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multivitamin (MVI) with minerals

Indications: - prevention & treatment of vitamin deficiency & mineral deficiency - multivitamins may slow cognitive aging in older adults [18] - multivitamin supplementation improves memory in older adults [20,21,22] - elderly who took a multivitamin with minerals scored better on some but not all cognition tests [20,21] - benefit for global cognition & episodic memory [22] Contraindications: - no benefit in primary prevention of cardiovascular disease [11,14,17] or cancer [15,17] - no benefit in preventing cancer, cardiovascular disease, or death, except for small benefit for cancer prevention with multivitamin use [19] - multivitamin use does not improve longevity [23] 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: 1) significantly fewer symptoms of infection (43% vs 73%) - upper respiratory tract infection specifically mentioned 2) incidence of infection was significantly lower in: a) subject < 65 years of age (relative risk 0.6) b) subjects with diabetes mellitus (relative risk 0.2) 3) no effect on physical or mental health/quality of life 4) 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: 1) no difference in infection, emergency department visits, or hospitalizations; however, 2) subjects without dementia had more infections than demented patients & in the group, supplement recipients had fewer infections than placebo recipients [4] 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 [5] - no difference in composite outcome of myocardial infarction, stroke, or cardiovascular mortality [6] [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

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multivitamin (MVI) vitamin

Specific

M-Natal Plus

General

nutritional supplement

References

  1. Journal Watch 23(8):66, 2003 Barringer TA et al, Ann Intern Med 138:365, 2003 Fauzi W & Stampfer MI, Ann Intern Med 138:430, 2003 http://www.annals.org/issues/v138n5/full/200303040-00005.html
  2. Avenell A et al Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): Pragmatic, randomised, double blind, placebo controlled trial. BMJ 2005 Aug 6; 331:324-9. PMID: 16081445 http://bmj.bmjjournals.com/cgi/content/full/331/7512/324
  3. Liu BA et al Effect of multivitamin and mineral supplementation on episodes of infection in nursing home residents: a randomized, placebo- controlled study. J Am Geriatr Soc. 2007 Jan;55(1):35-42. PMID: 17233683
  4. Neuhouser ML et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts. Arch Intern Med 2009 Feb 9; 169:294. PMID: 19204221
  5. Gaziano JM et al Multivitamins in the Prevention of Cancer in Men The Physicians' Health Study II Randomized Controlled Trial JAMA. 2012 Nov 14;308(18):1871-80. PMID: 23162860 http://jama.jamanetwork.com/article.aspx?articleid=1380451
  6. Sesso HD et al Multivitamins in the Prevention of Cardiovascular Disease in Men. The Physicians' Health Study II Randomized Controlled Trial. JAMA. 2012;308(17):1751-1760 PMID: 23117775 http://jama.jamanetwork.com/article.aspx?articleid=1389615 - Lonn EM Multivitamins in Prevention of Cardiovascular Disease JAMA. 2012;308(17):1802-1803 PMID: 23117781 http://jama.jamanetwork.com/article.aspx?articleid=1389595
  7. Madden MM et al Market Analysis of Vitamin Supplementation in Infants and Children. Evidence From the Dietary Supplement Label Database. JAMA Pediatr. Published online January 27, 2014. PMID: 24473529 http://archpedi.jamanetwork.com/article.aspx?articleid=1815477
  8. Prescriber's Letter 21(5): 2014 CHART: Multivitamins: Who Needs Them? PDF: Clinically Significant Drug-Induced Nutrient Depletion Detail-Document#: 300511 (subscription needed) http://www.prescribersletter.com
  9. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  10. Bjelakovic G, Gluud C. Vitamin and mineral supplement use in relation to all-cause mortality in the Iowa Women's Health Study. Arch Intern Med. 2011 Oct 10;171(18):1633-4. PMID: 21987193 - Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr. Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. Arch Intern Med. 2011 Oct 10;171(18):1625-33. PMID: 21987192
  11. The NNT: Vitamin and Antioxidant Supplements for Primary Prevention of Cardiovascular Disease. http://www.thennt.com/nnt/vitamins-and-antioxidants-for-primary-prevention-of-cardiovascular-disease/
  12. Moyer VA; U.S. Preventive Services Task Force. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement. Ann Intern Med. 2014 Apr 15;160(8):558-64. PMID: 24566474
  13. Manson JE, Bassuk SS. Vitamin and Mineral Supplements. What Clinicians Need to Know. JAMA. Published online February 5, 2018. PMID: 29404568 https://jamanetwork.com/journals/jama/fullarticle/2672264
  14. Kim J, Choi J, Kwon SY et al Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease. A Systematic Review and Meta-Analysis Circulation: Cardiovascular Quality & Outcomes. 2018;11:e004224. July 10, 2018 PMID: 29991644 http://circoutcomes.ahajournals.org/content/11/7/e004224 - Haslam A, Prasad V. Multivitamins Do Not Reduce Cardiovascular Disease and Mortality and Should Not Be Taken for This Purpose. How Do We Know That? PMID: 29991647 http://circoutcomes.ahajournals.org/content/11/7/e004886
  15. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  16. Khan SU, Khan MU, Riaz H et al Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Ann Intern Med. 2019. July 9. PMID: 31284304 https://annals.org/aim/article-abstract/2737825/effects-nutritional-supplements-dietary-interventions-cardiovascular-outcomes-umbrella-review-evidence - Pandey AC, Topol EJ Dispense With Supplements for Improving Heart Outcomes. Ann Intern Med. 2019. July 9. PMID: 31284306 https://annals.org/aim/article-abstract/2737826/dispense-supplements-improving-heart-outcomes
  17. Lou N USPSTF Still Not Swayed on Vitamins to Prevent Heart Disease, Cancer - Vitamin E, beta-carotene singled out as supplements to be avoided. MedPage Today May 4, 2021 https://www.medpagetoday.com/primarycare/preventivecare/92402
  18. Manson JE Multivitamins Slow Cognitive Aging in Older Adults. Medscape. December 10, 2021 https://www.medscape.com/viewarticle/963748 - Anderson P Multivitamins, but Not Cocoa, Tied to Slowed Brain Aging. Medscape. November 11, 2021. https://www.medscape.com/viewarticle/962772 - ClinicalTrials.gov COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind). https://clinicaltrials.gov/ct2/show/NCT03035201
  19. US Preventive Services Task Force Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326-2333. June 21 PMID: 35727271 https://jamanetwork.com/journals/jama/fullarticle/2793446 - O'Connor EA, Evans CV, Ivlev I et al Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022;327(23):2334-2347 PMID: 35727272 https://jamanetwork.com/journals/jama/fullarticle/2793447 - Jia J, Cameron NS, Linder JA. Multivitamins and Supplements - Benign Prevention or Potentially Harmful Distraction? JAMA. 2022;327(23):2294-2295 PMID: 35727292 https://jamanetwork.com/journals/jama/fullarticle/2793472
  20. Yeung LK et al Multivitamin supplementation improves memory in older adults: A randomized clinical trial. May 24 PMID: 37244291 https://ajcn.nutrition.org/article/S0002-9165(23)48904-6/fulltext
  21. Baker LD et al. Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial. Alzheimers Dement 2023 Apr; 19:1308. PMID: 36102337 PMCID: PMC10011015 (available on 2024-04-01)
  22. Vyas CM et al 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. Jan 18:S0002-9165(23)66342-7 PMID: 38244989 https://ajcn.nutrition.org/article/S0002-9165(23)66342-7/fulltext
  23. Loftfield E, O'Connell CP, Abnet CC et al Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts JAMA Netw Open. 2024 Jun 3;7(6):e2418729. PMID: 38922615 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820369 - Barnard ND et al. The limited value of multivitamin supplements. JAMA Netw Open 2024 Jun; 7:e2418965. PMID: 38922621 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820375