Folate status worsens in recently institutionalized elderly people withoutevidence of functional deterioration

Objective: To follow folate status, hematological and cognitive changes dur ing the first year of institutionalization among elderly subjects. Design: Prospective study Setting: Long-stay unit of the Dijon University Geriatric Hospital. Subjects: Twenty women and four men older than 65 years admitted consecutiv ely. Main outcome measures: Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating leve ls of folate, vitamin B-6, total homocysteine (tHcy), brood counts and cogn itive performance were determined in parallel. Results: From d 1 to d 360, mean folate and vitamin B-6 intakes remained be low the French RDA and mean folate intakes decreased significantly (Delta = -10.2%, p < 0.05). Mean plasma or erythrocyte folate decreased significant ly (Delta = -33.7%, p < 0.05 and Delta = -30.2%, p <0.001, respectively) fr om d 1 to d 360; no significant change was observed for the other blood par ameters. The incidence of folate deficiency increased (8% vs. 37% for plasm a folate <6.8 nmol/L and 8% vs. 17% for erythrocyte folate <340 nmol/L) fro m d 1 to d 360. Mean plasma pyridoxal 5'-phosphate (PLP) remained <20 nmol/ L during the one-year follow-up. There was no difference between genders fo r plasma tHcy. Although mean plasma tHcy was <14 mu mol/L, plasma tHcy was >14 mu mol/L in about one-third of the subjects. At each period, 50% or mor e subjects were anemic (Hct <35% in women and Hct <40% in men), but the ane mia was normocytic (MCV <100 fL). Subjects had a moderate dementia at admis sion, and no change was observed during the study. Conclusions: Subjects were already vitamin B-6 deficient at admission. Fola te status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deteriorat ion. Plasma tHcy didn't appear to be an earlier predictor of folate deficie ncy.