Summary
Vitamin supplementation in large dosages is increasingly common in the older population. Often, such supplementation is used in an attempt to improve an individual’s health status. There have been claims that the effects of vitamins halt the normal aging process or prevent and cure disease.
However, several recent studies have failed to demonstrate the efficacy of vitamin supplementation in preventing several types of cancer. In moderate dosages, supplementation with vitamin E (tocopherols) shows promise as a lipid antioxidant, and may reduce the risk of coronary heart disease. However, before vitamin E becomes an accepted medical therapy, further long term studies must be undertaken to examine the safety and efficacy of such therapy.
An adequate intake of vitamins should be ensured by adherence to a well balanced diet. However, the elderly are prone to circumstances that may prevent them from eating a balanced diet. In addition, there are several age-related medical conditions that may predispose individuals to dietary and vitamin deficiencies. To prevent vitamin deficiency diseases and their associated morbidity, modest vitamin supplementation may be necessary. However, supplementation should be reserved for individuals with documented deficiency or who are at risk of developing such deficiencies, especially those who are homebound or institutionalised.
Vitamins taken in large dosages should be considered as drugs. These medicines, which are obtainable over-the-counter, should be carefully regulated to prevent toxicity.
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References
Blumberg J. Nutrient requirements of the healthy elderly: should there be specific RDAs? Nutr Rev 1994; 52 (8 Suppl.): S15–8
Dwyer J. Nutritional problems of elderly minorities. Nutr Rev 1994; 52 (8 Suppl.): S24–7
Silver AJ. Anorexia of aging. Ann Intern Med 1988; 109: 892–4
Greska LP, Parraga IM, Clark CA. The dietary adequacy of edentulous older adults. J Prosthet Dent 1995; 73(2): 142–5
Rudman D, Abbasi AA, Isaacson K, et al. Observations on the nutrient intakes of eating-dependent nursing home residents: underutilisation of micronutrient supplements. J Am Coll Nutr 1995; 14(6): 604–13
Posner BM, Jette A, Smigelski C, et al. Nutritional risk in New England elders. J Gerontol 1994; 49 (3 Suppl.): M123–32
Shock NW, Grenlich RC, Andres R, et al. for the National Institute of Health (NIH). Normal human aging: the Baltimore Longitudinal Study of Aging. NIH Publication No. 84-2450. Baltimore (MD): US Department of Health and Human Services, 1984 Nov: 105–12
National Research Council. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press, 1989
Jylha M. Ten-year change in the use of medical drugs among the elderly: a longitudinal study and cohort comparison. J Clin Epidemiol 1994; 47(1): 69–79
Mant A, Whicker S, Sook Kwok Y. Over-the-counter self-medication: the issues. Drugs Aging 1992; 2(4): 257–61
Barone J, Taioli E, Muscat J, et al. Vitamin supplement use in a hospital-based population. Eur J Cancer Prev 1992; 1: 139–48
Alfin-Slater RB. Vitamin use and abuse in elderly persons. Ann Intern Med 1988; 109: 896–9
Barnett YA. Nutrition and the ageing process. Br J Biomed Sci 1994; 51: 278–87
Gray GE, Paganini-Hill A, Ross RK. Dietary intake and nutrient supplement use in a Southern California retirement community. Am J Clin Nutr 1983; 38: 122–8
Pitt HA, Costrini AM. Vitamin C prophylaxis in marine recruits. JAMA 1979; 241(9): 908–11
Schectman G. Estimating ascorbic acid requirements for cigarette smokers. Ann N Y Acad Sci 1993; 686: 335–45
Schectman G, Byrd JC, Hoffmann R. Ascorbic acid requirements for smokers: analysis of a population study. Am J Clin Nutr 1991; 53: 1466–70
Dawson EB, Harris WA, Teter MC, et al. Effect of ascorbic acid supplementation on the sperm quality of smokers. Fertil Steril 1992; 58(5): 1034–9
Paolisso G, D’Amore A, Balbi V, et al. Plasma vitamin C affects glucose homeostasis in healthy subjects and in non-insulin-dependent diabetics. Am J Physiol 1994; 266: E261–8
Stankova L, Riddle M, Larned J, et al. Plasma ascorbate concentrations and blood cell dehydroascorbate transport in patients with diabetes mellitus. Metabolism 1984; 33(4): 347–53
Paolisso G, Balbi V, Volpe C, et al. Metabolic benefits deriving from chronic vitamin C supplementation in aged non-insulin dependent diabetics. J Am Coll Nutr 1995; 14(4): 387–92
Schorah CJ, Tormey WP, Brooks GH, et al. The effect of vitamin C supplements on body weight, serum proteins, and general health of an elderly population. Am J Clin Nutr 1994; 34: 871–6
Breslow R. Nutritional status and dietary intake of patients with pressure ulcers: review of research literature 1943 to 1989. Decubitus 1991; 4(1): 16–21
Klaassen CD. Principles of toxicology and treatment of poisoning. In: Hardman JG, Limbird LE, editors. Goodman and Gil-man’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 63–75
Ghosh SK, Ekpo EB, Shah IU, et al. A double-blind, placebo-controlled parallel trial of vitamin C treatment in elderly patients with hypertension. Gerontology 1994; 40(5): 268–72
Lovat LB, Lu U, Palmer AJ, et al. Double-blind trial of vitamin C in elderly hypertensives. J Hum Hypertens 1993; 7: 403–5
Levine M, Dhariwal KR, Welch RW, et al. Determination of optimal vitamin C requirements in humans. Am J Clin Nutr 1995; 62 Suppl.: 1347S–56S
van der Wielen RPJ, van Heereveld HAEM, de Groot CPGM, et al. Nutritional status of elderly female nursing home residents: the effect of supplementation with a physiological dose of water-soluble vitamins. Eur J Clin Nutr 1995; 49: 665–74
Flagg EW, Coates RJ, Greenberg RS. Epidemiologie studies of antioxidants and cancer in humans. J Am Coll Nutr 1995; 14(5): 419–27
Jacob RA. Vitamin C. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 432–48
Bendich A. Safety issues regarding the use of vitamin supplements. Ann N Y Acad Sci 1992; 669: 300–10
Bendich A, Langseth L. Safety of vitamin A. Am J Clin Nutr 1989; 49: 358–71
Strijdom JG, Marais BJ, Koeslag JH. Ascorbic acid causes spuriously low blood glucose measurements. S Afr Med J 1993; 83: 64–5
Herbert V, Jacob E. Destruction of vitamin B12 by ascorbic acid. JAMA 1974; 230: 241–2
Herbert V, Jacob E, Wong KTJ, et al. Low serum B12 levels in patients receiving ascorbic acid in megadoses: studies concerning the effect of ascorbate on radioisotope vitamin B12 assay. Am J Clin Nutr 1978; 31: 253–8
Wandzilak TR, D’Andre SD, Davis PA, et al. Effect of high dose vitamin C on urinary oxalate levels. J Urol 1994; 151: 834–7
Rees DC, Kelsey H, Richards JDM. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. BMJ 1993; 306: 841–2
Vatassery GT, Johnson GJ, Krezowski AM. Changes in vitamin E concentrations in human plasma and platelets with age. J Am Coll Nutr 1983; 4: 369–75
Farrell PM, Roberts RJ. Vitamin E. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 326–41
Kilic F, Mitton K, Dzialoszynski T, et al. Modelling cortical cataractogenesis: 14. Reduction in lens damage in diabetic rats by a dietary regimen combining vitamins C and E and β-carotene. Dev Ophthalmol 1994; 26: 63–71
Augustin AJ, Briepohl W, Boker T, et al. Evidence for the prevention of oxidative tissue damage in the inner eye by vitamins E and C. Ger J Ophthalmol 1992; 1: 394–8
Meydani SN, Wu D, Santos MS, et al. Antioxidants and immune response in aged persons: overview of present evidence. Am J Clin Nutr 1995; 62 Suppl.: 1462S–76S
Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, α-tocopherol, or both as treatment for Alzheimer’s disease. N Engl J Med 1997; 336(17): 1216–22
Paolisso G, Di Marco G, Galzerano D, et al. Pharmacologic doses of vitamin E and insulin action in elderly subjects. Am J Clin Nutr 1994; 59: 1291–6
Boyle P, Zaridze DG, Smans M. Descriptive epidemiology of colorectal cancer. Int J Cancer 1985; 36(1): 9–18
Sandler RS, Lyles CM, Peipins LA, et al. Diet and risk of colorectal adenomas: macronutrients, cholesterol, and fiber. J Natl Cancer Inst 1993; 85(11): 884–91
Byers T, Perry G. Dietary carotenes, vitamin C and vitamin E as protective antioxidants in human cancers. Annu Rev Nutr 1992; 12: 139–59
Greenberg ER, Baron JA, Karagas MR, et al. Mortality associated with low plasma concentration of β-carotene and the effect of oral supplementation. JAMA 1996; 275(9): 699–703
The α-Tocopherol, β-Carotene Cancer Prevention Study Group. The effect of vitamin E and β-carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994; 330(15): 1029–35
Kushi LH, Fee RM, Sellers TA, et al. Intake of vitamins A, C, and E and postmenopausal breast cancer: the Iowa Women’s Health Study. Am J Epidemiol 1996; 144(2): 165–74
Rapola JM, Virtamo J, Haukka JK, et al. Effect of vitamin E and β-carotene on the incidence of angina pectoris: a randomized, double-blind, controlled trial. JAMA 1996; 275(9): 693–8
Stampfer M, Hennekens CH, Manson JE, et al. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993; 328(20): 1444–9
Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993; 328(20): 1450–6
Kushi LH, Folsom AR, Prineas RJ, et al. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med 1996; 334(18): 1156–62
Hodis HN, Mack WJ, LaBree L, et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. JAMA 1995; 273(23): 1849–54
Tardif JC, Cote G, Lesperance J, et al. Probucol and multivitamins in the prevention of restenosis after coronary angioplasty. N Engl J Med 1997; 337(6): 365–72
Stephens NG, Parsons A, Schofield PM, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996; 347: 781–6
Dieber-Rotheneder M, Puhl H, Waeg G, et al. Effect of oral supplementation with D-alpha-tocopherol on the vitamin E content of human low density lipoproteins and resistance to oxidation. J Lipid Res 1991; 32: 1325–32
Reaven PD, Herold DA, Barnett J, et al. Effects of vitamin E on susceptibility of low-density lipoprotein and low-density lipoprotein subfractions to oxidation and on protein glycation in NIDDM. Diabetes Care 1995; 18(6): 807–16
Corrigan JJ. The effect of vitamin E on warfarin-induced vitamin K deficiency. Ann N Y Acad Sci 1982; 393: 361–8
Marcus R, Coulston AM. Water-soluble vitamins: the vitamin B complex and ascorbic acid. In: Wonsiewecz M, McCurdy P, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 1535–72
Wang XD. Review: absorption and metabolism of β-carotene. J Am Coll Nutr 1994; 13(4): 314–25
Burton GW, Ingold KU. β-Carotene: an unusual type of lipid antioxidant. Science 1984; 224: 569–73
Basu TK, Donald FA, Gargreaves JA, et al. Seasonal variation of vitamin A (retinol) status in older men and women. J Am Coll Nutr 1994; 13(6): 641–5
Garry PJ, Hunt WC, Bandrofchak JL, et al. Vitamin A intake and plasma retinol levels in healthy elderly men and women. Am J Clin Nutr 1987; 46: 989–94
Shimizu H, Nagata C, Komatsu S, et al. Decreased serum retinol levels in women with cervical dysplasia. Br J Cancer 1996; 73(12): 1600–4
Zheng W, Sellers TA, Doyle TJ, et al. Retinol, antioxidant vitamins and cancers of the upper digestive tract in a prospective cohort study of postmenopausal women. Am J Epidemiol 1995; 142(9): 955–60
Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of β-carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 1996; 334(18): 1150–5
Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with β-carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996; 334(18): 1145–9
Greenberg ER, Baron JA, Tosteson TD, et al. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. N Engl J Med 1994; 331(3): 141–7
Hathcock JN, Hattan DG, Jenkins MY, et al. Evaluation of vitamin A toxicity. Am J Clin Nutr 1990; 52(2): 183–202
Olson JA. Vitamin A, retinoids, and carotenoids. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 287–307
Garewal HS, Diplock AT. How ‘safe’ are antioxidant vitamins? Drug Saf 1995; 13(1): 8–14
Marwick C. Trials reveal no benefit, possible harm of β-carotene and vitamin A for lung cancer prevention. JAMA 1996; 275(6): 422–3
Walters MR. Newly identified actions of the vitamin D endocrine system. Endocr Rev 1992; 13(4): 719–64
Lips P, Hackeng WHL, Jongen MJM, et al. Seasonal variation in serum concentrations of parathyroid hormone in elderly people. J Clin Endocrinol Metab 1983; 57(1): 204–6
Lips P, Wiersinga A, van Ginkel FC, et al. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab 1988; 67(4): 644–50
Krall EA, Sahyoun N, Tannenbaum S, et al. Effect of vitamin D intake on seasonal variation in parathyroid hormone secretion in postmenopausal women. N Engl J Med 1989; 321(26): 1777–83
Quesada JM, Coopmans W, Ruiz B, et al. Influence of vitamin D on parathyroid function in the elderly. J Clin Endocrinol Metab 1992; 75(2): 494–501
Baynes KCR, Boucher BJ, Feskens EJM, et al. Vitamin D, glucose tolerance and insulinaemia in elderly men. Diabetologia 1997; 40(3): 344–7
Salamone LM, Dallal GE, Zantos D, et al. Contributions of vitamin D intake and seasonal sunlight exposure to plasma 25-hydroxyvitamin D concentration in elderly women. Am J Clin Nutr 1994; 59(1): 80–6
Gloth FM, Gundberg CM, Hollis BW, et al. Vitamin D deficiency in homebound elderly persons. JAMA 1995; 274(21): 1683–6
Keane EM, Rochfort A, Cox J, et al. Vitamin-D-fortified liquid milk: a highly effective method of vitamin D administration for house-bound and institutionalised elderly. Gerontology 1992; 38(5): 280–4
van der Wielen RP, Lowik MR, van den Berg H, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 1995; 346: 207–10
McAlindon TE, Felson DT, Zhang Y, et al. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham study. Ann Intern Med 1996; 125(5): 353–9
Ooms ME, Roos JC, Bezemer PD, et al. Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. J Clin Endocrinol Metab 1995; 80(4): 1052–8
Prestwood KM, Pannullo AM, Denny AM, et al. The effect of a short course of calcium and vitamin D on bone turnover in older women. Osteoporos Int 1996; 6: 314–9
Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327(23): 1637–42
Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly persons: a randomized, placebo-controlled clinical trial. Ann Intern Med 1996; 124(4): 400–6
Dawson-Hughes B, Harris SS, Krall EA, et al. Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D. Am J Clin Nutr 1995; 61(5): 1140–5
Rao DR, Bello H, Warren AP, et al. Prevalence of lactose maldigestion: influence and interaction of age, race and sex. Dig Dis Sci 1994; 39(7): 1519–24
McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med 1992; 93(1): 69–77
Thorp JA, Gaston L, Caspers DR, et al. Current concepts and controversies in the use of vitamin K. Drugs 1995; 49(3): 376–87
Heaney RP. Bone mass, nutrition and other lifestyle factors. Am J Med 1993; 95 Suppl. 5A: 29S–33S
Sokoll LJ, Sadowski JA. Comparison of biochemical indexes for assessing vitamin K nutritional status in a healthy adult population. Am J Clin Nutr 1996; 63(4): 566–73
Ferland G, Sadoski JA, O’Brien ME. Dietary induced subclinical vitamin K deficiency in normal human subjects. J Clin Invest 1993; 91(4): 1761–8
Jie KS, Bots ML, Vermeer C, et al. Vitamin K intake and osteocalcin levels in women with and without aortic atherosclerosis: a population-based study. Atherosclerosis 1995; 116(1): 117–23
Szulc P, Chapuy MC, Meunier PJ, et al. Serum under-carboxylated osteocalcin is a marker of the risk of hip fracture in elderly women. J Clin Invest 1993; 91(4): 1769–74
Hodges SJ, Akesson K, Vergnaud P, et al. Circulating levels of vitamins K1 and K2 decreased in elderly women with hip fracture. J Bone Miner Res 1993; 8(10): 1241–5
Hodges SJ, Bejui J, Leclercq M, et al. Detection and measurement of vitamins K1 and K2 in human cortical and trabecular bone. J Bone Miner Res 1993; 8(8): 1005–8
Knapen MH, Jie KS, Hamulyak K, et al. Vitamin K-induced changes in markers for osteoblast activity and urinary calcium loss. Calcif Tissue Int 1993; 53(2): 81–5
Binkley NC, Suttie JW. Vitamin K nutrition and osteoporosis. J Nutr 1995; 125: 1812–21
Reed RL, Mooradian AD. Nutritional status and dietary management of elderly diabetic patients. Clin Geriatr Med 1990; 6(4): 883–901
Bettendorff L, Mastrogiacomo F, Kish SJ, et al. Thiamine, thiamine phosphates, and their metabolizing enzymes in human brain. J Neurochem 1996; 66(1): 250–8
Tanphaichitr V. Thiamin. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 359–65
Kwok T, Falconer-Smith JF, Potter JF, et al. Thiamine status of elderly patients with cardiac failure. Age Ageing 1992; 21(1): 67–71
Bates CJ. Human riboflavin requirements and metabolic consequences of deficiency in man and animals. World Rev Nutr Diet 1987; 50: 215–65
Boisvert WA, Castaneda C, Mendoza I, et al. Prevalence of riboflavin deficiency among Guatemalan elderly people and its relationship to milk intake. Am J Clin Nutr 1993; 58(1): 85–90
Lowik MR, van den Berg H, Kistemaker C, et al. Interrelationships between riboflavin and vitamin B6 among elderly people (Dutch Nutrition Surveillance System). Int J Vitam Nutr Res 1994; 64(3): 198–203
Leske MC, Wu SY, Hyman L, et al. Biochemical factors in the lens opacities: case-control study. The Lens Opacities Case-Control Study Group. Arch Ophthalmol 1995; 113(9): 1113–9
Winters LR, Yoon JS, Kalkwarf HJ, et al. Riboflavin requirements and exercise adaptation in older women. Am J Clin Nutr 1992; 56(3): 526–32
Boisvert WA, Mendoza I, Castaneda C, et al. Riboflavin requirement of healthy elderly humans and its relationship to macro-nutrient composition of the diet. J Nutr 1993; 123(5): 915–25
McCormick DB. Riboflavin. In: Shils ME, Olson JA, Shike M, editors. Odern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 366–75
Riggs KM, Spiro III A, Tucker K, et al. Relations of vitamin B-12, vitamin B-6, folate and homocysteine to cognitive performance in the Normative Aging Study. Am J Clin Nutr 1996; 63(3): 306–14
Deijen JB, van der Beck E, Orlebeke JF, et al. Vitamin B6 supplementation in elderly men: effects on mood, memory, performance and mental effort. Psychopharmacology 1992; 109: 489–96
Joosten E, van den Berg A, Riezler R, et al. Metabolic evidence that deficiencies of vitamin B-12 (cobalamin), folate, and vitamin B-6 occur commonly in elderly people. Am J Clin Nutr 1993; 58(4): 468–76
Leklem JE. Vitamin B6. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea and Febiger, 1994: 383–94
Rosenberg IH, Miller JW. Nutritional factors in physical and cognitive functions of elderly people. Am J Clin Nutr 1992; 55: 1237S–43S
Meydani SN, Hayek M, Coleman L. Influence of vitamins E and B6 on immune response. Ann N Y Acad Sci 1992; 669: 125–39
Reynolds TM, Marshall PD, Brain AM. Hip fracture patients may be vitamin B6 deficient: controlled study of serum pyridoxal-5′-phosphate. Acta Orthop Scand 1992; 63(6): 635–8
Leklem JE. Vitamin B6 reservoirs, receptors and red-cell reactions. Ann N Y Acad Sci 1992; 669: 34–41
Dakshinamurti K, Paulsoe CS, Viswanathan M. Vitamin B6 and hypertension. Ann N Y Acad Sci 1990; 585: 241–9
Lal KJ, Dakshinamurti K. Calcium channels in vitamin B6 deficiency-induced hypertension. J Hypertens 1993; 11(12): 1357–62
van der Beek EJ, van Dokkum W, Wedel M, et al. Thiamin, riboflavin and vitamin B6: impact of restricted intake on physical performance in man. J Am Coll Nutr 1994; 13(6): 629–40
Ubbink JB, van der Merwe A, Delport R, et al. The effect of a subnormal vitamin B-6 status on homocysteine metabolism. J Clin Invest 1996; 98(1): 177–84
Ellis JM, McCully KS. Prevention of myocardial infarction by vitamin B6. Res Commun Mol Pathol Pharmacol 1995; 89(2): 208–20
Talbott MC, Miller LT, Kerkvlict NI. Pyridoxine supplementation: effect on lymphocyte responses in elderly persons. Am J Clin Nutr 1987; 46(4): 659–64
Ellis JM, Folkers K. Clinical aspects of treatment of carpal tunnel syndrome with vitamin B6. Ann N Y Acad Sci 1990; 585: 302–20
Bernstein AL. Vitamin B6 in clinical neurology. Ann N Y Acad Sci 1990; 585: 250–60
Schaumburg H, Kaplan J, Windebank A, et al. Sensory neuropathy from pyridoxine abuse: a new megavitamin syndrome. N Engl J Med 1983; 309(8): 445–8
Berger AR, Schaumburg HH, Schroeder C, et al. Dose response, coasting, and differential fiber vulnerability in human toxic neuropathy: a prospective study of pyridoxine neurotoxicity. Neurology 1992; 42(7): 1367–70
Morimoto K, Kawada A, Hiruma M, et al. Photosensitivity from pyridoxine hydrochloride (vitamin B6). J Am Acad Dermatol 1996; 35(Pt 2): 304–5
Wilson JD. Vitamin deficiency and excess. In: Isselbacher KJ, Martin JB, Braunwald E, et al., editors. Harrison’s principles of internal medicine. 13th ed. New York: McGraw-Hill, 1994: 472–80
Durrington PN. Drug therapy of hyperlipidaemia. In: Hyperlipidaemia: diagnosis and management. 2nd ed. Cambridge: Cambridge University Press, 1995: 258–90
Miller NE. Pharmacological intervention for altering lipid metabolism. Drugs 1990; 40 Suppl. 1: 26–31
Oster G, Borok GM, Menzin J, et al. Cholesterol-Reduction Intervention Study (CRIS): a randomized trial to assess effectiveness and costs in clinical practice. Arch Intern Med 1996; 156(7): 731–9
Illingworth DR, Stein EA, Mitchel YB, et al. Comparative effects of lovastatin and niacin in primary hypercholesterolemia: a prospective trial. Arch Intern Med 1994; 154(14): 1586–95
Dalton TA, Berry RS. Hepatotoxicity associated with sustained-release niacin. Am J Med 1992; 93(1): 102–4
Gharavi AG, Diamond A, Smith DA, et al. Niacin-induced myopathy. Am J Cardiol 1994; 74(8): 841–2
Fraunfelder FW, Fraunfelder FT, Illingworth DR. Adverse ocular effects associated with niacin therapy. Br J Ophthalmol 1995; 79(1): 54–6
Shakir KM, Droll S, Aorill BS, et al. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc 1995; 70(6): 556–8
Wahlberg G, Walldius G, Efendic S. Effects of nicotinic acid on glucose tolerance and glucose incorporation into adipose tissue in hypertriglyceridaemia. Scand J Clin Lab Invest 1992; 52(6): 537–45
Lipman TO. Vitamins: hormonal and metabolic interrelationships. In: Becker KL, editor. Principles and practice of endocrinology and metabolism. 2nd ed. Philadelphia: J.B. Lippincott, 1995: 50–6
Lindenbaum J, Rosenberg IH, Wilson PWF, et al. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994; 60: 2–11
Pennypacker LC, Allen RH, Kelly JP, et al. High prevalency of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc 1992; 40(12): 1197–204
Cunha UG, Rocha FL, Peixoto JM, et al. Vitamin B12 deficiency and dementia. Int Psychogeriatr 1995; 7(1): 85–8
Crystal HA, Ortof E, Frishman WH, et al. Serum vitamin B12 levels and incidence of dementia in a healthy elderly population: a report from the Bronx Longitudinal Aging Study. J Am Geriatr Soc 1994; 42(9): 933–6
Beck WS. Diagnosis of megaloblastic anemia. Annu Rev Med 1991; 42: 311–22
Fairbanks VF. Tests for pernicious anemia: the ‘schilling test’. Mayo Clin Proc 1983; 58: 541–4
Carmel R. Approach to a low vitamin B12 level [letter]. JAMA 1994; 272(16): 1233
Carmel R, Sinow RM, Siegel ME, et al. Food cobalamin malabsorption occurs frequently in patients with unexplained low serum cobalamin levels. Arch Intern Med 1988; 148_(8): 1715–9
Carmel R. Subtle and atypical cobalamin deficiency states. Am J Hematol 1990; 34: 108–14
Allen RH, Stabler SP, Savage DG, et al. Metabolic abnormalities in cobalamin (vitamin B12) and folate deficiency. FASEB J 1993; 7: 1344–53
Allen LH, Casterline J. Vitamin B-12 deficiency in elderly individuals: diagnosis and requirements. Am J Nutr 1994; 60: 12–4
Boushey CJ, Beresford SAA, Omenn GS, et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA 1995; 274(13): 1049–57
Selhub J, Jacques PF, Bostom AG, et al. Association between plasma homocysteine concentrations and extracranial carotid artery stenosis. N Engl J Med 1995; 332(5): 286–91
Selhub J, Jacques PF, Wilson PWF, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993; 270(22): 2693–8
Stampfer MJ, Willett WC. Homocysteine and marginal vitamin deficiency: the importance of adequate vitamin intake. JAMA 1993; 270(22): 2726–7
Drinka PJ, Langer EH, Voeks SK, et al. Low serum folic acid levels in a nursing home population: a clinical experience. J Am Coll Nutr 1993; 12(2): 186–9
Oakley GP, Adams MJ, Dickinson CM. More folic acid for everyone, now. J Nutr 1996; 126 Suppl.: 751S–5S
Ubbink JB, Vermaak WJ, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994; 124(10): 1927–33
Stampfer MJ, Malinow MR. Can lowering homocysteine levels reduce cardiovascular risk? N Engl J Med 1995; 332(5): 328–9
Omaye ST. Safety of megavitamin therapy. In: Friedman M, editor. Advances in experimental medicine and biology. Vol. 177. New York: Plenum Press, 1984: 169–203
Campbell RK, Thorn SL. Micronutrients and diabetes: the supplementation controversy. Diabetes Spectrum 1995; 8(4): 238–46
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Thurman, J.E., Mooradian, A.D. Vitamin Supplementation Therapy in the Elderly. Drugs & Aging 11, 433–449 (1997). https://doi.org/10.2165/00002512-199711060-00003
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DOI: https://doi.org/10.2165/00002512-199711060-00003