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Zhou L, Bai X, Wu B, Tan Y, Li M, Yang Q. Characterizing Vitamin B12 Deficiency in Neurology Outpatients: A Retrospective Observational Study. Clin Neuropharmacol 2024; 47:87-96. [PMID: 38743602 DOI: 10.1097/wnf.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Clinical manifestations of vitamin B12 deficiency are varied and may result in missed or delayed diagnosis. This investigation explores the diverse clinical manifestations and demographic characteristics of vitamin B12 deficiency in neurology outpatients, aiming to enhance timely diagnosis and outcomes. METHODS The severity of vitamin B12 deficiency was classified as absolute (≤150 pg/mL) or borderline deficiency (150-300 pg/mL). We conducted a retrospective analysis of 165 outpatients with vitamin B12 deficiency at the department of neurology between May 2020 and May 2021. RESULT Absolute vitamin B12 deficiency was found in 23.0% of the patients. The most common age range was 50-60 years, the most common cause was vegetarianism, and the most common symptom was headache. Epileptiform symptoms were more likely to occur in younger patients (<20 years old) with vitamin B12 deficiency, whereas psychiatric symptoms were more likely to occur in older patients (>70 years old). Vegetarians, salivation, and nonmegaloblastic anemia were more obvious in patients with absolute vitamin B12 deficiency, whereas headaches often showed borderline B12 deficiency. CONCLUSIONS The clinical characteristics of vitamin B12 deficiency are complex and nonspecific. The diagnosis should be based on multiple factors.
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Affiliation(s)
- Li Zhou
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Bowen Wu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongjun Tan
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengxia Li
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Yang
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Quinn M, Halsey J, Sherliker P, Pan H, Chen Z, Bennett DA, Clarke R. Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: a systematic review. EClinicalMedicine 2024; 67:102366. [PMID: 38169713 PMCID: PMC10758734 DOI: 10.1016/j.eclinm.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Folic acid (pteroylmonoglutamic acid) supplements are highly effective for prevention of neural tube defects (NTD) prompting implementation of mandatory or voluntary folic acid fortification for prevention of NTDs. We used plasma folate levels in population studies by country and year to compare effects of folic acid fortification types (mandatory or voluntary folic acid fortification policies) on plasma folate levels, NTD prevalence and stroke mortality rates. Methods We conducted systematic reviews of (i) implementation of folic acid fortification in 193 countries that were member states of the World Health Organization by country and year, and (ii) estimated population mean plasma folate levels by year and type of folic acid fortification. We identified relevant English language reports published between Jan 1, 1990 and July 31, 2023 using Google Scholar, Medline, Embase and Global Health. Eligibility criteria were observational or interventional studies with >1000 participants. Studies of pregnant women or children <15 years were excluded. Using an ecological study design, we examined the associations of folic acid fortification types with NTD prevalence (n = 108 studies) and stroke mortality rates (n = 3 countries). Findings Among 193 countries examined up to 31 July 2023, 69 implemented mandatory folic acid fortification, 47 had voluntary fortification, but 77 had no fortification (accounting for 32%, 53% and 15% of worldwide population, respectively). Mean plasma folate levels were 36, 21 and 17 nmol/L in populations with mandatory, voluntary and no fortification, respectively (and proportions with mean folate levels >25 nmol/L were 100%, 15% and 7%, respectively). Among 75 countries with NTD prevalence, mean (95% CI) prevalence per 10,000 population were 4.19 (4.11-4.28), 7.61 (7.47-7.75) and 9.66 (9.52-9.81) with mandatory, voluntary and no folic acid fortification, respectively. However, age-standardised trends in stroke mortality rates were unaltered by the introduction of folic acid fortification. Interpretation There is substantial heterogeneity in folic acid fortification policies worldwide where folic acid fortification are associated with 50-100% higher population mean plasma folate levels and 25-50% lower NTD prevalence compared with no fortification. Many thousand NTD pregnancies could be prevented yearly if all countries implemented mandatory folic acid fortification. Further trials of folic acid for stroke prevention are required in countries without effective folic acid fortification policies. Funding Medical Research Council (UK) and British Heart Foundation.
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Affiliation(s)
- Matthew Quinn
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jim Halsey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Hongchao Pan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Bennett DA, Parish S, Millwood IY, Guo Y, Chen Y, Turnbull I, Yang L, Lv J, Yu C, Davey Smith G, Wang Y, Wang Y, Peto R, Collins R, Walters RG, Li L, Chen Z, Clarke R. MTHFR and risk of stroke and heart disease in a low-folate population: a prospective study of 156 000 Chinese adults. Int J Epidemiol 2023; 52:1862-1869. [PMID: 37898918 PMCID: PMC10749746 DOI: 10.1093/ije/dyad147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The relevance of folic acid for stroke prevention in low-folate populations such as in China is uncertain. Genetic studies of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which increases plasma homocysteine (tHcy) levels, could clarify the causal relevance of elevated tHcy levels for stroke, ischaemic heart disease (IHD) and other diseases in populations without folic acid fortification. METHODS In the prospective China Kadoorie Biobank, 156 253 participants were genotyped for MTHFR and 12 240 developed a stroke during the 12-year follow-up. Logistic regression was used to estimate region-specific odds ratios (ORs) for total stroke and stroke types, IHD and other diseases comparing TT genotype for MTHFR C677T (two thymine alleles at position 677 of MTHFR C677T polymorphism) vs CC (two cytosine alleles) after adjustment for age and sex, and these were combined using inverse-variance weighting. RESULTS Overall, 21% of participants had TT genotypes, but this varied from 5% to 41% across the 10 study regions. Individuals with TT genotypes had 13% (adjusted OR 1.13, 95% CI 1.09-1.17) higher risks of any stroke [with a 2-fold stronger association with intracerebral haemorrhage (1.24, 1.17-1.32) than for ischaemic stroke (1.11, 1.07-1.15)] than the reference CC genotype. In contrast, MTHFR C677T was unrelated to risk of IHD or any other non-vascular diseases, including cancer, diabetes and chronic obstructive lung disease. CONCLUSIONS In Chinese adults, the MTHFR C677T polymorphism was associated with higher risks of stroke. The findings warrant corroboration by further trials of folic acid and implementation of mandatory folic acid fortification programmes for stroke prevention in low-folate populations.
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Affiliation(s)
- Derrick A Bennett
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Parish
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iain Turnbull
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | | | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Richard Peto
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin G Walters
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kerlikowsky F, Schuchardt JP, Hahn A. Folate, vitamin B12 and vitamin D status in healthy and active home-dwelling people over 70 years. BMC Geriatr 2023; 23:673. [PMID: 37853337 PMCID: PMC10585793 DOI: 10.1186/s12877-023-04391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Ageing is characterised by physiological changes that can affect the nutrient availability and requirements. In particular, the status of vitamin D, cobalamin and folate has often been found to be critical in older people living in residential care. However, there is a lack of studies investigating the status of these nutrients in healthy and active home-dwelling elderly people. METHODS The aim of this cross-sectional study was to assess the status of vitamin D based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D], cobalamin based on serum concentrations of holotranscobalamin (holoTC) and folate based on red blood cell (RBC) folate in unsupplemented, healthy and active German home-dwelling subjects ≥ 70 years of age (n = 134, mean ± SD: 75.8 ± 4.5 years). Dietary intake was assessed by 3-day food recalls. The study was conducted between March and November of 2021 (during the COVID-19 pandemic). RESULTS The mean 25-(OH)D concentration was high at 85.1 ± 26.0 nmol/L, while the majority of women (92%) and men (94%) had 25-(OH)D concentrations ≥ 50 nmol/L. Less than 10% of men and women had 25-(OH)D concentrations < 50 nmol/L. The mean holoTC concentration was 88.9 ± 33.7 pmol/L (94.8 ± 34.6 pmol/L in women and 73.6 ± 25.6 in men). Only 8% of the women were cobalamin deficient (< 50 pmol/L holoTC) compared to 22% of the men. The mean RBC folate concentration was 831 ± 244 nmol/L, while the prevalence of folate deficiency was 10%. Linear regression analysis showed that only folate equivalent intake was associated with the relevant nutrient status marker. CONCLUSION Our findings suggest that healthy, independently living older people with high levels of education, physical activity, and health awareness are not necessarily at higher risk of vitamin D, folate and cobalamin deficiency. Further studies are needed to verify these findings and to identify lifestyle and dietary patterns that can predict adequate nutrient status for healthy ageing. TRIAL REGISTRATION This study is officially recorded in the German Clinical Trials Register (DRKS00021302).
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Affiliation(s)
- Felix Kerlikowsky
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany.
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O'Connor D, Molloy AM, Laird E, Kenny RA, O'Halloran AM. Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment. Proc Nutr Soc 2023; 82:315-328. [PMID: 36938798 DOI: 10.1017/s0029665123002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.
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Affiliation(s)
- Deirdre O'Connor
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon Laird
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Physical Education and Sport, University of Limerick, Limerick, Ireland
| | - Rose Anne Kenny
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling M O'Halloran
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Wang X, Rong L, Shen M, Yu Q, Chen Y, Li J, Xie J. Rheology, Texture and Swallowing Characteristics of a Texture-Modified Dysphagia Food Prepared Using Common Supplementary Materials. Foods 2023; 12:2287. [PMID: 37372499 DOI: 10.3390/foods12122287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
A dysphagia diet is a special eating plan. The development and design of dysphagia foods should consider both swallowing safety and food nutritional qualities. In this study, the effects of four food supplements, namely vitamins, minerals, salt and sugar, on swallowing characteristics, rheological and textural properties were investigated, and a sensory evaluation of dysphagia foods made with rice starch, perilla seed oil and whey isolate protein was carried out. The results showed that all the samples belonged to foods at level 4 (pureed) in The International Dysphagia Diet Standardization Initiative (IDDSI) framework, and exhibited shear thinning behavior, which is favorable for dysphagia patients. Rheological tests showed that the viscosity of a food bolus was increased with salt and sugar (SS), while it decreased with vitamins and minerals (VM) at shear rates of 50 s-1. Both SS and VM strengthened the elastic gel system, and SS enhanced the storage modulus and loss modulus. VM increased the hardness, gumminess, chewiness and color richness, but left small residues on the spoon. SS provided better water-holding, chewiness and resilience by influencing the way molecules were connected, promoting swallowing safety. SS brought a better taste to the food bolus. Dysphagia foods with both VM and 0.5% SS had the best sensory evaluation score. This study may provide a theoretical foundation for the creation and design of new dysphagia nutritional food products.
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Affiliation(s)
- Xin Wang
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Liyuan Rong
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Mingyue Shen
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Qiang Yu
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Yi Chen
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Jinwang Li
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
| | - Jianhua Xie
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China
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7
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Wee AKH, Sultana R. Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus - A primary-care retrospective cohort study. BMC PRIMARY CARE 2023; 24:102. [PMID: 37081390 PMCID: PMC10116480 DOI: 10.1186/s12875-023-02057-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Like many developed nations, the prevalence of both older people and type-2 diabetes mellitus (T2DM) in Singapore is rising. This demographic shift predisposes the population to greater risks of both frailty and its complications that can be further aggravated by vitamin B12 deficiency -a highly prevalent associated variable that is potentially modifiable. Indeed, B12 deficiency adversely impacts the neuro-cognitive, haematological, and even the immune systems; jeopardizing our aspirations for successful aging. Despite this, many patients with T2DM in primary care remain unscreened due to a lack of clear guidelines for regular B12 screening. We therefore investigated the determinants of B12 deficiency in community-dwelling patients with T2DM, with the aim of profiling patients most in need of B12-deficiency screening. METHODS B12 deficiency was evaluated using a retrospective cross-sectional cohort of 592 primary-care patients with T2DM, recruited from 2008 to 2011 from a Polyclinic in Singapore. RESULTS B12 deficiency (serum B12 < 150 pmol/L) was present in 164 (27.7%) patients and was associated with a higher "metformin daily dose" (OR = 2.79; 95% CI, 2.22-3.48, P < 0.001); "age ≥ 80 years" (OR = 2.86; 95% CI, 1.31-6.25, P = 0.008); "vegetarianism" (OR = 21.61; 95% CI, 4.47-104.44, P < 0.001); and "folate deficiency" (OR = 2.04; 95% CI, 1.27-3.28, P = 0.003). Conversely, "Prescribed B12 supplementation" was associated with a lower odds of B12 deficiency (OR = 0.37; 95% CI: 0.22-0.61, P < 0.001). The area under the receiver operating characteristic curve was 0.803 (95% CI: 0.765-0.842). "Metformin daily dose" correlated interchangeably with "Metformin 1-year cumulative dose" (r = 0.960; P < 0.01), and also associated linearly with "duration of diabetes" (B = 0.113, P < 0.0001). Independent of the duration of T2DM, 29.3% of the B12-deficient patients needed > 1 screening test before the detection of B12 deficiency. CONCLUSIONS Primary-care screening for B12 deficiency should be part of the annual laboratory review of patients with T2DM regardless of the duration of T2DM -especially when they are prescribed ≥ 1.5 g/day of metformin; ≥ 80 years old; vegetarian; and not prescribed B12 supplementation. Concurrent evaluation for associated folate (vitamin B9) deficiency is essential when addressing T2DM-associated B12 deficiencies. Current "Metformin daily dose" is an accurate proxy of both cumulative metformin exposure and duration of T2DM.
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Affiliation(s)
- Andrew Kien Han Wee
- SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, #01-792, Singapore, 440080, Republic of Singapore.
- SingHealth Duke-NUS Medical School. Family Medicine Academic Clinical Programme ("FM ACP"), Office of Academic & Clinical Development, 8 College Road, Singapore, 169857, Republic of Singapore.
| | - Rehena Sultana
- Duke-NUS Medical School, Centre for Quantitative Medicine, 8 College Road, Singapore, 169857, Republic of Singapore
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Verstovsek S. How I manage anemia related to myelofibrosis and its treatment regimens. Ann Hematol 2023; 102:689-698. [PMID: 36786879 PMCID: PMC9998582 DOI: 10.1007/s00277-023-05126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by mutations (most frequently in JAK2, CALR, or MPL), burdensome symptoms, splenomegaly, cytopenia, and shortened life expectancy. In addition to other clinical manifestations, patients with MF often develop anemia, which can either be directly related to MF pathogenesis or a result of MF treatment with Janus kinase (JAK) inhibitors, such as ruxolitinib and fedratinib. Although symptoms and clinical manifestations can be similar between the 2 anemia types, only MF-related anemia is prognostic of reduced survival. In this review, I detail treatment and patient management approaches for both types of anemia presentations and provide recommendations for the treatment of MF in the presence of anemia.
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Affiliation(s)
- Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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9
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Nutritional Care for the Older Adult. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Design of Cereal Products Naturally Enriched in Folate from Barley Pearling By-Products. Nutrients 2022; 14:nu14183729. [PMID: 36145105 PMCID: PMC9500880 DOI: 10.3390/nu14183729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Folate is a fundamental vitamin for human health in prevention of many diseases; however, unfortunately its deficiency is widespread, so a greater availability of folate rich foods is desirable. The aim of this study was to design new cereal products naturally enriched in folate using barley flour from pearling as ingredient. Folate content of unfortified and fortified commercial grain-based products was considered to identify the best ingredients for new formulation and for folate content comparisons. Nineteen Italian barley cultivars were evaluated for their folate content and Natura was chosen for its highest folate levels = 69.3 μg/100 g f.w. Application of pearling gave a by-product flour with a high folate level: 221.7 ± 7.0 μg/100 g; this flour was employed to design pasta and biscuits naturally enriched in folate: 87.1 μg/100 g and 70.1 ± 3.7 μg/100 g f.w., respectively. Folate content of new products is higher than commercial samples: 39.2 μg/100 g in refined pasta, 60.4 μg/100 g in wholemeal pasta, 62.1 μg/100 g in fortified biscuits and 10.4 μg/100 g in unfortified ones. Enriched pasta had higher folate retention (68.5%) after cooking compared to the fortified one (27.8%). This research shows promising results concerning the pearling technique to design new cereal products naturally enriched in folates.
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‘Closing the loop’: re-audit of the diagnosis and management of vitamin B12 deficiency in general practice. Ir J Med Sci 2022:10.1007/s11845-022-03103-w. [DOI: 10.1007/s11845-022-03103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
Abstract
Introduction
Vitamin B12 deficiency is common in Ireland, The Irish Longitudinal Study on Aging (TILDA) survey indicates 12% of over 50s in Ireland are low or deficient. The condition is commonly managed exclusively in general practice.
Aim
The intention of this audit was to establish whether B12 deficiency is diagnosed correctly and whether there was over-treatment of patients.
Methods
The audit was conducted in an urban general practice in midwest Ireland. The primary limitation was the low number of patients. Thirty-five patients were included after practice database searches. An initial audit was performed which compared with the standard, Royal University of Bath: ‘Guidelines for the Investigation & Management of B12 deficiency’.
Results
The recommendations from this audit were to complete follow-on investigations and to switch over patients from IM to oral replacement. Twenty-one patients were then recalled, and investigations were performed. Ten patients were then switched from IM replacement to oral therapy. A re-audit was then completed. The re-audit showed marked improvement in compliance, from 17% (n = 6) to 83% (n = 29). The reduction in patients on IM therapy will decrease practice burden, with an annual reduction of nurse consultations by 46, representing a 30% decrease in nurse consultations for IM vitamin B12. This equates to an annual cost reduction of €1,340.
Conclusion
This closed loop audit demonstrated that there was over treatment and under investigation of patients with B12 deficiency in general practice and that auditing of this process could both reduce risk for patients and save money and time.
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12
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Neoh K, Page A, Chin-Yee N, Doree C, Bennett MI. Practice review: Evidence-based and effective management of anaemia in palliative care patients. Palliat Med 2022; 36:783-794. [PMID: 35331051 PMCID: PMC9087312 DOI: 10.1177/02692163221081967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anaemia is a common sequela of advanced disease and is associated with significant symptom burden. No specific guidance exists for the investigation and management of anaemia in palliative care patients. AIM We aim to offer a pragmatic overview of the approaches to investigate and manage anaemia in advanced disease, based on guidelines and evidence in disease specific patient groups, including cancer, heart failure and chronic kidney disease. DESIGN Scoping review methodology was used to determine the strength of evidence supporting the investigation and management of anaemia in patients with advanced disease. DATA SOURCES A search for guidelines was performed in 2020. National or international guidelines were examined if they described the investigation or management of anaemia in adult patients with health conditions seen by palliative care services written within the last 5 years in the English language. Searches of MEDLINE, the Cochrane library and WHO guidance were made in 2019 to identify key publications that provided additional primary data. RESULTS Evidence supports patient-centred investigation of anaemia, results of which should guide targeted intervention. Blanket use of blood transfusion should be avoided, with evidence supporting a more restrictive approach to transfusion. Routine use of oral iron and erythropoetin stimulating agents (ESAs) are not recommended. Insufficient evidence exists to determine the effectiveness of IV iron in this patient group. CONCLUSION We advocate early consideration and investigation of anaemia, guided by symptom burden and patient preferences. Correction of reversible causes should be the mainstay of treatment, with a restrictive approach to blood transfusion. Research is required to evaluate the efficacy of IV iron in these patients.
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Affiliation(s)
- Karen Neoh
- St Gemma’s Hospice, Leeds, UK
- Karen Neoh, St Gemma’s Hospice, 329
Harrogate Road, Leeds, LS17 6QD, UK.
| | - Andrew Page
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, Leeds, UK
| | - Nicolas Chin-Yee
- Department of Medicine, Division of
Palliative Care, St. Michael’s Hospital, Toronto, Canada
| | - Carolyn Doree
- NHS Blood and Transplant Systematic
Review Initiative, Oxford, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, Leeds, UK
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13
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Nutrition policy: developing scientific recommendations for food-based dietary guidelines for older adults living independently in Ireland. Proc Nutr Soc 2022; 81:49-61. [DOI: 10.1017/s0029665122001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.
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14
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Low folate predicts accelerated cognitive decline: 8-year follow-up of 3140 older adults in Ireland. Eur J Clin Nutr 2022; 76:950-957. [PMID: 35022554 DOI: 10.1038/s41430-021-01057-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine associations of plasma folate concentrations and risk of global and domain-specific cognitive decline in older people. METHODS Data of 3140 participants from The Irish Longitudinal Study on Ageing (TILDA), a nationally-representative cohort of adults aged ≥50 years were used over 8-year follow-up. Biannual cognitive assessments included the Mini-Mental State Examination (MMSE), verbal fluency and immediate and delayed word recall tests (Waves 1-5) and the Montreal Cognitive Assessment, (MoCA) (Waves 1 and 3). Plasma folate concentrations were measured in stored blood collected at baseline. Mixed effects Poisson and linear regression determined associations between baseline folate concentrations and cognition. RESULTS In multivariable-adjusted models of those aged ≥50 years at baseline, low folate at baseline (<11.2 nmol/L) was associated with higher proportions of MMSE errors (incidence rate ratio [IRR] = 1.10; 95% confidence interval [CI] (1.00, 1.21), lowest vs. highest quintile) over 8 years. Plasma folate <21.8 nmol/L predicted declines in episodic memory for immediate (beta [β] = -0.26; 95% CI (-0.48, -0.03), β = -0.29; 95% CI (-0.50, 0.08) and β = -0.29; (-0.50, -0.08), for lowest three vs. highest quintile) and delayed recall (β = -0.20; 95% CI (-0.38, -0.01), β = -0.18; 95% CI (-0.37, -0.01) and β = -0.19; (-0.36, -0.01) lowest three vs. highest quintile). There were no significant associations in a subsample aged ≥65 years. CONCLUSION In those aged ≥50 years, lower concentrations of folate may have differential relationships with cognitive domains. Folate <11.2 nmol/L predicted a decline in global cognitive function, while <21.8 nmol/L predicted poorer episodic memory. Low folate was associated with accelerated decline in cognitive function and is an important marker for cognitive decline among older people.
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15
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Heffernan M, Doherty LC, Hack Mendes R, Clarke M, Hodge S, Clements M, McAnena L, Rivelsrud M, Ward M, Strain JJ, McNulty H, Brennan L. Effectiveness of a fortified drink in improving B vitamin biomarkers in older adults: a controlled intervention trial. Nutr Metab (Lond) 2021; 18:104. [PMID: 34876175 PMCID: PMC8650259 DOI: 10.1186/s12986-021-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Older adults are reported to have sub-optimal B vitamin status; targeted food-based solutions may help to address this. The objectives of the OptiAge food intervention study were to develop and investigate the effectiveness of a B vitamin-fortified drink in improving B vitamin biomarkers in older Irish adults with a primary outcome of change in the B vitamin biomarker status. Methods A double-blinded randomised controlled trial was performed in parallel at University College Dublin and Ulster University. Participants aged > 50 years were recruited following screening for exclusion criteria (i.e. taking medications known to interfere with B vitamin metabolism, supplements containing B vitamins, consuming > 4 portions of B vitamin-fortified foods per week or diagnosed with gastrointestinal, liver or pulmonary disease). Recruited participants meeting the inclusion criteria were randomised (by sex and study centre) to receive daily for 16 weeks either B vitamin-fortified or placebo drinks as developed by Smartfish, Norway. Each B vitamin-fortified drink (200 ml) contained 200 µg folic acid, 10 µg vitamin B12, 10 mg vitamin B6 and 5 mg riboflavin, while the placebo was an identical, isocaloric formulation without added B vitamins. Fasting blood samples were collected pre- and post-intervention which were used to measure the primary outcome of change in B vitamin biomarker levels. Results A total of 95 participants were randomised, of which 81 commenced the trial. Of these, 70 completed (37 in the active and 33 in the placebo groups). Intention to treat (ITT) analysis of the B vitamins demonstrated a significant improvement in all B vitamin biomarkers in the active compared to placebo groups: p < 0.01 for each of serum folate, serum vitamin B12 and plasma pyridoxal 5′-phosphate (vitamin B6) and the functional riboflavin biomarker, erythrocyte glutathione reductase activation coefficient (EGRac). Correspondingly, a significant lowering of serum homocysteine from 11.9 (10.3–15.1) µmol/L to 10.6 (9.4–13.0) µmol/L was observed in response to the active treatment (P < 0.001). Similar results were seen in a per-protocol analysis. Conclusions The results demonstrate that a B vitamin-fortified drink was effective in optimising B vitamin status, making this a useful intervention option to improve B vitamin status in older adults. Trial registration ISRCTN, ISRCTN61709781—Retrospectively registered, https://www.isrctn.com/ISRCTN61709781 Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00630-8.
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Affiliation(s)
- Maria Heffernan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Leanne C Doherty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Roberta Hack Mendes
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Michelle Clarke
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Stephanie Hodge
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | | | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Lorraine Brennan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
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16
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Porter KM, Hoey L, Hughes CF, Ward M, Clements M, Strain J, Cunningham C, Casey MC, Tracey F, O'Kane M, Pentieva K, McAnena L, McCarroll K, Laird E, Molloy AM, McNulty H. Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B-12 status, and the impact of fortified foods, in older adults. Am J Clin Nutr 2021; 114:1286-1294. [PMID: 34134144 PMCID: PMC8488868 DOI: 10.1093/ajcn/nqab193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking. OBJECTIVES To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults. METHODS Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008-2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value < -0.5. A pepsinogen I:II ratio <3 was considered indicative of AG. RESULTS AG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P < 0.001) and plasma holotranscobalamin (holoTC; P < 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P < 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0-4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG. CONCLUSIONS Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.
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Affiliation(s)
- Kirsty M Porter
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Jj Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Conal Cunningham
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Miriam C Casey
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, Northern Ireland, United Kingdom
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
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17
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Vora RM, Alappattu MJ, Zarkar AD, Soni MS, Karmarkar SJ, Antony AC. Potential for elimination of folate and vitamin B 12 deficiency in India using vitamin-fortified tea: a preliminary study. BMJ Nutr Prev Health 2021; 4:293-306. [PMID: 34308138 PMCID: PMC8258070 DOI: 10.1136/bmjnph-2020-000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/14/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction The majority of Indian women have a poor dietary folate and vitamin B12 intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea-the second most common beverage worldwide (after water)-is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B12, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India. Methods Women (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate plus either 0.1 mg vitamin B12 (Group-1, n=19) or 0.5 mg vitamin B12 (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared. Results Most women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B12 levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p<0.05) and 6.69 ng/mL (95% CI 3.93 to 9.44, p<0.05), respectively; however, Group-0 experienced an insignificant rise of 1.26 ng/mL (95% CI -4.08 to 0.16). In addition, over one-half and two-thirds of women in Group-1 and Group-2, respectively, exhibited increases in serum vitamin B12 levels over 300 pg/mL. There was also a significant post-interventional increase in the mean haemoglobin concentration in Group-1 of 1.45 g/dL (95% CI 0.64 to 2.26, p=0.002) and Group-2 of 0.79 g/dL (95% CI 0.11 to 1.42, p=0.027), which reflected a bona fide clinical response. Conclusion Tea is an outstanding scalable vehicle for fortification with folate and vitamin B12 in India, and has potential to help eliminate haematological and neurological complications arising from inadequate dietary consumption or absorption of folate and vitamin B12.
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Affiliation(s)
- Ravindra M Vora
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Implementing The Lancet Commission on Global Surgery in India, Sangli, Maharashtra, India
| | - Meryl J Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Apoorva D Zarkar
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Sangli, Maharashtra, India
| | - Mayur S Soni
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Sangli, Maharashtra, India
| | - Santosh J Karmarkar
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Aśok C Antony
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Meyer M, Leiss F, Greimel F, Renkawitz T, Grifka J, Maderbacher G, Weber M. Impact of malnutrition and vitamin deficiency in geriatric patients undergoing orthopedic surgery. Acta Orthop 2021; 92:358-363. [PMID: 33538225 PMCID: PMC8231356 DOI: 10.1080/17453674.2021.1882092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is growing evidence that hypoproteinemia is an important risk factor for adverse events after surgery. Less is known about the impact of vitamin deficiency on postoperative outcome. Therefore we evaluated the prevalence and impact of malnutrition and vitamin deficiency in geriatric patients undergoing elective orthopedic surgery.Patients and methods - In a retrospective analysis of 599 geriatric patients who had undergone elective orthopedic surgery in 2018 and 2019, hypoproteinemia, and deficiency of vitamin D, vitamin B12, and folate were assessed. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between malnourished patients and patients with normal parameters. Multivariable logistic regression models were used to assess the relationship between malnutrition and postoperative adverse events, controlling for confounding factors such as age, sex, diabetes mellitus, and frailty.Results - Patients with malnutrition showed a higher rate of reoperation (13% vs. 5.5%; p = 0.01) and exhibited more wound-healing disorders (7.4% vs. 1.3%, p = 0.001) as well as Clavien-Dindo IV° complications (7.4% vs. 2.4%; p = 0.03). Deficiency of vitamin D led to a higher rate of falls (8.4% vs. 2.9%, p = 0.006). Deficiency of vitamin B12 and folate did not affect postoperative adverse events. Although correlated to frailty (p = 0.004), multivariable regression analysis identified malnutrition as independent risk factor for reoperation (OR 2.6, 95% CI 1.1-6.2) and wound healing disorders (OR 7.1, CI 1.9-26).Interpretation - Malnutrition is common among geriatric patients undergoing elective orthopedic surgery and represents an independent risk factor for postoperative adverse events.
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Affiliation(s)
- Matthias Meyer
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach; ,Correspondence:
| | - Franziska Leiss
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Felix Greimel
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | | | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Günther Maderbacher
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Markus Weber
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
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Rodd BG, Tas AA, Taylor KDA. Dysphagia, texture modification, the elderly and micronutrient deficiency: a review. Crit Rev Food Sci Nutr 2021; 62:7354-7369. [PMID: 33905267 DOI: 10.1080/10408398.2021.1913571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dysphagia is an underlying symptom of many health issues affecting a person's ability to swallow. Being unable to swallow correctly may limit food intake and subsequently micronutrient status. The elderly may be the most at risk group of suffering dysphagia as well as most likely to be deficient in micronutrients. The use of texture-modified meals is a common approach to increasing dysphagia sufferer's food intake. The modification of food may affect the micronutrient content and currently there is a limited number of studies focusing on micronutrient content of texture-modified meals. This review considers the prevalence of dysphagia within the elderly UK community whilst assessing selected micronutrients. Vitamin B12, C, D, folate, zinc and iron, which are suggested to be most likely deficient in the general elderly UK population, were reviewed. Each micronutrient is considered in terms of prevalence of deficiency, metabolic function, food source and processing stability to provide an overview with respect to elderly dysphagia sufferers.
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Affiliation(s)
- B G Rodd
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - A A Tas
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - K D A Taylor
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
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20
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Wee AKH. COVID-19's toll on the elderly and those with diabetes mellitus - Is vitamin B12 deficiency an accomplice? Med Hypotheses 2021; 146:110374. [PMID: 33257090 PMCID: PMC7659645 DOI: 10.1016/j.mehy.2020.110374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/20/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 exacts a disproportionate toll on both the elderly and those with diabetes; these patients are more likely to require costly intensive care, longer hospitalisation, and die from complications. Nations would thus find it extremely difficult to either lift or sustain socially, economically, and politically damaging restrictions that keep this group of people safe. Without a vaccine, there is thus an urgent need to identify potential modifiable risk factors which can help manage overall fatality or recovery rates. Case fatality rates are highly variable between (and even within) nations; nutritional differences have been proposed to account significantly for this disparity. Indeed, vitamin B12 deficiency is a common denominator between the elderly and those with diabetes. The question on hand thus lies on whether managing B12 deficiencies will impact COVID-19 fatality outcome or recovery rates. Herein, we review the latest evidence that shows that B12 deficiency associates in multiple areas very similar to where COVID-19 exerts its damaging effects: immunologically; microbiologically; haematologically; and through endothelial cell signalling-supporting the hypothesis that B12 deficiency is a potential modifiable risk factor in our fight against COVID-19.
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Affiliation(s)
- Andrew Kien Han Wee
- SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, #01-792, Singapore 440080, Singapore; SingHealth Duke-NUS Medical School, Family Medicine Academic Clinical Programme ("FM ACP"), Office of Academic & Clinical Development, 8 College Road, Singapore 169857, Singapore.
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21
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Del Mondo A, Smerilli A, Sané E, Sansone C, Brunet C. Challenging microalgal vitamins for human health. Microb Cell Fact 2020; 19:201. [PMID: 33138823 PMCID: PMC7607653 DOI: 10.1186/s12934-020-01459-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Vitamins' deficiency in humans is an important threat worldwide and requires solutions. In the concept of natural biofactory for bioactive compounds production, microalgae represent one of the most promising targets filling many biotechnological applications, and allowing the development of an eco-sustainable production of natural bioactive metabolites. Vitamins are probably one of the cutting edges of microalgal diversity compounds. MAIN TEXT Microalgae can usefully provide many of the required vitamins in humans, more than terrestrial plants, for instance. Indeed, vitamins D and K, little present in many plants or fruits, are instead available from microalgae. The same occurs for some vitamins B (B12, B9, B6), while the other vitamins (A, C, D, E) are also provided by microalgae. This large panel of vitamins diversity in microalgal cells represents an exploitable platform in order to use them as natural vitamins' producers for human consumption. This study aims to provide an integrative overview on vitamins content in the microalgal realm, and discuss on the great potential of microalgae as sources of different forms of vitamins to be included as functional ingredients in food or nutraceuticals for the human health. We report on the biological roles of vitamins in microalgae, the current knowledge on their modulation by environmental or biological forcing and on the biological activity of the different vitamins in human metabolism and health protection. CONCLUSION Finally, we critically discuss the challenges for promoting microalgae as a relevant source of vitamins, further enhancing the interests of microalgal "biofactory" for biotechnological applications, such as in nutraceuticals or cosmeceuticals.
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Affiliation(s)
- Angelo Del Mondo
- Stazione Zoologica Anton Dohrn, Istituto Nazionale Di Biologia, Ecologia e Biotecnologie marine, Villa Comunale, 80121, Napoli, Italy
| | - Arianna Smerilli
- Stazione Zoologica Anton Dohrn, Istituto Nazionale Di Biologia, Ecologia e Biotecnologie marine, Villa Comunale, 80121, Napoli, Italy
| | - Elisabet Sané
- Stazione Zoologica Anton Dohrn, Istituto Nazionale Di Biologia, Ecologia e Biotecnologie marine, Villa Comunale, 80121, Napoli, Italy
| | - Clementina Sansone
- Stazione Zoologica Anton Dohrn, Istituto Nazionale Di Biologia, Ecologia e Biotecnologie marine, Villa Comunale, 80121, Napoli, Italy.
| | - Christophe Brunet
- Stazione Zoologica Anton Dohrn, Istituto Nazionale Di Biologia, Ecologia e Biotecnologie marine, Villa Comunale, 80121, Napoli, Italy
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22
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Zhu Y, Minović I, Dekker LH, Eggersdorfer ML, van Zon SK, Reijneveld SA, Kootstra-Ros JE, Kema IP, Bakker SJ, Navis GJ, Riphagen IJ. Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study. Nutrients 2020; 12:nu12092659. [PMID: 32878227 PMCID: PMC7551314 DOI: 10.3390/nu12092659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60–75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.
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Affiliation(s)
- Yinjie Zhu
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
- Correspondence: ; Tel.: +31(0)62-665-2320
| | - Isidor Minović
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Louise H. Dekker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | | | - Sander K.R. van Zon
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.K.R.v.Z.); (S.A.R.)
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.K.R.v.Z.); (S.A.R.)
| | - Jenny E. Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Ido P. Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | - Ineke J. Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
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Amenyah SD, Ward M, Strain JJ, McNulty H, Hughes CF, Dollin C, Walsh CP, Lees-Murdock DJ. Nutritional Epigenomics and Age-Related Disease. Curr Dev Nutr 2020; 4:nzaa097. [PMID: 32666030 PMCID: PMC7335360 DOI: 10.1093/cdn/nzaa097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/27/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022] Open
Abstract
Recent advances in epigenetic research have enabled the development of epigenetic clocks, which have greatly enhanced our ability to investigate molecular processes that contribute to aging and age-related disease. These biomarkers offer the potential to measure the effect of environmental exposures linked to dynamic changes in DNA methylation, including nutrients, as factors in age-related disease. They also offer a compelling insight into how imbalances in the supply of nutrients, particularly B-vitamins, or polymorphisms in regulatory enzymes involved in 1-carbon metabolism, the key pathway that supplies methyl groups for epigenetic reactions, may influence epigenetic age and interindividual disease susceptibility. Evidence from recent studies is critically reviewed, focusing on the significant contribution of the epigenetic clock to nutritional epigenomics and its impact on health outcomes and age-related disease. Further longitudinal studies and randomized nutritional interventions are required to advance the field.
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Affiliation(s)
- Sophia D Amenyah
- Genomic Medicine Research Group , School of Biomedical Sciences, Ulster University, Northern Ireland, United Kingdom. BT52 1SA
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom. BT52 1SA
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom. BT52 1SA
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom. BT52 1SA
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom. BT52 1SA
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom. BT52 1SA
| | - Caitlin Dollin
- Genomic Medicine Research Group , School of Biomedical Sciences, Ulster University, Northern Ireland, United Kingdom. BT52 1SA
| | - Colum P Walsh
- Genomic Medicine Research Group , School of Biomedical Sciences, Ulster University, Northern Ireland, United Kingdom. BT52 1SA
| | - Diane J Lees-Murdock
- Genomic Medicine Research Group , School of Biomedical Sciences, Ulster University, Northern Ireland, United Kingdom. BT52 1SA
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Kanti G, Anadol-Schmitz E, Bobrov P, Strassburger K, Kahl S, Zaharia OP, Sarabhai T, Karusheva Y, Burkart V, Markgraf DF, Trenkamp S, Ziegler D, Szendroedi J, Roden M. Vitamin B12 and Folate Concentrations in Recent-onset Type 2 Diabetes and the Effect of Metformin Treatment. J Clin Endocrinol Metab 2020; 105:5812595. [PMID: 32219330 DOI: 10.1210/clinem/dgaa150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/23/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT Vitamin B12 and folate deficiency are not only linked to hematological, neurological, and cardiovascular diseases, but are also associated with insulin resistance. Metformin can decrease vitamin B12 and folate concentrations. OBJECTIVE To examine (1) effects of short-term metformin treatment on serum holotranscobalamin (holoTC) and folate and (2) their association with insulin sensitivity in recent-onset type 2 diabetes. DESIGN This cross-sectional analysis comprised patients (known disease duration <12 months) on metformin monotherapy (MET, n = 123, 81 males, 53 ± 12 years) or nonpharmacological treatment (NPT, n = 126, 77 males, 54 ± 11 years) of the German Diabetes Study. MAIN OUTCOME MEASURES HoloTC (enzyme-linked immunosorbent assay), cobalamin, and folate (electrochemiluminescence); beta-cell function and whole-body insulin sensitivity, measured during fasting (HOMA-B, HOMA-IR) and intravenous glucose tolerance tests combined with hyperinsulinemic-euglycemic clamp tests. RESULTS HoloTC (105.4 [82.4, 128.3] vs 97 [79.7, 121.9] pmol/L) and folate concentrations (13.4 [9.3, 19.3] vs 12.7 [9.3, 22.0] nmol/L) were similar in both groups. Overall, holoTC was not associated with fasting or glucose-stimulated beta-cell function and insulin-stimulated glucose disposal. Cobalamin measurements yielded similar results in representative subgroups. In NPT but not MET, folate levels were inversely correlated with HOMA-IR (r = -0.239, P = .007). Folate levels did not relate to insulin sensitivity or insulin secretion in the whole cohort and in each group separately after adjustment for age, body mass index, and sex. CONCLUSIONS Metformin does not affect circulating holoTC and folate concentrations in recent-onset type 2 diabetes, rendering monitoring of vitamin B12 and folate dispensable, at least during the first 6 months after diagnosis or initiation of metformin.
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Affiliation(s)
- Georgia Kanti
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Evrim Anadol-Schmitz
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Pavel Bobrov
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Sabine Kahl
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Oana P Zaharia
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Theresia Sarabhai
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Yanislava Karusheva
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Daniel F Markgraf
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Sandra Trenkamp
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Plasma concentrations of vitamin B 12 and folate and global cognitive function in an older population: cross-sectional findings from The Irish Longitudinal Study on Ageing (TILDA). Br J Nutr 2020; 124:602-610. [PMID: 32329423 DOI: 10.1017/s0007114520001427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.
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Wakeman M, Archer DT. Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels? Diabetes Metab Syndr Obes 2020; 13:2093-2108. [PMID: 32606868 PMCID: PMC7308123 DOI: 10.2147/dmso.s237454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/27/2020] [Indexed: 12/13/2022] Open
Abstract
Metformin is the first-choice drug in uncomplicated type 2 diabetes (T2DM) and is effective in improving glycaemic control. It is the most widely prescribed oral antidiabetic medicine and has a good safety profile. However, there is an abundance of evidence that metformin use is associated with decreased Vitamin B12 status, though the clinical implications of this in terms of increased risk of diabetic peripheral neuropathy are debated. There is growing evidence that other B vitamins, vitamin D and magnesium may also be impacted by metformin use in addition to alterations to the composition of the microbiome, depending on the dose and duration of therapy. Patients using metformin for prolonged periods may, therefore, need initial screening with intermittent follow-up, particularly since vitamin B12 deficiency has similar symptoms to diabetic neuropathy which itself affects 40-50% of patients with T2DM at some stage. Among patients with T2DM, 40% are reported to experience symptomatic gastroesophageal reflux disease (GORD), of whom 70% use oral antidiabetic medications. The most common medications used to treat GORD are proton pump inhibitors (PPIs) and antagonists of histamine selective H2 receptors (H2RAs), both of which independently affect vitamin B12 and magnesium status. Research indicates that co-prescribing metformin with either PPIs or H2RAs can have further deleterious effects on vitamin B12 status. Vitamin B12 deficiency related to metformin and polypharmacy is likely to contribute to the symptoms of diabetic neuropathy which may frequently be under-recognised. This review explores current knowledge surrounding these issues and suggests treatment strategies such as supplementation.
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Affiliation(s)
- Michael Wakeman
- Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, SunderlandSR1, UK
- Correspondence: Michael Wakeman Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, SunderlandSR1 3SD, UKTel +44 191 5153381 Email
| | - David T Archer
- Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, SunderlandSR1, UK
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27
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Ortet-Walker A, Ponsford A, McIntosh B. Communicating with patients using a new vitamin B12 deficiency leaflet. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:1450-1454. [PMID: 31835933 DOI: 10.12968/bjon.2019.28.22.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this quality improvement project was to improve patients' knowledge about their vitamin B12 deficiency by developing an information leaflet and engaging nursing staff in providing this educational tool to patients with the condition. Following two 'plan, do, study, act' cycles to test and improve implementation of the leaflet, the nursing team met the goal of 100% compliance with providing educational information to patients. An increase in patient knowledge following provision of the leaflet was predicted, and achieved.
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O'Halloran AM, Laird EJ, Feeney J, Healy M, Moran R, Beatty S, Nolan JM, Molloy AM, Kenny RA. Circulating Micronutrient Biomarkers Are Associated With 3 Measures of Frailty: Evidence From the Irish Longitudinal Study on Ageing. J Am Med Dir Assoc 2019; 21:240-247.e5. [PMID: 31401047 DOI: 10.1016/j.jamda.2019.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the associations between 3 frailty instruments and circulating micronutrients in a large representative sample of older adults. DESIGN Cross-sectional data from a nationally representative cohort study conducted between October 2009 and July 2011. PARTICIPANTS AND SETTING Adults age ≥50 years (n = 4068) living in the community in Ireland. MEASUREMENTS Circulating micronutrients (lutein, zeaxanthin, folate, vitamin B-12, and vitamin D) were measured, transformed, and standardized. Frailty was assessed using the Frailty Phenotype, the Frailty Index, and the FRAIL Scale (fatigue, resistance, ambulation, illnesses, and loss of weight), instruments. Multinomial logistic regression determined associations between micronutrients and prefrailty or frailty. Models were adjusted for sociodemographic, lifestyle, health, and seasonal factors. RESULTS Adjusting for age, sex, and educational attainment, all 3 measures of frailty were associated with lower levels of lutein [relative risk ratios (RRRs): 0.43‒0.63], zeaxanthin (RRRs: 0.49‒0.63), and vitamin D (RRRs: 0.51‒0.75), and with the accumulation of micronutrient insufficiencies (RRRs: 1.42‒1.90). Attenuated but significant associations were also observed with all measures of prefrailty for lutein, vitamin D, and number of micronutrient insufficiencies. The associations with frailty persisted following additional adjustment for social, lifestyle, and health and seasonal factors, and following multiple test correction. CONCLUSIONS AND IMPLICATIONS We have presented the most consistent evidence in the largest study to date that micronutrient concentrations are associated with prefrailty and frailty in older adults. Our data suggest that low micronutrient status has potential as an easily modifiable marker and intervention target for frailty and supports further investigation into micronutrient supplementation and fortification to prevent frailty and disability among older adults.
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Affiliation(s)
- Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland.
| | - Eamon J Laird
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, Laboratory Medicine and Molecular Pathology, St James's Hospital, Dublin, Ireland
| | - Rachel Moran
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | | | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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Abstract
Population ageing is rapidly progressing and it is estimated that by 2050 one in every five people globally will be aged 60 years or over. Research has shown that adequate nutritional status can positively impact the ageing process, resulting in improved quality of life and the prevention of chronic disease and mortality. However, due to physiological and social changes associated with ageing, older adults may be at increased risk of nutrient deficiencies. This review aims to investigate the nutrient intake and status of older adults in Europe and to explore the potential role of fortified foods and nutritional supplements in addressing some of the nutritional challenges identified in this population group. The available literature has highlighted unfavourable intakes of total and saturated fat, sugar, salt and dietary fibre together with low intakes and suboptimal status of key micronutrients such as vitamins D, B2, B12, folate and calcium. Evidence has shown that the consumption of fortified foods and use of nutritional supplements make significant contributions to intakes and status of these micronutrients in older adults. Continued monitoring of nutrient intake and status is important in light of changing fortification practices and food consumption patterns. Future strategies to address the nutritional issues identified in older adults could include the promotion of healthy food choices together with improvements of the food supply including reformulation (fat, sugar and salt), food fortification or supplementation to support successful ageing of our populations.
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