Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services

Johnson, Mary Ann; Hawthorne, Nicole A; Brackett, Wimberly R; Fischer, Joan G.; Gunter, Elaine W.; Allen, Robert H.; Stabler, Sally P.

doi:10.1093/ajcn/77.1.211

Cited by 94 publications

(83 citation statements)

References 43 publications

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“…Low folate or cobalamin status or renal impairment account for the majority of cases with increased tHcy (49 -53 ). In populations eating food fortified with folic acid, renal impairment and cobalamin deficiency are the most important determinants (54 ). Homozygosity for the methylenetetrahydrofolate reductase (MTHFR) 677C3 T polymorphism is the most common genetic determinant (55,56 ).…”

Section: Biological Determinantsmentioning

confidence: 99%

Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion

et al. 2004

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Background: Measurement of plasma total homocysteine has become common as new methods have been introduced. A wide range of disorders are associated with increased concentrations of total homocysteine. The purpose of this review is to provide an international expert opinion on the practical aspects of total homocysteine determinations in clinical practice and in the research setting and on the relevance of total homocysteine measurements as diagnostic or screening tests in several target populations. Methods: Published data available on Medline were used as the basis for the recommendations. Drafts of the recommendations were critically discussed at meetings over a period of 3 years. Outcome: This review is divided into two sections: (a) determination of homocysteine (methods and their performance, sample collection and handling, biological determinants, reference intervals, within-person variability, and methionine loading test); and (b) risk assessment and disease diagnosis (homocystinuria, folate and cobalamin deficiencies, cardiovascular disease, renal failure, psychiatric disorders and cognitive impairment, pregnancy complications and birth defects, and screening of elderly and newborns). Each of these subsections concludes with a separate series of recommendations to assist the clinician and the research scientist in making informed decisions. The review concludes with a list of unresolved questions. © 2004 American Association for Clinical ChemistryIncreased plasma total homocysteine (tHcy) 7 is a sensitive marker of folate and cobalamin (vitamin B 12 ) deficiency (1, 2 ) and an independent risk factor for cardiovascular disease (CVD) (3,4 ). Plasma tHcy concentrations are also related to birth defects (5 ), pregnancy complications (6 ), psychiatric disorders (7 ), and cognitive impairment in the elderly (8 ). The measurement of tHcy in the clinical setting is thus potentially of great importance (9 ).The introduction of tHcy assays in the mid-1980s (10, 11 ) started a new era of research on Hcy. However, it was the advent of immunoassays in the latter half of the 1990s (12, 13 ) that changed tHcy determinations from research tools to widely used clinical chemistry tests. As a result, interest in this field has increased exponentially in both routine diagnostics and research.Although several reviews on tHcy determinations have been published (14 -18 ), few have provided recommendations for their use in clinical practice (19 -23 ). Our aim was to review the practical aspects of tHcy determinations in clinical practice as well as in the research setting and to survey the data on tHcy in diagnostics or as screening tests in several target populations.Ideally, guidelines should be established by a multidisciplinary team including all relevant stakeholders, and the recommendations should be according to evidence-based medicine (24 ). There are not sufficient data in the Hcy field, however, to use such an approach. In particular, -32 (2004) Review 3 data from controlled clinical trials are sparse. Neverth...

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Section: Biological Determinantsmentioning

confidence: 99%

Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion

et al. 2004

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“…(6)(7)(8) It is well known that homocystinuria patients are often diagnosed with osteoporosis. (9) High homocysteine (Hcy) levels can be modified by dietary folate, vitamin B 12 , and vitamin B 6 . Both moderate hyperhomocysteinemia and vitamin B 12 deficiency are highly prevalent in old age (10)(11)(12) and may play a role in diseases that are characteristic for old age.…”

Section: Introductionmentioning

confidence: 99%

“…(9) High homocysteine (Hcy) levels can be modified by dietary folate, vitamin B 12 , and vitamin B 6 . Both moderate hyperhomocysteinemia and vitamin B 12 deficiency are highly prevalent in old age (10)(11)(12) and may play a role in diseases that are characteristic for old age. In vivo and in vitro studies support disturbance of crosslinking of collagen in bone by Hcy as a possible explanation.…”

Section: Introductionmentioning

confidence: 99%

Homocysteine and Vitamin B12 Status Relate to Bone Turnover Markers, Broadband Ultrasound Attenuation, and Fractures in Healthy Elderly People

Dhonukshe-Rutten

Pluijm²,

Groot

et al. 2005

Journal of Bone and Mineral Research

194

127

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Hyperhomocysteinemia may contribute to the development of osteoporosis. The relationship of Hcy and vitamin B 12 with bone turnover markers, BUA, and fracture incidence was studied in 1267 subjects of the Longitudinal Aging Study Amsterdam. High Hcy and low vitamin B 12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.Introduction: Hyperhomocysteinemia may contribute to the development of osteoporosis. Vitamin B 12 is closely correlated to homocysteine (Hcy). The main objective of our study was to examine the association of Hcy and vitamin B 12 status and the combined effect of these two with broadband ultrasound attenuation (BUA), bone turnover markers, and fracture. Materials and Methods: Subjects were 615 men and 652 women with a mean age of 76 ± 6.6 (SD) years of the Longitudinal Aging Study Amsterdam (LASA). At baseline (1995/1996), blood samples were taken after an overnight fast for dairy products. Plasma Hcy was measured with IMx, serum vitamin B 12 with competitive immunoassay (IA) luminescence, serum osteocalcin (OC) with immunoradiometric assay (IRMA), and urinary excretion of deoxypyridinoline (DPD) with competitive IA and corrected for creatinine (Cr) concentration. CVs were 4%, 5%, 8%, and 5%, respectively. BUA was assessed in the heel bone twice in both the right and left calcaneus. Mean BUA value was calculated from these four measurements. CV was 3.4%. After baseline measurements in 1995, a 3-year prospective follow-up of fractures was carried out until 1998/1999. Subjects were grouped by using two different approaches on the basis of their vitamin B 12 concentration, normal versus low (<200 pM) or lowest quartile (Q1) versus normal quartiles (Q2-Q4), and Hcy concentration, normal versus high (>15 M) or highest quartile (Q4) versus normal quartiles (Q1-Q3). Analysis of covariance was performed to calculate mean values of BUA, OC, and DPD/Cr urine based on the specified categories of Hcy and vitamin B 12 and adjusted for several confounders (potential confounders were age, sex, body weight, body height, current smoking [yes/no], mobility, cognition). The relative risk (RR) of any fracture was assessed with Cox regression analysis. Quartiles were used when Hcy and vitamin B 12 were separately studied in their relationship with fracture incidence. Results: Fourteen percent of the men and 9% of the women had high Hcy (>15 M) and low vitamin B 12 (<200 pM) concentrations. Women with vitamin B 12 levels <200 pM and Hcy concentrations >15 M had lower BUA, higher DPD/Cr, and higher OC concentrations than their counterparts. In men, no differences were found between the different Hcy and vitamin B 12 categories in adjusted means of BUA, OC, or DPD/ Cr urine . Twenty-eight men and 43 women sustained a fracture during the 3-year follow-up period. The adjusted RR for fractures (95% CI) for men with high Hcy and/or low vitamin B 12 concentrations was 3.8 (1.2-11.6) compared with men with normal Hcy and vitamin B 12 concentrations....

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“…States of vitamin B12 deficiency and malabsorption were reported with increasing age > 70 years, [24,26 ] and severe cases hypothyroidism [27]. However, in our case mix, we excluded those older than 65 years and clinical cases of hypothyroidism.…”

Section: Resultsmentioning

confidence: 99%

The Role of Metformin on Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus

Niafar¹,

Jamali²,

Lotfibakhshaiesh³

et al. 2015

Eur Res J

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U n c o r r e c t e d P r o o f ABSTRACTObjectives. To evaluate the vitamin B12 (VB12) deficiency in patients with type 2 diabetes mellitus (DM-2) using metformin or other hypoglycemic agents. Methods. 400 patients with DM-2 were divided into two arms (N = 200/group); 1) those receiving metformin (MET) for at least six months and 2) those receiving hypoglycemic agents other than metformin (OHA). Serum VB12 concentrations were measured. Data were analyzed by using two-sample t-test for numerical data and chi-square with logistic regression analysis for categorical data. Numerical values were expressed as means ± standard deviations. Null hypotheses were rejected at P < 0.05. Results. Definite biochemical VB12 deficiency (<148 pmol/L) was found in 29/200 (14.5%) of the MET group while it was observed in 4/200 (2%) in the OHA group (P < 0.001). Similarly, possible VB12 deficiency (serum concentrations <185 pmol/L) was found in 39 (19.2%) of the MET group and 12 (6%) in the OHA group (P < 0.001). There was positive correlation between low VB12 level and metformin administration (R2 = 0.26, P < 0.001). Conclusions. Patients with DM-2 on metformin had lower VB12 levels than those on other hypoglycemic drugs. The relation between VB12 deficiency and metformin therapy indicates the need for periodic measurement of serum VB12 levels in patients treated with metformin.

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Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services

Abstract: Vitamin B-12 deficiency was prevalent and was associated with poor cognition, anemia, and hyperhomocysteinemia.

Cited by 94 publications

References 43 publications

Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion

Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion

Homocysteine and Vitamin B12 Status Relate to Bone Turnover Markers, Broadband Ultrasound Attenuation, and Fractures in Healthy Elderly People

The Role of Metformin on Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus

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