Food-cobalamin malabsorption in elderly patients: clinical manifestations and treatment.
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.
Andrès
Emmanuel
E
Department of Internal Medicine, Diabetes and Metabolic Disorders, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
Affenberger
Stéphane
S
Vinzio
Stéphane
S
Kurtz
Jean-Emmanuel
JE
Noel
Esther
E
Kaltenbach
Georges
G
Maloisel
Frédéric
F
Schlienger
Jean-Louis
JL
Blicklé
Jean-Frédéric
JF
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
D006454:Hemoglobins; D006710:Homocysteine; D014805:Vitamin B 12