Writing in the journal JAMA Network Open, researchers from the Memorial Sloan Kettering Cancer Center and Harvard T.H. Chan School of Public Health examined 11 National Health and Nutrition Examination Survey (NHANES) cycles from 1999 through 2023 which included more than 63,000 adults.
They found supplement use increased from 51% to 60%, particularly among older adults.
“As the baby boom cohort ages, the growing older adult population, many of whom have multiple chronic conditions and polypharmacy, may face increasing risks of drug-supplement interactions and rely on supplements for disease management and health promotion,” the researchers wrote. “This underscores the need to document and understand patterns of use in the population, and the need to evaluate the efficacy and safety of supplements.”
They added that the study provides one of the most comprehensive assessments to date of long-term supplement trends across different products and demographics, “offering important insights for informing health care practitioners and public health decision-making.”
Increasing consumption
The global supplement market is valued at nearly $200 billion and is expected to double by 2033. More than 100,000 dietary supplements exist in the marketplace, and among U.S. adults, especially older people, supplement use is high. Consumption increased during the COVID-19 pandemic and continues to grow.
As consumers take supplements to improve or maintain their overall health, only one in four products are consumed under the direction of a health care professional. According to the researchers, the evidence demonstrating the impact of supplements is mixed. Whereas multivitamins for cognitive function and vitamin D or omega-3 for autoimmune disease have findings suggesting benefits, other supplements may demonstrate little benefit and even harm.
“For example, evidence is insufficient to support routine single-vitamin or multivitamin use for preventing cardiovascular disease or cancer,” the researchers explained. “In addition, evidence on adverse interactions between supplements and medications remains limited for many products despite the large and growing supplement marketplace.”
Despite increased public interest in supplements, no comprehensive review accounted for emerging trends in the market. The aim of the study was to evaluate nearly 25 years of national trends in supplement use.
Study details
Researchers conducted household and telephone interviews where participants were asked whether they had taken dietary supplements over the last month. Participants reported what supplements they used and supplements were identified as vitamins, minerals, multivitamin-multimineral supplements, and nonvitamin-nonmineral (NVNM) supplements. Over the NHANES cycles, certain demographic groups were more likely to use supplements, including older adults.
Overall, multivitamin-multimineral (MVMM) use declined but the consumption of vitamins, minerals and botanicals outside of MVMM increased from 1999 to 2023. During the prepandemic and early-pandemic years, supplement use of vitamins, minerals, and several NVNM, including products marketed for immune support, increased during that era as compared with later-pandemic and postpandemic periods.
Over the two decades, consumers expanded their reasons for taking supplements, including for micronutrient intake, adaptogenic, anti-inflammatory, gut, skin and joint health. Consumers also expressed a need for more personalized supplements rather than one-size-fits-all multivitamins.
During the period, several vitamins and minerals increased in popularity, including vitamin K, which has been associated with bone, cardiovascular and metabolic health, and vitamin D, which has potential roles in diabetes, Alzheimer disease, autoimmune disease and cancer progression and/or mortality.
Immune or anti-inflammatory support supplements, such as zinc, elderberry, ashwagandha, and turmeric and curcumin, were marketed over long-term and between the prepandemic, early-pandemic, later-pandemic and postpandemic periods, parallel with increased immune-related supplement use during COVID-19.
The use of probiotics, prebiotics, collagen and hyaluronic acid show increasing consumer demand for digestive, skin and joint health products. Some clinical evidence supports the efficacy of probiotics and prebiotics in gastrointestinal conditions, and collagen and hyaluronic acid have been studied for potential benefits to improve skin and joint-related conditions. In contrast, several trace mineral supplements (vanadium, nickel, tin, and silicon) have declined in use likely because of safety concerns and limited evidence of efficacy.
“Although previous studies reported stable supplement use from 1999 through 2012 and higher prevalence in recent years, our analysis clarified these patterns by showing that the long-term increase was largely driven by a rise beginning around 2009 to 2010,” the researchers explained. “This coincided with rapid market expansion over the past 10 to 20 years, reflecting increasing interest in health maintenance and the rise of social media enabling direct-to-consumer marketing.”
However, some supplements popular in the early 2000s, including ephedra, which was used for weight loss and athletic performance but later banned for toxic effects, saw significant decline in use. Goldenseal, ginkgo and ginseng also saw reductions in consumption over concerns of drug interactions and lack of efficacy.
“Collectively, these increases and decreases illustrate how regulation, evolving evidence, and shifting consumer preferences shape long-term patterns of supplement use,” the researchers wrote. “Consumer perceptions may also be influenced by supplement labeling, as commonly used label claims may prompt inferences of disease-related benefit beyond their explicit labeling.”
Source: JAMA Network Open. doi: 10.1001/jamanetworkopen.2026.19291. “Emerging Patterns in Dietary Supplement Use Among US Adults, 1999-2023”. Authors: Chun Sing Lam et al.
