Up to what age is a multivitamin (multiple vitamin) recommended?

Multivitamin Recommendations Based on Age

Multivitamins are not routinely recommended for healthy adults of any age for the prevention of cardiovascular disease or cancer, as there is insufficient evidence to support their use. 1

Evidence-Based Recommendations by Age Group

Children and Special Populations

• The USPSTF recommendations do not apply to children, pregnant women, or those with known nutritional deficiencies 1
• For these populations, specific nutritional supplementation may be indicated based on individual needs

Healthy Adults

• The U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to assess the balance of benefits and harms of multivitamins for the prevention of cardiovascular disease or cancer 1
• The USPSTF explicitly states that their recommendations apply to "healthy adults without special nutritional needs" who were "typically aged 50 years or older" 1
• There is no specific age cutoff for when multivitamins should be discontinued

Older Adults

• For older adults (particularly those in long-term care facilities), a daily multivitamin supplement may be appropriate, especially for those with reduced energy intake 1
• All older adults should be advised to have a calcium intake of at least 1,200 mg daily 1

Considerations for Specific Populations

Middle-Aged to Older Adults

• Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults 2
• Multivitamin use has been shown to improve nutritional status in this population 2
• Obese individuals may be at greater risk of clinical deficiency in vitamins B6 and D 2

Cancer Survivors

• Cancer survivors tend to use supplements at higher rates than the general population 1
• 52-58% of cancer survivors report using multivitamins 1
• However, supplements may interact with cancer treatments in unfavorable ways 1

Potential Benefits and Harms

Benefits

• Multivitamin use is associated with lower prevalence of inadequacies for folate, iodine, selenium, and vitamins B6, B12, and D 2
• In successfully aging elderly, multivitamin supplementation may help address deficiencies in essential vitamins that develop over time 3

Harms

• Supplementation with β-carotene increases the risk for lung cancer in persons at increased risk for this condition 1
• Multivitamin use can increase the proportion of individuals exceeding the tolerable upper intake level for certain nutrients like folic acid 2
• Some studies have shown increased risk of cancers in relation to using certain vitamins 4

Usage Patterns

• 49% of U.S. adults used at least one dietary supplement between 2007-2010 1
• 32% reported using a multivitamin-multimineral supplement 1
• Usage is more common in women, older adults, non-Hispanic whites, and those with higher education levels 5

Clinical Decision-Making Algorithm

1. Assess if patient falls into a special population category (children, pregnant women, chronically ill, hospitalized, or known nutritional deficiency)

   • If yes: Follow specific guidelines for that population
   • If no: Continue to step 2

2. Evaluate nutritional risk factors in adults:

   • Age ≥70 years with reduced energy intake
   • Involuntary weight loss >10 pounds or 10% body weight in <6 months
   • Specific nutrient deficiencies identified through testing
   • If any present: Consider multivitamin supplementation
   • If none present: Continue to step 3

3. For healthy adults without special needs:

   • Explain that current evidence does not support routine multivitamin use for preventing cardiovascular disease or cancer
   • Emphasize obtaining nutrients through a balanced diet
   • Avoid β-carotene and vitamin E supplements specifically

Common Pitfalls to Avoid

• Assuming multivitamins are harmless - they may increase risk of exceeding tolerable upper limits for certain nutrients
• Recommending multivitamins as a substitute for a healthy diet
• Failing to recognize potential interactions between supplements and medications
• Overlooking that supplement content and concentration can vary considerably between commercial formulations

In conclusion, while there is no specific age cutoff for discontinuing multivitamins, the evidence does not support their routine use in healthy adults of any age for preventing cardiovascular disease or cancer. For older adults with reduced energy intake, a daily multivitamin may be appropriate, but this should be based on individual nutritional needs rather than age alone.