Haemoglobin, Vitamin B<sub>12</sub> and Folate Levels in the Elderly

Elwood, Peter Creighton; Shinton, N. K.; Wilson, C. I. D.; Sweetnam, P. M.; Frazer, A. C.

doi:10.1111/j.1365-2141.1971.tb02717.x

Cited by 71 publications

(41 citation statements)

References 15 publications

(7 reference statements)

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“…37 In a Korean population aged 60 to 95 years, the prevalence of anemia was 13.6%, but higher in women (14.7%) than in men (9.9%). 38 In the present study, the prevalence of anemia in the elderly was similar to that found in other population-based studies: 22,23,[39][40][41][42][43][44] 13.2% overall (about 11-12% not considering thalassemia), 12.6% in women and 14.1% in men. The high prevalence of anemia estimated in the very old (over 85 years old, 31.3%) is consistent with that recently reported the Newcastle 85+ cohort for (29.8%).…”

Section: Associations Of Mild Anemia With Other Clinical Conditionssupporting

confidence: 89%

“…47 Data on mild anemia (hemoglobin concentration between 10.0 g/dL and WHO lower limits of normal) can be drawn only from few, mainly small and not so recent, population-or community-based studies (Online Supplementary Table S3). 17,22,23,[39][40][41][42][43]48 In the present study, mild grade anemia accounted for some 84% of the cases; the majority of these subjects were unaware of being anemic. This seems to confirm that mild anemia in the elderly often goes unscreened and undiagnosed or is disregarded and not reported to the patient by the physician.…”

Section: Associations Of Mild Anemia With Other Clinical Conditionsmentioning

confidence: 93%

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Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

et al. 2010

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The online version of this article has a Supplementary Appendix. BackgroundHemoglobin concentrations slightly below the lower limit of normal are a common laboratory finding in the elderly, but scant evidence is available on the actual occurrence of mild anemia despite its potential effect on health. The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly. Design and MethodsThis was a prospective, population-based study in all residents 65 years or older in Biella, Italy. ResultsBlood test results were available for analysis from 8,744 elderly. Hemoglobin concentration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10.0−11.9 g/dL in women and 10.0−12.9 g/dL in men) affected 11.8% of the elderly included in the analysis, while the estimated prevalence in the entire population was 11.1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. The underlying cause of mild anemia remained unexplained in 26.4% of the cases, almost one third of which might be accounted for by myelodysplastic syndromes. In a random sample of non-anemic elderly at baseline (n=529), after about 2 years, the annual incidence rate of mild anemia was 22.5 per 1000 person-years and increased with increasing age. ConclusionsThe prevalence and incidence of mild anemia increase with age and mild anemia affects more than one out of ten elderly individuals. Unexplained anemia is common and may be due to myelodysplastic syndromes in some cases.Key words: elderly, hemoglobin, incidence, mild anemia, prevalence, types of anemia. " population-based study. Haematologica 2010;95(11):1849-1856. doi:10.3324/haematol.2010 This is an open-access paper. Citation: Tettamanti M, Lucca U, Gandini F, Recchia A, Mosconi P, Apolone G, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Savoia L, Fasolo G, Ponchio L, Della Porta MG, and Riva E. Prevalence, incidence and types of mild anemia in the elderly: the "Health and AnemiaPrevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

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Section: Associations Of Mild Anemia With Other Clinical Conditionssupporting

confidence: 89%

Section: Associations Of Mild Anemia With Other Clinical Conditionsmentioning

confidence: 93%

Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

et al. 2010

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“…43 However, the course of subclinical deficiency often appears stationary. [61][62][63] The biochemical abnormalities themselves frequently fluctuate 64,65 ; mildly to moderately elevated MMA levels improved spontaneously in 44% of 432 cases retested 1 to 4 years later, and only 16% worsened. 64 Those observations notwithstanding, the impulse for medical intervention is such that controlled cobalamin trials in subclinical deficiency have been called unethical by some investigators.…”

Section: Expansion and Redefinition Of Cobalamin Deficiencymentioning

confidence: 99%

How I treat cobalamin (vitamin B12) deficiency

Carmel

2008

Blood

274

223

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The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient. (Blood. 2008;112: 2214-2221)

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“…It is reasonable to suppose that the elderly might be particularly prone to develop folic acid deficiency because of diminished financial resources, reduced mobility and apathy over food [8]. Surveys of community-based elderly have found a high prevalence of levels of folate which are below commonly accepted lower limits of the normal range [9] and institutionalised elderly have been found to have significantly low serum and red cell folate levels [10]. Reports have shown low serum folate in 80% of an elderly population [8] and low red cell folate in 70% of a lowincome elderly population [3].…”

Section: Discussionmentioning

confidence: 99%

Use of Folic Acid-Fortified Milk in the Elderly Population

et al. 1998

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Folic acid deficiency is common in the elderly population, resulting in anaemia, dementia, many neurological sequelae and an indirect role in atheromatous disease. An increase in natural food folate is relatively ineffective at increasing folate status and the use of folate fortification of foodstuffs is recommended. The aim of our study was to assess the benefits of folic acid-fortified milk to the folate status of an elderly institutionalised population. 49 subjects received fortified milk as part of their daily diet for at least 6 months (active group) and 40 subjects received unfortified milk (control group). Our results showed a mean serum folate level in the active group of 5.81 (1.1–17.6) µg/l compared to the control group mean of 2.16 (0.5–9.4) µg/l (p < 0.001; normal range for serum folate 2.7–20 µg/l). Similarly the mean red cell folate level in the active group of 316.5 (130–905) µg/l was significantly higher than the control group mean of 196.1 (95–490) µg/l (p < 0.001; normal range for red cell folate 150–1,000 µg/l). Our results suggest that folic acid-fortified milk is an efficacious and acceptable method of administration of folic acid in the elderly population and we recommend the use of folic acid-fortified milk in the regular daily diet of the elderly population.

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Haemoglobin, Vitamin B₁₂ and Folate Levels in the Elderly

Cited by 71 publications

References 15 publications

Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

How I treat cobalamin (vitamin B12) deficiency

Use of Folic Acid-Fortified Milk in the Elderly Population

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Haemoglobin, Vitamin B12 and Folate Levels in the Elderly

Cited by 71 publications

References 15 publications

Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study

How I treat cobalamin (vitamin B12) deficiency

Use of Folic Acid-Fortified Milk in the Elderly Population

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Product

Resources

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Haemoglobin, Vitamin B₁₂ and Folate Levels in the Elderly