title: Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services.
abstract: BACKGROUND
  The effect of the folate food fortification program on the prevalence of hyperhomocysteinemia in the older population with coexisting vitamin B-12 deficiency is not known.
  
  
  OBJECTIVE
  The objective was to determine the prevalence of hyperhomocysteinemia and vitamin B-12 deficiency in elderly who were using Title IIIc nutrition services, after folate food fortification in the United States.
  
  
  METHODS
  Demographic, nutritional, cognitive, routine diagnostic, and serum methylmalonic acid (MMA) and total homocysteine (tHcy) tests were performed in a convenience sample of 103 elderly enrolled in nutrition service programs in rural northeast Georgia. A subgroup (n = 27) was treated with vitamin B-12, 2.5 mg, and a multivitamin with 400 micro g folic acid, 2 mg vitamin B-6, and 27 mg ferrous fumarate.
  
  
  RESULTS
  The total cohort included 103 participants (+/- SD age: 76.4 +/- 8.1; 80% female; 68% white, 32% African American). Vitamin B-12 deficiency (serum vitamin B-12 < 258 pmol/L and MMA > 271 nmol/L) was present in 23%. Mean serum folate was high, 39.3 nmol/L, and no subject had serum folate < 6.8 nmol/L. Mean tHcy was 17.6 +/- 7.2 micro mol/L in vitamin B-12-deficient subjects and 10.8 +/- 3.6 micro mol/L in those who were nondeficient. Determinants of high tHcy were vitamin B-12 deficiency, high serum creatinine, and low red blood cell folate. Those with vitamin B-12 deficiency were more likely to have poor cognition (58% compared with 20%, P < 0.001) and anemia (38% compared with 18%, P = 0.042). High-dose oral B-12 therapy lowered mean MMA and tHcy by 49% and 32%, respectively.
  
  
  CONCLUSIONS
  Vitamin B-12 deficiency was prevalent and was associated with poor cognition, anemia, and hyperhomocysteinemia.
authors.affiliation: Department of Foods and Nutrition, University of Georgia, Athens, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Johnson
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Hawthorne
authors.forename: Wimberly R
authors.initials: WR
authors.lastname: Brackett
authors.forename: Joan G
authors.initials: JG
authors.lastname: Fischer
authors.forename: Elaine W
authors.initials: EW
authors.lastname: Gunter
authors.forename: Robert H
authors.initials: RH
authors.lastname: Allen
authors.forename: Sally P
authors.initials: SP
authors.lastname: Stabler
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004045:Dietary Services; D005260:Female; D005492:Folic Acid / Q000097:blood; D005845:Georgia / Q000453:epidemiology; D005853:Geriatrics; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support; D015995:Prevalence; D011795:Surveys and Questionnaires; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D005492:Folic Acid; D014805:Vitamin B 12