Study: Multivitamine and reducing the risk of chronic diseases
Study: Multivitamine and reducing the risk of chronic diseases
reference
Raubiainen S, Rist PM, Glynn RJ, Buring Je, Gaziano JM, Sesso Hd. Multivita glons and the risk of cardiovascular diseases in men. j Nutr . 2016; 146 (6): 1235-1240.
objective
It should be examined how taking multivitamins with the risk of cardiovascular diseases (CVD) in initially healthy men at the beginning of the Study
Design
expected cohort; Researchers followed a group of male doctors over a period of 12 years. The men provided a wide range of self-reported lifestyle and clinical factors as well as taking selected food and nutritional supplements, including taking multivitamins.
participant
18,530 male doctors from the age of 40 took part in the cohort of the Physicians' Health Study I (PhS I); All men were free of Cancer and Cvd.
at the beginning (1982)
The Physicians' Health Study was originally designed as randomized, controlled 2 × 2 factor study to test the effects of aspirin and beta-carotene on cancer and cardiovascular diseases. From 1982 to 1995, PHS I 22,071 male doctors aged 40 to 84, who were free of cancer and cardiovascular diseases at the beginning of the studies (1982). This prospective follow-up cohort study by Rautiainen et al. only included 18,530 men in the analysis, since the participants were excluded if information about the use of nutritional supplements or selected lifestyle, clinical and nutritional factors were missing.
parameter evaluated
The incidence of CVD events, including non-fatal myocardial infarction (mi), non-fatal stroke and cardiac revascularization (coronary artery-bypass surgery and/or percutaneous transluminal coronary anangioplasty) was determined using self-reports on annual questionnaires. Reported cardiovascular events were confirmed by an end point committee of doctors. Deaths were identified and persecuted using reports from family members, postal authorities and the National Death Index. Further details on the criteria used to confirm the study parameters are well documented in the section with the title "Determination of CVD cases".
primary result measurements
Incidence of cardiovascular events, including non-fatal Wed, non-fatal stroke and cardiac revascularization (coronary artery-bypass surgery and/or percutaneous transluminal coronary angioplasty).
important knowledge
The researchers found no connection between taking multivitamins at the beginning of the course and the risk of severe cardiovascular events, heart attack, stroke or cardiovascular deaths. However, the use of multivitamins was significantly associated with a 14 % lower risk of cardiac revascularization and a 11 % lower risk of ischemic heart disease, defined as an incidental myocardial infarction or cardiac revascularization. Self -reported intake of multivitamins over a long period of time (> 20 years) was significantly associated with a 44 % lower risk of serious cardiovascular diseases.
practice implications
The use of nutritional supplements is widespread in the United States, with current surcharge data show that 68 % of American adult dietary supplements are taking. 1 vitamins and minerals are the most widespread category of dietary supplements, and the "multivitamin" is still the most frequently consumed Product. 1 Users of nutritional supplements report that you take such products for general health and well-being as well as for specific health and nutrient advantages. 1 If you talk to patients about why you take a multivitamin, most answer that you take it as an insurance policy that are not covered by diet alone can.
For nutritional practitioners, this study increases the existing practice that consists in evaluating a person's diet and recommending a nutritional supplement if there are nutrient deficiencies.
consumers take multivitamins to increase the nutrient density of their diet. However, the scientific and medical communities often evaluate the advantages of taking a multivitamin due to its ability to reduce the risk of serious chronic diseases such as cancer, cardiovascular diseases and others. The examination of the advantages of nutritional supplements for the occurrence of chronic diseases with a long latency is a scientific challenge that is not well suited for pharmaceutical studies -like control studies - the scientific framework that has been developed to evaluate the effectiveness of medicinal products.
to rely exclusively on pharmaceutical clinical studies to evaluate the effect of nutritional supplements leads to incorrect over-generalizations, such as the notorious annals of internal medicine editorial "Enough is enough: no more money for vitamin and mineral additives." Studies and a report by the US Preventive Service Task Force (USPSTF), all of which came to the same conclusions: zero. The editorial categorically rejected every possible benefit of a vitamin and mineral supplement without compensating for the discussion with scientifically supported health advantages that have an impact on the real world, such as folic acid and iodine to prevent neural pipe defects or cognitive deficits in newborns; People; 6 Correction of iron deficiency in children; 7 or the provision of missing nutrients for endangered population groups. 8 Instead, the authors described all vitamin and mineral supplements as "waste of money" in an influential medical magazine. It is noteworthy that the USPStF report, one of the three studies that served as the basis for the editorial, recognizes that its systematic review of the scientific literature was “a review of studies, a study design that is mainly used to assess drug therapy. This design may not be ideal for evaluating nutrients in a placebo The medication study is not exposed to the medication.
The Take Home measurement of the current study (Rautiainen et al.) Should not be surprised. A daily multivitamin is not a panacea for preventing cardiovascular diseases. However, there were indications of a benefit at selected endpoints such as a 14 % lower risk of cardiac revascularization and a 11 % lower risk of ischemic heart disease. There was also a significant "Homerun" finding of a statistically significant, 44 % lower risk of cardiovascular diseases in men who, according to their own statement, had a multivitamin preparation for 20 or more years. However, the authors cleverly encourage readers to interpret this finding with caution, since (a) this is an observation study; (b) There were a small number of participants who provided for multivitaMinkonsum for 20 or more years; and (c) We already know that the use of multivitamins is positive with other healthy lifestyle and nutritional factors that reduce their risk for CVD.
patients with a perfect diet who offer optimal amounts of all nutrients may not require a multivitamin preparation. However, the 2015-2020 nutritional guidelines for Americans are identified potassium, fiber, cholin, magnesium, calcium and vitamins A, D, E and C as a lack of nutrients for Americans. 6 From the perspective of a clinic, this means that the typical American nutrition has significant nutrient deficiency. For the majority of the Americans, taking a multivitamin preparation is a prudent recommendation that fills nutrient gaps that are not closed solely by nutrition.
- CRN consumer Survey 2015 on nutritional supplements. Website of the Council for responsible nutrition. (Link away). Accessed on June 8, 2016.
- Shao A, Mackay D. A comment on the relationship between nutrients and chronic diseases and the new paradigm of the evidence -based diet. Nat med j . 2010; 2: 12.
- Guallar E, Stranges S, Mulrow C, Appel LJ, Miller he. Enough is enough: stop wasting money for vitamin and mineral additives. ann internal med . 2013; 159 (12): 850-851.
- Wolff T, Witkop CT, Miller T, Syed SB; US-Task Force for Preventive Services. Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the US Preventive Services Task Force. ann internal med . 2009; 150 (9): 632-639.
- Council on Environmental Health, Rogan WJ, Paulson Ja, et al. Iodine deficiency, pollutant chemicals and the thyroid: new information about an old problem. Pädiatrie . 2014; 133 (6): 1163-1166.
- Ministry of Health and US Agriculture Ministry. 2015–2020 nutrition guidelines for Americans . 8th edition Washington, DC: Ministry of Health; 2015.
- Baker RD, Greer FR; Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron deficiency anemia in infants and small children (0-3 years). Pädiatrie . 2010; 126 (5): 1040-1050.
- Elorinne al, Alfthan G, Erlund I, et al. Food and nutrient absorption and nutritional state of Finnish vegans and non-vegetarians. plus one . 2016; 11 (2): 2.
- Fortmann SP, Burda Bu, Senger Ca, et al. Vitamin and mineral additives in primary prevention of cardiovascular diseases and cancer: an updated systematic evidence analysis for the US Preventive Services Task Force. ann internal med . 2013; 159 (12): 824-834.
- Rautiainen S, Wang L, Gaziano JM, Sesso Hd. Who uses multivitamine? A cross -sectional study in the Physicians' Health Study. EUR J Nutr . 2014; 53 (4): 1065-1072.