High Prevalence of Cobalamin Deficiency in Elderly Outpatients

Pennypacker, Leslye C.; Allen, Robert H.; Kelly, James P.; Matthews, L. M.; Grigsby, Jim; Kaye, Kathryn; Lindenbaum, John; Stabler, Sally P.

doi:10.1111/j.1532-5415.1992.tb03641.x

Cited by 386 publications

(263 citation statements)

References 35 publications

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“…We do not regard it as evidence of Cbl deficiency. This occurs even in those whose serum Cbl is well over 500 pg/ml (Pennypacker et al, 1992) and who, despite an initially high serum MMA level, can hardly be harbouring Cbl deficiency, although this is what the authors seem to believe.…”

Section: Methylmalonic Acid (Mma) Levelsmentioning

confidence: 42%

“…If the raised MMA levels are regarded as due to Cbl deficiency, the frequency of PA in a group whose age averages 77 years would be 15%. Pennypacker et al (1992) selected 152 outpatients aged 65 or more with serum Cbl levels < 300 pg/ml. Raised MMA levels were present in 14·5%; half of these had serum Cbl levels between 200 and 300 pg/ml and the other half had Cbl levels < 200 pg/ml.…”

Section: Methylmalonic Acid (Mma) Levelsmentioning

confidence: 99%

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Diagnosis of Cobalamin Deficiency: The Old and the New

Chanarin¹,

Metz

1997

Br J Haematol

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Section: Methylmalonic Acid (Mma) Levelsmentioning

confidence: 42%

Section: Methylmalonic Acid (Mma) Levelsmentioning

confidence: 99%

Diagnosis of Cobalamin Deficiency: The Old and the New

Chanarin¹,

Metz

1997

Br J Haematol

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“…The observations of the present study, when combined with those of van Asselt et al, (1998) and Bjorkegren and Svardsudd (2001), suggest that older people living in Europe may be at risk of functional vitamin B 12 deficiency. Functional B 12 deficiency in North America has also been highlighted (Pennypacker et al, 1992;Lindenbaum et al, 1994;Carmel et al, 1999;Stabler et al, 1999), especially in Caucasians (Carmel et al, 1999;Stabler et al, 1999). It is unlikely to be due to a simple lack of vitamin B 12 in the diet, and thus is more likely to relate to impaired absorption or retention of the vitamin, by mechanisms that remain poorly understood (Howard et al, 1998;van Asselt et al 1998).…”

Section: Discussionmentioning

confidence: 99%

Relationship between methylmalonic acid, homocysteine, vitamin B12 intake and status and socio-economic indices, in a subset of participants in the British National Diet and Nutrition Survey of people aged 65 y and over

et al. 2003

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Objective: Assessment of functional vitamin B 12 status in a subset of the respondents in the British National Diet and Nutrition Survey of people aged 65 y and over. Setting: National Diet and Nutrition Survey: a British nationwide cross-sectional sample of people aged 65 y and over, living either in the community or in institutions such as nursing homes, during one calendar year spanning 1994 -1995. Methods: Methylmalonic acid (MMA) concentrations were measured in plasma samples from 313 subjects (ca 14% of those originally enrolled in the survey). The results were compared with those for serum vitamin B 12 , vitamin B 12 intakes and other status and intake estimates and with socio-demographic indices. Results: Of the NDNS participants overall, 20% had serum vitamin B 12 concentrations < 150 pmol=l. In the subset studied here, 24% of free-living and 46% of institution-living participants had MMA >0.5 mmol=l. Geometric mean MMA increased with age, from 0.25 mmol=l in people aged 65 -74 y to 0.38 mmol=l in people aged 85 þ y. There was little evidence for any gender difference in MMA. It was inversely correlated with serum vitamin B 12 and with red blood cell folate; it was positively correlated directly with total homocysteine, but not significantly with serum folate or with vitamin B 12 intake. Among respondents with high MMA, a subgroup had normal serum vitamin B 12 but higher-than-average plasma urea and creatinine. Socio-demographic co-variates of MMA included receipt of State income benefits, social class of head of household, and educational attainment. These indices were not correlated with serum vitamin B 12 . Conclusions: The progressive increase in MMA with age is metabolic evidence for increasing risk of functional vitamin B 12 deficiency with increasing age in older people. There is evidence that renal function is linked to high MMA in some older people. Age and renal function are thus both important when establishing upper reference limits for MMA. The socio-demographic observations suggest a link between poverty and poor functional vitamin B 12 status in older British people.

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“…6 25.6± > 10. 9 Pennypacker et al [22] significantly reduced serum MMA as well as tHcy; folic acid treatment gave a significant further reduction in tHcy.…”

Section: /20mentioning

confidence: 97%

Elevated serum levels of methylmalonic acid and homocysteine in elderly people. A population‐based intervention study

Björkegren

Svärdsudd²

1999

Journal of Internal Medicine

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Abstract. Bjo Èrkegren K, Sva Èrdsudd K (University Hospital Uppsala; Skutska Èr Primary Health Care Center, Skurska Èr, Sweden). Elevated serum levels of methylmalonic acid and homocysteine in elderly people. A population-based intervention study. J Intern Med; 246: 317±324.Objectives. There is uncertainty amongst clinicians about the definitions of cobalamin and folate deficiency and therefore about the indications for treatment. In this report we present the results of systematic cobalamin and folic acid treatment based upon serum cobalamin, total homocysteine (tHcy) and methylmalonic acid (MMA) analyses in a population-based sample. Subjects. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey (n = 266). Sixty-nine persons who had serum cobalamin , 300 pmol L 21 and serum MMA $0.37 mmol L 21 or serum tHcy $15 mmol L 21 and who had no cobalamin or folic acid substitution were selected for treatment.Interventions. Initially all 69 patients were given cobalamin orally or intramuscularly. Those who remained high in tHcy were in addition given folic acid treatment. Main outcome measures. Serum cobalamin, serum MMA and serum tHcy. Results. After 6 months of cobalamin treatment, serum MMA became normal in 13 out of 15 persons. Mean serum tHcy decreased but was normalized in only 15 out of 56 persons. After 3 months of folic acid treatment added to those who still had an abnormal serum tHcy, serum tHcy had normalized in all but one person. Conclusions. Cobalamin treatment normalizes increased MMA values and combined cobalamin and folic acid treatment normalizes tHcy, suggesting a pretreatment deficiency of tissue cobalamin and folate in spite of normal serum cobalamin and folate values in the majority of cases.

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High Prevalence of Cobalamin Deficiency in Elderly Outpatients

Cited by 386 publications

References 35 publications

Diagnosis of Cobalamin Deficiency: The Old and the New

Diagnosis of Cobalamin Deficiency: The Old and the New

Relationship between methylmalonic acid, homocysteine, vitamin B12 intake and status and socio-economic indices, in a subset of participants in the British National Diet and Nutrition Survey of people aged 65 y and over

Elevated serum levels of methylmalonic acid and homocysteine in elderly people. A population‐based intervention study

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