The impact of low micronutrient intake is a major public health concern on a global scale, as it means that individuals are more vulnerable to infection, disease and early death. According to the National Institutes of Health (NIH), more than one third of Americans now complement their diet by taking a multivitamin mineral supplement to boost their intake.1 However, the debate surrounding the requirement for and the efficacy of multivitamin supplementation is ongoing.
The Annals of Internal Medicine recently published a letter presenting arguments in support of the view that daily multivitamin supplementation is a safe and effective way to complement the diet of individuals and achieve the recommended intake of essential micronutrients.2 The letter was written in response to a previous communication, “Enough is enough: Stop wasting money on vitamin and mineral supplements”, which claimed that there is little or no evidence to support the use of dietary supplements by the majority of the population in the United States (US).3 Indeed, it went as far as to suggest that supplements may even cause harm in certain individuals. The authors concluded that healthcare professionals should advise against multivitamin intake and that research into the effects of multivitamins should be discontinued, as it has repeatedly demonstrated null results.
Making the case
In fact, there is strong science in support of the benefits of multivitamin supplementation. The latest response, drafted by a group of scientists led by Dr Balz Frei (Linus Pauling Institute at Oregon State University), demonstrates that only a small proportion of people in the US currently follow the Dietary Guidelines for Americans.3 This means that the majority of the US population does not meet the Institute of Medicine’s recommendations for the dietary intake of all vitamins and essential minerals, which can potentially lead to a number of health concerns. Daily multivitamin and mineral supplements formulated at approximately the Daily Value can be an effective and low cost way to fill nutritional gaps in individuals, and long-term use is not associated with any adverse health effects.
The evidence cited in the letter includes the findings of numerous studies to demonstrate that the majority of adults in the US do not get the Estimated Average Requirement of essential micronutrients, including vitamins A, D, E and K, magnesium, calcium and potassium from their diet.4 The authors also highlight the role that multivitamin and mineral supplements may play in helping to decrease the risk of chronic disease. For example, the Physicians’ Health Study II is the largest and longest randomised clinical trial of a multivitamin and mineral supplement conducted to date and reported a statistically significant 8% reduction in total cancer incidence in male physicians.5
DSM welcomes the publication of the letter. There is a strong body of evidence to demonstrate the benefits that can be gained from daily multivitamin use, but ‘sensational’ headlines often gain coverage because of the controversial nature of the content. These conflicting messages can only confuse consumers and it is important that scientists, healthcare professionals and governments respond collectively to consistently reinforce the wealth of existing safe science. DSM has joined with Dr Frei and his fellow scientific experts to highlight the critical role that daily multivitamin supplementation can play in overall nutrition and health, as well as the need for ongoing research into potential health benefits.
Vitamin E
To give an example, DSM is currently engaging with a number of experts in the field of vitamin E research to address the urgent requirement for further studies into the micronutrient. The partnerships allow members of the scientific community to discuss emerging research, including the reported benefits of vitamin E in Alzheimer’s disease and studies to show that vitamin E can improve the pathophysiological and histological status in non-alcoholic fatty liver disease and non-alcoholic steatohepatitis patients.6,7 It is part of DSM’s work to highlight the undersupply of vitamin E intake globally and to better understand the health benefits that sufficient vitamin E intake can provide.
There is a need to revisit approaches to defining appropriate dietary requirements for vitamin E
There is also a need to revisit approaches to defining appropriate dietary requirements for vitamin E. The current recommended daily intake of vitamin E varies according to the age, gender and criteria applied in individual countries. However, people should consume at least 15mg of alpha-tocopherol per day to benefit from decreased risks of mortality and chronic disease, as well as to preserve the integrity of the cell membrane. Dietary survey data in the US indicates that the average intake of alpha-tocopherol from food is only 6.9mg/day. This means that more than 90% of the US population does not currently meet the daily dietary recommendations for vitamin E.4 There is ongoing work to determine the appropriate assessment of vitamin E status and functionality, and new biomarkers need to be identified to define vitamin E adequacy and inadequacy more accurately.
Vitamin D
Intake of vitamin D tells a similar story. It can be difficult to consume the recommended levels through diet or exposure to sunlight alone, and certain individuals have a predisposition to low levels of vitamin D, including breast fed infants, elderly, institutionalized or obese individuals and African Americans of all ages. The Institute of Medicine (IOM) developed new Dietary Reference Intakes (DRIs) in 2010. These concluded that the Recommended Daily Allowance (RDA) should now be 600 IU per day for adults and children.8
More than one third of the global population may suffer from low levels of vitamin D
Yet vitamin D deficiency remains a major public health concern. According to the latest study from the International Osteoporosis Foundation (IOF), more than one third of the global population may suffer from low levels of vitamin D. This is taken to be mean serum levels of 25(OH)D, which is below 50nmol/L and is a value that is considered to be inadequate by health authorities worldwide.9 This affects both the industrialised and developing worlds. Supplementation remains a key way to overcome this issue.
The number of studies demonstrating the importance of vitamin D is growing rapidly as scientists, healthcare practitioners and governments further their understanding of its role in human health. Extensive studies have been conducted into the benefits of vitamin D and its essential role in aiding calcium uptake; yet, there is evidence to suggest that vitamin E offers a wide number of other health benefits. For example, a study was published earlier this year on the relationship between vitamin D and breast cancer survival rates.10 The meta-analysis of five clinical studies, with data from more than 4,000 breast cancer patients, found that those with the highest levels of vitamin D intake benefited from twice the survival rate of those with the lowest intake. Research has also recently been published in Neurology to demonstrate that vitamin D deficiency in older people may double the risk of developing dementia and Alzheimer’s disease.11
Leading the way
DSM is committed to advancing research into the health benefits associated with multivitamin supplementation and is leading an initiative — Vitamins in Motion — to highlight the critical role vitamins play in overall nutrition and health. The campaign advocates for increased access, through innovative solutions, to the essential vitamins all people need to be healthy and well nourished.
References
1. http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional.
2. B. Frei, et al., “Enough is Enough [Letter],” Ann. Intern. Med. 160(11), 807 (2014).
3. E. Guallar, et al., “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements [Editorial],” Ann. Intern. Med. 159, 850–851 (2013).
4. V.L. Fulgoni 3rd, et al., “Foods, Fortificants and Supplements: Where do Americans Get Their Nutrients?” J. Nutr. 141, 1847–1854 (2011).
5. J.M. Gaziano, et al., “Multivitamins in the Prevention of Cancer in Men: The Physicians’ Health Study II Randomized Controlled Trial,” JAMA 308, 1871–1880 (2012).
6. M.W. Dysken, et al., “Effect of Vitamin E and Memantine on Functional Decline in Alzheimer’s Disease: The TEAM-AD VA Cooperative Randomized Trial,” JAMA 311(1), 33–44 (2014).
7. A.J. Sanyal, et al., “Pioglitazone, Vitamin E or Placebo for Nonalcoholic Steatohepatitis,” N. Engl. J. Med. 362(18), 1675–1685 (2010).
8. www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-calcium-and-vitamin-D.aspx.
9. J. Hilger, et al., “A Systematic Review of Vitamin D Status in Populations Worldwide,” Br. J. Nutr. 111(1), 23–45 (2013).
10. S.B. Mohr, et al., “Meta-Analysis of Vitamin D Sufficiency for Improving Survival Rates of Patients with Breast Cancer,” Anticancer Research 34(3), 1163–1166 (2014).
11. T.J. Littlejohns, et al., “Vitamin D and the Risk of Dementia in Alzheimer’s Disease,” Neurology. Published online ahead of print: www.neurology.org/content/early/2014/08/06/WNL.0000000000000755.short?rss=1.