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Bokayeva K, Jamka M, Walkowiak D, Duś-Żuchowska M, Herzig KH, Walkowiak J. Vitamin Status in Patients with Phenylketonuria: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:5065. [PMID: 38791104 PMCID: PMC11120668 DOI: 10.3390/ijms25105065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The published data on the vitamin status of patients with phenylketonuria (PKU) is contradictory; therefore, this systematic review and meta-analysis evaluated the vitamin status of PKU patients. A comprehensive search of multiple databases (PubMed, Web of Sciences, Cochrane, and Scopus) was finished in March 2024. The included studies compared vitamin levels between individuals diagnosed with early-treated PKU and healthy controls while excluding pregnant and lactating women, untreated PKU or hyperphenylalaninemia cases, control groups receiving vitamin supplementation, PKU patients receiving tetrahydrobiopterin or pegvaliase, and conference abstracts. The risk of bias in the included studies was assessed by the Newcastle-Ottawa scale. The effect sizes were expressed as standardised mean differences. The calculation of effect sizes with 95% CI using fixed-effects models and random-effects models was performed. A p-value < 0.05 was considered statistically significant. The study protocol was registered in the PROSPERO database (CRD42024519589). Out of the initially identified 11,086 articles, 24 met the criteria. The total number of participants comprised 770 individuals with PKU and 2387 healthy controls. The meta-analyses of cross-sectional and case-control studies were conducted for vitamin B12, D, A, E, B6 and folate levels. PKU patients demonstrated significantly higher folate levels (random-effects model, SMD: 1.378, 95% CI: 0.436, 2.320, p = 0.004) and 1,25-dihydroxyvitamin D concentrations (random-effects model, SMD: 2.059, 95% CI: 0.250, 3.868, p = 0.026) compared to the controls. There were no significant differences in vitamin A, E, B6, B12 or 25-dihydroxyvitamin D levels. The main limitations of the evidence include a limited number of studies and their heterogeneity and variability in patients' compliance. Our findings suggest that individuals with PKU under nutritional guidance can achieve a vitamin status comparable to that of healthy subjects. Our study provides valuable insights into the nutritional status of PKU patients, but further research is required to confirm these findings and explore additional factors influencing vitamin status in PKU.
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Affiliation(s)
- Kamila Bokayeva
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Małgorzata Jamka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego Str. 39, 60-356 Poznań, Poland;
| | - Monika Duś-Żuchowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Karl-Heinz Herzig
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
- Research Unit of Biomedicine and Internal Medicine, Biocenter of Oulu, Medical Research Center, Oulu University Hospital, University of Oulu, Aapistie Str. 5, 90220 Oulu, Finland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
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de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients 2022; 14:nu14050982. [PMID: 35267957 PMCID: PMC8912303 DOI: 10.3390/nu14050982] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy;
| | - Paola Emilia Ferrara
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Giuseppe Raguso
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark
| | - Gianpaolo Ronconi
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Migliario
- Dental Clinic, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
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Hailu BA, Ketema G, Beyene J. Mapping of mothers' suffering and child mortality in Sub-Saharan Africa. Sci Rep 2021; 11:19544. [PMID: 34599223 PMCID: PMC8486808 DOI: 10.1038/s41598-021-98671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Child death and mothers who suffer from child death are a public health concern in Sub-Saharan Africa. The location and associated factors of child death and mothers who suffer child death were not identified. To monitor and prioritize effective interventions, it is important to identify hotspots areas and associated factors. Data from nationally representative demographic and health survey and Multiple Indicator Cluster administrated in 42 Sub-Sahara Africa countries, which comprised a total of 398,574 mothers with 1,521,312 children. Spatial heterogeneity conducted hotspot regions identified. A mixed-effect regression model was run, and the adjusted ratio with corresponding 95% confidence intervals was estimated. The prevalence of mothers who suffer child death 27% and 45-49 year of age mother 48%. In Niger, 47% of mothers were suffering child death. Women being without HIV knowledge, stunted, wasted, uneducated, not household head, poor, from rural, and from subtropical significantly increased the odds of the case (P < 0.05). The spatial analysis can support the design and prioritization of interventions. Multispectral interventions for mothers who suffer from child death are urgently needed, improve maternal health and it will reduce the future risk of cases.
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Affiliation(s)
| | - Gebremariam Ketema
- Department of Pharmacy, Collage of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Gasmi A, Chirumbolo S, Peana M, Mujawdiya PK, Dadar M, Menzel A, Bjørklund G. Biomarkers of Senescence during Aging as Possible Warnings to Use Preventive Measures. Curr Med Chem 2021; 28:1471-1488. [PMID: 32942969 DOI: 10.2174/0929867327999200917150652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
Human life expectancy is increasing significantly over time thanks to the improved possibility for people to take care of themselves and the higher availability of food, drugs, hygiene, services, and assistance. The increase in the average age of the population worldwide is, however, becoming a real concern, since aging is associated with the rapid increase in chronic inflammatory pathologies and degenerative diseases, very frequently dependent on senescent phenomena that occur alongside with senescence. Therefore, the search for reliable biomarkers that can diagnose the possible onset or predict the risk of developing a disease associated with aging is a crucial target of current medicine. In this review, we construct a synopsis of the main addressable biomarkers to study the development of aging and the associated ailments.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Alain Menzel
- Laboratoires Réunis, Junglinster, Luxembourg, Norway
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
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Park SH, Han SH, Chang KJ. Comparison of nutrient intakes by nutritional anemia and the association between nutritional anemia and chronic diseases in Korean elderly: Based on the 2013-2015 Korea National Health and Nutrition Examination Survey Data. Nutr Res Pract 2019; 13:543-554. [PMID: 31814930 PMCID: PMC6883233 DOI: 10.4162/nrp.2019.13.6.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/06/2019] [Accepted: 08/29/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/OBJECTIVES The elderly are reported to have a high prevalence of nutritional anemia when they have lower intakes of nutrients or chronic diseases. This study was conducted to compare nutritional status according to nutritional anemia and to determine associations between nutritional anemia and chronic diseases in Korean elderly. MATERIALS/METHODS This study utilized data on 3,258 elderly aged ≥ 65 years gathered during the 6th Korea National Health and Nutrition Examination Survey 2013-2015. Subjects were divided into nutritional anemia (NA) group (n = 415) and non-NA group (n = 2,843) by hemoglobin concentration. Nutrient intakes were assessed using dietary intake data obtained using the 24-hour recall method. The odds ratios (ORs) for nutritional anemia by chronic diseases were determined. Statistical analysis was performed using SPSS Ver. 23.0. RESULTS Of 3,258 subjects, 12.7% had nutritional anemia. Intakes of potatoes, pulses, and mushrooms by males and potatoes, fruits, meats, eggs, and seafood by females were significantly lower in NA group than in non-NA group. The proportion of the subjects whose intakes of protein, vitamin A, vitamin B1, vitamin B2, niacin, and iron less than estimated average requirement (EAR) were significantly higher in NA group compared to non-NA group. After adjusting for age, the number of family members, energy intake, and alcohol drinking, ORs for nutritional anemia in the subjects with diabetes and myocardial infarction or angina pectoris were significantly higher by 1.74 times and 1.59 times as compared to the subjects without those diseases, respectively. However, ORs for nutritional anemia in the subjects with obesity, abdominal obesity, and hypertriglyceridemia were significantly lower by 0.64 times, 0.60 times, and 0.59 times as compared to the subjects without those diseases, respectively. CONCLUSIONS The results of this study suggested that nutritional management should be done to enable the Korean elderly to consume foods with high hematopoietic nutrients density to prevent nutritional anemia. Korean elderly need to make regular efforts to check for nutritional anemia.
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Affiliation(s)
- So Hyun Park
- Department of Food and Nutrition, Inha University, 100 Inha-ro, Michuhol-Gu, Incheon 22212, Korea
| | - So Hee Han
- Department of Food and Nutrition, Inha University, 100 Inha-ro, Michuhol-Gu, Incheon 22212, Korea
| | - Kyung Ja Chang
- Department of Food and Nutrition, Inha University, 100 Inha-ro, Michuhol-Gu, Incheon 22212, Korea
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Obeid R, Heil SG, Verhoeven MMA, van den Heuvel EGHM, de Groot LCPGM, Eussen SJPM. Vitamin B12 Intake From Animal Foods, Biomarkers, and Health Aspects. Front Nutr 2019; 6:93. [PMID: 31316992 PMCID: PMC6611390 DOI: 10.3389/fnut.2019.00093] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
The EAT-Lancet commission recently suggested that transformation to healthy diets by 2050 will require a reduction of at least 50% in consumption of foods such as red meat and sugar, and a doubling in the global consumption of fruits, vegetables, nuts, and legumes. A diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits. Notably, the risk of vitamin B12 deficiency increases when consuming a diet low in animal products. Humans are dependent on animal foods such as dairy products, meat, fish and eggs. Vitamin B12 deficiency is common worldwide, especially in populations with low consumption of animal foods because of low socioeconomic status, ethical reasons, or because of their lifestyle (i.e., vegans). According to the European Food Safety Authoroty, the recommended adequate intake of vitamin B12 is 4.0 μg/d for adults, and vitamin B12 requirements are higher during pregnancy and lactation. Infants and children from deficient mothers and elderly people are at risk for vitamin B12 deficiency. Diagnosis of vitamin B12 deficiency is hampered by low specificity of available biomarkers, and there is no consensus yet regarding the optimal definition of low vitamin B12 status. In general, a combination of at least two biomarkers is recommended. Therefore, this review presents an overview of vitamin B12 biochemistry and its biomarkers. We further summarize current recommendations of vitamin B12 intake, and evidence on the associations of vitamin B12 intake from different nutrient-dense animal foods with vitamin B12 status markers. Finally, potential consequences of low vitamin B12 status on different health outcomes for pregnant women, infants and elderly are presented.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maxime M A Verhoeven
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Simone J P M Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases Maastricht University, Maastricht, Netherlands
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Lee EA, Shin DW, Yoo JH, Ko HY, Jeong SM. Anemia and Risk of Fractures in Older Korean Adults: A Nationwide Population-Based Study. J Bone Miner Res 2019; 34:1049-1057. [PMID: 30690784 DOI: 10.1002/jbmr.3675] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/13/2018] [Accepted: 12/22/2018] [Indexed: 12/13/2022]
Abstract
Anemia is a common health problem in older adults and is associated with risk factors for fracture such as low physical function and low bone mass. The aim of this study was to examine the relationship between anemia and fracture risk in older adults. We conducted a retrospective cohort study from 2003 to 2013. The participants were community-dwelling Korean adults aged 65 years and older who participated in the National Health Screening Program (n = 72,131) between 2003 and 2008. Anemia (<12 g/dL for women and <13 g/dL for men) and severity of anemia (mild: 11 g/dL ≤ Hb < 12 g/dL; moderate to severe: Hb < 11 g/dL) were defined by World Health Organization (WHO) criteria. The incidence of any fractures, vertebral fractures, and femur fractures was identified using ICD-10 codes. Cox proportional hazard regression models were used to assess risk of fracture according to anemia. Anemia was associated with increased risk of fracture in men (any: adjusted hazard ratio [aHR] = 1.29, 95% confidence interval [CI] 1.18-1.41; vertebral: aHR = 1.20, 95% CI 1.03-1.40; femur: aHR = 1.71, 95% CI 1.44-2.04), and less strongly but still significantly in women (any: aHR = 1.10, 95% CI 1.11-1.41; vertebral: aHR = 1.11, 95% CI 1.03-1.20; femur: aHR = 1.37, 95% CI 1.25-1.52). Higher risk was observed in subjects with moderate-to-severe anemia in both sexes. Considering the high prevalence of anemia in older adults, it is important that health professionals recognize increased fracture risk in older adults with anemia. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Eun Ae Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hyun Yoo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Young Ko
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Health Screening Center, Seoul, Korea
| | - Su Min Jeong
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
There is a large body of literature demonstrating the efficacy of maternal folic acid intake in preventing birth defects, as well as investigations into potential adverse consequences of consuming folic acid above the upper intake level (UL). Recently, two authoritative bodies convened expert panels to assess risks from high intakes of folic acid: the U.S. National Toxicology Program and the UK Scientific Advisory Committee on Nutrition. Overall, the totality of the evidence examined by these panels, as well as studies published since the release of their reports, have not established risks for adverse consequences resulting from existing mandatory folic acid fortification programs that have been implemented in many countries. Current folic acid fortification programs have been shown to support public health in populations, and the exposure levels are informed by and adherent to the precautionary principle. Additional research is needed to assess the health effects of folic acid supplement use when the current upper limit for folic acid is exceeded.
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Affiliation(s)
- Martha S. Field
- Division of Nutritional SciencesCornell UniversityIthacaNew York
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Folate rescues vitamin B 12 depletion-induced inhibition of nuclear thymidylate biosynthesis and genome instability. Proc Natl Acad Sci U S A 2017; 114:E4095-E4102. [PMID: 28461497 DOI: 10.1073/pnas.1619582114] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Clinical vitamin B12 deficiency can result in megaloblastic anemia, which results from the inhibition of DNA synthesis by trapping folate cofactors in the form of 5-methyltetrahydrofolate (5-methylTHF) and subsequent inhibition of de novo thymidylate (dTMP) biosynthesis. In the cytosol, vitamin B12 functions in the remethylation of homocysteine to methionine, which regenerates THF from 5-methylTHF. In the nucleus, THF is required for de novo dTMP biosynthesis, but it is not understood how 5-methylTHF accumulation in the cytosol impairs nuclear dTMP biosynthesis. The impact of vitamin B12 depletion on nuclear de novo dTMP biosynthesis was investigated in methionine synthase-null human fibroblast and nitrous oxide-treated HeLa cell models. The nucleus was the most sensitive cellular compartment to 5-methylTHF accumulation, with levels increasing greater than fourfold. Vitamin B12 depletion decreased de novo dTMP biosynthesis capacity by 5-35%, whereas de novo purine synthesis, which occurs in the cytosol, was not affected. Phosphorylated histone H2AX (γH2AX), a marker of DNA double-strand breaks, was increased in vitamin B12 depletion, and this effect was exacerbated by folate depletion. These studies also revealed that 5-formylTHF, a slow, tight-binding inhibitor of serine hydroxymethyltransferase (SHMT), was enriched in nuclei, accounting for 35% of folate cofactors, explaining previous observations that nuclear SHMT is not a robust source of one-carbons for de novo dTMP biosynthesis. These findings indicate that a nuclear 5-methylTHF trap occurs in vitamin B12 depletion, which suppresses de novo dTMP biosynthesis and causes DNA damage, accounting for the pathophysiology of megaloblastic anemia observed in vitamin B12 and folate deficiency.
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Troesch B, Weber P, Mohajeri MH. Potential Links between Impaired One-Carbon Metabolism Due to Polymorphisms, Inadequate B-Vitamin Status, and the Development of Alzheimer's Disease. Nutrients 2016; 8:E803. [PMID: 27973419 PMCID: PMC5188458 DOI: 10.3390/nu8120803] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/24/2022] Open
Abstract
Alzheimer's disease (AD) is the major cause of dementia and no preventive or effective treatment has been established to date. The etiology of AD is poorly understood, but genetic and environmental factors seem to play a role in its onset and progression. In particular, factors affecting the one-carbon metabolism (OCM) are thought to be important and elevated homocysteine (Hcy) levels, indicating impaired OCM, have been associated with AD. We aimed at evaluating the role of polymorphisms of key OCM enzymes in the etiology of AD, particularly when intakes of relevant B-vitamins are inadequate. Our review indicates that a range of compensatory mechanisms exist to maintain a metabolic balance. However, these become overwhelmed if the activity of more than one enzyme is reduced due to genetic factors or insufficient folate, riboflavin, vitamin B6 and/or vitamin B12 levels. Consequences include increased Hcy levels and reduced capacity to synthetize, methylate and repair DNA, and/or modulated neurotransmission. This seems to favor the development of hallmarks of AD particularly when combined with increased oxidative stress e.g., in apolipoprotein E (ApoE) ε4 carriers. However, as these effects can be compensated at least partially by adequate intakes of B-vitamins, achieving optimal B-vitamin status for the general population should be a public health priority.
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Affiliation(s)
- Barbara Troesch
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - M Hasan Mohajeri
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
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Fonseca C, Marques F, Robalo Nunes A, Belo A, Brilhante D, Cortez J. Prevalence of anaemia and iron deficiency in Portugal: the EMPIRE study. Intern Med J 2016; 46:470-8. [DOI: 10.1111/imj.13020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Fonseca
- Anemia Working Group Portugal; Lisbon Portugal
- Internal Medicine Department; S. Francisco Xavier Hospital/Centro Hospitalar Lisboa Ocidental; Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisbon Portugal
| | - F. Marques
- Anemia Working Group Portugal; Lisbon Portugal
- Internal Medicine Department; S. Francisco Xavier Hospital/Centro Hospitalar Lisboa Ocidental; Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisbon Portugal
| | - A. Robalo Nunes
- Anemia Working Group Portugal; Lisbon Portugal
- Imunnohemotherapy (Transfusion Medicine) Department; Centro Hospitalar Lisboa Norte; Lisbon Portugal
| | - A. Belo
- Anemia Working Group Portugal; Lisbon Portugal
- OM Pharma; Lisbon Portugal
| | - D. Brilhante
- Anemia Working Group Portugal; Lisbon Portugal
- Hematology Department, Cancer Portuguese Institute; Francisco Gentil - Lisbon; Lisbon Portugal
| | - J. Cortez
- Anemia Working Group Portugal; Lisbon Portugal
- Laboratory Medicine Unit, Nova Medical School/Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisbon Portugal
- Clinical Pathology (Haematology Laboratory), Cancer Portuguese Institute; Francisco Gentil - Lisbon; Lisbon Portugal
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Nicolas G, Witthöft CM, Vignat J, Knaze V, Huybrechts I, Roe M, Finglas P, Slimani N. Compilation of a standardised international folate database for EPIC. Food Chem 2016; 193:134-40. [PMID: 26433299 DOI: 10.1016/j.foodchem.2014.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 09/23/2014] [Accepted: 11/08/2014] [Indexed: 01/13/2023]
Abstract
This paper describes the methodology applied for compiling an "international end-user" folate database. This work benefits from the unique dataset offered by the European Prospective Investigation into Cancer and Nutrition (EPIC) (N=520,000 subjects in 23 centres). Compilation was done in four steps: (1) identify folate-free foods then find folate values for (2) folate-rich foods common across EPIC countries, (3) the remaining "common" foods, and (4) "country-specific" foods. Compiled folate values were concurrently standardised in terms of unit, mode of expression and chemical analysis, using information in national food composition tables (FCT). 43-70% total folate values were documented as measured by microbiological assay. Foods reported in EPIC were either matched directly to FCT foods, treated as recipes or weighted averages. This work has produced the first standardised folate dataset in Europe, which was used to calculate folate intakes in EPIC; a prerequisite to study the relation between folate intake and diseases.
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Affiliation(s)
- Geneviève Nicolas
- Nutrition and Metabolism Section, Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Cornelia M Witthöft
- Department of Food Science, Uppsala BioCenter, Swedish University of Agricultural Sciences, SLU, P.O. Box 7051, SE-750 07 Uppsala, Sweden
| | - Jérôme Vignat
- Nutrition and Metabolism Section, Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Viktoria Knaze
- Nutrition and Metabolism Section, Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Inge Huybrechts
- Nutrition and Metabolism Section, Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Mark Roe
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Paul Finglas
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Nadia Slimani
- Nutrition and Metabolism Section, Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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Nutritional status and survival among old adults: an 11-year population-based longitudinal study. Eur J Clin Nutr 2015; 70:320-5. [PMID: 26153193 DOI: 10.1038/ejcn.2015.109] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/19/2015] [Accepted: 06/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES The impact of nutritional status on survival among community-dwelling older adults is unclear. We aimed to investigate the prevalence and association of poor nutritional status, including malnutrition and risk for malnutrition defined by the Mini-Nutritional Assessment-Short Form (MNA-SF) with survival, and to explore the role of relevant biomarkers (hemoglobin, albumin and C-reactive protein) in this association. SUBJECTS/METHODS This study included 3041 participants aged ⩾ 60 in the Swedish National study on Aging and Care-Kungsholmen. On the basis of the total score in MNA-SF, nutritional status for each participant was assessed as normal (score 12-14), risk for malnutrition (8-11) or malnutrition (<8). Over an 11-year follow-up, survival status was observed. Data were analysed using logistic regression, flexible parametric survival and Laplace models. RESULTS Of all the participants, 51 (1.7%) had malnutrition and 751 (24.7%) were at risk for malnutrition. The multi-adjusted hazard ratio (95% confidence interval) of mortality was 2.40 (1.56-3.67; P<0.001) for malnutrition and 1.49 (1.29-1.71; P<0.001) for risk for malnutrition. The median ages at death of participants with malnutrition and risk for malnutrition were ~3 and 1.5 years shorter than those with normal nutritional status, respectively, whereas malnutrition or risk for malnutrition together with abnormal biomarker (hemoglobin and albumin) levels was related to 1 year more shortened survival. CONCLUSIONS Malnutrition and risk for malnutrition are highly prevalent and significantly associated with a shorter survival. Poor nutritional status in combination with abnormalities in the biomarkers is associated with even more shortened survival.
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Abstract
Background:Iron deficiency anemia (IDA) has been implicated in the etiology of transient ischemic attack and ischemic stroke. This study aimed to: 1) document IDA prevalence in patients ≥ 65 years of age admitted to hospital with transient ischemic attack or first ischemic stroke, and 2) investigate dietary intake as a predictor of iron status.Methods:Ninety-four patients were enrolled. An algorithm containing values for hemoglobin, ferritin, total iron binding capacity, transferrin saturation, and serum transferrin receptor measured at admission was used to identify IDA. Usual dietary intake was assessed with the Clue II food frequency questionnaire.Results:Prevalence estimates were 6.4% for IDA, 2.1% for iron deficiency without anemia, and 6.4% for anemia from other causes. IDA prevalence was significantly higher than published National Health and Nutrition Examination Survey III (NHANES III) estimates for gender-specific age groups ≥ 70 years (One-Sample Proportion Test; males p = 0.038 [n= 37]; females p = 0.002 [n=44]). A comparison of IDA prevalence against selected controls from the NHANES III database yielded an odds ratio (OR) of 6.3, 95% confidence interval (CI) 0.8 to 53.7, which was not statistically significant (Fisher's Exact Test; n=94; p = 0.118). Multivariate linear regression analysis of dietary intake with indicators of iron status (n=58) revealed only iron supplements (p = 0.013) and heme iron intake (p = 0.038) as negative predictors of total iron binding capacity (p<0.05).Conclusions:These findings support the initiation of a prospective case control study to investigate IDA as a risk factor for ischemic stroke in elderly patients.
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Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 2014; 9:1187-96. [PMID: 25092968 PMCID: PMC4113572 DOI: 10.2147/cia.s61125] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anemia in later life is associated with increased morbidity and mortality. The purpose of this study was to evaluate the prevalence and possible causes of anemia in the elderly in a well defined hospital cohort. Methods Participants in this cross-sectional, retrospective analysis included all inpatients and outpatients aged ≥64 years with complete blood counts treated at Innsbruck Medical University Hospital between October 1, 2004 and September 29, 2005 (n=19,758, median age 73 years). Results According to World Health Organization criteria, 21.1% of these patients were anemic, ie, 30.7% and 37.0% at 80+ years and 90+ years, respectively. The prevalence of anemia was significantly correlated with advanced age (r=0.21; P<0.001) and male sex (P<0.001). In anemic patients, renal insufficiency with a glomerular filtration rate <30 mL/min/1.73 m2 (11.3% versus 2.1%), hyperinflammation (62.1% versus 31.4%), absolute (14.4% versus 6.9%) or functional (28.2% versus 11.8%) iron deficiency, and folate deficiency (6.7% versus 3.0%) were observed significantly more often than in nonanemic subjects (P<0.001). The pathogenesis of anemia was multifactorial, with decreased renal function (glomerular filtration rate <60 mL/min/1.73 m2), signs of inflammation, and functional iron deficiency detected in 11.4% of anemic patients. Hemoglobin was significantly correlated with elevated C-reactive protein (r= −0.296; P<0.001) and low transferrin saturation (r=0.313; P<0.001). Mean corpuscular volume correlated only weakly with the various anemia subtypes. Cytopenias and morphologic alterations suggestive of underlying myelodysplastic syndromes were found in a substantial proportion of anemic patients, including thrombocytopenia (5.4%), leukopenia (8.26%), and macrocytic alterations (18.4%). Conclusion Anemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. A hitherto undiagnosed myelodysplastic syndrome can be assumed in a relevant proportion of patients. Morphologic classification based on mean corpuscular volume is inadequate from the standpoint of pathogenesis. New parameters are needed to differentiate the multifactorial pathogenesis of anemia in the elderly.
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Affiliation(s)
- Veronika Bach
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Guenter Schruckmayer
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Ines Sam
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Georg Kemmler
- Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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Busti F, Campostrini N, Martinelli N, Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Front Pharmacol 2014; 5:83. [PMID: 24795637 PMCID: PMC4006029 DOI: 10.3389/fphar.2014.00083] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/04/2014] [Indexed: 12/13/2022] Open
Abstract
Iron deficiency (ID) is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i.e., due to multiple concurring causes, including inadequate dietary intake or absorption, occult bleeding, medications. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging. Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.
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Corona LP, Andrade FCD, Duarte YADO, Lebrao ML. The association of hemoglobin concentration with disability and decreased mobility among older Brazilians. J Nutr Health Aging 2014; 18:336-41. [PMID: 24626764 DOI: 10.1007/s12603-013-0389-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association between hemoglobin concentration and disability and mobility difficulty among older adults living in São Paulo, Brazil. DESIGN Cross-sectional study. SETTING Population-based study conducted in São Paulo, Brazil. PARTICIPANTS Adults age 60 and over (n=1,256) from the third data collection wave of the SABE Study (Health, Well-being, and Aging) conducted in 2010. MEASUREMENTS Two outcome measures were included in the analyses: 1) a difficulty to perform at least one of the instrumental activities of daily living (IADL) and 2) mobility difficulty, which was assessed using the Short Physical Performance Battery (SPPB). Logistic regression models assessed the association between hemoglobin and each of the outcome measures. All analyses were adjusted for sociodemographic and health characteristics. RESULTS The prevalence of IADL disability was 26.8% and 10.7% of participants had mobility difficulty. The mean hemoglobin concentration was significantly lower in older adults who already presented disability (13.7g/dL versus 14.4g/dL among independent elderly) or decreased mobility (13.4g/dL versus 14.3g/dL among elderly with preserved mobility). Higher values of hemoglobin concentration were associated with lower the risk of IADL disability (OR=0.88; p=0.04) and mobility difficulty (OR=0.81; p=0.02). Hemoglobin concentrations showed a dose-response effect in the probability of each outcome. CONCLUSIONS Lower hemoglobin concentration was associated with a higher probability of IADL disability and mobility difficulty, showing a clear dose-response effect.
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Affiliation(s)
- L Pires Corona
- Ligiana Pires Corona, MS, Faculty of Public Health, Sao Paulo, Sao Paulo Brazil,
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Koenig V, Stanga Z, Zerlauth M, Bernasconi L, Risch M, Huber A, Risch L. Prevalence of vitamin B(12) depletion and deficiency in Liechtenstein. Public Health Nutr 2014; 17:241-7. [PMID: 23237337 PMCID: PMC10282312 DOI: 10.1017/s1368980012005289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Data about vitamin B(12) (B(12)) deficiency in the general population are scarce. The present study was performed to determine the prevalence of B(12) deficiency in the general population of the Principality of Liechtenstein, as well as to identify sub-populations potentially at high risk. DESIGN Retrospective study. SETTING Ambulatory setting, population of the Principality of Liechtenstein. SUBJECTS Seven thousand four hundred and twenty-four patients seeking medical attention whose serum samples were referred for routine work-up in an ambulatory setting were consecutively enrolled. Serum total B(12) was determined in all patients in this cohort. In addition, for a subgroup of 1328 patients, serum holotranscobalamin was also measured. Prevalence of B(12) deficiency was calculated. Further, multivariate logistical regression models were applied to identify covariates independently associated with B(12) deficiency and depletion. RESULTS Nearly 8% of the general population was suffering from either B(12) depletion or deficiency. The ratio between B(12) depletion and deficiency was 2:1 for all age ranges. Pathological changes were detected predominantly in older people. Female gender was a significant predictor of B(12) depletion. In the cohort, nearly 40% exhibited either depletion or deficiency of B(12). CONCLUSIONS B(12) depletion and deficiency are common in Liechtenstein, a Central European country. The measurement of biochemical markers represents a cost-efficient and valid assessment of the B(12) state. When a deficiency of B(12) is diagnosed at an early stage, many cases can be treated or prevented, with beneficial effects on individual outcomes and subsequent potential reductions in health-care costs.
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Affiliation(s)
- Victoria Koenig
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
| | - Zeno Stanga
- Division of Endocrinology, Diabetes and Clinical Nutrition and Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Manfred Zerlauth
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
| | - Luca Bernasconi
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
- LMZ Risch Laboratories, Pregassona, Switzerland
| | - Martin Risch
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
| | - Andreas Huber
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
| | - Lorenz Risch
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Qi YP, Do AN, Hamner HC, Pfeiffer CM, Berry RJ. The prevalence of low serum vitamin B-12 status in the absence of anemia or macrocytosis did not increase among older U.S. adults after mandatory folic acid fortification. J Nutr 2014; 144:170-6. [PMID: 24306216 PMCID: PMC5291239 DOI: 10.3945/jn.113.183095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Whether folic acid fortification and supplementation at the population level have led to a higher prevalence of vitamin B-12 deficiency in the absence of anemia remains to be examined among a nationally representative sample of older U.S. adults. We assessed the prevalence of low vitamin B-12 status in the absence of anemia or macrocytosis before and after fortification among adults aged >50 y using cross-sectional data from the NHANES 1991-1994 (prefortification) and 2001-2006 (postfortification). We compared the prefortification and postfortification prevalence of multiple outcomes, including serum vitamin B-12 deficiency (<148 pmol/L) and marginal deficiency (148-258 pmol/L) with and without anemia (hemoglobin <130 g/L for men, <120 g/L for women) and with and without macrocytosis (mean cell volume >100 fL) using multinomial logistic regression, adjusting for age, sex, ethnicity, body mass index, C-reactive protein, and vitamin B-12 supplement use. Prefortification and postfortification serum vitamin B-12 deficiency without anemia [4.0 vs. 3.9%; adjusted prevalence ratio (aPR) (95% CI): 0.98 (0.67, 1.44)] or without macrocytosis [4.2 vs. 4.1%; aPR (95% CI): 0.96 (0.65, 1.43)] remained unchanged. Marginal deficiency without anemia [25.1 vs. 20.7%; aPR (95% CI): 0.82 (0.72, 0.95)] or without macrocytosis [25.9 vs. 21.3%; aPR (95% CI): 0.82 (0.72, 0.94)] were both significantly lower after fortification. After fortification, higher folic acid intake was associated with a lower prevalence of low serum B-12 status in the absence of anemia or macrocytosis. Results suggest that the prevalence of low serum B-12 status in the absence of anemia or macrocytosis among older U.S. adults did not increase after fortification. Thus, at the population level, we found no evidence to support concerns that folic acid adversely affected the clinical presentation of vitamin B-12 deficiency among older adults.
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Affiliation(s)
- Yan Ping Qi
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA,To whom correspondence should be addressed.
| | - Ann N. Do
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Heather C. Hamner
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Christine M. Pfeiffer
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert J. Berry
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
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Sanchez H, Albala C, Lera L, Dangour AD, Uauy R. Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354). Nutr J 2013; 12:124. [PMID: 24016218 PMCID: PMC3848755 DOI: 10.1186/1475-2891-12-124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/31/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.
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Affiliation(s)
- Hugo Sanchez
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Cecilia Albala
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Lydia Lera
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Alan D Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Uauy
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
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Cliquet MG. Anemia in the elderly: an important clinical problem. Rev Bras Hematol Hemoter 2013; 35:87-8. [PMID: 23741183 PMCID: PMC3672115 DOI: 10.5581/1516-8484.20130026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/14/2013] [Indexed: 12/21/2022] Open
Affiliation(s)
- Marcelo Gil Cliquet
- Faculdade de Ciências Médicas e da Saúde, Pontifícia Universidade Católica de São Paulo - PUC-SP, Sorocaba, SP, Brazil
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Mansoor MA, Stea TH, Schneede J, Reine A. Early Biochemical and Hematological Response to Intramuscular Cyanocobalamin Therapy in Vitamin B12-Deficient Patients. ANNALS OF NUTRITION AND METABOLISM 2013; 62:347-53. [DOI: 10.1159/000347065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022]
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Silva CLÁD, Lima-Costa MF, Firmo JOA, Peixoto SV. Nível de hemoglobina entre idosos e sua associação com indicadores do estado nutricional e uso de serviços de saúde: Projeto Bambuí. CAD SAUDE PUBLICA 2012; 28:2085-94. [DOI: 10.1590/s0102-311x2012001100008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/17/2012] [Indexed: 01/23/2023] Open
Abstract
O objetivo deste estudo foi descrever a prevalência de anemia e avaliar a associação de nível de hemoglobina (Hb) com indicadores do estado nutricional e uso de serviços de saúde em uma população idosa (≥ 60 anos). Dos 1.742 idosos participantes da linha de base da coorte de Bambuí, Minas Gerais, Brasil, foram incluídos 1.441 (82,7%). A variável dependente foi o nível de Hb e as independentes foram número de hospitalizações e visitas ao médico nos 12 meses precedentes à entrevista, índice de massa corporal (IMC) e albumina sérica. Foi realizada regressão linear multivariada estratificada por sexo e ajustada por fatores de confusão. A prevalência de anemia foi baixa na população (4,5%), sem diferenças entre sexos e significativamente maior em idosos mais velhos (10,2%). Baixos níveis de Hb foram associados ao maior número de consultas médicas e a menores valores de albumina sérica e IMC em ambos os sexos. O estudo sugere um ciclo complexo entre baixos níveis de Hb, desnutrição e atendimento médico, o que deve ser considerado na estruturação de programas de saúde para idosos.
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Park JY, Vollset SE, Melse-Boonstra A, Chajès V, Ueland PM, Slimani N. Dietary intake and biological measurement of folate: A qualitative review of validation studies. Mol Nutr Food Res 2012; 57:562-81. [DOI: 10.1002/mnfr.201200105] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/08/2012] [Accepted: 08/01/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Jin Young Park
- Dietary Exposure Assessment Group; Nutrition and Metabolism Section; International Agency for Research on Cancer; Lyon; France
| | - Stein Emil Vollset
- Norwegian Institute of Public Health and University of Bergen; Kalfarveien; Bergen; Norway
| | - Alida Melse-Boonstra
- Division of Human Nutrition; Wageningen University; EV Wageningen; The Netherlands
| | - Véronique Chajès
- Biomarkers Group; Nutrition and Metabolism Section; International Agency for Research on Cancer; Lyon; France
| | - Per Magne Ueland
- Section for Pharmacology; University of Bergen; New Lab Building; Bergen; Hordaland; Norway
| | - Nadia Slimani
- Dietary Exposure Assessment Group; Nutrition and Metabolism Section; International Agency for Research on Cancer; Lyon; France
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Gaier ED, Kleppinger A, Ralle M, Mains RE, Kenny AM, Eipper BA. High serum Cu and Cu/Zn ratios correlate with impairments in bone density, physical performance and overall health in a population of elderly men with frailty characteristics. Exp Gerontol 2012; 47:491-6. [PMID: 22484083 PMCID: PMC3928553 DOI: 10.1016/j.exger.2012.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 12/18/2022]
Abstract
Serum Cu levels rise with age and high Cu/Zn ratios are linked with multiple-cause mortality in the elderly. The relationships of these parameters to measures of musculoskeletal health and frailty have not yet been analyzed. We used inductively coupled mass spectrometry to assess serum levels of Cu and Zn and probed for relationships between serum Cu levels and the Cu/Zn ratio with specific measures of bone, physical and overall health in a cohort of 144 frail elderly men. Subjects were divided into quintiles based on serum metal levels and comparisons for functional measures were made between the reference (middle) group and the low and high groups. Subjects' serum metal values were normally distributed. We found significant correlations between high Cu/Zn ratios and deficits in femoral bone mineral density, measures of speed and strength, muscle mass and hematocrit. High Cu/Zn ratios were also correlated with decreased triglycerides and increased reliance on ADL assistance. This study identifies specific deficits associated with high Cu/Zn ratios that span multiple organ systems and supports earlier studies indicating that serum Cu levels and the Cu/Zn ratio may serve as useful predictive biomarkers for poor health in the elderly.
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Affiliation(s)
- Eric D Gaier
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Alison Kleppinger
- Center on Aging, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Martina Ralle
- Department of Biochemistry and Molecular Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Richard E Mains
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Anne M Kenny
- Center on Aging, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Betty A Eipper
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, USA
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Comparison of standardised dietary folate intake across ten countries participating in the European Prospective Investigation into Cancer and Nutrition. Br J Nutr 2011; 108:552-69. [DOI: 10.1017/s0007114511005733] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Folate plays an important role in the synthesis and methylation of DNA as a cofactor in one-carbon metabolism. Inadequate folate intake has been linked to adverse health events. However, comparable information on dietary folate intake across European countries has never been reported. The objective of the present study was to describe the dietary folate intake and its food sources in ten countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cross-sectional analysis was conducted in 36 034 participants (aged 35–74 years) who completed a single 24 h dietary recall using a computerised interview software program, EPIC-Soft® (International Agency for Research on Cancer, Lyon). Dietary folate intake was estimated using the standardised EPIC Nutrient DataBase, adjusted for age, energy intake, weight and height and weighted by season and day of recall. Adjusted mean dietary folate intake in most centres ranged from 250 to 350 μg/d in men and 200 to 300 μg/d in women. Folate intake tended to be lower among current smokers and heavier alcohol drinkers and to increase with educational level, especially in women. Supplement users (any types) were likely to report higher dietary folate intake in most centres. Vegetables, cereals and fruits, nuts and seeds were the main contributors to folate intake. Nonetheless, the type and pattern of consumption of these main food items varied across the centres. These first comparisons of standardised dietary folate intakes across different European populations show moderate regional differences (except the UK health conscious group), and variation by sex, educational level, smoking and alcohol-drinking status, and supplement use.
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Chen Z, Thomson CA, Aickin M, Nicholas JS, Van Wyck D, Lewis CE, Cauley JA, Bassford T. The relationship between incidence of fractures and anemia in older multiethnic women. J Am Geriatr Soc 2011; 58:2337-44. [PMID: 21143442 DOI: 10.1111/j.1532-5415.2010.03183.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To prospectively examine the relationship between anemia and incident fractures of the hip, spine, and all skeletal sites in women from diverse racial and ethnic backgrounds enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials. DESIGN Prospective cohort study. SETTING Forty WHI clinical centers across the United States. PARTICIPANTS Postmenopausal women (n=160,080), mean age 63.2±7.2, were recruited and followed for an average of 7.8 years. MEASUREMENTS Anemia was defined as hemoglobin levels at baseline less than 12 g/dL. All fractures were self-reported. Trained physicians further confirmed hip fractures using medical records. RESULTS Eight thousand seven hundred thirty-nine of the participants (5.5%) were anemic. The age-adjusted incidence rate of hip fractures per 10,000 person-years was 21.4 in women with anemia and 15.0 in women without anemia; higher incidence rates for spine and all fractures were also observed in anemic women. After multiple covariates were included in the Cox proportional hazards models, significantly greater fracture risk associated with anemia still existed, as demonstrated by hazard ratios of fractures associated with anemia of 1.38 (95% confidence interval (CI)=1.13-1.68) for hip, 1.30 (95% CI=1.09-1.55) for spine, and 1.07 (95% CI=1.01-1.14) for all types. No significant racial or ethnic difference was found in these relationships. CONCLUSION A significantly greater fracture risk was observed in multiethnic postmenopausal women with anemia. Given the high prevalence of anemia in the elderly population, it is important to better understand the relationship and mechanisms linking anemia to fracture risk.
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Affiliation(s)
- Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA.
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Selmi C, Leung PSC, Fischer L, German B, Yang CY, Kenny TP, Cysewski GR, Gershwin ME. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol 2011; 8:248-54. [PMID: 21278762 DOI: 10.1038/cmi.2010.76] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anemia and immunological dysfunction (i.e. immunosenescence) are commonly found in older subjects and nutritional approaches are sought to counteract these phenomena. Spirulina is a filamentous and multicellular bule-green alga capable of reducing inflammation and also manifesting antioxidant effects. We hypothesized that Spirulina may ameliorate anemia and immunosenescence in senior citizens with a history of anemia. We enrolled 40 volunteers of both sexes with an age of 50 years or older who had no history of major chronic diseases. Participants took a Spirulina supplementation for 12 weeks and were administered comprehensive dietary questionnaires to determine their nutritional regimen during the study. Complete cell count (CCC) and indoleamine 2,3-dioxygenase (IDO) enzyme activity, as a sign of immune function, were determined at baseline and weeks 6 and 12 of supplementation. Thirty study participants completed the entire study and the data obtained were analyzed. Over the 12-week study period, there was a steady increase in average values of mean corpuscular hemoglobin in subjects of both sexes. In addition, mean corpuscular volume and mean corpuscular hemoglobin concentration also increased in male participants. Older women appeared to benefit more rapidly from Spirulina supplements. Similarly, the majority of subjects manifested increased IDO activity and white blood cell count at 6 and 12 weeks of Spirulina supplementation. Spirulina may ameliorate anemia and immunosenescence in older subjects. We encourage large human studies to determine whether this safe supplement could prove beneficial in randomized clinical trials.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA 95616, USA
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Gaskell H, Derry S, Moore RA. Is there an association between low dose aspirin and anemia (without overt bleeding)? Narrative review. BMC Geriatr 2010; 10:71. [PMID: 20920233 PMCID: PMC2956719 DOI: 10.1186/1471-2318-10-71] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 09/29/2010] [Indexed: 12/23/2022] Open
Abstract
Background Overt bleeding associated with low dose aspirin (LDA) is well-recognized, little attention is given to the possibility of association between LDA and occult bleeding, although this is known to occur in healthy volunteers. LDA is used increasingly in primary and secondary prevention of a number of medical conditions, many of which are common in older people, as is anemia. Anemia in older people is associated with adverse outcomes including disability, morbidity and mortality. The purpose of this study was to review the evidence that LDA might cause anemia without overt bleeding. Methods An extensive narrative review was carried out. Electronic searching (including database links) and reference lists of reports were used to identify studies reporting on use of aspirin ≤325 mg/day and anemia or change in hemoglobin (Hb) without overt bleeding. Data were extracted from reports of trials, adverse drug reactions (ADRs) and prevalence studies of adults aged ≥18 years, published since 1980. Results There are few relevant data, with considerable heterogeneity among trial designs, duration, and patient characteristics in studies of LDA. In five randomised trials (n = 5879) in (mostly secondary) prevention, the majority of patients were men without peptic ulcer disease aged 50-70 years and no consistent association between LDA and change in Hb was found. In two smaller studies (n = 609) of primary prevention in healthy patients aged ≥70 years, there was a small but statistically significant fall in Hb with LDA. Observational studies, and data from trials in which use of LDA was not a primary focus of the study, were inconclusive. Conclusions It is not clear whether there is an association between LDA and anemia in the absence of overt bleeding, but there may be an association between LDA and fall in Hb in (a subset of) older patients. The available evidence has significant limitations, which are discussed; studies including more older patients, and publication of individual patient data, would help clarify this important matter.
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Affiliation(s)
- Helen Gaskell
- Department of Clinical Geratology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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Urrutia A, Sacanella E, Mascaro J, Formiga F. [Anemia in the elderly]. Rev Esp Geriatr Gerontol 2010; 45:291-7. [PMID: 20692732 DOI: 10.1016/j.regg.2010.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents.
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Affiliation(s)
- Agustín Urrutia
- Servicio de Medicina Interna, Unidad de Geriatría de Agudos, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW To review the prevalence, causes and functional significance of vitamin B12 deficiency in vulnerable subpopulations including older adults and the developing embryo. RECENT FINDINGS It is becoming increasingly recognized that the susceptibility to vitamin B12 deficiency may change throughout the life cycle, with the developing embryo and older adults exhibiting elevated risk. Recent data implicate low vitamin B12 status as a risk factor for birth defects resulting from improper neural tube development. The potential for vitamin supplementation and/or food fortification to ameliorate the risk of deficiency in these subpopulations is discussed. SUMMARY The prevalence and impact of vitamin B12 deficiency varies throughout the life cycle, with older adults and potentially the developing embryo having the greatest risk and susceptibility. Additional research is needed to develop effective public health interventions that address the unique causes of this nutritional deficiency, which differ among at-risk subpopulations.
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Affiliation(s)
- Patrick J Stover
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14850, USA.
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Carmel R. Does high folic acid intake affect unrecognized cobalamin deficiency, and how will we know it if we see it? Am J Clin Nutr 2009; 90:1449-50. [PMID: 19889828 DOI: 10.3945/ajcn.2009.28835] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Mary Marian
- From the University of Arizona–College of Medicine and Department of Nutritional Sciences, Tucson, Arizona, and Auburn University, Auburn, Alabama
| | - Gordon Sacks
- From the University of Arizona–College of Medicine and Department of Nutritional Sciences, Tucson, Arizona, and Auburn University, Auburn, Alabama
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