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Abstract
purpose: This study assesses the value of the urinary methylmalonic acid (MMA) assay by gas
chromatography mass spectrometry as a screening procedure for detection of cobalamin
(Cbl) deficiency and estimates the prevalence of undetected Cbl deficiency in elderly
populations.
subjects and methods: A total of 809 elderly individuals over age 65 were screened using random spot urine
specimens from 4 different sites: a health fair, retirement apartments, a hospital-based
elderly assessment center, and a nursing home. Follow-up tests included serum total
Cbl, serum MMA, and normalization of urinary and serum MMA levels with Cbl intramuscular
(IM) therapy.
results: The prevalence of elevated urinary MMA varied across population groups, from 3.0%
in elderly visiting a health fair to 5.1% in elderly residing in retirement apartments.
Follow-up on 35 of 36 subjects with elevated urinary MMA levels showed that 18 had
low serum total Cbl (less than 180 pg/mL at Hospital 1 or less than 200 pg/mL at Hospital
2), 12 had lownormal Cbl (180 or 200 pg/mL to 350 pg/mL), and 5 had normal Cbl. Of
the 12 subjects with low-normal Cbl on retesting, further assessment was performed
in 7, and all 7 of these subjects had evidence of Cbl deficiency. Cbl IM therapy was
initiated for 23 subjects; 16 were seen for follow-up and all had normal urinary MMA.
conclusion: The relatively high prevalence of undetected Cbl deficiency identified in the seniors
warrants additional studies of elderly populations. The sensitivity, convenience,
and noninvasive nature of the urinary MMA assay by gas chromatography mass spectrometry
make it a practical screening test.
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Article info
Publication history
Accepted:
November 6,
1992
Received:
September 17,
1992
Footnotes
☆This work was supported in part by the National Institute on Aging, grant number 5R01 AG04970-03, and was presented in part at conventions of the American Society of Hematology, December 1989, Atlanta, Georgia, and December 1991, Denver, Colorado.
Identification
Copyright
© 1993 Published by Elsevier Inc.
