Folate Status Worsens in Recently Institutionalized Elderly People without Evidence of Functional Deterioration
Jeanne-Chantal Essama-Tjani, MSc, Jean-Claude Guilland, PhD, Geneviève Potier de Courcy, PhD, Françoise Fuchs, RD, and Dominique Richard, MD
Laboratoire de Physiologie, Faculté de Médecine, Dijon Cedex (J.-C.E.-T., J.-C.G., F.F.), Centre de Gériatrie de Champmaillot (D.R.), Dijon, ISTNA-CNAM, Paris (G.P.d.C.), FRANCE [firstname.lastname@example.org]
Objective: To follow folate status, hematological and cognitive changes during the first year of institutionalization among elderly subjects.
Design: Prospective study.
Setting: Long-stay unit of the Dijon University Geriatric Hospital.
Subjects: Twenty women and four men older than 65 years admitted consecutively.
Main outcome measures: Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating levels of folate, vitamin B-6, total homocysteine (tHcy), blood counts and cognitive performance were determined in parallel.
Results: From d 1 to d 360, mean folate and vitamin B-6 intakes remained below the French RDA and mean folate intakes decreased significantly ( = -10.2%, p<0.05). Mean plasma or erythrocyte folate decreased significantly (= -33.7%, p<0.05 and = -30.2%, p<0.001, respectively) from d 1 to d 360; no significant change was observed for the other blood parameters. The incidence of folate deficiency increased (8% vs. 37% for plasma folate <6.8 nmol/L and 8% vs.17% for erythrocyte folate <340 nmol/L) from d 1 to d 360. Mean plasma PLP remained < 20 nmol/L during the one-year follow-up. There was no difference between gender for plasma tHcy. Although mean plasma tHcy was < 14 mol/L, plasma tHcy was > 14 mol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Ht < 35% in women and Ht < 40% in men), but the anemia was normocytic (MCV < 100fL). Subjects had a moderate dementia at admission, and no change was observed during the study.
Conclusions: Subjects were already vitamin B-6 deficient at admission. Folate status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deterioration. Plasma tHcy didn’t appear to be an earlier predictor of folate deficiency.