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Vitamin B₁₂ (cobalamin) deficiency in elderly patients

From the Departments of Internal Medicine and of Diabetes and Metabolic Diseases, Medical Clinic B (Andrès, Loukili, Noel, Abdelgheni, Blicklé), Internal Medicine and Geriatrics (Kaltenbach, Noblet-Dick), Internal Medicine and Nutrition (Perrin, Schlienger), and the Oncology and Hematology Department (Maloisel), Strasbourg University Hospitals, Strasbourg, France.

Abstract

VITAMIN B₁₂ OR COBALAMIN DEFICIENCY occurs frequently (> 20%) among elderly people, but it is often unrecognized because the clinical manifestations are subtle; they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. Causes of the deficiency include, most frequently, food-cobalamin malabsorption syndrome (> 60% of all cases), pernicious anemia (15%–20% of all cases), insufficent dietary intake and malabsorption. Food-cobalamin malabsorption, which has only recently been identified as a significant cause of cobalamin deficiency among elderly people, is characterized by the inability to release cobalamin from food or a deficiency of intestinal cobalamin transport proteins or both. We review the epidemiology and causes of cobalamin deficiency in elderly people, with an emphasis on food-cobalamin malabsorption syndrome. We also review diagnostic and management strategies for cobalamin deficiency.

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