UPDATED June 19, 2018 // Nearly one third of children and adolescents in the United States used dietary supplements between 2013 and 2014, new data show. Whereas the overall supplementation rate appears to have remained stable in the last 10 years, the use of alternative herbal, nonvitamin, and nonmineral supplements has nearly doubled, researchers report in a letter published online today in JAMA Pediatrics.
"Dietary supplements are not required to go through the same [US Food and Drug Administration] regulations and approval process as prescription drugs. As a result, we know very little about their safety and effectiveness, especially in children," said lead author Dima Qato, PharmD, MPH, PhD, an assistant professor of pharmacy systems, outcomes and policy at the University of Illinois at Chicago College of Pharmacy, in a news release. "Many dietary supplements have also been implicated in adverse drug events, especially cardiovascular, which is a safety concern."
"We simply do not know if there are any benefits to children that outweigh the potential harms, and this study suggests supplement use is widespread and therefore an important, yet often ignored, public health issue," she continued.
Steven Abrams, MD, chair of the American Academy of Pediatrics Committee on Nutrition, concurs with that view. "Supplements are not necessary nutritionally and will not compensate for a poor diet, but parents continue to use them as a 'backup,' as these prevalence rates indicate," said Abrams, who is chair of the Department of Pediatrics at Dell Medical School in Austin, Texas. "Omega-3s and melatonin are generally benign but should not be used in place of treatment for clinical disorders such as [attention-deficit/hyperactivity disorder], both because there is little data to support their efficacy and because these products are unregulated."
Clinicians should act on these data, he said. "Given the prevalence of supplement use in this population, pediatricians should be careful to ask parents about all of the products their child uses, prescription and [over-the-counter] drugs as well as supplements, and counsel them appropriately about the risks."
To estimate the prevalence of supplementation, including nutritional and alternative medicine products, in children and adolescents aged 0 to 19 years, Qato and colleagues analyzed nationally representative data from six cycles of the National Health and Nutrition Examination Surveys, from 2003-2004 through 2013-2014.
They calculated the prevalence of dietary supplement use, including the use of both nutritional products and alternative medicines, based on responses to the question asking whether the child/adolescent had used or taken any vitamins, herbals, or other supplements in the last 30 days and documentation of the specific products used. For the analysis, the authors classified supplements as nutritional products (those containing primarily vitamins or minerals) or alternative medicines (herbal, nonvitamin, or nonmineral products), and then by their primary use or primary ingredient.
In the 2013 to 2014 survey, 4404 respondents (either a parent or child older than 16 years) answered the supplementation question. Of these, 36.4% of the participants were 0 to 5 years old, 35.5% were 6 to 12 years old, and 28.1% were 13 to 19 years old; 50.9% were boys.
The overall supplementation rate during this period was 33.2% (95% CI, 30.4%-36.2%), which is similar to that observed in the earliest survey in 2003 to 2004.
However, the use of alternative medicines nearly doubled, going from 3.7% (95% CI, 2.8%-4.7%) in 2003 to 2004 to 6.7% (95% CI, 4.8%-8.3%; P < .001) in 2013 to 2014.
The rise is attributed in large part to increasing use of omega-3 fatty acid supplements (0.4% [95% CI, 0.2%-0.9%] in 2003-2004 vs 2.3% [95% CI, 1.4%-3.5%] in 2013-2014; P < .001), which have been promoted as natural remedies for attention deficit and other cognitive disorders, and melatonin supplements (0% vs 0.9%; P < .001), which are used to help regulate sleep patterns.
The most common dietary supplements from 2013 to 2014 were multivitamins (25.1%; 95%CI, 22.3%-28.1%), followed by supplements for immunity (3.8%; 95% CI, 2.8%-5.2%), omega-3 fatty acids (2.3%; 95% CI, 1.4%-3.6%), and sleep aids (1.1%; 95% CI, 0.6%-1.9%), the authors report.
Although the use of any dietary supplement was lowest in adolescents, the use of alternative medicine supplements specifically was highest in this group, they note.
Supplement use patterns were similar for younger boys and girls, but differed among adolescents. Adolescent girls were significantly more likely to use iron, calcium, multivitamins, and single vitamins, particularly vitamin B products, whereas adolescent boys were more likely to use omega-3 fatty acid and bodybuilding supplements.
Taken together, the findings are especially notable because of the risk for preventable harm. "Many of the most commonly used supplements, including multivitamins, are implicated in preventable adverse drug events among this population. In addition, commonly used nutritional products (eg, iron, calcium, and vitamin D) and alternative medicines (eg, bodybuilding supplements), are also increasingly associated with adverse cardiovascular effects, including arrhythmias, that can lead to sudden cardiac death, a serious yet underreported problem in children and adolescents," the authors write.
Further, they note, the rise in alternative medicine use in this population, specifically melatonin and omega-3 fatty acid supplements, which are promoted as having cognitive and sleep benefits for patients with attention-deficit/hyperactivity disorder, "is particularly noteworthy given that attention-deficit/hyperactivity disorder drugs, which are frequently used in older children and adolescents, are also associated with serious cardiovascular effects."
The study authors disclosed financial or other relationships with Public Citizen's Health Research Group, the US Food and Drug Administration's Peripheral and Central Nervous System Advisory Committee; and reported being a paid consultant to IQVIA, MesaRx Innovations, Monument Analytics, OptumRx's National Pharmacy& Therapeutics Committee, and NowPow, LLC. The Robert Wood Johnson Foundation provided funding support to two of the authors.
JAMA Pediatrics. Published online June 18, 2018. Full text
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