JAMA Forum: Given Their Potential for Harm, It’s Time to Focus on the Safety of Supplements

A recent study published in JAMA Pediatrics used National Health and Nutrition Examination Survey data to examine supplement use among children. The researchers used 6 recent waves of the survey (from 2003-2004 through 2013-2014), specifically focusing on children and adolescents through 19 years of age. Parents provided answers to questions if the children were younger than 16 years.

Respondents were asked if they had “used or taken any vitamins, minerals, herbals, or other dietary supplements in the past 30 days.” If they answered “yes” to any questions, they were asked—in person—to show containers for those supplements so that the answers could be confirmed and recorded.

Supplements were grouped into 2 categories. Those that consisted mostly of vitamins or minerals were called “nutritional products.” Others, like herbal supplements, and those not consisting mostly of vitamins and minerals were called “alternative medicines.” About a third of children and adolescents—a massive number—use dietary supplements. Multivitamins were the most common nutritional product, followed by omega-3 fatty acids.

Increasing Use of Alternative Medicines
Nutritional product use has remained steady over time, but the use of alternative medicines increased from 3.7% to 6.7%. Much of this increase was due to more children and adolescents using omega-3 fatty acids and melatonin.

It’s important to stop at this point and ask why. Fish oil supplements and the fatty acids they contain have been studied pretty extensivelyin adult populations who might actually be at risk of heart disease, and that research has found that they didn’t seem to work. There’s absolutely no evidence that they are useful in children. Other alternative products, like melatonin, are being used more often, even though data on children—certainly safety data—are lacking. In other cases, alternative medicines such as nootropics, drugs that are supposed to advance cognitive function, are gaining in popularity, too.

Even the nutritional product use is of questionable benefit for many individuals. Do we really believe that the vast majority of children in the United States are deficient in vitamins and minerals? I’m not talking about children with diagnosed deficiencies, which are rare, and then absolutely need to be treated.  Most cases of deficiencies involve vitamin D deficiency in kids younger than 1 year or iron deficiency in children aged 1 to 5 years. The vast majority of children who take a multivitamin are healthy children who—if anything—are likely getting more than enough.

Drug-Drug Interactions and Other Concerns
Concerns about supplement use are not limited to children. A study published in JAMA Internal Medicine in 2016 looked at how the prevalence of dietary supplements and over-the-counter medication use changed among the elderly from 2005 to 2011. More than 2000 people, on average older than 70 years, were interviewed twice. Between 2005 and 2011, over-the-counter medications decreased from 44% to 38%. The use of supplements, however, increased from 52% to 64%. 

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Autor / Fonte:JAMA Forum
Link: https://newsatjama.jama.com/2018/08/15/jama-forum-given-the-their-potential-for-harm-its-time-to-focus-on-the-safety-of-supplements/