Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes – a population‐based study

Abstract

Abstract. Bjo Èrkegren K, Sva Èrdsudd K (Uppsala University, University Hospital, Uppsala and Skutska Èr Primary Health Care Centre, Skutska Èr, Sweden). Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue de®ciency markers amongst elderly Swedes. A population-based study. J Intern Med 2001; 249: 423±432.Objectives. The possibilities of detecting tissue cobalamin and folate de®ciency are under debate. In this report the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) and their interrelations in a representative random population sample are presented. Design. Cohort study. Setting. A general mid-Swedish population. Subjects. A 20% random sample of persons 70 years or older in a de®ned geographical area were invited to a survey. A total of 235 (85%) persons responded, out of whom 224 had no interfering diseases. Main outcome measures. Serum cobalamin, folate, MMA and tHcy. Results. The serum levels of cobalamin, folate, MMA and tHcy were all correlated to cobalamin and folic acid treatment. They were also correlated to the intake of multivitamin preparations. In addition, serum cobalamin was higher in untreated women than in men but not correlated to age. Serum folate was correlated neither to sex nor age. Serum tHcy and MMA were both directly correlated to age but MMA not to sex. MMA was inversely correlated to serum cobalamin but not to serum folate, whereas serum tHcy was inversely correlated to serum cobalamin, folate and creatinine. Neither serum cobalamin, folate, MMA nor tHcy had any signi®cant correlation to haemoglobin, erythrocyte volume fraction (EVF) or mean red cell volume. Half of the study population had abnormal MMA or tHcy levels, suggesting a latent or overt tissue de®ciency of cobalamin or folate. Conclusions. A substantial proportion of the elderly general population had signs of low tissue levels of cobalamin or folate. Amongst those who took multivitamin preparations this proportion was much lower.

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

“…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).…”

Early Biochemical and Hematological Response to Intramuscular Cyanocobalamin Therapy in Vitamin B₁₂-Deficient Patients

“…In some earlier studies, the objective has been to determine the effect of cobalamin therapy on p-tHcy and s-MMA concentrations [36,37]. However, data on p-tCys measurements are scarce in this group of patients.…”

Homocysteine measurements in geriatric patients

“…However, a positive correlation was observed between tHcy and S-vitamin B 12 , while no correlation between tHcy and B-folate was found. S-methylmalonic acid, which was not measured in this study, is another valid indicator of vitamin B 12 deficiency, though not of folate deficiency [23], and would therefore not have contributed in the diagnosis of this deficiency state. In the light of the absence of a correlation between tHcy and B-folate, the question remains whether S-folate is preferable in the diagnostics of folate deficiency in geriatric patients.…”