Methylmalonic Acid and Homocysteine as Indicators of Vitamin B12 Deficiency in Patients with Gastric Cancer after Gastrectomy

Vitamin B12 deficiency is a common complication in patients after gastrectomy. Elevated methylmalonic acid (MMA) and homocysteine are better indications of vitamin B12 deficiency than vitamin B12 serum level. We compared MMA and homocysteine levels of patients with gastric cancer after gastrectomy (n = 151) with controls (n = 142) and evaluated the prevalence of vitamin B12 deficiency using MMA and homocysteine in patients. MMA and homocysteine levels were significantly higher (p < 0.05) in patients with gastric cancer after gastrectomy. Of the 151 patients assessed after gastrectomy, 32 patients (21.2%) were vitamin B12 deficient as defined by serum MMA levels > 350 nmol/L, and 8 patients (5.3%) were vitamin B12 deficient as defined by serum homocysteine levels > 15 μmol/L. Both MMA and homocysteine levels were elevated in 7 patients. Among 33 patients with elevated MMA or homocysteine levels, 8 patients (24.2%) were vitamin B12 deficient based on a serum vitamin B12 level < 200 pg/mL. Additionally, levels of MMA and homocysteine were compared pre- and post-gastrectomy in 27 patients. The median MMA level was higher in patients with post-gastrectomy compared to pre-gastrectomy, while the median serum homocysteine level was not significantly different. These results indicate that using serum vitamin B12 levels alone may fail to detect vitamin B12 deficiency. Additional assessments of MMA and homocysteine levels are useful to evaluate possible vitamin B12 deficiency in patients who underwent a gastrectomy, and MMA is a better indicator than homocysteine to detect early changes in vitamin B12 levels.

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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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Dietary Intake and Status of Vitamin B12 in Slovenian Population

Nutrients ◽

10.3390/nu14020334 ◽

2022 ◽

Vol 14 (2) ◽

pp. 334

Author(s):

Živa Lavriša ◽

Hristo Hristov ◽

Maša Hribar ◽

Katja Žmitek ◽

Anita Kušar ◽

...

Keyword(s):

Vitamin B12 ◽

Age Groups ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

High Serum ◽

Health Concern ◽

Dietary Vitamin ◽

Serum Homocysteine ◽

Daily Vitamin ◽

B12 Deficiency

Vitamin B12 deficiency poses a health concern, especially in vulnerable populations. Dietary vitamin B12 intake was obtained by two 24 h dietary recalls and food propensity questionnaires in a representative Slovenian cross-sectional food consumption survey, SI.Menu (n = 1248 subjects; 10–74 years). For a subgroup of 280 participants, data on serum vitamin B12 were available through the Nutrihealth study. The estimated usual population-weighted mean daily vitamin B12 intakes were 6.2 µg (adults), 5.4. µg (adolescents), and 5.0 µg (elderly). Lower intakes were observed in females. Inadequate daily vitamin B12 intake (<4 µg) was detected in 37.3% of adolescents, 31.7% of adults, and 58.3% elderlies. The significant predictors for inadequate daily vitamin B12 intake were physical activity score in all age groups, sex in adolescents and adults, financial status and smoking in elderly, and employment in adults. Meat (products), followed by milk (products), made the highest vitamin B12 contribution in all age groups. In adolescents, another important vitamin B12 contributor was cereals. The mean population-weighted serum vitamin B12 levels were 322.1 pmol/L (adults) and 287.3 pmol/L (elderly). Low serum vitamin B12 concentration (<148 nmol/L) and high serum homocysteine (>15 µmol/L) were used as criteria for vitamin B12 deficiency. The highest deficiency prevalence was found in elderlies (7.0%), particularly in males (7.9%). Factors associated with high serum homocysteine were also investigated. In conclusion, although vitamin B12 status was generally not critical, additional attention should be focused particularly to the elderly.

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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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Cognitive impairment and vitamin B12: a review

International Psychogeriatrics ◽

10.1017/s1041610211002511 ◽

2012 ◽

Vol 24 (4) ◽

pp. 541-556 ◽

Cited By ~ 71

Author(s):

Eileen Moore ◽

Alastair Mander ◽

David Ames ◽

Ross Carne ◽

Kerrie Sanders ◽

...

Keyword(s):

Cognitive Impairment ◽

Vitamin B12 ◽

Neurodegenerative Disease ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Small Subset ◽

High Dose ◽

Serum Homocysteine ◽

B12 Deficiency ◽

Potential Impact

ABSTRACTBackground: This review examines the associations between low vitamin B12 levels, neurodegenerative disease, and cognitive impairment. The potential impact of comorbidities and medications associated with vitamin B12 derangements were also investigated. In addition, we reviewed the evidence as to whether vitamin B12 therapy is efficacious for cognitive impairment and dementia.Methods: A systematic literature search identified 43 studies investigating the association of vitamin B12 and cognitive impairment or dementia. Seventeen studies reported on the efficacy of vitamin B12 therapy for these conditions.Results: Vitamin B12 levels in the subclinical low-normal range (<250 ρmol/L) are associated with Alzheimer's disease, vascular dementia, and Parkinson's disease. Vegetarianism and metformin use contribute to depressed vitamin B12 levels and may independently increase the risk for cognitive impairment. Vitamin B12 deficiency (<150 ρmol/L) is associated with cognitive impairment. Vitamin B12 supplements administered orally or parenterally at high dose (1 mg daily) were effective in correcting biochemical deficiency, but improved cognition only in patients with pre-existing vitamin B12 deficiency (serum vitamin B12 levels <150 ρmol/L or serum homocysteine levels >19.9 μmol/L).Conclusion: Low serum vitamin B12 levels are associated with neurodegenerative disease and cognitive impairment. There is a small subset of dementias that are reversible with vitamin B12 therapy and this treatment is inexpensive and safe. Vitamin B12 therapy does not improve cognition in patients without pre-existing deficiency. There is a need for large, well-resourced clinical trials to close the gaps in our current understanding of the nature of the associations of vitamin B12 insufficiency and neurodegenerative disease.

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Low serum vitamin B12 is associated with recurrent pregnancy loss in Syrian women

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2008.247 ◽

2008 ◽

Vol 46 (9) ◽

Cited By ~ 18

Author(s):

Ulrich Hübner ◽

Ahmad Alwan ◽

Muhidin Jouma ◽

Mohammad Tabbaa ◽

Heike Schorr ◽

...

Keyword(s):

Vitamin B12 ◽

Methylmalonic Acid ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Serum Folate ◽

Functional Markers ◽

Unexpected Result ◽

Recurrent Abortion ◽

B12 Deficiency ◽

Low Serum

Abstract: Hyperhomocysteinemia and B-vitamin deficiency are associated with recurrent abortion. Recent studies have not investigated functional markers of vitamin B12 deficiency, such as methylmalonic acid.: A total of 43 consecutive Syrian women with unexplained recurrent abortion and 32 pregnant controls were enrolled in the study. Serum folate, vitamin B12, methylmalonic acid and plasma homocysteine were determined.: Vitamin B12 was significantly decreased in patients with recurrent abortion compared to controls (mean concentrations 197 vs. 300 pg/mL, p=0.004). The lowest mean serum vitamin B12 (172 pg/mL) was observed in primary aborters. Homocysteine was elevated in aborters in comparison to controls (8.3 vs. 7.1 μmol/L, p=0.093). Folate and methylmalonic acid did not differ significantly between the study groups. A highly significant correlation between homocysteine and methylmalonic acid and vitamin B12 was observed only in patients but not in controls (p<0.001 and p=0.002, respectively). In the logistic regression model, only serum vitamin B12 emerged with a significant odds ratio.: The results confirm low serum vitamin B12 in recurrent abortion patients. However, methylmalonic acid did not support that functional vitamin B12 plays a role in this group. This unexpected result might be due to a decrease of the metabolically inert vitamin B12 fraction (holohaptocorrin) or confounding factors. Further studies are necessary to investigate the role of vitamin B12 deficiency in recurrent abortion.Clin Chem Lab Med 2008;46:1265–9.

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Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy

Oncology ◽

10.1159/000513888 ◽

2021 ◽

pp. 1-9

Author(s):

Tsutomu Namikawa ◽

Masahiro Maeda ◽

Keiichiro Yokota ◽

Jun Iwabu ◽

Masaya Munekage ◽

...

Keyword(s):

Gastric Cancer ◽

Vitamin B12 ◽

Total Gastrectomy ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Kochi Medical School ◽

B12 Deficiency ◽

Red Blood Cell Count ◽

Baseline Characteristics ◽

Vitamin B12 Supplementation

Background: This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. Methods: The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. Results: Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). Conclusions: Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.

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ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v11i1.23750 ◽

2018 ◽

Vol 11 (1) ◽

pp. 402

Author(s):

Zaozianlungliu Gonmei ◽

Supriya Dwivedi ◽

Gurudayal Singh Toteja ◽

Karuna Singh ◽

Naval Kishore Vikram ◽

...

Keyword(s):

Vitamin B12 ◽

Elderly Population ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Serum Homocysteine ◽

B12 Deficiency ◽

Prevalence Of Anemia

Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 μmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency.

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A Case of Subacute Combined Degeneration of Spinal Cord Diagnosed by Vitamin B12 Administration Lowering Methylmalonic Acid

Case Reports in Neurology ◽

10.1159/000505321 ◽

2020 ◽

Vol 12 (1) ◽

pp. 27-34 ◽

Cited By ~ 1

Author(s):

Daisuke Hara ◽

Masashi Akamatsu ◽

Heisuke Mizukami ◽

Bunta Kato ◽

Takaaki Suzuki ◽

...

Keyword(s):

Spinal Cord ◽

Vitamin B12 ◽

Methylmalonic Acid ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Lower Limbs ◽

Total Serum ◽

Subacute Combined Degeneration ◽

Laboratory Findings ◽

B12 Deficiency

Subacute combined degeneration of the spinal cord (SCDS) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency. It is known that typical SCDS is frequently accompanied by megaloblastic anemia and increased serum methylmalonic acid (MMA) or homocysteine (Hcy) levels on laboratory findings, and marked abnormalities on spinal cord magnetic resonance imaging (MRI). A 45-year-old woman was admitted to our hospital with a 2-year history of worsening mild weakness, numbness in bilateral lower limbs, and gait disturbance. On admission, as laboratory findings, blood count showed macrocytosis without anemia, and biochemical tests showed mild reduction in total serum vitamin B12 level and no increase of MMA and Hcy levels; there were no abnormal findings on spinal cord MRI. After administration of vitamin B12, her sensorimotor symptoms were improved and laboratory examination showed that macrocytosis was improved, serum vitamin B12 was increased, and serum MMA levels were decreased. This improved clinical course and the laboratory findings following vitamin B12 administration confirmed the diagnosis of SCDS due to vitamin B12 deficiency. SCDS presents with highly variable symptoms and laboratory findings, and observation of MMA levels and neurologic symptoms before and after vitamin B12 administration may be useful for diagnosing SCDS.

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ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i1.23750 ◽

2018 ◽

Vol 11 (1) ◽

pp. 402 ◽

Cited By ~ 1

Author(s):

Zaozianlungliu Gonmei ◽

Supriya Dwivedi ◽

Gurudayal Singh Toteja ◽

Karuna Singh ◽

Naval Kishore Vikram ◽

...

Keyword(s):

Vitamin B12 ◽

Elderly Population ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Serum Homocysteine ◽

B12 Deficiency ◽

Prevalence Of Anemia

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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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