Home

We challenge the suggestion of Congress that the Older Americans Act (OAA) Nutrition Program should provide multivitamin-mineral supplements (MVMs) in addition to meals. MVMs are not a quick fix for poor diets. They do not contain calories, protein, essential fatty acids, or fiber, nor do they adequately address nutritional gaps of some vitamins and minerals. Older adults with chronic health conditions who take multiple medications are at greater risk than the general healthy population for nutrient-drug interactions and toxicity. The OAA Nutrition Program is not an appropriate venue to indiscriminately distribute MVMs, because there is insufficient evidence of their benefits and safety. The program's limited funds and efforts should instead be directed to nutrient-dense healthy meals, quality food service, and greater accessibility to individualized nutrition services.

CONCLUSIONS

OAA Nutrition Program participants are older, are at higher nutritional risk, have lower incomes, and may have morelimited access to food than the general older population. Participants in home-delivered meal programs are even more vulnerable; they are frailer and have more functional impairments resulting from nutrition-related diseases and conditions.1 MVMs can help fill intake gaps for some, but not all, vitamins and minerals. Evidence of health benefits and safety of supplement use among older adults with multiple health problems and medications, however, is insufficient to recommend the indiscriminate distribution of MVMs to OAA Nutrition Program participants.

A scientifically sound, safer strategy to address micronutrient inadequacies among older adults is to increase offerings of nutrientdense foods and to expand access to nutrition services (i.e., screening, assessment, education, and counseling provided by registered dietitians). A decision to recommend an MVM and the types and amounts of nutrients to supplement must be individualized, with dietary intake, health status, and medication use taken into account. Those determined to need an MVM should take an appropriate one daily, not only on days they receive a program meal.

Food sources of nutrients remain the ideal way to improve nutrition intakes and meet the OAA goals. MVMs are not a one-size- fits-all quick fix for poor diets because they do not address the poor intakes of energy, protein, essential fatty acids, and fiber that may also result from inadequate food intake. Because OAA Nutrition Program meals typically provide more than half of participants' daily intakes of many nutrients, it is more important that nutrient-dense foods be incorporated into meals to best meet the needs of vulnerable older adults. Doing so requires nutrition and food-service expertise.

Positive health outcomes relate more to food intake patterns than to intakes of specific nutrients.40 Nutritious, culturally appropriate OAA Nutrition Program meals provide more than a source of nutrients; they offer psychological and social benefits as well. Diverting funds from food to MVMs could undermine the program's goals of reducing hunger and food insecurity, promoting socialization, and enhancing the health and well-being of older adults6 and could challenge the foundation of federal nutrition policy.

Screening for malnutrition risk and appropriate nutrition assessments and interventions-including additional meals and, if appropriate, dietary and liquid nutritional supplements-should be an integral part of evidence-based, consumer- directed care.41 If, as a nation, we are serious about enabling older Americans to remain in their homes and communities and enhancing their quality of life, food and nutrition services cannot be taken for granted or corrected by a one-size-fits-all, quick-fix pill.