If only Nutrition Guidance could be as Simple as Nutrition Headlines
In an editorial in the New York Times, Paul Offit and Sarah Erush opine on the Children’s Hospital of Philadelphia policy that parents discontinue use of dietary supplements when their children are hospitalized. As a parent, one of the most horrifying experiences in the world is having a child require medical attention beyond routine checkups and vaccinations. The transfer of responsibility for your child to a medical doctor in a hospital creates an overwhelming feeling of helplessness as a parent. Yet, it is necessary because the child needs medical attention. And to fully apply their knowledge in the medical treatment of your child under special circumstances, doctors need to know what the child is consuming. This is responsible medical treatment.
It isn’t responsible to state that multivitamin supplements should be regulated as drugs. Drugs are developed and administered by physicians to treat diseases. Unless nutrition is being administered intravenously under medical supervision, we choose foods to get nutrients essential for life. This happens daily. Sometimes at home. Increasingly more often, away from home. As the number of miles driven daily increases the risk of being involved in an accident, people who eat more typically consume more nutrients. Like car fuel efficiency depends upon driving conditions, actual nutrient intakes depend upon food choices.
When queried, people typically state preferences for natural foods which have undergone minimal processing (whatever natural may mean). The reality is that most people obtain essential nutrients in the form of enriched and fortified foods (Fulgoni et al., 2011). While some experts argue that voluntary fortification of foods may be dangerous; when < 4% of children exceed the Upper Tolerable Limit (the UL is the highest level of intake that is likely to pose no adverse health effects for almost all individuals) it is very clear that millions of people would be nutritionally disadvantaged if fortification levels were lowered. Because of their smaller body size, a serving of any food provides a greater proportion of the nutrient needs of a younger child. This increases the probability of exceeding the UL but it is offset by the fact that children eat less.
It isn’t responsible to deride the benefits of multivitamin supplements. For better or for worse, the reality is that many children (and adults) do not eat a balanced diet and are at risk of inadequate intakes of vitamin E, vitamin D, and vitamin A (Economos et al., 2013). Research shows that children are given dietary supplements, usually multivitamins, to prevent nutrient shortfalls (Dwyer et al., 2013). Children with a ‘usual place at which they received conventional care’, probably those with long-term health issues, are more likely to use dietary supplements. Outside of vitamin-mineral supplements, the most likely products used by children are ones to address gastrointestinal issues (flax products, prebiotics, probiotics, and dietary fiber). Children who do not use dietary supplements have significantly higher prevalence of inadequate intakes of calcium, magnesium, phosphorus, vitamin A and vitamin C (Bailey and colleagues).
Nutrition is simple. People need essential vitamins and nutrients to survive. This includes children. A multivitamin is insurance when a diet may not be perfect. A multivitamin shouldn’t be a mega-dose; it should provide a mix of essential nutrients, probably never more than 50% of the UL for any nutrient. Because the ‘practice of nutrition’ is complicated by culinary preferences, cultural habits, and individuality (age, sex, size, activity), nutrition guidance is never so simple as ‘supplements are bad’. Skipping supplements may make good headlines but it is not good nutritional advice.
Sacco JE, Dodd KW, Kirkpatrick SI, Tarasuk V. Voluntary food fortification in the United States: potential for excessive intakes. 2013 Eur J Clin Nutr doi: 10.1038/ejcn.2013.051
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? 2011 J Nutr doi: 10.3945/jn.111.142257
Economos CD, Moore CE, Hyatt RR, Kuder J, Chen T, Meydani SN, Meydani M, Klein E, Biancuzzo RM, Holick M. Multinutrient-fortified juices improve vitamin D and vitamin E status in children: a randomized controlled trial. 2013 J Acad Nutr Diet doi: 10.1016/j.and.2013.07.027
Dwyer J, Nahin RL, Rogers GT, Barnes PM, Jacques PM, Sempos CT, Bailey R. Prevalence and predictors of children’s dietary supplement use: the 2007 National Health Interviews Survey. 2013 Am J Clin Nutr doi: 10.3945/ajcn.112.052373
Bailey RL, Fulgoni VL, Keast DR, Lentino CV, Dwyer JT. Do dietary supplements improve micronutrient sufficiency in children and adolescents?2012 J Pediatric doi: 10.1016/j.jpeds.2012.05.009