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

A cross-sectional study of self-reported dietary supplement use, associated factors, and adverse events among young adults in Kuwait

BACKGROUND

Dietary supplements (DS) are commonly used to improve overall health status and correct nutritional deficiencies. However, with the global rise in DS use, there is an increased risk of misuse and/or excessive use leading to toxicity and adverse events (AE). Research on DS use and DS-related AE is limited in Kuwait. This study aimed to explore the prevalence of DS use, its associated factors, and reported AE in a population of young adults.

METHODS

A cross-sectional study was carried out using an online self-administered questionnaire. Non-probabilistic sampling was used via multiple social media platforms. Logistic regression analysis was performed to assess the association between sociodemographic, lifestyle characteristics and health status with DS use and AE.

RESULTS

The prevalence of DS use was 68.24%. DS use was found to be associated with age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03-1.13; p-value [p] = < 0.001) and being female (OR = 1.55, 95% CI 1.01-2.41; p = 0.047). AE related to DS use were found to be associated with having respiratory disorders (asthma) (OR = 2.09, 95% CI 1.07-4.05; p = 0.029) and digestive disorders (OR = 3.22, 95% CI 1.24-8.35; p = 0.016).

CONCLUSION

The study findings provide valuable insights into current DS use in young adults in Kuwait, which may enable the strategic development of targeted interventions and health promotion awareness campaigns. Furthermore, they emphasize the necessity of implementing regulations and policies to effectively manage DS use and monitor AE reporting in Kuwait.

Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

Protein intake affects erythrocyte glutathione synthesis in healthy adults aged ≥60 years in a repeated-measures trial

BACKGROUND

Protein recommendations for older adults are based on nitrogen balance data from young adults. Physiological studies using the indicator amino acid oxidation method suggest they need 30% to 50% more protein than current recommendations. We herein present glutathione (GSH) as a physiological estimate of protein adequacy in older adults.

OBJECTIVES

The objective was to measure GSH kinetics in response to varying protein intakes in a repeated-measures design in healthy adults aged ≥60 y using the precursor-product method.

METHODS

Sixteen healthy older adults (n = 8 male and n = 8 female; body mass index ≤30 kg/m2) were studied. Each received 4 of 6 protein intakes in random order (0.66, 0.8, 0.9, 1.1, 1.3 and 1.5 g⋅kg-1⋅d-1). At each intake level, participants underwent isotope infusion studies of 7 h duration following a 3-d adaptation to the test level of protein. On the fourth day, GSH fractional (FSR) and absolute synthesis (ASR) rates were quantified by measuring the incorporation of U-[13C2-15N]glycine into GSH at isotopic steady state. A mixed-effect change-point regression model was used to determine a breakpoint in FSR and ASR. Secondary outcomes included plasma concentrations of oxidative stress markers, homocysteine, 5-L-oxoproline (5-OP), and urinary sulfate. The effect of secondary outcomes on GSH kinetics was analyzed using a joint linear mixed-effect model and Tukey's post hoc test.

RESULTS

A protein intake of 1.08 g⋅kg-1⋅d-1 (95% confidence interval [CI]: 0.83, 1.32; Rm2 = 0.207; Rc2 = 0.671; P < 0.001) maximized GSH FSR. There was no effect of protein intake on concentrations of erythrocyte GSH, plasma homocysteine, oxidative stress markers, or 5-OP (P > 0.05). Protein intake had a positive effect on urinary sulfate excretion (P < 0.0001).

CONCLUSION

A protein intake of 1.08 g⋅kg-1⋅d-1 from a high-quality protein maximized GSH synthesis in adults ≥60 y. This lends support to data suggesting a requirement higher than the current recommendation. This study was registered at clinicaltrials.gov as NCT02971046.

How does Canada's new vitamin D fortification policy affect the high prevalence of inadequate intake of the vitamin?

TAKE-HOME MESSAGE

The 2023 vitamin D fortification policy may significantly reduce inadequacies in non-supplement consumers; however, the policy is far from eliminating population-level vitamin D inadequacies and supplementation should still be encouraged.

Dietary supplements increase the risk of excessive micronutrient intakes in Danish children

PURPOSE

Dietary supplement use is common in Northern Europe. Many dietary supplements contain 100% of nutrient reference values (NRV) of micronutrients. This study investigates the contribution of dietary supplements to micronutrient intake, the prevalence of excess intake of micronutrients, and parental characteristics of dietary supplement use in Danish children.

METHODS

Data on 499 4-10-year-old children from the Danish National Survey of Diet and Physical Activity 2011-2013 were analysed using non-parametric statistics to compare micronutrient intake from the diet and dietary supplements to the reference intake (RI), and to the tolerable Upper Intake Level (UL) for users and non-users of dietary supplements. Furthermore, characteristics of the parents of users and non-users of dietary supplements were examined by logistic regression analysis.

RESULTS

Sixty-four percent of the children were dietary supplement users. Multivitamin-mineral supplements were the most frequently used type of supplement (60%). Children of never-smokers were more likely to use supplements than children of smokers. Users had significantly higher total intakes of 15 micronutrients compared to non-users. Intakes of vitamin A, zinc, and iodine from the diet alone exceeded ULs in 12-30% of the children. Use of dietary supplements gave rise to 21-73% of children in exceedance of the aforementioned three ULs as well as the UL for iron (6-45%).

CONCLUSION

Dietary supplement use was common among 4-10-year-old Danish children and resulted in a considerable proportion of users exceeding the ULs for vitamin A, zinc, iodine, and iron. The long-term health consequences of exceeding these ULs for children are unknown.

Use of vitamins and/or minerals among adults and the elderly in urban areas of Brazil: prevalence and associated factors

The purpose of the present study was to estimate the prevalence of vitamin and/or mineral use among urban Brazilian populations aged 20 years and over and to identify associated factors. Data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines in Brazil (PNAUM) were analyzed and a population-based cross-sectional study with probability sampling was performed in urban areas of Brazil's five geographic regions from September 2013 to February 2014. The estimated prevalence of vitamin and/or mineral use was 4.8% (95%CI: 4.3-5.3), higher in women 6.4% (95%CI: 5.7-7.1) and in the elderly population 11.6% (95%CI: 10.5-12.8). Vitamin and/or mineral use was associated with the following factors: women, 60 years of age or older, economic class A/B, chronic disease(s) and self-perceived health held as average and very poor/poor. Multivitamins and multiminerals were the most used ones with 24.5% (95%CI 20.1-29.4), followed by calcium and vitamin D with 23.4% (95%CI 19.7-27.5). Data suggest that elderly women should be the reference public for actions aimed at promoting rational use. Nationwide epidemiological surveys should increase monitoring of these products to support the analysis of trends.

Children Aged 5-6 Years in Vancouver, Canada Meet Dietary Recommendations for Folate and Vitamin B12 but not Choline

BACKGROUND

Choline, folate, and vitamin B12 are required for growth and development, but there is limited information on the intakes and relationships to biomarkers of status in children.

OBJECTIVES

The objective of this study was to determine the choline and B-vitamin intakes and relationship to biomarkers of status in children.

METHODS

A cross-sectional study was conducted in children (n = 285, aged 5-6 y) recruited from Metro Vancouver, Canada. Dietary information was collected by using 3 24-h recalls. Nutrient intakes were estimated by using the Canadian Nutrient File and United States Department of Agriculture database for choline. Supplement information was collected by using questionnaires. Plasma biomarkers were quantified by using mass spectrometry and commercial immunoassays, and relationships to dietary and supplement intake were determined by using linear models.

RESULTS

Daily dietary intakes of choline, folate, and vitamin B12 were [mean (SD)] 249 (94.3) mg, 330 (120) DFE μg, and 3.60 (1.54) μg, respectively. Top food sources of choline and vitamin B12 were dairy, meats, and eggs (63%-84%) and for folate, were grains, fruits, and vegetables (67%). More than half of the children (60%) were consuming a supplement containing B-vitamins, but not choline. Only 40% of children met the choline adequate intake (AI) recommendation for North America (≥250 mg/d); 82% met the European AI (≥170 mg/d). Less than 3% of children had inadequate folate and vitamin B12 total intakes. Some children (5%) had total folic acid intakes above the North American tolerable upper intake level (UL; >400 μg/d); 10% had intakes above the European UL (>300 μg/d). Dietary choline intake was positively associated with plasma dimethylglycine, and total vitamin B12 intake was positively associated with plasma B12 (adjusted models; P < 0.001).

CONCLUSIONS

These findings suggest that many children are not meeting the dietary choline recommendations, and some children may have excessive folic acid intakes. The impact of imbalanced one-carbon nutrient intakes during this active period of growth and development requires further investigation.

Dietary Supplement Use and Associated Factors Among Adults Working in Urban Settings in Tanzania: A Cross-Sectional Study

Dietary supplements are products consumed to provide nutrients or other substances that the user may not consume in sufficient amounts through normal diets. Despite their increased global popularity, there is still scant information regarding the use of dietary supplements and associated factors among adult populations in Tanzania. This study aimed to assess the extent of dietary supplement use and factors associated with use among adults working in urban settings. This was a cross-sectional study involving 419 adults working in public and private institutions within the Ilala District of Dar es Salaam who were selected using stratified and simple random sampling techniques. The study's data was collected using quantitative methods through a self-administered questionnaire. Data analysis was done through descriptive statistics for frequencies, means, standard deviations, and proportions; cross-tabulations with chi-square tests for comparing observed differences in supplement use; and multivariable logistic regression for identifying factors associated with supplement use. A P-value of <.05 was considered statistically significant in the analysis. The prevalence of dietary supplement use among working adults was 46.5%, where 36.9% reported regular and 63.1% occasional supplement use, respectively. Seven types of dietary supplements were identified to be consumed, of which 45.1% of the respondents consumed more than one type of dietary supplement. Multivitamins (64.1%) were the most frequently reported type of supplement consumed, followed by Mineral (34.9%) and Herbal/Botanical (26.7%) supplements. The most commonly reported reason for dietary supplement use among working adults was to improve overall health (67.1%). A third of the users (35.9%) admitted to self-prescribing dietary supplements without seeking professional medical advice. The use of dietary supplements was significantly associated with being female (AOR = 2.243, 95% CI 1.415-3.555, P = .001) and knowledgeable of supplements (AOR = 6.756, 95% CI 4.092-11.154, P < .001). Overall, the use of dietary supplements is popular among adults working within urban settings, but its use is exacerbated by perceived knowledge and self-prescription instead of health professional advice. Therefore, there is a need for further studies to explain better the underlying drivers for perceived knowledge on decision-making. There is also a strong need for extensive health education to prevent inappropriate or excessive use of supplements which might lead to potential adverse events.

The Prevalence of Dietary Supplements That Claim Estrogen-like Effects in Japanese Women

Recently, adverse events, such as irregular vaginal bleeding and menstrual disorders, associated with the use of dietary supplements containing Pueraria mirifica, have been reported in Japan. P. mirifica contains phytoestrogens, such as deoxymiroestrol and miroestrol. Therefore, we investigated the use of supplements that claim to have estrogen-like effects (i.e., estrogen-like supplements) in Japanese women aged from 15 to 69 years old in an online survey. The prevalence of estrogen-like supplement use was 5%, accounting for approximately 15% of the sample, including ex-users. The majority of the users were in their 40s and 50s, mainly using these supplements for the treatment of menopausal symptoms. In contrast, the younger generation mainly used them for beauty purposes, such as weight loss, mastogenic effects, and skin care. Many of them visited a clinic or took medicines for menstrual-related troubles. In all age groups, soybeans/isoflavones were the most commonly used, followed by equol and placenta. Participants in their teens and 20s also used P. mirifica. Among them, 16.2% had experienced adverse events, including irregular vaginal bleeding, breast swelling and pain, and heavy menstruation. In conclusion, estrogen-like supplement use is associated with adverse events; thus, it is necessary to pay attention to the use of these supplement. Furthermore, because the purpose of use differs depending on generation, caution according to each generation is necessary.

Dietary Supplement Use in Relation to Socio-Demographic and Lifestyle Factors, including Adherence to Mediterranean-Style Diet in University Students

The study aimed to examine socio-demographic and lifestyle determinants, including diet quality, of dietary supplement (DS) use among 2545 students who attended public universities in Warsaw. The data was collected using a self-administered health and lifestyle questionnaire and a 5-day dietary record method. Diet quality was assessed using a Mediterranean Diet Score. To determine the covariates of DS use, multivariate-adjusted logistic regression models with an estimation of odds ratios (ORs) and 95% confidence intervals (95% CIs) were used. The results showed that 41% of participants were DS users. The following predictors of DS use were identified: gender (male vs. female; OR:0.62, 95% CI:0.50–0.79), physical activity (high vs. low; OR:1.79, 95% CI:1.45–2.20), BMI (≥25 vs. 18.5–24.9 kg/m²; OR:0.77, 95% CI:0.61–0.98), cigarette smoking (yes vs. no; OR:0.67, 95% CI:0.52–0.86), and presence of chronic diseases (yes vs. no; OR:2.37, 95% CI:1.89–2.98). Moreover, higher nutritional knowledge, special diet usage, eating more meals/day, and fortified food consumption were determinants of DS use. Adherence to the Mediterranean-style diet was positively associated with DS use, a 1-score increment was associated with a 10% (p-trend = 0.011) higher probability of DS usage. Given that the use of vitamins and/or minerals is common among university students and their users are characterized by eating a higher quality diet, investigating the contribution of DS in overall dietary nutrient intake warrants further study.