Nutrient-dense foods and exercise in frail elderly: effects on B vitamins,homocysteine, methylmalonic acid, and neuropsychological functioning

Background: Frail elders are at risk of suboptimal micronutrient status, fu nctional decline, and neurologic disorders. The influence of oral multimicr onutrients in physiologic doses and of moderately intense physical exercise on homocysteine (Hcy), methylmalonic acid (MMA), and neurologic functionin g have not yet been investigated. Objective: Our goal was to determine the effects of enriched foods and exer cise on blood vitamins, Hcy, MMA, and neuropsychological functioning in the frail. Design: A 17-wk randomized controlled intervention trial was used to study 1) enriched foods plus a social program, 2) regular foods plus exercise, 3) enriched foods plus exercise, and 4) regular foods plus a social program. Enriched foods contained multiple micronutrients (25-100% of the Dutch reco mmended dietary allowances); exercises focused on strength, coordination, f lexibility, and endurance. Vitamin (cobalamin, red blood cell folate, and p yridoxal 5'-phosphate), Hcy, and MMA concentrations were measured and 2 neu ropsychological tests were conducted. Results: Vitamin concentrations were higher in the supplemented groups than in the unsupplemented groups (P < 0.001; total n = 130). Compared with bas eline, cobalamin in the supplemented groups was increased by 22%, plasma fo late by 101%, red blood cell folate by 87%, and pyridoxal 5'-phosphate by 6 8%. Concentrations in the unsupplemented groups changed by -2%, -6%, 1%, an d -13%, respectively. Hcy decreased by 25% and MMA by 30% in the supplement ed groups, compared with a small increase in Hcy (2%) and decrease in MMA ( 9%) in the unsupplemented groups. Exercise did not significantly affect vit amin, Hcy, or MMA concentrations. No significant effect of either intervent ion was observed on the neuropsychological tests. Conclusions: The decrease in Hcy and MMA in frail elders confirms a subclin ical metabolic deficiency state. Enriched foods containing physiologic amou nts of micronutrients have a beneficial effect on these metabolites. No eff ects of B vitamins on mental health were identified.