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Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women^1,2,3

¹ From the Division of Hematology, Department of Medicine, University of Colorado Health Sciences Center, Denver; the Division of Geriatrics, Departments of Medicine and Epidemiology, Johns Hopkins Medical Institutions, Baltimore; the Department of Preventive Medicine, University of Tennessee, Memphis; the Department of Neurology, University of Maryland School of Medicine, Baltimore; and the Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, MD.

Background: Many previous investigations of cobalamin and folate status were performed in white populations.

Objective: Our objective was to determine whether there are racial differences in the prevalence of cobalamin and folate deficiency.

Design: The study was a cross-sectional comparison of baseline serum cobalamin, folate, methylmalonic acid (MMA), total homocysteine (tHcy), and creatinine concentrations, complete blood count, and vitamin supplementation in 550 white and 212 African American subjects from a cohort of physically disabled older women.

Results: The mean (±SD) serum MMA concentration was significantly higher in whites than in African Americans: 284 ± 229 compared with 218 ± 158 nmol/L (P = 0.0001). tHcy concentration was higher in African Americans than in whites: 12.4 ± 7.0 compared with 10.9 ± 4.6 µmol/L (P = 0.001). Serum cobalamin was lower in whites (P = 0.0002). Cobalamin deficiency (serum cobalamin <258 pmol/L and MMA >271 nmol/L) was more frequent in the white women (19% compared with 8%; P < 0.0003). Folate deficiency (serum folate <11.4 nmol/L, tHcy >13.9 µmol/L, and MMA <271 nmol/L) was more prevalent in African Americans than in whites (5% compared with 2%; P = 0.01). Multivitamin use was associated with lower tHcy but not with MMA concentrations. Regression models showed that age >85 y, African American race, serum creatinine >90 µmol/L, and high MMA concentration were all significantly correlated with higher tHcy. Creatinine > 90 µmol/L, white race, and folate concentration were positively associated with MMA concentration.

Conclusions: Cobalamin deficiency with elevated serum MMA concentration is more prevalent in elderly white than in African American women and elevated serum tHcy and folate deficiency are more prevalent in elderly African American than in white women.

Key Words: Race • methylmalonic acid • homocysteine • cobalamin • folate • women • elderly • multivitamin use

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