The Journal of Nutrition Health and Aging

, Volume 12, Issue 5, pp 303–308 | Cite as

Markers of B-vitamin deficiency and frailty in older women

  • A. M. Matteini
  • J. D. Walston
  • M. D. Fallin
  • K. Bandeen-Roche
  • W. H. L. Kao
  • R. D. Semba
  • R. H. Allen
  • J. Guralnik
  • L. P. Fried
  • S. P. Stabler
Nutrition

Abstract

Objective: To evaluate the association between markers of vitamins B12, B6 and folate deficiency and the geriatric syndrome of frailty.Design: Cross-sectional study of baseline measures from the combined Women’s Health and Aging Studies.Setting: Baltimore, Maryland.Participants: Seven hundred three community-dwelling women, aged 70–79.Measurements: Frailty was defined by five-component screening criteria that include weight, grip strength, endurance, physical activity and walking speed measurements and modeled as binary and 3-level polytomous outcomes. Independent variables serum vitamin B6, vitamin B12, methylmalonic acid, total homocysteine, cystathionine and folate were modeled continuously and as abnormal versus normal.Results: Serum biomarker levels varied significantly by race. All analyses were race-stratified and results are reported only for Caucasian women due to small African American sample size. In polytomous logistic regression models of 3-level frailty, Caucasian women with increasing MMA, defined either continuously or using a predefined threshold, had 40–60% greater odds of being prefrail (p-values < 0.07) and 1.66–2.33 times greater odds of being frail (p-values < 0.02) compared to nonfrails after adjustment for age, education, low serum carotenoids, alcohol intake, cardiovascular disease and renal impairment. Both binary and polytomous frailty models evaluating vitamin B12 as the main exposure estimated odds ratios that were similar in trend yet slightly less significant than the MMA results.Conclusions: These results suggest that vitamin B12 deficiency may contribute to the frailty syndrome in community-dwelling older women. Future studies are needed to explore these relationships longitudinally.

Key words

Frailty syndrome vitamins B6 B12 and folate older women 

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References

  1. 1.
    Stabler, S.P., J. Lindenbaum, and R.H. Allen, Vitamin B-12 deficiency in the elderly: current dilemmas. Am J Clin Nutr, 1997. 66(4): p. 741–9.PubMedGoogle Scholar
  2. 2.
    Depeint, F., et al., Mitochondrial function and toxicity: role of B vitamins on the onecarbon transfer pathways. Chem Biol Interact, 2006. 163(1-2): p. 113–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Friso, S., et al., Low circulating vitamin B(6) is associated with elevation of the inflammation marker C-reactive protein independently of plasma homocysteine levels. Circulation, 2001. 103(23): p. 2788–91.PubMedGoogle Scholar
  4. 4.
    Looker, H.C., et al., Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res Rev, 2007. 23(3): p. 193–201.PubMedCrossRefGoogle Scholar
  5. 5.
    Elias, M.F., et al., Homocysteine, folate, and vitamins B6 and B12 blood levels in relation to cognitive performance: the Maine-Syracuse study. Psychosom Med, 2006. 68(4): p. 547–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Bartali, B., et al., Low micronutrient levels as a predictor of incident disability in older women. Arch Intern Med, 2006. 166(21): p. 2335–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Metz, J., et al., The significance of subnormal serum vitamin B12 concentration in older people: a case control study. J Am Geriatr Soc, 1996. 44(11): p. 1355–61.PubMedGoogle Scholar
  8. 8.
    Buchner, D.M. and E.H. Wagner, Preventing frail health. Clin Geriatr Med, 1992. 8(1): p. 1–17.PubMedGoogle Scholar
  9. 9.
    Fried, L.P. and J. Walston, Frailty and Failure to Thrive, in Principles of Geriatric Medicine and Gerontology, W.R. Hazzard, et al., Editors. 1999, McGraw Hill: New York. p. 1387–1402.Google Scholar
  10. 10.
    Michelon, E., et al., Vitamin and carotenoid status in older women: associations with the frailty syndrome. J Gerontol A Biol Sci Med Sci, 2006. 61(6): p. 600–7.PubMedGoogle Scholar
  11. 11.
    Semba, R.D., et al., Low serum micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci, 2006. 61(6): p. 594–9.PubMedGoogle Scholar
  12. 12.
    Morris, M.S., et al., Elevated serum methylmalonic acid concentrations are common among elderly Americans. J Nutr, 2002. 132(9): p. 2799–803.PubMedGoogle Scholar
  13. 13.
    Herrmann, W., et al., Functional vitamin B12 deficiency and determination of holotranscobalamin in populations at risk. Clin Chem Lab Med, 2003. 41(11): p. 1478–88.PubMedCrossRefGoogle Scholar
  14. 14.
    Lindenbaum, J., et al., Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr, 1994. 60(1): p. 2–11.PubMedGoogle Scholar
  15. 15.
    Morris, M.S., P.F. Jacques, and J. Selhub, Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone, 2005. 37(2): p. 234–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Herrmann, W., et al., Role of homocysteine, cystathionine and methylmalonic acid measurement for diagnosis of vitamin deficiency in high-aged subjects. Eur J Clin Invest, 2000. 30(12): p. 1083–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Allen, L.H. and J. Casterline, Vitamin B-12 deficiency in elderly individuals: diagnosis and requirements. Am J Clin Nutr, 1994. 60(1): p. 12–4.PubMedGoogle Scholar
  18. 18.
    The Homocysteine, S.C., Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. Jama, 2002. 288(16): p. 2015–22.CrossRefGoogle Scholar
  19. 19.
    Kado, D.M., et al., Homocysteine levels and decline in physical function: MacArthur Studies of Successful Aging. Am J Med, 2002. 113(7): p. 537–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Prins, N.D., et al., Homocysteine and cognitive function in the elderly: the Rotterdam Scan Study. Neurology, 2002. 59(9): p. 1375–80.PubMedGoogle Scholar
  21. 21.
    Gjesdal, C.G., et al., Plasma total homocysteine level and bone mineral density: the Hordaland Homocysteine Study. Arch Intern Med, 2006. 166(1): p. 88–94.PubMedCrossRefGoogle Scholar
  22. 22.
    McCracken, C., et al., Methylmalonic acid and cognitive function in the Medical Research Council Cognitive Function and Ageing Study. Am J Clin Nutr, 2006. 84(6): p. 1406–11.PubMedGoogle Scholar
  23. 23.
    Dhonukshe-Rutten, R.A., et al., Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men. J Nutr, 2003. 133(3): p. 801–7.PubMedGoogle Scholar
  24. 24.
    Fried, L.P., et al., Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci, 2004. 59(3): p. 255–63.PubMedGoogle Scholar
  25. 25.
    Walston, J., et al., Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc, 2006. 54(6): p. 991–1001.PubMedCrossRefGoogle Scholar
  26. 26.
    Guralnik, J.M., et al., The Women’s Health and Aging Study: Health and Social Characteristics of Older Women with Disability, in NIH Publication No. 95-4009, N.I.o. Aging., Editor. 1995, National Institute on Aging: Bethesda, MD. p. http://www.grc.nia.mh.gov/branches/ledb/whasbook/title.htm.Google Scholar
  27. 27.
    Fried, L.P., et al., Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol A Biol Sci Med Sci, 2000. 55(1): p. M43–52.PubMedGoogle Scholar
  28. 28.
    Folstein, M.F., S.E. Folstein, and P.R. McHugh, “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975. 12(3): p. 189–98.PubMedCrossRefGoogle Scholar
  29. 29.
    Fried, L.P., et al., Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001. 56(3): p. M146–56.PubMedGoogle Scholar
  30. 30.
    Bandeen-Roche, K., et al., Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci, 2006. 61(3): p. 262–6.PubMedGoogle Scholar
  31. 31.
    Allen, R.H., et al., Elevation of 2-methylcitric acid I and n levels in serum, urine, and cerebrospinal fluid of patients with cobalamin deficiency. Metabolism, 1993. 42(8): p. 978–88.PubMedCrossRefGoogle Scholar
  32. 32.
    Stabler, S.P., et al., Elevation of serum cystathionine levels in patients with cobalamin and folate deficiency. Blood, 1993. 81(12): p. 3404–13.PubMedGoogle Scholar
  33. 33.
    Stabler, S.P., et al., Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women. Am J Clin Nutr, 1999. 70(5): p. 911–9.PubMedGoogle Scholar
  34. 34.
    Semba, R.D., et al., Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clin Exp Res, 2003. 15(6): p. 482–7.PubMedGoogle Scholar
  35. 35.
    Levey, A.S., et al., A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med, 1999. 130(6): p. 461–70.PubMedGoogle Scholar
  36. 36.
    Levey, A.S., et al., Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2005. 67(6): p. 2089–100.PubMedCrossRefGoogle Scholar
  37. 37.
    Schafer, J.L., Analysis of Incomplete Multivariate Data. 1997, New York: Chapman and Hall.Google Scholar
  38. 38.
    Cappola, A.R., et al., Association of IGF-I levels with muscle strength and mobility in older women. J Clin Endocrinol Metab, 2001. 86(9): p. 4139–46.PubMedCrossRefGoogle Scholar
  39. 39.
    Green, R. and J.W. Miller, Vitamin B12 deficiency is the dominant nutritional cause of hyperhomocysteinemia in a folic acid-fortified population. Clin Chem Lab Med, 2005. 43(10): p. 1048–51.PubMedCrossRefGoogle Scholar
  40. 40.
    McKinley, M.C., et al., Low-dose vitamin B-6 effectively lowers fasting plasma homocysteine in healthy elderly persons who are folate and riboflavin replete. Am J Clin Nutr, 2001. 73(4): p. 759–64.PubMedGoogle Scholar
  41. 41.
    Selhub, J., et al., Relationship between plasma homocysteine and vitamin status in the Framingham study population. Impact of folic acid fortification. Public Health Rev, 2000. 28(1-4): p. 117–45.PubMedGoogle Scholar
  42. 42.
    Johnson, M.A., et al., Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services. Am J Clin Nutr, 2003. 77(1): p. 211–20.PubMedGoogle Scholar
  43. 43.
    Hvas, A.M. and E. Nexo, Holotranscobalamin as a predictor of vitamin B12 status. Clin Chem Lab Med, 2003. 41(11): p. 1489–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France and Serdi Éditions 2008

Authors and Affiliations

  • A. M. Matteini
    • 1
  • J. D. Walston
    • 1
  • M. D. Fallin
    • 1
  • K. Bandeen-Roche
    • 1
  • W. H. L. Kao
    • 1
  • R. D. Semba
    • 1
  • R. H. Allen
    • 2
  • J. Guralnik
    • 3
  • L. P. Fried
    • 1
  • S. P. Stabler
    • 2
  1. 1.Johns Hopkins UniversityBaltimore
  2. 2.University of Colorado Health Sciences CenterDenver
  3. 3.National Institute on AgingBethesda

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