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Mushtaq M, Usmani MR, Hameed N, Anwar A, Hashmi AA. Serum Vitamin B12 Deficiency in Chronic Hemodialysis Patients. Cureus 2024; 16:e58751. [PMID: 38779272 PMCID: PMC11110947 DOI: 10.7759/cureus.58751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Essential vitamins like folate and vitamin B12 are crucial for many physiological functions. Patients with renal failure undergoing regular hemodialysis in the general population may experience harmful effects from vitamin B12 deficits. Therefore, this study aimed to determine the frequency of vitamin B12 deficiency in hemodialysis patients and its association with other clinical parameters. Methods This cross-sectional study was conducted at the dialysis unit of Patel Hospital and Lifeline Hospital, Karachi, using a non-probability consecutive sampling technique after obtaining ethical approval from Lifeline Hospital (LLH/HR/02-22). The study duration was six months, from January 10, 2023, to July 22, 2023. A total of 135 adult renal failure patients with ages >18 and <70 years on maintenance hemodialysis for >1 year were included in the study. The chi-square test was used to determine the association between vitamin B12 deficiency and age and gender. A p-value of 0.05 was considered statistically significant. Results The study findings showed that out of 135 patients, 82 (60.7%) were males and 53 (39.3%) were females, with a mean age of 50.80 ± 10.03 years. The duration of hemodialysis was approximately 1-2 years in 98 (72.6%) patients, 2-3 years in 27 (20.0%) patients, and 3-4 years in only 9 (6.7%) patients. The mean serum vitamin B-12 levels were 411.61 ± 224.95 pg/ml, with 30 (22.2%) of the subjects being deficient. In terms of duration of hemodialysis, there was a significant association (p= 0.013). Between patients with normal 4 (4%) and deficient 5 (17%) vitamin B12 and 3-4 years of hemodialysis. Conclusion In this study, we found that a significant proportion of patients on chronic hemodialysis had vitamin B12 deficiency. Moreover, vitamin B12 deficiency was significantly associated with duration of hemodialysis. Therefore, we recommend periodic vitamin B12 testing in hemodialysis patients to avoid any associated complications.
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Affiliation(s)
- Mehdi Mushtaq
- Nephrology, Patel Hospital, Karachi, PAK
- Nephrology, Lifeline Hospital, Karachi, PAK
| | | | | | - Adnan Anwar
- Physiology, Hamdard College of Medicine & Dentistry, Karachi, PAK
- Internal Medicine, Essa General Hospital, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Anaya-Loyola MA, Brito A, Vergara-Castañeda H, Sosa C, Rosado JL, Allen LH. Low Serum B12 Concentrations Are Associated with Low B12 Dietary Intake But Not with Helicobacter pylori Infection or Abnormal Gastric Function in Rural Mexican Women. Nutrients 2019; 11:nu11122922. [PMID: 31810343 PMCID: PMC6950710 DOI: 10.3390/nu11122922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background: Gastric function, Helicobacter pylori infection, and vitamin B12 (B12) dietary intake were assessed as predictors of serum B12. Methods: H. pylori antibodies, gastric function, B12 dietary intake, and biochemical/hematological parameters were measured in 191 adult women from two rural communities in Querétaro, Mexico. Results: The overall mean serum B12 concentration was 211 ± 117 pmol/L. The prevalences of low (≤ 148 pmol/L), marginal (148 to 221 pmol/L), and adequate (> 221 pmol/L) serum B12 were 28.4%, 31.1%, and 40.5%, respectively. Seventy-one percent of women tested positive for H. pylori antibodies. The prevalence of gastric function categories did not differ by serum B12 categories. The odds ratio for having low serum B12 was 2.7 (p = 0.01) for women with an intake below the estimated average requirement, 3.6 (p = 0.01) for those in the lowest tertile of total B12 intake, and 3.0 (p = 0.02) for those in the lowest tertile of B12 intake from animal source foods. Age and B12 intake were predictors of serum B12 concentrations [serum B12 (pmol/L) = 90.060 + 5.208 (B12 intake, µg/day) + 2.989 (age, years). Conclusions: Low serum B12 concentrations were associated with low B12 dietary intake but not with H. pylori infection or abnormal gastric function in rural Mexican women.
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Affiliation(s)
- Miriam A. Anaya-Loyola
- Escuela de Nutrición, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, México, Av de las Ciencias S/N, Santiago de Querétaro, QT 76230, Mexico; (M.A.A.-L.); (C.S.); (J.L.R.)
| | - Alex Brito
- Laboratory of Pharmacokinetics and Metabolomic Analysis. Institute of Translational Medicine and Biotechnology. I.M. Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya St., 119991 Moscow, Russia;
- Luxembourg Institute of Health, Department of Population Health, NutriHealth Group, 1 A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Haydé Vergara-Castañeda
- Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México, Clavel 200, Prados de La Capilla, Santiago de Querétaro, QT 76176, Mexico;
| | - Carina Sosa
- Escuela de Nutrición, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, México, Av de las Ciencias S/N, Santiago de Querétaro, QT 76230, Mexico; (M.A.A.-L.); (C.S.); (J.L.R.)
| | - Jorge L. Rosado
- Escuela de Nutrición, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, México, Av de las Ciencias S/N, Santiago de Querétaro, QT 76230, Mexico; (M.A.A.-L.); (C.S.); (J.L.R.)
| | - Lindsay H. Allen
- USDA, ARS Western Human Nutrition Research Center, 430 W. Health Sciences Drive, University of California, Davis, CA 95616, USA
- Correspondence:
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Nouri A, Patel K, Montejo J, Nasser R, Gimbel DA, Sciubba DM, Cheng JS. The Role of Vitamin B 12 in the Management and Optimization of Treatment in Patients With Degenerative Cervical Myelopathy. Global Spine J 2019; 9:331-337. [PMID: 31192102 PMCID: PMC6542160 DOI: 10.1177/2192568218758633] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss the relationship between degenerative cervical myelopathy (DCM) and vitamin B12 deficiency. Specifically, it is the aim to outline the rational for future research into assessment and therapeutic optimization of vitamin B12 in the treatment of DCM. METHODS Literature review. RESULTS DCM is the commonest cause of spinal cord impairment, with an average age of presentation in the sixth decade. Patients at this age have also been reported to have a high prevalence of vitamin B12 deficiency, with estimates of up to 20% in the elderly. Vitamin B12 deficiency can result in subacute combined degeneration of the spinal cord (SACD), and several case reports have pointed to patients with both DCM and SACD. Both SACD and reversible compressive injury due to DCM necessitate remyelination in the spinal cord, a process that requires adequate vitamin B12 levels. Basic science research on nerve crush injuries have shown that vitamin B12 levels are altered after nerve injury and that vitamin B12 along with dexamethasone or nonsteroidal anti-inflammatory drugs can reduce Wallerian degeneration. Furthermore, it has been suggested that a combination of B-vitamins can reduce glutamate-induced neurotoxicity. CONCLUSIONS Given the high prevalence of clinical and subclinical vitamin B12 deficiency in the elderly, the role of vitamin B12 in myelination, and vitamin B12 deficiency as a differential diagnosis of DCM, it is important to investigate what role vitamin B12 levels play in patients with DCM in terms of baseline neurological function and whether optimization of vitamin B12 levels can improve surgical outcome. Furthermore, the routine assessment of vitamin B12 levels in patients considered for DCM surgery should be considered.
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Affiliation(s)
- Aria Nouri
- Department of Neurosurgery, Yale University, New Haven, CT, USA
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Kishan Patel
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Julio Montejo
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Rani Nasser
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - David A. Gimbel
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph S. Cheng
- Department of Neurosurgery, Yale University, New Haven, CT, USA
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
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ESTRADA ELENA, PERSAUD-SHARMA DHARAM, CORREDOR RAULGUSTAVO. Organic etiology of delusional parasitosis in the Hispanic population: a case report. ARCH CLIN PSYCHIAT 2019. [DOI: 10.1590/0101-60830000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- ELENA ESTRADA
- Citrus Psychiatry Health Network, USA; Florida International University, USA
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Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H, Raiten DJ. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J Nutr 2018; 148:1995S-2027S. [PMID: 30500928 PMCID: PMC6297555 DOI: 10.1093/jn/nxy201] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/06/2017] [Accepted: 08/02/2018] [Indexed: 12/31/2022] Open
Abstract
This report on vitamin B-12 (B12) is part of the Biomarkers of Nutrition for Development (BOND) Project, which provides state-of-the art information and advice on the selection, use, and interpretation of biomarkers of nutrient exposure, status, and function. As with the other 5 reports in this series, which focused on iodine, folate, zinc, iron, and vitamin A, this B12 report was developed with the assistance of an expert panel (BOND B12 EP) and other experts who provided information during a consultation. The experts reviewed the existing literature in depth in order to consolidate existing relevant information on the biology of B12, including known and possible effects of insufficiency, and available and potential biomarkers of status. Unlike the situation for the other 5 nutrients reviewed during the BOND project, there has been relatively little previous attention paid to B12 status and its biomarkers, so this report is a landmark in terms of the consolidation and interpretation of the available information on B12 nutrition. Historically, most focus has been on diagnosis and treatment of clinical symptoms of B12 deficiency, which result primarily from pernicious anemia or strict vegetarianism. More recently, we have become aware of the high prevalence of B12 insufficiency in populations consuming low amounts of animal-source foods, which can be detected with ≥1 serum biomarker but presents the new challenge of identifying functional consequences that may require public health interventions.
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Affiliation(s)
- Lindsay H Allen
- USDA, Agricultural Research Service Western Human Nutrition Research Center, University of California, Davis, CA
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD
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Agnoli C, Baroni L, Bertini I, Ciappellano S, Fabbri A, Papa M, Pellegrini N, Sbarbati R, Scarino ML, Siani V, Sieri S. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis 2017; 27:1037-1052. [PMID: 29174030 DOI: 10.1016/j.numecd.2017.10.020] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Interest in vegetarian diets is growing in Italy and elsewhere, as government agencies and health/nutrition organizations are emphasizing that regular consumption of plant foods may provide health benefits and help prevent certain diseases. METHODS AND RESULTS We conducted a Pubmed search, up to September, 2015, for studies on key nutrients (proteins, vitamin B12, iron, zinc, calcium, vitamin D, and n-3 fatty acids) in vegetarian diets. From 295 eligible publications the following emerged: Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements). Since the plant protein digestibility is lower than that of animal proteins it may be appropriate for vegetarians to consume more proteins than recommended for the general population. Vegetarians should also be encouraged to habitually consume good sources of calcium, iron and zinc - particularly vegetables that are low in oxalate and phytate (e.g. Brassicaceae), nuts and seeds, and calcium-rich mineral water. Calcium, iron, and zinc bioavailability can be improved by soaking, germination, and sour-dough leavening that lower the phytate content of pulses and cereals. Vegetarians can ensure good n-3 fatty acid status by habitually consuming good sources of a-linolenic acid (walnuts, flaxseeds, chia seeds, and their oils) and limiting linoleic acid intake (corn and sunflower oils). CONCLUSIONS Well-planned vegetarian diets that include a wide variety of plant foods, and a reliable source of vitamin B12, provide adequate nutrient intake. Government agencies and health/nutrition organizations should provide more educational resources to help Italians consume nutritionally adequate vegetarian diets.
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Affiliation(s)
- C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Baroni
- Primary Treatment Unit, Northern Health and Social Security District 9, Treviso, Italy
| | | | - S Ciappellano
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, University of Milan, Milan, Italy
| | - A Fabbri
- Nutrition Unit, Hygiene, Food and Nutrition Services, Department of Public Health, Local Health Unit, Reggio Emilia, Italy
| | - M Papa
- Independent Researcher, Italy
| | - N Pellegrini
- Department of Food and Drug, University of Parma, Parma, Italy
| | | | - M L Scarino
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics, Rome, Italy
| | - V Siani
- Independent Researcher, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy.
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Green R, Allen LH, Bjørke-Monsen AL, Brito A, Guéant JL, Miller JW, Molloy AM, Nexo E, Stabler S, Toh BH, Ueland PM, Yajnik C. Vitamin B 12 deficiency. Nat Rev Dis Primers 2017; 3:17040. [PMID: 28660890 DOI: 10.1038/nrdp.2017.40] [Citation(s) in RCA: 421] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vitamin B12 (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.
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Affiliation(s)
- Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, 4400 V Street, PATH Building, Davis, California 95817, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | | | - Alex Brito
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | - Jean-Louis Guéant
- Inserm UMRS 954 N-GERE (Nutrition Génétique et Exposition aux Risques Environnementaux), University of Lorraine and INSERM, Nancy, France
| | - Joshua W Miller
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Anne M Molloy
- School of Medicine and School of Biochemistry and Immunology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ebba Nexo
- Department of Clinical Medicine, Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Stabler
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Ban-Hock Toh
- Centre for Inflammatory Diseases, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Per Magne Ueland
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Section for Pharmacology, Department of Clinical Science, University of Bergen, Bergen, Norway
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Abstract
The prevalence of vitamin B12 deficiency increases with age. Patients with dementia and spouses of patients with dementia are at special risk for the development of vitamin B12 deficiency. In a normal diet this vitamin is present only in animal source foods; therefore, vegans frequently develop vitamin B12 deficiency if not using supplements or foods fortified with cobalamin. Apart from dementia, most of these manifestations are completely reversible under correct therapy; therefore it is crucial to identify and to treat even atypical presentations of vitamin B12 deficiency as early as possible. This article deals with the physiology and pathophysiology of vitamin B12 metabolism. A practice-oriented algorithm which also considers health economic aspects for a rational laboratory diagnosis of vitamin B12 deficiency is presented. In cases with severe neurological symptoms, therapy should be parenteral, especially initially. For parenteral treatment, hydroxocobalamin is the drug of choice.
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Affiliation(s)
- A H Leischker
- Klinik für Allgemeine Innere Medizin und Altersmedizin, Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland,
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Matamala JM, Nuñez C, Verdugo RJ, Lera L, Sánchez H, Albala C, Castillo JL. Vitamin B12 status does not influence central motor conduction time in asymptomatic elderly people: a transcranial magnetic stimulation study. Somatosens Mot Res 2014; 31:136-40. [PMID: 24694205 DOI: 10.3109/08990220.2014.897603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Vitamin B12 deficiency causes neurologic and psychiatric disease, especially in older adults. Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract. OBJECTIVE To test corticospinal tract projections using motor evoked potentials (MEPs) by transcranial magnetic stimulation (TMS) in asymptomatic older adults with low vitamin B12 (B12) levels. METHODS Cross-sectional study of 53 healthy older adults (>70 years). MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles, at rest and during slight tonic contraction. Central motor conduction time (CMCT) was derived from the latency of MEPs and peripheral motor conduction time (PMCT). Neurophysiological variables were analyzed statistically according to B12 status. RESULTS Median age was 74.3 ± 3.6 years (58.5% women). Twenty-six out of the 53 subjects had low vitamin B12 levels (B12 < 221 pmol/l). MEPs were recorded for all subjects in upper and lower extremities. There were no significant differences in either latency or amplitude of MEPs and CMCT between low and normal B12 groups. There was a significant PMCT delay in the lower extremities in the low B12 group (p = 0.014). CONCLUSIONS No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12-deficient older adults. The peripheral nervous system appears to be more vulnerable to damage attributable to this vitamin deficit. The neurophysiological evaluation of asymptomatic older adults with lower B12 levels should be focused mainly in peripheral nervous system evaluation.
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Affiliation(s)
- José Manuel Matamala
- Department of Neurological Science, Faculty of Medicine, University of Chile , Santiago , Chile and
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Sanchez H, Albala C, Lera L, Dangour AD, Uauy R. Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354). Nutr J 2013; 12:124. [PMID: 24016218 PMCID: PMC3848755 DOI: 10.1186/1475-2891-12-124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/31/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.
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Affiliation(s)
- Hugo Sanchez
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Cecilia Albala
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Lydia Lera
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Alan D Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Uauy
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
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Clase CM, Ki V, Holden RM. Water-soluble vitamins in people with low glomerular filtration rate or on dialysis: a review. Semin Dial 2013; 26:546-67. [PMID: 23859229 PMCID: PMC4285924 DOI: 10.1111/sdi.12099] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
People with low glomerular filtration rate and people on dialysis are spontaneously at risk for vitamin deficiency because of the potential for problems with decreased appetite and decreased sense of smell and taste, leading to decreased intake, and because decreased energy or decreased cognitive ability results in difficulties in shopping and cooking. Imposed dietary restrictions because of their renal dysfunction and because of comorbidities such as hypertension and diabetes exacerbate this problem. Finally, particularly for water-soluble vitamins, loss may occur into the dialysate. We did not identify any randomized trials of administering daily doses close to the recommended daily allowances of these vitamins. In people who are eating at all, deficiencies of B5 and B7 seem unlikely. It is unclear whether supplements of B2 and B3 are necessary. Because of dialyzability and documented evidence of insufficiency in dialysis patients, B1 supplementation is likely to be helpful. B6, B9, and B12 are implicated in the hyperhomocysteinemia observed in patients on dialysis. These vitamins have been studied in combinations, in high doses, with the hope of reducing cardiovascular outcomes. No reductions in patient-important outcomes were seen in adequately powered randomized trials. Because of their involvement in the homocysteine pathway, however, supplementation with lower doses, close to the recommended daily allowances, may be helpful. Vitamin C deficiency is common in patients on dialysis who are not taking supplements: low-dose supplements are warranted. Vitamins for dialysis patients contain most or all of the B vitamins and low-dose vitamin C. We are not aware of any medical reasons to choose one over another.
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Affiliation(s)
- Catherine M Clase
- Department of Medicine, McMaster UniversityHamilton, ON, Canada
- Department of Clinical Epidemiology, McMaster UniversityHamilton, ON, Canada
| | - Vincent Ki
- Department of Medicine, McMaster UniversityHamilton, ON, Canada
| | - Rachel M Holden
- Department of Medicine, Queen's UniversityKingston, ON, Canada
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Fedosov SN. Biochemical markers of vitamin B12 deficiency combined in one diagnostic parameter: the age-dependence and association with cognitive function and blood hemoglobin. Clin Chim Acta 2013; 422:47-53. [PMID: 23583557 DOI: 10.1016/j.cca.2013.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin B12 deficiency is diagnosed by measurements of total B12, holo-transcobalamin (holoTC), methylmalonic acid (MMA) and total homocysteine (Hcy) in blood. Results of the individual biochemical tests are often contradictory. Here the four markers are combined to achieve a more reliable indication of the B12 status. The results are aligned with hemoglobin and cognitive score. METHODS Databases from the literature were plotted in coordinates x=(holoTC·B12)(1∕2), y=1∕2·log10(MMA·Hcy), where distribution of points revealed the subgroups characterized by logarithmic ratios lr=log10[(holoTC·B12)/(MMA·Hcy)]. Distance between the subgroups w=lr(Test)-lr(Normal) was taken as a robust biochemical indicator of B12 status ("wellness parameter"). RESULTS The dependence of lr(Normal) vs. age was described by a mathematical function to correct parameter w. The B12 status was defined as "excellent" (w≈+0.4), "normal" (w≈0), "transitional" (w≈-0.5), "deficient" (w≈-1.7) and "pernicious" (w≈-3.0). The groups of individuals with either w≥0 or w≤-1 exhibited the statistically significant differences in both hemoglobin and cognitive score. Analogous assessment of B12 status by the individual markers agreed with only one out of two physiological characteristics. CONCLUSION Combined parameter w is a reliable diagnostic tool.
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Affiliation(s)
- Sergey N Fedosov
- Department of Engineering Science, Aarhus University, Science Park, Aarhus C, Denmark.
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Dullemeijer C, Souverein OW, Doets EL, van der Voet H, van Wijngaarden JP, de Boer WJ, Plada M, Dhonukshe-Rutten RAM, In 't Veld PH, Cavelaars AEJM, de Groot LCPGM, van 't Veer P. Systematic review with dose-response meta-analyses between vitamin B-12 intake and European Micronutrient Recommendations Aligned's prioritized biomarkers of vitamin B-12 including randomized controlled trials and observational studies in adults and elderly persons. Am J Clin Nutr 2013; 97:390-402. [PMID: 23269815 DOI: 10.3945/ajcn.112.033951] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many randomized controlled trials (RCTs) and observational studies have provided information on the association between vitamin B-12 intake and biomarkers. The use of these data to estimate dose-response relations provides a useful means to summarize the body of evidence. OBJECTIVE We systematically reviewed studies that investigated vitamin B-12 intake and biomarkers of vitamin B-12 status and estimated dose-response relations with the use of a meta-analysis. DESIGN This systematic review included all RCTs, prospective cohort studies, nested case-control studies, and cross-sectional studies in healthy adult populations published through January 2010 that supplied or measured dietary vitamin B-12 intake and measured vitamin B-12 status as serum or plasma vitamin B-12, methylmalonic acid (MMA), or holotranscobalamin. We calculated an intake-status regression coefficient ( ) for each individual study and calculated the overall pooled and SE ( ) by using random-effects meta-analysis on a double-log scale. RESULTS The meta-analysis of observational studies showed a weaker slope of dose-response relations than the meta-analysis of RCTs. The pooled dose-response relation of all studies between vitamin B-12 intake and status indicated that a doubling of the vitamin B-12 intake increased vitamin B-12 concentrations by 11% (95% CI: 9.4%, 12.5%). This increase was larger for studies in elderly persons (13%) than in studies in adults (8%). The dose-response relation between vitamin B-12 intake and MMA concentrations indicated a decrease in MMA of 7% (95% CI: -10%, -4%) for every doubling of the vitamin B-12 intake. The assessment of risk of bias within individual studies and across studies indicated risk that was unlikely to seriously alter these results. CONCLUSION The obtained dose-response estimate between vitamin B-12 intake and status provides complementary evidence to underpin recommendations for a vitamin B-12 intake of populations.
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Affiliation(s)
- Carla Dullemeijer
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, Netherlands.
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Doets EL, van Wijngaarden JP, Szczecińska A, Dullemeijer C, Souverein OW, Dhonukshe-Rutten RAM, Cavelaars AEJM, van 't Veer P, Brzozowska A, de Groot LCPGM. Vitamin B12 Intake and Status and Cognitive Function in Elderly People. Epidemiol Rev 2012; 35:2-21. [DOI: 10.1093/epirev/mxs003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/13/2022] Open
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15
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Ajayi OI, Bwayo-Weaver S, Chirla S, Serlemitsos-Day M, Daniel M, Nouraie M, Edwards K, Castro O, Lombardo F, Gordeuk VR. Cobalamin status in sickle cell disease. Int J Lab Hematol 2012; 35:31-7. [PMID: 22830455 DOI: 10.1111/j.1751-553x.2012.01457.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Some studies comparing serum cobalamin in individuals with and without sickle cell disease (SCD) have suggested a higher prevalence of cobalamin deficiency in SCD but others have not. Our aim was to prospectively compare cobalamin status in African-Americans with and without SCD. METHODS We analyzed blood samples from 86 subjects in two groups: SCD (n = 29) and non-SCD (n = 57). Serum cobalamin, folate, homocysteine, methylmalonic acid (MMA), anti-intrinsic factor antibody, Helicobacter pylori antibody, and gastrin were measured and compared. RESULTS The median cobalamin was 235 pM in the SCD group vs. 292 pM in the non-SCD group (P-value = 0.014). No significant differences in MMA or homocysteine were seen. Using the criteria of a low cobalamin and an elevated MMA or an elevated MMA alone, cobalamin deficiency was suggested in 4 (13.8%) in the SCD group and 6 (10.5%) in the non-SCD group. Two of these SCD patients and four of these control subjects had chronic renal disease, which may lead to elevated MMA in the absence of cobalamin deficiency. The remaining four met criteria for cobalamin deficiency, 2 (6.9%) in the SCD group and 2 (3.5%) in the non-SCD group (P = 0.6). CONCLUSION A lower cobalamin was observed in SCD patients without a higher prevalence of cobalamin deficiency. The inclusion of haptocorrin and holotranscobalamin measurement in future studies may provide a better assessment of cobalamin status in this patient group.
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Affiliation(s)
- O I Ajayi
- Department of Internal Medicine, Division of Hematology-Oncology, Howard University Hospital, 2041 Georgia Avenue N.W, Washington, DC 20060, USA.
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Abstract
Vitamin B12 (B12) is essential in activating folate needed in DNA synthesis. Inadequate intake results in the impairment of nerve transmission and inadequate synthesis of erythrocytes and other hematological cells. Two separate mechanisms of B12 absorption exist, a receptor-mediated endocytosis that occurs in the distal ileum and the mass-action pharmacologic mechanism. The recommended dietary allowance for B12 for adults issued by the Institute of Medicine is 2.4 µg/d. B12 is only found in meats and other foods of animal origin. B12 deficiency is widespread. Two main causes of deficiency include inadequate absorption and intake. Elderly and vegetarians are at highest risk for deficiency. Prevalence of deficiency ranges from 7% of the US population 3 years and older to 90% among vegans. The best way to assess deficiency is by using methylmalonic acid. Populations at risk could benefit from using B12 supplements and from fortification of flour.
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Affiliation(s)
- Roman Pawlak
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina (RP)
- Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (PSJ)
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York (SR)
- Namaste Nutrition, Watertown, Massachusetts (DC-D)
- Sutter Medical Foundation, Roseville, California (DL)
| | - Parrott Scott James
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina (RP)
- Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (PSJ)
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York (SR)
- Namaste Nutrition, Watertown, Massachusetts (DC-D)
- Sutter Medical Foundation, Roseville, California (DL)
| | - Sudha Raj
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina (RP)
- Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (PSJ)
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York (SR)
- Namaste Nutrition, Watertown, Massachusetts (DC-D)
- Sutter Medical Foundation, Roseville, California (DL)
| | - Diana Cullum-Dugan
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina (RP)
- Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (PSJ)
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York (SR)
- Namaste Nutrition, Watertown, Massachusetts (DC-D)
- Sutter Medical Foundation, Roseville, California (DL)
| | - Debbie Lucus
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina (RP)
- Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (PSJ)
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York (SR)
- Namaste Nutrition, Watertown, Massachusetts (DC-D)
- Sutter Medical Foundation, Roseville, California (DL)
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MacFarlane AJ, Greene-Finestone LS, Shi Y. Vitamin B-12 and homocysteine status in a folate-replete population: results from the Canadian Health Measures Survey. Am J Clin Nutr 2011; 94:1079-87. [PMID: 21900461 DOI: 10.3945/ajcn.111.020230] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin B-12 is an important cofactor required for nucleotide and amino acid metabolism. Vitamin B-12 deficiency causes anemia and neurologic abnormalities-a cause for concern for the elderly, who are at increased risk of vitamin B-12 malabsorption. Vitamin B-12 deficiency is also associated with an increased risk of neural tube defects and hyperhomocysteinemia. The metabolism of vitamin B-12 and folate is interdependent, which makes it of public health interest to monitor biomarkers of vitamin B-12, folate, and homocysteine in a folic acid-fortified population. OBJECTIVE The objective was to determine the vitamin B-12, folate, and homocysteine status of the Canadian population in the period after folic acid fortification was initiated. DESIGN Blood was collected from a nationally representative sample of ∼5600 participants aged 6-79 y in the Canadian Health Measures Survey during 2007-2009 and was analyzed for serum vitamin B-12, red blood cell folate, and plasma total homocysteine (tHcy). RESULTS A total of 4.6% of Canadians were vitamin B-12 deficient (<148 pmol/L). Folate deficiency (<320 nmol/L) was essentially nonexistent. Obese individuals were less likely to be vitamin B-12 adequate than were individuals with a normal BMI. A total of 94.9% of Canadians had a normal tHcy status (≤13 μmol/L), and individuals with normal tHcy were more likely to be vitamin B-12 adequate and to have high folate status (>1090 nmol/L). CONCLUSIONS Approximately 5% of Canadians are vitamin B-12 deficient. One percent of adult Canadians have metabolic vitamin B-12 deficiency, as evidenced by combined vitamin B-12 deficiency and high tHcy status. In a folate-replete population, vitamin B-12 is a major determinant of tHcy.
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Hsieh MS, Wu TG, Su J, Cheng WJ, Hsieh SM, Chi WM. Investigation of Cyanocobalamin Interferences to an Electrochemical Based Hemoglobin Test System. ANAL LETT 2011. [DOI: 10.1080/00032719.2010.520389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Abstract
Cobalamin (vitamin B12) deficiency in the elderly is an under recognized problem in daily clinical practice. It seems to be important because the deficiency of this vitamin can lead to irreversible neurological damage, anemia, osteoporosis, and cerebrovascular and cardiovascular diseases. Some clinical abnormalities that we thought were related to the normal aging changes may actually be caused by cobalamin deficiency, such as lack of ankle jerk reflex. The prevalence of cobalamin deficiency increases with age (ranges from 0.6% to 46% depending on the population studies and criteria for diagnosis). Other than clinical manifestations, there are some biomarkers for detection of cobalamin deficiency: the red blood cell mean corpuscular volume (MCV); serum cobalamin level; plasma holotranscobalamin; serum methylmalonic acid (MMA) levels and serum homocysteine levels. The interpretation and the application of these biomarkers are here presented.
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Affiliation(s)
- W Chatthanawaree
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors. Am J Clin Nutr 2010; 91:1733-44. [PMID: 20357042 DOI: 10.3945/ajcn.2009.28671] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Folate deficiency has serious consequences for the fetus. Folic acid fortification of food addresses this problem. However, clinical consequences of vitamin B-12 deficiency may be worsened by high folic acid intakes, perhaps as a direct result of unmetabolized folic acid, which does not occur naturally in body tissues. OBJECTIVE We attempted to attribute associations that we previously found between higher folate status and anemia and cognitive test performance to circulating unmetabolized folic acid or 5-methyltetrahydrofolate (5MeTHF). DESIGN The subjects (n = 1858) were senior participants in the US National Health and Nutrition Examination Survey (1999-2002) who had normal renal function and reported no history of stroke, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries. Subjects had undergone a phlebotomy, a complete blood count, and cognitive and dietary assessments. RESULTS Circulating unmetabolized folic acid was detected in approximately 33% of the subjects and was related to an increased odds of anemia in alcohol users. In seniors with a serum vitamin B-12 concentration <148 pmol/L or a plasma methylmalonic acid concentration > or =210 nmol/L, the presence compared with the absence of detectable circulating unmetabolized folic acid was related to lower cognitive test scores and lower mean cell volume. In the same subgroup, higher serum 5MeTHF was related to an increased odds of anemia and a marginally significantly decreased odds of macrocytosis. In seniors with a normal vitamin B-12 status, a higher serum 5MeTHF concentration was related to higher cognitive test scores. CONCLUSION Results of this epidemiologic study were somewhat consistent with reports on the folic acid treatment of patients with pernicious anemia, but some findings were unexpected.
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Abstract
Reasons to fortify flour with vitamin B12 are considered, including the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in the elderly in wealthier countries, and the adverse functional consequences of poor vitamin B12 status. From a global perspective, the main cause of inadequate intake and status is a low intake of animal-source foods; even lacto-ovo vegetarians have lower serum vitamin B12 concentrations than omnivores, and for various reasons many populations have limited consumption of animal-source foods. Infants are vitamin B12-depleted from early infancy if their mothers' vitamin B12 status and intake are poor during pregnancy and lactation. Even in the United States, more than 20% of the elderly have serum vitamin B12 concentrations that indicate depletion, and an additional 6% have deficiency, primarily due to gastric atrophy, which impairs the absorption of the vitamin from food but usually not from supplements or fortified foods. Although the evidence is limited, it shows that fortified flour, consumed as bread, can improve vitamin B12 status. Where vitamin B12 fortification is implemented, the recommendation is to add 20 μg/kg flour, assuming consumption of 75 to 100 g flour per day, to provide 75% to 100% of the Estimated Average Requirement; the amount of the vitamin that can be added is limited by its cost. The effectiveness of this level of addition for improving vitamin B12 status in programs needs to be determined and monitored. In addition, further research should evaluate the bioavailability of the vitamin from fortified flour by elderly people with food cobalamin malabsorption and gastric atrophy.
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22
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Folate and vitamin B12status of women of reproductive age living in Hanoi City and Hai Duong Province of Vietnam. Public Health Nutr 2009; 12:941-6. [DOI: 10.1017/s1368980008003479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTo assess the folate and vitamin B12status of a group of Vietnamese women of reproductive age and to estimate the rate of neural tube defects (NTD) based on red blood cell (RBC) folate concentrations.Design and subjectsA representative sample of non-pregnant women (15–49 years) living in Hanoi City (n244) and Hai Duong Province (n245).MeasuresRBC folate, plasma vitamin B12and plasma holo-transcobalamin (holoTC), a sensitive indicator of vitamin B12status.ResultsMean (95 % CI) concentrations of RBC folate, plasma B12and plasma holoTC were 856 (837, 876) nmol/l, 494 (475, 513) pmol/l and 78 (74, 82) pmol/l, respectively. Only 3 % and 4 % of women had plasma B12and holoTC concentrations indicative of deficiency. No woman had an RBC folate concentration indicative of deficiency (<317 nmol/l). Only 47 % of women had an RBC folate concentration ≥905 nmol/l. Accordingly, we predict the NTD rate in these regions of Vietnam to be 14·7 (14·2, 15·1) per 10 000 pregnancies.ConclusionThere was no evidence of folate and vitamin B12deficiency among this population of Vietnamese women. However, suboptimal folate status may be placing three out of five women at increased risk of NTD. Reductions in NTD rates are still possible and women would benefit from additional folic acid during the periconceptional period from either supplements or fortified foods.
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23
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Abstract
In considering the vitamin B-12 fortification of flour, it is important to know who is at risk of vitamin B-12 deficiency and whether those individuals would benefit from flour fortification. This article reviews current knowledge of the prevalence and causes of vitamin B-12 deficiency and considers whether fortification would improve the status of deficient subgroups of the population. In large surveys in the United States and the United Kingdom, approximately 6% of those aged > or =60 y are vitamin B-12 deficient (plasma vitamin B-12 < 148 pmol/L), with the prevalence of deficiency increasing with age. Closer to 20% have marginal status (plasma vitamin B-12: 148-221 pmol/L) in later life. In developing countries, deficiency is much more common, starting in early life and persisting across the life span. Inadequate intake, due to low consumption of animal-source foods, is the main cause of low serum vitamin B-12 in younger adults and likely the main cause in poor populations worldwide; in most studies, serum vitamin B-12 concentration is correlated with intake of this vitamin. In older persons, food-bound cobalamin malabsorption becomes the predominant cause of deficiency, at least in part due to gastric atrophy, but it is likely that most elderly can absorb the vitamin from fortified food. Fortification of flour with vitamin B-12 is likely to improve the status of most persons with low stores of this vitamin. However, intervention studies are still needed to assess efficacy and functional benefits of increasing intake of the amounts likely to be consumed in flour, including in elderly persons with varying degrees of gastric atrophy.
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Affiliation(s)
- Lindsay H Allen
- US Department of Agriculture, ARS Western Human Nutrition Research Center, University of California, Davis, Davis, CA 95616, USA.
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24
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Abstract
This review describes current knowledge of the main causes of vitamin B12 and folate deficiency. The most common explanations for poor vitamin B12 status are a low dietary intake of the vitamin (i.e., a low intake of animal-source foods) and malabsorption. Although it has long been known that strict vegetarians (vegans) are at risk for vitamin B12 deficiency, evidence now indicates that low intakes of animal-source foods, such as occur in some lacto-ovo vegetarians and many less-industrialized countries, cause vitamin B12 depletion. Malabsorption of the vitamin is most commonly observed as food-bound cobalamin malabsorption due to gastric atrophy in the elderly, and probably as a result of Helicobacter pylori infection. There is growing evidence that gene polymorphisms in transcobalamins affect plasma vitamin B12 concentrations. The primary cause of folate deficiency is low intake of sources rich in the vitamin, such as legumes and green leafy vegetables, and the consumption of these foods may explain why folate status can be adequate in relatively poor populations. Other situations in which the risk of folate deficiency increases include lactation and alcoholism.
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25
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Abstract
The most common cause of vitamin B12 deficiency in older people is malabsorption of food-bound vitamin B12. Thus, it is suggested that the recommended daily allowance of 2.4 microg/d be met primarily with crystalline vitamin B12, which is believed to be well absorbed in individuals who have food-bound malabsorption. There is concern that high intakes of folic acid from fortified food and dietary supplements might mask the macrocytic anemia of vitamin B12 deficiency, thereby eliminating an important diagnostic sign. One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms. Another study suggests that once vitamin B12 deficiency is established in subjects with food-bound malabsorption, 40 microg/d to 80 microg/d of oral crystalline vitamin B12 for 30 d does not reverse the biochemical signs of deficiency. Together, these studies provide further evidence that public health strategies are needed to improve vitamin B12 status in order to decrease the risk of deficiency and any potentially adverse interactions with folic acid.
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Affiliation(s)
- Mary Ann Johnson
- Faculty of Gerontology, Department of Foods and Nutrition, Dawson Hall, Building 1010, University of Georgia, Athens, GA 30602-3622, USA.
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26
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Miller J, Aiello A, Haan M, Green R, Allen L. Reply to J Kountouras et al. Am J Clin Nutr 2007. [DOI: 10.1093/ajcn/86.3.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Josh Miller
- Department of Medical Pathology and Laboratory Medicine School of Medicine University of California, Davis Davis, CA 95616
| | - Allison Aiello
- School of Public Health Department of Epidemiology 611 Church Street, Room 315 University of Michigan Ann Arbor, MI 48104
| | - Mary Haan
- School of Public Health Department of Epidemiology 611 Church Street, Room 315 University of Michigan Ann Arbor, MI 48104
| | - Ralph Green
- Department of Medical Pathology and Laboratory Medicine School of Medicine University of California, Davis Davis, CA
| | - Lindsay Allen
- US Department of Agriculture Agricultural Research Service Western Human Nutrition Research Center University of California, Davis Davis, CA
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27
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Solomon LR. Disorders of cobalamin (Vitamin B12) metabolism: Emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev 2007; 21:113-30. [DOI: 10.1016/j.blre.2006.05.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Miller JW, Garrod MG, Rockwood AL, Kushnir MM, Allen LH, Haan MN, Green R. Measurement of Total Vitamin B12 and Holotranscobalamin, Singly and in Combination, in Screening for Metabolic Vitamin B12 Deficiency. Clin Chem 2006; 52:278-85. [PMID: 16384886 DOI: 10.1373/clinchem.2005.061382] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: The standard screening test for vitamin B12 deficiency, measurement of total plasma vitamin B12, has limitations of sensitivity and specificity. Plasma vitamin B12 bound to transcobalamin (holoTC) is the fraction of total vitamin B12 available for tissue uptake and therefore has been proposed as a potentially useful alternative indicator of vitamin B12 status.
Methods: We compared the diagnostic accuracy of total vitamin B12, holoTC, and a combination of both measures to screen for metabolic vitamin B12 deficiency in an elderly cohort (age ≥60 years). Plasma methylmalonic acid and homocysteine were used as indicators of vitamin B12 deficiency.
Results: Low total vitamin B12 (<148 pmol/L) and low holoTC (<35 pmol/L) were observed in 6.5% and 8.0%, and increased methylmalonic acid (>350 nmol/L) and homocysteine (>13 μmol/L) were observed in 12.1% and 17.0% of the study participants. In multiple regression models, holoTC explained 5%–6% more of the observed variance in methylmalonic acid and homocysteine than did total vitamin B12 (P ≤0.004). ROC curve analysis indicated that total vitamin B12 and holoTC were essentially equivalent in their ability to discriminate persons with and without vitamin B12 deficiency. Individuals with low concentrations of both total vitamin B12 and holoTC had significantly higher concentrations of methylmalonic acid and homocysteine than did individuals with total vitamin B12 and/or holoTC within the reference intervals (P <0.001).
Conclusions: HoloTC and total vitamin B12 have equal diagnostic accuracy in screening for metabolic vitamin B12 deficiency. Measurement of both holoTC and total vitamin B12 provides a better screen for vitamin B12 deficiency than either assay alone.
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Affiliation(s)
- Joshua W Miller
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA 95817, USA
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29
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Green TJ, Venn BJ, Skeaff CM, Williams SM. Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders. Eur J Clin Nutr 2004; 59:205-10. [PMID: 15483636 DOI: 10.1038/sj.ejcn.1602059] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the serum vitamin B(12) status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B(12) status. DESIGN A cross-sectional nationally representative population-based survey. METHOD Serum vitamin B(12) concentrations were used to assess vitamin B(12) 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 B(12) 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 B(12) 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 B(12) concentrations. An intake of vitamin B(12) from food that exceeded the recommended dietary allowance (2.4 mug/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 B(12) status. Vitamin B(12) supplement users had a reduced risk of having deficient and marginal vitamin B(12) status (RR 0.3; 95% CI: 0.1, 0.8). CONCLUSIONS There is a relatively high prevalence of deficient and marginal serum vitamin B(12) 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 B(12) status, it did not fully explain the prevalence of low serum vitamin B(12).
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Affiliation(s)
- T J Green
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
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30
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Abstract
Pernicious anemia is a common cause of megaloblastic anemia throughout the world and especially in persons of European or African descent. Dietary deficiency of vitamin B12 due to vegetarianism is increasing and causes hyperhomocysteinemia. The breast-fed infant of a vitamin B12-deficient mother is at risk for severe developmental abnormalities, growth failure, and anemia. Elevated methylmalonic acid and/or total homocysteine are sensitive indicators of vitamin B12-deficient diets and correlate with clinical abnormalities. Dietary vitamin B12 deficiency is a severe problem in the Indian subcontinent, Mexico, Central and South America, and selected areas in Africa. Dietary vitamin B12 deficiency is not prevalent in Asia, except in vegetarians. Areas for research include intermittent vitamin B12 supplement dosing and better measurements of the bioavailability of B12 in fermented vegetarian foods and algae.
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Affiliation(s)
- Sally P Stabler
- Division of Hematology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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