Aging, Neurological Diseases, and Vitamin B12

By: Susan Ocon and Nora Ko

Outline
1. Background of Vitamin B12 2. A study on Vitamin B12 deficiency, and its relationship to Aging and Neurological Diseases

Expected Population Growth of Aging American Society

In 2011, 40 million people in the USA were 65 years and older1 In 2050, 89 million people in the USA are expected to be 65 years and older1

Mather, Mark. Population Bulletin.2011.

Growth Trends

www.aoa.gov/aoaroot/aging_statistics/.../By_Age_65_and_over.xls

What is vitamin B12?

Water soluble1 Synthesized from bacteria2 Cofactor in nucleic acid metabolism3
Methionine synthase4 L-methylmalonyl-CoA mutase4
1

http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

http://www.veganhealth.org/b12/int

http://www.iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity% 20Files/Nutrition/DRIs/New%20Material/7_%20Nutrients%20Summary.pdf
4

http://www.nal.usda.gov/fnic/DRI/DRI_Thiamin/306-356_150.pdf

zidenberg-cherr. Vitamin Requirements:Nut111B. 2012

Food Sources of Vitamin B12

How is B12 Absorbed in Humans

Food-B12 + R 1. Cobalamins are bound to proteins in the food consumed1 2. In the stomach, pepsin and hydrochloric acid release linkage of B12 to food1 3. R protein (hatocorrins) binds to food in stomach or duodenum1

R + Food-B12 STOMACH HCL R-B12

IF

4. Bound R protein to B12 and IF move to small intestine1

R-B12 + IF

Gropper. Advanced Nutrition and Human Metabolism. 6th Edition

Absorption Continued...
1. pH becomes alkaline and panectic protease hydrolyze R and B121

Small Intestine: duodenum

R-B12 + IF

2. After release B12 binds to IF1

IF-B12 + R Small Intestine: ileum

3. Protein receptor Cubilin accepts B12 and passes to other proteins to cross basolateral membrane into the blood1 IF-B12

Gropper. Advanced Nutrition and Human Metabolism. 6th Edition

Problems with Absorption in Elderly

Decrease in IF secretion by parietal cells1
pernicious anemia

Decrease in HCL secretion by parietal cells1

achlorhydria and atrophic gastritis

Medications for treatment of ulcers and gastroesophageal reflux disease1

decrease HCL secretion
1

Gropper. Advanced Nutrition and Human Metabolism. 6th Edition

Vitamin B12 Requirements (RDA)

B12 is measured in serum levels; normal ranges 120-180 pmol/L or 170-250 pg/mL1 Age 19-70: 2.4 micrograms/day2 Age 51 and older advised consume B12 in supplement form or fortified foods2

zidenberg-cherr. Vitamin Requirements:Nut111B. 2012

http://www.iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity% 20Files/Nutrition/DRIs/5_Summary%20Table%20Tables%201-4.pdf

Functions of B12 are...

Red blood cell formation1 Neurological Function1 DNA synthesis1 Prevents megaloblastic anemia2
1 2

http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ http://ods.od.nih.gov/factsheets/VitaminB12-QuickFacts/

Diseases caused by Vitamin B12 Deficiency

Traditionally, Anemia1 Neuropsychiatric problems: sensory disturbances in extremities1 impaired vision1 loss of bowel and bladder control1 extrapyramidal symptoms1 motor restlessness, spasms, and inability to move1
(These diseases are commonly found in older populations and may be attributed to other causes).1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Role of B12 and Folate in Human Body

Cobalamin 5-methyl THF Methionine methionine adenosyl transferase s-adenosyl methionine

Methylene THF reductase 5,10-methylene THF Serine hydroxymethyltransferase THF methylcobalamin methionine synthase

s-adenosyl homocysteine

Homocysteine

Role of Folate

Role of B12

Cystathionine

Pathway of B12: Sulfur Amino Acid Metabolism

zidenberg-cherr. Vitamin Requirements:Nut111B. 2012

VITAMIN B12 DEFICIENCY IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES

The Journal of Nutrition, Health and Aging: Volume 16, Number 3, 2012 By: C. Mirkazemi, G.M. Peterson, P.C. Tenni, S.L. Jackson

Study Question
How prevalent is undiagnosed vitamin B12 deficiency among a population of five nursing homes in southern Tasmania, Australia?1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Methods
Five residential aged care facilities in S. Tasmania agreed to do the study1 130 cases responded positively to having their serum vitamin B12 levels measured1 Mean age was 88 years old1 Serum B12 tests were performed by a local pathology provider using the IMMULITE 2000 Vitamin B12 Analyser Model: L2KVB21
1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Methods (2)
The analyzer was limited to 111 pmol/L to 870 pmol/L1 <150 pmol/L is deficient1 150-250 pmol/L is borderline1 Several statistical measures were used: ttest for independence from differences between groups1 One way ANOVA, chi-square for categorical data1 Pearson's rank was used to measure for correlation1 p-values <0.05 considered only1
1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Results
Mean B12 serum level 282 pmol/L1 14% of residents had B12 serum level of less than 150 pmol/L1 36% of residents had B12 serum level of 150-250 pmol/L1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Results Continued

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Results Continued

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Researchers' Conclusion

There is not a significant amount of undiagnosed vitamin B12 deficiency among the population studied in the southern Tasmania, Australian nursing homes.1
1

Mirkazemi, C. et al., Jour of Nutr, Health and Aging, 2012

Critique on the Study

Measuring homocysteine serum levels or methylmalonic acid serum levels might have increased accuracy of vitamin deficiency and neurological diseases. Americans need to look at study cutoffs differently because the DRI is different.

Importance for the Study Results for the Future

There should be a regular screening of elderly people before they are placed into nursing homes or during physical examinations for old people who do not live in nursing homes. This study should be performed in US again comparing free living elderlies vs nursing homes elderlies

Questions?