Examining the Clinical Usefulness of Urine Methylmalonic Acid for Diagnosis of Vitamin B-12 Deficiency in Older Adults: A Pilot Study.

The urinary methylmalonic acid (uMMA)/creatinine ratio was feasible to measure via filter paper urine samples analyzed by tandem mass spectrometry in community-dwelling older adults.

• All urine filter paper samples were successfully received and analyzed across 4 monthly collection timepoints
• Study enrolled 53 community-dwelling adults aged ≥70 years
• Most participants (n = 45) maintained a supplementation adherence rate of 95% or higher
• The study used a 3-month quasi-experimental pre-post design

Vitamin B-12 supplementation led to a statistically significant reduction in uMMA/creatinine levels.

• Participants received 1200 µg/day of peroral vitamin B-12 supplementation
• Supplementation duration was 3 months
• The reduction in uMMA/creatinine ratio was described as statistically significant
• Monthly fasting urine samples were collected to track changes over time

Vitamin B-12 supplementation was associated with significant improvements in balance performance.

• Balance was assessed using the Berg Balance Scale and the Activities-specific Balance Confidence Scale
• Assessments were conducted before and after the 3-month supplementation period
• The improvement in balance was described as statistically significant following supplementation

Vitamin B-12 supplementation was associated with significant improvements in cognitive performance.

• Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA)
• Assessments were conducted before and after the 3-month supplementation period
• The improvement in cognitive performance was described as statistically significant

A significant correlation was observed between reduction in the uMMA/creatinine ratio and cognitive improvement.

• The correlation was between the magnitude of uMMA/creatinine ratio decrease and the degree of cognitive improvement on the MoCA
• This correlation supports the potential clinical utility of uMMA as a treatment-response biomarker
• No similar correlation analysis was reported for balance outcomes

No significant changes in neurophysiological markers were detected following vitamin B-12 supplementation.

• Neurophysiological function was assessed using motor evoked potentials (MEP) latency
• MEP latency was measured before and after the 3-month supplementation period
• No statistically significant changes in MEP latency were observed
• The authors suggested that extended supplementation periods may be needed to detect neurophysiological changes