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Madebo T, Bemanian M, Vold JH, Chowdhury R, Aas CF, Druckrey-Fiskaaen KT, Johansson KA, Fadnes LT. Vitamin B12 Levels, Substance Use Patterns and Clinical Characteristics among People with Severe Substance Use Disorders: A Cohort Study from Western Norway. Nutrients 2022; 14:nu14091941. [PMID: 35565908 PMCID: PMC9105230 DOI: 10.3390/nu14091941] [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: 03/26/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
People with severe substance use disorder (SUD) have a higher burden of micronutrient deficiency compared with the general population. The aim of this study was to investigate vitamin B12 status and risk factors of deficiency related to substance use, opioid agonist therapy (OAT), as well as hepatitis C infection and liver fibrosis. In this prospective cohort study, participants were recruited from outpatient OAT and SUD clinics in western Norway, and assessed annually with a clinical interview and exam, including venous blood sampling. Data were collected between March 2016 and June 2020, and a total of 2451 serum vitamin B12 measurements from 672 participants were included. The median serum vitamin B12 concentration was 396 (standard deviation 198) pmol/L at baseline, 22% of the population had suboptimal levels (<300 pmol/L) and 1.2% were deficient at baseline (<175 pmol/L). No clear associations were seen with substance use patterns, but liver disease and younger age were associated with higher vitamin B12 levels. Although the majority of participants had satisfactory vitamin B12 levels, about a fifth had suboptimal levels that might or might not be adequate for metabolic needs. Future studies could investigate potential gains in interventions among patients with suboptimal but non-deficient levels.
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Affiliation(s)
- Tesfaye Madebo
- Department of Pulmonary Medicine, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Correspondence: (T.M.); (L.T.F.)
| | - Mitra Bemanian
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, 45, Vijay Mandal Enclave, Kalu Sarai New Delhi, Delhi 110016, India;
| | - Christer Frode Aas
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
| | - Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway; (M.B.); (J.H.V.); (C.F.A.); (K.T.D.-F.); (K.A.J.)
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box, 7804 Bergen, Norway
- Correspondence: (T.M.); (L.T.F.)
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Vitamin B12 deficiency in the institutionalized elderly: A regional study. Exp Gerontol 2015; 69:221-5. [DOI: 10.1016/j.exger.2015.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/21/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022]
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den Elzen WPJ, van der Weele GM, Gussekloo J, Westendorp RGJ, Assendelft WJJ. Subnormal vitamin B12 concentrations and anaemia in older people: a systematic review. BMC Geriatr 2010; 10:42. [PMID: 20573208 PMCID: PMC2900261 DOI: 10.1186/1471-2318-10-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 06/23/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pernicious anaemia is undeniably associated with vitamin B12 deficiency, but the association between subnormal vitamin B12 concentrations and anaemia in older people is unclear. The aim of this systematic review was to evaluate the association between subnormal vitamin B12 concentrations and anaemia in older people. METHODS Clinical queries for aetiology and treatment in bibliographic databases (PubMed [01/1949-10/2009]; EMBASE [01/1980-10/2009]) were used. Reference lists were checked for additional relevant studies. Observational studies (> or =50 participants) and randomized placebo-controlled intervention trials (RCTs) were considered. RESULTS 25 studies met the inclusion criteria. Twenty-one observational cross-sectional studies (total number of participants n = 16185) showed inconsistent results. In one longitudinal observational study, low vitamin B12 concentrations were not associated with an increased risk of anaemia (total n = 423). The 3 RCTs (total n = 210) were well-designed and showed no effect of vitamin B12 supplementation on haemoglobin concentrations during follow-up in subjects with subnormal vitamin B12 concentrations at the start of the study. Due to large clinical and methodological heterogeneity, statistical pooling of data was not performed. CONCLUSIONS Evidence of a positive association between a subnormal serum vitamin B12 concentration and anaemia in older people is limited and inconclusive. Further well-designed studies are needed to determine whether subnormal vitamin B12 is a risk factor for anaemia in older people.
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Affiliation(s)
- Wendy PJ den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerda M van der Weele
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi GJ Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem JJ Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Schneede J. Prerequisites for establishing general recommendations for diagnosis and treatment of vitamin B12deficiency and cost‐utility evaluation of these guidelines. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 63:369-75. [PMID: 14599159 DOI: 10.1080/00365510310002068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is currently no consensus on how to define, diagnose and treat vitamin B12 deficiency. This is partly due to insufficient and non-uniform study design. It is essential to come to a harmonization of rational study designs. In order to evaluate new tests for the diagnosis of vitamin B12 deficiency, it is important that independent and unequivocal criteria for a clear-cut definition of the disease are used. Furthermore, it is crucial to have a mutual understanding on the progression of the disease, how fast the different symptoms may develop and on the expected time frame of treatment and evaluation of response. The kind and intensity of treatment must also be agreed upon. The present article overviews the potential strategies of how to define and diagnose vitamin B12 deficiency and on follow-up of treatment response. Finally, based on these considerations, the prerequisites of a cost-utility analysis of guidelines for diagnosing vitamin B12 deficiency are discussed.
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Affiliation(s)
- J Schneede
- Department for Pharmacology, University of Bergen, Norway.
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Metz J. A High Prevalence of Biochemical Evidence of Vitamin B12 or Folate Deficiency does not Translate into a Comparable Prevalence of Anemia. Food Nutr Bull 2008; 29:S74-85. [DOI: 10.1177/15648265080292s111] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Based on biochemical evidence, a high prevalence of biochemical evidence of vitamin B12 or folate deficiency has been reported in a number of areas in the world. The evidence that these biochemical abnormalities lead to a comparable prevalence of anemia is reviewed. The overall contribution of vitamin B12 deficiency to the global burden of anemia is probably not significant, except perhaps in women and their infants and children in vegetarian communities. In developed countries, folate-deficiency anemia is uncommon. In some developing countries, this anemia is still seen, but there are no comprehensive data on the relative prevalence compared with anemia due to malaria, iron-deficiency, hemoglobinopathy, and HIV disease. It seems unlikely that folate deficiency makes a major contribution to the burden of anemia in developing countries. Iron-deficiency anemia may coexist with vitamin B12 and especially folate deficiency, and may confound the hematological features of the vitamin deficiencies whose prevalence would then be underestimated. Supplementation of the diet of pregnant women with folic acid can virtually eliminate folate-deficiency anemia in these women. There are very few data on the hematological effect of vitamin B12 supplementation or fortification at the population level. The addition of vitamin B12 to the supplementation of the diet of pregnant women with iron and folic acid does not produce an increased hematological response, at least in nonvegetarian populations. There are numerous reports of the effect of folic acid fortification of food on tests of folate status, but only a single published report on the hematological response was found.
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Granel B, Serratrice J, Disdier P, Laugier R, Weiller PJ. [Asymptomatic gastric phytobezoar and anaemia due to iron deficiency revealing an autoimmune gastritis]. Presse Med 2004; 33:1180-2. [PMID: 15523289 DOI: 10.1016/s0755-4982(04)98887-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED This observation recalls that gastric phytobezoar should lead to a search for an underlying disease and that a iron deficiency can be associated and hide macrocytosis related to a vitamin B12 deficiency. CASE REPORT A 19 year-old woman consulted for asthenia. Microcyte anaemia associated with iron deficiency was diagnosed. Upper digestive endoscopy revealed severe, totally asymptomatic phytobezoar. Biological investigations revealed a vitamin B12 deficiency, high serum gastrin level and strong positivity for gastric antiparietal anti-cell antibodies, suggestive of an autoimmune gastritis. Total immunoglobulin A deficiency was also noted. DISCUSSION Autoimmune gastritis is responsible for megaloblastic anaemia (vitamin B12 deficiency) but can also provoke microcytic (iron-deficiency) anaemia due to insufficient absorption of the latter and related to gastric achlorhydria. Phytobezoar might also be related to achlorhydria and/or gastroparesia associated with autoimmune gastritis. Hence, autoimmune gastritis should be searched for when confronted with unexplained gastric bezoar or iron-deficiency anaemia.
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Affiliation(s)
- B Granel
- Service de médecine Interne, Hôpital de la Timone, Marseille
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Refsum H, Smith AD, Ueland PM, Nexo E, Clarke R, McPartlin J, Johnston C, Engbaek F, Schneede J, McPartlin C, Scott JM. Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion. Clin Chem 2004; 50:3-32. [PMID: 14709635 DOI: 10.1373/clinchem.2003.021634] [Citation(s) in RCA: 685] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: Measurement of plasma total homocysteine has become common as new methods have been introduced. A wide range of disorders are associated with increased concentrations of total homocysteine. The purpose of this review is to provide an international expert opinion on the practical aspects of total homocysteine determinations in clinical practice and in the research setting and on the relevance of total homocysteine measurements as diagnostic or screening tests in several target populations.Methods: Published data available on Medline were used as the basis for the recommendations. Drafts of the recommendations were critically discussed at meetings over a period of 3 years.Outcome: This review is divided into two sections: (a) determination of homocysteine (methods and their performance, sample collection and handling, biological determinants, reference intervals, within-person variability, and methionine loading test); and (b) risk assessment and disease diagnosis (homocystinuria, folate and cobalamin deficiencies, cardiovascular disease, renal failure, psychiatric disorders and cognitive impairment, pregnancy complications and birth defects, and screening of elderly and newborns). Each of these subsections concludes with a separate series of recommendations to assist the clinician and the research scientist in making informed decisions. The review concludes with a list of unresolved questions.
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Affiliation(s)
- Helga Refsum
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK.
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Ray JG, Vermeulen MJ, Langman LJ, Boss SC, Cole DEC. Persistence of vitamin B12 insufficiency among elderly women after folic acid food fortification. Clin Biochem 2003; 36:387-91. [PMID: 12849871 DOI: 10.1016/s0009-9120(03)00061-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To estimate the associated risk of folate and vitamin B12 (B12) insufficiency, as well as vitamin repletion, following folic acid food fortification. DESIGN Retrospective cross-sectional study over a 5-year period. SETTING Two large laboratory databases in the provinces of Ontario and British Columbia, Canada. PARTICIPANTS Canadian women aged 65 years and over who underwent concomitant clinical testing of serum folate and B12 during the pre-fortification period of January 1996 to December 1997 in Ontario (n = 733) and British Columbia (n = 3839), and in the near-complete post-fortification period of January 1998 to December 2000 in Ontario (n = 4415) and British Columbia (n = 6677). MEASUREMENTS Geometric mean concentrations of serum folate and B12 before and after folate fortification. Prevalence ratios (PR) were used to separately compare the post- and pre-fortification period rates of folate deficiency (below 6.0 nmol/L); B12 insufficiency (below 150 pmol/L); and B12 insufficiency in combination with supraphysiological concentrations of serum folate (above 45 nmol/L). RESULTS The mean baseline folate and B12 concentrations were similar between provinces. Using the combined provincial data, the mean serum folate concentration increased by 64% after fortification, from 14.8 to 24.2 nmol/L (p < 0.001). The average B12 concentration increased from 280 to 300 pmol/L, which was more pronounced in BC (p < 0.001) than in Ontario (p = 0.16). The prevalence of folate deficiency declined from 6.3% to 0.88% after fortification (PR 0.14, 95% confidence interval [CI] 0.11-0.18), while the decline in B12 deficiency was less pronounced (PR 0.78, 95% CI 0.71-0.86). CONCLUSIONS The prevalence of combined B12 insufficiency with supraphysiological concentrations of serum folate increased from 0.09% pre-fortification to 0.61% post (PR 7.0, 95% CI 2.6-19.2). The introduction of folic acid food fortification was associated with a substantial improvement in the folate status of Canadian women aged 65 years and older, paralleled by a large decline in the rate of folate deficiency. Improvement in the B12 status of these women was far less pronounced. Because the prevalence of combined B12 insufficiency and supraphysiological concentrations of serum folate may have increased with folic acid food fortification, consideration should be given to confirming this finding, and possibly, to the addition of B12 to folate fortified foods.
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Affiliation(s)
- J G Ray
- Department of Medicine, Sunnybrook and Women's College Health Science Centre, Toronto, Ontario, Canada.
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Kwok T, Cheng G, Woo J, Lai WK, Pang CP. Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women. Am J Hematol 2002; 70:186-90. [PMID: 12111763 DOI: 10.1002/ajh.10134] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We have examined the independent effect of vitamin B(12) deficiency on hematological indices in older Chinese vegetarian women using a cross-sectional study design: 119 women older than 55 years who had been vegetarian for more than 3 years were studied. Fasting blood samples were taken for complete blood count, serum iron, total serum iron binding capacity, serum iron saturation, serum vitamin B(12), serum folate, serum methylmalonic acid levels (MMA), and renal function test. Subjects with iron deficiency (iron saturation <15%) and those with serum creatinine >150 mmol/L were excluded. The prevalence of definite vitamin B(12) deficiency (vitamin B(12) level < 150 pmol/L and MMA >or= 0.4 micromol/L) was 42%. Another 32.8% had possible vitamin B(12) deficiency (either criterion). The prevalence of iron deficiency was 10%. After exclusions, 96 subjects were further analyzed. Vitamin B(12) deficiency defined by serum vitamin B(12) and MMA was associated with a decrease in hemoglobin concentrations by up to 0.9 g/dL, but it was not associated with an increase in mean corpuscular volume (MCV). Serum MMA but not vitamin B(12) levels correlated inversely with hemoglobin and platelet counts and positively with MCV, after adjustment of confounding factors. However, the percentage of subjects with anemia did not increase significantly until serum MMA became >1.0 micromol/L. In conclusion, vitamin B(12) deficiency was associated with a significant decrease in hemoglobin concentration. However, anemia associated with vitamin B(12) deficiency was seldom macrocytic. We recommend that older vegetarians should be given vitamin B(12) supplements routinely.
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Affiliation(s)
- T Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin.
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10
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Chui CH, Lau FY, Wong R, Soo OY, Lam CK, Lee PW, Leung HK, So CK, Tsoi WC, Tang N, Lam WK, Cheng G. Vitamin B12 deficiency--need for a new guideline. Nutrition 2001; 17:917-20. [PMID: 11744340 DOI: 10.1016/s0899-9007(01)00666-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Many patients with vitamin B12 deficiency do not have anemia or macrocytosis, but the prevalence of B12 deficiency in patients without macrocytosis is not known. METHODS We investigated the prevalence of B12 deficiency among patients with normocytosis and microcytosis and recommended a screening strategy. All patients (n = 3714) with serum B12 measured at the Prince of Wales Hospital in 1996 were reviewed. The prevalence of serum B12 less than 140 pmol/L was determined for the following patient subgroups: younger than 70 y, older than 70 y, anemic, non-anemic, macrocytic, normocytic, microcytic, documented iron deficiency, and documented thalassemia. RESULTS The prevalence of B12 deficiency (<140 pmol/L) ranged from 4.8% to 9.8% among the different subgroups. CONCLUSIONS Whatever screening criteria were used, a significant number of B12-deficient patients will be missed. Therefore, there may be a case for universal vitamin B12 screening.
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Affiliation(s)
- C H Chui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Flood VM, Webb KL, Smith W, Mitchell P, Bantick JM, Macintyre R, Sindhusake D, Rubin GL. Folate fortification: potential impact on folate intake in an older population. Eur J Clin Nutr 2001; 55:793-800. [PMID: 11528496 DOI: 10.1038/sj.ejcn.1601228] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2000] [Revised: 03/06/2001] [Accepted: 03/11/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the potential impact of different models of folate fortification of Australian foods on the folate intakes of older Australians. DESIGN Dietary data were collected using a food frequency questionnaire from people attending a population-based health study. SETTING Two postcode areas west of Sydney, Australia. SUBJECTS A total of 2895 people aged over 49 y, obtained from a door knock census (79% of 3654 subjects examined). MAIN OUTCOME MEASURES The folate intake in this population was estimated using four different models: (1) pre-fortification folate values; (2) current voluntary folate fortification in Australia; (3) universal fortification of all foods permitted to add folate, at 25% recommended dietary intake (RDI) per reference serve; and (4) universal fortification of all foods permitted to add folate, at 50% RDI per reference serve. The increased bioavailability of synthetic folic acid (SFA) was included in the analysis. RESULTS At current voluntary folate fortification, approximately 65% of this population consume 320 microg dietary folate equivalents (DFE) or more per day from diet and supplements, and 0.4% (n=10) consume greater than the recommended upper safety level of 1000 microg from SFA. More than 95% of this older population would be expected to consume more than 320 microg DFE from diet and supplements with universal fortification at 50% of the RDI, and 0.5% (n=14) may consume greater than 1000 microg/day of SFA. CONCLUSIONS There is unlikely to be a large increase in the proportion of older persons who are likely to consume more than the upper safety level of intake with universal folate fortification. As most of those who currently or are predicted to consume over 1000 microg SFA take supplements containing folic acid, it is highly recommended that vitamin B12 be included in any vitamin supplements containing folate. SPONSORSHIP This study was supported by the Australian National Health and Medical Research Council (NHMRC).
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Affiliation(s)
- V M Flood
- Department of Public Health and Community Medicine, Westmead Hospital, University of Sydney, Sydney, Australia.
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Affiliation(s)
- R J Elin
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
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Abstract
Poor nutritional status is one of the major factors associated with functional decline and mortality in older persons. Older persons are at increased risk for malnutrition because of the physiologic anorexia of aging. During a stay in a subacute care facility, attention to nutrition is a major component of the rehabilitative process. The pathophysiology of malnutrition, diagnostic techniques available to diagnose malnutrition, causes and management of protein energy malnutrition, specific nutritional problems caused by vitamin and trace element deficiency, and nutritional management of specific diseases (e.g., hip fracture and diabetes mellitus) are reviewed.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education, and Clinical Center, St. Louis Veterans Affairs Medical Center, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, Missouri63104, USA
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Deleu D, Louon A, Sivagnanam S, Sundaram K, Okereke P, Gravell D, Al-Salmy HS, Al Bahrani I, Nam D, Knox-MacAulay H, Hanssens Y. Long-term effects of nitrous oxide anaesthesia on laboratory and clinical parameters in elderly Omani patients: a randomized double-blind study. J Clin Pharm Ther 2000; 25:271-7. [PMID: 10971777 DOI: 10.1046/j.1365-2710.2000.00287.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS This study examined the long-term effects of nitrous oxide anaesthesia on serum levels of cobalamin and folate, red cell folate levels and haematological parameters, and neurological status in elderly Omani patients. METHODS Sixty-nine consecutive patients undergoing ophthalmic surgery were randomly and double-blind assigned to nitrous oxide or propofol anaesthesia. They met the following entry criteria: age 55 years or above, no major organ failure, no clinical signs or symptoms of cobalamin or folate deficiency, mean cell volume (MCV) </= 96 fl, haematocrit (Hct) higher than 0.3 and no cobalamin and/or folate substitution therapy during the preceding months. Serum levels of cobalamin and folate, red cell folate levels, and haematological parameters were measured prior to anaesthesia and 3-5 weeks later. At that time, the patients also underwent thorough neurological examination. RESULTS Data of 51 patients were complete and considered for analysis. In both nitrous oxide and propofol group, the range of exposure time was comparable (+/-1 h). In the nitrous oxide group, a slight but significant decrease in haemoglobin, Hct, and red blood cell count (RBC) (P < 0.001) was observed, whereas there was a mild increase in mean cell haemoglobin (MCH) and mean cell volume (P < 0.05). In addition, there was a significant decrease in serum folate levels (P < 0.05). Hct and RBC decreased slightly in the propofol group (P < 0. 05), whereas there was a small increase in MCH. There was no difference between the two anaesthetics with regard to serum cobalamin and red cell folate levels, but there was a significant decrease in serum folate levels in the nitrous oxide group compared to those in the propofol group. Three patients with pre-existing low red cell folate levels, who were randomized to nitrous oxide anaesthesia, developed clinical symptoms of folate deficiency. CONCLUSION This study showed that short-term (40-80 min) nitrous oxide anaesthesia did not affect cobalamin levels but reduced serum folate levels in this elderly population. Although this reduction was clinically irrelevant, some patients with pre-existing asymptomatic folate deficiency developed nitrous oxide-induced folate deficiency.
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Affiliation(s)
- D Deleu
- Department of Clinical Pharmacology, Sultan Qaboos University, PO Box 35, Al-Khod, Muscat-123, Sultanate of Oman.
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Arens U. Bettering B12. NUTR BULL 1999. [DOI: 10.1111/j.1467-3010.1999.tb00895.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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