Decrease In Vitamin B12 Research Articles

Unraveling the Association of Liver Steatosis and Fibrosis with Vitamin B12: A Cross-Sectional Study

Background: There are conflicting studies reporting both an increase and a decrease in vitamin B12 (VB12) levels in non-alcoholic fatty liver disease (NAFLD). In this study, we aimed to dissect the effects of steatosis and fibrosis on VB12. Methods: This is a cross-sectional study including all patients with a vibration-controlled transient elastography (VCTE) performed at the Hospital Miguel Servet (Zaragoza, Spain) between 2019 and 2022 for a chronic liver disease and having a recent blood test for VB12 levels. Liver fibrosis was assessed by VCTE and hepatic steatosis by ultrasonography and/or through controlled attenuation parameter (CAP). Results: 1195 patients (NAFLD n = 441, other chronic liver disease n = 754) were included. Median age was 57 years, 53% female. Patients with NAFLD had lower levels of VB12 compared to the rest of chronic liver diseases (289 vs. 313 pg/mL, p < 0.001). A significant negative correlation was observed between VB12 levels and hepatic steatosis measured by CAP (r = −0.13, p < 0.001). A significant positive correlation was observed between VB12 levels and liver stiffness in patients with NAFLD in both sexes (men r = 0.31, p < 0.001 and women r = 0.15, p = 0.016). A significant association between VB12 levels and liver fibrosis in cirrhosis stage was observed in patients with NAFLD (OR 1.06, 95% CI, 1.025–1.098, p = 0.001). Conclusion: VB12 levels were lower with greater hepatic steatosis. In NAFLD, VB12 levels were lower compared to other chronic liver diseases but their levels increased with higher liver stiffness and in cirrhosis stage.

Effect of calcium supplementation on reversing metformin-based inhibition of vitamin B12 bioavailability in healthy adults using a [13C] cyanocobalamin tracer – A pilot study

Metformin is a widely prescribed first line drug for the treatment of type 2 diabetes mellitus (DM). Studies have shown that the use of metformin is often associated with a decrease in vitamin B12 (B12) levels in patients with DM. Few studies have shown that this effect could be mitigated with calcium supplementation. In the present study, we quantified the effect of metformin, and metformin co-administered with calcium on B12 absorption using a novel stable isotope [13C] cyanocobalamin tracer. A pilot crossover study was conducted to estimate the bioavailability of B12 in healthy subjects, using [13C] cyanocobalamin as a tracer. In the study, [13C] cyanocobalamin was administered orally to the participants followed by hourly venous sampling to measure the concentration of the tracer and estimate bioavailability. This protocol was followed for three experiment days, each separated by a one month wash out period. As part of the study, all participants received the tracer alone for the control day (C), metformin 850mg along with the tracer for the metformin day (M) and metformin 850mg with calcium 500mg and the tracer for the metformin calcium day (MC). Seven participants completed all three experiment days. The mean B12 bioavailability (±SD, n=7) was 42.6±10.2% for the control day (C), 30.8±15.3% for the metformin day (M) and 46.4±8.6% for the metformin-calcium day (MC). Repeated measures ANOVA was done and the pairwise comparison showed a significant difference in the B12 bioavailability between control and metformin day (C vs M p=0.010), and between the metformin and metformin with calcium day (M vs MC p=0.003). B12 bioavailability reduced significantly from baseline (C) when metformin (M) was administered and this reduction was reversed when calcium was co-administered (MC) in healthy participants. In patients using metformin, calcium supplementation as a strategy to prevent B12 deficiency needs to be further studied.

Impairment of Nutritional Status and Quality of Life Following Minimal-Invasive Esophagectomy-A Prospective Cohort Analysis.

Minimal-invasive resection of the esophagus for esophageal cancer has led to a relevant decrease in postoperative morbidity. Postoperatively, patients still suffer from surgical and adjuvant therapy-related symptoms impairing nutrition and quality of life. The aim of this study was to evaluate the nutritional status and associated symptoms six months after esophagectomy. Patients who attended follow-up examination six months after minimal-invasive esophagectomy were included. Blood and fecal tests, quality of life surveys (QLQ-C30 and QLQ-OG25) and nutritional risk screening (NRS) were performed. Twenty-four patients participated. The mean weight loss was 11 kg. A significant decrease in vitamin B12 (737 to 467 pg/mL; p = 0.033), ferritin (302 to 126 ng/mL; p = 0.012) and haptoglobin (227 to 152 mg/dL; p = 0.025) was found. In total, 47% of the patients had an impaired pancreatic function (fecal elastase < 500 µg/g). Physical (72 to 58; p = 0.034) and social functioning (67 to 40; p = 0.022) was significantly diminished, while self-reported global health status remained stable (52 to 54). The number of patients screened and found to be in need of nutritional support according to NRS score decreased slightly (59% to 52%). After MIE, patients should be meticulously monitored for nutritional status after surgery.

Plasma homocysteine, serum vitamin B12 and folic acid status in newly detected schizophrenic patients of eastern India

Introduction and Aim: Schizophrenia is a disastrous mental disorder that causes chronic disability. Even after many years of scientific research the underlying pathophysiology of this disorder is unclear. Deficiency of vitamin-B12 and folic acid are associated with many mental disorders. Increase in homocysteine increases risk of several disorders including schizophrenia. Materials and Methods: Plasma homocysteine, serum vitamin B12 and folic acids were measured in 30 newly diagnosed schizophrenic cases and values were compared with 50 age and sex matched controls. Results: Plasma homocysteine was significantly increased in schizophrenic cases in comparison to controls, vitamin B12 was significantly decreased in cases in comparison to controls. Increase in homocysteine in cases showed a significant negative correlation with vitamin-B12 of cases. Conclusion: This study proves an association between increase in homocysteine and decrease in vitamin B12 with schizophrenia.

Ferric Carboxymaltose Versus Ferrous Glycine Sulfate For Treatment of Iron Deficiency Anemia and Their Effect On Vitamin B12 And Folic Acid: A Retrospective Study

Aim Anemia is a major public health problem, affecting about one-third of the world's population, and is most commonly caused by iron deficiency. Iron deficiency anemia requires oral or intravenous iron replacement therapy. The purpose of this study was to assess the change in several hematological parameters, vitamin B12, and folic acid from baseline to the first month of follow-up following therapy with oral ferrous glycine sulfate or intravenous ferric carboxymaltose. Methods: All patients who received oral ferrous glycine sulfate or intravenous ferric carboxymaltose for the treatment of iron deficiency anemia between January 1, 2016, and December 31, 2018, were included in the trial. Along with age and gender information, values of hemoglobin, ferritin, transferrin saturation, mean corpuscular volume, vitamin B12, and folic acid were derived from patients’ records at the beginning of treatment and first month follow-up. Results: Laboratory values obtained after treatment showed statistically significant improvement in both groups (intra group, p&amp;lt;0.001). When the percentage of change between groups was compared: Percentage-based increases in hemoglobin, mean corpuscular volume, transferrin saturation and ferritin values were significantly higher in the ferric carboxymaltose group (p&amp;lt;0.001). The percentage decrease in vitamin B12 and folic acid values was higher in the ferric carboxymaltose group (p=0.005 and p=0.01, respectively) when compared with oral ferrous glycine sulfate group. Conclusions: According to the findings of our study, iron deficiency anemia can be treated very successfully using ferric carboxymaltose; however, it should be remembered that concurrent supplementation of elements such vitamin B12 and folic acid is necessary for the appropriate progression of erythropoiesis.

The effect of N2O gas on serum cobalamin and homocysteine in patients undergoing orthopedic surgery

Nitrous oxide (N 2 O) is an inhaled anesthetic drug that uses during surgery and recently proposed as a treatment for mood disorder in a research setting. Exposure to N2O during surgery can cause hematopoietic and neural side effects. The purpose of this study was to the designation of serum cobalamin, homocysteine and CBC factors changes after exposure to nitrous oxide during orthopedic surgery. This study has been done on 30 patients undergoing orthopedic operations from 2016 until 2018. All patients are scheduled for orthopedic surgery. All patients received nitrous oxide during their anesthesia period. Blood samples were taken from patients 48 hours before surgery and 24 hours after surgery. All samples froze at -20°c immediately after collecting. Then samples transferred to the university laboratory with regards to keeping a cold chain for analysis. Paired T-test and Wilcoxon test were used for comparing vitamin B12, homocysteine, and CBC parameters. Nitrous oxide resulted in marked vitamin B12 and homocysteine level change. Mean concentration of vitamin B12 reduced after exposure to N2O. This difference was significant when analyzed using paired sample T-test (p=0.0001). homocysteine concentration means decreased after exposure to N2O and this difference was statistically significant (p=0.0001). Nitrous oxide will lead to a decrease in vitamin B12 and an increase in homocysteine and mean corpuscular volume in the early postoperative period.

Vitamin B12 in Pregnancy and its Relationship with Maternal BMI and Gestational Diabetes Mellitus

Objectives:To determine the levels of vitamin B12 in pregnant women and to explore the relationship of vitamin B12 with maternal BMI and gestational diabetes mellitus.Methods:This cross-sectional study was conducted at Department of Physiology, UHS, Lahore from February 2019 to March 2020. Ninety pregnant women in early third trimester of pregnancy were selected. Forty-five women had gestational diabetes and forty-five were healthy pregnant women. Serum vitamin B12 and fasting blood glucose (FBG) levels were determined by ELISA and glucose oxidase method respectively. 1st trimester BMI was also recorded. SPSS version 23 was used to analyze the data.Results:Serum vitamin B12 was significantly lower in GDM group (149.41±13.66) as compared to non-GDM group (357.49±42.07). BMI was significantly higher in GDM group (32.94±2.10) as compared to non-GDM group (23.52±1.83). Significant negative correlation (-0.78**) was observed between 1st trimester BMI and vitamin B12 in late pregnancy. Regression analysis revealed that high BMI was associated with decrease in vitamin B12 and increased risk of gestational diabetes mellitus (3.26***). Moreover, vitamin B12 was partially mediating the relationship between BMI and FBG.Conclusion:Low vitamin B12 levels have an association with maternal BMI and gestational diabetes mellitus.

Effect of metformin on serum level of vitamin B12 and folate in patients of type-2 diabetes mellitus

Background: Several types of DM are caused by a complex interaction of genetic and environmental factors. Depending on the etiology of the DM, factors contributing to hyperglycaemia include- reduced insulin secretion, decreased glucose utilization, and increased glucose production.Objective of the current study was to study the effect of metformin on the level of vitamin B12 and folate in patients of type 2 DM.Methods: This is hospital based study before and after metformin therapy randomized controlled trial was conducted in medicine ward of M. B. hospital, Udaipur. Baseline serum vitamin B12 and folate level of all patients were measured and treatment with metformin 500 mg twice a day was given for 6 months. After 6 months serum vitamin B12 and folate level of all patients were re-evaluated.Results: There was a significant positive correlation (r=0.824, p&lt;0.001) between decrease in vitamin B12 and decrease in folate level after metformin treatment. When analysis for change in vitamin B12 is compared with change in MCV values after 6 months, negative correlation (r=-0.08, p&gt;0.05) was obtained. A non significant correlation (r=-0.08, p&gt;0.05) with change in level of serum folate and change in MCV values or haemoglobin level was obtained.Conclusions: Low serum vitamin B12 level is associated with longer duration and higher dose of metformin use. Routine determination of vitamin B12 level in patients with type 2 DM on high dose of metformin and those with prolonged use of metformin might help in identifying patients that would benefit from vitamin B12 supplements.

English

Several studies have confirmed the increased incidence of vitamin B12 deficiency in patients with type 2 diabetes mellitus. Metformin is currently the most commonly used anti-diabetic drug, metformin being prescribed as first-line therapy for patients with type 2 diabetes mellitus (T2DM) worldwide. Other disorders including insulin resistance, such as polycystic ovary syndrome (PCOS), can also be treated with metformin. Metformin has positive effects on metabolism, weight loss, and vascular defence of carbohydrates, but it also has significant side effects. Patients on long-term treatment with metformin, for example, have been shown to be at risk of anemia. This may be because of a decrease in metformin-related vitamin B12. It is estimated that 30 percent of patients undergoing long-term metformin treatment have experienced vitamin B12 malabsorption, with a 14 percent to 30 percent reduction in serum vitamin B12 concentration. A critical nutrient for wellbeing is vitamin B12. It plays a significant role in the functioning and the production of red blood cells in the brain and nervous system. In addition to anemia, a deficiency of vitamin B12 may increase the severity of peripheral neuropathy in T2DM patients. In addition, since vitamin B12 is involved in the most critical homocysteine (Hcy) metabolism pathway, a decrease in vitamin B12 will increase plasma concentrations of Hcy, which in patients with T2DM and PCOS is closely linked to cardiovascular disease. Evaluating serum vitamin B12 levels will also provide an early diagnosis of the status of the deficiency. This will offer an incentive for harm caused by routine screening and early detection to be reversed. KEY WORDS Vitamin B12, Metformin, Diabetes Mellitus, Glycated Hb

Skin manifestations after bariatric surgery

BackgroundSkin signs observed in morbid obesity may change as the weight reduces, especially post-bariatric surgery (BaS). Data concerning the skin findings exclusively in post-BaS patients remain limited.MethodsSeventy post-BaS patients were examined for cutaneous abnormalities. The patients were divided into those with successful weight loss (% excessive body weight loss (EBWL) of at least 50%) and a non-successful group (%EBWL < 50%).ResultsForty-six patients with successful weight loss demonstrated a significantly lower prevalence of acanthosis nigricans on the neck, axillae and inguinal areas, keratosis pilaris (KP) and pebble fingers. However, a higher prevalence of alopecia was observed. After adjustment with patients’ factors, KP (adjusted odds ratio (aOR) = 0.21, 95%CI 0.06–0.74, p = 0.02) and pebble fingers (aOR = 0.09, 95%CI 0.01–0.89, p = 0.04) remained significantly less likely in patients with successful weight loss. Laboratory results comparing pre- and post-surgery values revealed significant decreases in fasting plasma glucose, hemoglobin A1c, and triglyceride and an increase of high-density lipoproteins in both groups. However, significant decreases of liver aminotransferases (AST and ALT) were observed only in the successful group (p = 0.04, 0.003). Nonetheless, a decrease in vitamin B12 (p = 0.01) was observed in the successful group.ConclusionWeight loss after BaS provided an improvement for metabolic profiles. Successful weight reduction resulted in better skin improvement. However, nutritional supplements may be necessary.Trial registrationThai Clinical Trials Registry TCTR20171003002. Registered October 3. 2017, retrospectively registered.

Vitamin and mineral levels in children with autism spectrum disorder

The aim of this study was to compare the vitamin and mineral values of the patients followed up in the Child Psychiatry Outpatient Clinic with the diagnosis of autism spectrum disorder to healthy controls in the same age group and to investigate whether vitamin-mineral values were related to autism weight (CARS score).Between September 2017 and September 2018, we worked at Bak?rköy Dr. Sadi Konuk Training and Research Hospital Children and Adolescent Mental Health and Diseases outpatient clinic with autism spectrum disorder patients with childhood autism assessment scale (CARS) was weighted. Age, gender, height, weight, blood Iron, Vitamin B12, Folate and 25 (OH) Vitamin D levels of all patients included in the study were recorded. Mann-Whitney U, Pearson chi-square and Fisher's exact test were used to evaluate the data. In this study, 108 patients with ASD were compared with 115 normal cases. There was no statistically significant decrease in Vitamin B12, Folate, Iron and Vitamin D levels in patients with ASD compared to normal patients. According to CARS score, there was no statistically significant difference in vitamin B12, Folate, Iron and Vitamin D levels in children with mild and severe ASD. In our study, it was concluded that vitamin B12, Folate, Iron and Vitamin D levels in children with ASD were not lower than healthy children, and there was no difference between mild and severe cases according to CARS score.

Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes.

Metformin can cause serum vitamin B12 deficiency, but studies on the influence of its duration and dose are lacking. We investigated vitamin B12 deficiency in patients with type 2 diabetes using metformin, in conjunction with other related factors. This cross-sectional study included 1111 patients with type 2 diabetes who took metformin for at least 6 months. Serum vitamin B12 levels were quantified using a competitive-binding immunoenzymatic assay, and vitamin B12 deficiency was defined as serum B12 <300 pg/mL. Information on metformin use and confounding variables were collected from records or questionnaires and interviews. Serum vitamin B12 deficiency occurred in 22.2% of patients (n = 247). After adjusting for confounders, a 1 mg increase in daily metformin dose was associated with a 0.142 pg/mL decrease in vitamin B12 (P < .001). Compared with a daily dose of <1000 mg, the adjusted odds ratios for 1000 to 1500, 1500 to 2000, and ≥2000 mg metformin were 1.72 (P = .080), 3.34 (P < .001), and 8.67 (P < .001), respectively. Vitamin B12 deficiency occurred less often in patients taking multivitamins (odds ratio 0.23; P < .001). After adjusting for confounding factors, there was no correlation between B12 deficiency and duration of metformin use. Serum homocysteine levels showed significant negative correlation with vitamin B12. Metformin at ≥1500 mg/d could be a major factor related to vitamin B12 deficiency, whereas concurrent supplementation of multivitamins may potentially protect against the deficiency. Serum homocysteine levels were negatively correlated with vitamin B12 levels, suggesting that B12 deficiency due to metformin use may occur at the tissue level. However, this hypothesis will require further study.

EARLY DEMENTIA AND EPIGENETICS OF ALZHEIMER'S DISEASE: A CLINICAL APPROACH

Alzheimer's disease (AD) is the main cause of dementia, affects 17-20% of people > 65 years and 50% > 85 years. AD only appears in late adulthood, and the risk to develop the disease doubles every 5 years after age 65. Heritability for AD is estimated to explain between half of total AD cases. Almost half of AD being attributable to non-genetic risk factors in which epigenetics mechanisms are supposedly involved. Expression with epigenetics has been ignored in clinical practice. Early detection and treatment may delay the full blown expression of the more grave disease of memory loss like AD. A consecutive cohort of 183 patients to present to neurology clinic was included; Set of blood test and Montreal Cognitive Assessment (MoCA) screening for the work of neurological complaint.ANA immunoassay and titer> 1:40 with positive and type, Vit B12 level < 300, folate <6. Vit D level <30, CRP>.05 Homocystine level >12 were positive. MoCA score of < 26 was MCI 25-20, 20–15 moderate & <15 sever memory loss. M:F, age 16 to 92 yrs. Vitamin B12 levels are significantly correlated with their homocysteine levels (t = −3.6375, df = 13, p-value = 0.003008). For every 1 umol/L increase in homocysteine, there is a 6.652 pg/mL decrease in Vitamin B12. In addition, Homocysteine levels are significantly linearly related with their MoCA scores (t = −3.9187, df = 141, p-value = 0.0001383). For every 1 umol/L increase in Homocysteine levels, there is a .25025 decrease in MoCA scores. In terms of Vitamin D, the data provides evidence that patients’ Vitamin D levels are significantly correlated with their MoCA scores (t = 2.6162, df = 44, p-value = 0.01214). For every 1 increase in Vitamin D, there is a 0.3455 increase in MoCA scores. Mean MoCA score for patients who are ANA positive is significantly less than 26 (t = −2.6437, df = 17, p-value = 0.008532). Active vigilance and early intervention with simple treatable cause of memory loss may delay the onset of dementia and AD.

RELEVANCE OF WELL DEFINE LABORATORY TESTS MEMORY PANEL IN DEMENTIA WORKUP

To study associations between antinuclear antibodies (ANA), CRP, Vit D, Vit b12 and homocysteine level in patient with memory loss. There has been stigmatic approach to patients with memory loss as every elderly patient with memory loss get Alzheimer's disease by default, it not common for patients to ask do I have Alzheimer's. A consecutive cohort of 182 patients to present to neurology clinic was included; Set of blood test and Montreal Cognitive Assessment (MoCA) screening for the work of neurological complaint. ANA profiles were determined by line immunoassay with titer> 1:40 with positive and type, Vit B12 level < 300, VitD level <30, CRP>.05 Homocystine level >12 were positive. MoCA score of < 26 was MCI 25-20, 20–15 moderate & <15 sever memory loss. This data provides evidence that patients’ Vitamin B12 levels are significantly correlated with their homocysteine levels (t = −3.6375, df = 13, p-value = 0.003008). For every 1 umol/L increase in homocysteine, there is a 6.652 pg/mL decrease in Vitamin B12. In addition, Homocysteine levels are significantly linearly related with their MoCA scores (t = −3.9187, df = 141, p-value = 0.0001383). For every 1 umol/L increase in Homocysteine levels, there is a .25025 decrease in MoCA scores. In terms of Vitamin D, the data provides evidence that patients’ Vitamin D levels are significantly correlated with their MoCA scores (t = 2.6162, df = 44, p-value = 0.01214). For every 1 increase in Vitamin D, there is a 0.3455 increase in MoCA scores. Mean MoCA score for patients who are ANA positive is significantly less than 26 (t = −2.6437, df = 17, p-value = 0.008532). The memory blood panel work up should include the most cost effective way and should lead the physicians to invest time in treatable cause of the memory loss in early age dementia. The above results show direct correlation with memory loss and deficiency of Vit B12, Vit D and increase Blood homcysteine level.

Mechanistic Insights Into the Cross-Feeding of Ruminococcus gnavus and Ruminococcus bromii on Host and Dietary Carbohydrates.

Dietary and host glycans shape the composition of the human gut microbiota with keystone carbohydrate-degrading species playing a critical role in maintaining the structure and function of gut microbial communities. Here, we focused on two major human gut symbionts, the mucin-degrader Ruminococcus gnavus ATCC 29149, and R. bromii L2-63, a keystone species for the degradation of resistant starch (RS) in human colon. Using anaerobic individual and co-cultures of R. bromii and R. gnavus grown on mucin or starch as sole carbon source, we showed that starch degradation by R. bromii supported the growth of R. gnavus whereas R. bromii did not benefit from mucin degradation by R. gnavus. Further we analyzed the growth (quantitative PCR), metabolite production (1H NMR analysis), and bacterial transcriptional response (RNA-Seq) of R. bromii cultured with RS or soluble starch (SS) in the presence or absence of R. gnavus. In co-culture fermentations on starch, 1H NMR analysis showed that R. gnavus benefits from transient glucose and malto-oligosaccharides released by R. bromii upon starch degradation, producing acetate, formate, and lactate as main fermentation end-products. Differential expression analysis (DESeq 2) on starch (SS and RS) showed that the presence of R. bromii induced changes in R. gnavus transcriptional response of genes encoding several maltose transporters and enzymes involved in its metabolism such as maltose phosphorylase, in line with the ability of R. gnavus to utilize R. bromii starch degradation products. In the RS co-culture, R. bromii showed a significant increase in the induction of tryptophan (Trp) biosynthesis genes and a decrease of vitamin B12 (VitB12)-dependent methionine biosynthesis as compared to the mono-culture, suggesting that Trp and VitB12 availability become limited in the presence of R. gnavus. Together this study showed a direct competition between R. bromii and R. gnavus on RS, suggesting that in vivo, the R. gnavus population inhabiting the mucus niche may be modulated by the supply of non-digestible carbohydrates reaching the colon such as RS.

Homocysteine and vitamin B12: Other causes of neural tube defects in Eastern Uttar Pradesh and Western Bihar population.

Neural tube defects (NTDs) are congenital malformations with an incidence of 1-10/1000 live births. Homocysteine and vitamin B12 metabolism have been shown to be associated with NTDs. To investigate the status of maternal and neonate's folic acid, homocysteine, and vitamin B12 levels and their association with the risk of development of NTDs in the population of Eastern Uttar Pradeshand Western Bihar, India. This study is a cross-sectional, retrospective study where 96 mothers who either had a first NTD child or had a history of NTD child in the family and 126 neonates with spina bifida were recruited during the period 2012-2015. Eighty-four control mothers whose previous and current pregnancies were normal, and 87 control neonates who had no defects and were within the same age range as the NTD affected neonates, recruited from the department of pediatric surgery, were enrolled in the study. Plasma concentrations of folic acid, vitamin B12, and homocysteine were compared between cases and controls. The folic acid level in the mothers and neonates was within the normal limit. A significant increase in the level of homocysteine in mothers with affected pregnancy and in neonate cases in comparison to control mothers was obseved. Further, a significant decrease in the level of vitamin B12 in mothers with NTD neonates and in the affected neonates was noted. A negative correlation was found between homocysteine and vitamin B12 levels in case and control mothers. A correlation of an increase in serum homocysteine with a decrease in vitamin B12 was seen in mothers of neonates with NTD. A similar observation as made in the neonates with NTDs. It may be suggested that maternal decrease in vitamin B12, in mothers who have normal folic acid may be associated with NTD in their children.

Anemia after biliopancreatic diversion

At present, biliopancreatic diversion (BPD) is one of the most effective surgery for the treatment of morbid obesity. However, long-term complications, including different types of anemia are known to occur after such intervention. Objective of the study. To investigate pathogenetic mechanisms of anemia and clinical condition of the patients undergone BPD taking into account risk factors of anemia development, its therapy and prevention. Material and methods. Eighty patients who had undergone BPD surgery were included in the study. Postoperative oral administration of iron medications (IMs) was recommended to all patients. 49 of them regularly received IMs, 31 patients were not given IMs or took them for no more than 2 months after surgery. The follow-up was 3-7 years. Results. A reliable decrease of hemoglobin levels was observed in all patients after BPD. This reduction began as early as month 3 after surgery and progressed during the 7 year follow-up. Iron deficiency anemia (IDA) was diagnosed in 30% of the patients after BPD. Mean levels of hemoglobin, ferritin and serum iron after BPD were significantly lower in patients having risk factors of IDA as well as in patients not receiving iron therapy. Iron deficiency anemia was revealed in 33.3% of the patients regularly receiving IMs in doses containing 100 mg elemental iron per day. There was no significant decrease of vitamin B12 and folic acid levels during 7 years of follow-up. Only one case (1.25%) of B12 deficiency anemia was registered. Normochromic normocytic anemia characterized by normal serum iron and increased ferritin and C-reactive protein levels, was diagnosed after BPD in 7.85% of the patients. Conclusion. BPD surgery is the important risk factor of anemia (especially IDA) development. In compliant patients. Continuous intake of IMs makes up for iron deficiency but in some others IDA occurred despite regular IMs administration. Normochromic normocytic anemia after BPD may be due to chronic inflammation.

Comparison of Selected Nutrients in Raw, Whole Egg from USDA Data Releases (1976 – 2010)

BackgroundEggs are an important component of the US diet. The USDA released nutrient data for raw, whole eggs based on compilations in 1976, 1988–89, 2000–01 and 2010.MethodsThe 1976 compilation was primarily from literature data, the 1988–89 samples were from samples provided by egg producers nationwide, and the 2000–01 and 2010 samples were part of the Nutrient Data Laboratory (NDL) National Food and Nutrient Analysis Program (NFNAP).Except for the 1976 literature compilation, samples from the other years were analyzed by commercial and university laboratories approved by NDL for nutrient analysis of food samples.ResultsThere were only minor changes in total fat and protein, calcium, iron, phosphorus and sodium over this time period. There was a 22% decrease in cholesterol from 1976 to 1988–89, no significant change from 1988–89 to 2000–01. The mean cholesterol content decreased 51 mg/100 g (12%; p &lt; 0.0001), from 423 mg/100 g in 2000–2001 to 372 (range 344–405) in 2010. Over the same period, average Vitamin D3 increased by 60%, to 2.05 mg [80 IU]/100 g (range 0.97–12.1). Samples from 2010 contained 0.65 mg 25‐OH‐D3/100 g (range 0.43–1.32).There was a 43% decrease in vitamin B12 from 1976 to 2010.ConclusionRecommendations on egg intake may allow for more eggs in the diet resulting in increase in egg consumption. USDA is planning on a future NFNAP sampling to monitor egg nutrients with a special interest in cholesterol, vitamin D3 and vitamin B12.Support or Funding InformationThis work was supported by the USDA Agricultural Research Service. Partial support was received from the National Institutes of Health, agreement #Y1CN5010, and from the Egg Nutrition Center

A Randomized, Placebo-Controlled Trial in Women of Childbearing Age to Assess the Effect of Folic Acid and Methyl-Tetrahydrofolate on Erythrocyte Folate Levels

Objective: To evaluate the efficacy of a multi-vitamin/mineral preparation (MMP) in achieving erythrocyte folate levels (Fol-E) considered preventive of neural tube defects (NTDs). Methods: In this single-center, double-blind, randomized, placebo (PBO)-controlled trial, healthy women of childbearing potential (WCBP) took either an oral MMP containing 400 μg folic acid and 451 μg L-5-methyltetrahydrofolate (MTHF) or PBO once daily for 16 weeks. Primary endpoints were achievement of Fol-E ≥ 906 nmol/L at Week 4 and maintenance of this level once achieved. Secondary efficacy variables were plasma concentrations of folate, homocysteine, and vitamins B2, B6, and B12 at Week 4, 8, 12, and 16. Results: Of the 40 women enrolled, 20 were randomized to each study arm. All but one PBO-subject completed the study as planned. Baseline characteristics in both groups were comparable with mean Fol-E around 500 nmol/L. In contrast to only one PBO-subject, all MMP subjects achieved and maintained the target Fol-E (MMP: 100% vs PBO: 5%, p<0.001), 14 (70%) MMP subjects already by Week 4 (means ± SD: 976 ± 186 vs 629 ± 215 nmol/L, p<0.001). In plasma, the only change under PBO was a 10% decrease of vitamin B12 whereas under MMP folate and vitamin B6 significantly increased and homocysteine significantly decreased. There was no serious and only one severe adverse event (AE); most common AEs were gastrointestinal with greater incidence in the MMP group (30% versus 5%). Conclusion: Supplementation with folic acid and MTHF at equimolar amounts was efficacious in replenishing Fol-E of WCBP within 4 weeks to levels considered protective of NTDs.

A comparative study of levels of vitamin B12 in patients of type 2 diabetes mellitus on metformin and not on metformin at tertiary care center

Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. The objective of this study is to determine the frequency of vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are not on metformin. Methods: The study was a hospital based, case control type of analytical study conducted in SMS Medical College & Hospital, Jaipur during a period of 1 year. The study group has 50 patients with a diagnosis of T2DM and a prescription history of metformin for ≥18 months and control group has 50 patients with diagnosis of T2DM and no history of metformin use in the past five years. The following data was recorded for each patient: age, sex, weight, height, body mass index (BMI), years with diabetes, total daily dose of and years on metformin. Serum vitamin B12 was measured using an immunoassay method. Data were statistically analyzed. Results: Mean serum vitamin B12 levels in the study group was 431.84±265.76 and in control was 744.76±271.927 and the difference was statistically significant. Mean serum vitamin B12 levels in vegetarians (547.27±303.011) were significantly lower than in non-vegetarian (699.22±307.992) (p value 0.029). A significant negative correlation existed between the S. vitamin B12 and duration of diabetes (r= -0.445) by using Pearson’s correlation coefficient in study group. Conclusions: Metformin is significantly associated with decrease in vitamin B12. So we recommend that vitamin B12 should be measured prior to initiation of metformin therapy and later annually in patients of type 2 diabetes mellitus who are on metformin therapy for long duration (≥3-4 years) or in higher doses (≥2gm/day).