B0015 - Trends in Prescription and Non-Prescription Digestive Enzyme Use in the United States From 2009 to 2020

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Kira L. Newman, MD, PhD

University of Michigan
Ann Arbor, MI

Kira L. Newman, MD, PhD, Peter D. Higgins, MD, PhD, MSc
University of Michigan, Ann Arbor, MI

Introduction: The use of digestive enzymes like amylase, lipase, and related compounds has not been well-characterized. There are both prescription medications and nonprescription supplements that contain a range of digestive enzymes, which may impact the gut microbiome in diverse ways or have other effects. Our aim was to describe the use of prescription and non-prescription digestive enzymes by US adults and children and reported reasons.

Methods: We used data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) from 2009 to 2020 to assess prescription and nonprescription supplement use in the prior 30 days. We evaluated ingredient lists to identify those including digestive enzymes. We then compared trends in use over time and by sex, age, race/ethnicity, education, income, and alcohol use using quasipoisson models.

Results: Prescription and nonprescription digestive enzyme use was stable from 1999 to 2020. Prevalence of use of non-prescription digestive enzyme-containing products was 1.6% for all age groups (95% confidence interval (CI) 1.4-1.8, Table). Prevalence of prescription digestive enzymes was 0.05% overall (95% CI 0.03-0.07, Table). Rates of non-prescription digestive enzymes were significantly higher in older age groups (Table). Individuals aged 60 years and older were the most likely to take prescription digestive enzymes (0.2% prevalence, p=0.006 compared to < 60 years). There were no significant gender-related differences in digestive enzyme use. Non-Hispanic white individuals were significantly more likely to use non-prescription digestive enzymes than other racial/ethnic groups (p=0.003). There was significantly more non-prescription digestive enzyme use by individuals who had ever used alcohol (p=0.01), had higher household incomes (p< 0.001), and had some college education or more (p=0.005 compared to less than a 9^th grade education). The most common reasons for non-prescription digestive enzyme use were to improve and maintain overall health and to get more energy. Only 13% of people on non-prescription digestive enzyme supplements reported that the product was recommended by a healthcare provider.

Discussion: Around 5.3 million people in the United States take non-prescription digestive enzymes. Higher income, older, more educated, non-Hispanic white people who have ever used alcohol are more likely to take non-prescription enzymes. They are most often used without the recommendation of a healthcare provider.

Characteristics	Non-prescription digestive enzymes			Prescription digestive enzymes
	Estimate (% prev)	SE	p-value	Estimate (% prev)	SE	p-value
Overall	1.64	0.10		0.05	0.01
Age
Under 20 years	0.55	0.08	Ref.	0.01	0.01	Ref.
20-39 years	1.71	0.19	< 0.001	0.03	0.02	0.43
40-59 years	1.93	0.18	< 0.001	0.02	0.01	0.50
60 and over	2.60	0.31	< 0.001	0.16	0.04	< 0.001
Gender
Men	1.49	0.12	Ref.	0.05	0.01	Ref.
Women	1.78	0.15	0.12	0.05	0.01	0.66
Race/Ethnicity
Hispanic	1.17	0.15	Ref.	0.04	0.02	Ref.
Non-Hispanic Asian	1.15	0.17	0.94	0.05	0.04	0.62
Non-Hispanic Black	1.06	0.12	0.54	0.08	0.03	0.17
Non-Hispanic White	1.96	0.18	< 0.01	0.05	0.01	0.48
Other	1.84	0.55	0.14	0.07	0.07	0.54
Education level (adults)
Less than 9th grade	0.98	0.27	Ref.	0.07	0.04	Ref.
9th-11th grade, no HS diploma	1.15	0.27	0.66	0.11	0.05	0.53
High school graduate/GED	1.19	0.16	0.52	0.04	0.02	0.37
Some college or AA degree	2.21	0.20	< 0.01	0.09	0.02	0.52
College graduate or above	2.91	0.31	< 0.001	0.04	0.01	0.74
Household Percent income to poverty ratio
PIR≤130%	0.92	0.12	Ref.	0.06	0.02	Ref.
PIR >130%	1.93	0.13	< 0.001	0.05	0.01	0.50
Alcohol use
Ever	2.38	0.28	Ref.	0.08	0.03	Ref.
Never	1.59	0.34	0.04	0.05	0.03	0.56

Table: Characteristics of non-prescription and prescription digestive enzyme use in the United States. Weighted estimates as percent prevalence in the United States based off a sample of n=55,969 individuals. P-values from unadjusted quasipoisson models of enzyme use and each characteristic. Data from CDC NHANES 2009-2020.

Disclosures:

Kira Newman indicated no relevant financial relationships.

Peter Higgins: AbbVie – Consultant. Amgen – Consultant. Eli Lilly – Consultant. Gastrointestinal Health Foundation – Consultant. Genentech – Consultant. Imedex – Consultant. JBR Pharma – Consultant. Lycera – Consultant. National Institutes of Health – Grant/Research Support. Pfizer – Consultant. Takeda – Consultant, Grant/Research Support. The Crohn’s & Colitis Foundation – Grant/Research Support. Vindico Medical Education – Consultant.

Kira L. Newman, MD, PhD, Peter D. Higgins, MD, PhD, MSc. B0015 - Trends in Prescription and Non-Prescription Digestive Enzyme Use in the United States From 2009 to 2020, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.