Conference Evaluates the Value of Multivitamin/Mineral Supplements in Chronic Disease Prevention

On May 15-17, ODS and the Office of Medical Applications of Research sponsored an NIH State-of-the-Science Conference to assess the available evidence on the safety and efficacy of dietary supplements containing multiple vitamins and minerals (MVMs) to help prevent chronic diseases. More than one-third of adults in the United States are estimated to take MVMs, so it was appropriate to examine whether this regular use is safe and might provide health benefits—specifically, reducing the risks of heart disease, cancer, osteoporosis, vision loss, and other chronic conditions that afflict a majority of Americans as they age.

More than 500 people attended this 3-day conference in the Natcher Auditorium on the NIH campus, which focused on six questions:

• What are the current patterns and prevalence of the public's use of MVM supplements?
• What is known about the dietary nutrient intake of MVM users versus non-users?
• What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention?
• What is the efficacy of MVM in chronic disease prevention in the general population of adults?
• What is known about the safety of MVM for the generally healthy population?
• What are the major knowledge gaps and research opportunities regarding MVM use?

(The term MVM referred to any supplement containing three or more vitamins and minerals, without herbal ingredients, and with each nutrient at a dose less than the Tolerable Upper Intake Level [UL] determined by the Food and Nutrition Board.)

The conference was part of the NIH Consensus Development Program in which carefully selected panels review the science on important medical or healthrelated practices. The 13-member panel assembled for this event included experts in food science and human nutrition, biostatistics, biochemistry, toxicology, family and geriatric medicine, pediatrics, cancer prevention, disease prevention and health promotion, and consumer protection. The panel was chaired by J. Michael McGinnis, MD, Senior Scholar at the Institute of Medicine of the National Academies.

In developing its formal statement, the panel listened to the presentations by 19 invited speakers, heard the questions and comments of participants during the discussion sessions, and reviewed published research. They also studied the results of a systematic review of randomized controlled trials on the topic prepared by the Agency for Healthcare Research and Quality (AHRQ) Evidencebased Practice Center at Johns Hopkins University.

The panel concluded that there was insufficient scientific evidence to determine whether or not the regular use of MVMs help to prevent chronic disease. According to Dr. McGinnis, "More than half of American adults are taking dietary supplements, the majority of which are MVMs, and the bottom line is that we don't know for sure that they're benefiting from them. In fact, we're concerned that some people may be getting too much of certain nutrients." The panel emphasized that its findings pertained only to generally healthy adults and did not include pregnant women, children, or those with disease.

The panel did recommend nutrient supplements in some cases. It urged that postmenopausal women take calcium and vitamin D supplements to protect bone health. And it advised non-smoking adults with early-stage, age-related macular degeneration to consider taking supplements of zinc and the antioxidants vitamins C, E, and beta carotene. The panel also endorsed previous recommendations that women of childbearing age consume enough folic acid to prevent neural tube defects in infants.

Media attention
Dozens of reporters from top news organizations attended the press briefing both in person and via the internet. As a result, articles appeared in major media publications such as The Washington Post, Los Angeles Times, and USA Today. CNN and NPR covered the story and included it on their Web sites. Coverage by Associated Press and Reuters new services ensured articles about the conference in many other newspapers, broadcasts, and Web sites located throughout the United States and around the world—from as far away as Russia and Malaysia. ODS Director Paul Coates and Dr. McGinnis gave numerous radio interviews both together and individually to discuss the conference panel's findings.

Go to http://consensus.nih.gov/2006/2006MultivitaminMineralSOS028main.htm to access a full set of materials from the conference, including the program and abstracts book, the panel statement (which will also appear in the September 5 Annals of Internal Medicine), the Johns Hopkins evidence-based review, and an NIH press release. A webcast archive of the entire conference is also available there. In December, the American Journal of Clinical Nutrition will publish a supplement of the conference that includes the scientific papers prepared by the speakers based on their presentations.

NAPRALERT Database: 31 Years Old and Still Growing

Interested in review articles on Aloe vera? Want to learn about the historical use and biological-testing results of Turnera diffusa (better known as damiana, used as an aphrodisiac by the ancient Mayans)? For these and many other such queries, consider using NAPRALERT (NAtural PRoducts ALERT) the largest relational database of the world's literature on the traditional uses, chemistry, and pharmacology of natural products and their ingredients, including secondary metabolites. It can be accessed directly at http://napralert.org.

Begun in 1975, NAPRALERT contains more than 200,000 scientific papers and reviews that represent animal, plant, and microbial organisms from all countries of the world. The database now provides an easier-to-use interface and format. The Web site includes the results of several sample searches so a potential user may learn whether the information desired can be found in the database. The cost to receive a list of citations and a summary is based on the number of citations a search reveals (50¢ each for 100 or fewer; 25¢ each for 101 or more).

NAPRALERT is maintained by the Program for Collaborative Research in the Pharmaceutical Sciences at the College of Pharmacy, University of Illinois at Chicago, under the direction of Norman R. Farnsworth, PhD. ODS has provided some financial support to maintain NAPRALERT. Dr. Farnsworth also directs an ODS cofunded Botanical Research Center focused on women's health issues.

CARDS Database Expanded

The Computer Access to Research on Dietary Supplements (CARDS) database provides information on dietary supplement related projects funded by the federal government since fiscal year (FY) 1999. CARDS currently contains projects funded through FY2004 for the National Institutes of Health (NIH) and the Department of Defense, and through FY2002 for the U.S. Department of Agriculture (USDA). Project information received from NIH for FY2005 and USDA for FY2003 are currently being coded by ODS staff and will be available in the fall. Access the CARDS database at http://dietary-supplements.info.nih.gov/ research/cards_database.aspx.

Upcoming Events

August 5-9
The 47th Annual Meeting of the American Society of Pharmacognosy*
Arlington, VA
Dr. Joseph Betz will chair a workshop titled Bucking the System: Non-Academic Careers for Natural Products Scientists and a symposium titled Clinical Evaluation of Herbs and Supplements: Trials, Toxicology, and Drug Interactions. ODS has provided financial support for the meeting and travel awards to two postdocs.

August 21
Standardization of the Terminology for Expression of Analytical Results for Isoflavones
University, MS (The University of Mississippi)
ODS is sponsoring this 1-day symposium.

September 1-29
NIH Visitors Center, Building 45*
Bethesda, MD

September 10-13
Heart Failure Society of America: 10th Annual Scientific Meeting
Seattle, WA
Dr. Rebecca Costello will co-moderate a session titled Nutritional Aspects of Heart Failure.

September 16-19
Food & Nutrition Conference & Expo (American Dietetic Association)*
Honolulu, HI
At a session titled What You Need to Know About Multivitamin and Mineral Supplements, Dr. Leila Saldanha will preside. Dr. Johanna Dwyer will present "State of the science: multivitamin-mineral supplements and chronic disease risk." Dr. Mary Frances Picciano will present "What are intakes of key nutrients among American children, and what supplements are they taking?"

September 18-20
30th National Nutrient Databank Conference: The Role of Food Composition in Improving Dietetic Practice
Honolulu, HI
Dr. Johanna Dwyer will deliver a presentation titled "Progress in developing dietary supplement databases at NIH's Office of Dietary Supplements." Dr. Mary Frances Picciano's presentation is titled "Development of NOADS: The NHANES (National Health and Nutrition Examination Survey) Online Analyst for Dietary Supplements: a web-based tool for analysis of total nutrient intakes and their relation to biomarkers of nutritional status."

October 5-8
American College of Nutrition, 47th Annual Meeting/Symposium*
Reno, NV
Dr. Rebecca Costello will moderate a session titled Nutrition in Preventive Medicine and Chronic Disease Management at which Dr. Sushil K. Jain, an NIH and ODS grantee, will present.

October 18-20
SupplySide West International Trade Show and Conference*
Las Vegas, NV
Dr. Elizabeth Yetley will chair and speak at a session titled Understanding the Systematic Review Process in Evidence-Based Decisions. Dr. Joseph Betz will chair and speak at a session titled Defining and Demonstrating Quality.

October 26-28
AARP National Event & Expo: Life@50+*
Anaheim, CA
* ODS will be exhibiting at these venues through October. Stop by to learn more about us, meet several of our staff, and pick up some of our materials.