Multivitamin Mineral Supplements and Aging

​Hung Van Le*
Biologics & Drug Targets, ProSci LLC, Rockaway, The United States
ORCID
https://orcid.org/0000-0002-6913-2373 (Hung Van Le)

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Abstract
This narrative review summarizes key recent clinical findings on the daily use of multivitamin-mineral (MVM) supplements, with emphasis on evidence most relevant to aging and personal health decisions. Recent randomized trials suggest that daily MVM use in older adults may provide modest but clinically meaningful benefits in selected domains, especially global cognition and episodic memory, with less consistent evidence for executive function. Additional findings support a reduction in cataract incidence, a potential benefit for some cancer outcomes, and a possible slowing of biological aging as measured by epigenetic clocks. By contrast, current evidence does not support clear benefits for cardiovascular disease prevention, adjudicated mild cognitive impairment, dementia incidence, or age-related macular degeneration. These findings both complement and contrast with current recommendations from major health agencies, which remain cautious and do not endorse routine MVM use for all adults. The practical implication is not that everyone should take a daily MVM, but that the newer evidence provides a stronger basis for individualized decision-making. Readers may find this information useful when considering their own diet, age, chronic conditions, medications, and family history, and when deciding whether discussion of MVM supplementation with a clinician is warranted as part of a broader strategy to support healthy aging.

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Bottom line
 
Current evidence suggests that multivitamin-mineral supplementation in older adults:
 
May help

• Global cognition
• Episodic memory
• Cataract prevention
• Biological aging markers
• Some cancer outcomes

 
Has not been shown to help

• Cardiovascular disease
• Dementia prevention
• Age-related macular degeneration

 
Should not replace

• Healthy diet
• Physical activity
• Smoking cessation
• Blood pressure control
• Vaccination

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Introduction
Although the topic may seem trivial and often appears in the news or in everyday conversation, the concerns are legitimate. Vitamin and mineral deficiencies are a worldwide problem, especially in lower-income countries where inadequate nutrition remains widespread. One recent estimate suggests that up to 5 billion of the world’s 8.3 billion people have micronutrient deficiencies, with different effects in males and females [1]. Even in higher-income settings, adequate intake is not guaranteed because diet, lifestyle, health status, cultural factors, and aging all influence nutritional needs.
 
Fortunately, people in higher-income countries have access to abundant, generally clear guidance on meeting micronutrient needs through diet and, when appropriate, supplementation. In the United States, for example, the Centers for Disease Control and Prevention (CDC) provides guidance about micronutrients, the U.S. Preventive Services Task Force (USPSTF) offers its own recommendations, and the National Institutes of Health (NIH) Office of Dietary Supplements provides fact sheets for consumers and health professionals.
 
Despite the guidance provided by health agencies, many people still rely primarily on advice from trusted clinicians when deciding whether to take multivitamin-mineral supplements (MVMs). Others, more skeptical of the medical establishment, related industries, or public health agencies, may follow medical news closely to better understand their health and the implications of new findings. Recent reports that daily MVM use may slow epigenetic clocks [2] are likely to renew interest in a familiar question: whether to take MVMs, and if so, at what stage of life.

Do daily multivitamins slow epigenetic clocks and reduce biological age?
The original study by Li et al. (2026) [3] was a prespecified ancillary analysis of the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), a large randomized, placebo-controlled trial involving 958 older adults with a mean age of 70 years. Participants received a daily multivitamin-multimineral supplement (Centrum Silver), cocoa extract, both interventions, or placebo. Researchers measured five DNA methylation-based “epigenetic clocks” at baseline and again after two years.
 
The main finding for the multivitamin arm was a statistically significant slowing of biological aging on two of the five clocks studied, especially PCPhenoAge [4] and PCGrimAge [5]. The estimated effect corresponded to roughly 2.5 to 5 fewer months of biological aging over two years. Participants whose biological age exceeded their chronological age at baseline appeared to benefit most. Additional analyses suggested that participants whose clock measures improved also showed lower inflammation and better preservation of cognitive function.
 
Methodologically, this is among the strongest supplement studies conducted to date because it was randomized, placebo-controlled, prospectively planned, and based on a relatively large, well-characterized cohort. The findings are thought-provoking, but by themselves they are unlikely to change clinical practice for prescribing multivitamin-mineral supplements to older adults. That caution is understandable because the study also has important limitations.
 
Most importantly, epigenetic clocks are surrogate end points. They do not show that participants lived longer, avoided disability, prevented fractures, or reduced cardiovascular events. Instead, they reflect changes in biomarkers thought to track biological aging. Whether modest improvements in these clocks translate into meaningful clinical benefits remains uncertain. A biomarker can reach statistical significance without producing clear patient benefit. In addition, the effect size was modest, not all clocks changed, and the study was not designed to identify which components of the multivitamin-multimineral supplement produced the observed effect. Without a stronger mechanistic basis, targeted recommendations would be difficult.
 
The most encouraging aspect of the study is its consistency with earlier COSMOS and Physicians’ Health Studies (PHS) examining the effects of daily multivitamin use on major health outcomes. The new findings on biological age, as measured by epigenetic clocks, should therefore be interpreted in the context of the broader clinical evidence from those large trials.

Effects of daily MVM treatment on cancer incidence
The effects of daily MVM use on cancer incidence were examined in both the PHS and COSMOS trials.
 
In a randomized, double-blind, placebo-controlled trial, Gaziano et al. [6] evaluated daily MVM use in 14,641 U.S. male physicians aged 50 years or older in PHS II, including 1,312 men with a history of cancer at randomization. Median follow-up was 11.2 years (range, 10.7–13.3). Among men with and without a prior cancer history, daily MVM use was associated with a modest reduction in overall cancer incidence. Subgroup analyses further suggested that survivors of epithelial cancers may have benefited the most.
 
A later COSMOS trial, reported by Sesso et al. [7], examined a larger and more heterogeneous cohort of 21,442 U.S. adults (12,666 women aged 65 years or older and 8,776 men aged 60 years or older) who were free of major cardiovascular disease and recently diagnosed cancer at baseline. This randomized, double-blind, placebo-controlled trial had a much shorter median follow-up of 3.6 years. In contrast to PHS II, COSMOS found no statistically significant difference in overall cancer incidence or all-cause mortality between the multivitamin and placebo groups. However, subgroup analyses by cancer site suggested a significant reduction in lung cancer incidence.
 
These results are not necessarily contradictory. PHS II showed a small reduction in total cancer incidence after more than a decade of supplementation in male physicians, whereas COSMOS found no statistically significant reduction during a much shorter follow-up in an older, more heterogeneous population. Given the substantial differences in follow-up duration, demographic composition, and baseline risk, the two trials are best viewed as complementary rather than as directly comparable tests of the same hypothesis.

Effects of daily MVM treatment on cognition, memory, and executive function
Three COSMOS studies reported since 2023 have provided the clearest evidence to date on the cognitive effects of daily MVM supplementation in older adults.
 
In COSMOS-Mind, a randomized, double-blind, placebo-controlled substudy of 2,262 participants (mean age 73 years; 60% women; 89% non-Hispanic White), Baker et al. [8] evaluated the effect of daily MVM use on global cognition after a mean follow-up of three years. Compared with placebo, daily MVM supplementation produced a statistically significant benefit in global cognition, with the largest effect among participants with a history of cardiovascular disease. Benefits were also observed for episodic memory and executive function.
 
In the same year, Yeung et al. [9] analyzed a different COSMOS subgroup, COSMOS-Web, consisting of 3,562 older adults (mean age 71 years; 67% women; 93% non-Hispanic White) followed for up to three years. The primary end point was episodic memory at one year, with three secondary outcomes assessed over three years: episodic memory, performance on novel object recognition tasks, and executive function. Compared with placebo, participants assigned to daily MVM supplementation showed significantly better episodic memory at one year and across the full three-year follow-up. No significant differences were detected for the other two secondary outcomes.
 
The most recent analysis, reported by Vyas et al. [10], drew on all three cognitive COSMOS subgroups: COSMOS-Clinic (573 participants, two years of follow-up), COSMOS-Web (2,472 participants, three years), and COSMOS-Mind (2,158 participants, three years). COSMOS-Clinic was used to assess global cognition as the primary end point, with episodic memory and executive function as secondary outcomes after two years. The study found modest benefits in global cognition and significantly more favorable change in episodic memory, but no benefit for executive function or attention. The authors then performed a meta-analysis across all three COSMOS cognitive subgroups, focusing on global cognition and episodic memory as primary outcomes. Compared with placebo, daily MVM supplementation was associated with significantly more favorable change over time in both domains.
 
Taken together, these three studies suggest that daily MVM supplementation improves global cognition and episodic memory in older adults, whereas evidence for executive function is less consistent. Memory improvement appears to be the most robust and reproducible finding, and improvement in global cognition is reasonably well supported. A benefit for executive function remains plausible but is not yet firmly established. This may reflect greater biological heterogeneity in executive function or the use of measures that are noisier and less statistically powerful.

Effects of daily MVM treatment on cognitive impairment and dementia
Progressive decline in global cognition, memory, and executive function can lead to mild cognitive impairment (MCI) and, eventually, dementia—outcomes that can be formally adjudicated by expert panels. Sachs et al. [11] examined whether daily MVM supplementation, compared with placebo, affected the incidence of adjudicated MCI and all-cause dementia in the COSMOS-Mind cohort of 2,662 participants with a mean age of 73 years. After three years of follow-up, the incidence of neither outcome differed significantly between the MVM and placebo groups. However, among participants adjudicated as having MCI, those assigned to daily MVM performed better on tests of global cognition and executive function when scores at the time of adjudication were compared with scores obtained one year earlier. In the smaller subgroup adjudicated as having dementia, no clear differences were observed in global cognition, executive function, or memory. These latter results should be interpreted cautiously because the dementia subgroup was small and therefore statistically underpowered. Overall, COSMOS-Mind did not show that daily MVM supplementation reduces the incidence of cognitive impairment or dementia over three years, but the favorable cognitive findings within the MCI subgroup are consistent with the broader cognitive benefits reported elsewhere in COSMOS, including by Baker et al. (2023) [8].

Effects of daily MVM treatment on cataract and age-related macular degeneration (AMD)
Cataracts are common in older adults, whereas AMD is less common but remains a major cause of vision loss. Christen et al. [12] evaluated whether long-term daily multivitamin supplementation affected the incidence of cataract and age-related macular degeneration in 14,641 male physicians aged 50 years or older in the Physicians’ Health Study. In this randomized, double-blind, placebo-controlled trial, participants were followed for a mean of 11.2 years. Daily multivitamin use was associated with a modest but statistically significant reduction in cataract risk, but it had no significant effect on visually significant AMD. The cataract finding is consistent with results from two smaller independent trials: Maraini et al. [13], which followed 1,020 participants aged 55 to 75 years for about nine years, and Sperduto et al. [14], which studied 2,141 participants aged 45 to 74 years in a rural Chinese community over five to six years.

Effects of daily MVM treatment on cardiovascular disease
Two large randomized trials—PHS II (Sesso, H. D. et al. [15]) and COSMOS (Sesso, H. D. et al. [7])—found that daily MVM supplementation did not reduce major cardiovascular events, myocardial infarction, stroke, or cardiovascular mortality. Mean treatment and follow-up durations were 11.2 years in PHS II and 3.6 years in COSMOS. The PHS II cohort included 14,641 U.S. male physicians aged 50 years or older, whereas COSMOS enrolled 21,442 U.S. adults, including 12,666 women aged 65 years or older and 8,776 men aged 60 years or older.

Discussion
 
Taken together, the evidence reviewed here suggests that daily multivitamin-mineral (MVM) supplementation has produced several clinically relevant benefits in large randomized trials, although the strength of evidence varies by outcome. The most reproducible benefits have been observed in cognition among older adults, especially for global cognition and episodic memory in the COSMOS substudies, with less consistent evidence for executive function. Table 1 also indicates a modest reduction in overall cancer incidence in PHS II, a possible reduction in epithelial cancer incidence in that trial, a signal for lower lung cancer incidence in COSMOS, and a statistically significant reduction in cataract incidence in long-term follow-up studies. The newer COSMOS-Blood findings add a biologically interesting signal that daily MVM supplementation may modestly slow epigenetic aging, but this result should still be regarded as supportive rather than definitive because biological age is a surrogate marker rather than a hard clinical outcome. By contrast, the evidence does not currently support a reduction in cardiovascular events, mild cognitive impairment incidence, dementia incidence, or age-related macular degeneration.
 
For personal health, these findings are potentially meaningful because they point to benefits in areas that strongly affect independence and quality of life with aging. Even modest preservation of memory or global cognition may matter to older adults who want to maintain functional autonomy, medication management, financial judgment, and social engagement. A small reduction in cancer incidence or cataract risk can also be clinically meaningful when applied over many years, especially because cataracts and cancer are common age-related conditions. At the same time, the significance of these benefits should not be overstated. The demonstrated effects are generally modest, they do not establish that MVMs are a substitute for a healthy diet, and they do not show broad protection across all major chronic diseases. The most reasonable interpretation is that daily MVM supplementation may serve as a low-risk supportive strategy for selected adults, particularly when micronutrient intake may be less reliable because of age, appetite changes, chronic illness, restricted diets, or medication use.
 
These newer findings also create an important tension with current health agency recommendations. The U.S. Preventive Services Task Force (USPSTF) states that evidence remains insufficient to recommend for or against multivitamins for the prevention of cancer or cardiovascular disease in community-dwelling, nonpregnant adults, while specifically recommending against beta carotene and vitamin E for those purposes. That position is understandable because the USPSTF framework focuses on prevention of major clinical end points in generally healthy populations and gives substantial weight to consistency, magnitude of effect, and certainty across trials. Similarly, the NIH Office of Dietary Supplements emphasizes that MVMs do not replace healthy dietary patterns, that formulations vary substantially, and that supplements can help fill nutrient gaps but can also increase the risk of excessive intake of some nutrients. The CDC likewise frames micronutrient sufficiency as important for health but does not treat routine MVM use as a universal preventive intervention for all adults. In other words, the newer trial results do not necessarily overturn existing agency guidance; rather, they suggest that the evidence base for selected benefits of daily MVM supplementation in older adults is becoming stronger than many recommendations currently reflect.
 
A practical way to leverage this information is to think about MVM supplementation through the lens of personal risk rather than as a universal rule. A person with a family history of cognitive decline, memory problems, cataracts, or certain cancers might view the current data as a reason to discuss a standard, age-appropriate MVM with a clinician, especially if dietary intake is inconsistent or if there are risk factors for micronutrient insufficiency such as gastrointestinal disease, vegetarian or highly restrictive eating patterns, low appetite, frailty, polypharmacy, or alcohol overuse. Someone with established cardiovascular disease should recognize that current evidence does not support MVM use as a strategy to prevent heart attack, stroke, or cardiovascular death, even though cognitive benefits may still be relevant in some subgroups. Likewise, a person with a strong family history of dementia should understand that the current evidence is more supportive for slowing cognitive decline than for preventing adjudicated dementia over the short term. This distinction matters because expectations should be realistic: MVMs may help preserve function in some domains, but they should not be presented as a proven way to prevent all age-related diseases.
 
As for timing, the best time to think seriously about MVM supplementation is probably before nutritional vulnerability becomes obvious, but not necessarily in early adulthood for everyone. The clearest trial evidence in this review comes from adults in later life, generally from the early 60s onward, when risks of cognitive decline, cataract, cancer, and subclinical nutritional insufficiency become more relevant. For many people, midlife is therefore a reasonable time to begin considering whether their diet, health conditions, medications, and family history justify supplementation, while older adulthood is the period in which potential benefits may be most actionable. This does not mean that every healthy younger adult should take a daily MVM, nor does it imply that starting later guarantees benefit. Rather, it suggests that MVM use is best approached as part of anticipatory aging care: a decision revisited when diet quality declines, chronic disease accumulates, or family history raises concern about cognitive or age-related outcomes. In that sense, the new evidence is most useful not as a blanket recommendation, but as a prompt for individualized, age-aware decision-making grounded in both personal health context and the limits of the current evidence.

Conclusion
 
Our review summarizes the latest clinical findings on the daily use of multivitamin-mineral (MVM) supplements and shows that the evidence now supports selected benefits more clearly than many people may realize, particularly for global cognition, episodic memory, cataract risk, and possibly biological aging, with a potential benefit for some cancer outcomes, while benefits for cardiovascular disease, dementia, and some other outcomes remain unproven. In that sense, this review both supplements and contrasts current information and recommendations from health agencies, which appropriately remain cautious and do not endorse routine MVM use for all adults. The most useful implication is not a blanket recommendation, but a stronger basis for individualized reflection and action. At different stages of life, especially in midlife and older adulthood, individuals can use this information to consider their diet, health conditions, medications, and family history, discuss the possible role of MVM supplementation with their doctors, and decide whether a standard, age-appropriate product fits their overall preventive health strategy. Used thoughtfully, MVM supplementation may be one small but meaningful part of a broader plan to support healthy aging.

References
 

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