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Marketing data show that Americans spent $20.3 billion on dietary supplements in 2004. For caregivers attempting to track what goes into their patients' bodies, it's important to know just what supplements people are taking.
Several researchers tackled the subject in presentations at the American Dietetic Association's Food and Nutrition Conference and Expo, held October 22–25 in St. Louis, Mo.
More than 50% of U.S. adults reported using a dietary supplement within the last 30 days, according to Mary Frances A. Picciano, PhD, a senior nutrition scientist at the Office of Dietary Supplements (ODS) of the National Institutes of Health in Bethesda, Md. She cites data gathered by the National Health and Nutrition Examination Surveys (NHANES).
"When making nutritional assessments you have to include supplement data," Picciano says.
Offering a research case study as an example, she asks, Is calcium related to national trends in prevalence rates for hypertension? Investigators would have to collect complete data on subjects' food sources, supplements, and antacid use (almost 25% of the NHANES respondents report taking an antacid containing calcium) to calculate a total dietary intake of calcium—not an easy task unless one knows which supplements contain how much of a particular ingredient.
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Help is on the way, Picciano says, in the form of the NHANES online analysis of dietary supplements, or NOADS, a new database that will provide total nutrient intakes from all sources and the relative contribution of each. Designed to be a new tool for dietitians' practice, NOADS should be available in 2006.
SUPPLEMENTS TO SELF-MEDICATE
A 2003 survey of 2,000 grocery shoppers provides additional detail about the prevalence of dietary supplement use by demographics and health status. Johanna T. Dwyer, DSc, RD, a senior scientist at ODS and director of the Frances Stern Nutrition Center in Boston, presented the results.
The survey found that greater supplement use was associated with older age, especially when users were in poor health or feeling poorly. Use was higher among females and also higher among non-Hispanic whites compared with blacks or Hispanics. Over the previous 12 months, many took supplements for what they perceived to be medical or nutritional problems. Yet the Dietary Supplement Health and Education Act (DSHEA) of 1995 designates dietary supplements neither for the prevention nor for the treatment of disease, Dwyer notes.
"But consumers view dietary supplements as helpful in prevention and treatment. They are often used in ways quite different than the law intended," she says.
Among respondents, 45% said supplements were helpful for preventing high blood pressure, 44% for heart disease, and 43% for high cholesterol. As for treating diseases, 50% said they would use supplements for high blood pressure, 50% for heart disease, 48% for high cholesterol, 42% for diabetes, and 42% for obesity/overweight.
Over half the respondents reported using prescription medications as a first choice for treating specific health problems, but a third reported first using vitamins, minerals, herbal dietary supplements, and alternative health care.
"There are a lot of interactions between dietary supplements and medications," Dwyer says. "We need to get [patients] to fully report what they take."
Asking about supplement use is not always as straightforward as it may seem, but dietitians need to make sure they "get it on the charts," she says.
"Since many regard supplement use as part of their overall self
health care efforts, it is important for dietitians to include questions about
supplement use when counseling patients, to assess readiness for change when
dietary supplements are medically indicated, and to make medically based
recommendations on dietary supplements when appropriate," Dwyer says.
Food Nutrient Tool for Patients
Nutrition labels on packaged food offer a good starting place for people who want to monitor their intake. But how to track that penne with pesto that Grandma makes or the steak and potatoes ordered at a local restaurant?
The Agricultural Research Service (ARS) has rolled out a free nutrient database of common foods designed to help consumers make more informed food choices. The "What's in the Foods You Eat?" search tool is a downloadable product offering a breakdown of 61 nutrients for more than 13,000 foods Americans typically consume.
The nutrition information is provided in familiar portion sizes (that also can be adjusted) and weights. It is based on the Food and Nutrient Database for Dietary Studies 1.0 used for What We Eat in America, the dietary intake interview component of NHANES, and also for MyPyramid Tracker, an online food intake and assessment tool (www.mypyramidtracker.gov), and the Department of Agriculture's Pyramid Servings Database.
ARS, a scientific research agency of the Food and Drug Administration, unveiled the new database October 24 in St. Louis, Mo., at the American Dietetic Association's Food and Nutrition Conference and Expo.
The search tool can be downloaded to a PC at www.ars.usda.gov/foodsearch.
Footnotes
The Nutrient Data Laboratory (NDL) at the Department of Agriculture's Beltsville (Md.) Human Nutrition Research Center is working with the National Institutes of Health's Office of Dietary Supplements to plan and develop a Dietary Supplement Ingredient Database (DSID) to monitor the levels of ingredients in dietary supplement products. The end result will be a publicly available database of a mix of data and product types that will enable nutrition professionals to assess total intake from foods, beverages, and dietary supplements. The DSID will be maintained on NDL's Web site: www.nal.usda.gov/fnic/foodcomp.
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