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Vitamin B-12 deficiency in the elderly: current dilemmas
S P Stabler1, J Lindenbaum, R H Allen
1Department of Medicine, University of Colorado Health Sciences Center, Denver 80220, USA. jonesjo@jove.UCHSC.edu
The American Journal of Clinical Nutrition
|October 10, 1997
Summary
Vitamin B-12 deficiency affects many older adults, often presenting subtly. Early diagnosis and appropriate oral vitamin B-12 supplementation are crucial for managing elevated methylmalonic acid levels in this population.
Area of Science:
- Gerontology
- Nutritional Biochemistry
- Clinical Medicine
Background:
- Vitamin B-12 deficiency is prevalent in up to 15% of the elderly.
- Subtle clinical signs and comorbidities complicate diagnosis and treatment response assessment in older adults.
- Elevated methylmalonic acid (MMA) and homocysteine are key biochemical markers for vitamin B-12 deficiency.
Purpose of the Study:
- To highlight the prevalence and diagnostic challenges of vitamin B-12 deficiency in the elderly.
- To emphasize the importance of diagnosing vitamin B-12 status before folic acid supplementation.
- To explore the potential of oral vitamin B-12 for normalizing MMA levels in older adults.
Main Methods:
- Review of existing literature on vitamin B-12 deficiency in the elderly.
- Analysis of biochemical markers such as methylmalonic acid and total homocysteine.
- Evaluation of the efficacy of oral vitamin B-12 supplementation.
Main Results:
- Many elderly individuals with hyperhomocysteinemia have undiagnosed vitamin B-12 deficiency.
- Standard multivitamin doses of vitamin B-12 may be insufficient to lower MMA levels.
- Clinical presentation is often unreliable for diagnosing deficiency in this age group.
Conclusions:
- Elderly individuals with elevated MMA and/or homocysteine require vitamin B-12 assessment before folic acid supplementation.
- Oral vitamin B-12 supplementation can be effective, but requires adequate dosing.
- Further research is needed to establish practical diagnostic and treatment strategies for vitamin B-12 deficiency in the elderly.