title: Food-cobalamin malabsorption in elderly patients: clinical manifestations and treatment.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 micromol/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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Diabetes and Metabolic Disorders, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Andrès
authors.forename: Stéphane
authors.initials: S
authors.lastname: Affenberger
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vinzio
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Kurtz
authors.forename: Esther
authors.initials: E
authors.lastname: Noel
authors.forename: Georges
authors.initials: G
authors.lastname: Kaltenbach
authors.forename: Frédéric
authors.initials: F
authors.lastname: Maloisel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Schlienger
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Blicklé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001247:Asthenia / Q000188:drug therapy / Q000209:etiology; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D003221:Confusion / Q000188:drug therapy / Q000209:etiology; D004487:Edema / Q000188:drug therapy / Q000209:etiology; D004909:Erythrocyte Indices; D005260:Female; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000188:drug therapy / Q000209:etiology; D006402:Hematologic Diseases / Q000188:drug therapy / Q000209:etiology; D006454:Hemoglobins / Q000032:analysis; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007565:Jaundice / Q000188:drug therapy / Q000209:etiology; D008286:Malabsorption Syndromes / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D010292:Paresthesia / Q000188:drug therapy / Q000209:etiology; D011115:Polyneuropathies / Q000188:drug therapy / Q000209:etiology; D012021:Reflex, Abnormal; D012189:Retrospective Studies; D014805:Vitamin B 12 / Q000097:blood / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy
chemical_list: D006454:Hemoglobins; D006710:Homocysteine; D014805:Vitamin B 12