Emergency Department Visits for Adverse Events Related to Dietary Supplements
Open accessAbstract
BACKGROUND: Dietary supplements, such as herbal or complementary nutritional products and micronutrients (vitamins and minerals), are commonly used in the United States, yet national data on adverse effects are limited. METHODS: We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements. RESULTS: On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement-related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits. CONCLUSIONS: An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.).
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Assessments of adverse event reports related to dietary supplementation, including in pediatric populations, have revealed that creatine was rarely mentioned and was not associated with any significant number or any consistent pattern of adverse events.
“Additionally, assessments of adverse event reports related to dietary supplementation, including in pediatric populations, have revealed that creatine was rarely mentioned and was not associated with any significant number or any consistent pattern of adverse events [238–240].”
From International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine (2017) · cites this paper as [238]
The Results > Products section reports emergency department visits for dietary-supplement adverse events, including unsupervised child ingestions. But our copy does not mention creatine or assess whether it was rarely reported or lacked a consistent pattern of adverse events (searched: creatine and pediatric supplement adverse events). No page number is available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDietary supplements have been estimated to be implicated in more than 20,000 emergency department visits and 2000 hospitalizations in the US annually.
“Given the public perception that dietary supplements are safe, it would likely be a surprise to consumers that dietary supplements have been estimated to be implicated in more than 20,000 emergency department visits and 2000 hospitalizations in the US annually [55].”
From Critical Differences Between Dietary Supplement and Prescription Omega-3 Fatty Acids: A Narrative Review (2020) · cites this paper as [55]
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- Authors
- Geller, A. I., Shehab, N., Weidle, N. J., Lovegrove, M. C., Wolpert, B. J., Timbo, B. B., Mozersky, R. P., & Budnitz, D. S.
- Affiliations
- Center for Food Safety and Applied Nutrition (US)
- Centers for Disease Control and Prevention (US)
- United States Food and Drug Administration (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-10-15
- Volume
- 373
- Issue
- 16
- Pages
- 1531-1540
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC6196363
- OpenAlex
- W2330664058
- Cited by
- 502
- References
- 22
- Citations by year
- 2026: 35 · 2025: 44 · 2024: 41 · 2023: 46 · 2022: 50 · 2021: 45 · 2020: 58 · 2019: 40 · 2018: 47 · 2017: 48 · 2016: 43 · 2015: 5
- FWCI
- 93.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- U.S. Consumer Product Safety Commission
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- dietary supplements, emergency department visits, micronutrients, weight loss supplements, energy supplements, hospitalization, choking, dysphagia, tachycardia, emergency department surveillance, young adults, older adults, supplement safety
- MeSH terms
- Adolescent, Adult, Aged, Complementary Therapies, Calcium, Child, Child, Preschool, Emergency Service, Hospital, Female, Hospitalization, Humans, Iron, Phytotherapy, Middle Aged, Population Surveillance, Potassium, United States, Age Distribution, Micronutrients, Dietary Supplements, Young Adult
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