Multivitamins and Nutritional Adequacy in Middle-Aged to Older Americans by Obesity Status

Abstract

Multivitamins are the most commonly consumed dietary supplement in the United States and worldwide. Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults, and multivitamin use has been shown to improve status in this population. This analysis aimed to assess contributions of sporadic and consistent multivitamin use to total usual micronutrient intakes and associated nutritional biomarkers among middle-aged to older US adults age ≥51 years, stratified by obesity status. Self-reported dietary intake and laboratory measures from the National Health and Nutrition Examination Survey were used in these analyses. The National Cancer Institute method was used to assess usual intakes of 18 micronutrients. Compared with food alone, multivitamin use was associated with a lower prevalence of inadequacies and improved nutritional biomarker status for folate, iodine, selenium, and vitamins B₆, B₁₂, and D. Consistent use decreased the prevalence of inadequacy for most micronutrients assessed, except for those micronutrients typically not found (or in miniscule amounts) in standard multivitamin products. In addition to a lower prevalence of inadequacy for many micronutrients associated with consistent use of multivitamins, sporadic use decreased the prevalence of inadequacy for a greater number of micronutrients in obese versus nonobese individuals. Multivitamin use (sporadic and consistent) also increased the proportion of individuals who exceeded the tolerable upper intake level for folic acid to 8%–10%. Nutritional biomarker data indicate that obese individuals may be at greater risk of clinical deficiency in vitamins B₆ and D. Use of gender- and age-specific multivitamins may serve as a practical means to increase micronutrient status and decrease prevalences of clinical deficiency in the middle-aged to older population, particularly in those who are obese.

Keywords:

• dietary supplement
• multivitamin
• nutrient
• nutritional biomarker
• obesity
• usual intake

Acknowledgments

The authors thank Ms. Christina West for her assistance in formatting and copyediting the manuscript.

Declaration of interest

C.L.F. and T.C.W. disclose research grant funding from Pfizer Consumer Healthcare for other National Health and Nutrition Examination Survey data analysis. T.C.W. is the Principal and CEO of the Think Healthy Group, Inc., a food science and nutrition consulting firm dedicated to advancing cutting-edge research and public health through engagement of industry, academia, government, media, and nongovernmental organizations. Additional information, published manuscripts, presentations, and sources of funding for all projects can be found at www.drtaylorwallace.com.

Additional information

Notes on contributors

Cara L. Frankenfeld

Cara L. Frankenfeld, PhD, is an Associate Professor at George Mason University in Fairfax, Virginia. She received her PhD from the University of Washington. Professor Frankenfeld serves on the Editorial Board of the Journal of Nutrition and is an Associate Editor for Annals of Epidemiology. She is an epidemiologist whose research focuses on understanding the influence of complex exposures on health. She applies advanced quantitative methods to research questions in the areas of nutrition (public health nutrition, microbiome, phytoestrogens), environmental health (chemical exposure), and social determinants of health (residential segregation, spatial factors), with applications across different diseases and health conditions.

Taylor C. Wallace

Taylor C. Wallace, PhD, CFS, FACN, is Adjunct Professor in the Department of Nutrition and Food Studies at George Mason University in Fairfax, Virginia, and Principal and CEO at the Think Healthy Group. He earned his PhD from The Ohio State University. He has served on the Boards of Directors of the Institute of Food Technologists, Alliance for Food and Health, Feeding Tomorrow, and Phi Tau Sigma. He is the 2015 recipient of the Charles A. Regus Award, given by the American College of Nutrition for original research and innovation in the field of nutrition. Dr. Wallace is the Editor-in-Chief of the Journal of Dietary Supplements, Deputy Editor-in-Chief of the Journal of the American College of Nutrition, the editor of 6 academic textbooks, and an author of over 50 peer-reviewed manuscripts and book chapters. His academic research interests are in the area of nutritional interventions to promote health and prevent the onset of chronic disease.