{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:54:39Z","timestamp":1789610079732,"version":"build-2803163510"},"reference-count":85,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2007,10,25]],"date-time":"2007-10-25T00:00:00Z","timestamp":1193270400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Proc. Nutr. Soc."],"published-print":{"date-parts":[[2007,11]]},"abstract":"<jats:p>In the UK vitamin B<jats:sub>12<\/jats:sub>deficiency occurs in approximately 20% of adults aged &gt;65 years. This incidence is significantly higher than that among the general population. The reported incidence invariably depends on the criteria of deficiency used, and in fact estimates rise to 24% and 46% among free-living and institutionalised elderly respectively when methylmalonic acid is used as a marker of vitamin B<jats:sub>12<\/jats:sub>status. The incidence of, and the criteria for diagnosis of, deficiency have drawn much attention recently in the wake of the implementation of folic acid fortification of flour in the USA. This fortification strategy has proved to be extremely successful in increasing folic acid intakes pre-conceptually and thereby reducing the incidence of neural-tube defects among babies born in the USA since 1998. However, in successfully delivering additional folic acid to pregnant women fortification also increases the consumption of folic acid of everyone who consumes products containing flour, including the elderly. It is argued that consuming additional folic acid (as \u2018synthetic\u2019 pteroylglutamic acid) from fortified foods increases the risk of \u2018masking\u2019 megaloblastic anaemia caused by vitamin B<jats:sub>12<\/jats:sub>deficiency. Thus, a number of issues arise for discussion. Are clinicians forced to rely on megaloblastic anaemia as the only sign of possible vitamin B<jats:sub>12<\/jats:sub>deficiency? Is serum vitamin B<jats:sub>12<\/jats:sub>alone adequate to confirm vitamin B<jats:sub>12<\/jats:sub>deficiency or should other diagnostic markers be used routinely in clinical practice? Is the level of intake of folic acid among the elderly (post-fortification) likely to be so high as to cure or \u2018mask\u2019 the anaemia associated with vitamin B<jats:sub>12<\/jats:sub>deficiency?<\/jats:p>","DOI":"10.1017\/s0029665107005873","type":"journal-article","created":{"date-parts":[[2007,10,25]],"date-time":"2007-10-25T12:03:56Z","timestamp":1193313836000},"page":"548-558","source":"Crossref","is-referenced-by-count":63,"title":["Folate and vitamin B<sub>12<\/sub>: friendly or enemy nutrients for the elderly"],"prefix":"10.1017","volume":"66","author":[{"given":"Geraldine J.","family":"Cuskelly","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Mooney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian S.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2007,10,25]]},"reference":[{"key":"S0029665107005873_ref027","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711133372007"},{"key":"S0029665107005873_ref026","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)61041-6"},{"key":"S0029665107005873_ref079","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.1.221"},{"key":"S0029665107005873_ref001","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(76)91213-7"},{"key":"S0029665107005873_ref034","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.5.1241"},{"key":"S0029665107005873_ref011","first-page":"1767","article-title":"Carence en vitamine B12 chez le sujet age (Vitamin B12 deficiency in the elderly)","volume":"28","author":"Pautas","year":"1999","journal-title":"Presse Med"},{"key":"S0029665107005873_ref062","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/clinchem\/48.3.407","article-title":"Measuring and interpreting holo-transcobalamin(holo-transcobalamin II)","volume":"48","author":"Carmel","year":"2002","journal-title":"Clin Chem"},{"key":"S0029665107005873_ref044","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200006000-00001"},{"key":"S0029665107005873_ref069","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-124-5-199603010-00009"},{"key":"S0029665107005873_ref045","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/46.3.387"},{"key":"S0029665107005873_ref074","volume-title":"Folate and Disease Prevention","year":"2006"},{"key":"S0029665107005873_ref017","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.03453.x"},{"key":"S0029665107005873_ref066","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(94)90149-X"},{"key":"S0029665107005873_ref041","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1997.00124.x"},{"key":"S0029665107005873_ref023","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00087-4"},{"key":"S0029665107005873_ref057","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.2830340205"},{"key":"S0029665107005873_ref030","first-page":"20","article-title":"Vitamin requirements in old age","volume":"3","author":"Russell","year":"1992","journal-title":"Age Nutrition"},{"key":"S0029665107005873_ref071","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/65.6.1790"},{"key":"S0029665107005873_ref029","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/59.5.1213S"},{"key":"S0029665107005873_ref012","first-page":"2061","article-title":"Food cobalamin malabsorption: a usual cause of vitamin B12 deficiency","volume":"160","author":"Andres","year":"2000","journal-title":"Arch Intern Med"},{"key":"S0029665107005873_ref038","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2004.01393.x"},{"key":"S0029665107005873_ref065","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2004.043828"},{"key":"S0029665107005873_ref073","unstructured":"73. Food Standards Agency (2002) Report from the Folic Acid Stakeholder meeting. London: Food Standards Agency."},{"key":"S0029665107005873_ref055","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.2830340206"},{"key":"S0029665107005873_ref032","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/58.4.468"},{"key":"S0029665107005873_ref053","first-page":"77A","article-title":"Vitamin B12 status in elderly subjects with low haemoglobin","volume":"63","author":"Mooney","year":"2004","journal-title":"Proc Nut Soc"},{"key":"S0029665107005873_ref019","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.23.9.1227"},{"key":"S0029665107005873_ref018","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.9.1349"},{"key":"S0029665107005873_ref077","first-page":"237","volume-title":"Folate in Health and Disease","author":"Savage","year":"1995"},{"key":"S0029665107005873_ref048","volume-title":"Folic Acid and the Prevention of Disease","year":"2000"},{"key":"S0029665107005873_ref037","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00040041097008"},{"key":"S0029665107005873_ref060","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2003.027458"},{"key":"S0029665107005873_ref031","first-page":"946","article-title":"Anemia caused by vitamin B 12 deficiency in subjects aged over 75 years: new hypotheses. A study of 20 cases","volume":"21","author":"Andres","year":"2000","journal-title":"Rev Med Interne"},{"key":"S0029665107005873_ref082","doi-asserted-by":"publisher","DOI":"10.1079\/BJN20051618"},{"key":"S0029665107005873_ref040","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1995.tb07408.x"},{"key":"S0029665107005873_ref061","doi-asserted-by":"publisher","DOI":"10.1515\/CCLM.2003.228"},{"key":"S0029665107005873_ref002","first-page":"63","article-title":"Folate\/vitamin B12 interrelationship","volume":"28","author":"Scott","year":"1994","journal-title":"Essays in Biochemistry"},{"key":"S0029665107005873_ref083","doi-asserted-by":"publisher","DOI":"10.1080\/00365510310002068"},{"key":"S0029665107005873_ref046","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380080016007"},{"key":"S0029665107005873_ref010","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-3536(05)80226-4"},{"key":"S0029665107005873_ref039","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199107000-00001"},{"key":"S0029665107005873_ref033","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1601540"},{"key":"S0029665107005873_ref051","doi-asserted-by":"publisher","DOI":"10.1080\/00365510050184994"},{"key":"S0029665107005873_ref067","doi-asserted-by":"publisher","DOI":"10.1172\/JCI112476"},{"key":"S0029665107005873_ref008","doi-asserted-by":"publisher","DOI":"10.1111\/j.0954-6820.1968.tb02452.x"},{"key":"S0029665107005873_ref022","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1D189"},{"key":"S0029665107005873_ref020","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.19.2251-a"},{"key":"S0029665107005873_ref080","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.9.2792"},{"key":"S0029665107005873_ref084","doi-asserted-by":"publisher","DOI":"10.1016\/S0899-9007(01)00666-9"},{"key":"S0029665107005873_ref006","volume-title":"Gastrointestinal Hepatobiliary and Nutritional Physiology","author":"Chang","year":"1996"},{"key":"S0029665107005873_ref004","first-page":"123","article-title":"Anemia in older adults","volume":"12","author":"Woodman","year":"2005","journal-title":"Curr Opin Hematol"},{"key":"S0029665107005873_ref005","doi-asserted-by":"publisher","DOI":"10.1136\/gut.30.12.1686"},{"key":"S0029665107005873_ref007","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nutr.19.1.357"},{"key":"S0029665107005873_ref081","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.6.1474"},{"key":"S0029665107005873_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/S0953-6205(03)00074-8"},{"key":"S0029665107005873_ref052","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/80.3.322"},{"key":"S0029665107005873_ref078","volume-title":"Safe Upper Limits for Vitamins and Minerals","year":"2003"},{"key":"S0029665107005873_ref047","unstructured":"47. Finch S , Doyle W , Lowe C , Bates CJ , Prentice A , Smithers G & Clarke PC (1998) The National Diet and Nutrition Survey: People Aged 65 Years or Over. vol. 1: Report of the Diet and Nutrition Survey. London: H. M. Stationery Office."},{"key":"S0029665107005873_ref036","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nutr.24.012003.132440"},{"key":"S0029665107005873_ref021","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-200001000-00006"},{"key":"S0029665107005873_ref085","first-page":"271","volume-title":"Human Nutrition and Dietetics","author":"Scott","year":"2000"},{"key":"S0029665107005873_ref054","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-872399"},{"key":"S0029665107005873_ref050","doi-asserted-by":"publisher","DOI":"10.1159\/000205559"},{"key":"S0029665107005873_ref043","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198806303182604"},{"key":"S0029665107005873_ref016","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-3536(05)80224-0"},{"key":"S0029665107005873_ref072","first-page":"787","article-title":"Vitamin B12-deficiency and the fortification of food with folic-acid \u2013 review","volume":"49","author":"Bower","year":"1995","journal-title":"Eur J Clin Nutr"},{"key":"S0029665107005873_ref059","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.270.14.8152"},{"key":"S0029665107005873_ref070","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.23.2981"},{"key":"S0029665107005873_ref024","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.51.1.357"},{"key":"S0029665107005873_ref056","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1182\/asheducation-2003.1.62","article-title":"Update on cobalamin, folate, and homocysteine","volume":"1","author":"Carmel","year":"2003","journal-title":"Am Soc Hematol Educ Program"},{"key":"S0029665107005873_ref068","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1992.tb03641.x"},{"key":"S0029665107005873_ref064","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2003.00173.x"},{"key":"S0029665107005873_ref009","doi-asserted-by":"publisher","DOI":"10.3109\/00365519409088580"},{"key":"S0029665107005873_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01181-6"},{"key":"S0029665107005873_ref035","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(83)91064-1"},{"key":"S0029665107005873_ref015","doi-asserted-by":"publisher","DOI":"10.1016\/j.revmed.2004.03.008"},{"key":"S0029665107005873_ref025","first-page":"941","volume-title":"Wintrobe's Clinical Hematology","author":"Lee","year":"1999"},{"key":"S0029665107005873_ref075","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8223(97)00044-8"},{"key":"S0029665107005873_ref042","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.12.1289"},{"key":"S0029665107005873_ref063","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.989_9.x"},{"key":"S0029665107005873_ref076","first-page":"244","article-title":"Adverse effects of increased dietary folate. Relation to measures to reduce the incidence of neural tube defects","volume":"17","author":"Chanarin","year":"1994","journal-title":"Clin Invest Med"},{"key":"S0029665107005873_ref049","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90070-2"},{"key":"S0029665107005873_ref058","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-2712(01)00003-8"},{"key":"S0029665107005873_ref028","first-page":"270","article-title":"Absorption, distribution and excretion of vitamin B12","volume":"30","author":"Nicolas","year":"1994","journal-title":"Ann Gastroenterol Hepatol"},{"key":"S0029665107005873_ref003","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)90649-8"}],"container-title":["Proceedings of the Nutrition Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0029665107005873","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T11:22:21Z","timestamp":1587986541000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0029665107005873\/type\/journal_article"}},"subtitle":["Symposium on \u2018Micronutrients through the life cycle\u2019"],"short-title":[],"issued":{"date-parts":[[2007,10,25]]},"references-count":85,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2007,11]]}},"alternative-id":["S0029665107005873"],"URL":"https:\/\/doi.org\/10.1017\/s0029665107005873","relation":{},"ISSN":["0029-6651","1475-2719"],"issn-type":[{"value":"0029-6651","type":"print"},{"value":"1475-2719","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,10,25]]}}}