ONSs contain nearly all essential nutrients, including vitamins and minerals. A 2014 Cochrane Review40 examined the results of 14 RCTs evaluating the effects of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers. The trials were heterogeneous with regard to participants, interventions, nutrients used in the interventions, comparisons, and outcomes, and the review found no clear evidence of an improvement in pressure ulcer healing from the nutritional supplements.
A more recent review by Heintschel and Heuberger38 considered 10 studies of ONS, including both standard and speciality formulas. The review focused specifically on zinc, based on the role of this essential mineral in a number of anabolic processes including DNA repair and protein metabolism as well as several aspects of immunocompetence. Zinc intakes tend to be low in older adults, but there is a lack of reliable biomarkers of zinc status. While the authors concluded that both standard and speciality ONS improved outcomes, it was not possible to distinguish a preferable formulation. The authors also noted the unreliability of zinc biomarkers and the lack of a significant response of pressure injury to zinc sulfate administration as factors that furthered hampered understanding of the potential impact of zinc status. Thus, while the role of ONS in the prevention and treatment of pressure ulcers was confirmed, the precise role of micronutrients such as zinc await confirmation through further studies in higher quality and more consistent RCTs.
Summary
Vitamins and minerals perform essential metabolic and physiologic functions in the body, can be obtained from a wide variety of foods, and also can be consumed as supplements when insufficiently supplied from diet alone or when therapeutic doses are needed. Frank micronutrient deficiencies produce classic deficiency syndromes and clearly should be treated. Marginally deficient intakes over time can also lead to suboptimal outcomes in a variety of systems and should be corrected. Users of supplements of vitamins and minerals, such as MVMs, are less likely than nonusers to be deficient in several micronutrients.13 Along with a healthy dietary pattern, a daily MVM may be a practical way to compensate for shortfalls in micronutrient intakes.4,13 Supplements of various vitamins and minerals generally have not been beneficial in primary prevention of chronic diseases. The development and progression of chronic diseases occur over decades, so it is unlikely that a few years of supplementation in late life will prevent diseases such as cancer and cardiovascular diseases.
Key points
Age‐associated changes in food intake, such as social factors, psychological problems, physiological decrements, chronic disease, polypharmacy, and medical factors, contribute to protein‐calorie inadequacies and deficiencies of micronutrients.
Single and/or MVM preparations are frequently consumed by older adults, and drug–nutrient interactions may be of concern because of polypharmacy.
Beyond their function in general health, the role of each micronutrient for prevention and treatment of specific chronic diseases is unclear based on the available data from clinical trials.
Given the limited support for the efficacy of micronutrient supplements in preventing disease and the potential concerns about adverse effects, it is essential to read labels and select supplements that contain equal to or less than the recommended amounts of specific nutrients (e.g. 100% of recommendations for general health).
References
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