Cynthia A. Thomson, PhD, RD, from the Mel and Enid Zuckerman College of Public Health at the University of Arizona in Tucson, and colleagues examined long-term health outcomes among postmenopausal women in the Women’s Health Initiative CaD trial involving 36,282 women with no history of breast or colorectal cancer. Participants were randomly assigned to receive 1000mg calcium carbonate with 400 IU vitamin D₃ daily or placebo.

The researchers found that after a median cumulative follow-up of 22.3 years, women randomly assigned to CaD vs placebo had a reduction in cancer mortality (hazard ratio, 0.93), and an increase in CVD mortality (hazard ratio, 1.06). No overall effect was seen on other measures, including all-cause mortality. There was considerable variation observed in estimates of cancer incidence when stratified by whether participants reported supplement use before randomization, while no variation was seen for estimates in mortality, except for CVD mortality.

“Effects of vitamin D supplementation for cancer prevention may depend on achieving serum vitamin D concentrations above 50nmol/L,” the authors write. “Given the study design, we could not disentangle the added benefit or harms of supplementation with CaD in combination vs vitamin D alone, a topic worthy of future study.”

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HealthDay News — Dietary supplement (DS) use is common in the US, according to a study published online April 18 in the National Health Statistics Reports, a publication from the US Centers for Disease Control and Prevention.

Suruchi Mishra, PhD, from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues present prevalence estimates for DS use using data from the 2017 to March 2020 prepandemic National Health and Nutrition Examination Survey (NHANES) for children and adolescents aged 0 to 19 years and adults aged 20 years and older (6324 and 9924 individuals, respectively).

The researchers found that 34.8% of children and adolescents and 58.5% of adults used at least one DS in the past 30 days during 2017 to March 2020. Except for children aged 12 to 24 months, use was higher among females than males. Among adults, DS use increased with income and education. Higher DS use was reported among non-Hispanic Asian and non-Hispanic White adults than Hispanic and non-Hispanic Black adults. Among adults, use of multiple DSs increased with age. Overall, 23.5 and 31.5% of youth and adults, respectively, reported use of a multivitamin mineral, while 3.0 and 18.5%, respectively, reported vitamin D use. Most adults using a multivitamin mineral or vitamin D reported daily use.

“These results indicate that any DS and multiple DS intake is common in the United States, and national surveys, such as NHANES, should continue to monitor DS use among children, adolescents, and adults,” the authors write.

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HealthDay News — Almost no dietary supplements in the US provide key nutrients at sufficient doses for pregnant women, according to a study published in the April issue of the American Journal of Clinical Nutrition.

Noting that most pregnant women in the US are at risk for inadequate intake of key nutrients from food alone during pregnancy, Katherine A. Sauder, PhD, from the University of Colorado Anschutz Medical Campus in Aurora, and colleague estimated the doses of supplementation needed to help most pregnant women achieve the recommended intake. From 2007 to 2019, 24-hour dietary recalls were conducted in 2450 pregnant participants aged 14 to 50 years. The usual intake of vitamins A and D, folate, calcium, iron, and ω-3 fatty acids was estimated from food alone.

For supplementation, the target dose was 198mcg or greater retinol activity equivalents of total vitamin A, 7 to 91mcg vitamin D, 169 to 720mcg dietary folate equivalents of folic acid, 383 to 943mg calcium, 13 to 22mg iron, and 59mg or greater ω-3 fatty acids. The researchers found that 69 products (33 prenatal) out of 20,547 dietary supplements contained all 6 nutrients, and 7 products (2 prenatal) contained target doses of 5 nutrients. Only 1 product contained target doses of all 6 nutrients, but it required 7 tablets per daily serving and cost about $200 per month.

“Reformulation or development of products that maximize the number of pregnant women receiving enough (but not too much) vitamin A, vitamin D, folic acid, calcium, iron, and ω-3 FAs is needed,” the authors write.

Two authors disclosed financial ties to the nutrition and other industries.

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HealthDay News — Directly providing prenatal iron supplements significantly improves average hematocrit levels throughout pregnancy and reduces anemia in underserved patients, according to a study published online September 1 in JAMA Network Open.

Lisa R. Thiele, MD, MPH, from the University of Texas (UT) Southwestern Medical Center in Dallas, and colleagues evaluated if providing rather than recommending supplements with iron at prenatal visits in a medically underserved community is associated with improved hematologic indices and reduced blood transfusion. The analysis included 13,910 patients who delivered between May 13 and December 13, 2020, and were provided a prenatal supplement with iron throughout pregnancy or who delivered between January 1 and August 1, 2019, before supplements were dispensed.

The researchers found that providing iron-containing prenatal supplements was associated with higher average hematocrit levels at all time points, including a mean difference of 1.27% on admission for delivery versus those who were not directly dispensed iron. Among patients only recommended supplements, 18% had anemia on admission vs 11% with iron-containing supplements dispensed (risk ratio, 0.61). After program implementation, postpartum transfusion for acute blood loss anemia was cut by one-third in patients (from 10 to 6.6 per 1000; risk ratio, 0.62).

“We can make a large impact on our patients’ health and outcomes by implementing simple interventions,” coauthor Catherine Y. Spong, MD, also from UT Southwestern Medical Center, said in a statement. “This study demonstrates the efficacy of a public health initiative to reduce maternal anemia and the most common cause of severe maternal morbidity and gives other institutions data to implement similar programs in their own populations.”

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