American Journal of Clinical Nutrition, Vol 68, 328-334, Copyright © 1998 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

Role of cobalamin intake and atrophic gastritis in mild cobalamin deficiency in older Dutch subjects

DZ van Asselt, LC de Groot, WA van Staveren, HJ Blom, RA Wevers, I Biemond and WH Hoefnagels
Department of Geriatric Medicine, University Hospital Nijmegen, The Netherlands. D.vanAsselt@czzoger.azn.nl

BACKGROUND: The reason for the high prevalence of mild cobalamin (vitamin B-12) deficiency in the elderly is poorly understood. OBJECTIVE: We aimed to determine the reason for this high prevalence. DESIGN: We examined cobalamin intake, the presence and severity of atrophic gastritis, the presence of Helicobacter pylori infection, and plasma cobalamin and methylmalonic acid (MMA) concentrations in 105 healthy, free-living, older subjects aged 74-80 y. RESULTS: Mild cobalamin deficiency, ie, low to low-normal plasma cobalamin concentrations (< 260 pmol/L) and elevated plasma MMA concentrations (> 0.32 micromol/L), were found in 23.8% of subjects; 25.7% of subjects were not cobalamin deficient (plasma cobalamin > or = 260 pmol/L and plasma MMA < or = 0.32 micromol/L). Six subjects (5.8%), including 1 with mild cobalamin deficiency, had dietary cobalamin intakes below the Dutch recommended dietary intake of 2.5 microg/d. Mildly cobalamin- deficient subjects had lower total (diet plus supplements) cobalamin intakes (median: 4.9 microg/d; 25th and 75th percentiles: 3.9, 6.4) than did non-cobalamin-deficient subjects (median: 6.3 microg/d; 25th and 75th percentiles: 5.4, 7.9) (P = 0.0336), mainly because of less frequent use of cobalamin supplements (8% compared with 29.6%; chi2 = 3.9, P = 0.048). Atrophic gastritis was found in 32.4% of the total study group: mild to moderate in 19.6% and severe in 12.7%. The prevalence of severe atrophic gastritis, but not mild-to-moderate atrophic gastritis, was higher in mildly cobalamin-deficient subjects (25%) than in non-cobalamin-deficient subjects (3.7%) (chi2 = 4.6, P = 0.032). The prevalence of immunoglobulin G antibodies to H. pylori was similar in mildly cobalamin-deficient subjects (54.2%) and in non- cobalamin-deficient subjects (44.4%) (chi2 = 0.5, P = 0.5). CONCLUSIONS: The high prevalence of mild cobalamin deficiency in healthy, free-living, older Dutch subjects could be explained by inadequate cobalamin intake or severe atrophic gastritis in only 28% of the study population. Other mechanisms explaining mild cobalamin deficiency in older people must be sought.

This article has been cited by other articles:

				R. Carmel The Disappearance of Cobalamin Absorption Testing: A Critical Diagnostic Loss J. Nutr., November 1, 2007; 137(11): 2481 - 2484. [Full Text] [PDF]

				K. F Wyckoff and V. Ganji Proportion of individuals with low serum vitamin B-12 concentrations without macrocytosis is higher in the post folic acid fortification period than in the pre folic acid fortification period Am. J. Clinical Nutrition, October 1, 2007; 86(4): 1187 - 1192. [Abstract] [Full Text] [PDF]

				A. de Bree, L. A van Mierlo, and R. Draijer Folic acid improves vascular reactivity in humans: a meta-analysis of randomized controlled trials Am. J. Clinical Nutrition, September 1, 2007; 86(3): 610 - 617. [Abstract] [Full Text] [PDF]

				L. Hao, J. Ma, J. Zhu, M. J. Stampfer, Y. Tian, W. C. Willett, and Z. Li Vitamin B-12 Deficiency Is Prevalent in 35- to 64-Year-Old Chinese Adults J. Nutr., May 1, 2007; 137(5): 1278 - 1285. [Abstract] [Full Text] [PDF]

				V. Ganji and M. R Kafai Population reference values for plasma total homocysteine concentrations in US adults after the fortification of cereals with folic acid. Am. J. Clinical Nutrition, November 1, 2006; 84(5): 989 - 994. [Abstract] [Full Text] [PDF]

				M. N. Weck and H. Brenner Prevalence of Chronic Atrophic Gastritis in Different Parts of the World. Cancer Epidemiol. Biomarkers Prev., June 1, 2006; 15(6): 1083 - 1094. [Abstract] [Full Text] [PDF]

				M. V. Bor, E. Lydeking-Olsen, J. Moller, and E. Nexo A daily intake of approximately 6 {micro}g vitamin B-12 appears to saturate all the vitamin B-12-related variables in Danish postmenopausal women Am. J. Clinical Nutrition, January 1, 2006; 83(1): 52 - 58. [Abstract] [Full Text] [PDF]

				R. A. Dhonukshe-Rutten, M. van Zutphen, L. C. de Groot, S. J. Eussen, H. J Blom, and W. A van Staveren Effect of supplementation with cobalamin carried either by a milk product or a capsule in mildly cobalamin-deficient elderly Dutch persons Am. J. Clinical Nutrition, September 1, 2005; 82(3): 568 - 574. [Abstract] [Full Text] [PDF]

				T. M. Scott, K. L. Tucker, A. Bhadelia, B. Benjamin, S. Patz, R. Bhadelia, E. Liebson, L. L. Price, J. Griffith, I. Rosenberg, et al. Homocysteine and B Vitamins Relate to Brain Volume and White-Matter Changes in Geriatric Patients With Psychiatric Disorders Am J Geriatr Psychiatry, December 1, 2004; 12(6): 631 - 638. [Abstract] [Full Text] [PDF]

				L. C. P. M. G. de Groot, M. W. Verheijden, S. de Henauw, M. Schroll, W. A. van Staveren, and for the SENECA Investigators Lifestyle, Nutritional Status, Health, and Mortality in Elderly People Across Europe: A Review of the Longitudinal Results of the SENECA Study J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2004; 59(12): 1277 - 1284. [Abstract] [Full Text] [PDF]

				K. L Tucker, B. Olson, P. Bakun, G. E Dallal, J. Selhub, and I. H Rosenberg Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial Am. J. Clinical Nutrition, May 1, 2004; 79(5): 805 - 811. [Abstract] [Full Text] [PDF]

				A. K. Campbell, J. W. Miller, R. Green, M. N. Haan, and L. H. Allen Plasma Vitamin B-12 Concentrations in an Elderly Latino Population Are Predicted by Serum Gastrin Concentrations and Crystalline Vitamin B-12 Intake J. Nutr., September 1, 2003; 133(9): 2770 - 2776. [Abstract] [Full Text] [PDF]

				R. Carmel Mild Transcobalamin I (Haptocorrin) Deficiency and Low Serum Cobalamin Concentrations Clin. Chem., August 1, 2003; 49(8): 1367 - 1374. [Abstract] [Full Text] [PDF]

				V. Ganji and M. R Kafai Demographic, health, lifestyle, and blood vitamin determinants of serum total homocysteine concentrations in the third National Health and Nutrition Examination Survey, 1988-1994 Am. J. Clinical Nutrition, April 1, 2003; 77(4): 826 - 833. [Abstract] [Full Text] [PDF]

				A. de Bree, W. M. Verschuren, A.-L. Bjorke-Monsen, N. M. van der Put, S. G Heil, F. J. Trijbels, and H. J Blom Effect of the methylenetetrahydrofolate reductase 677C->T mutation on the relations among folate intake and plasma folate and homocysteine concentrations in a general population sample Am. J. Clinical Nutrition, March 1, 2003; 77(3): 687 - 693. [Abstract] [Full Text] [PDF]

				R. Carmel, R. Green, D. S. Rosenblatt, and D. Watkins Update on Cobalamin, Folate, and Homocysteine Hematology, January 1, 2003; 2003(1): 62 - 81. [Abstract] [Full Text] [PDF]

				A. De Bree, W. M. M. Verschuren, D. Kromhout, L. A. J. Kluijtmans, and H. J. Blom Homocysteine Determinants and the Evidence to What Extent Homocysteine Determines the Risk of Coronary Heart Disease Pharmacol. Rev., December 1, 2002; 54(4): 599 - 618. [Abstract] [Full Text] [PDF]

				L. L. Kwan, O. I. Bermudez, and K. L. Tucker Low Vitamin B-12 Intake and Status Are More Prevalent in Hispanic Older Adults of Caribbean Origin Than in Neighborhood-Matched Non-Hispanic Whites J. Nutr., July 1, 2002; 132(7): 2059 - 2064. [Abstract] [Full Text] [PDF]

				M J M Chin A Paw, N de Jong, E G Schouten, W A van Staveren, and F J Kok Physical exercise or micronutrient supplementation for the wellbeing of the frail elderly? A randomised controlled trial Br. J. Sports Med., April 1, 2002; 36(2): 126 - 131. [Abstract] [Full Text] [PDF]

				A.-M. Hvas, J. Ellegaard, and E. Nexo Vitamin B12 Treatment Normalizes Metabolic Markers But Has Limited Clinical Effect: A Randomized Placebo-controlled Study Clin. Chem., August 1, 2001; 47(8): 1396 - 1404. [Abstract] [Full Text] [PDF]

				A.-M. Hvas, J. Ellegaard, and E. Nexo Increased Plasma Methylmalonic Acid Level Does Not Predict Clinical Manifestations of Vitamin B12 Deficiency Arch Intern Med, June 25, 2001; 161(12): 1534 - 1541. [Abstract] [Full Text] [PDF]

				N. de Jong, M. J. C. A Paw, L. C. de Groot, R. A. Rutten, D. W Swinkels, F. J Kok, and W. A van Staveren Nutrient-dense foods and exercise in frail elderly: effects on B vitamins, homocysteine, methylmalonic acid, and neuropsychological functioning Am. J. Clinical Nutrition, February 1, 2001; 73(2): 338 - 346. [Abstract] [Full Text] [PDF]

				H Cohen, W M Weinstein, and R Carmel Heterogeneity of gastric histology and function in food cobalamin malabsorption: absence of atrophic gastritis and achlorhydria in some patients with severe malabsorption Gut, November 1, 2000; 47(5): 638 - 645. [Abstract] [Full Text] [PDF]

				R. M Russell The aging process as a modifier of metabolism Am. J. Clinical Nutrition, August 1, 2000; 72(2): 529S - 532. [Abstract] [Full Text] [PDF]

				K. L Tucker, S. Rich, I. Rosenberg, P. Jacques, G. Dallal, P. W. Wilson, and J. Selhub Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring Study1 Am. J. Clinical Nutrition, February 1, 2000; 71(2): 514 - 522. [Abstract] [Full Text] [PDF]

				R. Carmel, R. Green, D. W Jacobsen, K. Rasmussen, M. Florea, and C. Azen Serum cobalamin, homocysteine, and methylmalonic acid concentrations in a multiethnic elderly population: ethnic and sex differences in cobalamin and metabolite abnormalities Am. J. Clinical Nutrition, November 1, 1999; 70(5): 904 - 910. [Abstract] [Full Text] [PDF]

				Nynke de Jong, M. J. M. C. A Paw, L. C. P. G. M. de Groot, Cees de Graaf, F. J. Kok, and W. A. van Staveren Functional Biochemical and Nutrient Indices in Frail Elderly People Are Partly Affected by Dietary Supplements but Not by Exercise J. Nutr., November 1, 1999; 129(11): 2028 - 2036. [Abstract] [Full Text]

				B. N. Ames Cancer prevention and diet: Help from single nucleotide polymorphisms PNAS, October 26, 1999; 96(22): 12216 - 12218. [Full Text] [PDF]

				R. Carmel Mild cobalamin deficiency in older Dutch subjects Am. J. Clinical Nutrition, April 1, 1999; 69(4): 738 - 739. [Full Text] [PDF]

				B. N. AMES Micronutrient Deficiencies: A Major Cause of DNA Damage Ann. N.Y. Acad. Sci., January 1, 1999; 889(1): 87 - 106. [Abstract] [Full Text] [PDF]