Dietary supplements are products containing nutrients sold in various medicinal forms, and their widespread use may stem from the conviction that a preparation that looks like a drug must have therapeutic properties. The aim of this scoping review is to present what is known about the effects of using selected dietary supplements in the context of chronic diseases, as well as the risks associated with their use. The literature shows that the taking of vitamin and mineral supplements by healthy people neither lowers their risk of cardiovascular diseases nor prevents the development of malignancies. Many scientific societies recognize that omega-3 fatty acids lower blood triglycerides, but whether taking them prevents heart disease is less clear-cut. Taking weight loss supplements is not an effective method of fighting obesity. Often, some supplements are increasingly sold illegally, which is then also associated with the higher risk that they may be adulterated with banned substances, thus making them even more dangerous and potentially life-threatening. Supplements are necessary in cases of nutrient deficiency; however, even though prescription is not required, their use should be recommended and monitored by a physician.
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Authors | Study Design | Participants | Type of Dietary Supplements | Duration of the Study | Results |
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Authors | Study Design | Participants(n) | Type of Dietary Supplements | Duration of the Study | Results | ||||||
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The ASCEND Study Collaborative Group 2018 [22] | RCT | ||||||||||
Onakpoya et al., 2013 [110 | 15,480 patients with diabetes aged ≥ 40 years | Omega-3 fatty acids | Mean: 7.4 years | No effect on serious vascular events | |||||||
] | Meta-analysis, 20 RCTs | 1038 | Chromium | 8–26 weeks | 0.5 kg more weight loss as compared with placebo | Manson et al., 2019 [23] | RCT | 25,871 patients aged ≥ 50 years | Omega-3 fatty acids | Median: 5.3 years | No effect on cardiovascular events |
Tsang et al., 2019 [111] | Meta-analysis, 21 trials | 1316 | Chromium | ≤12 weeks | 0.75 kg more weight loss as compared with placebo | Bhatt et al., 2019 [24] | |||||
Moraru et al., 2018 [113] | Meta-analysis, 14 RCTs | 1101 | Chitosan | ||||||||
Median: 7.0 years | |||||||||||
13% increase in heart failure | |||||||||||
4–52 weeks | 1.01 kg more weight loss as compared with placebo | ||||||||||
Wang et al., 2019 [ | |||||||||||
71 | |||||||||||
] | |||||||||||
Mendelian randomization study | |||||||||||
7781 participants | |||||||||||
Vitamin E | |||||||||||
No data | |||||||||||
Genetically determined higher blood levels of vitamin E increases the risk of CAD and MI, increases the concentration of LDL cholesterol and triglycerides, decreases HDL cholesterol concentration | |||||||||||
Schwingshackl et al., 2017 [13] | Meta-analysis, 49 RCTs | 287,304 participants | Vitamins and minerals | 1.0–11.2 years | 12% reduction in cardiovascular mortality with vitamin E supplementation; no beneficial effect from other vitamin/mineral supplementation |
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Kim et al., 2018 [60] | Meta-analysis, 18 clinical trials and prospective cohort studies | 2,019,862 participants | Multivitamins and minerals | 5.0–19.1 years | No effect on cardiovascular mortality, CHD mortality, stroke mortality, stroke incidence | ||||||
Li et al., 2018 [52] | Meta-analysis, 12 RCTs | 23,207 patients aged 21.9–64.7 years | Multivitamins and minerals | 1.0–86.4 months | No effect on risk of hypertension; significant reduction of systolic BP in subjects with hypertension | ||||||
Khan et al., 2019 [61] | An umbrella review: 9 systematic review, 4 RCTs, 105 meta-analyses | 992,129 participants | Multivitamins and antioxidants | No data | No effect on cardiovascular diseases outcomes | ||||||
Loffredo et al., 2015 [73] | Meta-analysis, 16 RCTs | Up to 39,876 patients aged > 50 years | Antioxidants | 0.5–9.4 years | 18% reduction in MI with vitamin E supplementation | ||||||
Vivekananthan et al., 2003 [72] | Meta-analysis, 32 RCTs | 81,788 patients | Vitamin E, beta- carotene | 1.4–12.0 years | No effect from supplementation of vitamin E on cardiovascular mortality, cerebrovascular events; significant increase in cardiovascular death with beta-carotene supplementation |
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Poorolajal et al., 2017 [53] | Meta-analysis, 23 RCTs | 1213 patients with hypertension, mean age: 19–75 years | Potassium | 4–52 weeks | Significant reduction of systolic and diastolic BP | ||||||
Filippini et al., 2020 [54] | Meta-analysis, 32 RCTs | 1764 patients mainly with hypertension aged 18–79 years | Potassium | 4–15 weeks | Significant reduction of systolic and diastolic BP |
Authors | Study Design | Participants | Type of Dietary Supplements | Duration of the Study | Results | |||||||||||
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Omenn et al., 1996 [80] | RCT | 18,314 smokers | Beta-carotene and vitamin A | Mean: 4 years | 28% increase in lung cancer incidence | |||||||||||
Albanes et al., 1996 [81] | RCT | 29,133 smokers aged 50–69 years | Beta-carotene, vitamin E | Median: 6.1 years | 16% increase in lung cancer incidence with beta-carotene supplementation; no effect on lung cancer incidence with vitamin E supplementation. |
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Lee et al., 2005 [ | RCT | 698179 patients with cardiovascular diseases or diabetes, median age: 64 years | Purified EPA ethyl ester (icosapent ethyl) | ]Median: 4.9 years | RCT25% reduction in primary endpoints: cardiovascular death, non-fatal MI, non-fatal stroke, coronary revascularization, unstable angina; | 39,876 healthy women aged ≥ 45 years | Vitamin E |
Mean: 10.1 years26% reduction in secondary endpoints: cardiovascular death, non-fatal MI, non-fatal stroke | ||||||||
No effect on cancer incidence | Nicholls et al., 2020 [27] | |||||||||||||||
Gaziano et al., 2009 [77 | RCT | ] | RCT13,078 patients with high cardiovascular risk, mean age: 62.5 years | Omega-3 fatty acids | Over 3 years | No effect on major cardiovascular events | ||||||||||
14,641 men aged ≥ 50 years | Vitamin E, vitamin C | Mean: 8.0 years | No effect on cancer incidence | Rizos et al., 2012 [29] | Systematic review and meta-analysis, 20 RCTs | |||||||||||
Huang et al., 2020 [115] | Meta-analysis, 15 RCTs | 1130 | Chitosan | ≥12 weeks | 0.89 kg more weight loss, 0.39 kg/m2 more BMI loss, and 0.69% more body fat loss as compared with placebo | Klein et al., 2011 [78]68,680 patients aged 49–70 years | Omega-3 fatty acids | Median: 2.0 years | No effect on cardiac death, MI, and stroke | |||||||
RCT | 34,887 men aged ≥50 years | Vitamin E, selenium | ||||||||||||||
Baladia et al., 2014 [116 | 7.0–12.0 years | ] | Meta-analysis, 5 RCTs | 260 | Green tea, green tea extract17% increase in prostate cancer incidence with vitamin E supplementation; | 12 weeks no effect on prostate cancer incidence with selenium supplementation |
No effect on body weight | Kotwal et al., 2012 [30] | Meta-analysis, 20 RCTs | 62,851 patients in primary and secondary prevention settings | ||||||
Lin et al., 2020 [117] | Omega-3 fatty acids | 6 months–6 years | ||||||||||||||
Park et al., 2011 [55] | 14% reduction in vascular death; | no effect on cardiovascular events, coronary events, cerebrovascular events, arrhythmia | ||||||||||||||
Cohort study | 182,099 patients aged 45–75 years | Multivitamins | Mean: 11 years | No effect on cancer incidence | Meta-analysis, 22 RCTs | 2357 | Green tea extract | 4–14 weeks | Kwak et al., 2012 [31] | Meta-analysis, 14 RCTs | 20,485 patients with cardiovascular diseases aged 40–80 years | Omega-3 fatty acids | 1.0–4.7 years | No effect on cardiovascular events, MI, congestive heart failure, and stroke | ||
1.78 kg more weight loss and 0.65 kg/m | 2 | more BMI loss as compared with placebo | Ambrosone et al., 2019 [99] | Prospective study | 1134 patients with breast cancer | Antioxidants, multivitamins vitamin B12, iron, | ||||||||||
Onakpoya et al., 2011 [ | 6 months | 120] | 41% increased risk of recurrence with antioxidant supplementation both before and during chemotherapy; | no effect of multivitamins on survival outcomes; | Meta-analysis, 12 RCTs |
7062-fold decrease in the probability of disease-free survival for vitamin B12 supplementation both before and during chemotherapy; | hydroxycitric acid from Garcinia cambogia | 2–12 weeks 79% higher risk of recurrence with iron supplementation both before and during chemotherapy |
0.88 kg more weight loss as compared with placebo | Casula et al., 2013 [32] | Meta-analysis, 11 RCTs | 15,348 patients with cardiovascular diseases | Omega-3 fatty acids | 1.0–3.5 years | 32% reduction in cardiac death, 25% reduction in MI; no effect on stroke |
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Narita et al., 2018 [83] | Prospective study | 79,705 participants | Retinol, vitamin C, vitamin E, alfa- carotene, and beta-carotene | Mean: 5 years | ||||||||||||
Golzarand et al., 2020 [121] | 26% increase in lung cancer incidence in men with higher dietary retinol intake; | Meta-analysis, 8 RCTs | no associations with lung cancer incidence for vitamin C, vitamin E, alfa-carotene and beta-carotene intake | 530 | Garcinia cambogia | 8–12 weeks | 1.34 kg more weight loss, 0.99 kg/m2 more BMI loss, and 0.42% more body fat loss, 4.16 cm more loss of waist circumference as compared with placebo | Wen et al., 2014 [33] | Meta-analysis, 14 RCTs | 32,656 patients with CHD | ||||||
Van Gorkom et al., 2019 [96] | A systematic review, 19 trials | No data | Omega-3 fatty acids | <3 months–4.6 years | 12% reduction in death from cardiac causes, 14% reduction in sudden cardiac death | |||||||||||
Vitamin C | 1 week–12 months | |||||||||||||||
Stohs 2017 [123 | No positive effect of vitamin C supplementation on cancer patients | ] | Review 30 trials | 600 | Citrus aurantium extract | No data | No proven effect on body weight | Abdelhamid et al., 2018 [35] | Meta-analysis, 79 RCTs | 112,059 adults in primary and secondary prevention settings | Omega-3 fatty acids | |||||
Pais et al., 2013 [85] | 12–72 months | Little or no effect on cardiovascular mortality, CHD mortality, cardiovascular events, stroke, arrhythmia | ||||||||||||||
Meta-analysis, 20 RCTs | 268,590 participants | Antioxidants | No data | Aung et al., 2018 [34] | Meta-analysis, 10 RCTs | 77,917 high-risk patients | Omega-3 fatty acids | 1.0–6.2 years | No effect on CHD mortality, non-fatal MI, CHD events, major vascular events | |||||||
No effect on colorectal cancer incidence with antioxidant supplementation | ||||||||||||||||
Park et al., 2017 [79] | Meta-analysis, 14 RCTs | 147,383 participants | Antioxidants | 1.0–13.0 years | No effect on bladder cancer incidence with antioxidant supplementation | Mazidi et al., 2019 [36] | Meta-analysis, 13 RCTs | 127,447 patients | ||||||||
Cortés-Jofré et al., 2020 [ | Omega-3 fatty acids | 84] | Meta-analysis, 12 RCTs | 733–212,314 participants 35–84 years | AntioxidantsNo data | 9% reduction in CHD death, 5% reduction in major vascular event, 11% reduction in non-fatal MI, 5% reduction in all-cause mortality | ||||||||||
2.0–12.0 years | No beneficial effect on lung cancer incidence for combination of vitamins A, C, E + selenium + zinc supplementation; | 84% increase in lung cancer incidence in women with vitamin C supplementation; | 10% increase in lung cancer incidence in smokers and people with history of asbestos exposure with vitamin A supplementation | Hu et al., 2019 [37] | Meta-analysis, 13 RCTs | 127,447 patients, mean age: 64.3 years | Omega-3 fatty acids | |||||||||
Bjelakovic et al., 2014 [91] | 5 years | 8% reduction in MI, 8% reduction in CHD death, 5% reduction in total CHD, 7% reduction in CVD death, 3% reduction in total CVD | ||||||||||||||
Meta-analysis, 18 RCTs | 50,623 participants | Vitamin D | Mean: 6 years | No effect on cancer incidence; | 12% reduction in cancer death. |
Casula et al., 2020 [38] | Meta-analysis, 16 RCTs | |||||||||
Goulao et al., 2018 [89] | 81,073 participants | Omega-3 fatty acids | ≥1 year | 9% reduction in cardiac mortality, 10% reduction in major adverse cardiovascular events, 17% reduction in MI; | Meta-analysis, 30 RCTs more benefits were seen in secondary prevention |
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18,808 participants | Vitamin D | Median: 1,0–6.2 years | No effect on cancer incidence and mortality | Lombardi et al., 2020 [39] | Meta-analysis, 14 studies | 125,763 patients | Omega-3 fatty acids | Median: 4.6 years | ||||||||
Keum et al., 2019 [90] | 21% reduction in cardiac death, 29% reduction in MI, 26% reduction in coronary revascularization, 27% reduction in unstable angina, and 22% reduction in major vascular events—for high-dose omega-3 fatty acids (> 1 g per day); | 49% increase in bleeding events and 35% increase in atrial fibrillation events—for high-dose omega-3 fatty acids (> 1 g per day) | ||||||||||||||
Meta-analysis, 5–10 RCTs | 6537 cases | Vitamin D | 3–10 years | No effect on cancer incidence; | 13% reduction in cancer death |
Wang et al., 2009 [51] | RCT | 128 obese women aged 18–50 years with hypertension or/and hyperglycemia, and/or hyperlipemia | Multivitamins and minerals | 26 weeks | Significant reduction of systolic and diastolic BP | |||||
Park et al., 2011 [55] | Cohort study | 182,099 patients aged 45–75 years | Multivitamins | Mean: 11 years | No effect on mortality from cardiovascular diseases | |||||||||||
Sesso et al., 2012 [56] | RCT | 14,641 males aged ≥ 50 years | Multivitamins | 10.7–13.3 years | No effect on cardiovascular events, MI, stroke, cardiovascular disease mortality | |||||||||||
Rautiainen et al., 2016 [50] | Prospective cohort study | 28,157 women aged ≥ 45 years free of hypertension at baseline | Multivitamins | Mean: 11.5 years | No association with the risk of hypertension | |||||||||||
Albert et al., 2008 [57] | RCT | 5442 women with a history of cardiovascular diseases or three or more coronary risk factors aged ≥ 40 years | Folic acid, vitamin B6, vitamin B12 | 7.3 years | No significant effect on risk of major cardiovascular events | |||||||||||
Galan et al., 2010 [58] | RCT | 2501 patients with a history of ischemic heart disease or stroke, mean age: 60.9 years | Folic acid, vitamin B6, vitamin B12 | Median: 4.7 years | No significant effect on risk of major cardiovascular events | |||||||||||
Huo et al., 2015 [59] | RCT | 20,702 patients with hypertension, without a history of stroke or myocardial infarction aged 45–75 years | Enalapril, folic acid | Median: 4.5 years | 21% reduction in first stroke and 20% reduction in composite cardiovascular events | |||||||||||
Lee et al., 2005 [69] | RCT | 39,876 healthy women aged ≥ 45 years | Vitamin E | Mean: 10.1 years | No effect on MI, stroke; 24% reduction in cardiovascular death |
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Lonn et al., 2005 [70] | RCT | 9541 patients with vascular disease or diabetes | Vitamin E |