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Serum cobalamin, homocysteine, and methylmalonic acid concentrations in a multiethnic elderly population: ethnic and sex differences in cobalamin and metabolite abnormalities^1,2,3

¹ From the Department of Medicine, New York Methodist Hospital, Brooklyn, NY; the Departments of Medicine and Pathology, University of Southern California School of Medicine and the Los Angeles County–USC Medical Center, Los Angeles; the Departments of Clinical Pathology and Cell Biology, The Cleveland Clinic Foundation, Cleveland; the Department of Clinical Biochemistry, Aarhus University Hospital at Skejby, Aarhus, Denmark; and the Department of Medicine, Department of Veterans Affairs Outpatient Clinic, Los Angeles.

Background: Low cobalamin concentrations and mild hyperhomocysteinemia are common in the elderly but ethnic differences have not been defined.

Objective: Our objective was to determine the demographic characteristics of cobalamin deficiency in the elderly and its role in their hyperhomocysteinemia.

Design: We measured serum cobalamin, total homocysteine (Hcys), and methylmalonic acid (MMA) concentrations in 725 subjects >60 y old, and folate concentrations in 520 subjects.

Results: After exclusion of subjects taking cobalamin supplements or with renal insufficiency, high prevalences of low cobalamin (11.8%), high MMA (16.6%), and high Hcys (26.1%) concentrations were seen. Most cobalamin concentrations <140 pmol/L appeared to reflect deficiency because 78.3% of them were accompanied by abnormal metabolites. Subjects with cobalamin concentrations of 140–258 pmol/L had significantly fewer metabolic abnormalities. A low cobalamin concentration and renal insufficiency were the strongest predictors of abnormal Hcys concentrations. Elderly men had higher Hcys concentrations than did women (P = 0.0001). Whites and Latin Americans had lower cobalamin concentrations than did blacks and Asian Americans (P < 0.005). Whites also had higher Hcys concentrations than all the other groups (P < 0.05). When included in the analysis, renal insufficiency in subjects was associated with 23.8% of all high Hcys and 25.5% of all high MMA concentrations; most with renal insufficiency were Asian American and black men.

Conclusions: Mild cobalamin deficiency is most common in elderly white men and least common in black and Asian American women. Hyperhomocysteinemia, which is most strongly associated with low cobalamin concentrations, is also most common in elderly whites, whereas that associated with renal insufficiency is more common in blacks and Asian Americans. Ethnic differences in cobalamin deficiency and the Hcys patterns associated with it or with renal insufficiency warrant consideration in supplementation strategies. Extending suspicion of deficiency to persons with cobalamin concentrations of 140–258 pmol/L appears to provide more disadvantages than advantages.

Key Words: Cobalamin • cobalamin deficiency • homocysteine • methylmalonic acid • folate • ethnicity • blacks • Asians • Latin Americans • elderly • men • women

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