Vitamin B12 and folate and the risk of anemia in old age: the Leiden 85-Plus Study

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Arch Intern Med. 2008 Nov 10;168(20):2238-44.

Vitamin B12 and folate and the risk of anemia in old age: the

Leiden 85-Plus Study.

den Elzen WP, Westendorp RG, Frölich M, de Ruijter W, Assendelft

WJ, Gussekloo J.

Department of Public Health and Primary Care, Leiden University

Medical Center, Post Zone V-0-P, PO Box 9600, 2300 RC Leiden, the

Netherlands. w.p.j.den_elzen@...

BACKGROUND: Screening for deficiencies in vitamin B(12) and folate

is advocated to prevent anemia in very elderly individuals. However, the

effects of vitamin B(12) and folate deficiency on the development of

anemia in old age have not yet been established. METHODS: The current

study is embedded in the Leiden 85-Plus Study, a population-based

prospective study of subjects aged 85 years. Levels of vitamin B(12),

folate, and homocysteine were determined at baseline. Hemoglobin levels

and mean corpuscular volume (MCV) were determined annually during 5

years of follow-up. RESULTS: We analyzed data from 423 subjects who did

not use any form of cyanocobalamin, hydroxocobalamin, or folic acid

supplementation, neither at baseline nor during follow-up. Folate

deficiency (<7 nmol/L; n = 34) and elevated homocysteine levels (>13.5

mumol/L; n = 194) were associated with anemia at baseline (adjusted odds

ratio [OR], 2.44; 95% confidence interval [CI], 1.06-5.61; and adjusted

OR, 1.82; 95% CI, 1.08-3.06, respectively), but vitamin B(12) deficiency

(<150 pmol/L; n = 68) was not (adjusted OR, 1.51; 95% CI, 0.79-2.87).

Furthermore, vitamin B(12) deficiency was not associated with the

development of anemia during follow-up (adjusted HR, 0.92; 95% CI,

0.46-1.82) or with changes in MCV (adjusted linear mixed model; P =

..77). Both folate deficiency and elevated homocysteine levels were

associated with the development of anemia from age 85 years onward

(adjusted HR, 3.33; 95% CI, 1.55-7.14; and adjusted HR, 1.70; 95% CI,

1.01-2.88, respectively), but not with an increase in MCV over time (P >

..30). CONCLUSION: In the general population of very elderly individuals,

anemia in 85-year-old subjects is associated with folate deficiency and

elevated homocysteine levels but not with vitamin B(12) deficiency.

Publication Types:

* Research Support, Non-U.S. Gov't

PMID: 19001201 [PubMed - in process]

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