High Prevalence of Vitamin B12 Deficiency and No Folate Deficiency in Young Children in Nepal

Background: In this study, the aim was to evaluate the prevalence of vitamin D, vitamin B12, ferritin, and folate deficiencies in adolescence to clarify the need for early diagnosis and therapy. Methods: The medical records of adolescents between 10 and 18 years of age between 01 September 2018 and 28 February 2019 as healthy with non-specific complaints, or due to well-child care visits, were analyzed retrospectively. Results: A total of 1847/2507 (73.6%) adolescents were included in the study. The prevalence of vitamin D deficiency was 25.7% (n: 178/691). Vitamin B12 deficiency prevalence was 69.2% (n: 753/1088). The prevalence of anemia and ferritin deficiency was 4.8% and 13.26%. The prevalence of folate deficiency was 37.9% (n: 413/1088). VDD prevalence was statistically significantly higher in females than males (F/M:116/62). VB12D prevalence, the number and mean age of females with hemoglobin deficiency, and low ferritin levels was found to be statistically significantly higher in females than males. Conclusions: The prevalence of vitamin D, vitamin B12, folate deficiency and low ferritin levels was found to be high among adolescents. In particular, adolescents admitting with non-specific complaints and for control purposes in big cities must be considered to be at risk for the deficiency of these vitamins and low level of ferritin.

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The effect of folate analogues and vitamin B12 on provision of thymine nucleotides for DNA synthesis in megaloblastic anemia

Blood ◽

10.1182/blood.v59.3.634.bloodjournal593634 ◽

1982 ◽

Vol 59 (3) ◽

pp. 634-640

Author(s):

MR Taheri ◽

RG Wickremasinghe ◽

BF Jackson ◽

AV Hoffbrand

Keyword(s):

Vitamin B12 ◽

De Novo ◽

Megaloblastic Anemia ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Minor Role ◽

B12 Deficiency ◽

Thymidylate Synthesis ◽

Marrow Cells

The role of vitamin B12 in the folate dependent biosynthesis of thymidine nucleotides is controversial. In an attempt to clarify this, three methods have been used to assess the relative efficacy of vitamin B12 (hydroxocobalamin) and various folate analogues in titrated concentrations at correcting ‘de novo’ thymidylate synthesis by megaloblastic human marrow cells: (1) The deoxyuridine (dU) suppression test which analyses the reduction in (3H)-thymidine labeling of DNA by unlabeled dU. Marrow cells were also labeled with (6–3H)-dU with assessment of (2) its incorporation into DNA and (3) the accumulation of (6–3H)-deoxyuridine monophosphate (3H-dUMP). The three methods gave similar results. In both, N6-formyl tetrahydrofolate (formyl-FH4) was the most effective agent at correcting thymidylate synthesis in megaloblastic anemia due to vitamin B12 or folate deficiency. Vitamin B12 corrected the lesion in vitamin B12 deficiency but not in folate deficiency. Tetrahydrofolate (FH4) and folic acid were effective in deficiency of vitamin B12 or folate, although in both deficiencies they were less effective than formyl-FH4. Methyl-FH4 was effective in folate deficiency but not in vitamin B12 deficiency. These results confirm the failure of methyl-FH4 utilisation in vitamin B12 deficiency. They suggest that if vitamin B12 is needed in the formylation of FH4, this is a minor role in provision of the correct coenzyme for thymidylate synthesis compared with its major role of provision of FH4 from methyl- FH4.

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Anemia and Micronutrient Deficiencies in Young Children in Urban Slums of Mumbai, India

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_033 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 828-828

Author(s):

Amy Fothergill ◽

Samantha Huey ◽

Jere Haas ◽

Shobha Udipi ◽

Padmini Ghugre ◽

...

Keyword(s):

Iron Deficiency ◽

Young Children ◽

Vitamin B12 ◽

Serum Ferritin ◽

Vitamin B12 Deficiency ◽

Urban Slums ◽

Severe Anemia ◽

Micronutrient Deficiencies ◽

Serum Retinol ◽

B12 Deficiency

Abstract Objectives To examine the burden of anemia and micronutrient deficiencies among young children living in urban slums of Mumbai, India. Methods Participants were children 10–18 months of age (n = 278) residing in urban slums in Mumbai who were screened as part of a randomized feeding trial of biofortified pearl millet. Venous blood was collected by a pediatric phlebotomist and hemoglobin (Hb) concentrations were assessed via Coulter counter. Samples were processed and stored <−80°C until laboratory analyses. Serum ferritin (SF), vitamin B12, and erythrocyte (RBC) folate concentrations were analyzed via chemiluminescence. C-reactive protein (CRP) was analyzed by nephelometry, α-1 acid glycoprotein (AGP) was analyzed by spectrophotometry, and serum retinol was evaluated via HP-LC. Serum ferritin and serum retinol levels were adjusted for inflammation using methods proposed by Thurman. Anemia and severe anemia were defined as Hb < 11.0 g/dL and Hb < 7.0 g/dL. Iron deficiency (ID) was defined as SF < 12.0 µg/L, iron insufficiency was defined as SF < 20.0 µg/L, and inflammation was defined as CRP > 5.0 mg/L. Iron deficiency anemia was defined as Hb < 11.0 g/dL and SF < 12.0 µg/L. Vitamin A deficiency was defined as serum retinol <20.0 µg/L. Vitamin B12 deficiency and vitamin B12 insufficiency were defined as <148.0 pmol/L and <221.0 pmol/L; folate deficiency was defined as RBC folate <340 nmol/L. Linear and binomial regression models were used to examine associations of micronutrient biomarkers with Hb levels and risk of anemia. Results A total of 75.5% of children were anemic and 2.9% had severe anemia. The prevalence of iron deficiency was 61.4% (69.5% after Thurman adjustment), 57.4% of children had IDA, and 9.7% had CRP > 5.0 mg/L. The prevalence of vitamin B12 deficiency was 17.0%, 41.8% of children had vitamin B12 insufficiency, and 19.9% had folate deficiency. Among anemic children, 84.5% had ≥1 micronutrient deficiency and 22.7% had ≥ 2 micronutrient deficiencies. Iron deficiency (RR: 2.15; 95% CI: 1.55, 2.99; P < 0.001), and vitamin B12 deficiency (RR: 1.32; 95% CI: 1.09, 1.60; P < 0.01) were associated with significantly increased risk of anemia. Conclusions Findings indicate that the burden of anemia, iron deficiency, and vitamin B12 insufficiency were high in young children in Mumbai, India. Funding Sources Harvest Plus; AF was supported by the National Institutes of Health.

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An Analysis of Transcobalamin II Gene Polymorphisms and Serum Levels of Homocysteine, Folate and Vitamin B12 in Chinese Patients with Crohn's Disease

Digestive Diseases ◽

10.1159/000471848 ◽

2017 ◽

Vol 35 (5) ◽

pp. 463-471

Author(s):

Shuzi Zheng ◽

Chaoqun Wu ◽

Wei Yang ◽

Xuanping Xia ◽

Xiuqing Lin ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin B12 ◽

Mutant Allele ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Serum Homocysteine ◽

B12 Deficiency ◽

Folate And Vitamin B12 ◽

Transcobalamin Ii

Objectives: The study aimed to investigate the association of Crohn's disease (CD) with transcobalamin II (TCN2) polymorphisms and serum homocysteine, folate, and vitamin B12 levels. Methods:TCN2 (rs1801198, rs9606756) were genotyped by iMLDR in 389 CD patients and 746 controls. Furthermore, 102 CD patients and 153 controls were randomly selected for examination of serum homocysteine, folate, and vitamin B12 levels by enzymatic cycling assay and chemiluminescence immunoassay, respectively. Results: Mutant allele (G) and genotype (AG + GG) of (rs9606756) were higher in CD patients than in controls (both p < 0.05). So were they in ileocolonic CD patients and stricturing CD patients compared to controls (all p < 0.05). Mutant allele (G) and genotype (CG + GG) of (rs1801198) were more prevalent in stricturing CD patients than in controls (both p < 0.05). Compared to controls, average homocysteine level was enhanced in CD patients (p = 0.003), whereas average folate and vitamin B12 levels were reduced in CD patients (both p < 0.001). The prevalence of hyperhomocysteinemia, folate deficiency, and vitamin B12 deficiency was higher in CD patients than in controls (all p < 0.01). Both folate deficiency and vitamin B12 deficiency were independently related to risk of CD (both p < 0.01). Conclusion:TCN2 (rs1801198, rs9606756) polymorphisms as well as folate deficiency and vitamin B12 deficiency are correlated with CD.

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P413 HIGH PREVALENCE OF VITAMIN B12 DEFICIENCY IN SAMARITAN COMMUNITY ON THE MOUNT GERIZIM

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70475-7 ◽

2008 ◽

Vol 3 ◽

pp. 204

Author(s):

E.A. Merzon ◽

P. Singer ◽

R. Schneeweiss ◽

T. Rips ◽

E. Kitai

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

High Prevalence ◽

B12 Deficiency

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High prevalence of cognitive dysfunction and vitamin B12 deficiency in patients with type 2 diabetes over 50 years

Endocrine Abstracts ◽

10.1530/endoabs.70.aep298 ◽

2020 ◽

Author(s):

Letícia Weinert ◽

Fabiana Romani ◽

Machado Eduardo Coelho

Keyword(s):

Type 2 Diabetes ◽

Vitamin B12 ◽

Cognitive Dysfunction ◽

Vitamin B12 Deficiency ◽

High Prevalence ◽

B12 Deficiency

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Défice de Vitamina B12 na Diabetes Mellitus Tipo 2

Acta Médica Portuguesa ◽

10.20344/amp.8860 ◽

2017 ◽

Vol 30 (10) ◽

pp. 719

Author(s):

Carlos Tavares Bello ◽

Ricardo Miguel Capitão ◽

João Sequeira Duarte ◽

Jorge Azinheira ◽

Carlos Vasconcelos

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Common Disease ◽

High Prevalence ◽

B12 Deficiency ◽

Diabetic Population

Introduction: Type 2 diabetes mellitus is a common disease, affecting up to 13.1% of the Portuguese population. In addition to the known micro and macrovascular complications, drug side effects constitute a major concern, leading to changes in the treatment guidelines, which favor safety over efficacy. Metformin is the first-line pharmacological treatment for most patients with type 2 diabetes mellitus; however, it has been associated with vitamin B12 deficiency in up to 30% of treated patients. The authors describe the prevalence of vitamin B12 deficiency in a diabetic population and explore the possible underlying factors.Material and Methods: Retrospective, observational study. Clinical and laboratory data of type 2 diabetes mellitus patients whose vitamin B12 status was evaluated in the last decade (2005 - 2016) were analyzed. Patients with known malabsorptive syndromes or having undergone bariatric surgery were excluded from the study. Statistical analysis of the data was done and the results were considered statistically significant at p values < 0.05.Results: The study included a total of 1007 patients (58% women) with a mean age of 66.4 ± 12.2 years and 11 ± 10.4 years of type 2 diabetes mellitus duration. These patients had a high prevalence of complications: diabetic renal disease 47.7%, neuropathy 9.2%, retinopathy 14.9%, coronary artery disease 8.4%, cerebrovascular disease 10.9%, and peripheral arterial disease 5.5%. Vitamin B12 deficiency (< 174 ng / dL) was present in 21.4% of the population and this subgroup was older (68.4 vs 65.8 years, p = 0.006), had a longer type 2 diabetes mellitus duration (13.35 vs 10.36 years; p = 0.001), higher prevalence of retinopathy (20.9% vs 13.3%; p = 0.005) and thyroid dysfunction (34% vs 23.7%; p = 0.002). Vitamin B12 deficiency was also more frequent in patients treated with metformin (24.7% vs 15.8%; p = 0.017), antiplatelet agents (25.4% vs 16.2%, p < 0.001), and calcium channel blockers (26.8% vs 18.2%; p = 0.001). After adjustment for possible confounders, the variables associated with B12 deficiency were: metformin, hypothyroidism, age and type 2 diabetes mellitus duration.Discussion: Despite the retrospective design, the results report a high prevalence of vitamin B12 deficiency in the type 2 diabetic population. This study also demonstrates that the B12 deficiency risk is higher in older people, with longer diabetes mellitus duration, hypothyroidism and treated with metformin.Conclusion: Further studies are needed to identify the risk factors for the B12 deficit. The recognition of these variables will contribute to optimize the screening and prevention of the B12 deficiency in type 2 diabetes mellitus.

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Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.191 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S87-S87

Author(s):

S N Mattox ◽

D Kozman ◽

G Singh

Keyword(s):

Vitamin B12 ◽

Clinical Laboratory ◽

Tertiary Care ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Normal Serum ◽

Serum Folate ◽

Folate Supplementation ◽

B12 Deficiency ◽

The Difference

Abstract Introduction/Objective To identify clinical/laboratory factors associated with folate deficiency in tertiary care patients. Methods We reviewed the medical records of 1019 patients with serum folate <7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate > 23 ng/mL. Results Serum prealbumin levels were subnormal in 54.8% of patients with serum folate <7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the <7.0 ng/mL folate group. In 62.4% of patients with serum folate <7.0 ng/mL, 1 or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the 2 groups regarding diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the <7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful. Conclusion The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary care patients have levels <7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels <7.0 ng/mL should be evaluated for malnutrition, despite BMI > 25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.

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Vitamin B12 Deficiency and the Role of Gender: A Cross-Sectional Study of a Large Cohort

Annals of Nutrition and Metabolism ◽

10.1159/000488326 ◽

2018 ◽

Vol 72 (4) ◽

pp. 265-271 ◽

Cited By ~ 12

Author(s):

Ili Margalit ◽

Eytan Cohen ◽

Elad Goldberg ◽

Ilan Krause

Keyword(s):

Gender Differences ◽

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Cross Sectional Study ◽

Sensitivity Analyses ◽

Healthy Population ◽

Sectional Study ◽

Cross Sectional ◽

B12 Deficiency

Background: Vitamin B12 deficiency is associated with hematological, neurological, and cardiovascular consequences. Epidemiologic data on these related illnesses indicate gender differences. Methods: A cross-sectional study was designed to examine gender differences in vitamin B12 deficiency among a healthy population. Data from healthy individuals aged 18–65, who were provided with a routine medical evaluation during 2000–2014, were retrieved from the medical charts. Individuals with background illnesses and those who had used medications or nutritional supplements were excluded. Vitamin B12 deficiency was defined by 2 cutoff values (206 and 140 pmol/L). The multivariate analysis was adjusted for age, body mass index, estimated glomerular filtration rate, hyperhomocysteinemia, folate deficiency, albumin, and transferrin saturation. Sensitivity analyses were implemented by excluding individuals with anemia, hyperhomocysteinemia, or folate deficiency and by age stratification. Results: In all, 7,963 individuals met the inclusion criteria. Serum vitamin B12 mean levels were 312.36 and 284.31 pmol/L for women and men respectively (p < 0.001). Deficiency prevalence was greater for men (25.5%) in comparison with women (18.9%; p < 0.001). Men were strongly associated with severe deficiency (adjusted OR 2.26; 95% CI 1.43–3.56). Conclusions: Among the healthy population, men are susceptible to vitamin B12 deficiency. This can be explained by neither diet habits nor estrogen effects. Genetic variations are therefore hypothesized to play a role.

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Compromised Vitamin B12 Status of Indian Infants and Toddlers

Food and Nutrition Bulletin ◽

10.1177/0379572120950886 ◽

2020 ◽

Vol 41 (4) ◽

pp. 430-437

Author(s):

Bentu Kalyan G ◽

Medha Mittal ◽

Rahul Jain

Keyword(s):

Vitamin B12 ◽

Dietary Habits ◽

Vitamin B12 Deficiency ◽

Infants And Toddlers ◽

Indian Children ◽

High Prevalence ◽

Animal Milk ◽

B12 Deficiency ◽

Positive Effect ◽

Apparently Healthy

Background: Vitamin B12 deficiency is prevalent worldwide especially in vegetarian communities. Its deficiency in early childhood may result in serious neurological and cognitive deficits. It is important to know the prevalence among our infants and toddlers so that nutritional policy changes could be suggested in this regard. Objective: To evaluate the vitamin B12 status of apparently healthy Indian children between 6 and 23 months of age. Methods: Apparently healthy Indian children (n = 210), of age 6 to 23 months, attending pediatric outpatient department were recruited and samples obtained to evaluate their hemogram and levels of vitamin B12, folate, and ferritin. Data were analyzed to obtain the mean levels and the proportion of participants deficient in vitamin B12. The dietary habits of the children were also analyzed and correlated with their vitamin B12 status. Results: Vitamin B12 deficiency was observed in 37.6% of the participants. Conclusions: There is a high prevalence of vitamin B12 deficiency in our infants and toddlers, and there is need to initiate supplement to prevent any possible neurological consequences. Early initiation of animal milk had a positive effect on the vitamin B12 status of the child, though it was not significant.

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