The potential protective roles of folate and the metabolically related B-vitamins (vitamins B12, B6 and riboflavin) in diseases of ageing are of increasing research interest. The most common cause of folate and riboflavin deficiencies in older people is low dietary intake, whereas low B12 status is primarily associated with food-bound malabsorption, while sub-optimal vitamin B6 status is attributed to increased requirements in ageing. Observational evidence links low status of folate and the related B-vitamins (and/or elevated concentrations of homocysteine) with a higher risk of degenerative diseases including cardiovascular disease (CVD), cognitive dysfunction and osteoporosis. Deficient or low status of these B-vitamins alone or in combination with genetic polymorphisms, including the common MTHFR 677 C → T polymorphism, could contribute to greater disease risk in ageing by causing perturbations in one carbon metabolism. Moreover, interventions with the relevant B-vitamins to optimise status may have beneficial effects in preventing degenerative diseases. The precise mechanisms are unknown but many have been proposed involving the role of folate and the related B-vitamins as co-factors for one-carbon transfer reactions, which are fundamental for DNA and RNA biosynthesis and the maintenance of methylation reactions. This review will examine the evidence linking folate and related B-vitamins with health and disease in ageing, associated mechanisms and public health implications.

Aims and objectives-To determine the feasibility and acceptability of using trained volunteers as mealtime assistants for older hospital inpatients.Background-Poor nutrition among hospitalised older patients is common in many countries and associated with poor outcomes. Competing time pressures on nursing staff may make it difficult to prioritise mealtime assistance especially on wards where many patients need help.

Context Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes. Objective To determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults. Setting and Participants Community-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment. Main Outcome Measures Biomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB). Results Metformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤−1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74). Conclusions Use of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.

Background Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking. Objectives To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults. Methods Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008–2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value &lt; −0.5. A pepsinogen I:II ratio &lt;3 was considered indicative of AG. Results AG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P &lt; 0.001) and plasma holotranscobalamin (holoTC; P &lt; 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P &lt; 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0–4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG. Conclusions Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.

Globally populations are ageing and mental health disorders, including dementia and depression, are reported as the leading cause of disability and ill health in older people (1). Epidemiological and randomised trial evidence supports potential roles for folate and the metabolically related B-vitamins in preventing cognitive dysfunction and depression in ageing, but the evidence is inconsistent (2). The aim of this study was to investigate the effect of supplementation with folate and related B-vitamins, over a 2 year period, on cognitive function (primary outcome) and depression (secondary outcome) in older adults. The B-vitamins and Brain Health in Older People (BrainHOP) randomised controlled trial was conducted in adults aged 70 years and older. Participants were randomised to receive a supplement containing folic acid (400 µg), vitamin B12 (10 µg), vitamin B6 (10 mg) and riboflavin (10 mg) or placebo daily. Cognitive function was assessed before and after the 2-year intervention using the Frontal Assessment Battery (FAB) and the Repeatable Battery of the Assessment of Neuropsychological Status (RBANS). Depression was assessed using the Centre for Epidemiological Studies Depression (CES-D) scale. Of the 328 participants initially recruited, 249 (74%) participants completed the intervention. Results showed that B-vitamin intervention appeared to have no significant effect on either frontal lobe or global cognitive function (as measured by FAB and RBANS, respectively). However, when specific domains within global cognition (i.e. RBANS index scores) were examined separately, B-vitamin intervention was found to protect against visuospatial cognitive decline over the two year period (Table).

Worldwide the number of adults aged 60 years and over is predicted to reach 2 billion by 2050, (1) and hence the associated chronic diseases of ageing will continue to increase in the coming decades. Mental health disorders such as depression are common in older age and are major contributors to disability and poor quality of life.(2) Folate and the related B-vitamins (vitamin B12, vitamin B6 and riboflavin) involved in one-carbon metabolism are required for normal brain function and thus may have a protective role against depression. We have recently reported that low biomarker status of the relevant B-vitamins was associated with an increased risk of depression:(3) however it is unclear whether protective biomarker status can be achieved through natural food sources alone or if fortification and/or supplementation with B-vitamins is required. The aim of this study was to investigate the role of fortified food and supplements in optimising B-vitamin biomarker status in older adults, to levels associated with a reduced risk of depression.This investigation was conducted as part of the Trinity Ulster Department of Agriculture (TUDA) Ageing cohort study (n 5186), where detailed health and lifestyle information was collected along with measurements of cognitive and mental health. Some 70 % of participants were fortified food consumers while 11 % were B-vitamin supplement users. Participants were categorised on the basis of dietary sources of B-vitamins as: natural food sources only; fortified food consumers; or supplement users (with and without concurrent consumption of fortified foods) (Table). B-vitamin biomarkers were examined in relation to each dietary category.Data presented as medians. Differences were assessed using ANCOVA with Bonferroni post hoc tests on log-transformed data when applicable, controlling for age, gender, BMI and smoking. Values across a row without a common superscript letter are significantly different (P < 0·05). Abbreviations: RBC, red blood cell; PLP, pyridoxal 5-phosphate; EGRac, erythrocyte glutathione reductase co-efficient.Biomarker status of each B-vitamin increased significantly with increasing intakes of fortified foods while non-consumers of fortified foods or supplements had the lowest status of all B-vitamin biomarkers. As previously reported, (3) lowest biomarker status of folate (p 0·003), vitamin B6 (p 0·034) and riboflavin (p 0·011) were, in turn, associated with an increased risk of depression by 47-78 %.In conclusion, natural food sources alone appear to be insufficient in achieving a biomarker concentration of B-vitamins associated with lowest risk of depression, while regular consumption of fortified foods or supplements appear to be associated with biomarker concentrations that may protect mental health in ageing. These findings, if confirmed through randomised controlled trials, may have implications for dietary recommendations or fortification policy.

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The number of adults aged 60 years and over is predicted to reach up to 2 billion by 2050 and hence the associated health and socioeconomic costs will continue to increase. Cognitive dysfunction, depression and anxiety are significant problems of ageing. Preventing or delaying the onset of these disorders should therefore be a public health priority. Accumulating evidence suggests that low status of folate and the related B-vitamins (B12, B6 and riboflavin) are linked to an increased risk of these conditions 1,2,3. The aim of this study is to investigate whether these B-vitamins are determinants of neuropsychiatric health in ageing. Participants for this investigation were recruited to the Trinity Ulster Department of Agriculture (TUDA) Ageing cohort study and health, clinical, medication, lifestyle and nutritional details were collected (n 5186). A non-fasting blood sample was taken for the analysis of B-vitamin biomarkers. Cognitive function was assessed using the Mini Mental State Examination (MMSE), and depression and anxiety were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D) (a score ⩾16•0 suggestive of depression) and the Hospital Anxiety and Depression (HADS) scale (a score ⩾11•0 suggestive of anxiety).