Prospective evaluation of protein bound vitamin B₁₂(cobalamin) malabsorption in the elderly using trout flesh labelled in vivo with ⁵⁷Co-cobalamin

Abstract

Background-The frequency of dietary protein bound vitamin B 12 malabsorption in elderly patients remains controversial. Aims-To evaluate this malabsorption in elderly hospitalised patients using a modified Schilling test. Patients-Fourteen elderly patients with low B 12 blood levels were prospectively selected from 394 hospitalised patients. Methods-The modified Schilling test was performed with trout labelled in vivo.Results-The test was normal in five healthy elderly subjects, in 7/8 patients with pancreatic insuYciency, and in nine non-elderly patients with antral gastritis. The low decision limit was established at 3.3% (median 4.8%). From the 14 elderly patients with low B 12 prospectively selected from 394 hospitalised patients, seven had a real deficiency with anaemia and an increased homocysteine and/or methylmalonate serum level. The modified Schilling test showed malabsorption in five of these patients, including two in which the standard Schilling test was normal, and three in which the standard Schilling test was partially corrected by an intrinsic factor. Conclusions-Protein bound vitamin B 12 malabsorption was detected in at least 0.5% of elderly hospitalised patients, using the labelled trout flesh absorption test. (Gut 1997; 41: 475-479)

Concentrations of Plasma Methylmalonic Acid in 80-Year-Olds Show Only Weak Relation to Psychological Performance

“…In 9 subjects, the increased concentration of plasma methylmalonic acid could probably be attributed to a marginal tissue deficiency of cobalamin since these subjects also had a decreased concentration of serum cobalamin and/or an elevated concentration of plasma homocysteine. Only a few of these subjects had proven pernicious anaemia; the rest may have various degrees of cobalamin malabsorption due to atrophic gastritis or intestinal pathology (14)(15)(16)(24)(25)(26). These findings are in agreement with earlier studies (14-16, 24, 25).…”

Helicobacter pylori serologic status has no influence on the association between fucosyltransferase 2 polymorphism (FUT2 461 G→A) and vitamin B-12 in Europe and West Africa

“…During the gastric phase of vitamin B-12 absorption, the low pH of the stomach and the peptic acid digestion of food proteinbound cobalamin are necessary for the release of cobalamin (18)(19)(20). H. pylori-induced chronic atrophic gastritis may cause a disturbance of acid/peptic secretion, which can in turn cause food-cobalamin malabsorption (20,21).…”

Malabsorption Syndromes

“…Thus, new tests using cobalamin bound to protein such as eggs or to chicken serum have been developed to gain accuracy in this common cause of cobalamin deficiency [165,166]. In addition, another interesting modified Schilling test was reported by Aimone-Gastin et al [167], who succesfully performed a labelled trout flesh absorption test. Measurement of serum metabolite concentrations were also proposed as a sensitive index of significant cobalamin deficiency and its usefulness in indicating recovery after cobalamin administration was demonstrated.…”