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Several studies have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms. Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants, folic acid, B and D vitamins, and multivitamin supplements have no clear benefit. The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries. The evidence also has implications for research. Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. However, clinical trials have been equivocal and sometimes contradictory. Finally, implications on the clinical management and public health recommendations concerning the use of nutritional supplements in chronic disease will be addressed. Likewise, issues around the marketing and advertising of these supplements in the general public will be also discussed.

Nutritional Supplements and Chronic Disease: Bridging the Gap between Myth and Reality