Proton-pump inhibitor therapy and vitamin B12status in an inpatient hospital setting.
The risk for impaired vitamin B12status increases with age, as does the use of proton pump inhibitors (PPI). Long-term use of PPIs is associated with several nutritional deficiencies including B12. Currently, there are no recommendations for B12screening among patients taking PPIs. Data were abstracted on B12concentrations, B12-containing supplement use, medications, and select hematological values from a retrospective chart review of 658 adults, 391 with serum B12concentrations, admitted to 6 different medical units at 2 regional hospitals in Southwestern Ontario between 2010 and 2012. We found no difference between PPI users and nonusers and serum B12concentrations (404 ± 224 vs 369 ± 213 pmol/L; P = 0.0690). This may be due to use of B12containing multivitamins in 41% of PPI users. Regression modelling found that aging increases the odds of having an impaired B12status (<220 pmol/L) by 1.4 times and those using B12supplements are almost 4 times more likely to have an impaired status. Mean corpuscular volume was not related to B12status. In this population, older PPI users are more likely to be using multivitamins, which may delay nutritional deficiencies. However, the lower B12concentrations of PPI users taking only B12supplements is a concern and requires further research. Finally, physicians need to be aware that mean corpuscular volume is no longer recommended as an effective biomarker for B12screening and updated screening protocols need to be used to reduce the possibility of adverse neurological effects from impaired B12status.
a Department of Nutritional Sciences, FitzGerald Building, University of Toronto, 150 College St, Toronto, ON M5S 3E2.|b The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8.
Brenda
B
Hartman
c Brescia University College, 1285 Western Rd, London, ON N6G 1H2.|d London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9.
Mary
M
Donnelly-VanderLoo
c Brescia University College, 1285 Western Rd, London, ON N6G 1H2.
Tiffany
T
Watson
c Brescia University College, 1285 Western Rd, London, ON N6G 1H2.
Colleen
C
O'Connor
c Brescia University College, 1285 Western Rd, London, ON N6G 1H2.
Janet
J
Madill
B12; inhibiteur de la pompe à protons (« IPP »); mean corpuscular volume (MCV); nutrition; proton pump inhibitor (PPI); supplements; suppléments; volume globulaire moyen (« MCV »)