Kirsty M Porter1, Mary Ward1, Catherine F Hughes1, Maurice O'Kane2, Leane Hoey1, Adrian McCann3, Anne M Molloy4, Conal Cunningham5, Miriam C Casey5, Fergal Tracey6, Sean Strain1, Kevin McCarroll5, Eamon Laird4, Alison M Gallagher1, Helene McNulty1. 1. Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom. 2. Clinical Chemistry Laboratory, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom. 3. Bevital AS, Laboratoriebygget, Bergen, Norway. 4. School of Medicine, Trinity College Dublin, Dublin, Ireland. 5. Mercers Institute for Research on Aging, St James's Hospital, Dublin, Ireland. 6. Causeway Hospital, Northern Health and Social Care Trust, Coleraine, Northern Ireland, United Kingdom.
Abstract
CONTEXT: Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes. OBJECTIVE: To determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults. SETTING AND PARTICIPANTS: Community-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment. MAIN OUTCOME MEASURES: Biomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB). RESULTS: Metformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤-1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74). CONCLUSIONS: Use of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.
CONTEXT: Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes. OBJECTIVE: To determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults. SETTING AND PARTICIPANTS: Community-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment. MAIN OUTCOME MEASURES: Biomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB). RESULTS:Metformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤-1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74). CONCLUSIONS: Use of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.
Authors: Nathalie Mangel; Jared B Fudge; Wilhelm Gruissem; Teresa B Fitzpatrick; Hervé Vanderschuren Journal: Front Plant Sci Date: 2022-04-04 Impact factor: 6.627
Authors: Adam H Dyer; Eamon Laird; Leane Hoey; Catherine F Hughes; Helene McNulty; Mary Ward; J J Strain; Maurice O'Kane; Fergal Tracey; Anne M Molloy; Conal Cunningham; Donal J Sexton; Kevin McCarroll Journal: Int J Geriatr Psychiatry Date: 2022-07 Impact factor: 3.850
Authors: Mary Ward; Catherine F Hughes; J J Strain; Rosie Reilly; Conal Cunningham; Anne M Molloy; Geraldine Horigan; Miriam Casey; Kevin McCarroll; Maurice O'Kane; Michael J Gibney; Albert Flynn; Janette Walton; Breige A McNulty; Adrian McCann; Laura Kirwan; John M Scott; Helene McNulty Journal: BMC Med Date: 2020-11-11 Impact factor: 8.775