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OBJECTIVE:: To determine the serum vitamin B12 status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B12 status. DESIGN:: A cross-sectional nationally representative population-based survey. METHOD:: Serum vitamin B12 concentrations were used to assess vitamin B12 status. The presence and severity of atrophic gastritis was classified using serum pepsinogen I and II. SUBJECTS:: A total of 466 noninstitutionalized urban and rural dwelling New Zealanders aged 65?y or older who participated in the 1997 National Nutrition Survey. RESULTS:: The prevalence of deficient (<148?pmol/l) and marginal (148-221?pmol/l) serum vitamin B12 concentrations was 12 and 28%, respectively. The prevalence of atrophic gastritis was 6.7%(severe 3.1%, mild-moderate 3.6%). While atrophic gastritis increased the relative risk (RR, 95%CI) of having a deficient or marginal serum vitamin B12 concentration by 21-fold (6-67) and five-fold (1-17), respectively, those who had atrophic gastritis made up only 33 and 6%of the participants with deficient or marginal serum vitamin B12 concentrations. An intake of vitamin B12 from food that exceeded the recommended dietary allowance (2.4?µg/day) did not protect against deficient (RR 0.5; 95%CI: 0.2, 1.2) or marginal (RR 0.9; 95%CI: 0.5, 1.7) serum vitamin B12 status. Vitamin B12 supplement users had a reduced risk of having deficient and marginal vitamin B12 status (RR 0.3; 95%CI: 0.1, 0.8). CONCLUSIONS:: There is a relatively high prevalence of deficient and marginal serum vitamin B12 concentrations among older New Zealanders. However, the prevalence of atrophic gastritis was low in the New Zealand elderly compared with other surveys. Although atrophic gastritis was a risk factor for low vitamin B12 status, it did not fully explain the prevalence of low serum vitamin B12. SPONSORSHIP:: The New Zealand Ministry of Health and an Otago Research Grant.European Journal of Clinical Nutrition (2005) 59, 205-210. doi:10.1038/sj.ejcn.1602059 Published online 13 October 2004 [ABSTRACT FROM AUTHOR]