Multivitamin Use and the Risk of Mortality and Cancer Incidence The Multiethnic Cohort Study

Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI 96813, USA.
American journal of epidemiology (Impact Factor: 5.23). 02/2011; 173(8):906-14. DOI: 10.1093/aje/kwq447
Source: PubMed


Although multivitamin/mineral supplements are commonly used in the United States, the efficacy of these supplements in preventing chronic disease or premature death is unclear. To assess the relation of multivitamin use with mortality and cancer, the authors prospectively examined these associations among 182,099 participants enrolled in the Multiethnic Cohort Study between 1993 and 1996 in Hawaii and California. During an average 11 years of follow-up, 28,851 deaths were identified. In Cox proportional hazards models controlling for tobacco use and other potential confounders, no associations were found between multivitamin use and mortality from all causes (for users vs. nonusers: hazard ratio = 1.07, 95% confidence interval: 0.96, 1.19 for men; hazard ratio = 0.96, 95% confidence interval: 0.85, 1.09 for women), cardiovascular diseases, or cancer. The findings did not vary across subgroups by ethnicity, age, body mass index, preexisting illness, single vitamin/mineral supplement use, hormone replacement therapy use, and smoking status. There also was no evidence indicating that multivitamin use was associated with risk of cancer, overall or at major sites, such as lung, colorectum, prostate, and breast. In conclusion, there was no clear decrease or increase in mortality from all causes, cardiovascular disease, or cancer and in morbidity from overall or major cancers among multivitamin supplement users.

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    • "In the randomized PHS II study described above, MVM supplementation trended positively, but did not alter total mortality significantly (P = .13) [16]. Several large observational studies have similarly shown no increase in risk of mortality among MVM supplement users [72,85,86], as did a meta-analysis of 21 RCTs (RR: 0.98; 95% CI: 0.94–1.02) [15]. "
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    ABSTRACT: A balanced and varied diet is the best source of essential vitamins and minerals; however, nutrient deficiencies occur, including in populations with bountiful food supplies and the means to procure nutrient-rich foods. For example, the typical American diet bears little resemblance to what experts recommend for fruit, vegetables, and whole grains, which serve as important sources of an array of vitamins and minerals. With time, deficiencies in one or more micronutrients may lead to serious health issues. A common reason people take multivitamin and mineral (MVM) supplements is to maintain or improve health, but research examining the effectiveness of MVMs in the prevention of certain chronic conditions is ongoing. In addition to the utility of MVMs for filling in relatively small but critical nutritional gaps, which may help prevent conditions such as anemia, neural tube defects, and osteoporosis, some evidence supports possible benefits of MVM supplementation with regard to cancer prevention (particularly in men) and prevention or delay of cataract, as well as some aspects of cognitive performance. Unlike some single-vitamin supplements, MVM supplements are generally well tolerated and do not appear to increase the risk of mortality, cerebrovascular disease, or heart failure. The potential benefits of MVM supplements likely outweigh any risk in the general population and may be particularly beneficial for older people.
    Full-text · Article · Jul 2014 · Nutrition Journal
    • "Here, we review scientific evidence regarding the effects of MVM supplements on risk of various chronic diseases, including cancer, CVD, and age-related eye diseases, and some basic biological functions. Data from both RCTs (Blot et al., 1993; Li et al., 1993a, 1993b; Sperduto et al., 1993; Bogden et al., 1994; Richer, 1996; Leng et al., 1997; AREDS, 2001a; Graat et al., 2002; Hercberg et al., 2004; Richer et al., 2004; Avenell et al., 2005; Wolters et al., 2005; Bartlett and Eperjesi, 2007; McNeill et al., 2007; Maraini et al., 2008; Gaziano et al., 2012; Sesso et al., 2012; Age-Related Eye Disease Study 2 Research Group, 2013) and observational, prospective cohort studies (Hunter et al., 1993; Kim et al., 1993; Stampfer et al., 1993; Losonczy et al., 1996; Giovannucci et al., 1998; Rimm et al., 1998; Christen et al., 1999; Zhang et al., 1999; Mares-Perlman et al., 2000; Michaud et al., 2000; Watkins et al., 2000; Zhang et al., 2001; Fuchs et al., 2002; Jacobs et al., 2002; Muntwyler et al., 2002; Wu et al., 2002; Stevens et al., 2005; Zhang et al., 2006; Iso and Kubota, 2007; Lawson et al., 2007; Messerer et al., 2008; Neuhouser et al., 2009; Pocobelli et al., 2009; Larsson et al., 2010a, 2010b; Rautiainen et al., 2010a, 2010b; Hara et al., 2011; Hotaling et al., 2011; Mursu et al., 2011; Park et al., 2011; Li et al., 2012; Zhang et al., 2012) are examined , and the limitations of each study type are discussed. "
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    ABSTRACT: abstract We reviewed recent scientific evidence regarding the effects of MVM supplements on risk of chronic diseases, including cancer, cardiovascular disease, and age-related eye diseases. Data from randomized controlled trials (RCTs) and observational, prospective cohort studies were examined. The majority of scientific studies investigating the use of MVM supplements in chronic disease risk reduction reported no significant effect. However, the largest and longest RCT of MVM supplements conducted to date, the Physicians' Health Study II (PHS II), found a modest and significant reduction in total and epithelial cancer incidence in male physicians, consistent with the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) trial. In addition, PHS II found a modest and significant reduction in the incidence of nuclear cataract, in agreement with several other RCTs and observational, prospective cohort studies. The effects of MVM use on other subtypes of cataract and age-related macular degeneration remain unclear. Neither RCTs nor prospective cohort studies are without their limitations. The placebo-controlled trial design of RCTs may be inadequate for nutrient interventions, and residual confounding, measurement error, and the possibility of reverse causality are inherent to any observational study. National surveys show that micronutrient inadequacies are widespread in the US and that dietary supplements, of which MVMs are the most common type, help fulfill micronutrient requirements in adults and children.
    No preview · Article · Jun 2014 · Critical Reviews in Food Science and Nutrition
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    • "Although the literature is limited, other similar observational studies have also shown positive effects on the risk mortality for both multivitamins (Park, Murphy, & Wilkens, 2011; Rautiainen et al., 2010) and single-nutrient supplements (DIPART (Vitamin D Individual Patient Analysis of Randomized Trials) Group, 2010; Lee, Willett, & Fuchs 2011; Patterson, White, Kristal, Neuhouser, & Potter, 1997). The Multiethnic Cohort Study most notably showed a decrease in cancer incidence, and thus mortality, with long-term consumption of multivitamins (Park et al., 2011). Multivitamins were inversely associated with myocardial infarction in a cohort of Swedish women, especially when used for long term by women without cardiovascular disease (Rautiainen et al., 2010), directly contradicting the findings of Mursu et al. (Mursu et al., 2011). "
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    ABSTRACT: ABSTRACT This special article seeks to provide balance and clarity to the confusion brought about by the conclusions resulting from a recent study published in Archives of Internal Medicine by Mursu et al. (2011). An examination of three key limitations of the study provides context to why additional research is needed: (a) Nonusers were poorly defined; (b) supplement users were healthier than nonusers; and (c) the number of supplement users increased throughout the study. Although the literature is limited, other similar observational studies have also shown positive effects on the risk mortality for both multivitamins and single-nutrient supplements. Observational trials are an essential component of evidence-based nutrition but do not offer certainty because other data, such as the one generated from randomized controlled trials, are equally important in regard to the totality of evidence. The Senior Scientific Advisory Committee for the Council for Responsible Nutrition, an industry trade group, feels that the conclusions of the study by Mursu et al. (2011) are overstated and suggests that researchers analyze cohort(s) designed to specifically examine vitamin and mineral supplements free of confounding from factors, such as hormone replacement therapy, to better assess their benefits to the general population.
    Full-text · Article · May 2013 · Journal of Dietary Supplements
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