Profiling Dietary Supplement Use: Current Data and Challenges

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Profiling Dietary Supplement Use Current Data
and Challenges

• Office of Dietary Supplements Conference
• Bioavailability of Nutrients and Other Bioactive
  Components of Dietary Supplements Defining the
  Research Agenda
• January 5, 2000
• James T. Heimbach, Ph.D., F.A.C.N.
• Mary M. Murphy, M.S., R.D.
• Judith S. Douglass, M.S., R.D.
• ENVIRON International Corporation

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2 RecentPrivate Surveys
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The Growing Self-CareMovement

• Telephone survey of 1000 food shoppers
• Interviewing February-March, 1999
• Sponsored by Prevention Magazine and the Food
  Marketing Institute (FMI)

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The Growing Self-CareMovement(Prevention/FMI
Survey)

• Products used to maintain health 1998 1999
• OTC medications 85 76
• Vitamins minerals 67 72
• Fortified foods NA 66
• Herbal remedies 28 36
• Homeopathic remedies 15 17

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The Growing Self-CareMovement(Prevention/FMI
Survey)

• Use to Use to prevent treat
• colds colds
• Vitamins minerals 60 50
• Herbal remedies 32 34

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Consumer Perceptions and Useof Vitamins
Herbal Products

• Telephone survey of 2,000 individuals age 18
• Interviewing winter, 1998-99
• Sponsored by Leiner Health Care Products (used by
  permission)

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Consumer Perceptions and Useof Vitamins
Herbal Products(Leiner Health Care Products)

• Take a vitamin supplement daily 55
• Multivitamin 45
• Vitamin C 24
• Vitamin E 22
• Vitamin A 3
• Zinc 5
• Iron 3
• Take an herbal product daily 14
• Ginkgo 6
• Ginseng 5

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Consumer Perceptions and Useof Vitamins
Herbal Products(Leiner Health Care Products)

• Vitamin/ Herbal
• Why take product Mineral Product
• General health 40 41
• Prevent illness 30 20
• Compensate for poor diet 26 --
• Improve energy -- 10
• Improve memory -- 10

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National Nutrition Monitoring and Related
Research Program (NNMRRP)

• Established by the National Nutrition Monitoring
  and Related Research Act of 1990 (Public Law
  101-445)
• Encompasses the set of activities necessary to
  provide timely information about the role and
  status of factors that bear on the contribution
  that nutrition makes to the health of the people
  of the United States.

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National Nutrition Monitoring and Related
Research Program Five Components

• dietary, nutritional, and health status
  measurements
• food consumption measurements
• food composition measurements and nutrient data
  banks
• dietary knowledge and attitude measurements
• food supply and demand determinations

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National Nutrition Monitoring and Related
Research Program Keystone Surveys

• National Health and Nutrition Examination Surveys
  (DHHS/CDC/NCHS)
• NHANES III, 1988-1994
• Nationwide Food Consumption Surveys (USDA/ARS)
• Continuing Surveys of Food Intakes by Individuals
  (CSFII 1994-96)

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National Nutrition Monitoring and Related
Research Program Other Major Surveys

• National Health Interview Surveys (DHHS/CDC/NCHS)
• Annual NHIS (since 1957)
• Split-sample design with variable modules
• Various surveillance surveys (DHHS/CDC)
• Health and Diet Survey (DHHS/FDA)
• Special surveys

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Third National Health and Nutrition Examination
Survey(NHANES III)

• Period covered
• Fall 1988 to Fall 1994
• Number of respondents
• 33,994 interviewed
• 31,311 examined
• Data obtained
• food consumption measurements (1 day)
• dietary, nutritional, and health status
  measurements

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Third National Health and Nutrition Examination
Survey(NHANES III)

• Key indicators
• food nutrient intakes
• body measurements
• hematological tests
• biochemical analyses of whole blood serum
• blood pressures
• EKGs

• urine tests
• bone densiometry
• dental exams
• gallbladder ultrasonography
• cognitive physical functioning

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1994-96 Continuing Surveys of Food Intakes by
Individuals(1994-96 CSFII)

• Period covered
• January 1994 to December 1996
• Number of respondents
• 16,103 provided Day-1 data
• 15,303 provided 2 days of data
• Data obtained
• food consumption measurements on two
  nonconsecutive days

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Current Activities

• NHANES IV
• similar to NHANES III
• in field now
• will become continuous
• 1998 CSFII Childrens Survey
• January 1998 to December 1998
• methodology similar to 1994-96 CSFII
• interviewed 5,300 children birth to 9 years
• summary data released December 1999
• CD-ROMs available March 2000

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Future Plan Unified NHANES/CSFII

• Scheduled to begin January 2001
• Continuous survey
• 10,000 respondents per year
• oversample African-American, Mexican-American,
  and low-income populations
• 5,000 CATIs providing 2 days of data
• 5,000 CAPIs in the MECs providing 1 day of data
  10 sub-sample providing 2 days
• CD-ROMs to be released approximately 15 months
  after completion of each year

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provide timely information

• Time between surveys--
• NHANES I 1971-74
• NHANES II 1976-80
• NHANES III
• 1988-94
• NHANES IV
• 1999- ?

• NFCS 1977-78
• CSFII 1985-86
• NFCS 1987-88
• CSFII 1989-91
• CSFII 1994-96
• CSFII 2001- ?

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provide timely information

• Time from completion of survey fieldwork to
  release of data--
• Old standard 2-? years
• New standard 14-15 months

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NutrientBioavailability

• Not a priority ...

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ExampleIron Bioavailability

• Non-heme iron absorption from a meal containing
  meat, fish, or chicken is about 4 times greater
  than from equivalent portions of milk, cheese, or
  eggs.
• Rossander et al., 1979

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Enhancers and Inhibitorsof Iron Absorption

• - Phytic acid
• - Oxylates
• - Polyphenols
• - Calcium phosphate

• Ascorbic acid
• Heme iron
• Other meat factors

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Proposed Research Paradigm

• Link data on enhancers and inhibitors in foods
  with USDA food codes
• Determine, for each eating occasion, the amount
  of non-heme iron as well as enhancers and
  inhibitors
• Employ iron absorption model to estimate the
  amount of bioavailable iron

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factors that bear on the contribution that
nutrition makes

• National data regarding consumer
• use of dietary supplements--
• in CSFII
• in NHANES
• in NHIS

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Dietary Supplementsin CSFII

• How often, if at all, do you take any vitamin
  supplement in pill or liquid form? Would you
  say--
• Every day or almost every day,
• Every so often, or
• Not at all?

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Dietary Supplementsin CSFII

• Which of these types of supplements do you
  usually take?
• multivitamin
• multivitamin with iron or other minerals
• vitamin C and iron
• single vitamins or minerals (list)
• Do you take a fish oil supplement?
• Do you take a fiber supplement?

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Dietary Supplementsin NHANES

• Have you taken any vitamins or minerals in the
  past month?
• How many vitamin or mineral products do you
  take?
• list all supplements reported, ask to see
  container, record product name and manufacturer
  or distributor

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Dietary Supplementsin NHANES

• How often did you take PRODUCT in the past
  month?
• How much PRODUCT did you take each time you
  took it?
• For how long have you been taking this type of
  product?

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Dietary Supplementsin NHIS

• Questions on use of vitamin and mineral
  supplements were included in 1987 and in 1992
• Have you taken any vitamin or mineral supplement
  in the past year?
• Information was obtained on frequency of use of
  multivitamins and a variety of specific vitamin
  or mineral supplements

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Challenge

• little change
• BIG EFFECT

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Challenge

• Product Identification
• Brand A
• formulation?
• Brand B
• formulation?
• Brand X
• ????????????

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Challenge

• Product Characterization
• Product Consistency

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Challenge

• Survey Respondent Burden
• Necessary
• Nice to know
• Cant put EVERYTHING
• into NHANES/CSFII!

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Recommendation

• Examine critically the data needs for dietary
  supplement ingredients--
• Detailed linkage with food/nutrient intake
• General linkage with food/nutrient intake
• No needed linkage with food/nutrient intake

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Some thoughts on taxonomy...

• Vitamins, minerals
• Other substances found primarily in foods
• Substances found in foods at low levels
• Substances not found in foods, but with
  known/suspected food/nutrient interactions
• Substances not found in foods and with no
  suspected food/nutrient interactions

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Estimated Usual Intake of IronDiet Alone v. Diet
Supplements(Source NHANES III)
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Estimated Usual Intake of IronDiet Alone v. Diet
Supplements(Source NHANES III)
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Intake of Vitamin C From FoodsFemales Age 9
(Source NHANES III)
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Use of Vitamin C SupplementsFemales Age 9
(Source NHANES III)
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Use of Vitamin C Supplementsby Dietary Vitamin C
Intake
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Thank You!