Adequacy of nutrients important for brain health and dietary supplement use among older adults in the U.S. POINTER trial

Background & objective Consumption of diets insufficient in essential nutrients contributes to unhealthy aging. The objective of this study is to evaluate adequacy of key nutrients that reflect the food components of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) dietary pattern, one deemed important for brain health. Setting/design Cross-sectional analyses of diets of participants in the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (US POINTER) trial Participants Adults, aged 60–79 years and at risk of cognitive impairment (sedentary, suboptimal diet, other risk factors) were enrolled in the US POINTER, a phase III two-year randomized controlled trial comparing the impact of two lifestyle interventions on brain health. Measurements Before randomization, participants completed a food frequency questionnaire (FFQ) assessing usual intake of foods and beverages, and vitamin and/or mineral supplements. Median daily nutrient intakes were expressed as a percentage of sex- and age-specific Estimated Average Requirement (EAR) or Adequate Intake (AI), and Tolerable Upper Limit (UL) criteria. Results Of the 2111 enrolled participants, 2041 completed the FFQs (69% women). Nearly half reported multivitamin multimineral supplement use (49%, men; 49%, women). Common individual supplements included vitamins D (36%), E (25%), C (23%), and B 12 (19%) as well as calcium (16%). Based on food alone, the proportion of participants with inadequate intakes was high across several nutrients. Supplements improved nutrient adequacy for most (except for choline, fiber and potassium) but contributed to intakes for some that exceed the UL cutoffs (vitamins A (n = 28), B 9 (n = 134), B 3 (n = 160) and zinc (n = 196)). Conclusions Widespread nutrient inadequacy (especially those integral to the MIND dietary pattern) is evident among non-supplement users. Supplement use improves adequacy but raises concerns about excessive intakes that exceed ULs. Assessment of diet and supplement intake is essential to address nutrient inadequacies in at-risk older adults. Clinical Trial Registration Number : NCT03688126, submitted 9/26/2018.