Â Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin &lt;130 g/L and &lt;120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 &lt;203 pg/ml and hyperhomocysteinemia as serum homocysteine &gt;15 Î¼mol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency

Bansal, Priyanka Gupta

Dwivedi, Supriya

Gonmei, Zaozianlungliu

Singh, Karuna

Toteja, Gurudayal Singh

Vikram, Naval Kishore

English

Innovare Academic Sciences: E-Journals

Vol 11, Issue 1, 2018Online - 2455-3891 Print - 0974-2441ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLYZAOZIANLUNGLIU GONMEI1,2, SUPRIYA DWIVEDI1,3, GURUDAYAL SINGH TOTEJA1,5*, KARUNA SINGH2, NAVAL KISHORE VIKRAM4, PRIYANKA GUPTA BANSAL11Division of Nutrition, Centre for Promotion of Nutrition Research & Training with special focus on North East, Tribal & Inaccessible population (Indian Council of Medical Research), New Delhi, India. 2Department of Food & Nutrition, Amity Institute of Food Technology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India. 3Department of Biotechnology, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India. 4Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. 5Department of Nutrition, Desert Medicine Research Centre (Indian Council of Medical Research), Jodhpur, Rajasthan, India. Email: gstoteja@gmail.comReceived: 20 November 2017, Revised and Accepted: 18 December 2017ABSTRACTObjective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 µmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency.Keywords: Elderly, Anemia, Vitamin B12, Homocysteine.INTRODUCTIONThe population of older adults aged 60 and above is growing rapidly worldwide. In India, respectively, 73.3 million and 30.6 million elderly resides in rural and urban areas [1]. It is estimated that almost 50% of elderly in India suffer from chronic diseases and 5% suffer from immobility [2]. Anemia is considered as an important marker in the investigation of health as it can be easily diagnosed and markedly affects the quality of life of an elderly [3]. It is common in elderly and is associated with adverse outcomes such as weakness, increased falls, depression, hospitalization, and mortality [4,5]. Around one-third of elderly with anemia have iron, folate, and/or Vitamin B12 deficiency [6]. Vitamin B12 deficiency may occur due to poor nutrition, stomach/intestinal problems and can result in anemia [7]. Homocysteine levels are increased due to a genetic deficiency of the enzymatic pathways involved in its catabolism, nutritional deficiencies, lifestyle, physiological conditions, drugs, and diseases, which induces a deficiency of folic acid, Vitamins B12 and B6 [8].In India, the prevalence of anemia is 58.4%, 53%, and 22.7% among children (6–59 months), women (15–49 years), and men (15–49 years), respectively, as per National Family Health Survey 4 (2015–16) [9]. However, there is no nationwide survey for elderly to indicate the overall prevalence of anemia. Moreover, there are limited studies in India reporting the prevalence of anemia with Vitamin B12 deficiency among elderly. Hence, the present study has been conducted to assess the prevalence of anemia with Vitamin B12 deficiency among elderly in slums of West Delhi.METHODSA cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. Community survey of slums was carried out to identify elderly with the help of local community leaders and paramedical working in the area. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12, and homocysteine. Hemoglobin was analyzed using direct cyanmethemoglobin method, while serum Vitamin B12 and homocysteine were analyzed using chemiluminescent immunometric assay (Immulite 1000 analyzer, Siemens). Institutional Ethical Clearance was obtained. A written informed consent was taken from all the study volunteers.All biochemical analysis was done at National Accreditation Board for Testing and Calibration Laboratories (NABL) Accredited Laboratory, Centre for Promotion of Nutrition Research and Training with special focus on Northeast, Tribal and Inaccessible Population (Indian Council of Medical Research), New Delhi. Internal and external quality control of analysis was maintained by running controls along with the samples and by participation in external quality assurance programs.Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively [10], Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml [11] and hyperhomocysteinemia as serum homocysteine >15 µmol/l [12].RESULTSThe overall prevalence of anemia and Vitamin B12 deficiency among elderly was 57.76% and 36.36%, respectively. Prevalence of anemia was higher among female (61.82%) compared to male (54.10%) (Table 1). The prevalence of mild, moderate, and severe anemia was 31.90%, 24.14%, and 1.72%, respectively. Prevalence of mild anemia was higher in male (36.07%) while the prevalence of moderate anemia was higher in female (32.737%).© 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11i1.23750Research Article403Asian J Pharm Clin Res, Vol 11, Issue 1, 2018, 402-404 Gonmei et al. The prevalence of Vitamin B12 deficiency (Table 2) was higher in male (41.67) than female (31.71%). Similarly, the prevalence of hyperhomocysteinemia was higher in male (73.91) than female (53.49%). Both Vitamin B12 deficiency and hyperhomocysteinemia were higher among vegetarians. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively (Table 3).DISCUSSIONOur study revealed the prevalence of anemia as 57.76% among elderly, with 31.90%, 24.14%, and 1.72% having mild, moderate, and severe anemia, respectively. Our findings are similar to a study carried out among adolescent girls in the same study locale where the prevalence of anemia was reported as 58.7%, with 31.6%, 25.7%, and 1.4% of subjects being mild, moderate, and severely anemic [13]. Studies carried out among elderly in different parts of the country have reported the prevalence of anemia ranging from 27.8% to 96% [14-18].A study carried out in Bengaluru reported a lower prevalence of Vitamin B12 deficiency (16%) and hyperhomocysteinemia (13%) as 35% of the study population was consuming multivitamin supplements [12]. Studies carried out among adults in Maharashtra (58%) and Assam (55%) reported similar findings on the prevalence of hyperhomocysteinemia [19,20]. While a study carried out among adults residing in an urban slum and adjacent non slum area in the Southern area of New Delhi revealed a higher prevalence of hyperhomocysteinemia (84%) [21].Data of 1770 elderly individuals aged 60 years and older elderly males obtained from the 2001-2002 National Health and Nutrition Examination Health Survey revealed that elderly male is at higher risk of folate and Vitamin B12 deficiencies [22]. Our study also indicated a higher prevalence of Vitamin B12 deficiency among male (41.67%) than female (31.71%).Around one-third of anemia is nutritional anemia mainly due to calorie and protein restriction, iron, Vitamin B12, and folic deficiency [23]. Our study also revealed Vitamin B12 deficiency among 33.33% of elderly with anemia. Both Vitamin B12 deficiency and hyperhomocysteinemia were higher among vegetarians. Non-consumption of animal foods may result in the low intake of Vitamin B12, thereby resulting in lowered Vitamin B12 levels and elevated homocysteine concentrations in vegetarians [24].CONCLUSIONMore than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency.ACKNOWLEDGMENTThe authors acknowledge the support of Indian Council of Medical Research and University Grants Commission.REFERENCES1. Ministry of Statistics and Programme Implementation, Government of India. Elderly in India; 2016. Available from: http://www.mospi.nic.in/sites/default/files/publication_reports/ElderlyinIndia_2016.pdf. [Last accessed on 2017 Sep 25].2. Kumar V. Ageing in India--an overview. Indian J Med Res 1997;106:257-64.3. Corona LP, de Oliveira Duarte YA, Lebrão ML. Prevalence of anaemia and its associated factors in older adults: Evidence from the SABE Study. Rev Saude Publica 2014;48:723-31.4. Beghé C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: A systematic review of the literature. Am J Med 2004;116 Suppl 7A:3S-10.5. Denny SD, Kuchibhatla MN, Cohen HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med 2006;119:327-34.6. Patel KV. Epidemiology of anemia in older adults. Semin Hematol 2008;45:210-7.7. Kushali DJ, Singh M, Roopa G, Joshi KH. Comparison study of vitaminB-12 for its efficacy and bioavailability of various formulations in the treatment of pernicious anemia. Int J Pharm Pharm Sci 2015; 7 Suppl 1:6-8.8. Souad L, Cherifa A, Naimi D. The effects of homocysteine on plasma biochemical parameters and aortic matrix metalloproteinases activities. Int J Pharm Pharm Sci 2015;7:459-62.9. NFHS 4 India Fact Sheet. Available from: http://www.rchiips.org/NFHS/pdf/NFHS4/India.pdf. [Last accessed on 2017 June 11].10. WHO. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization (WHO/NMH/NHD/MNM/11.1); 2011.11. WHO. Technical consultation on folate and vitamin B12 deficiencies. Food Nutr Bull 2008;29 Suppl 2:S238-S44.12. Shobha V, Tarey SD, Singh RG, Shetty P, Unni US, Srinivasan S, et al. Vitamin B12 deficiency and levels of metabolites in an apparently normal urban south Indian elderly population. Indian J Med Res 2011;134:432-9.13. Bansal PG, Toteja GS, Bhatia N, Vikram NK, Siddhu A, Kumar AG, et al. Deficiencies of serum ferritin and vitamin B12, but not folate, are common in adolescent girls residing in a slum in Delhi. Int J Vitam Nutr Res 2015;85:14-22.14. Malhotra VM, Kabra PR, Bhayya S, Malhotra R. Prevalence and correlates of anemia among elderly population of rural Nalgonda: A cross-sectional analytic study. Int J Public Health Res 2016;3:166-71.15. Agarwalla R, Saikia AM, Parashar M, Pathak R, Islam F. Assessment of prevalence of anemia in and its correlates among community-dwelling elderly of Assam, India: A cross-sectional study. Int J Nutr Pharmacol Neurol Dis 2016;6:23-7.16. Barman SK, Lata K, Ram R, Ghosh N, Sarker G, Shahnawaz K. A study of morbidity profile of geriatric population in an urban community of Kishanganj, Bihar, India. GJMEDPH 2014;3:1.17. Shrivastava SR, Hippargi SB, Ambali AP, Yelikar BR. Patterns of anaemia in geriatric group. J Krishna Inst Med Sci Univ 2013;2:77-81.18. Sudarshan BP, Chethan TK. A study to assess the prevalence of anemia and activities of daily living among elderly population residing in a South Indian rural community. Int J Community Med Public Health 2016;3:437-41.Table 1: Prevalence of anemia in elderlyType n (%)All (n=116) Male (n=61) Female (n=55)Anemia 67 (57.76) 33 (54.10) 34 (61.82)Mild 37 (31.90) 22 (36.07) 15 (27.27)Moderate 28 (24.14) 10 (16.39) 18 (32.73)Severe 2 (1.72) 1 (1.64) 1 (1.82)Table 2: Prevalence of Vitamin B12 deficiency and hyperhomocysteinemia in elderlyn Serum hcy>15 µmol/ln (%) n (%)All 77 28 (36.36) 99 57 (57.57)Male 36 15 (41.67) 46 34 (73.91)Female 41 13 (31.71) 43 23 (53.49)Vegetarian 22 11 (50.00) 23 15 (65.22)Non vegetarian 29 10 (34.48) 31 18 (58.06)Table 3: Prevalence of anemia with vitamin B12 deficiency and hyperhomocysteinemian Serum hcy>15 µmol/ln (%) n (%)Male 24 10 (41.67) 25 18 (72.00)Female 27 7 (25.93) 28 16 (57.14)All 51 17 (33.33) 53 34 (64.15)n Serum  Vita in B12<203 pg/mln Serum  Vitamin B12<203 pg/ml404Asian J Pharm Clin Res, Vol 11, Issue 1, 2018, 402-404 Gonmei et al. 19. Yagnik CS, Deshpande SS, Lubree HG, Naik SS, Bhat DS, Uradev BS, et al. Vitamin B12 deficiency and hyperhomocystenemia in rural and urban Indians. J Assoc Physicians India 2006;54:775-82.20. Das M, Ghose M, Borah NC, Choudhury N. A community based study of the relationship between homocysteine and some of the life style factors. Indian J Clin Biochem 2010;25:295-301.21. Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K, et al. Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban north India. Eur J Nutr 2002;41:68-77.22. Hinds HE, Johnson AA, Webb MC, Graham AP. Iron, folate, and vitamin B12 status in the elderly by gender and ethnicity. J Natl Med Assoc 2011;103:870-7.23. Bianchi VE. Role of nutrition on anemia in elderly. Clin Nutr ESPEN 2016;11:e1-e11.24. Elmadfa I, Singer I. Vitamin B-12 and homocysteine status among vegetarians: A global perspective. Am J Clin Nutr 2009;89:1693S-1698.

ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

https://innovareacademics.in/journals/index.php/ajpcr/article/download/23750/13703/113201

ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

Abstract

Similar works

Full text

Available Versions

Innovare Academic Sciences: E-Journals