Dietary supplement use in women: current status and future directions-introduction and conference summary.

The use of dietary supplements has increased dramatically as our knowledge about the role of nutrients and other bioactive components of food in health has increased. Although much of the information about the diet and health connection that has driven this trend is related to the reduction of chronic disease risk in adults, belief in the prophylactic use of dietary intervention including the use of dietary supplements has been extended to consumers throughout the life cycle. In response to a congressional mandate, the Office of Dietary Supplements (ODS) of the National Institutes of Health (NIH) organized a conference in January 2000 to explore the current state of our knowledge about the important issues related to bioavailability of dietary supplements. The conference, supported by a consortium that included organizations both within (NIH, U.S. Department of Agriculture, Food and Drug Administration and Centers for Disease Control and Prevention) and outside the federal research community, was intended to identify research needed to expand our knowledge about factors influencing the digestion, absorption and biological activity of nutrients and other bioactive components of dietary supplements. One of the clearest findings emerging from this meeting was that the use of dietary supplements by children (infancy through adolescence), women and the elderly is increasing. However, little is known about either the evidence base to support appropriate indications or the safety of these supplements for use by these groups. To address this knowledge gap a second conference was organized by the Office of Prevention Research and International Programs of the National Institute of Child Health and Human Development (NICHD) and NIH ODS to focus on dietary supplement use by children. In determining the scope of issues to be covered at the conference, the organizers used the definition of dietary supplements as provided by the Dietary Supplement Health and Education Act of 1994 (1), which specifies the following: The Dietary Supplement Health and Education Act defines dietary supplements as a: product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet. The results of the conference on children were recently published (2,3). Among the findings that emerged from the two initial conferences was that women of reproductive age are a major user group and one particularly targeted to increase use of dietary supplements. Because of the important developmental milestones (both physiological and behavioral) that occur in women in the period encompassing adolescence through menopause, it is essential that the health care community have a clearer understanding of how diet and nutrition may interact and affect developmental processes. Little is known about the interaction between the use of the broad range of dietary supplements and health outcomes in women throughout these critical periods of development. Such knowledge is essential to the evaluation of both the justification and safety of dietary supplement by women. In January 2002, a two-day conference was conducted to present current research about dietary supplement use by women in both U.S. and international populations. The goals of the conference were to develop a focused research program in this area. The issues explored included characteristics of 1 From the National Institutes of Health (NIH) conference “Dietary Supplement Use in Women: Current Status and Future Directions” held on January 28–29, 2002, in Bethesda, MD. The conference was sponsored by the National Institute of Child Health and Human Development and the Office of Dietary Supplements, NIH, U.S. Department of Health and Human Services (DHHS) and was cosponsored by the Centers for Disease Control and Prevention, Food and Drug Administration Office of Women’s Health, NIH Office of Research on Women’s Health, National Institute of Diabetes and Digestive and Kidney Diseases Division of Nutrition Research Coordination, DHHS; National Center for Complementary Medicine, U.S. Department of Agriculture Agricultural Research Service; International Life Sciences Institute North America; March of Dimes; and Whitehall Robbins Healthcare. Conference proceedings were published in a supplement to The Journal of Nutrition. Guest editors for this workshop were Mary Frances Picciano, Office of Dietary Supplements, NIH, DHHS; Daniel J. Raiten, Office of Prevention Research and International Programs, National Institute of Child Health and Human Development, NIH, DHHS; and Paul M. Coates, Office of Dietary Supplements, NIH, DHHS. 2 To whom correspondence should be addressed. E-mail: [email protected].