Original Article

European Journal of Clinical Nutrition (2009) 63, S226–S238; doi:10.1038/ejcn.2009.83

Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study

Guarantor: G Skeie
Contributors: GS performed statistical analyses and wrote the article. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. GS, ML, PA, PJ, VP, AP, EMN, KA, TP, MN, MT, KN, JH, LW, ES, AO, SN, VH, GD, CC, DE contributed to the reclassification of data from their respective countries, and gave input on statistical analyses, interpretation of results and drafting of the article. TB, AH, HV, PW, MCBR, PF, EL, NS gave input on the statistical analyses, interpretation of results and drafting of the manuscript. The other co-authors were local EPIC collaborators involved in the design of the study and data collection. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the article and approved the final version.

G Skeie1, T Braaten1, A Hjartåker2, M Lentjes3, P Amiano4, P Jakszyn5, V Pala6, A Palanca6, E M Niekerk7, H Verhagen7, K Avloniti8, T Psaltopoulou8, M Niravong9, M Touvier9,10, K Nimptsch11,27, J Haubrock12, L Walker13, E A Spencer13, N Roswall14, A Olsen14, P Wallström15, S Nilsson16, C Casagrande17, G Deharveng17, V Hellström16, M-C Boutron-Ruault9, A Tjønneland14, A M Joensen18, F Clavel-Chapelon9, A Trichopoulou8, C Martinez19, L Rodríguez20, G Frasca21, C Sacerdote22, P H M Peeters23, J Linseisen11,28, A Schienkiewitz12, A A Welch3,30, J Manjer24, P Ferrari17,29, E Riboli25, S Bingham3,26,malt, D Engeset1, E Lund1 and N Slimani17

  1. 1Institute of Community Medicine, University of Tromsø, Tromsø, Norway
  2. 2Cancer Registry of Norway, Oslo, Norway
  3. 3Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK
  4. 4Public Health Department of Guipuzkoa, Basque Government, San Sebastian and CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  5. 5Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain
  6. 6Nutritional Epidemiology Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  7. 7National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  8. 8Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
  9. 9INSERM, ERI 20, Institut Gustave Roussy, Villejuif, France
  10. 10AFSSA (French Food Safety Agency), DERNS/PASER, Maisons-Alfort, France
  11. 11Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
  12. 12Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
  13. 13Cancer Epidemiology Unit, University of Oxford, Oxford, UK
  14. 14Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
  15. 15Department of Clinical Sciences, Lund University, Malmö, Sweden
  16. 16Department of Nutritional Research, University of Umeå, Umeå, Sweden
  17. 17Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
  18. 18Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
  19. 19Andalusian School of Public Health, Granada and CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  20. 20Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
  21. 21Cancer Registry, Azienda Ospedaliera 'Civile - M.P. Arezzo', Ragusa, Italy
  22. 22Institute for Scientific Interchange Foundation, Turin, Italy
  23. 23Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  24. 24Department of Surgery, Malmö University Hospital, Malmö, Sweden
  25. 25Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK
  26. 26Diet and Cancer Group, MRC Mitochondrial Biology Unit, Cambridge, UK

Correspondence: G Skeie, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway. E-mail: Guri.Skeie@uit.no

27Current address: Harvard School of Public Health, Department of Nutrition, Boston, USA

28Current address: Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany

29Current address: Data Collection and Exposure Unit (DATEX), European Food Safety Authority, Parma, Italy

30Current address: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

maltThe author is deceased.

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Abstract

Background:

 

Dietary supplement use is increasing, but there are few comparable data on supplement intakes and how they affect the nutrition and health of European consumers. The aim of this study was to describe the use of dietary supplements in subsamples of the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Methods:

 

Specific questions on dietary supplement use were asked as a part of single 24-h recalls performed on 36 034 men and women aged 35–74 years from 1995 to 2000.

Results:

 

Between countries, the mean percentage of dietary supplement use varied almost 10-fold among women and even more among men. There was a clear north–south gradient in use, with a higher consumption in northern countries. The lowest crude mean percentage of use was found in Greece (2.0% among men, 6.7% among women), and the highest was in Denmark (51.0% among men, 65.8% among women). Use was higher in women than in men. Vitamins, minerals or combinations of them were the predominant types of supplements reported, but there were striking differences between countries.

Conclusions:

 

This study indicates that there are wide variations in supplement use in Europe, which may affect individual and population nutrient intakes. The results underline the need to monitor consumption of dietary supplements in Europe, as well as to evaluate the risks and benefits.

Keywords:

dietary supplements, Europe, EPIC, 24-h dietary recall, vitamins, minerals

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