Low serum cobalamin levels in a population study of 70- and 75-year-old subjects

Abstract

We examined causes and hematological consequences of low serum cobalamin (vitamin B12) concentration in two representative population samples of 70-year-old (N = 293) and 75-year-old subjects (N = 486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N = 16, with pernicious anemia in six), partial gastrectomy (N = 6), and intestinal malabsorption (N = 4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.

Gastric Status and Vitamin B12 Levels in Cardiovascular Patients

“…First, undiagnosed clinically significant, severe deficiency of vitamin B12 (serum level <150 pM) is surprisingly prevalent in hospitalized elderly cardiovascular patients in The Netherlands but this prevalence corresponds with present literature data that a clinically significant deficiency of vitamin B12 occurs in 5%-20% of people aged 60 or over in Western populations in general [1][2][3]. However, in our study population, with a mean age of 65 years, we found that nearly half of the patients (45%) were vitamin deficient or had serum levels of vitamin B12 at least lower than 250 pM.…”

“…Vitamin B12 deficiency is prevalent among the elderly [1][2][3][4]. Vitamin B12 is involved in the development of pernicious anemia, neurological disorders, and hyperhomocysteinaemia.…”

“…Only after binding to intrinsic factor (IF) are the IF-B12 complexes absorbed in the terminal ileum. Because of the complexity of the absorption process, a vitamin B12 deficiency can develop due to several causes, where low dietary intake, low production of intrinsic factor, and gastric and ileum pathology are the most common reasons [1,7]. Consequently, gastric dysfunction, due to either gastritis or atrophic corpus gastritis, can cause low secretion of IF, malabsorption, and, finally, vitamin B12 deficiency.…”

Holotranscobalamin is not influenced by decreased renal function in elderly men: the MrOS Sweden study

“…2,3 Early and reliable diagnosis of cobalamin deficiency is important, since potentially irreversible neurological damage may be the first clinical sign. In non-vitamin-supplemented populations, the prevalence of atrophic body gastritis exceeds that of macrocytic anaemia caused by cobalamin deficiency, 2,4 illustrating the slow progress of the atrophy and the long time needed to deplete cobalamin stores. Serum concentrations of total cobalamin have low sensitivity and specificity for diagnosing deficiency, particularly in the large grey zone of values surrounding calculated lower reference limits.…”

Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial

“…Pernicious anaemia occurs in 0.3% of the total Swedish population and 2% over the age of 70 (Nilsson-Ehle et al, 1989). Neurological signs may be more common in this group Healton et al, 1991).…”