Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification
Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification
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DOI：
10.1093/ajcn/85.1.193
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发表时间：
2007-01-01
影响因子：
7.1
通讯作者：
Selhub, Jacob
中科院分区：
文献类型：
--
作者：
Savaria Morris, Martha;Jacques, Paul F.;Selhub, Jacob
背景：关于叶酸治疗恶性贫血的历史报道表明，高水平的叶酸强化延迟了维生素B-12缺乏症的诊断或加剧了其影响，这影响了许多老年人。然而，这一想法是有争议的，因为观测数据很少，而且没有定论。此外，实验研究是不道德的。目的：我们研究了1999-2002年美国国家健康和营养检查调查的老年参与者的血清叶酸和维生素B-12状态与贫血、巨噬细胞增多和认知障碍(即数字符号编码分数和34)的关系。设计：受试者血清肌酐水平正常，无中风、酗酒、近期贫血治疗或肝脏、甲状腺或冠状动脉疾病的病史(n=1459)。结果：在控制了人口学特征、癌症、吸烟、饮酒、血清铁蛋白和血肌酐后，低维生素B-12状态与贫血[优势比(OR)：2.7；95%CI：1.7；4.2)、巨核细胞增多(OR：1.8；认知损害(OR：2.5；95%CI：1.6，3.8)。在维生素B-12水平低的组中，血清叶酸；59nmol/L(80%)，而不是
Background: Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical.Objective: We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score < 34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey.Design: The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration < 148 pmol/L or a serum methylmalonic acid concentration > 210 nmol/L-the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine.Results: After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% Cl: 1.7,4.2), macrocytosis (OR: 1.8; 95% Cl: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% Cl: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate > 59 nmol/L (80th percentile), as opposed to