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To the Editor: Based on their meta-analysis of antioxidant supplementation trials, Dr Bjelakovic and colleagues¹ conclude that some of the intervention nutrients appeared to be associated with increased mortality. Particular aspects of their approach, analysis, and reported findings may have led to incomplete or biased determinations of the real effect of such nutrients in various populations.

Although vitamin A is related to beta carotene (and other provitamin A carotenoids) by virtue of its in vivo formation through oxidative cleavage of the latter, it is not considered an antioxidant nutrient.² Its primary inclusion in the meta-analysis, except as an eligible trial cosupplement, is therefore surprising, with specific implications for the 2 trials that tested vitamin A only. Controlled trials of several other nonantioxidant vitamins could have been similarly included in the analysis along with those testing vitamin A.

Nearly half of the studies originally identified from the literature (405 of 815) . . . [Full Text of this Article]

Demetrius Albanes, MD
daa@nih.gov
Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, Maryland

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