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Multivitamin and mineral supplements

When to consider supplementation for patients

When could you consider a multivitamin and mineral supplement?

Unlike inadequate macronutrient intake which can result in visible weight loss, a lack of micronutrients may be more difficult to notice immediately.1  Micronutrients are an important component within the malnutrition definition, with NICE describing malnutrition as: “a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.”2

With the majority of malnourished patients, a ‘Food First’ diet should always be the initial approach to consider.3,4 Oral nutritional supplements (ONS) in addition to regular meals, can be considered for high-risk patients, when food intake alone is insufficient or when it is anticipated that food alone is insufficient to meet daily nutritional requirements.3,4

In instances where dietary modifications and intake alone are not expected to be able to correct identified micronutrient deficiencies, supplementation with relevant micronutrient(s) is also a management option and may be beneficial in appropriate patients.2

What does the research say on supplementation for micronutrient deficiencies?

Research indicates that targeted supplementation to address identified micronutrient deficiencies, may:
  • Improve immune function5,6
  • Reduce risk of acute infections5,6
  • Support optimal bone mineral density7
  • Improve prognosis of diseases8,9,10
  • Improve recovery amongst hospital inpatients.8
Vitamin and mineral deficiencies rarely occur in isolation and physiological processes are the result of micronutrients working in combination, highlighting the importance of providing a comprehensive range of micronutrients to eligible patients requiring nutritional support.11

What about guidelines and guidance on micronutrient supplementation?

Appropriate micronutrient supplementation is acknowledged in clinical guidelines for nutrition support for adults with, or at risk of, malnutrition.2,11   NICE Clinical Guidelines 32 on Nutrition Support for Adults, state that: “If there is concern about the adequacy of micronutrient intake, a complete oral multivitamin and mineral supplement providing the reference nutrient intake for all vitamins and trace elements should be considered by healthcare professionals with the relevant skills and training in nutrition support who are able to determine the nutritional adequacy of a patient’s dietary intake.”2 In appropriate circumstances, the prescription of a multivitamin and mineral supplement is allowed on the NHS.12-14 NHS England has advised Integrated Care Boards that vitamins and minerals can be prescribed for patients who have a medically diagnosed deficiency, including those with a lifelong or chronic condition, or have undergone surgery that results in malabsorption. Continuing need should be reviewed on a regular basis.12 Wales and Northern Ireland also offer their own advice on multivitamin and mineral supplementation which can be found on our guidance page.13,14

Visit the guidance page here

The importance of micronutrients

Learn about why micronutrients matter when it comes to malnutrition.

Find out more
  1. Norman K, et al. Malnutrition in Older Adults—Recent Advances and Remaining Challenges. Nutrients 2021, 13, 2764. https://doi.org/10.3390/nu13082764
  2. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. NICE Clinical guideline 32. Published 22 February 2006.
  3. How is malnutrition prevented and treated? BAPEN. Available at: https://www.bapen.org.uk/malnutrition​/introduction-to-malnutrition/how-is-malnutrition-prevented-and-treated/
  4. How should I initially manage a person with malnutrition or risk of malnutrition? NICE CKS. Available at: https://cks.nice.org.uk/topics/adult-malnutrition/management/management-of-malnutrition/
  5. Gombart AF, Pierre A, Maggini S. A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients. 2020 Jan 16;12(1):236.
  6. Calder P. Nutrition and immunity: lessons for COVID-19. Eur J Clin Nutr. 2021; 75(9): 1309-1318.
  7. Martiniakova M, et al. The Role of Macronutrients, Micronutrients and Flavonoid Polyphenols in the Prevention and Treatment of Osteoporosis. Nutrients. 2022; 14(3):523.
  8. Berger MM, et al. Micronutrient Deficiencies in Medical and Surgical Inpatients. J Clin Med. 2019; 8(7):931.
  9. Pasricha SR, et al. Iron deficiency. Lancet. 2021; 397(10270):233-248.
  10. Yuen RC, Tsao SY. Embracing cancer immunotherapy with vital micronutrients. World J Clin Oncol. 2021 Sep 24;12(9):712-724.
  11. Berger, M et al. ESPEN micronutrient guideline. Clinical Nutrition. 2022;41:1357-1424.
  12. Policy guidance: conditions for which over the counter items should not be routinely prescribed in primary care, NHS England, 2024. Available at: https://www.england.nhs.uk/long-read/policy-guidance-conditions-for-which-over-the-counter-items-should-not-be-routinely-prescribed-in-primary-care/
  13. All Wales Medicines Strategy Group. Items Identified as Low Value for Prescribing in NHS Wales – Paper 3, February 2020. Available at: https://awttc.nhs.wales/files/guidelines-and-pils/items-identified-as-low-value-for-prescribing-in-nhs-wales-paper-3-v4-pdf/
  14. Northern Ireland Department of Health (NI DoH) and Health and Social Care Board (HSCB). Deprescribing: Limited Evidence List and Stop List. June 2025. Available at: https://niformulary.hscni.net​/deprescribing/prescribing-stop-list/

References accessed February 2026.

Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk or by searching for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Pharmacovigilance at Alliance Pharmaceuticals Ltd, Tel: 01249 466966, email: pharmacovigilance@alliancepharma.co.uk.