Prevalence Of Vitamin B12 Deficiency Research Articles

Impact of Prevalent Dietary Pattern on Serum Vitamin B12 Status and Its Association With Inflammation Among Reproductive Age Women.

Association between vitamin B12 deficiency (VB12D) and dietary patterns being well documented has bearing on obstetrics and neonatal outcomes. However, relationship between VB12D and serum inflammatory markers (IMs), particularly in vegetarian diet and Polycystic ovary syndrome (PCOS), remains elusive. This cross-sectional study assesses VB12D and IMs among reproductive age women consuming different diets. Nonvegetarian (PCOS, n = 104; healthy, n = 148) and vegetarian women (PCOS n = 112; healthy, n = 186) are for evaluated clinical, biochemical, hormonal assessment, inflammatory, and four vitamin B 12 (VB12) markers. VB12D is defined by Fedosov's wellness quotient (4cB12). Using 4cB12, prevalence of VB12D is discerned in 54.4% (PCOS: 72.1%; healthy 36.5%) and 93.4% (PCOS: 95.9%; healthy: 91.9%) among nonvegetarians and vegetarians, respectively. Vegetarian PCOS women depict lowest median (interquartile range [IQR]) of serum B12 76.2(72.6) pgmL-1, holotranscobalamine (HTC) 37.9(11.3) and highest homocysteine (HCY) 40.32(6.0) µmolL-1, methylmalonic acid (MMA) 352.26(156.7) nmolL-1 with highest Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and IMs (Monocyte chemoattractant protein 1 (MCP-1), High sensitivity C-reactive protein (hs-CRP), Tumour Necrosis Factor alpha (TNF-α)and Interleukin 6 (IL-6)). Significant correlation of serum hs-CRP, TNF-α, and IL-6 with VB12 markers is observed. The VB12D is rampant among reproductive age women that gets exacerbated by PCOS or vegetarian diet. It is directly correlated with magnitude of proinflammatory markers. The results carry substantial implications for public health policies aimed at improving preconception maternal VB12 status for better future pregnancy and offspring outcomes.

Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar

It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing emergency, near famine-like conditions (IPC4). Although Madagascar is generally considered among the most undernourished of countries, empirical data in the form of biological samples to validate these claims are extremely limited. Our research drew data from three studies conducted between 2013–2020 and provided comprehensive biomarker profile information for 4,710 individuals from 30 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for both sexes and across all ages, with 66.5% of the population estimated to be deficient in zinc, 15.6% depleted in vitamin B12 (3.6% deficient), 11.6% deficient in retinol, and lower levels of iron deficiency (as indicated by 11.7% deficient in ferritin and 2.3% deficient assessed by soluble transferrin receptors). Beyond nutrient status biomarkers, nearly one quarter of the population (24.0%) exhibited chronic inflammation based on high values of α-1-acid glycoprotein, and 12.3% exhibited acute inflammation based on high values of C-reactive protein. There is an 8-fold difference between the lowest and highest regional observed prevalence of vitamin B12 deficiency, a 10-fold difference in vitamin A deficiency (based on retinol), and a 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on ferritin), highlighting strong geographical variations in micronutrient deficiencies across Madagascar.

Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12.

Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.

A review on vitamin B12 deficiency induced by metformin

Multiple studies have established a higher prevalence of vitamin B12 deficiency in patients who have type 2 diabetes mellitus (T2DM). Metformin is prescribed as the 1st line oral glucose-lowering medication for individuals with T2DM. However, metformin therapy has been linked to vitamin B12 malabsorption, which can result in both biochemical and clinical manifestations of vitamin B12 deficiency. The long-term use of metformin is associated with a significant decrease in vitamin B12 levels, particularly in doses greater than 2000 mg per day over a period of 4 years. Vitamin B12 is a water-soluble vitamin. It acts as a cofactor for enzymes involved in DNA synthesis and neuroprotection at the cellular level. Hence, vitamin B12 deficiency can lead to various clinical consequences, including hematologic abnormalities such as megaloblastic anemia and hypersegmented neutrophil formation, peripheral neuropathy, and progressive axonal demyelination, hyperhomocysteinemia (HHcy). The latest "standards of medical care in diabetes-2017" issued by the American diabetes association recommends periodic assessment of B12 status and, if necessary, the use of B12 replacement therapy in diabetic patients taking metformin. In order to address the vitamin B12 deficiency associated with metformin several therapies are available including prophylactic supplements of calcium and vitamin B12, discontinuation of metformin, and replenishment of vitamin B12 stores through intramuscular or oral therapy. It is important to regularly monitor vitamin B12 levels for at least annually to prevent complications of vitamin B12 deficiency and continue with supplementation if metformin is still being used.

VitaminB12 deficiency in diabetic patients treated with metformin: A narrative review.

Metformin is the most prescribed oral hypoglycemic drug and is considered by many health practitioners as the first-line treatment for non-insulin-dependent diabetes mellitus (T2DM). It is used either as a monotherapy or adjuvant to other anti-hyperglycemic agents. Most of its side effects are usually mild and self-limiting. However, several studies have shown an association between the use of metformin and low vitamin B12 levels in diabetic patients. The current review aimed to provide a literature review of the current published reports on the association, the possible mechanisms, and the related individualized risk factors that might lead to this incidence. The most accepted mechanism of the effect of metformin on vitamin B12 level is related to the absorption process where metformin antagonism of the calcium cation and interference with the calcium-dependent IF-vitamin B12 complex binding to the ileal cubilin receptor. In addition, many risk factors have been associated with the impact of metformin on vitamin B12 levels in diabetic patients such as dose and duration where longer durations showed a greater prevalence of developing vitamin B12 deficiency. Male patients showed lower levels of vitamin B12 compared to females. Black race showed a lower prevalence of vitamin B12 deficiency in metformin-treated patients. Moreover, chronic diseases including T2DM, hyperlipidemia, coronary artery disease, polycystic ovary disease (PCOD), obesity, and metformin therapy were significantly associated with increased risk of vitamin B12 deficiency.

Prevalence of Vitamin B12 deficiency in patients with type 2 diabetes mellitus on Metformin therapy at a single centre in Johannesburg, South Africa

Abstract Introduction: Metformin is a first-line oral hypoglycaemic agent for treating patients with type 2 diabetes mellitus (T2DM). Studies suggest that metformin use is associated with B12 deficiency. There is a paucity of data regarding this association in South Africa. The current study aimed to determine the prevalence of B12 deficiency in a South African cohort of T2DM patients on metformin therapy. Methods: The study was a retrospective clinical audit of patients recruited from a medical outpatient setting. A consecutive sampling technique was employed; T2DM patients who were 40 years or older and on metformin for a minimum of 6 months were recruited. B12 deficiency was defined as severe (&lt;150 pmol/L), moderate (150–169 pmol/L) or mild (170–200 pmol/L). Results: One hundred and one (n = 101) patients were enrolled, most of whom were females (65%). The prevalence of B12 deficiency was 14.9%, with most patients in the mild category. The majority of B12 deficient patients were female (67%), elderly (70.2 ±10.7 years) and of Coloured race (67%). The median duration of metformin use in B12 deficient and non-deficient patients was 10.9 (6–13) and 7 (3–12) years respectively (p =0.179). The median metformin dosage was 1700 mg. Older age (Adjusted odd ratio (AOR) 6.67 (1.16–38.3), p = 0.033) and Coloured race (AOR 7.8(1.78–34.2) p = 0.006) were associated with vitamin B12 deficiency. Conclusion: In our setting, vitamin B12 deficiency is prevalent amongst T2DM patients on metformin therapy. Older age and the novel finding of Coloured race were associated with B12 deficiency. We recommend screening for B12 deficiency amongst T2DM patients on metformin therapy.

Prevalence of vitamin B12 deficiency in patients treated with metformin

Background/Aim: Metformin has been associated with vitamin B 12 (cobalamin) deficiency, pushing scientific societies such as the American Diabetes Association and the European Association for the Study of Diabetes to emphasise the need for screening B 12 levels, without specific metformin doses or exposure durations triggering this screening. Robust data regarding the prevalence of B 12 deficiency in metformin-treated patients in Portugal are currently lacking. Aim of this study was to identify the prevalence of B 12 deficiency in a sample of diabetic patients taking metformin. Secondary objectives were determining the minimum dose and minimum and median time exposure time leading to this deficiency and identifying the average duration of metformin use in the patients with this deficiency. Methods: Descriptive and cross-sectional observational study was performed on a sample of 79 users from a population of 714 diabetic patients on metformin. Inclusion criteria comprised individuals aged 18 or older, receiving metformin for at least 1 month and voluntarily participating in the study. Exclusion criteria included a history of gastrectomy or B 12 supplementation. Results: A prevalence of 25.3 % of vitamin B 12 deficiency was identified in the study sample. Minimum doses of 500 mg of metformin per day and a minimum exposure period of 1 year were associated with B 12 deficiency. An average exposure time of 5.33 years was identified. Conclusion: These results align with the prevalence described in the few international studies and should alert physicians to potential clinical manifestations of this deficiency, such as anaemia and neurological symptoms like neuropathy.

Vitamin B12 Deficiency in Type 2 Diabetes Patients on Metformin

Type 2 Diabetes mellitus is a chronic metabolic disorder with complications of microangiopathies, macroangiopathies, neuropathy and nephropathy. Metformin is often the first line treatment in type 2 diabetes. There is evidence of a higher prevalence of vitamin B12 deficiency observed among patients on metformin. It is believed that Metformin may cause vitamin B12 malabsorption which aggravates neuropathy and anaemia. Methods A cross-sectional study was designed with randomly selected type 2 diabetes patients attending a tertiary diabetes clinic in Southern India, recruited over a period of 3 months, divided in 2 groups (control and study groups) based on their use of metformin. They were assessed for serum B12, Folic acid levels and mean corpuscular volume. Clinical manifestations of neuropathy, anaemia and vitamin B12 deficiency were documented on clinical examination. Results There were 100 patients recruited, showing those on metformin had a higher prevalence of vitamin B12 deficiency (58.3% vs 33.3%, p&lt;0.05), however, folic acid deficiency was lower (16.7% vs 37.5%, p&lt;0.05). Conclusion Patients with type 2 diabetes on metformin required protocols for monitoring and replacement of vitamin B12 as necessary, to prevent onset of neuropathy.

Prevalence and Predictors of Vitamin B12 Deficiency in Children with Severe Acute Malnutrition, and its Association with Development.

To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development. In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II). The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated (P <0.001) with developmental delay. There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.

Vitamin B&lt;sub&gt;12&lt;/sub&gt; – a scoping review for Nordic Nutrition Recommendations 2023

Vitamin B12 (cobalamin) is essential for normal metabolic function, and even moderate deficiency of this vitamin has negative health effects. Vitamin B12 is found in animal foods, and as vegetarian diets are increasingly popular in Western countries, one might expect a higher prevalence of vitamin B12 deficiency in the Nordic population. Setting recommendations for vitamin B12 intake has proven to be difficult, as uptake of vitamin B12 varies substantially, the clinical deficiency symptoms are often diffuse, and there is no clear agreement on the decision limits for vitamin B12 deficiency. Vitamin B12 deficiency is reported to be particularly common among pregnant women and infants, despite the fact that less than 1% of Norwegian pregnant women have a cobalamin intake below the Nordic Nutrition Recommendations 2012-recommended level of 2.0 µg/day. In addition, the assumption that breast milk contains sufficient vitamin B12 for optimal health and neurodevelopment during the first 6 months of life does not comply with the high prevalence of insufficient vitamin B12 status in this age group. Recommended intakes of vitamin B12 vary among age groups and must be based on markers of cobalamin status, indicating an optimal intracellular biochemical status, and not merely absence of clinical signs of vitamin B12 deficiency.

Vitamin B12 status among asymptomatic young adult females and its association with some anthropometric and biochemical parameters: A cross-sectional study from Makkah (cobalamin deficiency in young adult females).

This study was designed to measure the prevalence of vitamin B12 deficiency among young adult females in Makkah City and study its correlation with some anthropometric and biochemical indicators. A cross-sectional study and a detailed questionnaire were used to collect information from 402 young women aged 19 to 22 years, who were university students. Moreover, dietary assessments using a validated food frequency questionnaire and anthropometric measurements were performed. The mean values of serum vitamin B12, serum folate, hemoglobin, and body mass index (BMI) were 343.29 ± 148.16 pg/mL, 12.72 ± 2.62 ng/mL, 12.69 ± 1.41 g/dL, and 22.64 ± 4.24 kg/m2, respectively. About three-quarters of the study sample had normal vitamin B12 levels, while the rest had vitamin B12 deficiency. Meanwhile, a significant negative association (r = -0.201, P = .048) was found between abdominal fat and serum vitamin B12 levels. This study concluded that the young adult females' population from Makkah City is among the risk groups for vitamin B12 deficiency, which is highly correlated with inappropriate values of weight, body fat, and some blood indices. Appropriate dietary interventions and awareness are needed for this population.

Vitamin B12 Deficiency among Metformin Treated Type 2 Diabetic Mellitus Patients Visiting the Department of Medicine of a Tertiary Care Centre.

About 424.9 million people worldwide are affected by Diabetes mellitus. Prevalence among people 20-79 years old in Nepal was 4% in 2017. It is associated with microvascular and macrovascular complications such as peripheral neuropathy leading to risk of foot ulcers and amputation, and impaired sensation in their feet. The study aimed to find the prevalence of vitamin B12 deficiency among metformin-treated type 2 diabetic patients visiting the Department of Medicine of a tertiary care centre. A descriptive cross-sectional study was conducted in a tertiary care centre between 24 May 2021 to 24 May 2022 after obtaining ethical approval from the Institutional Review Committee. Patients who visited the Department of Medicine and gave informed consent were included in the study. Patients with underlying comorbidities were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 330 patients, vitamin B12 deficiency was seen in 33 (10%) (6.76-13.24, 95% Confidence Interval). Among them, 27 (81.82%) were male and 6 (18.18%) were female. The prevalence of vitamin B12 deficiency was found to be higher than other studies done in similar settings. diabetic neuropathy; metformin; type 2 diabetes; vitamin B12.

Prevalence of Vitamin B12 deficiency in Kano, northwestern Nigeria with reference to diabetes mellitus status and metformin use

Prevalence of Vitamin B12 deficiency in Kano, northwestern Nigeria with reference to diabetes mellitus status and metformin use

Evaluation of vitamin B12 values at time of diagnosis in 0- to 36-month-old children with food allergies

ObjectivesThe relationship between food allergies and vitamin B12 deficiency in young children remains unclear despite extensive studies on the nutritional status of affected children. The aim of this study was to compare vitamin B12 levels in children with recently diagnosed food allergies and healthy children ages 0 to 36 mo. MethodsA retrospective study at Başkent University Hospital analyzed 773 patients ages 0 to 36 mo. Participants were divided into two groups: food allergy and healthy. Vitamin B12 deficiency (<300 ng/mL) was assessed using χ2 tests and regression analyses. ResultsThe sample comprised 773 children ages 0 to 36 mo, with a mean age of 16 ± 9 mo (range: 1–36). Among the participants, 399 (52%) were healthy children, whereas 374 (48%) had food allergies. The prevalence of vitamin B12 deficiency was higher in children with food allergies (38%) than in healthy children (21%; P < 0.001). According to both univariate and multivariate regression analyses, formula feeding showed a negative association with vitamin B12 deficiency (β = –0.54; 95% confidence interval [CI], 0.35–0.97; P = 0.038). On the other hand, having allergic diseases (β = 0.69; 95% CI, 0.30–0.83; P = 0.040) and breastfeeding for <6 mo (β = 1.35; 95% CI, 1.41–10.50–0.50; P = 0.009) exhibited a positive association with vitamin B12 deficiency. ConclusionFood-allergic children ages 0 to 36 mo were at higher risk for vitamin B12 deficiency. Formula feeding had a protective effect, whereas allergic diseases and breastfeeding for <6 mo were risk factors. Further investigation is needed to understand the underlying mechanisms. Monitoring B12 levels and interventions are crucial for the nutritional well-being of food-allergic children.

Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis.

Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy. PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran's Q, I 2 tests. Egger's test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency. Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ± 4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I 2 : 98.85, τ 2 = 0.05, Q (13) = 1127.8, P < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness. Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.

Prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin, a cross-sectional study in primary healthcare.

Several studies documented that metformin use contributes to vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM). However, there has been a lack of data assessing this issue in Jordan. Assess the vitamin B12 serum levels, frequency of vitamin B12 deficiency, and related factors among Jordanian patients with T2DM patients treated with metformin. a total of 447 subjects attending a primary health care center were included in this cross-sectional study consisting of T2DM patients who use metformin and a control group of non-diabetics. Serum B12 levels were evaluated and B12 deficiency was defined as serum B12 levels ≤ 200 pmol/L. Associations of B12 serum levels or B12 deficiency with other factors like gender, age, and duration of T2DM were analyzed. There was no significant difference in serum B12 levels nor the frequency of vitamin B12 deficiency between T2DM metformin-treated patients and control groups. Among metformin-treated patients there was no difference relating to age, type 2 diabetes mellitus duration, proton pump inhibitors use, and metformin use (duration, dose) between patients with or without B12 deficiency. The prevalence of vitamin B12 deficiency among T2DM patients on metformin treatment in this study was high (48.9%). However, the treatment with metformin and the dose of metformin use was not associated with vitamin B12 deficiency.

Preliminary evaluation of the diagnostic performance of Roche Elecsys® active vitamin B12 versus total vitamin B12 for vitamin B12 deficiency screening.

The prevalence of vitamin B12 deficiency is high in at-risk populations with sometimes irreversible consequences. Beside total B12 (TVB12), active B12 (AVB12) is a promising first-line marker. Only Abbott AVB12 assays were largely evaluated and generally demonstrated benefit in clinical practice. More recently developed Roche AVB12 still requires some investigations. Our study aimed to evaluate the Roche Elecsys® AVB12 immunoassay performance versus Roche Elecsys® TVB12 competition assay. and Methods: We included 175 patients at Rouen University Hospital who had a TVB12 value <300 pmol/L. We evaluated performance of AVB12 by comparing the results with TVB12 and MMA values in case of disagreement. Positive correlation was found between the AVB12 and TVB12. We found a disagreement between TVB12 and AVB12 in 18.8% of cases. Among 33 cases of disagreement, 76% had normal AVB12 but low TVB12, whereas 24% had low AVB12 and normal TVB12. Thirty-one MMA determinations were performed: 71% showed agreement between MMA and AVB12, versus 29% between MMA and TVB12. TVB12 reported a sensitivity (Se) at 66.7%, specificity (Sp) at 20%, positive predictive value (PPV) at 16.7% and negative predictive value (NPV) at 71.4% for the prediction of MMA elevation. We determined an optimized cut-off value of 45.5 pmol/L for AVB12, which reported a Se 66.7%, Sp 60%, PPV 30.7%, and NPV 88.9%. Our results provide preliminary evidence that Roche AVB12 may offer better discrimination than Roche TVB12 in the diagnosis of vitamin B12 deficiency. Further more detailed evaluation is warranted.

A Study on Vitamin B12 Levels in Hypothyroid Patients Presenting to a Tertiary Care Teaching Hospital.

Background and aims The prevalence of vitamin B12 deficiency is found to coexist in hypothyroid patients, causing the persistence of symptoms concomitant to both diseases even on adequate thyroxine supplementation. Primary objective To study vitamin B12 levels in patients with hypothyroidism. Secondary objective To study the clinical profile of patients with hypothyroidism with special reference to anemia, and to study the association between vitamin B12 deficiency with anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroglobulin (anti-Tg) antibodies in patients with hypothyroidism. Methods and results A single-centriccross-sectional study was carried out over a period of one year. Among 100 hypothyroid patients, 68% were found to be vitamin B12 deficient, among whom 73.5% were females. Of patients with raised anti-TPO antibodies,78.6% had vitamin B12 deficiency (p = 0.01), while 78% of patients with raised anti-Tg antibodies were vitamin B12 deficient (p = 0.07). The Pearson correlation coefficient (r) of vitamin B12 with anti-TPO and anti-Tg antibodies was -0.302 (p = 0.002) and -0.253 (p = 0.011), respectively. Conclusion There is a predilection of hypothyroid patients towarddeveloping anemia, with vitamin B12 deficiency as a major etiology. This finding can be correlated with the hematopoietic action of thyroid-stimulating hormones as well as autoimmune thyroid disease predisposing to pernicious anemia.

Effects of metformin on vitamin B12 levels, including dose and duration of therapy: a narrative review

Background: Metformin, a biguanide derivative medication, is administered worldwide as the first-line treatment for patients with type 2 diabetes mellitus. Despite its many advantages, it is not devoid of side effects. As many studies have evidenced thus far, metformin treatment may increase the risk of vitamin B12 deficiency, with the prevalence of this deficiency varying from 1.8% to 53.2%. We performed a review of studies to summarize their results and present dose and duration associations between metformin therapy and serum cobalamin levels. Aim of the study: The purpose of this study was to evaluate the relationship between metformin and vitamin B12 deficiency from a historical perspective.Material and Methods: Thirty articles focused on vitamin B12 deficiency during metformin therapy, collected from the PubMed database from 1971 to July 2021, were analyzed.Results: Based on the literature reviewed, we observed a prevalence of vitamin B12 deficiency with metformin use ranging from 1.8% to 53.2%, with a median of 11.2%. In studies with follow-up longer than six months, the incidence of vitamin B12 deficiency during metformin treatment was approximately 6–10%. The vast majority of studies showed an inverse correlation between dose and length of metformin intake and serum vitamin B12 levels. The findings of three out of 16 analyzed studies proved dose-only associations, and the other three showed time-only effects. Two studies found no relationship with these variables.Conclusions: Patients undergoing long-term metformin therapy, especially at high doses, should have their vitamin B12 levels measured regularly to protect them from complications resulting from cobalamin deficiency.

Prevalence and determinants of Vitamin B12 deficiency among subjects with Type 2 Diabetes in a tertiary institution in Southeast Nigeria

Vitamin B12 (Vit B12) deficiency is very common among diabetic subjects, although with variable prevalence. The aim of this study is to determine the prevalence of Vit B12 deficiency and its associated factors among patients with Diabetes Mellitus (DM). This study is important because Vit B12 deficiency is associated with metformin, which is a bedrock in the management of diabetic subjects. Since peripheral neuropathy is a recognized complication of DM, and also occurs in Vit B12 deficiency, it would be important to ascertain the role of Vit B12 deficiency in the emergence of peripheral neuropathy. Appropriate measures like vitamin supplementation would then be instituted in diabetics who are on metformin. A cross-sectional study was conducted at Enugu State University Teaching Hospital in Enugu, Nigeria, between January to July 2019. A total of 422 patients who fit the eligibility criteria were included in the study. Data on demographics, medication use, and anthropometry were obtained from each subject, while blood was drawn to study Vit B12 levels, Haemoglobin (Hb), Mean Cell Volume (MCV), and Glycated Heamoglobin (HbA1c). Vitamin B12 deficiency was defined as serum B12 level of ≤200 pg/mL. The prevalence of vitamin B12 deficiency among Type 2 DM patients was 16.6% (n=364). Predictors of Vit B12 deficiency in Type 2 diabetic subjects included duration of metformin use of more than five years (p&lt;0.0001). Other predictors of vitamin B12 deficiency include Body Mass Index (BMI), diabetes duration, and macrocytic anemia. This study suggests that the prevalence of Vit B12 deficiency among patients with DM in our population is substantial. This is more frequent among patients who have been on metformin for more than five years.