Multivitamin/Mineral Supplementation – The Key of Healthy Ageing (Part 2)

On the other hand, the benefits of MVM supplementation in improving cognition in older adults were demonstrated in the COSMOS-Mind trial (2022), a randomised two-by-two factorial 3-year trial enrolling 2,262 participants. The results indicated that daily MVM supplementation (Centrum Silver, Haleon) resulted in a significant benefit on global cognition versus placebo (p=0.007, Figure 4). Although former epidemiological studies supported for the cognition-enhancing effects of flavonoids, cocoa extract, which contains high quantities of flavanols, yielded no significant effect on global cognition versus placebo (p=0.28). Notably, MVM supplementation also benefited memory and executive function²⁶.

Figure 4. Three-year change in episodic memory composite by assignment to daily MVM supplementation²⁶, Active: MVM supplementation

Interestingly, the results suggested that the MVM cognitive benefits may be more pronounced among older adults with cardiovascular diseases. Moreover, based on the difference in composite scores, 3 years of MVM supplementation appeared to have slowed ageing by 1.8 years, or by 60%²⁶.

In the COSMOS-Web trial, an ancillary study of the COSMOS trial involving 3,562 older adults, daily MVM supplementation for 3 years resulted in a significantly better ModRey immediate recall test at 1 year (p=0.025), and across the 3 years of follow-up on average compared to placebo (p=0.011, Figure 5)²⁷. More recently, the clinic sub-cohort of COSMOS trial (COSMOS-Clinic), which included 573 participants, indicated that daily MVM supplementation leads to a significantly more favourable 2-year change in episodic memory.

Figure 5. Mean improvement on ModRey immediate recall between treatment groups²⁷, error bars: 95% CIs

Given the study design and the large sample sizes, the COSMOS trial and its ancillary studies provided high-quality evidence confirming the benefits of MVM supplementation on cognitive improvement in older adults. Notably, MVM supplementation holds promise as a safe and accessible approach to maintaining cognitive health²⁷. Meta-analysis further supports that MVM supplementation reduces cognitive ageing by 2 years²⁸. Of course, further investigations of the impacts of MVM supplementation on other organ systems is highly desirable. nonetheless, MVM supplementation should be avoided in patients with liver or kidney diseases and those who had organ transplants.

Polypharmacy Increases the Risk of Micronutrient Inadequacy 

Polypharmacy is common among older adults, especially those with chronic diseases. Practically, roughly 70% of older adults aged >70 years take 2 or more medications daily, and many people take more than 3. Common medications prescribed to older patients include anti-hypercholesteraemic, anti-hypertensives, antacids, anti-coagulants, analgesics, proton pump inhibitors (PPIs), hypoglycaemics, and diuretics29.

Remarkably, many medications hinder micronutrient absorption. PPIs have been reported to impair the absorption of vitamin B12, vitamin C, and iron, whereas metformin would reduce the status of vitamin B12 and folate. Furthermore, diuretics are associated with disturbances in electrolyte homeostasis, including magnesium and zinc29. Thus, older adults taking multiple medications are at risk of micronutrient inadequacy.

To evaluate whether MVM supplementation would improve the nutritional status of older adults receiving medication treatments, a randomised control trial (RCT) was conducted by Chen et al. (2020). In the trial, 54 adults on ≥1 chronic drug therapy were randomly assigned to receive MVM supplementation or placebo for 16 weeks. The results indicated that MVM supplementation had a greater change in nutrient status after 16 weeks than the placebo group for serum folate (7.5 vs –1.6 ng/mL, p<0.0001), vitamin B12 (159.2 vs –33.9 pg/mL, p=0.007), and plasma vitamin C (0.2 vs 0.0 mg/dL, p=0.004). Based on the findings, MVM supplementation improved the levels of vitamins B12, C and folate in older adults receiving drug therapies²⁹.

Ensuring the Optimal Nutritional Status for Older Adults 

To optimise the nutritional status of older adults, the first step is to evaluate the amount of intake. Although measuring micronutrient levels is not a usual practice, it can be considered for potential cases of micronutrient inadequacy, such as those with low intake or symptoms developed. Essentially, under-supplementation is not good, but over-supplementation is unwanted neither. The measurement of micronutrient levels would guide MVM supplementation protocol, such as using more specific supplements.

While emerging clinical data advocate MVM supplementation in countering micronutrient inadequacy and improving the nutritional status of older adults, there is no consensus on the optimal level of micronutrients. Thus, a clear definition of the appropriate levels of micronutrients is desirable. In order to provide a comprehensive understanding on patients’ nutritional status, developing affordable clinical tests for measuring micronutrient levels is a key mission for the professionals in nutrition discipline.

By virtue of its effectiveness in ensuring micronutrient adequacy demonstrated in the clinical studies highlighted above, MVM supplementation potentially improves physical health and overall wellbeing for people of all ages, particularly the older populations. Given the long-term improvement in global cognition, episodic memory, and executive function in older adults has been reported, prospective works investigating the long-term outcomes of MVM supplementation on overall quality of life are highly desirable.

References

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