Elevated serum levels of methylmalonic acid and homocysteine in elderly people.: A population-based intervention study

被引:21
作者
Björkegren, K [1 ]
Svärdsudd, K
机构
[1] Univ Uppsala, Univ Uppsala Hosp, Family Med Sect, Dept Publ Hlth & Caring Sci, S-75185 Uppsala, Sweden
[2] Skutskar Primary Hlth Care Ctr, Skutskar, Sweden
关键词
cobalamin; folate; homocysteine; methylmalonic acid; survey; treatment trial;
D O I
10.1046/j.1365-2796.1999.00559.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. There is uncertainty amongst clinicians about the definitions of cobalamin and folate deficiency and therefore about the indications for treatment. In this report we present the results of systematic cobalamin and folic acid treatment based upon serum cobalamin, total homocysteine (tHcy) and methylmalonic acid (MMA) analyses in a population-based sample. Subjects. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey (n = 266). Sixty-nine persons who had serum cobalamin < 300 pmol L-1 and serum MMA greater than or equal to 0.37 mu mol L-1 or serum tHcy greater than or equal to 15 mu mol L-1 and who had no cobalamin or folic acid substitution were selected for treatment. Interventions. Initially all 69 patients were given cobalamin orally or intramuscularly. Those who remained high in tHcy were in addition given folic acid treatment. Main outcome measures. Serum cobalamin, serum MMA and serum tHcy. Results. After 6 months of cobalamin treatment, serum MMA became normal in 13 out of 15 persons. Mean serum tHcy decreased but was normalized in only 15 out of 56 persons. After 3 months of folic acid treatment added to those who still had an abnormal serum tHcy, serum tHcy had normalized in all but one person. Conclusions, Cobalamin treatment normalizes increased MMA values and combined cobalamin and folic acid treatment normalizes tHcy, suggesting a pretreatment deficiency of tissue cobalamin and folate in spite of normal serum cobalamin and folate values in the majority of cases.
引用
收藏
页码:317 / 324
页数:8
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