Multivitamin and mineral supplements (MVM) represent the most commonly used category of nutritional interventions worldwide. Their use is justified by deficiency prevention, neuroprotection, immunomodulation and chronic disease prevention. However, assessing their actual clinical effectiveness requires reliance on Evidence-Based Medicine (EBM), including Cochrane meta-analyses, U.S. Preventive Services Task Force (USPSTF) reports and large randomized controlled trials (RCT).

The following review is a synthesis of scientific evidence available up to 2025.

1. Cognitive Function and Neurology

1.1. Geriatric Population and MCI (Mild Cognitive Impairment)

Historically, Cochrane reviews indicated a lack of strong evidence for dementia prevention. However, newer data from large RCTs, including COSMOS-Mind and COSMOS-Web (2022-2024), suggest that daily MVM supplementation may slow cognitive aging in older adults (over 65 years) by an estimated 2 years compared to placebo.

  • Observed effects: Improvement in episodic memory and executive function.
  • Mechanism: Probable correction of subclinical micronutrient deficiencies (vitamin B12, folate, zinc) important for neurotransmission.

1.2. Young Adults

No evidence of cognitive function improvement in young, healthy and adequately nourished individuals.

Sources: Baker LD et al., COSMOS-Mind Study, Alzheimer's & Dementia, 2022; Cochrane Database Syst Rev. 2020.

2. Mental Health and Well-Being

Research on the effects of MVM on anxiety symptoms, stress and "brain fog" is characterised by high heterogeneity. Although some clinical trials (e.g., the Swinburne University study series) suggest mood improvement and reduction of mental fatigue, this effect is strongest in individuals with suboptimal baseline nutritional status.

Conclusion: Insufficient evidence to recommend MVM as monotherapy for mood disorders in the general population.

3. Cardiovascular System (CVD)

The latest USPSTF guidelines (2022) and meta-analyses published in JAMA are unequivocal: MVM supplementation does not reduce the risk of cardiovascular disease incidence or death.

Studies such as Physicians' Health Study II (PHS II) showed no reduction in the incidence of myocardial infarction, stroke or cardiovascular mortality.

4. Immunology and Infectious Diseases

4.1. Immune Modulation

The effect on the immune system is closely correlated with nutritional status. In individuals with deficiencies (e.g., vitamin D, C, zinc, selenium), supplementation restores normal immune response.

4.2. Infection Prevention in the General Population

In healthy individuals without deficiencies, routine MVM supplementation does not significantly reduce the risk of respiratory tract infections (including COVID-19), although it may slightly shorten symptom duration.

5. Ophthalmology (AMD and Cataract)

A clear distinction must be made between standard multivitamin preparations and high-dose antioxidant formulas of the AREDS type.

  • AREDS/AREDS2 Formula: Effective in slowing progression of advanced age-related macular degeneration (AMD).
  • Standard multivitamins (e.g., "Centrum" type): The PHS II study showed only marginal cataract risk reduction and no effect on AMD development. They are not a first-line treatment for eye disease prevention.

6. Pregnancy and Periconceptional Period

This is the only area where micronutrient supplementation (particularly folic acid, iron, iodine and vitamin D) has Level A evidence.

  • Folic acid: Reduction of neural tube defect (NTD) risk by 50-70%.
  • Recommendation: Supplementation is mandatory for women of childbearing age planning pregnancy and during pregnancy.

7. Oncology

The 2022 USPSTF analysis states that evidence is "insufficient" to recommend MVM for cancer prevention.

Nuances: In the Physicians' Health Study II, a small (approximately 8%), statistically significant reduction in total cancer incidence was noted in men taking MVM for over 10 years. However, this did not translate into a reduction in cancer mortality.

Conclusion: MVM do not replace lifestyle changes and screening programmes.

8. All-Cause Mortality

Large cohort studies (including the NIH-AARP Diet and Health Study) and interventional meta-analyses show a neutral effect of multivitamins on lifespan.

Recent analyses (Loftfield et al., JAMA Network Open 2024) suggest no benefit in extending life, and in some subgroups (e.g., smokers taking high-dose beta-carotene) a possible increased risk.

9. Sport and Exercise Physiology

According to the position of the American College of Sports Medicine (ACSM) and the International Society of Sports Nutrition (ISSN):

  1. No ergogenic effect: In athletes without deficiencies, MVM do not increase VO2max, strength or power output.
  2. Indications: Supplementation is justified during periods of energy restriction (weight loss), with elimination diets and in sports with extremely high energy expenditure, where dietary intake may be insufficient to cover losses.

10. Clinical Summary

In light of EBM, multivitamins are not a panacea for civilisation diseases, but remain an important "nutritional insurance" tool.

Indication Level of Evidence Clinical Decision
Deficiency correction High Recommended (targeted)
Pregnancy (neural tube defects) High Recommended (prenatal)
Cognitive function (65+) Moderate Consider (per COSMOS)
AMD (AREDS formula) High Recommended in advanced disease
CVD prevention None/Low Not recommended
Life extension None Not recommended

Bibliography (selected):
1. Baker LD et al. Alzheimers Dement. 2022;18(11).
2. O'Connor EA et al. JAMA. 2022;327(23):2334-2347.
3. Sesso HD et al. JAMA. 2012;308(17):1751-60.
4. Loftfield E et al. JAMA Netw Open. 2024;7(6):e2418729.