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ucts, most women are not receiving sufficient folate from food alone. The USPSTF recommends that all women of childbearing age take a multivitamin containing 800 mcg of folate to help reduce the risk of neural tube defects. 9 Multivitamin supplementation is also important for patients adopting calo- rie-restricted diets or diets that exclude certain foods or food groups. 12 Role of the Pharmacist Approximately 90% of Americans receive inadequate dietary levels of one or more key vitamins and minerals—spe- cifically D, E, A, C, calcium, and magne- sium—and pharmacists have important roles in helping close this nutrition gap. 4 Pharmacists can educate patients in the general population regarding the impor- tance of vitamin and mineral supple- ments, which have been demonstrated to help provide nutritional support in addition to a healthy diet. 4 Pharmacists can also screen patients for particular characteristics that may place them at higher risk for insufficient micronutrient intake, including age/life stage, comorbidities, and medications. However, treatment of deficiencies and their associated conditions are beyond the scope of a daily multivitamin and must take place under the supervision of a physician. By evaluating patients' characteristics and nutritional needs, pharmacists can make appropriate recommendations regarding single- and multivitamin and mineral supplements to help patients close the vitamin and mineral gap. References 1. 2015 Survey of Pharmacists' OTC Recommenda- tions. OTC Guide, Pharmacy Times. June 2015. 2. Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press; 2006. 3. Underwood BA. Perspectives from micronutrient malnutrition elimination/eradication programmes. Bull World Health Organ. 1998;76(suppl 2):34-37. 4. Wallace TC, McBurney M, Fulgoni VL 3rd. Multivitamin/mineral supplement contribution to micronutrient intakes in the United States, 2007- 2010. J Am Coll Nutr. 2014;33(2):94-102. doi: 10.1080/07315724.2013.846806. 5. United States Department of Agriculture. Dietary reference intakes (DRIs): estimated average requirements. www.nal.usda.gov/fnic/DRI/ DRI_Tables/recommended_intakes_individuals. pdf. Accessed October 2015. 6. US Department of Agriculture and US Department of Health and Human Services. Dietary Guide- lines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Offce; 2010. 7. Ward E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutr J. 2014;13:72. doi: 10.1186/1475-2891-13-72. 8. S econd National Report on Biochemical Indica- tors of Diet and Nutrition in the U.S. Population. Atlanta, GA: Centers for Disease Control and Prevention; 2012. 9. US Preventive Services Task Force. Folic acid for the prevention of neural tube defects: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150(9):626-631. 10. Calcium: fact sheet for health professionals. National Institutes of Health website. https://ods. od.nih.gov/pdf/factsheets/Calcium-HealthProfes- sional.pdf. Accessed October 2015. 11. Magnesium: fact sheet for professionals. National Institutes of Health website. https://ods.od.nih. gov/pdf/factsheets/Magnesium-HealthProfession- al.pdf. Accessed October 2015. 12. Stein K. Severely restricted diets in the absence of medical necessity: the unintended conse- quences. J Acad Nutr Diet. 2014;114(7):986- 994. doi: 10.1016/j.jand.2014.03.008. Pharmacy Times PharmacyTimes.com December 2015 INFORMATION FOR THE PHARMACIST TABLE 2: VITAMINS/MINERALS, SOURCES, AND EFFECTS OF INSUFFICIENCY IN THE UNITED STATES 8-11 Vitamin/Mineral Dietary Sources Potential Consequences of Insufficiency Medications/Conditions Related to Insufficiency Vitamin A Vegetables, fruits, meats, animal products, butter, cream Corneal thinning, impaired bone growth Fat malabsorption syndromes, includ- ing celiac disease, Crohn's disease, and pancreatic disorders B 6 (pyridoxine) Meats, whole grains, vegetables, nuts Dermatitis, glossitis, depression, con- fusion, convulsions, anemia Isoniazid, high-dose oral contracep- tives B 12 (cobalamin) Fish, meat, poultry, eggs, milk, forti- fied breakfast cereals (important source for vegetarians) Macrocytic anemia Malabsorption syndromes Vitamin C Orange juice, grapefruit juice, fruits, vegetables, fortified cereals Impaired collagen biosynthesis Smoking Vitamin D Sunlight exposure, fortified break- fast cereals, fortified milk, fortified orange juice Poor bone strength Inadequate sun exposure, advanc- ing age Vitamin E Vegetables, fruits, meats, animal products, butter, cream, nuts, seeds Peripheral neuropathy (rare) Fat malabsorption syndromes, includ- ing celiac disease, Crohn's disease, and pancreatic disorders Folate Leafy green vegetables, fruit, dried beans, peas Macrocytic anemia, fetal neural tube defects from maternal insufficiency Alcohol, methotrexate, sulfa drugs, Crohn's disease Calcium Dairy foods (milk, yogurt, cheese), kale, Chinese cabbage, broccoli, fortified foods Osteoporosis, rickets Menopause, amenorrhea, lactose intolerance or cow's milk allergy, vegetarian diet Magnesium Green leafy vegetables, legumes, nuts, seeds, whole grains Early symptoms: loss of appetite, nausea, vomiting, fatigue, weakness Crohn's disease, celiac disease, region- al enteritis, resection/bypass of the small intestine, type 2 diabetes, alco- hol dependence, advancing age The Campaign for Essential Nutrients is committed to educating Americans about the essential role vitamin and mineral supplements can play in help - ing to fill their daily nutritional gaps. The Campaign for Essential Nutrients is sponsored (funded) by Bayer HealthCare LLC, DSM Nutritional Products, Pfizer Inc, and Pharmavite, LLC. The organizations came together as part of their shared commitment to provide consumers with simple ways to supple- ment their diets and get key daily nutrients.