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Multivitamin

Red Arrow  Facts Red Arrow  Functions
Red Arrow  Requirements & Recommendations Red Arrow  Deficiency Signs and Symptoms
Red Arrow  Toxicity Red Arrow  Dietary Sources
Red Arrow  Populations w/ Special Needs Red Arrow  Drug-Vitamin Interaction
Red Arrow  Research Summary

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Facts

  • Multivitamin-mineral supplements are the most commonly used dietary supplement.1
  • The Centers for Disease Control’s National Center for Health Statistics found that use of multivitamin/multimineral supplements by adults in the U.S. has increased from 1988 (30%) to 2006 (the most recent year from which data are available; 39%).2 Women are significantly more likely to use multivitamin/multimineral supplements than men.2
  • Daily use of a multivitamin can help to prevent or correct nutritional deficiencies. Multivitamins provide a combination of vitamins and minerals to help insure sufficient daily intake.
  • There are hundreds of multivitamin preparations which vary in both composition and quality. Some supplements contain only vitamins, some only minerals, and some contain other ingredients such as probiotics or herbs.


  • Functions

    • Multivitamins have been shown to improve nutrient status, particularly for those at risk for deficiencies such as people with type II diabetes mellitus, those with a poor diet, and the elderly.
    • Some epidemiologic studies suggest that multivitamin-mineral supplements reduce risk for prostate, colon, and stomach cancer with long-term use.
    • Daily multivitamin-mineral supplements with folic acid may reduce risk for cardiovascular disease.
    • Multivitamin-mineral supplements slow progression of age-related cataract.
    • Daily multivitamin-mineral supplements many reduce viral respiratory tract infections.
    • For people with type II diabetes mellitus, daily multivitamins have been shown to reduce infectious illness.
    • Recent studies indicate that multivitamin-mineral supplements may have beneficial effects for children with autism and for people with high stress.


  • Requirements & Recommendations

    A daily multivitamin-mineral supplement are recommended by the following:
    • CDC (March of Dimes): Recommends a daily multivitamin-mineral supplement containing at least 400 mcg folic acid for women of child bearing age.
    • Older Americans Act: The Older Americans Act was re-authorized in 2006 for five additional years. This act provides grants in the field of aging to states. The act recommends a daily multivitamin-mineral supplement for all seniors as a safe and effective means to ensure appropriate nutrition.4
    • Harvard School of Public Health: Recommended a multivitamin for all adults and children. 5


  • Deficiency Signs and Symptoms

    6,7
    • While classic micronutrient deficiency diseases such as scurvy, beriberi, pernicious anemia, and rickets are rare in the United States, recent studies indicate than many people currently have low levels of certain micronutrients. These reduced levels may contribute to development of chronic disease, infectious disease, and symptoms of stress, fatigue, and decreased mood.
    • Data collected during the National Health and Nutrition Examination Survey (NHANES, 2001-2002) indicate that 93% of people in the United States do not consume the estimated average requirement (EAR) for vitamin E, 56% for magnesium, 44% for vitamin A, 31% for vitamin C, 14% for vitamin B6, and 12% for zinc.7
    • A daily multivitamin-mineral supplement may alleviate micronutrient deficiencies and improve intake levels.


  • Toxicity

    Dietary Sources

    Selecting a high quality multivitamin and mineral supplement is important. Consumers can select high quality supplements by looking to trusted companies. A United States Pharmacopeia (USP) or Dietary Supplement Verification Program (DSVP) symbol on the product label indicates that the product has been tested for quality by the USP. Healthy adults should look for supplements containing nutrients at or near the RDA or DRI recommended levels. It is important to note that, in most cases, this level of supplementation is not possible with a single tablet (multiple tablets may be necessary). Tablets are the most widely available and most studied form of multivitamin supplements. Effervescent multivitamins, drink mixes, liquid multivitamin preparations, and even multivitamin candies are also available. The shelf life of tablets is generally longer than for liquid forms.


  • Populations w/ Special Needs

    • People over 60: for people over 60, a moderate daily multivitamin with vitamin B12 and vitamin D may be most beneficial. High levels of vitamin A can increase risk of hip fracture and should be avoided. High levels of iron can promote oxidative stress; supplements should contain less than 9 mg of iron.
    • Women: Daily multivitamin-minerals containing B vitamins and 400 to 800 mcg of folic acid have been recommended for women who could become pregnant or who take oral contraceptives.3
    • People with diabetes: People with diabetes are at high risk for development of nutrient deficiencies. A daily multivitamin-mineral can help prevent deficiencies and may have additional benefits.
    • Dieters: People who are trying to lose weight often deprive themselves of essential nutrients. A daily multivitamin-mineral supplement can help to prevent deficiencies.
    • Alcohol: Consumption of alcoholic beverages depletes the body of essential nutrients; a daily multivitamin-mineral supplement can help to alleviate depletion.


  • Drug-Vitamin Interaction

    Research Summary

    Topic: Cancer

    Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women.
    A prospective trial evaluated breast cancer incidence and multivitamin-mineral supplements in a cohort of Swedish women. Beginning in 1997, 35,329 women began participating in a study which evaluated multivitamin use and breast cancer risk factors. Nine-hundred-seventy-four women were diagnosed with breast cancer (mean follow-up 9.5 years). The relative risk for breast cancer with multivitamin use was 1.19 (multivariable; 95% CI: 1.04-1.37). The results of this prospective trial suggest that multivitamin use is associated with increased risk for breast cancer. These results warrant further evaluation.9 Supplement compostion: varied.
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    Antioxidant vitamin and mineral supplementation and prostate cancer prevention in the SU.VI.MAX trial.
    A subset of the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study investigated the effect of multivitamin and mineral supplementation on prostate cancer risk. This eight year study included 3,616 men randomized to consume either a multivitamin and mineral supplement or a placebo daily. Overall, the study found a moderate, non-significant decrease in risk for prostate cancer in the multivitamin and mineral group (hazard ratio 0.88). However, when stratified for prostate specific antigen (PSA) levels, an important qualification became evident. For men with normal PSA concentrations (less than 3 mcg/L) at baseline, supplementation with these vitamins and minerals resulted in a significant reduction in risk for prostate cancer (hazard ratio 0.52). For men with elevated PSA levels at baseline, consumption of the multivitamin and mineral supplement was associated with an increase in risk for development of prostate cancer (hazard ratio 1.54). The authors concluded that nutritional doses of these antioxidant vitamins and minerals could help to prevent prostate cancer in those with normal PSA levels.10 Supplement composition: vitamin C (120 mg), vitamin E (30 mg), beta-carotene (6 mg), selenium (100 mcg), and zinc (20 mg)
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    The SU.VI.MAX study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals.
    The Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study included 13,067 men and women in France and investigated the effect of a multivitamin preparation on cancer, cardiovascular disease, and mortality. Participants consumed a daily multivitamin-mineral supplement or a placebo for an average of 7.5 years. Daily consumption of the multivitamin-mineral supplement reduced risk for cancer in men by 31% versus placebo but not in women. Similarly, all cause mortality risk was reduced in men by 37% for men but not for women. Baseline antioxidant status was lower in the men than the women which may explain these differences. No beneficial effect on ischemic cardiovascular disease was found. Supplements similar to those used in the SU.VI.MAX study may help to improve nutrient status and reduce cancer risk, especially for men.11 Supplement composition: vitamin C (120 mg), vitamin E (30 mg), beta-carotene (6 mg), selenium (100 mcg), and zinc (20 mg)
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    Multivitamin use, folate, and colon cancer in women in the Nurses’ Health Study.
    The Nurses’ Health Study began in 1976 when 121,700 female registered nurses completed mailed health and nutrition surveys. Since its inception, the study has been updated every two years. An epidemiologic study involving 88,756 women from the Nurses’ Health Study investigated the potential associations between multivitamin use, folic acid intake, and colon cancer. Food sources were the primary source of folic acid for women in the lowest categories of folic acid intake. In the higher categories, multivitamins were the primary source of folic acid. For women consuming daily multivitamins, no reduction in risk for colon cancer was noted with less than four years of supplement use (RR 1.02). Non-significant reductions of risk were found for five to nine years (RR 0.83) or ten to fourteen years (RR 0.80) of supplement use. However, a significant reduction in risk for colon cancer emerged after fifteen years of folic acid containing multivitamin use (RR 0.25). Thus, it is suggested that long-term use of folic acid containing multivitamin supplements may reduce risk for colon cancer by 75% in women.12 Supplement composition: varied.
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    Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population.
    A large nutritional intervention trial was conducted in Linxian county, China with 29,584 adult men and women, aged 40 to 69 years. The study investigated the efficacy of specific vitamin and mineral combinations on mortality, particularly from cancer. Linxian county, China has one of the highest rates of esophageal and gastric cardia cancer. There were four treatment regimens: vitamin A with zinc, riboflavin with niacin, vitamin C with molybdenum, or beta-carotene with vitamin E and selenium at one to two times the RDA. Treatment with beta-carotene with vitamin E and selenium resulted in a significant decrease in all cause mortality rates. This reduction was primarily due to a reduction in cancer deaths and especially stomach cancer deaths. Supplementation for one to two years was necessary before these benefits became evident.13 Supplement composition: varied.
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    Topic: Mortality

    Dietary supplements and mortality rate in older women: the Iowa Women's Health Study.
    Supplement use and mortality were assessed in the Iowa Women’s Health Study. This prospective study included 38,772 women (mean age 61.6 years at baseline); participants self-reported supplement use at baseline (1986) and in 1997 and 2004. Use of several common supplements were associated with increased risk of mortality (all cause) compared to nonuse: multivitamins (hazard ratio, 1.06; 95% CI, 1.02-1.10; absolute risk increase, 2.4%), vitamin B6 (1.10; 1.01-1.21; 4.1%), folic acid (1.15; 1.00-1.32; 5.9%), iron (1.10; 1.03-1.17; 3.9%), magnesium (1.08; 1.01-1.15; 3.6%), zinc (1.08; 1.01-1.15; 3.0%), and copper (1.45; 1.20-1.75; 18.0%). Calcium supplement use was inversely related to mortality (hazard ratio, 0.91; 95% confidence interval, 0.88-0.94; absolute risk reduction, 3.8%). The results of this study suggest that use of certain supplements may increase risk for mortality.14 Additionally, the results of this study have been hotly debated.15-19 Further studies will help to clarify these results. Supplement composition: varied.
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    Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study.
    A prospective study evaluated associations between popular supplements and cancer incidence or mortality in the Multiethnic Cohort Study which included populations in California and Hawaii. Participants completed surveys including information about diet, medical history, and lifestyle upon enrollment; participants were followed for an average of 11 years. Participants completed a second questionnaire after five years. In all, 182,099 people were included in the study. During the follow-up period, 28,851 deaths were identified. No associations were found between multivitamin use and all cause mortality comparing supplement users and nonusers (HR=1.07, 95% CI: 0.96-1.19 for men; HR=0.96, 95% CI: 0.85-1.09 for women). No associations were found for cardiovascular disease or cancer (total or at specific sites) for men or women. The results of this trial suggest that multivitamin supplement use did not increase or decrease risk of mortality, cancer, or cardiovascular disease.20 Supplement composition: varied.
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    Topic: Cardiovascular disease

    Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women.
    A prospective trial investigated associations between myocardial infarction and multivitamin use in 31,671 women, aged 49 to 83, with no prior cardiovascular disease (CVD) and 2,262 women with diagnosed CVD. Participants completed a questionnaire and were followed for an average of 10.2 years. During their follow-up, 932 cases of myocardial infarction were identified in the previously CVD- free participants and 269 myocardial infarction cases in the group of women diagnosed with CVD at baseline. For women in the initially CVD-free group, multivitamin use compared with no supplement use had a hazard ratio (HR) of 0.73 (95% CI: 0.57-0.93); use of multivitamins for > 5 years was associated with a HR of 0.59 (95% CI: 0.44-0.80). For multivitamins plus other supplements the HR was 0.70 (95% CI: 0.57-0.87) while the HR for other supplements was 0.93 (95% CI: 0.81-1.08). No supplements were associated with reduction of myocardial infarction risk in the group diagnosed with CVD at baseline. The results of this study suggest that multivitamin use may reduce risk of myocardial infarction for women with no history of CVD. These results should be evaluated in the context of a clinical trial.21 Supplement composition: the multivitamins taken in the study contained approximately: vitamin A (0.9 mg), vitamin C (60 mg), vitamin D (5 mcg), vitamin E (9 mg), thiamine (1.2 mg), riboflavin (1.4 mg), vitamin B6 (1.8 mg), vitamin B12 (3 mcg), and folic acid (400 mcg).
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    Use of vitamin supplements and risk of total cancer and cardiovascular disease among the Japanese general population: a population-based survey.
    A prospective trial investigated cancer and cardiovascular disease incidence and use of popular vitamin supplements including multivitamins. The study involved the Japan Public Health Center Prospective Study cohort including 28,903 men and 33,726 women. Participants completed questionnaires in 1990-1994 and 1995-1998 concerning supplement use and were followed until 2005 for cardiovascular disease and 2006 for cancer incidence. Four-thousand-one cases of cancer were identified by 2006. While no association was found for supplement use and cancer in men, past use of supplements (HR 1.17, 95% CI 1.02-1.33) and recent use of supplements (HR 1.24, 95% CI 1.01-1.52) were associated with higher risk of cancer for women. One-thousand-fifty-eight cardiovascular disease cases were identified by 2005. Consistent use of supplements was associated with lower risk of cardiovascular disease for women compared to past or recent use (HR 0.60, 95% CI 0.41-0.89). No association was found for risk of cardiovascular disease in men. The results of this study suggest both possible benefits and possible harms from multivitamins and warrant further study.22 Supplement composition: varied.
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    Reduction of C-reactive protein levels through use of a multivitamin.
    A six month randomized, double-blind, placebo-controlled trial investigated the effect of a commercially available multivitamin-mineral product on C-reactive protein concentration. Eighty-seven men and women participated in the trial; plasma concentrations of vitamins C, E, B6, B12, folic acid, beta-carotene, and C-reactive protein were measured at baseline and after six months of supplementation. C-reactive protein was significantly reduced in subjects taking the daily multivitamin-mineral compared to those taking the placebo. This effect was most evident for people who had elevated C-reactive protein at baseline. These results may indicate a positive effect of multivitamin-mineral products with similar composition on cardiovascular disease risk.23 Supplement composition: vitamins A (5000 IU), C (1 g), D (400 IU), E (800 IU), K (25 mcg), B6 (25 mg), B12 (400 mcg), thiamine (3 mg), riboflavin (10 mg), niacinamide (20 mg), folic acid (800 mcg), biotin (300 mcg), pantothenic acid (10 mg), iodine (500 mcg), magnesium (400 mg), zinc (15 mg), selenium (100 mcg), copper (2 mg), chromium (100 mcg), potassium (400 mg), choline (500 mg), lycopene (10 mg), lutein (6 mg), and coenzyme Q10 (50 mg).
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    Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women—Stockholm Heart Epidemiology Program (SHEEP).
    The Stockholm Heart Epidemiology Program investigated possible factors associated with heart disease in Sweden. In this epidemiologic study, the association between self-selected multivitamin-mineral supplements and risk of myocardial infarction was assessed. One-thousand-two-hundred-ninety-six men and women with a first nonfatal myocardial infarction and 1,685 controls enrolled in the study. Fifty-seven percent of women and 35% of men in the control group used dietary supplements. Of those with a myocardial infarction, 42% of women and 27% of men used dietary supplements. Eighty-seven percent of the dietary supplements used were multivitamin-mineral products. For supplement users versus nonusers, the odds ratios of a myocardial infarction were 0.79 for men and 0.66 for women. This epidemiologic evidence indicates that low dose multivitamin-mineral supplements may reduce the risk for myocardial infarctions.24 Supplement composition: varied.
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    Complex multivitamin supplementation improves homocysteine and resistance to LDL-C oxidation.
    A randomized, placebo-controlled trial investigated the impact of a multivitamin-mineral supplement on the cardiovascular disease (CVD) risk factors elevated homocysteine (Hcy) concentration and LDL-cholesterol (LDL-C) oxidation. 182 men and women aged 24 to 79 years participated in this study. Subjects received a placebo or a daily multivitamin-mineral supplement. After 6 months of supplementation, the multivitamin-mineral supplemented group exhibited significant elevations of plasma vitamins B6, B12, C, E, folic acid, and beta-carotene (versus placebo). Homocysteine concentrations demonstrated significantly greater reductions in the multivitamin-mineral supplemented group versus placebo group. In addition, the LDL-C oxidation rate was reduced and the lag time was increased with multivitamin-mineral supplementation for 6 months. This study indicates that a multivitamin-mineral supplement may help reduce risk for CVD by lowering Hcy and improving LDL-C oxidation indices.25 Supplement composition: mixed retinols (5000 IU), vitamins C (1 g), D (400 IU), E (800 IU), K (25 mcg), B6 (25 mg), B12 (400 mg), thiamine (3 mg), riboflavin (10 mg), niacinamide (20 mg), folic acid (800 mcg), biotin (300 mcg), pantothenic acid (10 mg), iodine (150 mcg), magnesium oxide (400 mg), zinc oxide (15 mg), selenium chelate (100 mcg), copper gluconate (2 mg), chromium chelate (100 mcg), potassium phosphate (400 mg), choline (500 mg), lycopene (10 mg), lutein (6 mg), and coenzyme Q10 (50 mg).
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    Efficacy of a complex multivitamin supplement
    A 24 week pilot trial with 141 men and women investigated the efficacy of a multivitamin-mineral supplement on risk factors for cardiovascular disease (CVD). Subjects consumed a daily multivitamin-mineral supplement for 24 weeks and were assessed at baseline, 12 and 24 weeks. Vitamins B6, B12, C, E, beta-carotene, and folic acid significantly increased from baseline and both 12 and 24 weeks. Total homocysteine (Hcy) concentrations were significantly reduced after 12 weeks with no further reductions. Total Hcy concentrations correlated with vitamins B6, B12, and folic acid concentrations. LDL-cholesterol (LDL-C) oxidation rate was significantly reduced by 12 weeks and further reduced at 24 weeks, versus baseline. LDL-C oxidation lag time significantly increased by 12 weeks. Vitamin C was the only nutrient correlated with LDL-C oxidation rate. This pilot trial indicates that a commercially available multivitamin-mineral preparation positively influenced risk factors for CVD.26 Supplement composition: vitamins A (5000 IU), C (1 g), D (400 IU), E (400 IU), K (25 mcg), B6 (50 mg), B12 (400 mg), thiamine (3 mg), riboflavin (10 mg), niacinamide (20 mg), folic acid (800 mcg), biotin (300 mcg), pantothenic acid (10 mg), iodine (150 mcg), magnesium oxide (400 mg), zinc oxide (15 mg), selenium chelate (100 mcg), copper gluconate (2 mg), chromium chelate (100 mcg), potassium phosphate (400 mg), choline (500 mg), lycopene (5 mg), lutein (3 mg), and coenzyme Q10 (100 mg).
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    Topic: Eye health

    The Roche European American Cataract Trial (REACT): a randomized clinical trial to investigate the efficacy of an oral antioxidant micronutrient mixture to slow progression of age-related cataract
    A three month trial in the United States and the United Kingdom investigated the efficacy of a mixture of vitamin C (750 mg), vitamin E (600 mg), and beta-carotene (18 mg) for slowing the progression of cataract development. Subjects with early age-related cataract were enrolled in this randomized, prospective, double-blind, placebo-controlled trial from clinics in the US and UK. A total of 445 people were eligible for the trial and 297 were randomized to the multivitamin or placebo groups after a three month run-in period. Subjects were followed-up every four months for up to four years: 231 for two years (78%), 158 for three years (53%), and 36 for four years (12%). A small positive effect from the multivitamin supplementation was evident in the US patients after two years. After three years, a positive effect was evident in both the US and UK patients consuming the multivitamin preparation. These data demonstrated that this combination of beta-carotene, vitamin C, and vitamin E slowed progression of age-related cataract.27 Supplement composition: vitamin C (750 mg), vitamin E (600 mg), and beta-carotene (18 mg).
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    Topic: Infection and immunity

    Effect of a dietary supplement containing probiotic bacteria plus vitamins and minerals on common cold infections and cellular immune parameters.
    A randomized, double-blind clinical trial was conducted to evaluate the efficacy of a probiotic/multivitamin-mineral supplement to prevent common cold infections. 477 men and women (average age 36) were randomized to receive either a daily multivitamin or a placebo for 3 or 5.5 months. Viral respiratory tract infections were reduced by 13.6% in the supplemented group. Overall, respiratory tract infection symptoms declined by 19%, influenza symptoms decreased by 15% and days with fever were reduced by 54% in the supplemented group. No change in the duration of illness was noted. Leukocytes, lymphocytes, and monocytes significantly increased in the supplemented group during the first 14 days of supplementation. These data suggest that probiotic/multivitamin-mineral supplements may help to reduce viral respiratory tract infections.28 Supplement composition: probiotic bacteria (5x107 cfu; Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, and B. bifidum MF 20/5), vitamins C (60 mg), E (10 mg), A (800 mcg), K1 (30 mcg), B6 (2 mg), B1 (1.4 mg), B2 (1.6 mg), D (5 mcg), B12 (1 mcg), nicotinamide (18 mg), folic acid (200 mcg), biotin (150 mcg), pantothenic acid (6 mg), calcium (40 mg), phosphorus (16 mg), potassium (5 mg), chloride (4.5 mg), magnesium (5 mg), iron (14 mg), zinc (15 mg), manganese (2 mg), selenium (30 mcg), silicon (2 mcg), chromium (25 mcg), molybdenum (25 mcg), and iodine (150 mcg)
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    Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): pragmatic, randomised, double blind, placebo controlled trial.
    The MAVIS trial investigated the efficacy of a multivitamin and mineral supplement on infection in people over 65 years of age. Nine-hundred-ten men and women who did not take any dietary supplements participated in the trial. Subjects were randomized to receive either the multivitamin and mineral supplement or a placebo daily during the one year trial. Taking the multivitamin and mineral supplements did not reduce the number or duration of infections experienced during the trial.29 Supplement composition: vitamins A acetate (800 mcg), C (60 mg), D3 (5 mcg), E acetate (10 mg), B12 (1 mcg), thiamin (1.4 mg), riboflavin (1.6 mg), niacin (18 mg), pantothenic acid (6 mg), pyridoxine hydrochloride (2 mg), folic acid (200 mcg), iron fumarate (14 mg), potassium iodide (150 mcg), copper gluconate (0.75 mg), zinc oxide (15 mg), and manganese sulfate (1 mg)
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    Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial.
    A randomized, double-blind trial evaluated the effect of a multivitamin and mineral supplement on infection in people with and without type II diabetes mellitus. 130 men and women aged 45 to 64 years with (51) and without (79) type II diabetes mellitus participated in the study. Subjects consumed a placebo or multivitamin and mineral supplement daily for one year. Overall, 73% of the placebo group and only 43% of the multivitamin and mineral group reported infectious illness during the study period. Infection related absenteeism was significantly higher in the placebo versus the multivitamin and mineral groups (57% and 21%, respectively). When stratified for type II diabetes mellitus, all of the multivitamin and mineral benefits were accounted for by the subjects with diabetes. Among those with type II diabetes mellitus, 93% of the placebo group and only 17% of the multivitamin and mineral group reported infectious illness. Thus, a daily multivitamin and mineral supplement significantly reduced the incidence of infectious illness for those with type II diabetes mellitus.30 Supplement composition: vitamins A (4000 IU), B1 (4.5 mg), B2 (3.4 mg), B3 (20 mg), B6 (6 mg), B12 (30 mcg), C (120 mg), D (400 IU), E (60 IU), K (20 mcg), beta-carotene (1000 IU), biotin (30 mcg), pantothenic acid (15 mg), folic acid (400 mcg), calcium (120 mg), magnesium (100 mg), manganese (4 mg), copper (2 mg), iron (16 mg), zinc (22.5), iodine (150 mcg), selenium (105 mcg), and chromium (180 mcg)
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    Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial.
    The efficacy of vitamin E and multivitamin-mineral supplements on the incidence and severity of respiratory tract infections was investigated. Subjects were randomly assigned to consume the multivitamin-mineral supplement, 200 mg vitamin E acetate, both, or a placebo. Neither the multivitamin-mineral supplement nor the vitamin E supplement reduced the incidence of respiratory illness. However, the vitamin E supplement significantly increased the severity of illness. Vitamin E supplementation increased illness duration compared to placebo (19 days versus 14 days, respectively), number of symptoms (6 versus 4, respectively), presence of fever (36.7% versus 25.2 %, respectively), and activity restriction (52.3% versus 41.1%). These results suggest that multivitamins and vitamin E are not beneficial for preventing respiratory tract infections in well-nourished people.31 Supplement composition: vitamins A (600 mcg), C (60 mg), E (10 mg), D (5 mcg), K (30 mcg), B12 (1 mcg), beta-carotene (1.2 mg), thiamin (1.4 mg), riboflavin (1.6 mg), niacin (18 mg), pantothenic acid (6 mg), pyridoxine hydrochloride (2.0 mg), biotin (150 mcg), folic acid (200 mcg), zinc (10 mg), selenium (25 mcg), iron (4.0 mg), magnesium (30 mg), copper (1 mg), calcium (74 mg), phosphorus (49 mg), manganese (1.0 mg), chromium (25 mcg), molybdenum (25 mcg), and silicon (2 mcg)
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    Topic: Vitamin and nutrient status

    Multivitamin supplementation improves nutritional status and bone quality in aged care residents.
    A RDBPC trial investigated a multivitamin (MVM) preparation with respect to nutritional status, bone density, mobility & falls. 92 elderly participated in the 6 mo trial. Participants were randomly assigned to a MVM (n=49) or a placebo (n=43). Serum vitamin D increased more in the MVM group vs placebo (P<0.001). After 6 mo, 77% of participants in the MVM group vs 10% in the placebo group had adequate vitamin D concentrations (¡Ý 50 nmol/L; P<0.001). Serum folate increased more in the MVM vs placebo group (P<0.001). Serum vitamin B12 increased more in the MVM group vs placebo (P<0.001). Bone density increases were greater in the MVM group vs placebo (P=0.041). The MVM supp improved nutritional status & had a positive effect on bone density in this trial.32 Supp. comp: vits C(75 mg),D3(10 mcg),B12(25 mcg),E(D-¦Á-tocopheryl acid succinate, 12.2 mg),B6(pyridoxine HCl, 25 mg),¦Â-carotene(3 mg),biotin(100 mcg),Ca pantothenate(35 mg),choline bitartrate(7.9mg),folic acid(200 mcg),inositol(8 mg),nicotinamide(50 mg), riboflavin(10 mg), thiamine HCl(15 mg),Ca carbonate(elemental Ca 144 mg from 360 mg Ca CO3),Fe2+ fumarate(elemental Fe 5 mg from 15.2 mg ferrous fumarate),Mg oxide(elemental Mg 75 mg from 125 mg Mg oxide),Mn amino acid chelate(elemental Mn 750 mcg from 7.5 mg amino acid chelate),Zn amino acid chelate(elemental Zn 6 mg from 30 mg amino acid chelate),potassium sulfate(elemental potassium 1.5 mg from 3.4 mg potassium sulfate),bioflavonoids(25 mg), siberian ginseng(10 mg)
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    Daily intake of multivitamins during long-term intake of olestra in men prevents declines in serum vitamins A and E but not carotenoids.
    The fat substitute olestra has been shown to reduce serum concentrations of vitamins A, E, & carotenoids. A RCT was conducted to investigate the effects of a diet containing olestra & the impact of a commercially available MVM supplementation on serum vitamin concentrations. 45 healthy, overweight men, aged 21-60 yrs completed the 36 wk study. All subjects consumed a control diet consisting of 33% digestible fat, 52% carbohydrate, 15% protein during a 3-wk run-in period. Subjects were then randomized to continue the control diet, consume a fat-reduced diet (25% digestible fat,58% carbohydrate,17% protein), or a fat-substituted diet (25% digestible fat,58% carbohydrate,17% protein,19.6-45.2 g/d olestra) for 36 wks. By 12 wks, subjects consuming the olestra diet had significant reductions in â-carotene, lycopene, & lutein/zeaxanthin. Supplementation with a MVM containing vitamins A & E successfully prevented olestra-derived reductions in retinol & alpha-tocopherol.33 Supp. comp: vits A(3500 IU),C(60 mg),D(400 IU),E(30 IU),K(25 mcg),B6(2 mg),B12(6 mcg),thiamin(1.5 mg),riboflavin(1.7 mg),niacin(20 mg),folic acid(400 mcg),biotin(30 mcg),pantothenic acid(10 mg),calcium(162 mg),iron(18 mg),phosphorus(109 mg),iodine(150 mcg),magnesium(100 mg),zinc(15 mg),selenium(20 mcg),copper(2 mg),manganese(2 mg),chromium(120 mcg),molybdenum(75 mcg),chloride(72 mg),potassium(80 mg),boron(150 mcg),nickel(5 mcg),silicon(2 mg),tin(10 mcg),vanadium(10 mcg),lutein(250 mcg),lycopene(300 mcg)
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    Plasma changes in micronutrients following a multivitamin and mineral supplement in healthy adults.
    The bioavailability of riboflavin, folic acid, vitamin C, vitamin B12, iron, zinc, and copper from a multivitamin tablet was assessed. 15 adult volunteers (average age 42 yrs) participated in the 4 part trial. Each volunteer visited the study center 4 times, randomly assigned to a test of intestinal permeability, a test meal, the test meal plus a whole multivitamin, and the test meal plus a crushed multivitamin. Bioavailability of the 7 nutrients was assessed as the area under the curve for the 12 hours following the meal. From crushed or whole tablets, riboflavin, folic acid, and vitamin C AUC were significantly higher than the meal alone. Vitamin B12 AUC was significantly higher than the meal alone only from the crushed tablet. Conversely, iron AUC was only significantly higher than the meal alone from the whole tablet. No increases in copper and zinc were noted. Intestinal permeability was only associated with absorption of vitamin B12.34 Supp comp: vitamins A(3500 IU),C(60 mg),D(400 IU),E(30 IU),K(25 mcg),B6(2 mg),B12(6 mcg),thiamin(1.5 mg),riboflavin(1.7 mg),niacin(20 mg),folic acid(400 mcg),biotin(30 mcg),pantothenic acid(10 mg),calcium(162 mg),iron(18 mg),phosphorus(109 mg),iodine(150 mcg),magnesium(100 mg),zinc(15 mg),selenium(20 mcg),copper(2 mg),manganese(2 mg),chromium(120 mcg),molybdenum(75 mcg),chloride(72 mg),potassium(80 mg),boron(150 mcg),nickel(5 mcg),silicon(2 mg),tin(10 mcg),vanadium(10 mcg),lutein(250 mcg),lycopene(300 mcg)
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    Topic: Autism

    Pilot study of a moderate dose multivitamin/mineral supplement for children with autistic spectrum disorder
    A RDBPC study evaluated the effects of a commercially available multivitamin (MVM) in 20 children aged 3 to 8 yrs with autism spectrum disorder. At baseline, children with autistic spectrum disorder had significantly higher vit B6 levels (75% higher) and sig lower levels of vitamin C than a control group of age and sex matched normal children. The children were randomly assigned to receive the MVM vs. placebo for 3 mos. Subjects in the MVM group consumed increasing levels of a liquid MVM for 50 days, then maintained the highest dose for the remainder of the study; each child was given a max dose of 3 mL MVM/5 lbs bodyweight. For the children with autistic spectrum disorder who consumed the MVM, statistically significant improvements in sleep and gastrointestinal problems were reported.35 Supp comp: (per 30 mL) pro-vitamin A mixed carotenoids (10,500 IU), lutein & zeaxanthin (84 IU), vits B1 (30 mg), B2 (25 mg), B3 (35 mg), B5 (25 mg), B6 (30 mg), B12 (1.6 mg), C (800 mg), D3 (150 IU), E (250 IU), folic acid (800 mcg), biotin (150 mcg), choline (60 mg), inositol (60 mg), mixed bioflavonoids (400 mg), Ca (275 mg), chromium picolinate (100 mg), Mg ascorbate (200 mg), Mn succinate (3 mg), molybdenum (75 mcg), potassium ascorbate (75 mg), selenomethionine (85 mcg), sodium metasilicate (3 mg), methylsulfonylmethane (300 mcg), Zn picolinate (20 mg), betaine (400 mg), DMAE bitartrate (100 mg), n-acetyl cysteine (50 mg), and alpha lipoic acid (25 mg)
    Topic: Diabetes

    Multivitamins, individual vitamin and mineral supplements, and risk of diabetes among older U.S. adults.
    A prospective study evaluated associations between individual vitamin/mineral supplements, multivitamin-mineral supplements, and risk of diabetes using data from the National Institutes of Health American Association of Retired Persons Diet and Health Study. Data were collected beginning in 1995-1996 (with food frequency and other questionnaires) and diagnosis of diabetes was self reported in 2000; 232,007 people participated in the study. Diabetes was diagnosed in 14,130 people in 2000. Risk for diabetes diagnosis was not altered with use of multivitamin supplements: multivariate odds ratios comparing nonusers to multivitamin users taking vitamins less than once per week 1.07 (95% CI 0.94-1.21), one to three times per week 0.97 (0.88-1.06), four to six times per week 0.92 (0.84-1.00), and for seven or more times per week 1.02 (0.98-1.06) (P for trend=0.64). Vitamin C or calcium supplements were associated with significantly lower risk of diabetes (0.91 (0.86-0.97) for vitamin C supplements and 0.85 (0.80-0.90) for calcium supplements). Vitamin E and other individual vitamin or mineral supplements were not associated with diabetes risk in this large prospective study. The results of this study indicate that multivitamin supplements are not associated with diabetes risk; vitamin C and calcium supplements may alter risk for diabetes and further study is warranted.36 Supplement composition: varied.
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    Effects of zinc and multimineral vitamin supplementation on glycemic and lipid control in adult diabetes.
    A 4 mo RDBPC trial with 96 diabetics evaluated zinc (Zn) with/without multivitamin-mineral supp (MVM) for glycemic control & lipid concentrations. Participants were randomly assigned to 1 of 3 preparations: Zn (22 mg) w/ MVM, Zn alone, or a placebo. Compared to baseline, mean fasting blood sugar change was -0.33 mmol/L for the Zn+MVM, significant when compared with the other two groups (P=0.05; MVM only group +0.19 mmol/L and +0.43 mmol/L in the control group). Hb(A1C) was significantly reduced in the Zn+MVM group. Total cholesterol was reduced in the Zn+MVM group (P<0.05) & in the MVM group (P<0.05). Triglycerides were reduced in all groups (P<0.05). The Zn+MVM group reduced LDL cholesterol levels (P<0.05), cholesterol:HDL cholesterol ratio (from 3.39 to 3.21, P<0.05). Cholesterol:HDL ratio was reduced in the MVM group (P<0.05). The cholesterol:HDL ratio increased from 3.42 to 3.92 (P<0.05) w/ placebo. Zn+MVM improved metabolic control for people with diabetes. Glycemic control (Hb(A1C)), fasting & postprandial glucose, and serum lipid profiles were improved with Zn supplementation.37 Supp comp: vits A (as acetate; 5000 IU), D3 (cholecalciferol; 400 IU), E (tocopheryl acetate; 151 IU), thiamine nitrate (10 mg), riboflavin (10 mg), pyridoxine HCl (2 mg), cyanocobalamin (7.5 mcg), nicotinamide (50 mg), Ca pantothenate (10 mg), ascorbic acid (75 mg), Mg oxide (30 mg), Mn sulfate (2.8 mg), Cu sulfate (2 mg), Zn sulfate monohydrate (63 mg), and Se dioxide (70 mcg)
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    Topic: Stress

    Effect of a probiotic multivitamin compound on stress and exhaustion.
    A six month clinical trial investigated the efficacy of a probiotic multivitamin-mineral supplement on symptoms of stress and exhaustion. Forty-two adults with stress or exhaustion (aged 31 to 61 years) consumed the daily probiotic multivitamin-mineral supplement for six months. At the end of the study there was a 40.7% improvement in stress symptoms. In addition, a 29% decrease in infectious illness and a 91% decrease in gastrointestinal discomfort were noted. This simple clinical trial suggests that a probiotic multivitamin-mineral supplement may improve symptoms of stress and exhaustion.38 Supplement composition: vitamins A (800 mcg), D (5 mcg), E (10 mg), C (60 mg), B6 (2 mg), B12 (1 mcg), K (30 mcg), thiamin (1.4 mg), riboflavin 1.6 mg), niacin (18 mg), folic acid (200 mcg), biotin (0.15 mg), pantothenic acid (6 mg), calcium (40 mg), phosphorus (16 mg), iron (14 mg), magnesium (5 mg), zinc (15 mg), iodine (150 mcg), copper (2 mg), selenium (30 mcg), manganese (2 mg), silicon (2 mcg), chromium (25 mcg), molybdenum (25 mcg), chloride (4.5 mg), potassium (5 mg), and probiotic culture (Lactobacillus acidophilus, Bifidobacterium bifidum, B. longum; 10 million cfu)
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