Relationship between use of multivitamins and mineral supplements and frailty in older Korean population: a cross-sectional study using the Korea National Health and Nutrition Examination Survey 2018–2019
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Interest in healthy aging has grown with the increase in the older population. Nutritional intake is crucial in frailty. Therefore, we aimed to investigate the relationship between frailty and multivitamin and mineral supplements (MVMS), which can easily provide micronutrients.
Methods
The Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2018 to 2019 included 3,395 adults aged ≥65 years. Of these, 1,511 who did not consume dietary supplements (DS, non-DS group) and 415 who took MVMS (MVMS group) were included in the study. We modified Fried’s definition of frailty to fit the KNHANES data. Using multivariate logistic regression, we examined the association between MVMS use and frailty, which varied with satisfaction with total energy intake. Additional subgroup analyses were performed based on age, sex, and income.
Results
MVMS reduced most micronutrient deficiencies compared to obtaining nutrients solely through food. The overall analysis revealed no association between MVMS use and frailty (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.52–1.09). However, a subanalysis revealed that participants with a low income (≤25%) who took MVMS had decreased odds for frailty (OR, 0.55; 95% CI, 0.35–0.88) compared with the non-DS group. Furthermore, a significant association between using MVMS and frailty was confirmed in the group with low income and energy intake below the recommended daily allowance, with a low OR of 0.52 (95% CI, 0.30–0.90).
Conclusion
MVMS use was significantly associated with frailty among the low-income and low-daily energy intake groups.
As the elderly population increases globally, age-related frailty syndrome has become an important health problem. Frailty is a condition characterized by significantly reduced function of various organs, and these organs cannot recover adequately when exposed to stress. Globally, approximately 12%–24% of people aged ≥65 years experience frailty [1]. Frailty reduces quality of life in the older population and places a significant burden on the national healthcare system [2].
Physical activity and nutritional intake are necessary to maintain health in old age. A lack of nutrition affects the function of the whole body including cardiovascular, cognitive, musculoskeletal, immune, metabolic, and ophthalmological functions, making it more vulnerable to non-communicable diseases [3]. Aging-related physical changes can negatively affect nutritional status. For example, impaired taste and smell may cause loss of appetite, indigestion, delayed gastric emptying, reduced food consumption, and dental problems, resulting in difficulty in chewing food. Therefore, malnutrition is more common among older adults, and approximately 15% of people aged ≥65 years in Korea have poor nutrition [4].
Total energy and protein intakes are closely linked to frailty, and micronutrient intake also plays a role in this condition [5-8]. Micronutrient deficiencies are associated with a higher risk of frailty in community-dwelling older adults with malnutrition. Although micronutrient deficiencies are observed across the entire general population including young adults, they are more significant in older populations, those with low income and education levels, those on extreme diets, and those who have undergone bariatric surgery [9]. An estimate of the micronutrient gap can be obtained from several studies. Data from the United States [10], Europe [11], and Korea [12] have shown deficiencies in various micronutrients including vitamins A, B6, B12, C, D, and E; magnesium; calcium; iron, and zinc.
The US National Institute of Health defines multivitamin and mineral supplements (MVMS) as supplements containing three or more vitamins or minerals that may be unavailable in the diet at doses below the daily upper intake level [13,14]. MVMS should not be considered a replacement for a balanced diet. However, it may be particularly beneficial for people who consume insufficient food or are malnourished for various reasons. In previous studies, regular supplementation resulted in an estimated 75% reduction in the number of older adults with inadequate micronutrient intake [12,15,16].
We hypothesized that consuming MVMS to obtain sufficient micronutrients that cannot be obtained from the daily diet would be associated with a reduced prevalence of frailty. We focused on the relationship between frailty and use of MVMS formulations containing multiple vitamins and minerals rather than individual vitamins or supplements with few ingredients.
Methods
Data source and study population
This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2018 and 2019. The KNHANES is a nationally representative survey for assessing the health status of the Korean population, health-related awareness and behaviors, and nutritional intake. It comprises health, nutrition, and examination surveys. The health survey comprises a household survey, health interviews, and behavioral surveys. Sociodemographic information was obtained through health and behavioral surveys. The survey includes physical and anthropometric measurements, handgrip strength tests, and blood and urine tests. The nutritional survey investigates the current status of eating habits, use of dietary supplements (DS), nutritional knowledge, food safety, and food and nutrient intake using the 24-hour recall method.
Of the 16,109 individuals who participated in the 2018–2019 survey, 3,395 were aged >65 years. Of these, 315 individuals with missing responses to questions on the current use of DS and 134 with missing data on variables related to frailty components and nutrients were excluded. In addition, 32 individuals with extreme data values, such as total energy intake >4,000 kcal or total metabolic equivalent of the task (MET) for 1 week >10,000 kcal, were excluded. We initially selected 2,914 individuals: 1,403 individuals who used DS (including 415 who used MVMS) and 1,511 who did not use any DS. Ultimately, 1,926 individuals were selected as study participants, comprising 1,511 nonDS users and 415 MVMS users (Figure 1).
The 2018–2019 National Health and Nutrition Survey was conducted with the approval of the Institutional Review Board (IRB) of the Korea Centers for Disease Control and Prevention (IRB approval no., 2018-01-03-P-A and 2018-01-03-C-A), and informed consent was obtained from the survey participants.
Definition of frailty
We used the revised definition of frailty phenotypes established by Fried et al. [17]. To define modified frailty, we referred to previous research using KNHANES data (Table 1) [18-20]. Participants were classified as “frail” if three or more of the five components (weight loss, exhaustion, weakness, slowness, and low energy expenditure) were satisfied, “pre-frail” if one or two components were met, and “robust” if none of the components were met. This study analyzed frailty by dividing the participants into non-frail (robust and pre-frail) and frail groups.
Definition of the MVMS group
The DS survey, a nutritional survey, contained information such as the current use of DS, type of DS, product name, manufacturer, duration of use, number of doses, and dosage. The supplements consumed by the participants were categorized into 12 groups as follows: MVMS, vitamin C, omega-3 fatty acids, probiotics, red ginseng, calcium, vitamin A or lutein, propolis, vitamin D, iron, other vitamin and mineral supplements, and other supplements. We defined those who underwent MVMS as the MVMS group (n=451) and those who did not consume any DS as the non-DS group (n=1,511).
Nutrient intake and classification
In the KNHANES, data on nutrient intake through food were obtained through a 24-hour recall method, and data on nutrient intake through DS confirmed the intake of eight micronutrients including five vitamins (vitamin A, thiamine, riboflavin, niacin, and vitamin C) and three minerals (calcium, iron, and phosphorus). We determined whether nutrient intake through food alone or food and MVMS met these standards using the recommended nutrient intake (RNI) presented by the 2020 Dietary Reference Intakes for Koreans [21]. Moreover, to examine the association between frailty and micronutrients based on nutritional status, we classified participants into the meet-RNI and not-meet-RNI groups based on their total daily energy intake.
The recommended total energy for division into groups was ≥2,000 kcal for men aged 65–74 years and ≥1,900 kcal for those aged ≥75 years, whereas it was ≥1,600 kcal for women aged 65–74 years and ≥1,500 kcal for those aged ≥75 years.
Sociodemographic factors
The sociodemographic factors examined in this study included age, sex, education level, household income, living arrangements, physical activity level, smoking status, frequency of alcohol consumption, body mass index (BMI), and presence of comorbidities (chronic diseases or cancers). The participants were categorized into two age groups: 65–74 years and ≥75 years. Educational level was classified as below middle school, high school, or above. Household income was divided into quartiles (high, middle-high, middle-low, and low) and then reclassified into low income (≤25%) and other income levels (>25%). Smoking status was categorized as current smoker, former smoker, or nonsmoker. Alcohol consumption was defined as drinking less than once or more than twice per week. Physical activity was assessed by calculating the total MET score for 1 week. BMI (kg/m2) was categorized as underweight (BMI <18.5), normal (18.5≤ BMI <23), overweight (23≤ BMI <25), and obese (BMI ≥25) [22]. Comorbidities were classified based on the number of chronic diseases present: two or fewer chronic diseases versus three or more chronic diseases. Chronic diseases include hypertension, myocardial infarction, angina pectoris, stroke, diabetes, chronic kidney disease, and various cancers (stomach, liver, colon, breast, cervix, lungs, and thyroid).
Statistical analyses
The KNHANES uses a multi-stage stratified cluster sample design to represent the Korean population. We analyzed the data by applying weights related to the unit of analysis and variables used in the study by year. Continuous variables were analyzed using a general linear model, whereas categorical variables were assessed using the chi-square test. Using multivariate logistic analysis, we assessed the prevalence of frailty in the MVMS and non-DS groups. Age, sex, education, income, living arrangements, BMI, drinking frequency, smoking status, presence of chronic diseases, and total energy intake were used as adjustable variables. Physical activity was excluded as a variable for adjustment because it overlapped with one of the definitions of frailty. We also performed subanalyses based on age, sex, household income, and total energy intake using the same methodology. Statistical analyses were performed using STATA SE ver. 15.0 (Stata Corp.), with the significance level set at P<0.05.
Results
In this study, the DS and MVMS consumption rates among those aged ≥65 years were 48.15% and 14.24%, respectively. The baseline characteristics of the non-DS and MVMS groups are presented in Table 2. Participants in the MVMS group were younger than those in the non-DS group, with a higher proportion of women and people aged 65–74 years old. Compared to the non-DS group, the MVMS group also had a lower proportion of those with low education and household income levels, and no significant difference in the frequency of individuals living alone was observed between groups. Participants in the MVMS group had healthy lifestyle habits, smoked less frequently, and engaged in more physical activity than those in the non-DS group. However, no intergroup differences were observed in frequency of alcohol consumption. The BMI did not significantly differ between the two groups; however, the frequency of having three or more diseases and frailty was higher in the non-DS group than in the MVMS group. Frailty rates in the non-DS and MVMS groups were 19.1% and 12.1%, respectively.
Table 3 summarizes the information on the nutritional intake of the two groups. We compared the intake of macronutrients and micronutrients in the non-DS and MVMS groups to ascertain whether they met the RNI criteria.
Participants in the MVMS group had higher total energy, protein, and fat (excluding carbohydrates) intakes than those in the non-DS group. When comparing micronutrient intake through food only, the participants in the MVMS group had a significantly higher intake of riboflavin, niacin, vitamin C, calcium, phosphorus, and iron than those in the non-DS group. In addition, when micronutrients consumed through the MVMS with food were included, the intake of all nutrients was higher than that through food alone in the non-DS group. The proportion of people meeting the RNI food intake standards among this study’s participants aged ≥65 years was generally low, and the proportion of people meeting the RNI intake standards for thiamine, riboflavin, niacin, and vitamin C was exceptionally high when MVMS was consumed. When the participants were divided into two total energy groups based on whether they met the RNI criteria, the proportion of participants with insufficient total energy was higher in the non-DS group than in the MVMS group.
In this study, no correlation was identified between MVMS intake and frailty (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.52–1.09), even after adjusting for age, sex, education level, BMI, frequency of drinking, smoking status, presence of chronic disease, and total energy. In an additional subanalysis according to age, sex, and income level, the MVMS group showed a significantly lower rate of frailty than did the non-DS group, which comprised the lowest 25% quartile of the income group (OR, 0.55; 95% CI, 0.35–0.88). However, we observed no significant differences between age and sex subgroups regarding the association between MVMS intake and frailty (Table 4). In the analysis of total energy intake based on RNI, no overall correlation was observed between MVMS and frailty. In the group with low total energy intake and low income, a significant relationship was identified between MVMS intake and frequency of frailty (OR, 0.52; 95% CI, 0.30–0.90) (Table 5).
Discussion
In this study, no clear association was identified between MVMS use and frailty in the entire population aged ≥65 years. However, in older Korean adults with low income and insufficient daily energy intake, MVMS use was associated with a lower prevalence of frailty, suggesting that MVMS may help reduce the risk of frailty by supplementing deficient micronutrients.
Few studies directly examined the association between the use of MVMS and frailty. A previous meta-analysis examined the effects of DS on frailty among older adults. However, the types of DS were protein and multinutrient supplements, such as oral nutritional supplements including protein, probiotics, L-carnitine, and β-hydroxyl-βmethyl-butyrate. Multinutrient supplements improve frailty, and protein supplements improve body weight, muscle mass, and muscle strength [23]. However, neither was effective in a randomized study examining the effects of vitamin D and omega-3 supplementation on frailty [24]. In a review that examined the relationship between mineral supplementation and frailty, the results of the studies were inconsistent [25].
Low household income is associated with frailty [26,27]. Household income is significantly linked to overall mineral intake and the intake of whole individual nutrients [28,29]. The higher-income group had more adequate dietary habits with an appropriate intake of specific minerals and vitamins, whereas the lower-income group had higher rates of malnutrition and an increased risk of unbalanced vitamin intake [28,29].
In our study, the association between MVMS use and frailty according to the recommended calorie intake was only observed in the low household income and insufficient energy intake groups but not overall. Energy intake was also related to micronutrient intake. In a previous study, the proportions of men and women with two or more micronutrient deficiencies were 45% and 50%, respectively, when consuming 1,300 kcal of energy. However, as energy intake increased, the proportions decreased to 5% and 17%, respectively [30]. In this study, participants with low income and inadequate energy intake owing to poor diet were in a resilient, vulnerable group of frailty, and the OR of frailty decreased to 0.52 with MVMS use. This is an interesting and novel finding, as several previous studies have indicated an association between MVMS use and frailty.
In this analysis, most micronutrients were consumed at a lower rate than the recommended daily intake when obtained solely from food, and the use of supplements increased the proportion of older adults meeting the RNI for all nutrients except iron. Our study did not directly compare the prevalence of micronutrient inadequacy according to socioeconomic status (SES). However, previous studies have demonstrated that the prevalence of micronutrient inadequacy is also associated with income and is higher among low-SES groups than among high-SES [16]. MVMS use significantly increases micronutrient intake and reduces the proportion of people with an inadequate intake (below the estimated average requirement) of most nutrients [9,10,13,16]. Our results, and those of previous studies, suggest that MVMS intake is a simple and effective method for addressing multiple micronutrient deficiencies. Therefore, MVMS intake may reduce the risk of frailty. The MVMS may play various roles in reducing the risk of frailty. Vitamin D is associated with muscle function [23,24], vitamin B12 is essential for neurological and cognitive function [3,13], and antioxidant vitamins, such as vitamins C and E, are crucial for preventing frailty owing to their antioxidant function [5]. Minerals, such as calcium and magnesium, are important for bone and muscle health [25]. These nutrients may act either individually or synergistically to influence frailty. Multivitamins contain different vitamins and minerals; therefore, determining which micronutrients contributed primarily to the decreased occurrence of frailty in patients using the MVMS was difficult. Assessing nutrient deficiency in terms of nutrient intake and absorption is challenging.
To the best of our knowledge, this is the first nationally representative analysis comparing the prevalence of frailty between older Korean MVMS users and non-users. Our findings underscore that the benefits of multivitamin supplementation may differ across income levels. This study provides an opportunity to assess from a frailty perspective, through a detailed subanalysis, whether the MVMS could be a cost-effective and simple alternative for low-income older individuals at a high risk of nutritional deficiencies. The findings of this study should be interpreted within their limitations. First, owing to the cross-sectional design, this study could not demonstrate a causal relationship between MVMS intake and frailty. Second, the self-reported health information may have been biased. The MVMS data did not distinguish between habitual use or changes in dietary habits during the study. Lastly, MVMS products consumed by each individual may differ in nutritional content, quality, and nutrient absorption.
In conclusion, the effects of MVMS use on frailty differed based on income level, with significantly lower odds of frailty especially among the low-income and lower-daily energy intake groups. Older adults with a low SES were particularly vulnerable to healthcare policies aimed at preventing frailty. Providing more active support is necessary to prevent and manage frailty including addressing nutritional imbalances in older adults with lower SES. Further, thorough and wellstructured studies are required to address this issue. Although our research suggests some potential benefits of MVMS, MVMS is not a substitute for a balanced diet or healthy lifestyle. No supplements can compensate for poor dietary habits and unhealthy behaviors. Although multivitamins provide essential nutrients, they cannot completely prevent or treat specific diseases or health conditions. This should be considered part of a comprehensive healthcare plan that includes a balanced diet, appropriate medical care, physical activity, and nutritional supplementation.
Article Information
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Acknowledgments
We are grateful to the participants of the KNHANES study, which is available to the public as a data source.
Funding
None.
Data availability
Not applicable.
Author contribution
Conceptualization: HK, SGP. Data curation: SGP. Formal analysis: SGP. Investigation: SGP. Methodology: HK, SGP. Software: SGP. Validation: HK, SGP. Visualization: HK, SGP. Project administration: HK, SGP. Writing–original draft: HK, SGP. Writing–review & editing: HK, SGP. Final approval of the manuscript: all authors.
Figure. 1.
Flow chart of study population. KNHANES, Korean National Health and Nutrition Examination Survey; DS, dietary supplements; MET, metabolic equivalent of the task; MVMS, multivitamin and mineral supplements.
Table 1.
A modified definition of frailty using KNHANES dataset
Frailty components
Indicator
Measurement (scored as 1)
Weight loss
Self-reported unintentional weight loss
Unintentional weight loss ≥3 kg in prior year
Exhaustion
Self-reported level of perceived stress
Perception of extreme stress
Weakness
Hand grip strength
<28 kg for men and <18 kg for women of dominant hand based on Asian working group for sarcopenia
Slowness
EQ-5D; mobility
I have some problem in walking or I am confined to bed
Low energy expenditure
The Global Physical Activity Questionnaire
The lowest 20% of physical activity evaluated by METs for each gender based on data from the National Survey of Older Koreans (METs: men <494.65 kcal/wk and women <283.50 kcal/wk)
KNHANES, Korea National Health and Nutrition Examination Survey; EQ-5D, EuroQol-5 dimension; MET, metabolic equivalent of the task.
Table 2.
Baseline characteristics of participants in the non-DS and MVMS group
Values are presented as the estimated mean±standard error or estimated % (standard error) unless otherwise stated.
DS, dietary supplements; MVMS, multivitamin and mineral supplements; MET, metabolic equivalent task; BMI, body mass index.
a)Comorbidities included hypertension, cardiovascular disease, stroke, diabetes mellitus and cancers. Cancers included stomach, colon, liver, breast, cervical, lung, and other cancers.
b)Robust, none of the components are present; Pre-frail, 1 or 2 components present; Frail, if ≥3 components are present.
Table 3.
Nutritional intake of participants in the non-DS and MVMS group
Values are presented as the estimated mean±standard error or estimated % (standard error).
DS, dietary supplements; MVMS, multivitamin and mineral supplements; RE, retinol equivalents; RNI, recommended nutrient intake; NE, niacin equivalents.
a)Comparisons of nutrient intakes from food alone between non-DS group and MVMS group.
b)Comparisons of total nutrient intakes between non-DS group and MVMS group.
Table 4.
Association between intake of MVMS and frailty
Characteristic
Frail
Crude
Model 1
Model 2
Model 3
Total
Non-DS
1
1
1
1
MVMS
0. 58 (0.41–0.81)
0. 64 (0.45–0.92)
0.74 (0.51–1.08)
0.75 (0.52–1.09)
Male sex
Non-DS
1
1
1
1
MVMS
0.55 (0.30–0.98)
0.56 (0.30–1.04)
0.68 (0.35–1.33)
0.72 (0.37–1.37)
Female sex
Non-DS
1
1
1
1
MVMS
0.58 (0.38–0.87)
0.68 (0.44–1.04)
0.76 (0.49–1.19)
0.76 (0.49–1.19)
Age 65–74 y
Non-DS
1
1
1
1
MVMS
0.49 (0.27–0.88)
0.45 (0.25–0.82)
0.54 (0.29–1.00)
0.54 (0.29–1.01)
Age ≥75 y
Non-DS
1
1
1
1
MVMS
0.75 (0.49–1.16)
0.75 (0.49–1.16)
0.89 (0.57–1.39)
0.90 (0.58–1.39)
Income ≤25%
Non-DS
1
1
1
1
MVMS
0.53 (0.33–0.83)
0.53 (0.33–0.85)
0.54 (0.34–0.86)
0.55 (0.35–0.88)
Income >25%
Non-DS
1
1
1
1
MVMS
0.79 (0.47–1.33)
0.86 (0.50–1.48)
1.19 (0.68–2.10)
1.19 (0.69–2.06)
Multivariate logistic regression adjusted for crude, model 1 (age, sex), model 2 (age, sex, education level, income level, living alone), and model 3 (model 2 + body mass index, frequency of drinking, smoking status, presence of chronic disease, total energy). In sub-analysis, variables corresponding to the subgroup are excluded from the analysis.
MVMS, multivitamin and mineral supplements; DS, dietary supplements.
Table 5.
Association between intake of MVMS and frailty according to total energy intake
Variable
Frail
Total
Sex
Age (y)
Income (%)
Male
Female
65–74
≥75
≤25
>25
Did not meet the RNI
Non-DS
1
1
1
1
1
1
1
MVMS
0.79 (0.51–1.23)
0.90 (0.43–1.89)
0.71 (0.42–1.19)
0.60 (0.28–1.31)
0.89 (0.54–1.46)
0.52 (0.30–0.90)
1.39 (0.73–2.63)
Meet the RNI
Non-DS
1
1
1
1
1
1
1
MVMS
0.73 (0.36–1.47)
0.35 (0.07–1.72)
0.88 (0.38–2.02)
0.47 (0.16–1.39)
1.02 (0.43–2.42)
0.85 (0.35–2.04)
0.51 (0.14–1.82)
Multivariate logistic regression adjusted for age, sex, education level, income level, living alone, body mass index, frequency of drinking, smoking status, presence of chronic disease. In sub-analysis, variables corresponding to the subgroup are excluded from the analysis.
MVMS, multivitamin and mineral supplements; RNI, recommended nutrient intake; DS, dietary supplements.
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Relationship between use of multivitamins and mineral supplements and frailty in older Korean population: a cross-sectional study using the Korea National Health and Nutrition Examination Survey 2018–2019
Figure. 1. Flow chart of study population. KNHANES, Korean National Health and Nutrition Examination Survey; DS, dietary supplements; MET, metabolic equivalent of the task; MVMS, multivitamin and mineral supplements.
Graphical abstract
Figure. 1.
Graphical abstract
Relationship between use of multivitamins and mineral supplements and frailty in older Korean population: a cross-sectional study using the Korea National Health and Nutrition Examination Survey 2018–2019
Frailty components
Indicator
Measurement (scored as 1)
Weight loss
Self-reported unintentional weight loss
Unintentional weight loss ≥3 kg in prior year
Exhaustion
Self-reported level of perceived stress
Perception of extreme stress
Weakness
Hand grip strength
<28 kg for men and <18 kg for women of dominant hand based on Asian working group for sarcopenia
Slowness
EQ-5D; mobility
I have some problem in walking or I am confined to bed
Low energy expenditure
The Global Physical Activity Questionnaire
The lowest 20% of physical activity evaluated by METs for each gender based on data from the National Survey of Older Koreans (METs: men <494.65 kcal/wk and women <283.50 kcal/wk)
Characteristic
Non-DS (n=1,511)
MVMS (n=415)
P-value
Age (y)
73.44±0.18
72.42±0.29
0.003
65–74
54.6 (1.8)
63.9 (2.9)
0.007
≥75
45.4 (1.8)
36.1 (2.9)
Female sex
51.5 (1.5)
58.7 (2.4)
0.015
Education level ≤9 y
74.6 (1.6)
58.0 (3.0)
<0.001
The lowest 25% quartile of income
50.3 (1.9)
37.9 (3.2)
<0.001
Living alone
19.6 (1.1)
17.1 (2.1)
0.288
Current smoker
10.7 (1.1)
5.8 (1.3)
0.008
Frequent alcohol drinking
18.2 (1.1)
15.5 (2.0)
0.242
Total MET (kcal/wk)
397.21±26.00
548.47±49.56
0.005
BMI (kg/m2)
24.13±0.09
24.09±0.15
0.821
Underweight (BMI <18.5)
2.8 (0.5)
3.0 (0.9)
0.771
Normal (18.5≤ BMI <23)
33.2 (1.4)
32.0 (2.6)
Overweight (23≤ BMI <25)
25.6 (1.3)
28.3 (2.4)
Obesity (25≥ BMI)
38.4 (1.5)
36.7 (2.5)
No. of comorbidities ≥3a)
20.6 (1.3)
15.1 (2.1)
0.035
Frailtyb)
Robust
16.0 (1.3)
21.8 (2.2)
0.002
Pre-frail
64.9 (1.5)
66.0 (2.6)
Frail
19.1 (1.3)
12.1 (1.6)
Characteristic
Non-DS (n=1,511)
MVMS (n=415)
P-valuea)
P-valueb)
Food
Food
Food+MVMS
Nutritional intake
Total energy (kcal)
1,542.04±18.55
1,658.58±33.20
0.002
Carbohydrate (g)
266.16±3.02
273.82±5.57
0.192
Protein (g)
51.16±0.80
57.96±1.49
<0.001
Fat (g)
24.83±0.66
31.84±1.28
<0.001
Vitamin A (μg) RE
287.75±12.72
309.56±12.80
650.54±36.20
0.210
<0.001
≥RNI %
7.7 (0.9)
9.0 (1.6)
37.1 (2.9)
0.450
<0.001
Thiamine (mg)
1.12±0.01
1.14±0.02
30.32±1.48
0.578
<0.001
≥RNI %
52.6 (1.4)
55.4 (2.8)
98.3 (0.8)
0.393
<0.001
Riboflavin (mg)
1.07±0.02
1.30±0.03
18.12±1.70
<0.001
<0.001
≥RNI %
33.5 (1.6)
50.6 (2.9)
97.6 (1.0)
<0.001
<0.001
Niacin (mg) NE
9.79±0.18
10.69±0.34
32.28±1.58
0.020
<0.001
≥RNI %
20.4 (1.3)
26.3 (2.7)
72.7 (2.7)
0.041
<0.001
Vitamin C (mg)
51.55±2.13
60.02±3.44
186.85±9.07
0.032
<0.001
≥RNI %
10.8 (1.0)
12.6 (1.9)
78.2 (2.3)
0.347
<0.001
Calcium (mg)
424.93±10.76
490.03±19.53
578.07±21.97
0.003
<0.001
≥RNI %
10.6 (1.0)
14.5 (1.9)
22.1 (2.4)
0.053
<0.001
Phosphorus (mg)
832.86±13.09
950.74±24.14
963.05±24.10
<0.001
<0.001
≥RNI %
58.3 (1.6)
69.9 (2.6)
71.2 (2.7)
<0.001
<0.001
Iron (mg)
10.30±0.18
11.17±0.30
14.55±0.51
0.015
<0.001
≥RNI %
0.2 (0.1)
0.1 (0.1)
0.8 (0.5)
0.766
0.078
Total energy intake group according to RNI
Not meeting RNI
70.1 (1.4)
60.0 (2.8)
<0.001
Meeting RNI
29.9 (1.4)
40.0 (2.8)
Characteristic
Frail
Crude
Model 1
Model 2
Model 3
Total
Non-DS
1
1
1
1
MVMS
0. 58 (0.41–0.81)
0. 64 (0.45–0.92)
0.74 (0.51–1.08)
0.75 (0.52–1.09)
Male sex
Non-DS
1
1
1
1
MVMS
0.55 (0.30–0.98)
0.56 (0.30–1.04)
0.68 (0.35–1.33)
0.72 (0.37–1.37)
Female sex
Non-DS
1
1
1
1
MVMS
0.58 (0.38–0.87)
0.68 (0.44–1.04)
0.76 (0.49–1.19)
0.76 (0.49–1.19)
Age 65–74 y
Non-DS
1
1
1
1
MVMS
0.49 (0.27–0.88)
0.45 (0.25–0.82)
0.54 (0.29–1.00)
0.54 (0.29–1.01)
Age ≥75 y
Non-DS
1
1
1
1
MVMS
0.75 (0.49–1.16)
0.75 (0.49–1.16)
0.89 (0.57–1.39)
0.90 (0.58–1.39)
Income ≤25%
Non-DS
1
1
1
1
MVMS
0.53 (0.33–0.83)
0.53 (0.33–0.85)
0.54 (0.34–0.86)
0.55 (0.35–0.88)
Income >25%
Non-DS
1
1
1
1
MVMS
0.79 (0.47–1.33)
0.86 (0.50–1.48)
1.19 (0.68–2.10)
1.19 (0.69–2.06)
Variable
Frail
Total
Sex
Age (y)
Income (%)
Male
Female
65–74
≥75
≤25
>25
Did not meet the RNI
Non-DS
1
1
1
1
1
1
1
MVMS
0.79 (0.51–1.23)
0.90 (0.43–1.89)
0.71 (0.42–1.19)
0.60 (0.28–1.31)
0.89 (0.54–1.46)
0.52 (0.30–0.90)
1.39 (0.73–2.63)
Meet the RNI
Non-DS
1
1
1
1
1
1
1
MVMS
0.73 (0.36–1.47)
0.35 (0.07–1.72)
0.88 (0.38–2.02)
0.47 (0.16–1.39)
1.02 (0.43–2.42)
0.85 (0.35–2.04)
0.51 (0.14–1.82)
Table 1. A modified definition of frailty using KNHANES dataset
KNHANES, Korea National Health and Nutrition Examination Survey; EQ-5D, EuroQol-5 dimension; MET, metabolic equivalent of the task.
Table 2. Baseline characteristics of participants in the non-DS and MVMS group
Values are presented as the estimated mean±standard error or estimated % (standard error) unless otherwise stated.
DS, dietary supplements; MVMS, multivitamin and mineral supplements; MET, metabolic equivalent task; BMI, body mass index.
Comorbidities included hypertension, cardiovascular disease, stroke, diabetes mellitus and cancers. Cancers included stomach, colon, liver, breast, cervical, lung, and other cancers.
Robust, none of the components are present; Pre-frail, 1 or 2 components present; Frail, if ≥3 components are present.
Table 3. Nutritional intake of participants in the non-DS and MVMS group
Values are presented as the estimated mean±standard error or estimated % (standard error).
DS, dietary supplements; MVMS, multivitamin and mineral supplements; RE, retinol equivalents; RNI, recommended nutrient intake; NE, niacin equivalents.
Comparisons of nutrient intakes from food alone between non-DS group and MVMS group.
Comparisons of total nutrient intakes between non-DS group and MVMS group.
Table 4. Association between intake of MVMS and frailty
Multivariate logistic regression adjusted for crude, model 1 (age, sex), model 2 (age, sex, education level, income level, living alone), and model 3 (model 2 + body mass index, frequency of drinking, smoking status, presence of chronic disease, total energy). In sub-analysis, variables corresponding to the subgroup are excluded from the analysis.
MVMS, multivitamin and mineral supplements; DS, dietary supplements.
Table 5. Association between intake of MVMS and frailty according to total energy intake
Multivariate logistic regression adjusted for age, sex, education level, income level, living alone, body mass index, frequency of drinking, smoking status, presence of chronic disease. In sub-analysis, variables corresponding to the subgroup are excluded from the analysis.
MVMS, multivitamin and mineral supplements; RNI, recommended nutrient intake; DS, dietary supplements.
