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Sohouli MH, Almuqayyid F, Alfardous Alazm A, Ziamanesh F, Izze da Silva Magalhães E, Bagheri SE, Rodrigues de Oliveira B, Alfardous Alazm M, Adi AR, Alomar S, Abu-Zaid A. A comprehensive review and meta-regression analysis of randomized controlled trials examining the impact of vitamin B12 supplementation on homocysteine levels. Nutr Rev 2024; 82:726-737. [PMID: 37495210 DOI: 10.1093/nutrit/nuad091] [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] [Indexed: 07/28/2023] Open
Abstract
CONTEXT Although some research suggests that vitamin B12 (hereafter, B12) supplements can lower homocysteine (Hcy) levels and treat hyperhomocysteinemia, these results are still ambiguous when B12 is taken as an isolated supplement. OBJECTIVE This study sought to determine how existing randomized controlled trials (RCTs) could be used to examine the effects of B12 supplementation on Hcy. DATA SOURCES To find pertinent RCTs up to June 2022, databases, including PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase, were searched. DATA EXTRACTION All selected RCTs investigated the impact of B12 supplements on Hcy. A meta-analysis of the eligible studies was performed using the random-effects model. DATA ANALYSIS This review included a total of 21 RCTs (N = 1625 participants). Hcy levels were significantly lower after B12 supplementation compared with the control group (pooled weighted mean difference, -4.15 μmol/L; 95% confidence interval, -4.86, -3.45; P < 0.001), and this reduction was even greater with intervention durations ≥12 weeks and doses >500 µg/d. Furthermore, the effect of B12 supplementation in the form of hydroxocobalamin on the reduction of Hcy level was greater compared with other forms. CONCLUSION In conclusion, this meta-analysis shows that B12 supplementation has a positive impact on lowering blood Hcy levels, particularly when administered for a longer period and at a larger dose. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022364066.
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Affiliation(s)
- Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Fateme Ziamanesh
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elma Izze da Silva Magalhães
- Postgraduate Program in Food, Nutrition and Health, Department of Clinical Nutrition and Dietetics, Federal University of Rio Grande do Sul,São Luís, MA, Brazil
| | - Seyedeh Elaheh Bagheri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bianca Rodrigues de Oliveira
- Postgraduate Program in Food, Nutrition and Health, Department of Clinical Nutrition and Dietetics, Federal University of Rio Grande do Sul,São Luís, MA, Brazil
| | | | | | - Sara Alomar
- Department of Family Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Kerlikowsky F, Schuchardt JP, Hahn A. Folate, vitamin B12 and vitamin D status in healthy and active home-dwelling people over 70 years. BMC Geriatr 2023; 23:673. [PMID: 37853337 PMCID: PMC10585793 DOI: 10.1186/s12877-023-04391-2] [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: 03/10/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Ageing is characterised by physiological changes that can affect the nutrient availability and requirements. In particular, the status of vitamin D, cobalamin and folate has often been found to be critical in older people living in residential care. However, there is a lack of studies investigating the status of these nutrients in healthy and active home-dwelling elderly people. METHODS The aim of this cross-sectional study was to assess the status of vitamin D based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D], cobalamin based on serum concentrations of holotranscobalamin (holoTC) and folate based on red blood cell (RBC) folate in unsupplemented, healthy and active German home-dwelling subjects ≥ 70 years of age (n = 134, mean ± SD: 75.8 ± 4.5 years). Dietary intake was assessed by 3-day food recalls. The study was conducted between March and November of 2021 (during the COVID-19 pandemic). RESULTS The mean 25-(OH)D concentration was high at 85.1 ± 26.0 nmol/L, while the majority of women (92%) and men (94%) had 25-(OH)D concentrations ≥ 50 nmol/L. Less than 10% of men and women had 25-(OH)D concentrations < 50 nmol/L. The mean holoTC concentration was 88.9 ± 33.7 pmol/L (94.8 ± 34.6 pmol/L in women and 73.6 ± 25.6 in men). Only 8% of the women were cobalamin deficient (< 50 pmol/L holoTC) compared to 22% of the men. The mean RBC folate concentration was 831 ± 244 nmol/L, while the prevalence of folate deficiency was 10%. Linear regression analysis showed that only folate equivalent intake was associated with the relevant nutrient status marker. CONCLUSION Our findings suggest that healthy, independently living older people with high levels of education, physical activity, and health awareness are not necessarily at higher risk of vitamin D, folate and cobalamin deficiency. Further studies are needed to verify these findings and to identify lifestyle and dietary patterns that can predict adequate nutrient status for healthy ageing. TRIAL REGISTRATION This study is officially recorded in the German Clinical Trials Register (DRKS00021302).
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Affiliation(s)
- Felix Kerlikowsky
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany.
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Zibold J, von Livonius B, Kolarova H, Rudolph G, Priglinger CS, Klopstock T, Catarino CB. Vitamin B12 in Leber hereditary optic neuropathy mutation carriers: a prospective cohort study. Orphanet J Rare Dis 2022; 17:310. [PMID: 35945620 PMCID: PMC9361590 DOI: 10.1186/s13023-022-02453-z] [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: 03/07/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Leber hereditary optic neuropathy (LHON) is the most common mitochondrial disorder, frequently resulting in acute or subacute severe bilateral central vision loss. Vitamin B12 deficiency is also a known cause of optic neuropathy through mitochondrial dysfunction. Here we evaluated the prevalence and clinical significance of vitamin B12 deficiency in a large cohort of LHON patients and asymptomatic mutation carriers from a tertiary referral center. Methods From the Munich LHON prospective cohort study, participants included all LHON patients and asymptomatic LHON mutation carriers, who were recruited between February 2014 and March 2020 and consented to participate. Neurological, general, and ophthalmological examinations were regularly performed, as were laboratory tests. Vitamin B12 deficiency was diagnosed if serum vitamin B12 was below 201 pg/mL, or if 201–339 pg/mL plus low serum holotranscobalamin or elevated serum methylmalonic acid or elevated total plasma homocysteine. Results We analyzed 244 subjects, including 147 symptomatic LHON patients (74% males) and 97 asymptomatic mutation carriers (31% males). Median age at study baseline was 34 years (range 5–82 years). The prevalence of vitamin B12 deficiency was higher for LHON mutation carriers than for the general population in all age categories. This was statistically significant for the LHON mutation carriers under 65 years (21% vs. 5–7%, p = 0.002). While vitamin B12 deficiency prevalence was not statistically different between LHON patients and asymptomatic mutation carriers, its clinical correlates, e.g., macrocytosis and polyneuropathy, were more frequent in the subgroup of LHON patients. Excessive alcohol consumption was a significant predictor of vitamin B12 deficiency (p < 0.05). Conclusions The high prevalence of vitamin B12 deficiency in LHON mutation carriers, both asymptomatic mutation carriers and LHON patients, highlights the need for regular vitamin B12 screening in this population, in order to ensure early treatment, aiming for better outcomes. Our study is not conclusive regarding vitamin B12 deficiency as determinant for disease conversion in LHON, and further research is warranted to disentangle the role of vitamin B12 in the pathophysiology and prognosis of LHON.
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Affiliation(s)
- Julia Zibold
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany
| | - Bettina von Livonius
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Hana Kolarova
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.,Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Günter Rudolph
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Claudia S Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Claudia B Catarino
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.
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Světnička M, Sigal A, Selinger E, Heniková M, El-Lababidi E, Gojda J. Cross-Sectional Study of the Prevalence of Cobalamin Deficiency and Vitamin B12 Supplementation Habits among Vegetarian and Vegan Children in the Czech Republic. Nutrients 2022; 14:nu14030535. [PMID: 35276893 PMCID: PMC8838497 DOI: 10.3390/nu14030535] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Vegetarian (VG) and vegan (VN) diets in childhood are of growing interest due to their perceived health and environmental benefits. Concerns remain due to the possible disruption of healthy growth and development of children because of the scarcity of evidence-based studies. Among the nutrients of special concern is vitamin B12. Therefore, the Czech Vegan Children Study (CAROTS) decided to examine the relationship between B12 metabolism parameters and B12 intake through diet and supplementation. We analyzed laboratory parameters within n = 79 VG, n = 69 VN, and n = 52 omnivores (OM) children (0−18 years old). There were no significant differences in levels of holotranscobalamin (aB12), folate, homocysteine (hcys), or mean corpuscular volume. However, there was a significant difference in levels of cyanocobalamin (B12) (p = 0.018), even though we identified only n = 1 VG and n = 2 VN children as B12 deficient. On the other hand, we identified n = 35 VG, n = 28 VN, and n = 9 OM children with vitamin B12 hypervitaminosis (p = 0.004). This finding was related to a high prevalence of over-supplementation in the group (mean dose for VG 178.19 ± 238.5 µg per day; VN 278.35 ± 394.63 µg per day). Additionally, we found a significant (p < 0.05) difference between B12, aB12, and hcys levels of supplemented vs. non-supplemented VG/VN children. This can show that the intake of vitamin B12 via diet in the VG group might not be sufficient. Secondly, we analyzed a relation between supplement use in pregnancy and breastfeeding and its impact on vitamin B12 levels of children aged 0−3 years. Out of n = 46 mothers, only n = 3 (e.g., 6.5%) were not supplemented at all. We have not identified any clinical manifestation of B12 deficiency and only n = 1 child with low serum cobalamin, a child who did not receive vitamin B12 supplementation and whose mother took only low doses of vitamin B12 (25/µg/day).To conclude, we did not observe any life-threatening or severe consequences of laboratory-stated vitamin B12 deficiency; thus, our group was well supplemented. On the other hand, we have identified many subjects with vitamin B12 hypervitaminosis of unknown impact on their health. Further research and new guidelines for B12 supplementation among VG and VN children are needed.
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Affiliation(s)
- Martin Světnička
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
- Department of Pediatrics, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
- Correspondence: ; Tel.: +420-725-569-697
| | - Anat Sigal
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Pediatrics, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
| | - Eliška Selinger
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
- Centre for Public Health Promotion, The National Institute of Public Health, 10000 Prague, Czech Republic
| | - Marina Heniková
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
| | - Eva El-Lababidi
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Pediatrics, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
| | - Jan Gojda
- Centre for Research on Diabetes Metabolism, Nutrition of Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic; (A.S.); (E.S.); (M.H.); (E.E.-L.); (J.G.)
- Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, 10000 Prague, Czech Republic
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Pellinen T, Päivärinta E, Isotalo J, Lehtovirta M, Itkonen ST, Korkalo L, Erkkola M, Pajari AM. Replacing dietary animal-source proteins with plant-source proteins changes dietary intake and status of vitamins and minerals in healthy adults: a 12-week randomized controlled trial. Eur J Nutr 2021; 61:1391-1404. [PMID: 34837522 PMCID: PMC8921037 DOI: 10.1007/s00394-021-02729-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A shift towards more plant-based diets promotes both health and sustainability. However, controlled trials addressing the nutritional effects of replacing animal proteins with plant proteins are lacking. We examined the effects of partly replacing animal proteins with plant proteins on critical vitamin and mineral intake and statuses in healthy adults using a whole-diet approach. METHODS Volunteers aged 20-69 years (107 female, 29 male) were randomly allocated into one of three 12-week intervention groups with different dietary protein compositions: ANIMAL: 70% animal-source protein/30% plant-source protein; 50/50: 50% animal/50% plant; PLANT: 30% animal/70% plant; all with designed protein intake of 17 E%. We analysed vitamin B-12, iodine, iron, folate, and zinc intakes from 4-day food records, haemoglobin, ferritin, transferrin receptor, folate, and holotranscobalamin II from fasting blood samples, and iodine from 24-h urine. RESULTS At the end point, vitamin B-12 intake and status were lower in PLANT than in 50/50 or ANIMAL groups (P ≤ 0.007 for all). Vitamin B-12 intake was also lower in 50/50 than in ANIMAL (P < 0.001). Iodine intake and status were lower in both 50/50 and PLANT than in ANIMAL (P ≤ 0.002 for all). Iron and folate intakes were higher in PLANT than in ANIMAL (P < 0.001, P = 0.047), but no significant differences emerged in the respective biomarkers. CONCLUSIONS Partial replacement of animal protein foods with plant protein foods led to marked decreases in the intake and status of vitamin B-12 and iodine. No changes in iron status were seen. More attention needs to be paid to adequate micronutrient intakes when following flexitarian diets. CLINICAL TRIAL REGISTRY NCT03206827; registration date: 2017-06-30.
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Affiliation(s)
- Tiina Pellinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Essi Päivärinta
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Jarkko Isotalo
- The Computing Sciences Unit, Tampere University, Tampere, Finland
| | - Mikko Lehtovirta
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Suvi T Itkonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Liisa Korkalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Anne-Maria Pajari
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
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Rashid S, Meier V, Patrick H. Review of Vitamin B12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. Eur J Haematol 2021; 106:450-455. [PMID: 33341967 DOI: 10.1111/ejh.13571] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Vegetarianism and veganism are increasingly popular. The Food Standards Agency, biennial Food and You Survey of adults aged 16 years and over living in the UK, found that between 2012 and 2018 the proportion of people who reported never consuming dairy products had increased from 2% to 5%. However, veganism risks development of vitamin B12 deficiency as it is not available from plant sources. Moreover, its impact may be slow to be detected because body stores of vitamin B12 can last years. There is currently no published guidance on antenatal diagnosis and management of vitamin B12 deficiency. This paper reviews the metabolism, diagnosis and treatment of vitamin B12 in pregnancy. It concludes that national screening policymakers should consider introducing screening for B12 deficiency into the Antenatal and Newborn Screening Programmes for mothers and their infants if at risk of vitamin B12 deficiency. In the interim, national policy should be developed for prophylactic vitamin B12 supplementation in high-risk groups around the time of pregnancy.
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Affiliation(s)
- Sabia Rashid
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK
| | - Violet Meier
- Library and Knowledge Services, University Hospital Lewisham, London, UK
| | - Hannah Patrick
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK
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Circulatory and Urinary B-Vitamin Responses to Multivitamin Supplement Ingestion Differ between Older and Younger Adults. Nutrients 2020; 12:nu12113529. [PMID: 33212933 PMCID: PMC7698360 DOI: 10.3390/nu12113529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
Multivitamin and mineral (MVM) supplements are frequently used amongst older populations to improve adequacy of micronutrients, including B-vitamins, but evidence for improved health outcomes are limited and deficiencies remain prevalent. Although this may indicate poor efficacy of supplements, this could also suggest the possibility for altered B-vitamin bioavailability and metabolism in older people. This open-label, single-arm acute parallel study, conducted at the Liggins Institute Clinical Research Unit in Auckland, compared circulatory and urinary B-vitamer responses to MVM supplementation in older (70.1 ± 2.7 y, n = 10 male, n = 10 female) compared to younger (24.2 ± 2.8 y, n = 10 male, n = 10 female) participants for 4 h after the ingestion of a single dose of a commercial MVM supplement and standardized breakfast. Older adults had a lower area under the curve (AUC) of postprandial plasma pyridoxine (p = 0.02) and pyridoxal-5′phosphate (p = 0.03) forms of vitamin B6 but greater 4-pyridoxic acid AUC (p = 0.009). Urinary pyridoxine and pyridoxal excretion were higher in younger females than in older females (time × age × sex interaction, p < 0.05). Older adults had a greater AUC increase in plasma thiamine (p = 0.01), riboflavin (p = 0.009), and pantothenic acid (p = 0.027). In older adults, there was decreased plasma responsiveness of the ingested (pyridoxine) and active (pyridoxal-5′phosphate) forms of vitamin B6, which indicated a previously undescribed alteration in either absorption or subsequent metabolic interconversion. While these findings cannot determine whether acute B6 responsiveness is adequate, this difference may have potential implications for B6 function in older adults. Although this may imply higher B vitamin substrate requirements for older people, further work is required to understand the implications of postprandial differences in availability.
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Krzywański J, Mikulski T, Pokrywka A, Młyńczak M, Krysztofiak H, Frączek B, Ziemba A. Vitamin B 12 Status and Optimal Range for Hemoglobin Formation in Elite Athletes. Nutrients 2020; 12:nu12041038. [PMID: 32283824 PMCID: PMC7230602 DOI: 10.3390/nu12041038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Athletes and coaches believe in the ergogenic effect of vitamin B12 (which results from enhanced erythropoiesis) and they often insist on its unjustified supplementation. Therefore, our study aimed to assess the vitamin B12 status in Polish elite athletes and its influence on red blood cell parameters. Methods: In total, 1131 blood samples were collected during six years from 243 track and field athletes divided into strength and endurance groups, as well as according to the declared use of vitamin B12 injections. Results: An average vitamin B12 concentration in all subjects was 739 ± 13 pg/mL, with no cases of deficiency. A weak but significant relationship was found between vitamin B12 and hemoglobin concentrations. A significant increase in hemoglobin appeared from very low vitamin B12 concentration and up to approx. 400 pg/mL, while hemoglobin did not significantly change from 700 pg/mL and onwards. Vitamin B12 injections were used by 34% of athletes, significantly more often by endurance than by strength athletes. In athletes who declared no use of injections, a higher concentration of vitamin B12 was observed in the endurance group. Conclusion: The main finding of the present study is the determination of the range of vitamin B12 concentration which may favor better hemoglobin synthesis in athletes. They should regularly monitor vitamin B12 concentration and maintain the range of 400–700 pg/mL as it may improve red blood cell parameters. We might suggest application of a supplementation if necessary. Special attention is required in athletes with a vitamin B12 concentration below 400 pg/mL.
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Affiliation(s)
- Jarosław Krzywański
- National Centre for Sports Medicine, Żwirki i Wigury 63A, 02-091 Warsaw, Poland; (J.K.); (H.K.)
| | - Tomasz Mikulski
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Adolfa Pawińskiego 5, 02-106 Warsaw, Poland;
| | - Andrzej Pokrywka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland;
| | - Marcel Młyńczak
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, św. Andrzeja Boboli 8, 02-525 Warsaw, Poland;
| | - Hubert Krysztofiak
- National Centre for Sports Medicine, Żwirki i Wigury 63A, 02-091 Warsaw, Poland; (J.K.); (H.K.)
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Adolfa Pawińskiego 5, 02-106 Warsaw, Poland;
| | - Barbara Frączek
- Department of Sports Medicine and Human Nutrition, Institute of Biomedical Sciences, University of Physical Education in Krakow, al. Jana Pawła II 78, 31-571 Kraków, Poland;
| | - Andrzej Ziemba
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Adolfa Pawińskiego 5, 02-106 Warsaw, Poland;
- Correspondence:
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Cao J, Xu S, Liu C. Is serum vitamin B12 decrease a necessity for the diagnosis of subacute combined degeneration?: A meta-analysis. Medicine (Baltimore) 2020; 99:e19700. [PMID: 32243408 PMCID: PMC7440176 DOI: 10.1097/md.0000000000019700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the prevalence of subacute combined degeneration (SCD) patients with normal or elevated serum vitamin B12 level and to identify clinical characteristics of these patients. METHODS We searched PubMed, EMBASE, and Cochrane library, without language restriction up to June 2019 and included studies with SCD patients who were diagnosed with normal or elevated serum vitamin B12 levels. Meta-analysis was performed to estimate the prevalence of SCD in patients with normal or elevated serum vitamin B12 levels and compare the differences of clinical data between patients with low and no-low serum vitamin B12 level. RESULTS Six studies were included in our analysis, with a total number of 181 patients involved. The pooled proportion in patients with no-low serum vitamin B12 level was 31.0% (95% confidence interval [CI]: 22.5-40.8). There was no significant difference in the level of hemoglobin (Mean difference (MD): -3.05, 95% CI: -12.42 to 6.33. P = 0.52) and erythrocyte mean corpuscular volume (MD: -2.37, 95% CI: -11.17 to 6.43, P = 0.60) between SCD patients with no-low and those with low serum vitamin B12 levels. The meta-analysis showed that the functional disability rating scale on admission in patients with low serum vitamin B12 level was no worse than that with normal or elevated serum vitamin B12 level (MD: 0.29, 95% CI: -0.58 to 1.16, P = 0.51). CONCLUSION Decreased level of serum vitamin B12 may not be a necessity for the diagnosis of SCD. Approximately one third of the SCD patients have normal or elevated serum vitamin B12 level. No differences were found in clinical severity between patients with normal or elevated serum vitamin B12 level and those with low level of serum vitamin B12 on admission.
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Vitamin B12 Status Upon Short-Term Intervention with a Vegan Diet-A Randomized Controlled Trial in Healthy Participants. Nutrients 2019; 11:nu11112815. [PMID: 31752105 PMCID: PMC6893687 DOI: 10.3390/nu11112815] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Vegans are at an increased risk for certain micronutrient deficiencies, foremost of vitamin B12. Little is known about the short-term effects of dietary change to plant-based nutrition on vitamin B12 metabolism. Systemic biomarkers of vitamin B12 status, namely, serum vitamin B12 and holotranscobalamin, may respond quickly to a reduced intake of vitamin B12. To test this hypothesis, 53 healthy omnivore subjects were randomized to a controlled unsupplemented vegan diet (VD, n = 26) or meat-rich diet (MD, n = 27) for 4 weeks. Vitamin B12 status was examined by measurement of serum vitamin B12, holotranscobalamin (holo-TC), methylmalonic acid (MMA) and total plasma homocysteine (tHcy). Holo-TC decreased significantly in the VD compared to the MD group after four weeks of intervention, whereas metabolites MMA and tHcy were unaffected. Body weight remained stable in both groups. VD intervention led to a significant reduction of cholesterol intake, and adequate profiles of nutrient and micronutrient status. Lower intake of vitamin B12 was observed in VD, which was mirrored by a lower concentration of serum vitamin B12 and reduced holo-TC after 4 weeks. Plasma holo-TC may be a fast-responding biomarker to monitor adequate supply of vitamin B12 in plant-based individuals.
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Zemrani B, Bines JE. Monitoring of long-term parenteral nutrition in children with intestinal failure. JGH OPEN 2019; 3:163-172. [PMID: 31061893 PMCID: PMC6487815 DOI: 10.1002/jgh3.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 12/19/2022]
Abstract
Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long-term parenteral nutrition (PN) can occur. Main complications include intestinal failure-associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF-related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long-term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20-year experience at the Royal Children's Hospital in Melbourne Australia on this topic.
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Affiliation(s)
- Boutaina Zemrani
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition The Royal Children's Hospital Melbourne Victoria Australia
| | - Julie E Bines
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition The Royal Children's Hospital Melbourne Victoria Australia.,Murdoch Children's Research Institute Melbourne Victoria Australia
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12
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Denissen KFM, Heil SG, Eussen SJPM, Heeskens JPJ, Thijs C, Mommers M, Smits LJM, van Dongen MCJM, Dagnelie PC. Intakes of Vitamin B-12 from Dairy Food, Meat, and Fish and Shellfish Are Independently and Positively Associated with Vitamin B-12 Biomarker Status in Pregnant Dutch Women. J Nutr 2019; 149:131-138. [PMID: 30544236 DOI: 10.1093/jn/nxy233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background The effect of vitamin B-12 from different animal foods on vitamin B-12 biomarker status has not previously been evaluated in pregnant women. Objective We examined the association of vitamin B-12 intake from dairy, meat, fish (including shellfish), and eggs with circulating concentrations of vitamin B-12 biomarkers and with the presence of vitamin B-12 deficiency in 1266 pregnant women participating in the KOALA Birth Cohort Study. Methods Blood samples were collected in weeks 34-36 of pregnancy, and vitamin B-12 intake from foods and supplements was estimated with a semiquantitative food-frequency questionnaire (FFQ). Total vitamin B-12, holotranscobalamin (holoTC), and methylmalonic acid (MMA) were determined in plasma. Vitamin B-12 deficiency was defined as holoTC <35 pmol/L and MMA >0.45 μmol/L. Associations were evaluated with linear and logistic regression analyses, adjusting for potential confounders. Results Significant dose-response relations were observed between vitamin B-12 intake from dairy, meat, and fish and plasma vitamin B-12, holoTC, and MMA [P-trend for (shell)fish with MMA = 0.002; P-trend for dairy, meat, and fish with all other markers < 0.001]. The OR (95% CI) of vitamin B-12 deficiency in the third compared with the first tertile of dairy-derived vitamin B-12 was 0.13 (0.04, 0.49), and the ORs for vitamin B-12 from meat and fish were 0.33 (0.11, 0.97) and 0.25 (0.08, 0.82), respectively. Egg-derived vitamin B-12 was only associated with holoTC. Additional analyses showed that self-defined vegetarians and FFQ-defined lacto-ovo-vegetarians had lower median total dietary vitamin B-12 intake and considerably worse vitamin B-12 biomarker status than omnivores and pescatarians. Conclusions In pregnant Dutch women, higher intakes of vitamin B-12 from dairy, meat, and fish were positively associated with vitamin B-12 status, suggesting that dairy, meat, and fish are good sources of bioactive vitamin B-12 in pregnancy. Nevertheless, for (lacto-)vegetarians, vitamin B-12 supplementation is recommended.
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Affiliation(s)
- Karlijn F M Denissen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center, PO Box 2040, 3015 CN Rotterdam, Netherlands
| | - Simone J P M Eussen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Jim P J Heeskens
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Carel Thijs
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Monique Mommers
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Luc J M Smits
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Martien C J M van Dongen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Pieter C Dagnelie
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,DepartmentInternal Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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13
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Gröber U, Schmidt J, Kisters K. Important drug-micronutrient interactions: A selection for clinical practice. Crit Rev Food Sci Nutr 2018; 60:257-275. [PMID: 30580552 DOI: 10.1080/10408398.2018.1522613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical world in the past. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such interactions - depending on the duration of treatment and the status of micronutrients - impact the health of the patient and the action of the drugs, physicians and pharmacists should pay more attention to such interactions in the future. This review aims to sensitize physicians and pharmacists on drug micronutrient interactions with selected examples of widely pescribed drugs that can precipitate micronutrient deficiencies. In this context, the pharmacist, as a drug expert, assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task. The following article intends to point out the relevance of mutual interactions between micronutrients and various examples of widely used drugs, without claiming to be exhaustive.
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Affiliation(s)
- Uwe Gröber
- Academy of Micronutrient Medicine, Essen, Germany
| | | | - Klaus Kisters
- Academy of Micronutrient Medicine, Essen, Germany.,Medizinische Klinik I, St. Anna Hospital, Herne, Germany
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14
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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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15
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Velkova A, Diaz JEL, Pangilinan F, Molloy AM, Mills JL, Shane B, Sanchez E, Cunningham C, McNulty H, Cropp CD, Bailey-Wilson JE, Wilson AF, Brody LC. The FUT2 secretor variant p.Trp154Ter influences serum vitamin B12 concentration via holo-haptocorrin, but not holo-transcobalamin, and is associated with haptocorrin glycosylation. Hum Mol Genet 2017; 26:4975-4988. [PMID: 29040465 PMCID: PMC5886113 DOI: 10.1093/hmg/ddx369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/14/2022] Open
Abstract
Vitamin B12 deficiency is common in older individuals. Circulating vitamin B12 concentration can be used to diagnose deficiency, but this test has substantial false positive and false negative rates. We conducted genome-wide association studies (GWAS) in which we resolved total serum vitamin B12 into the fractions bound to transcobalamin and haptocorrin: two carrier proteins with very different biological properties. We replicated reported associations between total circulating vitamin B12 concentrations and a common null variant in FUT2. This allele determines the secretor phenotype in which blood group antigens are found in non-blood body fluids. Vitamin B12 bound to haptocorrin (holoHC) remained highly associated with FUT2 rs601338 (p.Trp154Ter). Transcobalamin bound vitamin B12 (holoTC) was not influenced by this variant. HoloTC is the bioactive the form of the vitamin and is taken up by all tissues. In contrast, holoHC is only taken up by the liver. Using holoHC from individuals with known FUT2 genotypes, we demonstrated that FUT2 rs601338 genotype influences the glycosylation of haptocorrin. We then developed an experimental model demonstrating that holoHC is transported into cultured hepatic cells (HepG2) via the asialoglycoprotein receptor (ASGR). Our data challenge current published hypotheses on the influence of genetic variation on this clinically important measure and are consistent with a model in which FUT2 rs601338 influences holoHC by altering haptocorrin glycosylation, whereas B12 bound to non-glycosylated transcobalamin (i.e. holoTC) is not affected. Our findings explain some of the observed disparity between use of total B12 or holoTC as first-line clinical tests of vitamin B12 status.
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Affiliation(s)
- Aneliya Velkova
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Jennifer E L Diaz
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Faith Pangilinan
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Anne M Molloy
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - James L Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver NICHD, Bethesda, MD 20852, USA
| | - Barry Shane
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Erica Sanchez
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | | | - Helene McNulty
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland
| | - Cheryl D Cropp
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, Bethesda, MD 21224, USA
| | - Joan E Bailey-Wilson
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, Bethesda, MD 21224, USA
| | - Alexander F Wilson
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, Bethesda, MD 21224, USA
| | - Lawrence C Brody
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
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16
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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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17
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Roessler FC, Wolff S. Rapid healing of a patient with dramatic subacute combined degeneration of spinal cord: a case report. BMC Res Notes 2017; 10:18. [PMID: 28057043 PMCID: PMC5216536 DOI: 10.1186/s13104-016-2344-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023] Open
Abstract
Background Prevalence of cobalamin deficiency is high especially in older patients and an immediate therapy start is necessary to prevent irreversible neurological damages. Unfortunately, the diagnosis of cobalamin deficiency is difficult and at present, there is no consensus for diagnosis of this deficiency. Therefore, we aim to elucidate a meaningful diagnostic pathway by a case report with an initially misleading medical history. Case presentation A 57 year-old Caucasian man suffering from dramatic myelosis of the cervical posterior columns. Apart from associated neurological symptoms (tactile hypaesthesia, reduced vibration sensation, loss of stereognosis and of two-point-discrimination) there were no further complaints; especially no gastrointestinal, haematological or psychiatric disorders were provable. Cobalamin (vitamin B12) serum level was normal. The diagnosis of subacute combined degeneration of spinal cord was confirmed by an elevated methylmalonic acid, and hyperhomocysteinemia. Cobalamin deficiency was caused by asymptomatic chronic atrophic inflammation of the stomach with a lack of intrinsic factor producing gland cells. This was revealed by increased gastrin and parietal cell antibodies and finally confirmed by gastroscopy. Parenteral substitution of cobalamin rapidly initiated regeneration. Conclusions This case demonstrates that normal cobalamin serum levels do not rule out a cobalamin deficiency. In contrast, path-breaking results can be achieved by determining homocysteine, holotranscobalamin, and methylmalonic acid.
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Affiliation(s)
- Florian C Roessler
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstraße 33, 35385, Gießen, Germany. .,Klinik und Poliklinik für Neurologie, Universitätsklinikum Standort Gießen, Klinikstraße 33, 35385, Gießen, Germany.
| | - Stephanie Wolff
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstraße 33, 35385, Gießen, Germany
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18
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Rizzo G, Laganà AS, Rapisarda AMC, La Ferrera GMG, Buscema M, Rossetti P, Nigro A, Muscia V, Valenti G, Sapia F, Sarpietro G, Zigarelli M, Vitale SG. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients 2016; 8:E767. [PMID: 27916823 PMCID: PMC5188422 DOI: 10.3390/nu8120767] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023] Open
Abstract
Cobalamin is an essential molecule for humans. It acts as a cofactor in one-carbon transfers through methylation and molecular rearrangement. These functions take place in fatty acid, amino acid and nucleic acid metabolic pathways. The deficiency of vitamin B12 is clinically manifested in the blood and nervous system where the cobalamin plays a key role in cell replication and in fatty acid metabolism. Hypovitaminosis arises from inadequate absorption, from genetic defects that alter transport through the body, or from inadequate intake as a result of diet. With the growing adoption of vegetarian eating styles in Western countries, there is growing focus on whether diets that exclude animal foods are adequate. Since food availability in these countries is not a problem, and therefore plant foods are sufficiently adequate, the most delicate issue remains the contribution of cobalamin, which is poorly represented in plants. In this review, we will discuss the status of vitamin B12 among vegetarians, the diagnostic markers for the detection of cobalamin deficiency and appropriate sources for sufficient intake, through the description of the features and functions of vitamin B12 and its absorption mechanism.
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Affiliation(s)
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, "G. Barresi", University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Gioacchina Maria Grazia La Ferrera
- Department of Gastroenterology and Digestive Endoscopy Maddalena Raimondi San Cataldo, Via Forlanini 5, San Cataldo, Caltanissetta 93017, Italy.
| | - Massimo Buscema
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Angela Nigro
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Vincenzo Muscia
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Micol Zigarelli
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, "G. Barresi", University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
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19
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Golding PH. Holotranscobalamin (HoloTC, Active-B12) and Herbert's model for the development of vitamin B12 deficiency: a review and alternative hypothesis. SPRINGERPLUS 2016; 5:668. [PMID: 27350907 PMCID: PMC4899389 DOI: 10.1186/s40064-016-2252-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/29/2016] [Indexed: 02/07/2023]
Abstract
The concentration of total vitamin B12 in serum is not a sufficiently sensitive or specific indicator for the reliable diagnosis of vitamin B12 deficiency. Victor Herbert proposed a model for the staged development of vitamin B12 deficiency, in which holotranscobalamin (HoloTC) is the first indicator of deficiency. Based on this model, a commercial immunoassay has been controversially promoted as a replacement for the total vitamin B12 test. HoloTC is cobalamin (vitamin B12) attached to the transport protein transcobalamin, in the serum, for delivery to cells for metabolism. Although there have been many published reports supporting the claims for HoloTC, the results of some studies were inconsistent with the claim of HoloTC as the most sensitive marker of vitamin B12 deficiency. This review examines the evidence for and against the use of HoloTC, and concludes that the HoloTC immunoassay cannot be used to measure vitamin B12 status any more reliably than total vitamin B12, or to predict the onset of a metabolic deficiency, because it is based on an erroneous hypothesis and a flawed model for the staged development of vitamin B12 deficiency. The author proposes an alternative model for the development of vitamin B12 deficiency.
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20
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Harrington DJ. Laboratory assessment of vitamin B12 status. J Clin Pathol 2016; 70:168-173. [PMID: 27169753 DOI: 10.1136/jclinpath-2015-203502] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
The detection and correction of vitamin B12 (B12) deficiency prevents megaloblastic anaemia and potentially irreversible neuropathy and neuropsychiatric changes. B12 status is commonly estimated using the abundance of the vitamin in serum, with ∼148 pmol/L (200 ng/L) typically set as the threshold for diagnosing deficiency. Serum B12 assays measure the sum of haptocorrin-bound and transcobalamin-bound (known as holotranscobalamin) B12 It is only holotranscobalamin that is taken up by cells to meet metabolic demand. Although receiver operator characteristic curves show holotranscobalamin measurement to be a moderately more reliable marker of B12 status than serum B12, both assays have an indeterminate range. Biochemical evidence of metabolic abnormalities consistent with B12 insufficiency is frequently detected despite an apparently sufficient abundance of the vitamin. Laboratory B12 status markers that reflect cellular utilisation rather than abundance are available. Two forms of B12 act as coenzymes for two different reactions. Methionine synthase requires methylcobalamin for the remethylation of methionine from homocysteine. A homocysteine concentration >20 µmol/L may suggest B12 deficiency in folate-replete patients. In the second B12-dependent reaction, methylmalonyl-CoA mutase uses adenosylcobalamin to convert methylmalonyl-CoA to succinyl-CoA. In B12 deficiency excess methylmalonyl-CoA is hydrolysed to methylmalonic acid. A serum concentration >280 nmol/L may suggest suboptimal status in young patients with normal renal function. No single laboratory marker is suitable for the assessment of B12 status in all patients. Sequential assay selection algorithms or the combination of multiple markers into a single diagnostic indicator are both approaches that can be used to mitigate inherent limitations of each marker when used independently.
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Affiliation(s)
- Dominic J Harrington
- The Nutristasis Unit, St Thomas' Hospital NHS Foundation Trust, London, UK.,Division of Women's Health, School of Medicine, King's College London, London, UK
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21
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Molloy A, Pangilinan F, Mills J, Shane B, O’Neill M, McGaughey D, Velkova A, Abaan H, Ueland P, McNulty H, Ward M, Strain J, Cunningham C, Casey M, Cropp C, Kim Y, Bailey-Wilson J, Wilson A, Brody L. A Common Polymorphism in HIBCH Influences Methylmalonic Acid Concentrations in Blood Independently of Cobalamin. Am J Hum Genet 2016; 98:869-882. [PMID: 27132595 DOI: 10.1016/j.ajhg.2016.03.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/08/2016] [Indexed: 12/20/2022] Open
Abstract
Methylmalonic acid (MMA) is a by-product of propionic acid metabolism through the vitamin B12 (cobalamin)-dependent enzyme methylmalonyl CoA mutase. Elevated MMA concentrations are a hallmark of several inborn errors of metabolism and indicators of cobalamin deficiency in older persons. In a genome-wide analysis of 2,210 healthy young Irish adults (median age 22 years) we identified a strong association of plasma MMA with SNPs in 3-hydroxyisobutyryl-CoA hydrolase (HIBCH, p = 8.42 × 10(-89)) and acyl-CoA synthetase family member 3 (ACSF3, p = 3.48 × 10(-19)). These loci accounted for 12% of the variance in MMA concentration. The most strongly associated SNP (HIBCH rs291466; c:2T>C) causes a missense change of the initiator methionine codon (minor-allele frequency = 0.43) to threonine. Surprisingly, the resulting variant, p.Met1?, is associated with increased expression of HIBCH mRNA and encoded protein. These homozygotes had, on average, 46% higher MMA concentrations than methionine-encoding homozygotes in young adults with generally low MMA concentrations (0.17 [0.14-0.21] μmol/L; median [25(th)-75(th) quartile]). The association between MMA levels and HIBCH rs291466 was highly significant in a replication cohort of 1,481 older individuals (median age 79 years) with elevated plasma MMA concentrations (0.34 [0.24-0.51] μmol/L; p = 4.0 × 10(-26)). In a longitudinal study of 185 pregnant women and their newborns, the association of this SNP remained significant across the gestational trimesters and in newborns. HIBCH is unique to valine catabolism. Studies evaluating flux through the valine catabolic pathway in humans should account for these variants. Furthermore, this SNP could help resolve equivocal clinical tests where plasma MMA values have been used to diagnose cobalamin deficiency.
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Sobczyńska-Malefora A, Pangilinan F, Plant GT, Velkova A, Harrington DJ, Molloy AM, Brody LC. Association of a transcobalamin II genetic variant with falsely low results for the holotranscobalamin immunoassay. Eur J Clin Invest 2016; 46:434-9. [PMID: 26951924 DOI: 10.1111/eci.12617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical use of holotranscobalamin (holoTC) testing to evaluate vitamin B12 status has increased in recent years. We present two patients (African Caribbean and Indian heritage), in which the holoTC assay indicated severe B12 deficiency (< 5 pmol/L). Additional clinical tests revealed that these patients had normal levels of total vitamin B12 in blood and unremarkable levels of two other markers of vitamin B12 status, homocysteine and methylmalonic acid. We hypothesized that these patients carry a variant in the transcobalamin gene (TCN2) that influences the most widely commercially available holoTC test - Active-B12 (Axis-Shield Diagnostics Ltd). DESIGN Exon sequencing of the TCN2 gene was carried out. Protein characterization included total transcobalamin (TCN2) detection by Western blot, and holoTC by (57) Co-labelled B12 binding followed by size fractionation. RESULTS Exon sequencing of TCN2 revealed both patients were homozygous for the minor allele of rs35838082 (p.R215W). Western blot and chromatographic analyses revealed that the serum of these patients contains intact transcobalamin and that this variant-containing protein binds vitamin B12 . The variant is rare in Caucasians (minor allele frequency (MAF) < 0·01) but more common in South Asians (MAF ~ 0·02) and those of African origin (MAF ~ 0·25). CONCLUSIONS The impeded ability to detect normal levels of holoTC in these two patients may be due to this variant interfering with the detection of holoTC by one or both of the monoclonal antibodies currently employed in the Active-B12 test. Laboratories should be aware of this variant and use confirmatory tests when applicable.
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Affiliation(s)
| | - Faith Pangilinan
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Gordon T Plant
- Medical Eye Unit, Guy's and St. Thomas' NHS Foundation Trust, Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Aneliya Velkova
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lawrence C Brody
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
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Upadhyay TR, Kothari N, Shah H. Association Between Serum B12 and Serum Homocysteine Levels in Diabetic Patients on Metformin. J Clin Diagn Res 2016; 10:BC01-4. [PMID: 27190787 DOI: 10.7860/jcdr/2016/17604.7518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/08/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Type-2 Diabetes Mellitus (T2DM) and metformin both can lower serum B12 (s.B12). Raised serum Homocysteine (s.Hcy) is considered as an early marker of B12 deficiency. AIM The study aimed to check whether homocysteine levels are more sensitive indicator of s. B12 deficiency or not among diabetics using metformin. MATERIALS AND METHODS Mean s.B12 and s.Hcy levels of 30 cases (diabetics on metformin <5years) were compared with 30 diabetic controls not on metformin and 31 nondiabetic controls and statistically analysed by ANOVA and post-hoc tests. RESULTS No significant differences in either s.B12 mean or s.Hcy mean were found between cases and diabetic controls. s.B12 mean did not differ significantly but s.Hcy mean was significantly higher among nondiabetics as compared to diabetic control. s. B12 level of Nondiabetic group was in borderline category while mean s. B12 levels of cases and diabetic control groups was in normal category but nearer to the lower cut off. Mean s.Hcy values in all the groups were high. Pearson correlation showed strong association between s.B12 and s.Hcy in all the groups. Additionally equation based on linear regression was derived to calculate either of the s.B12 or s.Hcy. On Receiver Operative Characteristic (ROC) curve, area under curve value was 0.842 for the value of s.Hcy. CONCLUSION In this study neither metformin nor T2DM could be identified as a cause for s.B12 lowering and raised s.Hcy in the scenario of low normal levels of s.B12 (<300pmol/L). If B12 deficiency recognized early using s. Hcy, consequences due to B12 deficiency can be prevented or delayed among nondiabetics as well as among diabetics and metformin users.
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Affiliation(s)
- Twinkal R Upadhyay
- Resident, Department of Biochemistry, H.M. Patel Centre for Medical Care and Education, Pamukh Swami Medical College and Shree Krishna Hospital , Karamsad, Gujarat, India
| | - Nitin Kothari
- Assistant Professor, Department of Pharmacology, Pacific Medical College and Hospital , Udaipur, Rajasthan, India
| | - Hitesh Shah
- Professor, Department of Biochemistry, H.M. Patel Centre for Medical Care and Education, Pamukh Swami Medical College and Shree Krishna Hospital , Karamsad, Gujarat, India
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Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians? Am J Prev Med 2015; 48:e11-26. [PMID: 25998928 DOI: 10.1016/j.amepre.2015.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/17/2022]
Abstract
The goal of this paper is to describe the role of vitamin B12 deficiency in cardiovascular disease development among vegetarians. Vegetarians have a high prevalence of vitamin B12 deficiency. Deficiency of this vitamin is associated with a variety of atherogenic processes that are mainly, but not exclusively, due to vitamin B12 deficiency-induced hyperhomocysteinemia. Each 5-μmol/L increase above 10 μmol/L of serum homocysteine is associated with a 20% increased risk of circulatory health problems. Mean homocysteine concentration >10 μmol/L among vegetarians was reported in 32 of 34 reports. Macrocytosis associated with vitamin B12 deficiency is also associated with fatal and non-fatal coronary disease, myocardial infarction, stroke, and other circulatory health problems. Compared with non-vegetarians, vegetarians have an improved profile of the traditional cardiovascular disease risk factors, including serum lipids, blood pressure, serum glucose concentration, and weight status. However, not all studies that assessed cardiovascular disease incidence among vegetarians reported a protective effect. Among studies that did show a lower prevalence of circulatory health problems, the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. In order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.
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Affiliation(s)
- Roman Pawlak
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina.
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Obeid R, Geisel J, Herrmann W. Comparison of two methods for measuring methylmalonic acid as a marker for vitamin B12 deficiency. ACTA ACUST UNITED AC 2015. [PMID: 29540015 DOI: 10.1515/dx-2014-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Methylmalonic acid (MMA) is a functional marker of vitamin B12 status and a valuable diagnostic tool. The gas chromatography mass spectrometry (GCMS) MMA assay has been used for decades in clinical studies. METHODS In this study, we compared a newly developed liquid chromatography tandem mass spectrometry assay for MMA (ClinMass® Complete Kit) with the GCMS method and further measured other relevant vitamin B12 markers (homocysteine, total B12 and holotranscobalamin) to validate the new liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. For this purpose, 138 samples that were sent to our routine laboratory total B12 assay were used. RESULTS The GCMS and LC-MS/MS assays showed a strong correlation (r=0.92, p<0.001) particularly at low holoTC levels (deficiency is more probable). Forty six cases had MMA>300 nmol/L with both methods. Only five subjects showed MMA GCMS>300 nmol/L, but MMA LC-MS/MS≤300 nmol/L. However, the LC-MS/MS method showed a slightly better correlation with other B12 markers (holoTC, total B12). In addition, the LC-MS/MS method offers several advantages over the GCMS method, such as saving time and costs, precision, flexibility and popularity in modern labs. CONCLUSIONS The new LC-MS/MS assay for MMA showed an excellent correlation to the GCMS method. The two methods showed similar agreements with other vitamin B12 markers.
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Affiliation(s)
- Rima Obeid
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany2Aarhus Institute of Advanced Studies, University of Aarhus, 8000 Aarhus C, Denmark
| | - Jürgen Geisel
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany
| | - Wolfgang Herrmann
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany
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26
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Results of a pilot study to provide evidence on the efficacy of vitamin B12 to normalise elevated homocysteine of vegetarians. Proc Nutr Soc 2015. [DOI: 10.1017/s0029665115004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dang S, Yan H, Zeng L, Wang Q, Li Q, Xiao S, Fan X. The status of vitamin B12 and folate among Chinese women: a population-based cross-sectional study in northwest China. PLoS One 2014; 9:e112586. [PMID: 25390898 PMCID: PMC4229226 DOI: 10.1371/journal.pone.0112586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/08/2014] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the status of the vitamin B12 and folate of Chinese women living in northwest China. Methods A population-based cross-sectional study was conducted in 2008 among Chinese women aged 10–49 years living in Shaanxi province of northwest China. A stratified multistage random sampling method was adopted to obtain a sample of 1170 women. The women were interviewed for collection of their background information and their plasma vitamin B12 and folate were measured with the immunoassay method. The status of both vitamins was evaluated and the prevalence of deficiency was estimated. Results The median value of the women was 214.5 pg/mL for vitamin B12 and 4.6 ng/mL for folate. The urban women had a significantly higher vitamin B12 (254.1 vs. 195.9 pg/mL) but lower folate (4.4 vs. 4.7 ng/mL) than rural women. Total prevalence of deficiency was 45.5% (95% CI: 42.6%∼48.4%) for vitamin B12 and 14.7% (95% CI: 12.6%∼16.8%) for folate. About 36% of women presented vitamin B12 deficiency alone, 5.2% belonged to folate deficiency alone and 9.5% was combined deficiency in both vitamins. More than 25% of the women were in marginal vitamin B12 status (200–299 pg/mL) and 60% in marginal status of folate (3–6 ng/mL). About 75.2% of rural women with folate deficiency were deficient in vitamin B12 and 46% for urban women. Quantile regression model found decreasing coefficient of folate status across 73 different quantiles of vitamin B12, which indicated that the women with folate deficiency had lower vitamin B12 significantly compared with those with no deficiency. Conclusions The deficiency of vitamin B12 and folate is still prevalent among the Chinese women in northwest China. Vitamin B12 deficiency could be more serious and the improvement of poor vitamin B12 status should be invoked when practicing the supplementation of folate against the neural tube defects in northwest China.
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Affiliation(s)
- Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
- * E-mail:
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Quanli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Qiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Shengbin Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Xiaojing Fan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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Mearns GJ, Koziol-McLain J, Obolonkin V, Rush EC. Preventing vitamin B12 deficiency in South Asian women of childbearing age: a randomised controlled trial comparing an oral vitamin B12 supplement with B12 dietary advice. Eur J Clin Nutr 2014; 68:870-5. [PMID: 24736677 DOI: 10.1038/ejcn.2014.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/20/2014] [Accepted: 02/28/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the effectiveness, acceptability and sustainability of interventions to reduce vitamin B12 (B12) deficiency in South Asian women before conception. SUBJECTS/METHODS A 6-month randomised controlled trial conducted in Auckland, New Zealand. Participants (62 South Asian women, 18-50 years old) were stratified by dietary practices, then randomised to three treatment groups: B12 Supplement (oral cyanocobalamin 6 μg/day) (n=21), Placebo (n=21), or B12 Dietary Advice (n=20). Primary outcome measures were changes in B12 biomarkers (serum B12 and holotranscobalamin (holoTC)) at 6 months. Dietary B12 intake was estimated from a B12 food-specific frequency questionnaire (B12FFQ). Intention-to-treat analysis was applied using 'last observation carried forward' method. Changes in B12 biomarkers by treatment were compared using analysis of variance. Pearson's correlations tested relationships between dietary B12 intake and B12 biomarkers. RESULTS At baseline, 48% of women tested as insufficient or deficient in serum B12 (<222 pmol/l) and 51% as insufficient or deficient in holoTC (<45 pmol/l). B12 status was moderately correlated with dietary B12 intake (r=0.5, 95% confidence interval (CI) (0.3-0.7)) and 44% of women reported insufficient dietary intake (<2.4 μg/day). B12 Supplement was the only treatment group to record a significant increase in B12 biomarkers over 6 months: serum B12 by 30% (95% CI (11-48%)) and holoTC by 42% (12-72%). CONCLUSIONS The prevalence of B12 insufficiency among Auckland South Asian women is high and moderately correlated with inadequate intake of foods that contain B12. Cyanocobalamin supplementation (6 μg/day) was associated with improved B12 biomarkers, with a potential to improve preconception B12 status in South Asian women.
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Affiliation(s)
- G J Mearns
- School of Health Care Practice, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - J Koziol-McLain
- Interdisciplinary Trauma Research Centre, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - V Obolonkin
- Centre for Child Health Research, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - E C Rush
- Centre for Child Health Research, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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29
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Koenig V, Stanga Z, Zerlauth M, Bernasconi L, Risch M, Huber A, Risch L. Prevalence of vitamin B(12) depletion and deficiency in Liechtenstein. Public Health Nutr 2014; 17:241-7. [PMID: 23237337 PMCID: PMC10282312 DOI: 10.1017/s1368980012005289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Data about vitamin B(12) (B(12)) deficiency in the general population are scarce. The present study was performed to determine the prevalence of B(12) deficiency in the general population of the Principality of Liechtenstein, as well as to identify sub-populations potentially at high risk. DESIGN Retrospective study. SETTING Ambulatory setting, population of the Principality of Liechtenstein. SUBJECTS Seven thousand four hundred and twenty-four patients seeking medical attention whose serum samples were referred for routine work-up in an ambulatory setting were consecutively enrolled. Serum total B(12) was determined in all patients in this cohort. In addition, for a subgroup of 1328 patients, serum holotranscobalamin was also measured. Prevalence of B(12) deficiency was calculated. Further, multivariate logistical regression models were applied to identify covariates independently associated with B(12) deficiency and depletion. RESULTS Nearly 8% of the general population was suffering from either B(12) depletion or deficiency. The ratio between B(12) depletion and deficiency was 2:1 for all age ranges. Pathological changes were detected predominantly in older people. Female gender was a significant predictor of B(12) depletion. In the cohort, nearly 40% exhibited either depletion or deficiency of B(12). CONCLUSIONS B(12) depletion and deficiency are common in Liechtenstein, a Central European country. The measurement of biochemical markers represents a cost-efficient and valid assessment of the B(12) state. When a deficiency of B(12) is diagnosed at an early stage, many cases can be treated or prevented, with beneficial effects on individual outcomes and subsequent potential reductions in health-care costs.
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Affiliation(s)
- Victoria Koenig
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
| | - Zeno Stanga
- Division of Endocrinology, Diabetes and Clinical Nutrition and Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Manfred Zerlauth
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
| | - Luca Bernasconi
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
- LMZ Risch Laboratories, Pregassona, Switzerland
| | - Martin Risch
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
| | - Andreas Huber
- Center of Laboratory Medicine, Kantonsspital Aarau, Switzerland
| | - Lorenz Risch
- LMZ Risch Laboratories, Labormedizinisches Zentrum Dr Risch, Landstrasse 157, 9494 Schaan, Liechtenstein
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Killen JP, Brenninger VL. Hydroxocobalamin supplementation and erythropoisis stimulating agent hyporesponsiveness in haemodialysis patients. Nephrology (Carlton) 2014; 19:164-71. [PMID: 24422907 DOI: 10.1111/nep.12205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term haemodialysis patients may be at risk of hydrosoluble vitamin deficiencies. This study aimed to test the hypothesis that in patients with serum B12 < 300 pmol/L, intramuscular hydroxocobalamin reduces erythropoietin requirements whilst maintaining haemoglobin concentrations (Hb). METHODS Study design was prospective, non-randomized, open label, with single group assignment. In 61 patients hydroxocobalamin 1000 μg was given weekly for 3 weeks and erythropoietin dose adjusted to target a Hb of 11-12 g/L. The primary outcome was the change in erythropoietin requirements at 2 years. Secondary outcomes included assessment of change in biochemical or clinical parameters. RESULTS The erythropoietin dose reduced from 11 000 ± 7000 (10 000) IU to 5000 ± 6000 (3000) IU per week (P < 0.001) with no change in Hb 116 ± 16 (117) g/L before and after 114 ± 15 (113) g/L (P = 0.488) hydroxocobalamin supplementation. Serum albumin rose from 35 ± 4 (35) g/L to 36 ± 4 (36) g/L (P = 0.03). A significant rise in red cell folate (RCF) and serum vitamin B12 levels was observed. Serum ferritin rose despite a reduction in intravenous iron usage and no significant change in c-reactive protein or transferrin saturation. CONCLUSIONS In HD patients with B12 < 300 pmol/L, following treatment with hydroxocobalamin there was reduced erythropoietin requirements, maintained Hb and a small but significant rise in the serum albumin. RCF may be low in haemodialysis patients with metabolic cobalamin deficiency and rises significantly after supplementation. Hydroxocobalamin supplementation may have the potential to reduce the cost of anaemia management.
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Affiliation(s)
- John P Killen
- Department of Renal Medicine, Cairns Hospital, North Cairns, Queensland, Australia
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An audit of holotranscobalamin (“Active” B12) and methylmalonic acid assays for the assessment of vitamin B12 status: Application in a mixed patient population. Clin Biochem 2014; 47:82-6. [DOI: 10.1016/j.clinbiochem.2013.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 08/08/2013] [Accepted: 08/11/2013] [Indexed: 11/18/2022]
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Gröber U, Kisters K, Schmidt J. Neuroenhancement with vitamin B12-underestimated neurological significance. Nutrients 2013; 5:5031-45. [PMID: 24352086 PMCID: PMC3875920 DOI: 10.3390/nu5125031] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/20/2013] [Accepted: 11/29/2013] [Indexed: 12/23/2022] Open
Abstract
Vitamin B12 is a cofactor of methionine synthase in the synthesis of methionine, the precursor of the universal methyl donor S-Adenosylmethionine (SAMe), which is involved in different epigenomic regulatory mechanisms and especially in brain development. A Vitamin B12 deficiency expresses itself by a wide variety of neurological manifestations such as paraesthesias, skin numbness, coordination disorders and reduced nerve conduction velocity. In elderly people, a latent Vitamin B12 deficiency can be associated with a progressive brain atrophy. Moderately elevated concentrations of homocysteine (>10 µmol/L) have been associated with an increased risk of dementia, notably Alzheimer's disease, in many cross-sectional and prospective studies. Raised plasma concentrations of homocysteine is also associated with both regional and whole brain atrophy, not only in Alzheimer's disease but also in healthy elderly people. Clinician awareness should be raised to accurately diagnose and treat early Vitamin B12 deficiency to prevent irreversible structural brain damage.
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Affiliation(s)
- Uwe Gröber
- Academy of Micronutrient Medicine, Zweigertstr. 55, Essen 45130, Germany; E-Mails: (K.K.); (J.S.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-201-8742984
| | - Klaus Kisters
- Academy of Micronutrient Medicine, Zweigertstr. 55, Essen 45130, Germany; E-Mails: (K.K.); (J.S.)
- St. Anna Hospital, Hospitalstr. 19, Herne 44649, Germany
| | - Joachim Schmidt
- Academy of Micronutrient Medicine, Zweigertstr. 55, Essen 45130, Germany; E-Mails: (K.K.); (J.S.)
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Vitamin B12: one carbon metabolism, fetal growth and programming for chronic disease. Eur J Clin Nutr 2013; 68:2-7. [PMID: 24219896 DOI: 10.1038/ejcn.2013.232] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022]
Abstract
This review brings together human and animal studies and reviews that examine the possible role of maternal vitamin B12 (B12) on fetal growth and its programming for susceptibility to chronic disease. A selective literature review was undertaken to identify studies and reviews that investigate these issues, particularly in the context of a vegetarian diet that may be low in B12 and protein and high in carbohydrate. Evidence is accumulating that maternal B12 status influences fetal growth and development. Low maternal vitamin B12 status and protein intake are associated with increased risk of neural tube defect, low lean mass and excess adiposity, increased insulin resistance, impaired neurodevelopment and altered risk of cancer in the offspring. Vitamin B12 is a key nutrient associated with one carbon metabolic pathways related to substrate metabolism, synthesis and stability of nucleic acids and methylation of DNA which regulates gene expression. Understanding of factors regulating maternal-fetal one carbon metabolism and its role in fetal programming of non communicable diseases could help design effective interventions, starting with maternal nutrition before conception.
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Interactions between plasma concentrations of folate and markers of vitamin B(12) status with cognitive performance in elderly people not exposed to folic acid fortification: the Hordaland Health Study. Br J Nutr 2013; 111:1085-95. [PMID: 24229560 DOI: 10.1017/s000711451300336x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A combination of high folate with low vitamin B12 plasma status has been associated with cognitive impairment in a population exposed to mandatory folic acid fortification. The objective of the present study was to examine the interactions between plasma concentrations of folate and vitamin B12 markers in relation to cognitive performance in Norwegian elderly who were unexposed to mandatory or voluntary folic acid fortification. Cognitive performance was assessed by six cognitive tests in 2203 individuals aged 72-74 years. A combined score was calculated using principal component analysis. The associations of folate concentrations, vitamin B12 markers (total vitamin B12, holotranscobalamin (holoTC) and methylmalonic acid (MMA)) and their interactions in relation to cognitive performance were evaluated by quantile regression and least-squares regression, adjusted for sex, education, apo-ɛ4 genotype, history of CVD/hypertension and creatinine. Cross-sectional analyses revealed an interaction (P= 0·009) between plasma concentrations of folate and vitamin B12 in relation to cognitive performance. Plasma vitamin B12 concentrations in the lowest quartile ( < 274 pmol/l) combined with plasma folate concentrations in the highest quartile (>18·5 nmol/l) were associated with a reduced risk of cognitive impairment compared with plasma concentrations in the middle quartiles of both vitamins (OR 0·22, 95 % CI 0·05, 0·92). The interaction between folate and holoTC or MMA in relation to cognitive performance was not significant. In conclusion, this large study population unexposed to mandatory folic acid fortification showed that plasma folate, but not plasma vitamin B12, was associated with cognitive performance. Among the elderly participants with vitamin B12 concentrations in the lower range, the association between plasma folate and cognitive performance was strongest.
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Daily milk intake improves vitamin B-12 status in young vegetarian Indians: an intervention trial. Nutr J 2013; 12:136. [PMID: 24107225 PMCID: PMC3851996 DOI: 10.1186/1475-2891-12-136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Asymptomatic Indian lacto vegetarians, who make up more than half of the Indian population in different geographic regions, have distinctly low vitamin B-12 concentrations than non- vegetarians. Vegetarians consume milk but it seems that the amount is not enough to improve vitamin B-12 status or vitamin B-12 concentration in milk itself may be low. The aim of this study was to determine if daily milk consumption can improve vitamin B-12 status. Methods Fifteen male and 36 female, young healthy post-graduate volunteers participated. Blood from ten participants (4 males and 6 females) was collected (day-1). They continued their regular diet for next fourteen days and on day-15, blood of all 51 participants was collected, plasma vitamin B-12 concentration was measured and were divided into two groups; Normal (vitamin B-12 >148 pmol/L, n = 22) and Vitamin B-12 deficient (<148 pmol/L, n = 29), the remaining plasma was stored. All participants consumed 600 ml. of non-enriched buffalo milk (200 × 3) during the day along with their usual diet. Next day blood was collected for plasma holotranscobalamin II measurement. Subjects from deficient group continued to drink 400 ml of milk daily for next 14 days and blood was collected on day-30. Plasma holotranscoabalamin II (day-1, 15, 16, 30), vitamin B-12, folate, total homocysteine, creatinine and hematoloical parameters (day-1, 15, 30), and milk vitamin B-12 concentrations (day-15, 16, 30) were measured. Results Fifty seven per cent of the participants were vitamin B-12 deficient and 65% were hyperhomocysteinemic. No significant difference in biomarkers was observed when there was no intervention. Plasma holotranscobalamin II concentration increased from 19.6 to 22.27 pmol/L (p < 0.0001) 24 hrs after milk load in the whole group. Plasma vitamin B-12 increased from 92.5 to 122 pmol/L and tHcy concentrations decreased from 31.9 to 24.9 μ mol/L (p < 0.0001 for both) 14 days after regular milk intake in vitamin B-12 deficient subjects. Conclusions Regular intake of milk improved vitamin B-12 status of vitamin B-12 deficient vegetarians indicating a potential dietary strategy to improve the vitamin status.
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Arendt JFB, Nexo E. Unexpected high plasma cobalamin : proposal for a diagnostic strategy. Clin Chem Lab Med 2013; 51:489-96. [PMID: 23241600 DOI: 10.1515/cclm-2012-0545] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/24/2012] [Indexed: 01/13/2023]
Abstract
It is well-established that more than 8% of patients examined for vitamin B12 deficiency unexpectedly have increased plasma levels of the vitamin, but so far there are no guidelines for the clinical interpretation of such findings. In this review, we summarise known associations between high plasma cobalamin and diseases. We report associations mainly with cancer, liver and kidney diseases, but also with a number of other diagnostic entities. The pathogenic background is poorly understood and is likely to be multi-factorial, involving increased concentrations of one or both of the circulating cobalamin binding proteins, transcobalamin and haptocorrin. Based on current knowledge, we suggest a strategy for the clinical interpretation of unexpected high plasma cobalamin. Since a number of the associated diseases are critical and life-threatening, the strategy promotes the concept of 'think the worst first'. It is important to realise that high cobalamin levels can be an unspecific marker for cancer. If this can be ruled out, diseases of the liver and kidney should be considered.
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Affiliation(s)
- Johan F B Arendt
- Department of Clinical Biochemistry, Aarhus University Hospital, Norrebrogade 44, 8000Aarhus C, Denmark.
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Lewerin C, Nilsson-Ehle H, Jacobsson S, Karlsson MK, Ohlsson C, Mellström D. Holotranscobalamin is not influenced by decreased renal function in elderly men: the MrOS Sweden study. Ann Clin Biochem 2013; 50:585-94. [PMID: 23901143 DOI: 10.1177/0004563212474939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subclinical cobalamin deficiency is common in the elderly, but the sensitivity and specificity of serum total cobalamin for this diagnosis is poor. Serum holotranscobalamin (holoTC), a measure of biologically available cobalamin, is considered a better marker for early cobalamin depletion than total cobalamin. However, in elderly populations, health-related reference intervals for holoTC and correlations to renal function are not entirely clear. METHODS HoloTC was determined with an automated microparticle enzyme immunoassay (AxSYM®) in 790 elderly non-vitamin-supplemented Swedish men, median age 75.3 years. Renal function was assessed with creatinine, cystatin C and estimated glomerular filtration rate (eGFR calculated from creatinine). RESULTS Median holoTC was 51.8 pmol/L, the health-related reference interval 19.6-132.3 pmol/L. There was no significant difference in mean holoTC in probands with normal compared to high creatinine (P = 0.80) and cystatin C (P = 0.82). No significant differences between the quartiles of creatinine or cystatin C in mean of log holoTC were seen. HoloTC correlated strongly with total cobalamin (r = 0.69, P < 0.001), weaker with eGFRcreatinine (r = -0.09, P < 0.05) and creatinine (r = 0.09, P < 0.05), the latter correlation was only seen in subjects with creatinine <100 µmol/L. HoloTC correlated negatively with plasma total homocysteine (r = -0.24, P < 0.001), but not with cystatin C and age. CONCLUSIONS Serum holoTC in healthy elderly men shows the same distribution as earlier described for a younger reference population. In this group of elderly subjects, holoTC did not correlate to reduced renal function. Thus, holoTC appears to be a promising tool for evaluating cobalamin status also in elderly populations.
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Affiliation(s)
- Catharina Lewerin
- Section of Hematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Sweden
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Serum vitamin B12 not reflecting vitamin B12 status in patients with type 2 diabetes. Biochimie 2013; 95:1056-61. [DOI: 10.1016/j.biochi.2012.10.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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Hill MH, Flatley JE, Barker ME, Garner CM, Manning NJ, Olpin SE, Moat SJ, Russell J, Powers HJ. A vitamin B-12 supplement of 500 μg/d for eight weeks does not normalize urinary methylmalonic acid or other biomarkers of vitamin B-12 status in elderly people with moderately poor vitamin B-12 status. J Nutr 2013; 143:142-7. [PMID: 23236022 DOI: 10.3945/jn.112.169193] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Plasma vitamin B-12 is the most commonly used biomarker of vitamin B-12 status, but the predictive value for low vitamin B-12 status is poor. The urinary methylmalonic acid (uMMA) concentration has potential as a functional biomarker of vitamin B-12 status, but the response to supplemental vitamin B-12 is uncertain. A study was conducted to investigate the responsiveness of uMMA to supplemental vitamin B-12 in comparison with other biomarkers of vitamin B-12 status [plasma vitamin B-12, serum holotranscobalamin (holoTC), plasma MMA] in elderly people with moderately poor vitamin B-12 status. A double-blind, placebo-controlled, randomized 8-wk intervention study was carried out using vitamin B-12 supplements (500 μg/d, 100 μg/d, and 10 μg/d cyanocobalamin) in 100 elderly people with a combined plasma vitamin B-12 <250 pmol/L and uMMA ratio (μmol MMA/mmol creatinine) >1.5. All biomarkers had a dose response to supplemental vitamin B-12. Improvements in plasma vitamin B-12 and serum holoTC were achieved at cobalamin supplements of 10 μg/d, but even 500 μg/d for 8 wk did not normalize plasma vitamin B-12 in 8% and serum holoTC in 12% of people. The response in uMMA was comparable with plasma MMA; 15-25% of people still showed evidence of metabolic deficiency after 500 μg/d cobalamin for 8 wk. There was a differential response in urinary and plasma MMA according to smoking behavior; the response was enhanced in ex-smokers compared with never-smokers. uMMA offers an alternative marker of metabolic vitamin-B12 status, obviating the need for blood sampling.
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Affiliation(s)
- Marilyn H Hill
- Human Nutrition Unit, Department of Oncology, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
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Plasma total homocysteine status of vegetarians compared with omnivores: a systematic review and meta-analysis. Br J Nutr 2013; 109:785-94. [DOI: 10.1017/s000711451200520x] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is strong evidence indicating that elevated plasma total homocysteine (tHcy) levels are a major independent biomarker and/or a contributor to chronic conditions, such as CVD. A deficiency of vitamin B12can elevate homocysteine. Vegetarians are a group of the population who are potentially at greater risk of vitamin B12deficiency than omnivores. This is the first systematic review and meta-analysis to appraise a range of studies that compared the homocysteine and vitamin B12levels of vegetarians and omnivores. The search methods employed identified 443 entries, from which, by screening using set inclusion and exclusion criteria, six eligible cohort case studies and eleven cross-sectional studies from 1999 to 2010 were revealed, which compared concentrations of plasma tHcy and serum vitamin B12of omnivores, lactovegetarians or lacto-ovovegetarians and vegans. Of the identified seventeen studies (3230 participants), only two studies reported that vegan concentrations of plasma tHcy and serum vitamin B12did not differ from omnivores. The present study confirmed that an inverse relationship exists between plasma tHcy and serum vitamin B12, from which it can be concluded that the usual dietary source of vitamin B12is animal products and those who choose to omit or restrict these products are destined to become vitamin B12deficient. At present, the available supplement, which is usually used for fortification of food, is the unreliable cyanocobalamin. A well-designed study is needed to investigate a reliable and suitable supplement to normalise the elevated plasma tHcy of a high majority of vegetarians. This would fill the gaps in the present nutritional scientific knowledge.
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Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, Lucus D. How prevalent is vitamin B(12) deficiency among vegetarians? Nutr Rev 2013; 71:110-7. [PMID: 23356638 DOI: 10.1111/nure.12001] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vegetarians are at risk for vitamin B(12) (B12) deficiency due to suboptimal intake. The goal of the present literature review was to assess the rate of B12 depletion and deficiency among vegetarians and vegans. Using a PubMed search to identify relevant publications, 18 articles were found that reported B12 deficiency rates from studies that identified deficiency by measuring methylmalonic acid, holo-transcobalamin II, or both. The deficiency rates reported for specific populations were as follows: 62% among pregnant women, between 25% and almost 86% among children, 21-41% among adolescents, and 11-90% among the elderly. Higher rates of deficiency were reported among vegans compared with vegetarians and among individuals who had adhered to a vegetarian diet since birth compared with those who had adopted such a diet later in life. The main finding of this review is that vegetarians develop B12 depletion or deficiency regardless of demographic characteristics, place of residency, age, or type of vegetarian diet. Vegetarians should thus take preventive measures to ensure adequate intake of this vitamin, including regular consumption of supplements containing B12.
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Affiliation(s)
- Roman Pawlak
- Department of Nutrition Science, East Carolina University, Greenville, NC 27858, USA.
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Spence JD. B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes. Clin Chem Lab Med 2013; 51:633-7. [DOI: 10.1515/cclm-2012-0465] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/27/2012] [Indexed: 01/19/2023]
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Abstract
Cobalamin (Cbl, vitamin B12) consists of a corrinoid structure with cobalt in the centre of the molecule. Neither humans nor animals are able to synthesize this vitamin. Foods of animal source are the only natural source of cobalamin in human diet. There are only two enzymatic reactions in mammalian cells that require cobalamin as cofactor. Methylcobolamin is a cofactor for methionine synthase. The enzyme methylmalonyl-CoA-mutase requires adenosylcobalamin as a cofactor. Therefore, serum concentrations of homocysteine (tHcy) and methylmalonic acid (MMA) will increase in cobalamin deficiency. The cobalamin absorption from diet is a complex process that involves different proteins: haptocorrin, intrinsic factor and transcobalamin (TC). Cobalamin that is bound to TC is called holotranscobalamin (holoTC) which is the metabolically active vitamin B12 fraction. HoloTC consists 6 and 20% of total cobalamin whereas 80% of total serum cobalamin is bound to another binding protein, haptocorrin. Cobalamin deficiency is common worldwide. Cobalamin malabsorption is common in elderly subjects which might explain low vitamin status. Subjects who ingest low amount of cobalamin like vegetarians develop vitamin deficiency. No single parameter can be used to diagnose cobalamin deficiency. Total serum cobalamin is neither sensitive nor it is specific for cobalamin deficiency. This might explain why many deficient subjects would be overlooked by utilizing total cobalamin as status marker. Concentration of holotranscobalamin (holoTC) in serum is an earlier marker that becomes decreased before total serum cobalamin. Concentrations of MMA and tHcy increase in blood of cobalamin deficient subjects. Despite limitations of these markers in patients with renal dysfunction, concentrations of MMA and tHcy are useful functional markers of cobalamin status. The combined use of holoTC and MMA assays may better indicate cobalamin status than either of them. Because Cbl deficiency is a risk factor for neurodegenerative diseases an early diagnosis of a low B12 status is required which should be followed by an effective treatment in order to prevent irreversible damages.
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Affiliation(s)
- Wolfgang Herrmann
- Department of Clinical Chemistry and Laboratory Medicine, University of Saarland, 66421, Homburg, Germany,
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Riedel BM, Molloy AM, Meyer K, Fredriksen A, Ulvik A, Schneede J, Nexø E, Hoff G, Ueland PM. Transcobalamin polymorphism 67A->G, but not 776C->G, affects serum holotranscobalamin in a cohort of healthy middle-aged men and women. J Nutr 2011; 141:1784-90. [PMID: 21865561 DOI: 10.3945/jn.111.141960] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Two polymorphic variants in the gene coding for transcobalamin II (TCN2), TCN2 776C- > G and TCN2 67A- > G, may alter serum holotranscobalamin (holoTC), which in turn may affect cellular uptake of cobalamin (Cbl) and thereby Cbl status indicators. We studied the effects of TCN2 776C- > G and TCN2 67A- > G on blood concentrations of holoTC, Cbl, methylmalonic acid (MMA), and total homocysteine (tHcy) in 2411 individuals (50-64 y) that had been selected on the basis of these TCN2 genotypes from 10601 Norwegian inhabitants. The serum holoTC concentration was lower in TCN2 67AG (55 ± 0.75 pmol/L) and 67GG (48 ± 2.14 pmol/L) than in 67AA (62 ± 0.67 pmol/L) (P < 0.001) but did not differ among TCN2 776C- > G genotypes. The polymorphisms interacted as serum holoTC determinants (P = 0.001) and the presence of TCN2 67AG and GG in strata of 776CC and CG, but not 776GG, increased the risk of having serum holoTC < 45.6 pmol/L [tertile 1 vs. tertiles 2 and 3: OR = 2.5 (95% CI 1.8-3.5) for 67AG; OR = 5.7 (95% CI 3.5-9.1) for 67GG in 776CC; OR = 2.1 (95% CI 1.6-2.9) for 67AG; and OR = 4.5 (95% CI 2.4-8.2) for 67GG in 776CG; all P < 0.001]. Plasma MMA, tHcy, and Cbl were not affected by either polymorphism. In summary, serum holoTC, but not plasma Cbl, MMA, or tHcy, varied according to TCN2 67A- > G genotypes. It remains to be determined whether this polymorphic effect on serum holoTC alters its diagnostic utility as Cbl status indicator.
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Affiliation(s)
- Bettina M Riedel
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
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Obeid R, Shannan B, Herrmann W. Advanced glycation end products overload might explain intracellular cobalamin deficiency in renal dysfunction, diabetes and aging. Med Hypotheses 2011; 77:884-8. [PMID: 21880434 DOI: 10.1016/j.mehy.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
Advanced glycation end products (AGEs) contribute to aging. Cobalamin (Cbl) is required for cell growth and functions, and its deficiency causes serious complications. Diabetics and renal patients show high concentrations of Cbl, but metabolic evidence of Cbl deficiency that is reversible after Cbl treatment. Cbl might be sequestered in blood and cannot be delivered to the cell. Megalin mediates the uptake of transcobalamin-Cbl complex into the proximal tubule cells. Megalin is involved in the uptake and degradation of AGEs. In aging, diabetes or renal dysfunction, AGEs might overload megalin thus lowering Cbl uptake. Transcobalamin-Cbl might retain in blood. Shedding of megalin and transcobalamin receptor under glycation conditions is also a possible mechanism of this phenomenon.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Saarland, 66421 Homburg, Germany.
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Utility of measuring vitamin B12 and its active fraction, holotranscobalamin, in neurological vitamin B12 deficiency syndromes. J Neurol 2010; 258:393-401. [DOI: 10.1007/s00415-010-5764-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 08/30/2010] [Accepted: 09/16/2010] [Indexed: 11/27/2022]
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Woo KS, Kim KE, Park JS, Park JI, Han JY. Relationship between the Levels of Holotranscobalamin and Vitamin B12. Korean J Lab Med 2010; 30:185-9. [PMID: 20445338 DOI: 10.3343/kjlm.2010.30.2.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To date, the determination of serum vitamin B12 levels has been the most common laboratory test for the assessment of vitamin B12 status; however, the diagnostic accuracy of this test is low. To obtain a more sensitive marker, a new test to measure holotranscobalamin (holoTC) levels has been introduced. In this study, we assessed 45 patients for whom a vitamin B12 test had been requested and 139 anemic patients. We investigated the associations between the levels of homocysteine (Hcy) and those of holoTC, serum vitamin B12, and folate and assessed the diagnostic value of holoTC levels as a marker for vitamin B12 deficiency. We also determined the precision of the AxSYM holoTC assay by calculating the coefficient of variance (CV). The within-run and between-run precision values were excellent, as all CV values were less than 3.5%. The holoTC levels were low (<35 pmol/L) in 7 samples, and 6 of these samples had normal total serum vitamin B12 levels. In 2 of these samples, high Hcy levels (>12 micromol/L) indicated vitamin B12 deficiency. Thus, the holoTC levels were more sensitive than the serum vitamin B12 levels for indicating vitamin B12 status. If the serum vitamin B12 level is 151-300 pmol/L, the levels of holoTC alone or in combination with serum vitamin B12 levels are likely to be more useful markers than serum vitamin B12 levels alone.
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Affiliation(s)
- Kwang Sook Woo
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
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Fedosov SN. Metabolic signs of vitamin B(12) deficiency in humans: computational model and its implications for diagnostics. Metabolism 2010; 59:1124-38. [PMID: 20051280 DOI: 10.1016/j.metabol.2009.09.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 09/17/2009] [Indexed: 11/19/2022]
Abstract
Early diagnostics of cobalamin (Cbl, vitamin B(12)) deficiency is primarily based on measurements of the relevant metabolic markers in blood plasma--total B(12), specific Cbl-saturated transporter holo-transcobalamin (holoTC), and substrates of Cbl-dependent enzymatic reactions methylmalonic acid (MMA) and homocysteine (Hcy). Concentrations of B(12) and holoTC decrease whereas MMA and Hcy increase under deficiency. Yet, the results of individual tests are often contradictory and do not guarantee unambiguous diagnosis. The current work describes the metabolic manifestation of vitamin B(12) deficiency in terms of flux equations fitted to data sets from literature. The model mathematically connects all the markers and presents 4 independent measurements as a single point (x, y) in the combined coordinates x = (holoTC x B(12))((1/2)) and y = (1/2)log(10)(MMA x Hcy). Pairwise averaging compensates for the individual fluctuations of the markers caused by (1) irregular spikes of holoTC, (2) delayed change of the total plasma B(12) buffered by an internal Cbl depot, and (3) variations in the production/excretion velocities of MMA and Hcy. Bivariate distribution of the marker combinations (x, y) reveals several peaks of frequency in the analyzed mixed population. The peaks seem to represent the reference subgroups with different B(12) physiology and characteristic values of "wellness parameter": w = log(10)(holoTC(n)) + log(10)(B(12n)) - log(10)(MMA(n)) - log(10)(Hcy(n)), where concentrations are normalized (eg, MMA(n) = MMA/MMA(normal)). Dynamic response of the organism to B(12) intake is quantified and described as an additional analytical tool when classifying uncertain cases. The discussed mathematical approaches are of general applicability in diagnostics.
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Affiliation(s)
- Sergey N Fedosov
- Protein Chemistry Laboratory, Department of Molecular Biology, University of Aarhus, Science Park, DK 8000 Aarhus C, Denmark.
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Bamonti F, Moscato GA, Novembrino C, Gregori D, Novi C, De Giuseppe R, Galli C, Uva V, Lonati S, Maiavacca R. Determination of serum holotranscobalamin concentrations with the AxSYM active B(12) assay: cut-off point evaluation in the clinical laboratory. Clin Chem Lab Med 2010; 48:249-53. [PMID: 19961395 DOI: 10.1515/cclm.2010.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A reliable early marker is required for diagnosis of cobalamin deficiency. We calculated an appropriate holotranscobalamin (HoloTC) cut-off point for identifying cobalamin deficiency using an immunoenzymatic assay. METHODS Determination of the cut-off threshold and correlation between HoloTC and the other diagnostic parameters routinely used for vitamin B(12) deficiency [total vitamin B(12) (tB(12)), folate, homocysteine] were measured in 250 routine blood specimens from 107 men (mean age 59.0+/-18.8 years) and 143 women (mean age 54.2+/-23.1 years). The inclusion criterion was serum tB(12) concentration <or=221 pmol/L. RESULTS Analytical performance results agreed with those reported by others. A weak correlation (R=0.42) was found between HoloTC and tB(12). A 40 pmol/L cut-off threshold was chosen for HoloTC and the associated sensitivity and specificity was 0.86 and 0.66, respectively. Out of 250 tested samples, 126 showed tB(12) concentrations 139-221 pmol/L (gray zone, GZ) and 124 had tB(12) concentrations <139 pmol/L (low, L). Values less than the cut-off for HoloTC were present in 68.2% and 37.9% of cases in the GZ and L group, respectively (p<0.01), and in 53.2% of subjects. CONCLUSIONS Our results confirmed the analytical reliability of the AxSYM HoloTC assay. The method is adequate for routine use and a cut-off threshold of 40 pmol/L is appropriate for assessing cobalamin deficiency in populations with reduced tB(12) values.
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Affiliation(s)
- Fabrizia Bamonti
- Dipartimento Scienze Mediche, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Fondazione IRCCS, Milan, Italy.
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