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Abdelwahab OA, Abdelaziz A, Diab S, Khazragy A, Elboraay T, Fayad T, Diab RA, Negida A. Efficacy of different routes of vitamin B12 supplementation for the treatment of patients with vitamin B12 deficiency: A systematic review and network meta-analysis. Ir J Med Sci 2024; 193:1621-1639. [PMID: 38231320 PMCID: PMC11128391 DOI: 10.1007/s11845-023-03602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/25/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND This systematic review and network meta-analysis aimed to evaluate the three different administration routes of vitamin B12: oral, intramuscular (IM), and sublingual (SL) routes. METHODS We searched four electronic databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL Register of Controlled Trials). We included only comparative studies. We performed a frequentist network meta-analysis to measure network estimates for the relative outcomes. Moreover, we conducted a pairwise meta-analysis using a random effect model to obtain direct estimates for outcomes. All outcomes were continuous, and the relative treatment effects were pooled as mean difference (MD) with 95% confidence intervals. RESULTS Thirteen studies were included in the meta-analysis, with a total of 4275 patients. Regarding increasing vitamin B12 levels, the IM route ranked first, followed by the SL route (MD = 94.09 and 43.31 pg/mL, respectively) compared to the oral route. However, these differences did not reach statistical significance owing to the limited number of studies. Regarding the hemoglobin level, the pooled effect sizes showed no difference between all routes of administration that could reach statistical significance. However, the top two ranked administration routes were the oral route (78.3) and the IM route (49.6). CONCLUSION All IM, oral, and SL routes of administration of vitamin B12 can effectively increase the level of vitamin B12 without significant differences between them, as thought previously. However, the IM route was the top-ranked statistically but without clinical significance. We found no significant difference among studied administrated routes in all other CBC parameters and homocysteine levels.
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Affiliation(s)
- Omar Ahmed Abdelwahab
- Medical Research Group of Egypt, Cairo, Egypt.
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Ahmed Abdelaziz
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sherein Diab
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ali Khazragy
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Toka Elboraay
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Taha Fayad
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Oral and Dental Medicine, Sinai University, Sinai, Egypt
| | - Rehab Adel Diab
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Ahmed Negida
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmount, UK
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Gharibzahedi SMT, Moghadam M, Amft J, Tolun A, Hasabnis G, Altintas Z. Recent Advances in Dietary Sources, Health Benefits, Emerging Encapsulation Methods, Food Fortification, and New Sensor-Based Monitoring of Vitamin B 12: A Critical Review. Molecules 2023; 28:7469. [PMID: 38005191 PMCID: PMC10673454 DOI: 10.3390/molecules28227469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
In this overview, the latest achievements in dietary origins, absorption mechanism, bioavailability assay, health advantages, cutting-edge encapsulation techniques, fortification approaches, and innovative highly sensitive sensor-based detection methods of vitamin B12 (VB12) were addressed. The cobalt-centered vitamin B is mainly found in animal products, posing challenges for strict vegetarians and vegans. Its bioavailability is highly influenced by intrinsic factor, absorption in the ileum, and liver reabsorption. VB12 mainly contributes to blood cell synthesis, cognitive function, and cardiovascular health, and potentially reduces anemia and optic neuropathy. Microencapsulation techniques improve the stability and controlled release of VB12. Co-microencapsulation of VB12 with other vitamins and bioactive compounds enhances bioavailability and controlled release, providing versatile initiatives for improving bio-functionality. Nanotechnology, including nanovesicles, nanoemulsions, and nanoparticles can enhance the delivery, stability, and bioavailability of VB12 in diverse applications, ranging from antimicrobial agents to skincare and oral insulin delivery. Staple food fortification with encapsulated and free VB12 emerges as a prominent strategy to combat deficiency and promote nutritional value. Biosensing technologies, such as electrochemical and optical biosensors, offer rapid, portable, and sensitive VB12 assessment. Carbon dot-based fluorescent nanosensors, nanocluster-based fluorescent probes, and electrochemical sensors show promise for precise detection, especially in pharmaceutical and biomedical applications.
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Affiliation(s)
| | - Maryam Moghadam
- Institute of Human Nutrition and Food Science, Division of Food Technology, Kiel University, 24118 Kiel, Germany
| | - Jonas Amft
- Institute of Human Nutrition and Food Science, Division of Food Technology, Kiel University, 24118 Kiel, Germany
| | - Aysu Tolun
- Institute of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
| | - Gauri Hasabnis
- Institute of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
| | - Zeynep Altintas
- Institute of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
- Kiel Nano, Surface and Interface Science-KiNSIS, Kiel University, 24118 Kiel, Germany
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3
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Borges-Vieira JG, Cardoso CKS. Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: a systematic review of randomized controlled trials. Nutr Neurosci 2023; 26:187-207. [PMID: 35156551 DOI: 10.1080/1028415x.2022.2031494] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This systematic review aimed to evaluate the efficacy of B vitamins and vitamin D therapy in improving the standard treatment of depression and anxiety disorders. We also aimed to gather the evidence supporting the recommendations for supplementation in clinical practice. METHODS Performed between March 2020 and September 2021, the main inclusion criteria were randomized controlled trials (RCTs), with patients ≥ 18 years old, both sexes, fulfilling target diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), or mild to severe depressive and anxiety symptoms. In addition, the RCTs were included if the scales to assess the severity of the symptoms were standardized rating scales in psychiatric. Trials that reported diagnoses of schizophrenia, perinatal depression, bipolar depression, sleep disorders, eating disorders, cancer, and multiple sclerosis in association with any of the mentioned diagnoses were excluded. RESULTS We identified 20 RCTs that matched all eligibility criteria, totaling 2,256 subjects, diagnosed with MDD, GAD, and depressive or anxiety symptoms. Supplementation with folic acid or L-methylfolate, B1, B12 or methylcobalamin, and vitamin D (in different doses and study duration) significantly decreased depression score scales by increasing response to standard pharmacological treatment or as monotherapy, including partial or complete remission. As for anxiety symptoms, the availability of results is limited to adjuvant vitamin D therapy. DISCUSSION B vitamins and vitamin D associated with other compounds also showed significant results, so the improvement in symptoms cannot be attributed strictly to those. Our results suggest that intervention with B vitamins and/or vitamin D may be an effective and well-tolerated adjuvant strategy for improving the symptoms of depression and anxiety, according to the patient's clinical status and nutritional biomarkers.
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Affiliation(s)
- Jaqueline G Borges-Vieira
- Biomedical Scientist, Genetics Specialization. Bachelor of Science in Nutrition, Department of Nutrition, School of Social and Health Sciences, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Camila K Souza Cardoso
- Ph.D. in Health Sciences, School of Medicine, Federal University of Goiás. Professor of Nutrition, Department of Nutrition, School of Social and Health Sciences, Pontifical Catholic University of Goiás, Goiânia, Brazil
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Gold SL, Manning L, Kohler D, Ungaro R, Sands B, Raman M. Micronutrients and Their Role in Inflammatory Bowel Disease: Function, Assessment, Supplementation, and Impact on Clinical Outcomes Including Muscle Health. Inflamm Bowel Dis 2023; 29:487-501. [PMID: 36287025 DOI: 10.1093/ibd/izac223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Stephanie L Gold
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Manning
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kohler
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ryan Ungaro
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Vitamin B 12 deficiency presenting as intestinal pseudo-obstruction in short bowel syndrome: A case report. Nutrition 2023; 106:111895. [PMID: 36435090 DOI: 10.1016/j.nut.2022.111895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022]
Abstract
Bowel obstruction and nutrient deficiencies are commonly encountered complications seen during follow-up of patients with short bowel syndrome. It is rare to see vitamin B12 deficiency among micronutrient deficits. The onset of B12 deficiency can be insidious, with autonomic features preceding other symptoms. In this study, we report a case in which vitamin B12 deficiency presented with intestinal dysmotility mimicking mechanical bowel obstruction.
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Temova Rakuša Ž, Roškar R, Hickey N, Geremia S. Vitamin B 12 in Foods, Food Supplements, and Medicines-A Review of Its Role and Properties with a Focus on Its Stability. MOLECULES (BASEL, SWITZERLAND) 2022; 28:molecules28010240. [PMID: 36615431 PMCID: PMC9822362 DOI: 10.3390/molecules28010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Vitamin B12, also known as the anti-pernicious anemia factor, is an essential micronutrient totally dependent on dietary sources that is commonly integrated with food supplements. Four vitamin B12 forms-cyanocobalamin, hydroxocobalamin, 5'-deoxyadenosylcobalamin, and methylcobalamin-are currently used for supplementation and, here, we provide an overview of their biochemical role, bioavailability, and efficacy in different dosage forms. Since the effective quantity of vitamin B12 depends on the stability of the different forms, we further provide a review of their main reactivity and stability under exposure to various environmental factors (e.g., temperature, pH, light) and the presence of some typical interacting compounds (oxidants, reductants, and other water-soluble vitamins). Further, we explore how the manufacturing process and storage affect B12 stability in foods, food supplements, and medicines and provide a summary of the data published to date on the content-related quality of vitamin B12 products on the market. We also provide an overview of the approaches toward their stabilization, including minimization of the destabilizing factors, addition of proper stabilizers, or application of some (innovative) technological processes that could be implemented and contribute to the production of high-quality vitamin B12 products.
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Affiliation(s)
| | - Robert Roškar
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Neal Hickey
- Department of Chemical and Pharmaceutical Sciences, Centre of Excellence in Biocrystallography, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Silvano Geremia
- Department of Chemical and Pharmaceutical Sciences, Centre of Excellence in Biocrystallography, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
- Correspondence:
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Karakousis ND, Pyrgioti EE, Georgakopoulos PN, Papanas N. Vitamin B 12 and Diabetic Foot: Α Mini-Review. INT J LOW EXTR WOUND 2022:15347346221143018. [PMID: 36448193 DOI: 10.1177/15347346221143018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
This narrative mini-review article aimed to investigate the potential association of vitamin B12 levels with diabetic neuropathy (DN) and diabetic foot ulcers (DFUs). It was demonstrated that B12 deficiency seems to be related to DFUs in cases of metformin administration and bariatric surgery. B12 supplementation with dietary measures and agents may improve DN and quality of life (QoL). However, data are still preliminary and more experience is needed.
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Affiliation(s)
| | | | | | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
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8
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Roberts G, Benusiglio PR, Bisseling T, Coit D, Davis JL, Grimes S, Guise TA, Hardwick R, Harris K, Mansfield PF, Rossaak J, Schreiber KC, Stanich PP, Strong VE, Kaurah P. International Delphi consensus guidelines for follow-up after prophylactic total gastrectomy: the Life after Prophylactic Total Gastrectomy (LAP-TG) study. Gastric Cancer 2022; 25:1094-1104. [PMID: 35831514 PMCID: PMC9588655 DOI: 10.1007/s10120-022-01318-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic total gastrectomy (PTG) remains the only means of preventing gastric cancer for people with genetic mutations predisposing to Hereditary Diffuse Gastric Cancer (HDGC), mainly in the CDH1 gene. The small but growing cohort of people undergoing PTG at a young age are expected to have a life-expectancy close to the general population, however, knowledge of the long-term effects of, and monitoring requirements after, PTG is limited. This study aims to define the standard of care for follow-up after PTG. METHODS Through a combination of literature review and two-round Delphi consensus of major HDGC/PTG units and physicians, and patient advocates, we produced a set of recommendations for follow-up after PTG. RESULTS There were 42 first round, and 62 second round, responses from clinicians, allied health professionals and patient advocates. The guidelines include recommendations for timing of assessments and specialties involved in providing follow-up, micronutrient supplementation and monitoring, bone health and the provision of written information. CONCLUSION While the evidence supporting the guidelines is limited, expert consensus provides a framework to best manage people following PTG, and could support the collection of information on the long-term effects of PTG.
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Affiliation(s)
- Geoffrey Roberts
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Cambridge Oesophagogastric Centre, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - Patrick R Benusiglio
- Genetics Department, Pitié-Salpêtrière and Saint-Antoine Hospitals, AP-HP Sorbonne University, Paris, France
| | - Tanya Bisseling
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Coit
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Sam Grimes
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Theresa A Guise
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Richard Hardwick
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Peter P Stanich
- The Ohio State University Wexner Medical Center, Columbus, USA
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9
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Pratama S, Lauren BC, Wisnu W. The efficacy of vitamin B 12 supplementation for treating vitamin B 12 deficiency and peripheral neuropathy in metformin-treated type 2 diabetes mellitus patients: A systematic review. Diabetes Metab Syndr 2022; 16:102634. [PMID: 36240684 DOI: 10.1016/j.dsx.2022.102634] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Metformin-treated type 2 diabetes mellitus (T2DM) patients are at higher risk of vitamin B12 deficiency and more severe neuropathy symptoms. There is still no guideline suggesting vitamin B12 supplementation for this population. This study aimed to analyze the efficacy of vitamin B12 supplementation in this population. METHOD Studies reporting the efficacy of vitamin B12 supplementation in metformin-treated T2DM patients were systematically searched in PubMed, Cochrane, EBSCOHost, and Scopus following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Additional relevant studies were searched manually through citations. Study quality and risk of bias were assessed using suitable tools. RESULTS Seven clinical trials with a total of 506 participants were included. Using the Cochrane's Risk of Bias 2 tools for clinical trials, 4 studies were assessed to have high risk of bias and 3 studies had low risk of bias. There were 5 studies that measured changes in serum vitamin B12 level, all of which reported a statistically significant increase after supplementation. Significant reductions in homocysteine after supplementation were found in 2 studies. Its effect on neuropathy symptoms was still unclear, with 2 studies reporting a significant improvement and 1 study reporting no significant effect. CONCLUSIONS The results of this systematic review support the implementation of vitamin B12 supplementation for metformin-treated T2DM to prevent or treat vitamin B12 deficiency and neuropathy. More high-quality clinical studies are required to generate quantitative analysis and to encourage supplementation in available guidelines.
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Affiliation(s)
- Samuel Pratama
- Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia.
| | | | - Wismandari Wisnu
- Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia; Division of Endocrine, Metabolic and Diabetes, Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, 10430, Indonesia
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Elangovan R, Baruteau J. Inherited and acquired vitamin B12 deficiencies: Which administration route to choose for supplementation? Front Pharmacol 2022; 13:972468. [PMID: 36249776 PMCID: PMC9559827 DOI: 10.3389/fphar.2022.972468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Vitamin B12 or cobalamin deficiency is a commonly encountered clinical scenario and most clinicians will have familiarity prescribing Vitamin B12 to treat their patients. Despite the high prevalence of this condition, there is widespread heterogeneity regarding routes, schedules and dosages of vitamin B12 administration. In this review, we summarise the complex metabolic pathway of Vitamin B12, the inherited and acquired causes of Vitamin B12 deficiency and subsequently highlight the disparate international practice of prescribing Vitamin B12 replacement therapy. We describe the evidence base underpinning the novel sublingual, intranasal and subcutaneous modes of B12 replacement in comparison to intramuscular and oral routes, with their respective benefits for patient compliance and cost-saving.
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Affiliation(s)
- Ramyia Elangovan
- Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Julien Baruteau
- Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- National Institute of Health Research Great Ormond Street Biomedical Research Centre, London, United Kingdom
- *Correspondence: Julien Baruteau,
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11
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Amer MM, Kamal AH, Hammad SF, Habib AA. Stability Indicating RP-HPLC method for Methylcobalamin determination in different dosage forms: application to photodegradation kinetics and pH-rate profiling. J Sep Sci 2022; 45:2877-2886. [PMID: 35670513 DOI: 10.1002/jssc.202200132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/05/2022]
Abstract
A stability-indicating RP-HPLC method for methylcobalamin determination was developed. Stress degradation under variable conditions was carried out. Methylcobalamin had pronounced susceptibility to hydrolysis under acidic, alkaline, and photolytic conditions; further study of photolytic degradation kinetics and pH rate profiling over pH range 2-11 was carried out. Photodegradation of methylcobalamin followed zero-order kinetics with half-life 0.99hour equivalent to 1971.53 lux. Methylcobalamin followed pseudo first order kinetics upon exposure to acidic and alkaline hydrolysis with highest stability at pH 5 and least stability at pH 2. Optimization of chromatographic conditions was performed using two level full factorial design, chromatographic analysis was executed using Inertsil® column (250×4.6 mm, 5μm) maintained at 25◦ C. Elution was carried out using 25mM potassium dihydrogen phosphate (pH adjusted with phosphoric acid to 3.8): methanol: acetonitrile (55:35:10, v/v) as mobile phase. The flow rate was 1.0 mL/min. Detection was carried out at 220 nm using diode array detector. The method was validated as per ICH guidelines; the linearity was over concentration range 2-160 μg/mL with coefficient of determination 0.9995. The method was effectively applied for determination of methylcobalamin in Cobalvex® ampoule, cobal® tablet, cobal-F® tablet and methyltechon® oral dissolvable film without interfering from excipients within run time six minutes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mona M Amer
- Department of pharmaceutical analytical Chemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Amira H Kamal
- Department of pharmaceutical analytical Chemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Sherin F Hammad
- Department of pharmaceutical analytical Chemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Ahmed A Habib
- Department of pharmaceutical analytical Chemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Welfare JG, Mortelliti MJ, McGlade CA, Hartman TW, Dempsey JL, Lawrence DS. Assessment of Photoreleasable Linkers and Light-Capturing Antennas on a Photoresponsive Cobalamin Scaffold. J Org Chem 2022; 87:5076-5084. [PMID: 35353509 PMCID: PMC9727707 DOI: 10.1021/acs.joc.1c02931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cobalamin has shown promise as a light-sensitive drug delivery platform owing to its ease of modification and the high quantum yields for drug photorelease. However, studies to date on the general photochemistry of alkyl cobalamins have primarily focused on methyl and adenosyl-substituted derivatives, the natural cofactors present in various enzymatic species. We describe the synthesis and photolytic behavior of cobalamin conjugates comprised of different combinations of fluorophores and β-axial ligands. In general, cobalamin conjugates containing β-axial alkyl substituents undergo efficient photolysis under aqueous conditions, with quantum yields up to >40%. However, substituents that are large and hydrophobic, or unable to readily support the presumed radical intermediate, suffer less efficient photolysis (<15%) than smaller, water-soluble, analogs. By contrast, quantum yields improve by 2-fold in DMF for cobalamins containing large hydrophobic β-axial substituents. This suggests that drug release from carriers comprised of membranous compartments, such as liposomes, may be significantly more efficient than the corresponding photorelease in an aqueous environment. Finally, we explored the impact of fluorophores on the photolysis of alkyl cobalamins under tissue-mimetic conditions. Cobalamins substituted with efficient photon-capturing fluorophores display up to 4-fold enhancements in photolysis relative to unsubstituted derivatives. In summary, we have shown that the photosensitivity of alkyl cobalamin conjugates can be tuned by altering the Co-appended alkyl moiety, modulating the polarity of the environment (solvent), and installing photon-capturing fluorophores onto the cobalamin framework.
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Silva WRD, Dos Santos AA, Xerez MC, de Morais EF, de Oliveira PT, Silveira ÉJDD. Recognition and management of vitamin B12 deficiency: Report of four cases with oral manifestations. SPECIAL CARE IN DENTISTRY 2021; 42:410-415. [PMID: 34902172 DOI: 10.1111/scd.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 01/13/2023]
Abstract
Vitamins are organic compounds present in low concentrations in food, performing vital and specific cell metabolism functions. Vitamin B12 is essential for red blood cell formation in the bone marrow and its deficiency is caused, mainly, by gastrointestinal malabsorption. In addition to systemic manifestations, oral signs and symptoms have also been associated to this condition such as glossitis, papillary atrophy, painful erythema areas, burning sensation, dysgeusia, lingual paresthesia and itching. This study aims to report four cases of oral manifestations caused by vitamin B12 deficiency. All patients presented oral mucosa lesions. Vitamin B12 deficiency was diagnosed based in clinical characteristics and complementary exams. Oral supplementation for vitamin B12 deficiency was conducted/realized in three patients, while one patient was treated with parenteral doses. All of them showed partial or total remission of the signs and symptoms.
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Affiliation(s)
- Weslay Rodrigues da Silva
- Dentistry Sciences Posto Graduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - André Azevedo Dos Santos
- Dentistry Sciences Posto Graduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mariana Carvalho Xerez
- Dentistry Sciences Posto Graduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Everton Freitas de Morais
- Dentistry Sciences Posto Graduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Patrícia Teixeira de Oliveira
- Dentistry Sciences Posto Graduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Grammatikopoulou MG, Gkiouras K, Dardiotis E, Zafiriou E, Tsigalou C, Bogdanos DP. Peeking into the future: Transdermal patches for the delivery of micronutrient supplements. Metabol Open 2021; 11:100109. [PMID: 34337377 PMCID: PMC8318979 DOI: 10.1016/j.metop.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Adhesive transdermal delivery devices (patches) are the latest advancement in the delivery of micronutrients. A common challenge in this mode of delivery includes surpassing the physical barrier of the skin, while the use of microneedle (MN) arrays, or pretreatment of the skin with MNs can be used for a more successful outcome. Limited evidence from human non-randomized trials point to a sub-optimal delivery of iron through skin patches, although no MNs were used in those trials. Moreover, the use of patches proved inefficient in reducing the prevalence of micronutrient deficiencies in post-bariatric surgery patients. The delivery of minerals was tested in animals using reservoir-type patches, gel/foam patches, MNs and iontophoresis. Results from these studies indicate a possible interplay between the dietary manipulation of mineral intake and the trandermal delivery through patches, as reduced, or regular dietary intake seems to increase absorption of the delivered mineral. Moreover, intervention duration could be an additional factor affecting absorption. Possible adverse events from animal studies include redness or decolorization of skin. In vitro and ex vivo studies revealed an increase in vitamin K, vitamin D and iron delivery, however a variety of methodological discrepancies are apparent in these studies, including the models used, the length of the MNs, the duration of application, temperature control and total micronutrient load in the patches. Data indicate that pre-treating the skin with MNs might enhance delivery; however, a source of variability in the observed effectiveness might include the different molecular weights of the nutrients used, skin factors, the ideal tip radius and MN wall thickness. Non-human studies indicate a potential benefit in combining MN with iontophoresis. Presently, the transdermal delivery seems promising with regard to nutritional supplementation, however limited evidence exists for its efficacy in humans. Future research should aim to control for both intervention duration, possible deficiency status and for the dietary intake of participants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Laboratory of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christina Tsigalou
- Department of Microbiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Current Nanocarrier Strategies Improve Vitamin B12 Pharmacokinetics, Ameliorate Patients' Lives, and Reduce Costs. NANOMATERIALS 2021; 11:nano11030743. [PMID: 33809596 PMCID: PMC8001893 DOI: 10.3390/nano11030743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022]
Abstract
Vitamin B12 (VitB12) is a naturally occurring compound produced by microorganisms and an essential nutrient for humans. Several papers highlight the role of VitB12 deficiency in bone and heart health, depression, memory performance, fertility, embryo development, and cancer, while VitB12 treatment is crucial for survival in inborn errors of VitB12 metabolism. VitB12 is administrated through intramuscular injection, thus impacting the patients’ lifestyle, although it is known that oral administration may meet the specific requirement even in the case of malabsorption. Furthermore, the high-dose injection of VitB12 does not ensure a constant dosage, while the oral route allows only 1.2% of the vitamin to be absorbed in human beings. Nanocarriers are promising nanotechnology that can enable therapies to be improved, reducing side effects. Today, nanocarrier strategies applied at VitB12 delivery are at the initial phase and aim to simplify administration, reduce costs, improve pharmacokinetics, and ameliorate the quality of patients’ lives. The safety of nanotechnologies is still under investigation and few treatments involving nanocarriers have been approved, so far. Here, we highlight the role of VitB12 in human metabolism and diseases, and the issues linked to its molecule properties, and discuss how nanocarriers can improve the therapy and supplementation of the vitamin and reduce possible side effects and limits.
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Didangelos T, Karlafti E, Kotzakioulafi E, Margariti E, Giannoulaki P, Batanis G, Tesfaye S, Kantartzis K. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2021; 13:395. [PMID: 33513879 PMCID: PMC7912007 DOI: 10.3390/nu13020395] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022] Open
Abstract
AIM To investigate the effect of normalizing vitamin B12 (B12) levels with oral B12 (methylcobalamin) 1000 μg/day for one year in patients with diabetic neuropathy (DN). PATIENTS AND METHODS In this prospective, double-blind, placebo-controlled trial, 90 patients with type 2 diabetes on metformin for at least four years and both peripheral and autonomic DN were randomized to an active treatment group (n = 44) receiving B12 and a control group (n = 46) receiving a placebo. All patients had B12 levels less than 400 pmol/L. Subjects underwent measurements of sural nerve conduction velocity (SNCV), sural nerve action potential (amplitude) (SNAP), and vibration perception threshold (VPT), and they performed cardiovascular autonomic reflex tests (CARTs: mean circular resultant (MCR), Valsalva test, postural index, and orthostatic hypotension). Sudomotor function was assessed with the SUDOSCAN that measures electrochemical skin conductance in hands and feet (ESCH and ESCF, respectively). We also used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE, respectively) and questionnaires to evaluate quality of life (QoL) and level of pain (pain score). RESULTS B12 levels increased from 232.0 ± 71.8 at baseline to 776.7 ± 242.3 pmol/L at follow-up, p < 0.0001, in the active group but not in the control group. VPT, MNSIQ, QoL, pain score, SNCV, SNAP, and ESCF significantly improved in the active group (p < 0.001, p = 0.002, p < 0.0001, p < 0.000, p < 0.0001, p < 0.0001, and p = 0.014, respectively), whereas CARTS and MNSIE improved but not significantly. MCR, MNSIQ, SNCV, SNAP, and pain score significantly deteriorated in the control group (p = 0.025, p = 0.017, p = 0.045, p < 0.0001, and p < 0.0001, respectively). CONCLUSIONS The treatment of patients with DN with 1 mg of oral methylcobalamin for twelve months increased plasma B12 levels and improved all neurophysiological parameters, sudomotor function, pain score, and QoL, but it did not improve CARTS and MNSIE.
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Affiliation(s)
- Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (E.K.); (E.K.); (E.M.); (G.B.)
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (E.K.); (E.K.); (E.M.); (G.B.)
| | - Evangelia Kotzakioulafi
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (E.K.); (E.K.); (E.M.); (G.B.)
| | - Eleni Margariti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (E.K.); (E.K.); (E.M.); (G.B.)
| | - Parthena Giannoulaki
- Department of Nutrition and Dietetics, University General Hospital of Thessaloniki ‘’AHEPA’’, 54621 Thessaloniki, Greece;
| | - Georgios Batanis
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (E.K.); (E.K.); (E.M.); (G.B.)
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Kοnstantinos Kantartzis
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72076 Tübingen, Germany;
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany
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18
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Sanz-Cuesta T, Escortell-Mayor E, Cura-Gonzalez I, Martin-Fernandez J, Riesgo-Fuertes R, Garrido-Elustondo S, Mariño-Suárez JE, Álvarez-Villalba M, Gómez-Gascón T, González-García I, González-Escobar P, Vargas-Machuca Cabañero C, Noguerol-Álvarez M, García de Blas-González F, Baños-Morras R, Díaz-Laso C, Caballero-Ramírez N, Herrero de-Dios A, Fernández-García R, Herrero-Hernández J, Pose-García B, Sevillano-Palmero ML, Mateo-Ruiz C, Medina-Bustillo B, Aguilar-Jiménez M. Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care: a pragmatic, randomised, non-inferiority clinical trial (OB12). BMJ Open 2020; 10:e033687. [PMID: 32819927 PMCID: PMC7440823 DOI: 10.1136/bmjopen-2019-033687] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. DESIGN Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). PARTICIPANTS 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. INTERVENTIONS The IM arm received 1 mg VB12 on alternate days in weeks 1-2, 1 mg/week in weeks 3-8 and 1 mg/month in weeks 9-52. The oral arm received 1 mg/day in weeks 1-8 and 1 mg/week in weeks 9-52. MAIN OUTCOMES Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. RESULTS The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were -0.7% (133 out of 135 vs 129 out of 130; 95% CI: -3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: -1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were -6.3% (103 out of 112 vs 115 out of 117; 95% CI: -11.9 to -0.1; p=0.025) and -6.8% (103 out of 140 vs 115 out of 143; 95% CI: -16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>-10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. CONCLUSIONS Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low. TRIAL REGISTRATION NUMBERS NCT01476007; EUDRACT (2010-024129-20).
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Affiliation(s)
- Teresa Sanz-Cuesta
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esperanza Escortell-Mayor
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Cura-Gonzalez
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jesus Martin-Fernandez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Oeste. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Rosario Riesgo-Fuertes
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Sur, Gerencia Asistencial Atención Primaria, Madrid, Spain
| | - Sofía Garrido-Elustondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Sureste, Gerencia Asistencial Atención Primaria, Madrid, Spain
| | - Jose Enrique Mariño-Suárez
- Healthcare Centre El Greco, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Mar Álvarez-Villalba
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Healthcare Centre María Jesús Hereza, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Tomás Gómez-Gascón
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación e Innovación Biomédica de Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Inmaculada González-García
- Healthcare Centre Barajas, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Paloma González-Escobar
- Healthcare Centre Buenos Aires, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | | | - Mar Noguerol-Álvarez
- Healthcare Centre Cuzco, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Francisca García de Blas-González
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Healthcare Centre Mendiguchía Carriche, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Raquel Baños-Morras
- Healthcare Centre Buenos Aires, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Concepción Díaz-Laso
- Healthcare Centre Fuentelarreina, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Nuria Caballero-Ramírez
- Healthcare Centre Juncal, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Alicia Herrero de-Dios
- Healthcare Centre Miguel de Cervantes, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Rosa Fernández-García
- Healthcare Centre Santa Isabel, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Jesús Herrero-Hernández
- Healthcare Centre Lavapiés, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Belen Pose-García
- Healthcare Centre Mendiguchía Carriche, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | | | - Carmen Mateo-Ruiz
- Pharmacy Department, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Beatriz Medina-Bustillo
- Pharmacy Department, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Monica Aguilar-Jiménez
- UICEC Hospital Ramón y Cajal. Plataforma SCReN, Hospital Ramón y Cajal; Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Understand the current prevalence, health benefits, and health risks of vegetarian diets. RECENT FINDINGS Since the publishing of the Adventist Health Study 2 in 2013, there have been several prospective diet studies demonstrating and challenging the health benefits and risks of the vegetarian diet. The definition of the vegetarian diet has become more specific over time and requires standardization for research purposes. Despite an uptrend in sales rates of plant-based foods per year, a 2018 Gallup poll showed overall stagnation of the percentage of self-reported vegetarians and vegans compared to percentages obtained 6 years prior. Compared to the Adventist Health Study, more recent vegetarian diet studies have demonstrated significant although smaller risk reductions for mortality in cardiovascular disease, cerebrovascular disease, diabetes mellitus, and chronic kidney disease. Recent studies have correlated certain food groups with early death or increased longevity. In addition, the vegetarian health risks of deficiencies of protein, omega-3 fatty acids, vitamin D, vitamin B12, iron, calcium, and zinc are explored.
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Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up. Obes Surg 2020; 29:3277-3284. [PMID: 31201694 DOI: 10.1007/s11695-019-03985-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the two most frequently performed bariatric operations. These two types of metabolic surgery alter the anatomy and function of digestive tract producing significant weight loss in morbidly obese patients but may lead to malnutrition. AIM Analysis of incidence and severity of malnutrition after bariatric surgery in patients submitted to RYGB or LSG during 12 months of follow-up. MATERIAL AND METHODS Retrospective study of 98 patients after RYGB (n = 47) or LSG (n = 51) assessed for nutritional deficiencies during 12 months after surgery was conducted. The differences in body mass index (BMI) and blood tests including erythrocytes, haemoglobin, total protein, albumin, iron, ferritin, transferrin, vitamin B12, folic acid, calcium and phosphorus concentrations were compared between groups before the operations and at 1 and 12 months. RESULTS Nutritional deficiencies were common before surgery with prevalence up to 19.6% for albumin in the LSG group. Median preoperative BMI levels and albumin concentrations were higher in the RYGB group compared to the LSG group, but there was no difference in percent excess weight loss (%EWL) at 1 and 12 months between LSG and RYGB. One month after LSG erythrocyte count, haemoglobin, iron, ferritin and transferrin levels were significantly higher than in the RYGB group. These differences subsided at 12 months. At 12 months, only the prevalence of vitamin B12 deficiency was significantly higher in the RYGB group. CONCLUSION Both RYGB and LSG lead to nutritional deficiencies despite different properties of operations and similar %EWL during follow-up.
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Vitamin B Supplementation and Nutritional Intake of Methyl Donors in Patients with Chronic Kidney Disease: A Critical Review of the Impact on Epigenetic Machinery. Nutrients 2020; 12:nu12051234. [PMID: 32349312 PMCID: PMC7281987 DOI: 10.3390/nu12051234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular morbidity and mortality are several-fold higher in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in the general population. Hyperhomocysteinemia has undoubtedly a central role in such a prominent cardiovascular burden. The levels of homocysteine are regulated by methyl donors (folate, methionine, choline, betaine), and cofactors (vitamin B6, vitamin B12,). Uremia-induced hyperhomocysteinemia has as its main targets DNA methyltransferases, and this leads to an altered epigenetic control of genes regulated through methylation. In renal patients, the epigenetic landscape is strictly correlated with the uremic phenotype and dependent on dietary intake of micronutrients, inflammation, gut microbiome, inflammatory status, oxidative stress, and lifestyle habits. All these factors are key contributors in methylome maintenance and in the modulation of gene transcription through DNA hypo- or hypermethylation in CKD. This is an overview of the epigenetic changes related to DNA methylation in patients with advanced CKD and ESRD. We explored the currently available data on the molecular dysregulations resulting from altered gene expression in uremia. Special attention was paid to the efficacy of B-vitamins supplementation and dietary intake of methyl donors on homocysteine lowering and cardiovascular protection.
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Estourgie-van Burk GF, van der Kuy PHM, de Meij TG, Benninga MA, Kneepkens CMF. Intranasal treatment of vitamin B 12 deficiency in children. Eur J Pediatr 2020; 179:349-352. [PMID: 31758311 DOI: 10.1007/s00431-019-03519-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023]
Abstract
Vitamin B12 deficiency is traditionally treated with intramuscular injections of cobalamin, which are stressful events for children. In adults, studies have shown adequate absorption of intranasally administered vitamin B12. To date, data concerning efficacy of intranasal administration of vitamin B12 in children are lacking. We report on ten cases of children with vitamin B12 deficiency who were successfully treated with intranasal administration of a spray containing hydroxocobalamin. The mean baseline vitamin B12 concentration increased from 126.3 pmol/l (SD 55.4) to 1914.7 pmol/l (SD 1509.7). No side effects were reported.Conclusion: In children, intranasal application of vitamin B12 seems a safe and effective alternative to intramuscular injections, leading to higher compliance and less burden to patients.What is Known:• Children with vitamin B12deficiency are traditionally treated with intramuscular cobalamin injections, which are costly and painful.• Studies in adults showed that intranasal application of hydroxocobalamin leads to normalisation of vitamin B12levels.What is New:• The intranasal application of vitamin B12resulted in a substantial increase of the mean baseline vitamin B12levels without any side effect.• These data encourage a systematic evaluation of intranasal treatment of vitamin B12deficiency in order to define safety, optimal dosage and administration frequency.
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Affiliation(s)
| | - P Hugo M van der Kuy
- Department of Clinical Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tim G de Meij
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location VU Medical Centre, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands
| | - C M Frank Kneepkens
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location VU Medical Centre, Amsterdam, The Netherlands
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