title: Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials.
abstract: Our aim was to assess the efficacy of dietary supplements in the primary prevention of cause-specific death, cardiovascular disease (CVD), and cancer by using meta-analytical approaches. Electronic and hand searches were performed until August 2016. Inclusion criteria were as follows: 1) minimum intervention period of 12 mo; 2) primary prevention trials; 3) mean age ≥18 y; 4) interventions included vitamins, fatty acids, minerals, supplements containing combinations of vitamins and minerals, protein, fiber, prebiotics, and probiotics; and 5) primary outcome of all-cause mortality and secondary outcomes of mortality or incidence from CVD or cancer. Pooled effects across studies were estimated by using random-effects meta-analysis. Overall, 49 trials (69 reports) including 287,304 participants met the inclusion criteria. Thirty-two trials were judged as low risk-, 15 trials as moderate risk-, and 2 trials as high risk-of-bias studies. Supplements containing vitamin E (RR: 0.88; 95% CI: 0.80, 0.96) significantly reduced cardiovascular mortality risk, whereas supplements with folic acid reduced the risk of CVD (RR: 0.81; 95% CI: 0.70, 0.94). Vitamins D, C, and K; selenium; zinc; magnesium; and eicosapentaenoic acid showed no significant risk reduction for any of the outcomes. On the contrary, vitamin A was linked to an increased cancer risk (RR: 1.16; 95% CI: 1.00, 1.35). Supplements with β-carotene showed no significant effect; however, in the subgroup with β-carotene given singly, an increased risk of all-cause mortality by 6% (RR: 1.06; 95% CI: 1.02, 1.10) was observed. Taken together, we found insufficient evidence to support the use of dietary supplements in the primary prevention of cause-specific death, incidence of CVD, and incidence of cancer. The application of some supplements generated small beneficial effects; however, the heterogeneous types and doses of supplements limit the generalizability to the overall population.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany; lukas.schwingshackl@dife.de.
authors.forename: Lukas
authors.identifier: 0000-0003-3407-7594
authors.initials: L
authors.lastname: Schwingshackl
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.|Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Stelmach-Mardas
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Gottschald
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Dietrich
authors.affiliation: Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria; and.
authors.forename: Georg
authors.initials: G
authors.lastname: Hoffmann
authors.affiliation: Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Chaimani
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D004032:Diet; D019587:Dietary Supplements; D006801:Humans; D015994:Incidence; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood; D009369:Neoplasms / Q000401:mortality* / Q000517:prevention & control*; D015596:Nutrition Assessment; D064887:Observational Studies as Topic; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic
chemical_list: D018977:Micronutrients
keywords: cancer; cardiovascular disease; dietary supplements; meta-analysis; mortality; systematic review