Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals.

BACKGROUND: Some studies have shown that short-term use of proton pump inhibitors decreases the absorption of vitamin B12, but the results of studies into long-term proton pump inhibitor use and vitamin B12 deficiency are inconsistent. AIM: To investigate whether long-term proton pump inhibitor use is associated with an abnormal vitamin B12 status in elderly individuals. METHODS: One hundred and twenty-five long-term (>3, years) proton pump inhibitor users aged 65, years and above were recruited from general practices. Their 125 partners (who did not use proton pump inhibitors) served as the reference group. Vitamin B12 status was determined by serum levels of vitamin B12 and homocysteine, and mean corpuscular volume. RESULTS: No differences in mean vitamin B12 levels were observed between the long-term proton pump inhibitor users and their partners [345 (s.d. 126), pm vs. 339 (s.d. 133), pm, P, =, 0.73], even after adjustment for age, gender, Helicobacter pylori status and C-reactive protein levels (P, =, 0.87). Four proton pump inhibitor users and three partners had vitamin B12 levels <150, pm (3% vs. 2%, P, =, 1.00). No differences between the groups were observed in homocysteine levels and mean corpuscular volume. CONCLUSIONS: No association between long-term proton pump inhibitor use and vitamin B12 status was observed. Regular testing for low vitamin B12 levels in elderly patients on long-term treatment with proton pump inhibitors is therefore not recommended.

Renal disease in relatives of Indo-Asian Type 2 diabetic patients with end-stage diabetic nephropathy.

AIMS/HYPOTHESIS: Indo-Asian immigrants in The Hague, The Netherlands, have a nearly 40-fold higher risk of end-stage diabetic nephropathy compared to the Caucasian population. To detect a genetic susceptibility for nephropathy within the Indo-Asian population, we assessed whether familial clustering of nephropathy occurs in families of Indo-Asian Type 2 diabetic patients. METHODS: We compared nephropathy prevalence between two groups of first-degree relatives of Indo-Asian patients with Type 2 diabetes; the first group (case relatives) consisted of 169 relatives of patients with end-stage diabetic nephropathy; the second group (control relatives) consisted of 161 relatives of diabetic patients who had no nephropathy. The case and control relatives were examined for diabetes, blood pressure, renal function, microalbuminuria and urine dipstick measurements. RESULTS: The mean age was 41 years and similar in the case and control relatives. Diabetes was distributed equally in both family groups. We did not find more nephropathy in first-degree relatives of Indo-Asian Type 2 diabetic patients with end-stage diabetic nephropathy in comparison with the control-relatives. CONCLUSION/INTERPRETATION: We could not detect a genetic susceptibility for diabetic nephropathy within the Indo-Asian population. The lack of familial clustering of renal disease in Indo-Asian diabetic patients points to a general genetic or environmental susceptibility for diabetic nephropathy in this population.