In a recent research letter published in JAMA Open Network, a team of ODS researchers explored pre-pandemic dietary supplement use in the United States, focusing on consumer perceptions of immune health benefits.
The analysis drew data from the January 2017-March 2020 Pre-Pandemic National Health and Nutrition Examination Survey (NHANES) and the Dietary Supplement Label Database (DSLD), a public-use database developed by ODS in 2008 to provide researchers and consumers with information on dietary supplement composition.
“[The research] found that 11 % of the U.S. population took a dietary supplement for perceived immune benefits and that usage differed by several sociodemographic and health characteristics,” ODS reported. “Additionally, among those using a dietary supplement for perceived immune benefits, the majority (60.1%) used a product with label claims related to immune benefits, 28.3% used the product exclusively for perceived immune benefits, and 16.6% did so due to a health care provider recommendation.”
What were people purchasing for immune health?
Before the pandemic, the Council for Responsible Nutrition’s annual consumer surveys showed that many Americans consistently turned to dietary supplements to boost their immune health, with popular choices including vitamins D, C and zinc.
The trend was not limited to vitamins and minerals—herbal products known for their immune and respiratory health benefits also saw strong demand in the years leading up to the pandemic. According to the American Botanical Council, elderberry sales rose by nearly 35% in 2017 from a year prior, reaching over $19 million, while echinacea experienced a 22.9% increase to nearly $85 million. By 2018, horehound, a member of the mint family associated respiratory health benefits, led the market with $146.6 million in sales. Echinacea, elderberry and turmeric also continued to register increased demand.
While many took supplements during this period to support overall health, label claims emphasizing immune benefits were a key factor in consumers' choices, appearing on more than half of the supplements purchased in this category, the ODS researchers reported.
In terms of demographics, the study also reflected that among the 15,560 people considered, the healthier and wealthier showed the greatest preference for dietary supplement for perceived immune benefits.
“Prevalence increased as education, family income, food security, self-rated diet quality and self-rated overall health improved,” the researchers reported. “Prevalence also differed by age and was higher among those who identified as non-Hispanic Black, non-Hispanic White and other.”
Although the overall use of immune supplements—whether for perceived immune benefits based on doctor’s recommendations or for immune purposes exclusively—was relatively low, the analysis indicated that usage was higher among older adults and those in poorer health. The majority of those taking dietary supplements for perceived immune benefits also reported at least one additional reason for use, the most common of which was to maintain health or stay healthy (40%).
Perceived immune benefits
Considering supplement claims on label, the ODS paper references a 2022 investigation funded by the Consortium for Health and Military Performance conducted in partnership with the National Center for Natural Products Research. Here, the researchers tested select dietary supplements marketed to support and boost the immune system to determine whether product labels were accurate and whether any product was misbranded or adulterated.
“This case series study analyzed 30 dietary supplement products purchased from Amazon.com with claims related to immune health,” the study reported. “Seventeen of 30 products had inaccurate labels; 13 were misbranded and nine had additional components detected but not claimed on the label.”
While these findings of misleading claims are not representative of all dietary supplement products marketed for immune health, the ODS team noted that over 25,000 supplement labels in the Dietary Supplement Label Database display the word immune or immunity, “suggesting immune benefits are a prevalent and marketable motivation for dietary supplement use.”
“[B]ecause many U.S. residents use dietary supplements for perceived immune benefits, continued research in diverse populations is needed to determine their clinical relevance,” they wrote. “Additionally, while dietary supplements can help improve nutrient intake, upstream nutritional disparities must also be addressed.”
Upstream nutritional disparities related to immunity might include socioeconomic factors, food access and environmental conditions.
Source: JAMA Open Network. doi: 10.1001/jamanetworkopen.2024.59291. “Prepandemic Prevalence of Dietary Supplement Use for Immune Benefits.” Authors: Margaret A. Nagai-Singer, Edwina Wambogo, Stefan Pasiakos and Jaime Gahche.
