Evaluation of cobalamin and folate deficiency in older people

INTRODUCTION

Vitamin-B12 or cobalamin and folate are essential micronutrients required for the production of blood cells,
maintaining nervous system, regulating folic acid and B 12-dependent genetic processes, and maintenance mucosa
[1]. Vitamin-B12 is the only water soluble vitamin stored by the human body for a sufficient time and the liver is the
primary storage site of the vitamin [2]. Since turnover of vitamin-B 12 is approximately 0.1% per day, it would take
almost 2-10 years to develop B 12 deficiency even when a diet is completely lacking in the vitamin [2, 3]. But besides
that a regular consumption of folic acid is required as there is no storage of the vitamin in human body. Cobalamin
and folic acid are mainly required for the biochemical reactions which are vital for the production of DNA and
protein [5].With the help of active coenzyme form of folic acid and cobalamin, methionine synthase takes part in re-
methylation process of homocysteine. Hence insufficiency of cobalamin or folic acid in body causes hyper-
homocysteinemia. Methyl-malonyl coenzyme-A mutase, the enzyme required for the conversion of methyl-malonyl
coenzyme-A into succinyl coenzyme-A also needs cobalamin residues.

Symptoms of cobalamin deficiency are variable; hardly its deficiency shows typical symptoms like macrocytic
anemia, neurological disorder and subacute combined degeneration of spinal cord [4]. Common problems of elderly
population like fatigue, weakness, malaise, dizziness and cognitive declines are the frequently occurring clinical
manifestation of cobalamin deficiency [4, 5]. Macrocytic anemia is also a symptom of folic acid deficiency but
neurological symptoms are not same for both parameters. Hence the proper evaluation of the exact prevalence of
these deficiencies is essential to rectifying the deficiency disorders otherwise symptoms, especially like neurological
manifestations will be untreated [6].

MATERIALS AND METHODS

This cross-sectional study was conducted in a tertiary care hospital of Chennai, Tamil Nadu in between December
2017 to March 2018, with the approval of Institutional Human Ethical Committee, CARE (Ethical Guidelines for
Biomedical Research on Human Participants, ICMR, 2006). The study include a random sampling of 100 healthy
elderly individual aged above 60 years, who were the general OPD patients of Chettinad Hospital and Research
Institute. Patients who were taking vitamin-supplements, on hormone replacement therapy, suffering from diabetes
mellitus, hypertension were excluded from the study. Sample size was calculated according to the prevalence rate of
12%s. Informed consent was obtained from all the participants or else from their descendants in case of incapable
patients before sample collection. Data regarding medical history, dietary habit and other life style factors were
obtained through a structured questionnaire from all the participants. Anthropometric measurements were carried
out for height and weight measurements and BMI was calculated by this following formula - weight (Kg)/ height
(meter2). Approximately 5 ml of fasting blood sample was collected from the antecubital vein of each patient by
trained phlebotomist in plain red topped vacutainer. Fresh blood sample was centrifuged to obtain serum.

Estimation of serum vitamin-B12 and folic acid was done by analyzing fresh serum samples by chemiluminescence
immunoassay (CLIA). Standard protocol provided with the assessment kit was followed for the analysis. After
estimation all the participants were distributed into 3 groups according to their serum level of vitamin-B 12; absolute
deficient group (<145 pg/dL), borderline deficient group (145-180 pg/dL) and normal individual (180-914 pg/dL)
[21] and in 2 groups according to folic acid levels; deficient groups (<5.89 ng/dL) and normal individual (5.9 - 24.8
ng/dL).

Statistical analysis
RESULTS

AGE SEX

50-59 60-69 70 AND χ2 P MALE FEMALE χ2 P VALUE

YEARS YEARS ABOVE VALUE (%) (%)
(%) (%) (%)

VITAMI NORMAL 16 26 8 7.761 0.101 20 16 0.661 0.719

N B12

ABSOLUTE 12 24 11 26 29
DEFICIENCY

INTERMEDIATE 8 5 0 9 10
DEFICIENCY

FOLIC NORMAL 28 18 4 2.479 0.648 36 31 1.087 0.581

ACID

ABSOLUTE 29 14 4 15 20
DEFICIENCY

INTERMEDIATE 10 3 0 4 4
DEFICIENCY