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Cobalamin: a critical vitamin in the elderly.
Prev Med 2004; 39(6):1256-66PM

Abstract

Vitamin B(12) deficiency is a common problem in elderly subjects. If a serum cobalamin level of about 150 pmol/L (200 pg/mL) is considered normal, 10-15% of the elderly are deficient. Today, however, a threshold of 220-258 pmol/L (300-350 pg/mL) is recognized as desirable in the elderly, or else sensitive markers like the blood concentration of homocysteine or methylmalonic acid (MMA) are used. Then the prevalence of cobalamin deficiency rises to up to 43%. In the elderly, this high prevalence of poor cobalamin status is predominantly caused by atrophic gastritis type B. Atrophic gastritis results in declining gastric acid and pepsinogen secretion, and hence decreasing intestinal absorption of the cobalamin protein complexes from food. About 20-50% of the elderly are affected. Furthermore, the reduced acid secretion leads to an alkalinization of the small intestine, which may result in bacterial overgrowth and thus to a further decrease of the bioavailability of the vitamin. In addition, some drugs such as proton pump inhibitors or H2 receptor antagonists inhibit the intestinal absorption of vitamin B(12). An already moderately reduced vitamin B(12) level is associated with vascular disease and neurocognitive disorders such as depression and impaired cognitive performance. Furthermore, a poor vitamin B(12) status is assumed to be involved in the development and progression of dementia (e.g., Alzheimer's dementia). This is especially observable if the folic acid status is reduced as well. Due to the insecure supply, the cobalamin status of elderly persons (>/=60 years) should be regularly controlled and a general supplementation with vitamin B(12) (>50 microg/day) should be considered.

Authors+Show Affiliations

Nutrition Physiology and Human Nutrition Unit, Department of Food Science, Centre of Applied Chemistry, University of Hanover, D-30453 Hannover, Germany. maike.wolters@lw.uni-hannover.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15539065

Citation

Wolters, Maike, et al. "Cobalamin: a Critical Vitamin in the Elderly." Preventive Medicine, vol. 39, no. 6, 2004, pp. 1256-66.
Wolters M, Ströhle A, Hahn A. Cobalamin: a critical vitamin in the elderly. Prev Med. 2004;39(6):1256-66.
Wolters, M., Ströhle, A., & Hahn, A. (2004). Cobalamin: a critical vitamin in the elderly. Preventive Medicine, 39(6), pp. 1256-66.
Wolters M, Ströhle A, Hahn A. Cobalamin: a Critical Vitamin in the Elderly. Prev Med. 2004;39(6):1256-66. PubMed PMID: 15539065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cobalamin: a critical vitamin in the elderly. AU - Wolters,Maike, AU - Ströhle,Alexander, AU - Hahn,Andreas, PY - 2004/11/13/pubmed PY - 2005/5/20/medline PY - 2004/11/13/entrez SP - 1256 EP - 66 JF - Preventive medicine JO - Prev Med VL - 39 IS - 6 N2 - Vitamin B(12) deficiency is a common problem in elderly subjects. If a serum cobalamin level of about 150 pmol/L (200 pg/mL) is considered normal, 10-15% of the elderly are deficient. Today, however, a threshold of 220-258 pmol/L (300-350 pg/mL) is recognized as desirable in the elderly, or else sensitive markers like the blood concentration of homocysteine or methylmalonic acid (MMA) are used. Then the prevalence of cobalamin deficiency rises to up to 43%. In the elderly, this high prevalence of poor cobalamin status is predominantly caused by atrophic gastritis type B. Atrophic gastritis results in declining gastric acid and pepsinogen secretion, and hence decreasing intestinal absorption of the cobalamin protein complexes from food. About 20-50% of the elderly are affected. Furthermore, the reduced acid secretion leads to an alkalinization of the small intestine, which may result in bacterial overgrowth and thus to a further decrease of the bioavailability of the vitamin. In addition, some drugs such as proton pump inhibitors or H2 receptor antagonists inhibit the intestinal absorption of vitamin B(12). An already moderately reduced vitamin B(12) level is associated with vascular disease and neurocognitive disorders such as depression and impaired cognitive performance. Furthermore, a poor vitamin B(12) status is assumed to be involved in the development and progression of dementia (e.g., Alzheimer's dementia). This is especially observable if the folic acid status is reduced as well. Due to the insecure supply, the cobalamin status of elderly persons (>/=60 years) should be regularly controlled and a general supplementation with vitamin B(12) (>50 microg/day) should be considered. SN - 0091-7435 UR - https://www.unboundmedicine.com/medline/citation/15539065/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091743504002361 DB - PRIME DP - Unbound Medicine ER -