What's New From the USPSTF
This series of fact sheets is based on the work of the U.S. Preventive Services Task Force (USPSTF). The USPSTF systematically reviews the evidence of effectiveness of a wide range of clinical preventive services—including screening, counseling, and chemoprevention (the use of medication to prevent diseases)—to develop recommendations for preventive care in the primary care setting.
This fact sheet presents highlights of USPSTF recommendations on this topic and should not be used to make treatment or policy decisions.
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What Does the USPSTF Recommend?
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence
is insufficient to recommend for or against the use of supplements of:
- Vitamins A, C, or E,
- Multivitamins with folic acid,
- Antioxidant combinations for the prevention of cancer or cardiovascular
disease.
The USPSTF recommends against the use of beta-carotene supplements, either
alone or in combination, for the prevention of cancer or cardiovascular disease.
This recommendation applies only to the use of vitamin supplements by healthy
adults to prevent cancer and cardiovascular disease.
The Task Force did not review evidence for vitamin supplementation in patients
with known or potential nutritional deficiencies—including pregnant and
lactating women, children, the elderly, and people with chronic disease—or
special populations of patients, such as those taking medicines that require
vitamin supplementation.
What Does the Evidence Indicate?
There is inadequate evidence that vitamins, when taken to supplement a healthy
diet, can prevent heart disease or cancer. Studies reviewed by the Task Force
were not of long enough duration for the Task Force to draw clear conclusions.
The longest study reviewed by the USPSTF lasted 5-6 years, which may not have
been long enough to rule out a possible benefit. The results from high-quality
studies are mixed. A few observational studies suggest a possible benefit of
some vitamin supplementation on both heart disease and cancer, but the results
from other studies show no benefit. Even for the observational studies that
show some benefit, the Task Force could not be certain whether the benefit could
be attributed to vitamin supplementation or to other factors.
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There is inadequate evidence that vitamin supplementation prevents heart disease or cancer.
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Should People Take Vitamin Supplements?
With the exception of vitamin supplements that can cause harm, there is little
reason to discourage people who wish to take vitamins from doing so. Taking
vitamin supplements does not replace the need to eat a healthy diet, although
taking vitamin supplements may be appropriate for people whose diet does not
provide the recommended daily allowance of specific vitamins. Recommended daily
allowance information is available from the Institute of Medicine's Dietary
Reference Intake (DRI).
All patients should receive information about the benefits of a diet rich in
fruit, vegetables, and legumes, as well as information about other foods and
nutrients that should be emphasized or avoided.
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Taking vitamins does not replace the need to eat a healthy diet.
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What Are the Potential Harms of Vitamin Supplements?
Beta-carotene supplements were associated with an increased risk for lung cancer
among smokers, especially heavy smokers, in 2 randomized clinical trials (RCTs);
the effects of beta-carotene supplementation among nonsmokers are unknown.
Moderate doses of vitamin A may reduce bone mineral density. High doses of
vitamin A may be toxic to the liver and put pregnant women at risk for delivering
babies with birth defects.
People who choose to take vitamins should be encouraged to adhere to the dosages
recommended in the DRI of the Institute of Medicine, since the potential harms
of higher dosages outweigh the potential benefits.
More Information
For more information on vitamin supplementation, contact the following organizations:
healthfinder®
http://www.healthfinder.gov
Institute of Medicine (IOM)
Dietary Reference Intake
http://www.iom.edu/iom/iomhome.nsf/WFiles/webtablevitamins/$file/webtablevitamins.pdf
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More detailed information on this subject is available in the following evidence summaries:
These
evidence summaries, and the USPSTF Recommendations and Rationale, can be found on the Agency for Healthcare
Research and Quality (AHRQ) Web site (http://www.preventiveservices.ahrq.gov) and through the National Guideline
Clearinghouse™ (http://www.guideline.gov).
USPSTF Members
Members of the USPSTF represent the fields of family medicine, gerontology,
obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology.
Members of the USPSTF at the time this recommendation was finalized were:
Alfred O. Berg, M.D., M.P.H., Chair
Janet D. Allan, Ph.D., R.N., C.S., Vice-chair
C. Tracy Orleans, Ph.D.
Jeffrey F. Peipert, M.D., M.P.H.
Paul S. Frame, M.D.
Nola J. Pender, Ph.D., R.N.
Charles J. Homer, M.D., M.P.H.
Albert L. Siu, M.D., M.S.P.H.
Mark S. Johnson, M.D., M.P.H.
Steven M. Teutsch, M.D., M.P.H.
Jonathan D. Klein, M.D., M.P.H.
Carolyn Westhoff, M.D., M.Sc.
Tracy A. Lieu, M.D., M.P.H.
Steven H. Woolf, M.D., M.P.H.
AHRQ Publication No. APPIP03-0012
Current as of June 2003
Internet Citation:
Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular
Disease. What's New from the USPSTF. AHRQ Publication No. APPIP03-0012,
June 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/vitamins/vitaminswh.htm
540 Gaither Road Rockville, MD 20850