Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B12 status, and the impact of fortified foods, in older adults

Kirsty Porter, L. Hoey, Catherine Hughes, M Ward, Michelle Clements, JJ Strain, Conal Cunningham, Miriam Casey, Fergal Tracey, Maurice O'Kane, K. Pentieva, LB McAnena, Kevin McCarroll, Eamon Laird, Anne M. Molloy, H McNulty

Research output: Contribution to journalArticlepeer-review


Background: Atrophic gastritis (AG) and proton-pump inhibitor (PPI) use result in gastric acid suppression that can impair the absorption of vitamin B12 from foods. The crystalline B12 form, found in fortified foods, does not require gastric acid for its absorption and may thus be beneficial for older adults with hypochlorhydria, but evidence is lacking. Objective: To investigate associations of AG and PPI use with vitamin B12 status, and the potential protective role of fortified foods, in older adults. Design: Eligible participants (n 3299) not using B12 supplements were drawn from the Trinity-Ulster and Department of Agriculture (TUDA) cohort, a study of non-institutionalized adults ≥60 years recruited in 2008-2012. B12 status was measured using four biomarkers and B12 deficiency was defined as a combined indicator value of < -0.5. A pepsinogen I:II ratio <3 was considered indicative of AG. Results: AG was identified in 15% of participants and associated with significantly lower serum total vitamin B12 (P <0.001) and plasma holotranscobalamin (P <0.001), and higher prevalence of B12 deficiency (38%), compared to PPI users (21%) and controls (without AG and non-users of PPIs; 15%; P <0.001). PPI drugs were used (≥6 months) by 37% of participants and were associated with lower holotranscobalamin concentrations, but only in participants taking higher doses (≥ 30 mg/day). Regular, compared to non-regular, consumption of fortified foods (i.e. ≥5 and 0-4 portions per week, respectively) was associated with higher B12 biomarkers in all participants, but inadequate to restore normal B12 status in those with AG. Conclusions: Older adults who have AG and/or higher dose PPI use are more likely to have indicators of B12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced B12 status, but higher levels of added B12 than currently provided may be warranted to optimize status in people with AG.
Original languageEnglish
JournalThe American Journal of Clinical Nutrition
Publication statusAccepted/In press - 17 May 2021

Bibliographical note

Published open access via the read and publish agreement


  • Vitamin B12 biomarkers
  • atrophic gastritis
  • proton pump inhibitor drugs
  • fortified foods
  • food-bound malabsorption
  • hypochlorhydria
  • older adults


Dive into the research topics of 'Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B12 status, and the impact of fortified foods, in older adults'. Together they form a unique fingerprint.

Cite this