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The key role of micronutrients
ARTICLE IN PRESS Clinical Nutrition (2007) 26, 159
Available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/clnu
CORRESPONDENCE The key role of micronutrients We read the review article by Professor Alan Shenkin on the key role of micronutrients with interest.1 He suggests that our trial (The MAVIS trial)2 confirms the balance of evidence towards a harmful effect in older people from taking supplements in terms of infection. Our trial found no statistically significant effect on days of infection, contacts with primary care or quality of life from supplementation. We presume that he is referring to the mean difference between intervention and placebo groups in Euroqol assessment of quality of life of 0.019 (95% CI 0.040–0.002, P ¼ 0:08). Quality of life differences measured by the SF12 were 0.07 (95% CI 0.90 to 1.03, P ¼ 0:89) for the physical component score and 0.03 (95% CI 1.11–1.05, P ¼ 0:96) for the mental component score. The incidence rate ratios for supplemented versus placebo group were 0.96 (95% CI 0.78–1.19, P ¼ 0:74) for contacts with primary care and 1.07 (95% CI 0.90–1.27, P ¼ 0:41) for days of self reported infections. All the confidence intervals for the primary endpoints ruled out clinically significant effects. Nonsignificant trends for one set of results in a negative direction should not be interpreted as harm.
2. The Writing Group of the MAVIS Trial. A pragmatic randomised double-blind, placebo-controlled trial of the effect of vitamin and mineral supplements on morbidity from infections in men and women aged 65 years and over (MAVIS trial). BMJ 2005;331:324–7.
Alison Avenell, Marion K. Campbell, Jonathan A. Cook, Anne C. Milne, Craig R. Ramsay, Audrey I. Stephen Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK E-mail address: [email protected] (A. Avenell)
Philip C. Hannaford Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK
Mary M. Kilonzo, Luke D. Vale Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
Geraldine McNeill We are very grateful to The Health Foundation (formerly PPP Healthcare Medical Trust) for funding the MAVIS trial (ISRCTN 66376460). The Health Services Research Unit and Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed are those of the authors.
References
Department of Environmental and Occupational Medicine, University of Aberdeen, Liberty Safe Work Research Centre, Foresterhill Road, Aberdeen AB25 2ZP, UK
D. Gwyn Seymour Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
1. Shenkin A. The key role of micronutrients. Clin Nutr 2006;25: 1–13.
0261-5614/$ - see front matter & 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2006.07.002
Available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/clnu
CORRESPONDENCE The key role of micronutrients We read the review article by Professor Alan Shenkin on the key role of micronutrients with interest.1 He suggests that our trial (The MAVIS trial)2 confirms the balance of evidence towards a harmful effect in older people from taking supplements in terms of infection. Our trial found no statistically significant effect on days of infection, contacts with primary care or quality of life from supplementation. We presume that he is referring to the mean difference between intervention and placebo groups in Euroqol assessment of quality of life of 0.019 (95% CI 0.040–0.002, P ¼ 0:08). Quality of life differences measured by the SF12 were 0.07 (95% CI 0.90 to 1.03, P ¼ 0:89) for the physical component score and 0.03 (95% CI 1.11–1.05, P ¼ 0:96) for the mental component score. The incidence rate ratios for supplemented versus placebo group were 0.96 (95% CI 0.78–1.19, P ¼ 0:74) for contacts with primary care and 1.07 (95% CI 0.90–1.27, P ¼ 0:41) for days of self reported infections. All the confidence intervals for the primary endpoints ruled out clinically significant effects. Nonsignificant trends for one set of results in a negative direction should not be interpreted as harm.
2. The Writing Group of the MAVIS Trial. A pragmatic randomised double-blind, placebo-controlled trial of the effect of vitamin and mineral supplements on morbidity from infections in men and women aged 65 years and over (MAVIS trial). BMJ 2005;331:324–7.
Alison Avenell, Marion K. Campbell, Jonathan A. Cook, Anne C. Milne, Craig R. Ramsay, Audrey I. Stephen Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK E-mail address: [email protected] (A. Avenell)
Philip C. Hannaford Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK
Mary M. Kilonzo, Luke D. Vale Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
Geraldine McNeill We are very grateful to The Health Foundation (formerly PPP Healthcare Medical Trust) for funding the MAVIS trial (ISRCTN 66376460). The Health Services Research Unit and Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed are those of the authors.
References
Department of Environmental and Occupational Medicine, University of Aberdeen, Liberty Safe Work Research Centre, Foresterhill Road, Aberdeen AB25 2ZP, UK
D. Gwyn Seymour Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
1. Shenkin A. The key role of micronutrients. Clin Nutr 2006;25: 1–13.
0261-5614/$ - see front matter & 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2006.07.002