Vitamin B12 Status Upon Short-Term Intervention with a Vegan Diet—A Randomized Controlled Trial in Healthy Participants

Vegans are at an increased risk for certain micronutrient deficiencies, foremost of vitamin B12. Little is known about the short-term effects of dietary change to plant-based nutrition on vitamin B12 metabolism. Systemic biomarkers of vitamin B12 status, namely, serum vitamin B12 and holotranscobalamin, may respond quickly to a reduced intake of vitamin B12. To test this hypothesis, 53 healthy omnivore subjects were randomized to a controlled unsupplemented vegan diet (VD, n = 26) or meat-rich diet (MD, n = 27) for 4 weeks. Vitamin B12 status was examined by measurement of serum vitamin B12, holotranscobalamin (holo-TC), methylmalonic acid (MMA) and total plasma homocysteine (tHcy). Holo-TC decreased significantly in the VD compared to the MD group after four weeks of intervention, whereas metabolites MMA and tHcy were unaffected. Body weight remained stable in both groups. VD intervention led to a significant reduction of cholesterol intake, and adequate profiles of nutrient and micronutrient status. Lower intake of vitamin B12 was observed in VD, which was mirrored by a lower concentration of serum vitamin B12 and reduced holo-TC after 4 weeks. Plasma holo-TC may be a fast-responding biomarker to monitor adequate supply of vitamin B12 in plant-based individuals.

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Zinc Deficiency Is Associated with Anemia Among Children Under 24 Months-of-age in Rural Guatemala (P10-111-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-111-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ana Palacios ◽

Kristen Hurley ◽

Silvia De Ponce ◽

Victor Alfonso ◽

Nicholas Tilton ◽

...

Keyword(s):

Iron Deficiency ◽

Vitamin B12 ◽

Maternal Education ◽

Controlled Trial ◽

Venous Blood ◽

Public Health Problem ◽

York Academy ◽

Major Public Health Problem ◽

Micronutrient Deficiencies ◽

Cross Sectional

Abstract Objectives Anemia is a major public health problem among young children. In addition to iron deficiency, other micronutrient deficiencies have been associated with anemia. The purpose of this study was to identify biomarkers associated with anemia in children <5 years from rural Guatemala. Methods A total of 182 infants (6–24 m) and 207 preschoolers (36–60 m) were recruited from community surveillance to participate in a randomized controlled trial of nutrition and child development. Methods included measured weight, length/height and venous blood draws. Inclusion criteria were length/height-for-age z-score <-1.0 and Hb >7.0 g/dL. Cross-sectional analyses using generalized linear mixed models of baseline data examined associations between anemia (Hb <11.0 g/dL) and micronutrient deficiencies, adjusting for maternal, child and sociodemographic variables. Iron deficiency was defined as low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L. Deficiencies for other parameters were designated as: zinc <65 µg/dL; vitamin B12 < 200 pg/mL; and plasma folate <3 ng/mL or erythrocyte folate <100 ng/mL. Results Prevalence of anemia was 56% in infants and 12% in preschoolers. Among anemic infants/preschoolers, rates of iron, zinc, folate and vitamin B12 deficiencies were 83/75%; 63/18%; 3/4%; and 9/0%, respectively. For infants, the odds of anemia were higher when children were zinc deficient [OR = 3.59;95%CI (1.64–7.85)], after adjusting for community cluster, sex, age, maternal education and household size. No biomarkers were associated with anemia in preschoolers. Conclusions Iron and zinc are common micronutrient deficiencies in children from low- and middle-income countries. These findings suggest that micronutrient deficiencies coexist among children in Guatemala, and that zinc should be considered as part of the prevention strategies to reduce anemia. In preschoolers, no biomarkers were associated with anemia, suggesting that other biological and psychosocial factors could be influencing anemia in this age group. Funding Sources The Mathile Institute for the Advancement of Human Nutrition, Sackler Institute for Nutrition Science of the New York Academy of Sciences.

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Cell Blood Count Alterations and Patterns of Anaemia in Autoimmune Atrophic Gastritis at Diagnosis: A Multicentre Study

Journal of Clinical Medicine ◽

10.3390/jcm8111992 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1992 ◽

Cited By ~ 5

Author(s):

Marco Vincenzo Lenti ◽

Edith Lahner ◽

Gaetano Bergamaschi ◽

Emanuela Miceli ◽

Laura Conti ◽

...

Keyword(s):

Iron Deficiency ◽

Vitamin B12 ◽

Atrophic Gastritis ◽

Blood Count ◽

Serum Vitamin ◽

Pernicious Anaemia ◽

Micronutrient Deficiencies ◽

Cross Sectional ◽

Distribution Width ◽

Autoimmune Atrophic Gastritis

Background: Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 ± 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 ± 15.8 years, F:M ratio = 2.3:1). Pernicious anaemia (132/316 cases, 41.7%) was more common in males (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 ± 14.6 versus 58.9 ± 14.9 years; p = 0.014), while iron deficiency anaemia (112/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 ± 16.6 versus 60.2 ± 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13–18.50, p < 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia.

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Multi-Micronutrient–Fortified Biscuits Decreased Prevalence of Anemia and Improved Micronutrient Status and Effectiveness of Deworming in Rural Vietnamese School Children

Journal of Nutrition ◽

10.3945/jn.108.099754 ◽

2009 ◽

Vol 139 (5) ◽

pp. 1013-1021 ◽

Cited By ~ 64

Author(s):

Tran Thuy Nga ◽

Pattanee Winichagoon ◽

Marjoleine A. Dijkhuizen ◽

Nguyen Cong Khan ◽

Emorn Wasantwisut ◽

...

Keyword(s):

School Children ◽

Controlled Trial ◽

Urinary Iodine ◽

Cost Effective ◽

Micronutrient Deficiencies ◽

Parasitic Infestation ◽

Double Blind ◽

School Based ◽

Micronutrient Status ◽

Micronutrient Fortification

Abstract Concurrent micronutrient deficiencies are prevalent among Vietnamese school children. A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of school children. However, the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation. To evaluate the efficacy of school-based intervention using multi-micronutrient–fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren, a randomized, double-blind, placebo-controlled trial was conducted among 510 primary schoolchildren, aged 6–8 y, in rural Vietnam. Albendazole (Alb) (400 mg) or placebo was given at baseline. Nonfortified or multi-micronutrient–fortified biscuits including iron (6 mg), zinc (5.6 mg), iodine (35 μg), and vitamin A (300 μg retinol equivalents) were given 5 d/wk for 4 mo. Multi-micronutrient fortification significantly improved the concentrations of hemoglobin (+1.87 g/L; 95% CI: 0.78, 2.96), plasma ferritin (+7.5 μg/L; 95% CI: 2.8, 12.6), body iron (+0.56 mg/kg body weight; 95% CI: 0.29, 0.84), plasma zinc (+0.61 μmol/L; 95% CI: 0.26, 0.95), plasma retinol (+0.041 μmol/L; 95% CI: 0.001, 0.08), and urinary iodine (+22.49 μmol/L; 95% CI: 7.68, 37.31). Fortification reduced the risk of anemia and deficiencies of zinc and iodine by >40%. Parasitic infestation did not affect fortification efficacy, whereas fortification significantly enhanced deworming efficacy, with the lowest reinfection rates in children receiving both micronutrients and Alb. Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming.

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Serum vitamin B12 levels in severe acute malnutrition hospitalized children between age group 6 months to 59 months in Kangra, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183546 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1997

Author(s):

Ajay Vaid ◽

Milap Sharma ◽

Jamunashree B. ◽

Piyush Gautam

Keyword(s):

Vitamin B12 ◽

Severe Acute Malnutrition ◽

Megaloblastic Anemia ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Work Capacity ◽

Acute Malnutrition ◽

Age Group ◽

Female Ratio ◽

Increased Risk

Background: Child malnutrition is a major global health problem contributing to childhood morbidity, mortality, impaired intellectual development, suboptimal adult work capacity and increased risk of diseases in adulthood. Severe acute malnutrition, among children below five years of age remains a major embarrassment, and impediment to optimal human capital development in India.Methods: The study was an observational study conducted in the Department of Pediatrics and Biochemistry at Dr. RPGMC Kangra at Tanda, Himachal Pradesh. All children aged between 6 to 59 months presenting in the Department of Pediatrics with SAM (Severe Acute Malnutrition) and fulfilling the inclusion and exclusion criteria were included in the study after taking the informed consent from the guardian in local language.Results: Out of 48 children included in the study, 28 (58%) children were Males and 20 (42%) children were females with male to female Ratio 1.3:1. Out of 48 children 28 (58%) were vitamin B12 deficient and 20 (42%) were non-deficient. In the present study 53.5% (15) of males were vitamin B12 deficient. Out of 20 females 65% (13) of females were vitamin B12 deficient, showed slight preponderance of females over males. It has been observed that younger age group children mostly <2-year-old were, the most vulnerable group as far as vitamin B12 deficiency is considered (16%)Conclusions: Micronutrients play a central part in metabolism and in maintenance of tissue functions. All severely malnourished children have vitamin and mineral deficiencies. The most common type of anemia was microcytic followed by megaloblastic anemia.

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Vitamin B 12: the hidden ingredient of stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200249 ◽

2020 ◽

Vol 8 (2) ◽

pp. 644

Author(s):

Mehul Prajapati ◽

Labani M. Ghosh

Keyword(s):

Risk Factors ◽

Vitamin B12 ◽

Serum Vitamin ◽

Serum Levels ◽

Control Group ◽

Case Group ◽

Cerebral Stroke ◽

Chi Square ◽

Median Serum ◽

Increased Risk

Background: Study aimed to evaluate the relationship between vitamin B12 and acute cerebral stroke in this study.Methods: Blood samples drawn within 24 hours after the stroke from hospitalized patients (n=100) and from 100 control cases matched for age, sex and other modifiable risk factors of stroke were analyzed. With a competitive, ECLIA, serum levels of vitamin B12 were measured. The quantitative data of the groups was compared using Analysis of Varience and Tukeys HSD post hoc test for comparison. Chi-square tests were used.Results: Median serum vitamin B12 levels were significantly lower in the patients than in the control subjects, 188.71 and 256.25 pg/ml respectively (p=0.0001). This difference was independent from other risk factors. The mean age in case group was 62.49 (SD: 12.45 years) and 56.62 (SD: 13.05 years) in control group with p=0.001. Therefore, prevalence of stroke is more between 6th and 7th decade of life. Mean serum vitamin B12 levels were lower in males (201.8pg/ml) than the females (268.pg/ml) in the case group.Conclusions: Low vitamin B12 is associated with an increased risk of stroke, and its relationship is independent from the other known modifiable stroke risk factors.

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Adverse effect of metformin therapy on serum vitamin B12 and folate: Short-term treatment causes disadvantages?

Medical Hypotheses ◽

10.1016/j.mehy.2013.05.025 ◽

2013 ◽

Vol 81 (2) ◽

pp. 149-151 ◽

Cited By ~ 9

Author(s):

Lijuan Xu ◽

Zhimin Huang ◽

Xiaoying He ◽

Xuesi Wan ◽

Donghong Fang ◽

...

Keyword(s):

Adverse Effect ◽

Vitamin B12 ◽

Serum Vitamin ◽

Term Treatment ◽

Short Term ◽

Short Term Treatment ◽

Metformin Therapy

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Does Tranexamic Acid Reduce Knee Swelling and Improve Early Function Following Arthroscopic Meniscectomy? A Double-Blind Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119866122 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986612 ◽

Cited By ~ 3

Author(s):

Mary Nugent ◽

Jedediah H. May ◽

Jack D. Parker ◽

David C. Kieser ◽

Michael Douglas ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Treatment Group ◽

Tranexamic Acid ◽

Range Of Motion ◽

Normal Saline ◽

Controlled Trial ◽

Short Term ◽

Randomized Controlled ◽

Increased Risk ◽

Arthroscopic Meniscectomy

Background: Arthroscopic meniscectomy often results in rapid recovery and return to preinjury activities; however, postoperative hemarthrosis and swelling can lead to pain, decreased range of motion, and delayed return to work and leisure activities. Tranexamic acid (TXA) is a lysine-based inhibitor of plasminogen to plasmin that has gained popularity in arthroplasty surgery for reducing blood loss and, more recently, in anterior cruciate ligament reconstruction by reducing postoperative hemarthrosis, swelling, and pain while increasing function in the short term. Purpose: To determine whether there is a role for TXA in improving the short-term results of swelling, pain, and function following arthroscopic meniscectomy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We performed a prospective double-blinded randomized controlled trial in 41 patients undergoing arthroscopic meniscectomy by comparing patients treated with intravenous TXA with those treated with a placebo (normal saline). A single surgeon treated all patients. Following randomization, a dose of 1 g of TXA in 100 mL of normal saline (treatment group) or 100 mL of normal saline (placebo group) was given intravenously at induction prior to tourniquet inflation by the anesthetist. The anesthetist administering the TXA or placebo was not blinded, but all other clinicians involved were. Patients were evaluated by a blinded observer at postoperative days 3, 14, and 30, with the range of motion, swelling, pain levels (visual analog scale), and Lysholm and Tegner knee scores recorded. Results: Patient demographics were similar in both groups. In the treatment group, there was a nonsignificant improvement in range of motion ( P = .056) and swelling ( P = .384) at 14 days; however, there was a significant improvement in the Tegner score at 3 days ( P = .0064). The complication profile was similar between the groups. Conclusion: The administration of 1 g of intravenous TXA in routine arthroscopic meniscectomy may improve early functional recovery without increased risk. A larger study is required to confirm these results and further evaluate any potential benefit. Registration: ACTRN12618001600235 (Australian New Zealand Clinical Trials Registry).

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Micronutrient Status of Young Adolescents in Rural Bangladesh: The JiVitA-1 Birth Cohort (FS01-04-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.fs01-04-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sarah Baker ◽

Kerry Schulze ◽

Lee Wu ◽

Saijuddin Shaikh ◽

Hasmot Ali ◽

...

Keyword(s):

Vitamin D ◽

Nutritional Status ◽

Vitamin D Deficiency ◽

Birth Cohort ◽

Controlled Trial ◽

Micronutrient Deficiencies ◽

Z Score ◽

Young Adolescents ◽

Blood Draw ◽

Micronutrient Status

Abstract Objectives We assessed micronutrient status in young rural Bangladeshi adolescents to determine prevalence of deficiency by sex, age, season and dietary pattern. Methods In a birth cohort of >30,000 youth in whom data on health, development, and nutritional status was collected in 2015–2017, venous blood was drawn from a ∼3% subsample (n = 991, 9–13 years old). Participants’ mothers had been in a cluster-randomized, placebo-controlled trial of daily antenatal beta-carotene or vitamin A supplementation in 2001–2007. Hemoglobin (Hb) was obtained at blood draw; plasma ferritin, folate, cobalamin (B12), homocysteine (Hcy), thyroglobulin (Tg), and C-reactive protein (CRP) were measured by chemiluminescent immunoassay, 25-hydroxyvitamin D [25(OH)D] by commercial immunoassay, and zinc by atomic absorption spectrometry. Results Participants were short (height-for-age Z-score -1.59 ± 0.93 in boys, -1.65 ± 0.98 in girls) and thin (BMI-for-age Z-score -1.49 ± 1.06 in boys, -1.28 ± 1.08 in girls). Anemia (Hb < 120 g/L, 11.4%) was common but iron deficiency (ferritin < 15 μg/L, 0.5%) was not. Folate (< 6.8 nmol/L, 3.3%) and vitamin B12 (<150 pmol/L, 5.2%) deficiencies, elevated Hcy (>18 μmol/L, 0.8%) and inflammation (CRP >5 mg/L, 3.3%) were uncommon. However, deficiencies of vitamin D (25(OH) D < 50 nmol/L, 43.0%), iodine (Tg > 40 µg/L, 21.9%), and zinc (< 8.6 µmol/L, 18.8%) were prevalent. Only vitamin D deficiency was more prevalent in girls than boys (54.0% versus 31.4%, P < 0.0001), doubling in girls from 32.5% at 10 to 69.7% at 13 years of age. Vitamin D deficiency was highest in winter and zinc deficiency highest during the monsoon. In preliminary analyses, micronutrient deficiencies were not significantly associated with dietary intake patterns derived from three 7-day food frequencies collected over ∼1 year. Conclusions Young adolescents in rural northern Bangladesh experienced anemia and vitamin D, iodine and zinc deficiencies; however, iron, folate, and B12 deficiencies, hyperhomocysteinemia, and inflammation were uncommon. Further resolution of dietary data and exploration of other contextual features may reveal specific risk factors for micronutrient deficiencies, informing our understanding of adolescent nutritional status in this setting. Funding Sources The Bill and Melinda Gates Foundation, Sight and Life.

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Intestinal permeability and inflammation mediate the association between nutrient density of complementary foods and biochemical measures of micronutrient status in young children: results from the MAL-ED study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz151 ◽

2019 ◽

Vol 110 (4) ◽

pp. 1015-1025 ◽

Cited By ~ 4

Author(s):

Benjamin J J McCormick ◽

Laura E Murray-Kolb ◽

Gwenyth O Lee ◽

Kerry J Schulze ◽

A Catharine Ross ◽

...

Keyword(s):

Systemic Inflammation ◽

Transferrin Receptor ◽

Lower Risk ◽

Micronutrient Deficiency ◽

Dietary Intakes ◽

Micronutrient Deficiencies ◽

Complementary Foods ◽

Nutrient Density ◽

Micronutrient Status ◽

Increased Risk

ABSTRACTBackgroundEnvironmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation.ObjectiveWe tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status.MethodsUsing data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network.ResultsA greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations.ConclusionsEED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.

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