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, 2002). Vitamin D and/or calcium are important modifiable factors associ- elderly and dietary supplements: benefits and risks 127
ated with optimal bone health. Kahwati et al. (2018) compiled 11 randomized
controlled trials, and concluded that compared with placebo, supplementation
with vitamin D decreased total fracture incidence. Several clinical studies also
investigated multivitamin supplements intake and possible prevention of ath-
erosclerosis and cardiovascular disease. These studies have pointed to potential
reductions in the risk to develop age-related diseases among older people who
reported long-term use of multivitamins (Walrand, 2018).

Both randomized clinical interventions and observational studies high-
light the protective effects associated with diets supplemented with fish oil
and omega-3 PUFA, particularly the longer chain fatty acids, eicosapentaeno-
ic acid (EPA), and docosahexaenoic acid (DHA). EPA and DHA supplemen-
tations have been extensively studied therapeutically in a wide variety of dis-
ease conditions, though principally cardiovascular diseases (Walrand, 2018).
Beside fewer cardiovascular deaths due to higher plasma levels of omega-3 PU-
FAs, recent studies suggest that they may be also associated with cognitive sta-
tus in older people. Ammann et al. (2017) have reported that higher levels of
blood DHA+EPA may help protect against the development of dementia in old-
er women. Furthermore, omega-3 PUFAs may also modulate physical perfor-
mance in the elderly, as has been shown that they enhance muscle anabolic re-
sponses (Lalia et al., 2017).

Milk protein consists of whey - a fast digested protein with a large amount
of leucine, which has been suggested as being responsible for enhanced abili-
ty to stimulate muscle protein anabolism. In a systematic review by Liao et al.
(2017), it was confirmed that, dietary protein supplementation combined with
exercise had a strong effect in preventing age-related muscle mass attenuation
and leg strength loss in older people. Results from the study by Koutsofta et
al. (2019) showed that combined protein administration through supplemen-
tal proteins for a period of up to 12 months may positively affect osteoporosis
in postmenopausal women.

A prospective study comprising 1640 aged participants showed that per-
sons with high dietary intake of flavonoids maintained better cognitive func-
tions at the baseline and showed slower cognitive decline over a period of 10
years (Letenneur et al., 2007).

Risks associated with DS use
Although supplement use provides potential benefits by increasing nutrient
intake, there are potential drawbacks. Firstly, the concurrent use of prescrip-
tion medications and DS has become more common among older adults which
increases the risk of potential drug-nutrient interactions. Of particular con-
cern is polypharmacy, or the concurrent use of more than five prescription
medications, which is common in elderly. The most problematic common herb
with a very high risk of drug-nutrient interactions is St. John’s wort (Hyperi-
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