Check out this interesting article for those of you interested in understanding more about how strongly nutrition influences health outcomes, and importantly how supplementation fits into the equation! Enjoy 🙂

Calcium, fish oil, and multivitamins enhance the health benefits of a healthy diet

Many chronic diseases, including obesity and cardiovascular disease (CVD) are significantly influenced by diet and lifestyle factors. While there are a multitude of studies demonstrating that a diet rich in fruit and vegetables reduces the risk of CVD, the impact of diet combined with supplementation on health outcomes remains unknown.

A recent large scale longitudinal study found that a long term healthy diet combined with nutritional supplementation positively influenced health outcomes. These results were not found in those consuming an unhealthy diet, despite taking similar supplements.

This suggests that the beneficial effects of supplementation are enhanced by the consumption of a healthy diet.

Nutrition is one of the most important modifiable factors in the prevention of chronic disease, with the literature increasingly supporting the view that alterations in diet have a significant impact on health throughout life.1 There are a multitude of studies demonstrating that a diet rich in fruit and vegetables reduces the risk of cardiovascular disease2 (CVD), some cancers3 and all-cause mortality.4 Further to this, there is considerable evidence to suggest that multivitamin and mineral (MVM) supplementation may reduce the risk of CVD and some cancers.5 Less known, is the impact of diet combined with supplementation on health outcomes.

The authors of a recent large scale longitudinal study sought to investigate whether a healthy diet combined with specific supplements may contribute to improved health outcomes, or whether supplementation may offer some protection against obesity and/or CVD when consumed alongside a poor diet.6

Baseline and follow up data over a ten year period was analysed from 69,990 adults participating in the 45 and Up study. The study looked at supplementation of an MVM, fish oil and/or calcium supplement. Nutritional intake was measured via food frequency reporting, and dietary scores were identified via the consumption of adequate serves of fruit (≥ 2 serves) and vegetables (≥ 5 serves) daily, the frequency of grains and lean protein consumption per week, whether or not dairy was consumed, and alcohol consumption.

Overall, it was found that participants who maintained a healthy diet over the ten year period, combined with MVM or fish oil supplementation, had a lower risk of CVD than those not taking supplements. The authors also concluded that those taking a calcium supplement while maintaining a healthy diet had a lower incidence of obesity. These associations were not found in those consuming an unhealthy diet, despite taking similar supplements. This suggests that the beneficial effects of supplementation are enhanced by the consumption of a healthy diet, and support the old adage that “you can’t out supplement a bad diet”.

The benefit of fish oil supplementation on cardiovascular health is well established and is likely due to alterations in plaque inflammation, formation and stabilisation, and the modification of lipoproteins and triglycerides.7 The indication from the study that the combination of a healthy diet with calcium supplementation lowers the risk of obesity was a novel finding. The authors propose that this may be due to the influence of calcium on adipogenesis, fat metabolism, adipocyte proliferation and apoptosis, thermogenesis, faecal fat excretion and the modification of the gut microbiome.6 While a mechanism of action was not suggested for the influence of MVM supplementation on CVD risk, it is possible that supplementation enhanced the impact of a healthy diet – whereby a diet rich in fruits and vegetables has been shown to prevent the oxidation of lipids and increase the formation of endothelial prostacyclin that inhibits platelet aggregation and reduces vascular tone.2

While this study encompasses a comprehensive analysis of longitudinal data from a large population study, it must be noted that all dietary consumption, supplement intake and health outcomes were self-reported, thus the possibility of measurement bias exists. Despite this, the finding that nutritional supplementation improves long term health outcomes when combined with a healthy diet is an exciting one, offering a potential treatment strategy for practitioners and motivation for patients alike.

References

World Health Organisation (2003). Diet, nutrition and the prevention of chronic disease: report of a joint WHO/FAO expert Geneva. https://www.who.int/dietphysicalactivity/publications/trs916/en/ 1.

World Health Organisation (2003). Diet, nutrition and the prevention of chronic disease: report of a joint WHO/FAO expert Geneva. https://www.who.int/dietphysicalactivity/publications/trs916/en/

Wang, X., Ouyang, Y., Liu, J., Zhu, M., Zhao, G., Bao, W., & Hu, F. B. (2014). Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ (Online), 349. https://doi.org/10.1136/bmj.g4490

Grosso, G., Buscemi, S., Galvano, F., Mistretta, A., Marventano, S., Vela, V. La, Drago, F., Gangi, S., Basile, F., & Biondi, A. (2013). Mediterranean diet and cancer: Epidemiological evidence and mechanism of selected aspects. BMC Surgery, 13(SUPPL.2), S14. https://doi.org/10.1186/1471-2482-13-S2-S14

Nguyen, B., Bauman, A., Gale, J., Banks, E., Kritharides, L., & Ding, D. (2016). Fruit and vegetable consumption and all-cause mortality: Evidence from a large Australian cohort study. International Journal of Behavioral Nutrition and Physical Activity, 13(1). https://doi.org/10.1186/s12966-016-0334-5

Blumberg, J. B., Bailey, R. L., Sesso, H. D., & Ulrich, C. M. (2018). The evolving role of multivitamin/multimineral supplement use among adults in the age of personalised nutrition. In Nutrients (Vol. 10, Issue 2). MDPI AG. https://doi.org/10.3390/nu10020248

Xu, X., Shi, Z., Liu, G., Chang, D., Inglis, S. C., Hall, J. J., Schutte, A. E., Byles, J. E., & Parker, D. (2021). The Joint Effects of Diet and Dietary Supplements in Relation to Obesity and Cardiovascular Disease over a 10-Year Follow-Up: A Longitudinal Study of 69,990 Participants in Australia. Nutrients, 13(3), 944. https://doi.org/10.3390/nu13030944

Kromhout, D., Yasuda, S., Geleijnse, J. M., & Shimokawa, H. (2012). Fish oil and omega-3 fatty acids in cardiovascular disease: Do they really work? In European Heart Journal (Vol. 33, Issue 4, pp. 436–443). Oxford University Press. https://doi.org/10.1093/eurheartj/ehr362

https://www.biomedica.com.au/page/1144/calcium-fish-oil-and-multivitamins-enhance-the-health-benefits-of-a-healthy-diet