Association of Elevated Homocysteine Level and Vitamin B12 Deficiency With Anemia in Older Adults

A recent article in the Archives 1 reported on the development of anemia in the Leiden 85-Plus Study. Folate deficiency and elevated serum homocysteine level were associated with anemia both at baseline and at the 5-year follow-up. However, the authors did not assess associations between anemia and dietary and red blood cell folate levels. It is important to investigate these relationships because folate deficiency generally develops as a result of inadequate dietary intake, and red blood cell folate concentration is more reliable than serum level. We therefore explored associations between anemia and elevated homocysteine level, as well as with vitamin B12 and serum, red blood cell, and dietary folate deficiencies, in a representative population of older adults.