Skip to main content
×
Home

Folate and vitamin B12 status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK

  • Robert Clarke (a1), Paul Sherliker (a1), Harold Hin (a2), Anne M. Molloy (a3), Ebba Nexo (a4), Per M. Ueland (a5), Kathleen Emmens (a1), John M. Scott (a3) and John Grimley Evans (a6)...
Abstract

Concerns about risks for older people with vitamin B12 deficiency have delayed the introduction of mandatory folic acid fortification in the UK. We examined the risks of anaemia and cognitive impairment in older people with low B12 and high folate status in the setting of voluntary fortification in the UK. Data were obtained from two cross-sectional studies (n 2403) conducted in Oxford city and Banbury in 1995 and 2003, respectively. Associations (OR and 95 % CI) of cognitive impairment and of anaemia with low B12 status (holotranscobalamin < 45 pmol/l) with or without high folate status (defined either as serum folate >30 nmol/l or >60 nmol/l) were estimated after adjustment for age, sex, smoking and study. Mean serum folate levels increased from 15·8 (sd 14·7) nmol/l in 1995 to 31·1 (sd 26·2) nmol/l in 2003. Serum folate levels were greater than 30 nmol/l in 9 % and greater than 60 nmol/l in 5 %. The association of cognitive impairment with low B12 status was unaffected by high v. low folate status (>30 nmol/l) (OR 1·50 (95 % CI 0·91, 2·46) v. 1·45 (95 % CI 1·19, 1·76)), respectively. The associations of cognitive impairment with low B12 status were also similar using the higher cut-off point of 60 nmol/l for folate status ((OR 2·46; 95 % CI 0·90, 6·71) v. (1·56; 95 % CI 1·30, 1·88)). There was no evidence of modification by high folate status of the associations of low B12 with anaemia or cognitive impairment in the setting of voluntary fortification, but periodic surveys are needed to monitor fortification.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Folate and vitamin B12 status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Folate and vitamin B12 status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Folate and vitamin B12 status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Dr Robert Clarke, fax +44 1865 743985, email robert.clarke@ctsu.ox.ac.uk
References
Hide All
1Department of Health (2006) Folate and Disease Prevention. London: Scientific Advisory Committee on Nutrition.
2Clarke R, Refsum H, Birks J, et al. (2003) Screening for vitamin B12 and folate deficiency in older people. Am J Clin Nutr 77, 12411247.
3Clarke R, Grimley Evans J, Schneede J, et al. (2004) Vitamin B12 and folate deficiency in older people. Age Ageing 33, 3441.
4Hin H, Clarke R, Sherliker P, et al. (2006) Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. Age Ageing 35, 416422.
5Clarke R, Sherliker S, Hin H, et al. (2007) Detection of vitamin B12 deficiency in older people by vitamin B12, or the active fraction of vitamin B12, holotranscobalamin. Clin Chem 53, 963970.
6Mills JL, Von Kohorn I, Conley MR, et al. (2003) Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain. Am J Clin Nutr 77, 14741477.
7Metz J, McNeil AR & Levin M (2004) The relationship between serum cobalamin concentration and mean red cell volume at varying concentrations of serum folate. Clin Lab Haematol 26, 323325.
8Dhar M, Bellevue R & Carmel R (2003) Pernicious anemia with neuropsychiatric dysfunction in a patient with sickle cell anemia treated with folate supplementation. N Engl J Med 348, 22042207.
9Morris MC, Evans DA, Bienias JL, Tangney CC, Hebert LE, Scherr PA & Schneider JA (2005) Dietary folate and vitamin B12 intake and cognitive decline among community-dwelling older persons. Arch Neurol 62, 641645.
10Morris MS, Jacques PF, Rosenberg IH & Selhub J (2007) Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr 85, 193200.
11Medical Research Council Cognitive Function and Ageing Study (1998) Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. Psychol Med 28, 319335.
12Folstein MF, Folstein SE & McHugh PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12, 189198.
13Ulleland M, Eilertsen I, Quadros EV, et al. (2002) Direct assay for cobalamin bound to transcobalamin (holo-transcobalamin) in serum. Clin Chem 48, 526532.
14Nexo E, Christensen AL, Hvas AM, Petersen TE & Fedosov SN (2002) Quantification of holo-transcobalamin, a marker of vitamin B12 deficiency. Clin Chem 48, 561562.
15Refsum H, Smith AD, Ueland PM, et al. (2004) Facts and recommendations about total homocysteine determinations: an expert opinion. Clin Chem 50, 332.
16Husek P (1998) Chloroformates in gas chromatography as general purpose derivitizating agents. J Chromatogr Biomed Sci Appl 717, 5791.
17Molloy AM & Scott JM (1997) Microbiological assay for serum, serum and red-cell folate using cryopreserved, microliter plate method. Meth Enzymol 281, 4353.
18Clarke R, Birks J, Nexo E, Ueland PM, Schneede PM, Scott J, Molloy A & Evans JG (2007) Low vitamin B12 status and risk of cognitive decline in older people. Am J Clin Nutr 86, 13841391.
19Selhub J, Morris MS & Jacques PF (2007) In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. Proc Natl Acad Sci 104, 19952000.
20Clarke R (2006) Vitamin B12, folic acid, and the prevention of dementia. N Engl Med 354, 28172819.
21Clarke R (2008) B-Vitamins and prevention of dementia. Proc Nutr Soc 67, 7581.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 20
Total number of PDF views: 129 *
Loading metrics...

Abstract views

Total abstract views: 151 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.