title: Vitamin B12 and folate and the risk of anemia in old age: the Leiden 85-Plus Study.
abstract: BACKGROUND
  Screening for deficiencies in vitamin B(12) and folate is advocated to prevent anemia in very elderly individuals. However, the effects of vitamin B(12) and folate deficiency on the development of anemia in old age have not yet been established.
  
  
  METHODS
  The current study is embedded in the Leiden 85-Plus Study, a population-based prospective study of subjects aged 85 years. Levels of vitamin B(12), folate, and homocysteine were determined at baseline. Hemoglobin levels and mean corpuscular volume (MCV) were determined annually during 5 years of follow-up.
  
  
  RESULTS
  We analyzed data from 423 subjects who did not use any form of cyanocobalamin, hydroxocobalamin, or folic acid supplementation, neither at baseline nor during follow-up. Folate deficiency (<7 nmol/L; n = 34) and elevated homocysteine levels (>13.5 mumol/L; n = 194) were associated with anemia at baseline (adjusted odds ratio [OR], 2.44; 95% confidence interval [CI], 1.06-5.61; and adjusted OR, 1.82; 95% CI, 1.08-3.06, respectively), but vitamin B(12) deficiency (<150 pmol/L; n = 68) was not (adjusted OR, 1.51; 95% CI, 0.79-2.87). Furthermore, vitamin B(12) deficiency was not associated with the development of anemia during follow-up (adjusted HR, 0.92; 95% CI, 0.46-1.82) or with changes in MCV (adjusted linear mixed model; P = .77). Both folate deficiency and elevated homocysteine levels were associated with the development of anemia from age 85 years onward (adjusted HR, 3.33; 95% CI, 1.55-7.14; and adjusted HR, 1.70; 95% CI, 1.01-2.88, respectively), but not with an increase in MCV over time (P > .30).
  
  
  CONCLUSIONS
  In the general population of very elderly individuals, anemia in 85-year-old subjects is associated with folate deficiency and elevated homocysteine levels but not with vitamin B(12) deficiency.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Post Zone V-0-P, PO Box 9600, 2300 RC Leiden, the Netherlands. w.p.j.den_elzen@lumc.nl
authors.forename: Wendy P J
authors.initials: WP
authors.lastname: den Elzen
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Marijke
authors.initials: M
authors.lastname: Frölich
authors.forename: Wouter
authors.initials: W
authors.lastname: de Ruijter
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology*; D003430:Cross-Sectional Studies; D004909:Erythrocyte Indices; D005260:Female; D005492:Folic Acid / Q000097:blood; D005494:Folic Acid Deficiency / Q000150:complications*; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000150:complications*
chemical_list: D006454:Hemoglobins; D006710:Homocysteine; D005492:Folic Acid; D014805:Vitamin B 12