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Khalil MT, Rathore FA. Letter to the Editor on "The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study". Arch Phys Med Rehabil 2024; 105:1407-1408. [PMID: 38570180 DOI: 10.1016/j.apmr.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024]
Affiliation(s)
- Muhammad Tawab Khalil
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Convoy Road, Rawalpindi, Pakistan.
| | - Farooq Azam Rathore
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Convoy Road, Rawalpindi, Pakistan
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Impact of Vitamin B12 Insufficiency on the Incidence of Sarcopenia in Korean Community-Dwelling Older Adults: A Two-Year Longitudinal Study. Nutrients 2023; 15:nu15040936. [PMID: 36839293 PMCID: PMC9967932 DOI: 10.3390/nu15040936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
The longitudinal effect of B12 insufficiency on sarcopenia has not yet been investigated in older adults. We aimed to study the impact of B12 levels on alterations in muscle mass, function and strength over two years. Non-sarcopenic older adults (n = 926) aged 70-84 were included. Using the Korean Frailty and Aging Cohort Study, this two-year longitudinal study used data across South Korea. The tools used for assessing muscle criteria were based on the Asian Working Group for Sarcopenia guidelines. Participants were divided into the insufficiency (initial serum B12 concentration < 350 pg/mL) and sufficiency groups (≥350 pg/mL). Logistic regression analyses were performed to evaluate the effect of initial B12 concentration on sarcopenia parameters over a two-year period. In women, multivariate analysis showed that the B12 insufficiency group had a significantly higher incidence of low SPPB scores (odds ratio [OR] = 3.28, 95% confidence interval [CI] = 1.59-6.76) and sarcopenia (OR = 3.72, 95% CI = 1.10-12.62). However, the B12 insufficiency group did not have a greater incidence of sarcopenia or other parameters in men. Our findings suggest B12 insufficiency negatively impacts physical performance and increases the incidence of sarcopenia only in women.
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Nutritional Care for the Older Adult. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Samson ME, Yeung LF, Rose CE, Qi YP, Taylor CA, Crider KS. Vitamin B-12 malabsorption and renal function are critical considerations in studies of folate and vitamin B-12 interactions in cognitive performance: NHANES 2011-2014. Am J Clin Nutr 2022; 116:74-85. [PMID: 35584808 PMCID: PMC10961698 DOI: 10.1093/ajcn/nqac065] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/09/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive health is a public health concern among older adults. Dietary supplement (SUP) use is common and concerns have been raised about high folic acid intake among those with vitamin B-12 deficiency and exacerbation of poor cognitive performance (PCP). OBJECTIVES We evaluated SUP use, usual folic acid intake, and blood folate and vitamin B-12 concentrations in relation to cognitive performance. METHODS We used NHANES 2011-2014 data on adults aged ≥60 y (n = 2867) and estimated total usual folic acid intake from diet and supplements, vitamin B-12 intake from SUPs, blood folates, vitamin B-12 concentrations, vitamin B-12 insufficiency (≤258 pmol/L), high folate (serum folate ≥59 nmol/L or RBC folate ≥1609 nmol/L), and PCP (<34 on the Digit Symbol Substitution Test). We assessed folate distributions adjusted for multiple variables, including renal function. RESULTS Compared with persons without PCP, adults with PCP were less likely to use supplements containing folic acid (mean ± SEE: 34.4% ± 2.4%) or vitamin B-12 (mean ± SEE: 47.5% ± 1.6%). Among vitamin B-12-insufficient adults, 18.0% ± 1.6% (mean ± SEE) reported taking a vitamin B-12 supplement. Among participants with high folate and insufficient vitamin B-12 concentrations, 34.3% ± 11.5% (mean ± SEE) reported taking vitamin B-12-containing supplements. Persons with high folate and normal vitamin B-12 concentrations had lower odds of PCP [aOR (adjusted odds ratio): 0.61; 95% CI: 0.45, 0.83] than persons with normal folate and vitamin B-12. Persons with high folate and normal methylmalonic acid (MMA) had lower odds of PCP (OR: 0.56; 95% CI: 0.40, 0.78) than those with normal folate and MMA concentrations. After adjustment for renal function, elevated risk of PCP was attenuated among persons with high folate and MMA. Concurrent high folate and insufficient vitamin B-12 concentrations were not associated with PCP. CONCLUSIONS Differential associations between vitamin B-12 and MMA highlight the need to consider renal function in studies of high folate and low vitamin B-12 status. Consumption of vitamin B-12 supplements concurrent with low vitamin B-12 status may indicate vitamin B-12 malabsorption.
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Affiliation(s)
- Marsha E Samson
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
- Epidemic Intelligence Service Program, CDC, Atlanta, GA, USA
| | - Lorraine F Yeung
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Christopher A Taylor
- National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
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Chae SA, Kim HS, Lee JH, Yun DH, Chon J, Yoo MC, Yun Y, Yoo SD, Kim DH, Lee SA, Chung SJ, Soh Y, Won CW. Impact of Vitamin B12 Insufficiency on Sarcopenia in Community-Dwelling Older Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312433. [PMID: 34886159 PMCID: PMC8656801 DOI: 10.3390/ijerph182312433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 10/31/2022]
Abstract
Vitamin B12 (B12) is involved as a cofactor in the synthesis of myelin. A lack of B12 impairs peripheral nerve production, which can contribute to sarcopenia. In this cross-sectional study, we aimed to investigate the relationship between B12 insufficiency and sarcopenia in community-dwelling older Korean adults. A total of 2325 (1112 men; 1213 women) adults aged 70-84 years were recruited. The tools used for sarcopenia were based on the Asian Working Group for Sarcopenia (AWGS) guidelines. Individuals with low appendicular skeletal muscle mass index (ASMI) (<7.0 kg/m2 for men; <5.4 kg/m2 for women) and low hand grip strength (HGS) (<28 kg for men; <18 kg for women) were defined as the sarcopenia group. Among this group, those who showed low physical performance (≤9 points on the Short Physical Performance Battery (SPPB)) were defined as the severe sarcopenia group. B12 concentrations were classified into insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Univariate and multivariate logistic regression analyses were used to evaluate the relationship between sarcopenia and B12 levels. Low ASMI showed a high incidence in the B12-insufficient group. However, HGS, SPPB, and the severity of sarcopenia showed no correlation with B12. Further, insufficient B12 may affect muscle quantity rather than muscle strength or physical performance.
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Affiliation(s)
- Seon A Chae
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Hee-Sang Kim
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Jong Ha Lee
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Dong Hwan Yun
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Jinmann Chon
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Myung Chul Yoo
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Yeocheon Yun
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Sung Joon Chung
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Yunsoo Soh
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
- Correspondence: (Y.S.); (C.W.W.)
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
- Correspondence: (Y.S.); (C.W.W.)
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Gana W, De Luca A, Debacq C, Poitau F, Poupin P, Aidoud A, Fougère B. Analysis of the Impact of Selected Vitamins Deficiencies on the Risk of Disability in Older People. Nutrients 2021; 13:3163. [PMID: 34579039 PMCID: PMC8469089 DOI: 10.3390/nu13093163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Vitamin deficiencies have a serious impact on healthy aging in older people. Many age-related disorders have a direct or indirect impact on nutrition, both in terms of nutrient assimilation and food access, which may result in vitamin deficiencies and may lead to or worsen disabilities. Frailty is characterized by reduced functional abilities, with a key role of malnutrition in its pathogenesis. Aging is associated with various changes in body composition that lead to sarcopenia. Frailty, aging, and sarcopenia all favor malnutrition, and poor nutritional status is a major cause of geriatric morbidity and mortality. In the present narrative review, we focused on vitamins with a significant risk of deficiency in high-income countries: D, C, and B (B6/B9/B12). We also focused on vitamin E as the main lipophilic antioxidant, synergistic to vitamin C. We first discuss the role and needs of these vitamins, the prevalence of deficiencies, and their causes and consequences. We then look at how these vitamins are involved in the biological pathways associated with sarcopenia and frailty. Lastly, we discuss the critical early diagnosis and management of these deficiencies and summarize potential ways of screening malnutrition. A focused nutritional approach might improve the diagnosis of nutritional deficiencies and the initiation of appropriate clinical interventions for reducing the risk of frailty. Further comprehensive research programs on nutritional interventions are needed, with a view to lowering deficiencies in older people and thus decreasing the risk of frailty and sarcopenia.
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Affiliation(s)
- Wassim Gana
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Arnaud De Luca
- Nutrition Mobile Unit, Regional University Hospital Centre, 37000 Tours, France;
- Inserm UMR 1069, Nutrition, Croissance et Cancer, 37032 Tours, France
| | - Camille Debacq
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Fanny Poitau
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
| | - Pierre Poupin
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Amal Aidoud
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Bertrand Fougère
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Education, Ethics, Health (EA 7505), Tours University, 37000 Tours, France
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Zhou J, Ma L, Zhao L, Sheng J, Xu Y, Chen J, Yu L, Sun Q, Zhou H, Zhu S, Lu Z, Wei B. Association Between the Prognostic Nutritional Index and Cognitive Function Among Older Adults in the United States: A Population-Based Study. J Alzheimers Dis 2021; 83:819-831. [PMID: 34366335 DOI: 10.3233/jad-210141] [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: 11/15/2022]
Abstract
BACKGROUND Nutritional status has been recognized as an important factor influencing cognitive function-related diseases, but few comprehensive nutrition indicators are available to assess the risk of cognitive decline. OBJECTIVE This study aimed to investigate the relationship between the prognostic nutritional index (PNI) and cognitive function in an elderly population, and the differences in nutrient intake between different levels of nutritional risk. METHODS Based on cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, we included 2,564 older participants. The lower quartile of each of the four cognitive tests was considered to have cognitive function impairment (CFI). Binary and multivariate logistic regression models were used to estimate the relationship between the PNI and the odds ratio of CFI. RESULTS After adjustment for confounding variables, we found that the odds of CFI were significantly lower for participants with normal PNI levels than for those with low PNI levels. In a comparison of global cognitive impairment scores, participants with a normal PNI had lower ratios of poor cognitive performance than those with a low PNI. By comparing the nutrient intake at different PNI levels, we found a reduction in the intake of protein, dietary fiber, total saturated fatty acids, and multiple micronutrients in the low PNI group. CONCLUSION Our study shows that the PNI can be a good predictor of the odds of CFI in the elderly population and that it is a convenient indicator of reduced intake of nutrients which may be important to brain health.
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Affiliation(s)
- Jie Zhou
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Luping Ma
- Department of Radiology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Lulei Zhao
- Department of Radiology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang Province, China
| | - Jiamin Sheng
- Department of Radiology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Yuhua Xu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Jie Chen
- Department of Laboratory Medicine, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Liangjun Yu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Quan Sun
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Hangyang Zhou
- Department of Radiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, Zhejiang Province, China
| | - Shaofeng Zhu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Zefeng Lu
- Department of Radiology, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China
| | - Bo Wei
- Department of Neurology, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China
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Electrochemical sensors as a versatile tool for the quantitative analysis of Vitamin B12. CHEMICAL PAPERS 2021. [DOI: 10.1007/s11696-021-01574-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Stein J, Geisel J, Obeid R. Association between neuropathy and B-vitamins: A systematic review and meta-analysis. Eur J Neurol 2021; 28:2054-2064. [PMID: 33619867 DOI: 10.1111/ene.14786] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/04/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peripheral neuropathy (PN) is common in patients with diseases that are in turn associated with deficiency of the B-vitamins, and vitamin treatment has shown mixed results. METHODS This systematic review and meta-analysis studied the association between PN/pain and B-vitamin biomarkers and investigated whether vitamin treatment can ameliorate the symptoms. PubMed and Web of Science were searched according to the study protocol. RESULTS A total of 46 observational and seven interventional studies were identified and included in the data synthesis. The presence of PN was associated with lowered B12 levels (pooled estimate [95% CIs] = 1.51 [1.23-1.84], n = 34, Cochran Q Test I2 = 43.3%, p = 0.003) and elevated methylmalonic acid (2.53 [1.39-4.60], n = 9, I2 = 63.8%, p = 0.005) and homocysteine (3.48 [2.01-6.04], n = 15, I2 = 70.6%, p < 0.001). B12 treatment (vs. the comparators) showed a non-significant association with symptom improvement (1.36 (0.66-2.79), n = 4, I2 = 28.9%). Treatment with B1 was associated with a significant improvement in symptoms (5.34 [1.87-15.19], n = 3, I2 = 64.6%, p = 0.059). Analysis of seven trials combined showed a non-significant higher odds ratio for improvement under treatment with the B-vitamins (2.58 [0.98-6.79], I2 = 80.0%, p < 0.001). CONCLUSIONS PN is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine. Overall, interventional studies have suggested that B-vitamins could improve symptoms of PN. Available trials have limitations and generally did not investigate vitamin status prior to treatment. Well-designed studies, especially in non-diabetes PN, are needed. This meta-analysis is registered at PROSPERO (ID: CRD42020144917).
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Affiliation(s)
- Johannes Stein
- Saarland University, Saarbrucken, Germany.,Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Juergen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
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Amirdelfan K, Pope JE, Gunn J, Hill MM, Cotten BM, Beresh JE, Dobecki D, Miller N, Mehta P, Girardi G, Deer TR. Clinical Validation of a Multi-Biomarker Assay for the Evaluation of Chronic Pain Patients in a Cross-Sectional, Observational Study. Pain Ther 2020; 9:511-529. [PMID: 32495188 PMCID: PMC7648807 DOI: 10.1007/s40122-020-00175-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Chronic pain assessment and post-treatment evaluation continues to be challenging due to a lack of validated, objective tools to measure patient outcomes. Validation of mechanistic pain biomarkers would allow clinicians to objectively identify abnormal biochemistry contributing to painful symptoms. METHODS We describe the clinical validation of a multi-biomarker assay with algorithmic analysis known as the Foundation Pain Index (FPI) in diverse cohorts of chronic pain patients in a prospective, cross-sectional, observational validation study. Levels of 11 urinary pain biomarkers were measured and tabulated using a proprietary algorithm to generate FPI scores for chronic pain subjects (N = 153) and age- and sex-matched pain-free controls (N = 334). RESULTS FPI scores were significantly correlated with the 36-Item Short Form Health Survey (SF-36) scores among chronic pain subjects (P value < 0.015) and specific components of SF-36, including emotional well-being, limitations due to emotional problems, and general health (P value < 0.05). Area under ROC analysis (AUROC) revealed FPI to accurately distinguish biomarker profiles between pain-free and chronic pain cohorts (AUROC: 0.7490, P value < 0.0001) as well as the SF-36 scores between chronic pain subjects with low vs. high FPI scores (AUROC: 0.7715, P value < 0.01). CONCLUSIONS Our findings establish the validity and discriminatory power of a novel multi-biomarker test that evaluates the role of biochemistry in chronic pain and correlates with clinical assessments of patients. This test provides novel, reproducible, objective data which may pave the way for non-opioid therapeutic strategies to treat chronic pain.
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Affiliation(s)
| | - Jason E Pope
- Evolve Restorative Center, 416 Aviation Blvd Ste B, Santa Rosa, CA, 95403, USA
| | - Joshua Gunn
- Ethos Research and Development, LLC, 29 E 6th Street, Newport, KY, 41071, USA.
| | - Melissa M Hill
- Ethos Research and Development, LLC, 29 E 6th Street, Newport, KY, 41071, USA
| | - Bradley M Cotten
- Ethos Research and Development, LLC, 29 E 6th Street, Newport, KY, 41071, USA
| | - John E Beresh
- Beresh Pain Management, Inc, 840 NW Washington Blvd #C, Hamilton, OH, 45013, USA
| | - Douglas Dobecki
- San Diego Pain Institute, 7625 Mesa College Dr Ste 315A, San Diego, CA, 92111, USA
| | - Nathan Miller
- Coastal Pain and Spinal Diagnostics, 6221 Metropolitan St, Carlsbad, CA, 92009, USA
| | - Pankaj Mehta
- Pain Specialists of Austin, 2500 W William Cannon Dr Ste 206, Austin, TX, 78745, USA
| | - George Girardi
- Front Range Pain Medicine, 3744 S Timberline Rd Ste 102, Fort Collins, CO, 80525, USA
| | - Timothy R Deer
- Center for Pain Relief, 400 Court St Ste 100, Charleston, WV, 25301, USA
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11
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Linghui D, Shi Q, Chi C, Xiaolei L, Lixing Z, Zhiliang Z, Birong D. The Association Between Leukocyte Telomere Length and Cognitive Performance Among the American Elderly. Front Aging Neurosci 2020; 12:527658. [PMID: 33192450 PMCID: PMC7661855 DOI: 10.3389/fnagi.2020.527658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
Background Age-related cognitive decline begins in middle age and persists with age. Leukocyte telomere length (LTL) decreases with age and is enhanced by inflammation and oxidative stress. However, whether shorter LTL correlates with cognitive decline remains controversial. Aims We aimed to investigate the relationship between LTL and cognitive decline in the American elderly. Methods We used data from the 1999 to 2002 U.S. National Health and Nutrition Examination Survey (NHANES). We included participants aged 65–80 with available data on LTL and cognitive assessments. The cognitive function assessment used the digit symbol substitution test (DSST). We applied multivariate modeling to estimate the association between LTL and cognitive performance. Additionally, to ensure robust data analysis, we converted LTL into categorical variables through quartile and then calculated the P for trend. Results After adjusting for age, cardiovascular disease (CAD) score, gender, race, body mass index (BMI), and educational level, LTL showed a positive correlation with DSST score (odds ratio [OR] 3.47 [0.14, 6.79], P = 0.04). Additionally, to further quantify the LTL–DSST interaction, we found a similar trend when LTL was regarded as a categorical variable (quartile) (P for trend = 0.03). Conclusion LTL was associated with cognitive capabilities among the elderly, implying that LTL might be a biomarker of cognitive aging.
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Affiliation(s)
- Deng Linghui
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiu Shi
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Chi
- Department of Immunology and Microbiology, Guiyang College of Traditional Chinese Medicine, Guiyang, China
| | - Liu Xiaolei
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Lixing
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zuo Zhiliang
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Birong
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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12
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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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13
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Abstract
Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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14
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An R, Nickols-Richardson SM, Alston RJ, Shen S, Clarke C. Fresh- and lean-pork intake in relation to functional limitations among US older adults, 2005-2016. Nutr Health 2020; 26:295-301. [PMID: 32674655 DOI: 10.1177/0260106020940121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pork consumption, in particular fresh/lean-pork consumption, provides protein and other essential micronutrients that older adults need daily and may hold the potential to prevent functional limitations resulting from sub-optimal nutrition. AIM Assess fresh/lean-pork intake in relation to functional limitations among older adults in the USA. METHODS Individual-level data came from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 waves. Nineteen validated questions assessed five functional limitation domains: activities of daily living (ADLs); instrumental activities of daily living (IADLs); leisure and social activities (LSAs); lower extremity mobility (LEM); and general physical activities (GPAs). Logistic regressions were performed to examine pork, fresh-pork and fresh lean-pork intake in relation to functional limitations among NHANES older adults (n = 6135). RESULTS Approximately 21, 18 and 16% of older adults consumed pork, fresh pork and fresh lean pork, respectively. An increase in pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 12%, IADLs by 10% and any functional limitation by 7%. An increase in fresh-pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 13%, IADLs by 10%, GPAs by 8%, and any functional limitation by 8%. Similar effects were found for fresh lean-pork consumption on ADLs, IADLs, GPAs and any functional limitation. CONCLUSION This study found some preliminary evidence linking fresh/lean-pork consumption to a reduced risk of functional limitations. Future studies with longitudinal/experimental designs are warranted to examine the influence of fresh/lean-pork consumption on functional limitations.
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Affiliation(s)
- Ruopeng An
- Brown School, 7548Washington University, USA.,Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, USA
| | | | - Reginald J Alston
- Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, USA
| | - Sa Shen
- College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, USA
| | - Caitlin Clarke
- Department of Sociology, 14589University of Illinois at Urbana-Champaign, USA
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15
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Menegardo CS, Friggi FA, Santos AD, Devens LT, Tieppo A, Morelato RL. Deficiência de vitamina B12 e fatores associados em idosos institucionalizados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar a frequência de deficiência de vitamina B12 e fatores associados em idosos institucionalizados. Método Analisamos 65 idosos, com idade média de 80±9 anos (61-113), de uma instituição geriátrica filantrópica de longa permanência. A dosagem sérica de vitamina B12 foi analisada e classificada em: normal (≥299 pg/mL), limítrofe (200-298 pg/mL) e deficiência (<200 pg/mL). Foi analisada a associação com tempo de permanência na instituição, declínio cognitivo e funcional, uso regular de biguanidas e inibidores de bomba de prótons, considerados fatores de risco para hipovitaminose B12, utilizando os testes de análise bivariada (paramétrica e não paramétrica) e regressão de Poisson. Resultados A deficiência de vitamina B12 estava presente em 21,5% e valores limítrofes em 32,3% da amostra. Dentre os idosos, 52,9% apresentavam demência de causas diversas, 49,2% hipertensão arterial, 29,2% com anemia (21,5% normocítica, 4,6% microcítica e 3,1% macrocítica), 18,5% diabéticos; 27,7% faziam uso de polifarmácia, com 12,3% em uso de metformina e 16,9% com inibidores de bomba de prótons. No modelo multivariado não houve associação entre a deficiência de vitamina B12 com as variáveis estudadas. Conclusão Observamos uma frequência importante de valores limítrofes e baixos de vitamina B12 nos pacientes dessa instuição geriátrica de cuidados permanentes, porém sem associação com os fatores de risco para sua deficiência estudado, o que torna importante a inclusão da dosagem sérica dessa vitamina na rotina de exames laboratoriais desse grupo.
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Affiliation(s)
| | | | | | | | - Alessandra Tieppo
- Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Brasil
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16
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Brinkley TE, Berger M, Callahan KE, Fieo RA, Jennings LA, Morris JK, Wilkins HM, Kritchevsky SB. Workshop on Synergies Between Alzheimer's Research and Clinical Gerontology and Geriatrics: Current Status and Future Directions. J Gerontol A Biol Sci Med Sci 2019; 73:1229-1237. [PMID: 29982466 PMCID: PMC6454460 DOI: 10.1093/gerona/gly041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
Age is the strongest risk factor for physical disability and Alzheimer's disease (AD) and related dementias. As such, other aging-related risk factors are also shared by these two health conditions. However, clinical geriatrics and gerontology research has included cognition and depression in models of physical disability, with less attention to the pathophysiology of neurodegenerative disease. Similarly, AD research generally incorporates limited, if any, measures of physical function and mobility, and therefore often fails to consider the relevance of functional limitations in neurodegeneration. Accumulating evidence suggests that common pathways lead to physical disability and cognitive impairment, which jointly contribute to the aging phenotype. Collaborations between researchers focusing on the brain or body will be critical to developing, refining, and testing research paradigms emerging from a better understanding of the aging process and the interacting pathways contributing to both physical and cognitive disability. The National Institute of Aging sponsored a workshop to bring together the Claude D. Pepper Older Americans Independence Center and AD Center programs to explore areas of synergies between the research concerns of the two programs. This article summarizes the proceedings of the workshop and presents key gaps and research priorities at the intersection of AD and clinical aging research identified by the workshop participants.
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Affiliation(s)
- Tina E Brinkley
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Kathryn E Callahan
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert A Fieo
- Department of Geriatric Research, University of Florida, Gainesville
| | - Lee A Jennings
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center
| | - Jill K Morris
- Department of Neurology, Alzheimer's Disease Center, University of Kansas
| | - Heather M Wilkins
- Department of Neurology, Alzheimer's Disease Center, University of Kansas
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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17
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Squires PJ, Pahor M, Manini TM, Brown JD. Effect of Gastric Acid Suppressants on Response to a Physical Activity Intervention and Major Mobility Disability in Older Adults: Results from the Lifestyle Interventions for Elders (LIFE) Study. Pharmacotherapy 2019; 39:816-826. [PMID: 31230397 DOI: 10.1002/phar.2299] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Proton pump inhibitors (PPIs) and histamine2 receptor antagonists (H2 RAs) are associated with pharmacologic effects that may be detrimental to mobility and response to physical activity. Mobility disability and injurious fall outcomes in PPI and H2 RA users were compared with nonusers in this secondary analysis of data from the Lifestyle Interventions for Elders (LIFE) study. METHODS Participants ages 70-89 years were randomized to a physical activity (PA) or successful aging intervention and evaluated by medication use. Confounders included baseline demographic characteristics, physical function, cognitive function, sleep quality, and acid reflux symptoms that were adjusted via propensity score weighting. Outcomes were incident and persistent major mobility disability (MMD and pMMD) and injurious falls. Weighted proportional hazard models evaluated independent and interaction effects of PPIs and H2 RAs. RESULTS No interaction was found between PPIs and H2 RAs and the PA intervention. Drug use associations were significant for H2 RAs (hazard ratio [HR] 1.74 [95% confidence interval [CI] 1.12-2.68]) and PPIs (HR 1.32 [95% CI 1.02-1.70]) compared with nonusers for pMMD. PPIs were associated with increased injurious falls compared with nonusers (HR 1.44 [95% CI 1.06-1.96]). Pooling of data from the H2 RA and PPI exposure groups showed a 26% increase in MMD (HR 1.26 [95% CI 1.07-1.48]), a 44% increase in pMMD (HR 1.44 [95% CI 1.16-1.77]), and a 48% increase in injurious falls (HR 1.48 [95% CI 1.15-1.91]) compared with nonusers. All direct comparisons between PPIs and H2 RAs were nonsignificant. CONCLUSIONS Compared with nonusers, participants using either PPIs or H2 RAs had an increased risk of MMD, pMMD, and injurious falls. It is not known if these effects are related to the individual pharmacology of each medication, reduced acid secretion, or the underlying disease state. Further study is required to determine causality.
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Affiliation(s)
- Patrick J Squires
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida
| | - Todd M Manini
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida
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18
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Wolffenbuttel BH, Wouters HJ, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B 12) Deficiency. Mayo Clin Proc Innov Qual Outcomes 2019; 3:200-214. [PMID: 31193945 PMCID: PMC6543499 DOI: 10.1016/j.mayocpiqo.2019.03.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although cobalamin (vitamin B12) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B12 deficiency may present with the classic megaloblastic anemia. In clinical practice, many cases of vitamin B12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B12 deficiency in whom the diagnosis was either based on low serum B12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B12 therapy. We discuss the possible clinical signs and symptoms of patients with B12 deficiency and the various pitfalls of diagnosis and treatment.
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Affiliation(s)
- Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - Hanneke J.C.M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - M. Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
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19
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Thong BKS, Ima-Nirwana S, Chin KY. Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1571. [PMID: 31060319 PMCID: PMC6540255 DOI: 10.3390/ijerph16091571] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies (n = 14), although some studies reported no significant relationship (n = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk.
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Affiliation(s)
- Benjamin Ka Seng Thong
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
| | - Kok-Yong Chin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
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20
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Abstract
Older adults are particularly vulnerable to compromised nutritional status. With advancing age, the consumption of a high-quality, nutritionally dense diet is increasingly essential to optimize health and well-being. Proportionally, macronutrient needs for older adults are similar to younger adults, however overall calorie requirements tend to decline with age. Unique factors influencing food intake should be considered and individualized guidance should be designed to help overcome medical, physical, and social barriers to a healthy diet. The goal for nutrition intervention should ultimately be to promote health and quality of life across the continuum of the aging process.
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Affiliation(s)
- Melissa Bernstein
- Department of Nutrition, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
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21
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Röhrig G, Gütgemann I, Kolb G, Leischker A. Klinisch-hämatologisches Bild des Vitamin-B12-Mangels im Alter. Z Gerontol Geriatr 2018; 51:446-452. [DOI: 10.1007/s00391-018-1410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
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22
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Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations. Nutr Res Rev 2018; 31:204-224. [DOI: 10.1017/s0954422418000045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractThe possible roles of selected B vitamins in the development and progression of sarcopenia are reviewed. Age-related declines in muscle mass and function are associated with huge and increasing costs to healthcare providers. Falls and loss of mobility and independence due to declining muscle mass/function are associated with poor clinical outcomes and their prevention and management are attractive research targets. Nutritional status appears a key modifiable and affordable intervention. There is emerging evidence of sarcopenia being the result not only of diminished anabolic activity but also of declining neurological integrity in older age, which is emerging as an important aspect of the development of age-related decline in muscle mass/function. In this connection, several B vitamins can be viewed as not only cofactors in muscle synthetic processes, but also as neurotrophic agents with involvements in both bioenergetic and trophic pathways. The B vitamins thus selected are examined with respect to their relevance to multiple aspects of neuromuscular function and evidence is considered that requirements, intakes or absorption may be altered in the elderly. In addition, the evidence base for recommended intakes (UK recommended daily allowance) is examined with particular reference to original datasets and their relevance to older individuals. It is possible that inconsistencies in the literature with respect to the nutritional management of sarcopenia may, in part at least, be the result of compromised micronutrient status in some study participants. It is suggested that in order, for example, for intervention with amino acids to be successful, underlying micronutrient deficiencies must first be addressed/eliminated.
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23
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Urios A, Mangas-Losada A, Gimenez-Garzó C, González-López O, Giner-Durán R, Serra MA, Noe E, Felipo V, Montoliu C. Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits. Liver Int 2017; 37:1013-1022. [PMID: 27988985 DOI: 10.1111/liv.13345] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/07/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Cognitive dysfunction in cirrhotic patients with minimal hepatic encephalopathy (MHE) is associated with falls. Alterations in postural control and stability could contribute to increase falls risk in these patients. We aimed to assess whether postural control and direction-specific limits of stability are altered in cirrhotic patients with MHE compared to patients without MHE and controls. We also assessed if alterations in postural control correlate with neurological impairment and/or blood biomarkers. METHODS Posturography analysis, attention Stroop test and bimanual and visuo-motor coordination tests were performed in 18 controls, 19 patients with cirrhosis without MHE and 17 with MHE, diagnosed by PHES. Posturography was assessed by NedSVE® /IBV system under four sensory conditions. Limits of stability and rhythmic weight-shifting tests were also performed. Blood ammonia and serum interleukins were also measured. Falls were assessed after 12-24 months follow-up. RESULTS MHE patients show impaired balance, mainly on unstable surface with eyes open, with longer reaction and confinement times and lower success in Limits of Stability test compared to patients without MHE. Performance in attention and motor coordination tests correlated with most posturography parameters alterations. Logistic regression analysis shows that posturography parameters and bimanual coordination test are good predictors of falls. CONCLUSION Balance patterns and limits of stability in MHE patients are impaired compared to patients without MHE and controls. This seems to contribute to a higher falls risk. Attention and motor coordination deficits could contribute to balance impairment in patients with MHE.
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Affiliation(s)
- Amparo Urios
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | | | - Carla Gimenez-Garzó
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | | | | | - Miguel A Serra
- Unidad de Digestivo, Hospital Clínico de Valencia, Departamento Medicina, Universidad de Valencia, Valencia, Spain
| | - Enrique Noe
- Servicio de Daño, Cerebral del Hospital Valencia al Mar, Valencia, Spain
| | - Vicente Felipo
- Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | - Carmina Montoliu
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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24
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Kancherla V, Elliott JL, Patel BB, Holland NW, Johnson TM, Khakharia A, Phillips LS, Oakley GP, Vaughan CP. Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans. J Am Geriatr Soc 2017; 65:1061-1066. [PMID: 28182265 PMCID: PMC5435502 DOI: 10.1111/jgs.14761] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the association between long-term metformin therapy and serum vitamin B12 monitoring. DESIGN Retrospective cohort study. SETTING A single Veterans Affairs Medical Center (VAMC), 2002-2012. PARTICIPANTS Veterans 50 years or older with either type 2 diabetes and long-term metformin therapy (n = 3,687) or without diabetes and no prescription for metformin (n = 13,258). MEASUREMENTS We determined diabetes status from outpatient visits, and defined long-term metformin therapy as a prescription ≥500 mg/d for at least six consecutive months. We estimated the proportion of participants who received a serum B12 test and used multivariable logistic regression, stratified by age, to evaluate the association between metformin use and serum B12 testing. RESULTS Only 37% of older adults with diabetes receiving metformin were tested for vitamin B12 status after long-term metformin prescription. The mean B12 concentration was significantly lower in the metformin-exposed group (439.2 pg/dL) compared to those without diabetes (522.4 pg/dL) (P = .0015). About 7% of persons with diabetes receiving metformin were vitamin B12 deficient (<170 pg/dL) compared to 3% of persons without diabetes or metformin use (P = .0001). Depending on their age, metformin users were two to three times more likely not to receive vitamin B12 testing compared to those without metformin exposure, after adjusting for sex, race and ethnicity, body mass index, and number of years treated at the VAMC. CONCLUSION Long-term metformin therapy is significantly associated with lower serum vitamin B12 concentration, yet those at risk are often not monitored for B12 deficiency. Because metformin is first line therapy for type 2 diabetes, clinical decision support should be considered to promote serum B12 monitoring among long-term metformin users for timely identification of the potential need for B12 replacement.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - John L. Elliott
- Division of General Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - N. Wilson Holland
- Division of General Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
| | - Theodore M. Johnson
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
- Division of General Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, GA
| | - Anjali Khakharia
- Division of General Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, GA
| | - Lawrence S. Phillips
- Atlanta VA Medical Center, Decatur, GA
- Division of Endocrinology, Lipids & Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Godfrey P. Oakley
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Camille P. Vaughan
- Division of General Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, GA
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Vidoni ML, Pettee Gabriel K, Luo ST, Simonsick EM, Day RS. Vitamin B12 and Homocysteine Associations with Gait Speed in Older Adults: The Baltimore Longitudinal Study of Aging. J Nutr Health Aging 2017; 21:1321-1328. [PMID: 29188896 PMCID: PMC5726303 DOI: 10.1007/s12603-017-0893-4] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to assess the independent associations of serum levels of vitamin B12 and plasma concentrations of homocysteine with gait speed decline. DESIGN, SETTING, PARTICIPANTS This study utilized longitudinal analysis of participants 50 years or older from The Baltimore Longitudinal Study of Aging, N=774. MEASUREMENTS Gait speed (m/s) was assessed using the 6-meter usual pace test. Vitamin B12 and homocysteine concentrations were collected using standard clinical protocols. Linear mixed effects regression was stratified by baseline age category (50-69, 70-79, and ≥80 years old). RESULTS Mean follow-up time for the total study sample was 5.4 ± 2.0 years. No association between vitamin B12 and gait speed decline over the follow-up time for any age group was found. Elevated homocysteine concentrations were associated with decline in gait speed after adjustment for covariates (50-69: β= -0.005, p=.057; 70-79: β= -0.013, p<.001, ≥80: β= -0.007, p=.054). CONCLUSION Homocysteine and vitamin B12 are inversely related, yet only homocysteine was associated with gait speed decline in this population of healthy older adults. Given these results, future research should be directed towards investigating the relationship in populations with greater variation in vitamin B12 concentrations and other mechanisms influencing homocysteine concentrations.
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Affiliation(s)
- M L Vidoni
- R. Sue Day, University of Texas Health Science Center at Houston School of Public Health, Division of Epidemiology, Human Genetics, and Environmental Science, Michael and Susan Dell Center for Healthy Living, Houston, TX, USA,
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Abstract
Maintaining optimal health and well-being in the older adult requires understanding of how physiologic changes influence nutritional status, familiarity with the available validated tools to assess status, identification of factors predisposing older adults to malnutrition, and evidence-based practice regarding the nutritional needs of this age group. Evidence-based guidance on these core practice components is provided to the clinician in this article.
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Affiliation(s)
- Hope Barkoukis
- Department of Nutrition, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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[Vitamins and nutritional supplements in older persons: How to diagnose and when to substitute?]. Internist (Berl) 2016; 56:1318-24. [PMID: 26349908 DOI: 10.1007/s00108-015-3778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite an excellent food supply in Germany, a large percentage of older persons living at home or institutionalized older persons suffer from or are at risk for malnutrition. The purpose of this article is to highlight the association between nutrient deficiencies and age-related diseases and give rational recommendations for substitution. Both malnutrition and low levels of specific nutrients are associated with cognitive and functional impairment, dementia, and depression in older persons. Most prevalent are deficiencies in vitamin B1, vitamin B12, and vitamin D. Serum levels are often misleading and show false negative results in vitamin B1 and B12 deficiencies; therefore, determination of erythrocyte transketolase activity (ETKA) and the thiamine pyrophosphate (TPP) effect for vitamin B1 and of methylmalonic acid and holotranscobalamine for vitamin B12 is recommended. Prophylactic supplementation with vitamins is not supported by prospective trials; however, positive data from observational studies support a Mediterranean diet combined with intake of vitamins, antioxidants, and unsaturated fatty acids. Older persons should be regularly screened for malnutrition and the threshold for determination of vitamin B1, B12, and vitamin D should be low. Vitamin substitution should be reserved for proven deficits. There is now data regarding cognition from prospective trials on effects of a healthy diet combined with other life-style factors like physical and cognitive activity.
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Kong D, Liu L, Song S, Kuang H, Xu C. Development of Sensitive, Rapid, and Effective Immunoassays for the Detection of Vitamin B12 in Fortified Food and Nutritional Supplements. FOOD ANAL METHOD 2016. [DOI: 10.1007/s12161-016-0543-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Keenan A, Whittam B, Rink R, Kaefer M, Misseri R, King S, Cain M. Vitamin B12 deficiency in patients after enterocystoplasty. J Pediatr Urol 2015; 11:273.e1-5. [PMID: 26165193 DOI: 10.1016/j.jpurol.2015.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Serum B12 deficiency is a known sequlae of enterocystoplasty. The complications of B12 deficiency include megaloblastic anemia, neuropsychiatric disease, and demyelinating diseases such as peripheral neuropathy. Some studies have suggested that underlying disease states may be more important than enteric absorptive capacity in predicting acquired B12 deficiency. A 38% incidence of low or low-normal serum B12 in patients who have undergone enterocystoplasty has previously been reported, and oral B12 supplementation has been demonstrated to be an effective short-term therapy; however, the long-term results remain unclear. AIMS This study hypothesized that oral vitamin B12 supplementation in patients with B12 deficiency following enterocystoplasty is an effective long-term treatment. Additionally, it sought to determine if underlying disease state predicts B12 deficiency following enterocystoplasty. DESIGN Children who underwent enterocystoplasty at the present institution prior to August 2007 were reviewed. Patients with non-ileal augment, insufficient follow-up or hematologic disorders were excluded. Patients with low or low-normal B12 levels were included. Treatment consisted of daily oral therapy of 250 mcg or monthly parenteral therapy of 1000 mcg IM. Separately, the institutional database of 898 patients who underwent enterocystoplasty was searched and patients with at least one post-operative B12 level were highlighted. The indication for enterocystoplasty was classified as neuropathic or non-neuropathic. RESULTS Twenty-three patients met inclusion criteria. The mean follow-up was 49 months (range 5-85) following initial abnormal B12 level. On the last follow-up, 4/23 (17%) patients had normal serum B12 levels. No patients reported sequelae of long-term B12 deficiency. In the secondary investigation, 113 patients met inclusion criteria. A total of 101 had neuropathic indications for enterocystoplasty, and 12 had non-neuropathic indications. At any time during follow-up, 48/101 (47.5%) neuropathic patients had low or low-normal B12 levels, and 4/12 (33.3%) non-neuropathic patients had low or low-normal B12 levels during follow-up (P = 0.54) (Figure). DISCUSSION The initial success of oral B12 deficiency treatment following enterocystoplasty does not persist over time. This contradicts previous results with short duration follow-up. Underlying disease as the indication for enterocystoplasty did not predict B12 deficiency risk. The study was limited by the small number of patients with B12 deficiency who were started on treatment, as well as by the small number of patients with non-neuropathic indications for enterocystoplasty. CONCLUSION The aims of the study were met. Further investigation is required to assess predictors of B12 deficiency following enterocystoplasty.
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Affiliation(s)
- Alison Keenan
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Benjamin Whittam
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Richard Rink
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Martin Kaefer
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Rosalie Misseri
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Shelly King
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Mark Cain
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
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Abstract
The prevalence of vitamin B12 deficiency increases with age. Patients with dementia and spouses of patients with dementia are at special risk for the development of vitamin B12 deficiency. In a normal diet this vitamin is present only in animal source foods; therefore, vegans frequently develop vitamin B12 deficiency if not using supplements or foods fortified with cobalamin. Apart from dementia, most of these manifestations are completely reversible under correct therapy; therefore it is crucial to identify and to treat even atypical presentations of vitamin B12 deficiency as early as possible. This article deals with the physiology and pathophysiology of vitamin B12 metabolism. A practice-oriented algorithm which also considers health economic aspects for a rational laboratory diagnosis of vitamin B12 deficiency is presented. In cases with severe neurological symptoms, therapy should be parenteral, especially initially. For parenteral treatment, hydroxocobalamin is the drug of choice.
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Affiliation(s)
- A H Leischker
- Klinik für Allgemeine Innere Medizin und Altersmedizin, Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland,
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Abstract
Older adults are becoming a significant percentage of the world's population. A multitude of factors, from the normal aging process to the progression of chronic disease, influence the nutrition needs of this very diverse group of people. Appropriate micronutrient intake is of particular importance but is often suboptimal. Here we review the available data regarding micronutrient needs and the consequences of deficiencies in the ever growing aged population.
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Affiliation(s)
- Stephanie C Montgomery
- Division of General Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie M Streit
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mara Lee Beebe
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
| | - Pinckney J Maxwell
- Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, South Carolina
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Use of natural compounds in the management of diabetic peripheral neuropathy. Molecules 2014; 19:2877-95. [PMID: 24603557 PMCID: PMC6271156 DOI: 10.3390/molecules19032877] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
Nephropathy, retinopathy cardiomyopathy and peripheral neuropathy are all recognized as important complications in about 50% of diabetes mellitus (DM) patients, mostly related to a poor glycemic control or to an improper management of this pathology. In any case, amongst others, diabetic peripheral neuropathy (DPN) seems the leading and most painful complication usually affecting many DM patients. For this reason, this work was conceived to review the large variety of strategies adopted for management of DPN, starting from the most conventional therapies to arrive at alternative approaches. From this perspective, both the most popular pharmacological treatments used to respond to the poorly effect of common analgesics—non-steroidal anti-inflammatory drugs (NSAIDS) and opioids—understood as gabapentin vs. pregabalin clinical use, and the guidelines provided by Oriental Medicine as well as by a long list of natural compounds that many authors identify as possible therapeutic or alternative agents to replace or to combine with the existing therapies will be included. Moreover, in the effort to provide the widest panel of remedies, the most antique techniques of acupuncture and electrostimulation will be considered as alternative, which are useful approaches to take into account in any non-pharmacological strategy for DPN management.
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