Vitamin B12 (Cobalamin) Deficiency in Elderly Patients
Review Synthèse Vitamin B12 (cobalamin) deficiency in elderly patients Emmanuel Andrès, Noureddine H. Loukili, Esther Noel, Georges Kaltenbach, Maher Ben Abdelgheni, Anne E. Perrin, Marie Noblet-Dick, Frédéric Maloisel, Jean-Louis Schlienger, Jean-Frédéric Blicklé Abstract and these should be excluded as causes of cobalamin defi- ciency before a diagnosis is made. To obtain cutoff points VITAMIN B12 OR COBALAMIN DEFICIENCY occurs frequently (> 20%) of cobalamin serum levels, patients with known complica- among elderly people, but it is often unrecognized because the tions are compared with age-matched control patients clinical manifestations are subtle; they are also potentially serious, without complications. Because different patient popula- particularly from a neuropsychiatric and hematological perspec- tions have been studied, several serum concentration defin- tive. Causes of the deficiency include, most frequently, food- itions have emerged.5–7 Varying test sensitivities and speci- cobalamin malabsorption syndrome (> 60% of all cases), perni- ficities result from the lack of a precise “gold standard.” cious anemia (15%–20% of all cases), insufficent dietary intake The definitions of cobalamin deficiency used in this review and malabsorption. Food-cobalamin malabsorption, which has are shown in Box 1. Based in part on the work of Klee7 and only recently been identified as a significant cause of cobalamin in part on our own work,8 they are calculated for elderly pa- deficiency among elderly people, is characterized by the inability to release cobalamin from food or a deficiency of intestinal cobal- tients. The first definition is simpler to interpret, but it re- amin transport proteins or both. We review the epidemiology and quires that blood samples be drawn on 2 separate days.
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