High prevalences of vitamin B ₁₂ and folic acid deficiency in elderly subjects in Israel

The prevalences of vitamin B ₁₂ and folic acid deficiency in the general Israeli population of elders has not been assessed. We measured plasma cobalamin and folic acid concentrations in 418 subjects from four institutions for the aged. 749 subjects attending 19 geriatric day centres and 104 healthy controls. Methylmalonic acid (MMA) and/or homocysteine concentrations were determined in subjects who had a cobalamin concentration <221 pmol/l or folic acid concentration <11 nmol/l respectively. The prevalences of vitamin B ₁₂ deficiency (cobalamin <147 pmol/l and MMA ≥0.24 μmol/l), and folic acid deficiency (folic acid <11 nmol/l and homocysteine of >15 μmol/l) in subjects from day centres were 12.6% and 16.4% respectively, and in subjects from institutions 1.2% and 2.2% respectively (P <0.001). Multiple logistic regression analysis indicated that the relative risk of living at home versus institutions for the aged was highly significant, with odds ratios (OR) of 6.8 [95% confidence interval (CI) 2.6-18.0] for vitamin B ₁₂ deficiency and 6.6 (95% CI 2.9-13.1) for folic acid deficiency. Analysis of data for day centre patients showed that folic acid deficiency was a significant risk factor of vitamin B ₁₂ deficiency (adjusted OR 3.68, 95% CI 2.27-5.98), and vitamin B ₁₂ deficiency was a significant risk of folic acid deficiency (adjusted OR 3.69, 95% CI 2.27-6.01). These data suggest that malnutrition is a major cause of the highly prevalent deficiencies of vitamin B ₁₂ and/or folic acid in elderly Israeli subjects dwelling at home.