Publications by authors named "Jaime J Gahche"

39 Publications

Supplemental Vitamin D Increased Serum Total 25-Hydroxyvitamin D in the US Adult Population During 2007-2014.

J Nutr 2021 May 24. Epub 2021 May 24.

National Center for Environmental Health, CDC, Atlanta, GA, USA.

Background: Data from the 2007-2010 NHANES suggested that vitamin D supplements contributed to increased serum concentrations of 25-hydroxyvitamin D [25(OH)D] in the US population.

Objectives: We sought to determine whether 25(OH)D continued to increase during NHANES 2011-2014 and whether associations of 25(OH)D with preselected covariates differed across time periods.

Methods: For this study, 25(OH)D was measured in adults (≥20 y) using LC-MS/MS. Descriptive and regression analyses were stratified by survey period to investigate the effects of age, race-Hispanic origin, sex, season, BMI, dietary vitamin D, and vitamin D-containing supplements. A multiple linear regression model was used to assess 25(OH)D changes between two 4-y survey periods, namely 2007-2010 and 2011-2014.

Results: We observed several significant concomitant increases between 2007-2010 and 2011-2014: unadjusted mean 25(OH)D increased by 2.7 nmol/L (95% CI: 0, 5.4 nmol/L; P = 0.048), the percentage of persons taking any vitamin D-containing supplements increased 2.9% (95% CI: 0.03, 5.5%; P = 0.0314), and the percentage of persons taking high-dose (≥1000 IU/d) vitamin D-containing supplements increased 8.6% (95% CI: 6.9, 9.9%; P < 0.0001). With covariate adjustment, the increase in 25(OH)D from 2007-2010 to 2011-2014 was no longer statistically significant [1.4 nmol/L (95% CI: -3.0, 0.23 nmol/L; P = 0.09)]. After adjustments, several large differences in 25(OH)D remained, namely non-Hispanic blacks had 25(OH)D 22 nmol/L lower than that of non-Hispanic whites, and users of vitamin D-containing supplements ≥1000 IU/d had 25(OH)D 31 nmol/L higher than that of nonusers.

Conclusions: After adjusting for vitamin D supplement dose, the overall adjusted increase in 25(OH)D was no longer statistically significant, suggesting that changes in US adults' 25(OH)D concentrations between NHANES periods 2007-2010 and 2011-2014 may primarily be associated with changes in vitamin D supplementation.
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http://dx.doi.org/10.1093/jn/nxab147DOI Listing
May 2021

Opportunities for Adding Undernutrition and Frailty Screening Measures in US National Surveys.

Adv Nutr 2021 May 19. Epub 2021 May 19.

Office of Dietary Supplements, NIH, Bethesda, MD, USA.

Both undernutrition and frailty adversely affect the health and functional outcomes of the older adult population. Timely and accurate national data are necessary to assess those at risk of these debilitating but often preventable conditions, to correct them and support healthy aging. The objective was to identify relevant measures in undernutrition and frailty screening tools and determine if these measures are collected in recent protocols for US national surveys sampling older adults and which measures could be added to be able to better assess risk of undernutrition and frailty. Commonly used undernutrition and frailty screening tools were evaluated to identify measures that were unique or common to both. US national surveys were examined to determine whether they included older adults in their survey sample, collected health measures from participants, in what form, and whether they were functional indexes or survey questions. A comparative analysis of survey protocols was performed to determine which surveys collected data related to the measures of undernutrition and frailty. Of the 8 national surveys, only 3 provided ≥1 physical measurement (i.e., height/weight, grip strength, balance). Most surveys included self-reported data on height/weight, physical functioning/mobility, disability, and psychological components. Whereas 6 included questions on food security/food program participation, only 1 collected data on dietary intake. Currently national surveys include only limited health measures that can be used to identify undernutrition and frailty risk in older adults. Adding a few simple screening measures already included in popular screening tools, such as grip strength, unintentional weight loss, and loss of appetite, to national surveys which monitor older Americans would facilitate estimation of the prevalence of undernutrition and frailty risk, better estimate those at risk, provide an opportunity to set national goals to reduce their risk, and help implement strategies for improved health outcomes.
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http://dx.doi.org/10.1093/advances/nmab056DOI Listing
May 2021

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

Objective: The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

Methods: Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

Results: Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

Conclusions: Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/ajcn/nqab113DOI Listing
May 2021

Nonfood Prebiotic, Probiotic, and Synbiotic Use Has Increased in US Adults and Children From 1999 to 2018.

Gastroenterology 2021 Apr 23. Epub 2021 Apr 23.

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Electronic address:

Background & Aims: Public interest in pre- , pro-, and synbiotic products is increasing because of interactions between gut microbiota and human health. Our aim was to describe nonfood (from dietary supplements or medication) pre-, pro-, and synbiotic use by US adults and children and reported reasons.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we text-mined dietary supplement and prescription medication labels and ingredients to identify pre-, pro-, and synbiotic products used in the past 30 days. We describe trends in use from 1999 to 2018 (n = 101,199) and prevalence in 2015-2016 and 2017-2018 (n = 19,215) by age groups, sex, ethnicity/race, education, income, self-reported diet and health quality, and prescription gastrointestinal medication use stratified by children (<19 years) and adults (19+ years).

Results: Nonfood pre-, pro-, and synbiotic use increased up to 3-fold in recent cycles. Prevalence of use for all ages for prebiotics was 2.4% (95% confidence interval [CI], 2.0-2.9), for probiotics was 4.5% (95% CI, 3.5-5.6), and for synbiotics was 1.1% (95% CI, 0.8-1.5). Use was highest among older adults (8.8% [95% CI, 5.4-13.3] among those aged 60-69 years for probiotics), non-Hispanic Whites, those with higher educational attainment and income, those with more favorable self-reported diet or health quality, and those with concurrent prescription gastrointestinal medication use. The top reasons for use were for digestive health and to promote/maintain general health. Less than 30% reported using these products based on a health care provider's recommendation.

Conclusions: One in 20 US adults or children use nonfood, pre-, pro-, or synbiotic products, and use has sharply increased in recent years. Most individuals voluntarily take these products for general digestive or overall health reasons.
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http://dx.doi.org/10.1053/j.gastro.2021.04.037DOI Listing
April 2021

Dietary Supplement Use Among Adults: United States, 2017-2018.

NCHS Data Brief 2021 Feb(399):1-8

Dietary supplement use is common in the United States (1). The additional nutrients provided by dietary supplements can help meet recommended nutrient targets but can also potentially lead to excess intakes (2,3). This report describes recent prevalence estimates for dietary supplement use among U.S. adults, the distribution of the number of dietary supplements used, and the most common types of dietary supplements used. Trends in dietary supplement use from 2007-2008 through 2017-2018 are also reported.
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February 2021

Dietary Supplement Use in Children and Adolescents Aged ≤19 Years - United States, 2017-2018.

MMWR Morb Mortal Wkly Rep 2020 Oct 30;69(43):1557-1562. Epub 2020 Oct 30.

Dietary supplement use is common among children and adolescents. During 2013-2014, approximately one third of children and adolescents (persons aged ≤19 years) in the United States were reported to use a dietary supplement in the past 30 days, and use varied by demographic characteristics (1,2). Dietary supplements can contribute substantially to overall nutrient intake, having the potential to both mitigate nutrient shortfalls as well as to lead to nutrient intake above recommended upper limits (3). However, because nutritional needs should generally be met through food consumption according to the 2015-2020 Dietary Guidelines for Americans, only a few dietary supplements are specifically recommended for use among children and adolescents and only under particular conditions (4). The most recently released data from the National Health and Nutrition Examination Survey (NHANES) during 2017-2018 were used to estimate the prevalence of use among U.S. children and adolescents of any dietary supplement, two or more dietary supplements, and specific dietary supplement product types. Trends were calculated for dietary supplement use from 2009-2010 to 2017-2018. During 2017-2018, 34.0% of children and adolescents used any dietary supplement in the past 30 days, with no significant change since 2009-2010. Use of two or more dietary supplements increased from 4.3% during 2009-2010 to 7.1% during 2017-2018. Multivitamin-mineral products were used by 23.8% of children and adolescents, making these the products most commonly used. Because dietary supplement use is common, surveillance of dietary supplement use, combined with nutrient intake from diet, will remain an important component of monitoring nutritional intake in children and adolescents to inform clinical practice and dietary recommendations.
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http://dx.doi.org/10.15585/mmwr.mm6943a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641005PMC
October 2020

High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES.

Am J Clin Nutr 2020 12;112(6):1547-1557

Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA.

Background: Potential safety concerns relative to impaired cognitive function may exist when high folic acid exposures are combined with low vitamin B-12 status.

Objectives: We aimed to examine the relation of the coexistence of high folate and low vitamin B-12 status with cognitive function, utilizing various definitions of "high" folate status.

Methods: Cross-sectional data from older adults (≥60 y; n = 2420) from the 2011-2014 NHANES were analyzed. High folate status was defined as unmetabolized serum folic acid (UMFA) > 1 nmol/L or serum total folate > 74.1 nmol/L, and low vitamin B-12 status as methylmalonic acid > 271 nmol/L or serum vitamin B-12 < 150 pmol/L. Logistic regression models estimated ORs of scoring low on 1 of 4 cognitive tests: the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Delayed Recall (CERAD-DR) and Word Learning tests, and the Animal Fluency test (AF).

Results: A significant interaction was observed relative to scoring low on the DSST (<34; UMFA; P-interaction = 0.0071) and AF (serum folate; P-interaction = 0.0078) for low vitamin B-12 and high folate status. Among those with low vitamin B-12, high UMFA or high serum total folate was associated with higher risk of scoring low on the DSST (OR: 2.16; 95% CI: 1.05, 4.47) and the AF (OR: 1.93; 95% CI: 1.08, 3.45). Among those with "normal" vitamin B-12, higher UMFA or serum total folate was protective on the CERAD-DR. In noninteraction models, when high folate and normal vitamin B-12 status was the reference group, low vitamin B-12 combined with high UMFA was associated with greater risk based on the DSST (<34, OR: 2.87; 95% CI: 1.85, 4.45; <40, OR: 2.22; 95% CI: 1.31, 3.75) and AF (OR: 1.97; 95% CI: 1.30, 2.97); but low vitamin B-12 and lower UMFA (OR: 1.69; 95% CI: 1.16, 2.47) was also significantly associated for DSST < 40 risk.

Conclusions: Low vitamin B-12 was associated with cognitive impairment both independently and in an interactive manner with high folate for certain cognitive performance tests among older adults.
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http://dx.doi.org/10.1093/ajcn/nqaa239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184300PMC
December 2020

Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014.

Public Health Nutr 2020 09 29;23(13):2268-2279. Epub 2020 May 29.

Department of Nutrition Science, Purdue University, West Lafayette, IN47907, USA.

Objective: To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

Design: Cross-sectional study.

Setting: Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

Participants: Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

Results: A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

Conclusions: Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
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http://dx.doi.org/10.1017/S1368980020000257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429309PMC
September 2020

Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States.

Obstet Gynecol 2020 03;135(3):623-633

Department of Nutrition Science, Purdue University, West Lafayette, Indiana; the Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland; the Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah; and the Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.

Objective: To estimate the prevalence of use and the micronutrient contribution of dietary supplements among pregnant, lactating, and nonpregnant and nonlactating women in the United States.

Methods: Cross-sectional data from 1,314 pregnant, 297 lactating, and 8,096 nonpregnant and nonlactating women (aged 20-44 years) in the 1999-2014 National Health and Nutrition Examination Survey were combined to produce statistically reliable, nationally representative estimates. Information about dietary supplements used in the past 30 days was collected through an interviewer-administered questionnaire and in-home inventory. The prevalence of nutrient-specific supplement use, mean daily nutrient intakes from supplements among users, and motivations for supplement use were assessed. Differences by age, income, and trimester within pregnant women were also tested.

Results: Seventy-seven percent of pregnant women and 70% of lactating women used one or more dietary supplements, whereas 45% of nonpregnant and nonlactating women used supplements. In particular, 64% of pregnant and 54% of lactating women used prenatal supplements. Mean intakes of thiamin, riboflavin, niacin, folic acid, vitamins B6, B12, and C, iron, and zinc from supplements alone were at or above their respective recommended dietary allowances (RDAs) among pregnant and lactating supplement users. About half of pregnant and 40% of lactating women took supplements based on the recommendation of a health care provider. Among pregnant women, those in their first trimester, aged 20-34 years, or in a lower-income family were less likely to use supplements compared with their counterparts.

Conclusion: The majority of pregnant and lactating women used dietary supplements, which contributed many nutrients in doses above the RDAs. Although inadequate Intakes of folate and iron are of concern among pregnant women who are not using supplements, supplement users often consumed high doses, suggesting a potential need of health care providers to discuss dietary supplement use and the recommended doses of nutrients during pregnancy and lactation.
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http://dx.doi.org/10.1097/AOG.0000000000003657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138460PMC
March 2020

Total Usual Micronutrient Intakes Compared to the Dietary Reference Intakes among U.S. Adults by Food Security Status.

Nutrients 2019 Dec 22;12(1). Epub 2019 Dec 22.

Interdepartmental Nutrition Program, Purdue University, 700 W. State Street, West Lafayette, IN 47907, USA.

This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011-2014 data ( = 9954). DS data were collected via an in-home interview; the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K; similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults.
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http://dx.doi.org/10.3390/nu12010038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019721PMC
December 2019

Demographic, Physiologic, and Lifestyle Characteristics Observed with Serum Total Folate Differ Among Folate Forms: Cross-Sectional Data from Fasting Samples in the NHANES 2011-2016.

J Nutr 2020 04;150(4):851-860

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Atlanta, GA, USA.

Background: Serum folate forms were measured in the US population during recent NHANES to assess folate status.

Objective: We describe post-folic acid-fortification concentrations of serum folate forms in the fasting US population ≥1 y from the NHANES 2011-2016.

Methods: We measured 5 biologically active folates and 1 oxidation product (MeFox) of 5-methyltetrahydrofolate (5-methyl-THF). We calculated geometric means of 5-methyl-THF, unmetabolized folic acid (UMFA), nonmethyl folate (sum of tetrahydrofolate, 5-formyltetrahydrofolate, and 5,10-methenyltetrahydrofolate), total folate (sum of above biomarkers), and MeFox by demographic, physiologic, and lifestyle variables; estimated the magnitude of variables on biomarker concentrations after covariate adjustment; and determined the prevalence of UMFA >2 nmol/L.

Results: After demographic adjustment, age, sex, and race-Hispanic origin were significantly associated with most folate forms. MeFox increased with age, while 5-methyl-THF, UMFA, and nonmethyl folate displayed U-shaped age patterns. Compared with non-Hispanic whites, non-Hispanic blacks had 23% lower predicted 5-methyl-THF but comparable UMFA; non-Hispanic Asians had comparable 5-methyl-THF but 28% lower UMFA; Hispanics, non-Hispanic Asians, and non-Hispanic blacks had ∼20% lower MeFox. After additional physiologic and lifestyle adjustment, predicted UMFA and MeFox concentrations were 43% and 112% higher, respectively, in adults with chronic kidney disease and 17% and 15% lower, respectively, in adults consuming daily 1-<2 alcoholic beverages; 5-methyl-THF concentrations were 20% lower in adult smokers. The prevalence of UMFA >2 nmol/L was highest in persons aged ≥70 y (9.01%) and lowest in those aged 12-19 y (1.14%). During 2011-2014, the prevalence was 10.6% in users and 2.22% in nonusers of folic acid-containing supplements.

Conclusions: In fasting persons ≥1 y, the demographic, physiologic, and lifestyle characteristics observed with serum total folate differed among folate forms, suggesting biological and/or genetic influences on folate metabolism. High UMFA was mostly observed in supplement users and older persons.
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http://dx.doi.org/10.1093/jn/nxz278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138665PMC
April 2020

Comparison of 4 Methods to Assess the Prevalence of Use and Estimates of Nutrient Intakes from Dietary Supplements among US Adults.

J Nutr 2020 04;150(4):884-893

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs).

Methods: The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011-2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR.

Results: Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR.

Conclusions: A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults.This trial was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/jn/nxz306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138661PMC
April 2020

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps.

J Community Health 2020 06;45(3):640-660

Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA.

Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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http://dx.doi.org/10.1007/s10900-019-00739-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188699PMC
June 2020

Folate status in the US population 20 y after the introduction of folic acid fortification.

Am J Clin Nutr 2019 11;110(5):1088-1097

National Center for Environmental Health, CDC, Atlanta, GA, USA.

Background: Enriched cereal-grain products have been fortified in the United States for >20 y to improve folate status in women of reproductive age and reduce the risk of folic acid-responsive neural tube birth defects (NTDs).

Objectives: Our objectives were to assess postfortification changes in folate status in the overall US population and in women aged 12-49 y and to characterize recent folate status by demographic group and use of folic acid-containing supplements.

Methods: We examined cross-sectional serum and RBC folate data from the NHANES 1999-2016.

Results: Serum folate geometric means increased from 2007-2010 to 2011-2016 in persons aged ≥1 y (38.7 compared with 40.6 nmol/L) and in women (35.3 compared with 37.0 nmol/L), whereas RBC folate showed no significant change. Younger age groups, men, and Hispanic persons showed increased serum and RBC folate concentrations, whereas non-Hispanic black persons and supplement nonusers showed increased serum folate concentrations. The folate insufficiency prevalence (RBC folate <748 nmol/L; NTD risk) in women decreased from 2007-2010 (23.2%) to 2011-2016 (18.6%) overall and in some subgroups (e.g., women aged 20-39 y, Hispanic and non-Hispanic black women, and supplement nonusers). After covariate adjustment, RBC folate was significantly lower in all age groups (by ∼10-20%) compared with persons aged ≥60 y and in Hispanic (by 8.2%), non-Hispanic Asian (by 12.1%), and non-Hispanic black (by 20.5%) compared with non-Hispanic white women (2011-2016). The 90th percentile for serum (∼70 nmol/L) and RBC (∼1800 nmol/L) folate in supplement nonusers aged ≥60 y was similar to the geometric mean in users (2011-2014).

Conclusions: Blood folate concentrations in the US population overall and in women have not decreased recently, and folate insufficiency rates are ∼20%. Continued monitoring of all age groups is advisable given the high folate status particularly in older supplement users.
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http://dx.doi.org/10.1093/ajcn/nqz184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821545PMC
November 2019

The Dietary Supplement Label Database: Recent Developments and Applications.

J Nutr 2018 08 3;148(Suppl 2):1428S-1435S. Epub 2018 Aug 3.

Division of Health and Nutrition Examination Surveys/Analysis Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

Objective: To describe the history, key features, recent enhancements, and common applications of the Dietary Supplement Label Database (DSLD).

Background And History: Although many Americans use dietary supplements, databases of dietary supplements sold in the United States have not been widely available. The DSLD, an easily accessible public-use database was created in 2008 to provide information on dietary supplement composition for use by researchers and consumers.

Rationale: Accessing current information easily and quickly is crucial for documenting exposures to dietary supplements because they contain nutrients and other bioactive ingredients that may have beneficial or adverse effects on human health. This manuscript details recent developments with the DSLD to achieve this goal and provides examples of how the DSLD has been used.

Recent Developments: With periodic updates to track changes in product composition and capture new products entering the market, the DSLD currently contains more than 71,000 dietary supplement labels. Following usability testing with consumer and researcher user groups completed in 2016, improvements to the DSLD interface were made. As of 2017, both a desktop and mobile device version are now available. Since its inception in 2008, the use of the DSLD has included research, exposure monitoring, and other purposes by users in the public and private sectors.

Future Directions: Further refinement of the user interface and search features to facilitate ease of use for stakeholders is planned.

Conclusions: The DSLD can be used to track changes in product composition and capture new products entering the market. With over 71,000 DS labels it is a unique resource that policymakers, researchers, clinicians, and consumers may find valuable for multiple applications.
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http://dx.doi.org/10.1093/jn/nxy082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597011PMC
August 2018

Federal Monitoring of Dietary Supplement Use in the Resident, Civilian, Noninstitutionalized US Population, National Health and Nutrition Examination Survey

J Nutr 2018 08 3;148(Suppl 2):1436S-1444S. Epub 2018 Aug 3.

National Institutes of Health, Office of Dietary Supplements, Bethesda MD.

Objective: This review summarizes the current and previous data on dietary supplement (DS) use collected from participants in the National Health and Nutrition Examination Survey (NHANES), describes the NHANES dietary supplement database used to compute nutrient intakes from DSs, discussed recent developments and future direction, and describes many examples to demonstrate the utility of these data in informing nutrition research and policy.

Background And History: Since 1971, NHANES, has been collecting information on the use of DSs from participants. These data are critical to national nutrition surveillance and have been used to characterize usage patterns, examine trends over time, assess the percentage of the population meeting or exceeding nutrient recommendations, and to help elucidate the sources contributing nutrients to the diet of the US population.

Rationale: Over half of adults and about one-third of children in the United States use at least one dietary supplement in the past 30 days. Dietary supplements contribute to the dietary intake of nutrients and bioactive compounds in the US and therefore need to be assessed when monitoring nutritional status of the population and when studying diet-health associations.

Recent Developments: With the recent development and availability of the Dietary Supplement Label Database (DSLD), a comprehensive DS database that will eventually contain labels for all products marketed in the US, NHANES DS data will be more easily linked to product information to estimate nutrient intake from DS.

Future Directions: Over time, NHANES has both expanded and improved collection methods. The continued understanding of sources of error in collection methods will continue to be explored and is critical to improved accuracy.

Conclusions: NHANES provides a rich source of nationally representative data on the usage of dietary supplements in the US.
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http://dx.doi.org/10.1093/jn/nxy093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516064PMC
August 2018

Vitamin D status in the United States, 2011-2014.

Am J Clin Nutr 2019 07;110(1):150-157

Office of Dietary Supplements, National Institutes of Health, Bethesda, MD.

Background: Vitamin D is important for bone health; in 2014 it was the fifth most commonly ordered laboratory test among Medicare Part B payments.

Objectives: The aim of this study was to describe vitamin D status in the US population in 2011-2014 and trends from 2003 to 2014.

Methods: We used serum 25-hydroxyvitamin D data from NHANES 2011-2014 (n = 16,180), and estimated the prevalence at risk of deficiency (<30 nmol/L) or prevalence at risk of inadequacy (30-49 nmol/L) by age, sex, race and Hispanic origin, and dietary intake of vitamin D. We also present trends between 2003 and 2014.

Results: In 2011-2014, the percentage aged ≥1 y at risk of vitamin D deficiency or inadequacy was 5.0% (95% CI: 4.1%, 6.2%) and 18.3% (95% CI: 16.2%, 20.6%). The prevalence of at risk of deficiency was lowest among children aged 1-5 y (0.5%; 95% CI: 0.3%, 1.1%), peaked among adults aged 20-39 y (7.6%; 95% CI: 6.0%, 9.6%), and fell to 2.9% (95% CI: 2.0%, 4.0%) among adults aged ≥60 y; the prevalence of at risk of inadequacy was similar. The prevalence of at risk of deficiency was higher among non-Hispanic black (17.5%; 95% CI: 15.2%, 20.0%) than among non-Hispanic Asian (7.6%; 95% CI: 5.9%, 9.9%), non-Hispanic white (2.1%; 95% CI: 1.5%, 2.7%), and Hispanic (5.9%; 95% CI: 4.4%, 7.8%) persons; the prevalence of at risk of inadequacy was similar. Persons with higher vitamin D dietary intake or who used supplements had lower prevalences of at risk of deficiency or inadequacy. From 2003 to 2014 there was no change in the risk of vitamin D deficiency; the risk of inadequacy declined from 21.0% (95% CI: 17.9%, 24.5%) to 17.7% (95% CI: 16.0%, 19.7%).

Conclusion: The prevalence of at risk of vitamin D deficiency in the United States remained stable from 2003 to 2014; at risk of inadequacy declined. Differences in vitamin D status by race and Hispanic origin warrant additional investigation.
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http://dx.doi.org/10.1093/ajcn/nqz037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263437PMC
July 2019

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

J Nutr 2019 02;149(2):181-197

School of Medicine, Wake Forest, Winston-Salem, NC.

The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.
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http://dx.doi.org/10.1093/jn/nxy264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374152PMC
February 2019

Dietary Supplement Use among Infants and Toddlers Aged <24 Months in the United States, NHANES 2007-2014.

J Nutr 2019 02;149(2):314-322

Office of Dietary Supplements, NIH, Bethesda, MD.

Background: Limited nationally representative data are available on dietary supplement (DS) use and resulting nutrient exposures among infants and toddlers.

Objective: This study evaluated DS use among US infants and toddlers to characterize DS use, estimate nutrient intake from DSs, and assess trends in DS use over time.

Methods: Using nationally representative data from NHANES (2007-2014) and trends over time (1999-2014), we estimated prevalence of DS use and types of products used for US infants and toddlers aged <2 y (n = 2823). We estimated median daily intakes of vitamins and minerals consumed via DSs for all participants aged <2 y, by age groups (0-11.9 mo and 12.0-23.9 mo), and by feeding practices for infants 0-5.9 mo.

Results: Overall, 18.2% (95% CI: 16.2%, 20.3%) of infants and toddlers used ≥1 DS in the past 30 d. Use was lower among infants (0-5.9 mo: 14.6%; 95% CI: 11.5%, 18.1%; 6-11.9 mo: 11.6%; 95% CI: 8.8%, 15.0%) than among toddlers (12-23.9 mo: 23.3%; 95% CI: 20.4%, 26.3%). The most commonly reported DSs were vitamin D and multivitamin infant drops for those <12 mo, and chewable multivitamin products for toddlers (12-23.9 mo). The nutrients most frequently consumed from DSs were vitamins D, A, C, and E for those <2 y; for infants <6 mo, a higher percentage of those fed breast milk than those fed formula consumed these nutrients via DSs. DS use remained steady for infants (6-11.9 mo) and toddlers from 1999-2002 to 2011-2014, but increased from 7% to 20% for infants aged 0-5.9 mo.

Conclusions: One in 5 infants and toddlers aged <2 y use ≥1 DS. Future studies should examine total nutrient intake from foods, beverages, and DSs to evaluate nutrient adequacy overall and by nutrient source.
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http://dx.doi.org/10.1093/jn/nxy269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551282PMC
February 2019

Dietary Supplement Use among U.S. Children by Family Income, Food Security Level, and Nutrition Assistance Program Participation Status in 2011⁻2014.

Nutrients 2018 Sep 1;10(9). Epub 2018 Sep 1.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

This analysis characterizes use of dietary supplements (DS) and motivations for DS use among U.S. children (≤18 years) by family income level, food security status, and federal nutrition assistance program participation using the 2011⁻2014 National Health and Nutrition Examination Survey data. About one-third (32%) of children used DS, mostly multivitamin-minerals (MVM; 24%). DS and MVM use were associated with higher family income and higher household food security level. DS use was lowest among children in households participating in the Supplemental Nutrition Assistance Program (SNAP; 20%) and those participating in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC; 26%) compared to both income-eligible and income-ineligible nonparticipants. Most children who used DS took only one (83%) or two (12%) products; although children in low-income families took fewer products than those in higher income families. The most common motivations for DS and MVM use were to "improve (42% or 46%)" or "maintain (34 or 38%)" health, followed by "to supplement the diet (23 or 24%)" for DS or MVM, respectively. High-income children were more likely to use DS and MVM "to supplement the diet" than middle- or low-income children. Only 18% of child DS users took DS based on a health practitioner's recommendation. In conclusion, DS use was lower among children who were in low-income or food-insecure families, or families participating in nutrition assistance programs.
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http://dx.doi.org/10.3390/nu10091212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163871PMC
September 2018

Dietary Supplement Use Differs by Socioeconomic and Health-Related Characteristics among U.S. Adults, NHANES 2011⁻2014.

Nutrients 2018 Aug 17;10(8). Epub 2018 Aug 17.

Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN 47907, USA.

The objective of this study was to estimate the prevalence of use and types of dietary supplements (DS) used by U.S. adults (≥19 years) by sociodemographic characteristics: family income-to-poverty ratio (PIR), food security status, and Supplemental Nutrition Assistance Program (SNAP) participation using NHANES 2011⁻2014 data ( = 11,024). DS use was ascertained via a home inventory and a retrospective 30-day questionnaire. Demographic and socioeconomic differences related to DS use were evaluated using a univariate statistic. Half of U.S. adults (52%) took at least one DS during a 30-day period; multivitamin-mineral (MVM) products were the most commonly used (31%). DS and MVM use was significantly higher among those with a household income of ≥ 350% of the poverty level, those who were food secure, and SNAP income-ineligible nonparticipants across all sex, age, and race/ethnic groups. Among women, prevalence of use significantly differed between SNAP participants (39%) and SNAP income-eligible nonparticipants (54%). Older adults (71+ years) remained the highest consumers of DS, specifically among the highest income group (82%), while younger adults (19⁻30 years), predominantly in the lowest income group (28%), were the lowest consumers. Among U.S. adults, DS use and the types of products consumed varied with income, food security, and SNAP participation.
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http://dx.doi.org/10.3390/nu10081114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116059PMC
August 2018

Use of Iodine-Containing Dietary Supplements Remains Low among Women of Reproductive Age in the United States: NHANES 2011-2014.

Nutrients 2018 Mar 29;10(4). Epub 2018 Mar 29.

Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

In the United States, the American Thyroid Association recommends that women take a dietary supplement containing 150 µg of iodine 3 months prior to conception and while pregnant and lactating to support fetal growth and neurological development. We used data from the National Health and Nutrition Examination Survey 2011–2014 to describe the use of dietary supplements with and without iodine in the past 30 days among 2155 non-pregnant, non-lactating (NPNL) women; 122 pregnant women; and 61 lactating women. Among NPNL women, 45.3% (95% Confidence Interval [CI]: 42.0, 48.6) used any dietary supplement and 14.8% (95% CI: 12.7, 16.8) used a dietary supplement with iodine in the past 30 days. Non-Hispanic black and Hispanic women were less likely to use any dietary supplement as well as one with iodine, than non-Hispanic white or non-Hispanic Asian women ( < 0.05). Among pregnant women, 72.2% (95% CI: 65.8, 78.6) used any dietary supplement; however, only 17.8% (95% CI: 11.4, 24.3) used a dietary supplement with iodine. Among lactating women, 75.0% (95% CI: 63.0, 87.0) used a dietary supplement; however, only 19.0% (95% CI: 8.8, 29.2) used a dietary supplement with iodine. Among NPNL women using a supplement with iodine, median daily iodine intake was 75.0 µg. Self-reported data suggests that the use of iodine containing dietary supplements among pregnant and lactating women remains low in contrast with current recommendations.
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http://dx.doi.org/10.3390/nu10040422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946207PMC
March 2018

Dietary Supplement Use Was Very High among Older Adults in the United States in 2011-2014.

J Nutr 2017 10 30;147(10):1968-1976. Epub 2017 Aug 30.

Office of Dietary Supplements, National Institutes of Health, Bethesda, MD.

Dietary supplements (DSs) have the potential to be both beneficial and harmful to health, especially in adults aged ≥60 y, and therefore it is important to monitor the patterns of their use. This study evaluated DS use by adults aged ≥60 y to characterize the use of DSs, determine the motivations for use, and examine the associations between the use of DSs and selected demographic, lifestyle, and health characteristics. Data from 3469 older adults aged ≥60 y from the 2011-2014 NHANES were analyzed. DSs used in the past 30 d were ascertained via an interviewer-administered questionnaire in participants' homes. The prevalence of overall DS use and specific types of DSs were estimated. The number of DSs reported and the frequency, duration, and motivation(s) for use were assessed. Logistic regression models were constructed to examine the association between DS use and selected characteristics. Seventy percent of older adults in the United States reported using ≥1 DS in the past 30 d; 54% of users took 1 or 2 products, and 29% reported taking ≥4 products. The most frequently reported products were multivitamin or mineral (MVM) (39%), vitamin D only (26%), and omega-3 fatty acids (22%). Women used DSs almost twice as often as men [adjusted OR (aOR), 1.8; 95% CI: 1.5, 2.3). Those not reporting prescription medications were less likely to take a DS than those reporting ≥3 prescription medications (aOR, 0.4; 95% CI: 0.3, 0.6). The most frequently reported motivation for DS use was to improve overall health (41%). Use of DSs among older adults continues to be high in the United States, with 29% of users regularly taking ≥4 DSs, and there is a high concurrent usage of them with prescription medications.
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http://dx.doi.org/10.3945/jn.117.255984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610553PMC
October 2017

Normative Values for Cardiorespiratory Fitness Testing Among US Children Aged 6-11 years.

Pediatr Exerc Sci 2017 05 4;29(2):177-185. Epub 2017 Jan 4.

2 Baystate Medical Center.

Background: Nationally representative normative values for cardiorespiratory fitness (CRF) have not been described for US children since the mid 1980s.

Objective: To provide sex- and age-specific normative values for CRF of US children aged 6-11 years.

Methods: Data from 624 children aged 6-11 years who participated in the CRF testing as part of the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey, a cross-sectional survey, were analyzed. Participants were assigned to one of three age-specific protocols and asked to exercise to volitional fatigue. The difficulty of the protocols increased with successive age groups. CRF was assessed as maximal endurance time (min:sec). Data analysis was conducted in 2016.

Results: For 6-7, 8-9, 10-11 year olds, corresponding with the age-specific protocols, mean endurance time was 12:10 min:sec (95% CI: 11:49-12:31), 11:16 min:sec (95% CI: 11:00-11:31), and 10:01 min:sec (95% CI: 9:37-10:25), respectively. Youth in the lowest 20th percentile for endurance time were more likely to be obese, to report less favorable health, and to report greater than two hours of screen time per day.

Conclusions: These data may serve as baseline estimates to monitor trends over time in CRF among US children aged 6-11 years.
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http://dx.doi.org/10.1123/pes.2016-0167DOI Listing
May 2017

B-vitamin status and bone mineral density and risk of lumbar osteoporosis in older females in the United States.

Am J Clin Nutr 2015 Sep 29;102(3):687-94. Epub 2015 Jul 29.

Eunice Kennedy Shriver National Institute of Child and Human Development, NIH, Bethesda, MD;

Background: Previous data suggest that elevated serum total homocysteine (tHcy) may be a risk factor for bone fracture and osteoporosis. Nutritional causes of elevated tHcy are suboptimal B-vitamin status. To our knowledge, this is the first nationally representative report on the relation of B vitamins and bone health from a population with folic acid fortification.

Objective: The purpose of this analysis was to examine the relation between B-vitamin status biomarkers and bone mineral density (BMD), risk of osteoporosis, and biomarkers of bone turnover.

Design: We examined the relation of tHcy, methylmalonic acid (MMA), and serum/red blood cell folate and total-body and lumbar spine BMD in women aged ≥50 y participating in the NHANES 1999-2004 (n = 2806), a nationally representative cross-sectional survey. These are the only years with concurrent measurement of tHcy and whole-body dual-energy X-ray absorptiometry. We also examined B-vitamin biomarkers relative to bone turnover markers, bone alkaline phosphatase, and urinary N-terminal cross-linked telopeptide of type I collagen in a 1999-2002 subset with available data (n = 1813).

Results: In comparison with optimal concentrations, women with elevated tHcy were older with lower serum vitamin B-12, red blood cell folate, and dietary micronutrient intakes and had significantly higher mean ± SE markers of bone turnover (bone alkaline phosphatase: 15.8 ± 0.59 compared with 14.0 ± 0.25 μg/L; urinary N-terminal cross-linked telopeptide of type I collagen: 48.2 ± 2.9 compared with 38.9 ± 0.90 nmol bone collagen equivalents per mmol creatinine/L). Elevated MMA (OR: 1.88; 95% CI: 1.10, 3.18) and tHcy (OR: 2.17; 95% CI: 1.14, 4.15) were related to increased risk of lumbar osteoporosis. When examined as a continuous variable, tHcy was negatively associated, serum folates were positively associated, and MMA and vitamin B-12 were not significantly associated with lumbar and total-body BMD.

Conclusion: In this nationally representative population of older US women with high exposure to B vitamins through food fortification and dietary supplements, only elevated tHcy and MMA were independently associated with risk of lumbar spine osteoporosis.
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http://dx.doi.org/10.3945/ajcn.115.108787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548174PMC
September 2015

Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States.

J Nutr 2015 Mar 7;145(3):572-8. Epub 2015 Jan 7.

Disease Prevention.

Background: Multivitamin-mineral (MVM) products are the most commonly used supplements in the United States, followed by multivitamin (MV) products. Two randomized clinical trials (RCTs) did not show an effect of MVMs or MVs on cardiovascular disease (CVD) mortality; however, no clinical trial data are available for women with MVM supplement use and CVD mortality.

Objective: The objective of this research was to examine the association between MVM and MV use and CVD-specific mortality among US adults without CVD.

Methods: A nationally representative sample of adults from the restricted data NHANES III (1988-1994; n = 8678; age ≥40 y) were matched with mortality data reported by the National Death Index through 2011 to examine associations between MVM and MV use and CVD mortality by using Cox proportional hazards models, adjusting for multiple potential confounders.

Results: We observed no significant association between CVD mortality and users of MVMs or MVs compared with nonusers; however, when users were classified by the reported length of time products were used, a significant association was found with MVM use of >3 y compared with nonusers (HR: 0.65; 95% CI: 0.49, 0.85). This finding was largely driven by the significant association among women (HR: 0.56; 95% CI: 0.37, 0.85) but not men (HR: 0.79; 95% CI: 0.44, 1.42). No significant association was observed for MV products and CVD mortality in fully adjusted models.

Conclusions: In this nationally representative data set with detailed information on supplement use and CVD mortality data ∼20 y later, we found an association between MVM use of >3 y and reduced CVD mortality risk for women when models controlled for age, race, education, body mass index, alcohol, aspirin use, serum lipids, blood pressure, and blood glucose/glycated hemoglobin. Our results are consistent with the 1 available RCT in men, indicating no relation with MVM use and CVD mortality.
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http://dx.doi.org/10.3945/jn.114.204743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336535PMC
March 2015

Estimating caffeine intake from energy drinks and dietary supplements in the United States.

Nutr Rev 2014 Oct;72 Suppl 1:9-13

Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA.

No consistent definition exists for energy products in the United States. These products have been marketed and sold as beverages (conventional foods), energy shots (dietary supplements), and in pill or tablet form. Recently, the number of available products has surged, and formulations have changed to include caffeine. To help characterize the use of caffeine-containing energy products in the United States, three sources of data were analyzed: sales data, data from federal sources, and reports from the Drug Abuse Warning Network. These data indicate that sales of caffeine-containing energy products and emergency room visits involving their consumption appear to be increasing over time. Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 indicate that 2.7% [standard error (SE) 0.2%] of the US population ≥1 year of age used a caffeine-containing energy product, providing approximately 150-200 mg/day of caffeine per day in addition to caffeine from traditional sources like coffee, tea, and colas. The highest usage of these products was among males between the ages of 19 and 30 years (7.6%, SE 1.0). Although the prevalence of caffeine-containing energy product use remains low overall in the US population, certain subgroups appear to be using these products in larger amounts. Several challenges remain in determining the level of caffeine exposure from and accurate usage patterns of caffeine-containing energy products.
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http://dx.doi.org/10.1111/nure.12138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658518PMC
October 2014

Why US children use dietary supplements.

Pediatr Res 2013 Dec 3;74(6):737-41. Epub 2013 Sep 3.

1] Office of Dietary Supplements, The National Institutes of Health, Bethesda, Maryland [2] Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Background: Dietary supplements are used by one-third of children. We examined motivations for supplement use in children, the types of products used by motivations, and the role of physicians and health care practitioners in guiding choices about supplements.

Methods: We examined motivations for dietary supplement use reported for children (from birth to 19 y of age; n = 8,245) using the National Health and Nutrition Examination Survey 2007-2010.

Results: Dietary supplements were used by 31% of children; many different reasons were given as follows: to "improve overall health" (41%), to "maintain health" (37%), for "supplementing the diet" (23%), to "prevent health problems" (20%), and to "boost immunity" (14%). Most children (~90%) who use dietary supplements use a multivitamin-mineral or multivitamin product. Supplement users tend to be non-Hispanic white, have higher family incomes, report more physical activity, and have health insurance. Only a small group of supplements used by children (15%) were based on the recommendation of a physician or other health care provider.

Conclusion: Most supplements used by children are not under the recommendation of a health care provider. The most common reasons for use of supplements in children are for health promotion, yet little scientific data support this notion in nutrient-replete children.
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http://dx.doi.org/10.1038/pr.2013.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873849PMC
December 2013

The prevalence of using iodine-containing supplements is low among reproductive-age women, NHANES 1999-2006.

J Nutr 2013 Jun 24;143(6):872-7. Epub 2013 Apr 24.

Centers for Disease Control and Prevention/National Center for Health Statistics, Division of National Health and Nutrition Examination Surveys, Hyattsville, MD, USA.

During pregnancy, the iodine requirement rises to meet demands for neurological development and fetal growth. If these requirements are not met, irreversible pathological cognitive and behavioral changes to the fetus may ensue. This study estimated the prevalence of iodine-containing dietary supplement (DS) use and intakes of iodine from DSs among pregnant women and nonpregnant women of reproductive age (15-39 y) who were interviewed and examined in NHANES 1999-2006 (n = 6404). Although 77.5% of pregnant women reported taking one or more DSs in the past 30 d, only 22.3% consumed an iodine-containing supplement. Most pregnant women reported using one DS and reported taking this product daily. The vast majority of iodine-containing DSs reported by pregnant women claimed an iodine content of 150 μg iodine/serving on the label. Pregnant women using at least one DS containing iodine had a mean daily iodine intake of 122 μg/d from supplements; the median value was 144 μg/d. Median urinary iodine concentrations (UICs) were similar for pregnant and nonpregnant women in the population aged 15-39 y. The median UIC was 148 μg/L for pregnant women and 133 μg/L for nonpregnant women. The WHO has established a cutoff for insufficient iodine intake at <150 μg/L for pregnant women and <100 mg/L for those who are not pregnant. This suggests that as a population, we may not be meeting adequate intakes of iodine for pregnant women. More research is needed on the iodine intakes of pregnant women and women of reproductive age on their total iodine intake from all sources, not just DSs.
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http://dx.doi.org/10.3945/jn.112.169326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652883PMC
June 2013