Hypovitaminosis B12 Research Articles

Management of nutritional deficiencies following one anastomosis gastric bypass (OAGB): a single-center experience.

Metabolic/bariatric surgery (MBS) remains the most effective and long-lasting treatment for obesity and its complications. Apart from any surgical complications, the often less obvious but possibly severe side-effects of nutritional deficiencies have become of interest in recent years. OAGB is known to come with the need for thorough supplementation. Retrospective study; university-hospital based. Assessing nutritional issues and their management in a real-life cohort of patients undergoing OAGB. Patients that underwent OABG between 01/2018 and 08/2019 were retrospectively assessed. Laboratory values (gained from electronic patients charts) were analyzed for nutritional issues (parathyroid hormone, vitamin A, E, D, B12, folic acid, albumin, ferritin, iron, and transferrin saturation) as well as postoperative complications and reoperations. Furthermore, weight development, improvement/remission of obesity-related complications, and regular intake of multivitamin supplementation (MVS) were assessed. 120 patients underwent OAGB; 89 were female. A follow-up was available for 101 patients. Mean length of follow-up was 27.8 ± 20.9months. OAGB led to a %TWL of 36.7 ± 9.5% and %EWL of 86.8 ± 25.5%. Preoperative deficiencies were vitamin D (53.3%), followed by folic acid (16.7%) and vitamin A (6.7%). During follow-up, every patient developed at least one deficiency, hypovitaminosis D and A were predominant (74.3% and 41.0%), and 31 suffered from folic acid deficiency (30.7%). Hypovitaminosis B12 and calcium deficiency was observed in three patients (2.9%). Although advised to, only 45.5% opted for the intake of specialized MVS, whereas 10% did not take any MVS at all. More than half of all patients (53.5%) took additional supplements. Nineteen patients underwent reoperations associated with the initial OAGB. Two conclusions can be drawn: First, there is a general need for bypass patients to get assessed for a broad array of deficiencies over time. Second, MVS is essential for patients that had bypass surgery. Additionally, compliance needs to be promoted by educating patients as well as other treating physicians.

Comparative Study of Hypovitaminosis B12 Associated with Metformin in Combination with Sulfonylurea or Dpp-4 Inhibitors

Comparative Study of Hypovitaminosis B12 Associated with Metformin in Combination with Sulfonylurea or Dpp-4 Inhibitors

Polyglandular Syndrome type III in a young patient: case report

Introduction: Autoimmune polyglandular syndromes (APS) are rare diseases defined by the coexistence of at least two autoimmune endocrine diseases. Objective: To describe a case of type III polyglandular syndrome in a young patient. Case report: Female, 37 years old, with hypothyroidism, presented with a weight loss of 9 kg, daily vomiting, asthenia, fatigue, and postprandial fullness for 3 months. He also reported arthritis in his wrists, shoulders, and hips. In laboratory tests, macrocytic and hyperchromic anemia associated with leukopenia, as well as hypovitaminosis B12, was observed. Pernicious anemia was investigated as the cause of this deficiency. Upper digestive endoscopy showed moderate gastritis – histopathological with gastric atrophy, positive anti-intrinsic factor antibody. Due to inflammatory arthralgia, ANA was requested, with an associated positive anti-dsDNA result of 1:80. In the EULAR/2019 diagnostic criteria for Systemic Lupus Erythematosus (SLE), she presented 14 points, thus she was diagnosed with SLE, and hydroxychloroquine (HXC) was started. Conclusion: SPA is rare, mainly in association with non-glandular autoimmunity, following an early diagnosis.

B12 Hypovitaminosis Revealed by Melanoderma in an Infant: A Case Report

Vitamin B12 or cobalamin is a micronutrient found mainly in dairy and meat products. It is essential in the synthesis of DNA and RNA. In infants, hypovitaminosis B12 often causes neurological and hematological signs, and skin changes such as melanoderma are an uncommon manifestation. Blood count may not show anemia or macrocytosis, and decreased serum vitamin B12 associated with methylmalonic aciduria or total homocysteine levels confirm the diagnosis. Etiological assessment should also concern the mother. Early replacement treatment with vitamin B12 is the cornerstone of management. We report the case of B12 hypovitaminosis revealed by a delay in psychomotor milestones and stunted growth in height and weight associated with melanoderma, without anemia or macrocytosis on the blood count.

Pancytopenia Due to Vitamin B12 and Folic Acid Deficiency—A Case Report

We report a case of severe pancytopenia in a 15-year-old patient due to a severe deficiency in vitamin B12 and folic acid, probably of nutritional origin. The clinical and biological course was favorable after vitamin supplementation. With this case, we discuss the diagnostic approach of pancytopenia with megaloblastic anemia in children and adolescents, as well as the mechanisms involved in vitamin B12 and B9 deficiency. Hypovitaminosis B12 is known in its severe form but its diagnosis is often made difficult by insidious signs and symptoms. Traditional intramuscular replacement therapy has now proven to be effective orally. The clinical manifestations of folic acid deficiency are relatively similar to those of vitamin B12 deficiency, reflecting their intricate co-enzymatic functions. Its supplementation is administered orally.

Frequency of Hypovitaminosis B12 in Pregnant Women with Gestational Diabetes Mellitus

Objective: To determine the frequency of hypovitaminosis B12 in pregnant females presented with gestational diabetes mellitus. Study Design: Retrospective study Place and Duration: The department of Gynaecology and Obstetrics, Category A Hospital, Batkhela Malakand and Muhammad Teaching Hospital, Peshawarfor the duration of six months from October 2020 to March 2021. Methodology: Total 190 pregnant women (95 GDM, 95 non-GDM) were enrolled in this study. Patient’s ages were ranging between 18 to 40 years. Detailed demographics including age, gestational age, body mass index (BMI), and gravidty were recorded after taking informed written consent. Blood samples were taken from all the patients for measuring vitamin B12 status. Hypovitaminosis B12 was defined as <300 pg/ml. Data was analyzed by SPSS 24.0. Results: Mean age of patients was 32.46±6.82 years. Mean BMI was 26.24±2.34 kg/m2. Mean gestational age was 34.56±2.18 weeks. 105 (55.26%) women were multigravida. 80 (42.11%) patients had vitamin B12 level <300 pg/ml. Patients with GDM had high rate of vitaminosis B12 deficiency as compared to non-GDM patients (65.26% Vs 18.95%). A significant association was observed between GDM and hypovitaminosis B12 with p-value <0.0001. Conclusion: Vitamin B12 deficiency was significantly associated with gestational diabetes mellitus with frequency of 65.26%. Keywords: Vitaminosis B12, Gestational Diabetes Mellitus, Pregnancy

Relationship Of Serum Homocysteine And Vitamin B12 With Outcome Of Acute Ischemic Stroke In Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality especially in developing countries. Studies had reported elevated levels of serum homocysteine(hcy) and vitamin B12 (Vit B12) in patients with stroke. Objectives: To determine the relationship between hcy, and Vit B12 outcome in acute ischaemic stroke Materials and Methods: Hundred acute Ischaemic stroke patients were recruited into the study and were followed up for 2years. Serum homocysteine and vitamin B12 was done using ELISA. Patients outcome either dead or alive was recorded at 1 month and at 24 months. Results: Majority of the participants 62% were males with hcy of 1.62±0.37µmol/L and 38% were females with hcy of 1.62±0.31µmol/L. Vit B12 of males were 97.00 (181.30,80.00) pg/ml and females had a Vit B12 of 90.00(140.00,70.00) pg/ml. Thirty-four percent of patients had hyperhomocysteinaemia (>1.7µmol/L) while 64% had normal homocysteine levels. Also, 81% had hypovitaminosis B12 (<199.72pg/ml) and 19% had normal vit B12 on admission. There was no statistically significant difference (p value =0.932) between mean hcy levels of 25 dead patients (1.67 ±0.22µmol/L) and 58 patients that survived at one month (1.68±0.37µmol/L). Similarly, there is no statistically significant difference (p value =0.869) between mean Vit B12 levels of 25 dead patients (113.75±79.37pg/ml) and 58 patients that survived at one month (117.50±87.17pg/ml). After 24months of follow up, 31patients died. There is no statistically significant difference (p value=0.328). between mean homocysteine of 31 dead patients (1.62±0.30µmol/L) and the 47 patients that survived (71±0.36µmol/L). There was no statistically significant difference (p value= 0.214) between the Vitamin B12 concentration of the dead patients (131.29±104.01pg/ml) compared to those who survived (106.81±68.73pg/ml). Conclusion: There is no relationship between Homocysteine and vitamin B12 with outcome in patients admitted with an acute ischaemic stroke

Astrogliosis in an Experimental Model of Hypovitaminosis B12: A Cellular Basis of Neurological Disorders due to Cobalamin Deficiency.

Cobalamin deficiency affects human physiology with sequelae ranging from mild fatigue to severe neuropsychiatric abnormalities. The cellular and molecular aspects of the nervous system disorders associated with hypovitaminosis B12 remain largely unknown. Growing evidence indicates that astrogliosis is an underlying component of a wide range of neuropathologies. Previously, we developed an in vitro model of cobalamin deficiency in normal human astrocytes (NHA) by culturing the cells with c-lactam of hydroxycobalamin (c-lactam OH-Cbl). We revealed a non-apoptotic activation of caspases (3/7, 8, 9) in cobalamin-deficient NHA, which may suggest astrogliosis. The aim of the current study was to experimentally verify this hypothesis. We indicated an increase in the cellular expression of two astrogliosis markers: glial fibrillary acidic protein and vimentin in cobalamin-deficient NHA using Western blot analysis and immunocytochemistry with confocal laser scanning microscopy. In the next step of the study, we revealed c-lactam OH-Cbl as a potential non-toxic vitamin B12 antagonist in an in vivo model using zebrafish embryos. We believe that the presented results will contribute to a better understanding of the cellular mechanism underlying neurologic pathology due to cobalamin deficiency and will serve as a foundation for further studies.

Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension : A Randomized Clinical Trial.

Midterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain. To determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone. Randomized clinical trial. (ClinicalTrials.gov: NCT01784848). Investigator-initiated study at Heart Hospital (HCor), São Paulo, Brazil. Patients with hypertension receiving at least 2 medications at maximum doses or more than 2 medications at moderate doses and with a body mass index (BMI) between 30.0 and 39.9 kg/m2 were randomly assigned (1:1 ratio). RYGB plus MT or MT alone. The primary outcome was at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg. Key secondary outcomes were number of antihypertensive medications, hypertension remission, and BP control according to current guidelines (<130/80 mm Hg). Among 100 patients (76% female; mean BMI, 36.9 kg/m2 [SD, 2.7]), 88% from the RYGB group and 80% from the MT group completed follow-up. At 3 years, the primary outcome occurred in 73% of patients from the RYGB group compared with 11% of patients from the MT group (relative risk, 6.52 [95% CI, 2.50 to 17.03]; P < 0.001). Of the randomly assigned participants, 35% and 31% from the RYGB group and 2% and 0% from the MT group achieved BP less than 140/90 mm Hg and less than 130/80 mm Hg without medications, respectively. Median (interquartile range) number of medications in the RYGB and MT groups at 3 years was 1 (0 to 2) and 3 (2.8 to 4), respectively (P < 0.001). Total weight loss was 27.8% and -0.1% in the RYGB and MT groups, respectively. In the RYGB group, 13 patients developed hypovitaminosis B12 and 2 patients required reoperation. Single-center, nonblinded trial. RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity. Ethicon, represented in Brazil by Johnson & Johnson do Brasil.

A study of serum homocysteine and serum vitamin B12 levels in patients with retinal vein occlusion and its correlation

To find out the association of serum homocysteine levels and serum vitamin B-12 levels in patients with retinal vein occlusion.Patients of all age group and any sex who are coming in vitreoretinal OPD of department of ophthalmology at a tertiary care hospital of Western Maharashtra were studied. 50 cases of RVO and same number of age and sex matched controls were taken into consideration. All patients were underwent for assay of serum homocysteine by ECLIA method and serum Vitamin B12 by CMIA method.The highest number of cases were of BRVO (60%) followed by CRVO (30%) and only one case of TVO (2%) was noted. The average level of homocysteine in RVO and control group is found to be 23.80 and 12.43 whereas the standard deviation of homocysteine level in RVO group is 13.28 and control group is 10.58. Therefore levels of homocysteine are significantly higher in RVO group in comparison with control group. Vitamin B-12 level was 455.86 in control group and 325.8 in RVO group. The P value suggests that, Vitamin B12 was significantly lower in case group compared to controls. Vitamin B-12 levels were significantly lower in cases with a higher Homocysteine level. Hype-rhomocysteinemia and hypovitaminosis B12 is significantly present in cases of retinal vein occlusion irrespective of types and underlying systemic diseases.

Proton Pump Inhibitors Intake and Iron and Vitamin B12 Status: A Prospective Comparative Study with a Follow up of 12 Months.

BACKGROUND:Proton pump inhibitors (PPIs) represent the most widely prescribed antisecretory agents, but their prolonged use, may influence iron and vitamin B12 status, which could have important implications for clinical practice.AIM:We undertook this study aiming to investigate the association between PPIs use for 12 months and potential changes in iron and vitamin B12 status, as well as whether this potential association varies among four specific PPI drugs used in the study.METHODS:A total of 250 adult subjects were recruited into this study, of which 200 subjects were PPIs users while 50 subjects belonged to the control group. Serum iron, ferritin, vitamin B12, and homocysteine (Hcy) levels were measured before the start of the study and after 12 months. Mann - Whitney U test and Kruskal - Wallis test was used to compare the baseline characteristics of the study groups, while Wilcoxon test was used to analyse post - pre differences.RESULTS:Statistical analysis showed significant changes within PPIs group and specific PPIs subgroups between the two-time points in serum ferritin and vitamin B12 levels, respectively, while no significant changes in serum iron and homocysteine levels were shown. However, subsequent diagnosis of hypoferremia and hypovitaminosis B12 in the whole study sample at 12 months was established in only 3.8% and 2.9% of the subjects, respectively.CONCLUSION:PPIs use for 12 months did not result in clinically significant iron and/or vitamin B12 deficiency; thus, these findings argue routine screening under normal circumstances, although monitoring in elderly and malnourished may be of precious value.

Demographic Characteristics and Association of Serum Vitamin B12, Ferritin and Thyroid Function with Premature Canities in Indian Patients from an Urban Skin Clinic of North India: A Retrospective Analysis of 71 Cases.

Background:The incidence of self-reported premature hair graying (PHG) seems to be on the rise. PHG has a profound impact on the patient's quality of life. It remains an incompletely understood etiology with limited and modest treatment options.Aim:The evaluation of the demographic and clinical profile of patients with premature canities, and exploration of the association of this entity with certain systemic disorders suspected to be related to its etiology.Methods:Seventy-one cases of premature canities (onset noticed by patients before 25 years of age) presenting to an urban skin clinic in Gurugram, India, between September 2012 and September 2015 with this complaint were retrospectively analyzed. The patient records were retrieved that provided details of the onset, duration and pattern of involvement, history, and examination findings (scalp, cutis, and general physical). Since all these patients had been screened for anemia, thyroid disorder, fasting blood glucose, and Vitamin B12 levels at the time of presentation, these parameters were also available for analysis.Results:The mean age at onset of graying was 10.2 ± 3.6 years (range: 5–19 years), with an almost equal gender distribution. The earliest age of onset recorded was 5 years. A positive family history of PHG (at least one of the biological parents or siblings) was obtained in 64 (90.1%) of the cases. The temporal regions of the scalp (35.2%) were most commonly involved followed by the frontal region (18.3%). Hypovitaminosis B12 and hypothyroidism showed significant association with the disorder, whereas anemia, serum ferritin, and fasting blood glucose did not.Conclusion:The age of onset of hair graying can be as low as 5 years. Temporal and frontal areas are the most commonly involved sites. A strong family history, Vitamin B12 deficiency, and hypothyroidism are strongly associated with PHG. Larger case–control studies are mandated for discerning the correlation of these and other risk factors with PHG.

Assessment of homocysteine, Vitamin B12, and Zinc levels among patients with acute ischemic stroke in Northwestern Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality. Several risk factors have been identified, which are the target of preventive strategies, they include hyperhomocysteinemia, hypovitaminosis B12, and low zinc levels. There is paucity of data on the biochemical risk factors in our environment which necessitated this study. Objective: To evaluate the serum levels of homocysteine, vitamin B12, and zinc in patients with acute ischemic stroke in Zaria. Patients and Methods: This is a case-control study conducted over 13 months in ABUTH Zaria. One hundred patients with clinical diagnosis of ischemic stroke diagnosed, confirmed by brain CT-scan and Siriraj stroke score of less than -1, and equal number of apparently healthy age, and sex-matched were recruited. Their fasting serum homocysteine and vitamin B12 were measured using enzyme-linked immunosorbent assay, while zinc was measured using direct colorimetric method. Stroke severity was determined using National Institute of Health Stroke Score (NIHSS), patients with NIHSS score of 1–4, 5–15, and 16–42 were classified as mild, moderate, and severe stroke respectively. Results: Mean serum homocysteine for patients was significantly higher than that of controls (P < 0.05) and mean serum zinc and vitamin B12significantly lower compared to that of controls (P < 0.05). There was no association between hyperhomocysteinemia, low vitaminB12, and low zinc concentrations with the severity of stroke using NHISS Score. Conclusion: Elevated serum homocysteine, low vitamin B12, and zinc were found to be significant risk factors associated with ischemic stroke.

A 67-year-old man with cognitive decline incidentally diagnosed with gastric submucosal tumor

Introduction.–Vitamin B12 deficiency can lead tomemory loss, disorientation and dementia is well known from the past. Therefore when we first meet the patient who have cognitive decline, we must check the Vitamin B12 level. Methods and results.– A 67-year-old man visited our clinic with cognitive decline. He had no specific past history of illness. Two years ago, memory complaint was started. His neuropsychological test showed both frontal and left temporal lobe dysfunction. His educationwas 16years. Korean-MiniMental State Examination (KMMSE) score was 26 and Clinical Dementia Rating (CDR) score was 0.5. And sum of box score was 4. He was in mild dementia state. The routine lab tests revealed that he had vitamin B12 deficiency. Vitamin B12 level was 45pg/mL and homocysteinwas 83.8umol/L. His hemogoblin was 13.3 g/dL. Antiparietal cell antibody(Ab) was positive and anti intrinsic factor Abwas negative. Gastrin level was increased. Under the esophagogastroduodenoscopy, there was no evidence of atrophic gastritis but gastric submucosal tumor was found. If the autoimmune gastritis was in chronic state, atrophic gastritismight be found. Usually after chronic stage of autoimmune gastritis, gastric cell dysplasia and submucosal tumor can occur. But in this case, there was no anemia and no atrophic gastritis. It suggests his hypovitaminosis B12 state has not been that long. Conclusions.– Whether his submucosal tumor was due to autoimmune gastritis or incidental growth, it was a unique case who did not have pernicious anemia and atrophic gastritis have a gastric submucosal tumor.

Cobalamin deficiency, hyperhomocysteinemia, and dementia.

Although consensus guidelines recommend checking serum B12 in patients with dementia, clinicians are often faced with various questions: (1) Which patients should be tested? (2) What test should be ordered? (3) How are inferences made from such testing? (4) In addition to serum B12, should other tests be ordered? (5) Is B12 deficiency compatible with dementia of the Alzheimer's type? (6) What is to be expected from treatment? (7) How is B12 deficiency treated? On January 31st, 2009, a Medline search was performed revealing 1,627 citations related to cobalamin deficiency, hyperhomocysteinemia, and dementia. After limiting the search terms, all abstracts and/or articles and other references were categorized into six major groups (general, biochemistry, manifestations, associations and risks, evaluation, and treatment) and then reviewed in answering the above questions. The six major groups above are described in detail. Seventy-five key studies, series, and clinical trials were identified. Evidence-based suggestions for patient management were developed. Evidence is convincing that hyperhomocysteinemia, with or without hypovitaminosis B12, is a risk factor for dementia. In the absence of hyperhomocysteinemia, evidence is less convincing that hypovitaminosis B12 is a risk factor for dementia. B12 deficiency manifestations are variable and include abnormal psychiatric, neurological, gastrointestinal, and hematological findings. Radiological images of individuals with hyperhomocysteinemia frequently demonstrate leukoaraiosis. Assessing serum B12 and treatment of B12 deficiency is crucial for those cases in which pernicious anemia is suspected and may be useful for mild cognitive impairment and mild to moderate dementia. The serum B12 level is the standard initial test: 200 picograms per milliliter or less is low, and 201 to 350 picograms per milliliter is borderline low. Other tests may be indicated, including plasma homocysteine, serum methylmalonic acid, antiparietal cell and anti-intrinsic factor antibodies, and serum gastrin level. In B12 deficiency dementia with versus without pernicious anemia, there appear to be different manifestations, need for further workup, and responses to treatment. Dementia of the Alzheimer's type is a compatible diagnosis when B12 deficiency is found, unless it is caused by pernicious anemia. Patients with pernicious anemia generally respond favorably to supplemental B12 treatment, especially if pernicious anemia is diagnosed early in the course of the disease. Some patients without pernicious anemia, but with B12 deficiency and either mild cognitive impairment or mild to moderate dementia, might show some degree of cognitive improvement with supplemental B12 treatment. Evidence that supplemental B12 treatment is beneficial for patients without pernicious anemia, but with B12 deficiency and moderately-severe to severe dementia is scarce. Oral cyanocobalamin is generally favored over intramuscular cyanocobalamin.

Vitamin B12 concentrations in psychiatric patients

In an attempt to evaluate the possible relationship between vitamin B12 deficiency and mental disease, the blood content of vitamin B12 was investigated in 835 consecutive psychiatric patients. Low serum vitamin B12 values were found in approximately 10% of these patients, due to latent pernicious anaemia in one case, post-gastrectomy in seven cases and small intestinal resection in one case. In the remaining 72 cases vitamin B12 deficiency was probably caused by nutritional insufficiency. After correction of the dietary defect there was a spontaneous increase in serum vitamin B12 in 75% of these patients. No specific psychiatric syndrome was connected with hypovitaminosis B12, but a preponderance of arteriosclerotic dementia suggests that low serum vitamin B12 values are secondary to mental illness leading to apathy and loss of appetite. Most cases will recover without further vitamin B12 supplements. But some patients may need treatment because of severe mental and physical disabilities.

Evaluation of the Segal uropepsin test in screening for hypovitaminosis B12

Evaluation of the Segal uropepsin test in screening for hypovitaminosis B12

Some occult lesions in captive primates

AbstractRecent findings have shown that a state of hypovitaminosis B12 occurs easily in many primates in captivity on vegetarian diets. Pathological lesions of the nervous system, oral mucous membranes, blood, reproduction and growth which are extensive yet occult may result. Attention is drawn to these facts and their relevance to the experimentalist is noted.