Australian Health Survey: Nutrition - Supplements

This publication presents information on Australians' consumption of dietary supplements from the 2011-12 National Nutrition and Physical Activity Survey (NNPAS) component of the 2011-13 Australian Health Survey (AHS).

While it is recognised that it is best to obtain nutrients from a balanced diet, it may be necessary for some people to take dietary supplements to increase their nutrient intake¹. Analysis in this publication provides a picture of the effect of dietary supplements on total intakes of various vitamins and minerals across the Australian population based on intakes of supplements from the first 24-hour food recall in the survey (i.e. Day 1).

This publication complements information on usual nutrient intakes, which were modelled using two days (i.e, Day 1 and Day 2) of reported consumption of foods and beverages in NNPAS and published in Australian Health Survey: Usual Nutrient Intakes, 2011-12 (cat. no. 4364.0.55.008). It measured levels of nutrient adequacy in the population assessed according to what people 'usually' eat and did not include the contribution of supplements to nutrient intakes. See Day 1 / Day 2 intake in the Glossary for more information.

Calcium is a mineral required for the growth and maintenance of bones and teeth, as well as proper functioning of the muscular and cardiovascular systems. Low calcium intake is linked to osteoporosis, a low bone density condition particularly affecting post-menopausal women.¹ Milk and milk-based foods are the richest sources of calcium in the Australian diet, although it is also found in other products² as well as dietary supplements.

A key finding from previous analysis of nutrition data from the Australian Health Survey was that nearly three quarters of females (73%) and half of all males (51%) aged two years and over did not meet requirements for calcium based on their usual intakes of foods and beverages only (see Australian Health Survey: Usual Nutrient Intakes, 2011-12 cat. no. 4364.0.55.008).

This chapter presents information on Australians' consumption of calcium from supplements, including the effect on overall calcium intakes due to this supplementation.

The National Health and Medical Research Council (NHMRC) describes the Estimated Average Requirements (EARs) for calcium, which are the daily levels of calcium estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group³. Calcium requirements are higher for adolescents undergoing bone mass growth, for women after menopause, and for older men.

In 2011-12, 2.3 million females aged 2 years and over (21%), had some level of intake of calcium from supplements (9% of 2-18 year olds, 21% of 19-50 year olds and 28% of those aged 51 years and over) compared with 14% or approximately 1.5 million males (9% of 2-18 year olds, 15% of 19-50 year olds and 15% of those aged 51 years and over).

Reported intakes of calcium from dietary supplements on the day prior to interview varied from scant traces up to well above 2000mg for some individuals. The distribution of intakes is skewed for all age and sex groups. For examples, the median intake of calcium from supplements for adults aged 19 years and over was 104mg, which is considerably lower than the average of 245mg.

The following graph shows the proportion of people aged 19 years and over who had consumed calcium from supplements by various amounts on the day prior to interview. Almost half (49%) of people who took calcium from supplements took less than 100mg, while there are peaks at 600mg and 1200mg.

In 2011-12, average amounts of calcium consumed from foods and beverages only were 865mg for males aged 2 years and over and 745mg for females aged 2 years and over. When supplements were taken into account, average calcium intakes increased to 887mg and 801mg for males and females respectively.

The effect of supplementation varied by age and sex, being greatest for females aged 51 years and over. In 2011-12, females aged 51-70 years consumed an average of 741mg of calcium from foods and beverages only on the day prior to interview, and when calcium from supplements were taken into account this increased to 855mg. Similarly, calcium intakes for women aged 71 years and over increased from 674mg to 783mg when supplementation was taken into account.

Analysis in the remainder of this article considers adults aged 19 years and over who consumed 100mg or more of calcium from supplements on the day prior to interview. This definition excludes those persons who obtained only relatively small amounts of calcium from supplements, such as when used as a binding agent.

More female than male adults consumed 100mg or more of calcium from supplements (13% compared to 6%). Nearly one in five (18%) women aged 51 years and over reported taking supplements which contained 100mg or more of calcium, while around one in eight (12%) women aged 31-50 years did so. This compared with 7% for both men aged 31-50 years, and men aged 51 years and over.

One way of considering the effect of taking supplements is to compare the median calcium intakes of people who took supplements with those who did not.

For females aged 19-50 years who consumed 100mg or more of calcium from supplements, median intakes were higher from foods and beverages compared with those who consumed less than 100mg of calcium from supplements, however there was no significant difference for females aged 51 years and over. Whereas, males who consumed 100mg or more of calcium from supplements had similar median intakes from foods and beverages compared with those who consumed less than 100mg of calcium from supplements, with the exception of males aged 31-50 years.

When intakes from supplements were taken into account, people who had consumed 100mg or more of calcium from supplements had higher median intakes of calcium than those who consumed less than 100mg of calcium from supplements for all adult age and sex groups, with the exception of males aged 19-30 years.

For people who had consumed 100mg or more of calcium from supplements, median calcium intakes on the day prior to interview were greater than the respective EARs for all adult age and sex groups, with the exception of males aged 19-30 and over 71 years. For example, for females aged 51 years and over who consumed 100mg or more calcium from supplements, median intakes increased from 692mg from foods and beverages only to 1,266mg when supplements were taken into account, (higher than the EAR of 1,100mg).

Another way of considering the effect of taking calcium from supplements is to compare individuals’ reported intakes of calcium on the day prior to interview to the EAR. While no adjustment has been made to include information from the second 24-hour recall day, the following section provides an indicator of the effect of dietary supplements on intakes of calcium. Table 2 shows the proportion of the population aged 19 years and over who had intakes of calcium which met the EAR.

The proportion of males with intakes of calcium that were equal to or greater than the EAR from foods and beverages only remained similar when supplements were taken into account (49% to 50% for males aged 19-50 years and 32% to 34% for males aged 51 years and over). Proportions were also similar for females aged 19-50 years at 36% and 39% respectively. However for females aged 51 years and over, the proportion with intakes of calcium that were equal to or greater than the EAR increased from 14% to 24% when supplements were taken into account based on intakes on the day prior to interview.

Also, amongst adults who consumed 100mg or more calcium from supplements, the effect was more marked. In particular, 14% of females aged 51 years and over who consumed 100mg or more of calcium from supplements had intakes of calcium that were equal to or greater than the EAR, based on their consumption of foods and beverages only, but this proportion increased to 63% when calcium from supplements was taken into account. An increase in proportion was also apparent for females aged 19-50 years and adult males who consumed 100mg or more of calcium from supplements.

Vitamin D is essential for the body to absorb calcium effectively, which is important for bone health and muscle function and for preventing conditions such as osteoporosis. The main source of Vitamin D is exposure to sunlight, although small amounts can be obtained through some foods, such as fatty fish and fortified margarine and milk.⁴

The Australian Health Survey found that the majority of Australian adults had sufficient levels (>50nmol/L) of Vitamin D in 2011–12. Just under one in four (23%), or 4 million adults, had a Vitamin D deficiency, which comprised 17% with a mild deficiency, 6% with a moderate deficiency and less than 1% with a severe deficiency. Overall, rates of Vitamin D deficiency were very similar for both men and women. People who took Vitamin D supplements had lower levels of Vitamin D deficiency than those who did not take supplements (7% compared with 23%). Interestingly, among those with relatively high Vitamin D levels of greater than or equal to 100nmol/L, only around one in ten were taking Vitamin D supplements.⁵

One in twenty adults (5%) reported taking Vitamin D supplements in 2011-12, while three per cent of people aged 2 years and over consumed both Vitamin D and calcium supplements either combined or separately.

A key finding from Australian Health Survey: Usual Nutrient Intakes, 2011-12 (cat. no. 4364.0.55.008) was that 73% of females and 51% of males aged two years and over did not meet requirements for calcium based on their usual intake of foods and beverages.

Analysis in this article found that when calcium from supplements consumed on the day prior to interview was taken into account, average intakes of calcium for males were similar increasing only slightly from 865mg to 887mg. However, for females, average intakes increased from 745mg to 801mg with the inclusion of supplements. In particular, for females aged 51-70 years average intakes increased from 741mg to 855mg and for females aged 71 years and over from 674mg to 783mg.

Iron is responsible for transporting oxygen in the blood to tissues throughout the body. It is also involved in the immune system, muscle function and cognitive functioning. Iron is found in a range of food sources, with cereal products and meat, poultry and game products and dishes being the primary sources in the Australian food supply.¹

A key finding from previous analysis of nutrition data from the Australian Health Survey was that one in eight people (13%) aged two years and over did not meet their iron requirements based on their intakes from food. Females were considerably more likely than males to have inadequate iron intakes, with 23% not meeting the requirements compared with 3% respectively (See Australian Health Survey: Usual Nutrient Intakes, 2011-12, cat. no. 4364.0.55.008).

This chapter presents information on Australians' consumption of iron from supplements, including the effect on overall iron intakes due to this supplementation. Women who were pregnant or breast feeding have been excluded from analysis in this article as they have different requirements.²

The National Health and Medical Research Council (NHMRC) describes the Estimated Average Requirements (EARs) for iron, which are the daily levels of iron estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group.³ Iron requirements are higher during periods of rapid growth, such as childhood, adolescence and during pregnancy, as well as for females who menstruate.

In 2011-12, 1.3 million females aged 2 years and over (13%), had some level of intake of iron from supplements (8% of 2-18 year olds, 15% of 19-50 year olds, and 14% of those aged 51 years and over) compared with 9% or approximately 960,000 males (8% of 2-18 year olds, 10% of 19-50 year olds and 8% of those aged 51 years and over).

Reported intakes of iron from dietary supplements on the day before interview varied from scant traces up to above 100mg for some individuals. The distribution of intakes is skewed for most age and sex groups. For example, the median intake of iron from supplements for females aged 19-30 years was 5mg, which is considerably lower than the average of 12mg.

The following graph shows the proportion of females aged 19-30 years who had consumed iron from supplements by various amounts on the day prior to interview. Just over one in five (22%) of these who consumed iron from supplements took 4mg or less, while there was a peak of 34% just above 5mg.

In 2011-12, average amounts of iron consumed from foods and beverages only were 12.2mg for males aged 2 years and over and 9.3mg for females aged 2 years and over on the day prior to interview. When supplements were taken into account, average iron intakes increased to 12.7mg and 10.3mg for males and females respectively.

The effect of supplementation varied by age and sex, being greatest for females aged 19-50 years. In 2011-12, females aged 19-30 years consumed an average 9.5mg of iron from foods and beverages only on the day prior to interview, and when iron from supplements were taken into account this increased to 11.1mg. Similarly, iron intakes for women aged 31-50 years increased from 9.4mg to 10.7mg when supplementation was taken into account.

This section analyses median intakes of iron to understand the effect of taking supplements.

While those who consumed iron from supplements appear to have higher intakes from foods and beverages, these differences are not significant with the exception of males aged 9-13 and 31-50 years.

When intakes from supplements were taken into account, people who had consumed iron from supplements had higher median intakes of iron than those who did not consume iron from supplements for all age and sex groups, with the exception of females aged 14-18 years.

For people who had consumed iron from supplements, median iron intakes on the day prior to interview were greater than the respective EARs for all age and sex groups, with the exception of females aged 14-18 years.

Another way of considering the effect of taking iron from supplements is to compare individuals’ reported intakes of iron on the day prior to interview to the EAR. While no adjustment has been made to include information from the second 24-hour recall day, the following section provides an indicator of the effect of dietary supplements on intakes of iron. Table 2 shows the proportion of the population aged 2 years and over who had intakes of iron which met the EAR.

Overall, 72% of females aged 2 years and over had intakes of iron that were equal to or greater than the EAR based on their consumption of foods and beverages only. When consumption of iron from supplements was taken into account, this proportion increased slightly to 75%. For males the rates were similar (88% compared with 89%).

However, amongst adults who consumed iron from supplements the effect was more marked. In particular, 60% of females who consumed iron from supplements aged 31-50 years had intakes of iron that were equal to or greater than the EAR based on their consumption of foods and beverages only, but this proportion increased to 94% when iron from supplements was taken into account. Similarly, almost all males who consumed iron from supplements had intakes that were equal to or greater than the EAR.

A key finding from Australian Health Survey: Usual Nutrient Intakes, 2011-12 (cat. no. 4364.0.55.008) was that 23% of females and 3% of males aged 2 years and over did not meet requirements for iron based on their usual intake from foods and beverages. Analysis in this article found that when iron from supplements consumed on the day prior to interview was taken into account, average intakes of iron did not change a great deal. For females, average intakes increased from 9.3mg to 10.3mg with the inclusion of supplements, and from 12.2mg to 12.7mg for males. Therefore, while supplements were not included in the estimated usual intakes, they would have been unlikely to change levels of inadequate intakes across the entire population.

However, analysis also shows that for particular age and sex groups the consumption of iron from supplements had a greater effect, considerably increasing median intakes of iron on the day prior to interview. For example, for females aged 19-30 years and over who consumed iron from supplements, median intakes increased from 9.3mg from foods and beverages only to 15.7mg when supplements were taken into account.

The 2011–13 Australian Health Survey (AHS) is the largest and most comprehensive health survey ever held in Australia. The survey, conducted throughout Australia, collected a range of information about health related issues, including health status, risk factors, health service usage and medications. The 2011–13 AHS incorporated the National Nutrition and Physical Activity Survey (NNPAS). It involved the collection of detailed physical activity information using self-reported and pedometer collection methods, along with detailed information on dietary intake and foods consumed from over 12,000 participants across Australia. The nutrition component is the first national nutrition survey of adults and children (aged two years and over) conducted in over 15 years.

Information for the nutrition component of the NNPAS was gathered using a 24-hour dietary recall on all foods, beverages and dietary supplements consumed on the day prior to the interview (Day 1). Where possible, at least eight days after the first interview, respondents were contacted to participate in a second 24-hour dietary recall via telephone interview (Day 2). This publication presents results from the first interview (Day 1), with the focus on the use of dietary supplements and their contribution to nutritional status. It complements data published in Australian Health Survey: Usual Nutrient Intakes (cat. no. 4363.0.55.008) which represents persons' usual nutrient intakes.

This publication is one of several ABS releases of results from the 2011-13 Australian Health Survey (AHS). The AHS is the largest, most comprehensive health survey ever conducted in Australia. It combines the existing ABS National Health Survey (NHS) and the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) together with two new elements - a National Nutrition and Physical Activity Survey (NNPAS) and a National Health Measures Survey (NHMS).

The following diagram shows how the various elements combine to provide comprehensive health information for the overall Australian population. The content for each component survey is listed along with the ages of respondents for which topics were collected.

As shown in the above diagram, the AHS is made up of three components:

• the National Health Survey (NHS)
• the National Nutrition and Physical Activity Survey (NNPAS)
• the National Health Measures Survey (NHMS).

All people selected in the AHS were selected in either the NHS or the NNPAS, however data items in the core were common to both surveys and therefore information for these data items is available for all persons in the AHS. All people were then invited to participate in the voluntary NHMS.

As indicated in the diagram, 20,500 people participated in the NHS, answering questions about items such as detailed health conditions, health risk factors and medications as well as all items in the core content. For the NHS component (those items collected only in the NHS and not the core), the sample size is similar to that of previous National Health Surveys and therefore the results are comparable. However for those items collected in the core, the sample size (32, 000 people) is approximately 1.5 times that in the past and therefore the estimates for core items such as smoking and Body Mass Index are expected to be more accurate in particular at finer disaggregates than in previous surveys. 

The AHS does not exclude Aboriginal and Torres Strait Islander people where they are randomly selected in the general population sample. However, the AHS also includes an additional representative sample of around 13,000 Aboriginal and Torres Strait Islander people for which first results were released in November 2013. This is a separate collection of Aboriginal and Torres Strait Islander people living in remote and non-remote areas, including discrete communities. The structure is the same as outlined above, comprised of the National Aboriginal and Torres Strait Islander Health Survey component, the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity component and the National Aboriginal and Torres Strait Islander Health Measures Survey component.

For more information on future releases see Release schedule.

This release previously used catalogue number 4364.0.55.010.