Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults



      The aim of the study was to evaluate the relationship between supplement categories and adverse events in children, adolescents, and young adults.


      This is a retrospective observational study using adverse event reports between January 2004 and April 2015 in the U.S. Food and Drug Administration Adverse Event Reporting System on food and dietary supplements database. We quantified the relative risks for severe medical events of dietary supplements sold for various functions relative to vitamins among individuals aged between 0 and 25 years. Severe medical events include death, disability, life-threatening events, hospitalization, emergency room visit, and/or required intervention to prevent permanent disability.


      There were 977 single-supplement–related adverse event reports affecting individuals aged between 0 and 25 years over 11 years (50.6% female; age: mean = 16.5 years, standard deviation = 7.5 years). Supplements sold for muscle building (risk ratio [RR] = 2.7; 95% confidence interval [CI] = 1.9–4.0), energy (RR = 2.6; 95% CI = 1.9–3.6), and weight loss (RR = 2.6; 95% CI = 1.9–3.4) were associated with almost three times the risk for severe medical events compared with vitamins.


      Consumption of dietary supplements sold for weight loss, muscle building, and energy involved increased risks for severe medical events compared with vitamins. Proactive enforcement of regulations is needed to reduce access and consumption among children, adolescents, and young adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Statista
        Dietary supplements market size United States 2024 forecast. Secondary dietary supplements market size United States 2024 forecast 2018.
        (Available at:)
        • Kantor E.D.
        • Rehm C.D.
        • Du M.
        • et al.
        Trends in dietary supplement use among US adults from 1999-2012.
        JAMA. 2016; 316: 1464-1474
        • McClafferty H.
        • Vohra S.
        • Bailey M.
        • et al.
        Pediatric Integrative Medicine.
        Pediatrics. 2017; 140: e20171961
        • Pomeranz J.L.
        • Barbosa G.
        • Killian C.
        • Austin S.B.
        The dangerous mix of adolescents and dietary supplements for weight loss and muscle building: Legal strategies for state action.
        J Public Health Manag Pract. 2015; 21: 496-503
        • U.S. Food and Drug Administration
        FDA consumer health information. Secondary FDA consumer health information.
        2017 (Available at:)
        • U.S. Food and Drug Administration
        FDA warning letters issued to four makers of caffeinated alcoholic beverages. Secondary FDA warning letters issued to four makers of caffeinated alcoholic beverages.
        November 17, 2010 (Available at:)
        • Blanck H.M.
        • Serdula M.K.
        • Gillespie C.
        • et al.
        Use of nonprescription dietary supplements for weight loss is common among Americans.
        J Am Diet Assoc. 2007; 107: 441-447
        • Guyda H.J.
        Use of dietary supplements and hormones in adolescents: A cautionary tale.
        Paediatr Child Health. 2005; 10: 587-590
        • Meyer F.
        • O'Connor H.
        • Shirreffs S.M.
        Nutrition for the young athlete.
        J Sports Sci. 2007; 25 Suppl 1: S73-S82
        • Cohen P.A.
        • Travis J.C.
        • Keizers P.H.
        • et al.
        The stimulant higenamine in weight loss and sports supplements.
        Clin Toxicol (Phila). 2019; 57: 125-130
        • O'Connor A.
        New York attorney general targets supplements at major retailers.
        The New York Times. February 3, 2015; (Available at:)
        • Cohen P.A.
        • Travis J.C.
        • Keizers P.H.
        • et al.
        Four experimental stimulants found in sports and weight loss supplements: 2-amino-6-methylheptane (octodrine), 1,4-dimethylamylamine (1,4-DMAA), 1,3-dimethylamylamine (1,3-DMAA) and 1,3-dimethylbutylamine (1,3-DMBA).
        Clin Toxicol (Phila). 2018; 56: 421-426
        • Grundlingh J.
        • Dargan P.I.
        • El-Zanfaly M.
        • Wood D.M.
        2, 4-dinitrophenol (DNP): A weight loss agent with significant acute toxicity and risk of death.
        J Med Toxicol. 2011; 7: 205
        • Stickel F.
        • Shouval D.
        Hepatotoxicity of herbal and dietary supplements: An update.
        Arch Toxicol. 2015; 89: 851-865
        • Yen M.
        • Ewald M.B.
        Toxicity of weight loss agents.
        J Med Toxicol. 2012; 8: 145-152
        • Li N.
        • Hauser R.
        • Holford T.
        • et al.
        Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts.
        Br J Cancer. 2015; 112: 1247
        • Cohen P.A.
        • Venhuis B.J.
        Adulterated sexual enhancement supplements: More than mojo.
        JAMA Intern Med. 2013; 173: 1169-1170
        • Corazza O.
        • Martinotti G.
        • Santacroce R.
        • et al.
        Sexual enhancement products for sale online: Raising awareness of the psychoactive effects of yohimbine, maca, horny goat weed, and Ginkgo biloba.
        Biomed Res Int. 2014; 2014
        • Ali F.
        • Rehman H.
        • Babayan Z.
        • et al.
        Energy drinks and their adverse health effects: A systematic review of the current evidence.
        Postgrad Med. 2015; 127: 308-322
        • Geller A.I.
        • Shehab N.
        • Weidle N.J.
        • et al.
        Emergency department visits for adverse events related to dietary supplements.
        N Engl J Med. 2015; 373: 1531-1540
        • Golden N.H.
        • Schneider M.
        • Wood C.J.P.
        Preventing obesity and eating disorder in adolescents.
        Pediatrics. 2016; 138: e20161649
        • LaBotz M.
        • Griesemer B.A.
        • Council on Sports Medicine and Fitness
        Use of performance-enhancing substances.
        Pediatrics. 2016; 138: e20161300
        • Liyanage C.R.
        • Kodali V.
        Case report: Bulk muscles, loose cables.
        BMJ Case Rep. 2014; 2014
        • Pillitteri J.L.
        • Shiffman S.
        • Rohay J.M.
        • et al.
        Use of dietary supplements for weight loss in the United States: Results of a national survey.
        Obesity. 2008; 16: 790-796
        • Wilson K.M.
        • Klein J.D.
        • Sesselberg T.S.
        • et al.
        Use of complementary medicine and dietary supplements among US adolescents.
        J Adolesc Health. 2006; 38: 385-394
        • Field A.E.
        • Austin S.B.
        • Camargo C.A.
        • et al.
        Exposure to the mass media, body shape concerns, and use of supplements to improve weight and shape among male and female adolescents.
        Pediatrics. 2005; 116: e214-e220
        • Eisenberg M.E.
        • Wall M.
        • Neumark-Sztainer D.
        Muscle-enhancing behaviors among adolescent girls and boys.
        Pediatrics. 2012; 130: 1019-1026
        • Qato D.M.
        • Alexander G.C.
        • Guadamuz J.S.
        • Lindau S.T.
        Prevalence of dietary supplement use in US children and adolescents, 2003-2014.
        JAMA Pediatr. 2018; 172: 780-782
        • Sonawane K.B.
        • Cheng N.
        • Hansen R.A.
        Serious adverse drug events reported to the FDA: Analysis of the FDA adverse event reporting system 2006-2014 database.
        J Manag Care Spec Pharm. 2018; 24: 682-690
        • U.S. Food and Drug Administration
        Guidance for industry: Questions and answers regarding adverse event reporting and recordkeeping for dietary supplements as required by the Dietary Supplement and Nonprescription Drug Consumer Protection Act.
        (In: Nutrition Center for Food Safety and Nutrition)2013
        • American Academy of Pediatrics
        Kids should not consume energy drinks, and rarely need sports drinks, says AAP.
        May 30, 2011 (Available at:)
        • Austin S.B.
        • Liu S.H.
        • Tefft N.
        Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects.
        Prev Med. 2018; 114: 39-46
        • Jo C.L.
        • Ambs A.
        • Dresler C.M.
        • Backinger C.L.
        Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation.
        Prev Med. 2017; 95: 89-95
        • Lovegrove M.C.
        • Hon S.
        • Geller R.J.
        • et al.
        Efficacy of flow restrictors in limiting access of liquid medications by young children.
        J Pediatr. 2013; 163: 1134-1139.e1
        • Cellini M.
        • Attipoe S.
        • Seales P.
        • et al.
        Dietary supplements: Physician knowledge and adverse event reporting.
        Med Sci Sports Exerc. 2013; 45: 23-28
        • Herriman M.
        • Fletcher L.
        • Tchaconas A.
        • et al.
        Dietary supplements and young teens: Misinformation and access provided by retailers.
        Pediatrics. 2017; 139: e20161257

      Linked Article

      • The Good, the Bad and the Ugly: Not All Supplements are Equal
        Journal of Adolescent HealthVol. 65Issue 5
        • Preview
          The recent article “Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults” [1] raises serious concerns about the appropriate interpretation of adverse event data. Its secondhand use of data from the Food and Drug Administration. (FDA) Adverse Event Reporting System lacks any context. The law establishing the FDA Adverse Event Reporting System expressly states that “the submission of an adverse event report in compliance with this section shall not be construed as an admission that the dietary supplement caused or contributed to the adverse event.” In other words, they are not presumed to be causal [2].
        • Full-Text
        • PDF
      • The Good, the Bad, and the Ugly: Not All Supplements Are Equal
        Journal of Adolescent HealthVol. 65Issue 5
        • Preview
          I read with interest the article by Or et al. [1] on adverse events to dietary supplements in adolescent and young adults. Although I appreciate it and agree on most of the authors' conclusions, I would like to make two additional considerations.
        • Full-Text
        • PDF
      • Dietary Supplements: Caveat Emptor Redux
        Journal of Adolescent HealthVol. 65Issue 4
        • Preview
          The dangers of patent medicines in the late 19th century were well documented, and later reforms led to entirely new government regulations that were designed to end the old concept of “caveat emptor” or “let the buyer beware.” One of the most important of these regulatory agencies was an early version of the Food and Drug Administration (FDA), created by the Pure Food and Drug Act of 1906 [1]. More than 100 years later, with extensive FDA safety hurdles in place for bringing new medications to market, it would be reasonable to think that the risky days of patent medicine were long behind us.
        • Full-Text
        • PDF