May 23, 2019

K.J. Ford.1, D.J. Jorgenson 2, E.J.L. Landry 3, S.J. Whiting1

1 College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon SK
2 College of Pharmacy & Nutrition & Medication Assessment Centre, University of Saskatchewan, Saskatoon SK
3 Medication Assessment Centre, University of Saskatchewan, Saskatoon SK

Vitamin and mineral supplements have been available for decades. Individuals who take multiple medications and those who are at risk for low nutritional intake from food, may benefit from using these types of supplements. On the other hand, too much nutrient supplementation can lead to over supplementation, that is, daily intake exceeds the tolerable upper intake level (UL). This over supplementation poses a risk of adverse effects such as kidney stone formation from excessive supplemental calcium (Ross et al. 2011).

The purpose of our study was to assess personal vitamin and mineral supplement use of adults, 50 years of age and older, who were referred (by a physician or self) for a medication assessment at the University of Saskatchewan Medication Assessment Centre between 2014-2017. Over 200 individuals were included in this study, of which 75% reported taking one or more supplements daily, regardless of age or sex. Of those using supplements, 39.8% exceeded the UL for one or more micronutrients. Over supplementation was associated with intake of more than one of type of supplement per day. Due to the complex medical profile of these patients (mean medication use was 6.5, excluding any supplements), intake exceeding the UL may put them at increased risk for adverse health effects such as kidney stones from calcium (Otten et al. 2006).

While use of certain vitamin and mineral supplements may be justified in this population (e.g., vitamin D in adults over 50 years of age or younger adults at risk of osteoporosis), high intakes of some nutrients revealed that risk of over supplementation was possible while little evidence of benefit was seen. That is, intake of certain vitamins or minerals was not related to any reported condition of the patient. Interestingly, despite recommendations for vitamin D supplementation in older adults (400 IU/day), only 64.6% of patients assessed reported supplementing adequately. Contrarily, niacin is not a nutrient of concern for this age group but was taken in excess by 14.7% of supplement users, which could trigger adverse reactions such as flushing (Otten et al. 2006).

Specialized knowledge in dietary intake and the role of supplements in achieving recommended intakes should be integrated into patient care. Our findings highlight the importance of a multidisciplinary team approach to complex medication and supplement assessments. Assessing vitamin and mineral supplement use should be part of both nutrition and medication assessments.

Summary of Key Points:

  • Over consumption of supplements is common in medically-complex older adults.
  • Practice support tools should be developed so that selection of vitamin and mineral supplements is targeted for health needs of older adults.
  • Improved interdisciplinary collaboration between health care providers could help streamline supplement use in older adults with complex medical profiles.

Original Article:

Ford KL, Jorgenson DJ, Landry EJL, Whiting SJ. Vitamin and mineral supplement use in medically complex, community-living, older adults. Appl Physiol Nutr Metab. Published on the web 10 January 2019,

This article is a summary of an article published in Applied Physiology, Nutrition and Metabolism. If you intend to cite any information in this article, please consult the original article and cite that source. This summary was written for the Canadian Society for Exercise Physiology and it has been reviewed by the CSEP Knowledge Translation Committee.