Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification
BACKGROUND:Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational dat...
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| Veröffentlicht in: | The American journal of clinical nutrition 2007, Vol.85 (1), p.193-200 |
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| creator | Morris, Martha Savaria Jacques, Paul F Rosenberg, Irwin H Selhub, Jacob |
| description | BACKGROUND:Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical. OBJECTIVE:We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score 59 nmol/L (80th percentile), as opposed to |
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This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical. OBJECTIVE:We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score <34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey. DESIGN:The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration <148 pmol/L or a serum methylmalonic acid concentration >210 nmol/L--the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine. RESULTS:After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate >59 nmol/L (80th percentile), as opposed to <=59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were <1.0 (Pinteraction < 0.05), but significantly <1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9). CONCLUSION:In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.]]></description><identifier>ISSN: 0002-9165</identifier><identifier>EISSN: 1938-3207</identifier><identifier>DOI: 10.1093/ajcn/85.1.193</identifier><identifier>PMID: 17209196</identifier><identifier>CODEN: AJCNAC</identifier><language>eng</language><publisher>Bethesda, MD: American Society for Nutrition</publisher><subject>Aged ; Aging - blood ; Americans ; anemia (disease) ; Anemia - blood ; Anemia - epidemiology ; Anemia - prevention & control ; Anemia, Macrocytic - blood ; Anemia, Macrocytic - epidemiology ; Anemia, Macrocytic - prevention & control ; Biological and medical sciences ; cognition ; Cognition Disorders - blood ; Cognition Disorders - epidemiology ; Cognition Disorders - prevention & control ; Confidence Intervals ; Creatinine - blood ; elderly ; elderly nutrition ; Feeding. Feeding behavior ; Female ; folic acid ; Folic Acid - administration & dosage ; Folic Acid - blood ; Folic Acid - metabolism ; food fortification ; Food, Fortified ; Fundamental and applied biological sciences. Psychology ; Humans ; macrocytosis ; Male ; men ; Nutrition Surveys ; Nutritional Status ; Odds Ratio ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vitamin B 12 - blood ; Vitamin B 12 Deficiency - complications ; Vitamin B 12 Deficiency - diagnosis ; vitamin B12 ; vitamin deficiencies ; women</subject><ispartof>The American journal of clinical nutrition, 2007, Vol.85 (1), p.193-200</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c505t-a3df16f61eb65fbeb58256a4501bc817a3e454986806c2202b39d265c904721b3</citedby><cites>FETCH-LOGICAL-c505t-a3df16f61eb65fbeb58256a4501bc817a3e454986806c2202b39d265c904721b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,4022,27922,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18448872$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17209196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morris, Martha Savaria</creatorcontrib><creatorcontrib>Jacques, Paul F</creatorcontrib><creatorcontrib>Rosenberg, Irwin H</creatorcontrib><creatorcontrib>Selhub, Jacob</creatorcontrib><title>Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification</title><title>The American journal of clinical nutrition</title><addtitle>Am J Clin Nutr</addtitle><description><![CDATA[BACKGROUND:Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical. OBJECTIVE:We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score <34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey. DESIGN:The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration <148 pmol/L or a serum methylmalonic acid concentration >210 nmol/L--the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine. RESULTS:After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate >59 nmol/L (80th percentile), as opposed to <=59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were <1.0 (Pinteraction < 0.05), but significantly <1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9). CONCLUSION:In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.]]></description><subject>Aged</subject><subject>Aging - blood</subject><subject>Americans</subject><subject>anemia (disease)</subject><subject>Anemia - blood</subject><subject>Anemia - epidemiology</subject><subject>Anemia - prevention & control</subject><subject>Anemia, Macrocytic - blood</subject><subject>Anemia, Macrocytic - epidemiology</subject><subject>Anemia, Macrocytic - prevention & control</subject><subject>Biological and medical sciences</subject><subject>cognition</subject><subject>Cognition Disorders - blood</subject><subject>Cognition Disorders - epidemiology</subject><subject>Cognition Disorders - prevention & control</subject><subject>Confidence Intervals</subject><subject>Creatinine - blood</subject><subject>elderly</subject><subject>elderly nutrition</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>folic acid</subject><subject>Folic Acid - administration & dosage</subject><subject>Folic Acid - blood</subject><subject>Folic Acid - metabolism</subject><subject>food fortification</subject><subject>Food, Fortified</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>macrocytosis</subject><subject>Male</subject><subject>men</subject><subject>Nutrition Surveys</subject><subject>Nutritional Status</subject><subject>Odds Ratio</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vitamin B 12 - blood</subject><subject>Vitamin B 12 Deficiency - complications</subject><subject>Vitamin B 12 Deficiency - diagnosis</subject><subject>vitamin B12</subject><subject>vitamin deficiencies</subject><subject>women</subject><issn>0002-9165</issn><issn>1938-3207</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUFv1DAQhS0EokvhyBV8gVOz9TixY18qlYoCUiUO0LM1cZytqyRebO9K_SP8XpzuisLF9sjfvHmaR8hbYGtguj7HezufK7GGNej6GVmVU1U1Z-1zsmKM8UqDFCfkVUr3jAFvlHxJTqDlTIOWK_L7OoyYHcW5p3ufcfIz_VQBpylj3iVayugK4cNMcyiYmzye0QltDPYhh-TT2WOzDZvZZ7931E9b9HFyc166w9i7SC8nF73F-VEw35V5G0fDQIcwekvR-r48Y_ZDgZZZr8mLAcfk3hzvU3J7_fnn1dfq5vuXb1eXN5UVTOQK634AOUhwnRRD5zqhuJDYCAadVdBi7RrRaCUVk5Zzxrta91wKq1nTcujqU3Jx0N3uusn1tpiOOJpt9BPGBxPQm_9_Zn9nNmFvQHGlGl4EPh4FYvi1cymbySfrxrFsKuySkaphSmpdwOoAlsWlFN3wdwgwsyRpliSNEgZMybDw7_519kQfoyvAhyOAyeI4RJytT0-cahql2sXh-wM3YDC4iYW5_cEZ1AyAC12s_QESDrKf</recordid><startdate>2007</startdate><enddate>2007</enddate><creator>Morris, Martha Savaria</creator><creator>Jacques, Paul F</creator><creator>Rosenberg, Irwin H</creator><creator>Selhub, Jacob</creator><general>American Society for Nutrition</general><general>American Society for Clinical Nutrition</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>2007</creationdate><title>Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification</title><author>Morris, Martha Savaria ; Jacques, Paul F ; Rosenberg, Irwin H ; Selhub, Jacob</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c505t-a3df16f61eb65fbeb58256a4501bc817a3e454986806c2202b39d265c904721b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aging - blood</topic><topic>Americans</topic><topic>anemia (disease)</topic><topic>Anemia - blood</topic><topic>Anemia - epidemiology</topic><topic>Anemia - prevention & control</topic><topic>Anemia, Macrocytic - blood</topic><topic>Anemia, Macrocytic - epidemiology</topic><topic>Anemia, Macrocytic - prevention & control</topic><topic>Biological and medical sciences</topic><topic>cognition</topic><topic>Cognition Disorders - blood</topic><topic>Cognition Disorders - epidemiology</topic><topic>Cognition Disorders - prevention & control</topic><topic>Confidence Intervals</topic><topic>Creatinine - blood</topic><topic>elderly</topic><topic>elderly nutrition</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>folic acid</topic><topic>Folic Acid - administration & dosage</topic><topic>Folic Acid - blood</topic><topic>Folic Acid - metabolism</topic><topic>food fortification</topic><topic>Food, Fortified</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>macrocytosis</topic><topic>Male</topic><topic>men</topic><topic>Nutrition Surveys</topic><topic>Nutritional Status</topic><topic>Odds Ratio</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vitamin B 12 - blood</topic><topic>Vitamin B 12 Deficiency - complications</topic><topic>Vitamin B 12 Deficiency - diagnosis</topic><topic>vitamin B12</topic><topic>vitamin deficiencies</topic><topic>women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morris, Martha Savaria</creatorcontrib><creatorcontrib>Jacques, Paul F</creatorcontrib><creatorcontrib>Rosenberg, Irwin H</creatorcontrib><creatorcontrib>Selhub, Jacob</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morris, Martha Savaria</au><au>Jacques, Paul F</au><au>Rosenberg, Irwin H</au><au>Selhub, Jacob</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification</atitle><jtitle>The American journal of clinical nutrition</jtitle><addtitle>Am J Clin Nutr</addtitle><date>2007</date><risdate>2007</risdate><volume>85</volume><issue>1</issue><spage>193</spage><epage>200</epage><pages>193-200</pages><issn>0002-9165</issn><eissn>1938-3207</eissn><coden>AJCNAC</coden><abstract><![CDATA[BACKGROUND:Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical. OBJECTIVE:We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score <34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey. DESIGN:The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration <148 pmol/L or a serum methylmalonic acid concentration >210 nmol/L--the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine. RESULTS:After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate >59 nmol/L (80th percentile), as opposed to <=59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were <1.0 (Pinteraction < 0.05), but significantly <1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9). CONCLUSION:In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.]]></abstract><cop>Bethesda, MD</cop><pub>American Society for Nutrition</pub><pmid>17209196</pmid><doi>10.1093/ajcn/85.1.193</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aging - blood Americans anemia (disease) Anemia - blood Anemia - epidemiology Anemia - prevention & control Anemia, Macrocytic - blood Anemia, Macrocytic - epidemiology Anemia, Macrocytic - prevention & control Biological and medical sciences cognition Cognition Disorders - blood Cognition Disorders - epidemiology Cognition Disorders - prevention & control Confidence Intervals Creatinine - blood elderly elderly nutrition Feeding. Feeding behavior Female folic acid Folic Acid - administration & dosage Folic Acid - blood Folic Acid - metabolism food fortification Food, Fortified Fundamental and applied biological sciences. Psychology Humans macrocytosis Male men Nutrition Surveys Nutritional Status Odds Ratio Vertebrates: anatomy and physiology, studies on body, several organs or systems Vitamin B 12 - blood Vitamin B 12 Deficiency - complications Vitamin B 12 Deficiency - diagnosis vitamin B12 vitamin deficiencies women |
| title | Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification |
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