Homocysteine, folate, vitamin B-12, and physical function in older adults: cross-sectional findings from the Singapore Longitudinal Ageing Study

Abstract

Background: There is a paucity of studies, as well as inconsistent findings, on the associations of homocysteine, folate, and vitamin B-12 with physical function and decline in older persons. Objective: We investigated the independent associations of homocysteine, folate, and vitamin B-12 with gait and balance performance and Instrumental Activities of Daily Living (IADL) in community-living older persons. Design: We performed cross-sectional analyses on baseline data of 796 respondents in the Singapore Longitudinal Ageing Study who had laboratory measurements of fasting homocysteine folate and vitamin B-12 and completed Performance Oriented Mobility Assessment (POMA) of gait and balance and self-reports of IADLs. Results: In multivariate analyses in which sex, age, education, housing type, comorbidities, hospitalization, depression and global cognitive scores, BMI, creatinine, arthritis and hip fracture, serum albumin and hemoglobin, and physical activities were controlled for, we showed that homocysteine, independently of folate and vitamin B-12, showed significant negative associations with POMA balance (P = 0.02), POMA gait scores (P , 0.01), and IADL (P , 0.01). Serum folate showed a significant positive association only with POMA balance scores (P , 0.045). No significant independent associations for vitamin B-12 were observed. Conclusions: The independent association of elevated homocysteine and low folate, but not vitamin B-12, on physical and functional decline was supported in this study. Interventional studies of the physical functional effects of folate and vitamin B-12 status in different populations are needed.Am J Clin Nutr 2012;96: 1362-8.

Vitamin B12 and homocysteine associations with gait speed in older adults: The Baltimore Longitudinal Study of Aging

“…The results of this study support previous research identifying elevated homocysteine levels as a risk factor for gait speed and physical function decline (7–9, 20, 30). The lack of a relationship between vitamin B12 and gait speed has not been previously explored.…”

“…The lack of a relationship between vitamin B12 and gait speed has not been previously explored. Yet, these results are consisted with other null results investigating the associations between vitamin B12 and physical function (9, 17, 31), balance (9, 12), and gait performance (9). Vitamin B12 deficiency has been shown to be a risk factor for frailty in older women (32).…”

“…Cross-sectional studies assessing vitamin B12 serum levels and measures of physical function have conflicting results. In an analysis of adults aged 55 years and older in Singapore, vitamin B12 concentration examined as a continuous variable was not associated with changed in the Performance Oriented Mobility Assessment score of gait performance (9); whereas, vitamin B12 deficiency (defined as serum B12 <200 pmol/L and serum homocysteine >20 μmol/L) was associated with peripheral neuropathy and disability in a representative population of U.S. adults aged 60 years and older (12). Likewise, van Schoor et al, found women in the lowest quartile of serum vitamin B12 concentration were more likely to score lower on a walking test than women in the highest quartile, but this association was only in the cross-sectional analysis, not longitudinal analysis (17).…”

Relationship between Homocysteine and Muscle Strength Decline: The Baltimore Longitudinal Study of Aging

“…Elevated homocysteine concentrations are a known risk factor for vascular disease (6,7) and have been associated with fractures, disability, frailty, slow gait speed, poor balance, and poor physical function. (7,8,9) There is no standard cut point for elevated homocysteine concentrations but high homocysteine is frequently defined as >13 μmol/L(10) and the prevalence of high homocysteine among adults aged 60 years and older is nearly 20%. (11) Concentrations of homocysteine are influenced by renal function, (12) behavioral factors (smoking, alcohol use, and caffeine consumption), genetic mutations (MTHFR C677T), and nutritional intake (folate, vitamin B12, and vitamin B6).…”

Folate and B12 serum levels in association with depression in the aged: a systematic review and meta-analysis

“…Actually, a link between blood levels of B-complex vitamins and depression has been implied since the mid-1960s (Alpert, Mischoulon, Nierenberg, & Fava, 2000). Aging-related disturbances in absorption, transfer, and metabolism as well as poor nutritional condition are all contributing factors (Ng, Aung, Feng, Scherer, & Yap, 2012). Plausible biological mechanisms for the potential association between B-complex vitamins and depression have been demonstrated focusing on their role in the methionine synthesis.…”