Serum B12 Levels Research Articles

Effect of Anti-Diabetic Drugs on Vitamin B12 and Mineral Levels and their Role in Inflammation in type II Diabetes Mellitus (T2DM)

Objectives: The purpose of the present study is to know the association between antidiabetic drugs and serum B12, and minerals like calcium, phosphorus, magnesium and zinc to understand their role in inflammation in type 2 diabetes mellitus. Methods: The sample size is 500 blood samples of both genders which was divided into 3 groups: A, B, and C. Group A on metformin of daily dosage 500mg consisted of 200 subjects, Group B on other anti-diabetic drugs of daily dosage 2 mg consisted of 200 subjects. Both groups A and B had no other complications from diabetes. Group C included controls, consisting of 100 healthy individuals with no history of diabetes. Findings: When compared between two drug(metformin and sulfonylureas) groups, the percentages of Serum B12, calcium, phosphorus, magnesium and zinc in both male and female groups were significantly decreased and consequently, inflammatory markers like leptin, IL-6, hsCRP, TNF-a were significantly increased in metformin group rather than who were on metformin and other associated drug group. Novelty : Decreased serum B12 levels in type 2 diabetes mellitus who are on metformin drug represents the potential trigger for inflammatory process which leads to micro and macrovascular complications when compared to sulfonylurea drug group. Keywords: Diabetes mellitus; Cobalamine; Calciumdependent process; Antioxidants; Inflammatory process

Significant increase of serum B12 levels with high-dose oral vitamin B12 supplementation with or without intrinsic factor after Roux-en-Y gastric bypass: A randomized controlled trial

VitB12 deficiency is frequently encountered after RYGB. Low-dose oral supplements are not sufficient to avoid this deficiency, often implying treatment with intramuscular injections. As IF plays an important role in vitB12 absorption, there might be an additional effect in adding IF to oral vitB12 supplements. This randomized, monocentric, double-blind, placebo-controlled trial evaluates the short-term effect of high-dose (1000 μg) oral vitB12 supplementation on serum vitB12 levels after RYGB. 225 patients were randomized into three treatment arms: vitB12, vitB12 in combination with intrinsic factor (vitB12IF) or placebo. Serum vitB12 levels 6 months postoperatively were significantly higher in patients receiving vitB12 compared to placebo (p < 0.001). A mean decrease of 197.6 (SD ± 37) ng/L vitB12 and an augmentation of 154 (SD ± 97.8) ng/L and 202.3 (SD ± 113) ng/L were respectively observed in the placebo, vitB12 and vitB12IF groups. Our study shows no significant benefit in adding IF compared to high dose oral vitB12 without IF (p = 0.711). High-dose oral vitB12 supplements significantly increase serum vitB12 levels after RYGB, confirming the efficacy of such treatment, without a significant benefit of adding IF to the vitB12 supplement. • RCT comparing high-dose oral vitB12 ± Intrinsic factor supplementation after RYGB with placebo. • Serum vitB12 declines without supplementation after Roux-en-Y gastric bypass (RYGB). • High-dose oral vitB12 supplementation increases serum vitB12 levels after RYGB. • Addition of intrinsic factor has no significant benefit on postoperative vitB12 level.

Effect of B12 supplementation on renal anemia among hemodialysis patients at El-Najar hospital, Gaza strip

Introduction: Patients with end-stage renal disease (ESRD) are predisposed to nutritional deficiencies, resulting in vitamin B12 deficiency with negative hematologic consequences. Objective: This study aimed to investigate the impact of intramuscular B12 on renal anemia among ESRD patients receiving hemodialysis (HD) at El-Najar hospital, Gaza Strip. Patients and Methods: A case-control study conducted, which included 110 healthy controls and 110 HD patients who received B12 on a daily, weekly, and monthly basis over two months. Sociodemographics and current diseases were reported. Serum levels of serum B12, white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), and platelet (PLT) were recorded before and after treatment. Data analysis was conducted using SPSS. Results: Baseline serum B12 level was significantly lower in HD patients compared to controls (362.62 ± 166.40 versus 483.36 ± 115.07 ρg/mL, P&lt;0.001), which significantly improved after vitamin B12 treatment (639.08 ± 362.99 ρg/mL, P&lt;0.001). Additionally, mean WBCs, RBCs, Hb, and PLT levels were significantly increased after treatment (P&lt;0.001). Serum B12 level was positively and significantly (P&lt;0.001) correlated with levels of WBC (r = 0.45), RBC (r = 0.43), Hb (r = 0.39) and PLT (r = 0.51), and negatively correlated with MCV (r = -0.46, P&lt;0.001). Conclusion: Administration of vitamin B12 improves serum B12 levels in HD patients, which was associated with increased WBCs, RBCs, Hb, and PLT levels and decreased MCV levels. Treatment by vitamin B12 can improve HD patients’ renal anemia. Future studies with larger sample sizes and prolonged follow-up are advocated.

Association of dietary factors with plasma homocysteine and coronary heart disease outcome

ObjectiveThe aim of the present study was to investigate the association between serum levels of vitamins B12, B6, folic acid and hyperhomocysteinemia with the risk of coronary heart disease (CHD). Material and methodsA case control study was carried out involving 105 newly diagnosed coronary heart disease patient of both gender (age range 25–60years) and 105 age and sex matched normal healthy individuals at Punjab Institute of Cardiology, Lahore. Fasting blood samples were collected from both cases and controls. Sera were analyzed for folic acid, vitamin B6 and B12 using high performance liquid chromatography (HPLC). Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) and traditional risk factors were also assessed. ResultsMean plasma homocysteine level in cases (22.33±9.22μmol/L) was significantly higher (P=0.0001) than controls (12.5±3.73μmol/L). Mean serum folic acid concentration, serum vitamin B6 and vitamin B12 were significantly lower in cases than the mean levels in controls (P<0.05). When compared to controls the data revealed significantly greater deficiency of folic acid, vitamin B6 and B12 in coronary heart disease patients. Statistically significant inverse correlation was observed between folic acid, vitamin B6, B12 and plasma homocysteine concentration (r=−0.463, r=−0.431 and r=−0.294, respectively). ConclusionNutritional deficiency of folic acid, vitamin B12 and B6 were common in coronary heart disease patients with an inverse correlation of plasma homocysteine concentration with these vitamins. Substantial deficiency of these vitamins along with hyperhomocysteinemia could be further aggravating the risk of CHD in Pakistani population.

PREVALENCE OF NUTRITIONAL ANEMIA IN MUMBAI, 3- YEAR STUDY DONE IN INDIAN REFERENCE LABORATORY

Introduction: - Anemia is major health problem which affects children, women of reproductive age groups to a signicant extent. This study was done to study prevalence of anemia in Mumbai across different age groups. Aims And Objectives: - To study prevalence of nutritional anemia in Mumbai with respect to age group &amp; gender To compare prevalence of vitamin B12 deciency anemia with iron deciency anemia To establish correlation between RBC indices with serum Iron &amp; Serum B12 levels Method: - We did a retrospective analysis of serum iron prole, CBC, Vitamin B12, Folic acid data obtained in referral laboratory in Mumbai over a span of 3 years (2019-2021). Population studied belonged to Mumbai metropolitan region. CBC was analyzed on DXH Coulter. Serum Iron, serum ferritin, TIBC, Vitamin B12 &amp;serum folic acid were analyzed on Cobas analyzers. We compared &amp; correlated results according to gender &amp; age Results: - Prevalence of low serum Iron &amp; serum ferritin was seen in females as compared to males (P&lt; 0.001). However low levels of vitamin B12 was signicantly seen in males as compared to females (P&lt;0.001). Low serum iron, Ferritin, MCH, MCV and high TIBC were signicantly associated with low Hemoglobin (P&lt;0.001)

Decreased Serum B12 Due To Antidiabetic Drugs

Background: The first-line medication, metformin, can decrease hepatic gluconeogenesis and improve insulin sensitivity. Metformin inhibits the mitochondrial respiratory chain at the molecular level, which leads to an increase in adenosine monophosphate-activated protein kinase, which enhances insulin sensitivity. With no known renal or hepatic disease, updated recommendations recommend using metformin as a first-line glucose-lowering medication in conjunction with lifestyle changes. Metformin has been demonstrated to lower vitamin B12 levels. Vitamin B12 is a vitamin that is necessary for proper hemopoietic, neurocognitive, and cardiovascular function. Vitamin B12 deficiency has been shown to be quite common in people with type 2 diabetes mellitus, both biochemically and clinically. Diabetes is thought to be an oxidative stress and chronic inflammatory disease. Vitamin B-12 is an antioxidant, as per recent research, and a low vitamin B-12 level might be a contributing factor to oxidative stress, particularly in diabetic patients. Vitamin B-12 is an antioxidant and anti-inflammatory substance that may influence oxidative stress responses, including inflammatory reactions. As a result, the goal of this research was to study at possible associations between vitamin B-12 status and inflammation in Type 2 diabetes mellitus who are on metformin and on metformin with other associated anti-diabetic drugs. Aims and Objectives: In our study we tried to see the association between serum B12 levels and proinflammatory cytokines which lead to many macrovascular complications like cardiovascular diseases, renal failure etc. Materials and Methods: The present study recruited 500 participants between 30 and 65 years of age. patient pool who has been recently diagnosed as type 2 diabetics on metformin usage for more than 12 to 18 months. The study design was divided into 3 groups: A, B, and C. Group A consisted of 200 subjects with type 2 diabetes only on metformin with a daily dosage of 500 mg/day, and Group B consisted of 200 subjects with type 2 diabetes who were on both metformin with a daily dosage of 500 mg/day and other anti-diabetic drugs of around 2 mg/day. Both groups A and B had no other complications from diabetes. Group C included controls, consisting of 100 healthy individuals with no history of diabetes. Results: The percentages of Serum B12, in both male and female groups were significantly decreased in cases and consequently, inflammatory markers like leptin, IL-6, hsCRP, TNF-α were significantly increased who were on metformin than who were on metformin and other associated drug group. Conclusions: Findings from this study clearly indicates the link between decrease in B12 and progression of inflammation. the role of metformin in vitB12 deficiency levels, uncontrolled glucose levels, and chronic inflammatory responses in T2DM patients, gradually leading to the dire consequences of B12 deficiency.

Risk Assessment of Vitamin B12 Deficiency in Male Population of Bahawalpur District

The primary goal of this study was to investigate the prevalence of vitamin B12 insufficiency in various age groups. It is descriptive cross-sectional research in which 180 individuals were assessed for vitamin B12 from the district of Bahawalpur. Patients were placed into groups based on their ages. BMI and serum B12 levels were analyzed and a questionnaire was filled out by them. Data were statistically analyzed through T-test, ANOVA followed by post-hoc Dunnette T3 test, and frequency by Chi-square test. Results revealed that Vitamin B12 statically differed in groups of marital status, sun exposure/day/hour, diet groups, diabetic groups, and age groups. While BMI differed according to different weight groups, sun exposure/day/hour, diabetic groups. The frequency of all the groups statistically differed in all the groups. BMI had a negative correlation with the Vitamin B12 level. It was concluded that the male population was not at risk but the old population at the risk of low levels of vitamin B12.

Factors associated with vitamin B12 deficiency in adults attending tertiary care Hospital in Vadodara: a case control study

BackgroundIn India, approximately 75% of population that is over 650 million people have B12 deficiency majority of which is caused by variation in demography, diet, and religion. Conditions such as smoking, alcohol, and antacid use are certain causes for incidence of vitamin B12 deficiency. Looking at various adverse health effects of drinking demineralized water, there is possibility that it may also be one of the newly associated factors for increasing incidence and prevalence of vitamin B12 deficiency.ObjectiveTo assess the risk factors associated with vitamin B12 deficiency.MethodsA case control study was conducted at SSG Hospital in Vadodara, Gujarat, wherein all the patients visiting the hospital from November 2017 to June 2018 with symptoms suggestive of B12 deficiency and serum B12 level below 200pg/mL were included in the study. Information regarding the vitamin B12 deficiency was obtained from the patients. Controls were selected and matched with cases as per age group to minimize confounding.ResultsOur study showed statistically significant association of vegetarian diet (p value=0.0027, OR=2.00) (odds ratio), dark complexion (0.0069, OR=2.53), socio economic status (p value= 0.0001), and use of RO (reverse osmosis) water (p value=0.0099, OR=3.61) with vitamin B12 deficiency at 95% CI (confidence interval).ConclusionIndependent association between use of R.O. water, vegetarian diet, socio economic class, and dark complexion with vitamin B12 deficiency.

The Etiology of Anemia Among Pregnant Women in the Hill State of Himachal Pradesh in North India: A Cross-Sectional Study.

Background and objectiveAnemia during pregnancy is a major cause of maternal and fetal complications including mortality. A study of the etiology of anemia is required to formulate guidelines for the prevention and treatment of the condition. To this end, we conducted a study among anemic women in northern India.Materials and methodsA cross-sectional study was conducted among anemic antenatal women attending the outpatient department at a tertiary care hospital in Himachal Pradesh, India, involving 172 participants. Complete blood count, serum ferritin level, serum B12, serum folate levels, high-performance liquid chromatography (HPLC), liver function tests, and renal function tests were performed.ResultsThe mean hemoglobin level among the subjects was 8.87 g/dl with a standard deviation of 0.79; 50% of women had serum ferritin levels of less than 15 ng/ml, 48.8% had serum B12 levels of less than 150 pg/ml. and 33.72% of women had serum folate levels of less than 3 ng/ml. Of note, 13.37% of women had either low or deficient levels for all three parameters; 14 women had abnormal results on HPLC. All nutrient deficiencies (ferritin, folate, and vitamin B12) were found in all morphological types of anemia. Significantly, 73.26% of iron-deficient anemic women had additional folate or vitamin B12 deficiencies, suggesting that additional methods would be required to decrease the prevalence of anemia. Two-thirds of the women in our study were vegetarians, a contributing factor towards a high percentage of vitamin B12 deficiency among women. ß-thalassemia trait was the most common abnormality found, consistent with the high prevalence of ß-thalassemia in north India.ConclusionMultiple deficiencies should be treated simultaneously in anemic women. Vitamin B12 deficiency is an important contributor to anemia, in addition to iron and folate deficiency.

Vitamin B12: A Non-invasive Biomarker for Monitoring Hepatocellular Carcinoma Development among Egyptian HCV-Infected Patients

Several studies have revealed an association between the high serum levels of vitamin B12 (vit B12) and the stage of chronic liver diseases. This study analyzes serum vit B12 levels among Egyptian hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) patients. The serum levels of vit B12 were examined in HCV patients without cirrhosis (HCV group, n=30), with cirrhosis (HCV+cirrhosis group, n=24), HCC patients (HCC group, n=30), and healthy individuals (control group, n=16). Serum vit B12 levels increased significantly in HCV+cirrhosis and HCC groups compared with the control group. HCC patients showed a significant increase in vit B12 levels compared with HCV patients with cirrhosis. Moreover, HCV patients without cirrhosis showed no significant increase in vit B12 level than the control group. Also, patients with fibrosis scores (F) from F2 to F4 showed a significant increase in serum vit B12 levels compared with the control group. Regarding correlations with liver functions, serum vit B12 was negatively correlated with serum albumin level and positively correlated with total bilirubin level. Interestingly, serum vit B12 was also positively correlated with serum AFP level. This clinical study revealed that the level of vit B12 could be used as a non-invasive biomarker to monitor liver fibrosis and HCC development among HCV-infected patients.

Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

BackgroundThe Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure.MethodsAll first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing.ResultsAmong 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed.ConclusionEven though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

Association of serum vitamin B12 with immuno-hematological parameters in treatment-naive HIV positive cases.

The manifestations of human immunodeficiency virus (HIV) infection and vitamin B12 deficiency overlap each other, so early diagnosis and intervention is important. The study aims to find out serum vitamin B12 level and its association with CD4 and CD8 count, clinical-staging, and hemato-biochemical status in newly diagnosed HIV positive cases. Fifty-five confirmed HIV cases above 18 years of age and equal number of age and sex matched controls were recruited for the study. CD4 and CD8 counts were analyzed by Flow cytometer. Complete Blood Count, Serum vitamin B12, Folic acid, ferritin, and C-Reactive Protein (CRP) concentration were done. Serum vitamin B12 was observed to be significantly low in HIV positive cases than healthy controls with a mean value of 240.62 ± 56.75 pg/ml and 317.57 ± 52.56 pg/ml, respectively. Decreased CD4 counts with elevated levels of ferritin and CRP was seen in HIV positive individuals. The subgroup analysis based on the levels of vitamin B12 was directly proportional to CD4 counts. CD8 counts also registered a significant association with serum B12 level, yet the response is not proportionate with the level of vitamin B12 deficiency. Nearly one-third of HIV positive cases revealed vitamin B12 deficiency. During the early stage, fast dividing immune cells cause increased consumption of micronutrients contributing toward vitamin B12 deficiency. It contributes to disorders in methylation affecting the immune function and NK Cell activity which increases the number of CD8 cells. Hence, vitamin B12 is a beneficial immunological modulator of HIV infection and can be a potent game changer in resource constrained set up.

Assessment of megaloblastic anemia in geriatrics in Lagos State, Nigeria

Background Deficiency in some of the water-soluble vitamins such as vitamin B9 (folate) and vitamin B12 (cobalamin) is associated with multiple diseases seen in the elderly, for example, anemia, dementia, Alzheimer's disease, cancers, and osteoporosis. This study, using enzyme-linked immunosorbent assay, aimed to determine the serum levels of vitamins B9 (folate) and B12 (cobalamin)/homocysteine in the elderly. Packed cell volume and mean corpuscular volume were correlated with these vitamins. Materials and methods This was a descriptive, cross-sectional study done at the geriatric clinic of Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, Nigeria. Following the receipt of the Institution's Ethics Committee approval, elderly participants, aged 65 years and above were recruited consecutively. Their blood was collected into EDTA and plain bottles for the determination of full blood count and folate and vitamin B12/homocysteine, respectively. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) version 23.0. The P value was set at less than or equal to 0.05. Results A total of 90 participants were recruited consisting of 50 (55.6%) females and 40 (44.4%) males. The overall mean folate, vitamin B12, and homocysteine were 7.64 ± 2.39 ng/ml, 514 ± 237.95 pg/ml, and 8.37 ± 6.88, respectively. Only 2.2 and 1.1% of the elderly had vitamin 12 and folate deficiencies, respectively, and 13.3% had elevated homocysteine. Packed cell volume was statistically significantly correlated with folate, vitamin B12, mean corpuscular volume, and homocysteine (P=0.001). Conclusion Vitamin B12 and folate deficiencies are uncommon in the elderly population in Lagos. The incidence of hyperhomocysteinemia is also low among them.

A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics

A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics

Neuropsychiatric manifestations in vitamin B12 deficiency.

Vitamin B12 deficiency can have distressing neuropsychiatric symptoms. It can have an etiological role in clinical presentations like depression, anxiety, psychosis, dementia, and delirium, requiring screening of at-risk populations. Few mechanisms that underlie the neuropsychiatric manifestations of B12 deficiency include alteration in one-carbon metabolism, genetic vulnerability, and alteration in folate metabolism. Maintaining a high serum B12 level in elderly can be protective against Alzheimer's disease (AD). In an established AD, its deficiency is associated with higher cognitive decline and risk for delirium. The other mental changes associated with B12 deficiency include apathy, agitation, impaired concentration, insomnia, persecutory delusions, auditory and visual hallucinations, and disorganized thought-process. Besides serum vitamin B12, plasma methylmalonic acid (MMA) and homocysteine helps in diagnosis. The chapter focuses on early recognition and effective treatment of these neuropsychiatric manifestations of vitamin B12 deficiency.

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.

The effect of vitamins B12, B6 and folate supplementation on homocysteine metabolism in a low-income, urbanised, black elderly community in South Africa

Objectives: The aim of this study was to assess the effect of vitamins B12, B6 and folate supplementation at >100% Recommended Dietary Allowances (RDA) for six months on serum homocysteine (Hcy) levels of an elderly urbanised black South African community. Design: An experimental, non-equivalent control group intervention study design was used in a 104 purposively selected sample. Two groups were compared: hyperhomocysteinaemic (hyperHcy) (n = 61) and normo-homocysteinaemic (normoHcy) (n = 43). Setting: Elders attending a day-care centre in Sharpeville, Gauteng, South Africa. Subjects: All subjects were equivalent in age (> 60 years), race (black) and unemployed/pensioner. Outcome measures: The following parameters were determined at baseline and after the six-month supplementation: serum Hcy, vitamins B6, B12 and folate levels, red cell count, mean cell volume, haemoglobin, haematocrit and the nutritional intake of vitamin B6, B12 and folate. Results: A very high incidence (66.36%) of hyperhomocysteinaemia was present in the sample. The mean ± standard deviation (SD) serum Hcy level in hyperhomocysteinaemic individuals decreased statistically significantly from 25.00 ± 8.00 umol/l to 18.80 ± 12.00 umol/l after the intervention. The number of respondents with an increased Hcy level decreased from 100% (baseline) to 67% after the intervention. Conclusions: It is concluded that supplementation of vitamins B6, B12 and folate is an effective Hcy-lowering approach to reduce hyperhomocysteinaemia in an elderly population, and thereby reduce their risk of cardiovascular disease (CVD). Summary The supplementation had a beneficial effect on the respondents’ serum vitamin B6 as well as their haemopoiesis (decreased macrocytosis).

Subacute combined degeneration of spinal cord, optic atrophy and thrombocytopenia without anemia secondary to B12 deficiency

Long-standing vitamin B12 deficiency can lead to neurological manifestations such as optic atrophy and subacute combined degeneration of the cord without causing significant anemia. In addition, folic acid supplementation could mask the hematological manifestations of vitamin B12 deficiency and delay the presentation of neurological manifestations We present a case of a 32-year-old vegan woman on long-term sodium valproate and folic acid treatment presenting with progressive weakness of bilateral lower limbs for three months and reduced vision in both eyes for two weeks duration. Further evaluation revealed optic atrophy, combined degeneration of the spinal cord, macrocytosis, thrombocytopenia, and severely deficient serum B12 levels. With B12 replacement therapy, the patient’s overall wellbeing improved.

Bile Acid Malabsorption as a Consequence of Cancer Treatment: Prevalence and Management in the National Leading Centre.

Simple SummaryBile acid malabsorption is a common albeit a very underdiagnosed gastroenterology condition especially in cancer cohort of patients. Our study, performed at the National leading centre for treatment of cancer, focuses on prevalence and management of bile acid malabsorption in patients reviewed in our specialized clinic. Currently, precise diagnosis and excellent treatments exist for this disease.The aim was to establish prevalence of bile acid malabsorption (BAM) and management in patients who underwent treatment for malignancy. Retrospective evaluation of data in patients seen within six months (August 2019–January 2020) was carried out. Demographic, nuclear medicine (Selenium Homocholic Acid Taurine (SeHCAT) scan result), clinical (previous malignancy, type of intervention (medication, diet), response to intervention) and laboratory (vitamin D, vitamin B12 serum levels) data were searched. In total, 265 consecutive patients were reviewed. Out of those, 87/265 (33%) patients (57 females, 66%) were diagnosed with BAM. Mean age was 59 +/− 12 years. The largest group were females with gynaecological cancer (35), followed by haematology group (15), colorectal/anal (13), prostate (9), upper gastrointestinal cancer (6), another previous malignancy (9). Severe BAM was most common in haematology (10/15; 67%) and gynaecological group (21/35; 60%). Medication and low-fat diet were commenced in 65/87 (75%), medication in 10/87 (11%), diet in 6/87 (7%). Colesevelam was used in 71/75 (95%). Symptoms improved in 74/87 (85%) patients. Vitamin D insufficiency/deficiency was diagnosed in 62/87 (71%), vitamin B12 deficiency in 39/87 (45%). BAM is a common condition in this cohort however treatments are highly effective.

Vitamin B12 Supplementation and Vitamin B12 Blood Serum Levels: Evaluation of Effect Modification by Gender and Smoking Status

Research suggests that high intake of supplemental vitamin B12 may be associated with increased risk of cancer, with some evidence that this association may vary by gender and smoking status. This investigation evaluates if similar patterns in association are observed for data for 11,757 adults from the National Health and Nutrition Examination Survey (1999-2006). Survey-weighted multivariable-adjusted linear regression was used to evaluate the association between regular B12 supplement use and log-transformed serum B12 levels. Persons taking vitamin B12 through a multivitamin/multimineral (MVMM) had a median supplemental intake of 12 mcg/day (Q1: 6, Q3: 25), compared to 100 mcg/day (Q1: 22, Q3: 500) for persons reporting supplemental B12 intake through a MVMM-exclusive source. MVMM users had a geometric mean serum B12 26% (95% CI: 23%-30%) higher than nonusers, whereas MVMM-exclusive users’ geometric mean was 61% (95% CI: 53%-70%) higher than nonusers (p-trend < 0.001). Although a positive trend (p-trend < 0.001) was observed for both men and women, the association was stronger among women (p-interaction < 0.001). No interaction was observed for smoking status (p-interaction = 0.45). B12 supplementation is associated with higher levels of serum B12, with significant interaction by gender but not smoking. Further work is needed to better understand the interplay of B12 and gender.