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INTRODUCTION

Vitamins are essential for normal human growth and development.5 By definition, a vitamin is a substance present in small amounts in natural foods, is necessary for normal metabolism, and the lack of which in the diet causes a deficiency disease.46

A standard North American diet is sufficient to prevent overt vitamin deficiency diseases.71,82 However, suboptimal vitamin status is common in Western populations and is a risk factor for chronic diseases such as cardiovascular disease, cancer, and osteoporosis.71,82 Groups at risk include older adults, hospitalized patients, alcohol-dependent individuals, pregnant women those with gastrointestinal disorders, those following gastric bypass interventions and other patients with poor nutritional status. The American Dietetic Association posits that the best strategy for promoting optimal health and reducing chronic disease is to choose a wide variety of nutrient-rich foods, and the use of supplements can help some people meet their nutritional needs.167 Health care professionals should identify patients with poor nutrition or other reasons for increased vitamin needs and offer guidance on vitamin supplementation. It is suggested without evidence that because most people do not consume an optimal amount of vitamins by diet alone, adults should take vitamin and mineral supplements because the potential benefits likely outweigh any risk in the general population and may be particularly beneficial in older adults. The choice of supplement should reflect the patient’s age, gender, stage of life, health status, risk factors, and family history and should involve physician guidance.253

National Health and Nutrition Examination Survey (NHANES) data collected from 2003 to 2006 demonstrate that dietary supplement use was reported by 49% of the population age 1 year and older, an increase of approximately 10% from NHANES data from 1988 to 1994, with 79% of users taking them daily for the previous 30 days.22 Among adults and children, multivitamins and multiminerals (MVMMs) were the most commonly reported dietary supplement, with 33% of the population reporting use. The Council for Responsible Nutrition (CRN), a trade organization for the dietary supplement industry, has conducted yearly surveys since 2000 on the prevalence of dietary supplement use in the United States. Analysis of their data from 2007 to 2011 demonstrate an increased prevalence of dietary supplement use, 64% to 69% in adults, compared with previous NHANES surveys.1 More recently, the CRN revealed in a 2015 report that the percentage of American adults taking dietary supplements has remained consistent at 68% from the years 2012 to 2015.188 Ninety-eight percent of these dietary supplement users take vitamins and minerals, the most popular category of supplements, with the top five including a multivitamin (78%), vitamin D (32%), vitamin C (27%), calcium (24%), and vitamin B/B complex (18%). The CRN reported that the primary reasons given for supplement use are for overall health and wellness and to fill dietary nutrient gaps.1 Current data suggest minimal, if any, risk associated with MVMM use ...

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