Abstract
Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.
Highlights
We propose that the determination of the cut-off point for the diagnosis of iron or vitamin deficiency anemia should be based on the analysis of the receiver-operating characteristic (ROC) curve
A significantly higher incidence of anemia was observed in men than in women and the frequency higher incidence of anemia was observed in men than in women and the frequency of anemia of anemia increased with age, reaching 44.8% in nonagenarian men
To the best of our knowledge, the only population-based survey on a nationally representative group of older people that includes the etiological classification of anemia is the NHANES III study performed in the USA in 1988–1994 and published in 2004 [23]
Summary
According to World Population Prospects announced by United Nations in 2019, there were 703 million persons aged 65 years or over around the world. The number of older persons is projected to double by 2050 and the percentage will rise from 9% to 16%. Population aging concerning the number and proportion of older persons in the entire population is observed in every country in the world [1]. The demand for health care goods and services is linked to the age structure of the population and, notably, with the share of older people in the overall population
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