Susy Cedeno Arevalo
Harvard T. H. Chan School of Public Health -ECE - PPCR Program, Boston, MA, USA; Fundacion Valle del Lili, Cali, Colombia.
Maria Lucia Andrews
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Candel Therapeutics.
Tanya Mateo
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; CEDIMAT, Santo Domingo, Dominican Republic
Branda Arismendy
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Luisa Cruz
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA. PUCMM, Santiago, Dominican Republic.
Andres Gomez
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Raphaela Anderson Colares
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Instituto D'or de Pesquisa e Ensino, Rio de Janeiro, Brazil.
Daniel Villareal
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
Daniela Godoy
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Hospital del Trabajador, Santiago, Chile.
Oludolapo Omoyiola
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Memorial Sloan Kettering Group
Shailza Kathuria
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Camila Schumacher Kluge
Harvard T.H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
Yasmim Helen Dias de Souza
Harvard T.H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
Abisoye Ajayi
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Memorial Sloan Kettering Group
Jerry Li
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Aline Fares
Harvard T.H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Beatriz Bartulic Machado
Harvard T.H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Natalia Soto
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Tecnologico de Monterrey, CCM
Hebe Castillo Molina
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA. Facultad Mexicana de Medicina Universidad La Salle, FMM ULSA, Ciudad de México, México.
Alessandro Solis
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Universidad de Ciencias Medicas UCIMED, San Jose, Costa Rica
Giannina Melgarejo
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Dorcas Thairu
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA
Oluwatosin Ajibola
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Memorial Sloan Kettering Group
Erica Adissy
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Hospital do Coracao, Brazil
Ahmed Salem Alsuliamani
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA: Riyadh Saudi Arabia King Fahad Medical City
David Rodriguez
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Abbott EPD, Bogota, Colombia.
Ana Fandinho
Harvard T. H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Instituto D'or de Pesquisa e Ensino, Rio de Janeiro, Brazil.
Federica Rossetto
Harvard T.H. Chan School of Public Health - ECE - PPCR Program, Boston, MA, USA; Fondazione Don Carlo Gnocchi Onlus, Italy
Abstract
Background: Digestive supplements are widely used in the United States, yet their association with gastrointestinal symptoms in the general population remains unclear.
Objective: To evaluate the association between digestive supplement use and self-reported abdominal pain among U.S. adults using nationally representative NHANES 2017–2018 data.
Methods: We analyzed 5,564 adults aged ≥20 years from NHANES 2017–2018. The exposure was self-reported use of supplements to improve digestion. The outcome was abdominal pain during the past 12 months. Survey-weighted logistic regression models were used to estimate crude and adjusted odds ratios (ORs), accounting for demographic, socioeconomic, behavioral, and clinical covariates. Effect modification by age was assessed through interaction testing and stratified analyses.
Results: The analytic sample included 5,569 adults (mean age 48.3 years; 53.1% female; mean BMI 29.8 verall, 5.7% reported supplement use for digestion. In unadjusted analyses, supplement use was significantly associated with abdominal pain (OR 1.76, 95% CI 1.18–2.64, p = 0.009). In the fully adjusted model, the association was attenuated and no longer statistically significant, though a trend remained (OR 1.58, 95% CI 0.96–2.60, p = 0.068). Anxiety (OR 2.21, 95% CI 1.77–2.76), sleep disturbance (OR 1.97, 95% CI 1.62–2.39), and prior gallbladder surgery (OR 2.42, 95% CI 1.61–3.62) were independently associated with abdominal pain. Although the overall supplement-by-age interaction was not statistically significant, stratified analyses demonstrated progressively stronger associations with advancing age, reaching statistical significance among adults aged ≥60 years.
Conclusions: Digestive supplement use was more strongly associated with abdominal pain among older adults, although the overall association attenuated after adjustment for demographic, psychosocial, and clinical factors. Anxiety, sleep disturbance, and prior gallbladder surgery emerged as independent correlates of abdominal pain. The cross-sectional design precludes determination of temporality; abdominal pain may lead to increased supplement use, supplement use may contribute to symptoms in some individuals, or both mechanisms may coexist. These findings highlight the importance of contextualizing digestive supplement use within broader clinical and psychosocial profiles, particularly in aging populations.
