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Multivitamin/Mineral Supplements and Prevention of Chronic Disease
Evidence Reports/Technology Assessments, No. 139
Investigators: Han-Yao Huang, PhD, MPH, Benjamin Caballero, MD, PhD, Stephanie Chang, MD, MPH, Anthony Alberg, PhD, MPH, Richard Semba, MD, MPH, Christine Schneyer, MD, Renee F Wilson, MSc, Ting-Yuan Cheng, MSc, Gregory Prokopowicz, MD, MPH, George J Barnes, II, BA, Jason Vassy, and Eric B Bass, MD, MPH.
Structured Abstract
Objective:
To review and synthesize published literature on the efficacy of multivitamin/mineral supplements and certain single nutrient supplements in the primary prevention of chronic disease in the general adult population, and on the safety of multivitamin/mineral supplements and certain single nutrient supplements, likely to be included in multivitamin/mineral supplements, in the general population of adults and children.
Data Sources:
All articles published through February 28, 2006, on MEDLINE,® EMBASE,® and the Cochrane databases.
Review Methods:
Each article underwent double reviews on title, abstract, and inclusion eligibility. Two reviewers performed data abstraction and quality assessment. Differences in opinion were resolved through consensus adjudication.
Results:
Few trials have addressed the efficacy of multivitamin/mineral supplement use in chronic disease prevention in the general population of the United States. One trial on poorly nourished Chinese showed supplementation with combined β-carotene, vitamin E and selenium reduced gastric cancer incidence and mortality, and overall cancer mortality. In a French trial, combined vitamin C, vitamin E, β-carotene, selenium, and zinc reduced cancer risk in men but not in women. No cardiovascular benefit was evident in both trials. Multivitamin/mineral supplement use had no benefit for preventing cataract. Zinc/antioxidants had benefits for preventing advanced age-related macular degeneration in persons at high risk for the disease.
With few exceptions, neither β-carotene nor vitamin E had benefits for preventing cancer, cardiovascular disease, cataract, and age-related macular degeneration. β-carotene supplementation increased lung cancer risk in smokers and persons exposed to asbestos. Folic acid alone or combined with vitamin B12 and/or vitamin B6 had no significant effects on cognitive function. Selenium may confer benefit for cancer prevention but not cardiovascular disease prevention. Calcium may prevent bone mineral density loss in postmenopausal women, and may reduce vertebral fractures, but not non-vertebral fractures. The evidence suggests dose-dependent benefits of vitamin D with/without calcium for retaining bone mineral density and preventing hip fracture, non-vertebral fracture and falls.
We found no consistent pattern of increased adverse effects of multivitamin/mineral supplements except for skin yellowing by β-carotene.
Conclusion:
Multivitamin/mineral supplement use may prevent cancer in individuals with poor or suboptimal nutritional status. The heterogeneity in the study populations limits generalization to United States population. Multivitamin/mineral supplements conferred no benefit in preventing cardiovascular disease or cataract, and may prevent advanced age-related macular degeneration only in high-risk individuals. The overall quality and quantity of the literature on the safety of multivitamin/mineral supplements is limited.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- Purpose
- Specific Aims
- Use of Multivitamin/mineral Supplements in the United States
- Chronic Disease
- Common Pathologic Mechanisms of Chronic Diseases
- Possible Mechanisms of Action of Vitamins and Minerals in Chronic Disease Prevention
- Factors that Affect the Efficacy and Safety of Vitamin/mineral Supplement Use in Chronic Disease Prevention
- The Tolerable Upper Intake Levels of Daily Nutrient Intake
- Federal Regulation of Vitamin/mineral Supplements
- Conceptual Framework
- 2. Methods
- 3. Results
- 4. Discussion
- Summary of the Key Findings
- Efficacy of Multivitamin/mineral Supplements
- Efficacy of β-carotene
- Efficacy of Vitamin E
- Vitamin/mineral Supplement Use and Total Mortality
- Timing and Duration of Supplement Use
- Doses of Vitamin/mineral Supplements
- Safety Consideration
- Limitations
- Conclusions
- Future Research
- Implications
- Appendixes
- References and Included Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0018. Prepared by: The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.
Suggested citation:
Huang HY, Caballero B, Chang S, Alberg A, Semba R, Schneyer C, Wilson RF, Cheng TY, Prokopowicz G, Barnes II GJ, Vassy J, Bass EB. Multivitamin/Mineral Supplements and Prevention of Chronic Disease. Evidence Report/Technology Assessment No. 139. (Prepared by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018). AHRQ Publication No. 06-E012. Rockville, MD: Agency for Healthcare Research and Quality. May 2006.
This report is based on research conducted by The Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0018).The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
The investigators have no relevant financial interests in the report. The investigators have no employment, consultancies, honoraria, or stock ownership or options, or royalties from any organization or entity with a financial interest or financial conflict with the subject matter discussed in the report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Review The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference.[Ann Intern Med. 2006]Review The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference.Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR, Wilson RF, Cheng TY, Vassy J, Prokopowicz G, et al. Ann Intern Med. 2006 Sep 5; 145(5):372-85. Epub 2006 Jul 31.
- Drugs for preventing lung cancer in healthy people.[Cochrane Database Syst Rev. 2020]Drugs for preventing lung cancer in healthy people.Cortés-Jofré M, Rueda JR, Asenjo-Lobos C, Madrid E, Bonfill Cosp X. Cochrane Database Syst Rev. 2020 Mar 4; 3(3):CD002141. Epub 2020 Mar 4.
- Review Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force.[Ann Intern Med. 2013]Review Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force.Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Ann Intern Med. 2013 Dec 17; 159(12):824-34.
- NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention.[NIH Consens State Sci Statemen...]NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention.. NIH Consens State Sci Statements. 2006 May 15-17; 23(2):1-30.
- Review Drugs for preventing lung cancer in healthy people.[Cochrane Database Syst Rev. 2012]Review Drugs for preventing lung cancer in healthy people.Cortés-Jofré M, Rueda JR, Corsini-Muñoz G, Fonseca-Cortés C, Caraballoso M, Bonfill Cosp X. Cochrane Database Syst Rev. 2012 Oct 17; 10:CD002141. Epub 2012 Oct 17.
- Multivitamin/Mineral Supplements and Prevention of Chronic DiseaseMultivitamin/Mineral Supplements and Prevention of Chronic Disease
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