Background: 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.
The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) (Ref-1) at Brigham and Women’s Hospital, an affiliate of Harvard Medical School is a clinical trial that randomized 21,442 men and women across the United States. Ref-2
Objectives: This study aimed to test MVM effects on cognitive change using in-person, detailed neuropsychological assessments and conduct a metaanalysis within COSMOS (COcoa Supplement and Multivitamin Outcomes Study) cognitive substudies for a robust evaluation of MVM effects on cognition.
Methods: COSMOS is a 2 2 factorial trial of cocoa extract (500 mg flavanols/d) and/or a daily MVM supplement for cardiovascular disease and cancer prevention among 21,442 United States adults aged 60 y.
There were 573 participants in the clinic subcohort of COSMOS (that is, COSMOS-Clinic) who completed all cognitive tests administered at baseline. For the meta-analysis, we included nonoverlapping participants across 3 COSMOS cognitive substudies: COSMOS-Clinic (n ¼ 573); COSMOS-Mind (n ¼ 2158); COSMOS-Web (n ¼ 2472).
Results: In COSMOS-Clinic, we observed a modest benefit of MVM compared with placebo on global cognition over 2 y {mean difference [95% confidence interval (CI)] ¼ 0.06 SD units (SU) ( 0.003, 0.13)}, with a significantly more favorable change in episodic memory [mean difference (95% CI) ¼ 0.12 SU (0.002, 0.23)] but not in executive function or attention [mean difference (95% CI) ¼ 0.04 SU ( 0.04, 0.11)].
The meta-analysis of COSMOS substudies showed clear evidence of MVM benefits on global cognition [mean difference (95% CI) ¼ 0.07 SU (0.03, 0.11); P ¼ 0.0009] and episodic memory [mean difference (95% CI) ¼ 0.06 SU (0.03, 0.10); P ¼ 0.0007]; the magnitude of effect on global cognition was equivalent to reducing cognitive aging by 2 y.
Funding The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is supported by an investigator-initiated grant from
- Mars Edge, a segment of Mars dedicated to nutrition research and products
- Pfizer Consumer Healthcare
- National Institutes of Health (NIH), Bethesda, MD.
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