Serum Vitamin B12 Deficiency Research Articles

Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes.

Metformin can cause serum vitamin B12 deficiency, but studies on the influence of its duration and dose are lacking. We investigated vitamin B12 deficiency in patients with type 2 diabetes using metformin, in conjunction with other related factors. This cross-sectional study included 1111 patients with type 2 diabetes who took metformin for at least 6 months. Serum vitamin B12 levels were quantified using a competitive-binding immunoenzymatic assay, and vitamin B12 deficiency was defined as serum B12 <300 pg/mL. Information on metformin use and confounding variables were collected from records or questionnaires and interviews. Serum vitamin B12 deficiency occurred in 22.2% of patients (n = 247). After adjusting for confounders, a 1 mg increase in daily metformin dose was associated with a 0.142 pg/mL decrease in vitamin B12 (P < .001). Compared with a daily dose of <1000 mg, the adjusted odds ratios for 1000 to 1500, 1500 to 2000, and ≥2000 mg metformin were 1.72 (P = .080), 3.34 (P < .001), and 8.67 (P < .001), respectively. Vitamin B12 deficiency occurred less often in patients taking multivitamins (odds ratio 0.23; P < .001). After adjusting for confounding factors, there was no correlation between B12 deficiency and duration of metformin use. Serum homocysteine levels showed significant negative correlation with vitamin B12. Metformin at ≥1500 mg/d could be a major factor related to vitamin B12 deficiency, whereas concurrent supplementation of multivitamins may potentially protect against the deficiency. Serum homocysteine levels were negatively correlated with vitamin B12 levels, suggesting that B12 deficiency due to metformin use may occur at the tissue level. However, this hypothesis will require further study.

Anemia, hematinic deficiencies, and gastric parietal cell antibody positivity in atrophic glossitis patients with or without hyperhomocysteinemia

Our previous study found that 127 of 1064 atrophic glossitis (AG) patients have hyperhomocysteinemia. This study assessed whether the AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity than AG patients without hyperhomocysteinemia or healthy control subjects. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 127 AG patients with hyperhomocysteinemia, 937 AG patients without hyperhomocysteinemia, and 532 healthy control subjects were measured and compared. We found that 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies and serum GPCA positivity than 532 healthy control subjects (all P-values<0.001) and significantly higher frequencies of blood Hb and serum vitamin B12 and folic acid deficiencies and serum GPCA positivity than 937 AG patients without hyperhomocysteinemia (all P-values<0.001). Moreover, 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of macrocytic anemia and significantly lower frequencies of normocytic anemia than 937 AG patients without hyperhomocysteinemia (both P-values<0.001). Pernicious anemia (22 cases) was found onlyinAG patients with hyperhomocysteinemia but not in AG patients without hyperhomocysteinemia. AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than healthy control subjects and significantly higher frequencies of anemia, serum vitamin B12 and folic acid deficiencies, and serum GPCA positivity than AG patients without hyperhomocysteinemia.

Hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in atrophic glossitis patients with normocytosis

Normocytosis is defined as having the mean corpuscular volume (MCV) between 80fL and 99.9fL. This study evaluated whether 944 atrophic glossitis (AG) patients with normocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects or 1064 AG patients. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 944 AG patients with normocytosis, 1064 AG patients, and 532 healthy control subjects were measured and compared. We found that 12.4%, 14.5%, 2.3%, 2.0%, 9.0%, and 25.7% of 944 AG patients with normocytosis had blood hemoglobin (Hb), iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Furthermore, 944 AG patients with normocytosis had significantly higher frequencies of blood Hb, iron, vitamin B12, folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values<0.01). On the contrary, 944 AG patients with normocytosis had significantly lower frequencies of blood Hb and vitamin B12 deficiencies and hyperhomocysteinemia than overall 1064 AG patients (all P-values<0.05). We conclude that there are significantly higher frequencies of anemia and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with normocytosis than in healthy control subjects. On the contrary, AG patients with normocytosis have significantly lower frequencies of blood Hb and vitamin B12 deficiencies and hyperhomocysteinemia than overall AG patients.

Hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in atrophic glossitis patients with macrocytosis

Macrocytosis is defined as having the mean corpuscular volume (MCV)≧100fL. This study evaluated whether 41 atrophic glossitis (AG) patients with macrocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects or 1064 AG patients. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 41 AG patients with macrocytosis, 1064 AG patients, and 532 healthy control subjects were measured and compared. We found that 73.2%, 22.0%, 73.2%, 4.9%, 80.5%, and 56.1% of 41 AG patients with macrocytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 41 AG patients with macrocytosis had significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects or 1064 AG patients (all P-values<0.001). In addition, 41 AG patients with macrocytosis also had significantly higher frequencies of serum iron and folic acid deficiencies than 532 healthy control subjects (both P-values<0.001). Pernicious anemia was found in 22 AG patients with macrocytosis. There are significantly higher frequencies of anemia and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with macrocytosis than in healthy control subjects. AG patients with macrocytosis also have significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than AG patients.

Does serum gastric parietal cell antibody titer have influence on anemia and vitamin B12 deficiency in atrophic glossitis patients?

Our previous study found 284 gastric parietal cell antibody (GPCA)-positive atrophic glossitis (AG) patients (so-called GPCA+AG patients in this study) in a group of 1064 AG patients. This study evaluated whether high-titer (GPCA titer≥160) GPCA+AG patients had greater frequencies of anemia, vitamin B12 deficiency, macrocytosis, and hyperhomocysteinemia than low-titer (GPCA titer<160) GPCA+AG patients. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 117 high-titer GPCA+AG patients, 167 low-titer GPCA+AG patients, and 532 healthy control subjects were measured and compared. We found that 12.0%, 29.1%, 23.1%, 16.2%, 1.7%, and 23.1% of 117 high-titer GPCA+AG patients and 5.4%, 17.4%, 17.4%, 7.2%, 1.2%, and 14.4% of 167 low-titer GPCA+AG patients were diagnosed as having macrocytosis, blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. Moreover, both 117 high-titer and 167 low-titer GPCA+AG patients had significantly greater frequencies of macrocytosis, blood hemoglobin, serum iron and vitamin B12 deficiencies, and hyperhomocysteinemia than 532 healthy control subjects (all P-values<0.05). In addition, 117 high-titer GPCA+AG patients also had greater frequencies of anemia (P=0.029, statistically significant), serum vitamin B12 deficiency (P=0.027, statistically significant), macrocytosis (P=0.075, marginal significance), and hyperhomocysteinemia (P=0.085, marginal significance) than 167 low-titer GPCA+AG patients. For GPCA+AG patients, high-titer GPCA+AG patients have greater frequencies of anemia, serum vitamin B12 deficiency, macrocytosis, and hyperhomocysteinemia than low-titer GPCA+AG patients.

Relationship Between Nutritional Status and Insomnia Severity in Older Adults

ObjectivesBoth insomnia and malnutrition are quite common and can cause similar negative consequences, such as falls, depression, and cognitive impairment in older adults, but there is no study investigating the relationship between the 2. The aims were to investigate relationships between insomnia/insomnia severity and Mini Nutritional Assessment (MNA) score and serum nutrient levels. Setting and participantsAged 65 years or older, 575 outpatients were included. MethodsMNA scores >23.5, 17-23.5, and <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. Insomnia Severity Index (ISI) with scores of 8 and higher indicated insomnia, which was further stratified as mild (8-14), moderate (15-21), or severe (22-28). ResultsThe mean age was 73.1 ± 7.7 years, with 73.2% being female. The prevalence of patients with no insomnia, mild insomnia, moderate insomnia, and severe insomnia were 34.4%, 20.9%, 30.1%, and 14.6%, respectively. After adjusting for gender, education, number of drugs, Charlson Comorbidity Index, presence of depression, and Mini-Mental State Examination scores, patients with insomnia had lower MNA scores than those without insomnia (OR = 0.84, 95% CI: 0.7-0.9, P < .001). There were significant relationships between moderate/severe insomnia and the presence of malnutrition and risk of malnutrition (OR = 1.6, 95% CI: 1.0-2.5, P = .046; OR = 1.6, 95% CI: 1.0-2.7, P = .042) and MNA scores (OR = 0.83, 95% CI: 0.7-0.9, P < .001)/OR = 0.82, 95% CI: 0.7-0.9, P < .001). There was no significant difference between insomnia severity status and serum vitamin D, vitamin B12, folate levels, or classification of these nutrients (P > .05). Conclusions/ImplicationsThere is a close relationship between MNA scores and insomnia or insomnia severity in older adults. Therefore, when evaluating an older patient with insomnia, malnutrition should be evaluated, or insomnia should also be questioned in an older patient with malnutrition. Thus, more effective management of the 2 can be possible.

Blood profile of atrophic glossitis patients with thyroglobulin antibody/thyroid microsomal antibody positivity but without gastric parietal cell antibody positivity

Our previous study found that 304 of 1064 atrophic glossitis (AG) patients have thyroglobulin antibody (TGA) positivity and/or thyroid microsomal antibody (TMA) positivity but without gastric parietal cell antibody positivity (GPCA־TGA+/TMA+AG patients). This study mainly assessed whether the serum TGA/TMA positivity was significantly associated with anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA־TGA+/TMA+AG patients. The mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between 304 GPCA־TGA+/TMA+AG patients and 476 GPCA-negative, TGA-negative, and TMA-negative AG patients (GPCA־TGA־TMA־AG patients) or 532 healthy control subjects. We found significantly lower MCV and lower mean blood Hb and iron levels as well as significantly greater frquencies of microcytosis, macrocytosis, blood Hb, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia in 304 GPCA־TGA+/TMA+AG patients than in 532 healthy control subjects. However, no significant differences in the MCV and mean blood Hb, iron, vitamin B12, folic acid, and homocysteine leve1s as well as no significant differences in the frequencies of microcytosis, macrocytosis, blood Hb, iron, and folic acid deficiencies, and hyperhomocysteinemia were discovered between 304 GPCA־TGA+/TMA+AG patients and 476 GPCA־TGA־TMA־AG patients. The 304 GPCA־TGA+/TMA+AG patients had a significantly greater frquency of serum vitamin B12 deficiency than 476 GPCA־TGA־TMA־AG patients. The disease of AG itself plays a significant role in causing anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA־TGA+/TMA+AG patients. However, the serum TGA/TMA-positivity is not significantly associated with anemia, serum iron and folic acid deficiencies, and hyperhomocysteinemia in GPCA־TGA+/TMA+AG patients.

Concentrations of Intra-erythrocyte Folate, Serum Vitamin B12, and Hemoglobin in Women of Childbearing Age and Associated Factors

Objective: The aim was to verify the relations among intra-erythrocyte folate, serum vitamin B12, and hemoglobin concentrations in women of childbearing age and their association with several socioeconomic and demographic variables, nutritional status, and food consumption in the city of Recife, Northeastern Brazil.Methods: This was a cross-sectional study with a random sample of 1,210 women of childbearing age from the city of Recife. Concentrations of serum vitamin B12 and intra-erythrocyte folate were analyzed by immunoassay and hemoglobin concentrations by automated determination. A questionnaire was used to collect socioeconomic and demographic data of nutritional status and a food frequency questionnaire was used to evaluate food consumption.Results: Reductions in hemoglobin concentrations were found in 141 women (12.0%; 95% confidence interval (CI), 10.3–13.9), serum vitamin B12 in 81 women (7.0%; 95% CI, 5.7–8.6), and only 1 woman had a reduction in intra-erythrocyte folate concentrations. No women had a concomitant reduction of intra-erythrocyte folate, serum vitamin B12, and hemoglobin concentrations. However, 13 women (1.1%; 95% CI, 0.6–1.9) had a concomitant deficiency of hemoglobin and vitamin B12. Intra-erythrocyte folate concentrations were higher in women of a higher age and income. Hemoglobin concentrations were lower in smokers, and serum vitamin B12 concentrations did not show a significant variation in relation to socioeconomic, demographic, and anthropometric parameters. There was no strong correlation between food consumption and biochemical concentrations evaluated.Conclusion: Despite the strategies to eradicate anemia, this nutritional deficiency was dominant. Serum vitamin B12 deficiency outpacing intra-erythrocyte folate is worrying due to the lack of programs to fight against vitamin B12 insufficiency. Age and income were directly related to intra-erythrocyte folate concentrations. Food consumption suggests that there is a homeostatic control to maintain equilibrium at biochemical concentrations.

The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus.

AimsTo compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12.MethodsIn this retrospective study, we recruited 412 individuals with T2DM: 319 taking metformin, and 93 non-metformin users. Demographics, dietary assessment for vitamin B12 intakes, and medical history were collected. Participants were assessed for peripheral neuropathy. Blood specimens were collected and checked for serum vitamin B12 levels. The differences between the two groups were analyzed using an independent t-test for continuous data, and the Chi-squared or Fisher's exact test was used for categorical data. The relationship of vitamin B12 deficiency with demographics and clinical characteristics was modeled using logistic regression.ResultsThe prevalence of B12 deficiency was 7.8% overall, but 9.4% and 2.2% in metformin users and non-metformin users, respectively. The odds ratio for serum vitamin B12 deficiency in metformin users was 4.72 (95% CI, 1.11–20.15, P = 0.036). There were no significant differences in a test of peripheral neuropathy between the metformin users and non-metformin users (P > 0.05). Low levels of vitamin B12 occurred when metformin was taken at a dose of more than 2,000 mg/day (AOR, 21.67; 95% CI, 2.87–163.47) or for more than 4 years (AOR, 6.35; 95% CI, 1.47–24.47).ConclusionIndividuals with T2DM treated with metformin, particularly those who use metformin at large dosages (> 2,000 mg/day) and for a longer duration (> 4 years), should be regularly screened for vitamin B12 deficiency and metformin is associated with B12 deficiency, but this is not associated with peripheral neuropathy.

Vitamin B12 Deficiency in Children With Infantile Spasms: A Case-Control Study.

There have been few case reports showing association of vitamin B12 deficiency with infantile spasms. We planned this study to see if there was an association of serum vitamin B12 deficiency in children with development of infantile spasms. Cases included children with infantile spasms of ages 6 months to 3 years. The controls were children in the same age group who had global developmental delay but no history of epileptic spasms. Mean serum vitamin B12, serum homocysteine, and urinary methylmalonic acid levels were measured in both groups and compared. Children with infantile spasms had lower mean serum vitamin B12 levels (354.1 pg/mL; standard deviation 234.1 pg/mL) as compared to children with global developmental delay without spasms (466.7 pg/mL; standard deviation 285.5 pg/mL) ( P value < .05). Mean serum homocysteine level (13.9 vs 7.8 μmol/L, P = .02) and mean urinary methylmalonic acid level (68.1 mmol/mol of creatinine vs 26.1 mmol/mol of creatinine, P = .03) were elevated in children with infantile spasms than in controls. Fourteen children (35.0%) with infantile spasms were vitamin B12 deficient compared with 3 (7.50%) controls ( P = .005). Thus, vitamin B12 deficiency may have an association with infantile spasms. More studies are needed before recommending routine measurement of serum B12 levels in children with infantile spasms.

Association between pre-pregnancy weight status and maternal micronutrient status in early pregnancy.

Inadequate maternal micronutrient status during pregnancy can lead to short- and long-term health risks for mother and offspring. The present study investigated the association between pre-pregnancy weight status and micronutrient status during pregnancy. Maternal blood samples were collected during early pregnancy (median 13, interquartile range 12-15 weeks) and were assayed for serum folate, ferritin, Fe and vitamin B12. Regression modelling was used to assess the association between pre-pregnancy underweight, normal weight, overweight and obesity, and micronutrient levels, as well as the odds for deficiencies. The Amsterdam Born Children and their Development (ABCD) study, the Netherlands. Women with singleton pregnancies without diabetes (n 4243). After adjustment for covariates, overweight women and obese women had lower (β; 95 % CI) folate (-1·2; -2·2, -0·2 and -2·3; -4·0, -0·7 nmol/l, respectively) and Fe (-1·7; -2·3, -1·1 and -3·6; -4·7, -2·6 μmol/l, respectively) levels than women with normal weight. Furthermore, overweight women had 6 % (95 % CI -9, -3 %) and obese women had 15 % (-19, -10 %), lower vitamin B12 levels, and obese women had 19 % (6, 32 %) higher ferritin levels, than normal-weight women. Obese women had higher odds (OR; 95 % CI) for folate deficiency (2·03; 1·35, 3·06), Fe deficiency (3·26; 2·09, 5·08) and vitamin B12 deficiency (2·05; 1·41, 2·99) than women with normal weight. Underweight was not associated with micronutrient status. During early pregnancy, women with pre-pregnancy overweight and obesity had lower serum folate, Fe and vitamin B12 status. This resulted in increased risk of serum folate, Fe and vitamin B12 deficiencies in women with obesity.

The association between serum vitamin B12 deficiency and tension-type headache in Turkish children.

This study aimed to determine the relationship between serum vitamin B12 level and tension-type headache. The study groups consisted of 75 patients (40 females, 35 males) with headache and a control group of 49 healthy children (25 females, 24 males). Serum vitamin B12 level < 200pg/ml was defined as deficient, and < 160pg/ml as severely deficient. The serum vitamin B12 level was measured by the electrochemiluminescence (ECLIA) method. The serum vitamin B12 levels in the headache and control groups were 273.01 ± 76.77 and 316.22 ± 74.53pg/ml, with the difference determined as statistically significant (p = 0.003). In the case group, 18/75 patients (24%) had a serum vitamin B12 level below the normal of 200pg/ml, and in the control group 4/49 (8%) patients were also below the normal range (p = 0.021). The serum vitamin B12 level in the children with tension-type headache was significantly lower than that in the control group. From the results of the study, it was concluded that there may be an association between vitamin B12 level and tension-type headache. However, further clinical studies are needed.

Hematinic deficiencies in patients with recurrent aphthous stomatitis: variations by gender and age.

BackgroundThe aim of this study was to evaluate the association between hematinic deficiencies and recurrent aphthous stomatitis (RAS).Material and Methods517 RAS patients and 187 healthy controls were enrolled in the present study. Hematinic deficiencies, including serum ferritin, folic acid, and vitamin B12 deficiencies were assessed for each participant. Gender and age were taken into account and the collected data were statistically analysed.ResultsCompared with the healthy controls, a significantly higher overall frequency of hematinic deficiencies was found in RAS patients (p<0.001). When gender and age were taken into account, significant differences in hematinic deficiencies were observed among RAS patients. Serum ferritin deficiency was much more common in young and middle-aged female RAS patients (age<60). Serum folate deficiency and serum vitamin B12 deficiency were both much more common in the young adult group of male RAS patients (21–40 years of age). Logistic regression analysis revealed that both gender and age have significant correlation with the presence of hematinic deficiencies in the RAS patients.ConclusionsSignificant variations in hematinic deficiencies were demonstrated in RAS patients across different genders and age groups. We suggest that further studies on the hematinic deficiencies of RAS patients should take into account the gender and age of participants. Key words:Recurrent aphthous stomatitis, hematinic deficiencies, gender, age.

Study of vitamin B12 status and the consequential clinico-hematological profile in healthy vegetarian population in Nepal

Background: A strict vegetarian diet has been associated with an increased risk of vitamin B12 deficiency. Clinical manifestations of cobalamin deficiency are hematologic and neurological symptoms. The purpose of this study was to determine the prevalence of vitamin B12 deficiency in healthy vegetarian population and to study the clinical and hematological profile of vitamin B12 deficient subjects.Methods: A community based cross-sectional observational study was conducted through preplanned camps in Kathmandu Nepal. 166 vegetarian people were investigated for serum vitamin B12 level and their hematological profile was done. They were examined for neurological manifestation of vitamin B12 deficiency.Results: The mean serum vitamin B12 level of the vegetarian in this study was 271.34 ±241.74 pg/ml (mean ± SD)., 53.6 % had serum vitamin B12 deficiency. 56.5 % of male and 47.1 % of female had vitamin B12 deficiency. The risk of vitamin B12 deficiency is more in males than females with odds ratio 1.201 (CI=95%) which is not statistically significant with p-value 0.312. There was no significant difference in vitamin B12 level in different age group.The study population had mean hemoglobin of 13.12 ± 1.72 gm/dl. Anemia was present in 34.9 % of study population. 33.9 % of male and 37.3 % of female had anemia. There was no significant difference in anemia in male and female vegetarian (p-value 0.72). 40% of patient who had vitamin B12 deficiency had anemia.A significant low hemoglobin level and higher MCV were found as level of serum vitamin B12 decreased. Only one patient had macrocytic anemia.There were few symptoms but not specific to vitamin B12 deficiency.Conclusion: The result of present study show that prevalence of vitamin B12 deficiency among healthy vegetarian was 53.6% with higher prevalence in male and elder age group.Prevalence of anemia was 34.9% in this study with elderly group and females being more affected.There was significant correlation between vitamin B12 and hemoglobin level and significant negative correlation with MCV. Although, not significant, leucocytes count, lymphocyte count and platelets were low in vitamin B12 deficient population.Few clinical features were present in vitamin B12 deficient subjects but neurological features specific to vitamin B12 deficiency were not seen.

FOLATE AND SYNTHETIC FOLIC ACID INTAKE, SERUM B VITAMIN AND HOMOCYSTEINE CONCENTRATIONS, AND COGNITIVE IMPAIRMENT IN ELDERLY BRAZILIANS

Background: An increased risk of cognitive decline in the elderly with B12 deficiency has been associated with excessive synthetic folic acid in food fortification and supplements. Objectives: To assess the dietary folate and folic acid intake from food fortification, as well as serum vitamin B12, folate, iron, and homocysteine concentrations among the elderly and their relationships with cognitive changes. Design: Cross-sectional, observational study. Setting and Participants: Community-dwelling elderly (N = 40), predominantly female (90%), with an average age of 69 years. Measurements: Dietary intake information was collected using four 24-hour dietary recalls, adjusted for iron and folic acid in fortified flour and supplements. Serum vitamin B12, B6, folate, iron, and homocysteine concentrations were determined. Cognitive function was assessed using the Mini-Mental State Examination, adjusted for educational level. Results: Possible serum vitamin B12 deficiency (&lt;258 pmol/L) was present in 5% of the elderly participants, while 27.5% had possible functional deficiency (&lt;400 pmol/L). No serum folate deficiency (&lt;6.8 nmol/L) was observed; however, 15% had possible deficiency (&lt;13.6 nmol/L), and 7.5% had supraphysiological levels. Hyperhomocysteinemia (≥15 µmol/L) was present in 65% of the sample. Almost half of the participants (47.5%) showed cognitive impairment. There were no significant relationships between the Mini-Mental State Examination results and the B12, folate, iron, and homocysteine concentrations. However, the participants with serum vitamin B12 levels &lt;400 pmol/L tended to have poorer Mini-Mental State Examination scores, which were related to older age (P = 0.045) and changes in the oral cavity (P = 0.034). In addition, folic acid consumption was inversely related with serum vitamin B12 levels (P = 0.030). Macrocytosis was not observed. Conclusions: Although Mini-Mental State Examination-assessed cognitive impairment was not related with the investigated biochemical variables, increased folic acid consumption seems to have a negative impact on vitamin B12 metabolism; therefore, fortification may be contributing to functional disability and masking hematological signs in the elderly.

Vitamin B12 status in women of childbearing age in the UK and its relationship with national nutrient intake guidelines: results from two National Diet and Nutrition Surveys

ObjectiveTo assess serum B12, folate and the associated homocysteine (Hcy) levels among women of childbearing age in the UK and examine their association with dietary intake in relation to the...

Oxidative Stress Markers in Vitamin B12 Deficiency.

In this study, we report the status of oxidative stress markers in vitamin B12 deficiency and their relation to clinical, laboratory, and neurophysiological findings. Fifty-one subjects with serum vitamin B12 deficiency (<211pg/ml) were included. Plasma glutathione (GSH), malondialdehyde (MDA) and serum total antioxidant capacity (TAC) were measured in the patients and 53 controls. These markers were also compared between subacute combined degeneration (SACD) and non-SACD vitamin B12 deficiency patients groups as well as with normal controls. In the patients, GSH, MDA and TAC were correlated with demographic, clinical, hematological, biochemical, nerve conduction study (NCS), visual evoked potential (VEP) and somatosensory-evoked potential (SEP) findings. In the study group, 20 (39.2%) patients had SACD manifesting with myeloneuropathy, cognitive or behavioral abnormalities, and 31(60.8%) patients had non-SACD neurological manifestations. The GSH (2.46 ± 0.32 vs. 2.70 ± 0.36mg/dl; P = 0.002) and TAC (2.13 ± 0.38 vs. 2.33 ± 0.24nmol Trolox eq/l, P = 0.005) levels were lower, and MDA levels (4.01 ± 0.69 vs. 3.00 ± 0.45nmol/ml, P < 0.001) were higher in B12 deficiency group compared with controls. Similar trend was found in SACD and non-SACD vitamin B12 deficiency groups. GSH levels correlated with abnormal VEP (r = 0.54; P < 0.01), TAC with female gender (r = 0.43; P = 0.002) and joint position impairment (r = -0.34; P = 0.01), and MDA with LDH (r = 0.41; P = 0.01). Vitamin B12 deficiency was associated with reduction in GSH and TAC and increase in MDA levels which were more marked in SACD compared to non-SACD group.

Deficiencies of Serum Ferritin and Vitamin B12, but not Folate, are Common in Adolescent Girls Residing in a Slum in Delhi.

Anemia among adolescent girls is one of the major challenges faced by India. The present study was undertaken to assess the prevalence of anemia and status of other hematological parameters among adolescent girls (11 - 18 years) residing in an urban slum of Delhi. A total of 794 adolescent girls were recruited for the study. The prevalence of anemia was estimated using the cyanmethemoglobin method. Serum levels of ferritin, folic acid and vitamin B12 were estimated for anemic subjects. The prevalence of anemia was reported as 58.7 %, with 31.6 %, 25.7 % and 1.4 % of subjects being mild, moderate and severely anemic. Hemoglobin levels of subjects who had attained menarche were found to be significantly lower than those who had not attained menarche. The prevalence of serum ferritin, folic acid and vitamin B12 deficiency among those who were anemic was reported as 41.1 %, 5.0 % and 63.3 % respectively. A total of 23.5 % anemic subjects had concomitant micronutrient deficiencies of serum vitamin B12 and ferritin. The results indicate that supplemental iron and vitamin B12 may better address the burden of anemia in adolescent girls in Delhi.

Vitamin B12 deficiency in the elderly: is it worth screening?

Vitamin B12 deficiency is common among the elderly. Elderly people are particularly at risk of vitamin B12 deficiency because of the high prevalence of atrophic gastritis-associated food-cobalamin (vitamin B12) malabsorption, and the increasing prevalence of pernicious anaemia with advancing age. The deficiency most often goes unrecognised because the clinical manifestations are highly variable, often subtle and non-specific, but if left undiagnosed the consequences can be serious. Diagnosis of vitamin B12 deficiency, however, is not straightforward as laboratory tests have certain limitations. Setting a cut-off level to define serum vitamin B12 deficiency is difficult; though homocysteine and methylmalonic acid are more sensitive for vitamin B12 deficiency, it may give false result in some conditions and the reference intervals are not standardised. At present, there is no consensus or guideline for diagnosis of this deficiency. It is most often based on the clinical symptoms together with laboratory assessment (low serum vitamin B12 level and elevated serum homocysteine or methylmalonic acid level) and the response to treatment to make definitive diagnosis. Treatment and replacement with oral vitamin B12 can be as effective as parenteral administration even in patients with pernicious anaemia. The suggested oral vitamin B12 dose is 1 mg daily for a month, and then maintenance dose of 125 to 250 µg for patients with dietary insufficiency and 1 mg daily for those with pernicious anaemia. Vitamin B12 replacement is safe and without side-effects, but prompt treatment is required to reverse the damage before it becomes extensive or irreversible. At present, there is no recommendation for mass screening for vitamin B12 in the elderly. Nevertheless, the higher prevalence with age, increasing risk of vitamin B12 deficiency in the elderly, symptoms being difficult to recognise, and availability of safe treatment options make screening a favourable option. However, the unavailability of reliable diagnostic tool or gold standard test makes screening difficult to carry out.

Pernicious Anemia in Patients with Primary Biliary Cirrhosis, Autoimmune Hepatitis, and Chronic Viral Hepatitis

Backgrounds: Cases of Pernicious Anemia (PA) with Autoimmune Liver Diseases (ALDs) or chronic viral hepatitis have been uncommon. There have been few articles regarding the associations between these diseases. Methods: A review of concomitant cases of PA in patients with ALDs, such as Auto Immune Hepatitis (AIH) or Primary Biliary Cirrhosis (PBC), and patients with chronic viral hepatitis with or without Interferon (IFN) treatment were conducted. Results: Six cases of concomitant PA and ALDs (five were PBC and one was AIH) and seven cases of chronic viral hepatitis (six were due to HCV, one was due to HBV; five cases were of IFN-induced PA and two were of PA without IFN treatment) have been reported. In these concomitant cases, serum vitamin B12 deficiency was documented in all 13 cases and serum Intrinsic Factor Antibodies (IFA) were positive in 11 of 12 cases, excluding one case in which detection of IFA was not mentioned. Conclusions: Although concomitant cases of PA in patients with ALDs or chronic viral hepatitis have been rarely reported, PA should be considered in cases of progressive macrocytic anemia in these patients.