#345 Vitamin and Mineral supplementation: A USPSTF Update with Dr. Michael Barry

July 20, 2022 | By Paul Williams

Video

Can vitamins prevent CVD and cancer? We kind of don’t have the answer!

Is vitamin and mineral supplementation safe? Effective? Listen as our esteemed guest Dr. Michael Barry talks to us about the new United States Preventive Services Task Force recommendation regarding the role of vitamin and mineral supplementation in preventing cardiovascular disease and cancer.

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Credits

• Producers: Paul Williams MD, FACP and Elena Gibson, MD
• Writer: Paul Williams MD, FACP
• Show notes: Paul Williams MD, FACP
• Infographic and Cover Art: Elena Gibson, MD
• Hosts: Paul Williams MD, FACP and Elena Gibson MD 
• Production team: Podpaste
• Guest: Michael Barry MD

USPSTF Recommendation for Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer

What are the updated recommendations?

• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements or single or paired nutrient supplements (other than beta-carotene and vitamin E), for the prevention of cardiovascular disease and cancer.  I statement (insufficient evidence)
• The USPSTF recommends against the use of beta-carotene or vitamin E supplements for the prevention of cardiovascular disease and cancer. D grade (discourages this service)

What’s the fine print?

• This recommendation applies to community-dwelling, nonpregnant adults.
• Importantly, it does not apply to children, pregnant persons, or persons who are chronically ill or have a known nutritional deficiency.
• There is a separate USPSTF recommendation that recommends that all persons who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg of folic acid.
• The USPSTF found 9 randomized controlled trials that reported on health outcomes associated with multivitamin supplementation.
  • The COSMOS trial found no effect of multivitamin supplementation on all-cause mortality after 3.6 years (a relatively short follow-up period)
  • Multivitamin use was not associated with an effect for most outcomes, and there was discordance in the results of some studies.
  • These factors led the Task Force to conclude there was insufficient evidence to recommend multivitamin supplementation.
• Studies looking at individual vitamins or minerals such as vitamin D, folic acid, vitamin C, vitamin B₃ and vitamin B₆ did not demonstrate sufficient evidence to recommend for or against use in healthy, nonpregnant persons.
• The USPSTF did identify harm with beta-carotene supplementation, which increased cardiovascular disease mortality and increased the risk of lung cancer in persons who smoke or had asbestos exposure.
• Two trials included in the evidence review showed an increased risk of hemorrhagic stroke associated with vitamin E supplementation.

How is this different from the last recommendation?

• Although there were 52 new studies reviewed for this current recommendation, it is consistent with the 2014 USPSTF recommendation on this topic.

How can this be incorporated into practice?

• These recommendations can be used as a jumping-off point to discuss evidence-based recommendations to prevent cardiovascular disease (e.g., statin therapy and exercise) and cancer (e.g., colorectal cancer screening).

Links

1. USPSTF Final Recommendation Statement: Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer
2. Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication
3. COSMOS trial results
4. USPSTF Recommendation Statement – JAMA 2022

Goal

Listeners will explain the USPSTF recommendation for vitamin, mineral, and multivitamin supplementation to prevent cancer and cardiovascular disease.

Learning objectives

After listening to this episode listeners will…  

1. Become familiar with the USPSTF recommendation regarding vitamin and mineral supplementation.
2. Recognize the heterogeneity of evidence that led to the recommendation stating there is insufficient evidence to assess benefits and harms of vitamin and mineral supplementation (other than beta-carotene and vitamin E)
3. Recognize the potential harms associated with vitamin E and beta-carotene supplementation.
4. Utilize these recommendations to have important conversations with their patients regarding evidence-based preventive care.

Disclosures

Dr. Barry reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Williams PN, Gibson E, and Barry M. “#345 USPSTF update: Recommendations about vitamin supplementation with Dr. Michael Barry”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date, July 20 2022.