Consensus of the Brazilian Association of Nutrology on diagnosis, prophylaxis, and treatment of vitamin B12 deficiency

Introduction: Vitamin B12 deficiency is quite prevalent in all age groups and all regions of the country, however, there is a need for standardization of clinical management recommendations. Objective: It was to achieve a consensus on the diagnosis, prophylaxis, and treatment of vitamin B12 deficiency. Methods: An integrative review of the scientific literature was carried out in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases and on governmental and regulatory websites. Results: According to the literary search carried out by the authors of this study, 84 scientific works were selected. Based on these findings, in the timeline from 1999 to 2022, randomized controlled clinical studies represented the majority, and prospective and retrospective studies with significant sample sizes were elucidated in this consensus on the vitamin B12 administration for all patient populations. The basis of this scientific evidence was determined by appropriate clinical trials, with additional endpoints including patient clinical symptoms and biochemical parameters in addition to serum and marginal B12 level. Conclusions: Based on the scientific literature, the recommendations of the Brazilian Association of Nutrology for diagnosis, prophylaxis, and treatment of vitamin B12 deficiency were presented

Involuntary weight loss in elderly individuals: assessment and treatment

CONTEXT: The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. DESIGN: Narrative review