Skip to main content

Advertisement

Log in

Vegetarian Nutrition for the Older Adult: Vitamin B12, Iron, and Zinc

  • Nutrition and Aging (MC Serra, Section Editor)
  • Published:
Current Nutrition Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Health organizations throughout the world advocate diets that emphasize vegetables, fruits, pulses, grains, and minimally processed staple foods as beneficial throughout life and in old age. However, concern exists that the dietary exclusion or minimalization of flesh foods may compromise the nutritional status of some nutrients, including vitamin B12, iron, and zinc.

The purpose of this study is to discuss the metabolism and dietary sources of vitamin B12, iron, and zinc and review observational studies that investigate the status of these micronutrients in older vegetarians compared to their non-vegetarian counterparts.

Recent Findings

The few comparative studies that are available suggest that vitamin B12 status is lower in older vegetarian compared to omnivorous populations; however, subclinical vitamin B12 deficiency due to malabsorption is prevalent regardless of dietary pattern. Zinc status appears comparable but not optimal in either group. Whether iron status is compromised in older vegetarians compared to non-vegetarians is unclear.

Summary

Dietary practices that improve zinc and iron bioavailability are appropriate strategies in the management of suboptimal nutrient status in apparently healthy older vegetarian populations. Older populations may benefit from vitamin B12 and zinc supplementation, irrespective of dietary pattern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Melina V, Craig W, Levin S, Hoek AC, Luning PA, Weijzen P, et al. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116:1970–80.

    Article  PubMed  Google Scholar 

  2. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, et al. Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutr. 1998;1:33–41.

    Article  CAS  PubMed  Google Scholar 

  3. Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014:353S–8S.

  4. Hickson M. Malnutrition and ageing. Postgrad Med J. 2006;82:2–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Phillips F. Vegetarian nutrition. Br Nutr Found Nutr Bull. 2005;30:132–67.

    Article  Google Scholar 

  6. Vijg J, Wei JY. Understanding the biology of aging: the key to prevention and therapy. J Am Geriatr Soc. 1995;43:426–34.

    Article  CAS  PubMed  Google Scholar 

  7. Thane P. The muddled history of retiring at 60 and 65. New Soc. 1978;45:234–6.

    Google Scholar 

  8. Glascock A, Feinman S. A holocultural analysis of old age. Comp Soc Res. 1980;3:311–32.

    Google Scholar 

  9. Alam I, Larbi A, Pawelec G, Paracha PI. Relationship between anthropometric variables and nutrient intake in apparently healthy male elderly individuals: a study from Pakistan. Nutr J. 2011;10:111.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Tyrovolas S, Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Miret M, et al. Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective. Exp Gerontol. 2015;64:70–7.

    Article  CAS  PubMed  Google Scholar 

  11. World Health Organization. WHO|Definition of an older or elderly person. World Health Organization; 2016 [cited 2016 Oct 8]. Available from: http://www.who.int/healthinfo/survey/ageingdefnolder/en/

  12. Foster M, Samman S. Vegetarian diets across the lifecycle: impact on zinc intake and status. Adv Food Nutr Res. 2015;74:93–131.

    Article  PubMed  Google Scholar 

  13. Solomon LR. Disorders of cobalamin (vitamin B12) metabolism: emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev. 2007;21:113–30.

    Article  CAS  PubMed  Google Scholar 

  14. Combs Jr. GF. The vitamins: fundamental aspects in nutrition and health. 4th ed. Elsevier Inc.; 2012.

  15. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand: including recommended dietary intakes. Canberra, Australia; 2006.

  16. O’Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010;2:299–316.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch Intern Med. 1996;156:1097–100.

    Article  CAS  PubMed  Google Scholar 

  18. Carmel R. Anemia and aging: an overview of clinical, diagnostic and biological issues. Blood Rev. 2001;15:9–18.

    Article  CAS  PubMed  Google Scholar 

  19. Wians F. Blood Tests: Normal Values—Appendixes—Merck Manuals Professional Edition [online] [Internet]. [cited 2017 Jan 21]. Available from: http://www.merckmanuals.com/professional/appendixes/normal-laboratory-values/blood-tests-normal-values#false.

  20. Carmel R, Sinow RM, Karnaze DS. Atypical cobalamin deficiency. Subtle biochemical evidence of deficiency is commonly demonstrable in patients without megaloblastic anemia and is often associated with protein-bound cobalamin malabsorption. J Lab Clin Med. 1987;109:454–63.

    CAS  PubMed  Google Scholar 

  21. • Carmel R. Cobalamin (vitamin B12). Mod. Nutr. Heal. Dis. 11th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. This chapter provides an excellent overview of vitamin B 12 nutrition in humans, including the causes and diagnosis of vitamin B 12 deficiency .

  22. Health Canada, Health Products and Food Branch O of NP and P. Dietary reference intakes tables: reference values for vitamins [online] [Internet]. 2005 [cited 2016 Oct 24]. Available from: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_vitam_tbl-eng.php.

  23. Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington: National Academies Press; 1998.

    Google Scholar 

  24. Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr. 1999;19:357–77.

    Article  CAS  PubMed  Google Scholar 

  25. Herbert V. Vitamin B-12: plant sources, requirements, and assay. Am J Clin Nutr. 1988;48:852–8.

    CAS  PubMed  Google Scholar 

  26. Russell RM, Baik H, Kehayias JJ. Older men and women efficiently absorb vitamin B-12 from milk and fortified bread. J Nutr. 2001;131:291–3.

    CAS  PubMed  Google Scholar 

  27. Arkbåge K, Witthöft C, Fondén R, Jägerstad M. Retention of vitamin B12 during manufacture of six fermented dairy products using a validated radio protein-binding assay. Int Dairy J. 2003;13:101–9.

    Article  Google Scholar 

  28. Armstrong BK, Davis RE, Nicol DJ, van Merwyk AJ, Larwood CJ. Hematological, vitamin B12, and folate studies on Seventh-day Adventist vegetarians. Am J Clin Nutr. 1974;27:712–8.

    CAS  PubMed  Google Scholar 

  29. Watanabe F. Vitamin B12 sources and bioavailability. Exp Biol Med. 2007;232:1266–74.

    Article  CAS  Google Scholar 

  30. Doscherholmen A, McMahon J, Ripley D. Vitamin B12 absorption from eggs. Proc Soc Exp Biol Med. 1975;149:987–90.

    Article  CAS  PubMed  Google Scholar 

  31. Watanabe F, Yabuta Y, Bito T, Teng F. Vitamin B12-containing plant food sources for vegetarians. Nutrients. 2014;6:1861–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. United States Department of Agriculture (Agricultural Research Service). USDA Food Composition Database [Internet]. [cited 2016 Nov 27]. Available from: https://ndb.nal.usda.gov/ndb/

  33. Miyamoto E, Yabuta Y, Kwak CS, Enomoto T, Watanabe F. Characterization of vitamin B12 compounds from Korean purple laver (Porphyra sp.) products. J Agric Food Chem. 2009;57:2793–6.

    Article  CAS  PubMed  Google Scholar 

  34. Nout MJR, Rombouts FM. Recent developments in tempe research. J Appl Bacteriol. 1990;69:609–33.

    Article  Google Scholar 

  35. Bito T, Teng F, Ohishi N, Takenaka S, Miyamoto E, Sakuno E, et al. Characterization of vitamin B12 compounds in the fruiting bodies of shiitake mushroom (Lentinula edodes) and bed logs after fruiting of the mushroom. Mycoscience. 2014;55:462–8.

    Article  CAS  Google Scholar 

  36. Kwok T, Cheng G, Lai WK, Poon P, Woo J, Pang CP. Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons. Nutrition. 2004;20:764–8.

    Article  CAS  PubMed  Google Scholar 

  37. Chiu THT, Huang H-Y, Chiu Y-F, Pan W-H, Kao H-Y, Chiu JPC, et al. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG. PLoS One. 2014;9:e88547.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Krajcovicova-Kudlackova M, Babinska K, Blazicek P, Valachovicova M, Spustova V, Mislanova C, et al. Selected biomarkers of age-related diseases in older subjects with different nutrition. Bratisl Lek Listy. 2011;112:610–3.

    CAS  PubMed  Google Scholar 

  39. Sivaprasad M, Shalini T, Balakrishna N, Sudarshan M, Lopamudra P, Suryanarayana P, et al. Status of vitamin B12 and folate among the urban adult population in South India. Ann Nutr Metab. 2016;68:94–102.

    Article  CAS  PubMed  Google Scholar 

  40. Carmel R. Efficacy and safety of fortification and supplementation with vitamin B12: biochemical and physiological effects. Food Nutr Bull. 2008;29:S177–87.

    Article  PubMed  Google Scholar 

  41. Su T-C, Jeng J-S, Wang J-D, Torng P-L, Chang S-J, Chen C-F, et al. Homocysteine, circulating vascular cell adhesion molecule and carotid atherosclerosis in postmenopausal vegetarian women and omnivores. Atherosclerosis. 2006;184:356–62.

    Article  CAS  PubMed  Google Scholar 

  42. Su T-C, Torng P-L, Jeng J-S, Chen M-F, Liau C-S. Arterial function of carotid and brachial arteries in postmenopausal vegetarians. Vasc Health Risk Manag. 2011;7:517–23.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Deriemaeker P, Aerenhouts D, De Ridder D, Hebbelinck M, Clarys P. Health aspects, nutrition and physical characteristics in matched samples of institutionalized vegetarian and non-vegetarian elderly (> 65yrs). Nutr Metab. 2011;8:37.

    Article  Google Scholar 

  44. •• Sobiecki JG, Appleby PN, Bradbury KE, Key TJ. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res. 2016;36:464–77. This cohort study compares differences in nutrient intakes and compliance with dietary recommendations according to dietary pattern among a large number of participants, including vegans .

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Gilsing AMJ, Crowe FL, Lloyd-Wright Z, Sanders TAB, Appleby PN, Allen NE, et al. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010;64:933–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Carmel R, Green R, Jacobsen DW, Rasmussen K, Florea M, Azen C. Serum cobalamin, homocysteine, and methylmalonic acid concentrations in a multiethnic elderly population: ethnic and sex differences in cobalamin and metabolite abnormalities. Am J Clin Nutr. 1999;70:904–10.

    CAS  PubMed  Google Scholar 

  47. Hill MH, Flatley JE, Barker ME, Garner CM, Manning NJ, Olpin SE, et al. A vitamin B-12 supplement of 500 g/d for eight weeks does not normalize urinary methylmalonic acid or other biomarkers of vitamin B-12 status in elderly people with moderately poor vitamin B-12 status. J Nutr. 2013;143:142–7.

    Article  CAS  PubMed  Google Scholar 

  48. Wessling-Resnick M. Iron. In: Ross AC, editor. Mod. Nutr. Heal. Dis. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.

  49. Anderson JJB. Minerals. In: Mahan LK, Escott-Stump S, editors. Krause’s food, Nutr. Diet Ther. 11th ed. Philadelphia: Saunders; 2004.

    Google Scholar 

  50. Samman S. Iron Nutr Diet. 2007;64:S126–30.

    Article  Google Scholar 

  51. Knutson M, Wessling-Resnick M. Iron metabolism in the reticuloendothelial system. Crit Rev Biochem Mol Biol. 2003;38:61–88.

    Article  CAS  PubMed  Google Scholar 

  52. Johnson MA, Fischer JG, Bowman BA, Gunter EW. Iron nutriture in elderly individuals. FASEB J. 1994;8:609–21.

    CAS  PubMed  Google Scholar 

  53. MacPhail AP. Iron. In: Mann J, Truswell AS, editors. Essentials Hum. Nutr. 4th ed. Oxford University Press; 2012.

  54. • Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16. This Lancet Seminar discusses the clinical presentation, epidemiology, pathophysiology, diagnosis, and management of iron deficiency anaemia and identifies outstanding research questions for treatment .

    Article  CAS  PubMed  Google Scholar 

  55. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL, et al. Prevalence of iron deficiency in the United States. J Am Med Assoc. 1997;277:973–6.

    Article  CAS  Google Scholar 

  56. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr. 2009;12:444–54.

    Article  PubMed  Google Scholar 

  57. World Health Organization (WHO). Iron deficiency anaemia assessment, prevention, and control: a guide for programme managers. Geneva; 2001.

  58. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.

    Article  Google Scholar 

  59. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Lombardi-Boccia G, Martinez-Dominguez B, Aguzzi A. Total heme and non-heme iron in raw and cooked meats. J Food Sci. 2002;67:1738–41.

    Article  CAS  Google Scholar 

  61. Health Canada, Health Products and Food Branch O of NP and P. Dietary reference intakes tables: reference values for elements [online] [Internet]. 2005 [cited 2015 Jan 10]. Available from: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_elements_tbl-eng.php

  62. Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington: National Academies Press; 2001.

    Google Scholar 

  63. Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78:633S–9S.

    CAS  PubMed  Google Scholar 

  64. Collings R, Harvey LJ, Hooper L, Hurst R, Brown TJ, Ansett J, et al. The absorption of iron from whole diets: a systematic review. Am J Clin Nutr. 2013;98:65–81.

    Article  CAS  PubMed  Google Scholar 

  65. Samman S, Sandström B, Toft MB, Bukhave K, Jensen M, Sørensen SS, et al. Green tea or rosemary extract added to foods reduces nonheme-iron absorption. Am J Clin Nutr. 2001;73:607–12.

    CAS  PubMed  Google Scholar 

  66. Cook JD. Adaptation in iron metabolism. Am J Clin Nutr. 1990;51:301–8.

    CAS  PubMed  Google Scholar 

  67. Dabek J, Hyvonen-Dabek M, Adlercreutz H, Harkonen M, Hamalainen E, Ollus A, et al. Simultaneous investigation of dietary and plasma copper, zinc, iron and selenium in pre- and post-menopausal omnivores, vegetarians and patients with early breast cancer. J Nutr Med. 1994;4:403–14.

    Google Scholar 

  68. Ródenas S, Sanchez-Munoz FJ, Bastida S, Sevillano MI, Larrea Marín T, Gonzalez-Munoz MJ. Blood pressure of omnivorous and semi-vegetarian postmenopausal women and their relationship with dietary and hair concentrations of essential and toxic metals. Nutr Hosp. 2011;26:874–83.

    PubMed  Google Scholar 

  69. Kim M-H, Choi M-K, Sung C-J. Bone mineral density of Korean postmenopausal women is similar between vegetarians and nonvegetarians. Nutr Res. 2007;27:612–7.

    Article  CAS  Google Scholar 

  70. Kim M-H, Bae YJ. Postmenopausal vegetarians’ low serum ferritin level may reduce the risk for metabolic syndrome. Biol Trace Elem Res. 2012;149:34–41.

    Article  CAS  PubMed  Google Scholar 

  71. Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol. 1989;11:525–36.

    Article  CAS  PubMed  Google Scholar 

  72. Mocchegiani E, Romeo J, Malavolta M, Costarelli L, Giacconi R, Diaz LE, et al. Zinc: dietary intake and impact of supplementation on immune function in elderly. Age. 2013;35:839–60.

    Article  CAS  PubMed  Google Scholar 

  73. Lowe NM, Fraser WD, Jackson MJ. Is there a potential therapeutic value of copper and zinc for osteoporosis? Proc Nutr Soc. 2002;61:181–5.

    Article  CAS  PubMed  Google Scholar 

  74. Scott D, Blizzard L, Fell J, Giles G, Jones G. Associations between dietary nutrient intake and muscle mass and strength in community-dwelling older adults: the Tasmanian older adult cohort study. J Am Geriatr Soc. 2010;58:2129–34.

    Article  PubMed  Google Scholar 

  75. Wysokinski A, Sobow T, Kloszewska I, Kostka T. Mechanisms of the anorexia of aging—a review. Age. 2015;37:9824.

    Article  Google Scholar 

  76. August D, Janghorbani M, Young VR. Determination of zinc and copper absorption at three dietary Zn-Cu ratios by using stable isotope methods in young adult and elderly subjects. Am J Clin Nutr. 1989;50:1457–63.

    CAS  PubMed  Google Scholar 

  77. Kim J, Paik HY, Joung H, Woodhouse LR, King JC. Plasma zinc but not the exchangeable zinc pool size differs between young and older Korean women. Biol Trace Elem Res. 2011;142:130–6.

    Article  CAS  PubMed  Google Scholar 

  78. Jansen J, Karges W, Rink L. Zinc and diabetes–clinical links and molecular mechanisms. J Nutr Biochem. 2009;20:399–417.

    Article  CAS  PubMed  Google Scholar 

  79. Little PJ, Bhattacharya R, Moreyra AE, Korichneva IL. Zinc and cardiovascular disease. Nutrition. 2010;26:1050–7.

    Article  CAS  PubMed  Google Scholar 

  80. Samman S. Zinc. Nutr Diet. 2007;64:S131–4.

    Article  Google Scholar 

  81. Sandström B. Bioavailability of zinc. Eur J Clin Nutr. 1997;51:S17–9.

    PubMed  Google Scholar 

  82. Gibson RS, Perlas L, Hotz C. Improving the bioavailability of nutrients in plant foods at the household level. Proc Nutr Soc. 2006;65:160–8.

    Article  CAS  PubMed  Google Scholar 

  83. World Health Organisation. Trace elements in human nutrition and health. Geneva; 1996.

  84. •• Foster M, Chu A, Petocz P, Samman S. Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans. J Sci Food Agric. 2013;93:2362–71. This systematic review and meta-analysis consolidates existing research and elucidates the association between habitual vegetarian diets and dietary zinc intake and status in adults .

    Article  CAS  PubMed  Google Scholar 

  85. Hunt I, Murphy NJ, Henderson C. Food and nutrient intake of Seventh-day Adventist women. Am J Clin Nutr. 1988;48:850–1.

    CAS  PubMed  Google Scholar 

  86. Nieman DC, Underwood BC, Sherman KM, Arabatzis K, Barbosa JC, Johnson M, et al. Dietary status of Seventh-day Adventist vegetarian and non-vegetarian elderly women. J Am Diet Assoc. 1989;89:1763–9.

    CAS  PubMed  Google Scholar 

  87. Vasto S, Mocchegiani E, Candore G, Listì F, Colonna-Romano G, Lio D, et al. Inflammation, genes and zinc in ageing and age-related diseases. Biogerontology. 2006;7:315–27.

    Article  CAS  PubMed  Google Scholar 

  88. Kim H-N, Song S-W, Choi W-S. Association between serum zinc level and body composition: the Korean National Health and Nutrition Examination Survey. Nutrition. 2015;32:332–7.

    Article  PubMed  Google Scholar 

  89. Evans WJ, Campbell WW. Sarcopenia and age-related changes in body composition and functional capacity. J. Nutr. 1993:465–8.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Meika Foster.

Ethics declarations

Conflict of Interest

Meika Foster is the Founding Director of Edible Research NZ Ltd. (www.edibleresearch.com), a company that provides translational research services in food and nutrition science.

Anna Chu declares that she has no conflict of interest.

Samir Samman declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Nutrition and Aging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foster, M., Chu, A. & Samman, S. Vegetarian Nutrition for the Older Adult: Vitamin B12, Iron, and Zinc. Curr Nutr Rep 6, 80–92 (2017). https://doi.org/10.1007/s13668-017-0194-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13668-017-0194-x

Keywords

Navigation