Source: United States Preventive Services Task Force (USPSTF) and JAMA

What is this about?

This edition of Connections newsletter provides a copy of 3 articles and a patient education insert in this week’s online JAMA publications. The 4 articles have been combined into one PDF and include:

• The USPSTF issuance itself
• An explanatory article with summaries of data findings for physicians
• An objective analysis of the pro’s and con’s of the recommendations
• An educational insert for patients/employees about the recommendations

This new issuance of recommendations from USPSTF covers vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.  Cardiovascular diseases and cancer accounts for slightly more than half of all annual deaths in the U.S. each year.  Approximately half of the U.S. adult population that have been surveyed by the National Center for Health Statistics (NCHS) indicate they had used at least one dietary supplement in the previous 30 days. Dietary supplements constitute a $50 billion industry in the U.S. The recommendations of the USPSTF include the balance of harms and benefits of the preventive practice under review.

The summary of the main recommendations from the USPSTF are:

Population Characteristics	Recommendations of USPSTF	Strength of Evidence**
Community-dwelling nonpregnant adults*	The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer.	“D”
Community-dwelling nonpregnant adults	The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer. See the Practice Considerations section for additional information regarding the “I” statement.	“I”
Community-dwelling nonpregnant adults	The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single – or pared-nutrient supplements (other than beta carotene and vitamin E for the prevention of cardiovascular disease or cancer. See the Practice Considerations section for additional information regarding the “I” statement.	“I”

* = This means adults that are not institutionalized and not pregnant.

** = “D” means enough evidence to recommend against,  “I” means insufficient evidence to recommend for its use.

Why is this important?

These 3 articles and an educational insert combined into one PDF document are important because they provide an in-depth explanation of the research methodology and scientific conclusions concerning the use of vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer. The practice of dietary supplementation is a huge industry and I believe is used by a significant portion of American adults as a substitute for adopting healthy lifestyle choices.  “Denial” is not just a river in Africa.  The economic ramifications and behavior change implications of dietary supplementation are likely to be enormous and pivotal to adoption of healthy behaviors by individual employees and their family members.

What can you do with this document?

• First, the PDF answer the questions…”Can some portion of our national heart disease and cancer deaths be prevented by selected dietary supplement use? And “What specific dietary supplement (i.e., beta carotene or Vitamin E) should be avoided?”
• Next, skim the 4 document for the major findings that are particularly relevant to your organization and population.
• Next, determine what specific uses you might put this information to and the communication channels that might be used, particularly the 4^th document which is a patient/employee education piece.
• Next, examine the role that the covered dietary supplements play in your wellness program targeting and interventions and consider introducing this information while pointing out the confirmed health effects of regular physical activity and sound nutrition practices.
• Next, if you choose to hold an educational session on recommended dietary supplement strategies use it to help people review the objective evidence for various practices and explain how powerful the placebo effects are in all of us.
• Finally, periodically examine the dietary supplement issues of your work force and consider whether additional program interventions and activities are needed.

In summary, this evidence-based set of recommendations on selected dietary supplement use is an important new finding that has significant economic and behavioral implications for all working populations.

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I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.