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Effect of Multivitamin–Mineral Supplementation vs Placebo on Cognitive Function
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This study evaluated the effect of multivitamin–mineral (MVM) supplementation on cognitive function in a clinic subcohort of the COSMOS trial. The participants underwent in-person detailed neuropsychologic assessments at baseline and at 2 years. Furthermore, a meta-analysis of three cognitive studies within COSMOS was conducted for a robust evaluation. Compared with placebo, MVM supplementation moderately improved global cognition over the 2-year period, with a significantly more favorable change observed in episodic memory.
- This study suggests that MVM supplementation leads to favorable changes in cognitive function as well as episodic memory and can, therefore, be prescribed to older adults to prevent cognitive decline.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Longer effects of multivitamin-mineral (MVM) supplementation on late-life cognitive function remain untested using in-person, detailed neuropsychological assessments. Furthermore, insufficient evidence exists for healthcare providers to recommend daily MVM supplements to prevent cognitive decline.
OBJECTIVES
To: 1) test MVM effects on cognitive change using in-person, detailed neuropsychological assessments; 2) conduct a meta-analysis within COSMOS (COcoa Supplement and Multivitamin Outcomes Study) cognitive sub-studies for a robust evaluation of MVM effects on cognition.
DESIGN
COSMOS is a 2x2 factorial trial of cocoa extract [500 mg flavanols/day] and/or a daily multivitamin-mineral supplement for cardiovascular disease and cancer prevention among 21,442 US adults aged ≥60 years. There were 573 participants in the clinic sub-cohort of COSMOS (i.e., COSMOS-Clinic) who completed all cognitive tests administered at baseline. For meta-analysis, we included non-overlapping participants across three COSMOS cognitive sub-studies: COSMOS-Clinic (n=573); COSMOS-Mind (n=2158); COSMOS-Web (n=2472).
RESULTS
In COSMOS-Clinic, we observed a modest benefit of MVM, compared to placebo, on global cognition over 2 years [mean difference (95% confidence interval (CI))=0.06 standard deviation units (SU) (-0.003, 0.13)], with a significantly more favorable change in episodic memory [mean difference (95% CI)=0.12 SU (0.002, 0.23)] but not in executive function/attention [mean difference (95% CI)=0.04 SU (-0.04, 0.11)]. Meta-analysis of COSMOS sub-studies showed clear evidence of MVM benefits on global cognition [mean difference (95% CI)=0.07 SU (0.03, 0.11); p=0.0009] and episodic memory [mean difference (95% CI)=0.06 SU (0.03, 0.10); p=0.0007]; magnitude of effect on global cognition was equivalent to reducing cognitive aging by 2 years.
CONCLUSIONS
In COSMOS-Clinic, daily MVM supplementation led to a significantly more favorable 2-year change in episodic memory. The meta-analysis within COSMOS cognitive sub-studies indicated that daily MVM significantly benefited both global cognition and episodic memory. These findings within the COSMOS trial support the benefits of a daily MVM in preventing cognitive decline among older adults.
TRIAL REGISTRATION
i) COSMOS - ClinicalTrials.gov identifier: NCT02422745, URL: https://www.
CLINICALTRIALS
gov/study/NCT02422745; ii) COSMOS-Mind - ClinicalTrials.gov identifier: NCT03035201, URL: https://clinicaltrials.gov/study/NCT03035201; iii) COSMOS-Web - ClinicalTrials.gov identifier: NCT04582617, URL: https://clinicaltrials.gov/study/NCT04582617.
Additional Info
Effect of multivitamin-mineral supplementation versus placebo on cognitive function: Results from the clinic sub-cohort of the COSMOS randomized clinical trial and meta-analysis of three cognitive studies within COSMOS
Am J Clin Nutr 2023 Dec 21;0(0)10, CM Vyas, JE Manson, HD Sesso, NR Cook, PM Rist, A Weinberg, MV Moorthy, LD Baker, MA Espeland, LK Yeung, AM Brickman, OI OkerekeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Association of multivitamin supplementation with cognitive health
The ideal multivitamin (MVI) is the one that nature grows in the form of vegetables and fruits. Eating these foods also results in the consumption of fiber that feeds the microbiome, slows sugar absorption, and maintains regularity. Most humans should not need an MVI if they are eating well. In fact, the Iowa Women’s Health Study found that older women who took an MVI had a higher mortality rate (HR, 1.06) than those who did not take an MVI.1
The COSMOS study2 resulted in several papers looking at the health outcomes of 21,442 adults in the US taking a regular MVI (Centrum Silver), a supplement containing cocoa and green tea flavonoids, or a placebo. The patients were followed prospectively for 3.6 years. The COSMOS study was sponsored by Pfizer, the maker of Centrum Silver, and Mars Edge, the maker of the cocoa. Previous COSMOS publications showed no reduction in the incidence of cancer, but the cocoa and green tea flavonoids were associated with a 27% reduction in cardiovascular mortality.3 In the COSMOS-Mind paper, there was no cognitive protection with the consumption of flavonoids, but a trend towards a reduction in the incidence of mild cognitive impairment and dementia was observed in the MVI group.4
This latest study included some cherry-picking from subset groups that underwent cognitive assessment testing at baseline and again after 2 years (COSMOS-Clinic, n = 573; COSMOS-Mind, n = 2158; and COSMOS-Web, n = 2742). Combining these subset populations resulted in benefits in global cognitive function and memory in those taking an MVI compared with those taking a placebo. This mild effect size was equivalent to preventing the amount of mental decline that happens within 2 years of aging later in life.
If you have seen the ingredient list of an MVI, you would have seen the ingredients of one MVI. However, most MVIs have a foundation of fat-soluble vitamins (A, D, E, and K), vitamins C and B, and minerals. Below is the product label of the MVI used in this study. It also includes lutein and lycopene. Lutein is important for preventing macular degeneration, and lycopene is rich in red-colored foods such as tomatoes and has recently been associated with lowering the blood pressure.5
Should you take an MVI to save your brain? I don’t know. The risk–benefit ratio seems pretty good. But I think we would have more benefit if we supported our local organic farmers instead of Pfizer and the makers of candies to get all these nutrients and consumed a high-fiber, plant-forward diet.
References
Murcia-Lesmes D, Domínguez-López I, Laveriano-Santos EP, et al. Association between tomato consumption and blood pressure in an older population at high cardiovascular risk: observational analysis of PREDIMED trial. Eur J Prev Cardiol. 2023 Nov 24. doi: 10.1093/eurjpc/zwad363. Online ahead of print. https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwad363/7450162?searchresult=1&login=false