其他
补充维生素和矿物质真的有用吗?听听BMJ咋说?
关键信息:
●随机试验的数据并不支持服用维生素、矿物质和鱼油补充剂可以降低非传染性疾病的风险。
●与不服用补充剂的人相比,服用补充剂的人多为女性、老年人,并且往往获得过更高水平的教育、拥有更高的收入和更健康的生活方式。
●补充剂的使用显著降低了多种营养素摄入不足的流行率,但也增加了某些营养素摄入过量的比率。
●需要进一步研究(包括低收入和中等收入国家),以评估补充剂对一般人群和具有特殊营养需求人群的健康的长期影响。
膳食补充剂的流行
补充剂的受众是谁?
BOX 1 人群营养素摄入量定义:
平均需要量(Estimated average requirement,EAR):能满足一半健康人群的需求量的每日营养平均摄入量。
营养摄入不足(Inadequate nutrient intake):摄入不足的人口流行率可表示为营养素摄入量低于平均需要量的人口的百分比。
可耐受最高摄入量(Tolerable upper intake):对于某特定人群中的几乎所有健康个体均不产生危害的每日摄入量的最高水平。当摄入量高于可耐受最高摄入量的上限时,潜在的健康危害风险增加。
补充剂是否必不可少?
补充剂能预防非传染性疾病吗?
BOX 2 维生素和矿物质补充剂的研究领域:
●从食物或补充剂中摄入的营养素对健康的不同影响
●多种营养素之间以及与其他生物活性物质的协同作用
●特定人群的研究(例如,老年人、少数民族、纯素食者)
●营养遗传学与“组学”科学
●个性化补充
●低收入和中等收入国家的特定需要
下一步呢?
1.Ford JA, MacLennan GS, Avenell A, Bolland M, Grey A, Witham M, RECORD Trial Group. Cardiovascular disease and vitamin D supplementation: trial analysis, systematic review, and meta-analysis. Am J Clin Nutr2014;100:746-55. doi:10.3945/ajcn.113.082602 pmid:250571562.Skeie G, Braaten T, Hjartåker A, et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr2009;63(Suppl 4):S226-38. doi:10.1038/ejcn.2009.83 pmid:198882763.O’Brien SK, Malacova E, Sherriff JL, Black LJ. The prevalence and predictors of dietary supplement use in the Australian population. Nutrients2017;9:E1154. doi:10.3390/nu9101154 pmid:290654924.Kang M, Kim DW, Baek YJ, et al. Dietary supplement use and its effect on nutrient intake in Korean adult population in the Korea National Health and Nutrition Examination Survey IV (2007-2009) dataEur J Clin Nutr2014;68:804-10. doi:10.1038/ejcn.2014.77 pmid:248240115.Black LI, Clarke TC, Barnes PM, Stussman BJ, Nahin RL. Use of complementary health approaches among children aged 4-17 years in the United States: national health interview survey, 2007-2012. Natl Health Stat Report2015;(78):1-19.pmid:256715836.Chen F, Du M, Blumberg JB, et al. Association among dietary supplement use, nutrient intake, and mortality among US adults: a cohort study. Ann Intern Med2019;170:604-13. doi:10.7326/M18-2478 pmid:309595277.Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999-2012. JAMA2016;316:1464-74. doi:10.1001/jama.2016.14403 pmid:277273828.Blumberg JB, Frei B, Fulgoni VL, Weaver CM, Zeisel SH. Contribution of dietary supplements to nutritional adequacy in various adult age groups. Nutrients2017;9:E1325. doi:10.3390/nu9121325 pmid:292110079.Qato DM, Alexander GC, Guadamuz JS, Lindau ST. Prevalence of dietary supplement use in us children and adolescents, 2003-2014. JAMA Pediatr2018;172:780-2. doi:10.1001/jamapediatrics.2018.1008 pmid:2991301310.Blumberg JB, Frei B, Fulgoni VL, Weaver CM, Zeisel SH. Contribution of dietary supplements to nutritional adequacy by socioeconomic subgroups in adults of the United States. Nutrients2017;10:E4. doi:10.3390/nu10010004 pmid:2927188311.Bailey RL, Fulgoni VL 3rd., Keast DR, Dwyer JT. Dietary supplement use is associated with higher intakes of minerals from food sources. Am J Clin Nutr2011;94:1376-81. doi:10.3945/ajcn.111.020289 pmid:2195564612.Harrison RA, Holt D, Pattison DJ, Elton PJ. Are those in need taking dietary supplements? A survey of 21 923 adults. Br J Nutr2004;91:617-23. doi:10.1079/BJN20031076 pmid:1503568913.Murphy SP, White KK, Park SY, Sharma S. Multivitamin-multimineral supplements’ effect on total nutrient intake. Am J Clin Nutr2007;85:280S-4S. doi:10.1093/ajcn/85.1.280S. pmid:1720921014.Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in US adults. Nutrients2017;9:E849. doi:10.3390/nu9080849 pmid:2879245715.Bailey RL, West KP Jr., Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab2015;66(Suppl 2):22-33. doi:10.1159/000371618 pmid:2604532516.Bishai D, Nalubola R. The history of food fortification in the United States: its relevance for current fortification efforts in developing countries. Econ Dev Cult Change2002;51:37-53doi:10.1086/34536117.Institute of Medicine Committee on Use of Dietary Reference Intakes in Nutrition Labeling. Dietary reference intakes: guiding principles for nutrition labeling and fortification.National Academies Press, 2003.18.Shakur YA, Tarasuk V, Corey P, O’Connor DL. A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada. J Nutr2012;142:534-40. doi:10.3945/jn.111.149450 pmid:2229857419.Briefel R, Hanson C, Fox MK, Novak T, Ziegler P. Feeding Infants and Toddlers Study: do vitamin and mineral supplements contribute to nutrient adequacy or excess among US infants and toddlers?J Am Diet Assoc2006;106(Suppl 1):S52-65. doi:10.1016/j.jada.2005.09.041 pmid:1637663020.Moyer VA, US Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med2013;158:691-6. doi:10.7326/0003-4819-158-6-201303190-00588 pmid:2344016321.Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol2018;71:2570-84. doi:10.1016/j.jacc.2018.04.020 pmid:2985298022.Martí-Carvajal AJ, Solà I, Lathyris D, Dayer M. Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev2017;8:CD006612. doi:10.1002/14651858.CD006612.pub5. pmid:2881634623.Huo Y, Li J, Qin X, et al., CSPPT Investigators. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA2015;313:1325-35. doi:10.1001/jama.2015.2274 pmid:2577106924.Sesso HD, Buring JE, Christen WG, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA2008;300:2123-33. doi:10.1001/jama.2008.600 pmid:1899719725.Manson JE, Cook NR, Lee IM, et al., VITAL Research Group. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med2019;380:33-44. doi:10.1056/NEJMoa1809944 pmid:3041562926.Hsia J, Heiss G, Ren H, et al., Women’s Health Initiative Investigators. Calcium/vitamin D supplementation and cardiovascular events. Circulation2007;115:846-54. doi:10.1161/CIRCULATIONAHA.106.673491 pmid:1730993527.Scragg R, Stewart AW, Waayer D, et al. Effect of monthly high-dose vitamin D supplementation on cardiovascular disease in the Vitamin D Assessment Study: a randomized clinical trial. JAMA Cardiol2017;2:608-16. doi:10.1001/jamacardio.2017.0175 pmid:2838480028.Manson JE, Cook NR, Lee IM, et al., VITAL Research Group. Marine n-3 >fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med2019;380:23-32. doi:10.1056/NEJMoa1811403 pmid:3041563729.Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev2018;7:CD003177. doi:10.1002/14651858.CD003177.pub3. pmid:3001976630.Aung T, Halsey J, Kromhout D, et al., Omega-3 Treatment Trialists’ Collaboration. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol2018;3:225-34. doi:10.1001/jamacardio.2017.5205 pmid:2938788931.Hu Y, Hu FB, Manson JE. Marine omega-3 supplementation and cardiovascular disease: an updated meta-analysis of 13 randomized controlled trials involving 127 477 participants. J Am Heart Assoc2019;8:e013543. doi:10.1161/JAHA.119.013543 pmid:3156700332.Manson JE, Bassuk SS, Cook NR, et al., VITAL Research Group. Vitamin D, marine n-3 fatty acids, and primary prevention of cardiovascular disease current evidence. Circ Res2020;126:112-28. doi:10.1161/CIRCRESAHA.119.314541 pmid:3189565833.Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med1994;330:1029-35. doi:10.1056/NEJM199404143301501 pmid:812732934.Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med1996;334:1150-5. doi:10.1056/NEJM199605023341802 pmid:860218035.Klein EA, Thompson IM Jr., Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA2011;306:1549-56. doi:10.1001/jama.2011.1437 pmid:2199029836.Mason JB. Folate, cancer risk, and the Greek god, Proteus: a tale of two chameleons. Nutr Rev2009;67:206-12. doi:10.1111/j.1753-4887.2009.00190.x pmid:1933571437.Cole BF, Baron JA, Sandler RS, et al., Polyp Prevention Study Group. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA2007;297:2351-9. doi:10.1001/jama.297.21.2351 pmid:1755112938.Vollset SE, Clarke R, Lewington S, et al., B-Vitamin Treatment Trialists’ Collaboration. Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50,000 individuals. Lancet2013;381:1029-36. doi:10.1016/S0140-6736(12)62001-7 pmid:2335255239.Lappe J, Watson P, Travers-Gustafson D, et al. Effect of vitamin D and calcium supplementation on cancer incidence in older women: a randomized clinical trial. JAMA2017;317:1234-43. doi:10.1001/jama.2017.2115 pmid:2835092940.Manson JE, Bassuk SS, Buring JE, VITAL Research Group. Principal results of the vitamin d and omega-3 trial (VITAL) and updated meta-analyses of relevant vitamin D trials. J Steroid Biochem Mol Biol2020;198:105522. doi:10.1016/j.jsbmb.2019.105522 pmid:3173334541.Song M, Lee IM, Manson JE, et al., VITAL Research Group. Effect of supplementation with marine ω-3 fatty acid on risk of colorectal adenomas and serrated polyps in the US general population: a prespecified ancillary study of a randomized clinical trial. JAMA Oncol2019;6:108-15. doi:10.1001/jamaoncol.2019.4587 pmid:3175085542.Seida JC, Mitri J, Colmers IN, et al. Clinical review: Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab2014;99:3551-60. doi:10.1210/jc.2014-2136 pmid:2506246343.Song Y, Cook NR, Albert CM, Van Denburgh M, Manson JE. Effects of vitamins C and E and beta-carotene on the risk of type 2 diabetes in women at high risk of cardiovascular disease: a randomized controlled trial. Am J Clin Nutr2009;90:429-37. doi:10.3945/ajcn.2009.27491 pmid:1949138644.Pittas AG, Dawson-Hughes B, Sheehan P, et al., D2d Research Group. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med2019;381:520-30. doi:10.1056/NEJMoa1900906 pmid:3117367945.Zhao JG, Zeng XT, Wang J, Liu L. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA2017;318:2466-82. doi:10.1001/jama.2017.19344 pmid:2927993446.Yao P, Bennett D, Mafham M, et al. Vitamin D and calcium for the prevention of fracture: a systematic review and meta-analysis. JAMA Netw Open2019;2:e1917789. doi:10.1001/jamanetworkopen.2019.17789 pmid:3186010347.Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA2019;322:736-45. doi:10.1001/jama.2019.11889 pmid:3145404648.Yang B, Campbell PT, Gapstur SM, et al. Calcium intake and mortality from all causes, cancer, and cardiovascular disease: the Cancer Prevention Study II Nutrition Cohort. Am J Clin Nutr2016;103:886-94. doi:10.3945/ajcn.115.117994 pmid:26864361