Changes in Dietary Supplement Use Among Children and Adolescents in the United States, 2015–2016 to 2021–2023

Dietary supplements, often implicated in preventable adverse drug events, are also a leading cause of morbidity and mortality from poisonings in children and adolescents in the United States.1,2 In a prior study, we found that one-third of children and adolescents used dietary supplements and that the use of alternative medicines increased between 2003 and 2014.2 Despite substantial growth in the dietary supplement market,3 and recent evidence of the harmful effects of supplements on children and adolescents,4 current data on their use in younger US populations are lacking. We used nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of dietary supplement use, including both nutritional products and alternative medicines, among children and adolescents in the United States.We analyzed the 3 most recent cycles (from 2015–2016, 2017–2020, and 2021–2023) of NHANES for a sample of children and adolescents (aged 0–19 years) who participated in the dietary supplement questionnaire. Detailed information on data collection has been previously described.3 In summary, participants were asked whether they had “used or taken any vitamins, minerals, herbals, or other dietary supplements in the past 30 days.” Information on supplement categorization is provided in the Supplemental Methods.We used descriptive statistics to estimate the prevalence of dietary supplement use by age group in each of the 3 NHANES cycles. We also analyzed the prevalence in the use of the most commonly used supplements by age group and sex. For these analyses, we pooled the first 2 cycles (2015–2016 and 2017–2020) and compared with the most recent cycle (2021–2023). All prevalence estimates were based on Taylor linearization methods that include weights to account for the complex survey design. Analyses were conducted using R statistical software (version 4.4.2). All P values reported are 2-sided. The study was considered exempt by the University of Southern California Institutional Review Board.During our study period (2015–2023), of the 12 528 individuals aged 0 to 19 years whose dietary supplements data were analyzed, 4536 (36.2%) were younger children aged 0 to 5 years, 4459 (35.6%) were older children aged 6 to 12 years, and 3533 (28.2%) were adolescents aged 13 to 19 years. Similar to 2015–2016, 35.2% (95% CI, 31.2%–38.8%) of children and adolescents used dietary supplements in 2021–2023 (Figure 1A). Although the use of nutritional products did not change between 2015–2016 and 2021–2023 (from 32.5% to 32.9%, respectively), the use of alternative medicines increased (from 3.0% vs 4.2%; P = .19). In 2021–2023, the use of any dietary supplements, particularly nutritional products, was greater in boys than in girls in both younger and older children (Figure 1B). During adolescence, the use of any dietary supplement (36.2% vs 25.3%; P < .01), specifically nutritional products (38.7% vs 28.7%; P < .05), was significantly greater in girls than in boys. Alternative medicine use was similar among adolescents but was higher in girls than in boys aged 0 to 5 years (4.5% vs 1.0%; P < .01).While multivitamins/minerals were persistently used by 1 in 5 children and adolescents between 2015–2020 and 2021–2023 (Table 1), there were notable increases in single vitamins, including vitamin D (from 3.0% to 5.0%; P = .02), zinc (from 1.0% to 2.6%; P < .001), and iron (from 0.8% to 2.0%; P = .003). Increases in the use of alternative medicines was driven by increases in the use of melatonin (1.4% vs 2.5%; P = .03), probiotic (0.7% vs 1.5%; P = .02), and fiber (1.3% vs 2.7%; P = .004) supplements. These trends varied across age groups, with the most pronounced sex differences observed during adolescence. For example, iron, zinc, probiotics, and weight-loss supplements were increasingly used among adolescent girls, whereas adolescent boys were more likely to use melatonin and bodybuilding supplements.In this recent nationally representative study, approximately one-third of children and adolescents continue to use dietary supplements in the United States. Many commonly used nutritional supplements (eg, multivitamins/minerals, iron, calcium) and alternative medicines (eg, weight loss, bodybuilding) are implicated in adverse drug events and poisonings in younger populations.1–4 Despite limited evidence of their safety and effectiveness,5 the most pronounced increases were observed for alternative medicines, specifically probiotics and fiber supplements, which may be due to increased awareness of their benefits in the management of gastrointestinal symptoms.6 The increase in melatonin use, which is often promoted for sleep, is an important safety concern given substantial increases in emergency department visits related to melatonin ingestions in pediatric populations7 and evidence that melatonin content often exceeds labeled quantity.8 Increases in the use of vitamin D and zinc may reflect heightened parental awareness about their potential benefits in immune and cardiovascular health, whereas the growing use of iron supplements, particularly in adolescent girls, may be due to the increased prevalence of iron deficiency anemia.9Increasing awareness of the risks associated with the growing use of weight-loss and bodybuilding supplements is particularly important as they are the most frequently implicated supplements in adverse events, including fatal, in adolescents in the United States.4