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Abel N, Stern F, Tal S. On-admission serum 25(OH)D level and mortality within one year in older patients. BMC Geriatr 2024; 24:664. [PMID: 39118005 PMCID: PMC11308204 DOI: 10.1186/s12877-024-05166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Mounting evidence suggests that vitamin D deficiency is associated with a higher risk of many chronic non-skeletal, age-associated diseases as well as mortality. AIM To determine, in older patients aged ≥ 80, the prevalence of vitamin D deficiency and its association with comorbidity, laboratory tests, length of stay and mortality within one year from blood withdrawal on admission to acute geriatrics ward. METHODS We retrospectively surveyed electronic hospital health records of 830 older patients. The recorded data included patient demographics (e.g., age, sex, stay duration, readmissions number, death within one year from blood withdrawal on admission), medical diagnoses, laboratory results, including 25-hydroxyvitamin D [25(OH)D], and medications. We compared the characteristics of the patients who survived to those who died within one year. RESULTS On admission, in 53.6% patients, vitamin D levels were lower than 50 nmol/L, and in 32%, the levels were ≤ 35 nmol/L. Persons who died were likely to be older, of male sex, were likely to be admitted for pneumonia or CHF, were likely to have lower level of albumin or hemoglobin, lower level of vitamin D or higher vitamin B12 and higher level of creatinine, were also likely to have had a lengthier hospitalization stay, a greater number of hospitalizations in the last year, a higher number of comorbidities, to have consumption of ≥5 drugs or likely to being treated with insulin, diuretics, antipsychotics, anticoagulants or benzodiazepines. Higher age, male sex, on-admission CHF, higher number of drugs, lower albumin, higher vitamin B12, vitamin D < 50 nmol/L, and consumption of antipsychotics and anticoagulants - were predictors of mortality. CONCLUSION Hypovitaminosis D is predictive of mortality in older patients within one year from hospitalization in the acute geriatric ward, but a causal relationship cannot be deduced. Nevertheless, older patients in acute care settings, because of their health vulnerability, should be considered for vitamin D testing. In the acutely ill patients, early intervention with vitamin D might improve outcomes. Accurate evaluation of mortality predictors in this age group patients may be more challenging and require variables that were not included in our study.
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Affiliation(s)
- Nadav Abel
- Geriatric Department, Hartzfeld Hospital at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel
| | - Felicia Stern
- The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Sari Tal
- Acute Geriatrics Department, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel.
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Ts R, Ranganathan RS, Solai Raja M, Srivastav PSS. Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin Therapy. Cureus 2023; 15:e37466. [PMID: 37187650 PMCID: PMC10176038 DOI: 10.7759/cureus.37466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Background Long-term metformin treatment in individuals with type 2 diabetes mellitus causes vitamin B12 insufficiency, which is typically neglected, undetected, and under-treated. A severe deficit may cause life-threatening neurological problems. This study assessed the prevalence of vitamin B12 deficiencies among T2DM patients and its factors at a tertiary hospital in the Tamil Nadu district of Salem. Materials and Methods This is an analytical cross-sectional study conducted in a tertiary care hospital in the Salem district, Tamil Nadu, India. Patients with type 2 diabetes mellitus who were prescribed metformin at the outpatient department of general medicine took part in the trial. Our research instrument was a structured questionnaire. We used a questionnaire containing information on sociodemographic characteristics, metformin use among diabetic mellitus patients, diabetes mellitus history, lifestyle behaviors, anthropometric measurement, examination findings, and biochemical markers. Prior to administering the interview schedule, each participant's parents provided written informed consent. A thorough medical history, physical exam, and anthropometric examination were performed. Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Among the study participants, we diagnosed nearly 43% of diabetes cases in participants between the ages of 40-50 years, while we diagnosed 39% aged under 40 years. Nearly 51% had diabetes for 5-10 years, while only 14% had diabetes for over 10 years. In addition, 25% of the study sample had a positive family history of type 2 diabetes. Nearly 48% and 13% of the study group had been on metformin for 5-10 years and >10 years, respectively. The majority, 45%, were found to take 1000 mg of metformin per day, whereas just 15% take 2 g per day. In our study, the prevalence of vitamin B12 insufficiency was 27%, and nearly 18% had borderline levels. The duration of diabetes mellitus, the duration of metformin intake, and the dose of metformin were statistically significant (p-value = 0.05) among the variables associated with diabetes mellitus and vitamin B12 deficiency. Conclusion The results of the study show that a deficiency in vitamin B12 increases the likelihood that diabetic neuropathy would worsen. Therefore, individuals with diabetes who take larger dosages of metformin (more than 1000mg) for an extended period must have their vitamin B12 levels monitored often. Preventative or therapeutic vitamin B12 supplementation can mitigate this issue.
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Affiliation(s)
- Rathis Ts
- General Medicine, Vinayaka Mission Kirupananda Variyar Medical College and Hospital, Salem, IND
| | | | - Moogaambiga Solai Raja
- Internal Medicine, Vinayaka Mission Kirupananda Variyar Medical College and Hospital, Salem, IND
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Zhu X, Tang Y, Cheang I, Gao R, Liao S, Yao W, Zhou Y, Zhang H, Li X. Nonlinear associations of serum cobalamin with risk of all-cause and cardiovascular mortality in hypertensive adults. Hypertens Res 2023; 46:1276-1286. [PMID: 36805030 DOI: 10.1038/s41440-023-01218-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 02/22/2023]
Abstract
Our study aims to evaluate the associations between the serum cobalamin (vitamin B12) and related biomarkers with mortality in hypertensive adults. Data on serum cobalamin from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 and 2011-2014 were included. Mortality status was linked to National Death Index mortality data through 31 December, 2019. Cox regression and restricted cubic spline (RCS) analyses were used to determine the hazard ratios (HRs) and 95% CIs for mortality risk. A total of 9934 hypertensive adults were included in the analysis (mean age, 58.1 ± 17.5 years; 4899 [49.3%] men). At 11.0 years of mean follow-up, 935 cardiovascular deaths and 3096 all-cause deaths were identified. Compared to the third quartiles, the first and fourth quartiles of serum cobalamin were associated with risk of cardiovascular mortality, with multivariable-adjusted HRs of 1.26 (1.05-1.53) and 1.40 (1.17-1.68). Similar results were observed in the relationship between serum cobalamin and all-cause mortality. These results were supported by the RCS analysis. The inflection points for the nonlinear associations of serum cobalamin with cardiovascular and all-cause mortality were 649.9 pg/mL and 577.2 pg/mL, respectively. In addition, compared with the second quartile of circulating methylmalonic acid (MMA, a cobalamin-deficiency marker), this association with the fourth quartile was evident for an increased rate of cardiovascular and all-cause mortality, with 111% (HR = 2.11, 1.71-2.61) and 73% (HR = 1.73, 1.55-1.93) increase. Findings suggest that both lower and higher serum cobalamin concentrations were associated with a higher risk of cardiovascular and all-cause mortality in hypertensive adults. This study was a prospective cohort study that included serum cobalamin data from 9934 hypertensive adults from the NHANES from 1999-2006 and 20011-2014. Findings suggested that both lower and higher serum cobalamin concentrations were associated with a higher risk of cardiovascular and all-cause mortality in hypertensive adults.
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Affiliation(s)
- Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yuan Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China.
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
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Tal S. Mortality in the Oldest-Old Adults After Discharge From Acute Geriatric Ward. Gerontol Geriatr Med 2023; 9:23337214231156300. [PMID: 37250599 PMCID: PMC10214041 DOI: 10.1177/23337214231156300] [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: 10/12/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 05/31/2023] Open
Abstract
Aim: To examine risk factors for post-discharge mortality in the oldest-old patients. Methods: We have assessed the risk factors for mortality after discharge from acute geriatric ward in 448 patients aged ≥90. Results: Low albumin, high urea, and full dependence were risk factors for mortality within 1 month and within 1 year after discharge from hospital. Age-adjusted Charlson Comorbidity Index score, neuroleptic drug treatments and frailty were specific risk factors for post-discharge mortality within 1 year. By Cox regression analysis, the risk factors associated with higher hazard ratios for post-discharge mortality within 14 years follow-up were age-adjusted Charlson Comorbidity Index score, poor functional status, anemia and dementia as comorbidities, neuroleptic drug treatments, low albumin, high urea, and high vitamin B12. Conclusion: Optimal treatment of the condition due to which the patient has been hospitalized and of the medical complications that occurred during hospitalization, while preventing functional decline, might secure longer post-discharge survival.
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Affiliation(s)
- Sari Tal
- Geriatrics Department, Kaplan Medical
Center, Affiliated With the Hebrew University of Jerusalem, Rehovot, Israel
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Batista KS, Cintra VM, Lucena PAF, Manhães-de-Castro R, Toscano AE, Costa LP, Queiroz MEBS, de Andrade SM, Guzman-Quevedo O, Aquino JDS. The role of vitamin B12 in viral infections: a comprehensive review of its relationship with the muscle-gut-brain axis and implications for SARS-CoV-2 infection. Nutr Rev 2022; 80:561-578. [PMID: 34791425 PMCID: PMC8689946 DOI: 10.1093/nutrit/nuab092] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This comprehensive review establishes the role of vitamin B12 as adjunct therapy for viral infections in the treatment and persistent symptoms of COVID-19, focusing on symptoms related to the muscle-gut-brain axis. Vitamin B12 can help balance immune responses to better fight viral infections. Furthermore, data from randomized clinical trials and meta-analysis indicate that vitamin B12 in the forms of methylcobalamin and cyanocobalamin may increase serum vitamin B12 levels, and resulted in decreased serum methylmalonic acid and homocysteine concentrations, and decreased pain intensity, memory loss, and impaired concentration. Among studies, there is much variation in vitamin B12 doses, chemical forms, supplementation time, and administration routes. Larger randomized clinical trials of vitamin B12 supplementation and analysis of markers such as total vitamin B12, holotranscobalamin, total homocysteine and methylmalonic acid, total folic acid, and, if possible, polymorphisms and methylation of genes need to be conducted with people with and without COVID-19 or who have had COVID-19 to facilitate the proper vitamin B12 form to be administered in individual treatment.
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Affiliation(s)
- Kamila S Batista
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Vanessa M Cintra
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Paulo A F Lucena
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Raul Manhães-de-Castro
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Ana E Toscano
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Larissa P Costa
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Maria E B S Queiroz
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Suellen M de Andrade
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Omar Guzman-Quevedo
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Jailane de S Aquino
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
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Xu K, Liu X, Liu J, Zhang Y, Ding X, Li L, Sun J. Association between serum vitamin B12 and risk of all-cause mortality in elderly adults: a prospective cohort study. BMC Geriatr 2021; 21:497. [PMID: 34530742 PMCID: PMC8447618 DOI: 10.1186/s12877-021-02443-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Results from previous studies that linking vitamin B12 to risk of chronic diseases or mortality are inconsistent. We hereby explore the association between serum concentration of vitamin B12 and all-cause mortality risk in elderly adults. METHODS Participants aged over 65 years in the Chinese Longitudinal Healthy Longevity Survey were included in present prospective cohort study. Serum vitamin B12 was assessed at the 2011-2012 and 2014 wave, respectively. Participants were divided into three groups based on two cut-off points - 10th and 90th percentiles of vitamin B12 concentrations - in the whole population. Cox regression model was used to calculate the hazard ratio (HR) and 95 % confidence intervals (95 % CIs), and restricted cubic spline function was further modelled to investigate their dose-response associations. RESULTS Among 2,086 participants [mean ± SD: 87.74 ± 11.24 years, 908 (43.53 %) males], 943 (45.21 %) died during an average follow-up of 3.34 (SD: 1.63) years. Comparing with participants with middle concentration of serum vitamin B12, participants with high concentration had an increased risk of all-cause mortality [HR (95 %CIs): 1.30 (1.03-1.64)], whereas participants with low concentration had an insignificantly decreased risk of all-cause mortality (0.96, 0.76-1.20). The positive association between high concentration of serum vitamin B12 and all-cause mortality was also observed among the male and in a series of sensitivity analyses. In the dose-response analysis, a J-shape pattern was observed, but the non-linear association was only significant in males (Pnon-linearity = 0.0351). CONCLUSIONS High concentration of serum vitamin B12 was associated with an increased risk of all-cause mortality in a J-shaped pattern. The precise mechanisms underlying the association remain to be explored.
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Affiliation(s)
- Kangjun Xu
- Department of Public Health, Shenyang Medical College, Liaoning, China
| | - Xiyu Liu
- Department of Public Health, Shenyang Medical College, Liaoning, China
| | - Jiaxin Liu
- Department of Public Health, Shenyang Medical College, Liaoning, China
| | - Yingying Zhang
- Department of Public Health, Shenyang Medical College, Liaoning, China
| | - Xiaohui Ding
- Department of Public Health, Shenyang Medical College, Liaoning, China
| | - Lin Li
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Caffaratti C, Plazy C, Mery G, Tidjani AR, Fiorini F, Thiroux S, Toussaint B, Hannani D, Le Gouellec A. What We Know So Far about the Metabolite-Mediated Microbiota-Intestinal Immunity Dialogue and How to Hear the Sound of This Crosstalk. Metabolites 2021; 11:406. [PMID: 34205653 PMCID: PMC8234899 DOI: 10.3390/metabo11060406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/25/2022] Open
Abstract
Trillions of microorganisms, termed the "microbiota", reside in the mammalian gastrointestinal tract, and collectively participate in regulating the host phenotype. It is now clear that the gut microbiota, metabolites, and intestinal immune function are correlated, and that alterations of the complex and dynamic host-microbiota interactions can have deep consequences for host health. However, the mechanisms by which the immune system regulates the microbiota and by which the microbiota shapes host immunity are still not fully understood. This article discusses the contribution of metabolites in the crosstalk between gut microbiota and immune cells. The identification of key metabolites having a causal effect on immune responses and of the mechanisms involved can contribute to a deeper insight into host-microorganism relationships. This will allow a better understanding of the correlation between dysbiosis, microbial-based dysmetabolism, and pathogenesis, thus creating opportunities to develop microbiota-based therapeutics to improve human health. In particular, we systematically review the role of soluble and membrane-bound microbial metabolites in modulating host immunity in the gut, and of immune cells-derived metabolites affecting the microbiota, while discussing evidence of the bidirectional impact of this crosstalk. Furthermore, we discuss the potential strategies to hear the sound of such metabolite-mediated crosstalk.
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Affiliation(s)
- Clément Caffaratti
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
| | - Caroline Plazy
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
- Service de Biochimie Biologie Moléculaire Toxicologie Environnementale, UM Biochimie des Enzymes et des Protéines, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France
- Plateforme de Métabolomique GEMELI-GExiM, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France;
| | - Geoffroy Mery
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
- Department of Infectiology-Pneumology, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Abdoul-Razak Tidjani
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
| | - Federica Fiorini
- Plateforme de Métabolomique GEMELI-GExiM, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France;
| | - Sarah Thiroux
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
| | - Bertrand Toussaint
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
- Service de Biochimie Biologie Moléculaire Toxicologie Environnementale, UM Biochimie des Enzymes et des Protéines, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France
- Plateforme de Métabolomique GEMELI-GExiM, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France;
| | - Dalil Hannani
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
| | - Audrey Le Gouellec
- Faculty of Medicine, CNRS, Grenoble INP, CHU Grenoble-Alpes, University Grenoble Alpes, TIMC (UMR5525), 38000 Grenoble, France; (C.C.); (C.P.); (G.M.); (A.-R.T.); (S.T.); (B.T.)
- Service de Biochimie Biologie Moléculaire Toxicologie Environnementale, UM Biochimie des Enzymes et des Protéines, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France
- Plateforme de Métabolomique GEMELI-GExiM, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France;
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Park J, Choi JH, Choi HJ, Hong SH, Park CS, Choi JH, Chae MS. Predictive role of vitamin B 12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis. BMJ Open 2020; 10:e038990. [PMID: 33191257 PMCID: PMC7668363 DOI: 10.1136/bmjopen-2020-038990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT). DESIGN Retrospective observational cohort study. SETTING University hospital, from January 2009 to December 2018. PARTICIPANTS A total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated. RESULTS Preoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900 pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level. CONCLUSIONS Our study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.
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Affiliation(s)
- Jaesik Park
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Jung Hee Choi
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Ho Joong Choi
- Surgery, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Sang Hyun Hong
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Chul Soo Park
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Jong Ho Choi
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Min Suk Chae
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
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Abstract
BACKGROUND There is conflicting evidence in the literature on the association between (elevated) serum B12 concentrations and subsequent disease or mortality. We evaluated in the NHANES general population the association of serum B12 concentrations as well as vitamin B12 supplement intake with all-cause, cardiovascular, and cancer-related mortality, while taking into account demographic and lifestyle factors and significant other diseases which are known to be associated with poorer outcome. METHODS The main outcomes of our study were all-cause mortality, cardiovascular mortality, and cancer-related mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index public access files through December 31, 2015. The association of serum B12 concentrations and vitamin B12 supplement intake with mortality was assessed with Cox proportional hazard (PH) models, with adjustment for a number of relevant demographic and lifestyle factors and comorbidity. RESULTS The final study population of 24,262 participants had a mean age of 48 (SD 19) years; 50.1% were males. The median follow-up duration was 109 months (range 1-201 months). On the census day of December 31, 2015, 3023 participants were determined as deceased (12.5%). The fully adjusted Cox PH model indicated that low serum B12 concentrations < 140 pmol/l were associated with a small increase in all-cause (hazard ratio, HR 1.39, 95% CI 1.08-1.78, p = 0.011) and cardiovascular (HR 1.64, 95% CI 1.08-2.47, p = 0.020) mortality. Similarly, high serum B12 concentrations > 700 pmol/l were associated with an increase in cardiovascular mortality only (HR 1.45, 95% CI 1.01-2.06, p = 0.042). Participants with a diagnosis of hypertension, dyslipidemia, CVD, and cancer more frequently used vitamin B12-containing supplements than those without these diagnoses. We could not demonstrate an association between vitamin B12 supplement intake and mortality, when adjusted for comorbidity. CONCLUSIONS In the general population of NHANES, low serum B12 concentrations were associated with a moderate increase in all-cause mortality. There was a small but significant increase in cardiovascular mortality in the groups with low or high serum B12. High intake of vitamin B12 in the form of supplements was not associated with any adverse effect on mortality and therefore can be regarded as safe.
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Couderc AL, Puchades E, Villani P, Arcani R, Farnault L, Daumas A, Courcier A, Greillier L, Barlesi F, Duffaud F, Salas S, Costello R, Gentile G, Pradel V, Suchon P, Venton G. High Serum Vitamin B12 Levels Associated with C-Reactive Protein in Older Patients with Cancer. Oncologist 2020; 25:e1980-e1989. [PMID: 32745312 DOI: 10.1634/theoncologist.2019-0894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A Comprehensive Geriatric Assessment (CGA) has been proposed to assess prognosis and to adapt oncological care in older patients with cancer. However, few biological markers are incorporated in the CGA. METHODS This comparative study on older patients with cancer was realized before final therapeutic decision and during a CGA that included biological markers. Our objective study was to know if the serum vitamin B12-C-reactive protein index (BCI) can help to estimate early death and unplanned hospitalization. Associations between BCI and unplanned hospitalization or mortality were analyzed using ordered multivariate logistic regression. FINDINGS We included 621 older cancer adults in outpatient care with a median age of 81 years (range, 70-98 years) from September 2015 to May 2018. In this study, 5.6% of patients died within 3 months, 8.8% had unplanned hospitalization within 1 month, and 11.4% had unplanned hospitalization within 3 months. Hypercobalaminemia was present in 83 patients (13.4%), and 34 patients (5.5%) had BCI >40,000. According to the multivariate analysis, BCI was a prognostic factor of mortality within 3 months and unplanned hospitalizations at 1 and 3 months. Impaired activities of daily living (ADL) and palliative care were also risk factors for mortality within 3 months. Impaired instrumental ADL, low albumin level, and palliative care were risk factors for unplanned hospitalization at 1 month. INTERPRETATION BCI could be routinely added to the CGA process, as part of a pretreatment workup, in order to assess more precisely the frailties and to adapt oncological care in older patients treated for cancer. IMPLICATIONS FOR PRACTICE Aging comes with an increase of frailties and comorbidities. To identify frailties in older patients with cancer, this study used a Comprehensive Geriatric Assessment, which allowed for the adaptation of each treatment plan in accordance with the individual needs of the patients. However, biological characteristics were not included in this assessment. This study showed that hypercobalaminemia and vitamin B12 -C-reactive protein index may be potential markers for cancer with poor prognosis, particularly in the older population. These biological markers can be used in geriatric oncology and general medicine.
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Affiliation(s)
- Anne-Laure Couderc
- Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France
- Etablissement Français du Sang, Anthropologie, Droit, Ethique en Santé, Centre National de la Recherche Scientifique (CNRS), Marseille, France
| | - Eddy Puchades
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Patrick Villani
- Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France
- Etablissement Français du Sang, Anthropologie, Droit, Ethique en Santé, Centre National de la Recherche Scientifique (CNRS), Marseille, France
| | - Robin Arcani
- Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France
| | - Laure Farnault
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Aurélie Daumas
- Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Anais Courcier
- Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Florence Duffaud
- Oncology Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Sébastien Salas
- Oncology Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Régis Costello
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
| | | | - Vincent Pradel
- Public Health Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre Suchon
- Hematology Laboratory Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Recherche en Cardiovasculaire et Nutrition (C2VN), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), INSERM, Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille Université, Marseille, France
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Zulfiqar AA, Sui Seng X, Duhamel E, Kadri N, Doucet J, Andres E. [What to do before a hypervitaminia B12 in the elderly]. SOINS. GERONTOLOGIE 2017; 22:41-43. [PMID: 28413015 DOI: 10.1016/j.sger.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hypervitanimia B12 is an early marker of serious pathologies. These include solid neoplasms, malignant blood diseases and acute/chronic hepatopathies. Hypervitaminemia B12 in geriatrics is thereby an indicator in the diagnosis and prognosis of these conditions.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de médecine interne-gériatrie-thérapeutique, CHU Rouen, Hôpital Saint-Julien, 76000 Rouen, France.
| | - Xavier Sui Seng
- Département de médecine interne-gériatrie-thérapeutique, CHU Rouen, Hôpital Saint-Julien, 76000 Rouen, France
| | - Elise Duhamel
- Département de médecine interne-gériatrie-thérapeutique, CHU Rouen, Hôpital Saint-Julien, 76000 Rouen, France
| | - Nadir Kadri
- Département de médecine interne-gériatrie-thérapeutique, CHU Rouen, Hôpital Saint-Julien, 76000 Rouen, France
| | - Jean Doucet
- Département de médecine interne-gériatrie-thérapeutique, CHU Rouen, Hôpital Saint-Julien, 76000 Rouen, France
| | - Emmanuel Andres
- Département de médecine interne, CHRU Strasbourg, 67000 Strasbourg, France
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Romain M, Sviri S, Linton DM, Stav I, van Heerden PV. The role of Vitamin B12 in the critically ill--a review. Anaesth Intensive Care 2016; 44:447-52. [PMID: 27456173 DOI: 10.1177/0310057x1604400410] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vitamin B12 is an essential micronutrient, as humans have no capacity to produce the vitamin and it needs to be ingested from animal proteins. The ingested Vitamin B12 undergoes a complex process of absorption and assimilation. Vitamin B12 is essential for cellular function. Deficiency affects 15% of patients older than 65 and results in haematological and neurological disorders. Low levels of Vitamin B12 may also be an independent risk factor for coronary artery disease. High levels of Vitamin B12 are associated with inflammation and represent a poor outlook for critically ill patients. Treatment of Vitamin B12 deficiency is simple, but may be lifelong.
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Affiliation(s)
- M Romain
- Intensivist, Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - S Sviri
- Intensivist, Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - D M Linton
- Intensivist, Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - I Stav
- Data Manager, Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - P V van Heerden
- Director, General Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
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Tal S, Stern F, Polyak Z, Ichelzon I, Dror Y. Moderate 'multivitamin' supplementation improved folate and vitamin B12 status in the elderly. Exp Gerontol 2016; 84:101-106. [PMID: 27620820 DOI: 10.1016/j.exger.2016.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
The dependent elderly are widely considered to be at higher risk of nutritional problems. Suboptimal micronutrient intake might put the elderly, especially those living in nursing homes, at high risk of morbidity. So far, no public authority, except for the Israel Ministry of Health, has issued particular recommendations for micronutrient supplementation for the elderly. We hypothesized that moderate 'multivitamin' supplementation could improve the vitamin status of the dependent elderly. The study took place in two nursing homes and included 144 dependent elderly (males/females, 35/109). Demographic and clinical data as well as routine blood tests were retrieved from the patient electronic medical records. After a two-year daily 'multivitamin' supplementation, containing 120μg of folic acid, there was a small and non-significant increase of 12% in serum folate; the same 'multivitamin' preparatory, containing 2.4μg of vitamin B12, significantly increased serum vitamin B12 by 8%. Three models of evaluation clearly showed the effect of a two- year vitamin supplementation: 1. The number of subjects with the lowest baseline concentration range, decreased, with moderate concentration, increased, with no difference at the higher concentrations; 2. Above each vitamin concentration, the number of subjects was higher than at baseline; 3. The two vitamins at the two lower concentration tertiles increased, and at the highest tertile, folate was not affected, whereas vitamin B12 decreased. Therefore, very moderate 'multivitamin' supplementation, as practiced in our study, has a high probability of improving vulnerable old population health status without causing any adverse effects to others.
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Affiliation(s)
- Sari Tal
- Geriatric Medicine Department, Kaplan Medical Center, Rehovot, The Hebrew University of Jerusalem, Israel
| | - Felicia Stern
- Institute of Biochemistry, Food Science and Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Zeev Polyak
- The Jaques H. Asseoff Seniors Citizens Home, Rishon LeZion, Israel; Ashdod Home for the Aged, Ashdod, Israel
| | - Ina Ichelzon
- Geriatric Medicine Department, Kaplan Medical Center, Rehovot, The Hebrew University of Jerusalem, Israel
| | - Yosef Dror
- Institute of Biochemistry, Food Science and Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Israel.
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Association between metformin and vitamin B 12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis. DIABETES & METABOLISM 2016; 42:316-327. [PMID: 27130885 DOI: 10.1016/j.diabet.2016.03.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 12/22/2022]
Abstract
AIM Metformin is the most widely used oral hypoglycaemic drug, but it may lower B12 status, which could have important clinical implications. We undertook a systematic review and meta-analysis of the relationship between metformin use and vitamin B12 deficiency in persons with type 2 diabetes. METHODS Electronic database searches were undertaken (1st January 1957-1st July 2013) using the Cochrane library, Scopus, CINAHL, Grey literature databases, Pub Med Central, NICE Clinical Guidelines UK, and ongoing clinical trials. Included studies were of any study design, with data from patients with type 2 diabetes of any age or gender, taking any dose or duration of metformin. Planned primary outcomes were serum vitamin B12 levels, % prevalence or incidence of vitamin B12 deficiency and risk of vitamin B12 deficiency. RESULTS Twenty-six papers were included in the review. Ten out of 17 observational studies showed statistically significantly lower levels of vitamin B12 in patients on metformin than not on metformin. Meta-analysis performed on four trials demonstrated a statistically significant overall mean B12 reducing effect of metformin of 57pmol/L [WMD (fixed)=-0.57 (95% CI: -35 to -79pmol/L)] after 6weeks to 3months of use. CONCLUSION The evidence from this review demonstrates an association between metformin usage and lower levels of vitamin B12 by 57pmol/L, which leads to frank deficiency or borderline status in some patients with type 2 diabetes. This suggests that it is prudent to monitor B12 levels in these patients who are at increased risk of deficiency.
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Bodenez C, Andro M, Jannou V, Estivin S, Gentric A. Overuse of Vitamin B12 Supplementation in French Nursing Homes. J Am Geriatr Soc 2016; 64:669-71. [DOI: 10.1111/jgs.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Bodenez
- Internal Medicine and Geriatrics; University Hospital; Brest France
| | - Marion Andro
- Internal Medicine and Geriatrics; University Hospital; Brest France
| | - Virginie Jannou
- Internal Medicine and Geriatrics; University Hospital; Brest France
| | - Sandrine Estivin
- Internal Medicine and Geriatrics; University Hospital; Brest France
| | - Armelle Gentric
- Internal Medicine and Geriatrics; University Hospital; Brest France
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Arendt JFH, Farkas DK, Pedersen L, Nexo E, Sørensen HT. Elevated plasma vitamin B12 levels and cancer prognosis: A population-based cohort study. Cancer Epidemiol 2015; 40:158-65. [PMID: 26724465 DOI: 10.1016/j.canep.2015.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elevated plasma vitamin B12 levels (cobalamin, Cbl) are associated with increased short-term cancer risk among patients referred for this laboratory measurement. We aimed to assess prognosis in cancer patients with elevated plasma Cbl. METHODS We conducted a population-based cohort study using data from Danish medical registries during 1998-2014. The study included 25,017 patients with a cancer diagnosis and Cbl levels of 200-600 pmol/L (reference/normal range), 601-800 pmol/L and >800 pmol/L measured up to one year prior to diagnosis, and a comparison cohort of 61,988 cancer patients without a plasma Cbl measurement. Patients treated with Cbl were excluded. Survival probability was assessed using Kaplan-Meier curves. Mortality risk ratios (MRR) were computed using Cox proportional hazard regression, adjusted for age, sex, calendar year, cancer stage and comorbidity, scored using the Charlson comorbidity index. RESULTS Survival probabilities were lower among patients with elevated Cbl levels than among patients with normal levels and among members of the comparison cohort [(1-year survival,%) Cbl: 200-600 pmol/L: 69.3%; 601-800 pmol/L: 49.6%; >800 pmol/L: 35.8%; comparison cohort: 72.6%]. Thirty-day mortality was elevated for patients with Cbl levels of 601-800 pmol/L or >800 pmol/L, compared to patients with levels of 200-600 pmol/L [(MRR (95% confidence interval): 601-800 pmol/L vs. 200-600 pmol/L: 1.9 (1.6-2.2); >800 pmol/L vs. 200-600 pmol/L: 2.7 (2.4-3.1)]. This association remained robust for 31-90-day and 91-365-day mortality, showing similar dose-response patterns. CONCLUSION Cancer patients with elevated Cbl levels had higher mortality than those with normal Cbl levels. These findings may have clinical significance for assessing the prognosis of cancer patients.
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Affiliation(s)
- Johan Frederik Håkonsen Arendt
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Norrebrogade 44 Building 9, DK-8000 Aarhus C, Denmark.
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
| | - Ebba Nexo
- Department of Clinical Biochemistry, Aarhus University Hospital, Norrebrogade 44 Building 9, DK-8000 Aarhus C, Denmark.
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
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Zulfiqar AA, Martin-Kleisch A. Hypervitaminosis B12 As an Additional Prognostic Indicator in Elderly Adults with a Neoplastic Disease: Report of a Case and Review of the Literature. J Am Geriatr Soc 2015; 63:2220-1. [PMID: 26481001 DOI: 10.1111/jgs.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Department of Internal Medicine and Geriatrics, University Hospital of Reims, Reims, France
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Abstract
OPINION STATEMENT Anaemia is a common multifactorial extraintestinal manifestation in IBD patients. Moreover, anaemia represents an important health problem among the elderly population and has a significant impact on healthcare utilisation and costs. Data on the prevalence, diagnosis and management of anaemia in elderly IBD patients are scarce, since clinical trials have largely excluded this population. In this review, we reconsider anaemia in older IBD patients in the light of new diagnostic and therapeutic tools.
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Affiliation(s)
- Jürgen Stein
- Gastroenterology and Clinical Nutrition, DGD Clinics Frankfurt-Sachsenhausen, Teaching Hospital of the Goethe University Frankfurt, Schulstrasse 31, 60594, Frankfurt/Main, Germany,
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Abstract
Vitamin B12 deficiency is a common condition which can present with non-specific clinical features, and in severe cases with neurological or haematological abnormalities. Although classically caused by pernicious anaemia, this condition now accounts for a minority of cases and vitamin B12 deficiency occurs most often due to food-bound cobalamin malabsorption. Since missing the diagnosis can result in potentially severe complications, including degeneration of the spinal cord and pancytopaenia, vitamin B12 deficiency must be diagnosed early and managed appropriately. Intramuscular injections have been the mainstay of treatment, but oral replacement therapy can be effective in many cases. There is accumulating evidence that high vitamin B12 levels (values varied from 350-1,200 pmol/l) are associated with haematological and hepatic disorders, in particular with malignancy. This review focuses on the developments in the clinical features and management of vitamin B12 deficiency over the last decade.
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Affiliation(s)
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
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21
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Zeuschner CL, Hokin BD, Marsh KA, Saunders AV, Reid MA, Ramsay MR. Vitamin B₁₂ and vegetarian diets. Med J Aust 2015; 199:S27-32. [PMID: 25369926 DOI: 10.5694/mja11.11509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/29/2012] [Indexed: 01/13/2023]
Abstract
Vitamin B₁₂ is found almost exclusively in animal-based foods and is therefore a nutrient of potential concern for those following a vegetarian or vegan diet. Vegans, and anyone who significantly limits intake of animal-based foods, require vitamin B₁₂-fortified foods or supplements. Vitamin B₁₂ deficiency has several stages and may be present even if a person does not have anaemia. Anyone following a vegan or vegetarian diet should have their vitamin B₁₂ status regularly assessed to identify a potential problem. A useful process for assessing vitamin B₁₂ status in clinical practice is the combination of taking a diet history, testing serum vitamin B₁₂ level and testing homocysteine, holotranscobalamin II or methylmalonic acid serum levels. Pregnant and lactating vegan or vegetarian women should ensure an adequate intake of vitamin B₁₂ to provide for their developing baby. In people who can absorb vitamin B₁₂, small amounts (in line with the recommended dietary intake) and frequent (daily) doses appear to be more effective than infrequent large doses, including intramuscular injections. Fortification of a wider range of foods products with vitamin B₁₂, particularly foods commonly consumed by vegetarians, is likely to be beneficial, and the feasibility of this should be explored by relevant food authorities.
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Affiliation(s)
| | | | - Kate A Marsh
- Northside Nutrition and Dietetics, Sydney, NSW, Australia
| | - Angela V Saunders
- Corporate Nutrition, Sanitarium Health and Wellbeing, Berkeley Vale, NSW, Australia
| | - Michelle A Reid
- Corporate Nutrition, Sanitarium Health and Wellbeing, Berkeley Vale, NSW, Australia
| | - Melinda R Ramsay
- Sanitarium Health and Wellbeing Services, Sanitarium Health and Wellbeing, Sydney, NSW, Australia
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Mézière A, Audureau E, Vairelles S, Krypciak S, Dicko M, Monié M, Giraudier S. B12 deficiency increases with age in hospitalized patients: a study on 14,904 samples. J Gerontol A Biol Sci Med Sci 2014; 69:1576-85. [PMID: 25063081 DOI: 10.1093/gerona/glu109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cobalamin deficiency is responsible for hematological, neurological, neurocognitive, and neuropsychiatric impairments and is a risk factor for cardiovascular diseases, particularly in the elderly people. METHODS In order to determine B12 status in old inpatients, a total number of 14,904 hospitalized patients in whom B12 measurements were performed in five hospitals in the Paris metropolitan area were included from January 1, 2011 to December 31, 2011. The aims of the study were to determine whether age had an impact on B12 and folate deficiencies and to evaluate correlations between B12 and biological parameters-folate, hemoglobin, mean cell volume, homocystein (tHcy)-and age. RESULTS Patients were aged 70.3±19.5 years. Low B12 concentration (<200ng/L) was observed in 4.6% of cases, 24.2% had middle B12 concentration (200-350ng/L), 12.6% were functional B12 deficient (B12 < 350 ng/L associated to high tHcy level, tHcy > 17 µmol/L), 20.4% had low folate concentration (folate < 4 µg/L), 10.6% were functional folate deficient (folate < 4 µg/L associated to tHcy > 17 µmol/L), and 4.7% of patients were both functional B12 and folate deficient. The B12 or folate deficient patients had lower mean cell volume level than nondeficient patients. Increase in mean cell volume and tHcy concentrations with age and decrease in B12, folate, and hemoglobin levels with age were observed. Frequency of functional B12 deficiency was 9.6% in patients aged 30-60 years and 14.2% in patients over 90 years. Frequency of functional folate deficiency was 9.5% in 30-60 years and 12.1% in >90 years. CONCLUSIONS In inpatients, functional B12 deficiency and functional folate deficiency increase with age and are not associated with anemia or macrocytosis. False vitamin B deficiencies are frequent.
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Affiliation(s)
- Anthony Mézière
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire La Pitié Salpêtrière - Charles Foix, SSR Orthogériatrique, Fondation d'Heur et Chemin Delatour, Ivry sur Seine, France. Département de Gériatrie and
| | - Etienne Audureau
- Département de Statistique et d'Epidémiologie, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire Henri Mondor, Créteil, France. Laboratoire d'Investigation Clinique (LIC-EA 4393), Université Paris Est Créteil, Créteil, France
| | - Stéphane Vairelles
- Service d'Hématologie biologique, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire Henri Mondor, Créteil, France
| | | | - Michèle Dicko
- Département de Gériatrie and Faculté de Médecine, Université Paris Est Créteil, Créteil, France
| | - Marguerite Monié
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire La Pitié Salpêtrière - Charles Foix, SSR Orthogériatrique, Fondation d'Heur et Chemin Delatour, Ivry sur Seine, France
| | - Stéphane Giraudier
- Service d'Hématologie biologique, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire Henri Mondor, Créteil, France. Faculté de Médecine, Université Paris Est Créteil, Créteil, France.
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Vitamin B12 status in metformin treated patients: systematic review. PLoS One 2014; 9:e100379. [PMID: 24959880 PMCID: PMC4069007 DOI: 10.1371/journal.pone.0100379] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/26/2014] [Indexed: 02/05/2023] Open
Abstract
Objective Randomized controlled trials and observational studies have yielded inconsistent results on the effects of metformin on vitamin B12 reduction. We therefore performed a systematic review to analyze the effects of metformin on vitamin B12 concentration. Methods PubMed, Medline, Embase, and the Cochrane central registry of controlled trials were searched to identify randomized controlled trials and observational studies exploring the association between metformin and vitamin B12 concentration in patients with type 2 diabetes mellitus or polycystic ovary syndrome. The main outcome measure was changes in serum vitamin B12 concentration after 6–208 weeks of treatment with metformin, as compared with placebo or other anti-hyperglycemic therapy. Results Six randomized controlled trials met the inclusion criteria. Serum vitamin B12 concentrations were significantly lower in patients treated with metformin than in those who received placebo or rosiglitazone (mean difference [MD], −53.93 pmol/L; 95% confidence interval [CI], −81.44 to −26.42 pmol/L, P = 0.0001). Subgroup analysis identified four trials in which patients received a lower dose of metformin (<2000 mg/d) and two in which they received a higher dose (≥2000 mg/d), with MDs in vitamin B12 concentration after metformin treatment of −37.99 pmol/L (95% CI, −57.44 to −18.54 pmol/L, P = 0.0001) and −78.62 pmol/L (95% CI, −106.37 to −50.86 pmol/L, P<0.00001), respectively. Conclusions The reduction of vitamin B12 may be induced by metformin in a dose dependent manner.
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Low serum vitamin B12 levels among psychiatric patients admitted in Butabika mental hospital in Uganda. BMC Res Notes 2014; 7:90. [PMID: 24533701 PMCID: PMC3931663 DOI: 10.1186/1756-0500-7-90] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022] Open
Abstract
Background Psychiatric manifestations have been noted in patients with low serum vitamin B12 levels even in the absence of other neurologic and/or haematologic abnormalities. There is no literature on low serum B12 prevalence among Ugandans with psychiatric illnesses. The aim of this study was to establish the prevalence, risk factors, and clinical manifestations of low serum vitamin B12 among psychiatric patients admitted in a Mental Health Hospital in Uganda. Method Using a cross sectional descriptive study design, 280 in-patients selected by systematic sampling were studied using a standardized protocol. Low serum vitamin B12 was defined as a level < 240 pg /mL. Results We found a prevalence of low serum B12 in 28.6% of the participants. Absent vibration sense which was significantly associated (58.3% Vs. 26.7%: OR = 3.84 (95% C.I. 1.18, 12.49); p-value = 0.025) with low vitamin B12 was observed among 12 participants. Macro-ovalocytes present among 23 participants on peripheral film were significantly associated with low serum levels (73.9% Vs. 26.2%: OR = 7.99 (95% C.I. 3.01, 21.19) p-value < 0.0001). Factors significantly associated with low serum B12 levels included psychiatric diagnosis of schizophrenia (AOR 1.74 (95% C.I. 1.00, 3.02); p-value = 0.049), duration of psychiatric illness > or = 3 years (AOR 2.27 (95% C.I. 1.29, 3.98); p-value = 0.004), and hospitalization < 3 weeks (AOR 4.01 (95% C.I. 1.02, 15.79); p-value = 0.047). Female participants were associated with protection from low serum levels (AOR 0.4 (95% C.I. 0.22, 0.73); p-value = 0.003). Conclusion Low serum B12 is common among hospitalized psychiatric patients with the majority having no haematological findings. Associated risk factors included having a psychiatric diagnosis of schizophrenia, a shorter duration of hospitalization and longer duration of psychiatric illness. Female participants were less likely to have low serum vitamin B12 levels. Routine screening for serum vitamin B12 levels should be adopted by all hospitals for admitted psychiatric patients.
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Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat 2013; 2013:641943. [PMID: 24187647 PMCID: PMC3800649 DOI: 10.1155/2013/641943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/06/2013] [Accepted: 08/20/2013] [Indexed: 01/07/2023] Open
Abstract
Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.
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Concentration plasmatique élevée de la vitamine B12 : un indicateur des maladies hépatiques ou tumorales. Rev Med Interne 2013; 34:337-41. [DOI: 10.1016/j.revmed.2012.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/19/2012] [Accepted: 10/07/2012] [Indexed: 11/18/2022]
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Serum vitamin B12 not reflecting vitamin B12 status in patients with type 2 diabetes. Biochimie 2013; 95:1056-61. [DOI: 10.1016/j.biochi.2012.10.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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Grossfeld A, Dekel S, Lerman Y, Sherman S, Atzmony L, Salai M, Justo D. Symptomatic venous thromboembolism in elderly patients following major orthopedic surgery of the lower limb is associated with elevated vitamin B12 serum levels. Clin Biochem 2012; 46:54-8. [PMID: 23000313 DOI: 10.1016/j.clinbiochem.2012.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 09/08/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Elevated vitamin B12 serum levels are associated with systemic inflammation and mortality. Since venous thromboembolism (VTE) is associated with systemic inflammation and mortality as well, we have hypothesized that it is also associated with elevated vitamin B12 serum levels in elderly patients following major orthopedic surgery of the lower limb. METHODS This is a retrospective study. Medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation following major orthopedic surgery of the lower limb during 2007-2009 were reviewed. The study group included symptomatic VTE patients. The control group included patients in whom VTE was excluded. Demographics, co-morbidities, VTE risk factors, vitamin B12 serum levels, and 1-year mortality were studied. RESULTS The cohort included 197 elderly patients (median age: 82 years): 140 (71.1%) women and 57 (28.9%) men. Overall, 20 (10.2%) patients had VTE (study group) and in 177 (89.8%) patients VTE was excluded (control group). Vitamin B12 serum levels were higher in the study group compared with the control group (median: 634 vs. 409 pg/dL, p=0.024). The incidence of elevated vitamin B12 serum levels (≥500 pg/dL) was higher in the study group compared with the control group (odds ratio 3.1, p=0.031). Elevated vitamin B12 serum levels were associated with VTE (odds ratio 5.3, p=0.011) and with 1-year mortality (odds ratio 6.6, p=0.015) independent of demographics, co-morbidities, and VTE risk factors. CONCLUSIONS Symptomatic VTE is associated with elevated vitamin B12 serum levels in elderly patients following major orthopedic surgery of the lower limb.
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Affiliation(s)
- Anat Grossfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci 2012; 57:2408-15. [PMID: 22359191 DOI: 10.1007/s10620-012-2083-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 02/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The U.S. population is aging and the burden of geriatric inflammatory bowel disease (IBD) patients has increased. Systematic data describing phenotypic presentation, treatment regimens, outcomes and comorbidities in elderly IBD patients is limited. We performed a retrospective observational study of IBD patients age ≥65 followed in a 20-hospital system to determine patterns of phenotypic presentation, treatment, polypharmacy, nutritional status and comorbidity. METHODS Data were extracted from electronic medical record based on ICD-9 coding/indexed terms on Crohn's disease (CD) and ulcerative colitis (UC) patients. RESULTS A total of 393 geriatric IBD patients were identified (49.1% males; 50.9% females; 61.8% UC; 38.2% CD; 73.4 ± 6.6 years old). Younger age at diagnosis of CD (≤64) was associated with greater prevalence of small bowel surgeries (63.6%) compared with those diagnosed after age ≥65 (20.9%) (p < 0.005). Fistulizing/penetrating disease was frequent in patients diagnosed with CD at a younger age (43.6% compared to 7%) (p < 0.005). IBD maintenance treatment included: 44% 5-ASA agents; 31.6% maintenance prednisone (defined as ≥6 months treatment duration); 4.8% steroid suppositories; 5.6% 6MP/azathioprine; 1.3% methotrexate; 1.3% adalimumab; 1.3% infliximab; 9.4% loperamide/diphenoxylate/atropine; 0.5% had no IBD medications. Longer duration of CD disease correlated with vitamin B12, vitamin D and iron deficiency. CONCLUSION Geriatric patients diagnosed with CD earlier in life had greater small bowel involvement compared with new onset geriatric CD. There is low utilization of immunomodulator and biologic agents in geriatric IBD patients. Duration of CD correlates with nutrient deficiency. Prospective studies are warranted in this respect.
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Hou CT, Wu YH, Cheng CH, Huang PN, Huang YC. Higher plasma homocysteine is associated with lower vitamin B6 status in critically ill surgical patients. Nutr Clin Pract 2012; 27:695-700. [PMID: 22868281 DOI: 10.1177/0884533612449654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperhomocysteinemia might be at least partially due to compromised B vitamin status in critically ill patients and has been linked with critical illness. This study was conducted to examine the association between plasma homocysteine with B vitamins and clinical outcomes in critically ill surgical patients. METHODS Thirty-two patients in the surgical intensive care unit (SICU) were enrolled. Disease severity (Acute Physiology and Chronic Health Evaluation II score), hematological values, serum and erythrocyte folate, serum vitamin B₁₂, plasma, and erythrocyte pyridoxal 5'-phosphate (PLP) were determined within 24 hours of admission and again after 7 days. RESULTS The prevalence of hyperhomocysteinemia in the patients was either 46.9% (plasma homocysteine ≥12 µmol/L) or 31.3% (plasma homocysteine ≥15 µmol/L) on day 1 in the SICU and increased to 62.5% (plasma homocysteine ≥12 µmol/L) and 37.5% (plasma homocysteine ≥15 µmol/L) on day 7 after admission to the SICU. Plasma homocysteine, serum folate, and vitamin B₁₂ significantly increased by day 7, whereas plasma and erythrocyte PLP remained constant throughout the study. Plasma homocysteine was not correlated with serum folate and vitamin B₁₂. However, plasma and erythrocyte PLP on day 1 were adversely associated with day 1 levels of plasma homocysteine after adjusting for potential confounders. Plasma homocysteine on day 1 or changes (Δ day 7-day 1) did not show any association with clinical outcomes. CONCLUSIONS Lower plasma PLP might be a significant factor for increased plasma homocysteine in critically ill surgical patients. The association between plasma homocysteine and clinical outcomes was not found.
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Affiliation(s)
- Chen-Tai Hou
- Critical Care, Changhua Christian Hospital, Changhua, Taiwan
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Dhobale M, Chavan P, Kulkarni A, Mehendale S, Pisal H, Joshi S. Reduced Folate, Increased Vitamin B12 and Homocysteine Concentrations in Women Delivering Preterm. ANNALS OF NUTRITION AND METABOLISM 2012; 61:7-14. [DOI: 10.1159/000338473] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
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Prediction of all-cause mortality by B group vitamin status in the elderly. Clin Nutr 2011; 31:191-8. [PMID: 22071291 DOI: 10.1016/j.clnu.2011.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 10/18/2011] [Accepted: 10/18/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated. METHODS The Taiwanese Elderly Nutrition and Health Survey (1999-2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008. RESULTS Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58-0.95) and 0.74 (0.57-0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38-0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment. CONCLUSIONS Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.
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Harrington AL, Dixon TM, Ho CH. Vitamin B12 Deficiency as a Cause of Delirium in a Patient With Spinal Cord Injury. Arch Phys Med Rehabil 2011; 92:1917-20. [DOI: 10.1016/j.apmr.2011.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/26/2011] [Accepted: 06/08/2011] [Indexed: 10/15/2022]
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Abstract
AIM To find out which of the two predictors, Charlson co-morbidity index or vitamin B12, better estimates the risk of in-hospital mortality in seriously ill patients. METHOD Electronic hospital records of 1509 elderly patients aged 65 and older were retrospectively surveyed. RESULTS Albumin, age and elevated vitamin B12 levels were significantly associated with increased in-hospital mortality. Charlson co-morbidity index was not significantly associated with death. The highest mortality (24.3%) was found in the group of patients who were concomitantly in the lowest albumin quartile and the highest vitamin B12 levels quartile. In this group, mortality increased significantly with age. By elasticity calculation, vitamin B12 capability to predict mortality was higher by ≈ 3 times than that of Charlson co-morbidity index. CONCLUSION In view of the fact that vitamin B12 levels have been found to predict mortality, they should be measured in geriatric practice, in addition to albumin levels, as a practical and reliable tool for identifying high risk elderly hospitalized patients. Probably, a combination of two or more available and inexpensive routinely taken tests can give a better estimation of mortality than some complicated tools, like Charlson co-morbidity index.
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Affiliation(s)
- S Tal
- Geriatric Medicine Department, Kaplan Medical Center, P.O. Box 1, Rehovot 76100, Israel.
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Gerstel C, Zarate Lagunes M, Vischer UM. FECAL INCONTINENCE RESOLVED USING METFORMIN WITHDRAWAL. J Am Geriatr Soc 2011; 59:756-7. [DOI: 10.1111/j.1532-5415.2011.03358.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Baztán JJ, Gavidia JJ, Gómez-Pavón J, Esteve A, Ruipérez I. HIGH VITAMIN B12 LEVELS AND IN-HOSPITAL MORTALITY. J Am Geriatr Soc 2010; 58:2237-8. [DOI: 10.1111/j.1532-5415.2010.03116.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW To analyse the anti-inflammatory and antioxidant properties of vitamin B12 and evaluate current evidence on vitamin B12 status in the critically ill with systemic inflammation. RECENT FINDINGS Data on vitamin B12 status of intensive care unit patients are scarce. Cobalamins could potentially be useful agents for inhibiting nitric oxide synthase and nitric oxide production, controlling nuclear factor-kappa B activation, and restoring optimal bacteriostasis and phagocytosis in which transcobalamins play a proven role. The antioxidant properties of vitamin B12, with a glutathione-sparing effect, are secondary to stimulation of methionine synthase activity and reaction with free oxygen or nitrogen radicals. Large parenteral doses are routinely administered for cyanide poisoning, with only mild, reversible side-effects. Current evidence suggests that high-dose parenteral vitamin B12 may prove an innovative approach to treat critically ill systemic inflammatory response syndrome patients, especially those with severe sepsis/septic shock. In this setting, vitamin B12 and transcobalamins could modulate systemic inflammation contributing to the anti-inflammatory cascade and potentially improve outcome. SUMMARY Despite evidence from animal studies, so far there are no clinical intervention trials that have studied vitamin B12 as a pharmaconutrient strategy for critical care. Well designed animal and clinical studies are required to clarify several outstanding questions on the optimal posology, safety, and efficacy of high-dose vitamin B12 in the critically ill.
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Affiliation(s)
- William Manzanares
- Department of Critical Care Medicine, Hospital de Clínicas, Dr Manuel Quintela, Faculty of Medicine, (University Hospital), Universidad de la República, UDELAR, Montevideo, Uruguay.
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