Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B-12 status, and the impact of fortified foods, in older adults

Abstract

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 < −0.5. A pepsinogen I:II ratio <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 < 0.001) and plasma holotranscobalamin (holoTC; P < 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 < 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.

Nutrition policy: developing scientific recommendations for food-based dietary guidelines for older adults living independently in Ireland

“…In Ireland, studies from the TUDA cohort reported that metformin use was associated with a 45 % increased risk of vitamin B 12 deficiency and a 48 % increased risk of vitamin B 6 deficiency (58) , while those taking a proton pump inhibitor are more likely to have indicators of vitamin B 12 deficiency (59) .…”

Mechanistic Link between Vitamin B12 and Alzheimer’s Disease

“…A recent study (2021) demonstrated an association of atrophic gastritis (AG) with significantly lower serum total vitamin B12 levels compared to individuals without AG. A possible explanation for this finding could be that this disease mediates the suppression of gastric acid and may thereby impair the absorption of vitamin B12 from foods [ 207 ]. In line with this, an earlier study also reported a prevalence of 2.5% of low serum vitamin B12 levels related to atrophic corpus gastritis [ 208 ].…”

The Effects of Proton Pump Inhibitors in Acid Hypersecretion-Induced Vitamin B12 Deficiency: A Systematic Review (2022)

“…The most recent 2021 cohort study examined 3299 community-dwelling older adults (1216 PPI users, 2083 non-PPI users) and the protective role of fortified foods on vitamin B12 levels [ 15 ]. The study concluded that participants with higher PPI doses (≥30 mg/d) for more than six months were significantly associated with a higher prevalence of vitamin B12 deficiency (21% compared with 15% in controls; p = 0.001), lower holotranscobalamin (holoTC), and high MMA levels.…”