Anaemia: cobalamin deficiency was common in the elderly.

Clinical bottom line (level 4)

  1. 40% of elderly patients had low serum cobalamin levels.
  2. Around 12% had evidence of anaemia.
Lindenbaum et al: American Journal of Clinical Nutrition 1994; 60: 2-11
Expires December 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: community study, USA

548 patients (aged range 67 to 96 years; mean 77, 64% female) undergoing routine examination



Outcomes studied:
  • low serum cobalamin <258 pmol/l
  • high methylmalonic acid high if >3 SD above normal
  • high Hcy high if >3 SD above normal
  • low cobalamin and high methylmalonic acid
  • low cobalamin and high Hcy

    • All patients had serum cobalamin, folate, methylmalonic acid and homocysteine levels.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    low serum cobalamin ? 222/548 41%
    (36% to 45%)
    high methylmalonic acid ? 82/548 15%
    (12% to 18%)
    high Hcy ? 39/548 7.1%
    (5.0% to 9.3%)
    low cobalamin and high methylmalonic acid ? 62/548 11%
    (8.7% to 14%)
    low cobalamin and high Hcy ? 31/548 5.7%
    (3.7% to 7.6%)

    • 12% of patients were anaemic (typically normocytic).

    Comments

    1. No clear definition of cobalamin deficiency was given. Many patients had abnormal metabolite levels with normal cobalamin levels indicating a possible deficiency.

    Citation

    1. Lindenbaum J, Rosenberg IH, Wilson PWF, et al: Prevalence of cobalamin deficiency in the Framingham elderly population. American Journal of Clinical Nutrition 1994; 60: 2-11
    Search Terms: reference in review article
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer:

    Clinical Question.
    Patient undergoing routine examination
    Intervention or Exposure prevalence
    Outcome cobalamin and methylmalonic acid