Hemoglobin, folate and vitamin B12 status of economically deprived elderly women

Brief Communication
*Zaozianlungliu Gonmei1,Anupa Siddhu2,Gurudayal Singh Toteja1,Supriya Dwivedi1,Vasundhra Chand1,Naval Kishore Vikram3,AK Dixit4,Sarika Tyagi1
1Centre for Promotion of Nutrition Research & Training with special focus on North East, Tribal & Inaccessible population (Indian Council of Medical Research), New Delhi, India
2Department of Food and Nutrition, University of Delhi, New Delhi, India
3Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
4Desert Medicine Research Centre, Jodhpur, Rajasthan, India
DOI:http://dx.doi.org/10.24816/jcgg.2017.v8i4.06

  • Abstract
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Abstract

Anemia with iron, folate, and/or vitamin B12 deficiency is common among elderly. Limited studies have been carried out in India. The study was undertaken to assess the status of hemoglobin, serum folate and vitamin B12 of economically deprived elderly women (aged 60 to 70 years) residing in Delhi, India. A total of 60 elderly women were enrolled in the study. Blood samples were analysed for hemoglobin, serum folic acid, vitamin B12. Anemia was observed among 66.67% of the participants. The prevalence of mild, moderate and severe anemia was 28.3%, 35% and 3.3% respectively. Around 12% and 38% of participants had low serum folate (<10 nmol/L) and vitamin B12 levels (<150 pmol/L) respectively.

Keywords:

anemia, elderly, folate, vitamin B12

Article Outline

  1. Introduction
  2. Material and methods
  3. Results
  4. Discussion
  5. Conflict of interest statement
  6. References

Abstract

Anemia with iron, folate, and/or vitamin B12 deficiency is common among elderly. Limited studies have been carried out in India. The study was undertaken to assess the status of hemoglobin, serum folate and vitamin B12 of economically deprived elderly women (aged 60 to 70 years) residing in Delhi, India. A total of 60 elderly women were enrolled in the study. Blood samples were analysed for hemoglobin, serum folic acid, vitamin B12. Anemia was observed among 66.67% of the participants. The prevalence of mild, moderate and severe anemia was 28.3%, 35% and 3.3% respectively. Around 12% and 38% of participants had low serum folate (<10 nmol/L) and vitamin B12 levels (<150 pmol/L) respectively.

Keywords:

anemia, elderly, folate, vitamin B12

1. Introduction

Anemia is common among elderly with approximately one-third having iron, folate, and/or vitamin B12 deficiency.1,2 Vitamin B12 deficiency due to intrinsic factor deficiency and malabsorption are common among older people. Folate deficiency occurs mainly due to poor diet, intestinal malabsorption, excessive alcohol intake and in people with excessive demands or medical conditions or use of certain drugs.3 There is limited data in the country on status of hemoglobin, folate and vitamin B12 among elderly. This study was undertaken with the aim to assess the levels of hemoglobin, folate and vitamin B12 among economically deprived elderly women residing in Delhi.

2. Material and methods

The study was carried out from January to March 2013 among 60 elderly women aged 60 to 70 years, residing in an urban slum, Kirti Nagar, West Delhi. Those suffering from chronic disease were not enrolled. Institutional ethical clearance was obtained. A written informed consent was taken from all the study volunteers. Blood samples collected were analyzed for hemoglobin, vitamin B12, folate and homocysteine.

All biochemical analysis was done at National Accreditation Board for Testing and Calibration Laboratories (NABL) Accredited Laboratory, Centre for Promotion of Nutrition Research and Training with special focus on North-East, Tribal and Inaccessible Population (Indian Council of Medical Research), New Delhi. Hemoglobin was analyzed using direct cyanmethemoglobin method. Dietary intake of nutrients was collected using 24 hour recall method and food frequency questionnaire.

Anemia was defined as <7.45 mmol/L using World Health Organization (WHO) cut off for hemoglobin.4 Folate and vitamin B12 deficiency was defined as <10 nmol/L and

<150 pmol/L respectively according to WHO, Technical Consultation on Folate and Vitamin B12 Deficiencies.5

3. Results

Out of 60 study volunteers, 40 (66.67%) were anaemic. The mean hemoglobin (Hb) of the study volunteers was 6.95 mmol/L. The prevalence of mild, moderate and severe anemia was 28.3% (Hb; 6.83-7.39 mmol/L), 35% (Hb;4.96-6.76 mmol/L), and 3.3% (Hb; <4.96 mmol/L) respectively. Around 12% and 38% of participants had serum folate <10 nmol/L and vitamin B12 <150 pmol/L respectively. Around 12.5% and 35% of the study volunteers had anemia as well as deficiency of folate and vitamin B12 respectively. Both serum folate and vitamin B12 deficiency was observed to higher in vegetarian (18.75% and 50% respectively) than non vegetarian (6.67% and 30% respectively).

Information on dietary intake of nutrients was also collected from 49 elderly women. Nutrient intake of elderly women indicated gross inadequacy in folate, vitamin B12, vitamin B6, vitamin A, riboflavin, carotenes and minerals like zinc, magnesium and iron. Energy, protein, calcium, niacin and ascorbic acid were moderately adequate.

4. Discussion

Our study indicated prevalence of anemia as 67 % among elderly women. A study carried out among economically deprived elderly in Kishanganj, Bihar, India also reported prevalence of anemia as 63%.6 Shrivastava et al also reported prevalence of anemia as 67.6% and 69.8% among elderly males and females respectively in a hospital based study carried out in Karnataka, India.7 An ICMR study carried among adolescent girls and pregnant women indicated prevalence of anemia over 85%.8

Our study also showed that around 12% and 38% elderly women had low levels of serum folate (<10 nmol/L) and vitamin B12 levels (<150 pmol/L) respectively. This may be due to low intake of folate and vitamin B12 rich foods like milk and milk products, meat and meat products. Studies have shown that folate and vitamin B12 intake were associated with plasma folate and vitamin B12 concentration.9

A study conducted in Bangalore, India revealed that about 16% of south Indian elderly population belonging to upper middle and upper income group had subnormal plasma vitamin B12 levels.10 Hospital based studies carried out in Ahmedabad, India11 reported prevalence of vitamin B12 deficiency as 62.5 % among elderly. Similar to our findings, a study carried out among 470 children (12-52 months) in National Capital Territory (NCT) of Delhi revealed 38% prevalence of vitamin B12 deficiency.12

Vitamin B12 deficiency was observed to be more common among anemic subjects in the present study. A

study carried out among 794 economically deprived adolescent girls (11-18 years) residing in Delhi, India also reported that prevalence of folic acid and vitamin B12 deficiency among those who were anemic was 5.0 % and

63.3 % respectively.13 Gopinath et al14 also reported that vitamin B12 deficiency rather than serum folate deficiency was associated with anemia.

A review on prevalence of vitamin B12 deficiency among vegetarians indicated that prevalence ranged from 0 to 86.5% among elderly.15 Our study also revealed that vitamin B12 deficiency was 50% among vegetarians and 30% among non vegetarians.

Anemia with vitamin B12 and folate deficiency is common among economically deprived elderly women. However, the present study has been conducted in a small number of subjects and may not actually represent the study population. Hence, the data may be used to plan studies with larger sample size in future.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgement

The authors wish to thank the CNRT staffs for their help in data collection.

References

  1. Gaskell H, Derry S, Moore RA and McQuay HJ. Prevalence of anemia in older persons: systematic review. BMC Geriatrics. 2008;8:1
  2. Patel KV. Epidemiology of Anemia in Older Adults. Semin Hematol.
    2008;45:210-7.

  3. Clarke R, Evans JG, Schneede J, Nexo E, Bates C, Fletch A, et al. Vitamin B12 and folate deficiency in later life. Age and Ageing. 2004;33:34-41
  4. WHO. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. 2011 (WHO/NMH/NHD/MNM/11.1)
  5. WHO. Technical consultation on Folate and Vitamin B12 Deficiencies. Food and Nutrition Bulletin. 2008;29:S238-44.
  6. Barman SK, Lata K, Ram R, Ghosh N, Sarker G, Shahnawaz K. A study of morbidity profile of geriatric population in an urban community of Kishanganj, Bihar, India. GJMEDPH. 2014;3(1).
  7. Shrivastava SR, Hippargi SB, Ambali AP, Yelikar BR. Patterns of Anemia in Geriatric group. JKIMSU 2013;2(1):77-81.
  8. Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311-5.
  9. Chen KJ, Pan WH, Shaw NS, Huang RF, Lin BF. Association between dietary folate-rich food intake and folate status of elderly Taiwanese. Asia Pac J Clin Nutr. 2005;14:244-9.
  10. Shobha V, Tareya, SD, Shetty P, Unni US, Srinivasan K, Kurpad AV. Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population. Indian J Med Res. 2011;134:432-9.
  11. Parmar V, Shah P, Khubchandani A, Solanki V, Vaghela V, Jadav J. Vitamin B12 Status in different Age Groups. Int J Res Med. 2015;4(2);113-5.
  12. Kapil U, Toteja GS, Bhadoria AS. Cobalamin and Folate Deficiencies among Children in the Age Group of 12-59 Months in India. Biomed J. 2015;38:162-6.
  13. Bansal PG, Toteja GS, Bhatia N, Vikram NK, Siddhu A, Kumar AG, et al. Deficiencies of Serum Ferritin and Vitamin B12, but not Folate, are Common in Adolescent Girls Residing in a Slum in Delhi. Int J Vitam Nutr Res. 2015;85:14-22.
  14. Gopinath B, Rochtchina E, Flood V, Mitchell P. Association of Elevated Homocysteine Level and Vitamin B12 Deficiency With Anemia in Older Adults. Arch Intern Med. 2009;169:901-2.
  15. Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr. 2014;68(5):541-8.

References

  1. Gaskell H, Derry S, Moore RA and McQuay HJ. Prevalence of anemia in older persons: systematic review. BMC Geriatrics. 2008;8:1

  2. Patel KV. Epidemiology of Anemia in Older Adults. Semin Hematol.
    2008;45:210-7.


  3. Clarke R, Evans JG, Schneede J, Nexo E, Bates C, Fletch A, et al. Vitamin B12 and folate deficiency in later life. Age and Ageing. 2004;33:34-41


  4. WHO. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. 2011 (WHO/NMH/NHD/MNM/11.1)


  5. WHO. Technical consultation on Folate and Vitamin B12 Deficiencies. Food and Nutrition Bulletin. 2008;29:S238-44.


  6. Barman SK, Lata K, Ram R, Ghosh N, Sarker G, Shahnawaz K. A study of morbidity profile of geriatric population in an urban community of Kishanganj, Bihar, India. GJMEDPH. 2014;3(1).


  7. Shrivastava SR, Hippargi SB, Ambali AP, Yelikar BR. Patterns of Anemia in Geriatric group. JKIMSU 2013;2(1):77-81.


  8. Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311-5.


  9. Chen KJ, Pan WH, Shaw NS, Huang RF, Lin BF. Association between dietary folate-rich food intake and folate status of elderly Taiwanese. Asia Pac J Clin Nutr. 2005;14:244-9.


  10. Shobha V, Tareya, SD, Shetty P, Unni US, Srinivasan K, Kurpad AV. Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population. Indian J Med Res. 2011;134:432-9.


  11. Parmar V, Shah P, Khubchandani A, Solanki V, Vaghela V, Jadav J. Vitamin B12 Status in different Age Groups. Int J Res Med. 2015;4(2);113-5.


  12. Kapil U, Toteja GS, Bhadoria AS. Cobalamin and Folate Deficiencies among Children in the Age Group of 12-59 Months in India. Biomed J. 2015;38:162-6.


  13. Bansal PG, Toteja GS, Bhatia N, Vikram NK, Siddhu A, Kumar AG, et al. Deficiencies of Serum Ferritin and Vitamin B12, but not Folate, are Common in Adolescent Girls Residing in a Slum in Delhi. Int J Vitam Nutr Res. 2015;85:14-22.


  14. Gopinath B, Rochtchina E, Flood V, Mitchell P. Association of Elevated Homocysteine Level and Vitamin B12 Deficiency With Anemia in Older Adults. Arch Intern Med. 2009;169:901-2.


  15. Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr. 2014;68(5):541-8.