TOPLINE

The use of probiotic supplements increased sharply in the US from 2009 to 2023 — by 287% among individuals aged 20 years or older and 786% among individuals younger than 20 years — whereas the consumption of microbiome-supportive foods remained practically unchanged. Even though probiotic users consumed greater amounts of fiber and more foods with high microbial content than nonusers, this dietary advantage appeared to fade over time.

METHODOLOGY

• Dietary supplements — especially probiotics, which are heavily marketed directly to consumers — are becoming more popular among US adults and children. However, whether this trend is accompanied by meaningful dietary improvements, such as eating more fiber or fermented foods, remains unclear.
• Researchers analyzed national survey data from 2009 to 2023 to quantify trends in probiotic use and the consumption of fiber and foods with high microbial content.
• A total of 62,700 survey respondents with supplement data (representing a weighted sample of 242,605,800 US residents) and 54,776 respondents with dietary recall data (representing 256,823,335 US residents) were included.
• Probiotic use was determined through 30-day recall by searching reported supplement ingredient information for probiotic bacteria and related terms; information on dietary fiber and caloric intake was also obtained using dietary recalls.
• Dietary live microbe intake was estimated using a classification system that categorized foods as having low (< 10,000 colony-forming units [CFUs]/g), medium (10,000-10,000,000 CFUs/g), or high (> 10,000,000 CFUs/g) live microbe content.

TAKEAWAY

• During the study period, probiotic use increased sharply from 1.8% to 6.96% among individuals aged 20 years or older and from 0.63% to 5.58% among individuals younger than 20 years (both P < .001), representing increases of 287% and 786%, respectively.
• Fiber intake changed minimally over time and remained below the recommended 14 g/1000 kcal level across all age groups. Among individuals aged 20 years or older, fiber intake decreased slightly from 8.52 g/1000 kcal to 8.26 g/1000 kcal (P = .009), and among individuals younger than 20 years, fiber intake increased slightly from 7.37 g/1000 kcal to 7.97 g/1000 kcal (P = .0166).
• The intake of foods with high microbial content declined modestly after 2011-2012; however, average intake of microbial foods increased slightly.
• Probiotic users generally had higher fiber intake (1.35 g/1000 kcal more) and higher scores for average microbial food intake (0.042 points higher; both P < .001) than nonusers, but these microbiome-focused dietary patterns appeared to weaken over time.

IN PRACTICE

"The increasing probiotic supplement use by adults and children in the US, with a lack of corresponding improvements in diet, highlights a gap in health policy and communication. There is a need for public health interventions to improve the microbial and fiber content of the American diet to promote microbiome health," the authors wrote.

SOURCE

The study was led by Kira L. Newman, MD, PhD, University of Michigan, Ann Arbor, Michigan. It was published online as a Research Letter on September 7 in Clinical Gastroenterology and Hepatology.

LIMITATIONS

The study was cross-sectional in nature. Response rates were lower in the more recent survey cycles.

DISCLOSURES

Several authors reported receiving consulting fees, research support, or stock options from various pharmaceutical and biotechnology companies or holding patents related to these companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.