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Cited by 45Complementary and Alternative Medicine StudiesPharmaceutical Quality and CounterfeitingConsumer Attitudes and Food Labeling

The DOI matches its Crossref record; 15 of the 17 references it cites were found in a registry or an index.

Analysis of Select Dietary Supplement Products Marketed to Support or Boost the Immune System

Open access
Crawford, Cindy, Avula, Bharathi, Lindsey, Andrea T., Walter, Abraham, Katragunta, Kumar, Khan, Ikhlas A., Deuster, Patricia A.·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.26040PMC PMC9366544
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Abstract

Importance: Cold, flu, and immunity dietary supplement product sales have skyrocketed since the start of the COVID-19 pandemic. Supporting or boosting the immune system has become an important reason for using dietary supplements, and many consumers are purchasing products through online platforms. Objectives: To examine whether select dietary supplement products advertised as supporting or boosting the immune system are accurately labeled according to the Supplement Facts label of listed ingredients and to qualitatively describe the product labels' characteristics in terms of claims made. Design, Setting, and Participants: In this case series, 30 featured immune health dietary supplements were selected and purchased from Amazon.com in May 2021. Product analysis was performed using liquid chromatography-mass spectrometry. The list of ingredients detected through analysis for each product was compared with the ingredients on the product's Supplement Facts label to determine whether the product's label was accurate. Claims made on product labels were also evaluated by using the Operation Supplement Safety Scorecard's set of questions to describe the labels' characteristics. Results: A total of 30 select dietary supplement products were evaluated. Thirteen of the 30 products had accurate labels based on the product analysis. Of the 17 products with inaccurate labels, 13 had ingredients listed on the labels that were not detected through analysis, such that their labels were misbranded. Nine products had substances detected that were not claimed on the product labels, some of which may be considered adulterated. Five were misbranded and contained additional components not claimed on the label. No product had third-party certification seals present on the packaging. Ten of the 13 products with accurate labels received a score of 4 or more when applying the Operation Supplement Safety Scorecard, meaning the product was "likely okay/less risky." Conclusions and Relevance: In this case series study, most of the products tested had inaccurate labels and claims that were inconsistent with requirements the US Food and Drug Administration has put forward for dietary supplements. Quality control measures seem to be insufficient for most of these select products, and claims made on labels may be misleading consumers who purchase products.

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  • Several studies of the accuracy of dietary supplement labeling have found that many of the products analyzed contained significantly lower amounts of the specific ingredient or additional, possibly risky, ingredients that were not declared on the supplement label [29,32,33,76-81].

    “Several studies of the accuracy of dietary supplement labeling have found that many of the products analyzed contained significantly lower amounts of the specific ingredient or additional, possibly risky, ingredients that were not declared on the supplement label [29,32,33,76–81].”

    From How reliable is the labeling of a commercial phytosteroid product? A 12-week randomized double-blind training study (2025) · cites this paper as [78]

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2 of the 17 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Brush, 2020, Immunity is everything: as the pandemic brings attention to the immune system, many question the attitudes and assumptions about it., Nutr Bus J
  2. Juntti, 2020, The whole pandemic package: immunity is just the start as consumers scoop up supplements for sleep, stress and more., Nutr Bus J, 1
  3. Brush, 2021, Don’t talk about vaccines: Supplement brands wary to wade into the fray, for two big reasons., Nutr Bus J, 1
  4. Brush, 2021, Amazon as crystal ball: can natural brands and retailers use e-commerce to predict trends?, Nutr Bus J, 13

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Metadata

Authors
Crawford, C., Avula, B., Lindsey, A. T., Walter, A., Katragunta, K., Khan, I. A., & Deuster, P. A.
Affiliations
  • Henry M. Jackson Foundation (US)
  • University of Mississippi (US)
  • Uniformed Services University of the Health Sciences (US)
Corresponding author
Deuster, Patricia A.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-08-10
Volume
5
Issue
8
Pages
e2226040
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.26040
PMC
PMC9366544
OpenAlex
W4293496876
Cited by
45
References
17
Citations by year
2026: 10 · 2025: 11 · 2024: 9 · 2023: 12 · 2022: 3
FWCI
9.15
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
Keywords
dietary supplements, misbranding, supplement adulteration, online supplement sales, consumer health claims, COVID-19 pandemic
MeSH terms
COVID-19, Humans, Immune System, United States, United States Food and Drug Administration, Dietary Supplements, Pandemics

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