The Leiden 85-Plus Study
“Vitamin B12 and folate and the risk of anemia in old age”
Department of Public Health and Primary Care, Leiden University Medical Center, Post Zone V-0-P, PO Box 9600 2300 RC Leiden The Netherlands.
BACKGROUND — Screening for deficiencies in vitamin B(12) and folate is advocated to prevent anemia in very elderly individuals. However, the effects of vitamin B(12) and folate deficiency on the development of anemia in old age have not yet been established.
METHODS — The current study is embedded in the Leiden 85-Plus Study, a population-based prospective study of subjects aged 85 years.
- Levels of vitamin B(12), folate, and homocysteine were determined at baseline.
- Hemoglobin levels and mean corpuscular volume (MCV) were determined annually during 5 years of follow-up. RESULTS:
- We analyzed data from 423 subjects who did not use any form of cyanocobalamin, hydroxocobalamin, or folic acid supplementation, neither at baseline nor during follow-up.
- Folate deficiency (<7 nmol/L; n = 34) and elevated homocysteine levels (>13.5 mumol/L; n = 194) were associated with anemia at baseline (adjusted odds ratio [OR], 2.44; 95% confidence interval [CI], 1.06-5.61; and adjusted OR, 1.82;95% CI, 1.08-3.06, respectively), but vitamin B(12) deficiency (<150 pmol/L; n = 68) was not (adjusted OR, 1.51; 95% CI, 0.79-2.87).
- Furthermore, vitamin B(12) deficiency was not associated with the development of anemia during follow-up (adjusted HR, 0.92; 95% CI, 0.46-1.82) or with changes in MCV (adjusted linear mixed model; P = .77).
- Both folate deficiency and elevated homocysteine levels were associated with the development of anemia from age 85 years onward (adjusted HR, 3.33; 95% CI, 1.55-7.14; and adjusted HR, 1.70; 95% CI, 1.01-2.88, respectively), but not with an increase in MCV over time (P > .30).
CONCLUSION — In the general population of very elderly individuals, anemia in 85-year-old subjects is associated with folate deficiency and elevated homocysteine levels but not with vitamin B(12) deficiency.
Recent Publications on Vitamin B 12 Deficiency you can find on http://www.bioportfolio.com/indepth/Vitamin_B_12_Deficiency.html
NOTE — The absence of vitamin B12 deficiency gives rise to question “can absorption of enough of the combination B12. B9, B6 lower the presence of elevated homocysteine levels” as is established that the presence of too much homocysteine can produce negative cardio-vasculair conditions. And what about the presence of Methylmalonic acid.
Because — Increased methylmalonic acid levels may indicate a vitamin B12 deficiency. However, it is sensitive without being specific. MMA is elevated in 90-98% of patients with B12 deficiency. This test may be overly sensitive, as 25-20% of patients over the age of 70 have elevated levels of MMA, but 25-33% of them do not have B12 deficiency. For this reason, MMA is not routinely recommended in the elderly.