chp6 results *upgraded version* by data sub-group
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CHP6 Results *UPGRADED VERSION*
By Data Sub-group
Pilot Study
Total doors knocked184
Uncontactable88
Doors answered96
Uneligible1
Participated30
Rejected49
Uncontactable16
Fully completed28
Partially completed2
Fieldwork
Total doors knocked2046
Uncontactable487
Doors answered1559
Uneligible119
Participated687
Rejected668
Uncontactable85
Fully completed682
Partially completed5
Demographics of study sample
Is our sample representative of the population?
Age & Gender
Ethnic group & Marital status
Educational level & Personal yearly income
Housing type
Prevalence of the usage of dietary supplements in Singaporean adults
(“use” and “dietary supplements” as defined by Lit Review)
Prevalence
No. of different supplements used
n: 382 Median: 2 Inter-quartile
range: 1 – 4
Average length of use n: 380 Median:
3 yrs Inter-
quartile range:1 yr 3 mnths – 6 yrs 3 mnths
Longest length of use n: 380 Median:
4 yrs 6 mnths
Inter-quartile range: 2 yrs – 10 yrs
Spending on supplements per year n: 348 Median:
$200 Inter-
quartile range:$100 – $600
Prevalence & proportion prescribed by group of supplement
Supplement group
Usage Prevalence
Proportion of total uses (n)
Proportion prescribed by
Western doctor
Animal products 36.5 % 37.2 % (437) 7.6 %
Vitamins / Minerals
35.4 % 35.9 % (422) 30.3 %
Herbal products 27.4 % 27.0 % (317) 1.9 %
Overall 55.6 % 100.0 % (1176)
14.2 %
Prevalence for top 10 supplements
Factors associated with the use of dietary supplements
What Lit Review tells us Factors established to have positive association
with the use of dietary supplements Female gender High education level High socio-economic status Alcohol drinking High physical activity Non-obese / low BMI Concern with healthy diet, vegetarians Stressful lifestyle Presence of a medical condition, medication use Positive view of the potential health benefits of using
supplements
What Lit Review tells us Factors with contradictory reports on
association with the use of dietary supplements Age Smoking Self-perceived health status
Statistical tests used To evaluate relationship between 2 qualitative
variables Chi-square test
Pearson chi-square & Fisher’s exact test for p values Linear-by-linear association for trend
To evaluate relationship between a quantitative and a qualitative variable Independent samples t-test & One-way analysis of
variance (ANOVA) For t-test, equal variances assumed or unassumed is used
depending on p value from Levene’s test Log transformation using ln (is done first if continuous
variable is not normally distributed) Results presented after re-conversion back to geometric
mean & relative mean difference
Gender
Male(306)
Female (381)
0%
10%
20%
30%
40%
50%
60%
70%
47.1%
62.5%
Pre
vale
nce
of
sup
ple
men
t u
se
Use of supplement
Gender PR 95% CI p
Male (306) 1.000 (reference) -
Female (381) 1.327 (1.152 - 1.530) 0.000
Education level
No formal(108)
Primary(162)
Secondary(189)
Tertiary(192)
0%
10%
20%
30%
40%
50%
60%
70%
38.9%
54.3%63.0%
58.0%
Pre
vale
nce
of
supple
ment
use
Use of supplement
Education level PR 95% CI p
Overall p = 0.001
No formal qualification (108) 1.000 (reference) -
Primary (PSLE) (162) 1.397 (1.061 - 1.840)
0.013
Secondary (O level / N level / ITE) (189) 1.619 (1.248 - 2.101)
0.000
Tertiary (A level / Polytechnic / University) (192)
1.492 (1.149 - 1.938)
0.001
Ethnic group Ethnic group is not a significant factor
affecting the use of dietary supplements in general
It becomes significant only when we stratify by specific supplement useUse of Manuka etc honey / Royal jelly
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 9.5% 1.000 (reference) -
Malay (49) 24.5% 2.159 (1.25-3.729) 0.013Use of Multi-vitamins
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 6.2% 1.000 (reference) -
Indian (94) 13.8% 2.217 (1.213-4.052) 0.017
Ethnic group
Use of Calcium
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 17.8% 1.694 (1.015 - 2.829)
0.040
Malay & Indian (143) 10.5% 1.000 (reference) -
Use of Cordyceps
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 5.5% 7.839 (1.077 - 57.057)
0.011
Malay & Indian (143) 0.7% 1.000 (reference) -
Use of Bird's Nest
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 7.4% 3.514 (1.102 - 11.206)
0.019
Malay & Indian (143) 2.1% 1.000 (reference) -
Ethnic group
Use of Berry extracts
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 10.6% 3.784 (1.396 - 10.261)
0.003
Malay & Indian (143) 2.8% 1.000 (reference) -
Use of Echinacea
Ethnic group Prevalence
PR 95% CI p
Chinese (529) 6.4% 9.191 (1.269 - 66.566)
0.006
Malay & Indian (143) 0.7% 1.000 (reference) -
Household income per year
Below $24,000
(219)
$24,000 to $72,000
(224)
$72,001 and above(78)
0%
10%
20%
30%
40%
50%
60%
70%
80%
49.3%58.5%
66.7%
Pre
va
len
ce o
f su
pp
lem
en
t u
se
Use of supplement
Household income per year PR 95% CI p
Overall p = 0.017; p for trend = 0.053
Below $24,000 (219) 1.000 (reference) -
$24,000 to $72,000 (224) 1.186 (0.997 - 1.411)
0.057
$72,001 and above (78) 1.352 (1.100 - 1.662)
0.008
Household income per yearSpending on supplements in 1 year (S$) (among
users)
Household income per year
Geometric mean
Relative mean
difference
95% CI p
Overall p = 0.010
Below $24,000 (219) 178.70 1.000 (reference) -
$24,000 to $48,000 (144)
283.67 1.587 (1.092 – 2.308) 0.016
$48,001 and above (158)
292.89 1.639 (1.147 – 2.342) 0.007
Smoking status
0%10%20%30%40%50%60%70% 57.9%
44.3%
Pre
vale
nce o
f supp
lem
ent
use
Use of supplement
Smoking status PR 95% CI p
Non / Ex smokers (570) 1.000 (reference) -
Current daily / occasional smokers (115)
0.766 (0.617 – 0.951)
0.010
Confounding We suspect gender to be a confounder for
smoking statusSmoking status
Gender
Use of supplement
Confounding
Male Stratum Use of supplement
Smoking status PR 95% CI p
Non / Ex smokers (208) 1.000 (reference) -
Current daily / occasional smokers (97)
0.913 (0.702 – 1.188)
0.539
Female Stratum Use of supplement
Smoking status PR 95% CI p
Non / Ex smokers (362) 1.000 (reference) -
Current daily / occasional smokers (18)
0.703 (0.417 – 1.185)
0.135
Crude (unstratified) Use of supplement
Smoking status PR 95% CI p
Non / Ex smokers (570) 1.000 (reference) -
Current daily / occasional smokers (115)
0.766 (0.617 – 0.951)
0.010
Confounding After stratification by gender, using the
Mantel-Haenszel ratio calculation, the adjusted PRR for smoking is 0.860, which is 12.3% different from the crude ratio of 0.766.
Since this difference is >10%, it could be significant.
Thus, gender is a potential confounder for smoking with regards to its effects on the use of supplements.
It could be investigated further by using multi-variate analysis.
Physical activity
Yes(380)
No(304)
46%
48%
50%
52%
54%
56%
58%
60% 59.2%
51.0%
Exercise at least once a week
Pre
va
len
ce o
f su
pp
lem
en
t u
se
Use of supplement
Exercise at least once a week PR 95% CI p
Yes (380) 1.161 (1.011 - 1.333)
0.037
No (304) 1.000 (reference) -
View that diet provides sufficient nutrients
Yes(441)
No / Don't know(242)
48%
50%
52%
54%
56%
58%
60%
62%
52.6%
61.2%
Pre
vale
nce
of
sup
ple
men
t u
se
Use of supplement
Diet provides sufficient nutrients
PR 95% CI p
Yes (441) 1.000 (reference) -
No / Don’t know (242) 1.163 (1.017 - 1.330)
0.036
Diagnosed with chronic disease(s)
Presence (310) Absence (374)48%
50%
52%
54%
56%
58%
60%
62%
59.7%
52.4%
Pre
va
len
ce o
f su
pp
lem
en
t u
se
Use of supplement
Diagnosed with chronic disease(s)
PR 95% CI p
Yes (310) 1.139 (0.997 - 1.301)
0.057
No (374) 1.000 (reference) -
Diagnosed with chronic disease(s)
Use of animal product
Diagnosed with chronic disease(s)
Prevalence
PR 95% CI p
Yes (310) 41.3% 1.255 (1.032 - 1.528)
0.023
No (374) 32.9% 1.000 (reference) -
Diagnosed with chronic disease(s)
Average length of use across all supplement(s) used (months) (among users)
Chronic disease
Geometric mean
Relative mean
difference
95% CI p
Yes (310) 38.31 1.339 (1.034 – 1.733) 0.027
No (374) 28.61 1.000 (reference) -Longest length of use across all supplement(s)
used (months) (among users)
Chronic disease
Geometric mean
Relative mean
difference
95% CI p
Yes (310) 52.57 1.154 (1.026 – 1.804) 0.032
No (374) 38.63 1.000 (reference) -
Specific chronic diseases diagnosed
Yes(42)
No(642)
0%
10%
20%
30%
40%
50%
60%
70%
80% 71.4%
54.7%
Diagnosed with Arthritis
Pre
va
len
ce o
f su
pp
lem
en
t u
se
Use of supplement
Diagnosed with Arthritis
PR 95% CI p
Yes (42) 1.306 (1.066 – 1.603)
0.037
No (642) 1.000 (reference) -
Yes(12)
No(672)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 91.7%
55.1%
Diagnosed with Osteoporosis
Pre
va
len
ce o
f su
pp
lem
en
t u
se
Specific chronic diseases diagnosed
Use of supplement
Diagnosed with Osteoporosis
PR 95% CI p
Yes (12) 1.665 (1.385 – 2.000)
0.015
No (672) 1.000 (reference) -
View that supplements are effective in improving health
0%
20%
40%
60%
80%
14.3%28.3%32.0%
65.6%81.8%
Pre
vale
nce o
f su
pple
ment
use
Use of supplement
View that supplements are effective
PR 95% CI p
Overall p = 0.000; p for trend = 0.008
Strongly disagree / Disagree (60) 0.833 (0.516 - 1.344)
0.510
Neutral (153) 1.000 (reference) -
Strongly agree / Agree (471) 2.095 (1.649 - 2.661)
0.000
View that there is scientific evidence for the use of supplements
Stro
ngly d
isagr
ee
(8) Disa
gree
(94) Neu
tral
(195
)Agr
ee
(341
)
Stro
ngly a
gree
(46)
0%
20%
40%
60%
80%
100%
37.5%36.2%47.7%
61.9%87.0%
Pre
vale
nce
of
supple
ment
use
Use of supplement
View that there is scientific evidence
PR 95% CI p
Overall p = 0.000
Strongly disagree / Disagree (102) 0.761 (0.566 - 1.023)
0.065
Neutral (195) 1.000 (reference) -
Strongly agree / Agree (387) 1.360 (1.154 - 1.603)
0.000
View that supplements can have harmful side effects
0%
20%
40%
60%
80%
100%100.0%
63.0%44.4%
56.8%75.0%
Pre
vale
nce o
f su
pple
ment
use
Use of supplement
View that can have side effects PR 95% CI p
Overall p = 0.000
Strongly disagree / Disagree (196) 1.446 (1.203 - 1.740)
0.000
Neutral (207) 1.000 (reference) -
Strongly agree / Agree (280) 1.302 (1.085 - 1.562)
0.004
Overview of characteristics & relation to use of supplement Significantly related & shown in this ppt
Gender Ethnic group Education level Household income Smoking status Physical activity View that diet is sufficient Presence of chronic disease Diagnosed with Arthritis & Osteoporosis View that supplements are effective View that supplements have scientific evidence View that supplements can have harmful side effects
Green – shown by Lit Review to be positively relatedYellow – inconclusive evidence from Lit Review
Overview of characteristics & relation to use of supplement Not significantly related, but still shown in this
ppt Age Body mass index Healthy diet (fruits / vegetables) **to be confirmed
again
Green – shown by Lit Review to be positively relatedYellow – inconclusive evidence from Lit Review
Overview of characteristics & relation to use of supplement Not significantly related & not shown in this ppt at
all Marital status Occupational status Alcohol intake Pack-years of smoking Months since quit smoking Dietary restriction Diagnosed with other specific chronic disease Pregnancy Self-perceived health status Stress in lifestyle Adequacy of sleep
Green – shown by Lit Review to be positively relatedYellow – inconclusive evidence from Lit Review
Profile of a typical supplement user Female Has up to secondary or tertiary level education Has high household income per year Is a non-smoker Exercises at least once a week Views that diet does not provide sufficient
nutrients Is diagnosed with chronic disease(s), particularly
Arthritis and Osteoporosis Views that supplements are effective in improving
health and that there is scientific evidence for their use
Not significant - Age
Use of supplement
Age Prevalence
Overall p = 0.235
21-39 (young adults) (227)
55.9%
40-59 (middle-aged) (302)
58.3%
60 and above (elderly) (158)
50.0%
Age
Use of supplement
Geometric mean
p
User (381) 44.35 0.775
Non-user (303) 44.68 -
Not significant - Body mass index (BMI)
Use of supplement
Body mass index Prevalence
Overall p = 0.525
<23 (normal / underweight) (332) 54.8%
23 and above (overweight / obese) (330)
57.3%
Body mass index
Use of supplement
Mean p
User (371) 23.61 0.977
Non-user (291) 23.62 -
Healthy diet **not confirmed**
Use of supplement
Servings of fruit or vegetables consumed per day
Prevalence
Overall p = 0.731
0 (17) 52.9%
0.5 and 1.0 (70) 51.4%
1.5 and above (598) 56.2%
Servings of fruit or vegetables consumed per day
Use of supplement
Mean p
User (381) 2.88 0.960
Non-user (304) 2.88 -
A look at Calcium in detail
The top of the list supplement
Gender
Male(306)
Female (381)
0%
5%
10%
15%
20%
25%
8.5%
22.6%
Pre
vale
nce
of
Calc
ium
use
Use of Calcium
Gender PR 95% CI p
Male (306) 1.000 (reference) -
Female (381) 2.657 (1.759 - 4.011) 0.000
Gender stratified by age (>55)
Male(84)
Female (74)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
16.7%
47.3%
Pre
vale
nce
of
Calc
ium
use
Age > 55 Stratum Use of Calcium
Gender PR 95% CI p
Male (84) 1.000 (reference) -
Female (74) 2.248 (1.288 - 3.921) 0.003
Age
21-39(227)
40-59(302)
60 and above(158)
0%
5%
10%
15%
20%
25%
11.0%
17.2%
22.2%
Pre
vale
nce
of
Calc
ium
use
Use of Calcium
Age PR 95% CI p
Overall p = 0.012
21-39 (young adults) (227) 1.000 (reference) -
40-59 (middle-aged) (302) 1.563 (1.002 - 2.439)
0.047
60 and above (elderly) (158) 2.011 (1.225 - 3.223)
0.004
Reasons, sources of information & KAP
What is the most common reason for using dietary
supplements?
What Lit Review tells us The motivations for taking supplements can
be varied and include ensuring nutritional adequacy, reducing one’s risk for certain diseases and age-related changes, and enhancing physical performance.
Women are more likely to be using supplements to promote weight loss, burn-up fat, prevent colds, improve memory, and relieve stress; whereas men are more likely to use supplements to enhance athletic performance, retard the onset of aging, build muscle, and improve sexual function.
Reason(s) for taking supplement(s)
n = 846
Reason(s) stratified by age group
n = 846
p = 0.000
p = 0.389
p = 0.000
p = 0.255
p = 0.011
p = 0.018
p = 0.137
p = 0.136
p = 0.086
Stratified by gender – cosmetic purpose
Male(144)
Female(238)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
3.5%
16.0%
Use
of
sup
ple
men
t fo
r co
smeti
c p
urp
ose
(am
on
g
use
rs)
Use of supplement for cosmetic purpose
Gender PRR 95% CI p
Male (144) 1.000 (reference) -
Female (238) 4.547 (1.832 - 11.287) 0.000
Is there an association between particular supplements and
special reasons for taking them?(Reasons stratified by
supplement)
For cosmetic purpose
p = 0.002
p = 0.000
p = 0.013
p = 0.117
To compensate for deficiencies in diet
p = 0.049
p = 0.075
p = 0.049
p = 0.000
What is the most common way people are introduced to dietary
supplements?
What Lit Review tells us The relative ease with which individuals can
access information on an extensive number of topics (eg. via the Internet) has increased interest in the use of dietary supplements.
Source(s) of information among users
n = 648
Source(s) of information stratified by age group
n = 648
p = 0.002
p = 0.011
p = 0.019
p = 0.210
p = 0.671
p = 0.289
Stratified by supplement – Traditional Medicine practitioner
p = 0.011
p = 0.007
p = 0.002
p = 0.003
p = 0.290
Questionable sources of information? Among all users who strongly agree or agree
that supplements can have harmful side effects (163), 46.6% (76) obtain information about supplements
from friends & family and/or advertisements only (and no other sources)
Among all users who strongly agree or agree that supplements have scientific evidence for use (251), 45.8% (115) obtain information about
supplements from friends & family and/or advertisements only (and no other sources)
What is the most common reason for not using dietary
supplements?
Reason for not taking supplement
n = 302
How does knowledge of dietary supplements influence their
perceived effectiveness?
What Lit Review tells us Women and those with higher education are
more likely to use supplements based on evidence-based indications.
View that there is scientific evidence for the use of supplements
View supplements are effective
View that there is scientific evidence
PR 95% CI p
Overall p = 0.000; p for trend = 0.000
Strongly disagree / Disagree (102) 0.816 (0.619 - 1.076)
0.144
Neutral (195) 1.000 (reference) -
Strongly agree / Agree (387) 1.753 (1.512 - 2.033)
0 .000
0%
20%
40%
60%
80%
100%
25.0%41.5%49.2%
85.6%91.3%
Pro
port
ion w
ho v
iew
that
supple
ments
are
eff
ect
ive
Chronic diseases & supplement use
Top 5 chronic diseases
Our study MOH 2007
Chronic disease
Prevalence (n)
% on regular
medication(s)
% using supplement(
s)
Prevalence
Hyperlipidemia 21.5 % (148) 66.2 % 58.1 % 12.5 %
Hypertension 20.7 % (142) 83.1 % 59.9 % 12.0 %
Diabetes mellitus
8.0 % (55) 96.4 % 49.1 % 4.6 %
Arthritis 6.1 % (42) 57.1 % 71.4 % 10.1 %
Asthma 5.2 % (36) 58.3 % 61.1 % 6.6 %
Specific chronic diseases & supplements
Use of Combined vitamins & minerals
Diagnosed with Hyperlipidemia
Prevalence
PR 95% CI p
Yes (148) 3.4% 0.342 (0.139 - 0.839)
0.012
No (536) 9.9% 1.000 (reference) -
Use of Manuka etc honey / Royal jelly
Diagnosed with Diabetes mellitus
Prevalence
PR 95% CI p
Yes (55) 0.0% - - 0.002
No (629) 12.9% 1.000 (reference) -
Specific chronic diseases & supplements
Yes(42)
No(642)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
38.1%
15.0%
Diagnosed with Arthritis
Pre
va
len
ce o
f C
alc
ium
use
Use of Calcium Use of Glucosamine / Chondroitin
Diagnosed with Arthritis
PR 95% CI p PR 95% CI p
Yes (42) 2.548 (1.662 - 3.906)
0.000
3.335 (1.942 - 5.728)
0.000
No (642) 1.000 (reference) - 1.000 (reference) -
Yes(42)
No(642)
0%
5%
10%
15%
20%
25%
30%
35%
28.6%
8.6%
Diagnosed with Arthritis
Pre
va
len
ce o
f G
luco
sam
ine
/
Ch
on
dro
itin
use
Specific chronic diseases & supplements
Yes(36)
No(648)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18% 16.7%
5.6%
Diagnosed with Asthma
Pre
va
len
ce o
f B
ird
’s N
est
use
Use of Bird’s Nest
Diagnosed with Asthma
PR 95% CI p
Yes (36) 3.000 (1.353 - 6.653)
0.018
No (648) 1.000 (reference) -
Drug-supplement interactions Among those with at least 1 chronic disease
diagnosed (310), 26.1% (81) are on medication(s) only 18.1% (56) are on supplement(s) only 41.6% (129) are on both medication(s) and
supplement(s) 14.2% (44) are on neither
448156 129
n = 310
supplement medicationpresence of chronic disease
Drug-supplement interactions 32.5% of all supplement users are on regular
medication(s) for chronic disease(s) 88.6% of all those on regular medication(s) for
chronic disease(s) use at least 1 supplement Among supplement users on medication(s) for
chronic disease(s), 23.0% know about the possible drug-supplement
interaction(s) 49.6% have discussed the usage of supplement(s)
with their doctor 23.4% have discussed the usage of supplement(s)
with their doctor AND none of the supplements used were prescribed by a doctor
Example Aspirin-Gingko increases risk of bleeding (as
cited in the article by Dima M. Qato et al.) From our study,
9.5% of those on regular medications for Heart disease (likely to be on Aspirin) are also using Gingko extracts 10.0% of those using Gingko extracts are on regular
medications for Heart disease Among all Gingko users on medication(s) for
chronic disease(s), 16.7% are aware of the possible drug-supplement
interactions 50.0% have discussed the usage of supplement with
their doctor
Summary of important findings 55.6% of the Singaporean adult population use
dietary supplements. Calcium is the most widely used dietary
supplement. 14.2% of all supplement uses are prescribed by a
Western doctor. Half of the population spend between $100 – $600
on dietary supplements per year. The most common reasons for taking dietary
supplements are to improve general health and to prevent disease.
Reasons for use change depending on age, gender and supplement used.
Summary of important findings People mostly get their information about dietary
supplements from family & friends and advertisements.
The most important reasons keeping people from using dietary supplements are that they are unnecessary and too expensive.
Knowledge of the scientific evidence of dietary supplements increases their perceived effectiveness.
There exists drug-supplement interactions which people are largely not aware of.
About half of those on regular medication(s) and also using supplements have not discussed the issue of supplement usage with their doctors.
Summary of important findings The use of dietary supplements is associated with
female gender, high education level, high socioeconomic status, non-smoker, physical activity, presence of a chronic medical condition (especially Arthritis or Osteoporosis), positive opinion of supplements and the view that one’s diet is insufficient.
Chinese are more likely to use Bird’s Nest, Cordyceps, Echinacea and Berry extracts.
Knowledge of the harmful side effects of dietary supplements do not seem to matter.
Use of dietary supplements is unrelated to age, alcohol drinking, obesity, self-perceived health status or stress levels.
Thank you
Questions? Suggestions?
Prepared answers to possible questions
“Prepared answers” Q. In the questionnaire, people taking
Combined vitamins & minerals or Multi-minerals could have also responded yes to taking Calcium, causing the prevalence to be falsely high?
A. Out of 112 who responded yes to taking (single) Calcium, only 18 (16.1%) also responded yes to taking Combined vitamins & minerals and/or Multi-minerals. The remaining 94 (83.9%) form the majority who
responded yes to taking (single) Calcium only
“Prepared answers” Q. Since response rate is only 50.7%, what
about refusal bias? A. Out of 668 units which rejected us, we
managed to capture simple demographic data (gender, ethnicity & age) for 127 units (19.0%)
See next 2 slides for comparison graphs.
Gender & Ethnic group
p = 0.165 p = 0.061
Estimated age
p = 0.002
“Prepared answers” Q. Can you give other examples of significant drug-
supplement interactions besides Aspirin-Gingko? A. (Summary of Lit Review team’s research) In clinical
practice, polypharmacy is common, and to the mixture physicians prescribe, patients add various over-the-counter medications, vitamins, herbs, and foods.
For example, Warfarin is known to interact with Garlic, Gingko, Glucosamine, Omega fatty acids / Fish oil & Vitamin E. The consequence is prolonged INR and increased risk of bleeding. Intracerebral haemorrhage, subdural haematoma and spontaneous hyphema are possible.
As a precaution, patients on Warfarin should have INR measured within a week of starting any supplement.
Patients may not be forthcoming about the use of supplements, even if it causes severe adverse effects, because they fear censure.
Fruits (not the kind of results we expect!)
Use of supplement
Servings of fruit consumed per day
Prevalence
PR 95% CI p
0 (120) 47.5% 1.000 (reference) -
0.5 & above (565) 57.3% 1.207 (0.987 - 1.476)
0.055
Use of vitamin/mineral
Servings of fruit consumed per day
Prevalence
PR 95% CI p
0 (120) 25.0% 1.000 (reference) -
0.5 & above (565) 37.5% 1.501 (1.082 - 2.083)
0.009
Vegetables
Use of supplement
Servings of vegetables consumed per day
Prevalence
PR 95% CI p
0 – 1.0 (270) 60.0% 1.000 (reference) -
1.5 & above (415) 52.8% 0.880 (0.770 - 1.005)
0.070
Use of animal product
Servings of vegetables consumed per day
Prevalence
PR 95% CI p
0 – 1.0 (270) 42.2% 1.000 (reference) -
1.5 & above (415) 33.0% 0.782 (0.643 - 0.951)
0.015
Vegetables
Use of Combined vitamins & minerals
Servings of vegetables consumed per day
Prevalence
PR 95% CI p
0 – 1.0 (270) 10.0% 1.000 (reference) -
1.5 & above (415) 7.5% 0.567 (0.346 - 0.927)
0.025
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