Validity of methods used to assess vitamin and mineral supplement use

Assessing vitamin and mineral supplement use is important because supplement use per se is an exposure of interest for the risk of several chronic diseases and because supplements contribute a large proportion of total (diet plus supplement) micronutrient intake, another important exposure in epidemiologic research. Unfortunately, little is known about methods for obtaining valid information about supplement use. The authors conducted a validation study in 1996 comparing supplement data collected in a telephone interview and from a self-administered questionnaire with data derived from a detailed, in-person interview and transcription of the labels of supplement bottles (i.e., a gold standard) among adult supplement users in Washington State (n = 104). Spearman correlation coefficients comparing average daily supplemental vitamin and mineral intake from the interview or questionnaire with the gold standard ranged from 0.76 (95% confidence interval 0.66-0.83) for vitamin C to 0.08 (95% confidence interval -0.14 to 0.29) for iron, with a mean of about 0.5. The principal sources of error were inaccurate assumptions about the micronutrient composition of multiple vitamins and respondent confusion regarding the distinction between multiple vitamins and single supplements. These results suggest that commonly used epidemiologic methods of assessing supplement use may incorporate significant amounts of error in estimates of some nutrients.