Quantitative assessment of dietary supplement intake in 77,000 French adults: impact on nutritional intake inadequacy and excessive intake
Dietary supplements (DS) are largely consumed in Western countries without demonstrating their nutritional benefits and safety in the general population. The aims, in a large population-based study of French adults, were: (1) to compare the prevalence of nutrient intake inadequacy and the proportion of individuals exceeding tolerable upper intake levels (UL) between DS users and non-users, and (2) to quantify the extent of potentially “at-risk” DS use practices (e.g., DS/drugs contraindicated association or use of beta-carotene DS in smokers).
76,925 participants, 47.6% men and 52.4% women, mean age 46.9 ± 16.3 years were enrolled to the NutriNet-Santé cohort and they completed a quantitative DS questionnaire and three 24 h dietary records. A composition database including > 8000 DS was developed. Variance reduction was applied to estimate usual intakes and analyses were weighted according to the French census data.
Among DS users of the specific nutrient, DS contributed to 41% of total intake for vitamin D in men, 55% in women; and to 20% of total intake for pyridoxine in men, 21% in women. Compared to dietary intakes only, their prevalence of inadequacy was reduced by 11% for vitamin C, 9% for magnesium, 6% for pyridoxine in men, and 19% for calcium, 12% for iron, and 11% for magnesium in women (p < 0.0001). The proportion of subjects exceeding UL reached 6% for iron and 5% for magnesium in men, and 9% for iron in women. 6% of DS users had potentially “at-risk” practices.
While DS use contributed to decrease the prevalence of insufficient intake for several nutrients, it also conveyed excessive intake of iron and magnesium. Besides, a substantial proportion of potentially “at-risk” DS use practices was reported.
KeywordsDietary supplements Nutrient intake inadequacy Tolerable upper intake levels Drug interactions
Estimated average requirement
Saturated fatty acids
Monounsaturated fatty acids
Polyunsaturated fatty acids
The authors thank all the volunteers of the NutriNet-Santé cohort. We extend special thanks to Ludivine Ursule, Cédric Agaesse, Claudia Chahine, Marion Genest and Anne-Elise Dussouiler, dietitians, for the elaboration of the DS composition database. We also thank Véronique Gourlet, Nathalie Arnault, Stephen Besseau, Laurent Bourhis, Yasmina Chelghoum, Than Duong Van, Younes Esseddik, Paul Flanzy, Julien Allègre, Mac Rakotondrazafy, Fabien Szabo, Roland Andrianasolo, and Fatoumata Diallo for their technical contribution to the NutriNet-Santé study. This work was conducted in the framework of the French network for Nutrition and Cancer Research (NACRe network), https://www6.inra.fr/nacre/.
This work was funded by the Cancéropôle Ile de France/Région Ile de France. Philippine Fassier and Mélanie Deschasaux were funded by PhD grants from the Cancéropôle Ile de France/Région Ile-de-France. The NutriNet-Santé study was supported by the following public institutions: Ministère de la Santé, Institut de Veille Sanitaire (InVS), Institut National de la Prévention et de l’Education pour la Santé (INPES), Région Ile-de-France (CORDDIM), Fondation pour la Recherche Médicale (FRM), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Conservatoire National des Arts et Métiers (CNAM) and Université Paris 13.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Clarke TC, Black LI, Stussman BJ et al (2015) Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Rep 79:1–16Google Scholar
- 9.ANSES (2017) Etude Individuelle Nationale des Consommations Alimentaires 3 (INCA 3)Google Scholar
- 10.ANSES (2009) Etude Individuelle Nationale des Consommations Alimentaires 2 (INCA 2). AFFSA Fr Food Saf Agency Maisons AlfortGoogle Scholar
- 16.French Agency for Food, Environmental and Occupational Health & Safety (2015) ANSES opinion on the evaluation of the intakes of vitamins and minerals derived from the non-enriched diet, the fortified diet and the dietary supplements in the French population: estimation of the usual intakes, the prevalences of inadequacy and the Risk of exceeding the tolerable upper levels. https://www.anses.fr/fr/system/files/NUT2012sa0142.pdf. Accessed 30 July 2018
- 32.IPAQ Group (2005) Guidelines for data processing and analysis of the international physical activity questionnaire (IPAQ)Google Scholar
- 33.Vidal (1997) Dictionnaire VIDAL. VIDAL, ParisGoogle Scholar
- 37.Le Moulec N, Deheerger M, Preziosi P et al (2016) Validation du manuel-photos utilisé pour l’enquête alimentaire de l’étude SU.VI.MAXGoogle Scholar
- 38.NutriNet-Santé coordination (2013) Table de composition des aliments—Etude NutriNet-Santé. Economica 2013, ParisGoogle Scholar
- 42.INSEE (2016) French National Census Data. Inst Natl Stat Etudes EconGoogle Scholar
- 47.Martin A (2001) Apports nutritionnels conseille´s pour la population française (Recommended Dietary Allowances for the French Population), 3rd edn. Tec & Doc Lavoisier, ParisGoogle Scholar
- 48.EFSA (2013) Scientific opinion on dietary reference values for vitamin C. EFSA J 11:68Google Scholar
- 49.NNR (2012) Nordic nutrition recommendations 2012. No Nord 2014:002Google Scholar
- 50.IOM (2011) Dietary intakes for calcium and vitamin D. Institute of Medicine, National Academies Press, Washington, DCGoogle Scholar
- 51.SCF (2000) Opinion of the scientific committee on food on the tolerable upper intake level of seleniumGoogle Scholar
- 52.SCF (2002) Opinion of the scientific committee on food on the tolerable upper intake level of iodineGoogle Scholar
- 53.SCF (2002) Opinion of the scientific committee on food on the tolerable upper intake level of seleniumGoogle Scholar
- 54.SCF (2003) Opinion of the scientific committee on food on the tolerable upper intake level of calciumGoogle Scholar
- 55.SCF (2003) Opinion of the scientific committee on food on the tolerable upper intake level of copperGoogle Scholar
- 61.Food and Nutrition Board (1997) Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Institute of Medicine (IOM), National Academy Press, Washington, DCGoogle Scholar
- 62.Food and Nutrition Board (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc: a report of the panel on micronutrients. National Academy Press, Washington, DCGoogle Scholar
- 63.AICR/WCRF (2007) (2016) American Institute for Cancer Research/ World Cancer Research Fund. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. WashingtonGoogle Scholar
- 67.Verdot C, Torres M, Salanave B, Deschamps V (2017) Corpulence des enfants et des adultes en France métropolitaine en 2015. Résultats de l’étude Esteban et évolution depuis 2006. Bull Epidémiol Hebd 13:234–41Google Scholar