The journal of nutrition, health & aging

, Volume 15, Issue 9, pp 744–750 | Cite as

The oldest old: Red blood cell and plasma folate in African American and white octogenarians and centenarians in Georgia

  • Dorothy B. Hausman
  • M. A. Johnson
  • A. Davey
  • J. L. Woodard
  • L. W. Poon
  • R. H. Allen
  • S. P. Stabler
Red Blood Cell, Plasma Folate in African American and White Octogenarians, Centenarians



To determine the overall folate status of a population-based multi-ethnic sample of octogenarians and centenarians and the specific dietary, demographic and physiological factors associated with observed abnormalities.


Population-based multiethnic sample of adults aged 80 to 89 and 98 and above.


Northern Georgia, USA.


Men and women aged 80 to 89 (octogenarians, n = 77) and 98 and older (centenarians, n = 199).


Wilcoxon rank sum tests, and Chi square and logistic regression analyses were used to examine associations of low and high folate status with hematological indicators and other variables of interest.


The prevalence of low red blood cell (RBC) folate was low overall, but tended to be higher in centenarians than in octogenarians (6.5% vs. 1.3%, p = 0.058; defined as RBC folate < 317 nmol/L). The risk of having lower RBC folate (< 25th vs. > 25th percentile for RBC folate for 60yr+ in NHANES 1999–2000) was greater in association with vitamin B12 deficiency (OR = 5.36; 95%CI: 2.87–10.01), African American race (OR = 4.29; 95%CI: 2.08–8.83), and residence in a skilled nursing facility (OR = 3.25; 95%CI: 1.56–6.78) but was not influenced by age, gender, B-vitamin supplement use, high/low food score or presence of atrophic gastritis. Combined high plasma folate and low vitamin B12 status was present in some individuals (n=11), but was not associated with increased prevalence of anemia or cognitive impairment in this study.


Low RBC folate status (< 317 nmol/L) was rare in this post folic acid fortification sample of octogenarians and centenarians. RBC folate status (< 25th percentile) was strongly associated with 1) vitamin B12 deficiency, which has strong implications for vitamin treatment, and 2) with being African American, suggesting racial disparities exist even in the oldest old.

Key words

Folate vitamin B12 centenarians disparities fortification 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Johnson MA, Davey A, Park S, Hausman DB, Poon LW, for the Georgia Centenarian Study. Age, race and season predict vitamin D status in African American and White octogenarians and centenarians. J Nutr Health Aging 2008;12:690–695.PubMedGoogle Scholar
  2. 2.
    Johnson MA, Hausman DB, Davey A, Poon LW, Allen RH, Stabler SP for the Georgia Centenarian Study. Vitamin B12 deficiency in African American and white octogenarians and centenarians in Georgia. J Nutr Health Aging 2010;14:339–345.PubMedCrossRefGoogle Scholar
  3. 3.
    Quadri P, Fragiacomo C, Pezzati R, Zanda E, Forloni G, Tettamanti M, Lucca U. Homocysteine, folate and vitamin B-12 in mild cognitive impairment, Alzheimer disease and vascular dementia. Am J Clin Nutr. 2004:80;114–122.PubMedGoogle Scholar
  4. 4.
    Ravaglia G, Forti P, Maioli F, Martelli M, Servadei L, Brunetti N, Porcellini E, Licastro F. Homocysteine and folate as risk factors for dementia and Alzheimer disease. Am J Clin Nutr. 2005;82:636–643.PubMedGoogle Scholar
  5. 5.
    Selhub J. The many facets of hyperhomocysteinemia: studies from the Framingham cohorts. J Nutr. 2006;136:1726S–1730S.PubMedGoogle Scholar
  6. 6.
    McCully KS. Homocysteine, vitamins, and vascular disease prevention. Am J Clin Nutr. 2007;86(supple):1563S–1568S.PubMedGoogle Scholar
  7. 7.
    McNulty H, Pentieva K, Hoey L, Ward M. Homocysteine, b-vitamins and CVD. Proc Nut Soc 2008;67:232–237.CrossRefGoogle Scholar
  8. 8.
    Forti P, Rietti E, Pisacane N, Olivelli V, Dalmonte E, Mecocci P, Ravaglia G. Blood homocysteine and risk of depression in the elderly. Arch Gerontol Geriatr. 2010;51:21–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Nilsson K, Gustafson L, Hutberg B. Plasma homocysteine, cobalamin/folate status, and vascular disease in a large population of psychogeriatric patients. Dement Geriatr Cogn Disord. 2006;22:358–366.PubMedCrossRefGoogle Scholar
  10. 10.
    Snowdon DA, Tully CL, Smith CD, Perez Riley K, Markesbery WR. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr 2000;71:993–998.PubMedGoogle Scholar
  11. 11.
    Pfeiffer CM, Caudill SP, Gunter EW, Osterloh J, Sampson EJ. Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999–2000. Am J Clin Nutr 2005;82:442–450.PubMedGoogle Scholar
  12. 12.
    Pfeiffer CM, Johnson CL, Jain RB, Yetley EA, Picciano MF, Rader JI, Fisher KD, Mulinare J, Osterloh JD. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988–2004. Am J Clin Nutr 2007;86:718–727.PubMedGoogle Scholar
  13. 13.
    Ganji V, Kafai MR. Trends in serum folate, RBC folate, and circulating total homocysteine concentrations in the United States: Analysis of data from National Health and Nutrition Examination Surveys, 1988–1994, 1999–2000 and 2001–2002. J Nutr 2006;136:153–158.PubMedGoogle Scholar
  14. 14.
    McDowell MA, Lacher DA, Pfeiffer CM, Mulinare J, Picciano MF, Rader JI, Yetley EA, Kennedy-Stephenson, J, Johnson CL. Blood folate levels: the latest NHANES results. NCHS Date Brief 2008; May:1–8.Google Scholar
  15. 15.
    Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitaminB-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr 2007;85:193–200.PubMedGoogle Scholar
  16. 16.
    Selhub J, Morris MS, Jacques PF. In vitamin B-12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. PNAS 2007;104:19995–20000.PubMedCrossRefGoogle Scholar
  17. 17.
    Ray JG, Vermeulen MJ, Langman LJ, Boss SC, Cole DEC. Persistence of vitamin B12 insufficiency among elderly women after folic acid fortification. Clin Biochem 2003; 36:386–391.CrossRefGoogle Scholar
  18. 18.
    Brouwer I, Verhoef P. Folic acid fortification: is masking of vitamin B-12 deficiency what we should really worry about? Am J Clin Nutr 2007;86:897–898.PubMedGoogle Scholar
  19. 19.
    Wyckoff KF, Ganji V. Proportion of individuals with low serum vitamin B-12 concentrations without macrocytosis is higher in the post-folic acid fortification period than in the pre-folic acid fortification period. Am J Clin Nutr 2007;86:1187–1192.PubMedGoogle Scholar
  20. 20.
    Selhub J, Morris MS, Jacques PF, Rosenberg IH. Folate-vitamin B-12 interaction in relation to cognitive impairment, anemia and biochemical indicators of vitamin B-12 deficiency. Am J Clin Nutr 2009;89:702–706S.CrossRefGoogle Scholar
  21. 21.
    Miller JW, Garrod MG, Allen LH, Haan MN, Green R. Metabolic evidence of vitamin B-12 deficiency, including high homocysteine and methlymalonic acid and low holotranscobalamin, is more pronounced in older adults with elevated plasma folate. Am J Clin Nutr 2009;90:1586–1592.PubMedCrossRefGoogle Scholar
  22. 22.
    Poon LW, Jazwinski SM, Green RC, Woodard JL, Martin P, Rodgers WL, Johnson MA, Hausman DB, Arnold J, et al. Methodological considerations in studying centenarians: lessons learned from the Georgia centenarian studies. Ann Rev Gerontology and Geriatrics 2007;27:213–264.Google Scholar
  23. 23.
    Stabler SP, Marcell PD, Podell ER, Allen RH, Lindenbaum J. Assay of methylmalonic acid in the serum of patients with cobalamin deficiency using capillary gas chromatography-mass spectrometry. J Clin Invest 1986;77:1610–1612.CrossRefGoogle Scholar
  24. 24.
    Stabler SP, Marcell PD, Podell ER, Allen RH, Savage DG, Lindenbaum J. Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography-mass spectrometry. J Clin Invest 1988;81:466–474.PubMedCrossRefGoogle Scholar
  25. 25.
    Allen RH, Stabler SP, Savage DG, Lindenbaum J. Elevation of 2-methylcitric acid I and II levels in serum, urine, and cerebrospinal fluid of patients with cobalamin deficiency. Metabolism 1993;42:978–988.PubMedCrossRefGoogle Scholar
  26. 26.
    Johnson MA, Hawthorne NA, Brackett WR, Fischer JG, Gunter EW, Penninx BW, Allen RH, Stabler SP. Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services. Am J Clin Nutr 2003;77:211–220.PubMedGoogle Scholar
  27. 27.
    Stabler SP, Allen RH, Fried LP, Pahor M, Kittner SJ, Penninx BWJH, Gurlanik JM. Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women. Am J Clin Nutr 1999;70:911–919.PubMedGoogle Scholar
  28. 28.
    Samloff IM, Varis K, Ihamaki T, Siurala M, Rotter JI. Relations among serum pepsinogen I, serum pepsinogen II, and gastric mucosal histology: a study in relatives of patients with pernicious anemia. Gastroenterology 1982;83:204–209.PubMedGoogle Scholar
  29. 29.
    Blanc B, Finch CA, Hallberg L, et al. Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser. 1968;405:1–40.Google Scholar
  30. 30.
    Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: the Mini-Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 1996;54:59–65.CrossRefGoogle Scholar
  31. 31.
    Johnson MA, Davey A, Hausman DB, Park S, Poon LW, for the Georgia Centenarian Study. Dietary differences between centenarians residing in communities and in skilled nursing facilities:the Georgia Centenarian Study. Age 2006;28:333–341.CrossRefGoogle Scholar
  32. 32.
    US Department of Health and Human Services and US Department of Agriculture (2005) Dietary Guidelines for Americans 2005. Available online at
  33. 33.
    National Institutes of Health: National Heart Lung and Blood Institute, North American Association for the Study of Obesity. Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 2000 [cited; 1–80]. Available from:
  34. 34.
    Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.PubMedCrossRefGoogle Scholar
  35. 35.
    Folstein MF, Folstein SE, McHugh PR, Fanjiang G. Mini-Mental State Examination user’s guide. Odessa, FL: Psychological Assessment Resources 2001.Google Scholar
  36. 36.
    Ravaglia G, Forti P, Maioli F, Vettori C, Grossi G, Bargossi AM, Caldarera M, Franceschi C, Facchini A, Mariani E, Cavalli G. Elevated plasma homocysteine levels in centenarians are not associated with cognitive impairment. Mech Ageing Dev. 2000; 121:251–261.PubMedCrossRefGoogle Scholar
  37. 37.
    Malaguarnera M, Pistone G, Motta M, Vinci E, Oreste G, Avellone G, Musumeci S. Elevated plasma total homocysteine in centenarians. Clin Chem Lab Med 2004; 42:307–310.PubMedCrossRefGoogle Scholar
  38. 38.
    Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Food and Nutrition Board. National Academy of Sciences. 1998. Washington DC: National Academy Press.Google Scholar
  39. 39.
    Stover PJ. One-carbon metabolism-genome interactions in folate-associated pathologies. J Nutr 2009;139:2402–2405.PubMedCrossRefGoogle Scholar
  40. 40.
    Stabler SP. Vitamin B12. In: Present Knowledge in Nutrition, 9th edition, Volume II. Bowan BA, Russell RM, eds. International Life Sciences Institute, Washington, DC 2006.Google Scholar
  41. 41.
    Dowd JB, Aiello AE. Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US? Int J Epidemiol. 2008;37:1059–1066.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • Dorothy B. Hausman
    • 1
    • 6
  • M. A. Johnson
    • 1
  • A. Davey
    • 2
  • J. L. Woodard
    • 3
  • L. W. Poon
    • 4
  • R. H. Allen
    • 5
  • S. P. Stabler
    • 5
  1. 1.Department of Foods and NutritionUniversity of GeorgiaAthensUSA
  2. 2.Department of Public HealthTemple UniversityPhiladelphiaUSA
  3. 3.Department of PsychologyWayne State UniversityDetroitUSA
  4. 4.Institute of GerontologyUniversity of GeorgiaAthensUSA
  5. 5.University of Colorado Denver Health Sciences CenterAuroraUSA
  6. 6.Department of Foods and NutritionThe University of GeorgiaAthensUSA

Personalised recommendations