Multivitamin-multimineral supplements' effect on total nutrient intake

Use of multivitamin-multimineral supplements is widespread and can contribute substantially to total nutrient intakes. In the Hawaii-Los Angeles Multiethnic Cohort (MEC), 48% of men and 56% of women without chronic diseases reported use of multivitamin supplements at least weekly over the past year. We calculated the prevalence of nutrient adequacy for 17 nutrients based on responses to a self-administered quantitative food-frequency questionnaire administered to MEC participants at baseline in 1993-1996. Although the prevalence of nutrient adequacy from food only was higher for multivitamin supplement users (n = 21 056) than for nonusers (n = 69 715), differences averaged only 2 percentage points. For multivitamin users, the prevalence of adequacy improved by an average of 8 percentage points for both men and women when intake from supplements was included. Users were also more likely to have potentially excessive intakes, particularly for iron, zinc, vitamin A, and niacin. The 26 735 MEC participants in Hawaii who answered an open-ended question about multivitamin use in 1999-2001 reported using 1246 different products. The nutrient profile of these products varied widely, and the composition of products at the 90th percentile was 10-fold greater than the composition at the median for some nutrients. We conclude that analyses of nutrient adequacy and excess for supplement users should be extended to national samples and that composition data on actual supplements used are preferable to assuming a default nutrient profile for multivitamin supplements. Multivitamin products could be better formulated to reduce the prevalence of inadequacy and also to reduce the risk of excessive intakes. KEY WORDS Multivitamins, dietary supplements, nutrient adequacy, excessive intakes