Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B-12 status, and the impact of fortified foods, in older adults.

Abstract

BACKGROUND:

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. 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.

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.

METHODS:

Eligible 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.

RESULTS:

AG 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.

CONCLUSIONS:

Older 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.

• Authors: Kirsty M Porter, Leane Hoey, Catherine F Hughes, Mary Ward, Michelle Clements, Jj Strain, Conal Cunningham, Miriam C Casey, Fergal Tracey, Maurice O'Kane, Kristina Pentieva, Liadhan McAnena, Kevin McCarroll, Eamon Laird, Anne M Molloy, Helene McNulty
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 114 Issue 4 Pg. 1286-1294 (10 04 2021) ISSN: 1938-3207 [Electronic] United States
• PMID: 34134144 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Chemical References

• Biomarkers
• Pepsinogens
• Proton Pump Inhibitors
• Vitamin B Complex
• Vitamin B 12

Topics

• Achlorhydria (complications)
• Aged
• Aging
• Biomarkers (blood)
• Female
• Food, Fortified
• Gastritis, Atrophic (complications)
• Humans
• Male
• Nutritional Status
• Pepsinogens (blood)
• Prevalence
• Proton Pump Inhibitors (adverse effects)
• Vitamin B 12 (administration & dosage, blood, therapeutic use)
• Vitamin B 12 Deficiency (blood, diet therapy, etiology)
• Vitamin B Complex (administration & dosage, blood, therapeutic use)