title: Nutrient-dense foods and exercise in frail elderly: effects on B vitamins, homocysteine, methylmalonic acid, and neuropsychological functioning.
abstract: BACKGROUND
  Frail elders are at risk of suboptimal micronutrient status, functional decline, and neurologic disorders. The influence of oral multimicronutrients in physiologic doses and of moderately intense physical exercise on homocysteine (Hcy), methylmalonic acid (MMA), and neurologic functioning have not yet been investigated.
  
  
  OBJECTIVE
  Our goal was to determine the effects of enriched foods and exercise on blood vitamins, Hcy, MMA, and neuropsychological functioning in the frail.
  
  
  METHODS
  A 17-wk randomized controlled intervention trial was used to study 1) enriched foods plus a social program, 2) regular foods plus exercise, 3) enriched foods plus exercise, and 4) regular foods plus a social program. Enriched foods contained multiple micronutrients (25-100% of the Dutch recommended dietary allowances); exercises focused on strength, coordination, flexibility, and endurance. Vitamin (cobalamin, red blood cell folate, and pyridoxal 5'-phosphate), Hcy, and MMA concentrations were measured and 2 neuropsychological tests were conducted.
  
  
  RESULTS
  Vitamin concentrations were higher in the supplemented groups than in the unsupplemented groups (P < 0.001; total n = 130). Compared with baseline, cobalamin in the supplemented groups was increased by 22%, plasma folate by 101%, red blood cell folate by 87%, and pyridoxal 5'-phosphate by 68%. Concentrations in the unsupplemented groups changed by -2%, -6%, 1%, and -13%, respectively. Hcy decreased by 25% and MMA by 30% in the supplemented groups, compared with a small increase in Hcy (2%) and decrease in MMA (9%) in the unsupplemented groups. Exercise did not significantly affect vitamin, Hcy, or MMA concentrations. No significant effect of either intervention was observed on the neuropsychological tests.
  
  
  CONCLUSIONS
  The decrease in Hcy and MMA in frail elders confirms a subclinical metabolic deficiency state. Enriched foods containing physiologic amounts of micronutrients have a beneficial effect on these metabolites. No effects of B vitamins on mental health were identified.
authors.affiliation: Division of Human Nutrition and Epidemiology, Wageningen University, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: de Jong
authors.forename: M J
authors.initials: MJ
authors.lastname: Chin A Paw
authors.forename: L C
authors.initials: LC
authors.lastname: de Groot
authors.forename: R A
authors.initials: RA
authors.lastname: Rutten
authors.forename: D W
authors.initials: DW
authors.lastname: Swinkels
authors.forename: F J
authors.initials: FJ
authors.lastname: Kok
authors.forename: W A
authors.initials: WA
authors.lastname: van Staveren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D015444:Exercise / Q000502:physiology*; D005260:Female; D005527:Food, Fortified; D016330:Frail Elderly; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood*; D009422:Nervous System Diseases / Q000517:prevention & control; D009424:Nervous System Physiological Phenomena; D009426:Netherlands; D009483:Neuropsychological Tests; D018673:Nutrition Policy; D009752:Nutritional Status; D009753:Nutritive Value; D012951:Socialization; D011795:Surveys and Questionnaires; D014803:Vitamin B Complex / Q000097:blood*
chemical_list: D006710:Homocysteine; D014803:Vitamin B Complex; D008764:Methylmalonic Acid