Low serum cobalamin levels in a population study of 70- and 75-year-old subjects

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Abstract
We examined causes and hematological consequences of low serum cobalamin (vitamin B12)concentration in two representative population samples of 70- year-old (N=293) and 75- year- old subjects (N=486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N=16, with pernicious anemia in six), partial gastrectomy (N=6), and intestinal malabsorption (N=4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.