Abstract
Studies on the nutritional status of vegetarians in Spain are lacking. Prevention of vitamin B12 deficiency is the main concern, as dietary sources are of animal origin. The present study aimed to evaluate vitamin B12 and folate status of Spanish vegetarians using classical markers and functional markers. Participants were adult and healthy lacto-ovo vegetarians (forty-nine subjects) and vegans (fifty-four subjects) who underwent blood analyses and completed a FFQ. Serum vitamin B12, homocysteine (Hcy), methylmalonic acid (MMA), erythrocyte folate and haematological parameters were determined. The effects of the type of plant-based diet, and the intake of supplements and foods were studied by a FFQ. Mean erythrocyte folate was 1704 (sd 609) nmol/l. Clinical or subclinical vitamin B12 deficiency was detected in 11% of the subjects (MMA>271nmol/l) and 33% of the participants showed hyperhomocysteinaemia (Hcy>15µmol/l). Regarding plant-based diet type, significantly higher Hcy was observed in lacto-ovo vegetarians compared with vegans (P=0·019). Moreover, use of vitamin B12 supplements involved an improvement of vitamin B12 status but further increase in erythrocyte folate (P=0·024). Consumption of yoghurts was weakly associated with serum vitamin B12 adequacy (P=0·049) and that of eggs with lower Hcy (P=0·030). In conclusion, Spanish vegetarians present high folate status but vitamin B12 subclinical deficiency was demonstrated using functional markers. The lack of influence of dietary sources on functional markers and the strong effect of vitamin B12 supplement intake emphasise the need of cobalamin supplementation in both lacto-ovo vegetarians and vegans.
Highlights
Studies on the nutritional status of vegetarians in Spain are lacking
The lack of influence of dietary sources on functional markers and the strong effect of vitamin B12 supplement intake emphasise the need of cobalamin supplementation in both lacto-ovo vegetarians and vegans
In the present study we evaluate the vitamin B12 and folate status of Spanish vegetarians using markers of clinical deficiency and subclinical deficiency (Hcy, methylmalonic acid (MMA) and erythrocyte folate), constituting the first complete study on vitamin B12 and folate status in this population
Summary
Studies on the nutritional status of vegetarians in Spain are lacking. Prevention of vitamin B12 deficiency is the main concern, as dietary sources are of animal origin. Vitamin B12, or cobalamin, acts as a cofactor of the enzymes methionine synthase, acting in the conversion of homocysteine (Hcy) to methionine, and methylmalonyl-CoA mutase, that produces succinyl-CoA from methylmalonyl-CoA, the active form of methylmalonic acid (MMA)(6) These reactions are involved in the methionine cycle and the folate cycle, both essential for DNA and RNA synthesis, erythropoiesis and the production of neurotransmitters[1,7,8]. Other food sources are scarce and include several mushroom species like shiitake (Lentinula edodes), black trumpet (Craterellus cornucopioides) and golden chanterelle (Cantharellus cibarius), and certain algae and cyanobacteria such as Chlorella and spirulina (Arthrospira platensis) These are frequently used to produce tablets consumed as cobalamin supplements by vegetarians and vegans[21]. Vitamin B12 deficiency is considered an extended problem for vegetarians, especially for vegans, if nutritional cobalamin supplements are not consumed[4,24]
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