multivitamin (MVI) with minerals

Indications

• prevention & treatment of vitamin deficiency & mineral deficiency
• multivitamins may slow cognitive aging in older adults
• multivitamin supplementation improves memory in older adults
  • elderly who took a multivitamin with minerals scored better on some but not all cognition tests
  • benefit for global cognition & episodic memory

Contraindications

• no benefit in primary prevention of cardiovascular disease or cancer
• no benefit in preventing cancer, cardiovascular disease, or death, except for small benefit for cancer prevention with multivitamin use

Clinical trials

[1] small study

Study design

• small study 158 patients, age 45 or older
• randomized placebo-controlled
• multivitamin + minerals QD for one year

Results:

• significantly fewer symptoms of infection (43% vs 73%)
  • upper respiratory tract infection specifically mentioned
• incidence of infection was significantly lower in:
  • subject < 65 years of age (relative risk 0.6)
  • subjects with diabetes mellitus (relative risk 0.2)
• no effect on physical or mental health/quality of life
• MOST subjects were able to correctly identify their assignment to multivitamin with minerals vs placebo

[2] MAVIS trial

Study design:

• 910 older adults (age, 65) healthy community dwelling multivitamins + minerals vs placebo

Primary outcomes were

• contacts with primary care providers for infections self-reported days of infection
• health-related quality of life

Secondary outcomes were related to

• antibiotic prescriptions
• hospital admissions
• outpatient visits
• adverse events
• adherence to medication regimens

Results:

• after 1 year, none of the measured outcomes differed significantly between the 2 groups

[3] Toronto Study of elderly 85+ years

• 763 residents (mean age, 85) of 21 nursing homes in Toronto
• randomized, placebo controlled, 18 months of follow-up

Results:

• no difference in infection, emergency department visits, or hospitalizations; however,
• subjects without dementia had more infections than demented patients & in the group, supplement recipients had fewer infections than placebo recipients

Women's Health Initiative

Study design: 161 808 participants, 8 year follow-up

Results:

• little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women

[5,6] Physicians' Health Study II

Study design

• 15,000 male U.S. physicians age >= 50 were randomized to a daily multivitamin or placebo
• subjects followed for roughly 11 years

Results:

• small but significant reduction in total cancer diagnoses
• no difference in composite outcome of myocardial infarction, stroke, or cardiovascular mortality

[10] Iowa Women's Health Study

Study design:

• observational study
• 38,722 older women, mean age: 61.6 years
• women followed for 22 years
• 15,594 deaths (40.2%) in these 22 years

Results:

• vitamin & mineral supplementation associated with increased mortality in older women, especially with iron supplementation

[16]

• multivitamins; vitamin A, vitamin C, & vitamin E; vitamin D alone; reduced saturated fat intake; & the Mediterranean diet with no effect no effect on mortality or cardiovascular disease
• reduced salt intake a
  • lowers risk of all-cause mortality in normotensive only
  • lowers risk of cardiovascular mortality in hypertensive only
• omega-3 long-chain polyunsaturated fatty acids associated with reduced risk of coronary artery disease & myocardial infarction
• folic acid lowers risk for stroke
• calcium + vitamin D supplements increases risk for stroke
• (suboptimal quality of the evidence)

[18] COSMOS-Mind

• funded by the National Institute on Aging

Study design

• 2262 men & women nationwide, > 65, mean age = 73 years
• cognitive assessments: baseline assessment & at years 1, 2, and 3
• telephone-administered cognitive battery including a composite global score, assessment of episodic memory, executive function, & other domains

Results:

• over 3 years of treatment, older aldults randomized to multivitamins did significantly better than those randomized to a placebo
• investigators estimate that multivitamins slow cognitive aging by 60% over 3 years, reducing cognitive aging by 1.8 years
• subgroup with cardiovascular disease may have a particularly strong benefit

More general terms

• nutritional supplement

More specific terms

• M-Natal Plus

Additional terms

• multivitamin (MVI)
• vitamin

Patient information

multivitamin/mineral patient information