An update on cobalamin deficiency in adults

Area of Science:

• Nutritional Science
• Gastroenterology
• Hematology

Background:

• Cobalamin (vitamin B12) deficiency is prevalent in the elderly (>65 years), often presenting with subtle neuropsychiatric and hematological manifestations.
• Key causes include pernicious anemia and food-cobalamin malabsorption, a recently identified disorder affecting cobalamin release from food.
• Genetic mutations in cobalamin absorption pathways contribute to megaloblastic anemia.

Purpose of the Study:

• To review the causes and clinical significance of cobalamin deficiency, particularly in older adults.
• To highlight the emerging understanding of food-cobalamin malabsorption syndrome.
• To discuss current and emerging therapeutic strategies for cobalamin deficiency.

Main Methods:

• Literature review of cobalamin deficiency causes, manifestations, and management.
• Analysis of recent findings on food-cobalamin malabsorption and genetic factors.
• Evaluation of established and novel cobalamin administration routes.

Main Results:

• Cobalamin deficiency, though common, is frequently underdiagnosed due to non-specific symptoms.
• Food-cobalamin malabsorption, often linked to atrophic gastritis and medication use, is a significant cause.
• Genetic factors play a role in hereditary megaloblastic anemia related to cobalamin uptake.

Conclusions:

• Early recognition and management of cobalamin deficiency are crucial, especially in the elderly.
• Understanding food-cobalamin malabsorption is key for effective treatment strategies.
• Investigating new administration routes, like oral cobalamin, offers promising therapeutic advancements.