Use of dietary supplements lead to 23,000 emergency visits each year

Adverse events from dietary supplements cause an estimated 23,000 emergency department (ED) visits each year, which result in more than 2,100 hospitalizations annually, according to a study by researchers at the Centers for Disease Control and Prevention (CDC).

Dietary supplements include herbals (botanical products), complementary nutritionals (eg, amino acids), and micronutrients (vitamins and minerals), wrote the authors, whose study was published October 15, 2015 in the New England Journal of Medicine.

More than one quarter (28%) of ED visits attributed to supplement-related adverse events involved young adults (ages 20 to 34), with a mean age of 32. Weight-loss supplements and energy products caused more than half these visits, which commonly involved cardiac symptoms (palpitations, chest pain, or tachycardia), the researchers found.

Older adults (ages 65 and older) were more likely than younger adults to be hospitalized after ED visits related to supplements. Swallowing problems caused nearly 40% of these adverse events, with micronutrients implicated in more than 80% of ED visits.

Children who ingested dietary supplements without adult supervision accounted for one fifth (21%) of ED visits. Nearly two-thirds of these pediatric incidents involved micronutrients.

Researchers obtained these adverse event statistics from 10 years of data (2004 to 2013) taken from the 63 hospitals participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. The researchers used these data to extrapolate the adverse events associated with dietary supplements for the entire United States.

Since 1994, the estimated number of supplement products has increased from 4,000 to more than 55,000 in 2012 (the most recent year for which data are available). Although the numbers of ED visits and hospitalizations related to dietary supplements are a fraction of those reported for pharmaceutical products, “dietary supplements are regulated and marketed under the presumption of safety,” the researchers wrote.

Dietary supplement manufacturers are not required to undertake safety testing, demonstrate efficacy, obtain FDA approval, or provide evidence that label claims are not false or misleading to consumers. Post-marketing reporting is required only for serious adverse events.

In response to the study, a statement from the trade association for the dietary supplement industry argued that the findings should be considered in relation to the many Americans who take supplements:

“The results of this study reinforce that dietary supplements are safe products, particularly when put into context with the number of people—over 150 million Americans—who take dietary supplements every year,” stated Duffy MacKay, ND, senior vice president of scientific and regulatory affairs for the Council for Responsible Nutrition. “To put this projected number of 23,000 annual emergency room (ER) visits into context, we estimate that far less than one-tenth of 1% of dietary supplement users experience an emergency room visit annually.”

Also in response to the study, four obesity research groups issued a joint statement recommending that weight loss supplements claiming curative or medicinal qualities should be subject to FDA review and approval.

“While we acknowledge that there may be effective dietary supplements on the market, there is a clear need for long-term data showing the benefits, safety, and effectiveness for these unregulated treatments claiming weight management,” said Steven R. Smith, MD, past-president of The Obesity Society and Chief Scientific Officer at Florida Hospital, Orlando, FL.