Role of Centrum® Silver® in Improving Micronutrient Status in Older Men

Older adults are at increased risk of various chronic diseases, in which inadequate levels of
vitamins and minerals may play a significant role, including cardiovascular disease,
Alzheimer's disease, liver disease, and cancer. Most adults in the United States do not meet
the Recommended Dietary Allowance (RDA) or Adequate Intake (AI) of many vitamins and
nutritionally-essential minerals from diet alone, including vitamins A, C, D, E and K,
calcium, magnesium, and potassium. Older adults are particularly susceptible to micronutrient
inadequacies because of limited absorption, increased requirements, or - in the case of
vitamin D - decreased synthetic capacity in the skin. Thus, there is a strong rationale for
supplementing the diets of older adults with a multivitamin/multimineral supplement, such as
Centrum® Silver®. However, little is currently known about the bioavailability of the
Centrum® Silver® formula in this age demographic.

Epidemiological studies and recent clinical trials have shown that use of
multivitamin/mineral supplements has beneficial effects on disease risk in men, including
those of advanced age. It is assumed that these benefits of multivitamin/mineral supplements
are achieved through changes in nutrition status. However, it has never been documented if
there are concomitant changes in micronutrient levels in individuals who consume these
supplements. Furthermore, changes in nutritional status in older individuals taking
multivitamin/multimineral supplements are a subject that has yet to be explored.

Therefore, this study seeks to recruit men who are in generally good health, 70 years of age
or older, to assess their vitamin and mineral status before and after six months
(approximately 24 weeks) of supplementation with Centrum® Silver®. The investigators
hypothesize that consuming multivitamin/multimineral supplements everyday will result in
measurable increases in the status of one or more vitamins or minerals in the body.
Concentrations of several vitamins and minerals in blood samples will be performed, along
with a general assessment of micronutrient status in white blood cells (primary outcomes). To
see if these changes in nutrition status impact other aspects of human health, changes in
lipid and lipoprotein profiles, antioxidant status, metabolic health, and inflammation and
treatment differences in cognitive function will be assessed (secondary outcomes). Centrum®
Silver® supplementation may or may not have any effect on these secondary outcomes, when
compared to a placebo, unless there are measurable changes in the primary outcomes.

The expectation is that the results of this research will add to a general understanding of
multivitamin/mineral supplements and how well they can improve the nutritional status of
older adults. By employing direct and functional methods to assay for nutritional content,
this study will determine how well these methods correlate and by using both assay methods
unique insight into the mechanism(s) whereby multivitamin/multimineral supplements might or
might not lead to improvements in health may be ascertained.

Inclusion Criteria:

Participants must be willing to:

- Consume a multivitamin/mineral supplement or placebo tablet each day during the
6-month study period

- Fill out online food frequency questionnaires

- Refrain from taking dietary supplements (vitamins, minerals, certain antacids, energy
drinks, fortified cereals, or nutritional shakes) other than those provided during the
study, with an exception for vitamin D. Users of multivitamin supplements must agree
to avoid taking these supplements for two months before the study begins.

- Refrain from taking acid-blockers during the course of the study.

- Wear an activity monitor about the wrist continuously for two one-week periods, except
when exposed to water, before and during multivitamin supplementation.

- Give blood samples on 3 separate occasions

- Participate in cognitive testing procedures

Exclusion Criteria:

- Currently taking supplements as recommended/ordered by a physician to correct a
nutritional deficiency, with an exception for vitamin D supplements

- Current or recent (two years) history of smoking (tobacco or marijuana)

- Dysphagia or difficulty swallowing.

- Bariatric (gastric bypass) surgery or serious chronic illness that might affect
absorption of multivitamins or minerals such as Crohn's disease, unmanaged celiac
disease, chronic diarrhea, ulcerative colitis, gastritis, or a diagnosis of
malabsorption syndrome.

- A diagnosis of cancer with chemotherapy or radiation treatment during the previous 5
years.

- Major surgery in the past 6 months or planned major surgery during the duration of the
study.

- Prior heart attack, stroke, or heart failure.

- Uncontrolled stage II hypertension (blood pressure above 159/99 mm Hg).

- A current diagnosis of kidney, liver, or thyroid disease.

- Diabetes (Type 1 or Type 2).

- History of hypoglycemia or low blood sugar.

- Hb1ac levels > 6.4%.

- Current use of certain drugs to control blood sugar, thyroid medications, anti-seizure
medication, anxiolytics, or antidepressants (see Post-Screen Drug Review).

- BMI < 18.5 or > 35

- History of psychological or neurological disorders, or a diagnosis of dementia.

- Head injury with loss of consciousness of > 5 minutes in the last 5 years.

- Chronic Migraines - More than fifteen headache days per month over a three month
period of which more than eight are migraines.

- Score < 26 on the mini-mental state exam.

- Present treatment for drug or alcohol problems.

- Habit of taking three or more alcoholic drinks per day.

- Corrected visual acuity worse than 20/50.

- Anyone who cannot handwrite a letter or move a computer joystick with one of their
hands.

- Cannot hear well enough to understand spoken instructions.