.3) years. There was no consistent evidence of effect modification by various foods, nutrients, dietary patterns, or baseline supplement use on the effect of multivitamin use on CVD end points. Statistically significant interaction effects were observed between multivitamin use and vitamin B6 intake on myocardial infarction, between multivitamin use and vitamin D intake on CVD mortality, and between multivitamin use and vitamin B12 intake on CVD mortality and total mortality. However, there were inconsistent patterns in hazard ratios across tertiles of each dietary factor that are likely explained by multiple testing.

Conclusions and Relevance

The results suggest that baseline nutritional status does not influence the effect of randomized long-term multivitamin use on major CVD events. Future studies are needed to investigate the role of baseline nutritional biomarkers on the effect of multivitamin use on CVD and other outcomes.

Trial Registration

clinicaltrials.gov Identifier: NCT00270647.

Dietary supplements and disease prevention - a global overview

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.

Vitamin-Mineral Supplement Use Patterns in Elderly Koreans: Data from the 2007-2008 Korean National Health and Nutrition Examination Survey

Background

Vitamin-mineral supplements are the most popular dietary supplements in Korea. However, few studies have assessed the relationship between vitamin-mineral supplementation and associated factors among the Korean elderly. The purpose of this study was to assess the use of vitamin-mineral supplements among elderly in Korea as well as its association with sociodemographic factors, health-related behaviors, medical conditions, and nutrient intake.

Methods

This study was based on data from the Korean National Health and Nutrition Examination Survey, conducted by the Korean Ministry of Health and Welfare from 2008 to 2009. Data from 3,294 elderly men and women (65 years of age and older) were analyzed. Multivariable-weighted logistic regression model analysis was used to evaluate the association between vitamin-mineral supplement use and sociodemographic factors, health-related habits, and medical conditions.

Results

Vitamin-mineral supplementation was reported by 16.3% of the participants. The most common reason for using dietary supplements was recommendations from friends and acquaintances. Highly educated person, female participants had a greater likelihood of taking vitamin-mineral supplements. In addition, analysis of nutrient intake from food sources alone revealed a lower proportion of vitamin-mineral supplement users with nutrient intakes below the estimated average requirements for vitamin A, vitamin C, thiamine, riboflavin, niacin, calcium, iron, and phosphorus, compared to nonusers. However, vitamin-mineral supplementation was not associated with health-related behaviors or medical conditions.

Conclusion

Highly educated person, elderly Korean women had a greater likelihood of using vitamin-mineral supplements. In addition, nutrient intakes from food sources alone were significantly higher among vitamin-mineral supplement users. Finally, vitamin-mineral supplementation may be an indicator of healthier diet in elderly Koreans.

The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents

BACKGROUND/OBJECTIVES

The use of dietary supplements (DSs) by children and adolescents is increasing. The aim of this study was to identify the characteristics of DS users and examine the nutritional contributions of DSs to total nutrient intakes in children and adolescents, using data obtained from a national survey.

SUBJECTS/METHODS

In total, 3134 subjects aged 9-18 years who participated in the 4th Korea National Health and Nutrition Examination Survey (2007-2009) were selected; the survey included 24-h recall questions on food intake and questions on DS use over the past year. Nutrient intakes from DSs were calculated using the aid of a label-based database on such supplements, and individual total nutrient intakes were derived by combining information on the foods and DSs consumed by each subject.

RESULTS

There were 895 DS users (28.5%), 85.2% of whom (n=577) had complete DS nutrient information and were therefore defined as identified-DS users. Identified-DS users were slightly younger and had a greater household income and better nutritional knowledge than did non-users. The most frequently consumed type of supplement was a 'multivitamin and minerals' complex. For total nutrient intake, identified-DS users had a significantly higher intake of most of the nutrients, except for macronutrient and sodium than non-users. In all identified-DS users, the contribution of vitamins and minerals from DSs to total nutrient intake was higher than energy and macronutrients.

CONCLUSIONS

DS use by children and adolescents can improve micronutrient status, but it also increases the risk of excessive intake of certain vitamins and minerals.

Parathyroid hormone, calcium, and sodium bridging between osteoporosis and hypertension in postmenopausal Korean women

The coexistence of osteoporosis and hypertension, which are considered distinct diseases, has been widely reported. In addition, daily intake of calcium and sodium, as well as parathyroid hormone levels (PTH), is known to be associated with osteoporosis and hypertension. This study aimed to determine the association of low calcium intake, high sodium intake, and PTH levels with osteoporosis and hypertension in postmenopausal Korean women. Data for postmenopausal Korean women aged 50 years or older were obtained from the Korea National Health and Nutrition Examination Survey 2008-2011. Osteoporosis was diagnosed using dual energy X-ray absorptiometry, while hypertension was diagnosed using blood pressure data. The odds ratios for osteoporosis and hypertension were calculated using logistic regression analysis for quartiles of the daily calcium intake, daily sodium intake, and PTH levels. Women with hypertension had a high coexistence of osteoporosis (43.6 vs. 36.5 %; P = 0.022), and vice versa (21.1 vs. 16.6 %; P = 0.022). PTH was significantly associated with osteoporosis and hypertension, and a high intake of calcium was strongly correlated with a low incidence of osteoporosis. This is the first study to report the characteristics of postmenopausal Korean women who have high dietary sodium intake and low dietary calcium intake, in association with the incidence of osteoporosis and hypertension. Osteoporosis and hypertension were strongly associated with each other, and PTH appears to be a key mediator of both diseases, suggesting a possible pathogenic link.

Herbal and dietary supplement use in Bangkok: a survey

BACKGROUND

People living in Asian countries including Thailand are likely to use herbal and dietary supplements (HDS). However, there is limited evidence of their usage in Thailand. The objectives of this study were to determine (1) the prevalence of HDS usage amongst a general population in Bangkok; (2) patterns of HDS use; (3) reasons why Bangkok residents use HDS.

METHODS

This cross-sectional survey recruited 400 Thai people aged 15 years or over at busy bus stops in Bangkok, Thailand, using convenience sampling. Data were collected via an interview regarding demographics, HDS usage and reasons of using HDS. Descriptive statistics, such as frequencies and percentages, were used to analyse the prevalence and the patterns of HDS use.

RESULTS

The prevalence of HDS usage in the previous 6 months was 52%. The majority of people who took herbs used them to treat illnesses (58%), whereas the majority of people who took dietary supplements used them to promote well-being (65%). Respondents reported using HDS due to their efficacy (28%), wanting to try them (26%) and safety concerns with conventional medicines (15%).

CONCLUSIONS

Health care providers should be aware of HDS use amongst Thai residents in Bangkok. Policy makers should educate people about appropriate HDS use.

Poor Socioeconomic and Nutritional Status Are Associated with Osteoporosis in Korean Postmenopausal Women: Data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES) 2009

OBJECTIVE

As the population ages, osteoporosis is a growing global public health problem. This study examined potential risk factors associated with osteoporosis in a nationally representative sample of Korean postmenopausal women.

METHODS

This study used data from a nationally representative sample of Korean menopausal women participating in the Korea National Health and Nutrition Examination Survey KNHANES 2009 (n = 1467; mean age ± SE = 65.2 ± 0.3 years). Bone mineral density of total femur, femoral neck, and spine was measured by dual-energy X-ray absorptiometry. Osteoporosis was determined as t-score of -2.5 or below in at least 1 of the 3 sites. Menopausal status was confirmed by self-reports.

RESULTS

About 41% of the study sample met the criteria for osteoporosis. Poor socioeconomic status, lower BMI, and shorter estrogen exposure duration were significantly associated with osteoporosis in the study sample. Poor dietary intake was also related to osteoporosis. In the age- and energy-adjusted logistic regression models, participants consuming less protein, vitamin B2, or vitamin C than the estimated average requirement (EAR) showed higher odds of having osteoporosis than their counterparts. Participants consuming no milk or milk products had 45% increased odds of having osteoporosis than those consuming milk or milk products.

CONCLUSION

The findings of this study suggest several risk factors associated with osteoporosis, which can be addressed in the development and implementation of tailored nutritional interventions to promote the bone health of Korean postmenopausal women.

Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008-2010)

CONTEXT

Little is known about the interactions between dietary calcium intake and bone strength parameters in populations or areas with low calcium intake.

OBJECTIVE

The objective of the study was to investigate the relationship between dietary calcium intake and bone mineral density (BMD) or bone geometry in an Asian population with low calcium intake.

DESIGN AND SETTING

This was a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey, 2008-2010.

PARTICIPANTS

A total of 3448 men and 3812 women older than 50 years were stratified by daily dietary calcium intake: less than 400 mg/d, 400-799 mg/d, 800-1199 mg/d, and 1200 mg/d or greater.

MAIN OUTCOME MEASURES

BMD was measured by dual-energy X-ray absorptiometry and the geometric index was calculated.

RESULTS

Mean daily calcium intake was 470 mg/d in this population. BMD in the lumbar spine (both sexes) and femoral neck (women) was significantly lower only when calcium intake was less than 400 mg/d. In men, femoral neck and total hip BMD was positively related to calcium intake up to 1200 mg/d. Calcium intake less than 400 mg/d was negatively related to femoral cortical thickness and buckling ratio. These interactions disappeared when the 25-hydroxyvitamin D level was 30 ng/mL or greater in men and 20 ng/mL or greater in women.

CONCLUSIONS

Low calcium intake was significantly related with low BMD and increased risk of osteoporosis. However, the association between calcium and BMD was not consistently linear, and a sufficient vitamin D level appears to compensate for the negative influences of low calcium intake on bone.

Dietary supplement use and its effect on nutrient intake in Korean adult population in the Korea National Health and Nutrition Examination Survey IV (2007-2009) data

BACKGROUND/OBJECTIVES

Although there is an increasing trend of dietary supplement (DS) use, few researches have evaluated nutrient intake from DS. This study aimed to establish a nutrient database (NDB) for DS and estimate the effect of DS on total nutrient intake by Korean adults.

SUBJECTS/METHODS

The NDB for DS was established using the label information of products reported in the Korea National Health and Nutrition Examination Survey (KNHANES) IV. Of the 16,031 participants who were ≥20 years old, 2053 products were reported as being taken by 5606 subjects. But nutrient composition could be identified by searching product name only in 1158 products consumed by 3844 subjects (DS users). Total nutrient intake of DS users was obtained by combining intakes from diet and DS.

RESULTS

Dietary supplement use was higher in women, in middle-aged people and in those with higher education and low smoking and drinking preferences. Nutrients obtained from food were higher in DS users than in nonusers for most nutrients, particularly in women. When total nutrient intake was evaluated in DS users, the percentage of subjects whose intake was below the estimated average requirement for Koreans decreased for several vitamins and minerals, but the percentage of subjects whose intake was above the tolerable upper intake levels increased for vitamin A, vitamin C and iron.

CONCLUSIONS

The newly developed NDB for DS will be an important resource for more accurate assessment of nutrient intake as well as evaluation of the relationship between nutrition and health. Further research is needed to update a more comprehensive NDB applicable to diverse populations.

Who uses multivitamins? A cross-sectional study in the Physicians' Health Study

PURPOSE

The aim of this study was to examine the prevalence of self-reported multivitamin use in the Physicians' Health Study (PHS) cohort and its association with various lifestyle, clinical, and dietary factors to improve our understanding of who tends to use multivitamins.

METHODS

Among 18,040 middle-aged and older men, information on lifestyle and clinical factors was collected from a baseline enrollment questionnaire, and supplement use and dietary factors were assessed through a food-frequency questionnaire. Four categories of multivitamin use were considered: (1) no supplement use, (2) use of multivitamins only, (3) use of multivitamins with other individual vitamin/mineral supplements, and (4) use of other supplements only. We used logistic regression to calculate multivariate odds ratios and 95% confidence intervals of taking multivitamin supplements for various lifestyle, clinical and dietary factors.

RESULTS

Overall, 36% of men reported current multivitamin use. Men who were older, current smokers, and currently using aspirin were 143, 43, and 74% more likely to use multivitamins only. Men having a history of hypercholesterolemia were 16% more likely to use multivitamins only. A 14, 24, and 26% greater likelihood of using multivitamins was also observed among men consuming more fruits and vegetables, whole grains, and tea, respectively. Similar associations were observed for the likelihood of using multivitamins with other supplements; however, men with higher physical activity, history of cancer, hypertension, higher consumption of nuts, and lower consumption of red meat and coffee were also more likely to use multivitamins with other supplements (all P < 0.05).

CONCLUSION

Self-reported multivitamin use associated with lifestyle, clinical and dietary factors may be an indicator of healthy behaviors. These results provide important information for the interpretation of the recent findings from the PHS II trial and consideration of results from observational studies of multivitamin use and chronic disease.

Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009

BACKGROUND

Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors.

METHODS

Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used.

RESULTS

The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7).

CONCLUSION

A longer duration of smoking cessation correlated with better health behaviors.

The use of complementary and alternative medicine by people with cardiovascular disease: a systematic review

BACKGROUND

Complementary and alternative medicine (CAM) may offer benefits as well as risks to people with cardiovascular disease. Understanding the prevalence and the nature of CAM use will encourage beneficial CAM therapies, prevent potential herb-drug interactions and foster communication between patients and physicians.

METHODS

A systematic search of eight bibliographic databases was conducted for studies that investigated CAM use in patients with cardiovascular diseases. Two independent reviewers selected relevant abstracts and evaluated the quality of included studies.

RESULTS

Twenty-seven studies were included. Prevalence of CAM use in cardiac patients ranged from 4% - 61%. Biologically-based therapies usage ranged from 22% to 68%. Herbal medicines were used by between 2% and 46%. A large proportion of patients did not inform medical practitioners about their CAM use and up to 90% of treating physicians did not discuss CAM use with their patients.

CONCLUSIONS

CAM use in patients with cardiovascular disease appears common. The findings suggest that the effects of CAM on medical management of cardiovascular disease may be overlooked and that patient-physician communication need to be strengthened.

Patterns of dietary supplement use among older men and women in the UK: findings from the Hertfordshire Cohort Study

OBJECTIVES

To determine patterns of supplement use in a UK community-dwelling older population, and to investigate the extent to which supplement user groups differ, in terms of their sociodemographic and lifestyle characteristics, diet and morbidity.

DESIGN

Cross-sectional cohort study.

SETTING

Home interview and clinic visit.

PARTICIPANTS

3217 Hertfordshire Cohort Study participants, aged 59 to 73.

MEASUREMENTS

Information was obtained on the participant's social and medical history by a trained research nurse. Diet over the preceding 3 months was assessed by Food Frequency Questionnaire; compliance with 'healthy' eating recommendations was defined using individual scores for a 'prudent' dietary pattern, identified using principal components analysis. Details of all dietary supplements taken in the preceding 3 months were recorded. Individual supplements were allocated to one of 10 types based on their nutrient composition. Cluster analysis was used to define groups of supplement users.

RESULTS

45.4% of men and 57.5% of women reported taking at least one dietary supplement in the previous 3 month period. There were 5 distinct clusters of supplement users; these were common to men and women. They were labelled according to the principal supplement taken; oils, glucosamine, single vitamins, vitamins and minerals, and herbal products. These groups differed in their social class and prudent diet score, but few other characteristics. With the exception of a difference in diagnosis of diabetes among the women, there were no differences in morbidity between the supplement groups in either men or women.

CONCLUSIONS

Dietary supplement use is high in this population. There are distinct patterns of supplement use, which are related to sociodemographic and lifestyle characteristics including diet, though there were few clear differences in morbidity.