scholarly journals COBALAMIN DEFICIENCY IN THE ELDERLY

2020 ◽  
Vol 12 (1) ◽  
pp. e2020043 ◽  
Author(s):  
Giacomo Marchi ◽  
Fabiana Busti ◽  
Acaynne Lira Zidanes ◽  
Alice Vianello ◽  
Domenico Girelli
Keyword(s):  
Vitamin B12 ◽  
Early Recognition ◽  
Bone Marrow Failure ◽  
Oral Treatment ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Cobalamin Deficiency ◽  
High Dose

Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g. autoimmune gastritis) and drugs (e.g. antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting particularly elevated in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple and requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathies. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available and may be influenced by some confounders (e.g. folate deficiency, or chronic renal failure). Early recognition and treatment are crucial, since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.

scholarly journals Pernicious Anaemia: Mechanisms, Diagnosis, and Management

2020 ◽  
pp. 71-80
Author(s):  
Wafa Ammouri ◽  
Hicham Harmouche ◽  
Hajar Khibri ◽  
Souad Benkirane ◽  
Masrar Azlarab ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Bone Marrow Failure ◽  
Intrinsic Factor ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Pernicious Anaemia ◽  
Chronic Inflammatory Disease ◽  
Cobalamin Deficiency ◽  
Dietary Vitamin ◽  
Diagnostic Tools

Pernicious anaemia (PA) is an autoimmune disease of multifactorial aetiology involving environmental and immunological factors. It is the most common cause of cobalamin deficiency anaemia worldwide. The disease is a macrocytic anaemia caused by a vitamin B12 deficiency, which, in turn, is the result of intrinsic factor deficiency, a protein that binds avidly to dietary vitamin B12 and promotes its transport to the terminal ileum for absorption. Despite the advances in understanding the pathogenesis and molecular biology, diagnosis of PA is still challenging for clinicians because of its complexity, diverse clinical presentations, and the limitations of the available diagnostic tools for the evaluation of cobalamin status and the presence of chronic autoimmune atrophic gastritis. Asymptomatic autoimmune gastritis, a chronic inflammatory disease of the gastric mucosa, precedes the onset of corpus atrophy by 10–20 years. Diagnostic dilemmas could occur when patients with PA present with spuriously normal or high cobalamin levels, normocytic or microcytic anaemia, nonanaemic macrocytosis, autoimmune haemolytic anaemia, pseudo-thrombotic microangiopathy, hyperhomocysteinemia-associated thromboembolism, pseudoleukemia, bone marrow failure, and neurologic manifestations without anaemia or macrocytosis. Other autoimmune disorders, especially thyroid disease, Type 1 diabetes mellitus, and vitiligo, are also commonly associated with PA. The present review focusses on novel aspects regarding the pathogenesis, clinical presentation, and the diagnostic approach of PA; the true usefulness of serum vitamin B12 levels; and the risk of adenocarcinoma and gastric carcinoids as well as their treatment and monitoring strategies.

scholarly journals State of the art review: oral and nasal vitamin B12 therapy in the elderly

QJM ◽  
2019 ◽  
Vol 113 (1) ◽  
pp. 5-15
Author(s):  
E Andrès ◽  
A -A Zulfiqar ◽  
T Vogel
Keyword(s):  
Elderly Patients ◽  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
The Elderly ◽  
Cochrane Library ◽  
Oral Vitamin ◽  
Hand Search ◽  
Noticeable Improvement ◽  
Google Search

Summary The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by ‘PubMed’ and ‘Scholar Google’ search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the ‘Cochrane Library’ and the ‘ISI Web of Knowledge’. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from ‘CARE B12’ research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

Cognitive impairment and vitamin B12: a review

2012 ◽  
Vol 24 (4) ◽  
pp. 541-556 ◽  
Author(s):  
Eileen Moore ◽  
Alastair Mander ◽  
David Ames ◽  
Ross Carne ◽  
Kerrie Sanders ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Vitamin B12 ◽  
Neurodegenerative Disease ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Small Subset ◽  
High Dose ◽  
Serum Homocysteine ◽  
B12 Deficiency ◽  
Potential Impact

ABSTRACTBackground: This review examines the associations between low vitamin B12 levels, neurodegenerative disease, and cognitive impairment. The potential impact of comorbidities and medications associated with vitamin B12 derangements were also investigated. In addition, we reviewed the evidence as to whether vitamin B12 therapy is efficacious for cognitive impairment and dementia.Methods: A systematic literature search identified 43 studies investigating the association of vitamin B12 and cognitive impairment or dementia. Seventeen studies reported on the efficacy of vitamin B12 therapy for these conditions.Results: Vitamin B12 levels in the subclinical low-normal range (<250 ρmol/L) are associated with Alzheimer's disease, vascular dementia, and Parkinson's disease. Vegetarianism and metformin use contribute to depressed vitamin B12 levels and may independently increase the risk for cognitive impairment. Vitamin B12 deficiency (<150 ρmol/L) is associated with cognitive impairment. Vitamin B12 supplements administered orally or parenterally at high dose (1 mg daily) were effective in correcting biochemical deficiency, but improved cognition only in patients with pre-existing vitamin B12 deficiency (serum vitamin B12 levels <150 ρmol/L or serum homocysteine levels >19.9 μmol/L).Conclusion: Low serum vitamin B12 levels are associated with neurodegenerative disease and cognitive impairment. There is a small subset of dementias that are reversible with vitamin B12 therapy and this treatment is inexpensive and safe. Vitamin B12 therapy does not improve cognition in patients without pre-existing deficiency. There is a need for large, well-resourced clinical trials to close the gaps in our current understanding of the nature of the associations of vitamin B12 insufficiency and neurodegenerative disease.

scholarly journals Study of vitamin B12 status and the consequential clinico-hematological profile in healthy vegetarian population in Nepal

2017 ◽  
Vol 7 (1) ◽  
pp. 41-46
Author(s):  
Pramod Paudel ◽  
Jagdish Prasad Agrawal ◽  
Santosh Timilsena ◽  
Jyoti Subedi
Keyword(s):  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Hemoglobin Level ◽  
Cobalamin Deficiency ◽  
P Value ◽  
Hematological Profile ◽  
Significant Difference ◽  
B12 Deficiency ◽  
Study Population

Background: A strict vegetarian diet has been associated with an increased risk of vitamin B12 deficiency. Clinical manifestations of cobalamin deficiency are hematologic and neurological symptoms. The purpose of this study was to determine the prevalence of vitamin B12 deficiency in healthy vegetarian population and to study the clinical and hematological profile of vitamin B12 deficient subjects.Methods: A community based cross-sectional observational study was conducted through preplanned camps in Kathmandu Nepal. 166 vegetarian people were investigated for serum vitamin B12 level and their hematological profile was done. They were examined for neurological manifestation of vitamin B12 deficiency.Results: The mean serum vitamin B12 level of the vegetarian in this study was 271.34 ±241.74 pg/ml (mean ± SD)., 53.6 % had serum vitamin B12 deficiency. 56.5 % of male and 47.1 % of female had vitamin B12 deficiency. The risk of vitamin B12 deficiency is more in males than females with odds ratio 1.201 (CI=95%) which is not statistically significant with p-value 0.312. There was no significant difference in vitamin B12 level in different age group.The study population had mean hemoglobin of 13.12 ± 1.72 gm/dl. Anemia was present in 34.9 % of study population. 33.9 % of male and 37.3 % of female had anemia. There was no significant difference in anemia in male and female vegetarian (p-value 0.72). 40% of patient who had vitamin B12 deficiency had anemia.A significant low hemoglobin level and higher MCV were found as level of serum vitamin B12 decreased. Only one patient had macrocytic anemia.There were few symptoms but not specific to vitamin B12 deficiency.Conclusion: The result of present study show that prevalence of vitamin B12 deficiency among healthy vegetarian was 53.6% with higher prevalence in male and elder age group.Prevalence of anemia was 34.9% in this study with elderly group and females being more affected.There was significant correlation between vitamin B12 and hemoglobin level and significant negative correlation with MCV. Although, not significant, leucocytes count, lymphocyte count and platelets were low in vitamin B12 deficient population.Few clinical features were present in vitamin B12 deficient subjects but neurological features specific to vitamin B12 deficiency were not seen.

scholarly journals ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

2018 ◽  
Vol 11 (1) ◽  
pp. 402
Author(s):  
Zaozianlungliu Gonmei ◽  
Supriya Dwivedi ◽  
Gurudayal Singh Toteja ◽  
Karuna Singh ◽  
Naval Kishore Vikram ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Elderly Population ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Serum Homocysteine ◽  
B12 Deficiency ◽  
Prevalence Of Anemia

 Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 μmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency.

scholarly journals Age dependency of plasma vitamin B12 status markers in Dutch children and adolescents

2021 ◽  
Author(s):  
M. Rebecca Heiner-Fokkema ◽  
Ineke J. Riphagen ◽  
Nicole S. Wiersema ◽  
Jelmer J. van Zanden ◽  
Jenny E. Kootstra-Ros ◽  
...  
Keyword(s):  
Young Children ◽  
Vitamin B12 ◽  
Reference Values ◽  
Methylmalonic Acid ◽  
Early Recognition ◽  
Vitamin B12 Deficiency ◽  
Reference Intervals ◽  
Cobalamin Deficiency ◽  
Plasma Vitamin ◽  
B12 Deficiency

Abstract Background Vitamin B12 deficiency in children may be associated with (severe) neurological manifestations, therefore recognition is important. Diagnosing vitamin B12 deficiency in children is challenging. This study aimed to investigate plasma methylmalonic acid, holotranscobalamin, and total cobalamin in children 0–18 years of age and to estimate age-dependent reference intervals. Methods Plasma vitamin B12 markers were measured in collected plasma samples of 170 children 0–18 years visiting a local primary care laboratory. All had within-reference hemoglobin and MCV values. Pediatric plasma vitamin B12 biomarkers were measured and reference values were derived thereof. Results Plasma methylmalonic acid was higher in young children, in particular between 1 and 6 months of age; total cobalamin and holotranscobalamin were highest from 0.5 to 4 years and decreased till 10 years of age. Plasma holotranscobalamin was highly correlated with plasma total cobalamin; their ratio was independent of age. Plasma methylmalonic acid was slightly more related to total cobalamin than to holotranscobalamin. A large proportion of mainly young children would be misclassified when adult references are applied. Conclusions Pediatric reference values for cobalamin markers are necessary to allow for early recognition and monitoring of children suspect of (clinical) cobalamin deficiency. Impact We analyzed three plasma vitamin B12 status markers, i.e., total cobalamin, holotranscobalamin, and methylmalonic acid, in the plasma of 170 children 0–18 years of age and were able to derive reference intervals thereof. Recognition of vitamin B12 deficiency in children is important but challenging as pediatric reference intervals for plasma vitamin B12 status markers, particularly plasma holotranscobalamin, are not well described. We think that our results may help early recognition and monitoring of children suspect of (clinical) vitamin B12 deficiency.

scholarly journals ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

2018 ◽  
Vol 11 (1) ◽  
pp. 402 ◽  
Author(s):  
Zaozianlungliu Gonmei ◽  
Supriya Dwivedi ◽  
Gurudayal Singh Toteja ◽  
Karuna Singh ◽  
Naval Kishore Vikram ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Elderly Population ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Serum Homocysteine ◽  
B12 Deficiency ◽  
Prevalence Of Anemia

 Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 μmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency.

Bioavailability of Vitamin B12

2010 ◽  
Vol 80 (45) ◽  
pp. 330-335 ◽  
Author(s):  
Lindsay Helen Allen
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
The Elderly ◽  
Radioactive Isotopes ◽  
Animal Source Foods ◽  
Dietary Requirements ◽  
In Vivo Labeling ◽  
B12 Deficiency ◽  
Vitamin B12 Malabsorption

Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied to diagnose vitamin B12 malabsorption, including Schilling’s test, which is now used rarely, but these do not quantify percent bioavailability. Most of the information on B12 bioavailability from foods was collected 40 to 50 years ago, using radioactive isotopes of cobalt to label the corrinoid ring. The data are sparse, and the level of radioactivity required for in vivo labeling of animal tissues can be prohibitive. A newer method under development uses a low dose of radioactivity as 14C-labeled B12, with measurement of the isotope excreted in urine and feces by accelerator mass spectrometry. This test has revealed that the unabsorbed vitamin is degraded in the intestine. The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods. This has important implications for the assessment and interpretation of bioavailability values, setting dietary requirements, and interpreting relationships between intake and status of the vitamin.

scholarly journals Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

2018 ◽  
Vol 7 (10) ◽  
pp. 304 ◽  
Author(s):  
Emmanuel Andrès ◽  
Abrar-Ahmad Zulfiqar ◽  
Khalid Serraj ◽  
Thomas Vogel ◽  
Georges Kaltenbach
Keyword(s):  
Vitamin B12 ◽  
Prospective Studies ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Cochrane Library ◽  
Clinical Approach ◽  
Oral Vitamin ◽  
Hand Search ◽  
B12 Deficiency

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

The Danger of B12 Deficiency in the Elderly

1998 ◽  
Vol 12 (4) ◽  
pp. 215-226 ◽  
Author(s):  
Margaret Wynn ◽  
Arthur Wynn
Keyword(s):  
Nervous System ◽  
Risk Factor ◽  
Heart Disease ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Pernicious Anaemia ◽  
The Elderly ◽  
Nerve Cells ◽  
Accelerated Ageing ◽  
B12 Deficiency

Vitamin B12 deficiency damages nerve cells and aggravates nervous system disorders even in the absence of evidence of anaemia. Prevalence of B12 deficiency increases with age especially over 65 and is frequently associated with Alzheimer's disease. Recent American surveys record a higher prevalence of B12 deficiency and of undiagnosed and untreated pernicious anaemia in the elderly than reported earlier. B12 deficiency is also reported to be a risk factor for heart disease, stroke and accelerated ageing.

Sign in / Sign up

Export Citation Format

Share Document