Vitamin B12 and folate deficiency in later life

Clarke, Robert; Evans, John Grimley; Schneede, Joern; Nexø, Ebba; Bates, CJ; Fletcher, Astrid; Prentice, Ann; Johnston, Carole; Ueland, Per Magne; Refsum, Helga; Sherliker, Paul; Birks, Jacqueline; Whitlock, Gary; Breeze, Elizabeth; Scott, John M.

doi:10.1093/ageing/afg109

Cited by 284 publications

(182 citation statements)

References 20 publications

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“…We reviewed serum vitamin B-12 concentrations to determine the sufficiency using cutoff values of ,148 pmol/L (21-24), 200 pmol/L (25)(26)(27), and 258 pmol/L (7,28,29). We also used vitamin B-12 status based on the cutoffs that Stabler et al (30) originally proposed and that we modified for this analysis.…”

Section: Biochemical Methodsmentioning

confidence: 99%

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Bailey¹,

Carmel²,

Green³

et al. 2011

The American Journal of Clinical Nutrition

130

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Background: Various definitions, criteria, tests, and cutoffs have been used to define vitamin B-12 status; however, a need exists for the systematic study of vitamin B-12 status in the United States because of concerns about high folic acid intakes and the potential for associated adverse effects. Objective: The objective was to determine the effect of different cutoff choices on outcomes and of the different degrees of serum vitamin B-12 status, definable by the concurrent use of a functional and circulating marker as the first steps to developing a data-based consensus on the biochemical diagnosis of vitamin B-12 deficiency. Design: Data from NHANES, a nationally representative crosssectional survey, were examined for adults aged .19 y (mean 6 SD age: 45 6 1 y) from 1999 to 2004 (n = 12,612). Results: Commonly used cutoffs had a greater effect on prevalence estimates of low vitamin B-12 status with the use of vitamin B-12 than with the use of methylmalonic acid (MMA; 3-26% and 2-6%, respectively). A cutoff of .148 pmol/L for vitamin B-12 and of 210 nmol/L for MMA resulted in significant misclassifications. Approximately 1% of adults had a clear vitamin B-12 deficiency (low vitamin B-12 and elevated MMA); 92% of adults had adequate vitamin B-12 status. A high percentage of younger women characterized the group with low vitamin B-12 and normal MMA (2% of adults) and may have falsely reflected low vitamin B-12. Adults with elevated MMA (5%) only were demographically similar (ie, by age and race) to the deficient group and may have included some individuals with early vitamin B-12 deficiency. Conclusions: These analyses indicate the challenges of assessing vitamin B-12 status when uncertainties exist about the appropriate cutoffs. Future studies should determine definable endpoints to achieve this goal.Am J Clin Nutr 2011;94:552-61.

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Section: Biochemical Methodsmentioning

confidence: 99%

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Bailey¹,

Carmel²,

Green³

et al. 2011

The American Journal of Clinical Nutrition

130

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“…Vitamin B 12 deficiency chiefly occurs in the elderly, in whom it is predominantly the result of malabsorption caused by lack of intrinsic factor (pernicious anaemia), gastric atrophy or ileal disease (24)(25)(26)(27) . Age-independent causes include inadequate intake (e.g.…”

Section: Vitamin B 12mentioning

confidence: 99%

“…Deficiency of vitamin B 12 results in an accumulation of blood concentrations of Hcy and methylmalonic acid (24) . Low serum vitamin B 12 concentrations have been reported in about 10% of older adults and the prevalence increases with age from about 5% at age 65 years to 20% at age 85 years (19,25) . In older adults individuals presenting with low vitamin B 12 concentrations rarely have the classical features of macrocytic anaemia and neuropathy.…”

Section: Vitamin B 12mentioning

confidence: 99%

B-vitamins and prevention of dementia

Clarke

2008

Proc. Nutr. Soc.

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Elevated plasma homocysteine (Hcy) concentrations have been implicated with risk of cognitive impairment and dementia, but it is unclear whether low vitamin B 12 or folate status is responsible for cognitive decline. Most studies reporting associations between cognitive function and Hcy or B-vitamins have used a cross-sectional or case-control design and have been unable to exclude the possibility that such associations are a result of the disease rather than being causal. The Hcy hypothesis of dementia has attracted considerable interest, as Hcy can be easily lowered by folic acid and vitamin B 12 , raising the prospect that B-vitamin supplementation could lower the risk of dementia. While some trials assessing effects on cognitive function have used folic acid alone, vitamin B 12 alone or a combination, few trials have included a sufficient number of participants to provide reliable evidence. An individualpatient-data meta-analysis of all randomised trials of the effects on cognitive function and vascular risk of lowering Hcy with B-vitamins will maximise the power to assess the epidemiologically-predicted differences in risk. Among the twelve large randomised Hcy-lowering trials for prevention of vascular disease, data should be available on about 30 000 participants with cognitive function. The principal investigators of such trials have agreed to combine individual-participant data from their trials after their separate publication.Folate: Vitamin B 12 : Homocysteine: Dementia

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“…Even worse, among the elderly, a large percentage has a biochemical vitamin B deficiency (Clarke et al, 2004). There are three ways to improve the B-vitamin status in the population: increasing the intake of B-vitamin-rich foods, of supplements and of fortified foods.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, folate and vitamin B 12 deficiencies are relatively common in the elderly (Clarke et al, 2004). There are three ways to increase the intake of B-vitamins: increasing the intake of B-vitaminrich foods, supplements and fortified foods.…”

Section: Introductionmentioning

confidence: 99%

Effect of fortified spread on homocysteine concentration in apparently healthy volunteers

Vliet

Jacobs²,

Deckere

et al. 2006

Eur J Clin Nutr

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Objective: To determine the effect of folic acid, vitamin B 6 and B 12 fortified spreads on the blood concentrations of these vitamins and homocysteine. Design and setting: A 6-week randomized, double-blinded, placebo-controlled, parallel trial carried out in a clinical research center. Subjects: One hundred and fifty healthy volunteers (50% males). Interventions: For 6 weeks, the subjects consumed the test spreads (20 g/day): containing per 20 g (1) 200 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 , or (2) 400 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 or (3) no B-vitamins (control spread). Results: The B-vitamin status increased on using the test spreads, with the largest effect on the serum folate concentration: 48% in men and 58% in women on spread 1 and 92 and 146%, respectively, on spread 2 (P-values all o0.05). The plasma homocysteine decreased in the groups treated with the fortified spreads as compared to the control group. Average decreases were for males: 0.771.5 mmol/l (6.8%) on spread 1 and 1.771.7 mmol/l (17.6%) on spread 2 and for females: 1.471.2 mmol/l (14.2%) and 2.472.0 mmol/l (23.3%), respectively (P-values all o0.05). Conclusions: Consumption of a spread fortified with folic acid, vitamin B 6 and vitamin B 12 for 6 weeks significantly increases the blood concentrations of these vitamins and significantly decreases the plasma concentration of homocysteine. Fortified staple foods like spreads can contribute to the lowering of homocysteine concentrations.

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Vitamin B12 and folate deficiency in later life

Abstract: the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.

Cited by 284 publications

References 20 publications

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

B-vitamins and prevention of dementia

Effect of fortified spread on homocysteine concentration in apparently healthy volunteers

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