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USPSTF rejects beta carotene, vitamin E for CVD, cancer prevention
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Current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamins for the prevention of CVD or cancer, according to the US Preventive Services Task Force.
In its first update on the topic since 2003, the task force concluded that beta carotene and vitamin E, specifically, do not reduce the risk for CVD or cancer. According to the panel, current evidence is inadequate to demonstrate that beta carotene supplementation increases the risk for lung cancer in at-risk individuals. The US Preventive Services Task Force (USPSTF) also concluded that vitamin E supplementation is associated with little or no significant harm. Therefore, it stated that the net benefit of beta carotene supplementation is negative and the net benefit of vitamin E supplementation is zero.
“The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer,” the statement written by Virginia A. Moyer, MD, MPH, and colleagues reads.
The recommendations apply to healthy individuals without special nutritional needs. The recommendations do not apply to children, women who are pregnant or may become pregnant, those who are chronically ill, patients who are hospitalized and people with a known nutritional deficiency.
The appropriate intake of vitamins and minerals is essential to overall health, but the task force noted that the 2010 Dietary Guidelines for Americans written by the US Department of Agriculture and US Department of Health and Human Services suggested that nutrients should primarily come from foods.
“Adequate nutrition by eating a diet rich in fruits, vegetables, whole grains, fat-free and low-fat dietary products, and seafood has been associated with a reduced risk for [CVD] and cancer,” Moyer and colleagues wrote.
Significant research gaps remain, according to the statement. For example, two randomized controlled trials suggest that multivitamin supplements have a potential cancer prevention benefit in men, but “future trials should be more representative of the general population … and have enough power to demonstrate whether there are true subgroup differences.”
Challenges persist in the study of nutrients using the same rigor as the study of drugs, so “new and innovative research methodologies for examining effects of nutrients that account for the unique complexities of nutritional research but maintain rigorous designs should be explored,” the task force wrote. It can also be challenging to extrapolate results from clinical trials to the general population because “considerable variability likely exists in the content and concentration of ingredients in commercially available formulations.”
There were not enough data to adequately assess the balance of benefits and harms for CVD or cancer prevention on vitamin A, vitamin C, vitamin D with or without calcium, selenium and folic acid, according to the statement.
This statement updates the 2003 USPSTF recommendation, which concluded that evidence was insufficient to recommend for or against use of vitamins A, C or E, multivitamins with folic acid, or antioxidant combinations for the prevention of CVD or cancer. The task force then recommended against the use of beta carotene supplements alone or in combination for the prevention of CVD or cancer. For the new recommendation, the USPSTF considered additional evidence on nutritional supplements, including vitamin D, vitamin E, calcium, selenium and folic acid.
Disclosure: The task force members report no relevant financial disclosures.
Perspective
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C. Noel Bairey Merz, MD, FACC, FAHA
I agree with the recommendations, and the new statement will not change the way I practice because I have ascribed to this advice for many years. This is a careful review of existing clinical trial data in humans asking if vitamin supplements prevent disease or prolong life, which found no vitamin worth recommending and two vitamins, beta carotene and vitamin E, that should not be consumed. The good news is that other than beta carotene, there does not appear to be harm. The bad news is that there also does not appear to be benefit, so the old saying that Americans have the most expensive urine in the world due to our relatively high consumption of vitamins appears to remain true.
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