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Cao B, Xiao Y, Liu D. Associations of methylmalonic acid and depressive symptoms with mortality: a population-based study. Transl Psychiatry 2024; 14:297. [PMID: 39030164 PMCID: PMC11271623 DOI: 10.1038/s41398-024-03015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024] Open
Abstract
Methylmalonic acid (MMA), a biomarker of mitochondrial dysfunction, has been reported to be associated with depression in specific populations (i.e., older adults and postpartum women). Our study aimed to investigate to what extent MMA was associated with depressive symptoms and mortality in the general population, and assess whether depressive symptoms mediate the relationship between MMA and mortality. We analyzed cross-sectional data from 8343 participants from the US National Health and Nutrition Examination Survey. MMA was measured by liquid chromatography-tandem mass spectrometry, while depressive symptoms were measured by the Patient Health Questionnaire-9. Mortality data were obtained through linkage with National Death Index records. Linear regression models were performed to assess the association between MMA and depressive symptoms. The Cox proportional hazard regression model was utilized to assess the association of MMA and depressive symptoms with mortality. Mediation analysis was conducted within the counterfactual framework. In this general population, each SD (around 0.49 μmol/L) increase in MMA was associated with a 0.03 SD (approximately 0.15 score) increase in depressive symptoms (β = 0.033, 95% CI: 0.010, 0.055, p = 0.005). Notably, this association was more pronounced in men and participants over 60 years old. Higher levels of MMA and having more depressive symptoms were associated with a higher risk of mortality. However, depressive symptoms do not mediate the relationship between MMA and mortality. Elevated MMA levels were associated with depressive symptoms and an increased risk of mortality. These findings suggest that mitochondrial dysfunction may contribute to the multifactorial etiology of depression.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, P. R. China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, 400715, P. R. China
| | - Yefei Xiao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, P. R. China
| | - Dan Liu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
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2
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Zhan F, Lin G, Su L, Xue L, Duan K, Chen L, Ni J. The association between methylmalonic acid, a biomarker of mitochondrial dysfunction, and cause-specific mortality in Alzheimer's disease and Parkinson's disease. Heliyon 2024; 10:e29357. [PMID: 38681550 PMCID: PMC11053175 DOI: 10.1016/j.heliyon.2024.e29357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024] Open
Abstract
Background Alzheimer's disease (AD) and Parkinson's disease (PD) are the leading causes of death among the elderly. Recent research has demonstrated that mitochondrial dysfunction, which is hallmark of neurodegenerative diseases, is a contributor to the development of these diseases. Methods and materials Methylmalonic acid (MMA), AD, PD, inflammatory markers and covariates were extracted from the National Health and Nutrition Examination Survey (NHANES). The classification of the inflammatory markers was done through quartile conversion. A restricted cubic spike function was performed to study their dose-response relationship. MMA subgroups from published studies were used to explore the correlation between different subgroups and cause-specific mortality. Multivariable weighted Cox regression was carried out to investigate MMA and cause-specific mortality in patients with AD and PD. Weighted survival analysis was used to study the survival differences among MMA subgroups. Results A non-linear correlation was observed between MMA and AD-specific death and PD-specific mortality. The presence of MMA Q4 was linked to increased death rates among AD patients (HR = 6.39, 95%CI: 1.19-35.24, P = 0.03) after controlling for potential confounders in a multivariable weighted Cox regression model. In PD patients, the MMA Q4 (Q4: HR: 5.51, 95 % CI: 1.26-24, P = 0.02) was also related to increased mortality. The results of survival analysis indicated that the poorer prognoses were observed in AD and PD patients with MMA Q4. Conclusion The higher level of mitochondria-derived circulating MMA was associated with a higher mortality rate in AD and PD patients. MMA has the potential to be a valuable indicator for evaluating AD and PD patients' prognosis in the clinic.
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Affiliation(s)
- Fangfang Zhan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China
| | - Gaoteng Lin
- Department of Urology, The 900th Hospital of Joint Logistic Support Force, Fuzhou, China
| | - Lifang Su
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, 351106, China
| | - Lihong Xue
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, 351106, China
| | - Kefei Duan
- Department of Geriatric Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Longfei Chen
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China
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3
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Zhang J, Wu L, Wang S, Pan Y, Zhang A. Increased serum methylmalonic acid levels were associated with the presence of cognitive dysfunction in older chronic kidney disease patients with albuminuria. BMC Geriatr 2024; 24:159. [PMID: 38360610 PMCID: PMC10870521 DOI: 10.1186/s12877-024-04759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the correlation between serum methylmalonic acid (MMA) levels and cognition function in patients with chronic kidney disease (CKD). METHODS In this cross-sectional study, we included 537 CKD individuals aged ≥ 60-year-old with albuminuria from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four cognitive tests including the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Delayed Recall and Word Learning tests, and the Animal Fluency test (AF) were performed. Associations between MMA and cognition scores were assessed with linear regression models. RESULTS MMA level was negatively associated with residual renal function and nutrition status. After multivariate adjustment, elevated serum MMA levels were independently correlated with decline of cognition in CKD patients with albuminuria. CONCLUSION Our study showed that higher serum MMA levels were independently associated with the presence of cognition dysfunction in CKD patients. The exact pathogenesis of MMA and cognition needs further research.
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Affiliation(s)
- Jialing Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Leiyun Wu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Shiyuan Wang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Yajing Pan
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China.
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China.
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4
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Cao B, Xue Y, Liu D. The association between methylmalonic acid, a biomarker of mitochondria dysfunction, and phenotypic age acceleration: A population-based study. Arch Gerontol Geriatr 2024; 117:105176. [PMID: 37713936 DOI: 10.1016/j.archger.2023.105176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/16/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
Phenotypic age acceleration (PAA) is a sensitive marker of biological aging. Circulating methylmalonic acid (MMA) is a novel biomarker of mitochondrial dysfunction and has been associated with age-related disorders. Our study aimed to investigate to what extent circulating MMA was associated with PAA, and whether the association was independent of vitamin B12 status and renal function in the general population. We analyzed cross-sectional data from 13,023 participants across a wide age range (mean age: 38.9 years, range: 12 - 85 years, 51.1% women) from the US National Health and Nutrition Examination Survey (NHANES). PAA was calculated based on the published algorithm. Linear regression models were performed to assess the association between circulating MAA and PAA. Only 31% of the variation in MMA levels was explained by age, sex, race/ethnicity, social economic status, vitamin B12 status, and renal function. Per unit increase in circulating MAA (1.0 nmol/L) was associated with 1.59 years increase in PAA (β = 1.59, 95% CI: 1.17, 2.00, p < 0.001) after adjusting for multiple confounders. Importantly, PAA increased with circulating MMA levels independent of vitamin B12, creatine, and homocysteine levels. The association was more pronounced in subgroups of age ≥ 65 years, women, underweight, vitamin B12 < 400 μmol/L, and homocysteine ≥ 10 μmol/L. The association was much stronger among participants with cardiovascular diseases (CVDs) than without CVDs. In conclusion, our current population-based study showed that mitochondria-derived circulating MMA was associated with increased phenotypic age acceleration in the general population.
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Affiliation(s)
- Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - Yu Xue
- Department of Clinical Nutrition, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, Sichuan, China
| | - Dan Liu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
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5
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Dhar I, Lysne V, Ulvik A, Svingen GFT, Pedersen ER, Bjørnestad EØ, Olsen T, Borsholm R, Laupsa-Borge J, Ueland PM, Tell GS, Berge RK, Mellgren G, Bønaa KH, Nygård OK. Plasma methylmalonic acid predicts risk of acute myocardial infarction and mortality in patients with coronary heart disease: A prospective 2-cohort study. J Intern Med 2023; 293:508-519. [PMID: 36682040 DOI: 10.1111/joim.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Elevated plasma methylmalonic acid (MMA) is reported in patients with established coronary heart disease (CHD) and is considered a marker of vitamin B12 deficiency. Moreover, MMA-dependent reactions have been linked to alterations in mitochondrial energy metabolism and oxidative stress, key features in the pathophysiology of cardiovascular diseases (CVDs). OBJECTIVES We examined whether plasma MMA prospectively predicted the long-term risk of acute myocardial infarction (AMI) and mortality. METHODS AND RESULTS Using Cox modeling, we estimated hazard ratios (HRs) for endpoints according to per 1-SD increment of log-transformed plasma MMA in two independent populations: the Western Norway Coronary Angiography Cohort (WECAC) (patients evaluated for CHD; n = 4137) and the Norwegian Vitamin Trial (NORVIT) (patients hospitalized with AMI; n = 3525). In WECAC and NORVIT, 12.8% and 18.0% experienced an AMI, whereas 21.8% and 19.9% died, of whom 45.5% and 60.3% from CVD-related causes during follow-up (range 3-11 years), respectively. In WECAC, age- and gender-adjusted HRs (95% confidence interval) were 1.18 (1.09-1.28), 1.25 (1.18-1.33), and 1.28 (1.17-1.40) for future AMI, total mortality, and CVD mortality, respectively. Corresponding risk estimates were 1.19 (1.10-1.28), 1.22 (1.14-1.31), and 1.30 (1.19-1.42) in NORVIT. These estimates were only slightly attenuated after multivariable adjustments. Across both cohorts, the MMA-risk association was stronger in older adults, women, and non-smokers. CONCLUSIONS Elevated MMA was associated with an increased risk of AMI and mortality in patients with suspected or verified CHD.
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Affiliation(s)
- Indu Dhar
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Espen Ø Bjørnestad
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Robert Borsholm
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Johnny Laupsa-Borge
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolf K Berge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Kaare H Bønaa
- Department of Circulation and medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic for Heart Diseases, St. Olav's University Hospital, Trondheim, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Hiseni P, Snipen L, Wilson RC, Furu K, Hegge FT, Rudi K. Prediction of high fecal propionate-to-butyrate ratios using 16S rRNA-based detection of bacterial groups with liquid array diagnostics. Biotechniques 2023; 74:9-21. [PMID: 36601888 DOI: 10.2144/btn-2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Butyrate and propionate represent two of three main short-chain fatty acids produced by the intestinal microbiota. In healthy populations, their levels are reportedly equimolar, whereas a deviation in their ratio has been observed in various diseased cohorts. Monitoring such a ratio represents a valuable metric; however, it remains a challenge to adopt short-chain fatty acid detection techniques in clinical settings because of the volatile nature of these acids. Here we aimed to estimate short-chain fatty acid information indirectly through a novel, simple quantitative PCR-compatible assay (liquid array diagnostics) targeting a limited number of microbiome 16S markers. Utilizing 15 liquid array diagnostics probes to target microbiome markers selected by a model that combines partial least squares and linear discriminant analysis, the classes (normal vs high propionate-to-butyrate ratio) separated at a threshold of 2.6 with a prediction accuracy of 96%.
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Affiliation(s)
- Pranvera Hiseni
- Genetic Analysis AS, Kabelgata 8, Oslo, 0580, Norway.,Department of Chemistry, Biotechnology & Food Sciences, Norwegian University of Life Sciences, PO Box 5003, Aas, 1432, Norway
| | - Lars Snipen
- Department of Chemistry, Biotechnology & Food Sciences, Norwegian University of Life Sciences, PO Box 5003, Aas, 1432, Norway
| | - Robert C Wilson
- Department of Biotechnology, Inland Norway University of Applied Sciences, PO Box 400 Vestad, Elverum, 2418, Norway
| | - Kari Furu
- Genetic Analysis AS, Kabelgata 8, Oslo, 0580, Norway
| | | | - Knut Rudi
- Department of Chemistry, Biotechnology & Food Sciences, Norwegian University of Life Sciences, PO Box 5003, Aas, 1432, Norway.,Department of Biotechnology, Inland Norway University of Applied Sciences, PO Box 400 Vestad, Elverum, 2418, Norway
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7
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Haefliger R, Dries LS, Perassolo MS, Cardoso CDO. Neuropsychological assessment after long-term omeprazole treatment. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 35930436 DOI: 10.1080/23279095.2022.2106570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recent studies suggest that Omeprazole, a widely used treatment for gastric acid-related disorders, may have a significant effect on human cognition. However, there is no consensus on the matter. Though some studies suggest the drug is associated with an increased risk of cognitive decline, memory impairment, and dementia, this issue has not been sufficiently studied. Therefore, the goal of this study was to investigate the cognitive impairments associated with long-term Omeprazole treatment, with a focus on memory, attention, and executive functions. Additionally, we sought to verify whether the duration of treatment was associated with the magnitude of the associated cognitive impairments. The sample consisted of 30 participants of both genders treated with Omeprazole (experimental group) and 30 participants who did not use the drug (control group). The cognitive assessment battery: Verbal Fluency, Rey Auditory-Verbal Learning, Attention Assessment Battery, Five Digit Test, Hayling Test, and NEUPSILIN Subtest. The groups were compared using Student's T-tests, and the association between treatment duration and cognitive performance was examined using Pearson's coefficients. The results showed significant group differences in verbal fluency, short-term episodic memory, selective attention, and executive functions. The duration of Omeprazole treatment was also positively associated with the magnitude of cognitive impairment.
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Affiliation(s)
| | - Larissa Selbach Dries
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
| | - Magda Susana Perassolo
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
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8
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Carter B, Zenasni Z, Moat SJ, Hudson PR, Russell IT, McCaddon A. Plasma Methylmalonic Acid Concentration in Folic Acid-Supplemented Depressed Patients with Low or Marginal Vitamin B-12: A Randomized Trial. J Nutr 2021; 151:3738-3745. [PMID: 34510193 PMCID: PMC8643600 DOI: 10.1093/jn/nxab280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/29/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Individuals with low serum vitamin B-12 and high serum folate have higher plasma concentrations of methylmalonic acid (MMA). Whether folic acid (FA) causes an increase in MMA is not known. OBJECTIVES We aimed to determine the impact of FA supplementation on plasma MMA concentration in people with low or marginal serum vitamin B-12. METHODS We conducted a multicenter double-blind placebo-controlled randomized trial of oral FA (5 mg/d for 12 wk) in middle-aged patients treated with antidepressant medication participating in the FoLATED (Folate Augmentation of Treatment-Evaluation for Depression) trial. Participants defined as having "low" serum vitamin B-12 (vitamin B-12 ≥150 and <220 ng/L) or "marginal" serum vitamin B-12 (vitamin B-12 ≥ 220 and <280 ng/L) were included. The primary outcome of this substudy was MMA at week 12. A mixed-effects linear regression was fitted and reported using the adjusted mean difference (aMD). RESULTS A total of 177 participants were included (85 randomly assigned to placebo and 92 to FA); the mean ± SD age was 46.2 ± 11.8 y, and 112 (63.3%) were female. The MMA analysis included 135 participants and the aMD was -0.01 (95% CI: -0.06, 0.04; P = 0.71). Serum folate was measured on 166 participants and increased in the supplementation group; the aMD was 21.6 μg/L (95% CI: 8.13, 25.02 μg/L; P < 0.001). A total of 117 participants were assessed for RBC folate, which also increased in the supplementation group; the aMD was 461 μg/L (95% CI: 387, 535 μg/L; P < 0.001). CONCLUSIONS Supplementation of FA leads to an increase of serum and RBC folate, but does not change plasma MMA concentration in individuals with serum vitamin B-12 between 150 and 280 ng/L. We cannot exclude effects in older people or those with serum vitamin B-12 <150 ng/L. Previously reported associations may arise from effects of impaired vitamin B-12 status on folate metabolism.This trial was registered at www.isrctn.com as ISRCTN37558856.
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Affiliation(s)
- Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Zohra Zenasni
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stuart J Moat
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom,Department of Medical Biochemistry and Immunology & Toxicology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Ian T Russell
- Swansea Trials Unit, Swansea University Medical School, Swansea, United Kingdom
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Fiocco AJ, Krieger L, D'Amico D, Parrott MD, Laurin D, Gaudreau P, Greenwood C, Ferland G. A systematic review of existing peripheral biomarkers of cognitive aging: Is there enough evidence for biomarker proxies in behavioral modification interventions?: An initiative in association with the nutrition, exercise and lifestyle team of the Canadian Consortium on Neurodegeneration in Aging. Ageing Res Rev 2019; 52:72-119. [PMID: 31059801 DOI: 10.1016/j.arr.2019.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
Peripheral biomarkers have shown significant value in predicting brain health and may serve as a useful proxy measurement in the assessment of evidence-based lifestyle behavior modification programs, including physical activity and nutrition programs, that aim to maintain cognitive function in late life. The aim of this systematic review was to elucidate which peripheral biomarkers are robustly associated with cognitive function among relatively healthy non-demented older adults. Following the standards for systematic reviews (PICO, PRIMSA), and employing MEDLINE and Scopus search engines, 222 articles were included in the review. Based on the review of biomarker proxies of cognitive health, it is recommended that a comprehensive biomarker panel, or biomarker signature, be developed as a clinical end point for behavior modification trials aimed at enhancing cognitive function in late life. The biomarker signature should take a multisystemic approach, including lipid, immune/inflammatory, and metabolic biomarkers in the biological signature index of cognitive health.
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Affiliation(s)
| | - Laura Krieger
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Danielle D'Amico
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Danielle Laurin
- Laval University, Centre de recherche du CHU de Québec, QC, Canada
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10
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Zajac IT, Herreen D, Bastiaans K, Dhillon VS, Fenech M. The Effect of Whey and Soy Protein Isolates on Cognitive Function in Older Australians with Low Vitamin B 12: A Randomised Controlled Crossover Trial. Nutrients 2018; 11:nu11010019. [PMID: 30577611 PMCID: PMC6357102 DOI: 10.3390/nu11010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 01/01/2023] Open
Abstract
Whey protein isolate (WPI) is high in vitamin B12 and folate. These and other related markers (holotranscobalamin, methylmalonic acid and homocysteine) have been linked with cognitive health. This study explored the efficacy of WPI for improving cognitive function via delivery of vitamin B12. Moderately vitamin B12-deficient participants aged between 45 and 75 years (n = 56) were recruited into this randomised controlled crossover trial. Participants (55% female) consumed 50 g whey (WPI; active) or soy protein isolate (SPI; control) for eight weeks. Following a 16-week washout phase, they consumed the alternative supplement. Consumption of WPI significantly improved active B12 and folate status but did not result in direct improvements in cognitive function. However, there was evidence of improvement in reaction time (p = 0.02) and reasoning speed (p = 0.04) in the SPI condition for females. Additional analyses showed that changes in active B12, HcY and folate measures during WPI treatment correlated with improvements in cognitive function (all p < 0.05). Results indicate that WPI itself did not result in improved cognitive function but some evidence of benefit of SPI for females was found. However, consistent with previous research, we present further evidence of a role for active B12, HcY and folate in supporting cognitive improvement in adults with low B vitamin status.
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Affiliation(s)
- Ian T Zajac
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia.
| | - Danielle Herreen
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Kathryn Bastiaans
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Varinderpal S Dhillon
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Michael Fenech
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
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11
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Out M, Kooy A, Lehert P, Schalkwijk CA, Stehouwer CDA. Long-term treatment with metformin in type 2 diabetes and methylmalonic acid: Post hoc analysis of a randomized controlled 4.3year trial. J Diabetes Complications 2018; 32:171-178. [PMID: 29174300 DOI: 10.1016/j.jdiacomp.2017.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 01/03/2023]
Abstract
AIMS Metformin treatment is associated with a decrease of serum vitamin B12, but whether this reflects tissue B12 deficiency is controversial. We studied the effects of metformin on serum levels of methylmalonic acid (MMA), a biomarker for tissue B12 deficiency, and on onset or progression of neuropathy. METHODS In the HOME trial, 390 insulin-treated patients with type 2 diabetes were treated with metformin or placebo for 52months. In a post hoc analysis, we analyzed the association between metformin, MMA and a validated Neuropathy Score (NPS). RESULTS Metformin vs placebo increased MMA at the end of the study (95%CI: 0.019 to 0.055, p=0.001). Mediation analysis showed that the effect of metformin on the NPS consisted of a beneficial effect through lowering HbA1c (-0.020 per gram year) and an adverse effect through increasing MMA (0.042 per gram year), resulting in a non-significant net effect (0.032 per gram year, 95% CI: -0.121 to 0.182, p=0.34). CONCLUSION Metformin not only reduces serum levels of B12, but also progressively increases serum MMA. The increase of MMA in metformin users was associated with significant worsening of the NPS. These results provide further support that metformin-related B12 deficiency is clinically relevant. Monitoring of B12 in users of metformin should be considered.
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Affiliation(s)
- Mattijs Out
- Department of Internal Medicine, Care Group Treant, Location Bethesda Hoogeveen, 7909AA 1 Hoogeveen, Netherlands; Bethesda Diabetes Research Center, 7909AA 1 Hoogeveen, Netherlands
| | - Adriaan Kooy
- Department of Internal Medicine, Care Group Treant, Location Bethesda Hoogeveen, 7909AA 1 Hoogeveen, Netherlands; Bethesda Diabetes Research Center, 7909AA 1 Hoogeveen, Netherlands; Department of Internal Medicine, University Medical Center Groningen, Post Office 30.001, 9700 RB Groningen, Netherlands
| | - Philippe Lehert
- Department of Statistics, Faculty of Economics, Facultés Universitaires Catholiques de Mons, Louvain Academy, 7000 151 Mons, Belgium
| | - Casper A Schalkwijk
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6202 AZ 5800 Maastricht, Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6202 AZ 5800 Maastricht, Netherlands.
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Dhillon VS, Zabaras D, Almond T, Cavuoto P, James-Martin G, Fenech M. Whey protein isolate improves vitamin B12and folate status in elderly Australians with subclinical deficiency of vitamin B12. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201600915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Varinderpal S. Dhillon
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
| | - Dimitrios Zabaras
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
| | - Theodora Almond
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
| | - Paul Cavuoto
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
| | - Genevieve James-Martin
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
| | - Michael Fenech
- Genome Health Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity; Adelaide South Australia Australia
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Pascoe MC, Linden T. Folate and MMA predict cognitive impairment in elderly stroke survivors: A cross sectional study. Psychiatry Res 2016; 243:49-52. [PMID: 27367490 DOI: 10.1016/j.psychres.2016.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Elderly stroke survivors are at risk of malnutrition and long-term cognitive impairment. Vitamin B-related metabolites, folate and methylmalonic acid, have been implicated in cognitive function. We conducted a study exploring the relationship between blood folate, methylmalonic acid and post-stroke cognitive impairment. This is a cross sectional study of elderly Swedish patients (n=149) 20 months post-stroke, assessed using the Mini Mental State Examination, serum blood levels of methylmalonic acid and red blood cell levels of folate. Linear modeling indicated that low levels of blood folate and elevated methylmalonic acid significantly contributed to cognitive impairment in stroke survivors. Half of the stroke survivors were shown to have folate deficiency at 20 months after stroke. Folate deficiency is common long term after stroke and both low folate and elevated methylmalonic acid appear to be associated with long term cognitive impairment, in elderly Swedish stroke survivors.
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Affiliation(s)
- Michaela C Pascoe
- Centre for the Heart and Mind, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC 3000, Australia; Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia.
| | - Thomas Linden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
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Köbe T, Witte AV, Schnelle A, Grittner U, Tesky VA, Pantel J, Schuchardt JP, Hahn A, Bohlken J, Rujescu D, Flöel A. Vitamin B-12 concentration, memory performance, and hippocampal structure in patients with mild cognitive impairment. Am J Clin Nutr 2016; 103:1045-54. [PMID: 26912492 DOI: 10.3945/ajcn.115.116970] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/11/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Low-normal concentrations of vitamin B-12 (VitB12) may be associated with worse cognition. However, previous evidence has been mixed, and the underlying mechanisms remain unclear. OBJECTIVE We determined whether serum VitB12 concentrations within the normal range were linked to memory functions and related neuronal structures in patients with mild cognitive impairment (MCI). DESIGN In a cross-sectional design, we assessed 100 amnestic MCI patients (52 women; age range: 50-80 y) with low- and high-normal VitB12 concentration (median split: 304 pmol/L) for memory functions with the use of the Auditory Verbal Learning Test. MRI was performed at 3 tesla (n= 86) for the estimation of the volume and microstructure of the hippocampus and its subfields as indicated by the mean diffusivity on diffusion-weighted images. With the use of a mediation analysis, we examined whether the relation between VitB12 and memory performance was partially explained by volume or microstructure. RESULTS MCI patients with low-normal VitB12 showed a significantly poorer learning ability (P= 0.014) and recognition performance (P= 0.008) than did patients with high-normal VitB12. Also, the microstructure integrity of the hippocampus was lower in patients with low-normal VitB12, mainly in the cornu ammonis 4 and dentate gyrus region (P= 0.029), which partially mediated the effect of VitB12 on memory performance (32-48%). Adjustments for age, sex, education, apolipoprotein E e4 status, and total homocysteine, folate, and creatinine did not attenuate the effects. CONCLUSIONS Low VitB12 concentrations within the normal range are associated with poorer memory performance, which is an effect that is partially mediated by the reduced microstructural integrity of the hippocampus. Future interventional trials are needed to assess whether supplementation of VitB12 may improve cognition in MCI patients even in the absence of clinically manifested VitB12 deficiency. This trial was registered at clinicaltrials.gov as NCT01219244.
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Affiliation(s)
- Theresa Köbe
- Department of Neurology, NeuroCure Cluster of Excellence
| | - A Veronica Witte
- Department of Neurology, NeuroCure Cluster of Excellence, Department of Neurology, Max Planck Institute of Human Cognitive and Brain Sciences, Leipzig, Germany; Sonderforschungsbereich 1052 Obesity Mechanism Subproject A1, University of Leipzig, Leipzig, Germany
| | | | | | - Valentina A Tesky
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Jan Philipp Schuchardt
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University; Hannover, Germany
| | - Andreas Hahn
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University; Hannover, Germany
| | - Jens Bohlken
- Practice Bohlken for Neurology and Psychiatry, Berlin, Germany; and
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Medicine, Halle/Saale, Germany
| | - Agnes Flöel
- Department of Neurology, NeuroCure Cluster of Excellence, Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany;
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Affiliation(s)
- Serdar Tasdemir
- Department of Neurology, Beytepe Military Hospital, Ankara, Turkey
| | - Umit Hidir Ulas
- Department of Neurology, Gulhane Military Medical Academy, Ankara, Turkey
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Akter S, Hassan MR, Shahriar M, Akter N, Abbas MG, Bhuiyan MA. Cognitive impact after short-term exposure to different proton pump inhibitors: assessment using CANTAB software. ALZHEIMERS RESEARCH & THERAPY 2015; 7:79. [PMID: 26714488 PMCID: PMC4696341 DOI: 10.1186/s13195-015-0164-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/16/2015] [Indexed: 12/29/2022]
Abstract
Introduction Studies have shown that proton pump inhibitors (PPIs) increase the brain burden of amyloid-beta (Aβ) and also create vitamin B12 deficiency. However, these two phenomena have deleterious effect on cognition and Alzheimer’s disease (AD). Since the use of PPIs has increased tremendously for the last few years, it is of great public health importance to investigate the cognitive impact of PPIs. Hence, the purpose of this study was to investigate the degree of neuropsychological association of each PPI with different cognitive functions. Methods Sixty volunteers of either gender were recruited and divided randomly into six groups: five test groups for five classes of PPIs and one control group. All the groups participated in the five computerized neuropsychological tests (nine subtests) of the Cambridge Neuropsychological Test Automated Battery twice: at the beginning of the study and 7 days thereafter. Results We found statistically and clinically significant impairment in visual memory, attention, executive function, and working and planning function. One-way analysis of variance findings showed that all PPIs had a similar negative impact on cognition. However, paired-samples t tests indicated that omeprazole showed significant (p < 0.05) results in seven subtests; lansoprazole and pantoprazole showed significant results in five subtests; and rabeprazole showed significant results in four subtests. Among five classes of PPIs, esomeprazole showed comparatively less impact on cognitive function with significant results in three subtests. Conclusions The present study reveals for the first time that different PPIs have varying degrees of influence on different cognitive domains and have associations with AD. These findings should be considered when balancing the risks and benefits of prescribing these medications. A study done for a longer period of time with a larger sample size might yield better results.
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Affiliation(s)
- Sanjida Akter
- Department of Pharmacy, School of Medicine, University of Asia Pacific, House no. 73, Road no. 5A, Dhanmondi, Dhaka, 1209, Bangladesh.
| | - Md Rajib Hassan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, House no. 73, Road no. 5A, Dhanmondi, Dhaka, 1209, Bangladesh.
| | - Mohammad Shahriar
- Department of Pharmacy, School of Medicine, University of Asia Pacific, House no. 73, Road no. 5A, Dhanmondi, Dhaka, 1209, Bangladesh.
| | - Nahia Akter
- Department of Pharmacy, School of Medicine, University of Asia Pacific, House no. 73, Road no. 5A, Dhanmondi, Dhaka, 1209, Bangladesh.
| | - Md Golam Abbas
- Department of Molecular Neuroscience and Integrative Physiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Mohiuddin Ahmed Bhuiyan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, House no. 73, Road no. 5A, Dhanmondi, Dhaka, 1209, Bangladesh.
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Biemans E, Hart HE, Rutten GEHM, Cuellar Renteria VG, Kooijman-Buiting AMJ, Beulens JWJ. Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin. Acta Diabetol 2015; 52:383-93. [PMID: 25315630 DOI: 10.1007/s00592-014-0661-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
AIMS To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with depression, cognition and neuropathy in patients with type 2 diabetes using metformin. METHODS In an observational study, among 550 type 2 diabetes patients using metformin, cobalamin and holotranscobalamin (holoTCII) levels were measured at the annual diabetes checkup, and deficiencies were defined as <148 and <21 pmol/L, respectively. Depression and cognitive function were assessed with corresponding International Classification of Primary Care codes and questionnaires; neuropathy with medical record data and a questionnaire. Confounding variables were retrieved from medical records. Multivariable logistic and linear regressions were used with cobalamin status as independent variable; depression, cognition and neuropathy as dependent variables. RESULTS The mean duration of diabetes was 8.4 years (±5.8); mean duration of metformin use was 64.1 months (±43.2), with a mean metformin dose of 1,306 mg/day. A sufficient cobalamin level was independently associated with a decreased risk of depression (OR 0.42; 95 % CI 0.23-0.78) and better cognitive performance (β = 1.79; 95 % CI 0.07-3.52) adjusted for confounders. This indicates that cobalamin-deficient patients had a 2.4 times higher chance of depression and a 1.79 point lower cognitive performance score. HoloTCII was not associated with any outcome. CONCLUSIONS Cobalamin deficiency was associated with an increased risk of depression and worse cognitive performance, while holoTCII was not. Screening for cobalamin deficiency may be warranted in diabetes patients using metformin. Physicians should consider a cobalamin deficiency in diabetes patients using metformin with a depression or cognitive decline.
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Affiliation(s)
- Elke Biemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Silva D, Albers U, Santana I, Vicente M, Martins IP, Verdelho A, Guerreiro M, de-Mendonça A. Do MCI patients with vitamin B12 deficiency have distinctive cognitive deficits? BMC Res Notes 2013; 6:357. [PMID: 24010640 PMCID: PMC3846633 DOI: 10.1186/1756-0500-6-357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/03/2013] [Indexed: 12/05/2022] Open
Abstract
Background Vitamin B12 deficiency is common in older people, and may be responsible for reversible dementia. Low serum vitamin B12 levels were also observed in patients with Mild Cognitive Impairment (MCI). It is not known whether patients with vitamin B12 deficiency have a distinctive profile of cognitive impairment different from the episodic memory deficit usually observed in MCI. Results From a cohort of 310 patients with MCI followed in a memory clinic in Lisbon, only 10 cases with vitamin B12 deficiency were found. From collaboration with other neurologists, 5 further patients with vitamin B12 deficiency were added. These cases were compared to MCI patients with normal vitamin B12 levels in a ratio 1:3. The duration of subjective cognitive symptoms was significantly shorter in MCI patients with B12 deficiency (1.2±1.0 years) as compared to MCI patients with normal vitamin B12 levels (3.4±3.0 years, p<0.001, Student’ t test). There were no statistically significant differences in the neuropsychological tests between MCI patients with and without vitamin B12 deficiency. Vitamin B12 was started in MCI patients with vitamin B12 deficiency, with no noticeable clinical improvement. Conclusion MCI patients with low levels of vitamin B12 had no particular profile of cognitive impairment, however vitamin B12 deficiency might have precipitated the onset of symptoms. The effect of vitamin B12 supplementation in patients with MCI and low vitamin B12 levels should be clarified by future prospective studies.
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Affiliation(s)
- Dina Silva
- Dementia Clinics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Hughes CF, Ward M, Hoey L, McNulty H. Vitamin B12 and ageing: current issues and interaction with folate. Ann Clin Biochem 2013; 50:315-29. [DOI: 10.1177/0004563212473279] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A compromised vitamin B12 status is common in older people despite dietary intakes that typically far exceed current recommendations. The maintenance of an optimal status of vitamin B12 is not only dependent on adequate dietary intake but more critically on effective absorption which diminishes with age. The measurement of vitamin B12 is complicated by the lack of a gold standard assay. There are a number of direct and functional indicators of vitamin B12 status; however, none of these are without limitations and should be used in combination. Vitamin B12 is of public health importance, not only because deficiency leads to megaloblastic anaemia and irreversible nerve damage, but also because emerging evidence links low B12 to an increased risk of a number of age-related diseases, including cardiovascular disease, cognitive dysfunction, dementia and osteoporosis. Furthermore, there are concerns relating to potential adverse effects for older adults with low vitamin B12 status of over-exposure to folic acid in countries where there is mandatory fortification of food with folic acid. The aim of this review is to examine the known and emerging issues related to vitamin B12 in ageing, its assessment and inter-relationship with folate.
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Affiliation(s)
- Catherine F Hughes
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Mary Ward
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Leane Hoey
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Helene McNulty
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
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20
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Mann N. Human evolution and diet: a modern conundrum of health versus meat consumption, or is it? ANIMAL PRODUCTION SCIENCE 2013. [DOI: 10.1071/an13197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite negative press reports on the effect of meat and other animal-source foods (ASFs) on human health and a vocal minority who contend that humans evolved as vegetarians, scientific evidence contradicts these views. For several million years before the development of agriculture, our ancestors were heavily reliant on ASFs as a source of energy and critical substrates such as protein and long-chain omega-3 fatty acids. Numerous lines of evidence in the anthropological literature have confirmed this scenario. Studies on ASF composition and clinical trials on ASF consumption have provided clear evidence of a requirement for meat in the diet to provide nutrients essential to health, such as Vitamin B12, long-chain omega-3 fatty acids and bioavailable forms of iron and zinc. Other studies have demonstrated that lean ASFs have a role in cholesterol-lowering diets and are important for mental function. Finally, it is possible and desirable to produce meat of a lean nature that mimics the many healthy attributes of wild-game meats and, by emphasising pasture feeding over grain feeding, this can be achieved to a large extent in Australia.
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Cognitive function in an elderly population: interaction between vitamin B12 status, depression, and apolipoprotein E ε4: the Hordaland Homocysteine Study. Psychosom Med 2013; 75:20-9. [PMID: 23213264 DOI: 10.1097/psy.0b013e3182761b6c] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the cross-sectional relation between metabolic markers of vitamin B(12) status and cognitive performance, and possible effect modification by the presence of depression and apolipoprotein E (ApoE) ε4. METHODS This is a population-based study of 1935 participants, aged 71 to 74 years, from Norway. Participants were administered a cognitive test battery, and vitamin B(12) status was assessed by measurements of plasma vitamin B(12), holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine. RESULTS The geometric mean (95% confidence interval) for vitamin B(12) was 348 pM (341-354), whereas 5.9% of participants had vitamin B(12) levels lower than 200 pM. In linear regression analyses, holoTC (p = .039) and the holoTC/vitamin B(12) ratio (p = .013) were positively related, whereas MMA (p = .010) was inversely related, to global cognition, after adjustment for sex, education, ApoE status, plasma creatinine, and history of diabetes, cardiovascular disease, hypertension, and depression. Among those positive for ApoE ε4, but not among those without the ε4 allele, plasma vitamin B(12) was positively associated with global cognition (p = .015), whereas MMA was inversely related to global cognition (p = .036) and executive function (p = .014). In participants with depression, MMA was inversely associated with global cognition (p < .001) and episodic memory (p = .001). CONCLUSIONS Among the well-nourished elderly, low vitamin B(12) status is associated with cognitive deficit, particularly in those with the ApoE ε4 allele or with depression.
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McCaddon A. Vitamin B12 in neurology and ageing; clinical and genetic aspects. Biochimie 2012; 95:1066-76. [PMID: 23228515 DOI: 10.1016/j.biochi.2012.11.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/27/2012] [Indexed: 01/13/2023]
Abstract
The classic neurological and psychiatric features associated with vitamin B12 deficiency have been well described and are the subject of many excellent review articles. The advent of sensitive diagnostic tests, including homocysteine and methylmalonic acid assays, has revealed a surprisingly high prevalence of a more subtle 'subclinical' form of B12 deficiency, particularly within the elderly. This is often associated with cognitive impairment and dementia, including Alzheimer's disease. Metabolic evidence of B12 deficiency is also reported in association with other neurodegenerative disorders including vascular dementia, Parkinson's disease and multiple sclerosis. These conditions are all associated with chronic neuro-inflammation and oxidative stress. It is possible that these clinical associations reflect compromised vitamin B12 metabolism due to such stress. Physicians are also increasingly aware of considerable inter-individual variation in the clinical response to B12 replacement therapy. Further research is needed to determine to what extent this is attributable to genetic determinants of vitamin B12 absorption, distribution and cellular uptake.
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Affiliation(s)
- Andrew McCaddon
- School of Medicine, Cardiff University, Gwenfro Units 6/7, Wrexham Technology Park, Wrexham LL17 7YP, Wales, United Kingdom.
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Doets EL, van Wijngaarden JP, Szczecińska A, Dullemeijer C, Souverein OW, Dhonukshe-Rutten RAM, Cavelaars AEJM, van 't Veer P, Brzozowska A, de Groot LCPGM. Vitamin B12 Intake and Status and Cognitive Function in Elderly People. Epidemiol Rev 2012; 35:2-21. [DOI: 10.1093/epirev/mxs003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/13/2022] Open
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Vitamin B₁₂ status, cognitive decline and dementia: a systematic review of prospective cohort studies. Br J Nutr 2012; 108:1948-61. [PMID: 23084026 DOI: 10.1017/s0007114512004175] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Poor vitamin B₁₂ status may lead to the development of cognitive decline and dementia but there is a large variation in the quality, design of and results reported from these investigations. We have undertaken a systematic review of the evidence for the association between vitamin B₁₂ status and cognitive decline in older adults. A database search of the literature to 2011 was undertaken, using keywords related to vitamin B₁₂ and cognition. All prospective cohort studies assessing the association of serum vitamin B₁₂ or biomarkers were included. Quality assessment and extraction of the data were undertaken by two researchers. The quality assessment tool assigns a positive, neutral or negative rating. Of 3772 published articles, thirty-five cohort studies (n 14 325 subjects) were identified and evaluated. No association between serum vitamin B₁₂ concentrations and cognitive decline or dementia was found. However, four studies that used newer biomarkers of vitamin B₁₂ status (methylmalonic acid and holotranscobalamin (holoTC)) showed associations between poor vitamin B₁₂ status and the increased risk of cognitive decline or dementia diagnosis. In general, the studies were of reasonable quality (twenty-one positive, ten neutral and four negative quality) but of short duration and inadequate subject numbers to determine whether an effect exists. Future studies should be of adequate duration (at least 6 years), recruit subjects from the seventh decade, choose markers of vitamin B₁₂ status with adequate specificity such as holoTC and/or methylmalonic acid and employ standardised neurocognitive assessment tools and not screening tests in order to ascertain any relationship between vitamin B₁₂ status and cognitive decline.
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Abstract
Diseases of the central nervous system are found in patients with severe hyperhomocysteinemia (HHcy). Epidemiological studies show a positive, dose-dependent relationship between mild-to-moderate increases in plasma total homocysteine concentrations (Hcy) and the risk of neurodegenerative diseases, such as Alzheimer's disease, vascular dementia, cognitive impairment or stroke. HHcy is a surrogate marker for B vitamin deficiency (folate, B12, B6) and a neurotoxic agent. The concept of improving the patient's clinical outcome by lowering of Hcy with B vitamins seems to be attractive. Recent B vitamin supplementation trials demonstrated a slowing of brain atrophy and improvement in some domains of cognitive function. Meta-analysis of secondary prevention trials showed that B vitamins supplementation caused a decrease in plasma Hcy and a trend for lowering the risk of stroke. HHcy is common in elderly people. Therefore, it seems prudent to identify B vitamin deficient subjects and to ensure sufficient vitamin intake. Therefore, recent evidence supports the role of Hcy as a potential biomarker in age-related neurodegenerative diseases.
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Affiliation(s)
- Wolfgang Herrmann
- Department of Clinical Chemistry, Medical School, Saarland University, Homburg, Germany.
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McCracken C. Challenges of long-term nutrition intervention studies on cognition: discordance between observational and intervention studies of vitamin B12 and cognition. Nutr Rev 2010; 68 Suppl 1:S11-5. [DOI: 10.1111/j.1753-4887.2010.00325.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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L-methylfolate, methylcobalamin, and N-acetylcysteine in the treatment of Alzheimer's disease-related cognitive decline. CNS Spectr 2010; 15:2-5; discussion 6. [PMID: 20397369 DOI: 10.1017/s1092852900027589] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neuroinflammatory oxidative stress occurs early in AD pathology. Elevated blood Hcy is a useful marker for such neuroinflammation. Hcy contributes to pathological cascades involving AP and NFTs. In AD, Hcy should be lowered by B-vitamin supplements and NAC.
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Plenary Lecture 3: Food and the planet: nutritional dilemmas of greenhouse gas emission reductions through reduced intakes of meat and dairy foods. Proc Nutr Soc 2009; 69:103-18. [PMID: 20003639 DOI: 10.1017/s0029665109991868] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Legally-binding legislation is now in place to ensure major reductions in greenhouse gas emissions in the UK. Reductions in intakes of meat and dairy products, which account for approximately 40% of food-related emissions, are an inevitable policy option. The present paper assesses, as far as is possible, the risk to nutritional status of such a policy in the context of the part played by these foods in overall health and well-being and their contribution to nutritional status for the major nutrients that they supply. Although meat may contribute to saturated fat intakes and a higher BMI, moderate meat consumption within generally-healthy population groups has no measurable influence on morbidity or mortality. However, high consumption of red and processed meat has been associated with increased risk of colo-rectal cancer and recent advice is to reduce intakes to a maximum of 70 g/d. Such reductions in meat and haem-Fe intake are unlikely to influence Fe status in functional terms. However, overall protein intakes would probably fall, with the potential for intakes to be less than current requirements for the elderly. Whether it is detrimental to health is uncertain and controversial. Zn intakes are also likely to fall, raising questions about child growth that are currently unanswerable. Milk and dairy products, currently specifically recommended for young children and pregnant women, provide 30-40% of dietary Ca, iodine, vitamin B12 and riboflavin. Population groups with low milk intakes generally show low intakes and poor status for each of these nutrients. Taken together it would appear that the reductions in meat and dairy foods, which are necessary to limit environmental damage, do pose serious nutritional challenges for some key nutrients. These challenges can be met, however, by improved public health advice on alternative dietary sources and by increasing food fortification.
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Hoey L, Strain JJ, McNulty H. Studies of biomarker responses to intervention with vitamin B-12: a systematic review of randomized controlled trials. Am J Clin Nutr 2009; 89:1981S-1996S. [PMID: 19403638 DOI: 10.3945/ajcn.2009.27230c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mild vitamin B-12 deficiency is common among older adults, but evidence for setting dietary recommendations is limited because most studies have administered vitamin B-12 via nonoral routes or at doses several hundred times higher than current recommendations. Furthermore, different biomarkers of vitamin B-12 status have not been systematically reviewed. OBJECTIVE The aim was to assess the effectiveness of biomarkers of vitamin B-12 status through a systematic review of published randomized controlled trials of oral vitamin B-12 supplementation. DESIGN Methods included a structured search strategy on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases; formal inclusion and exclusion criteria; data extraction; validity assessment; and meta-analysis. RESULTS Eight randomized controlled trials were included, and all studies measured serum and plasma total vitamin B-12, 3 studies measured methylmalonic acid, and 6 studies measured total homocysteine response. All 3 biomarkers were found to be effective measures of altered vitamin B-12 intake in populations with low and borderline baseline vitamin B-12 status (P < 0.00001); however, in the case of total vitamin B-12, substantial heterogeneity that could not be fully explained by subgroup analysis was observed. Insufficient data were available to determine the effectiveness of plasma holotranscobalamin, which was measured in only one randomized controlled trial. CONCLUSIONS The available evidence suggests that plasma and serum concentrations of total vitamin B-12, methylmalonic acid, and total homocysteine are all effective biomarkers of a change in vitamin B-12 intake; however, because the available data were limited, it was not possible to examine fully the factors that could explain the substantial heterogeneity in total vitamin B-12. Future trials should include low-dose vitamin B-12 in adults across the entire age spectrum and measure the holotranscobalamin response to supplementation.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
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Tangney CC, Tang Y, Evans DA, Morris MC. Biochemical indicators of vitamin B12 and folate insufficiency and cognitive decline. Neurology 2009; 72:361-7. [PMID: 19171834 DOI: 10.1212/01.wnl.0000341272.48617.b0] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In some prospective studies, associations of serum vitamin B(12) and homocysteine concentrations with cognitive decline have been reported but few have examined the role of methylmalonic acid, a more specific marker of vitamin B(12) deficiency than homocysteine. OBJECTIVE The aim of the study was to determine whether serum concentrations of vitamin B(12) or selected metabolites are related to cognitive decline. METHODS A total of 516 subjects were selected in a stratified random sampling design from among Chicago Health and Aging Project participants for clinical evaluation. We used linear mixed models to examine the association of blood markers of vitamin B(12) status to change in cognitive scores over 6 years. Cognitive function was assessed every 3 years and measured as the sum of standardized scores on four tests. RESULTS Probable vitamin B(12) deficiency was observed in 14.2% of the sample. Elevated serum concentrations of homocysteine were present in 19.2% of subjects, and of methylmalonic acid, in 36.4%. Higher serum methylmalonic acid concentrations were predictive of faster rates of cognitive decline (beta = -0.00016, SE = 0.0001, p = 0.004) and higher serum vitamin B(12) concentrations were associated with slower rates of cognitive decline (beta = +0.00013, SE < 0.0001, p = 0.005) in multivariable adjusted mixed models. Serum concentrations of homocysteine had no relationship to cognitive decline. CONCLUSIONS Serum methylmalonic acid and vitamin B(12) concentrations may be the more important risk factors for cognitive decline when compared to serum homocysteine concentrations, particularly in older populations exposed to food fortification and possible supplements containing folic acid.
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Affiliation(s)
- Christine C Tangney
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL 60612, USA.
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Abstract
Vitamin B-12 deficiency is often associated with cognitive deficits. Here we review evidence that cognition in the elderly may also be adversely affected at concentrations of vitamin B-12 above the traditional cutoffs for deficiency. By using markers such as holotranscobalamin and methylmalonic acid, it has been found that cognition is associated with vitamin B-12 status across the normal range. Possible mediators of this relation include brain atrophy and white matter damage, both of which are associated with low vitamin B-12 status. Intervention trials have not been adequately designed to test whether these associations are causal. Pending the outcome of better trials, it is suggested that the elderly in particular should be encouraged to maintain a good, rather than just an adequate, vitamin B-12 status by dietary means.
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Affiliation(s)
- A David Smith
- Oxford Project to Investigate Memory and Ageing, the Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
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Matteini AM, Walston JD, Fallin MD, Bandeen-Roche K, Kao WHL, Semba RD, Allen RH, Guralnik J, Fried LP, Stabler SP. Markers of B-vitamin deficiency and frailty in older women. J Nutr Health Aging 2008; 12:303-8. [PMID: 18443711 PMCID: PMC2739594 DOI: 10.1007/bf02982659] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the association between markers of vitamins B12, B6 and folate deficiency and the geriatric syndrome of frailty. DESIGN Cross-sectional study of baseline measures from the combined Women's Health and Aging Studies. SETTING Baltimore, Maryland. PARTICIPANTS Seven hundred three community-dwelling women, aged 70-79. MEASUREMENTS Frailty was defined by five-component screening criteria that include weight, grip strength, endurance, physical activity and walking speed measurements and modeled as binary and 3-level polytomous outcomes. Independent variables serum vitamin B6, vitamin B12, methylmalonic acid, total homocysteine, cystathionine and folate were modeled continuously and as abnormal versus normal. RESULTS Serum biomarker levels varied significantly by race. All analyses were race-stratified and results are reported only for Caucasian women due to small African American sample size. In polytomous logistic regression models of 3-level frailty, Caucasian women with increasing MMA, defined either continuously or using a predefined threshold, had 40-60% greater odds of being prefrail (p-values < 0.07) and 1.66-2.33 times greater odds of being frail (p-values < 0.02) compared to nonfrails after adjustment for age, education, low serum carotenoids, alcohol intake, cardiovascular disease and renal impairment. Both binary and polytomous frailty models evaluating vitamin B12 as the main exposure estimated odds ratios that were similar in trend yet slightly less significant than the MMA results. CONCLUSIONS These results suggest that vitamin B12 deficiency may contribute to the frailty syndrome in community-dwelling older women. Future studies are needed to explore these relationships longitudinally.
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Obeid R, McCaddon A, Herrmann W. The role of hyperhomocysteinemia and B-vitamin deficiency in neurological and psychiatric diseases. Clin Chem Lab Med 2008; 45:1590-606. [PMID: 18067446 DOI: 10.1515/cclm.2007.356] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hyperhomocysteinemia (HHcy) is related to central nervous system diseases. Epidemiological studies show a positive, dose-dependent relationship between plasma total homocysteine (tHcy) concentration and neurodegenerative disease risk. tHcy is a marker of B-vitamin (folate, B(12), B(6)) status. Hypomethylation, caused by low B-vitamin status and HHcy, is linked to key pathomechanisms of dementia; B-vitamin supplementation could potentially reduce neurological damage. In retrospective studies, the association between tHcy and cognition is impressive; there is also evidence that tHcy-lowering treatment could be effective in primary and secondary stroke prevention. Increased tHcy and low serum folate occur in patients with Parkinson's disease, especially those receiving L-dopa. There is also an association between HHcy and multiple sclerosis, and between B-vitamin status and depression. Studies also confirm a causal role for tHcy in epilepsy, and certain anti-epileptics enhance HHcy. B-vitamin status should be optimized by ensuring sufficient intake in patients with neuropsychiatric diseases. HHcy occurs commonly in the elderly and can contribute to age-related neurodegeneration. Treatment with folic acid, B(12) and B(6) lowers tHcy. For secondary and primary prevention from several neuropsychiatric disorders, it seems prudent to actively identify deficient subjects and ensure sufficient vitamin intake.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, University Hospital of Saarland, Homburg/Saar, Germany
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Clarke R, Birks J, Nexo E, Ueland PM, Schneede J, Scott J, Molloy A, Evans JG. Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr 2007; 86:1384-91. [PMID: 17991650 DOI: 10.1093/ajcn/86.5.1384] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated total homocysteine (tHcy) concentrations have been associated with cognitive impairment, but it is unclear whether low vitamin B-12 or folate status is responsible for cognitive decline. OBJECTIVE We examined the associations of cognitive decline with vitamin B-12 and folate status in a longitudinal cohort study performed from 1993 to 2003 in Oxford, United Kingdom. DESIGN Cognitive function was assessed with the Mini-Mental State Examination on >/=3 occasions during 10 y and related to serum concentrations of vitamin B-12, holotranscobalamin (holoTC), tHcy, methylmalonic acid (MMA), and folate with the use of linear mixed models in 1648 participants who provided blood in 1995. RESULTS Cognitive function declined abruptly at younger ages in some participants but remained intact in others until very old age. In multivariate regression analyses after adjustment for established risk factors, concentrations of holoTC (a marker of reduced vitamin B-12 status), tHcy, and MMA predicted cognitive decline, but folate did not. A doubling in holoTC concentrations (from 50 to 100 pmol/L) was associated with a 30% slower rate of cognitive decline (-0.137 to -0.083), whereas a doubling in tHcy (from 10 to 20 micromol/L) or MMA (from 0.25 to 0.50 micromol/L) was associated with >50% more rapid cognitive decline (-0.090 to -0.169) and (-0.104 to -0.169), respectively. After adjustment for all vitamin markers simultaneously, the associations of cognitive decline with holoTC and MMA remained significant. CONCLUSIONS Low vitamin B-12 status was associated with more rapid cognitive decline. Randomized trials are required to determine the relevance of vitamin B-12 supplementation for prevention of dementia.
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Affiliation(s)
- Robert Clarke
- Clinical Trial Service Unit, University of Oxford,, University of Oxford, Oxford, United Kingdom.
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Molloy AM. Nutrition and metabolism. Curr Opin Lipidol 2007; 18:372-4. [PMID: 17495610 DOI: 10.1097/mol.0b013e32813aeae4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
As our population ages, diseases affecting memory and daily functioning will affect an increasing number of individuals, their families and the healthcare system. The social, financial and economic impacts will be profound. This article provides an overview of current dementia syndromes to assist clinicians in evaluating, educating and treating these patients.
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Affiliation(s)
- Kevin R Scott
- Pennsylvania State University, Department of Neurology, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
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Miller JW. Assessing the association between vitamin B-12 status and cognitive function in older adults. Am J Clin Nutr 2006; 84:1259-60. [PMID: 17158405 DOI: 10.1093/ajcn/84.6.1259] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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