Vitamin B-12 status, dietary protein intake and proton pump inhibitor use in geriatric rehabilitation subjects

Aim: To compare the dietary intake and nutritional status of users and non-users of proton pump inhibitor medications. Methods: Cross-sectional study of subacute rehabilitation inpatients. Forty-nine patients (nine men and 40 women) without dementia fulfilled the study criteria. Information was collected on admission and included medical history, duration of proton pump inhibitor medication use, nutritional status and cognitive scores. Dietary data were collected by food frequency questionnaire and blood samples were analysed for vitamin B₁₂, homocysteine and methylmalonic acid concentrations. Results: Age was 80.4 ± 7.7 (mean ± SD) years and body mass index was 26 ± 6.7kg/m². Twenty-one (of 49) subjects had subclinical vitamin B₁₂ deficiency, which was defined as serum vitamin B₁₂ <148pmol/L or 148-258pmol/L and methylmalonic acid >0.30μmol/L or tHcy >13μmol/L (women) and >15μmol/L (men). Subjects were stratified according to proton pump inhibitor use and vitamin B₁₂ status. The presence of subclinical deficiency was similar between the groups (χ²-test P= 0.17). Proton pump inhibitor users had higher dietary protein and calcium intakes (but not supplement calcium intakes) compared with non-users (93 vs 81g/day, P= 0.002 and 968 vs 742mg/day, P= 0.038, respectively). Conclusions: Subjects using proton pump inhibitor medications did not have lower vitamin B₁₂ status, but had higher dietary protein intakes suggesting higher intakes of meats, eggs and dairy foods may reduce the risk of developing vitamin B₁₂ deficiency whilst taking proton pump inhibitor medications.