Multivitamin

Source: Wikipedia, the free encyclopedia.
dietary minerals
.

A multivitamin is a preparation intended to serve as a

Codex Alimentarius Commission (the United Nations' authority on food standards) as a category of food.[1]

In healthy people, most scientific evidence indicates that multivitamin supplements do not prevent cancer, heart disease, or other ailments, and regular supplementation is not necessary.[2][3][4][5][6][7][8] However, specific groups of people may benefit from multivitamin supplements, for example, people with poor nutrition or those at high risk of macular degeneration.[3][9]

There is no standardized scientific definition for multivitamin.[10] In the United States, a multivitamin/mineral supplement is defined as a supplement containing three or more vitamins and minerals that does not include herbs, hormones, or drugs, where each vitamin and mineral is included at a dose below the tolerable upper intake level as determined by the Food and Drug Board, and does not present a risk of adverse health effects.[11]

Products and components

Many multivitamin formulas contain

antioxidants
.

Some nutrients, such as calcium and magnesium, are rarely included at 100% of the recommended allowance because the pill would become too large in size. Most multivitamins come in capsule form; tablets, powders, liquids, and injectable formulations also exist. In the United States, the

FDA requires any product marketed as a "multivitamin" to contain at least three vitamins and minerals; furthermore, the dosages must be below a "tolerable upper limit", and a multivitamin may not include herbs, hormones, or drugs.[12]

Uses

For certain people, particularly for older people, supplementing the diet with additional vitamins and minerals can have health impacts; however, the majority will not benefit.[13] People with dietary imbalances may include those on restrictive diets and those who cannot or will not eat a nutritious diet. Pregnant women and elderly adults have different nutritional needs compared to other adults, and a multivitamin may be indicated by a physician. Generally, medical advice is to avoid multivitamins during pregnancy, particularly those containing vitamin A, unless they are recommended by a health care professional. However, the NHS recommends 10μg of Vitamin D per day throughout the pregnancy and while breastfeeding, and 400μg of folic acid during the first trimester (first 12 weeks of pregnancy).[14] Some women may need to take iron, vitamin C, or calcium supplements during pregnancy, but only on the advice of a doctor.

In the 1999–2000 National Health and Nutrition Examination Survey, 52% of adults in the United States reported taking at least one dietary supplement in the last month and 35% reported regular use of multivitamin-multimineral supplements. Women versus men, older adults versus younger adults, non-Hispanic whites versus non-Hispanic blacks, and those with higher education levels versus lower education levels (among other categories) were more likely to take multivitamins. Individuals who use dietary supplements (including multivitamins) generally report higher dietary nutrient intakes and healthier diets. Additionally, adults with a history of prostate and breast cancers were more likely to use dietary and multivitamin supplements.[15]

Precautions

The amounts of each vitamin type in multivitamin formulations are generally adapted to correlate with what is believed to result in optimal health effects in large population groups. However, these standard amounts may not correlate with what is optimal in certain subpopulations, such as in children, pregnant women and people with certain medical conditions and medication.

The health benefit of vitamins generally follows a biphasic

dose-response curve, taking the shape of a bell curve, with the area in the middle being the safe-intake range and the edges representing deficiency and toxicity.[16] For example, the Food and Drug Administration recommends that adults on a 2,000 calorie diet get between 60 and 90 milligrams of vitamin C per day.[17] This is the middle of the bell curve. The upper limit is 2,000 milligrams per day for adults, which is considered potentially dangerous.[18]

In particular, pregnant women should consult their doctors before taking any multivitamins. For example, either an excess or deficiency of vitamin A can cause birth defects.[19]

Long-term use of

beta-carotene, vitamin A, and vitamin E supplements may shorten life,[2] and increase the risk of lung cancer in people who smoke (especially those smoking more than 20 cigarettes per day), former smokers, people exposed to asbestos, and those who use alcohol.[20] Many common brand supplements in the United States contain levels above the DRI
/RDA amounts for some vitamins or minerals.

Severe vitamin and mineral deficiencies require medical treatment and can be very difficult to treat with common over-the-counter multivitamins. In such situations, special vitamin or mineral forms with much higher potencies are available, either as individual components or as specialized formulations.

Multivitamins in large quantities may pose a risk of an acute

overdose due to the toxicity of some components, principally iron. However, in contrast to iron tablets, which can be lethal to children,[21] toxicity from overdoses of multivitamins are very rare.[22] There appears to be little risk to supplement users of experiencing acute side effects due to excessive intakes of micronutrients.[23]
There also are strict limits on the retinol content for vitamin A during pregnancies that are specifically addressed by prenatal formulas.

As noted in dietary guidelines from Harvard School of Public Health in 2008, multivitamins should not replace healthy eating or make up for unhealthy eating.[24][failed verification] In 2015, the U.S. Preventive Services Task Force analyzed studies that included data for about 450,000 people. The analysis found no clear evidence that multivitamins prevent cancer or heart disease, helped people live longer, or "made them healthier in any way."[25]

Research

Provided that precautions are taken (such as adjusting the vitamin amounts to what is believed to be appropriate for children, pregnant women or people with certain medical conditions), multivitamin intake is generally safe, but research is still ongoing with regard to what health effects multivitamins have.

Evidence of health effects of multivitamins comes largely from

Randomized controlled studies have been encouraged to address this uncertainty.[29]

Cohort studies

Centrum multivitamins produced by Pfizer, which were used in Physicians' Health Study II

In February 2009, a study conducted in 161,808

postmenopausal women from the Women's Health Initiative clinical trials concluded that after eight years of follow-up "multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality".[28] Another 2010 study in the Journal of Clinical Oncology suggested that multivitamin use during chemotherapy for stage III colon cancer had no effect on the outcomes of treatment.[30] A very large prospective cohort study published in 2011, including more than 180,000 participants, found no significant association between multivitamin use and mortality from all causes. The study also found no impact of multivitamin use on the risk of cardiovascular disease or cancer.[31]

A cohort study that received widespread media attention

Journal of the American Medical Association, the investigators observed no difference in the effect whether the study participants were or were not adherent to the multivitamin intervention, which diminishes the dose–response relationship.[35] The same editorial argued that the study did not properly address the multiple comparisons problem, in that the authors neglected to fully analyze all 28 possible associations in the study—they argue if this had been done, the statistical significance of the results would be lost.[35]

Using the same PHS-II study, researchers concluded that taking a daily multivitamin did not have any effect in reducing

heart attacks and other major cardiovascular events, MI, stroke, and CVD mortality.[36]

Systematic reviews and meta-analyses

One major meta-analysis published in 2011, including previous cohort and case-control studies, concluded that multivitamin use was not significantly associated with the risk of breast cancer. It noted that one Swedish cohort study has indicated such an effect, but with all studies taken together, the association was not statistically significant.[29] A 2012 meta-analysis of ten randomized, placebo-controlled trials published in the Journal of Alzheimer's Disease found that a daily multivitamin may improve immediate recall memory, but did not affect any other measure of cognitive function.[37]

Another meta-analysis, published in 2013, found that multivitamin-multimineral treatment "has no effect on mortality risk",[38] and a 2013 systematic review found that multivitamin supplementation did not increase mortality and might slightly decrease it.[39] A 2014 meta-analysis reported that there was "sufficient evidence to support the role of dietary multivitamin/mineral supplements for the decreasing the risk of age-related cataracts."[40] A 2015 meta-analysis argued that the positive result regarding the effect of vitamins on cancer incidence found in Physicians' Health Study II (discussed above) should not be overlooked despite the neutral results found in other studies.

Looking at 2012 data, a study published in 2018 presented meta-analyses on cardiovascular disease outcomes and all-cause mortality. It found that "conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks." The study dismissed the benefits of routinely taking supplements of vitamins C and D, beta-carotene, calcium, and selenium. Results indicated taking niacin may actually be harmful.[4][5]

In July 2019, another meta-analysis of 24 interventions in 277 trials was conducted and published in

folic acid supplements.[42] This analysis supports the results of two early 2018 studies that found no conclusive benefits from multivitamins for healthy adults.[6][43]

Expert bodies

A 2006 report by the U.S. Agency for Healthcare Research and Quality concluded that "regular supplementation with a single nutrient or a mixture of nutrients for years has no significant benefits in the primary prevention of cancer, cardiovascular disease, cataract, age-related macular degeneration or cognitive decline."[9] However, the report noted that multivitamins have beneficial effects for certain sub-populations, such as people with poor nutritional status, that vitamin D and calcium can help prevent fractures in older people, and that zinc and antioxidants can help prevent age-related macular degeneration in high-risk individuals.[9] A 2017 Cochrane Systematic Review found that multivitamins including vitamin E or beta carotene will not delay the onset of macular degeneration or prevent the disease,[44] however, some people with macular degeneration may benefit from multivitamin supplementation as there is evidence that it may delay the progression of the disease.[45] Including lutein and zeaxanthin supplements in with a multivitamin does not improve progression of macular degeneration.[45] The need for high-quality studies looking at the safety of taking multivitamins has been highlighted.[45]

According to the

Harvard School of Public Health: "... many people don't eat the healthiest of diets. That's why a multivitamin can help fill in the gaps, and may have added health benefits."[46] The U.S. Office of Dietary Supplements, a branch of the National Institutes of Health, suggests that multivitamin supplements might be helpful for some people with specific health problems (for example, macular degeneration). However, the Office concluded that "most research shows that healthy people who take an MVM [multivitamin] do not have a lower chance of diseases, such as cancer, heart disease, or diabetes. Based on current research, it's not possible to recommend for or against the use of MVMs to stay healthier longer."[3]

Regulations

United States

The first person to formulate vitamins in the US was Dr. Forrest C. Shaklee.[47] Shaklee introduced a product he dubbed "Shaklee's Vitalized Minerals" in 1915, which he sold until adopting the now ubiquitous term "vitamin" in 1929.[48]

Because of their categorization as a dietary supplement by the Food and Drug Administration (FDA), most multivitamins sold in the U.S. are not required to undergo the testing procedures typical of pharmaceutical drugs. However, some multivitamins contain very high doses of one or several vitamins or minerals, or are specifically intended to treat, cure, or prevent disease, and therefore require a prescription or medicinal license in the U.S. Since such drugs contain no new substances, they do not require the same testing as would be required by a New Drug Application, but were allowed on the market as drugs due to the Drug Efficacy Study Implementation program.[49]

Australia

Vitamins are classed as low-risk medications by the Therapeutic Goods Administration (TGA), and are therefore not assessed for efficacy, unlike most medicines sold in Australia. They require that the product is safe and that claims of efficacy can only be made in regards to minor ailments. No claims can be made about serious conditions. The TGA does not examine the contents of the product and whether it is what the label says it is, but they claim to carry out "targeted and random surveillance of products on the market."[50] They encourage people to report any unsafe products to them.

The TGA, however, has been criticized, by people such as

Australian Competition & Consumer Commission, for allowing more than a thousand types of claim, 86% of which are not supported by scientific evidence, including "softens hardness", "replenishes gate of vitality" and "moistens dryness in the triple burner".[51]

See also

References

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  4. ^ a b Litman RS (June 5, 2018). "New study on supplemental vitamins proves they're useless and a waste of money". Philly.com. Archived from the original on July 9, 2018. Retrieved July 9, 2018.
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External links
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