Risk Of Vitamin B12 Deficiency Research Articles

Factors associated with an increased risk of vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin

ABSTRACTBackgroundMetformin is used to treat type 2 diabetes mellitus, but prolonged use has been associated with vitamin B12 deficiency. Many other factors have also been associated with vitamin B12 deficiency. Studies on the possible additive effect of risk factors for developing a vitamin B12 deficiency are lacking.AimThe objective of this study was to assess the correlation between other known risk factors for vitamin B12 deficiency among patients with type 2 diabetes mellitus prescribed metformin who had a vitamin B12 deficiency.MethodFor inclusion in this single‐centre, retrospective cohort study, patients needed to be at least 18 years old, diagnosed with type 2 diabetes, taking metformin for at least 2 years and actively taking metformin during the study period. The primary outcome was the rate of low B12 levels with metformin. Secondary outcomes were risk factors associated with B12 deficiency. The patient and clinical characteristics were compared between the two study groups using Student's t‐test for continuous variables and chi‐squared tests for categorical variables. This project was exempt due to the local policy requirements that constitute research by the University of Arkansas for Medical Sciences Institutional Review Board (IRB) (IRB Program Manager, 11 August 2021). The justification for this ethics exemption was as follows: the project was determined to be of minimal risk to privacy of subjects because the research team had mechanisms to protect the personal health identifiers from improper use or disclosure; to destroy the identifiers at the earliest opportunity consistent with the conduct of research, and provided assurance that the identifiers will not be re‐used or disclosed to any other person or entity, except as required by law, for authorised oversight of the research project, or for other research as permitted by the HIPAA regulations.ResultsA total of 387 patients were included in this study, from which 364 patients had a vitamin B12 deficiency. The cohort was an average 69‐years‐old and predominantly female (66%). No risk factors were associated with a higher incidence of B12 deficiency. Patient age (p = 0.0063) and time on metformin (p = 0.0144) were significantly and negatively correlated with B12 deficiency.ConclusionYounger age and shorter duration of metformin use may increase the risk of vitamin B12 deficiency. Although guidelines recommend occasional checks, only 21% of patients had vitamin B12 levels assessed during the study period.

Vitamin B12 status and hyperhomocysteinemia in patients with Rheumatoid arthritis treated with methotrexate and folic acid

BackgroundRheumatoid arthritis (RA) is an inflammatory arthritis in which the immune system targets synovial joints. Methotrexate serves as the mainstay of treatment for RA due to its efficacy. However, patients treated with methotrexate are uniquely at risk for vitamin B12 deficiency and hyperhomocysteinemia due to coincident disease risk factors and the fact that methotrexate use is associated with malabsorption. The objective of this study was to assess for vitamin B12 deficiency among patients with RA treated with methotrexate and folic acid. MethodsThis cross-sectional study included 50 patients with RA treated with methotrexate and folic acid and 49 patients with RA treated with other therapies. Patients were matched by age, sex, race, renal function, and disease activity. We compared plasma vitamin B12, methylmalonic acid, and homocysteine levels between these two groups utilizing quantitative and categorical analyses. ResultsThirty-seven (74%) RA patients on methotrexate and folic acid had elevated plasma homocysteine levels compared with only 27 (55%) RA patients receiving other therapies (P < 0.05). The proportion of patients with low vitamin B12 and high methylmalonic acid levels did not differ between the two groups. ConclusionsOur data show high plasma homocysteine levels among RA patients treated with methotrexate and folic acid. While plasma vitamin B12 levels were similar between the two groups, high plasma homocysteine is also a sensitive marker of vitamin B12 deficiency. Additional studies should evaluate for the presence of clinical features of vitamin B12 deficiency and hyperhomocysteinemia among RA patients treated with methotrexate and folic acid.

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.

Vitamin B12 deficiency in older people: a practical approach to recognition and management

AbstractVitamin B12 deficiency is common in older people and is linked to anaemia, cognitive decline, and dementia. Clinical presentation is variable, ranging from no symptoms or subtle, non‐specific symptoms, through to serious, irreversible neurological symptoms if left untreated. Although common, it is often under‐recognised, with diagnosis usually occurring on incidental blood test screening. Older people are at increased risk of vitamin B12 deficiency due to insufficient dietary intake, malabsorption associated with aged‐related changes in gastrointestinal function, higher incidence of pernicious anaemia, and chronic use of interfering medications such as metformin and proton‐pump inhibitors. Early detection and treatment in symptomatic deficiency are crucial to prevent irreversible damage. Vitamin B12 intramuscular injection bypasses potential absorption issues and is traditionally the first‐line treatment in older people. However, emerging evidence suggests that high‐dose oral replacement may be as effective. Older people often require lifelong therapy due to the irreversible nature of the underlying cause of deficiency. This review provides an overview of vitamin B12 deficiency and its management in older people.

Risk of Anemia and Vitamin B12 Deficiency in Patients with Type 2 Diabetes Mellitus on Metformin Therapy: A Systematic Review and Meta-Analysis

Introduction Metformin is a commonly used medication for the treatment of Type 2 Diabetes Mellitus (T2DM). It has also been hypothesized to reduce the absorption of vitamin B12 in the GI tract. Development of B12 deficiency due to metformin-associated reduced absorption would take years to develop, because vitamin B12 has sufficient stores for 3-10 years. As such, the present systematic review and meta-analysis aims to evaluate the effect of metformin on anemia and vitamin B12 deficiency, with outcomes stratified by duration and dosage of metformin exposure. Methods Electronic searches were conducted on MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to June 2023, supplemented with manual citation search. Two reviewers independently and in duplicate assessed titles, abstracts, and full-text articles, with discrepancies resolved by a third member. Studies considered for inclusion were randomized controlled trials (RCTs) and non-randomized studies (NRS) in any language, evaluating anemia risk in T2DM patients using metformin compared to standard-of-care non-metformin treatments for T2DM . The primary outcome was frequency of anemia. Secondary outcomes included frequency of vitamin B12 deficiency, changes in serum hemoglobin and vitamin B12 levels, folate deficiency, changes in serum folic acid, and homocysteine levels. Results were stratified based on the Metformin Use Index (MUI), which categorizes daily metformin dose in mg x duration in years/1000 into three subgroups: MUI ≤ 5, MUI &amp;gt; 5, and MUI Unspecified (when the primary study did not report or stratify based on metformin dosage and duration). Mantel-Haenszel random effects model was used to synthesize binary and continuous endpoints, providing odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Results 7443 studies were retrieved from electronic databases and 26 studies comprising 6 RCTs, and 20 NRS were included. In total, 17343 patients were included in this systematic review. Overall, the risk of anemia did not significantly differ between the metformin and control group (OR 1.10 [95%CI 0.64, 1.91]). Subgroup analysis also revealed no significant differences between metformin and control in the MUI ≤ 5 group (OR 1.58 [95%CI 0.54, 4.58]) and the MUI &amp;gt; 5 group (OR 1.12 [95%CI 0.48, 2.65]). Metformin was associated with an increased risk of vitamin B12 deficiency compared to control (OR 2.32 [95%CI 1.51, 3.57]). Subgroup analysis demonstrated that the difference was only significant in the MUI &amp;gt; 5 (OR 3.57 [95%CI 2.98, 4.27]) and the MUI Unspecified groups (OR 2.24 [95%CI 1.48, 3.38]), but not in the MUI ≤ 5 group (OR 1.01 [95%CI 0.83, 1.23]). The subgroup differences were significant (p&amp;lt;0.01). Metformin was associated with a decrease in serum vitamin B12 level (MD -71.55 pmol/L [95%CI -89.27, -53.82]), and change in serum hemoglobin could not be pooled given only one primary study. Serum homocysteine was higher in the metformin group (MD 2.45 µmol/L [95%CI 1.48, 3.41]), and there were no significant differences between metformin and control in both incidence of folate deficiency and change in serum folic acid. Conclusion Metformin use does not appear to increase the risk of anemia compared to placebo or other standard-of-care treatments in T2DM. Vitamin B12 deficiency is associated with metformin use, however likely only in those with longer/greater-dose (metformin use index &amp;gt; 5). Monitoring and supplementation of vitamin B12 level are likely beneficial in this population. Our study is limited by heterogenous criteria for anemia and vitamin B12 deficiency across jurisdictions. Further studies on the safety profile of metformin are recommended to include anemia as an outcome and result-stratification based on metformin dose and duration.

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.

Effect of Metformin Use on Vitamin B12 Deficiency Over Time (EMBER): A Real-World Evidence Database Study

ObjectiveTo examine the extent to which metformin increases the risk of vitamin B12 deficiency and borderline deficiency over time in participants with type 2 diabetes mellitus (T2DM). MethodsUsing the All of Us database, adults aged ≥18 years with T2DM and a documented history of metformin use were included for the evaluation of B12 deficiency. Those with B12 deficiency before metformin use were excluded. Adjusted logistic regression models were used to evaluate the association between metformin use and long-term metformin use (≥4 years) and the risk of B12 deficiency. We conducted a subgroup analysis comparing differences in borderline B12 deficiency in metformin and non-metformin users. ResultsOf 36 740 participants with T2DM, 6221 (16.9%) had documented metformin use. The mean age of metformin users was 65.3 years. B12 deficiency was confirmed in 464 (7.5%) metformin users, and 1919 of 30 519 participants (6.3%) did not use metformin. Metformin users had a 4.7% increased risk of developing B12 deficiency compared with nonmetformin users (P = .44). Each additional year of metformin use was associated with 5% increased likelihood of deficiency (P < .05). Metformin use for ≥4 years resulted in a 41.0% increased odds of B12 deficiency, compared with those who used <4 years of metformin (P < .05). Metformin use increased the odds of borderline B12 deficiency by 27.0% (P < .05). ConclusionLong-term metformin use was associated with an increased risk of B12 deficiency in patients with T2DM, with compounding risk over time.

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.

Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan Children: Not So Obvious

Vegetarian diets have gained in popularity worldwide and therefore an increasing number of children may be exposed to the resulting nutritional consequences. Among them, the risk of micronutrient shortfall is particularly of concern. This narrative review aims to assess and discuss the relevance of micronutrient deficiency risk based on the available data. It mainly draws attention to iron, zinc, iodine, and vitamins B12 and D intake. Diets that are more restrictive in animal source foods, such as vegan diets, have a greater likelihood of nutritional deficiencies. However, the actual risk of micronutrient deficiency in vegetarian children is relatively difficult to assert based on the limitations of evidence due to the lack of well-designed studies. The risk of vitamin B12 deficiency must be considered in newborns from vegan or macrobiotic mothers and children with the most restrictive diet, as well as the risk of iron, zinc, and iodine deficiency, possibly by performing the appropriate tests. A lacto-ovo-vegetarian diet exposes a low risk if it uses a very varied diet with a sufficient intake of dairy products. Vegan and macrobiotic diets should be avoided during pregnancy and childhood. There is a need for education and nutrition guidance and the need for supplementation should be assessed individually.

Sociodemographic Factors and Nutritional Knowledge Impacts on Overall Vitamin B12 Intake in Older Women

BACKGROUND: The older population is at high risk for vitamin B12 deficiency, leading to various significant and chronic health problems. AIM: This study aimed to determine the association between sociodemographic characteristics, nutritional knowledge and overall vitamin B12 intake among older persons. METHODS: An observational study with a cross-sectional design was directed to 69 older women aged &gt; 50 years. Data was collected from subject responses to various questions on the google platform, guided by professional assistance. RESULT: The study showed an inversed association between employment status (p&lt;0.05), income level (p&lt;0.001) and overall vitamin B12 intake, including dietary and supplement intake. The results provided new insights on monthly income level playing a crucial role in VB12 rich food consumption patterns in older persons, which were mostly unemployed. CONCLUSION: Efforts are needed to increase the coverage of VB12 supplementation, either peroral or intramuscular injection, as a solution to meet the needs of VB12 source that is affordable and effective for the older population.

Caracterização do perfil alimentar e sociodemográfico de um grupo de mulheres vegetarianas colombianas em idade fértil no período 2021-2022

ABSTRACT Objective To determine the dietary and sociodemographic profile of vegetarian women of childbearing age (18 and 49 years) from the Valle de Aburrá Metropolitan Area in 2021-2022 Methods Through an online survey, 232 vegetarian and vegan women of childbearing age (18 to 49 years) from the Valle de Aburrá Metropolitan Area were surveyed regarding their sociodemographic characteristics, amount of time following this eating pattern and, type and reason for choosing vegetarianism, physical activity, use of nutritional supplements and frequency of consumption of certain food groups. Descriptive analyses, association of variables with the type of vegetarianism and multinomial regression models were performed. Results A total of 232 vegetarian women were surveyed: 60.8% were between 18 and 30 years of age and belonged mainly to the middle class. According to the type of diet, 68.1% used an ovo-lacto-vegetarian diet, 18.1% were vegan, 9.0% lacto-vegetarian and 4.8% ovo-vegetarian. Among the factors evaluated in their potential relationship with the different types of vegetarianism, it is highlighted that vitamin B12 supplementation presents a statistically significant association when using veganism as a comparison category. Conclusion According to the results, among young female adults the vegetarian eating style predominates, without significant differences as to the educational level, adequate levels of physical activity in most of the population; there was a higher prevalence of ovo-lacto-vegetarianism. Vitamin B12 supplementation was significantly higher in the vegan population, indicating that ovo-lacto and ovo-vegetarian populations may be at high risk of vitamin B12 deficiency.

Associations of Genetically Predicted Vitamin B12 Status across the Phenome.

Variation in vitamin B12 levels has been associated with a range of diseases across the life-course, the causal nature of which remains elusive. We aimed to interrogate genetically predicted vitamin B12 status in relation to a plethora of clinical outcomes available in the UK Biobank. Genome-wide association study (GWAS) summary data obtained from a Danish and Icelandic cohort of 45,576 individuals were used to identify 8 genetic variants associated with vitamin B12 levels, serving as genetic instruments for vitamin B12 status in subsequent analyses. We conducted a Mendelian randomisation (MR)-phenome-wide association study (PheWAS) of vitamin B12 status with 945 distinct phenotypes in 439,738 individuals from the UK Biobank using these 8 genetic instruments to proxy alterations in vitamin B12 status. We used external GWAS summary statistics for replication of significant findings. Correction for multiple testing was taken into consideration using a 5% false discovery rate (FDR) threshold. MR analysis identified an association between higher genetically predicted vitamin B12 status and lower risk of vitamin B deficiency (including all B vitamin deficiencies), serving as a positive control outcome. We further identified associations between higher genetically predicted vitamin B12 status and a reduced risk of megaloblastic anaemia (OR = 0.35, 95% CI: 0.20-0.50) and pernicious anaemia (0.29, 0.19-0.45), which was supported in replication analyses. Our study highlights that higher genetically predicted vitamin B12 status is potentially protective of risk of vitamin B12 deficiency associated with pernicious anaemia diagnosis, and reduces risk of megaloblastic anaemia. The potential use of genetically predicted vitamin B12 status in disease diagnosis, progression and management remains to be investigated.

PSUN222 Prevalence of Vitamin B12 Monitoring Among Patients Receiving Metformin in a Public Hospital

Abstract Background Metformin reduces intestinal absorption of Vitamin B12 in up to 30% of patients and lowers serum Vitamin B12 concentrations in 5-10%. The dose and duration of metformin use correlates with the risk of Vitamin B12 deficiency. Low serum levels may be detected as early as 3-4 months after starting metformin; however, symptomatic deficiency is more likely to present after 5-10 years of metformin therapy. In 2017, the American Diabetes Association (ADA) updated its treatment guidelines to recommend patients taking metformin undergo regular monitoring of Vitamin B12 levels. To better understand acceptance and application of these guidelines, we undertook an assessment of such monitoring within a single hospital center serving the low-income population in Atlanta, GA to assist in guiding optimal monitoring and patient management. Methods Data was collected from a single hospital center using electronic medical records (EMR) and the SlicerDicer tool to identify all outpatients for whom metformin was prescribed either as a single agent or in combination therapy during January 1 – December 31, 2021 and then measure Vitamin B12 prescribing among two cohorts during the same time period: primary care patients and patients followed by the diabetes center. Results During the period studied, of the total 2,336,914 patients documented in the EMR, 30,803 (0.01%) were outpatients whom metformin had been prescribed either as a single agent or in combination therapy. Of these, 816 patients (2.6%) had Vitamin B12 levels ordered and measured. The prevalence of Vitamin B12 levels ordered and measured was greater among primary care patients (673 of 8,971 [7.5%]) when compared with patients followed by the diabetes center (25 of 1,081 [2.3%]) (chi-square p&amp;lt;0.001). A second analysis determined that Vitamin B12 levels were abnormally low among 172 (23.7%) primary care patients and 25 (28%) patients followed by the diabetes center (chi-square p=0.78). Conclusion Our study determined that among two outpatient cohorts who were prescribed metformin there was suboptimal adherence to the ADA's recommendation for regular monitoring of Vitamin B12 levels. The findings of this study will be used to develop approaches for increasing and optimizing ordering and monitoring Vitamin B12 levels for patient care management. Increased awareness of the relationship between metformin and Vitamin B12 deficiency and standardized approaches to monitoring are needed. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Metformin may increase risk of vitamin B12 deficiency

Metformin may increase risk of vitamin B12 deficiency

Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians.

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12 and folic acid supplement use, and biomarkers (serum B12 (B12), plasma total homocysteine (tHcy), plasma methylmalonic acid (MMA) and serum folate). Vegans (n 115) and vegetarians (n 90) completed a 24-h dietary recall and a FFQ and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status was adequate in both vegans and vegetarians according to the cB12 indicator; however 4 % had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357 pmol/l, 9·0 µmol/l, 0·18 µmol/l, 1·30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25·8 nmol/l, vegetarians: 21·6 nmol/l, P = 0·027). Serum B12 concentration < 221 pmol/l was found in 14 % of all participants. Vegetarians revealed the highest proportion of participants below the recommended daily intake of 2 µg/d including supplements (40 v. 18 %, P < 0·001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (< 10 nmol/l) was uncommon overall (< 2·5 %). The combined indicator cB12 suggested that none of the participants was B12-depleted; however, low serum B12 concentration was found in 14 % of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians.

Making a meal out of bugs

Making a meal out of bugs

Association of MTHFR (rs 1801133) gene polymorphism with biochemical markers of B12 deficiency in type 2 diabetes mellitus patients on metformin therapy

BackgroundLong-term administration of metformin in Type 2 Diabetes mellitus (T2DM), interferes with the absorption of vitamin B12 resulting in deficiency. Low levels of vitamin B12 are associated with cardiovascular morbidity and mortality in T2DM patients. Several genetic variants are associated with vitamin B12 deficiency; one among them is Methylene Tetrahydrofolate reductase (MTHFR). We analyzed MTHFR (rs180133) polymorphism and its association with metformin induced vitamin B12 deficiency in T2DM patients. MethodsThree hundred T2DM patients were included. For the study and they were screened for vitamin B12 deficiency markers – Methyl malonic acid (MMA), Homocysteine (Hcy) and high sensitive C reactive protein (hsCRP). Genetic variant was analyzed by ARMS-PCR method. Data was analyzed with various statistical tools like ROC, Odds ratio and Likelihood ratio. ResultsThere is significant reduction in folic acid and vitamin B12 in metformin users. HsCRP, Hcy and MMA are significantly increased with P < 0.001 in patients with metformin induced B12 deficiency. T allele in MTHFR (T allele ORs =2.1, TT genotype =3.6) showed risk of vitamin B12 deficiency in T2DM patients on metformin therapy. MTHFR gene polymorphism of TT genotype had a Likelihood ratio (LR) of 2.46 for folic acid, 2.77 for MMA and 3.38 for Hcy. ConclusionWe found an association between MTHFR rs180133, 677C > T and vitamin B12 status in T2DM patients on metformin therapy. Folic acid, MMA and Hcy were found to have high specificity in concordance with MTHFR which showed to be a good predictor for vitamin B12 deficiency in T2DM patients on metformin therapy.

Nutritional and environmental benefits of increasing insect consumption in Africa and Asia

Most global dietary forecasts predict a reduction in nutritional deficiencies over the next several decades driven by significant increases in environmentally unsustainable livestock and animal source food consumption. Here, we explore a more environmentally sensitive alternative to improve global nutrition, consuming insects. Our study focuses on Africa and Asia, two continents with a history of eating insects and high rates of nutritional deficiency. We model the impact of adding modest amounts (2.5, 5 and 10 g per day, dry weight) of regionally appropriate and farmable species on total nutrient intake and population-wide risk of deficiency for specific nutrients of concern: protein, zinc, folate, and vitamin B12. We also estimate the total potential change in dietary iron. Five grams per day of insect consumption could alleviate a considerable amount of risk of nutritional deficiency: 67 million (95% uncertainty interval: 49–84 million) fewer people at risk of protein deficiency, 166 million (120–220 million) fewer people at risk of zinc deficiency, 237 million (120–439 million) fewer people at risk of folate deficiency, and 251 million (28–2271) fewer people at risk for vitamin B12 deficiency. For iron, per capita supplies could increase by 3% (0.8%–6.0%) with insects, and even more so for vulnerable groups in countries currently suffering severe rates of anemia: 4.2% (0.5%–8.8%) for women of childbearing age and 4.1% (0.4%–10.0%) for children under 5. Doubling or halving insect intake per capita causes the benefits for nutritional deficiency risk to roughly double or halve accordingly. Effects are most pronounced in South and Central Asia, though sub-Saharan Africa, East Asia, and Southeast Asia also see considerable reduction in nutritional risk. These results demonstrate the potential for insects to fill a crucial role in providing nutrition for these populous and rapidly developing regions while safeguarding the global environment.

Association of BHMT (rs 3733890) gene polymorphism with biochemical markers of B12 deficiency in T2DM patients on metformin therapy

Long term administration of metformin interferes with the absorption of vitamin B12 resulting in vitamin B12 deficiency.Among the various genetic variants that are associated vitamin B12 deficiency, we analyzed BHMT gene polymorphism and their association with metformin induced vitamin B12 deficiency in T2DM patients.A cross sectional study was done with 300 participants. Methyl malonic acid, homocysteine and high sensitive C reactive protein were analysed by Mass Spectrometry, Chemiluminescent analyser and Immunoturbidimetric method respectively. Genetic variants were analysed by ARMS-PCR method, Data was analyzed with various statistical tools like ROC, Odds ratio and Likelihood ratio. Significant reduction in folic acid and vitamin B12 in metformin users was found. High sensitive C reactive protein, homocysteine and methyl malonic acid are significantly increased in patients with metformin induced B12 deficiency. ‘A’ allele in BHMT (A allele OR =2.1, AA genotype =2.8) showed risk of vitamin B12 deficiency in T2DM patients on metformin therapy. BHMT gene polymorphism had LR of 2.65 for folic acid (AG genotype), 2.73 for MMA (AA genotype) and 2.63 for Homocysteine (AA genotype).We found an association between single nucleotide polymorphism of BHMT and diagnosis of vitamin B12 deficiency status in metformin users. Folic acid, MMA and homocysteine had high specificity in concordance with BHMT (rs3733890) polymorphism in predicting vitamin B12 deficiency. Early screening of SNP of BHMT in T2DM patients on metformin therapy will help us to identify group of people who are prone for vitamin B12 deficiency.

The Safety of TheVegan Diet During Pregnancy

There is an increasing number of people who go vegetarian. Some young parents also switch to this diet. The safety of vegetarian diets, especially ve-gan diets, is very important, especially during pregnancy. Unfortunately, reference publications do not provide coherent data on the safety of vegetar-ian diets during pregnancy. On the one hand, the vegan diet has advantages because it reduces the risk of heart disease and gestational diabetes. On the other hand, vegetarians/vegans should be aware of potential deficiencies of some nutrients (iron, zinc, vitamin B12, vitamin D, omega-3 fatty acids, cal-cium, iodine) and the clinical consequences for the foetus. For example, iron deficiency may affect cognitive abilities, behaviour, intelligence and increase the risk of preterm birth and low birth weight of infants. Plant food contains non-haem iron with variable absorption. Therefore, the vegan diet should include nutrients increasing the bioavailability of iron, e.g. ascorbic acid, carotene and retinol. Due to the fact that animal food is the main source of vitamin B12, vegans are at very high risk of vitamin B12 deficiency, which will affect the infant’s weight at birth. Low level of vitamin D, which is prevalent in animal food, is the most common deficiency among vegans and lacto-ovo vegetarians. This vitamin prevents gestational diabetes, reduces insulin resistance and guarantees normal function of the musculoskeletal system. Zinc deficiency during pregnancy may lead to preterm birth, neural tube defects or even miscarriage. In view of the clinical consequences of po-tential deficiencies of nutrients, the vegetarian/vegan diet should be well balanced.