Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study

Hin, Harold; Clarke, Robert; Sherliker, Paul; Atoyebi, Wale; Emmens, Kathleen; Birks, Jacqueline; Schneede, Joern; Ueland, Per Magne; Nexø, Ebba; Scott, John M.; Molloy, Anne M.; Donaghy, Michael; Frost, Chris; Evans, John Grimley

doi:10.1093/ageing/afl033

Cited by 161 publications

(136 citation statements)

References 27 publications

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“…Thus, the early diagnosis of vitamin B12 deficiency, which is important in preventing permanent neurological damage [2,3,16] , is often delayed. Low plasma vitamin B12 levels in most of the elderly asymptomatic patients are at the subclinical deficient status rather than the manifestation of physiological aging [7] .…”

Section: Discussionmentioning

confidence: 99%

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

et al. 2009

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Objective To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency. Results Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson's disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities. Conclusion Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.

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Section: Discussionmentioning

confidence: 99%

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

et al. 2009

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“…Vitamin B 12 deficiency chiefly occurs in the elderly, in whom it is predominantly the result of malabsorption caused by lack of intrinsic factor (pernicious anaemia), gastric atrophy or ileal disease (24)(25)(26)(27) . Age-independent causes include inadequate intake (e.g.…”

Section: Vitamin B 12mentioning

confidence: 99%

“…A subsequent analysis from the same study has reported that atrophy in the cerebral cortex and hippocampus is associated with elevated Hcy levels (30) . More recent evidence from a cross-sectional study of 1000 older adults in Banbury, Oxon., UK has demonstrated an association between cognitive impairment and low plasma levels of holotranscobalamin (the active fraction of vitamin B 12 ) and with high levels of methylmalonic acid (a metabolic marker of vitamin B 12 deficiency) in addition to elevated Hcy concentrations (26) .…”

Section: Dementiamentioning

confidence: 99%

B-vitamins and prevention of dementia

Clarke

2008

Proc. Nutr. Soc.

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Elevated plasma homocysteine (Hcy) concentrations have been implicated with risk of cognitive impairment and dementia, but it is unclear whether low vitamin B 12 or folate status is responsible for cognitive decline. Most studies reporting associations between cognitive function and Hcy or B-vitamins have used a cross-sectional or case-control design and have been unable to exclude the possibility that such associations are a result of the disease rather than being causal. The Hcy hypothesis of dementia has attracted considerable interest, as Hcy can be easily lowered by folic acid and vitamin B 12 , raising the prospect that B-vitamin supplementation could lower the risk of dementia. While some trials assessing effects on cognitive function have used folic acid alone, vitamin B 12 alone or a combination, few trials have included a sufficient number of participants to provide reliable evidence. An individualpatient-data meta-analysis of all randomised trials of the effects on cognitive function and vascular risk of lowering Hcy with B-vitamins will maximise the power to assess the epidemiologically-predicted differences in risk. Among the twelve large randomised Hcy-lowering trials for prevention of vascular disease, data should be available on about 30 000 participants with cognitive function. The principal investigators of such trials have agreed to combine individual-participant data from their trials after their separate publication.Folate: Vitamin B 12 : Homocysteine: Dementia

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“…Low serum vitamin B 12 concentrations have been reported in approximately 10 % of the elderly population in industrialized countries and this prevalence increases with age, from approximately 5 % at age 65 years to 20 % at age 85 years (1,2) . In clinical practice, vitamin B 12 deficiency is commonly manifested as macrocytic anaemia and through neurological signs; the latter may occur without the presence of anaemia in 20 % of cases (3) .…”

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confidence: 99%

High frequency of vitamin B₁₂ deficiency in a Brazilian population

Xavier

Costa

Annichino‐Bizzacchi

et al. 2010

Public Health Nutr.

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Objective: There are few studies regarding vitamin B 12 deficiency in developing countries. In Brazil, a late diagnosis of vitamin B 12 deficiency progressing to severe neurological damage is common. Thus, the aim of the present study was to verify the frequency of vitamin B 12 deficiency in two Brazilian populations (elderly and adult participants) and to compare different methods of vitamin B 12 deficiency detection. Design: Five hundred participants were recruited from health centres from south-east Brazil and were separated into two groups: 60 years old or more and 30-59 years old. Vitamin B 12 and folate concentrations were measured using electrochemiluminescence immunoassay (ECI) and RIA. Methylmalonic acid (MMA) was measured by LC coupled to tandem MS. Full blood counts were acquired using standard methods. Results: All participants had normal blood count results and mean cell volume less than 99 fl; none of them presented folate deficiency according to the results, which were all greater than 3 ng/ml. Cobalamin levels less than 200 pmol/l were identified by one of the two or by both methods in 7?2 % of the participants aged 60 years or more and 6?4 % of the participants aged 30-59 years. MMA levels were higher in older subjects (P 5 0?007) compared with younger subjects. A greater correlation of MMA v. RIA was observed than of MMA v. ECI (P 5 0?0017 v. P 5 0?014). MMA quantification estimated that cobalamin deficiency was present in more than 11 % of the subjects for both studied groups. Conclusions: The study shows that vitamin B 12 deficiency is frequent in Brazilian adults and suggests that RIA is more sensitive than ECl for measuring cobalamin levels.

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Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study

Abstract: low vitamin B12 concentrations are associated with cognitive impairment and missing ankle tendon jerks in older people in the absence of anaemia. Large-scale trials of vitamin B12 supplementation are required to assess the clinical significance of these associations.

Cited by 161 publications

References 27 publications

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

B-vitamins and prevention of dementia

High frequency of vitamin B₁₂ deficiency in a Brazilian population

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Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study

Abstract: low vitamin B12 concentrations are associated with cognitive impairment and missing ankle tendon jerks in older people in the absence of anaemia. Large-scale trials of vitamin B12 supplementation are required to assess the clinical significance of these associations.

Cited by 161 publications

References 27 publications

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

B-vitamins and prevention of dementia

High frequency of vitamin B12 deficiency in a Brazilian population

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High frequency of vitamin B₁₂ deficiency in a Brazilian population