Anemia no diabetes mellitus gestacional: implicações na instabilidade genômica / Anemia in gestational diabetes mellitus: implications for genomic instability

Introdução: Evidências têm mostrado uma associação entre anemia e Diabetes Mellitus. Contudo, a relação entre anemia e Diabetes Mellitus Gestacional (DMG) ainda não está bem estabelecida, bem como sua repercussão na instabilidade genômica. Portanto, objetivou-se verificar a associação entre anemia e instabilidade genômica em mulheres com DMG atendidas em um hospital universitário. Métodos: Estudo transversal com mulheres apresentando diagnóstico de DMG que realizaram pré-natal no Hospital Universitário de Santa Maria (RS). Informações referentes ao DMG, anemia e suplementação de ferro foram obtidas nos prontuários. A instabilidade genômica foi avaliada pelo ensaio de citoma em micronúcleos em células bucais (BMCyt). Resultados: Das 44 gestantes avaliadas, 28,6% apresentaram anemia e 79,5% foram suplementadas com ferro. Das gestantes que realizaram suplementação, 75,0% não apresentaram anemia gestacional. Níveis de hemoglobina não se associaram com a instabilidade genomica (p > 0,05), mas foi observada uma associação entre brotos nucleares e os níveis de glicemia (r = 0,977; p = 0,003). Conclusão: Não foi verificado associação entre anemia e instabilidade genômica em mulheres com DMG.(AU)

Introduction: There is evidence of an association between anemia and diabetes mellitus. However, the relationship between anemia and gestational diabetes mellitus (GDM) remains to be established, as well as its impact on genomic instability. Therefore, we aimed to examine the association between anemia and genomic instability in women with GDM treated at a university hospital. Methods: A cross-sectional study of women with a diagnosis of GDM who received prenatal care at the University Hospital of Santa Maria, southern Brazil. Data on GDM, anemia, and iron supplementation were obtained from medical records. Genomic instability was assessed by the buccal micronucleus cytome (BMCyt) assay. Results: Of 44 pregnant women evaluated, 28.6% had anemia and 79.5% received iron supplementation; of the latter, 75.0% did not have gestational anemia. Hemoglobin levels were not associated with genomic instability (p > 0.05), but an association was found between nuclear buds and blood glucose levels (r = 0.977; p = 0.003). Conclusion: There was no association between anemia and genomic instability in women with GDM.(AU)

[Not Available]. / Adherencia al consumo de los suplementos alimenticios del programa PROSPERA, en la reducción de la prevalencia de anemia en niños menores de tres años en el estado de San Luis Potosí, México.

Introducción: la anemia es un factor de riesgo en la población infantil con consecuencias graves para su crecimiento y desarrollo. Los programas de ayuda alimentaria pueden contribuir a su prevención y control. Objetivo: estudiar la adherencia al consumo de suplementos y su relación con la prevalencia de anemia en niños menores de tres años de edad en San Luis Potosí, México beneficiarios del programa PROSPERA.Métodos: se realizó un análisis comparativo en niños de 12 a 36 meses que consumen diferentes suplementos alimenticios: 414 pertenecientes al grupo de intervención y 334 al de comparación. Se midió la hemoglobina (Hb) por Hemocue clasificando como anémicos a quienes tuvieron valores <110 g/l. Se aplicaron pruebas de t de Student y X2. Se estimaron efectos de intervención mediante el método de diferencias en diferencias y un puntaje de adherencia al consumo de suplementos.Resultados: al final del estudio la prevalencia de anemia disminuyó 11.2 pp en el grupo de intervención y 8.7 pp en el de comparación; la interacción del puntaje de adherencia por suplemento y etapa de observación mostró que la adherencia al consumo de Bebida láctea + Vitaniño reduce el riesgo de presentar anemia (p = 0,14). El consumo de Nutrisano + Vitaniño se asoció con menor riesgo (0,2), ambos con respecto al consumo de Nutrisano.Conclusiones: el programa PROSPERA tuvo efectos importantes en la disminución de las prevalencias de anemia. Se recomienda llevar a cabo acciones para mejorar la adherencia al consumo de suplementos alimenticios, a fIn de mejorar la efectividad de los programas.

Eficacia de la Trofoterapia en el Tratamiento de la Anemia: Estudio Bibliométrico / The effectiveness of trophotherapy in anemia treatment: a bibliometrical study

Objetivo: Identificar, evaluar y sistematizar información acerca de la eficacia de la trofoterapia en el manejo de la anemia. Materiales y Métodos: Se realizó una búsqueda entre mayo y junio del 2014 en las bases de datos: PUBMED, EBSCO, Science Direct, Scopus, EMBASE. Para la selección de los artículos se consultó la Cochrane Handbook of Systematic Reviews of Intervention, versión 5.1.0. Se utilizó el formulario de extracción de datos Cochrane (2007) modificado para obtener la información de los artículos según los criterios de inclusión. Para evaluar la calidad metodológica de la evidencia se empleó la "Escala de Jadad", en el caso de los ensayos clínicos aleatorizados; y una lista de calidad estándar para estudios primarios de diferentes campos, descritos. Resultados: Seis (06) artículos cumplieron con los criterios de inclusión; solo dos (02) de ellos tuvieron una adecuada calidad metodológica. Dos (02) estudios referían el uso de preparados tradicionales en el tratamiento de la anemia; dos (02) estudios consideraron alimentos para el tratamiento de la anemia y un (01) estudio analizó extractos metanólicos. El término de "trofoterapia" o "trophoterapy"; no fueron encontrados en los tesauros (DeCS y MeSH) y ningún artículo científico hizo referencia al término ""trophoterapy" en el título. Conclusiones: Es importante definir y armonizar los conceptos en Trofoterapia, para que éstas puedan ser estudiadas, validadas e incorpradas en el sistema convencional de salud; sin embargo, existen indicios de la eficacia de Solenostemon monostachyus, Ipomoea involucrata, el aceite de semilla de Carica papaya y del alga espirulina para el tratamiento de la anemia falciforme y nutricional; pero estas investigaciones no se han abordado en el marco de la filosofía y paradigmas de la trofoterapia.

[Effects of a lipid-based nutrient supplement on hemoglobin levels and anthropometric indicators in children from five districts in Huánuco Peru]. / Efecto de un suplemento nutricional a base de lípidos en los niveles de hemoglobina e indicadores antropométricos en niños de cinco distritos de Huánuco, Perú.

UNLABELLED: Objectives . To determine the effect of consumption of a lipid-based nutrient supplement (LNS) on hemoglobin levels, anemia and anthropometric indicators in children aged six to eleven months old in five districts in the province of Ambo in the region of Huanuco, Peru. MATERIALS AND METHODS: A pre-experimental, pre-post study was performed. The study population included children aged six to eleven months old in 19 health facilities in five districts with very high vulnerability to chronic malnutrition in the province of Ambo, Huanuco. Data from 147 children who received the lipid-based nutrient supplement (LNS) from six to eleven months old were obtained. RESULTS: The mean hemoglobin significantly increased by 0.67 g/dL (p<0.05), the proportion of anemia dropped by 27 percentage points (p<0.001) and the mean z score for height/age decreased by 0.12 (p<0.05). No significant differences for z scores of weight/age and weight/height at the end of the study were found. The LNS had an adherence greater than 90%, and less than 10% of children in the study reported discomfort during consumption. CONCLUSIONS: LNS supplementation achieved improved hemoglobin levels and reduced the prevalence of anemia in children under twelve months, which might constitute an effective alternative to prevent and control childhood anemia.

Ready-to-use supplementary food increases fat mass and BMI in Haitian school-aged children.

BACKGROUND: In Haiti and other countries, large-scale investments in school feeding programs have been made with marginal evidence of nutrition outcomes. OBJECTIVE: We aimed to examine the effectiveness of a fortified ready-to-use supplementary food (RUSF), Mamba, on reduced anemia and improved body composition in school-aged children compared to an unfortified cereal bar, Tablet Yo, and control groups. METHODS: A cluster, randomized trial with children ages 3-13 y (n = 1167) was conducted in the north of Haiti. Six schools were matched and randomized to the control group, Tablet Yo group (42 g, 165 kcal), or Mamba group (50 g, 260 kcal, and >75% of the RDA for critical micronutrients). Children in the supplementation groups received the snack daily for 100 d, and all were followed longitudinally for hemoglobin concentrations, anthropometry, and bioelectrical impedance measures: baseline (December 2012), midline (March 2013), and endline (June 2013). Parent surveys were conducted at baseline and endline to examine secondary outcomes of morbidities and dietary intakes. Longitudinal regression modeling using generalized least squares and logit with random effects tested the main effects. RESULTS: At baseline,14.0% of children were stunted, 14.5% underweight, 9.1% thin, and 73% anemic. Fat mass percentage (mean ± SD) was 8.1% ± 4.3% for boys and 12.5% ± 4.4% for girls. In longitudinal modeling, Mamba supplementation increased body mass index z score (regression coefficient ± SEE) 0.25 ± 0.06, fat mass 0.45 ± 0.14 kg, and percentage fat mass 1.28% ± 0.27% compared with control at each time point (P < 0.001). Among boys, Mamba increased fat mass (regression coefficient ± SEE) 0.73 ± 0.19 kg and fat-free mass 0.62 ± 0.34 kg compared with control (P < 0.001). Mamba reduced the odds of developing anemia by 28% compared to control (adjusted OR: 0.72; 95% CI: 0.57, 0.91; P < 0.001). No treatment effect was found for hemoglobin concentration. CONCLUSION: To our knowledge, this is the first study to give evidence of body composition effects from an RUSF in school-aged children.

[Evaluation of the impact of multiple micronutrient powders on children anemia in three Andean regiones in Peru]. / Evaluación del impacto de los multimicronutrientes en polvo sobre la anemia infantil en tres regiones andinas del Perú

The aim of this research was to determine the impact of the strategy of multi-micronutrient supplementation (MMN) on the childhood anemia in three Andean regions of Peru. A sentinel surveillance system was established in 29 health centers of Andahuaylas, Ayacucho and Huancavelica (Peru) to monitor a cohort of children of 6 to 35 months of age whom been received MMM for a period of 12 months. Data regarding hemoglobin levels were gathered at the beginning and at the end of the research; they included consumption of MMN, and other data from clinical records and from growth and development charts. Between the child who completed the supplementation, the prevalence of anemia decreased from 70.2% to 36.6% (p value <0.01). 55,0% and 69,1% of children with mild and moderate anemia at the beginning of the supplementation got cured. This research shows that supplementation with MMN could be a valuable strategy to fight anemia.

[Impact of the provision of fortified cornmeal on anemia in preschoolers in the indigenous areas of Mexico]. / Impacto del suministro de harina de maíz fortificada en la anemia de preescolares de zonas indígenas de México.

OBJECTIVE: To estimate changes in anemia status in preschool age children at 9 months after the provision of soy- and iron-fortified cornflour. METHODS: A non-experimental pre-post evaluation study was performed in a sample of 98 boys and 96 boys aged between 6 and 24 months. We analyzed demographic, anthropometric, and biochemical variables. RESULTS: During the 9-month period, the hemoglobin level increased from 11.0 to 11.9 mg/dL (p<0,001). The prevalence of anemia (hemoglobin <11.0mg/dL) decreased from 52.6% to 25.3% (p<0,001). The indicators of height for age and body mass index changed from -2.1 (-5.5 to 2.8) to -2.3 (-6.5 to 1.3) (p<0,001) and from 0,4 (-3.1 to 2.9) to 0,7 (-2.2 to 3.9) (p<0,001), respectively. CONCLUSIONS: The decreased prevalence of anemia suggests that the provision of soy- (3%) and iron-fortified flour is a viable alternative for combating childhood anemia.

Evaluación del impacto de los multimicronutrientes en polvo sobre la anemia infantil en tres regiones andinas del Perú / Evaluation of the impact of multiple micronutrient powders on children anemia in three andean regiones in Peru

Con el objetivo de determinar el impacto de la administración con multimicronutrientes (MMN) en polvo sobre la anemia infantil en tres regiones andinas del Perú, se estableció un sistema de vigilancia centinela en 29 establecimientos de Andahuaylas, Ayacucho y Huancavelica, en niños de 6 a 35 meses de edad, a quienes se les indicó MMN por un periodo de 12 meses, entre el 2009 y 2011. Además de los datos sociodemográficos de los menores y las madres, se determinó los niveles de hemoglobina al inicio y al final del estudio. Entre los menores que culminaron la suplementación, la prevalencia de anemia se redujo de 70,2 a 36,6% (p<0,01), y se evidenció que el 55,0% y el 69,1% de niños con anemia leve y moderada al inicio del estudio, la habían superado al término del mismo. Se concluye que la suplementación con MMN en polvo puede ser una estrategia efectiva en la lucha contra la anemia.

The aim of this research was to determine the impact of the strategy of multi-micronutrient supplementation (MMN) on the childhood anemia in three Andean regions of Peru. A sentinel surveillance system was established in 29 health centers of Andahuaylas, Ayacucho and Huancavelica (Peru) to monitor a cohort of children of 6 to 35 months of age whom been received MMM for a period of 12 months. Data regarding hemoglobin levels were gathered at the beginning and at the end of the research; they included consumption of MMN, and other data from clinical records and from growth and development charts. Between the child who completed the supplementation, the prevalence of anemia decreased from 70.2% to 36.6% (p value <0.01). 55,0% and 69,1% of children with mild and moderate anemia at the beginning of the supplementation got cured. This research shows that supplementation with MMN could be a valuable strategy to fight anemia.

A alimentação e a anemia carencial em adolescentes / The feeding and iron deficiency anemia in adolescents

A anemia ferropriva é o problema nutricional de maior prevalência atualmente no mundo. Sua ocorrência é considerada maior nos países em desenvolvimento, onde 36% da população apresenta essa patologia

Anemia nutricional em crianças menores de 5 anos do municipio de Sâo Paulo: Papel da dieta na determinação de sua prevalência / Nutritional anemia in children under five years of the municipality of Sao Paulo: Role of diet in determining its prevalence

A relação entre anemia nutricional e dieta foi estudada em uma amostra probabilística de 307 crianças menores de 60 meses, moradoras no municipio de São Paulo. A ingestão de alimentos foi avaliada pelo método recordatório de 24 horas, através de entrevistas com as mães das crianças

Mortality risk in hemodialysis patients according to anemia control and erythropoietin dosing.

There is no consensus about the toxicity of erythropoiesis-stimulating agents among hemodialysis patients. We aimed to calculate the risk of death according to anemia control and erythropoietin (EPO) dosing among end-stage renal disease patients undergoing hemodialysis. We retrospectively studied 156 end-stage renal disease patients on hemodialysis from a single renal unit during 12 months. Participants were classified according to anemia control into four groups: excellent (A), good (B), moderate (C) and bad (D) control. They were also classified according to EPO dosing into two groups: usual and high EPO dosing. The Cox proportional hazards regression model, adjusted for the difference in age, sex, time on dialysis, comorbidity, albumin, and Kt/V index, was performed to calculate the risk of death according to anemia control and EPO dosing profiles. Multivariate analysis by backward stepwise logistic regression was used to calculate the risk of death according to the variables that differed in the comparison between survivors and nonsurvivors. The hazard ratio of death was not significant according to anemia control profile C/D vs. A/B, but hazard ratio was 2.967 (95% confidence interval [CI] = 1.132-7.777; P = 0.027) for high EPO dosing profile patients. The multivariate analysis showed comorbidity (odds ratio [OR] = 8.958; 95% CI = 2.843-26.223; P < 0.001], high EPO dosing profile (OR = 5.172; 95% CI = 1.663-16,081; P = 0.005), age (OR = 1.056; 95% CI = 1.020-1.094; P = 0.002), and mean hemoglobin (OR = 0.435; 95% CI = 0.267-0.709; P = 0.001) to be predictive of death. Even though we cannot conclude that mortality risk is due to EPO toxicity, hemodialysis patients using high EPO dosing must be seen as at risk.

Fortificação das farinhas com ferro e controle da anemia em gestantes de Teresina, Piauí, Brasil / Fortification of flours with iron and control of anemia in pregnant women in Teresina, Piauí, Brazil

OBJETIVO Comparar níveis de hemoglobina e ocorrência de anemia em gestantes antes e depois da fortificação das farinhas e caracterizar a prática alimentar de gestantes usuárias atuais dos serviços. MÉTODOS Estudo transversal que analisou dados de hemoglobina de gestantes atendidas em dois serviços públicos de maior demanda pré-natal do Município de Teresina, Piauí. Os dados foram obtidos de 854 prontuários de gestantes distribuídas em dois grupos: não fortificado (427 gestantes com parto anterior a junho/2004) e fortificado (427 gestantes com data da última menstruação posterior a junho/2005). Gestantes com nível de hemoglobina <11,0g/dL foram consideradas anêmicas. O consumo alimentar foi analisado por meio de questionário de frequência alimentar semiquantitativo. RESULTADOS Níveis médios de hemoglobina aumentaram significativamente de 11,7g/dL, DP=1,2 para 12,4g/dL, DP=1,3 (p<0,001) após a fortificação. A prevalência de anemia caiu de 27,2 por cento no grupo não fortificado para 11,5 por cento no grupo fortificado (p<0,001). CONCLUSÃO Houve melhora significativa no quadro de anemia após a fortificação das farinhas, o que sugere que a intervenção foi efetiva no controle da deficiência de ferro, porém o estudo não permite atribuir tal resultado apenas à implantação dessa medida, embora análise da prática alimentar tenha mostrado que as gestantes de Teresina (PI) apresentaram condição diferenciada de alimentação, com consumo frequente de fontes naturais de ferro e de facilitadores de sua absorção, além de alimentos fortificados.

OBJECTIVE This study compared the hemoglobin levels and the occurrence of anemia in pregnant women before and after the fortification of flours and characterized the eating habits of pregnant women who currently use the service. METHODS This cross-sectional study analyzed the hemoglobin data of pregnant women seen by two public services with greater prenatal demand in the city of Teresina, Piauí. The data were obtained from 854 medical records of the women distributed into two groups: not fortified (427 women who would deliver before June 2004) and fortified (427 women whose last menstruation was after June 2005). Women with a hemoglobin level <11.0g/dL were considered anemic. Food intake was analyzed by a semiquantitative food frequency questionnaire. RESULTS Mean hemoglobin levels increased significantly from 11.7g/dL, SD=1.2, to 12.4g/dL, SD=1.3 (p<0.001) after fortification. The prevalence of anemia decreased from 27.2 percent in the non-fortified group to 11.5 percent in the fortified group (p<0,001). CONCLUSION Anemia improved significantly after fortification of the flours, suggesting that the intervention effectively controlled iron deficiency. However, it is not possible to attribute the improved iron levels on this measure alone, even though analysis of their eating habits showed that pregnant women from Teresina (PI) presented unusual food habits, with frequent consumption of natural iron sources and foods that facilitate its absorption, in addition to the fortified foods.

Avaliação da biodisponibilidade de ferro ingerido por crianças em idade pré-escolar / Evaluation of iron bioavailability in preschool children

The study aimed to evaluate the bioavailability of iron ingested by children under six years old. The data were obtained from a population-based crosssectionalstudy aimed to evaluate the effect of flour fortification with ironon anemia in preschool children. The feeding data were obtained from 24-hour recalls. The bioavailability of iron intake was calculated by us ingthe algorithm proposed by Monsen et al. which takes into account the iron stock body, total iron intake, heme iron, nonheme iron, vitamin C and the amount of meat per meal. Among the 4032 of meals studied, 72% had alow iron bioavailability. None of the 774 children studied showed a daily diet with intermediate or high iron bioavailability, which may be partially explained by the deficient consumption of iron and/or by the consumption of food items which facilitate its absorption.

El foco del trabajo fue la evaluación de labio disponibilidad del hierro ingerido por niños menores de seis años de edad. Los datos fueron obtenidos de un estudio transversal de base poblacional que enfocaba valorar el efecto que la fortificación de harinas con hierro ejercía sobrela anemia de niños en edad preescolar. Los datos de la alimentación fueron obtenidos por mediode recordatorios registrados a cada 24 horas con las madres o responsables por los niños. La biodisponibilidad del hierro ingerido fue calculada por medio del algoritmo propuesto por Monsen et al., que considera el estoque corporal de hierro, la ingestión de hierro total; el hierro hemínico (Fe-hem); el hierro no hemínico (Feno-hem), la vitamina C y la cantidad de carne por comida. De las 4032 comidas estudiadas, un 72% presentaron baja disponibilidad de hierro. Ninguno de los 774 niños que fueron estudiados presentó una alimentación diaria con biodisponibilidad de hierro media o alta, lo que puede ser parcialmente explicado por deficiencia en el consumo de hierro y/o de alimentos que son facilitadores de la absorción del mineral.

O trabalho objetivou avaliar a biodisponibilidade do ferro ingerido por crianças menores de seis anos de idade. Os dados foram obtidos de estudo transversal de base populacional que avaliou o efeito da fortificação das farinhas com ferro sobre a anemia em pré-escolares. Foram aplicados recordatórios de 24 horas às mães ou responsáveis pelas crianças. A biodisponibilidade do ferro ingerido foi calculada através do algoritmo proposto por Monsen et al. que leva em consideração o estoque corporal de ferro, a ingestão de ferro total; ferro heme; ferro não heme; vitamina C e a quantidade de carne, por refeição. Das 4032 refeições estudadas, 72% apresentaram baixa biodisponibilidade de ferro. Nenhuma das 774 crianças estudadas apresentou alimentação diária com média ou alta biodisponibilidade de ferro, o que pode ser parcialmente explicado pelo consumo deficitáriode ferro e/ou de alimentos facilitadores de sua absorção.

[Anemia and obesity: a paradox of the nutritional transition in Brazil]. / Anemia e obesidade: um paradoxo da transição nutricional brasileira.

The aim of this study was to analyze the growing prevalence of anemia and overweight/obesity as contrasting trends in Brazil's nutritional transition. Twenty-eight studies published on anemia in children and childbearing-age women were selected, based on statistical representativeness, standardization of laboratory methods, and World Health Organization criteria. Overweight/obesity in adults was assessed by body mass index: 25 to 29.9 kg/m(2) (overweight) and > or =30 kg/m(2) (obesity). Three surveys were compared for analysis of tendencies: 1974/1975 (36.4%), 1989 (53.5%), and 2002/2003 (51.9%) for overweight/obesity prevalence. In the most representative study on anemia among children (< 11 g/dL), the prevalence increased from 22.0% (1974) to 46.9% (1995/1996). For pregnant woman (< 11 g/dL), results ranged from 14.7 to 40.4%. Prevalence of anemia among children and overweight/obesity among adults showed similar tendencies over time. Recent evidence of reduction in anemia can be attributed to flour supplementation with iron and folic acid. Anemia and overweight/obesity are associated with significant changes in food intake as a substratum of the nutritional transition.

Ferro, folato e vitamina B12: análise da ingestão e ocorrência de anemia em idosas / Iron, folate and vitamin B12: analysis of ingestion and occurrence anemia in elderly

Os autores avaliam a ingestão de micronutrientes relacionados à hematopoese e determinam a prevalência de anemia em pacientes do sexo feminino com idade superior a 60 anos, residentes na periferia do Distrito Federal. Para cada paciente foi determinada a média de ingestão diária de ferro, vitamina B12 e ácido fólico, por meio da análise dietética dos registros alimentares estimados de três dias alternados, seguida da determinação das dosagens séricas de cobalamina livre e hemocisteína. O diagnóstico de anemia foi estabelecido pela dosagem de hemoglobina total. Encontrou-se prevalência de anemia em 9,8 por cento das idosas estudadas. Não foi observada diferença significativa no consumo de ferro e ácido fólico entre pacientes anêmicas e não-anêmicas. No entanto, o consumo médio de vitamina B12 entre as pacientes não-anêmicas mostrou-se 2,6 vezes superior à ingestão média observada no grupo anêmico (p<0,05). Dosagens séricas de cobalamina e homocisteína mostraram-se aumentadas entre portadores de anemia. Os dados dos autores sugerem que a deficiência na ingestão de vitamina B12 constitui fator predisponente ao desenvolvimento de anemia em pacientes idosos.

This study aimed to estimate the average intake of hematopoiesis related micronutrients and to assess the prevalence of anemia in elder female subjects aged 60 years or older residing in the outskirts of the Brazilian Federal District. Mean daily consumption of iron, folic acid and vitamin B12 were determined for each patient by means of dietary analysis of food registries, followed by evaluation of free serum cobalamin and hemocysteine. Anemia diagnosis was established by quantification of total hemoglobin. Prevalence was found to assault 9.8 per cent of elderly studied. No significant difference has been observed in folic acid and iron intakes between anemic and non-anemic subjects. On the other hand, mean consumption of vitamin B12 was 2.6 fold higher among anemic patients (p<0.05). Accordingly, serum cobalamin and homocysteine dosages have shown marked increase in the anemic group. Our findings suggest that deficiency in vitamin B12 intake constitutes a predisposing factor to the onset of anemia in the elderly.