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Dhande D, Dhok A, Anjankar A, Nagpure S. A Case Report and Literature Review on Dietary Practices and Megaloblastic Anemia in a Young Female: Unraveling the Impact of Nutrition on Hematological Health. Cureus 2024; 16:e61550. [PMID: 38962588 PMCID: PMC11221392 DOI: 10.7759/cureus.61550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Megaloblastic anemia, stemming from vitamin B12 or folate deficiencies, poses diagnostic challenges due to its diverse clinical presentation. We report a case of a 25-year-old female college student presenting with symptoms indicative of megaloblastic anemia, attributed to her recent adoption of a strict vegetarian and vegan diet. Clinical manifestations included dizziness, palpitations, blurred vision, vertigo, headaches, burning sensations, excessive sweating, mouth ulcers, and unintentional weight loss. Physical examination revealed pale palpebral conjunctiva and sweating on the palms and soles. Laboratory findings confirmed megaloblastic anemia secondary to vitamin B12 deficiency, with elevated mean corpuscular volume (MCV), reticulocyte count, serum methylmalonic acid (MMA), and homocysteine levels. Treatment with intramuscular cyanocobalamin injections and oral vitamin B12 supplementation led to symptomatic improvement and normalization of hematological parameters. This case underscores the crucial role of dietary habits in hematological health. Vegetarian and vegan diets, devoid of animal products rich in vitamin B12, increase the risk of deficiency. Early recognition and management of such deficiencies are imperative to prevent long-term complications. A literature review corroborates the association between vegetarianism/veganism and megaloblastic anemia risk. Healthcare providers should vigilantly assess dietary histories, particularly in patients with hematological abnormalities. Further research is warranted to explore strategies for optimizing nutrient intake in individuals adhering to vegetarian or vegan diets, aiming to mitigate the risk of nutritional deficiencies and associated complications.
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Affiliation(s)
- Devshree Dhande
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archana Dhok
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Anjankar
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shailesh Nagpure
- Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Obeid R, Andrès E, Češka R, Hooshmand B, Guéant-Rodriguez RM, Prada GI, Sławek J, Traykov L, Ta Van B, Várkonyi T, Reiners K. Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus. J Clin Med 2024; 13:2176. [PMID: 38673453 PMCID: PMC11050313 DOI: 10.3390/jcm13082176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker and methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history, and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing the diagnosis of B12 deficiency. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency, and the treatment goals govern decisions regarding the route and dose of B12 therapy.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Emmanuel Andrès
- Department of Internal Medicine, Diabetes and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Richard Češka
- IIIrd Department of Internal Medicine, Center of Preventive Cardiology, University General Hospital, Charles University in Prague, 110 00 Prague, Czech Republic
| | - Babak Hooshmand
- Aging Research Center, Karolinska Institute, 171 65 Stockholm, Sweden
- Department of Neurology, Benedictus Klinikum Tutzing, 82327 Tutzing, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University Hospital, 80539 Munich, Germany
| | - Rosa-Maria Guéant-Rodriguez
- INSERM, UMR_S1256, NGERE–Nutrition, Genetics, and Environmental Risk Exposure, Faculty of Medicine of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
- Department of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, 54000 Vandoeuvre-lès-Nancy, France
| | - Gabriel Ioan Prada
- Clinical Department of the National Institute of Gerontology and Geriatrics “Ana Aslan”, University of Medicine and Pharmacy “Carol Davila”, 011241 Bucharest, Romania
| | - Jarosław Sławek
- Department of Neurology & Stroke, St. Adalbert Hospital, 80-462 Gdańsk, Poland
- Department of Neurological-Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Latchezar Traykov
- Department of Neurology, University Hospital “Alexandrovska”, Medical University, 1431 Sofia, Bulgaria
| | - Binh Ta Van
- Vietnam Institute of Diabetes and Metabolic Disorders, Hanoi Medical University, Hanoi 116001, Vietnam
| | - Tamás Várkonyi
- Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Karlheinz Reiners
- Consultant in Neurology and Clinical Neurophysiology, 41844 Wegberg, Germany
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Zhang J, Wu L, Wang S, Pan Y, Zhang A. Increased serum methylmalonic acid levels were associated with the presence of cognitive dysfunction in older chronic kidney disease patients with albuminuria. BMC Geriatr 2024; 24:159. [PMID: 38360610 PMCID: PMC10870521 DOI: 10.1186/s12877-024-04759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the correlation between serum methylmalonic acid (MMA) levels and cognition function in patients with chronic kidney disease (CKD). METHODS In this cross-sectional study, we included 537 CKD individuals aged ≥ 60-year-old with albuminuria from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four cognitive tests including the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Delayed Recall and Word Learning tests, and the Animal Fluency test (AF) were performed. Associations between MMA and cognition scores were assessed with linear regression models. RESULTS MMA level was negatively associated with residual renal function and nutrition status. After multivariate adjustment, elevated serum MMA levels were independently correlated with decline of cognition in CKD patients with albuminuria. CONCLUSION Our study showed that higher serum MMA levels were independently associated with the presence of cognition dysfunction in CKD patients. The exact pathogenesis of MMA and cognition needs further research.
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Affiliation(s)
- Jialing Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Leiyun Wu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Shiyuan Wang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Yajing Pan
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, 100053, Beijing, China.
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Cao B, Xue Y, Liu D. The association between methylmalonic acid, a biomarker of mitochondria dysfunction, and phenotypic age acceleration: A population-based study. Arch Gerontol Geriatr 2024; 117:105176. [PMID: 37713936 DOI: 10.1016/j.archger.2023.105176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/16/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
Phenotypic age acceleration (PAA) is a sensitive marker of biological aging. Circulating methylmalonic acid (MMA) is a novel biomarker of mitochondrial dysfunction and has been associated with age-related disorders. Our study aimed to investigate to what extent circulating MMA was associated with PAA, and whether the association was independent of vitamin B12 status and renal function in the general population. We analyzed cross-sectional data from 13,023 participants across a wide age range (mean age: 38.9 years, range: 12 - 85 years, 51.1% women) from the US National Health and Nutrition Examination Survey (NHANES). PAA was calculated based on the published algorithm. Linear regression models were performed to assess the association between circulating MAA and PAA. Only 31% of the variation in MMA levels was explained by age, sex, race/ethnicity, social economic status, vitamin B12 status, and renal function. Per unit increase in circulating MAA (1.0 nmol/L) was associated with 1.59 years increase in PAA (β = 1.59, 95% CI: 1.17, 2.00, p < 0.001) after adjusting for multiple confounders. Importantly, PAA increased with circulating MMA levels independent of vitamin B12, creatine, and homocysteine levels. The association was more pronounced in subgroups of age ≥ 65 years, women, underweight, vitamin B12 < 400 μmol/L, and homocysteine ≥ 10 μmol/L. The association was much stronger among participants with cardiovascular diseases (CVDs) than without CVDs. In conclusion, our current population-based study showed that mitochondria-derived circulating MMA was associated with increased phenotypic age acceleration in the general population.
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Affiliation(s)
- Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - Yu Xue
- Department of Clinical Nutrition, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, Sichuan, China
| | - Dan Liu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
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Casula S, Ettleson MD, Bianco AC. Are We Restoring Thyroid Hormone Signaling in Levothyroxine-Treated Patients With Residual Symptoms of Hypothyroidism? Endocr Pract 2023; 29:581-588. [PMID: 37419565 PMCID: PMC11221272 DOI: 10.1016/j.eprac.2023.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Levothyroxine (LT4) at doses that maintain the serum thyroid-stimulating hormone levels within the normal range constitutes the standard of care for the treatment of hypothyroidism. After a few months, this eliminates the signs and symptoms of overt hypothyroidism in the majority of patients, owing to the endogenous activation of thyroxine to triiodothyronine, the biologically active thyroid hormone. Still, a small percentage of the patients (10%-20%) exhibit residual symptoms, despite having normal serum thyroid-stimulating hormone levels. These symptoms include cognitive, mood, and metabolic deficits, with a significant impairment in psychological well-being and quality of life. OBJECTIVE To provide a summary of progress in the approach of patients with hypothyroidism that exhibit residual symptoms despite treatment. METHODS We reviewed the current literature and here we focused on the mechanisms leading to a deficiency of T3 in some LT4-treated patients, the role of residual thyroid tissue and the rationale for combination therapy with LT4 + liothyronine (LT3). RESULTS A score of clinical trials comparing therapy with LT4 versus LT4 + LT3 concluded that both are safe and equally effective (neither is superior); however, these trials failed to recruit a sufficiently large number of patients with residual symptoms. New clinical trials that considered LT4-treated symptomatic patients revealed that such patients benefit from and prefer therapy containing LT4 + LT3; desiccated thyroid extract has also been used with similar results. A practical approach to patients with residual symptoms and on initiation of combination therapy with LT4 + LT3 is provided. CONCLUSION A recent joint statement of the American, British, and European Thyroid Associations recommends that a trial with combination therapy be offered to patients with hypothyroidism that do not fully benefit from therapy with LT4.
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Affiliation(s)
- Sabina Casula
- Department of Endocrinology, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Matthew D Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois.
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Abstract
Reviewing the research presented in this article, it is evident that from an epidemiological perspective, it is important to evaluate the extent to which findings of sex and gender differences in Alzheimer's dementia (AD) are due to differences in longevity, survival bias, and comorbidities. Medical, genetic, psychosocial, and behavioral factors, in addition to hormonal factors, can differentially affect the risk and progression of AD in women versus men. Further, evaluation of sex differences in AD progression and the trajectory of change in cognitive function, neuroimaging, cerebrospinal fluid (CSF), and blood-based biomarkers of AD is needed. Finally, identifying sex differences in AD biomarkers and change across the lifespan is critical for the planning of prevention trials to reduce the risk of developing AD.
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Affiliation(s)
- Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison Street, Suite 1000, Chicago, IL 60612, USA.
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Vitamin B12: For more than just the treatment of megaloblastic anemia? Rev Clin Esp 2023; 223:114-119. [PMID: 36669740 DOI: 10.1016/j.rceng.2022.11.004] [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: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 01/19/2023]
Abstract
Vitamin B12, or cobalamin, belongs to the group of water-soluble vitamins and is ingested through food of animal origin such as eggs, milk, red meat and poultry, fish, and shellfish. Its clinical indication is the treatment of hypovitaminosis B12 administered orally or intramuscularly in the form of hydroxocobalamin. Hypovitaminosis B12 is mainly caused by deficient dietary intake (individuals with malnutrition, vegetarians or vegans, older adults, pregnant people, individuals with alcohol use disorder); when intestinal absorption is reduced (atrophic gastritis, malabsorption syndrome, gastrointestinal surgery); and for causes associated with the intake of drugs (antacids, metformin). Hypervitaminosis B12 has been associated with renal failure; liver diseases such as cirrhosis and acute-phase hepatitis; alcohol use disorder with or without liver involvement; solid tumors of the lung, liver, esophagus, pancreas, and colorectum; and in hematological malignancies such as leukemia and bone marrow dysplasia.
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Vitamina B12: ¿para algo más que el tratamiento de la anemia megaloblástica? REVISTA CLÍNICA ESPAÑOLA 2022. [DOI: 10.1016/j.rce.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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Luzzi S, Cherubini V, Falsetti L, Viticchi G, Silvestrini M, Toraldo A. Homocysteine, Cognitive Functions, and Degenerative Dementias: State of the Art. Biomedicines 2022; 10:2741. [PMID: 36359260 PMCID: PMC9687733 DOI: 10.3390/biomedicines10112741] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 07/30/2023] Open
Abstract
There is strong evidence that homocysteine is a risk factor not only for cerebrovascular diseases but also for degenerative dementias. A recent consensus statement renewed the importance and the role of high levels of homocysteine in cognitive decline in several forms of degenerative dementia, such as Alzheimer's disease. Although the molecular mechanisms by which homocysteine causes cell dysfunction are known, both the impact of homocysteine on specific cognitive functions and the relationship between homocysteine level and non-Alzheimer dementias have been poorly investigated. Most of the studies addressing the impact of hyperhomocysteinemia on dementias have not examined the profile of performance across different cognitive domains, and have only relied on screening tests, which provide a very general and coarse-grained picture of the cognitive status of the patients. Yet, trying to understand whether hyperhomocysteinemia is associated with the impairment of specific cognitive functions would be crucial, as it would be, in parallel, learning whether some brain circuits are particularly susceptible to the damage caused by hyperhomocysteinemia. These steps would allow one to (i) understand the actual role of homocysteine in the pathogenesis of cognitive decline and (ii) improve the diagnostic accuracy, differential diagnosis and prognostic implications. This review is aimed at exploring and revising the state of the art of these two strictly related domains. Suggestions for future research are provided.
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Affiliation(s)
- Simona Luzzi
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Veronica Cherubini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Giovanna Viticchi
- Neurology Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Mauro Silvestrini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Alessio Toraldo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Milan Center for Neuroscience (NeuroMI), 20126 Milan, Italy
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11
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Li A, Du M, Chen Y, Marks LA, Visser A, Xu S, Tjakkes GE. Periodontitis and cognitive impairment in older adults: The mediating role of mitochondrial dysfunction. J Periodontol 2022; 93:1302-1313. [PMID: 35363382 PMCID: PMC9790481 DOI: 10.1002/jper.21-0620] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increased attention has been focused on the associations of periodontal disease with the onset and progression of cognitive impairment. Although the associations are likely to be multifactorial, few studies have explored the role of mitochondrial dysfunction in the periodontitis-dementia link. METHODS Cross-sectional data of 1,883 participants aged ≥60 years in the National Health and Nutrition Examination Survey 2011-2014 were analyzed. The following data were collected: 1) general information on sociodemographic, behavioral, and health-related factors; 2) periodontal status (mean attachment loss [AL] and mean probing depth [PD]); 3) mitochondrion-derived biomarker of mitochondrial dysfunction (blood sample concentration of methylmalonic acid [MMA]); 4) cognitive function (Consortium to Establish a Registry for Alzheimer's disease immediate recall [CERAD-IR] and delay recall [CERAD-DR], animal fluency test, and digit symbol substitution test [DSST]). Mediation analysis weighted for complex survey design was used to assess the effect of MMA on the association of periodontal status with cognitive function after adjusting for potential confounders. RESULTS Participants with Stage III and IV periodontitis had lower scores on cognitive performance and higher MMA levels than those with Stages I/II periodontitis. Circulating MMA was significantly associated with CERAD-DR (weighted β [SE] = -0.076 [0.011]) and DSST (weighted β [SE] = -0.039 [0.009]), which mediated 9.9% and 6.0% of the total association of mean PD with cognitive function. Moreover, MMA mediated 11.7% and 5.8% of the association of mean AL with CERAD-DR and DSST, respectively. CONCLUSION The findings suggest that MMA, a biomarker of mitochondrial dysfunction, plays a mediating role in the link between periodontitis and cognitive impairment in older adults aged ≥60 years.
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Affiliation(s)
- An Li
- Center of Oral ImplantologyStomatological HospitalSouthern Medical UniversityGuangzhouChina,Center for Dentistry and Oral HygieneUniversity Medical Center Groningen (UMCG)University of GroningenGroningenThe Netherlands
| | - Mi Du
- Department of ImplantologyCheeloo College of MedicineShandong Engineering Laboratory for Dental Materials and Oral Tissue RegenerationSchool and Hospital of StomatologyShandong University & Shandong Key Laboratory of Oral Tissue RegenerationJinanChina
| | - Yuntao Chen
- Medical Statistics and Decision‐MakingDepartment of EpidemiologyUMCGUniversity of GroningenGroningenThe Netherlands,Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Luc A.M. Marks
- Center for Dentistry and Oral HygieneUniversity Medical Center Groningen (UMCG)University of GroningenGroningenThe Netherlands
| | - Anita Visser
- Center for Dentistry and Oral HygieneUniversity Medical Center Groningen (UMCG)University of GroningenGroningenThe Netherlands,Department for GerodontologyCollege of Dental SciencesRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
| | - Shulan Xu
- Center of Oral ImplantologyStomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Geerten‐Has E. Tjakkes
- Center for Dentistry and Oral HygieneUniversity Medical Center Groningen (UMCG)University of GroningenGroningenThe Netherlands
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Zhao Y, Dong X, Chen B, Zhang Y, Meng S, Guo F, Guo X, Zhu J, Wang H, Cui H, Li S. Blood levels of circulating methionine components in Alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:934070. [PMID: 35936764 PMCID: PMC9354989 DOI: 10.3389/fnagi.2022.934070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCirculating methionine components have been reported to be associated with Alzheimer’s disease (AD) and mild cognitive impairment (MCI), although outcomes are not always consistent.Materials and methodsDatabase searching was conducted using PubMed, Embase, Cochrane Library, and Web of Science from inception to 26 December 2021. In this study, two reviewers independently identified eligible articles and extracted the data. We used Joanna Briggs Institute (JBI) Critical Appraisal tools to assess the overall quality of the included studies. STATA software was employed to perform meta-analysis evaluating the standardized mean difference (SMD) with its 95% confidence intervals (CIs) using random-effects models. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.ResultsTotally, 30 observational studies were eligible for inclusion. Compared with cognitively normal controls, patients with AD had increased homocysteine (Hcy) levels in the blood [standardized mean difference (SMD) = 0.59, 95% confidence interval [CI]: 0.36–0.82, P = 0.000], plasma (SMD = 0.39, 95% CI: 0.23–0.55, P = 0.000), and serum (SMD = 1.56, 95% CI: 0.59–2.95, P = 0.002). Patients with MCI were not significantly different from controls (SMD = 0.26, 95% CI: –0.07–0.58, P = 0.127). Patients with AD or MCI did not significantly differ from controls of blood vitamin B12 levels, AD (SMD = –0.05, 95% CI: –0.19–0.08, P = 0.440), or MCI (SMD = 0.01, 95% CI: –0.16–0.17, P = 0.94). Some cohort studies have suggested that higher Hcy, methionine, and S-adenosylmethionine levels may accelerate cognitive decline in patients with MCI or AD, and vitamin B12 deficiency is a risk factor for the disease; however, the results of other studies were inconsistent. According to the GRADE system, all these outcomes scored very low to low quality, and no high-quality evidence was found.ConclusionOnly Hcy levels in the plasma and serum were found to be inversely related to the risk of AD. However, due to the low quality of supporting these results, high-quality studies are needed to verify these findings.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022308961.
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Affiliation(s)
- Yan Zhao
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Xinyi Dong
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Bingyu Chen
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
| | - Yizhou Zhang
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
- Neuroscience Research Center, Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Shijiazhuang, China
| | - Sijia Meng
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Fangzhen Guo
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
| | - Xiaojing Guo
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jialei Zhu
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Haoyue Wang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Huixian Cui
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
- Neuroscience Research Center, Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Shijiazhuang, China
- Huixian Cui,
| | - Sha Li
- Department of Anatomy, Hebei Medical University, Shijiazhuang, China
- Neuroscience Research Center, Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Shijiazhuang, China
- The Key Laboratory of Neural and Vascular Biology of Ministry of Education, Hebei Medical University, Shijiazhuang, China
- *Correspondence: Sha Li,
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13
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Wang C, Zhang Y, Shu J, Gu C, Yu Y, Liu W. Association Between Methylmalonic Acid and Cognition: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:901956. [PMID: 35844735 PMCID: PMC9276928 DOI: 10.3389/fped.2022.901956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Methylmalonic acid (MMA) is an intermediate metabolite of human body. The content of MMA in the blood of healthy people is very low, and its concentration will increase in some diseases and elderly people. Recent studies have shown that MMA has a variety of biological functions. The correlation between MMA and cognition, one of the important functions of the nervous system, is still uncertain. OBJECTIVE Meta-analyses were performed to assess whether elevated MMA was associated with the risk of cognitive decline. MATERIALS AND METHODS Cross-sectional studies, randomized controlled studies, and case-control studies on the relationship between MMA and cognition were obtained by searching PubMed, Web of Science, EMBASE, ProQuest, WANFANG MED ONLINE, China National Knowledge Infrastructure (CNKI) and Chongqing VIP until May 2022. Two researchers independently selected studies according to inclusion and exclusion criteria, evaluated study quality and extracted data. Meta-analyses were performed using Review Manager 5.4 software. The sensitivity analysis of meta-analysis was performed by One by one exclusion method. RESULTS A total of 11 studies were included, including six cross-sectional studies, two randomized controlled studies, and three case-control studies, with a sample of 16,533 subjects. Meta-analysis showed that there was no significant difference in cognitive level between high-level MMA subjects and low-level MMA subjects in the general population [SMD = -2.19, 95% CI (-4.76 ∼ 0.38), Z = 1.67, P = 0.09]. In the population supplemented with VitB12, the increase of MMA level caused by VitB12 supplementation was not related to the change of cognition [SMD = 0.32, 95% CI (-0.19 ∼ 0.84) z = 1.22, P = 0.22]. There was also no significant difference in MMA levels between patients with dementia and the control group [WMD = 20.89, 95% CI (-5.13 ∼ 46.92), z = 1.57, P = 0.12]. CONCLUSION In the general population, whether VitB12 is supplemented or not, there is no correlation between the increase of MMA level and the decrease of cognitive level. In dementia diseases, the level of MMA did not change significantly. High levels of MMA may not be a risk factor for cognitive impairment. The exact relationship between MMA and cognition needs further research. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021266310], identifier [CRD42021266310].
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Affiliation(s)
- Chao Wang
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Ying Zhang
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Jianbo Shu
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Chunyu Gu
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Yuping Yu
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Wei Liu
- Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China
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14
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Shea TB. Improvement of cognitive performance by a nutraceutical formulation: Underlying mechanisms revealed by laboratory studies. Free Radic Biol Med 2021; 174:281-304. [PMID: 34352370 DOI: 10.1016/j.freeradbiomed.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022]
Abstract
Cognitive decline, decrease in neuronal function and neuronal loss that accompany normal aging and dementia are the result of multiple mechanisms, many of which involve oxidative stress. Herein, we review these various mechanisms and identify pharmacological and non-pharmacological approaches, including modification of diet, that may reduce the risk and progression of cognitive decline. The optimal degree of neuronal protection is derived by combinations of, rather than individual, compounds. Compounds that provide antioxidant protection are particularly effective at delaying or improving cognitive performance in the early stages of Mild Cognitive Impairment and Alzheimer's disease. Laboratory studies confirm alleviation of oxidative damage in brain tissue. Lifestyle modifications show a degree of efficacy and may augment pharmacological approaches. Unfortunately, oxidative damage and resultant accumulation of biomarkers of neuronal damage can precede cognitive decline by years to decades. This underscores the importance of optimization of dietary enrichment, antioxidant supplementation and other lifestyle modifications during aging even for individuals who are cognitively intact.
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Affiliation(s)
- Thomas B Shea
- Laboratory for Neuroscience, Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.
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15
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Shavlovskaya OA, Bokova IA, Shavlovskiy NI, Yukhnovskaya YD. [Cobalamin in the complex treatment and prevention of cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:132-137. [PMID: 33834731 DOI: 10.17116/jnevro2021121031132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive impairment (CI) develops not only in structural damage to the central nervous system, but also in encephalopathies of dysmetabolic and deficiency etiology. Recently, special attention is focused on the appearance of CI due to the deficiency of cobalamin (vitamin B12) and folic acid (FA), the change in the level of homocysteine (HC). To detect vitamin B12 deficiency is possible by examining key biomarkers in serum based on a decrease in the levels of vitamin B12 and holotranscobalamin, and levels of methylmalonic acid (MMA) and HC. The article presents an analysis of studies conducted in Norway, Korea, India, and other countries to assess the risks of CI in the presence of reduced levels of vitamin B12 in the elderly, which demonstrated a decrease in brain volume in the elderly (according to MRI data) in combination with altered test parameters that assess cognitive functions. In many studies, female patients with reduced levels of vitamin B12 predominated among the studied patients. Also, some studies have demonstrated the effectiveness of complex CI therapy with the inclusion of vitamin B12 (both for oral and intravenous administration). Oral vitamin B12 therapy at a dose of 1000 μg has been shown to be adequate for the treatment of vitamin B12 deficiency. Also, the administration of vitamin B12 for prophylactic purposes is recommended for patients with subnormal or borderline concentrations of vitamin B12 in the blood serum.
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Affiliation(s)
- O A Shavlovskaya
- International University of Restorative Medicine, Moscow, Russia
| | - I A Bokova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N I Shavlovskiy
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yu D Yukhnovskaya
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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16
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Ilter D, Gomes AP. Age-induced metabolic reprogramming underlies cancer progression. Mol Cell Oncol 2021; 8:1876506. [PMID: 33860078 PMCID: PMC8018342 DOI: 10.1080/23723556.2021.1876506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Aging is a main risk factor for cancer. Using human serum we demonstrated that tumor progression and metastases occur, at least in part, as a manifestation of global metabolic deregulation of the aged host. This shows that the role of aging in cancer goes far beyond increased exposure time to mutagens; the aging process coordinates various aspects required for malignancy.
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Affiliation(s)
- Didem Ilter
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ana P. Gomes
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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17
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Agarwal P, Dhana K, Barnes LL, Holland TM, Zhang Y, Evans DA, Morris MC. Unhealthy foods may attenuate the beneficial relation of a Mediterranean diet to cognitive decline. Alzheimers Dement 2021; 17:1157-1165. [DOI: 10.1002/alz.12277] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Puja Agarwal
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
| | - Klodian Dhana
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois USA
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Thomas M Holland
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
| | - Yanyu Zhang
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
| | - Denis A. Evans
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
| | - Martha Clare Morris
- Rush Institute of Healthy Aging, Department of Internal Medicine Rush University Medical Center Chicago Illinois USA
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18
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Bailey RL, Jun S, Murphy L, Green R, Gahche JJ, Dwyer JT, Potischman N, McCabe GP, Miller JW. High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES. Am J Clin Nutr 2020; 112:1547-1557. [PMID: 32860400 PMCID: PMC8184300 DOI: 10.1093/ajcn/nqaa239] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Potential safety concerns relative to impaired cognitive function may exist when high folic acid exposures are combined with low vitamin B-12 status. OBJECTIVES We aimed to examine the relation of the coexistence of high folate and low vitamin B-12 status with cognitive function, utilizing various definitions of "high" folate status. METHODS Cross-sectional data from older adults (≥60 y; n = 2420) from the 2011-2014 NHANES were analyzed. High folate status was defined as unmetabolized serum folic acid (UMFA) > 1 nmol/L or serum total folate > 74.1 nmol/L, and low vitamin B-12 status as methylmalonic acid > 271 nmol/L or serum vitamin B-12 < 150 pmol/L. Logistic regression models estimated ORs of scoring low on 1 of 4 cognitive tests: the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Delayed Recall (CERAD-DR) and Word Learning tests, and the Animal Fluency test (AF). RESULTS A significant interaction was observed relative to scoring low on the DSST (<34; UMFA; P-interaction = 0.0071) and AF (serum folate; P-interaction = 0.0078) for low vitamin B-12 and high folate status. Among those with low vitamin B-12, high UMFA or high serum total folate was associated with higher risk of scoring low on the DSST (OR: 2.16; 95% CI: 1.05, 4.47) and the AF (OR: 1.93; 95% CI: 1.08, 3.45). Among those with "normal" vitamin B-12, higher UMFA or serum total folate was protective on the CERAD-DR. In noninteraction models, when high folate and normal vitamin B-12 status was the reference group, low vitamin B-12 combined with high UMFA was associated with greater risk based on the DSST (<34, OR: 2.87; 95% CI: 1.85, 4.45; <40, OR: 2.22; 95% CI: 1.31, 3.75) and AF (OR: 1.97; 95% CI: 1.30, 2.97); but low vitamin B-12 and lower UMFA (OR: 1.69; 95% CI: 1.16, 2.47) was also significantly associated for DSST < 40 risk. CONCLUSIONS Low vitamin B-12 was associated with cognitive impairment both independently and in an interactive manner with high folate for certain cognitive performance tests among older adults.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue
University, West Lafayette, IN, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue
University, West Lafayette, IN, USA
| | - Lisa Murphy
- Department of Nutrition Science, Purdue
University, West Lafayette, IN, USA
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of
California, Davis, Davis, CA, USA
| | | | - Johanna T Dwyer
- Office of Dietary Supplements, NIH, Bethesda,
MD, USA
- Frances Stern Nutrition Center, Tufts Medical
Center, Boston, MA, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging at
Tufts University School of Medicine, Boston, MA, USA
| | | | - George P McCabe
- Department of Statistics, Purdue University,
West Lafayette, IN, USA
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers
University, New Brunswick, NJ, USA
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19
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Boumenna T, Scott TM, Lee JS, Palacios N, Tucker KL. Folate, vitamin B-12, and cognitive function in the Boston Puerto Rican Health Study. Am J Clin Nutr 2020; 113:179-186. [PMID: 33184638 PMCID: PMC7779227 DOI: 10.1093/ajcn/nqaa293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There is evidence that low plasma vitamin B-12 and folate individually, as well as an imbalance of high folic acid and low vitamin B-12 status, may be associated with lower cognitive function. OBJECTIVES We examined dietary and plasma folate and vitamin B-12 status, and their interaction, in relation to cognitive function in a cohort of older Puerto Rican adults. METHODS The design is cross-sectional, with 1408 participants from the Boston Puerto Rican Health Study (mean ± SD age: 57.1 ± 7.9 y). Cognitive function was assessed with a comprehensive test battery and a global composite score was derived. Plasma folate, vitamin B-12, and methylmalonic acid (MMA) were assessed in fasting blood samples. RESULTS After adjusting for covariates, high plasma folate and high plasma vitamin B-12 were each positively associated with global cognitive score (β: 0.063; 95% CI: -0.0008, 0.127; P = 0.053 and β: 0.062; 95% CI: 0.009, 0.12; P = 0.023, respectively, for logged values, and β: 0.002; 95% CI: 0.00005, 0.004; P-trend = 0.044 and β: 0.00018; 95% CI: 0.00001, 0.0003; P-trend = 0.036, respectively, across tertiles). Nine percent of participants had vitamin B-12 deficiency (plasma vitamin B-12 < 148 pmol/L or MMA > 271 nmol/L), but none were folate deficient (plasma folate < 4.53 nmol/L). Deficient compared with higher vitamin B-12 was significantly associated with lower cognitive score (β: -0.119; 95% CI: -0.208, -0.029; P = 0.009). We could not examine the interaction for vitamin B-12 deficiency and high plasma folate, because there were too few individuals (<1% of the cohort) in this category to draw conclusions. CONCLUSIONS Low plasma vitamin B-12 and low plasma folate were each associated with worse cognitive function in this population. Vitamin B-12 deficiency was prevalent and clearly associated with poorer cognitive function. More attention should be given to identification and treatment of vitamin B-12 deficiency in this population. Additional, larger studies are needed to examine the effect of vitamin B-12 deficiency in the presence of high exposure to folic acid.
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Affiliation(s)
- Tahani Boumenna
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Tammy M Scott
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Department of Psychiatry, School of Medicine, Tufts University, Boston, MA, USA
| | - Jong-Soo Lee
- Department of Mathematical Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Natalia Palacios
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA,Geriatric Research Education Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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20
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Malik E, Rozner L, Adelson M, Schreiber S, Peles E. The Relation between Changes in Vitamin D and Vitamin B12 Levels, Body Mass Index and Outcome in Methadone Maintenance Treatment Patients. J Psychoactive Drugs 2020; 53:55-64. [PMID: 33143561 DOI: 10.1080/02791072.2020.1840680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients' Body Mass Index (BMI) increase during methadone maintenance treatment (MMT), and both Vitamins D and B12 deficiencies may be associated with BMI. We studied the relations between BMI, these vitamins and treatment outcome in patients with opioid use disorder receiving MMT. Vitamin B12 levels were available for 272 patients and Vitamin D levels were available for 260 patients. Of those 112 and 80 respectively had two measures (at admission or thereafter, and while stabilized or after one year in treatment). Patients' BMI levels and long-term retention were analyzed. Vitamin B12 was lower in patients abusing cocaine/amphetamine on admission. Vitamin D did not change over time, but a significant weight gain could be observed in 38 patients whose vitamin D was elevated compared to 42 whose levels were not, (25.4 ± 4.8 to 28.8 ± 5.2 vs. 24.3 ± 3.7 to 25.5 ± 4.0, p(Time) < 0.0005, p(Group) = 0.03, p(interaction) = 0.02). BMI changes correlated with vitamin D levels change (r = 0.26, p = .04). Longer cumulative retention was observed among the elevated vitamin D group (8.1 years, 95% CI 6.3-9.8) in comparison with the non-elevated group (4.8y 95% CI 3.6-6.1, Kaplan Meier, p = .02). Stimulants misuse was associated with low B12 levels. Vitamin D elevation is associated with weight gain and longer retention in treatment.
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Affiliation(s)
- Elad Malik
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lihi Rozner
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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21
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Health Risk, Functional Markers and Cognitive Status in Institutionalized Older Adults: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197303. [PMID: 33036324 PMCID: PMC7579099 DOI: 10.3390/ijerph17197303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
A Follow-up of vitamin B12 and lipids status is essential in older people, being closely related to non-communicable diseases. Their relationships with cognitive and physical status are not clear. The aim was to analyze the evolution of vitamin B12 and related parameters, lipid and hematological profiles, and their relationships with cognitive and physical status among institutionalized elderly. Sixty residents, ranged from 62 to 99, were evaluated. Biomarkers (vitamin B12 and related parameters, lipid and hematological profiles), functional capacity (handgrip, arm and leg strength), and cognitive status (Mini-Mental State Examination) were evaluated four times at 4-month intervals. At the beginning of the study, 63% and 70% of the sample showed abnormal homocysteine and folate values, respectively. At the end of the year, abnormal homocysteine increased to 68%, abnormal folate values decreased to 50%. Throughout the year, serum folate showed a significant increase (14.9 vs. 16.3 nmol/L), (p < 0.05). Serum cobalamin (299 vs. 273 pmol/L). HDL-cholesterol (49.9 vs. 47.0 mg/dL) and triglyceride levels (102.4 vs. 123.2 mg/dL) showed a significant decrease and increase respectively in mean values (all p < 0.05). Serum cobalamin and HDL-cholesterol were the most important biomarkers associated with cognitive function (both p < 0.05). The most relevant biomarkers associated with poor physical strength depending on the body part analyzed were low concentrations of HDL-cholesterol, LDL-cholesterol, apolipoprotein A1, and albumin (all p < 0.05). The evolution of lipid biomarkers, their significance with cognitive values, and association with handgrip, point to the importance of the handgrip measurement, a very simple test, as an important health marker. Both serum albumin and physical strength are important health markers in older people.
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22
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Wang S, Liu Y, Liu J, Tian W, Zhang X, Cai H, Fang S, Yu B. Mitochondria-derived methylmalonic acid, a surrogate biomarker of mitochondrial dysfunction and oxidative stress, predicts all-cause and cardiovascular mortality in the general population. Redox Biol 2020; 37:101741. [PMID: 33035815 PMCID: PMC7554255 DOI: 10.1016/j.redox.2020.101741] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inherited methylmalonic acidemia is characterized by mitochondrial dysfunction, oxidative stress, and damage of mitochondria-rich organs in children. It is unclear whether methylmalonic acid (MMA) is related to poor prognosis in adults. The study aims to investigate the associations of MMA with all-cause and cause-specific mortality in the general population. METHODS Overall, 23,437 adults from the US National Health and Nutrition Examination Survey (NHANES) were enrolled. NHANES 1999-2004 and 2011-2014 were separately used as primary and validation subsets (median follow-up 13.5 and 2.8 years, respectively). Circulating MMA was measured with gas chromatography/mass spectrophotometry. Hazard ratios (HR) were estimated using weighted Cox regression models. RESULTS During 163,632 person-years of follow-up in NHANES 1999-2004, 3019 deaths occurred. Compared with participants with MMA <120 nmol/L, those with MMA≥250 nmol/L had increased all-cause and cardiovascular mortality in the multivariable-adjusted model [HR(95%CI), 1.62 (1.43-1.84) and 1.66 (1.22-2.27), respectively]. The association was especially significant among participants with normal cobalamin. MMA remained an independent predictor of all-cause mortality occurring whether within 5-year, 5-10 years, or beyond 10-year of follow-up (each p for trend≤0.007). That association was repeatable in NHANES 2011-2014. Moreover, baseline MMA improved reclassification for 10-year mortality in patients with cardiovascular disease (net reclassification index 0.239, integrated discrimination improvement 0.022), overmatched established cardiovascular biomarkers C-reactive protein or homocysteine. CONCLUSIONS Circulating level of mitochondrial-derived MMA is strongly associated with elevated all-cause and cardiovascular mortality. Our results support MMA as a surrogate biomarker of mitochondrial dysfunction to predict poor prognosis in adults. The biological mechanisms under cardiovascular disease warrant further investigation.
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Affiliation(s)
- Shanjie Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yige Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinxin Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Wei Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Xiaoyuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Hengxuan Cai
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shaohong Fang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
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23
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Agarwal P, Morris MC, Barnes LL. Racial Differences in Dietary Relations to Cognitive Decline and Alzheimer's Disease Risk: Do We Know Enough? Front Hum Neurosci 2020; 14:359. [PMID: 33100990 PMCID: PMC7497764 DOI: 10.3389/fnhum.2020.00359] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
The elderly population in the US is increasing and projected to be 44% minority by 2060. African Americans and Hispanics are at increased risk of cognitive impairment and Alzheimer’s disease compared to non-Hispanic whites. These conditions are associated with many other adverse health outcomes, lower quality of life, and substantial economic burden. In the past few decades, diet has been identified as an important modifiable risk factor for cognitive decline and Alzheimer’s disease. Some studies report poor diet quality among African American and Hispanic older adult populations compared to their white counterparts. We have a limited understanding of how diet affects brain health in different racial-ethnic groups. One primary reason for our lack of knowledge is that most cohort studies are of majority non-Hispanic white participants. Moreover, those that do include minority participants do not publish their findings stratified by racial-ethnic groups, and likely have a less accurate measurement of dietary intake among minority groups. In this review, we summarize the current, albeit limited, literature on racial/ethnic differences in dietary relations to dementia outcomes. We will also discuss methodological issues in conducting nutrition studies in diverse cultures, and suggestions for future research directions. Overcoming the gaps will make it possible to make dietary recommendations for Alzheimer’s prevention that are more relevant for different racial/ethnic groups and set us on a faster track to reduce health disparities.
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Affiliation(s)
- Puja Agarwal
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, United States
| | - Martha C Morris
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, United States
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Rabensteiner J, Hofer E, Fauler G, Fritz-Petrin E, Benke T, Dal-Bianco P, Ransmayr G, Schmidt R, Herrmann M. The impact of folate and vitamin B12 status on cognitive function and brain atrophy in healthy elderly and demented Austrians, a retrospective cohort study. Aging (Albany NY) 2020; 12:15478-15491. [PMID: 32706338 PMCID: PMC7467363 DOI: 10.18632/aging.103714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dementia, and in particular Alzheimer's disease (AD), is a debilitating progressive disease with high prevalence in our society. Vitamin B12 and folate deficiency are potential modifiable risk factors. However, previous studies reported inconsistent results. RESULTS The average concentrations of all biochemical markers were within the respective reference ranges. Cross-sectional and longitudinal analyses did not reveal significant associations between biochemical markers and cognitive function, global or regional brain volume, cortical thickness or cortical surface area, neither in controls nor in AD patients. CONCLUSIONS Variations of direct and indirect markers of B12 and folate status are not associated with cognitive dysfunction and brain atrophy. METHODS This retrospective study explored the association between biochemical markers of B12 and folate status, cognitive function and MRI-based brain atrophy in cognitive normal elderly (controls) and AD patients. Folate, total and active vitamin B12 and MMA were measured in blood samples from 378 controls and 217 AD patients. Neuropsychiatric tests capturing memory, executive function and visuopractical skills were performed in all participants. Brain atrophy was assessed by MRI in 155 controls and 217 AD patients. In a subset of participants cognitive testing (n=234) and MRI (n=182) was repeated after an average median between 1.25 and 6.25 years.
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Affiliation(s)
- Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Günter Fauler
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Eva Fritz-Petrin
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Faculty of Medicine, Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
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25
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van Gool JD, Hirche H, Lax H, Schaepdrijver LD. Fallacies of clinical studies on folic acid hazards in subjects with a low vitamin B 12 status. Crit Rev Toxicol 2020; 50:177-187. [PMID: 32228273 DOI: 10.1080/10408444.2020.1727842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 2016 plea for revision of the 1 mg/day upper level of folic acid intake prompted us to comprehensively review the 1945-2017 literature on folic acid hazards in subjects with low cyanocobalamin. The concept of folic acid treatment 'masking' the anemia in undiagnosed cyanocobalamin deficiency, thereby delaying the diagnosis of neuropathy, does not account for the dissociation between the deficiency's hematologic and neurologic manifestations. Possible risks of this concept were addressed by 1963-1971 FDA rulings, classifying all folic acid preparations as prescription-only drugs, delivering ≤1 mg daily. The neuropathy in folic acid trials for 'pernicious anemia' is due to the singular use of folic acid-neuropathy improved or disappeared with replacement of folic acid by liver extract or cyanocobalamin. The hypothesis that cognitive impairment in 'subclinical' cyanocobalamin deficiency is folate-mediated is untenable. Of 6 papers specifically investigating this, none could prove that increased cognitive impairment was related to high folate intake. This review fully supports the safety of the 1 mg/day upper level for folic acid intake.
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Affiliation(s)
- Jan D van Gool
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Herbert Hirche
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Luc De Schaepdrijver
- Department of Nonclinical Safety, Janssen Research and Development, Beerse, Belgium
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26
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Koubaissi SA, Degheili JA. Severe Cobalamin Deficiency Disguised as Schistocytes: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1691-1694. [PMID: 31734686 PMCID: PMC6878968 DOI: 10.12659/ajcr.918807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 53 Final Diagnosis: Non immune intravascular hemolytic anemia Symptoms: Dyspnea • fatigue Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
- Salwa A Koubaissi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad A Degheili
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
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27
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Fiocco AJ, Krieger L, D'Amico D, Parrott MD, Laurin D, Gaudreau P, Greenwood C, Ferland G. A systematic review of existing peripheral biomarkers of cognitive aging: Is there enough evidence for biomarker proxies in behavioral modification interventions?: An initiative in association with the nutrition, exercise and lifestyle team of the Canadian Consortium on Neurodegeneration in Aging. Ageing Res Rev 2019; 52:72-119. [PMID: 31059801 DOI: 10.1016/j.arr.2019.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
Peripheral biomarkers have shown significant value in predicting brain health and may serve as a useful proxy measurement in the assessment of evidence-based lifestyle behavior modification programs, including physical activity and nutrition programs, that aim to maintain cognitive function in late life. The aim of this systematic review was to elucidate which peripheral biomarkers are robustly associated with cognitive function among relatively healthy non-demented older adults. Following the standards for systematic reviews (PICO, PRIMSA), and employing MEDLINE and Scopus search engines, 222 articles were included in the review. Based on the review of biomarker proxies of cognitive health, it is recommended that a comprehensive biomarker panel, or biomarker signature, be developed as a clinical end point for behavior modification trials aimed at enhancing cognitive function in late life. The biomarker signature should take a multisystemic approach, including lipid, immune/inflammatory, and metabolic biomarkers in the biological signature index of cognitive health.
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Affiliation(s)
| | - Laura Krieger
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Danielle D'Amico
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Danielle Laurin
- Laval University, Centre de recherche du CHU de Québec, QC, Canada
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28
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Babulal GM, Quiroz YT, Albensi BC, Arenaza-Urquijo E, Astell AJ, Babiloni C, Bahar-Fuchs A, Bell J, Bowman GL, Brickman AM, Chételat G, Ciro C, Cohen AD, Dilworth-Anderson P, Dodge HH, Dreux S, Edland S, Esbensen A, Evered L, Ewers M, Fargo KN, Fortea J, Gonzalez H, Gustafson DR, Head E, Hendrix JA, Hofer SM, Johnson LA, Jutten R, Kilborn K, Lanctôt KL, Manly JJ, Martins RN, Mielke MM, Morris MC, Murray ME, Oh ES, Parra MA, Rissman RA, Roe CM, Santos OA, Scarmeas N, Schneider LS, Schupf N, Sikkes S, Snyder HM, Sohrabi HR, Stern Y, Strydom A, Tang Y, Terrera GM, Teunissen C, Melo van Lent D, Weinborn M, Wesselman L, Wilcock DM, Zetterberg H, O'Bryant SE. Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: Update and areas of immediate need. Alzheimers Dement 2019; 15:292-312. [PMID: 30555031 PMCID: PMC6368893 DOI: 10.1016/j.jalz.2018.09.009] [Citation(s) in RCA: 307] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/12/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.
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Affiliation(s)
- Ganesh M Babulal
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada; Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arlene J Astell
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, CA; School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy; Department of Neuroscience, IRCCS-Hospital San Raffaele Pisana of Rome and Cassino, Rome and Cassino, Italy
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, the University of Melbourne, Australia
| | | | - Gene L Bowman
- Nutrition and Brain Health Laboratory, Nestlé Institute of Health Sciences, Lausanne, Switzerland; Department of Neurology, Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Adam M Brickman
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Gaël Chételat
- Inserm, Inserm UMR-S U1237, Université de Caen-Normandie, GIP Cyceron, Caen, France
| | - Carrie Ciro
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Hiroko H Dodge
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Simone Dreux
- Undergraduate Program of History and Science, Harvard College, Cambridge, MA, USA
| | - Steven Edland
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Anna Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine & Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisbeth Evered
- Melbourne Medical School, University of Melbourne, Australia
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
| | - Keith N Fargo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Hector Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of San Diego, CA, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | - Elizabeth Head
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - James A Hendrix
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Scott M Hofer
- Adult Development and Aging, University of Victoria, British Columbia, CA, USA
| | - Leigh A Johnson
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Roos Jutten
- VU University Medical Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Kerry Kilborn
- Department of Psychology, University of Glasgow, Glasgow, Scotland, UK
| | - Krista L Lanctôt
- Sunnybrook Research Institute of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jennifer J Manly
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Ralph N Martins
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Michelle M Mielke
- Department of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Esther S Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario A Parra
- School of Social Sciences, Department of Psychology, Heriot-Watt University, UK; Universidad Autónoma del Caribe, Barranquilla, Colombia; Neuroprogressive and Dementia Network, UK
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego School of Medicine, CA, USA
| | - Catherine M Roe
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Octavio A Santos
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Nikolaos Scarmeas
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA; Aiginition Hospital, 1st Neurology Clinic, Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Lon S Schneider
- Department of Psychiatry and The Behavioral Sciences, University of Southern California, CA, USA
| | - Nicole Schupf
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Sietske Sikkes
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Hamid R Sohrabi
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Graciela Muniz Terrera
- Centers for Clinical Brain Sciences and Dementia Prevention, University in Edinburgh, Scotland, UK
| | - Charlotte Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Debora Melo van Lent
- Department of Clinical Research, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael Weinborn
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Donna M Wilcock
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Sid E O'Bryant
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Zajac IT, Herreen D, Bastiaans K, Dhillon VS, Fenech M. The Effect of Whey and Soy Protein Isolates on Cognitive Function in Older Australians with Low Vitamin B 12: A Randomised Controlled Crossover Trial. Nutrients 2018; 11:nu11010019. [PMID: 30577611 PMCID: PMC6357102 DOI: 10.3390/nu11010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 01/01/2023] Open
Abstract
Whey protein isolate (WPI) is high in vitamin B12 and folate. These and other related markers (holotranscobalamin, methylmalonic acid and homocysteine) have been linked with cognitive health. This study explored the efficacy of WPI for improving cognitive function via delivery of vitamin B12. Moderately vitamin B12-deficient participants aged between 45 and 75 years (n = 56) were recruited into this randomised controlled crossover trial. Participants (55% female) consumed 50 g whey (WPI; active) or soy protein isolate (SPI; control) for eight weeks. Following a 16-week washout phase, they consumed the alternative supplement. Consumption of WPI significantly improved active B12 and folate status but did not result in direct improvements in cognitive function. However, there was evidence of improvement in reaction time (p = 0.02) and reasoning speed (p = 0.04) in the SPI condition for females. Additional analyses showed that changes in active B12, HcY and folate measures during WPI treatment correlated with improvements in cognitive function (all p < 0.05). Results indicate that WPI itself did not result in improved cognitive function but some evidence of benefit of SPI for females was found. However, consistent with previous research, we present further evidence of a role for active B12, HcY and folate in supporting cognitive improvement in adults with low B vitamin status.
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Affiliation(s)
- Ian T Zajac
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia.
| | - Danielle Herreen
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Kathryn Bastiaans
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Varinderpal S Dhillon
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Michael Fenech
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
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Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H, Raiten DJ. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J Nutr 2018; 148:1995S-2027S. [PMID: 30500928 PMCID: PMC6297555 DOI: 10.1093/jn/nxy201] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/06/2017] [Accepted: 08/02/2018] [Indexed: 12/31/2022] Open
Abstract
This report on vitamin B-12 (B12) is part of the Biomarkers of Nutrition for Development (BOND) Project, which provides state-of-the art information and advice on the selection, use, and interpretation of biomarkers of nutrient exposure, status, and function. As with the other 5 reports in this series, which focused on iodine, folate, zinc, iron, and vitamin A, this B12 report was developed with the assistance of an expert panel (BOND B12 EP) and other experts who provided information during a consultation. The experts reviewed the existing literature in depth in order to consolidate existing relevant information on the biology of B12, including known and possible effects of insufficiency, and available and potential biomarkers of status. Unlike the situation for the other 5 nutrients reviewed during the BOND project, there has been relatively little previous attention paid to B12 status and its biomarkers, so this report is a landmark in terms of the consolidation and interpretation of the available information on B12 nutrition. Historically, most focus has been on diagnosis and treatment of clinical symptoms of B12 deficiency, which result primarily from pernicious anemia or strict vegetarianism. More recently, we have become aware of the high prevalence of B12 insufficiency in populations consuming low amounts of animal-source foods, which can be detected with ≥1 serum biomarker but presents the new challenge of identifying functional consequences that may require public health interventions.
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Affiliation(s)
- Lindsay H Allen
- USDA, Agricultural Research Service Western Human Nutrition Research Center, University of California, Davis, CA
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD
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Abstract
Diet has been investigated in relation to its ability to promote cognitive function. However, evidence is currently limited and has rarely been systematically reviewed, particularly in a mild cognitive impairment (MCI) population. This review examined the effect of diet on cognitive outcomes in MCI patients. A total of five databases were searched to find randomised controlled trial (RCT) studies, with diet as the main focus, in MCI participants. The primary outcome was incident dementia and/or Alzheimer's disease (AD) and secondary outcomes included cognitive function across different domains using validated neuropsychological tests. Sixteen studies met the inclusion criteria. There was a high degree of heterogeneity relating to the nature of the dietary intervention and cognitive outcomes measured, thus making study comparisons difficult. Supplementation with vitamin E (one study, n 516), ginkgo biloba (one study, n 482) or Fortasyn Connect (one study, n 311) had no significant effect on progression from MCI to dementia and/or AD. For cognitive function, the findings showed some improvements in performance, particularly in memory, with the most consistent results shown by B vitamins, including folic acid (one study, n 266), folic acid alone (one study, n 180), DHA and EPA (two studies, n 36 and n 86), DHA (one study, n 240) and flavonol supplementation (one study, n 90). The findings indicate that dietary factors may have a potential benefit for cognitive function in MCI patients. Further well-designed trials are needed, with standardised and robust measures of cognition to investigate the influence of diet on cognitive status.
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32
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Mann NJ. A brief history of meat in the human diet and current health implications. Meat Sci 2018; 144:169-179. [PMID: 29945745 DOI: 10.1016/j.meatsci.2018.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023]
Abstract
Anthropological investigations have confirmed many times over, through multiple fields of research the critical role of consumption of animal source foods (ASF) including meat in the evolution of our species. As early as four million years ago, our early bipedal hominin ancestors were scavenging ASFs as evidenced by cut marks on animal bone remains, stable isotope composition of these hominin remains and numerous other lines of evidence from physiological and paleo-anthropological domains. This ASF intake marked a transition from a largely forest dwelling frugivorous lifestyle to a more open rangeland existence and resulted in numerous adaptations, including a rapidly increasing brain size and altered gut structure. Details of the various fields of anthropological evidence are discussed, followed by a summary of the health implications of meat consumption in the modern world, including issues around saturated fat and omega-3 fatty acid intake and discussion of the critical nutrients ASFs supply, with particular emphasis on brain function.
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Affiliation(s)
- Neil J Mann
- Faculty of Veterinary and Agricultural Science, University of Melbourne Parkville, Victoria 3010, Australia.
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Abstract
The biosynthesis of B12, involving up to 30 different enzyme-mediated steps, only occurs in bacteria. Thus, most eukaryotes require an external source of B12, and yet the vitamin appears to have only two functions in eukaryotes: as a cofactor for the enzymes methionine synthase and methylmalonylCoA mutase. These two functions are crucial for normal health in humans, and in particular, the formation of methionine is essential for providing methyl groups for over 100 methylation processes. Interference with the methionine synthase reaction not only depletes the body of methyl groups but also leads to the accumulation of homocysteine, a risk factor for many diseases. The syndrome pernicious anemia, characterized by lack of intrinsic factor, leads to a severe, sometimes fatal form of B12 deficiency. However, there is no sharp cutoff for B12 deficiency; rather, there is a continuous inverse relationship between serum B12 and a variety of undesirable outcomes, including neural tube defects, stroke, and dementia. The brain is particularly vulnerable; in children, inadequate B12 stunts brain and intellectual development. Suboptimal B12 status (serum B12<300pmol/L) is very common, occurring in 30%-60% of the population, in particular in pregnant women and in less-developed countries. Thus, many tens of millions of people in the world may suffer harm from having a poor B12 status. Public health steps are urgently needed to correct this inadequacy.
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Affiliation(s)
- A David Smith
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom.
| | - Martin J Warren
- School of Biosciences, University of Kent, Canterbury, Kent, United Kingdom
| | - Helga Refsum
- Department of Nutrition, University of Oslo, Oslo, Norway
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Mendonça N, Granic A, Mathers JC, Martin-Ruiz C, Wesnes KA, Seal CJ, Jagger C, Hill TR. One-Carbon Metabolism Biomarkers and Cognitive Decline in the Very Old: The Newcastle 85+ Study. J Am Med Dir Assoc 2017; 18:806.e19-806.e27. [PMID: 28647580 PMCID: PMC5576913 DOI: 10.1016/j.jamda.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Although the biological rationale for the association between folate, vitamin B12, and homocysteine with cognitive function seems plausible, conflicting results have been reported. This study aimed to determine the associations between 1-carbon (1-C) metabolism biomarkers (folate, vitamin B12, and homocysteine), and cognitive impairment at baseline and the rate of cognitive decline over 5 years in the very old. DESIGN The Newcastle 85+ Study was a prospective longitudinal study of people 85 years old and followed over 5 years in Northeast England. SETTING Community-dwelling and institutionalized. PARTICIPANTS The analytical sample included 765 very old participants with 1-C metabolism biomarkers and cognitive measures. MEASUREMENTS Global cognition was measured by the Standardized Mini-Mental State Examination (SMMSE) at baseline, and at 3 and 5 years of follow-up and, attention-specific cognition with the Cognitive Drug Research (CDR) System at baseline, and at 1.5 and 3.0 years of follow-up. Baseline red blood cell folate (RBC folate), plasma vitamin B12, and total homocysteine (tHcy) concentrations were determined by immunoassay. Linear mixed models were used to estimate the associations between quartiles of 1-C metabolism biomarkers and cognition over 3 (CDR) and 5 years (SMMSE). RESULTS Compared with participants in the lowest quartile of RBC folate concentrations (<612 nmol/L), those in the highest quartile of RBC folate concentrations (>1280 nmol/L) had 1 more point on the SMMSE at baseline (β = +1.02, SE = 0.43, P = .02). Those in quartile 4 of tHcy (>21.4 μmol/L) had 1 point less in the SMMSE at baseline than those in the lowest quartile (<13.5 μmol/L) (β = -1.05, SE = 0.46, P = .02). Plasma vitamin B12 was not predictive of global or attention-specific cognition at baseline and at follow-up. None of the 1-C metabolism biomarkers except tHcy was associated with the rate of decline in attention scores over 3 years. CONCLUSION RBC folate and tHcy, but not plasma vitamin B12, were associated with better global cognition in the very old at baseline but were not predictive of rate of decline over 5 years.
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Affiliation(s)
- Nuno Mendonça
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
| | - Antoneta Granic
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK; NIHR Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle University and Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - John C Mathers
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Keith A Wesnes
- Wesnes Cognition Ltd, Streatley-on-Thames, UK; Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK; Medical School, University of Exeter, Exeter, UK
| | - Chris J Seal
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Carol Jagger
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Tom R Hill
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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Porter K, Hoey L, Hughes CF, Ward M, McNulty H. Causes, Consequences and Public Health Implications of Low B-Vitamin Status in Ageing. Nutrients 2016; 8:E725. [PMID: 27854316 PMCID: PMC5133110 DOI: 10.3390/nu8110725] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 12/11/2022] Open
Abstract
The potential protective roles of folate and the metabolically related B-vitamins (vitamins B12, B6 and riboflavin) in diseases of ageing are of increasing research interest. The most common cause of folate and riboflavin deficiencies in older people is low dietary intake, whereas low B12 status is primarily associated with food-bound malabsorption, while sub-optimal vitamin B6 status is attributed to increased requirements in ageing. Observational evidence links low status of folate and the related B-vitamins (and/or elevated concentrations of homocysteine) with a higher risk of degenerative diseases including cardiovascular disease (CVD), cognitive dysfunction and osteoporosis. Deficient or low status of these B-vitamins alone or in combination with genetic polymorphisms, including the common MTHFR 677 C → T polymorphism, could contribute to greater disease risk in ageing by causing perturbations in one carbon metabolism. Moreover, interventions with the relevant B-vitamins to optimise status may have beneficial effects in preventing degenerative diseases. The precise mechanisms are unknown but many have been proposed involving the role of folate and the related B-vitamins as co-factors for one-carbon transfer reactions, which are fundamental for DNA and RNA biosynthesis and the maintenance of methylation reactions. This review will examine the evidence linking folate and related B-vitamins with health and disease in ageing, associated mechanisms and public health implications.
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Affiliation(s)
- Kirsty Porter
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Leane Hoey
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Catherine F Hughes
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Mary Ward
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Helene McNulty
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
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Lucock M, Beckett E, Martin C, Jones P, Furst J, Yates Z, Jablonski NG, Chaplin G, Veysey M. UV‐associated decline in systemic folate: implications for human nutrigenetics, health, and evolutionary processes. Am J Hum Biol 2016; 29. [DOI: 10.1002/ajhb.22929] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/13/2016] [Accepted: 09/25/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mark Lucock
- School of Environmental and Life SciencesUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - Emma Beckett
- School of Environmental and Life SciencesUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - Charlotte Martin
- School of Environmental and Life SciencesUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - Patrice Jones
- School of Environmental and Life SciencesUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - John Furst
- School of Maths and Physical SciencesUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - Zoe Yates
- School of Biomedical Sciences and PharmacyUniversity of NewcastlePO Box 127, Brush RdOurimbah NSW2258 Australia
| | - Nina G. Jablonski
- Anthropology DepartmentThe Pennsylvania State University409 Carpenter BuildingUniversity Park Pennsylvania16802
| | - George Chaplin
- Anthropology DepartmentThe Pennsylvania State University409 Carpenter BuildingUniversity Park Pennsylvania16802
| | - Martin Veysey
- School of Medicine and Public Health, University of Newcastle, NSW, 2308, Australia and, Central Coast Local Health DistrictTeaching and Research Unit, Gosford HospitalGosford NSW2250PO Box 361 Australia
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Pascoe MC, Linden T. Folate and MMA predict cognitive impairment in elderly stroke survivors: A cross sectional study. Psychiatry Res 2016; 243:49-52. [PMID: 27367490 DOI: 10.1016/j.psychres.2016.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Elderly stroke survivors are at risk of malnutrition and long-term cognitive impairment. Vitamin B-related metabolites, folate and methylmalonic acid, have been implicated in cognitive function. We conducted a study exploring the relationship between blood folate, methylmalonic acid and post-stroke cognitive impairment. This is a cross sectional study of elderly Swedish patients (n=149) 20 months post-stroke, assessed using the Mini Mental State Examination, serum blood levels of methylmalonic acid and red blood cell levels of folate. Linear modeling indicated that low levels of blood folate and elevated methylmalonic acid significantly contributed to cognitive impairment in stroke survivors. Half of the stroke survivors were shown to have folate deficiency at 20 months after stroke. Folate deficiency is common long term after stroke and both low folate and elevated methylmalonic acid appear to be associated with long term cognitive impairment, in elderly Swedish stroke survivors.
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Affiliation(s)
- Michaela C Pascoe
- Centre for the Heart and Mind, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC 3000, Australia; Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia.
| | - Thomas Linden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
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Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. Neurosci Biobehav Rev 2016; 69:280-98. [PMID: 27531233 DOI: 10.1016/j.neubiorev.2016.08.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elevated plasma homocysteine (Hcy) levels have been associated with cognitive dysfunction in a wide range of conditions. The aim of this review is to establish which cognitive domains and populations are the most affected. METHODS We systematically review the literature and consider all articles that showed any relationship between plasma Hcy levels and scores achieved on cognitive performance tests in both, the general population and patients suffering from central nervous system disorders and other diseases. When effect sizes were available and combinable, several meta-analyses were performed. RESULTS We found 111 pertinent articles. There were 24 cohort studies, 18 randomized trials, 21 case-control studies, and 48 cross-sectional studies. This review reveals a positive trend between cognitive decline and increased plasma Hcy concentrations in general population and in patients with cognitive impairments. Results from the meta-analyses also confirm this trend. Treatment with vitamin supplementation fails to show a reduction in cognitive decline. DISCUSSION Further investigations are warranted to clarify this relationship. Earlier detection of the elevated Hcy levels may be an effective intervention to prevent cognitive impairment and dementia.
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Affiliation(s)
- Esther Setién-Suero
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta Suárez-Pinilla
- Sackler Centre for Consciousness Science, Department of Informatics, University of Sussex, United Kingdom
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
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Horvat P, Gardiner J, Kubinova R, Pajak A, Tamosiunas A, Schöttker B, Pikhart H, Peasey A, Jansen E, Bobak M. Serum folate, vitamin B-12 and cognitive function in middle and older age: The HAPIEE study. Exp Gerontol 2016; 76:33-8. [PMID: 26808046 PMCID: PMC4839985 DOI: 10.1016/j.exger.2016.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/22/2022]
Abstract
Background Nutrient status of B vitamins, particularly folate and vitamin B-12, may be related to cognitive ageing but epidemiological evidence remains inconclusive. Objective The aim of this study was to estimate the association of serum folate and vitamin B-12 concentrations with cognitive function in middle-aged and older adults from three Central and Eastern European populations. Methods Men and women aged 45–69 at baseline participating in the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were recruited in Krakow (Poland), Kaunas (Lithuania) and six urban centres in the Czech Republic. Tests of immediate and delayed recall, verbal fluency and letter search were administered at baseline and repeated in 2006–2008. Serum concentrations of biomarkers at baseline were measured in a sub-sample of participants. Associations of vitamin quartiles with baseline (n = 4166) and follow-up (n = 2739) cognitive domain-specific z-scores were estimated using multiple linear regression. Results After adjusting for confounders, folate was positively associated with letter search and vitamin B-12 with word recall in cross-sectional analyses. In prospective analyses, participants in the highest quartile of folate had higher verbal fluency (p < 0.01) and immediate recall (p < 0.05) scores compared to those in the bottom quartile. In addition, participants in the highest quartile of vitamin B-12 had significantly higher verbal fluency scores (β = 0.12; 95% CI = 0.02, 0.21). Conclusions Folate and vitamin B-12 were positively associated with performance in some but not all cognitive domains in older Central and Eastern Europeans. These findings do not lend unequivocal support to potential importance of folate and vitamin B-12 status for cognitive function in older age. Long-term longitudinal studies and randomised trials are required before drawing conclusions on the role of these vitamins in cognitive decline. Epidemiological evidence linking B vitamins to cognitive ageing is inconclusive. Serum folate, vitamin B-12 and cognition were studied in older Eastern Europeans. Both vitamins were positively associated with 3-year verbal fluency. Folate and vitamin B-12 may be related to performance in some cognitive domains. More research is needed to clarify the causal relevance of B vitamins to cognition.
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Affiliation(s)
- Pia Horvat
- Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Julian Gardiner
- Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK
| | - Ruzena Kubinova
- National Institute of Public Health, Srobarova 48, 10042 Prague, Czech Republic
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagellonian University Collegium Medicum, Grzegorzecka 20, 31-531 Krakow, Poland
| | - Abdonas Tamosiunas
- Department of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Hynek Pikhart
- Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Anne Peasey
- Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Eugene Jansen
- Center for Health Protection, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Martin Bobak
- Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London WC1E 7HB, UK
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Siswanto O, Smeall K, Watson T, Donnelly-Vanderloo M, O'Connor C, Foley N, Madill J. Examining the Association between Vitamin B12 Deficiency and Dementia in High-Risk Hospitalized Patients. J Nutr Health Aging 2015; 19:1003-8. [PMID: 26624211 DOI: 10.1007/s12603-015-0660-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore the association between vitamin B12 deficiency and dementia in patients at high risk for vitamin B12 deficiency. DESIGN Chart review. SETTING Emergency, critical care/ trauma, neurology, medicine, and rehabilitation units of two hospitals in Southwestern Ontario, Canada. PARTICIPANTS Adult patients (n = 666) admitted from 2010 to 2012. Data collection included: reason for admission, gender, age, clinical signs and symptoms of B12 deficiency, serum B12 concentration, and B12 supplementation. Patients with dementia were identified based on their medication profile and medical history. Vitamin B12 deficiency (pmol/L) was defined as serum B12 concentration <148; marginal deficiency: ≥148-220 and adequate >220. Comparisons between B12-deficient patients with and without dementia were examined using parametric and non-parametric tests. RESULTS Serum B12 values were available for 60% (399/666) of the patients, of whom 4% (16/399) were B12-deficient and 14% (57/399) were marginally deficient. Patients with dementia were not more likely to be B12-deficient or marginally deficient [21% (26/121)] compared to those with no dementia [17% (47/278), p=0.27)]. Based on documentation, 34% (25/73) of the B12-deficient and marginally-deficient patients did not receive B12 supplementation, of whom 40% (10/25) had dementia. CONCLUSION In this sample of patients, there was no association between B12 deficiency and dementia. However, appropriate B12 screening protocols are necessary for high risk patient to identify deficiency and then receive B12 supplementation as needed.
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Affiliation(s)
- O Siswanto
- J Madill, Brescia University College, London ON, N6G1H2, Canada.
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White DJ, Cox KHM, Peters R, Pipingas A, Scholey AB. Effects of Four-Week Supplementation with a Multi-Vitamin/Mineral Preparation on Mood and Blood Biomarkers in Young Adults: A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients 2015; 7:9005-17. [PMID: 26529011 PMCID: PMC4663579 DOI: 10.3390/nu7115451] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022] Open
Abstract
This study explored the effects of four-week multi-vitamin and mineral (MVM) supplementation on mood and neurocognitive function in healthy, young adults. Fifty-eight healthy adults, 18–40 years of age (M = 25.82 years, SD = 4.87) participated in this randomised, double-blind, placebo-controlled trial, in which mood and blood biomarkers were assessed at baseline and after four weeks of supplementation. Compared to placebo, MVM supplementation was associated with significantly lowered homocysteine and increased blood B-vitamin levels (p < 0.01). MVM treatment was also associated with significantly improved mood, as measured by reduced scores on the “depression-dejection” subscale of the Profile of Mood States (p = 0.018). These findings suggest that the four weeks of MVM supplementation may have beneficial effects on mood, underpinned by elevated B-vitamins and lowered homocysteine in healthy young adults.
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Affiliation(s)
- David J White
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Katherine H M Cox
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Riccarda Peters
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Andrew B Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
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Djukic M, Wedekind D, Franz A, Gremke M, Nau R. Frequency of dementia syndromes with a potentially treatable cause in geriatric in-patients: analysis of a 1-year interval. Eur Arch Psychiatry Clin Neurosci 2015; 265:429-38. [PMID: 25716929 DOI: 10.1007/s00406-015-0583-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/08/2015] [Indexed: 01/10/2023]
Abstract
In addition to neurodegenerative and vascular causes of dementia, in the differential diagnosis potentially reversible conditions of dementia also must be assessed. Routine laboratory parameters and neuroimaging, which are recommended for the differential diagnosis of suspected dementia by the German S3 Guideline "Dementia", were retrospectively studied in 166 geriatric patients with suspected dementia. Delirium was diagnosed in six patients (3.6%). These six patients were excluded from the study. Of the 160 remaining patients, there were 99 (59.6%) with an already known dementia. In this subgroup of patients, we found a potentially treatable cause of dementia in 18.2%. In the remaining 61 patients (36.8%), the newly diagnosed dementia syndrome was established according to ICD-10 criteria. Potentially reversible causes of the dementia syndrome were found in 19 of these patients (31.1%). The most common cause was depressive pseudodementia in eight patients followed by vitamin B12 deficiency in six patients. A significant amount of our patients showed laboratory or imaging changes suggestive of potentially reversible causes of the dementia syndrome upon admission. The results of our study indicate the importance of careful differential diagnosis of dementia based on the recommendations of guidelines. Although therapy of these potential causes is not always accompanied by a full recovery, the identification and therapy of treatable causes of cognitive deficits are possible even for general practitioners, who often are the primary contact persons of affected individuals.
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Affiliation(s)
- Marija Djukic
- Department of Neuropathology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany,
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Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress. Eur J Clin Nutr 2015; 69:687-92. [PMID: 25563739 DOI: 10.1038/ejcn.2014.272] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE Functional cobalamin (Cbl; vitamin B12) deficiency (that is, high levels of the Cbl-dependent metabolites, methylmalonic acid (MMA) and homocysteine (HCys), despite normal serum Cbl values) is common in the elderly and is associated with neurocognitive abnormalities, but its cause is unknown. As only reduced Cbls are metabolically active, the possibility that functional Cbl deficiency is associated with disorders having biomarkers indicative of increased oxidative stress (oxidant risks) was considered. SUBJECTS/METHODS A retrospective record review of community-dwelling adults evaluated over a 12-year period for Cbl deficiency in a primary care setting who had serum Cbl values ⩾400 pg/ml (n=170). RESULTS When no oxidant risks were present, older subjects (⩾70 years) had higher metabolite values than younger individuals (<70 years). MMA values were even higher in the elderly when one oxidant risk was present and in younger subjects when two or more oxidant risks were present. Even at Cbl levels ⩾800 pg/ml, MMA values were increased in 73% of elderly subjects with at least one oxidant risk. HCys values were also higher in both age groups when at least two oxidant risks were present. Cyanocobalamin therapy decreased MMA and HCys values in 86 and 76% of subjects, respectively, with nonresponders more likely to have two or more oxidant risks. CONCLUSION Functional Cbl deficiency is associated with disorders marked by increased oxidative stress particularly in the elderly; it occurs even when Cbl levels are high and is not consistently corrected with high-dose cyanocobalamin therapy. Thus, current approaches to recognizing and managing this disorder may be inadequate.
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Barnes JL, Tian M, Edens NK, Morris MC. Consideration of nutrient levels in studies of cognitive decline. Nutr Rev 2014; 72:707-19. [PMID: 25323849 DOI: 10.1111/nure.12144] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Epidemiological studies suggest that certain micronutrients may improve or maintain cognitive function. Consistent demonstration of benefits in intervention trials has been elusive, possibly because most intervention trials do not select subjects on the basis of nutrient status and/or intake. The objective of this review was to identify levels of intake or markers of nutrient insufficiency that define at-risk older adult populations to determine whether these populations will benefit from nutritional intervention. This review examines evidence from interventional and prospective observational studies that evaluated the effects of folate, vitamin B12 , and vitamin E on cognitive decline in older populations. The studies suggest that supplementation may protect against cognitive decline when serum folate is <12 nmol/L or vitamin E intake is <6.1 mg/day. The literature is inadequate to define a level for vitamin B12 . Epidemiological studies investigating the relations of nutrients to cognitive decline should consider nutrient status in the reporting and interpretation of results. Randomized trials should design inclusion and exclusion criteria to select individuals with low intake and to disallow multivitamin intake. These recommendations may be useful for the design of valid trials and to advance the current understanding of nutrition and neurological diseases.
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Affiliation(s)
- Jennifer L Barnes
- Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Urbana-Champaign, Illinois, USA; Abbott Nutrition, Columbus, Ohio, USA
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Bredesen DE. Reversal of cognitive decline: a novel therapeutic program. Aging (Albany NY) 2014; 6:707-17. [PMID: 25324467 PMCID: PMC4221920 DOI: 10.18632/aging.100690] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 04/12/2023]
Abstract
This report describes a novel, comprehensive, and personalized therapeutic program that is based on the underlying pathogenesis of Alzheimer's disease, and which involves multiple modalities designed to achieve metabolic enhancement for neurodegeneration (MEND). The first 10 patients who have utilized this program include patients with memory loss associated with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI). Nine of the 10 displayed subjective or objective improvement in cognition beginning within 3-6 months, with the one failure being a patient with very late stage AD. Six of the patients had had to discontinue working or were struggling with their jobs at the time of presentation, and all were able to return to work or continue working with improved performance. Improvements have been sustained, and at this time the longest patient follow-up is two and one-half years from initial treatment, with sustained and marked improvement. These results suggest that a larger, more extensive trial of this therapeutic program is warranted. The results also suggest that, at least early in the course, cognitive decline may be driven in large part by metabolic processes. Furthermore, given the failure of monotherapeutics in AD to date, the results raise the possibility that such a therapeutic system may be useful as a platform on which drugs that would fail as monotherapeutics may succeed as key components of a therapeutic system.
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Affiliation(s)
- Dale E. Bredesen
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles, CA 90095
- Buck Institute for Research on Aging, Novato, CA 94945
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Mitchell ES, Conus N, Kaput J. B vitamin polymorphisms and behavior: evidence of associations with neurodevelopment, depression, schizophrenia, bipolar disorder and cognitive decline. Neurosci Biobehav Rev 2014; 47:307-20. [PMID: 25173634 DOI: 10.1016/j.neubiorev.2014.08.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/11/2014] [Accepted: 08/18/2014] [Indexed: 11/16/2022]
Abstract
The B vitamins folic acid, vitamin B12 and B6 are essential for neuronal function, and severe deficiencies have been linked to increased risk of neurodevelopmental disorders, psychiatric disease and dementia. Polymorphisms of genes involved in B vitamin absorption, metabolism and function, such as methylene tetrahydrofolate reductase (MTHFR), cystathionine β synthase (CβS), transcobalamin 2 receptor (TCN2) and methionine synthase reductase (MTRR), have also been linked to increased incidence of psychiatric and cognitive disorders. However, the effects of these polymorphisms are often quite small and many studies failed to show any meaningful or consistent associations. This review discusses previous findings from clinical studies and highlights gaps in knowledge. Future studies assessing B vitamin-associated polymorphisms must take into account not just traditional demographics, but subjects' overall diet, relevant biomarkers of nutritional status and also analyze related genetic factors that may exacerbate behavioral effects or nutritional status.
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Affiliation(s)
- E Siobhan Mitchell
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland.
| | - Nelly Conus
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
| | - Jim Kaput
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
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Martínez-Lapiscina EH, Galbete C, Corella D, Toledo E, Buil-Cosiales P, Salas-Salvado J, Ros E, Martinez-Gonzalez MÁ. Genotype patterns at CLU, CR1, PICALM and APOE, cognition and Mediterranean diet: the PREDIMED-NAVARRA trial. GENES & NUTRITION 2014; 9:393. [PMID: 24643340 PMCID: PMC4026432 DOI: 10.1007/s12263-014-0393-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/26/2014] [Indexed: 11/24/2022]
Abstract
The traditional Mediterranean diet (MedDiet) has shown beneficial effects on cognitive decline. Nevertheless, diet-gene interactions have been poorly evaluated. We aimed to investigate diet-gene interaction in the PREDIMED-NAVARRA randomized trial. A total of 522 participants (67 ± 6 years at baseline) enrolled in the PREDIMED-NAVARRA trial were randomly allocated to one of three diets: two MedDiets (supplemented with either extra-virgin olive oil or nuts) or a low-fat diet. They were evaluated with the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) after 6.5 years of intervention. Subjects were genotyped for CR1-rs3818361, CLU-rs11136000, PICALM-rs3851179 and Apolipoprotein E (ApoE) genes. We studied MedDiet-gene interactions for cognition and assessed the effect of the MedDiet on cognition across different genetic profiles. A significant interaction (p = 0.041) between CLU-rs11136000 and the MedDiet intervention on the MMSE was found with a beneficial effect of MedDiet among carriers of the T minor allele (B = 0.97, 95 % CI 0.45-1.49). Similar effect was observed for CR1-rs3818361, but no significant interaction was observed (p = 0.335). For PICALM-rs3851179, the MedDiet intervention showed a beneficial effect in both genotype groups. No apparent interaction was found for the CDT between intervention and gene variants. Similarly, participants randomly allocated to MedDiet groups, with favorable profiles of CR1, CLU and PICALM genes, significantly improved CDT scores compared to controls with the same genetic profile. Cognitive performance was better for non-ApoE4 and for ApoE4 carriers of MedDiet groups compared to controls, but for CDT performance, we only found statistical significant differences for non-ApoE4 carriers. A MedDiet intervention modulates the effect of genetic factors on cognition. The effect of MedDiet might be greater for subjects with a more favorable genetic profile.
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Affiliation(s)
- Elena H. Martínez-Lapiscina
- />Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina-Clínica Universidad de Navarra, Universidad de Navarra, C/Irunlarrea n1 1, Pamplona, Navarra 31008 Spain
- />Center for Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cecilia Galbete
- />Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina-Clínica Universidad de Navarra, Universidad de Navarra, C/Irunlarrea n1 1, Pamplona, Navarra 31008 Spain
| | - Dolores Corella
- />Department of Preventive Medicine, University of Valencia, Valencia, Spain
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Estefania Toledo
- />Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina-Clínica Universidad de Navarra, Universidad de Navarra, C/Irunlarrea n1 1, Pamplona, Navarra 31008 Spain
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Pilar Buil-Cosiales
- />Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina-Clínica Universidad de Navarra, Universidad de Navarra, C/Irunlarrea n1 1, Pamplona, Navarra 31008 Spain
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- />Navarra Public Health Service (Osasunbidea, Servicio Navarro de Salud), Pamplona, Spain
| | - Jordi Salas-Salvado
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- />Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Emilio Ros
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- />Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Miguel Á. Martinez-Gonzalez
- />Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina-Clínica Universidad de Navarra, Universidad de Navarra, C/Irunlarrea n1 1, Pamplona, Navarra 31008 Spain
- />CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Grodstein F, O'Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, Manson JE, Glynn RJ, Buring JE, Gaziano M, Sesso HD. Long-term multivitamin supplementation and cognitive function in men: a randomized trial. Ann Intern Med 2013; 159:806-14. [PMID: 24490265 PMCID: PMC3858850 DOI: 10.7326/0003-4819-159-12-201312170-00006] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite widespread use of multivitamin supplements, their effect on cognitive health-a critical issue with aging-remains inconclusive. To date, no long-term clinical trials have studied multivitamin use and cognitive decline in older persons. OBJECTIVE To evaluate whether long-term multivitamin supplementation affects cognitive health in later life. DESIGN Randomized, double-blind, placebo-controlled trial of a multivitamin from 1997 to 1 June 2011. The cognitive function substudy began in 1998. Up to 4 repeated cognitive assessments by telephone interview were completed over 12 years. (ClinicalTrials.gov: NCT00270647) SETTING: The Physicians' Health Study II. PATIENTS 5947 male physicians aged 65 years or older. INTERVENTION Daily multivitamin or placebo. MEASUREMENTS A global composite score averaging 5 tests of global cognition, verbal memory, and category fluency. The secondary end point was a verbal memory score combining 4 tests of verbal memory, which is a strong predictor of Alzheimer disease. RESULTS No difference was found in mean cognitive change over time between the multivitamin and placebo groups or in the mean level of cognition at any of the 4 assessments. Specifically, for the global composite score, the mean difference in cognitive change over follow-up was -0.01 SU (95% CI, -0.04 to 0.02 SU) when treatment was compared with placebo. Similarly, cognitive performance did not differ between the multivitamin and placebo groups on the secondary outcome, verbal memory (mean difference in cognitive change over follow-up, -0.005 SU [CI, -0.04 to 0.03 SU]). LIMITATION Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin. CONCLUSION In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits. PRIMARY FUNDING SOURCE National Institutes of Health, BASF, Pfizer, and DSM Nutritional Products.
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Vitamin B12 deficiency in relation to functional disabilities. Nutrients 2013; 5:4462-75. [PMID: 24225845 PMCID: PMC3847742 DOI: 10.3390/nu5114462] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/16/2013] [Accepted: 11/04/2013] [Indexed: 11/16/2022] Open
Abstract
This study was designed to assess whether symptoms, functional measures, and reported disabilities were associated with vitamin B12 (B12) deficiency when defined in three ways. Participants, aged 60 or more years of age, in 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were categorized in relation to three previously used definitions of B12 deficiency: (1) serum B12 < 148 pmol/L; (2) serum B12 < 200 pmol/L and serum homocysteine > 20 μmol/L; and (3) serum B12 < 258 pmol/L or serum methylmalonic acid > 0.21 μmol/L. Functional measures of peripheral neuropathy, balance, cognitive function, gait speed, along with self-reported disability (including activities of daily living) were examined with standardized instruments by trained NHANES interviewers and technicians. Individuals identified as B12 deficient by definition 2 were more likely to manifest peripheral neuropathy OR (odds) (95% confidence intervals), p value: 9.70 (2.24, 42.07), 0.004 and report greater total disability, 19.61 (6.22, 61.86) 0.0001 after adjustments for age, sex, race, serum creatinine, and ferritin concentrations, smoking, diabetes, and peripheral artery disease. Smaller, but significantly increased, odds of peripheral neuropathy and total disability were also observed when definition 3 was applied. Functional measures and reported disabilities were associated with B12 deficiency definitions that include B12 biomarkers (homocysteine or methylmalonic acid). Further study of these definitions is needed to alert clinicians of possible subclinical B12 deficiency because functional decline amongst older adults may be correctable if the individual is B12 replete.
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Weisfeld-Adams JD, Bender HA, Miley-Åkerstedt A, Frempong T, Schrager NL, Patel K, Naidich TP, Stein V, Spat J, Towns S, Wasserstein MP, Peter I, Frank Y, Diaz GA. Neurologic and neurodevelopmental phenotypes in young children with early-treated combined methylmalonic acidemia and homocystinuria, cobalamin C type. Mol Genet Metab 2013; 110:241-7. [PMID: 23954310 DOI: 10.1016/j.ymgme.2013.07.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/20/2013] [Accepted: 07/21/2013] [Indexed: 11/19/2022]
Abstract
Abnormal neurodevelopment has been widely reported in combined methylmalonic aciduria (MMA) and homocystinuria, cblC type (cblC disease), but neurodevelopmental phenotypes in cblC have not previously been systematically studied. We sought to further characterize developmental neurology in children with molecularly-confirmed cblC. Thirteen children at our center with cblC, born since implementation of expanded newborn screening in New York State, undertook standard-of-care evaluations with a pediatric neurologist and pediatric ophthalmologist. At most recent follow-up (mean age 50 months, range 9-84 months), of twelve children with early-onset cblC, three (25%) had a history of clinical seizures and two (17%) meet criteria for microcephaly. A majority of children had hypotonia and nystagmus. Twelve out of thirteen (92%) underwent neurodevelopmental evaluation (mean age 41 months; range 9-76 months), each child tested with standardized parental interviews and, where possible, age- and disability-appropriate neuropsychological batteries. All patients showed evidence of developmental delay with the exception of one patient with a genotype predictive of attenuated disease and near-normal biochemical parameters. Neurodevelopmental deficits were noted most prominently in motor skills, with relative preservation of socialization and communication skills. Nine children with early-onset cblC underwent magnetic resonance imaging and spectroscopy (MRI/MRS) at mean age of 47 months (range 6-81 months); common abnormalities included callosal thinning, craniocaudally short pons, and increased T2 FLAIR signal in periventricular and periatrial white matter. Our study further characterizes variable neurodevelopmental phenotypes in treated cblC, and provides insights into the etiopathogenesis of disordered neurodevelopment frequently encountered in cblC. Plasma homocysteine and MMA, routinely measured at clinical follow-up, may be poor predictors for neurodevelopmental outcomes. Additional data from large, prospective, multi-center natural history studies are required to more accurately define the role of these metabolites and others, as well as that of other genetic and environmental factors in the etiopathogenesis of the neurologic components of this disorder.
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Affiliation(s)
- James D Weisfeld-Adams
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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