Dietary supplements and disease prevention — a global overview

Key Points

  • In developing countries, limited access or adaptation to a healthful, well-balanced diet can cause micronutrient malnutrition, with irreversible health consequences affecting morbidity and mortality

  • Deficiencies in vitamin A and/or iron are prevalent among reproductive-aged women, infants and children in developing countries, with therapeutic doses required for treatment

  • In developing and developed countries, reproductive-aged women or those who are pregnant must ensure adequate intakes of folic acid, iron, calcium and iodine, which might require supplementation

  • In developed countries, adequate nutrient intake can usually be achieved through a well-balanced diet and supplementation might not confer additional health benefits (except among individuals with increased requirements)

  • Postmenopausal women and elderly men could benefit from a combination of low-dose calcium and vitamin D for bone health

  • Use of a multivitamin supplement with low levels of essential vitamins and minerals could be linked to reductions in the incidence of cancer and cataracts among men

Abstract

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.

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Acknowledgements

S.R. has received funding from COFAS 2 Marie Curie Fellowship, Stockholm, Sweden. J.E.M. has received grant or research support from the NIH (HL34594, CA138962 and HHSN268201100001C) for the for the VITamin D and OmegA-3 TriaL (VITAL) and other research studies. A.H.L has received funding from USDA 1950-51000-072-02S, USDA/NIFA/AFRI 2011-03389 and AHRQ/Contract HHSA290201200012I. H.D.S. has received grant support from the NIH (R01 HL102122) related to work on the VITamin D and OmegA-3 TriaL (VITAL).

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S.R. researched the data for the article. All authors provided a substantial contribution to discussions of the content. S.R., J.E.M., A.H.L. and H.D.S. contributed equally to writing the article. All authors contributed equally to review and/or editing of the manuscript before submission.

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Correspondence to JoAnn E. Manson.

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J.E.M. declares that she has received investigator-initiated grant support and/or donation of study pills from Mars Symbioscience, Pfizer Inc., PharmaViteProNova and BioPharma/BASF. H.D.S. declares that he has received investigator-initiated grant support (including donations of study pills) from the Council for Responsible Nutrition Foundation, Mars Symbioscience and Pfizer Inc. S.R. and A.H.L. declare no competing interests.

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Rautiainen, S., Manson, J., Lichtenstein, A. et al. Dietary supplements and disease prevention — a global overview. Nat Rev Endocrinol 12, 407–420 (2016). https://doi.org/10.1038/nrendo.2016.54

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