Should nutrient supplements be eaten and how should they be eaten？

Author: Wang Xingguo

Director of Nutrition Department of Dalian Central Hospital/headline signing author

Director of Liaoning Nutrition Society, executive vice chairman of Dalian Nutrition Society, professional skill appraisal expert of public dietitians in Liaoning Province, member of Clinical Nutrition Branch of Dalian Medical Association, and expert consultant of China Clinical Nutrition Network.

This article is taken from teacher Wang Xingguo’s new book, Encyclopedia of Nutrition for Middle-aged and Old People.

China Clinical Nutrition Network has been authorized to publish.

Nowadays, more and more people eat nutritional supplements (health food). According to a survey of more than 36,000 people conducted by the Nutrition Society of China in 2017, 30.50% of adult residents have bought nutrient supplement products, 54.85% have eaten them, and the consumption rate of the elderly is even higher. At the same time, there are also many criticisms that eating nutrient supplements is ineffective and even harmful to health. So, should nutrient supplements be eaten and how should they be eaten?

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01

Nutrient supplements are available, but they should not be abused.

Generally speaking, there are two main ways to solve the problem of nutritional deficiency. One way is to balance the diet, that is, to match the variety and quantity of the daily diet according to the recommendations of the Dietary Guidelines for China Residents 2022, which is the fundamental method applicable to all people. Another way is to eat nutrient supplements and fortified foods, which are suitable for people whose daily diet is not balanced enough, as well as pregnant women, nursing mothers, infants, the elderly and other special groups with high demand for certain nutrients, as well as people who have low sunshine, high-intensity exercise and physical activity, and live in special environments such as high temperature, low temperature and plateau or have specific occupations. In addition, for individuals with nutrient deficiency, it is a simple and effective method to use nutrient supplements (and at the same time, they should actively improve their diet). In short, nutritional supplements are neither a panacea nor a scourge, but one of the effective means to solve nutritional problems, provided, of course, that they are supplemented appropriately and reasonably. Nutritional supplements are necessary and beneficial for some people who cannot adhere to a balanced diet or have special nutritional needs.

At present, the use of nutrient supplements is roughly in three situations:

First, it must be supplemented, such as folic acid supplementation during pregnancy and pregnancy, vitamin D supplementation for infants, and universal iodine supplementation (iodized salt);

The second is to supplement dietary deficiency or to meet special needs, such as DHA for those with insufficient fish and shrimp intake, vitamin D for those with insufficient sun exposure, vitamin B12 for the elderly, dietary fiber for those with constipation, and protein powder for those who need a high-protein diet.

The third is abuse, no targeted supplement, follow the trend, or blindly increase the variety or dosage. These three situations are very common around us.

If anyone decides to use nutritional supplements, they should first follow the advice of relevant medical guidelines or expert consensus, and don’t abuse them blindly; Secondly, we should be targeted, make up for what is missing, make up for what is missing, and don’t overdo it. It is best to consult nutrition-related professionals, such as nutritionists, health managers or doctors.

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02

Nutrient supplements suitable for middle-aged and elderly people

Different from infants, children and pregnant women, middle-aged and elderly people are often accompanied by metabolic problems such as hyperglycemia, hyperlipidemia, hypertension, hyperuricemia, hyperhomocysteinemia and osteoporosis. These specific problems should be fully considered in both daily diet and nutrient supplements.

With the aging of population, osteoporosis has become an important public health problem in China. The prevalence rate of osteoporosis in the population over 50 years old in China is 20.7% for women and 14.4% for men. The prevalence of osteoporosis in people over 60 years old has increased significantly, especially in women. From the perspective of preventing osteoporosis, middle-aged and elderly people should first ensure calcium intake. The recommended daily intake of calcium for adults is 800 mg, and that for people aged 50 and over is 1000 mg. We should take enough calcium through diet as much as possible, take 300 ml of milk or a considerable amount of dairy products every day, often eat soy products, and eat calcium-rich foods such as green leafy vegetables every day. When calcium intake in the diet is insufficient, calcium agents can be given to supplement it. The selection of calcium agent should consider its calcium content, safety and effectiveness. Calcium carbonate has high calcium content and high absorption rate, and is easily soluble in gastric acid. The common adverse reactions are stomach discomfort and constipation.

For bone health, vitamin D may be more important than calcium, because vitamin D can promote the absorption of intestinal calcium, promote bone mineralization, maintain muscle strength, improve balance and reduce the risk of falling. Vitamin D is mainly synthesized by skin under sunlight (ultraviolet rays). People with insufficient sunlight should pay attention to vitamin D supplementation, with 400-600 international units per day for ordinary adults and 600-800 international units for the elderly aged 65 and over. With the social and economic development and lifestyle changes, especially the reduction of outdoor living and working hours, vitamin D deficiency has become a global public health problem. Epidemiological data show that vitamin D deficiency is common in Chinese population.

Vitamin D supplementation for the elderly is also helpful to prevent and treat muscle attenuation syndrome. Serum 25- hydroxyvitamin D3 of the elderly can be detected first. If it is lower than 30 ng/ml (75 nm/l), vitamin D should be supplemented, and 600-800 international units should be supplemented every day. Adequate intake of protein is more important for the prevention and treatment of muscular dystrophy syndrome. The recommended daily intake of protein for the elderly should be maintained at 1.0 ~ 1.5g/kg (body weight) and evenly distributed among three meals a day. In addition to high-protein foods such as milk, eggs, meat, fish and shrimp, supplementing whey protein is more beneficial to prevent muscle attenuation syndrome. In addition, the elderly suffering from muscular attenuation syndrome should be properly supplemented with nutritional supplements containing a variety of antioxidant nutrients (vitamin C, vitamin E, carotenoids, selenium).

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There is also a nutrient that is closely related to the joint health of the elderly. It is glucosamine, referred to as "glucosamine", which is the main component of cartilage tissue. According to the recommendation of China Nutrition Society, for adults with joint movement injury or osteoarthritis, 1000 mg of glucosamine or 1500 mg of glucosamine sulfate/glucosamine hydrochloride should be supplemented every day.

Anemia is also common in the elderly. The survey shows that the prevalence rate of anemia in the elderly over 60 years old is 12.6%. This is related to the weakened digestive function of the elderly and the decreased absorption rate of nutrients such as iron and vitamin B12. The elderly should pay attention to the detection of blood routine (including hemoglobin). If hemoglobin is found to be lower than normal and diagnosed as iron deficiency anemia, they should take iron (according to doctor’s advice). Vitamin C supplementation can promote iron absorption and help prevent iron deficiency anemia.

The effective component of fish oil is DHA, which is an ω-3 polyunsaturated fatty acid, which is beneficial to the nervous system and blood lipid metabolism of middle-aged and elderly people. High-purity fish oil can reduce triglyceride in blood by 30%~40%, with little adverse reaction and good tolerance. Low dose of omega-3 polyunsaturated fatty acids has weak lipid-lowering effect and only plays an auxiliary role. In addition, supplementing fish oil or ingesting fish rich in DHA is also helpful for the elderly who have lost muscle mass and weakened muscle function.

In addition, there are more and more clinical applications of (whey) protein powder, including patients before and after operation, severe patients, tumor radiotherapy and chemotherapy, burn patients, patients with infectious diseases, patients with wasting diseases, and elderly patients with muscle decline, all of whom advocate increasing protein supply or adopting a high-protein diet (except for patients with renal insufficiency and hepatic coma, please follow the doctor’s advice).

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03

Nutritional supplements suitable for vegetarians.

Vegetarians lack animal foods in their diets. If we don’t pay special attention to food collocation, we will easily lack protein, vitamin B12, iron, zinc and omega-3 polyunsaturated fatty acids. Vegetarians can refer to the recommendations of the healthy vegetarian model introduced later to match their diets. If the diet cannot meet the requirements of the healthy vegetarian model, they should consider supplementing protein, fish oil (omega-3 unsaturated fatty acids, DHA) and multivitamins and minerals containing iron, zinc and vitamin B12.

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04

Nutritional supplements suitable for dieters to lose weight.

All kinds of weight loss methods require direct or disguised reduction of energy intake, such as only 1200 kcal (female) or 1400 kcal (male) per day, and an average reduction of 500 kcal per day. It is often difficult for a diet to provide comprehensive and sufficient nutrients when the food intake or food types are obviously limited. At this time, you can consider supplementing multivitamins and minerals. Proper supplementation of vitamins and minerals during dieting and weight loss can not only avoid nutrient deficiency, but also avoid the effect of weight loss due to the lack of certain vitamins (such as vitamin D), minerals (such as calcium) and probiotics.

Most diets reduce energy intake (carbohydrate and fat) while ensuring protein’s intake. The high-protein (low-carbon) diet also advocates increasing protein’s intake. Supplementing protein is also a common practice of dieting and losing weight.

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05

The key to selecting nutrient supplement products

When you decide to choose a nutrient supplement, you should first choose a targeted type and appropriate dosage. The types and dosage of nutrient supplements have been mentioned above. Nutrient supplements are definitely not the more the better, the more complete the better, and you can’t choose or add them at will. If you don’t know what kind or dosage you should choose, you should consult a dietitian, health manager or doctor and follow their instructions.

In China, nutrient supplements are managed as health food, and there should be a special "police tactical unit" logo on the label of nutrient supplements that meet the requirements of health food. It is suggested that the nutrient supplement marked with "police tactical unit" should be the first choice. In addition, it is more important to choose a big brand. A good product formula is designed reasonably (in line with the needs of the corresponding population), and the types and quantities of nutrients are true and reliable, and there is no exaggeration in publicity. All nutrient supplement products should be treated with caution. If you can read the ingredient list and label, buyers or consumers should know their ingredients and attributes, avoid blind intake, and don’t be misled by product advertising. Nutrient supplements are food, not medicine, and cannot treat diseases. All nutrient supplement foods (except drugs) that claim to be able to treat diseases are suspected of violating regulations or false propaganda.

In a word, people should give priority to get all kinds of nutrients from the diet, and the body’s needs for nutrients can be met through reasonable dietary collocation. When the diet can’t meet the needs of nutrients, we can choose appropriate nutrient supplements according to our own physiological characteristics and real needs.

Editorial Department of China Clinical Nutrition Network

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