Oral Synthetic Folic Acid and Vitamin B12Supplements Work-If One Consumes Them

Vitamin fortification of puréed foods for long-term care residents

PURPOSE

Elderly people are at risk for malnutrition, and those who consume a puréed diet may be particularly at risk. A fortification procedure was developed at a long-term care (LTC) facility, and nutrient intakes and serum vitamin levels were assessed to determine whether they subsequently increased.

METHODS

Fortification levels were determined using a combination of two techniques: the Dietary Reference Intakes planning formula and Health Canada's defined nutrient contribution method. For six puréed foods, triangle sensory tests were performed to determine whether fortification changed the flavour of the foods. Four fortified foods were incorporated into the daily puréed menu at an LTC facility. Nutrient intakes of 10 residents and serum vitamin B12, folate, and 25-hydroxyvitamin D levels of 11 residents were analyzed at baseline and eight weeks after the intervention.

RESULTS

Nutrient intakes increased after the intervention for all nutrients in the fortification mix (p0.01). 25-hydroxyvitamin D and folate levels increased after the intervention (p0.01), but serum vitamin B12 levels did not change (p>0.05).

CONCLUSIONS

The development of acceptable vitamin-fortified puréed foods is feasible and is an effective way to increase the micronutrient status of LTC residents. Mineral fortification requires further work to minimize flavour changes.

If high folic acid aggravates vitamin B12 deficiency what should be done about it?

The most common cause of vitamin B12 deficiency in older people is malabsorption of food-bound vitamin B12. Thus, it is suggested that the recommended daily allowance of 2.4 microg/d be met primarily with crystalline vitamin B12, which is believed to be well absorbed in individuals who have food-bound malabsorption. There is concern that high intakes of folic acid from fortified food and dietary supplements might mask the macrocytic anemia of vitamin B12 deficiency, thereby eliminating an important diagnostic sign. One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms. Another study suggests that once vitamin B12 deficiency is established in subjects with food-bound malabsorption, 40 microg/d to 80 microg/d of oral crystalline vitamin B12 for 30 d does not reverse the biochemical signs of deficiency. Together, these studies provide further evidence that public health strategies are needed to improve vitamin B12 status in order to decrease the risk of deficiency and any potentially adverse interactions with folic acid.

A novel solution is needed to correct low nutrient intakes in elderly long-term care residents

Currently, there is no consensus about how to best treat malnutrition in elderly long-term care residents. A recent study found that the traditional treatment method of serving small, frequent meals was not effective at increasing energy intake. This review describes strategies to treat malnutrition in this vulnerable population.