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This article was originally published in The Tan Sheet

Executive Summary

VITAMIN SUPPLEMENTATION "MAY BE BENEFICIAL" TO LARGE SEGMENT OF POPULATION at the Recommended Dietary Allowance level, Meir Stampfer, MD, and Walter Willett, MD, suggested in an editorial in the Dec. 8 issue of the Journal of the American Medical Association. The editorial writers acknowledged that "most individuals consuming five servings of fruits and vegetables per day (a minority of Americans) would not benefit from supplement use." However, 11 pending results from randomized trials," Stampfer and Willett suggested that vitamin supplementation at the RDA level may be beneficial for the large segment of of the U.S. population not meeting dietary goals, and in particular elderly persons and women of childbearing age." The editorial by Stampfer and Willett responds to a study by Jacob Selhub, PhD, Tufts University, et al. appearing in the same issue of JAMA that found an inverse correlation between plasma levels of vitamins B[6], B[12] and folate and homocysteine levels in elderly subjects. Stampfer and Willett co-authored a study published in JAMA last year that found an association between high plasma levels of homocysteine and an increased risk of myocardial infarction. The editorial writers contended that "given the realities of U.S. diets, uncertainty about the timing and effectiveness of folate fortification, and the low cost and apparent absence of toxic effects of standard RDA-level multivitamins, a reasonable argument can be made for recommending such supplements for many individuals." Calling the Selhub study findings "striking," Stampfer and Willett said the study provides "further evidence that suboptimal intake of several vitamins is common, even in a population enrolled in a long-term health study." Furthermore, they added, "homocysteine elevations were not limited to a small subgroup with extremely low intake" in the Selhub study. Stampfer and Willett pointed out that the homocysteine concentration "nadir" was not reached until vitamin B[6] "approximated the RDA (2 mg/d for men, 1.6 mg/d for women), but half the [study] populations had levels lower than this." Similarly, the "nadir" was not reached until folate intake approached "about 400 mcg/d," well above RDA levels. The authors contended that "these observations support the restoration of 400 mcg/d as the RDA, which was the RDA level until recently." "Several investigators have demonstrated that elevated levels of homocysteine can often be normalized with nutritional supplements, particularly folate," the editorial writers pointed out. Concluding that "low [vitamin] intakes are associated with serious health consequences" beyond simple deficiency diseases, Stampfer and Willett maintained that "although the benefits of such supplements have not been proved, except for reducing neural tube defects, physicians must often weigh risks and benefits in the absence of complete information." The editorial calls for "randomized, placebo-controlled trials of primary and secondary prevention among persons with elevated levels of homocysteine," saying that both would be "quite feasible," though "trials of secondary prevention would be simpler because a smaller sample size would be needed."

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