Daily multivitamin didn’t preserve cognitive function in men

Major finding: The average difference in change on a global cognition composite score between men who took a daily multivitamin for an average of 8.5 years and those who took a placebo was –0.01 standard unit (95% confidence interval, –0.04 to 0.02)

Data source: Randomized, placebo-controlled trial involving almost 6,000 male physicians at least aged 65 years at enrollment.

Disclosures: Two of the 11 investigators reported grants from BASF. The study was funded by NIH, BASF, Pfizer, and DSM Nutritional Products.

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Case is closed on multivitamins

"Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries," according to an editorial published online Dec. 16 in the Annals of Internal Medicine.

The editorial’s five authors considered the multivitamin cognition study as well as two other studies also published Dec. 16 in Annals of Internal Medicine: a literature review that found no clear evidence that single and multivitamins reduce all-cause mortality, cardiovascular disease, or cancer; and a trial that found multivitamins did not reduce recurrent cardiovascular events.

"Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed – supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful," the editorial’s authors noted.

"These vitamins should not be used for chronic disease prevention. Enough is enough," they concluded.

The one exception might be vitamin D supplementation, "an open area of investigation, particularly in deficient persons," they noted. "Clinical trials have been equivocal and sometimes contradictory. Although future studies are needed to clarify the appropriate use of vitamin D supplementation, current widespread use is not based on solid evidence that benefits outweigh harms."

The lead author is Dr. Eliseo Guallar, a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. None of the five writers has any disclosures.



Daily multivitamins didn’t slow age-related cognitive decline, according to a multiyear, placebo-controlled study of almost 6,000 elderly male physicians.

"We saw no benefit of a daily multivitamin in slowing cognitive decline after more than a decade of treatment and follow-up. Long-term use of a daily multivitamin did not provide cognitive benefits," concluded investigators led by Francine Grodstein, Sc.D., and Jacqueline O’Brien, Sc.D., both of Brigham and Women’s Hospital, Boston, in an article published Dec. 16 in Annals of Internal Medicine.

As part of the Physicians’ Health Study II, 2,980 male physicians at least 65 years old were randomized to daily Centrum Silver (Pfizer) and 2,967 others to placebo. The groups had no significant differences in alcohol use, smoking, cardiovascular disease, diabetes, hypertension, hypercholesterolemia, exercise, or depression. The mean age at enrollment in both groups was about 72 years.

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Daily multivitamins probably don’t slow age-related cognitive decline in adults, experts say.

The men then took the East Boston Memory Test, the Telephone Interview for Cognitive Status (TICS), and other validated tests from which global composite and verbal memory scores were calculated. Testing was repeated three more times over an average duration of 8.5 years.

The researchers found no significant differences between the two groups over time in cognitive function change. During the follow-up period, the average difference in change between the multivitamin and placebo groups was –0.01 standard unit (confidence interval, –0.04 to 0.02) for the global composite score and –0.005 SU (CI, –0.04 to 0.03) for the verbal memory score. "At each follow-up assessment, there were no differences between the mean global composite" and verbal memory scores, the investigators said.

Likewise, multivitamins had no protective effect in subanalyses based on smoking, alcohol intake, body mass index, diabetes, hypertension, hypercholesterolemia, diet, depression, or folate use.

About 84% of patients in both groups reported taking at least two-thirds of their study pills. Overall, there was a mean yearly drop of 0.16 points on the 50-point TICS scale.

"A limitation of this study is that our population of male physician participants may have been too well nourished to observe benefits of supplementation," the investigators said. "This population is also unique in that the participants are all highly educated men, so it is possible that effects of multivitamins could have been different in a study population with varying levels of educational attainment."

Previous randomized, controlled studies of multivitamins and cognition have not shown benefits in patients who are well nourished, the researchers noted. "Trials testing high doses of individual vitamin supplements have generally had null results for cognition as well, including large-scale trials of antioxidant supplements and B vitamins," they added.

Two of the 11 investigators reported grants from BASF. The study was funded by the National Institutes of Health, BASF, Pfizer, and DSM Nutritional Products.

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