Cited by 165Nutritional Studies and DietNutrition and Health StudiesAntioxidant Activity and Oxidative Stress

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Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials

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Schwingshackl, Lukas, Boeing, Heiner, Stelmach-Mardas, Marta, Gottschald, Marion, Dietrich, Stefan, Hoffmann, Georg, Chaimani, Anna·2017·Advances in Nutrition

DOI 10.3945/an.116.013516PMC PMC5227980

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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.

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Authors: Schwingshackl, L., Boeing, H., Stelmach-Mardas, M., Gottschald, M., Dietrich, S., Hoffmann, G., & Chaimani, A.
Affiliations: German Institute of Human Nutrition (DE)
Poznan University of Medical Sciences (PL)
University of Vienna (AT)
University of Ioannina (GR)
Corresponding author: Schwingshackl, Lukas
ORCID: Schwingshackl, Lukas
Stelmach-Mardas, Marta
Gottschald, Marion
Dietrich, Stefan
Hoffmann, Georg
Chaimani, Anna
Venue: Advances in Nutrition
Publisher: Elsevier BV
Published: 2017-01
Volume: 8
Issue: 1
Pages: 27-39
ISSN: 2156-5376 (ISSN-L)
2161-8313
DOI: 10.3945/an.116.013516
PMC: PMC5227980
OpenAlex: W2576285435
Cited by: 165
References: 119
Citations by year: 2026: 6 · 2025: 7 · 2024: 9 · 2023: 25 · 2022: 22 · 2021: 32 · 2020: 14 · 2019: 15 · 2018: 28 · 2017: 7
FWCI: 2.84
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc/3.0/ (vor, 10 d)
Locations: Advances in Nutrition (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
Keywords: dietary supplements, primary prevention, cause-specific mortality, cardiovascular disease, cancer incidence, vitamin E, folic acid, vitamin A, beta-carotene, cardiovascular mortality, selenium, zinc, magnesium, eicosapentaenoic acid, prebiotics, probiotics, all-cause mortality
MeSH terms: Cardiovascular Diseases, Diet, Humans, Neoplasms, Primary Prevention, Nutrition Assessment, Incidence, Randomized Controlled Trials as Topic, Micronutrients, Dietary Supplements, Observational Studies as Topic

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Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials

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