The ODS cross-cutting themes include Healthy Americans, Healthy Lifespan, and Resilience. Although these are presented individually below, they integrate not only with the different ODS goals but also with each other. For example, research on health and resilience across different life stages will include studies that focus on segments of the U.S. populations. Although we highlight these three strategic priorities, we also consider additional relevant factors in new research opportunities. These include issues that impact nutrient status and health outcomes and factors that facilitate dietary supplement research. With this interactive lens, ODS will deepen knowledge of dietary supplements and health.
A. Healthy Americans
With a high rate of dietary supplement use among all Americans, it would not be surprising to find a higher intake among certain groups of people. One example is those living with chronic diseases such as hypertension, cardiovascular disease, obesity, and diabetes. Population-based research would seek to understand the dietary supplement use patterns of those living with chronic diseases and how those patterns compare across diseases and to those without any chronic diseases or conditions. Biological research will seek to understand how dietary supplements impact the prevention of chronic diseases, how they influence the course of the diseases or conditions, and how they interact with medications used to treat chronic conditions. An example of how ODS could better understand the relationship between dietary supplements and chronic disease is through the lens of understanding how dietary supplements are used by people seeking to combat obesity with GLP-1 medications. ODS can identify knowledge gaps in dietary supplements marketed for weight loss and in nutrition-related outcomes related to GLP-1 therapies where nutrient ingredient dietary supplements could play a role in closing nutrient gaps. Addressing these knowledge gaps is crucial to inform clinical practices, policy decisions, public health guidelines for safe use of dietary supplements, and improved nutrition-related health outcomes for GLP-1 users. The ultimate goal is preventing nutrient deficiencies associated with GLP-1 use and ensuring safety of dietary supplements.
ODS also can focus on populations at greatest risk of nutrient deficiencies such as those facing food insecurity, defined as the limited or uncertain availability of nutritionally adequate and safe foods or the limited or uncertain ability to acquire acceptable foods in socially acceptable ways. Studies have documented higher rates of diabetes, hypertension, obesity, heart disease, and other chronic diseases among adults living with food insecurity, and adults living with food insecurity have lower intakes of vitamin A, vitamin B6, calcium, magnesium, and zinc from their diets. Analyses of NHANES data that included dietary supplement intake found a higher prevalence of micronutrient inadequacy among adults living with food insecurity for copper; potassium; niacin; and vitamins C, D, E, and K in both men and women as well as inadequate levels of selenium only in men.
To better understand how dietary supplements impact the health of all Americans, ODS recognizes the need to improve methods for recruitment in research studies and development of data collection methodologies to increase participation. This is one of the objectives of the research capacity objective addressing rigor, reproducibility, and transparency.
New research will consider factors that include differences in biological mechanisms and outcome measures, community- and population-level dietary patterns, access to food and dietary supplements, and motivations for and attitudes surrounding use of nutritional and non-nutritional dietary supplements (e.g., botanicals, probiotics). These factors impact the utilization of and access to nutrients and phytochemicals in supplements and conventional food and might influence health of all Americans and across the lifespan.
B. Healthy Lifespan
During infancy and childhood, recommended intakes of macronutrients and most micronutrients are higher relative to body mass compared with those during adulthood. Older adults have an increased need for some nutrients while requiring less of others. At all stages of life nutrient inadequacies and, in some instances, excessive intakes, are associated with adverse health effects. However, the debate continues about the effect of dietary supplementation on health optimization across the lifespan.
The National Academy of Medicine's Food and Nutrition Board established estimated average requirements and adequate intakes as age- and sex-specific nutrient intake goals. The Dietary Guidelines for Americans 2020–2025
(DGA) identified calcium, potassium, dietary fiber, and vitamin D as dietary components of public health concern for the general U.S. population because low intakes are associated with risk of chronic disease. Conclusions from an analysis of 2003–2018 NHANES data suggest that nutrient intake and the percentage of the population meeting nutritional recommendations among U.S. adults have changed little over time. They also suggest that dietary supplement intake may help many U.S. adults meet nutrient requirements.
Other analyses of NHANES data support this conclusion. Data indicate that all age groups use dietary supplements and that dietary supplements contribute to increased intakes of nutrients; decreased population prevalence of inadequacy; and, for a small proportion of the population, nutrient excess. For example, an analysis of NHANES data from 2017 to 2018 showed that more than half of U.S. adults 20 to 59 years of age and about three-quarters of those older than 60 years of age used any dietary supplement in the past 30 days. The use of any dietary supplements and the number of supplements increases with age. The data also show that approximately one-third of children and adolescents used dietary supplements in the past 30 days. Analyses from earlier years found slightly less than one-fifth of infants and toddlers used dietary supplements, as did approximately three-fourths of pregnant and lactating women. The identification of nutrients of concern and the simultaneous widespread use of dietary supplements across all age groups call for additional investigations to understand associations among dietary supplement use, disease prevention, and health optimization at different ages and life stages as well as the biological mechanisms through which dietary supplements impact health.
Pregnant and lactating women have unique nutrient needs. ODS is planning a prenatal supplement workshop. The workshop will review the current state of the science for prenatal supplements; evaluate whether the nutrient levels in these supplements are appropriate for achieving optimal health outcomes; provide recommendations for further research; and, if sufficient data are available, suggest next steps to develop a scientific consensus on the appropriate ranges of nutrient content for prenatal supplements marketed in the United States.
The effects of dietary supplements on various chronic diseases or conditions remain unclear as does the understanding of how dietary supplements interact with other dietary supplements, medications, and lifestyle factors such as sleep, physical activity, and overall dietary intake. Age- and sex-limited population-based analyses can identify nutrients and chronic diseases or conditions of greatest concern and can inform new biological research to explore the mechanisms through which select dietary supplements influence specific chronic diseases or conditions at specific life stages. Analytical science-related activities may seek to understand factors in supplements that influence their uptake and metabolism; their ability to influence nutritional status; and their interactions with other dietary supplements, medications, or lifestyle. Some conditions and diseases to consider may include mucosal immunity, digestive diseases, autoimmune or immune-mediated diseases, and cardiorespiratory and cardiovascular diseases. Longevity and factors affecting lifespan and quality of life, including obesity, physical activity, cardiometabolic dysregulation, sarcopenia, and age-related physical and cognitive function decline, also may be considered.
C. Resilience
A focus on dietary supplements and resilience supports ongoing resilience research efforts at NIH and the U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion's Federal Plan for Equitable Long-Term Recovery and Resilience (Federal Plan for ELTRR). Given the high-level focus on resilience throughout the HHS and ODS' demonstrated success in coordinating resilience research efforts across the NIH through its coordination of the NIH Resilience Research Working Group, ODS will devote resources to clearly delineating the role of dietary supplements in advancing the science of resilience.
ODS began exploring resilience outcomes in investigations of dietary supplement ingredients as part of its efforts to address evidence gaps pertaining to the benefits and/or harms of dietary supplement use. Inconsistent methods, endpoints, and study design strategies have contributed to the heterogeneity in the scientific literature on potential resilience outcomes related to dietary supplements. ODS will promote the use of resilience research frameworks that focus on enhancing protective pathways to investigate the effects of dietary supplements on health.
The resilience research framework developed by the ODS-led NIH Resilience Research Working Group differs from previously published resilience models in its intentional focus on the system rather than the stressor. The framework considers that different stressors and risks can be constant occurrences and that understanding factors that strengthen or protect a system despite stress exposure can lead to a multipronged approach to health optimization. A special issue of Stress & Health titled "Harmonizing the Science of Resilience," led and coauthored by ODS staff, included contributions from 32 authors from across NIH ICOs, the United States Army Research Institute of Environmental Medicine (USARIEM), and academia. Each article examines research conducted in different resilience domains, identifying alignment with the working group's resilience framework. ODS used the resilience framework to develop a resilience research category for the NIH Research Condition and Disease Categorization system, identifying and reviewing 819 resilience research grants funded in 2023 from 12 NIH ICOs.
In September of 2024, ODS organized a workshop titled "Coordinating Measures and Metrics to Advance the Biomedical Science of Resilience" focused on identifying measures and metrics necessary to fully capture the protective pathways that elicit resilience and optimize human health across the lifespan. The workshop stimulated interest among NIH, federal, and academic researchers in the intersection of resilience outcome metrics across scientific domains. Workshop participants expressed great interest in expanding resilience research collaborations and will work with ODS to publish a special issue on resilience metrics.
Future work in the area of resilience may include mechanistic studies of dietary supplement ingredients and clinical studies that explore potential biomarkers of resilience to facilitate discovery of new protective pathways influenced by dietary supplements. For example, ODS may seek to better understand how dietary supplements impact the microbiome to offer protective effects for menopausal transitions or autoimmune diseases, ultimately resulting in long-term resilience outcomes.
