Vitamin B12 and folate deficiency in later life

TLDR

Vitamin B12 deficiency is conventionally diagnosed when serum vitamin B12 falls below 150 pmol l⁻¹. The study aims to assess the prevalence of vitamin B12 and folate deficiencies among older adults in the UK. Using a cross‑sectional analysis of 3,511 adults aged 65 + years from three UK studies, the authors estimated age‑specific prevalence of vitamin B12 and folate deficiencies, defining metabolically significant deficiency as low vitamin B12 (<200 pmol l⁻¹) or low folate (<7 nmol l⁻¹) combined with elevated homocysteine (>20 μmol l⁻¹). The prevalence of both vitamin B12 and folate deficiencies rises markedly with age, reaching at least 10 % in those 75 + years, and only about 10 % of B12‑deficient individuals also have folate deficiency, underscoring the importance of screening and treatment to prevent age‑related disability.

Abstract

Objectives: to examine the prevalence of vitamin B12 deficiency and folate deficiency in later life in representative samples of the elderly population in the United Kingdom. Design: a population-based cross-sectional analysis of 3,511 people aged 65 years or older from three studies was used to estimate the age-specific prevalence of vitamin B12 deficiency and of folate deficiency. Vitamin B12 deficiency is conventionally diagnosed if serum vitamin B12 < 150 pmol/l (‘low vitamin B12’). We defined ‘metabolically significant vitamin B12 deficiency’ as vitamin B12 < 200 pmol/l and blood total homocysteine >20 μmol/l. Folate deficiency, which usually refers to serum folate <5 nmol/l, was defined as ‘metabolically significant’ if serum folate was <7 nmol/l and homocysteine >20 μmol/l. Results: the prevalence of vitamin B12 deficiency, whether defined as low vitamin B12 or metabolically significant vitamin B12 deficiency increased with age in all three studies, from about 1 in 20 among people aged 65–74 years to 1 in 10 or even greater among people aged 75 years or greater. The prevalence of folate deficiency also increased with age, and was similar to that for vitamin B12 deficiencies, but only about 10% of people with low vitamin B12 levels also had low folate levels. Conclusion: the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.