USPSTF’s multivitamin report: ‘Akin to studying a hammer and concluding it is unsuitable for turning a screw’
Published recently in JAMA, the USPSTF report concluded that, “the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.”
The news has been picked up by many mainstream news outlets, which have mostly run with comments from the accompanying editorial by Jenny Jia, MD, Natalie Cameron, MD, and Jeffrey Linder, MD from the Northwestern University Feinberg School of Medicine, which concluded:
“Beyond wasted money, the focus on supplements might be viewed as a potentially harmful distraction. Rather than focusing money, time, and attention on supplements, it would be better to emphasize lower-risk, higher-benefit activities.”
An example of the headlines are:
WebMD: Vitamins, Supplements a Waste of Money for Most, Task Force Says
NBC News: No good evidence that vitamins prevent heart disease or cancer, panel says
CBS News: Experts say vitamin supplements are likely a waste of money
The task force did list some areas that require further study, noting that longer studies are needed to fully explore any links.
While the USPSTF did consider the largest multivitamin trial to date, COSMOS, (which did find benefits such as delaying age-related cognitive decline), it noted that, “the largest of these trials (COSMOS, n = 21,442) had a median follow-up of only 3.6 years, which may be too short for assessing cardiovascular disease and cancer outcomes”.
For the Physicians’ Health Study II, a large-scale, randomized, double-blind, placebo-controlled trial, which did find a significant 8% reduction in overall cancer risk in older male physicians taking a multivitamin, the USPSTF notes that is “limited to male physicians”.
Another knowledge gaps relates to, “whether there is heterogeneity across specific populations, or by baseline nutrient level or socioeconomic factors such as food insecurity, in the effects of vitamin, mineral, and multivitamin supplementation on cardiovascular disease and cancer outcomes, especially in persons with no known deficiencies and low prevalence of supplement use and in racially and ethnically diverse populations.”
CHPA: Narrow focus misses broader benefits
Dietary supplement trade associations weighed in on the task force’s guidance, with Duffy MacKay, ND, CHPA’s Senior Vice President of Dietary Supplements, commenting: “The USPSTF found again what it found in 2014 and in 2021, that there is not yet enough evidence to determine if vitamin and mineral supplements help prevent cardiovascular disease (CVD) and cancer.
“However, dietary supplements should not be confused with drugs, and beyond the narrow focus of this review, the broader evidence base for the benefits of dietary supplements is growing rapidly.
“The NIH Office of Dietary Supplements reminds consumers and healthcare providers that supplementation can be helpful for people including those over 50, those who could become pregnant, breastfed babies and toddlers, those who avoid certain foods or who have poor diets, and many others.”
CRN: “The apparent limited evidence should not be misinterpreted as the absence of evidence”
Andrea Wong, PhD, Sr VP of scientific & regulatory affairs at the Council for Responsible Nutrition (CRN), said that numerous research studies support the use of multivitamins by most Americans for a range of benefits.
“First, multivitamins fill in significant nutrition gaps in Americans. Government data shows that most Americans fall short in many key nutrients. In fact, the Food and Drug Administration and the 2020–2025 Dietary Guidelines for Americans identified that under-consumption of calcium, potassium, dietary fiber, and vitamin D is of public health concern for the general U.S. population because low intakes are associated with numerous health concerns.
“Second, the recent Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) is among the growing evidence that multivitamins help delay cognitive decline in older people.
“Finally, results of the Physicians’ Health Study II, a large-scale, randomized, double-blind, placebo-controlled trial showed an 8% reduction in overall cancer risk in older male physicians who took a multivitamin,” added Dr Wong.
“These are just a few of the many benefits from multivitamins, not to mention the benefits from individual ingredients that are in the multivitamin like B vitamins, vitamin D, etc.
“The apparent limited evidence should not be misinterpreted as the absence of evidence,” she said.
NPA: ‘Akin to studying a hammer and concluding it is unsuitable for turning a screw’
Daniel Fabricant, PhD, President and CEO of the Natural Products Association, stated: “This is no surprise to anyone in the dietary supplement industry, because any manufacturer claiming that the products could have these kinds of effects would be in violation of laws against false claims.
“The USPSTF plays an important role in the federal government’s approach to health care and reimbursement considerations, but this research is akin to studying a hammer and concluding it is unsuitable for turning a screw. Dietary supplement manufacturers are prohibited from saying their products would help prevent cardiovascular disease or cancer because they cannot, plain and simple,” he said.
2022; Volume 327, Issue 23, Pages 2326-2333. doi:10.1001/jama.2022.8970
“Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer - US Preventive Services Task Force Recommendation Statement”
Authors: US Preventive Services Task Force
2022, Volume 327, Issue 23, Pages 2294-2295. doi:10.1001/jama.2022.9167
Editorial: “Multivitamins and Supplements—Benign Prevention or Potentially Harmful Distraction?”
Authors: J. Jia, N.A. Cameron, J.A. Linder