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April 10, 1987, Vol 257, No. 14 >
ARTICLE | April 10, 1987

Vitamin Preparations as Dietary Supplements and as Therapeutic Agents FREE

[+] Author Affiliations

This report was submitted to the AMA House of Delegates in June 1985 as an informational report.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of the scientific literature as of November 1986.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (William R. Hendee, PhD).


JAMA. 1987;257(14):1929-1936. doi:10.1001/jama.1987.03390140099035
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Healthy adult men and healthy adult nonpregnant, nonlactating women consuming a usual, varied diet do not need vitamin supplements. Infants may need dietary supplements at given times, as may pregnant and lactating women. Occasionally, vitamin supplements may be useful for people with unusual life-styles or modified diets, including certain weight reduction regimens and strict vegetarian diets. Vitamins in therapeutic amounts may be indicated for the treatment of deficiency states, for pathologic conditions in which absorption and utilization of vitamins are reduced or requirements increased, and for certain nonnutritional disease processes. The decision to employ vitamin preparations in therapeutic amounts clearly rests with the physician. The importance of medical supervision when such amounts are administered is emphasized. Therapeutic vitamin mixtures should be so labeled and should not be used as dietary supplements.

(JAMA 1987;257:1929-1936)

REFERENCES

1 +
Council on Foods and Nutrition:  Vitamin preparations as dietary supplements and as therapeutic agents . JAMA 1959;;169:41-45.
2 +
Recommended Dietary Allowances , ed 9. Washington, DC, Food and Nutrition Board, National Research Council, National Academy of Sciences, 1980;.
3 +
FDA Consumer Memo: Nutrition Labels and U.S. RDA , publication (FDA) 81-2146. US Dept of Health and Human Services, 1981;.
4 +
Essentials of an Adequate Diet , Home Economics Research report 3. US Dept of Agriculture, 1957;.
5 +
Food: The Hassle-Free Guide to a Better Diet , Home and Garden bulletin 328. US Dept of Agriculture, 1979;.
6 +
Nutrition and Your Health: Dietary Guidelines for Americans , ed 2, Home and Garden bulletin 232. US Dept of Agriculture, 1985;.
7 +
Olson RE:  Function and metabolism of vitamin K . Annu Rev Nutr 1984;;4:281-337.
8 +
Committee on Nutrition: Pediatric Nutrition Handbook , ed 2. Elk Grove Village, Ill, American Academy of Pediatrics, 1985;, pp 37-48,185-186.
9 +
Welsh SO, Marston RM:  Review of trends in food use in the United States, 1909-1980 . J Am Diet Assoc 1982;;81:120-128.
10 +
FAO/WHO Handbook on Human Nutritional Requirements , monograph service 61. Geneva, World Health Organization, 1974;.
11 +
Butte NF, Calloway DH, Van Duzen JL:  Nutritional assessment of pregnant and lactating Navajo women . Am J Clin Nutr 1981;;34:2216-2228.
12 +
American Dietetic Association:  Position paper on vegetarian approach to eating . J Am Diet Assoc 1980;;77:61-69.
13 +
Mirkin GB, Shore RN:  The Beverly Hills diet: Dangers of the newest weight loss fad . JAMA 1981;; 246:2235-2237.
14 +
American Medical Association, Department of Foods and Nutrition:  Multivitamin preparations for parenteral use: A statement by the Nutrition Advisory Group . JPEN 1979;;3:258-262.
15 +
Rudman D, Williams PJ:  Nutrient deficiencies during total parenteral nutrition . Nutr Rev 1985;; 43:1-13.
16 +
Lieber CS:  To drink (moderately) or not to drink . N Engl J Med 1984;;310:846-848.
17 +
Pequignot G, Tuyns AJ:  Compared toxicity of ethanol on various organs , in Stock C, Bode J, Sarles H (eds): Alcohol and the Gastrointestinal Tract . Paris, Editions INSERM, 1980;, vol 95, pp 17-32.
18 +
Neville JN, Eagles JA, Samson G, et al:  Nutritional state of alcoholics . Am J Clin Nutr 1968;;21: 1329-1340.
19 +
Shaw S, Lieber CS:  Nutrition and alcoholism , in Goodhart R, Shils ME (eds): Modern Nutrition in Health and Disease , ed 6. Philadelphia, Lea & Febiger, 1980;.
20 +
Kopple JD:  Nutritional therapy in kidney failure , in Olson RE (ed): Present Knowledge in Nutrition , ed 5. Washington, DC, The Nutrition Foundation Inc, 1984;, pp 772-796.
21 +
Franklin JC, Rosenberg IH:  Impaired folic acid absorption in inflammatory bowel disease: Effects of salicylazosulfapyridine (Azulfidine) . Gastroenterology 1973;;64:517-525.
22 +
Mandell GL, Saude MA:  Drugs used in the chemotherapy of tuberculosis and leprosy , in Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1980;, pp 1200-1221.
23 +
Roe DA:  Nutrient and drug interactions . Nutr Rev 1984;;42:141-154.
24 +
Rosenberg J:  Vitamin-responsive inherited metabolic disorders . Adv Hum Genet 1976;;6:1-74.
25 +
Peck GL, Olsen TG, Yoder FW, et al:  Prolonged remissions of cystic and conslobate acne with 13-cisretinal acid . N Engl J Med 1979;;300:329-333.
26 +
Kane JP, Malloy MJ, Tun P, et al:  Normalization of low-density lipoprotein levels in heterozygous familial hypercholesterolemia with combined drug regimen . N Engl J Med 1981;;304:251-258.
27 +
Alhadeff L, Gulatieri T, Lipton M:  Toxic effects of water-soluble vitamins . Nutr Rev 1984;;42:33-40.
28 +
Olson RE:  Vitamin E and its relation to heart disease . Circulation 1973;;48:179-184.
29 +
Farrell PM:  Deficiency states, pharmacologic effects and nutrient requirements , in Machlin LJ (ed): Vitamin E: A Comprehensive Treatise . New York, Marcel Dekker Inc, 1980;, pp 579-594.
30 +
Bieri JG, Corash L, Hubbard VS:  Medical uses of vitamin E . N Engl J Med 1983;;308:1063-1071.
31 +
Smithells RW, Nevin NC, Seller MJ, et al:  Further experience of vitamin supplementation for prevention of neural tube defect recurrences . Lancet 1983;;1:1027-1031.
32 +
Seller MJ:  Periconceptional vitamin supplementation to prevent recurrence of neural tube defects . Lancet 1985;;1:1392-1393.
33 +
Laurence KM, James N, Miller M, et al:  Double-blind randomized controlled trial of folate treatment before conception to prevent occurrence of neural-tube defects . Br Med J 1981;;282:1509-1511.
34 +
Blessing P:  Scientists study effect of vitamins in preventing neural tube defects . News and Features From NIH 1985;;85( (5) ):8-9.
35 +
Stewart ML, McDonal JT, Levy AS, et al:  Vitamin/mineral supplement use: A telephone survey of adults in the United States . J Am Diet Assoc 1985;;85:1585-1590.
36 +
Willett W, Sampson L, Bain C, et al:  Vitamin supplement use among registered nurses . Am J Clin Nutr 1981;;34:1121-1125.
37 +
Woolliscroft JO:  Megavitamins: Fact and fancy . DM 1983;;29:1-56.
38 +
Chalmers TC:  Effects of ascorbic acid on the common cold: An evaluation of the evidence . Am J Med 1975;;58:532-536.
39 +
Doll R, Peto R:  The causes of cancer: Quantitative estimates of avoidable risks of cancer in the U.S. today . JCNI 1981;;66:1192-1308.
40 +
Creagan ET, Moertel CG, O'Fallon JR, et al:  Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer . N Engl J Med 1979;;301:687-690.
41 +
Moertel CG, Fleming TR, Creagan ET, et al:  High dose vitamin C versus placebo in the treatment of patients who have had no prior chemotherapy: A randomized double-blind comparison . N Engl J Med 1985;;312:137-141.
42 +
Herbert V:  Toxicity of 25000 IU vitamin A supplements in `health food' users . Am J Clin Nutr 1982;;36:185-186.
43 +
Muenter MD, Perry HO, Ludwig J:  Chronic vitamin A intoxication in adults . Am J Med 1971;; 50:129-136.
44 +
Goodman DS:  Vitamin A and retinoids in health and disease . N Engl J Med 1984;;310:1023-1031.
45 +
Lammer EJ, Chen DT, Hoar RM, et al:  Retinoic acid embryopathy . N Engl J Med 1985;;313: 837-841.
46 +
Forfar JO, Balf CL, Maxwell GM, et al:  Idiopathic hypercalcemia of infancy: Clinical and methodological studies with special reference to the etiological role of vitamin D . Lancet 1956;;1:982-985.
47 +
Howard JE, Meyer RJ:  Intoxication by vitamin D . J Clin Endocrinol Metab 1948;;8:895-910.
48 +
Farrell PM, Bieri JG:  Megavitamin E supplementation in man . Am J Clin Nutr 1975;;28:1381-1386.
49 +
Schaumburg H, Kaplan J, Windebank A, et al:  Sensory neuropathy from pyridoxine abuse: A new megavitamin syndrome . N Engl J Med 1983;;309: 445-448.
50 +
DiPalma JR, Richie DM:  Vitamin toxicity . Annu Rev Pharmacol Toxicol 1977;;17:133-148.
51 +
 Establishment of a monograph: Vitamin and mineral drug products for over-the-counter human use . Federal Register 1979;;44( (March 16) ):16126-16201.

Figures

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Council on Foods and Nutrition:  Vitamin preparations as dietary supplements and as therapeutic agents . JAMA 1959;;169:41-45.
2 +
Recommended Dietary Allowances , ed 9. Washington, DC, Food and Nutrition Board, National Research Council, National Academy of Sciences, 1980;.
3 +
FDA Consumer Memo: Nutrition Labels and U.S. RDA , publication (FDA) 81-2146. US Dept of Health and Human Services, 1981;.
4 +
Essentials of an Adequate Diet , Home Economics Research report 3. US Dept of Agriculture, 1957;.
5 +
Food: The Hassle-Free Guide to a Better Diet , Home and Garden bulletin 328. US Dept of Agriculture, 1979;.
6 +
Nutrition and Your Health: Dietary Guidelines for Americans , ed 2, Home and Garden bulletin 232. US Dept of Agriculture, 1985;.
7 +
Olson RE:  Function and metabolism of vitamin K . Annu Rev Nutr 1984;;4:281-337.
8 +
Committee on Nutrition: Pediatric Nutrition Handbook , ed 2. Elk Grove Village, Ill, American Academy of Pediatrics, 1985;, pp 37-48,185-186.
9 +
Welsh SO, Marston RM:  Review of trends in food use in the United States, 1909-1980 . J Am Diet Assoc 1982;;81:120-128.
10 +
FAO/WHO Handbook on Human Nutritional Requirements , monograph service 61. Geneva, World Health Organization, 1974;.
11 +
Butte NF, Calloway DH, Van Duzen JL:  Nutritional assessment of pregnant and lactating Navajo women . Am J Clin Nutr 1981;;34:2216-2228.
12 +
American Dietetic Association:  Position paper on vegetarian approach to eating . J Am Diet Assoc 1980;;77:61-69.
13 +
Mirkin GB, Shore RN:  The Beverly Hills diet: Dangers of the newest weight loss fad . JAMA 1981;; 246:2235-2237.
14 +
American Medical Association, Department of Foods and Nutrition:  Multivitamin preparations for parenteral use: A statement by the Nutrition Advisory Group . JPEN 1979;;3:258-262.
15 +
Rudman D, Williams PJ:  Nutrient deficiencies during total parenteral nutrition . Nutr Rev 1985;; 43:1-13.
16 +
Lieber CS:  To drink (moderately) or not to drink . N Engl J Med 1984;;310:846-848.
17 +
Pequignot G, Tuyns AJ:  Compared toxicity of ethanol on various organs , in Stock C, Bode J, Sarles H (eds): Alcohol and the Gastrointestinal Tract . Paris, Editions INSERM, 1980;, vol 95, pp 17-32.
18 +
Neville JN, Eagles JA, Samson G, et al:  Nutritional state of alcoholics . Am J Clin Nutr 1968;;21: 1329-1340.
19 +
Shaw S, Lieber CS:  Nutrition and alcoholism , in Goodhart R, Shils ME (eds): Modern Nutrition in Health and Disease , ed 6. Philadelphia, Lea & Febiger, 1980;.
20 +
Kopple JD:  Nutritional therapy in kidney failure , in Olson RE (ed): Present Knowledge in Nutrition , ed 5. Washington, DC, The Nutrition Foundation Inc, 1984;, pp 772-796.
21 +
Franklin JC, Rosenberg IH:  Impaired folic acid absorption in inflammatory bowel disease: Effects of salicylazosulfapyridine (Azulfidine) . Gastroenterology 1973;;64:517-525.
22 +
Mandell GL, Saude MA:  Drugs used in the chemotherapy of tuberculosis and leprosy , in Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1980;, pp 1200-1221.
23 +
Roe DA:  Nutrient and drug interactions . Nutr Rev 1984;;42:141-154.
24 +
Rosenberg J:  Vitamin-responsive inherited metabolic disorders . Adv Hum Genet 1976;;6:1-74.
25 +
Peck GL, Olsen TG, Yoder FW, et al:  Prolonged remissions of cystic and conslobate acne with 13-cisretinal acid . N Engl J Med 1979;;300:329-333.
26 +
Kane JP, Malloy MJ, Tun P, et al:  Normalization of low-density lipoprotein levels in heterozygous familial hypercholesterolemia with combined drug regimen . N Engl J Med 1981;;304:251-258.
27 +
Alhadeff L, Gulatieri T, Lipton M:  Toxic effects of water-soluble vitamins . Nutr Rev 1984;;42:33-40.
28 +
Olson RE:  Vitamin E and its relation to heart disease . Circulation 1973;;48:179-184.
29 +
Farrell PM:  Deficiency states, pharmacologic effects and nutrient requirements , in Machlin LJ (ed): Vitamin E: A Comprehensive Treatise . New York, Marcel Dekker Inc, 1980;, pp 579-594.
30 +
Bieri JG, Corash L, Hubbard VS:  Medical uses of vitamin E . N Engl J Med 1983;;308:1063-1071.
31 +
Smithells RW, Nevin NC, Seller MJ, et al:  Further experience of vitamin supplementation for prevention of neural tube defect recurrences . Lancet 1983;;1:1027-1031.
32 +
Seller MJ:  Periconceptional vitamin supplementation to prevent recurrence of neural tube defects . Lancet 1985;;1:1392-1393.
33 +
Laurence KM, James N, Miller M, et al:  Double-blind randomized controlled trial of folate treatment before conception to prevent occurrence of neural-tube defects . Br Med J 1981;;282:1509-1511.
34 +
Blessing P:  Scientists study effect of vitamins in preventing neural tube defects . News and Features From NIH 1985;;85( (5) ):8-9.
35 +
Stewart ML, McDonal JT, Levy AS, et al:  Vitamin/mineral supplement use: A telephone survey of adults in the United States . J Am Diet Assoc 1985;;85:1585-1590.
36 +
Willett W, Sampson L, Bain C, et al:  Vitamin supplement use among registered nurses . Am J Clin Nutr 1981;;34:1121-1125.
37 +
Woolliscroft JO:  Megavitamins: Fact and fancy . DM 1983;;29:1-56.
38 +
Chalmers TC:  Effects of ascorbic acid on the common cold: An evaluation of the evidence . Am J Med 1975;;58:532-536.
39 +
Doll R, Peto R:  The causes of cancer: Quantitative estimates of avoidable risks of cancer in the U.S. today . JCNI 1981;;66:1192-1308.
40 +
Creagan ET, Moertel CG, O'Fallon JR, et al:  Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer . N Engl J Med 1979;;301:687-690.
41 +
Moertel CG, Fleming TR, Creagan ET, et al:  High dose vitamin C versus placebo in the treatment of patients who have had no prior chemotherapy: A randomized double-blind comparison . N Engl J Med 1985;;312:137-141.
42 +
Herbert V:  Toxicity of 25000 IU vitamin A supplements in `health food' users . Am J Clin Nutr 1982;;36:185-186.
43 +
Muenter MD, Perry HO, Ludwig J:  Chronic vitamin A intoxication in adults . Am J Med 1971;; 50:129-136.
44 +
Goodman DS:  Vitamin A and retinoids in health and disease . N Engl J Med 1984;;310:1023-1031.
45 +
Lammer EJ, Chen DT, Hoar RM, et al:  Retinoic acid embryopathy . N Engl J Med 1985;;313: 837-841.
46 +
Forfar JO, Balf CL, Maxwell GM, et al:  Idiopathic hypercalcemia of infancy: Clinical and methodological studies with special reference to the etiological role of vitamin D . Lancet 1956;;1:982-985.
47 +
Howard JE, Meyer RJ:  Intoxication by vitamin D . J Clin Endocrinol Metab 1948;;8:895-910.
48 +
Farrell PM, Bieri JG:  Megavitamin E supplementation in man . Am J Clin Nutr 1975;;28:1381-1386.
49 +
Schaumburg H, Kaplan J, Windebank A, et al:  Sensory neuropathy from pyridoxine abuse: A new megavitamin syndrome . N Engl J Med 1983;;309: 445-448.
50 +
DiPalma JR, Richie DM:  Vitamin toxicity . Annu Rev Pharmacol Toxicol 1977;;17:133-148.
51 +
 Establishment of a monograph: Vitamin and mineral drug products for over-the-counter human use . Federal Register 1979;;44( (March 16) ):16126-16201.

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