Multivitamin Use and Overall and Site-Specific Cancer Risks in the National Institutes of Health–AARP Diet and Health Study

ABSTRACT Background Multivitamins are among the most commonly used supplements in the United States, but their effectiveness in preventing cancer remains unclear. Objectives We prospectively examined the association between multivitamin use and risks of overall and site-specific cancer in a large, well-characterized cohort to ascertain potential preventive or harmful relationships. Methods We examined 489,640 participants ages 50–71 in the NIH–American Association of Retired Persons (AARP) Diet and Health Study who were enrolled from 1995 to 1998. We linked to 11 state cancer registries in order to identify incident cancers. Multivitamin use was assessed by a baseline questionnaire. Cox proportional hazards regression models of multivitamin use were used to estimate HRs and 95% CIs for cancer risks in men and women, adjusted for potential confounders, including age, BMI, smoking, physical activity, the Healthy Eating Index 2015 score, and use of single-vitamin/-mineral supplements. Results A slightly higher overall cancer risk was observed in men (but not women) who consumed 1 or more multivitamins daily compared to nonusers [HRs, 1.02 (95% CI: 1.01–1.04) and 1.03 (95% CI: 1.00–1.07), respectively; P-trend = 0.002]. The latter reflected higher risks for prostate cancer (HR, 1.04; 95% CI: 0.98–1.10; P-trend = 0.005), lung cancer (HR, 1.07; 95% CI: 0.96–1.20; P-trend = 0.003), and leukemia (HR, 1.26; 95% CI: 1.02–1.57; P-trend = 0.003). Taking more than 1 multivitamin daily was also strongly positively associated with the risk of oropharyngeal cancer in women (HR, 1.53, 95% CI: 1.04–2.24; P-trend < 0.0001). By contrast, daily multivitamin use was inversely associated with the colon cancer risk in both sexes (HR, 0.82; 95% CI: 0.73–0.93; P-trend = 0.0003). Conclusions We found little evidence to support a cancer-preventive role for multivitamin use, with the exception of colon cancer, in both sexes in the NIH-AARP Diet and Health Study. In addition, slightly higher risks of overall, prostate, and lung cancer, as well as leukemia, were observed for greater multivitamin use in men, with a higher oropharyngeal cancer risk in women.

The Effects of Chemotherapy on Circulating Plasma Carotenoids and Fat-Soluble Vitamins in Breast Cancer Patients

Objectives Chemotherapy upregulates inflammatory processes as measured by circulating concentrations of pro-inflammatory cytokines and their signaling lipids. Our objective was to observe if breast cancer chemotherapy influenced the circulating concentrations of provitamin A and non-provitamin A carotenoids and fat-soluble vitamins (FSVs) in free-living patients. Methods Serum samples were collected from patients (n = 34) immediately prior to standard adjuvant and neo-adjuvant chemotherapy for breast cancer, and 4 months following chemotherapy commencement. Patient multivitamin and non-steroidal anti-inflammatory (NSAID) drug use was noted at both visits. Lipophilic extracts of serum were analyzed using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) to quantify α- and β-carotene, lycopene, lutein, zeaxanthin, β-cryptoxanthin, retinol, α-tocopherol and phylloquinone. Linear mixed models were developed to assess the relationship between the main factors (i.e., chemotherapy, multivitamin, and NSAID use), and their interaction effects, on serum carotenoid and fat-soluble vitamin concentrations. Random effects included a fixed intercept for each subject. Results Chemotherapy was significantly associated with reduced serum concentrations of α-carotene (P = 0.053) and retinol (P = 0.042), with a trend observed for reduced β-carotene (P = 0.076) and phylloquinone (P = 0.082). There was no main effect of multivitamin or NSAID use on any analytes investigated. An interaction effect was observed for chemotherapy * multivitamin use, with increased concentrations of serum retinol (P = 0.004) and lycopene (P = 0.004), and a trend observed for zeaxanthin (P = 0.087) for those who took multivitamins. Chemotherapy * NSAID use was also significantly associated with a trend in increased serum lutein (P = 0.061) for those who consumed NSAIDS. Conclusions Our results suggest randomized, controlled trials of multivitamin use and/or provitamin A carotenoid-rich food consumption merit further investigation in patients undergoing chemotherapy treatment. Funding Sources This research was supported by The Ohio State University Stefanie Spielman Breast Cancer Center Kroger Fund, Pelotonia, NIH R01CA189947, NIH Award Number Grant P30 CA016058, OSU, and OSUCCC.

A Case of Eccrine Chromhidrosis Due to Multivitamin Use

Chromhidrosis is a rare condition with a characteristic presentation of the secretion of colored sweat by apocrine or eccrine sweat glands. Eccrine chromhidrosis may occur by some water-soluble dyes in the systemic circulation, as a result of drug metabolism such as quinine, bisacodyl, clofazimine etc. or due to contamination of micro-organisms and rarely hyperbilirubinemia. The first and most important step for diagnosis of eccrine chromhidrosis is clinical evaluation. In the treatment of chromhidrosis, the suspected dye or drug should be eliminated from the body. This case report describes a patient who was diagnosed with eccrine chromhidrosis as a result of drug metabolism. The patient presented to the outpatient family medicine clinic of Ibn-i Sina Hospital with a complaint of blue sweating. Keywords: eccrine glands, vitamins, sweating, family practice

First‐Trimester Maternal Folic Acid Supplementation Reduced Risks of Severe and Most Congenital Heart Diseases in Offspring: A Large Case‐Control Study

Background Maternal folic acid supplementation (FAS) reduces the risk of neural tube defects in offspring. However, its effect on congenital heart disease (CHDs), especially on the severe ones remains uncertain. This study aimed to assess the individual and joint effect of first‐trimester maternal FAS and multivitamin use on CHDs in offspring. Methods and Results This is a case‐control study including 8379 confirmed CHD cases and 6918 controls from 40 healthcare centers of 21 cities in Guangdong Province, China. Adjusted odds ratios (aORs) of FAS and multivitamin use between CHD cases (overall and specific CHD phenotypes) and controls were calculated by controlling for parental confounders. The multiplicative interaction effect of FAS and multivitamin use on CHDs was estimated. A significantly protective association was detected between first‐trimester maternal FAS and CHDs among offspring (aOR, 0.69; 95% CI, 0.62–0.76), but not for multivitamin use alone (aOR, 1.42; 95% CI, 0.73–2.78). There was no interaction between FAS and multivitamin use on CHDs ( P =0.292). Most CHD phenotypes benefited from FAS (aORs ranged from 0.03–0.85), especially the most severe categories (ie, multiple critical CHDs [aOR, 0.16; 95% CI, 0.12–0.22]) and phenotypes (ie, single ventricle [aOR, 0.03; 95% CI, 0.004–0.21]). Conclusions First‐trimester maternal FAS, but not multivitamin use, was substantially associated with lower risk of CHDs, and the association was strongest for the most severe CHD phenotypes. We recommend that women of childbearing age should supplement with folic acid as early as possible, ensuring coverage of the critical window for fetal heart development to prevent CHDs.

Predictors of Insufficient Preconception Multivitamin Use: An IMPLICIT Network Study

Introduction: Adequate maternal nutrition before pregnancy is important to reduce the risk of poor birth outcomes. However, patients report suboptimal intake of multivitamins with folic acid (MVIs). Methods: We conducted a quality improvement study to identify predictors of insufficient multivitamin use in women of childbearing age at five University of Pittsburgh Medical Center (UPMC) family health centers that implemented the IMPLICIT interconception care (ICC) model of maternal health screenings during well-child visits (WCVs). We derived this analysis from a retrospective chart review of patient-reported demographic information and physician documented maternal behaviors of 758 women who accompanied their children to 2,706 total well-child visits. Insufficient multivitamin use was defined as having one or more visits where the mother reported that she was not taking multivitamins. Results: Insufficient multivitamin use at these health centers was associated with younger age (OR 0.96, 95% CI 0.92, 0.98), less than high school education (OR 3.3, 95% CI 1.56-6.80), public insurance (OR 1.56, 95% CI 1.05-2.34), and increased number of well-child visits attended (OR 1.46, 95% CI 1.31-1.61). Conclusion: Among women who received screening, younger, low-income, and less educated women are likely to benefit from targeted interventions to improve multivitamin use during the interconception period. Findings also suggest that WCVs are a viable access point to assess and address multivitamin use and other desired maternal health behaviors.

Abstract P519: Multivitamin Use And Arterial Stiffness In Older Women And Men

Introduction: A multivitamin (MV) is the most commonly taken supplement in older U.S. adults. Arterial stiffness is an important intermediate marker of cardiovascular disease (CVD). However, few studies have examined the association of MV use and arterial stiffness. Hypothesis: Regular multivitamin use is associated with lower levels of arterial stiffness. Methods: A subcohort of participants enrolled in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), a large scale randomized clinical trial testing a MV and a cocoa extract supplement on CVD and cancer, completed baseline measurement of arterial stiffness assessed by pulse wave velocity (PWV), augmentation index (AI), and central blood pressure (CBP). Frequency and duration of MV use was assessed via self-report questionnaire at baseline. The cross-sectional association of MV use and arterial stiffness was evaluated by multivariate linear regression with adjustment for conventional CVD risk factors. We also performed subgroup analyses to evaluate effect modification between MV use and sex, age, body mass index (BMI), and hypertension. Results: A total of 470 (229 women and 241 men) COSMOS participants were included in this study, with mean age 69.1±5.2 years, of whom 150 (32%) reported current MV use at baseline. Multivariate linear regression analysis revealed that current MV use (yes versus no) was significantly associated with lower PWV (β:-0.59±1.02, p=0.004) but not associated with other measures of arterial stiffness, including AI or CBP. There were also no consistent associations between frequency and duration of MV use with any of the measures of arterial stiffness. Also, there was no effect modification by sex, age, BMI, or hypertension on the association between MV use and arterial stiffness. Conclusions: MV use was associated with lower PWV in older subjects. Further results from the COSMOS trial on randomized MV supplementation and changes in arterial stiffness over 2 years will further elucidate the effects of MV on arterial stiffness.

Multivitamins and Nutritional Adequacy in Middle-Aged to Older Americans by Obesity Status

Multivitamins are the most commonly consumed dietary supplement in the United States and worldwide. Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults, and multivitamin use has been shown to improve status in this population. This analysis aimed to assess contributions of sporadic and consistent multivitamin use to total usual micronutrient intakes and associated nutritional biomarkers among middle-aged to older U.S. adults age 351 years, stratified by obesity status. Self-reported dietary intake and laboratory measures from the National Health and Nutrition Examination Survey were used in these analyses. The National Cancer Institute method was used to assess usual intakes of 18 micronutrients. Compared with food alone, multivitamin use was associated with a lower prevalence of inadequacies and improved nutritional biomarker status for folate, iodine, selenium, and vitamins B6, B12, and D. Consistent use decreased the prevalence of inadequacy for most micronutrients assessed, except for those micronutrients typically not found (or in miniscule amounts) in standard multivitamin products. In addition to a lower prevalence of inadequacy for many micronutrients associated with consistent use of multivitamins, sporadic use decreased the prevalence of inadequacy for a greater number of micronutrients in obese versus nonobese individuals. Multivitamin use (sporadic and consistent) also increased the proportion of individuals who exceeded the tolerable upper intake level for folic acid to 8–10%. Nutritional biomarker data indicate that obese individuals may be at greater risk of clinical deficiency in vitamins B6and D. Use of gender- and age-specific multivitamins may serve as a practical means to increase micronutrient status and decrease prevalences of clinical deficiency in the middle-aged to older population, particularly in those who are obese.