Sebastian J. Padayatty, MD; Mark Levine, MD
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0085.
Padayatty SJ, Levine M. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer. Ann Intern Med. 2014;160:654. doi: 10.7326/L14-5009
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Published: Ann Intern Med. 2014;160(9):654.
TO THE EDITOR:
Fortmann and colleagues’ meta-analysis (1) showed that vitamin and mineral supplementation provides little benefit and does not aid cognition (2) or prevent cardiovascular events (3). The authors concluded that supplements have no value. However, data constraints limit interpretation to a narrower conclusion: Supplementation in well-nourished persons does not affect the end points studied but may have other benefits or abolish signs and symptoms of unrecognized deficiencies, which are surprisingly common.
Many studies of vitamin supplements are flawed, including Fortmann and colleagues’ review, because vitamin concentrations at enrollment are usually not measured. It is predictable that study populations include those with low concentrations of vitamins, subclinical deficiencies, or both and others who are vitamin replete. These groups are distinguishable only if baseline, and preferably postsupplementation, vitamin concentrations are measured.
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