Dietary folate and vitamin B12 intake and cognitive decline among community-dwelling older persons. Vitamin B12 and folate and the risk of anemia in old age: the Leiden 85-Plus Study. Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts. Rationale and design of the B-PROOF study, a randomized controlled trial on the effect of supplemental intake of vitamin B12 and folic acid on fracture incidence Iron, folate and vitamin B12 status of an elderly South African population Five year changes in mental health and associations with vitamin B12/folate status of elderly Europeans. Effect of Vitamin B12 and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial Oral vitamin B12 supplementation reduces plasma total homocysteine concentration in women in India. Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with normal serum vitamin concentrations Pharmacological Dose of Vitamin B12 Is as Effective as Low-Dose Folinic Acid in Correcting Hyperhomocysteinemia of Hemodialysis Patients Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Low Folate Levels Are Associated with Reduced Risk of Colorectal Cancer in a Population with Low Folate Status Serum Vitamin B12, C and Folate Concentrations in the New Mexico Elder Health Survey: Correlations with Cognitive and Affective Functions Vitamin B(12) and folate in relation to the development of Alzheimer's disease. Vitamin Intervention for Stroke Prevention Trial: An Efficacy Analysis Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time. Vitamins B12, B6, and folic acid for cognition in older men
BACKGROUND Deficiencies in folate and vitamin B12 have been associated with neurodegenerative disease . OBJECTIVE To examine the association between rates of age-related cognitive change and dietary intakes of folate and vitamin B12 . DESIGN Prospect i ve study performed from 1993 to 2002 . SETTING Geographically defined biracial community in Chicago , Ill. PARTICIPANTS A total of 3718 residents , 65 years and older , who completed 2 to 3 cognitive assessment s and a food frequency question naire .  MAIN OUTCOME MEASURE Change in cognitive function measured at baseline and 3-year and 6-year follow-ups , using the average z score of 4 tests : the East Boston Tests of immediate and delayed recall , the Mini-Mental State Examination , and the Symbol Digit Modalities Test . RESULTS High folate intake was associated with a faster rate of cognitive decline in mixed models adjusted for multiple risk factors . The rate of cognitive decline among persons in the top fifth of total folate intake ( median , 742 microg/d ) was more than twice that of those in the lowest fifth of intake ( median , 186 microg/d ) , a statistically significant difference of 0.02 st and ardized unit per year ( P = .002 ) . A faster rate of cognitive decline was also associated with high folate intake from food ( P for trend = .04 ) and with folate vitamin supplementation of more than 400 microg/d compared with nonusers ( beta = -.03 , P<.001 ) . High total B12 intake was associated with slower cognitive decline only among the oldest participants . CONCLUSIONS High intake of folate may be associated with  cognitive decline in older persons . These unexpected findings call for further study of the cognitive implication s of high levels of dietary folate in older population BACKGROUND Screening for deficiencies in vitamin B(12 ) and folate is advocated to prevent anemia in very elderly individuals . However , the effects of vitamin B(12 ) and folate deficiency on the development of anemia in old age have not yet been established . METHODS The current study is embedded in the Leiden 85-Plus Study , a population -based prospect i ve study of subjects aged 85 years . Levels of vitamin B(12 ) , folate , and homocysteine were determined at baseline . Hemoglobin levels and mean corpuscular volume ( MCV ) were determined annually during 5 years of follow-up . RESULTS We analyzed data from 423 subjects who did not use any form of cyanocobalamin , hydroxocobalamin , or folic acid supplementation , neither at baseline nor during follow-up . Folate deficiency ( < 7 nmol/L ; n = 34 ) and elevated homocysteine levels ( > 13.5 mumol/L ; n = 194 ) were associated with anemia at baseline ( adjusted odds ratio [ OR ] , 2.44 ; 95 % confidence interval [ CI ] , 1.06 - 5.61 ; and adjusted OR , 1.82 ; 95 % CI , 1.08 - 3.06 , respectively ) , but vitamin B(12 ) deficiency ( < 150 pmol/L ; n = 68 ) was not ( adjusted OR , 1.51 ; 95 % CI , 0.79 - 2.87 ) . Furthermore , vitamin B(12 ) deficiency was not associated with the development of anemia during follow-up ( adjusted HR , 0.92 ; 95 % CI , 0.46 - 1.82 ) or with changes in MCV ( adjusted linear mixed model ; P = .77 ) . Both folate deficiency and elevated homocysteine levels were associated with the development of anemia from age 85 years onward ( adjusted HR , 3.33 ; 95 % CI , 1.55 - 7.14 ; and adjusted HR , 1.70 ; 95 % CI , 1.01 - 2.88 , respectively ) , but not with an increase in MCV over time ( P > .30 ) . CONCLUSION In the general population of very elderly individuals , anemia in 85-year-old subjects is associated with folate deficiency and elevated homocysteine levels but not with vitamin B(12 ) deficiency BACKGROUND Folate fortification of food aims to reduce the number of babies born with neural tube defects , but has been associated with cognitive impairment when vitamin B12 levels are deficient . Given the prevalence of low vitamin B12 levels among the elderly , and the global deployment of food fortification programs , investigation of the associations between cognitive impairment , vitamin B12 , and folate are needed . OBJECTIVE To investigate the associations of serum vitamin B12 , red cell folate , and cognitive impairment . METHODS Data were collected on 1,354 subjects in two studies investigating cognitive impairment , and from patients attending for assessment or management of memory problems in the Barwon region of south eastern Australia between 2001 and 2011 . Eligible subjects who had blood measurements of vitamin B12 and red cell folate taken within six months of cognitive testing were included . Subjects with stroke or neurodegenerative diseases other than Alzheimer 's disease were excluded . A Mini-Mental State Examination score of < 24 was used to define impaired cognitive function . RESULTS Participants with low serum vitamin B12 ( < 250 pmol/L ) and high red cell folate ( > 1,594 nmol/L ) levels were more likely to have impaired cognitive performance ( adjusted odds ratio ( AOR ) 3.45 , 95 % confidence interval ( CI ) : 1.60 - 7.43 , p = 0.002 ) when compared to participants with biochemical measurements that were within the normal ranges . Participants with high folate levels , but normal serum vitamin B12 , were also more likely to have impaired cognitive performance ( AOR 1.74 , 95 % CI : 1.03 - 2.95 , p = 0.04 ) . CONCLUSIONS High folate or folic acid supplements may be detrimental to cognition in older people with low vitamin B12 levels . This topic is of global significance due to the wide distribution of food fortification programs , so prospect i ve studies should be a high priority Background Osteoporosis is a major health problem , and the economic burden is expected to rise due to an increase in life expectancy throughout the world . Current observational evidence suggests that an elevated homocysteine concentration and poor vitamin B12 and folate status are associated with an increased fracture risk . As vitamin B12 and folate intake and status play a large role in homocysteine metabolism , it is hypothesized that supplementation with these B-vitamins will reduce fracture incidence in elderly people with an elevated homocysteine concentration . Methods / Design The B-PROOF ( B-Vitamins for the PRevention Of Osteoporotic Fractures ) study is a r and omized double-blind placebo-controlled trial . The intervention comprises a period of two years , and includes 2919 subjects , aged 65 years and older , independently living or institutionalized , with an elevated homocysteine concentration ( ≥ 12 μmol/L ) . One group receives daily a tablet with 500 μg vitamin B12 and 400 μg folic acid and the other group receives a placebo tablet . In both tablets 15 μg ( 600 IU ) vitamin D is included . The primary outcome of the study is osteoporotic fractures . Measurements are performed at baseline and after two years and cover bone health i.e. bone mineral density and bone turnover markers , physical performance and physical activity including falls , nutritional intake and status , cognitive function , depression , genetics and quality of life . This large multi-center project is carried out by a consortium from the Erasmus MC ( Rotterdam , the Netherl and s ) , VUmc ( Amsterdam , the Netherl and s ) and Wageningen University , ( Wageningen , the Netherl and s ) , the latter acting as coordinator . Discussion To our best knowledge , the B-PROOF study is the first intervention study in which the effect of vitamin B12 and folic acid supplementation on osteoporotic fractures is studied in a general elderly population . We expect the first longitudinal results of the B-PROOF intervention in the second semester of 2013 . The results of this intervention will provide evidence on the efficacy of vitamin B12 and folate supplementation in the prevention of osteoporotic fractures . Trial Registration The B-PROOF study is registered with the Netherl and s Trial ( NTR NTR1333 ) and with Clinical Trials.gov ( NCT00696514 ) Objectives : To determine the prevalence of anaemia and the haemopoietic nutrient status of older mixed ancestry ( coloured ) South Africans . Design : A cross-sectional analytic study . Subjects : A r and om sample of 200 non-institutionalized subjects aged ≥65 y of age , resident in urban Cape Town , was drawn using a two-stage cluster design . Methods : Trained fieldworkers interviewed subjects to obtain demographic and lifestyle data .  Dietary intake was assessed using a vali date d food frequency question naire . Fasting blood sample s were drawn for the determination of haematological parameters , serum vitamin B12 , serum folate , RBC folate and a full blood count . Results : The prevalence of anaemia was 13.9 % . Eight of the 26 cases of anaemia ( 31 % ) were associated with suboptimal haemopoietic nutrient status ; 2(25 ) and 3(38 ) cases of these 8 anaemic subjects had suboptimal vitamin B12 and folate status , respectively . Iron deficiency anaemia accounted for 5(63)% of the subjects with nutrition-related anaemia . Ten men and two women ( 6.5 % of subjects ) had raised serum ferritin concentrations , half of whom had abnormal biochemical parameters indicative of alcohol abuse . Conclusions : Older coloured South Africans , particularly women , should be encouraged to eat diets with a high nutrient density and to consume adequate amounts of foods high in iron , folate and vitamin B12 . Further investigation regarding the high prevalence of hyperferritinaemia found in the men in this population is indicated . Sponsorship : Financial assistance from the HSRC/UCT Centre for Gerontology , the South African Sugar Association , the Zerilda Steyn Memorial Trust and the Medical Research Council ( DL ) for this project is acknowledged OBJECTIVE To describe 5-year changes of mental health in SENECA participants , and to examine whether mental health is associated with the status of vitamin B12 and folate . DESIGN A longitudinal , multicentre study including a Baseline study , a Follow-up study , and a Finale study . SUBJECTS Inhabitants of 11 European towns , born between 1913 and 1918 , were r and omly selected at baseline to participate in the SENECA study . Of the 1099 enrolled subjects in the Follow-up study , 586 participated in the Finale study . INTERVENTION Mental health status was assessed by the  Mini-Mental State Examination ( MMSE , cognitive impairment defined as MMSE<23 ) and the  15-item Geriatric Depression Scale  ( GDS , depression defined as GDS>5 ) . RESULTS In the Finale study , mean overall MMSE score was 26.1 for men and 25.6 for women , while mean overall GDS score was 3.1 for men and 4.1 for women . Among subjects that participated in both the Follow-up and the Finale study , MMSE scores decreased with 0.9 points ( P<0.0001 ) and 1.0 points ( P<0.0001 ) among men and women respectively . The GDS scores decreased with 0.7 points ( P<0.0001 ) for men and 0.8 points ( P<0.0001 ) for women . Among subjects that participated in the Finale study , no significant correlations have been observed between mental health and vitamin B12/folate status . CONCLUSION In the Finale study , mental health of the majority of the SENECA participants remained intact . In contrast to the Follow-up study , no associations between mental health and vitamin B12/folate status were emerged High plasma homocysteine ( Hcy ) levels are associated with increased osteoporotic fracture incidence . However , the mechanism remains unclear . We investigated the effect of Hcy-lowering vitamin B12 and folic acid treatment on bone mineral density ( BMD ) and calcaneal quantitative ultrasound ( QUS ) parameters . This r and omized , double-blind , placebo-controlled trial included participants aged ≥65 years with plasma Hcy levels between 12 and 50 µmol/L. The intervention comprised 2-year supplementation with either a combination of 500 µg B12 , 400 µg folic acid , and 600 IU vitamin D or placebo with 600 IU vitamin D only . In total , 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS .  Femoral neck ( FN ) BMD , lumbar spine ( LS ) BMD , calcaneal broadb and ultrasound attenuation ( BUA ) , and calcaneal speed of sound ( SOS ) were assessed . After 2 years , FN-BMD and BUA had significantly decreased , while LS-BMD significantly increased ( all p < 0.01 ) and SOS did not change in either treatment arm . No statistically significant differences between the intervention and placebo group were present for FN-BMD ( p = 0.24 ) , LS-BMD ( p = 0.16 ) , SOS ( p = 0.67 ) , and BUA ( p = 0.96 ) . However , exploratory subgroup analyses revealed a small positive effect of the intervention on BUA at follow-up among compliant persons > 80 years ( estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group , p = 0.04 for difference ) . In conclusion , this study showed no overall effect of treatment with vitamin B12 and folic acid on BMD or QUS parameters in elderly , mildly hyperhomocysteinemic persons , but suggests a small beneficial effect on BUA in persons > 80 years who were compliant in taking the supplement People in India have a high prevalence of low vitamin B12 status and high plasma total homocysteine ( tHcy ) concentrations . In a proof of principle trial , we studied the effect of oral vitamin B12 ( 500 microg ) and /or 100 g cooked green leafy vegetables ( GLV ) every alternate day in a 2x2 factorial design over a 6-week period . Forty-two non-pregnant vegetarian women ( age 20 - 50 years ) were r and omly allocated to four study groups . Clinical measurements were made at the beginning and at the end of the study , and blood sample s were collected before , and 2 and 6 weeks after commencement of intervention . Forty women completed the trial . Twenty-six women had low vitamin B12 status ( < 150 pmol/L ) and 24 had hyperhomocysteinemia ( > 15 micromol/L ) . GLV supplementation did not alter plasma folate or tHcy .  Vitamin B12 supplementation increased plasma vitamin B12 concentration ( 125 to 215 pmol/L , p < 0.05 ) and reduced tHcy concentration ( 18.0 to 13.0 micromol/L , p < 0.05 ) within first 2 weeks , both of which remained stable for the next 4 weeks . Plasma vitamin B12 and tHcy concentrations did not change in those who did not receive vitamin B12 , and there was no change in plasma folate concentration in any of the groups . Blood haemoglobin concentration increased marginally within first two weeks in those women who received vitamin B12 ( by 3 g/L , p < 0.05 ) and the number of women with macrocytosis decreased from 2 to zero . There was no change in vibration sensory threshold during the period of the study . High-dose per oral vitamin B12 supplementation significantly reduced plasma tHcy within 2 weeks but did not achieve normal plasma tHcy concentration even after 6 weeks . People in India have a high prevalence of low vitamin B12 status and high plasma total homocysteine ( tHcy ) concentrations In a prospect i ve , multicentre , double-blind controlled study , the effect of an intramuscular vitamin supplement containing 1 mg vitamin B12 , 1.1 mg folate , and 5 mg vitamin B6 on serum concentrations of methylmalonic acid ( MMA ) , homocysteine ( HCYS ) , 2-methylcitric acid ( 2-MCA ) , and cystathionine ( CYSTA ) was compared with that of placebo in 175 elderly subjects living at home and 110 in hospital .  Vitamin supplement and placebo were administered eight times over a 3-week period . Vitamin supplement but not placebo significantly reduced all four metabolite concentrations at the end of the study in both study groups . The maximum effects of treatment were usually seen within 5 - 12 days . Initially elevated metabolite concentrations returned to normal in a higher proportion of the vitamin than of the placebo group : 92 % vs 20 % for HYCS ; 82 % vs 20 % for MMA ; 62 % vs 25 % for 2-MCA ; and 42 % vs 25 % for CYSTA . The response rate to vitamin supplements supports the notion that metabolic evidence of vitamin deficiency is common in the elderly , even in the presence of normal serum vitamin levels . Metabolite assays permit identification of elderly subjects who may benefit from vitamin supplements Various regimens of folic acid-based and vitamin B12 ( Vit B12 ) supplementations have been tried for lowering plasma homocysteine ( Hcy ) levels in uremic patients . However , the therapeutic potency of low-dose folic acid and Vit B12 alone is not properly understood . In this study , seventy-five patients on chronic hemodialysis ( HD ) therapy were r and omized into three groups . The FNA group received intravenous ( IV ) supplementation with folinic acid 3 mg weekly ; the Vit B12 group received IV supplementation with vitamin B12 1 mg weekly ; and the combination group received IV supplementation with both agents weekly  . Blood levels of Hcy , folic acid , and Vit B12  were measured monthly for three months . After three months of treatment , plasma levels of Hcy decreased significantly in all three groups when compared with their baselines ( all p < 0.05 ) . The final Hcy level was significantly lower in the combination group ( 11.5 ± 2.3 μmol/L ) when compared with that of the FNA group ( 15.9 ± 5.6 μmol/L , p < 0.05 ) but not with the Vit B12 group ( 15.9 ± 11.6 μmol/L ) , although their baseline levels were similar . The percentage decreases of tHcy at the end of the treatment in the FNA group , Vit B12 group , and combination group were 16.4 % , 29.3 % , and 38.9 % respectively . Our study showed that IV pharmacologic dose of Vit B12 alone is as effective as low-dose folic acid in correcting hyperhomocysteinemia in chronic HD patients , and combining both drugs in low doses may have added effects OBJECTIVE The associations of vitamin B(12 ) , folate , and homocysteine with depression were examined in a population -based study . METHOD The authors screened 3,884 elderly people for depressive symptoms . Subjects with positive screening results had psychiatric workups .  Folate , vitamin B(12 ) , and homocysteine blood levels  were compared in 278 persons with depressive symptoms , including 112 with depressive disorders , and 416 r and omly selected reference subjects . Adjustments were made for age , gender , cardiovascular disease , and functional disability . RESULTS Hyperhomocysteinemia , vitamin B(12 ) deficiency , and to a lesser extent , folate deficiency were all related to depressive disorders . For folate deficiency and hyperhomocysteinemia , the association with depressive disorders was substantially reduced after adjustment for functional disability and cardiovascular disease , but for vitamin B(12 ) this appeared independent . CONCLUSIONS The association of vitamin B(12 ) and folate with depressive disorders may have different underlying mechanisms . Vitamin B(12 ) may be causally related to depression , whereas the relation with folate is due to physical comorbidity Background : A diet rich in folate is associated with a reduced colorectal cancer risk , whereas the role of circulating levels is less clear . The aim of this study was to relate prediagnostic plasma folate , vitamin B12 , and homocysteine concentrations to the risk of colorectal cancer . Methods : This was a prospect i ve case – control study of 331 cases and 662 matched controls nested within the population -based Northern Sweden Health and Disease Study . Median follow-up time from recruitment to diagnosis was 10.8 years . Results : Plasma folate concentrations were positively related to colorectal cancer risk ; multivariate odds ratios were 1.62 [ 95 % confidence intervals ( CI ) , 1.08–2.42 ] and 1.42 ( 95 % CI , 0.94–2.21 ) for the middle and highest versus lowest tertile , respectively . In subjects with follow-up < 10.8 years , a statistically significant doubled risk was observed for the middle and highest versus lowest tertile , whereas findings for longer follow-up times were null . A positive risk relationship was also observed for tumor stage III – IV but not I – II . Plasma vitamin B12 concentrations were inversely associated with rectal cancer risk . Homocysteine was not significantly related to colorectal cancer risk . Conclusions : In this population -based , nested case – control study , low plasma folate concentrations were associated with a reduced colorectal cancer risk . This protective role was mainly observed in subjects with higher tumor stage or shorter follow-up time between recruitment and diagnosis . Low circulating folate status may protect against colorectal cancer or suppress progression of preneoplastic or neoplastic lesions . Impact : These findings may have relevance for the ongoing debate about m and atory folic acid fortification of flour . Cancer Epidemiol Biomarkers Prev ; 23(10 ) ; 2136–44 . © 2014 AACR Objectives : 1 ) To compare serum vitamin B12 , C and folate concentrations in a r and omly selected sample of elderly ( age 65 years or older ) male and female Hispanics and nonHispanic whites ( NHW ) and 2 ) to examine associations between serum B12 , C and folate concentrations compared to measures of cognitive and affective ( depression ) functions . Methods : Equal numbers of male and female Hispanics and NHW were r and omly sample d from the Health Care Financing Administration ( Medicare ) registrant list for Bernalillo County , New Mexico , and asked to volunteer for a paid home interview followed by a paid comprehensive interview/examination covering health and health-related issues . In addition to serum determinations of B12 , C and folate , associations were examined between these vitamins and measures of cognitive and affective functions . Results : Males and Hispanics had lower serum vitamin B12 , C and folate concentrations than females and NHW respectively . Participants taking a multivitamin supplement ( MVI ) had higher serum vitamin concentrations than those not taking MVI . There were significant associations between serum folate concentrations and measures of cognitive function , not seen with B12 or C , nor between any of the vitamins and affective function . Conclusions : Hispanics , even after adjustments for gender , age , vitamin supplementation , vitamin content of dietary foods , education and household income , had lower serum concentrations of B12 , C and folate than NHW . The most significant associations observed were those between serum folate and various measures of cognitive function , even after adjusting for presence of depression OBJECTIVE To explore the associations of low serum levels of vitamin B(12 ) and folate with  AD occurrence . METHODS A population -based longitudinal study in Sweden , the Kungsholmen PROJECT A r and om sample of 370 nondemented persons , aged 75 years and older and not treated with B(12 ) and folate  , was followed for 3 years to detect incident AD cases . Two cut-off points were used to define low levels of vitamin B(12 ) ( < or = 150 and < or = 250 pmol/L ) and folate ( < or = 10 and < or = 12 nmol/L ) , and all analyses were performed using both definitions . AD and other types of dementia were diagnosed by specialists according to DSM-III-R criteria . RESULTS When using B(12 ) < or = 150 pmol/L and folate < or = 10 nmol/L to define low levels , compared with people with normal levels of both vitamins , subjects with low levels of B(12 ) or folate had twice higher risks of developing AD ( relative risk [ RR ] = 2.1 , 95 % CI = 1.2 to 3.5 ) . These associations were even stronger in subjects with good baseline cognition ( RR = 3.1 , 95 % CI = 1.1 to 8.4 ) . Similar relative risks of AD were found in subjects with low levels of B(12 ) or folate and among those with both vitamins at low levels . A comparable pattern was detected when low vitamin levels were defined as B(12 ) < or = 250 pmol/L and folate < or = 12 nmol/L. CONCLUSIONS This study suggests that vitamin B(12 ) and folate may be involved in the development of AD . A clear association was detected only when both vitamins were taken into account , especially among the cognitively intact subjects . No interaction was found between the two vitamins . Monitoring serum B(12 ) and folate concentration in the elderly may be relevant for prevention of AD Background and Purpose — The Vitamin Intervention for Stroke Prevention trial ( VISP ) intention-to-treat analysis did not show efficacy of combined vitamin therapy for recurrent vascular events in patients with nondisabling stroke . Reasons for lack of efficacy may have included folate fortification of grain products , inclusion of the recommended daily intake for B12 in the low-dose arm , treatment with parenteral B12 in patients with low B12 levels in both study arms , a dose of B12 too low for patients with malabsorption , supplementation with non study vitamins , and failure of patients with significant renal impairment to respond to vitamin therapy . We conducted an efficacy analysis limited to patients most likely to benefit from the treatment , based on hypotheses arising from evidence developed since VISP was initiated . The criteria for this subgroup were defined before any data analysis . Methods — For this analysis , we excluded patients with low and very high B12 levels at baseline ( < 250 and > 637 pmol/L , representing the 25th and 95th percentiles ) , to exclude those likely to have B12 malabsorption or to be taking B12 supplements outside the study and patients with significant renal impairment ( glomerular filtration rate < 46.18 ; the 10th percentile ) . Results — This subgroup represents 2155 patients ( 37 % female ) , with a mean age of 66±10.7 years . For the combined end point of ischemic stroke , coronary disease , or death , there was a 21 % reduction in the risk of events in the high-dose group compared with the low-dose group ( unadjusted P=0.049 ; adjusted for age , sex , blood pressure , smoking , and B12 level P=0.056 ) . In Kaplan – Meier survival analysis comparing 4 groups , patients with a baseline B12 level at the median or higher r and omized to high-dose vitamin had the best overall outcome , and those with B12 less than the median assigned to low-dose vitamin had the worst ( P=0.02 for combined stroke , death , and coronary events ; P=0.03 for stroke and coronary events ) . Conclusions — In the era of folate fortification , B12 plays a key role in vitamin therapy for total homocysteine . Higher doses of B12 , and other treatments to lower total homocysteine may be needed for some patients BACKGROUND B-vitamin deficiencies have been associated with depression ; however , there is very little prospect i ve evidence from population -based studies of older adults . OBJECTIVE We examined whether dietary intakes of vitamins B-6 , folate , or vitamin B-12 were predictive of depressive symptoms over an average of 7.2 y in a community-based population of older adults . DESIGN The study sample consisted of 3503 adults from the Chicago Health and Aging project , an ongoing , population -based , biracial ( 59 % African American ) study in adults aged > or = 65 y.  Dietary assessment was made by food-frequency question naire . Incident depression was measured by the presence of > or = 4 depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale . RESULTS The logistic regression models , which used generalized estimating equations , showed that higher total intakes , which included supplementation , of vitamins B-6 and B-12 were associated with a decreased likelihood of incident depression for up to 12 y of follow-up , after adjustment for age , sex , race , education , income , and antidepressant medication use . For example , each 10 additional milligrams of vitamin B-6 and 10 additional micrograms of vitamin B-12 were associated with 2 % lower odds of depressive symptoms per year . There was no association between depressive symptoms and food intakes of these vitamins or folate . These associations remained after adjustment for smoking , alcohol use , widowhood , caregiving status , cognitive function , physical disability , and medical conditions . CONCLUSION Our results support the hypotheses that high total intakes of vitamins B-6 and B-12 are protective of depressive symptoms over time in community-residing older adults Objective : To investigate whether supplementing older men with vitamins B12 , B6 , and folic acid improves cognitive function . Methods : The investigators recruited 299 community-representative hypertensive men 75 years and older to a r and omized , double-blind controlled clinical trial of folic acid , vitamin B6 , and B12 supplementation vs placebo over 2 years . The primary outcome of interest was the change in the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-cog ) . A secondary aim of the study was to determine if supplementation with vitamins decreased the risk of cognitive impairment and dementia over 8 years . Results : The groups were well-balanced for demographic and biochemical parameters . There was no difference in the ADAS-cog change from baseline to 24 months between the placebo ( 0.8 , SD 4.0 ) and vitamins group ( 0.7 , SD 3.4 ) . The adjusted scores in the treatment groups did not differ over time ( placebo 0.2 lower , z = 0.71 , p = 0.478 ) . There was a nonsignificant 28 % decrease in the risk of cognitive impairment ( odds ratio 0.72 , 95 % confidence interval 0.25–2.09 ) and dementia ( hazard ratio 0.72 , 95 % confidence interval 0.29–1.78 ) over 8 years of follow-up . Conclusions : The daily supplementation of vitamins B12 , B6 , and folic acid does not benefit cognitive function in older men , nor does it reduce the risk of cognitive impairment or dementia . Classification of evidence : This study provides Class I evidence that vitamin supplementation with daily doses of 400 μg of B12 , 2 mg of folic acid , and 25 mg of B6 over 2 years does not improve cognitive function in hypertensive men aged 75 and older
The effects did not differ by sex or by age group .
Conclusions Evidence on the effects of supplementation of low concentrations of vitamin B12 and folate on haematological parameters in community-dwelling older people is inconclusive .
Background / objectives Low vitamin B12 and folate levels in community-dwelling older people are usually corrected with supplements .
However , the effect of this supplementation on haematological parameters in older persons is not known .