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Given the prevalence of gastric atrophy in the elderly, should we screen elder for B12 deficiency ?
asked Sep 01 at 07:19AM in General Medicine
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0Votes
answered Sep 03 at 10:56AMAlexandre,
I believe that once screening and treating with Vitamin B12 is shown to be cost-effective, it should be done. The elderly is indeed at risk for Vitamin B12 deficiency.
This following Vitamin B12 patient support group article shows that there may be a growing sentiment for the push of overall Vitamin B12 screening and treating in the UK:
http://www.b12d.org/content/dr-chandy-visits-no-10-downing-st -
0Votes
answered Sep 04 at 10:14AMYour questions is right on target, and I am sure you already know that gastric atrophy creates other problems as well. Not only is there decreased production of Intrinsic Factor which in turn leads to decreased absorption of B12, but there is also decreased gastric acid production, leading to achlorhydria and subsequent iron deficiency anemia. Also, individuals with gastric atrophy, are 2-3 times greater risk for gastric cancer.
If, holistically we treat patients, we need to be mindful of all these things and more
Gerry -
0Votes
answered Sep 05 at 07:22AMIn one word Yes. Elderly individuals also should have their Vitamin D levels tested. Not only is B-12 important in gastric health but is as important to mental health. The research indicates the prominence B-12 plays in Alzheimer's disease, depression, Bipolar disorder, and vascular cognitive impairment.
Problems that can be avoided by simple diagnostic tests and treatment like vitamin supplements should always be ordered for the elderly. -
0Votesanswered Sep 05 at 09:00AMThe role of multivitamin supplementation in the elderly needs to be explored. Some of the elderly are prone to nutritional deficiencies as has been pointed out.
This article explores this:
http://my.clevelandclinic.org/heart/prevention/alternative/vitamins_elderly.aspx -
0Votesanswered Sep 06 at 06:26AMThanks very much for your responses.
In fact, my question hides several others. The last serious and large review on the subject i've found was published in june 2008, in a supplement of a Food & Nutrition Bulletin dedicated on folate and B12 deficiencies (http://www.ncbi.nlm.nih.gov/pubmed/18709880)
Reading this, i would underline few points :
- B12 deficiency looks like frequent in elderly, but epidemiologic knowlege is poor on the subject
- low B12 blood level seems to be linked to cognitive impairment in elderly, but we don't know what is the real weight of B12 deficiencies in cognitive impairment's aetiogies. We don't know if a systematic supplementation reduces significatively it's incidence (http://www.ncbi.nlm.nih.gov/pubmed/18709888).
- B12 deficiency leads to anemia, but we don't know what is the "out-of-hospital" prevalence of it (i.e. it's ambulatory impact). Furthermore, a "subnormal" B12 level may not affect hematopoiesis (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900261/?tool=pubmed)
Giving the low cost of B12 laboratory test & supplementation, i agree that a logical attitude for a GP would be to prescribe them without wondering, but it looks not really "evidence-based" : in a primary care medicine perspective, the real public health benefit of a such attitude remains unclear.
Otherwise, i focused this discussion on gastric atrophy because it also raise different clinical issues :
1/ Discovering a B12 deficiency should theorically lead to practice a gastroscopy to seek for a neoplasm (regardless of iron deficiency comorbidities).
=> What is the benefit/risk balancy between investigate or not elderly before giving cobalamin supplementation ?
=> What to do in case of subnormal results ?
2/ Oral supplementation seems to be efficient (http://www.ncbi.nlm.nih.gov/pubmed/20088746).
=> What supplementation schema may we apply ? (actually, in France, there are only 250 & 1000 µg dosage forms, which is far too much for a daily supplementation. Lower dosages are systematically presented in multivitamin associations)
Best regards,
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