Food-cobalamin malabsorption in elderly patients: Clinical manifestations and treatment

• Published in: The American journal of medicine Vol. 118; no. 10; pp. 1154 - 1159
• Main Authors: Andrès, Emmanuel, Affenberger, Stéphane, Vinzio, Stéphane, Kurtz, Jean-Emmanuel, Noel, Esther, Kaltenbach, Georges, Maloisel, Frédéric, Schlienger, Jean-Louis, Blicklé, Jean-Frédéric
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2005; Elsevier; Elsevier Sequoia S.A
• Subjects: Aged; Aged, 80 and over; Asthenia - drug therapy; Asthenia - etiology; Atrophic gastritis; Biological and medical sciences; Cobalamin deficiency; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Cohort Studies; Confusion - drug therapy; Confusion - etiology; Dietary supplements; Drugs; Edema - drug therapy; Edema - etiology; Elderly patients; Erythrocyte Indices; Female; Follow-Up Studies; Food-cobalamin malabsorption; Gastritis, Atrophic - drug therapy; Gastritis, Atrophic - etiology; General aspects; Hematologic Diseases - drug therapy; Hematologic Diseases - etiology; Hemoglobins - analysis; Homocysteine - blood; Humans; Jaundice - drug therapy; Jaundice - etiology; Malabsorption Syndromes - blood; Malabsorption Syndromes - diagnosis; Malabsorption Syndromes - drug therapy; Male; Medical disorders; Medical sciences; Older people; Oral cobalamin treatment; Paresthesia - drug therapy; Paresthesia - etiology; Polyneuropathies - drug therapy; Polyneuropathies - etiology; Reflex, Abnormal; Retrospective Studies; Vitamin B; Vitamin B 12 - blood; Vitamin B 12 - therapeutic use; Vitamin B 12 Deficiency - blood; Vitamin B 12 Deficiency - complications; Vitamin B 12 Deficiency - drug therapy; Drugs; Cobalamin deficiency; Atrophic gastritis; Oral cobalamin treatment; Food-cobalamin malabsorption; Elderly patients; Human; Medicine; Symptomatology; Treatment; Patient; Cobalamine; Elderly; Food
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2005.02.026

Approximately 15% of people aged more than 60 years old have a cobalamin (vitamin B12) deficiency, mainly in relation with food-cobalamin malabsorption (FCM). To date, no study has documented this disorder in the elderly. There is also little information on clinical consequences. We studied 92 elderly patients with well-established FCM who were extracted from an observational cohort study (1995-2004) of 172 consecutive elderly patients with documented cobalamin deficiency. The median patient age was 76 ± 8 years; 60 patients were women. The most common clinical manifestations were neurologic or psychologic: mild sensory polyneuropathy (44.6%), confusion or impaired mental functioning (22.8%), and physical asthenia (20.7%). Hematologic abnormalities were reported in at least one third of the patients: anemia (21%), leukopenia (10.9%), thrombopenia (8.7%), and pancytopenia (6.5%). All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean value (± standard deviation) of 131 ± 38 pg/mL and total serum homocysteine level of 22.1 ± 9.3 μmol/L. The mean hemoglobin level was 10.9 ± 2.5 g/dL and the mean erythrocyte cell volume 95.7 ± 12.7 fL. Correction of the serum vitamin B12 levels and hematologic abnormalities was achieved equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin. This study suggests that in elderly patients, FCM may be associated with significant neurologic, psychologic, and hematologic abnormalities, which seem to respond equally well to either oral or parenteral vitamin B12 therapy.