Abstract
Emerging evidence indicates an association between obesity, metformin use and reduced vitamin B12 status, which can have serious hematologic, neurologic and psychiatric consequences. This study aimed to examine B12 status in obese adolescents with pre-diabetes and/or clinical features of insulin resistance. Serum B12 was measured using chemiluminescence immunoassay in 103 (43 male, 60 female) obese (mean body mass index (BMI) z-score ± SD (2.36 ± 0.29)), adolescents aged 10 to 17 years, median (range) insulin sensitivity index of 1.27 (0.27 to 3.38) and 13.6% had pre-diabetes. Low B12 (<148 pmol/L) was identified in eight (7.8%) and borderline status (148 to 221 pmol/L) in an additional 25 (24.3%) adolescents. Adolescents with borderline B12 concentrations had higher BMI z-scores compared to those with normal concentrations (2.50 ± 0.22 vs. 2.32 ± 0.30, p = 0.008) or those with low B12 concentration (2.50 ± 0.22 vs. 2.27 ± 0.226, p = 0.041). In conclusion, nearly a third of obese adolescents with clinical insulin resistance had a low or borderline serum B12 status. Therefore, further investigations are warranted to explore the cause and the impact of low B12 status in obese pediatric populations.
Highlights
Vitamin B12, an essential vitamin found in animal and fortified food products, has a fundamental role in DNA synthesis, optimal haemopoiesis and neurological function
The results indicate that almost one-third of the obese adolescents were classified with low or borderline vitamin B12 status
We speculate that obese adolescents at risk of developing type 2 diabetes may have a greater risk of low B12 status compared to the general paediatric obese population
Summary
Vitamin B12, an essential vitamin found in animal and fortified food products, has a fundamental role in DNA synthesis, optimal haemopoiesis and neurological function. B12 deficiency is associated with a spectrum of disease from asymptomatic to serious haematological, neurologic and psychiatric manifestations and the possible risk of irreversible neurological damage despite treatment [1]. B12 deficiency is well documented in adults with inadequate intake, gut malabsorption or pernicious anaemia. Malabsorption of B12 is associated with metformin therapy, an insulin sensitizer used for the treatment of type 2 diabetes [2] and increasingly in obese, insulin resistant, adolescents [3]
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