Micronutrients and Older Adults

Abstract

The aging population worldwide is increasing. Although many older adults are living longer, healthier lives, aging is also associated with a variety of physiologic and psychological changes that influence nutrition status and the need for medical care. Many factors increase the risk for poor nutrient intake among older adults. Suboptimal micronutrient intake for particular vitamins and minerals is reported to be common.

Get full access to this article

View all access options for this article.

References

National Center for Health Statistics, Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/pressroom/97facts/disable.htm. Accessed July 22, 2008.

Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract.2006 ;12:110 -118.

U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: USDHHS;2000 .

Griep MI, Mets TF, Vercruysse A, et al. Food odor thresholds in relation to age, nutritional, and health status. J Gerontol A Biol Sci Med Sci. 1995;50A:B407 -B414.

Hays NP, Roberts SB. The anorexia of aging in humans. Physiol Behav.2006 ;88:257 -266.

Drewnowski A, Shultz JM. Impact of aging on eating behaviors, food choices, nutrition, and health status. J Nutr Health Aging. 2001;5:75 -79.

Weekes E. The incidence of malnutrition in medical patients admitted to hospital in south London. Proc Nutr Soc. 1999 ;58:126A .

Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med.2006 ;144:37 -48.

Mion LC, McDowell JA, Heaney LK. Nutritional assessment of the elderly in the ambulatory care setting. Nurse Pract Forum. 1994;5:46 -51.

10.

Rowe JW, Kahn RL. Successful Aging. 1st ed. New York, NY: Knopf; 1998.

11.

Proctor BD, Dalaker J. Poverty in the United States: 2001. U.S. Census Bureau, current population reports; 60-214. Washington, DC: U.S. Government Printing Office. http://www.census.gov/prod/2002pubs/p60-219.

12.

The Merck Manual of Geriatrics. Chapter 11: Continuity of care: integration of services. www.merck.com/mrkshared/mmg/secl/chll. Accessed August 28, 2008.

13.

Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA.2002 ;287:3127 -3129.

14.

Sebastian RS, Cleveland LE, Goldman JD, Moshfegh AJ. Older adults who use vitamin/mineral supplements differ from nonusers in nutrient intake adequacy and dietary attitudes. J Am Diet Assoc.2007 ;107:1322 -1332.

15.

Feskanich D, Singh V, Willett WC, Colditz GA. Vitamin A intake and hip fractures among postmenopausal women. JAMA.2002 ;287:47 -54.

16.

Promislow JHE, Goodman-Gruen D, Slymen SJ, Barrett-Connor E. Retinol intake and bone mineral density in the elderly: the Rancho Bernardo study. J Bone Miner Res.2002 ;17:1349 -1358.

17.

Melhus H, Michaelsson K, Kindmark A, et al. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk of hip fracture. Ann Intern Med.1998 ;129:770 -778.

18.

Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III). Arch Intern Med.2000 ;160:931 -936.

19.

Food and Nutrition Board, Institute of Medicine. Vitamin C. In: Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academies Press;2000 : 95-185.

20.

Micronutrient Information Center: Vitamin C. Linus Pauling Institute at Oregon State University. www.http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/. Accessed July 30, 2008.

21.

Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the United States: the third National Health and Nutrition Examination Survey, 1988-1994. Am J Public Health.2004 ;94:870 -875.

22.

Waters DD, Alderman EL, Hsia J, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. JAMA. 2002;288:2432 -2440.

23.

Douglas RM, Hemila H, D'Souza R, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2004;(4):CD000980 .

24.

MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet.2002 ;360(9326):23 -33.

25.

Massey LK, Liebman M, Kynast-Gales SA. Ascorbate increases human oxaluria and kidney stone risk. J Nutr.2005 ;135:1673 -1677.

26.

Hendler SS, Rorvik DR, eds. PDR for Nutritional Supplements. Montvale, NJ: Medical Economics;2001 .

27.

Tan AG, Mitchell P, Flood VM, et al. Antioxidant nutrient intake and the long-term incidence of age-related cataract: the Blue Mountains Eye Study. Am J Clin Nutr.2008 ;87:1899 -1905.

28.

Jacques PF, Taylor A, Hankinson SE, et al. Long-term vitamin C supplement use and prevalence of early age-related lens opacities. Am J Clin Nutr.1997 ;66:911 -916.

29.

Valero MP, Fletcher AE, DeStavola BL, Vioque J, Alepuz VC. Vitamin C is associated with reduced risk of cataract in a Mediterranean population. J Nutr. 2002;132:1299 -1306.

30.

Age-Related Eye Disease Study (AREDS). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol.2001 ;119:1439 -1452.

31.

Cherniack EP, Levis S, Troen BR. Hypovitaminosis D: a widespread epidemic. Geriatrics.2008 ;63:24 -30.

32.

Shinchuk L, Holick MF. Vitamin D and rehabilitation: improving functional outcomes. Nutr Clin Pract.2007 ;22:297 -304.

33.

Holick MF. Vitamin D and sunlight: strategies for cancer prevention and other health benefits. Clin J Am Soc Nephrol.2008 ;3(5):1548 -1554.

34.

Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc.2006 ;81:353 -373.

35.

Autier P, Gandini S. Vitamin D supplementation and total mortality. Arch Intern Med.2007 ;167:1730 -1737.

36.

Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med.2007 ;167:1159 -1165.

37.

Robsahm TE, Tretli S, Dahlback A, Moan J. Vitamin D3 from sunlight may improve the prognosis of breast-, colon-, and prostate cancer (Norway). Cancer Causes Control.2004 ;15:149 -158.

38.

Zhou W, Heist RS, Liu G, et al. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non–small-cell lung cancer patients. J Clin Oncol.2007 ;25:479 -485.

39.

Ahn J, Peters U, Albanes D, et al. Serum vitamin D concentration and prostate cancer risk: a nested case–control study. J Natl Cancer Inst. 2008;100:796 -804.

40.

Freedman DM, Looker AC, Chang SC, Graubard BI. Prospective study of serum vitamin D and cancer mortality in the United States. J Natl Cancer Inst. 2007;99:1594 -1602.

41.

Food and Nutrition Board, Institute of Medicine. Vitamin D. In: Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press;1999 : 250-287.

42.

Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet.1998 ;351(9105):805 -806.

43.

Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr.2005 ;135:317 -322.

44.

Roux C, Bischoff-Ferrari HA, Papapoulos SE, de Papp AE, West JA, Bouillon R. New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion. Curr Med Res Opin. 2008;24:1363 -1370.

45.

Jacobs ET, Alberts DA, Foote JA, et al. Vitamin D insufficiency in Southern Arizona. Am J Clin Nutr.2008 ;87:608 -613.

46.

Ahuja JK, Goldman JD, Moshfegh AJ. Current status of vitamin E nutriture. Ann N Y Acad Sci.2004 ;1031:387 -390.

47.

Maras JE, Bermudez OI, Qiao N, Bakun PJ, Boody-Alter EL, Tucker KL. Intake of alpha-tocopherol is limited among US adults. J Am Diet Assoc. 2004;104:567 -575.

48.

Food and Nutrition Board, Institute of Medicine. Vitamin K. In: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academies Press;2001 : 162-196.

49.

Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr.1999 ;69:74 -79.

50.

Booth SL, Dallal G, Shea MK, Gundberg C, Peterson JW, Dawson-Hughes B. Effect of vitamin K supplementation on bone loss in elderly men and women. J Clin Endocrinol Metab.2008 ;93:1217 -1223.

51.

Booth SL, Centurelli MA. Vitamin K: a practical guide to the dietary management of patients on warfarin. Nutr Rev.1999 ;57 (9 pt 1):288 -296.

52.

Baik HW, Russell RM. Vitamin B₁₂ deficiency in the elderly. Annu Rev Nutr.1999 ;19:357 -377.

53.

Food and Nutrition Board, Institute of Medicine. Vitamin B₁₂. In: Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B₆, Vitamin B₁₂, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academies Press;1998 : 306-356.

54.

National Institutes of Health, Office of Dietary Supplements. Dietary supplement fact sheet: vitamin B12. http://ods.od.nih.gov/factsheets/vitaminb12.asp. Accessed August 1, 2008.

55.

Cuskelly GJ, Mooney KM, Young IS. Folate and vitamin B₁₂: friendly or enemy nutrients for the elderly. Proc Nutr Soc. 2007; 66:548 -558.

56.

D'Anci KE, Rosenberg IH. Folate and brain function in the elderly. Curr Opin Clin Nutr Metab Care.2004 ;7:659 -664.

57.

Food and Nutrition Board, Institute of Medicine. Folic acid. In: Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B₆, Vitamin B₁₂, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academies Press;1998 : 193-305.

58.

Go Red For Women. Updated guidelines advise focusing on women's lifetime heart risk: update gives definitive answers on HRT, aspirin, supplements. http://www.goredforwomen.org/newsroom/02_20_2007.html. Accessed August 14, 2008.

59.

Pfeiffer CM, Caudill SP, Gunter EW, Osterloh J, Sampson EJ. Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999-2000. Am J Clin Nutr.2005 ;82:442 -450.

60.

Centers for Disease Control and Prevention. Blood folate levels: the latest NHANES results. http://www.cdc.gov/nchs/data/databriefs/db06.htm. Accessed July 31, 2008.

61.

Smith AD, Young-In K, Refsum H. Is folic acid good for everyone? Am J Clin Nutr.2008 ;87:517 -533.

62.

Smith AD. Folic acid fortification: the good, the bad, and the puzzle of vitamin B-12. Am J Clin Nutr.2007 ;85:3 -5.

63.

Savage DG, Lindenbaum J. Neurological complications of acquired cobalamin deficiency: clinical aspects. Baillieres Clin Haematol. 1995;8:657 -678.

64.

Savage D, Lindenbaum J. Folate-cyanocobalamin interactions. In: Bailey L, ed. Folate in Health and Disease. New York, NY: Marcel Dekker; 1995:237 -285.

65.

Morris MC, Evans DA, Bienias JL, et al. Dietary folate and vitamin B12 intake and cognitive decline among community-dwelling older persons. Arch Neurol.2005 ;62:641 -645.

66.

Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B12 status in relation to anemia, macrocytosis, and cognitive impairment among older Americans in the age of folic acid fortification. Am J Clin Nutr. 2007;85:193 -200.

67.

Charles D, Ness AR, Campbell D, Davey Smith G, Hall MH. Taking folate in pregnancy and risk of maternal breast cancer. BMJ. 2004;329:1375 -1376.

68.

Cole BF, Baron JA, Sandler RS, et al. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA. 2007; 297:2351 -2359.

69.

Song J, Medline A, Mason JB, Gallinger S, Kim YI. Effects of dietary folate on intestinal tumorigenesis in the apcMin mouse. Cancer Res.2000 ;60:5434 -5440.

70.

Song J, Sohn KJ, Medline A, Ash C, Gallinger S, Kim YI. Chemopreventive effects of dietary folate on intestinal polyps in Apc+/–Msh2-/-mice. Cancer Res.2000 ;60:3191 -3199.

71.

Bonaa K. NORVIT: randomised trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. 2005. http://www.escardio.org/knowledge/OnlineLearning/slides/ESC_Congress_2005/BonaaFP1334. Accessed August 8, 2008.

72.

HOPE. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med.2006 ;354:1567 -1577.

73.

Lanske B, Razzaque MS. Vitamin D and aging: old concepts and new insights. J Nutr Biochem.2007 ;18:771 -777.

74.

Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract.2007 ;22:286 -296.

75.

Lanham-New SA. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc Nutr Soc.2008 ;67:163 -167.

76.

Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr. 2000;(suppl):83S -99S.

77.

Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannebaum S. A controlled clinical trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med. 1990;323:878 -883.

78.

Cummings RG. Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int.1990 ;47:194 -201.

79.

Nordin BEC. Calcium and osteoporosis. Nutrition.1997 ;13:664 -686.

80.

Shea B, Wells G, Cranney A, et al. Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analysis of therapies for post-menopausal osteoporosis, VII: meta-analysis of Ca supplementation for the prevention of postmenopausal osteoporosis. Endocrinol Rev. 2002;23:552 -559.

81.

Suzuki Y, Davison KS, Chilibeck PD. Total calcium intake is associated with cortical bone mineral density in a cohort of postmenopausal women not taking oestrogen. J Nutr Health Aging.2003 ;7:296 -299.

82.

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med.1997 ;337:670 -676.

83.

Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res.2004 ;19:370 -378.

84.

Chapuy MC, Arolot ME, Duboeuf F, et al. Vitamin D and calcium to prevent hip fractures in elderly women. N Engl J Med.1992 ;327:1637 -1642.

85.

Cummings RG, Nevitt MC. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res.1997 ;12:1321 -1329.

86.

Recker RR, Hinders S, Davies KM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res. 1996;11:1961 -1966.

87.

Reid IR, Ames RW, Evans MC, et al. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med.1995 ;98:331 -335.

88.

Reinhart RA. Magnesium metabolism: a review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med.1988 ;148:2415 -2420.

89.

MacIntyre I, Robinson CJ. Magnesium and the gut: experimental and clinical observations. Ann N Y Acad Sci.1969 ;162:865 -873.

90.

Durlach J, Bac P, Durlach V, Rayssiguier Y, Bara M, Guiet-Bara A. Magnesium status and ageing: an update. Magnes Res.1998 ; 11:25 -42.

91.

Ilich JZ, Kerstetter JE. Nutrition in bone health revisited: a story beyond calcium. J Am Coll Nutr.2000 ;19:715 -737.

92.

Rude RK, Gruber HE. Magnesium deficiency and osteoporosis: animal and human observations. J Nutr Bicochem.2004 ;15:710 -716.

93.

Reginster JY, Strause L, Deroisy R, Lecart MP, Saltman P, Franchimont P. Preliminary report of decreased serum magnesium in postmenopausal osteoporosis. Magnesium.1989 ;8:106 -109.

94.

Odabasi E, Turan M, Aydin A, Akay C, Kutlu M. Magnesium, zinc, copper, manganese, and selenium levels in postmenopausal women with osteoporosis: can magnesium play a key role in osteoporosis? Ann Acad Med Singapore. 2008;37:564 -567.

95.

Yano K, Heilbrun LK, Wasnich RD, Hankin JH, Vogel JM. The relationship between diet and bone mineral content of multiple skeletal sites in elderly. Am J Clin Nutr.1985 ;42:877 -888.

96.

Tucker K, Kiel DP, Hannan MT, Felson DT. Magnesium intake is associated with bone-mineral density (BMD) in elderly women. J Bone Miner Res. 1995;10:S466 .

97.

Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnes Res. 1993 ;6:155 -163.

98.

Abraham GE, Grewal H. A total dietary program emphasizing magnesium instead of calcium: effect on the mineral density of calcaneous bone in post-menopausal women on hormonal therapy. J Reprod Med. 1990;35:503 -507.

99.

Dominguez LJ, Barbagallo M, Lauretani F, et al. Magnesium and muscle performance in older persons: the InCHIANTI study. Am J Clin Nutr. 2006;84:419 -426.

100.

Wolf FI, Cittadini A. Chemistry and biochemistry of magnesium. Mol Aspects Med.2003 ;24:3 -9.

101.

Prasad AS. Zinc: an overview. Nutrition.1995 ;11:93 -99.

102.

Prasad AS. Zinc: mechanisms of host defense. J Nutr. 2007;137:1345 -1349.

103.

Briefel RR, Bialostosky K, Kennedy-Stephenson J, McDowell MA, Ervin RB, Wright JD. Zinc intake of the U.S. population: findings from the third National Health and Nutrition Examination Survey, 1988-1994.2000 ;130(55 Suppl):13675 -13735.

104.

King JC, Cousins RJ. Zinc. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease. 10th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006: 271.

105.

Prasad AS, Meftah S, Abdallah J, et al. Serum thymulin in human zinc deficiency. J Clin Invest.1988 ;82:1202 -1210.

106.

Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol.2001 ;119:1417 -1436.

107.

Carmel R. Nutritional anemias and the elderly. Semin Hematol. 2008;45:225 -234.

108.

Garry PJ, Hunt WC, Baumgartner RN. Effects of iron intake on iron stores in elderly men and women: longitudinal and cross-sectional results. J Am Coll Nutr.2000 ;19:262 -269.

109.

Hershko C, Patz J, Ronson A. The anemia of achylia gastrica revisted. Blood Cells Mol Dis.2007 ;39:178 -183.

110.

Pieracci FM, Barie PS. Diagnosis and management of iron-related anemias in critical illness. Crit Care Med.2006 ;34:1898 -1905.

111.

Baker H. Nutrition in the elderly: hypovitaminosis and its implications. Geriatrics.2007 ;62:22 -26.

112.

Goulding MR, Rogers ME, Smith SM. Trends in aging—United States and worldwide. MMWR Morbid Mortal Wkly Rep. 2003; 52:101-106. http://www.cdc.gov/mmwr.

113.

Nutrition and Your Health: Dietary guidelines for Americans. http://www.health.gov/dietaryguidelines/dga2005/report/HTML/A_ExecSummary.htm. Accessed August 8, 2008.

114.

United States Department of Agriculture, National Agriculture Library. Dietary guidance. DRI tables. http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=256&topic_id=1342&level3_id=5140. Accessed February 25, 2009.

115.

Committee on Nutrition Services for Medicare Beneficiaries. Food and Nutrition Board Institute of Medicine. The role of nutrition in maintaining health in the nation's elderly evaluating coverage of nutrition services for the Medicare population. http://www.nap.edu/openbook.php?isbn=0309068460. Accessed August 1, 2008.

116.

The National Academies. Older Americans Act Amendments of 2006. http://www7.nationalacademies.org/ocga/Laws/PL109_365.asp. Accessed August 4, 2008.

117.

Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2005;1:CD003288 . DOI:10.1002/14651858.CD003288 . pub2.

118.

McKay DL, Perrone G, Rasmussen H, et al. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr.2000 ;19:613 -621.

119.

Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev. 2008;3:CD004183 . DOI:10.1002/14651858.CD004183 . pub3.

120.

Watkins ML, Erickson JD, Thun MJ, et al. Multivitamin use and mortality in a large prospective study. Am J Epidemiol. 2000;152:149 -162.

121.

Stevens VL, McCullough ML, Diver WR, et al. Use of multivitamins and prostate cancer mortality in a large cohort of US men. Cancer Causes Control. 2005;16:643 -650.

122.

Lawson KA, Wright ME, Subar A, et al. Multivitamin use and risk of prostate cancer in the National Institutes of Health: AARP diet and health study. J Natl Cancer Inst.2007 ;99:754 -764.

123.

Miller ER III, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med.2005 ;142:37 -46.

124.

Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006 ;145:372 -385.

125.

Bradford GS, Taylor CT. Omeprazole and vitamin B12 deficiency. Ann Pharmacother.1999 ;33:641 -643.

126.

Kasper H. Vitamin absorption in the elderly. Int J Vitam Nutr Res. 1999;69:169 -172.

127.

Termanini B, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison Syndrome. Am J Med. 1998;104:422 -430.

128.

Dharmarajan TS, Kanagala MR, Murakonda P, et al. Do acid-lowering agents affect vitamin B₁₂ status in older adults? J Am Med Dir Assoc. 2008;9:162 -167.

129.

Hirschowitz BI, Worthington J, Mohnen J. Vitamin B₁₂ deficiency in hypersecretors during long-term acid suppression with proton-pump inhibitors. Aliment Pharmacol Ther.2008 ;27(11):1110 -1121.

130.

Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol.2004 ;57:422 -428.

131.

Bauman WA, Shaw S, Jayatilleke K, Spungen AM, Herbert V. Increased intake of calcium reverses the B12 malabsorption induced by metformin. Diabetes Care.2000 ;23:1227 -1231.

132.

Albert CM, Cook NR, Gaziano JM, et al. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA. 2008;299:2027 -2036.

133.

Lange H, Suryapranata H, De Luca G, et al. Folate therapy and in-stent restenosis after coronary stenting. N Engl J Med. 2004;350:2673 -2681.

134.

Shrubsole MJ, Jin F, Dai Q, et al. Dietary folate intake and breast cancer risk: results from the Shanghai Breast Cancer Study. Cancer Res. 2001;61:7136 -7141.