To determine the body composition differences across age, 133 men with chronic spinal cord injury (SCI) (66 with tetraplegia, 67 with paraplegia) were compared with an age-, height-, and ethnicity-matched able-bodied male reference population (n = 100) using two different dual-energy X-ray absorptiometry densitometers. The effects of duration of injury, level, and completeness of lesion were analyzed in the SCI population. Independent of age, total body and regional lean mass were lower and fat mass was higher in persons with SCI compared with controls. The SCI group was 13 +/- 1% (means +/- SE) fatter per unit of body mass index (kg/m2) compared with the control group (P < 0.0001). Advancing age was strongly associated with less lean mass and greater adiposity in those with SCI, whereas it was mildly related in the controls. Total body and regional arm and trunk, but not leg, lean tissues were lower in subjects with SCI, across all ages, than in the controls. In summary, persons with SCI were fatter for any body mass index and demonstrated significantly less lean and more adipose tissues for any given age compared with controls.

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OBJECTIVE -Of patients who are prescribed metformin, 10-30% have evidence of reduced vitamin B 12 absorption. B 12 -intrinsic factor complex uptake by ileal cell surface receptors is known to be a process dependent on calcium availability. Metformin affects calciumdependent membrane action. The objective of this study was to determine the magnitude and mechanism of the reduction in serum vitamin B 12 after metformin administration. RESEARCH DESIGN AND METHODS-A comparative study design was employed using 2 groups (metformin and control). A total of 21 patients with type 2 diabetes received sulfonylurea therapy; 14 of these 21 patients were switched to metformin. Monthly serum total vitamin B 12 measurements and holotranscobalamin (holoTCII) (B 12 -TCII) were performed. After 3 months of metformin therapy, oral calcium supplementation was administered.RESULTS -Serial serum vitamin B 12 determinations revealed a similar decline in vitamin B 12 and holoTCII. Oral calcium supplementation reversed the metformin-induced serum holoTCII depression.CONCLUSIONS -Patients receiving metformin have diminished B 12 absorption and low serum total vitamin B 12 and TCII-B 12 levels because of a calcium-dependent ileal membrane antagonism, an effect reversed with supplemental calcium.

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