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).
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.
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.
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.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Pharmacy employees’ involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies
BMC Complementary and Alternative Medicine Open Access 19 July 2019
Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries
European Journal of Nutrition Open Access 28 March 2018
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Bates CJ, Prentice A, van der Pols JC, Walmsley C, Pentieva KD, Finch S et al. (1998). Estimation of the use of dietary supplements in the National Diet and Nutrition Survey: people aged 65 years and over. An observed paradox and a recommendation. Eur J Clin Nutr 52, 917–923.
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C (2007). Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 297, 842–857.
Bjelakovic G, Nikolova D, Simonetti RG, Gluud C (2004). Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet 364, 1219–1228.
Block G, Sinha R, Gridley G (1994). Collection of dietary-supplement data and implications for analysis. Am J Clin Nutr 59, S232–S239.
Brownie S, Myers S (2004). Wading through the quagmire: making sense of dietary supplement utilization. Nutr Rev 62, 276–282.
Brustad M, Braaten T, Lund E (2004). Predictors for cod-liver oil supplement use—the Norwegian Women and Cancer Study. Eur J Clin Nutr 58, 128–136.
Brustad M, Skeie G, Braaten T, Slimani N, Lund E (2003). Comparison of telephone vs face-to-face interviews in the assessment of dietary intake by the 24 h recall EPIC SOFT program—the Norwegian calibration study. Eur J Clin Nutr 57, 107–113.
Brzozowska A, Enzi G, Amorin CJ (2002). Medicine use and supplementation practice among participants of SENECA Study. J Nutr Health Aging 6, 34–38.
Conner M, Kirk SF, Cade JE, Barrett JH (2001). Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use. Soc Sci Med 52, 621–633.
Cruz JA, Moreiras-Varela O, van Staveren WA, Trichopoulou A, Roszkowski W (1991). Intake of vitamins and minerals. Euronut SENECA investigators. Eur J Clin Nutr 45 (Suppl 3), S121–S138.
de Jong N, Ocke MC, Branderhorst HA, Friele R (2003). Demographic and lifestyle characteristics of functional food consumers and dietary supplement users. Br J Nutr 89, 273–281.
Dwyer J, Picciano MF, Raiten DJ (2003). Collection of food and dietary supplement intake data: What we eat in America-NHANES. J Nutr 133, S590–S600.
Dwyer JT, Holden J, Andrews K, Roseland J, Zhao C, Schweitzer A et al. (2007). Measuring vitamins and minerals in dietary supplements for nutrition studies in the USA. Anal Bioanal Chem 389, 37–46.
Egeberg R, Frederiksen K, Olsen A, Johnsen NF, Loft S, Overvad K et al. (2009). Intake of wholegrain products is associated with dietary, lifestyle, anthropometric and socio-economic factors in Denmark. Public Health Nutr; 12, 1519–1530.
Elmståhl S, Wallström P, Berglund G, Janzon L, Johansson U, Larsson S et al. (1994). The use of dietary supplements in relation to dietary habits in a Swedish middle-aged population. Scand J Nutr 38, 94–97.
European Parliament and Council (2002). Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements. Off J Eur Commun L183, 12.07.2002, pp 51–57.
Food Standards Agency (2002). The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years. Vol. 1. Types and Quantities of Foods Consumed. HMSO: London.
Greger JL (2001). Dietary supplement use: consumer characteristics and interests. J Nutr 131, S1339–S1343.
Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR et al. (2006). 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 145, 372–385.
Jenab M, Salvini S, van Gils CH, Brustad M, Shakya-Shrestha S et al. (2009). Dietary intakes of β-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort. Eur J Clin Nutr 63(Suppl 4), S150–S178.
Johansson L, Solvoll K, Bjorneboe GEA, Drevon CA (1997). Dietary habits among Norwegian men and women. Scand J Nutr 41, 63–70.
Klipstein-Grobusch K, Kroke A, Voss S, Boeing H (1998). [Influence of lifestyle on the use of supplements in the Brandenburg nutrition and cancer study]. Z Ernahrungswiss 37, 38–46.
Knudsen VK, Rasmussen LB, Haraldsdottir J, Ovesen L, Bulow I, Knudsen N et al. (2002). Use of dietary supplements in Denmark is associated with health and former smoking. Public Health Nutr 5, 463–468.
Linseisen J, Welch AA, Ocké M, Amiano P, Agnoli C, Ferrari P et al. (2009). Dietary fat intake in the European Prospective Investigation into Cancer and Nutrition: results from the 24-h dietary recalls. Eur J Clin Nutr 63(Suppl 4), S61–S80.
Messerer M, Johansson SE, Wolk A (2001). Use of dietary supplements and natural remedies increased dramatically during the 1990s. J Intern Med 250, 160–166.
Messerer M, Johansson SE, Wolk A (2004). The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men. J Nutr 134, 1800–1805.
Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V et al. (2005). Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 16, 655–663.
Mulholland CA, Benford DJ (2007). What is known about the safety of multivitamin–multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 85, 318S–322S.
Ocké MC, Buurma-Rethans EJM, Fransen HP (2005). Dietary Supplement Use in the Netherlands. Current Data and Recommendations for Future Assessment. RIVM Report 350100001 National Institute of Public Health and the Environment (RIVM): Bilthoven, The Netherlands.
Olsen A, Halkjær J, van Gils CH, Buijsse B, Verhagen H, Jenab M et al. (2009). Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63(Suppl 4), S122–S149.
Palmer ME, Haller C, McKinney PE, Klein-Schwartz W, Tschirgi A, Smolinske SC et al. (2003). Adverse events associated with dietary supplements: an observational study. Lancet 361, 101–106.
Park SY, Murphy SP, Wilkens LR, Yamamoto JF, Kolonel LN (2006). Allowing for variations in multivitamin supplement composition improves nutrient intake estimates for epidemiologic studies. J Nutr 136, 1359–1364.
Pera G, Gonzales CA and Grupo EPIC en Espana (1999). Consumo de suplementos vitaminicos y minerales en poblacion adulta sana de cinco provincias de Espana. Gaceta Sanitaria 13, 326–327.
Radimer KL (2003). National nutrition data: contributions and challenges to monitoring dietary supplement use in women. J Nutr 133, 2003S–2007S.
Reinert A, Rohrmann S, Becker N, Linseisen J (2007). Lifestyle and diet in people using dietary supplements. Eur J Nutr 46, 165–173.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5 (Suppl), S1113–S1124.
Rock CL, Newman VA, Neuhouser ML, Major J, Barnett M (2004). Antioxidant supplement use in cancer survivors and the general population. J Nutr 134, S3194–S3195.
Serra Majem LI, Ribas L, Saiz de Bustamante P, Lopez Blanco F, Barbachano M (1996). Consumo de suplementos vitaminico-minerales en la poblacion espanola (1996). Nutricion Clinica 16, 7–15.
Skeie G, Hjartaker A, Lund E (2006). Diet among breast cancer survivors and healthy women. The Norwegian Women and Cancer Study. Eur J Clin Nutr 60, 1046–1054.
Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M et al. (2000). Standardization of the 24-h diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.
Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5 (Suppl), S1125–S1145.
Timbo BB, Ross MP, McCarthy PV, Lin CT (2006). Dietary supplements in a national survey: prevalence of use and reports of adverse events. J Am Diet Assoc 106, 1966–1974.
Touvier M, Kesse E, Volatier JL, Clavel-Chapelon F, Boutron-Ruault MC (2006). Dietary and cancer-related behaviors of vitamin/mineral dietary supplement users in a large cohort of French women. Eur J Nutr 45, 205–214.
Velicer CM, Ulrich CM (2008). Vitamin and mineral supplement use among US Adults after cancer diagnosis: a systematic review. J Clin Oncol 26, 665–673.
Wallström P, Elmståhl S, Hanson B, stergren P, Johansson U, Janzon L et al. (1996). Demographic and psychosocial characteristics of middle-aged women and men who use dietary supplements. Results from the Malmö Diet and Cancer Study. Eur J Public Health 6, 188–195.
WCRF/AICR (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. American Institute for Cancer Research/World Cancer Research Fund: Washington, DC.
Welch AA, Fransen H, Jenab M, Boutron-Ruault MC, Tumino R, Agnoli C et al. (2009). Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63(Suppl 4), S101–S121.
Yetley EA (2007). Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr 85, S269–S276.
The work of GS was supported by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation and the Norwegian Cancer Society.
This study was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l’Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean Association for Epidemiological Research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council; and the Norwegian Foundation for Health and Rehabilitation. We thank Connie Stripp for her efforts in classifying the Danish supplements, Sarah Somerville, Nicole Suty and Karima Abdedayem for assistance with editing and Kimberley Bouckaert and Heinz Freisling for technical assistance.
Guarantor: G SkeieContributors: 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.
Rights and permissions
About this article
Cite this article
Skeie, G., Braaten, T., Hjartåker, A. et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr 63 (Suppl 4), S226–S238 (2009). https://doi.org/10.1038/ejcn.2009.83
- dietary supplements
- 24-h dietary recall
This article is cited by
Dietary intake of total, heme and non-heme iron and the risk of colorectal cancer in a European prospective cohort study
British Journal of Cancer (2023)
Understanding nutritional intake of Chinese farmers from the perspective of sustainable livelihood analysis
Environmental Science and Pollution Research (2021)
Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment
Current Cardiology Reports (2020)
Pharmacy employees’ involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies
BMC Complementary and Alternative Medicine (2019)
No association between vitamin C and E supplementation and grip strength over 5 years: the Colaus study
European Journal of Nutrition (2019)