General Medicine · Medical Literature
US Dietary Supplement Use Increasing, Especially in Older Adults
Abstract
Dietary supplement use in the US increased from 1999 to 2023, according to a study published in JAMA Network Open.
Clinical relevance
This cross-sectional analysis of 25-year NHANES trend data (1999–2023) addresses a critical surveillance gap regarding the evolving landscape of dietary supplement use across the U.S. adult population. The study is particularly relevant now given that the global supplement market is valued at nearly $200 billion and projected to double by 2033, and because older adults—who bear the highest burden of polypharmacy and multimorbidity—are the fastest-growing segment of supplement users. Clinicians in general medicine, geriatrics, and primary care should be aware of these trends to proactively screen for supplement use, counsel patients appropriately, and evaluate potential drug-supplement interactions.
Key findings
1. Overall dietary supplement use among U.S. adults increased from 51% to 60% between 1999 and 2023, representing a net 9-percentage-point rise over 25 years. 2. The most pronounced increase was observed in adults aged 65 and older, in whom use rose from 62% to 78%—the largest demographic gain identified in the study. 3. Vitamin D use surged dramatically, rising from approximately 5% of adults in 1999 to 29% in 2023; omega-3/fish oil use rose from approximately 2% to 14% over the same period, reflecting a shift toward targeted supplementation. 4. Multivitamin-multimineral (MVMM) use declined over the study period, while use of individual vitamins, minerals, and nonvitamin-nonmineral (NVNM) supplements—including botanicals and products marketed for immune support—increased, indicating a trend toward personalized supplementation strategies. 5. Supplement use was more prevalent among women, individuals with higher income or education, and those with health insurance, highlighting sociodemographic disparities in access and utilization. 6. A pandemic-era spike in supplement use (particularly immune-support products, vitamins, and minerals) was observed during prepandemic and early-pandemic years, which attenuated in later-pandemic and postpandemic periods. NOTE: Specific confidence intervals, p-values, and NNT/NNH were not available in the accessible abstract or reporting; quantitative estimates above are derived from reported proportions.
Practice implications
Clinicians should routinely and explicitly query all patients—particularly adults aged 65 and older with polypharmacy or chronic disease—about dietary supplement use, as nearly 4 in 5 older adults now report current use and only 1 in 4 products is taken under healthcare professional guidance. Given the documented shift away from multivitamins toward targeted supplements such as high-dose vitamin D and omega-3 fatty acids, providers should assess specific products, doses, and indications to counsel patients on evidence-based benefits (e.g., vitamin D in deficiency states, omega-3 for hypertriglyceridemia) versus unsupported uses, and to screen for clinically significant drug-supplement interactions (e.g., omega-3 with anticoagulants, botanicals with cytochrome P450 substrates). Institutional efforts to update medication reconciliation workflows to systematically capture supplement use are warranted, particularly for older adults where the risk of supplement-drug interactions is highest.