Low Serum Levels Of Vitamin B12 Research Articles

Relationship between vitamin B12 levels and insulin resistance in postmenopausal women from Colombia Caribbean

Introduction: The high prevalence of low vitamin B12 serum levels has been recognized as a public health problem in Latin America; however, the current magnitude of this deficiency in Colombia is uncertain. Low levels of vitamin B12 can induce clinical and subclinical hematological and neurological disorders. Epidemiological studies have demonstrated a relationship between vitamin B12 deficiency and cardiovascular diseases (CVDs). However, the role of vitamin B12 in insulin resistance has been poorly studied. Objective: This study aimed to evaluate the relationship between vitamin B12 serum levels and biochemical and anthropometric markers related to CVDs and insulin resistance in postmenopausal women from Colombia Caribbean. Methods: Correlational, descriptive study. By convenience sampling, 182 postmenopausal women from the medical consultation service of a health institution were linked. Serum vitamin B12 levels, anthropometric variables (body mass index, abdominal perimeter), and biochemical variables (glycemia, insulin, lipid profile, HOMA IR) were evaluated. Results: The average value of the vitamin B12 serum level was 312.5 ± 122.5 pg/mL (230.6 ± 90.4 pmol/L); 46.7% of the women had less than adequate levels of 300 pg/mL (> 221 pmol/L), and 9. 9% were deficient, with levels of less than 200 pg/mL (148 pmol/L). The women with metabolic syndrome were 63.7%, and according to HOMA IR, 52.7 % had insulin resistance. A significant inverse relationship was shown between serum vitamin B12 levels with basal glycemic (P =0.002) and HOMA-IR (P =0.040). Conclusions: A significant inverse relationship between vitamin B12 levels and basal glycemia and HOMA-IR was observed. These findings highlight vitamin B12 deficiency in postmenopausal women and suggest nutritional supplementation.

Comparison of first-episode psychosis and firstepisode mania patients with healthy controls regarding serum vitamin B12 and folate levels

Objective: There is information in the literature that vitamin B12 and folate play a role in the etiology of schizophrenia and bipolar disorder. On the basis of this idea, in this study, we compared patients with schizophrenia and bipolar disorder in their first episode of illness with healthy controls (HC) regarding their vitamin B12 and folate levels. Method: In this study, vitamin B12 and folate blood levels of patients with first-episode psychosis (FEP) and first-episode mania (FEM) were compared with those of HC. Sixty-seven volunteers aged 18–65 years without any additional psychiatric or organic diseases were recruited from all three groups. Results: According to the statistical analysis, vitamin B12 blood level was significantly lower in the FEP group than in HC (p=0.002). According to the logistic regression analyses, it was determined that vitamin B12 blood levels significantly predicted being in the FEP group (p=0.009), whereas neither vitamin B12 nor folate blood levels were associated with being in the FEM group. The predictive effect of vitamin B12 deficiency for being in the FEP group was statistically significant (p=0.002), whereas the diagnosis of vitamin B12 deficiency alone was not associated with being in the FEM group. Conclusion: Low vitamin B12 serum levels can be seen in patients with FEP. In these patients, vitamin B12 replacement therapy may increase the effect of antipsychotic therapy.

Low vitamin B12 levels and gastric parietal cell antibodies in patients with aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders

In up to 80 % of patients, neuromyelitis optica (NMO, Devic’s syndrome), is associated with antibodies to aquaporin-4 (AQP4-Ab), the most abundant water channel in the central nervous system [2, 6–8, 10, 11]. However, AQP4 is also highly expressed in the basal cell membrane of gastric parietal cells (GPC) and, accordingly, serum AQP4-Ab from patients with NMO has been shown to bind to GPC [10]. The latter fact is of particular interest because humoral autoimmunity to GPC is a common cause of vitamin B12 deficiency and because low vitamin B12 levels can cause subacute combined degeneration of the spinal cord (SACD) as well as optic neuropathy and may thus aggravate neurological deficits in patients with NMO, a disease mainly characterized by spinal cord and optic nerve damage (Fig. 1) [14]. Moreover, AQP4-Ab is known to be frequently associated with other, co-existing autoantibodies; however, the frequency of gastric parietal cell antibodies (PCA) in NMO has not been systematically studied so far. We retrospectively identified 13 patients with NMO spectrum disorders (NMOSD) in whom vitamin B12 levels had been determined as part of the diagnostic workup (Table 1). All of these patients were AQP4-IgGpositive. In 6 of the 13 patients (46.2 %) vitamin B12 serum levels were low (\300 pmol/l) [12]. Levels ranged between 118 and 204 pmol/l (median, 150 pmol/l) (Table 1). Methylmalonic acid (MMA) and homocystein (HC), respectively, two markers of vitamin B12 deficiency, had been determined in two of these patients and were elevated in both (MMA: 5.19 mg/g creatinine, reference range,\2; HC: 15.4, reference range,\13.9). In three further patients, repeat testing was done and confirmed the low serum vitamin B12 status (160 pmol/l at baseline and 170 pmol/l 24 months later in patient 1; 204 at baseline and 259 64 months later in patient 2; 166 at baseline, 174 1 month later, and 139 another 18 months later in patient 3). Classical cytoplasmic PCA were present in three patients, two of whom had low vitamin B12 levels. Of these three patients, two had anti-H/K-ATPase (HKA) and none had anti-intrinsic-factor antibodies (IFA); one had classic PCA but was negative for both HKA and IFA. The remaining four patients with low vitamin B12 levels were all negative for HKA and IFA. Of note, vitamin B12 levels were also not very high in most of the remaining patients (median, 365 pmol/l; after excluding one patient with values[1500, which indicate possible vitamin B12 supplementation). Disease duration at the time of blood sampling did not differ significantly between patients with vitamin B12 levels \300 pmol/l and the remaining patients (68 vs. 42 months). Our results suggest that low vitamin B12 serum levels may be relatively common in AQP4-Abpositive NMOSD. The finding that a subgroup of patients harbors HKA is in line with a known predisposition towards humoral autoimmunity in patients with AQP4-Abpositive NMO, which has been previously reported in association with myasthenia gravis [5, 9], connective tissue disorders [4, 13, 15], or celiac disease [1, 3]. Interestingly, S. Jarius (&) B. Wildemann Division of Molecular Neuroimmunology, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany e-mail: sven.jarius@med.uni-heidelberg.de

Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the literature

Elevated serum homocysteine, decreased folate and low vitamin B(12) serum levels are associated with poor cognitive function, cognitive decline and dementia. Despite evidence of an epidemiological association, randomised controlled trials did not provide any clear evidence so far that supplementation with vitamin B(12) and/or folate improves dementia or slows cognitive decline, even though it might normalise homocysteine levels. In this report, we review the current knowledge on the relationship between homocysteine, folate and vitamin B(12) levels and the way their disruption influences cognitive function in adults.

Vitamin B12 Status and Its Association with Helicobacter pylori Infection in Alcohol Dependent Patients

Both infection with Helicobacter pylori and alcohol abuse have been associated with low vitamin B12 serum levels. The interaction between both risk factors is unknown. The aim of this study was to determine whether Helicobacter pylori infection is associated with low vitamin B12 levels in alcohol dependent patients. Blood samples were obtained from adult alcohol dependent patients undergoing detoxification and analyzed for serum vitamin B12 levels. Helicobacter pylori infection was serologically measured. Patient characteristics, medication use and alcohol consumption at admission were assessed by interview. A total of 6 out of 89 patients included presented low vitamin B12 levels, all were sub clinical deficient (<250 pmol/L) and none were clinical deficient (<150 pmol/L). Infection with Helicobacter pylori was present in 29% of the patients. The average vitamin B12 levels in Helicobacter pylori seropositive and seronegative patients were 1,033 pmol/L (SD 741) and 971 pmol/L (SD 717), respectively. The relation between Helicobacter pylori infection and vitamin B12 deficiency was not of significance (OR=0.48; 95% CI [0.05-4.32]). In conclusion, Helicobacter pylori infection is not a risk factor for low vitamin B12 levels in alcohol dependent patients.

Subnormal serum vitamin B12 and behavioural and psychological symptoms in Alzheimer's disease.

The objective of this study was to examine whether patients with Alzheimer's disease (AD) with subnormal vitamin B12 levels show more frequent behavioural and psychological symptoms of dementia (BPSD) than AD patients with normal vitamin B12 levels. The design was a prospective case-control study. The study took place at a memory-clinic of a department of geriatric medicine in a teaching hospital. There were seventy-three consecutive outpatients with probable AD, including 61 patients with normal and 12 patients with subnormal (<200 pg/ml) vitamin B12. BPSD were measured using the subscales disturbed behaviour and mood of the Nurses' Observation Scale for Geriatric Patients (NOSGER), the Cornell Scale for Depression and the four criteria for personality change in dementia from the International Classification of Diseases (ICD-10). Controlling for dementia duration and degree of severity of the cognitive deficits, there were significant inverse associations between vitamin B12 status and ICD-10 irritability (p=0.045) and NOSGER subscale disturbed behaviour (p=0.015). Low vitamin B12 serum levels are associated with BPSD in AD. Vitamin B12 could play a role in the pathogenesis of behavioural changes in AD.