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Yilmaz K, Wirth R, Daubert D, Pourhassan M. Prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients. J Nutr Health Aging 2024; 28:100039. [PMID: 38280831 DOI: 10.1016/j.jnha.2024.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVE Malnutrition and micronutrient deficiencies represent significant concerns in geriatric care, leading to adverse health outcomes in older adults. The study aimed to investigate the prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients. DESIGN AND SETTING This prospective, observational study was conducted in a geriatric acute care unit. PARTICIPANTS The study included 156 malnourished older adults. MEASUREMENTS Malnutrition was identified using the Mini Nutritional Assessment-Short Form. Micronutrient status was assessed through serum analysis of vitamins (A, B1, B6, B12, C, D, E, H, K, folic acid) and minerals (iron, zinc, copper, selenium) within 24 h post-admission. RESULTS The average patient age was 82.3 ± 7.5 years, with 69% female. The results revealed a high prevalence of micronutrient deficiencies, with 90% of patients exhibiting deficiencies in three or more micronutrients. Notably, every patient presented at least one micronutrient deficiency. Common deficiencies were found in vitamins C (75%), D (65%), H (61%), and K (45%), as well as folic acid (37%), iron (31%), zinc (36%) and selenium (35%). In binary regression analysis, the amount of previous weight loss was significantly associated with a higher prevalence of multiple (>2) micronutrient deficiencies (P = 0.045). Other variables such age (P = 0.449), gender (P = 0.252), BMI (P = 0.265) and MNA-SF score (P = 0.200) did not show any significant association with the prevalence multiple micronutrient deficiencies. CONCLUSION The high prevalence of micronutrient deficiencies in malnourished older hospitalized patients underscore the urgent need for targeted interventions to address micronutrient deficiencies in this population, promoting their health status.
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Affiliation(s)
- Kübra Yilmaz
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Diana Daubert
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany.
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Liu L, Zhou J, Chen C, Qu Y, Wang J, Lu F, Liu Y, Cai J, Ji S, Li Y, Gu H, Zhao F, Lyu Y, Shi X. Vitamin B 12 is associated negatively with anemia in older Chinese adults with a low dietary diversity level: evidence from the Healthy Ageing and Biomarkers Cohort Study (HABCS). BMC Geriatr 2024; 24:18. [PMID: 38178043 PMCID: PMC10768404 DOI: 10.1186/s12877-023-04586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The associations between plasma vitamin B12 level and anemia under different dietary patterns in elderly Chinese people are poorly understood. We aimed to examine the associations between plasma vitamin B12 levels and anemia under different dietary patterns in adults aged 65 years and older in nine longevity areas in China. METHODS A total of 2405 older adults completed a food frequency questionnaire at the same time as a face-to-face interview. The dietary diversity score (DDS) was assessed based on the food frequency questionnaire, with the low DDS group referring to participants with a DDS score ≤ 4 points. Vitamin B12 levels were divided into two groups of high (>295 pg/mL) and low (≤ 295 pg/mL) with the median used as the cut-off point. Sub-analyses were also performed on older adults divided into tertiles of vitamin B12 levels: low (< 277 pg/mL), medium (277-375 pg/mL) and high (> 375 pg/mL) to study the association of these levels with anemia. RESULTS Six hundred ninety-five (28.89%) of these people were diagnosed with anemia and had a mean age of 89.3 years. Higher vitamin B12 levels were associated with a decreased risk of anemia (multi-adjusted OR, 0.59, [95% CI, 0.45 ~ 0.77] P < 0.001) in older adults with a low DDS, whereas no significant association between vitamin B12 levels and anemia was found in older adults with a high DDS in a full-model after adjustment for various confounding factors (multi-adjusted OR, 0.88, [95% CI, 0.65 ~ 1.19], P = 0.41). CONCLUSION The relationship between vitamin B12 levels and the prevalence of anemia was significant only when the level of dietary diversity in the older adults was relatively low. The dietary structure of the population should be taken into consideration in combination in order to effectively improve anemia status by supplementing vitamin B12.
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Affiliation(s)
- Ling Liu
- Hospital of Beijing Forestry University, Beijing, 100083, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Chen Chen
- Beijing Municipal Health Commission Information Center, Beijing Municipal Health Commission Policy Research Center, Beijing, 100034, China
| | - Yingli Qu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing Municipal Health Commission Policy Research Center, Beijing, 100034, China
| | - Yingchun Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Jiayi Cai
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Saisai Ji
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yawei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Heng Gu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yuebin Lyu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China.
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China.
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Plotnikoff GA, Dobberstein L, Raatz S. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023; 15:1387. [PMID: 36986117 PMCID: PMC10056340 DOI: 10.3390/nu15061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.
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Affiliation(s)
| | | | - Susan Raatz
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
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4
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Wang PC, Gussekloo J, Arai Y, Abe Y, Blom JW, Duncan R, Jagger C, Kerse N, Martin-Ruiz C, Palapar L, den Elzen WPJ. The effects of single and a combination of determinants of anaemia in the very old: results from the TULIPS consortium. BMC Geriatr 2021; 21:457. [PMID: 34372781 PMCID: PMC8351428 DOI: 10.1186/s12877-021-02389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 07/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in oldest-old individuals: Leiden 85-plus Study, LiLACS NZ, Newcastle 85+ study, and TOOTH. Five selected determinants (iron, vitamin B12, and folate deficiency; low estimated glomerular filtration rate (eGFR); and high C-reactive protein (CRP)) were summed. This sum score was used to investigate the association with the presence and onset of anaemia (WHO definition). The individual study results were pooled using random-effects models. Results In the 2216 participants (59% female, 30% anaemia) at baseline, iron deficiency, low eGFR and high CRP were individually associated with the presence of anaemia. Low eGFR and high CRP were individually associated with the onset of anaemia. In the cross-sectional analyses, an increase per additional determinant (adjusted OR 2.10 (95% CI 1.85–2.38)) and a combination of ≥2 determinants (OR 3.44 (95% CI 2.70–4.38)) were associated with the presence of anaemia. In the prospective analyses, an increase per additional determinant (adjusted HR 1.46 (95% CI 1.24–1.71)) and the presence of ≥2 determinants (HR 1.95 (95% CI 1.40–2.71)) were associated with the onset of anaemia. Conclusion Very old adults with a combination of determinants of anaemia have a higher risk of having, and of developing, anaemia. Further research is recommended to explore causality and clinical relevance. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02389-2.
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Affiliation(s)
- Pin-Chun Wang
- Leiden University Medical Center, Master's Vitality and Ageing, PO Box 9600, 2300 RC, Leiden, the Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.,Department of Internal Medicine, Gerontology and Geriatrics Section, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Rachel Duncan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, 1072, New Zealand
| | - Carmen Martin-Ruiz
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Leah Palapar
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, 1072, New Zealand
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands. .,Atalmedial Diagnostics Centre, Amsterdam, The Netherlands. .,Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands.
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5
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Abrahamsen JF, Monsen ALB, Ranhoff AH, Nilsen RM, Engtrø E, Rekdal M, Kruger K. No association between subnormal serum vitamin B12 and anemia in older nursing home patients. Eur Geriatr Med 2020; 11:247-254. [PMID: 32297187 DOI: 10.1007/s41999-019-00269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Since evidence of an association between vitamin B12 (B12) deficiency and anemia in older people is limited and inconclusive, we wanted to investigate this association in old, frail nursing home patients. METHODS The study includes patients admitted to short-term, post-acute care (n = 765) and residents in long-term care (LTC) (n = 1665), in the municipality of Bergen. Anemia was defined according to the WHO criteria: Hb < 13 g/dL in men and < 12 g/dL in women, and as Hb < 11 g/dL, in both sex (moderate/severe anemia). The presence of anemia was analyzed in patients with subnormal (< 250 pmol/L), normal (250-650 pmol/L) and high (> 650 pmol/L) B12, and the association between anemia and clinical parameters, and including B12, was analyzed using logistic regression models. The use of B12 supplementation was investigated in the LTC patients. RESULTS Mean age of the 2430 patients was 86 ± 7 years. WHO-defined anemia was seen in 1023 (42%), and moderate/severe anemia in 384 (16%) of the patients. In multiple logistic regression analyses, we found no statistically significant associations of subnormal B12 with WHO-defined anemia or moderate/severe anemia. Renal insufficiency, iron deficiency and CRP > 10 mg/L were significantly associated with both types of anemia, (p < 0.001). Among the LTC residents, 405 (24%) received B12 supplements, 112 (7%) of them had elevated B12 > 650 pmol/L. CONCLUSION In older nursing home patients, no association was observed between subnormal B12 and anemia. Older patients in Western societies with mild/moderate anemia should not be treated with B12 supplements without further investigation.
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Affiliation(s)
- Jenny Foss Abrahamsen
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway. .,Kavli Research Centre, Haraldsplass Deaconess Hospital, Bergen, Norway.
| | | | | | - Roy M Nilsen
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Kjell Kruger
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Wang X, Sun N, Meng X, Chen M, Jiang C, Cai J. Review of clinical nerve repair strategies for neurorestoration of central nervous system tumor damage. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Central nervous system (CNS) tumors are common. In recent years, with the continuous development and popularization of neurosurgery and the advancement of diagnostic and therapeutic instruments, the diagnosis and treatment of diseases have made great progress, but the prognosis of patients depends on multiple clinical factors. In this study, we selected various literatures in the PubMed and Google Scholar search engines using the keywords "nerve repair strategies" , "central nervous system tumor" as well as searched scientifically reviewed historical perspectives and recent advancements and achievements in Neurorestoratology of the CNS. Therefore, this study focuses on the Neurorestoratology of the CNS and its prospects, aiming to provide scientific guidance for the clinical diagnosis and treatment of CNS tumors in the future, and improve the prognosis and quality of life of patients.
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7
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Ruegsegger GN, Vanderboom PM, Dasari S, Klaus KA, Kabiraj P, McCarthy CB, Lucchinetti CF, Nair KS. Exercise and metformin counteract altered mitochondrial function in the insulin-resistant brain. JCI Insight 2019; 4:130681. [PMID: 31534057 DOI: 10.1172/jci.insight.130681] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022] Open
Abstract
Insulin resistance associates with increased risk for cognitive decline and dementia; however, the underpinning mechanisms for this increased risk remain to be fully defined. As insulin resistance impairs mitochondrial oxidative metabolism and increases ROS in skeletal muscle, we considered whether similar events occur in the brain, which - like muscle - is rich in insulin receptors and mitochondria. We show that high-fat diet-induced (HFD-induced) brain insulin resistance in mice decreased mitochondrial ATP production rate and oxidative enzyme activities in brain regions rich in insulin receptors. HFD increased ROS emission and reduced antioxidant enzyme activities, with the concurrent accumulation of oxidatively damaged mitochondrial proteins and increased mitochondrial fission. Improvement of insulin sensitivity by both aerobic exercise and metformin ameliorated HFD-induced abnormalities. Moreover, insulin-induced enhancement of ATP production in primary cortical neurons and astrocytes was counteracted by the insulin receptor antagonist S961, demonstrating a direct effect of insulin resistance on brain mitochondria. Further, intranasal S961 administration prevented exercise-induced improvements in ATP production and ROS emission during HFD, supporting that exercise enhances brain mitochondrial function by improving insulin action. These results support that insulin sensitizing by exercise and metformin restores brain mitochondrial function in insulin-resistant states.
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Affiliation(s)
| | | | | | | | | | | | - Claudia F Lucchinetti
- Department of Neurology, and.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Larsson A, Carlsson L, Karlsson B, Lipcsey M. Rapid testing of red blood cell parameters in primary care patients using HemoScreen™ point of care instrument. BMC FAMILY PRACTICE 2019; 20:77. [PMID: 31174471 PMCID: PMC6554883 DOI: 10.1186/s12875-019-0971-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
Background Patients with anemia are frequently encountered in primary care. Once anemia is detected, it is essential to define the type and identify the underlying cause prior to initiation of treatment. In most cases, the cause can be determined using information from the patient history, physical exam, and complete blood counts (CBC). Point of care testing of blood cell counts would speed up the work up of anemia patients. The aim of the present study was to evaluate if the HemoScreen™ instrument (PixCell Medical, Yokneam Ilit, Israel) could be used for primary care samples. It is a POCT instrument that utilizes single sample cuvettes and image analysis of full blood count including RBC, Hemoglobin, MCV, MCH, platelets, WBC, and WBC 5-part differential. Methods We compared the HemoScreen™ and the Sysmex XN instrument results of 100 primary care patient samples focusing on the total white blood cells, red blood cell parameters RBC, Hemoglobin, MCH, MCV and platelets. Results Deming correlations between the HemoScreen™ and the Sysmex XN instruments for the CBC were WBCHemoScreen™ = 1.016* WBCSysmex + 0.34; r = 0.981, RBCHemoScreen™ = 0.988* RBCSysmex + 0.015; r = 0.974, HemoglobinHemoScreen™ = 1.081* HemoglobinSysmex − 11.25; r = 0.964, MCHHemoScreen™ = 0.978* MCHSysmex + 0.78; r = 0.939, MCVHemoScreen™ = 0.963* MCVSysmex + 8.68; r = 0.946, PlateletsHemoScreen™ = 0.964* PlateletsSysmex + 25.7; r = 0.953. Conclusion The HemoScreen™ instrument could provide rapid and accurate test results for evaluation of the red blood cell parameters in primary care. This new technology is interesting as it allows the analysis red blood cell parameters also at small primary care centers.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Section Clinical Chemistry, Uppsala University, Akademiska sjukhuset, entrance 61, 3rd floor, SE-751 85, Uppsala, Sweden.
| | - Lena Carlsson
- Department of Medical Sciences, Section Clinical Chemistry, Uppsala University, Akademiska sjukhuset, entrance 61, 3rd floor, SE-751 85, Uppsala, Sweden
| | - Bo Karlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- The Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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Wolffenbuttel BH, Wouters HJ, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B 12) Deficiency. Mayo Clin Proc Innov Qual Outcomes 2019; 3:200-214. [PMID: 31193945 PMCID: PMC6543499 DOI: 10.1016/j.mayocpiqo.2019.03.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although cobalamin (vitamin B12) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B12 deficiency may present with the classic megaloblastic anemia. In clinical practice, many cases of vitamin B12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B12 deficiency in whom the diagnosis was either based on low serum B12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B12 therapy. We discuss the possible clinical signs and symptoms of patients with B12 deficiency and the various pitfalls of diagnosis and treatment.
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Affiliation(s)
- Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Correspondence: Address to Bruce H. R. Wolffenbuttel, MD, PhD, Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31 9700 RB Groningen, The Netherlands
| | - Hanneke J.C.M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - M. Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
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10
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Literacy's Role in Health Disparities. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prevalence of Nutritional Anemia and Hyperhomocysteinemia in Urban Elderly. Indian J Clin Biochem 2018; 34:330-335. [PMID: 31391724 DOI: 10.1007/s12291-018-0756-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/28/2018] [Indexed: 01/17/2023]
Abstract
The data on the prevalence of nutritional anemia among the urban elderly population in India was limited. Hence, the present study was carried out with an aim to assess the prevalence of nutritional anemia and its association with vitamin B12, folate, ferritin and homocystine among the urban elderly population. A community- based cross-sectional study was carried out among 282 urban elderly (≥ 60 years) subjects (186 males and 96 females) in Hyderabad. Fasting blood samples were collected and hemoglobin (Hb) was estimated by cyanmethemoglobin method. Plasma Folic acid and vitamin B12 levels were estimated by RIA and homocysteine and ferritin levels were estimated by ELISA methods. The overall prevalence of anemia (Hb < 12 g/dL for females and < 13 g/dL for males) among the urban elderly was 20.6% and the prevalence was found to be increasing with the age. The prevalence of vitamin B12 (< 203 pg/mL), folic acid (< 4 ng/mL), ferritin (< 15 ng/mL) and hyperhomocysteinemia (≥ 12 µmol/L) in these subjects was 36.0%, 8.2%, 1.1% and 24.3% respectively. The prevalence of anemia due to deficiencies of iron (ferritin < 15 ng/mL), folate and vitamin B12 was 5.45%, 9.1% and 42.3% respectively. A significant association was observed between the prevalence of anemia with ferritin and hyperhomocysteinemia. In conclusion, the prevalence of anemia and nutritional anemia among the urban-based elderly was 20.6% and 56.85% respectively. The association of anemia with hyperhomocysteinemia needs further studies.
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12
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The effect of vitamin B12 and folic acid supplementation on routine haematological parameters in older people: an individual participant data meta-analysis. Eur J Clin Nutr 2018. [PMID: 29520083 DOI: 10.1038/s41430-018-0118-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Low vitamin B12 and folate levels in community-dwelling older people are usually corrected with supplements. However, the effect of this supplementation on haematological parameters in older persons is not known. Therefore, we executed a systematic review and individual participant data meta-analysis of randomised placebo-controlled trials (RCTs). SUBJECTS/METHODS We performed a systematic search in PubMed, EMBASE, Web of Science, Cochrane and CENTRAL for RCTs published between January 1950 and April 2016, where community-dwelling elderly (60+ years) who were treated with vitamin B12 or folic acid or placebo. The presence of anaemia was not required. We analysed the data on haematological parameters with a two-stage IPD meta-analysis. RESULTS We found 494 full papers covering 14 studies. Data were shared by the authors of four RCTs comparing vitamin B12 with placebo (n = 343) and of three RCTs comparing folic acid with placebo (n = 929). We found no effect of vitamin B12 supplementation on haemoglobin (change 0.00 g/dL, 95% CI: -0.19;0.18), and no effect of folic acid supplementation (change -0.09 g/dL, 95% CI: -0.19;0.01). The effects of supplementation on other haematological parameters were similar. The effects did not differ by sex or by age group. Also, no effect was found in a subgroup of patients with anaemia and a subgroup of patients who were treated >4 weeks. CONCLUSIONS Evidence on the effects of supplementation of low concentrations of vitamin B12 and folate on haematological parameters in community-dwelling older people is inconclusive. Further research is needed before firm recommendations can be made concerning the supplementation of vitamin B12 and folate.
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Wang J, Wang H, Chang S, Zhao L, Fu P, Yu W, Man Q, Scherpbier R, Pan L, Duan Y, Yin SA. The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China. PLoS One 2015; 10:e0140840. [PMID: 26488490 PMCID: PMC4619061 DOI: 10.1371/journal.pone.0140840] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively. METHODS In this cross-sectional study, a total of 1370 children under 3 years old were selected based on probability proportional to size sampling principles from poor counties of China. Basic characteristics data were collected by questionnaire; then anthropometrics and hemoglobin were measured in the field and anemia prevalence evaluated. Venous blood was drawn from children aged 12-35 months (N = 553) to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS Among children aged 0-35 months, the prevalence of stunting, low body weight and wasting was 17.5%, 8.6% and 5.1%, respectively, and 25.6% of the children were affected by anemia, with more anemic infants and younger children than older children (P <0.01). There were 26.5%, 12.8%, 14.1% and 20.0% of the children aged 12-35 months affected by iron deficiency, vitamin D deficiency, folic acid deficiency and vitamin B12 deficiency, respectively. For children aged 0-11 months who were breastfed, the mothers' anemic status was the only factor associated with the child's anemia (OR = 2.6; 95% CI: 1.2-5.4, P < 0.05). For children aged 12-35 months, multivariate logistic regression indicated that anemia was significantly associated with iron and vitamin B12 deficiency (OR = 5.3; 95% CI: 1.9-14.5, P < 0.01) and monotonous diet (OR = 2.3; 95% CI: 1.1-4.7, P < 0.05) after adjusting for age and gender. CONCLUSION The prevalence of anemia was higher in children under 2 years old and requires urgent intervention. An effective intervention strategy should include iron and vitamin B12 supplements, improving dietary diversity and controlling breastfeeding mothers' anemia.
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Affiliation(s)
- Jie Wang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Wang
- Department of Population Research, China Population and Development Research Center, Beijing, China
| | - Suying Chang
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Liyun Zhao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ping Fu
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wentao Yu
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Robert Scherpbier
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Lili Pan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Duan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shi-an Yin
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Arlet JB, Rachas A, Colombet I, Pouchot J, Chiche L. Les internistes français abusent-ils du dosage de la vitaminémie B12 ? Rev Med Interne 2015; 36:495-7. [DOI: 10.1016/j.revmed.2014.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 05/13/2014] [Accepted: 05/28/2014] [Indexed: 01/20/2023]
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Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 2014; 9:1187-96. [PMID: 25092968 PMCID: PMC4113572 DOI: 10.2147/cia.s61125] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anemia in later life is associated with increased morbidity and mortality. The purpose of this study was to evaluate the prevalence and possible causes of anemia in the elderly in a well defined hospital cohort. Methods Participants in this cross-sectional, retrospective analysis included all inpatients and outpatients aged ≥64 years with complete blood counts treated at Innsbruck Medical University Hospital between October 1, 2004 and September 29, 2005 (n=19,758, median age 73 years). Results According to World Health Organization criteria, 21.1% of these patients were anemic, ie, 30.7% and 37.0% at 80+ years and 90+ years, respectively. The prevalence of anemia was significantly correlated with advanced age (r=0.21; P<0.001) and male sex (P<0.001). In anemic patients, renal insufficiency with a glomerular filtration rate <30 mL/min/1.73 m2 (11.3% versus 2.1%), hyperinflammation (62.1% versus 31.4%), absolute (14.4% versus 6.9%) or functional (28.2% versus 11.8%) iron deficiency, and folate deficiency (6.7% versus 3.0%) were observed significantly more often than in nonanemic subjects (P<0.001). The pathogenesis of anemia was multifactorial, with decreased renal function (glomerular filtration rate <60 mL/min/1.73 m2), signs of inflammation, and functional iron deficiency detected in 11.4% of anemic patients. Hemoglobin was significantly correlated with elevated C-reactive protein (r= −0.296; P<0.001) and low transferrin saturation (r=0.313; P<0.001). Mean corpuscular volume correlated only weakly with the various anemia subtypes. Cytopenias and morphologic alterations suggestive of underlying myelodysplastic syndromes were found in a substantial proportion of anemic patients, including thrombocytopenia (5.4%), leukopenia (8.26%), and macrocytic alterations (18.4%). Conclusion Anemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. A hitherto undiagnosed myelodysplastic syndrome can be assumed in a relevant proportion of patients. Morphologic classification based on mean corpuscular volume is inadequate from the standpoint of pathogenesis. New parameters are needed to differentiate the multifactorial pathogenesis of anemia in the elderly.
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Affiliation(s)
- Veronika Bach
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Guenter Schruckmayer
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Ines Sam
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Georg Kemmler
- Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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Sirdah MM, Yassin MM, El Shekhi S, Lubbad AM. Homocysteine and vitamin B12 status and iron deficiency anemia in female university students from Gaza Strip, Palestine. Rev Bras Hematol Hemoter 2014; 36:208-12. [PMID: 25031061 PMCID: PMC4109749 DOI: 10.1016/j.bjhh.2014.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/19/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Nutritional deficiencies are very significant to the overall health of humans at all ages and for both genders, yet in infants, children and women of childbearing age these deficiencies can seriously affect growth and development. The present work is aimed to assess homocysteine and vitamin B12 status in females with iron deficiency anemia from the Gaza Strip. METHODS Venous blood samples were randomly collected from 240 female university students (18-22 years old) and parameters of the complete blood count, serum ferritin, homocysteine and vitamin B12 were measured. Statistical analysis included the t-test and analysis of variance (ANOVA) using the IBM SPSS software (version 18). Statistical significance was set for p-values <0.05. RESULTS The results revealed that 20.4% of the students have iron deficiency anemia. The mean serum vitamin B12 level in females with iron deficiency anemia (212.9±62.8pg/mL) was significantly lower than in normal controls (286.9±57.1pg/mL) and subjects with microcytic anemia and normal ferritin (256.7±71.1pg/mL). Significantly higher serum homocysteine levels were reported in the iron deficiency anemia group (27.0±4.6μmol/L) compared to normal controls (15.5±2.9μmol/L) and in subjects with microcytic anemia and normal ferritin (18.1±2.7μmol/L). Statistically significant negative correlations were reported for serum homocysteine with serum ferritin, vitamin B12, hemoglobin, and hematocrit levels. CONCLUSION Important associations were found between serum homocysteine and markers of iron deficiency. Monitoring homocysteine levels might be essential to understand the development of different clinical conditions including anemia. It seems necessary to conduct prospective trials to determine whether treating anemia ameliorates homocysteine levels.
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17
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Toprak B, Yalcın HZ, Colak A. Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders? Int J Lab Hematol 2013; 36:409-14. [DOI: 10.1111/ijlh.12158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/12/2013] [Indexed: 12/21/2022]
Affiliation(s)
- B. Toprak
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
| | - H. Z. Yalcın
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
| | - A. Colak
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
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18
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Lechleitner M, Hoppichler F. [Gender aspects of malnutrition and associated sequelae. Prevention and therapy]. Z Gerontol Geriatr 2013; 46:511-6. [PMID: 23929193 DOI: 10.1007/s00391-013-0535-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malnutrition is related to a range of secondary complications. The prevalence of many of these sequelae is higher in elderly women than in men, thus resulting in a higher level of impairment and reduced quality of life. Multiple factors lead to the development of malnutrition and socioeconomic causes, such as poverty among the elderly and isolation, are more common in elderly women. The age-associated loss of muscle mass is more pronounced in women than in men and the risk of developing sarcopenia and frailty is increased. The prevalence of sarcopenic obesity is higher in women than in men. Malnutrition increases the risk of osteoporosis and about 80 % of all osteoporosis patients are women. Furthermore, low serum levels of vitamin D correlate more closely to a poorer cognitive outcome in elderly women than they do in men. The prevention, early diagnosis and therapy of malnutrition is of great clinical importance, particularly to preserve physical functional capacity and thus quality of life in elderly women.
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Affiliation(s)
- M Lechleitner
- Landeskrankenhaus Hochzirl, Anna Dengel-Haus, 6170, Zirl, Österreich.
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19
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Chiche L, Mancini J, Arlet JB. Indications for cobalamin level assessment in departments of internal medicine: a prospective practice survey. Postgrad Med J 2013; 89:560-5. [DOI: 10.1136/postgradmedj-2012-131024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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den Elzen WPJ, de Craen AJM, Wiegerinck ET, Westendorp RGJ, Swinkels DW, Gussekloo J. Plasma hepcidin levels and anemia in old age. The Leiden 85-Plus Study. Haematologica 2012; 98:448-54. [PMID: 23065507 DOI: 10.3324/haematol.2012.068825] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepcidin, an important regulator of iron homeostasis, is suggested to be causally related to anemia of inflammation. The aim of this study was to explore the role of plasma hepcidin in anemia among older persons from the general population. The Leiden 85-Plus Study is a population-based study of 85-year olds in Leiden, the Netherlands. Eighty-five-year old inhabitants of Leiden were enrolled between September 1997 and September 1999. At the age of 86, plasma hepcidin was determined with time of flight mass spectrometry in 490 participants [160 (32.7%) male, 114 (23.3%) with anemia]. Anemia was defined according to criteria of the World Health Organization (hemoglobin level <13 g/dL for men and hemoglobin <12 g/dL for women). The median plasma hepcidin level was 3.0 nM [interquartile range (IQR) 1.8-4.9]. We found strong correlations between plasma hepcidin and body iron status, C-reactive protein and erythropoietin levels. Significantly higher hepcidin levels were found in participants with anemia of inflammation (P<0.01), in participants with anemia of kidney disease (P=0.01), and in participants with unexplained anemia (P=0.01) than in participants without anemia. Participants with iron-deficiency anemia had significantly lower plasma hepcidin levels than participants without anemia (P<0.01). In conclusion, older persons with anemia of inflammation have higher hepcidin levels than their counterparts without anemia. The potential clinical value of hepcidin in future diagnostic algorithms for anemia has to be explored.
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Affiliation(s)
- Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Willems JM, den Elzen WPJ, Vlasveld LT, Westendorp RGJ, Gussekloo J, de Craen AJM, Blauw GJ. No increased mortality risk in older persons with unexplained anaemia. Age Ageing 2012; 41:501-6. [PMID: 22417980 DOI: 10.1093/ageing/afs031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND in older persons, anaemia is associated with a number of unfavourable outcomes. In approximately 30% of older persons with anaemia, the cause of the anaemia is unexplained. We assessed the clinical differences between subjects with explained and unexplained anaemia and investigated whether these subjects have different mortality patterns compared with subjects without anaemia. DESIGN observational prospective follow-up study. SETTING the Leiden 85-plus study. PARTICIPANTS four hundred and ninety-one persons aged 86 years. METHODS the study population was divided in three groups: (i) no anaemia (reference group, n=377), (ii) explained anaemia (iron deficiency, folate deficiency, vitamin B12 deficiency, signs of myelodysplastic syndrome or renal failure, n=74) and (iii) unexplained anaemia, (n=40). Mortality risks were estimated with Cox-proportional hazard models. RESULTS haemoglobin levels were significantly lower in subjects with explained anaemia than in subjects with unexplained anaemia (P<0.01). An increased risk for mortality was observed in subjects with explained anaemia [HR: 1.93 (95% CI: 1.47-2.52), P<0.001], but not in subjects with unexplained anaemia [HR: 1.19 (95% CI: 0.85-1.69), P=0.31]. Adjusted analyses (sex, co-morbidity, MMSE, institutionalised and smoking) did not change the observed associations for both explained and unexplained anaemic subjects. CONCLUSION older subjects with unexplained anaemia had similar survival compared with non-anaemic subjects. Increased mortality risks were observed in subjects with explained anaemia compared with non-anaemic subjects.
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22
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Mirkazemi C, Peterson GM, Tenni PC, Jackson SL. Vitamin B12 deficiency in Australian residential aged care facilities. J Nutr Health Aging 2012; 16:277-80. [PMID: 22456786 DOI: 10.1007/s12603-011-0348-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the prevalence of undiagnosed vitamin B12 deficiency among residential aged care facility residents in southern Tasmania, Australia, and to identify associated risk factors. DESIGN AND SETTING Cross-sectional study of residents from five southern Tasmanian residential aged care facilities. PARTICIPANTS Two hundred and fifty-nine residents without a prior diagnosis of vitamin B12 deficiency or recorded serum B12 level within the past 6 months were approached to have their serum B12 level tested. One hundred and sixty (61%) residents consented and their doctors were contacted for further consent. A total of 130 (50%) residents completed the study. MEASUREMENTS Clinical and demographic characteristics, and serum B12 level. RESULTS Of the 130 residents tested, 18 residents (14%) were considered vitamin B12 deficient (serum level <150 pmol/L), 47 (36%) were equivocal (150 pmol/L to 250 pmol/L) and 65 (50%) had normal serum B12 levels (>250 pmol/L). There was a weak negative correlation between age and serum B12 level in those residents not taking a multivitamin (n=120, r=-0.19, p<0.05). The use of a multivitamin or antipsychotic drug were associated with altered mean serum B12 levels (+137 pmol/L, p<0.001 and -70 pmol/L, p<0.001 respectively). CONCLUSION As vitamin B12 deficiency can manifest in a range of symptoms that are frequently misdiagnosed, the finding of undetected deficiency in 14% of residents is a cause for concern. Oral multivitamin supplementation may help prevent deficiency, and potentially treat existing deficiencies in older institutionalised people.
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Affiliation(s)
- C Mirkazemi
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania 7001, Australia
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Madrazo González Z, García Barrasa A, Rafecas Renau A. Anemia, hierro, transfusión y alternativas terapéuticas. Revisión desde una perspectiva quirúrgica. Cir Esp 2010; 88:358-68. [DOI: 10.1016/j.ciresp.2010.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 11/27/2009] [Accepted: 03/12/2010] [Indexed: 12/31/2022]
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Gilsing AMJ, Crowe FL, Lloyd-Wright Z, Sanders TAB, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr 2010; 64:933-9. [PMID: 20648045 PMCID: PMC2933506 DOI: 10.1038/ejcn.2010.142] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Vegans, and to a lesser extent vegetarians, have low average circulating concentrations of vitamin B12; however, the relation between factors such as age or time on these diets and vitamin B12 concentrations is not clear. The objectives of this study were to investigate differences in serum vitamin B12 and folate concentrations between omnivores, vegetarians and vegans and to ascertain whether vitamin B12 concentrations differed by age and time on the diet. SUBJECTS/METHODS A cross-sectional analysis involving 689 men (226 omnivores, 231 vegetarians and 232 vegans) from the European Prospective Investigation into Cancer and Nutrition Oxford cohort. RESULTS Mean serum vitamin B12 was highest among omnivores (281, 95% CI: 270-292 pmol/l), intermediate among vegetarians (182, 95% CI: 175-189 pmol/l) and lowest among vegans (122, 95% CI: 117-127 pmol/l). In all, 52% of vegans, 7% of vegetarians and one omnivore were classified as vitamin B12 deficient (defined as serum vitamin B12 <118 pmol/l). There was no significant association between age or duration of adherence to a vegetarian or a vegan diet and serum vitamin B12. In contrast, folate concentrations were highest among vegans, intermediate among vegetarians and lowest among omnivores, but only two men (both omnivores) were categorized as folate deficient (defined as serum folate <6.3 nmol/l). CONCLUSION Vegans have lower vitamin B12 concentrations, but higher folate concentrations, than vegetarians and omnivores. Half of the vegans were categorized as vitamin B12 deficient and would be expected to have a higher risk of developing clinical symptoms related to vitamin B12 deficiency.
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Affiliation(s)
- A M J Gilsing
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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den Elzen WPJ, van der Weele GM, Gussekloo J, Westendorp RGJ, Assendelft WJJ. Subnormal vitamin B12 concentrations and anaemia in older people: a systematic review. BMC Geriatr 2010; 10:42. [PMID: 20573208 PMCID: PMC2900261 DOI: 10.1186/1471-2318-10-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 06/23/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pernicious anaemia is undeniably associated with vitamin B12 deficiency, but the association between subnormal vitamin B12 concentrations and anaemia in older people is unclear. The aim of this systematic review was to evaluate the association between subnormal vitamin B12 concentrations and anaemia in older people. METHODS Clinical queries for aetiology and treatment in bibliographic databases (PubMed [01/1949-10/2009]; EMBASE [01/1980-10/2009]) were used. Reference lists were checked for additional relevant studies. Observational studies (> or =50 participants) and randomized placebo-controlled intervention trials (RCTs) were considered. RESULTS 25 studies met the inclusion criteria. Twenty-one observational cross-sectional studies (total number of participants n = 16185) showed inconsistent results. In one longitudinal observational study, low vitamin B12 concentrations were not associated with an increased risk of anaemia (total n = 423). The 3 RCTs (total n = 210) were well-designed and showed no effect of vitamin B12 supplementation on haemoglobin concentrations during follow-up in subjects with subnormal vitamin B12 concentrations at the start of the study. Due to large clinical and methodological heterogeneity, statistical pooling of data was not performed. CONCLUSIONS Evidence of a positive association between a subnormal serum vitamin B12 concentration and anaemia in older people is limited and inconclusive. Further well-designed studies are needed to determine whether subnormal vitamin B12 is a risk factor for anaemia in older people.
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Affiliation(s)
- Wendy PJ den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerda M van der Weele
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi GJ Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem JJ Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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