Abstract
ABSTRACTBackgroundAtrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking.ObjectivesTo investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults.MethodsEligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008–2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value < −0.5. A pepsinogen I:II ratio <3 was considered indicative of AG.ResultsAG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P < 0.001) and plasma holotranscobalamin (holoTC; P < 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P < 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0–4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG.ConclusionsOlder adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.
Highlights
Food-bound malabsorption is widely considered the main contributor to subclinical vitamin B-12 deficiency in older adults in high-income countries [1]
BP, blood pressure; pump inhibitors (PPIs), proton-pump inhibitor; TUDA, Trinity-Ulster and Department of Agriculture. 2P < 0.05; analysis via χ 2 for categorical variables or ANCOVA for continuous variables on log-transformed data as appropriate with Bonferroni post hoc tests. 3Alcohol; 1 unit equates with 25 mL spirits, 220 mL beer, or 85 mL wine. 4Participants who consumed foods fortified with vitamin B-12 at least once per week
Atrophic gastritis (AG), characterized biochemically by a pepsinogen I:II ratio
Summary
Food-bound malabsorption is widely considered the main contributor to subclinical vitamin B-12 deficiency in older adults in high-income countries [1]. Atrophic gastritis (AG) [2] and chronic use of acid suppression drugs such as proton pump inhibitors (PPIs) [3] are among the contributing factors to vitamin B-12 malabsorption. Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. Objectives: To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults. Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0–4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG. Conclusions: Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency.
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