Longevity & Aging · Metabolic & Cardiometabolic
dietary and anti-aging supplements does not improve hard health outcomes
In plain terms: Without a diagnosed deficiency, do supplements fail to improve hard health outcomes?
Part of: • Aging
Broadly supported for hard endpoints (mortality, CVD, cancer) where multivitamins and popular longevity supplements show null RCT results — but not absolute: at least one large RCT (COSMOS) found a modest multivitamin benefit on cognition.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
What the evidence shows
For hard endpoints the evidence supports this: SELECT found no cancer prevention from selenium or vitamin E, a Cochrane analysis of twelve trials in 19,715 people found no selenium benefit, and vitamin D did not prevent type 2 diabetes in VITAL. Not absolute — COSMOS-Mind found a modest multivitamin benefit on cognition, so it holds for mortality and disease, not everything.
The evidence (15)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Lippman SM, Klein EA, Goodman PJ, Lucia MS, Thompson IM, Ford LG, Parnes HL, Minasian LM, Gaziano JM, Hartline JA, Parsons JK, Bearden JD, Crawford ED, Goodman GE, Claudio J, Winquist E, Cook ED, Karp DD, Walther P, Lieber MM, Kristal AR, Darke AK, Arnold KB, Ganz PA, Santella RM, Albanes D, Taylor PR, Probstfield JL, Jagpal TJ, Crowley JJ, Meyskens FL, Baker LH, Coltman CA 2009 · JAMA | RCT | supports | high | SELECT: selenium and/or vitamin E did not prevent prostate or other cancers in generally healthy men, supporting no-benefit. |
| Baker LD, Manson JE, Rapp SR, Sesso HD, Gaussoin SA, Shumaker SA, Espeland MA 2023 · Alzheimers Dement | RCT | mixed | moderate | COSMOS-Mind: multivitamin showed a modest cognitive benefit in older adults while cocoa extract did not, a partial exception on a soft outcome. |
| Rees K, Hartley L, Day C, Flowers N, Clarke A, Stranges S 2013 · The Cochrane database of systematic reviews | meta-analysis | supports | high | Cochrane meta-analysis of 12 RCTs (19,715 participants) found selenium supplementation had no significant effect on all-cause mortality (RR 0.97), CVD mortality (RR 0.97), or CVD events, concluding trial evidence does not support selenium f |
| Tobias DK, Pradhan AD, Duran EK, Li C, Song Y, Buring JE, Cook NR, Mora S, Manson JE 2025 · Nat Commun | RCT | supports | high | VITAL-T2D: vitamin D supplementation did not reduce incident type 2 diabetes in a general older US population. |
| Yeung LK, Alschuler DM, Wall M, Luttmann-Gibson H, Copeland T, Hale C, Sloan RP, Sesso HD, Manson JE, Brickman AM 2023 · Am J Clin Nutr | RCT | contradicts | moderate | COSMOS multivitamin RCT: modest improvement in memory/cognition in older adults without diagnosed deficiency — a genuine positive exception that narrows the absolute claim. |
| Alexander DD, Weed DL, Chang ET, Miller PE, Mohamed MA, Elkayam L 2013 · J Am Coll Nutr | meta-analysis | supports | moderate | 12 cohorts plus 3 RCTs: multivitamin use not associated with reduced all-cause/CVD/cancer mortality in healthy adults — null for the outcomes that matter. |
| Park SJ, Manson JE, Kim E, Glynn RJ, Rist PM, Allison MA, Sesso HD 2026 · Thromb Haemost | RCT | supports | moderate | COSMOS ancillary: neither cocoa extract nor multivitamin significantly reduced venous thromboembolism in older adults. |
| Holanda MT, Mediano MFF, Hasslocher-Moreno AM, Gonzaga BMS, Carvalho ACC, Ferreira RR, Garzoni LR, Pereira-Silva FS, Pimentel LO, Mendes MO, Azevedo MJ, Britto C, Moreira OC, Fernandes AG, Santos CM, Constermani J, Paravidino VB, Maciel ER, Carneiro FM, Xavier SS, Sperandio da Silva GM, Santos PF, Veloso HH, Brasil PEAA, de Sousa AS, Bonecini-de-Almeida MG, da Silva PS, Sangenis LHC, Saraiva RM, Araujo-Jorge TC 2021 · EClinicalMedicine | RCT | tested-null | low | RCT of selenium 100mcg/day vs placebo for 1 year in 66 Chagas cardiomyopathy patients found no significant improvement in primary outcome (LVEF) overall. A small subgroup (B2 stage, n=12) showed a signal, but this is not a hard-outcome bene |
| Ogata S, Manson JE, Kang JH, Buring JE, Lee IM, Nishimura K, Sakata Y, Danik JS, D'Agostino D, Mora S, Albert CM, Cook NR 2023 · Nutrients | RCT | mixed | moderate | Reanalysis of VITAL using win-ratio composite outcomes found marine n-3 supplementation did not meaningfully reduce cardiovascular events in healthy older adults. |
| Li J, Sesso HD, Kim E, Manson JE, Friedenberg G, Clar A, Copeland T, Shadyab AH, Wactawski-Wende J, Tinker L, Liu S 2023 · Diabetes Care | RCT | supports | high | COSMOS: cocoa extract supplementation did not reduce incident type 2 diabetes in older adults, supporting no hard-outcome benefit. |
| Setayesh A, Arzhang P, Baniasadi MM, Lahouti M, Azadbakht L 2026 · Int J Obes | meta-analysis | mixed | moderate | Resveratrol RCT meta-analysis: inconsistent/inconclusive effects on anthropometrics and adipokines — no reliable outcome benefit, consistent with claim. |
| Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE 2012 · JAMA | RCT | contradicts | high | PHS II: daily multivitamin modestly but significantly reduced total cancer incidence in male physicians, a hard-outcome benefit that partly contradicts the no-benefit claim. |
| O'Connor EA, Evans CV, Ivlev I, Rushkin MC, Thomas RG, Martin A, Lin JS 2022 · JAMA | meta-analysis | supports | high | USPSTF evidence review: insufficient/no benefit of vitamin-mineral supplements for preventing CVD or cancer in generally healthy, non-deficient adults; possible harm (beta-carotene) — strongly supports the claim for hard outcomes. |
| Vinceti M, Filippini T, Del Giovane C, Dennert G, Zwahlen M, Brinkman M, Zeegers MP, Horneber M, D'Amico R, Crespi CM 2018 · The Cochrane database of systematic reviews | meta-analysis | supports | high | Cochrane meta-analysis of 10 RCTs (27,232 participants) found selenium supplementation did not reduce cancer incidence (RR 1.01) or mortality (RR 1.02) versus placebo; some RCTs showed increased risk of high-grade prostate cancer, type 2 di |
| Neves PM, Almeida S, Domingues V 2026 · Cureus | observational | supports | low | Narrative review, not evidence: 'Narrative review of guidelines, randomized trials, and meta-analyses indexed in major databases (2000-August 2025).' 'This is not a systematic review.' Concludes 'In generally nourished adults, multivitamins do not reduce cardiovascular events or mortality'. Review — zero weight. |
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.