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.

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Functional vitamin B12 deficiency in phenylketonuria patients and healthy controls: An evaluation with combined indicator of vitamin B12 status as a biochemical index

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563220935140 ◽

2020 ◽

Vol 57 (4) ◽

pp. 291-299

Author(s):

Merve Akış ◽

Melis Kant ◽

İshak Işık ◽

Pelin Teke Kısa ◽

Engin Köse ◽

...

Keyword(s):

Liquid Chromatography ◽

Vitamin B12 ◽

Children And Adolescents ◽

Methylmalonic Acid ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Healthy Controls ◽

Biochemical Index ◽

Significant Difference ◽

B12 Deficiency

Background Vitamin B12 deficiency frequently appears in phenylketonuria patients having a diet poor in natural protein. The aims of this study were to evaluate vitamin B12 status in phenylketonuria patients by using combined indicator of vitamin B12 status (cB12) as well as methylmalonic acid and homocysteine, more specific and sensitive markers, in comparison with healthy controls. Methods Fifty-three children and adolescents with phenylketonuria under dietary treatment and 30 healthy controls were assessed cross-sectionally. Serum vitamin B12 and folate concentrations were analysed by chemiluminescence immunoassay. Plasma methylmalonic acid and total homocysteine concentrations were measured by liquid chromatography-tandem mass spectrometry and liquid chromatography, respectively. cB12 was calculated by using a formula involving blood parameters. Results Methylmalonic acid and folate concentrations in phenylketonuria group were higher compared with controls. Methylmalonic acid concentrations were high in 56.5% of the patients and 26.7% of the controls with normal vitamin B12 concentrations. Based on cB12, a significant difference within the normal values was detected between the groups. However, although 24.5% of phenylketonuria patients and 13.3% of controls had decreased vitamin B12 status according to cB12, there was no significant difference. Conclusion Children and adolescents with phenylketonuria having a strict diet can be at risk of functional vitamin B12 deficiency. This deficiency can be accurately determined by measuring methylmalonic acid concentrations. Calculation of cB12 as a biochemical index did not provide additional information compared with the measurement of methylmalonic acid alone, but may be helpful for classification of some patients with increased methylmalonic acid as having adequate vitamin B12 status.

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The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210270 ◽

2021 ◽

Vol 8 (2) ◽

pp. 165

Author(s):

Ramesh Dasarathan ◽

Rajendran Velayudham ◽

Haridoss Krishnan ◽

Senthilkumar S.

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Metformin Therapy ◽

Significant Difference ◽

B12 Deficiency

Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.

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Vitamin B12 Deficiency in Eastern India: A Hospital Based Cross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46642.14685 ◽

2021 ◽

Author(s):

Debasmita Bandyopadhyay ◽

Jayati Roy Choudhury ◽

Kasturi Mukherjee

Keyword(s):

Vitamin B12 ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Cross Sectional Study ◽

P Value ◽

Eastern India ◽

Cross Sectional ◽

Severe Deficiency ◽

B12 Deficiency ◽

Mild Deficiency

Introduction: The prevalence of vitamin B12 deficiency is common (around 40%) in people older than 65 years of age and in people who are strict vegetarians. The major sources of Viamin B12 are meat, fish, dairy products and fortified cereals. Aim: To study the prevalence and common types of presentations of vitamin B12 deficiency among 20-80 years aged, non-vegetarian people attending a tertiary care hospital in a state of Eastern India. Materials and Methods: This hospital based cross-sectional study was conducted at IPGME&R and SSKM Hospital between July 2018 to December 2019. Serum samples were collected from 478 adult patients presenting with different symptoms like pallor, fatigue, numbness and tingling sensation in limbs, memory loss, alopecia etc., which may be related to vitamin B12 deficiency. These samples were screened for serum vitamin B12 level by chemiluminescence method in ADVIA, Centaur CP (SIEMENS). Data were analysed statistically by graph pad prism 8 software. Significance of the difference between means were detected using Student’s unpaired t-test and calculating the p-value (p-value <0.05 were considered as significant). Results: Among 184 females, 50 (27.17%) were found to be Vitamin B12 deficient (VBD). Among them, 18 (36%) had mild deficiency (serum vitamin B12 level 201-220 pmol/L), 22 (44%) had moderate (serum vitamin B12 level 150-200 pmol/L) and 10 (20%) had severe deficiency (serum vitamin B12 level <150 pmol/L). A total of 35 (70%) of the VBD females were of <50 years of age. Among 294 males, 83 (28.23%) were found to be VBD. Among them, 34 (41%) had mild deficiency (serum vitamin B12 level 201-220 pmol/L), 36 (43%) had moderate (serum vitamin B12 level 150-200 pmol/L) and 13 (16%) had severe deficiency (serum vitamin B12 level <150 pmol/L). Total 43 (51.8%) of VBD male persons were of <50 years age. Among VBD female patients, 24 (48%) had neuropathy and among VBD male patients, 54 (65%) had neuropathy. Conclusion: So, it can be concluded that if regular screening is done for serum vitamin B12 in symptomatic patients irrespective of age, a number of problems can be reduced or cured by diagnosing VBD patients and treating them with vitamin B12 either by dietary modification or medicinal supplementation.

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Vitamine B12 Deficiency Presenting As Severe Pancytopenia in Adult Patients. a Monocentric Study of 104 Cases

Blood ◽

10.1182/blood.v128.22.4812.4812 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4812-4812

Author(s):

Zoubida Tazi Mezalek ◽

Wafaa Ammouri ◽

Mouna Maamar ◽

Meriem Bourkia ◽

Hicham Harmouche ◽

...

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Cobalamin Deficiency ◽

Serum Lactate Dehydrogenase ◽

Vitamine B12 ◽

Significant Difference ◽

High Prevalence ◽

B12 Deficiency ◽

The Mean ◽

Severe Pancytopenia

Abstract Vitamin B12 deficiency should be suspected in all patients with unexplained anemia and/or neuropsychiatric symptoms, and special attention should be paid to patients at risk (the elderly, vegetarians, patients with autoimmune thyroiditis or vitiligo, patients receiving proton pump inhibitors or biguanides for prolonged periods). Documented symptomatic pancytopenia related to cobalamin deficiency is very rare representing less than 5% cases in different series. We aim to report an important series of pancytopenia related to cobalamin deficiency to analyze the clinical, biological and outcomes of those patients. Methods : Consecutive patients presented with B12 deficiency and pancytopenia were included. Charts were retrospectively reviewed from an internal medicine department during a period of 15 years (2000-2015). Diagnosis of cobalamine deficiency used the vitamin B12 dosage bellow 200 pg/ml. Assessment included clinical features, blood count and morphological review and a statistical analysis of those parameters comparing pancytopenic and non-pancytopenic patients. Results The medical records of 268 consecutive patients hospitalized for cobalamin deficiency from January 2000 to December 2015 were identified and retrospectively analyzed. Among them, 104 patients had pancytopenia (38.8%). The median age was 55+17 years and the sex ratio : 1. Pancytopenia revealed vitamin B12 deficiency in all cases. Neurological manifestations were associated in 13 cases and digestive involvement in 16 cases. Twenty five patients presented with febrile neutropenia. Fourteen patients (13.4%) presented with "pseudo" thrombotic microangiopathy. The mean hemoglobin level was 58+19 g/L, the neurtophils count was 1188+579/µl and median platelets count was 69.616+34.379/µl. Macrocytosis was present in 80.7% of patient with mean MCV was 106+11 fl, but was normal (<95 fl) in 20 patients. The mean serum vitamine B12 levels was 80+11 pg/ml. The median serum lactate dehydrogenase level was high (3.204 IU/L). The causes of B12 vitamin deficiency were mainly food cobalamin malabsorption (63.4%) and pernicious anemia (28.8%). Correction of the hematological abnormalities was achieved in all patients treated with either intramuscular, subcutaneous or oral cyanocobalamin. Significant differences appears comparing patients with or without pancytopenia. Pancytopenic patients had significantly lower MCV mean (p=0.001), lower polynuclear neutrophils count and lower platelets count. Atrophic gastritis was also significantly associated with pancytopenia (p=0.005). There was no significant difference in mean haemoglobin level (p=0.3), serum cobalamin level (p=0.17). Looking at other variables that could explain the high prevalence of pancytopenia in our series, there were no difference in ferritinemia level or number of patients with of iron deficiency . Conclusion In this study, based a single institution with a large number of consecutive patients with well-documented cobalamin deficiency, we found a high prevalence (38,8%) of severe pancytopenia. We don't find yet an explanation for those findings. Those results can also remind us that severe vitamin B12 deficiency may present with findings mimicking malign hematologic disorder and timely recognition and supplementation lead to resolution of symptoms and blood abnormalities. Disclosures No relevant conflicts of interest to declare.

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Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

Journal of Clinical Medicine ◽

10.3390/jcm7100304 ◽

2018 ◽

Vol 7 (10) ◽

pp. 304 ◽

Cited By ~ 2

Author(s):

Emmanuel Andrès ◽

Abrar-Ahmad Zulfiqar ◽

Khalid Serraj ◽

Thomas Vogel ◽

Georges Kaltenbach

Keyword(s):

Vitamin B12 ◽

Prospective Studies ◽

Clinical Manifestations ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Cochrane Library ◽

Clinical Approach ◽

Oral Vitamin ◽

Hand Search ◽

B12 Deficiency

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

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Circulating antibody to transcobalamin II causing retention of vitamin B12 in the blood

Blood ◽

10.1182/blood.v49.6.987.bloodjournal496987 ◽

1977 ◽

Vol 49 (6) ◽

pp. 987-1000 ◽

Cited By ~ 2

Author(s):

R Carmel ◽

B Tatsis ◽

L Baril

Keyword(s):

Vitamin B12 ◽

Binding Capacity ◽

Megaloblastic Anemia ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

High Serum ◽

The Status ◽

B12 Deficiency ◽

Long Acting

A patient with recurrent pulmonary abscess, weight loss, and alcoholism was found to have extremely high serum vitamin B12 and unsaturated vitamin B12-binding capacity (UBBC) levels. While transcobalamin (TC) II was also increased, most of his UBBC was due to an abnormal binding protein which carried greater than 80% of the endogenous vitamin B12 and was not found in his saliva, granulocytes, or urine. This protein was shown to be a complex of TC II and a circulating immunoglobulin (IgGkappa and IgGlambda). Each IgG molecule appeared to bind two TC II molecules. The reacting site did not interfere with the ability of TC II to bind vitamin B12, but did interfere with its ability to transfer the vitamin to cells in vitro. The site was not identical to that reacting with anti-human TC II antibody produced in rabbits. Because of this abnormal complex, 57Co-vitamin B12 injected intravenously was cleared slowly by the patient. However, no metabolic evidence for vitamin B12 deficiency was demonstrable, although the patient initially had megaloblastic anemia apparently due to folate deficiency. The course of the vitamin B12-binding abnormalities was followed over 4 yr and appeared to fluctuate with the status of the patient's illness. The IgG-TC II complex resembled one induced in some patients with pernicious anemia by intensive treatment with long-acting vitamin B12 preparations. The mechanism of induction of the antibody formation in our patient is unknown.

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The Level of Serum Pepsinogen in Diagnosing and Evaluating the Severity of Subacute Combined Degeneration Due to Vitamin B12 Deficiency

Frontiers in Neurology ◽

10.3389/fneur.2021.604523 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaoyan Chen ◽

Rong Wang ◽

Xusheng Huang ◽

Fei Yang ◽

Shengyuan Yu

Keyword(s):

Vitamin B12 ◽

Neurological Complication ◽

Vitamin B12 Deficiency ◽

Inverse Correlation ◽

Cobalamin Deficiency ◽

Serum Pepsinogen ◽

Roc Curve Analysis ◽

Subacute Combined Degeneration ◽

B12 Deficiency ◽

Autoimmune Atrophic Gastritis

Subacute combined degeneration (SCD) is a neurological complication of cobalamin deficiency, which is usually caused by chronic autoimmune atrophic gastritis. Serum pepsinogen 1 and the ratio of pepsinogen 1/pepsinogen 2 (PG1/2) can reflect the severity of gastric atrophy.Objective: This work aims to investigate whether decreased serum PG1 and PG1/2 ratio are helpful in diagnosing SCD and reflecting the severity of SCD.Methods: We retrospectively analyzed the clinical and laboratory tests of 65 cases of SCD due to vitamin B12 deficiency and compared the laboratory parameters of SCD with 65 age- and sex-matched amyotrophic lateral sclerosis (ALS) patients.Results: PG1 and PG1/2 ratio were decreased in 80 and 52.3% of SCD patients, respectively. Compared to patients with PG1/2 ratio ≥3.0, patients with PG1/2 ratio <3.0 had more severe anemia, larger mean corpuscular volume (MCV), lower level of vitamin B12, higher folate and homocysteine (Hcy), more severe changes in somatosensory evoked potential (SEP), and higher rate of lesions in spinal MRI (P < 0.05). PG1 and PG1/2 ratio had inverse correlation with MCV and N20 latency in SEP examination (P < 0.05). PG1/2 ratio, RBC count, and Hcy were independent risk factors for SCD in logistic regression analyses. The ROC curve analysis revealed that the diagnostic accuracy of PG1 and PG1/2 ratio was 72.2 and 73.0%, respectively, while the cutoff values were 22.4 ng/ml and 2.43 for SCD, respectively.Conclusions: Decreased PG1 and PG1/2 ratio are helpful for the diagnosis and evaluation of the severity of SCD due to vitamin B12 deficiency.

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EFEK FORTIFIKASI VITAMIN B12 TERHADAP KADAR VITAMIN B12 SERUM DAN HOMOSISTEIN SERUM PADA VEGETARIAN

Jurnal Ilmu Kesehatan Bhakti Husada: Health Sciences Journal ◽

10.34305/jikbh.v11i1.150 ◽

2020 ◽

Vol 11 (1) ◽

pp. 114-120

Author(s):

Susianto Susianto

Keyword(s):

Vitamin B12 ◽

Homocysteine Level ◽

Megaloblastic Anemia ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Natural Sources ◽

Serum Homocysteine ◽

Microparticle Enzyme Immunoassay ◽

B12 Deficiency ◽

Community Trial

Introduction: Vegetarians consume plant-based foods with or without eggs and milk. Vegetarians are at risk of vitamin B12 deficiency, as natural sources of vitamin B12 are limited to animal-based foods. Vitamin B12 deficiency can lead to megaloblastic anemia, nerve damage and increase homocysteine level. Higher homocysteine level can increase the risk of coronary heart disease and stroke. The objective of this study was to investigate the effect of vitamin B12 fortification on the level of serum vitamin B12 and homocysteine in vegetarian. Method: The research design was an experimental study, community trial. The samples were 42 vegetarians with vitamin B12 deficiency (< 156 pmol/L) selected from 118 vegetarians as members of Indonesia Vegetarian Society (IVS) Pekanbaru, treated by vitamin B12 fortified oatmeal for three months from March to June 2010. Serum vitamin B12 and homocysteine were measured by electrochemiluminescent immunoassay and microparticle enzyme immunoassay method respectively. Result: Prevalence of vitamin B12 deficiency in vegetarian was 35.6%. Statistical analysis showed a significant increase of serum vitamin B12 from 124.6 to 284.6 pmol/L (p=0.001) and significant decrease of serum homocysteine from 20.1 to 15.1 µmol/L (p=0.001). Conclusion: Consumption of vitamin B12 fortified oatmeal increases the level of serum vitamin B12 and decreases the level of serum homocysteine significantly in vegetarian with vitamin B12 deficiency.

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RELATIONSHIP OF MATERNAL VITAMIN B12 STATUS IN PREGNANCY WITH PRETERM BIRTH AND MATERNAL HEALTH RISKS

International Medical Journal ◽

10.37436/2308-5274-2020-2-7 ◽

2020 ◽

pp. 32-38

Author(s):

VICTORIA LAZAROVA SPASOVA ◽

LILIA IVANOVA KOLEVA ◽

MARIETA ANTONOVA POPOVA ◽

VALENTINA BOYANOVA PETKOVA ◽

MILEN VENTZISLAVOV DIMITROV

Keyword(s):

Preterm Birth ◽

Vitamin B12 ◽

Pregnant Women ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Inverse Association ◽

Maternal Vitamin ◽

B12 Deficiency ◽

The Impact ◽

In Pregnancy

Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women. Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.

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