Risk Factors For B12 Deficiency Research Articles

Vitamin B12 Supplementation in Psychiatric Practice.

Vitamin B12 (B12, cobalamin) deficiency has been associated with neuropsychiatric symptoms, suggesting a role for B12 supplementation both as a treatment for psychiatric symptoms due to B12 deficiency and as an augmentation strategy for pharmacological treatments of psychiatric disorders. This critical review discusses the major causes of B12 deficiency, the range of psychiatric and non-psychiatric manifestations of B12 deficiency, the indications for testing B12 levels, and the evidence for B12 supplementation for major psychiatric disorders. We find that high-quality evidence shows no benefit to routine B12 supplementation for mild depressive symptoms or to prevent depression. There is very limited evidence on the role of B12 supplementation to augment antidepressants. No high-quality evidence to date suggests a role for routine B12 supplementation in any other major psychiatric disorder. No formal guidelines indicate when clinicians should test B12 levels for common psychiatric symptoms, in the absence of major risk factors for deficiency or cardinal symptoms of deficiency. No robust evidence currently supports routine B12 supplementation for major psychiatric disorders. However, psychiatrists should be aware of the important risk factors for B12 deficiency and should be able to identify symptoms of B12 deficiency, which requires prompt testing, medical workup, and treatment. Testing for B12 deficiency should be considered for atypical or severe psychiatric presentations.

Prevalence of Vitamin B12 Deficiency among Exclusively Breast Fed Term Infants in South India.

Vitamin B12 is not synthesized in the body and its only dietary sources are non-vegetarian. The breast milk of mothers in resource poor countries who are on predominantly vegetarian diets is deficient in vitamin B12. Hence exclusive breast feeding (EBF) may result in B12 deficiency in the infant, which can affect the neurodevelopmental outcome. Our aim was to study the serum vitamin B12 levels among EBF infants and identify the risk factors for B12 deficiency. This cross-sectional study was done among EBF, term, otherwise healthy infants, 1-6 month of age in the well-baby clinic .The sociodemographic data of mother and the infants' anthropometric measurements were noted and blood samples were sent for complete blood count and serum vitamin B12 levels. The data were analysed using SPSS software version 16. We enrolled 149 EBF infants, aged 1-6 months and the mean age was 3.1 (±1.03) months. The mean serum vitamin B12 level was 199.91 (±112.523) pg/ml. Low serum vitamin B12 levels (<200 pg/ml) was seen in 95 (63.7%) infants. On multivariate analysis, there were no other significant risk factors for B12 deficiency in the infants. The prevalence of vitamin B12 deficiency among EBF infants is 63.7%. Because of its importance in neurological development during infancy, there is an urgent need to address this issue while promoting exclusive breast feeding.

Characterization of B12 Deficiency in Patients with Plasma Cell Disorders

Background:Although vitamin B12 deficiency has been reported in patients with plasma cell dyscrasias (PCDs), no mechanism has been identified. Excess free light chains (FLCs), readily measurable by the serum FLC assay since 2001, could disrupt the renal proximal tubule receptors megalin and cubulin where B12 is reabsorbed. We sought to identify risk factors for B12 deficiency in PCD patients to elucidate a possible mechanism. In particular, we hypothesized that rates of B12 deficiency would be higher in PCD patients with higher FLC burdens.Methods:Of 1482 patients with ICD9 codes for PCDs, 530 met the inclusion criteria of having both serum B12 and FLC values. We reviewed the electronic medical records to obtain clinical data collected in the time preceding the patient's lowest B12 level. Patients were excluded if the lowest B12 was elevated in the setting of known concurrent vitamin B12 replacement therapy.Data from eligible patients were analyzed using chi-square, Student's independent t test, and Spearman's rank-order correlation to identify associations between B12 insufficiency (defined as <250 pg/ml or <350pg/ml and B12 treatment history) and PCD characteristics. This retrospective study was approved by the Mount Sinai IRB.Results:Overall, 26.6% patients were found have vitamin B12 insufficiency. Other than an IgG isotype PCD (P=0.025) there were no significant differences in age, gender, or PCD diagnosis between patients with and without B12 insufficiency (see Table 1).As expected, there was a strong negative correlation between eGFR and involved FLC, r(248) = -0.277, p < 0.001. However, unexpectedly, there was also a significant negative correlation between B12 level and eGFR, rs(487) = -0.106, p = 0.019 such that insufficient B12 was associated with normal eGFR (p = 0.001). There was no correlation between B12 level and involved FLC (p = 0.948) nor B12 level and Bence Jones proteinuria (p = 0.302).Discussion:While our data do not appear to support the proposed mechanism of FLC disruption of renal receptors, B12 deficiency was more common in our sample (26.6%) than the previously reported 13.6% prevalence among PCD patients (Baz et al Cancer 2004). While B12 deficiency and PCDs are both associated with higher age, the prevalence of B12 deficiency among older adults is only 10-15% (Baik et al Annu Rev Nutr 1999). Therefore, prospective studies are needed to explore other characteristics of PCD patients, such as chemotherapy treatment (Tandon et al Indian Pediatr 2015) or aspirin use (van Oijen et al Am J Cardiol 2004), contributing to a high prevalence of B12 deficiency in this population. Detection and treatment of B12 deficiency among PCD patients remains clinically important to reduce ensuing sequelae of neurologic dysfunction and cytopenias, which are complications of PCDs and their treatments.Table 1Demographics and disease characteristics by B12 status.Vitamin B12 StatusInsufficient B12Normal B12TotalpGenderN%aN%aN%bMale7830.218069.825848.70.066Female6323.220976.827251.3Total14126.638973.4530Age at PCD Diagnosis (median)61620.857PCDN%aN%aN%bMultiple myeloma6035.910764.116778.40.488Non-multiple myeloma1430.43269.64621.6Total7434.713965.3213IsotypeN%aN%aN%bIgG5044.26355.811353.30.025IgA922.53177.54018.9IgM330.0770.0104.7Kappa only416.02184.02511.8Lambda only833.31666.72411.3Total7434.913865.1212Renal Function (KDOQI stages)N%aN%aN%bStage 1-25236.98963.114129.00.001Stage 36729.116370.923047.2Stage 41216.76083.37214.8Stage 5818.23681.8449.0Total13928.534871.5487a row percent, b column percentTable 2Light chain burden and relevant labs by B12 status.Vitamin B12 StatusInsufficient B12Normal B12TotalpFLC Burden*N%aN%aN%bNormal FLC1234.32365.73516.40.354Not measurable FLC, abnl ratio2340.43459.65726.8Measureable FLC, nl BJP1826.15173.96932.4Measurable FLC, elevated BJP1544.11955.93416.0Massive BJP (>3g/24hr)633.31266.7188.5Total7434.713965.3213Labs (medians)Folate, serum14.014.60.919MCV91.392.40.055Hemoglobin10.910.60.940LDH1861990.145Albumin3.83.90.958*normal = (sFLC<100mg/l), k/l ratio 0.26-1.85; measureable = sFLC ³100mg/l; abnl ratio = k/l ratio<0.26 or >1.85; elevated bence jones protein (BJP) = M-spike or BJP>200mg/24hrarow percent, b column percent DisclosuresChari:Array Biopharma: Consultancy, Other: Institutional Research Funding, Research Funding; Biotest: Other: Institutional Research Funding; Millennium/Takeda: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Onyx: Consultancy, Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Higher prevalence of metformin-induced vitamin B12 deficiency in sulfonylurea combination compared with insulin combination in patients with type 2 diabetes: a cross-sectional study.

Long-term and high-dose treatment with metformin is known to be associated with vitamin B12 deficiency in patients with type 2 diabetes. We investigated whether the prevalence of B12 deficiency was different in patients treated with different combination of hypoglycemic agents with metformin during the same time period. A total of 394 patients with type 2 diabetes treated with metformin and sulfonylurea (S+M group, n = 299) or metformin and insulin (I+M group, n = 95) were consecutively recruited. The vitamin B12 and folate levels were quantified using the chemiluminescent enzyme immunoassay. Vitamin B12 deficiency was defined as vitamin B12≤300 pg/mL without folate deficiency (folate>4 ng/mL). The mean age of and duration of diabetes in the subjects were 59.4±10.5 years and 12.2±6.7 years, respectively. The mean vitamin B12 level of the total population was 638.0±279.6 pg/mL. The mean serum B12 levels were significantly lower in the S+M group compared with the I+M group (600.0±266.5 vs. 757.7±287.6 pg/mL, P<0.001). The prevalence of vitamin B12 deficiency in the metformin-treated patients was significantly higher in the S+M group compared with the I+M group (17.4% vs. 4.2%, P = 0.001). After adjustment for various factors, such as age, sex, diabetic duration, duration or daily dose of metformin, diabetic complications, and presence of anemia, sulfonylurea use was a significant independent risk factor for B12 deficiency (OR = 4.74, 95% CI 1.41–15.99, P = 0.012). In conclusion, our study demonstrated that patients with type 2 diabetes who were treated with metformin combined with sulfonylurea require clinical attention for vitamin B12 deficiency and regular monitoring of their vitamin B12 levels.

Should we monitor vitamin B12 and folate levels in Crohn's disease patients?

Objective. Crohn's disease commonly involves the small intestine, which is the site of vitamin B12 and folate absorption. Our aim was to define the prevalence of vitamin B12 and folate deficiency in patients with Crohn's disease and to identify predictive factors associated with such abnormalities. Methods. Two years prospective study of 180 consecutive Crohn's disease patients. Vitamin B12 and folate deficiency was defined as serum levels below 200 pg/ml and 3 ng/ml, respectively. We analysed prevalence of these deficiencies and possible predictive factors including small intestine resection, disease location, activity and duration of disease. Controls were ulcerative colitis patients (n = 70). Results. The prevalence of B12 deficiency in Crohn's disease was 15.6% (95%CI 9.7–20%) compared with 2.8% (95%CI 0.8–9.8%) in ulcerative colitis (p = 0.007). With regard to folate deficiency, the prevalence in patients with Crohn's disease was 22.2% (95%CI 16–28%) compared with 4.3% (95%CI 1.4–12%) in ulcerative colitis (p = 0.001); 7.8% of Crohn's disease patients had macrocytic anemia. Ileal resection was found to be a risk factor for B12 deficiency (OR 2.7; 1.2–6.7; p = 0.02), and disease activity a risk factor for folate deficiency (OR 2.4; 1.2–5.1; p = 0.01). Conclusion. A significant proportion of patients with Crohn's disease suffer from vitamin B12 and/or folate deficiency, suggesting that regular screening should be performed, with closer monitoring in patients with ileal resection or active disease.

PWE-093 Screening with Holotranscobalamin is Superior to Serum B12 in Identifying Vitamin B12 Deficiency in Patients with Crohn’S Disease

IntroductionRisk factors for vitamin B12 deficiency in patients with Crohn’s disease (CD) include ileal disease and previous ileal resections. Screening for B12 deficiency is traditionally through serum B12 which is...

Prevalence of and Risk Factors for Vitamin B12 Deficiency in Patients with Crohnʼs Disease

Purpose: Crohn's disease is an inflammatory condition of the GI tract that can commonly involve the terminal ileum which is the site of B12 absorption. The aim of this study was to define the prevalence of vitamin B12 deficiency in a population with Crohn's disease and to identify risk factors associated with B12 deficiency. Methods: Medical records of 201 patients with Crohn's disease evaluated at a tertiary care center were retrospectively reviewed to determine the prevalence of B12 deficiency and to evaluate for risk factors associated with B12 deficiency. The prevalence of B12 deficiency in a control population of 40 patients with ulcerative colitis was also assessed. Results: The prevalence of an abnormal B12 level in patients with Crohn's disease was 18.4% (95% CI 13.1–23.8%) compared with 5% (95% CI 0–11.8%) (p=.035) in ulcerative colitis controls. Risk factors for B12 deficiency in patients with Crohn's disease included prior ileal (OR, 7.22; 95%CI 1.97–26.51) or ileocolonic (OR, 5.81; 95% CI 2.09–16.12) resection and the need for ongoing medical therapy (OR, 2.59; 95% CI 1.03–6.47). Neither disease location nor duration was independently associated with the risk of B12 deficiency. Conclusions: Abnormal B12 levels are common in patients with Crohn's disease. Given the complications that can be seen with low B12 levels, and the high prevalence in this population, we would advocate that patients with Crohn's disease be screened for B12 deficiency as part of the ongoing care for the management of the Crohn's disease. Special attention should be given to those that have had a prior ileal or ileocolonic surgery.