JAMA 2022;327:2334-47. Nutrition intervention trials in Linxian, China: Multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. . In Canada, almost all prenatal MVM supplements provide 1,000 mcg/day of folic acid. Be sure to check the percent daily value (% DV) to see what proportion of your daily allotment youregetting. Studies of the association between MVM use and CVD outcomes have focused on several outcomes, including cardiovascular events and mortality. Arch Intern Med 2004;164:2335-42. Saturated fat : A type of fat found in abundance in butter, whole milk, ice cream, full-fat cheese, fatty meats, poultry skin, and palm and coconut . 2007;1:42-55. [, Baker LD, Manson JE, Rapp SR, Sesso HD, Gaussoin SA, Shumaker SA, et al. Formulations for children, adult men and women, pregnant people, and seniors typically provide different amounts of the same vitamins and minerals to meet the needs of these populations. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative. October 11, 2022 Among the 69.8% who took a dietary supplement (most likely a prenatal MVM supplement), the risk of inadequate intakes of many nutrients was lower. Folic acid supplementation for the prevention of neural tube defects. Manufacturers sometimes offer these MVMs in packs of two or more pills for users to take daily. Multivitamins in the prevention of cancer and cardiovascular disease: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. Dark stools. Multivitamins and minerals are also used to treat vitamin or mineral deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, certain medications, and many other conditions. Studies of MVM users reveal no adverse effects, except that both treatment and placebo groups in some studies experienced some minor gastrointestinal issues [61]. Mishra S, Stierman B, Gahche JJ, Potischman N. Stierman B, Mishra S, Gahche JJ, Potischman N, Hales CM. Some MVMs contain amounts of some vitamins and minerals that are substantially higher than the DV, RDA, AI, or even, in some cases, the established Tolerable Upper Intake Level (UL). Am J Clin Nutr 2022;115:1501-10. However, use of MVs or MVMs conferred no protection among participants consuming less than two alcoholic beverages per day, whereas use among those consuming more was associated with a 29% lower risk of colon cancer mortality. Varying definitions of MVMs and the ability of manufacturers to change the composition of their products at will further complicate the study of MVMs' potential health impacts because different studies do not use products of similar composition. The FNB notes that RDAs and AIs for nutrients are levels of intake to ingest, on average, each day from the diet [6]. Many multivitamin products also contain minerals such as calcium, iron, magnesium, potassium, and zinc. The known vitamins include A, C, D, E, and K, and the B vitamins: thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxal (B6), cobalamin (B12), biotin, and folate/folic acid. Am J Clin Nutr 2010;91:1268-1272. The studies included a total of 91,074 healthy adults (average age 62 years) taking the MVs or MVMs for an average of 43 months, and the investigators reported 8,794 deaths. Theoretical basis for harm. Office of Dietary Supplements. 8. Most studies of the potential value of MVMs to enhance health and prevent disease have been observational and compared individuals who chose to take MVM supplements with others who did not take supplements. Further metabolism of vitamin D to its major circulating form (25(OH)D) and hormonal form (1,25(OH)2D) takes place in the liver and kidney, respectively, but also in other tissues where the 1,25(OH)2D produced serves a paracrine/autocrine function . [, Grodstein F, O'Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Taking excess vitamin A (as retinol or other preformed forms of vitamin A but not beta-carotene) during pregnancy can increase the risk of birth defects in infants. JAMA 2012;308:1751-60. Multivitamin/mineral supplements (MVM) are widely used in many populations. MVM supplementation did not have a beneficial or harmful effect on risk of stillbirths or of perinatal and neonatal mortality in comparison with iron and folic acid supplementation. [, Park S-Y, Murphy SP, Wilkens LR, Henderson BE, Kolonel LN. What is a multivitamin? Vitamin B5. Nutrients 2017, 9, 849. Observational studies The USPSTF also noted that beta-carotene supplementation may increase the risk of mortality from CVD. After the investigators followed participants for up to 20 additional years, when participants were no longer taking the study supplement, the use of the MVMs during the RCT did not result in lower rates of total mortality or mortality from any cause of death examined, including cancer, heart disease, and stroke [45]. Check Price on Amazon. The DGA, noting the difficulty of obtaining sufficient vitamin D from foods, advises that young children might need to continue taking a vitamin D supplement after age 12 months [54]. One RCT randomized 1,708 participants aged 50 years and older who had had an MI at least 6 weeks earlier to take a daily MVM containing 27 nutrients (many in doses higher than recommended amounts) for a median of 31 months (range 13 to 60 months) or a placebo as well as their standard medications. Eye floaters are small, semi-transparent specks or cobweb-like substances that appear to float in the eye's vitreous humor, which is the clear, gel-like fluid that fills . RCTs MVMs and Use of Supplements Containing Individual Nutrients Found in MVMs Adults in their 50s and older The trials included 141,849 pregnant people from low- or middle-income countries in Africa and Asia as well as in Mexico (where malnutrition and micronutrient deficiencies are not uncommon); only one of the studies was conducted in a high-income country, the United Kingdom. The NCCIH Clearinghouse provides information onNCCIHand complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. By age 71 or older, 48% of women and 43% of men were taking supplements. [, Sesso HD, Rist PM, Aragaki AK, Rautiainen S, Johnson LG, Friedenberg G, et al. This section summarizes the evidence on the use of MVMs to increase nutrient intakes and to improve health or prevent chronic disease. Phytochemicals present in honey can mitigate the primary mechanisms of oxidative stress and are deliberated as nutraceutical food responsible for mitigating risk factors for cancer and cardiovascular diseases. MVM use is less common among smokers and members of certain ethnic and racial groups, such as African Americans, Hispanics, and Native Americans, than among Whites. JAMA 2017;317:183-9. Iron is necessary for the production of hemoglobin. A review of 16 RCTs of MVs and MVMs (containing more than four nutrients including, in most cases, at least one mineral) in 1,719 participants who had at least one of six types of psychiatric symptoms (depression, post-disaster stress, antisocial behavior, behavioral deficits in dementia, attention-deficit/hyperactivity disorder, or autism) found that the supplements provided no clear reduction in symptoms [47]. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. MVMs taken once a day that contain all or most vitamins and minerals, most in amounts that do not exceed the Daily Values (DVs), Recommended Dietary Allowances (RDAs), or Adequate Intakes (AIs) for these nutrients. Improve health or prevent chronic disease For example, the Agency for Healthcare Research and Quality, in an evidence-based review of the role of MVMs in chronic disease prevention, defined MVMs as products containing at least three vitamins and minerals in amounts below the UL but no herbs, hormones, or drugs [7]. 1. The randomized Linxian dysplasia nutrition intervention trial after 26 years of follow-up: No effect of multivitamin supplementation on mortality. US Pharm. Pharmacodynamics. Previous. [, Prentice RL. Absorption of Vitamins. The FNB does not address whether or to what extent nutrient supplements can compensate for dietary inadequacies. For more information about building a healthy dietary pattern refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's MyPlate. When you combine at least two or more of these brain-enhancing formulas, what you get is called a stack. The products provided an average of 14 nutrients, although the products with 3 nutrients in 5 trials did not contain a mineral. Many types of MVMs, the focus of this fact sheet, are available in the marketplace. However, one study in this meta-analysis found a 19% higher risk of breast cancer in 25.5% of 35,329 Swedish women who reported taking an MV or MVM (in most cases nutrients in amounts close to RDA levels) than in women who did not take these supplements over an average of 9.5 years [21]. Overall, women are more likely (34.0%) to take an MVM than men (28.3%) [2]. [, O'Connor EA, Evans CV, Ivlev I, Rushkin MC, Thomas RG, Martin A, Lin JS. But taking an MVM can also raise the chances of getting too much of some nutrients, like iron, vitamin A, zinc, niacin, and folate/folic acid, especially when a person takes more than a basic, once-daily product that provides 100 percent of the daily value (DV) ofnutrients. Dietary vitamins and minerals play ubiquitous roles throughout the human body by serving as veritable "helping hands" (e.g. August 25, 2022 . Supplemental vitamins and minerals for cardiovascular disease prevention and treatment. Circ Cardiovasc Qual Outcomes 2018; 11(7):e004224. Minerals (especially taken in large doses) can cause side effects such as tooth staining . The use of MVMs resulted in lower odds of low birth weight (less than 2,500 g) by 12%, birth at a smaller size than normal for gestational age by 8%, and premature births (before week 37 of pregnancy) by 10% than use of supplements containing iron with or without folic acid alone or placebo. Pregnancy vitamin with Omega-3 for baby's brain development. The model comprises an oxygenation that is coupled to carbon-carbon bond . However, the supplement users had a 14% lower risk of undergoing cardiac revascularization (coronary angioplasty or coronary artery bypass grafting). The main mechanism of action is through its ability to boost metabolism, reduce appetite, and increase energy levels. Take your multivitamin with a full glass of water. Participants receiving the supplement did not have significantly fewer cardiovascular events, but this finding should be interpreted with caution because many participants did not take the supplement or placebo as directed, and others withdrew from the study early. Overall, MVM supplementation was not associated with better cardiovascular outcomes, including lower risk of mortality from CVD and coronary heart disease, or of stroke incidence and mortality. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. MVMs, in particular, are popular supplements, currently taken by an estimated one-third of all adults in the United States, and one-quarter of children and adolescents take an MVM or MV [2,3]. The trials included a total of 15,283 pregnant adolescents and young adults from low- or middle-income countries in Africa and Asia. Both the men's and women's One a Day 50+ multivitamins, which Miller and Sonpal recommend, contain calcium and vitamin D, a powerful combo for keeping aging bones strong. Excess nutrient intakes are even more likely among MVM users who also take single vitamin and mineral supplements [15]. A similar meta-analysis of 13 RCTs investigated whether use by pregnant adolescents and young adults aged 10-19 years of an MVM (containing multiple nutrients) led to better birth outcomes than supplementation with only iron and folic acid [34]. Multivitamin use and cardiovascular disease in a prospective study of women. Taking excess amounts of vitamin A (preformed retinol form, not as beta-carotene) during pregnancy has been shown to increase the risk of birth defects. Long-term multivitamin supplementation and cognitive function in men: A randomized trial. Adults in this age group might not be able to absorb enough of the protein-bound, naturally occurring vitamin B12 in food because gastric acidity tends to decline and atrophic gastritis tends to become more common with age [6]. This is the essential step leading to carboxylation and activation of the blood-clotting proteins. Among the more common ingredients are amino acids, protein, creatine, and caffeine. Even after using MVs and MVMs daily for at least 10 years, the women had the same risk of breast cancer as the nonusers. The Age-Related Eye Disease Study (AREDS), which was led by NIHs National Eye Institute and concluded in 2001, showed that daily high doses of vitamins C and E, beta-carotene, and the minerals zinc and coppercalled the AREDS formulationcan help slow the progression to advanced age-related macular degeneration (AMD), a blinding eye disease. cofactors and coenzymes) in biological processes. MVMs can also increase the likelihood that users will have intakes of some nutrients that are higher than the ULs [14]. Common side effects may include: upset stomach . Therefore, these terms refer to products that have widely varying compositions [5]. The Dietary Guidelines for Americans 20152020 recommends that people should aim to meet their nutrient requirements through a healthy eating pattern that includes nutrient-dense forms of foods. Excess intakes can also be a concern for people taking MVMs that contain some vitamins or minerals in amounts approaching or exceeding the UL. The mechanism of action of vitamin K is discussed in terms of a new carbanion model that mimics the proton abstraction from the gamma position of protein-bound glutamate. For example, several B vitamins are necessary for basic survival function, such as converting glucose from food into cellular energy (adenosine triphosphate . This study prospectively followed 18,530 male physicians aged 40 years and older, of whom 20% reported taking an MV or MVM for an average of 12.2 years [24]. Vitamin K. Accessed January 12, 2011. Vitamin (Common Names) Recommended Dietary Allowance (RDA) or Daily Adequate Intake (AI)*. Deficiency: Symptoms include paresthesia, or "pins and needles . Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information. [, Jenkins DJA, Spence JD, Giovannucci EL, Kim Y-I, Josse RG, Vieth R, et al. Target Actions . Introduction. Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial. For example, 27.7% had inadequate intakes of vitamin A from foods alone, but this rate dropped to 15.5% when supplements were included. [, Age-Related Eye Disease Study Research Group. ET, or . Whether you are stacking different types of natural nootropics, synthetic . [, Bird JK, Murphy RA, Ciappio ED, McBurney MI. The FNB advises people older than 50 years to obtain recommended amounts of vitamin B12, mainly from fortified foods or dietary supplements. Vitamin C is responsible for synthesizing collagen and is necessary for proper wound healing.6 Vitamin C is also secreted in breast milk thus, a higher dietary intake is recommended for lactating women to make up for this loss. Systematic information on the bioavailability and bioequivalence of vitamins and minerals in marketed products and on potential drug interactions is scarce. Brand Name: Generic Name: 32 Multivitamins & Multiminerals Dosage form: Tablet Indications: For the prevention and treatment of vitamins & mineral deficiencies as a complete daily nutritional supplement. Vit. In one RCT of 29,133 male Finnish smokers, those who took supplemental beta-carotene (20 mg/day), with or without vitamin E (50 mg/day as dl-alpha tocopheryl acetate), had an 18% higher incidence of lung cancer during 58 years of follow-up than smokers who took a placebo or vitamin E [64]. However, the quality of the studies was generally poor, most had small samples (as few as 20 participants), and they used different MVs and MVMs and outcome measures. . Inflammation comes from the Latin word inflammare, which means "to set on fire.". If you have questions about affording vitamin supplements, contact CF Foundation Compass by calling 844-COMPASS, Monday through Friday, 9 a.m. until 7 p.m. Nutri-Vet has provided us with their Multi-Vite Paw-Gel for cats that is the best overall supplement available. In another RCT of 18,314, smokers, former smokers, and asbestos-exposed persons, participants who took a combination of 30 mg/day of beta-carotene plus 25,000 IU/day of vitamin A (as retinol) had a 28% higher lung cancer risk than those taking a placebo after an average 4-year follow-up period [65]. A randomized trial. An ancillary study to COSMOS, known as COSMOS-Mind, enrolled 2,262 of the older COSMOS participants (mean age 73 years) to investigate whether the cocoa extract, MVM, or both supplements might improve cognition as compared to placebo over 3 years of daily use [43]. J Acad Nutr Diet 2018;118:2162-73. Vitamin B12 (Cobalamin) Mechanism and Deficiency. Vitamins A, C, D and E were used alone, in combination or with other nutritional and non . These interactions can make a drug less effective, increase the action of a drug, or cause unexpected side effects. Ironically, the populations at highest risk of nutritional inadequacy who might benefit the most from MVMs are the least likely to take them [1]. The difference between vitamins and minerals. Upper Limit. Explore the pages linked above to learn about: What vitamin D, iron, and zinc do. NCCIH has provided this material for your information. Multivitamins are a combination of many different vitamins that are normally found in foods and other natural sources.. Multivitamins are used to provide vitamins that are not taken in through the diet. Studies that have examined associations of MVMs with CVD risk include the Physicians Health Study I. Infants and children J Nutr 2016;146:1235-40. How much vitamin D, iron, and zinc . B12 6mcg, biotin 30mcg, folic . MVM use is also more common among the children of women who take supplements; older adults; individuals with more education, a higher income, a healthier lifestyle and diet, and lower body-mass index (BMI); and residents of the western United States [1,2]. At baseline, 37.8% reported taking an MVM (typically containing 2030 vitamins and minerals). Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States. After adjustment for potentially confounding variables (e.g., age, race, BMI, serum lipids, and blood pressure), the use of MVMs for more than 3 years was associated with a substantial 44% reduction in CVD mortality rates among women, but not men. Check Price on Chewy. Vomiting. Dietary supplement use differs by socioeconomic and health-related characteristics among U.S. adults, NHANES 2011-2014. Neither baseline use nor changes in use of MVMs over time were associated with changes in the long-term risk of major CVD events, MI, stroke, cardiac revascularizations, or death from CVD. For more information on safe upper levels of nutrients, visit the NIH Office of Dietary Supplements at: Smokers, and possibly former smokers, should avoid MVM products that provide more than 100% DV for vitamin A (either as preformed retinol or beta-carotene or some combination of the two) because two studies have linked high supplemental doses of these nutrients with an increased risk of lung cancer insmokers. Function: It is necessary for producing energy and hormones. The World Health Organization recommends iron and folic acid supplementation throughout pregnancy [57]. Taking an MVM increases overall nutrient intake and helps some people get the recommended amounts of vitamins and minerals when they cant or dont get them from food alone. Espaol (Spanish) | Print. Results from several studies demonstrate both the use of MVMs for nutritional insurance by some individuals and the potential of MVMs to lead to excessive intakes for others. MVMs providing nutrients at or up to 100% DV do not typically interact with medications. Side effects of multivitamins include: Constipation. Adv Nutr 2020;11:753-9. Health care providers sometimes prescribe MVMs for people who have medical conditions and diseases that impair digestion, absorption, or use of nutrients. mechanism of action of multivitamins and minerals. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia. MVM supplementation resulted in 13% lower odds of low birth weight, 12% lower odds of preterm birth, and 14% lower odds of small size for gestational age than iron and folic acid supplementation alone. Duplication is encouraged. Dietary supplements to enhance exercise and athletic performance come in a variety of forms, including tablets, capsules, liquids, powders, and bars. MMWR 2020;69:1557-62. Am J Clin Nutr 2015;101:144-52. Disclaimer: This content has been produced purely for informational and educational purposes only and is never intended to be used as a substitute for professional medical guidelines including diagnosis, advice, and treatment. Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer. Therefore, the folic acid intakes of pregnant people who take these supplements and consume any foods fortified with this nutrient exceed the UL for this nutrient (1,000 mcg), even though many do not consume recommended amounts of folate from dietary sources alone [18]. Ann Intern Med 2013;159:797-805. It is not intended to substitute for the medical expertise and advice of your health care provider(s). In particular, in pregnant women, MVM together with iron and folic acid are recommended to improve birth outcome and reduce low birth weight and rates of miscarriage. Basic MVMs contain both vitamins and minerals, most in amounts that do not exceed the DVs. Cochrane Database of Systematic Reviews 2019, Issue 3. The results showed no significant associations between MV or MVM use and risk of major CVD events, including myocardial infarction (MI), stroke, and CVD death. . Acknowledging that most health care providers recommend that pregnant people take a daily prenatal MVM, the DGA states that this practice may be necessary to meet the needs for folate or folic acid, iron, iodine, and vitamin D during pregnancy [54]. J Am Coll Cardiol 2021;77:423-36. Marra MV, Bailey RL. The fat-soluble group includes the Vitamins A, D, E and K, while vitamins of the B complex (B1, B2, B6, B12, niacin, pantothenic . NIH State-of-the-Science Panel. It is also indicated to meet the increased demands for vitamins & minerals. The Physicians Health Study II was the longest clinical trial to investigate whether MVMs might help prevent chronic disease. However, supplement use increased the proportion of pregnant people with some intakes of iron (27.9%) and folic acid (33.4%) above the UL. Nausea. Cataracts and age-related macular degeneration (AMD)
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