Multivitamin Use and B Vitamin Status in a Homebound Elderly Population

Authors: BUELL, JENNIFER - JM USDA HNRCA @ TUFTS; ARSENAULT, LISA - JM USDA HNRCA @ TUFTS; SCOTT, TAMMY - TUFTS-NEMC; QIU, WENDY - TUFTS-NEMC; Rosenberg, Irwin; FOLSTEIN, MARSHAL - TUFTS-NEMC; Tucker, Katherine

Submitted to: Journal of Nutrition Health and Aging
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/10/2006
Publication Date: 7/1/2007
Citation: Buell, J.S., Arsenault, L.N., Scott, T.M., Qiu, W.Q., Rosenberg, I., Folstein, M.F., Tucker, K. 2007. Multivitamin Use and B Vitamin Status in a Homebound Elderly Population. Journal of Nutrition Health and Aging. 11(4):299-303.

Interpretive Summary: Mild nutritional deficiencies are not uncommon in the elderly, and evidence for the benefits of multivitamin use is beginning to accumulate. Multivitamin use has been associated with a lower risk of heart disease, colon cancer, breast cancer, and length of infection in older adults. A recent report estimates that more widespread use of multivitamins among adults over 65 years of age may significantly reduce healthcare costs through reductions in heart disease and improved immune function. Homebound elderly are at increased risk for micronutrient deficiencies, and nutritional status in this population has not been adequately described. The purpose of this study is to investigate the association between multivitamin use and B vitamin status in a racially diverse group of 418 homebound elders aged 65-99 years. Both white and black elders had a high prevalence of dietary intakes below the Estimated Average Requirement for folate, vitamin B6, and vitamin B12. Multivitamin use was associated with improved vitamin B6, vitamin B12, and folate status in each group. Elderly individuals with low intakes of folate, B12, and B6 have been shown in other studies to score lower on tests of memory and abstract reasoning and patients with dementia have lower concentrations of B vitamins. If these associations hold true, multivitamin intervention may go beyond improving nutritional status and possibly help reduce chronic disease. Also, these subjects have a considerable burden of chronic disease, which may put them at higher risk of nutrient inadequacy. We conclude that physician directed multivitamin use could enhance the routine care of the homebound elderly.

Technical Abstract: Homebound elderly are at increased risk for micronutrient deficiencies, and nutritional status in this population has not been adequately described. There is evidence for beneficial effects of multivitamin use and a greater understanding of their nutritional contribution could identify behaviors that may help alleviate excess chronic disease. The purpose of this analysis is to investigate, in a racially diverse group of homebound elders, the association of multivitamin use with measures of plasma B vitamin concentrations. We examined the cross-sectional association between multivitamin use and plasma concentrations of B vitamins and homocysteine in 236 white and 182 black homebound elders (65–99y). Dietary intake was assessed and demographic and health information was ascertained. White and black elders had a high prevalence of dietary intakes below the Estimated Average Requirement for folate (38.1 and 40.7%), vitamin B6 (16.9 and 19.2%), and vitamin B12 (3 and 3.9%) respectively. Multivitamin use was associated with higher mean plasma B vitamin concentrations in each group. In whites, multivitamin users had higher concentrations of vitamin B6 (64.6 vs. 32.4 nmol/L; p<0.001), vitamin B12 (398 vs. 324 pmol/L; P<0.001) and folate (39.4 vs. 30.4 nmol/L; P<0.001). Black multivitamin users had higher concentrations of vitamin B6 (53.7 vs. 29.5 nmol/L; P<0.001), B12 (427 vs. 372 pmol/L; P<0.05) and folate (35.7 vs. 25.4 nmol/L; P<0.001) than non-users. Multivitamin supplementation was associated with higher mean plasma concentrations of vitamins B6, B12, and folate.