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Folate Status Worsens in Recently Institutionalized Elderly People without Evidence of Functional Deterioration

Laboratoire de Physiologie, Faculté de Médecine, Dijon Cedex (J.-C.E.-T., J.-C.G., F.F.), France
Centre de Gériatrie de Champmaillot (D.R.), France
Dijon, ISTNA-CNAM, Paris (G.P.d.C.), France

Address reprint requests to: J.-C. Guilland, Ph.D., Laboratoire de Physiologie, Faculté de Médecine, 7, Boulevard Jeanne d’Arc, BP 87900, 21079 Dijon Cedex, France.

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 pyridoxal 5'-phosphate (PLP) remained <20 nmol/L during the one-year follow-up. There was no difference between genders for plasma tHcy. Although mean plasma tHcy was <14 µmol/L, plasma tHcy was >14 µmol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Hct <35% in women and Hct <40% in men), but the anemia was normocytic (MCV <100 fL). 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.

Key words: Folate, homocysteine, vitamin B-6, dietary intake, biochemical status, blood counts, cognitive deterioration, hospitalized elderly people

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