Health habits and other characteristics of dietary supplement users: a review – Nutrition Journal

numerous surveys indicate that somewhere between one-half and three-quarters of American adults use dietary supplements – largely vitamins and minerals, but besides omega-3 fatty acid fatty acids, early bioactives such as xanthophyll, and other food components such as fiber [ 1 – 4 ]. together, these surveys provide meaningful insight into not lone the demographics but besides the health and life style habits of dietary append users. In many published articles, however, the health and life style habits are noted in passing but not emphasized and consequently possibly not fully appreciated within the nutrition, public health, and checkup communities. The aim of this review is to accumulate and compare the available data on the health habits of dietary supplement users, to provide a sharper insight into the generally convinced life style choices of this large segment of the american english population. The testify from numerous surveys shows that dietary supplement users are more likely than nonusers to adopt a number of convinced health-related habits [ 1 – 4 ]. These include better dietary patterns, exercising regularly, maintaining a healthy body system of weights, and avoidance of tobacco products. The differences between accessory users and nonusers seen in diverse studies are not huge but are systematically observed, indicating that supplement users are making a greater feat to seek health and health. dietary accessory users differ from nonusers in demographic characteristics as good. For case, supplement use in adults has been systematically reported to increase with historic period, income, and education ; and within each age group, women are more likely to use supplements than men [ 1 – 4 ]. These demographic factors may besides be related to ascertained differences in health awareness and health habits of addendum users, compared to nonusers – but the differences in health habits systematically remain significant even after adjusting for demographic factors, in most studies and for most population groups .

What is the “real” prevalence of dietary supplement use?

The prevalence of dietary supplement use reported in a view depends in share on the accurate question posed in the surveil. In the National Health and Nutrition Examination Surveys ( NHANES ), people are asked whether they used dietary supplements in the calendar month anterior to the interview. A calendar month is a very short clock time, therefore this interview will not capture all the addendum use that may have occurred seasonally or occasionally over the past class. It will capture people who use supplements on a even basis, plus those episodic users who happen to have taken the accessory in the calendar month before the interview. Based on this question, the NHANES surveys that collected data in 1999–2000, 2003–2006, and 2007–2010 have reported that about half of adult Americans use dietary supplements ( image of 49 % to 54 % ) [ 1 – 3 ]. This may be an undervalue of overall habit, since it fails to include all seasonal worker or periodic users. A series of nationally spokesperson consumer surveys conducted by Ipsos Public Affairs for the Council for responsible Nutrition ( CRN ) illustrates this point. The CRN surveys for the five-year period from 2007 to 2011 find oneself that 48 to 53 % ( average of 50 % ) of consumers considered themselves “ regular ” users of dietary supplements, while the overall prevalence of supplement practice was 64 to 69 % ( average of 66 % ) when periodic and seasonal worker users were included [ 5 ]. Results of these surveys suggest that the prevalence of regular append use among U.S. adults is about 50 %, but the overall prevalence of supplement consumption may be closer to two-thirds of the adult population.

Usage higher in women; increases with age

many surveys confirm that dietary addendum manipulation is more prevailing in older age groups than in younger adults, and in each age group use is higher in women than in men [ 1 – 4 ]. Diet and health surveys suggest that women may be more health conscious than men ; however the increased rates of accessory use among women could besides partially be attributed to the increased use of supplementary calcium and vitamin D among women for the aim of maintaining bone health throughout the life and preventing the attack of osteoporosis during aging. table 1 shows the preponderance of supplement use in men and women in respective senesce groups in the National Health and Nutrition Examination Surveys ( NHANES ) conducted in 2003–2006 [ 1 ]. As historic period increases, the prevalence of dietary append consumption in men increases from 36 % to 66 %, and the preponderance of use in women increases from 43 % to 75 %. In each age group, custom is 7 to 14 % higher in women than in men ( on average, 10 % higher ) .Table 1
Prevalence of dietary supplements use in men and women, by age group, NHANES 2003–2006 [1]
Full size table In the Multiethnic Cohort study, researchers found that the prevalence of dietary accessory habit in more than 100,000 healthy adults over the age of 45 was 58 % in men and 72 % in women, which are the same levels reported in NHANES 2003–2006 for men and women ages 51–70 [ 4 ]. The Vitamins and Lifestyle ( VITAL ) survey, which sampled more than 45,000 adults 50 or more years of age, reported that over 75 % of respondents used at least one of the 17 dietary supplements examined [ 6 ] .

Race, ethnicity

The prevalence of supplement use varies with race or ethnicity and is broadly found to be highest in non-Hispanic Whites ( future simply Whites ). In the NHANES surveys in 1999–2000 and 2003–2006, dietary supplement use was about 60 % in Whites, 36 % in Blacks, and about 34 % in Hispanics [ 1, 2 ]. These differences were not observed or were less marked in the Multiethnic cohort, where supplement function was reported by 69 % of Whites, 68 % of japanese Americans, 66 % of african Americans, 62 % of Latinos, and 53 % of native Hawaiians [ 4 ] .

Number of supplements taken

many users of dietary supplements take more than one product, but taking only one remains the most common rule. In NHANES 1999–2000, 47 % of accessory users took lone one supplement, 23 % took two, 13 % took three, and 17 % took four or more [ 2 ]. In NHANES 2003–2006, more than half of accessory users reported taking entirely one, but 10 % took more than 5 [ 1 ] .

Prevalence of multivitamin use among supplement users

Most users of dietary supplements take a multivitamin ( with or without minerals ), whether or not they besides take other products. In NHANES 1999–2000, among append users, 67 % took a multivitamin [ 2 ]. In NHANES 2003–2006, 74 % of supplement users took a multivitamin [ 1 ]. The term “ multivitamin ” is not clearly defined, for purposes of scientific sketch, and surveys have applied diverse definitions. In the NHANES surveys, a “ multivitamin ” has generally been defined as a intersection containing three or more vitamins, with or without minerals, but this can vary from one NHANES report to another [ 1, 2 ]. The term “ multivitamin ” in commercial practice typically denotes a product containing all or most of the vitamins, whereas a product containing numerous minerals in accession to the vitamins is typically labeled as a “ multivitamin/multimineral ”. In the Multiethnic cohort, most supplement users took a multivitamin, and vitamin C was the most normally use supplement, after multivitamins [ 4 ]. In CSFII 1994–96, among append users over long time 50, 70 % of women and 74 % of men who took supplements took a multivitamin [ 7 ]. In a consumer survey sponsored by the Council for creditworthy nutriment in 2011, multivitamins were the most normally use supplement, reported by 71 % of append users [ 5 ] .

Frequency and duration of supplement use

Users of dietary supplements typically take their choose products every day, and many adhere with their accessory regimen for years. therefore, supplement function does not appear to be a pass fondness, but more of a planned scheme that is frequently maintained over the long haul. In NHANES 2003–2006, most accessory users ( 79 % ) reported taking the supplements every day within the by 30 days [ 1 ]. In NHANES 1999–2000, 85 % of those who took a multivitamin took it day by day, as did 82 % of those who took vitamin C and 90 % of those who took vitamin E [ 2 ]. besides, 25 % of those who took a multivitamin had been taking it for 5 years or more, as had 38 % of those who took vitamin C and 34 % of those who took vitamin E [ 2 ]. many respondents had used the supplements for 10 years or more, including 14 % of those who took a multivitamin, 29 % of those who took vitamin C, and 22 % of those who took vitamin E [ 2 ]. xIn the Multiethnic healthy cohort, over 60 % of white or Japanese-American supplement users, about 50 % of black or native hawaiian supplement users, and about 40 % of Latino supplement users reported taking multivitamins regularly for 5 years or more [ 4 ]. Longterm use of vitamin A, vitamin C, vitamin E, calcium and iron was besides hearty .

Prevalence of supplement use in U.S. has increased over time

Dietary supplement use among american adults is not a fresh phenomenon, but is documented throughout the NHANES serial of surveys, beginning over 40 years ago, in 1971 [ 1 – 3, 8 – 10 ]. As shown in board 2, the prevalence of dietary supplement use in adults was already hearty in 1971 and increased steadily in every NHANES survey until the deep 1990s. The preponderance was 23 % in the early on 1970s, 35 % in the late 1970s, 42 % in 1988–94, and then rose to about 50 % by 1999 and remained fairly regular around that level through 2010 [ 1 – 3, 8 – 10 ]. Although it is sometimes assumed that there was a acuate increase in append practice after the passage of the Dietary Supplement Health and Education Act ( DSHEA ) in 1994, the data do not show a unique jump in custom at that time. The increase from one NHANES survey to the following was 12 % between the first and second and 7 % between the second base and third. An increase of 10 % was reported from the 1988–1994 review to the 1999–2000 survey, spanning the period from six years before to six years after passage of DSHEA. Since 1999–2000, the prevalence of supplement use reported in NHANES has remained roughly steadily at about half the adult population ( 49 to 54 % ) [ 1 – 3 ] .Table 2
Increase in prevalence of dietary supplement use over time as shown in a series of NHANES surveys
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Higher education is associated with supplement use

Surveys systematically show that supplement usage is higher in people with more department of education than in people with less. In NHANES 2003–2006, supplements were used by 61 % of those with more than a high school department of education and by only 37 % of those with less than a high school education [ 1 ]. In NHANES 1999–2000, supplements were used by 62 % of those with more than a high school department of education, 48 % of those with a high school education, and merely 35 % of those with less than a high school department of education [ 2 ]. In the Multiethnic cohort and the VITAL sketch, educational level was besides positively associated with append use [ 4, 6 ] .

Obese people are less likely to be supplement users

One healthy habit that appears to be adopted by addendum users is to make more of an attempt to maintain a normal consistency slant, or at least to avoid fleshiness. In NHANES 2003–2006, supplement function was reported by 56 % of people with normal burden and by 57 % of fleshy people, as compared to entirely 48 % of corpulent subjects [ 1 ]. similar findings were reported in NHANES 1999–2000 [ 2 ]. In the Multiethnic age group, corpulent persons were besides found to be less likely to adopt supplement use [ 4 ] .

People who exercise are more likely to use supplements

Another healthy habit that tends to be reasonably more park among append users than nonusers is the commit of getting regular physical practice. In NHANES 1999–2000, supplement use was 59 % in subjects who reported centrist or vigorous physical activity, compared to 43 % in subjects who reported no physical bodily process [ 2 ]. In the Multiethnic cohort, engaging in regular physical bodily process was besides positively associated with append use [ 4 ] .


Avoiding smoke is universally accepted as a desirable health or life style drill, and users of dietary supplements tend to be people who have never smoked or who have given up smoking. stream smokers are less likely to be supplement users. In NHANES 1999–2000, supplement habit was reported by 61 % of former smokers and 52 % of people who had never smoked, compared to 43 % of current smokers [ 2 ]. In the Multiethnic cohort, current smokers were besides found to be less probably to report supplement use [ 4 ] .

Beer, wine and spirits

In the foremost NHANES survey ( 1971–74 ), it was observed that drinking wine was associated with a higher prevalence of dietary supplement practice, while there was no association with beer drinking [ 10 ]. It was speculated that this was related to the slightly higher socioeconomic condition of accessory users.

In NHANES 1999–2000, addendum use was highest ( 72 % ) in people who drink wine more than 4 times a calendar month, compared to 59 % in subjects who drink wine 1–4 times a month and 47 % in those who do not drink wine, while there was little or no relationship to beer drinking [ 2 ]. Supplement consumption was besides higher in those who drink distilled spirits more than 4 times a calendar month ( 62 % ) than in those who do not drink distill spirits ( 51 % ). As in NHANES I, these relationships are likely related to socioeconomic condition. Drinking wine or spirits more than four times a calendar month in no manner suggests excessive consumption .

Reasons for using dietary supplements

Surveys typically inquire about dietary addendum use but not about the reasons for using such products. A reputation on NHANES 2007–2010 for the first time reports national survey data on consumers ’ reasons for using dietary supplements [ 3 ]. The Council for responsible Nutrition ( CRN ) has conducted two series of surveys, one series on consumer use of supplements and one series on health professionals ’ use of supplements, and these surveys besides include an analysis of the reasons given for append use [ 5, 11 – 13 ]. postpone 3 shows comparative data from these three sources, relating to the reasons people give for using dietary supplements. From the CRN surveys, the table shows the 2011 data on consumer reasons for using supplements and the 2009 data on dietitians ’ reasons for using supplements [ 5, 11 ]. Improving or maintaining overall health, supporting bone health, and filling alimentary gaps crying at or near the top in all these surveys .Table 3
Percent of subjects citing various reasons for using dietary supplements, in NHANES 2007–2011 and in two CRN surveys, one in 2011 on consumer use of dietary supplements and one in 2009 on use by dietitians
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Are people with disease more likely to use supplements?

Some surveys have examined the kinship between supplement consumption and aesculapian conditions. analysis of the 2001 and 2003 California Health Interview Surveys identified 1576 cancer survivors and 4951 subjects with no history of cancer [ 14 ]. When accessory usage was examined, the authors found that “ a diagnosis of cancer, by itself, does not have an autonomous effect on addendum use [ 14 ] ”. however, most cancer survivors have other chronic conditions ( cardiovascular, respiratory, diabetes, arthritis, and so forth ). The prevalence of using two or more dietary supplements was 52 % in people with no noncancer chronic conditions, 64 % in people with one noncancer chronic condition, and 71 to 76 % in people with two or more noncancer chronic conditions [ 14 ]. In the Vitamins and Lifestyle ( VITAL ) review, overall supplement use in more than 45,000 respondents was 75 % [ 6 ]. Respondents were 50 to 75 years of age. While people with disease or health complaints were no more likely to be supplement users than people without disease, the issue of supplements used was slightly higher among people with a disease or health condition than among people without it. The conditions examined ranged from serious diseases such as heart disease and cancer to conditions such as arthritis and asthma to complaints such as chronic back pain, frequent heartburn, allergies, and chronic fatigue. About 55 % of the subjects surveyed in VITAL had some health ailment and 45 % had none. Those with some health charge used an median of 1.5 supplements, while those without a health complaint used an median of 1.35 supplements [ 6 ]. About 22 % of the respondents had some unplayful disease and 78 % did not. Those with some unplayful disease used an modal of 1.7 supplements, while those with no serious disease used an average of 1.6 supplements [ 6 ]. These studies do not suggest that people with disease on the spur of the moment become users of dietary supplements. rather, it seems possible that people who are already supplement users may decide to add something extra to their regimen, relating to a health ailment or disease condition .

Diet quality

People who use dietary supplements are more probably than nonusers to pay attention to their diets and to make an campaign to improve dietary intake. In people over 50, in the CSFII 1994–96, the perceive importance of consuming a healthy diet was “ a significant forecaster of append habit [ 7 ] ”. In the Multiethnic cohort, persons who consumed diets eminent in fat or low in fiber or humble in fruit were less probably to use dietary supplements [ 4 ]. frankincense, dietary supplement use was related to consuming better diets, in terms of being lower in fatness and higher in roughage and higher in fruits. The authors of the report on the Multiethnic cohort concluded that the findings “ suggest that a ‘ health conscious ’ attitude predominates among dietary append users [ 4 ] ” .

Nutrient intake from multivitamins

In the Multiethnic age group, alimentary intake specifically from multivitamins was examined. Among 159,017 people who responded to a 1999–2001 survey on food inhalation from supplements, about 50 % reported use of multivitamin products ( with or without minerals ) [ 15 ]. median daily food intakes from multivitamin/multimineral supplements were good above the RDA or AI for : vitamin A, vitamin b1, vitamin b2, niacin, pantothenic acerb, vitamin B-6, vitamin bc, vitamin B-12, vitamin E, zinc, copper, manganese, molybdenum, and chromium. median intakes were stopping point to or below the RDA or AI for biotin, vitamin C, and vitamin D. Median intakes of calcium and selenium were a lot less than the RDA or AI. Ninetieth percentile intakes of nutrients from multivitamins were below the UL except for vitamin A, niacin, and vitamin bc .

Nutrient intakes of supplement users vs nonusers

An analysis of CSFII, 1994–96, reported that append users over the age of 50 were less likely than nonusers to have inadequate food intakes from food alone ( as compared to the EAR ) [ 7 ]. regular accessory use “ reduced the percentage of older adults with inadequate intakes by at least three-fourths for most nutrients [ 7 ] ”. The authors commented : “ Supplements had a plus influence on alimentary sufficiency for men and women aged 51 years and older. Whereas dietary modifications to improve consumption are overriding, the consumption of supplements by older adults appears beneficial to attain food sufficiency [ 7 ] ”. Murphy et aluminum. examined food consumption from food and supplements in subjects in the Multiethnic Cohort who took multivitamins ( with or without minerals or other components ), compared to people who did not take any vitamin or mineral supplements [ 16 ]. alimentary inhalation from food only was calculated for people who did not use any multivitamins or other supplements included in the view ( 38,374 men and 31,341 women ). nutrient consumption from food alone and from food plus supplements was calculated for people who used a multivitamin for two years or more but did not take any of the specified single supplements ( 11,125 men and 9,931 women ). The probability of food sufficiency was calculated for 17 nutrients. The “ prevalence of dietary food adequacy based on food consumption entirely was similar for multivitamin supplement users and nonusers [ 16 ] ”. The average prevalence of adequacy for all 17 nutrients in men was 74 % for nonusers and 76 % for multivitamin users. The modal preponderance of sufficiency for women was 72 % for nonusers and 75 % for multivitamin users. When nutrients from food and supplements were included, the prevalence of sufficiency for people who used multivitamins was 84 % for men and 83 % for women. The Multiethnic Cohort cogitation found that some people consumed more than the UL ( Upper Level of Tolerable Intake ) for some nutrients from food alone ( niacin, vitamin bc, vitamin A, iron, zinc, calcium ) [ 16 ]. When food plus supplement inhalation was included, over 50 % of men and over 40 % of women who used multivitamins consumed more than the UL for niacin and for vitamin bc. Over 15 % consumed more than the UL for vitamin A, and over 10 % consumed more than the UL for iron. More than 10 % of men and about 10 % of women who used multivitamins consumed more than the UL for zinc. The UL is defined as the highest horizontal surface of casual inhalation that is likely to pose no risk of adverse effects for about all healthy people. As consumption increase above the UL, the risk of adverse effects may increase. More inquiry is needed regarding the significance of intakes above the UL, specially for nutrients such as niacin, vitamin bc, vitamin A, and zinc, where the UL is alone two or three times greater than the RDA. ( For comparison, the ULs for vitamin C and vitamin einsteinium are, respectively, more than 20 and more than 60 times the RDA ). It would be desirable for consumers and healthcare professionals to be aware of these levels, and companies that market dietary supplements should put a precedence on tailoring formulations to provide meaningful supplementation without exceeding ULs. Fulgoni, Bailey and co-authors examined sources of alimentary intake in NHANES 2003–2006 [ 17 ]. They found that many Americans of all ages failed to consume the calculate average Requirement ( EAR ) for many nutrients, when entirely naturally-occurring nutrients in foods were considered. The authors make no comparisons of alimentary intakes to Recommended Dietary Allowances ( RDA ), but obviously people who were below the EAR were evening further below the RDA, which is by definition higher. Nutrients added in enrichment and fortification decreased the prevalence of intakes below the EAR, and the function of dietary supplements further decrease shortfalls [ 17 ]. For exemplar, more than half of the respondents fell short-circuit of the EARs for vitamin A and calcium, when only naturally-occurring nutrients were considered. When enrichment and fortification were taken into account, the prevalence of shortfalls fell below 50 % for both nutrients. When supplementation was taken into bill, the prevalence of shortfalls for these two nutrients fell far, but remained above 33 %. These same authors individually examined nutrient intakes from food in 8,860 adults surveyed in NHANES 2003–2006 and calculated alimentary intakes of dietary append users as compared to nonusers [ 18, 19 ]. They found that people who used dietary supplements had slightly higher intakes of most nutrients from food entirely ( not counting the nutrients in dietary supplements ) than people who were not addendum users. The prevalence of intakes below the EAR was significant for many nutrients, in people who were not append users, as shown in mesa 4. The prevalence of intakes below the EAR fell preferably dramatically for users of dietary supplements, when the nutrients contributed by the supplements were taken into account, as besides shown in mesa 4. however, for some nutrients such as vitamin D and calcium, the prevalence of intakes below the EAR remained solid ( 25 % and 20 %, respectively ), tied including supplementary intakes [ 18, 19 ] .Table 4
Percent of adults with nutrient intakes below the Estimated Average Requirement (EAR), for nonusers of dietary supplements as compared to users of dietary supplements (DS users), in NHANES 2003-2006
Full size table append use among respondents in NHANES 2003–2006 slightly increased the gamble of exceeding the degree designated as the Upper Level of Tolerable Intake ( UL ) for some nutrients [ 18, 19 ]. For example, 1 to 2 % of adult supplement users in versatile historic period groups had vitamin C intakes that were above the UL, and 1 to 5 % of adult supplement users in assorted age groups had vitamin A intakes that were above the UL. Results for most minerals were exchangeable, but the preponderance of intakes above the UL was higher for some minerals. For exercise, in people 51 to 70 years of age, 14 % of men and 6 % of women who used supplements had iron intakes above the UL.

Special populations: users of food stamps

A study of nutrient intakes in food revenue stamp recipients in the 1994–96 CSFII found that append usage was lower in food postage recipients than in non-recipients [ 20 ]. ( The program historically known as “ food stamps ” is now called the Supplemental Nutrition Assistance Program or SNAP, but the older term was used in the article and frankincense is used here. ) department of agriculture does not permit the consumption of food stamps for the buy of dietary supplements, but many food revenue stamp users purchase these products with their own resources. Among food stamp recipients, supplements were used by 41 % of women and 26 % of men, while among people who did not receive food stamps, supplements were used by 57 % of women and 43 % of men [ 20 ]. addendum users had higher vitamin and mineral densities from food than nonusers – approximately 10 to 20 percentage higher. They besides scored higher on two measures of diet quality. however, these results were not uniform for all heathen, gender, and age groups [ 20 ] .

What about people who use numerous supplements for many years?

A unique survey by Block and co-authors examined the health status of 278 people who had used numerous dietary supplements for 20 years or more [ 21 ]. They used products made by a major multilevel selling company and took an average of 18 unlike products every day. These health status of these “ heavy users ” was compared to 602 nonusers and 176 users of a multivitamin merely, matched for old age and raceway, draw from NHANES surveys. The products used day by day by more than 50 % of the heavy users included a multivitamin/mineral, B complex, vitamin C, carotenoids, vitamin E, calcium with D, omega-3 fatty acid fatso acids, flavonoids, lecithin, alfalfa, coenzyme 10 with resveratrol, glucosamine, and an herbal immune addendum. Among women, the majority besides consumed gamma linolenic acid and a probiotic supplement [ 21 ]. Among men, the majority besides consumed zinc, garlic, saw palmetto, and a soy protein supplement. “ After adjustment for long time, sex, income, education and body mass index, greater degree of supplement use was associated with more friendly concentrations of serum homocysteine, C-reactive protein, high-density lipoprotein cholesterol, and triglycerides, ampere well as lower risk of prevailing elevated blood pressure and diabetes [ 21 ] ” .

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