Frail elderly people are particularly at risk for nutritional deficiencies that can contribute to cardiovascular disease, functional decline and neurological disorders. Moderately increased homocysteine (Hcy) and methlylmalonic acid (MMA) are markers of folate, vitamin B6 or B12 deficiency. In a study published in the American Journal of Clinical Nutrition, de Jong et al. conducted a series of controlled interventions to determine if supplementation with nutrient-dense foods, an exercise program, or a combination of the two would benefit elderly subjects' nutritional status and neurological functioning. Food enrichment seemed to offer the most tangible health benefits by lowering serum concentrations of Hcy and MMA. Yet supplementation with nutrient-dense foods produced no improvement in the subjects' test scores on neuropsychological functioning, and the exercise program had no effect on indexes of nutritional health, whether it was combined with supplementation or not.
The study population was composed of 130 free-living Dutch frail elderly, 72% of them female, with an average age of 78 years and with borderline-normal vitamin levels. None exercised regularly or used multivitamin supplements, and all subjects had a below average body mass index. They were randomly assigned either to a control group or to an intervention group that included supplementation with nutrient-dense foods containing 100% of the requirements for folic acid, vitamin B12 and vitamin B6; an exercise program; or a combination of the two.
After 17 weeks of the intervention trial, serum concentrations of these vitamins rose in the supplemented groups, and both Hcy and MMA were significantly decreased by 25% and 30%, respectively. The exercise program did not have an additive effect on any of the metabolites measured, and the subjects' performance on neuropsychological functioning tests showed an insignificant improvement. The positive effect of supplementation on these metabolites emphasizes the subclinical vitamin deficiency state in this group of frail elderly. Similar decreases in Hcy in previous studies predicted a 10% reduction in risk of coronary artery disease, but more data are needed to interpret what a 10% reduction of risk would mean in an elderly population. The overall decline in total Hcy and MMA in the supplemented population confirms previous research pointing to the need to decrease these metabolites, even when initial plasma vitamin concentrations are within normal ranges.
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De Jong, Nynke, et al. Nutrient-dense foods and exercise in frail elderly: effects on B vitamins, homocysteine, methylmalonic acid, and neuropsychological functioning. Am J Clin Nutr 2001;73:338-46.
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