This article is originally publish as: Susan Roberts, PhD True or False? What Your Older Patients Believe About Nutrition by MedPage Today.
As the information is concise I am taking liberty to re-post it here. I there is any conflict, kindly advise.
Edits in italics.
Tracy Hampton, PhD
Reviewed by Jackie Ballou Erdos, MS, RD, CSSD, Registered Dietitian & Owner, Balancing Act Nutrition, New York, NYIN BRIEF
- Numerous studies looking at the effects of multivitamins on overall health as well as on specific health parameters have generated conflicting results.
- The only long-term, large-scale randomized clinical trial on multivitamin use, conducted just in men, found modest but significant reductions in cancer and cataracts, but not cardiovascular disease or cognitive decline. Results from randomized clinical trials indicate no survival benefit to multivitamin use.
- For healthy adults with good access to nutrition, multivitamins may provide a low risk nutritional "top-up". But ya still wanna eat your veggies!
- However, for adults at who have, or at high risk for nutritional deficiencies, multivitamins are safe products that can provide clear benefits.
Changes associated with normal aging and age-related diseases can impact the nutritional intake of older adults, which in turn affects aspects of health ranging from cardiovascular function to cognition. As the years pass, many may wonder whether they should take a daily multivitamin to fill any gaps in their diet.
“For very healthy patientshttp://24636538-181122512915269833.preview.editmysite.com/editor/main.php# with a great diet, a multivitamin may not be necessary; however, a simple multivitamin is unlikely to hurt either, so it becomes a personal choice,” said Katherine Tucker, PhD, a Professor of Nutritional Epidemiology in the Department of Clinical Laboratory & Nutritional Sciences at UMass Lowell.
However, as we age, our need for calories decreases while our need for nutrition increases.
“As nutrient inadequacies are more common with aging, though, a multivitamin supplement may be useful for many individuals, particularly if the diet is not adequate in nutrient quality or quantity.”
Multiple factors come into play when considering the nutritional needs of older and elderly adults—for example, their specific health conditions, activity level, caloric requirements, and ability to access and prepare food (not to mention their personal food preferences) will shift over time and have varying effects on their dietary intake. Tucker noted that aging is often associated with a decreased sense of smell and appetite that may lead to inadequate nutrient intake, as well as malabsorption of nutrients that can decrease the health benefits of consumed foods. “Therefore, at the same time that energy requirement is decreasing, the need for many specific nutrients is increasing,” she said. “Vitamin B12, for example, is a common deficiency due to poor absorption as stomach acid decreases. This means that it is very important to choose nutrient-dense foods and to avoid empty calorie foods and, in cases of deficiency, supplements may be needed.”
Numerous observational studies looking at the effects of multivitamins on overall health as well as on specific health parameters have generated conflicting results. “The observational studies evaluating multivitamin use on various health outcomes have been mixed, but there are many methodologic limitations that have not been fully accounted for,” said Howard Sesso, ScD, MPH, an Associate Epidemiologist at the Divisions of Preventive Medicine and Aging at Brigham and Women’s Hospital, and an Associate Professor of Medicine at Harvard Medical School.
“For example, there are hundreds of multivitamin formulations on the market, making it difficult generalize multivitamin as a single category. We also know that those taking multivitamins may differ in important ways compared to non-users that observational studies try, but probably don’t optimally, account for,” he says.
The best evidence for any effects of a multivitamin on health comes from randomized clinical trials, for which only one long-term, large-scale trial—the Physicians’ Health Study II (PHS II), which included men aged 50 years and older—has been completed. A 2012 analysis of PHS II by Sesso and his colleagues found that multivitamins did not reduce major cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, after more than a decade of treatment and follow-up.1
Daily multivitamin supplementation in PHS II has been found to modestly but significantly reduce the risk of total cancer.2 In addition, daily multivitamin use modestly and significantly decreased the risk of cataracts, but had no significant effect on visually significant age-related macular degeneration.3 Among male physicians aged 65 years or older in PHS II, long-term use of a daily multivitamin did not provide cognitive benefits.4
“We recently initiated a new clinical trial, the COcoa Supplement and Multivitamin Outcomes Study, or COSMOS, to examine the long-term health effects of multivitamin use in older women, plus see whether we can replicate in women the encouraging findings on cancer and cataract seen in PHS II,” said Sesso.
Although benefits of multivitamins may only be modest at best in healthy individuals, supplements containing combinations of certain nutrients can provide clear benefits for those who have, or are at high risk for, deficiencies.5 “In a patient with poor health status, nutrient status should be checked,” said Tucker. “Nutrient supplements make a big difference if there are deficiencies; however, too many supplements may also be harmful.” Tucker pointed to deficiencies in vitamins B12 and D as common among older patients, noting that these vitamins may need to be taken in doses higher than those contained in a standard multivitamin. On the other hand, care should be taken to avoid too much folic acid, iron, and preformed vitamin A, or retinol.
“The major multivitamin brands tend to represent safe products, so there is likely no downside to taking a multivitamin in addition to maintaining a healthy lifestyle and diet,” said Sesso. “But it remains unclear whether taking a multivitamin actually reduces disease risk, though PHS II did provide encouraging data that warrants replication.”
As a footnote, many health professionals look to reputable sites like these to ensure that supplement has been tested for purity and to ensure the amount listed on the label matches the amount in the supplement:
Natural Medicine Database
- Sesso HD, Christen WG, Bubes V, et al. Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA. 2012;308:1751-1760.
- Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA. 2012;308:1871-1880.
- Christen WG, Glynn RJ, Manson JE, et al. Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2014;121:525-534.
- Grodstein F, O'Brien J, Kang JH, et al. Long-term multivitamin supplementation and cognitive function in men: a randomized trial. Ann Intern Med. 2013;159:806-814.
- Ward E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutr J. 2014;13:72.