Should older adults take a multivitamin? For decades, most healthcare providers have taken the stance that a balanced diet should provide all the nutrients one needs. Multivitamin-mineral (MVM) supplements are generally recommended to individuals who are pregnant or planning to conceive and to those with conditions that affect the metabolism and/or absorption of nutrients. Nonetheless, about 80% of Americans take some type of supplement; MVMs are popular and are taken by an estimated one-third of all adults in the United States.
While older adults are concerned about brain health and the inevitable decline in cognitive function that comes with aging, few randomized clinical trials (RCTs) have tested the effects of MVM supplements on cognitive change in older adults. In a recent study, a research team including Chirag Vyas, MBBS, MPH, and Olivia Okereke, MD, MS, examined the effects of MVM on cognitive changes using data from the COSMOS (COcoa Supplement and Multivitamin Outcomes Study) – a 2×2 factorial trial of cocoa extract (500 mg flavanols/day) and/or a daily MVM supplement for cardiovascular disease and cancer prevention among 21,442 US adults (60 years or older).
Vyas and colleagues first analyzed data from 573 participants in a clinic subcohort (COSMOS-Clinic) who had been seen in-person and who had completed all cognitive tests administered at baseline. In the COSMOS-Clinic cohort, the researchers observed a modest benefit of MVM compared to placebo on global cognition over two years. There was a statistically significant benefit for change in episodic memory but not in executive function or attention.
In addition, Vyas and colleagues performed a meta-analysis including nonoverlapping participants who took part in three COSMOS cognitive substudies: COSMOS-Clinic (n = 573); COSMOS-Mind (telephone-based cognitive assessments; n = 2158); and COSMOS-Web (computer-based cognitive assessments; n = 2472). The treatment duration across these studies ranged from 2 to 3 years. The meta-analysis of COSMOS substudies showed clear evidence of MVM benefits on global cognition and episodic memory. The researchers estimate that the daily multivitamin slowed global cognitive aging by the equivalent of two years compared to placebo..
A Compelling Argument for the Use of Multivitamins with Minerals
In the COSMOS-Clinic substudy, where 573 older participants were evaluated using in-person neuropsychological assessments, daily use of a multivitamin with minerals was associated with a significantly more favorable change in episodic memory over two years of follow-up. Similarly, a meta-analysis including multiple COSMOS cognitive substudies (5,203 participants) indicates that daily MVM had significant benefits for both global cognition and episodic memory. These findings support the beneficial effects of a daily MVM in preventing cognitive decline among older adults.
The MVM used in this study was Centrum Silver. This preparation contains a comprehensive supplement of daily intake values, not megadoses, of more than 20 micronutrients such as B vitamins (folic acid, niacin, B-1, B-2, B-6, and B-12); vitamins A, C, D, and E and minerals (calcium, magnesium, selenium, zinc, copper, chromium, and manganese).
While this study indicates the benefits of a daily MVM on slowing cognitive aging, it is important to note that MVM supplements should not be perceived as a substitute for a healthy diet or a healthy lifestyle, but as a complementary strategy. It is true that there are other, possibly more effective interventions, such as exercise, that we can recommend as a means of preserving cognitive function in older adults; however, many older adults may not be able to pursue these recommendations due to a variety of health reasons. Moreover, MVM supplements are safe, affordable (about 10 cents per day), and easily accessible.
Other members of the research team included JoAnn Manson, Howard Sesso, Nancy Cook, Pamela Rist, Alison Weinberg, M Vinayaga Moorthy, Laura Baker, Mark Espeland, Lok-Kin Yeung, and Adam Brickman.
Read More
Vyas CM, Manson JE, Sesso HD, Cook NR, Rist PM, Weinberg A, Moorthy MV, Baker LD, Espeland MA, Yeung LK, Brickman AM, Okereke OI. Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS. Am J Clin Nutr. 2024 Mar;119(3):692-701. doi: 10.1016/j.ajcnut.2023.12.011.
In the News
Multivitamin-Mineral Supplementation Prevents Cognitive Decline in Older Adults (Psychiatry Advisor)
What We Know About Multivitamins and Memory (New York Times)
