Clinical significance of low cobalamin levels in older hospital patients

Asselt, D.Z.B. van; Blom, Henk J.; Zuiderent, R.; Wevers, Ron A.; Jakobs, C.; Broek, W.J.A.A. van den; Lamers, C. B. H. W.; Corstens, F.H.M.; Hoefnagels, W.H.L.

doi:10.1016/s0300-2977(00)00048-6

Cited by 44 publications

(32 citation statements)

References 38 publications

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“…Although atrophic gastritis was strongly associated with low serum vitamin B 12 in our study population, 77% of people with deficient (o148 pmol/l) and 94% with marginal vitamin B 12 (148-221 pmol/l) were classifed as having normal mucosa or superficial gastritis. This is in agreement with other studies (van Asselt et al, 2000;Campbell et al, 2003), and appears to contradict current opinion that reduced gastric acid production due to atrophic gastritis combined with bacterial overgrowth is the underlying mechanism of malabsorption of food-bound vitamin B 12 (Baik & Russell, 1999). Although serum pepsinogen has good sensitivity and specificity for correctly classifying people with normal mucosa and severe atrophic gastritis, it may underestimate the prevalence of mild-moderate atrophic gastritis (Samloff et al, 1982).…”

Section: Discussionsupporting

confidence: 83%

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

et al. 2004

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Objective: To determine the serum vitamin B 12 status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B 12 status. Design: A cross-sectional nationally representative population-based survey. Method: Serum vitamin B 12 concentrations were used to assess vitamin B 12 status. The presence and severity of atrophic gastritis was classified using serum pepsinogen I and II. Subjects: A total of 466 noninstitutionalized urban and rural dwelling New Zealanders aged 65 y or older who participated in the 1997 National Nutrition Survey. Results: The prevalence of deficient (o148 pmol/l) and marginal (148-221 pmol/l) serum vitamin B 12 concentrations was 12 and 28%, respectively. The prevalence of atrophic gastritis was 6.7% (severe 3.1%, mild-moderate 3.6%). While atrophic gastritis increased the relative risk (RR, 95% CI) of having a deficient or marginal serum vitamin B 12 concentration by 21-fold (6-67) and five-fold (1-17), respectively, those who had atrophic gastritis made up only 33 and 6% of the participants with deficient or marginal serum vitamin B 12 concentrations. An intake of vitamin B 12 from food that exceeded the recommended dietary allowance (2.4 mg/day) did not protect against deficient (RR 0.5; 95% CI: 0.2, 1.2) or marginal (RR 0.9; 95% CI: 0.5, 1.7) serum vitamin B 12 status. Vitamin B 12 supplement users had a reduced risk of having deficient and marginal vitamin B 12 status (RR 0.3; 95% CI: 0.1, 0.8).Conclusions: There is a relatively high prevalence of deficient and marginal serum vitamin B 12 concentrations among older New Zealanders. However, the prevalence of atrophic gastritis was low in the New Zealand elderly compared with other surveys. Although atrophic gastritis was a risk factor for low vitamin B 12 status, it did not fully explain the prevalence of low serum vitamin B 12 .

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Section: Discussionsupporting

confidence: 83%

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

et al. 2004

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“…For age, various studies using direct absorption testing have shown that most elderly persons do not have FCM, and their rates of FCM are only slightly higher than in younger adults. According to some authors, advanced age is a physiological condition that is frequently associated with non-dissociation [12]. Our…”

Section: Epidemiology and Associated Causesmentioning

confidence: 79%

“…Some authors reported a prevalence of 40% among elderly patients living in institutions [1,12]. According to our own experience, the prevalence of cobalamin deficiency (serum levels of cobalamin <200 pg/mL and total homocystein >13μmol/L) among hospitalized patients for any reason approaches 5%, with FCM accounting for 50% to 60% of cases (with the criteria of FCM reported in Table 1) [1,6].…”

Section: Epidemiology and Associated Causesmentioning

confidence: 97%

The Syndrome of Food-Cobalamin Malabsorption: A Personal View in a Perspective of Clinical Practice

Serraj¹

2011

J Blood Disord Transfus

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SummaryThis article presents recent findings on cobalamin deficiencies due to food-cobalamin malabsorption or nondissociation of vitamin B12 from its carrier proteins syndrome. These findings might be of interest to medical practitioners. This disorder, for which a definitive consensus on the criteria for diagnosis is not yet available, is the leading cause of cobalamin deficiency in the elderly. In practice, food-cobalamin malabsorption is a diagnosis of exclusion, and requires the deductive elimination of all other causes of cobalamin deficiencies, particularly pernicious anaemia. The causes or associated disorders of food-cobalamin malabsorption are multiple and include gastric pathologies, Helicobacter pylori infections and certain drugs (biguanides and proton pump inhibitors). Depending on the disease aetiology, treatment of food-cobalamin malabsorption involves oral supplementation of doses lower than those required for pernicious anaemia.

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“…La prévalence s'élèverait entre 30 et 40% chez les sujets âgés et/ou institutionnalisés [63,82]. Ces chiffres varient selon le seuil de normalité retenu par les auteurs.…”

Section: Epidémiologie De La Carence En Vitamine B12unclassified

“…Les voies nasales et sublinguales ont été aussi testées pour le traitement de la carence en vitamine B12, toutes causes confondues ; des résultats satisfaisants ont également été obtenus avec ces voies d'administration [82].…”

Section: Diagnostic Et Traitement De La Carence En Vitamine B12unclassified

Carence en vitamine B12 (1^repartie) : mise au point

Loup-Leuciuc

Loup

Lombardi

et al. 2011

Med Buccale Chir Buccale

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(Reçu le 12 mai 2011, accepté le 24 juin 2011) Mots clés : vitamine B12 / métabolisme / carence / manifestationsRésumé -Classiquement, la carence en vitamine B12 s'accompagne d'une anémie mégaloblastique, de manifestations neuropsychiatriques et d'une glossite de Hunter. En réalité, les manifestations sont protéiformes et chacune d'elles peut rester longtemps isolée. Les manifestations stomatologiques, souvent discrètes, peuvent précéder de plusieurs années les autres manifestations. Elles constituent parfois un signe d'appel pour le dépistage précoce de cette carence. Depuis une bonne dizaine d'années, la conception de la physiopathologie de la carence en vitamine B12 a beaucoup évolué : on a identifié le syndrome de non-dissociation de la vitamine B12 des protéines porteuses qui constitue maintenant la principale cause de carence en vitamine B12 et il a été démontré qu'on peut effectuer un traitement de la carence per os. Key words: vitamin B12 / metabolism / deficiency / manifestationsAbstract -Vitamin B12 deficency. Part 1: update and littérature review. Vitamin B12 deficiency is classically accompanied by a megaloblastic anemia, neuropsychiatric disorders and an Hunter glossitis. Clinical manifestations are indeed polymorphic and each may remain the only one for a long period of time. Stomatological manifestations, often mild, may precede the others of many years. They sometimes are the first sign to early diagnose this deficiency. Since the last ten years, the physiopathology of vitamin B12 deficiency has considerably changed. In fact, nowadays, the main cause is the syndrome of food cobalamin malabsorption. It has also been demonstrated that the deficiency may now treated by an oral cobalamin therapy.La vitamine B12 est une vitamine hydrosoluble qui a une structure chimique proche de celle de l'hème avec un atome central constitué par du cobalt, d'où le nom de cobalamine (Fig. 1).Elle existe sous plusieurs formes regroupées dans la famille des cobalamines : cyanocobalamine, hydroxocobalamine, mé-thylcobalamine et adénosylcobalamine. La cyanocobalamine et l'hydroxocobalamine sont les seules formes stables. On peut considérer que les recherches sur la vitamine B12 ont commencé au XIX e siècle avec la description d'une anémie mortelle, l'anémie pernicieuse, par Thomas Addison et Michael Anton Biermer. Vers 1920, George Whipple, George Minot et William Murphy, tous les trois Prix Nobel de médecine en 1934, ont démontré que des extraits de foie sous forme de compléments alimentaires étaient susceptibles de corriger certaines anémies. On en a conclu que les extraits de foie contenaient le facteur extrinsèque, en réalité de la vitamine

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Clinical significance of low cobalamin levels in older hospital patients

Cited by 44 publications

References 38 publications

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

The Syndrome of Food-Cobalamin Malabsorption: A Personal View in a Perspective of Clinical Practice

Carence en vitamine B12 (1^repartie) : mise au point

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Clinical significance of low cobalamin levels in older hospital patients

Cited by 44 publications

References 38 publications

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

The Syndrome of Food-Cobalamin Malabsorption: A Personal View in a Perspective of Clinical Practice

Carence en vitamine B12 (1repartie) : mise au point

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Product

Resources

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Carence en vitamine B12 (1^repartie) : mise au point