Trends in hair, skin, and nails supplement use: Data from the National Health and Nutrition Examination Survey 2011-2020

To the Editor: Hair, skin, and nails (HSN) supplements are increasingly popular despite limited evidence and lack of regulatory oversight.1Perez-Sanchez A.C. Tantry E.K. Burns E.K. Perez V.M. Prabhu S. Katta R. Skin, hair, and nail supplements: marketing and labeling concerns.Cureus. 2020; 12e12062https://doi.org/10.7759/cureus.12062Crossref Google Scholar We examined characteristics and temporal trends of HSN supplement use using 2011-2020 National Health and Nutrition Examination Survey data. A representative sample, including National Health and Nutrition Examination Survey 2011-2012, 2013-2014, 2015-2016, and 2017-March 2020, prepandemic data, were used (response rates of 72.6%, 71.0%, 61.3%, and 51.0%, respectively). Our outcome of interest was past-month HSN supplement use, defined as past 30-day self-reported consumption of vitamins, minerals, herbals, and other dietary supplements for “healthy skin, hair, and nails.” Participant sociodemographic characteristics were examined and those with missing data were excluded. Multivariable logistic regression was performed, and odds ratios were calculated to investigate associations between sociodemographic characteristics and HSN supplement use. Statistical analyses were performed using SAS v9.4 (SAS Institute, Cary, NC). Of 40,959 participants, 3.9% reported past-month HSN supplement use (Table I). HSN supplement users were more often younger (20-39 years old) and female. Adjusted odds of HSN supplementation were significantly higher in individuals 20-39 years old (adjusted odds ratio [aOR] 1.67; 95% confidence interval [CI], 1.28-2.17) compared to individuals ≥65 years-old (Table II). Females (aOR 3.14; 95% CI, 2.64-3.75) were more likely than males to report HSN supplement use, as were Black (aOR 1.56; 95% CI, 1.26-1.93) and Hispanic/Latino individuals (aOR 1.31; 95% CI, 1.09-1.58) compared to non-Hispanic White individuals. Individuals with more than high school education (aOR 1.30; 95% CI, 1.05-1.61) were more likely to report HSN supplement use than those that did not graduate high school.Table IHair, skin, and nails dietary supplement use in prior 30 days among US adults by population characteristics, NHANES 2011-2020∗NHANES 2017-March 2020 prepandemic data were used.CharacteristicsNo hair, skin, and nails supplement useHair, skin, and nails supplement useP valueNo.Weighted % (95% CI)No.Weighted % (95% CI)Total (unweighted; weighted)39,357; 548,049,2561,602; 20,165,270Age (years)<.001 20-39995226.8 (25.1-28.6)52334.3 (29.8-38.8) 40-6416,92245.0 (43.3-46.6)71244.0 (39.5-48.5) ≥6512,48328.2 (26.2-30.1)36721.7 (17.5-25.9)Sex<.001 Male17,48143.4 (42.3-44.6)36419.9 (17.0-22.9) Female21,87656.6 (55.4-57.7)123880.1 (77.1-83.0)Race/Ethnicity<.001 Non-Hispanic White17,86773.3 (70.5-76.2)57665.9 (61.8-70.1) Black77198.1 (6.7-9.5)41412.0 (9.3-14.7) Hispanic/Latino780010.9 (9.0-12.7)34413.3 (10.8-15.9) Other race/ethnicity†Other race/ethnicity includes multiracial.59717.7 (6.7-8.7)2688.8 (7.0-10.5)Education status.06 Less than high school651210.2 (9.0-11.4)1998.0 (6.1-9.8) High school graduate824820.5 (18.9-22.0)27918.6 (14.8-22.5) Greater than high school24,59769.3 (67.1-71.6)112473.4 (69.5-77.3)Poverty income ratio.30 Below poverty level669510.8 (9.6-12.1)25211.8 (9.2-14.3) At/above poverty level32,66289.2 (87.9-90.4)135088.2 (85.7-90.8)Smoking status.04 Current594614.1 (13.0-15.2)22014.2 (11.0-17.5) Former10,70828.6 (26.9-30.2)36423.9 (20.5-27.4) Never22,70357.3 (55.7-59.0)101861.8 (57.7-66.0)Bold values indicate statistically significant results, defined as P < .05.CI, Confidence interval; NHANES, National Health and Nutrition Examination Survey; US, United States.∗ NHANES 2017-March 2020 prepandemic data were used.† Other race/ethnicity includes multiracial. Open table in a new tab Table IIMultivariable unadjusted and adjusted∗Adjusted for age, sex, race/ethnicity, education, poverty income ratio, smoking status, and survey year. odds ratios of hair, skin, and nails dietary supplement use in prior 30 days, NHANES 2011-2020†NHANES 2017-March 2020 prepandemic data were used.VariableuOR95% CIaOR∗Adjusted for age, sex, race/ethnicity, education, poverty income ratio, smoking status, and survey year.95% CIAge 20-391.66(1.31-2.09)1.67(1.28-2.17) 40-641.27(1.00-1.62)1.28(1.00-1.65) ≥651.00Ref1.00RefSex Male1.00Ref1.00Ref Female3.08(2.58-3.68)3.14(2.64-3.75)Race/Ethnicity Non-Hispanic White1.00Ref1.00Ref Black1.65(1.34-2.02)1.56(1.26-1.93) Hispanic/Latino1.37(1.13-1.65)1.31(1.09-1.58) Other Race/Ethnicity‡Other race/ethnicity includes multiracial.1.27(1.02-1.57)1.19(0.96-1.47)Education Less than high school1.00Ref1.00Ref High school graduate1.17(0.83-1.63)1.13(0.82-1.55) Greater than high school1.36(1.12-1.65)1.30(1.05-1.61)Poverty income ratio Below poverty level1.10(0.92-1.31)0.96(0.80-1.16) At/above poverty level1.00Ref1.00RefSmoking status Current0.94(0.71-1.23)1.10(0.84-1.43) Former0.78(0.65-0.93)1.00(0.82-1.21) Never1.00Ref1.00RefSurvey year 2011-20121.00Ref1.00Ref 2013-20141.22(0.88-1.69)1.23(0.88-1.72) 2015-20161.46(1.10-1.94)1.49(1.11-1.99) 2017-2020†NHANES 2017-March 2020 prepandemic data were used.2.03(1.51-2.74)2.08(1.55-2.79)Bold values indicate statistically significant results.aOR, Adjusted odds ratio; CI, confidence interval; NHANES, National Health and Nutrition Examination Survey; Ref, reference; uOR, unadjusted odds ratio.∗ Adjusted for age, sex, race/ethnicity, education, poverty income ratio, smoking status, and survey year.† NHANES 2017-March 2020 prepandemic data were used.‡ Other race/ethnicity includes multiracial. Open table in a new tab Bold values indicate statistically significant results, defined as P < .05. CI, Confidence interval; NHANES, National Health and Nutrition Examination Survey; US, United States. Bold values indicate statistically significant results. aOR, Adjusted odds ratio; CI, confidence interval; NHANES, National Health and Nutrition Examination Survey; Ref, reference; uOR, unadjusted odds ratio. Examining temporal trends, individuals surveyed in 2015-2016 (aOR 1.49; 95% CI, 1.11-1.99) and 2017-2020 (aOR 2.08; 1.55-2.79) were more likely to report HSN supplement use than individuals in 2011-2012. Overall, participants reporting past-month HSN supplement use increased from 2.5% (95% CI, 1.9%-3.0%) in 2011-2012 to 4.9% (95% CI, 4.0%-5.7%) in 2017-2020. We observed a trend of increasing HSN supplementation, nearly doubling from 2011-2012 to 2017-2020. This finding parallels projected global beauty supplement market growth from $3.5 billion in 2016 to $6.8 billion in 2024.2Burns E.K. Perez-Sanchez A. Katta R. Risks of skin, hair, and nail supplements.Dermatol Pract Concept. 2020; 10e2020089https://doi.org/10.5826/dpc.1004a89Crossref PubMed Google Scholar Promotion by celebrities and social media influencers may contribute to this trend.2Burns E.K. Perez-Sanchez A. Katta R. Risks of skin, hair, and nail supplements.Dermatol Pract Concept. 2020; 10e2020089https://doi.org/10.5826/dpc.1004a89Crossref PubMed Google Scholar HSN supplement use was more likely among younger, female, Black, and Hispanic/Latino individuals, as well as those with more than high school education. Limited data support HSN supplement use and significant risks exist. Biotin, one of the most common HSN supplements, can interfere with thyroid and cardiac function testing, prompting a U.S. Food and Drug Administration warning.3Lipner S.R. Rethinking biotin therapy for hair, nail, and skin disorders.J Am Acad Dermatol. 2018; 78: 1236-1238https://doi.org/10.1016/j.jaad.2018.02.018Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Heavy metals, including arsenic, lead, mercury, and cadmium, have been found in best-selling collagen supplements.4Paul K. Consumer beware: these popular collagen supplements contain heavy metals.https://www.organicconsumers.org/blog/consumer-beware-these-popular-collagen-supplements-contain-heavy-metalsDate: 2020Date accessed: December 2, 2022Google Scholar Additionally, a study of HSN supplements uncovered numerous safety concerns, including nutrient “overdosing,” lack of warning labels, and quality issues.5Perez-Sanchez A.C. Burns E.K. Perez V.M. Tantry E.K. Prabhu S. Katta R. Safety concerns of skin, hair and nail supplements in retail stores.Cureus. 2020; 12e9477https://doi.org/10.7759/cureus.9477Crossref Google Scholar The use of health-related claims without adequate evidence, such as “promotes younger looking skin,” may also mislead consumers.1Perez-Sanchez A.C. Tantry E.K. Burns E.K. Perez V.M. Prabhu S. Katta R. Skin, hair, and nail supplements: marketing and labeling concerns.Cureus. 2020; 12e12062https://doi.org/10.7759/cureus.12062Crossref Google Scholar Limitations include the use of self-reported data and inability to examine specific supplements and reason for use (eg, hair loss). As HSN supplementation has increased and may carry associated risks, dermatologists should recognize risk factors for HSN supplement use and advise on potential risks and benefits. None disclosed.